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Choi YS, Chang MJ, Shin YB, Kim TW, Chang CB, Kang SB. The Relationship between Western Ontario and McMaster Universities Osteoarthritis Index Score and Satisfaction after Total Knee Arthroplasty Changes Over Time. J Knee Surg 2024; 37:374-380. [PMID: 37380042 DOI: 10.1055/a-2119-3403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
This study aimed to determine whether there was a relationship between preoperative patient-reported outcome measures (PROMs) and satisfaction after total knee arthroplasty (TKA), and whether there was a relationship between the amount of improvement in PROM or final PROM and satisfaction and whether that relationship differed 1 and 2 years after TKA. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and satisfaction of 267 limbs who underwent TKA were analyzed. Logistic regression analysis was performed to determine whether there was a relationship between preoperative WOMAC or improvement in WOMAC or final WOMAC and satisfaction at 1 and 2 years after TKA. Pearson and Filon's z test was performed to determine whether there was a difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC. There was no significant relationship between preoperative WOMAC and satisfaction. A higher improvement in WOMAC total score and better final WOMAC total scores at 1 and 2 years after TKA were related to greater satisfaction. At 1 year after TKA, there was no significant difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC. However, 2 years after TKA, the final WOMAC function and total score were more related to satisfaction than the amount of improvement in WOMAC function and total score. In the early postoperative period, there was no difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC, whereas over time, the final WOMAC was more related to satisfaction.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Bin Shin
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Cho Y, Kim H, Yook G, Yong S, Kim S, Lee N, Kim YJ, Kim JH, Kim TW, Chang MJ, Lee KM, Chang CB, Kang SB, Kim JH. Predisposal of Interferon Regulatory Factor 1 Deficiency to Accumulate DNA Damage and Promote Osteoarthritis Development in Cartilage. Arthritis Rheumatol 2024. [PMID: 38268484 DOI: 10.1002/art.42815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 01/05/2024] [Accepted: 01/23/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Interferon regulatory factor 1 (IRF1) is a transcriptional regulator conventionally associated with immunomodulation. Recent molecular analyses mapping DNA binding sites of IRF1 have suggested its potential function in DNA repair. However, the physiologic significance of this noncanonical function remains unexplored. Here, we investigated the role of IRF1 in osteoarthritis (OA), a condition marked by senescence and chronic joint inflammation. METHODS OA progression was examined in wild-type and Irf1-/- mice using histologic assessments and microcomputed tomography analysis of whole-joint OA manifestations and behavioral assessments of joint pain. An integrated analysis of assay for transposase-accessible chromatin with sequencing and whole transcriptome data was conducted for the functional assessment of IRF1 in chondrocytes. The role of IRF1 in DNA repair and senescence was investigated by assaying γ-H2AX foci and senescence-associated beta-galactosidase activity. RESULTS Our genome-wide investigation of IRF1 footprinting in chondrocytes revealed its primary occupancies in the promoters of DNA repair genes without noticeable footprint patterns in those of interferon-responsive genes. Chondrocytes lacking IRF1 accumulated irreversible DNA damage under oxidative stress, facilitating their entry into cellular senescence. IRF1 was down-regulated in the cartilage of human and mouse OA. Although IRF1 overexpression did not elicit an inflammatory response in joints or affect OA development, genetic deletion of Irf1 caused enhanced chondrocyte senescence and exacerbated post-traumatic OA in mice. CONCLUSION IRF1 offers DNA damage surveillance in chondrocytes, protecting them from oxidative stress associated with OA risk factors. Our study provides a crucial and cautionary perspective that compromising IRF1 activity renders chondrocytes vulnerable to cellular senescence and promotes OA development.
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Affiliation(s)
- Yongsik Cho
- Institute for Basic Science and Seoul National University, Seoul, South Korea, and Liflex Science, Cheongju, South Korea
| | - Hyeonkyeong Kim
- Institute for Basic Science and Seoul National University, Seoul, South Korea, and Liflex Science, Cheongju, South Korea
| | - Geunho Yook
- Institute for Basic Science and Seoul National University, Seoul, South Korea
| | - Sangmin Yong
- Institute for Basic Science and Seoul National University, Seoul, South Korea
| | - Soy Kim
- Institute for Basic Science and Seoul National University, Seoul, South Korea
| | - Narae Lee
- Institute for Basic Science and Seoul National University, Seoul, South Korea
| | - Yi-Jun Kim
- Ewha Womans University, Seoul, South Korea
| | | | - Tae Woo Kim
- Seoul National University and Boramae Hospital, Seoul, South Korea
| | - Moon Jong Chang
- Seoul National University and Boramae Hospital, Seoul, South Korea
| | - Kyoung Min Lee
- Seoul National University and Boramae Hospital, Seoul, South Korea
| | - Chong Bum Chang
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung-Baik Kang
- Seoul National University and Boramae Hospital, Seoul, South Korea
| | - Jin-Hong Kim
- Seoul National University and Institute for Basic Science, Seoul, South Korea, and Institute of Green-Bio Science and Technology, Pyeongchang, South Korea
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Choi YS, Chang MJ, Lee JH, Lee JH, D'Lima DD, Kim TW, Chang CB, Kang SB. Repair of medial meniscus posterior root tear is effective for root healing and cartilage regeneration in opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:5799-5811. [PMID: 37940662 DOI: 10.1007/s00167-023-07637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE This study aimed to determine whether the repair of a medial meniscus posterior root tear (MMPRT) is effective for MMPRT healing, cartilage regeneration, and clinical outcomes in opening wedge high tibial osteotomy (OWHTO). METHODS This retrospective study included 80 patients who underwent OWHTO and subsequent second-look arthroscopy. The patients were divided into OWHTO-with-MMPRT-repair (n = 40) and OWHTO alone (n = 40) groups, and the healing rates (complete/partial/failure) were compared. Each group was further divided into over- and under-corrected subgroups to compare healing rates. The International Cartilage Repair Society (ICRS) grade, cartilage defect size, Koshino stage, ICRS cartilage repair assessment score of the medial femoral condyle (MFC), and International Knee Documentation Committee (IKDC) scores between the OWHTO-with-MMPRT-repair and OWHTO alone groups were compared according to whether microfracture was performed on the MFC. RESULTS The overall healing rate of the MMPRT was higher in the OWHTO-with-MMPRT-repair group than that in the OWHTO alone group (P < 0.001). In addition, in the subgroup analysis, no difference in the MMPRT healing rate between the over-correction and under-correction groups when MMPRT repair was performed (n.s). In contrast, without MMPRT repair, the healing rate was lower in the under-correction group than that in the over-correction group (P = 0.03). Cartilage regeneration of the OWHTO-with-MMPRT-repair group was superior to that of the OWHTO alone group (P < 0.05). The IKDC subjective scores of the OWHTO-with-MMPRT-repair and OWHTO alone groups were 34.5 and 33.1 before surgery (n.s) and 50 and 47.2 at one year after surgery, respectively (n.s). These differences between the two groups for cartilage regeneration and IKDC subjective scores showed the same pattern regardless of microfractures. CONCLUSIONS MMPRT repair during OWHTO might improve MMPRT healing, even with under-correction, and cartilage regeneration of MFC, regardless of microfracture. However, OWHTO with MMPRT repair might not improve short-term clinical outcomes compared to OWHTO alone. Further randomized clinical trials are necessary. LEVEL OF EVIDENCE III, Retrospective cohort study.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Ji Han Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Jae Hee Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Tae Woo Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea.
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Yoon JS, Yon CJ, Lee D, Lee JJ, Kang CH, Kang SB, Lee NK, Chang CB. Assessment of a novel deep learning-based software developed for automatic feature extraction and grading of radiographic knee osteoarthritis. BMC Musculoskelet Disord 2023; 24:869. [PMID: 37940935 PMCID: PMC10631128 DOI: 10.1186/s12891-023-06951-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The Kellgren-Lawrence (KL) grading system is the most widely used method to classify the severity of osteoarthritis (OA) of the knee. However, due to ambiguity of terminology, the KL system showed inferior inter- and intra-observer reliability. For a more reliable evaluation, we recently developed novel deep learning (DL) software known as MediAI-OA to extract each radiographic feature of knee OA and to grade OA severity based on the KL system. METHODS This research used data from the Osteoarthritis Initiative for training and validation of MediAI-OA. 44,193 radiographs and 810 radiographs were set as the training data and used as validation data, respectively. This AI model was developed to automatically quantify the degree of joint space narrowing (JSN) of medial and lateral tibiofemoral joint, to automatically detect osteophytes in four regions (medial distal femur, lateral distal femur, medial proximal tibia and lateral proximal tibia) of the knee joint, to classify the KL grade, and present the results of these three OA features together. The model was tested by using 400 test datasets, and the results were compared to the ground truth. The accuracy of the JSN quantification and osteophyte detection was evaluated. The KL grade classification performance was evaluated by precision, recall, F1 score, accuracy, and Cohen's kappa coefficient. In addition, we defined KL grade 2 or higher as clinically significant OA, and accuracy of OA diagnosis were obtained. RESULTS The mean squared error of JSN rate quantification was 0.067 and average osteophyte detection accuracy of the MediAI-OA was 0.84. The accuracy of KL grading was 0.83, and the kappa coefficient between the AI model and ground truth was 0.768, which demonstrated substantial consistency. The OA diagnosis accuracy of this software was 0.92. CONCLUSIONS The novel DL software known as MediAI-OA demonstrated satisfactory performance comparable to that of experienced orthopedic surgeons and radiologists for analyzing features of knee OA, KL grading and OA diagnosis. Therefore, reliable KL grading can be performed and the burden of the radiologist can be reduced by using MediAI-OA.
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Affiliation(s)
- Ji Soo Yoon
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea
| | - Chang-Jin Yon
- Department of Orthopaedic Surgery, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | | | | | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Na-Kyoung Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea.
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Chang MJ, Choi YS, Shin JH, Yoon TH, Kim TW, Chang CB, Kang SB. Comparison of failure rates and functional outcomes between hamstring autografts and hybrid grafts in anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2023; 109:103499. [PMID: 36462633 DOI: 10.1016/j.otsr.2022.103499] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The viability of augmenting small-diameter hamstring autografts with allografts remains unclear. Recent studies have reported different clinical results after allograft augmentation. Hence, we sought to determine whether hamstring autografts and hybrid grafts differed in terms of failure rates and functional outcomes after anterior cruciate ligament (ACL) reconstruction. We also evaluated whether the results of the comparisons differed based on allograft sterilization methods. PATIENTS AND METHODS This systematic review and meta-analysis were performed by searching the PubMed, Cochrane Library, and EMBASE databases to identify prospective or retrospective studies (evidence levels 1, 2, or 3) that compared the failure rates and functional outcomes of ACL reconstruction using autografts and hybrid grafts. RESULTS We identified 15 relevant studies, including 1,521 patients, with 798 and 723 treated using autografts and hybrid grafts, respectively. Fourteen studies were retrospective comparative studies, and one was a prospective randomized controlled trial. Of these, three studies used non-irradiated allografts. In the analysis of all participants, no significant differences in failure rates and subjective International Knee Documentation Committee (IKDC) scores were observed between the autograft and hybrid graft groups. Comparing the autograft and hybrid graft groups that used non-irradiated allografts, no differences in the failure rates and subjective IKDC scores were also noted. Meanwhile, in the groups that used irradiated allograft, the autograft group demonstrated higher Lysholm knee scores and reduced anterior laxity than the hybrid graft group. DISCUSSION Overall, ACL reconstruction using hybrid grafts may not reduce failure rates compared to reconstructions using hamstring autografts, although hybrid grafts with irradiation may decrease functional outcomes. LEVEL OF EVIDENCE III; systematic review of level II and III studies.
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Affiliation(s)
- Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Yun Seong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | | | - Tae Hyuck Yoon
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnamsi, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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Hill WS, Dohnalek MH, Ha Y, Kim SJ, Jung JC, Kang SB. A Multicenter, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial to Evaluate the Efficacy and Safety of a Krill Oil, Astaxanthin, and Oral Hyaluronic Acid Complex on Joint Health in People with Mild Osteoarthritis. Nutrients 2023; 15:3769. [PMID: 37686801 PMCID: PMC10490060 DOI: 10.3390/nu15173769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Osteoarthritis is a significant global health problem. Many patients seek more effective alternatives to nonsteroidal anti-inflammatory medicines or commercial supplements to manage joint pain and inflammation. FlexPro MD® (FP-MD) combines krill oil, astaxanthin, and lower molecular weight hyaluronic acid to support joint health. A 12-week, randomized, double-blind, placebo-controlled trial compared the efficacy and safety of FP-MD and placebo once daily in participants (n = 100) with mild osteoarthritis of the knee or hip joint. For the primary endpoint of joint pain score, per-protocol participants (n = 75) in the FP-MD group (n = 37) had a statistically significantly greater mean reduction from baseline in the Korean Visual Analog Scale (K-VAS) at week 12 compared with participants in the placebo group (n = 38) (20.8 ± 16.16 mm vs. 10.6 ± 17.58, p = 0.0105). The Korean Western Ontario and McMaster Universities Osteoarthritis Index (K-WOMAC) total score was also significantly improved in the FP-MD group at week 12 compared with placebo (-13.0 ± 13.62 vs. -5.5 ± 18.08, p = 0.0489), especially an improvement in pain score (-2.5 ± 2.92 vs. -1.3 ± 3.94, p = 0.02635). FP-MD group had greater improvement in joint function scoring by investigator assessment (p = 0.0127) and by group participants (p = 0.0070). A statistically significantly greater number of patients reported adverse events in the placebo group compared with the FP-MD group (16% vs. 4%, p = 0.0455), most commonly gastrointestinal disorders in both of the groups. These findings suggest that FP-MD is well tolerated and can be effectively used to address joint pain in patients diagnosed with mild osteoarthritis, the main symptom of this condition.
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Affiliation(s)
- W. Stephen Hill
- US Nutraceuticals, Inc. d/b/a Valensa International, Eustis, FL 32726, USA; (W.S.H.); (M.H.D.)
| | - Margaret H. Dohnalek
- US Nutraceuticals, Inc. d/b/a Valensa International, Eustis, FL 32726, USA; (W.S.H.); (M.H.D.)
| | - Yejin Ha
- NOVAREX Co., Ltd., 80, Osongsaengmyeong 14-ro, Osong-eup, Chueongju-si 28220, Republic of Korea;
| | - Seok-Jung Kim
- Department of Orthopedic Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Cheonbo-ro, Uijeongbu-si 11765, Republic of Korea;
| | - Jae-Chul Jung
- NOVAREX Co., Ltd., 80, Osongsaengmyeong 14-ro, Osong-eup, Chueongju-si 28220, Republic of Korea;
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Boramae Hospital, Seoul 07061, Republic of Korea
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Kim TW, Chang MJ, Shin CY, Chang CB, Kang SB. A randomized controlled trial for comparing efficacy and safety between intraarticular polynucleotide and hyaluronic acid for knee osteoarthritis treatment. Sci Rep 2023; 13:9419. [PMID: 37296122 PMCID: PMC10256705 DOI: 10.1038/s41598-023-35982-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Although the use of intra-articular polynucleotide (IA PN) injection as a viscosupplement for knee osteoarthritis (OA) treatment has been proposed, its efficacy and safety compared to high molecular weight hyaluronic acid (HMWHA) injection has not yet been established. The present double-blind, multicenter, randomized controlled trial aimed to investigate the efficacy and safety of IA PN injection compared to IA HMWHA injection. A total of 60 patients (15 men, 45 women, 64.5 ± 7.5 years) with knee OA (Kellgren-Lawrence grade 1-4) were randomly allocated to each group. All patients were given three IA injections of PN (n = 30) or HMWHA (n = 30) at intervals of 1 week. The primary endpoint was the change rate in weight-bearing pain (WBP) 16 weeks from the baseline. The secondary endpoint included multiple measurements: the change rate in WBP rate at 8 weeks; the change rate in pain level at rest and during walking at 8 and 16 weeks; the Korean-Western Ontario and McMaster University Osteoarthritis index; the Euro-Quality of Life-5 Dimension; Clinical Global Impression, Patient Global Impression at 8 and16 weeks, and total consumption of rescue medicine. The mean change rate in the WBP at 16 weeks from the baseline was - 54.0 ± 38.1% in the IA PN group and - 42.8 (± 35.8%) in the IA HMWHA group, and there was no significant difference between the two groups (p = 0.296). All secondary endpoints related with pain and functional outcome also showed no significant difference between the two groups. Pain at the injection site and swelling were reported as adverse events, and the incidence was similar between the two groups. IA PN showed comparable efficacy and safety to IA HMWHA at 3 times injection with an interval of 1 week. IA PN can be useful alternative to IA HMWHA for the treatment of knee OA.
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Affiliation(s)
- Tae Woo Kim
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chung Yeop Shin
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea.
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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Kyung MG, Bae TS, Baek HH, Chang MJ, Kim TW, Kang SB. Optimal hinge level in opening wedge high tibial osteotomy: Biomechanical analysis using finite element method. Clin Biomech (Bristol, Avon) 2023; 107:106027. [PMID: 37315477 DOI: 10.1016/j.clinbiomech.2023.106027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND While the concept of a safe zone, which can minimize the hinge fracture when performing opening wedge high tibial osteotomy, has been introduced, there is a lack of understanding of the biomechanical environment at the lateral tibial cortex. This study aimed to evaluate the effect of the hinge level on the biomechanical environment at the lateral cortex of the tibia with heterogeneous finite element models. METHODS Finite element models of biplanar opening wedge high tibial osteotomy based on computed tomography images of a control subject and three patients with medial compartment knee osteoarthritis were created. In each model, three different hinge levels (proximal, middle, and distal) were set. The process of opening the gap during the operation was simulated, and the maximum von Mises stress values at the lateral tibial cortex were calculated for each hinge level and correction angle. FINDINGS The maximum von Mises stress value at the lateral tibial cortex was the lowest when the hinge was at the middle, while the value was the highest when the hinge was at the distal level. Furthermore, it was demonstrated that a higher correction angle yielded a higher probability of lateral tibial cortex fracture. INTERPRETATION The findings of this study demonstrate that the hinge at the point where the upper end of the articular cartilage of the proximal tibiofibular joint is located provides the least possibility of lateral tibial cortex fracture, as this is an anatomically independent position from the fibula.
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Affiliation(s)
- Min Gyu Kyung
- Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Soo Bae
- Department of Biomedical Engineering, Jungwon University, Chungcheongbuk-do, Republic of Korea
| | - Hyeong Ho Baek
- Department of Biomedical Engineering, Jungwon University, Chungcheongbuk-do, Republic of Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Park HJ, Chang MJ, Kim TW, Chang CB, Kang SB. Differences in Resumption of Orthopedic Surgery According to Characteristics of Surgery during COVID-19 Pandemic: National Registry Data. Clin Orthop Surg 2023; 15:327-337. [PMID: 37008965 PMCID: PMC10060775 DOI: 10.4055/cios22177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 04/04/2023] Open
Abstract
Background Healthcare services have been restricted after the coronavirus disease 2019 (COVID-19) outbreak. With the pandemic still ongoing, the patterns of orthopedic surgery might have changed. The purpose of this study was to determine whether the reduced volumes of orthopedic surgery were recovered over time. Among the trauma and elective surgery, which accounted for most orthopedic surgical procedures, we also sought to elucidate whether the changes in the volumes of orthopedic surgery differed according to the type of surgery. Methods The volumes of orthopedic surgery were analyzed using the Health Insurance Review and Assessment Service of Korea databases. The surgical procedure codes were categorized depending on the characteristics of the procedures. The actual volumes of surgery were compared with the expected volumes to elucidate the effect of COVID-19 on surgical volumes. The expected volumes of surgery were estimated using Poisson regression models. Results The reducing effect of COVID-19 on the volumes of orthopedic surgery weakened as COVID-19 continued. Although the total volumes of orthopedic surgery decreased by 8.5%-10.1% in the first wave, those recovered to a 2.2%-2.8% decrease from the expected volumes during the second and third waves. Among the trauma and elective surgery, open reduction and internal fixation and cruciate ligament reconstruction decreased as COVID-19 continued, while total knee arthroplasty recovered. However, the volumes of hemiarthroplasty of the hip did not decrease through the year. Conclusions The number of orthopedic surgeries, which had decreased due to COVID-19, tended to recover over time, although the pandemic was still ongoing. However, the degree of resumption differed according to the characteristics of surgery. The findings of our study will be helpful to estimate the burden of orthopedic surgery in the era of persistent COVID-19.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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10
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Park HJ, Chang MJ, Cho HJ, Hong E, Kim TW, Chang CB, Bae TS, Kwak DS, Kang SB. Medial Meniscus Posterior Root Repair Restores Contact Pressure and Contact Area to Its Native State Even After Opening-Wedge High Tibial Osteotomy: A Cadaveric Biomechanical Study. Arthroscopy 2023; 39:638-646. [PMID: 36191732 DOI: 10.1016/j.arthro.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To elucidate the effect of medial meniscus posterior root (MMPR) repair during opening-wedge high tibial osteotomy (OWHTO) in terms of contact pressure (CP) and contact area (CA). METHODS Nine fresh-frozen human cadaveric knee specimens were included. Each specimen was tested under 9 conditions comprising 3 different degrees of correction during OWHTO (neutral, 5° of valgus, and 10° of valgus) and 3 different types of MMPR conditions (intact, torn, and repaired). The prepared specimens were attached to a customized tibiofemoral jig in a fully extended state. The CP and CA generated by a tibiofemoral axial load of 650 N was recorded using the Tekscan sensor's pressure mapping software. Statistical analysis was performed using a repeated measures analysis of variance. RESULTS The increased CP and decreased CA in torn MMPR was decreased and increased, respectively, to the intact MMPR after repairing, irrespective of whether OWHTO was performed. The mean CP at a correction angle of 5° of valgus was 0.4067 ± 0.0768 MPa for intact MMPR, which increased to 0.7340 ± 0.1593 MPa for the torn MMPR and decreased to 0.3614 ± 0.0639 MPa for the repaired MMPR. In addition, the proportion of decrease in CP and increase in CA after MMPR repair was constant, compared with the torn MMPR, irrespective of the degree of correction during OWHTO. CONCLUSIONS MMPR repair decreases CP and increases CA, irrespective of whether OWHTO is performed. The biomechanical advantage of repairing torn MMPR is maintained, regardless of the degree of correction during OWHTO. CLINICAL RELEVANCE Both OWHTO and MMPR repair are known to protect the medial compartment of the knee. However, there are concerns in performing 2 procedures simultaneously. Results of our study showed that concurrent repair of the MMPR during OWHTO is useful for protecting the medial compartment of the knee with respect to tibiofemoral contact biomechanics.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Ho-Jung Cho
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunah Hong
- Department of Biomedicine & Health Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Tae Soo Bae
- Department of Biomedical Engineering (BME), Jungwon University, Chungcheongbuk-do, Republic of Korea
| | - Dai-Soon Kwak
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
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11
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Lee NK, Won SJ, Lee JY, Kang SB, Yoo SY, Chang CB. Presence of Night Pain, Neuropathic Pain, or Depressive Disorder Does Not Adversely Affect Outcomes After Total Knee Arthroplasty: A Prospective Cohort Study. J Korean Med Sci 2022; 37:e309. [PMID: 36345255 PMCID: PMC9641149 DOI: 10.3346/jkms.2022.37.e309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND A considerable proportion of patients warranting total knee arthroplasty (TKA) have night pain, neuropathic pain, and/or depressive disorder, which may not be resolved by TKA. This prospective, longitudinal cohort study aimed to document the prevalence of night pain, neuropathic pain, and depressive disorder in patients with advanced knee osteoarthritis undergoing TKA and to determine whether the specific coexisting pain and/or disorder at the time of TKA adversely affected postoperative outcomes. METHODS In this study, 148 patients undergoing TKA were longitudinally evaluated. The presence of night pain, neuropathic pain (determined using Douleur Neuropathique 4 [DN4]) and depressive disorder (determined using the Patient Health Questionnaire-9 [PHQ-9]) was determined before and 6 weeks, 3 months and 1 year after TKA. In addition, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and EuroQol-5 Dimension (EQ-5D) scores were assessed before and 1 year after TKA. Potential associations of night pain, neuropathic pain, and/or depressive disorder with pre- and postoperative WOMAC and EQ-5D scores were examined in subgroup analyses. RESULTS Preoperatively, 72% (n = 106) of patients reported night pain, and the prevalences of neuropathic pain and depressive disorder were 15% and 17%, respectively. Preoperatively, compared with patients without night pain, those with night pain had significantly poorer preoperative WOMAC scores, but no significant difference was seen between groups 1 year after TKA. Preoperatively, the WOMAC, EQ-5D, and EQ-5D health scores of patients with neuropathic pain were not significantly different from those of patients without neuropathic pain, and there was no difference in clinical outcome scores 1 year after TKA between these groups. Preoperatively, the patients with depressive disorder showed significantly poorer preoperative WOMAC, EQ-5D, and EQ-5D health scores than those without depressive disorder, but no significant differences in scores were observed 1 year after TKA between these groups. CONCLUSION This study revealed a considerable prevalence of night pain, neuropathic pain, and depressive disorder in patients undergoing TKA and that patients with these specific conditions reported poorer functional and quality of life scores preoperatively. However, such adverse effects disappeared after TKA. Our study findings suggest that TKA can provide satisfactory outcomes for patients with these specific conditions.
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Affiliation(s)
- Na-Kyoung Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Samuel Jaeyoon Won
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Psychiatry and Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - So Young Yoo
- Department of Psychiatry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Psychiatry and Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
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12
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Park HJ, Chang MJ, Kim TW, Chang CB, Kang KS, Kang SB. Subchondral Bone Condition and Intraoperative Grading of Cartilage Degeneration Underneath Patella Unrelated to the Clinical Outcome after TKA with Unresurfaced Patella. J Knee Surg 2022; 35:1417-1424. [PMID: 33607675 DOI: 10.1055/s-0041-1723980] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The degree of cartilage degeneration assessed intraoperatively may not be sufficient as a criterion for patellar resurfacing in total knee arthroplasty (TKA). However, single-photon emission tomography/computed tomography (SPECT/CT) is useful for detecting osteoarthritic involvement deeper in the subchondral bone. The purpose of the study was to determine whether SPECT/CT reflected the cartilage lesion underneath the patella in patients with end-stage osteoarthritis (OA) and whether clinical outcomes after TKA without patellar resurfacing differed according to the severity of patellofemoral (PF) OA determined by visual assessment and SPECT/CT findings. This study included 206 knees which underwent TKA. The degree of cartilage degeneration was graded intraoperatively according to the International Cartilage Repair Society grading system. Subjects were classified into low and high uptake groups according to the degree of bone tracer uptake (BTU) on SPECT/CT in the PF joint. The Feller's patella score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed preoperatively and postoperative 1 and 2 years. The increased BTU in the PF joint was associated with more severe degenerative cartilage changes underneath the patella (p < 0.001). The risk for the presence of denudated cartilage was greater in the high uptake group (odds ratio = 5.89). There was no association between clinical outcomes and visual grading of patellar cartilage degeneration or the degree of BTU on SPECT/CT. The visual assessment of the degree of cartilage degeneration underneath the patella and preoperative SPECT/CT evaluation of the PF joint were not predictive of clinical outcome after TKA with unresurfaced patella.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kee Soo Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
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13
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Lee NK, Kim TW, Lee S, Choi YS, Kang SB, Chang CB. Effect of distance between the feet on knee joint line orientation after total knee arthroplasty in standing full-limb radiographs. Knee Surg Sports Traumatol Arthrosc 2022; 30:3032-3040. [PMID: 34269849 DOI: 10.1007/s00167-021-06662-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/04/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Although knee joint line orientation (KJLO) after total knee arthroplasty (TKA) has been emphasized as an important factor that can affect postoperative knee kinematics, the effect of foot position on KJLO has not been fully understood. This study aimed to (1) identify the anatomical and positional factors that determine KJLO after TKA, and (2) determine the effect of foot position on KJLO after TKA. The hypothesis of this study was that the post-TKA KJLO would change depending on the distance between the feet, as well as the coronal implant positions. METHODS A total of 92 radiographs from 46 patients who underwent TKA were retrospectively reviewed. Two postoperative standing full-limb anteroposterior radiographs taken with the feet in different positions (with both feet in contact with each other or shoulder width apart) from each patient were evaluated. The correlation between KJLO after TKA and possible anatomical and positional factors, including leg length, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), ankle joint line orientation (AJLO), mechanical tibiofemoral angle (mTFA), and distance between the feet, were analyzed, and the KJLO equation was computed using multiple linear regression. KJLO was also compared among different combinations of valgus or varus alignment of the femoral and tibial components. RESULTS LDFA, MPTA, AJLO, and distance between the feet were identified as determinants of KJLO after TKA, and the distance between the feet was strongly correlated with KJLO. Based on the KJLO equation (KJLO [°] = 107.548 - 0.441 × LDFA [°] - 0.832 × MPTA [°] + 0.093 × AJLO [°] + 0.037 × ITD [mm]), KJLO changes by 3.7° per 100 mm of distance between the feet. The KJLO of patients with valgus femoral and varus tibial components was more parallel to the ground than those with other combinations. CONCLUSION KJLO after TKA was strongly affected by the distance between the feet when taking full-limb radiography, and the KJLO changed by 3.7° per 100 mm of distance between the feet. To assess the KJLO after TKA reproducibly, standardization of the distance between the feet is necessary. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Na-Kyoung Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Tae Woo Kim
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul, South Korea.
| | - Sanghoon Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Yun Seong Choi
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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14
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Choi YS, Kim TW, Song SC, Kim SY, Chang MJ, Kang SB. Asymmetric transepicondylar axis between varus and valgus osteoarthritic knees in windswept deformity can be predicted by hip-knee-ankle angle difference. Knee Surg Sports Traumatol Arthrosc 2022; 30:3024-3031. [PMID: 34258661 DOI: 10.1007/s00167-021-06661-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Studies regarding the best strategy to determine appropriate femoral component rotation during bilateral total knee arthroplasty (TKA) in wind swept deformities (WSD) are very limited. The purpose of this study was (1) to evaluate whether femoral rotational profiles differ between varus and valgus osteoarthritic knees in WSD and (2) to analyze the correlation between femoral rotational profiles and coronal radiologic parameters. METHODS A total of 40 patients who were diagnosed with bilateral knee osteoarthritis with WSD between January 2010 and December 2020 at a single institution were retrospectively reviewed. On axial computed tomography scans, femoral rotational profile parameters such as the clinical transepicondylar axis (cTEA) and anterior-posterior (AP) axis were compared between valgus and varus osteoarthritic knees. In standing full-limb AP radiographs, coronal radiographic parameters including hip-knee-ankle angle (HKA), valgus correction angle (VCA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured in both knees. The correlation between the varus-valgus cTEA difference, and differences in coronal radiologic parameters was analyzed. RESULTS In valgus osteoarthritic knees, cTEA was significantly increased compared to varus osteoarthritic knees by 1.5° (valgus: 7.65° ± 1.82°, varus: 6.15° ± 1.58°, p < 0.001). All coronal radiologic parameters, including HKA, LDFA, MPTA, JLCA, and VCA, were significantly different between valgus and varus knees. In correlation analysis, the varus-valgus cTEA difference was significantly correlated with LDFA (r = 0.365, p = 0.021), MPTA (r = 0.442, p = 0.004), and HKA differences (r = 0.693, p < 0.001), with the HKA difference showing the strongest correlation with the cTEA difference. CONCLUSION In bilateral knee osteoarthritis with WSD, valgus knees showed significantly increased cTEA compared to varus knees, and the cTEA difference positively correlated with the HKA difference between valgus and varus knees. To determine the optimal femoral component rotation during TKA in WSD, assessment of cTEA with pre-operative CT scans or careful intra-operative measurement is recommended, especially in patients with large HKA difference. LEVEL OF EVIDENCE III, Retrospective cohort study.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea
| | - Seung Cheol Song
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea
| | - Sang Yoon Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea.
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15
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Chang MJ, Ro DH, Kim TW, Lee YS, Han HS, Chang CB, Kang SB, Lee MC. Worse outcome of debridement, antibiotics, and implant retention in acute hematogenous infections than in postsurgical infections after total knee arthroplasty: a multicenter study. Knee Surg Relat Res 2022; 34:38. [PMID: 35978420 PMCID: PMC9387081 DOI: 10.1186/s43019-022-00165-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We sought to determine (1) the success rate of debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection (PJI) of the knee in patients with acute postsurgical infection and in those with acute hematogenous infection via a multicenter study, (2) the factors related to the failure of DAIR for overall acute PJI and acute hematogenous PJI via subgroup analysis, and (3) whether the PJI recurrence patterns differed between the two groups over time after DAIR.
Methods
This retrospective multicenter study included 101 acute knee PJI. Acute postsurgical PJI was defined as PJI diagnosed < 3 months following initial knee arthroplasty surgery. DAIR was performed for 34 cases of acute postsurgical PJIs (postsurgical group) and 67 cases of acute hematogenous PJIs (hematogenous group). The success rates between groups were compared, and factors related to DAIR failure were analyzed.
Results
The overall success rate of DAIR was 77%. The success rate tended to be higher in the postsurgical group than in the hematogenous group (p = 0.060). However, there was no significant factor related to DAIR failure in the subgroup analysis of acute hematogenous PJIs. In the postsurgical group, the recurrence of PJI occurred until 3 months, whereas in the hematogenous group, recurrence occurred for up to 2 years.
Conclusions
The failure rate tended to be higher in the acute hematogenous PJI group than in the acute postsurgical PJI group. Since acute hematogenous infections may recur for a longer period than postsurgical infections, careful follow-up is required after DAIR.
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16
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Choi YS, Oh JB, Chang MJ, Kim TW, Kang KS, Kang SB. Delayed normalization of C-Reactive protein and erythrocyte sedimentation rate was not associated with inferior clinical outcomes after total knee arthroplasty. J Orthop Sci 2022; 28:589-596. [PMID: 35331605 DOI: 10.1016/j.jos.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/06/2022] [Accepted: 02/16/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of this study aimed to identify the proportion of patients with delayed normalization of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) after TKA, to determine postoperative thresholds predictive of prolonged elevation. Further, we aimed to determine if the clinical outcomes of patients with prolonged elevation were inferior to those without prolonged elevation. METHODS The records of 211 unilateral and 320 bilateral TKA were reviewed. Patients were divided into the normal and elevation group based on CRP and ESR levels at 6 weeks and 3 months. The temporal pattern of CRP and ESR change in both groups was compared, and thresholds predictive of elevation at 6 weeks and 3 months were identified. Further, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and Tegner activity scale of both groups at 6 months, 1 year, and 2 years after TKA were compared. RESULTS The proportion of patients with elevated CRP and ESR at 6 weeks and 3 months was CRP: 24.2%, 10%, ESR: 51.6%, 29.9% in unilateral and CRP: 31.5%, 10.6%, ESR: 58.1%, 42.7% in bilateral TKA. The thresholds for elevation at 6 weeks and 3 months were 9.5 mg/dL, 11.4 mg/dL (CRP at 6 weeks) and 81.5 mm/h, 74.5 mm/h (ESR at 3 months). There was no difference in the WOMAC score and Tegner activity scale between both groups. CONCLUSIONS CRP and ESR are often elevated for a prolonged period even in the absence of infection after TKA. Such cases show distinct temporal patterns, which are predictable, and do not appear to have a significant effect on clinical outcome.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea.
| | - Jong Byung Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea.
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea.
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea.
| | - Kee Soo Kang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea.
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17
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Choi YS, Kim TW, Chang MJ, Kang SB, Chang CB. Enhanced recovery after surgery for major orthopedic surgery: a narrative review. Knee Surg Relat Res 2022; 34:8. [PMID: 35193701 PMCID: PMC8864772 DOI: 10.1186/s43019-022-00137-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/08/2022] [Indexed: 12/17/2022] Open
Abstract
Background With increasing interest in enhanced recovery after surgery (ERAS), the literature on ERAS in orthopedic surgery is also rapidly accumulating. This review article aims to (1) summarize the components of the ERAS protocol applied to orthopedic surgery, (2) evaluate the outcomes of ERAS in orthopedic surgery, and (3) suggest practical strategies to implement the ERAS protocol successfully. Main body Overall, 17 components constituting the highly recommended ERAS protocol in orthopedic surgery were identified. In the preadmission period, preadmission counseling and the optimization of medical conditions were identified. In the preoperative period, avoidance of prolonged fasting, multimodal analgesia, and prevention of postoperative nausea and vomiting were identified. During the intraoperative period, anesthetic protocols, prevention of hypothermia, and fluid management, urinary catheterization, antimicrobial prophylaxis, blood conservation, local infiltration analgesia and local nerve block, and surgical factors were identified. In the postoperative period, early oral nutrition, thromboembolism prophylaxis, early mobilization, and discharge planning were identified. ERAS in orthopedic surgery reduced postoperative complications, hospital stay, and cost, and improved the patient outcomes and satisfaction with accelerated recovery. For successful implementation of the ERAS protocol, various strategies including the standardization of care system, multidisciplinary communication and collaboration, ERAS education, and continuous audit system are necessary. Conclusion The ERAS pathway enhanced patient recovery with a shortened length of stay, reduced postoperative complications, and improved patient outcomes and satisfaction. However, despite the significant progress in ERAS implementation in recent years, it has mainly focused on major surgeries such as arthroplasty. Therefore, further efforts to apply, audit, and optimize ERAS in various orthopedic surgeries are necessary.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul, South Korea.,Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
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18
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Kang D, Lee J, Jung J, Carlson BA, Chang MJ, Chang CB, Kang SB, Lee BC, Gladyshev VN, Hatfield DL, Lee BJ, Kim JH. Selenophosphate synthetase 1 deficiency exacerbates osteoarthritis by dysregulating redox homeostasis. Nat Commun 2022; 13:779. [PMID: 35140209 PMCID: PMC8828855 DOI: 10.1038/s41467-022-28385-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
Aging and mechanical overload are prominent risk factors for osteoarthritis (OA), which lead to an imbalance in redox homeostasis. The resulting state of oxidative stress drives the pathological transition of chondrocytes during OA development. However, the specific molecular pathways involved in disrupting chondrocyte redox homeostasis remain unclear. Here, we show that selenophosphate synthetase 1 (SEPHS1) expression is downregulated in human and mouse OA cartilage. SEPHS1 downregulation impairs the cellular capacity to synthesize a class of selenoproteins with oxidoreductase functions in chondrocytes, thereby elevating the level of reactive oxygen species (ROS) and facilitating chondrocyte senescence. Cartilage-specific Sephs1 knockout in adult mice causes aging-associated OA, and augments post-traumatic OA, which is rescued by supplementation of N-acetylcysteine (NAC). Selenium-deficient feeding and Sephs1 knockout have synergistic effects in exacerbating OA pathogenesis in mice. Therefore, we propose that SEPHS1 is an essential regulator of selenium metabolism and redox homeostasis, and its dysregulation governs the progression of OA. Osteoarthritis is caused by the gradual accumulation of oxidative stress in cartilage. Here, the authors show that dysregulation of the selenium metabolic pathway underlies a shift in redox homeostasis in chondrocytes, leading to chronic osteoarthritic changes in joints.
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Affiliation(s)
- Donghyun Kang
- Center for RNA Research, Institute for Basic Science, Seoul, 08826, South Korea.,Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, 08826, South Korea
| | - Jeeyeon Lee
- Center for RNA Research, Institute for Basic Science, Seoul, 08826, South Korea.,Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, 08826, South Korea
| | - Jisu Jung
- Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, 08826, South Korea
| | - Bradley A Carlson
- Mouse Cancer Genetics Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Boramae Hospital, Seoul, 07061, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Boramae Hospital, Seoul, 07061, South Korea
| | - Byung Cheon Lee
- Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, 02841, South Korea
| | - Vadim N Gladyshev
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Dolph L Hatfield
- Mouse Cancer Genetics Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Byeong Jae Lee
- Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, 08826, South Korea. .,Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, 08826, South Korea.
| | - Jin-Hong Kim
- Center for RNA Research, Institute for Basic Science, Seoul, 08826, South Korea. .,Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, 08826, South Korea. .,Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, 08826, South Korea.
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19
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Chang MJ, Shin JY, Yoon C, Kim TW, Chang CB, Kang SB. Effect of Sequential Intravenous and Oral Tranexamic Acid on Hemoglobin Drop After Total Knee Arthroplasty: A Randomized Controlled Trial. J Bone Joint Surg Am 2022; 104:154-159. [PMID: 34705756 DOI: 10.2106/jbjs.20.02174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is typically discontinued on the day of total knee arthroplasty (TKA). However, bleeding may persist for several days. We sought to determine whether sequential administration of intravenous (IV) and oral TXA could reduce hemoglobin (Hb) drop more than IV TXA alone. We also wanted to determine whether the use of additional oral TXA increased the rate of complications of deep vein thrombosis (DVT) or symptomatic pulmonary embolism (PE). METHODS This prospective, randomized controlled trial included 141 patients. We compared the Hb drop, estimated blood loss (EBL), and transfusion rate of patients receiving IV TXA alone (group IV, n = 48) to those of patients who received IV TXA followed by oral TXA for 2 days (group 2D, n = 46) or 5 days (group 5D, n = 47). IV TXA was administered 10 minutes prior to the tourniquet release and 3 hours after the first IV TXA administration. Computed tomography (CT) was performed on postoperative day 6 to identify radiographic evidence of DVT. We also assessed the prevalence of symptomatic DVT and PE. RESULTS There were no differences in maximal Hb drop, Hb drops measured at each time point, EBL, or transfusion rate among the 3 groups. The mean maximal Hb drop was 3.5 g/dL in group IV, 3.2 g/dL in group 2D, and 3.4 g/dL in group 5D. The mean EBL was 999.9 mL in group IV, 886.4 mL in group 2D, and 972.5 mL in group 5D. One patient in each group required a transfusion. There were no differences in the prevalence of radiographic evidence of DVT or symptomatic DVT. Symptomatic DVT occurred in 3 patients in group IV and 2 patients in group 5D. One patient in group IV developed a symptomatic PE. CONCLUSIONS Although there was no increase in the complication rate, the sequential administration of oral TXA for up to 5 days after IV TXA did not decrease Hb drop. Therefore, our findings suggest that sequential use of oral and IV TXA is not recommended. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Joung Youp Shin
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chan Yoon
- Department of Orthopedic Surgery, Seoul Bumin Hospital, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
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20
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Choi YS, Kim TW, Jeong JH, Han SB, Chang MJ, Chang CB, Kang SB. Comparative Analysis of T-score Discordance between a Registry-Based Korean Population and Atypical Femoral Fracture Patients of a Single Institution. Clin Orthop Surg 2022; 14:352-360. [PMID: 36061840 PMCID: PMC9393286 DOI: 10.4055/cios21258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of this study was to analyze the epidemiology of T-score discordance between the spine and femur in the South Korean population and compare the prevalence of T-score discordance between the Korean osteoporosis population and atypical femoral fracture (AFF) patients. Methods A total of 12,422 subjects from the Korea National Health and Nutrition Examination Survey were reviewed retrospectively. T-score discordance was defined as a difference of ≥ 1 standard deviation between the lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD). The prevalence of T-score discordance (low LS [LS BMD < FN BMD], low FN [LS BMD > FN BMD], and total [low LS + low FN]) was investigated in the osteoporosis and non-osteoporosis groups and stratified by sex and age. T-score discordance of 63 patients with AFFs diagnosed at a single institution was compared with that of the Korean osteoporosis population using propensity score matching. Results T-score discordance was prevalent in the Korean osteoporosis population (44.8%), and low LS discordance (37.5%) was more frequently seen than low FN discordance (7.2%) (p < 0.001). The prevalence of total and low LS discordance was significantly higher in AFF patients than in the Korean osteoporosis population (total discordance: 69.8% and 42.5%, respectively; low LS discordance: 63.5% and 31.7%, respectively; p < 0.001). Conclusions T-score discordance was highly prevalent in the Korean osteoporosis population, and low LS discordance was more common than low FN discordance. Nevertheless, the prevalence of low LS discordance was significantly higher in AFF patients than in the Korean osteoporosis population.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Hwa Jeong
- Joint center, Cheil Orthopedic Hospital, Seoul, Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University School of Medicine, Seoul, Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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21
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Cho Y, Jeong S, Kim H, Kang D, Lee J, Kang SB, Kim JH. Disease-modifying therapeutic strategies in osteoarthritis: current status and future directions. Exp Mol Med 2021; 53:1689-1696. [PMID: 34848838 PMCID: PMC8640059 DOI: 10.1038/s12276-021-00710-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/18/2021] [Accepted: 09/22/2021] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is the most common form of arthritis. It is characterized by progressive destruction of articular cartilage and the development of chronic pain and constitutes a considerable socioeconomic burden. Currently, pharmacological treatments mostly aim to relieve the OA symptoms associated with inflammation and pain. However, with increasing understanding of OA pathology, several potential therapeutic targets have been identified, enabling the development of disease-modifying OA drugs (DMOADs). By targeting inflammatory cytokines, matrix-degrading enzymes, the Wnt pathway, and OA-associated pain, DMOADs successfully modulate the degenerative changes in osteoarthritic cartilage. Moreover, regenerative approaches aim to counterbalance the loss of cartilage matrix by stimulating chondrogenesis in endogenous stem cells and matrix anabolism in chondrocytes. Emerging strategies include the development of senolytic drugs or RNA therapeutics to eliminate the cellular or molecular sources of factors driving OA. This review describes the current developmental status of DMOADs and the corresponding results from preclinical and clinical trials and discusses the potential of emerging therapeutic approaches to treat OA.
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Affiliation(s)
- Yongsik Cho
- grid.31501.360000 0004 0470 5905Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, 08826 South Korea ,grid.410720.00000 0004 1784 4496Center for RNA Research, Institute for Basic Science, Seoul, 08826 South Korea
| | - Sumin Jeong
- grid.31501.360000 0004 0470 5905Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, 08826 South Korea ,grid.31501.360000 0004 0470 5905Department of Business Administration, Business School, Seoul National University, Seoul, 08826 South Korea
| | - Hyeonkyeong Kim
- grid.31501.360000 0004 0470 5905Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, 08826 South Korea ,grid.410720.00000 0004 1784 4496Center for RNA Research, Institute for Basic Science, Seoul, 08826 South Korea
| | - Donghyun Kang
- grid.31501.360000 0004 0470 5905Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, 08826 South Korea ,grid.410720.00000 0004 1784 4496Center for RNA Research, Institute for Basic Science, Seoul, 08826 South Korea
| | - Jeeyeon Lee
- grid.31501.360000 0004 0470 5905Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, 08826 South Korea ,grid.410720.00000 0004 1784 4496Center for RNA Research, Institute for Basic Science, Seoul, 08826 South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Boramae Hospital, Seoul, 07061, South Korea.
| | - Jin-Hong Kim
- Department of Biological Sciences, College of Natural Sciences, Seoul National University, Seoul, 08826, South Korea. .,Center for RNA Research, Institute for Basic Science, Seoul, 08826, South Korea. .,Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, 08826, South Korea.
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22
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Topolnitskiy E, Chekalkin T, Marchenko E, Yasenchuk Y, Kang SB, Kang JH, Obrosov A. Evaluation of Clinical Performance of TiNi-Based Implants Used in Chest Wall Repair after Resection for Malignant Tumors. J Funct Biomater 2021; 12:jfb12040060. [PMID: 34842727 PMCID: PMC8628886 DOI: 10.3390/jfb12040060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022] Open
Abstract
In this study, we assessed the outcomes after surgical treatment of thoracic post-excision defects in 15 patients, using TiNi knitted surgical meshes and customized artificial TiNi-based ribs. Methods: Eight patients were diagnosed with advanced non-small cell lung cancer (NSCLC) invading the chest wall, of which five patients were T3N0M0, two were T3N1M0, and one was T3N2M0. Squamous cell carcinoma was identified in three of these patients and adenocarcinoma in five. In two cases, chest wall resection and repair were performed for metastases of kidney cancer after radical nephrectomy. Three-dimensional CT reconstruction and X-ray scans were used to plan the surgery and customize the reinforcing TiNi-based implants. All patients received TiNi-based devices and were prospectively followed for a few years. Results: So far, there have been no lethal outcomes, and all implanted devices were consistent in follow-up examinations. Immediate complications were noted in three cases (ejection of air through the pleural drains, paroxysm of atrial fibrillation, and pleuritis), which were conservatively managed. In the long term, no complications, aftereffects, or instability of the thoracic cage were observed. Conclusion: TiNi-based devices used for extensive thoracic lesion repair in this context are promising and reliable biomaterials that demonstrate good functional, clinical, and cosmetic outcomes.
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Affiliation(s)
- Evgeniy Topolnitskiy
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
- Department of Surgery, Siberian State Medical University, 634050 Tomsk, Russia
| | - Timofey Chekalkin
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
- R&D Center, TiNiKo Co., Ochang 28119, Korea;
- Correspondence:
| | - Ekaterina Marchenko
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
| | - Yuri Yasenchuk
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
| | - Seung-Baik Kang
- Boramae Medical Center, Seoul National University Hospital, Seoul 07061, Korea;
| | | | - Aleksei Obrosov
- Laboratory of Medical Materials, Tomsk State University, 634045 Tomsk, Russia; (E.T.); (E.M.); (Y.Y.); (A.O.)
- Department of Physical Metallurgy and Materials Technology, Brandenburg University of Technology, 03-046 Cottbus, Germany
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23
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Park HJ, Kang SB, Park J, Chang MJ, Kim TW, Chang CB, Choi BS. Patterns and Distribution of Deep Vein Thrombosis and Its Effects on Clinical Outcomes After Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med 2021; 9:23259671211030883. [PMID: 34692875 PMCID: PMC8532235 DOI: 10.1177/23259671211030883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Although a few studies have reported the incidence of deep vein thrombosis (DVT) after opening-wedge high tibial osteotomy (OWHTO), previous studies focused only on symptomatic DVT. Information is lacking regarding the overall incidence of DVT after OWHTO, thrombus location, and the relationship between DVT and clinical outcome. Purpose: To determine the overall incidence of DVT and classify the location of DVT after OWHTO. We also determined whether significant differences in clinical improvement exist in patients with and without DVT at 6 months and at 2 years after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included 46 patients (47 knees) who underwent OWHTO. All patients were instructed to perform knee range of motion exercises and partial weightbearing after drain removal. None of the patients received a chemoprophylaxis for DVT except intermittent pneumatic compression. DVT was diagnosed using 128-row multidetector computed tomography performed before discharge on the fourth postoperative day. The location was classified into 6 segments in the distal portion (muscular and axial veins) and proximal portion (popliteal, femoral, and common femoral veins and veins located above the iliac vein). International Knee Documentation Committee (IKDC) score was assessed preoperatively and postoperatively at 6 months, 1 year, and 2 years using a linear mixed model. Results: Although the incidence of symptomatic DVT was 8.5% (n = 4), the overall incidence of early DVT was 44.7% (n = 21). All DVTs were located in the distal portion of the lower extremity vein, and 76.2% of the DVTs were located in an axial vein. The IKDC scores were 33.6 ± 7.2 and 35.3 ± 9.1 (P = .910) preoperatively, 38.1 ± 5.6 and 40.6 ± 8.4 (P = .531) at 6 months after surgery, and 44.8 ± 6.9 and 45.9 ± 11.4 (P = .786) at 2 years after surgery in patients without and those with DVT, respectively. Conclusion: The overall incidence of early DVT after OWHTO was 44.7%. DVT after OWHTO was found particularly around the osteotomy site (76.2%). Patients with DVT did not have inferior short-term clinical outcomes after surgery.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jisu Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Byung Sun Choi
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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24
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Suh D, Chang MJ, Park HJ, Chang CB, Kang SB. Assessment of Anterolateral Ligament of the Knee After Primary Versus Revision Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:23259671211026237. [PMID: 34676268 PMCID: PMC8524717 DOI: 10.1177/23259671211026237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/28/2021] [Indexed: 01/26/2023] Open
Abstract
Background: The anterolateral ligament of the knee (ALL) is a component of the lateral
complex that stabilizes the structure against rotational force and may be
associated with the outcome of anterior cruciate ligament (ACL)
reconstruction (ACLR). Purpose: To (1) find whether the visibility of the structure of the ALL is different
in primary and revision ACLR groups, (2) determine whether the abnormal
findings of the ALL structure on magnetic resonance imaging (MRI) scans are
associated with type of trauma in ACL injury and mode of graft failure, and
(3) determine whether there are differences in knee functional scores
between patients with or without abnormal findings of the ALL structure on
MRI scans in primary and revision ACLR groups. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 40 patients who underwent primary ACLR and
39 patients who underwent revision ACLR. Conventional MRI (1.5-T) scans
taken before primary or revision ACLR were obtained and analyzed for
visibility of the ALL, frequency and degree of injury of the ALL, and ALL
signal anomalies. We also evaluated 1-year postoperative functional knee
scores using the subjective International Knee Documentation Committee and
Lysholm scores. Results: Visibility of the ALL was better in the primary ACLR group than the revision
ACLR group (38% vs 14%; P = .041). The primary ACLR group
showed a lower degree of injury across the femoral, meniscal, and tibial
attachment sites than did the revision ACLR group (30% vs 13%, 41% vs 8%,
and 62% vs 26%, respectively). Relative signal anomaly of the ALL was more
frequent in the case of contact versus noncontact trauma of the ACL (85% vs
15%; P = .035), while absolute signal anomaly was equally
observed between cases of contact and noncontact trauma in the primary ACLR
group (50% vs 50%). No association was observed between ALL signal anomalies
and 1-year postoperative functional knee scores. Conclusion: The revision ACLR group offered less visibility and showed a tendency for
more frequent, higher degree of injury to the structure of the ALL.
Regardless of observational differences between the 2 groups, no definite
relevance was observed between the image and the functional outcome. For the
assessment of the ALL, routinely performed conventional MRI alone is
insufficient to make a clinical decision.
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Affiliation(s)
- Dongwhan Suh
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Daejeon, Republic of Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung Jun Park
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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25
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Lee NK, Lee KM, Han H, Koo S, Kang SB, Chang CB. Relationship between radiographic measurements and knee adduction moment using 3D gait analysis. Gait Posture 2021; 90:179-184. [PMID: 34492504 DOI: 10.1016/j.gaitpost.2021.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/13/2021] [Accepted: 08/30/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Radiographic factors estimate the state of the static knee joint, and it is questionable how well these parameters reflect the dynamic knee condition. The external knee adduction moment (KAM) during gait is known to be a kinetic variable contributing to osteoarthritis progression. This study aims to investigate the effects of static radiographic parameters on the dynamic KAM during gait. METHODS Overall, 123 patients (mean age, 65.7 years; standard deviation, 8.1 years; 34 men and 89 women) were included. Seven radiographic parameters including the mechanical tibiofemoral angle (mTFA), Kellgren-Lawrence grade, and ankle joint line orientation (AJLO) were measured on radiographs, and the maximum KAM and KAM-time integral in the stance phase were obtained using three-dimensional gait analysis. The correlation and multiple regression analyses were performed for identifying significant radiographic measurements associated with the KAM. RESULTS Most of the radiographic measurements correlated with the maximum KAM and KAM-time integral. As a result of multiple regression analysis, the mTFA (p < 0.001) and AJLO (p = 0.003) were identified as significant factors associated with the KAM-time integral (R2 = 0.450); the mTFA (p < 0.001) and AJLO (p = 0.003) were identified as a significant factor associated with the maximum KAM (R2 = 0.352) in multiple regression analysis. The discriminant validity of KAM was highest at varus 5.7 degree of the mTFA and 7.5 degree of the AJLO. SIGNIFICANCE The mTFA and AJLO were significantly associated with the KAM. However, to be used as a surgical indication for corrective osteotomy, a longitudinal study is needed to validate whether the mTFA and AJLO values directly cause osteoarthritis progression as we have suggested. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Na-Kyoung Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea.
| | - Heesoo Han
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seungbum Koo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejon, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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26
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Cho S, Lee H, Hwang JY, Choi JS, Kim HJ, Kim TW, Kang SB. Prevalence and Characteristics of Onychomycosis in Patients with Knee Osteoarthritis: A Single-centre Prospective Cross-sectional Study. Acta Derm Venereol 2021; 101:adv00526. [PMID: 34405245 PMCID: PMC9413647 DOI: 10.2340/00015555-3895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Knee disorders that compromise patients’ lower leg movements and self-care may put these patients at greater risk of onychomycosis. However, little is known about the prevalence of onychomycosis in patients with knee diseases. This study evaluated the prevalence and characteristics of onychomycosis in patients with knee osteoarthritis. A total of 520 consecutive patients with symptomatic knee osteoarthritis who visited the Department of Orthopedics for a potential knee surgery were evaluated for onychomycosis by PCR-based reverse blot hybridization assay. Of the 520 patients, 308 (59.2%) were diagnosed with onychomycosis. Age (p = 0.004), male sex (p = 0.015), and being barefooted (p = 0.031) were statistically significant risk factors for onychomycosis. Knee disease severity, based on Kellgren-Lawrence grade, was associated with severity of onychomycosis. The impairment of physical function and self-care caused by knee disorders may increase the prevalence of onychomycosis in these patients.
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Affiliation(s)
- Soyun Cho
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
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27
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Park HJ, Kang SB, Chang MJ, Chang CB, Jung WH, Jin H. Association of Gap Healing With Angle of Correction After Opening-Wedge High Tibial Osteotomy Without Bone Grafting. Orthop J Sports Med 2021; 9:23259671211002289. [PMID: 34026915 PMCID: PMC8120544 DOI: 10.1177/23259671211002289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Studies have reported that opening wedge high tibial osteotomy (OWHTO) without bone grafting has outcomes that are similar to or even better than those of OWHTO with bone grafting, especially after use of a locking plate. However, a consensus on managing the gap after OWHTO has not been established. Purpose: To determine the degree of gap healing achieved without bone grafting, the factors associated with gap healing, and whether additional gap healing would be obtained after plate removal. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 73 patients who underwent OWHTO without bone grafting between 2015 and 2018. Patients in the study were divided into 2 groups based on the correction angle: small correction group (<10°; SC group) and large correction group (≥10°; LC group). The locking plate used in OWHTO was removed at a mean of 13.5 months after surgery in 65 patients. Radiographic indexes were measured: gap filling height, gap vacancy ratio (GVR), and osteotomy filling index. The acceptable gap healing was defined as an osteotomy filling index ≥3. The factors related to gap healing around the osteotomy site were selected after multicollinearity analysis. Results: Although both groups achieved acceptable gap healing regardless of the correction angle, the SC group showed higher and earlier gap healing than did the LC group (gap healing rate 81.4% in the SC group vs 41.7% in the LC group at 3 months postoperatively). The GVR was 8.6% in the SC group and 15.3% in the LC group at 12 months after surgery (P = .005). Both the amount of time that elapsed after surgery and the correction angle were associated with gap healing (P < .05). Additional gap healing was observed after plate removal, as the GVR decreased 2.7% more in the patients with plate removal than in patients who did not have plate removal (P = .012). Conclusion: All patients achieved acceptable gap healing without bone graft. The degree of gap healing was higher in the SC group and increased over time. Gap healing was promoted after plate removal. Considering the results of this study, a bone graft is not necessary in routine OWHTO in terms of gap healing.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Woon Hwa Jung
- Department of Orthopedic Surgery, Murup Hospital, Gyeongnam, Republic of Korea
| | - Heejin Jin
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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Lee Y, Kim J, Kim MS, Kwon Y, Shin S, Yi H, Kim H, Chang MJ, Chang CB, Kang SB, Kim VN, Kim JH, Kim JS, Elledge SJ, Kang C. Coordinate regulation of the senescent state by selective autophagy. Dev Cell 2021; 56:1512-1525.e7. [PMID: 33915088 DOI: 10.1016/j.devcel.2021.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/05/2021] [Accepted: 04/05/2021] [Indexed: 01/10/2023]
Abstract
Cellular senescence is a complex stress response implicated in aging. Autophagy can suppress senescence but is counterintuitively necessary for full senescence. Although its anti-senescence role is well described, to what extent autophagy contributes to senescence establishment and the underlying mechanisms is poorly understood. Here, we show that selective autophagy of multiple regulatory components coordinates the homeostatic state of senescence. We combined a proteomic analysis of autophagy components with protein stability profiling, identifying autophagy substrate proteins involved in several senescence-related processes. Selective autophagy of KEAP1 promoted redox homeostasis during senescence. Furthermore, selective autophagy limited translational machinery components to ameliorate senescence-associated proteotoxic stress. Lastly, selective autophagy of TNIP1 enhanced senescence-associated inflammation. These selective autophagy networks appear to operate in vivo senescence during human osteoarthritis. Our data highlight a caretaker role of autophagy in the stress support network of senescence through regulated protein stability and unravel the intertwined relationship between two important age-related processes.
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Affiliation(s)
- Yeonghyeon Lee
- School of Biological Sciences, Seoul National University, Seoul 08826, South Korea
| | - Jaejin Kim
- School of Biological Sciences, Seoul National University, Seoul 08826, South Korea
| | - Mi-Sung Kim
- School of Biological Sciences, Seoul National University, Seoul 08826, South Korea
| | - Yoojin Kwon
- School of Biological Sciences, Seoul National University, Seoul 08826, South Korea
| | - Sanghee Shin
- School of Biological Sciences, Seoul National University, Seoul 08826, South Korea; Center for RNA Research, Institute of Basic Science, Seoul 08826, South Korea
| | - Hyerim Yi
- School of Biological Sciences, Seoul National University, Seoul 08826, South Korea; Center for RNA Research, Institute of Basic Science, Seoul 08826, South Korea
| | - Hyeonkyeong Kim
- School of Biological Sciences, Seoul National University, Seoul 08826, South Korea; Center for RNA Research, Institute of Basic Science, Seoul 08826, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Boramae Hospital, Seoul 07061, South Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Boramae Hospital, Seoul 07061, South Korea
| | - V Narry Kim
- School of Biological Sciences, Seoul National University, Seoul 08826, South Korea; Center for RNA Research, Institute of Basic Science, Seoul 08826, South Korea
| | - Jin-Hong Kim
- School of Biological Sciences, Seoul National University, Seoul 08826, South Korea; Center for RNA Research, Institute of Basic Science, Seoul 08826, South Korea
| | - Jong-Seo Kim
- School of Biological Sciences, Seoul National University, Seoul 08826, South Korea; Center for RNA Research, Institute of Basic Science, Seoul 08826, South Korea
| | - Stephen J Elledge
- Department of Genetics, Harvard Medical School and Division of Genetics, Brigham and Women's Hospital, Howard Hughes Medical Institute, Boston, MA 02115, USA
| | - Chanhee Kang
- School of Biological Sciences, Seoul National University, Seoul 08826, South Korea.
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Han HS, Yun KR, Cho K, Kim TW, Kang SB. Relationships between the changes in flexion contracture and standing flexion angle of the knee and sagittal spinal alignment after total knee arthroplasty. Knee 2021; 29:374-380. [PMID: 33706029 DOI: 10.1016/j.knee.2021.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/02/2020] [Accepted: 02/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The sagittal spinal alignment interacts with the lower extremity in patients with combined degenerative disease of the spine and lower extremity. This study aimed to clarify the relationships between the reciprocal changes in sagittal alignment of the knee, pelvis, and spine after total knee arthroplasty (TKA) in osteoarthritis patients. METHODS Prospectively, 36 patients who underwent primary TKA for severe knee osteoarthritis were enrolled. Their clinical and radiological evaluation included assessments of the knee flexion contracture (KFC) and standing knee flexion angle (KFA), as well as spinopelvic parameters and the global sagittal spinal alignment from standing whole-lower-extremity and whole-spine radiographs preoperatively and at postoperative 2 weeks, 6 weeks, 6 months, 1 year, and 2 years. Linear mixed models were used to assess the relationships between KFC/KFA and between spinopelvic/global sagittal spinal alignments. RESULTS The KFC decreased abruptly immediately after TKA, and the correction was maintained for 2 years postoperatively. The KFA decreased gradually and approached the value of the KFC after 2 years. Of the spinopelvic parameters, sacral slope and pelvic incidence decreased significantly, in ways related to changes in KFA. There was no significant relationship between sagittal spinal alignment and postoperative changes in KFC. CONCLUSION Although the flexion contracture was corrected immediately after TKA, the standing KFA improved gradually over 2 years. The pelvic parameters showed compensatory changes according to the KFA. The decompensated sagittal spinal malalignment was not related to a relapse in flexion contracture.
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Affiliation(s)
- Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Kuk-Ro Yun
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Kwanjae Cho
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea.
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Park HJ, Chang MJ, Kang SB, Hwang IU, Kim JS, Chang CB. Effects of preoperative, scheduled administration of antiemetics in reducing postoperative nausea and vomiting in patients undergoing total knee arthroplasty. Medicine (Baltimore) 2021; 100:e24143. [PMID: 33429790 PMCID: PMC7793323 DOI: 10.1097/md.0000000000024143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
There is no established protocol regarding the timing of administration of antiemetics in patients undergoing total knee arthroplasty (TKA). The purpose of this study was to determine whether preoperative, rather than postoperative administration of an antiemetic could reduce postoperative nausea and vomiting (PONV) in patients undergoing TKA, and whether there was a difference in postoperative pain, patient satisfaction and complications after TKA between the 2 different administration times.The included patients (N = 101) either received intravenous administration of the ramosetron 1 hour before surgery (N = 50) or at the end of surgery (N = 51) consecutively order. The incidence of PONV and the frequency of rescue medicine use were recorded until 48 hours postoperatively. The severity of postoperative pain and patient satisfaction were assessed using the visual analogue scale. The incidence of complications associated with use of antiemetic was assessed.Preoperative administration of ramosetron did not decrease PONV during the first 48 hours. There was no significant difference in the incidence of nausea and vomiting, use of rescue antiemetics, and the severity of nausea (P > .05). Postoperative pain, satisfaction scores, and the incidence of complications were not different between the 2 groups (P > .05).Preoperative administration of ramosetron did not show clinical advantage in reducing POVN, postoperative pain and improving patient satisfaction. However, the outcomes of complications were not inferior to those of postoperative administration. Therefore, under the current protocol of multimodal therapies, timing of administration of pre-emptive antiemetic did not have significant effect on PONV.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Il-ung Hwang
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
| | - Jong Seop Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
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Kim HJ, Park HJ, Oh JB, Chang MJ, Kang SB, Kim YK, Oh SH, Chang CB. Retrospective study of relationship between vastus medialis volume on SPECT-CT and outcome of unilateral total knee arthroplasty. Medicine (Baltimore) 2021; 100:e24138. [PMID: 33429788 PMCID: PMC7793406 DOI: 10.1097/md.0000000000024138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/08/2020] [Indexed: 01/05/2023] Open
Abstract
Although the importance of quadriceps femoris function was reported previously, little is known about volume-related factors and their effects on clinical outcomes after total knee arthroplasty (TKA). We sought to determine whether there was a bilateral difference in vastus medialis muscle volume measured on single-photon emission computed tomography-computed tomography (SPECT-CT) in patients who underwent unilateral TKA. We also aimed to determine whether vastus medialis volume was related to osteoarthritis (OA) severity or scintigraphic uptake degree around the knee joint on SPECT-CT. And finally, we attempted to investigate the factors, such as vastus medialis volume and scintigraphic uptake degree, associated with the functional outcomes of TKA.This retrospective study included 50 patients (41 female, 9 male) undergone unilateral TKA due to primary OA. The maximal cross-sectional area of the vastus medialis was measured on axial SPECT-CT images. Scintigraphic uptake degrees and Kellgren-Lawrence (K-L) grade at the tibiofemoral joints were assessed. We compared maximal cross-sectional area of the vastus medialis on SPECT-CT for difference of bilateral lower limbs. We also analyzed the relationship between volume of vastus medialis and scintigraphic uptake measured on SPECT-CT and the severity of OA on conventional radiographs. The clinical outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at baseline and at 1 and 2 years after surgery. The relationship between preoperative muscle volume and scintigraphic uptake on SPECT-CT and WOMAC index was analyzed.The amount of muscle volume measured on SPECT-CT was smaller in operated limb in patients who underwent unilateral TKA. Preoperative vastus medialis muscle volume was not related to preoperative OA severity measured on conventional radiographs and scintigraphic uptake on SPECT-CT. However, a decreased vastus medialis muscle volume was related to worse clinical outcomes after TKA (P = .045), whereas the degree of scintigraphic uptake on SPECT-CT was not associated with postoperative clinical outcomes.Muscle volume of vastus medialis was decreased in the operated knee than in the nonoperated knee, and that was correlated with worse postoperative results. Even if the preoperative volume of vastus medialis were not related to OA severity on conventional radiographs and scintigraphic uptake on SPECT-CT, preservation and improvement of the muscle mass of the knee undergoing TKA is important.
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Affiliation(s)
| | | | | | | | | | | | - So Hee Oh
- Department of Biostatistics, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Kim TW, Kang SB, Chang CB, Moon SY, Lee YK, Koo KH. Current Trends and Projected Burden of Primary and Revision Total Knee Arthroplasty in Korea Between 2010 and 2030. J Arthroplasty 2021; 36:93-101. [PMID: 32703708 DOI: 10.1016/j.arth.2020.06.064] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to (1) document the total knee arthroplasty (TKA) use in Korea from 2010 to 2018, (2) evaluate whether rapid increase in TKA use has been maintained, and (3) estimate the projected TKA burden to 2030 based on the current use. METHODS Using the Health Insurance Review and Assessment Korean database, procedural rate, growth rate, and revision burden of primary and revision TKAs in Korea between 2010 and 2018 were analyzed. TKA procedural numbers were also stratified by age and gender. Then, the projected TKA burden to 2030 including procedural number and medical costs were estimated using linear and quasi-Poisson regression models, respectively. RESULTS Between 2010 and 2018, procedural rate of primary and revision TKAs has increased by 35% and 68%, respectively. More than 85% of primary and revision TKAs were performed on female patients, and the subgroup of patients aged ≥80 years showed a marked increase in primary and revision TKA use. According to the projection model, the number of primary and revision TKAs is predicted to increase between 53% and 91%, and between 75% and 155%, respectively, by 2030. CONCLUSION Between 2010 and 2018, the procedural rates of primary and revision TKAs in Korea increased gradually by 35% and 68%, respectively, and previously observed striking growth rate has markedly slowed. Nevertheless, compared to 2018, the burdens of primary and revision TKAs are projected to increase up to 91% and 155%, respectively, by 2030. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Tae Woo Kim
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Sun-Young Moon
- Department of Public Health Science, Complex Disease and Genome Epidemiology Branch, School of Public Health, Seoul National University, Seoul, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul, South Korea
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Shin JY, Chang MJ, Kim MK, Kang SB, Kim KI, Park HG, Lee S, Kim SH, Han SB, Lee HJ, Moon YW, Yoo JD. Efficacy and safety of short-term use of a pelubiprofen CR and aceclofenac in patients with symptomatic knee osteoarthritis: A double-blinded, randomized, multicenter, active drug comparative, parallel-group, phase IV, non-inferiority clinical trial. PLoS One 2020; 15:e0238024. [PMID: 32991606 PMCID: PMC7523996 DOI: 10.1371/journal.pone.0238024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/07/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION At present, information about clinical efficacy and adverse events of controlled release (CR) form of pelubiprofen, a prodrug of 2-arylopropionic acid with relatively selective effects on cyclooxygenase-2 activity, remains scarce. In this study, we sought to determine non-inferiority of pelubiprofen CR 90 mg/day compared to aceclofenac 200 mg/day regarding clinical efficacy and adverse events after a 4-week course of medication in the patients with symptomatic knee osteoarthritis. MATERIALS AND METHODS A total of 191 patients were randomly assigned to take either pelubiprofen CR 90 mg (n = 95) or aceclofenac 200 mg (n = 96). The primary outcome variable was non-inferiority of pain reduction between baseline and week 4 when assessed using a 100 mm pain visual analogue scale (VAS). Pelubiprofen was considered non-inferior to aceclofenac if the upper limit of the one-sided 97.5% confidence interval for the difference in terms of pain VAS was above 15 mm (the average change of pain VAS in the pelubiprofen group-pain VAS reduction in the aceclofenac group). Secondary outcome variables were the changes in 100 mm pain VAS at week 2 versus baseline, K-Western Ontario, and McMaster University Arthritis Index (K-WOMAC) changes at weeks 2 and 4 as compared to baseline, patient global assessment at weeks 2 and 4. The frequency and amount of rescue medicine usage at weeks 2 and 4 were also evaluated as the secondary outcome variable. For safety analysis, adverse events, clinical laboratory tests, vital signs, and physical examinations were assessed and conducted at each follow-up visit. RESULTS At week 4, the pain VAS values were significantly reduced in both groups receiving either pelubiprofen CR 90 mg or aceclofenac 200 mg as compared to the baseline. However, the pelubiprofen group and the aceclofenac group respectively showed the pain VAS changes of -22 and -21.9 in the pre-protocol set and -20.8 and -21.7 in the full analysis set, confirming non-inferiority. The pelubiprofen CR 90 mg showed a reduced incidence of adverse events compared to the aceclofenac 200 mg (p = 0.005). CONCLUSIONS Pelubiprofen CR 90 mg is as effective as aceclofenac 200 mg with reduced adverse events for the treatment of symptomatic knee osteoarthritis.
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Affiliation(s)
- Joung Youp Shin
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myung Ku Kim
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Republic of Korea
- * E-mail:
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hee Gon Park
- Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Sahnghoon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Korea University Medical Center, Seoul, Republic of Korea
| | - Han Jun Lee
- Department of Orthopaedic Surgery, Chung-Ang University, School of Medicine, Seoul, Republic of Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Doo Yoo
- Department of Orthopaedic Surgery, Ewha Womans University School of Medicine, Ewha Medical Research Center, Seoul, Republic of Korea
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Kim MS, Chun CH, Wang JH, Kim JG, Kang SB, Yoo JD, Chon JG, Kim MK, Moon CW, Chang CB, Song IS, Ha JK, Choi NY, In Y. Microfractures Versus a Porcine-Derived Collagen-Augmented Chondrogenesis Technique for Treating Knee Cartilage Defects: A Multicenter Randomized Controlled Trial. Arthroscopy 2020; 36:1612-1624. [PMID: 31785390 DOI: 10.1016/j.arthro.2019.11.110] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/01/2019] [Accepted: 11/16/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical efficacy and safety of treating patients with a cartilage defect of the knee with microfractures and porcine-derived collagen-augmented chondrogenesis technique (C-ACT). METHODS One hundred participants were randomly assigned to the control group (n = 48, microfracture) or the investigational group (n = 52, C-ACT). Clinical and magnetic resonance imaging (MRI) outcomes were assessed 12 and 24 months postoperatively for efficacy and adverse events. Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) assessment was used to analyze cartilage tissue repair. MRI outcomes for 50% defect filling and repaired tissue/reference cartilage (RT/RC) ratio were quantified using T2 mapping. Clinical outcomes were assessed using the visual analogue scale (VAS) for pain and 20% improvement, minimal clinically important difference (MCID), and patient acceptable symptom state for Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee score. RESULTS MOCART scores in the investigation group showed improved defect repair and filling (P = .0201), integration with the border zone (P = .0062), and effusion (P = .0079). MRI outcomes showed that the odds ratio (OR) for ≥50% defect filling at 12 months was statistically higher in the investigation group (OR 3.984, P = .0377). Moreover, the likelihood of the RT/RC OR becoming ≥1 was significantly higher (OR 11.37, P = .0126) in the investigation group. At 24 months postoperatively, the OR for the VAS 20% improvement rate was significantly higher in the investigational group (OR 2.808, P = .047). Twenty-three patients (52.3%) in the control group and 35 (77.8%) in the investigation group demonstrated more than the MCID of KOOS pain from baseline to 1 year postoperatively, with a significant difference between groups (P = .0116). CONCLUSION In this multicenter randomized trial, the addition of C-ACT resulted in better filling of cartilage defect of the knee joint. LEVEL OF EVIDENCE Level Ⅰ, Multicenter Randomized Controlled Trial.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Churl Hong Chun
- Department of Orthopaedic Surgery, Wonkwang University Hospital, College of Medicine, Wonkwang University, Iksan, Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, College of Medicine, Sungkyunkwan University of School of Medicine, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Doo Yoo
- Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Je-Gyun Chon
- Department of Orthopaedic Surgery, Daejeon Sun Hospital, Daejeon, Korea
| | - Myung Ku Kim
- Department of Orthopaedic Surgery, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Chan Woong Moon
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - In Soo Song
- Department of Orthopaedic Surgery, Daejeon Sun Hospital, Daejeon, Korea
| | - Jeong Ku Ha
- Department of Orthopedic Surgery, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Nam Yong Choi
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Kang D, Shin J, Cho Y, Kim HS, Gu YR, Kim H, You KT, Chang MJ, Chang CB, Kang SB, Kim JS, Kim VN, Kim JH. Stress-activated miR-204 governs senescent phenotypes of chondrocytes to promote osteoarthritis development. Sci Transl Med 2020; 11:11/486/eaar6659. [PMID: 30944169 DOI: 10.1126/scitranslmed.aar6659] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/14/2018] [Accepted: 02/22/2019] [Indexed: 12/17/2022]
Abstract
A progressive loss of cartilage matrix leads to the development of osteoarthritis (OA). Matrix homeostasis is disturbed in OA cartilage as the result of reduced production of cartilage-specific matrix and increased secretion of catabolic mediators by chondrocytes. Chondrocyte senescence is a crucial cellular event contributing to such imbalance in matrix metabolism during OA development. Here, we identify miR-204 as a markedly up-regulated microRNA in OA cartilage. miR-204 is induced by transcription factors GATA4 and NF-κB in response to senescence signals. Up-regulated miR-204 simultaneously targets multiple components of the sulfated proteoglycan (PG) biosynthesis pathway, effectively shutting down PG anabolism. Ectopic expression of miR-204 in joints triggers spontaneous cartilage loss and OA development, whereas miR-204 inhibition ameliorates experimental OA, with concomitant recovery of PG synthesis and suppression of inflammatory senescence-associated secretory phenotype (SASP) factors in cartilage. Collectively, we unravel a stress-activated senescence pathway that underlies disrupted matrix homeostasis in OA cartilage.
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Affiliation(s)
- Donghyun Kang
- Center for RNA Research, Institute for Basic Science, 08826 Seoul, South Korea.,Department of Biological Sciences, College of Natural Sciences, Seoul National University, 08826 Seoul, South Korea
| | - Jungkwon Shin
- Center for RNA Research, Institute for Basic Science, 08826 Seoul, South Korea.,Department of Biological Sciences, College of Natural Sciences, Seoul National University, 08826 Seoul, South Korea
| | - Yongsik Cho
- Center for RNA Research, Institute for Basic Science, 08826 Seoul, South Korea.,Department of Biological Sciences, College of Natural Sciences, Seoul National University, 08826 Seoul, South Korea
| | - Hyeon-Seop Kim
- Center for RNA Research, Institute for Basic Science, 08826 Seoul, South Korea.,Department of Biological Sciences, College of Natural Sciences, Seoul National University, 08826 Seoul, South Korea
| | - Young-Ran Gu
- Center for RNA Research, Institute for Basic Science, 08826 Seoul, South Korea.,Department of Biological Sciences, College of Natural Sciences, Seoul National University, 08826 Seoul, South Korea
| | - Haedong Kim
- Center for RNA Research, Institute for Basic Science, 08826 Seoul, South Korea.,Department of Biological Sciences, College of Natural Sciences, Seoul National University, 08826 Seoul, South Korea
| | - Kwon Tae You
- Center for RNA Research, Institute for Basic Science, 08826 Seoul, South Korea.,Department of Biological Sciences, College of Natural Sciences, Seoul National University, 08826 Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Boramae Hospital, 07061 Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Boramae Hospital, 07061 Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Boramae Hospital, 07061 Seoul, South Korea
| | - Jong-Seo Kim
- Center for RNA Research, Institute for Basic Science, 08826 Seoul, South Korea.,Department of Biological Sciences, College of Natural Sciences, Seoul National University, 08826 Seoul, South Korea
| | - V Narry Kim
- Center for RNA Research, Institute for Basic Science, 08826 Seoul, South Korea.,Department of Biological Sciences, College of Natural Sciences, Seoul National University, 08826 Seoul, South Korea
| | - Jin-Hong Kim
- Center for RNA Research, Institute for Basic Science, 08826 Seoul, South Korea. .,Department of Biological Sciences, College of Natural Sciences, Seoul National University, 08826 Seoul, South Korea.,Interdisciplinary Program in Bioinformatics, Seoul National University, 08826 Seoul, South Korea
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Yoon C, Chang MJ, Chang CB, Chai JW, Jeong H, Song MK, Shin JH, Kang SB. Bone Mineral Density Around the Knee Joint: Correlation With Central Bone Mineral Density and Associated Factors. J Clin Densitom 2020; 23:82-91. [PMID: 30120026 DOI: 10.1016/j.jocd.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/04/2018] [Accepted: 07/10/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The aims of this study were to (1) assess the bone mineral density (BMD) around the knee joint, (2) determine the correlation between central and knee BMDs, and (3) investigate the factors associated with BMD around the knee joint in patients with knee osteoarthritis (OA). METHODOLOGY This cross-sectional study included 122 patients who underwent total knee arthroplasty. Central and knee dual-energy X-ray absorptiometry was performed preoperatively. BMD at 6 regions of interest (ROIs) around the knee joint were measured, and their correlations with central BMD were determined using Spearman's correlation analysis. Lower limb alignment, severity of OA, body mass index (BMI), preoperative functional and pain scores were assessed to elucidate the factors associated with knee BMD using linear regression analysis. RESULTS Around the knee joint, BMD was the lowest at the distal femoral metaphysis and lateral tibial condyle. Knee BMD was significantly correlated with central BMD. However, the correlation coefficients varied by the ROI. Additionally, multivariate analysis revealed different associations with respect to the regions around the knee joint. Varus alignment of the lower limb was associated with increased BMD of the medial condyles and decreased BMD of lateral condyles. High grade OA was a protective factor; it was associated with increased BMD at the lateral condyles of the femur and tibia. Higher BMI was an independent protective factor in all ROIs around the knee joint except the lateral femoral condyles. Lower functional level was not associated with decreased BMD, whereas a higher pain score was significantly associated with lower BMD at the proximal tibial metaphysis. CONCLUSIONS Knee BMD was significantly correlated with central BMD. However, the correlations varied with the regions around the knee joint probably due to their independent association with the alignment of the lower limb, severity of OA, BMI, and preoperative pain level.
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Affiliation(s)
- Chan Yoon
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea;.
| | - Jee Won Chai
- Department of Radiology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Hyunseok Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Min Kyu Song
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Jae Hoon Shin
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
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Chang MJ, Lee SA, Kang SB, Hwang KM, Park HJ, Lee KH, Seo JG, Chang CB. A retrospective comparative study of infection control rate and clinical outcome between open debridement using antibiotic-impregnated cement beads and a two-stage revision in acute periprosthetic knee joint infection. Medicine (Baltimore) 2020; 99:e18891. [PMID: 31977899 PMCID: PMC7004723 DOI: 10.1097/md.0000000000018891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to determine whether the infection control rate of a modified debridement, antibiotics, and implant retention (DAIR) protocol (DAIR with antibiotic-impregnated cement beads) is comparable to that of 2-stage revision for acute periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). We also aimed to determine whether this modified DAIR technique produced better clinical results than those obtained using 2-stage revision in terms of functional outcome, range of motion (ROM), and patient satisfaction at 2 years after surgery.This retrospective comparative study included patients who underwent modified DAIR (7 patients, 9 knees) or 2-stage revision (8 patients, 9 knees) for acute PJI of the knee joint. Infection control rate, functional outcome measured using Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, ROM and patient satisfaction were compared between the two groups.There was no difference in infection control rates between the modified DAIR and 2-stage revision groups (78% vs 78%, respectively). In contrast, surgical outcome in the modified DAIR group was tended to be better than 2-stage revision group, but it did not reach statistical significance. Median maximal range of flexion was 103° in the modified DAIR group and it was 90° in the 2-stage group (P = .191). In addition, the median WOMAC function score was 24 in the modified DAIR group and it was 30 in the 2-stage group (P = .076). Median patient satisfaction measured using visual analogue scale was 8 in the modified DAIR group and 5 in the 2-stage group (P = .069).The infection control rates of the modified DAIR protocol and 2-stage revision protocol were similar for the treatment of acute PJI of the knee joint. However, the modified DAIR protocol could not provide substantially increased functional outcomes and patient satisfaction compared to 2-stage revision. Therefore, the modified DAIR technique should be considered to be of limited use in patients with high surgical morbidity.
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Affiliation(s)
- Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Keum Min Hwang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Hyung Jun Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Kyoung Hwan Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
| | - Jai Gon Seo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center
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Chang MJ, Kang SB, Chang CB, Han DH, Park HJ, Hwang K, Park J, Hwang IU, Lee SA, Oh S. Posterior condylar offset changes and its effect on clinical outcomes after posterior-substituting, fixed-bearing total knee arthroplasty: anterior versus posterior referencing. Knee Surg Relat Res 2020; 32:10. [PMID: 32660651 PMCID: PMC7219226 DOI: 10.1186/s43019-019-0022-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022] Open
Abstract
Background We sought to determine whether there was a difference in the posterior condylar offset (PCO), posterior condylar offset ratio (PCOR) and clinical outcomes following total knee arthroplasty (TKA) with anterior referencing (AR) or posterior referencing (PR) systems. We also assessed whether the PCO and PCOR changes, as well as patient factors were related to range of motion (ROM) in each referencing system. Methods This retrospective study included 130 consecutive patients (184 knees) with osteoarthritis who underwent primary posterior cruciate ligament (PCL)-substituting fixed-bearing TKA. The difference between preoperative and postoperative PCO and PCOR values were calculated. Clinical outcomes including ROM and Western Ontario and McMaster University (WOMAC) scores were evaluated. Furthermore, multiple linear regression analysis was performed to determine the factors related to postoperative ROM in each referencing system. Results The postoperative PCO was greater in the AR group (28.4 mm) than in the PR group (27.4 mm), whereas the PCO was more consistently preserved in the PR group. The mean postoperative ROM after TKA was greater in the AR group (129°) than in the PR group (122°), whereas improvement in WOMAC score did not differ between the two groups. Preoperative ROM was the only factor related to postoperative ROM in both groups. Conclusions There was no difference in postoperative PCO in AR and PR group and the PCO was not associated with postoperative ROM. PCO was more consistently preserved after surgery in the PR group. The postoperative PCO and PCOR changes did not affect the postoperative ROM. Furthermore, similar clinical outcomes were achieved in the AR and PR groups. Trial registration Retrospectively registered (Trial registration number: 06-2010-110).
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Affiliation(s)
- Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, South Korea.
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, South Korea
| | - Do Hwan Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, South Korea
| | - Hyung Jun Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, South Korea
| | - Keummin Hwang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, South Korea
| | - Jisu Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 03080, South Korea
| | - Il-Ung Hwang
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 03080, South Korea
| | - Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, 05278, South Korea
| | - Sohee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, 07061, South Korea
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Bae KJ, Kang SB, Kim J, Lee J, Go TW. Reduction and fixation of anterior inferior tibiofibular ligament avulsion fracture without syndesmotic screw fixation in rotational ankle fracture. J Int Med Res 2019; 48:300060519882550. [PMID: 31885342 PMCID: PMC7607056 DOI: 10.1177/0300060519882550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective We aimed to present the radiographic and functional outcomes of anatomical reduction and fixation of anterior inferior tibiofibular ligament (AITFL) avulsion fracture without syndesmotic screw fixation in rotational ankle fracture. Methods We retrospectively reviewed 66 consecutive patients with displaced malleolar fracture combined with AITFL avulsion fracture. We performed reduction and fixation for the AITFL avulsion fracture when syndesmotic instability was present after malleolar fracture fixation. A syndesmotic screw was inserted only when residual syndesmotic instability was present even after AITFL avulsion fracture fixation. The radiographic parameters were compared with those of the contralateral uninjured ankles. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were assessed 1 year postoperatively. Results Fifty-four patients showed syndesmotic instability after malleolar fracture fixation and underwent reduction and fixation for AITFL avulsion fracture. Among them, 45 (83.3%) patients achieved syndesmotic stability, while 9 (16.7%) patients with residual syndesmotic instability needed additional syndesmotic screw fixation. The postoperative radiographic parameters were not significantly different from those of the uninjured ankles. The mean AOFAS score was 94. Conclusion Reduction and fixation of AITFL avulsion fracture obviated the need for syndesmotic screw fixation in more than 80% of patients with AITFL avulsion fracture and syndesmotic instability.
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Affiliation(s)
- Kee Jeong Bae
- Department of Orthopaedic Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jihyeung Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jaewoo Lee
- Department of Orthopaedic Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Tae Won Go
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
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Park JY, Chang CB, Kang DW, Oh S, Kang SB, Lee MC. Development and validation of a prediction model for knee joint line orientation after high tibial osteotomy. BMC Musculoskelet Disord 2019; 20:434. [PMID: 31526379 PMCID: PMC6747748 DOI: 10.1186/s12891-019-2820-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 09/09/2019] [Indexed: 11/18/2022] Open
Abstract
Background Maintenance of optimal knee joint line orientation (KJLO) is important after high tibial osteotomy (HTO). No tools, however, are currently available that could predict the value of postoperative KJLO before surgery. First, this study sought to determine the effects of various preoperative anatomical alignment parameters to postoperative KJLO. Based upon these analyses, we aimed to devise an equation that predicts the value of postoperative KJLO. Methods A total of 14 radiographic parameters were measured in preoperative and postoperative full-limb standing anteroposterior radiographs on 50 patients who underwent open-wedge HTO. The parameters were analysed using multivariable linear regression to predict KJLO after HTO. External validation of the equation was done with 20 patients who underwent HTO at another institution. Results After HTO, KJLO increased from − 0.8° to 2.9° (P < 0.001). Based on the multivariable linear regression analysis, an equation was derived that can estimate postoperative KJLO after HTO; postoperative KJLO(°) = 1.029 + 0.560 × preoperative KJLO(°) + 0.310 × preoperative tibia plateau inclination(°) + 0.463 × aimed correction angle(°). The adjusted coefficients of determination value for this equation was 0.721. The equation also showed good calibration and predictability in external validation with predicted squared correlation coefficient of 0.867. Conclusions This study analysed the effects of preoperative anatomical alignment parameters on the postoperative KJLO. An equation which predicts postoperative KJLO with preoperative anatomical alignment factors was devised and validated. This equation would help in selecting optimal patients for HTO and in selecting the optimal target correction angle in HTO.
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Affiliation(s)
- Jae-Young Park
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Dong-Wan Kang
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Sohee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
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Shin JH, Chang MJ, Kang SB, Chang CB, Kim DH, Lee SA, Mok SJ. Management and clinical outcomes of periprosthetic fractures after total knee arthroplasty with a stem extension. Medicine (Baltimore) 2019; 98:e16088. [PMID: 31232950 PMCID: PMC6636976 DOI: 10.1097/md.0000000000016088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There is little information about the management and clinical outcomes of the periprosthetic fracture after total knee arthroplasty (TKA) with a stem extension. The purposes of this study were to demonstrate management of the periprosthetic fractures after TKA with a stem extension, to report treatment outcomes, and to determine whether dual-plate fixation is superior to single-plate fixation regarding the radiographic bone union time and incidence of metal failure.This retrospective study included 15 knees with periprosthetic fractures after TKA using a stem extension. We demonstrated the fracture characteristics and management according to the fracture location and implant stability. The radiographic union time was determined. Complications, range of motion, and functional outcomes, including Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score were assessed. Periprosthetic fractures after TKA with stem extension were 1 metaphyseal fracture without implant loosening, 7 diaphyseal fractures adjacent to the stem without implant loosening, 3 diaphyseal fractures away from the stem without implant loosening, and 4 fractures with implant loosening.Treatment included immobilization using a long leg cast, open reduction and internal fixation (ORIF), and re-revision TKA. There was no difference in functional outcomes and range of motion pre- and posttreatment. The complications included 2 cases of subsequent implant loosening. Patients in the dual-plating required a shorter bony union time than those in the single-plating (2.4 ± 1.1 vs 7.4 ± 2.2 months; P = .003).Periprosthetic fractures after TKA with stem extension could be managed individually according to the fracture location and implant stability. Complications were not uncommon even if patients were able to return to their preinjury functional level posttreatment. To avoid complications after ORIF, the dual plate was superior to the single plate, and subtle implant loosening should not be overlooked.
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Affiliation(s)
- Jae Hoon Shin
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center
| | - Dong Hwi Kim
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju
| | - Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Su Jung Mok
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center
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Kokorev О, Hodorenko V, Chekalkin T, Gunther V, Kang SB, Chang MJ, Kang JH. Evaluation of allogenic hepato-tissue engineered in porous TiNi-based scaffolds for liver regeneration in a CCl
4
-induced cirrhosis rat model. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/aae974] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lee SA, Kang SB, Yoon C, Chang CB, Chang MJ, Seo JG. Temporal Value of C-Reactive Protein and Erythrocyte Sedimentation Rate after Total Knee Arthroplasty in Patients with Elevated Preoperative C-Reactive Protein: A Matched-Pair Analysis. Indian J Orthop 2019; 53:437-441. [PMID: 31080284 PMCID: PMC6501634 DOI: 10.4103/ortho.ijortho_96_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to determine whether temporal values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) after total knee arthroplasty (TKA) differ between patients with and without elevated preoperative CRP. We hypothesized that temporal pattern of CRP and ESR change would differ between the two groups. MATERIALS AND METHODS This retrospective study included 30 TKAs with a diagnosis of osteoarthritis with elevated preoperative CRP (>1 mg/dl) without clinical signs and symptoms of infection before surgery (elevated CRP group). Patients without elevated preoperative CRP were matched in a 1:10 fashion according to age, sex, number of comorbidities and whether TKA was unilateral or bilateral (nonelevated CRP group). The temporal values of CRP and ESR after TKA were compared between the two groups until 2 months after surgery. RESULTS The mean peak values of CRP and ESR after surgery were similar between the two groups in both unilateral and bilateral TKAs. In the unilateral TKA, mean values of CRP and ESR and the proportions of the knees with normal CRP and ESR at 2 months after surgery were similar in the two groups. However, in the bilateral TKA, mean values of CRP and ESR were higher and the proportions of the knees with normal CRP and ESR at 2 months after surgery were lower in the elevated CRP group compared to the nonelevated CRP group. CONCLUSIONS When performing TKA in patients with elevated preoperative CRP, the fact that the levels of CRP and ESR may not be normalized until 2 months after surgery should be considered during followup.
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Affiliation(s)
- Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea,Address for correspondence: Prof. Seung-Baik Kang, Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-Road, Dongjak-Gu, Seoul 07061, South Korea. E-mail:
| | - Chan Yoon
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Jai Gon Seo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Chang MJ, Jeong HJ, Kang SB, Chang CB, Yoon C, Shin JY. Relationship Between Coronal Alignment and Rotational Profile of Lower Extremity in Patients With Knee Osteoarthritis. J Arthroplasty 2018; 33:3773-3777. [PMID: 30126713 DOI: 10.1016/j.arth.2018.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/13/2018] [Accepted: 07/24/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We aimed at determining whether the coronal alignment of lower extremity was related to rotational geometry of distal femur, femoral anteversion, and tibial torsion in patients with knee osteoarthritis. METHODS A total of 422 lower extremities were divided into 3 groups according to the coronal alignment: valgus (n = 31), neutral (n = 78), and varus group (n = 313). Condylar twisting angle was measured to determine rotational geometry of distal femur as the angle between the clinical transepicondylar axis and the posterior condylar line. Femoral anteversion was assessed using the angle between a line intersecting the femoral neck and the posterior condylar line (pFeAV) and the angle between the same line and transepicondylar axis that is not affected by posterior condylar variations (tFeAV). Tibial torsion was evaluated by measuring the angle between the posterior condyles of the proximal tibia and the transmalleolar axis. RESULTS As the coronal alignment changed from varus to valgus, the condylar twisting angle increased (r = 0.253, P < .001; 6.6° in varus, 7.4° in neutral, and 10.2° in valgus group). Although the pFeAV also increased (r = 0.145, P = .003), the tFeAV did not change significantly (P = .218). Mean tFeAV was 4.3° in varus, 4.7° in neutral, and 6.5° in valgus group. In contrast, as the coronal alignment changed from varus to valgus, the external tibial torsion increased (r = 0.374, P < .001; 22.6° in varus, 26.3° in neutral, and 32.6° in valgus group). CONCLUSION The change patterns of the rotational profiles of the lower extremity according to the coronal alignment should be considered in order to obtain satisfactory rotational alignment after TKA.
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Affiliation(s)
- Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Bundang Jesaeng General Hospital, Seongnam, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chan Yoon
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Joung Youp Shin
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
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Jeong JH, Chang MJ, Kang SB, Chang CB, Yoon C, Park J, Lee SA. Prevalence of excessive lateral pressure syndrome in varus osteoarthritic candidates for high tibial osteotomy. Knee 2018; 25:1192-1196. [PMID: 30414792 DOI: 10.1016/j.knee.2018.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/30/2018] [Accepted: 10/17/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to determine the prevalence of excessive lateral pressure syndrome (ELPS) in potential candidates for high tibial osteotomy (HTO) using single-photon emission computed tomography-computed tomography (SPECT-CT). We also sought to identify risk factors related to the presence of ELPS. METHODS This retrospective study included 150 patients (216 knees) who were candidates for HTO from an initial screening of 3579 patients (7158 knees). There were 183 female and 33 male knees with a mean age of 58 years. The presence of ELPS was defined as a grade 3 uptake on the SPECT-CT at the lateral PF joint. To determine the risk factors related to the ELPS, multivariate regression analysis was performed with independent demographic and radiographic variables. RESULTS Increased uptake on the lateral side of the PF joints was detected in 120 knees (56% of total subjects). Of these, 34 (16%) knees presented with a grade 3 uptake, which indicated the presence of ELPS. No single risk factor had significant associations with the presence of ELPS. CONCLUSIONS A considerable number of the knees that were candidates for HTO had ELPS. Nonetheless, we did not find any risk factor related to the presence of ELPS. These results suggest that surgeons should be cautious when diagnosing concomitant ELPS despite acceptable radiographic findings from patellofemoral joints when performing HTO.
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Affiliation(s)
- Jin Hwa Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea.
| | - Chan Yoon
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Jisu Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, South Korea
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Lee SA, Kang SB, Chang CB, Chang MJ, Kim YJ, Song MK, Jeong JH. Does the severity or cause of preoperative stiffness affect the clinical results and range of motion after total knee arthroplasty? PLoS One 2018; 13:e0205168. [PMID: 30308050 PMCID: PMC6181344 DOI: 10.1371/journal.pone.0205168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 09/20/2018] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to assess the overall clinical results and range of motion (ROM) after total knee arthroplasty (TKA) in patients with preoperative stiffness. We also aimed to determine whether the severity or cause of the stiffness can affect the clinical outcome after surgery. This retrospective study included 122 knees (117 patients) with follow-up of more than 2 years (mean age, 64.3 years). TKA was performed using posterior-stabilized, varus-valgus constrained (VVC), and hinged prostheses. To determine the effect of the severity of stiffness on the clinical outcome, the subjects were divided into two groups: the severe group (preoperative ROM ≤ 50°; 18 knees) and the moderate group (preoperative ROM, 50°–90°; 104 knees). Then, clinical results and ROM were compared according to the severity or cause of preoperative stiffness. After surgery, preoperative ROM (mean, 78°; range, 25°- 90°) was improved (mean, 107°; range, 70°- 130°). The severe group more frequently used the VVC or hinged prostheses (72% vs. 18%). Furthermore, the severe group had worse knee and function scores as well as more complications (33% vs. 13%), even though the severe group had a greater ROM increment (47° vs. 27°) after surgery. Patients with osteoarthritis and rheumatoid arthritis showed better ROM and clinical results compared to patients with infectious or traumatic arthritis. Although TKA in stiff knees can be successful, the results are inferior in knees with severe stiffness and knees with infectious or traumatic arthritis.
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Affiliation(s)
- Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
- * E-mail:
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Young Jun Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Min Kyu Song
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Jin Hwa Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
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Chang MJ, Jeong JH, Chang CB, Kim YJ, Seo BK, Song MK, Kang T, Kang SB. Revision surgery for failed anterior cruciate ligament reconstruction with extension deficiency. Scand J Med Sci Sports 2018; 28:2604-2610. [PMID: 30102809 DOI: 10.1111/sms.13274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/06/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Some patients with recurrent symptomatic instability after primary anterior cruciate ligament (ACL) reconstruction have an extension deficiency (ED). This study (a) compared preoperative clinical conditions between the ED and non-ED groups undergoing revision ACL reconstruction, (b) documented clinical and arthroscopic findings in ACL-reconstructed patients with reinstability and ED, and (c) determined whether the ED could be resolved and whether the clinical results of revision surgery differed between the ED and non-ED groups. METHODS This study included 58 patients who underwent revision ACL reconstruction. Patients were divided into the ED and non-ED groups. Preoperatively, the demographics and clinical conditions of the two groups were compared. Intraoperatively, the pathological structures that related to ED were documented. After surgery, the degree of postoperative ED and functional outcomes were compared between the two groups at 2-year follow-up. RESULTS The International Knee Documentation Committee subjective score and SF-36 physical component summary scores were worse in the ED group than the non-ED group preoperatively (54 vs 48 [P = 0.014]; 42 vs 39 [P = 0.031], respectively). Intraoperatively, the ED group showed significantly more frequent graft malposition (50% vs 5%), anvil osteophytes (44% vs 0%), and scarring around posterior intercondylar notch (100% vs 0%). However, there was no difference in the degree of postoperative ED and functional outcome between the two groups at follow-up. CONCLUSIONS ED in patients with recurrent instability after primary ACL reconstruction could be treated with good clinical result by addressing the pathological conditions causing ED in addition to ACL re-reconstruction.
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Affiliation(s)
- Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Hwa Jeong
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Jun Kim
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Bo-Kyung Seo
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Min Kyu Song
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Taehoon Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
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Yoon C, Chang MJ, Chang CB, Song MK, Shin JH, Kang SB. Medial Tibial Periprosthetic Bone Resorption and Its Effect on Clinical Outcomes After Total Knee Arthroplasty: Cobalt-Chromium vs Titanium Implants. J Arthroplasty 2018; 33:2835-2842. [PMID: 29773278 DOI: 10.1016/j.arth.2018.04.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/22/2018] [Accepted: 04/16/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recently, concerns arose over the medial tibial bone resorption of a novel cobalt-chromium implant. This study aimed at investigating the effects of tibial component material, design, and patient factors on periprosthetic bone resorption and at determining its association with clinical outcomes after total knee arthroplasty (TKA). METHODS A total of 462 primary TKAs using 5 types of implants were included. To evaluate tibial periprosthetic bone resorption, we assessed radiolucent lines and change in bone mineral density at the medial tibial condyle (BMDMT). Factors related to bone resorption were assessed using regression analysis. Clinical outcomes were also evaluated with respect to periprosthetic bone resorption. RESULTS Compared to titanium implants, cobalt-chromium implants showed a higher incidence of complete radiolucent lines (23.1% vs 7.9% at 2 years post-TKA) and a greater degree of BMDMT reduction. However, there was no significant difference between the implants made of the same material. Increased medial tibial bone resorption was associated with male sex, osteoporosis, larger preoperative varus deformity, longer follow-up period, and lower body mass index. The periprosthetic bone resorption was not associated with clinical outcomes including changes in range of motion and Western Ontario and McMaster Universities Osteoarthritis Index score. Furthermore, no cases warranted additional surgery. CONCLUSION Periprosthetic bone resorption was associated with implant material but not with implant design. Moreover, patient factors were related to the medial tibial bone resorption post-TKA. However, the periprosthetic bone resorption was not associated with short-term clinical outcomes. We contend that researchers should incorporate integrative considerations when developing and assessing novel implants.
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Affiliation(s)
- Chan Yoon
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Min Kyu Song
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Hoon Shin
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
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Chang MJ, Song MK, Kyung MG, Shin JH, Chang CB, Kang SB. Incidence of deep vein thrombosis before and after total knee arthroplasty without pharmacologic prophylaxis: a 128-row multidetector CT indirect venography study. BMC Musculoskelet Disord 2018; 19:274. [PMID: 30064411 PMCID: PMC6069712 DOI: 10.1186/s12891-018-2166-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/02/2018] [Indexed: 11/12/2022] Open
Abstract
Background We sought to document the incidences of deep vein thrombosis (DVT) before and after total knee arthroplasty (TKA). In addition, we aimed to explor whether routine preoperative DVT evaluation was useful to establish DVT treatment strategies after TKA. Finally, we wanted to evaluate whether the incidences of DVT differed between patients undergoing unilateral and staged bilateral TKA within the same hospitalization period. Methods The retrospective study included 153 consecutive patients (253 knees) with osteoarthritis who underwent primary TKA. After surgery, mechanical compression devices (only) were used for DVT prophylaxis. DVT status before and after TKA was determined via 128-row, multidetector, computed tomography/indirect venography. Results Overall, the preoperative DVT incidence was 2.6% per patient and 1.6% per knee. All preoperative DVTs were distal in nature and asymptomatic. After TKA, newly developed thrombi were evident in various calf veins, without propagation of any pre-existing thrombi. Postoperatively, the overall incidences of DVT were 69.9% per patient and 58.5% per knee. The DVT incidences were 66% per patient and 69.8% per knee in the unilateral TKA group. In contrast, the incidences were 72% per patient and 55.5% per knee in the staged bilateral TKA group. There was one case of symptomatic distal (unilateral TKA; 0.65% per patient and 0.4% per knee) and proximal DVT (bilateral TKA; 0.65% per patient and 0.4% per knee), respectively. Conclusions The incidence of symptomatic DVT was low in Asian patients treated with mechanical compression devices alone, although substantial portion of patients had DVT after surgery. Routine preoperative DVT evaluation is probably not necessary; preoperative DVT was rare and of limited clinical relevance. Furthermore, staged bilateral TKA during a single period of hospitalization does not increase the incidence of DVT.
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Affiliation(s)
- Moon Jong Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea
| | - Min Kyu Song
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea
| | - Min Gyu Kyung
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea
| | - Jae Hoon Shin
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul, 07061, South Korea.
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Chang MJ, Song MK, Shin JH, Yoon C, Chang CB, Kang SB. Two-stage approach to total knee arthroplasty using colistin-loaded articulating cement spacer for vancomycin-resistant Pseudomonas aeruginosa infection in an arthritic knee. Eur J Orthop Surg Traumatol 2018; 29:227-230. [PMID: 29915953 DOI: 10.1007/s00590-018-2268-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/09/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND A two-stage approach to total knee arthroplasty (TKA) using an antibiotic-impregnated articulating cement spacer is an option for an infected arthritic knee. Vancomycin combined with broad-spectrum antibiotics can be used to make an antibiotic-impregnated articulating cement spacer. Causative organisms are sometimes not confirmed before surgery. Joint infections of multidrug-resistant organisms are increasing. Therefore, routine combinations of antibiotics may not be effective. METHODS AND RESULTS We present a case of a patient who developed vancomycin-resistant Pseudomonas aeruginosa infection in an arthritic knee. A 71-year-old man was initially diagnosed with pyogenic arthritis caused by Staphylococcus aureus. He underwent arthroscopic debridement elsewhere. However, the infection persisted. He was referred to our hospital, and we performed a two-stage TKA using a vancomycin-based antibiotic-impregnated articulating cement spacer. Vancomycin-resistant P. aeruginosa was identified after surgery. Intravenous colistin was added. However, this failed, either because vancomycin was not effective against P. aeruginosa, or because insufficient systemic colistin due to colistin-induced acute kidney injury. Therefore, debridement was repeated, and colistin-loaded cement spacer was inserted. The spacer delivered high concentrations of colistin to the infected joint with decreased systemic effects. Thus, less systemic colistin was used. The infection was controlled without recurrent acute kidney injury. One year after surgery, conversion to TKA was successfully performed. CONCLUSION A two-stage approach to TKA using a colistin-loaded articulating cement spacer can be used for an arthritic knee infected by vancomycin-resistant P. aeruginosa. Furthermore, local administration of colistin using a cement spacer can reduce the systemic side effects of colistin.
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Affiliation(s)
- Moon Jong Chang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 156-707, South Korea
| | - Min Kyu Song
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 156-707, South Korea
| | - Jae Hoon Shin
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 156-707, South Korea
| | - Chan Yoon
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 156-707, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 156-707, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 156-707, South Korea.
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