No abstract available in English.
Knee Prosthesis ; Knee

PURPOSE: This study is to compare the size distribution of current total knee prostheses with a measurements of Korean knees. MATERIALS AND METHODS: 566 consecutive osteoarthritic knees were measured, intraoperatively, for anteroposterior(AP) dimension of medial and lateral condyle, and mediolateral(ML) dimension of distal femur and proximal tibia. The size distribution of 5 total knee arthroplasty(TKA) systems were compared with these measurements. RESULTS: Regarding femoral component, the numbers of available lateral AP sizes within +/-1SD of Korean knees were two in Genesis II, PFC-RPF, Scorpio and one in Advance MPK, LPS-Flex. Those of available ML sizes for +/-1SD range were two in all systems. Regarding tibial component, the numbers of available lateral AP sizes for +/-1SD range were four in Scorpio, three in LPS-Flex, PFC-RPF and two in Advance MPK, Genesis II. Those of available ML sizes for +/-1SD range were two in Advance MPK, Scorpio and one in the others. CONCLUSION: Korean-friendly total knee prostheses should incorporate the size distribution as well as the dimension of the Korean knees.
Femur ; Knee Prosthesis* ; Knee* ; Tibia

After total knee replacement, the breakage of implant is unusual. We have been experienced the two cases, one is the porous tibial plate breakage that Miller/Galante total knee system(MG TKS) and the other is the metal-backed polyethylene patellar component breakage with low contact stress(LCS) pros-thesis. Revisions have been performed by using Nexgen and modular posterior stabilized P.F.C. total knee system. Considerations of these causes are habitual abrupt hyperflexion of the knee and weight bear-ing. So we need to careful observation of long term clinical, radiological and survival results of total knee prosthesis in regard of the breakage of implant.
Arthroplasty, Replacement, Knee* ; Knee ; Knee Prosthesis ; Polyethylene

Skin and soft tissue defect developed after total knee arthroplasty have important influence on prosthesis survival. Thus an adequate treatment have to be performed according to the size and depth of defect. We report a case of dorsalis pedis flap for treatment of skin and soft tissue defect combined with infection after conversion total knee arthroplasty and its good result with a review of the literature.
Arthroplasty ; Knee ; Prosthesis Failure ; Skin

OBJECTIVETo detail our early experience and technique of a modified two-stage reimplantation protocol using antibiotic-loaded articulating cement spacers (ALACSs) for treatment of late periprosthetic infection after total knee arthroplasty (TKA).

METHODSFrom January 2006 to February 2009, a series of 21 patients (21 knees) with late infected TKAs were treated by radical debridement and removal of all components and cement, and then articulating spacers were implanted using antibiotic-impregnated bone cement. For this purpose, 4 g vancomycin powder was mixed with per 40 g cement. Graduated knee motion and partial weight bearing activity were encouraged in the interval period. Each patient received an individual systemic organism-sensitive antimicrobial therapy for 4.9 (range, 2-8) weeks followed by a second-stage TKA revision. All the patients were regularly followed up using the American Knee Society Scoring System.

RESULTSEach case underwent a successful two-stage exchange and had infection eradicated, none had recurrent infection after an average of 32.2 (range, 17-54) months of follow-up. Preoperatively, the mean knee score was 53.5 points, function score was 27.3 points, pain score was 25.7 points, range of motion (ROM) was 82.0 degree extensor lag was 2 degree Between stages, the mean knee score was increased to 61.3 points, function score to 45 points, pain score to 35 points, ROM to 88.2 degree and extensor lag to 3.4 degree At final follow-up, the mean knee score was further increased to 82.1 points, function score to 74.5 points, pain score to 42.1 points, ROM to 94.3 degree and knee extension lag to 1.9 degree The interval period was 11.5 (range, 6-32) weeks. The amount of bone loss was unchanged between stages. No patient developed noticeable dysfunction of the liver or kidney or other complications such as impaired wound healing, deep venous thrombosis, pulmonary embolism, cerebrovascular accidents, etc.

CONCLUSIONSTreating infected TKA with ALACS avoids spacer-related bone loss, preserves knee function between stages, and eradicates infection effectively without significant complications. The early clinical results are inspiring. The authors believe that radical and repeated (if needed) debridement, individual application of systemic antibiotics, and reasonable timing judgement upon the secondary revision are all key factors related to a successful outcome with two-stage reimplantation procedure for infected TKA.

PURPOSE: This study was performed to compare the postoperative maximal flexion angle (MFA) of standard PCL-substituting (PS) prosthesis with that of high-flexion PS prosthesis after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 81 patients (133 knees) were enrolled in this study. Sixty-eight primary bilateral TKAs were performed in 34 consecutive patients. The bilateral TKAs were performed in a staged sequential manner, with a standard PS prosthesis in one knee and a high-flexion PS prosthesis in the contralateral knee. We also analyzed the results of another 47 patients as several control groups, and this consisted of standard or high-flexion PS total knee prostheses in the bilateral TKAs, and standard or high-flexion PS total knee prostheses in the unilateral TKAs. The patients were clinically assessed with the Knee Society scoring system and the MFA was measured with a goniometer. RESULTS: At the last follow up, the mean postoperative MFA of the 34 patients operated with the combination of different prostheses was 131.6+/-10.4degrees for high-flexion prosthesis side and 131.6+/-9.5degrees for standard prosthesis side respectively. There was no statistically significant difference. On comparing with the results of the 47 patients in the control group, no statistically significant difference in the mean postoperative MFA was found between the groups. CONCLUSION: We found no significant differences between the high-flexion PS prosthesis and the standard PS prosthesis in the postoperative MFA.
Arthroplasty ; Follow-Up Studies ; Humans ; Knee ; Knee Prosthesis ; Prostheses and Implants

PURPOSE: This study is to establish a detailed anthropometric data of Korean female knee and to compare the data with current total knee prostheses. MATERIALS AND METHODS: 476 consecutive osteoarthritic knees were measured intraoperatively about anteroposterior (AP) dimension of medial and lateral condyle, and mediolateral (ML) dimension of distal femur as well as proximal tibia. Dimensions of 5 total knee arthroplasty (TKA) systems were compared with these measurements. RESULTS: The AP dimension of medial and lateral condyle, and ML dimension of distal femur were 60.3+/-3.5 mm, 60.9+/-3.2 mm and 68.4+/-3.9 mm, respectively. Those of proximal tibia were 47.4+/-2.8 mm, 39.5+/-3.1 mm and 67.4+/-2.9 mm, respectively. Korean femurs below -1 standard deviation (SD) in lateral AP dimension had narrower ML dimension than femoral prostheses. And most femurs above -1 SD in lateral AP dimension had wider ML dimension than femoral prostheses. Korean tibias had wider ML dimension than tibial prostheses. CONCLUSION: Current total knee prostheses had tendency to ML overhang in small femurs and ML undercoverage in other femurs, and tendency to ML undercoverage or posterolateral overhang in tibias. Thus, Korean anthropometric data should be considered in Korean-friendly prostheses.
Arthroplasty ; Female* ; Femur ; Humans ; Knee Prosthesis ; Knee* ; Prostheses and Implants ; Tibia

Despite the continually improving results of total knee arthroplasty, infection remains the most debilitating complication. The treatments of infected total knee arthroplasty were variable, but initially we removed infected implants and inserted antibiotic containing cemented spacer. Postoperatively, patients were mobilized in a 30 knee flexion state and treated with parenteral antibiotics. After control of infection was clinically and radiologically determined, we inserted PCL substitute total knee prosthesis. Five days postoperatively, patient began touch down standing exercise. We observed two cases in whom infected total knee arthroplasty had been salvaged successfully with two-stage implantation using cement spacers containing antibiotics.
Anti-Bacterial Agents* ; Arthroplasty* ; Humans ; Knee Prosthesis ; Knee* ; Replantation*

To determine size and shape discrepancy between the bone of Korean women and the prostheses in total knee arthroplasty, the height(antero-posterior length) and width(medio-lateral length) of the distal femur and the proximal tibia were measured at the bone resection level for 104 knees of 62 female patients who underwent primary total knee arthroplasty and compared with the same parameters of the total knee prostheses designed by five different companies. On the condition that the height of the prostheses matched with each cases of the bone were optimal, the difference in the width was evaluated, and the criteria of the discrepancy were overhang if the width of the prosthesis was larger than bone, optimal if width of the prosthesis was same or smaller and difference was within 5 mm, and down-size if smaller and difference was over Smm. In femoral prostheses, 34.6% of all were optimal, 13.1%, overhang and 52.3%, down-size. In tibial prosthesis, 54.1% of all were optimal, 13.9%, overhang and 32%, down-size. In conclusion, although further investigation for clinical application is needed, there were discrepancies in size and shape between the femur and tibia of Korean women and total knee prostheses and improvement in design should be considered.
Arthroplasty* ; Female ; Femur ; Humans ; Knee Prosthesis ; Knee* ; Prostheses and Implants* ; Tibia

We report the case of a polyethylene tibial post fracture in a 72-year-old woman 14 months after a Scorpio posterior-stabilized (PS) total knee arthroplasty. The polyethylene wear was found around the fracture site of the post, especially over the anterior aspect of the post base. The failure mechanism of the post fracture in the present case was anterior impingement with excessive wear over the base of the anterior aspect of the tibial post, which became a stress-riser of post and cam articulation. This is the first report of a polyethylene tibial post fracture of a Scorpio PS prosthesis.
Aged ; *Arthroplasty, Replacement, Knee ; Female ; Humans ; Knee Joint/radiography ; Knee Prosthesis/*adverse effects ; Osteoarthritis, Knee/surgery ; *Polyethylenes ; *Prosthesis Failure ; Reoperation