ABSTRACT
Objective: To explore the feasibility of establishment of a artificial joint aseptic loosening mouse model by cobalt-chromium particles stimulation. Methods: Twenty-four 8-week-old male severe combined immunodeficient (SCID) mice were divided into experimental group ( n=12) and control group ( n=12). The titanium nail was inserted into the tibial medullary cavity of mouse in the two groups to simulate artificial joint prosthesis replacement. And the cobalt-chromium particles were injected into the tibial medullary cavity of mouse in experimental group. The survival of the mouse was observed after operation; the position of the titanium nail and the bone mineral density of proximal femur were observed by X-ray film, CT, and Micro-CT bone scanning; and the degree of dissolution of the bone tissue around the tibia was detected by biomechanical test and histological staining. Results: Two mice in experimental group died, and the rest of the mice survived until the experiment was completed. Postoperative imaging examination showed that there was no obvious displacement of titanium nails in control group, and there were new callus around the titanium nails. In experimental group, there was obvious osteolysis around the titanium nails. The bone mineral density of the proximal tibia was 91.25%±0.67%, and the maximum shear force at the tibial nail-bone interface was (5.93±0.85) N in experimental group, which were significantly lower than those in control group [102.07%±1.87% and (16.76±3.09) N] ( t=5.462, P=0.041; t=3.760, P=0.046). Histological observation showed that a large number of inflammatory cells could be seen around the titanium nails in experimental group, while there was no inflammatory cells, and obvious bone tissue formation was observed in control group. Conclusion: The artificial joint aseptic loosening mouse model can be successfully established by cobalt-chromium particles stimulation.
ABSTRACT
BACKGROUND: Previous studies on the clinical efficacy of total knee arthroplasty in the treatment of rheumatoid arthritis have been reported, but the effects of total knee arthroplasty on joint function and related biochemical parameters in patients with rheumatoid arthritis are little reported. Thereafter, more clinical evidence is needed. OBJECTIVE: To analyze the effect of total knee arthroplasty on joint function and related biochemical indicators in patients with rheumatoid arthritis. METHODS: Clinical data of 64 patients with 64 knees who underwent total knee arthroplasty were retrospectively analyzed. Comparative analysis of Hospital for Special Surgery, range of motion of the knee joint and quality of life scores before and 1 year after surgery was conducted. Changes of biochemical indicators such as C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate were detected. The incidence of complications at 1 month after surgery was recorded. The study was approved by the Ethical Committee of Changzhou Traditional Chinese Medicine Hospital, and all patients signed the informed consents. RESULTS AND CONCLUSION: (1) Compared with the baseline levels, the Hospital for Special Surgery score, range of motion of the knee joint and quality of life scores at 1 year after surgery was significantly increased (P < 0.01), and the levels of C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate were significantly decreased (P < 0.01). (2) One patient developed infection and two patients developed deep vein thrombosis of the lower extremity, which was relieved after symptomatic treatment. These results imply that total knee arthroplasty has a good clinical effect on rheumatoid arthritis, which can improve knee function and reduce the levels of C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate, and has good safety.
ABSTRACT
OBJECTIVE: At present, it has become a consensus that elderly patients with femoral intertrochanteric fracture should be treated by surgery. The main surgical methods are hip arthroplasty and proximal femoral nail antirotation. There are many reports on the clinical effects of these two surgical methods, but which surgical treatment is the better choice under different conditions is still controversial. The clinical efficacy and safety of hip arthroplasty and proximal femoral nail antirotation in the treatment of intertrochanteric fractures in the elderly were evaluated by meta-analysis. METHODS: The databases of PubMed, Cochrane Library, Embase, CNKI, Wanfang and VIP were searched to screen and compare the clinical randomized controlled trials of hip arthroplasty and proximal femoral nail antirotation in the treatment of elderly femoral intertrochanteric fractures from 2000 to 2020. The quality of the research was evaluated independently according to the evaluation tools recommended by the Cochrane system evaluator manual 5.3. Operation time, intraoperative blood loss, hospital stay, first weight bearing time, postoperative Harris function score, postoperative orthopedic complications and postoperative medical complications were selected as evaluation indexes. According to the results, the forest plot was drawn by RevMan 5.3 software, and the data were analyzed. RESULTS: After screening, a total of eight articles were included, containing three English articles and five Chinese articles, all of which were clinical randomized controlled trials. There were 8 articles of grade B, including 716 patients. The results of meta-analysis showed that the operation time of the proximal femoral nail antirotation group was shorter (WMD=15.48, 95%CI:7.78-23.19, P < 0.05), the intraoperative blood loss was less (WMD=104.61, 95%CI:58.86-150.36, P < 0.05), and the initial weight-bearing time of the hip arthroplasty group was shorter (WMD=-12.16, 95%CI:-18.68 to-5.63; P < 0.05). There was no significant difference in postoperative average hospital stay, Harris function score, postoperative orthopedic complications and postoperative medical complications. CONCLUSION: For elderly patients with intertrochanteric fracture, artificial hip arthroplasty can accelerate the functional recovery of hip joint, shorten the time of bed rest, and enable patients to carry out weight-bearing exercise in the early stage. With the continuous progress of artificial hip arthroplasty and the development of minimally invasive technology, the trauma caused by operation is getting smaller and smaller. Under the premise of strengthening perioperative management (such as strengthening preoperative preparation and postoperative management, shortening operation time, reducing bleeding, and actively dealing with basic diseases), compared with proximal femoral nail antirotation, hip arthroplasty has more advantages in the treatment of femoral intertrochanteric fractures in the elderly.
ABSTRACT
Artificial prosthesis is an important tool to help amputees to gain or partially obtain abled human limb functions. Compared with traditional prosthesis which is only for decoration or merely has feedforward control channel, the perception and feedback function of prosthesis is an important guarantee for its normal use and self-safety. And this includes the information of position, force, texture, roughness, temperature and so on. This paper mainly summarizes the development and current status of artificial prostheses in the field of perception and feedback technology in recent years, which is derived from two aspects: the recognition way of perception signals and the feedback way of perception signals. Among the part of recognition way of perception signals, the current commonly adopted sensors related to perception information acquisition and their application status in prosthesis are overviewed. Additionally, from the aspects of force feedback stimulation, invasive/non-invasive electrical stimulation, and vibration stimulation, the feedback methods of perception signals are summarized and analyzed. Finally, some problems existing in the perception and feedback technology of artificial prosthesis are proposed, and their development trends are also prospected.
Subject(s)
Humans , Amputees , Artificial Limbs , Feedback, Sensory , Prosthesis Design , Prosthesis ImplantationABSTRACT
BACKGROUND:Bone graft for acetabular reconstruction includes morselized bone graft, structural bone graft and hybrid bone graft, and the morselized bone has been widely used because of the advantages of simple production and short healing time. OBJECTIVE:To explore the key technologies and clinical effect of impaction bone grafting with morselized bone in total hip revision for AAOS Ⅲ acetabular deficiency. METHODS:Sixteen cases of AAOS Ⅲ acetabular deficiency were treated with impaction bone grafting with morselized bone combined with metal devicesor constructive bone grafting. The hip Harris scores and radiographic data were compared before and after treatment. The effect of impaction bone grafting with morselized bone on acetabular deficiency was assessed. RESULTS AND CONCLUSION:Al the patients were fol owed-up at 3, 6, 12 months after surgery and every half a year successively. The pain of hip joints after operation was relieved significantly and the walking function was restored. The hip Harris score was improved from 48.00 points before surgery to 84.94 points after surgery (Pacetabular cup prosthesis did not displaced, and no displacement and breakage happened to the metal devices. Impaction bone grafting with morselized bone in total hip revision for AAOS Ⅲ acetabular deficiency can effectively reconstruct the acetabular bone structure, retain and restore the acetabular bone mass, and it has good technical advantages and good clinical effects.
ABSTRACT
BACKGROUND:The basic idea of artificial disc replacement is the intension to minimize the impact on adjacent segments based on the premise of stabilizing index segment, then prevent and reduce the incidence of adjacent segment degeneration. OBJECTIVE:To explore the indications and contraindications of artificial disc replacement, peri-operative economics considerations, long-term complications, as wel as the effect of artificial lumbar disc replacement combined with fusion surgery. METHODS:The PubMed database, CNKI database and SinoMed database over the past decade were searched for the related articles. The retrospective and prospective clinical trials of artificial lumbar disc replacement were included. Repetitive studies and stale perspectives were excluded. A total of 34 articles were summarized and analyzed in the end. RESULTS AND CONCLUSION:Since the first artificial lumbar disc prosthesis designed to be commercial y distributed in 1982, there have been a plenty of clinical trials on lumbar disc replacement. However, there is no answer to many problems that encountered in clinical trials. The effect of the number of replaced segment on the clinical outcomes, the effect of facet joint degeneration on the clinical outcomes, selection of the patients with the history of lumbar disc surgery, age of the patients and the rest time before disc replacement should be taken into consideration in the researches on indications and contraindications of artificial disc replacement. The intraoperative blood loss, operation time and hospital stay after replacement can be used to evaluate whether lumbar disc replacement is better than the traditional lumbar fusion surgery or not. The complications after lumbar disc replacement include heterotopic ossification, implants mechanical failure, and facet joint and adjacent segment degeneration. The combination of lumbar disc replacement and fusion surgery for the treatment of multi-segmental lumbar disc diseases can achieve complement and thus obtaining the efficacy that better than the application of one surgery alone.
ABSTRACT
BACKGROUND:The patients receiving total knee arthroplasty are high in average age, and often accompanied with hypertension, diabetes and other basic diseases. Due to the poor physical conditions of the patients, perioperative hemorrhage becomes the important factor that affecting the safety of replacement. OBJECTIVE:To analyze perioperative hidden hemorrhage of primary total knee arthroplasty, and to explore the method of evaluating perioperative blood loss by osteoarthritis severity before total knee arthroplasty. METHODS:A retrospective analysis of 126 knee osteoarthritis patients undergoing total knee arthroplasty was conducted. Al the patients were divided into two groups according to Kel gren and Lawrecne imaging classification:stage Ⅲ group and stage Ⅳ group. The hidden hemorrhage of the patients in two groups was calculated. RESULTS AND CONCLUSION:The average total blood loss of the patients was 1 560 mL, included hidden hemorrhage 865 mL (55%). The mean blood loss of stage Ⅲ group was 1 290 mL with the mean hidden hemorrhage of 684 mL (53%). The mean blood loss of stage Ⅳ group was 1 644 mL with the mean hidden hemorrhage of 921 mL (56%). Statistical analysis showed there were significant differences of total blood loss and hidden hemorrhage between two groups (Phidden hemorrhage. The results indicate that higher grade of osteoarthritis imaging classification, the more of total blood loss and hidden hemorrhage, while the change of the percentage of hidden hemorrhage is not significant. Preoperative evaluation of patients’ blood loss by osteoarthritis severity has great significance for blood management and surgical safety of patients.
ABSTRACT
BACKGROUND:Now, domestic total knee arthroplasty surgeries mainly use medial parapatel ar approach, with the disadvantages of large trauma and slower recovery. The quadriceps sparing approach is more accorded with normal anatomy, which can keep the knee extension system intact. The clinical comparison between quadriceps sparing approach and medial parapatel ar approach is rare. OBJECTIVE:To compare the early effect of total knee arthroplasty through quadriceps sparing approach and medial parapatel ar approach. METHODS:From January 2009 to January 2010, 55 patients (70 knees) were randomly divided into quadriceps sparing approach group (n=26, 35 knees) and medial parapatel ar approach group (n=29, 35 knees). Patients in two groups received total knee arthroplasty through quadriceps sparing approach and medial parapatel ar approach respectively. The incision length, operative time, postoperative drainage volume, additional amount of etoricoxib tablets, pain degree, straight leg raising time, start walking time, hospitalization time, range of motion of knee joint, Hospital for Special Surgery Knee Score, radiographic alignment of al components and complications were compared between two groups. Al the prostheses used in this study were the Sigma type prostheses provided by the rotation platform of Johnson&Johnson Company. RESULTS AND CONCLUSION:Al the patients were fol owed-up for 12-24 months without infections, deep vein thrombosis, neurovascular injury, prosthesis instability, prosthesis loosening or displacement. Position of al the prostheses was normal in patients. The operative time in the quadriceps sparing approach group was longer than that in the medial parapatel ar approach group (P=0.00), while the incision length, postoperative drainage volume, additional amount of etoricoxib tablets, visual analog scale, straight leg raising time, start walking time, hospitalization time, range of motion of knee joint at 3 days after replacement and Hospital for Special Surgery Knee Score in the quadriceps sparing approach group were better than those in the medial parapatel ar approach group (Psignificant differences in range of motion of knee joint at 3 days after replacement and Hospital for Special Surgery Knee Score between two groups. The early effect of total knee arthroplasty through quadriceps sparing approach is better than the medial parapatel ar approach, and there is no significant difference in prosthesis alignment between two methods.
ABSTRACT
BACKGROUND:The effects of artificial joint replacement, osteotomy and reconstruction in the treatment of Crown Ⅳ-type congenital dislocation of hip in adult are not very satisfied. OBJECTIVE:To evaluate the effect of artificial total hip arthroplasty and hip-self procedure in the treatment of Crown Ⅳ-type congenital dislocation of hip in adult patients. METHODS:Twenty-three adult patients with Crown Ⅳ-type congenital dislocation of hip were treated with artificial total hip arthroplasty and hip-self procedure. There were 2 males and 21 females with an average age of (24.26±3.56) years ranging 20 to 35 years. The effect was evaluated according to the Harrris evaluation standard, and the statistical analysis was performed. RESULTS AND CONCLUSION:Al of the patients were fol owed-up for 12-60 months, averaged of (26.60±13.16) months. Statistical comparison with the SPSS 19.0 system showed there was significant difference of the Harrris scores between preoperation and postoperation period (P<0.05). The artificial total hip arthroplasty and hip-self procedure can be used to reconstruct the normal function of hip joint, relieve pain and increase the joint stability, which is considered as the best method for the treatment of Crown Ⅳ-type congenital dislocation of hip in adult.
ABSTRACT
BACKGROUND:As an oral anticoagulant drug, many experiments have proved that rivaroxaban can prevent the deep venous thromboembolism after the hip arthroplasty. The foreign literatures indicate that it can significantly reduce the incidence of deep venous thromboembolism after extending the treatment course to 35 days. But there is no significant conclusion at home, and the safety of drugs after extentding the course has not been confirmed. OBJECTIVE:To analyze the efficacy and safety of rivaroxaban versus low-molecular-weight heparin for the prevention of deep venous thrombosis after the hip arthroplasty. METHODS:106 patients with primary unilateral hip arthroplasty in the Second Clinical Medical College of Shanxi Medical University between March 2011 and September 2012 were selected. The patients were randomly divided into rivaroxaban group and low-molecular-weight heparin group. The patients in two groups were given drugs at 6 hours after replacement, the patients in the rivaroxaban group were given rivaroxaban 10 mg/d with the course of 5 weeks;the patients in the low-molecular-weight heparin group were given low-molecular-weight heparin 4 100 U/d with the course of 2 weeks. RESULTS AND CONCLUSION:The review and fol ow-up results showed there was no deep vein thrombosis or symptoms of deep vein thrombosis in patients of the rivaroxaban group after replacement, while seven cases (13%) of deep vein thrombosis were observed in the low-molecular-weight heparin group, and there was significant difference in the incidence rate of deep vein thrombosis between two groups (P0.05). The results indicate that ful course of rivaroxaban has clear effect and reliable security in the prevention of deep venous thrombosis after hip arthroplasty.
ABSTRACT
10.3969/j.issn.2095-4344.2013.26.003
ABSTRACT
10.3969/j.issn.2095-4344.2013.26.004
ABSTRACT
10.3969/j.issn.2095-4344.2013.26.002
ABSTRACT
10.3969/j.issn.2095-4344.2013.26.005
ABSTRACT
BACKGROUND:Posterior dislocation after total hip replacement is one of the most common complications that second only to loosen, and can affect the stability of the hip joint seriously. There is controversy on the effect of femoral head diameter and acetabular anteversion on the stability of hip joint in clinical study. OBJECTIVE:To investigate the effect of the femoral head diameter and acetabular anteversion on the stability of hip joint after hip prosthesis replacement. METHODS:The femoral head diameter and acetabular anteversion that affect the posterior instability after hip prosthesis replacement were measured on the cadaveric bone. The acetabular shel was inserted at 0°-20° of anteversion at five degree intervals. The femoral heads with different diameters (28, 32 and 36 mm) were used for experiment, the internal rotation degrees to dislocation caused by hip at 90° flexion and 0° adduction and at 90° flexion and 30° adduction were recorded. RESULTS AND CONCLUSION:When the cup anteversion varied from 0° to 15°, there was an increase in the degree of internal rotation angle that could cause hip dislocation with the increasing of femoral head diameter (P<0.05). When the cup anteversion varied from 15° to 20°, the increasing trend was not significant. With the hip at 90° flexion and 0° adduction, and the cup anteversion varied from 15° to 20°, the stability of 36 mm group was significantly higher than that of the 28 mm and 32 mm groups (P<0.01);the stability of 32 mm group was higher than that of 28 mm group when the acetabular anteversion in 10° or more (P<0.05);there was no significant difference in stability between groups when the anteversion less than 10°. With the hip at 90° flexion and 30° adduction, the stability of 36 mm group was significantly higher than that of the 28 mm and 32 mm groups (P<0.01);the stability of 32 mm group was higher than that of 28 mm group when the acetabular anteversion in 10° or more (P<0.05);there was no significant difference in stability between groups when the anteversion less than 10°. The results indicate that the increasing of acetabular anteversion can reduce the occurrence of dip dislocation, but when it is difficult to choice the acetabular anteversion, large-diameter femoral head is preferred to increase the stability of hip joint.
ABSTRACT
BACKGROUND:Artificial total disc replacement is one treatment of low back pain in recent years, but the report on the effect of disc replacement on lumbar sagittal plane is rare. OBJECTIVE:To analyze the effect of lumbar disc replacement on lumbar lordosis. METHODS:Retrospective analysis of radiographic data of 17 patients who underwent lumbar disc replacement for single segment degenerative disc disease was carried out. Data measurement included preoperative and postoperative lumbar lordosis, diseased segmental lordosis and lumbar intervertebral angle. RESULTS AND CONCLUSION:Al the 17 patients were fol owed-up for more than 12 months. Lumbar disc replacement was performed at L4-5 segment in three cases and L5-S1 segment in 14 cases. The average diseased segmental lordosis and lumbar lordosis were increased significantly after replacement when compared with those before replacement (P<0.05);the lumbar intervertebral angle was increased after replacement when compared with that before replacement, but the difference was not significant. The results indicate that lumbar disc replacement for the treatment of single segment degenerative disc disease can increase the lumbar lordosis and diseased segmental lordosis, which can help to improve the lumbar sagittal balance. The postoperative lumbar intervertebral angle has no correlation with the implant angle of the prosthesis on the replace segment.
ABSTRACT
BACKGROUND:As lumbar spine biomechanics research is unceasingly thorough and the constant development of related fusion and dynamic fixation device, the spine fusion technique which is represented by artificial disc replacement is a new choice to the spine surgeons. Therefore, it is particularly important to design reasonable artificial intervertebral disc. OBJECTIVE:To establish the finite element model of the new artificial disc replacement of the lumbar motion segment for further biomechanical study. METHODS:The L3-4 thin-section CT images of a healthy male volunteer was selected, combined with human anatomy data and applied the reverse engineering technology to rebuild the lumbar spine model with medical image software Mimics and tool software Geomagic Studio. The three-dimensional model of the silicone artificial disc was converted into a finite element model through software ANSYS12.0. RESULTS AND CONCLUSION:Through CT scanning, digital image processing and computer-aided design, the three-dimensional model of the lumbar motion segment and the finite element model of artificial disc replacement were successful y established. The finite element model contained 691 085 units and 1 008 913 nodes which could be applied constraint and load and could be used for spinal biomechanics and the further research of the new artificial intervertebral disc.
ABSTRACT
[Objective] Total hip replacement has given good results in the elderly population but with an increasing number of younger patients requiring hip replacement,soft tissue and bone preservation has become important.Studies have shown that a more natural loading of the proximal femur leads to preservation of bone stock and aids remodeling.Proxima hip was developed keeping these requirements in mind.[Methods] Twenty nine Proxima hip replacements were performed on twenty one patients between July 2006 and March 2008 by the senior author.The average age of the patients at the time of surgery was 44 years.Eight of the patients had bilateral hip replacement in the same sitting.The implant used was a Proxima stem with a large diameter metal on metal XL head.Particular care was taken in preserving the full length of femoral neck and the trechanteric muscles.The patients were assessed by Harris hip acore,return to normal and advanced hip functions and satisfaction levels.All patients were followed up with serial X rays and clinical examination.[Results] Average duration of follow up was 1 year.The mean Harris hip score pre surgery was 48 and at last follow up was 88.All patients at 3 to 4 months achieved full weight bearing.One patient had an intra-operation fracture of the lateral cortex which recovered without any sequelae.Another patient had persistent thigh pain without any apparent cause and a poor result.One stem was revised because of aseptic loosening after 9 months.None of the hips showed any sign of acetabular cup loosening or migration.[Conclusions] Early results in this young group of patients are very encouraging.This small implant relies on the preserved neck and the lateral flare for its stability,ensuring a more natural loading of the proximal femur and preserving bone stock and facilitating remodeling.As our results show the Proxima stem as an implant that stands the test of biomechanics and holds a promising future.
ABSTRACT
[Objective]To investigate the outcomes of cementless metasul metal-on-metal total hip arthroplasty.[Method]Metasul metal-on-metal total hip arthroplasty of 30 hips in 25 patients was performed from August 2003 to December 2005.There were 11 males and 14 females with an average age of 47 years(28-72 years).Harris hip scores were determined before surgery and at the last follow-up examination.Standardized radiographs were obtained to evaluate component conditions.Blood samples were taken to determine serum chromium levels with use of atomic absorption spectrometry.[Result]Twenty-three patients(28 hips)were followed up with a mean period of 3.6 years(2.5-4.8 years).The mean Harris hip score improved from 49.5(17-78)points preoperatively to 93.4(55-99)points at the time of final follow-up.Twenty-two hips(85%)had an excellent result.Radiolucent lines were found in 3 hips.Focal femoral osteolysis was seen only in one patient.Sciatic nerve was injured in one case,which showed rehabilitation after 2.5 years.One hip had periprothetic infection because of diabetes 4 years after operation.There was no measurable wear by X-rays.No dislocation or fracture was found.The median serum chromium concentration was 0.082 ?g/mL(0.020～0.140 ?g/mL).No patient was diagnosed with renal insufficiency or hematologic malignancy during the study period.[Conclusion]The outcomes of Metasul metal-on-metal total hip arthroplasty are satisfactory.However,additional follow-up is necessary to determine any possible long-term deleterious effects.
ABSTRACT
[Objective]To evaluate the clinical outcome of the Ribbed anatomic cementless prosthesis.[Method]A total of 1436 hips in 956 patients undergone THR with Ribbed anatomic cementless prosthesis were reviewed.Between March 1997 and September 2005,1 249 hips in 832 patients were available for clinical and radiological follow-up.The mean follow-up period was 6.7 years with a minimum of 2 and a maximum of 10.5 years.The patients were evaluated with Harris Hip Score and radiographic analysis.[Result]The mean Harris Hip Score increased from 34.7 preoperatively to 91.5 postoperatively.Excellent and good functional improvement was seen in 96.3% of the operated patients.There was neither periprosthetic osteolysis nor evidence of loosening on follow-up radiographs.[Conclusion]Ribbed anatomic cementless prosthesis is found to be performing well with good clinical and radiological result.