The Relationship between Osteoarthritis of the Knee and Bone Mineral Density of Proximal Femur: A Cross-Sectional Study from a Korean Population in Women

임군일,권오진,김장희 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.4

Background: The relationship between osteoarthritis (OA) and osteoporosis (OP) is complicated and it may differ according to the site or stage of disease. The purpose of this cross-sectional study is to examine the relationship between the severity of radiological knee OA and the degree of OP in the ipsilateral proximal femur as denoted by bone mineral density (BMD) in a Korean population, especially among women. Methods: One hundred ninety-five female patients who had knee pain and radiological knee OA were investigated with respect to the relationship of knee OA severity with BMD. The BMD of the proximal femur and spine was measured by dual energy X-ray absorptiometry, and the severity of knee OA was evaluated based on Kellgren-Lawrence (K-L) radiographic criteria, joint space narrowing (JSN) and mechanical axis of knee alignment. Partial correlation analysis and ANCOVA adjusted for confounding factors (age and body mass index) were performed to assess the relationship. Results: There was a statistically significant relationship between the BMD of the proximal femur and JSN, and the BMD of the proximal femur was positively associated with increased joint space width. There was a lack of association between the spine BMD and JSN. The BMD of the proximal femur was also significantly lower in patients who had a higher K-L grade. Conclusions: The radiographic finding of severe OA in the knee is associated with decreased BMD of the ipsilateral proximal femur including the femoral neck, trochanter, intertrochanter, and region of the entire hip (neck, trochanter, and Ward’s triangle).

동측 대퇴골 근위부 (경부 및 전자간) 및 간부의 동시 골절의 수술적 치료의 결과

박희곤 ( Hee Gon Park ),유재성 ( Jae Sung Yoo ) 대한골절학회 2011 대한골절학회지 Vol.24 No.4

목적: 동측 대퇴골 근위부 (경부 및 전자간) 및 간부의 동시 골절에 대해 수술적 치료를 한 환자에서 진단과정 및 수술 후 결과를 비교 분석하여 보고자 한다. 대상 및 방법: 1995년 8월부터 2009년 7월까지 본원에서 동측 대퇴골 근위부와 간부 골절로 수술을 시행받고 1년 이상 추시가 가능하였던 24예를 대상으로 하였다. 연령, 성별, 골절의 위치, 골절 유형, 고정 방법, 진단 시기, 수술 시기, 동반 손상, 골유합 시기, 합병증 등을 조사하였고, Friedman과 Wyman 기준에 따라 술 후 기능을 평가하였다. 결과: 술 후 골유합 시기, 합병증 발생, 기능은 나이, 성별, 진단 시기, 수술 시기, 고정 방법, 동반 손상 유무에 따라서는 유의한 차이가 없었으나 근위부 및 간부의 골절 분쇄 정도에 따라 골유합에서 유의한 차이를 보였으며, 동반 손상의 유무에 따라 술 후 기능의 유의한 차이를 보였다. 24예 중 6예 (25%)에서 경부 골절의 초기 진단에 실패하였으며, 그 중 4예는 수술 중 발견하여 다발성 핀고정술을 시행하였으며, 2예는 수술 후 발견되어 2차적으로 경부 골절에 대해 고정술을 시행하였다. 대퇴 간부 골절은 24예 중 21예에서 골유합을 얻었으며, 불유합 3예는 골이식술을 시행하여 골유합을 얻었다. 대퇴 근위부 골절은 24예 중 23예에서 골유합을 얻었고 1예의 불유합을 보였다. 최종 추시상 Friedman과 Wyman의 기능 평가에서 11예에서 우수, 11예에서 양호, 2예에서 불량한 결과를 보였다. 결론: 동측 대퇴골 근위부 및 간부의 동시 골절의 경우 대퇴골 근위부 골절이 간과되지 않도록 충분한 이학적 및 방사선학적 검사가 선행되어야 하며, 대퇴 골두의 무혈성 괴사 및 불유합을 줄이기 위해서는 조기 진단이 필수적이며 근위부 골절의 해부학적 정복 및 견고한 내고정이 중요하다. Purpose: To analyze diagnostic process and clinical data in cases of fracture of the femoral shaft with fracture of the proximal femur. Materials and Methods: We reviewed 24 cases of patient who undergone surgery for fracture of the femoral shaft with ipsilateral fracture of the proximal femur and more than 1 year of examination of follow up was available. Age, sex.location and classification of the fracture, the time of diagnosis and operation, the method of operation, the associated injuries, the time of bony union and complication were investigated, postoperative function was evaluated on Friedman and Wyman criteria. Results: Bony union showed significant difference in the displacement and comminution of fracture, postoperative function revealed significant difference according to the associated injuries. The 6 cases (25%) out of 24 cases are failed early diagnosis, 4 cases out of 6 cases was detected during operation and 2cases was found after surgery. 21 cases out of 24 cases of femoral shaft fractures showed union, 23 cases out of 24 cases of femoral neck fractures showed union. There were eleven good, eleven fair, and two poor functional result according to Friedman and Wyman criteria. Conclusion: Precious clinical and radiologic examination is needed not to miss the diagnosis of proximal femur fractures in ipsilateral femoral shaft fractures with proximal femur fractures. Anatomical reduction and rigid fixation of proximal femur are important to reduce avascular necrosis of femoral head and nonunion of proximal femoral fractures.

DXA를 이용한 대퇴골 근위부와 요추부 골밀도 측정을 통한 골다공증 진단의 일치도

박진영,이종명,임철민,양희석,김태균 대한골다공증학회 2013 Osteoporosis and Sarcopenia Vol.11 No.3

Objectives: To evaluate the correlation between T-score of lumbar spine and that of proximal femur using dual energy x-ray absorptiometry (DXA) and the accuracy of the diagnosis of osteoporosis. Material and Methods: From December 2009 toJanuary 2012, 300 female patients were selected who underwent bone mineral density (BMD) test using DXA. After measuring BMD of proximal femur and lumbar spine, the score of BMD in each age group was compared by two sites. Also, the concordance of the diagnosis of osteoporosis was evaluated. Results: The result showed significantly lower T-score and BMD as it goes to the elderly group. As it goes for 60’s age group and even more for 70’s age group, lumbar spine showed lower BMD than proximal femur. In all age groups, lumbar spine and proximal femur T-score showed significant correlation; however, it showed the least states at 60’s age group. Discordance rate of osteoporosis diagnosis was 33% and 47.3% each at lowest t-score and total t-score. 60’s age group showed the highest discordance rate, and osteoporosis group showed the highest rate. Conclusions: When measuring BMD for diagnosis of osteoporosis, since it shows significant discordance between proximal femur and lumbar spine, it is necessaryto measure BMD simultaneously on both parts.

근위 대퇴골에 발생한 섬유성 골 이형성증의 수술적 치료방법에 따른 결과

김정일 ( Jeung Il Kim ),서정탁 ( Jeung Tak Suh ),서근택 ( Kuen Tak Suh ),김휘택 ( Hui Taek Kim ),천상진 ( Sang Jin Cheon ),문남훈 ( Nam Hoon Moon ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.3

Purpose: Single or multiple fibrous dysplasia of the proximal femur can cause coxa vara, Shepherd`s crook deformity and a leg length discrepancy for those patients who require surgical treatment. We wanted to evaluate the efficiency of surgical treating fibrous dysplasia of the proximal femur. Materials and Methods: Among the patients who underwent surgical treatment at our hospital during the period of June, 2001 to October, 2007, we selected 18 patients who underwent curettage and bone graft or valgus osteotomy and internal fixation due to proximal femur involvement. The clinical results were analyzed based on the patients` clinical records and radiologic findings. Results: The group of patients with a normal neck-shaft angle (Group 1) could achieve satisfactory results by undergoing curettage, bone graft and internal fixation. The other group of patients who progressed to Shepherd`s crook deformity (Group 2) could have satisfactory results when they underwent valgus osteotomy and soft tissue release or both proximal femur shortening osteotomy and valgus osteotomy, but not with undergoing valgus osteotomy only. Conclusion: Varus deformity in patients with fibrous dysplasia may progress even though they undergo valgus osteotomy. It is important to consider the preoperative biomechanical condition of the proximal femur before performing surgery.

단순 방사선에서의 한국인의 정상 근위 대퇴부의 해부학적 측정: 항회전 근위 대퇴 골수정을 이용한 수술 시 문제점

박종석 ( Jong Seok Park ),김우종 ( Woo Jong Kim ),소재완 ( Jae Wan Soh ),장병웅 ( Byung Woong Jang ),김태헌 ( Tae Heon Kim ),서유성 ( You Sung Suh ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.4

목적: 한국인의 근위 대퇴부를 측정하여 항회전 근위 대퇴 골수정 삽입 시 문제점을 개선하고자 한다. 대상 및 방법: 2007년 2월부터 2011년 4월까지 대퇴부 전자간 골절로 내원하여 항회전 근위 대퇴 골수정으로 치료 받은 환자 230예를 대상으로 하였다. 단순 방사선을 이용하여 건측 대퇴부의 경간각과 골수정이 삽입되는 골수강에서 협부의 직경 및 환측의 수술 후 대전자부터 근위 골수정까지 돌출되어 있는 길이를 측정하여 평균, 표준편차를 계산하였고 성별과 측정값간의 상관관계를 알아보고자 한다. 결과: 평균 경간각은 129.7°(111.0~138.3°), 직경은 14.5 mm(9.7~23.1 mm), 돌출 길이는 5.5 mm(1.5~15.3 mm)를 나타내었다. 통계학적 결과로 경간각과 성별은 유의한 차이가 있었다(p=0.000). 협부의 직경과 성별은 유의한 차이를 보이지 않았다(p=0.775). 돌출 길이와 성별의 상관관계도 성별과 유의한 차이를 보이지 않았다(p=0.753). 결론: 항회전 근위 골수정을 이용한 대퇴부 전자간 골절 수술에서 기구 선택이 제한적이었던 경험을 토대로 한국인의 해부학적 대퇴부의 경간각과 지름 및 골수정의 돌출 길이를 제시하며 한국인 체형에 맞는 골수정 규격의 다양화와 골수정의 근위부 길이가 좀 더 짧은 새로운 기구 제작에 사용될 수 있을 것이라 사료된다. Purpose: We propose to improve the use of Proximal Femoral Nail Anti-rotation in Korea by reporting anatomical measurements of the normal Korean proximal femur. Materials and Methods: A total of 230 patients were enrolled who had all experienced a femoral intertrochanteric fracture and undergone the Proximal Femoral Nail Anti-rotation surgical procedure between February 2007 and April 2011. We measured the neck-shaft angle and endosteal width at the isthmus of a normal femur, and the distance between the greater trochanter and the nail tip of the Proximal Femoral Nail Anti-rotation in post-operative plain radiography. We analyzed the average and standard deviations of the measurements. We also investigated correlations with the patient gender. Results: The average neck-shaft angle and endosteal width at the isthmus were 129.7°(111.0~138.3°) and 14.5 mm (9.7~23.1 mm), respectively. The average protruded nail length was 4.9 mm (1.0~15.0 mm). The femur neck-shaft angle had a correlation ratio with gender (p=0.000). However, the endosteal width at the isthmus level and the protruded nail length had no correlation ratio with gender (p=0.108, 0.573, respectively). Conclusion: Until now, in intertrochanteric fracture operations using Proximal Femoral Nail Anti-rotation, the selection of devices has been extremely limited. Through this study we present the average Korean anatomical neckshaft angle, endosteal width of the femur, and protruding length of the nail tip. We expect that these numerical values can be used in the production of new devices with shorter proximal nails, which would be more appropriates for Koreans.

Surgical Treatment of Pathological Fractures Occurring at the Proximal Femur

최원식,김갑중,이상기,양대석,정상욱,최한결,박현종 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.2

Purpose: To analyze the results of surgical treatment for pathological fractures at the proximal femur. Materials and Methods: Nineteen patients with a pathologicalfracture were included. The mean age was 65.7 years old. The patients comprised8 males and 11 females. Primary tumors, types of pathological fractures, surgical procedures, and postoperative complications were recorded. MusculoskeletalTumor Society (MSTS) functional score was used for functional evaluation. A Kaplan-Meier survival analysis was used to determine survival rate. Results:The primary malignancies were 6 cases of breast cancer, 3 cases of lung cancer, 3 cases of renal cell carcinoma, 2 cases of cholangiocarcinoma, 2 cases of hepatocellular carcinoma, 1 case of esophageal cancer, 1 case of colon cancer, and 1 case of ovarian cancer. Pathological fractures included 8 cases of pertrochantericfractures and 11 cases of subtrochanteric fractures. Intramedullary nailingwas performed in 10 cases, and joint replacement surgery was performed in 9 cases. Postoperative complications included local recurrence in 1 case, infection in 1 case, and nail breakage in 1 case. The mean postoperative MSTS score was 21. The mean survival period was 10.6 months. Patient survival rates were 42.1% after 6 months, 26.3% after 12 months, and 10.5% after 24 months. Conclusion: Surgical treatment of pathological fractures at the proximal femur provided early ambulation, and excellent pain relief. The surgery was well tolerated emotionally. Surgery is necessary for improving the quality of life in such patients; however, more cases of pathological fractures in these regions should be subjected to detailed analysis.

Primary Intraosseus Xanthoma Involving the Proximal Femur in a Normolipidemic Patient: A Case Report

( Won Chul Shin ),( Nam Hoon Moon ),( Kuen Tak Suh ) 대한고관절학회 2016 Hip and Pelvis Vol.28 No.3

We report the case of a 25-year-old woman presenting with left hip pain. A lesion was found in the proximal femoral metaphysis. Benign bone tumor, such as intraosseous lipoma or liposclerosing myxofibrous tumor, was suspected based on simple radiographs and magnetic resonance images. Curettage of the lesion and bone grafting was performed. Histologic findings reflected primary intraosseous xanthoma of the proximal femur. Laboratory tests revealed the patient to be normolipidemic, while immunoelectrophoretic fractionation of lipoproteins revealed normal values for alpha, pre-beta, beta, and chylomicrons. At the one-year follow-up, there was no evidence of local recurrence. This is the first reported case of primary intraosseous xanthoma of the proximal femur in a normolipidemic patient.

대퇴전자부 골절에 있어 근위부 대퇴골 금속정을 이용한 수술적 치료

손성근,김성수,김철홍,이명진,김상국 대한고관절학회 2003 Hip and Pelvis Vol.15 No.3

Primary Intraosseus Xanthoma Involving the Proximal Femur in a Normolipidemic Patient: A Case Report

신원철,문남훈,서근택 대한고관절학회 2016 Hip and Pelvis Vol.28 No.3

We report the case of a 25-year-old woman presenting with left hip pain. A lesion was found in the proximal femoral metaphysis. Benign bone tumor, such as intraosseous lipoma or liposclerosing myxofibrous tumor, was suspected based on simple radiographs and magnetic resonance images. Curettage of the lesion and bone grafting was performed. Histologic findings reflected primary intraosseous xanthoma of the proximal femur. Laboratory tests revealed the patient to be normolipidemic, while immunoelectrophoretic fractionation of lipoproteins revealed normal values for alpha, pre-beta, beta, and chylomicrons. At the one-year follow-up, there was no evidence of local recurrence. This is the first reported case of primary intraosseous xanthoma of the proximal femur in a normolipidemic patient.

대퇴골 변형이 동반된 속발성 고관절염에서 근위 조립형 대퇴주대를 이용한 인공 고관절 전치환술

강준순 ( Joon Soon Kang ),문경호 ( Kyong Ho Moon ),김경훈 ( Kyung Hoon Kim ) 대한고관절학회 2006 Hip and Pelvis Vol.18 No.4

목적: 고관절 변형이 동반된 속발성 고 관절염 환자에서 근위 조립형 대퇴주대를 이용하여 인공 고관절 치환술을 시행하고 최소 2년 이상 추시 관찰한 경과를 분석하였다. 대상 및 방법: 2001년 1월부터 2004년 3월까지 무시멘트 근위 조립형 대퇴주대를 이용하여 인공 고관절 치환술을 시행 하고 최소 24개월 이상 추시 관찰이 가능한 42명 45례를 대상으로 임상 및 방사선 결과를 분석하였다. 전례에서 S-ROM 근위 조립형 주대를 사용하였으며 평균 추시 기간은 44개월(24~60개월)이었다. 환자의 평균 연령은 48.5세 (21~65)였으며 여자(65.5%)가 많았다. 수술 전 진단명은 발달성 고관절 이형성증이 26례, LCP 후유증이 13례, 골단 이형성증 2례, 화농성 고관절염 후유증 3례, 선천성 내반고 1례이었다. 결과: 최종 추시에서 Harris 고관절 점수는 술전 평균 52.2점(32~72)에서 85.5점(57~99)으로 향상되었다. 모든 예에서 대퇴 스템의 안정된 소견을 보였으며, 골성 고정이 37례, 섬유성 고정이 8례 있었다. 대퇴 주대 주변의 골용해 소견이나 2 mm 이상의 진행성 방사선 투과 음영선은 관찰되지 않았다. 합병증으로 탈구가 2례, 주대 주변부 골절 1례, 감염성 비구컵 이완 1례, 좌골 신경마비가 1례가 있었다. 전체적으로 최종 추시상 41례(91.9%)에서 양호 이상의 임상 결과를 나타내었다. 결론: 고관절 변형이 있는 속발성 고관절염 환자에서 대퇴골 근위 및 원위 고정이 가능한 근위 조립형 대퇴 주대를 이용한 인공 고관절 치환술을 시행하여 만족스러운 추시 결과를 얻었다. Purpose: The purpose of this study was to evaluate the clinical and radiological results of total hip arthroplasty using a proximal modular femoral stem in patients who had secondary coxarthrosis associated with a deformed femur. Materials and Methods: Forty-two patients (45 hips) with secondary coxarthrosis were evaluated after primary total hip arthroplasty using an S-ROM proximal modular femoral stem, between January 2001 and March 2004. The average follow-up was 44 months (range, 24 to 60 months). The mean age of the patients was 48.5 years old and there was a predominance of female patients (65.5%). The preoperative diagnoses included 26 cases of developmental dysplasia of the hip, 13 cases of sequalae of LCP, 2 cases of epiphyseal dysplasia, 3 cases of sequalae of pyogenic arthritis, and 1 case of congenital coxa vara. Results: The average Harris hip score improved from 52.2 points to 85.5 points. All the femoral stems demosntrated stable fixation, which included 37 cases by bony ingrowth and 8 cases by stable fibrous ingrowth. Neither osteolysis nor progressive radiolucent lines around the femoral stems were found at the latest follow-up. Postoperative complications included: 2 cases of hip dislocations, 1 case of periprosthetic fracture, 1 case of infected cup loosening, and 1 case of sciatic nerve palsy. Overall, forty-one hips (91.9%) exhibited excellent or good clinical results at the most recent follow-up. Conclusion: For advanced secondary coxarthrosis, total hip arthroplasty with use of a proximal modular femoral stem yielded good mid-term results based on clinical and radiological criteria.