Double plating through different approaches for periprosthetic femoral fracture following total knee arthroplasty / 中国骨伤

OBJECTIVE@#To study clinical effects of double plating through different approaches for communicated and obvious osteoporosis periprosthetic femoral fracture following total knee arthroplasty(TKA).@*METHODS@#From July 2010 to June 2017, 21 patients with periprosthetic femoral fracture following TKA were divided into two groups according to operative approach. Fifteen patients in medial and lateral double approaches group, including 5 males and 10 females aged from 63 to 79 years old with an average of (67.2±5.9) years old; 11 patients were type 33-A2 and 4 patients were type 33-A3 according to AO-OTA classification; 12 patients injured by falling down and 3 patients by traffic accident; treated with double plating. Six patients in medial parapatellar approach group, including 3 males and 3 females, aged from 61 to 74 years old with an average of (64.6±6.0) years old; 3 patients were type 33-A2 and 3 patients were type 33-A3 according to AO-OTA classification; 5 patients injured by falling down and 1 patient by traffic accident; treated with double plating. Operative time, blood loss, postoperative drainage, fracture healing time were compared between two groups; HSS score and radiology at 3 and 12 months were compared between two groups.@*RESULTS@#All patients were followed up, and the follow-up time of bilateral approaches group ranged from 12 to 18 months with an average of (14.2±2.6 ) months, while the follow-up time of single approach group ranged from 12 to 16 months with an average of (12.6±2.5) months, and there was no statistical difference between two groups. The operative time and postoperative drainage in bilateral approaches group were (107.2±10.4) min and (213.9±30.4) ml, while in sigle approach group was (95.4±12.8) min and (256.8±34.2) ml, and the differences were significant(0.05). HHS score at 3 and 12 months after operation in bilateral approach were 82.9±5.7 and 84.8±7.1, while in single approach group were 83.6±6.1 and 86.3±6.8; there was no statistical difference in HSS score between two groups(>0.05). According to HSS score at 12 months after operation, 2 cases got excellent results and 13 good in bilateral approaches group; 1 case got excellent result and 4 good and 1 moderate in single approach group; but there was no statistical difference between two groups (χ²=2.625, =0.105). There wase no significant differences in complications between bilateral approaches group(2 cases) and single approach group (1 case)(>0.05).@*CONCLUSIONS@#Double plating technique for communicated and obvious osteoporosis periprosthetic femoral fracture following TKA could obtain good function of knee joint. The medial parapatellar approach has shorter operative time, while the bilateral approaches had less drainage.

Mid-term follow-up study of hip arthroplasty for internal fixation failure of femoral intertrochanteric fractures in the elderly / 中国骨伤

<p><b>OBJECTIVE</b>To retrospective analysis the mid-term follow-up effect of hip joint replacement in elderly patients with failure of intertrochanteric fractures of the hip joint internal fixation.</p><p><b>METHODS</b>From December 2008 to December 2011, 32 elderly patients underwent arthroplasty after intertrochanteric fracture fixation failure, of which, 4 death cases were excluded from the study, and the remaining 28 cases were in the study group. The age of patients ranged from 69 to 83 years old with a mean of 75 years old. The time from the internal fixation to the hip replacement were 8 to 72 months. Among them, 6 patients were Evans I type, 11 patients were Evans II type, 9 patients were Evans III type, and 2 patients were Evans IV type. Nine cases showed fracture of the lateral plate before operation, while 15 cases were femoral head screw cut-out and 4 cases were screw loosening. Harris score was used to compare the changes of hip function before operation with the final follow-up. Imaging results(X-ray) and erythrocyte sedimentation rate(ESR) were performed during the follow-up.</p><p><b>RESULTS</b>All patients were followed up from 4 to 7 years with an average of 5.3 years. Pain was significantly reduced or disappeared in patients compared with pre-operation. And hip function was significantly improved. Two cases had moderate pain after the physical activity and 4 cases had mild pain after the physical activity. At the final follow-up, 19 patients resumed free walking, 8 patients required walking with walking sticks, and 1 patient needed walking aid. The Harris scores improved from preoperative 34.9±2.4 to 83.4±5.7 at the final follow-up, among them, 15 cases were classified as excellent, 10 as good, 2 as fair, and 1 as poor. X-ray examination showed no prosthesis loosening and sinking fracture.</p><p><b>CONCLUSIONS</b>Salvage THA surgery could improve the hip function and the quality of life for old patients with intertrochanteric fracture fixation failure, and the middle-term follow-up results support that.</p>

Case report: A 10 years follow-up of periprosthetic femoral fracture after total hip arthroplasty in osteopetrosis / 中华创伤杂志(英文版)

Osteopetrosis is an inherited disorder characterized by increased bone density and brittle bone quality. Degenerative changes often occur after the age of 40 in patients with osteopetrosis. Operative intervention is the primary treatment option if the clinical manifestation of secondary osteoarthritis is severe. A 44-year-old male suffering autosomal dominant osteopetrosis and progressive unilateral hip osteoarthritis required a total hip arthroplasty. However, there were several technical challenges associated with this procedure including creating a femoral medullary canal and developing a Vancouver type B2 periprosthetic femoral fracture postoperatively. To afford some experience for the management of similar cases, we here present our technical solutions to these problems.

Computed tomography angiography and magnetic resonance imaging performance of acute segmental single compartment syndrome following an Achilles tendon repair: A case report and literature review / 中华创伤杂志(英文版)

Acute compartment syndrome of the lower extremity is a serious postinjury complication that requires emergency treatment. Early diagnosis is of paramount importance for a good outcome. Four muscle compartments in the calf (anterior, lateral, deep posterior, and superficial posterior) may be individually or collectively affected. Acute segmental single-compartment syndrome is an extremely rare condition characterized by high pressure in a single compartment space with threatening of the segmental tissue viability. In this case report, we describe a young man with Achilles tendon rupture who complained of postoperative pain in the anterior tibial region. Emergent computed tomography angiography and magnetic resonance imaging revealed local muscle edema. Segmental anterior compartment syndrome was diagnosed and fasciotomy was performed.

Medium-term follow-up outcomes of total hip arthroplasty for patients with ankylosing spondylitis / 中国骨伤

<p><b>OBJECTIVE</b>To retrospectively study medium-term follow-up outcomes of total hip arthroplasty (THA) for patients with ankylosing spondylitis (AS).</p><p><b>METHODS</b>From January 2000 to December 2008, 67 patients (88 hip joints) with AS were treated with all ceramic interface THA. And 55 patients (74 hips) were finally followed up. Among them, there were 30 males and 25 females, with an average age of 32.6 (ranged 19 to 58) years old. Sixty-one hips were treated with biological prosthesis and 13 hips were treated with hybrid prosthesis. Fifty-five patients were followed up at least 5 years, with an average of (75.2 +/- 8.6) months. Clinical symptoms and radiography information were evaluated after follow-up.</p><p><b>RESULTS</b>Harris hip score were significantly improved from 30.8 +/- 7.0 preoperatively to 85.2 +/- 5.5 at the last follow-up (P<0.01). The hip movement range increased from (21.2 +/- 8.5) degrees preoperatively to (142.0 +/- 10.2) degrees postoperatively (P<0.01). The 5-year survival of prosthesis was 95.9%. One patient were renovated because of internal wall broken caused by injury, 1 was renovated for infection, 1 was renovated for fracture arround femoral stem prostheses, and 1 was treated with conservative treatment by dislocation. Three cases with abnormal sound were cured with non-operation. 7 cases with heterotopic ossification were not treated, 2 cases with thigh pain received conservative treatment. Bone dissolve around prosthesis, loose and sink of femur and acetabulum prosthesis were occurred in other cases.</p><p><b>CONCLUSION</b>THA for the treatment of AS is a reliable method, which has a satisfied medium-term follow-up outcomes.</p>

Yoga is found hazardous to the meniscus for Chinese women / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Yoga is becoming more and more popular in the female society while the concomitant sports injury is seldom mentioned. Many clinicians have noted that yoga may result in knee problems, which though requires more researches to corroborate. This investigation was conducted to ascertain the relationship between yoga and meniscus injury as well as the extent of impairment according to variant yoga practice periods.</p><p><b>METHODS</b>Totally 819 women aged 20-49 years who practiced yoga or other popular sports including badminton, jogging, climbing hills, etc for at least one hour per day were selected to participate in this research. These subjects were required to complete a questionnaire and receive relevant physical examination. Magnetic resonance (MR) scan of the knee was recommended for the suspicious subjects for ultimate diagnosis. The subject with abnormal meniscus MR signals was defined as a case and matched with two controls in terms of age and body mass index (BMI). Altogether there were 273 cases and 546 controls. The nested case-control model was adopted to assess the risk of meniscus injury between variant exposures in practicing yoga and several other popular sports. Moreover, the 181 yoga subjects were subdivided into three groups according to different exercise durations, followed by further analysis with the variables of age, BMI and Lysholm score.</p><p><b>RESULTS</b>Yoga was found associated with a higher risk (P equal to 0.008, OR equal to 1.621) of meniscus injury compared with badminton, jogging and climbing hills. The three yoga subgroups showed statistical difference between each other in terms of Lysholm score (P equal to 0.027) and BMI (P equal to 0.003). The subjects with longer-term yoga practice had lighter weight but lower Lysholm scores.</p><p><b>CONCLUSIONS</b>Yoga perhaps exerts destructive impact on the meniscus for Chinese women, yet it needs further verifications. Furthermore, the female yoga players with longer exercise duration are more susceptible to meniscus injury though they can become leaner.</p>

A preliminary report of patellofemoral arthroplasty in isolated patellofemoral arthritis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Isolated patellofemoral osteoarthritis is not uncommon. Surgical treatment of isolated patellofemoral arthritis remains controversial and poses a challenging treatment dilemma. The present study aimed to evaluate the short-term results of patellofemoral arthroplasty for patients with isolated patellofemoral osteoarthritis.</p><p><b>METHODS</b>We analyzed 11 patellofemoral arthroplasties performed from March 2006 to September 2009 in 11 patients with isolated patellofemoral arthritis. The patients comprised 2 males and 9 females with an average age of 53.7 years (range, 46 - 74 years). Standard weightbearing radiographs were taken in the anteroposterior, lateral, and 45° axial views. The knee pain and functional status were evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scales and American Knee Society (AKS) scores. For comparison, 23 total knee arthroplasties in 23 patients with primary tibiofemoral osteoarthritis were matched according to age, gender, bilaterality and body mass index. The duration of follow-up was 23.7 months (range, 12 - 47 months).</p><p><b>RESULTS</b>The majority of the 11 patients experienced improvement in their patellofemoral symptoms after patellofemoral arthroplasty. The WOMAC scores improved considerably by 7.4 points with respect to pain and by 5.2 points with respect to function. The AKS scores also improved considerably by 23.9 points with respect to pain and 44.3 points with respect to function. Although the clinical outcomes after patellofemoral arthroplasty were not better than those after total knee arthroplasty, patellofemoral arthroplasty exhibited advantages in the shorter operation time, lower blood loss and increased postoperative range of motion. At the latest follow-up, there was no clinical or radiographic evidence of patellofemoral maltracking, loosening or wear.</p><p><b>CONCLUSIONS</b>On the basis of our experience in this relatively small series of patients with a short-term follow-up, patellofemoral arthroplasty is an effective treatment alternative to total knee arthroplasty in isolated patellofemoral arthritis. MRI and arthroscopy may contribute to define those patients with isolated patellofemoral degeneration.</p>

Combined use of extensively porous coated femoral components with onlay cortical strut allografts in revision of Vancouver B2 and B3 periprosthetic femoral fractures / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Periprosthetic femoral fractures following total hip arthroplasty are getting more prevalent. The aim of this study was to evaluate the clinical results of combined use of uncemented extensively porous coated femoral components with onlay cortical strut allografts in revision of Vancouver type B2 and B3 periprosthetic femoral fractures.</p><p><b>METHODS</b>Thirteen hips after total hip arthroplasty in 13 patients who suffered a Vancouver B2 or B3 periprosthetic fracture were treated with an uncemented extensively porous coated femoral component combined with onlay cortical strut allografts. Each patient was assigned a Harris hip score, and a visual analog scale (VAS) score for pain and satisfaction. Radiographs were examined for component stability, fracture site and allograft-host union and allograft reconstruction.</p><p><b>RESULTS</b>At an average of 5.3-year follow-up, no patient required repeat revision. The average Harris hip score was (71.8 +/- 6.3) points, the pain VAS score was (16.6 +/- 4.3) points, and the patient satisfaction VAS score was (81.5 +/- 5.7) points. Radiographic examination showed no detectable loosening of the prostheses, and 12 cases were presented fixation by osseointegration and the other one was stable fibrous ingrown fixation. All fractures united for (5.2 +/- 1.4) months in average. And all onlay strut allografts united to host bone for about (11.5 +/- 2.6) months.</p><p><b>CONCLUSIONS</b>Combined use of uncemented, long stemmed, extensively porous coated implant with cortical onlay strut allografts can achieve good clinic results and high rate of union for both fracture site and allograft-host bone junction. This technique could be used routinely to augment fixation and healing of Vancouver B2 and B3 periprosthetic fractures.</p>

Use of mid-vastus approach in less invasive primary total knee arthroplasty / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Total knee arthroplasties (TKR) combined with the concept of reduced trauma to tissue has been performed by many doctors. The aim of this study was to retrospectively assess the early results of a group of TKR with a mid-vastus approach, which was characterized as no patellar eversion, no disruption of suprapatellar pouch and extensor mechanism, and to compare the outcome with conventional operative techniques.</p><p><b>METHODS</b>A total of 59 patients (67 knees) were followed. All patients received the same prosthesis of Genesis II posterior-stabilized total knees. Of them, 29 consecutive patients (34 knees) had a mid-vastus approach and were operated on with less invasive instruments and techniques. The mean follow-up duration was 11.6 months. Clinical evaluations were performed according to the Hospital for Special Surgery scores; radiographic assessment followed the guidelines of the Knee Society. Postoperative recovery of quadriceps strength and the extensor mechanism was also evaluated.</p><p><b>RESULTS</b>No prosthetic loosening or anterior knee pain was found at the latest follow-up; 1 patient had a superficial infection and postoperative stiffness of the knee who undertook a debridement and manipulation several months later. The angulations of tibial osteotomy were within normal range. The average preoperative and postoperative Hospital for Special Surgery scores were 57.9 points and 86.1 points respectively. The mean postoperative range of motion was 113.5 degrees . Most patients regained their quadriceps strength at the third or fourth month postoperatively.</p><p><b>CONCLUSIONS</b>The overall early results from using the mid-vastus approach were comparable with that of using a standard approach, and the exposure did not affect the accuracy of the tibial cut. The muscle maximal contraction strength recovered gradually after operation. The approach was safe and patients of this group obtained satisfactory outcomes.</p>

Position of the prosthesis and the incidence of dislocation following total hip replacement / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Dislocation is the second most common complication of hip replacement surgery, and impact of the prosthesis is believed to be the fundamental reason. The present study employed Solidworks 2003 and MSC-Nastran software to analyze the three dimensional variables in order to investigate how to prevent dislocation following hip replacement surgery.</p><p><b>METHODS</b>Computed tomography (CT) imaging was used to collect femoral outline data and Solidworks 2003 software was used to construct the cup model with variabilities. Nastran software was used to evaluate dislocation at different prosthesis positions and different geometrical shapes. Three dimensional movement and results from finite element method were analyzed and the values of dislocation resistance index (DRI), range of motion to impingement (ROM-I), range of motion to dislocation (ROM-D) and peak resisting moment (PRM) were determined. Computer simulation was used to evaluate the range of motion of the hip joint at different prosthesis positions.</p><p><b>RESULTS</b>Finite element analysis showed: (1) Increasing the ratio of head/neck increased the ROM-I values and moderately increased ROM-D and PRM values. Increasing the head size significantly increased PRM and to some extent ROM-I and ROM-D values, which suggested that there would be a greater likelihood of dislocation. (2) Increasing the anteversion angle increased the ROM-I, ROM-D, PRM, energy required for dislocation (ENERGY-D) and DRI values, which would increase the stability of the joint. (3) As the chamber angle was increased, ROM-I, ROM-D, PRM, Energy-D and DRI values were increased, resulting in improved joint stability. Chamber angles exceeding 55 degrees resulted in increases in ROM-I and ROM-D values, but decreases in PRM, Energy-D, and DRI values, which, in turn, increased the likelihood of dislocation. (4) The cup, which was reduced posteriorly, reduced ROM-I values (2.1 -- 5.3 degrees ) and increased the DRI value (0.073). This suggested that the posterior high side had the effect of 10 degrees anteversion angle.</p><p><b>CONCLUSIONS</b>Increasing the head/neck ratio increases joint stability. Posterior high side reduced the range of motion of the joint but increased joint stability; Increasing the anteversion angle increases DRI values and thus improve joint stability; Increasing the chamber angle increases DRI values and improves joint stability. However, at angles exceeding 55 degrees , further increases in the chamber angle result in decreased DRI values and reduce the stability of the joint.</p>

Total knee replacement for posttraumatic degenerative arthritis of the knee / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the results of total knee arthroplasty (TKA) in patients with posttraumatic degenerative arthritis due to a previous fracture around the knee.</p><p><b>METHODS</b>We analyzed the results of 15 TKAs, performed from 1997 to 2003, in 15 patients with post-traumatic degenerative arthritis due to a previous fracture around knee. There were 3 women and 12 men with an average age of 58 years (range, 31-76 years). The time from fracture to arthroplasty averaged 8.2 years (range, 2-27 years). Internal fixation had previously been performed in 8 patients resulting in retained hardware. At the time of arthroplasty a femoral fracture malunion was present in two knees. Lateral retinacular release (4 knees), extensor mechanism realignment (1 knee) or medial collateral ligament reconstruction (1 knee) were needed at the time of arthroplasty.</p><p><b>RESULTS</b>Follow-up averaged 35 months (range, 12-73 months). No patient was lost for follow-up. According to the Knee Society Score scale, the mean preoperative knee score was 37 (range, 10-70) and functional score was 41 (range, 0-60). They were improved significantly to a mean of 84 (range, 10-100) and 76 (range, 20-100) points, respectively at the latest follow-up. The mean knee arc of motion were improved from 84 degree preoperation to 94 degree at the latest follow-up. Postoperative manipulation under anesthesia for poor motion was carried out in 4 knees. No knee had aseptic loosening that required subsequent revision. Two knees developed superficial infection and were treated with debridement. It subsequently recovered with the retention of components.</p><p><b>CONCLUSIONS</b>Significant improvement in function and relief of pain has been achieved in patients with previous fractures undergoing subsequent TKA. However, this procedure is technically demanding and patients are at increased risk for restricted motion and need more care following TKA. This study suggests that the outcome of TKA may be improved further by making special efforts to restore limb alignment, to ensure correct component positioning, and to manage soft tissue balance.</p>

Femoral component revision using extensively porous-coated cementless stem / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the clinical and radiographic results of extensively porous-coated femoral stem in revision of total hip arthroplasty (THA).</p><p><b>METHODS</b>From January 1999 to December 2003, fifteen hips of fifteen cases received revision of THA with extensively porous-coated femoral stem. There were six males and nine females. The average age was 66 years (ranging 58-82 years). The reason for the revision was aseptic loosening in 10 cases, septic loosening in 2, femoral shaft fracture around loose implant in 2, and femoral revision for malposition of the femoral component in 1. All the patients were clinically evaluated using Harris hip score and radiographically evaluated both preoperatively and postoperatively at regular follow-up intervals.</p><p><b>RESULTS</b>No patients were lost for follow-up. The average length of follow-up was 2.3 years (range, 1-5 years). The average preoperative Harris hip score was 42 points, which was improved to 89 points at latest follow-up. The latest follow-up showed that bone in-growth occurred in fourteen stems and solid fibrous fixation in one. Complications consisted of femoral shaft fracture in two cases (1 undisplaced distal femur fracture and 1 cortical perforation at the tip of the prosthesis), and postoperative dislocation in one. There was no mechanical failure of the stem in this study.</p><p><b>CONCLUSIONS</b>Satisfactory results of short-term clinical and radiographic follow-up have been achieved in using extensively porous-coated femoral stem for revision of THA. It should be noticed that the straight, 203 mm stem should be used with caution in short people.</p>

Treatment of ipsilateral hip and femoral shaft fractures with reconstructive intramedullary interlocking nail / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the results of reconstructive intramedullary interlocking nail in the treatment of ipsilateral hip and femoral shaft fractures.</p><p><b>METHODS</b>From August 1997 to November 2001, 13 patients were treated with the reconstructive intramedullary interlocking nail. Nine patients were associated with ipsilateral femoral neck fractures, three with ipsilateral intertrochanteric fractures, and one with subtrochanteric fracture.</p><p><b>RESULTS</b>The follow-up time was from 6 to 38 months with an average of 14 months. All the femoral shaft and hip fractures healed up well. There was no nonunion of the femoral neck, and only one varus malunion. No patient had avascular necrosis of the femoral head. The average healing time for femoral neck fracture was 4.6 months and for shaft fracture 5.8 months. The joint movement and other functions were fairly resumed.</p><p><b>CONCLUSIONS</b>The reconstructive intramedullary interlocking nail, with less trauma, reliable fixation, and high rate of fracture healing, is an ideal method of choice in the treatment of ipsilateral hip and femoral shaft fractures.</p>

Total hip arthroplasty with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the outcome of total hip arthroplasty (THA) with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis.</p><p><b>METHODS</b>Between 1995 and 2002, we implanted 23 cementless cups and femoral head autografts in 20 patients with hip dysplasia and osteoarthritis. In this study, a retrospective study was made on 21 hips in 20 patients (18 females and 2 males, aged 50 years on an average) with developmental hip dysplasia treated by THA with a cementless cup and femoral head autograft. The acetabular cup was placed at the level of the true acetabulum and all the patients required autogenous femoral head grafts due to acetabular deficiency. The average rate of the acetabular cup covered by the femoral head autograft was 31% (ranging from 10% to 45%). Eight hips had less than 25% cup coverage and thirteen between 25% and 50%. The average follow-up period was 4.7 years (range, 1-8 years). The replacing outcome was evaluated by modified Harris hip score. Preoperative and follow-up radiographs were made.</p><p><b>RESULTS</b>All the autografts were united to the host bones. No autograft was collapsed or no component from the hip was loosed in all the patients. According to the modified Harris hip score, the average hip score increased from 46 before operation to 89 at the final review. Before operation, the leg-length discrepancy was greater than 2 cm in all the patients except one with bilateral hip dysplasia. After operation, only 2 out of 20 patients had a leg-length discrepancy greater than 1 cm. Three hips showed minor bone resorption in the lateral portion of the graft, which did not support the cup. Three hips developed Grade 1 Brooker heterotopic ossification and one developed Grade 2.</p><p><b>CONCLUSIONS</b>THA with a cementless cup and a femoral head autograft for patients with osteoarthritis resulted from hip dysplasia can result in favorable outcomes. This method can provide reliable acetabular fixation and restore the acetabular bone stock in patients with developmental hip dysplasia when the cementless cup covered by the graft does not exceed 50%.</p>

A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To observe the long-term outcome of high tibial osteotomy (HTO) in treating medial compartment osteoarthrosis of knees.</p><p><b>METHODS</b>A retrospective study was carried out on 194 patients (215 knees) treated with HTO for medial compartment osteoarthritis at the Orthopaedic Hospital of Kiel University between 1985 and 1996.</p><p><b>RESULTS</b>One hundred and sixty-one knees (144 patients) were followed up for 1.5-12 years with an average of 7.5 years and their data were reviewed. The proportion of excellent outcome were 97.3%, 93.6% and 78.2% two, five and over five years after HTO, respectively. The revision rate of total knee arthroplasty (TKA) was 11.8% (19 knees retreated with TKA for HTO failure). The survivorship analysis of the 19 knees retreated with TKA showed an expected survival rate of 98.7%, 95.0% and 84.1% 2, 5 and 10 years after HTO, respectively. There were 5.6% complications (12/161), including five superficial wound infections, one deep infection, five delayed bone healing, and one peroneal nerve palsy. Fifty patients (54 knees) missed follow-up, among them 10 patients (11 knees) died.</p><p><b>CONCLUSIONS</b>HTO is an effective method in treating medial compartment osteoarthritis with a varus knee. Appropriate overcorrection of femorotibial alignment is the key for the success of the operation. But as the long-term effect is concerned, there is a trend of deterioration and some of the patients may have a second operation of revision with TKA.</p>

A long-term follow-up study of high tibial osteotomy in medial compartment osteoarthrosis / 中华外科杂志

<p><b>OBJECTIVE</b>To observe long-term outcome of high tibial osteotomy (HTO) in treating the medial compartment osteoarthrosis of the knee.</p><p><b>METHODS</b>A retrospective study was made between 1985 and 1996, of 194 patients (215 knees) who had HTO in medial compartment osteoarthritis at the Orthopaedic Hospital of Kiel University.</p><p><b>RESULTS</b>One hundred and sixty-one knees were reviewed at an average follow-up of 7.5 years (range, 1.5 - 12 years). 97.3% good and excellent results up to two years postoperatively; 93.6% good and excellent results up to five years postoperatively; at over five years, 78.2% good and excellent. Nineteen (11.8%) knees had required conversion of their HTO to a total knee arthroplasty (TKA). The survive rate of HTO taking as TKA as an end point is 98.7% in 2 years; 95.0%, 5 years and 84.1%, 10 years.</p><p><b>CONCLUSIONS</b>We believe that the high tibial osteotomy is one of good methods in treating the medial compartment osteoarthritis of the knee, overcorrection the femorotibial alignment is the key step of the operation. Postoperatively, there is a trend of the results to get worse with time and a part of the patients had been revised to total knee arthroplasty because of a poor result.</p>

Total hip arthroplasty with uncemented cup and femoral head autografts for coxarthrosis due to dysplasia / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the outcomes of total hip arthroplasty (THA) for coxarthrosis due to dysplasia with acetabular reconstruction of an uncemented cup in conjunction with a femoral head autograft.</p><p><b>METHODS</b>A retrospective study was made on 21 hips in 20 patients (18 female and 2 male; average age, 50 years) with developmental hip dysplasia treated by THA with use of an uncemented cup. The acetabular cup was placed at the level of the true acetabulum; all patients required autogenous femoral head grafts due to acetabular deficiency. The average coverage of the acetabular cup by the femoral head autograft was 31% (range, 10% to 45%). Eight hips had less than 25% cup coverage and 13 between 25% and 50%. The average follow-up period was 4.7 years (range, 1-8 years). All patients were evaluated with the use of a modified Harris hip score. Radiographic evaluations were made by preoperative and follow-up.</p><p><b>RESULTS</b>All autografts were seen to be united to host-bone. No collapse of the autograft and no hip had the evidence of loosening of component seen in all patients. According to the modified Harris hip score, the average hip score increased from 46 at preoperation to 89 at the final review. Preoperative leg-length discrepancy was greater than 2 cm seen in all except 1 patient with bilateral hip dysplasia. After surgery, only 2 of 20 patients still had a leg-length discrepancy greater than 1 cm. Three hips showed minor resorption in the lateral portion of the graft which was not supporting the cup. Three hips developed grade 1 Brooker heterotopic ossification and one had grade 2.</p><p><b>CONCLUSIONS</b>THA with an uncemented cup in conjunction with a femoral head autograft for coxarthrosis due to dysplasia could obtain favorable results. This method could provide reliable acetabular fixation and appeared to restore acetabular bone stock in patients with developmental hip dysplasia when the coverage of the cementless cup by the graft does not exceed 50%.</p>

Effect of dehydroepiandrosterone on experimental osteoarthritis in rabbits / 中华风湿病学杂志

Objective To observe the effect of intra-articular injection of dehydroepiandrosterone (DHEA)on the experimental osteoarthritis in rabbits and study the mechanism.Methods Forty rabbits un derwent unilateral anterior cruciate ligament transection(ACLT)and then divided into two groups randomly. 100?mol/L DHEA resolved in the dimethylsulphoxide were injected into the knees of experimental rabbits 4 weeks after transection,once a week for five weeks.Rabbits in the control group were treated under the same schedule using dimethylsulphoxide.All rabbits were killed 9 weeks after ACLT and the knee joints were evalu- ated by gross morphology and histology.The mRNA expression of metalloproteinases-3(MMP-3),tissue in- hibitor of metalloproteinases-1(TIMP-1)and interleukin-lbeta(IL-1?)in the cartilage and synovium was analyzed using reverse transcription polymerase chain reaction(RT-PCR).Results Gross morphologic in- spection and histological evaluation showed that the extent and grade of cartilage and synovium damage in the experimental group were less severe than the control group.The mRNA expression of MMP-3 in cartilage and synovium decreased significantly in the experimental group(both P＜0.05).The mRNA expression of TIMP-1 in cartilage and synovium increased significantly in the experimental group compared with that in the control group(both P＜0.05).No significant difference of IL-1?mRNA expression in cartilage was found between the experimental and the control groups(P＞0.05).The mRNA expression of IL-1?in the synovium was signifi- cantly suppressed in the experimental group compared with that in the control group(P＜0.01).Conclusion DHEA protects against cartilage degradation,alleviates synovium inflammation and inhibits the progression of osteoarthritis in the experimental model.Down-regulation of MMP-3 and up-regulation of TIMP-1 in cartilage and synovium and IL-1?in the synovium may be the mechanism of the protective effect of DHEA on os- teoarthritis.

Treatment of comminuted trochanteric fractures and non-union of trochanteric osteotomy in revision total hip arthroplasty / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the clinical efficacy of the treatment of comminuted trochanteric fractures and trochanteric osteotomy non-union in revision total hip arthroplasty with tension-band fixation.</p><p><b>METHODS</b>A retrospective review of 295 revision total hip operations performed between 1992 and 1998 was undertaken. Twenty hips of 19 patients with comminuted fractures or nonunion of the greater trochanter were stabilized with tension band technique. Multiple 2.0 mm k-wires and tension-band wires were placed through the intact cortex distally and the abductor tendon proximally in the pattern "8".</p><p><b>RESULTS</b>The average follow-up was 30 months. The Harris Hip Score improved on average from 45 preoperatively to 89 at follow-up. Sixteen hips with intra-operative trochanteric fracture through osteolytic bone and four hips with symptomatic trochanteric nonunion were approached with tension band fixation. Perioperative loss of fixation in one patient required a repeated surgery. The same fixation at the second operation achieved an uneventful healing. Two patients had a 2 cm proximal migration of one K-wire without loss of bony fixation. The trochanteric fractures healed with no further proximal wire migration. One patient had loss of fixation with trochanteric escape at 6 weeks post-operatively. The patient has abductor weakness with Trendleburg limp but without pain. On average, radiographic examination showed that healing occurred at 16.6 weeks postoperatively. Six patients developed grade 1 heterotopic ossification and two patients grade 3. All were asymptomatic. None of the 19 patients experienced a dislocation during the follow-up.</p><p><b>CONCLUSIONS</b>Tension-band fixation for greater trochanter can enhance the success rate of revision total hip arthroplasty without a deficient abductor mechanism.</p>