• The Journal of Korean Physical Therapy
• /
• v.26 no.5
• /
• pp.296-301
• /
• 2014

Purpose: The purpose of this study was to investigate the effect of strengthening exercises of hip abductors on muscle strength and ambulation for patients with ACL reconstruction. Methods: The subjects were randomly assigned to the intervention group (general exercise plus strengthening of hip abductors) or the control group (general exercise without the strengthening of hip abductors). Both groups participated in a six-week exercise protocol after the surgery for ACL reconstruction. The knee strength test (quadriceps, hamstring, hip abductor) and gait analysis were performed in pretest and post-test. Results: Muscle strength was measured using the Biodex system III model (Biodex Medical System, Inc, NY, US). The results showed no significant difference in knee strength (quadriceps, hamstring) between the two groups (p>0.05), however, there was a significant difference in hip abductors (p<0.05). The gait analysis was measured with Gaitrite system (CIR System Inc, US). Results of comparison between groups showed a significant increase in the step length of both groups. (p<0.05), and there was a significant difference in the affected leg of the intervention group(p<0.05). Conclusion: Exercise of hip abductors for patients with ACL reconstruction provides significant benefits with respect to improvement of muscle strength in hip abductors, increasing the stride. This result indicates that a training program designed for ACL reconstruction patients should include strengthening of the hip abductor. We think that further study is needed to determine the relationship of hip muscles and knee joint for patients with ACL reconstruction.

• Hip & pelvis
• /
• v.30 no.4
• /
• pp.260-268
• /
• 2018

Purpose: This study was performed to assess the clinical and radiological outcomes following one-stage hip reconstruction, consisting of open reduction femoral shortening and pelvic osteotomy, for neglected developmental dislocation of the hip (DDH). Materials and Methods: This is a retrospective analysis of 77 hips in 65 patients (46 females and 19 males; 12 had bilateral dislocations), operated at a Ghurki Trust Teaching Hospital in Pakistan between 2013 and 2015. The average age at surgery was $11.02{\pm}3.43$ years. According to the Tonnis classification, there were 10, 14, 22, and 31 patients in grades 1, 2, 3, and 4, respectively. The pelvic procedure utilized in this study was triple osteotomy (47 hips) followed by double and Salter osteotomy (18 and 12 hips, respectively). Postoperative evaluations were conducted using the modified MacKay's scoring system (functional outcomes) and Severin's scoring method (radiological assessment). Results: Postoperatively, there were 38 (49.4%), 19 (24.7%), 14 (18.2%), and 6 (7.8%) hips in Severin grade I, II, III and IV, respectively. According to the modified McKay criteria, there were 22 hips (28.6%) in excellent condition, 44 (57.1%) in good condition, 9 (11.7%) in fair condition and 2 (2.6%) in poor condition. Both patients with poor outcomes had an unstable, painful hip with evidence of avascular necrosis of the femoral head. Conclusion: Based on the results presented here, we recommend the single stage procedure of open reduction, femoral shortening and pelvic osteotomy for treatment of DDH in older children with good to excellent functional and radiological outcomes.

• Hip & pelvis
• /
• v.35 no.1
• /
• pp.40-46
• /
• 2023

Purpose: A variety of short Exeter stems designed specifically for use in performance of total hip arthroplasty (THA) in primary and revision settings have recently been introduced. Some have been used 'off label' for hip reconstruction. The aim of this study is to report clinical and radiological results from the Exeter V40 125 mm stem in performance of primary THA and revision THA. Materials and Methods: This study had a retrospective design. Insertion of 58 (24 primary, 34 revision) Exeter V40 125 mm stems was performed between 2015 and 2017. The minimum follow-up period was two years. Assessment of the Oxford hip score (OHS), EuroQol-5 Dimension (EQ-5D), and radiological follow-up was performed at one and two years. Results: In the primary group, the preoperative, mean OHS was 13.29. The mean OHS was 32.86 and 23.39 at one-year and two-year post-surgery, respectively. The mean EQ-5D-3L scores were at 0.14, 0.59, and 0.35, preoperatively, at one-year follow-up and two-year follow-up, respectively. In the revision group, the mean preoperative OHS was 19.41. The mean OHS was 30.55 and 26.05 at one-year and two-year post-surgery, respectively. The mean EQ-5D-3L scores were 0.33, 0.61, and 0.48 preoperatively, at one-year follow-up and two-year follow-up, respectively. No progressive or new radiolucent lines were observed around any stem at the time of the final follow-up in all patients in both groups. Conclusion: Encouraging results regarding use of Exeter V40 125 mm stems have been reported up to two years following surgery in primary and revision THA settings.

• Hip & pelvis
• /
• v.35 no.3
• /
• pp.183-192
• /
• 2023

Purpose: This study aims to determine which intertrochanteric (IT) hip fracture and patient characteristics predict the necessity for adjunct reduction aides prior to prep and drape aiming for a more efficient surgery. Materials and Methods: Institutional fracture registries from two academic medical centers from 2017-2022 were analyzed. Data on patient demographics, comorbidities, fracture patterns identified on radiographs including displacement of the lesser trochanter (LT), thin lateral wall (LW), reverse obliquity (RO), subtrochanteric extension (STE), and number of fracture parts were collected, and the need for additional aides following traction on fracture table were collected. Fractures were classified using the AO/OTA classification. Regression analyses identified significant risk factors for needing extra reduction aides. Results: Of the 166 patients included, the average age was 80.84±12.7 years and BMI was 24.37±5.3 kg/m². Univariate regression revealed increased irreducibility risk associated with RO (odds ratio [OR] 27.917, P≤0.001), LW (OR 24.882, P<0.001), and STE (OR 5.255, P=0.005). Multivariate analysis significantly correlated RO (OR 120.74, P<0.001) and thin LW (OR 131.14, P<0.001) with increased risk. However, STE (P=0.36) and LT displacement (P=0.77) weren't significant. Fracture types 2.2, 3.2, and 3.3 displayed elevated risk (P<0.001), while no other factors increased risk. Conclusion: Elderly patients with IT fractures with RO and/or thin LW are at higher risk of irreducibility, necessitating adjunct reduction aides. Other parameters showed no significant association, suggesting most fracture patterns can be achieved with traction manipulation alone.

• The Journal of the Korean bone and joint tumor society
• /
• v.13 no.2
• /
• pp.113-118
• /
• 2007

Surgical treatment of pelvic bone tumors represent one of the most complicated problem in musculoskeletal oncology. Because of three dimensional anatomy of the pelvis, tumors reach huge sizes and the diagnosed late relatively to a similar tumors in extremity. Especially, there are limited reconstruction methods to keep the function of hip joint after resection of periacetabular tumors, and the results of reconstruction is not so promissing. We present one case of periacetabular metastatic tumor from renal cell carcinoma, which was resected with wide margin and reconstructed with composite of pasteurized autogenous bone graft and constrained total hip arthroplasty.

• Archives of Reconstructive Microsurgery
• /
• v.25 no.2
• /
• pp.43-48
• /
• 2016

Purpose: Perforator flap-using ischial sore reconstruction is performed in a prone position. But after the surgery, recurrence frequently occurs in a sitting position. In this sense, we introduce modified flap insetting method which closely resembles patient's sitting position to lessen the flap tension surgically. Materials and Methods: Authors tried to check a skin tension difference between prone position and sitting position in normal people group and to find out the importance of performing flap insetting in hip flexion position. Healthy volunteers were collected (n=20) and designed the same length of 4 divided sections around the ischium. Lengths of each section were measured when hip joint was flexed to 90 degree and when both hip and knee joints were flexed to 90 degree and the statistical evaluation was performed. Twenty cases with ischial sore underwent reconstructive surgery using perforator flap under hip flexion position and followed-up for any recurrences. Results: There was a meaningful difference between the joint flexed skin length and that of the neutral position. Flap showed sufficient thickness over 12 months. Conclusion: It seems that recurrence could be reduced when the reconstructed flap could sufficiently cover in a sitting position regarding its significant length difference in normal people group.

• The Journal of the Korean bone and joint tumor society
• /
• v.9 no.1
• /
• pp.115-123
• /
• 2003

Study Design: A retrospective clinical and radiographic review. Objectives: The purpose of this study was to suggest recycling bone autotransplantation with extracorporeal heat-treatment as one of favorable reconstruction method for malignant bone tumors of pelvis through 3 cases. Summary of Literature Review: There are many biologic and nonbiologic reconstruction method in pelvic reconstruction. Cases: Case 1- A 20-year-old women had chief complaint of right hip and thigh pain started 3 months ago and done curettage and bone cementing at right ilium at other hospital. She had impression of malignant bone tumor and undergone postoperative radiation therapy for 6 cycles. After that she was referred to our hospital and undergone wide excision of right ilium and recycling bone autotransplantation with extracorporeal heat-treatment at 132 degree celsius for 2 minutes internal fixation with pelvic reconstruction plate and total hip replacement arthroplasty (ABG$^{(R)}$). There was no evidence of distant metastasis and revealed well-differentiated osteosarcoma on postoperative pathology. Neither adjuvant nor neoadjuvant chemotherapy were done. Case 2- A 56-year-old women who suffered right thigh pain for 3 months was detected radiologic abnormality at right pelvis. After incisional biopsy, osteosarcoma was diagnosed. We had undergone wide excision of right ilium and recycling bone autotransplantation with extracorporeal low heat-treatment at 65 degree celsius for 30minutes internal fixation with pelvic reconstruction plate and total hip replacement arthroplasty (ABG$^{(R)}$). There was no evidence of distant metastasis and revealed high-grade osteosacoma which was fibroblastic type on postoperative pathology. Adjuvant chemotherapy (HDMTX, ADR, CDDP) was done immediate after wound healing was completed. Case 3- A 46-year-old women was incidently found mass at left ilium which was suspected chondrosarcoma. We had undergone wide excision of left ilium and recycling bone autotransplantation with extracorporeal low heat-treatment at 65 degree celsius for 30minutes internal fixation with pelvic reconstruction plate and total hip replacement arthroplasty (Protek$^{(R)}$). There was no evidence of distant metastasis and revealed chondrosarcoma which was graded II/III on postoperative pathology. Results: Oncologic and functional outcome at final follow-up were for case 1, final follow-up time was 7 years, is no evidence of disease and functional score is 53% according to Ennecking et al. During follow-up, evidence of radiologic union was at about 1 and 6 months after operation. The case had breakage of pelvic reconstruction plate and some resorption of autotransplated bone, but no symptom present. For case 2, final follow-up was 3 years and 6 months, is no evidence of disease and functional score is 60%. For case 3, final follow-up was 7 months, no evidence of disease and functional score is 63% which is improving state. Discussion: 3 cases which were undergone recycling bone autotransplantation with extracorporeal heat-treatment and total hip replacement arthroplasty had relatively successful oncologic and functional outcome. Taking account that difficulty in using allograft in Korea this method is thoght to be one of the useful way to reconstruct pelvis after resection of primary malignant bone tumor of the pelvis.

• Hip & pelvis
• /
• v.35 no.2
• /
• pp.122-132
• /
• 2023

Purpose: The dome technique is a technique used in performance of revision total hip arthroplasty (THA) involving intraoperative joining of two porous metal acetabular augments to fill a massive anterosuperior medial acetabular bone defect. While excellent outcomes were achieved using this surgical technique in a series of three cases, short-term results have not been reported. We hypothesized that excellent short-term clinical and patient reported outcomes could be achieved with use of the dome technique. Materials and Methods: A multicenter case series was conducted for evaluation of patients who underwent revision THA using the dome technique for management of Paprosky 3B anterosuperior medial acetabular bone loss from 2013-2019 with a minimum clinical follow-up period of two years. Twelve cases in 12 patients were identified. Baseline demographics, intraoperative variables, surgical outcomes, and patient reported outcomes were acquired. Results: The implant survivorship was 91% with component failure requiring re-revision in only one patient at a mean follow-up period of 36.2 months (range, 24-72 months). Three patients (25.0%) experienced complications, including re-revision for component failure, inter-prosthetic dual-mobility dissociation, and periprosthetic joint infection. Of seven patients who completed the HOOS, JR (hip disability and osteoarthritis outcome score, joint replacement) survey, five patients showed improvement. Conclusion: Excellent outcomes can be achieved using the dome technique for management of massive anterosuperior medial acetabular defects in revision THA with survivorship of 91% at a mean follow-up period of three years. Conduct of future studies will be required in order to evaluate mid- to long-term outcomes for this technique.

• Archives of Reconstructive Microsurgery
• /
• v.24 no.2
• /
• pp.41-49
• /
• 2015

Free or pedicled vascularized fibular grafts (VFG) are useful for the reconstruction of large skeletal defects, particularly in cases of scarred or avascular beds, or in patients with combined bone and soft tissue defects. Compared to non-VFG, VEG, which contains living osteocytes and osteoblasts, maintains its own viability and serves as good osteoconductive and osteoinductive graft. Due to its many structural and biological advantages, the free fibular osteo- or osteocutaneous graft is considered the most suitable autograft for the reconstruction of long bone defects in the injured extremity. The traditional indication of VFG is the long bone and soft tissue defect, which cannot be reconstructed using a conventional operative method. Recently, the indications have been widely expanded not only for defects of midtibia, humerus, forearm, distal femur, and proximal tibia, but also for the arthrodesis of shoulder and knee joints. Because of its potential to allow further bone growth, free fibular epiphyseal transfer can be used for the hip or for distal radius defects caused by the radical resection of a tumor. The basic anatomy and surgical techniques for harvesting the VFG are well known; however, the condition of the recipient site is different in each case. Therefore, careful preoperative surgical planning should be customized in every patient. In this review, recently expanded surgical indications of VFG and surgical tips based on the author's experiences in the issues of fixation method, one or two staged reconstruction, size mismatching, overcoming the stress fracture, and arthrodesis of shoulder and knee joint using VFG are discussed with the review of literature.

• Journal of architectural history
• /
• v.19 no.5
• /
• pp.25-47
• /
• 2010

The purpose of this study is to reconstruct the wooden frame structure of Buddhist temple, Kumdang in Youngamsaji which assumed to be built in the 9th century of Unified Silla Dynasty. The remaining site of Kumdang in Youngamsaji is investigated thoroughly with a particular attention to bay size and column distribution. The five ancient Buddhist temples which were built in the same period also have the same frame type as Youngamsaji Kumdang. These five ancient Buddhist temples and Kumdang in Youngamsaji are meticulously investigated in terms of their bay sizes and measuring modules. The framework schema is devised as a conceptual tool to conjecture wooden frame structures of Buddhist temple. A theoretical differentiation between frame type and frame structure is attempted to formulated a wooden frame structure as a stepping-stone for the reconstruction of traditional wooden building. The wooden frame structure of 9C Kumdang in Youngamsaji mainly follows the oldest Korean wooden pavilion, Muryangsujeon in Busuk temple, with a hip and gable roof. The wooden frame structure of 9C Kumdang in Youngamsaji is reconstructed through 3D computer modeling to such an extent that every wooden components of the structure can be 3D printed. The reconstruction also takes reference from the Cai-Fen system in Yingzao Fashi.