Two Different Total Hip Arthroplasties for Hartofilakidis Type C1 Developmental Dysplasia of Hip in Adults / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) is more complex than the normal hip, with large replacement risks and many complications. Although nonosteotomy THA is convenient to perform, femoral osteotomy shortening can avoid blood vessel and nerve traction injuries. This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH.</p><p><b>METHODS</b>Data on 48 DDH patients who underwent THA were analyzed retrospectively. The patients were divided into two groups: Group A 29 cases (nonosteotomy), and group B 19 cases (osteotomy). Harris and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, limb length discrepancy (LLD), radiological data on the hip, and claudication were evaluated. Data were analyzed by using paired-sample Student's t-test, independent-sample Student's t-test, and Pearson's Chi-square test; the test level was α =0.05.</p><p><b>RESULTS</b>Postoperative Harris (90.7 ± 5.1) and WOMAC scores (88.0 ± 10.6) were significantly improved compared with preoperative Harris (44.8 ± 5.7) and WOMAC scores (42.0 ± 5.3) in group A (P < 0.05). Postoperative Harris (90.4 ± 2.8) and WOMAC scores (88.2 ± 5.9) were significantly improved compared with preoperative Harris (44.4 ± 4.2) and WOMAC scores (43.2 ± 4.3) in group B (P < 0.05). One case of dislocation occurred in group A; after closed reduction, dislocation did not recur. In group A, 2 patients developed cutaneous branch injury of the femoral nerve, which spontaneously recovered without treatment. Postoperative LLD >2 cm was seen in one case in group A and five cases in group B. Postoperative claudication showed no significant difference between the two groups (P > 0.05). No patients developed infection; postoperative X-rays showed that the location of the prosthesis was satisfactory, and the surrounding bone was not dissolved.</p><p><b>CONCLUSIONS</b>THA is effective and safe for DDH. For unilateral high dislocation DDH patients with limb lengthening ≤4 cm and good tissue conditions, THA without femoral osteotomy may be considered.</p>

Surgical treatment of recurrent dislocation after total hip arthroplasty: the algorithmic approach and clinical outcome / 中华外科杂志

<p><b>OBJECTIVES</b>To study the surgical techniques and clinical outcomes of the revision surgery to treat recurrent dislocation after total hip arthroplasty.</p><p><b>METHODS</b>From March 1997 to November 2010, 12 patients (12 hips) with revision total hip arthroplasty for recurrent dislocation were reviewed. There were 5 male and 7 female, aged from 20 to 73 years (mean age 52.7 years), whose body mass index (BMI) were 14.8-30.0 kg/m2 (mean 23.6 kg/m2). The Harris score and WOMAC score were registered and analyzed before surgery and at the time of latest follow-up. Any episode of dislocation and other complications such as deep infection, deep vein thrombosis and pulmonary embolism (DVT-PE) events, periprosthetic fracture, or early aseptic loosening were recorded.</p><p><b>RESULTS</b>Twelve patients were successfully followed for 1.0-12.7 years (mean 4.0 years). No further dislocation episodes reported and all the hips were stable at the time of follow-up. No one complicated as deep infection, DVT-PE events, periprosthetic fracture, or early aseptic loosening. The Harris score was greatly improved from 38±21 before surgery to 81±9 at the time of last follow-up with statistic significance (t=-8.616, P<0.05) accompany with the WOMAC score elevation from 54±21 to 82±12 significantly (t=-6.200, P<0.05).</p><p><b>CONCLUSION</b>With a reasonable algorithmic approach, the recurrent dislocated total hip arthroplasty can be treated with a relatively high success rate.</p>

Effect of lumbar nerve dorsal roots section on the rat bone structural changes of lower limb / 中华显微外科杂志

Objective To investigate the rat bone structural changes of lower limb following lumbar nerve dorsal roots section.Methods Forty-eight mature female Wistar rats were divided into posterior radi- cotomy(PR)and comtrol groups randomly.The bilateral femoral bone mineral density(BMD)and biome- chanics characteristics were analyzed 2,4 and 8 weeks after the radicotomy.The same operation except the radicotomy was done in the sham group.Results In PR group,2,4,and 8 weeks after the radicotomy,the BMD of femur was(0.221?0.008)g/cm~3,(0.213?0.015)g/cm~3 ,and(0.216?0.105)g/cm~3 ,respective- ly;while that was(0.223?0.005)g/cm~3,(0.218?0.014)g/cm~3 ,and(0.208?0.111)g/cm~3 in control group.No significant difference was observed between the two groups(P＞0.05).In PR group,2,4,and 8 weeks after the operation,the mean maximum load in three-point bending test of femun midshaft was(93.64?8.76)N,(89.77?11.18)N and(93.21?8.74)N,respectively,and was lower than the values of the con- trol group at the same time point(95.94?6.29)N,(91.63?9.43)N,(95.57?8.64)N,However,there was no significant difference between the two groups(P＞0.05).Accordingly,there was no significant difference in the energy absorption in femun midshaft between the two groups(P＞0.05).Conclusion The selective rhizotomies of part lumbar never dorsal roots might not cause the loss of the femur BMD and the change of bio- mechanics property significantly in short period.