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Objective@#To analyze the clinicopathological features of pseudotumor-like tissue around aseptic joint arthroplasty and aseptic lymphocytic vasculitis-associated lesions (ALVAL) scores. The characters of wear granules were observed.@*Methods@#Total 122 cases were retrieved from the surgical pathology files between May 2015 and August 2018 in the department of pathology in Beijing Jishuitan Hospital, which included the knee joint arthroplasty (10 cases) and hip arthroplasty (112 cases). There were 62 females and 60 males. Patients′ age ranged from 29 to 86 years (mean 56 years). The pseudotumor-like tissue around aseptic joint arthroplasty were stained with HE and analyzed by two ALVAL score systems. The characters of wear granules were observed by light microscope and polarized light.@*Results@#The cohort included 62 females and 60 males. Patients′ age ranged from 29 to 86 years (mean 56 years). Compbell-ALVAL system includes synovial lining,inflammatory infiltrate and tissue organization. The scores were: low (0-4): 18cases; moderate (5-8): 101 cases; high (9-10): 3 cases. Oxford-ALVAL system only evaluated the inflammatory infiltrate,and the scores were:0 grade:56 cases; 1 grade:51 cases; 2 grade: 12 cases; 3 grade:3 cases. Cases with high score in the Compbell-ALVAL system were concordant with the 3 grade of the Oxford-ALVAL system. Under light microscope,the metal particles were small black granules; the polyethylene fibers were needle-like and easily visible in polarized light. The polymethylmethacrylate showed clear spaces because of particle melting.@*Conclusions@#The Compbell-ALVAL scoring system is based on the histologic analysis of pseudotumor-like tissue around aseptic joint arthroplasty, and the Oxford-ALVAL scoring systems is based on lymphocytic response. The wear particles could be differentiated by the features in the light microscope.
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Objective To investigate the early outcomes of revision hip arthroplasty using restoration modular (RM) stem.Methods Fifty-nine patients underwent revision hip arthroplasty with RM stem from April 2012 to June 2015 in our center with a minimal of two years follow-up.The patients including 24 male and 35 female had a median age of 61.0 (56,66) years.The median BMI was 24.0 (22.5,26.0) kg/m2,while the median interval from the primary surgery was 10.5 (6.0,14.5) years.The rea sons for revision inculded infection in 8 patients,aseptic loosening in 45,recurrent dislocation in 1,and periprosthetic fracture in 5.There were 3 cases of type B2 and 2 cases of B3 periprosthetic fracture according to Vancouver classification.The bone defects severity was conducted according to Paprosky classification that 14 patients in type Ⅱ,31 in type ⅢA,8 in type ⅢB,and 1 in type Ⅳ.Acetabular component were revised in 56 cases.Patients were followed up at 3 months,6 months,1 year and annually thereafter for clinical and radiological evaluation.Results All the patients were followed up with a median duration of 30.4 (27.3,37.9)months,the median Harris score significantly improved from 37 (31,53) points preoperatively to 84 (80,95) points at the last follow up (Z=-6.681,P=0.000).There were 3 patients had perforation or fracture intra-operatively,two of them were fixed by strut allograft.The other one who did not compromise the implant stability was not fixed.Extended trochanteric osteotomy was applied in 14 cases and they healed well at 3-6 months during follow-up.There was one case of early dislocation at 6 days postoperatively,which was treated with close reduction and immobilization without recurrence.No infection,stem fracture,hematoma formation and sciatic nerve injury were reported.No femoral component loosening was identified at the latest follow-up.Median subsidence was 1.0 (0,2.0) mm with the maximum case 6.0 mm and 3 cases 3.5 mm.All of subsidence developed within the first year postoperatively but without further aggravation.The affected leg lengthened 17.5± 10.1 mm (range 2-40 mm) after operation.The affected leg was shorter 17.5± 12.6 mm (shorter 44.4 mm to longer 3.0 mm) than that in the normal side pre-operatively.However,the distinction decreased to 0.1±9.6 mm postoperatively (shorter 24.8 mm to longer 22.4 mm,t=-10.538,P=0.000).Conclusion Early satisfactory results are achieved in hip revision using RM modular stem at the femoral side.The modular design could simplify the surgical procedure with better control of leg length and joint stability.Long-term follow-up is still required for further evaluation.
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Objective To investigate the early outcomes of reconstruction of severe acetabular bone defects by the use of tantalum trabecular metal cup combined with tantalum augment in total hip replacement.Methods From April 2014 to December 2015,23 patients (24 hips) underwent total hip arthroplasty by the use of tantalum trabecular metal cups combined with tantalum augments.There were 11 males (12 hips) and 12 females (12 hips),with the average age 54 years (range,38-65 years).We tried to reconstruct an annular support for the cup.If an annular support cannot be reconstructed,the cup obtains primary stability based on the three point fixation rationale.Flexible placing of the TM cup combined with the augments helped reconstruction of the socket ring or supporting points,thus achieving rigid primary stability of the cup and restoring center of rotation.Harris hip score and Western Ontario and McMaster Universities (WOMAC) osteoarthritis index score were recorded.Any severe intraoperative complications including vascular or nerve injury and severe postoperative complications such as periprosthetic joint infection,dislocation or periprosthetic fracture were reported.The vertical position of the center of rotation from the interteardrop line and the horizontal position of the center of rotation from the teardrop were measured and analyzed.Results The average follow-up duration was 16 months (range,7-28 months).The mean Harris hip score was 35.3±12.1 preoperatively and 82.7±8.3 postoperatively (t=-16.991,P＜0.001).The mean WOMAC score was 39.1 ±24.0 preoperatively and 87.2± 11.4 postoperatively (t=-7.671,P＜ 0.001).The average vertical location of the center of rotation was 44.02± 11.65 mm preoperatively and 22.96±8.24 mm postoperatively.All the tantalum cups and augments were stable.There was no periprosthetic joint infection,dislocation,nerve injury or periprosthetic fracture.Conclusion Reconstruction of Paprosky Ⅲ acetabular bone defects by the use of tantalum trabecular metal cup combined with tantalum augment can achieve good primary stability and restore the center of rotation with almost normal hip biomechanics.The short-term outcomes are satisfied.
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BACKGROUND:Crowe IV developmental dysplasia of the hip is rarely seen clinical y. However, when treated with routine total hip arthroplasty, severe deformities in the bone and soft tissue can lead to high rate of operation failure and increased occurrence of complications. Total hip arthroplasty in combination with subtrochanteric osteotomy may be an option to resolve this problem. OBJECTIVE:To retrospectively analyze the clinical outcome and safety of Crowe IV developmental dysplasia of the hip treated by the combination of total hip arthroplasty and subtrochanteric osteotomy in 17 cases. METHODS:Twenty-one hips (17 cases) of Crowe IV developmental dysplasia of the hip treated by the combination of total hip arthroplasty and subtrochanteric osteotomy were retrospectively analyzed and fol owed for at least 2 years from January 2006 to June 2011. Complications, hip function, and radiological changes were evaluated. RESULTS AND CONCLUSION:The mean fol ow-up period was (48.0±20.5) months. Harris’s score was increased postoperatively (P<0.05). The main complains were lower limb length discrepancy, difficulty in standing up from squatting, muscle weakness, and soft tissue tightness. One greater trochanter fracture occurred and was fixed by hook plate fixation. There were four femoral shaft splits treated by cerclage. One patient represented with femoral nerve palsy and got partial recovery until the latest fol ow-up. There was no deep infection, dislocation or prosthesis loosening. Crowe IV developmental dysplasia of the hip could be effectively treated by total hip arthroplasty in combination with subtrochanteric osteotomy, which requires high surgical techniques to control the complications. Further fol ow-up is required for long-term results.
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Objective To evaluate intra-and interobserver reliability of analysis of lower limb alignment on DR digital images using AutoCAD.Methods Angles on AP view and long leg view were measured three times by two trained observers separately using these two methods in 140 knees.The intra-and interobserver intraclass correlation coefficients with 95% CIs of two methods were calculated and compared with Fisher z transformation and Z test.Paired t test was used in comparing time consumption.Results For AutoCAD method,inter ICCs were 0.942? 0.993 ,intra ICCs were 0.937～0.999.For X-ray films method,inter ICCs were 0.736～0.981,intra ICCs were 0.759～0.951.Corresponding ICCs of AutoCAD method were higher than those of X-ray films method,most of which had significant differences(P<0.01).The consuming time of two observers in measuring one knee using AutoCAD method was 89.6 seconds and 94.3 seconds shorter than those using X-ray films method respectively.Both had significant differences(P<0.01).Conclusion It was a fast reliable method to assess lower limb alignment on DR digital images using AutoCAD.
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BACKGROUND: Unrepaired bucket handle meniscus tear(BHMT)could result in partial or total meniscectomy,which aggravates the degeneration of knee joint.The long-term,large sample studies regarding the success rate of BHMT repair are few.OBJECTIVE: To retrospectively analyze the clinical result of arthroscopic BHMT repair and explore the preoperative diagnosis,repair technique,treatment effect evaluation and influential factors,so as to investigate ideal repair method of large meniscus tear injury.METHODS: From May 2002 to November 2005,90 patients with repairable BHMT were treated in Sports Medical Center of Beijing Jishuitan Hospital.Of the 90 patients,61(63 menisci)were followed up for over 2 years with an average duration of 38months(24-66 months).The indications of BHMT repair include red-red area and red-white area injuries,reductable,meniscus with no compound tear or degeneration.RESULTS AND CONCLUSION: Of the 61 followed up patients,53 menisci in 51 patients(84%)were assessed by second-look arthroscopy; 53 of 61 patients(87%)were asymptomatic,4(6%)patients were partial asymptomatic and 4(6%)had recurrent locking showing failure.Second-look arthroscopic examination showed that 44 menisci(83%)were healed completely,5(9%)partially healed,and 4(7%)not healed.The total failure rate was 8%(5/63),and success rate was 92%,including complete healed,partial healed,asymptomatic and partial asymptomatic patients.For large bucket-handle meniscus tears involving red-red and red-white zones,reliable arthroscopic hybrid suture technique,provides stable suture strength along the whole length of injured region and consequently achieves improved clinical outcomes in combination with anterior cruciate ligament.