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<p><b>BACKGROUND</b>It has rarely been reported about the changes of hemoglobin (Hb) and hematocrit (Hct) in elderly patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA). This study aimed to evaluate the changes of Hb and Hct after TKA or THA in elderly patients, and analyze its relationship with sex and type of arthroplasty.</p><p><b>METHODS</b>This is a prospective cohort study, including 107 patients receiving TKA or THA without allogeneic blood transfusion. There were 54 males and 53 females, with a mean age of 69.42 years. Levels of Hb and Hct were examined preoperatively and during the 6 months follow-up after operation.</p><p><b>RESULTS</b>Levels of Hb and Hct decreased postoperatively and reached their minimum points on postoperative day 4. Thereafter, Hb and Hct recovered to their preoperative levels within 6-12 weeks. No significant differences in the levels of Hb and Hct were noticed between different sexes. THA patients showed significantly greater drop in Hb and Hct than TKA patients in the first 4 days postoperatively (P < 0.05).</p><p><b>CONCLUSIONS</b>Levels of Hb and Hct decreased during the first 4 days after arthroplasty and gradually returned to their normal levels within 6-12 weeks postoperatively. THA may be associated with higher postoperative blood loss than TKA.</p>
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Female , Humans , Male , Middle Aged , Arthroplasty , Methods , Blood Transfusion , Hematocrit , Hemoglobins , Metabolism , Hip , General Surgery , Knee , General Surgery , Prospective StudiesABSTRACT
Objective To assess the clinical significance of modular femoral component in restoring femoral offset after total hip arthroplasty.Methods Data of 75 patients,who had undergone THA with modular femoral component from June 2009 to June 2012,were retrospectively analyzed.There were 42 males and 33 females,aged from 44 to 83 years (average,64.7±12 years).There were 40 cases of left hip and 35 cases of right hip.The average Harris hip score was 54±6 (range,32 to 65) before operation.The Zimmer M/L Taper hip prosthesis with Kinectiv technology was used in all patients.Preoperative templating was utilized to accurately predict the prosthetic size and the femoral offset.During the surgery,the femoral offset was measured accurately,and the appropriate femoral neck prosthesis was selected in order to restore the femoral offset and reconstruct hip abductor moment arm.The femoral offset and leg length were measured according to X-rays after operation.The Harris hip score was used to assess the clinical results.Results The femoral offset was reconstructed in all patients,ranging from-3.0 to 3.0 mm (average,1.3±0.3 mm).The average leg length discrepancy was improved to 3.0±0.8 mm.All patients were followed up for 6 to 36 months (average,19.7 months).The average hip abduction angle was 40°±10° at 12 weeks after operation.The average Harris hip score was 86±13 (range,65-94) at 12 weeks after operation and 95±15 (range,78 to 98) at final follow-up.There was no hip dislocation and femoral acetabular impingement syndrome.Conclusion Modular femoral component can restore femoral offset without changing the leg length,which can result in good hip abductor strength,range of motion of the hip and stability,as well as less complications.
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Objective To explore the differences of the joint function and the patient's satisfaction between two different methods to reconstruct limb length for unilateral Crowe Ⅳ developmental dysplasia of the hip (DDH).Methods The clinical controlled study were used.21 cases with unilateral DDH Crowe Ⅳ treated with total hip arthroplasty were divided into 2 groups randomly.The patients in the first group were reconstructed the limb with the compensatory length and those in the second group were did with the real length.The patients were followed up 10 years.Two independent sample t-test was used to compare these two operations.Harris scores and SF-36 scores were used in the test.Survival analysis with Kaplan-Meier method was involved in the survival of the prosthesis and then test with Log-rank test.X-ray films of different period were compared to confirm the prosthetic loosening.Results Seventeen patients were followed up 8-10 years.There were no significant differences both in Harris score and most of the SF-36 scores at the median follow-up of 10 years.The item mental healthy of SF-36 expressed significant difference.Five patients required revision.There were 10 cases suffered with polyethylene wear,6 cases with severe osteoporosis in greater trochanter,and 3 cases with osteolytic reaction.Conclusion There are no significant differences between the two surgical method in the survival rate of prosthesis and the joint function in the median follow up.The satisfaction of the control groups is lower than the trial groups both at the early stage after the operation and the median follow up.The revision rate between the two groups is similar but the reason is different.
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Objective To compare the early results of total knee arthroplasty using high flexion (HF) versus standard posterior-stabilized (PS) prosthesis tibial insert. Methods From February 2005 to July 2008, 203 patients (216 knees) underwent total knee arthroplasty using Genesis Ⅱ prosthesis and were randomly distributed into group A (98 patients with 107 knees, HF insert) or group B (105 patients with 109 knees, PS insert). There were no significant differences between the two groups in the preoperative Knee Society score (KSS) knee score, KSS function score, and range of motion. They were followed-up for 1 year and compared using KSS knee score, KSS function score and range of motion. Results 91 patients (98 knees)were followed up in group A, and 94 patients (96 knees) were followed up in group B. The postoperative knee active range of motion was 121.1°±6.9° in group A, and was 118.6°±8.1° in group B. The improvement of knee active range of motion was 17.1°±13.3° in group A, and was 16.1°±18.8° in group B. The postoperative range of passive motion of group A and group B were 127.2°±7.1° and 121.0°±7.8° respectively. The postoperative KSS knee score was 86.9±7.6 in group A, and was 87.5±6.8 in group B. The postoperative KSS function score was 91.2±8.7 in group A, and was 90.1±9.3 in group B. The range of passive motion of groupA was better than that of group B (P ＜0.05). There were no significant differences between the two groups in other aspects. Complications include deep vein thrombosis (DVT), 4 patients in group A and 3 in group B,wound fat liquefaction, 3 patients in group A and 5 in group B, synarthrophysis, 2 patients in group A and 3 in group B. Conclusion This prospective randomized clinical trial demonstrates no differences between PS and HF in early clinical outcomes, except the range of passive flexion.
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BACKGROUND: Previous artificial ligament is easy to break for material fatigue and to appear synonitis for materialbiocompatibility.OBJECTIVE: To observe the application effect of ligament advanced reinforcement system (LARS) artificial ligament inreconstruction of anterior cruciate ligament via follow-up.DESIGN, TIME AND SETTING: An own control, follow-up observation was performed between August 2004 andJanuary 2007 at the Department of Orthopedics and Joint Surgery, Shanghai Changzheng Hospital, Shanghai, China.PARTICIPANTS: Twenty-eight patients with anterior cruciate ligament injury, including 16 with sport injury and 12 withvehicle accident injury.MATERIALS: The main component of LARS artificial ligament (Laboratoire d'Applieation et de Recherche Scientifique,France) is the high-tenacity polyester fiber polyethylene terephthalate.METHODS: Twenty-eight patients with anterior cruciate ligament injury were performed arthroscopic reconstruction of theligament with LARS artificial ligament and were averagely followed up for 20 months.MAIN OUTCOME MEASURES: Patients' anterior drawer test, Lysholm score, range of motion prior to transplantationand in follow-up.RESULTS: The knee unstable symptom of 28 patients disappeared, anterior drawer test was negative, joint function wasgood with the flexion of 5.71 to 129.64 degrees. Average Lysholm score raised from (45.7±9.82) points prior totransplantation to (86.5±6.44) points after transplantation (P < 0.001). All patients resumed normal activities at 2 monthsafter transplantation, without acute or chronic synovitis and host response to materials.CONCLUSION: LARS artificial ligament is a relatively safe transplantation material and especially suitable to reconstructanterior cruciate ligament with sport injury. Mid-/short-term follow-up shows good result.
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In this review,concepts concerning etiology and nonoperative and operative treatment methods have been analyzed.This article is based almost exclusively on peer-reviewed studies.The etiology of nontraumatic osteonecrosis of the femoral head may have genetic basis.The interaction between certain risk factors and a genetic predisposition may determine whether this disease will develop in a particular individual.Early diagnosis and intervention prior to collapse of the femoral head is key to a successful outcome of joint-preserving procedures.The rational for use of joint-sparing procedure in the treatment of this disease is based on radiographic measurements and findings with other imaging modalities.The results of joint-preserving procedures are less satisfactory than the results of total hip arthroplasty for femoral head than have already collapsed.New pharmacological measures as well as the use of growth and differentiation factors for the prevention and treatment of this disease may eventually alter our treatment approach,but it is necessary to await results of clinical research with long-term follow-up of these patients.
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Objective To evaluate the effect of arthroscopic reshaping procedures on symptomatic discoid meniscus and compare the outcomes between children and adults. Methods The medical records of those who had undergone arthroscopic reshaping procedures for symptomatic discoid meniscus between January 1997 to December 2000 were reviewed. Results Fifty-four patients had been followed up more than 7 years, including 38 children and 16 adults. The average Lysholm score increased from (65.0?10.0) preoperatively to (72.0?10.0) postoperatively. The average 8.2-year follow-up showed no obvious clinical symptoms and signs or osteoarthritis in children. Fourteen knees in adults were found osteoarthritis on X-ray film, of which 6 showed the symptoms and signs of osteoarthritis. Conclusion The midterm efficacy of arthroscopic surgery for symptomatic discoid menisci and the occurrence of postoperative osteoarthritis are related to age and injury course.
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To investigate the behavior of meniscal fibrocartilage cells in vitro ,human meniscal fibrocartilage cells were harvested from adolescents and sequentially digestied with 0 50% trypsin and 0 2% collagenase (type2). The isolated cells were cultured in Ham'sF 12 medium and identified by histochemical methods. Cell proliferation, morphology and ultrastructure were observed by phase contrast microscope and electronic microscope. In primarily cultured cells, fusiform cells dominated and they were confirmed by the positive result of immunohistochemical examination for type collagen staining. Our results indicate that it is a simple and highly effective method.
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To investigate the repairing effect of fibrochondrocyte collagen construct in meniscus lesion, fibrochondrocytes were isolated and expanded in vitro , then seeded onto collagen construct .18 dogs with wedged shape lesion in the lateral meniscus were randomly divided into 3 groups: the lesion were filled with either cell collagen construct or collagen or untreated. The lateral meniscus was then examined grossly and histologically at different periods. The results showed that the lesions that had been filled with fibrochondrocyte collagen construct healed with fibrocartilage tissue. The results suggest that tissue engineering method is practical.
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0.05). Conclusion Compared with the Whiteside′s line, the transepicondylar axis seems to be more reliable to determine the rotational alignment of femoral component in total knee arthroplasty. The posterior femoral condylar angle of the Chinese people is larger than that of the Caucasians. If the widely used way of 3? lateral rotational orientation of the femoral component referring to the posterior condylar surfaces of the femur in total knee arthroplasty is adopted, it tends to produce internal malrotation of the femoral prosthesis after operation.