Which Osteotomy for Osteonecrosis of the Femoral Head and Which Patient for the Osteotomy?

Transtrochanteric curved varus osteotomy (TCVO) and transtrochanteric rotational osteotomy (TRO) are joint-preserving procedures for osteonecrosis of the femoral head. The purpose of this review is to provide up-to-date guidelines for the osteotomies. One retrospective comparison revealed that TCVO has shorter operation time, less bleeding, lower incidence of osteophyte formation, and lower rate of secondary collapse. To obtain successful results of the osteotomy, the patient should be younger than 40 years and should have a body mass index of less than 24 kg/m2. The osteotomy should be performed in early stages of femoral head osteonecrosis before marked collapse of the femoral head. The patient should have a medium-size lesion and an enough viable bone to restore the intact articular surface and subchondral bone in the weight-bearing area

A case of idiopathic isolated hypoglossal nerve palsy in a Korean child

Hypoglossal nerve palsy (HNP) is an uncommon neurological abnormality that can provoke characteristic clinical signs, including unilateral atrophy of the tongue musculature. We present the case of a healthy 11-year-old Korean male who was admitted to the outpatient department of our institution with acute onset dysarthria, tongue fasciculations, and right-sided tongue weakness upon awakening. His evaluation included a virology work-up, neck magnetic resonance imaging (MRI), brain MRI, and otorhinolaryngological physical examination; all tests were normal and showed no evidence of inflammation. Fifteen days after the onset of symptoms, the patient recovered completely. Herein, we report a case of idiopathic isolated HNP in a Korean male

Natural progress of D-dimer following total joint arthroplasty: a baseline for the diagnosis of the early postoperative infection

Background Early detection followed by prompt intervention is essential for the treatment of periprosthetic joint infection (PJI). D-dimer, a fibrin degradation product, characteristically changes rapidly during early postoperative period and has a short half-life. The aim of this prospective study was to measure postoperative change of D-dimer level after joint arthroplasty in conjunction with ESR and CRP. Methods ESR, CRP, and D-dimer levels were measured on the day before surgery, postoperative days 1, 2, 3, and 5 and weeks 2 and 6 in 65 patients who underwent elective primary total hip arthroplasty (38 hips in 38 patients) or total knee arthroplasty (27 knees in 27 patients). We compared perioperative changes of the three biomarkers. Results ESR level was elevated from postoperative day 1 and reached a peak level of 45 mm/h at postoperative day 5. The elevation persisted until postoperative week 6. CRP level was elevated from postoperative day 1 and reached a peak level of 10 mg/dl between postoperative day 2 and day 3. The CRP level was decreased to the normal level around postoperative week 2. D-dimer level was sharply elevated and peaked to 4.5 μg/dl at postoperative day 1. At postoperative day 2, it decreased to baseline level. After then, it slowly elevated again and reached a second peak at postoperative week 2. Conclusion D-dimer showed a more rapid rise and fall than ESR and CRP in very early postoperative period. The D-dimer test might be effective in early detection of PJI, if combined with levels of ESR and CRP. The postoperative change of D-dimer in our study can serve as a baseline for early diagnosis of PJI.This study was supported by Corentec (Cheonan, South Korea)

Burden and future projection of revision Total hip Arthroplasty in South Korea

Background The annual number of hip arthroplasties is increasing combined with the aging population worldwide. In accordance with the increasing number of primary hip arthroplasties, the number of revision total hip arthroplasties (THAs) is expected to increase. The incidence and burden of revision THAs in the United States and have been reported by registry studies. To identify potential differences according to ethnics and regional practice, it is important to obtain data from East Asia. Nevertheless, there has been a lack of studies on the burden and future projection of revision THA based on a large-scale database in East Asia. The purpose of this study was to evaluate annual incidence and burden of revision THAs and to project the future burden in South Korea. Methods We identified primary THAs, primary hemiarthroplasties (HAs) and revision THAs, which were performed from 2010 to 2018, using database of Health Insurance and Review and Assessment (HIRA); nation-wide medical claim system of South Korea. The annual incidence rates (per 100,000) of primary THA, primary HA and revision THA, and the annual burden of revision THA; the number of revision THAs divided by the sum of primary hip arthroplasties and revision THAs, were calculated. The future burden of revision THAs were projected through 2030 using generalized linear model with Quasi-poisson regression. Results During the 9-year period, the annual incidences of primary THA, primary HA and revision THA increased by 47, 29 and 3%, respectively, while the revision burden decreased from 0.13 to 0.10. Compared to 2018, the annual incidences of primary THA, HA, and revision THA were projected to increase by 7.2, 2.3 and 1.1% per year, respectively, whereas the burden of revision THA was projected to decrease to 0.07 in 2030. Conclusion Trends of revision THA in South Korea were similar with those of national registry studies from the United States. The annual incidence of revision THA has steadily increased, whereas its burden has decreased. Findings of our study could be used for epidemiological comparison between Western countries and East Asia as well as for the establishment of medical policies of revision THA in East Asian countries.This study was funded by a grant of the Korea Health Technology R&D funded by the Ministry of Health & Welfare, Republic of Korea [grant number: HI18C0284]. The role of the funding by grant was in the access to and the analysis of the database

Effects of Age and Body Mass Index on the Results of Transtrochanteric Rotational Osteotomy for Femoral Head Osteonecrosis

Background: Advanced-stage osteonecrosis and a large area of necrotic bone are known risk factors for failure of transtrochanteric rotational osteotomy of the hip in patients with osteonecrosis. The purpose of this study was to determine whether there are other risk factors for failure of this osteotomy. Methods: One hundred and five patients (113 hips) underwent an anterior transtrochanteric rotational osteotomy for the treatment of femoral head osteonecrosis and were followed for a mean of 51.3 months postoperatively. Radiographic failure was defined as secondary collapse or osteoarthritic change. Multivariate analysis was performed to assess factors associated with secondary collapse and osteophyte formation. The Kaplan-Meier product-limit method was used to estimate survival. Results: Secondary collapse occurred in twenty-seven hips (24%), and fourteen hips (12%) were converted to a total hip arthroplasty. At the time of the most recent follow-up, the hip scores according to the system of Merle d`Aubigne et al. ranged from 6 to 18 points (mean, 15.8 points). Multivariate analysis showed that the stage of the necrosis (III or greater) (hazard ratio = 3.28; 95% confidence interval = 1.49 to 7.24), age of the patient (forty years or older) (hazard ratio = 1.08; 95% confidence interval = 1.02 to 1.14), body mass index ( >= 24 kg/m(2)) (hazard ratio = 1.19; 95% confidence interval = 1.03 to 1.38), and extent of the necrosis (a combined necrotic angle of >= 230 degrees) (hazard ratio = 1.08; 95% confidence interval = 1.04 to 1.11) were associated with secondary collapse. Seven of the eighty-six hips without collapse showed progression to osteoarthritis. The survival rate at 110 months was 63.4% (95% confidence interval 51.1% to 75.7%) with total hip arthroplasty or radiographic failure as the end point and 56.0% (95% confidence interval 44.6% to 67.4%) with total hip arthroplasty, radiographic failure, or loss to follow-up as the end point. Conclusions: Our study showed that age, body mass index, and the stage and extent of the osteonecrosis were determining factors for secondary collapse, unsatisfactory clinical results, and conversion to total hip arthroplasty. These factors should be considered when selecting patients for a transtrochanteric rotational osteotomy. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.Nam KW, 2008, J BONE JOINT SURG AM, V90A, P477, DOI 10.2106/JBJS.F.01582Kearns SR, 2006, CLIN ORTHOP RELAT R, P103, DOI 10.1097/01.blo.0000238868.22852.ddHa YC, 2006, J BONE JOINT SURG AM, V88A, P35, DOI 10.2106/JBJS.F.00535Yoo JJ, 2006, J BIOMED MATER RES B, V78B, P70, DOI 10.1002/jbm.b.30457Jacobsen S, 2004, OSTEOARTHR CARTILAGE, V12, P692, DOI 10.1016/j.joca.2004.05.010.Daniel J, 2004, J BONE JOINT SURG BR, V86B, P177, DOI 10.1302/0301-620X.86B2.14600Hisatome T, 2004, ARCH ORTHOP TRAUM SU, V124, P77, DOI 10.1007/s00402-003-0610-0Flugsrud GB, 2002, ARTHRITIS RHEUM, V46, P675, DOI 10.1002/art.10115Nishii T, 2002, J ORTHOPAED RES, V20, P130Koo KH, 2001, J BONE JOINT SURG BR, V83B, P83HOUGAARD P, 2000, ANAL MULTIVARIATE SUInao S, 1999, CLIN ORTHOP RELAT R, P141Steinberg ME, 1999, CLIN ORTHOP RELAT R, P262Langlais F, 1997, CLIN ORTHOP RELAT R, P110Smith SW, 1996, J BONE JOINT SURG AM, V78A, P1702KIM YH, 1995, CLIN ORTHOP RELAT R, P73HOLMAN AJ, 1995, J RHEUMATOL, V22, P1929HOUGAARD P, 1995, LIFETIME DATA ANAL, V1, P255DEAN MT, 1993, J BONE JOINT SURG BR, V75, P597SUGANO N, 1992, J BONE JOINT SURG BR, V74, P734KATZ RL, 1992, CLIN ORTHOP RELAT R, P145SUGIOKA Y, 1992, CLIN ORTHOP RELAT R, P111SAITO S, 1989, CLIN ORTHOP RELAT R, P198TOOKE SMT, 1987, CLIN ORTHOP RELAT R, P150FICAT RP, 1985, J BONE JOINT SURG BR, V67, P3CORNELL CN, 1985, ORTHOP CLIN N AM, V16, P757PARFITT AM, 1984, CALCIFIED TISSUE INT, V36, pS123TOTTY WG, 1984, AM J ROENTGENOL, V143, P1273SUGIOKA Y, 1978, CLIN ORTHOP RELAT R, P191SWEZEY RL, 1976, RHEUMATOL REHABIL, V15, P10KERBOUL M, 1974, J BONE JOINT SURG BR, VB 56, P291MERLEDAUBIGNE R, 1965, J BONE JOINT SURG B, V47, P612KAPLAN EL, 1958, J AM STAT ASSOC, V53, P457

Isolated fracture of the ceramic head after third-generation alumina-on-alumina total hip arthroplasty

BACKGROUND: While most reports of component fracture following alumina-on-alumina total hip arthroplasty have involved the acetabular liner, few have involved fracture of the alumina femoral head. In the present multicenter study, we investigated ceramic head fractures in a cohort of patients who underwent third-generation alumina-on-alumina total hip arthroplasty. METHODS: We performed a retrospective study of 312 patients (367 hips) who underwent alumina-on-alumina total hip arthroplasty without cement at four participating centers with the use of a 28-mm BIOLOX forte femoral head and a BIOLOX forte liner from July 2001 to October 2003. Three hundred and five patients (359 hips) were evaluated at a mean of forty-five months postoperatively. Clinical follow-up with use of the Harris hip score and radiographic evaluation were performed at six weeks; at three, six, and twelve months; and every six months thereafter. Retrieved ceramic implants were examined by means of visual inspection. RESULTS: Five hips (1.4%) in five patients were revised because of a ceramic head fracture during the follow-up period. The ceramic head fractures occurred during normal daily activities at a mean of 22.6 months postoperatively. A short neck had been used in all five hips in which a fracture occurred, compared with 121 (34.2%) of the 354 hips in which a fracture did not occur (p = 0.009). The fracture involved a circular crack along the circumference of the thinnest portion of the head component at the proximal edge of the bore. The fracture also involved multiple vertical cracks extending radially along the longitudinal axis from the circumference of the circular crack line to the lower edge of the head component. CONCLUSIONS: In the present study, the rate of ceramic head fracture associated with one design of a short-neck modular alumina femoral head was 1.4% (five of 359). The extent to which these findings are generalizable to other designs that utilize this type of femoral head is unknown

Fate of untreated asymptomatic osteonecrosis of the femoral head

BACKGROUND: Magnetic resonance imaging has made it possible to detect asymptomatic lesions of osteonecrosis of the femoral head before abnormalities appear on plain radiographs. The extent of a necrotic lesion is known to be an important prognostic factor. In this study, we evaluated the fate of untreated asymptomatic osteonecrosis of the femoral head with an emphasis on the size of the lesion. We hypothesized that a lesion smaller than a certain size would not progress to symptomatic disease. METHODS: One hundred and five initially asymptomatic hips of patients with bilateral nontraumatic osteonecrosis of the femoral head who had been followed without any treatment for at least five years or until pain developed were enrolled in this study. The extent of a lesion was estimated according to the area of the lesion based on a two-dimensional analysis on magnetic resonance images or on plain radiographs at the time of diagnosis. RESULTS: Sixty-two hips became symptomatic, and forty-three hips remained asymptomatic for more than five years (average, eight years and seven months). Of the twenty-one hips with a small necrotic lesion (50% of the area of the femoral head), fifty became painful. Forty-six of the sixty-two hips that became symptomatic required surgery. Pain developed within five years after the diagnosis in fifty-eight (94%) of the sixty-two symptomatic hips. CONCLUSIONS: No treatment appears to be necessary for asymptomatic necrotic lesions with an area smaller than 30% of the femoral head, as the vast majority of these lesions will remain asymptomatic for more than five years

How does the multidimensional frailty score compare with grip strength for predicting outcomes after hip fracture surgery in older patients? A retrospective cohort study

Background Frailty and low handgrip strength (HGS) are associated with adverse outcomes after hip fracture (HF) surgery. We aimed to compare the predictive role of frailty and HGS for adverse outcome in HF patients. Methods We included older patients (age ≥ 65 years) who underwent HF surgery to compare the predictive role of HGS and hip-multidimensional frailty score (Hip-MFS) for postoperative complications and mortality. The Hip-MFS was calculated based on comprehensive geriatric assessment (CGA), and HGS was measured with a hand dynamometer. The primary outcome was a composite of postoperative complications (e.g., pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission). The secondary outcomes were 6-month mortality and mortality at the end of follow-up. Results The median observation time was 620.5 days (interquartile range: 367.0–784.8 days). Among the 242 patients (mean age: 81.5 ± 6.7 years, 73.1% women), 106 (43.8%) experienced postoperative complications. The 6-month mortality and mortality at the end of follow-up were 7.4% (n = 18) and 20.7% (n = 50), respectively. The Hip-MFS (odds ratio [OR], 1.250; 95% confidence interval [CI], 1.092–1.432) and HGS (OR, 1.147; 95% CI, 1.082–1.215) could predict postoperative complications. The Hip-MFS could predict both 6-month mortality (hazard ratio [HR], 1.403; 95% CI, 1.027–1.917) and mortality at the end of follow-up (HR, 1.493; 95% CI, 1.249–1.769) after adjustment, while HGS was only associated with mortality at the end of follow-up (HR, 1.080; 95% CI, 1.024–1.139). For mortality at the end of follow-up, predictive models with the Hip-MFS were superior to those with HGS in the time-dependent receiver-operating curve analysis after adjustment (p = 0.017). Furthermore, the addition of Hip-MFS or HGS to the American Society of Anesthesiologists (ASA) classification improved its prognostic ability. Conclusions Both the Hip-MFS and HGS could predict postoperative complications and improve prognostic utility when combined with the ASA classification. The Hip-MFS was a stronger predictor of mortality than HGS after HF surgery. HGS could be a useful pre-screening tool to identify patients at a high risk of postoperative complications and those who may benefit from further CGA.This research was supported by the grants from the Seoul National University Bundang Hospital (SNUBH) Research Fund [grant number 14–2017-023]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Alumina-on-Alumina Total Hip Arthroplasty A Concise Follow-up, at a Minimum of Ten Years, of a Previous Report

We previously reported the five-to-six-year results of the use of third-generation alumina-on-alumina bearings in a consecutive series of 100 primary cementless total hip arthroplasties. This report presents the longer-term outcomes of these same bearings, at a minimum of ten years postoperatively. Eighty-six of eighty-eight hips available for the study retained the original bearings at the time of the latest follow-up. Thirteen hips were associated with noise, and six hips demonstrated fretting of the femoral neck on radiographs. Two hips required a change of the bearings because of a ceramic head fracture. The ten-year survival rate of the alumina-on-alumina total hip prostheses, with revision of any implant for any reason as the end point, was 99.0%. On the basis of those results, we concluded that the rate of survival of primary cementless total hip prostheses with third-generation alumina-on-alumina bearings is excellent at ten years. However, the risk of ceramic fracture, noise, and impingement between the metal neck and the ceramic liner should be a concern to surgeons, and patients should be informed of these risks before surgery.Koo KH, 2008, J BONE JOINT SURG AM, V90A, P329, DOI 10.2106/JBJS.F.01489Sugano N, 2007, J BONE JOINT SURG BR, V89B, P455Yoo JJ, 2005, J BONE JOINT SURG AM, V87A, P530, DOI 10.2106/JBJS.D01753Allain J, 1998, J BONE JOINT SURG AM, V80A, P1355Joshi RP, 1998, J BONE JOINT SURG BR, V80B, P585MARTELL JM, 1993, J BONE JOINT SURG AM, V75A, P554MALONEY WJ, 1990, J BONE JOINT SURG AM, V72A, P1025BELLAMY N, 1988, J RHEUMATOL, V15, P1833ENGH CA, 1987, J BONE JOINT SURG BR, V69, P45SARMIENTO A, 1985, J BONE JOINT SURG AM, V67A, P48GRUEN TA, 1979, CLIN ORTHOP RELAT R, P17DELEE JG, 1976, CLIN ORTHOP RELAT R, P20HARRIS WH, 1969, J BONE JOINT SURG AM, VA 51, P737KAPLAN EL, 1958, J AM STAT ASSOC, V53, P457