BackgroundSoft tissue balancing which is above all most important factor of total knee arthroplasty, has been performed by subjective methods. Recently objective orthosensor has been developed for compartment pressure measurement. The purpose of this study was: (1) to quantify the compartment pressure of the joint throughout the range of motion during TKA using orthosensor, (2) to determine the usefulness of orthosensor by analyzing correlation between the pressure in both compartment with initial trial and after final implantation, and (3) to evaluate the types and effectiveness of additional ligament balancing procedures to compartment pressure.MethodsEighty-four patients underwent total knee arthroplasty (TKA) using VERASENSE Knee System. TKA was performed by measured resection and modified gap balance technique. Compartment pressure was recorded on full extension, 30°, 60°, 90° and full flexion at initial (INI), after each additional procedure, and after final (FIN) implantation. “Balanced” knees were defined as when the compartment pressure difference was less than 15 pounds.ResultsThirty patients (35.7%) showed balanced knee initially and 79 patients (94.0%) showed balance after final implantation. The proportion of balanced knee after initial bony resection, modified gap balancing TKAs showed significantly higher proportion than measured resection TKAs (P = 0.004) On both compartment, the pressure was generally decreased throughout the range of motion. Linear correlation on both compartment showed statistically significant throughout the range on motion, with higher correlation value on the lateral compartment. Total 66 additional ligament balancing procedures were performed.ConclusionUsing orthosensor, we could obtain 94% quantified balance knee, consequently. And between the techniques, measured resection TKA showed less balanced knee and also required more additional procedures compared to modified gap balancing TKA. Furthermore, with the acquired quantified data during appropriate ligament balancing, the surgeon could eventually reduce the complications associated with soft tissue imbalance in the future.
We investigated reference values for cardiorespiratory fitness (CRF) for healthy Koreans and Koreans with coronary heart disease (CHD) and used them to identify inter-ethnic differences in CRF, differences over time in CRF, and differences in CRF between the healthy population and patients with CHD. The study population for healthy Koreans was derived from the database of KISS FitS (Korea Institute of Sports Science Fitness Standards) between 2014 and 2015. The study population for Koreans with CHD was derived from the database of the Korea University Guro Hospital Cardiac Rehabilitation Registry between June 2015 and December 2018. In healthy Koreans, there was a significant difference between sex and age groups for VO 2 max. The VO 2 max of healthy Koreans differed from that of Westerners in age-related reference values. Our results were not significantly different from those of the Korean population in the past, except for a small decline in the young population. There seemed to be a clear inter-ethnic difference in CRF. We could also identify signs of small change in CRF in younger age groups. Therefore, CRF should be assessed according to ethnic or national standards, and it will be necessary to establish a reference for each nation or ethnicity with periodic updates.
The thoracolumbar injury classification and severity score (TLICS) system help surgeons decide whether patients should undergo initial operative treatment or nonoperative treatment. However, the best treatment for patients with TLICS 4 fracture remains unknown. The aim of this study was to identify the risk factors for nonoperative treatment failure in patients with TLICS 4 fracture and establish treatment standards for TLICS 4 fractures. This study included 44 patients with TLICS 4 fracture who initially received nonoperative treatment. We divided these patients into two groups: the successful nonoperative treatment group included 18 patients, and the operative treatment group after nonoperative treatment failure included 26 patients. In multiple logistic regression analysis, spinal canal compromise (odd ratio = 1.316) and kyphotic angle (odd ratio = 1.416) were associated with nonoperative treatment failure in patients with TLICS 4 fracture. Other factors, including age, sex, BMI, initial VAS score, and loss of vertebral body height, were not significantly associated with nonoperative treatment failure in these patients. Spinal canal compromise and kyphotic angle were associated with nonoperative treatment failure in patients with TLICS 4 fracture. Therefore, we recommend the surgeon observe spinal canal compromise and kyphotic angle more carefully when deciding on the treatment of patients with TLICS 4 fracture.
Purpose: There are limited reports for the results of the fourth-generation ceramic-on-ceramic (CoC) articulation total hip arthroplasty (THA). And, throughout the surgical experience, we encountered some cases of liner pulling-out phenomenon after liner fixation and femoral preparation. The objective of this study was to evaluate the incidence, risk factors of delta ceramic liner or head fractures, and also the clinical and radiological results of using the fourth-generation CoC articulation in THA. Patients and Methods: We retrospectively reviewed 242 patients (263 hips) who underwent primary THA using the fourth-generation CoC articulation with a minimum followup of 2 years. Demographic data, Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Patient's satisfactory level were recorded. The radiological evaluation was used to evaluate the implant fixation and complications. Mean followup duration was 5.2 years. Results: Mean HHS and WOMAC score were significantly ( P < 0.05) improved at the last followup. About 98.5% of the patients were satisfied with results of the surgery. All acetabular components were placed in adequate position and there was no osteolysis on acetabular or femoral components and subsidence of femoral stem. Four patients showed complications including one-liner fracture. Conclusion: Our midterm study demonstrated excellent clinical and radiological results with only one ceramic liner fracture. Moreover, the results of this study indicate that one possible cause of pulling-out phenomenon is the resonance effect during implantation in Dorr type A patients with the thick cortex. If the surgeon is aware of the liner malposition throughout the operation, the fourth-generation CoC articulation THA could be an outstanding treatment.
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