The objective of this study is to assess the role of articulating spacer in two stage reimplantation of infected TKA. Fifteen patients with deep infected total knee arthroplasties were treated by two stage reimplantation protocol between Jan. 1987 and Oct. 1997. Seven cases in Group A were treated by debridement, removal of the prosthesis and placement of antibiotic impregnated cement spacer before reimplantation. Eight cases in Group B were treated by debridement, and reinsertion of the retrieved implant after autoclaving with antibiotic impregnated cement fixation. The average follow-up period was 77 months(range, 28-141 months) in group A, and 25 months(range, 12-63 months) in group B. The average knee flexion after revision was 82 degrees in group A, and 106 degrees in group B. The average HSS knee rating score was 80 points in group A, and 88 points in group B. No patient had recurrence of infection during the follow-up period. In conclusion, our method using articulating spacer allowed emly range of motion and partial weight bearing during the spacer phase. This methods also delivered high local concentration of antibiotics and kept the functional joint before a second-stage reimplantation.
Anti-Bacterial Agents ; Arthroplasty* ; Debridement ; Follow-Up Studies ; Humans ; Joints ; Knee* ; Prostheses and Implants ; Range of Motion, Articular ; Recurrence ; Replantation* ; Weight-Bearing

No abstract available.
Arthritis* ; Arthroplasty* ; Arthroplasty, Replacement, Knee*

The fabella, which means little bean is a sesamoid bone located in the lteral head of the gastrocnemius muscle. It has been estimated from radiographic studies, that fabella presents in 11.5%-12.9% of adult knees, and bilaterally in more than 50% of the adult population. The salient features of the fabellar syndrome includes intermittent pain in the posterolateral region, accentuated by knee extension and localized tendemess caused by compression against the femoral condyle. We experienced a case of fabella impingement syndrome which includes symptom of intermittent pain in the posterolateral region, intermittent locking and limitation of knee motion, gd report with review of literatures where it has not ever been introduced.
Adult ; Head ; Humans ; Knee ; Muscle, Skeletal ; Sesamoid Bones

The results of unicompartmental knee arthroplasty are still controversial. The purpose of this study is to evaluate the clinical results of three different component systems of unicompartmental knee arthroplasties. From December 1982 to January 1996, 106 unicompartmental knee arthroplasties were performed. There were 13 Modular II(group I), 47 Microloc(group II) and 46 Allegretto(group III) unicompartmental knee arthroplasties. Average follow-up period was 7 years 1 month. At the last follow-up, average knee score of Hospital for Special Surgery(HSS) was 92 points and average tibiofemoral angle was valgus 3.5 degrees. Among three groups, there was no significant difference in knee score of HSS and tibiofemoral angle. Twelve knees(11%) in all three groups have required revision. The causes of revision were six implant wears(all in group II), five implant loosenings(one in group I and four in group III) and one deep infection(in group II). In conclusion, the results of unicompartmental knee arthroplasty at average 7.1 years follow-up period were satisfactory. High incidence of insert wear in Microloc unicompartmental knee arthroplasty(group II) might be due to thin polyethylene insert supported by metal backed tibial tray.
Arthroplasty* ; Follow-Up Studies ; Incidence ; Knee Joint ; Knee* ; Polyethylene

Failure of total joint replacement is often due to infection. Many efforts have been made to reduce the rate of infection. The use of antibiotic-acrylic bone cement composites for the preventlon and treatment of infection after joint replacement surgery has been advocated. Early reports of clinical success using bone cement containing antibiotics are encouraging, but different results of antibacterial effect of antibiotic-acrylic bone cement were reported in vitro and in vivo studies. The purpose of this experiment is to determine the effectiveness of bone cement itself on bacterial growth, stability of antibiotics in cured bone cement, and whether antibiotic acrylic bone cement composites produce an effective antimicrobial concentration in tissue fluid of hip joint and if so, the duration of it. 30 rabbits were used as test animal: 3 each for hemiarthroplasty and for hemiarthroplasty with the insertion of bone cement as control; 6 each for dicloxacillin, cephacetrile, gentamycin and amlkacin impregnated bone cements. Antibiotic activities were measured by disk diffusion method and tube dilution method using tissue fluid collected through tube inserted in the hip joint of the animals. The results were as follows: 1. Bone cement itself does not have antibacterial effec: on the growth of Staphyiococcus aureus and Escherichia coli. Antibiotic impregnated acrylic bone cements showed antibacterial effects which were stable for 3 weeks in vitro test. 2. After the insertion of antibiotic-acrylic bone cement composites, maximal concentrations of antibiotics in tissue fluid were measured at 1 hour. The concentration of antibiotics remained in tissue fluid at relatively high level for 2 days, and decreased abruptly there after. Inhibition zones in disk diffusion method could be measured until 3rd day in dicloxacillin group and 4th day in cephacetrile, gentamycin and amikacin group. No antibacterial effect could be measured in control groups. 3. On first postoperative day the concentrations of antibiotics in tissue fluid were measured as 64 mcg/ml in dicloxacillin group and 128 mcg/ml in cephacetrille, gentamycin and amikacin group. The antiblotic activities in tissue fluid could be measured for 6 days in dicloxacillin group and 7 days in cephacetrile, gentamycin and amikacin group using tube dilution method. No antibiotic activities were measured in tissue fluid of control groups. As a result of this study, it is proved that the concentration of antibiotics in tissue fluid of hip joint can be maintained above the level of minimal inhibitory concentration for about a week when antibiotic-acrylic bone cement composite is used in joint replacement arthroplasty. The impregnation of antibiotics in crylic bone cement is proved to be effective in the prevention of exogenous infection, especially in the protection of damaged tissue prone to infection postoperatively.
Amikacin ; Animals ; Anti-Bacterial Agents ; Arthroplasty, Replacement ; Bone Cements ; Cephacetrile ; Dicloxacillin ; Diffusion ; Escherichia coli ; Gentamicins ; Hemiarthroplasty ; Hip Joint ; In Vitro Techniques ; Joints ; Methods ; Polymethyl Methacrylate ; Rabbits

The 5 patients, who had severe limitation of knee motion following open operative procedures, and were treated by the percutaneous release of adhesions under arthroscopy, were reviewed. The range of the knee motion and function were markedly improved. Therefore, intra-articular release of adhesions under arthroscopic control was assumed very useful.
Ankylosis ; Arthroscopy ; Humans ; Knee ; Surgical Procedures, Operative

Synovectomy of the knee in rheumatoid arthritis has been recommended as an effective procedure which improved symptoms such as pain, swelling, and limitation of motion. But some problems, such as limitation of range of motion, infection, long hospital days, occured in open synovectomy. Arthroscopic synovectomy yields reliable result compatible to open synovectomy with less invasiveness and postoperative morbidity. The authors analyzed 20 knees of 14 patients who has done synovectomy of knee in Kyung Hee University Hospital from September 1989 to October 1992. Of the 14 patients, thirteen were females and only one was male, ten knees were affected on the right and ten on the left respectively. Five knees were operated as open synovectomy and fifteen knees as arthroscopic synovectomy. In six patients, both knees were operated either open or arthroscopic synovectomies. The preoperative diagnosis of 20 knees were rheumatoid arthritis as clinically, serologically and radiologically, 13 knees are confirmed as pathologically. Average hospital days after operation were 19 days in open synevectomy and 11 days in arthroscopic synovectomy. Average operation time were 72 minutes in open synovectomy and 84 minutes in arthroscopic synovectomy. No complication occured as a result of these synovectomies. After average follow up of 19 monthes, 1 knee from 5 knees in open synovectomy and 3 knees from 15 knees in arthroscopic synovectomy had pain and intermittent swelling as postoperatively. And only 1 knee in open synovectomy had loss of range of motion. No other patients lost motion in their knees. Preoperatively 17 knees showed radiographic change of rheumatoid arthritis and 16 knees showed no progressive radiographic deterioration at final follow up. And patients overall showed a significiantly increased functional status postoperatively. In conclusion, the result obtained after arthroscopic synovectomy are comparable with those obtained after open synovectomy. In addition arthroscopic procedure had lessened postoperative morbidity as loss of range of motion, postoperative infection, long hospital days and useful as palliative surgery in advanced rheumatoid arthritis.
Arthritis, Rheumatoid ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Knee ; Male ; Palliative Care ; Range of Motion, Articular

There are many difficulties in operative technique of total knee replacement of bony ankylotic knee, because it accompanies the deformity of the knee, contracture of soft tissue and bony ankylosis. It is said that there are poor gaining of post-operative range of motion and development of many problems in wound healing. We performed conversion TKR in seventeen patients who had fused knee between Jan. 1985 and Dec. 1991. After follow up of average three years and four months, we analyse the results. Sixteen patients were women and one was man. There were eight cases of tuberculosis knees, seven cases of septic knees and two cases of posttraumatic arthritis. Thirteen cases had previous knee surgery and in another four cases knee fusion developed spontaneously. Average age of patients were 35 years old. Operation was performed between ten months and twenty years averaging nine years after knee fusion. When blood chemistry and physical examination showed no findings of infection, operation was performed. We used bone cement in 8 cases and autogenous bone graft in 4 cases for large bone defect. For release of soft tissue contracture, in 8 cases, we lengthened quadriceps tendon with the method of V-Y advancement technique and in another 4 cases, performed patella tendon transfer from tibial tuberosity. Operative time was between three hours and four hours fifteen minutes, average three hours and fourty minutes. The results of these patients were as follows; 1. The postoperative average range of motion was 72° (20°-125°). The average extension lag was 9. 2. The average Hospital for Special Surgery knee rating score improved from 57 preoperatively to 84 postoperatively. 3. There were two patients who had pain on walking, but radiologically and clinically there were no loosening signs. 4. In three patients who had poor gaining of range of motion after operation, we performed arthroscopic adhesiolysis. There were two cases of transient peroneal nerve palsy which were recovered within 1 month and in another two case of deep infection with β-hemolytic streptococcus and pseudomonas, we performed knee fusion after one year ten months and one month after TKR. In conclusion, conversion TKR is a successful procedure which can obtain the restoration of function of the fused knee, especially in the cases that have adequate soft tissue condition, extensor mechanism and good bone stock.
Ankylosis ; Arthritis ; Arthroplasty, Replacement, Knee ; Chemistry ; Congenital Abnormalities ; Contracture ; Female ; Follow-Up Studies ; Humans ; Knee ; Methods ; Operative Time ; Paralysis ; Patellar Ligament ; Peroneal Nerve ; Physical Examination ; Pseudomonas ; Range of Motion, Articular ; Streptococcus ; Tendons ; Transplants ; Tuberculosis ; Walking ; Wound Healing

Clinical study of 40 cases who have used steroid preparations was done during past 6 months from March 72 to September 72. 1. The youngest patient was twenty, the oldest seventy-four and the average fifty-two. Eighty percent was included between from 41 to 70 year of age. 2. And the sex ratio was 1:4.7. 3. Diagnostic incidence was 47.5% in degenerative arthritis and 40% in rheumatoid arthritis. 4. The causes of administration were multiple joint pain (35%), lumbago (27.5%) and pain on knee joint (25%) in order. 5. Prednisolone (60%), dexacortisil (25%) and dexamethasone (12.5%) were used in 97.5%. 6. The source of steroid was drung store (95%) or doctor (5%). 7. The time from first dose to last dose was less than 1month (20%), 1–3 month(10%), 4–6 month (7.5%) and more than 1 year (52.5%). And 3 cases have used for more than 5 years, 8. Eighteen cases (45%) used steroid continuously and 22 cases (55%) irregularly. 9. Transient effectiveness was experienced in 92.5% with steroid administration, that was one of the causes of steroid usage without doctor's prescription. 10. The side effects were as follows; moon face (62.5%), ulcer (20%), fat deposition (15%), osteoporosis (15%), peripheral edema (10%), elevation of blood pressure (7.5%), malar flush(7.5%), vertebral compression fracture (7.5%), obesity (5%), psychotic change (5%), pyogenic arthritis (5%), diabetes (2.5%), sepsis (2.5%), adrenal insufficiency (2.5%), avascular necrosis (2.5%) and stress fracture of femur neck (2.5%).
Adrenal Insufficiency ; Arthralgia ; Arthritis ; Arthritis, Rheumatoid ; Blood Pressure ; Clinical Study ; Dexamethasone ; Edema ; Femur Neck ; Fractures, Compression ; Fractures, Stress ; Humans ; Incidence ; Knee Joint ; Low Back Pain ; Moon ; Necrosis ; Obesity ; Orthopedics ; Osteoarthritis ; Osteoporosis ; Prednisolone ; Prescriptions ; Sepsis ; Sex Ratio ; Ulcer

No abstract available.
Ankle* ; Arthroplasty*