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The early detection of deep infection is very important for the total knee replacement because post-TKR infection affords disastrous results. The C-reactive protein is widely used as a marker for detection of postoperative infection. But there were few papers ahout C-reactive protein levels after total joint replacement, especially after total knee replacement respect to its value. We analysed the change of C-reactive protein value after total knee replacement in osteoarthritis and rheumatoid arthritis, peiformed from April, 1993 to Dec. 1995. The results are as follows: 1. In OA, postoiperative maximum C-reactive protein values were reached in 3 day at'ter surgeq. The C- reactive protein values werc decreased fastly and then, the values were consistently normalized nearly 2 weeks after the operation. 2. The C-reactive protein levels in RA were higher than in OA before the operation. The values were restored to pre-operative level in nearly 1 week after operation. 3. The peak level of C-reactive protein was usually reached on the third day after the operation. The incidence of high value in C-reactive protein, above 10 mg/dl, was more frequent in OA than in RA. 4. The bone cement gives no effect on C-reactive protein values in OA and RA. We think that this results will be helpful for early detection of infection after total knee replacement.
Authors performed a retrospective matched-pair study for 64 uncemented total hip arthroplasty which include same number of hips with porous coated and HA(Hydroxyapatite) porous coated femoral components using same kind of implant (Zimmer Anatomic') to identify whether HA coat was efficient to get more favorable clinical results. Results were as followings. Excellent function was achieved at 6 months in HA group and 1 year in porous group and mean Harris hip score main- tained higher in HA group compare to porous group for whole period of follow up. Mean time of weight bearing without support since operation was 6.4 weeks in HA group and 10.1 weeks in porous group, which was statistically significant. Endosteal bone formation was noted mostly in zone 2, 6 in both groups and appeared earlier with larger extent and higher incidence in HA group compare to porous group. Radiolucencies were seen in zone 4 most commonly in both groups and the extent and the incidence of radiolucency were smaller and lower in HA group compare to porous group. Endosteal osteolysis were seen in 2 cases in HA group and 3 cases in porous group, and that in HA group was noted first earlier and smaller in mean size compare to that in porous group. Engh s radiologic score for fixation and stability was increasing in fixation scale and decreasing in stability scale with time in both groups, and maintain higher in HA group compare to porous group. Conclusively, HA coated implants improved and stabilized clinical and radiologic results earlier, and maintained superior results compare to porous coated implants until average 5 years follow up.
Authors reviewed 85 primary total hip arthroplasties in which a Harris-Galante porous coated acetabular component had been used with minimum 2 years follow up (average 50 months) to identify the radiographic and clinical results. The results were followings. 1. With insertion of uncemented acetabular component with line to line technique, initial gaps were existed in 44 of 85 cases (51.8%) and present predominant in zone 1. 2. Incidence of radiolucent line in cases without initial gap was lower than that initial gap, but which was not statistically significant. 3. Incidence of progressive radiolucent line in cases without initial gap was significantly lower than that with initial gap. 4. Mean liner wear rate was 0.31 +-0.14mm/year 5. 2 cases of pelvic osteolysis and 1 case of aseptic loosening were developed, and 2 cases of revisions were performed because of recurrent dislocation and dislodgement of polyethylene liner. 6. Final radiographic results according to Glassman and Engh's criteria in cases without initial gap were better than those with initial gap. Conclusively, radiographic results without initial gap between uncemented acetabular component and bone were significantly better than those with initial gap, especially in terms of the incidence of progressive radiolucent line. So, it is necessary to improve surgical technique to eliminate or reduce initial peripheral gap around socket, and press fit might be one of the good answer.