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Medical Treatment of Ankylosing Spondylitis.

Hip & Pelvis.2014;26(3):129-135. doi:10.5371/hp.2014.26.3.129

The diagnosis of ankylosing spondylitis is often delayed due to ambiguous clinical manifestations and strict diagnostic criteria. However, imaging techniques such as magnetic resonance imaging have been found effective for the early diagnosis of non-radiographic sacroiliitis. New tumor necrosis factor alpha (TNF-alpha) inhibitors have good efficacy for patients with persistently high disease activity despite conventional nonsteroidal anti-inflammatory drug treatment. Thus, early diagnosis and aggressive treatments are essential for ankylosing spondylitis patients. Because many patients complain of musculoskeletal pains, especially around the sacroiliac joint area, hip specialists should be informed of up-to-date knowledge. In this review, we discuss new diagnostic criteria for ankylosing spondylitis, administration methods of TNF-alpha inhibitors, and the long-term follow-up results for patients treated with TNF-alpha inhibitors.
Diagnosis ; Early Diagnosis ; Follow-Up Studies ; Hip ; Humans ; Magnetic Resonance Imaging ; Musculoskeletal Pain ; Sacroiliac Joint ; Sacroiliitis ; Specialization ; Spondylitis, Ankylosing* ; Tumor Necrosis Factor-alpha

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Acetabular Insufficiency Fracture Following Prolonged Alendronate Use and the Failure of Total Hip Arthroplasty in “Frozen” Bone: Two Cases Report.

Sang Joon KWAK ; Yoon Je CHO ; Gwang Young JUNG ; Joo Hyun LEE ; Young Soo CHUN ; Kee Hyung RHYU

Hip & Pelvis.2017;29(4):286-290. doi:10.5371/hp.2017.29.4.286

Atypical insufficiency fracture of the femur following prolonged bisphosphonate use is well described. Regardless of the cause, insufficiency fracture of the acetabulum is extremely rare, and no reports have described insufficiency fractures of the acetabulum that are associated with prolonged bisphosphonate use. This report demonstrates the possibility of insufficiency fracture at the acetabulum following long-term alendronate use and the necessity of particular care in managing insufficiency fractures in “frozen” bone. We describe two cases of insufficiency fracture of the acetabulum following 6 years of alendronate use. Given the patients' medical histories and bone biopsy findings, these insufficiency fractures were thought to be attributable to alendronate use. One case involved the left hip and the presence of pelvic fractures on the opposite side. The patient was treated using cementless total hip arthroplasty (THA), which failed 1 year after surgery. The hip was revised with a massive bone graft and a supportive wire mesh. The other case was managed via THA with a Ganz reinforcement ring due to concerns regarding the use of a cementless implant.
Acetabulum* ; Alendronate* ; Arthroplasty, Replacement, Hip* ; Biopsy ; Femur ; Fractures, Stress* ; Hip ; Humans ; Transplants

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Primary Total Hip Arthroplasty Using Summit® Stems in Korean: Minimum Four-year Follow-up.

Jae Sik YOON ; Joon Sun KANG ; Kyoung Ho MOON

Hip & Pelvis.2017;29(4):228-233. doi:10.5371/hp.2017.29.4.228

PURPOSE: The aim of this study was to assess the mid-term results of primary cementless total hip arthroplasty (THA) using Summit® stems. MATERIALS AND METHODS: One hundred twenty-eight arthroplasties in 121 patients who were performed THA from December 2004 to March 2013, were reviewed retrospectively a minimum of 4 years follow-up (mean age, 60.3 years; mean postoperative follow up period, 86.3 months). For a clinical evaluation, the Harris hip score (HHS) was used to assess outcome. Radiographic evaluation was done through spot welds, subsidence, stress shielding, canal filling. RESULTS: The mean HHS was 69.8 points preoperatively, and it improved significantly to 96.3 points at the final follow-up. Postoperatively, 10 patients experienced thigh pain and 7 patients showed a moderate limping gait. There was not only early stem subsidence but there was no more subsidence at last follow up. One hundred eighteen hips showed radiographic signs of stem bone ingrowth, and 10 hips showed fibrous ingrowth at the last follow-up. Stress shielding occurred in 85 hips and third degree stress shielding was observed in 6 hips. Complication arose in 10 hips due to dislocation. Although revisions due to recurrent dislocations led to acetabular component revision in one hip, no revisions arose due to isolated aseptic loosening of the femoral component. CONCLUSION: The clinical and radiological mid-term results of primary THA using Summit® stems revealed solid initial fixation and bone ingrowth stable fixation. Considering the satisfactory clinical results, Summit® stems may be a good treatment option in Korean patients who were required hip arthroplasty
Acetabulum ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Dislocations ; Femur ; Follow-Up Studies* ; Gait ; Hip ; Humans ; Retrospective Studies ; Thigh

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Results of Total Hip Arthroplasty with 36-mm Metallic Femoral Heads on 1st Generation Highly Cross Linked Polyethylene as a Bearing Surface in Less than Forty Year-old Patients: Minimum Ten-year Results.

Won Kee CHOI ; Jae Jung KIM ; Myung Rae CHO

Hip & Pelvis.2017;29(4):223-227. doi:10.5371/hp.2017.29.4.223

PURPOSE: We evaluated long-term clinical and radiographic results in patients underwent primary total hip arthroplasty (THA) using 36-mm metallic femoral head and 1st generation highly cross-linked polyethylene among patients aged 40 years and less, with minimum 10 years follow-up. MATERIALS AND METHODS: We retrospectively reviewed 20 hips underwent primary THA by one hip surgeon using 36-mm femoral head and 1st generation highly cross-linked polyethylene from 2004 to 2006. Mean follow up was 131.55 months. Clinical follow-ups included functional measurements. And we evaluated post operative complications, prosthesis loosening, failure, and osteolysis. For radiologic evaluations, together with position of acetabular cup at 6 weeks later of postoperation, we separately calculated the penentrations of femoral heads into polyethylene liners during postoperation and one year later check-ups, and during one year later check-ups and final check-ups. Polywear pro3D 5.10 software was used to measure penetrations of femoral head. RESULTS: Mean acetabular cup inclination and anteversion were 49.02° and 10.19°, respectively. Mean thickness of the polyethylene liner at 45° was 6.44 mm. There were no major complications such as implant loosening or osteolysis, and one case of dislocation occurred. Average modified Harris hip score at final follow-up was 91, and Merle d'Aubigne and Postel scores 15 were or over. Average femoral head penetration of bedding wear was 0.170±0.039 mm/year. Steady-state wear rates was 0.059±0.006 mm/year. CONCLUSION: Results of THA with 36-mm metallic femoral heads on 1st generation highly cross linked as a bearing surface in less than 40 year-old patients were satisfactory.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Dislocations ; Follow-Up Studies ; Head* ; Hip ; Humans ; Osteolysis ; Polyethylene* ; Prosthesis Failure ; Retrospective Studies

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Diagnosis and Treatment of Inflammatory Joint Disease.

Yeesuk KIM ; Hyun Cheol OH ; Jang Won PARK ; In Sung KIM ; Jun Young KIM ; Ki Choul KIM ; Dong Sik CHAE ; Woo Lam JO ; Joo Hyoun SONG

Hip & Pelvis.2017;29(4):211-222. doi:10.5371/hp.2017.29.4.211

Arthritis damages the cartilage within joints, resulting in degenerative changes, including loss of function and joint instability. Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the spine and bone-to-tendon attachment area within the sacroiliac joint leading to back pain and progressive spinal stiffness. In the final stages, AS causes hyperkyphosis-a condition closely tied to the human leukocyte antigen-B27 gene. Rheumatoid arthritis is a chronic, systemic autoimmune disease characterized by the simultaneous inflammation of the synovium of multiple joints, leading to joint damage (e.g., destruction, deformation and disability). In the past, nonsteroidal anti-inflammatory drugs or conventional disease-modifying antirheumatic drug (DMARDs) have been used for the treatment of these autoimmune diseases, but biologic DMARDs have recently been introduced with excellent results. Gout is a chronic inflammatory disease that causes an alteration of joints resulting in severe pain. Specifically, gout is associated with an accumulation of uric acid within the body resulting from dysregulated purine metabolism, causing recurrent paroxysmal inflammation in the joints. Allopurinol and febuxostat are the primary treatment options for individuals with gout. It is necessary to have an accurate understanding of the pathogenesis, pathological ecology and treatment of AS, rheumatoid arthritis, and gouty arthritis, which are the representative diseases that may cause inflammatory arthritis.
Allopurinol ; Antirheumatic Agents ; Arthritis ; Arthritis, Gouty ; Arthritis, Reactive ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Back Pain ; Cartilage ; Diagnosis* ; Ecology ; Febuxostat ; Gout ; Humans ; Inflammation ; Joint Diseases* ; Joint Instability ; Joints* ; Leukocytes ; Metabolism ; Sacroiliac Joint ; Spine ; Spondylitis, Ankylosing ; Synovial Membrane ; Uric Acid

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Superior Gluteal Artery Injury during Percutaneous Iliosacral Screw Fixation: A Case Report.

Suk KANG ; Phil Hyun CHUNG ; Jong Pil KIM ; Young Sung KIM ; Ho Min LEE ; Gyeong Soo EUM

Hip & Pelvis.2015;27(1):57-62. doi:10.5371/hp.2015.27.1.57

Percutaneous iliosacral screw fixation is commonly practiced to treat unstable posterior pelvic ring injuries. The number of reported cases of iatrogenic complications is increasing. We present a case of superior gluteal artery injury during bilateral percutaneous iliosacral screw fixation in a patient with sacral fracture of spino-pelvic dissociation. This complication was managed by arterial embolization. We discussed the cause, prevention and treatment of arterial injury along with a review of literature.
Arteries* ; Humans

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Simultaneous Bilateral Fracture of Femoral Neck in Korea: A Case Report.

Jai Hyung PARK ; Hwa Jae JEONG ; Hun Kyu SHIN ; Eugene KIM ; Taeg Su KO ; Young Min CHOI

Hip & Pelvis.2015;27(1):53-56. doi:10.5371/hp.2015.27.1.53

Unilateral femoral neck factures are common and their incidence is increasing. However, simultaneous bilateral femoral neck fractures are rare. Although cases of simultaneous bilateral femoral neck fractures have been reported, most were caused by strong muscle contractions during electroconvulsive therapy. Simultaneous bilateral femoral neck fractures caused by a simple fall are an extremely rare injury; therefore, limited literature is available, and no case has been reported in Korea. We report herein a case of simultaneous bilateral femoral neck fractures caused by a simple fall. An 83-year-old woman visited the emergency department with bilateral hip joint pain and gait disturbance, which developed 1 day after a fall. Tenderness and severe limitation in left hip joint range of motion and mild limitation in right hip joint range of motion were observed on a physical examination. A Garden type IV femoral neck fracture in the left hip joint and a Garden type I femoral neck fracture in the right hip joint were observed on plain radiography. She underwent right screw fixation and left bipolar hemiarthroplasty 2 days after admission. The patient could walk using a walker 4 weeks postoperatively. Bone union in the right femoral neck was observed at the 3 month follow-up. No specific findings were observed at the left hip hemiarthroplasty site.
Aged, 80 and over ; Electroconvulsive Therapy ; Emergency Service, Hospital ; Female ; Femoral Neck Fractures ; Femur Neck* ; Follow-Up Studies ; Gait ; Hemiarthroplasty ; Hip ; Hip Joint ; Humans ; Incidence ; Korea ; Muscle Contraction ; Physical Examination ; Radiography ; Range of Motion, Articular ; Walkers

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Unusual Cause of Hip Pain: Intrusion of the Acetabular Labrum.

Se Ang JANG ; Young Ho CHO ; Young Soo BYUN ; Dae Geun JEONG ; In Ho HAN ; Min Guek KIM

Hip & Pelvis.2015;27(1):49-52. doi:10.5371/hp.2015.27.1.49

Femoroacetabular impingement and dysplatic hip joint is well known cause of osteoarthritis. In these diseases, labral tear and subsequent cartilage damage is thought to be main pathophysiology of development of osteoarthritis. If there are no known bony abnormalities, we called it as idiopathic osteoarthritis. Normal appearance of acetabular labrum is a continuous, usually triangular structure that attaches to the bony rim of the acetabulum and is completed at the inferior portion by the transverse acetabular ligament over the acetabular notch. A few authors reported intra-articular labrum and its relation to the development of osteoarthritis. But they didn't comment the primary bony abnormality especially acetabulum. We'd like to report x-ray, computed tomogram, magnetic resonance arthrogram and arthroscopic findings of a case had double contour sign of acetabular dome combined with intrusion of acetabular labrum.
Acetabulum* ; Cartilage ; Femoracetabular Impingement ; Hip Joint ; Hip* ; Ligaments ; Osteoarthritis

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Arthroscopic Resection of Osteochondroma of Hip Joint Associated with Internal Snapping: A Case Report.

Heung Tae JUNG ; Deuk Soo HWANG ; Yoo Sun JEON ; Pil Sung KIM

Hip & Pelvis.2015;27(1):43-48. doi:10.5371/hp.2015.27.1.43

A 16-year old male patient visited the hospital complaining of inguinal pain and internal snapping of right hip joint. In physical examination, the patient was presumed to be diagnosed femoroacetabular impingement (FAI) and acetabular labral tear. In radiologic evaluation, FAI and acetabular labral tear were identified and bony tumor associated with internal snapping was found on the posteromedial portion of the femoral neck. Despite of conservative treatment, there was no symptomatic improvement. So arthroscopic labral repair, osteoplasty and resection of bony tumor were performed. The tumor was pathologically diagnosed as osteochondroma through biopsy and all symptoms improved after surgery. There was no recurrence, complication or abnormal finding during 1 year follow up. Osteochondroma located at posteromedial portion of femoral neck can be a cause of internal snapping hip and although technical demands are challenging, arthroscopic resection can be a good treatment option.
Acetabulum ; Arthroscopy ; Biopsy ; Femoracetabular Impingement ; Femur Neck ; Follow-Up Studies ; Hip ; Hip Joint* ; Humans ; Male ; Osteochondroma* ; Physical Examination ; Recurrence

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Changes in Tip-Apex Distance by Position and Film Distance Measured by Picture Archiving and Communication System (PACS).

Kyu Yeol LEE ; Sung Soo KIM ; Hyeon Jun KIM ; Dong Ho HA ; Hyung Min YOON ; Hyun Su DO

Hip & Pelvis.2015;27(1):36-42. doi:10.5371/hp.2015.27.1.36

PURPOSE: The tip-apex distance (TAD) is used to predict the clinical outcome of intertrochanteric fracture fixation. We aimed to measure the changes in TAD by position and film distance using Picture Archiving and Communication System (PACS). MATERIALS AND METHODS: We used a femur replica with a 10degrees femoral neck anteversion and a 130degrees neck shaft angle. Proximal femoral nail antirotation nail and a helical blade were inserted into the replica. Radiographs were taken at the neutral position and after applying 10degrees, 20degrees, 30degrees, 40degrees internal/external rotation, 10degrees abduction, and 10degrees and 40degrees adduction to the mechanical axis. Radiographs were taken at the replica-film distance of 10 cm and 20 cm under the same conditions, mimicking the differences in Focus-film distance (FFD), which reflect the patient's contour in clinical settings. A radiologist and an orthopedic surgeon measured the TAD twice using PACS. The average error was 2 mm (4.5%) and the standard error was +/-3.04. TADs in the neutral position constituted the standard values to measure the relative errors. RESULTS: TADs increased with an increase in the external rotation and abduction of the replica. TADs decreased with an increase in the internal rotation and adduction of the replica. For comparable measurements, relative errors were higher at FFDs of 20 cm compared to FFDs of 10 cm. CONCLUSION: Since the femur is internally rotated and adducted for reduction, orthopedic surgeons would assess the lag screw to be closer to the apex of femur on intraoperative radiographs. To have a correct measurement of the TAD after fixation of intertrochanteric fractures, radiographs should be taken in neutral position and measurement errors should be considered based on the patient's size.
Axis ; Femur ; Femur Neck ; Fracture Fixation ; Hip Fractures ; Neck ; Orthopedics

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