• Hip & pelvis
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• v.30 no.4
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• pp.210-218
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• 2018

Purpose: This is a report on the outcomes associated with a consecutive series of 1,000 cementless hip arthroplasties utilizing the $Bencox^{(R)}$ hip stem-the first Korean-developed hip prosthesis. Materials and Methods: A consecutive series of 1,000 hip arthroplasties using the $Bencox^{(R)}$ hip stem were analyzed, starting from its initial release (September 2006) until June 2014. Patients in this consecutive series underwent surgery for fractures (n=552), arthritis (n=155), avascular necrosis (n=209), and revisions (n=84). Of these 1,000 cases, patients with a minimum follow-up of at least 1 year (n=616) were retrospectively analyzed for radiographic and clinical outcomes (i.e., Harris hip score). The stability of the prosthesis was evaluated by examining subsidence. Results: During the follow-up period (mean follow-up period of 54.8 months), there were 2 cases requiring revision of the femoral stem-both were caused by periprosthetic fractures and neither involved stem loosening. The mean Harris hip score during follow-up was 95.5. Bone ongrowth occurred in 95% of patients; no cases of subsidence or aseptic loosening of the stem were detected, and no cases of postoperative complications such as ceramic breakage were observed. Conclusion: Clinical and radiographic evaluations of hip arthroplasty using the $Bencox^{(R)}$ hip stem revealed excellent outcomes with an average of 54.8 month follow-up in a consecutive series of 1,000 cases.

• Journal of the Korean Orthopaedic Association
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• v.54 no.3
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• pp.244-253
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• 2019

Purpose: Total hip arthroplasty was performed using a direct anterior approach (DAA) on an ordinary operation table and a short femoral stem. The clinical radiographic results were evaluated by a comparison with those performed using the modified hardinge (anterolateral approach, ALA) method. Materials and Methods: From January 2013 to November 2015, 102 patients who underwent total hip arthroplasty using DAA (DAA group) and the same number of patients using ALA (ALA group), both performed by a single surgeon, were compared and analyzed retrospectively. The operation time and amounts of bleeding were compared, and the improvement in post-operative pain, ambulatory capacity and functional recovery of the hip joint were checked. The location of insertion of the acetabular cup and femoral stem were evaluated radiologically, and the complications that occurred in the two groups were investigated. Results: The amount of bleeding was significantly smaller in the DAA group (p=0.018). Up to 3 weeks postoperatively, recovery of hip muscle strength was significantly higher in the DAA group (flexion/extension strength p=0.023, abduction strength p=0.031). The Harris hip score was significantly better in the DAA group for up to 3 months (p<0.001) and the Koval score showed significantly better results in the DAA group up to 6 weeks (p≤0.001). The visual analogue scale score improvement was significantly higher in the DAA group by day 7 (p=0.035). The inclination angle (p<0.001) and anteversion angle (p<0.001) of the acetabular cup were located in the safe zone of the DAA group more than in the ALA group, and there was no statistically significant difference in the position of the femur stem and leg length difference. During surgery, two cases of greater trochanter fracture occurred in the DAA group (p=0.155). Conclusion: The DAA performed in the ordinary operation table using a short femoral stem showed post-operative early functional recovery. Because a simple to use fluoroscope was used during surgery with an anatomical position familiar to the surgeon, it is considered to be useful for the insertion of implants into the desired position and for an approach that is useful for the prevention of leg length differences.

• Journal of the Korean Orthopaedic Association
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• v.55 no.6
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• pp.503-510
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• 2020

Purpose: Bipolar hemiarthroplasty is used as an alternative to open reduction and internal fixation for unstable intertrochanteric fractures in elderly patients. Recent advances in medical systems and technologies have resulted in increased survival rates after intertrochanteric fractures of the femur, requiring selection of the appropriate femoral stems considering the mid- to long-term duration of survival. Hemiarthroplasty was performed for unstable intertrochanteric fractures using a double tapered quadrilateral femoral stem (C2 stem), and the clinical and radiological results were evaluated as a five-year follow-up post-surgery. Materials and Methods: From January 2004 to December 2013, 43 patients (43 hips) who underwent hemiarthroplasty with a C2 stem were enrolled in this study. Their mean age was 78.6 years (range, 70-84 years), and the mean follow-up period was 85.4 months (range, 60-96 months). During the follow-up period, clinical parameters, such as the changes in pain, walking ability, and functional status, were examined. Radiologically, changes in the proximal femur, such as osteoporosis and bone resorption of cortical bone, were noted. Complications that occurred during the follow-up period, such as dislocation and prosthetic features, were also reviewed. Results: Initially, the pain was relieved postoperatively, but it increased four years after surgery. The walking ability was reduced by two steps in nine patients after 60 months, and the Harris hip score was reduced significantly postoperatively after two to three years. Radiologically, cortical osteoporosis occurred in 14 patients. Five patients developed cortical bone resorption. Four of them showed nonunion of the trochanteric fracture fragments, and three of them suffered reverse oblique fractures. Conclusion: Careful selection considering the general health condition and remaining lifespan of the patient would be necessary for primary hip hemiarthroplasty using a 3C type cementless femoral stem for unstable intertrochanteric fractures in elderly patients with osteoporosis.

• Tribology and Lubricants
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• v.13 no.1
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• pp.82-87
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• 1997

The modern orthopaedics frequently uses the total hip replacement in the artificial hip joint. The wear in this joint requires a re-replacement of hip joints because it is under the severe load and friction conditions. To solve these problems the previous studies have been mainly focussed on the development of new materials. The research of new materials, however, needs much time and effort since it should be experimented for its bio-compatibility, friction, and wear characteristics. To reduce the work, in this study, the finite element analysis is applied to find new combinations of bio-materials in the total hip replacement which has the excellent contact characteristics. A non-linear FEM program MARC with 5-node axisymmetric element was used for analyzing the contact stresses between the hip joints. The computed results show that in case of acetabulum UHMWP has good characteristics, in femoral head, $Al_2O_3$, and in stem, Ti6Al4V.

• Journal of the Korean Orthopaedic Association
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• v.54 no.3
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• pp.281-286
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• 2019

Avascular necrosis (AVN) is defined as the cellular death of bone and bone marrow components due to the loss of blood supply, and associated with post-traumatic or non-traumatic events. AVN usually involves the epiphysis of a long bone, such as the femoral and humeral heads, which are susceptible to osteonecrosis. Many studies have been conducted but they were restricted to investigations of femoral head avascular necrosis. The presence of osteonecrosis in the proximal femur may impair biological fixation after total hip arthroplasty. We report a 56-year-old male patient with avascular necrosis located not only at the femoral head, but also in the entire femur, including the medullary cavity, who underwent total hip arthroplasty 2 years earlier along with a review of the relevant literature.

• Advances in Computational Design
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• v.4 no.3
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• pp.239-250
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• 2019

The insertion of femoral implants is the most important phase for surgeons, given the characteristics of the cement during its mixing phase, generating residual stresses of thermal origin that increase the different stresses induced in the bone cement. The aim of our study is to determine the different stresses that affect the cement and more particularly at the cement-implant interface for different temperatures, and to make a comparison with the cement at ambient temperature. It was concluded that, there are a large concentration of stresses in the proximal part of the cement. For normal stresses, the bone cement is affected by stresses of tension and compression due to the effect of polymerization and the contraction of the cement.

• Korean Journal of Computational Design and Engineering
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• v.13 no.3
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• pp.200-208
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• 2008

Total Hip Replacement(THR) is a surgical procedure that replaces a diseased hip joint with a prosthesis. A plastic or metal cup forms the socket, and the head of the femur is replaced by a metal ball on a stem placed inside the femur. Due to the various types and shapes of human hip joint of every individual, a selected commercial implant sometimes may not be the best-fit to a patient, or it cannot be applied because of its discrepancy. Hence extracting geometry parameters of hip joint is one of the most crucial processes in designing custom-made implants. This paper describes the framework of a methodology to extract the geometric parameters of the hip joint. The parameters include anatomical axis, femoral head, head offset length, femoral neck, neck shaft angle, anteversion, acetabulum, and canal flare index. The proposed system automatically recommends the size and shape of a custom-made hip implant with respect to the patient's individual anatomy from 3D models of hip structures. The proposed procedure creating these custom-made implants with some typical examples is precisely presented and discussed in this paper.

• Journal of Yeungnam Medical Science
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• v.7 no.1
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• pp.69-80
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• 1990

A clinical analysis was done on 23 patients(24 hips) with fracture of the femoral neck, who had been admitted and treated at our Orthopedic department during the period of 4 years, from Jan, 1984 to May 1988. The results were as follows : 1. 23 patients were comprised of 4 males and 19 females, and 11 patients were over 65 years old. 2. 18 cases of 24 cases were due to minor traumas such as slipping down, and for over 65 years old, all cases were due to simple minor traumas, 8 cases were showed a severe osteoporosis, below grade 3 of the Singh's index. 3. 14 cases of 24 cases were displaced subcapital fractures, and 6 cases displaced transcervical fractures. Only 4 cases were the undisplaced transcervical fractures. 4. In treatment of fractures internal fixations after manipulation were performed in 14 cases and primary arthroplasties in 10 cases. Secondary arthroplasties were done in complicated 4 cases of 14 cases treated with internal fixations. 5. Complications after internal fixation were developed in 7 cases out of 14 cases, avascular necrosis in 6, nonunions in 2, pin migrations in 3, and metal failure in 1 case. 6. In 14 arthroplasty immediate surgical fitness of femoral stem were related to late loosening of femoral stem(correlation coefficient r=-0.68, p<0.01).

• Parasites, Hosts and Diseases
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• v.52 no.2
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• pp.151-162
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• 2014

The technique of stem cells or hepatocytes transplantation has recently improved in order to bridge the time before whole-organ liver transplantation. In the present study, unfractionated bone marrow stem cells (BMSCs) were harvested from the tibial and femoral marrow compartments of male mice, which were cultured in Dulbecco's modified Eagle's medium (DMEM) with and without hepatocyte growth factor (HGF), and then transplanted into Schistosoma mansoni- infected female mice on their 8th week post-infection. Mice were sacrificed monthly until the third month of bone marrow transplantation, serum was collected, and albumin concentration, ALT, AST, and alkaline phosphatase (ALP) activities were assayed. On the other hand, immunohistopathological and immunohistochemical changes of granuloma size and number, collagen content, and cells expressing OV-6 were detected for identification of liver fibrosis. BMSCs were shown to differentiate into hepatocyte-like cells. Serum ALT, AST, and ALP were markedly reduced in the group of mice treated with BMSCs than in the untreated control group. Also, granuloma showed a marked decrease in size and number as compared to the BMSCs untreated group. Collagen content showed marked decrease after the third month of treatment with BMSCs. On the other hand, the expression of OV-6 increased detecting the presence of newly formed hepatocytes after BMSCs treatment. BMSCs with or without HGF infusion significantly enhanced hepatic regeneration in S. mansoni-induced fibrotic liver model and have pathologic and immunohistopathologic therapeutic effects. Also, this new therapeutic trend could generate new hepatocytes to improve the overall liver functions.

• 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.