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Medial Unicompartmental Knee Arthroplasty in Patients with Spontaneous Osteonecrosis of the Knee
Won Sik Choy,Kap Jung Kim,Sang Ki Lee,Dae Suk Yang,Choon-Myeon Kim,Ju Sang Park 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.4
Background: We analyzed the clinical and radiologic results of patients with spontaneous osteonecrosis of the knee treated byminimally invasive medial unicompartmental arthroplasty using Oxford Uni. Methods: We reviewed 22 knees in 21 patients which were treated for spontaneous osteonecrosis between 2002 and 2006. Patientsincluded one male and 20 females. The mean age was 70.8 years (range, 53 to 82 years). The mean follow-up period was70.3 months (range, 48 to 93 months). The clinical results were evaluated using the Hospital for Special Surgery (HSS) knee scoreand the range of motion of the knee preoperatively and at the fi nal follow-up. Preoperative plain radiographs and magnetic resonanceimages were analyzed to determine the size and stage of osteonecrotic lesions. Results: The mean HSS knee score was 64.3 (range, 54 to 75) preoperatively and 92.0 (range, 71 to 100) at the fi nal follow-up. The mean preoperative fl exion contracture was 8.9o (range, 0 to 15o) and 0.2o (range, 0 to 5o) at the fi nal follow-up. The mean furtherfl exion increased from 138.6o (range, 100 to 145o) preoperatively to 145.6o (range, 140 to 150o) at the fi nal follow-up. Activefull fl exion was possible within 2 months of the operation. The squatting position was possible in 16 patients (84.2%) out of 19,except one case of bronchiectasis and one case of spine fracture. The cross-leg posture was possible in 19 patients (90.5%) out of21. The mean tibiofemoral angle was improved from varus 0.98o to valgus 3.22o. Meniscal bearing dislocation occurred in 2 casesand femoral component loosening occurred in 1 case. Conclusions: Unicompartmental knee arthroplasty using Oxford Uni could be an alternative treatment option in spontaneous osteonecrosisof the knee.
Ceramic-on-Ceramic Total Hip Arthroplasty: Minimum of Six-Year Follow-up Study
Won Sik Choy,김갑중,이상기,Kyoung Wan Bae,Yoon-Sub Hwang,Chang Kyu Park 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.3
Background: This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard towear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years. Methods: We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that hadbeen performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). Themean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%),degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septichip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groinor thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures. Results: The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoralstems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), andaround the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around thecup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes ofacetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years. Conclusions: The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with nodetectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option ofprimary total hip arthroplasty for variable indications.
Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients
Won Sik Choy,안재훈,Joon-Hyuk Ko,Byoung Sup Kam,Do-Hyun Lee 대한정형외과학회 2010 Clinics in Orthopedic Surgery Vol.2 No.4
Background: Bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients is a viable option that can prevent the complications of an open reduction, such as nonunion and metal failure. This study evaluated the clinicoradiological results of cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients. Methods: Forty hips were followed for more than 2 years after cementless bipolar hemiarthroplasty using a Porocoat® AML Hip System. The mean age was 78.8 years and the mean follow-up period was 40.5 months. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using a range of indices. Results: At the last follow-up, the mean Harris hip score was 80.6 points. There were one case of hip pain and one case of thigh pain. Twenty-four cases (60%) showed no decrease in ambulation capacity postoperatively. Radiologically, there were 23 cases (57.5%) of fixation by bone ingrowth and 17 cases (42.5%) of stable fibrous fixation. There were no cases of osteolysis. Eleven cases (27.5%) of new bone formation were found around the stem. All stems were stable without significant changes in alignment or progressive subsidence. Conclusions: The short-term results of cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures were satisfactory.
Mid-Term Results of Oxford Medial Unicompartmental Knee Arthroplasty
Won-Sik Choy,Kap Jung Kim,Sang Ki Lee,Dae Suk Yang,Neung Ki Lee 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.3
Background: This study examined the clinical and radiologic mid-term results of patients treated by Oxford minimally invasiveunicompartmental knee arthroplasty. Methods: One hundred and eighty-eight knees of unicompartmental knee arthroplasties with Oxford Uni® in 166 patients (16males and 150 females), which were performed between 2002 and 2005, were reviewed. The mean age was 65.3 years (range, 44to 82 years) and the mean follow-up period was 79.8 months (range, 56 to 103 months). The preoperative diagnosis was osteoarthritisin 166 patients, osteonecrosis of the medial femoral condyle in 20 and chondrocalcinosis in 2. Results: The mean Hospital for Special Surgery (HSS) knee score was 67.5 (range, 52 to 75) preoperatively and 89.9 (range, 85to 100) at the fi nal follow-up. The mean preoperative fl exion contracture was 6.5o (range, 0 to 15o) and 0.8o (range, 0 to 5o) at thefi nal follow-up. The mean full fl exion increased from 135o (range, 90 to 150o) preoperatively to 150o (range, 140 to 165o) at the fi nalfollow-up. Active full fl exion was possible within 2 postoperative months. The squatting and cross-leg postures were possible in133 patients (80.1%) and 152 patients (91.6%) at the fi nal follow-up. The mean tibiofemoral angle was improved from varus 1.5oto valgus 4.8o. Complications were encountered in 18 cases (9.5%). A bearing dislocation occurred in 10 cases (5.3%), tibial componentloosening in 4 cases (2.1%), femoral loosening in 3 cases (1.6%) and lateral translation in 1 case (0.5%). The mean time fora bearing dislocation was 22.6 months (range, 3 to 70 months) postoperatively. Seven cases returned to the predislocation level ofactivity with the insertion of a thicker bearing and 3 cases converted to total knee arthroplasty. Conclusions: Minimally invasive unicompartmental knee arthroplasty with Oxford Uni® provided rapid recovery, good pain reliefand excellent function suitable for the Korean lifestyle. In contrast, the high complication rates of Oxford Uni® encountered in themid-term results suggested less reliability than total knee arthroplasty.