Long-term outcomes of total knee arthroplasty in patients with hemophilic arthropathy / 中华骨科杂志

Objective To evaluate the long-term outcomes of total knee arthroplasty (TKA) for end-stage hemophilic arthropathy.Methods Eighteen patients (24 knees) with hemophilic arthropathy underwent TKA from June 2003 to January 2009 were retrospectively reviewed.All patients were hemophilia A with an average age of 33.7± 13.0 years (18-56tyears) old at Surgery.Pharmacokinetic tests of coagulation factors were performed after consultation of hematologist.Based on the guideline of World Federation of hemophilia,the protocol of coagulation factor replacement was adjusted according to our experience and the financial status.Normally,peak level of coagulation factor concentrations were maintained at 100％ on the day of surgery,at about 80％ in the first 3 days after surgery,at 60％ on the postoperative days of 4-6 and at 40％ on postoperative days of 7-10.The dose was then gradually tapered to 20％ or 30％.Zimmer prosthesis was used in three cases (PS prosthesis in two cases,LCCK prosthesis in one case),Centerpulse prosthesis in three cases,and the rest were from Smith & Nephew (including one case of constrained prosthesis and one case of revision prosthesis).Preoperative and last follow-up Hospital for Special Surgery (HSS) score,Knee Society Score (KSS),knee flexion contracture and complications were evaluated.Results Fourteen patients(20 knees) were followed-up,with an average duration of 124±17 months (96-145 months).Knee flexion contracture improved from 16.7°±12.2° (0°-40°) preoperative to 3.3 °±5.0° (0°-10°) at the last follow-up.The average preoperative HSS score was 42.4± 16.0 (t 0-60),whereas postoperative score was 74.8± 10.6 (59-87).The preoperative KSS clinical and functional score were 36.1 ± 10.5 (20-50) and 36.1±5.5 (25-40),which were improved to 85.8±7.1 (70-93) and 80.9±22.4 (40-100) at the last follow-up,respectively.Postoperative infection,aseptic loosening of the implant and hematoma occurred in one patient respectively.All of them recovered after a revision surgery.One patient had secondary skin ulceration due to tension blisters and recovered after anterolateral thigh myocutaneous flap transplantation.Conclusion The long-term outcomes of TKA under coagulation factor substitution for hemophilic arthropathy are promising.However,the effects are inferior to those in non-hemophilic patients,and the risk of infection,aseptic loosening of the implant and hematoma are higher.

Surgical treatment in heamophilic patients with musculoskeletal disorder / 中华骨科杂志

Objective To study the surgical treatment strategy for heamophilic arthropathy and musculoskeletal appara?tus. Methods A total of 120 heamophilic patients underwent 166 primary operations from January 1996 to June 2015 in Pe?king Union Medical College Hospital, with the average age of 29.7±12 years (from 6 to 61 years). Hemophilic type A accounted for 109 patients and hemophilic type B accounted for 11. Eighty?seven patients presented with bleeds within the joints, with 63 cases for knee involved, 29 cases for hip, 11 cases for ankle. Fifteen patients presented with intramuscular bleeds, 21 patients with heamophilic pseudotumors. Strategy of clotting factor replacement therapy was designed according to the different level of opera?tion procedure. The clinical manifestation, operative strategy, clinical outcome and complications were retrospectively recorded. Results 41 cases (34.2%) of patients underwent surgeries for more than one location. Totally, 166 procedures were performed for 120 patients. There were 103 procedures of joint arthroplasty (62.0%, 103/166), 21 procedures of pseudotumor resection (12.7%, 21/166), 15 procedures of tendon lengthening, 12 procedures of ankle arthrodesis, 13 procedures for knee flexion contracture. There were 30 cases of postoperative complications, with the rate of 18.1% (30/166). The coagulation related complication was 4.8%in this group (8/166). The surgical procedure related complication was 7.2%(12/166). All the preoperative symptoms were relieved during the follow?up. Conclusion Surgical treatment was effective for the heamophilic arthropathy and lesion of mus?culoskeletal apparatus, under the reasonable clotting factor replacement therapy. The incidence of perioperative complication in heamophilic patients is higher than that in non?hemophilic patients. Closely inspection was inevitable for perioperative treat?ment in hemophilic patients.

Midterm outcomes of autologous femoral head grafting in total hip arthroplasty for developmental dysplasia of the hip / 中华骨科杂志

Objective To evaluate the midterm outcomes of autologous femoral head grafting in total hip arthroplasty for developmental dysplasia of the hip.Methods From October 2001 to December 2011,36 patients (36 hips) with developmental dysplasia of the hip were treated by total hip arthroplasty with autologous femoral head grafting,of which 34 cases were followed up for at least 30 months.There were 6 males and 28 females.16 patients were involved in the left hip and 18 in right hip.The average age at the operation was 51 years (range,28-68 years).According to Crowe classification for developmental dysplasia of the hip,12 were type Ⅱ,16 type Ⅲ,and 6 type Ⅳ.Cementless prostheses were used for all,but one patient,who received a hybrid prosthesis.Clinical outcomes were evaluated according to Harris score and complications.Components migration,periprosthetic bone changes,the polyethylene wear rate were measured radiologically.Components position and bone healing were assessed in the anteriorposterior and lateral X-ray of the hips.Results Thirty-four patients (34 hips) were followed up for an average duration of 64.1 months (range,31-153 months).The average Harris score was 35.4 (range,23-56) preoperatively,and was 89 (range,82-95) at the latest follow-up.Twenty-eight were classified as excellent,and 6 were good,and the excellent and good rate was 100％.10 cases presented with bone absorption 2-8 months postoperatively.Four patients suffered from dislocation after surgery.All the cases were treated successfully with close reduction,except one with redislocation.Close reduction was performed for this case,and no dislocation occurred again.One patient had periprosthetic fracture due to a fall and open reduction and plate fixation was performed.The fracture was healed at 1 year follow-up,with good position of the implants.Another patient had hypertensive intracerebral hemorrhage 1 year after the surgery,who was treated by conservative treatment and had hemiplegia and apraxia of the surgical hip.Conclusion Autologous femoral head grafting for the treatment of developmental dysplasia of the hip has a satisfactory clinical and radiographic outcomes at an average of five-year follow-up.Bone graft absorption is a natural process of structural bone grafting.Joint dislocation is the most common complication of THA in developmental dysplasia of the hip.

Three-dimensional finite element analysis of adolescent idiopathic scoliosis correction by different correction methods / 中国组织工程研究

CT data regarding PUMCⅡ d2 adolescent idiopathic scoliosis obtained from one female patient were input into modeling software minics 11.11 to obtain medical simulation model.Then finite element analysis models of AIS patients (T1-S) were created by introducing simulation models into software abaqus 6.7.Finite element models of T6 11 segments were corrected by 5 different correction methods:simple concave bracing,simple convex pressurization,concave distraction and convex compression simultaneously,concave distraction prior to convex compression and concave distraction after convex pressurization.Abaqus software was used to simulate correction of scoliosis with vertebral arch pedicle screw by loading 50 N,100 N,and 200 N distraction forces on the concave side pedicles of the end vertebrae T6 and T11.The displacement of vertebrae T6 in Y-axis (sagittal plane) and Z-axis (coronal plane),which respectively represented the correction effects of kyphosis and scoliosis,was compared between prior to and after correction.Simple concave distraction provided better outcomes in terms of displacement of T6 in Z-axis than the remaining four methods (P ＜ 0.01).Concave distraction and convex compression simultaneously,concave distraction prior to convex pressurization and concave distraction after convex compression produced identical displacements of T6 in Y-axis,which were all better than simple concave distraction (P＜ 0.01).The present findings imply that for curative effects of five methods on correction of scoliosis in the coronal plane:simple concave distraction＞ concave distraction and convex compression simultaneously = concave distraction prior to convex compressio= concave distraction after convex compression ＞ simple convex pressurization;for curative effects of five methods on correction of kyphosis in the sagittal plane:simple convex compression ＞ concave distraction and convex compression simultaneously = concave distraction prior to convex compression= concave distraction after convex compression＞ simple concave bracing.Simple concave distraction could not produce obvious corrective effects on kyphosis rather than lead to worsened kyphosis to some extent.Simple convex compression could not produce obvious corrective effects on scoliosis rather than result in aggravated scoliosis to some extent.