• Journal of Veterinary Clinics
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• v.31 no.2
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• pp.125-128
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• 2014

A 7-year-old, intact female Golden Retriever weighing 38 kg was referred for left coxofemoral joint luxation. On physical examination, pain and crepitus were noted atthe left hip joint during joint extension. Radiological examination revealed coxofemoral joint luxation and mild degenerative bone changes in the left hip joint. We performed minimally invasive arthroscopy-assisted reduction with TightRope$^{(R)}$ as a treatment option; however, the left coxofemoral joint was reluxated after one month postoperatively. We performed cementless total hip replacement (THR) of the luxated left coxofemoral joint. At tenmonths after surgery, the dog could sit, stand, walk normally and jump comfortably without lameness. The thigh girth measurement of the operated limb was 108.6% of the contralateral limb. Based on the present case, THR can be a successful treatment for coxofemoral joint luxation in dogs with failed coxofemoral joint reduction.

• Journal of Veterinary Clinics
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• v.31 no.2
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• pp.121-124
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• 2014

A 7-year-old, intact female Jindo dog was presented for assessment of weight-bearing lameness of the right hindlimb. On physical examination, crepitus and pain was noted in the right coxofemoral joint upon extension. Radiographs revealed a craniodorsal luxation of the right coxofemoral joint and degenerative joint disease (DJD) of both coxofemoral joints. Total hip replacement (THR) was performed for the right coxofemoral joint. Intraoperatively, dorsal acetabular rim (DAR) deficiency was noted, which can be related to a high risk for acetabular cup implant dislocation. Deficiency of the dorsal acetabular rim realigned with the acetabular cup using universal locking plate (ULP) and polymethylmethacrylate (PMMA) bone cement. After surgery, the patient had an uneventful course and a successful outcome. The ROM and thigh girth were dramatically improved. There were no complications associated with prosthesis implants. Hip luxation with dorsal acetabular rim deficiency in a dog was successfully repaired with THR and dorsal acetabular rim augmentation using ULP and PMMA bone cement. This technique should be considered when conventional THR is precluded by dorsal acetabular rim deficiency.

• Journal of the Korean Orthopaedic Association
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• v.56 no.3
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• pp.253-260
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• 2021

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.

• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.244-252
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• 2020

Purpose: Total femoral replacement (TFR) is an extreme form of limb salvage. Considering the rarity of this procedure, reports have focused on the complications and a proper indication is unclear. This study analyzed 36 patients with TFR who were asked the following: 1) prognostic factors related to survival in patients who underwent TFR with a tumoral cause; 2) overall implant and limb survival; 3) complications, functional outcome, and limb status for patients surviving for more than 3 years. Materials and Methods: According to the causes for TFR, 36 patients were categorized into three groups: extensive primary tumoral involvement (group 1, 15 cases), tumoral contamination by an inadvertent procedure or local recurrence (group 2, 16 cases), and salvage of a failed reconstruction (group 3, 5 cases). The factors that may affect the survival of patients included age, sex, cause of TFR, and tumor volume change after chemotherapy. Results: The overall five-year survival of the 36 patients was 31.5%±16.2%. The five-year survival of 31 patients with tumoral causes was 21.1%±15.6%. The five-year survival of 50.0%±31.0% in patients with a decreased tumor volume after chemotherapy was higher than that of increased tumor volume (p=0.02). The five-year survival of 12 cases with a wide margin was 41.7%±27.9%, whereas that of the marginal margin was 0.0%±0.0% (p=0.03). The ten-year overall implant survival of 36 patients was 85.9%±14.1%. The five-year revision-free survival was 16.6%±18.2%. At the final follow-up, 12 maintained tumor prosthesis, three underwent amputation (rotationplasty, 2; above knee amputation, 1), and the remaining one had knee fusion. Among 16 patients with a follow-up of more than three years, 14 patients underwent surgical intervention and two patients had conservative management. Complications included infection in 10 cases, local recurrences in two cases, and one case each of hip dislocation, bushing fracture, and femoral artery occlusion. Conclusion: Patients showing an increased tumor volume after chemotherapy and having an inadequate surgical margin showed a high chance of early death. In the long-term follow-up, TFR showed a high infection rate and the functional outcome was unsatisfactory. Nevertheless, this procedure is an inevitable option of limb preservation in selected patients.

• Journal of the Korean Orthopaedic Association
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• v.56 no.1
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• pp.26-33
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• 2021

Purpose: This study evaluated the results of dual plate fixation for periprosthetic femur fracture after total knee arthroplasty (TKA). Materials and Methods: From October 2007 to February 2013, 23 cases of periprosthetic femur fracture after TKA were treated at the author's hospital. There were 13 cases of fixation using a medial and lateral dual plate when the stability of the fracture site could not be achieved by one side fixation with a follow-up of more than one year. The cases included no loosening of the femoral component in fractures that were categorized as Lewis-Rorabeck classification II and supracondylar comminuted fractures and elongation of the fracture line to the lateral epicondyle of the femur or stem in the medullary canal. The mean age was 72 years (65-82 years), and 11 cases were female. Three cases had a stem due to revision. The mean bone marrow density was -3.2 (-1.7 to -4.4), and the mean period from primary TKA to periprosthetic fractures was 28 months (1-108 months). The mean follow-up period was 23 months (12-65 months). The medial fracture site was first exposed via the subvastus approach. Second, the supplementary plate was fixed on the lateral side of the fracture using a minimally invasive plate osteosynthesis technique. The average union time, complications, and Hospital for Special Surgery Knee Score (HSS) at the last follow-up were evaluated. Results: The mean union time was 17.4 weeks (7-40 weeks). Two cases showed delayed bone union and nonunion occurred in one case, in whom bone union was achieved three months later after re-fixation using a dual plate with an autogenous bone graft. The mean varusvalgus angulation was 1.67 degrees (-1.2-4.9 degrees), and the mean anterior-posterior angulation was 2.86 degrees (0-4.9 degrees) at the last follow-up. The mean knee range of motion was 90 degrees, and the HSS score was 85 points (70-95 points) at the last follow-up. Conclusion: Dual plate fixation for periprosthetic femur fractures that had not achieved stability by one side plate fixation after TKA showed a good clinical result that allowed early rehabilitation.

• Journal of Biomedical Engineering Research
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• v.23 no.2
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• pp.119-130
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• 2002

The nonlinear finite element program has been developed to analyze the design performance of an artificial hip prosthesis and long term behavior of a treated femur with stems made of composite material after cementless total hip arthroplasty(THA). The authors developed the three dimentional FEM models of femoral bone with designed composite stem which was taken with elliptic cross section of 816 brick elements under hip contact load and muscle farce in simulating single leg stand. Using the program, density changes, stress distributions and micromotions of the material femoral bone were evaluated by changing fiber orientation of stems for selected manufacturing method such as plate cut and bend mold. The results showed that the composite materials such as AS4/PEEK and T300/976 gave less bone resorption than the metallic material such as cobalt chrome alloy, titanium alloy and stainless steal. It was found that increasing the long term stability of the prosthesis in the femur could be obtained by selecting the appropriate ply orientation and stacking sequence of composite.

• Proceedings of the KSME Conference
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• 2008.11a
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• pp.1518-1520
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• 2008

Recent clinical studies have shown that computer navigation for total knee arthroplasty (TKA) provides improved component alignment accuracy. However, femoral stress fracture after computernavigated TKA have been reported due to the pin hole and we hypothesized that osteoporosis would be one of the key factors in pin hole fracture after computer-navigated TKA. We investigated the von-Mises stress around the femoral pin-hole for different elastic modulli and ultimate stresses and four different pin penetration modes to understand the aging effect on femoral stress fracture risk after computer-navigated TKA by finite element analysis. In this study, aging effect was shown to increase the femoral stress fracture risk for all pin penetration modes. Especially, aging effect was shown dramatically in the transcortical pin penetration mode.

• Journal of the Korean Orthopaedic Association
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• v.55 no.2
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• pp.117-126
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• 2020

Total knee arthroplasty is performed widely in degenerative arthritis of the knee joint, and the frequency of use is increasing. Efforts should be made to achieve functional recovery, such as returning to daily life, and the recovery of strength and range of motion after surgery. The procedure should be approached from a range of perspectives, such as patient factors, surgical technique and rehabilitation. The patient's age, degree of obesity, sex, and strength of the quadriceps muscle can affect the functional recovery after surgery. In addition, the patient's mental state, such as expectation value and satisfaction, can also have an effect. For functional recovery, patient education, pain control, and strengthening of the quadriceps muscle can be performed prior to surgery. Postoperative physiotherapy, such as icing and compression, transcutaneous electrical nerve stimulation therapy, neuromuscular electrical stimulation therapy, low frequency low intensity magnetic field therapy, strengthening of quadriceps muscle, and range of motion exercise can also be applied. In recent years, hydrotherapy, which restores the strength and balance of the leg, is being performed increasingly. These treatments are not only performed shortly after surgery, but are also performed continuously. In addition, the surgeon should apply it appropriately considering the patient's condition, compliance, and social and psychological conditions.

• Journal of the Korean Orthopaedic Association
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• v.53 no.6
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• pp.490-497
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• 2018

Purpose: To evaluate the utility of ceramic-on-polyethylene articular bearing surface when cementless total hip arthroplasty is performed in patients older than 65 years through an analysis of the minimum five-year follow-up results using the ceramic femoral head and cross-linked polyethylene liner. Materials and Methods: From March 2010 to September 2012, 51 patients (56 hips) who were older than 65 years were enrolled in this retrospective study. The mean age at surgery was $70.9{\pm}5.1years$ old. A clinical assessment was analyzed using the Harris hip score. For the radiographic assessment, the cup inclination and anteversion, stem alignment, and wear amount were measured. The postoperative complications were also determined. Results: The mean Harris hip score was improved from preoperative 48 points to postoperative 87 points (p<0.05). The mean cup inclination was $40.9^{\circ}{\pm}6.4^{\circ}$ and the mean cup anteversion was $20.3^{\circ}{\pm}8.1^{\circ}$. The mean cup anteversion of the elevated liner-used group (16 cases) was $14.3^{\circ}{\pm}7.9^{\circ}$ and the mean cup anteversion of the neutral liner used group (40 cases) was $22.4^{\circ}{\pm}9.1^{\circ}$ (p<0.05). The mean stem alignment angle was $0^{\circ}$ (range, varus $4^{\circ}$-valgus $4^{\circ}$). The mean linear wear amount was $0.458{\pm}0.041mm$ and the average annual linear wear rate was $0.079{\pm}0.032mm/yr$. Six cases (10.7%) of intraoperative periprosthetic femoral fractures were encountered. Conclusion: Based on these results, the use of a ceramic-on-polyethylene articular bearing surface in elderly patients with cementless total hip arthroplasty is beneficial. On the other hand, careful effort is needed to prevent intraoperative periprosthetic femoral fractures.

• Journal of Korean Orthopaedic Sports Medicine
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• v.11 no.1
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• pp.51-56
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• 2012

Purpose: Golf is a popular sports activity after total knee arthroplasty in old age patients. We evaluated golf and implant loosening through the radiologic method. We also evaluated correlation of patterns of golf activity and clinical outcome to suggest guidelines to the patients. Materials and Methods: We carried out a retrospective case-control study of 80 patients (80 knees) who underwent TKR between 2005 and 2008, and followed up more than 3 years. We divided patients who played golf after TKR as a study group and who did not participate sports activities as a control group. We calculated the sum of width of radiolucent line in 7 sections around femoral component, 7 sections around tibial components and 5 sections in patella component using American Knee Society Roentgenographic Evaluation and Scoring system respectively. The inclusion criteria, was BMI (body mass index) was between 25 and $30kg/m^2$, and UCLA activity-level rating System score was between 5 and 8. We also got the information of patients' patterns of golf activities such as 1. the interval from surgery to return to golf activity. 2. the frequency of golf activities 3. using spike or cart. We obtained the information from patient's questionnaire and telephone interview. We compared with the VAS (visual analogue scale) respectively. And handicaps and driving distance was evaluated as well. Results: The study group's mean sum of radiologic score was 0.84 mm and 0.69 mm in control group. This is not statistically significant (p=0.22). Too early returning to golf (p=0.01) and left knee replacement (p<0.01) were statistically significant factors affecting clinical outcomes of golf activities after total knee arthroplasty. Conclusion: We concluded that golf activities after total knee arthroplasty is not correlated with radiographic loosening, and we need to give an explanation to the patients about increased pain when returing to golf too early and left side arthroplasties.