Poster Presentation - Arthroplasty 2018
Hyun Hee Choi
Assistant professor, Department of Internal Medicine, Hallym University, South Korea
Title: Traumatic popliteal artery entrapment syndrome
Hyun Hee Choi (Biography)
Hyun Hee Choi has her expertise in evaluation and passion in improving the health. Her speciality and interesting subjects are coronary artery disease intervention and endovascular treatment of peripheral artery disease. She already got the degree of physics in the Ewha Womans University before being doctor. So she has tried to use her knowledge of physics to evaluation and improvement of medical department .
Hyun Hee Choi (Abstract)
A 20 year old man presented 1month history of left calf pain with limping and coldness. He is a soldier. He fell into a tank hatch by accident 1month ago. After that accident, he had left calf clamping pain and limping gait. He had no past medical history. His left lower leg was cold and left foot color was paler. The motor power was decreased to grade 4 and the sensory deficit was 5/10. His left popliteal artery pulse was slightly decreased and dorsalis pedis artery pulse was weak. The simple x-ray showed no bony abnormalities. The ultrasound showed decreased amplitude of left proximal popliteal artery and disappeared biphasic pattern of distal left popliteal artery compared with right popliteal artery. But peripheral CT angiography showed no significant luminal narrowing of both lower leg arteries. We couldn’t perform Ankle-brachial index because patient’s pain was severe during tourniquet compression. So we checked digital infrared thermal imaging (DITI). In the DITI, there was no visible thermal imaging of left below the knee level and it means the left lower leg temperature was below the 26 degree. The MRA showed decreased left artery size below popliteal artery compared with right artery and MRI showed swelling and edema of left posterior deep muscle. So we performed peripheral angiogram, we can find the short segment narrowing of left popliteal artery. He was performed popliteal artery angioplasty with saphenous vein patch. At post operation 10 days, DITI showed increased left leg temperature, but there was still temperature deference about 3 degree between left and right leg. At 4 months after surgery, DITI showed no temperature difference between left and right leg. Therefore, his final diagnosis was traumatic popliteal artery entrapment syndrome. And DITI is a useful and non invasive diagnostic tool for evaluation of vascular insufficiency.
Raffaele Borghi
Rizzoli Orthopaedic Institute, Bologna, Italy
Title: Treatment of articular cartilage lesion of the knee: biopolymer hydrogel and microfracture versus microfracture only technique
Raffaele Borghi (Biography)
Raffaele Borghi is working at Rizzoli Orthopaedic Institute, Bologna, Italy and also working in Villa Regina Hospital, Bologna, Italy.
Raffaele Borghi (Abstract)
Objectives: Articular cartilage injuries of the knee are a common finding in patients with knee pain. In recent years, thermo-gelling biopolymer systems have elicited interest for biomedical applications, such as filler matrix for treatment of osteoarthritis and post-traumatic cartilage lesion. The purpose of this study was to evaluate and compare outcomes in two groups of patients, one treated with microfractures (MF), and one treated with microfracture and a thermo-sensitive bio-adhesive hydrogel made of polyglucosamine/glucosamine carbonate (JR). Methods: Sixtynine patients with symptomatic articular cartilage lesions in the knee, grade III-IV (Outerbridge), treated from January 2015 to April 2015, were prospectively divided into two groups. All patients were treated with standard knee arthroscopy procedure, also associated with other treatment such as meniscal repair. The 46 patients included in JR group, were treated with microfractures, plus a thermo-sensitive bio-adhesive hydrogel made of polyglucosamine/glucosamine carbonate that was applied directly on the site after marrow stimulation. In MF group, 23 patients were treated with arthroscopic microfractures as traditionally described by Steadman. All patients were allowed to full weight bearing 3 hours after surgery. The patients were evaluated clinically using WOMAC scores preoperatively, at 6 month, 1 year and 2 years follow up, and VAS scores, preoperatively, at 48 hours, 1 month and 6 months, 1 year and 2 years follow up. MRI and T2 mapping were performed before surgery and after 6 months to control the quality of the regenerated cartilage. Results: The demographics and comorbid conditions known to affect outcome of cartilage repair techniques were similar between the two groups. No adverse event or complications related to surgery were observed or reported by patients. At 48 hours from surgery VAS score decreased of 41% (JR group) and of 32% (MF group), at 1 month, the decrease were 72% (JR) and 53% (MF), at 6 months there was no pain in the JR group, and a decrease of 89% in the MF group, no pain was registered in both group afterwards. Before surgery WOMAC score was 56.5 in the JR group, and 58.9 in the MR group, at 6 months follow up was 7.4 in JR and 28.4 in MR, and at the last follow up 4.4 in JR group, and 41.9 in MR group. Results from T2 mapping in JR group were compared with results from native cartilage. Biopsy was performed in 2 patients of the JR group who needed new surgical procedure due to trauma; both biopsies contained hyaline-like cartilage. Conclusions: Patients treated with biopolymer hydrogel and microfracture technique obtained better clinical results than patients treated with only microfracture. This new technique resulted to be safe and allowed significant improvements in function and pain.
Kee Haeng Lee
Orthopedic professor, catholic university of korea
Title: Treatment of proximal femur osteomyelitis occurred after proximal femoral nail anti-rotation fixation, with antibiotic cement-coated tibia intramedullary nail: A case report
Kee Haeng Lee (Biography)
Kee Haeng Lee is Orthopedic professor of catholic university of korea. He is master of arthroplasty of hip. He is also interested in osteoporosis & sarcopenia.
Kee Haeng Lee (Abstract)
Introduction : Antibiotic cement-coated intramedullary nails maintain a locally high antibiotic concentration while contributing to bone stability. We present a case of femoral subtrochanteric fracture in a patient with an infected nonunion who was successfully treated for an infection and nonunion using an antibiotic cement-coated tibial intramedullary nail. Case report : A 79-year-old woman with a right femoral subtrochanteric fracture underwent internal fixation using proximal femoral nail antirotation (PFNA). She developed osteomyelitis with nonunion at the surgical site, 10 months postoperatively. A two-stage surgery, including removal of the existing PFNA to treat the infection and stable fixation to treat the nonunion, is generally performed but requires a prolonged hospitalization period. We therefore decided to insert an antibiotic cement-coated intramedullary nail in a one-stage surgery. However, the patient’s diaphysis of the femur was too shallow to insert the antibiotic cement-coated intramedullary nail, even when using the smallest femoral intramedullary nail. Stable fixation could not be achieved using an antibiotic cement-coated intramedullary K-wire, thus, we decided to use an antibiotic cement-coated tibial intramedullary nail. After coating the nail with bone cement mixed with antibiotics, bone fixation was achieved by inserting the nail at the site of the PFNA. The patient’s symptoms improved, symptoms from the infection disappeared, and bone union was confirmed. Discussion : Osteomyelitis occurred because of postoperative infection following a proximal femoral fracture. Antibiotic cement-coated tibial intramedullary nails are an effective option to treat patients with osteomyelitis of the femur and achieve bone union where nonunion persists with a shallow intramedullary femoral canal.
Gab-Lae Kim
Associate professor, Hallym University College of Medicine, Seoul, Korea
Title: Deformity correction of foot and ankle after TKR : Case report
Gab-Lae Kim (Biography)
Gab-Lae Kim is an Associate Professor currently in the Hallym University College of Medicine in the Department of Orthopaedic Surgery at Seoul, Korea.
Gab-Lae Kim (Abstract)
Introduction Total knee arthroplasty (TKA) has proved to be a highly successful procedure for the relief of debilitating pain associated with degenerative joint disease. The 10- to 15-year survivorship of primary TKA now routinely exceeds 90%. However, despite advancements in surgical technique, implant design, and postoperative management, complications continue to be a relatively common. Like infection, tendon rupture, instability which is common complication after TKR, the instability of hind foot alignment has also been reported. We reported about a satisfied case; ankle, foot deformity correction for malrotation after TKA which didn`t performed about correction of knee. Case Report 68-year patient has visited and showed hind foot malalignment and claw toe deformity after Total knee arthroplasty one year ago. Patient was suffered by pain and feel like paralysis below ankle which was unable to walk about one year ago. Patient have insufficient action on plantarflexion of ankle and have limited ROM of toes. Also we found in standing position patient showed equinovarus deformity of ankle, claw toe deformity of foot and Achilles tightening about 6cm. On AP standing view patient showed genu recurvatum and slightly elevation of right ankle joint. To correct these deformity, we did tibialis anterior tendon transfer, flexor hallucis longus graft, plantar fasciotomy, and ilizarov external fixator applied. AP standing view after deformity correction showed genu recurvatum angle and hind foot alignment was improved and patient feel much better than before surgery. Discussion Genu recurvatum deformities are unusual before total knee arthroplasty (TKA), occurring in less than 1% of patients. Because of its rarity, concern may exist regarding the recurrence of the deformity and the potential for instability after TKA. Recurvatum may be associated with a severe osseous deformity, including genu valgum, capsular or ligamentous laxity, and, rarely, neuromuscular disease. In the presence of the latter, a plantarflexion contracture of the ankle also may be present. Therefore, specific attention should be given preoperatively to evaluation of the quadriceps, hamstrings, and gastrocnemius complex. Because genu recurvatum is known to recur in patients with certain neuromuscular disorders, the etiology of the hyperextension deformity must be elucidated thoroughly before surgery. In the absence of neuromuscular disease, however, hyperextension deformities tend not to recur after TKA. Over the past few years, many different procedures for the correction of genu recurvatum have been proposed. The least technically challenging approach is to tighten the extension gap by underresecting the distal femur, using a thicker polyethylene liner, and placing the femoral component in slight flexion. Another option is to tighten the collateral ligaments in extension to obtain a tighter extension gap and prevent hyperextension deformity. The other option is to use a rotating-hinge TKA with an extension stop to reduce the risk of hyperextension instability postoperatively. We focused on the problem of ankle joint due to genu recurvatum and performed an anterior tibialis tendon transfer and plantar fasciotomy as the main operation for soft tissue surgery to correct the malalignment of hind foot and correct the following claw tow deformity. We experienced a satisfactory case in which genu recurvatum was also corrected as a result of the corrected ankle joint.
Daniel (Dan) Li
Northwestern University, Illinois
Title: Biomaterial Advances in Arthroplasty
Daniel (Dan) Li (Biography)
Daniel (Dan) Li has participated in a wide variety of both basic and clinical research regarding biomaterials in the context of orthopaedic applications, such as the use of hydrogels as a novel drug-eluting mechanism to combat osteomyelitis and tuberculosis infection. He has spent significant time overseas with the orthopaedics department at the 309th Hospital of the PLA in Beijing, China, working under the team of Dr. Yuanzheng Ma, as well as completing his undergraduate degree in Materials Science and Engineering at the University of Illinois. There, he conducted research under the John Rogers Research Group investigating novel biodegradable electronics. Currently, he is performing clinical outcomes research at Northwestern University regarding the evaluation of prosthetic joint infection.
Daniel (Dan) Li (Abstract)
3D Printing aims to deliver intricate biomedical devices based upon advanced diagnostic imaging. With the current upsurge in public interest and increasing access to low-cost printers, efforts are underway to produce patient-specific anatomical models, customized implants, and individualized instrumentation. Examples include the development of disposable surgical saw guides and cutting blocks in total knee arthroplasty. These devices help minimize tissue loss and optimize the native biomechanics of the patient. This review explores the evolution of 3D Printing technology in the context of biomaterials. It also aims to critiques the major challenges ahead in optimizing bioinks and biologic performance in bringing 3D bioprinting to clinical practice. Common materials include metals, bioceramics, synthetics, and natural polymers; each have specific mechanical properties, processing methodology, and cell-material interaction. Biofunctional biomaterials are an emerging class of materials that display adaptability and activity at every phase of bone growth. These biomaterials have been shown to promote osteogenic differentiation, improve calcium phosphate (CaP) precipitation, and regulate osteoblast gene expression. When crafted to emulate the specific micro-environment of bone, polymer-surface modifications accelerate bony ingrowth. 3D printing holds promise as a scaffold for bone regeneration as precise control of the overall geometry and internal porous structure. The accompanying biomaterials may be successfully embedded within multi-cellular co-cultures and specific growth factors modulated to optimize growth and fixation [2, 6]. Bioceramics such as hydroxyapatite (HA), calcium phosphate, and bioglass, are osteogenic and promote cell proliferation, though they have been shown to lack appropriate mechanical strength. Composite scaffolds of HA and tricalcium phosphate and polycaprolactone (PCL)-HA with carbon backbones have been investigated to optimize biocompatibility and architecture to improve the porosity and mechanical strength of these constructs. Furthermore, microscale manipulation of biomaterials allow for integration of antimicrobial properties to combat infection.