• Hip & pelvis
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• 제35권4호
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• pp.238-245
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• 2023

Purpose: Elderly patients with degenerative diseases undergo treatment for the hip and spine; these patients present with various symptoms. This study focused on patients with residual symptoms, predominantly pain, even after receiving treatment for their spinal lesions. Materials and Methods: Patients who underwent total hip arthroplasty (THA) between 2016 and 2022 at a single tertiary hospital were included in the study. Of the 417 patients who underwent primary THA, a retrospective review of 40 patients with previous lesions of the spine was conducted. Patients were stratified to two cohorts: Patients with symptoms related to the spine (Group A), and those with hip-related symptoms (Group B). Preand postoperative comparisons of groups A and B were performed. Results: Improvements in patients' symptoms were observed in groups A and B after THA. In Group A, the mean preoperative visual analog scale (VAS) score was 5.10±0.876, which showed a postoperative decrease to 2.70±1.767. In Group B, the mean preoperative VAS score was 5.10±1.539, which showed a postoperative decrease to 2.67±1.493. Conclusion: According to the findings, promising results were achieved with THA in treatment of debilitating diseases of the hip for both the prognosis of the disease, as well as the patients' symptoms. In addition, in some cases elderly patients with dual pathologies underwent treatment for spinal lesions without performance of any evaluation related to the hip. Thus, evaluation of a patient's hip must be performed and performance of THA in patients with symptoms even after treatment of spinal lesions is recommended.

• Hip & pelvis
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• 제36권2호
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• pp.87-100
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• 2024

Total hip arthroplasty (THA) is an effective treatment for osteoarthritis, and the popularity of the direct anterior approach has increased due to more rapid recovery and increased stability. Instability, commonly caused by component malposition, remains a significant concern. The dynamic relationship between the pelvis and lumbar spine, deemed spinopelvic motion, is considered an important factor in stability. Various parameters are used in evaluating spinopelvic motion. Understanding spinopelvic motion is critical, and executing a precise plan for positioning the implant can be difficult with manual instrumentation. Robotic and/or navigation systems have been developed in the effort to enhance THA outcomes and for implementing spinopelvic parameters. These systems can be classified into three categories: X-ray/fluoroscopy-based, imageless, and computed tomography (CT)-based. Each system has advantages and limitations. When using CT-based systems, preoperative CT scans are used to assist with preoperative planning and intraoperative execution, providing feedback on implant position and restoration of hip biomechanics within a functional safe zone developed according to each patient's specific spinopelvic parameters. Several studies have demonstrated the accuracy and reproducibility of robotic systems with regard to implant positioning and leg length discrepancy. Some studies have reported better radiographic and clinical outcomes with use of robotic-assisted THA. However, clinical outcomes comparable to those for manual THA have also been reported. Robotic systems offer advantages in terms of accuracy, precision, and potentially reduced rates of dislocation. Additional research, including conduct of randomized controlled trials, will be required in order to evaluate the long-term outcomes and cost-effectiveness of robotic-assisted THA.

• Hip & pelvis
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• 제30권4호
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• pp.276-281
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• 2018

Pseudotumors are not uncommon complications after total hip arthroplasty (THA) and may occur due to differences in bearing surfaces of the head and the liner ranging from soft to hard articulation. The most common causes of pseudotumors are foreign-body reaction, hypersensitivity and wear debris. The spectrum of pseudotumor presentation following THA varies greatly-from completely asymptomatic to clear implant failure. We report a case of pseudo-tumor formation with acetabular cup aseptic loosening after revision ceramic-on-metal hip arthroplasty. The patient described herein underwent pseudotumor excision and re-revision complex arthroplasty using a trabecular metal shell and buttress with ceramic-on-polyethylene THA. Surgeons should be aware of the possibility of a pseudotumor when dealing with revisions to help prevent rapid progression of cup loosening and implant failure, and should intervene early to avoid complex arthroplasty procedures.

• Hip & pelvis
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• 제36권2호
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• pp.77-86
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• 2024

Knowledge of the relationship between the hip and spine is essential in the effort to minimize instability and improve outcomes following total hip arthroplasty (THA). A detailed yet straightforward preoperative imaging workup can provide valuable information on pelvic positioning, which may be helpful for optimum placement of the acetabular cup. For a streamlined preoperative assessment of THA candidates, classification systems with a capacity for providing a more personalized approach to performance of THA have been introduced. Familiarity with these systems and their clinical application is important in the effort to optimize component placement and reduce the risk of instability. Looking ahead, the principles of the hip-spine relationship are being integrated using emerging innovative technologies, promising further streamlining of the evaluation process.

• The Korean Journal of Physiology and Pharmacology
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• 제16권1호
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• pp.43-48
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• 2012

Glutamate excitotoxicity is emerging as a contributor to degeneration of spinal cord motoneurons in amyotrophic lateral sclerosis (ALS). Recently, we have reported that ghrelin protects motoneurons against chronic glutamate excitotoxicity through the activation of extracellular signal-regulated kinase 1/2 and phosphatidylinositol-3-kinase/Akt/glycogen synthase kinase-$3{\beta}$ pathways. Previous studies suggest that activated microglia actively participate in the pathogenesis of ALS motoneuron degeneration. However, it is still unknown whether ghrelin exerts its protective effect on motoneurons via inhibition of microglial activation. In this study, we investigate organotypic spinal cord cultures (OSCCs) exposed to threohydroxyaspartate (THA), as a model of excitotoxic motoneuron degeneration, to determine if ghrelin prevents microglial activation. Exposure of OSCCs to THA for 3 weeks produced typical motoneuron death, and treatment of ghrelin significantly attenuated THA-induced motoneuron loss, as previously reported. Ghrelin prevented THA-induced microglial activation in the spinal cord and the expression of pro-inflammatory cytokines tumor necrosis factor-${\alpha}$ and interleukin-$1{\beta}$. Our data indicate that ghrelin may act as a survival factor for motoneurons by functioning as a microglia-deactivating factor and suggest that ghrelin may have therapeutic potential for the treatment of ALS and other neurodegenerative disorders where inflammatory responses play a critical role.

• 한국지진공학회논문집
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• 제15권4호
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• pp.1-12
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• 2011

지진취약도 분석은 원자력 발전소의 내진성능평가를 위하여 발전되어져 왔지만, 현재는 적용성이 건물과 교량 등에도 확대되어지고 있다. 일반적으로 지진취약도 곡선은 수많은 지진가속도 기록을 이용하여 비선형 시간이력해석으로 구한다. 비선형 시간이력해석에 의한 지진취약도 분석은 구조물의 모델링과 해석에 많은 시간이 소요되는 과정을 요구한다. 비선형 시간이력해석의 이와 같은 약점을 보완하기 위해서 변위계수법과 역량스펙트럼 방법과 같은 간단한 해석방법을 지진취약도 분석에 적용하였다. 변위계수법과 역량 스펙트럼 방법을 적용한 지진취약도 곡선의 정확성을 평가하기 위하여, 철근콘크리트 전단벽 구조물에 대한 변위계수법과 역량스펙트럼 방법을 적용한 지진취약도 곡선을 비선형 시간이력해석에 의해 구해진 지진취약도 곡선과 비교하였다. 지진취약도 곡선의 작성을 위해서는 설계스펙트럼에 대응되는 190개의 인공지진과 Shinozuka 등이 제안한 방법이 적용되었다.

• 공업화학
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• 제8권6호
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• pp.907-913
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• 1997

3,5,5-trimethylhexanoic acid(THA)와 트리메틸올프로판을 에스테르화시켜 중간생성물을 얻은 후, 중간생성물 속의 알키드 폴리올 성분인 THA의 함량을 10, 20, 30wt.%로 변화시키면서 1,4-부탄디올, 트리메틸올프로판 및 아디프산과 축중합하여 알키드 변성폴리에스테르를 각각 합성하였다. 위에서 합성된 알키드 변성폴리에스테르에 폴리이소시아네트쪽 성분인 Desmodur L-75와 블렌드하여 2성분계 폴리우레탄 도료를 제조하였다. 제조된 도료의 도막처리후의 제반 물성시험을 해 본 결과 3,5,5-trimethylhexanoic acid의 함량증가에 따라 $8^-$점의 높은 연화도, 2~3시간의 짧은 건조시간 및 18~23시간의 긴 가사시간을 나타내어 알키드기의 장점이 일부 나타남을 확인하였다.

• Clinics in Orthopedic Surgery
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• 제10권4호
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• pp.398-406
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• 2018

Background: Hypoalbuminemia (serum albumin < 3.5 g/dL) is associated with increased morbidity and mortality in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, costs associated with hypoalbuminemia remain unknown. This study investigated the effect of serum albumin on direct treatment costs, length of stay (LOS), and readmissions for primary and revision THA and TKA patients. Methods: All adult patients at a single institution undergoing primary or revision THA or TKA between January 2014 and December 2016 were retrospectively reviewed. Patients were stratified by preoperative serum albumin level. The primary outcome was total direct costs at index hospitalization. Secondary outcomes included LOS and readmission within 30 days. Multivariable regressions were utilized to adjust for demographics and comorbidities. Results: Of 3,785 patients, 114 (3.0%) had hypoalbuminemia. After adjustment, hypoalbuminemia was associated with a 16.2% increase in costs (${\beta}=0.162$; 95% confidence interval [CI], 0.112 to 0.213; p < 0.001), representing an average cost increase of $3,383 (95% CI, $2,281 to $4,485) relative to costs for serum albumin > 4.5 g/dL. The increased total costs were significantly higher in revision ($4,322, p = 0.034) than in primary ($3,446, p < 0.001) procedures. In adjusted regression, each 1.0 g/dL increase in serum albumin yielded a 6.6% reduction in costs (${\beta}=-0.066$; 95% CI, -0.090 to -0.042]; p < 0.001), for average savings of $1,282 (95% CI, $759 to $1,806) per unit albumin. Adjusted regressions demonstrated that a 1-point increase in serum albumin reduced readmissions by 53% (odds ratio, 0.47; 95% CI, 0.31-0.73; p = 0.001) and LOS by 0.6 days (${\beta}=-0.60$; 95% CI, -0.76 to -0.44; p < 0.001). Conclusions: Hypoalbuminemia is associated with increased total direct costs, LOS, and readmissions following primary and revision THA and TKA. Future efforts to predict and address total costs should take into consideration the patient's preoperative serum albumin levels.

• Hip & pelvis
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• 제35권1호
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• pp.40-46
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• 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
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• 제36권2호
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• pp.108-119
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• 2024

Purpose: The incidence of deep vein thrombosis (DVT) following total hip arthroplasty (THA) without chemoprophylaxis could be as high as 50% in Caucasians. However, according to several subsequent studies, the incidence of venous thromboembolic events (VTE) in Asians was much lower. The routine use of chemoprophylaxis, which could potentially cause increased bleeding, infection, and wound complications, has been questioned in low-incidence populations. The objective of this study is to determine the incidence of VTE after primary THA without chemoprophylaxis in an Asian population using a fast-track rehabilitation protocol and to verify the safety profile for use of 'mechanical prophylaxis alone' in patients with standard risk of VTE. Materials and Methods: This is a retrospective cohort study of 542 Hong Kong Chinese patients who underwent primary THA without chemoprophylaxis. All patients received intermittent pneumatic compression and graduated compression stockings as mechanical prophylaxis. Multimodal pain management was applied in order to facilitate early mobilisation. Routine duplex ultrasonography was performed between the fourth and seventh postoperative day for detection of proximal DVT. Results: All patients were Chinese (mean age, 63.0±11.9 years). Six patients developed proximal DVT (incidence rate, 1.1%). None of the patients had symptomatic or fatal pulmonary embolism. Conclusion: The incidence of VTE after primary THA without chemical prophylaxis can be low in Asian populations when following a fast-track rehabilitation protocol. Mechanical prophylaxis alone can be regarded as a reasonably safe practice in terms of a balanced benefit-to-risk ratio for Asian patients with standard risk of VTE.