일차 슬관절 전치환술 시 내·외반 구속형 치환물이 필요했던 사례들의 원인 분석

공동의(Dong Yi Kong),박상훈(Sang Hoon Park),최충혁(Choong Hyeok Choi) 대한정형외과학회 2021 대한정형외과학회지 Vol.56 No.3

목적: 일차 슬관절 전치환술 시에는 일반적으로 가능한 한 구속력이 적은 치환물을 이용한 슬관절 전치환술이 권장된다. 그럼에도 불구하고 후방 십자인대 보존형 혹은 대치형 치환물로 적절한 슬관절 안정성을 얻기가 불가능한 경우에는 수술 중 내ㆍ외반 구속형 슬관절 치환물로 전환을 고려해야 한다. 내ㆍ외반 구속형 치환물이 항시 구비되어 있지 않는 국내 현실을 감안하여 일차 슬관절 전치환술의 효율적인 술 전 계획을 위해 내ㆍ외반 구속형 슬관절 치환물을 준비하는 적응증을 제시하고자 본 연구를 시행하였다. 대상 및 방법: 2003년 5월부터 2016년 2월까지 시행되었던 일차 슬관절 전치환술 1,797예 중 내ㆍ외반 구속형 슬관절 치환물로 일차 슬관절 전치환술이 시행되었던 27명(29예)를 대상으로 내ㆍ외반 구속형 슬관절 치환물로 최종 결정한 원인 등을 후향적으로 분석하였다. 결과: 일차 슬관절 전치환술 시 내ㆍ외반 구속형 슬관절 치환물이 사용된 경우는 전체 일차 슬관절 전치환술 중 29예로 1.6%의 빈도를 보였다. 남자 6명, 여자 21명이었으며, 2명에서 양측 모두 내ㆍ외반 구속형 치환물이 필요하였다. 환자의 나이는 평균 63.4세(34–79세)였고, 술 전 최대신전각도는 평균 16.2° (-20°–90°), 최대굴곡각도는 평균 111.7° (35°–145°)였다. 일차 슬관절 전치환술 시 내ㆍ외반 구속형 치환물이 필요하였던 원인으로는 심한 외반 변형으로 내ㆍ외반 불안정성을 보강하기 위한 경우가 10예, 심한 강직으로 인해 내ㆍ외반 구속형 치환물이 사용되었던 경우가 10예였으며, 과거력상 내측측부인대 4예, 외측측부인대 1예, 원위 대퇴골과의 무혈성 괴사로 인한 경우가 4예였다. 심한 외반 변형으로 수술을 시행한 10예 경우의 술 전 슬관절 전후방기립 사진상 해부학적 대퇴경골간각은 평균 25.7° (21°–43°)의 외반각을 보였고, 심한 강직으로 수술을 시행한 10예 경우의 굴곡 구축은 평균 37.5° (20°–90°), 관절운동범위는 평균 48.5° (10°–70°)였다. 결론: 20° 이상의 해부학적 대퇴경골간각의 외반 변형, 굴곡 구축 20° 이상 및 관절운동범위 70° 이하를 가진 관절운동 제한, 과거 측부인대 손상 병력이 의심되는 경우에는 일차슬관절 전치환술 시라도 술 전 계획 시 내ㆍ외반 구속형 치환물을 준비하는 것이 수술 중 발생할 수 있는 불안정성의 해결에 도움이 될 것으로 생각된다. Purpose: The least constrained prosthesis is generally recommended in primary total knee arthroplasty (TKA). Nevertheless, a varus/valgus constrained (VVC) prosthesis should be implanted when a semi-constrained prosthesis is not good for adequate stability, especially in the coronal plane. In domestic situations, however, the VVC prosthesis could not always be prepared for every primary TKA case. Therefore, it is sometimes impractical to use a VVC prosthesis for unsual unstable situations. This study provides information for preparing VVC prostheses in the preoperative planning of primary TKA through an analysis of primary VVC TKA cases. Materials and Methods: This study reviewed 1,797 primary TKAs, performed between May 2003 and February 2016. The reasons for requiring VVC prosthesis and the preoperative conditions in 29 TKAs that underwent primary TKA with a VVC prosthesis were analyzed retrospectively. Results: In primary TKA, 29 cases (1.6%) in 27 patients (6 male and 21 female) used VVC prosthesis. Two patients underwent a VVC prosthesis on both knees. The mean age of the patients was 63.4 years old (34–79 years). The mean flexion contracture was 16.2° (-20°–90°), and the mean angle of great flexion was 111.7° (35°–145°). The situations requiring a VVC prosthesis were severe valgus deformity in 10 knees, knee stiffness requiring extensive soft tissue release in 10 knees, previously injured collateral ligaments in five knees, and distal femoral bone defect due to avascular necrosis in four knees. The mean tibiofemoral angle was 25.7° (21°–43°) in 10 cases with a valgus deformity. The mean flexion contracture was 37.5° (20°–90°), and the mean range of motion was 48.5° (10°–70°) in 10 cases with knee stiffness. Conclusion: The preparation of VVC prosthesis is recommended, even for primary TKA in cases of severe valgus deformity (tibiofemoral angle>20°), stiff knee (the range of motion: less than 70° with more than 20° flexion contracture), and the cases with a previous collateral ligament injury. This information will help in the preparation of adequate TKA prostheses for unusual unstable situations.

Revision Total Knee Arthroplasty with a Cemented Posterior Stabilized, Condylar Constrained or Fully Constrained Prosthesis: A Minimum 2-year Follow-up Analysis

황선철,Jae-Yeon Kong,Dae-Cheol Nam,김동희,박형빈,정순택,조세현 대한정형외과학회 2010 Clinics in Orthopedic Surgery Vol.2 No.2

Background: The clinical and radiological outcomes of revision total knee arthroplasty with a cemented posterior stabilized (PS), condylar constrained knee (CCK) or a fully constrained rotating hinge knee (RHK) prosthesis were evaluated. Methods: This study reviewed the clinical and radiological results of 36 revision total knee arthroplasties with a cemented PS, CCK, and RHK prosthesis in 8, 25, and 13 cases, respectively, performed between 1998 and 2006. The mean follow-up period was 30 months (range, 24 to 100 months). The reason for the revision was aseptic loosening of one or both components in 15, an infected total knee in 18 and a periprosthetic fracture in 3 knees. The average age of the patients at the time of the revision was 65 years (range, 58 to 83 years). The original diagnosis for all primary total knee arthroplasties was osteoarthritis except for one case of a Charcot joint. All revision prostheses were fixed with cement. The bone deficiencies were grafted with a cancellous allograft in the contained defect and cortical allograft fixed with a plate and screws in the noncontained defect. A medial gastrocnemius flap was needed to cover the wound dehiscence in 6 of the 18 infected cases. Results: The mean Knee Society knee score improved from 28 (range, 5 to 43) to 83 (range, 55 to 94), (p < 0.001) and the mean Knee Society function score improved from 42 (range, 10 to 66) to 82 (range, 60 to 95), (p < 0.001) at the final follow-up. Good or excellent outcomes were obtained in 82% of knees. There were 5 complications (an extensor mechanism rupture in 3 and recurrence of infection in 2 cases). Three cases of an extensor mechanism defect (two ruptures of ligamentum patellae and one patellectomy) were managed by the RHK prosthesis to provide locking stability in the heel strike and push off phases, and two cases of recurrent infection used an antibiotic impregnated cement spacer. The radiological tibiofemoral alignment improved from 1.7° varus to 3.0° valgus in average. Radiolucent lines were observed in 18% of the knees without progressive osteolysis. Conclusions: Revision total knee requires a more constrained prosthesis than primary total knee arthroplasty because of the ligamentous instability and bony defect. This short to midterm follow-up analysis demonstrated that a well planned and precisely executed revision can reduce pain and improve the knee function significantly. Infected cases showed as good a result as those with aseptic loosening through the use of antibiotics-impregnated cement beads and proper soft tissue coverage with a medial gastrocnemius flap.

인공 종양대치물을 이용한 사지구제술후의 보행 분석

이상훈,정진엽,김한수,김병성,이한구,Lee, Sang-Hoon,Chung, Chin-Youb,Kim, Han-Soo,Kim, Byung-Sung,Lee, Han-Koo 대한근골격종양학회 1997 대한골관절종양학회지 Vol.3 No.1

Prosthetic replacement is one of the most common methods of reconstruction after resection of malignant tumor around the knee. Gait analysis provides a relative objective data about the gait function of patients with prosthesis. The purpose of this study was to compare the gait pattern of the patients who underwent limb salvage surgery with prosthesis for distal femur and that of patients with prosthesis for proximal tibia. This study included ten patients (4 males, 6 females, mean age 22.7 years, range 14-36) who underwent a wide resection and Kotz hinged modular reconstruction prosthesis replacement and six normal adult(Control). The site of bone tumor was the distal femur (Group 1) in six patients and proximal tibia (Group 2) in 4 patients. The follow-up period ranged from 15 to 82 months (mean : 33 months). The evaluation consisted of clinical assessment, radiographic assessment, gait analysis using VICON 370 Motion Analysis System. The gait analysis included the linear parameters such as, walking velocity, cadence, step length, stride length, stance time, swing time, single support and double support time and the three-dimensional kinematics (joint rotation angle, velocity of joint rotation) of ankle, knee, hip and pelvis in sagittal, coronal and transverse plane. For the kinetic evaluation, the moment of force (unit: Nm/kg) and power (unit: Watt/kg) of ankle, knee and hip joint in sagittal, coronal and transverse plane. In the linear parameters, cadence, velocity, step time and single support were decreased in both group 1 and group 2 compared with control. Double support decreased in group 2 compared with control significantly(p<.05). In contrast to our hypothesis, there was no significant difference between group 1 and group 2. In Kinematics, we observed significant difference (p<.05) of decreased knee flexion in loading response (G2<G1<control) and extension in mid stance in group 2 compared with group 1. In group 2, the greater knee coronal and transverse plane motion and decreased maximum ankle dorsiflexion in terminal stance and terminal swing, and decreased maximum hip extension in terminal stance were also significant(p<.05). In kinetics, the maximum knee flexion moment and sum of flexion moment at stance were increased in group 2 significantly(p<.05). Maintenance of extensor mechanism through secure attachment of patellar tendon is believed to be more important than the amount of resected quadriceps muscle foe active knee extension and powerful stance. Gait analysis is very useful and objective in the assessment of postoperative gait function and also helpful in establishing a physical therapy program and a novel prosthesis design with physiologic mechanism.

Comparison of Revision Rates Due to Aseptic Loosening between High-Flex and Conventional Knee Prostheses

( Young-joon Choi ),( Ki Won Lee ),( Jung-ki Ha ),( Joo-yul Bae ),( Suk Kyu Lee ),( Sang-bum Kim ),( Dong-kyo Seo ) 대한슬관절학회 2018 대한슬관절학회지 Vol.30 No.2

Purpose: The purpose was to evaluate and compare the revision rate due to aseptic loosening between a high-flex prosthesis and a conventional prosthesis. Materials and Methods: Two thousand seventy-eight knees (1,377 patients) with at least 2 years of follow-up after total knee arthroplasty were reviewed. Two types of implants were selected (LPS-Flex and LPS, Zimmer) to compare revision and survival rates and sites of loosened prosthesis component. Results: The revision rate of the LPS-Flex (4.9%) was significantly higher than that of the conventional prosthesis (0.6%) (p<0.001). The 5-, 10-, and 15-year survival rates were 98.9%, 96.2% and 92.0%, respectively, for the LPS-Flex and 99.8%, 98.5% and 93.5%, respectively, for the LPS. The survival rate of the high-flex prosthesis was significantly lower than that of the conventional prosthesis, especially in the mid-term period (range, 5 to 10 years; p=0.002). The loosening rate of the femoral component was significantly higher in the LPS-Flex prosthesis (p=0.001). Conclusions: The LPS-Flex had a higher revision rate due to aseptic loosening than the LPS prosthesis in the large population series with a long follow-up. The LPS-Flex should be used carefully considering the risk of femoral component aseptic loosening in the mid-term (range, 5 to 10 years) follow-up period after initial operation.

Full Cementation in Revision Total Knee Arthroplasty Using a Constrained Condylar Knee Prosthesis with an Average 7-Year Follow-up

( Ki-tae Kwon ),( Kye-young Han ),( Woon-sang Lee ),( Do-hoon Kim ) 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.4

Purpose: To evaluate clinical and radiological outcome of the full cementation technique in revision total knee arthroplasty (TKA) using a constrained condylar knee (CCK) prosthesis. Materials and Methods: Between January 2008 and March 2012, 18 cases (16 patients) of fully cemented revision TKA were performed using a CCK prosthesis. Fifteen cases of aseptic loosening (13 patients) and 3 cases of infection were included. There were 2 males and 14 females with a mean age of 76.7 years at the time of surgery, and the average follow-up was 81 months. Clinically, the pain score, function score and Hospital for Special Surgery (HSS) score were evaluated. Radiologically, loosening, radiolucent lines and migration of implant were evaluated. Results: Preoperatively, the pain score, function score and HSS score were 50.3, 24.4 and 61.8 points, respectively. At the latest follow-up, the scores were improved to 84.8, 63.6 and 85.6 points, respectively (p<0.05). Loosening or migration of implant was not observed in any cases. Radiolucent lines were observed in 5 cases underneath the tibial component without progression during the follow-up. Conclusions: The full cementation technique in revision TKA using a CCK showed excellent clinical results. Although radiolucent lines were observed in 27.8% underneath the tibial component, there was no progression to loosening or instability.

노면 적응형 대퇴 의족개발을 위한 발목 관절 부하가변형 하퇴 의족 적용에 대한 연구

엄수홍,나선종,류중현,박세훈,이응혁 한국전기전자학회 2019 전기전자학회논문지 Vol.23 No.3

This study is the method which is adapted to control ankle joint movement for resolving the problem of gait imbalancein intervals where gait environments are changed and slope walking, as applying terrain-adaptive technique to intelligentabove-knee prosthesis. In this development of above-knee prosthesis, to classify the gait modes is essential. Fordistinguishing the stance phases and the swing phase depending on roads, a machine learning which combines decisiontree and random forest from knee angle data and inertial sensor data, is proposed and adapted. By using this method, theankle movement state of the prosthesis is controlled. This study verifies whether the problem is resolved throughbutterfly diagram.

Early Clinical Outcomes of a New Posteriorly Stabilized Total Knee Arthroplasty Prosthesis: Comparisons with Two Established Prostheses evi

( Nimesh P. Jain ),( Sung Yup Lee ),( Vivek M. Morey Ms ),( Suri Chong ),( Yeon Gwi Kang ),( Tae Kyun Kim ) 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.3

Purpose: We sought to determine whether early clinical performance of new posterior stabilized (PS) knee system, the Vega-PS (Aesculap), is better than that of two established total knee arthroplasty (TKA) prostheses, the E.motion-PS (Aesculap) and the Genesis II (Smith & Nephew) in terms of functional outcomes, patient satisfaction, and incidence of adverse events. Materials and Methods: We compared the clinical outcomes of 206 consecutive TKAs using Vega-PS with those of 205 TKAs using E.motion-PS and 216 TKAs using Genesis II at 2 years of follow-up. Results: Overall, the knees with the Vega-PS had better functional outcome scores than the knees with the E.motion-PS, but had similar outcome scores to the knees with the Genesis II, as evident from the American Knee Society knee score (94.2 vs. 92.5 vs. 93.2), Western Ontario McMaster Universities Osteoarthritis (WOMAC) stiffness index (1.8 vs. 2.3 vs. 2.0), WOMAC function index (11.8 vs. 16.8 vs. 18.5), Short Form 36 (SF-36) physical component summary score (41.9 vs. 39.3 vs. 41.6), and SF-36 mental component summary score (50.0 vs. 45.8 vs. 46.9). Patient satisfaction was higher in the Vega-PS and Genesis II groups than the E.motion-PS group. No notable group differences were found in terms of the incidence of adverse events. Conclusions: The Vega-PS, a newly developed PS fixed bearing prosthesis, had comparable or superior clinical performance in comparison with the two established fixed or mobile bearing PS prostheses.

Intelligent control of an MR prosthesis knee using of a hybrid self-organizing fuzzy controller and multidimensional wavelet NN

Hassan Sayyaadi,Seiyed Hamid Zareh 대한기계학회 2017 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.31 No.7

A Magneto rheological (MR) rotary brake as a prosthesis knee is addressed here. To the gait of the amputee, the brake, automatically adapts knee damping coefficient using only local sensing of the knee torque and position. It is difficult to design a model-based controller, since the MR knee system has nonlinear and very complicated governing mathematical equations. Hence, a Hybrid self-organizing fuzzy controller and multidimensional wavelet neural network (HSFCMWNN) is proposed here to control the knee damping coefficient using of the inverse dynamics of the MR rotary damper. A Self-organizing fuzzy controller (SOFC) is also proposed and during the control process, the SOFC continually updates fuzzy rules, while at the beginning contains blank fuzzy rules. Therefore the problem of finding appropriate fuzzy rules and consequently membership functions for the design of a fuzzy logic controller is ignored by using of the SOFC. It is, however, difficult to select appropriate parameters (learning rate and weighting distribution) in the SOFC which are crucial for control of MR prosthesis knee. To deal with this drawback, a hybrid self-organizing fuzzy and multidimensional wavelet neural network is employed appropriately. The proposed strategy uses a Multidimensional wavelet neural network (MWNN) to adjust these parameters in real time, to achieve to optimal values. First, the MWNN is trained by Stochastic gradient algorithm (SGA) and then to reduce the learning cycle to be needed and the appropriate error, a learning procedure based on the Levenberg-Marquardt (LM) algorithm is adopted intentionally. Simulation results demonstrate that the HSFCMWNN performs better in control performance than that of the SOFC in improving gait of the amputee.

Full Cementation in Revision Total Knee Arthroplasty Using a Constrained Condylar Knee Prosthesis with an Average 7-Year Follow-up

권기태,한규영,이운상,김도훈 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.4

Purpose: To evaluate clinical and radiological outcome of the full cementation technique in revision total knee arthroplasty (TKA) using a constrained condylar knee (CCK) prosthesis. Materials and Methods: Between January 2008 and March 2012, 18 cases (16 patients) of fully cemented revision TKA were performed using a CCK prosthesis. Fifteen cases of aseptic loosening (13 patients) and 3 cases of infection were included. There were 2 males and 14 females with a mean age of 76.7 years at the time of surgery, and the average follow-up was 81 months. Clinically, the pain score, function score and Hospital for Special Surgery (HSS) score were evaluated. Radiologically, loosening, radiolucent lines and migration of implant were evaluated. Results: Preoperatively, the pain score, function score and HSS score were 50.3, 24.4 and 61.8 points, respectively. At the latest follow-up, the scores were improved to 84.8, 63.6 and 85.6 points, respectively (p<0.05). Loosening or migration of implant was not observed in any cases. Radiolucent lines were observed in 5 cases underneath the tibial component without progression during the follow-up. Conclusions: The full cementation technique in revision TKA using a CCK showed excellent clinical results. Although radiolucent lines were observed in 27.8% underneath the tibial component, there was no progression to loosening or instability.

Comparison of Patellofemoral Outcomes between Attune and PFC Sigma Designs: A Prospective Matched-Pair Analysis

Rajesh Navin Maniar,Nishit Bhatnagar,Rohan Bidwai,Ankur Dhiman,Debashish Chanda,Nishant Sanghavi 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.1

Background: Attune (DePuy Synthes) prosthesis was designed to overcome patellofemoral complications associated with PFC Sigma (DePuy Synthes) prosthesis. The aim of our study was to compare the incidence of anterior knee pain (AKP), patellofemoral crepitus (PCr), and functional outcome between them. Methods: This prospective matched-pair study was conducted between January 2014 and June 2015, during which 75 consecutive Attune total knee arthroplasties (TKAs) were matched with 75 PFC Sigma TKAs based on age, sex, body mass index, pathology, and deformity. A single surgeon performed all the operations with aid of computer navigation, using a posterior-stabilized prosthesis with patellar resurfacing. Outcome was assessed by new Knee Society Score (NKSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. AKP and PCr were assessed by a patient-administered questionnaire till 2 years of follow-up. Three pairs were lost to follow-up and finally 72 pairs were analyzed. Results: One patient in each group reported AKP and 1 patient from each group had PCr at 2 years postoperatively. None of these patients required additional surgery. The incidence of lateral retinacular release was higher with PFC Sigma (5/72) than Attune (2/72); however, this was statistically not significant (p = 0.4). The Attune group had a significantly greater range of motion (ROM) at 3 months postoperatively (p = 0.049). At final follow-up, ROM was comparable between two prosthesis designs. NKSS and WOMAC scores were also comparable between the groups. Conclusions: We observed that both Attune and PFC Sigma had a low and comparable incidence of AKP and PCr up to 2 years of follow-up. The Attune group achieved a significantly greater ROM at 3 months postoperatively. At 2 years of follow-up, both prostheses had excellent and comparable clinical and functional results.