Perioperative transfusion analysis and blood ordering schedule update for total knee arthroplasty / 中国输血杂志

【Objective】 To investigate the perioperative rate of allogeneic red blood cell (RBC) transfusion in patients who underwent total knee arthroplasty (TKA) and its risk factors, and to identify its cross-match to transfusion ratio (C∶T ratio). 【Methods】 Anesthetic data of patients who underwent TKA from January 2014 to October 2019 in Peking Union Medical College Hospital were collected and analyzed retrospectively. Perioperative allogeneic RBC transfusion rate was calculated, and binary Logistic regression analysis was performed to identify its risk factors in these patients. The overall C∶T ratio was calculated and divided into subgroups based on surgery type and age group. 【Results】 The study enrolled 2 903 patients. The perioperative rate of allogeneic RBC transfusion in TKA patients was 10.9% (95% CI 9.8%~12.0%) and overall C∶T ratio was 5.6∶1. The independent risk factors leading to perioperative allogeneic RBC transfusion included advanced age(OR=1.025, 95% CI 1.009~1.042, P<0.01), preoperative hemoglobin level(OR=0.966, 95% CI 0.954~0.978, P<0.001), preoperative anemia(OR=3.543, 95% CI 2.052~6.119, P<0.001), hematological diseases(OR=6.462, 95% CI 2.479~16.841, P<0.001), bilateral surgery(OR=7.681, 95% CI 5.759~10.245, P<0.01) and revision surgery(OR=9.584, 95% CI 4.360~21.065, P<0.001). 【Conclusion】 The risk factors for perioperative allogeneic RBC transfusion in TKA patients included advanced age, preoperative low hemoglobin level, preoperative anemia, hematological diseases, bilateral surgery and revision surgery. Only type and screen tests are recommended if patients receiving unilateral primary TKA surgery are less than 75 years old without anemia and hematological diseases, while at least one to four units of blood should be cross-matched if patients are with preoperative anemia and hematological diseases or will receive bilateral and revision arthroplasty.

Periprosthetic Femur Fracture in a 73-Year-Old Female: A Case Report

Increasing use of joint replacement for various conditions has led to a new group of fractures- the periprosthetic fractures. Periprosthetic fractures are considered which are associated with an orthopaedic implant. Worldwide incidence of Periprosthetic fractures is increasing due to increased number of primary joint arthroplasties and other revision surgeries. Periprosthetic femoral fracture can be classified as intraoperative & post-operative. The intraoperative periprosthetic fractures usually occur during the insertion of the femoral stem, often preceded by an area of increased cortical thickness. The management of these fractures are complex and usually needs application of basic principles to fit an individual situation rather than having a fixed set of rules. Standard treatment protocol includes use of locking plate with encirclage wires. In this study, we provide a case of periprosthetic femur fracture pain. A 75-year-old woman presented to us with pain in her right hip and thigh. The patient was a homemaker who had cemented total hip replacement surgery due to a femoral neck fracture 27 days back. After the primary replacement surgery, the patient appeared to be doing well and adhering to the hip precautions. While getting out of bed, she tripped and fell carelessly in the morning & complained of severe pain in her right hip. After assessment of all her medical conditions and physical examination, she was advised for revision surgery. An open reduction and internal fixation of the fracture with revision of the femoral component was planned. Risks, benefits, and alternatives were discussed at length with her and her family. The patient and her family agreed to the operative plan.

The reoperation strategy after laparoscopic sleeve gastrectomy / 中华消化外科杂志

At present, laparoscopic sleeve gastrectomy (LSG) has become the most popular bariatric surgery worldwide. LSG is simple to operate, with few complications and favorable short-term weight loss results. However, with massive LSG performed, its disadvantages have become increasingly prominent. More and more patients require revisional surgery due to insufficient weight loss, weight regain and reflux esophagitis. Based on clinical experience and existing clinical evidence, the author reviews the reoperation strategies after LSG.

Revision for Aseptic Loosening of Tumor Prosthesis in Lower Limbs / 肿瘤防治研究

Objective To determine the prosthesis survival and limb function after revision of global modular replacement system (GMRS) tumor prosthesis. Methods We retrospectively analyzed the clinical data of 16 patients who developed aseptic loosening of lower extremity tumor prosthesis and subsequently received revision with GMRS from 2009 to 2012. Kaplan-Meier method was used to calculate the 5- and 8-year survival rates of the prosthesis. The MSTS function scale was used to evaluate the functional outcomes. Results The average follow-up time was 90 months (52-118 months). The 5- and 8-year survival rates of GMRS prosthesis were both 94%. After revision, two patients failed, including one case of infection and one case of repeated aseptic loosening. The average interval between the first joint replacement and revision surgery was 81 months (27-187 months). Until the last follow-up, 93.3%(14/15) of the patients did not develop repeated aseptic loosening, 85.7%(12/14) of the patients who underwent GMRS revision had a longer loosening-free survival than those with the primary joint replacement (90.6±19.3 vs. 43.4±29.7 months, P=0.001). The average MSTS functional score was 27.7(24-30). Conclusion The incidence of repeated aseptic loosening for GMRS prosthesis is low and the limb function is good. The reported technique is satisfactory in the middle and long term.

A Multi-Disciplinary Approach for the Management of Prosthetic Joint Infections: An Australian Perspective

@#Introduction: Prosthetic joint infections (PJI) are a major complication of hip and knee arthroplasty, imposing significant morbidity and mortality. Orthopaedic oncology units have utilised a multi-disciplinary team (MDT) approach for some time. PJI is not only an equally lifethreatening condition, it also requires input from multiple healthcare personnel and treatment can vary significantly between individuals given the diversity in microbiological, surgical and host factors. Our arthroplasty service established an MDT meeting to manage this complex patient group. This study describes the philosophy and implementation of an MDT approach to the management of PJIs at a tertiary hospital in Australia. Materials and methods: A retrospective review of all patients that presented to the MDT PJI meeting from October 2017 to April 2020 was performed. Patient characteristics, microbiological profile and management were reviewed. Results: One hundred and one patients were reviewed over 2.5 years with a mean age of 69.2 years (SD 11.9). Patients presenting predominantly had a primary TKR (32%) or primary THR (22%). Results of Microbiology cultures varied, with 42% Gram-positive organisms, 13% Gramnegative organisms, 2% fungus and 1% yeast origin. Management mainly consisted of two-stage revision (28%), debridement-antibiotics-and-implant retention (22%) and antibiotic suppression (14%). A total of 91.5% of patients who underwent surgical management were considered cured at one year. Conclusion: PJIs are complex and require coordinated care by a number of healthcare personnel. The MDT process has allowed collaboration between Orthopaedic, Infectious Disease and Microbiology departments and aims to improve the quality of care provided to patients, potentially reducing morbidity and mortality of patients with PJI.

Research progress of causes and strategies in revision surgery for atlantoaxial dislocation / 中国骨伤

Atlantoaxial dislocation (AAD) is a kind of life-threatening atlantoaxial structural instability and a series of neurological dysfunction caused by common multidisciplinary diseases. The operation risk is extremely high because it is adjacent to the medulla oblongata and the location is deep. With the increase of the number of operations in the upper cervical region, postoperative complications such as failure of internal fixation, non fusion of bone graft and poor prognosis gradually increase.Incomplete primary operation, non fusion of bone graft, infection and congenital malformation are the potential causes. In addition, considering the objective factors such as previous graft, scar formation and anatomical marks changes, revision surgery is further difficult. However, there is currently no standard or single effective revision surgery method. Simple anterior surgery is an ideal choice in theory, but it has high risk and high empirical requirements for the operator;simple posterior surgery has some defects, such as insufficient reduction and decompression;anterior decompression combined with posterior fixation fusion is a more reasonable surgical procedure, but many problems such as posterior structural integrity and multilevel fusion need to be considered.This article reviews the causes and strategies of AAD revision surgery.

Prótesis total de fémur en pacientes no oncológicos / Total femur prosthesis in non-oncological patients

Resumen: Introducción: Las prótesis totales de fémur (PTF) son un procedimiento muy excepcional y más aún en pacientes no oncológicos. El objetivo es analizar una serie de casos de prótesis total de fémur, su seguimiento y resultados a largo plazo. Material y métodos: Estudio retrospectivo en el que se incluyeron siete pacientes, intervenidos desde 2011 hasta 2014. Tras aplicar los criterios de exclusión (seguimiento y pacientes oncológicos), se analizaron cuatro pacientes. Se utilizó la clasificación de Paprosky para medir el defecto óseo y se valoraron diferentes parámetros: número de cirugías previas, duración de la cirugía, complicaciones, cirugías de revisión, escala de valoración funcional y seguimiento clínico radiológico. Resultados: Edad media de 78.5 años al implante de la prótesis total de fémur (PTF). El defecto óseo en el fémur (1-IIIA, 2-IIIB y 1-IV) fue más importante que en el acetábulo (2-I, 1-IIA y 1-IIB). El tiempo medio de la cirugía fue de 110 minutos. El motivo de la cirugía de revisión más frecuente fue el recambio del componente acetabular en tres pacientes debido a inestabilidad. La complicación más frecuente fue la infección. Flexión media de cadera de 85 grados y extensión de 0. La diferencia entre la valoración funcional Harris Hip Score pre- y post- es de 54.9 puntos, en la escala de Enneking fue de 14.25 puntos de media y la escala de dolor (VAS) medio es inferior a 2. El seguimiento promedio es de aproximadamente siete años y medio. Conclusiones: La PTF es una cirugía sin protocolo estandarizado al día de hoy. La infección en nuestra serie está siempre presente y el componente acetabular constreñido evitaría inestabilidades. Por lo que el implante de PTF debe ser a pacientes muy bien seleccionados.

Abstract: Introduction: Total femoral replacement (TFR), it is an uncommon surgery in non-oncological patients. Our main objective is to review our total femur replacement surgeries and analyze functional and clinical outcomes. Material and methods: We retrospectively review our series of seven non-oncological patients treated at our center with a TFR from 2011 to 2014. After excluding patients (Oncological patients or non-follow up) we revised four patients. Paprosky bone loos classification and different values were studied: number and time of surgeries, complications, revision surgeries, functional scales, and follow-up. Results: Mean age of 78.5 years. According to Paprosky classification of femur bone loss: 1 IIIA, 2 were IIIB, 1 IV. On the other side acetabular loss: 2 I, 1 IIA, 1 IIB. Surgical time for TFR was 110 minutes on average. Three patients were need revision surgery due to instability. And every single patient suffered from chronic infection. Mean range of motion was 85 flexion, 0o extension. Comparing preoperative and postoperative Harris Hip Score for hip function was 54.9 points and Enneking score was an average of 14.25 points better in our patients with TFR. Visual analogue pain score was on average less than two points. Mean follow-up is almost seven and a half years. Conclusions: TFP has not a standardized surgical protocol yet. Infection is always present in our series and acetabular constrained components in TFR avoid instability complications. TFP should be implanted only in selected patients.

Causes and countermeasures for weight regain after bariatric surgery / 中华消化外科杂志

Although bariatric surgery is the most effective and durable treatment for obesity and related metabolic diseases, weight regain (WR) after surgery is a common problem and cannot be neglected. The causes of WR are complex and require a comprehensive assessment and long-term follow-up conducted by a multidisciplinary team. The treatment for WR should be indivi-dualized according to the anatomical condition, lifestyle habits, psychological state, and compliance of patients. The authors review the current retrospective and prospective studies on the risk factors for WR, and summarize the clinical evidence on the behavioral, pharmacotherapeutic, and surgical interventions. Basing on the available research results, the authors consider that harmonized criteria for WR diagnosis is imperative. It is necessary to further clarify WR predictors, optimal combination of surgical and non-surgical therapies, and to explore the ideal time-point of medication usage by designing prospective studies, which have great importance for maintaining weight loss and preven-tion and treatment of WR after bariatric surgery.

Artificial urinary sphincter surgery in the special populations: Neurological, revision, concurrent penile prosthesis and female stress urinary incontinence groups / 亚洲男科学杂志(英文版)

The artificial urinary sphincter (AUS) remains the standard of care in men with severe stress urinary incontinence (SUI) following prostate surgery and radiation. While the current AUS provides an effective, safe, and durable treatment option, it is not without its limitations and complications, especially with regard to its utility in some 'high-risk' populations. This article provides a critical review of relevant publications pertaining to AUS surgery in specific high-risk groups such as men with spinal cord injury, revision cases, concurrent penile prosthesis implant, and female SUI. The discussion of each category includes a brief review of surgical challenge and a practical action-based set of recommendations. Our increased understandings of the pathophysiology of various SUI cases coupled with effective therapeutic strategies to enhance AUS surgery continue to improve clinical outcomes of many patients with SUI.

Etiology and Treatment of Revision Shoulder Arthroplasty / 대한정형외과학회잡지

The rapidly increasing rate of shoulder arthroplasty is certain to increase the number of revision arthroplasties because of parallel increases in complication numbers. It has been widely reported that the causes of revision shoulder arthroplasty include rotator cuff deficiency, instability, glenoid or humeral component loosening, implant failure, periprosthetic fracture, and infection. Revision arthroplasty can be technically challenging, and surgical options available for failed shoulder arthroplasty are limited, especially in patients with glenoid bone loss or an irreparable rotator cuff tear. Furthermore, the outcomes of revision arthroplasty are consistently inferior to those of primary arthroplasty. Accordingly, surgical decision making requires a good understanding of the etiology of failure. Here, we provide a review of indications of revision arthroplasty and of the surgical techniques used by failure etiology.

Feasibility of Revision Cochlear Implant Surgery for Better Speech Comprehension

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the efficacy of revision cochlear implant (CI) surgery for better speech comprehension targeting patients with low satisfaction after first CI surgery. SUBJECTS AND METHODS: Eight patients who could not upgrade speech processors because of an too early CI model and who wanted to change the whole system were included. After revision CI surgery, we compared speech comprehension before and after revision CI surgery. Categoies of Auditory Performance (CAP) score, vowel and consonant confusion test, Ling 6 sounds, word and sentence identification test were done. RESULTS: The interval between surgeries ranged from eight years to 19 years. Same manufacturer’s latest product was used for revision surgery in six cases of eight cases. Full insertion of electrode was possible in most of cases (seven of eight). CAP score (p-value=0.01), vowel confusion test (p-value=0.041), one syllable word identification test (p-value=0.026), two syllable identification test (p-value=0.028), sentence identification test (pvalue=0.028) had significant improvement. Consonant confusion test (p-value=0.063), Ling 6 sound test (p-value=0.066) had improvement but it is not significant. CONCLUSIONS: Although there are some limitations of our study design, we could identify the effect of revision (upgrade) CI surgery indirectly. So we concluded that if patient complain low functional gain or low satisfaction after first CI surgery, revision (device upgrade) CI surgery is meaningful even if there is no device failure.

Revision of Schatzker type Ⅵ tibial plateau fracture failure focus on the recovery of lower limb alignment / 中华外科杂志

Objective@#To explore the influence of the lower extremity abnormal alignment and the joint surface, and to explore the surgical skills.@*Methods@#Twenty-two cases of tibial plateau Schatzker Ⅵ fracture internal fixation failure revision from January 2012 to January 2017 in Department of Orthopedics, Shanghai 10th Hospital.One year follow-up after initial surgery to make sure of failure.Three-dimensional CT scan, radiography, infection index, gait analysis, knee joint ROM, femur tibia angle, tibial plateau tibial shaft angle and posterior slope if tibial plateau were observed. The medial approach and bi-planer osteotoma were used.Autogenous iliac bone graft, postoperative fast recovery channel were used.Follow-up point included preoperative and postoperative 7 days, 6 weeks, 3 months, and 6 months.Obvervational index included double lower limbs radiography, knee society score(KSS), complications such as infection, skin necrosis, joint main passive activity, double lower limbs alignment the last follow-up SF-36 scale.Rate was compared by χ2 test, measurement data using paired sample t test.Correlation was analyzed by Pearson correlation regression testing.@*Results@#Twenty-two patients received follow-up.KSS, more than 21 cases were benign, with good gait.One case was poor, with claudication gait.Not skin necrosis, no deep infection cases, 1 case get blisters 2 days postoperatively, and disappear after 5 days with detumescence and cold therapy.Whether restoring force line affect the KSS significantly(χ2=22.000, P=0.000). Knee joint ROM, SF-36 score, KSS and lower limb alignment were improved significantly. In different individual the articular surface and anatomical angle recovered greatly but the posterior slope angle was quite difference which has no correlation with KSS and SF-36 scale(P>0.01).@*Conclusions@#Revision of Schatzker type Ⅵ tibial plateau fracture failure should focus on the recovery of lower limb alignment.moderate overcorrect bone cutting and joint surface height can bring benefits to the postoperative knee function.Revision surgery patients have greater psychological pressure, more early psychological intervention is necessary.

Revision surgery for malar reduction: causes and treatment strategies / 中华医学美学美容杂志

Objective To discuss the correlation between initial malar reduction procedures and the method of revision procedures and the personalized treatment strategies for the second deformity of postoperative prominent malar complex.Methods From January 2003 to December 2017,27 patients underwent personalized revision surgery of malar reduction according to the different second deformity of malar complex.The surgical technique included the double support malar reduction technique,orthotopic malar osteotomy technique,malar bone grinding surgery,and autogenous bone transplantation.Results A total of 27 patients subjected to revision surgery for malar reduction between November 2006 and December 2017 were retrospectively reviewed.22 patients were satisfied with aesthetic outcomes after the first revision procedure,while 5 patients were satisfied after 2 or 3 procedures follow-up for 10 to 12 months.Conclusions The incidence of complications after malar reduction is related to the first surgical method.According to the unsatisfactory results,it can be repaired individually to obtain a better clinical repair effect.

Clinical effects of the in-situ microinvasive revision surgery on the fibrotic filtering bleb with the guidance of UBM / 眼科新进展

Objective To investigate the clinical effects of microinvasive revision surgery on the patients of the fibrotic filtering bleb with the guidance of ultrasound biomicroscopy (UBM).Methods A prospective,nonrandomized clinical controlled trial was conducted,which had 2 groups according to the results from UBM during the same period in our hospital,including the patients with the microinvasive revision surgery (28 patients of 28 eyes,group A) and the in-situ traditional revision surgery of larger incision (27 patients of 27 eyes,group B).The clinical data of the patients were collected and the main observation targets were the change of the postoperative visual acuity (VA),intraocular pressure (IOP),the operation success rate and the complications.Results There were no significant differences in the gender,age,glaucoma types,primary operation modes,postoperative follow-up time and preoperative VA (all P ＞0.05).The average duration of hospital stay,postoperative VA and the postoperative complications of group A were better than those of group B and the differences were statistically significant (all P ＜ 0.05).There was no significant difference in IOP at different time points between the two groups (all P ＞ 0.05).The operative successful rates of the two groups were 64.3％ and 66.6％,respectively(P ＞ 0.05).Conclusion The in-situ microinvasive revision surgery on the basis of the UBM examination is a good choice for patients with the fibrotic filtering bleb of the unlocked inner passageway in the filter aisle and a latent liquid dark cavity that is interlinked with the anterior chamber under the scleral flap or the liquid dark cavity of the capsule.

Laparoscopic Adjustable Gastric Band as a Revision Surgery for Failed Vertical Gastric Sleeve or Roux-en-Y Gastric Bypass

Background: Bariatric surgery is seen as one of the most successful option for the control of morbid obesity and obesity related complications. Although, there are many surgical options available the Lincey Alexida, Xiaohua Qi, Patrick B. Asdell, José M. Martínez Landrón, Samarth B. Patel, Faustino Allongo. Frederick Tiesenga. Laparoscopic Adjustable Gastric Band as a Revision Surgery for Failed Vertical Gastric Sleeve or Roux-en-Y Gastric Bypass. IAIM, 2017; 4(12): 37-42. Page 38 laparoscopic vertical sleeve gastrectomy and the Roux-en-Y gastric bypass are among the most selected treatment methods. Even though the sleeve gastrectomy and the gastric bypass has proven to be efficacious in weight reduction in morbid obesity there are still some reported failures. Aim: This study main objective is to see if an adjustable gastric band can be offered as a sensible option for patients who have had a previously failed vertical sleeve gastrectomy or the Roux-en-Y gastric bypass surgery. The procedure will be classified as a revision surgery to increase the possibilities of additional weight loss not achieved with the sleeve gastrectomy or gastric bypass surgery alone. Method: A retrospective review of the charts for all the bariatric patients from April 2012 to April 2017 was conducted. The chart review yielded 12 patients who underwent either adjustable band over a previously failed vertical sleeve procedure or the adjustable band over a previously failed Roux-enY gastric bypass procedure. The patients were divided into two groups, group A and B. Group A is comprised of the 8 out 12 patients who had a previous failed gastric sleeve procedure. Group B has the remaining 4 patients who had a failed gastric bypass procedure. Observation: Both groups who underwent adjustable gastric band laparoscopically as a revision procedure after a two year follow up appointment showed Group A had a mean estimate weight loss of 30.75 lbs. (11%) with a mean Body Mass Index of 40.7 kg/m2 and Group B had a mean estimate weight loss of 42 lbs. (15%) with a mean Body Mass Index of 36.77 kg/m2 . Group A had an Excess Body Weight Loss of 27% at 1 month and 33% at the 2 year follow up and Group B had an Excess Body Weight Loss of 42.2%. Group B had an Excess Body Weight Loss of 15.1 % at 1 month and 42.2% at the 2 year follow up. Conclusion: Group A had an average of 27% Excess Body Weight Loss and Group B had an Excess Body Weight Loss of 15.1% after 1 month on follow up. Our study was limited by the small sample size. We suggest that further investigational studies, with greater and more diverse sample sizes, be conducted to assure the benefit of using the adjustable gastric band as a revision surgery. Based on our results we conclude that the adjustable gastric band as a revision surgery is a promising and sensible alternative treatment option for patients with a previously failed laparoscopic vertical sleeve gastrectomy or a failed Roux-en-Y gastric bypass.

Causes prevention and treatment for cerebrospinal leak after lumbar revision surgery / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the causes and explore the measures of prevention and treatment of the cerebrospinal leak after lumbar revision surgery.</p><p><b>METHODS</b>The clinical data of 24 patients(17.78%) with cerebrospinal leak among 135 cases after lumbar revision surgery from January 2011 to January 2016 was retrospectively studied. Of them, 12 cases due to severe adhesion caused by scar formation; 4 cases due to yellow ligament hyperplasia adhesion with dura mater occurred dural tears when separating adhesion; 2 cases with severe hyperplasia and ossification of lumbar posterior longitudinal ligament occurred dural tears when revealing intervertebral disk; 2 cases due to improper nailing happened dural tears during operation. And the other 4 cases without obvious dural tears in surgery, occurred cerebrospinal leak one to two days after surgery. And the 24 patients were treated with the measures of prevention and treatment preoperatively, intraoperatively, and postoperatively.</p><p><b>RESULTS</b>Twenty-four patients with cerebrospinal leak were cured after treatment and were follow-up for 6 to 30 months. No recurrence of cerebrospinal leake or local and systemic complications were found.</p><p><b>CONCLUSIONS</b>Scar formation is the main cause of cerebrospinal leak in lumbar revision surgery. As for lumbar revision surgery, as long as the standard control measures are taken, it can significantly reduce the incidence of cerebrospinal leak, achieve better clinical efficacy, and fundamentally solve the cerebrospinal leak problem that has plagued both doctors and patients for a long time.</p>

Outcomes of Revision Surgery Following Instrumented Posterolateral Fusion in Degenerative Lumbar Spinal Stenosis: A Comparative Analysis between Pseudarthrosis and Adjacent Segment Disease

STUDY DESIGN: Retrospective study. PURPOSE: We examined the clinical and radiological outcomes of patients who received revision surgery for pseudarthrosis or adjacent segment disease (ASD) following decompression and instrumented posterolateral fusion (PLF). OVERVIEW OF LITERATURE: At present, information regarding the outcomes of revision surgery for complications such as pseudarthrosis and ASD following instrumented PLF is limited. METHODS: This study examined 60 patients who received PLF for degenerative lumbar spinal stenosis and subsequently developed pseudarthrosis or ASD leading to revision surgery. Subjects were divided into a group of 21 patients who received revision surgery for pseudarthrosis (Group P) and a group of 39 patients who received revision surgery for ASD (Group A). Clinical outcomes were evaluated using the visual analogue scales for back pain (VAS-BP) and leg pain (VAS-LP), the Korean Oswestry disability index (K-ODI), and each patient's subjective satisfaction. Radiological outcomes were evaluated from the extent of bone union, and complications in the two groups were compared. RESULTS: VAS-LP at final follow-up was not statistically different between the two groups (p =0.353), although VAS-BP and K-ODI at final follow-up were significantly worse in Group P than in Group A (all p <0.05), and only 52% of the patients in Group P felt that their overall well-being had improved following revision surgery. Fusion rates after the first revision surgery were 71% (15/21) in Group P and 95% (37/39) in Group A (p =0.018). The rate of reoperation was significantly higher in Group P (29%) than in Group A (5%) (p =0.021) due to complications. CONCLUSIONS: Clinical and radiological outcomes were worse in patients who had received revision surgery for pseudarthrosis than in those who had revision surgery for ASD. Elderly patients should be carefully advised of the risks and benefits before planning revision surgery for pseudarthrosis.

Cause and Management of Patients With Failed Endonasal Dacryocystorhinostomy

OBJECTIVES: Endonasal dacryocystorhinostomy (DCR) is a well-established treatment method in patients with nasolacrimal duct obstruction. However, there are a few reports about the overall management of failed endonasal DCR. We investigated the causes and management strategies of failed endonasal DCR. METHODS: This retrospective review included 61 patients (61 eyes) who had undergone revision surgery by the same surgeon after failed endonasal DCR between January 2008 and December 2012. The appropriate revision method was determined after analysis of the etiology of failure by the fluorescein dye disappearance test, nasal endoscopy, lacrimal irrigation, and probing. The criteria for success of the revision surgery were defined by the passage of fluid without resistance upon lacrimal irrigation and normalization of the tear meniscus height. RESULTS: The mean duration between the primary endonasal DCR and revision surgery was 15.3 months. The average follow-up period after revision surgery was 12.2 months. The most common cause of endoscopic revision surgery was membranous obstruction. Endoscopic revision surgery was performed in 48 patients, while lacrimal silicone tube intubation under endoscopy was performed in 13 patients. The most common indication for lacrimal silicone tube intubation was functional epiphora. The overall success rate of the revision surgery was 89%. CONCLUSION: The most common cause of failed endonasal DCR was membranous obstruction. When patients with failed endonasal DCR presented at the clinic, it is important to identify the cause of the failure. Revision surgery could increase the final success rate of endonasal DCR.

Treatment for culture-negative periprosthetic joint infection after total hip arthroplasty with revision / 局解手术学杂志

Objectives To compare the effect of one-stage revision and two-stage revision for the treatment of culture-negative peripros-thetic joint infection after total hip arthroplasty.Methods A retrospective study was conducted with the clinical data of 41 patients who had chronic periprosthetic joint infection after total hip arthroplasty and then underwent one or two-stage revision surgery from February 2006 to February 2014.The patients were divided into two groups according to different surgical way,namely the 16 patients who received the one-stage revision surgery were regarded as the OSR group,and the other 25 cases who underwent the two-stage revision surgery were regarded as the TSR group.The clinical efficacy of the two surgical way were assessed with Harris Hip score,visual analogue scale (VAS),and rate of infection clearance.Results The average duration of follow up was 29.7 months (9 to 48 months).At the last follow-up,Harris Hip score of TSR group was higher than that of the OSR group,and the difference was statistically significant (P =0.04),and the VAS score of TSR group was lower than that of the OSR group with statistical differences (P =0.02).Additionally,the rate of infection clearance in TSR group was significantly higher than OSR group (P =0.04).Conclusion Culture-negative periprosthetic joint infection can be effectively controled by one or two-stage revision surgery.However,patients got a better prognosis after two-stage revision surgery.

Application of 3D printing technology in reconstruction of an complex periprosthetic femoral fracture of tumor knee joint / 吉林大学学报(医学版)

Objective:To perform the preoperative design and operative simulation for periprosthetic femoral fractures (PFF)in one patient with complex tumor knee replacement under assistance of three-dimensional (3D) printing technology,and to explore a more accurate and feasible way to restore the normal anatomy and function of this kind of patients.Methods:The female patient aged 32 years old diagnosed with PFF after an complex tumor knee replacement was selected.The CT images of the patient’s bilateral legs were collected and reconstructed.The bilateral femurs were virtually sliced and the important parameters at each location of both sides were recorded respectively.Novel femoral stem and nail paths were specially designed on the basis of original prosthesis according to these parameters. Then vitual assemble was made with the residual femur. The prosthetic femoral stem components and navigator were customized based on the 3D simulation results when no more errors were found.The residual femoral resin model,customized components and navigator were printed with an SLA 3D printer.The bone cement was taken out and newly designed femoral stem was implanted successfully according to the steps designed preoperatively.The preconcerted allograft bone plates were applied for patch of the bone defect.The pathological results,X-ray and functional scores were included in the observation indexes. Results: With the help of successfully preoperative computer matching,successfully printed bone model-prosthesis assemble and re-customized navigator,the operation was successfully performed.The postoperative alignment shown in the X-ray image was good.The patient was able to normally walk and squat one month after operation with a crutch.MSTS93 score was improved from 0 before operation to 14 only one month after operation.Conclusion:As for PFF of complex tumor knee joint,preoperative design and simulation with 3D printing technology may provide a more accurately and effectively operative outcome than traditional methods.