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Objective Studying the experience of total hip revision in the femur side with AML prosthesis retrospectively,and to analyze its value.Methods Thirty-five cases were revised with AML prosthesis after failed total hip arthroplasty in the femur side,the bone loss was I-Ⅲb according to Paprosky classification.Results Mean follow-up periods was 17 months,no screenage of prosthesis subside,migrating and more bone loss were showed in all cases postoperatively.Mean Harris score was increased from 37 to 92.Conclusion AML prosthesis is a good choice for the total hip revision in the femur side with I-Ⅲb by Paprosky classification.
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[Objective] To measure the patella thickness and to investigate the techniques and safety of patella resurfacing during total knee arthroplasty in Chinese patients with rheumatoid arthritis.[Methods]From Jan.2005 to Jan.2006,the maximal and minimum thickness of the patella,the preserved thickness of bony patella after resurfacing and the total thickness of patella composite after patella replacement in 95 consecutive total knee arthroplasty for rheumatoid arthritis were measured.The patients were followed-up after operation,anterior knee pain and patella fracture were recorded.[Results]1)The mean maximal thickness before resurfacing was(22.01?1.64)mm(range,18~26 mm),the mean minimum thickness before resurfacing was(11.69?2.33)mm(range,6~16mm).2)The mean thickness of preserved bony patellar thickness was(13.23?0.96)mm,(range,11~16 mm),including 11 mm in 4 knees(4.2%),12 mm in 15 knees(12.7%),13 mm in 38 knees(40%),14 mm in 32 knees(33.7%),15 mm in 5 knees(5.3%)and 16 mm in 1 knee(1.1%).The mean thickness of the patella composite was 21.42 mm(range,20~25 mm),the thickness of resurfaced patella was equal to or thinner than the preoperative patellar thickness in 86 knees(90.5%).Anterior knee pain was found in 3 knees,but no patellar fracture or component loosening occurred.[Conclusion]1)The patellar thickness in rheumatoid arthritis is thinner than the thickness in normal patella.2)It is a safe option to retain bony patella thickness at 12~14 mm during patellar resurfacing in Chinese adults with rheumatoid arthritis.3)Patellar resurfacing in patients with rheumatoid arthritis has a good result in a short term.Careful attention to good surgical technique in component alignment and patellar resurfacing is crucial to obtain good results.
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[Objective]To investigate the method and efficiency of operative modified rotational acetabular osteotomy for treatment of adult acetabular dysplasia. [Methods]Twenty-seven patients with 30 hips with acetabular dysplasia were treated with modified rotational acetabular osteotomy. The study group consisted of three men with 3 hips and twenty-four women with 27 hips,the average age of the patients was 29.4 years(range,fifteen to forty-two years ).The anteroposterior plevis view,lateral and abduction view of bilateral hip were taken,CE angle(center-edge angle) and AC angle(acetabular roof obliquity) were measured,the changes of the rotational center of the hip ,Shenton's line and the degree of osteoarthritis were recorded ,the Harris score was obtained before and after operation.[Results]The femoral head coverage was improved in all patients. On average ,the CE angle was improved from 3.2 (-15?～15?)to 28.5?(20?～40?),the AC angle was declined from 26.6?(15?～38?)to 3.9?(0?～12?). The rotational center of the hip was medialized in 19 hips(63.3%),the discontinuity rate of Shenton's line was declined from 67% to 23%. On average 4.2 years follow-up ,1 case lost follow-up,the degree of osteoarthritis in 28 hips was not aggravated,pain was aggravated in 1 hip ,the Harris score was improved from 82.7(67～96) to 97.8(87～100).Two patients have had Fibre-union of pubic and one patient has had stress fracture of the inferior pubic ramus postoperatively,non-union of iliac and posterior column of the osteotomy or the greater trochanter was not found.[Conclusion]The method of modified rotational acetabular osteotomy for treatment of adult acetabular dysplasia is effective and safety.
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[Objective]To investigate the method and effeciency of management massive acetabular bone defect with impaction bone grafting plus mesh in revision total hip arthroplasty[Method]Twenty-one patients 21 hips with massive acetabular bone defect were treated with impaction bone grafting plus mesh during Dec 2001 to Jan 2006,including 6 men and 15 women,the average age were 51.9 years at the revision operation(range,38~77 years).The acetabular defects of the patients in this study group were type III(combined defect)according to the American Academy of Orthopaedic Surgeons(AAOS)classification scheme.At first the combined defect was transformed into cavitary defect with metal mesh,then the contained acetabulum was tightly packed with deep-frozen morselized cancellous allograft chips(size 7~10mm),the anatomy of the hip was reconstructed and the cup was inserted after pressurizing the cement directly onto the graft.The AP view of the hip at 3 days,3 months,1 year and yearly after the operation were obtained,cup migration according to the teardrop and radiolucent line were evaluated,at the same time the Harris hip score were also evaluated.[Result]The mean follow-up time was 2.8 years,the mean Harris hip score improved from 46.4 points preoperatively to 81.3 points at the final evaluation,no cup migration were found,except for one dislocation and one sciatic nerve injury,as well as lost follow-up for one hip.[Conclusion]Impaction bone grafting plus mesh is an effective approach to treat massive acetabular bone defect in revision total hip arthroplasty,it can restore bone stock and help the cup to be placed to the anatomic position,as well as provide execellent prothesis stability.
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[Objective]To measure the change of anatomic configuration of proximal tibial after high tibial osteotomy and probe its clinical consequences.[Method]From 2001 to 2005,there were 59 knees of 35 patients with medial unicompartmental osteoarthritis treated with closing-wedge high tibial osteotomy.Anatomic configuration of proximal tibia were measured both pre and postoperatively on radiographs.They included posterior slope angle of proximal tibia,tibial angle,lateral shift of articular surface of proximal tibial and level of the joint line.The alteration of the above features was calculated and analyzed statistically with paired t test.[Result]The mean tibial posterior slope angle were(8.9??2.6?)preoperatively and(5.0??2.3?)postoperatively.The tibial posterior slope angle was averagely decreased about(3.9??1.7?).Tibial angle were(99.1??4.3?)and(91.1??3.8?)before and after high tibial osteotomy respectively.Lateral shift of articular surface of proximal tibial were(46.2?3.6)% and(53.1?3.9)% in pre and postopratively.Level of joint line was(41.2?3.6)mm and(38.0?3.2)mm in pre and postopratively.Statistical analysis indicated that there was significant difference of posterior slope angle or tibial angle or lateral shift of articular surface of proximal tibial or level of joint line between pre and post operative(P
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[Objective]To investigate the method and efficiency of operative femoral supracondylar varus osteotomy combined with new blade plate on treatment of valgus deformity of knees.[Method]Thirty-seven patients with 43 knees with valgus deformity were treated with femoral supercondylar varus osteotomy with Giebel blade plate(Link company/Germany)from Oct.2000 to Oct.2005.The study group consisted of seven men with 8 knees and thirty women with 35 knees,the average age of the patients was 31.2 years(range,fifteen to seventy years).Eleven patients with 13 knees had lateralcompartment osteoarthritis,Ahlback stage Ⅰ eight patients with 10 knees and stage Ⅱ three patients 3 knees.The full-length Ap view of the lower extremity and the weightbearing AP view of the knee were obtained before and after operation,as well as the femoral angle and femoral-tibial angle were evaluated.The Giebel blade plates were taken out average 1.5 year after operation and the patients were followed-up,bone union and the change of the correction angles and the pain of the knees were evaluated.[Result]All deformity of the knees were well corrected,the femoral angle were corrected from 71.7?(62?～75?) to 82.1?(78?～85?),the average correction angle was 10.4?(8?～21?).With average 1.5 year follow-up thirty four patients with 40 knees got good bone union,two knees had non-union and we changed the internal fixationwith bone autc-grafting and got good results,as well as lost follow-up for one knee.The pain relieved in 10 knees with lateral osteoarthritis and disappeared in 3 knees after operation.[Conclusion]Femoral supracondylar varus deformity of the knee,the technique is simple and damage is slight,fixation is safety and effective.
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Osteoarthritis is mainly caused by the degenerative changes of cartilage and cartilage extracellular matrix,while Aggrecanases degradate Proteoglycans which are the major components of cartilage.This review includes three aspects:(1) We have concluded the major enzymes(ADAMTS-4 and ADAMTS-5) which regulate the metabolism of cartilage extracellular matrix.Meanwhile,we have summarized the structure of aggrecanases(ADAMTS-4 and ADAMTS-5) and introduced the function of each regional structure;(2) We have concluded the way cytokines and glycosaminoglycans regulate the metabolism of aggrecanases,and discussed the regulation and control principle of cytokines and glycosaminoglycan;(3) We have summarized the majority of inhibitors to the aggrecanases,introduced the endogenic inhibitors,and put our emphasis on the extrinsic inhibitors(chelating agents,polypeptides and so on).Through deeper research on the enzymes,it will help us further understand the pathogenesis of osteoarthritis,and open up new avenues to clinical treatment.Abstract:SUMM ARY Osteoarthritis is mainly caused by the degenerative changes of cartilage and cartilage extra-cellular matrix,while Aggrecanases degradate Proteoglycanswhich are the major components of cartilage.This review includes three aspects:(1) W e have concluded the major enzymes(ADAMTS-4 and ADAMTS-5) which regulate the metabolism of cartilage extracellular matrix.Meanwhile,we have sum-marized the structure of aggrecanases(ADAMTS-4 and ADAMTS-5) and introduced the function of each regional structure;(2) W e have concluded the way cytokines and glycosam inoglycans regulate the metab-olism of aggrecanases,and d iscussed the regulation and control principle of cytokines and glycosam inogly-can;(3) W e have summarized the majority of inhibitors to the aggrecanases,introduced the endogenic inhibitors,and put our emphasis on the extrinsic inhibitors(chelating agents,polypeptides and so on).Through deeper research on the enzymes,it will help us further understand the pathogenesis of osteoar-thritis,and open up new avenues to clinical treatment.
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Objective To investigate the effect of femoral design on anterior knee pain after patella reserving total knee arthroplasty. Methods From 15 January to 15 February 2002, 44 patients and 59 knees were followed up. Among these patients, 40 patients and 51 knees were included in this study, the rest cases were excluded for one or more of following factors. 1)Knee flexion was less than 80 degrees;2)Radiography showed that there were surgical errors such as: femoral component flexion more than 30, anterior femoral cortex notching, and patellar baja or alta. According to current generally accepted criteria, femoral components were classified as "Patella Friendly" group and "Patella Unfriendly" group. The percentage and severity of anterior knee pain was measured with patient visual pain index and Knee Society Functional Score System. Results The aforementioned two groups consisted of "Patella Friendly" group 21 knees and "Patella Unfriendly" group 31 knees. The average anterior knee pain score of "Patella Friendly" group and "Patella Unfriendly" group was respectively 1.58 (0-8) and 3.32 (0-6). The percentage of pain free patients of the two groups was 64% and 9%. There was significant statistical difference between the groups in terms of anterior knee pain score (t=4.642, P
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Objective To evaluate the results of treatment with the high tibial osteotomy and fixtation with the new Giebel blade plate for osteoarthritis of the knee, and to discuss the indication for this technique. Methods Seventy patients(108 knees), 14 male and 56 female, with an average age of 59.6 years (range 38-76)were reviewed. The average postoperative follow up was 12 months (from 6 to 20 months ). Pain was complained chiefly in the medial aspect of the knee joint and the majority of patients had slight degree of genu varum. This new Giebel blade plate acts as a tension band when it is placed on the site for fixation, the proximal tibial fibular joint was not exposed during surgery so that the fibular head was well preserved, avoiding common peroneal nerve injury. The periosteum opposite to the incision position was left intact for the sake of the stability and acted as a hinge around which the wedge osteotomy was closed. AP and lateral radiography of knee joint was taken pre and post operation for comparison. Results During the follow up, the patients show satisfied pain relief, improvement of joint function, correction of the deformity either genu varum or valgum. Earlier rehabilitation exercise should be carried out and the complication was rare. Conclusion The characteristics of this method are its convenient application, the stable fixation and the well preserved joint function. The advantage of high tibial osteotomy was shown sufficiently by the use of Giebel blade plate.
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Objective To evaluated the result of modified Mitchell operation for treatment of hallux valgus. Methods From March 1998 to October 2001, 39 feet of 20 patients were treated with modified Mitchell procedure. Before operation, HVA averaged 29.5? and IMA averaged 12.5? were measured on standing AP radiographs. The lateral displacement of the capital fragment was depended on the amount of IMA and the capital fragment shifted plantarly 2-3 mm. Fixation was achieved with an absorbable screw. The lateral spike on the distal fragment was not preserved in this operation. Results After follow-up of 11-38 months, patients rated as excellent or good in 97.4%. The average postoperative HVA was 14.5? and IMA was 8.5?, the average HAV correction was 15? and 4? for the IMA. Conclusion The modified Mitchell procedure provides satisfactory deformity correction. The transverse arch of metatarsals is reconstructed since distal part of the first metatarsal is shifted plantarly in this operation.