Dexmedetomidine potential in attenuating postoperative delirium in elderly patients after total hip joint replacement

SUMMARY OBJECTIVE: This study aims to evaluate the effectiveness of dexmedetomidine in reducing the occurrence of postoperative delirium in elderly patients after total hip joint replacement. METHODS: Patients who have undergone total hip joint replacement and who were admitted to the hospital from August 1, 2017, to August 1, 2020, were included in this study. After initial screening, 327 out of 385 patients were selected and randomly assigned to either dexmedetomidine (0.1 μg/kg/h, n=163) or placebo (n=164) groups. The occurrence of delirium was examined twice a day for one week by using the Confusion Assessment Method. Furthermore, 30-day all-cause mortality, hospitalization duration and costs, and the presence of any postoperative complications were also evaluated. RESULTS: The postoperative delirium incidence was significantly lower in the dexmedetomidine group compared to that in the placebo group (13.8 vs. 29.3%, p<0.01). The hospitalization duration (17.2±6.3 vs. 15.6±4.2, p=0.006) and cost (4.5±0.9 vs. 4.9±1.1, p=0.001) in the dexmedetomidine group were also lower than those in the placebo group. Meanwhile, no significant difference between the 30-day all-cause mortality of the two groups was observed (p=0.60). In terms of safety, no significant differences between the occurrence of hypotension and bradycardia were also observed. CONCLUSION: Our findings show that the dexmedetomidine medication can reduce the postoperative delirium incidence in older total hip joint replacement patients and can subsequently decrease the related hospitalization duration and cost of these patients.

The working efficiency improvement strategies of ambulatory surgery center serving for hip / knee joint replacement / 中国实用护理杂志

In order to respond to the call of the National Health Commission to implement day surgery, this study elaborated the work process and the efficiency improvement strategies of hip and knee joint replacement in ambulatory surgery centre in foreign countries. It summarized the good points in process, summarized the management experience, combined with domestic conditions. It explored the key steps and matters needing attention related to the ambulatory surgery center of hip and knee joint replacement to provide reference for operating efficiency and speeding up the process of Enhanced Rehabilitation After Surgery in orthopedic field.

Current situation of joint replacement in outpatient department abroad and its Enlightenment to China / 中国实用护理杂志

With the acceleration of the aging process of the population, the demand for joint replacement continues to increase. Under the background of enhanced recovery after surgery, outpatient joint replacement has become a safe, economic and effective model to shorten the average length of stay and reduce the cost of hospitalization. It has been widely used in foreign countries, but there are still some limitations in the development and promotion in China. Therefore, this study intends to review the perioperative management plan and implementation effect of joint replacement in foreign countries, in order to provide reference for the implementation and improvement of the concept of fast track surgery for bone and joint in China.

Risk factors for myocardial infarction following primary total joint arthroplasty / 中国组织工程研究

BACKGROUND: Myocardial infarction is one of the catastrophic complications after total joint arthroplasty. However, the risk factors and predictive model have not been reported in previous research after total joint arthroplasty. OBJECTIVE: To study the incidence and risk factors of myocardial infarction after total joint arthroplasty, and develop a nomogram for predicting the myocardial infarction after total joint arthroplasty. METHODS: We retrospectively reviewed the data of 5 746 patients who underwent total hip arthroplasty or total knee arthroplasty in the Affiliated Hospital of Qingdao university and the People’s Hospital of Xixiu District between September 2013 and July 2017. The baseline characteristic, preoperative comorbidities, preoperative examinations, operative data, other hospital information and follow-up data were collected, recorded and were used to analyze the risk factors of myocardial infarction. In addition, a nomogram was developed based on the independent risk factors for predicting the myocardial infarction after total joint arthroplasty, and receiver operating characteristic curve and calibration curve were used to evaluate the nomogram. RESULTS AND CONCLUSION: Forty-eight patients affected myocardial infarction within 14 days after total joint arthroplasty, and the incidence of myocardial infarction was 0.8%. Multivariate Logistic analysis indicated that age-adjusted Charlson Comorbidity Index, anesthesia type and atrial fibrillation were independent risk factors for postoperative myocardial infarction (P < 0.05). The risk of myocardial infarction in patients with age-adjusted Charlson Comorbidity Index ≥ 5 was higher than patients with age-adjusted Charlson Comorbidity Index < 5. The risk of myocardial infarction in patients receiving general anesthesia was higher than that of patients receiving epidural/lumber anesthesia. The risk of myocardial infarction in patients combined with atrial fibrillation was higher than that in patients without it. Receiver operating characteristic curve showed that the nomogram has a high degree of discrimination (AUC=0.730, 95%CI: 0.661-0.799), and the calibration curve showed that the model had a high degree of calibration. A predictive model based on age-adjusted Charlson Comorbidity Index, anesthesia type and atrial fibrillation can accurately predict the myocardial infarction following total joint arthroplasty.

A Comparative Study of Efficacy of Epidural Ropivacaine (0.2%) and Bupivacaine (0.125%) with Fentanyl (2 mueg/mL) for Postoperative Analgesia in Patients Undergoing Joint Replacement Surgeries

Epidural analgesia is an important component of the multimodal approach to pain management. It is used effectively for postoperative pain management following joint replacement surgeries. In this study, we aimed to evaluate the post-operative analgesic efficacy of epidural Ropivacaine (0.2%) – Fentanyl (2 µg/mL) and epidural Bupivacaine (0.125%) - Fentanyl (2 µg/mL) on patients undergoing joint replacement surgeries.METHODS60 adult patients of ASAPS grade I or II between ages 25 - 65 years of either sex undergoing elective joint replacement surgeries were randomly allocated to two groups: Group A (ropivacaine group) receiving ropivacaine 0.2% (40 mL) + fentanyl (2 µg/mL) and Group B (bupivacaine group) receiving bupivacaine 0.125% (40 mL) + fentanyl (2 µg/mL).RESULTSThe immediate post-operative VAS scores for pain at rest and on touch of patients in the two groups were close to no-pain status. Mean VAS scores at rest showed an incremental trend with passage of time. At 24 hour postoperative interval, mean VAS score at rest was 3.13 ± 0.43 in group A and 3.10 ± 0.40 in group B while mean VAS score on touch was 3.20 ± 0.55 in group A and 3.40 ± 0.68 in group B. Statistically, there was no significant difference between the two groups at any of the follow-up intervals. Thus, as far as analgesic effect of the two drugs was concerned, both the drugs have comparable efficacy in terms of mean VAS scores. In the present study, median VAS scores peaked at 6-hour postoperative interval and remained at same level till the end of study.CONCLUSIONSIn our study, both ropivacaine (0.2%) and bupivacaine (0.125%) with fentanyl (2 µg/mL) combinations showed similar efficacy in postoperative pain management with almost stable hemodynamic profile. Moreover, the ropivacaine group gives better motor blockade and lower overall rescue analgesic needs.

Osteoartrosis interfacetaria secundaria a material de osteosíntesis

La osteoartritis interfacetaria es una de las formas de presentación de la enfermedad degenerativa en la columna vertebral. Se presenta la radiografía de un paciente masculino, mestizo, de 57 años de edad, con antecedentes de fractura de cadera 18 años atrás, por lo que fue sometido a intervención quirúrgica. Se halló evidencias de signos de osteoartrosis interfacetaria causada por el material de osteosíntesis empleado durante la intervención quirúrgica. Se indicaron antiinflamatorios no esteroideos y el reemplazo articular mediante prótesis de porcelana de la cadera derecha y se extrajeron las dos varillas colocadas en la cirugía previa. Se mantiene con tratamiento con antiinflamatorios y ha existido mejoría del dolor lumbar.

Osteoarthritis of the interface is one of the forms of presentation of the degenerative processes to novel spine; It has a greater expression at the level of the spine. An x-ray of a 57-year-old male, mestizo patient is presented, who has a history of hip fracture 18 years ago and in which signs of interface osteoarthritis caused by the osteosynthesis material used during the surgical procedure are evident.

Arthrodesis versus Arthroplasty of the First Metatarsophalangeal Joint in the Treatment of Hallux Rigidus - A Comparative Study of Appropriately Selected Patients / Artrodese versus artroplastia da primeira articulação metatarsofalângica no tratamento do hallux rigidus - Estudo comparativo de pacientes selecionados apropriadamente

Abstract Objective Historical results of arthroplasty of the first metatarsophalangeal joint (1MTP) are relatively poor; however, improvements in the understanding of the normal foot biomechanics, implant materials and design currently make arthroplasty a reasonable option in appropriately selected patients. The present study aimed to compare the clinical and radiographic results of 1MTP arthrodesis and arthroplasty in the treatment of hallux rigidus and to present a rationale for patient selection for arthroplasty. Methods A total of 36 patients (38 feet) with hallux rigidus submitted to surgery (12 arthrodesis and 26 arthroplasties) were prospectively included in the study. Pain was assessed using the visual analogue scale (VAS) and the functional status was assessed using the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) scale. Complications and radiographic results were also analyzed, and survival rates were calculated for both procedures. Results All of the patients reported significant improvement in pain and functional status after surgery. Patients submitted to arthroplasty had better functional results on the AOFAS-HMI scale (89.7 versus 65.7 points; p < 0.001) and better pain relief (VAS 1.6 versus 3.9 points; p = 0.002) when compared with the group submitted to arthrodesis. There was one case of infection in the arthroplasty group and 2 cases of pseudarthrosis in the arthrodesis group. Conclusion Arthrodesis provides pain relief and satisfactory results but alters the biomechanics of gait. Like arthrodesis, arthroplasty improves pain significantly, being a more physiological alternative to preserve the biomechanics of the foot. While the two surgical methods yielded good clinical results, selected patients submitted to arthroplasty had better clinical scores and lower revision rates.

Resumo Objetivo Historicamente, os resultados da artroplastia da primeira articulação metatarsofalângica (1MTP) eram relativamente ruins; no entanto, melhorias na compreensão da biomecânica normal do pé, nos materiais e no design dos implantes, tornam a artroplastia um tratamento aceitável em pacientes selecionados. O presente estudo pretendeu comparar os resultados clínicos e radiográficos da artrodese com os da artroplastia da 1MTP no tratamento de hallux rigidus e apresentar um racional para seleção de pacientes para artroplastia. Métodos Um total de 36 pacientes (38 pés) com hallux rigidus operados (12 artrodeses e 26 artroplastias) foram prospectivamente incluídos. A dor foi avaliada com recurso à escala visual analógica (VAS) e o resultado funcional usando a escala American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI). As complicações e os resultados radiográficos foram também registrados e a taxa de sobrevida calculada para os dois procedimentos. Resultados Todos os pacientes referiram uma melhoria significativa na dor e nos resultados funcionais após a cirurgia. Os pacientes submetidos a artroplastia tiveram melhor resultado funcional na escala AOFAS-HMI (89,7 versus 65.7 pontos; p < 0.001) e melhor alívio da dor (VAS 1,6 versus 3,9 pontos; p = 0,002) quando comparados com os doentes submetidos a artrodese. Registrou-se um caso de infecção no grupo da artroplastia e 2 casos de pseudoartrose no grupo da artrodese. Conclusão A artrodese permite alívio da dor e resultados satisfatórios, mas altera a biomecânica da marcha. Tal como a artrodese, a artroplastia melhora a dor significativamente, sendo uma alternativa mais fisiológica para preservar a biomecânica do pé. Apesar dos dois tratamentos terem bons resultados clínicos, em pacientes selecionados, a artroplastia teve melhores resultados clínicos e menor taxa de revisão.

Current status of surgical treatment for traumatic arthritis / 解放军医学杂志

Traumatic arthritis (TA) is one of the common diseases of bone and joint caused by trauma. The main pathological changes are degeneration of articular cartilage and secondary hyperplasia and ossification of cartilage. The main clinical manifestations are joint pain and dysfunction of movement. Its pathogenesis is still unclear. At present, the treatment of TA is based mainly on symptoms rather than etiology, including physical therapy, drug treatment, surgical treatment, etc. Conservative treatment (physical therapy, drug treatment) can only alleviate short-term pain, and the long-term effect is not satisfactory. Thus, patients with middle and late TA tend to choose surgical treatment. At present, the surgical treatment of TA includes arthroscopic debridement, arthrodesis, cartilage repair, osteotomy, artificial joint replacement, 3D printing technology, etc. There are differences in the postoperative efficacy. This article reviews the current situation of surgical treatment for TA.

Crisk assessment of contralateral knee arthroplasty after unilateral total knee arthroplasty / 中国组织工程研究

BACKGROUND: After total knee arthroplasty, some patients will receive the contralateral total knee arthroplasty again, but the influencing factors of contralateral knee surgery are not clear at present. OBJECTIVE: To evaluate the risk ratio of contralateral knee to total knee arthroplasty in patients with osteoarthritis of both knees after total knee arthroplasty, and to analyze the risk factors of contralateral total knee arthroplasty by clinical and radiographic indicators. METHODS: Data of 193 patients admitted to Affiliated Hospital of Xuzhou Medical University from 2013 to 2015 with bilateral knee osteoarthritis and undergoing unilateral total knee arthroplasty (follow-up time of 1-66 months) were retrospectively analyzed. The patients were divided into bilateral arthroplasty and unilateral arthroplasty groups based on whether the contralateral knee joint was replaced. K-M survival analysis was used to evaluate the risk ratio of contralateral knee total knee arthroplasty. Age, gender, body mass index, primary surgical side, non-operative knee Hospital for Special Surgery score, pain, mechanical axis perpendicular angle, medial and lateral joint space, femoral tibial angle, hip knee ankle angle, and Kellgren-Lawrence grade at initial surgery were used to assess the risk of contralateral total knee arthroplasty. RESULTS AND CONCLUSION: (1) Fifty-eight patients (30.1%) received contralateral total knee arthroplasty. The risk of nonoperative knee surgery at 1 year was 8%, and the risk of nonoperative knee surgery at 5 years was 32%. (2) The K-L grade was highly correlated with the risk of future nonoperative total knee arthroplasty (P < 0.001). The mean survival time of the nonoperative knee with K-L grade 4 was 45.7 months, and the 5-year surgical risk was 44.3%. (3) Age, gender, initial surgery side and body mass index, medial and lateral joint space, and hip knee ankle angle were not risk factors for progression to contralateral total knee arthroplasty. Nonoperative knee mechanical axis perpendicular angle (risk ratio=1.437, P < 0.001), femoral tibial angle (risk ratio=1.232, P <0.001) and K-L classification (risk ratio=2.110, P=0.005) were independent risk factors. Patients with femoral tibial angle ≥185.8° and mechanical axis perpendicular angle ≥2.75° had a higher risk of contralateral total knee arthroplasty (P <0.001). (4) The preoperative Hospital for Special Surgery score of the bilateral arthroplasty group was significantly lower than that of the unilateral arthroplasty group (P=0.039). Visual analogue scale pain score in the preoperative bilateral arthroplasty group was significantly higher than that in the unilateral arthroplasty group (P=0.013). At 6 months postoperatively, Hospital for Special Surgery score was improved in both groups, but still lower in the bilateral arthroplasty group than that in the unilateral arthroplasty group (P=0.003). (5) Not all patients with bilateral knee osteoarthritis need to receive contralateral total knee arthroplasty after unilateral total knee arthroplasty, and patients with severe knee osteoarthritis (K-L grade 4) are at high risk of needing contralateral total knee arthroplasty. Preoperative contralateral knee mechanical axis perpendicular angle, femoral tibial angle, Hospital for Special Surgery score and pain degree can be used as important factors to recommend patients or arrange a reoperation plan.

Clinical pathways in total hip or knee arthroplasty as compared with traditional pathways: A meta-analysis / 中国组织工程研究

BACKGROUND: Hip and knee arthroplasty has been widely carried out in various levels of hospitals. The amount of hip and knee joint surgery has increased year by year. The surgical methods and techniques have reached a difficult time. Promoting the clinical pathway is an effective method to improve the treatment effect. OBJECTIVE: To systemically evaluate the difference between the clinical pathways and conventional pathways in total hip arthroplasty and total knee arthroplasty. METHODS: Clinical trials about the comparison of conventional and clinical pathways in total hip arthroplasty and total knee arthroplasty were searched in MEDLINE, Cochrane Library, EMbase, and CNKI. Study selection, data collection and evaluation of methodological quality were undertaken by two reviewers independently. The Cochrane Collaboration’s RevMan 5.0 was used for data analyses. RESULTS AND CONCLUSION: (1) Totally 17 clinical trials meeting research design criteria were included in this analysis, including 13 semi-randomized controlled trials and 4 randomized controlled trials. (2) The incidence of complications in the traditional method group was higher than that in the clinical pathway group [OR=0.63, 95%C/(0.53, 0.74), P < 0.000 01]. (3) Pain visual analogue scale score [MD=1.49, 95%C/(0.69, 2.85), P=0.001], postoperative Harris hip score [MD=19.31, 95%C/(-13.98, -4.92), P< 0.000 1], and 5-year prosthesis survival rate [OR=0.59, 95% Cl (0.36, 0.98), P=0.04] were better in the clinical pathway group than in the traditional method group. (4) There was no significant difference in postoperative mean deviation of mechanical axes of lower limbs after total knee arthroplasty in both groups [MD-0.0Q, 95%C/(-0.14, 0.14), P=0.99]. (5) Results showed that compared with traditional technique, hip and knee arthroplasty patients who entered the clinical pathway had better clinical efficacy, fewer complications and better joint function after operation.

Learning curve and early clinical results of total hip arthroplasty with MAKO robot assisted posterolateral approach / 中国组织工程研究

BACKGROUND: With the maturity of total hip arthroplasty, the need for operative accuracy is highly increasingto get better operative results. The joint replacement technique assisted by MAKO robot makes the precision of the operation possible. However, this technology has a certain learning curve, and early replacement results and complications should be the major concern. OBJECTIVE: To analyze the learning curve and early clinical results of total hip arthroplasty through the posterolateral approach assisted by the MAKO robot. METHODS: From March 2017 to March 2018, 26 patients undergoing hip arthroplasty via posterolateral approach assisted by MAKO robots in West Hospital (Haikou Orthopedics and Diabetes Hospital), Haikou Hospital, Xiangya School of Medicine, Central South University, including 12 males and 14 females, were retrospectively analyzed. The problems and early clinical outcomes of hip replacement in the early learning curve were focused on. RESULTS AND CONCLUSION: The operation time was 56-155 minutes, mean (87.0 ± 16.1) minutes. The dominant bleeding was 220-850 mL, mean (336±246) mL. The acetabular abduction angle was (41,3±2.7)°. The acetabular anteversion angle was (16.4±3.4)°. The difference in lower limb length was (1,0±2.0) mm, and the femoral offset error value was (1.6±0.6) mm. Intraoperative femoral fractures occurred in one case. No infection, sciatic nerve injury or wound-related complications occurred. The weight bearing time was 3-6 weeks, mean (3.8±2.1) weeks. Harris score was (92.1 ±4.7) 3 months after surgery. It is indicated that the MAKO robot-assisted total hip arthroplasty via posterolateral approach showed that patient’s postoperative pain improved; the function recovered quickly; the clinical results were good; the operation time decreased with the proficiency; the prosthesis position was within the safe range; and the blood loss was within the acceptable range.

Underlying targets and mechanism of taohong siwu decoction in prosthetic joint infection on network pharmacology / 中国组织工程研究

BACKGROUND: Taohong Siwu Decoction has a good effect in the treatment of periprosthetic infection after joint replacement, and can improve the function of joint movement. However, most present studies focus on the antibacterial effect of single drug and its components in the prescription, and there is little research on the compound and other mechanisms. OBJECTIVE: To explore the mechanism of Taohong Siwu Decoction in the treatment of periprosthetic joint infection. METHODS: Ingredients and target genes of Semen Persicae, Carthami Flos, Rehmanniae Radix Praeparata, Paeoniae Radix Alba, Angelicae Sinensis Radixand and Chuanxiong Rhizoma were screened by Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform. Periprosthetic joint infection-related target genes were obtained from the human gene database (GeneCards). Cytoscape3.7.2 was used for constructing a “Drug-Ingredient-Target-Disease” network. The key target genes were introduced into the STRING to construct protein-protein interaction network. We analyzed the mechanism by Kyoto Encyclopedia of Genes and Genomes and Gene Ontology biological enrichment analysis. RESULTS AND CONCLUSION: (1) Totally 15 active components, such as quercetin, luteolin and kaempferol, were screened from Taohong Siwu Decoction, which acted on 34 key genes, such as vascular endothelial growth factor A, tumor necrosis factor, and interleukin-6. (2) Gene Ontology function enrichment showed that the biological process and function of Taohong Siwu Decoction were concentrated in positive regulation of biological process, response to chemical stimulus, response to stress, and regulation of apoptosis. (3) Kyoto Encyclopedia of Genes and Genomes pathway enrichment showed that the treatment of periprosthetic joint infection by Taohong Siwu Decoction mainly involved pathways in cancer, AGE-RAGE signaling pathway, fluid shear stress and atherosclerosis, inflammatory bowel disease and cytokine-cytokine receptor interaction pathway. (4) Through the study of network pharmacology, it is found that Taohong Siwu Decoction could treat periprosthetic joint infection by inhibiting bacterial growth and improving hemorheology, which provided a preliminary theoretical basis for the application of “activating circulation and removing blood stasis” in periprosthetic joint infection and a new idea for subsequent experiments.

Debridement antibiotics irrigation and implant retention for the treatment of acute infection after total knee arthroplasty / 中国组织工程研究

BACKGROUND: Compared with revision surgery, debridement antibiotics irrigation and implant retention for treatment of periprosthetic joint infection has the advantages of fewer traumas, shorter time, and lower cost. However, the indications and perioperative management are still controversial. OBJECTIVE: To review the application of preoperative indication, intraoperative operation and postoperative antibiotic application of debridement antibiotics irrigation and implant retention for the periprosthetic joint infection. METHODS: PubMed, Web of Science, Embase, and The Cochrane Library database were retrieved from 2000 to 2018. The key words were “total knee arthroplasty, periprosthetic joint infection, diagnose, treatment”. Chinese literature was searched in the Wanfang database and CNKI from 2000 to 2018, and the keywords were “arthroplasty, postoperative infection, debridement antibiotics irrigation and implant retention”. Relevant literatures were screened, and the success rate of retained prosthesis in the treatment of infection after joint replacement was counted. The most accurate diagnostic criteria and the most effective treatment methods were summarized. RESULTS AND CONCLUSION: At present, there is no unified international standard for the diagnosis of periprosthetic joint infection after joint replacement. Many organizations have put forward some consensus and guidelines. Parvizi et al. proposed new diagnostic criteria for periprosthetic joint infection based on other consensus and guidelines, which is highly sensitive and specific, and has been accepted by most people. Debridement antibiotics irrigation and implant retention is suitable for patients with stable and well-fixed prosthesis, short symptom duration, good soft tissue, and no sinus tract formation. During the operation, the infected necrotic tissue and the suspected infected tissue should be thoroughly removed. The iodine-blood water should be soaked for half an hour; the new gasket should be replaced; and the sterilized towel should be replaced with a new set of surgical tools. According to the results of postoperative culture, sensitive antibiotics were combined and rifampin was taken orally out of hospital for 4 months. Debridement antibiotics irrigation and implant retention is the best method for the treatment of periprosthetic joint infection, and has the advantages of less pain, less cost, high acceptance and avoiding revision.

Nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft for the treatment of ARCO stage III osteonecrosis of the femoral head / 中国组织工程研究

BACKGROUND: It remains controversial whether patients with ARCO stage III osteonecrosis of the femoral head should be treated with femoreal head preserving surgery, and what the clinical efficacy of femoreal head preserving surgery is. OBJECTIVE: To investigate the clinical efficacy of nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft in the treatment of ARCO stage III osteonecrosis of the femoral head METHODS: From March 2017 to September 2018, 36 patients (32 male and 4 female, 16-58 years old) with ARCO state III osteonecrosis of the femoral head who received treatment in Aviation General Hospital were included in this study. Among these patients, three had bilateral osteonecrosis of the femoral head and 33 had unilateral osteonecrosis of the femoral head. According to ARCO classification, 35 hips fell into stage IIIA, 3 hips in stage IIIB, and 1 hip in stage IIIC. All included paitents underwent nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft. Postoperative follow up was performed. Hip joint function was evaluated using Harris hip score. The degree of collapse of the femoral head was evaluated using X-ray imaging. The osteogenesis in the necrotic area was determined by CT scans. This study was approved by Aviation General Hospital Ethics Committee (Ethics code: HK2019-01-04). RESULTS AND CONCLUSION: (1) Thirty-six patients were followed up for (19.28±6.51) months. At the last follow-up, 4 hips ultimately underwent total hip arthroplasty with the success rate of 89.7%(35/39). (2) Harris hip score revealed that at the last follow-up, the excellent and good rate of hip function was significantly higher than that before surgery (71.8%,17.5%, P=0.000). (3) Last follow-up CT scans revealed obvious osteogenesis was observed in 26 of 35 hips at ARCO stage IIIA and it was observed in neither 3 hips at ARCO stage IIIB nor in 1 hip at ARCO stage IIIC. (4) At the last follow-up, X-ray showed that there was progress in 5 of the 35 hips (IIIA), 3 of which progressed to ARCO stage IIIB, 2 to ARCO stage IV, and the remaining 30 hips were stable without progression; three hips in ARCO stage IIIB progressed, including 2 progressed to ARCO stage IIIC and 1 to ARCO stage IV; 1 hip in ARCOIIIC stage progressed to ARCO stage IV. The results suggest that nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft has a good effect on the treatment of ARCO stage III osteonecrosis of the femoral head.

Clinical significance of external wall of femoral intertrochanteric fracture and the treatment of internal fixation / 中国组织工程研究

BACKGROUND: The concept of the lateral wall as a hot area has emerged in recent years, and has great guiding significance for the treatment of intertrochanteric fractures. OBJECTIVE: To review the definition, scope, thickness of the lateral wall and its important role in the surgical treatment of intertrochanteric fractures. METHODS: The authors searched Wanfang, CNKI, PubMed, and Web of Science. The search terms were “intertrochanteric fracture, lateral wall, fracture fixation” in Chinese and English. The retrieved documents were sorted, analyzed and summarized. RESULTS AND CONCLUSION: (1) The definition, scope, thickness and measurement method of the lateral wall and its clinical significance were sorted out. (2) Classification criteria based on lateral intertrochanteric fractures of the femur were summarized. (3) In terms of treatment, four kinds of treatment methods: Extramedullary fixation, intramedullary fixation, artificial joint replacement and other treatment methods were listed. Causes and treatment of fracture of lateral wall during and after operation were analyzed. (4) The results showed that the integrity of the lateral wall directly affected the stability of the internal fixation, even the success of the internal fixation. The complete lateral wall can prevent the distal femur from moving inward and the head pin from withdrawing, and prevent the coxa varus deformity. Clinicians should make use of detailed imaging examination, analyze fracture types, comprehensively consider various factors, and select appropriate repair methods.

Osteochondroma of mandibular ramus and condylar neck: simultaneous resection and reconstruccion with personalized alloplastic joint prosthesis / Osteocondroma de la rama mandibular y cuello del cóndilo: resección y reconstrucción simultánea con prótesis articular personalizada aloplástica

Osteochondromas are benign osteogenic tumors that can attain great size, which may require resection and additional treatment to restore the jaw's shape and function. In this report, an osteochondroma located on the mandibular ramus and neck of the condyle was resected and reconstructed simultaneously through a total joint replacement. After the surgery, the patient remains asymptomatic and recovers opening and closing ranges, phonation and the masticatory function. The immediate reconstruction after resection is a good alternative to avoid a second operation and the presurgical virtual planning ensures the complete removal of the lesion using cutting guides and covering the entire defect with a customized alloplastic joint prosthesis.

Los osteocondromas son tumores osteogénicos benignos que pueden alcanzar grandes tamaños, los cuales requieren de resección quirúrgica y generalmente de algún tratamiento adicional para restaurar la forma y la función mandibular. En este caso, un osteocondroma localizado en la rama mandibular y el cuello del cóndilo fue reseccionado y reconstruido simultáneamente a través de un reemplazo articular total. Después de la cirugía, el paciente permanece asintomático y recupera los intervalos de apertura y cierre, la fonación y la función masticatoria. La reconstrucción inmediata después de la resección es una buena alternativa para evitar una segunda operación, y la planificación virtual prequirúrgica garantiza la eliminación completa de la lesión utilizando guías de corte y cubriendo todo el defecto con una prótesis articular aloplástica personalizada.

¿Qué hay de nuevo para el diagnóstico de infecciones periprotésicas después del Consenso de Filadelfia? / What's new for the diagnosis of periprosthetic infections after the Philadelphia consensus?

Resumen: Actualmente contamos con diversos métodos de laboratorio para el diagnóstico de las infecciones periprotésicas, algunos ampliamente probados y otros en estudio. Han aparecido nuevos biomarcadores después del Consenso de Filadelfia, por tal motivo, nos planteamos hacer una revisión acerca de qué hay de nuevo para su diagnóstico después del Consenso y cuáles podrían ser los más útiles para el trabajo clínico diario. Material y métodos: Se revisaron artículos publicados entre 2013-2017 en cinco revistas de alto impacto. Las variables fueron: tipo de biomarcador, cifras de corte, sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo, área bajo la curva, razón de momios diagnósticos y cocientes de probabilidad positivos y negativos. Se calificó nivel de evidencia. Resultados: Los resultados se agruparon en Tablas. Se encontraron 54 artículos, de los cuales 31 no se ajustaban a los criterios de inclusión y fueron excluidos; sólo se incluyeron 23. Se encontraron 19 biomarcadores, cinco de los cuales no habían sido reportados hasta antes de 2013: La α defensina sinovial 1, la β defensina humana 3, el lactato sinovial y los receptores tipo Toll 1 y Toll 6. Conclusión: Los biomarcadores que ofrecen mayor utilidad clínica para el diagnóstico de IAP son: la proteína C reactiva, la esterasa leucocitaria, la interleucina-6, la interleucina-1β, la α-defensina y la interleucina-17. Detectamos cinco nuevos marcadores. Los estudios analizados muestran heterogeneidad en sensibilidad, especificidad y en sus cifras de corte. En la mayoría no usan aplicaciones estadísticas avanzadas que los harían más confiables.

Abstract: We now have a great variety of laboratory diagnostic tools, for the detection of PJI, some of them widely used and others under study. After the Philadelphia Consensus, they have emerged some new biomarkers. Because of that, we consider useful to review which new biomarkers we have for the diagnosis of PJI after the Consensus and which of them could be more useful in daily clinic work. Material and methods: We searched for articles published from 2013 to 2017 in 5 high impact journals. The analized variables were: biomarker type, cutoff value, sensitivity, specificity, positive predictive value, negative predictive value, area under the curve, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio. We value their evidence level. Results: Results were grouped in Tables. They were found 54 articles, 31 of them didn't meet the inclusion criteria so they were excluded; 23 studies were included in the revision. We found a total of 19 biomarkers studies, 5 of them weren't reported before 2013: Sinovial α defensin 1, human β defensin-3, sinovial lactate and Toll-like receptors 1 and 6. Conclusion: Of all the markers reviewed for the diagnosis of PJI, C reactive protein, esterase test strip, interleukin-6, interleukin-1 β, α defensin and interleukin-17 show the highest diagnostic utility. We found 5 new markers. The articles studies show high heterogeneity in their reported sensitivity, specificity and cutoff values. In most of them were not used advanced statistical tools which could make them more reliable.

Effect of home visit intervention on joint function and life ability of patients after hip arthroplasty / 中国实用护理杂志

Objective@#To observe the effect of home visit on joint function and complications of patients undergoing hip replacement.@*Methods@#Ninety cases of patients with artificial hip replacement who were admitted to our hospital from January to December 2017 were randomly divided into two groups by random Number Table Method.45 patients in the control group were given routine nursing after discharge, and 45 patients in the observation group were treated with home visit nursing. The hip function and living ability of the two groups were evaluated 8, 12, 16 weeks after discharge,and the complication rate was compared.@*Results@#The self-care ability scores of the observation group at 8, 12 and 16 weeks after discharge were 102.23±11.20, 108.36±10.41, 116.25±10.36 higher than those of the control group at 97.86±10.35), 100.21±14.26, 104.23±15.6, with significant differences (t=1.922, 3.097, 4.294, P < 0.05 or 0.01). The Harris scores of the observation group at 8, 12 and 16 weeks after discharge were 82.31±11.27, 87.38±10.05, 95.10±11.23 higher than those of the control group at 78.02±10.23, 83.41±11.74, 89.43±11.62, with significant differences (t=1.891, 1.723, 2.343, P < 0.05). The incidence of complications in the observation group at 16 weeks after discharge was 0 lower than 13.33% (6/45) in the control group (χ2=6.429, P=0.011).@*Conclusions@#Home visit intervention can improve the self-nursing ability of the patients after hip joint operation, promote the recovery of hip function and life ability, and reduce the complications.

Effect of different anesthesia methods on perioperative volume load of lower limb joint replacement in patients with coronary heart disease / 中国医师进修杂志

Objective@#To compare the effects of general anesthesia, intraspinal anesthesia combined with general anesthesia and lumbar plexus block combined with general anesthesia on the volume load of lower limb joint replacement surgery in patients with coronary heart disease.@*Methods@#One hundred and twenty patients (ASA classification Ⅱ-Ⅲ) with coronary heart disease who underwent selective lower extremity arthroplasty in Hubei Aerospace Hospital from January 2017 to November 2018 were randomly divided into three groups: general anesthesia group (group A), spinal canal combined with superficial general anesthesia group (group B) and lumbar plexus nerve block combined with superficial general anesthesia group (group C), with 40 cases in each group. The mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), stroke volume index (SVI) and stroke volume variation (SVV) were observed and recorded at the time of entering operation room (T0), immediate induction of anesthesia(T1), immediately after the operation (T2), 1 h after surgery (T3) and at the end of the operation (T4) in three groups. The operation time, anesthesia time and the incidence of complications of the three groups were recorded.@*Results@#At T1, HR, MAP, CI and SVV of the three groups were lower than T0, and SVV were higher than T0, and there were significant differences (P < 0.05). At T1 and T2, the MAP, CI and SVI in group B were significantly lower than those in group A and group C[T1: (76.8 ± 5.4) mmHg (1 mmHg=0.133 kPa)vs. (84.4 ± 14.9) and (86.4 ± 19.1) mmHg, (1.9 ± 0.6) L/(min·m2) vs. (2.5 ± 0.7) and (2.3 ± 0.5) L/(min·m2), (35.5 ± 11.5) ml/m2 vs.(40.5 ± 11.8) and (39.2 ± 10.3) ml/m2; T2: (74.6 ± 6.7) mmHg vs. (89.9 ± 17.8) and (82.8 ± 19.7) mmHg, (2.6 ± 0.7) L/(min·m2) vs. (2.8 ± 0.7) and (2.6 ± 0.4) L/(min·m2), (38.2 ± 13.7) ml/m2 vs. (44.9 ± 7.9) and (45.8 ± 8.3) ml/m2], and at T1, the SVV of group B was significantly higher [(15.6 ± 2.1)% vs. (13.8 ± 4.3)% and (13.9 ± 2.9)%], and there were significant differences (P < 0.05). At T2-T4, the HR and MAP of group A were significantly higher than those of the other two groups (P < 0.05). The incidence of hypertension, hypotension and unstable angina pectoris in group C was significantly lower than that in group A and group B [5.0%(2/40) vs. 20.0%(8/40) and 35.0%(14/80)](P < 0.05).@*Conclusions@#Lumbar plexus block combined with shallow general anesthesia is safer for patients with coronary heart disease because of its smaller fluctuation of volume load index, more stable hemodynamics and lower incidence of cardiovascular adverse events.

Non-cemented modular prosthetic reconstruction for bone defect after tumor resection in lower extremities / 中国修复重建外科杂志

Objective: To report the preliminary clinical results and analyze the prognostic factors of prosthetic failures with non-cemented modular prosthetic reconstruction after tumor resection in lower extremities. Methods: A clinical data of 150 patients with lower extremity tumors treated with MEGASYSTEM-C non-cemented modular prosthetic reconstruction between October 2011 and September 2016 was retrospectively analyzed. There were 88 males and 62 females, aged from 12 to 81 years, with a median age of 24 years. According to World Health Organization (WHO) classification of bone tumors, 120 cases were primary malignant tumors, 27 cases were intermediate tumors, and 3 cases were metastatic tumors. Among them, 134 cases underwent primary operation and 16 cases underwent reoperation after recurrence. Eighty-seven patients with malignant tumors received chemotherapy before and after operation, and no patient received local radiotherapy during perioperative period. Proximal femur was reconstructed in 32 cases, distal femur in 83 cases, and proximal tibia in 35 cases. The postoperative follow-up time, the results of oncology (survival status and tumor recurrence), and prosthesis failure (prosthesis survival rate, reasons for failure, treatment plan after failure) were recorded. The reason of the prosthesis failure was classified into 5 types according to the classification defined by Henderson et al. Kaplan-Meier survival analysis and Log-Rank test were used to analyze patient and prosthesis survival. Lower extremity function was assessed by using the Musculoskeletal Tumor Society (MSTS) scoring system and MSTS scores were compared for patients with different reconstruction sites. Results: All patients were followed up 5-84 months, the median follow-up time was 39 months. During the follow-up period, there were 116 cases of tumor-free survival, 10 cases of tumor-bearing survival, and 24 died of lung metastasis or multiple metastases. The 3-year and 5-year survival rates of 120 patients with primary malignant tumors were 83.1% and 76.6%. There was no significant difference in survival rate between different reconstruction sites ( P=0.851). Seven cases (4.7%) had local recurrence at 7-21 months after operation. The 3-year and 5-year survival rates of the prosthesis in 150 patients were 94.4% and 92.5%. There was no significant difference in survival rate between different reconstruction sites ( P=0.765). There were 26 failures in 24 patients (16.0%) during the follow-up period. There were 9 cases of type 1 failure, 1 case of type 2 failure, 3 cases of type 3 failure, 5 cases of type 4 failure, and 8 cases of type 5 failure. At last follow-up, 120 of the 126 patients survived without prosthetic failure. Except that the influence of different parts of prosthesis on the incidence of type 4 failure ( P=0.029), the influence of chemotherapy on the incidence of type 5 failure ( P=0.002) were significant, the influence of other types of failure on different reconstructed parts of prosthesis, initial operation, and perioperative chemotherapy had no significant difference ( P>0.05). There were 5 cases of amputation (4 cases of type 5 failure, 1 case of type 4 failure), 3 cases of prosthesis removal (1 case of type 2 failure, 1 case of type 3 failure, 1 case of type 4 failure), 3 cases of revision while keeping the original prosthesis (2 cases of type 1 failure, 1 case of type 5 failure). The overall MSTS score was 24±3. The MSTS scores were 24±3, 25±3, and 23±3 in patients whose reconstruction sites located in proximal femur, distal femur, and proximal tibia, respectively, showing no significant difference ( F=3.014, P=0.052). Conclusion: The short-term follow-up showed a lower incidence of complications and good function for MEGASYSTEM-C non-cement modular prosthesis system in treatment of bone defects after lower limb tumor resection. The main factors affecting the early survival of prosthesis were tumor progression and infection.