Propensity score-matched study of uni-condylar arthroplasty in elderly patients with knee osteoarthritis / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy of unicompartmental knee arthroplasty (UKA) in the treatment of knee osteoarthritis in patients over 75 years old.@*METHODS@#The clinical efficacy of primary fixed platform UKA in patients with osteoarthritis, was retrospectively analyzed from October 2014 to November 2020. Age, body mass index (BMI), range of motion (ROM), preoperative joint function score, the quality of life score and other preoperative indicators were measured by propensity score matching (PSM). The patients were divided into elderly group (≥75 years old) and control group (<75 years old). Oxford knee score(OKS), Western Ontario McMaster Universities osteoarthritis index(WOMAC), Short Form-12 including physical component summary (PCS), mental component summary(MCS), minimal clinically important difference(MCID ) and clinical complications were evaluated preoperatively and postoperatively.@*RESULTS@#A total of 514 patients were analyzed, 428 patients fulfilled the inclusion criteria. A propensity-score matching study was conducted to eliminate confounding factors. After 1∶2 propensity match, there were 84 patients in elderly group (≥75 years), age ranged from 75 to 88 years old, with an average of (78.79±3.08) years old, and 168 patients in control group (<75 years), age ranged from 47 to 74 years old, with an average of (64.10±5.96)years old. The follow-up duration of two groups ranged from 12 to 84 months with an average of (29.35±16.52) months in elderly group, and 12 to 85 months with an average of (31.83±17.34) months in control group. There was only significant difference in age between the elderly and control groups preoperatively (P<0.01). Postoperatively, the elderly group showed significantly higher WOMAC (P<0.01) and lower SF-12 PCS scores (P<0.01) as compared to the control group. There was no significant difference between the elderly group and the control group in knee range of motion, OKS and the proportion of each scoring system reaching the minimum clinical difference value (P>0.05). In the aspect of preperative complications, the elderly group exhibited more surgical site complications and postoperative delirium compared to control group(P<0.05). The differences in other indicators including deep vein thrombosis, acute urinary retention, cardiovascular events, cerebrovascular events and radiolucent lines around prothesis were not statistically significant(P>0.05).@*CONCLUSION@#UKA in the treatment of elderly patients over 75 years old with knee osteoarthritis was safe and feasible, and could obtain satisfactory short-term efficacy.

Fixed-bearing unicompartmental knee arthroplasty for medial compartmental knee osteoarthritis / 中国骨伤

OBJECTIVE@#To evaluate short-term clinical results of fixed-bearing unicompartmental knee arthroplasty (UKA) for patients with medial compartmental knee osteoarthritis.@*METHODS@#From January 2015 to December 2017, 62 patients with medial compartmental knee osteoarthritis were treated by fixed-bearing UKA. Among them, including 19 males and 43 females, aged from 47 to 83 years old with an average of (65.3±8.2) years old. The courses of disease ranged from 5 to 72 months with an average of(19.4±14.3) months. Postoperative complications were observed, VAS score was used to observe degree of pain relief, Hospital for Special Surgery(HSS) score was used to evaluate clinical effects.@*RESULTS@#All patients were followed up from 4 to 40 months with an average of(19.9 ±10.2) months. The incision healed well without blood transfusion, hospital stays ranged from 2 to 10 days with an average of (3.5±1.6) days. No deep infection, dislocation, loosing or per prosthetic fracture occurred after operation, while 1 patient suffered from posterior tibial vein thrombosis. HSS score improved from 69.9±7.2 before operation to 90.1±7.4 at final following-up, and 51 patients obtained excellent results, 9 patients good and 2 moderate. VAS score decreased from 3.8±0.9 before operation to 1.1±0.9 at final following-up.@*CONCLUSIONS@#Fixed-bearing UKA for medial compartmental knee osteoarthritis could obtain short-term clinical results for shorter hospital stay, less complications. with fewer complication and fast recovery.

Clinical outcome of enhanced recovery after surgery for hemiarthroplasty for the treatment of femoral neck fractures in elderly patients / 中国骨伤

OBJECTIVE@#To analyze and evaluate the clinical outcomes of enhanced recovery after surgery(ERAS) for hemiarthroplasty for the treatment of femoral neck fractures in elderly patients.@*METHODS@#From January 2015 to December 2016, 466 patients with femoral neck fractures were admitted in our department. Among them, 154 patients were more than 80 years old, with an average age of (83.9±3.2) years old (ranged, 80 to 96 years old), including 27 males and 127 females. According to Garden classification system, 68 cases were type III and others were type IV. ERAS for hemiarthroplasty were performed for all the patients. The time before operation, blood transfusion rate, complications rate, lenth of stay and Harris score system were evaluated.@*RESULTS@#Among 154 patients, 142 patients were followed up, with an average duration of 24.6 months(ranged, 14 to 38 months). Thirty-two patients (20.8%) completed the operation within 48 hours after admission, 67 patients(43.5%) completed the operation within 72 hours after admission, 76 patients(49.4%) discharged within 48 hours after operation, and the blood transfusion rate was 15.9%. One patient was re-hospitalized because of prosthetic dislocation. The re-hospitalization rate was 0.6%. No other patients were re-hospitalized because of superficial or deep infection or periprosthetic fracture. At the latest follow-up, the Harris hip score was 90.2±7.1, 106 patients got an excellent result, 23 good and 9 fair.@*CONCLUSIONS@#ERAS for hemiarthroplasty can effectively shorten hospitalization time, relieve pain, reduce blood transfusion rate, reduce postoperative complications, and do not increase the readmission rate of elderly patients with femoral neck fracture, which can achieve good clinical efficacy.

Biomechanical comparison between resurfacing hip arthroplasty and normal proximal femur / 医用生物力学

Objective To investigate the variation of stress distributions on proximal femur after hip resurfacing arthroplasty (HRA) by using three-dimensional (3D) finite element method. Methods The 3D finite element model of proximal femur was reconstructed based on 64-slice spiral CT scan image data. Both the stress distributions on proximal femur after metal-on-metal HRA and normal proximal femur were studied, so as to analyze the biomechanical environment changes after HRA. Results After HRA, the superior, anterior, rear and inferior area of the proximal femoral head showed significant stress shielding, with peak stress of 0.60, 0.57, 0.66, 0.79 MPa, respectively, and stress shielding rate of 99.80%, 99.16%, 98.92%, 96.66%, respectively. Increased stress occurred in most regions of the distal femoral head, while stress shielding appeared only in rear area of the distal femoral head, with stress shielding rate of 4.92%. Increased stress occurred in anterior region of the proximal femoral neck, while stress shielding appeared in the superior, inferior and rear area of the proximal femoral neck, with shielding rate of 16.48%, 22.75% and 7.83%, respectively. Increased stress also occurred in inferior area of the distal femoral neck, while the remaining area showed stress shielding. The stress in greater trochanter increased by 9.22%, and the stress shielding rate for lesser trochanter area and basal area of femoral neck were 2.49% and 14.44%, respectively. Conclusions Stress distributions on most regions of proximal femur after HRA were similar to that on normal femur, and the stress transfer was close to physiological status, which could effectively avoid obvious stress shielding in proximal femur and preserve bone mass, which could contribute to normal physiological activity of patients.

Evaluation of early clinical results of two stage hip replacement after failed internal fixation for femoral neck fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the early clinical results of two stage hip replacement after failed internal fixation for femoral neck fractures in young patients.</p><p><b>METHODS</b>From June 2008 to June 2010,24 patients with femoral head necrosis caused by failed internal fixation were treated with hip arthroplasty. Among them, 12 patients were male and 12 patients were female, with an average age of 42.9 years old (ranged, 18 to 58). According to Harris score and X-ray examination, the clinical result was evaluated.</p><p><b>RESULTS</b>Twenty-three cases were followed up with an average age of 34.4 months (ranged, 25 to 48). After operation, 1 case complicated with the dislocation of hip joint. No deep infection of hip joint, prosthetic loosing or peripheral fracture was found. The mean Harris score was 90.9 +/- 4.3, and 18 obtained excellent results, 4 good and 1 fair.</p><p><b>CONCLUSION</b>Although treatment of femoral head necrosis with two stage hip replacement after failed internal fixation is difficult during operation, its early result is satisfactory.</p>

Short-term result of hip resurfacing arthroplasty in the treatment of patients with femoral head necrosis / 中国骨伤

<p><b>OBJECTIVE</b>To study short-term results of hip resurfacing arthroplasty (HRA) in the treatment of patients with avascular necrosis of femoral head (ANFH), and to explore indication and strategy in this surgery.</p><p><b>METHODS</b>From December 2006 to December 2009, 37 patients (43 hips) with avascular necrosis of femoral head were treated with total hip resurfacing arthroplasty. Among the patients, 25 patients were male and 12 patients were female, with an average age of 44.5 years (ranged, 21 to 67 years). According to ARCO classification, 3 hips were 3A stage, 6 hips were 3B stage, 16 hips were 3C stage and 18 hips were 4 stage. X-ray evaluation of the patients were conducted. The clinical results were evaluated by the Harris hip score system including pain,range of motion, correction of deformity and total function.</p><p><b>RESULTS</b>Thirty-four patients (40 hips) were followed up with an average period of 32.4 months (ranged, 16 to 53 months), and 3 patients were lost. Thirty-seven hips got complete relief of joint pain and 3 patients feel aching pain after walking. There was 1 heterotopic ossification, no femoral neck fracture no dislocation, no infection and no revision in all patients. From pre-operation to present, the average Harris hip score improved significantly from (51.5 +/- 1.7) to (94.3 +/- 1.4). Thirty-seven hips got an excellent result, 3 hips good and no poor.</p><p><b>CONCLUSION</b>The total hip resurfacing arthroplasty is an effective solution for the problems of the younger and active patients with ANFH, and the short-term results are satisfying.</p>

Case-control study on acute colonic pseudo-obstruction after total hip or knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the incidence, predisposing factors and therapeutic modalities of acute colonic pseudo-obstruction (ACPO) in patients after total hip arthroplasties (THA) and total knee arthroplasties (TKA).</p><p><b>METHODS</b>From January 2006 to December 2009, 12 patients with ACPO after THA and TKA operation were investigated retrospectively,who were viewed as the ACPO group. There were 10 males and 2 females with an average age of (78 +/- 12) years in the ACPO group. Other 853 patients without ACPO after THA and TKA operation were viewed as the control group treated at the same period. The incidence of ACPO was calculated. The clinical data were collected and compared between the two groups including patient age, gender, procedure, anesthetic class, clinical presentation, radiographic findings, duration from index surgery to diagnosis of ACPO, treatment, postoperative mobilization time, and length of hospital stay.</p><p><b>RESULTS</b>The incidence of ACPO was 1.4%. The incidence of primary THA (1.3%) was higher than that of primary TKA (0.4%); the incidence of hip and knee revisions (5.0%) was higher than that of primary THA and TKA (1.0%); there was no difference in incidence between hip revisions (5.5%) and knee revisions (4.0%). The mean age was (78 +/- 12) years old in ACPO group and (71 +/- 13) in the control group. The male/female ratio was 5:1 in ACPO group and 2:3 in control group. There were statistical differences in mean age and gender ratio between the two groups. No association was found with respect to anesthetic class. On average, ACPO occurred at 2.5 days after index surgery. The abdominal distention occurred in all 12 cases, nausea or vomiting in 8 cases and abdominal pain in 3 cases. Radiographically cecal dilation occurred in all cases and intestinal dilation in 3 cases. All patients initially were treated conservatively with immediate cessation of oral intake,a nasogastric tube and oral mineral oil. Three patients received a rectal tube. Only 1 patient required endoscopic decompression. There were no deaths after ACPO in the series. Mean mobilization time after surgery averaged (5.0 +/- 2.2) days in ACPO group compared with (2.5 +/- 1.1) days in the control group. Mean hospital stay averaged (16.5 +/- 6.4) days in ACPO group compared with (10.5 +/- 4.5) days in the control group. There were statistical differences in mean mobilization time after surgery and mean hospital stay between two groups.</p><p><b>CONCLUSION</b>ACPO mainly happened in old male patients. The majority cases response to conservative treatment and their prognoses are good. But ACPO will delay mobilization time after surgery and increase hospital stay.</p>

Comparison of humeral head replacement and internal fixation for the treatment of 3 parts and 4 parts fractures of proximal humerus in the elderly / 中国骨伤

<p><b>OBJECTIVES</b>To compare the indication, technical keys during surgery and early results of humeral head replacement and internal fixation for the 3 parts and 4 parts fractures of proximal humerus in the elderly.</p><p><b>METHODS</b>From July. 2004 to July. 2006,58 patients with 3 parts and 4 parts fractures of proximal humerus were randomly treated with AO locked compressive plates (LCP) or humeral head replacement. In LCP group, there were 12 males and 16 females with an average age of (66.5 +/- 1.4) years, including 24 cases of 3 parts fractures, 1 case of 3 parts fractures with dislocation, 2 cases of 4 parts fractures and 1 case of 4 parts fractures with dislocation. In the humeral head replacement group,there were 12 males and 18 females with an average age of (68.9 +/- 3.5) years, including 9 cases of 3 parts fractures, 2 cases of 3 parts fractures with dislocation, 12 cases of 4 parts fractures, 4 cases of 4 parts fractures with dislocation and 3 cases of humeral head split fractures. Trauma series X-rays of shoulder were taken after operation, 2-week, 6-week, 10-week, 16-week, 6-month and the latest followed-up. VAS, SST (simple shoulder test) questionnaire, ASES (American shoulder & elbow surgeon)score, Constant-Murley score and UCLA score had been adopted for evaluation at the latest followed-up.</p><p><b>RESULTS</b>The mean followed-up period of LCP group was 29.8 months and that of humeral head replacement group was 28.2 months. VAS of LCP group and humeral head replacement group were (2.2 +/- 1.5) and (2.6 +/- 1.9), respectively. There was a statisticaly difference between the two groups (P = 0.002). The degrees of forward elevation of shoulder in LCP group and humeral head replacement group were 110.2 degrees (81 degrees to 130 degrees) and 120.2 degrees (89 degrees to 140 degrees), respectively. There was a statistical difference between the two groups (P = 0.031). ASES score, Constant-Murley score, UCLA score and response "yes" in SST questionnaire in LCP group were 87.7 +/- 2.2, 83.9 +/- 6.8, 30.3 +/- 2.2, 8.0 +/- 0.9, and in humeral head replacement group were 86.4 +/- 4.5, 85.5 +/- 5.6, 31.2 +/- 2.1, 9.0 +/- 0.7, respectively. There was no significant difference between the two groups in ASES score, Constant-Murley score, UCLA score and SST questionnaire.</p><p><b>CONCLUSION</b>Both humeral head replacement and internal fixation are effective treatment for the 3 parts and 4 parts fracture of proximal humerus in the elderly. Humeral head replacement is more technically demanding and has a strict indications. The satisfactory results of humeral head replacement are based on the suitable placement of prostheses and the correct reconstruction of rotator cuff insertion.</p>

Hip resurfacing arthroplasty in patients with ankylosing spondylitis / 中国骨伤

<p><b>OBJECTIVE</b>To study the short-term results of metal on metal hip resurfacing arthroplasty (HRA) for the treatment of patients with ankylosing spondylitis (AS), to explore the indications and technology of this surgery.</p><p><b>METHODS</b>From February 2006 to April 2008, 11 patients (15 hips) with ankylosing spondylitis were treated with metal on metal total hip resurfacing arthroplasty. Among them, 9 patients were male, and 2 patients were female, with an average age of 32.5 years (ranged from 16 to 53 years). The comparative study on preoperative and postoperative pain, range of motion, correction of deformity and function evaluation were performed. The preoperative and postoperative Harris scores were compared and the feasibility and technical difficulty were analyzed.</p><p><b>RESULTS</b>Ten patients were followed up for an average period of 16.2 months (ranged from 8 to 34 months) and 1 patient was lost. Pain disappeared in 10 patients. There were no heterotopic ossification, no femoral neck fracture, no dislocation, no infection and no revision in all patients. From preoperation to present, the mean flexion angle of hip was improved from preoperative 0 degrees to 75 degrees to postoperative 35 degrees to 105 degrees; the mean abducting angle of hip was improved from preoperative 0 degrees to 30 degrees to postoperative 15 degrees to 55 degrees; and the average Harris hip score improved significantly from (30.9 +/- 3.4) (2-47) to (85.1 +/- 3.1) (46-94). According to evaluation criteria, 10 hips got an excellent result, 3 good and 1 poor.</p><p><b>CONCLUSION</b>The total hip resurfacing arthroplasty is an effective solution for the treatment of the younger and active patients with AS and it shows satisfactory short-term results. It is very significant to analysis the different conditions of patients so as to choose proper strategy.</p>