Clinical efficacy of arthroscopy combined with irrigation and drainage in the treatment of brucellosis of the hip.

PURPOSE: To evaluate the short-term clinical efficacy of hip arthroscopy combined with catheter irrigation and drainage in the treatment of brucellosis of the hip. METHODS: From 2015 to 2020, 11 patients with a diagnosis of brucellosis-induced unilateral hip joint arthritis were treated with arthroscopic debridement and lesion synovectomy. Catheterization was performed during the operation, and normal saline lavage was continued after the operation. A regimen of doxycycline plus rifampicin, plus a third-generation cephalosporin in cases of refractory infections, were used for three months. RESULTS: The rate of positive synovial bacterial culture during the operation was 91% (10/11). Postoperative pathological examination of 11 patients showed purulent arthritis; this result combined with the disease history led to the diagnosis of all patients with brucellosis of the hip. All patients were followed up for more than 24 months. From three months after surgery to the last follow-up, both ESR and CPR were within the normal range, but the VAS score decreased significantly (P < 0.05), and the mHHS and HOS-ADL scores increased significantly (P < 0.01). Compared with that on preoperative imaging, the measurement of the hip joint space on imaging at the last follow-up showed no significant change (P > 0.01). CONCLUSION: Arthroscopic treatment of brucellosis in the hip joint not only preserves the joint fluid and lesion tissue for a clear diagnosis but also allows thorough removal of the infected and injured tissue during surgery. Hip arthroscopy combined with postoperative tube irrigation and drainage is an effective method for the diagnosis and treatment of brucellosis in the hip joint.

Suspension fixation of iliac bone grafts under arthroscopy is an effective method for the treatment of unstable bony Bankart disease of the shoulder joint in patients with joint relaxation.

PURPOSE: To evaluate the results of arthroscopic autologous iliac bone graft suspension fixation combined with the Remplissage procedure in the treatment of recurrent shoulder dislocation with bony Bankart lesions and joint hyperlaxity. METHODS: From 2018 to 2020, 22 patients with joint laxity underwent arthroscopic autologous iliac bone graft suspension fixation and Bankart repair combined with the Remplissage procedure due to recurrent shoulder dislocation. Clinical assessment included range of motion (forward flexion, abduction, 90° external rotation, conventional external rotation, adduction, and internal rotation), visual analog scale (VAS) score, Rowe score, University of California Los Angeles (UCLA) score, and Western Ontario Shoulder Instability Index (WOSI) score. Post-operatively, the healing of the bone graft was evaluated with computed tomography (CT) scanning. RESULTS: All 22 patients were followed up for a mean of 19.3 ± 4.1 months. CT imaging showed that the healing time of the bone graft was 6-8 weeks. The patient satisfaction rate was 100%, there were no cases of redislocation, all patients returned to their preinjury training state, and the fear test was negative. At the final follow-up, the UCLA, VAS, Rowe, and WOSI scores were 29.8 ± 2.1, 2.2 ± 0.8, 89.4 ± 4.2, and 482.3 ± 46.2, respectively (p < 0.001). CONCLUSION: Arthroscopic autologous iliac bone graft suspension fixation and Bankart repair combined with the Remplissage procedure are effective in preventing recurrent instability with joint hyperlaxity. Furthermore, no patient had redislocation. LEVEL OF EVIDENCE: IV.

[Posterior capsule releasing in total knee arthroplasty for patients with rheumatoid arthritis with stiff knees in flexion].

OBJECTIVE: To investigate the correct method of bone resection and posterior capsular soft tissue releasing in total knee arthroplasty (TKA) for the patients with rheumatoid arthritis with stiff knee in flexion. METHODS: From November 2009 to January 2012,15 patients with rheumatoid arthritis with stiff knee in flexion underwent primary TKA and releasing of the posterior soft tissues. There were 7 males and 8 females,aged 22 to 75 years old (58.7 years old on average). The preoperative range of movement(ROM) was (3.2 ± 1.7)°. According to Knee Society score (KSS) criterion, the preoperative clinical score was 23.3 ± 12.5 and functional score was 35.2 ± 9.8. Based on the correct osteotomy, effective releasing of posterior structures was used for different degrees of flexion contracture during the TKA procedure. RESULTS: All the patients were followed up, and the average duration was 2.3 years (1.6 to 3 years). At the latest follow-up,the KSS clinical score was 81.7 ± 6.5 and functional score was 82.8 ± 9.3. The flexion and extension ROM of the knee joint was (103.5 ± 13.1). Three knees remained 50 flexion contracture deformity, but the function of the affect knees was good. CONCLUSION: The effective releasing of the soft tissue of posterior capsule is a major management for correction of the flexion contracture in TKA. The correct releasing of posterior structure can not only achieve fundamental gap of TKA but also effectively avoid bone over-resection.