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The WeChat public platform has profoundly influenced the propagation mode of medical ethics.Through the fitting of logistic ordinary differential equation,the analysis of two-level of propagation model and path,this paper constructed the propagation mode of medical ethics based on WeChat public platform.In practice,by means of accurate positioning,pushing quality content,the integration with new media forms,online interaction and other ways,the conversion rate of WeChat push will be enhanced,which will therefore promote the transmission efficiency of medical ethics.
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Objective To assess the mid-or long-term clinical outcomes of the structural bone graft of superolateral acetabulum in total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH).Methods Thirty-three patients with DDH (33 hips) were treated by THA with the structural bone graft of superolateral acetabulum technique between April 2002 and December 2011.There were 28 females and 5 males with the mean age at surgery 54.0±14.5 years (21-76 years).The degree of dislocation was graded preoperatively as Crowe Ⅱ in 12 patients,Crowe Ⅲ in 8 patients,and Crowe Ⅳ in 13 patients.The following outcomes were assessed,Harris hip score (HHS),the leg-length discrepancy,the height and horizontal distance of center of hip rotation,rate of cup coverage,the coverage ratio of bone graft,periprosthetic osteolysis,bone ingrowth,and cup loosening.Results The average follow-up was 9.3±3.3 years (5-15 years).The HHS improved from 40.9±13.7 preoperatively to 93.6±7.8 at the final follow-up (t=21.483,P=0.000).The leg-length discrepancy decreased from 24.2± 17.1 mm pre-operatively to 3.7±3.5 mm at postoperative 3 months (t=6.747,P=0.000).The height and horizontal distance of center of hip rotation decreased from preoperative 45.9±16.0 mm and 42.9±8.7 mm to postoperative 23.8±5.8 mm and 23.6±2.9 mm (t=7.460,P=0.000;t=12.090,P=0.000) at postoperative 3 days,respectively.The cup coverage and coverage ratio of bone graft was 100％ and 27.1％±6.9％,respectively.All grafts appeared to be incorporated without evidence of resorption and collapse.The mean time of incorporation was 7.6 ± 2.8 months.The coverage ratio of bone graft ＞25％ have a significantly long time of incorporation than that ＜25％ (9.4±2.3 months versus 6.3±2.4 months,t=5.357,P=0.000).At the final follow-up,all hips showed bone ingrowth fixation of the acetabular cup and stem.Five hips showed osteolysis,two hips in acetabular zone Ⅱ,three hips in femur zone Ⅰ and five hips in femur zone Ⅶ.The main complications were intraoperative femoral fractures (61％) without neurological damage,nonunion and dislocation.Conclusion The structural bone graft of superolateral acetabulum in THA for DDH can achieve satisfactory mid-or long-term outcomes.The superolateral acetabular deficiency can be reconstructed by bone graft.The bone graft coverage less than 25％ is conducive to fusion of bone graft and acetabular bone.However,intraoperative femoral fracture is common complication.
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Objective To analyze the epidemiology,mechanisms of injury,type of fracture,clinical and radiological feature of acetabular fractures in patients aged 60 years and older.Methods Retrospectively analyzed the clinical data of patients with acetabular fractures between Janurary 1990 and December 2013 in Orthopaedic Department of the First Affiliated Hospital of Soochow University.According to certain inclusion and exclusion criteria,a total of 637 patients (637 hips) with acetabular fractures were included in the study.The patients were divided into 2 group acetabular fractures in elderly (≥60 years) and acetabular fractures in younger patients (＜ 60 years).Analysis of mechanism of injury,fracture pattern,the annual incidence of fracture,radiological features,associated injuries.Results 133 patients were ≥60 years and the remaining 504 were ＜ 60 years.We identified a significant increase in the incidence of elderly with acetabular fractures between 1990 and 2013 (6.7％ in 1990 vs.40.0％ in 2013).The incidence of associated injuries were significant lower in the elderly than younger (27.1％ vs.48.8％).The most common mechanism of injury in the elderly was a fall (36.1％),but this accounted for only 0.2％ of the younger with fractures.The incidence of anterior wall,anterior column,anterior and posterior hemitransverse were significant higher in the elderly than younger.The incidence of radiological features were significant higher in the elderly than younger,including quadrilateral plate fracture,Gull sign,anterior dislocation of hip,femoral head injury,comminuted posterior wall fracture and posterior wall marginal impaction,except posterior dislocation of hip which was significant lower in the elderly than younger.Conclusion There was an increasing trend of the proportion of elderly in acetabular fractures and the mean age of patients with fractures during the period of study.The older had a different incidence of associated injuries,mechanism of injury,fracture pattern,and radiological features compared with the younger.
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Objective To evaluate the mid-and long-term clinic results of ceramic-on-ceramic joint in total hip arthroplasty (THA) in younger patients.Methods A retrospective review was made on 72 younger patients who had THA with ceramic-on-ceramic bearings due to femoral head necrosis or inborn hip dysplasia between March 2001 and March 2011.There were 32 females and 40 males,at a mean age of (35.2 ± 7.6)years (range,17-45 years).Patients were evaluated with Harris hip score and University of California,Los Angeles (UCLA) activity score.Radiological findings were recorded including component loosening,ostelysis,and ceramic bearing related complications.Results Duration of followup was (8.5 ±2.4) years (range,5-12 months).At the final follow-up,Harris hip score was increased to (93.8 ±4.3)points (range,85-100 points) compared to preoperative (46.1 ± 12.3) points (range,27-70 points) and UCLA activity score was increased to (7.1 ± 1.4)points (range,4-10 points) compared to preoperative (4.0 ± 1.2) points (range,2-6 points) (P ＜ 0.05).At the final follow-up,no osteolysis or prosthesis loosening occurred,but there were ceramic sandwich liner fractures in two patients (two hips),dislocation in one patient (one hip) and squeaking in one patient (one hip).After revision due to the ceramics break,the 8-year survival rate was 97％ (95％ CI91.9-100.0).Conclusion Ceramicon-ceramic joint in THA satisfies the activity demand in younger patients,with excellent mid-and longterm clinical results.
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Objective:To investigate the effect of DKK1 on linearly patterned programmed cell necrosis (LPPCN) and vasculogenic mim-icry (VM) and the related molecular mechanism in non-small cell lung cancer (NSCLC). Methods:A total of 173 human NSCLC speci-mens were collected to detect LPPCN by H&E staining, detect VM with CD31/PAS double staining, and investigate DKK1 and related protein expression by immunohistochemistry. The clinical pathological significance of LPPCN, VM, and DKK1 and the correlation of them were analyzed. Human NSCLC H460-DKK1 cells were engrafed in nude mice to evaluate the influence of DKK1 up-regulation on VM and LPPCN in vivo. Results:Approximately, 14.45%(25/173) of NSCLC had VM and 49.71%(86/173) had LPPCN. 25.6%(22/86) of NSCLC cases in LPPCN-positive group formed VM. Both of VM and LPPCN were all correlated with poor differentiation, late TNM stage, easy recurrence and metastasis and poor prognosis in NSCLC. DKK1 expression in the VM-positive group and the LPPCN-positive group was higher than that in the VM-negative group and the LPPCN-negative group, respectively. DKK1, LPPCN, and VM were positive-ly correlated with VE-cadherin, MMP-2,β-catenin nuclear expression and Twist1. H460-DKK1 transplantation tumor model confirmed that DKK1 promotes the expression of VM and LPPCN and related proteins in NSCLC. Conclusion:The increase of theβ-catenin and Twist1 expression induced by DKK1 may promote the formation of LPPCN and VM in NSCLC.
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Objective To compare the therapeutic effect of Pilates and conventional training after total hip arthroplasty (THA).Methods Fifty-eight patients who had undergone minimally invasive total hip replacement surgery were divided into an observation group (n =29) and a control group (n =29) using a random number table.The observation group was given Pilates rehabilitation training,including a series of exercises especially designed for this condition,for 6 months after the operation.The control group was provided with conventional postoperative rehabilitation training including passive range of motion exercise,balance training,etc.,lasting for 1 to 2 months in hospital,followed by self-training after discharge.At 1 month,3 months and 6 months after the operation hip joint function was evaluated in both groups using the Harris hip score and the modified Barthel index (MBI).The time for first out-of-bed activity after the operation,length of hospital stay and postoperative complications of the two groups were also recorded.Results At 1 month after the operation,the average Harris hip score and MBI score of the observation group were significantly better than those of the control group [(59.78 ± 6.22) vs (51.26 ± 3.42) and (52.56 ± 16.67) vs (45.63 ± 15.24),respectively].Two and 4 months later,in the observation group the average Harris hip score had improved significantly to (82.12 ± 3.32) and further to (91.42 ± 5.91),while the MBI score increased significantly to (58.39 ± 13.32) and (81.17 ± 13.87).The same tendency was observed in the control group and at those two time points no significant difference was observed between the observation group and the control group.The patients in the observation group had their first out-of-bed ambulation significantly earlier,a significantly shorter average hospital stay and significantly fewer postoperative complications.Conclusion Pilates training after minimally invasive THA can promote earlier and quicker functional recovery than conventional rehabilitation training.
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Objective To determine the factors influencing the results of open reduction and internal fixation for displaced intra-articular calcaneal fracture (DIACF).Methods From May 2009 to June 2013, 80 patients with DIACF involving in 91 feet were treated by open reduction and internal fixation.Mean age was 38.7 years (range, 18-72 years).Patients were grouped according to the possible factors related to the operative results, including the Sanders classification of fracture, quality of fracture reduction, postoperative B(o)hler angle, width of postoperative calcaneus, and time to surgery after injury.Clinical result was evaluated and compared within each group.Results Mean duration of follow-up was 18.3 months (range, 14-26 months).The clinical results were excellent for 67 feet (74％), good for 12 feet (13％), fair for 7 feet (8％) and poor for 5 feet (5％), which yielded 87％ good to excellent results.Good to excellent results in Sanders Ⅱ , Ⅲ and Ⅳ groups reached 94％, 85％ and 53％ respectively, in quality of fracture reduction ≤ 2 mm and ＞ 2 mm groups reached 93％ and 30％ respectively, in postoperative B(o)hler angle ＜ 15° and ≥15° groups reached 33％ and 90％ respectively;in broadening of postoperative calcaneus ＜ 1 cm and ≥ 1 cm groups reached 92％ and 17％ respectively, in time to surgery after injury ≤14 days and ＞ 14 days groups reached 91％ and 43％ respectively, in age ≤60 years old and ＞ 60 years old groups reached 85％ and 88％ respectively.Except for the age group, the clinical result differed significantly within group (P ＜ 0.05).Conclusions Fracture type, reduction quality, postoperative B(o)hler angle, width of postoperative calcaneus, time to surgery after injury are the factors influencing on the operative results of patients with displaced intra-articular calcaneal fracture.Thereupon the unfavorable influences should be avoided to improve the operative results.
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Objective:To investigate the correlations of Lauren classification and world health organization (WHO) classification of gastric cancer (GC) with microvascular density (MVD), matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor 1 (VEGFR1), vascular endothelial growth factor receptor 2 (VEGFR2), and p53. Methods:The clinical data of 89 patients with GC were collected. The collected specimens were categorized on the basis of Lauren classification and WHO classification. CD34/periodic acid-Schiff (PAS) double staining was performed to validate MVD. Immunohistochemistry was conducted to investigate the expression levels of MMP-2, MMP-9, VEGF, VEGFR1, VEGFR2, and p53. Results:MVD was not correlated with Lauren classification or WHO classification (P>0.05). Lauren typing was associated with the expression levels of MMP-9, VEGFR1, and p53 (P0.05). Cox proportional hazards model revealed that Lauren classification and WHO classification were the prognostic factors of overall survival (P<0.05). Conclusion:This research on tumor related factors, angiogenesis, and different classifications of GC may provide new methods to treat this disease.
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BACKGROUND:Anatomic medul ary locking (AML) femoral prosthesis is circular cylinder and has satisfactory efficacy. However, some scholars found the complications such as thigh pain, loss of bone at the proximal end of the femur, and wearing-related osteolysis. F2L femoral prosthesis is cone-shaped and also has satisfactory efficacy, but the thigh pain incidence is relatively low. ＜br> OBJECTIVE:To compare the intermediate-long term results of AML versus F2L in total hip arthroplasty. ＜br> METHODS:Between November 1997 and January 2005, we retrospectively reviewed 60 patients (66 hips) undergoing total hip arthroplasty using biological femoral prosthesis. At fol ow-up examination, 58 hips in 52 patients were available for clinical and roentgenographic review. 26 AML devices were placed in 24 patients, and 32 F2L devices were placed in 28 patients. The AML group were reviewed with an average of 12.7 years fol ow-up (range 10 years and 3 months to 15 years and 5 months), while the F2L group were reviewed with an average of 9.5 years fol ow-up (range 8 years and 3 months to 11 years and 1 month). The clinical results were evaluated with Harris methods and X-ray examination. Kaplan-Meier analysis was performed to evaluate the survival of femoral component. End point was radiographical loosening or revision of the femoral component for any reason. ＜br> RESULTS AND CONCLUSION:There were no significant difference between AML and F2L about Harris score in the latest fol ow-up (P>0.05). After surgery, the incidence of thigh pain was significantly lower in F2L group than that in AML group (P＜0.05). In AMKL group, the stress-shielding 1 level was observed in 21 hips (81%), and 2 level in five hips (19%);in F2L group, the stress shielding 0 level was observed in 20 hips (62%) and 1 level in 12 hips (38%). There were significant differences between the two groups (P＜0.05). The stress shielding showed significant differences between the two groups (P＜0.05). The incidence of osteolysis in F2L group was significantly lower than that in AML group (P＜0.05). Kaplan-Meier analysis showed that, the survival rate of both AML and F2L components were 1.0 (95%confidence interval:0.98-1.00). Experimental findings indicate that, both AML and F2L femoral prosthesis have a satisfactory long-term efficacy after total hip arthroplasty, and the incidence of thigh pain and osteolysis is significantly lower in F2L group.
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BACKGROUND:Total knee arthroplasty mainly used fixed platform, but more and more movable platform was selected year by year in the clinic. Rotary platform theoretical y can apparently improve the curative effects, but it has not been verified in the clinic. OBJECTIVE:To summarize the design characteristics and clinical results of Gemini MKII (Link, Germany) rotary platform. METHODS:From January 2004 to January 2009, 108 patients (119 knees) including 31 males and 77 females were treated with total knee arthroplasty by using Gemini MKII system. There were 97 unilateral cases and 11 bilateral cases at the first stage of replacement. Preoperative diagnosis:1 case of hemophilic arthritis, 1 case of venereal Charcot’s disease, 8 cases of post-traumatic arthritis, 11 cases of rheumatoid arthritis, and 87 cases of degenerative osteoarthritis. The prosthesis was fixed with bone cement. None received patel ar replacement. RESULTS AND CONCLUSION:None experienced infection, femoral condyle fracture or nerve and vascular damage. Except bilateral replacement, the average operation time of unilateral replacement was (56±13) minutes. Average postoperative hemoglobin decreased (25±5) g/L. After replacement, hemoglobin maintained over 100 g/L in 83 patients (86%), without blood transfusion. Knee joint score and function score recovered to (92.0±4.7) points and (90.3±6.8) points at half years after replacement, and became (94.4±3.2) points and (91.6±5.9) points during final fol ow-up, which was significantly improved as compared with that pre-replacement (P<0.01). No revision surgery should be done for lining prolapse or spin out, osteolysis and prosthesis loosening. These results indicated that the early and midterm results of Gemini MKII rotating-platform prosthesis were satisfactory, but the long-term results remain to be confirmed.
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BACKGROUND:Femoral offset reconstruction is significant for recovering strength of abductor and the balance of soft tissue tension surrounding hip joint, maintaining joint stabilization, restoring joint function, reducing limping after replacement, decreasing prosthetic abrasion, and the incidence of joint prosthesis dislocation. OBJECTIVE:To discuss effect of femoral offset reconstruction on hip joint function in total hip arthroplasty. METHODS:We comparatively analyzed 20 patients (20 hips) undergoing the modular prosthesis (S-ROM) total hip arthroplasty and 19 patients (20 hips) undergoing the one modular prosthesis (Corail) total hip arthroplasty at the same time. According to Harris hip score and radiography results, hip joint function and femoral offset reconstruction rate were comparatively studied in both groups. RESULTS AND CONCLUSION:No infection, fracture, dislocation, deep venous thrombosis or neurovascular injury occurred in either group. Clinical fol ow-up results:In the modular prosthesis and one modular prosthesis groups, there was no significant difference in preoperative Harris hip score between the femoral offset reconstruction and non-reconstruction groups (P>0.05). At 12 months and the latest fol ow-up, the Harris hip score was higher in the patients with femoral offset reconstruction than those with femoral offset non-reconstruction (P0.05). These results indicated that functional recovery and the range of abduction were better in patients with femoral offset reconstruction than those without femoral offset reconstruction. Modular prosthesis has a high rate of femoral offset reconstruction.
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BACKGROUND:Ribbed anatomic femoral stem meets the biomechanical features of the femur, and has achieved satisfactory clinical efficacy with good initial stability, rapid bone growth and low stress shielding. OBJECTIVE:To evaluate the design features and clinical results of the cementless anatomic Ribbed femoral stem (Ribbed stem) in total hip arthroplasty. METHODWe retrospectively analyzed 52 patients (52 hips) with hip joint disease who were treated with Ribbed stem in total hip arthroplasty between March 2010 and March 2012. There were 20 males and 32 females. The mean age was 59 years (range 22-78 years). The mean fol ow-up was 3.1 years (range 2-4 years). The preoperative and postoperative Harris hip scores, the rate of postoperative thigh pain, the incidence of intraoperative femoral fracture, wound healing, dislocation and revision were recorded. Radiographic evaluation was used to evaluate the rate of stem fil , subsidence of femoral stem, periprosthetic radiolucent line, bone ingrowth, stress shielding, and osteolysis. RESULTS AND CONCLUSION:The incidence of intraoperative femoral fracture was 6%. Al incisions were healed. There were no cases of hip dislocation and revision;the rate of thigh pain was 6%, no patient had thigh pain after 1 year postoperatively. The mean preoperative Harris hip score was 48 points, which improved to a mean of 96 points at the final fol ow-up. Postoperative X-ray showed that al patients had a satisfactory femoral fil in both planes and al of the femoral stems were wel-fixed at the final fol ow-up. The average fil ing rate was 91%, 88%and 86%by normotopia imaging, while 88%, 85%and 81%by lateral imaging, at the metaphysic, middle and distal ends respectively. At the final fol ow-up, 49 hips (92%) showed stable bone ingrowth, 3 hips showed stable fiber ingrowth. No osteolysis around the components at the femur or acetabulum was observed. 5 (10%) hips appeared the subsidence of femoral stems, which were<2 mm. The stress shielding phenomenon occurred in al patients, including first-degree in 31 hips, second-degree in 19 hips, third-degree in 2 hips, and fourth-degree in no case. Experimental findings indicate that, Ribbed stem with a rational design can achieve satisfactory clinical outcomes with good initial stability, rapid bone growth and low stress shielding.
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This study was aimed to analyze the dynamic accumulation of active ingredients of Echinacea purpurea. Contents of cichoric acid and total polyphenols in different parts through the whole growth process were determined by HPLC and colorimetry. The results showed that the content of total polyphenol changed little in annual plant. There were differences in content of cichoric acid of different parts in different periods. And the content reached the maximum at flowering stage. It was concluded that the harvest stage depended on the content of cichoric acid. The results provided theoretical basis for induced plant in Shandong province.
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Objective To investigate the influence of cartilage degeneration grades of patellar on the clinical outcomes after total knee arthroplasty (TKA) without patellar resurfacing.Methods 151 patients performed TKA without patellar resurfacing from February 2007 to January 2010 were retrospective studied.There were 65 males and 86 females,with the mean age of 65±5.0 years (range,56-82 years).The mean duration of follow-up was 3.5 years (range,2-5 years).Intraoperatively,the cartilage degeneration was classified according to Outerbridge classification.At the final follow-up,the patients' satisfaction was evaluated,and the incidence of anterior knee pain was assessed using visual analogue scale (VAS).If VAS was more than 3 points,patient was defined suffered anterior knee pain.Compare KSS and patella score of patients with different grades of cartilage degeneration.Results The articular cartilage of the patella was graded according to Outerbridge:grade Ⅰ in 18 patients,grade Ⅱ in 36 patients,grade Ⅲ in 62 patients,and grade Ⅳ in 35 patients.At the final follow-up,the patients' satisfaction rate and the anterior knee pain rate was 96.7％ 046/151) and 4.0％ (6/151),respectively.In the patients with different grades of cartilage degeneration,the patient satisfaction rate (H=5.54,P=0.14),anterior knee pain rate (H=0.56,P=0.91),KSS (knee score:F=1.95,P=0.12； function score:F=2.11,P=0.10) and patella score (F=1.35,P=0.26) were not found to be significantly difference.Conclusion The differentiae grades of cartilage degeneration may not affect the clinical outcomes of TKA.TKA without patella resurfacing appears to be a reasonable option for degenerative osteoarthritis.
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ObjectiveTo evaluate the intermediate term efficacy of posterior stabilized (PS) total knee arthroplasty(TKA) and posterior cruciate-retaining(CR) TKA and explore the clinical related problem.MethodsThe clinical data of 84 patients (87 knees) who treated with primary TKA from May 1992 to May 2006 were analyzed retrospectively.The intermediate term efficacy was compared between PS TKA (PS group,41 cases with 43 knees) and CR TKA (CR group,43 cases with 44 knees).ResultsAll the patients were followed up for 5-10(7.6 ± 1.5 ) years,no infection,dislocation or neurovascular injury occurred in both groups.But 1 knee occurred intraoperative posterolateral femoral condyle fracture in PS group.The lateral retinacular release rate was 2.3％ ( 1/43 ) and 2.3％ (1/44) in PS group and CR group,respectively.The incidence of anterior knee pain was 4.7％(2/43 ) and 4.5％(2/44) after 6 months surgery in PS group and CR group.The incidence of anterior knee pain was 0 at the end of follow-up in both groups.There was no significant difference in the lateral retinacular release rate and the incidence of anterior knee pain between two groups (P ＞0.05).The range of motion and American knee society score(KSS) was similar and no statistical difference was found between two groups(P ＞ 0.05 ).The incidence of patellar tilt or subluxation in X-ray was 2.3％ (1/43) and 2.3％ (1/44) at the end of follow-up in PS group and CR group.There was no significant difference between two groups (P ＞ 0.05 ).At the end of follow-up,no osteolysis,X-ray radiolucent zone and prosthesis loosening were found in both groups.There was no revision owing to loosening or other reasons.ConclusionsThe intermediate term efficacy of PS TKA and CR TKA is near a tie.However,the future efficacy still need further follow-up.
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ObjectiveTo summarize the clinical result of the proximal femoral shaft splitting at sagittal view in primary total hip arthroplasty (THA) in treatment of ultimate hip disease combined with femoral metaphyseal stenosis deformity.MethodsA retrospective study was done on 18 patients with proximal femoral deformity (22 hips including 14 patients with unilateral hips and 4 with bilateral hips)treated from January 2000 to December 2009.There were three males and 15 females, at age range of 41-75 years (average 54 years).According to Berry classification system, all patients were indentified as metaphyseal segment abnormality and deformity, including developmental type disease (congenital hip dysplasia) in 17 patients and old tuberculosis of the hip in one.The congenital hip dysplasia was diagnosed as type Ⅳ by using the Crowe classification system.All the patients were treated with the proximal femoral shaft splitting, subtrochanteric shortening with overlapping femoral resection and V-shaped derotational osteotomy.In the meantime, standard biological fixation of the femoral stem prosthesis was performed.ResultsThere found no dislocation, infection, lower extremity nerve stretch injury or uncontrolled proximal femur fractures.X-ray showed that all acetabular cups were placed at the anatomical position and that the initial femoral stem prosthesis fixation was rated as good.All osteotomy areas were healed within 3-6 months.Limb length discrepancy was restored to average 3 cm after surgery.The patients were followed up for 1-10 years (average six years), which showed that the average Harris hip score was improved from preoperative 30 to postoperative 93, with no aseptic loosening or osteolysis or radiolucent line around the femoral component, no prosthesis sinking or varus displacement, or no patients needing revision of the femoral component.ConclusionsThe proximal femoral shaft splitting at sagittal view and standard biological fixation of the femoral stem prosthesis can attain satisfactory result for patients with ultimate hip disease combined with femoral metaphyseal stenosis deformity.
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Objective To evaluate the midterm results of the revision total hip replacement with a fluted and tapered modular stem. Methods Nineteen patients (21 hips) underwent revision total hip arthroplasty from May 2000 to August 2005 were reviewed. There were 13 females and 6 males, with an average age of 67 years. Pre-revision diagnosis included aseptic loosening of the cups and stems associated with femoral defects (Paprosky classification) type Ⅱ 4 hips (19%), type Ⅲa 14 hips (67%), and type Ⅲb 3 hips (14%). The adopted acetabular component was SPH (Lima-Lto, Italy), and femoral component was a fluted and tapered modular stem (Lima-Lto, Italy). Clinical and radiographic evaluations were performed postoperatively. Results The mean follow-up was 7 years (range, 5-10). The Harris hip score improved from 46.2±15.2 preoperatively to 90.3±5.3 postoperatively, and maintain 92.2±3.5 at the latest follow-up. The X-ray films showed bone ingrowths fixation in 20 hips (95%) and fibrous stable fixation in 1 hip (5%). The average stem subsidence was 2.4 mm (range, 0-10 mm). There were no re-revisions of the femoral stem for any reason. Conclusion The midterm results of revision total hip replacement with a fluted and tapered modular stem in Paprosky type Ⅱ, Ⅲ a, Ⅲ b femoral defect associated aseptic loosening of the femoral stem was encouraging.
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Objective To investigate periprosthetic femoral shaft remodeling with tapered femoral stems after total hip arthroplasty (THA) for elderly patients and evaluate the mid-term clinical outcomes.Methods The study involved 30 elderly (70-90 years) patients (34 hips) treated with femoral shaft remodeling with tapered stems after THA from January 2003 to January 2005. The postoperative X-ray images were collected and perioperative periprosthetic bone mineral density was analyzed by dual-energy X-ray absorptiometry (DEXA). The Harris score was applied in follow-up observation, and Kaplan-Meier method was used to evaluate the working life of the femoral prosthesis. Results Four patients were died of lung cancer. The remaining 26 patients ( 30 hips) were followed up for 5-7 years ( mean, six years). The postoperative X-ray measurements showed that total hip prosthesis subsidences were less than 1.5 mm within one year in 12 hips, with no prosthesis loosening observed. Bone proliferations were seen in Gruen zones 2, 3, 4, 5, 6, 11 and 12, and bone resorptions were seen in zones l and 7. DEXA showed that bone mineral density was increased in Gruen zones 2,3,4 and 5, but decreased mainly in Gruen zones 1,6 and 7. The increase of bone mineral density in zones 2 and 5 was faster compared to other sites six months after the operation ( P ＜ 0.05 ) and the change of bone mineral density was prone to be stable in two years ( P ＞ 0.05 ). Within one year after initial implantation, periprosthetic bone mineral density was significantly decreased ( P ＜ 0.05 ). Two years after the operation, rare changes of periprosthetic bone mineral density were found ( P ＞ 0.05 ), with only regional redistribution of bone mass from the proximal to the distal femur. The Harris score of hip joint function was increased from preoperative 38.56 ± 8.21 to 86.32 ± 6. 01 at the final follow-up. The 6-year survival rate of the prosthesis was 100%. Conclusion Femoral shaft remodeling with tapered stems after total hip arthroplasty for the elderly patients shows good periprosthetic bone remodeling and satisfactory mid-term clinical results.
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BACKGROUND: Greatly higher elastic modulus of traditional metal prosthesis than bone elastic modulus is mechanical factor for aseptic loosening of artificial joint, resulting in stress shielding, bone resorption and bone atrophy.OBJECTIVE: To measure femoral stress after prosthetic replacement made of carbon fiber reinforced poly-ether-ether-ketone (CF/PEEK), and compare with domestic AML prosthesis, so as to explore the application prospect of compound material in total hip femoral head prosthesis. DESIGN, TIME AND SETTING: Comparative analysis was performed at Orthopedics Laboratory, First Hospital of Soochow University and Institute of Biomechanical Engineering of Shanghai University from September 2002 to March 2004.MATERIALS: CF/PEEK prosthesis was designed by the authors, composed of long CF/PEEK compound material as inner layer, 100 Gpa and short CF/PEEK compound material as outer layer, 20 Gpa; the layer intensity at stress center was strengthened, and the appearance and size of the CF/PEEK prosthesis simulated domestic AML cobalt alloy prosthesis (Beijing Huajiehao Company). Five pairs (10 femurs) of femurs were from fresh adult cadavers. METHODS: Five pairs of human cadaveric femora were divided equally into left and right groups: one group received a cobalt-chrome molybdenum alloy (CoCrMo) implant and the other received CF/PEEK implant. Strain-gauge rosettes were attached to external surface of each implant and proximal femora. The loading condition simulated single-limb stance. MAIN OUTCOME MEASURES: strains distribution on the normal femur and femoral surface after replacement with two kinds of prostheses; shearing strain at femur-prosthesis interface of two groups.RESULTS: Following prosthesis implantation, the strains exhibited a progressive proximal-to-distal increase, which was similar to that in the intact femur, and the strain was maximum near the distal prosthesis. The strains on the medial and lateral surface of the femur were reduced after implantation of both types of implants. The pattern and magnitude of the strains, however, were closer to those in the intact femur after insertion of CF/PEEK prosthesis than in the CoCrMo one. CONCLUSION: Mechanical performance of CF/PEEK compound prosthesis is similar to bone tissue, and can provide similar strain under loading condition. Therefore, it can provide immediate postoperative stability and proximal loading transfer.
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Objective To identify the relationship of the femoral morphology with the sex and age, analyze and compare the two methods of defining the morphology of marrow cavity.Methods AP and lateral radiography of the hip joint was made in 45 patiens who accepted total hip arthroplasty.The anatomic parameters of the proximal femur were measured on those radiography.The femoral morphology was analyzed using Dorr criteria and Noble class respectively.Results (1)The anatomic parameters of the proximal femur were not correlated with the age in male.(2)The inner diameter of canal 10 em distal to the lesser trochanter, isthmus width and canal to calar isthmus rate were positively correlated with age in female.(3)The medial cortical and lateral cortical thickness 10 cm distal to the lesser trochanter,cortical index and canal-flare index were negatively correlated with age in female.(4)According to Dorr criteria,13 femora were classified as type A,20 as type B,and 12 as type C.According to Noble class,4 femora were classified as champagne type,34 as normal type,and 7 as stove pipe type.Conclusions The femoral morphology don't change with age in male.The width of femoral canal increase with age in female.Type C of Dorr criteria contains all of stove pipe type and a portion of normal type.