• Journal of Korean Neurosurgical Society
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• v.64 no.4
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• pp.495-504
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• 2021

Three-dimensional printing (3DP) applications possess substantial versatility within surgical applications, such as complex reconstructive surgeries and for the use of surgical resection guides. The capability of constructing an implant from a series of radiographic images to provide personalized anatomical fit is what makes 3D printed implants most appealing to surgeons. Our objective is to describe the process of integration of 3DP implants into the operating room for spinal surgery, summarize the outcomes of using 3DP implants in spinal surgery, and discuss the limitations and safety concerns during pre-operative consideration. 3DP allows for customized, light weight, and geometrically complex functional implants in spinal surgery in cases of decompression, tumor, and fusion. However, there are limitations such as the cost of the technology which is prohibitive to many hospitals. The novelty of this approach implies that the quantity of longitudinal studies is limited and our understanding of how the human body responds long term to these implants is still unclear. Although it has given surgeons the ability to improve outcomes, surgical strategies, and patient recovery, there is a need for prospective studies to follow the safety and efficacy of the usage of 3D printed implants in spine surgery.

• Clinics in Shoulder and Elbow
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• v.27 no.1
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• pp.59-71
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• 2024

Background: Restoration of external (ER) and internal rotation (IR) after Grammont-style reverse shoulder arthroplasty (RSA) is often unreliable. The purpose of this systematic review was to evaluate the influence of RSA medio-lateral offset and subscapularis repair on axial rotation after RSA. Methods: We conducted a systematic review of studies evaluating axial rotation (ER, IR, or both) after RSA with a defined implant design. Medio-lateral implant classification was adopted from Werthel et al. Meta-analysis was conducted using a random-effects model. Results: Thirty-two studies reporting 2,233 RSAs were included (mean patient age, 72.5 years; follow-up, 43 months; 64% female). The subscapularis was repaired in 91% (n=2,032) of shoulders and did not differ based on global implant lateralization (91% for both, P=0.602). On meta-analysis, globally lateralized implants achieved greater postoperative ER (40° [36°-44°] vs. 27° [22°-32°], P<0.001) and postoperative improvement in ER (20° [15°-26°] vs. 10° [5°-15°], P<0.001). Lateralized implants with subscapularis repair or medialized implants without subscapularis repair had significantly greater postoperative ER and postoperative improvement in ER compared to globally medialized implants with subscapularis repair (P<0.001 for both). Mean postoperative IR was reported in 56% (n=18) of studies and achieved the minimum necessary IR in 51% of lateralized (n=325, 5 cohorts) versus 36% (n=177, 5 cohorts) of medialized implants. Conclusions: Lateralized RSA produces superior axial rotation compared to medialized RSA. Lateralized RSA with subscapularis repair and medialized RSA without subscapularis repair provide greater axial rotation compared to medialized RSA with subscapularis repair. Level of evidence: 2A.

• Journal of the Korean Society of Radiology
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• v.8 no.5
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• pp.217-223
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• 2014

The aim of this study is evaluation of dose distribution on radiation therapy planning system with the CT image of high-density material inserted phantom. Gammex 467 Tissue Characterization Phantom is used to acquire an image similar to the human tissues and insert a Titanium to generate metal artifact. The acquired images were reconstructed with Metal Artifact Reduction for Orthopedic Implants (O-MAR). By using the treatment planning system, the volume was analyzed and dose distribution was extracted. Photon dose distribution in linear accelerator was measured by the $MapCHECK^{TM}$ and compared with planned and measured dose distributions. In result of the comparative analysis, when artifact is generated by Titanium, The volume applied O-MAR was increased 6.8% to BR-12 Breast and 40.2% to LV 1 Liver. After O-MAR was used, Dose distribution was higher 1.4 to 1.6% than before. Consequently, The artifact caused by metal objects should be removed if possible, and after that used in the radiotherapy treatment plan can be considered to reduce errors.

• Clinics in Shoulder and Elbow
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• v.23 no.3
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• pp.152-155
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• 2020

Periprosthetic fracture after total elbow replacement surgery is a difficult complication to manage, especially when it comes together with implant loosening. If stem revision and internal fixation of the periprosthetic fracture are performed simultaneously, this would be a very challenging procedure. Most of total elbow replacement implants are cemented type. Cement usage at periprosthetic fracture site may interfere healing of fractured site. Authors underwent internal fixation with use of locking plate and cerclage wire for periprosthetic fracture, allogenous fibular strut bone inserted into the humerus intramedullary canal allowing the fractured site to be more stable without cement usage. At 10-month follow-up, the complete union and good clinical outcome was achieved. We present a novel technique for treating periprosthetic fracture with implant loosening after total elbow replacement surgery, using intramedullary allogenous fibula strut bone graft.

• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.271-275
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• 2020

Trauma is frequently implicated in the development of sarcomas, including rhabdomyosarcoma. Rare soft tissue sarcomas have been reported to arise in scar tissue following surgical procedures or thermal or acid burns, at fracture sites, and in the vicinity of plastic or metal implants, usually after a latent period of several years. The authors encountered a case of a rhabdomyosarcoma arising from the forearm crushed by a conveyor belt 11 years ago. Several possible etiological factors for sarcoma development were identified in this patient, including tissue damage and inflammation, as well as the presence of metal implants and the limb's exposure to radiation during multiple imaging tests. After severe soft tissue damage, the occurrence of a sarcoma should be considered and more attention should be paid to the causative factors for sarcoma.

• Clinics in Shoulder and Elbow
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• v.18 no.2
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• pp.105-112
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• 2015

In orthopedic trauma surgery, treatment of intraarticular distal humerus fractures is a challenge. With development of implants and biomechanical studies, surgical strategies with recommendations including preoperative computed tomography images, proper approaches and open reduction and internal fixation with dual plates have emerged. In addition, as an effort to provide stable fixation to permit early elbow motion, different methods of internal fixation, particularly plate configuration, have evolved. Using dual plates, either oriented parallel to each other or orthogonal, stable fixation has been achieved and satisfactory clinical outcomes have been reported. With rationales and advantages/disadvantages of each plate configuration, both techniques are selected according to surgeons' preference, and, in specific cases, one could be preferred over another. The key to successful fixation by either technique is obtaining anatomical reduction with restoration of two stable columns of the distal humerus.

• Clinics in Shoulder and Elbow
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• v.13 no.2
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• pp.194-201
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• 2010

Purpose: We evaluated clinical and radiological results for open reduction and internal fixation of acromioclavicular dislocation without coracoclavicular ligament repair after removal of implants. Materials and methods: Clinical and radiological results were obtained for 53 patients who underwent open reduction and internal fixation of an acromioclavicular joint dislocation between 1998 and 2007. A total of 21 patients were treated with a modified-Phemister method and 32 patients were treated with a Hook plate method. All subjects were surveyed after removal of their implants. The Constant scoring system was administered postoperatively to evaluate clinical results. Radiologic outcomes were evaluated by both coracoclavicular intervals on plain films. Results: Constant scores were $87.59{\pm}7.8$ in the Phemister group and $89.35{\pm}5.3$ in the Hook plate group. For both groups, the mean coracoclavicular interval at preoperative radiography was 15.9 mm at the injured site and 8.0 mm at the opposite site. After metal removal, the mean difference between coracoclavicular distances between normal and injured sites were 1.0 mm for the Hook plate group and 1.2 mm for the modified Phemister method group (p>0.05). Conclusion: Open reduction and internal fixation of an acromioclavicular joint without coracoclavicular ligament repair shows good long-term clinical and radiological results.

• Proceedings of the Korean Institute of Surface Engineering Conference
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• 2018.06a
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• pp.25-25
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• 2018

Electron beam melting (EBM) is one of powder based additive manufacturing technology used to produce parts for high geometrical complexity and directly with three-dimensional computer aided design (CAD) model. It is kind of the most promising methods with additive manufacturing for a wide range of medical applications, such as orthopedic, dental implant, and etc. This research has been investigated the microstructure and mechanical properties of as fabricated and hot iso-static pressing (HIP) processed specimens, which are made by an Arcam A1 EBM system. The Ti-6Al-4V titanium alloy powder was used as a material for the 3 dimensional printing specimens. Mechanical properties were conducted with EBM manufacturing and computer numerical control (CNC) machining specimens, respectively. Surface morphological analysis was conducted by scanning electron microscopy (SEM) for their surface, dissected plan, and fractured surface after tensile test. The mechanical properties were included tensile stress-strain and nano-indentation test as a analysis level between nano and macro. As following highlighted results, the stress-strain curves on elastic region were almost similar between as fabricated and HIP processed while the ductile (plastic deformed region) properties were higher with HIP than that of as fabricated processed.

• Journal of the Korean Society of Manufacturing Process Engineers
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• v.12 no.4
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• pp.34-39
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• 2013

For orthopedic artificial metal stainless steel, the magnetization of the magnetic field due to the presence of the titanium was to observe the change. Magnetic field meter (Tesla meters) a certain distance (ISO Centre) 1.5 Tesla magnetic field, the magnetization in the center with the passage of time were measured. Therefore, these artificial metal clip shape and magnetization of the sample size to produce a ferromagnetic material for comparison is the experimental dependence. For comparison of the experimental dependence of the magnetization, thereby producing a test piece size such as shaping prosthetic metal Clip is a ferromagnetic material. The experimental results, the metal orthopedic implants, there was no change in the magnetization indicated by ferromagnetic material in its natural state. However, in a magnetic field of 1.5T (Tesla), showed a sensitivity that is magnetized rapidly compared to the ferromagnetic material. In conclusion, high in the order of Clip, Stainless, of Titanium, the degree of dependence of the magnetization intensity of magnetization was the order Stainless, Titanium, of Clip in a magnetic field.

• Clinics in Orthopedic Surgery
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• v.10 no.4
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• pp.427-432
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• 2018

Background: The purpose of this study was to evaluate the usefulness of sonication technique for microbiological diagnosis and the sterility of the recycled autoclaved femoral components from infected total knee arthroplasty (TKA) using a sonication method. Methods: Nineteen femoral implants explanted from patients with infected TKA were sterilized with a standard autoclave method. Standard culture of the fluid before and after sonication of the sterilized implants was performed to detect pathogenic microorganisms. Additional experiments were performed to evaluate the sterility of the recycled implant by inducing artificial biofilm formation. Methicillin-resistant Staphylococcus aureus (MRSA) was inoculated into 10 implants and sterilization in a standard autoclave was performed, and then the fluid was cultured before and after sonication. Results: Two of the 19 sterilized implants were positive for growth of bacteria after sonication, whereas no growth was detected in the cultured fluid from the sterilized implants before sonication. The bacteria were Staphylococcus species in all two cases. In one of 10 implants inoculated with MRSA, the culture was positive for growth of bacteria both before and after sonication. However, Staphylococcus epidermidis was cultured from both occasions and thus this implant was thought to be contaminated. Conclusions: We found sonication for identification of pathogens could be helpful, but this finding should be interpreted carefully because of the possibility of contamination. Sterilization of an infected femoral implant with an autoclave method could be a good method for using the temporary articulating antibiotic spacer in two-stage revision arthroplasty.