Early outcomes of 5G remote telesupervised robot assisted total hip arthroplasty in the treatment of Kaschin-Beck disease with hip problem / 中华骨科杂志

Objective:To evaluate the early clinical outcomes of 5G remote telesupervised robot assisted total hip arthroplasty in the treatment of Kaschin-Beck disease with hip problems in Tibet through retrospective analysis of the hip surgery cohort.Methods:According to the operation procedure, 55 Kaschin-Beck disease patients (59 hips) undergoing total hip arthroplasty from November 2020 to November 2021 in the Karub District People's Hospital in Qamdo were divided into the conventional THA group (cTHA) and the 5G remote telesupervised robot assisted THA group (rTHA). Two of them underwent cTHA on both hips, while the other two patients underwent cTHA and rTHA separately of each hip, and the rest underwent single hip surgeries. In the cTHA group, there were 30 patients (32 hips), 16 males (17 hips) and 14 females (15 hips), aged 56.56±9.33 years (range, 36-76 years); In the rTHA group, there were 27 patients (27 hips), 10 males and 17 females, aged 55.41±10.90 years (range, 24 to 79 years). Before operation, Harris hip score was recorded and femoral offset (FO) and leg length difference (LLD) were measured via X-ray images. The operation time was collected during the hip surgery and an average network delay of 172.28±36.58 ms and a 1.08% data packet loss ratio is obtained during telesupervision. 24 hours post-operatively, the FO and LLD were both measured via the X-ray images, as well as the inclination and anteversion of the acetabular cup. The Harris scores were collected in the following up. The operation time, FO, LLD, inclination, anteversion and Harris score were compared between the two groups.Results:All cases in both groups were followed up for an average of 9.39±2.43 months (range, 6-19 months). There were no significant differences in pre-operative FO and LLD, preoperative Harris scores or average follow-up time between the two groups. The operation time in rTHA group was 126.41±12.78 min, which is significantly longer than the time 88.81±8.83 min in cTHA group ( t=13.31, P<0.001). After operation, the FO was significantly increased and the LLD was significantly decreased ( P<0.05). The postoperative LLD was 0.63±0.65 cm in the robot group and 1.15±0.71 cm in the conventional group, the difference was statistically significant ( t=2.88, P=0.006). However, there was no significant difference in the FO, inclination and anteversion between the two groups post-operatively ( P>0.05). The Harris scores of both groups were significantly improved compared with that before the operation. Additionally, the Harris score of the two groups was significantly higher than that before surgery, and the postoperative Harris score of the rTHA was 69.00±12.33 higher than that of the cTHA (62.31±11.87), with statistical significance ( t=2.12, P=0.039). The ratio of excellence of Harris score was 19% (5/27) in the rTHA and 9% (3/32) in the cTHA, with no significant difference between groups (χ 2=1.05, P=0.522). Conclusion:Compared to conventional surgery, 5G remote telesupervised robot assisted total hip arthroplasty has more advantages in improving the joint functions in the treatment of hip problems caused by Kashin-beck disease in Tibet Autonomous Region, and facilitates more accurate adjustment of lower limb length difference, even though it consumes more operation time.

Surgical management in treating periprosthetic femoral fractures after hip arthroplasty / 中华骨科杂志

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％.

Classification and treatment of periprosthetic femoral fractures after hip arthroplasty / 中华骨科杂志

With the increasing number of hip arthroplasty and the extension of implant survival,the risk of periprosthetic femoral fractures are gradually growing.The technical challenge of the surgical management of periprosthetic femoral fractures leads to poor functional outcome,implant survival and patient satisfaction compared to primary hip arthroplasty.The risk factors of periprosthetic femoral fractures involve both of the bone quality of the patient and the surgical techniques of the primary surgery,including age and gender of the patient,osteoporosis,previous surgical history and the type of the components.In order to avoid the occurrence of periprosthetic fractures,precautions including the assessment of the patient status and bone quality as well as the selection of proper prosthesis and surgical procedures should be taken before the primary surgery.During the primary surgery,more attention should be paid to prevent the damage of host bone and make sure the correct placement of the implants.The aseptic loosening should be detected and treated as early as possible in the regular post-operative follow up.The diagnosis of periprosthetic femoral fracture mainly bases on the detailed history,symptoms,signs and serial X-rays after operation.The most extensively used classification system of the periprosthetic femoral fracture is the Vancouver classification.For the treatment of different types of fractures,conservative therapy is recommended for most Vancouver type A fractures.The surgical management is the best choice for most Vancouver type B fractures.Whether the stem revision is necessary or not depends on the stability the component.The treatment of Vancouver type C fractures should be in accordance with the principles of regular femur fractures.However,more attention should be paid to choose proper device according to the existence of the femoral component in the proximal part of the fracture.Through the analysis of the pathogenesis and risk factors of periprosthetic femoral fractures and the discussion of the diagnosis,classification and treatment principles,we expect to provide a standard treatment protocol for the periprosthetic femoral fractures following hip arthroplasty.

Comparison and estimation of different diagnostic methods in detecting the presence of periprosthetic joint infection / 中华外科杂志

<p><b>OBJECTIVE</b>To compare and estimate the diagnostic value and characteristic of different diagnostic methods (blood laboratory test, histological analysis, synovial fluid cytological test and microbiological examination) in detecting the presence of periprosthetic joint infection.</p><p><b>METHODS</b>Data of 52 patients underwent hip or knee joint revision in Peking University People's Hospital Arthritis Clinic and Research Center between July 2013 and March 2015 were analyzed retrospectively. For each patient, results of blood laboratory tests(peripheral-blood white blood cell, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (Hs-CRP)), histological analysis, synovial fluid white cell count (SWCC), microbiological examinations (synovial fluid, tissue and prosthetic joint sonication fluid) were collected. Data were analyzed by t-test, independent sample median test or χ(2) test, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for each method were calculated and compared by receiver operating characteristic curve.</p><p><b>RESULTS</b>There were 30 female and 22 male patients. Twenty-one patients (40.4%) were diagnosed as PJI. The levels of CRP, ESR, IL-6 and Hs-CRP in patients with PJI were higher than that in aseptic failure patients (Z=23.084, 13.499, 5.796, 17.045, all P<0.05). The sensitivities of CRP, ESR, IL-6 and Hs-CRP were 90.5%, 81.0%, 95.0% and 90.0%. The sensitivities of histological analysis and SWCC were 55.0% and 70.6%, while they had high specificity as 89.7% and 85.7%. The sensitivity of sonication fluid culture was 90.0%, which was higher than that of tissue culture (71.4%) and synovial fluid culture (65.0%) (χ(2) = 5.333, 6.400, all P<0.05).</p><p><b>CONCLUSIONS</b>The tests of CRP, ESR, IL-6 and Hs-CRP have good value in detecting PJI preoperatively. Histological analysis and SWCC have high specificity, which could help to exclude PJI. Sonication fluid culture has a higher sensitivity than tissue culture and synovial fluid culture.</p>

Characteristics of non-traumatic meniscus injury observed under the arthroscopy / 中华骨科杂志

Objective To discuss the characteristics of non?traumatic meniscus injury in patients with different age ob?served under the arthroscopy. Methods All non?traumatic meniscus injury patients operated during 2012 were included. The name, age, symptoms, signs, Lysholm score before surgery, meniscus injury location, type, and concomitant damage were collect?ed. The inclusive criteria were 1) III degree meniscus tear confirmed by MRI,2) typical symptom of meniscus injury,3) no acute symptom and history of acute injury,4) conservative treatment failed,5) and confirmed subsequently by the surgery. SPSS19.0 (SPSS Inc., USA) was used for statistical analysis. Disease frequencies were calculated for different ages in patients, and gender, disease side (left or right), the type of meniscus injury and the concomitant injury in patients of different ages were compared with the chi square test. Results All the 201 patients were divided into two groups due to whether the patients were older than 45 years. The age of surgery was bimodal distribution (20 yrs and 60 yrs). There were more lateral meniscus tears in the younger group(merely LM 56.10%), and more medial meniscus tears in the older group(merely MM 66.90%). The major type of medial meniscus tear in young patients were longitudinal(27.80%), beak sample tear(38.90%)and horizontal tear(27.80%); in old patients the main type were beak sample tear(20.60%), horizontal tear(27.20%), tear of root(19.10%)and complicated tear (31.60%). But in lateral meniscus, there were more beak sample tear(45.50%)and complicated tear(22.70%)in young pa?tients, and more than 70%were complicated tear in old patients. There were more ACL tear(34.15%), discoid lateral meniscus (21.95%)and cyst of menisci(9.76%)in young patients, but more cartilage injury(81.25%)in the old patients. Conclusion Non?traumatic meniscus tear in younger patients happened more in lateral meniscus, with more concomitant ACL tear, lateral dis?coid meniscus and cyst,but in the older group, there are more medial tear and concomitant with more cartilage injury. And the types of tear are different in the two groups.