• 대한물리의학회지
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• 제19권1호
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• pp.95-105
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• 2024

PURPOSE: This study aimed to utilize the International Classification of Functioning, Disability, and Health (ICF) tool to identify a problem list and explore intervention effects using proprioceptive neuromuscular facilitation (PNF) for improving the crosswalk performance of patients who have undergone a bilateral hip arthroplasty. METHODS: The subject of this study was a 43-year-old male who had undergone a bilateral hip arthroplasty. To address the subject's functional status, a clinical decision-making process was carried out in the order of examination, evaluation, diagnosis, prognosis, intervention, and outcome. Patient information during the examination was collected using the ICF core set. The evaluation involved listing the items of each problem using the ICF assessment sheet and identifying the interaction between activity limitations and the impairment level. The diagnosis explicitly described the causal relationships derived from the evaluation using ICF terminology. The prognosis presented activity goals, body function, and structured goals in terms of the activity and participation levels that needed to be achieved for an individual's functional status. The intervention approached problems through the four components of the PNF philosophy, namely basic principles and procedures, techniques, and patterns, in an indirect-direct-task sequence. Results were compared before and after the intervention using the ICF evaluation display. RESULTS: The results of the study showed that the primary activity limitation, which was the walking time across the crosswalk, showed improvement, and the trunk's counter rotation and the weight-bearing capacity of both the lower limbs, which were impairment level indicators, were enhanced. CONCLUSION: This study suggests that PNF intervention strategies will serve as a positive approach for improving crosswalk walking in patients with bilateral hip arthroplasty.

• Hip & pelvis
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• 제36권2호
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• pp.129-134
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• 2024

Purpose: Preoperative planning has become essential in performance of total hip arthroplasty (THA). However, data regarding the effect of the planner's experience on the accuracy of digital preoperative planning is limited. The objective of this study was to assess the accuracy of digital templating in THA based on the surgeon's experience. Materials and Methods: A retrospective study was conducted. An analysis of 98 anteroposterior pelvic radiographs, which were individually templated by four surgeons (two hip surgeons and two orthopaedic residents) using TraumaCad^® digital planning, was performed. A comparison of preoperatively planned sizes with implanted sizes was performed to evaluate the accuracy of predicting component size. The results of preoperative planning performed by hip surgeons and orthopaedic residents were compared for testing of the planner's experience. Results: Femoral stem was precisely predicted in 32.4% of cases, acetabular component in 40.3%, and femoral offset in 76.7%. Prediction of cup size showed greater accuracy than femoral size among all observers. No differences in any variable were observed among the four groups (acetabular cup P=0.07, femoral stem P=0.82, femoral offset P=0.06). All measurements showed good reliability (intraclass correlation coefficient [ICC] acetabular cup: 0.76, ICC femoral stem: 0.79). Conclusion: The results of this study might suggest that even though a surgeon's experience supports improved precision during the planning stage, it should not be restricted only to surgeons with a high level of experience. We consider preoperative planning an essential part of the surgery, which should be included in training for orthopaedics residents.

• Hip & pelvis
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• 제34권1호
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• pp.56-61
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• 2022

Purpose: Histopathologic analysis of femoral head specimens following total hip arthroplasty (THA) is a routine practice that represents a significant use of health care resources. However, it occasionally results in discovery of undiagnosed hematopoietic malignancy and other discrepant diagnoses such as avascular necrosis. The purpose of this study was to determine the rate of discordant and discrepant diagnoses discovered from routine histopathological evaluation of femoral heads following THA and perform a cost analysis of this practice. Materials and Methods: A review of patients undergoing primary THA between 2004-2017 was conducted. A comparison of the surgeon's preoperative and postoperative diagnosis, and the histopathologic diagnosis was performed. In cases where the clinical and histopathology differed, a review determined whether this resulted in a change in clinical management. Medicare reimbursement and previously published cost data corrected for inflation were utilized for cost calculations. Results: A review of 2,134 procedures was performed. The pathologic diagnosis matched the postoperative diagnosis in 96.0% of cases. Eighty-three cases (4.0%) had a discrepant diagnosis where treatment was not substantially altered. There was one case of discordant diagnosis where lymphoma was diagnosed and subsequently treated. The cost per discrepant diagnosis was $141,880 and per discordant diagnosis was $1,669 when using 100% Medicare reimbursement and Current Procedural Terminology (CPT) code combination 88304+88311. Conclusion: Histopathologic analysis of femoral head specimens in THAs showed an association with high costs given the rarity of discordant diagnoses. Routine use of the practice should be at the discretion of individual hospitals with consideration for cost and utility thresholds.

• Hip & pelvis
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• 제34권2호
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• pp.106-114
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• 2022

Purpose: While initial fixation using a press-fit of the acetabular cup is critical for the durability of the component, restoration of the hip center is regarded as an attributable factor for implant survival and successful outcome. In protrusio acetabuli (PA), obtaining both restoration of the hip center and the press-fit of the acetabular cup simultaneously might be difficult during total hip arthroplasty (THA). We tested the hypothesis that use of a medialized cup, if press-fitted, will not result in compromise of the implant stability and outcome after cementless THA of PA. Materials and Methods: A total of 26 cementless THAs of 22 patients with PA were reviewed. During THA, press-fit of the cup was prioritized rather than hip center restoration. A press-fit was obtained in 24 hips. A pressfit could not be obtained in the two remaining hips; therefore, reinforcement acetabular components were used. Restoration of the hip center was achieved in 17 cups; 15 primary cups and two reinforcement components; it was medialized in nine cups. Implant stability and modified Harris hip score (mHHS) between the two groups were compared at a mean follow-up of 5.1 years (range, 2-16 years). Results: Twenty-six cups; 17 restored cups and nine medialized press-fitted cups, remained stable at the latest follow-up. A similar final mHHS was observed between the restored group and the medialized group (83.6±12.1 vs 83.8±10.4, P=0.786). Conclusion: Implant stability and favorable results were obtained by press-fitted cups, irrespective of hip center restoration. THA in PA patients showed promising clinical and radiological results.

• 대한기계학회논문집A
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• 제28권11호
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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.

• Clinics in Shoulder and Elbow
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• 제26권3호
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• pp.245-251
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• 2023

Background: For anatomic total arthroscopic repair, cementless humeral fixation has recently gained popularity. However, few studies have compared clinical, radiographic, and patient-reported outcomes between cemented and press-fit humeral fixation, and none have performed follow-up for longer than 5 years. In this study, we compared long-term postoperative outcomes in patients receiving a cemented versus press-fit humeral stem anatomic arthroscopic repair. Methods: This study retrospectively analyzed 169 shoulders that required primary anatomic total shoulder arthroplasty (aTSA). Shoulders were stratified by humeral stem fixation technique: cementation or press-fit. Data were collected pre- and postoperatively. Primary outcome measures included range of motion, patient reported outcomes, and radiographic measures. Results: One hundred thirty-eight cemented humeral stems and 31 press-fit stems were included. Significant improvements in range of motion were seen in all aTSA patients with no significant differences between final cemented and press-fit stems (forward elevation: P=0.12, external rotation: P=0.60, and internal rotation: P=0.77). Patient reported outcome metrics also exhibited sustained improvement through final follow-up. However, at final follow-up, the press-fit stem cohort had significantly better overall scores when compared to the cemented cohort (visual analog score: P=0.04, American Shoulder and Elbow Surgeon Score: P<0.01, Simple Shoulder Test score: P=0.03). Humeral radiolucency was noted in two cemented implants and one press-fit implant. No significant differences in implant survival were observed between the two cohorts (P=0.75). Conclusions: In this series, we found that irrespective of humeral fixation technique, aTSA significantly improves shoulder function. However, within this cohort, press-fit stems provided significantly better outcomes than cemented stems in terms of patient reported outcome scores. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• 제23권1호
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• pp.20-26
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• 2020

Background: High complication rate after open reduction and internal fixation can lead to use of primary total elbow replacement (TER) in treatment of complex distal humerus fractures in elderly patients. The purpose of this study was to investigate the short-term outcomes and complications after primary TER in patients with complex distal humerus fracture. Methods: Nine patients with acute complex distal humerus fracture were treated by primary TER using the semiconstrained Coonrad-Morrey prosthesis. The mean age of patients was 72.7 years (range, 63-85 years). Clinical and radiographic outcomes were evaluated over a mean follow-up of 29.0 months (range, 12-65 months) using visual analog scale (VAS) score for pain; Mayo elbow performance score (MEPS); Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score; and serial plain radiographs. Complications were also evaluated. Results: At the final follow-up, mean VAS, MEPS, and Quick-DASH scores were 1.2, 80.5, and 20, respectively. The mean range of motion was 127.7° of flexion, 13.8° of extension, 73.3° of pronation, and 74.4° of supination. There was no evidence of bushing wear or high-grade implant loosening on serial plain radiographs. Three complications (33.3%) comprising two periprosthetic fractures and one ulnar neuropathy were observed. Conclusions: Primary TER for treatment of complex distal humerus fractures in elderly patients yielded satisfactory short-term outcomes. However, surgeons should consider the high complication rate after primary TER.

• Hip & pelvis
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• 제36권2호
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• pp.120-128
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• 2024

Purpose: The purpose of this study was to compare the clinical and radiographic outcomes with use of short-curved stems versus standard-length single wedged stems over a minimum follow-up period of five years. Materials and Methods: A retrospective study of primary total hip arthroplasties performed using the Fitmore^® stem (127 hips, 122 patients) and the M/L taper^® stem (195 hips, 187 patients) between October 2012 and June 2014 was conducted. The clinical and radiographic outcomes were obtained for evaluation over a minimum follow-up period of five years. Results: In both the Fitmore^® and M/L taper^® groups, the mean Harris hip score improved from 52.4 and 48.9 preoperatively to 93.3 and 94.5 at the final follow-up, respectively (P=0.980). The mean Western Ontario and McMaster Universities Osteoarthritis Index scores also improved from 73.3 and 76.8 preoperatively to 22.9 and 25.6 at the final follow-up, respectively (P=0.465). Fifteen hips (Fitmore^®: 14 hips; M/L taper^®: one hip, P<0.001) developed intraoperative cracks and were treated simultaneously with cerclage wiring. Radiography showed a radiolucent line in 24 hips in the Fitmore^® group and 12 hips in the M/L taper^® group (P=0.125). Cortical hypertrophy was detected in 29 hips (Fitmore^® group: 28 hips; M/L taper^® group: one hip, P<0.001). Conclusion: Similarly favorable clinical and radiographic outcomes were achieved with use of both short-curved stems and standard-length single wedged stems. However, higher cortical hypertrophy and a higher rate of femoral crack were observed with use of Fitmore^® stems.

• Journal of Trauma and Injury
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• 제31권3호
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• pp.177-180
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• 2018

Heterotopic bone formation in abdominal incisions is a recognized but uncommon sequela of abdominal surgery. On the other hand, the formation of ectopic bone is a well-recognized complication following arthroplasty of the hip. Heterotopic ossification of midline abdominal incision scars is a subtype of myositis ossificans traumatica. Ectopic bone formation of midline abdominal incisions may cause regional pain or discomfort in the patient after surgery. If symptomatic, treatment is complete excision with primary closure. Radiologically, it is important to distinguish this benign entity from postoperative complications. We report a 69-year-old male who underwent exploratory laparotomy for traumatic small bowel perforation. A segment of abnormal hard tissue was found in the abdominal wall. Heterotopic ossification may occur at various sites and is a recognized but infrequent sequela of exploratory laparotomy. This case highlights clinical and etiological features of this finding.

• Clinics in Shoulder and Elbow
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• 제15권2호
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• pp.130-137
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• 2012

목적: 골다공증이 있는 노인환자에서 상완골 원위부 관절부위 골절로 관혈적 정복술 및 내고정술과 주관절 전치환술 시행 후 기능적 결과에 대해서 평가 보고하였다. 대상 및 방법: 2007년1월부터 2009년 10월까지 상완골 원위부 관절내 골절을 주소로 내원한 65세 이상의 환자 24명을 대상으로 하였으며 18명은 후방 도달법을 이용하여 관혈적 정복술 및 내고정술을 시행하고 (Fig. 1), 6명은 주관절 전치환술을 시행하였다 (Fig. 2). 평균 추시 기간은 16.3 개월 이였으며 골절형태는 AO 분류로 8명이 C2, 16명이 C3 형태의 골절이였다. 추시 시 모든 환자들은 방사선촬영 및 신체검사를 시행하였고, Mayo 주관절 수행점수, 및 DASH 점수를 이용하여 임상적 결과를 측정하였다. 결과: Group I 18예 모두 골유합 되었으며 골절부터 골유합까지 평균 기간은 14주였다. 합병증으로 2예에서 주두골 절골부위에 불유합이 관찰되었으며 척골신경증상을 보였던 2예 중 1예는 전방이전술에도 불구하고 개선되지 않았다. Mayo 주관절 수행점수는 평균 87.0점이였으며, DASH 점수는 평균 32.4점이였다. 마지막 추시 시에 시행한 이학적 검사에서 굴곡은 평균 121.0도 (95~145도), 굴곡구축은 평균 12도 (0~35)이였다. Group II 6예 모두 추시 기간내 합병증은 없었으며, Mayo 주관절 수행점수는 평균 89.1점 이였으며, DASH 점수는 평균 44.3점이었다. 마지막 추시 시에 시행한 이학적 검사에서 굴곡은 평균 125.1도 (100~145도), 굴곡 구축은 평균 12.6도 (0~30)이였다. 결론: 골다공증을 동반한 고령의 상완골 원위부 관절내 골절 환자에서 적절한 환자 선택시 내고정술 뿐만 아니라 전치환술에서도 단기 추시 시 만족할만한 결과를 보임을 확인할 수 있었다.