[Objective] To determine the long term survivorship and establish the idea I correction angle in proximal tibial osteotomy for primary osteoarthritis. [Method] Seventy-nine patients suffering from primary osteoarthritis (111 knees) were performed with proximal tibial valgus osteotomy from 1985 to 1997, among which 74 women (106 knees) and 5 men (5 knees). The age ranged from 37 to 70 years (mean, 55 years). Postoperatively, hospital for Special Surgery knee score (HSS) was used for clinical assessment. The femorotibial angle (FTA) was measured to classifiy patients to group Ⅰ of 61 knees with less than 7 of valgus; group Ⅱ of 23 knees with 7～9 of valgus; group Ⅲ of 27 knees with over 10 of valgus. Closed wedge osteotomy was performed in all cases. HSS was assessed pre-and post-operatively. [Result] The average follow-up period was 9 years and 6 months (2 years and 4 months to 14 years and 1 month). The HSS knee score averaged 60 points preoperatively, 94 after 1 year and 87 at the last follow-up. Falure I was the need for conversion of a proximal tibial osteotomy to a total knee arthrop lasty, and Failure Ⅱ was the need for conversion of HSS knee score of less than 60 points. The 4 and 14 years survival rates were 99% and 85% using the first definition of failure, and 96. 4% and 75.1% using the second. [Conclusion] Proximal tibial osteotomy is reliable for treating unicompartmental osteoarthritis, providing that the postoperative femorotibial angle is corrected to more than 7° of valgus and falls in the range of 10°～15°.

PURPOSE: To evaluate long-term results of an anterior lumbar fusion with posterior instrumentation using a bicortical iliac allograft. MATERIALS AND METHODS: Fifty-one patients underwent anterior lumbar fusion with posterior instrumentation using an iliac allograft. This study included 28 patients and 37 levels, and was followed for at least 5 years. Clinical and radiological results were evaluated. RESULTS: Bony fusion was obtained in 92% of the levels and excellent or good clinical results were achieved in 82% of the patients. Mean intervertebral disc space of 10.7 mm preoperatively was increased to 14.6 mm postoperatively and became 12 mm at final follow-up. Ascrew breakage was noted in one patient. CONCLUSION: Our data suggest that bicortical iliac allograft is a satisfactory graft material and produces acceptable clinical and radiological results in anterior lumbar fusion with posterior instrumentation. However, with respect to fusion quality the allograft should be a substitute for autograft in selected case.
Allografts* ; Autografts ; Follow-Up Studies* ; Humans ; Intervertebral Disc ; Spine ; Transplants

Cubitus varus deformity of the elbow may not only cause cosmetic problems, but delayed functional deficiencies also. This case report demonstrated delayed posterolateral rotatory instability due to lateral collateral ligament complex avulsion long after posttraumatic cubitus varus. Satisfactory results were obtained using cubitus varus correction and reattachment of the lateral collateral ligament complex to the lateral epicondyle of the humerus.
Congenital Abnormalities ; Elbow* ; Humerus ; Lateral Ligament, Ankle

PURPOSE: To compare the measurements using a navigation system and radiographic measurement in an open wedge high tibial osteotomy under navigation control. MATERIALS AND METHODS: From July, 2005 to January, 2007, 32 open wedge high tibial osteotomies were performed using a navigation system for osteoarthritis of the knee. The postoperative mechanical axis % (MA%), which is planned on the navigation system, were 62%. The mechanical axis (MA) and MA% were measured on the navigation system. The preoperative and postoperative MA and MA% were measured on the radiographs. The angles measured with the navigation system and radiographs were compared. RESULTS: On the navigation system, the mean MA before osteotomy was varus 8.8degrees. The mean MA and MA% after fixation were valgus 2.9degrees and 57.7%. On the radiographs, the mean MA was varus 9.7degrees preoperatively and valgus 4.0degrees postoperatively. The mean MA% was 10.2% preoperatively and valgus 64.4% postoperatively. There were positive correlations between the values measured with the navigation system and the radiographs (r>0.5, p<0.001). CONCLUSION: There were significant correlations between the values measured with the navigation system and radiographs in an open wedge high tibial osteotomy using a navigation system. The correction angle from the navigation system is reliable, predictable and controllable during surgery.
Axis, Cervical Vertebra ; Knee ; Osteoarthritis ; Osteotomy ; Surgery, Computer-Assisted

PURPOSE: To compare the radiologic measurements of the mechanical axis and the implant position of Total Knee Arthroplasty (TKA) using a computer-assisted navigation system with those using conventional TKA in varus deformity. MATERIALS AND METHODS: From January 2004 to January 2005, 49 TKAs using a CT-free navigation system (Vector Vision(R), BrainLab, Heirnstetten, Germany) (Group I) and 24 TKAs using the conventional technique (Group II) were performed on patients who had a preoperative varus deformity>10degrees. The patients were also subdivided into two groups, patients with a varus deformity<20degrees (group A) and patients with varus deformity > 20degrees (group B). The PFC Sigma implants were used in both groups. The mechanical axis and implant position were measured by 2 observers according to the reontgenographic evaluation system of the American Knee Society. RESULTS: There was no significant difference in alpha, beta, delta angle and mechanical axis between group I and II. There was a significant difference in the gamma angle between group I and II (p<0.05). There was a significant difference in the alpha and beta angle and mechanical axis between group IA and IB (p<0.05). There was a significant difference in the alpha angle and mechanical axis between group IIA and IIB (p<0.05). There was a positive correlation between the measured angle by the respective observers in all groups (p<0.05). CONCLUSION: Patients with a preoperative varus deformity>20degrees tended to have more postoperative varus mechanical alignment than those with a preoperative varus deformity between 10degrees and 20degrees after TKA. More careful attention during the registration of the femoral mechanical axis should be paid in patients with a larger varus deformity in TKA using a computer-assisted navigation system. On the other hand, a reasonable mechanical valgus angle should be considered in femoral bone cutting for a varus deformity of the distal femur in conventional TKA. In addition, inadequate positioning of intramedullary rod should be recognized in conventional TKA.

PURPOSE: To analyze clinical and radiological results of patients who underwent treatment for a femur supracondyle fracture following total knee arthrosplasty(TKA). MATERIALS AND METHODS: Between January 1991 and March 2005, A total of 33 knees of 30 patients(2 male, 31 female knees) were treated for periprosthetic supracondyle fractures following TKA. The mean age of patients was 60.5 years and the mean follow-up period was 3.5 years(range, 1 year~9 years and 1 month). In accordance with the modified Neer classification, 3 cases were classified as Type 1; 23 cases, Type 2; 4 cases, Type 3; and 3 cases, Type 4. Treatment methods included closed reduction and cast immobilization in 8 cases, Ender nailing in 8 cases, open reduction and internal fixation in 14 cases, and total knee arthroplasty using a long stem in 3 cases. RESULTS: Among 2,325 knees with primary TKA, 33 cases occurred a supracondylar fracture. The incidence of 1.4%. The range of motion reduced from the mean of 113.1 degrees before the fracture to the mean of 94.3 degrees at the last follow-up. The conservative group reduced from 112.3 degrees to 71.9 degrees while the operative group decreased from 113.3 degrees to 102.0 degrees. The HSS knee rating score declined from the mean of 88.1 points before the fracture to the mean of 81.4 points at the last follow-up. The score of the conservative group was down to 70 points from 87.5 points and that of the operative group decreased to 85.4 points from 88.3 points. The femorotibial angle, which was 6.39 degrees of varus before the fracture, was measured 3.07 degrees of varus at the last follow-up. The femorotibial angle decreased from 6.2 degrees to 1.1 degrees of valgus in the conservative group and from 6.5 degrees to 3.7 degrees of valgus in the operative group. Only one of the total 33 cases had nonunion. CONCLUSION: In the treatment for the supracondylar fractures of TKA, the decreased amount of postoperative ROM, HSS score and femorotial angle were all less in an operative treatment than conservative treatment. Revision arthroplasty using a long stem showed satisfactory results in patients with component loosening.
Arthroplasty* ; Classification ; Female ; Femur ; Follow-Up Studies ; Humans ; Immobilization ; Incidence ; Knee* ; Male ; Periprosthetic Fractures ; Range of Motion, Articular

A previous report by this laboratory demonstrated that bacterial iron chelator (siderophore) triggers inflammatory signals, including the production of CXC chemokine IL-8, in human intestinal epithelial cells (IECs). Microarray-based gene expression profiling revealed that iron chelator also induces macrophage inflammatory protein 3 alpha (MIP-3alpha)/ CC chemokine-ligand 20 (CCL20). As CCL20 is chemotactic for the cells involved in host adaptive immunity, this suggests that iron chelator may stimulate IECs to have the capacity to link mucosal innate and adaptive immunity. The basal medium from iron chelator deferoxamine (DFO)-treated HT-29 monolayers was as chemotactic as recombinant human CCL20 at equivalent concentrations to attract CCR6+ cells. The increase of CCL20 protein secretion appeared to correspond to that of CCL20 mRNA levels, as determined by real-time quantitative RT-PCR. The efficacy of DFO at inducing CCL20 mRNA was also observed in human PBMCs and in THP-1 cells, but not in human umbilical vein endothelial cells. Interestingly, unlike other proinflammatory cytokines, such as TNF-alpha and IL-1beta, a time-dependent experiment revealed that DFO slowly induces CCL20, suggesting a novel mechanism of action. A pharmacologic study also revealed that multiple signaling pathways are differentially involved in CCL20 production by DFO, while some of those pathways are not involved in TNF-alpha-induced CCL20 production. Collectively, these results demonstrate that, in addition to some bacterial products known to induce host adaptive immune responses, direct chelation of host iron by infected bacteria may also contribute to the initiation of host adaptive immunity in the intestinal mucosa.
Calcium/metabolism ; Cell Movement/drug effects ; Chemokines, CC/genetics/*metabolism ; Deferoxamine/*pharmacology ; Egtazic Acid/analogs & derivatives/pharmacology ; HT29 Cells ; Humans ; Immunity, Mucosal/*drug effects ; Intestinal Mucosa/*drug effects/immunology/metabolism ; Iron Chelating Agents/*pharmacology ; Macrophage Inflammatory Proteins/genetics/*metabolism ; NF-kappa B/metabolism ; Phosphoprotein Phosphatase/physiology ; Protein Transport/drug effects ; Protein-Serine-Threonine Kinases/physiology ; RNA, Messenger/genetics/metabolism ; Receptors, Chemokine/metabolism ; Research Support, Non-U.S. Gov't