Objective To investigate the medium-term effectiveness of straight tapered rectangular femoral prosthesis in total hip arthroplasty (THA). Methods Between May 2004 and June 2006, 58 cases (61 hips) of hip joint disease underwent THA with straight tapered rectangular femoral prosthesis and the clinical data of 43 cases (45 hips) followed up more than 6 years were retrospectively analyzed. There were 21 males (23 hips) and 22 females (22 hips) with an average age of 51.6 years (range, 25-75 years), including 12 cases (12 hips) of congenital developmental dysplasia of the hip, 1 case (1 hip) of osteoarthritis secondary to acetabular dysplasia, 1 case (1 hip) of hip deformity after poliomyelitis, 9 cases (9 hips) of femoral neck fractures, 8 cases (8 hips) of avascular necrosis of the femoral head, 8 cases (8 hips) of osteoarthritis of the hip joint, 2 cases (3 hips) of rheumatoid arthritis, and 2 cases (3 hips) of ankylosing spondylitis. Unilateral replacement was performed in 41 cases and bilateral replacement in 2 cases. The Harris score was 41.7 ± 10.4 before operation. X-ray examination was performed to analyze the location of femoral prostheses and evaluate the stability of the prosthesis-bone interface, and Harris score was used to evaluate the hip function. Results Periprosthetic fracture occurred in 3 hips, and thigh pain in 4 hips after operation. Forty-three cases (45 hips) were followed up 74-99 months (mean, 85 months). Harris score was 87.6 ± 8.3 at last follow-up, showing significant difference when compared with preoperative score (t=23.14, P=0.00). The X-ray examination showed that 9 hips had heterotopic ossification; bone resorption caused by stress shielding was observed at the proximal femur in 42 hips. But the stability of the prosthesis-bone interface was good; no infection or dislocation occurred; and no revision for aseptic loosening was performed in all cases. The survival rate of the femoral prosthesis was 100% during medium-term follow-up. Conclusion THA with straight tapered rectangular femoral prosthesis has good medium-term effectiveness.
ObjectiveTo summarize the clinical experience of the treatment for complex aortic coarctation with extra anatomic bypass and anatomic correction techniques. MethodsThe clinical data of patients with complex aortic coarctation treated in the First Affiliated Hospital of Nanjing Medical University and Friendship Hospital of Ili Kazakh Autonomous Prefecture between April 2012 and November 2020 were retrospectively reviewed. ResultsA total of 12 patients were enrolled, including 5 males and 7 females aged 11-54 (34.3±16.2) years. Extra anatomic bypass grafting was performed in 8 patients and anatomic correction was performed in 4 patients. The operations were successful in all patients. There was no perioperative death. The average cardiopulmonary bypass time was 203.0±46.0 min (7 median incision patients), and the average intraoperative blood loss was 665.0±102.0 mL. The average postoperative ventilator support time was 32.3±7.5 h, and the average postoperative hospital stay time was 10.2±4.3 d. The mean drainage volume of median incision was 1 580.0±360.0 mL, and the mean drainage time was 9.3±2.7 d. The mean drainage volume of left thoracotomy was 890.0±235.0 mL, and the mean drainage time was 4.8±2.5 d. One patient had a transient hoarse after operation and recovered 6 months later. The follow-up period ranged from 2 to 10 years with an average time of 81.0±27.0 months. All patients had a recovery of hypertension, cardiac afterload after 2 years postoperatively. One patient who received an artificial blood vessel replacement in situ was examined stenosis recurrence at the third year after discharge. Others were asymptomatic during the follow-up period. There were no death or other complications. ConclusionThe treatment strategy for complex aortic coarctation should be individualized according to the anatomical features and concomitant heart diseases. Extra anatomic bypass technique is a safe and feasible choice.