Variability of Measurement of Patellofemoral Indices with Knee Flexion and Quadriceps Contraction: An MRI-Based Anatomical Study

Edward Laugharne, FRCS,Navi Bali, FRCS,Sanjay Purushothamdas, FRCS,Faris Almallah, FRCR,Rik Kundra, FRCS 대한슬관절학회 2016 대한슬관절학회지 Vol.28 No.4

purpose: The purpose of this study was to investigate the impact of varying knee flexion and quadriceps activity on patellofemoral indices measured on magnetic resonance imaging (MRI).Materials and Methods: MRI of the knee was performed in 20 patients for indications other than patellar or patellofemoral pathology. Axial and sagittal sequences were performed in full extension of the knee with the quadriceps relaxed, full extension of the knee with the quadriceps contracted, 30° flexion of the knee with the quadriceps relaxed, and 30° flexion with the quadriceps contracted. Bisect offset, patella tilt angle, Insall-Salvati ratio and Caton-Deschamps index were measured.results: With the knee flexed to 30° and quadriceps relaxed, the mean values of patellar tilt angle, bisect offset, Insall-Salvati ratio and Caton-Deschamps index were all within normal limits. With the knee extended and quadriceps contracted, the mean patellar tilt angle (normal value, <15°) was 14.6° and the bisect offset (normal value, <65%) was 65%, while the Caton-Deschamps index was 1.34 (normal range, 0.6 to 1.3). With the knee extended and quadriceps relaxed, the mean Caton-Deschamps index was 1.31.conclusions: MRI scanning of the knee in extension with the quadriceps contracted leads to elevated patellofemoral indices. MRI taken with the knee in 30° of flexion allows more reliable assessment of the patellofemoral joint and minimises the confounding effect of quadriceps contraction.

Pancreatitis-Primary Hyperparathyroidism Association: Case Report and Literature Review

Muhammad Abdullah,FRCS (England),FRCS (Glasgow) 대한갑상선-내분비외과학회 2002 The Koreran journal of Endocrine Surgery Vol.2 No.1

The relationship of cause and effect between acute pancreatitis and primary hyperparathyroidism (pHPT) continues to be debated. Critics see any association of pancreatitis with pHPT as only incidental or even a result of parathyroid surgery. Counter arguments claim that pancreatitis is actually a manifestation of pHPT and definitive management of such pancreatitis should be directed towards dealing with the hyperparathyroidism. Our paper aims to review the debate in the published medical literature starting from the first reporting of such association in 1947. In this controversy we add our own case of a 49-year old non-alcoholic man presenting with recurrent attacks of acute pancreatitis. Investigated with ultrasound, CT scan, ERCP and biochemical profiles, it was not until his 3<SUP>rd</SUP> admission that his raised serum calcium was acted upon. High intact parathyroid levels were confirmed. Open neck exploration found a solitary parathyroid adenoma. After surgery the serum calcium returned to normal and abdominal symptoms have not recurred in the subsequent three years. This supports our belief that acute pancreatitis is one of the symptoms of pHPT, often caused by a parathyroid adenoma and curable by its excision. Calcium and parathyroid profiles should be scrutinized in all fresh cases of acute pancreatitis. (Korean J Endocrine Surg 2002;2:55-57)

Ectopic Pregnancy; A Nigerian Urban Experience

( Etuknwa Bassey Tom,Frcs ),( Frcs Azu Onyemaechi Okpara ),( Peter Aniekan Imo ),( Ekandem Gabriel John ),( Bsc Olaifa Kayode ),( Aquaisua Aquaisua Nyong ),( Ikpeme Enobong ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.5

Objective To assess the incidence of ectopic pregnancy (EP) in St. Luke`s Hospital, Anua in Uyo metropolis, Nigeria. Data on EP incidence in developing countries are rare and often out of date, particularly in Nigeria. Methods A fi ve-year retrospective study (2000-2004) was carried out, examining all cases of EP registered in the medical fi les of records in the casualty, maternity and surgical departments of St. Luke`s Hospital, Anua in Uyo metropolis, which before the advent of the University of Uyo Teaching Hospital, in 2002, was the hub of medical activities in Akwa Ibom State. Results Within the period under study, 2,3951 pregnancies was registered in that hospital out of which 72 cases of ectopic pregnancies was reported (3/1,000 pregnancies). Most of the affected females were young single women and students with 81.9% of them between 21 and 30 years of age. Mortality was 1.4% in the study. Related risk factors included pelvic inflammatory disease, previous history of abortions, infertility and a previous history of EP. These problems are compounded by social issues leading to multiple sexual partners and fi nancial stress resulting from the palpable poverty in Nigeria today. Conclusion Reports of hospital-based incidence of EP in various centers across Nigeria varies but has increased over the last decade. Health professionals and public health offi cials in developing countries, especially those in Africa, should consider EP as a major obstetric problem for maternal morbidity. Early detection and more public education as well as advocacy programs targeted at women are needed to solve the problem of EP in Uyo, Akwa Ibom state, Nigeria.

The Effect of Sagittal Knee Deformity on Preoperative Measurement of Coronal Mechanical Alignment during Total Knee Arthroplasty

( Gautam M Shetty ),( Arun Mullaji Frcs Mch ),( Ahmed Adel Khalifa ),( Abhik Ray ),( Vivek Nikumbha ) 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.2

Purpose: The purpose of this prospective study was to determine correlation between coronal mechanical alignment measured on preoperative standing full-length radiographs and navigation during total knee arthroplasty (TKA) in the presence of an associated sagittal deformity (hyperextension and flexion deformity). Materials and Methods: Coronal mechanical alignment measured on preoperative, standing, full-length, hip-to-ankle anteroposterior radiographs was compared with intraoperative measurements recorded with computer navigation in 200 primary navigated TKAs. Results: The mean difference in mechanical alignment between the two techniques was significantly greater (p=0.001) in patients with an associated flexion deformity >10° when compared to knees with associated flexion deformity ≤10°; 48% of knees with a flexion deformity >10° had a difference of ≥3° between the full-length radiograph and navigation alignment measurements. There was a strong correlation between the radiographic and navigation measurement techniques. Conclusions: The mean difference in coronal mechanical alignment between the two techniques was significantly higher in patients with an associated flexion deformity >10°. Hence, surgeons should take caution when relying on preoperative full-length radiographs for determining coronal mechanical alignment in patients with an associated flexion deformity >10° where using navigation may be more reliable.

Management of Gonarthrosis with a Rotating Hinge Prosthesis: Minimum 10-Year Follow-up

Daniel Kendoff,Carl Haasper,Thorsten Gehrke,Wolfgang Klauser,Nemandra Sandiford,FRCS (Tr/Orth) 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.4

Background: The use of hinged designs is usually reserved for severe deformities or instability in contemporary total knee arthroplasty (TKA). Results have been mixed with some authors reporting relatively high incidences of complications. The aim of this study is to present the results of primary TKA performed with a hinged prosthesis with a minimum 10-year follow-up. We also examined the factors that influence survivorship of this prosthesis. Methods: A total of 238 primary TKA procedures were performed using hinged prostheses. Indications included osteoarthritis, rheumatoid arthritis, posttraumatic deformity, and arthritis. Clinical outcomes were assessed using the Hospital for Special Surgery score. Radiologic assessment was performed at each follow-up. Survivorship was calculated based on the Kaplan-Meier method. All complications were documented. Results: Mean follow-up was 13.5 years (standard deviation [SD], 3.4). Mean flexion at final review was 118° (SD, 20°). Fifty-four percent and 20% reported excellent and good functional scores, respectively. Survivorship was 94% at 13.5 years in patients over 60 years of age and 77% in patients less than 60 years of age. Survivorship in patients with preoperative varus deformity was 96% and that in valgus knees was 79%. Conclusions: The results of this study suggest that when rotating hinges are used for primary TKA, the best results are achieved in patients over 60 years old. The indications for this design in the setting of primary TKA include significant deformities, severe bone loss, and ligamentous laxity.

Association of tumor differentiation grade and survival of women with squamous cell carcinoma of the uterine cervix

Koji Matsuo,Rachel S. Mandelbaum,Hiroko Machida,Sanjay Purushothamdas, FRCS,Brendan H. Grubbs,Lynda D. Roman,Jason D. Wright 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.6

Objective: To examine the association between tumor grade and survival for women with squamous cervical cancer. Methods: This retrospective observational study utilized the Surveillance, Epidemiology, and End Result program data between 1983 and 2013 to examine women with squamous cervical cancer with known tumor differentiation grade. Multivariable analyses were performed to assess independent associations between tumor differentiation grade and survival. Results: A total of 31,536 women were identified including 15,175 (48.1%) with grade 3 tumors, 14,084 (44.7%) with grade 2 neoplasms and 2,277 (7.2%) with grade 1 tumors. Higher tumor grade was significantly associated with older age, higher stage disease, larger tumor size, and lymph node metastasis (all, p<0.001). In a multivariable analysis, grade 2 tumors (adjusted-hazard ratio [HR]=1.21; p<0.001) and grade 3 tumors (adjusted-HR=1.45; p<0.001) were independently associated with decreased cause-specific survival (CSS) compared to grade 1 tumors. Among the 7,429 women with stage II–III disease who received radiotherapy without surgical treatment, grade 3 tumors were independently associated with decreased CSS compared to grade 2 tumors (adjusted-HR=1.16; p<0.001). Among 4,045 women with node-negative stage I disease and tumor size ≤4 cm who underwent surgical treatment without radiotherapy, grade 2 tumors (adjusted-HR=2.54; p=0.028) and grade 3 tumors (adjusted-HR=4.48; p<0.001) were independently associated with decreased CSS compared to grade 1 tumors. Conclusion: Our study suggests that tumor differentiation grade may be a prognostic factor in women with squamous cervical cancer, particularly in early-stage disease. Higher tumor grade was associated with poorer survival.

Hylan GF-20 Viscosupplementation in the Treatment of Symptomatic Osteoarthritis of the Knee: Clinical Effect Survivorship at 5 Years

( Tarek Boutefnouchet Mbchb Mrcs Pgcmed Msc ),( Guru Puranik Mbbs Mch ),( Esther Holmes Bsc ),( Karl M Bell Frcs ) 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.2

Purpose: Controversies remain surrounding the choice of hyaluronic acid products and patient selection. A study was conducted to report the long-term survivorship of intra-articular injection effect of high molecular weight hyaluronic preparation hylan GF-20 (Synvisc-One) for patients with symptomatic knee osteoarthritis. Materials and Methods: A retrospective observational analysis of a single therapeutic series was carried out. The analysis was conducted to determine therapeutic effect survivorship taking arthroplasty and any other surgical interventions as endpoint results. Results: Seventy-seven consecutive patients (82 knees) were followed up for five years. At one-year follow-up, 71 knees (87%) responded to treatment and only 8 knees (10%) were offered arthroplasty due to persistence of symptoms. At five-year follow-up, 41 (50%) were still considered responders. During the study period, repeat injection was given in 9 knees (11%). Arthroplasty (either total or unicompartmental) was required in 26 (31%). Kaplan-Meier survivorship analysis of therapeutic effect demonstrated 67% survival at 5 years with arthroplasty as endpoint and 58% survival at 5 years with all secondary interventions as endpoint. Conclusions: This study demonstrates a significantly longer duration of clinical benefit of hylan GF-20 injection. Present results may suggest a notion of an ideal delay therapeutic strategy for patients not ready to receive an arthroplasty. Further studies will be required to help characterise these subsets of patients.

Availability of Total Knee Arthroplasty Implants for Metal Hypersensitivity Patients

Sanil Harji Ajwani, BSc (hons), MBChB, MRCS,Charalambos P. Charalambous, BSc, MBChB, MSc, MD, FRCS (Tr&Orth) 대한슬관절학회 2016 대한슬관절학회지 Vol.28 No.4

purpose: To provide information on the type of “hypersensitivity-friendly” components available for primary total knee arthroplasty (TKA) in the current market. Materials and Methods: Implant manufactures were identified using the 2013 National Joint Registries of the United Kingdom and Sweden and contacted to obtain information about the products they offer for patients with metal hypersensitivity.results: Information on 23 TKA systems was provided by 13 implant manufacturers. Of these, 15 systems had options suitable for metal hypersensitivity patients. Two types of “hypersensitivity-friendly” components were identified: 10 implants were cobalt chrome prostheses with a “hypersensitivity-friendly” outer coating and 5 implants were made entirely from non-cobalt chrome alloys. conclusions: The results of this study suggest that several hypersensitivity TKA options exist, some of which provide the same designs and surgical techniques as the conventional implants. The information in this study can guide TKA surgeons in making informed choices about implants and identifying implants that could be examined in future controlled studies comparing outcomes between “hypersensitivity-friendly” and conventional implants.

Case Report : Pseudogout: A Rare Cause of Acute Arthritis Following Arthroscopic Anterior Cruciate Ligament Reconstruction

( Mahvash Zaman Mbchb ),( Numaera Sabir Mbchb ),( Simon Peter Mill Mbchb ),( Charalambos P Charalambous Frcs ) 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.3