ABSTRACT
Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.
ABSTRACT
TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.
ABSTRACT
Objective@#To investigate the clinical effects of primary revision after artificial hip replacement and causes of revision surgery.@*Methods@#A total of 344 patients who underwent revision surgery after total hip arthroplasty (THA) and artificial femoral head replacement from January 2010 to December 2016 were retrospectively analyzed. There were 141 males and 203 fe-males, with a mean age 65.64±10.81 years (28-87 years). A total of 351 hip revisions were performed in 344 patients with 7 pa-tients in bilateral revisions. All patients were followed up for 60.38±22.75 months (24-105 months). All patients with periprosthet-ic infection underwent two-stage revision after prosthesis placement, and all others underwent one-stage revision. The clinical out-comes of revision surgery were assessed with the Harris hip score and the survival rate of the revision prosthesis. According to the duration from artificial hip replacement to revision surgery, all patients were divided into early revision (less than 5 years) and late revision (more than 5 years) groups. They were also divided into two groups according to the age of the patient in revision sur-gery: >55-year-old and ≤55-year-old groups. The causes of revision, hip reoperation and re-revision were recorded.@*Results@#In the 351 hip revisions, a total of 238 (67.8%) had aseptic loosening, 41 (11.7%) periprosthetic fractures, 30 (8.5%) periprosthetic infection, 23 (6.6%) recurrent dislocation and 19 (5.4%) the eccentric liner wear. The infection rate was significantly higher in the early revision group (21.1%) than that in the late revision group (4.2%) (χ2=24.443, P<0.001). The aseptic loosening rate was sig-nificantly higher in the late revision group (72.4%) than that in the early revision group (54.4%) (χ2=9.899, P=0.002). Sixteen pa-tients underwent hip surgery after revision, including 6 recurrent dislocations, 4 aseptic loosening, 3 periprosthetic fractures, and 3 periprosthetic infections. Eight of them underwent revision surgery, including 4 cases of aseptic loosening, 2 cases of periprosthet-ic fractures, and 2 cases of recurrent dislocation. The duration from the primary revision to the second revision was 22.1±10.0 months (1-75 months). The 5-year and 8-year survival rates of the revision prostheses were 99.3%[95%CI(98.3%, 100.3%)] and 92.6% [95%CI(87.1%, 98.1%)], respectively. The proportions of prosthetic infection and eccentric liner wear in the ≤55-year-old group were significantly higher than those in the >55-year-old group (χ2=3.981, P=0.046; χ2=5.226, P=0.022), while the propor-tion of aseptic loosening in the >55-year-old group was significantly higher than that in the ≤55-year-old group (χ2=5.254, P=0.022). The 8-year survival rates of the revision prostheses of ≤55-year-old group and >55-year-old group were 76.8% [95%CI(50.5%, 103.1%)] and 95.4% [95%CI(91.1%, 99.7%)], respectively.@*Conclusion@#Young patients have a higher risk of re-revi-sion after revision THA.
ABSTRACT
Objective To investigate the clinical effects of primary revision after artificial hip replacement and causes of revision surgery. Methods A total of 344 patients who underwent revision surgery after total hip arthroplasty (THA) and artificial femoral head replacement from January 2010 to December 2016 were retrospectively analyzed. There were 141 males and 203 fe?males, with a mean age 65.64±10.81 years (28-87 years). A total of 351 hip revisions were performed in 344 patients with 7 pa?tients in bilateral revisions. All patients were followed up for 60.38±22.75 months (24-105 months). All patients with periprosthet?ic infection underwent two?stage revision after prosthesis placement, and all others underwent one?stage revision. The clinical out?comes of revision surgery were assessed with the Harris hip score and the survival rate of the revision prosthesis. According to the duration from artificial hip replacement to revision surgery, all patients were divided into early revision (less than 5 years) and late revision (more than 5 years) groups. They were also divided into two groups according to the age of the patient in revision sur?gery:＞55?year?old and≤55?year?old groups. The causes of revision, hip reoperation and re?revision were recorded. Results In the 351 hip revisions, a total of 238 (67.8%) had aseptic loosening, 41 (11.7%) periprosthetic fractures, 30 (8.5%) periprosthetic infection, 23 (6.6%) recurrent dislocation and 19 (5.4%) the eccentric liner wear. The infection rate was significantly higher in the early revision group (21.1%) than that in the late revision group (4.2%) (χ2=24.443, P＜0.001). The aseptic loosening rate was sig?nificantly higher in the late revision group (72.4%) than that in the early revision group (54.4%) (χ2=9.899, P=0.002). Sixteen pa?tients underwent hip surgery after revision, including 6 recurrent dislocations, 4 aseptic loosening, 3 periprosthetic fractures, and 3 periprosthetic infections. Eight of them underwent revision surgery, including 4 cases of aseptic loosening, 2 cases of periprosthet? ic fractures, and 2 cases of recurrent dislocation. The duration from the primary revision to the second revision was 22.1 ± 10.0 months (1-75 months). The 5?year and 8?year survival rates of the revision prostheses were 99.3%[95% CI(98.3%, 100.3%)] and 92.6% [95% CI(87.1%, 98.1%)], respectively. The proportions of prosthetic infection and eccentric liner wear in the≤55?year?old group were significantly higher than those in the＞55?year?old group (χ2=3.981, P=0.046; χ2=5.226, P=0.022), while the propor?tion of aseptic loosening in the＞55?year?old group was significantly higher than that in the ≤55?year?old group (χ2=5.254, P=0.022). The 8?year survival rates of the revision prostheses of ≤55?year?old group and＞55?year?old group were 76.8% [95% CI (50.5% , 103.1% )] and 95.4% [95% CI (91.1% , 99.7% )], respectively. Conclusion Young patients have a higher risk of re?revi?sion after revision THA.