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Park JS, Kweon SH, Kang SJ, Jo YH. Long-term Follow-up Results of Femoral Revision Hip Arthroplasty Using Impaction Bone Grafting and Standard Cemented Polished Stem. Clin Orthop Surg 2023; 15:734-739. [PMID: 37811512 PMCID: PMC10551692 DOI: 10.4055/cios23052] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background To report the long-term clinical and radiologic results of impaction bone grafting and standard cemented polished stem for femoral revision arthroplasty in patients with extensive bone deficiency. Methods We retrospectively reviewed 47 hips that underwent femoral revision hip arthroplasty using an impaction-morselized allograft with a standard cemented polished stem. The average age at the time of revision hip arthroplasty was 55 years (range, 39-75 years). The modified Harris hip score (HHS) was used for clinical evaluation. The radiologic evaluation focused on stem subsidence, stem position, progressive radiolucent lines, bone remodeling, and the incorporation of allografts. Results The modified HHS improved from an average of 55.04 (range, 25-79.5) preoperatively to 90.1 (range, 81-93.2) at the last follow-up. The mean follow-up duration was 13.5 years (10.9-17.8 years). The radiographic analysis revealed stable stems. Femoral stems showed an average subsidence of 3.2 mm (range, 2-8 mm) in the cement mantle. However, there was no mechanical failure or subsidence of the cement mantle in the femurs. The stem position was neutral or varus less than 5°. No progressive radiolucent line or osteolysis was observed. Evidence of cortical and trabecular remodeling was observed in all cases. There were four cases of intraoperative cracks and four cases of distal femur splitting. Conclusions Initial stem stability using impaction bone grafting and a standard cemented polished stem in femoral revision arthroplasty resulted in good outcome. Delicate impaction grafting techniques and intraoperative crack and splitting fixation are the points that need attention for successful long-term results.
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Affiliation(s)
- Jin Sung Park
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Seok Hyun Kweon
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Sung Ju Kang
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Yang Hun Jo
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
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Abstract
Purpose A basicervical femoral fracture is defined as a fracture of base of neck of femur that occurs medially from intertrochanteric line above lesser trochanter. In this study, we intended to evaluate radiological and clinical results of basicervical femoral fractures treated by intramedullary nailing. Materials and Methods Fifteen patients, who underwent intramedullary nailing among 50 patients, out of 50 who were diagnosed with basicervical femoral fractures from July 2012 to May 2015 were studied. All of 15 patients' fracture were two-part basicervical fractures. Using radiography, we characterized the: i) state of reduction, ii) location of the lag screw, iii) tip apex distance (TAD), and iv) sliding distance of lag screw and bone union. Additionally, we performed clinical assessment before injury and at final follow-up. Results In radiological assessment, we achieved acceptable reduction state in all patients. All lag screws were fixated on appropriate locations. Mean TAD was 17.3 mm (11.0–21.1 mm), which showed insertion point of <25 mm in all cases. The mean sliding distance of the lag screw was 5.1 mm (0.1–16.0 mm) at the final follow-up. The mean bone union period was 4.8 months (3–10 months) with achieving in all cases. In clinical assessment, Harris hip score, visual analogue scale score and Western Ontario and McMaster Universities Arthritis Index score, all of them significantly improved postoperatively compared with preoperative scores (P<0.05). Conclusion In elderly patients with basicervical femoral fractures, treatment with intramedullary nailing showed satisfactory results, considered to be a useful method if performed with skilled technique.
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Affiliation(s)
- Seok Hyun Kweon
- Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Sung Hyun Lee
- Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Seng Hwan Kook
- Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Young Chae Choi
- Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Korea
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Bae KH, Kim JW, Kim TK, Kweon SH, Kang HJ, Kim JY, Joo MS, Kim DM. Is the arthroscopic modified tension band suture technique suitable for all full-thickness rotator cuff tears? J Shoulder Elbow Surg 2016; 25:1457-63. [PMID: 27017412 DOI: 10.1016/j.jse.2016.01.004] [Citation(s) in RCA: 4] [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: 08/16/2015] [Revised: 12/29/2015] [Accepted: 01/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND We aimed to identify the clinical and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears of all sizes with a modified tension band suture technique. METHODS Among 63 patients who underwent arthroscopic rotator cuff repair for a full-thickness rotator cuff tear with the modified tension band suture technique at a single hospital between July 2011 and March 2013, 47 were enrolled in this study. The mean follow-up period was 29 months. Visual analog scale scores, range of motion, American Shoulder and Elbow Surgeons scores, Constant scores, and Shoulder Strength Index were measured preoperatively and at the final follow-up. For radiologic evaluation, we conducted magnetic resonance imaging 6 months postoperatively and ultrasonography at the final follow-up. We allocated the small and medium tears to group A and the large and massive tears to group B and then compared clinical outcomes and repair integrity. RESULTS Postoperative clinical outcomes at the final follow-up showed significant improvements compared with those seen during preoperative evaluations (P < .001). However, group B showed worse clinical results than group A. Evaluation with magnetic resonance imaging performed 6 months postoperatively and ultrasonography taken at the final follow-up revealed that group B showed a significantly higher retear rate than did group A (69% vs. 6%, respectively; P < .001). CONCLUSION Arthroscopic repair with the modified tension band suture technique for rotator cuff tears was a more suitable method for small to medium tears than for large to massive tears.
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Affiliation(s)
- Kyu Hwan Bae
- Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Jeong Woo Kim
- Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Republic of Korea.
| | - Tae Kyun Kim
- Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Seok Hyun Kweon
- Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Hong Je Kang
- Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Jong Yun Kim
- Department of Orthopedic Surgery, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Min Su Joo
- Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Dong Moon Kim
- Department of Social Physical Education, Wonkwang University, Iksan, Republic of Korea
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Abstract
Symptomatic aneurysmal bone cysts with expansible lesions in the pelvis are rare in children. The management of an aggressive vascular lesion in a female child is challenging. The standard treatment for aneurysmal bone cysts is accompanied by a high risk of local recurrence. A 12-year-old female presented with a history of pelvic pain for 5 months. Plain radiographs and magnetic resonance imaging showed a very large expansile lytic lesion arising from the right iliac bone. Intralesional curettage, electric cauterization, chemical sclerotherapy and allogeneic bone graft were performed through the window of the iliac crest. At a follow-up consultation 3.5 years post-surgery, the child had painless full-range movement in the hip joint with no recurrence. Although many treatment options are described, our patient was treated successfully using curettage and allogeneic bone graft without recurrence.
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Affiliation(s)
- Chae Geun Kim
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Seok Hyun Kweon
- Department of Orthopaedic Surgery, Wonkwang University College of Medicine, Iksan, Korea
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Kweon SH, Choi SS, Lee SI, Kim JW, Kim KM. Coracoclavicular Ligament Augmentation Using Tight-Rope ®for Acute Acromioclavicular Joint Dislocation - Preliminary Report -. Clin Shoulder Elb 2013. [DOI: 10.5397/cise.2013.16.2.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lee HG, Hsu A, Goto H, Nizami S, Lee JH, Cadet ER, Tang P, Shaji R, Chandhanayinyong C, Kweon SH, Oh DS, Tawfeek H, Lee FY. Aggravation of inflammatory response by costimulation with titanium particles and mechanical perturbations in osteoblast- and macrophage-like cells. Am J Physiol Cell Physiol 2012; 304:C431-9. [PMID: 23255578 DOI: 10.1152/ajpcell.00202.2012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The interface between bone tissue and metal implants undergoes various types of mechanical loading, such as strain, compression, fluid pressure, and shear stress, from daily activities. Such mechanical perturbations create suboptimal environments at the host bone-implant junction, causing an accumulation of wear particles and debilitating osseous integration, potentially leading to implant failure. While many studies have focused on the effect of particles on macrophages or osteoprogenitor cells, differential and combined effects of mechanical perturbations and particles on such cell types have not been extensively studied. In this study, macrophages and osteoprogenitor cells were subjected to physiological and superphysiological mechanical stimuli in the presence and absence of Ti particles with the aim of simulating various microenvironments of the host bone-implant junction. Macrophages and osteoprogenitor cells were capable of engulfing Ti particles through actin remodeling and also exhibited changes in mRNA levels of proinflammatory cytokines under certain conditions. In osteoprogenitor cells, superphysiological strain increased proinflammatory gene expression; in macrophages, such mechanical perturbations did not affect gene expression. We confirmed that this phenomenon in osteoprogenitor cells occurred via activation of the ERK1/2 signaling pathway as a result of damage to the cytoplasmic membrane. Furthermore, AZD6244, a clinically relevant inhibitor of the ERK1/2 pathway, mitigated particle-induced inflammatory gene expression in osteoprogenitor cells and macrophages. This study provides evidence of more inflammatory responses under mechanical strains in osteoprogenitor cells than macrophages. Phagocytosis of particles and mechanical perturbation costimulate the ERK1/2 pathway, leading to expression of proinflammatory genes.
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Affiliation(s)
- Heon Goo Lee
- Center for Orthopaedic Research, Columbia Orthopaedics, Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Kim JW, Chun CH, Shim DM, Kim TK, Kweon SH, Kang HJ, Bae KH. Arthroscopic treatment of lateral epicondylitis: comparison of the outcome of ECRB release with and without decortication. Knee Surg Sports Traumatol Arthrosc 2011; 19:1178-83. [PMID: 21479640 DOI: 10.1007/s00167-011-1507-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [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] [Received: 11/05/2010] [Accepted: 03/28/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to compare the early clinical results of arthroscopic extensor carpi radialis brevis (ECRB) release with and without bone decortication in the treatment of lateral epicondylitis. MATERIALS AND METHODS Thirty-eight patients who were surgically treated for lateral epicondylitis between 2004 and 2008 were included in this retrospective review. Among these 38 patients, 19 underwent arthroscopic ECRB release and 19 patients underwent both ECRB release with decortication of the lateral epicondyle. Outcome measures included pain assessment measured by visual analog scale (VAS) preoperatively, on postoperative day one, at two and 4 weeks postoperatively, and at the final follow-up visit. Functional evaluation was made with the Mayo Elbow Performance Index and grip strength measurement. RESULTS Patients who underwent simple ECRB release had significantly less pain than patients who underwent ECRB release and decortication immediately postoperatively (p < 0.05). This group also showed a lower VAS score on exertion 2 weeks and 4 weeks after simple ECRB release (p < 0.05). The mean time taken to return to work was 24.2 ± 18.3 days in the group that underwent simple ECRB release and 39 ± 22.7 days in the group that underwent ECRB release with decortication (p < 0.05). CONCLUSIONS Arthroscopic release of the ECRB is an effective method of treatment in patients with recalcitrant lateral epicondylitis. Decortication of the lateral epicondyle leads to increased pain postoperatively and did not improve clinical results.
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Affiliation(s)
- Jeong Woo Kim
- Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, 344-2 Shinyong-dong, Iksan, Chunbuk, Korea.
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Kweon SH, Oka T, Ito M, Morita M, Natori Y. Monoclonal-antibody-based enzyme-linked immunosorbent assay for HMG 2b nonhistone protein in chick liver. J Immunoassay 1991; 12:487-99. [PMID: 1806585 DOI: 10.1080/01971529108053276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Monoclonal antibodies were prepared against the high mobility group (HMG) protein 2b from chick liver chromatin and a monoclonal-antibody-based enzyme-linked immunosorbent assay (ELISA) was developed for chick HMG 2b. The sensitivity of the assay is about ten times that of the previously described radioimmunoassay and solid-phase enzyme immunoassay for HMG proteins. With the use of ELISA technique, the amount of HMG 2b (micrograms protein/mg DNA) in the livers of 1-day old and 70-day old chicks was found to be 2.56 +/- 0.4, and 1.20 +/- 0.2, respectively. The age-dependent change in the level of HMG proteins probably reflects changes in the functional state of chromatin during ageing.
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Affiliation(s)
- S H Kweon
- Department of Nutritional Chemistry, School of Medicine, University of Tokushima, Japan
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Oka T, Kweon SH, Ito M, Han JP, Fujii T, Natori Y. Effect of gastric distention on RNA synthesis in neonatal chick liver. Biochem Biophys Res Commun 1990; 166:973-7. [PMID: 1689155 DOI: 10.1016/0006-291x(90)90906-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
RNA synthesis in the nuclei of liver from newly hatched chicks was enhanced 1.25 fold at 10 min after intragastric administration of water. Differential inhibition of RNA synthesis by alpha-amanitin indicated that the enhancement mainly represented rRNA synthesis; the synthesis of mRNA and tRNA was scarcely affected. Enhanced RNA synthesis was accompanied by greater susceptibility of nuclei to digestion by micrococcal nuclease, indicating that the chromatin structure was modified. It was further shown that the "water effect" was mimicked by distention of the stomach by raising the pressure in the intragastric balloon. Since the prior administration of atropine abolished the "water effect", the enhancement of hepatic RNA synthesis may be mediated by hepatic nervous system.
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Affiliation(s)
- T Oka
- Department of Nutritional Chemistry, School of Medicine, University of Tokushima, Japan
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