Objective To investigate the effectiveness of Y-shaped osteotomy for treatment of developmental coxa vara in children. Methods Between January 2008 and October 2011, 10 cases (14 hips) of developmental coxa vara were treated. There were 4 boys (5 hips) and 6 girls (9 hips), aged 5-12 years (mean, 7.8 years). All the children had obvious lameness and limitations of hip abduction, adduction, and rotation. The anteroposterior pelvic X-ray films showed that the collodiaphysial angle ranged from 46 to 110° (mean, 87°); Hilgenreiner-epiphyseal angle (HE) ranged from 36 to 93° (mean, 57°); and the articulotrochanteric distance (ATD) ranged from — 25 to 6 mm (mean, — 3 mm). The subtrochanteric Y-shaped osteotomy was performed and angle steel plate was used for internal fixation. Results All incisions healed by first intention without surgery-related complication. All cases were followed up 14-40 months (mean, 18 months). The symptom of lameness disappeared or obviously alleviated; the range of motion of hip abduction, adduction, and rotation were increased. Postoperative X-ray films showed that the vertical epiphyseal plate of proximal femur was returned to the horizontal. After operation, the collodiaphysial angle was 130-153° (mean, 137°); HE angle was 23-35° (mean, 27°); and the ATD was 3-22 mm (mean, 14 mm). According to LIU Jiande’s assessment standards, the results were excellent in 5 hips, good in 8 hips, and fair in 1 hip, and the excellent and good rate was 92.8%. The other children had no recurrence of coxa vara except 1 case after 30 months. Conclusion The Y-shaped osteotomy is a simple and effective method to treat developmental coxa vara in children, which can fully correct the deformity, and patients can exercise early because of firm internal fixation.
Objective To investigate the effects of altering the femoral offset after total hip arthroplasty on postoperative pain and function. Methods A total of 162 patients undergoing single total hip arthroplasty between March 2009 and December 2011 met the inclusion criteria. According to difference of femoral offset between operative side and contralateral side, the patients were divided into 3 groups: decreased offset group (lt; — 5 mm, 30 cases), normal offset group ( — 5-5 mm, 87 cases), and increased offset group (gt; 5 mm, 45 cases). There was no significant difference in gender, age, and disease duration among 3 groups (P gt; 0.05). The types of femoral stem and head prosthesis were compared among 3 groups. Short Form 12 Health Survey (SF-12) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, and Harris score were used to evaluate the clinical outcomes. Results Standard offset femoral prosthesis was most used, followed by increased offset femoral prosthesis, and decreased offset femoral prosthesis was least in 3 groups. The types of femoral stem and head prosthesis showed no significant difference among 3 groups (P gt; 0.05). The patients were followed up 12-33 months (mean, 25 months). There was no significant difference in SF-12 score among 3 groups at 1 year after operation (P gt; 0.05); there was no significant difference in WOMAC pain and stiffness scores among 3 groups (P gt; 0.05) except WOMAC body function score (P lt; 0.05). According to Harris scoring criteria, the results were excellent in 13 cases, good in 8 cases, fair in 7 cases, and poor in 2 cases in decreased offset group; the results were excellent in 42 cases, good in 34 cases, fair in 9 cases, and poor in 2 cases in normal offset group; the results were excellent in 31 cases, good in 12 cases, and fair in 2 cases in increased offset group; and significant difference was found among 3 groups (Z= — 3.152, P=0.008). Conclusion Increased offset is more conducive to joint functional recovery and pain relief; decreased offset may lead to joint function deterioration and pain aggravation.
【Abstract】 Objective To evaluate the operative technique and the short-term cl inical effect of cementless total hiparthroplasty (THA) for developmental dislocation of the hip in adults. Methods From December 1997 to October 2006, 61patients (78 hips) with developmental dislocation of the hip were treated with the cementless THA. There were 8 males and 53 females with the average age of 31.4 years (ranging from 17 years to 56 years). According to the classification of Hartofilakidis, 15 cases were type I (18 hips), 23 type II (31 hips), and 23 type III (29 hips). All the patients were exposed through the posterolateral approach. The threaded cup with coating was put at or near the level of the true acetabulum in all cases. Full coating stems were used in femoral sides, and shortening osteotomy below trochanter of femur was performed in 12 cases. Results Sixty patients (76 hips) were followed up with the mean duration of 49 months (range 12 to 118 months). All the hips of osteotomy and bone ingrowth acquired union 3 to 14 months after the operation. No patient had radiographic evidence of aseptic loosening of prosthesis. The average leg length of the hips with femoral shortening osteotomy was lengthened 2.0 to 4.5 cm. All patients had pain rel ief and no obvious motion l imitation, l imp gait and pelvic obl iquity. The Harris scores were 40.28 ± 9.84 preoperatively and 90.92 ± 2.80 postoperatively (P lt; 0.001). One patient with postoperative femoral nerve palsy completely recovered 4 months after the operation. Conclusion Cementless THA for developmental dislocation of the hip in adults produces significantly better results, although it presents great technical difficulties.
ObjectiveTo explore the effectiveness of total hip arthroplasty (THA) for non-functional bony ankylosed hip in young and middle-aged patients. MethodsBetween January 2010 and March 2013, 14 cases (19 hips) of non-functional bony ankylosed hip were treated by THA. There were 9 males and 5 females, aged 37.5 years on average (range, 23-58 years). The left hip was involved in 6 cases, the right hip in 3 cases, and bilateral hips in 5 cases. The causes were tuberculosis in 2 patients, ankylosing spondylitis in 5 patients, traumatic arthritis in 5 patients, osteoarthritis in 1 patient, and suppurative infection in 1 patient. The disease duration was 7-18 years with an average of 8.9 years. Flexion stiffness was observed in 10 hips, flexion abduction stiffness in 6 hips, and flexion adduction shortening stiffness in 3 hips. Only 5 patients could walk with a crutch before operation. Harris hip score was 24.368±7.625. ResultsThe average operation time was 63.4 minutes (range, 50-90 minutes). The average intraoperative blood loss was 196.8 mL (range, 100-400 mL). Patients obtained primary healing of incision; no complication of neurovascular injury, fracture, joint dislocation, or infection occurred. All patients were followed up 2.2 years on average (range, 1 year to 4 years and 3 months). The Harris score was 86.837±7.742 at last follow-up, showing significant difference when compared with preoperative score (t=-41.956, P=0.000). The results were excellent in 5 hips, good in 11 hips, fair in 2 hips, and poor in 1 hip, with an excellent and good rate of 84.2%. All patients could basically take care of themselves; 2 patients could walk with crutch, and the other patients could walk without crutch. X-ray films showed that prosthesis was in good position; no shifting, loosening, or sinking was found. Heterotopic ossification occurred in 2 hips. ConclusionTHA is an effective surgical approach to treat non-functional bony ankylosed hip in young and middle-aged patients.
ObjectiveTo explore the method of acetabular orientation determination in total hip arthroplasty (THA) for bony ankylosed hip and the accuracy of the postoperative evaluation. MethodsBetween January 2009 and March 2013, 33 consecutive patients (49 hips) underwent THA. There were 25 males and 8 females with a mean age of 35.8 years (range, 18-69 years). The left hip was involved in 10 cases, the right hip in 7 cases, and bilateral hips in 16 cases. The causes were ankylosing spondylitis in 18 patients, tuberculosis in 6 patients, traumatic arthritis in 6 patients, osteoarthritis in 2 patients, and suppurative infection in 1 patient. The disease duration was 7-15 years with an average of 10.8 years. The acetabular orientation was determined with periacetabular bone marks (the upper margin of the obturator foramen, acetabular notch etc.) and soft tissue signs (acetabulum transverse ligament etc.). The hip or pelvic radiograph was taken to measure the acetabular prosthesis anteversion and abduction angle, and upward or downward, inward or outward acetabular migration degree. The acetabular anteversion angle of 15 degrees, the abduction angle of 45 degrees, and upward or downward, inward or outward acetabular migration degree of 0 served as a reference value to evaluate the accuracy of acetabular position. ResultsThere was no complications of neurovascular injury, fracture, joint dislocation, and infection. All of patients were followed up 13-63 months (mean, 30.3 months). The anteversion angle and abduction angle were (13.904±4.034)° and (42.898±7.474)° at last follow-up, showing no significant difference when compared with reference value (t=1.386, P=0.178; t=1.969, P=0.055). The inward or outward and upward or downward acetabulum migration degree were (2.530±2.261) mm and (3.886±3.334) mm respectively, showing significant differences when compared with reference value (t=7.830, P=0.000; t=8.159, P=0.000); it was less than 5 mm in 29 hips, 5-10 mm in 18 hips, and more than 10 mm in 2 hips; the acetabulum center coincidence rate was 59.2%. ConclusionFor bony ankylosed hip having loss of normal anatomy structure, intraoperative residues and permanent anatomical structure should be used for acetabular positioning.
ObjectiveTo systematically evaluate the efficacy and safety of intra-articular injection of hyaluronic acid for knee osteoarthritis. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about intra-articular injection of hyaluronic acid for knee osteoarthritis from inception to February 2016. The meta-analysis was conducted using RevMan 5.3 software. ResultsA total of 17 RCTs involving 4 070 patients were included. The results of metaanalysis showed that: there were no significant differences in WOMAC pain scores (7 weeks: MD=-0.01, 95%CI -0.46 to 0.44, P=0.98; 13 weeks: MD=-0.01, 95%CI -0.46to 0.43, P=0.95; 26 weeks: MD=0.32, 95%CI -0.04 to 0.67, P=0.08), stiffness scores (7 weeks: MD=0.10, 95%CI -0.26 to 0.45, P=0.59; 13 weeks: MD=0.24, 95%CI -0.11 to 0.60, P=0.17; 26 weeks: MD=0.06, 95%CI -0.09 to 0.22, P=0.42), and life function scores (7 weeks: MD=-0.20, 95%CI -0.75to 0.36, P=0.49; 13 weeks: MD=-0.02, 95%CI -0.57 to 0.52, P=0.93; 26 weeks: MD=0.30, 95%CI -0.07 to 0.67, P=0.11) between the hyaluronic acid group and the control group in 7-, 13- and 26 weeks. However, the hyaluronic acid group was superior to the control group in 50-step test (MD=-0.49，95%CI -7.36 to -3.61，P<0.000 01). ConclusionCurrent evidence suggests that intra-articular injection of hyaluronic acid has better effect than control treatment for pain at movement. However, due to the limited quantity of the included studies, the above conclusion still need to be verified by more high quality studies．
ObjectiveTo systematically evaluate the effectiveness of arthroscopic debridement versus non-operative treatment for degenerative meniscal tear. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 7, 2015), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about arthroscopic debridement versus non-operative treatment for degenerative meniscal tear from inception to July 2015. The meta-analysis was conducted using RevMan 5.3 software. ResultsA total of nine RCTs involving 1 023 patients were included. The results of meta-analysis showed that:there were no significant differences between two groups at different follow-up time points in knee scoring scale (less than 6 months:SMD=0.12, 95%CI -0.11 to 0.35, P=0.30; 1 year:SMD=-0.03, 95%CI -0.18 to 0.11, P=0.65; 2 years:SMD=-0.07, 95%CI -0.32 to 0.19, P=0.61) and pain score (less than 6 months:MD=0.30, 95%CI -0.10 to 0.70, P=0.14; 1 year:MD=0.10, 95%CI -0.40 to 0.60, P=0.70; 2 years:MD=0.02, 95%CI -0.52 to 0.92, P=0.90). ConclusionCurrent evidence suggests that arthroscopic debridement hasn't better effective than non-operative treatment for degenerative meniscal tear, however, due to the limited quantity of the included studies, the above conclusion still need more high quality research to be verified.
ObjectiveTo explore the short-term effectiveness of Mako robot-assisted total hip arthroplasty (THA) via posterolateral approach.MethodsThe clinical data of 64 patients (74 hips) treated with Mako robot-assisted THA via posterolateral approach (robot group) between May 2020 and March 2021 were retrospectively analyzed and compared with the clinical data of 52 patients (55 hips) treated with traditional THA via posterolateral approach (control group) in the same period. There was no significant difference in general data such as gender, age, side, body mass index, disease type, and preoperative Harris score between the two groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the two groups. Acetabular inclination angle, acetabular anteversion angle, and lower limbs discrepancy were measured after operation. At last follow-up, the improvement of hip pain and function was evaluated by visual analogue scale (VAS) score, Harris score, and forgetting joint score (FJS-12).ResultsIn the robot group, 3 patients (including 1 patient with acetabular fracture during operation) were converted to routine THA because the pelvic data array placed at the anterior superior iliac spine was loose, resulting in data error and unable to register the acetabulum; the other patients in the two groups completed the operation successfully. The operation time and intraoperative blood loss in the robot group were significantly higher than those in the control group (P<0.05). All patients were followed up 1-10 months, with an average of 4.6 months. In the robot group, 1 patient with ankylosing spondylitis had acetabular prosthesis loosening at 2 days after operation, underwent surgical revision, and 10 patients had lower limb intermuscular vein thrombosis; in the control group, 1 patient had left hip dislocation and 5 patients had lower extremity intermuscular vein thrombosis; there was no complication such as sciatic nerve injury, incision exudation, and periprosthetic infection in both groups. There was no significant difference in the incidence of complications between the robot group and the control group (17.2% vs.11.5%) (χ2=0.732, P=0.392). At last follow-up, the acetabular anteversion angle and FJS-12 score in the robot group were was significantly greater than those in the control group, and the lower limbs discrepancy was significantly less than that in the control group (P<0.05); there was no significant difference in acetabular inclination angle and VAS score between the two groups (P>0.05). The Harris scores of the two groups were significantly improved when compared with those before operation (P<0.05), but there was no significant difference in the difference of pre- and post-operative score between the two groups (t=1.632, P=0.119).ConclusionCompared with traditional surgery, Mako robot-assisted THA can optimize the accuracy and safety of acetabular cup implantation, reduce the length difference of the lower limbs, and has a certain learning curve. Its long-term effectiveness needs further research to confirm.