• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.52-58
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• 2019

Purpose: Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). On the other hand, a standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. The clinical progress of staged reimplantation in patients who had fungus-related PJI after TKA was reviewed retrospectively. Materials and Methods: Ten patients who had a fungal related PJI after TKA between 2006 and 2017 using staged reimplantation surgery were reviewed. These patients were compared with 119 patients who had a PJI in the same period. The failure rate of infection control, intravenous antimicrobial using the period, and the clinical results were evaluated by comparing the range of motion and Korean knee score (KKS) between pre-staged reimplantation and the last follow-up. Results: In the fungal infection group, 7 out of 10 cases (70.0%) had failed in infection control using staged reimplantation and in the non-fungal group, 7 out of 119 cases (5.9%) had failed (p=0.04). In the non-fungal group, the mean duration of antibiotics was 6.2 weeks. In the fungus group, the mean duration of antibiotics was 15.3 weeks, which was 9.1 weeks longer (p<0.001). The range of motion of the knee was increased in the two groups (p=0.265). At the last follow-up, the KKS was 71.01 points in the non-fungal group and 61.3 points in the fungal group (p=0.012). Erythrocyte sedimentation rate and C-reactive protein (CRP) decreased in the two groups, but the CRP was significantly different in the two groups (p=0.007). Conclusion: The treatment of fungus-related PJIs using staged reimplantation showed uneven clinical progress and unsatisfactory clinical improvements compared to non-fungal PJI. Therefore, it is necessary to consider the use of an antifungal mixed cement spacer at resection arthroplasty and oral antifungal agent after reimplantation.

• Journal of the Korean Orthopaedic Association
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• v.54 no.5
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• pp.418-426
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• 2019

Purpose: This study analyzed the features of humeral head decentralization in large to massive rotator cuff tears with a shoulder dislocation in the elderly. Moreover, shoulder instability and treatment were reviewed. Materials and Methods: From May 2005 to February 2017, Group A containing 45 cases (45 patients) over 65 years old accompanied by a large or massive rotator cuff tear with a shoulder dislocation and Group B containing 45 cases (45 patients) without a shoulder dislocation were enrolled. The mean ages in Groups A and B were 73.2 and 72.1 years old, and the mean follow-up periods were 30.7 and 31.3 months, respectively. Twenty-one cases (46.7%) in Group A underwent rotator cuff repair, and 8 cases (17.8%) underwent concomitant rotator cuff repair with Bankart repair. Sixteen cases (35.6%) underwent reverse total shoulder arthroplasty for cuff tear arthropathy. 45 cases (100%) in Group B underwent rotator cuff repair. The off-the center and head elevation were measured in the preoperative magnetic resonance imaging (MRI) of Groups A and B. The preoperative and postoperative visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score in Groups A and B were compared. Results: In Groups A and B, the mean off-the centers were posterior 7.41 mm and posterior 2.02 mm (p=0.03), and the mean head elevations were superior 6.66 mm and superior 2.44 mm (p=0.02), respectively. The mean ASES scores of Groups A and B were 32.8 and 33.4 before surgery, and 77.1 (p=0.02) and 78.1 (p=0.02) after surgery (p=0.18), respectively. The mean UCLA scores of Groups A and B were 13.1 and 12.8 before surgery, and 28.9 (p=0.02) and 29.5 (p=0.01) after surgery (p=0.15), respectively. Conclusion: Patients over 65 years old with a shoulder dislocation in large to massive rotator cuff tears had higher off-the center and head elevation on the preoperative MRI than those without a shoulder dislocation. This measurement can help predict preceding shoulder instability. Early rotator cuff repairs should be performed and other treatments, such as Bankart repair and reverse total shoulder arthroplasty, should also be considered.

• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.1-8
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• 2019

Globally, the elderly population is increasing rapidly, which means that the number of deformity correction operations for elderly spine deformity patient has increased. On the other hand, for aged patients with deformity correction operation, preoperative considerations to reduce the complications and predict a good clinical outcome are not completely understood. First, medical comorbidity needs to be evaluated preoperatively with the Cumulative Illness Rating Scale for Geriatrics or the Charlson Comorbidity Index scores. Medical comorbidities are associated with the postoperative complication rate. Managing these comorbidities preoperatively decreases the complications after a spine deformity correction operation. Second, bone densitometry need to be checked for osteoporosis. Many surgical techniques have been introduced to prevent the complications associated with posterior instrumentation for osteoporosis patients. The preoperative use of an osteogenesis inducing agent - teriparatide was also reported to reduce the complication rate. Third, total body sagittal alignment need to be considered. Many elderly spine deformity patients accompanied degenerative changes and deformities at their lower extremities. In addition, a compensation mechanism induces the deformed posture of the lower extremities. Recently, some authors introduced a parameter including total body sagittal alignment, which can predict the clinical outcome better than previous parameters limited to the spine or pelvis. As a result, total body sagittal alignment needs to be considered for elderly spine deformity patients after a deformity correction operation. In conclusion, for elderly spine deformity patients, medical comorbidities and osteoporosis need to be evaluated and managed preoperatively to reduce the complication rate. In addition, total body sagittal alignment needs to be considered, which is associated with better clinical outcomes than the previous parameters limited to the spine or pelvis.

• Journal of the Korean Orthopaedic Association
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• v.54 no.5
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• pp.427-434
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• 2019

Purpose: This study evaluated the long term clinical and radiographic results and the survival rates of unicompartmental knee arthroplasty (UKA). In addition, the factors affecting the survival of the procedure were analyzed and the survival curve was compared according to the affecting factors. Materials and Methods: Ninety-nine cases of UKA performed between December 1982 and January 1996 were involved: 10 cases with Modular II, 44 cases with Microloc, and 45 cases with Allegretto prostheses. The mean follow-up period was 16.5 years. Clinically, the hospital for special surgery (HSS) scoring system and the range of motion (ROM) were evaluated. Radiographically, the femorotibial angle (FTA) was measured. The survival rate was analyzed using the Kaplan-Meier method. Cox regression analysis was used to identify the factors affecting the survival according to age, sex, body mass index, preoperative diagnosis, and type of implant. The Kaplan-Meier survival curves were compared according to the factors affecting the survival of UKA. Results: The overall average HSS score and ROM was 57.7 and 134.3° preoperatively, 92.7 and 138.4° at 1 year postoperatively, and 79.1 and 138.4° at the last follow-up (p<0.001, respectively). The overall average FTA was varus 0.8° preoperatively, valgus 4.1° at postoperative 2 weeks, and valgus 3.0° at the last follow-up. The overall 5-, 10-, 15- and 20-year survival rates were 91.8%, 82.9%, 71.0%, and 67.0%, respectively. The factors affecting the survival were the age and type of implant. The risk of the failure decreased with age (hazard ratio=0.933). The Microloc group was more hazardous than the other prostheses (hazard ratio=0.202, 0.430, respectively). The survival curve in the patients below 60 years of age was significantly lower than those of the patients over 60 years of age (p=0.003); the survival curve of the Microloc group was lower compared to the Modular II and Allegretto groups (p=0.025). Conclusion: The long-term clinical and radiographic results and survival of UKA using old fixed bearing prostheses were satisfactory. The selection of appropriate patient and prosthesis will be important for the long term survival of the UKA procedure.

• Journal of the Korean Orthopaedic Association
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• v.54 no.4
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• pp.336-342
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• 2019

Purpose: To examine the relationship between the progression of a kyphotic deformity and the magnetic resonance imaging (MRI) findings in conservatively treated osteoporotic thoracolumbar compression fracture patients. Materials and Methods: This study categorized the patients who underwent conservative treatment among those patients who underwent treatment under the suspicion of a thoracolumbar compression fracture from January 2007 to March 2016. Among them, this retrospective study included eighty-nine patients with osteoporosis and osteopenia with a bone density of less than -2.0 and single vertebral body fracture. This study examined the MRI of anterior longitudinal ligament or posterior longitudinal ligament injury, superior or inferior endplate disruption, superior of inferior intravertebral disc injury, the presence of low signal intensity on T2-weighted images, and bone edema of intravertebral bodies in fractured intravertebral bodies. Results: In cases where the superior endplate was disrupted or the level of bone edema of the intravertebral bodies was high, the kyphotic angle, wedge angle, and anterior vertebral compression showed remarkably progression. In the case of damage to the anterior longitudinal ligament or the superior disc, only the kyphotic angle was markedly prominent. On the T2-weighted images, low signal intensity lesions showed a high wedge angle and high anterior vertebral compression. On the other hand, there were no significant correlations among the posterior longitudinal ligament injury, inferior endplate disruption, inferior disc injury, and the progression of kyphotic deformity and vertebral compression. The risk factors that increase the kyphotic angle by more than 5° include the presence of injuries to the anterior longitudinal ligament, superior endplate disruption, and superior disc injury, and the risk factors were 21.3, 5.1, and 8.5 times higher than those of the uninjured case, and the risk differed according to the level of bone edema. Conclusion: An osteoporotic thoracolumbar compression fracture in osteoporotic or osteopenic patients, anterior longitudinal ligament injury, superior endplate and intravertebral disc injury, and high level of edema in the MRI were critical factors that increases the risk of kyphotic deformity.

• Journal of the Korean Orthopaedic Association
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• v.54 no.4
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• pp.343-352
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• 2019

Purpose: The purpose of this study was to document the sonographic morphology of the subscapularis footprint, particularly the 1st facet, of the non-pathologic subscapularis tendon and footprint, and analyze the correlation between the size of the 1st facet and the demographic variables. Materials and Methods: Between March 2015 and December 2017, retrospectively data analysis was performed for the ultrasound (US) scans of 115 consecutive shoulder (mean age 53.4 years, range 23-74 years) with non-pathologic subscapularis tendon and footprint. The sonographic findings of the 1st facet of the subscapularis footprint was a very unique, flat, broad, and plane angle in the upward direction, which were distinguished from the other facets. On US, the transverse (medio-lateral) and longitudinal (superior-inferior) length of the 1st facet on axis of the humerus shaft were recorded. The demographic variables, including age, site, body height, weight, body mass index (BMI), and arm length, were reviewed. Results: On US, the mean transverse length of the 1st facet was 12.75 mm (range 10.54-14.50 mm, standard deviation [SD] 0.712) and the mean longitudinal length was 12.22 mm (range 9.20-13.30 mm, SD 0.888). The transverse and longitudinal length of the size of the 1st facet were significantly greater in males than in females (p<0.001, p=0.001). Of the demographic data (body height, weight, BMI, arm length) that showed a significant positive linear correlation, the correlation with body height (transverse r=0.749, p<0.001; longitudinal r=0.642, p<0.001) showed the strongest relationship, and the correlation with the BMI was weakly related. The relationships between the size of the 1st facet to site/age were not statistically significant or appeared to have no linear correlation. Conclusion: The structural and morphologic features of the 1st facet of the subscapularis footprint on the US were identified. This will provide anatomic knowledge of an US examination for subscapularis tendon pathology.

• Journal of Popular Narrative
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• v.25 no.1
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• pp.393-425
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• 2019

This paper focuses on Alain Resnais's representative works (1955), (1959), and (1963), and analyzes how he implements a representation of memory though cinematic apparatus. These three films deal with horrific memories that seem impossible to reproduce aesthetically such as the Holocaust, the Hiroshima Atomic Bomb, World War II, and the war in Algeria. The reappearance of events that stripped humans of even their minimum dignity can naturally be associated with ethical issues. These events can never be reproduced because they cannot be explained in the human language. It is also impossible to reproduce in a way that doesn't invade other peoples' sufferings, nor displays the pain of others as spectacles. Alain Resnais was a director who realized that if factual representation was not possible from the beginning, truthfulness would have to be approached through cinematic form. Therefore, he tries to overcome these problems through cinematic forms. First, he shifts to action films to avoid the obscenity of documentary. shows the records of camps captured by German forces in the past, while shows the pain of others in a fictional form of representation. Next, he describes how the trauma affects the identity of the main character through a flashback in , but also shows a main character who is experiencing trauma without a flashback in Flashbacks have the effect of showing the effects of trauma on the main character, but at the same time they involve the obscenity of enjoying the suffering of others. Nonetheless, the absence of flashbacks highlights the impossibility of representation. This is because it is not silent in the impossibility of representation but is constantly approaching. The attitude that repeatedly circles around impossibility is an ethical form that maximizes the impossibility of representation. In conclusion, this is the ethics of representation that Alain Resnais showed in his films.

• Journal of Popular Narrative
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• v.25 no.3
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• pp.211-266
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• 2019

Films of the 1960s in both Korea and Egypt share many common characteristics. These include the main trend of such films' in addition to some of the political situations. This trend mainly relates to the adaptation of novels into films. In the late 1940s, Andre Bazin wrote his ideas about a similar phenomenon in Europe and the United States. Based on Bazin's thoughts and other examples for films adapted from novels in the 1940-60s, I found that the trend in both Korea and Egypt can be explained as an international phenomenon, in which film developed to a further stage due to a dialectic between content and form after the increase in the development of film techniques. The trend in Korea is believed to have led to the so-called golden era of Korean movies, while in Egypt films adapted from literature were not able to earn high profits, even though in a 1996 list of the best 100 Egyptian films, 23 had been adapted from novels. To explain the reasons behind this phenomenon, I looked into the internal demand from filmmakers themselves to further develop the industry through the articles written at that time. In addition, I explored the different situations and policies that influenced film production in both countries in the 1960s. I found that political situations and policies could have helped in the continuity of such trend, but it is difficult to consider these as the main reason for its creation, in contrast to the internal demand, which I believe is the main reason for the creation of such direction.

• Journal of Popular Narrative
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• v.25 no.1
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• pp.55-85
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• 2019

In this article, we examine the real meaning behind the stories in which the N-po Generation (Millennial Generation) is depicted, through the observation of entertainment programs, TV series, and movies. This could be an opportunity to investigate the aspects of emotional customs of our era, which have been described by television media as portraying the complex and multifaceted reality in the most mundane and popular manner while influencing the public. Problems with youth unemployment, the polarization of life, and instability are not only global issues but situations that specifically occur in South Korea. It is thus vital to pay attention to the inner side of the N-po Generation who enjoy Sohwakhaeng (small but certain happiness) by eating alone as the placebo effect of this tough reality. This is an agenda that should be viewed as a problem in the fundamental design of South Korean society. The consciousness of the problem shown in the TV series has been drawing attention. The TV series Because depicts a love narrative that concentrates on emotions in a relationship that started between housemates due to poverty and housing problems, leading to marriage. Thus, the TV series persuasively dramatized 'confluent love' in the N-po Generation. In the movie , Miso can be regarded as a symbol that represents the emergence of a new generation of cultural sensitivity. There is a suggestion in the sequence of that identifies the pursuit of taste with the discovery of identity. The TV series is a growth narrative that deals heavily with youth unemployment, temporary workers, fragmented families, and dating violence. The housemates in find emotional stability through interaction with each other, and courageously approach their individual problems. In the process, images of women, who are empathetic towards others and are willing to jointly solve their problems, are calmly depicted to reveal a story of growth revolving around a ground emotional community. The current problem that South Korean society should contemplate is how to be fully human beyond mere survival, and how to further seek the conditions of human existence. In that sense, what we should pursue is a notion of 'publicness', which can put several generations together. Because of the reality that confliction between generations must be triggered, in order to make a passage of sympathizing, mass media's sensitivity training becomes more important. This may be the duty of mass media.

• Journal of Popular Narrative
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• v.25 no.3
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• pp.67-99
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• 2019

This paper analyzed romance novels imported into Korea in the 1980s and examined the traits of Korean girls' culture at that time. To this end, This paper chose as subjects the series of 'high-teen romance' published by Samjungdang, 'princess bestseller' by Seoul Publishing and the 'silhouette romance' by Joongang Ilbo in the 1980s. Through the aspects of the paperback romances, the traits of the artist, the content of the work, and the response of the reader, this paper analyzed the position and affection of romance as a genre in Korean culture in the 1980s. In the 1980s, most of the paperback romances available in Korea were translations of the modern and progressive present lines of Harlequin Enterprise's category romance. There were also many writers who were mostly introduced with progressive characters like Charlotte Lamb. The Harlequin romance depicts a story of sensual love. These translated 1980s paperback romance novels allowed girls in Korea to freely imagine the problems of sex and love. In particular, it showed a new perspective on women's sexuality. In Korean love novels, the sexuality of women was treated as an object for the gaze of men. The novels of female writers as college student who criticized this dealt with women's sexuality, but focused on criticism and resistance to the ideology of chastity. The paperback romance made it possible for women to freely enjoy their sexuality by escaping the ethical standards of reality. In addition, the paperback romance was an escape from the frustration of love. Romantic love in Korean love novels did not lead to the unification of mind and body, and always ended in tragedy. On the contrary, the paperback romance started with the fear of the girl who felt love for the first time, showed the process of winning over anxiety, confirming love and reaching a happy marriage. Through this, girls understood general love that was not subordinated to the ideology of chastity, and accepted love positively. The process of establishing romance as a genre in Korean culture and the traits of its readers have not yet been sufficiently clarified yet. This paper compared the romance genre with the other love novels of the day, explaining the position and meaning of the romance genre in Korean culture in the 1980s. Through this, we were able to chart the historical development of the Korean romance genre.