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Complications of Medial Unicompartmental Knee Arthroplasty.

Jong Hun JI ; Sang Eun PARK ; In Soo SONG ; Hanvit KANG ; Ji Yoon HA ; Jae Jung JEONG

Clinics in Orthopedic Surgery.2014;6(4):365-372. doi:10.4055/cios.2014.6.4.365

BACKGROUND: We report intra- and postoperative complications of unicompartmental knee arthroplasty (UKA). METHODS: This study was conducted on 246 cases of UKA which were performed for degenerative osteoarthritis confined to the medial compartment, from May 2002 to May 2010, for which follow-up periods longer than one year were available. Complications were divided into intra- and postoperative complications. Pre- and postoperative clinical scores, the range of motion, and radiologic findings were analyzed. RESULTS: Complications developed in a total of 24 cases (9.8%, 24/246). Among them, 6 cases had intraoperative complications while 18 had postoperative complications. Among the 6 intraoperative complications, one fracture of the medial tibial condyle, two fractures of the intercondylar eminence, one rupture of the medial collateral ligament, one widening of the peg hole leading to femoral component malposition and late failure, and one total knee arthroplasty (TKA) conversion of a large bony defect of tibial avascular necrosis were observed. Among the 18 postoperative complications, four cases of aseptic loosening of the femoral component, one soft tissue impingement due to malalignment, nine cases of polyethylene bearing dislocation, one case of suprapatellar bursitis, one periprosthetic fracture, one TKA conversion due to medial component overhanging, and one TKA conversion due to pain of unexplained cause were observed. CONCLUSIONS: The mid-term clinical outcomes of UKA were excellent in our study. However, the incidence of complications was very high (9.8%). To prevent intra- and postoperative complications, proper selection of the patients and accurate surgical techniques are required.
Aged ; Arthroplasty, Replacement, Knee/*adverse effects/methods ; Female ; Humans ; Intraoperative Complications ; Male ; Middle Aged ; Osteoarthritis, Knee/radiography/*surgery ; Postoperative Complications ; Retrospective Studies

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Secondary Chondrosarcoma from an Osteochondroma of the Proximal Tibia Involving the Fibula.

Hwan Seong CHO ; Ilkyu HAN ; Han Soo KIM

Clinics in Orthopedic Surgery.2017;9(2):249-254. doi:10.4055/cios.2017.9.2.249

There are few reports on the surgical treatment of secondary malignancy arising from an osteochondroma on the lateral side of the proximal tibia. From March 2008 to December 2011, 3 patients were treated for a secondary chondrosarcoma from an osteochondroma of the proximal tibia involving the fibula. The operative procedure can be summed up as follows: (1) resection of the tumor including the fibula; (2) preservation of the peroneal nerve and the fibular head; and (3) arthrodesis of the proximal tibiofibular joint. Serial radiological studies showed successful fusion in the proximal tibiofibular joint in all patients. The Musculoskeletal Tumor Society functional scores were excellent in all 3 patients. No patients showed instability of the ipsilateral knee joint in any direction. All 3 patients could return to sports activities. Until the last follow-up, there was no evidence of disease recurrence. We suggest that the operative procedure described in this article would provide satisfactory oncological and functional outcomes.
Arthrodesis ; Chondrosarcoma* ; Fibula* ; Follow-Up Studies ; Head ; Humans ; Joints ; Knee Joint ; Osteochondroma* ; Peroneal Nerve ; Recurrence ; Return to Sport ; Surgical Procedures, Operative ; Tibia*

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Platelet-Derived Growth Factor Receptor-Positive Pericytic Cells of White Adipose Tissue from Critical Limb Ischemia Patients Display Mesenchymal Stem Cell-Like Properties.

Eo Jin KIM ; Sang Gyo SEO ; Hyuk Soo SHIN ; Doo Jae LEE ; Ji Hye KIM ; Dong Yeon LEE

Clinics in Orthopedic Surgery.2017;9(2):239-248. doi:10.4055/cios.2017.9.2.239

BACKGROUND: The pericytes in the blood vessel wall have recently been identified to be important in regulating vascular formation, stabilization, remodeling, and function. We isolated and identified pericyte-like platelet-derived growth factor receptor beta-positive (PDGFRβ+) cells from the stromal vascular fraction (SVF) of adipose tissue from critical limb ischemia (CLI) patients and investigated their potential as a reliable source of stem cells for cell-based therapy. METHODS: De-identified subcutaneous fat tissues were harvested after amputation in CLI patients. Freshly isolated SVF cells and culture-expanded adipose-derived stem cells (ADSCs) were quantified using flow cytometry. A matrigel tube formation assay and multi-lineage differentiation were performed to assess pericytic and mesenchymal stem cell (MSC)-like characteristics of PDGFRβ+ ADSCs. RESULTS: PDGFRβ+ cells were located in the pericytic area of various sizes of blood vessels and coexpressed mesenchymal stem cell markers. PDGFRβ+ cells in freshly isolated SVF cells expressed a higher level of stem cell markers (CD34 and CXCR4) and mesenchymal markers (CD13, CD44, CD54, and CD90) than PDGFRβ– cells. In vitro expansion of PDGFRβ+ cells resulted in enrichment of the perivascular mesenchymal stem-like (PDGFRβ+/CD90+/CD45–/CD31–) cell fractions. The Matrigel tube formation assay revealed that PDGFRβ+ cells were located in the peritubular area. CONCLUSIONS: PDGFRβ+ ADSCs cells demonstrated a good multilineage differentiation potential. Pericyte-like PDGFRβ+ cells from the SVF of adipose tissue from CLI patients had MSC-like characteristics and could be amplified by in vitro culture with preservation of their cell characteristics. We believe PDGFRβ+ cells in the SVF of adipose tissue can be used as a reliable source of stem cells even in CLI patients.
Adipose Tissue ; Adipose Tissue, White* ; Adult Stem Cells ; Amputation ; Blood Vessels ; Extremities* ; Flow Cytometry ; Humans ; In Vitro Techniques ; Ischemia* ; Mesenchymal Stromal Cells ; Pericytes ; Platelet-Derived Growth Factor* ; Receptors, Platelet-Derived Growth Factor ; Stem Cells ; Subcutaneous Fat

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Revision Surgery for Recurrent Pain after Excision of the Accessory Navicular and Relocation of the Tibialis Posterior Tendon.

Hong Joon CHOI ; Woo Chun LEE

Clinics in Orthopedic Surgery.2017;9(2):232-238. doi:10.4055/cios.2017.9.2.232

BACKGROUND: The results of operative treatments for symptomatic accessory navicular are debatable. In some cases, recurrent pain may develop after the Kidner procedure. The purpose of this study is to review the reasons for recurrent pain after the Kidner procedure and to suggest possible options for revision surgery. METHODS: We reviewed the clinical and radiological outcomes in 9 patients who underwent revision surgery for recurrent pain after the Kidner procedure. During the revision surgery, the tibialis posterior tendon was reattached to the navicular either by advancing the tendon in 4 patients or by lengthening the tendon in another 4 patients. In the other 1 patient, the flexor digitorum longus tendon was transferred. Surgeries for the accompanying deformities were performed simultaneously in all patients. The results were evaluated using the American Orthopaedic Foot and Ankle Society ankle-hindfoot score and a visual analog scale. The mean follow-up was 2.3 years (range, 1 to 5 years). RESULTS: The mean American Orthopedic Foot and Ankle Society ankle-hindfoot score improved from 71.25 to 81.50 in the advancement group, and 71.75 to 90.00 in the lengthening group. The mean visual analog scale improved from 7.75 to 4.25 in the advancement group and from 7.50 to 1.75 in the lengthening group. CONCLUSIONS: Recurrent pain after the Kidner procedure was associated with pes planovalgus or hindfoot valgus deformity. In revision surgery, correction of the associated deformities and reattachment of the tibialis posterior tendon after lengthening may need to be considered.
Ankle ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Humans ; Orthopedics ; Tendons* ; Visual Analog Scale

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Measurement Methods for Humeral Retroversion Using Two-Dimensional Computed Tomography Scans: Which Is Most Concordant with the Standard Method?.

Joo Han OH ; Woo KIM ; Angel A CAYETANO

Clinics in Orthopedic Surgery.2017;9(2):223-231. doi:10.4055/cios.2017.9.2.223

BACKGROUND: Humeral retroversion is variable among individuals, and there are several measurement methods. This study was conducted to compare the concordance and reliability between the standard method and 5 other measurement methods on two-dimensional (2D) computed tomography (CT) scans. METHODS: CT scans from 21 patients who underwent shoulder arthroplasty (19 women and 2 men; mean age, 70.1 years [range, 42 to 81 years]) were analyzed. The elbow transepicondylar axis was used as a distal reference. Proximal reference points included the central humeral head axis (standard method), the axis of the humeral center to 9 mm posterior to the posterior margin of the bicipital groove (method 1), the central axis of the bicipital groove –30° (method 2), the base axis of the triangular shaped metaphysis +2.5° (method 3), the distal humeral head central axis +2.4° (method 4), and contralateral humeral head retroversion (method 5). Measurements were conducted independently by two orthopedic surgeons. RESULTS: The mean humeral retroversion was 31.42°± 12.10° using the standard method, and 29.70°± 11.66° (method 1), 30.64°± 11.24° (method 2), 30.41°± 11.17° (method 3), 32.14°± 11.70° (method 4), and 34.15°± 11.47° (method 5) for the other methods. Interobserver reliability and intraobserver reliability exceeded 0.75 for all methods. On the test to evaluate the equality of the standard method to the other methods, the intraclass correlation coefficients (ICCs) of method 2 and method 4 were different from the ICC of the standard method in surgeon A (p < 0.05), and the ICCs of method 2 and method 3 were different form the ICC of the standard method in surgeon B (p < 0.05). CONCLUSIONS: Humeral version measurement using the posterior margin of the bicipital groove (method 1) would be most concordant with the standard method even though all 5 methods showed excellent agreements.
Arthroplasty ; Elbow ; Female ; Humans ; Humeral Head ; Humerus ; Male ; Methods* ; Orthopedics ; Shoulder ; Surgeons ; Tomography, X-Ray Computed

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Acromion Index in Korean Population and Its Relationship with Rotator Cuff Tears.

Dong Ho KUM ; Jun Ho KIM ; Keun Min PARK ; Eun Su LEE ; Yong Bok PARK ; Jae Chul YOO

Clinics in Orthopedic Surgery.2017;9(2):218-222. doi:10.4055/cios.2017.9.2.218

BACKGROUND: Among the many causes of rotator cuff tears, scapular morphology is associated with the accelerating degenerative process of the rotator cuff. Acromion index (AI) was previously introduced and compared in two populations. METHODS: We enrolled 100 Korean patients diagnosed with full-thickness rotator cuff tears by magnetic resonance imaging and intraoperative arthroscopic findings between January and December 2013. Another 100 Korean patients with an intact rotator cuff tendon identified on magnetic resonance imaging and other shoulder diseases, such as frozen shoulder and instability, were enrolled as controls. We retrospectively compared these 100 rotator cuff tear patients (mean age, 63 years) and 100 controls (mean age, 51 years) in this study. Two independent orthopedic surgeons assessed the AI on radiographs. We performed an interobserver reliability test of the AI assessment, and then compared the AI between two groups. RESULTS: The measurement of the AI showed excellent reliability (intraclass correlation coefficient, 0.82). The mean AI in the rotator cuff tear group was 0.68 and it was significantly different between groups (p<0.001, 95% confidence interval). The AI was not related to tear size. CONCLUSIONS: Our study showed that the AI was an effective predictive factor for rotator cuff tears in a Korean population.
Acromion* ; Bursitis ; Humans ; Magnetic Resonance Imaging ; Orthopedics ; Prognosis ; Retrospective Studies ; Rotator Cuff* ; Shoulder ; Surgeons ; Tears* ; Tendons

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Clinical Outcomes and Complications during the Learning Curve for Reverse Total Shoulder Arthroplasty: An Analysis of the First 40 Cases.

Chul Hyun CHO ; Kwang Soon SONG ; Tae Won KOO

Clinics in Orthopedic Surgery.2017;9(2):213-217. doi:10.4055/cios.2017.9.2.213

BACKGROUND: The purpose of this study was to investigate the results and complications during the learning curve of reverse total shoulder arthroplasty (RTSA) for rotator cuff deficiency. METHODS: We retrospectively reviewed the first 40 cases of RTSA performed by a single surgeon. The mean age of patients was 72.7 years (range, 63 to 81 years) and mean follow-up period was 26.7 months (range, 9 to 57 months). Clinical outcomes were evaluated using a visual analog scale (VAS) for pain, the University of California at Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeon (ASES) score, subjective shoulder value (SSV), and active range of motion (ROM). Intraoperative and postoperative complications were also evaluated. RESULTS: The average VAS pain score, UCLA score, ASES score, and SSV improved from 6.9%, 12.8%, 29.0%, and 29.0% before surgery to 1.6%, 27.0%, 73.3%, and 71.5% after surgery, respectively (p < 0.001). The mean forward flexion, abduction, and external rotation improved from 68.0°, 56.9°, and 28.0° before surgery to 131.0°, 112.3°, and 38.8° after surgery, respectively (p < 0.001, p < 0.001, and p = 0.021). However, the mean internal rotation did not improve after surgery (p = 0.889). Scapular notching was observed in 33 patients (51.5%). Eight shoulders (20%) had complications, including 2 major (1 deep infection and 1 glenoid fixation failure) and 6 minor complications (3 brachial plexus injuries, 2 acromial fractures, and 1 intraoperative periprosthetic fracture). CONCLUSIONS: The first 40 cases of RTSA performed by a single surgeon during the learning curve period showed satisfactory short-term follow-up results with an acceptable complication rate.
Arthroplasty* ; Brachial Plexus ; California ; Elbow ; Follow-Up Studies ; Humans ; Learning Curve* ; Learning* ; Postoperative Complications ; Range of Motion, Articular ; Retrospective Studies ; Rotator Cuff ; Shoulder* ; Visual Analog Scale

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The Dimensions of the Scapula Glenoid in Japanese Rotator Cuff Tear Patients.

Yoshiharu SHIMOZONO ; Ryuzo ARAI ; Shuichi MATSUDA

Clinics in Orthopedic Surgery.2017;9(2):207-212. doi:10.4055/cios.2017.9.2.207

BACKGROUND: Reverse total shoulder arthroplasty has become a widely accepted surgical procedure in Japan since the time when the implants were approved for use in 2014. There is a doubt, however, as to whether the implants designed for Western people are suitable for Japanese people, particularly for females of relatively small stature. The purpose of this study was to investigate the glenoid dimension, with special focus on the length after glenoid reaming, in Japanese rotator cuff tear patients. METHODS: Fifty-six shoulders of 55 patients (35 males and 20 females; mean age, 63.8 years) were studied. Using the three-dimensional computed tomography images of the entire scapula before shoulder surgery, we measured the glenoid height and width, and calculated the correlation between these measurements and the patient's height. Further, we measured the anteroposterior length of the scapular neck at the subchondral bone and the length at 15 mm medial to the subchondral bone, to simulate both the glenoid width after reaming (width of the ‘virtual reamed surface’) and the space available for the end of the center post of a standard glenoid baseplate. RESULTS: The average glenoid height and width were 35.8 mm and 28.1 mm in males and 30.8 mm and 23.4 mm in females, respectively. There was a significant correlation between patient height and glenoid size (glenoid height, r = 0.69; width, r = 0.75; p < 0.01). The mean value of the width of the virtual reamed surface was 27.0 mm in males and 22.5 mm in females. The mean anteroposterior length at 15 mm medial to the subchondral bone was 12.4 mm in males and 9.5 mm in females; the length was shorter than 8 mm in 6 female shoulders. CONCLUSIONS: There was a significant correlation between patient height and glenoid size. Considering that the common diameter of the commercially available baseplates and their center posts is greater than 25 mm and 8 mm, respectively, these prosthetic parts would be too large, especially for the Japanese female glenoid. Given that the current results of Japanese shoulder dimensions are similar to those of Asian people, ‘Asian size implants’ should be developed.
Arthroplasty ; Asian Continental Ancestry Group* ; Female ; Glenoid Cavity ; Humans ; Japan ; Male ; Neck ; Rotator Cuff* ; Scapula* ; Shoulder ; Tears*

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Reverse Total Shoulder Arthroplasty: Salvage Procedure for Failed Prior Arthroplasty.

Seong Hwan JO ; Jung Youn KIM ; Nam Su CHO ; Yong Girl RHEE

Clinics in Orthopedic Surgery.2017;9(2):200-206. doi:10.4055/cios.2017.9.2.200

BACKGROUND: To evaluate the clinical outcome of revision of primary shoulder replacement by using reverse total shoulder arthroplasty (RTSA). METHODS: Seven patients underwent revision RTSA with a mean follow-up of 22.1 months (range, 12 to 54 months). Their mean age at the time of operation was 75.5 years (range, 70 to 80 years). Assessments were performed on the preoperative and postoperative visual analogue scale (VAS) score, muscle strength, range of motion, University of California at Los Angeles (UCLA) score, Constant score, subjective satisfaction and the anteroposterior and axillary views of the glenohumeral joint. The primary operation was hemiarthroplasty in 5 patients, total shoulder replacement in 1 patient, and reverse shoulder arthroplasty in 1 patient. The cause of revision surgery was infection in 2 patients, humeral stem loosening in 2 patients, glenoid arthropathy in 2 patients, and glenoid loosening in 1 patient. The mean duration from primary operation to revision surgery was 52 months (range, 27 to 120 months). RESULTS: The VAS score for pain during motion was improved from 7.3 preoperatively to 2.1 postoperatively (p = 0.03). There were increases in the mean active forward flexion (from 62.1° to 92.8°), abduction (from 70° to 87.1°), external rotation (from 44.2° to 47.4°), and internal rotation (from L5 to L4; p > 0.05) postoperatively. Performance in activities of daily living improved (p > 0.05), except for lifting 10 lb above the shoulder (from 1.2 to 1.1; p = 0.434). Overall, 5 of 7 patients were satisfied with the results of revision surgery. The mean Constant score improved from 44.8 preoperatively to 57.1 postoperatively (p = 0.018). The mean UCLA score improved from 12.8 preoperatively to 22.8 postoperatively (p = 0.027). In the postoperative radiological evaluation, no radiolucency was observed around the base plate or humeral stem. CONCLUSIONS: Pain could be reduced after revision RTSA, but improvements in range of motion and function were difficult to achieve. We think that the patients' satisfaction was relatively high despite the low function score due to the preoperative severe pain and marked limitation of range of motion.
Activities of Daily Living ; Arthroplasty* ; California ; Follow-Up Studies ; Hemiarthroplasty ; Humans ; Lifting ; Muscle Strength ; Range of Motion, Articular ; Shoulder Joint ; Shoulder*

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Comparison of the Extent of Degeneration among the Normal Disc, Immobilized Disc, and Immobilized Disc with an Endplate Fracture.

Wonki CHOI ; Sukkyun SONG ; Seungbum CHAE ; Sangbong KO

Clinics in Orthopedic Surgery.2017;9(2):193-199. doi:10.4055/cios.2017.9.2.193

BACKGROUND: This study attempts to prove a cause and effect relationship between spine immobilization following posterior fixation for unstable burst fractures and degeneration observed following hardware removal. METHODS: We enrolled 57 patients (259 intervertebral discs [IVDs]) who underwent only posterior instrumentation without fusion for thoracolumbar and lumbar unstable burst fractures. We arbitrarily named the IVD that has an endplate fracture after immobilization using pedicle screws as the fractured endplate and immobilized disc (FEID), the IVD that has no endplate fracture after immobilization using pedicle screws as the nonfractured endplate and immobilized disc (NFEID), and the IVD that has no endplate fracture and no immobilization instrumentation as the normal disc (ND). At 2 years after implant removal, magnetic resonance imaging (MRI) was performed again for comparison. The extent of disc degeneration was classified using the Pfirrmann classification system. RESULTS: FEIDs were present in 67 levels, NFEIDs in 78 levels, and NDs in 114 levels. According to the Pfirrmann classification, 7.9% of the NDs, 32.1% of the NFEIDs, and 43.3% of the FEIDs were more degenerated at 2 years after implant removal. The FEIDs and NFEIDs were more degenerated than the NDs and the FEIDs were more degenerated than the NFEIDs at statistically significant levels (p < 0.001 for both). CONCLUSIONS: Spine immobilization with transpedicular screws has a significant influence on disc degeneration, and an endplate fracture accelerates the degeneration process.
Classification ; Humans ; Immobilization ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Magnetic Resonance Imaging ; Pedicle Screws ; Spine

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