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 and clinical efficacy of total knee arthroplasty for osteoarthritis patients with Parkinson's disease / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical efficacy and experience of total knee arthroplasty in treating knee osteoarthritis patients with Parkinson's disease.</p><p><b>METHODS</b>From January 2011 to January 2014, 19 knee osteoarthritis patients with Parkinson's disease treated with total knee arthroplasty were collected. Among them, including 9 males and 10 females aged from 61 to 83 years old with an average of 71.3 years old. Radiology results were checked before and after operation. VAS score and KSS score were applied to evaluate clinical effects. Patients were classified according to HoehnYahr grade, 3 cases in grade 1, 4 cases in grade 1.5, 2 cases in grade 2, 4 cases in grade 2.5, 2 cases in grade 3 and 1 case in grade 4.</p><p><b>RESULTS</b>Nineteen patients were followed up from 3 to 7 years with an average of 4.3 years. The pain of patients was significantly reduced or disappeared. All incisions were healed at stage I. At the latest follow-up, 3 patients had knee pain, and mild pain in 1 patient, moderate in 1 patient without severe pain. VAS score was reduced from preoperative 8.4±1.3 to the latest follow-up 3.1±1.2, the difference was statistically significant (0.05). KSS score improved from 43.6±7.3 before operation to 91.8±10.6 after operation. The condition of Parkinson's were controlled by medicine. No loosening and subsidence of prosthesis by X-ray examination.</p><p><b>CONCLUSIONS</b>Total knee arthroplasty is a safe and effective method for the treatment of Parkinson's disease and has satisfactory mid-term clinical effect.</p>

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>

Efficacy analysis on hip replacement for hip-joint diseases with Parkinson disease / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical efficacy of hip replacement for hip-joint diseases with Parkinson disease.</p><p><b>METHODS</b>From December 2011 to December 2016, 18 patients with hip-joint diseases with Parkinson disease treated by hip replacement, including 8 males and 10 females aged from 59 to 87 years old with an average of 71 years old. Among them, 3 cases were developmental dysplasia of hip, 3 cases were femoral head necrosis and 12 cases were femoral neck fracture. All patients manifested with obvious pain and limitation of stepping ability. Postoperative complications were observed and Harris score were used to compare hip joint function after operation.</p><p><b>RESULTS</b>The incision were healed well, and pain were alleviated or disappeared, and hip joint function were improved. Eighteen patients were followed up from 1 to 3 years with an average of 2.3 years. At the latest follow up, 14 cases recovered freedom-walk, 2 cases could walk with walking stick, 1 case could walk with walking aid and 1 case was died. Among 18 patients, 2 cases were occurred dislocation, and 1 case were died for cardiac disease at 3 months after operation. Four patients were occurred slight pain. There were significant differences in Harris scores among preoperative (41.7±1.4), 6 months after operation(80.1±5.4) and the final follow-up (83.4±2.1), and 10 cases got excellent result, 4 good, 1 fair and 2 poor.</p><p><b>CONCLUSIONS</b>Application of hip replacement for hip-joint diseases with Parkinson disease is a safe and effective clinical therapy, and has advantages of less complications and rapid recovery of hip joint function.</p>

Study on biomechanical stability in simulated femoral neck fracture fixation by two cannulated screws / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the stability of internal fixation for femoral neck fracture(FNF) using two or three cannulated screws directed to different fracture lines, and to provide a theoretical basis for the clinical decision making.</p><p><b>METHODS</b>Fifteen fresh frozen human femur samples were selected and the FNF model was established with Pauwels angle of 30°, 50° and 70° respectively. The models were fixed with three or two cannulated screws, and their differences at tensile strength, subsidence, shear strength and composite displacement, gap distance, torsional angle and stiffness values of four types of femur were evaluated to identify their biomechanical stability.</p><p><b>RESULTS</b>With Pauwels angle of 30° and 50°, no statistical differences at the referenced outcomes were observed between two and three cannulated screw fixation for FNF(>0.05). With the Pauwels angle of 70 °, three cannulated screws fixation were significantly superior to two cannulated screws fixation for FNF(<0.05). Nevertheless, when Pauwels angle was 70°, three cannulated screws fixation turned out to be relative instable compared with Pauwels angle of 30° and 50°.</p><p><b>CONCLUSIONS</b>With Pauwels angle of 30° and 50°, two cannulated screws fixation was similarly stable as using three cannulated screws for FNF. Three cannulated screws fixation were obviously superior to two cannulated screws fixation when Pauwels angle was 70°, but the application of three cannulated screws could still be insufficiently stable when only such routine fixations were utilized. Therefore, Angle Stabilizing System or anti-sliding screws were needed to enhance the stability of FNF fixation.</p>

Biomechanical research on upper femur with vertical and bending stress / 中国骨伤

<p><b>OBJECTIVE</b>To study the bone state with ultimate stress by examining biomechanical distribution of upper femur in Chinese, in order to accumulate more experiences for clinical work.</p><p><b>METHODS</b>Totally 60 Chinese femurs from fresh cadavers were randomly divided into two groups. All the femurs were cleaned, and the body age ranged from 36 to 72 years old, averaged 56.4 years, including 41 from males, and 19 from females. These two groups underwent mechanical stress and bending stress tests. Special mechanical laboratory and machines were used to get the information. Results about the loading value at each testing point under stress were collected.</p><p><b>RESULTS</b>The four faces of the upper femur suffered different stress under external forces. The bone on upper femur can tolerate more mechanical stress than bending stress. Medial and lateral region of the femur neck and the rear side of the small tuberosity section were themain position enduring the vertical stress. The rear position of the base femur neck and the small tuberosity section were the main regions enduring the bending stress. Those main positions had strong cancellous bones. The intertrochanteric fracture fixation and artificial femoral stems were designed depending on this biomechanical basis.</p><p><b>CONCLUSION</b>According to our experiment result, doctors need to chose more effective fixations for upper femur fracture, and femoral stems for the patients. More information should be collected by further researches.</p>

Analysis on morphology and stability of femoral hip prosthesis based on the revision operation / 中国骨伤

<p><b>OBJECTIVE</b>According to the information obtained from the revision of total hip arthroplasty, the situations of the artificial femoral stem under physiological stress were analyzed preliminarily. In order to accumulate clinical experience, the discussions about how to enlongate the life of artifical joints were performed.</p><p><b>METHODS</b>Fifty-three patients required revision operations were selected, including 28 males and 25 females,with an average age of 74.66 years old (61 to 84 years old). The average life of artificial joints was 18.24 years (3 to 27 years). The initial weightbearing was started 11 days (5 to 16 days) after the first operation. The main reasons for the revision were the spontaneous loosening and trauma. Based on imaging and surgical findings, as well as the histological pathology, the situations of the stems in human bodies were determined.</p><p><b>RESULTS</b>Femoral prosthesis would sink under physiological stress. The design of femoral stems, motion of patients', and bone growth determined the secondary stability. Straight stems were helpful for physiological subsidence of prosthesis, achieving the stability with close bone-implant contact by bone growth,which allowed the patient to do early landing exercise. The collared prosthesis and prosthesis combined with internal fixation limited the subsidence of femoral stems. Their stability depends on the time of initial placement and the bone growth for supporting. Delaying the inital weightbearing was suggested for patients with these protheses.</p><p><b>CONCLUSION</b>According to the actual situation of the patients, the appropriate chosen of femoral stems and time to perform the weightbearing can extend the life of the femoral prosthesis.</p>

Selective COX-2 inhibitor versus nonselective COX-1 and COX-2 inhibitor in the prevention of heterotopic ossification after total hip arthroplasty: a meta-analysis of randomised trials / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical efficiency of selective cyclo-oxygenase-2 (COX-2) inhibitor compared to traditional nonselective NSAIDs for the prevention of heterotopic ossification (HO) after total hip arthroplasty (THA).</p><p><b>METHODS</b>By searching Medline, Embase, CENTRAL (Cochrane Central Register of Controlled Trials) and Science Citation Index et al, only randomised controlled studies of selective COX-2 inhibitors VS nonselective COX-1 and COX-2 inhibitors for the prevention of HO after THA were included. The quality assessment of included studies was evaluated according to the standard of the Cochrane Collaboration, and the data were analysised by statistic software Stata 10.0. The HO incidence of both groups in different degrees was compared.</p><p><b>RESULTS</b>Four eligible randomised controlled trials of totally 808 patients were included. Meta-analysis results showed that no statistically significant difference was found in overall incidence of HO (RR = 1.08, 95% CI: 0.71-1.64,P = 0.73), incidence of moderate severe HO (Brooker II and III) (RR = 0.83, 95% CI: 0.48-1.42, P = 0.49) and any grade of Brooker classification between two groups. In all included studies, 16 patients receiving nonselective COX inhibitor (4.4%) discontinued treatment because of gastrointestinal toxicity,whereas 10 patients in the selective COX-2 inhibitor group (2.7%) discontinued for gastrointestinal side effects.</p><p><b>CONCLUSION</b>The selective COX-2 inhibitors are as equally effective as nonselective NSAIDs for the prevention of HO after THA. Considering the side effects of nonselective NSAIDs, selective COX-2 inhibitors were recommend for the prevention of HO after THA.</p>

Total hip arthroplasty for crowe type IV developmental dysplasia of the hip with S-ROM prosthesis / 中国骨伤

<p><b>OBJECTIVE</b>To develop the techniques of total hip arthroplasty(THA) for Crowe type IV developmental dysplasia of the hip (DDH) with S-ROM prosthesis,and to assess its clinical results.</p><p><b>METHODS</b>From October 2000 to October 2011,30 patients (36 hips) with Crowe type IV DDH underwent THA,including 6 patients with bilateral hip involved and 24 patients with unilateral. S-ROM prosthesis was adopted together with subtrochanteric transverse osteotomy. All the cementless acetabular cups were placed at the original anatomic location. The threaded cups were put in or near the level of the true acetabulum in all patients. Full coating stems were used in femoral side. All the patients were evaluated by using the Modified Harris Hip Score. Radiographic evaluations were made preoperatively and during follow-up.</p><p><b>RESULTS</b>Two patients lost of follow-up. Twenty-seven patients with 32 hips were followed up,and the average duration was 48 months (ranging from 7 to 84 months). There was 1 patient with bilateral THA died from hemorrhagic shock. Two patients could walk freely with the visible fracture lines at 12th and 18th months postoperatively. There were no complications such as infection or nerve injuries. Modified Harris Hip Score improved from preoperative 41.7+/-3.7 to postoperative 89.1+/-2.9. There was no acetabular or femoral component revision because of mal-position or loosening of the prostheses in all patients. Postoperative X-ray showed that all the prostheses in place,good integration between acetabular cups,femoral prosthesis and host bone without loosening. All bone grafts were integrated. All the hips acquired union of osteotomy and bone in-growth. None of the patients had radiographic evidence of aseptic loosening of prosthesis.</p><p><b>CONCLUSION</b>For the complex DDH, follow methods should be used to improve therapeutic effects:good exposure of the true acetabulum,deepen acetabulum, femoral shortening, oblique osteotomy, using the S-ROM prosthesis.</p>

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>

Pure alumina bearings with cementless stems versus sandwich bearings with cemented stems in total hip arthroplasty / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Ceramic bearing surfaces have been introduced to prevent osteolysis after total hip arthroplasty (THA), but little is known about the difference in clinical and radiological results between pure alumina and sandwich alumina bearings. The purpose of this study was to analyze the results obtained with third-generation alumina-on-alumina THA with two different designs both in liner and femoral stem fixation after a minimum follow-up of 4.2 years.</p><p><b>METHODS</b>The results of 195 primary alumina-on-alumina THAs in 167 patients were evaluated. The procedures were performed between January 1998 and October 2006. Three patients died and 11 patients were lost to follow-up, leaving a total of 153 patients (181 hips) available for study. In the 88 group A patients, 107 hips were implanted using pure alumina bearings with cementless femoral stems. These patients were followed for (6.84 ± 1.49) years. In the 65 group B patients, 74 hips were implanted using sandwich alumina ceramic bearings with cemented femoral stems. These patients had a follow-up period of (7.73 ± 1.60) years. Patients in both groups were evaluated clinically and radiographically.</p><p><b>RESULTS</b>One ceramic liner fracture occurred in group A and five took place in group B (P < 0.05), four of them revised for liner fracture. In each group, one acetabular shell migration happened without liner breakage and two hips developed deep infections, and all these six hips received revisions. Nine femoral components loosened in group B, with seven undergoing revisions. Kaplan-Meier survivorship at 5 years for revision of any component for any reason in group A was 96.26% compared to 90.54% in group B (P < 0.05). Better function was determined in group A (average Harris hip scores: 92.13 ± 2.85) than in group B (average Harris hip scores: 86.03 ± 4.21) and the difference was significant (P < 0.05). Squeaking was not recorded in either group.</p><p><b>CONCLUSIONS</b>The sandwich design of the acetabular bearings can not reduce the migration rate in ceramic bearings but increase the liner fracture rate compared to pure ceramic liners. The high loosening rate in fluted and taped designed cemented stems with sandwich liners warrant caution to their use.</p>

High throughout proteomic analysis of non-traumatic osteonecrosis of the femoral head / 中国骨伤

<p><b>OBJECTIVE</b>To explore proteins associated with non-traumatic osteonecrosis of the femoral head in adults by using high throughput proteomic approach.</p><p><b>METHODS</b>From July 2008 to February 2009, 10 patients with non-traumatic osteonecrosis of the femoral head (7 males, 3 females) and 10 patients with fresh femoral head fracture (5 males, 5 females) who underwent total hip arthroplasty were enrolled randomizedly in the study. The median age was 52 years and 63 years respectively. Necrotic bone tissues were harvested as experimental group from the femoral head of patients with osteonecrosis of the femoral head, and normal bone tissues were collected as the control group from the patients with femoral head fracture. After bone tissues were demineralized, total bone proteins were extracted sequentially by using four different lysis buffers. Thereafter, SDS-PAGE, in-gel digestion and subsequent multi-dimensional liquid chromatography-tandem mass spectrometry (MDLC-MS/MS) were applied to separate and identify the extracted proteins. Different expression level of the proteins in both groups was investigated by TPP software,and different expression protein analysis was then carried out by Turbo SEQUEST. Western blot was applied finally to evaluate the accuracy of mass spectrometry.</p><p><b>RESULTS</b>The in-depth proteome analysis in experimental and control groups revealed 1 233 and 999 high-confidence proteins with two or more peptides respectively,and the false-positive rate was 0.8%. In total, 192 differentially expressed proteins were identified in experimental samples. At compared with the control, 107 and 53 proteins were identified with the level upregulated and downregulated at least 3 folds respectively. Among them, 34 proteins were found highly associated with osteonecrosis of the femoral head. Downregulated expression of GPCR26 and CHST2, similar with results of mass spectrometry analysis,were confirmed by Western blot in the necrotic bone tissues.</p><p><b>CONCLUSION</b>The pathogenesis of the non-traumatic osteonecrosis of the femoral head has been demonstrated a complicated process and remained unknown. These identified differentially expressed proteins might be promising biomarker candidates for early diagnosis of the devastating disease. This study sheds new light on novel approach to understand the pathogenesis of osteonecrosis of the femoral head.</p>

S-ROM modular arthroplasty combined with transverse subtrochanteric shortening for Crowe type IV congenital dislocation of hip / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This work was carried out to evaluate the clinical efficacy and the complications of S-ROM modular hip arthroplasty combined with transverse subtrochanteric shortening for Crowe type IV congenital dislocation of the hip (CDH).</p><p><b>METHODS</b>A total of 28 consecutive patients with Crowe type IV CDH received treatment using this surgical technique from June 2003 to June 2010. The follow-up was conducted at 3 days, 1, 6, and 12 months after the operation and later annually at the outpatient of our hospital. Sequential pelvic plain film and normotopia film of the affected hip joint were taken. The limp and the Trendelenburg sign were also assessed, the ischiadic nerve injury was also evaluated by electromyogram, and Harris hip scores were recorded.</p><p><b>RESULTS</b>After operation, both the alignment and the position of the transverse osteotomies were good. None of the patients had presented complications of joint infection, prosthesis loosening, joint dislocation, or nerve injury.</p><p><b>CONCLUSIONS</b>S-ROM modular hip arthroplasty combined with transverse subtrochanteric shortening was a satisfactory and safe technique for the Crowe type IV congenital hip dislocation within a mean follow up of 53 months. Transverse subtrochanteric shortening could effectively prevent the distraction injury of sciatic nerve.</p>

Treatment of femoral neck fractures after the fixation of ipsilateral femoral shaft by antegrade intramedullary nail / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the treatment of femoral neck fractures after the fixation of ipsilateral femoral shaft fracture by antegrade intramedullary nail.</p><p><b>METHODS</b>A retrospective study on 12 patients with femoral neck fractures after the fixation of ipsilateral femoral shaft fracture by antegrade intramedullary nail, which were identified intraoperatively or postoperatively from January 2000 to January 2010. All the patients were treated with 2 supplemental screws placed anteriorly and posteriorly to intramedullary nail seperately. All the patients were periodic followed-up, fractures union and functional recovery were evaluated.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 10 to 36 months (averaged 16.5 months). The mean healing time was 3.6 months in femoral neck fractures and 5.4 months in femoral shaft fractures. No osteonecrosis of femoral head was found. According to Harris scoring system for hip function, 7 patients got an excellent result, 3 good, 2 fair.</p><p><b>CONCLUSION</b>Treatment of femoral neck after the fixation of ipsilateral femoral shaft by antegrade intramedullary nail with 2 screws placed anteriorly and posteriorly to intramedullary nail separately is feasible, and has the advantages of reliable fixation, less trauma and high rate of fracture healing.</p>

Comparison of minimally invasive surgery and mini-incision technique for total hip arthroplasty: a sub-group meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It is well accepted that the minimally invasive surgery (MIS) for total hip arthroplasty (THA) should combine with less or no muscle damage and is different from mini-incision technique and MIS should have better outcomes than mini-incision surgery. The aim of current analysis was to apply an explicitly defined sub-group analysis to confirm whether this hypothesis is true.</p><p><b>METHODS</b>A computerized literature search was applied to find any data concerning MIS or mini-incision THAs. A multistage screening was then performed to identify randomized studies fulfilling the inclusive criteria for the analysis. The data were extracted, and sub-group analyses of MIS or mini-incision surgery for different kinds of outcomes were carried out. The P(sub) value for difference between MIS sub-group and mini-incision sub-group was also calculated.</p><p><b>RESULTS</b>Eleven studies that fulfilling the inclusion criteria were included, with 472 cases in the study group (MIS or mini-incision) and 492 cases in the conventional group. The overall analysis showed the study group would achieve less surgical duration (P = 0.037), intraoperative blood (P < 0.001) and incision length (P < 0.001) than conventional group. The difference between sub-groups showed, the MIS would achieve shorter incision length (P(sub) < 0.05) and bigger cup abduction angle (P(sub) < 0.05), and cause more blood loss (P (sub) < 0.05) than mini-incision technique. Other indexes were comparable between the two sub-groups.</p><p><b>CONCLUSIONS</b>Though further high quality studies are still needed, the result of current analysis offered an initial conclusion that MIS THA failed to achieve a better clinical outcome than mini-incision technique. The exact definition of MIS still needs to be improved.</p>

Study on the correlation between knee osteoarthritis imaging and effects of arthroscope / 中国骨伤

<p><b>OBJECTIVE</b>To explore the indications of arthroscope for the treatment of knee osteoarthritis and investigate the correlation between knee osteoarthritis imaging and effects of arthroscope.</p><p><b>METHODS</b>From 2005.8 to 2008.4, 86 patients with knee osteoarthritis underwent arthroscope examination and treatment. Among the patients, 44 patients were male, and 42 patients were female, ranging in age from 46 to 67 years, averaged 56.3 years. Arthrodial cartilage of knee was graded by ICRS MR, and by Kellgern Laqrence X-ray. All the patients were followed up, and the duration ranged from 12 to 30 months. The Lysholm score was evaluated at the follow-up time.</p><p><b>RESULTS</b>Among 86 knees in 86 cases, cartilage injury degree of knees was graded as follows: grade 4 in 30 cases, grade 3 in 22 cases, grade 2 in 20 cases, grade 1 in 12 cases, grade 0 in 2 cases, mean grade (2.77 +/- 1.138). Postoperative Lysholm score ranged from 59 to 100, averaged (95.17 +/- 7.556), Kendall's correlation coefficient was -0.089, P = 0.317. There was no correlations between cartilage injury degree and Lysholm score. X-ray of knees was graded as follows: grade 4 in 0 cases, grade 3 in 24 cases, grade 2 in 38 cases, grade 1 in 17 cases, grade 0 in 7 cases, mean grade was (2.13 +/- 0.67), the Kendall's correlation coefficient was -0.851 with negative correlations (P = 0.036) between postoperative Lysholm score and K/L grade.</p><p><b>CONCLUSION</b>There is no correlation between the grade of knee cartilage injury confirmed by MRI (1.5T) and effects of arthroscopy, and the grade is not a gold standard as an operation indication in arthroscope procedure. The K/L grade in X-ray had important effects.</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>

Comparison of the relativity of MRI appearance of cartilage injuries and postoperative effect of arthroscope on articular cartilage disease of knee / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the indication of arthroscope by examining the correlations between cartilage injury degree confirmed by MRI and postoperative effect.</p><p><b>METHODS</b>From Aug. 2005 to April 2008, 87 cases with knee osteoarthritis were treated by arthroscopes including 44 males and 43 females,aged from 16 to 67 years (means 46.3 years). Arthrodial cartilage of knee was graded by ICRS MR, and the therapeutic effect was evaluated by Lysholm scoring.</p><p><b>RESULTS</b>All 87 knees of 87 cases were followed-up for from 12 to 30 months (averaged 23 months). The cartilage injury degree of knees was graded as follows: grade 4 in 30 cases, grade 3 in 23 cases, grade 2 in 20 cases, grade 1 in 12 cases, grade 0 in 2 cases, means grade (2.770 +/- 1.138). Postoperative Lysholm score was from 59 to 100, means (95.170 +/- 7.556). Coefficient correlation (r) = -0.152, P = 0.159 > 0.05. Although the results had no correlations between cartilage injury degree and Lysholm score, negative correlation tendency existed.</p><p><b>CONCLUSION</b>The patients with higher grade of knee cartilage injury degree confirmed by MRI (1.5T) have worse effect after operation, the grade is not a gold standard as a operation indication in arthroscopic procedure.</p>

Total hip arthroplasty for patients with osteoarthritis secondary to hip pyogenic infection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pyogenic hip arthritis occurs most often in young patients. Delayed treatment causes significant anatomical deformation of bony and soft tissue structures leading to premature onset of secondary osteoarthritis. Total hip arthroplasty (THA) in patients who had osteoarthritis secondary to hip pyogenic infection has been associated with high complication rates.</p><p><b>METHODS</b>We analyzed 19 THAs performed from April 2003 to July 2008 in adults with osteoarthritis secondary to hip pyogenic infection (average age 40.7 years; range 34-52 years). There were 7 males and 12 females, the average age of infection was 10.6 years (range 7-13 years) and the average quiescent period of infection was 29.5 years (range 22-41 years). The count of white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined routinely before surgery. The duration of followup was 34 months (range 6-52 months).</p><p><b>RESULTS</b>There was no evidence of infection according to laboratory values, intraoperative exploration and bacterial culture of joint fluids and synovial tissues. Split fracture above the lesser trochanter occurred in two hips and healed without adverse sequelae after fixation with wires. One patient with sciatic nerve palsy was successfully treated by positioning the hip in extension and the knee in flexion with complete resolution of motor symptoms one month later. There were no cases of dislocation, deep vein thrombosis, or postoperative reinfection. The symptoms and hip joint activities were significantly improved. The median Harris hip score improved from 47.3 preoperatively to 89.7 and the median range of motion from 53 degrees to 125 degrees.</p><p><b>CONCLUSIONS</b>It is safe and efficient to perform THA in patients who had osteoarthritis secondary to pyogenic hip arthritis when the infection is quiescent. The key points of successful surgery are exclusion of active infection preoperatively, quiescent period of infection more than ten years and adequate intraoperative soft tissue releases.</p>

Biomechanical strength of bone cement impregnated with diphosphonate / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the biomechanical strength of diphosphonate impregnated bone cement (DIBC).</p><p><b>METHODS</b>DIBC specimens were manufactured and randomly assigned to the control groups and the DIBC groups. According to the corresponding ASTM/ISO standards, the static biomechanical strength and the fatigue limit were tested systematically. The particle size distribution of diphosphonate powder was analyzed with the laser light scattering method. The fatigue test results, given as number of cycles-to-failure, were analyzed using the linearized format of the two-parameter Weibull function.</p><p><b>RESULTS</b>With the drug load increased, there was a slight increase in static biomechanical strength and a moderate decrease in fatigue limit, both with statistical significance. When immersed in PBS before the tests, the DIBC specimens presented an overall significant decrease of static biomechanical strength and fatigue limit. The profile of drug particle sizes presented a normal distribution.</p><p><b>CONCLUSIONS</b>The adopted diphosphonate is a much homogeneous powder which contains particles with a low range of sizes. The impregnation of diphosphonate exerted no or less negative effect on the biomechanical strength of the acrylic bone cement, of which the static strength of DIBC is maintained high above the ASTM/ISO standards.</p>