Modified Charnley Clamp 를 이용한 슬관절 유합술

배대경,이동희,권병기 ( Dae Kyung Bae,Dong Hee Lee,Byung Gi Kwon ) 대한슬관절학회 1995 대한슬관절학회지 Vol.7 No.1

Arthrodesis of knee was indicated in cases of tuberculosis of knee, pyogenic arthritis, severe pain after traumatic arthritis and infection after arthroplasty of knee. 1n the treatment of tuberculosis of the knee, when abseess formation threatens the integrity of neighboring structure and continued drainage is progressively debilitating the patient, removal of infected focus is indicated and arthrodesis or amputation is indicated when destruction is extensive. Total knee replacement has become popular for treatment of arthritis and its most serious cornplication of total knee arthroplasty is infection. The presence of massive bone loss, severe ligamentous instability, and soft tissue loss as well as well as infection with multiple organisms or antibiotic resistant organism will limit the options abailable and are best managed by arthrodesis. Failure of previous two-stage reimplantation for infection is also an indication for arthrwte.dsis. Currently employed methods for arthrodesis are external fixation, intramedullary rod and plate and screw fixation. We performed knee arthrodesis using a modified Charnley clamp in nine patients who were six tuberculosis of the knee and three infected total knee replacement patients between Nov. ] 991 and Jan. 1994. After follow up of average 16.5 months, we analysed the results. Average age was 54 years old and average duration from arthrodesis to removal of fixative was 4.4 months. Debridement of knee was performed before arthrodesis in three cases of tuberculosis of knee and two cases of infected tota1 knee mthroplasty. In infected total knee arthroplasty, removal of prosthesis and arthrodesis was performed same time. In all nine patients, long leg cast was applied postoperatively or before discharge. Succcssful arthrodesis was ohtamed in all nine cases with low cost modified Charntey clamp.

P . F . C . 인공 슬관절전치환술의 최근 결과

배대경,김형구,김진원 ( Dae Kyung Bae,Hyung Koo Kim,Jin Won Kim ) 대한슬관절학회 1992 대한슬관절학회지 Vol.4 No.1

The P.F.C (Press-Fit Condylar) knee was designed in 1982 and first implanted cli- nically in 1984. It was intended to provide a condylar knee system for posterior cru- ciate retention and fixed without use of cement. We analyzed 104 knees, which could be followed up, underwent the P.F.C total knee arthroplasty in the period from Jan. 1988 to June. 1991. The follow-up duration ranged from one year to four years and five months averaging two years and 10 months. The radiologic measurement was evaluated by Radiologic Measurement of Ameri- can Knee Society in the A.P, lateral and Merchants view. The Knee Rating Scoring System of Hospital for Special Surgery was used for preoperative and postoperative functional assessments. Causes of disease were Osteoarthritis in 70 knees, rheumatoid arthritis in 31 knees and others in 3 knees. The results analyzed are as follows; 1. The average range of motion was increased from 108.6 degrees preoperatively to 121.7 degrees postoperatively. 2, The average Knee Rating Score of Hospital for Special Surgery was improved from 50.4 preoperatively to 86 postoperatively. 3. The average flexion contracture was decreased from 24.7 degrees in 62 knees preoperatively to 7.5 degrees in 24 knees postaperatively. 4. The average bitiofernoral angle was corrected from valgus 3.9 degrees to valgus 6.4 degrees. 5. The average congruence angle was 2.8 degrees in 27 knees of osteoarthritis postoperatively. 6. The average thickness of patella were 20.6 mm preoperatively, and 21.4 mm postoperatively. 7. The average height of patella by Insall were 1:1.01 preoperatively, and 1: 1.11 postoperatively. 8. The cement was used in all components of 25 knees, not in 31 knees. 9. The bone graft for tibial bone defect was used in 18 knees.

후방십자인대 대치형 Medial Pivot Knee를 이용한 슬관절 전치환술 -단기 추시 결과-

조성도 ( Sung Do Cho ),염윤석 ( Yoon Seok Youm ),정지영 ( Ji Young Jeong ),박기봉 ( Ki Bong Park ) 대한슬관절학회 2009 대한슬관절학회지 Vol.21 No.1

Purpose: To evaluate minimum 2-year follow-up clinical and radiological results after total knee arthroplasty (TKA) with a posterior cruciate ligament (PCL) substituting (PS) Medial Pivot Knee. Materials and Methods: Seventy knees in 48 patients, who could be followed up more than 2 years after TKA with PS Advance(R) Medial Pivot Knee from October 2004 to February 2006, were evaluated retrospectively. The evaluations included the preoperative and postoperative range of motion (ROM), tibiofemoral angle, Knee Society (KS) knee and function score and postoperative complications. Results: The ROM increased from preoperative mean flexion contracture of 6.3° and further flexion of 116.4° to a postoperative mean flexion contracture of 1.9° and further flexion of 120.5°. The tibiofemoral angle changed from preoperative varus 4° to postoperative valgus 5.5°. The KS knee and function score improved from 46 and 37 before surgery to 87 and 83 after surgery, respectively (p<0.05). The complications were 2 cases of periprosthetic patellar fracture and 1 case of early failure of the tibial component. Conclusion: The minimum 2 year follow-up results after TKA with PS Medial Pivot Knee were satisfactory.

슬관절 전치환술에서 삽입물의 생존율에 대한 분석

배대경,선승덕,송영석 ( Dae Kyung Bae,Seung Deok Sun,Young Suk Song ) 대한슬관절학회 1995 대한슬관절학회지 Vol.7 No.2

Survivorship analysis is used to calculate a predicted cummulative rate of success for this series of total joint replacements long-term folow-up. Survivorship analysis has been advocated a providing annual and overall failure rates, as well as the probabilities of implant survival. The survivorship of total knee replacement between 1982 and 1992 with follow-up period of up 12 years was estimated by Dobb's method(1980), and we analyzed clinically and radiologically 397 patients(588 knees) which were followed up more than 2 years(from 2 years to 12 years 4 months, average 8 years 6 months). Also, we evaluated the knee function according to the functional knee scores of Hospital for Spedial Surgery. 1. The average age at operation was 57.1 years(from 19 years to 89 years). Male was 43 patients and female was 354 patients. 2. There were oseoarthritis in 317 knees(53.8%), rtheumatoid arthritis in 213 knees(36.2%), secondary osteorthritis in 31 knees(5.4%), tuberculous arthritis in 16 knees(2.7%), and Charcot joint in 11 knees(1.9%). 3. The Hospial for Special Surgery functional knee and pain scores was improved from average 57.5 points preoperatively to average 86.4 points postoperatively.The results were satisfactory in 536 knees(91.2%, excellent in 66.4% and good in 24.8%). 4. Revision surgery was performed in 28 knees of the 588 knees(4.7%), due to aseptic loosening or patellar component wearing in 16 knees(2.7%) and septic loosening in 12knees (2.0%). 5. Survival rate of total knee replacements with reliability ws 84.2%,9 years after operation for 397 patients, 588 knees. In surmmary, total knee replacements is a effective and satisfying procedure which canobtain relief of pain, repair of defomity, restoration of the function, improvements of life quality and long term survivorship.

Results of total knee arthroplasty for painless, stiff knees

Choi Young-Joon,Seo Dong-Kyo,Lee Ki Won,Ra Ho Jong,Kang Hyun Wook,Kim Jin Kyung 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Stiff knees, like completely ankylosed or arthrodesed knees, can be painless. Total knee arthroplasty (TKA) for these painless, stiff knees is technically demanding. However, it can correct the alignment and advance the range of motion to improve quality of life. So, we reviewed the preoperative and postoperative results of functional and pain scores, range of motion (ROM) and complications in painless, stiff knees treated by TKA.Fifteen painless, stiff knees underwent TKA from January 1998 to January 2017. The mean follow-up period was 15.4 (2.4–22.2) years. All the knees were completely ankylosed or arthrodesed. Clinical outcome and complications were evaluated using medical record review, serial plan radiography, ROM assessment, Knee Society score (KSS), Knee Society function score (FS), and a visual analog scale for pain (VAS). All patients were satisfied with their operated knees. Mean KSS and FS scores were improved from 36 and 50.9 to 76.9 and 67.2, respectively ( P < 0.001 and P = 0.01). The mean ROM increased from 0º preoperatively to 77.6º (15–130) at the final follow-up ( P < 0.001). The mean VAS had worsened from 0 preoperatively to 0.2 postoperatively, however it was not significant ( P = 0.1). Major postoperative complications were reported in five of the knees (33.3%). The results of TKA for painless, stiff knees were satisfactory with improved ROM and quality of life. Although some patients had mild pain and complications postoperatively, they were satisfied with the result. However, our study recommends that surgeons should consider the high rate of complications in the completely ankylosed or arthrodesed knees.A retrospective case series, Level IV.

Knee joint line related to bony landmarks of the knee: a radiologic study in a Thai population

( S. Tantavisut ),( C. Amarase ),( S. Ngarmukos ),( C. Tanavalee ),( A. Tanavalee1 ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Background: During revision total knee arthroplasty (TKA), knee joint line restoration may be difficult due to bone loss or structural changes. Although bony landmarks are consistent and can be used as references, there are limited data in Asian patients. We studied the knee joint line related to bony landmarks of the knee in a Thai population. Materials and methods: Magnetic resonance imaging (MRI) of 140 healthy knees of Thai patients (70 males, 70 females) were investigated. In all knees, a perpendicular line from knee joint line to the medial epicondyle (distance A) and the lateral epicondyle (distance B) in the coronal plane were measured. In the sagittal plane, a perpendicular line from the knee joint line to the fibular head (distance C), the tibial tubercle (distance D), and the inferior patellar pole (distance E) were measured. The femoral transepicondylar width (FW) was measured along the transepicondylar axis. The ratios of distances A, B, C, D, and E related to FW were evaluated (epicondylar ratio). Results: The mean and standard deviation (SD) of distances A, B, C, D, E, and FW were 27.1 ± 2.7 mm, 21.7 ± 2.5 mm, 12.6 ± 3 mm, 21.3 ± 3.6 mm, 7.6 ± 4.8 mm, and 76.7 ± 3.99, respectively. There was wide variation of measured values, with statistically significant differences between genders in distances A, B, C, and FW. The mean and SD of epicondylar ratios A/FW, B/FW, C/FW, D/FW, and E/FW were 0.35 ± 0.02, 0.29 ± 0.02, 0.16 ± 0.05, 0.28 ± 0.04, and 0.09 ± 0.04, respectively. All epicondylar ratios demonstrated less variation than all measured distances, with statistical differences between genders in the A/FW and D/FW ratios. However, the B/FW ratio had the highest consistent mean value. In addition, it had narrower SD than the rest (0.29 ± 0.02; range, 0.22-0.33). Conclusions: In Thai knees, the measured distances from bony landmarks to the knee joint line had higher variation than the epicondylar ratio. Among all studied epicondylar ratios, the ratio between lateral epicondyle to joint line distance (distance B)/FW demonstrated the narrowest range of mean and SD values; therefore, this could be the most reliable landmark for intraoperative knee joint line verification by multiplying the FW of the patient by 0.29 to get distance B in that patient.

슬관절 골관절염 환자의 슬관절 주위근의 근력비와 Q-각과의 관계

김선엽(Suhn-yeop Kim) 한국전문물리치료학회 2005 한국전문물리치료학회지 Vol.12 No.1

The quadriceps-angle (Q-angle) and the ratio of hamstring/quadriceps (H/Q) are important for the stability of the knee and for protection from excessive stress. The aim of this study was to examine the association between Q-angle and H/Q ratio with and without knee osteoarthritis. We compared knee osteoarthritis patients with symptom-free women. The mean age of the patients in the arthritis group (25 women, osteoarthritis) was 59.7 years. The non-arthritis group consisted of 25 women with a mean age of 55.2 years. of the 25 women with osteoarthritis, 5 had the condition in their left knee, 5 had it in their right knee, and 15 had it on both sides. There was no significant difference in the knee Q-angle of the left and right knees of the arthritis group and the non-arthritis-group (p>.05). The strength of all the muscles around the involved right knee in the arthritis group was significantly weaker than that of the non-arthritis group (p<.05). However, in the left knee, only the strength of the knee extensors and internal rotators was significantly weaker than that of the non-arthritis group (p<.05). The Q-angle was not associated with the H/Q ratio and internal rotators/external rotators ratio of the involved knee in the arthritis group (p>.05). Neither was the Q-angle associated with the pain level of an involved knee in the arthritis group (p>.05). The knee pain was not associated with the H/Q ratio of the involved knee in the arthritis group (p>.05). The Q-angle was not associated with the ratio of H/Q and pain level of the involved knee in the osteoarthritis women.

Anthropometry of Nonarthritic Asian Knees: Is It Time for a Race-Specific Knee Implant?

Mohan Hariharan,Chhabria Prasidh,Bagaria Vaibhav,Tadepalli Kalyan,Naik Lokesh,Kulkarni Rajiv 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.2

Background: This study was done to study the anthropometry of nonarthritic Asian knees; to determine the differences in morphology between knees of different ethnicities and to compare the knee anthropometry values with sizes of available knee implants. Methods: Magnetic resonance imaging scans of 100 nonarthritic Indian knees were analyzed. Anteroposterior (AP) length, mediolateral (ML) length, and aspect ratio of the distal femur and proximal tibia, patellar length, and patellar tendon length were measured. These values were compared with values of other ethnicities from literature. The values were also compared with sizes of available knee implants and evaluated for mismatch. Results: All the parameters of female knees were significantly smaller than those of male knees (p < 0.05). The distal femur of Indian knees resembled that of Chinese knees with similar AP and ML lengths and aspect ratio. The distal femur of Indian knees had a significantly smaller AP, ML, and aspect ratio than those of Hispanic knees did. In comparison to Caucasian distal femur, Indian knees had smaller AP and ML lengths and larger aspect ratio. In terms of the proximal tibia, the Indian knees were smaller than Chinese (only ML), Caucasian (AP and ML) and Hispanic (AP and ML) knees. On comparison with implant sizes, there was a mismatch between the distal femur morphology and the dimensions of all implants. For a given AP length, the ML dimensions of all implants were smaller than the measured ML length of the knee. However, the tibial components of all the studied implants correlated well with the tibial morphology. Conclusions: Distinct anthropometric differences exist between knees of different ethnicities. The knees of females were smaller than the knees of males. In Indian knees, the ML-AP aspect ratio of the distal femur was higher than that of the currently available femoral components. These results suggest the need for race-specific knee implants.

후방십자인대 보존형 Medial Pivot Knee

배대경(Dae Kyung Bae),윤경호(Kyoung Ho Yoon),김선구(Seon Goo Kim),박경준(Kyoung Jun Park) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.1

목적: 후방십자인대 보존형 Medial pivot knee를 사용하여 슬관절 전치환술을 시행한 후 임상결과 및 방사선학적 결과를 분석하고 후방십자인대를 보존하는데 따른 수술 술기에 대해 알아보았다. 대상 및 방법: 2002년 3월부터 2003년 12월까지 후방십자인대 보존형 Medial pivot knee로 슬관절 전치환술을 시행 받은 28명(40예)을 대상으로 하였다. 평균 추시 기간은 2.8년(2년-3.7년)이었다. 술 전과 최종 추시 시의 임상결과를 관절운동범위, 슬관절 점수 및 기능 점수로 평가하였고 방사선학적 평가도 병행하였다. 결과: 굴곡구축은 술 전 평균 5.4°에서 최종 추시 시 평균 0.6°로 호전되었고 최대 굴곡은 숨 전 평균 126.1°, 최종 추시 시 평균 126.6°였다. 슬관절 점수는 술 전 평균 60.0에서 최종 추시 시 평균 94.8, 기능 접수는 술 전 평균 55.3에서 최종 추시 시 평균 87.0으로 향상되었다. 술 후 방사선학적 분석에서 평균 α각, β각, γ각, δ각은 각각 95.1°, 91.1°, 3.6°, 84.0°였다. 전 예에서 술 후 합병증은 없었다. 결론: 후방십자인대 보존형 Medial pivot knee를 사용한 슬관절 전치환술의 단기 추시결과는 양호하였다. Purpose: To analyze the clinical and radiographic results of patients who underwent total knee arthroplasty with a posterior cruciate retaining medial pivot knee, and to identify the technical aspects in preserving the posterior cruciate ligament. Materials and Methods: From March 2002 to Dec 2003, 40 total knee arthroplasties with a cruciate retaining medial pivot knee were implanted in 28 cases. The average follow-up period was 2.8 years (range, 2 to 3.7 years). The clinical and radiographic results were evaluated using the clinical and roentgenographic evaluation and scoring system of the American Knee Society. Results: The average flexion contracture before surgery was 5.4°, which improved to 0.6° at the last follow-up. The average preoperative knee flexion was 126.1° and 126.6° at the last follow-up. The average knee score improved from 60 points preoperatively to 94.8 points postoperatively, and the average functional score improved from 55.3 points to 87.0 points at the final evaluation. The average post operative α, β, γ and δ angles were 95.1°, 91.1°, 3.6° and 84.0°, respectively. There were no postoperative complications. Conclusion: The short term clinical results in patients who had undergone total knee arthroplasty with a cruciate retaining medial pivot knee was acceptable.

동일 환자에서 시행한 슬관절 부분치환술과 전치환술의 비교

김경태(Kyung Tae Kim),이송(Song Lee),박훈석(Hoon Seok Park),조근호(Kun Ho Cho),김관수(Kwan Soo Kim) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.4

목적: 양측 슬관절에 부분치환술과 전치환술을 각각 시행한 환자에서 수술의 결과를 비교 분석하고 각 수술에 대한 환자들의 주관적 선호도와 만족도 등을 알아 보고자 하였다. 대상 및 방법: 2002년 1월부터 2004년 12월까지 한 쪽 슬관절에는 부분치환술을, 반대쪽에는 전치환술을 시행 받았던 51명의 퇴행성 슬관절염 환자를 대상으로 평균 4년의 추시 결과를 분석하였다. 결과: 슬관절 점수는 부분치환술의 경우 술 전 평균 53.5점에서 최종 추시 시 90.7점으로 증가하였고, 전치환술에서는 술 전 평균 50.4점에서 89.8점으로 향상되었다. 슬관절 운동 범위는 부분치환술에서 술 전 평균 124.7°에서 133.2°로, 전치환술에서 술 전 평균 122.5°에서 127.1°로 증가되었다. 대퇴 경골각은 부분치환술에서는 수술 전 평균 0.3° 내반에서 5.6° 외반으로, 전치환술에서는 수술 전 평균 2.4° 내반에서 5.8° 외반으로 교정되었다. 환자의 선호도는 23명(45%)은 부분치환술이, 19명(37%)은 전치환술이 더 좋다고 하였으며, 환자의 만족도는 양측 모두 42명(82%)에서 매우 만족 또는 만족의 결과를 보였다. 결론: 동일 환자의 양측 슬관절에 시행한 부분치환술과 전치환술의 결과는 평균 4년 추시 상 두 수술 모두 매우 양호하였으며, 부분치환술에서 관절 운동 범위가 좀 더 증가하였으나 그 외에는 유의한 차이가 없었다. Purpose: To compare the clinical and radiographic results of unicompartmental knee arthroplasty(UKA) and total knee arthroplasty (TKA) in the same patient, and to investigate patient preference and satisfaction. Materials and Methods: Among the 56 patients who underwent a UKA in one knee and a TKA in the opposite knee between January 2002 and December 2004, 51 patients were followed up. The average follow-up period was 4 years. Results: The average Knee Society Score (KSS) improved from 53.5 preoperatively to 90.7 at last follow-up in the UKA knee, and from 50.4 to 89.8 in the TKA knee. The mean range of knee motion also improved from 124.7° to 133.2° in the UKA knee, and from 122.5° to 127.1° in the TKA knee. The tibiofemoral angle changed from 0.3° of varus to 5.6° of valgus in the UKA knee, and from 2.4° of varus to 5.8° of valgus in the TKA knee. For patient preference, 23 patients (45%) preferred the UKA knee and 19 patients (37%) preferred the TKA knee. Most patients (42 patients, 82%) reported being 'very satisfied' or 'satisfied' with both knees. Conclusion: The clinical and radiographic results of both the UKA and the TKA in the same patient were satisfactory at the 4-year follow-up. The UKA knee had a slightly better range of knee motion, but there was essentially no difference between the UKA knee and the TKA knee.