PURPOSE: The purpose of this study is to investigate the relative surgical risk and problems in hip hemiarthroplasty for treatment of an unstable intertrochanteric fracture in elderly patients over 80 years old. MATERIALS AND METHODS: Between April 2005 and May 2010, 58 patients whose age was over 80 years were available for inclusion in this study. They were divided into two groups: group 1 included 30 patients with femoral neck fracture and group 2 included 28 patients with intertrochanteric fracture. No significant differences in average age, concomitant disease, and walking ability before development of fracture were noted between the two groups. The following factors, including interval from development of fracture to operation, operation time, amount of blood loss, start time of walking after operation, duration of hospital stay, complications, revision rate, and walking ability were compared between the two groups. RESULTS: Operation time was an average of 85.2 minutes in group 1 and 97.5 minutes in group 2(P=0.03). The amount of bleeding was an average of 483 cc in group 1 and 695 cc in group 2(P=0.006). Similar results for walking start and recovery of walking ability after operation were observed in the two groups. No significant differences were observed in duration of hospital stay, complications, and revision rate. While 25 patients in group 1(83.3%) showed restoration of walking ability after operation to the same level of walking before injury, 19 patients in group 2(67.8%) showed restoration of walking ability postoperatively. CONCLUSION: Even though patients in group 2 showed a longer operation time and a higher amount of blood loss, compared with those in group 1, patients in group 2 had similar surgical risk and complications, compared with those in group 1. Therefore, primary hip hemiarthropalsty could be a good treatment option for intertrochanteric fracture in elderly.
Aged ; Femoral Neck Fractures ; Femur Neck ; Hemiarthroplasty ; Hemorrhage ; Hip ; Hip Fractures ; Humans ; Length of Stay ; Walking

Anterior dislocation of lunate is rare, it can result in median nerve compression and attritional rupture of flexor tendon when delay diagnosed. We report a patient with second finger flexor tendon rupture and carpal tunnel syndrome caused by neglected anterior lunate dislocation. Patient underwent operative treatment for that excised lunate, released carpal tunnel and reconstructed second flexor tendon using palmaris longus tendon. One year after surgery, fucntional and neurologic symptom were recovered. Also carpal alignment was maintained on plain radiographs, even after excision of the lunate.
Carpal Tunnel Syndrome* ; Dislocations* ; Fingers ; Humans ; Median Nerve ; Neurologic Manifestations ; Rupture* ; Tendons*

Purpose: The purpose of our study is to examine early radiographic findings and clinical signs of failure of the microstructure surface HA-coated acetabular cup. Material and methods: This study included 41 revisions of 204 THA with hydroxyapatite-coated acetabular cup from April 1992 to November 1996. Radiolucent line around cups, change in the cup angle and osteolysis were evaluated in serial radiographs. Acetabular cup was defined as loosening if any movement occurred at the bone and socket interface by manual rotation and extension force intraoperatively or migration of more than 2 mm and change of the cup angle by more than 5 degrees in radiographs. Results: The radiolucent line was observed in 12 of the 41 hips at an average of 55.4 months postoperatively and was most commonly located in zone III. All of the 12 hips showing radiolucent lines were classified as loosening by radiographically in 8 cases and intraoperatively in 4 cases. Radiographic loosening occurred at an average of 28.8 months after the appearance of a radiolucent line. Inguinal pain was noted in 18 of the 19 cases revised for acetabular cup loosening. Conclusion: The most important radiographic finding for the early diagnosis of loosening was progressive radiolucent lines, which occurred most frequently in zone 3.
Acetabulum* ; Arthroplasty, Replacement, Hip ; Early Diagnosis ; Hip ; Osteolysis

A dislocation after total hip arthroplasty is a serious complication that is related to the component position and poor patient compliance. Therefore, the attendants and surgeons need to be aware of the risk factors for dislocations and take steps to prevent them. In addition, the surgeon should insert the components within the safe zone. The patients should also be informed of possibility of dislocations after total hip arthroplasty. Dislocations can be treated conservatively but a recurrent dislocation requires surgery. The causes of recurrent dislocations must be evaluated before surgery to achieve a high success rate.
Arthroplasty ; Dislocations ; Hip ; Humans ; Patient Compliance ; Risk Factors

Periprosthetic fractures after total hip arthroplasty or hemiarthroplasty are an uncommon complication. These fractures have problems of fixation of fracture and stability of the femoral component. Ipsilateral femoral fractures after hip arthroplasty occurred in 14 cases (11 patients) out of 510 hip arthroplasties performed between January 1985 and May 1996. These fractures occurred at an average of 3 years and 6 months after primary hip arthroplasty. These fractures were classified by Johansson classification. Nine fractures were treated with plate and cerclage wires. Four fractures were treated with skeletal traction. Bone graft was applied to the fracture site in 9 fractures which were treated by open reduction and internal fixation with plate and cerclage wires. Average follow up period was 21 months. The results were as follows. 1. All but three of the fractures had been developed by low energy trauma. Seven patients had osteolytic lesion around femoral component. Of the seven patients who had osteolytic lesions, six patients had periprosthetic fractures which connected with osteolytic lesions. We think that osteolysis is one of the important factors of the periprosthetic fractures after hip arthroplasty. 2. Four cases were treated by skeletal traction. One case had malunion. Progressive subsidence of femoral component was noted after union of fracture in 3 cases. Therefore these periprosthetic fractures which had an osteolysis and subsidence preoperatively should be managed with operative methods. 3. Nine fractures which had treated with plates and autogenous bone graft showed good hip joint function with stable femoral component. We think that stabilization of periprosthetic fractures with plates and cerclage seemed to be a good method for femoral fractures after hip arthroplasty.
Arthroplasty* ; Arthroplasty, Replacement, Hip ; Classification ; Femoral Fractures* ; Follow-Up Studies ; Hemiarthroplasty ; Hip Joint ; Hip* ; Humans ; Osteolysis ; Periprosthetic Fractures ; Traction ; Transplants

Synthetic hydroxyapatite is a safe, nontoxic, biocompatible, and osteoconductive material. Hydroxyapatite-coated implants have the property of achieving a very strong bond with living bone in a relatively short period. From March 1992 to June 1994, 140 hydroxyapatite-coated primary total hip prostheses were implanted. This study included 60 cases that could follow up minimum 3 years. At the time of mean follow up, 45 months after operation, the mean Harris hip score was 92 points. Only two patients complained of thigh pain at last follow up. On radiographic evaluation, radiolucent lines were seen around the uncoated distal part of the stem in 46 percents of the implants. No radiolucent line was observed around the coated area of the prosthesis. Cancellous condensation was seen in 95 per cents of the implants at the Gruen zone 2 and 6 area. Cortical hypertrophy was present in 32 percents. Fourteen cases had the gaps at the bone to acetabular cup interface in the immediate postoperative period. The gaps disappeared in 12 months after operation. Five implants were revised because of polyethylene wear, cup migration and periprosthetic fracture. The clinical outcome was excellent. But this result was obtained in the relatively short-term follow up. Longer-term data will be the only true test of the value of hydroxyapatite coated implant.
Acetabulum ; Arthroplasty, Replacement, Hip ; Durapatite* ; Follow-Up Studies ; Hip Prosthesis* ; Hip* ; Humans ; Hypertrophy ; Periprosthetic Fractures ; Polyethylene ; Postoperative Period ; Prostheses and Implants ; Thigh

Many uncemented acetabular components use transfixation screws to stabilize the acetabular component until ingrowth of bone occurs. But the use of transacetabular screw fixation in total hip arthroplasty could increase the incidence of intrapelvic complications including neurovascular injury, extrinsic compression and erosion of intrapelvic organs. Metal debris was attributed to corrosion or fretting between screw and metal shell may lead to pelvic osteolysis. A foreign body reaction to metal and polyethylene wear debris in a loose acetahular component eroded the medial wall of the acetabulum and produced an intrapelvic mass. We experienced a case of intrapelvic pseudocyst in a failed total hip arthroplasty. The cyst communicated with hip joint through the transacetabular fixation screw which was placed near the center of the acetahulum.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Corrosion ; Cytochrome P-450 CYP1A1 ; Foreign-Body Reaction ; Hip ; Hip Joint ; Incidence ; Osteolysis ; Polyethylene

PURPOSE: To evaluate the efficacy of proximal femoral nail for intertrochanteric fracture. MATERIALS AND METHODS: From June 2001 to March 2005, 45 intertrochanteric fractures were treated with a proximal femoral nail for intertrochanteric fracture and followed-up at least one year. The average age was 71.3 years (34~91 years). The causes of fracture were slip down in 38 cases and fall down in 7 cases. Fractures were classified with AO classification; 20 cases in type A1, 22 cases in type A2 and 3 cases in type A3. Antirotational pin was used in 25 of 45 fractures according to fracture stability. Radiological result was determined with a union. Walking ability was evaluated in the last follow-up. RESULTS: The fractures were fixed in anatomical position in 36 cases, in valgus position in 3 cases and varus position in 6 cases. Union was occurred in 43 of 45 cases. The sliding distance of lag screw was an average of 5.63 mm and it had no association with fracture type, TAD, usage of antirational screw, usage of distal screw and BMD. Twenty-six of 45 patients (57.7%) were recovered to pre-injury state of walking ability. Complications were occurred in 3 patients (6%). CONCLUSION: Proximal femoral nail was a useful instrument for all type intertrochanteric fractures, but antirotational pin was not necessary in the stable type A1 intertrochnatirc fractures.
Classification ; Femur ; Follow-Up Studies ; Hip Fractures ; Humans ; Walking

Spontaneous osteonecrosis of the knee (SPONK) is rare disease and most common in the medial femoral condyle. This condition presents with acute onset of pain in elderly patients, usually without a history of trauma. The exact etiology of SPONK is still debated. There are several options for the treatment according to the size, progression and site of the osteonecrosis. SPONK usually occurs in one knee. The spontaneous osteonecrosis of the medial tibial plateau is less recognized than osteonecrosis of the medial femoral condyle. And, in this case, SPONK in the medial tibial plateau of the contralateral knee followed SPONK in the medial femoral condyle, and bony destruction extended to the lateral aspect of the lateral tibial eminence from the medial tibial plateau. The best treatment has not yet been defined. This condition of the tibial side has been managed by total knee replacement resulting in a satisfactory outcome.
Aged ; Arthroplasty, Replacement, Knee ; Humans ; Knee ; Osteonecrosis ; Rare Diseases

PURPOSE: We reviewed the clinical and radiological outcomes of total hip arthroplasty and bipolar hemiarthroplasty for avascular necrosis of the femoral head. MATERIALS AND METHODS: From January 1986 to December 1989, 24 cases were treated with total hip arthroplasty and 27 cases with bipolar hemiarthroplasty for avascular necrosis of the femoral head. Clinical outcomes were assessed using Harris Hip Score. Serial radiographs of the hip were used to assess stability of the femoral component, change of the acetabular cup angle, osteolysis of acetabulum or femur, wear of polyliner and erosion of the acetabular cartilage. RESULTS: The average Harris Hip Score was 93.1 in bipolar hemiarthroplasty group and 86.8 in total hip arthroplasty group at last follow up. Femoral osteolysis was observed in 17 patients of 24 total hip arthroplasties and in 14 patients of 27 bipolar hemiarthroplasties. Acetabular osteolysis was observed in 8 cases of 24 total hip arthroplasties. Revision was undertaken 8 cases (33.3%) in the total hip arthroplasty group and 6 cases (22.2%) in the bipolar hemiarthroplasty group. The main causes of revision were wear of polyliner and severe osteolysis in the total hip arthroplasty group and erosion of the acetabular cartilage in the bipolar arthroplasty group. CONCLUSION: The main cause of failure after total hip arthroplasty for avascular necrosis of the femoral head was using a 32 mm femoral head and a polyliner less than 8mm thickness.
Acetabulum ; Arthroplasty* ; Arthroplasty, Replacement, Hip ; Cartilage ; Femur ; Follow-Up Studies ; Head* ; Hemiarthroplasty ; Hip* ; Humans ; Necrosis* ; Osteolysis