Long-term results of synovectomy in total knee arthroplasty: a prospective, randomized controlled trial / 中华医学杂志(英文版)

BACKGROUND@#Synovectomy has been introduced into total knee arthroplasty (TKA) with the aim of relieving pain and inflammation of the synovium. However, there are no long-term, comparative data to evaluate the effect of synovectomy in TKA. This study was aimed at assessing pain, function, and complications in patients undergoing synovectomy during TKA for osteoarthritis (OA) at long-term follow-up.@*METHODS@#This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA. Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA. The overall efficacy of both strategies was evaluated by determination of blood loss, the Knee Society score (KSS), and knee inflammation conditions during a 3-month postoperative period. The postoperative pain, range of motion (ROM), and complications were sequentially evaluated to compare the two groups until 10 years after surgery.@*RESULTS@#At the 10-year follow-up, both groups had a similarly significantly improved ROM (114.88 ± 9.84° vs. 114.02 ± 9.43°, t  = 0.221, P  = 0.815) and pain relief with no differences between the two groups (1.0 [1.0] vs. 1.0 [1.5], U  = 789.500, P  = 0.613). Similar changes in total blood loss, KSS, and knee inflammation were found in both groups during 3 months postoperatively ( P  > 0.05). Additionally, there was no significant difference regarding complications and satisfaction between the two groups ( P  > 0.05).@*CONCLUSIONS@#Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain, ROM, and satisfaction during a 10-year follow-up. In addition, it may not result in more blood loss and increased incidence of long-term complications. Based on our long-term findings, it should not be performed routinely.@*TRIAL REGISTRATION@#Chinese Clinical Trial Registry, ChiCTR-INR-16008245; https://www.chictr.org.cn/showproj.aspx?proj=13334 .

A Survey of the Current Status of Surgical Treatment of Hemophilic Osteoarthropathy in China Mainland 17 Grade A General Hospitals / 罕见病研究

  Objective  To understand the current status of surgical treatment for hemophilia osteoarthropathy (HO) in China.  Methods  Using an online questionnaire, select domestic hospitals that partici-pated in the compilation of the 'Guideline for perioperative management of hemophilia patients undergoing orthopaedic surgery in China ', in addition to members of the National Joint Surgery Group, and the Orthopedic Branch of the Chinese Medical Association for targeted investigation and analysis.  Results  A total of 17 domestic hospitals were included, all of which were general hospitals. Hospitals that started HO surgery treatment before 2000 accounted for 35.29%. A total of 3057 surgical cases of HO were reported by those hospitals. The most commonly performed surgical procedures were hip and knee joint replacement. The most commonly used coagulation factor replacement regimen was recombinant coagulation factor preparation. Ten hospitals reported finding patients with transfusion-related infectious diseases. Bleeding and hematoma formation were the most frequently reported surgical complications. Excessive length of hospital stay and high economic costs were the most frequently reported problems.  Conclusions  Surgical treatment for HO in 17 hospitals is mainly carried out in some large comprehensive medical centers in the eastern region. Compared with the patient base, the popularity and number of surgeries are still relatively insufficient. It is necessary to further standardize the treatment system by standardizing factor replacement and strengthening rehabilitation to improve surgical treatment outcomes.

Comparison of earlier functional recovery in total hip arthroplasty patients using a direct anterior approach or posterolateral approach / 中华骨科杂志

Objective To compare faster rehabilitation of different surgical approaches in total hip arthroplasty (THA)patients using a direct anterior approach or posterolateral approach.Methods Sixty-eight patients (35 in direct anterior THA and 33 in posterolateral THA) from September 2015 to March 2016 were recruited in the present study.The incision length,operation duration,intraoperative blood loss,serum creatinekinase (CK),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),interleukin-6 (IL-6) and visual analogue scale (VAS) pain score were compared between two groups respectively.The Harris hip score,the University of California at Los Angeles (UCLA) pain,walking,and activity scores,postoperative hospital length of stays,gait analysis,component placement and complications were also compared.Results The mean incision length,operation duration,intraoperative blood loss were 11.23±0.97 cm,73.77±9.20 min and 157.15±35.83 ml in the DAA group respectively,while those in PLA group were 15.16±1.12 cm,64.12±13.31 min and 126.97±45.45 ml.The mean incision length of the DAA group were significantly less than that of the PLA group.The DAA group underwent longer operation time that associated with more intraoperative blood loss.The levels of CK and inflammation markers were increased in the PLA group compared with those in the DAA group.The VAS pain score was less in the DAA group than the PLA group within postoperative 72 hours.Functional recovery in the DAA group was faster than that in the PLA group based on the Harris hip score,UCLA scores,and gait analysis up to 3 months.There was no difference in these outcomes between the groups beyond 6 months.The average postoperative hospital length of stay was 2.95±0.24 days and 3.35±0.51 days for the DAA group and PLA group respectively.The patients in DAA group required less postoperative hospital length of stays.The angle of acetabular cup anteversion in the DAA group (16.4°±2.3°) was lesser than that in the PLA group (20.4°±2.8°).There was one intraoperative nondisplaced greater trochanter fracture in the DAA group,whereas no intraoperative complications were occurred in the PLA group.Conclusion The present study showed that using direct anterior approach in THA provided significant benefits for patients in terms of muscle damage,VAS score,hospital length of stays and functional recovery in the early stage postoperatively compared to using posterolateral approach.

Malformation correction of femoral medullary cavity in hip revision arthroplasty for implant loosening / 中华骨科杂志

Objective To investigate the results of malformation correction of femoral medullary cavity in hip revision for implant loosening.Methods From January 2010 to December 2016,24 patients (24 hips) were received hip revision arthroplasty using femoral medullary cavity correction technique.Nineteen patients (19 hips) were followed up.Ten patients were male and 9 female with mean age of 69.1 years (range 44-84).The followings are the reasons for revision:15 patients for osteolysis with implant loosening,4 for periprosthetic infection,bone cement implant and stage two revision.Fourteen patients received bone cement implants and 5 received uncemented implants for primary arthroplasty.During revision,13 patients underwent femoral bone cortical windowing and 6 received extended trochanteric osteotomy technique to exposure medullary cavity,grinding sclerotic bone and filling bone defect,correcting cavity to normal morphology and implant anatomic revision stem.The hip function was evaluated with Harris score.Peri-operation complications were also collected.Implant position,fixation condition and implant loosening were evaluated from the supine anteroposterior radiograph of the pelvic and a lateral hip radiograph.Results The mean follow up duration was 58 months (range 17-82).The mean Harris score improved significantly from 41.52±10.94 (range 17-64) preoperatively to 91.63±6.70 (range 72-99) postoperatively.Mild limp occurred in 2 patients (11％,2/19) and intermittent hip pain occurred in 1 patient (5％,1/19).Peri-prosthetic fracture occurred in 1 patient and was treated with double stranded wire fixation.No deep venous thrombosis,dislocation and infection occurred.No revision was performed.For bone cortical windowing patients,the length of the cortical windows varied from 3.0 to 9.0 cm (mean 4.78±1.84),the width ranged from 1.0-3.0 cm (mean 1.82± 0.50).For extended trochanteric osteotomy patient,the length of the osteotomy varied form 12.0-20.0 cm (mean 16.00±3.37),the width ranged from 2.5 to 3.0 cm (mean 2.75±0.29).All the revision stems were in neutral position without varus or valgus.All the osteotomy sites were bone heal and fracture lines were disappeared.Conclusion In order to restore the normal bone cavity morphology and femoral alignment,correction bone cavity technique is required in patients receiving hip revision with femoral cavity malformation and anatomy alignment abnormal.This technique can ensure neutral position of revision stem without peri-prosthetic fracture.

Biomechanical research on effects of joint line height on stress of medial and lateral compartment after unicompartmental knee arthroplasty / 中华骨科杂志

Objective To investigate biomechanical effects of different joint line height on unicompartmental knee arthroplasty (UKA) and to provide biomechanical evidence for surgical decision during UKA using finite element analysis (FEA).Methods On the basis of knee joint CT data from a healthy volunteer (male,30 years old,165 cm and 60 kg) and UKA prosthesis 3D scanned data,the 3D models of normal knee and UKA were constructed.Subject-specific finite element models with inhomogeneous material property assignment were constructed for normal knee and UKA with 3 different height of joint line (-3 mm,0 mm and +3 mm).Starting from the tibial articular surface,5 sections were extracted with 2 mm interval.30 nodes were selected in medial and lateral area,respectively on each section.The mean stress value of nodes was defined as the stress level of subchondral bone.Results Mean values of stress on polyethylene upper surface of 0,-3 and+3 mm joint line position were 14.84,26.81and 20.86 MPa,and the difference was statistical significant (t0vs-3=4.896,P0vs-3=0.000;t0vs+3=3.455,P0v+3=0.008;t-3vs+3=2.579,P-3vs+3=0.020).Mean values of stress on tibial prosthesis upper surface of 0,-3 and +3 mm joint line position were 29.69,50.49 and 39.99MPa,respectively,and the difference was statistical significant(t0vs-3=5.675,P0vs-3=0.000;t0vs+3=4.755,P0v+3=0.001;t-3vs+3=4.783,P-3vs+3=0.000).When joint line was in 0 mm height,stress level of subchondral bone was similar to that of normal knee.When joint line was in-3 mm height,significantly increased stress was found on polyethylene (increased 81％) and tibial component (increased 70％) surface compared with that of 0 mm height,while stress on trabecular bone under lateral tibial articular surface also increased by 8.7％.When joint line was in +3 mm height,increased stress on polyethylene (increased 41％) and tibial component (increased by 35％) surface were less than that of-3 mm height.Stress on trabecular bone under lateral articular surface decreased by 55.6％ compared with 0 mm height.Conclusion During UKA,ensuring a normal height of joint line is benefit to keep the stress path of the medial and lateral tibia similar with normal knee and decrease the risk of premature polyethylene wear,tibial component subsidence and periprosthetic fracture.

Comparison of earlier functional recovery in total hip arthroplasty patients using a direct anterior approach or posterolateral approach / 中华骨科杂志

Objective To compare faster rehabilitation of different surgical approaches in total hip arthroplasty (THA)patients using a direct anterior approach or posterolateral approach.Methods Sixty-eight patients (35 in direct anterior THA and 33 in posterolateral THA) from September 2015 to March 2016 were recruited in the present study.The incision length,operation duration,intraoperative blood loss,serum creatinekinase (CK),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),interleukin-6 (IL-6) and visual analogue scale (VAS) pain score were compared between two groups respectively.The Harris hip score,the University of California at Los Angeles (UCLA) pain,walking,and activity scores,postoperative hospital length of stays,gait analysis,component placement and complications were also compared.Results The mean incision length,operation duration,intraoperative blood loss were 11.23±0.97 cm,73.77±9.20 min and 157.15±35.83 ml in the DAA group respectively,while those in PLA group were 15.16±1.12 cm,64.12±13.31 min and 126.97±45.45 ml.The mean incision length of the DAA group were significantly less than that of the PLA group.The DAA group underwent longer operation time that associated with more intraoperative blood loss.The levels of CK and inflammation markers were increased in the PLA group compared with those in the DAA group.The VAS pain score was less in the DAA group than the PLA group within postoperative 72 hours.Functional recovery in the DAA group was faster than that in the PLA group based on the Harris hip score,UCLA scores,and gait analysis up to 3 months.There was no difference in these outcomes between the groups beyond 6 months.The average postoperative hospital length of stay was 2.95±0.24 days and 3.35±0.51 days for the DAA group and PLA group respectively.The patients in DAA group required less postoperative hospital length of stays.The angle of acetabular cup anteversion in the DAA group (16.4°±2.3°) was lesser than that in the PLA group (20.4°±2.8°).There was one intraoperative nondisplaced greater trochanter fracture in the DAA group,whereas no intraoperative complications were occurred in the PLA group.Conclusion The present study showed that using direct anterior approach in THA provided significant benefits for patients in terms of muscle damage,VAS score,hospital length of stays and functional recovery in the early stage postoperatively compared to using posterolateral approach.

Malformation correction of femoral medullary cavity in hip revision arthroplasty for implant loosening / 中华骨科杂志

Objective To investigate the results of malformation correction of femoral medullary cavity in hip revision for implant loosening.Methods From January 2010 to December 2016,24 patients (24 hips) were received hip revision arthroplasty using femoral medullary cavity correction technique.Nineteen patients (19 hips) were followed up.Ten patients were male and 9 female with mean age of 69.1 years (range 44-84).The followings are the reasons for revision:15 patients for osteolysis with implant loosening,4 for periprosthetic infection,bone cement implant and stage two revision.Fourteen patients received bone cement implants and 5 received uncemented implants for primary arthroplasty.During revision,13 patients underwent femoral bone cortical windowing and 6 received extended trochanteric osteotomy technique to exposure medullary cavity,grinding sclerotic bone and filling bone defect,correcting cavity to normal morphology and implant anatomic revision stem.The hip function was evaluated with Harris score.Peri-operation complications were also collected.Implant position,fixation condition and implant loosening were evaluated from the supine anteroposterior radiograph of the pelvic and a lateral hip radiograph.Results The mean follow up duration was 58 months (range 17-82).The mean Harris score improved significantly from 41.52±10.94 (range 17-64) preoperatively to 91.63±6.70 (range 72-99) postoperatively.Mild limp occurred in 2 patients (11％,2/19) and intermittent hip pain occurred in 1 patient (5％,1/19).Peri-prosthetic fracture occurred in 1 patient and was treated with double stranded wire fixation.No deep venous thrombosis,dislocation and infection occurred.No revision was performed.For bone cortical windowing patients,the length of the cortical windows varied from 3.0 to 9.0 cm (mean 4.78±1.84),the width ranged from 1.0-3.0 cm (mean 1.82± 0.50).For extended trochanteric osteotomy patient,the length of the osteotomy varied form 12.0-20.0 cm (mean 16.00±3.37),the width ranged from 2.5 to 3.0 cm (mean 2.75±0.29).All the revision stems were in neutral position without varus or valgus.All the osteotomy sites were bone heal and fracture lines were disappeared.Conclusion In order to restore the normal bone cavity morphology and femoral alignment,correction bone cavity technique is required in patients receiving hip revision with femoral cavity malformation and anatomy alignment abnormal.This technique can ensure neutral position of revision stem without peri-prosthetic fracture.

The efficacy and safety of postoperative retransfusion drain following total hip arthroplasty: a Meta-analysis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effectiveness and safety of post-operative retransfusion drain(PRD) after total hip arthroplasty.</p><p><b>METHODS</b>A systematic literature review based on PubMed, EMBase, the Cochrane Library, China Biology Medicine disc, CNKI, VIP and WanFang Database in any language regarding PRD following total hip arthroplasty was performed.The data was evaluated using modified Jadad score and then analyzed using RevMan 5.2.</p><p><b>RESULTS</b>Nine randomized controlled trials totaling 1 824 patients, 913 patients in PRD group and 911 in control group, were eligible for data extraction and Meta-analysis.The results indicated that the use of PRD could reduce the requirement of allogeneic blood transfusion when compared with ordinary vacuum drainage (RR=0.61, 95% CI= 0.47-0.79), but the benefit was not found when compared with no drainage group(RR=1.07, 95% CI=0.67-1.71). And the postoperative hemoglobin level was higher in PRD group(MD=0.14, 95% CI=0.01-0.27, P=0.04). No significant difference was identified regarding transfusion index, length of hospital stay, the incidence of febrile reaction and wound-related complications.</p><p><b>CONCLUSIONS</b>PRD in reducing requirement of blood transfusion following THA is effective and safe when compared with ordinary vacuum drainage, but the benefit is not found when compared with no drainage.And more robust evidence is needed to confirm this result.</p>

Mid-term effects of total hip arthroplasty using metal-on-metal prosthesis with large diameter femoral head / 中华骨科杂志

Objective To evaluate mid?term clinical outcomes associated with total hip arthroplasty using metal?on?met?al prosthesis with large diameter femoral head. Methods From March 2007 to December 2009, 153 patients (177 hips) with ad?vanced hip diseases undergoing large diameter femoral head metal?on?metal total hip arthroplasty in our hospital were retrospec?tively analyzed in this study. Clinical physical examination and radiographic examination were used to evaluate hip function and the incidence of complications (implant loosening and inflammatory pseudotumor);ICP?MS method was used to determine serum cobalt ion and chromium ion levels and compare with normal values;revision was set as the prosthesis endpoint to evaluate the five year survival rate of implant. Results A total of 145 patients (169 hips) were followed up for average 72.4 months (67-80 months), the follow?up rate was 94.8% (145/153). For the involved patients, 85 were male (104 hips), 60 were female (65 hips);age 20-78 years old, average 49.3±12.6 years old. All patients received ASRTM?XL large femoral head metal?on?metal to?tal hip arthroplasty operation. At the end of follow?up, the average Harris hip score improved from 44.2±12.6 points preopera?tively to 91.5±5.7 points. A total of 8 patients received revision, 3 for acetabular implant spinout?out and 5 for hip inflammato?ry pseudotumor. The prosthetic survival rate 5 years after operation was 95.3% (161/169) for revision. Serum cobalt (2.89 μg/L) and chromium (3.31 μg/L) ion levels were significantly increased compared with normal value (<0.5 μg/L). Conclusion For the fixation and friction interface disadvantages, acetabular implant spinout?out and inflammatory pseudotumor might occur for patient receiving large femoral head metal?on?metal THA. The mid?term prosthetic survival rate was also low, with metal ion levels increased significantly. For primary THA, large femoral head metal?on?metal prosthesis cannot be the first choice.

Expression of miRNA-140 in Chondrocytes and Synovial Fluid of Knee Joints in Patients with Osteoarthritis / 中国医学科学杂志(英文版)

Objective To investigate the expression of miRNA-140 in chondrocytes and synovial fluid of osteoarthritis (OA) patients, and explore the relationship between the miRNA-140 expression and OA severity.Methods This study enrolled 30 OA patients who underwent total knee arthroplasty for chondrocytes sampling and 30 OA patients who underwent intra-articular injection for synovial fluid sampling. All OA patients were grouped into mild [Kellgren and Lawrence (KL) grade 1-2], moderate (KL grade 3) and severe (KL grade 4), with 10 in each subgroups for each sampling purposes. 7 non-OA patients and 10 patients with knee injury were collected for cartilage and synovial fluid sampling respectively as control groups. Chondrocytes were isolated from the cartilage tissue and cultured in vitro. Quantitative real time PCR for miRNA-140 in chondrocytes and synovial fluid were performed, and the U6 snRNA was used as internal control. The expression difference of miRNA-140 among groups and correlation between the expression and the KL grade of OA were analysed using one-way ANOVA and Spearman test respectively. Results The expression of miRNA-140 in chondrocytes of knees in OA patients was reduced than that in normal knees, and the between-group difference was statistically significant (F=305.464, P<0.001). miRNA-140 could be detected in synovial fluid of both normal knees and OA knees, its relative expression level was reduced in synovial fluid of OA group compared with normal group, and the between-group difference was statistically significant as well (F=314.245, P<0.001). The relative expression level of miRNA-140 in both chondrocytes and synovial fluid were negatively correlated with the KL grade of OA(r=-0.969, P<0.001; r=-0.970, P<0.001). Conclusion miRNA-140 could be detected in chondrocytes and synovial fluid of OA patients, and its expression was negatively correlated with the severity of OA.

The effect of adductor canal block and femoral nerve block under multimodal analgesia for early analgesic effect and re-habilitation after total knee replacement / 中华骨科杂志

Objective To compare adductor canal block with femoral nerve block under multimodal analgesia for early analgesic effect and rehabilitation after total knee replacement (TKA). Methods Eighty patients who were scheduled to undergo TKA were randomly divided into two groups:adductor canal block (ACB) group and femoral nerve block (FNB) group. All the pa?tients were given Celecoxib (200 mg, bid) three days preoperative. The ACB group was given adductor canal block with ropivacaine (5 g/L, 20 ml) and 0.1 mg epinephrine half an hour before the surgery. The FNB group was given femoral nerve block with ropivacaine (3.33 g/L, 30 ml) and 0.1 mg epinephrine half an hour before the surgery. Both of the two groups were given local infiltration analge?sia with ropivacaine (2.5 g/L, 20 ml) and 0.1 mg epinephrine after click into the prosthesis. After surgery, all the patients were given Diclofenac Sodium (50 mg, q12h, p.o.), oxycodone hydrochloride sustained?release tablets (10 mg, q12 h, p.o.) and Parecoxib (40 mg, q12 h, i.m.) until discharged. The resting and motion Numeric Rating Scales (NRS) scores, the knee joint range of motion, the muscle strength of quadriceps femoris, total Meperidine hydrochloride consumption, postoperative hospital stay and the side effects and complications were recorded. Results The resting and motion NRS scores were similar to the ACB group of FNB group which were not statistically significant. The range of motion (1, 2, 3 days after surgery) and muscular strength of quadriceps femofis (within 24 hours) in the ACB group was better than in the FNB group. The average length of postoperative hospital stay was shorter in the ACB group than it was in FNB group. In the ACB group the range of motion at 14 day, total Meperidine hydrochloride con?sumption and the side effects were similar to the FNB group. Conclusion Under multimodal analgesia, the adductor canal block had similar early analgesia effects with the femoral nerve block when TKA was performed. However, compared with FNB, the ACB was more beneficial to patients regarding the early postoperative rehabilitation to patient.

Clinic value of myocardiac perfusion imaging in coronary risk assessment in patients planning total joint arthroplasty / 中华骨科杂志

Objective To explore clinic value of nuclear myocardiac perfusion imaging (MPI) in perioperative coronary risk assessment in patients with heart diseases planning arthroplasty,and compare the conformity and effect on surgery planning between MPI and coronary computed tomography angiogram (CTA).Methods Prospectively collect clinical data of 228 patients with heart diseases planning joint arthroplasty,all patients had MPI and CTA test to assess perioperative coronary risk.The conformity and effect on surgery planning between the MPI and CTA was analyzed,and the occurrence of cardio-vascular complication was recorded.Results MPI showed that 215 patients had no myocardial ischemia except for 13.CTA showed that 113 cases had no coronary stenosis,51 cases had light coronary stenosis,39 cases had middle coronary stenosis and 12 cases had severe coronary stenosis in patients with no myocardial ischemia.CTA also found that 3 cases had no coronary stenosis,4 cases had light coronary stenosis,3 cases had middle coronary stenosis and 3 cases had severe coronary stenosis in patients with myocardial ischemia.The conformity between MPI and CTA was low.222 patients had completed operation except for 6 cases.MPI rather than CTA had conspicuous effect on surgery planning.There was no angina,myocardial infarction or cardiac death associated with myocardial ischemia.The postoperative cardio-vascular complications included 6 cases of heart failure,4 cases of atrial fibrillation and 1 case of cerebral infarction.Conclusion MPI is a direct index to judge blood supply of the myocardium,which can exactly predict the risk of perioperative myocardial ischemia and the prognosis.It's helpful for preoperative planning,reducing risk of perioperative complications through screening and excluding high-risk patients.

Medium-term curative effect of extensively coated non-modular femoral stem in two-stage infection revision after joint replacement / 中华骨科杂志

Objective To determine medium-term curative effect of extensively coated non-modular femoral stems in twostage infection revision after joint replacement.Methods We retrospectively analyzed 33 patients (33 hips) who had a two-stage infection revision after total hip replacement arthroplasty from March 2005 to December 2006.Among of them,there were 20 men (20 hips) and 13 women (13 hips).Their mean age was 66.1±7.2 years with a range from 52 to 80.The two-stage revision protocol consisted of joint prosthesis taken out in the first stage,thorough debridement,hand-molded antibiotic bone cement spacer,and two-stage joint revision after anti-infective therapy.Anti-infective therapy included intravenous antimicrobial therapy for 4 weeks and oral antibiotics for 6 weeks.Harris hip score (HHS) was used to evaluate functions of hip joint.X-ray films were used to perform clinical and radiological evaluations of prosthesis stability,displacement and looseness.Reinfection criteria were the same as the criteria used to diagnose the joint infection.Results Follow-up visit was carried out for all patients for 5-9 years (6.1±1.7 years on the average).No infection or prosthesis looseness happened after two-stage revision.Microculture of samples taken during two-stage revision or pathological examination was negative.Harris hip joint score rose to 89.1 ±8.5 in the last follow-up visit from preoperative 42.3±6.5.30 patients achieved stable bone ingrowths and the remaining three had stable fibrous ingrowths.Impacted bone graft at acetabulum side for 11 patients and all impacted bone graft in marrow cavity were fused well with the host bones.Allogeneic cortical bone plate grafts were used in 10 hips on the femoral side.Nine of these cortical bone plates fused with the host bones after postoperative 1 year,whereas one fused after 2 years.Conclusion Using extensively coated non-modular femoral stems combined with intramedullary allograft in two-stage revision for treating infection can achieve satisfactory medium-term survival rate of prosthesis and infection clearance rate.

Perioperative management and short-term clinical evaluation in hemophilia arthritis patients following total knee arthroplasty: a retrospective study / 中华骨科杂志

Objective To investigate the perioperative management,coagulation factor regulation in total knee arthroplasty (TKA) for hemophilia arthritis and evaluate its short-term clinical efficacy.Methods A retrospective study was performed in hemophilia arthritis patients who had undergone TKA from March,2009 to March,2014.Patients with type A hemophilia received Lyophilized Human Factor Ⅷ,and type B hemophilia patients received Prothrombin Complex.Perioperative accurate dosage of coagulation factor was determined by preliminary test.AORI T1,T2 bone defects were filled with PMMA,and severe contained AORI T3 defects were fixed with impaction allograft and screws,and for non-contained AORI T3 bone defects,structural allografts and stem extension may be considered.Knee function was evaluated by HSS score,and imaging change was evaluated by anteroposterior and lateral radiographs of knee at latest follow-up.Results Eight patients (10 knees) were included with a mean age of 38.3±5.0 years,in which 6 were type A,and the other 2 were type B.Preoperative APTT was 63.9±4.0 s,and coagulation factor activity was 2.6％±0.9％.All the patients had flexion deformity with extension of-12.0°±5.9° and flexion of-88.0°± 11.4°.Three patients (3 knees) had valgus deformity with-3.0°±5.4°,and 2 patients (4 knees) had varus deformity with-4.5°±6.0°.All the 8 patients were followed for a mean of 14.3 months.The range of motion was improved with 0°-98.5°±6.7° at latest follow-up,and the postoperative HSS score was 88.3±4.6 compared with 42.3±10.9 preoperatively.Bone-grafting was survival,and no loosening of prosthesis or screws were detected from X-ray at latest follow-up.Conclusion The early results of TKA in Hemophilia arthritis patients are satisfactory.Preoperative preliminary test was helpful to determine the accurate dosage of coagulation factor.A stable high level of coagulation factor was vital to control bone-cement bleeding and make prosthesis stable.Tibial bone defects involving ＜ 1/3 area and ＜ 1 cm in depth could be filled with PMMA,and impaction allograft and screws could be used to fix severe contained bone defects.For segmental bone defects,except of structural allograft,stem extension was recommended to reduce stress and increase stability.

Perioperative efficiency and safety of different regimen of tranexamic acid on total knee arthroplasty / 中华骨科杂志

Objective To explore the perioperative efficiency and safety of different regimen of tranexamic acid (TXA) in total knee arthroplasty (TKA).Methods From February 2013 to May 2013,150 female patients with knee osteoarthritis underwent unilateral TKA were randomly divided into three groups,50 cases in each group.Patients received 10 mg/kg TXA by fast intravenous infusion before closing the wound in first group (single dose group),patients in second group received two doses of 10 mg/kg TXA before closing the wound and 3 hours postoperation (repeated dose group),patients in the third group didn't receive TXA (control group).The postoperative blood loss via drainage,the total blood loss,the hidden blood loss,the postoperative hemoglobin concentration at different times and the numher of patients need blood transfusion were recorded.All patients were observed for detecting deep vein thrombosis (DVT) by the color doppler ultrasonography within 5 days postoperation,and the symptomatic DVT and pulmonary embolism (PE) were observed within 90 days postoperation.Results The blood loss via drainage was significantly less in the single dose group (273.6±99.6 ml) and repeated dose group (168.5±80.8 ml) compared with the control group (447.2±101.9 ml),and it was significantly less in the repeated dose group than the single dose group; the total blood loss was significantly less in the single dose group (959.1±291.7 ml) and repeated dose group (818.7±206.9 ml) compared with the control group (1 100.8±288.3 ml),and it was significantly less in the repeated dose group than in the single dose group; there was no differ ences about the hidden blood loss among the three groups.The hemoglobin concentration was significantly higher in the single dose group and repeated dose group than in the control group in day 1,3 and 5 postoperation; and it was significantly higher in the repeated dose group compared with the single dose group.The ratio of transfusion was significantly less in the single and repeated dose groups than in the control group,but no differences exists between the single dose group and repeated dose group.There was no DVT in all of the three groups within 5 days postoperation,and there was no symptomatic DVT and PE in all of the three groups within 90 days.Conclusion 10 mg/kg of TXA infused intravenous before closing the wound is effective and safe in TKA,another dose 3 hours postoperation is much more effective and will not increase the danger of DVT and PE.

Three-dimensional computerized preoperative planning of acetabular prostheses implantation in total hip arthroplasty with Crowe Ⅳ type developmental dysplasia of the hip patients / 中华骨科杂志

Objective To study whether 3D computerized pre?operative planning is accuracy and reliability in CroweⅣtype developmental dysplasia of the hip (DDH) patients undergoing total hip arthroplasty (THA). Methods Between September 2009 and February 2011, 20 CroweⅣtype DDH patients (20 hips) were included in this study. The 3D pre?operative planning was performed using Mimics software to predict the acetabular component size, acetabular component abduction angle, hip rota?tion center position, the acetabular component coverage and number of patients received structural bone graft. The results were compared with traditional acetate templating technique and post?operative results. Results 70%(14/20) components were pre?dicted exactly and 30%(6/20) components were predicted with one size using 3D computerized planning, comparing with 25%(5/20) components were exactly, 45%(9/20) components were with one size and 30%(6/20) were with two size or more using conven?tional acetate templating technique. Statistically analysis revealed that 3D planning was more accuracy than templating technique regarding acetabular component prediction (t=-4.66, P=0.00). There was no significant difference between the 3D computerized planned acetabular component abduction angle (3D plan 41.10°±4.87°, postoperative 44.98°±10.83°, t=0.88, P=0.42), hip rota?tion center distance (horizontal distance:3D plan 77.51 ± 7.78 mm, postoperative 79.85 ± 8.61 mm, t=-1.95, P=0.11;vertical dis?tance:3D plan 42.79±8.22 mm, postoperative 44.98±10.83 mm, t=-1.27, P=0.26), acetabular component host coverage (3D plan 77.73%± 10.51%, postoperative 78.98%± 10.24%, t=-1.84, P=0.09), and that found post?operatively. Five patients were consid?ered to need structural bone graft according to 3D computerized planning, which was highly coincident with the intraoperative find?ings in all five cases. Conclusion 3D computerized pre?operative planning using Mimics software is an accurate and reliable technique in treating CroweⅣtype DDH patients undergoing THA.

X-ray image characteristics and related measurements in the ankles of 118 adult patients with Kashin-Beck disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Kashin-Beck disease (KBD) is a chronic, degenerative osteoarthropathy that causes severe skeletal deformation. Although many researchers have proven that almost all KBD patients who showed an increaseing proximo-distal gradient had radiographic abnormalities of the ankle, few detailed description of radiographic changes in the ankles of patients with KBD has been reported, especially for variable measurements of ankle changes. The purpose of this study was to demonstrate the radiographic characteristics of the ankles of adult KBD patients.</p><p><b>METHODS</b>One hundred and eighteen adult KBD patients from september to October 2010 in Rongtang county in China were examined with lateral radiographs of the right ankle. The morphological abnormalities in the talus, calcaneus, navicular bone, distal tibia, and joint space were analyzed, and the calcaneus length, height, length-height ratio, tuber angle, front angle, plantar angle, and distal tibia anteroposterior (AP) length were measured using Riepert's method.</p><p><b>RESULTS</b>Eighty-one patients (68.6%) had abnormal ankle radiographs; 72 (88.9%) patients had talus changes, 69 (85.2%) patients had calcaneus changes, 28 (34.6%) patients had navicular bone changes, and 48 (59.2%) patients had distal tibia changes. For 118 KBD patients, the average calcaneus length was 7.4 cm, height was 4.3 cm, and the length-height ratio was 1.7. The calcaneus tuber angle was 28.2°, front angle was 38.0° and the plantar angle was 74.2°. The distal tibia anteroposterior length was 4.05 cm. Compared with 50 normal adults (control group), significant differences were found for the calcaneus length, the calcaneus length-height ratio, and the distal tibia AP length.</p><p><b>CONCLUSIONS</b>Patients with KBD have characteristic abnormalities on ankle radiographs; talus depression and deformity, calcaneus shortening deformity, and distal tibia deformity with AP length widening were the most typical changes.</p>

Revision arthroplasty using an anti-protrusio cage for Paprosky type Ⅲ acetabular bone deficiency:a middle-term follow-up / 中华骨科杂志

Objective To investigate the middle-term results of anti-protrusio cage combining with allograft bone graft for revision arthroplasty of Paprosky type Ⅲ acetabular bone defect.Methods A retrospective analysis was done for 19 patients (20 hips) with Paprosky type Ⅲ acetabular bone defect who received acetabular revisions using anti-protrusio cage from January 2002 to December 2009.There were 11 males and 8 females,aged from 42 to 76 years (average,57.4 years).There were 7 hips (35％) of Paprosky type ⅢA acetabular bone defect,and 13 hips (65％) of type ⅢB.The follow-up time was (5.8±2.4) years.Hip function of patients was judged by Harris hip scores pre-and post-operation.The outcome of acetabular prostheses and bone grafts were assessed by radiologic evaluation.The five-year cage failure-free survival rate was assessed by Kaplan-Meier survivorship analysis.Results The Harris hip scores improved from preoperative 14.6±4.3 to 83.5±7.9 at the final follow-up.Lower limb discrepancy improved from preoperative (26.3±9.1) mm to postoperative (1.2±3.4) mm.The hip rotation center was reconstructed from preoperative(23.6±7.4) mm up-toward and (4.4±14.7) mm lateral-toward dislocation to inside Ranawat triangle.All the allograft bone was incorporated with host bone.None of cage displacement,screw fracture,progressive radiolucency and cement fracture was observed.Mild allograft bone resorption was observed in 3 hips (15％).There was no moderate or severe bone resorption found at the final follow-up.The five-year cage failure-free survival rate was 100％ (95％ CI,0.95-1.00).Conclusion The revision using anti-protrusio cage combined with allograft bone graft shows satisfying middle-term clinical and radiological results in the treatment of Paprosky type Ⅲ acetabular bone defect.

Analgesic effects of local infiltration analgesia in multimodal analgesia for unilateral primary total knee arthroplasty / 中华骨科杂志

Objective To evaluate the efficacy and safety of local infiltration analgesia in the multimodal analgesia protocol.Methods Sixty patients who were scheduled to undergo TKA were randomly divided two groups:local infiltration analgesia (LIA) group (n=30) or the non-local infiltration analgesia (N-LIA) group (n=30).All patients were given Celecoxib 200 mg bid,3 days preoperative,and a single-injection femoral nerve block (SFNB) half an hour before the surgery (ropivacaine 3.3 g/L,30 ml).The LIA group was given local infiltration analgesia with ropivacaine (2.5 g/L,60 ml) and 0.1 mg epinephrine before suture the operative incision.The N-LIA group didn't do the LIA.Both of the two groups didn't use the patient controlled analgesia.The VAS scores,the knee joint range of motion,the muscle strength of quadriceps femoris and the side effects and complications were recorded.Results The VAS scores were lower in LIA group than in the N-LIA group,these scores at 2 h to 48 h after surgery at rest and after 24 h at motion had statistical significance.The range of motion and the muscular strength of quadriceps femoris in the LIA group were better than in the N-LIA group.In the LIA group the use of opioids was less and the side effects were lower.The average length of hospital stay after the operation was shorter in the LIA group than the N-LIA group.Conclusion This multimodal perioperative analgesia protocol that include SFNB and LIA offered improved pain control and minimal side effects to patients undergoing TKA.

In vivo kinematics analysis of the knee joint of people after fixed-bearing posterior stabilized total knee arthroplasty / 中华骨科杂志

Objective To compare the kinematics of the knee joint of normal Chinese people and people after fixed-bearing posterior stabilized total knee arthroplasty while doing weight-bearing deep knee-bending using fluoroscopy analysis.Methods From June to December 2010,ten volunteers and ten patients with fixed-bearing posterior stabilized total knee arthroplasty (TKA) were required to perform weight-bearing deep knee-bending activity under surveillance of roentgenization,motion between femur and tibia was analyzed with interval of 15° according to two-to three-dimensional (2D-3D) registration technique.Results During weight-bearing deep knee-bending,the average weight-bearing maximal flexion was 136° in the normal group,which was significantly higher than the 125° in the TKA group.All 10 normal knees present posterior translation of femoral condyle during deep knee-bending,posterior translation of the lateral condyle was greater than medial condyle,thereby creating a medial pivot type of axial rotational pattern in which the tibia internally rotates relative to the femur as flexion increased.The average amount of posterior femoral translation of the medial condyle was 7.3±1.2 mm,whereas the lateral condyle translated posteriorly 19.3±3.1 mm.All knees experienced tibia rotated internally during progressive flexion,and the average amount of axial rotation for the ten subjects from 0° to 135° was 23.8±3.4°.From extension to maximal flexion,the average amount of posterior translation of medial condyle was 1.4±0.6 rmm,whereas the lateral condyle translated 6.4±1.7 mm in the posterior direction in the fixed-bearing posterior-stabilized TKA.The average amount of tibial internal rotation was 8.5°±3.4°.Conclusion In normal Chinese people,during knee flexion activities the lateral condyle experiences significantly more amount of posterior translation than the medial condyle,leading to the tibia present medial pivot internal rotation relative to the femur,and the PFC-Sigrna fixed-bearing posterior stabilized designs has the similar kinematics with normal knee,but the posterior condylar translation and tibial axial rotation are much less than the normal.