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.
ObjectiveTo investigate the effectiveness of total elbow arthroplasty (TEA) via olecranon osteotomy approach. Methods Between January 2011 and December 2021, 22 patients (25 sides) with elbow joint disease were treated with TEA via olecranon osteotomy approach. There were 9 males and 13 females with an average age of 52.0 years (range, 32-80 years). The disease involved unilateral elbow joint in 19 cases, including 12 cases on the left side and 7 cases on the right side, and 3 cases with bilateral elbow joints. There were 3 cases (3 sides) of osteoarthritis, 7 cases (9 sides) of rheumatoid arthritis, 6 cases (7 sides) of traumatic arthritis, 4 cases (4 sides) of distal humeral fracture, and 2 cases (2 sides) of elbow tuberculosis. The operation time, intraoperative blood loss, and postoperative complications were recorded. The Mayo Elbow Performance Score (MEPS) and range of motion (ROM) were used to evaluate the elbow joint function, and imaging was used to review the position of the prosthesis and the healing of the osteotomy. ResultsThe operation time ranged from 53 to 120 minutes (mean, 90.6 minutes); intraoperative blood loss ranged from 10 to 200 mL (mean, 68.4 mL). All incisions healed by first intention. All patients were followed up 3.9-126.7 months, with a median time of 47.6 months. At last follow-up, the MEPS scores of 22 patients ranged from 72 to 100 (mean, 91.6); the elbow joint function was rated as excellent in 17 sides, good in 7 sides, and fair in 1 side, with an excellent and good rate of 96%. Elbow joint ROM was 98°-140° in flexion (mean, 119.7°), 5°-23° in extension (mean, 13.9°), 70°-90° in anterior rotation (mean, 83.3°), and 63°-90° in posterior rotation (mean, 79.4°). The follow-up time of 17 patients (20 sides) without fracture and joint stiffness before operation was 3.9-126.7 months, with a median time of 53.9 months; at last follow-up, the MEPS score and the elbow joint ROM were significantly better than those before operation (P<0.05). The follow-up time of 5 patients (5 sides) with fracture and joint stiffness before operation was 12.0-124.2 months, with a median time of 40.1 months. At last follow-up, MEPS scores ranged from 89 to 100 (mean, 91.2), and elbow joint ROM restored. Two cases (2 sides) developed ulnar nerve symptoms after operation, and 1 case (1 side) suffered from periprosthetic fracture and periprosthetic infection after revision, and the elbow prosthesis was removed. The prosthesis survival rate was 96%. During follow-up, no prosthesis loosening occurred. ConclusionThe intraoperative visual field exposure of TEA via the olecranon osteotomy approach is sufficient, which can reduce the incidence of complications such as triceps weakness and ulnar nerve injury, effectively improve the function of the elbow joint, and obtain satisfactory effectiveness.
Objective To investigate the difference of total knee arthroplasty (TKA) with tantalum monoblock tibial component (TMT) and cemented tibial plateau prosthesis in patients of different ages. Methods The clinical data of 248 patients (392 knees) who underwent primary TKA between May 2014 and May 2019 and met the selection criteria were retrospectively analyzed. There were 54 males (98 knees) and 194 females (294 knees). Of the 122 patients (183 knees), less than 65 years old, 52 (75 knees, group A1) were treated with TMT and 70 (108 knees, group B1) were treated with cemented tibial plateau prosthesis; of the 126 patients (209 knees), more than 65 years old, 57 (82 knees, group A2) were treated with TMT and 69 (127 knees, group B2) were treated with cemented tibial plateau prosthesis. The baseline data of patients, perioperative indicators [hemoglobin (Hb), hematocrit (Hct), total blood loss, unilateral operation time], effectiveness evaluation indicators [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analogue scale (VAS) score, Knee Society Scoring System (KSS) score, active flexion and extension range of motion (ROM) of the knee joint], complications, and imaging indicators [tibial prosthesis varus angle (β angle), tibial prosthesis posterior slope angle (δ angle), tibio-femoral angle, occurrence of radiolucent line, prosthesis survival rate] were recorded and compared. Results There was no significant difference in gender, age, height, weight, body mass index, Kellgren-Lawrence grading, the length of hospital stay, and follow-up time between groups A1, B1 and groups A2, B2 (P>0.05). The unilateral operation time in groups A1 and A2 was significantly shorter than that in the corresponding groups B1 and B2 (P<0.05). There was no significant difference in differences of pre- and post-operative Hb and Hct and total blood loss between groups A1, B1 and groups A2, B2 (P>0.05). There was no significant difference in preoperative effectiveness evaluation indicators between groups A1, B1 and groups A2, B2 (P>0.05). There were significant differences in the differences of pre- and post-operative WOMAC activity and pain scores, KSS function and pain scores, and VAS scores between groups A1 and B1 (P<0.05); there was no significant difference in WOMAC stiffness score and ROM (P>0.05). There was no significant difference in the above indicators between groups A2 and B2 (P>0.05). There was no significant difference in the incidence of complications (2.7% vs 6.5%, 3.7% vs 3.1%) and prosthesis survival rate (100% vs 97.2%, 100% vs 99.2%) between groups A1, B1 and groups A2, B2 (P>0.05). During follow-up, there was no significant difference in β angle, δ angle, and tibio-femoral angle between groups A1, B1 and groups A2, B2 (P>0.05). In the evaluation of knee X-ray radiolucent line, 2 knees of group A1 and 2 knees of group A2 had radiolucent line at prosthesis-bone interface immediately after operation, and the radiolucent line was gradually filled by new bone, without new radiolucent line. During follow-up, 1 knee of group B1 and 1 knee of group B2 had prosthesis-bone interface radiolucent line, without radiolucent line widening or prosthesis loosening. Conclusion TMT is recommended in patients less than 65 years old, and the two types of prostheses are available for patients nore than 65 years old. However, the long-term effectiveness of the two types of prosthesis in patients of different ages needs further follow-up.