Periprosthetic fractures: the increasing challenges / 中华创伤骨科杂志

Surgery for periprosthetic fractures (PPF) is one of the most complex procedures in orthopedics. It is difficult, highly risky and extremely challenging, because the patients are usually advanced in age and suffering from essential organ dysfunction, numerous comorbidities, poor overall body condition, poor bone quality combined with osteolysis and even bone loss, and because the surgeons have to apply the concepts and techniques of Modern Orthopedic Trauma and artificial joint revision techniques in fracture fixation and prosthesis revision. This paper expounds on the clinical challenges due to the characteristics of PPF in order to call on clinical surgeons to update their concepts, deal with seriously and standardize their PPF treatment, and effectively improve their efficacy.

Research progress of continuous passive movement after total knee arthroplasty / 国际外科学杂志

With the common occurrence of knee osteoarthritis, total knee arthroplasty has become an effective method for the treatment of middle and late knee osteoarthritis. Continuous passive movement is an effective auxiliary method for rehabilitation after total knee arthroplasty, but it also has some limitations. This article reviews the research progress of continuous passive movement after total knee arthroplasty.

Lubricación in vitro en prótesis articulares / In Vitro Lubrication In Joint Prostheses

Entender el desgaste prematuro en reemplazos articulares debido a una lubricación deficiente, que puede resultar en valores de fricción altos, es un tema amplio e intrincado de abordar. Además, si el lubricante es el fluido sinovial, los mecanismos de lubricación que ocurren son aún más complejos de develar. En este artículo se revisa el estado de conocimiento actual de la lubricación sinovial, así como las características reológicas del fluido lubricante. Asimismo, se mencionan algunas técnicas experimentales y métodos numéricos con los que se ha estudiado el problema de la lubricación. En algunas simulaciones numéricas de la lubricación en reemplazos articulares no se considera el efecto del esfuerzo cortante del líquido sinovial ya que se asume que tiene un comportamiento newtoniano, sin embargo, otras investigaciones han demostrado que al asumir un comportamiento no newtoniano el proceso de lubricación se afecta significativamente. Con todo esto, incorporar todos los factores que pueden afectar la lubricación en reemplazos articulares, en simulaciones numéricas hasta la fecha es un reto. A través de diversas investigaciones se buscan nuevos materiales, diseños y técnicas de análisis que permitan incrementar la vida útil de los implantes para así reducir las cirugías de revisión(AU)

derstanding premature wear in joint replacements due to poor lubrication, which can result in high friction values, is a broad and intricate topic to address. In addition, if the lubricant is the synovial fluid, the lubrication mechanisms that occur are even more complex to unveil. This article reviews the current state of knowledge on synovial lubrication, as well as the rheological characteristics of the lubricating fluid. It is also made a mention of some experimental techniques and numerical methods with which the problem of lubrication has been studied. In some numerical simulations of lubrication in joint replacements the effect of the shear stress of the synovial fluid is not considered since it is assumed to have a Newtonian behavior; however, other research has shown that by assuming a non-Newtonian behavior the lubrication process is significantly affected. With all this, incorporating all the factors that can affect lubrication in joint replacements, in numerical simulations to date is a challenge. Through various investigations, new materials, designs and analysis techniques are sought to increase the useful life of implants in order to reduce revision surgeries(AU)

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.

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.

Role and mechanism of endoplasmic reticulum stress response induced by wear particles in osteolysis / 中国骨伤

OBJECTIVE@#To analyze the role of endoplasmic reticulum stress response in the development of osteoblast apoptosis and osteolysis in osteolytic bone tissue, and to explore the causes of artificial joint loosening, so as to provide new ideas and theoretical basis for the prevention and treatment of artificial joint loosening.@*METHODS@#The animal model of osteolysis induced by wear particles was established by mouse skull, and randomly divided into 4 groups, 7 rats in each group:group 1, blank control group;group 2, wear particles tial6v4 nano alloy powder (TiNPs) group;group 3, endoplasmic reticulum stress response positive control (TiNPs+Tg) group; group 4, endoplasmic reticulum stress response inhibitor (TiNPs+4-PBA) group. The pathological changes of osteolysis were observed by toluidine blue staining, HE staining and ALP staining;the expression of endoplasmic reticulum stress response marker protein was detected by Western Blotting;the apoptosis of osteoblasts in osteolytic skull tissue was detected by TUNEL and Caspase-3 immunohistochemistry.@*RESULTS@#Wear particles TiNPs can induce osteolysis in vitro, aggravate the infiltration of inflammatory cells and inhibit the differentiation and maturation of osteoblasts. At the same time, wear particles can also up regulate the markers of endoplasmic reticulum stress response and promote the apoptosis of osteoblasts in osteolytic bone tissue. After adding 4-PBA, an inhibitor of endoplasmic reticulum stress (4-PBA), on the basis of wear particles TiNPs, the symptoms of osteolysis were significantly relieved, bone erosion and inflammatory infiltration were significantly reduced, the differentiation and maturation of osteoblasts were improved, the number of apoptotic osteoblasts decreased sharply, and the expression of endoplasmic reticulum stress marker protein gradually decreased.@*CONCLUSION@#Endoplasmic reticulum stress is involved in the formation of osteolysis and plays an important role in the occurrence and development of osteolysis. At the same time, endoplasmic reticulum stress can be used as a new therapeutic target to provide new ideas and methods for clinical reversal or treatment of osteolysis and aseptic loosening.

Infecções em próteses ortopédicas: avaliação dos fatores associados no Hospital Governador Celso Ramos / Prosthetic joint infection: assessment of associated factors in the Hospital Governador Celso Ramos

Introdução: O número de procedimentos de artroplastia vem aumentando significativamente com o passar dos anos e, consequentemente, suas complicações, como a infecção da prótese ortopédica. Objetivo: Avaliar os fatores associados às infecções em próteses ortopédicas no Hospital Governador Celso Ramos, analisando as características clínicas e demográficas e os fatores referentes ao procedimento cirúrgico. Métodos: Estudo observacional do tipo caso-controle, sendo selecionados 233 pacientes, 184 controles (sem infecção) e 49 casos (com infecção); estudo realizado a partir da coleta de dados em prontuário com instrumento de coleta elaborado pelos autores. Dados analisados com o programa SPSS. Aprovado pelo CEP no número de parecer 1419055. Resultados: Nas características clínicas avaliadas, o sexo masculino foi mais presente entre o grupo caso, mostrando significância estatística (OR = 2,070, p = 0,019). Nas variáveis relacionadas com procedimento cirúrgico os pacientes que já haviam realizado artroplastia apresentaram maior chance de infecção (OR = 1,812, p = 0,047). Quando o motivo do procedimento foi a revisão da prótese, esta variável apresentou significância estatística (OR = 3,309, p = 0,001). O principal motivo pelos quais os pacientes realizaram procedimento de artroplastia foi por osteoartrite e 79% das próteses foram no quadril. Discussão: Observou-se como fatores associados a infecção, a presença do sexo masculino e quando o motivo do procedimento foi devido a necessidade de revisão da prótese. As demais variáveis analisadas no estudo provavelmente não apresentaram correlação, devido ao número reduzido de prontuários coletados. Conclusão: Observa-se como fatores associados ao aumento das taxas de infecção na protése ortopédica o sexo masculino e indicação do procedimento por necessidade de revisão da prótese.

Introduction: The number of procedures of arthroplasty has been increasing significantly over the years and consequently its complications such as periprosthetic joint infection. Objective: To evaluate the factors associated with periprosthetic joint infection in the Hospital Governador Celso Ramos, analyzing the clinical and demographic characteristics and the factors related to the surgical procedure. Methods: Observational case-control study. 233 patients were selected, 184 controls (without infection) and 49 cases (with infection). The study was carried out from the collection of data in medical records with a tool prepared by the authors. Results: Among the clinical characteristics evaluated, males were more present in the group that evolved with infection, showing statistical significance (OR = 2.070, p = 0.019). In the variables related to the surgical procedure, patients who had already performed arthroplasty had a higher chance of infection (OR = 1.812, p = 0.047). When the reason of the procedure was the revision of the prosthesis, this variable presented statistical significance (OR = 3.309, p = 0.001). The main reason the patients underwent arthroplasty was osteoarthritis, and 79% of the prosthesis were in the hip. Discussion: It was observed that factors associated with the outcome were the presence of the male gender and when the reason for the procedure is due to the necessity of revision of the prosthesis. The other variables analyzed in the study probably did not present correlation due to the reduced number of medical records analyzed. Conclusion: The factors associated with increased infection rates are male and indication of the procedure due to the necessity of prosthesis revision.

Comparison of Biological and Mechanical Prostheses for Heart Valve Surgery: A Systematic Review of Randomized Controlled Trials / Comparação de Próteses Biológicas e Mecânicas para Cirurgia de Válvula Cardíaca: Revisão Sistemática de Estudos Controlados Randomizados

Abstract Background: The choice of a mechanical (MP) or biological prosthesis (BP) for patients with valvular heart disease undergoing replacement is still not a consensus. Objective: We aimed to determine the clinical outcomes of MP or BP placement in those patients. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared biological prostheses and mechanical prostheses in patients with valvular heart diseases and assessed the outcomes. RCTs were searched in the MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS and Web of Science (from inception to November 2014) databases. Meta-analyses were performed using inverse variance with random effects models. The GRADE system was used to rate the quality of the evidence. A P-value lower than 0.05 was considered significant. Results: A total of four RCTs were included in the meta-analyses (1,528 patients) with follow up ranging from 2 to 20 years. Three used old generation mechanical and biological prostheses, and one used contemporary prostheses. No significant difference in mortality was found between BP and MP patients (risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of bleeding was significantly lower in BP patients than MP patients (RR = 0.64; 95% CI 0.52-0.78); however, reoperations were significantly more frequent in BP patients (RR = 3.60; 95% CI 2.44-5.32). There were no statistically significant differences between BP and MP patients with respect to systemic arterial embolisms and infective endocarditis (RR = 0.93; 95% CI 0.66-1.31, RR = 1.21; CI95% 0.78-1.88, respectively). Results in the trials with modern and old prostheses were similar. Conclusions: The mortality rate and the risk of thromboembolic events and endocarditis were similar between BP and MP patients. The risk of bleeding was approximately one third lower for BP patients than for MP patients, while the risk of reoperations was more than three times higher for BP patients.

Resumo Fundamento: A escolha de próteses mecânicas ou biológicas para pacientes com doença de válvula cardíaca ainda não é um consenso. Objetivo: Determinar os desfechos clínicos de próteses mecânicas e biológicas nesses pacientes. Métodos: Conduzimos uma revisão sistemática e metanálise e estudos controlados randomizados (RCTs) que compararam próteses mecânicas e biológicas em pacientes com doenças de válvulas cardíaca, e avaliamos seus resultados. A busca por RCTs foi feita nas bases de dados MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS e Web of Science (do início a novembro de 2014). As metanálises foram realizadas usando variação inversa com modelos de efeitos aleatórios. Usamos o sistema GRADE para avaliar a qualidade da evidência. Um valor menor que 0,05 foi considerado significativo. Resultados: Um total de quatro RCTs foi incluído na metanálise (1528 pacientes) com acompanhamento de 2 a 20 anos. Em três estudos, foram utilizadas próteses mecânicas e biológicas mais antigas, e em um estudo próteses contemporâneas. Não foi observada diferença de mortalidade entre os pacientes que receberam próteses mecânicas e biológicas (risco relativo, RR = 1,07; IC95% 0,99-1,15). O risco de sangramento foi significativamente mais baixo nos pacientes que receberam próteses biológicas que naqueles com próteses mecânicas (RR = 0,64; IC95% 0,52-0,78). Contudo, as reoparações foram mais frequentes em pacientes com próteses biológicas (RR = 3,60; IC95% 2,44-5,32). Não houve diferenças estatisticamente significativas entre pacientes com próteses biológicas e mecânicas em relação à embolia arterial sistêmica e endocardite infecciosa (RR = 0,93; IC95% 0,66-1,31; RR = 1,21; IC95% 0,78-1,88, respectivamente). Resultados entre os estudos com próteses modernas e antigas foram similares. Conclusões: A taxa de mortalidade e o risco de eventos tromboembólicos e endocardite foram similares entre os pacientes que receberam próteses biológicas e mecânicas. O risco de sangramentos foi aproximadamente um terço menor nos pacientes com próteses biológicas que mecânicas, ao passo que o risco de reoperação foi mais que três vezes maior nos pacientes com próteses biológicas.

Distribution characteristics and clinical significance of clavicle microindentation hardness / 中华创伤杂志

Objective@#To investigate the distribution characteristics and significance of bone hardness in different segments and layers of clavicle.@*Methods@#The right clavicles of three fresh Chinese corpses were taken and then divided into proximal, middle and distal segments according to Allman's classification. The clavicles were cut with diamond saw in the vertical of long axis equidistant exactly into 15 layers (proximal: 3 layers; midshaft: 7 layers; distal: 5 layers), and each layer was divided into four directions: superior, inferior, anterior, and posterior. The bone hardness were measured by Vickers microindentation, HV(kgf/mm2). The distribution of bone hardness was recorded and analyzed.@*Results@#A total of 180 parts of cortical bone were measured, generating 900 measurements. Meanwhile, a total of 45 parts of cancellous bone were measured, generating 225 measurements. We found that: (1)The average hardness of cortical bone was (35.9±8.1)HV, and the midshaft segment [(41.3±6.8)HV] was harder than the proximal segment [(33.8±6.1)HV] and the distal segment [(29.7±5.4)HV](P<0.05); (2)The average hardness of cancellous bone was (30.7±6.2)HV, and there were significant differences among the midshaft segment [(34.5±5.5)HV], the proximal segment [(29.2±2.9)HV] and the distal segment [(26.3±5.1)HV](P<0.05); (3)for cortical bone, the hardest segment was the fifth layer of the midshaft segment [(44.8±8.6)HV] while the most soft segment was the fourth layer of the distal segment [(28.0±3.5)HV](P<0.05); (4)for cancellous bone, the hardest segment was the fifth layer of the midshaft segmnet [(36.8±5.1)HV] while the most soft was the fifth layer of the distal segment [(23.0±4.4)HV](P<0.05); (5)There were no statistically significant differences among four directions of segments(P>0.05).@*Conclusion@#The microindentation hardness varies greatly among different segments and layers of the clavicles. The cortical bone and cancellous bone have consistent hardness changes, which shows that the middle segment is obviously harder than the proximal and distal segments with a gradually gradient decreasing trend from the middle to both ends. The data can be used to guide the design of 3D printing implants that conform to the stress conduction characteristics of the clavicle under physiological conditions, and provide good data support for the modeling and finite element analysis of the clavicle under simulated physiological conditions.

Progress on diagnosis of prosthetic joint infections / 中华临床感染病杂志

Periprosthetic joint infection ( PJI), defined as infection involving the joint prosthesis and adjacent tissue, is one of the most serious complications associated with joint arthroplasty.Its accurate diagnosis is still a challenge confronted by arthroplasty surgeons.In this article, we summarize the latest progress on the serological , synovial fluid, microbiologic, histopathological and radiological diagnosis of PJI to provide new concepts for arthroplasty surgeons.

Distribution characteristics and clinical significance of clavicle microindentation hardness / 中华创伤杂志

Objective To investigate the distribution characteristics and significance of bone hardness in different segments and layers of clavicle. Methods The right clavicles of three fresh Chinese corpses were taken and then divided into proximal, middle and distal segments according to Allman's classification. The clavicles were cut with diamond saw in the vertical of long axis equidistant exactly into 15 layers ( proximal:3 layers; midshaft:7 layers; distal:5 layers ) , and each layer was divided into four directions:superior, inferior, anterior, and posterior. The bone hardness were measured by Vickers microindentation, HV ( kgf/mm2 ) . The distribution of bone hardness was recorded and analyzed. Results A total of 180 parts of cortical bone were measured, generating 900 measurements. Meanwhile, a total of 45 parts of cancellous bone were measured, generating 225 measurements. We found that:(1)The average hardness of cortical bone was (35.9 ±8.1)HV, and the midshaft segment[(41.3 ±6.8)HV] was harder than the proximal segment [(33.8 ±6.1)HV] and the distal segment [(29.7±5.4)HV](P<0.05);(2)Theaveragehardnessofcancellousbonewas(30.7±6.2)HV, and there were significant differences among the midshaft segment [(34. 5 ± 5. 5)HV], the proximal segment [(29.2±2.9)HV] and the distal segment [(26.3 ±5.1)HV](P<0.05);(3)for cortical bone, the hardest segment was the fifth layer of the midshaft segment [(44. 8 ± 8. 6)HV] while the most soft segment was the fourth layer of the distal segment [(28. 0 ± 3. 5)HV](P<0. 05);(4)for cancellous bone, the hardest segment was the fifth layer of the midshaft segmnet [(36. 8 ± 5. 1)HV] while the most soft was the fifth layer of the distal segment [(23. 0 ± 4. 4) HV] (P<0. 05);(5) There were no statistically significant differences among four directions of segments(P >0. 05). Conclusion The microindentation hardness varies greatly among different segments and layers of the clavicles. The cortical bone and cancellous bone have consistent hardness changes, which shows that the middle segment is obviously harder than the proximal and distal segments with a gradually gradient decreasing trend from the middle to both ends. The data can be used to guide the design of 3D printing implants that conform to the stress conduction characteristics of the clavicle under physiological conditions, and provide good data support for the modeling and finite element analysis of the clavicle under simulated physiological conditions.

Research progress of artificial wrist joint prosthesis / 中国修复重建外科杂志

Objective: To summarize the research progress of the artificial wrist joint prosthesis.

Hot issues related to modern hip prosthetic materials / 医学研究生学报

Artificial prosthetic material is one of the important factors determining the effect of artificial hip replacement.There are mainly three types of interfaces in the prosthetic materials: the fixed in-terface,the friction interface,and the interface between the modular prostheses.Porous metals improve the osseointegration of the bio-logical fixed interface.High crosslinking polyethylene and composite ceramics significantly reduce the wear of the friction interface.The modular prostheses of ceramic ball head can reduce the wear particles and corrosion.However,the prosthesis loosening,wear and metal corrosion are still the most important factors affecting the medium-long term effects of artificial hip replacement.This article reviews the research progress of artificial hip prosthesis materials from the perspective of the three prosthetic interfaces.

Biomateriais utilizados na artroplastia parcial ou total da articulação temporomandibular: uma revisão de literatura / Biomaterials used in partial or total temporomandibular joint arthroplasty: a review of the literature

Introdução: as disfunções da articulação temporomandibular constituem uma variedade de doenças que compreendem disfunções nos músculos da mastigação, nas estruturas articulares ou em ambos. Em alguns casos a melhora da disfunção pode decorrer apenas de tratamento clínico conservador, porém, quando os resultados não são favoráveis, o tratamento cirúrgico deve ser considerado. A reconstrução articular parcial ou total é uma das formas de tratamento cirúrgico disponível. Objetivo: objetivo deste trabalho foi realizar uma revisão bibliográfica sobre os principais biomateriais disponíveis para a reconstrução da articulação temporomandibular. Método: o trabalho foi realizado na base de dados da Pubmed, Scielo e Periódicos Capes. Os descritores empregados foram: artoplastia temporomandibular, prótese articular, disfunção temporomandibular. As referências foram avaliadas quanto à relevância correlacionadas ao tema proposto. Foram selecionados os artigos em português e inglês, publicados no período de Janeiro 1971 a outubro de 2017. Considerações finais: existe a recomendação de haver uma continuidade de esforços para melhorar o material aloplástico para que os resultados obtidos com essa técnica se tornem o tratamento padrão para a DTM severa, contudo é importante não se esquecer de esgotar as modalidades terapêuticas conservadoras antes de se prosseguir para qualquer tipo de cirurgia. Nos casos onde uma prótese articular total é indicada, que os princípios biomecânicos sejam respeitados e que estudos clínicos metodologicamente adequados sejam realizados para fundamentarem esta condição de maneira referendada para a substituição aloplástica da ATM.

Introduction: temporomandibular joint dysfunctions are a variety of diseases that include dysfunctions in masticatory muscles, joint structures, or both. In some cases the improvement of the dysfunction may only result from conservative clinical treatment, however, when the results are not favorable the surgical treatment should be considered. Partial or total joint reconstruction is one of the forms of surgical treatment available. Objective: the objective of this work was to perform a bibliographic review on the main biomaterials available for the reconstruction of the temporomandibular joint. Method: work was carried out in the database of Pubmed, Scielo and Capes Periodicals. The descriptors employed were: temporomandibular arthroplasty, joint prosthesis, temporomandibular dysfunction. The references were evaluated regarding the relevance correlated to the proposed theme. The articles in Portuguese and English, published between January 1971 and October 2017, were selected. Final remarks: there is a recommendation for continuity of efforts to improve the alloplastic material so that the results obtained with this technique become the treatment standard for severe TMD, but it is important to remember to exhaust the conservative therapeutic modalities before proceeding for any type of surgery. In cases where a total joint prosthesis is indicated, biomechanical principles are respected and methodologically adequate clinical studies are performed to support this condition in a manner recommended for the alloplastic replacement of TMJ.

Management of Periprosthetic Joint Infection / 대한고관절학회지

Periprosthetic joint infection (PJI) is a serious complication after arthroplasty, which is associated with pain, prolonged hospital stay, multiple surgeries, functional incapacitation, and even mortality. Using scientific and efficient management protocol including modern diagnosis and treatment of PJI and eradication of infection is possible in a high percentage of affected patients. In this article, we review the current knowledge in epidemiology, classification, pathogenesis, diagnosis and treatment of PJI.

Effect of ceramic on ceramic total hip arthroplasty in Crowe IV developmental dysplasia of the hip / 中国骨伤

<p><b>OBJECTIVE</b>To observe the clinical effect of ceramic on ceramic total hip arthroplasty(THA)in Crowe IV developmental dysplasia of the hip(DDH).</p><p><b>METHODS</b>From April 2008 to December 2015, 137 hips of 111 Crowe IV DDH patients received THA using Forte or Delta ceramic on ceramic by one senior surgeon, which consists of 85 unilateral hips and 26 bilateral hips. The average age of the patients was(38.88±10.83) years old ranging from 18 to 68 years old. The mean follow-up was(41.16±21.50) months ranging from 12 to 96 months. All the patients were evaluated by Harris Hip Score. Radiographic evaluations were made preoperatively and during follow-up. Harris scores, the incidence of complications such as ceramic fracture, squeaking, dislocation were observed.</p><p><b>RESULTS</b>The mean preoperative Harris score was 56.54±15.67, the mean postoperative Harris score was 88.30±6.86(=0.017). Periprosthetic osteolysis was not deteced around any cup. No ceramic fracture occurred. There were 3 cases of revision surgery due to infection, losening of the stem and limb length discrepancy, respectively; 3 cases of dislocation occurred. Seventy-seven patients were recorded the gait and the hip mobility, the hip flexion of 69 patients were above 120 degrees.</p><p><b>CONCLUSIONS</b>Ceramic on ceramic bearing showed an encouraging result in Crowe IV DDH total hip arthroplasty.</p>

Application of Tri-Lock bone preservation stem in acetabular protrusion combined with shorten defect of femoral head and neck / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the manipulation technique and clinical outcome of Tri-Lock bone preservation stem for acetabular protrusion combined with shorten defect of femoral head and neck.</p><p><b>METHODS</b>From January 2013 to December 2015, 10 patients(12 hips) with acetabular protrusion combined with shorten defect of femoral head and neck were treated with total hip arthroplasty(THA) including 5 males and 5 female with an average age of(51.6±3.0) years old ranging from 42.5 to 67.5 years old. The acetabular prostheses were all biological prosthesis with the ceramic lining, the whole ceramic femoral head was used in all the cases. The posterior-lateral hip incision was adopted in the surgery. The follow-up was carried out in 12 months after the surgery, and later once a year. The Harris score system in growth of femoral side described was used to assess the joint function of the patients before and after the surgery.</p><p><b>RESULTS</b>Ten patients were followed up for 8 to 48 months with an average of 33.0±3.5. All the incisions healed well and there were no complications such as femoral fracture, infection, dislocation and neurovascular injuries. The biological compression of the acetabulum and the stem of the femur was realized immediately after operation in 10 patients(12 hips). X-ray at 3 months after the operation showed bone growth were extended in a wide range, which could achieve bone fixation, no loosening and re-invagination. The range of hip movement increased from (45.8±7.5)° to (90.0±6.5)° at the final follow-up, with flexion increased to (89.0±6.0)°, abduction increased to (35.5±7.3)° and internal rotation increased to(31.8±6.6)°, the outer rotation increased to(32.6±5.2)°. The mean Harris scores had improved from 45.7±7.5 pre-operatively to 93.5±8.0 post-operatively, there was statistically significant difference between before and after surgery (=144.832,<0.05).</p><p><b>CONCLUSIONS</b>Combined with acetabular treatment, Tri-Lock bone retention of the femoral stem in the treatment of femoral head and neck with shortening of the acetabular retraction and severe hip joint soft tissue contracture in patients, could be well pressed and retained more bone. The reconstruction of the acetabulum and the delamination of soft tissue are required during the operation. The results were safe and satisfactory in the middle and short term follow-up.</p>

Reconstrução cirúrgica de reabsorção condilar progressiva severa: relato de caso / Surgical reconstruction of severe progressive condylar resorption: case report

A reabsorção condilar progressiva é uma condição de etiologia controversa, caracterizada pela diminuição gradual do volume do côndilo mandibular, podendo o paciente apresentar, ao exame clínico, sinais e sintomas, como instabilidade oclusal e esquelética, oclusão classe II, mordida aberta anterior, dor e retrognatismo mandibular. Dentre os métodos terapêuticos para o seu tratamento, destacam-se a utilização de enxertos e próteses articulares, associados ou não à cirurgia ortognática para a reconstrução do côndilo mandibular. Este trabalho tem como objetivo relatar o caso clínico de uma paciente do sexo feminino, 28 anos de idade, portadora de artrite reumatoide juvenil, com presença de reabsorção condilar progressiva severa, abertura bucal máxima de 20 mm, dispneia noturna, retrusão mandibular e perfil facial convexo. Ela foi tratada no Hospital Federal dos Servidores do Estado por meio de cirurgia ortognática maxilomandibular com rotação anti-horária do plano oclusal e instalação de prótese condilar bilateral customizada TMJ Concepts®. A reconstrução total proporcionou uma perfeita adaptação à estrutura óssea remanescente, com melhora estético-funcional da paciente. Segue em controle pós operatório de dois anos, sem recidiva e com oclusão satisfatória... (AU)

Progressive condylar resorption is a controversial etiology condition characterized by the gradual decrease in the condylar volume, and the patient may present in clinical examination signs and symptoms such as occlusal and skeletal instability, occlusion Class II, anterior open bite, pain and retrognathism mandibular. Among the therapeutic methods for their treatment, it highlights the use of grafts and prosthetic joint, with or without orthognathic surgery for the reconstruction of the mandibular condyle. The purpose this study is to report the case of a female patient, 28 years old, holder of juvenile rheumatoid arthritis, with the presence of severe progressive condylar resorption, maximum mouth opening 20 mm, nocturnal dyspnoea, mandibular retraction and convex facial profile. It was treated at the Hospital Federal dos Servidores do Estado through orthognathic surgery maxilomandibular with counterclockwise rotation of the occlusal plane and installation of customized bilateral condylar prosthesis TMJ Concepts®. The total reconstruction provided a perfect adaptation to the remaining bone structure, aesthetic and functional improvement of the patient. The same goes for postoperative control two years without recurrence and satisfactory occlusion... (AU)

Development and preliminary clinical application of home-made temporomandibular joint prostheses / 中华口腔医学杂志

Objective@#To explore the clinical application of home-made temporomandibular joint (TMJ) prostheses.@*Methods@#Self-developed TMJ prostheses were applied for end stage osteoarthritis, TMJ ankylosis, condylar tumors after biomechanical examination. The stability of the prostheses toward bone was evaluated during operation. Post-operative CT scans and clinical follow-ups were taken to check changes of mouth opening, position of the prostheses, bone resorption around the screws, and heterotopic bone formation around artificial condyle.@*Results@#There were 6 patients accepted 7 prostheses smoothly without infection and other complications. Post-operative follow-ups were from 6 to 13 months with a mean of 7.6 months. Mouth opening was significantly improved from (16.2±14.4) mm before operation to (31.5±4.8) mm during follow-ups (P=0.01). All prostheses were stable without screw loose and heterotopic bone formation.@*Conclusions@#Home-made TMJ prostheses were stable after primary clinical application, but the long-term results need to be observed.

Measurement of morphologic parameters of fixed area of Chinese temporomandibular joint prosthesis with three-dimensional computed tomography images and its significance / 吉林大学学报(医学版)

Objective:To measure the morphologic data of Chinese temporomandibular joint (TMJ) with computed tomography (CT) reconstruction technology,and to clarify the safe area for the fixation of Chinese temporomandibular joint prosthesis.Methods:A total of 100 adult skulls were scanned by CT and reconstructed.The width,thickness and angle h1,h2,h3,h4,d1,d2,d3,d4,ab,bc,cd,ad,α and β of zygomatic arch,the width and height BD and h of articular fossa and the width,thickness and angle S,h5,h6,h7,l1,l2,l3,l4,l5,m1,m2,m3,m4,m5 and γ of mandible in the fixed area of the TMJ prosthesis were measured;all the measurement indexes were divided into left and right groups by direction,and SPSS 19.0 software was used for the comparion of the measurement between left and right groups.Results:There were no statistical differences in the measurement index values of h1,h2,h3,h4,d1,d2,d3,d4,ab,bc,cd,ad,α,β,BD,h,S,h5,h6,h7,l1,l2,l3,l4,l5,m1,m2,m3,m4,m5 and γ in zygomatic arch,articular fossa and mandible in the fixed area of the TMJ prosthesis between left and right groups (P＞0.05);the width of h2 was longer than that of h3 in zygomatic arch (P=0.048);the thickness of d3 was thicker than that of d4 (P＜0.01).Conclusion:The measurement data of TMJ fixed area is obtained with three-dimensional CT images.