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Gerrard Gan, MRCS,Yee Hong Teo,Ernest Beng Kee Kwek 대한정형외과학회 2018 Clinics in Orthopedic Surgery Vol.10 No.2
Background: Periprosthetic fractures around a total knee replacement (TKR) can be complex and difficult to manage, requiring the surgical expertise of the trauma and arthroplasty surgeon. There are a number of treatment modalities available, each with their own merits and limitations. As data on tumor prosthesis revision in periprosthetic fractures is sparse, this study aims to evaluate the results of revision using a tumor prosthesis and compare them with those of fixation using a locking plate in periprosthetic fractures after TKR. Methods: This is a retrospective study of 15 patients who underwent either tumor prosthesis revision (n = 7) or locking plate fixation (n = 8) for supracondylar femoral periprosthetic fractures in our hospital from 2009 and 2014. The mean follow-up time for these patients was 44 months. This study’s main outcome measures were pain relief, return to premorbid ambulatory function, and complications. Results: The revision and fixation groups saw five versus three patients achieve pain relief (71.4% vs. 37.5%, p = 0.315), and two versus four patients return to their premorbid ambulatory function (28.6% vs. 50%, p = 0.608) at the follow-up, respectively. The mean time to weight-bearing in the revision group and fixation group was 2.9 days and 18.9 weeks, respectively (p = 0.001). There were eight complications seen in the revision group with none requiring reoperation; there were five complications seen in the fixation group, and two required reoperation. Conclusions: The results of revision TKR using a tumor prosthesis were comparable to those of fixation using a locking plate in periprosthetic fractures after TKR. Tumor prosthesis revision may be considered as a viable alternative to locking plate fixation when indicated.
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( 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.
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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.
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Kar Wai Phoebe Lam,MBChB,MRCS,PgDipSEM,DPD,MScDPD 대한미용의학회 2018 대한미용의학회지 Vol.2 No.2
Subdermal monopolar radiofrequency (RF) redefines jawline by delivering controlled thermal energy that induced soft tissue contraction. However, the type of candidates best suited for this treatment has not been determined. A retrospective analysis of the treatment results and satisfaction, at 6 weeks and 3 months, in 15 female patients, aged 34 to 77 years, with mild to moderate skin laxity (Submental Skin Laxity Grading [SMSLG], 1-3) and submental fat (SMF) (Clinician rating-SMF-Rating Scale [CR-SMF-RS], 1-3), and a Subject Self Rating Scale (SSRS) ≤2. They received ThermiRF to either jowl and neck or neck only, in a single clinic, between the period of October 2017 to July 2018. The probe treatment temperature was set and maintained between 52°C to 65°C whereas the epidermal temperature was targeted around 42°C to 43°C. All patients with SMSLG 2 to 3, reported at least 1 grade SMSLG response with a mean change of 1.23 of CR-SMF-RS and mean change of 3.08 of SSRS. None of the patients experienced a burn or erythema following treatment. Transient swelling, nodule and mild numbness following ThermiRF procedure has been reported but all resolved completely with time. All reported GAIS ≥3 and 46.7% reported a Global Aesthetic Improvement Scale (GAIS) score of 5, i.e. optimal results by 3 months. Therefore, according to treatment results those with good to at least moderate skin laxity (SMSLG, 2-3), mild to moderate SMF (CR-SMF, 1-3) and absent of platysmal pathology reported at least a one-grade improvement on SMSLG and CR-SMF-RS within 3 months of ThermiRF treatment. Level of Evidence: IV
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