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This study aimed to compare outcomes between ankylosing spondylitis (AS) treated with and without bisphosphonate (BP; non-BP) through a meta-analysis. The Medline (via PubMed), Cochrane, Scopus, and Embase databases were searched for studies that evaluated the outcomes of AS, including patient age, disease duration, disease activity, and bone mineral density (BMD), published between January 2000 and March 2020. Two authors extracted the data independently. Any discrepancies were resolved by a consensus. Six comparative studies were identified. No significant differences were found between the BP and non-BP groups in terms of demographic characteristics, disease activity, and BMD, except for follow-up erythrocyte sedimentation rate (ESR). The follow-up ESR was higher in the BP than in the non-BP group. A literature review identified six comparative studies reporting the outcomes of BP and non-BP treatments for AS. Despite the heterogeneity, a limited number of meta-analyses reported that BP treatment was not clearly better than non-BP treatment. Hence, further large-scale multicenter studies are required to validate our results.

Objective: This meta-analysis aimed to investigate the changes in sagittal spinopelvic alignment in degenerative lumbar scoliosis (DLS) from the preoperative state to the last follow-up.Methods: The MEDLINE via PubMed, Cochrane, Scopus, and Embase databases were searched for studies published between January 2010 and January 2019 evaluating radiological parameters including the coronal Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) in DLS. Two authors performed data extraction independently. All discrepancies were resolved by consensus.Results: The 34 studies identified showed significant decreases in overall and subgroup Cobb angles from the preoperative state to the last follow-up. Both overall TK and LL were significantly increased from the preoperative state to the last follow-up. In subgroup analysis, LLs in the long fusion, combined approach, and posterior approach group were significantly increased at the final follow-up, but the LL increase in the short fusion group was not significant at the last follow-up. However, there was no significant change in SVA, PI, SS, and PT from the preoperative state to the last follow-up.Conclusions: A literature review identified 34 studies reporting preoperative and last follow-up data on spinal fusion in DLS. Despite heterogeneity, a limited meta-analysis showed significant improvement in the coronal Cobb angle, TK, and LL after spinal fusion in DLS. A large, randomized clinical trial would be necessary to validate our results.

Although translated versions of the Foot Function Index (FFI) in several languages are available, the absence of a Korean version has precluded comparing the data from Korea with the data from other countries using the FFI. We, therefore, evaluated the reliability and validity of the adapted Korean version of the FFI. We translated the English version of the FFI into Korean and back into English. We mailed the Korean version of the visual analog scale, FFI, and the previously validated Medical Outcomes Study Short-Form 36-item questionnaire (SF-36) to 121 patients with treated foot complaints. To evaluate the test-retest reliability and internal consistency, we used the intraclass correlation coefficient and Cronbach's α, respectively. We also evaluated the concurrent and construct validity of Korean version of the FFI by comparing the visual analog scale and SF-36. Cronbach's α was 0.91 and 0.95 for the pain and disability subscales, respectively. The reproducibility was good, and a strong correlation between the FFI and the SF-36 and visual analog scale with related content was observed, indicating good construct validity.The Korean version of the FFI is a reliable and valid questionnaire for the self-assessment of pain and disability in Korean patients with foot complaints.

Although translated versions of the Oxford Knee Score (OKS) in several languages are available, the absence of a Korean version precludes comparing data from Korea with that from other countries using the OKS.We therefore evaluated the reliability and validity of the adapted Korean version of the OKS.We first translated the English version of the OKS into Korean, then back into English, then held expert committee discussions to finalize the Korean version. We then mailed the Korean version of the VAS for pain, OKS, and the previously validated SF-36 to 142 patients who underwent TKAs for knee osteoarthritis. Factor analysis and reliability assessment using the kappa statistic of agreement for each item, the intraclass correlation coefficient, and Cronbach's alpha were conducted. To determine the subscales of the OKS, we used the factor analysis. We also evaluated concurrent and construct validity by comparing the responses to the OKS with the results of the VAS and SF-36 using Pearson's correlation coefficient.All items had a kappa statistic of agreement greater than 0.6. The OKS showed test and retest reliability as follows: OKS, 0.848; Factor 1, 0.867; and Factor 2, 0.819. Internal consistency of Cronbach's alpha was as follows: OKS, 0.932; Factor 1, 0.907; Factor 2, 0.867. The OKS correlated (r = 0.692) with the VAS. The Korean version of the OKS correlated with the SF-36 total and individual domain (physical functioning, role physical, bodily pain) scores.The adapted Korean version of the OKS was translated and showed acceptable measurement properties. The data suggest it is suitable for assessing outcomes in Korean-speaking patients having TKAs.

Streptococcus dysgalactiae subspecies dysgalactiae (SDSD), Lancefield group C streptococcus, is an animal pathogen which often causes pyogenic infection in domestic animals. Human infection by SDSD has been reported as a cellulitis on the upper arm, but a prosthetic joint infection caused by SDSD after total knee arthroplasty (TKA) has not yet been reported in the literature demonstrating that its clinical manifestation and management have not been well established. In this case report, we aimed to present a case of SDSD prosthetic joint infection after TKA, which was successfully treated by two-stage re-implantation with an application of antibiotic-impregnated cement spacer.

Low bone mass and osteopenia have been reported in the axial and peripheral skeleton of adolescent idiopathic scoliosis (AIS) patients. Furthermore, several recent studies have shown that gene polymorphisms are related to osteoporosis. However, no study has yet linked polymorphisms in the vitamin D receptor (VDR) gene and bone mass in AIS. Accordingly, the authors examined the association between bone mass and VDR gene polymorphisms in 198 girls diagnosed with AIS. The VDR BsmI (rs1544410), FokI (rs2228670) and Cdx2 (rs11568820) polymorphisms and bone mineral density at the lumbar spine (LSBMD) and femoral neck (FNBMD) were analyzed and compared to their levels in healthy controls. Mean LSBMD and FNBMD in AIS patients were lower than in age- and sex-matched healthy controls (P = 0.0022 and P = 0.0013, respectively). A comparison of genotype frequencies in AIS patients and controls revealed a significant difference for the BsmI polymorphism only (P = 0.0054). Furthermore, a significant association was found between the VDR BsmI polymorphism and LSBMD. In particular, LSBMD in AIS patients with the AA genotype was found to be significantly lower than in patients with the GA (P

Generalized low bone mass and osteopenia have been reported in the axial and peripheral skeleton of adolescent idiopathic scoliosis (AIS) patients. Recently, many studies have shown that gene polymorphisms are related to osteoporosis. However, no studies have linked the association between gene polymorphisms and bone mass of AIS. Therefore, this study examined the association between the bone mass and RANKL, RANK, and OPG gene polymorphisms in 198 girls diagnosed with AIS. OPG 163 A → G, 209 G → A, 245 T → G, and 1181 G → C polymorphisms; RANK 421 C → T and 575 C → T polymorphisms; and RANKL rs12721445 and rs2277438 polymorphisms, as well as the bone mineral density at the lumbar spine (LSBMD) and femoral neck (FNBMD) were analyzed. The 163 A → G, 209 G → A, and 245 T → G polymorphisms in the OPG gene were in complete linkage. No RANK 421 C → T and 575 C → T polymorphisms or RANKL rs12711445 polymorphism were observed. There was a significant association between the OPG gene 1181 G → C polymorphism and LSBMD. LSBMD in AIS with the CC genotype was found to be significantly higher than in AIS with the GC (P < 0.05) or GG (P < 0.01) genotype. However, there was no significant association between LSBMD or FNBMD and the OPG gene 245 T → G polymorphism or the RANKL rs2277438 polymorphism. These results suggest that the OPG gene 1181 G → C polymorphism is associated with LSBMD in girls with AIS.

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.

Septic arthritis caused by Klebsiella pneumonia in adults is rare and is rarely observed after total knee arthroplasty. Acute or early onset of septic arthritis caused by K. pneumoniae has been reported after total knee arthroplasty. However, to date the only one overseas case of late K. pneumoniae infection after total knee arthroplasty has been reported, with no such case in Korea. In addition, monomicrobial infections by K. pneumoniae are not frequently found but are found primarily in the form of polymicrobial infections. The purpose of this paper is to report on a case in which an 85-year-old female patient, who had undergone a total joint arthroplasty 11 years ago, developed the late onset of septic arthritis caused by monomicrobial K. pneumonia infection with a periprosthetic fracture through literature reviews.

Streptococcus sanguis (S. sanguis) is a gram positive streptococcus bacteria which is found in the normal bacterial fl ora of the oral cavity and the upper respiratory tract. It has low virulence, but it can cause bacterial endocarditis through the blood circulation when dental calculus are removed from the teeth or during surgical treatment. Septic arthritis caused by S. sanguis has been reported as infecting the sternoclavicular joint and the knee joint, but it is a quite rare infectious disease that has not been reported in Korea. Therefore, the authors report a case of the septic arthritis in the knee joint caused by S. sanguis in a patient with osteoarthritis of the knee, who has the history of periodontitis.

77 통신저자:고 영 철 부산시 연제구 거제2동 1330 부산의료원 정형외과 Tel:051-607-2862ᆞFax:051-507-3001 E-mail:drgo1973@nate.com 접수: 2011. 8. 25 심사 (수정): 1차 2011. 9. 16, 2차 2011. 11. 23 게재확정: 2011. 12. 9 Address reprint requests to:Young-Chul Ko, M.D. Department of Orthopedic Surgery, Busan Medical Center, 1330, Geoje 2-dong, Yeonje-gu, Busan 611-072, Korea Tel:82-51-607-2862ᆞFax:82-51-507-3001 E-mail:drgo1973@nate.com 강직성 척추염에서 불완전 마미증후군을 동반한 제3요추 전이성 손상의 치료

The Superior Shoulder Suspensory Complex (SSSC) is a bony and soft tissue ring comprising the glenoid process, the coracoid process, the coracoclavicular ligaments, the distal clavicle, the acromioclavicular joint, and the acromion. The SSSC maintains a normal stable relationship between the upper extremity and the axial skeleton. High-energy injury, such as traffic accident or a fall, can cause disruption of the SSSC. Single traumatic disruption of the SSSC is common. However, double disruption of the SSSC is infrequent and surgical management is generally necessary. We have experienced a case of triple fracture involving the coracoid process, the acromion, and the distal end of the clavicle. Such disruption of the SSSC has not been previously reported in our country and only one case has been reported in the Western literature; the authors obtained positive clinical results with surgical treatment. We report here on this case and include a review of the relevant literature.