Objective To study the effect of all-coated long stem prosthesis associated with allograft in revision total hip replacement (THR). Methods From January 1997 to January 2004, 20 patients with non-infectious loosened implant after primary THR were treated. There were 12 males and 8 females with a mean age of 65 years (58-77 years). The average period between primary THR and revision THR was 12 years (3-18 years). According to classification of Paprosky, there were10 cases of type II, 6 cases of type IIIA, 3 cases of type IIIB and 1 case of type IV. All-coated long stem prosthesis was used in all cases. Impacting bone grafting was done in 12 cases and impacting bone grafting associated with cortical strut grafting in 8 cases. The mean amount of morsel ized bone was 20 g (5-35 g), the length of cortical bone was 10-22 cm. Results All the incisions got heal ing by first intension. All patients were followed up for an average period of 36 months (16-48 months). Dislocation occurred at 5 days after operation and was cured with closed reduction and traction in 1 case. There was significant difference (P lt; 0.05) in the mean Harris score between preoperation (50.0 ± 2.3) and postoperation (90.0 ± 2.5). The X-ray checking showed that continuous radiolucent l ine of 3 mm occurred in 1 case, prosthesis subsidence of 5 mm and 7 mm in 2 cases and that no bone absorption was observed. Seven cases of cortical bone grafting union was achieved within 3 years except 1 case of cortical bone un-union. Conclusion It can obtained the initial stabil ization of prosthesis to use all-coated long stem prosthesis associated with allograft in revision THR to treat femur bone defect after THR. The short-term effects of the cl inical and X-ray checking are satisfactory, but future effect is to be observed.
Objective To analyse the results of posterior cruciate l igament-retained mobile-bearing total knee arthroplasty (TKA) in treatment of rheumatoid arthritis (RA) and to solve the problems often encountered during surgery. Methods From February 1999 to August 2005, the cl inical data from 73 patients with RA undergoing TKA were analysed retrospectively. In 73 patients, 38 patients were treated with posterior cruciate l igament-retained mobile-bearing prosthesis (group A), while 35 patients were treated with posterior stabil ized fixed-bearing prosthesis (group B). Another 70 patients with osteoarthritis (OA) treated with an posterior cruciate l igament-retained mobile-bearing prosthesis served as controls (group C). In group A, there were 8 males and 30 females with an average age of 56.5 years and an average diseasecourse of 16.8 years. In group B, there were 6 males and 29 females with an average age of 57.3 years and an average disease course of 17.1 years. In group C, there were 37 males and 33 females with an average age of 65.4 years and an average disease course of 10.8 years. There was no significant difference (P gt; 0.05) in general data between groups A and B, but there were significant differences (P lt; 0.05) when compared with group C. Results In groups A and B, 2 cases (5.3%) and 1 case (2.9%) had poor heal ing of incision, respectively; in group C, all cases had good heal ing of incision. There were significant differences in heal ing rate of incision between groups A, B and group C (P lt; 0.05). All patients were followed up 7.6 years on average (range, 3.5-10.5 years). Deep infection occurred in 1 case respectively in 3 groups, showing no significant difference (P gt; 0.05). Posterior instabil ity occurred in 1 case (2.6%) 5 years after operation in group A and 2 cases (2.9%) 9 years after operation in group C, and no posterior instabil ity occurred in group B; showing significant differences between groups A, C and group B (P lt; 0.05). There were significant differences (P lt; 0.05) in knee score, Feller patellar score, and anterior knee pain score between pre- and postoperative values among groups A, B, and C. There were significant differences (P lt; 0.05) in the function scores between pre- and post-operative values in 3 groups, between groups A, B and group C pre- and post-operatively. Conclusion Posterior cruciate l igament-retained mobile-bearing TKA can yield satisfactory cl inical results in treatment of RA at intermediate-term followup. This mobile-bearing prosthesis has a low prevalence of posterior instabil ity and a good outcome for anterior knee function without patellar resurfacing.