• Hip & pelvis
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• 제34권1호
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• pp.56-61
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• 2022

Purpose: Histopathologic analysis of femoral head specimens following total hip arthroplasty (THA) is a routine practice that represents a significant use of health care resources. However, it occasionally results in discovery of undiagnosed hematopoietic malignancy and other discrepant diagnoses such as avascular necrosis. The purpose of this study was to determine the rate of discordant and discrepant diagnoses discovered from routine histopathological evaluation of femoral heads following THA and perform a cost analysis of this practice. Materials and Methods: A review of patients undergoing primary THA between 2004-2017 was conducted. A comparison of the surgeon's preoperative and postoperative diagnosis, and the histopathologic diagnosis was performed. In cases where the clinical and histopathology differed, a review determined whether this resulted in a change in clinical management. Medicare reimbursement and previously published cost data corrected for inflation were utilized for cost calculations. Results: A review of 2,134 procedures was performed. The pathologic diagnosis matched the postoperative diagnosis in 96.0% of cases. Eighty-three cases (4.0%) had a discrepant diagnosis where treatment was not substantially altered. There was one case of discordant diagnosis where lymphoma was diagnosed and subsequently treated. The cost per discrepant diagnosis was $141,880 and per discordant diagnosis was $1,669 when using 100% Medicare reimbursement and Current Procedural Terminology (CPT) code combination 88304+88311. Conclusion: Histopathologic analysis of femoral head specimens in THAs showed an association with high costs given the rarity of discordant diagnoses. Routine use of the practice should be at the discretion of individual hospitals with consideration for cost and utility thresholds.

• Hip & pelvis
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• 제34권1호
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• pp.25-34
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• 2022

Purpose: Mortality rates following hip fracture surgery have been well-studied. This study was conducted to examine mortality rates in asymptomatic patients presenting for treatment of acute hip fractures with concurrent positive COVID-19(+) tests compared to those with negative COVID-19(-) tests. Materials and Methods: A total of 149 consecutive patients undergoing hip fracture surgery during the COVID-19 pandemic at two academic medical centers were reviewed retrospectively. Patients were divided into two groups for comparative analysis: one group included asymptomatic patients with COVID-19+ tests versus COVID-19- tests. The primary outcome was mortality at 30-days and 90-days. Results: COVID-19+ patients had a higher mortality rate than COVID-19- patients at 30-days (26.7% vs 6.0%, P=0.005) and 90-days (41.7% vs 17.2%, P=0.046) and trended towards an increased length of hospital stay (10.1±6.2 vs 6.8±3.8 days, P=0.06). COVID-19+ patients had more pre-existing respiratory disease (46.7% vs 11.2%, P=0.0002). Results of a Cox regression analysis showed an increased risk of mortality at 30-days and 90-days from COVID-19+ status alone without an increased risk of death in patients with pre-existing chronic respiratory disease. Conclusion: Factors including time to surgery, age, preexisting comorbidities, and postoperative ambulatory status have been proven to affect mortality and complications in hip fracture patients; however, a positive COVID-19 test result adds another variable to this process. Implementation of protocols that will promote prompt orthogeriatric assessments, expedite patient transfer, limit operating room traffic, and optimize anesthesia time can preserve the standard of care in this unique patient population.

• 한국운동역학회지
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• 제34권2호
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• pp.53-62
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• 2024

Objective: The purpose of this study was to analyze the differences in kinematic factors according to stretching treatment, myofascial release treatment, and static stretching treatment conditions during squat. Method: Twelve males with resistance training experience participated in this study. Participants performed squats without treatment (Pre-Test), and performed squats after treatment with the myofascial release technique (MRT) and static stretching (SS) on different days (post-test). Squat movements were captured using eight motion capture cameras (sampling rate: 250 Hz), and the peak joint angles of the ankle, knee, hip, and pelvis were calculated for each direction. One-way repeated ANOVA and Bonferroni post hoc analyses using SPSS 27 (IBM Corp. Armonk NY, USA) were used to compare the peak joint angle of the lower extremity joints and pelvis among the normal condition (squat without treatment), MRT condition (squat after MRT treatment) and SS condition (squat after static stretching). The statistical significance level was set at .05. Results: It was observed that the maximum ankle joint flexion angle during squats was statistically reduced under conditions of myofascial release and static stretching (p<.05), in comparison to the scenario where no stretching was performed. Furthermore, static stretching was found to enhance the maximum hip flexion angle during squat (p<.05), whereas the myofascial release stretching technique resulted in the minimal posterior pelvic tilt angle (p<.05). Conclusion: Employing myofascial release stretching as a preparatory exercise proved to be more efficacious in maintaining body stability throughout the execution of high-intensity squat movements by effectively managing the posterior tilt of the pelvis, as opposed to foregoing stretching or engaging in static stretching.

• 한국분말재료학회지
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• 제25권4호
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• pp.340-345
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• 2018

Additive manufacturing by electron beam melting is an affordable process for fabricating near net shaped parts of titanium and its alloys. 3D additive-manufactured parts have various kinds of voids, lack of fusion, etc., and they may affect crack initiation and propagation. Post process is necessary to eliminate or minimize these defects. Hot isostatic pressing (HIP) is the main method, which is expensive. The objective of this paper is to achieve an optimum and simple post heat treatment process without the HIP process. Various post heat treatments are conducted for the 3D-printed Ti-6Al-4V specimen below and above the beta transus temperature ($996^{\circ}C$). The as-fabricated EBM Ti-6Al-4V alloy has an ${\alpha}^{\prime}$-martensite structure and transforms into the ${\alpha}+{\beta}$ duplex phase during the post heat treatment. The fatigue strength of the as-fabricated specimen is 400 MPa. The post heat treatment at $1000^{\circ}C/30min/AC$ increases the fatigue strength to 420 MPa. By post heat treatment, the interior pore size and the pore volume fraction are reduced and this can increase the fatigue limit.

• Hip & pelvis
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• 제34권2호
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• pp.69-78
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• 2022

Fragility fractures of the pelvis (FFP) and fragility fractures of the sacrum (FFS), which are emerging in the geriatric population, exhibit characteristics that differ from those of pelvic ring disruptions occurring in the younger population. Treatment of FFP/FFS by a multidisciplinary team can be helpful in reducing morbidity and mortality with the goal of reducing pain, regaining early mobility, and restoring independence for activities of daily living. Conservative treatment, including bed rest, pain therapy, and mobilization as tolerated, is indicated for treatment of FFP type I and type II as loss of stability is limited with these fractures. Operative treatment is indicated for FFP type II when conservative treatment has failed and for FFP type III and type IV, which are displaced fractures associated with intense pain and increased instability. Minimally invasive stabilization techniques, such as percutaneous fixation, are favored over open reduction internal fixation. There is little evidence regarding outcomes of patients with FFP/FFS and more literature is needed for determination of optimal management. The aim of this article is to provide a concise review of the current literature and a discussion of the latest recommendations for orthopedic treatment and management of FFP/FFS.

• 대한관절경학회지
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• 제5권1호
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• pp.36-40
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• 2001

목적 : 고관절 동통을 호소하는 젊은 환자에 대한 관절경적 진단, 치료 및 이의 유용성을 분석하고자 하였다. 대상 및 방법 : 1997년 5월부터 1999년 6월까지 고관절 동통을 주소로 내원한 젊은 환자 7명 7례를 대상으로 병력, 이학적 검사, 방사선학적 검사 및 관절경 검사로 진단하고 관절경적 수술로 치료한 후 1년 이상 추시하였다. 결과 : 관절경적 진단 결과 7례 중 6례는 비구순 파열이 있었으며 1례는 만성 활액막염이었다. 관절경적 수술 후 5례는 통증이 소실되었으며, 2례는 경도의 통증을 호소하였고, 모든 예에서 일상 생활 및 체육 활동으로의 복귀가 가능하였다. 결론 : 젊은 환자의 동통성 고관절에 대한관절경적 수술은 비구순의 파열이나 활액막 질환의 진단과 치료에 유용한 것으로 사료된다.

• 대한정형도수물리치료학회지
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• 제21권2호
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• pp.63-71
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• 2015

Background: The purpose of the study, using the ICF Tool in the process of rehabilitation of artificial joint replacement surgery of the hip joint, goal setting and understanding of the problem, through the process of creating intervention strategies, useful clinical practical course for rehabilitation I try to present the data. Methods: Fracture was the left total hip replacement (THR) surgery due to women of 76 years old. I proceed in order screening, evaluation, diagnosis, prognosis, treatment planning and intervention, re-screening. Needs of the patient was walking short distances for using the toilet. In order to improve was carried out arbitration, after you have created a list of issues that limit the ability to walk short distances. Results: It was revealed improved results in self-paced walk test (SPWT) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to examine whether the goals. In addition, MMT VAS, DGI, and TUG is a detailed goal was improved. Conclusions: It can be shown objectively the results of interventions performed for the purpose of solving the problem which is grasped through clinical Practical course for short-range walking ability enhance patient THR. I considered practical clinical course using the ICF Tool would be useful.

• 근관절건강학회지
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• 제23권3호
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• pp.152-158
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• 2016

Purpose:The purpose of this study was to examine the degree of joint pain, limitation of daily activities, and frequency of outpatient visits. Methods: This secondary analysis study used the data from the fifth Korean National Health and Nutrition Examination Survey (KNHNES). The data about general characteristics, prevalence and treatment of osteoarthritis, limitation of activities of daily living (ADL) and frequency of outpatient visits and hospitalization in 424 osteoarthritis patients over 50 years old were derived from the database. Data were analyzed with complex samples in SPSS ver. 20.0. Results: Among people with knee joint pain, 79.3% reported they had more than 4 out of 10 points of the degree of pain. Meanwhile, 97.3% of people with hip joint pain reported that they had more than 4 out of 10 points of the degree of pain. People reporting 10 out of 10 point of pain were 21.4% of those with knee joint pain and 25% of those with hip joint pain. The mean of the degree of knee joint pain was 6.35, and the mean of the degree of hip joint pain was 6.89 out of 10 points. About 50% of people with osteoarthritis visited an outpatient clinic within the last 2 weeks, and 27% had limitation of ADL. Conclusion: It is necessary to develop an integrated intervention program to improve quality of life in patients with osteoarthritis.

• 한국정밀공학회지
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• 제24권2호
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• pp.140-148
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• 2007

THRA(Total Hip Replacement Arthroplasty) has been widely used for several decades as a viable treatment of otherwise-unsolved hip problems. In THRA surgery, cement mantle thickness is critical to long-term implant survival of femoral stem fixed with cement. Numerous studies reported thin or incomplete cement mantle causes osteolysis, loosening, and the failure of implant. To analyze the effect of femoral stem rotation on cement thickness, in this study, we select two most popular stems used in THRA. Using CAD models obtained from a 3D scanner, we measure the cement mantle thickness developed by the rotation of a femoral stem in the virtual space created by broaching. The study shows that as the femoral stem deviates from the target coordinates, the minimum thickness of cement decreases. Therefore, we recommend development of a new methodology for accurate insertion of a femoral stem along the broached space. Also, modification of the stem design robust to the unintentional movement of a femoral stem in the broached space, can alleviate the problem.

• 한국분말재료학회지
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• 제17권2호
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• pp.113-122
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• 2010

Two kinds of oxide-dispersion-strengthened (ODS) 316L stainless steel were manufactured using a wet mixing process(wet) and a mechanical alloying method (MA). An MA 316L ODS was prepared by a mixing of metal powder and a mechanical alloying process. A wet 316L ODS was manufactured by a wet mixing with 316L stainless steel powder. A solution of yttrium nitrate was dried after being in the wet 316L ODS alloy. The results showed that carbon and oxygen were effectively reduced during the degassing process before the hydroisostatic process (HIP) in both alloys. It appeared that the effect of HIP treatment on increase in impact energy was pronounced in the MA 316L ODS alloy. The MA 316L ODS alloy showed a higher yield strength and a smaller elongation, when compared to the wet 316L ODS alloy. This seemed to be attributed to the enhancement of bonding between oxide and matrix particles from HIP and to the presence of a finer oxide of about 20 nm from the MA process in the MA 316L ODS alloy.