Using titanium cerclage band to teat intra- and post-operative femoral fracture in total hip arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the treatment and clinical result of using titanium cerclage band to teat intra- and post-operative femoral fracture in total hip arthroplasty.</p><p><b>METHODS</b>From August 1999 to September 2007, twenty-two patients who suffered from intra-and post-operative femoral oblique fracture in total hip arthroplasty were reviewed among 2186 consecutive total hip arthroplasty patients performed by one surgeon. There were 12 fractures occurred intraoperative and 10 fractures postoperative. There are 9 primary and 13 revision total hip arthroplasty patients including 10 men and 12 women. All fractures are classified as Vancouver B1 type in 15 cases and B2 type in 7 cases. Two to five titanium cerclage bands had been used to fix the fracture followed by open reduction with 13 cases using 2 cerclage bands and 7 cases using 3 bands and 1 case using 4 bands and 1 case using 5 bands. Whether change the original stem or not depended on the classification of fractures and stability of stems. There were 15 cases of type B1 and 1 case of type B2 without changing stems and 6 cases of type B2 changing to revision stems of the same series of original stems.</p><p><b>RESULTS</b>All fractures showed successfully union for 12 - 20 weeks (average 18 weeks) after operation. The average Harris score of the hip improved to 90 points (80 to 95 points) at an average 6.5 years follow-up (4 to 11 years) and the average range of motion of the hip got to 120° (105° - 135°). Femoral prostheses were well-fixed without any subsidence or lucent lines or loosening. All patients were satisfied with the results with well-fixed and good alignment of femoral stem.</p><p><b>CONCLUSIONS</b>Strong fixation of the fractures and good initial stability of femoral stem can be obtained using titanium cerclage bands to fix the intra- and post-operative femoral oblique fracture. Original stems should be changed to revision stems in case of type B2 and be retained in case of type B1.</p>

Medium and long-term clinical results of using Zweymüller cup to treat protrusio acetabuli / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss long-term clinical results of using Zweymüller cup to treat protrusio acetabuli.</p><p><b>METHODS</b>From May 1998 to September 2006, 31 patients with 39 hips diagnosed protrusio acetabuli were treated with Zweymüller cup in total hip arthroplasties or revisions. There were 12 men and 19 women with average age of 57.6 years (from 30 to 82 years). The reasons causing protrusio acetabuli were as followed: rheumatoid arthritis 3 cases 6 hips, osteoarthritis followed femoral head necrosis 7 cases 12 hips, acetabular wear after hemi-arthroplasty 11 cases 11 hips and acetabular component loosening 10 cases 10 hips. During all operations, Zweymüller cup was used to fix the acetabular part.</p><p><b>RESULTS</b>All cases were followed up 6 months and one year after operations. Two patients with 3 hips were died for lung cancer and acute myocardial infarction respectively. Twenty-four cases with 31 hips got recent follow-up with average 7.4 years (from 5.0 to 11.5 years). The average Harris score improved from 31.0 (from 14 to 61) preoperatively to 84.7 (from 70 to 95) postoperatively. There was one infection in right hip after bilateral hip arthroplasty treating by removal prosthesis and cement spacer insert. But until now this patient still did not get revision for her internal medicine. One rheumatoid arthritis patient with two-stage bilateral hip arthroplasty was found slight internal migration and loosening line of left acetabular component, but the patient had no pain with good hip function. All other cases had good hip functions and were very satisfied with clinical results.</p><p><b>CONCLUSION</b>Using Zweymüller cup to treat protrusion acetabuli can get strong fixations and perfect medium and long-term clinical results for over 7.4 years.</p>

The second stage revision for infected total hip arthroplasty using antibiotic-loaded cement prosthesis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of two-stage revision for infected total hip arthroplasty (THA) using antibiotic-loaded cement prosthesis.</p><p><b>METHODS</b>From June 1999 to October 2004, 14 patients who admitted for infected primary total hip arthroplasty surgeries were performed revision surgery with antibiotic-loaded cement prosthesis in two-stage. The mean Harris score of pre-operation was 23. In the first stage operation, the following steps were performed, complete debridement, removal of infected prosthesis, implantation of cement spacer with antibiotics, treatment involved concomitant administration of 3 weeks of intravenous (IV) and 1 month of oral. After 6 months, antibiotic-loaded prosthesis was implanted in the second stage.</p><p><b>RESULTS</b>The mean follow-up was 18 months (7 - 26 months), no recurrent infection occurred in all 14 patients. The mean post-operation Harris score was 70.</p><p><b>CONCLUSIONS</b>The success of the protocol to control the delayed infection after THA are complete debridement, enough interval and using antibiotic-loaded cement prosthesis in two stage revision.</p>

Revision hip arthroplasty with the cementless prosthesis: 4 years follow-up study / 中华外科杂志

<p><b>OBJECTIVE</b>To examine the two to eight-year results associated with the use of this hip system.</p><p><b>METHODS</b>Between November 1996 and January 2001, 56 revision total hip arthroplasties with insertion of a Zweymüller BICON-PLUS cup and a cementless SLR-PLUS stem were performed in 55 consecutive patients (average age, fifty-nine years old, range, thirty to eighty years old).</p><p><b>RESULTS</b>At the time of the latest follow-up, 23 patients (24 hips) had lost to follow-up, leaving 32 patients for a minimum of 2 years of clinical and radiographical follow-up. The mean follow-up time was 4 years. Only 3 peri-operative complications occurred, including 1 great trochanter fracture during implant removal, 1 dislocation 2 d after operation with successful closed reduction, and 1 deep wound infection which necessitated reentry and debridement. No femoral stems or cups needed re-revision surgery. The average Harris hip score increased from 40.6 points preoperatively to 80.4 points at final follow-up. Radiographic analysis demonstrated that the position of stems and cups was unchanged and all showed radiographic evidence of bone ingrowth.</p><p><b>CONCLUSION</b>The favourable medium-term clinical results with the cementless Zweymüller hip system show that it is suitable as a revision system for total hip failures of both cemented and cementless primary fixation.</p>

Early diagnosis and treatment of pulmonary embolism after total joint replacement: report of five cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the early diagnosis and treatment of pulmonary embolism (PE) after total joint replacement (TJR).</p><p><b>METHODS</b>>From April 1987 to December 2001, we performed 1,336 total knee replacements (TKR(s)) in 926 patients and 1,745 total hip replacements (THR(s)) in 1,566 patients. In this group there were 5 PE patients after operation. Two patients died (all after TKR), and 3 patients salvaged successfully (2 after TKR, 1 after THR).</p><p><b>RESULTS</b>The total incidence of PE after TJR was 0.2% (5/2,492), the incidence of PE after TKR was 0.4% (4/926), and the incidence of PE after THR was 0.06% (1/1,556). In the patients who suffered PE, 2 died. The incidence of PE before 2000 was 0%.</p><p><b>CONCLUSIONS</b>Death after total joint replacement is due to pulmonary embolism (PE), especially massive PE. The incidence of PE after TKR is higher than that after THR. Pulmonary angiography is the gold standard for the diagnosis of PE. With more understanding on PE and more popularity of joint replacement, the diagnosis of PE after TJR is increased. More attention should be paid to PE in the patients with high risk after TJR.</p>