Through retrospective Jeju-cohort study at 2005, we found low rates of detection of osteoporosis (20.1%) and medication for osteoporosis (15.5%) in those who experienced hip fracture. This study was to determine the orthopedic surgeons' awareness could increase the osteoporosis treatment rate after a hip fracture and the patient barriers to osteoporosis management. We prospectively followed 208 patients older than 50 yr who were enrolled for hip fractures during 2007 in Jeju-cohort. Thirty four fractures in men and 174 in women were treated at the eight hospitals. During the study period, orthopedic surgeons who worked at these hospitals attended two education sessions and were provided with posters and brochures. Patients were interviewed 6 months after discharge using an evaluation questionnaire regarding their perceptions of barriers to osteoporosis treatment. The patients were followed for a minimum of one year. Ninety-four patients (45.2%) underwent detection of osteoporosis by dual energy x-ray absorptiometry and 67 (32.2%) were prescribed medication for osteoporosis at the time of discharge. According to the questionnaire, the most common barrier to treatment for osteoporosis after a hip fracture was patients reluctance. The detection and medication rate for osteoporosis after hip fracture increased twofold after orthopedic surgeons had attended the intervention program. Nevertheless, the osteoporosis treatment rate remains inadequate.

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Most epidural abscesses are a secondary lesion of pyogenic spondylodiscitis. An epidural abscess associated with pyogenic arthritis of the facet joint is quite rare. To the best of our knowledge, there is no report of the use of antibiotic-cement beads in the surgical treatment of an epidural abscess. This paper reports a 63-year-old male who sustained a 1-week history of radiating pain to both lower extremities combined with lower back pain. MRI revealed space-occupying lesions, which were located in both sides of the anterior epidural space of L4, and CT scans showed irregular widening and bony erosion of the facet joints of L4-5. A staphylococcal infection was identified after a posterior decompression and an open drainage. Antibiotic- bone cement beads were used as a local controller of the infection and as a spacer or an indicator for the second operation. An intravenous injection of anti-staphylococcal antibiotics resolved the back pain and radicular pain and normalized the laboratory findings. We point out not only the association of an epidural abscess with facet joint infection, but also the possible indication of antibiotic-bone cement beads in the treatment of epidural abscesses.

PurposeTo assess the efficacy and safety of autologous transfusion of filtered shed blood in total knee arthroplasty (TKA).Materials and MethodsA total of 42 patients with TKA (group A; without autologous transfusion in 15 patients, group B; with autologous transfusion in 27 patients) were evaluated retrospectively. The influence of autologous reinfusion of filtered blood, bleeding tendency, amount of blood drainage, rate of allogenic transfusion, and the postoperative changes of hemoglobin were analyzed.ResultsAllogenic transfusion was needed in 26.7% (4/15) of group A and none of group B till postoperative 48 hours. Till postoperative 14 days, 46.7% (7/15) of group A needed allogenic transfusion while 7.4% (2/27) in group B. The average drained blood volume was 1,197±400 mL in group A and 975±422 mL in group B. The average decrease of hemoglobin at postoperative 1, 7, and 14 days was 2.9±1.5, 2.9±1.6, and 2.3±1.5 g/dL respectively in group A and 2.7±0.8, 4.0±1.0, and 2.9±1.3 g/dL respectively in group B.ConclusionsAn autotransfusion system lowered the allogenic transfusion rate, while anticoagulants did not increase the amount of drained blood. An autotransfusion system with anticoagulants was effective and safe to save the shed blood in TKA.