No abstract available.
Peripheral Vascular Diseases*

Casts of 180 Korean male and female with normal occulsion of early permanent dentition (from dental age of Hellman III C, to IV A) were studied to measure the mesiodistal crown diameters and to calculate the coefficients of correlation between the teeth. From the study, the following conclusions were made: 1. Mesiodistal dimension of maxillary central incisors, canines, first molars and mandibular canines, first premolars, second premolars and first molars of male are larger than that of female. 2. Korean teeth are roughly intermediate between those of American Caucasian and those of American Negro. 3. In both sexes, the relation between the first and second premolars appeared highly correlated not only in the maxillary arch but also in the mandibular arch, and the relation between the central incisor and lateral incisor appeared highly correlated in the mandibular arch. 4. The relation between the maxillary and mandibular first premolars appeared highly correlated in both sex, and the relation between the maxillary canine and mandibular canine in male as well as between the maxillary central incisor and mandibular central incisor in female appeared highly correlated.
African Continental Ancestry Group ; Bicuspid ; Crowns* ; Dentition, Permanent ; Female ; Humans ; Incisor ; Male ; Molar ; Tooth*

PURPOSE: The aim of this study was to evaluate changes in the bearing surface of an alumina head and cup insert after difficult intraoperative reduction of the head. MATERIALS AND METHODS: In two consecutive cases, where the force required for reduction caused scratching on the edge of the acetabular metal shell and marginal cracking of the adjacent portion of the alumina insert, the reduced alumina head was dislocated and retrieved with the alumina cup insert. The changes of the bearing surface were evaluated by gross inspection and by scanning electron microscopy(SEM) and energy dispersive x-ray spectrometry (EDAX). RESULTS: In both cases, the scratched area of the alumina head was found to have discolored. SEM and EDXA showed the discoloration to be the result of metallic debris from the titanium alloy shell. The metallic debris that was transferred from the head also stained the bearing surface of the alumina insert. CONCLUSION: Metallic debris might increase bearing surface wear. If the cracked ceramic fragments from the cup insert are neglected, it is also possible that they could be trapped between bearing surfaces and increase wear.
Acetabulum ; Alloys ; Aluminum Oxide ; Arthroplasty, Replacement, Hip* ; Ceramics ; Head* ; Spectrometry, X-Ray Emission ; Titanium

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

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

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

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

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

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: To evaluate the role of a preoperative bone scan in determining the operative treatment methodof a femoral neck fracture. MATERIALS AND METHODS: Between January 2001 and December 2003, 62 out of 257 patients, who underwent a preoperative bone scan after a femoral neck fracture were included. The fractures was classified according to the stage of Garden. The uptake of the Tc-99m methylenediphosphonate (99mTc-MDP) isotope was estimated visually, and categories as -2 (the femoral head activity in the fractured side is general reduction compared with the opposite side), -1 (the activity is partial reduction), 0 (the activity is normal) and 1 (the activity is general increase ). RESULTS: 62 patients, 17 male and 45 female, with a mean age of 67.4 years (range 18 to 93) were investigated. Of the 19 patients with Garden stages I and II 17 were 0, and 1 each were -1 and -2. Eighteen patients were operated on with multiple pinning, and 1 with bipolar hemiarthroplasty. Of the 43 patients with Garden stages III and IV 37 were -2, 4 were -1 and 2 were 0. Thirty-eight patients were operated on with bipolar hemiarthroplasty. Four patients were operated on with total hip arthroplasty. One patient was operated on with multiple pinning. The operative method was changed in only 1 of the 62 patients due to the bone scan finding. CONCLUSION: The isotope uptake of the preoperative bone scan after a femoral neck fracture generally corresponded with the degree of fracture displacement. Therefore, a preoperative bone scan seems to play no significant role in determining the operative treatment method of a femoral neck fracture.
Arthroplasty, Replacement, Hip ; Female ; Femoral Neck Fractures* ; Femur Neck* ; Head ; Hemiarthroplasty ; Humans ; Male