Background: The clinical symptoms and radiographic appearance of osteomyelitis can mimic those of... more Background: The clinical symptoms and radiographic appearance of osteomyelitis can mimic those of bone tumors.
We evaluated the long-term outcome of patients with an osteosarcoma who had undergone prior manip... more We evaluated the long-term outcome of patients with an osteosarcoma who had undergone prior manipulative therapy, a popular treatment in Asia, and investigated its effects on several prognostic factors. Of the 134 patients in this study, 70 (52%) patients had manipulative therapy and 64 (48%) did not. The age, location, and size of tumour were not significantly different between the groups. The five-year overall survival rate was 58% and 92% in the groups with and without manipulative therapy (p = 0.004). Both the primary and overall rates of lung metastasis were significantly higher in the manipulative group (primary: 32% vs 3%, p = 0.003; overall lung metastasis rate: 51.4% vs 18.8%, p < 0.001). Patients who had manipulative therapy had higher local recurrence rates in comparison to patients who did not (29% vs 6%, p = 0.011). The prognosis for patients with osteosarcoma who had manipulative therapy was significantly poorer than those who had not. Manipulative therapy was an independent factor for survival. This form of therapy may serve as a mechanism to accelerate the spread of tumour cells, and therefore must be avoided in order to improve the outcome for patients with an osteosarcoma.
Osteonecrosis of the femoral head (ONFH) is an important indication for total hip arthroplasty in... more Osteonecrosis of the femoral head (ONFH) is an important indication for total hip arthroplasty in Taiwan. We demonstrated the etiologies of ONFH and outcomes based on stratification of patients according to different etiologies. We reviewed medical records and images from January 2000 to May 2010 in our database with the diagnosis of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;osteonecrosis of the femoral head.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; We categorized all patients into different etiologies, including corticosteroid, alcohol, and idiopathic. All patients received subsequent follow up for ipsilateral precollapse ONFH and contralateral disease-free femoral head status after initial diagnosis. Of the 1153 patients who had undergone 1674 hip surgeries including core decompression and total hip replacement, alcohol use was the most prevalent etiology in our population (45.2%). Patients with corticosteroid- and alcohol-associated ONFH were younger and more likely to have bilateral disease. Patients with alcohol- or steroid-associated ONFH were found to have a higher rate of contralateral disease and faster progression of precollapse ONFH than patients who had or had not undergone core decompression. Alcohol use had the greatest impact on ONFH in our population. Nonidiopathic ONFH patients had the worst outcome. Understanding the nature of progression of ONFH and incidence of contralateral disease may provide great prognostic value to detect and perform early intervention.
Giant cell tumor of the sacrum is usually silent in initial stages and not diagnosed until achiev... more Giant cell tumor of the sacrum is usually silent in initial stages and not diagnosed until achieving a large size. Intralesional curettage of the tumor has lower risk of neurological damage but is with high recurrence rate. Zoledronic acid-loaded cement was demonstrated to have cytotoxic effect on the cell line of giant cell tumor. This study evaluate if zoledronic acid-loaded bone cement would reduce the recurrence rate of sacral giant cell tumor after intralesional curettage. Four patients were diagnosed as sacral giant cell tumor and received intralesional curettage with placement of zoledronic acid-loaded bone cement for adjuvant local control. The clinical records including tumor location, tumor size, complication, follow-up status, and functional outcome were analyzed retrospectively. All four patients presented with cauda equina syndrome before surgery with mean tumor volume of 472.8 cm(3). With placement of zoledronic acid-loaded cement, no local recurrence was observed during the mean follow-up period of 28 months. All patients were found to have new bone regeneration on radiograph. All patients suffering from cauda equina syndrome were recovered. We suggested that placement of zoledronic acid-loaded bone cement was an effective adjuvant therapy for sacral giant cell tumor following intralesional curettage.
Postoperative radiation for prevention of heterotopic ossification (HO) has been proven effective... more Postoperative radiation for prevention of heterotopic ossification (HO) has been proven effective for the patients with ankylosing spondylitis (AS) after total hip arthroplasties (THA). This study aims to evaluate the effect of postoperative radiation in HO formation following THA in patients with AS. We retrospectively reviewed 129 hips from 91 patients with AS receiving primary THA from July 2004 to December 2012. There were total 38 patients (53 hips) did not receive postoperative prophylaxis in Group I. Moreover, 53 patients (76 hips) received postoperative single-fraction radiotherapy of 500 cGy in Group II. After a minimum 12-month follow-up, there was no significant difference in HO formation between the two groups (P=0.210). This study suggests that postoperative radiation may not be necessary in Asian patients.
Between January 1999 and August 2008, ninety-six femoral revisions were performed with extensivel... more 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 fr...
Journal of the Chinese Medical Association : JCMA, 2014
The local recurrence rate after surgical excision of intramuscular hemangioma reported is between... more The local recurrence rate after surgical excision of intramuscular hemangioma reported is between 18% and 61%. The aim of this study was to review the clinical outcome and local recurrence rate after surgical excision of nonpalpable intramuscular hemangioma using preoperative ultrasound-guided hookwire localization. We performed ultrasound-guided hookwire localization before excision surgery for nonpalpable intramuscular hemangioma in 37 cases between January 1997 and 2011. There were 20 females and 17 males, with a mean age of 30.2 years (range, 17-49 years). The mean localization procedure time was 10.6 minutes (range, 3-20 minutes). The average operation time was 48.6 minutes (range, 30-80 minutes). The average length of the excision wound was 5 cm (range, 4-11 cm), and the average hospital stay was 2.5 days (range, 2-4 days). The postoperative therapeutic report confirmed the diagnosis of intramuscular hemangioma. The average tumor size was 2.11 cm and all excision margins were ...
Bone prosthesis composite (BPC) had been widely-used in reconstruction after wide excision of mal... more Bone prosthesis composite (BPC) had been widely-used in reconstruction after wide excision of malignant tumors around the knee. However, implant selection for BPC remains a dilemma. Forty-one patients with high-grade malignant bone tumors around the knee who underwent excision and reconstruction with BPC and rotating hinged knee (RHK) prosthesis were included. The mean follow-up time was 54 months (range, 31-78 months). The average Musculoskeletal Tumor Society Rating score was 93.4% (range, 73-100%). The mean range of motion was 125°. Complications included 2 local recurrences, 2 nonunions, and 1 peri-prosthetic fracture. The reconstruction with BPC using the RHK prosthesis provided consistently good functional results with a low complication rate. The RHK prosthesis is a promising choice for BPC reconstruction.
Hip international : the journal of clinical and experimental research on hip pathology and therapy, Jan 5, 2014
To illustrate that Acremonium and Penicillium species are being increasingly recognised in peripr... more To illustrate that Acremonium and Penicillium species are being increasingly recognised in periprosthetic joint infections (PJIs). A 47-year-old male with liver cirrhosis and bilateral hip hemiarthroplasties complained of persistent right hip pain. Bone scan was suspicious for right hip septic arthritis. Laboratory studies revealed an elevated erythrocyte sedimentation rate (ESR; 127 mm/h) and C-reactive protein (CRP; 16.171 mg/L). At surgery caseous necrosis with a yellowish appearance around the hip was noted. Intraoperative cultures were positive for Acremonium and Penicillium species 2 weeks after inoculation. After 4 months of fluconazole monotherapy a successful revision right total hip arthroplasty was performed, the patient is walking without assistance at 1 year after surgery. We reported a prosthetic hip infection due to Acremonium and Penicillium species. Removal of the prosthesis, antifungal therapy, and re-implantation after 4 months were successful.
Hip international : the journal of clinical and experimental research on hip pathology and therapy, Jan 12, 2015
Minimally invasive procedures for total hip arthroplasty (THA) provide less surgery related traum... more Minimally invasive procedures for total hip arthroplasty (THA) provide less surgery related trauma, and perhaps a fast recovery and satisfaction. Using modified instruments, we reported clinical follow-up data for a modified anterolateral approach. Using specialised retractors to expose the acetabulum and femur, this single-incision technique preserved more gluteus medius tendon and provided access for soft tissue repair. The demographic data for 1003 patients undergoing THA with this technique are presented, including operative variables, complications, Harris Hip Score for clinical evaluation and cup inclination angle for radiographic evaluation. Average follow-up was 59 months (range 24-121). In 1077 primary THAs performed in 1003 patients, the median wound length was 6 cm (range 4.8-9.2), median operation time was 68 minutes (range 45-112). The mean perioperative blood loss was 422 mls (range 56-990). The median cup inclination angle was 44 degrees (range 33-54), median acetabul...
Total hip arthroplasty (THA) for patients with Crowe type IV developmental dysplasia of the hip i... more Total hip arthroplasty (THA) for patients with Crowe type IV developmental dysplasia of the hip is technically challenging. This group of patients has a higher incidence of nerve injury during THA. Although neurophysiologic intraoperative monitoring has been developed to provide nerve monitoring, it is not always available. The wake-up test has been used for intraoperative spinal cord monitoring during major spinal surgery, but no study has reported the use of the wake-up test for neurologic monitoring during THA in patients with severe developmental dysplasia of the hip. The authors retrospectively reviewed 22 THA procedures in 20 patients with Crowe type IV developmental dysplasia of the hip who underwent the wakeup test during THA. In the current study, 1 patient could not dorsiflex her foot during the wake-up test. Therefore, the authors immediately reduced the length of limb lengthening by 1 cm. Postoperative drop foot and numbness occurred but resolved completely 2 months later. None of the patients who showed no deficits in motion of the feet during the intraoperative wake-up test had signs of postoperative nerve injury. In the current study, there was no false-positive or false-negative finding. The authors concluded that the wake-up test, which is simple, safe, and reliable, is a useful technique and a possible alternative to neurophysiologic intraoperative monitoring in checking nerve function during THA in patients with severe developmental dysplasia of the hip.
Population-based evaluation on the incidence of postoperative venous thromboembolism (VTE) has no... more Population-based evaluation on the incidence of postoperative venous thromboembolism (VTE) has not yet been reported for Asians receiving arthroplasty. In Taiwan, thromboprophylaxis was not commonly applied for patients. The population-based cohort study aimed to investigate the epidemiology, and to determine the risk factors VTE for patients receiving hip or knee replacement without pharmacological thromboprophylaxis in Taiwan. We retrospectively acquired patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; data from National Health Insurance databases representing more than 99% of about 23 million Taiwanese citizens. The primary outcome was the incidence of composite symptomatic VTE within 28d ays after receiving hip or knee replacement surgery. During 2002 to 2006, there were 114,026 patients undergoing hip (n=61,460) or knee (n=52,566) replacement surgery. The occurrence rate of overall postoperative VTE was 0.44%. The incidence of pulmonary embolism was four in 10,000 patients receiving hip replacement or seven in 10,000 individuals undergoing knee replacement. The weekly cumulative incidence of VTE was persistently rising up to 28 days after surgery. Dramatic increase in risk of post-surgical VTE was associated with prior disease history of PE (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 for hip replacement, p=0.01 for knee replacement) or DVT (p=0.004 for hip replacement, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 for knee replacement). Prior claim of congestive heart failure was an independent risk factor associated with patients receiving knee arthroplasty (p=0.01). Life-threatening PE occurred and increased cumulatively up to 28 days after hip or knee arthroplasty in Asians. Proper prophylaxis for patients with the exposure of high risks needs to be scrutinized.
Treatment options for nonunion of the femoral shaft fracture after intramedullary nail fixation a... more 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.
Wide excision with a 2-3 cm safe margin is widely-accepted in treating high-grade osteosarcoma. H... more 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.
For diagnosing osteosarcoma correctly, a combination of clinical, radiological and histological e... more 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Unplanned treatment for high-grade osteosarcoma can result in failure of local control and earlier systemic metastases.
Background: The clinical symptoms and radiographic appearance of osteomyelitis can mimic those of... more Background: The clinical symptoms and radiographic appearance of osteomyelitis can mimic those of bone tumors.
We evaluated the long-term outcome of patients with an osteosarcoma who had undergone prior manip... more We evaluated the long-term outcome of patients with an osteosarcoma who had undergone prior manipulative therapy, a popular treatment in Asia, and investigated its effects on several prognostic factors. Of the 134 patients in this study, 70 (52%) patients had manipulative therapy and 64 (48%) did not. The age, location, and size of tumour were not significantly different between the groups. The five-year overall survival rate was 58% and 92% in the groups with and without manipulative therapy (p = 0.004). Both the primary and overall rates of lung metastasis were significantly higher in the manipulative group (primary: 32% vs 3%, p = 0.003; overall lung metastasis rate: 51.4% vs 18.8%, p < 0.001). Patients who had manipulative therapy had higher local recurrence rates in comparison to patients who did not (29% vs 6%, p = 0.011). The prognosis for patients with osteosarcoma who had manipulative therapy was significantly poorer than those who had not. Manipulative therapy was an independent factor for survival. This form of therapy may serve as a mechanism to accelerate the spread of tumour cells, and therefore must be avoided in order to improve the outcome for patients with an osteosarcoma.
Osteonecrosis of the femoral head (ONFH) is an important indication for total hip arthroplasty in... more Osteonecrosis of the femoral head (ONFH) is an important indication for total hip arthroplasty in Taiwan. We demonstrated the etiologies of ONFH and outcomes based on stratification of patients according to different etiologies. We reviewed medical records and images from January 2000 to May 2010 in our database with the diagnosis of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;osteonecrosis of the femoral head.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; We categorized all patients into different etiologies, including corticosteroid, alcohol, and idiopathic. All patients received subsequent follow up for ipsilateral precollapse ONFH and contralateral disease-free femoral head status after initial diagnosis. Of the 1153 patients who had undergone 1674 hip surgeries including core decompression and total hip replacement, alcohol use was the most prevalent etiology in our population (45.2%). Patients with corticosteroid- and alcohol-associated ONFH were younger and more likely to have bilateral disease. Patients with alcohol- or steroid-associated ONFH were found to have a higher rate of contralateral disease and faster progression of precollapse ONFH than patients who had or had not undergone core decompression. Alcohol use had the greatest impact on ONFH in our population. Nonidiopathic ONFH patients had the worst outcome. Understanding the nature of progression of ONFH and incidence of contralateral disease may provide great prognostic value to detect and perform early intervention.
Giant cell tumor of the sacrum is usually silent in initial stages and not diagnosed until achiev... more Giant cell tumor of the sacrum is usually silent in initial stages and not diagnosed until achieving a large size. Intralesional curettage of the tumor has lower risk of neurological damage but is with high recurrence rate. Zoledronic acid-loaded cement was demonstrated to have cytotoxic effect on the cell line of giant cell tumor. This study evaluate if zoledronic acid-loaded bone cement would reduce the recurrence rate of sacral giant cell tumor after intralesional curettage. Four patients were diagnosed as sacral giant cell tumor and received intralesional curettage with placement of zoledronic acid-loaded bone cement for adjuvant local control. The clinical records including tumor location, tumor size, complication, follow-up status, and functional outcome were analyzed retrospectively. All four patients presented with cauda equina syndrome before surgery with mean tumor volume of 472.8 cm(3). With placement of zoledronic acid-loaded cement, no local recurrence was observed during the mean follow-up period of 28 months. All patients were found to have new bone regeneration on radiograph. All patients suffering from cauda equina syndrome were recovered. We suggested that placement of zoledronic acid-loaded bone cement was an effective adjuvant therapy for sacral giant cell tumor following intralesional curettage.
Postoperative radiation for prevention of heterotopic ossification (HO) has been proven effective... more Postoperative radiation for prevention of heterotopic ossification (HO) has been proven effective for the patients with ankylosing spondylitis (AS) after total hip arthroplasties (THA). This study aims to evaluate the effect of postoperative radiation in HO formation following THA in patients with AS. We retrospectively reviewed 129 hips from 91 patients with AS receiving primary THA from July 2004 to December 2012. There were total 38 patients (53 hips) did not receive postoperative prophylaxis in Group I. Moreover, 53 patients (76 hips) received postoperative single-fraction radiotherapy of 500 cGy in Group II. After a minimum 12-month follow-up, there was no significant difference in HO formation between the two groups (P=0.210). This study suggests that postoperative radiation may not be necessary in Asian patients.
Between January 1999 and August 2008, ninety-six femoral revisions were performed with extensivel... more 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 fr...
Journal of the Chinese Medical Association : JCMA, 2014
The local recurrence rate after surgical excision of intramuscular hemangioma reported is between... more The local recurrence rate after surgical excision of intramuscular hemangioma reported is between 18% and 61%. The aim of this study was to review the clinical outcome and local recurrence rate after surgical excision of nonpalpable intramuscular hemangioma using preoperative ultrasound-guided hookwire localization. We performed ultrasound-guided hookwire localization before excision surgery for nonpalpable intramuscular hemangioma in 37 cases between January 1997 and 2011. There were 20 females and 17 males, with a mean age of 30.2 years (range, 17-49 years). The mean localization procedure time was 10.6 minutes (range, 3-20 minutes). The average operation time was 48.6 minutes (range, 30-80 minutes). The average length of the excision wound was 5 cm (range, 4-11 cm), and the average hospital stay was 2.5 days (range, 2-4 days). The postoperative therapeutic report confirmed the diagnosis of intramuscular hemangioma. The average tumor size was 2.11 cm and all excision margins were ...
Bone prosthesis composite (BPC) had been widely-used in reconstruction after wide excision of mal... more Bone prosthesis composite (BPC) had been widely-used in reconstruction after wide excision of malignant tumors around the knee. However, implant selection for BPC remains a dilemma. Forty-one patients with high-grade malignant bone tumors around the knee who underwent excision and reconstruction with BPC and rotating hinged knee (RHK) prosthesis were included. The mean follow-up time was 54 months (range, 31-78 months). The average Musculoskeletal Tumor Society Rating score was 93.4% (range, 73-100%). The mean range of motion was 125°. Complications included 2 local recurrences, 2 nonunions, and 1 peri-prosthetic fracture. The reconstruction with BPC using the RHK prosthesis provided consistently good functional results with a low complication rate. The RHK prosthesis is a promising choice for BPC reconstruction.
Hip international : the journal of clinical and experimental research on hip pathology and therapy, Jan 5, 2014
To illustrate that Acremonium and Penicillium species are being increasingly recognised in peripr... more To illustrate that Acremonium and Penicillium species are being increasingly recognised in periprosthetic joint infections (PJIs). A 47-year-old male with liver cirrhosis and bilateral hip hemiarthroplasties complained of persistent right hip pain. Bone scan was suspicious for right hip septic arthritis. Laboratory studies revealed an elevated erythrocyte sedimentation rate (ESR; 127 mm/h) and C-reactive protein (CRP; 16.171 mg/L). At surgery caseous necrosis with a yellowish appearance around the hip was noted. Intraoperative cultures were positive for Acremonium and Penicillium species 2 weeks after inoculation. After 4 months of fluconazole monotherapy a successful revision right total hip arthroplasty was performed, the patient is walking without assistance at 1 year after surgery. We reported a prosthetic hip infection due to Acremonium and Penicillium species. Removal of the prosthesis, antifungal therapy, and re-implantation after 4 months were successful.
Hip international : the journal of clinical and experimental research on hip pathology and therapy, Jan 12, 2015
Minimally invasive procedures for total hip arthroplasty (THA) provide less surgery related traum... more Minimally invasive procedures for total hip arthroplasty (THA) provide less surgery related trauma, and perhaps a fast recovery and satisfaction. Using modified instruments, we reported clinical follow-up data for a modified anterolateral approach. Using specialised retractors to expose the acetabulum and femur, this single-incision technique preserved more gluteus medius tendon and provided access for soft tissue repair. The demographic data for 1003 patients undergoing THA with this technique are presented, including operative variables, complications, Harris Hip Score for clinical evaluation and cup inclination angle for radiographic evaluation. Average follow-up was 59 months (range 24-121). In 1077 primary THAs performed in 1003 patients, the median wound length was 6 cm (range 4.8-9.2), median operation time was 68 minutes (range 45-112). The mean perioperative blood loss was 422 mls (range 56-990). The median cup inclination angle was 44 degrees (range 33-54), median acetabul...
Total hip arthroplasty (THA) for patients with Crowe type IV developmental dysplasia of the hip i... more Total hip arthroplasty (THA) for patients with Crowe type IV developmental dysplasia of the hip is technically challenging. This group of patients has a higher incidence of nerve injury during THA. Although neurophysiologic intraoperative monitoring has been developed to provide nerve monitoring, it is not always available. The wake-up test has been used for intraoperative spinal cord monitoring during major spinal surgery, but no study has reported the use of the wake-up test for neurologic monitoring during THA in patients with severe developmental dysplasia of the hip. The authors retrospectively reviewed 22 THA procedures in 20 patients with Crowe type IV developmental dysplasia of the hip who underwent the wakeup test during THA. In the current study, 1 patient could not dorsiflex her foot during the wake-up test. Therefore, the authors immediately reduced the length of limb lengthening by 1 cm. Postoperative drop foot and numbness occurred but resolved completely 2 months later. None of the patients who showed no deficits in motion of the feet during the intraoperative wake-up test had signs of postoperative nerve injury. In the current study, there was no false-positive or false-negative finding. The authors concluded that the wake-up test, which is simple, safe, and reliable, is a useful technique and a possible alternative to neurophysiologic intraoperative monitoring in checking nerve function during THA in patients with severe developmental dysplasia of the hip.
Population-based evaluation on the incidence of postoperative venous thromboembolism (VTE) has no... more Population-based evaluation on the incidence of postoperative venous thromboembolism (VTE) has not yet been reported for Asians receiving arthroplasty. In Taiwan, thromboprophylaxis was not commonly applied for patients. The population-based cohort study aimed to investigate the epidemiology, and to determine the risk factors VTE for patients receiving hip or knee replacement without pharmacological thromboprophylaxis in Taiwan. We retrospectively acquired patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; data from National Health Insurance databases representing more than 99% of about 23 million Taiwanese citizens. The primary outcome was the incidence of composite symptomatic VTE within 28d ays after receiving hip or knee replacement surgery. During 2002 to 2006, there were 114,026 patients undergoing hip (n=61,460) or knee (n=52,566) replacement surgery. The occurrence rate of overall postoperative VTE was 0.44%. The incidence of pulmonary embolism was four in 10,000 patients receiving hip replacement or seven in 10,000 individuals undergoing knee replacement. The weekly cumulative incidence of VTE was persistently rising up to 28 days after surgery. Dramatic increase in risk of post-surgical VTE was associated with prior disease history of PE (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 for hip replacement, p=0.01 for knee replacement) or DVT (p=0.004 for hip replacement, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 for knee replacement). Prior claim of congestive heart failure was an independent risk factor associated with patients receiving knee arthroplasty (p=0.01). Life-threatening PE occurred and increased cumulatively up to 28 days after hip or knee arthroplasty in Asians. Proper prophylaxis for patients with the exposure of high risks needs to be scrutinized.
Treatment options for nonunion of the femoral shaft fracture after intramedullary nail fixation a... more 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.
Wide excision with a 2-3 cm safe margin is widely-accepted in treating high-grade osteosarcoma. H... more 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.
For diagnosing osteosarcoma correctly, a combination of clinical, radiological and histological e... more 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 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Unplanned treatment for high-grade osteosarcoma can result in failure of local control and earlier systemic metastases.
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