Causes of Aseptic Persistent Pain after Total Knee Arthroplasty

임홍안,송은교,선종근,박경순,신영주,양홍연 대한정형외과학회 2017 Clinics in Orthopedic Surgery Vol.9 No.1

Background: Persistent pain after total knee arthroplasty (TKA) is dissatisfying to the patient and frustrating to the surgeon. The purpose of this study is to evaluate the aseptic causes and clinical course of intractable pain following TKA. Methods: Of the total 2,534 cases of primary TKA reviewed, 178 cases were classified as having aseptic persistent pain that was not resolved within 1 year after surgery. Except for the cases with periprosthetic fracture (56 knees), 122 cases of aseptic painful TKA were divided into two groups: intra-articular group (83 knees) and extra-articular group (39 knees). Results: In the intra-articular group, the main reasons for pain were aseptic loosening (n = 40), polyethylene wear (n = 16), instability (n = 10), recurrent hemarthrosis (n = 5), patellar maltracking (n = 4), tendon ruptures (n = 4), and stiffness (n = 2). In the extraarticular group, 10 knees (25.6%) were found to have nerve entrapment in the spine, 6 knees (15.4%) were found to have hip osteoarthritis or femoral head avascular necrosis. The reasons for persistent knee pain in the remaining 23 knees (59.0%) still remain elusive. Conclusions: Persistent pain after TKA originated from pathology of extra-articular origin in a considerable number of cases in this study. Therefore, it is important to perform thorough preoperative evaluations to reduce pain resulting from extra-articular causes. Furthermore, meticulous surgical procedures and optimal alignment are required to reduce pain of intra-articular origin related to implant wear, instability, and patellar maltracking.

요추간판 탈출증 환자에서 부분 마취하와 전신 마취하에 시행한 현미경적 요추간판 절제술의 비교

서형연,임홍안 대한척추외과학회 2013 대한척추외과학회지 Vol.20 No.4

Study Design: Retrospective study. Objectives: To evaluate the effectiveness of microdiscectomy under local anesthesia in comparison with general anesthesia. Summary of Literature Review: No comparative studies regarding the outcomes of microdiscectomy under local and general anesthesia could be found in the literature. Materials and Methods: Between May 2000 and June 2004, 88 patients who underwent microdiscectomy under local anesthesia (n=50,local anesthesia group) or under general anesthesia (n=38, general anesthesia group) were selected and included in this study with a follow up period more than 3 years. The operation time and duration of hospital stay were documented. The Visual Analogue Scale (VAS)and the Oswestry Disability Index (ODI) were used to evaluate the degree of symptom relief. The patient satisfaction was evaluated using the MacNab’s criteria and postoperative complications. Results: Between both groups there is no significant operation time difference. However, the average hospital stay duration in the general anesthesia group was 7.3 days, while it was 4.7 days in the local anesthesia group (P<0.05). The VAS and ODI scores were improved in both groups. Thirty-two cases (84.2%) of the general anesthesia group and 40 cases (80%) of the local anesthesia group showed satisfied results by the MacNab’s criteria with no statistically significant difference (P>0.05). Three patients in the general anesthesia group and 7 patients in the local anesthesia group needed a reoperation. Conclusions: A microdiscectomy under local anesthesia shows faster recovery period. But it shows also a relative high revision rate. In patients with old age and underlying disease, local anesthesia can be used for the microdiscectomy selectively and careful exploration of the herniated disc is required. 연구 계획: 후향적 연구. 목적: 부분 마취하에 현미경적 요추간판 절제술을 시행한 군과 전신 마취하에 시행한 군의 임상적 결과를 비교함으로서 부분 마취하 현미경적 요추간판 절제술의 효용성에 대하여 알아보고자 하였다. 선행문헌의 요약: 현미경적 요추간판 절제술에 있어서 부분 마취하와 전신 마취하의 임상적 결과를 비교한 연구는 아직 보고되지 않았다. 대상 및 방법: 2000년 5월부터 2004년 6월까지 현미경적 요추간판 절제술을 받고 3년 이상 추시가 가능하였던 88명의 환자를 선택한 다음 부분 마취하에 시행한 50명을 부분 마취군, 전신 마취하에 시행한 38명을 전신 마취군으로 구분하였다. 두 군간의 수술 시간 및 재원 기간을 비교하고 Visual Analogue Scale (VAS) 점수와 Oswestry Disability Index (ODI) 점수를 증상의 개선 정도를 평가하는데 사용하였다. 환자의 만족도는 MacNab’s criteria 및술 후 합병증의 발생 빈도를 통하여 알아보았다. 결과: 수술 시간에 있어서 두 군간의 유의한 차이는 없었으나 평균 재원 기간은 부분 마취군에서 4.7일인 반면 전신 마취군에서 7.3일이었다 (P<0.05). VAS 점수 및 ODI 점수는 두 군 모두 호전되었으며 MacNab’s criteria에 의하면 전신 마취군에서는 32예 (84.2%), 부분 마취군에서는 40예 (80%)에서 만족스러운 결과를 보고하였으며 두 군간의 통계학적 차이는 없었다. 전신 마취군에서는 3예(재발 2예, 혈종 1예), 부분 마취군에서는 7예(재발 5예, 혈종1예, 감염 1예)에서 재수술을 시행하였다. 결론: 부분 마취하 현미경적 요추간판 절제술은 회복 기간이 빨랐으나 높은 재수술률을 보였다. 고령 및 기저 질환 동반 환자에서 선택적으로 부분 마취하 현미경적 요추간판 절제술을 시행할 수 있겠으며 탈출된 추간판 조직의 주의깊은 탐색이 필요하다.

Causes and Clinical Outcomes of Revision Total Knee Arthroplasty

이동현,이성훈,송은규,선종근,임홍안,양홍열 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.2

purpose: The purpose of this study was to evaluate causes and clinical outcomes of revision total knee arthroplasty (TKA) with a minimum 2­year follow­up.Materials and Methods: We performed a retrospective review on the records of 225 revision TKAs performed from 2003 to 2012 at a single institution. Finally, 206 cases were conducted. To evaluate clinical outcomes, we checked the range of motion (ROM), Knee Society (KS) score, Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score preoperatively, 6 months postoperatively and yearly thereafter and complications after revision TKA.results: The causes of revision TKA were septic complications in 120 and aseptic complications in 86. The main aseptic complication was periprosthetic fracture in 36, followed by 25 loosening, 13 polyethylene wear and 9 instability. At the final follow­up, patients showed improvements in ROM and KS, HSS and WOMAC scores. Of the total, 7 patients underwent re­revision due to reinfection in 6 and periprosthetic fracture in 1.conclusions: Due to development of implants and surgical techniques, mechanical complications such as aseptic loosening and instability that need a revision decreased whereas septic complications relatively increased. Therefore, we should be cautious for the occurrence of infection. Overall, revision TKA provided clinical improvement in knee function and patient satisfaction.

Robotic Total Knee Arthroplasty with a Cruciate-Retaining Implant: A 10-Year Follow-up Study

양홍연,선종근,신영주,임홍안,송은규 대한정형외과학회 2017 Clinics in Orthopedic Surgery Vol.9 No.2

Background: This study compared clinical and radiological results between robotic total knee arthroplasty (TKA) and conventional TKA with a cruciate-retaining implant at 10-year follow-up. The hypothesis was that robotic TKA would allow for more accurate leg alignment and component placement, and thus enhance clinical and radiological results and long-term survival rates. Methods: A total of 113 primary TKAs performed using a cruciate-retaining implant in 102 patients from 2004 to 2007 were reviewed retrospectively. Of the 113 TKAs, 71 were robotic TKAs and 42 were conventional TKAs. Clinical outcomes (visual analogue scale pain score, Hospital for Special Surgery score, Western Ontario and McMaster University score, range of motion, and complications), radiological outcomes, and long-term survival rates were evaluated at a mean follow-up of 10 years. Results: Clinical outcomes and long-term survival rates were similar between the two groups. Regarding the radiological outcomes, the robotic TKA group had significantly fewer postoperative leg alignment outliers (femoral coronal inclination, tibial coronal inclination, femoral sagittal inclination, tibial sagittal inclination, and mechanical axis) and fewer radiolucent lines than the conventional TKA group. Conclusions: Both robotic and conventional TKAs resulted in good clinical outcomes and postoperative leg alignments. Robotic TKA appeared to reduce the incidence of leg alignment outliers and radiolucent lines compared to conventional TKA.

인공 고관절 치환술에서의 무시멘트 인공 삽입물

윤택림 ( Taek Rim Yoon ),박경순 ( Kyung Soon Park ),임홍안 ( Hong An Lim ) 대한고관절학회 2013 Hip and Pelvis Vol.25 No.1

The various implants used in total hip arthroplasty can be classified according to the design and the fixation type. In general, they can be divided into two groups; cemented and cementless types. The surgeon`s decision regarding which type of implant to use should be based on the goal of the arthroplasty operation, the bony deformity of the patient, the function of the involved hip joint, and the experience of the operator. When using cementless implants, primary fixation, survival rate, and successful fixation on long-term follow-up depend on the material of the implant, the bone quality, and, ultimately, the interaction between the implant and the bone. Cementless implants have shown a high success rate in primary total hip arthroplasty and relatively fine outcomes on long-term follow-up. In comparison of the two implant types, superiority has yet to be determined, however, a choice made based on the objective of the surgery, the function of the joint, the quality of the bone, and the surgeon`s experience will result in a good outcome. Therefore, we reviewed the qualities of cementless implants, the application, and the various procedures involving the implant.