Modified Charnley Clamp 를 이용한 슬관절 유합술

배대경,이동희,권병기 ( Dae Kyung Bae,Dong Hee Lee,Byung Gi Kwon ) 대한슬관절학회 1995 Knee Surgery and Related Research Vol.7 No.1

Arthrodesis of knee was indicated in cases of tuberculosis of knee, pyogenic arthritis, severe pain after traumatic arthritis and infection after arthroplasty of knee. 1n the treatment of tuberculosis of the knee, when abseess formation threatens the integrity of neighboring structure and continued drainage is progressively debilitating the patient, removal of infected focus is indicated and arthrodesis or amputation is indicated when destruction is extensive. Total knee replacement has become popular for treatment of arthritis and its most serious cornplication of total knee arthroplasty is infection. The presence of massive bone loss, severe ligamentous instability, and soft tissue loss as well as well as infection with multiple organisms or antibiotic resistant organism will limit the options abailable and are best managed by arthrodesis. Failure of previous two-stage reimplantation for infection is also an indication for arthrwte.dsis. Currently employed methods for arthrodesis are external fixation, intramedullary rod and plate and screw fixation. We performed knee arthrodesis using a modified Charnley clamp in nine patients who were six tuberculosis of the knee and three infected total knee replacement patients between Nov. ] 991 and Jan. 1994. After follow up of average 16.5 months, we analysed the results. Average age was 54 years old and average duration from arthrodesis to removal of fixative was 4.4 months. Debridement of knee was performed before arthrodesis in three cases of tuberculosis of knee and two cases of infected tota1 knee mthroplasty. In infected total knee arthroplasty, removal of prosthesis and arthrodesis was performed same time. In all nine patients, long leg cast was applied postoperatively or before discharge. Succcssful arthrodesis was ohtamed in all nine cases with low cost modified Charntey clamp.

감염 후유증으로 인한 강직성 관절에 시행한 슬관절 전치환술

배대경,임창무,조창현 ( Dae Kyung Bae,Chang Moo Yim,Chang Hyun Cho ) 대한슬관절학회 1997 Knee Surgery and Related Research Vol.9 No.1

Generally, exposure and the operative technique are common difficulty encountered in the total knee arthroplasty of ankylosed knee due to old infection sequelae. Also the postoperative range of motion and relief of pain is poor due to deformity and excessive soft tissue contracture around knee. There have heen few reports, however, that address the reconstructive challenge of total knee arthroplasty in a previously infected ankylosed knee. We perfoined TKA in thirty six patients who had ankylosed knee between July l986 and Dec. 199S. After follow up of average five years and one month, we analysed the results. The definition of ankylosis was a knee ROM less than 90 degree. Average age of patients were 36.7 years old. Twelve patients were meii and twenty four patients were women. Sixteen patients of partial ankylosis and twenty patients of complete ankylosis were performed oper- ation. There were nineteen cases of healed tubercuiosis knees and seventeen cases of healed pyogenic knees. For the release of soft tissue contracture in 9 cases, we lengthened quadrceps tendon with the method of modified V-Y advancement technique. Patella tendon was proximally reattached with staples and suture in 6 cases and tibial tubercle was proximally transferred in 3 cases. As results, the postoperative average range of motion was 79.3 (30 - l21') in complete ankylosis, 107 (60 - 135 ) in partial ankylosis. The average Hospital for Speciai Surgery knee rating score improved from 56.3 points preoperatively to 84.8 points postoperatively. Radiolucent line was observed in two Knees with less than 2mm width in three years and four months, and four years postoperatively, hut the patient had no pain. In five patients who had poor gain of range of motion after operation, we perfonned arthroscopic adhe- siolysis. In conclusion, regarding patient selection, reasonable hony development, relative]y healthy extensor mechanism and adequate soft tissue condition are important for success of TKA in old intection sequelae. TKA of ankylosed knee in old infection sequelae is a successful procedui which can ohtain the restoration of function of the ankylosed knee.

슬관절 전치환술에서 항생제를 혼합한 골시멘트 사용이 심부감염의 발생에 미치는 영향

배대경,김성수,권오수 ( Dae Kyung Bae,Sung Soo Kim,Oh Soo Kwon ) 대한슬관절학회 1996 Knee Surgery and Related Research Vol.8 No.2

Infection was a common complication during early days of total knee arthroplasty. With improved operative technique and particularly with the introduction the ultra-clean operating room and the use of antibiotics. Ini'ection ralc was reduced to as low as I or 2%. Prominent features of these effort is the incorporation of abtibiotics into bone cement. Many laboratory and clinical studies have focused on the use of antihioticinpregnateci cement in orthopaedic field. Despite of many studies, its usefulness and applicability is not well understood. The purpose of this study is to evaluate the effect of antibiotic-impregnated cement on total knee arthroplasty and to investigate the overall result of infection rate in total knee arthroplasty. We analysed 1032 cases of total knee arthroplasty which was consecutively performed on 713 patients during the period between Aug. 1982 and Dec. 1995. Ostcoarthris was diagnosed preoperatively in 651 knees, rheumatoid arthritis in 266 knees infection sequelae in 28 knees, Charcot joint in 8 knees, others 51 knees. 337 arthroplasties in 228 patients were cemented since Jan. 1990. We used antibiotic(Cephatril Na)impregnated cement (Simplex P) in 383 knees of 268 patients for prospective study. The results are as follows: 1) Deep infections occuned in 13 knees which were I I ostcoarthritis, 1.rheumatoid arthritis, 1 infection sequelae. Overall infection rate was 1.26 %. 2) The rate of infection in osteoarthritis was significantly higher than rheumatoid arthritis(p<0. I). 3) The rate of infection in cemented group was significantly higher than noncemented group(p<0.1). 4) There was no infection in artihiotic-impregnaled cemented arthroplasty, and the result was statistically significant compared to cemented group without using antibiotics(p<0.05). The use of antibiotic-impregnated cenrent is an effective inethod in lowering the rate of infection in total knee arthroplasty. But it is necessary to compare the result between the group using antibiotic-impregnated cement and the group using the uncemented implant for TKA.

슬관절 전치환술에서 삽입물의 생존율에 대한 분석

배대경,선승덕,송영석 ( Dae Kyung Bae,Seung Deok Sun,Young Suk Song ) 대한슬관절학회 1995 Knee Surgery and Related Research Vol.7 No.2

Survivorship analysis is used to calculate a predicted cummulative rate of success for this series of total joint replacements long-term folow-up. Survivorship analysis has been advocated a providing annual and overall failure rates, as well as the probabilities of implant survival. The survivorship of total knee replacement between 1982 and 1992 with follow-up period of up 12 years was estimated by Dobb's method(1980), and we analyzed clinically and radiologically 397 patients(588 knees) which were followed up more than 2 years(from 2 years to 12 years 4 months, average 8 years 6 months). Also, we evaluated the knee function according to the functional knee scores of Hospital for Spedial Surgery. 1. The average age at operation was 57.1 years(from 19 years to 89 years). Male was 43 patients and female was 354 patients. 2. There were oseoarthritis in 317 knees(53.8%), rtheumatoid arthritis in 213 knees(36.2%), secondary osteorthritis in 31 knees(5.4%), tuberculous arthritis in 16 knees(2.7%), and Charcot joint in 11 knees(1.9%). 3. The Hospial for Special Surgery functional knee and pain scores was improved from average 57.5 points preoperatively to average 86.4 points postoperatively.The results were satisfactory in 536 knees(91.2%, excellent in 66.4% and good in 24.8%). 4. Revision surgery was performed in 28 knees of the 588 knees(4.7%), due to aseptic loosening or patellar component wearing in 16 knees(2.7%) and septic loosening in 12knees (2.0%). 5. Survival rate of total knee replacements with reliability ws 84.2%,9 years after operation for 397 patients, 588 knees. In surmmary, total knee replacements is a effective and satisfying procedure which canobtain relief of pain, repair of defomity, restoration of the function, improvements of life quality and long term survivorship.

Anthropometry of Nonarthritic Asian Knees: Is It Time for a Race-Specific Knee Implant?

Mohan Hariharan,Chhabria Prasidh,Bagaria Vaibhav,Tadepalli Kalyan,Naik Lokesh,Kulkarni Rajiv 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.2

Background: This study was done to study the anthropometry of nonarthritic Asian knees; to determine the differences in morphology between knees of different ethnicities and to compare the knee anthropometry values with sizes of available knee implants. Methods: Magnetic resonance imaging scans of 100 nonarthritic Indian knees were analyzed. Anteroposterior (AP) length, mediolateral (ML) length, and aspect ratio of the distal femur and proximal tibia, patellar length, and patellar tendon length were measured. These values were compared with values of other ethnicities from literature. The values were also compared with sizes of available knee implants and evaluated for mismatch. Results: All the parameters of female knees were significantly smaller than those of male knees (p < 0.05). The distal femur of Indian knees resembled that of Chinese knees with similar AP and ML lengths and aspect ratio. The distal femur of Indian knees had a significantly smaller AP, ML, and aspect ratio than those of Hispanic knees did. In comparison to Caucasian distal femur, Indian knees had smaller AP and ML lengths and larger aspect ratio. In terms of the proximal tibia, the Indian knees were smaller than Chinese (only ML), Caucasian (AP and ML) and Hispanic (AP and ML) knees. On comparison with implant sizes, there was a mismatch between the distal femur morphology and the dimensions of all implants. For a given AP length, the ML dimensions of all implants were smaller than the measured ML length of the knee. However, the tibial components of all the studied implants correlated well with the tibial morphology. Conclusions: Distinct anthropometric differences exist between knees of different ethnicities. The knees of females were smaller than the knees of males. In Indian knees, the ML-AP aspect ratio of the distal femur was higher than that of the currently available femoral components. These results suggest the need for race-specific knee implants.

슬관절 전치환술의 10년 이상 장기 추시 결과

성상철 ( Seong Sang Cheol ),박윤근 ( Park Yun Geun ),김충현 ( Kim Chung Hyeon ),이명철 ( Lee Myeong Cheol ) 대한슬관절학회 2003 Knee Surgery and Related Research Vol.15 No.1

Purpose: We purpose to analyse the clinical and radiologic results of total knee arthoroplasty and long term survival rate and to assess the cause of failure. Methods & Materials : We retrospectively investigated 156 TKAs(110 patients) from January 1985 to March 1992 followed up for more than 10 year. These series of 110 patients included 20 men and 90 women, the mean follow-up period was 12 years 3 months(range 10~18 years). In primary diagnosis, there were Degenerative Arthritis (DA) 105 knees, Rheumatoid Arthritis(RA) 45 knees, others 6 knees. Of 156 knees, there were 139 Cruciate-Retaining type(CR), and 17 Posterior-Stabilized type(PS). Both femoral and tibial component was fixed with cement in 71 knee, 15 knee were fixed without cement, and only one component was fixed with cement in 70 knees(Hybrid). Press Fit Condylar(PFC) prosthesis were 133, Miller Galant(MG) were 16, and others 7. 16 cases of patella were preserved and 140 knees were resurfaced. The clinical outcome was evaluated according to the HSS and American Knee Society scoring system and radiologic analysis was made by tibiofemoral angle and radiolucent line by American Knee Society system. Results : The HSS score was improved from 51.7 to 86.4 and ROM was improved from 101.3° to 111.7°. The last ROM was improved in DA group than RA, and HSS score of PFC prosthesis was higher than Miller-Galante. The failure were seven(5.3%) in PFC, but seven (43.8%) in MG. The survival rate was 93.0% after 10 years, and 88.8% after 14 years when the endpoint was defined as revision arthroplasty. The arthroplasty fails due to wear, aseptic loosening and deep infection and patellofemoral complication. Conclusion : The total knee arthroplasty is a safe, durable, and predictable procedure and has a long survivorship if we select the proper prosthesis.

동일인에의 내반변형슬과 동반된 외반변형슬에 대한 슬관절 전치환술

송인수 ( In Soo Song ),전재균 ( Je Gyun Chon ),김준범 ( Jun Beom Kim ) 대한슬관절학회 2008 Knee Surgery and Related Research Vol.20 No.2

Purpose: We have performed total knee arthroplasty for treating valgus and varus in the knees of one person. We investigated the clinical characteristics of these patients and the relationship between the kind of deformity and the postoperative result. Materials and Methods: From March 2002 to May 2005, fourteen patients who had simultaneous varus and valgus knee deformities underwent total knee arthroplasties and they were followed for more than 12 months, and these were the subjects of our study. The average age was 64.6.years and the average follow-up period was 18.4 months. Follow-up imaging assessments were done and the clinical outcomes were evaluated using the HSS score at the last follow-up. Results: Nine cases had more pain in the varus knee preoperatively and two cases had more pain in the valgus knee preoperatively. In 8 cases, degenerative scoliosises were associated with the knee deformity and among these cases, seven cases had vlagus deformities in the right knees. In two cases, hip deformities were noted in the ipsilateral side of the valgus deformity. The preoperative mean valgus angle and varus angle was 10.5 degrees and 7.8 degrees, respectively. The postoperative valgus and varus angle improved to 6.8 and 6.0 degree, respectively. The HSS score improved from 64.7 to 86.0 points for the valgus deformities and from 61.5 to 86.9 points for the varus deformities. Postoperative patellar clunk syndrome was identified in one valgus knee and arthroscopic resection was then performed. The knee had completely recovered on the last follow-up. Conclusion: Simultaneous or staged total knee arthroplasties in patients with simultaneous varus and contralateral valgus knee deformities achieved satisfactory outcomes with regard to the objective orthopedic criteria as well as the overall patient satisfaction in terms of pain relief and function. We found that scoliosis and ipsilateral hip deformities concurred with knee deformities, and this indicated that hip deformity and scoliosis are related with knee deformities. We found no significant difference between the kind of deformity and the postoperative result, yet a prospective study with more cases and longer follow-up is recommended in the future to reaffirm our findings.

Phenotype-considered kinematically aligned total knee arthroplasty for windswept-deformity-associated osteoarthritis: surgical strategy and clinical outcomes

( Cheng-en Hsu ),( Meng-hsueh Tsai ),( Hsin-ting Wu ),( Jen-ting Huang ),( Kui-chou Huang ) 대한슬관절학회 2024 Knee Surgery and Related Research Vol.36 No.-

Background Windswept deformity (WSD) in relation to advanced osteoarthritis (OA) presents a significant surgical challenge in total knee arthroplasty (TKA). The primary goal of this study is to investigate the Prevalance of WSD associated osteoarthritis who have undergone total knee arthroplasty. The secondary goal is to explore the causes of WSD and its association with spinal deformity or leg length discrepancy in these patients. Finally, we evaluate the surgical outcomes of phenotype-considered kinematically aligned TKA (KA-TKA) in treating patients with WSD. Methods A review was conducted on data from 40 knees of 33 WSD patients who underwent phenotype-considered KA-TKA from August 2016 to December 2020. Patient demographics, associated diseases, preoperative and postoperative knee alignment angles, range of motion (ROM), Oxford Knee Score (OKS), and Knee Society Score (KSS) were collected and analyzed. Subgroup analysis for comparing the results between valgus and varus knees were also performed. Results Within the studied cohort of WSD patients, a substantial 64% displayed concomitant coronal spinal imbalance and 21% evidenced leg length discrepancy. Postoperative improvements were notable in knee alignments, ROM, OKS, and KSS following the application of the phenotype-considered KA-TKA approach. There were significant differences in the knee alignment angles, including mHKA, LDFA, and MPTA, between the valgus and varus side of knees (P = 0.018). However, no statistically significant difference were observed in the functional scores, comprising ROM, OKS, and KSS, between valgus and varus knees. Conclusions A high percentage of patients with WSD exhibited coronal spinal imbalance and leg length discrepancy. Phenotype-considered KA-TKA effectively provided alignment targets for the treatment of both varus and valgus knees in patients with WSD, achieving excellent short-term outcomes and acceptable knee alignment.

Knee joint line related to bony landmarks of the knee: a radiologic study in a Thai population

( S. Tantavisut ),( C. Amarase ),( S. Ngarmukos ),( C. Tanavalee ),( A. Tanavalee1 ) 대한슬관절학회 2022 Knee Surgery and Related Research Vol.34 No.-

Background: During revision total knee arthroplasty (TKA), knee joint line restoration may be difficult due to bone loss or structural changes. Although bony landmarks are consistent and can be used as references, there are limited data in Asian patients. We studied the knee joint line related to bony landmarks of the knee in a Thai population. Materials and methods: Magnetic resonance imaging (MRI) of 140 healthy knees of Thai patients (70 males, 70 females) were investigated. In all knees, a perpendicular line from knee joint line to the medial epicondyle (distance A) and the lateral epicondyle (distance B) in the coronal plane were measured. In the sagittal plane, a perpendicular line from the knee joint line to the fibular head (distance C), the tibial tubercle (distance D), and the inferior patellar pole (distance E) were measured. The femoral transepicondylar width (FW) was measured along the transepicondylar axis. The ratios of distances A, B, C, D, and E related to FW were evaluated (epicondylar ratio). Results: The mean and standard deviation (SD) of distances A, B, C, D, E, and FW were 27.1 ± 2.7 mm, 21.7 ± 2.5 mm, 12.6 ± 3 mm, 21.3 ± 3.6 mm, 7.6 ± 4.8 mm, and 76.7 ± 3.99, respectively. There was wide variation of measured values, with statistically significant differences between genders in distances A, B, C, and FW. The mean and SD of epicondylar ratios A/FW, B/FW, C/FW, D/FW, and E/FW were 0.35 ± 0.02, 0.29 ± 0.02, 0.16 ± 0.05, 0.28 ± 0.04, and 0.09 ± 0.04, respectively. All epicondylar ratios demonstrated less variation than all measured distances, with statistical differences between genders in the A/FW and D/FW ratios. However, the B/FW ratio had the highest consistent mean value. In addition, it had narrower SD than the rest (0.29 ± 0.02; range, 0.22-0.33). Conclusions: In Thai knees, the measured distances from bony landmarks to the knee joint line had higher variation than the epicondylar ratio. Among all studied epicondylar ratios, the ratio between lateral epicondyle to joint line distance (distance B)/FW demonstrated the narrowest range of mean and SD values; therefore, this could be the most reliable landmark for intraoperative knee joint line verification by multiplying the FW of the patient by 0.29 to get distance B in that patient.

P . F . C . 인공 슬관절전치환술의 최근 결과

배대경,김형구,김진원 ( Dae Kyung Bae,Hyung Koo Kim,Jin Won Kim ) 대한슬관절학회 1992 Knee Surgery and Related Research Vol.4 No.1

The P.F.C (Press-Fit Condylar) knee was designed in 1982 and first implanted cli- nically in 1984. It was intended to provide a condylar knee system for posterior cru- ciate retention and fixed without use of cement. We analyzed 104 knees, which could be followed up, underwent the P.F.C total knee arthroplasty in the period from Jan. 1988 to June. 1991. The follow-up duration ranged from one year to four years and five months averaging two years and 10 months. The radiologic measurement was evaluated by Radiologic Measurement of Ameri- can Knee Society in the A.P, lateral and Merchants view. The Knee Rating Scoring System of Hospital for Special Surgery was used for preoperative and postoperative functional assessments. Causes of disease were Osteoarthritis in 70 knees, rheumatoid arthritis in 31 knees and others in 3 knees. The results analyzed are as follows; 1. The average range of motion was increased from 108.6 degrees preoperatively to 121.7 degrees postoperatively. 2, The average Knee Rating Score of Hospital for Special Surgery was improved from 50.4 preoperatively to 86 postoperatively. 3. The average flexion contracture was decreased from 24.7 degrees in 62 knees preoperatively to 7.5 degrees in 24 knees postaperatively. 4. The average bitiofernoral angle was corrected from valgus 3.9 degrees to valgus 6.4 degrees. 5. The average congruence angle was 2.8 degrees in 27 knees of osteoarthritis postoperatively. 6. The average thickness of patella were 20.6 mm preoperatively, and 21.4 mm postoperatively. 7. The average height of patella by Insall were 1:1.01 preoperatively, and 1: 1.11 postoperatively. 8. The cement was used in all components of 25 knees, not in 31 knees. 9. The bone graft for tibial bone defect was used in 18 knees.