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Objective To explore the validity of two-staged revision for hip periprosthetic joint injection and intermediate-term clinical effects.Methods The clinical data of 31 cases who were underwent two-staged revision for unilateral hip periprosthetic joint infection in Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University from March 2014 to September 2016 were analyzed retrospectively.There were 13 males and 18 females,aged (67.5 ±7.8) years,with an age range of 52-79 years.All patients underwent two-staged revision,taking preoperative and intraoperative joint puncture fluid,intraoperative infection of soft tissue for bacterial culture was to clear medication.In first stage,prosthesis removed,debridement performed and antibiotic spacer implanted were performed.Antibiotics were used for 8 to 12 weeks for infection.In second stage,total hip arthroplasty revision was performed while infection was controlled.Harris hip scores,Short form 36 health status scores (SF-36),white blood cell counts,C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)were compared between preoperative and postoperative follow-up in all patients,and postoperative complications were recorded.Postoperative outpatient follow-up was 30.1 to 59.3 months,and reviewed every 12 months after 3 months,6 months,and 12 months.The follow-up deadline was April 2019.Measurement data were expressed as mean ± standard deviation (Mean ± SD).The t test was used to compare the preoperative and postoperative follow-up.Results All 29 patients were followed up for follow-up except 2 patients were lost to follow-up.Preoperative Harris hip score,SF-36,white blood cell count,CRP and ESR were (39.4 ± 5.6) scores,(398.8 ± 39.2) scores,(12.5 ± 0.6) × 109/L,(63.3 ± 10.1) mg/L and (83.7 ± 12.5) mm/h,respectively.The last follow-up oftbe above indicators were (76.9 ±9.3) scores,(649.3 ±67.5) scores,(9.1 ±0.5) × 109/L,(5.3 ± 1.7) mg/L and (10.2 ± 1.6) mm/h,respectively.The results of final followed-up were much better than the preoperative results and there were significant differences between postoperation and preoperation for all indexes.One patient developed postoperative hip dislocation and was treated with manual reduction under general anesthesia.The two patients were diagnosed hip periprosthetic joint infection of joint at 8 months and 15 months respectively after two-staged revision and treated by removing the hip prosthesis.One patient was performed revision again and the other was not performed any operation for poor health condition.The remaining 26 patients had no complications.Conclusions Two-staged revision for periprosthetic joint infection of hip joint can not only treat infection effectively but also can recover hip function significantly.The early and intermediate-term clinical effects of the surgical treatment is satisfied.
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Objective To evaluate the short-term clinical efficacy of three dimension printed titanium augments for the reconstruction of acetabular bone defects in revision total hip arthroplasty.Methods The retrospective study was conducted.To retrospectively analyze clinical data of 21 patients who were underwent revision total hip arthroplasty with severe acetabular bone defects reconstructed by three dimension printed titanium augment from March 2016 to September 2017 from Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University.There were 9 males and 12 females,age (58.9 ± 6.3) years,51-67 years,body mass index (23.8 ± 2.9) kg/m2.According preoperative CT scan of hip joints,three dimension printed titanium augments were designed for acetabular defects personality.The data including the vertical distance from centre of rotation to the interteardrop line in X-ray examination,preoperative Harris score,final follow-up Harris score of hip postoperatively,and complications were recorded.Outpatient visits ranged from 11.8 to 19.6 months.Measurement data were expressed as (Mean ± SD),and t test was used before and after surgery.Results For X-ray examination,the average vertical distance from centre of rotation to the interteardrop line was (6.1 ± 1.2) cm preoperatively and (2.8 ± 0.7) cm postoperatively,and the difference was statistically significant (P ＜ 0.01).The hip Harris score increased from preoperative (47.5 ± 6.4) scores to the last follow-up (84.6 ± 5.9) scores,and the difference was statistically significant (P ＜ 0.01).The final follow-up data showed the acetabular prosthesis and augments were stable,while there were no hip joint dislocation,periprosthetic joint infection,loosening of acetabular components and other complications.Conclusion Three dimension printed augments can reconstruct severe acetabular bone defects and restore the hip rotation centre.
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Objective To compare 3 kinds of preoperative scoring systems used to predict 30-day mortality in a hip fracture population,Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM),Portsmouth modified POSSUM (P-POSSUM) and Estimation of Physiologic Ability and Surgical Stress (E-PASS).Methods A retrospective study was conducted to analyze the aged 654 patients who had undergone surgery for femoral intertrochanteric fracture or femoral neck fracture from January 2010 through June 2014 at our hospital.They were 225 men and 429 women,60 to 103 years of age (average,71.7 years).There were 363 femoral intertrochanteric fractures and 291 femoral neck fractures.Closed reduction and intramedullary nailing was performed in 363 cases,artificial dipolar replacement in 242 cases,and total hip replacement in 49 cases.POSSUM,P-POSSUM and E-PASS scoring systems were used to predict the 30-day mortality.The discrepancy between the predictive risk and the actual observation was analyzed.Results Of the 654 patients,25 died within 30 days after operation.According to POSSUM scoring system,the predictability (observed deaths/POSSUM deaths) was 0.30,showing a significant difference between the predictive deaths and the actual deaths(x2=34.840,P=0.009).According to P-POSSUM and E-PASS scoring systems,the predictability was respectively 0.83 and 1.04,demonstrating no significant differences between the predictive deaths and the actual deaths(P ＞ 0.05).Conclusion P-POSSUM and E-PASS scoring systems may predict 30-day mortality more accurately than POSSUM scoring system in elderly patients undergoing hip fracture surgery.