Conversion Total Knee Arthroplasty after Failed High Tibial Osteotomy

송상준,배대경,김강일,이충환 대한슬관절학회 2016 대한슬관절학회지 Vol.28 No.2

Clinical results of high tibial osteotomy (HTO) deteriorate over time despite the initial satisfactory results. Several knees may require a conversion to total knee arthroplasty (TKA) because of failure such as the progression of degenerative osteoarthritis and the loss of the correction angle. It is important to know the long-term survival rate and common reason of failure in HTO to inform patients of postoperative expectations before surgery and to prevent surgical errors during surgery. In addition, it has been reported that clinical and radiological results, revision rate, and complication rate were poorer than those in patients without a previous HTO. There are few review articles that describe why conversion TKA after HTO is surgically difficult and the results are poor. Surgeons have to avoid the various complications and surgical errors in this specific situation. We would like to present the considering factors and technical difficulties during conversion TKA after HTO with a review of the literature. We could conclude through the review that the correction of deformity, lower amount of tibial bone resection, and sufficient polyethylene insert thickness, restoration of the joint line height, and adequate ligament balancing can be helpful in overcoming the technical challenges encountered during TKA following HTO.

Mid-term lifetime survivals of octogenarians following primary and revision total knee arthroplasties were satisfactory: a retrospective single center study in contemporary period

송상준,김강일,Bae Dae Kyung,Park Cheol Hee 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

As life expectancy increases, the number of octogenarians requiring primary and revision total knee arthroplasty (TKA) is increasing. Recently, primary TKA has become a common treatment option in octogenarians. However, surgeons may still be hesitant about performing revision TKA on octogenarians because of concern about risk and cost benefit. The purpose of this study was to investigate clinical outcomes, postoperative complications, and mid-term lifetime survival in octogenarians after primary and revision TKA. We retrospectively reviewed 231 primary TKAs and 41 revision TKAs performed on octogenarians between 2000 and 2016. The mean age of patients undergoing primary TKA was 81.9 years and that of patients undergoing revision TKA was 82.3 years ( p = 0.310). The age-adjusted Charlson comorbidity index was higher in revision TKA (4.4 vs. 4.8, p = 0.003). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were evaluated. The incidence of postoperative complications (TKA-related, specific or systemic) and lifetime survival rate (endpoint death determined by telephone or mail communication with patient or family) were investigated. The WOMAC and ROM improved significantly after primary and revision TKA, although postoperative results were worse in the revision group (33.1 vs. 47.2; 128.9° vs. 113.6°; p < 0.001, respectively). There were no cases of aseptic or septic component failure in either group. One case of periprosthetic fracture was observed in the revision group (0% vs. 2.4%, p = 0.151), and three cases of deep vein thrombosis (DVT)/pulmonary thromboembolism (PTE) (one case of DVT and two cases of PTE) were observed in the primary group (1.3% vs. 0%, p = 1.000). The most common systemic complication in both groups was delirium (7.4% vs. 14.6%, p = 0.131). There were no differences between the two groups in the other systemic complication rates. The 5-year and 10-year lifetime survival rates were 87.2% and 62.9%, respectively, in primary TKA and 82.1% and 42.2%, respectively, in revision TKA ( p = 0.017). Both primary and revision TKA are viable options for octogenarians, based on the satisfactory clinical outcomes, TKA-related complication rates, and mid-term lifetime survival. Delirium needs to be managed appropriately as the most common systemic complication in both primary and revision TKA in octogenarians.IV

What to Know for Selecting Cruciate-Retaining or Posterior-Stabilized Total Knee Arthroplasty

송상준,박희절,배대경 대한정형외과학회 2019 Clinics in Orthopedic Surgery Vol.11 No.2

There has been continuing debate about the superiority of cruciate-retaining (CR) total knee arthroplasty (TKA) versus posterior-stabilized (PS) TKA for obtaining knee joint stability with functional improvement. Many surgeons tend to select the type of prosthesis on the basis of their own training and experience. However, the selection must be based on a great store of knowledge rather than on the surgeon’s preconceptions or preferences. CR TKA may not be feasible in certain settings: posterior cruciate ligament insufficiency, severe deformity, and history of trauma or surgery. The risk of conversion from a CR type prosthesis to a PS type prosthesis might be high in patients with severe flexion contracture, steep posterior slope, and small femoral component size. The above factors should be carefully considered for an appropriate selection of the type of prosthesis. The surgeon should have a clear understanding on the technical differences between CR and PS TKAs. The amount of distal femoral resection, femoral component size, and tibial slope are particularly crucial for successful TKA. Unless they are meticulously determined, stiffness or instability will ensue, which can be difficult to resolve afterwards. There was no notable difference in functional outcome, range of motion, kinematics, and survival rate between CR and PS TKAs in most previous studies. Strict adherence to surgical indications and solid understanding of differences in surgical principles might be more important than the selection of either a CR or PS prosthesis.

Changes in Femoral Posterior Condylar Offset, Tibial Posterior Slope Angle, and Joint Line Height after Cruciate-Retaining Total Knee Arthroplasty

송상준,배대경,김강일,정호연 대한슬관절학회 2016 대한슬관절학회지 Vol.28 No.1

purpose: Changes in the femoral posterior condylar offset (PCO), tibial posterior slope angle (PSA), and joint line height (JLH) after cruciate-retaining total knee arthroplasty (CR-TKA) were evaluated to determine their influence on the flexion angle. materials and methods: A total of 125 CR-TKAs performed on 110 patients were retrospectively reviewed. Pre- and postoperative PCO, PSA, and JLH were compared using correlation analysis. Independent factors affecting the postoperative flexion angle of the knee were analyzed.results: The PCO was 28.2±2.0 mm (range, 24.5 to 33.1 mm) preoperatively and 26.7±1.8 mm (range, 22.2 to 31.2 mm) postoperatively (r=0.807, p<0.001). The PSA was 10.4°±4.9° (range, 1.6° to 21.2°) preoperatively and decreased to 4.9°±2.0° (2.2° to 10.7°) postoperatively (r=–0.023, p=0.800). The JLH was 16.2±3.0 mm (range, 10.2 to 27.5 mm) preoperatively and 16.1±2.6 mm (range, 11.1 to 24.8 mm) postoperatively (r=0.505, p<0.001). None of the independent factors affected the flexion angle (p>0.291). conclusions: Although the PCO and JLH did not change significantly after CR-TKA, the PSA decreased by 5.5° with a small range of variation. Restoration of the PCO and JLH could promote optimization of knee flexion in spite of the decreased PSA after CR-TKA.

Comparison of Clinical Results and Risk of Patellar Injury between Attune and PFC Sigma Knee Systems

송상준,Se Gu Kang,Cheol Hee Park,Dae Kyung Bae 대한슬관절학회 2018 대한슬관절학회지 Vol.30 No.4

Purpose: The purposes of this study were to compare clinical results after total knee arthroplasty (TKA) using the Attune and PFC Sigma knee designs and to investigate whether the use of the Attune prosthesis increased the risk of patellar injury in Asian patients. Materials and Methods: Three hundred knees that underwent TKA using Attune (group A) were compared to 300 knees that underwent TKA using PFC Sigma (group B). The Knee Society Knee Score (KS) and Function Score (FS), and range of motion (ROM) were compared. The residual patellar thickness was compared to evaluate the risk of patellar injury. Results: The postoperative KS and ROM of group A were better than those of group B (93.1 vs. 88.8, p<0.001 and 131.4° vs. 129.0°, p=0.008, respectively). The postoperative FS did not differ significantly between the two groups (80.9 vs. 78.7, p=0.427). The residual patella was thinner in group A (14.8 mm vs. 15.7 mm, p=0.003), which made up a higher proportion of the high­risk group for patellar fractures with a residual thickness of <12 mm (7.5% vs. 2.1%, p=0.003). Conclusions: TKA using the Attune prosthesis provided more favorable clinical results than TKA using PFC Sigma. However, the risk of injury in the residual patella was increased with use of the Attune prosthesis in Asian patients.

Snapping Knee due to a Femoral Osteochondroma after Total Knee Arthroplasty

송상준,Dae Kyung Bae,Cheol Hee Park 대한슬관절학회 2019 대한슬관절학회지 Vol.31 No.2

A female patient who underwent total knee arthroplasty presented with a snapping sensation over the left knee at 10 years postoperatively. Initially, the bony mass was visible on the medial femoral condyle radiographically at 5 years postoperatively. The mass had enlarged over time and her symptoms were progressive. The mass was excised at postoperative 18 years and confirmed as an osteochondroma histopathologically. The patient’s symptoms have been completely resolved for 3­year follow­up after excision.

Noise around the Knee

송상준,박철희,Hu Liang,김상준 대한정형외과학회 2018 Clinics in Orthopedic Surgery Vol.10 No.1

Noise in the knee joint is a common symptom that often leads to outpatient clinic visits. However, there have been no previous review articles regarding noise around the knee despite its high prevalence. We will review the noise characteristics according to sound nature and onset as well as factors for differentiation between physiological and pathological noises. In addition, we will describe causes of the physiological and pathological noises and management of noise in the knee. An appropriate review of the characteristics of noise, its pathophysiology, and factors for differentiation between physiological and pathological noises can facilitate patient guidance. It is important to differentiate between physiological noise and pathologic noise. In most cases, noise after surgery is simply the perception of noise that had been present previously due to emotional concerns. Minor problems associated with surgery, such as postoperative noise, can decrease patient satisfaction, especially among patients with high expectations. Following surgical principles and providing accurate information about physiological noise can decrease the risk of both pathological noise and patient dissatisfaction. In total knee arthroplasty, every attempt should be made to avoid patellar crepitus and clunk by using modern prostheses with proper patellofemoral conformity and by avoiding surgical errors.

Pain Management and Anesthesia in Total Knee Arthroplasty

송상준 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.2

Computer-Assisted Navigation in High Tibial Osteotomy

송상준,Dae Kyung Bae 대한정형외과학회 2016 Clinics in Orthopedic Surgery Vol.8 No.4

Computer-assisted navigation is used to improve the accuracy and precision of correction angles during high tibial osteotomy. Most studies have reported that this technique reduces the outliers of coronal alignment and unintended changes in the tibial posterior slope angle. However, more sophisticated studies are necessary to determine whether the technique will improve the clinical results and long-term survival rates. Knowledge of the navigation technology, surgical techniques and potential pitfalls, the clinical results of previous studies, and understanding of the advantages and limitations of the computer-assisted navigation are crucial to successful application of this new technique in high tibial osteotomy. Herein, we review the evidence concerning this technique from previous studies.

교합성 골수강 내 금속정 고정술로 치료한 경골 간부 쐐기형 골절

송상준 ( Sang Jun Song ),윤형구 ( Hyung Ku Yoon ),한수홍 ( Soo Hong Han ),박형근 ( Hyung Kun Park ),이인석 ( In Seok Lee ) 대한골절학회 2006 대한골절학회지 Vol.19 No.3

목적: 경골 간부 쐐기형 골절로 교합성 골수강 내 금속정 고정술을 시행한 환자의 골유합 기간을 조사하고 이에 영향을 미치는 인자를 분석하고자 한다. 대상 및 방법: 경골 간부 쐐기형 골절로 교합성 골수강 내 금속정 고정술을 시행 받은 후 1년 이상 추시가 가능하였던 32예를 대상으로 하였다. 방사선 사진상 쐐기형 골편의 직경 (%)과 길이 (mm)를 측정하였고, 수술 전, 후 쐐기형 골편의 전위 정도 (mm)를 측정하였다. 주골편과 쐐기형 골편의 골유합 기간을 조사하였고 (paired t-test), 쐐기형 골편의 직경, 길이, 수술 전, 후 전위 정도에 따른 골유합 기간을 비교하였다 (상관분석). 결과: 주골편 사이의 골유합 기간은 평균 술 후 15.3주 (6∼56주)였고, 주골편과 쐐기형 골편 사이의 골유합 기간은 술 후 평균 24.2주 (8∼64주)였다 (p=0.005). 쐐기형 골편의 길이와 골유합 기간의 상관 관계는 유의하지 않았으나 (p=0.681), 쐐기형 골편의 직경이 클수록 쐐기형 골편의 골유합 기간이 길었다 (r2=0.747, p=0.031), 쐐기형 골편의 수술 전 전위와 골유합 기간의 상관 관계는 유의하지 않았으나 (p=0.574), 수술 후 전위가 클수록 쐐기형 골편의 골유합 기간이 길었다 (r2=0.730, p=0.001). 결론: 폐쇄성 골수강 내 금속정 고정술로 경골 간부 쐐기형 골절의 치료 시 쐐기형 골편의 직경이 클 경우 골편의 전위에 대한 세심한 주의가 필요하리라 생각된다. Purpose: To investigate the bone union time of patients treated with interlocking intramedullary nailing in wedged tibial shaft fracture and to evaluate the factors that influence this result. Materials and Methods: 32 patients treated with interlocking intramedullary nailing for wedge tibial shaft fracture were reviewed with a follow-up period of more than 1 year. Radiographic results were assessed with diameter (%) and length (mm) of wedge fragment, pre and postoperative displacement (mm) of wedge fragment. We also checked the bone union time of the main fragment and the wedge fragment (paired t-test). We investigated the bone union time acocording to the diameter, length of wedge fragment, pre and postopertvie displacement (correlation analysis). Results: Bone union time of the main fragments averaged 15.3 weeks (6∼53 weeks) and that of wedge fragment averaged 24.2 weeks (8∼64 weeks) (p=0.005). There was no correspondence between wedge fragment diameter and bone union time (p=0.681), but the bone union time of wedge fragment increased in proportion to its diameter (r2=0.747, p=0.031). There was no correspondence between preoperative displacement of wedge fragment and bone union time (p=0.574), but the bone union time increased in proportion to postoperative displacement of wedge fragment (r2=0.730, p=0.001). Conclusion: Wedge fragments need longer time for bone union than main fragments in interlocking intramedullary nailing for wedge tibial shaft fractures. We need to pay attention to the displacemet of fragments in treating tibial shaft fractures with large wedge fragment.