Medial Unicompartmental Knee Arthroplasty in Patients with Spontaneous Osteonecrosis of the Knee

Won Sik Choy,Kap Jung Kim,Sang Ki Lee,Dae Suk Yang,Choon-Myeon Kim,Ju Sang Park 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.4

Background: We analyzed the clinical and radiologic results of patients with spontaneous osteonecrosis of the knee treated byminimally invasive medial unicompartmental arthroplasty using Oxford Uni. Methods: We reviewed 22 knees in 21 patients which were treated for spontaneous osteonecrosis between 2002 and 2006. Patientsincluded one male and 20 females. The mean age was 70.8 years (range, 53 to 82 years). The mean follow-up period was70.3 months (range, 48 to 93 months). The clinical results were evaluated using the Hospital for Special Surgery (HSS) knee scoreand the range of motion of the knee preoperatively and at the fi nal follow-up. Preoperative plain radiographs and magnetic resonanceimages were analyzed to determine the size and stage of osteonecrotic lesions. Results: The mean HSS knee score was 64.3 (range, 54 to 75) preoperatively and 92.0 (range, 71 to 100) at the fi nal follow-up. The mean preoperative fl exion contracture was 8.9o (range, 0 to 15o) and 0.2o (range, 0 to 5o) at the fi nal follow-up. The mean furtherfl exion increased from 138.6o (range, 100 to 145o) preoperatively to 145.6o (range, 140 to 150o) at the fi nal follow-up. Activefull fl exion was possible within 2 months of the operation. The squatting position was possible in 16 patients (84.2%) out of 19,except one case of bronchiectasis and one case of spine fracture. The cross-leg posture was possible in 19 patients (90.5%) out of21. The mean tibiofemoral angle was improved from varus 0.98o to valgus 3.22o. Meniscal bearing dislocation occurred in 2 casesand femoral component loosening occurred in 1 case. Conclusions: Unicompartmental knee arthroplasty using Oxford Uni could be an alternative treatment option in spontaneous osteonecrosisof the knee.

Ceramic-on-Ceramic Total Hip Arthroplasty: Minimum of Six-Year Follow-up Study

Won Sik Choy,김갑중,이상기,Kyoung Wan Bae,Yoon-Sub Hwang,Chang Kyu Park 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.3

Background: This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard towear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years. Methods: We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that hadbeen performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). Themean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%),degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septichip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groinor thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures. Results: The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoralstems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), andaround the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around thecup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes ofacetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years. Conclusions: The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with nodetectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option ofprimary total hip arthroplasty for variable indications.

Mid-Term Results of Oxford Medial Unicompartmental Knee Arthroplasty

Won-Sik Choy,Kap Jung Kim,Sang Ki Lee,Dae Suk Yang,Neung Ki Lee 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.3

Background: This study examined the clinical and radiologic mid-term results of patients treated by Oxford minimally invasiveunicompartmental knee arthroplasty. Methods: One hundred and eighty-eight knees of unicompartmental knee arthroplasties with Oxford Uni® in 166 patients (16males and 150 females), which were performed between 2002 and 2005, were reviewed. The mean age was 65.3 years (range, 44to 82 years) and the mean follow-up period was 79.8 months (range, 56 to 103 months). The preoperative diagnosis was osteoarthritisin 166 patients, osteonecrosis of the medial femoral condyle in 20 and chondrocalcinosis in 2. Results: The mean Hospital for Special Surgery (HSS) knee score was 67.5 (range, 52 to 75) preoperatively and 89.9 (range, 85to 100) at the fi nal follow-up. The mean preoperative fl exion contracture was 6.5o (range, 0 to 15o) and 0.8o (range, 0 to 5o) at thefi nal follow-up. The mean full fl exion increased from 135o (range, 90 to 150o) preoperatively to 150o (range, 140 to 165o) at the fi nalfollow-up. Active full fl exion was possible within 2 postoperative months. The squatting and cross-leg postures were possible in133 patients (80.1%) and 152 patients (91.6%) at the fi nal follow-up. The mean tibiofemoral angle was improved from varus 1.5oto valgus 4.8o. Complications were encountered in 18 cases (9.5%). A bearing dislocation occurred in 10 cases (5.3%), tibial componentloosening in 4 cases (2.1%), femoral loosening in 3 cases (1.6%) and lateral translation in 1 case (0.5%). The mean time fora bearing dislocation was 22.6 months (range, 3 to 70 months) postoperatively. Seven cases returned to the predislocation level ofactivity with the insertion of a thicker bearing and 3 cases converted to total knee arthroplasty. Conclusions: Minimally invasive unicompartmental knee arthroplasty with Oxford Uni® provided rapid recovery, good pain reliefand excellent function suitable for the Korean lifestyle. In contrast, the high complication rates of Oxford Uni® encountered in themid-term results suggested less reliability than total knee arthroplasty.

Modular Hemiarthroplasty for the Treatment of Fractures of the Proximal Humerus

Won-sik Choy,Kwang-won Lee,Moon-ho Sohn,Young-wan Kim 대한견주관절의학회 1997 대한견주관절학회 학술대회논문집 Vol.1997 No.5

Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients

Won Sik Choy,안재훈,Joon-Hyuk Ko,Byoung Sup Kam,Do-Hyun Lee 대한정형외과학회 2010 Clinics in Orthopedic Surgery Vol.2 No.4

Background: Bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients is a viable option that can prevent the complications of an open reduction, such as nonunion and metal failure. This study evaluated the clinicoradiological results of cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients. Methods: Forty hips were followed for more than 2 years after cementless bipolar hemiarthroplasty using a Porocoat® AML Hip System. The mean age was 78.8 years and the mean follow-up period was 40.5 months. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using a range of indices. Results: At the last follow-up, the mean Harris hip score was 80.6 points. There were one case of hip pain and one case of thigh pain. Twenty-four cases (60%) showed no decrease in ambulation capacity postoperatively. Radiologically, there were 23 cases (57.5%) of fixation by bone ingrowth and 17 cases (42.5%) of stable fibrous fixation. There were no cases of osteolysis. Eleven cases (27.5%) of new bone formation were found around the stem. All stems were stable without significant changes in alignment or progressive subsidence. Conclusions: The short-term results of cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures were satisfactory.

Preliminary Results of Uncemented Metal on Metal Total Hip Replacement Arthroplasty

Won-Sik Choy(최원식),Kwang-Won Lee(이광원),Whoan-Jeang Kim(김환정),Ha-Yong Kim(김하용),Young-Wan Kim(김영완),In-Sung Hwang(황인성),In-Sik Hwang(황인식) 대한정형외과학회 1998 대한정형외과학회지 Vol.33 No.6

동일인에서 슬관절 전 치환술 및 단일 구획 치환술 후 보행 분석 비교

최원식(Won-Sik Choy),김하용(Ha-Yong Kim),김갑중(Kap-Jung Kim),감병섭(Byung-Sup Kam) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.4

목적: 통일 환자에서 시행한 슬관절 단일 구획 치환술(UKA)과 전 치환술(TKA) 후 보행을 비교하고자 하였다. 대상 및 방법: 동일 환자에서 슬관절 전 치환술과 단일 구획 치환술을 받은 12예를 대상으로 하였다. 평균 연령은 70.3세(64-74)였다. 보행 분석은 슬관절 전 치환술 후 평균 14.6개월, 단일 구획 치환술 후 11.8개월에 시행하였다. 임상적, 방사선 평가 및 3차원 보행 분석을 시행하였다. 비슷한 연령대의 여자 7예를 대조군으로 하였다. 결과: 양 군 모두 임상적, 방사선학적으로 호전되었다. 보행 속도, 골반 경사, 초기 입각기의 슬관절 굴곡, 최대 슬관절 굴곡, 초기 입각기에서 하중 반응기 사이의 슬관절 운동 범위와 중간 입각기에서 초기 유각기 사이의 슬관절 운동 범위 및 족관절의 3호 족저 굴곡을 제외하고 양 군에서 정상 보행 형태를 보였다. 시상면상 초기 입각기에서 양 군의 슬관절 굴곡 정도가 유사했으나 정상 대조군과 차이가 있었으며, 하중 반응기에서는 양 군과 정상 대조군 간에 차이는 거의 없었다. 운동 역학에서 말기 입각기의 발들림 모우멘트, 하중 반응기의 수직 지면 반발력, 초기 입각기의 고관절 신전 모우멘트 및 힘 값에서 UKA군이 정상에 가까운 결과를 보였다. 결론: 단일 구획 치환술과 전 치환술 후 보행 양상은 정상에 가깝게 회복되었다. 골 변형 교정은 전 치환술을 시행 받은 군에서 더욱 정상적인 정렬을 보였으며, 운동 역학적으로는 지면 반발력 등의 측면에서 UKA군이 더욱 정상에 가깝게 회복되었다. Purpose: To compare the gait characteristics of unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) performed on the same patient. Materials and Methods: Twelve female patients with advanced degenerative arthritis of both knee joints were enrolled for the study group. The mean age was 70.3 (64-74) years old. One side of the knee joint had been replaced with UKA and the other side with TKA. The mean follow-up period was 11.8 months for the UKA side and 14.8 months for TKA side. The clinical and radiographic evaluations were performed. The gait features of the study group were assessed using computerized gait analysis. Seven age-matched healthy female volunteers (14 knees) were included as the normal control group. Results: The clinical and radiographic results improved after joint replacement in both groups. The postoperative gait was almost normalized regardless of the type of surgery performed, with the exception of some parameters including the walking speed, mean pelvic tilt, knee flexion at initial contact, peak knee flexion, knee flexion between initial contact and loading response, knee flexion between initial swing phase and mid-stance phase and ankle 3rd rocker. Knee flexion at the initial contact of UKA and TKA groups was similar, and was different from that of the normal control group. At the loading response, the amount of knee flexion was similar between the three groups. Kinetic data of the first peak vertical ground reaction force and hip extension moment at loading response were better in the UKA group. Conclusion: The gait features were normalized in both groups. The UKA group was better normalized than the TKA group in terms of the aspect of the gait features, whereas TKA group showed better correction of deformities.

Ilizarov 술식을 이용한 경골 천정 골절의 치료

최원식(Won Sik Choy),이광원(Kwang Won Lee),김환정(Whan Jeung Kim),민영식(Young Sik Min),김하용(Hwa Yong Kim),김유인(Yoo In Kim) 대한정형외과학회 1997 대한정형외과학회지 Vol.32 No.4

무시멘트 인공 고관절 치환술에서 tapered 대퇴삽입물의 방사선학적 분석

최원식(Won-Sik Choy),안재훈(Jae Hoon Ahn),황인식(In-Sik Hwang) 대한정형외과학회 2000 대한정형외과학회지 Vol.35 No.6

무시멘트 인공 고관절 전치환술 후 대퇴삽입물 주위의 골밀도 변화

최원식(Won-Sik Choy),안재훈(Jae Hoon Ahn),이광원(Kwang-Won Lee),김환정(Whoan-Jeang Kim),김하용(Ha-Yong Kim),박용범(Yong Bum Park),황인성(In-Sung Hwang) 대한정형외과학회 1999 대한정형외과학회지 Vol.34 No.6