Vnrus deformity is a common finding in patients who are candidates for toial knee replacement arthropiasty. To obtain excellent clinical results and to maintain well-aligned and stable prosthetic components in patients who have such a deformity, adequate ligament balancing as well as accurate cone.ction of bony alignment is required. But many technical problems are encountered. Especially the bony defect on the medial aspect of the tibia after adequate bone cutting and ligament imbalance with laxity in the lateral side and contracture in the medial side. Total knee replacement arthroplasty with 43 patients(56 cases) to be mcre than 10 degrees of varus of tibio-femoral angle was done by a single surgeon and reviewed retrospectively. The diagnosis was osteoarthritis in 46 cases, rheumatoid arthritis in 9 cases. The average follow up period was average 33 months(l-7 years). Preoperative varus deformity of average 13.5 degree., was corrected to valgus 6.69 degrees at last follow-up. Postoperative range of motion was 122.5 degree. And the mean knee society score improved from 24.8 to 87.2 postoperatively and the function score improved from 23.6 to 83.9 postoperatively. At self-assements, 88.2% of the patients was very satisfied or somewhat satisfied. Total knee replacement ;u1hroplasty in the patients with vaus deformity is effective procedure to corri.ct deformity and improve clini- c;1 and functional status, but long-term follow up period is required for changing alignment.
Arthritis, Rheumatoid ; Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Congenital Abnormalities* ; Contracture ; Diagnosis ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Osteoarthritis ; Range of Motion, Articular ; Retrospective Studies ; Tibia

We analysed the results of total knee replacement arthroplasty without patellar resurfacing in 20 patients(28 knees) retrospectively. The patella was not resurfaced when it maintained relatively healthy cartilage in osteoarthritis or the patella was too thin to be replaced in rheumatoid arthritis. The diagnoses were osteoarthritis in 11 and rheumatoid arthritis in 17 cases. The follow up period was 30.3 months in average(12-70 months). A lateral retinacular release was performed in 22 knees(78.6%). The mean knee society score improved from 45.4 preoperatively to 84.1 postoperatively and the functional score improved from 21.4 preoperatively to 63.3 postoperatively. The modified Kujala score was 43.2 points in osteoarthritis and 43.6 points in rheumatoid arthritis. We conclude the total knee replacement arthroplasty without patellar resurfacing shows good results, without high risk of postoperative peripatellar complication.
Arthritis, Rheumatoid ; Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Cartilage ; Diagnosis ; Follow-Up Studies ; Knee ; Osteoarthritis ; Patella ; Retrospective Studies

The congenital radio-ulnar synostosis is a rare malformation which often completely perevents pronation and supination of the forearm. Recently, this disese has no good result by treatment including various operative techniques. The authors have experience a case of the congenital radio-ulnar synostosis, which was corrected by modified Green method and satisfactory result was obtained.
Forearm ; Methods ; Pronation ; Supination ; Synostosis

The short term beneficial effect of arthroscopic excision of synovial tissue in knees with rheumatoid arthritis have been well documented. The purpose of this study to report the results of synovectomy in patients with rheumatoid arthritis who have been observed at least 3 years. We analysed the clinical result with modified Laurin criteria, radiologic change and patients own satisfaction degree with survey. The results were as follows; 1. The preoperative symptoms were pain (100%), swelling (100%), decreased range of motion (83%) and joint tenderness (74%), and those were improved postoperatively to 43%, 60%, 11%, 43% each other. 2. Among the laboratory parameters, C-reactive protein (CRP) was improved most significantly (pvalue =0.026). 3. On simple supine A-P X-rays, the width of medial joint space and lateral joint space were compared to preoperatively and postoperatively. The width of medial joint space was 4.33mm preoperatively, and it was changed to 3.22mm at last follow up (p=0.032). Those of lateral joint space was changed from 4.24mm preoperatively to 3.27mm at last tollow up (p=0.106). 4. The grade of articular cartilage damage was related with severity of preoperative symptoms and the patients with low grade of articular cartilage damage showed more postoperative improvement. The result of operation was related to symptom duration, degree of X-ray change and degree of cartilage damage. 5. 58% ot patients were satisfied to results of synovectomy, 28% were answered neither satisfied nor ansatisfied and 14% were unsatisf'ied to operation. We concluded the arthroscopic synovectomy of the knee joints was effective procedure to improve the clinical symptoms, range of knee motion and to alleviate the inflammatory reaction at mid-term period al'ter the operation. So we consider this procedure is a palliative treatment that modified and alleviate the progression of rheumatoid arthritis of knee joints.
Arthritis, Rheumatoid* ; C-Reactive Protein ; Cartilage ; Cartilage, Articular ; Follow-Up Studies ; Humans ; Joints ; Knee Joint* ; Knee* ; Palliative Care ; Range of Motion, Articular

The total knee arthroplasty (TKA) is now an established treatment of severe arthritis of the knee joint. The results of TKA estimate good result in mid-90% of patient. But most of assessing method was based on the evaluation methods, made by surgeons, so the patients own evaluation of success may different from the assessment of the surgeons. Especially the Korean life style is different from western style because Korean need more flexed knees for sitting position on the floor. But there no paper about patient subjective satisfactory result of Korean in the authors knowledge. So we studied the satisfactory degree about the outcome of TKA in Korean by the survey. A total 90 patients (103 cases), had undergone TKA were asked to complete a questionnaire-the questionnaire composed of question; ""are you satisfactory with operation?""and the answer; ""very satifactory, generally satisfactory, improved, no change or aggravated-about their satisfaction with the outcome of surgery. The results were as follows; 1.Of 90 patients, 90.3% were satisfied with the outcome of TKA. 2. The patints were satisfied 100% in avascular necrosis of femoral condyle, 83.8% in degenerative osteoarthritis, and 93.6% in rheumatoid arthritis. 3. The satisfactory degree had no relations with age, prevalent period, bilaterality and the evaluation period after the TKA (P>0.05). 4. There was a significant difference in knee scores between the patients who satisfied or not (P<0.05) and the satisfactory degree had a correlation with the points of knee score and amelioration rate of knee and function scores.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty* ; Humans ; Knee Joint ; Knee* ; Life Style ; Necrosis ; Osteoarthritis ; Surveys and Questionnaires

The purpose of this study is to evaluate the results of primary repair and autogenous tendon augrnentation for acute rupture of anterior cruciate ligament. We primarily repaired 13 cases of acute ACL injury with autogenous tendon augmentation between Jul. 1988 and Jan. 1996. Among 13 cases, there were 2 isolated ACL injuries and 11 cases were combined with MCL injuries. All 13 cases were followed up over 1 year. An average follow up period was 4.1 years (1.1 - 8). All patients had open primary rnultiple suture repair and semitendinosus tendon (11 cases) or iliotibial band (2 cases) augmentation at average 3.6 days after the injury. In 11 cases, medial collateral ligarnent injuries were noted and these ruptured ligaments were supplemented with staple or vicryl suture. We evaluated the results with Lysholm Knee Score, KT-1000 arthrometer, postoperative ROM of knee, thigh muscle atrophy, extension lag, Lachman and pivot shift test. The clinical results were as follows 1. Lysholm Knee Score was mean 87.2 points; over 90 points: 5 cases, 80-8$ points: 5 cases, 70-79 points: 3 cases 2. Using the KT-1000 arthrometer, the average side to side difference wm 1.8nun in 201b (89N) and the compliance index was average 1.7mm. 3. Postoperative ROM of knee was nearly normal and there was no extensioe lag in any cases. But, we performed arthroscopic adhesiolysis in one case for limited motion of knee joint a ( postoperative 8 months. Thigh circumference was measured 0.95 cm difference than the healthy side at 10cm above upper pole of patella. 4. Lachman test was positive in 2 cases. 5. Pivot shift test was positive in 2 cases. Even if not many cases, we obtained relatively satisfactory results. So the pirimary repair with autogenous tendon auynentation was recornmandable procedure for acute rupture of ACL, especially combined with MCL injury.
Anterior Cruciate Ligament ; Compliance ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Ligaments ; Methods ; Muscular Atrophy ; Patella ; Polyglactin 910 ; Rupture ; Sutures ; Tendons* ; Thigh

In shape and dimensions, the tibial plateaus are asymmetric with the larger medial tibial plateau and both have a posterior inclination with respect to the shaft of the tibia. Maximizing tibial coverage is an impotant consideration in total knee arthroplasty to provide stahility and load transfer and to improve long-term survival rate of the implants. Most tihial tray designs are symmetric, but several asymmetric designs are available. We evaluated the proximal tibial resection surface during total knee aithroplasty to delineate the tibial plateaus in korean. After tihial bone cut during 100 TKA procedures, the outline of tibial resection suiface was traced and rotational axis of true tibial component was marked intraoperatively. A line was drawn at the maximal anteroposterior (AP) diameter of lateral tibial condyle with parallel to rotational axis of component, and then a transverse axis was drawn at the midpoint of maximal AP diameter of 1ateral tibial condyle. Anteroposterior 10, 20, 30., 40% and midpoint from the media1 and lateral peripheries were calculated manually. The average AP medial 10, 20, 30 and 40% dimensions were 34.7, 43.8, 48.0 and 43.2mm, respectively. The average AP lateral 10, 20, 30 and 40% dimensions were 30.2, 38.4, 42.0 and 40.9mm, respectively. The ratio of medial/lateral AP dimensions 10, 20, 30 and 40% from periphery were 116.9, 114.7, 114.5 and 106.4%, respectively. From these data, we know the asymmetry of the proxirnal tibia1 plateaus in korean. We hope that rnore data will be ohtained in multicenter studies and it will help us to select tibia1 tray and to design the tibial component in korean. But, more accurate standard measures will he need to minimize an error of measurements.
Arthroplasty* ; Axis, Cervical Vertebra ; Hope ; Knee* ; Survival Rate ; Tibia

We reviewed radiographs of 11 patients with 17 total knee replacement arthroplasty(TKRA) cases. These patients had a residual flexion contracture over 20 degree after TKRA that corrected spontaneously during follow-up. The mean age of patients was 46.5 years(range, from twenty nine to sixty six). Seven patients were bilateral cases and all knees were cases of rheumatoid arthritis. The mean preoperative flex- ion contracture was 53.8 and immediately postoperative contracture was 23.5. The remaining flexion contracture after TKRA was completely corrected during follow-up period in all cases. We measured the distance from upper margin of tibial components to a certain point on the fibula. This point is on a line perpendicular to long axis of the tibia, drawn from a certain point on the fibula. This dis- tance was measured on postoperative radiographs and radiographs with improved flexion contracture, and the differences calculated. There was no significant difference between the two distances. Although the number of cases are small, we conclude that flexion contracture might be corrected to the extent of 20-30 degree by soft tissue stretching rather than bone subsidence.
Arthritis, Rheumatoid* ; Arthroplasty, Replacement, Knee ; Axis, Cervical Vertebra ; Contracture* ; Fibula ; Follow-Up Studies ; Humans ; Knee ; Tibia

Localized pigmented villonodular synovitis is a monoarticular proliferative condition that may affect any joint but is frequently found in the knee. The locaiized form was less frequent than the diffuse one. The estimated frequency of localized pigmented villonodular synovitis among patients performed an arthroscopic procedure was known one case lor each 2,500 cases. Previous reports pointed that the lower recurrence rate after the arthroscopic excision for localized form. We also experienced a case of localized pigmented viilonodular synovitis located at the posterior compartment of the knee, so we report this case with review of literatures.
Humans ; Joints ; Knee* ; Recurrence ; Synovitis ; Synovitis, Pigmented Villonodular*

The flexion contracture of knee was developed in long-standing knee joint arthritis like degenerative osteoarthritis and rheumatoid arthritis. One of the objectives in total knee replacement arthro-plasty (TKA) is to correct flexion deformity which is the frequent consequence of rheumatoid arthritis (RA) and osteoarthritis (OA). We defined the severe flexion contracture as above 30degrees deformity of knee joint. A review of 337 primary TKA was carried out between August 1989 and March 1995. We found that such deformity was present in 106 Knees (31.5%) of knees before the operation. We analysed the changing pattern and amount of improvement in flexion contracture with 70 knees, which we can follow up over 1 year (average 28.9 months). We corrected flexion contracture deformity only 62.7% in RA (29.2degrees out of 46.5degrees) and 85% in OA (30.4degrees out of 36.8degrees ). So the remaining flexion contracture immediate after TKA is 17.3degrees in RA and 6.4degrees in OA. After the operation, we educate the patient and care person to perform the knee joint stretching by intermittent gentle passive extension exercise for residual flexion contracture. In RA, the remaining flexion contracture immediate after TKA would be improved in follow-up period. At 1 year after TKA, the degree of flexion contracture was not significantly different between in RA ( 7.4degrees) and OA ( 5.0degrees) (independent t-test, P>0.05). The angle of further flexion of knee joint was not increased after TKA compare to preoperative angle, but the range of motion of knee joint was increased, so the increased range of motion was influenced only by the corrected flexion contracture degree. The American Knee Society Knee and Function scores were improved after the TKA (P<0.05). So we recommand that in RA, there is no need to correct the severe flexion contracture completely and it is permissible to remained residual flexion contracture within 1/3 of initial deformity, but in OA, correct the flexion contracture deformity completely during TKA procedure as possible.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty* ; Arthroplasty, Replacement, Knee* ; Congenital Abnormalities ; Contracture ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Osteoarthritis ; Range of Motion, Articular