ABSTRACT
Objective@#To investigate the clinical effects of primary revision after artificial hip replacement and causes of revision surgery.@*Methods@#A total of 344 patients who underwent revision surgery after total hip arthroplasty (THA) and artificial femoral head replacement from January 2010 to December 2016 were retrospectively analyzed. There were 141 males and 203 fe-males, with a mean age 65.64±10.81 years (28-87 years). A total of 351 hip revisions were performed in 344 patients with 7 pa-tients in bilateral revisions. All patients were followed up for 60.38±22.75 months (24-105 months). All patients with periprosthet-ic infection underwent two-stage revision after prosthesis placement, and all others underwent one-stage revision. The clinical out-comes of revision surgery were assessed with the Harris hip score and the survival rate of the revision prosthesis. According to the duration from artificial hip replacement to revision surgery, all patients were divided into early revision (less than 5 years) and late revision (more than 5 years) groups. They were also divided into two groups according to the age of the patient in revision sur-gery: >55-year-old and ≤55-year-old groups. The causes of revision, hip reoperation and re-revision were recorded.@*Results@#In the 351 hip revisions, a total of 238 (67.8%) had aseptic loosening, 41 (11.7%) periprosthetic fractures, 30 (8.5%) periprosthetic infection, 23 (6.6%) recurrent dislocation and 19 (5.4%) the eccentric liner wear. The infection rate was significantly higher in the early revision group (21.1%) than that in the late revision group (4.2%) (χ2=24.443, P<0.001). The aseptic loosening rate was sig-nificantly higher in the late revision group (72.4%) than that in the early revision group (54.4%) (χ2=9.899, P=0.002). Sixteen pa-tients underwent hip surgery after revision, including 6 recurrent dislocations, 4 aseptic loosening, 3 periprosthetic fractures, and 3 periprosthetic infections. Eight of them underwent revision surgery, including 4 cases of aseptic loosening, 2 cases of periprosthet-ic fractures, and 2 cases of recurrent dislocation. The duration from the primary revision to the second revision was 22.1±10.0 months (1-75 months). The 5-year and 8-year survival rates of the revision prostheses were 99.3%[95%CI(98.3%, 100.3%)] and 92.6% [95%CI(87.1%, 98.1%)], respectively. The proportions of prosthetic infection and eccentric liner wear in the ≤55-year-old group were significantly higher than those in the >55-year-old group (χ2=3.981, P=0.046; χ2=5.226, P=0.022), while the propor-tion of aseptic loosening in the >55-year-old group was significantly higher than that in the ≤55-year-old group (χ2=5.254, P=0.022). The 8-year survival rates of the revision prostheses of ≤55-year-old group and >55-year-old group were 76.8% [95%CI(50.5%, 103.1%)] and 95.4% [95%CI(91.1%, 99.7%)], respectively.@*Conclusion@#Young patients have a higher risk of re-revi-sion after revision THA.
ABSTRACT
Objective To investigate the clinical effects of primary revision after artificial hip replacement and causes of revision surgery. Methods A total of 344 patients who underwent revision surgery after total hip arthroplasty (THA) and artificial femoral head replacement from January 2010 to December 2016 were retrospectively analyzed. There were 141 males and 203 fe?males, with a mean age 65.64±10.81 years (28-87 years). A total of 351 hip revisions were performed in 344 patients with 7 pa?tients in bilateral revisions. All patients were followed up for 60.38±22.75 months (24-105 months). All patients with periprosthet?ic infection underwent two?stage revision after prosthesis placement, and all others underwent one?stage revision. The clinical out?comes of revision surgery were assessed with the Harris hip score and the survival rate of the revision prosthesis. According to the duration from artificial hip replacement to revision surgery, all patients were divided into early revision (less than 5 years) and late revision (more than 5 years) groups. They were also divided into two groups according to the age of the patient in revision sur?gery:＞55?year?old and≤55?year?old groups. The causes of revision, hip reoperation and re?revision were recorded. Results In the 351 hip revisions, a total of 238 (67.8%) had aseptic loosening, 41 (11.7%) periprosthetic fractures, 30 (8.5%) periprosthetic infection, 23 (6.6%) recurrent dislocation and 19 (5.4%) the eccentric liner wear. The infection rate was significantly higher in the early revision group (21.1%) than that in the late revision group (4.2%) (χ2=24.443, P＜0.001). The aseptic loosening rate was sig?nificantly higher in the late revision group (72.4%) than that in the early revision group (54.4%) (χ2=9.899, P=0.002). Sixteen pa?tients underwent hip surgery after revision, including 6 recurrent dislocations, 4 aseptic loosening, 3 periprosthetic fractures, and 3 periprosthetic infections. Eight of them underwent revision surgery, including 4 cases of aseptic loosening, 2 cases of periprosthet? ic fractures, and 2 cases of recurrent dislocation. The duration from the primary revision to the second revision was 22.1 ± 10.0 months (1-75 months). The 5?year and 8?year survival rates of the revision prostheses were 99.3%[95% CI(98.3%, 100.3%)] and 92.6% [95% CI(87.1%, 98.1%)], respectively. The proportions of prosthetic infection and eccentric liner wear in the≤55?year?old group were significantly higher than those in the＞55?year?old group (χ2=3.981, P=0.046; χ2=5.226, P=0.022), while the propor?tion of aseptic loosening in the＞55?year?old group was significantly higher than that in the ≤55?year?old group (χ2=5.254, P=0.022). The 8?year survival rates of the revision prostheses of ≤55?year?old group and＞55?year?old group were 76.8% [95% CI (50.5% , 103.1% )] and 95.4% [95% CI (91.1% , 99.7% )], respectively. Conclusion Young patients have a higher risk of re?revi?sion after revision THA.
ABSTRACT
Objective To investigate the effect of overexpression of cartilage oligomeric matrix protein (COMP) on BMP-2 induced cell osteogenic and chondrogenic differentiation of mesenchymal stem cells (MSCs).Methods MSCs,transfected with plasmid DNA encoding recombinant human COMP,were induced to differentiate into osteocytes and chondrocytes by BMP-2.Realtime PCR of osteogenic related markers (Col1a1,RUNX2,OPN,BGP) and chondrogenic related markers (Col2a1,SOX9,Aggrecan) were performed to evaluate the process of cell differentiation.ALP staining,Alizarin red S staining for osteogenic differentiation and alcian blue staining for chandrogenic differentiation were conducted to evaluate the tendency of cell differentiation.Results Real-time PCR assay presented the significantly higher (P＜0.05) COMP expression of MSCs when COMP gene was transfected into cells.The expression level of OPN was significantly (P＜0.05) down-regulated at all the time points in experimental group compared with that in control group.A final significant (P＜0.05) up-regulation of expression appeared in experimental group at the late stage of induction (day 7,14) compared with that in control group,even though a decrease (P＜0.05) expression of Col1a1,RUNX2 and BGP in experimental group occurred at the early stage of induction (day 3).The expression of Aggrecan and Col2a1 in experimental group was up-regulated (P＜0.05) at different time points compared with that in control group.And a significant higher (P＜0.05) expression of SOX9 in experimental group only appeared at day 7 compared with that in control group.ALP staining and Alizarin red S staining were weakened while alcian blue staining was enhanced.Conclusion COMP may inhibit BMP-2 induced osteogenic differentiation and promote BMP-2 induced chondrogenic differentiation,which may provide new insight for cartilage tissue engineering.