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ABSTRACT: Tissue engineering with stem cells is a fascinating approach for treating anterior cruciateligament (ACL) injuries. In our previous study, stem cells isolated from the human anteriorcruciate ligament were shown to possess extensive proliferation and differentiationcapabilities when treated with specific growth factors. However, optimal culture conditionsand the usefulness of fetal bovine serum (FBS) as a growth factor in in vitro culture systemsare yet to be determined. In this study, we compared the effects of different culture mediacontaining combinations of various concentrations of FBS and the growth factors basicfibroblastic growth factor (bFGF) and transforming growth factor β1 (TGF- β1) on theproliferation and differentiation of ligament-derived stem cells (LSCs) and bone marrowmesenchymal stem cells (BMSCs). We found that α-MEM plus 10% FBS and bFGF was ableto maintain both LSCs and BMSCs in a relatively undifferentiated state but with lower majorextracellular matrix (ECM) component gene expression and protein production, which isbeneficial for stem cell expansion. However, the differentiation and proliferation potentials ofLSCs and BMSCs were increased when cultured in MesenPRO, a commercially availablestem cell medium containing 2% FBS. MesenPRO in conjunction with TGF- β1 had thegreatest ability to induce the differentiation of BMSCs and LSCs to ligament fibroblasts,which was evidenced by the highest ligamentous ECM gene expression and proteinproduction. These results indicate that culture media and growth factors play a very importantrole in the success of tissue engineering. With α-MEM plus 10% FBS and bFGF, rapidproliferation of stem cellscan be achieved. In this study, MesenPRO was able to promotedifferentiation of both LSCs and BMSCs to ligament fibroblasts. Differentiation was furtherincreased by TGF- β1. With increasing understanding of the effects of different culture mediaand growth factors, manipulation of stem cells in the desired direction for ligament tissueengineering can be achieved.
Cell Transplantation 04/2013; · 5.13 Impact Factor
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ABSTRACT: Septic arthritis is the most rapidly destructive joint disease, but its early diagnosis remains challenging; delayed or inadequate treatment, even by expert physicians, can lead to irreversible joint destruction. Between 25% and 50% of patients develop irreversible loss of joint function, which is especially concerning in elderly patients. To understand the factors influencing the outcome of septic arthritis, the authors reviewed patients aged older than 50 years who had undergone debridement surgery for primary septic arthritis at their institution between 1998 and 2008. Ninety-two patients (92 knees) were enrolled in the study; 14 did not meet inclusion criteria and were excluded from the final analysis. Of the 78 included patients, 7 underwent arthrodesis, 22 underwent total knee arthroplasty, 19 were indicated for total knee arthroplasty for severe knee joint osteoarthritis but did not undergo surgery by the end of this study, and the remaining 30 had no or mild symptoms of osteoarthrosis and did not receive any surgical procedure. Staphylococcus aureus was the most common pathogenic agent (38%), followed by mixed bacterial infection (10%). Several factors negatively influenced the final clinical outcome, including delayed treatment, advanced macroscopic staging made during debridement surgery, performing multiple debridement surgeries, and a larger Lysholm score difference pre- and posttreatment. More antibiotics administered, longer duration of antibiotic treatment, and more pathogenic agents present were also significantly correlated with poor outcome. These findings shed new light on the management of septic arthritis. Accurate diagnoses and effective treatments are important for the clinical outcome of knee joint bacterial infection in elderly patients.
Orthopedics 04/2013; 36(4):e434-e443. · 2.66 Impact Factor
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ABSTRACT: BACKGROUND: Tricortical autograft has been commonly used in subtalar distraction arthrodesis (SDA) for severe calcaneal malunion. Structural allograft enriched with orthobiological agents is an alternative. This study was performed to evaluate the results of SDA using fresh-frozen allogeneic femoral head without the addition of orthobiological agents. MATERIALS AND METHODS: We retrospectively reviewed 15 consecutive SDA procedures (13 patients) with allogeneic femoral head augmented with local autograft for the treatment of severe calcaneal malunion. Clinical outcome was evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS) pain score, Short Form-12 (SF-12), range of motion (ROM) of the ankle joint, and patient satisfaction rate. Radiographic assessment included the talar declination angle (TDA), calcaneal inclination angle (CIA), lateral talocalcaneal angle (LTCA), heel height, calcaneal length, and union time. RESULTS: At a median follow-up of 36.0 months (range, 24-47 months), all 15 feet (100%) achieved union, at a median of 13.0 weeks (range, 12-18 weeks). The AOFAS score and VAS pain score improved significantly, with a satisfaction rate of 93.3%. The TDA, CIA, LTCA, and heel height improved significantly. The median increase in heel height was 8.6 mm (range, 1.9-20.1 mm). There was a significant reduction in calcaneal length. Complications included 1 varus malalignment, 1 complex regional pain syndrome, 1 hardware irritation, and 1 sural neuralgia. CONCLUSION: This study found that SDA using fresh-frozen femoral head allograft without an orthobiological agent was cost-effective and may have outcomes comparable to those using autograft or allograft enriched with orthobiological agents. LEVEL OF EVIDENCE: Level IV, retrospective case series.
The Foot and Ankle Online Journal 03/2013; · 1.22 Impact Factor
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ABSTRACT: Osteoblastoma occurring in the region of the hip is very rare, and vague symptoms with uncharacteristic radiographic features often lead to misdiagnosis. Because of radiographic and histological similarities, it must be carefully distinguished from osteoid osteoma, aneurysmal bone cyst, giant cell tumor, and osteosarcoma. Computed tomography is the preferred imaging modality as it is able to detect the nidus and images will not exhibit the flare phenomenon caused by surrounding inflammation seen with magnetic resonance imaging. For hip joint lesions in weight-bearing areas, intralesional curettage may achieve satisfactory outcomes as compared with wide resection. We herein report two cases of osteoblastoma in the hip region in which diagnosis was delayed that were successfully treated with curettage and followed by high-speed burring.
Journal of the Chinese Medical Association 02/2013; 76(2):115-20. · 0.79 Impact Factor
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ABSTRACT: Open tibial shaft fractures are the most common open fractures, and many complications can occur. During the treatment period, infection leading to osteomyelitis was the most common complication. However, no consensus exists regarding the ideal management for such cases in the literature.The purposes of this retrospective study were to review the treatment of patients with chronic tibial shaft osteomyelitis over the past 14 years who were referred to the authors' institution and to provide a staged protocol for spontaneous wound healing. The staged protocol included: (1) radical debridement for infected bone and soft tissue; (2) immediate application of Ilizarov's apparatus for all patients except those needing delayed application; (3) osteotomy in healthy bone; (4) simultaneous distraction-compression osteogenesis and histogenesis; (5) additional docking-site bone grafting; and (6) shifting the external fixator to a locked nail when callus formation was visible at the distraction site. Union was achieved in 15 of 16 patients, with an average external fixation time of 4.5 months (range, 3-6 months). No deformity or leg-length discrepancy greater than 1 cm occurred.In the treatment of chronic osteomyelitis, this staged protocol was safe and successful and allowed for union, realignment, reorientation, and leg-length restoration. Regarding the soft tissues, this technique provides a unique type of reconstructive closure for infected wounds. It is suggested that the staged protocol is reliable in providing successful simultaneous reconstruction for bone and soft tissue defects without flap coverage.
Orthopedics 12/2012; 35(12):e1769-e1774. · 2.66 Impact Factor
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ABSTRACT: Human immunodeficiency virus (HIV)-infected patients are at risk for bacterial and opportunistic infections with worsening immunosuppression.
From June 2000 to January 2009, six patients who were diagnosed with HIV infection underwent 10 joint replacement procedures, including six total hip arthroplasties, two total knee arthroplasties, and one shoulder hemiarthroplasty. An ordinary dose of postsurgical-empirical antibiotics was prescribed, with an average follow-up period of 38.6 months. All prostheses of total knee arthroplasty and shoulder hemiarthroplasty were fixed with vancomycin-impregnated bone cement.
The rate of postoperative infection for HIV infected patients is supposed to be higher than for HIV negative patients. However, in our institution, there have been no HIV- positive patients who have suffered postoperative infection.
HIV-positive patients can have excellent outcomes after undergoing various arthroplastic surgeries. This revelation, coupled with the advances in antiviral therapy that have helped to lengthen HIV patient lifespans, strongly suggests that these patients should receive arthroplastic surgery.
Journal of the Chinese Medical Association 11/2012; 75(11):595-9. · 0.79 Impact Factor
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ABSTRACT: Treatment options for nonunion of the femoral shaft fracture after intramedullary nail fixation are controversial. The methods of exchanging an existing nail with a larger-sized nail, dynamization, removal of the nail followed by plating, and bone grafting have all been reported. From those options, exchange nailing seems to be the most popular choice. In our study, we used plate augmentation and bone grafting with retention of the nail. The purpose of our study was to evaluate the effectiveness of this method in treating femoral shaft nonunion after open reduction and internal fixation with intramedullary nail fixation.
Between January 2003 and December 2009, 22 patients who had nonunion after open reduction and internal fixation with intramedullary nail for femoral shaft fracture were included in our study. There were 13 men and nine women participants, with a mean age of 34.3 years (range, 17-77 years). The mean period of nonunion after surgery was 20.0 months (range, 7-63 months). The patients were classified into three groups, atrophic, oligotrophic, and hypertrophic. We retained the nail and performed plate augmentation for all patients, with simultaneous autologous bone grafting as indicated. We followed up on all patients with plain film examination, and to assess functional recovery status to determine osseous union condition.
All 22 of the patients achieved postoperative bony union uneventfully at a mean time of 22.1 weeks (range, 12-40 weeks). The mean operative time was 105 minutes (range, 60-150 minutes), and the mean blood loss was 340 ml (range, 150-700 ml). All of the patients could walk bearing full weight without pain within 3 months. There were no significant complications such as broken hardware, implant back-out, axial or rotational malalignment, or deep infections.
Plate augmentation with retention of the nail with autologous bone grafting may be an effective and reliable alternative in treating nonunion of the femoral shaft fracture after open reduction and internal fixation with intramedullary nail.
Journal of the Chinese Medical Association 08/2012; 75(8):396-401. · 0.79 Impact Factor
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ABSTRACT: Between January 1999 and August 2008, ninety-six femoral revisions were performed with extensively porous-coated stems in Paprosky type III femoral defects (89 type IIIA and 7 type IIIB defects). Seven type IIIB defects with a mean canal of 16.5 mm were observed; 6 defects achieved stable bone ingrowth and 1 achieved stable fibrous condition. Average postoperative Harris Hip Score was 92.3±8 (range, 77-100), and all scores improved postoperatively. At a mean follow-up of 65.7 months, 92 stems achieved bone ingrowth, and 1 stem (type IIIB) achieved a stable fibrous condition. Three patients died from causes unrelated to the surgery during follow-up. The most frequent diagnosis for revision of the femoral component was loosening of the cementless stem (53 patients; 55.2%), followed by status after a Girdlestone procedure (21 patients; 21.8%), after total hip arthroplasty with acetabular wear (10 patients; 10.4%), loosening of the cemented stem (7 patients; 7.3%), and periprosthetic fracture (5 patients; 5.2%). The authors performed 65 total hip arthroplasty revisions, 23 femoral component revisions, and 8 revisions of femoral components with cemented liners in patients with well-fixed acetabular shells. Extensively porous-coated stems in femoral revision for Paprosky type III femoral defects provided good mid-term durability.
Orthopedics 07/2012; 35(7):e1017-21. · 2.66 Impact Factor
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ABSTRACT: This study was conducted to evaluate the results of treating hypertrophic nonunion of mid-shaft clavicle fracture with a limited contact dynamic compression plate (LC-DCP) without autologous cancellous bone graft.
From 1995 to 2008, 51 cases of hypertrophic nonunion of mid-shaft clavicle fracture were managed with open reduction and internal fixation by LC-DCP without bone graft involvement. Of these 51 cases, 30 had nonunion after failure of initial surgical treatment (Group 1), and 21 had nonunion after failure of conservative treatment (Group 2). Preoperative and postoperative case management were the same for both groups, with the average follow-up period being 20.4 months (range 18-36). Our study evaluated the radiographic results and functional outcomes of these cases according to the quick disability of arm, shoulder, and hand score.
All 51 cases resulted in uneventful unions. There was no statistically significant difference between the two groups regarding patient demography, cause of injury, preoperative and postoperative functional scores, length of operation, union time, and duration of hospitalization (p>0.05).
LC-DCP fixation is an effective method for treating hypertrophic nonunion of mid-shaft clavicle fracture. Local bone graft is sufficient to achieve necessary union, and autologous bone graft from other sites of the body appears unnecessary.
Journal of the Chinese Medical Association 05/2012; 75(5):216-20. · 0.79 Impact Factor
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ABSTRACT: The objective of this article is to report our clinical experience in the treatment of patients with scaphoid nonunion using The objective of this article is to report our clinical experience in the treatment of patients with scaphoid nonunion using
intercalated bone graft and Herbert’s screw and the long-term postoperative results with a minimum of fiveyears of follow-up. intercalated bone graft and Herbert’s screw and the long-term postoperative results with a minimum of fiveyears of follow-up.
We retrospectively reviewed 49 patients treated with carved intercalated bone graft and Herbert’s screw fixation from September We retrospectively reviewed 49 patients treated with carved intercalated bone graft and Herbert’s screw fixation from September
1987 to June 2001. Preoperative clinical manifestations and postoperative results were assessed by radiography, and functional 1987 to June 2001. Preoperative clinical manifestations and postoperative results were assessed by radiography, and functional
results, including grip force, range of motion of the wrist joint, and Cooney’s scoring chart, were evaluated. The union rate results, including grip force, range of motion of the wrist joint, and Cooney’s scoring chart, were evaluated. The union rate
was 93.9%. The average grip power, as well as wrist flexion and extension were significantly improved. Using Cooney’s scoring was 93.9%. The average grip power, as well as wrist flexion and extension were significantly improved. Using Cooney’s scoring
system, 29 patients were rated excellent and 17 good. For successful union, anatomical reduction with carved intercalated system, 29 patients were rated excellent and 17 good. For successful union, anatomical reduction with carved intercalated
bone grafting and Herbert’s screw fixation is definitely a reliable option. This method leads to a satisfactory long-term bone grafting and Herbert’s screw fixation is definitely a reliable option. This method leads to a satisfactory long-term
functional outcome. functional outcome.
L’objectif de cette étude est de rapporter le résultat clinique du traitement des pseudarthroses du scaphoïde traitées par L’objectif de cette étude est de rapporter le résultat clinique du traitement des pseudarthroses du scaphoïde traitées par
greffe intercalaire et vis de Herbert. Les résultats ont été évalués à long terme avec un minimum de recul à 5 ans. Matériel greffe intercalaire et vis de Herbert. Les résultats ont été évalués à long terme avec un minimum de recul à 5 ans. Matériel
et méthode: il s’agit d’une étude rétrospective de 49 patients traités selon cette technique de septembre 1987 à juin 2001. et méthode: il s’agit d’une étude rétrospective de 49 patients traités selon cette technique de septembre 1987 à juin 2001.
L’évaluation pré et post-opératoire a porté sur les signes cliniques, la radiographie, les signes fonctionnels en incluant L’évaluation pré et post-opératoire a porté sur les signes cliniques, la radiographie, les signes fonctionnels en incluant
la force de préhension et la mobilité du poignet ainsi que le score de Cooney. Résultats: le taux de consolidation a été de la force de préhension et la mobilité du poignet ainsi que le score de Cooney. Résultats: le taux de consolidation a été de
93,9%. La force de préhension et la mobilité du poignet en flexion et en extension ont été améliorées de façon significative. 93,9%. La force de préhension et la mobilité du poignet en flexion et en extension ont été améliorées de façon significative.
Le score de Cooney était côté sur 29 patients excellents et bons chez 17 patients. Conclusion: Cette technique est une technique Le score de Cooney était côté sur 29 patients excellents et bons chez 17 patients. Conclusion: Cette technique est une technique
parfaitement fiable du traitement des pseudarthroses et permet d’obtenir des résultats satisfaisants à long terme tant sur parfaitement fiable du traitement des pseudarthroses et permet d’obtenir des résultats satisfaisants à long terme tant sur
le plan fonctionnel que sur le plan anatomique. le plan fonctionnel que sur le plan anatomique.
International Orthopaedics 04/2012; 33(5):1295-1300. · 2.03 Impact Factor
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ABSTRACT: Some studies have reported the presence of audible squeaking in ceramic-on-ceramic total hip arthroplasty (THA), and several factors such as implant malposition or poor soft tissue recovery have been described as the cause. Our purpose was to determine the squeaking rate in the Asian population with a consecutive series of ceramic-on-ceramic THA. From 2003 to 2009, 413 THAs were performed by a single surgeon using a minimally invasive modified anterior-lateral approach. Using both questionnaire and physical examination, no squeaking was identified in any cases with a minimum of 2-year follow-up. Complications occurred in 4 patients. The results of this study suggested squeaking phenomenon after ceramic-on-ceramic THA may be eliminated.
The Journal of arthroplasty 03/2012; 27(8):1575-9. · 1.79 Impact Factor
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Yi-Sheng Chou,
Chun-Yu Liu,
Wei-Ming Chen, Tain-Hsiung Chen,
Paul Chih-Hsueh Chen,
Hung-Ta Hondar Wu,
Hong-Jen Chiou,
Cheng-Ying Shiau,
Yu-Chung Wu,
Chien-Lin Liu,
Ta-Chung Chao,
Cheng-Hwai Tzeng,
Chueh-Chuan Yen
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ABSTRACT: We explored the impact of frequency of surveillance imaging on disease-specific survival (DSS) in patients with extremity soft tissue sarcoma (STS).
Locoregional imaging (LRI) and chest imaging (CI) were used to detect local recurrence (LR) and distant metastasis (DM), respectively. Relapsing patients were retrospectively assigned to more frequent surveillance (MFS) or less frequent surveillance (LFS) groups, according to the median interval for each follow-up modality. Outcome measures included overall DSS (O-DSS), post-LR DSS, and post-DM DSS.
We assigned 165 patients to three distinct risk groups according to tumor size (≤5 vs. >5 cm), depth (superficial- vs. deep-seated), grade (I vs. II or III), and surgical margin (≥10 vs. <10 mm). Data for 80 patients who relapsed were analyzed. Among 50 high-risk (with all four risk factors) relapsing patients, those in the MFS group for either LRI or CI had better O-DSS (LRI, median 44.07 vs. 27.43 months, P = 0.008; CI, median 43.60 vs. 36.93 months, P = 0.036), post-LR DSS (median 27.20 vs. 10.63 months, P = 0.028) and post-DM DSS (median 13.20 vs. 6.24 months, P = 0.031).
More frequent follow-up were associated with improved survival in high-risk relapsing patients with extremity STS by providing greater opportunities for adequate reoperation.
Journal of Surgical Oncology 02/2012; 106(2):155-61. · 2.10 Impact Factor
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ABSTRACT: The purpose of this study was to compare the clinical and imaging outcomes of single-row and double-row suture anchor fixation in arthroscopic rotator cuff repair with emphasis on analysis of the effect of various tear size on repair integrity.
Fifty-three patents were randomized to either single-row or double-row rotator cuff repair at the time of surgical intervention. The clinical results were evaluated by applying the UCLA score and the ASES index and assessing muscle strength in abduction and external rotation with a minimum 2-year follow-up. The postoperative rotator cuff integrity was evaluated by magnetic resonance arthrography at 6-month and minimum 2-year follow-up.
We enrolled 27 patients in the single-row group and 26 patients in the double-row group. Statistically, the UCLA score; the ASES index; and muscle strength were significantly increased in both groups after surgery, but there was no significant difference between the 2 groups. At minimum 2-year follow-up, intact rotator cuffs were found in 17 patients in the single-row group and 20 in the double-row group, based on magnetic resonance arthrography results. Overall, there was no significant difference in postoperative structural integrity between the 2 groups at 6-month and 2-year follow-up. In patients with tear size larger than 3 cm, the muscle strength of the shoulder was significantly better in the double-row group. For the final imaging results, regardless of the tear size, there was no difference between the single-row and double-row groups.
Arthroscopic rotator cuff repair with double-row fixation showed better shoulder strength in patients with larger tear size (>3 cm) in comparison with single-row fixation. However, the imaging results showed no significant difference in cuff integrity in both groups in patients with any tear size at 6-month and minimum 2-year follow-up.
Level II, lesser-quality randomized control trial.
Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2012; 28(1):16-24. · 3.02 Impact Factor
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ABSTRACT: A retrospective study was conducted to evaluate the role of autologous bone graft in treating atrophic nonunion of midshaft clavicle fracture with a limited-contact dynamic compression plate (LC-DCP). Between 1995 and 2008, sixty cases of atrophic nonunion of midshaft clavicle fractures were managed with open reduction and internal fixation with an LC-DCP. The cases were separated into 2 groups to evaluate the effect of autologous bone graft in the enhancement of bone union. In group 1 (n=24), autologous bone graft was not used; in group 2 (n=36), autologous bone graft was used. Pre- and postoperative management were the same in both groups. Radiographic results and functional outcomes according to the Quick Disability of Arm, Shoulder, and Hand score were evaluated. Average follow-up was 25.2 months (range, 24-48 months).No statistically significant difference was found between the 2 groups regarding demography and preoperative functional scores (P>.05). Operative time and hospital stay were statistically significant longer in group 2 (P<.001), and donor site pain was apparent in group 2. All 60 patients had uneventful union. No statistically significant differences were found between the 2 groups regarding union time (average, 9.8 weeks in group 1 and 9.2 weeks in group 2) and postoperative functional scores (P>.05). Limited-contact dynamic compression plate fixation is an effective method for treating atrophic nonunion of midshaft clavicle fractures. Autologous bone graft was not needed.
Orthopedics 01/2012; 35(2):e197-201. · 2.66 Impact Factor
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ABSTRACT: Ewing sarcoma is extremely rare in people from East and Southeast Asia.
The records of 12 patients diagnosed with primary Ewing sarcoma and treated at our institution from 1997 to 2009 were retrospectively reviewed.
There were seven male and five female patients and their mean age at diagnosis was 22 years (range, 12-48 years). Two patients (16.7%) had distant metastasis at diagnosis. The primary tumor sites were the trunk in seven patients (58.3%) and the extremities in five patients (41.7%). Eleven patients received neoadjuvant chemotherapy followed by wide excision surgery, and then adjuvant chemotherapy. One patient received only chemotherapy without surgical intervention due to poor cardiac and pulmonary function. At a mean follow-up of 33 months, the 2-year overall survival rate (OS) was 45.5%. Distant metastasis was the only statistically significant prognostic factor of OS in our study. The 2-year OS rates of patients with lung metastasis and without lung metastasis were 0% and 42.9%, respectively (p = 0.021). The t(11;22)(q24:q12) translocation was present in all patients in our series.
We confirmed that distant metastases is highly predictive of a poor outcome, and that the t(11;22)(q24:q12) translocation was present in all patients in our series.
Journal of the Chinese Medical Association 01/2012; 75(1):16-20. · 0.79 Impact Factor
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ABSTRACT: Wide excision with a 2-3 cm safe margin is widely-accepted in treating high-grade osteosarcoma. However, a wider margin sacrifices more healthy bone and may jeopardize joint function. We hypothesize that our innovative hemicortical resection for such tumors leads to better joint function without higher recurrence rate.
Between August 2002 and April 2007, six patients of high-grade osteosarcoma were treated with hemicortical resection and biological reconstruction.
Five tumors were located around the knee and one was located in the distal tibia. The mean tumor size was 20.5 cm(3). The bone defects were reconstructed using recycled autograft in four cases (one by extracorporeal irradiation; three by liquid nitrogen) and structural allograft in two. In an average follow-up of 52 months (24-96), all patients survived without local recurrence or metastasis. All bone grafts incorporated well without mechanical failure or infection. The average Musculoskeletal Tumor Society score was 97.7%.
Hemicortical resection for high-grade osteosarcomas located eccentrically in the long bones may be a reliable technique leading to good joint function by preserving surrounding healthy tissues. The functional outcome was encouraging, although long-term follow-up is mandatory to validate. With the advancement of chemotherapy and radiographic three-dimensional imaging, the safe margin in wide excision of high-grade osteosarcoma may be narrowed down in light of joint surface preservation.
Journal of Surgical Oncology 12/2011; 105(8):825-9. · 2.10 Impact Factor
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ABSTRACT: For diagnosing osteosarcoma correctly, a combination of clinical, radiological and histological examinations is required. Erroneous treatment may cause local contamination and systemic seeding in patients. The purpose of this study was to compare outcomes of planned and unplanned treatment for osteosarcoma.
A retrospective review of patients with high-grade osteosarcoma who received appropriate surgical treatment and chemotherapy (n = 134) and those who were misdiagnosed and received unplanned surgery (n = 16) between July 1995 and February 2005.
Patients who received unplanned treatment were older (mean age: 29.7 vs. 19.7 years; P = 0.003) and had a smaller mean tumor volume (119 vs. 280 ml; P = 0.015). The 5-year survival rate was not statistically different between the groups. Patients who had unplanned treatment had a higher local recurrence rate (43.8 vs. 17.9%; P = 0.024) and a shorter mean time for recurrence (11.9 vs. 20.8 months; P = 0.036). Furthermore, in patients who underwent unplanned treatment, lung metastases occurred earlier (6.1 vs. 16.2 months P = 0.021) and the final limb salvage rate was less (68.7 vs. 87.3%; P < 0.001).
Unplanned treatment for high-grade osteosarcoma can result in failure of local control and earlier systemic metastases.
Japanese Journal of Clinical Oncology 11/2011; 41(11):1244-50. · 1.78 Impact Factor
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ABSTRACT: The purpose of this retrospective study was to compare clinical parameters in preoperative, perioperative, and postoperative categories between valgus and varus deformities in primary total knee arthroplasty (TKA) following midvastus approach. We compared 83 patients (83 TKAs in valgus) with 949 patients (1084 TKAs in varus), with a mean follow-up of 72 months. In valgus deformity, mean age and body mass index at TKA were younger and smaller with more percentage of patellar subluxation. Cutting thickness from distal femur, tibial plateau, and lateral aspect of posterior femur were significantly different. The incidence of lateral release was 10.8% in valgus and 2.1% in varus. Although several significant differences were observed in preoperative and perioperative categories, the postoperative functional results were similarly evaluated by Knee Society knee and function scores.
The Journal of arthroplasty 09/2011; 27(4):604-12. · 1.79 Impact Factor
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ABSTRACT: The use of hamstring tendon autografts for anterior cruciate ligament (ACL) surgery has become more and more common. The purposes of this study were to determine whether anthropomorphic measurement correlated with tendon sizes in Chinese patient group and whether tendon sizes in Chinese and Caucasian patient groups differed.
From 2008 to 2009, 100 patients that received double-bundle ACL reconstruction with autologous hamstring tendons were prospectively enrolled. The original lengths and triple-folded graft diameters of the individual semitendinosus (ST) and gracilis (Gr) tendons were recorded and correlated with the anthropometric data (height, weight, body mass index, gender, thigh length, shank length, leg length and bilateral thigh circumference) of the patients. Later, using height for predictions, the original heights of patients were added to the equations previously used for regression models to compare the tendon lengths in different ethnic groups.
After stepwise multiple linear regression analysis, the height and leg lengths showed greatest correlation with the lengths of both tendons. The lengths of both the semitendinosus and gracilis tendons in Caucasian patients were significantly longer than in the Chinese patients.
The results of this study showed that anthropomorphic measurements (height and leg length) correlated with tendon lengths. In addition, Caucasians had significantly longer hamstring tendons than the Chinese patients. LEVEL OF EVIDENCE : Prospective cohort study (prevalence), Level I.
Knee Surgery Sports Traumatology Arthroscopy 08/2011; 20(5):916-21. · 2.21 Impact Factor
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ABSTRACT: The result of treatment of infections involving antibiotic-resistant organisms in total knee arthroplasty (TKA) is often poor. We evaluated the efficacy of 2-stage revision in TKAs infected with resistant organisms and compared the clinical outcomes with articulating and conventional static spacers, in terms of both infection control and function.
In a prospective manner, from June 2003 to January 2007 selected patients with a TKA infected with resistant organisms were enrolled and treated with 2-stage re-implantation. The 45 patients were divided into 2 groups: group A (23 patients) implanted with the articulating spacers and group S (22 patients) implanted with static spacers. All patients followed the same antibiotic protocols and had the same re-implantation criteria. The efficacy of infection control was evaluated using re-implantation rate, recurrence rate, and overall success rate. The functional and radiographic results were interpreted with the Hospital of Special Surgery (HSS) knee score and the Insall-Salvati ratio.
With mean 40 (24-61) months of follow-up, 22 of 23 knees were re-implanted in group A and 21 of 22 were re-implanted in group S. Of these re-implanted prostheses, 1 re-infection occurred in group A and 2 occurred in group S. Range of motion after re-implantation, the final functional scores, and the satisfaction rate were better in group A. One third of the patients in group S, and none in group A, had a patella baja.
After 2-stage re-implantation of TKAs originally infected with resistant organisms, the clinical outcome was satisfactory-and similar to that reported after treatment of TKAs infected with low-virulence strains. Treatment with an articulating spacer resulted in better functional outcome and lower incidence of patella baja.
Acta Orthopaedica 08/2011; 82(4):460-4. · 2.17 Impact Factor
