Clinical Effectiveness of Home-Based Telerehabilitation Program for Geriatric Hip Fracture Following Total Hip Replacement.

OBJECTIVE: To compare the effectiveness of a six-month home-based telerehabilitation based on the Internet-based rehabilitation management system coupled with conventional outpatient care in elderly patients with hip fractures following total hip replacement (THR). METHODS: Elderly patients (aged over 65 years) with first hip fractures who underwent THR between March 2018 and September 2018 in Tianjin Hospital were enrolled in this study. Patients were divided into two groups: telerehabilitation group (n = 43) and telephone group (n = 42). A Internet-based telerehabilitation management system was established and applied on patients in the telerehabilitation group. For patients in the telephone group, the rehabilitation intervention was administered through conventional outpatient care (telephone along with outpatient follow-up). Data from the Harris hip scale (HHS), functional independence measure (FIM), self-rating anxiety scale (SAS), and postoperative complications at 1, 3, and 6 months after surgery were collected and compared between the two groups. RESULTS: A total of 85 elderly patients completed the 6-month follow-up assessment. Results showed that the HHS score was significantly higher in the telerehabilitation group than in the telephone group at 1 month (66.35 ± 4.63 vs 63.48 ± 4.49), 3 months (76.33 ± 4.52 vs 71.81 ± 3.84), and 6 months (84.23 ± 3.13 vs 77.29 ± 4.95) after surgery (P < 0.001). The FIM score was significantly higher in the telerehabilitation group than in the telephone group at 1 month (89.00 ± 5.63 vs 73.35 ± 8.70), 3 months (100.16 ± 4.56 vs 92.81 ± 5.17), and 6 months (111.70 ± 3.13 vs 98.64 ± 5.12) after surgery (P < 0.001). The SAS score was significantly lower in the telerehabilitation group than in the telephone group at 1 month (42.40 ± 3.07 vs 46.21 ± 3.53), 3 months (36.77 ± 2.26 vs 40.24 ± 1.66), and 6 months (29.26 ± 1.63 vs 33.81 ± 2.62) after surgery (P < 0.001). The overall complication rate was significantly lower in the telerehabilitation group than in the telephone group (14% vs 40.5%) (P < 0.05). CONCLUSION: Internet-based rehabilitation management system can not only promote the physical rehabilitation of patients, but also play a positive role in psychological rehabilitation and the prevention of complications, which provides new ideas and methods for clinical rehabilitation.

Effect of Home-based Telerehabilitation on the Postoperative Rehabilitation Outcome of Hip Fracture in the Aging Population.

OBJECTIVE: To investigate the effects of home-based telerehabilitation based on the Internet-based rehabilitation management system on hip function, activities of daily living and somatic integrative ability of elderly postoperative hip fracture patients. METHODS: From June 2020 to November 2020, we recruited 58 elderly postoperative hip fracture patients and randomly assigned them to the telephone group (n = 29) and the telerehabilitation group (n = 29). Both groups received routine discharge instructions, and the former received telephone follow-up after discharge, while the latter received remote rehabilitation based on the Internet-based rehabilitation management system. The Harris hip score (HHS), functional independence measure (FIM), timed up-and-go test (TUG), and short physical performance battery (SPPB) were used to evaluate the patients' hip function, activities of daily living, and overall somatic ability. RESULTS: There was no significant difference between the baseline data of the two groups before the intervention (P > 0.05); no matter after hip replacement or internal fixation, the HHS score and FIM score of both groups increased gradually with the postoperative time, and the scores in the telerehabilitation group were higher than those in the telephone group at 1 and 3 months after the intervention, and the difference was significant (P < 0.05); for patients after hip replacement, the TUG and SPPB scores in the telerehabilitation group were better than those in the telephone group at 3 months after the intervention, and the difference was significant (P < 0.05). CONCLUSIONS: The Internet-based rehabilitation management system applied to postoperative home rehabilitation of elderly hip fracture patients can improve the functional recovery of the hip joint and enhance the ability to perform activities of daily living and somatic integration to a certain extent. This seems to provide an effective option for conducting home rehabilitation.

Comparison of Transverse Cancellous Lag Screw and Ordinary Cannulated Screw Fixations in Treatment of Vertical Femoral Neck Fractures.

OBJECTIVE: To compare the clinical therapeutic effect of transverse cancellous lag screw (TCLS) fixations and ordinary cannulated screw (OCS) fixations for vertical femoral neck fractures. METHODS: A total of 62 eligible patients with an average age of 56.2 years (range, 19-45 years; 40 male and 22 female) with Pauwels' type III femoral neck fractures were recruited in our study from January 2016 to December 2017. Among the patients, 30 underwent TCLS fixation (TCLS group), and the others were treated with OCS fixation (OCS group). The baseline data, perioperative outcomes (operative time, intra-operative blood loss, reduction quality, and hospital time), postoperative outcomes evaluated by a variety of scales including visual analogue scale (VAS) score, EuroQol five dimensions questionnaire (EQ-5D) and Harris hip scores (HHS), and complications (nonunion, femoral head necrosis, femoral neck shortening, and failure of fixation) of the two groups were recorded to compare at 12-month follow-up. RESULTS: The mean follow-up time of included patients was 13.4 ± 1.6 months in the TCLS group and 13.7 ± 0.9 months in the OCS group. There was no statistically significant difference in the baseline data as well as perioperative outcomes, including operative time, intra-operative blood loss, the hemoglobin difference before and after treatment, quality of reduction, and hospital time between two groups. Likewise, the VAS score, the EQ-5D score, and complications rates including nonunion and femoral head necrosis had no distinct difference in two groups. However, HHS in the TCLS group were superior to those in the OCS group at 12-month follow-up, and the femoral neck shortening rate was prominently reduced in the TCLS group when compared with the OCS group. CONCLUSIONS: Treating vertical femoral neck fractures with the TCLS technique could significantly improve hip functional recovery and reduce the postoperative femoral neck shortening rate. The present study provides novel insight for the treatment of vertical femoral neck fractures.

Internal Fixation of Complicated Acetabular Fractures Directed by Preoperative Surgery with 3D Printing Models.

The purpose of this article is to evaluate the efficacy and feasibility of preoperative surgery with 3D printing-assisted internal fixation of complicated acetabular fractures. A retrospective case review was performed for the above surgical procedure. A 23-year-old man was confirmed by radiological examination to have fractures of multiple ribs, with hemopneumothorax and communicated fractures of the left acetabulum. According to the Letounel and Judet classification, T-shaped fracture involving posterior wall was diagnosed. A 3D printing pelvic model was established using CT digital imaging and communications in medicine (DICOM) data preoperatively, with which surgical procedures were simulated in preoperative surgery to confirm the sequence of the reduction and fixation as well as the position and length of the implants. Open reduction with internal fixation (ORIF) of the acetabular fracture using modified ilioinguinal and Kocher-Langenbeck approaches was performed 25 days after injury. Plates that had been pre-bent in the preoperative surgery were positioned and screws were tightened in the directions determined in the preoperative planning following satisfactory reduction. The duration of the operation was 170 min and blood loss was 900 mL. Postoperative X-rays showed that anatomical reduction of the acetabulum was achieved and the hip joint was congruous. The position and length of the implants were not different when compared with those in preoperative surgery on 3D printing models. We believe that preoperative surgery using 3D printing models is beneficial for confirming the reduction and fixation sequence, determining the reduction quality, shortening the operative time, minimizing preoperative difficulties, and predicting the prognosis for complicated fractures of acetabulam.

Intravenous versus topical tranexamic acid in primary total hip replacement: A systemic review and meta-analysis.

OBJECTIVE: Total hip arthroplasty (THA) is associated with substantial blood loss. Tranexamic acid (TXA) could reduce perioperative blood loss. The optimal administration routine of TXA remains controversial. The objective of the present systemic review and meta-analysis was to compare the effectiveness and safety of various application methods of tranexamic acid in primary THA. METHODS: Potential relevant literature was identified from electronic databases including Medline, PubMed, Embase, ScienceDirect, web of science and Cochrane Library. Grey academic studies were also identified from the references of the included literature. There was no language restriction. The pooling of data was carried out by using RevMan 5.1. RESULTS: Three randomized controlled trials (RCTs) and two non-RCTs involving 1614 patients met the inclusion criteria. Current meta-analysis indicated that there were no significant differences in terms of total blood loss (MD = -30.04, 95% CI: -114.67 to 54.59, P = 0.49), postoperative hemoglobin level (MD = -0.29, 95% CI: -0.68 to 0.10, P = 0.14), transfusion rate (RD = -0.02, 95% CI: -0.5 to -0.00, P = 0.09), length of stay ((MD = -0.14, 95% CI: -0.30 to 0.01, P = 0.07) or operation time ((MD = 1.00, 95% CI: -0.31 to 2.31, P = 0.14) between treatment groups. No significant differences were found regarding the incidence of adverse effects such as wound infection (RD = -0.01, 95% CI: -0.06 to 0.04, P = 0.66), myocardial infarction (MI) (RD = -0.01, 95% CI: -0.04 to 0.02, P = 0.61), deep venous thrombosis (DVT) (RD = 0.00, 95% CI: -0.01 to 0.01, P = 0.51) or pulmonary embolism (PE) (RD = RD = 0.00, 95% CI: -0.01 to 0.01, P = 0.63) between groups. CONCLUSION: The topical administration of TXA in THA carried similar hemostasis effects compared with intravenous use without an increased risk of thrombotic complications. No other adverse effect was identified. Topical TXA application was a simple, safe, effective and cost-effective adjunct for blood management following primary THA. For patients with a high risk of thromboembolic events, there may be benefits with topical administration.

[Detection of protein secretion and expression and osteogenic activity of adipose tissue-derived stem cells after in vitro transfection of vascular endothelial growth factor].

OBJECTIVE: To examine vascular endothelial growth factor (VEGF) protein secretion and expression and explore the osteogenic activity of adipose tissue-derived stem cells (ADSCs) after transfection of human VEGF. METHODS: The ADSCs were isolated from human adipose tissue after the digestion of collagenase.After identification by flow cytometry, the cells were cultured and passaged in nutritive medium. Gene sequence encoding human VEGF mature peptide was obtained by Trizol reagent method from human vascular tissue. Target gene VEGF was connected with bicistronic expression vector containing green fluorescent protein to form pSELECT-GFP zeo-VEGF for transfecting 2nd, 3rd, 4th, 5th generation ADSCs mediated by liposome. The transfection results were verified under fluorescence microscope. VEGF protein secretion by transfected cells was detected by enzyme-linked immunosorbent assay (ELISA). Second-generation transfected ADSCs were cultured under osteogenic conditions.The supernatant levels of alkaline phosphatase (ALP) and osteocalcin (OC) were detected. RESULTS: Liposome-mediated VEGF target gene fragment could transfect ADSCs successfully. ELISA quantitative detection showed that VEGF mRNA expression levels in supernatant of the transfected group was significantly higher than the control group. And there were significant differences. After osteogenic culturing, the detections of ELISA, real-time PCR and Western blot showed that the secretion of ALP and OC of VEGF transfected group was significantly higher than that of empty vector transfected and blank cell groups.And there were significant differences (P < 0.01). CONCLUSION: After transfected by liposome-mediated VEGF target gene fragment, human ADSCs can express biologically active VEGF mRNA in vitro continuously and effectively. Directional differentiation capacity of transfected ADSCs is significantly enhanced.