Objective To investigate the effect of femoral offset reconstruction on pelvic stabil ity during gait after total hip arthroplasty. Methods According to the inclusion criteria, 29 patients undergoing unilateral total hip arthroplasty between January 2000 and December 2005 were selected. There were 10 males and 19 females with an average age of 64.3 years (range, 33-75 years). The affected hips included 15 left hips and 14 right hips. The follow-up time was from 5 to 10 years (mean, 7.7 years). The Harris score was 90 to 100 (mean, 97) at last follow-up. The femoral offset ratio (FOR) was calculated by measuring the femoral offset of the bilateral hips on radiograph, and then the patients were divided into 2 groups: group A (the femoral offset of diseased hip was less than that of normal hip, n=10) and group B (the femoral offset of diseased hip was greater than that of normal hip, n=19). The pelvis kinematic variables were measured by three-dimensional gait analysis to collect the magnitude of pelvic obl ique angle (POA). Results In group A, the FOR was 0.81 ± 0.08 and the POA was (—0.42 ± 0.91)°. In group B, the FOR was 1.27 ± 0.15 and the POA was (1.02 ± 0.94)°. For the normal hip, the POA was (1.15 ± 0.85)°. The POA was significantly less in group A than in group B and the normal l imb (P lt; 0.05). The difference in POA had no significance between group B and the normal hip (P gt; 0.05). The POA was positive relative with FOR (r=0.534, P=0.003), and the regression equation was y= — 2.551+ 2.781x. Conclusion The femoral offset reconstruction is crucial to improve hip abductor function and gait.
Objective To summarize the strategies and treatment methods in correcting the maltracking of patellofemoral joints in the total knee arthroplasty (TKA). Methods From January 2000 to May 2007, the methods of releasing lateral retinaculum and tightening medial retinaculum of patellar, adjusting the position of the tibial prothesis properly and shifting the lateral 1/2 insertion inward to the medial side of patellar tendon, and reconstructing the patellar tendon insertion were used in correcting the maltracking of patellofemoral joints when the TKA was conducted for 49 knee joints of 48 cases. All thecases were females, aged 53-76 years old (66.8 on average). The course of disease was 6-23 years (16.2 years on average). Among all the cases, 37 with 38 knee joints were osteoarthritis, and 11 with 11 knee joints were arthritis pauperum. Different degrees of genu valgum and external rotation of knee joints were found in all cases. The genu valgum angle was 23-42° with an average of 33°. The Q angle was 16-23° with an average of 19°. Flexion deformity of knee joints with 8-35° (22° on average) was found in 23 cases. The preoperative KSS knee joint score was 21-51 points (32 points on average), and the function score was 29-45 points (33 points on average). Results All incisions obtained heal ing by first intension. All the patients were followed up for 7-82 months (52 months on average). Genu valgum deformity of knee joints was corrected in all cases. Residual flexion deformity with 5° of knee joints was found in 3 cases. The running track of patellofemoral joints returned to normal in all cases. Laceration or fragmentation was not found in reconstructed patellar l igaments. The postoperative KSS knee joint score was 76-89 points (82 points on average), and the function score was 81-90 points (85 points on average). The X-ray films from the very beginning of post-operation to the end of follow-up showed the prosthesis was normal. Conclusion In correcting the maltracking of patellofemoral joints in TKA, releasing lateral retinaculum and tightening medial retinaculum of patellar, adjusting the position of the tibial prothesis properly, shifting the lateral 1/2 insertion inward to the medial side of patellar tendon and reconstructing the patellar tendon insertion were efficient methods, without any adverse effect on the early rehabilitation training of knee joins.
ObjectiveTo evaluate the middle- and long-term effectiveness of primary total hip arthroplasty (THA) in patients with chronic autoimmune inflammatory diseases. MethodsBetween January 1990 and June 2006, 42 patients (51 hips) with chronic autoimmune inflammatory diseases underwent THA. There were 15 males (18 hips) and 27 females (33 hips) with an average age of 36.9 years (range, 22-70 years). The locations were the left side in 29 hips and the right side in 22 hips. Of 42 cases, there were 11 cases of systemic lupus erythematosus (13 hips), 16 cases of rheumatoid arthritis (22 hips), and 15 cases of ankylosing spondylitis (16 hips). The causes of THA included avascular necrosis of the femoral head in 26 cases (34 hips), ankylosis of the hip in 15 cases (16 hips), and fracture of the femoral neck in 1 case (1 hip). The Harris score was 32.49 ± 9.50. The physical component summary (PCS) and mental component summary (MCS) of short form 36 health survey scale (SF-36) scores were 25.53 ± 4.46 and 42.28 ± 6.27, respectively. ResultsAll incisions healed primarily. All 42 patients were followed up 5-21 years (mean, 9.1 years). At last follow-up, the Harris score was 89.25 ± 8.47; PCS and MCS of the SF-36 were 51.35 ± 4.28 and 55.29 ± 8.31, respectively; and significant differences in the scores were found between pre- and post-operation (P lt; 0.05). Complications included limp (4 cases), prosthesis dislocation (2 cases, 2 hips), periprosthetic fracture (1 case, 1 hip), aseptic loosening (2 cases, 2 hips), and ectopic ossification (3 cases, 3 hips). ConclusionTHA seems to be a good choice for patients with chronic autoimmune inflammatory diseases.