BACKGROUND: Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition. METHODS: Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated. RESULTS: The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively. CONCLUSIONS: The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.
Adolescent ; Adult ; *Arthroplasty, Replacement, Hip ; Biocompatible Materials ; Female ; Hip Joint/radiography/surgery ; Hip Prosthesis/*adverse effects ; Humans ; Joint Diseases/radiography/*surgery ; Male ; Metals/adverse effects ; Metals, Heavy/*poisoning ; Middle Aged ; Osteolysis/etiology/surgery ; Poisoning/etiology/*surgery ; Polyethylene/adverse effects ; Prosthesis Design ; *Prosthesis Failure/etiology ; Reoperation ; Young Adult

Postherpetic neuralgia (PHN) is one of the most difficult pain syndromes to treat. Invasive treatments may be considered when patients fail to obtain adequate pain relief from noninvasive treatment approaches. Here, we present three cases of PHN in the mandibular branch treated with ultrasound-assisted mental nerve block and pulsed radiofrequency treatment. None of the patients had adequate pain relief from the medical therapy, so we performed the mental nerve block on the affected side under ultrasound assistance. Two patients showed satisfactory pain relief continuously over 12 months without any further interventions, whereas one patient only had short-term pain relief. For the patient had short-term pain relief we performed pulsed radiofrequency treatment (PRFT) on the left mental nerve under ultrasound assistance. After PRFT, the patient had adequate pain relief for 6 months and there was no need for further management.
Humans ; Nerve Block* ; Neuralgia, Postherpetic* ; Pulsed Radiofrequency Treatment* ; Ultrasonography

BACKGROUND: In the midthoracic region, a fluroscope guided epidural block has been proposed by using a pedicle as a landmark to show the height of the interlaminar space (Nagaro's method). However, clinical implication of this method was not fully evaluated. We studied the clinical usefulness of a fluoroscope guided thoracic epidural block in the midthoracic region. METHODS: Twenty four patients were scheduled to receive an epidural block at the T6-7 intervertebral space. The patients were placed in the prone position. The needle entry point was located at the junction between midline of the pedicle paralleled to the midline of the T7 vertebral body (VB) and the lower border of T7 VB on anteroposterior view of the fluoroscope. The needle touched and walked up the lamina, and the interlaminar space (ILS) was sought near the midline of the VB at the height of the pedicle. RESULTS: The authors could not insert an epidural needle at T6-7 ILS in two patients and it was instead inserted at T5-6 ILS. However, other patients showed easy insertion at T6-7 ILS. The mean inward and upward angulations were 25degrees and 55degrees respectively. The mean actual depth and calculated depth from skin to thoracic epidural space were 5.1 cm and 6.1 cm respectively. Significant correlation between actual needle depth and body weight, podendal index (kg/m) or calculated needle depth was noted. CONCLUSIONS: The fluorposcope guided epidural block by Nagaro's method was useful in the midthoracic region. However, further study for the caudal shift of needle entry point may be needed.
Analgesia ; Body Weight ; Epidural Space ; Fluoroscopy ; Humans ; Needles ; Prone Position ; Skin ; Thoracic Vertebrae

We describe the case of a healthy young man with a femoral head fracture by low-energy trauma that occurred without evidence of hip dislocation. While plain radiographs showed no definite fracture or dislocation, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a femoral head fracture with a wedge-shaped cortical depression at the superomedial aspect of the femoral head. Our patient reported feeling that the right hip had been displaced from its joint for a moment. This probably represented subluxation with spontaneous relocation. The characteristic findings and possible mechanisms of this fracture were postulated on the basis of the sequential 3 dimensional-CT and MRI. The clinical results of conservative treatment were better than those of previously reported indentation fractures.
Femur Head/*injuries ; Hip Fractures/*diagnosis/etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed ; Young Adult

BACKGROUND: The number of human immunodeficiency virus (HIV)-infected patients is increasing constantly, and it is well known that there is a significantly high prevalence of osteonecrosis of the femoral head in HIV-infected patients. Therefore, it is important to develop methods that can ensure the safety of both the patients and medical personnel who participate in surgery on HIV-infected patients. Recently, the authors performed 8 procedures on 5 HIV-infected patients. This paper reports our experience. METHODS: This study examined the medical records and radiological studies of 5 HIV-infected patients who had undergone surgery around the hip joint from January, 2005 to September, 2007. During the procedures, their mean age was 38.6 years (range, 23 to 53 years) and all were male. Four of them were under an anti-retroviral therapy program. The reasons for the operations were nonunion of the femoral shaft after trauma in two patients and osteonecrosis of both femoral heads in three. One autologous bone grafting, one screw fixation with autologous bone grafting, five total hip replacement arthroplasties, and one multiple drilling were performed. All procedures were carried out according to the guidelines of HIV infection control made by the Korea Centers for Disease Control and Prevention. The mean follow-up period was 16.6 months (range, 4 to 37 months). RESULTS: The preoperative CD4 count was 130 in one patient, and 200 to 499 in the other 4. The viral loads were 15100 and 420 in two patients, and negative in the other 3. Bony union was achieved in those who had undergone autologous bone grafting. There were significant improvements in both the Harris Hip Score and functional state in those who had total hip replacement arthroplasty. There were no immediate postoperative complications, such as infection. During the follow-up period, one patient died from esophageal variceal bleeding. However, no surgery-related complications were observed in the other 4 patients. CONCLUSIONS: There were no significant complications in HIV-infected patients after the operations around the hip joint when their preoperative immunity was optimal. In addition, the safety of medical personnel can be assured when the operation is performed in line with the guidelines of HIV infection control.
Adult ; *Arthroplasty, Replacement, Hip/adverse effects ; Bone Transplantation ; CD4 Lymphocyte Count ; Femoral Fractures/complications/*surgery ; Femur Head Necrosis/complications/*surgery ; Fractures, Ununited/complications/*surgery ; HIV Infections/*complications/immunology/transmission/virology ; Humans ; Infectious Disease Transmission, Patient-to-Professional/prevention & control ; Male ; Middle Aged ; Postoperative Complications ; Viral Load ; Young Adult

PURPOSE: To report our early experience of hip arthroscopy. MATERIALS AND METHODS: Forty one patients (45 hips) who underwent hip arthroscopy from November 2007 to February 2009 were enrolled in the study. The population was divided into 3 groups in sequence. The operation time, fluoroscopic time, traction time, and complications were analyzed. RESULTS: There was no significant difference in operation time and traction time between the three groups. The fluoroscopic time decreased from 41 minutes in group I to 11 minutes in group III (p<0.01). There were four cases of nerve palsy; 2 pudendal nerve palsy in group I, 1 pudendal nerve palsy in group II, and 1 peroneal nerve palsy in Group III. All cases recovered completely within few days after surgery. Iatrogenic labral injury occurred in 4, 3 and 0 hips in group I, II and III, respectively. Iatrogenic cartilage damage to the femoral head occurred in 2, 3 and 1 hip in group I, II and III, respectively, which did not affect the outcomes. CONCLUSION: Definite improvement in the hip arthroscopy technique was observed in the fluoroscopic time. No serious complications, such as death or permanent nerve palsy, were encountered.
Arthroscopy ; Cartilage ; Head ; Hip ; Hip Joint ; Humans ; Paralysis ; Peroneal Nerve ; Pudendal Nerve ; Traction

PURPOSE: THA in patients with dysplastic hips secondary to infection of the hip joint is a technically challenging procedure because of long-standing anatomic abnormalities of the bone and soft tissues. Low friction, low wear, alumina-on-alumina bearing surfaces are an attractive alternative to conventional metal-on-polyethylene articulation, and may offer a promising option for young, active patients. Here, we evaluated the results of a modern alumina-on-alumina THA performed in patients with sequelae of the hip joint infection, with a 5-year minimum follow-up. MATERIALS AND METHODS: We retrospectively analyzed 48 primary cementless alumina-on-alumina THAs that had been performed in patients who had sequelae of the hip joint infection between November 1997 and December 2000. The average age of the patients at the time of the index arthroplasty was 36.7 years (range, 18-63 years) and41 patients were younger than 50 years old. They were followed-up for more than 5 years (average, 82 months range, 60-103 months). RESULTS: All hips had no recurrence of a hip joint infection. The mean Harris hip score improved from 61.6 points preoperatively to 92.2 points at the latest follow-up. All of the implants had radiographic evidence of bone ingrowth and no radiological loosening. During the follow-up period, nocup or stem was revised. Periprosthetic osteolysis was suspected in one hip. Leg length discrepancy was corrected from 26.2 mm preoperatively to 9.5 mm postoperatively. Postoperatively, the hip center migrated 11.7 mm medially and 5.2 mm inferiorly. Nonunion of the osteotomized greater trochanter occurred in two hips, but no postoperative infection or ceramic failure was observed. CONCLUSION: The 5-year minimum follow-up clinical results of modern alumina-on-alumina THA in patients with sequelae of the hip joint infection were encouraging. Our results show that alumina-on-alumina articulation offers a reliable alternative solution for young patients with technically difficult arthroplasties.
Aldosterone ; Arthroplasty ; Ceramics ; Femur ; Follow-Up Studies ; Friction ; Hip ; Hip Joint ; Humans ; Leg ; Osteolysis ; Recurrence ; Retrospective Studies ; Tacrine ; Ursidae

PURPOSE: Alumina-on-alumina bearing surfaces in total hip arthroplasties (THAs) are an attractive alternative coupling and may be a promising option for young active patients. This study evaluated the results of contemporary primary alumina-on-alumina cementless THAs performed in patients younger than 40 years. MATERIALS AND METHODS: This study evaluated the results in a consecutive series of 72 alumina-on-alumina THAs performed in 61 patients who were younger than 40 years old (average, 30 years; range, 18-39 years) after a minimum 5-year follow-up (average, 69 months; range, 60-83 months). RESULTS: The mean Harris hip score was 97.2 points at the latest follow-up. All the hips showed radiographic evidence of a bone ingrown prosthesis. No radiological loosening was found and no revision was required for either the stems or the cups. Ceramic wear was not detected in the 24 hips where differentiation of the femoral head was possible on radiographs, and no periprosthetic osteolysis was observed. A ceramic fracture after a major motor vehicle accident and an impingement-associated ceramic liner edge fracture for an inadequate abductor muscle tone occurred. During the follow-up period, no other ceramic fractures occurred as a result of normal everyday activity. CONCLUSION: From the viewpoints of wear, osteolysis, and implant fixation, the results of the contemporary alumina-on-alumina THAs performed in younger active patients were encouraging at the 5-year minimum follow up. However, in order to minimize the possibility of modern ceramic failure, a careful preoperative patient evaluation to determine the proper indication for ceramic bearings, and meticulous surgical techniques are recommended.
Adult* ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Ceramics ; Follow-Up Studies* ; Head ; Hip ; Humans ; Motor Vehicles ; Osteolysis ; Prostheses and Implants

Purpose: We evaluated the results of cementless acetabular revisions performed with morselized bone grafting and screw-fixed hemispherical cups with different surface treatments. Materials and Methods: Forty hips, which had been followed for more than 10 years, were included in this study. Reconstruction was performed with 10 hydroxyapatite (HA)-coated cups and 30 porocoated ones. The mean followup time was 12 years and 1 months (range, 10 years to 15 years). Re-revision or radiographic loosening was considered as an endpoint of follow-up. Results: The average Harris hip score improved from 52 points to 75 points. During the follow-up period, radiographic loosening was observed in 17 hips. The loosened implants were HA-coated cups in 8 hips and porocoated ones in 9 hips. In 14 of these, re-revision of the cups was performed. The re-revision rate was 20% for the porocoated cups and 80% for the HA-coated cups. There were 2 hips with liner wear, which had undergone liner and head changes. Bone grafts were united in all the hips. The average time to union was 5.2 months (range, 2 to 9 months), and the average time to incorporation was 12 months (range, 5 to 18 months). Conclusion: Our results imply that HA-coated cups have a significantly higher failure rate compared with the porocoated ones (P<0.05) after a minimum follow-up of 10 years. Morselized bone grafting with use of a porocoated cup is an effective modality, which can restore the bone loss of the acetabulum in revision total hip arthroplasty.
Acetabulum* ; Arthroplasty, Replacement, Hip ; Bone Transplantation ; Durapatite ; Follow-Up Studies* ; Head ; Hip ; Transplants

PURPOSE: The purpose of the current in vitro study was to evaluate the transfer of metal to both alumina and cobalt-chrome (Co-Cr) heads that were scraped by a titanium alloy surface under different load conditions. MATERIALS AND METHODS: Alumina and Co-Cr heads were scraped by an acetabular metal shell under various loads using a creep tester. Microstructural changes in the scraped area were visualized with a scanning electron microscope and chemical element changes were assessed using an energy dispersive X-ray spectrometry. Changes in the roughness of the scraped surface were evaluated by a three-dimensional surface profiling system. RESULTS: Metal transfer to alumina and Co-Cr heads began to be detectable at a 10~15 kg load, which could be exerted by one-handed force. At loads of 30, 50 kg, fissures occurred on the head surfaces in addition to metal transfer. CONCLUSION: This study reveals that metallic debris was transferred from the titanium alloy acetabular shell to both alumina and Co-Cr heads by minor scraping. When the contact force increased, scratching of the head surface occurred in addition to the transfer of metal. The results of this study suggest that the greatest possible effort should be made to protect femoral heads, regardless of material, from contact with metallic surfaces during total hip arthroplasty.
Acetabulum* ; Alloys ; Aluminum Oxide* ; Arthroplasty, Replacement, Hip ; Head* ; Spectrometry, X-Ray Emission ; Titanium