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Difference in the Surgical Approach in Reverse Total Shoulder Arthroplasty for Cuff Tear Arthroplasty: Comparison of the Radiological and Clinical Result according to the Deltopectoral and Anterosuperior Approach.

Chang Hyuk CHOI ; Byung Hoon KWACK ; Tae Bum OH

The Journal of the Korean Orthopaedic Association.2018;53(4):316-323. doi:10.4055/jkoa.2018.53.4.316

PURPOSE: This study compared the clinical and radiological results of reverse total shoulder arthroplasty (RSA) using an anterosuperior approach with those using a deltopectoral approach to determine the difference in cuff tear arthroplasty between both approaches. MATERIALS AND METHODS: A retrospective review of 24 consecutive patients who underwent RSA due to cuff tear arthroplasty from February 2014 to November 2015 was performed. The anterosuperior and deltopectoral approaches were 12 cases each. The mean age was 72 years and the mean follow-up period was 13.2 months. The clinical results were assessed using the visual analogue pain scale, American Shoulder and Elbow Surgeon score, Korean shoulder scoring system, and the Constant score. The prosthesis-scapular neck angle (PSNA), peg-glenoid rim distance (PGRD), scapular neck-inferior glenosphere rim distance (inferior glenosphere overhang), acromion-greater tuberosity (AT) distance, glenoid-greater tuberosity (GT) distance were assessed, and severity of notching according to the Nerot-Sirveaux classification, were measured from the radiology evaluation. RESULTS: Compared to the anterosuperior approach, the PSNA (9.6°, p=0.018) and inferior glenosphere overhang (2.0 mm, p=0.024) were significantly greater in the deltopectoral approach and the PGRD (2.2 mm, p=0.043) was shorter. The AT and GT distance was similar in the two groups. Two and three cases of implant notching occurred on deltopectoral approach and anterosuperior approach, respectively. No metal loosening, acromion fracture, or nerve injury was noted. The clinical results improved significantly in both groups, but there was no statistically significant difference between the two groups. CONCLUSION: The anterosuperior approach could cause the superior position of the glenoid baseplate and a decrease in the inferior tilt compared to the deltopectoral approach, but the clinical results had improved in both groups and there was no difference between the two groups.
Acromion ; Arthroplasty* ; Classification ; Elbow ; Follow-Up Studies ; Humans ; Neck ; Pain Measurement ; Retrospective Studies ; Shoulder* ; Tears*

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Morphologic Changes of Femoral Cam Lesion after Osteoplasty for Femoroacetabular Impingement.

Jung Mo HWANG ; Deuk Soo HWANG ; Chang Kyun NOH ; Long ZHENG ; Chang Hyun YOO

The Journal of the Korean Orthopaedic Association.2018;53(4):307-315. doi:10.4055/jkoa.2018.53.4.307

PURPOSE: We evaluated the morphologic change of cam lesion of femoroacetabular impingement (FAI) using 3-dimensional computed tomography (3D-CT) at the minimum 2-year follow-up and estimated its relationship with clinical outcomes. MATERIALS AND METHODS: Between February 2007 and March 2014, all patients who underwent hip arthroscopic femoroplasty under the impression of FAI were retrospectively evaluated. We selected patients who received 3D-CT and were followed-up for more than 2 years. We estimated the quantitative volume of femoroplasty, alpha angle and femoral head-neck offset using 3D-CT. RESULTS: Thirty-two patients (37 cases) were selected in our study. The mean age was 31.2 years (16–69 years) and the mean follow-up duration was 47.3 months (26–119 months). The mean resection volume measured after femoroplasty using 3D-CT was 48.9 mm2 (13.2–106.4 mm2), and follow-up mean resection volume was 37.9 mm2 (7.83–90.37 mm2). A little bit of the mean volumatic overgrowth of the resection area between immediate postoperative and last follow-up was shown; however, there was no statistically significant difference in the mean values (p>0.05). The clinical outcomes showed a significant improvement during the perioperative and follow-up periods in all categories (p < 0.05). CONCLUSION: There was no significant regrowth of cam lesion after femoroplasty for FAI at maximum 9 years. Moreover, in most cases, clinical outcomes were improved. This suggests that we were able to achieve good clinical outcomes without harmful anatomical regrowth of cam deformity using arthroscopic femoroplasty.
Congenital Abnormalities ; Femoracetabular Impingement* ; Follow-Up Studies ; Hip ; Humans ; Retrospective Studies

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Surgical Technique for Distal Femur Varization Osteotomy.

Yi Rak SEO ; Kyung Wook NHA ; Sung Sik HA

The Journal of the Korean Orthopaedic Association.2018;53(4):301-306. doi:10.4055/jkoa.2018.53.4.301

A closing wedge distal femoral osteotomy is a procedure to reduce pain and delay the progression of degenerative arthritis of knee by moving the weight bearing line from the lateral compartment to the medial side while preserving the knee joint. Age, weight bearing line, and the degree of arthritis are the essential factors to be considered at the time of surgery. The indications for distal femoral osteotomy are as follows. All patients are aged less than 65 years old, normal medial compartment of the knee with normal patello femoral joint, valgus deformity with lateral degenerative arthritis, younger patients with lateral osteochondritis, congenital osteochondrosis, and recurrent patellar dislocation with genu valgum. The distal femoral osteotomy provides the advantages of rapid pain reduction and short rehabilitation in young and active patients and patients who are subjected to heavy loads on the knee.
Arthritis ; Congenital Abnormalities ; Femur* ; Genu Valgum ; Humans ; Joints ; Knee ; Knee Joint ; Osteoarthritis ; Osteochondritis ; Osteochondrosis ; Osteotomy* ; Patellar Dislocation ; Rehabilitation ; Weight-Bearing

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Opening Wedge High Tibia Osteotomy.

Seung Min OH ; Kyung Wook NHA ; Jae Hwi HAN

The Journal of the Korean Orthopaedic Association.2018;53(4):293-300. doi:10.4055/jkoa.2018.53.4.293

Proximal tibial osteotomy is the preferred method for treating medial compartment knee arthritis with varus deformity. The purpose of this treatment is to reduce the weight burden of the lesion by correcting the mechanical axis of the patient with degenerative arthritis of medial tibiofemoral joint and abnormal alignment. In general, the proximal tibial osteotomy provides satisfactory clinical results when suitable patient are selected by considering the extent of cartilaginous injury and the age of the patient and the correct technique is performed. In tibial osteotomy, medial open wedge osteotomy is used widely because of its short operation time and relatively simple technique. This review describes the current knowledge of patient selection, preoperative evaluation and planning, treatment principles, surgical techniques, rehabilitation procedures and complications in open wedge high tibial osteotomy.
Arthritis ; Congenital Abnormalities ; Humans ; Joints ; Knee ; Knee Joint ; Methods ; Osteoarthritis ; Osteotomy* ; Patient Selection ; Rehabilitation ; Tibia*

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Osteotomy around the Knee: Indication and Preoperative Planning.

Seung Wan LIM ; Seung Min RYU ; Oog Jin SHON

The Journal of the Korean Orthopaedic Association.2018;53(4):283-292. doi:10.4055/jkoa.2018.53.4.283

Osteotomy around the knee is a widely considered surgical procedure for osteoarthritis with lower extremity malalignment. High tibial osteotomy (HTO) is performed for varus deformity, while distal femur osteotomy (DFO) is performed for valgus deformity. However, if the correction is insufficient, double osteotomy can also be considered. This report included the basic principles and current concepts of patient selection and preoperative planning in osteotomy around the knee.
Congenital Abnormalities ; Femur ; Knee Joint ; Knee* ; Lower Extremity ; Osteoarthritis ; Osteotomy* ; Patient Selection

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Corrigendum: Extensor Digitorum Brevis Manus.

Myung Hoon PARK ; Nak Chul KIM ; Tong joo LEE

The Journal of the Korean Orthopaedic Association.2018;53(4):374-374. doi:10.4055/jkoa.2018.53.4.374

Author requested to change the name of the last author. The correct name should be Tong joo Lee instead of Tong Ju Lee.

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Intradural Extramedullary Cysticercosis Involving the Thoracolumbar Spinal Canal in a Patient with Cerebral Cysticercosis.

Yu Hun JEONG ; Young Sang LEE ; Dong Chan EUN ; Chan Woong BYUN

The Journal of the Korean Orthopaedic Association.2018;53(4):369-373. doi:10.4055/jkoa.2018.53.4.369

Neurocysticercosis (NCC) by Taenia solium is the most common parasitic infection of the central nervous system involving the cerebrum. However, spinal involvement of NCC is rare. Spinal NCC can cause radiculopathy, myelopathy, cauda equina syndrome, and even paraparesis, depending on its location and size. Spinal NCC may require surgical treatment as a first-line treatment because medical therapy can further aggravate the inflammation due to dead cysts, resulting in clinical deterioration. The current standard therapy for spinal NCC is surgical decompression followed by medical therapy. We experienced a case of widespread thoracolumbar intradural extramedullary cysticercosis involving the spinal canal with cerebral cysticercosis. We report this rare case with literature review.
Central Nervous System ; Cerebrum ; Cysticercosis* ; Decompression, Surgical ; Humans ; Inflammation ; Neurocysticercosis ; Paraparesis ; Polyradiculopathy ; Radiculopathy ; Spinal Canal* ; Spinal Cord Diseases ; Spine ; Taenia solium

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Diagnosis of a Snapping Elbow Caused by Hypertrophic Plica, Using Ultrasound.

Si Jung SONG ; Kyoung Hwan KOH ; Dongjun PARK

The Journal of the Korean Orthopaedic Association.2018;53(4):364-368. doi:10.4055/jkoa.2018.53.4.364

This paper reports a case of a 21-year-old male patient who complained of intermittent pain and snapping at 110° of flexion in his left elbow joint. Magnetic resonance imaging revealed a band-like low signal intensity in front of the radiohumeral joint. An ultrasound was conducted to check its association with the symptoms. Observations of a high echo escaping from the radiohumeral joint at the point when snapping occurred indicated noted that the hypertrophic plica was a cause of the snapping. The hypertrophic plica removed arthroscopically, and the results were good for up to 6 months after surgery. If snapping is observed in the elbow joint, it will be necessary to consider the symptoms from the hypertrophic plica, although rare, and ultrasound might be an effective tool for a differential diagnosis.
Diagnosis* ; Diagnosis, Differential ; Elbow Joint ; Elbow* ; Humans ; Joints ; Magnetic Resonance Imaging ; Male ; Ultrasonography* ; United Nations ; Young Adult

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Comparison of Fixation Stability and Incidence of Extensor Tendon Injury according to the Screw Insertion Method in Volar Plate Fixation for Distal Radius Fractures.

Min Wook JOO ; Han Vit KANG ; Kee Won RHYU ; Min Sik PARK

The Journal of the Korean Orthopaedic Association.2018;53(4):358-363. doi:10.4055/jkoa.2018.53.4.358

PURPOSE: This retrospective study was aimed to analyze the differences in stability and extensor impairment after two different volar plating procedures to manage unstable distal radius fracture, which were the penetration of only near-cortex followed by screw fixation (Group 1) and perforation of dorsal cortex by drill-bit followed by fixation with the screws downsized after gauging (Group 2). MATERIALS AND METHODS: We reviewed the medical records of 491 patients with distal radius fracture treated with standard-sized, targeted distal radius plate in two institutions between April 2009 and May 2014. Finally, 341 patients with complete demographic data, records of AO classification of fractures, data on the lengths of inserted distal screws, radiologic parameters immediately and at 3 months after operation, as well as extensor impairments, were included in this study. There were 112 patients (98 women and 14 men) in Group 1, and 229 patients (171 women and 58 men) in Group 2. The mean age was 59.8 years for all the patients; 60.3 years in Group 1 and 59.5 years in Group 2. RESULTS: The mean length of the longest screws used in Group 2 was longer than that in Group 1; however, the mean length of the shortest screws used in Group 2 was shorter than that in Group 1. While the differences in changes for radial inclination measured immediately and at 3 months after the operation were statistically significant (p=0.019), the change of radial inclination in Group 2, which showed a greater change, was only 0.5 mm. There were two cases with extensor pollicis longus rupture in Group 1 and 2 respectively, and the difference in frequency according to each Group was not statistically significant (p=0.6). CONCLUSION: The superiority of one surgical procedure in terms of fracture stability on measured radiological parameters was not fully proven compared with the other one in this study. Therefore, it would be better to selectively use the surgical method of dorsal cortex perforation viadrill-bit followed by fixation only in limited circumstances.
Classification ; Female ; Humans ; Incidence* ; Medical Records ; Methods* ; Radius Fractures* ; Radius* ; Retrospective Studies ; Rupture ; Tendon Injuries* ; Tendons*

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Measuring Needle Angle and Depth for Lumbar Medial Branch Block Using Ultrasonography: An Evaluation of Efficiency Compared with Magnetic Resonance Imaging.

Changsu KIM ; Daemoo SHIM ; Seokjoong LEE ; Youngha WOO ; Samuel BAEK ; Haksun CHUNG

The Journal of the Korean Orthopaedic Association.2018;53(4):350-357. doi:10.4055/jkoa.2018.53.4.350

PURPOSE: The purpose of this study was to compare accuracy of proper needle insertion angle between magnetic resonance imaging (MRI) and ultrasonography during lumbar medial branch nerve block procedure. MATERIALS AND METHODS: Between January 2015 and June 2016, 80 people who underwent MRI in the past 3 months with improved lumbar pain after sono-guided medial branch nerve block were enrolled for analysis (male, 39; female, 41; average age, 63.3 years). The insertion angle and depth between the spinous process and needle at each target points were measured at various levels (superior, inferior segment of each facet joints from L2–3 to L5–S1). The needle was positioned 1 cm apart from both lateral sides of the probe, locating spinous process in the middle. A comparative analysis was performed between an ultrasonography and an MRI. We determined the statistical correlation between the two methods. RESULTS: The average differences with respect to the distance between each level on a sono-guided medial branch nerve block were 1.28±1.07 mm in L2 (7 cases), 1.27±4.26 mm in L3 (25 cases), 1.63±5.89 mm in L4 (93 cases), 1.99±4.12 mm in L5 (141 cases), and 1.51±3.87 mm in S1 (66 cases). The average differences regarding the angle of each level were 1.69°±1.34° in L2 (7 cases), 2.03°±5.35° in L3 (25 cases), 1.49°±3.42° in L4 (93 cases), −1.55°±3.67° in L5 (141 cases), and 1.86°±4.83° in S1 (66 cases). All measurements followed a normal distribution (p < 0.05), showing statistical correlation without significant difference (p < 0.05). CONCLUSION: After measuring each level using an MRI prior to performing the procedure, a sono-guided lumbar medial branch nerve block can be performed with greater safety and efficacy, especially for beginners.
Female ; Humans ; Magnetic Resonance Imaging* ; Needles* ; Nerve Block ; Spine ; Ultrasonography* ; Zygapophyseal Joint

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