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Objective:To prospectively analyze the early clinical effects of 3D-printed porous metal cup with hip dual-mobility revision (HDR) system in treating severe acetabular bone defects.Methods:A total of 17 patients with severe acetabular defects (15 patients in Allan-Gross type 4 and 2 patients in type 5; 2 patients in Paprosky type 2B, 4 patients in type 3A and 11 patients in type 3B) who underwent revision hip arthroplasty between July 2019 and May 2020 were analyzed. There were 7 males and 10 females (mean age 67.3±9.3 years; range 42-80 years). The average body mass index was 22.2±3.8 kg/m 2 (range 17.7-33.3 kg/m 2). The preoperative mean leg length discrepancy (LLD) was 42.9±31.1 mm (range 10-160 mm) . One patient presented positive Trendelenburg sign. The follow-up duration was 12.1±3.0 months (range 6-16 months). The clinical and radiographic hip scores in all patients were evaluated. Results:The mean Harris Hip Score (HHS) was 31.2±11.3 points at preoperatively, 63.5±10.0, 68.7±10.4 and 70.2±10.1 points at 3 days, 7 days and 1 month postoperatively. At the latest follow-up, HHS was increased to 81.6±7.0 points. The outer cup mean abduction angle was 48.1°±10.6° and the mean inclination angle was 10.8°±6.0° postoperatively. The inner cup mean abduction angle was 45.0°±6.2° and the mean inclination angle was 10.8°±3.7°. The mean LLD decreased to 11.1±3.8 mm (range: 0-15 mm) after surgery. At the latest follow-up, all acetabular components were radiologically stable without displacement. No osteolysis or absorption was observed. There was no infection, loosening or nerve injury in all cases.Conclusion:During short-term follow-up, the 3D-printed porous metal HDR system can effectively enhance the stability of implants with satisfied quality of life. It can provide a good result for the revision of total hip arthroplasty with severe acetabular defects.
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Objective@#To evaluate the clinical effects of the implantation of porous tantalum rod under three-dimensional (3D) C-arm positioning in the treatment of ARCO I and II non-traumatic femoral head necrosis.@*Methods@#Fifty patients (58 hips, 39 males and 11 females, mean age 33.52 years) with non-traumatic femoral head in ARCO I-II were included from January 2009 to December 2011. All patients received implantation of porous tantalum rod. The 3D C-arm X-ray positioning was used in 24 patients (29 hips), while traditional C-arm X-ray positioning was performed in the other patients. The visual analogue scale (VAS), Harris score and superior rate were evaluated at 0.5, 1, 2, and 4 years after the surgery. Total hip arthroplasty was regarded as the end event for survival rate.@*Results@#In the 3D C-arm X-ray positioning group, the VAS score decreased from 7.17±1.00 points preoperatively to 2.38±0.86 points at half year, to 2.10±1.40 points at 1 year, to 2.38±1.66 points at 2 years, and to 2.21±1.47 points at 4 years postoperatively (F=98.78, P=0.00). Meanwhile, the Harris score increased significantly from 73.97±3.49 points preoperatively to 89.90±1.93, 89.93±3.26, 89.21±5.83, 88.57±5.70 points at the follow up, respectively (F=84.35, P=0.00). According to the analysis of the pre-operative and post-operative image data, there was no significant difference in progress in the ARCO staging at 23 hips duration the follow-up. Four hips were developed to ARCO III and two hips to ARCO II. Thus, the success rate of operation was 79% (23/29). There were two hips underwent total hip arthroplasty, so the survival rate of femoral head was 93% (27/29). The trend of VAS score and Harris score in the C-arm X-ray positioning group was in accordance with the 3D C-arm X-ray positioning group but without statistically significant difference (P>0.05). The operation duration 31.38±3.96 min, blood loss 36.72±5.59 ml, the ratio of distance of metal rod to bone cortex in femoral neck 0.48±0.10, and the distance of mental rod to center of necrosis 0.18±0.07 cm in 3D C-arm X-ray positioning group was superior to C-arm X-ray positioning group (respectively 41.97±4.64 min, 41.49±4.46 ml, 0.46±0.06, 0.23±0.10 cm, P<0.05).@*Conclusion@#The implantation of tantalum rod in treating ARCO I-II non-traumatic femoral head necrosis can increase the function of hip joint, relieve the symptoms of necrosis of femoral head, alleviate the progress of femoral head necrosis in X-ray, and obtain a higher survival rate. The 3D C-arm positioning in surgical operation could improve the accuracy and safety of surgery.
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Objective To evaluate the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) in preventing heterotopic ossification after hip arthroscopy.Methods Literature search was conducted in PubMed,Embase,Cochrane Library,CNKI and Wanfang data with time range from January 1973 to November 2017.Clinical case control articles on NSAIDs in preventing heterotopic ossification after hip arthroscopy were screened based on the inclusion and exclusion criteria.Meta analysis was done using RevMan 5.3 software to investigate the incidence of complications such as heterotopic ossification and gastrointestinal bleeding after hip arthroscopy in patients taking NSAIDs orally.Results Six articles were included in the study,with a total of 754 cases and 536 controls.NSAIDs reduced the incidence of heterotopic ossification after hip arthroscopy (RR =0.09,95％ CI 0.03-0.27,P ＜ 0.05).Selective COX-2 inhibitor celecoxib (RR =0.17,95％ CI 0.03-0.91,P ＜ 0.05) and PG synthase inhibitor of naproxen (RR =0.17,95％ CI 0.09-0.32,P ＜ 0.05) were also effective in preventing heterotopic ossification.There was no significant difference in the incidence of gastrointestinal complications between the cases and controls after NSAIDs prophylaxis (RR =2.17,95％ CI 0.92-5.12,P ＞ 0.05).Conclusion NSAIDs can effectively reduce the incidence of heterotopic ossification after hip arthroscopy and does not increase the incidence of postoperative gastrointestinal complications.Therefore,it is effective and safe to use NSAIDs to prevent the occurrence of heterotopic ossification after hip arthroscopy.
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Objective To evaluate the clinical effects of the Masquelet technique combined with antibiotic calcium sulfate pellets in treating infected bone defects.Methods From February 2014 to February 2016,9 patients with infected bone defects were treated in our department,including 7 males and 2 females,with an average age of 37.0 years (range,24-56 years).6 cases were infected because of open fractures,3 infected after internal fixation operation.All defects were located in the lower limb diaphysis and metaphysis (3 cases in femur,6 cases in tibia).The length of the bone defects were 4-12 cm after debridement,all defects filled with PMMA loaded with Vancomycin,and fixed with exterual fixators.After 6-10 weeks,the bone cement spacers were taken out and the antibiotic calcium sulfate pellets were implanted into the membrane.A certain amount of autogenous cancellous bone granules would be mixed into the calcium sulfate pellets if the defect was larger than 6-8 cm.5 cases remained fixed with external fixators,3 cases replaced for plates,1 case replaced for plaster external fixator.Regular X-ray follow-ups were taken and complications recorded as well.Evaluate the healing of bone defect and functional recovery of adjacent joints by Samantha X score system,visual analogue scale (VAS) and Paley method,respectively.Results The 9 cases were followed up for a mean duration of 9.3 months (range,6-15 months).All bone defects healed after a mean time of 14 weeks (range,10-24 weeks).The wound poor healing occurred in only 1 case in the first stage of surgery,and cured by dressing changes.No complications of the recurrence of infection and implant failure.At the last follow-up,the average Samantha X score was 4.9,the VAS score was 0 to 3 (average 1.5) for patients standing on crutches and all the bone defect healing graded excellent evaluated by Paley method,the functional recovery of the adjacent joints graded:excellent in 6 cases,good in 2 cases,and fair in 1 case (the excellent and good rate was 89％).Conclusion Masquelet technique combined with antibiotic calcium sulfate particles is effective in the treatment of infected bone defects.
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Objective To compare the effect and safety between cemented and uncemented long-stem hip arthroplasty for treatment of unstable intertrochanteric fracture in the elderly.Methods A retrospective review was made on 70 cases (70-87 years old) undergone artificial long-stem hip arthroplasty of unstable intertrochanteric fracture between June 2012 and June 2014.According to the material of prostheses,the cases were assigned to cemented group (n =36) and uncemented group (n =34).Operation-related index,postoperative complications,ambulation time,Harris hip score and prosthesis stability and excellent results were compared between the two groups.Results There were no significant differences in operation time,bleeding volume and ambulation time between the two groups (P ＞ 0.05).Postoperative drainage volume and blood transfusion volume in cemented group [(277.4 ± 22.0) ml and (245.1 ± 17.8) ml] were lower than these in uncemented group[(294.2 ± 33.7) ml and (262.8 ± 30.9)ml] (P ＜0.05).Harris scores in cemented group were higher than these in uncemented group 1 and 3 months after operation(P ＜0.05),and there were no significant differences 6 and 12 months after operation(P ＞ 0.05).Complication rate had no significant difference between the two groups (P ＞ 0.05).Two cases were died of cement poisoning,one case of subsequent acute myocardial infarction,and two cases of subsequent acute cerebral infarction.Sixty-five cases were followed up for 12-36 months,which showed no complications such as prosthesis loosening,displacement or infection.Prosthesis stability and treatment excellent rate between the two groups were not significantly different (P ＞ 0.05).Conclusions Clinical efficacy of the two treatments is comparable,including good function recovery and early off-bed activity.Cemented long-stem hip arthroplasty reduces blood requirements,but the risk of cement poisoning exists.
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Objective To observe the outcome of uncemented hip arthroplasty for failed internal fixation of intertrochanteric fracture.Methods Seventeen patients admitted from Februaty 2010 to January 2014 were reviewed retrospectively in this study.The patients aged 67.2 years (range, 41-80 years) composed 6 males and 11 females.There were 15 patients with intertrochanteric fracture and 2 intertrochanteric and subtrochanteric fracture.The primary internal fixation method was dynamic hip screw (DHS) fixation in 2 patients, proximal femoral nail anti-rotation(PFNA) fixation in 12 patients and intramedullary nailing in 3 patients.Arthroplasty with a prosthetic hip was performed for 15 patients and with a prosthetic femoral head was done for 2 patients 3-48 months after the internal fixation.Harris score was used for evaluation of the results of hip arthroplasty.Preoperative Harris score was (32.6 ± 6.8)points.Results All the patients were followed up for 6 to 48 months.One patient with intraoperative femoral fracture experienced early subsidence and dislocation of femoral stem following allogeneic bone plate and titanium cable fixation and had further revision surgery.One patient had secondary subsidence of the femoral stem without pain and limitation of motion.One patient had primary infection recurrence after arthroplasty, but the infection remained uncured even after a series of treatments like repeated debridements, sustained vacuum drainage, prosthesis removal, debridement and temporary spacer implantation.Sixteen patients showed postoperative pain relief and good hip function recovery characterized by the ability to care for themselves and no prosthetic loosening.Harris hip score signficantly improved to (79.2 ± 15.9) points at the final follow-up (P ＜ 0.01).Conclusions Uncemented hip arthroplasty is an effective method for the failed internal fixation of peritrochanteric fracture.The procedure achieves satisfactory function recovery, early weight-bearing exercise and early recovery of self-care ability,and avoids the complications of bone cement use.
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BACKGROUND:The bone morphogenetic protein 2 (BMP2)/vascular endothelial growth factor (VEGF) dual gene activated nanobone putty has been constructed in the previous experiments. OBJECTIVE:To investigate the effects of osteogenesis and osteogenic gene expression in mice by implanting BMP2/VEGF dual gene activated nanobone putty. METHODS:Twenty-four Kunming mice (48 sides) were randomly divided into four groups. Animals in each group (12 samples) were injected different materials into the right thigh muscle pouches:nanobone putty+hBMP2/VEGF plasmid;nanobone putty+hBMP2 plasmid;blank plasmid+nanobone putty;nanobone putty only. The effects of osteogenesis were evaluated by radiography, histology and molecular biology analysis in 2, 4 weeks after operation. RESULTS AND CONCLUSION:Bone-like tissues were observed in groups of nanobone putty+hBMP2/VEGF plasmid and nanobone putty+hBMP2 plasmid after operation. There was apparent BMP2 and VEGF mRNA expression in group of nanobone putty+hBMP2/VEGF plasmid. Group of nanobone putty+hBMP2/VEGF plasmid was significantly better than group of nanobone putty+hBMP2 plasmid in the alkaline phosphatase levels, the speed of osteogenesisas and amount of new bone (P<0.05). Groups of blank plasmid+nanobone putty and nanobone putty had no obvious osteogenesis performance. Either BMP2/VEGF dual gene activated nanobone putty or BMP2 gene activated nanobone putty had the osteogenic ability in vivo. And the former was significantly enhanced in the speed and quality of osteogenesis.
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Objective To investigate the clinical effect of total hip replacement in patients with hip fusion .Methods 31cases (43 hips) with hip fusion underwent total hip replacement from January 2006 to December 2012 ,To retro-spective analysis on clinical curative effect and operation related issues .Results The mean time of follow-up was 14 .2 months(12 to 72 months) in 26 cases (37 hips) .All patients had good relief postoperative on hip pain ,knee pain and low back pain ,and the gait was closed to normal ,and the activities of daily living improved in part of cases ,including 16 cases went back to work .The assessment of X-ray showed that had not found any complications ,such as dislocation ,Osteolysis and loosening ,the excellent rate was 89 .19% .Conclusion For pa-tients with hip fusion ,Total hip replacement can improve the function of the hip fusion and relieve pain .
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Objective To retrospectively study the perioperative complications and postoperative function recovery of 93 patients treated with simultaneous bilateral total hip arthroplasty (THA). Methods A total of 93 patients (186 hips) undergone simultaneous bilateral THA from January 1999 to January 2009 in our hospital were involved in this study. There were 70 males and 23 females (at age range of 25-65 years, average 41. 8 years). The preoperative diagnosis included bilateral avascular necrosis of femoral head in 48 patients, rheumatoid arthritis in 11, developmental dysplasia of the hip in 26 and ankylosing spondylitis in 8. The intraoperative blood loss, Harris scores before operation and at final followup as well as perioperative complications were analyzed. Results All the patients were followed up for average 65 months (12-118 months), which showed femur fracture in one patient and infection six months after discharge in one patient. The Harris score was increased from (36.7 ±6.1) points preoperatively to (91.2±6.2) points at the final follow-up. Hip pain disappeared in 92 patients after operation and radiograph showed no loosening. Actebular loosening occurred in one patient 49 months after operation and was revised accordingly. Conclusion Under strict control of operation indications, suitable choice and implantation of the prosthesis and emphasis on perioperative management and postoperative rehabilitation, simultaneous bilateral THA is a safe and effective choice for bilateral hip diseases.
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BACKGROUND: Traditional treatment of intertrochanteric fractures includes dynamic hip screw (DHS), dynamic condylar screw (DCS), proximal femoral nail (PFN) and locking compress plate (LCP), most of them have positive results. However, these techniques are not utility for all patients with intertrochanteric fractures, especially for the senile patients whose ages are over 75 years. The intertrochanteric fractures are usually unstable, and most of them have medical complications, thus all these lead to a high failure rate of internal fixation. OBJECTIVE: To identify the methods and the therapeutic effects of hemiarthroplasty or arthreplasty with bone cement for unstable intertrochanteric fractures in senile patients. METHODS: There were 27 senile patients with unstable intertrochanteric fractures, including 11 males and 16 females, with the mean age of 84.6 years. All patients were adopted improved Gibson approach, and greater trochanter should be reduced anatomically as an important sign for measuring the lengths of the lower extremities and fixing of prostheses. Long-stem cementless calcar-raplacements were used in all patients, 2 arthroplasty owing to preexisting osteoarthritis and 25 hemiarthroplasty. RESULTS AND CONCLUSION: Nobody was dead during perioperative period. Weight bearing was permitted as soon as acute pain subsides (7-16 days after operation); 27 patients were followed up for 6 to 48 months, for 20 months on average. No prosthetic looseness and sinking happened, and the calluses were well mineralized. The Harris score was used to evaluate the therapeutic effect at 6 months after operation, which was 78 to 94, of 85.4 points on average, and the rate of fineness was 78%. One posterior hip dislocation and two deep venous thrombosis (DVT) of lower extremities occurred owing to improper caring. The results showed that the prosthetic replacement with bone cement is a reasonable preference for unstable intertrochanteric fractures in senile patients because of many virtues, such as earlier period weight bearing out of bed, low incidence of complications, and satisfaction of functional recovery of extremities.