ObjectiveTo investigate the clinical characteristic differences of cementless total hip arthroplasty (THA) between with and without subtrochanteric femoral shortening osteostomy in Crowe type IV developmental dysplasia of the hip (DDH). MethodsBetween January 2006 and March 2012, 21 patients (21 hips) with Crowe type IV DDH who underwent primary THA were enrolled according to inclusion criteria. According to whether subtrochanteric femoral shortening osteostomy was performed during THA or not, the patients were divided into 2 groups: THA with osteostomy group (n=9) and THA without osteotomy group (n=12). There was no significant difference in gender, age, body mass index, and hip Harris score between 2 groups (P>0.05) except leg length discrepancy (t=-3.170, P=0.005). The operation time, blood loss, postoperative drainage, complications, and radiography data were compared to evaluate the clinical characteristics. ResultsThe operation time, blood loss, and postoperative drainage of osteotomy group were all significantly greater than those of no osteotomy group (P<0.05). All patients achieved primary healing of incision; 1 patient (1 hip) had transient sciatic nerve symptom in osteotomy group. The average follow-up time was 53 months (range, 28-88 months). The X-ray films showed good fracture healing at 3-6 months after operation in osteostomy group. No prosthetic loosening or dislocation was found. The hip Harris score was 90.67±4.06 in osteostomy group and 92.17±3.27 in no osteostomy group, showing no significant difference between 2 groups (t=-0.938, P=0.360). The leg length discrepancy was (0.22±0.26) cm in osteostomy group and (0.18±0.27) cm in no osteostomy group, showing no significant difference (t=107.000, P=0.546). The leg length discrepancy was found in 6 patients of osteotomy group and 5 patients of no osteotomy group. One patient complained of thigh pain in osteotomy group; 2 patients had slight limp (Trendelenburg +) in no osteotomy group. ConclusionTHA can improve joint function and increase limb length in the treatment of Crowe type IV DDH. Subtrochanteric shortening osteotomy is an effective treatment which can be performed according to preoperative template measurement, leg length shortening, and the soft tissue tension.
目的 探讨人工髋关节置换术后Vancouver B1型股骨假体周围骨折的治疗方法。 方法 2006年4月－2011年2月采用记忆合金抓握式接骨板固定结合自体髂骨植骨治疗6例Vancouver B1型股骨假体周围骨折。其中男2例，女4例；年龄55～78岁，平均68.5岁。6例均为初次行人工关节置换术后6个月～3年，平均18.4个月发生假体周围骨折；骨折至手术时间为3～6 d，平均4.2 d。 结果 术后切口均Ⅰ期愈合，无深静脉血栓形成、肺部感染、肺栓塞等并发症发生。6例均获随访，随访时间13个月～4年，平均28.6个月。X线片示骨折全部愈合，愈合时间12～20周，平均14.8周。末次随访时Harris评分76～93分，平均83.6分；获优3例，良3例。无1例出现接骨板折断、松动，骨折再移位、骨不连、股骨假体松动等并发症。 结论 记忆合金抓握式接骨板结合自体髂骨植骨治疗Vancouver B1型股骨假体周围骨折具有固定可靠、操作简便的特点，可获满意临床疗效。
目的:探讨术后早期康复护理干预对骨盆恶性肿瘤半骨盆切除、组合式半骨盆+全髋关节置换术后的患肢功能的影响。方法：从2004年9月至2007年5月采用半骨盆切除、组合式半骨盆假体+全髋关节置换术治疗骨盆恶性骨肿瘤8例。其中软骨肉瘤4例，平滑肌肉瘤2例，骨肉瘤1例，恶性骨巨细胞瘤1例。外科分期:ⅠB期6例，ⅡB期2例。术后根据肿瘤切除范围、人工假体置换术后稳定性和骨盆髋周动力肌修复后的平衡程度，决定术后患肢体位、患髋活动范围、是否使用髋部支具；同时指导患者分阶段、渐进地进行患肢足踝、膝、髋关节的主被动训练，以及下床负重时间和步态调整。结果：随访10～32个月，平均15月。1例术后16个月死于恶性肿瘤扩散转移，7例存活。术后8个月患肢功能评定:优2例，良6例。ISOLS评分:15～26分，平均19.47分。结论：①对骨盆恶性骨肿瘤患者积极进行术后早期康复护理干预能有效的防止人工髋关节早期脱位；②患肢各关节分阶段有序的主动康复护理训练能提高骨盆和髋周肌肉肌力及其平衡度，对维持术后患者行走和步态的稳定有重要意义。
Objective To summarize the occurrence mechanism of backside wear, the method of evaluating backside surface damage, the relationship between backside wear and osteolysis in acetabulum, and the approach to reduce backside wear in total hip arthroplasty with modular acetabulum prosthesis. Methods The recent articles about the backside wear in acetabular liners were extensively reviewed. Results Backside wear in acetabular liners is connected with micromotion between the liner and the shell, rough interface, thickness of the liner, and impingement. The methods to evaluate backside wear damage are only proceeded in revised acetabular liners. Backside wear can generate polyethylene particles that is likely related to the process of osteolysis in acetabulum through the screw holes of metallic shell. To reduce backside wear between the liner and the shell, measures such as improved locking mechanisms, smooth inner metallic shell, maximized shell liner conformity, improving the quality of polyethylene, and reducing impingement can be taken. Conclusion There is no method of evaluating the backside wear in vivo. The relationship between backside wear and osteolysis in acetabulum as well as aseptic loosening of acetabulum prosthesis is controversial.
Objective To evaluate the effect of preoperative digital planning in acetabular reconstruction of total hip arthroplasty (THA) for development dysplasia of the hip (DDH). Methods A prospective study was performed on 42 patients with DDH undergoing primary THA between January 2009 and December 2011. The patients were divided into 2 groups according to whether preoperative digital planning was made or not; before operation, conventional imaging method was used in 23 cases (group A), and TraumaCad software was used for preoperative digital planning in 19 cases (group B). There was no significant difference in gender, age, body mass index, DDH classification, and preoperative Harris score between 2 groups (P gt; 0.05). The operation time, amount of bleeding, and postoperative complication were observed. After 7 days of operation, X-ray films were done to measure the vertical location, horizontal location, radiographic anteversion angle, radiographic inclination angle, and prosthesis size by TraumaCad software. The qualified rate of cup placement was compared between 2 groups. Coincidence rate of cup size between preoperative predicted by the digital planning and actually implanted in group B also was calculated. Results The operation time and the amount of bleeding were (119.25 ± 47.16) minutes and (410.00 ± 200.39) mL in group A and were (155.31 ± 84.03) minutes and (387.50 ± 251.99) mL in group B respectively, showing no significant difference between 2 groups (P gt; 0.05). Incision infection and prosthetic anterior dislocation occurred in 1 case of group A respectively, prosthetic posterior dislocation in 1 case of group B. The patients were followed up 1 year and 1 month to 4 years and 1 month (mean, 2 years and 8 months ) in group A, and 1 year and 3 months to 4 years (mean, 2 years and 7 months) in group B. At last follow-up, the Harris scores were 91.09 ± 5.35 in group A and 91.72 ± 3.48 in group B, which were significantly increased when compared with preoperative scores (P lt; 0.05), but no significant difference was found between 2 groups (t=0.41, P=0.69). The qualified rate of cup placement of group B (78.95%, 15/19) was significantly higher than that of group A (43.48%, 10/23) (χ2=5.43, P=0.02); the coincidence rate of the cup size between preoperative predicted by the digital planning and actually implanted was 68.42% (13/19). ConclusionPreoperative digital planning can further optimize the acetabular reconstruction in THA for DDH.
Objective To compare the effectiveness and linear wear rates between high cross-linked polyethylene cup liner and traditional polyethylene cup liner. Methods A retrospective analysis was made on the clinical data of 61 patients (64 hips) who underwent primary total hip arthroplasty (THA) between January 2005 and March 2007. According to the type of cup liner, 61 patients (64 hips) were divided into 2 groups: high cross-linked polyethylene cup liner was used in 30 cases (31 hips, trial group), and traditional polyethylene cup liner in 31 cases (33 hips, control group). There was no significant difference in gender, age, body weight, etiological factor, and preoperative Harris score between 2 groups (P gt; 0.05). Complication was observed after operation; Harris score was used to assess hip function; X-ray film analysis was done to observe osteolysis and prosthesis loosening, and to measure cumulative penetration of the femoral head and linear wear rate. Results All incisions healed by first intention without complication. All patients were followed up. The mean follow-up was 6.3 years (range, 5-7 years) in trial group, and was 6.5 years (range, 4-7 years) in control group. There was no significant difference in Harris score between 2 groups at the 3 months after operation and last follow-up (P gt; 0.05). Osteolysis was observed in 3 cases (3 hips) of control group, but no osteolysis in trial group. X-ray films showed no aseptic loosening in the patients of 2 groups. The mean cumulative penetration of trial group were significantly lower than those of control group at 1-7 years after operation (P lt; 0.05). Linear wear rate of trial group [(0.025 ± 0.002) mm/year] was significantly lower than that of control group [(0.086 ± 0.005 ) mm/year] (Z=6.804, P=0.000). Conclusion High cross-linked polyethylene cup liner has the similar effectiveness as traditional polyethylene cup liner, but it has lower linear wear rate than the traditional polyethylene cup liner.
Objective To compare the short-term effectiveness between primary cemented and uncemented total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) after renal transplantation. Methods The clinical data were retrospectively analyzed from 18 patients (21 hips) with ONFH after renal transplantation undergoing cemented THA in 11 cases (13 hips) (cemented group) and uncemented THA in 7 cases (8 hips) (uncemented group) between February 2005 and February 2012. There was no significant difference in gender, age, disease duration, ONFH stage, preoperative Harris score, and bone density between 2 groups (P gt; 0.05). Postoperative complications were observed in 2 groups; the hip function was assessed based on Harris scores; X-ray film was used to observe the prosthetic situation. Results All the wounds healed by first intention. The patients were followed up 6-77 months (mean, 46 months) in the cemented group, and 4-71 months (mean, 42 months) in the uncemented group. Femoral prosthesis infection occurred in 1 case (1 hip) respectively in each group; hip dislocation, femoral prosthesis loosening, and acetabular prosthesis loosening occurred in 1 case (1 hip) of the cemented group, respectively. At last follow-up, the incidences of postoperative complications and revision rate of the cemented group were 30.7% (4/13) and 23.1% (3/13) respectively, which were significantly higher than those of the uncemented group [12.5% (1/8) and 0 (0/8)] (P=0.047, P=0.040). Harris score was significantly increased to 94.1 ± 3.7 in the uncemented group and 90.0 ± 4.2 in the cemented group, showing significant differences compared with the preoperative scores in 2 groups (P lt; 0.05), but there was no significant difference between 2 groups (t=1.815, P=0.062). Postoperative X-ray films showed that the initial position of the prosthesis was satisfactory. At last follow-up, the bone fixation, fibrous stability, and loosening of the femoral prosthesis and loosening of acetabular prosthesis occurred in 9 hips, 3 hips, 1 hip, and 1 hip of the cemented group, respectively; bone fixation of the femoral prosthesis and stability of acetabular prosthesis were observed in all hips of the uncemented group. There was no heterotopic ossification in 2 groups. Conclusion Uncemented THA after renal transplantation can obtain satisfactory short-term effectiveness, and uncemented THA is better than the cemented THA; however, the middle- and long-term effectivenesses need further observation．
Objective To evaluate the effectiveness of limited open reduction and double plates internal fixation in the treatment of Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty. Methods A retrospective analysis was made on the clinical data of 12 patients with Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty between May 2007 and October 2012, who underwent limited open reduction and double plates internal fixation. Of 12 patients, 4 were male and 8 were female, aged 76-85 years (mean, 81.6 years); the left side was involved in 5 patients and the right side in 7 patients. The cement prosthesis was used in 3 cases and cementless prosthesis in 9 cases; double acting head of hip arthroplasty was performed in 4 cases and total hip arthroplasty in 8 cases. The median time from first hip arthroplasty to re-fracture was 13 months (range, 5 months-5 years). The causes of injury were traffic accident in 2 cases and falling in 10 cases. Combined fractures included contralateral tibial and fibular fractures and ipsilateral distal humeral fracture (1 case), ipsilateral proximal humeral fracture (2 cases), ipsilateral distal radial fracture (1 case), and rib fracture (1 case). The time from injury to operation was 5.6 days on average (range, 3-10 days). Results The incisions all healed by first intention, and no infection or deep venous thrombosis of lower extremity occurred. Twelve cases were followed up 6-24 months (mean, 13.3 months). One female patient died of acute myocardial infarction at 16 months after operation. All the fractures were healed, with X-ray healing time of 12.5 weeks on average (range, 10-16 weeks). The time of full weight bearing was 13 weeks on average (range, 10-18 weeks). Ten cases could walk freely after operation, and 2 cases could walk by the aid of walking aid appliance. At last follow-up, the Harris score of hip function was 87.3 on average (range, 75-93). Conclusion The method of limited open reduction and double plates internal fixation for Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty is effective in maintaining stability, protecting blood supply, promoting fracture healing, and doing functional exercise early. The long-term effectiveness needs further observation.
Objective To evaluate the effectiveness of bipolar prosthetic replacement for proximal femoral tumors from the perspectives of patient survival, prosthesis survival, functional outcomes, and complication rates. Methods Between July 2001 and July 2010, 96 patients with proximal femoral tumors underwent wide resection and bipolar prosthetic replacement, including 83 cases of primary femoral tumors and 13 cases of soft tissue sarcomas involving the proximal femur. There were 50 male and 46 female patients with a mean age of 43.2 years (range, 15-69 years). Prosthetic replacement for proximal femoral tumors was used in 85 patients and deactivated bone-prosthetic complex was used in 11 patients. According to Enneking staging, the patients were divided into 3 groups: group A, 24 patients at stages IA, IB, and benign lesion; group B, 56 patients at stages IIA and IIB; and group C, 16 patients at stage III, myeloma, and lymphoma. The American Musculoskeletal Tumor Society 1993 version (MSTS93) functional score was used to evaluate the lower limb function. Results Primary healing of incision was obtained in 93 patients; 3 patients had poor healing, which was cured after debridement. Of the patients, 89 were followed up 6.5 years on average (range, 1-10 years). During follow-up, 28 patients died of tumor. The 5- and 10-year survival rates of patients were 100% in group A, and were 56.5% and 41.5% in group B respectively, and the 5-year survival rate was 18.4% in group C; there was significant difference among 3 groups (P lt; 0.01). The 5- and 10-year survival rates of prosthesis were 74.4% and 62.5%, which were significantly higher than those of patients in groups B and C (P lt; 0.01). Sixty-one patients were followed up 1-10 years (mean, 4.7 years) for functional evaluation. The mean MSTS93 score of the survival patients was 79% (range, 63%-95%) at last follow-up. Complications were observed in 15 patients (16.9%): hip dislocation in 2, delayed infection in 2, aseptic loosening in 8, severe acetabulum wear in 1, and hip pain in 2. Conclusion Bipolar proximal femoral prosthetic replacement for proximal femoral tumors can provide a satisfactory functional outcome, especially for tumors at stage II or III and myeloma and lymphorma patients. Revision is needed because of main late complications of aseptic loosening, hip pain, and acetabulum wear.
Objective To study the effectiveness and acetabular prosthesis selection of the total hip arthroplasty (THA) for Crowe type IV congenital dysplasia of the hip with dislocation in adults. Methods Between June 2008 and May 2012, 8 adult patients (8 hips) with Crowe type IV congenital dysplasia of the hip with dislocation underwent THA. They were all female, aged 20-35 years with a mean age of 25 years. The left hip was involved in 5 cases and the right hip in 3 cases. The Harris score of involved hip was 53.9 ± 6.6. The shortened length of involved extremity was 4-6 cm (mean, 4.8 cm). The X-ray films showed complete dislocation in all cases. The acetabular prosthesis with diameter of 42-44 mm and S-ROM femoral prosthesis were used in THA. Results The incisions healed by first intention. There was no hip dislocation events and sciatic nerve injury during the follow-up. Femoral nerve injury occurred in 1 case and asymptomatic venous thrombosis of the leg muscle occurred in 2 cases. All the patients were followed up 1-5 years (mean, 3 years). All cases showed obvious improvement of claudication and could restore to work. At 6 months after operation, the mean length difference between affected and contralateral extremities was 0.4 cm (range, — 1.0-0.6 cm); the Harris score was significantly increased to 87.6 ± 0.3 (t=1.77, P=0.00). The X-ray films showed that all cases got bony union at 3-6 months after operation and stable interface between acetabular prosthesis and bone. No revision was involved during the follow-up. Conclusion THA with small acetabular cup and subtrochanteric osteotomy is an effective method in the treatment of Crowe type IV congenital dysplasia of the hip with dislocation in adults. The early effectiveness is satisfactory. The long-term survival rate of prosthesis needs to be followed up.