• Title/Summary/Keyword: Knee surgery

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Variation of Practice in Prophylactic Protocol to Reduce Prosthetic Joint Infection in Primary Hip and Knee Arthroplasty: A National Survey in the United Kingdom

  • James Morris;Lee Hoggett;Sophie Rogers;John Ranson;Andrew Sloan
    • Hip & pelvis
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    • v.35 no.4
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    • pp.228-232
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    • 2023
  • Purpose: Prosthetic joint infection (PJI) has an enormous physiological and psychological burden on patients. Surgeons rightly wish to minimise this risk. It has been shown that a standardised, evidence-based approach to perioperative care leads to better patient outcomes. A review of current practice was conducted using a cross-sectional survey among surgeons at multiple centers nationwide. Materials and Methods: An 11-question electronic survey was circulated to hip and knee arthroplasty consultants nationally via the BOA (British Orthopaedic Association) e-newsletter. Results: The respondents included 56 consultants working across 19 different trusts. Thirty-four (60.7%) screen patients for asymptomatic bacteriuria (ASB) preoperatively, with 19 (55.9%) would treating with antibiotics. Fifty-six (100%) screen for methicillin-resistant Staphylococcus aureus and treat if positive. Only 15 (26.8%) screen for methicillin-sensitive S. aureus (MSSA) or empirically eradicate. Zero (0%) routinely catheterize patients perioperatively. Forty-one (73.2%) would give intramuscular or intravenous gentamicin for a perioperative catheterisation. All surgeons use laminar flow theatres. Twenty-six (46.4%) use only an impervious gown, 6 (10.7%) exhaust pipes, and 24 (42.3%) surgical helmet system. Five different antimicrobial prophylaxis regimens are used 9 (16.1%) cefuroxime, 2 (3.6%) flucloxacillin, 19 (33.9%) flucloxacillin and gentamicin, 10 (17.9%) teicoplanin, 16 (28.6%) teicoplanin and gentamicin. Twenty-two (39.3%) routinely give further doses. Conclusion: ASB screening, treatment and intramuscular gentamicin for perioperative catheterisation is routinely practiced despite no supporting evidence base. MSSA screening and treatment is underutilised. Multiple antibiotic regimens exist despite little variation in organisms in PJI. Practice varies between surgeons and centers, we should all be practicing evidence-based medicine.

Treatment of Giant Cell Tumor Around Knee - by Intralesional Excision Using High Speed Burr and Methylmethacrylate - (슬관절 주변에 발생한 거대세포종의 치료 - 고속 바(High-Speed Burr)와 골 시멘트를 이용한 병소 내 절제술 -)

  • Park, Jong-Hoon;Lee, Soo-Yong;Jeon, Dae-Geun;Cho, Wan-Hyung;Song, Won-Seok;Kim, Jin-Wook;Koh, Han-Sang
    • The Journal of the Korean bone and joint tumor society
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    • v.11 no.2
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    • pp.160-167
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    • 2005
  • Purpose : Distal femur and proximal tibia are the common sites affected by giant cell tumor of bone. There are a variety of treatment modality including wide excision and intralesional curettage. We evaluated the local recurrence rates and the post-operative functional scores of giant cell tumors around knee joint and investigated the identification of possible prognostic factors for recurrence. Materials and Methods: We reviewed 41 patients pathologically confirmed as giant cell tumors around knee joint that have undergone intralesional curettage using high-speed burr and methylmethacrylate. We evaluated the recurrence rate and post-surgical functional score and possible prognostic factors for recurrence, such as, gender, age, tumor location, size, subchondral invasion, intra-articular invasion and the Campanacci Grades. Mean follow up period was 50 (12-122) months. Results: The recurrence rate was 17% and mean recurrence onset was 10 months postoperatively. According to Musculoskeletal Tumor Society (MSTS) functional evaluation system, the average score was 27.8(93%) and 78% had excellent function. According to our study, suspected prognostic factors revealed not significant for recurrence. Conclusion: We found no significant recurrence related factors. Intralesional excision with high-sped burring and PMMA provides a low recurrence rate, similar to others in the literature, and good functional scores.

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Treatment Methods for Functional Recovery after Total Knee Arthroplasty (슬관절 전치환술 후 기능 회복을 위한 치료법)

  • Kim, Young-mo;Joo, Yong-bum;Park, Il-young
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.2
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    • pp.117-126
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    • 2020
  • Total knee arthroplasty is performed widely in degenerative arthritis of the knee joint, and the frequency of use is increasing. Efforts should be made to achieve functional recovery, such as returning to daily life, and the recovery of strength and range of motion after surgery. The procedure should be approached from a range of perspectives, such as patient factors, surgical technique and rehabilitation. The patient's age, degree of obesity, sex, and strength of the quadriceps muscle can affect the functional recovery after surgery. In addition, the patient's mental state, such as expectation value and satisfaction, can also have an effect. For functional recovery, patient education, pain control, and strengthening of the quadriceps muscle can be performed prior to surgery. Postoperative physiotherapy, such as icing and compression, transcutaneous electrical nerve stimulation therapy, neuromuscular electrical stimulation therapy, low frequency low intensity magnetic field therapy, strengthening of quadriceps muscle, and range of motion exercise can also be applied. In recent years, hydrotherapy, which restores the strength and balance of the leg, is being performed increasingly. These treatments are not only performed shortly after surgery, but are also performed continuously. In addition, the surgeon should apply it appropriately considering the patient's condition, compliance, and social and psychological conditions.

Diagnosis of Meniscal Tear of the Knee Using Proton-weighted Fast Spin-Echo MR Imaging : Can be an Alternative to Conventional Spin-Echo Imaging\ulcorner (양지밀도강조 고속 스핀에코 자기공명영상을 이용한 슬관절 반월판 열상의 진단 : 고식적 스핀에코를 대체할 수 있는가\ulcorner)

  • 김기준;이재희;주종관;이성용
    • Investigative Magnetic Resonance Imaging
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    • v.3 no.1
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    • pp.73-77
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    • 1999
  • Purpose : The purpose of the study was to evaluate the sensitivity and specificity of proton-weighted fast spin-echo MR imaging in diagnosing the meniscal tear of knee as an reasonable substitute for conventional spin-echo imaging. Materials and Methods : 102 consecutive patients, proved by surgery, proved by surgery, were participated in this study. All of them were suspected internal derangement of knee, examined by fast spin-echo MR imaging including sagittal and coronal images on a 1.5T MR imager and underwent arthroscopic or open surgery of knee joint within 2 months. These images were reviewed retrospectively by three radiologists. The sensitivity and specificity of meniscal tear were calculated. Results : The sensitivity and specificity of meniscal tear using proton-weighted fast spin-echo MR imaging were 94%, 93% inmedialmeniscus and 92%, 88% in lateral meniscus. Conclusion : The sensitivity and specificity of meniscal tear using proton weighted fast-spin echo MR images were as high as those using conventional spin-echo images. The proton-weighted fast-spin echo MR imaging can be an alternative to conventional spin-echo MR imaging in diagnosing meniscal tear of the knee.

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Utility of Gait Analysis and Functional Assessment of Prosthetic Reconstruction in Bone Tumor around the Knee (슬관절 주위에 발생한 골종양 환자에서 종양 대치물을 이용한 재건술 후 기능적 평가 및 보행 분석의 유용성)

  • Lee, Jin-Ho;Seol, Young-Jun;Jung, Sung-Taek
    • The Journal of the Korean bone and joint tumor society
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    • v.18 no.2
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    • pp.51-58
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    • 2012
  • Purpose: This study attempts to know functional results and gait analysis usefulness in patients with bone tumor around knee joint tumors who underwent prosthesis knee joint reconstruction. Materials and Methods: Retrospective study was conducted with 7 patients out of 30 patients who underwent prosthesis knee joint reconstruction after wide marginal excision for bone tumor around knee in orthopedics of this hospital from 2001 to 2010. Functional assessment and gait analysis were perforemed. Results: For the SF-36 score, while 'role physical' and 'role emotional' items showed 100% (100 points) high scores individually, general health, physical function, vitality, and social function showed low scores. The mean score of MSTS was 88.1% (23.8 points [17-27]), indicating a relatively high score. For the gait analysis, mean gait velocity was 97.2 m/s, mean cadence was 105.6 step/min, mean stride length was 111.3 m, mean step length was 61.5 cm, swing phase was 39.8%cycle, stance phase was 60.1%cycle, mean single limb support was 37.1%cycle, mean double limb support was 13.0%cycle, and mean push off was 60.7%cycle. Conclusion: It is expected that prosthesis reconstruction after wide marginal excision for bone tumor around knee has relatively good functional results. Gait analysis was considered one of method which showed gait phase and assessed functional ability objectively by quantitative assessment post operative patient condition. It might help treatment and post operative rehabilitation planning with the functional assessment.

Ultrasonographic Diagnosis of the Patellar Clunk Syndrome after Posterior Stabilized Total Knee Arthroplasty - A Case Report - (후방 안정형 인공 관절 전치환술 후 슬개골 덜컹 증후군의 초음파적 진단 - 증례 보고 -)

  • Yoo, Jae Doo;Kim, Nam Ki;Chung, Jae Yoon
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.7 no.1
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    • pp.39-44
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    • 2014
  • The patellar clunk syndrome is one of the patellofemoral complication, caused by formation of the fibrous nodule at the suprapatellar region after total knee arthroplasty. The symptom involves painful catching, crepitus and clunk during knee extension. It has been mainly but not exclusively associated with the posterior stabilized total knee system. The fibrous nodule is entrapped in the femoral intercondylar notch of the femoral component during flexion and as the knee is extended, it displaces back to the trochlear groove abruptly and the typical symptoms occur. The risk of developing this complication is primarily related to the design of the femoral component and higher incidence was noted with earlier designs of posterior stabilized knee prosthesis. Modifications have been made to the femoral component to optimize the kinematics of the patellofemoral joint and thereby reduced the incidence of patellar clunk syndrome but did not eliminate the problem completely. Clinical examination is the gold standard of diagnosis and imaging study has been used as a possible adjunct to diagnosis. Especially ultrasonography is an imaging modality, which can be easily performed to detect the fibrous nodule on the quadriceps tendon. We report a case of patellar clunk syndrome which was diagnosed with ultrasonography.

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Localized Giant Cell Tumor of Tendon Sheath Arising from the Anterior Cruciate Ligament of the Knee - 2 Cases Report - (슬관절 전방십자인대에 발생한 국소형 건막 거대세포종 - 2례 보고 -)

  • Koo, Bon Seop;Kim, Kyung Chul;Lee, Ho Jooog
    • Journal of the Korean Arthroscopy Society
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    • v.3 no.2
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    • pp.146-149
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    • 1999
  • The localized form of a giant cell tumor of tendon sheath rarely affected the large weight-bearing joints. Only four cases of localized giant cell tumor arising in the knee joint could be found in the literatures. Physical examination of the affected knee could show pain, swelling, locking, giving way and limitation of extension, but it was difficult to differentiate from meniscal tear or cruciate ligament tear. Two cases of localized giant cell tumor of tendon sheath were incidentally found in the knees during the reconstruction of the anterior cruciate ligaments. Both tumors arising from the anterior cruciate ligament were excised arthroscopically and were confirmed to be localized giant cell tumor of tendon sheath by microscopic examination. The clinical results were good after complete excision, so we reported these cases with a review of the literatures.

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Localized Pigmented Villonodular Synovitis Developed on the Posterior Cruciate Ligament of the Knee: Treatment Using Posterior Trans-septal Portal - A Case Report - (후방 십자 인대에 발생한 국소형 색소 융모 결절성 활액막염 : 관절경하 후방 경격막 삽입구를 이용한 치료 - 증례 보고 -)

  • Lee, Gyu-Yeong;Lee, Hwa-Sung;Chang, Dong-Gune
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.3
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    • pp.264-267
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    • 2009
  • Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder of the synovium of joints. It occurs most commonly in the knee joint. The disease is composed of 2 different forms: diffuse and localized. The localized form is less frequent than the diffuse one. Most cases of localized PVNS involve the anterior compartment of the knee and can be usually easily diagnosed and treated with arthroscopy. We experienced a patient of localized PVNS developed on the posterior cruciate ligament, whose main symptom was persistent pain after trauma. This case occurs rarely and complete removal of the lesion was performed arthroscopically, using posterior trans-septal portal. We report this case with review of literatures.

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May-Thurner Syndrome after Total Knee Arthroplasty (인공 슬관절 전치환술 후 발생한 May-Thurner 증후군)

  • Shim, Chang Heon;Park, Jin Woo;Wang, Lih
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.3
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    • pp.277-281
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    • 2021
  • Iliac vein compression syndrome, which results in thrombosis of the left iliac veins, was first described by May and Thurner in 1957. May-Thurner syndrome should be considered when deep vein thrombosis-like symptoms appear, especially in the left lower extremities without an invasive procedure. The authors encountered an interesting case of a middle-aged female patient, who presented with sudden pain, swelling and skin color changes to the left lower extremity after right total knee arthroplasty and was diagnosed May-Thurner syndrome by computed tomography venography. This case is of clinical significance in that the early diagnosis of May-Thurner syndrome in the left lower extremity was made, which might have been overlooked after right total knee arthroplasty. This case is reported with a review of the literature review.

The Follow-up Results of Anterior Cruciate Ligament Reconstruction Using The Flexible Reamer (유연성 연마기를 이용한 관절경적 전방 십자 인대 재건술의 추시 결과)

  • Chae, In-Jung;Wang, Joon-Ho;Choi, Gi-Won;Song, Dong-Ik
    • Journal of the Korean Arthroscopy Society
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    • v.12 no.1
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    • pp.18-23
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    • 2008
  • Purpose: The purpose of this study is to evaluate the clinical results of the function and stability of ACL reconstruction using the flexible reamer. Materials and Methods: We reviewed 98 patients who taken ACL reconstruction using the flexible reamer from March, 1999 to May, 2004. And the follow-up period was more than 12 months in all cases. We used the subjective tests including Lysholm knee score and 2000 International Knee Documentation Committee(IKDC) subjective knee score, and the objective tests such as anterior drawer test, Lachman test, pivot shift test, and KT-2000 arthrometer to evaluate the clinical results. Results: In the range of motion of the affected knee, the extension deficit more than 5 degree was 8 cases preoperatively and 1 case postoperatively. The flexion deficit more than 5 degree was 12 cases preoperatively and 2 cases postoperatively. The mean Lysholm knee score was 61.3 point(${\pm}3.5$ SD) preoperatively and 87.7 point(${\pm}2.0$ SD) postoperatively. The mean 2000 International Knee Documentation Committee(IKDC) subjective knee score was 49 point(${\pm}3.3$ SD) preoperatively and 84 point (${\pm}2.2$ SD) postoperatively. 93 cases were more than grade II in Lachman test preoperatively and 5 cases postoperatively. 71 cases were more than grade II in pivot shift test preoperatively but 89 cases were negative postoperatively. The mean maximal manual difference by KT-2000 arthrometer was 6.8 mm(${\pm}1.9$ SD) preoperatively and 1.8 mm(${\pm}0.8$ SD) postoperatively. Conclusion: ACL reconstruction using the flexible reamer achieved the ideal isometric point of femur and anatomic graft placement, so we could obtain good results, especially in rotational stability.

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