Research progress on the revision of Metal-on-Metal hip arthroplasty due to adverse reactions to metal debris / 中国骨伤

The choice of friction interface has always been a controversial topic in hip arthroplasty. Although the metal-on-metal (MoM) interface has gradually faded out of our vision, its revision is a clinical difficulty. Adverse reactions to metal debris (ARMD) is the most common indication for MoM hip arthroplasty revision, and the clinical results of hip arthroplasty due to ARMD are not satisfactory. At present, the indications and suggestions for revision of ARMD are not uniform. In this article, the clinical diagnosis, indications of revision, risk factors of prognosis, intraoperative suggestions and reasons for revision of ARMD were summarized. This article briefly introduces the diagnosis and treatment strategies and precautions of hip arthroplasty due to ARMD, in order to provide reference for such patients in clinical practice.

Autologous blood transfusion drainage compared with no drainage in total knee arthroplasty: a meta-analysis and systematic review

This is the first meta-analysis to assess the clinical efficiency, safety and potential advantages regarding the use of ABT drains compared with no drainage which is controversial in total knee arthroplasty [TKA].A comprehensive literature search was carried out in March 2015 using the PubMed, Embase, and Cochrane Library databases. A meta-analysis was carried out on two retrospective comparative studies [RCSs] and five randomized controlled trials [RCTs]. The number of patients receiving homologous blood transfusion was the primary outcome of the meta-analysis; the secondary outcome measure was the mean drop in Hb level in comparison to the mean pre-operative HB level, the range of flexion of the knee joint, and infections of the wound after surgery. A total of 868 patients, who were included in two retrospective studies and five RCTs, were distributed into subgroups for the meta-analysis. This pooled data showed no benefit of ABT drainage compared no drainage in the homologous blood transfusion rate [13.05% and 16.91%, OR:0.73[0.47,1.13], Z=1.41, P=0.016;and 3.49% and 6.54%, OR: 0.50[0.12,2.01], Z=0.98,P=0.033,respectively in subgroups], Hb drop [Weight mean differences [WMD]: 0.20[-0.28,0.68], Z=0.82,P=0.41;WMD:0.16[-0.41,0.55], Z=0.93, P=0.35, respectively], range of flexion of the knee joint [WMDr-0.82 [-3.35,1.70], Z =0.64,P=0.52]and wound infection [OR:0.25[0.61,10.20]; Z =1.28, p=0.2] after TKA surgery. Our findings do not recommend the routine use of postoperative ABT drainage in total knee arthroplasty. Well-designed RCTs with large sample sizes, longer term measures and extensive follow-up period should be performed in the future to update the findings of this study