ABSTRACT
<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>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Arthroplasty , Methods , Hip Dislocation, Congenital , Diagnostic Imaging , General Surgery , Osteotomy , Methods , RadiographyABSTRACT
<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>
Subject(s)
Humans , Arthroplasty, Replacement, Hip , Methods , Minimally Invasive Surgical Procedures , Methods , Treatment OutcomeABSTRACT
<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>