No Abstract Available.
Animals ; Armoracia* ; Cats* ; Horseradish Peroxidase* ; Muscles*

The purpose of this study is to evaiuate the results of the reconstruction of acetabular bone defect with morselized bone graft and screw fixed hemispherical cup in revision of failed acetabular cup. Thirty four revisions of an acetabular component that had been performed in 34 patients between 1988 and 1993 at SNUH, and had followed more than four years were included in this study. The revised acetabulum was evaluated clinically by Harris hip score and radiologically by evaluating the osseous union, incorporation and resorption of graft, the amount of migration and cup angle change of revised components and periacetabular radiolucency. The mean Harris hip score was improved 52 to 84. All of the bone grafts united by 6.4 months and incorporated by 13.1 months. The graft bone resorption less than onefourth of the initial graft thickness was 91.2% (31 cases). There was no significant difference between pure allograft and allograft mixed with autograft in clinical and radiological results. Of 34 cases, 2 cases (5.9%) required rerevision of acetabulum for aseptic loosening. The two complications, postoperative infection and trochanteric bursitis were managed successfully with conservative methods. The results of the present study confirm the success of revision of the acetabulum with use of a hemispherical component stabilized with multiple small screws and morselized bone grafts filling bone defects.
Acetabulum* ; Allografts ; Autografts ; Bone Resorption ; Bursitis ; Femur ; Hip ; Humans ; Postoperative Complications ; Transplants*

Background: Subchondral fatigue fracture of the femoral head (SFFFH) is a rare disease, and its disease entity is established in recent decades. Although there are a few studies on SFFFH, most of them are case series involving around 10 cases, and the clinical course of SFFFH is still not well known. This study analyzed the factors affecting the clinical course of SFFFH. Methods: Patients who visited our institution from October 2000 to January 2019 were retrospectively evaluated. Of eligible cases, 89 hips (80 patients) were diagnosed with SFFFH and non-surgical treatment outcomes were analyzed. Radiographs and medical charts were reviewed for following factors: the degree of femoral head collapse, the interval between the onset of hip pain and the first hospital visit, hip dysplasia, osteoarthritic changes, sex, and age. Results: Hip pain decreased in 82 cases (92.1%) through non-surgical treatment, and 7 cases (7.9%) underwent surgery. Patients with good results of non-surgical treatment had improvement 2.9 months on average after the treatment. All cases without a collapsed femoral head (55 cases) had hip pain alleviation through non-surgical treatment. Cases with femoral head collapse of 4 mm or less and non-surgical treatment within 6 months from the onset of hip pain (22 cases) all had hip pain alleviation. Among 8 cases with femoral head collapse of 4 mm or less and non-surgical treatment after 6 months or more from the onset of hip pain, 3 underwent surgery and 1 had persistent hip pain. Those with femoral head collapse of over 4 mm (3 cases) all underwent surgery. The osteoarthritic changes, dysplastic hip, sex, and age were not statistically related to the success of non-surgical treatment. Conclusions The success of non-surgical treatment for SFFFH can be affected by the degree of femoral head collapse and the timing of non-surgical treatment.

Background: Herniation pits (HPs) have been considered to be an incidental finding, but recently femoroacetabular impingement (FAI) has been proposed as a possible cause of their formation. The findings on bone scans of HPs are variable in the literature: some showed increased uptake; the majority did not. We hypothesized that serial changes in image findings of HPs would explain the reason for the variable bone scan findings. Methods: Four patients (5 hips) were followed up for more than 7 years. All patients were women and regularly underwent bone scintigraphy after the diagnosis of breast cancer. Small lesions with increased uptake were first detected on bone scintigraphy at the age of 44 to 64 years. In all cases, the lesions were confirmed by magnetic resonance imaging and follow-up bone scintigrams were taken regularly. Four lesions were also evaluated by computed tomography. Changes in the size of the pits and the intensity of the increased uptake on bone scintigraphy were evaluated. Results: On the bone scintigrams, the lesions with increased uptake were detected in the femoral neck at 5–20 months after previous negative bone scintigraphy. There had been no events or symptoms associated with the newly detected increased uptake. On follow-up scans, the intensity of the uptake decreased gradually and the areas of increased uptake disappeared completely at 14–50 months after their first appearance. In 3 cases (2 patients), the pit size increased during follow-up. Conclusions The areas of increased uptake on bone scintigraphy gradually disappeared in all cases and the increase in pit size was frequent. There was no case in which signs or symptoms suggestive of FAI were noticed.

Trochlear motorneurons were identified by applying horseradish peroxidase(HRP) to superior oblique muscle in cats. Ninety five to ninety seven percent of the contralateral trochlear nucleus were stained 3-5% of ipsilateral side also labelled by HRP. These findings showed that superior oblique muscle was innervated by trochlear nuclei on both side.
Animals ; Armoracia* ; Cats* ; Horseradish Peroxidase* ; Trochlear Nerve

Malignant T-cell lymphoma is an abnormal tumor of the immune system which generally involves not only the lymphatic system but also the stomach, respiratory system, skin, orbit and, occasionally, the eyelids. The authors experienced a case of eyelid malignant T-cell lymphoma with skin involvement whose characteristic symptoms are anorexia, severe weight loss and systemic lymphadenopathy. Biopsy and immunohistochemical stain to UCHL-1 are the only diagnostic methods for differentiating the diagnosis from Hodgkin's disease. The patient was treated with cyclophosphamide, vincristine and prednisolone with a good prognosis and a 21 month-survival at present.
Anorexia ; Biopsy ; Cyclophosphamide ; Diagnosis ; Eyelids ; Hodgkin Disease ; Humans ; Immune System ; Lymphatic Diseases ; Lymphatic System ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Peripheral* ; Orbit ; Prednisolone ; Prognosis ; Respiratory System ; Skin ; Stomach ; Vincristine ; Weight Loss

PURPOSE: The goal of this study was to analyze the short to midterm results of Bernese periacetabular osteotomy for the patient with hip dysplasia. MATERIALS AND METHODS: Fourteen Bernese periacetabular osteotomies were performed in 13 patients and were followed-up for more than 2.5 years. All patients had been treated at Department of Orthopedic Surgery, Seoul National University Hospital from June 1998 to December 2007. We conducted an interview and asked the patients to complete the Harris hip score and pain visual analogue scale (VAS) score for clinical evaluation. Radiographic measurements included Tonnis osteoarthritis grade, center-edge angle of Wiberg, acetabular angle of Sharp, acetabular depth index, acetabular head index. RESULTS: Mean Harris hip score improved from 63.8 points preoperatively to 82.9 points postoperatively and pain VAS score improved from 7.6 points preoperatively to 0.8 points postoperatively. Based on Tonnis osteoarthritis grade, progression of osteoarthritis was found in 4 hips. Radiologically, center-edge angle of Wiberg, acetabular angle of Sharp, acetabular depth index and acetabular head index improved. Complications included superficial skin infection in one hip and non-union of pubic ramus in one. One patient had metal hypersensitivity to cortical screws and fracture of posterior column. CONCLUSION: The short to midterm results show Bernese periacetabular osteotomy is a satisfactory technique for treating early and mild hip-osteoarthritis patients with hip dysplasia clinically and radiographically.
Acetabulum ; Head ; Hip* ; Humans ; Hypersensitivity ; Orthopedics ; Osteoarthritis ; Osteotomy* ; Seoul ; Skin

PURPOSE: We wanted to evaluate the clinical characteristics of patients with multifocal osteonecrosis. MATERIALS AND METHODS: When two or more anatomic sites were affected by osteonecrosis, this was defined as multifocal osteonecrosis. We retrospectively reviewed the cases of multiple osteonecrosis that were diagnosed between January 1982 and December 2003, and we analyzed such clinical characteristics as the risk factors, the involved sites and the symptoms. RESULTS: Thirty-three of 1740 patients (2%) with multifocal osteonecrosis were found. They were 16 men and 17 women with a mean age of 48.7 years (range: 28 to 74). The associated factors included systemic lupus erythematosus (6 patients), aplastic anemia (2 patients), malignancy (2 patients), multiple sclerosis (2 patients), idiopathic pulmonary fibrosis (1 patient), Caisson's disease (1 patient), idiopathic (9 patients) and alcohol abuse (6 patients). Seventeen of 33 patients (52%) had a history of corticosteroid therapy. The involved sites included 33 femoral heads, 22 femoral and tibial condyles, 13 humeral heads, 4 talar bodies and 1 scaphoid. In total, 132 sites were involved (4.0 per patients). CONCLUSION: Chronic steroid therapy affected the high incidence of multifocal osteonecrosis. Therefore, further studies that would include bone scans are needed for patients who undergo steroid therapy, and especially when these patients show clinical symptoms.
Alcoholism ; Anemia, Aplastic ; Female ; Head ; Humans ; Humeral Head ; Idiopathic Pulmonary Fibrosis ; Incidence ; Lupus Erythematosus, Systemic ; Male ; Multiple Sclerosis ; Osteonecrosis ; Retrospective Studies ; Risk Factors

Background: The current trend of using short femoral stems in total hip arthroplasty (THA) is associated with angular deviation of the femoral stem towards the native femoral axis. The purpose of this study was to compare the difference in stem tilt angle between two different stems with a similar design except for the stem length. Methods: This is a retrospective review of 66 patients who underwent primary THA between April 2012 and May 2016, using a trans-gluteal direct lateral approach by a single surgeon. We evaluated the femoral stem tilt angle in both the coronal and sagittal planes and performed multivariate logistic regression analysis to evaluate possible risk factors. We also simulated the range of motion (ROM) of the hip joint using three-dimensional computer-aided design software (SolidWorks, 2016) to examine the clinical significance of femoral stem tilt. Results: The mean coronal tilt angle was 1.8° ± 1.0° in the conventional stem group and 1.6° ± 1.1° in the short stem group, showing no statistically significant difference between the groups (p = 0.570). However, the mean sagittal tilt angle was 4.0° ± 2.0° in the conventional stem group and 7.8° ± 2.0° in the short stem group (p < 0.001). The stem type and stem length had a linear correlation with the sagittal tilt angle (p < 0.001) in multivariate regression analysis. A simulated hip ROM demonstrated a 3.8° decrease in extension in proportion to a 3.8° increase in the mean sagittal stem tilt angle of the short femoral stem. Conclusions Anterior femoral stem tilting in the sagittal plane was prominent when the shorter stem was used, and anterior tilting was responsible for decreased ROM in hip extension.

Background: Most isolated greater trochanter (IGT) fractures are treated conservatively. However, some require surgical fixation although indications for surgery have not yet been established. Many surgeons perform surgical fixation when the intertrochanteric extension crosses the midline on magnetic resonance (MR) images. Nevertheless, for mechanical strength, cortical bone integrity is more important than that of intramedullary cancellous trabeculae. We retrospectively evaluated the clinical usefulness of multiplanar reformation computed tomography (MPR CT) in determining treatment strategies for IGT fractures. Methods: We evaluated 99 cases of suspected IGT fractures between October 2004 and December 2019. They were 66 women and 33 men with a mean age of 77 years. The mean follow-up period was 34 months. Most patients were evaluated with plain radiographs, followed by additional imaging study via MPR CT in 65 cases, magnetic resonance imaging (MRI) in 5 cases, and both in 17 cases. Typically, fractures were fixed surgically when a cortical breakage was detected in the intertrochanteric area on MPR CT, while fractures without evidence of cortical breakage on MPR CT were treated conservatively. Results: In 13 out of 82 cases evaluated by MPR CT, incomplete cortical breakage in the intertrochanteric area was detected, of which 10 were treated surgically. The remaining 3 cases were treated conservatively due to patient’s refusal, poor medical condition, and failure to detect breakage. Of 69 cases without cortical breakage, 61 cases were successfully treated conservatively.Among the 17 cases evaluated by both MPR CT and MRI, cortical breakage was detected in 3, of which the intertrochanteric extension crossed the midline on the MR image only in 1 case. Of the remaining 14 cases without breakage, the intertrochanteric extension crossed the midline in 5. Among these 5 cases, 3 were treated conservatively. Conclusions The results suggest that MPR CT is a useful imaging modality for further evaluation of IGT fractures. It was especially valuable in evaluating cortical bone integrity, which may be more critical for fracture stability.