Forty nine cases of the proximai tibial metaphyseal fractures treated and managed at the Department of Orthopedic Surgery, Severance Hospital from Jan. 1971 to Dec. 1980 were analysed in inclinical and radiological aspect. The results obtained from this study were as followings: l. Among the 49 patients, male were 30 patients and female 19 patients (M:F=1.6:1). 2. The main cause of the fractures was the traffic accident, 42 cases (85.7%). 3. The most common type of the fractures was the transverse fracture, 21 cases (42.9%). 4. The better prognosis of the treatment was the closed reduction. 5. The better prognosis of the fracture type was shown in the transverse fracture and the poor prognosis was in the anterior long oblique fracture. 6. In the union time of the fracture, there was no significant differences between the proximal tibial metaphyseal fracture and the tibial shaft fracture.
Accidents, Traffic ; Clinical Study ; Female ; Humans ; Male ; Orthopedics ; Prognosis ; Tibia

The results of cementless total knee arthroplasty(TKA) have improved steadly during the past decade due to development of design, fixation and surgical technique. We analyzed the results of 45 total knee arthroplasties performed with Anatomic Modular Knee(AMK) prosthesis at the department of Orthopedic Surgery, Yonsei University College of Medicine between June 1989 and December 1991 and compared their results of rheumatoid arthritis(RA) and osteoarthritis(OA) patients. The follow up ranged from 2 years to 4 years and 2 months (average 2 years and 8 months). Using the Hospital for Special Surgery(H.S.S.) rating system and Knee Society(K.S.) clinical rating system, we found that the clinical results were similar for RA group(Average; H.S.S. 86.1, K.S. 81.2/74.4) and OA group(Average; H.S.S. 88, K.S. 87.8/77.1) even though the preoperative knee score was lower in RA group(Average;H.S.S.42.8) than OA group(Average;H.S.S. 57.7). The average age of RA patients was 14 years younger than that of OA patients. The improvement of range of motin and preoperative flexion contracture after TKA was remarkable in RA group. The radiologic evaluation based on Knee Society roentgenographic evaluation system revealed proper alignment of all component and no definite radiologic loosening except 1 case in which postoperative deep infection had occurred. On the basis of this prospective clinical and radiologic review, we concluded that uncemented implantation of AMK prosthsis both in RA and OA patients was encouraging.
Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Contracture ; Follow-Up Studies ; Humans ; Knee ; Orthopedics ; Osteoarthritis ; Prospective Studies ; Prostheses and Implants

No abstract available.

The displacement of patellar components, such as dislocation or subluxation, causes polyethylene wear and further induces metallosis of the metal-backed patella. We compared two different patellar components, onset(Miller-Galante I) and inset(Whiteside-Ortholoc I)type, to understand the differences in patellar tracking according to their designs. Patellar prosthesis position in 43 primary total knee arthroplasties was evaluated with patellar tilt, patellar displacement from the center of the trochlear groove, medial placement, patellar thickness, and joint line height. For the MG(Miller-Galante I)group, the patellar displacement was laterally 50.0% and for the Ortholoc group, it was 33.3%. In the MG group, 4 cases of revision of the patellar component due to excessive polyethylene wear were performed, but there was no excessive wear of polyethylene in Ortholoc group. One of the primary factors which influence tracking of the patellofemoral joint is the difference in design between the patellar component and the femoral component. But in the opinion of the authors, the slope or lateral displacement of the patellar component have no correlation with each other under radiological measurements. However, the inset-type patellar component is a design that maintains the bony flange within the lateral flange, therefore relieving the shear stress and rotational forces loaded on the patellofemoral joint and protecting the metal-backing from exposure. Thereby, even if dislocation or subluxation of the patellar component should occur, polyethylene wear or metallosis caused by excessive wearing can be minimal.
Arthroplasty* ; Dislocations ; Joints ; Knee* ; Patella ; Patellofemoral Joint ; Polyethylene ; Prostheses and Implants

Fifty four consecutive total knee arthroplasties were reviewed to compare the accuracy of extramedullary versus intramedullary tibial resection guides. An extramedullary guide ( Group I ) was used in 25 cases and an intramedullary guide ( Group 2 ) was used in 29 cases. Group 1 system included the LCS knee system and Group 2 system included the Whiteside Ortholoc Advantim total condylar knee system. Preoperatively, the two groups were similar, with no statistical significant differences observed in diagnosis, alignment, and patient age. Postoperative tibial component alignment angles were similar in both group (Group 1, 0.8degrees varus; Group 2, 1.1degrees varus ). In group 1, 84% of tibial components were aligned within 2degrees of the 90degrees goal and in group 2, 83% of tibial components were aligned within the same range ( p > 0.05 ). In all cases, an intramedullary guide was used to prepare the distal femur. In femorotibial angles, with group 1 averaging 4.2degrees valgus versus 4.7degrees valgus in group 2 (p > 0.05). If the optimal femorotibial angle was defined by the range from 5+/-2, it was achieved in 76% in Group 1 and 72% in Group 2 ( p > 0.05 ). This study demonstrates no significant differences between the extramedullary and intramedullary group not only in optimal tibial component alignment angle but also in optimal femorotibial angle. This means that each system is satisfactory for the tibial side, but it is more important for the surgeon to appreciate that the indications, potential limitations and sources of errors are unique to each system and to decide which system to use according to the particular case in question.
Arthroplasty* ; Diagnosis ; Femur ; Humans ; Knee*

Fracture of intercondylar eminerce of the tibia indicate probable alteration of the cruciate ligament stability in the knee and occur from hyperextension injury of the knee and violent internal rotation of the tibia. Fracture of intercondylar eminence of the tibia has been classified by Meyer and Mckeever(1959, 1970) according to the degree of displacment and this classification is important as it pertains to the proper selection of treatment. The author studied 24 cases in 24 patients of fracture of the intercondylar eminerce of the tibia at the Department of Orthopedic Surgery of Severance Hospital during a 10 year period from Januaary, 1975 until December, 1984. The aim of this study was to find out incidence, cause and associated injury of the fracture of the intercondylar eminece of the tibia and was to asses the comparative results of the conservative and surgical treatment. The result of this study ase as follows ; 1. There is a predisposition for make in a ration of 3:1 and there is no age preponderance in occurance. 2.Majority of cause of injury was traffic accident(62.5%). 3.Isolated fracture of intercondylar eminence of the tibia was 15 cases (62.5%) associated knee joint injury shows 9 cases (37.5%). Among the associated knee joint injury, rupure of medial collateral ligament was 4 cases(44.4%), rupture of medial meniscus was 3 cases(33.3%) and rupture of lateral colateral ligament was 2 cases (22.2%). 4.By Meyer and Mckeever's classification, Type 2(41.7%) fracture of intercondylar eminence of the tibia was most common, and then Type 1(37.5%) and Type 3(20.8%) occured in order of frequency. 5. Type 1 and Type 2 fracture of the intercondylar eminence of the tibia resulted in good prognosis with only conservative treatment, and open reduction is not indicated. 6. Type 3 fracture of the intercondylar eminence of the tibia can be treated with conservative treatment if there is no associated injury of the knee joint.
Classification ; Clinical Study ; Collateral Ligaments ; Equidae ; Humans ; Incidence ; Knee ; Knee Joint ; Ligaments ; Menisci, Tibial ; Orthopedics ; Prognosis ; Rupture ; Tibia

Seventy consecutive ipsilateral fracture of the femur and tibia in sixty-eight patients from December 1974 through December 1984 treated at Severance Hospital were analysed in clinical and radiological aspect. 1. Fifty-nine patients were male and nine patients were female. The male patients were more injured in the ratio of 6: 1. The avarage age was 34. 2. The main cause of injuries were traffic accidents; 59 patients. (86.8%). 3. The majority of the fractures were shaft fracture; for example, femur shaft 57% and tibia shaft 47%, The open fracture of the tibia was 34% and the femur was 17%. 4. There were 24 cases of concomitant fracture and dislocation of other sites. A fat embolism was disgnosed in 4% of the patients. Four patients had died one month after sustaining injuries. 5. Over-all, a good or excellent functional result was achieved in 76% of the patients treated with internal fixation of both fracture, 65% of the patients with intexnal fixation for the femur fracture only and 35% of the patients managed conservatively.
Accidents, Traffic ; Dislocations ; Embolism, Fat ; Female ; Femur ; Fractures, Open ; Humans ; Male ; Tibia

Plasma sprayed coating of the hydroxyapatite(HA) are biocompatible and may contribute to the early fixation of total joint prosthesis. We studied 64 hips(58 patients) who had hydroxyapatite coated primary total hip arthroplasty during the period from January 1992 to June 1993 about clinical and radiological result prospectively. The components have been followed for a minimum of 26 months and an average 31 months. Harris hip score averaged 92 at most recent follow up intervals. At the last follow up, the pain in 7 cases(11%) respectively and only slightly to mild in mostly. Although thigh pain has been occurred in 7 cases(11%), all patients had not trouble in daily activity. In radiological evaluation, there was a rapid and good endosteal bone formation of implants with bone apposition on the Gruen zone 2 and 6 of HA coating area. No radiolucent line formation was detected around HA coated area. In acetabular component, the endosteal bone formation was found in 12 cases and the radiolucent line was occurred in 4 cases. No revision were done for the femoral and acetabular component. The result of the study indicate that this hydroxyapatite coated component can provide satisfactory clinical and radiological result. Further prospective follow up is necessary to determine whether the favorable early result of this implant are maintained over longer period.
Acetabulum ; Arthroplasty, Replacement, Hip ; Durapatite ; Follow-Up Studies ; Hip ; Humans ; Joint Prosthesis ; Osteogenesis ; Plasma ; Prospective Studies ; Thigh

Heterotopic ossification(HO) is a frequent complication of total hip arthroplasty(THA), If it is sevre enough, it can convert a successful result of the operation into a poor one. Among several strategies that researches in recent years have tested, radiation therapy have been accepted to have efficacy for prevention of heterotopic ossification by many authors. While postoperative irradiation has been shown to lower the incidence of HO effectively in high risk patients following THA, patients in multiple dose protocols continue to develop some heterotopic ossifiction despite therapy and have some problems. Ninteen patients received single dose exposure to 600 rad delivered within 48 hours of THA with shielding of prosthesis region. The patients were considered high risk group for developing HO because of hypertropic osteoarthritis, post-traumatic osteoarthritis or the presence of previous formed ectopic bone. The average follow up period was 10.2 months(range 6 months
Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Hip ; Humans ; Incidence ; Ossification, Heterotopic ; Osteoarthritis ; Osteogenesis ; Prostheses and Implants

No abstract available.
Femoral Neck Fractures* ; Femur Neck*