Introduction: This study examined the factors related to the amount of blood loss and transfusion after primary total hip arthroplasty. Materials and methods: Sixty THRA patients, who had records of perioperative complete blood counts and transfusion, were enrolled in this study. Age, gender, diagnosis, use of cement, size of an incision, operative time, intraoperative crack, estimated blood loss, use of suction drain and the amount drained were used as possible variables. Results: The decrease in the serum hemoglobin level immediately after and 1 day after surgery was 3.18 and 3.90g/dL respectively. An average of 2.30 units were transfused in 78.3% of cases. The preoperative serum hemoglobin level, the use of a suction drain and the amount drained was related to the total amount of transfusion. Adverse transfusion reactions were found to be associated with the amount of transfusion Discussion: The reduction in the hemoglobin level and total amount of blood transfused showed no relationship with the variances associated with the surgical techniques. The total amount of blood transfused was significantly lower in the groups that had no suction drain. Therefore, a reduction in the volume of intraoperative transfusion and avoiding use of a suction drain can reduce the total amount of blood needed and reduce the adverse reactions of the transfusion.
Arthroplasty, Replacement, Hip* ; Blood Cell Count ; Blood Group Incompatibility ; Diagnosis ; Humans ; Operative Time ; Suction

Authors investigated the possible role of intravascular hypercoagulable states on the etiology of Kegg-Clave-Perthes diesease. Forty-five patients with Legg-Clave-Perthes disease(31 avascular stages and 14 reossification stages) and twenty-two normal control patients were subjected to study for evaluation of coagulation and fibrinolysis system by means of the tests which included antiphospholipid antibody(APA), Protein C, Protein S and antithrombin- III (AT- III) for evaluation of coagulation system, and tissue type PIasminogen activator(tPA), Plasminogen activator inhibitor(PAI), D-dimer for fibrinolytic system. APA increased significantly in Legg-Clave-Perthes patients(p=0.016) as compared with control group, while Protein C(p=0.040) and Protein S(P=0.0001) decreased significantly in Legg-Clave- Perthes disease. AT- III increased in Legg-Clave-Perthes disease(p=0.0000). In contrast, there were no statistically significant differences in PAI, tPA, D-dimer between the Legg-Clave-Perthes disease and control group. There were no differences in all parameters between the avascular stage and reossification stage in patients with Legg-Clave-Perthes disease, Suggestive of possible inherent effect in coagulation system(hypercoagulable states) which does not change with time. Based on the above findings authors presumed that hypercoagulable state may contribute to the development of Legg-Calve-Perthes disease. However, to elucidate the etiology of Legg-Calve-Perthes disease, further extensive investigation should be followed, which include the familial tendency of hypercoagulable state, relationship with other multifactorial causes such as alcohol and steroids, and confirmation of intravascular thrombosis or decreased blood perfusion in the femoral head. Also, the significance of abnormally elevated AT-III on the disease should be answered.
Fibrinolysis ; Head ; Humans ; Legg-Calve-Perthes Disease ; Perfusion ; Plasminogen Activators ; Protein C ; Protein S ; Steroids ; Thrombosis

We reviewed 205 hips (in 151 patients, 125 men and 26 women) which were diagnosed osteonecrosis of femoral head and treated with bipolar endoprosthesis from 1985 to 1993 in Seoul National University Hospital to delineate the efficacy and indication of use of bipolar endoprosthesis in osteonecrosis. They were followed up for an average of 56 months (16 to 100 months). The mean age at operation was 44 years (21 to 84 years). The types of prosthesis used were as follows : Omnift (107), AML (57), Harris-Galante (19) and others (22). The preoperative Harris hip score improved from 49 points preoperatively to 89 points at last follow-up. The pain score improved from 18 points to 39 points, activity score from 9 points to 12 points and gait scare from 19 points to 31 points. The improvement pattern of activities and gait was converse, but that of pain was diverse. One hundred and seventy-eight hips (87%) were satisfactory (Harris hip score : more than 80 points) and 27 (13%) were unsatisfactory. Radiologic findings of last follow-up showed stable bony fixation in 186 hips (91%), stable fibrous fixation in 12 hips (6%) and unstable fixation in 7 hips (3%), Ten migrations of prosthesis were noted: cup migration 5 (2.4%) and stem sinking 5 (2.4%). Heterotopic ossification was noted in 9 (4.4%). Osteolysis in acetabular side was observed in 6 (3%) and in femoral side, 22 (11%). Complications were as follows : 4 stem loosening (1.9%), 5 fixed varus position of cup (2.4%) and 1 dislocation of cup (0.5%). Revision was performed in 4 (1.9%) and the causes were 1 infection, 1 protrusio acetabuli, 1 stem loosening and 1 cup dislocation. In conclusion, biopolar endoprosthesis generally gave good results. However, the improvement of pain was unpredictable. Increasing tendency of osteolysis was noted with increasing follow-up duration. Long-term follow-up is mandatory for the accurate determination of osteolysis.
Acetabulum ; Dislocations ; Follow-Up Studies ; Gait ; Head ; Hip ; Humans ; Male ; Ossification, Heterotopic ; Osteolysis ; Osteonecrosis ; Prostheses and Implants ; Seoul

Femoral stem fracture is an uncommon reason for the failure of total hip arthroplasty, with only 16 cases of fully coated stem fractures reported to date. Here we report a case in which a fully coated primary femoral stem fracture occurred after conversion to total hip arthroplasty for the non-union of an intertrochanteric fracture of the femur. Metallurgic evaluation of the etiology and mechanism revealed that the fracture was initiated by fatigue-related failure and completed by ductile failure on the posterior side of the fracture. Considering the recent trend of treating an intertrochanteric fracture with hip arthroplasty, possible stem failure should be considered, since most patients will have at least one of the known risk factors for stem fracture.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Femur ; Hip ; Humans ; Risk Factors

PURPOSE: This study was performed to find a method to utilize demineralized bone matrix as a vehicle for local delivery of the antibiotics for the treatment of chronic osteomyelitis. MATERIALS AND METHODS: Bovine bone blocks with the same size were randomly divided into 4 groups. Using Demineralization and hematoma coating, the different characteristics were given to each group, and Vancomycin was adsorbed to these bone blocks. We performed two identical experiments with Phosphate-buffered Saline and Fetal Bovine Serum as a solute. We exchange the solution with 24-hour interval for 6 weeks. The eluted concentrations of Vancomycin at each week were measured. RESULTS: Regardless of the solution used, the eluted concentration of Vancomycin was significantly higher in demineralized and hematoma-coated group than those of other groups. The eluted concentration of Vancomycin were 22.6ng/ml at week 6 in saline condition and 12.4ng/ml at week 5 in serum condition. CONCLUSIONS: We thought that demineralized and hematoma-coated cancellous bone can be used as a good vehicle for local antibiotics delivery.
Anti-Bacterial Agents ; Bone Matrix ; Hematoma* ; Osteomyelitis ; Vancomycin*

PURPOSE: The purpose of this study was to investigate the effect of diabetes mellitus on primary total hip arthroplasty by comparing the clinical outcomes of patients diagnosed to have diabetes mellitus before the operation with those without diabetes. MATERIALS AND METHODS: A total 413 patients who underwent unilateral cementless total hip arthroplasty from June 2006 to May 2009 were recruited and divided into diabetic and non-diabetic groups. The comparative analysis between the two groups was made. We evaluated Harris hip score, postoperative complications such as wound problem, surgical site infection, other medical complication and length of stay in hospital as clinical parameters. Radiographic evaluations were also included to determine loosening, dislocation and osteolysis. RESULTS: Patients with diabetes had an increased incidence of orthopaedic complications including surgical site infection and mortality, but other medical complications were not increased in diabetic patients. All complications after primary total hip arthroplasty were associated with diabetes mellitus, but the degree of diabetes was not associated with complications. CONCLUSION: Diabetes mellitus increases incidence of orthopaedic complications, particularly deep infection, after cementless primary total hip arthroplasty.
Arthroplasty, Replacement, Hip* ; Diabetes Mellitus* ; Dislocations ; Hip ; Humans ; Incidence ; Length of Stay ; Mortality ; Osteolysis ; Postoperative Complications ; Wounds and Injuries

BACKGROUND: This paper introduces a percutaneous reduction technique using one or two Steinman pin(s) to reduce sagittally unstable intertrochanteric fractures. METHODS: A fracture was defined as a sagittally unstable intertrochanteric fracture when posterior sagging of a distal fragment and flexion of the proximal fragment worsens after usual maneuvers for a closed reduction. Of 119 intertrochanteric fractures treated from June 2007 to December 2008, twenty-one hips showed sagittal instability. The sagittal displacement was reduced using a Steinmann pin as a joystick, and stabilized with a nail device. Nineteen hips were followed up for more than one year. The clinical and radiological results were reviewed in 19 hips and compared with those of the remaining cases. RESULTS: The demographics were similar in both groups. The mean anesthetic time did not differ. Although the pre-injury and final activity levels were significantly lower in the study group, the degree of recovery was the same. No clinical complications related to this technique were encountered. Radiologically, the reduction was good in all hips in both groups. Union was obtained in all cases without any time differences. CONCLUSIONS: This less invasive reduction technique is simple and safe to use for this type of difficult fracture.
Aged ; Aged, 80 and over ; Bone Nails ; Female ; Fracture Fixation, Internal/*methods ; Hip Fractures/radiography/*surgery ; Humans ; Male

We present a case of Aspergillus septic hip arthritis in an immunocompetent patient with undiagnosed recurrent pulmonary aspergillosis who underwent arthroscopic surgery. Biopsy specimens of synovium revealed fungal hyphae, confirming Aspergillus infection. Aspergillus septic hip arthritis can occur in immunocompetent patients, and arthroscopy can be a noninvasive surgical option in these cases.
Arthritis ; Arthritis, Infectious* ; Arthroscopy ; Aspergillus* ; Biopsy ; Female* ; Hip* ; Humans ; Hyphae ; Pulmonary Aspergillosis* ; Synovial Membrane

As the osteoporotic patient population grows, various periprosthetic fractures that cannot be classified appropriately can occur around the femur after hip arthroplasty. We experienced two cases of periprosthetic insufficiency fractures at subtrochanteric area of the femurs around radiographically loose cemented femoral stems. The ages of the patients were 75 years and 83 years. Both patients could not recall any history of trauma before the onset of pain. Both were treated non-operatively. Both healed uneventfully and did not recur after two years of follow up. When the osteoporotic patient with cemented stem showed sudden hip or thigh pain without a history of trauma, great attention should be focused to find this lesion.
Arthroplasty ; Femur ; Follow-Up Studies ; Fractures, Stress* ; Hip ; Humans ; Periprosthetic Fractures ; Thigh

PURPOSE: This study was designed to investigate the effect of bisphosphonate administration starting time on bone healing and to identify the best administration time following surgical treatment of osteoporotic intertrochanteric fractures. MATERIALS AND METHODS: Two hundreds and eighty four patients (284 hips; 52 males, 232 females) who underwent surgery following osteoporotic intertrochanteric fracture from December 2002 to December 2012 were retrospectively analyzed. The average follow-up period was 68.4 months. The patients were divided into three groups according to the time of bisphosphonate administration after operation: 1 week (group A; n=102), 1 month (group B; n=89), and 3 months (group C; n=93). Koval scores and change of Koval scores 1 year after operation were used for clinical evaluation. For radiologic evaluation, the time of callus appearance across the fracture line on sagittal and coronal radiographs and the time to absence of pain during hip motion was judged as the time of bone union. RESULTS: Koval scores one year after surgery for groups A, B, and C were 2.44, 2.36, and 2.43 (P=0.895), respectively. The mean time of union was 12.4, 11.9, and 12.3 weeks after operation in the three groups (P=0.883), respectively. There were zero cases of nonunion. There were 3, 5, and 7 cases of fixative displacement in the three groups, respectively, but the distribution showed no significant difference (P>0.472). CONCLUSION: The initiating time of bisphosphonate administration following surgery does not affect the clinical outcomes in patients with osteoporotic intertrochanteric fracture.
Bony Callus ; Diphosphonates ; Femur* ; Follow-Up Studies ; Hip ; Hip Fractures ; Humans ; Male ; Osteoporotic Fractures ; Retrospective Studies