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Multiple total knee arthroplasty (TKA) failure resulting from a recurrent infection is a challenging problem. Knee arthrodesis is one treatment option that normally involves the application of an external fixator, plate fixation, and intramedullary nailing. However, these approaches are not always successful, and a reinfection is a risk, particularly in older, medically compromised patients. This paper reports a new arthrodesis technique that uses a bundle of flexible intramedullary rods and an antibiotic-loaded cement spacer. This technique was used in two cases of multiple TKA failure that resulted from a recurrent infection. The procedure was successful in both cases with no evidence of rod or cement failure. Two advantages of this procedure are infection eradication and mechanical strength. However, this procedure should only be used for medically compromised elderly patients at high risk of rerevision TKA failure resulting from persistent periprosthetic infection because rod fracture or loosening can occur with time.

Posterior instability after a posterior ligament substituted total knee replacement is considered impossible due to the cam and post mechanism. Therefore, it has not been considered easily as a problem necessitating revision surgery. We report two cases of posterior instability after a fixed bearing posterior cruciate ligament substituted total knee replacement with a review of relevant literature.

36 통신저자:박 종 웅 경기도 안산시 단원구 고잔 1동 516 고려대학교 안산병원 정형외과 TEL: 031-412-6583ᆞFAX: 031-412-5549 E-mail: ospark@korea.ac.kr Address reprint requests to Jong Woong Park, M.D. Department of Orthopaedic Surgery, Korea University Ansan Hospital, 516, Gozan-dong, Danwon-gu, Ansan 425-707, Korea Tel: +82.31-412-6583, Fax: +82.31-412-5549 E-mail: ospark@korea.ac.kr Microvascular Anastomotic Coupler System을 이용한 쉽고, 빠른 혈관문합

Purpose: This study examined the effect of a microscopic residual tumor on the survival and recurrence rate by analyzing patients who had undergone a re-excision after an unplanned excision of a soft tissue sarcoma. Materials and Methods: From December 1985 to June 2002, 68 unplanned excisions of a soft tissue sarcoma at other institutes were referred to our service. All cases had undergone a re-excision and were re-evaluated for residual tumors. The male to female ratio was the same with an average age of 34.7 years. Staging followed the AJCC classification and there were 3 cases of la, 2 lb, 5 lIa,34 lIb, 24 III.Twenty six cases underwent surgical treatment only and 42 had added adjuvant therapy. The mean follow-up was 58.9 months. Results: At the final follow up, there were 48 CDF, 9 NED, 3AWD and 8 DOD. The CDF 5/16 year survival rates were 68.1/61.3%. Eight of the 23 residual tumor positive cases and 6 of the 45 residual tumor negative cases had a local recurrence. The tumor size, residual tumor, interval between the excision and reexcision, and stage were significant factors fora local recurrence. Statistical analysis revealed a local recurrence, metastasis and stage to be significant factors for survival. Conclusion: Local recurrence was the only controllable factor for survival. The presence of a residual tumor had an impact on the local recurrence. A re-excision afteran unplanned excision may reduce the incidence of a local recurrence.

Osteochondroma, the most frequent benign bone tumor, is composed of trabecular bone covered with a hyaline cartilage cap. It is well known that multiple osteochondromatosis may undergo malignant change. Such sarcomatous change usually present with the form of chondrosarcoma, and transformation to other malignancy is extremely rare. This report describes one case of osteosarcoma arising in patients who had multiple osteochondromatosis, and includes brief review of the literatures.

Purpose: To investigate the variation in the chemosensitivity in soft tissue sarcoma (STS), fresh biopsy with sample for culture was tested using the histoculture drug response assay (HDRA) method. Materials and Methods: 30 samples of fresh STS were obtained during either biopsy or surgical removal at our hospital between March, 2002 and March, 2004. Results: Drug sensitivity testing by HDRA showed that two drug, Doxorubicin and CDDP, had a significantly higher inhibition rate than BLM, CTX, DTIC, VCR or VP-16 in the thirty STS tested. Doxorubicin showed the highest inhibition rate in the liposarcoma. CDDP shoewd the significant inhibition rate in the synovial sarcoma and malignant fibrous histiocytpma. Depending on the morphological type, round cell sarcoma and pleomorphic sarcoma were more sensitive to Doxorubicin and CDDP than spindle cell sarcoma. In the round cell sarcoma, BLM, CTX, VP-16 and IFS also showed above 30% inhibition rate. Conclusion: Drug sensitivity testing in STS should be evaluated with clinical outcome in the future and then HDRA will provide useful information for selection of an anticancer agent for STS because of its ease of evaluation and high predictability.

Although the reconstruction with tumor prosthesis is a routine procedure for extremity sarcomas, this option has some technical limitation in children under 10 years old. Customized expandable tumor prosthesis is too expensive in most cases and arthrodesis of any kind is not functional. This report presents one case of osteosarcoma of distal femur in eight years old child which was reconstructed with adult type total elbow endoprosthesis as a reconstructive option, and includes brief review of the literature.

Purpose: The object of the current study was to evaluate the long term survival of synovial sarcoma and to find an appropriate treatment strategy with a favorable prognosis. Materials and Methods: Between August 1985 and June 2000, fifty nine synovial sarcoma patients without metastasis at presentation were analyzed and followed for 50.9 (8-161) months. Kaplan-Meier plots were used for survival analysis. Analyzed prognostic factors were sex, age, stage, location, surgical margin, chemotherapy, radiation therapy, local recurrence and metastasis. The log-rank test was used for univariate analysis and the Cox regression model for multivariate analysis. Results: Fourteen-year actual and continuous disease free survivals (ADF/CDF) were 56.4 and 49.7%, respectively. CDF of stage I-IIa and IIb-III were 53.6 and 43.2%, respectively (p=0.55). For local recurrence according to surgical margin, 4 recurrences occurred in 44 wide margins, 1 recurrence in 6 marginal margins, and 1 recurrence in 2 intralesional margins. Among 10 cases of local recurrence, 4 cases had metastasis. Local recurrence, metastasis, and surgical margin had statistical significance in the univariate (p

Purpose: The analysis points used in this study were the features, durations, and outcomes following different treatment modalities for an infected tumor prosthesis (TP). These were used to define an appropriate strategy for infected TP. Materials and Methods: From December 1986 to November 1999, 215 patients underwent a TP replacement operation in our hospital, and 17 patients with an infected TP were eligible for the study. Forty-two operative procedures were performed on 17 patients (scarectomy 11 cases, partial TP removal and bone cementation 9 cases, complete TP removal and bone cementation 20 cases, and amputation 2 cases). Freedom from infection was defined as no sign of inflammation for 3 months after the operation and its objective variables were CRP, ESR, physical examination, and culture free body fluid. Although one patient received several procedures, we considered each event as a separate variable. The survival rates of the procedures were analysed by Kaplan-Meier plots and these were compared using the log rank test. Results: The cumulative survival of each procedure was 0% by scarectomy at 11 months, 0% by partial TP removal and bone cementation at 12 months, and 34% by complete TP removal and bone cementation at 79 months. Significant differences in survival were found for these procedures (p

Purpose : This study was designed to examine whether human articular chondrocytes express heat shock protein 27 (hsp27) and to evaluate the relation between hsp27 and the apoptosis of chondrocytes. Materials and Methods : Knee joint articular cartilage was obtained from femoral condyle in osteoarthritis patients who underwent joint replacement surgery. Chondrocytes were isolated, cultured and then exposed to heat shock () for 1 hour to induce the expression of hsp27. 20 mM of sodium nitroprusside (SNP) was then added for 12 hours to evaluate the ability of hsp27 to prevent SNPinduced chondrocyte apoptosis. The expression of hsp27 was verified by Western blot and the rate of apoptosis was determined by flow cytometric analysis. Results : Heat shock resulted in the increased expression of hsp27 in chondrocytes. Heat-shocked groups had smaller numbers of apoptotic cells than control groups when both were exposed to apoptosis inducing stimuli. Conclusion : We conclude that hsp27 was expressed in human articular chondrocytes by heat shock and that the expression of hsp27 in chondrocytes increases their resistance to apoptosis. This result presents clues, which suggest that the induction of hsp27 could be a desirable future therapeutic strategy in human osteoarthritis.