Microbiology analysis of periprothetic joint infection post total hip and knee arthroplasty of 9 centers in Beijing between 2014 and 2016 / 中华外科杂志

Objective@#To investigate the microbiological test, antibiotic sensitivity and surgical treatment of periprosthetic joint infection(PJI) cases in post total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients.@*Methods@#A retrospective cross-sectional survey was conducted on 318 patients who underwent THA or TKA in 9 clinical centers in Beijing from January 2014 to December 2016.The data of microbiology, antibiotic sensitivity and surgical treatment were collected.The average age of patients was (62.3±13.1) years old (range: 21-86 years old), including 145 males and 173 females.The body mass index was (25.6±3.8) kg/m 2 (range: 15.6-38.1 kg/m2).@*Results@#In total, 318 patients had microorganisms detected by periprosthetic tissue culture or synovial fluid culture, 209 cases (65.7%) had Gram-positive bacteria, 29 cases (9.1%) had Gram-negative bacteria, 10 cases (3.1%) had fungi, 3 cases (0.9%) had non-tuberculous mycobacteria, 72 cases (22.6%) were negative, 69 cases (21.7%) had methicillin-resistant bacteria. The antibiotic sensitivity results showed that the overall resistance rate of penicillin, cefuroxime, amoxicillin+clavulanic acid was 79.9%, 69.9%, and 68.1%, respectively; meropenem, vancomycin, and linezolid resistance rate was 0. For the treatment methods of hip and knee PJI, two-stage revision surgery acounted for 72.9% (108/148) and 64.1% (109/170), respectively. One-stage revision surgery accounted for 21.6% (32/148) and 7.6% (13/170), and open debridement surgery accounted for 4.7%(7/148) and 26.4% (45/170).@*Conclusions@#Gram-positive bacteria was still the main pathogen of PJI.The methicillin-resistant bacteria and rare bacteria should be payed attention to. The Majority of hip and knee PJI cases were treated by two-stage revision surgery.

Effect of flurbiprofen axetil for postoperative analgesia on blood coagulation: a meta-analysis / 中华创伤骨科杂志

Objective To analyze the effect of flurbiprofen axetil (FA) on blood coagulation in patients undergoing surgery through systematic review and meta-analysis.Methods PubMed,WanFang and CNKI databases were searched from their establishment to August 2017 by computer retrieval for relevant literature on the blood coagulation effect of FA.The references of the studies included were also searched by hand.Two reviewers independently screened the literature,extracted data from full-text articles,and evaluated the methodological quality of included studies.All data were analyzed by Review Manager 5.3.Results Altogether 11 studies were finally included,consisting of 10 RCTs and one case-control study,involving 643 patients undergoing surgery.The mean Jadad score for all the studies included were less than 3,suggesting low methodological quality of the studies included.The pool analysis of 4 blood coagulation indexes (prothrombin time,thrombin time,activated partial thromboplastin time and fibrinogen) and platelet count showed that there were no significant differences between the control group and flurbiprofen axetil group before treatment and at 30 min,1-2 h,6-8 h,12 h,24 h and 48 h after treatment(P ＞ 0.05).As for other outcomes like Sonoelot coagulation indexes [activated clotting time of whole blood,coagulation rate and platelet function (PF)],time to peak,mean platelet volume,maximum platelet aggregation rate,platelet aggregation rate at 1 min (PAG1),platelet aggregation rate at 5 min (PAG5) and platelet aggregation rate maximum,no significant differences were found except in one study where PF was found to be lower at 2 h after treatment in the FA group than in the control group.Conclusion Use of FA in common clinical doses is safe for postoperative analgesia,because blood coagulation may not be significantly affected.

Locking compression plate versus retrograde intramedullary nail for periprosthetic supracondylar femoral fractures following total knee arthroplasty: a meta-analysis / 中华创伤杂志

Objective To evaluate the efficacy of locking compression plate (LCP) and retrograde intramedullary nail (RIMN) in the treatment of periprosthetic fractures after total knee arthroplasty (TKA),providing reference for surgeons to select the fixation approach.Methods Cochrane Library,PubMed,Embase,Medline,Wanfang database,VIP Database for Chinese Technical Periodicals,and China National Knowledge Infrastructure (CNKI) were searched to identify the retrospective comparison studies (RCS) which compared the clinical outcomes of LCP and RIMN for patients with periprosthetic supracondylar fractures of the distal femur after TKA.The quality of included literatures was evaluated by Newcastle-Ottawa scale(NOS).Meta-analysis was performed using Revman 5.3 software to compare the operation time,Knee society score (KSS),fracture healing time,nonunion rate,reoperation rate,and incidence of complications between the two groups.Results Ten retrospective comparison studies involving 487 patients were identified including LCP group (296 cases) and RIMN group (191 cases).The meta analysis results showed that no significant differences were found in the operation time (MD =10.89,95％ CI-9.56-31.33,P ＞ 0.05),KSS (MD =1.11,95％ CI-8.88-11.10,P =0.83),fracture healing time (MD =0.00,95％ CI-1.51-1.51,P ＞0.05),nonunion rate (OR =0.71,95％ CI 0.38-1.31,P ＞ 0.05),reoperation rate (OR =0.65,95％ CI 0.22-1.91,P ＞ 0.05),and complication incidence rate (0R=0.69,95％CI0.38-1.26,P＞0.05) between these two groups.Conclusions There are no significant differences in the operation time,KSS,fracture healing time,nonunion rate,reoperation rate,and complications between LCP and RIMN groups.LCP and RIMN have similar clinical outcomes in treating periprosthetic supracondylar femoral fracture following TKA.

The effects of varus degree on the early metabolic changes of the lateral compartment cartilage in knees with medial unicompartmental osteoarthritis / 中华骨科杂志

Objective To find the effects of varus degree on the early metabolic changes of the lateral compartment cartilage in knees with medial unicompartmental osteoarthritis by detecting glycosaminoglycan (GAG) in varus knees.Methods From June 2016 to December 2017,twenty middle-aged volunteers without osteoarthritis or coronal deformities were recruited as the control group.Sixty patients diagnosed as medial unicompartmental osteoarthritis were recruited as the osteoarthritis group.The patients were further divided into four groups according to the degrees of varus angle,namely 2°-5° varus group,5°-10° varus group,10°-15° varus group and ＞15° varus group with 15 patients in each group.Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) was performed in all participants.The dGEMRIC indices (T1Gd) representing GAG content were calculated in the weight-bearing femoral cartilage (wbFC),the posterior non-weight-bearing femoral cartilage (pFC),the lateral femoral cartilage (FC,wbFC+pFC) and the tibial cartilage (TC) in the lateral compartment by using Matlab 7.1 and MRIMapper software.Results T1Gd of wbFC,pFC,FC and TC were 400.3±51.5 ms,393.6±57.9 ms,397.5±52.3 ms and 448.6±62.5 ms in the control group,391.8±41.5 ms,407.2±43.8 ms,400.1±37.8 ms and 461.3±41.6 ms in 2°-5° varus group and 386.9±57.1 ms,401.3±73.5 ms,397.7±59.6 ms and 438.9±42.8 ms in 5°-10° varus group.There was no significant difference among the above three groups in T1Gd in any of the analyzed cartilage regions (P＞0.05).In 10°-15° varus group,T1Gd of wbFC,pFC,FC and TC were 380.1±45.5 ms,385.5±76.6 ms,384.0±53.5 ms and 400.2±43.8 ms,respectively.Although T1Gd of wbFC,pFC and FC in 10°-15° varus group were similar with that in the control group,2°-5° varus group and 5°-10° varus (P＞0.05),T1Gd of TC in 10°-15° varus group decreased significantly (P＜0.05).In addition,T1Gd of wbFC,pFC,FC and TC in ＞15° varus groupwere 327.7±54.3 ms,340.1±33.0 ms,334.9±36.0 ms and 363.6±48.6 ms,respectively.T1Gd of all regions of interest in ＞15° varus group were significantly lower than that informer four groups (P＜0.05).Conclusion In medial unicompartmental knee osteoarthritis,there is a relationship between varus degree and GAG content of the lateral compartment cartilage.If varus angle ≤10°,the GAG content of the lateral compartment cartilage was similar with the similar aged subjects without osteoarthritis.If varus angle ＞ 10°,GAG content of the lateral compartment decreases significantly.

Evolution and status of unicompartmental knee prostheses / 中国组织工程研究

BACKGROUND:Unicompartmental knee arthroplasty has been prevailed in orthopedics,but there is a lack of overview addressing unicompartmental knee prostheses.OBJECTIVE:To review the evolution and current situation of unicompartmental knee prostheses and to discuss its classifications,characters and clinical outcomes,thereby providing guidance for clinical application.METHODS:PubMed and WanFang databases were retrieved for the articles related to unicompartmental knee prostheses and its clinical outcomes.Totally 177 articles were retrieved,and finally 35 eligible articles plus other 4 reports were included after excluding repetitive studies.RESULTS AND CONCLUSION:(1) It has been more than 60 years since the birth of unicompartmental knee prostheses.Despite the difficult in the past,it comes to mature and the survival rate is more than 90％ at 10 years.(2) At present,the most popular prostheses include mobile-bearing (represented by Oxford 3) and fixed-bearing (represented by ZUK and Link).There is no significant difference in clinical outcomes between two designs.However,their differences have been noted in their modes and timing of failures.(3) Aseptic loosening and lateral osteoarthritis progression remain the most common failure modes in unicompartmental knee prostheses.(4) Cementless prostheses and individual unicompartmental knee prostheses based on CT or MRI scan maybe promote the long-term efficacy of unicompartmental knee prostheses.

Does a fixed distal femur resection angle influence radiographic alignment in total knee arthroplasty? / 中国组织工程研究

BACKGROUND: The distal femur resection in total knee arthroplasty is commonly made using a fixed angle relative to an intramedullary rod. Does a fixed distal femur resection angle influence radiographic alignment in primary total knee arthroplasty? OBJECTIVE: To research the femoral mechanical-anatomical angle in Chinese and how it affects the femoral component angle and postoperative mechanical alignment for total knee arthroplasty. METHODS: Totally 109 cases (148 knees) underwent primary total knee arthroplasty. One surgeon used a fixed resection angle of 5° (group A; n=56 cases, 76 knees). The second surgeon adjusted the resection angle according to preoperative coronal alignment, using 5° for neutral/mild varus, 6° for more severe varus, 4° for mild valgus and 3° for severe valgus knees (group B; n=53 cases, 72 knees). Preoperative hip-knee-ankle angle, femoral mechanical-anatomical angle, postoperative hip-knee-ankle angle, femoral component angle and tibial component angle were measured from standing hip-knee-ankle angle radiographs. For postoperative hip-knee-ankle angle, 177°-183° were considered as neutral mechanical axis. For femoral and tibial component angles, the target results were 88°-92°.RESULTS AND CONCLUSION: (1) There was no statistically significant difference between groups in postoperative hip-knee-ankle angle (group A: (178.78±3.57)°, group B: (178.23±2.78)°; P=0.302) and good rate of hip-knee-ankle angle (group A: 62%, group B: 65%). (2) The mean femoral mechanical-anatomical angle was (6.70±1.34)°preoperatively. There was no significant difference in the good rate of hip-knee-ankle angle (hip-knee-ankle angle < 7°:69%; hip-knee-ankle angle ≥7°: 55%; P=0.108) postoperatively. There was a statistically significant difference about good rate of femoral component angle between different femoral mechanical-anatomical angle angles (femoral mechanical-anatomical angle < 7°: 76%; femoral mechanical-anatomical angle ≥7°: 39%; P < 0.01). (3) There was a statistically significant correlation between preoperative femoral mechanical-anatomical angle and postoperative hip-knee-ankle angle (r=?0.42, P < 0.01) and postoperative femoral component angle (r=?0.58, P < 0.01). (4) The mean femoral mechanical-anatomical angle was larger than foreign values. When the resection angle less than femoral mechanical-anatomical angle, the femoral component may tend to be varus which could affect the lower extremity mechanical alignment. For the larger femoral mechanical-anatomical angle, we advise to adjust the resection angle according to measured value preoperatively.

Effect of femoral bowing angle on the lower limb alignment in different positions based on CT three-dimensional reconstruction / 中国组织工程研究

BACKGROUND: Measuring result of the lower limb alignment is often influenced by various factors, such as femoral bowing angle (FBA) in different positions.OBJECTIVE: To measure the FBA and femoral valgus correction angle (VCA) in different positions after CT reconstruction of lower limb model, and simulating X-ray examination, and to explore the rule of FBA affecting lower limb alignment.METHODS: Twenty patients undergoing CT angiography of lower extremity artery were enrolled, three-dimensional reconstruction of low limb was established on Mimics13.0 software based on CT data, and the FBA in standard posture was determined. All patients were divided into groups A (FBA > 2°), B (2° > FBA > 0°), C (0° > FBA > -2°) and D (FBA <-2°) (n=5 per group). Then each model was revolved through the vertical axis from 20° of internal rotation to 20° of external rotation by 2° for one motion, and 21 three-dimensional images were transformed into two-dimensional images to obtain the X-ray images of low limb. FBA and VCA in different positions were measured.RESULTS AND CONCLUSION: (1) The outcome measurements showed that FBA tended to be decreased in internal rotation and increased in external rotation. (2) VCA tended to be increased in external rotation and decreased in internal rotation. (3) FBA was positively correlated with VCA in the different positions (P < 0.01). (4) These results suggest that FBA can be altered with rotation and even expose influence on VCA. The bigger FBA is, the more influence on the lower limb alignment. Therefore, it is advisable to conduct the full length X-ray of lower limb in a standard posture, especially for the patients with larger FBA.

Cocktail therapy reduces hidden blood loss after total knee arthroplasty / 中国组织工程研究

BACKGROUND:Blood loss after total knee arthroplasty is a common problem that wil affect the clinical effects. As a kind of hemostatic medicine, tranexamic acid has been more and more used in reducing bleeding after joint replacement. However, there are few studies concerning the combined use of tranexamic acid with other hemostatic drugs. OBJECTIVE:To evaluate the efficacy and safety of intra-articular administration of cocktail wine (tranexamic acid plus diluted-epinephrine) on perioperative blood loss and transfusion in primary unilateral total knee arthroplasty. METHODS:From July 2013 to October 2015, 113 patients scheduled to undergo total knee arthroplasty were randomized into two groups. Cocktail wine group (57 patients) received intra-articular cocktail wine (3 g tranexamic acid plus 0.25 mg diluted-epinephrine;1:200 000). Tranexamic acid group (56 patients) received 3 g topical tranexamic acid alone. Al patients were not drain inserted after the operation. During perioperative period, intraoperative blood loss, postoperative dominant blood loss, occult blood loss and al ogeneic blood transfusion were observed. Within postoperative 90 days, the incidences of symptomatic deep venous thrombosis and pulmonary embolism were observed. RESULTS AND CONCLUSION:(1) The topical administration of cocktail wine significantly reduced total blood loss (P=0.007), hidden blood loss (P=0.000) and transfusion rate (0%vs. 5.4%), without increasing the risk of thromboembolic and hemodynamic complications (P>0.05). (2) Therefore, the hemostatic effect of topical tranexamic acid plus diluted-epinephrine was better than tranexamic acid alone. Their combination does not produce severe adverse reactions, and can be used as an important method to reduce blood loss after total knee arthroplasty.

Influence of tibial component slope on short-term clinical outcome for Oxford unicompartmental knee arthroplasty / 中华外科杂志

Objective@#To investigate the effects of tibial component slope change after microplasty (MP) Oxford unicompartmental knee arthroplasty (UKA) on short-term clinical outcome.@*Methods@#A total of 116 patients(128 UKAs)underwent UKA in Department of Orthopaedic Surgery of China-Japan Friendship Hospital between January 2014 and December 2015 were retrospectively reviewed. Totally 100 patients (108 UKAs) were finally included in the study. There were 31 males and 69 females, aging from 47 to 90 years (mean 67.2 years). The mean height was (161.9±8.4) cm and the mean body mass index (BMI) was (26.2±3.3) kg/m2. The posterior tibial slope (PTS) at preoperative and postoperative were measured on the lateral radiograph. The postoperative PTS were divided into five groups (<3°, 3° to 5°, 5° to 7°, 7° to 9° and>9°). The Oxford Knee Score (OKS) was recorded. Pearson correlation analysis, ANOVA and t test were used to analyze data.@*Results@#All operations were successfully accomplished and there were no transfusion, infection, thrombus and other complications. There was 1 patient accepted revision because of bearing dislocation. Compared to preoperative, the PTS decreased (6.5°±2.2° vs.9.6°±3.4°) postoperative, there was statistical difference (t=9.053, P<0.01). Only 3 patients were beyond the recommended range (2° to 12°). A total of 82 patients (86 UKAs) were followed up. The follow-up time was 1 to 2.9 years (mean 2 years). The OKS was 43.0±4.1 (mean 31 to 48). The PTS increased in 12 patients (12 UKAs) postoperative, the mean OKS was 40.5±5.2. The PTS decreased in 70 patients (74 UKAs), the mean OKS was 43.4±3.8. There were significant difference in OKS (t=2.347, P=0.021). There were no significant difference in OKS between the five groups. There were positive correlation between postoperative PTS and preoperative PTS (r=0.201, 95%CI: 0.001 to 0.396, P=0.037), there were no correlations between postoperative PTS and hight and BMI. There were negative correlations between OKS and postoperative PTS (r=-0.255, 95%CI: -0.063 to -0.427, P=0.018) and PTS change (r=-0.292, 95%CI: -0.08 to -0.475, P<0.01).@*Conclusions@#Satisfying PTS can be obtained by use of Oxford MP instrumentation. The clinical outcome of the postoperative PTS decreased was relatively better. Too large posterior slope of the tibial implant should be avoided.

Effects of icariin on microRNAs expression in bone microvascular endothelial cells in steroids-induced femoral head lesions / 中国组织工程研究

BACKGROUND:MicroRNAs (miRNAs) are widely involved in regulation of physiological processes, such as human development, cel proliferation, differentiation, and apoptosis, angiogenesis and lipid metabolism. MiRNAs also play an important regulating role in the pathological process of femoral head necrosis. At present, the research about the effect of icarin on miRNA expression in glucocorticoid- induced avascular necrosis is stil in the exploratory stage, and the specific targets, possible regulation mechanism and signaling pathway remain unclear. OBJECTIVE:To explore the effect of icarin on miRNA expression of bone microvascular endothelial cels in steroids-induced human femoral head lesionsin vitro. METHODS: Bone microvascular endothelial cels in cancelous bone of the femoral head were isolated and harvested in vitro. Icarin preconditioning preceded establishment of models of glucocorticoid-induced bone microvascular endothelial cel injury. Differential expression profiles and transcriptomes in glucocorticoid and normal groups were tested by miRNA microarrays. The most differentialy expressed miR-23b and miR-339 in microarray analysis were further confirmed by real-time quantitative PCR, Meanwhile the effects of icarin on the expression of miR-23b-5p and miR-339-5p were detected. RESULTS AND CONCLUSION:According to the microarray analysis, one miRNA was up-regulated and four mi RNAs were down-regulated in the glucocorticoid group (fold > 2,P < 0.05). Results of RT-qPCR revealed that miR-23b was down-regulated and miR-339 up-regulated in the glucocorticoid group, which were in agreement with the microarray analysis (P < 0.05). Icarin pretreatment effectively prevented the imbalances of miR-23b expression induced by glucocorticoid (P < 0.01). These findings indicate that Icarin may participate in the pathological process of steroid-induced femoral head necrosis through regulating the expression of miR-23b.

Finite element analysis of tibial slope in mobile-bearing unicompartmental knee arthroplasty / 中国组织工程研究

BACKGROUND:At present, there stil remain controversies concerning the choice of tibial slope in unicompartmental knee arthroplasty, and the related biomechanical studies are rare. OBJECTIVE:To find the rational tibial slope in mobile-bearing unicompartmental knee arthroplasty through the results of finite element analysis. METHODS:A finite element model of normal knee was established and validated using the techniques of three-dimensional reconstruction and finite element pre-processing. Then the finite element models of unicompartmental knee arthroplasty with different tibial slopes were established based on the normal knee model. The finite element analyses were conducted after the boundary conditions and loads were unified. RESULTS AND CONCLUSION: The finite element models of unicompartmental knee arthroplasty with different tibial slopes were established successfuly. The results of the finite element analyses indicated that the posteromedial tibial cortical and cancelous bone stress increased gradualy as the posterior slope increasing, as wel as the load distribution and the cartilage contact pressures of lateral compartment. The anteromedial tibial cortical stress increased significantly with the anterior slope. A posterior tibial slope of 0°-7° can be recommended when implanting a mobile-bearing unicompartmental knee arthroplasty.

Risk factors for lateral compartmental cartilage wear in varus knee osteoarthritis / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the gross features of articular cartilage wear in varus knee osteoarthritis, and discuss the risk factors for lateral compartmental cartilage erosion.</p><p><b>METHODS</b>Data prospectively collected from the dissection of 286 total knee arthroplasties (223 patients) with varus knee osteoarthritis from January 2013 to December 2013 were analyzed. At the operation, the gross assessments of articular cartilage, ligament and meniscus were recorded, and then the slices were evaluated for histologic analysis. Parameters of the patients with lateral compartmental cartilage erosion were compared with those without lateral compartmental cartilage erosion using the univariate analysis. Logistic regression analysis was used to analyze the risk factors associated with lateral compartmental cartilage erosion.</p><p><b>RESULTS</b>There were 223 patients with 286 knees were included,including 37 male patients (47 knees) and 189 female patients (239 knees), with an average age of (66±8) years (range 50-86 years), body mass index (BMI) was (27±5) kg/m2 (18.0-40.0 kg/m2). Varus degree was 8°±4° (1°-34°). Range of motion was 103°±21° (0°-143°), and Hospital for Special Surgery (HSS) score was 53±12 (29-76). Seventy-five knees (60 patients) showed lateral compartmental cartilage wear (26.2%). Environmental factors showed no differences in age, side, gender, BMI, range of motion,and HSS score (P>0.05). Factors significantly increasing the risk of lateral compartmental cartilage wear by univariate analysis included varus degree, activity level, duration of onset, meniscus, Weidow grade, Kellgren-Lawrence grade, collateral ligament and anterior cruciate ligament (P<0.05). Multiple Logistic regression analysis revealed the factors most highly associated with the increase risk for lateral compartmental wear were high activity level (OR=2.843, 95% CI: 1.010-8.002) and longer duration of onset (OR=1.216, 95% CI: 1.115-1.325). However, intact lateral meniscus (OR=0.012, 95% CI: 0.003-0.048) and anterior cruciate ligament (OR=0.406, 95% CI: 0.192-0.857) were associated with the protection of lateral compartmental.</p><p><b>CONCLUSIONS</b>In varus knee osteoarthritis, the wear incidence of lateral compartmental is low. High activity and increased duration of onset are risk factors of lateral compartmental wear, and intact meniscus and anterior cruciate ligament are protective factors.</p>

Treatment of patellofemoral osteoarthritis with patello-femoral joint arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To study the outcome and surgical technique of patello-femoral joint arthroplasty (PFJ) for osteoarthritis of the knee.</p><p><b>METHODS</b>From January 2010 to June 2012, 17 patients (24 knees) with patello-femoral compartmental osteoarthritis treated by PFJ were reviewed retrospectively. There were 2 male patients (4 knees) and 15 female patients (15 knees), with an average age of (64 ± 9) years (52-77 years) . The mean body mass index was (24 ± 3) kg/m² (18.0-30.1 kg/m²) . Patients were asked to return for follow-up examinations at 3, 6 months and at every year after PFJ. The range of motion (ROM), visual analogue scale(VAS), Hospital for Special Surgery score (HSS score) , Feller patella score, quadriceps muscle strength were evaluated before and after PFJ. The paired sample t-test and one-way analysis of variance (ANOVA) with replicate measures were used to determine whether there were statistically significant differences between the mean data.</p><p><b>RESULTS</b>All of the patients were followed up for 18-47 months, with a mean time of (29 ± 10) months, 75.0% patients were satisfied with the outcome of this surgical procedure 1 year postoperative, and 87.5% were satisfied 2 years postoperative. HSS score was increased from 61 ± 11 to 90 ± 6 at the final follow-up (t = 12.24, P = 0.000). VAS score was reduced from 6.7 ± 1.0 to 2.4 ± 1.0 (t = 15.84, P = 0.000). The mean post-operative ROM of the knees was 126° ± 7° (t = 3.25, P = 0.003). Feller patella scores were 18.0 ± 3.2 before operation, and 18.5 ± 4.5, 19.7 ± 3.4, 24.0 ± 3.8, 26.0 ± 3.3, 26.6 ± 2.5 at 3, 6, 12, 24 months after operation, final follow-up, respectively. Quadriceps muscle strength were 3.9 ± 0.5 before operation, and 3.7 ± 0.5, 3.9 ± 0.5, 4.2 ± 0.5, 4.3 ± 0.5, 4.3 ± 0.5 at 3, 6, 12, 24 months after operation, final follow-up, respectively. Repeated measures ANOVA found significant time effects for Feller patella scores (F = 38.97, P = 0.000) and quadriceps muscle (F = 6.89, P = 0.000). Feller patella scores and quadriceps muscle strength were low at 3, 6 months after operation, with no significant differences compared with pre-operation data (P > 0.05). The improvements of Feller patella scores and quadriceps muscle strength after 6 months were of significant difference compared with pre-operation and postoperative 6 months data (t = 5.65-10.65 and t = 2.18-2.73, P < 0.05) . Three knee reported continuing pains with quadriceps muscle strength less than 4 level.</p><p><b>CONCLUSIONS</b>PFJ is an effective method for patello-femoral compartmental osteoarthritis with less trauma. The early term outcome of PFJ is encouraging. Quadriceps muscle strength should be enhanced.</p>

Porous bioceramic beta-tricalcium phosphate for treatment of osteonecrosis of the femoral head / 中国组织工程研究

BACKGROUND:It is a clinical difficult in the treatment of osteonecrosis with joint preservation, and to solve this problem, a variety of bone graft substitutes are at the exploration stage. OBJECTIVE:To evaluate the clinical outcome of lightbulb operation with porous bioceramic β-tricalcium phosphate in a consecutive series of patients with osteonecrosis of the femoral head. METHODS:From January to December 2008, 58 patients (88 hips) who had undergone lightbulb operation with porous bioceramic β-tricalcium phosphate were involved in this study. Al patients were evaluated both clinicaly and radiographicaly at postoperative 3, 6, 12 months and annualy. Functional improvement was assessed with the Harris hip score. RESULTS AND CONCLUSION: Among these patients, 56 patients (85 hips) were folowed up for 2-5 years. According to the ARCO staging system, there were 27 hips of stage II, 40 hips of stage IIIa, 18 hips of IIIb. According to the hospital’s classification, type C was in 4 hips, L1 in 15 hips, L2 in 28 hips, and L3 in 38 hips. According to the Harris hip score system, excelent outcome was in 55 hips, good in 12 hips, fair in 5 hips and poor in 13 hips. Nine of 11 patients who failed to preserve their own joints were subjected to hip replacement. The  mean preoperative and postoperative Harris scores were 61.2 and 85.3, respectively, with a mean improvement of 24.1 points (P < 0.001). All hips were radiologically stable, with no progress of osteonecrosis, and bone density in the bone graft area increased obviously. The replacement time of porous bioceramic β-tricalcium phosphate was 1-1.5 years. These findings suggest that the porous bioceramic β-tricalcium phosphate provides an option to treat osteonecrosis of the femoral head with satisfactory clinical outcomes, and profits the repair and reconstruction of femoral head osteonecrosis. When in the lateral column of femoral head, the porous bioceramic β-tricalcium phosphate can play a supporting role in the lateral column of the necrotic area, and further prevent collapse, which is suitable for patients with osteonecrosis of the femoral head, especially for those with joint preservation.

Correlation between the coverage percentage of prosthesis and postoperative hidden blood loss in primary total knee arthroplasty / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss (HBL) in primary total knee arthroplasty (TKA).</p><p><b>METHODS</b>A total of 120 patients who had undergone unilateral TKA from August 2012 to May 2013 were retrospectively studied. The Gross formula was used to calculate the amount of HBL. Routine standard anteroposterior (AP) and lateral X-ray films of the knee joint were taken postoperatively and used to measure the percentages of coronal femoral and of coronal and sagittal tibial prosthetic coverage. Then Pearson's correlation analysis was performed to assess the correlations between the percentages of prosthetic coverage for each AP and lateral position and HBL on the first and third postoperative days.</p><p><b>RESULTS</b>The volumes of HBL on the first and third postoperative days after TKA were (786.5 ± 191.6) ml and (1 256.6 ± 205.1) ml, respectively, and lateral X-ray film measurements of percentages of coronal femoral, tibial coronal, and sagittal prosthetic coverage were (87.9 ± 2.5)%, (88.5 ± 2.2)%, and (89.1 ± 2.3)%, respectively. Pearson's correlation analysis showed statistically significant correlations between percentages of total knee prosthetic coverage for each AP and lateral position and volumes of HBL on the first and third postoperative days (P < 0.05).</p><p><b>CONCLUSIONS</b>HBL after TKA correlates with degree of prosthetic coverage. To some extent, the size of the surfaces exposed by osteotomy determines the amount of HBL. Choice of the appropriate prosthesis can significantly reduce postoperative HBL. Designing individualized prostheses would be a worthwhile development in joint replacement surgery.</p>

Fourth-generation ceramic-on-ceramic total hip arthroplasty in patients of 55 years or younger: short-term results and complications analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The incidence of total hip replacement in the younger and more active patients is ever increasing. The ceramic-on-ceramic (COC) bearing was developed to reduce wear debris-induced osteolysis and loosening and to improve the longevity of hip arthroplasties. Few studies have reported the clinical results and complications of the new zirconia-toughened ceramic total hip arthroplasty (THA).</p><p><b>METHODS</b>A consecutive series of 132 young patients (177 hips) that underwent primary cementless THAs between January 2010 and December 2012 were included in this study. These arthroplasties all had fourth-generation COC bearings performed through a posterolateral approach. The average age was (41.8 ± 8.3) years (ranging from 22 to 55 years), and the mean follow-up period was (24.5 ± 9.4) months (ranging from 12 to 47 months). The results were evaluated both clinically and radiographically. Harris hip score (HHS) was determined before surgery and at the time of each follow-up. Presence of postoperative groin or thigh pain and squeaking were recorded. Other complications such as dislocations, periprosthetic fractures, and ceramic components fractures were diagnosed and treated in emergency.</p><p><b>RESULTS</b>The average HHSs improved from preoperative 60.3 ± 10.7 (ranging from 29 to 76) to 91.0 ± 5.1 (ranging from 74 to 100) at the final follow-up (t = 45.064, P < 0.05), and 97.7% of cases were scored as excellent and good results. At the last follow-up, incidental inguinal pain was found in three hips (1.7%) and thigh pain in 11 hips (6.2%). Radiographs showed a high rate of new bone formation around the acetabular and stem components. No obvious osteolysis or prosthesis loosening was detected. Complications occurred in six hips (3.4%): posterior dislocation in two hips (1.1%), periprosthetic femoral fracture in one hip (0.6%), asymptomatic squeaking in two hips (1.1%), and ceramic liner fracture in one hip (0.6%).</p><p><b>CONCLUSIONS</b>The fourth-generation COC THA showed excellent clinical results in younger active patients with no osteolysis-related prosthesis failure at a short-term follow-up study. Surgeons should still be aware of the potential risks of complications such as dislocation, periprosthetic fracture, squeaking, and ceramic components fracture.</p>

Ability of lower teardrop edge to restore anatomical hip center height in total hip arthroplasty / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The acetabular teardrop is often used to guide acetabular component placement in total hip arthroplasty (THA). Placing the lower acetabular component aspect at the same level as the lower teardrop edge was assumed to restore the hip center of rotation. Here we radiographically analyzed the relationship between cup center and normal contralateral acetabulum center height on unilateral THA using this placement method.</p><p><b>METHODS</b>A total of 106 unilateral THA cases with normal contralateral acetabula were reviewed and the vertical and horizontal distances in relation to the lower acetabular teardrop edge from both hip joint centers, cup inclination, and anteversion were measured radiographically. The paired t-test was used to compare left and right hip center heights. Scatter plots and Pearson's correlation coefficients were used to evaluate differences in hip center heights, cup anteversion, inclination angles, and medialized cup center distance compared to the contralateral hip joint.</p><p><b>RESULTS</b>Cup center height was significantly greater (P < 0.01) than contralateral hip joint center height (93.4% in the 0-5 mm range, 6.6% >5 mm). There was a weak correlation between hip center height difference and inclination (r = 0.376, P < 0.01) and between difference and anteversion (r = 0.310, P < 0.01) but no correlation between difference and outer cup diameter (r = 0.184, P = 0.058) or difference and medialized cup center distance (r = -0.098, P = 0.318).</p><p><b>CONCLUSIONS</b>Although this method did not exactly replicate anatomic hip center height, the clinical significance of cup center height and anatomic hip center height differences is negligible. This acetabular component placement method has high simplicity, reliability, and stability.</p>

The classification of osteonecrosis of the femoral head based on the three pillars structure: China Japan Friendship Hospital (CJFH) classification / 中华骨科杂志

Objective To explore the regular progressive pattern of nontraumatic osteonecrosis of the femoral head (ONFH) in order to establish the reliable and convenient new classification of ONFH.Methods The coronal section of the femoral head was divided into three pillars (medial,central and lateral).The mid-coronal section of the femoral head on MRI was selected.The China-Japan Friendship Hospital (CJFH)classification of ONFH was established according to the site of necrotic focus in three pillars.A total of 153hips with ONFH were classified according to CJFH classification and Japanese Investigation Committee (JIC)classification,respectively.The collapse rate was observed and compared between both classifications of ONFH.Results The CJFH classification for ONFH consists of 3 types:type A,the medial pillar was involved; type B,the medial and central pillars were involved; type C,the lateral pillar was involved.According to site of necrosis focus in the lateral pillar,the type C was divided into 3 types:C1,there pillars were involved but there still was some normal tissue in lateral pillar;,C2,partial central pillar and all lateral pillar were involved; C3,the whole femoral head was involved.The natural history of the ONFH showed the collapse rate of type C2 and C3 in CJFH classification (95.3％) was higher than that (72.3％) of type C2 in JIC classification.Conclusion The CJFH classification of ONFH based on three pillars is more sensitive than JIC classification in predicting collapse of the femoral head.Moreover,the CJFH classification is convenient to use.

Early and middle-term results after surgical treatment for slipped capital femoral epiphysis / 中华骨科杂志

Objective To evaluate the early and middle-term results of in-situ single-screw fixation and subtrochanteric osteotomy of femur with external fixator for slipped capital femoral epiphysis(SCFE).Methods From June 1998 to July 2008, eleven patients (12 hips) with SCFE were treated, including 7males (8 hips) and 4 females (4 hips) with an average age of 14.3 years (range, 9-18). The average BMI was 31.1 g/m2. According to the Southwick measurement, mild (＜30°) in 6 cases (7 hips), moderate (30°-50°) in 2 cases (2 hips), and severe (＞50°) in 3 cases (3 hips). All the mild and moderate cases were undergone insitu single screw fixation, and three severe cases were performed subtrochanteric osteotomy of femur with external fixator. All the cases were evaluated at 3 months, 6 months and every year postoperatively. Results All the cases were followed up for average 5.6 years (range, 2-12). The Harris hip score increased from mean 74.8 points preoperatively to 90.6 points postoperatively, with 10 hips excellent, 1 hip good, 1 hip fair and 0 hip poor. The excellent and good rate was 91.7% (11/12). The X-ray showed the epiphyseal closure in in-situ single screw fixation cases, and no further increase in epiphyseal-shaft angle. Partial reduction of slipped epiphysis with normal joint spaces was observed in subtrochanteric osteotomy of femur with external fixator cases. Conclusion In-situ single screw fixation provides a surgical treatment option to treat mild and moderate SCFE with satisfactory clinical outcome, and profit to the prevention further slip. Subtrochanteric osteotomy of femur with external fixator is suitable for severe SCFE with late deformity. The realignment procedure can correct deformity and postpone or avoid the occurrence of osteoarthritis.

Arthroscopic drilling vs. micro-invasive surgery for the treatment of full-thickness chondral defects / 中华全科医师杂志

This retrospective study was to compare the clinical effects of arthroscopie drilling with arthroscopic microfracture technology on full-thickness chondral defects in 68 patients treated between March 2003 and June 2005. The patients were followed up for an average of (20 ± 5 ) months. Lysholm score and Tegner scale were used to evaluate the efficacy. For the arthrescopic drilling group (n = 15 ) and the microfracture surgery group (n =27) , total effective rates were 12/15 and 85% (23/27), respectively. Our data suggest that those two methods provide simple and effective surgical procedure for the treatment of chondral defects of the knee; the results of arthroscopic microfracture were significantly better than arthroscopic drilling.