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The present study shows the case of a patient with acetabular protrusions secondary to rheumatoid arthritis progressing to femoral neck fracture.The patient,a 64 years female,had a history of rheumatoid arthtitis for 38 years.The left hip pain and abnormal sound occurred when hip flexion for picking up.She was diagnosed with rheumatoid arthritis secordary to acetabular pelvic retraction and left femoral neck fracture by medical history,physical examination and imaging.Total hip arthroplasty was performed after preoperative examination.Hip dislocation,femoral head removal,acetabular reconstruction;cup fixation,and bone mass assessment are technical challenges during surgery.Based on literature review,this case is belonging to secondary acetabular pelvic retraction,which may be related to acetabular softening caused by rheumatoid arthritis.Whenthe stress from the femoral head exceeds the endurance of the softened acetabulum,the acetabulum protrudes into the pelvis and gradually wraps around the femoral head.Based on the pathological characteristics,itis speculated that the cause of femoral neck fracture is the direct hit of the femoral neck-acetabular rim during hip flexion.In this case,spiral cup prosthesis was used to achieve both the initial stability of the prosthesis and saving bone mass around the acetabulum.The patient was followed up for 3 months with satisfactory position of prosthesis and joint function.
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Objective To observe the clinical outcomes of the surgical management of periprosthetic femoral fractures following hip arthroplasty.Methods Twelve consecutive patients (6 male and 6 female) with the average age of 66.4± 15.0 years old (35 to 86 years old) undergoing surgical operation for periprosthetic femoral fractures between September 2009 and May 2016 were followed up at our center.Nine cases were fractured secondary to the primary hip arthroplasty while the others were patients with earlier revision surgery.The previous fixations of femoral components of 10 cases were cementless while the other two were cemented fixation.The enrolled patients were determined as Vancouver type B 1 (n=2),type B2 (n=7),type B3 (n=1) and type C (n=2) respectively.The occurrences of the fractures were observed at 3 weeks to 17 years post-operation (average 9.0±7.0 years).The patients were treated individually according to different Vancouver types.Type B 1 patients received simple cerclage fixation,as well as revisions with long-stem femoral implants and cerclage band were chosen for type B2 patients.In addition to the treatment for type B2 patients,allogenic cortical bone graft was also required for type B3 patients.Open reduction with locking plate internal fixations were options for patients with Vancouver type C fractures.The following-up included the X-ray images of the hips,Harris hip score and the visual analogue scale (VAS) for the pain of fracture site.The unions of the fractures were determined by both X-ray images and pain intensity of the fracture sites.Results The mean follow-up period was 41.6±26.0 months (range,12-92 months),without patient lost to follow up.VAS scores were 0,implying the clinical union of the fractures.One patients received multiple debridement post-operatively due to the periprosthetic infection.The VAS score of this patient was 6 at the follow up and the X-ray image indicated the nonunion of the fracture.The fracture union rate was 91.7％ (11/12).The Harris hip score was 23-92 (mean score,74.8±18.8),excellent for 2 cases,good for 6 cases,fair for 3 cases and poor for 1 case.The excellent and good rate was 66.7％ (8/12).Post-operative complications were observed in 4 patients (33.3％,4/12).One drainage tube was misplaced and sutured subcutaneously required a further exploration surgery.One periprosthetic infection occurring post-operatively induced the nonunion of the fracture.Aseptic loosing of femoral stem was observed in 2 cases and subsequent revision surgeries were conducted.Conclusion High incidence of complications is observed after the surgical treatment of periprosthetic femoral fractures following hip arthroplasty.Individually customized management regarding to the Vancouver type of periprosthetic femoral fractures leads to the clinical fracture union in 91.7％ of the patients in this case series.The excellent and good rate of the hip function in the early and mid-term stage after operation is 66.7％.
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Objective To investigate the clinical results of the primary total hip replacement (THR) and the secondary THR after failed internal fixation in the elderly patients with displaced femoral neck fracture so as to find the optimal treatment for displaced femoral neck fractures in the elderly patients. Methods From April 2001 to April 2007,16 patients (Study Group) treated with a secondary THR after failed internal fixation and 20 patients (Control Group) treated with a primary THR were enrolled in the study and followed up. There were seven males and nine females, at average age of 66. 5 years (50-85 years) and with mean follow-up period of 58. 25 months (24-96 months) in the Study Group. There were six males and 14 females, at average age of 68.1 years (51-83 years) and with mean follow-up period of 49.50 months (24-70 months) in the Control Group. All patients were active and lucid before they suffered fractures. Blood loss and operation duration in THR were compared. Hip function (Harris score) and health-related quality of life (HRQoL, KPS index score) were assessed during the follow-up after THR. Results Operative duration was (115.63 ±34.35) minutes in Study Group and (91.25 ±15.80) minutes in Control Group (P<0.05). Blood loss was (546.86 ±377.04) ml in Study Group and (320.00 ±155.94) ml in Control Group (P<0.05). At follow up, Harris score and KPS index score were (87. 25 ±7. 53) points and (95. 00 ±5. 16) points respectively in Study Group, and (90.20±5.46) points and (96.00 ±0.73) points respectively in Control Group (P>0.05). There were no infections or re-operations in two groups, but with one death in each group during the follow-up. Conclusions THR is the optimal treatment for displaced femoral neck fractures in the elderly patients.The secondary THR after failed internal fixation has higher risks in operation compared with the primary THR for a displaced femoral neck fracture in the elderly patient.
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[Objective]To evaluate the mid-term and long-term clinical outcome of total hip replacement in patients with congerital acetabular dysplasia.[Method]Twenty-five hips in 23 patients diagnosed as congemtal acetabular dysplasia were treated with total hip replacement.According to the classification ofPemer,17 hips belonged to type Ⅰ,5 type Ⅱ,2 type Ⅲ,and 1 type Ⅳ.The fixation of the prosthetic components was as follows: 5 cups and 7 stems with cement,20 cups and 18 stems with un-cement.[Result]The complications included femur trochanter fracture in 1 case,deep vein thrombosis in 1 case,limb discrepancy in 3 cases,All patients were followed.up with the duration of 8.2 years(3 to 11 years).The preoperative Harris hip score ranged from 25 to 59(average 44.5).After the operation,the pain was completely relieved and the Harris hip score ranged from.63 to 97(average 85.6).[Conclusion]Total hip replacement in congenital acetabular dysplasia could be somewhat difficult,because of the liability to complications.The technical difficulties encountered during surgery included the correction of the length of bilateral lower extremity,the balance of the abductor muscles,the release of the soft tissue,the dealing of the superior seganental defect of acetabulum and selection of the components.
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BACKGROUND: Chronic musculoskeletal pain can cause disability and decreased quality of life of patients. Probing into the therapeutic methods of musculoskeletal disease and choosing proper treatment drugs are important for patients.OBJECTIVE: To evaluate the efficacy and tolerance of controlled-release tramadol in patients with moderate to severe chronic pain of musculoskeletal origin.DESIGN: A self-control study was conducted.SETTING: Arthrtosis Institute, People' s Hospital Affiliated to Peking University.PARTICIPANTS: Patients who were in the Orthopaedic Outpatient Service,People' s Hospital of Peking University were involved. This observational study was conducted in 40 adults who experienced moderate to moderately severe chronic musculoskeletal pain that was not controlled by routine nonsteroidal anti-inflammatory drugs(NSAID) therapy.INTERVENTIONS: Any NSAIDs and other analgesics were prohibited. Patients initially took 50 mg of controlled-release tramadol (Tramcontin) every 12hours, supplemented by every 50 mg if insufficient pain relieved. Recommended daily maximum dose was 400 mg per day. The observation lasted for 4 weeks. The patients were asked for document therapy-relevant data every day and were interviewed every week to doctor assessment.MAIN OUTCOME MEASURES: Pain intensity before and after treatment, pain remission degree, all side effects and their severity.RESULTS: All cases were finished the study and no one withdrew from follow-up. No eligible patients exited from the study because of therapeutic failure or intolerance. In comparison with the initial visual analogue scale (VAS) mean value 6. 80 ± 1.84, the average VAS value at the end of observation was 1.00 ± 1.46, which had significant difference( P ＜ 0. 001) . An average pain reduction of (85. 50±5.35)%was obtained, among which 78% were absolutely and obviously lessened. Side effects were reported in 9cases (22%).Drowsiness and dizziness(6 cases) was the most common, followed by nausea (3 cases), vomiting (1 case), somnolence (2 cases), constipation and urinary retention (1 case) and blurred vision (1 case).CONCLUSION: Tramcontin, as slow-release tramadol, proved to be an effective, safe, and easy-to-use central acting analgesic has an important role in the management of chronic musculoskeletal pain. Light side effect and good tolerance has provided a new choice for treatment of chronic pain in the orthopaedic department.
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Objective The purpose was focused on discussing the causes of sciatic nerve injury following total hip replacement in order to introduce the methods for protecting sciatic nerve during operation by reviewing 655 consecutive total hip replacement and total hip revision. Methods From January 1998 to December 2001, 655 total hip replacement and total hip revision cases were performed in our hospital, 9 cases of which occurred as sciatic nerve injury postoperatively. There were 8 cases in 587 primary total hip replacements and one case in 68 total hip revisions. The 9 patients included 3 males with 3 hips and 6 females with 6 hips with an average age of 51 years ranging from 35 to 67 years old. In the group, 4 cases were diagnosed as avascular necrosis of femoral head, 2 cases as congenital acetabular dysplasia accompanied with osteoarthritis, 1 case as ankylosing spondylitis, 1 case as rheumatoid arthritis and 1 case as loosening of prosthesis. 8 prosthetic components of the hip were fixed by uncement, and the other one was fixed by cement. Results All of the 9 patients experienced sciatic nerve palsy sooner after operation, 8 cases of which suggested simple injury of common peroneal nerve, and 1 case a combined injury of common peroneal nerve and tibial nerve. Of the 9 cases, 7 cases underwent leg lengthening or soft tissue release because of hip joint stiffness during operation. After six to forty-eight months follow-up, the function of sciatic nerve was recovered completely in eight cases after half a year. The other one received total hip revision was not recovered from sciatic never palsy in six months, and the operation of never incision and exploration was performed. During operation, part of the sciatic nerve was found to become thinner without marked compression and other injury. Then release soft tissue around the injured never, the function of sciatic nerve was partly recovered one year after operation. Conclusion It is concluded that sciatic nerve injury associated with total hip arthroplasty is most commonly caused by over-lengthening the low extremity and mechanical compression. The function of sciatic nerve may be recovered in most patients with incomplete injury.
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Objective A retrospective analysis was conducted on 1 202 cases of total knee replacements (TKR) during the periord of 14 years, in order to study the special clinical features of the patients and their knee deformities, with the final purpose of finding the appropriate methods for the management. Methods From April 1987 to Augest 2001, 1202 cases of total knee arthroplasty were performed for 833 patients. There were 464 unilateral TKRs in 464 patients, and 738 bilateral TKRs in 369 patients. The diagnosis of the clincal conditions were osteoarthritis (include synovial chondromatosis and kaschin beck disease), rheumatoid arthritis, ankylosing spondylitis, also included were some rare rheumatic diseases of the knee such as pigmented villonodular synovitis, tuberculous arthritis, Charcot arthritis, hemophilic arthritis and psoriatic arthritis. Patients in this series also had several kinds of severe deformities such as genu varus with dislocation or medial plateau defect, genu valgus, flexion contracture of the knee, flexion deformity with joint fusion, flexion joint fusion with subluxation, and deformity in the low extremities involving multiple joints in patients with JRA. Results Some severe deformities were considered as contraindication of surfacing total knee replacement, however the life quality of patients had significant improvement after operations. Through the improvement of surgical skill, the complications following TKR in severe knee flexion deformity are less in number than that happened in the early days. Conclusion 1) TKR in China at the moment is facing more challenges and difficulties than that in the developed countries. 2)The proper types of prosthesis should be selected beforehand in order to get the good result. 3) Physical therapy is very important in the rehabilitation following TKR, so that the establishment of full time rehabilitation team is mandatory. 4)The key point for promoting TKR treatment for patients with various knee disease is to develop homemade prosthesis in China. [