Is simultaneous bilateral unicompartmental knee arthroplasty and total knee arthroplasty better than simultaneous bilateral total knee arthroplasty?

( Naosuke Nagata ),( Takafumi Hiranaka ),( Koji Okamoto ),( Takaaki Fujishiro ),( Toshikazu Tanaka ),( Anjiki Kensuke ),( Daiya Kitazawa ),( Ken Kotoura ) 대한슬관절학회 2023 대한슬관절학회지 Vol.35 No.-

Introduction This retrospective study aims to clarify if there are benefits of performing unicompartmental knee arthroplasty (UKA) on just one indicated side in patients who undergo simultaneous bilateral knee arthroplasty. Materials and methods We compared 33 cases of simultaneous bilateral UKA/total knee arthroplasty (TKA) (S-UT) with 99 cases of simultaneous bilateral TKA (S-TT). Comparison included blood tests [C-reactive protein (CRP), albumin, and D-dimer], the incidence of deep vein thrombosis (DVT), range of motion (ROM), and clinical scores before and 1 year after surgery. Results Clinical scores were not significantly different between the groups. The postoperative flexion angle was significantly better in UKA sides. Blood tests showed that the S-UT had a significantly higher albumin value at 4 and 7 days after surgery. The CRP value at 4 and 7 days, and the D-dimer value at 7 and 14 days after surgery were significantly lower in the S-UT. The S-UT had significantly lower incidence of DVT. Conclusions In cases of bilateral arthroplasty, if there is an indication on only one side, a better flexion angle can be obtained by UKA on that side, and with less surgical invasion. Moreover, the incidence of DVT is low, which is considered to be a benefit of performing UKA on just one side.

대퇴골두 무혈성 괴사시 Bipolar 형 골두 치환술과 고관절 전치환술의 비교연구

김영호 ( YH Kim ),김선재 ( SJ Kim ),최창옥 ( CU Choi ) 대한고관절학회 1992 Hip and Pelvis Vol.4 No.2

Authors reviewed 45 cases of bipolar hip arthroplasty and 70 cases of total hip arthroplasty which were performed as the management of avascular necrosis of femoral head with Ficat-Arlet stage III and IV from October, 1985 to October, 1991 to compare the results in both groups. And we also tried to identify the risk factors correlated with remarkable disadvantages in bipolar hip arthroplasty. The results were as followings: 1) As compared with the results of total hip arthroplasty, those of bipolar hip arthroplasty were markedly disadvantageous in terms of the incidence of acetabular erosion and proximal migration, and relatively disadvantageous to some extent in terms of incidence of groin or buttock pain, chronologic changes in hip function, and somewhat disadvantageous in terms of motion of external rotation which is necessary for cross leg position. 2) As compared with the results of total hip arthroplasty, those of bipolar. hip arthroplasty were markedly advantageous in terms of intraoperative blood loss and operation time, and slightly advantageous in the incidence of deep vein thrombosis. And with respect to another variables such as loosening rate of stem, incidence of thigh pain, the results were similar in both groups. 3) Heavy worker was a significantly meaningful risk factor and heavy weight more than 60Kg seemed to be another relatively meaningful risk factor to cause proximal migration of the bipolar cup. 4) In overall view, the results of bipolar hip arthroplasty were rather inferior to those of total hip arthroplasty especiaal in terms of acetabular procimal migration and groin of buttock pain.

Metal Allergy Screening Prior to Joint Arthroplasty and Its Influence on Implant Choice: A Delphi Consensus Study Amongst Orthopaedic Arthroplasty Surgeons

( Arif Razak ),( Ananthan Dave Ebinesan ),( Charalambos Panayiotou Charalambous ) 대한슬관절학회 2013 대한슬관절학회지 Vol.25 No.4

Purpose: This study was undertaken to obtain a consensus amongst joint arthroplasty experts with regards to metal allergy screening prior to joint arthroplasty and the choice of implant in patients with potential metal allergy. Materials and Methods: A web based Delphi consensus study was used including orthopaedic surgeons that had previously published on the topic of knee, hip or shoulder arthroplasty. Two rounds of questionnaires were sent via electronic mail. Consensus was considered reached if agreement was 60% or higher. Results: Eighteen surgeons responded to the first and 17 to the second round of questionnaires. There was consensus that patients having metal arthroplasty surgery should not be routinely questioned about metal allergy prior to surgery. There was consensus that patch testing is not necessary even if metal allergy is suspected. Most respondents agreed in proceeding with cobalt chromium or stainless steel implant in patients suspected of metal allergy regardless of the results of cutaneous patch testing. Conclusions: This consensus study suggests that routine metal allergy screening prior to joint arthroplasty is not essential. The use of traditional cobalt chromium/stainless steel implants is recommended regardless of the patient`s metal allergy status based on expert opinion through this study.

Factors affecting range of motion following two-stage revision arthroplasty for chronic periprosthetic knee infection

( Doo-yeol Kim ),( Young-chae Seo ),( Chang-wan Kim ),( Chang-rack Lee ),( Soo-hwan Jung ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Introduction: The purpose of this study was to evaluate factors that affect range of motion (ROM) following twostage revision arthroplasty as a treatment for chronic periprosthetic knee infection. Materials and methods: A total of 98 patients diagnosed with chronic periprosthetic joint infection (PJI) following primary total knee arthroplasty between January 2009 and December 2019 and then underwent two-stage revision arthroplasty were reviewed retrospectively. Multiple regression analysis was performed to evaluate the factors that affect ROM after two-stage revision arthroplasty. ROM after two-stage revision arthroplasty was used as a dependent variable, while age at the time of surgery, ROM at PJI diagnosis, ROM after the first-stage surgery, the interval between the first-stage surgery and the second-stage surgery, whether a re-operation was performed before the second-stage surgery, culture results (culture negative or culture positive), and body mass index (BMI) were used as independent variables. Results: Multiple regression analysis (R² = 0.843) revealed that among the independent variables, ROM (β = 0.604, P < 0.001) after the first-stage surgery, whether a re-operation was performed before the second-stage surgery (β = - 8.847, P < 0.001), the interval between the first-stage surgery and the second-stage surgery (β = - 0.778, P = 0.003), and BMI (β = - 0.698, P = 0.041) were associated with ROM after two-stage revision arthroplasty, the dependent variable. Conclusions: In two-stage revision arthroplasty for chronic periprosthetic knee infection, ROM after the first-stage surgery, whether a re-operation was performed before the second-stage surgery, the interval between the first-stage surgery and the second-stage surgery, and BMI were found to be factors that were associated with ROM after twostage revision arthroplasty.

Evaluation of Postoperative Range of Motion and Functional Outcomes after Cruciate-Retaining and Posterior-Stabilized High-Flexion Total Knee Arthroplasty

한창욱,한창동,양익환,이우석,박관규 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.4

Purpose: The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses. Materials and Methods: Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups. Results: After the 2-year postoperative period, the mean range of motion was 131° in the CR-Flex group and 133° in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2±9.1 points) than in the PS-Flex group (11.9±9.6 points); however, this difference was not statistically significant (p=non-significant). Conclusion: The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty. Purpose: The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses. Materials and Methods: Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups. Results: After the 2-year postoperative period, the mean range of motion was 131° in the CR-Flex group and 133° in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2±9.1 points) than in the PS-Flex group (11.9±9.6 points); however, this difference was not statistically significant (p=non-significant). Conclusion: The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty.

시멘트와 무시멘트 고관절 전치환술 후의 골소실

황성관 ( Sung Kwan Hwang ),박기홍 ( Ki Hong Park ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.2

Osteolysis and aseptic loosening do occur not only in cemented total hip arthroplasties but also in cementless ones. Recently, osteolysis became the main concern in total hip arthroplasty. Numerous articles, proving particulate debris, such as, polyethylene, PMMA, and metal particles can induce osteolysis, have been published. We examined ten hips which had received either cemented or cementless hip arthroplasty. We examined osteolytic lesions radiographically and microscopically and tried to find out the differences in biopsy findings between osteolytic lesions after cemented and cementless arthroplasty. The results were as follows 1) Acetabular osteolysis occurred in 4 hips with cemented total hip arthroplasty, and two hips with cementless one. 2)Femoral ostelysis developed in 4 hips with cemented total hip arthroplasty, and three hips with cementless one. 3) A similar histopathologic findings of foreign body reactions in cemented and cementless arthmplasty were found. 4) A foreign body reaction is stronger in cemented arthroplasty than cementless arthroplasty. 5) The polyethylene was a main source of osteolysis in both cemented and cementless arthroplasty. 6) The foregin body reaction was found in all lesions of osteolysis after cemented and cementless arthroplasties, the inflammatory reaction was considered as cell-mediated immune reaction.

고관절 전치환술에서 신경손상의 빈도 및 예후

박명식 ( Myung Sik Park ),황병연 ( Byung Yun Hwang ),송경진 ( Kyung Jin Song ),장선웅 ( Sun Ung Jang ) 전북대학교 의과학연구소 2002 全北醫大論文集 Vol.26 No.1

연구목적: 고관절 전치환술 후에 발생하는 신경손상 빈도와 예후를 분석, 연구 하고자 하였다. 연구방법: 1990년에서 1995년까지 고간절 전치환술을 받은 650명의 환자를 대상으로 하여 후향성 조사 방법으로 연구하였다. 연구결과: 고관절 전치환술 후 6례에서 (0.9%) 신경손상이 확인되었고, 그중 1례는 좌골 신경이 손상되었고, 나머지 5례에서는 비골 신경이 손상되었다. 이차성 골성 관절염으로 수술한 환자중 5례에서 신경손상이 발생하였으며 수술 후에 하지의 연장이 있었던 경우에서는 4례에서 신경 손상이 발생하였다. 또 6례의 신경 손상 중 5례가 일차 수술 후 발생 하였고 나머지 1례는 재치환술 후에 발생하였다. 신경 손상의 회복은 3례에서는 완전히 회복되었고, 2례는 3개월 이내에 회복되었으며, 1례는 변화가 없었다. 결론: 본 연구에서 고관절 전치환술 후 0.9%에서 신경손상이 발생하였다. 이러한 신경손상의 대부분은 수술시 과도한 견인, 수술 후 하지의 길이증가, 수술 기구등과 관련이 있다고 하며 재치환술에서 높게 발생 한다고 한다. 그러나 본 연구에서는 6례의 신경 손상 중 5례가 일차 수술 후에 발생하였고, 6례의 신경 손상 중 4례에서는 하지의 길이 증가가 있었다. 그러므로 수술시 보다 많은 주의가 필요하며 또한 치밀한 수술 전 계획으로 신경손상을 줄여야 할 것이다. Objectives: The purpose of this study was to analysis frequency and prognosis of nerve injury after total hip arthroplasty. Method: We reviewed, by using retrospective study, 650 patients received total hip arthroplasty that has been performed from 1990 to 1995. Results: Six patients showed nerve lesion after total hip arthroplasty and sciatic nerve was affected in I case of them and the peroneal nerve was affected in 5 cases of them. Of patients who were performed total hip arthroplasty due to secondary osteoarthritis, 5 cases nerve injury occurred. Among six patients, five patients showed after primary total hip arthroplasty, but only one patient showed after revision total hip arthroplasty. In recovery of nerve injury a complete recovery of function was 3cases, the decreased nerve function was 2 cases and until last follow up, and unchanged function was I case. Conclusion: A lesion of a peripheral nerve followed total hip arthroplasty was rare. Generally nerve injury was related to retractor, intraoperative over traction, limb lengthening, and thermal injury from cement. Our studies showed 0.9%. But this lesion was related to the leg lengthening after primary total hip arthroplasty for Acetabular dysplasia Careful operative technique and preoperative planning reduce the incidence of postoperative nerve injury.

Clinical Outcomes Following Revision Total Knee Arthroplasty: Minimum 2-Year Follow-up

Jonathan Quinn,Peter Jones,Ray Randle 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.1

Background: The longer-term outcomes of revision total knee arthroplasty are not well described in the current literature. Managing patient expectations of revision total knee arthroplasty can be challenging for orthopedic surgeons due to a paucity of data to guide decision-making. We present outcomes of revision total knee arthroplasty performed by a single surgeon over a 12-year period from 2004 through 2015. Methods: A retrospective review of hospital and private medical records demonstrated 202 revision total knee arthroplasties performed by the senior author in 178 patients from 2004 through 2015. Of these, 153 patients were available for assessment. Patients were contacted and invited to participate in a structured telephone interview to assess Oxford Knee Score (OKS) and patient satisfaction. All patients received the PFC (Depuy) prosthesis at a single institution and were followed up for minimum 2 years postoperatively at the time of review. Retrospective chart review was used to obtain other data for analysis including patient demographics, preoperative and postoperative range of motion (ROM), and intraoperative details. Results: This cohort demonstrated a 93.5% survival rate and an 85% satisfaction rate at a mean of 6.5 years postoperatively. Mean ROM improved from 100° (range, 5°–145°) to 112° (range, 35°–135°) (p < 0.001). The mean OKS was 39.25 (range, 14–48). The factors associated with improved postoperative outcomes included male sex, fewer previous revision total knee arthroplasty procedures, increased preoperative ROM, and receiving a less constrained implant. Conclusions: This study provides a comprehensive description of outcomes following revision total knee arthroplasty in a large patient cohort with a long follow-up. Although revision total knee arthroplasty is a challenging and complex aspect of arthroplasty surgery, high patient satisfaction and good functional outcomes can be achieved for the majority of patients.

Diabetes mellitus does not increase the risk of knee stiffness after total knee arthroplasty: a meta-analysis of 7 studies including 246 053 cases

( Christopher Jump ),( Rayaz A. Malik ),( Anoop Anand ),( Charalambos P. Charalambous ) 대한슬관절학회 2019 대한슬관절학회지 Vol.31 No.1

Purpose: The association of diabetes mellitus with knee stiffness after total knee arthroplasty is still being debated. The aim of this study was to assess through meta-analysis the impact of diabetes mellitus on the prevalence of postoperative knee stiffness after total knee arthroplasty. Methods: We conducted a literature search for terms regarding postoperative knee stiffness and diabetes mellitus on Embase, CINAHL, and PubMed NCBI. Results: Of 1142 articles, seven were suitable for analysis. Meta-analysis showed that diabetes mellitus does not confer an increased risk of primary or revision total knee arthroplasty-induced postoperative knee stiffness when compared to nondiabetic patients (primary total knee arthroplasty, estimated odds ratio [OR] 1.474 and 95% confidence interval [CI] 0.97-2.23; primary and revision total knee arthroplasty, OR 1.340 and 95% CI 0.97-1.83). Conclusion: There is no strong evidence that diabetes mellitus increases the risk of knee stiffness after total knee arthroplasty. The decision to proceed with total knee arthroplasty, discussion as part of the consent process, and subsequent rehabilitation should not differ between patients with and without diabetes mellitus with regards to risk of stiffness. Level of evidence: Level III (meta-analysis)

Intra-operative fractures in primary total knee arthroplasty - a systematic review

Purudappa Prabhudev Prasad,Ramanan Sruthi Priyavadhana,Tripathy Sujit Kumar,Varatharaj Sushrruti,Mounasamy Varatharaj,Sambandam Senthil Nathan 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Background: One of the rare complications of primary total knee arthroplasty is intra-operative fracture. Intraoperative fracture during revision knee arthroplasty has been well-documented but there is limited literature on fractures occurring during primary knee arthroplasty. We conducted a systematic review of the literature to compare and contrast the various studies to clearly define the predisposing factors, incidence, and characteristics of the fracture itself and to arrive at a consensus on the management and prevention of intra-operative fractures during primary knee arthroplasty. Methods: The PubMed/Medline, Cochrane, Scopus and Embase databases were searched using keywords “intraoperative fracture”, “distal femoral fracture”, “tibial fracture”, “patella fracture” and “primary total knee arthroplasty”. A total of 158 articles were retrieved and after further filtration and exclusion processing, 10 articles that evaluated intra-operative fractures in primary total knee arthroplasty were included for the review. Results: The reported incidence of intra-operative fractures varied from 0.2% to 4.4%. A higher incidence in female patients with a male to female ratio of 0.4 was reported. Posterior stabilized (PS) total knee arthroplasty was associated with higher risk of intra-operative femoral fractures by many authors in this review. Timing of occurrence and location of the intra-operative fractures can vary widely, with femoral fractures occurring more commonly during bone preparation, trialing and impaction of the final implant and tibial fractures occurring during preparation for the tibial keel and impaction of the tibial component. Conclusions: Intra-operative fractures during primary total knee arthroplasty are rare with higher risk associated with osteoporosis, rheumatoid arthritis, advanced age, female gender, chronic steroid use, metabolic bone disorders, PS type of femoral implant and difficult surgical exposure of the knee joint due to severe deformities. A plethora of management options have been utilized according to surgeon preference. Standard principles of fracture fixation and arthroplasty principles should be followed to achieve stable internal fixation and any unstable fracture site should be bypassed with the utilization of stemmed components. Satisfactory radiographic and functional outcome can be expected with appropriate treatment.