• Journal of the Korean Orthopaedic Association
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• v.55 no.1
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• pp.62-70
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• 2020

Purpose: External tibia torsion and proximal tibial vara have been reported in severe varus deformed osteoarthritis, which is a tibio-femoral angle of more than 20°. The radiology measurements were compared with those of control group and the preoperative and follow-up radiology and clinical results were examined. Materials and Methods: From January 2007 to March 2016, 43 knees from 37 persons, who underwent total knee arthroplasty for a severe varus deformity of more than 20° on the tibio-femoral angle on the standing radiographs and had a follow-up period more than two years, were examined. The mean follow-up period was 45.7 months. The control group, who underwent conservative treatments, had Kellgren-Lawrence grade three osteoarthritis and a tibio-femoral angle of less than 3° varus. The external tibial torsion of enrolled patients and control group were estimated using the proximal tibio-fibular overlap length and the tibial torsion values on computed tomography. The proximal tibia vara was measured using the proximal tibial tilt angle. The preoperative and postoperative proximal tibio-fibular overlap length, tibial torsion value, proximal tibial tilt angle, and hospital for special surgery (HSS) score were evaluated. Results: The mean proximal tibio-fibular overlap length was 18.6 mm preoperatively and 11.2 mm (p=0.031) at the follow-up. The control group had a mean proximal tibio-fibular overlap length of 8.7 mm (p=0.024). The mean tibial torsion value was 13.8° preoperatively and 14.0° (p=0.489) at the follow-up. The control group had a mean tibial torsion value of 21.9° (p=0.012). The mean proximal tibial tilt angle was 12.2° preoperatively and 0° (p<0.01) at the follow-up. The control group had a mean proximal tilt angle of 1.2° (p<0.01). The preoperative tibiofemoral angle and mechanical axis deviation were corrected from preoperative 28.3° and medial 68.4 mm to postoperative 0.7° and medial 3.5 mm (p<0.01, p<0.01), respectively. The HSS scores increased from 34 points of preoperatively to 87 points at the last follow-up (p=0.028). Conclusion: Patients with advanced osteoarthritis with a severe varus deformity of more than 20° had significant increases in the external tibial torsion and varus of the proximal tibia. The tibial torsion value before and after surgery in the enrolled patients was not changed statistically, but good clinical results without complications were obtained.

• Journal of the Korean Orthopaedic Association
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• v.56 no.1
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• pp.26-33
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• 2021

Purpose: This study evaluated the results of dual plate fixation for periprosthetic femur fracture after total knee arthroplasty (TKA). Materials and Methods: From October 2007 to February 2013, 23 cases of periprosthetic femur fracture after TKA were treated at the author's hospital. There were 13 cases of fixation using a medial and lateral dual plate when the stability of the fracture site could not be achieved by one side fixation with a follow-up of more than one year. The cases included no loosening of the femoral component in fractures that were categorized as Lewis-Rorabeck classification II and supracondylar comminuted fractures and elongation of the fracture line to the lateral epicondyle of the femur or stem in the medullary canal. The mean age was 72 years (65-82 years), and 11 cases were female. Three cases had a stem due to revision. The mean bone marrow density was -3.2 (-1.7 to -4.4), and the mean period from primary TKA to periprosthetic fractures was 28 months (1-108 months). The mean follow-up period was 23 months (12-65 months). The medial fracture site was first exposed via the subvastus approach. Second, the supplementary plate was fixed on the lateral side of the fracture using a minimally invasive plate osteosynthesis technique. The average union time, complications, and Hospital for Special Surgery Knee Score (HSS) at the last follow-up were evaluated. Results: The mean union time was 17.4 weeks (7-40 weeks). Two cases showed delayed bone union and nonunion occurred in one case, in whom bone union was achieved three months later after re-fixation using a dual plate with an autogenous bone graft. The mean varusvalgus angulation was 1.67 degrees (-1.2-4.9 degrees), and the mean anterior-posterior angulation was 2.86 degrees (0-4.9 degrees) at the last follow-up. The mean knee range of motion was 90 degrees, and the HSS score was 85 points (70-95 points) at the last follow-up. Conclusion: Dual plate fixation for periprosthetic femur fractures that had not achieved stability by one side plate fixation after TKA showed a good clinical result that allowed early rehabilitation.

• Journal of Biomedical Engineering Research
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• v.19 no.5
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• pp.503-511
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• 1998

In this study, the stress distribution for different tibial components was observed In order to Investigate the load transfer and potential failure mechanism of the tibial components subjected to dynamic impact loading and also to evacuate the effect of bone-implant bonding conditions on the implant system. The 3-dimensional finite element models included an intact tibia, cemented metal-backed tibial component, uncemented metal-blocked tibial component, cemented all-polyethylene tibial component, and metal-backed component with a debonded bone/stem interface. The results showed that the cemented metal-hocked component Induced slightly higher peak stress at stem tip than the uncemented component. The peak stress of the all-polyethylene tibia1 component at stem trip showed about half thats of metal-backed tibial components. The all-polyethylene component showed a similar dynamic response to intact tibia. In case of debonded bone/stem interface, the peak stress below the metal tray was three times Higher than that of the fully bonded interface and unstable stress distribution at the stem tip was observed with time, which causes another adverse bone apposition and implant loosening. Thus, the all-polyethylene tibial component bonded fully to the surrounding bone might be most desirable system under an impact loading.

• International Journal of Advanced Culture Technology
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• v.10 no.1
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• pp.108-115
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• 2022

The purpose of this study is to investigate the actual status of antithrombotic management before and after the procedure or surgery, the difference between the duration of medication suspension by clinical and demographic characteristics, and the patient's understanding and satisfaction after medication management by a dedicated nurse. The results were as follows. The most commonly used antithrombotic agents were aspirin and flavitol. The drug discontinuation period according to antithrombotic, procedures, and underlying diseases, there was a significant difference in duration for each variables(p<.000). In the case of antiplatelet drugs, 5-day suspension was the most frequent, and anticoagulants 2-day suspension was the most frequent. Depending on the procedure,colonoscope,nucleoplasty,rotator cuff repair,and total knee arthroplasty commonly showed more than 80% of 5-day discontinuation. The differences according to underlying diseases are as follows. 64.7% of all diseases discontinued on the 5th. The patient's understanding of the nurse's medication management performed before and after the procedure was found to be lower in Angina patients than those with other diseases. In terms of age, those in their 50s showed higher understanding than other age groups. There were no differences in understanding and satisfaction with the remaining characteristics.

• Journal of Life Science
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• v.16 no.5
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• pp.773-779
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• 2006

Eight of the individuals had a unilateral S-RAD TKA and Multi-Radius TKA ($Scorpio^{TM}$ PS, Howmedica-Osteonics, Inc.). The instrument were used Peak Motion Measurement $System^{TM}$, $MYOPAC^{TM}$EMG System, KIN-COM $III^{TM}$ System. The Figure 3 shows that the average time for the S-RAD group to accomplish the sit-to-stand movement was 1.59 s, which was 0.19 s less than the M-RAD group (p= 0.033). In Figure 5, the S-RAD TKA group tended to have $7^{\Omega}{\cdot}S^{-1}$ less trunk flexion velocity than that of the M-RAD group (p= 0.058). The Figure 6 shows that the S-RAD TKA limb tended to have less ADD displacement (p = 0.071) than that of the M-RAD TKA limb. We failed to find significant differences for ABD and ADD displacements between the S-RAD and M-RAD N-TKA limbs (p= 0.128 and 0.457, respectively). The VM of the S-RAD TKA limb demonstrated significant less RMS EMG than that of the M-RAD TKA limb from $60^{\Omega}$ to $15^{\Omega}$ of knee flexion (p 0.05). The VL of the S-RAD TKA limb also demonstrated significant less RMS EMG than that of the M-RAD TKA limb from $60^{\Omega}$ to $45^{\Omega}$ of knee flexion (p 0.05). Similar to the VM and VL, the RF of the S-RAD TKA limb showed less RMS EMG than that of the M-RAD TKA limb from $60^{\Omega}$ to $30^{\Omega}$ of knee flexion (p 0.05).

• Journal of Biomedical Engineering Research
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• v.19 no.1
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• pp.53-58
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• 1998

This study examined the distribution of bone mineral density(BMD) and the von Mises stress in the patella. The BMD of eighteen patellae were determined by using quantitative computed tomography and imaging analysis software. It was found that the BMD of the patella varied with location. BMD values were largest at the superior and lateral regions and decreased inferiorly and medially. This distribution appeared to correspond to the organization of trabeculae within the patella. A two-dimensional finite element analysis was performed on each patella. It was also found that the maximum von Mises stress in the patella occurred along the cortical shell on the non-articular surface. The trabecular von Mises stress existed in the posterior region of the patella. These findings demonstrated the potential for finite element studies in vivo. Further, such studies may lead to the development of custom-made, patient-specific patella prostheses.

• Hip & pelvis
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• v.34 no.4
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• pp.236-244
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• 2022

Purpose: The most recent diagnostic criteria for periprosthetic joint infection (PJI) include the use of the alpha-defensin (AD) lateral-flow (LF) test, but hip and knee arthroplasties were usually combined in previous studies. This prospective study was designed to examine the accuracy of the AD-LF test for diagnosis of PJI in chronic painful total hip arthroplasties (THA). Materials and Methods: Patients with chronic painful hip arthroplasties were prospectively enrolled between March 2018 and May 2020. Exclusion criteria included acute PJI or an insufficient amount of synovial fluid. The modified Musculoskeletal Infection Society (MSIS) criteria were primarily used for PJI diagnosis. Fifty-seven patients were included in the analysis group. Revision surgery was not performed in 38 patients, for different reasons (clinical group); these patients remain "Schrödinger's hips": in such cases PJI cannot be excluded nor confirmed until you "open the box". Results: The result of the AD-LF test was positive in nine patients and negative in 48 patients. Six patients were diagnosed with PJI. AD-LF sensitivity (MSIS criteria) was 83% (95% confidence interval [CI] 36-100%) and specificity was 92% (95% CI 81-98%). The positive and negative predictive value were 56% and 98%, respectively. Conclusion: The AD test is useful in addition to the existing arsenal of diagnostic tools, and can be helpful in the decision-making process. Not all patients with chronical painful THA will undergo revision surgery. Consequently, in order to determine the reliable diagnostic accuracy of this test, future PJI diagnostic studies should include a second arm of "Schrödinger's hips".

• Physical Therapy Korea
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• v.4 no.2
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• pp.89-99
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• 1997

임상 결과의 측정에서 새로운 관점을 갖는 것은 중요하다. 의료 재활은 심리적 측정의 질들(표준화, 신뢰도, 타당도)에서 충분한 노력에 수행되어지지 않아 왔기 때문에 환자와 프로그램 사이에 일반화된 기능적인 평가 범위가 부족하다. 장애의 적절한 측정을 위한 요구는 기능적인 상태에서 변화들을 알리고 치료의 필요성을 평가하고 치료를 계획하고 결과를 예측하고 보상 방법을 측정하기 위한 환자의 치료와 임상 연구에서 모두 나타난다. 세계적으로 사용되어지고 있는 기능 평가 도구인 FIM으로부터 이 연구는 신체적 측정의 기대되어진 것에 유사한 비율로 기능적 평가 측정들을 구성한다. 노인 재활에서 기능적인 결과의 측정은 중요한 몇 가지 점이 있다. 첫째는 접근에 기초한 기능적인 결과는 치료 목표 설정에 필요하다. 둘째는 도구는 기능적인 향상을 예상하는데 유용해야 한다. 셋째는 기능 평가는 적절한 타당도와 신뢰도와 함께 고려되어져야만 한다. 넷째는 다른 기능적 도구들이 함께 평가되어져야 할 필요가 있다는 것이다. FIM의 목록의 어려운 접들은 손상을 입은 집단에서는 다소 다양하다. 가장 중요한 부분이기 때문에 하나의 운동범위는 요통과 화상을 입은 환자를 제외한 모든 손상을 입은 집단들에게 적용되어 질 수 있다. 기능의 운동과 인지적인 면은 구분되어지는 것이 중요하였고 분리되어져서 치료되어 졌다. 어려운 목록들은 손상을 입은 집단에서 다양하였고, 다양한 손상의 종류의 독특한 영향을 반영하였다. FIM은 기능적인 장애를 측정하기 위해 고안되어진 또 다른 도구이다. 그리고 다른 것들은 의료 재활을 위한 국제적 자료 체계를 만들기 위한 것이다. FIM의 목적은 의료 재활의 결과를 확인하고 장애의 정도의 측정을 포함한다. FIM은 7가지 수준에서 사회적 인지, 의사 소통, 이동, 움직임 (mobility), 소변 관리, 자조 활동을 평가한다. 범위는 총체적 도움의 비율로부터 완전하게 독립적인 것까지의 범위이고 도움, 감독, 도구의 사용의 범위를 고려한다. 27,009의 환자를 조사한 최근 검사 기록들은 FIM이 움직임(motor)과 인지 기능을 평가하는 것이라는 것을 보여준다(Hinemann, 1993). FIM의 저자들은 자료가 프로그램 평가의 시도에서 즉각적으로 적용 할 수 있기를 기대한다. FSI은 어떤 과제의 수행에서 어려움에 관계된 정보를 제공하는 것을 나타내고 과제를 수행하기 위한 환자를 위한 변경된 전략들을 발달시키기 위해 노력하는 임상가들에게 유용할 수 있다. 두 도구 모두는 전통적인 범위들보다 고관절 골절을 동반한 장애의 좀더 정확한 정보를 모으도록 할 수 있다. 고찰된 모든 연구의 결과들은 골절 후에 남아 있는 잔여 장애의 중요한 수준을 강조한다. 골절 전의 보행으로 회복된 사람은 매우 드물었다. 대부분은 기본적인 움직임 혹은 옷입기, 개인 위생에 관계된 활동들에서 의존적이었다. 많은 사람들은 사회에서 활동을 할 수 없었다. 장애의 적절한 측정의 요구는 환자 치료와 기능적인 상태에서 변화를 알고 치료의 요구도를 측정하고 치료를 계획하고 결과를 예상하고 보상 수단을 결정하는 임상적 연구에서 모두 나타난다. 물리치료 분야는 분야의 다른 영역에서 기능적인 결과를 충족시키고 발달시키는 것이 필요하다.

• Journal of the Korean Arthroscopy Society
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• v.16 no.2
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• pp.167-174
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• 2012

Purpose: The purpose of this study is investigation of clinical and functional outcomes in homogeneous group with positive culture after arthroscopic management for pyogenic knee arthritis and analysis of factors affecting those outcomes. Materials and Methods: Thirty-two patients with positive culture after arthroscopic management were included. Mean follow-up period was 41.6 months. Clinical evaluation included death related to infection, recurrence, time to normalize erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), duration of administration of intravenous antibiotics and readmission. Radiographic evaluation was performed according to Kellgren and Lawrence. The prevalence of total knee arthroplasty was investigated and functional evaluation included modified Lysholm, Tegner activity and Korean version of the Western Ontario and McMaster Universities (K-WOMAC) score. Results: Staphylococcus aureus was identified in 21 patients. Time to normalize ESR and CRP was 78.0 and 67.6 days, respectively. Two patients died while there were six recurrences and five readmissions. Rate of recurrence was significantly high in patients with chronic renal failure (P=0.034) and incidence of readmission was associated with higher radiographic grade of osteoarthritis and rate of reoperation (P=0.032 and P=0.006, respectively). At the final follow-up, radiographic grade worsened in 21 patients and was associated with those at first visit. Five arthroplasties were performed. Average modified Lysholm score, Tegner activity score and K-WOMAC score were 53.5, 2.7, 44.2 points, respectively. Conclusion: The severity of osteoarthritis on final radiographs was associated with those at first visit. Patients with higher grade of osteoarthritis at first visit showed higher incidence of readmission and those with chronic renal failure demonstrated higher chances of recurrence.

• Investigative Magnetic Resonance Imaging
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• v.11 no.1
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• pp.27-32
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• 2007

Purpose : To evaluate the mucoid degeneration (MD) of the anterior cruciate ligament (ACL) of the knee by correlation of MRI findings with pathology, in the patients with osteoarthritis (OA). Materials and Methods : This study included 17 patients (mean 68.8 years old) who underwent preoperative MRI. In proton density-weighted sagittal and coronal images ACLs were evaluated for the thickness and signal intensity (SI). Total knee replacement arthroplasty was performed and the pathologic findings of ACL were evaluated. MD was classified as 3 grades according to the degenerated amount in microscopy. Thickness and SI was evaluated as normal or increased on MRI. Results : All of the 4 patients who showed thickened ACL showed increased SI on MRI. All of the 8 patients with increased SI of the ACL on MRI had MD in the ACL. However, remained 9 patients also had MD, in spite of their normal thickness and SI on MRI. Calcification was seen in 5 patients. Conclusion : Eight cases who showed ACL thickening or increased SI on MRI were well correlated with MD, however, because the other nine cases who showed normal thickness and normal SI of ACL on MRI also showed MD in pathology, normal MRI finding should not exclude the possibility of MD of ACL.