Formosan Journal of Musculoskeletal Disorders/中華骨科醫學雜誌
- OpenAccess
- Ahead-of-Print
中華民國骨科醫學會,正常發行
選擇卷期
- 期刊
- OpenAccess
Introduction: The treatment of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a challengeable task. Two-stage exchange arthroplasty is a commonly used treatment for chronic PJI. Purpose: The aim of this study was to investigate the successful rate and possible failure risk factors in patients undergoing a planned two-stage exchange arthroplasty for treatment of knee PJI. Methods: From March 2004 to February 2015, we retrospectively reviewed 35 patients have more than 36 months clinical follow-up with periprosthetic knee joint infections. The clinical outcomes were recorded to define the successful or fail treatment for the periprosthetic knee joint infections. Multiple factors such as obesity, comorbidities, diabetes, were recorded and analyzed to evaluate the risk factors of poor outcome. Results: Five patients were unable to receive second stage surgery with cement spacer retained due to variable reasons. Three patients ended with amputation due to uncontrolled infectious process. Overall 27 patients received two-stage exchange arthroplasty to treat knee PJI were analyzed in this study. However, two patients were loss follow-up during the period between 1st and 2nd time surgery. Two patients were treated with static cement spacer due to poor soft tissue condition. These 4 patients were excluded and overall 23 patients were included and analyzed. Overall success rate is 78.26%. 4 patients with recurrent infection were treated with additional surgical debridement. One patient with recurrent infection was treated with the second time two-stage arthroplasty. All of these patients were successful treated without further recurrent infection. Conclusion: We found that failure rate is increasing when considerate the failure between first stage and second stage surgery. In addition, patients without more than 36 months follow-up may have infection free due to honeymoon period but still in risk of reinfection.
- 期刊
- OpenAccess
Background: Traumatic hip dislocation is a usually high-energy injury and often leads to serious intra-articular pathologies. Hip arthroscopy is an increasingly popular minimally invasive procedure for intra-articular conditions. Purpose: This study was designed to review the arthroscopic diagnosis and treatment for mechanic hip symptoms after traumatic hip dislocation and evaluate clinical outcomes. Methods: Seven consecutive patients treated with arthroscopy for mechanical hip symptoms after traumatic hip dislocation between 2005 and 2014 were enrolled in the study. We use Tonnis classification for evaluation of hip osteoarthritis by preoperative and the last follow-up plain radiography. Visual analogue scale (VAS), modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item short-form (SF-12) were obtained for clinical outcome assessment. All patients were followed up for a minimum of 2 years. Results: The average age of the patients when undergoing hip arthroscopy was 32.7 years. The interval from injury to arthroscopy ranged from 3 days to 2 years, with a mean of 353 days. The mean operative time was 165 mins. Loose bodies were found in 6 patients. Four patients had labral tears, five had ligamentum teres lesions and six had chondral injuries at the femoral head or acetabulum. All preoperative clinical functional scores improved at last follow-up. The mean length of postoperative hospital stay was 2.6 days. No patients had surgery-related complication. Conclusion: Hip arthroscopy is a powerful tool to detect loose bodies or intra-articular fragments after traumatic hip dislocation and provides good-to-excellent clinical outcomes. For patients with mechanic hip symptoms after traumatic hip dislocation, early referral for hip arthroscopy surgeon is recommended.
- 期刊
- OpenAccess
Background: Open proximal tibial fractures are associated with significant morbidity due to increased risks of infection, nonunion, malunion, knee stiffness, and possible amputation. Several authors demonstrated the benefits of bridging external fixation followed by definitive internal fixation once the soft-tissue envelope had sufficiently healed. We recently demonstrated the benefits of external locked plating followed by definitive internal fixation. Purpose: The purpose of this study was to evaluate the biomechanical feasibility of definitive external locked plating for open proximal tibial fractures. Methods: Two types of constructs were tested: (1) internal locked plate fixation (ILPF) and (2) external locked plate fixation (ELPF). Specimens were evaluated under static or dynamic axial loading to assess construct stiffness, strength, durability and failure mode. Results: The mean of construct strength of the ILPF and ELPF groups was 2147.4 ± 460.56 N and 793.2 ± 96.78 N, respectively. The mean of construct stiffness of the ILPF and ELPF groups was 384.01 ± 40.37 N/mm and 87.35 ± 7.40 N/mm, respectively. Conclusion: In this study, external locked plating showed biomechanical flexibility and could reduce construct stiffness to promote fracture healing by callus formation. However, ELPF constructs were not as strong as standard locked plating constructs. If we want to use ELPF constructs as definitive treatment, further biomechanical study to improve construct strength is warranted.
- 期刊
- OpenAccess
Background: Patients with patellar malalignment (PM) are common in orthopedic clinics. Conservative treatment first for PM is generally supported. Generally, reinforcing vastus medialis obliquus (VMO) strength is most convincing. Knee extension had been reported to be able to initiate VMO activities in electromyogram (EMG). Also, goosestep training had been reported to be able to upraise VMO/vatus lateralis (VL) ratio in EMG. Purpose: The purpose of this prospective study was to investigate clinical effects of modified knee extension training on treating lateral patellar tilt or subluxation. Methods: Thirty-seven consecutive adult patients (average: 52 years) were treated with modified knee extension training. It was performed once each day and each time needed 50 times (about one minute). Plain knee radiographs of anteroposterior, lateral, and Merchant's axial views were taken before treatment. Exclusion criteria were trochlear dysplasia (＞ 144° of sulcus angle), patellar alta or dislocation, symmetrical mediolateral patellofemoral (P-F) joint space (P-F index = 1), and snapping hips clinically. Ten weeks later, clinical outcome using modified Kujala score (5 items with 40 points) and Merchant's axial radiograph (congruence angle, lateral P-F angle, and P-F index) were compared statistically. Results: All 37 patients with 68 knees (32 bilaterally and 4 unilaterally) were followed at the outpatients' department (OPD) at 10-12 weeks. Before treatment, none of patients were satisfactory (average knee score: 27.2 points). At the latest follow-up, 89% of patients (33/37) were satisfactory (p ＜ 0.001) with an average knee score of 33.1 (p = 0.01). Only the P-F index was statistically significant before and after treatment (3.6 vs. 2.1, p ＜ 0.001) on Merchant's axial radiographs. Conclusion: The described technique may be one of excellent techniques for conservative treatment of PM. The technique is simple and an 89% success rate is relatively acceptable. The P-F index may be practical for follow-up of treatment effect.
- 期刊
- OpenAccess
Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents, and it has a prevalence of 10.8 cases per 100,000 children. SCFE in adults is uncommon, with only 22 cases reported in the literature, and only 10 of them were related to panhypopituitarism. This article presents a 26-year-old man with panhypopituitarism who developed pain in the left hip and knee that proved to be a slipped femoral capital epiphysis, he was treated by in situ pinning and hormone replacement therapy. Most patients with congenital hypopituitarism present at young age when short stature is noted during childhood. This case with normal body height and had no medical care until the presentation of SCFE, which is unusual for hypopituitarism.
- 期刊
- OpenAccess
While iatrogenic neurologic deficits peri-operatively are possible in pediatric scoliosis correction, postoperative deficits are relatively more common in adolescents with early onset scoliosis (EOS) under maximal correction. For early prevention of the spinal cord at risk during surgery, the neurophysiologic intraoperative monitoring (NIOM) plays a critical role. This article will present a case about spinal cord ischemia injury detected by NIOM of a twelve-year-old girl with EOS. The application of NIOM and monitoring the spinal cord ischemia in pediatric scoliosis surgery should be considered essential for surgical quality and patient's safety via early detection of neurophysiologic signals change. In sum, the profession of NIOM should be introduced and promoted into the clinical practice in Taiwan in the future.
- 期刊
- OpenAccess
Fracture of non-modular femoral stem-neck junction failure after total hip arthroplasty is rare. We present a case of 52-year-old man with a fractured metal femoral stem-neck junction in a non-modular total hip replacement. The patient attended to emergency room with a fracture of the prosthetic neck of the femoral metal implant. The patient undergone a revision hip arthroplasty by splitting the femur for broken stem and implanting a new femoral stem with femoral wiring. Ceramic insert placed over the top of the acetabular ring was assembled with cement, and optimal neck length ceramic head was chosen.