• Title/Summary/Keyword: Total knee arthroplasty

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A Biomechanical Comparative Analysis between Single-Radius and Multi-Radius Total Knee Arthroplasty for Sit-to-Stand Movement (앉았다 일어나는 동작동안 단축회전반경 무릎인공관절 수술자와 다축회전반경 무릎인공관절 수술자의 운동역학적 비교분석)

  • Jin, Young-Wan
    • Journal of Life Science
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    • v.16 no.5
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    • pp.773-779
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    • 2006
  • Eight of the individuals had a unilateral S-RAD TKA and Multi-Radius TKA ($Scorpio^{TM}$ PS, Howmedica-Osteonics, Inc.). The instrument were used Peak Motion Measurement $System^{TM}$, $MYOPAC^{TM}$EMG System, KIN-COM $III^{TM}$ System. The Figure 3 shows that the average time for the S-RAD group to accomplish the sit-to-stand movement was 1.59 s, which was 0.19 s less than the M-RAD group (p= 0.033). In Figure 5, the S-RAD TKA group tended to have $7^{\Omega}{\cdot}S^{-1}$ less trunk flexion velocity than that of the M-RAD group (p= 0.058). The Figure 6 shows that the S-RAD TKA limb tended to have less ADD displacement (p = 0.071) than that of the M-RAD TKA limb. We failed to find significant differences for ABD and ADD displacements between the S-RAD and M-RAD N-TKA limbs (p= 0.128 and 0.457, respectively). The VM of the S-RAD TKA limb demonstrated significant less RMS EMG than that of the M-RAD TKA limb from $60^{\Omega}$ to $15^{\Omega}$ of knee flexion (p 0.05). The VL of the S-RAD TKA limb also demonstrated significant less RMS EMG than that of the M-RAD TKA limb from $60^{\Omega}$ to $45^{\Omega}$ of knee flexion (p 0.05). Similar to the VM and VL, the RF of the S-RAD TKA limb showed less RMS EMG than that of the M-RAD TKA limb from $60^{\Omega}$ to $30^{\Omega}$ of knee flexion (p 0.05).

Bone Mineral Density and Stress Distribution in Human Patella

  • Han, Seung-Moo;Jared Davis
    • Journal of Biomedical Engineering Research
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    • v.19 no.1
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    • pp.53-58
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    • 1998
  • This study examined the distribution of bone mineral density(BMD) and the von Mises stress in the patella. The BMD of eighteen patellae were determined by using quantitative computed tomography and imaging analysis software. It was found that the BMD of the patella varied with location. BMD values were largest at the superior and lateral regions and decreased inferiorly and medially. This distribution appeared to correspond to the organization of trabeculae within the patella. A two-dimensional finite element analysis was performed on each patella. It was also found that the maximum von Mises stress in the patella occurred along the cortical shell on the non-articular surface. The trabecular von Mises stress existed in the posterior region of the patella. These findings demonstrated the potential for finite element studies in vivo. Further, such studies may lead to the development of custom-made, patient-specific patella prostheses.

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Difference of Functional Outcome Measurements between Total Knee Arthroplasty and Knee Amputation (슬관절 절단과 슬관절성형술간의 가능 수행 측정)

  • Sung, Paul S.
    • Physical Therapy Korea
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    • v.4 no.2
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    • pp.89-99
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    • 1997
  • 임상 결과의 측정에서 새로운 관점을 갖는 것은 중요하다. 의료 재활은 심리적 측정의 질들(표준화, 신뢰도, 타당도)에서 충분한 노력에 수행되어지지 않아 왔기 때문에 환자와 프로그램 사이에 일반화된 기능적인 평가 범위가 부족하다. 장애의 적절한 측정을 위한 요구는 기능적인 상태에서 변화들을 알리고 치료의 필요성을 평가하고 치료를 계획하고 결과를 예측하고 보상 방법을 측정하기 위한 환자의 치료와 임상 연구에서 모두 나타난다. 세계적으로 사용되어지고 있는 기능 평가 도구인 FIM으로부터 이 연구는 신체적 측정의 기대되어진 것에 유사한 비율로 기능적 평가 측정들을 구성한다. 노인 재활에서 기능적인 결과의 측정은 중요한 몇 가지 점이 있다. 첫째는 접근에 기초한 기능적인 결과는 치료 목표 설정에 필요하다. 둘째는 도구는 기능적인 향상을 예상하는데 유용해야 한다. 셋째는 기능 평가는 적절한 타당도와 신뢰도와 함께 고려되어져야만 한다. 넷째는 다른 기능적 도구들이 함께 평가되어져야 할 필요가 있다는 것이다. FIM의 목록의 어려운 접들은 손상을 입은 집단에서는 다소 다양하다. 가장 중요한 부분이기 때문에 하나의 운동범위는 요통과 화상을 입은 환자를 제외한 모든 손상을 입은 집단들에게 적용되어 질 수 있다. 기능의 운동과 인지적인 면은 구분되어지는 것이 중요하였고 분리되어져서 치료되어 졌다. 어려운 목록들은 손상을 입은 집단에서 다양하였고, 다양한 손상의 종류의 독특한 영향을 반영하였다. FIM은 기능적인 장애를 측정하기 위해 고안되어진 또 다른 도구이다. 그리고 다른 것들은 의료 재활을 위한 국제적 자료 체계를 만들기 위한 것이다. FIM의 목적은 의료 재활의 결과를 확인하고 장애의 정도의 측정을 포함한다. FIM은 7가지 수준에서 사회적 인지, 의사 소통, 이동, 움직임 (mobility), 소변 관리, 자조 활동을 평가한다. 범위는 총체적 도움의 비율로부터 완전하게 독립적인 것까지의 범위이고 도움, 감독, 도구의 사용의 범위를 고려한다. 27,009의 환자를 조사한 최근 검사 기록들은 FIM이 움직임(motor)과 인지 기능을 평가하는 것이라는 것을 보여준다(Hinemann, 1993). FIM의 저자들은 자료가 프로그램 평가의 시도에서 즉각적으로 적용 할 수 있기를 기대한다. FSI은 어떤 과제의 수행에서 어려움에 관계된 정보를 제공하는 것을 나타내고 과제를 수행하기 위한 환자를 위한 변경된 전략들을 발달시키기 위해 노력하는 임상가들에게 유용할 수 있다. 두 도구 모두는 전통적인 범위들보다 고관절 골절을 동반한 장애의 좀더 정확한 정보를 모으도록 할 수 있다. 고찰된 모든 연구의 결과들은 골절 후에 남아 있는 잔여 장애의 중요한 수준을 강조한다. 골절 전의 보행으로 회복된 사람은 매우 드물었다. 대부분은 기본적인 움직임 혹은 옷입기, 개인 위생에 관계된 활동들에서 의존적이었다. 많은 사람들은 사회에서 활동을 할 수 없었다. 장애의 적절한 측정의 요구는 환자 치료와 기능적인 상태에서 변화를 알고 치료의 요구도를 측정하고 치료를 계획하고 결과를 예상하고 보상 수단을 결정하는 임상적 연구에서 모두 나타난다. 물리치료 분야는 분야의 다른 영역에서 기능적인 결과를 충족시키고 발달시키는 것이 필요하다.

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Arthroscopic Management for Pyogenic Arthritis with Positive Culture in the Knee Joint (배양 검사로 증명된 화농성 슬관절염의 관절경적 치료)

  • Baek, Seung-Hoon;Kim, Se Sik
    • Journal of the Korean Arthroscopy Society
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    • v.16 no.2
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    • pp.167-174
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    • 2012
  • Purpose: The purpose of this study is investigation of clinical and functional outcomes in homogeneous group with positive culture after arthroscopic management for pyogenic knee arthritis and analysis of factors affecting those outcomes. Materials and Methods: Thirty-two patients with positive culture after arthroscopic management were included. Mean follow-up period was 41.6 months. Clinical evaluation included death related to infection, recurrence, time to normalize erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), duration of administration of intravenous antibiotics and readmission. Radiographic evaluation was performed according to Kellgren and Lawrence. The prevalence of total knee arthroplasty was investigated and functional evaluation included modified Lysholm, Tegner activity and Korean version of the Western Ontario and McMaster Universities (K-WOMAC) score. Results: Staphylococcus aureus was identified in 21 patients. Time to normalize ESR and CRP was 78.0 and 67.6 days, respectively. Two patients died while there were six recurrences and five readmissions. Rate of recurrence was significantly high in patients with chronic renal failure (P=0.034) and incidence of readmission was associated with higher radiographic grade of osteoarthritis and rate of reoperation (P=0.032 and P=0.006, respectively). At the final follow-up, radiographic grade worsened in 21 patients and was associated with those at first visit. Five arthroplasties were performed. Average modified Lysholm score, Tegner activity score and K-WOMAC score were 53.5, 2.7, 44.2 points, respectively. Conclusion: The severity of osteoarthritis on final radiographs was associated with those at first visit. Patients with higher grade of osteoarthritis at first visit showed higher incidence of readmission and those with chronic renal failure demonstrated higher chances of recurrence.

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Mucoid Degeneration of Anterior Cruciate Ligament: Correlation between MR Imaging and Pathologic Findings in Patients with Osteoarthritis of the Knee (앞십자 인대의 점액 변성: 슬관절 퇴행성 관절염 환자에서 MRI 소견과 병리소견의 연관)

  • Ryu, Jeong-Ah;Liew, Hyun-Jeong;Kim, Sung-Moon;Shin, Myung-Jin;Shin, Hee-Jung;Cho, Kyung-Ja;Cho, Woo-Shin;Kang, Chang-Ho;Lee, Min-Hee;Kim, Mi-Sung;Park, Noh-Hyuck;Lee, Sang-Hoon
    • Investigative Magnetic Resonance Imaging
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    • v.11 no.1
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    • pp.27-32
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    • 2007
  • Purpose : To evaluate the mucoid degeneration (MD) of the anterior cruciate ligament (ACL) of the knee by correlation of MRI findings with pathology, in the patients with osteoarthritis (OA). Materials and Methods : This study included 17 patients (mean 68.8 years old) who underwent preoperative MRI. In proton density-weighted sagittal and coronal images ACLs were evaluated for the thickness and signal intensity (SI). Total knee replacement arthroplasty was performed and the pathologic findings of ACL were evaluated. MD was classified as 3 grades according to the degenerated amount in microscopy. Thickness and SI was evaluated as normal or increased on MRI. Results : All of the 4 patients who showed thickened ACL showed increased SI on MRI. All of the 8 patients with increased SI of the ACL on MRI had MD in the ACL. However, remained 9 patients also had MD, in spite of their normal thickness and SI on MRI. Calcification was seen in 5 patients. Conclusion : Eight cases who showed ACL thickening or increased SI on MRI were well correlated with MD, however, because the other nine cases who showed normal thickness and normal SI of ACL on MRI also showed MD in pathology, normal MRI finding should not exclude the possibility of MD of ACL.

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Comparative Study of Compliance for Venous Thromboembolism Prophylaxis (American College of Chest Physicians Guideline and American College of Orthopedic Surgeons Guideline) in High Risk Patients with a Venous Thromboembolism (정맥혈전 색전증 고위험군에서 시행한 혈전색전 예방요법(American College of Chest Physicians 지침 및 American College of Orthopedic Surgeons 지침)의 준수율 비교 연구)

  • Suh, You-Sung;Nho, Jae-Hwi;Jang, Byung-Woong;Kang, Deokwon;Won, Sung-Hun
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.4
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    • pp.317-326
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    • 2019
  • Purpose: To compare and analyze the rate of prevention of two venous thromboembolism prophylaxis guidelines in patients with artificial joint arthroplasty and hip joint fracture. Proper prophylaxis for preventing thromboembolism in orthopedic surgery is significant because of this fetal complication. Materials and Methods: This study compared and retrospective analyzed the rate of prevention using the medical records and radiographs of patients who underwent orthopedic surgery from March 2009 to February 2011 according to the American College of Chest Physicians (ACCP) guidelines and from March 2012 to February 2014 according to the American Academy of Orthopedic Surgeons (AAOS) guidelines. Results: The guidelines for venous thromboembolism prophylaxis have been applied to patients with artificial joint replacement and hip joint fracture, the compliance rate of the ACCP guidelines was 56.0% before surgery, 67.0% after surgery with chemical prophylaxis, and 80.5% with mechanical prophylaxis. In addition, the compliance rate of the AAOS guidelines was 74.1% with chemical prophylaxis, and 88.3% with mechanical prophylaxis, which was higher than the ACCP guidelines. The compliance rates of mechanical and chemical prophylaxis before and after surgery of the ACCP guidelines, and the compliance rate of mechanical and chemical prophylaxis of the AAOS guidelines were compared and analyzed. The results revealed statistical significance (p<0.05) before and after total knee replacement arthroplasty and hip joint fracture internal fixation and total high risk orthopedic surgery. Conclusion: Raising the compliance rate of prophylaxis of venous thromboembolism in high risk orthopedic surgery is necessary and people should follow the guidelines for a unified direction depending on which situation they are in.

Evaluation of image quality for metal artifact using protocol parameters in the MRI (자기공명영상에서 프로토콜 변화를 이용한 금속인공물의 영상평가)

  • Lee, Su-Hyun;Kim, Do-Gyoung;Kim, Yo-Han;Yeum, Hyei-Jeong;Lee, Heon-Jun;Lim, Ju-Yeon;Choi, Woo-Jeon;Kim, Dong-hyun
    • Proceedings of the Korean Institute of Information and Commucation Sciences Conference
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    • 2015.10a
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    • pp.582-585
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    • 2015
  • In the aging society, TKRA is steadily increased because of joint diseases. Artificial joint used in TKRA generates metal artifacts in the MRI. Metal artifact may affect diagnosis. In study, We are going to minimize the effect of metal artifact to improve the value of diagnosis by changing the sequence and the type of artificial joint(Co-Cr, Ni-Ti). 1.5T AVANTO, plastic containers and each of the artificial joint (Normal, Co-Cr, NiTi) were used. After the artificial joints fixed in a paper cup was inserted in a plastic container of cylindrical, Signal intensity was measured. To obtain strong and uniform signal intensity, the plastic container was filled with water. We changed Sequences(T1 TSE, T2 TSE, PD TSE) and obtained an Axial image. After excepting the maximum and minimum values, We calculated the average of SNR, CNR and PSNR. Consequently, The SNR, CNR value of PD TSE are measured higher than these of T1 TSE, T2 TSE and The PSNR of Co-Cr is higher than this of Ni-Ti. The SNR of Co-Cr is similar to the SNR of normal comparing this of Ni-Ti. As a result, Using sequence of PD Tse and Co-Cr alloy is considered to be useful.

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The Clinical Analysis of Lateral Discoid Meniscus in Adults Over 40 years old (40세 이상에서 발견된 외측 원판형 연골의 임상분석)

  • Lim, Hong-Chul;Noh, Kyoung-Sun;Jung, Hyo-Sub
    • Journal of the Korean Arthroscopy Society
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    • v.10 no.1
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    • pp.77-82
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    • 2006
  • Purpose: The purpose of this study was to analyze the clinical results of symptomatic lateral discoid meniscus found in adults over 40 years old. Materials & Methods: From March 1994 to March 2004, 53 cases treated for lateral discoid meniscus in 48 patients aged over 40 years with the mean age $48.4(40{\sim}62)$ who were followed up more than 1 year, were analyzed by physical findings, simple X-ray, MRI and arthroscopic exam. Results: Most of the cases (42 cases, 79.2%) had symptoms for less than 1 year duration. 26 cases(49.1 %) out of 53 had trauma history. Simple radiologic evaluation showed that lateral condylar abnormality such as the flattening of lateral femoral condyle, marginal osteophytes, and subchondral sclerosis was seen in 37cases(69.8%). Also medial condyle showed degenerative changes in 16 cases (30.2%). Tear of discoid meniscus in 45 cases(84.9%) were examined by arthroscope and tear was not detected in 8 cases(15.1%). Type of tear was complex(18 cases), longitudinal(12 cases), horizontal(11 cases) and transverse(4 cases). Concomitant medial meniscal rupture was found in 7 cases(13.2%). The simple procedure done was reshaping(46 cases), subtotal resection(5 cases), total resection(1 case) and meniscal repair after reshaping in 6 cases, and arthroplasty was performed after arthroscopic examination in 1 case. Conclusion: Onset of symptom in adult lateral discoid meniscus is usually traumatic in origin. Most cases showed radiologic abnormality such as degenerative change in lateral condyles as well as medial condyles and the results of preservative surgical treatment was the most preferred option in most patients.

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