• Journal of Korean Biological Nursing Science
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• v.16 no.4
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• pp.318-325
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• 2014

Purpose: The purpose of this study was to investigate the effects of preoperative patient controlled analgesia (PCA) education on total knee replacement arthroplasty (TKRA) patients' PCA usage, level of pain, the frequency of pro re nata (prn) administrations, number of ambulations/day and continuous passive motion (CPM) angle after TKRA. Methods: This research used the non-equivalent control group pre-test and post-test design. Forty-five TKRA patients at a hospital in Seoul, Korea were included for in the study. For the experimental group, a 20-minute education session was provided a day before surgery. Data were analyzed using Windows SPSS Statistics 21.0 program. Results: Knowledge was higher in the experimental group than in the control group (p<.001). Incidence of nausea was lower in the experimental group (p=.01). No significant differences were found in post-operative pain scores, the frequency of prn analgesics administrations, dizziness, number of ambulations/day and CPM angle. Conclusion: This study showed that pre-operative PCA education could be an effective nursing intervention for increasing patient knowledge on PCA and nausea reduction after TKRA.

• Journal of muscle and joint health
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• v.18 no.2
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• pp.203-214
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• 2011

Purpose: The purpose of the study was to identify the effects for 4-weeks muscle strengthening exercise program on pain, fatigue, and physical function(muscle strength of leg, walking competence, balance, flexibility of patella) in elderly women with total knee arthroplasty(TKA). Method: Utilizing a quasi-experimental design, 30 TKA patients consisted of the experimental group (n=15) and control group (n=15). The experimental group participated in the muscle strengthening exercise program, twice a day for 4 weeks. Data were analyzed with SPSS WIN 18.0 program, using repeated measure ANOVA. Result: As time goes by, There were significant differences in muscle strength of leg (F=6.60, p<.001), walking competence(F=7.15, p<.001), and balance(F=17.55, p<.001) between the experimental and the control groups. Conclusion: The findings of this study revealed the positive effects of muscle strengthening exercise program in elderly women with TKA.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.124-135
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• 2017

Background In cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA. Methods A systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis. Results A total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps) were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05) and limb salvage (89.8% vs. 100%, P=0.14) were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78), the rates of persistent infection (16.4% vs. 0%, P=0.14) and recurrent infection (9.1% vs. 4%, P=0.94) tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported. Conclusions Rates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.6
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• pp.4031-4039
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• 2015

The problems related with blood supply shortage and the stability of blood transfusion are on the rise, as it is expected that the blood doners will decrease but the blood use amount for aged population will increase, owing to low birth and aged population increase. The purpose of this study is to analyze the hospital characteristics which affect patients receiving and non-receiving blood transfusion for the knee and hip total replacement arthroplasty. Data were collected from Health Insurance Review and Assessment Service's 2011 sample data, and 5,370 inpatients were abstracted from them. Logistic regression analysis was performed, using SPSS 20. Independent variables used are hospital characteristics variables and patient characteristics variables. Hospital characteristics variables are hospital type, ownership, residence and the number of usable beds, and patient characteristics variables are gender, age, severity, type of anesthesia, main diagnosis, whether or not of anemia and insurance class. At the result of this study, it was found that hospital type, region, gender, age, severity, main diagnosis and whether or not of anemia were the factors that mostly affected the blood transfusion for knee arthroplasty. And hospital type, residence, gender, age, severity, type of anesthesia and whether of not of anemia were the factors that mostly affected the blood transfusion for hip arthroplasty. In addition to that, it is expected that this research which analyzed the present state of blood transfusion and its influence factors are cost effective, and would make a good use of preliminary data for good quality of medical service.

• Journal of Korean Medicine Rehabilitation
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• v.32 no.2
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• pp.123-138
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• 2022

Objectives This study was conducted to evaluate the clinical efficacy and safety of the chuna combination treatment for patients who complain of functional impairment and pain even 3 months after total knee arthroplasty. Methods 24 patients who had 3 months of surgery and who had knee joint pain with a score of 4 or higher on the numerical rating scale (NRS) for more than a week were selected as subjects. The test group received usual care and Chuna treatment and the control group received the administration of drugs as usual care. And then the clinical efficacy and safety were compared and evaluated. Follow-up was performed 1 month after the end of treatment. Results As a result of the analysis, it was confirmed that the primary parameter Korean Western Ontario and McMaster Universities (K-WOMAC) showed statistical significance in the amount of change in visit 2-visit 10 (V2-V10) in the pain domain and in the amount of change in visit 2-follow 1 (V2-FU1) in the functional domain and total score domain. The secondary parameter (NRS, risk of fall, and range of motion) showed a tendency to decrease in the degree of discomfort, but statistical significance could not be confirmed. Conclusions Because this study did not have enough study subjects, it is difficult to use the results as confirmatory evidence. However, it was confirmed that the 4-week Chuna treatment had a significant effect and safety in patients who underwent total knee arthroplasty. Therefore, this study is meaningful as a prior research data to prepare confirmatory evidence in the future.

• Quality Improvement in Health Care
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• v.28 no.2
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• pp.30-38
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• 2022

Purpose: The Health Insurance Review and Assessment Service (HIRA) in South Korea initiated a quality assessment (QA) program for blood transfusion healthcare services in 2020 to ensure patient safety and appropriate blood use. This study examines the quality of blood transfusion services since the first national QA program for blood transfusion services in Korea. Methods: We analyzed HIRA claims and QA investigation data based on inpatient medical records from all tertiary, general, and primary hospitals between October 2020 and March 2021. The target population was patients aged 18 years and older who received either total knee arthroplasty or red blood cell transfusion. The QA indicators for transfusion healthcare service consisted of four quality indicators and four monitoring indicators. Results: We analyzed the results of QA indicators for transfusion service from the medical records of 189,668 patients from 1,171hospitals and expressed indicators as proportions. The average results for evaluation indicators were as follows: transfusion checklist presence, 64.8%; irregular antibody tests, 61.8%; transfusions in which the hemoglobin levels before transfusion met the transfusion guidelines for patients undergoing total knee arthroplasty, 20.6%, and transfusions in patients undergoing total knee arthroplasty, 59.3%. The average results for monitoring indicators were as follows: transfusion management implementation in medical institutions, 56.9%; preoperative anemia management in anemia patients undergoing total knee arthroplasty, 43.9%; one-unit transfusions, 82.5%; and the transfusion index. Conclusion: The quality of blood transfusion healthcare varied and the assessment revealed that there is scope for improvement. Hospitals require more effective blood transfusion management and this can be facilitated by providing feedback on the QA results about blood transfusion healthcare services to medical institutions, and by disclosing the results to the public.

• Transactions of the Korean Society of Mechanical Engineers A
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• v.28 no.11
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• pp.1664-1671
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• 2004

It is necessary to have a model that describes the feature of the knee Joint with a sufficient accuracy. Koreans, however, do not have their own knee joint model to be used in the total knee replacement arthroplasty. They have to use European or American models which do not match Koreans. Three-dimensional visualization techniques are found to be useful in a wide range of medical applications. Three-dimensional imaging studies such as CT(computed tomography) and MRI(magnetic resonance image) provide the primary source of patient-specific data. Three-dimensional knee joint models were constructed by image processing of the CT data of 10 subjects. Using the constructed model, the dimensions of Korean knee joint were measured. And this study proposed a three-dimensional model and data, which can be helpful to develop Korean knee implants and to analyze knee joint movements.

• Archives of Plastic Surgery
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• v.45 no.3
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• pp.280-283
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• 2018

Knee revision arthroplasty following peri-prosthetic joint infections is a formidable challenge. Patients are at a high risk of recurrent infection, and the soft tissue over the revised implant is often of questionable quality. Flap reconstruction has improved the salvage rates of infected arthroplasties, and should be considered in all cases of revision arthroplasty. We present a challenging case requiring staged reconstruction with two free latissimus dorsi flaps after the initial use of a medial gastrocnemius flap.

• 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.

• Knee surgery & related research
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• v.30 no.4
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• pp.326-333
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• 2018

Purpose: To evaluate the reliability and validity of the femorotibial mechanical axis angle from radiographs in the weight bearing (WB) and supine positions compared with navigation-measured values. Materials and Methods: Sixty-eight cases of navigation-assisted total knee arthroplasty (TKA) were included. The pre- and postoperative whole leg radiographs (WLRs) in WB and supine positions were compared with the initial and final navigation values. Results: The mean mechanical axis angle from the preoperative WBWLR and navigation were not statistically different (p=0.079) and were correlated strongly with each other (intraclass correlation [ICC], 0.818). However, on postoperative measurements, although the WBWLR and navigation values were not different (p=0.098), they were not correlated with each other (ICC, 0.093). The standard error of measurement was $1.8^{\circ}{\pm}3.6^{\circ}$ for the preoperative WBWLR and $2.5^{\circ}{\pm}4.8^{\circ}$ for the postoperative WBWLR. The validity that was determined by the Bland-Altman plot was not acceptable for both pre- and postoperative measurements. Conclusions: The preoperative WBWLR could provide accurate but not precise measurement value of the femorotibial mechanical axis angle for navigation-assisted TKA, and postoperative measurements in navigation were not comparable with radiographic measurements. The lack of agreement was found between the radiographic and navigation measurements of the coronal alignment regardless of pre- or postoperative evaluation although the accuracy was found acceptable. Level of Evidence : Level 4.