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Biomechanical Properties of a New Anatomical Locking Metal Block Plate for Opening Wedge High Tibial Osteotomy: Uniplane Osteotomy

Seung Beom HAN ; Ji Hoon BAE ; Sung Jae LEE ; Tae Gon JUNG ; Kang Hee KIM ; Jae Ho KWON ; Kyung Wook NHA

The Journal of Korean Knee Society.2014;26(3):155-161. doi:10.5792/ksrr.2014.26.3.155

PURPOSE: The purpose of this study was to evaluate the biomechanical properties of a new anatomical locking metal block plate by comparing the initial biomechanical stability of three different fixation constructs for open wedge high tibial osteotomy (HTO). MATERIALS AND METHODS: Sawbones composite tibiae were used to make a 10-mm opening osteotomy model with uniplane technique. The osteotomy was secured with three different types of plates: Group I, new osteotomy plate without a metal block (n=5); Group II, new osteotomy plate with a 10-mm metal block (n=5); and Group III, two short metal block plates (n=5). Single load to failure test and staircase load-controlled cyclical failure test were performed. In the single load to failure test, the yield load, maximum failure load, and the displacement of the osteotomy gap were measured. In the staircase cyclical load to failure test, the total number of cycles to failure was recorded. Failure modes were observed during both single and cyclic load tests. RESULTS: Group II showed the highest yield and ultimate loads (1829+/-319 N, 3493+/-1250 N) compared to Group I (1512+/-157 N, 2422+/-769 N) and Group III (1369+/-378 N, 2157+/-210 N, p<0.05). The displacement of the opening gap in Group II (0.34+/-0.35 mm) was significantly lesser than the other groups (p<0.05). In the staircase cyclical load to failure test, the total number of cycles to failure was 12,860 at 950 N in Group III, 20,280 at 1,140 N in Group I, and 42,816 at 1,330 N in Group II (p<0.05). All the specimens showed complete fracture of the intact lateral sawbones area and slight displacement of the distal fragment of the specimens in the single load to test. None of the specimens showed deformed or broken screws and plates during the single load to test. During the fatigue test with staircase cyclic loading, no fracture of the lateral sawbones area was observed. CONCLUSIONS: This study demonstrated that the new anatomical locking metal block plate could provide sufficient primary stability for open wedge HTO. The addition of a metal block to this new plate can increase the stability of the osteotomy compared to the one without a metal block.
Fatigue ; Knee ; Osteotomy ; Tibia

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Minimum 5-year Follow-up Results of Minimally Invasive Total Knee Arthroplasty Using Mini-Keel Modular Tibial Implant

Ju Hyung YOO ; Byoung Kyu PARK ; Chang Dong HAN ; Hyun Cheol OH ; Sang Hoon PARK

The Journal of Korean Knee Society.2014;26(3):149-154. doi:10.5792/ksrr.2014.26.3.149

PURPOSE: To evaluate the minimum 5-year mid-term clinical and radiological results of minimally invasive surgery total knee arthroplasty (MIS-TKA) using a mini-keel modular tibia component. MATERIALS AND METHODS: We retrospectively evaluated 254 patients (361 cases) who underwent MIS-TKA between 2005 and 2006. The latest clinical and radiological assessments were done in 168 cases that had been followed on an outpatient basis for more than 5 postoperative years. Clinical results were assessed using the Hospital for Special Surgery (HSS) score and Knee Society score. Radiological evaluation included measurements of knee alignment. RESULTS: The average postoperative knee range of motion and HSS score were 134.3degrees+/-12.4degrees and 92.7degrees+/-7.0degrees, respectively. The average postoperative femorotibial angle and tibial component alignment angle were 5.2degrees+/-1.7degrees valgus and 90.2degrees+/-1.6degrees, respectively. The average tibial component posterior inclination was 4.8degrees+/-2.1degrees. The percentage of cases with tibial component alignment angle of 90degrees+/-3degrees was 96.1%, and that with the femorotibial angle of 6degrees+/-3degrees valgus was 94.0%. Radiolucent lines were observed in 20 cases (12.0%): around the femur, tibia, and patella in 14 cases, 10 cases, and 1 case, respectively. However, they were less than 2 mm and non-progressive in all cases. The survival rate was 99.4% and there was no implant-related revision. CONCLUSIONS: MIS-TKA using a mini-keel modular tibial plate showed satisfactory results, a high survival rate, and excellent clinical and radiological results in the mid-term follow-up.
Arthroplasty ; Femur ; Follow-Up Studies ; Humans ; Knee ; Outpatients ; Patella ; Range of Motion, Articular ; Retrospective Studies ; Surgical Procedures, Minimally Invasive ; Survival Rate ; Tibia

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Time-Dependent Clinical Results of Rotating-Platform Total Knee Arthroplasty According to Mechanical Axis Deviation

Han Jun LEE ; Ho Joong JUNG ; Young Bok JUNG ; Young Bong KO ; Min Ku SONG ; Seong Hwan KIM

The Journal of Korean Knee Society.2014;26(3):141-148. doi:10.5792/ksrr.2014.26.3.141

PURPOSE: We hypothesized that the low contact stress (LCS) posterior stabilization system in knees with < or =3degrees deviation of coronal alignment would provide more favorable clinical outcomes and survival rate over the course of time. MATERIALS AND METHODS: A retrospective study was performed on 253 consecutive cases of primary total knee arthroplasty (TKA). Patients were classified according to the degree of deviation of coronal alignment on the initial postoperative radiograph as Group 1 (< or =3degrees deviation) and Group 2 (>3degrees deviation). The clinical assessments were performed using the Knee Society score and Hospital for Special Surgery systems and Western Ontario and McMaster Universities index. RESULTS: The survival rate was 97.4% in Group 1 and 96.8% in Group 2. No statistically significant intergroup difference was observed in the clinical scores before surgery and since 1 year after surgery (p>0.05). However, a significant intergroup difference was noted between 6 months to 1 year after surgery (p<0.001). Less than 2 mm radiolucent lines were found more frequently in Group 2. Time-dependent improvement was noted within one year after TKA in both groups. CONCLUSIONS: Most of the expected improvements were achieved at 6 months after surgery in Group 1 and at 1 year after surgery in Group 2. The present study suggests that the LCS system yields time-dependent improvement regardless of coronal alignment deviation.
Arthroplasty ; Axis, Cervical Vertebra ; Humans ; Knee ; Ontario ; Retrospective Studies ; Survival Rate ; Treatment Outcome

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Total Knee Arthroplasty Using a Posterior Cruciate Ligament Sacrificing Medial Pivot Knee: Minimum 5-year Follow-up Results

Yoon Seok YOUM ; Sung Do CHO ; Seon Ho LEE ; Hye Yong CHO

The Journal of Korean Knee Society.2014;26(3):135-140. doi:10.5792/ksrr.2014.26.3.135

PURPOSE: To evaluate minimum 5-year follow-up clinical and radiological results of total knee arthroplasty (TKA) using a posterior cruciate ligament sacrificing (PS), non-substituting Advance Medial Pivot Knee. MATERIALS AND METHODS: One hundred and twenty knees in 80 patients who could be followed up for more than 5 years after TKA using the PS Advance Medial Pivot Knee were evaluated retrospectively. The evaluations included the preoperative and postoperative range of motion (ROM), tibiofemoral angle, Knee Society (KS) knee and function scores, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. The Kaplan-Meier method was used for survival analysis. RESULTS: The ROM increased from a preoperative mean flexion contracture of 7.6degrees and further flexion of 115.1degrees to a postoperative mean flexion contracture of 1.5degrees and further flexion of 120.5degrees. The tibiofemoral angle was changed from 4.6degrees varus preoperatively to 5.8degrees valgus postoperatively. The KS knee and function scores as well as WOMAC score significantly improved after surgery (p<0.05). Complications developed in 4 cases (3.3%): 2 cases of periprosthetic patellar fracture (1.7%) and 2 cases of aseptic loosening (1.7%). The seven-year survival rate was 98.1% in the Kaplan-Meier survival analysis. CONCLUSIONS: The minimum 5-year follow-up results of TKA using the PS Medial Pivot Knee were satisfactory.
Arthritis ; Arthroplasty ; Contracture ; Follow-Up Studies ; Humans ; Knee ; Ontario ; Posterior Cruciate Ligament ; Range of Motion, Articular ; Retrospective Studies ; Survival Rate

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Medial Meniscus Posterior Root Tear: A Comprehensive Review

Dhong Won LEE ; Jeong Ku HA ; Jin Goo KIM

The Journal of Korean Knee Society.2014;26(3):125-134. doi:10.5792/ksrr.2014.26.3.125

Damage to the medial meniscus root, for example by a complete radial tear, destroys the ability of the knee to withstand hoop strain, resulting in contact pressure increases and kinematic alterations. For these reasons, several techniques have been developed to repair the medial meniscus posterior root tear (MMPRT), many of which have shown complete healing of the repaired MMPRT. However, efforts to standardize or optimize the treatment for MMPRT are much needed. When planning a surgical intervention for an MMPRT, strict surgical indications regarding the effect of pullout strength on the refixed root, bony degenerative changes, mechanical alignment, and the Kellgren-Lawrence grade should be considered. Although there are several treatment options and controversies, the current trend is to repair the MMPRT using various techniques including suture anchors and pullout sutures if the patient meets the indications. However, there are still debates on the restoration of hoop tension and prevention of arthritis after repair and further biomechanical and clinical studies should be conducted in the future. The aim of this article was to review and summarize the recent literature regarding various diagnosis and treatment strategies of MMPRT, especially focusing on conflict issues including whether repair techniques can restore the main function of normal meniscus and which is the best suture technique to repair the MMPRT. The authors attempted to provide a comprehensive review of previous studies ranging from basic science to current surgical techniques.
Arthritis ; Diagnosis ; Humans ; Knee ; Menisci, Tibial ; Suture Anchors ; Suture Techniques ; Sutures

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Baker's Cyst Filled with Hematoma at the Lower Calf

Moon Jib YOO ; Jae Sung YOO ; Ho Seong JANG ; Chang Hwan HWANG

The Journal of Korean Knee Society.2014;26(4):253-256. doi:10.5792/ksrr.2014.26.4.253

Baker's cyst is a distension of the gastrocnemius-semimembranosus bursa of the knee, which communicates with the posterior portion of the joint capsule. Baker's cyst is commonly located in the inferomedial or superficial layers of the knee joint and rarely extends laterally or proximally. Complications of Baker's cysts are dissection, rupture, pseudothrombophlebitis, leg ischemia, nerve entrapment, and compartment syndrome. However, hematomas in the Baker's cyst have not been reported in Korea. We report a rare case of hematoma in the Baker's cyst with subfascial extension into the calf. The hematoma was demonstrated by magnetic resonance imaging and removed by mass excision.
Compartment Syndromes ; Hematoma ; Ischemia ; Joint Capsule ; Knee ; Knee Joint ; Korea ; Leg ; Magnetic Resonance Imaging ; Nerve Compression Syndromes ; Popliteal Cyst ; Rupture

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Localized Pigmented Villonodular Synovitis of the Proximal Tibiofibular Joint

Jae Ho KWON ; Jae Hwi HAN ; Vivian R D ALMEIDA ; Seong Hyun KIM ; Hai Jin PARK ; Kyung Wook NHA

The Journal of Korean Knee Society.2014;26(4):249-252. doi:10.5792/ksrr.2014.26.4.249

Pigmented villonodular synovitis (PVNS) is a rare disease. It is a benign neoplastic process typically affecting young to middle-aged adults and most commonly involving the knee, hip, and shoulder joints. The symptoms include diffuse pain and swelling with discomfort. We report a rare case of localized PVNS originating at the proximal tibiofibular joint in a 39-year-old female patient with radiologic changes for short duration of time. The clinical history, plain radiographs, magnetic resonance imaging, and pathologic findings of the reported patient were reviewed. Complete surgical excision was performed and there was no evidence of recurrence after one-year follow-up.
Adult ; Female ; Follow-Up Studies ; Hip ; Humans ; Joints ; Knee ; Magnetic Resonance Imaging ; Rare Diseases ; Recurrence ; Shoulder Joint ; Synovitis, Pigmented Villonodular

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Comparison of the Modified Transtibial Technique, Anteromedial Portal Technique and Outside-in Technique in ACL Reconstruction

Oog Jin SOHN ; Dong Chul LEE ; Kang Hyun PARK ; Hyo Sae AHN

The Journal of Korean Knee Society.2014;26(4):241-248. doi:10.5792/ksrr.2014.26.4.241

PURPOSE: To compare clinical and radiographic results of anterior cruciate ligament (ACL) reconstruction using modified transtibial technique (mTT), anteromedial (AM) portal technique and outside-in (OI) technique. MATERIALS AND METHODS: From March 2007 to December 2012, ACL reconstruction was performed using the mTT, AM portal technique and OI technique in 20 patients each. Anteroposterior and rotational stability were assessed using the GNRB arthrometer and pivot-shift test. Femoral tunnel obliquity was measured on the anteroposterior and lateral radiographs. RESULTS: Tegner score, Lysholm score, International Knee Documentation Committee score, pivot-shift test were improved at final follow-up in all three groups. However, statistical difference was not shown. Side-to-side difference in GNRB arthrometer was average of 1.4 mm, 1.0 mm and 0.9 mm in mTT, AM and OI group, showing the signicant difference between mTT and AM/OI groups (p<0.001). The mean femoral tunnel obliquity was 56.4degrees in the mTT group, 39.4degrees in the AM group and 33.6degrees in the OI group, showing significant intergroup difference (p<0.001). It showed the significant difference among three groups (p<0.001). CONCLUSIONS: Clinical results were improved in all three groups. Femoral tunnel obliquity in AM and OI were more horizontal on the coronal plane. They are thought to have more benefits in oblique positioning of the grafted ACL in rotational stability; however, there was no significant difference among three techniques in pivot-shift test to assess the rotational stability in this study.
Anterior Cruciate Ligament ; Follow-Up Studies ; Humans ; Knee ; Transplants

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Efficacy of Intra-Articular Injection of Thrombin-Based Hemostatic Agent in the Control of Bleeding after Primary Total Knee Arthroplasty

Ki Cheor BAE ; Chul Hyun CHO ; Kyung Jae LEE ; Eun Seok SON ; Si Wook LEE ; Suk Joong LEE ; Kyung Hwan LIM

The Journal of Korean Knee Society.2014;26(4):236-240. doi:10.5792/ksrr.2014.26.4.236

PURPOSE: To evaluate the hemostatic effect of intraarticular injection of a thrombin-based hemostatic agent in total knee arthroplasty (TKA). MATERIALS AND METHODS: We performed a prospective randomized controlled trial on the use of a thrombin-based hemostatic agent in patients undergoing unilateral TKA. A total of 100 TKA patients were enrolled, with 50 patients randomized into the study group and the other 50 patients into the controlled group. Drain output, hemoglobin level, total red blood cell loss for 24 hours after surgery, transfusion rates, and complications were assessed. RESULTS: Postoperative drain output was 525 mL in the study group and 667 mL in the control group (p=0.01). Nine patients in the study group and eighteen in the control group received blood transfusion (p=0.043). But, there was no significant difference between two groups in terms of hemoglobin level change and total red blood cell loss (p>0.05). CONCLUSIONS: The thrombin-based hemostatic agent demonstrated efficacy in reducing drain output and blood transfusion rates. Thus, we believe the use of a thrombin-based hemostatic agent should be considered as an option in orthopedic surgery that involves massive bleeding.
Arthroplasty ; Blood Transfusion ; Erythrocytes ; Hemorrhage ; Humans ; Injections, Intra-Articular ; Knee ; Orthopedics ; Osteoarthritis ; Prospective Studies

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Proposed Methods for Real-Time Measurement of Posterior Condylar Angle during TKA

Prateek BEHERA ; Devendra Kumar CHOUHAN ; Mahesh PRAKASH ; Mandeep DHILLON

The Journal of Korean Knee Society.2014;26(4):230-235. doi:10.5792/ksrr.2014.26.4.230

PURPOSE: Conventional instruments are known to result in high numbers of outliers in restoring femoral component rotation primarily due to fixed degree of external rotation resection relative to the posterior condylar line (PCL). Outliers can be reduced by determining the patient specific posterior condylar angle (PCA) preoperatively or intraoperatively. There is a paucity of methods that can be used during surgery for determining the PCA. We propose two simple, real-time methods to determine the PCA and hence to measure the axial anatomical variation during surgery. MATERIALS AND METHODS: The study was conducted using axial computed tomography (CT) scans of the knees of 26 patients. The commercial software K-PACS and our proposed two methods (trigonometric and protractor) were used to measure the angle between the transepicondylar axis and PCL, i.e., PCA. Statistical comparison between the mean angles obtained by K-PACS and our methods were done. RESULTS: The three methods resulted in similar PCAs. The mean PCA measured by the three methods were similar. The mean PCA value measured by the K-PACS, trigonometric method and protractor method was 6.27degrees (range, 0degrees to 12degrees), 6.23degrees (range, 0degrees to 11.11degrees) and 6.31degrees (range, 0degrees to 12degrees), respectively. There were significant correlations between the K-PACS measured PCA and trigonometrically or protractor measured PCA. CONCLUSIONS: Our novel, simple, easily reproducible, real-time and radiation-free PCA measurement methods obviate the need for preoperative CT scan for identification of patient specific PCA.
Arthroplasty ; Axis, Cervical Vertebra ; Humans ; Knee ; Osteoarthritis ; Passive Cutaneous Anaphylaxis ; Tomography, X-Ray Computed

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