Objective To systematically evaluate the difference in leg length discrepancy (LLD) between robot-assisted total hip arthroplasty (THA) and traditional THA. Methods The Cochrane Library, PubMed, Web of Science, EMbase, CNKI, Wanfang, VIP, and CBM databases were searched by computer to collect cohort studies of robot-assisted and traditional THAs from inception to August 11th, 2021. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 high-quality cohort studies were included. The results of Meta-analysis showed that compared with traditional THA, LLD after robot-assisted THA was smaller [MD=−1.64, 95%CI (−2.25, −1.04), P<0.001], Harris scores at 3 and 12 months after operation were higher [MD=1.50, 95%CI (0.44, 2.57), P=0.006; MD=7.60, 95%CI (2.51, 12.68), P=0.003]. However, the operative time was longer [MD=8.36, 95%CI (4.56, 12.17), P<0.000 1], and the postoperative acetabular anteversion angle was larger [MD=1.91, 95%CI (1.43, 2.40), P<0.001]. There was no significant difference in Harris score at 6 months, amnesia index (Forgotten joint score, FJS), postoperative acetabular abduction angle, and incidence of complication between the two groups (P>0.05). Conclusion Robot-assisted THA is superior to traditional THA in postoperative LLD.
ObjectiveTo evaluate the accuracy of using smartphone to measure the angle of acetabular component in total hip arthroplasty (THA). MethodsBetween June 2012 and September 2015, the acetabular abduction and anteversion angles were measured in 50 patients undergoing THA. There were 24 males and 26 females, aged 37 to 83 years (mean, 71 years). The left hip was involved in 22 cases and the right hip in 28 cases. Of 50 patients, 34 suffered from fracture of the femoral neck, and 16 suffered from avascular necrosis of the femoral head. Acetabular dysplasia was excluded in all cases. A smartphone was used to measure the acetabular abduction and anteversion angles during operation; standard Picture Archiving and Communication Systems (PACS) was used to measured the acetabular abduction and anteversion angles on the X-ray film at 1 week after operation. It was defined as positive that the component angle values by PACS measurement were greater than those by the smartphone measurement, whereas as negative. The two measurement methods were compared, and intra-observer variability was assessed by analyzing the intraclass correlation coefficient (ICC), the Mann-Whitney U-test was used to analyze difference. ResultsThe ICC was 0.84 in the acetabular component angles by smartphone and PACS measurement methods. The acetabular component abduction angle was (44.02±1.33)° and the anteversion angle was (17.62±2.20)° by smartphone measurement. The acetabular component abduction angle was (44.74±4.05)° and the anteversion angle was (17.22±5.57)° by PACS measurement. There was no significant difference between two measurement methods (Z=-1.977, P=0.482; Z=-0.368, P=0.713). The acetabular component angle was in the safe zone in 44 cases; and the acetabular component anteversion angle was beyond safe range of 1 to 5°, and the abduction angle was beyond safe range of 1 to 3° in 6 cases. Intra-measurement variability was -21 to +10° for the anteversion angle and -10 to + 9° for the abduction angle, indicating that the acetabular component anteversion angle by smartphone measurement was greater than that by the PACS measurement, and the abduction angle was less than that by PACS measurement. ConclusionSmartphone is a convenient tool to measure the acetabular component angle in THA.
ObjectiveTo explore the clinical outcomes of acetabular revision using a metal reconstruction cage. MethodsBetween October 2006 and October 2013, 16 patients (16 hips) underwent acetabular revision with a metal reconstruction cage. There were 4 males and 12 females, with the mean age of 62.7 years (range, 49-78 years). The time from total hip arthroplasty to revision was 3-15 years (mean, 8.2 years). The causes for revision were aseptic acetabular loosening in 15 cases, and femoral periprosthetic fracture (Vancouver type B3) in 1 case. According to the American Academy of Orthopaedic Surgeons (AAOS) classification, there were 12 cases of type III and 4 cases of type IV; according to the Paprosky classification, there were 12 cases of type IIIA and 4 cases of type IIIB. Harris score was used for hip function evaluation, and visual analogue scale (VAS) for pain in the thigh. X-ray films were taken for imaging evaluation. ResultsHealing of incision by first intention was obtained in all patients. Deep venous thrombosis occurred in 1 patient, and was cured after anticoagulation therapy. No complications of infection, neurovascular injury, and prosthetic dislocation were found. Sixteen patients were followed up 6.8 years on average (range, 2-9 years). The Harris score was significantly increased from preoperative 42.44±4.66 to 91.88±3.28 at last follow-up (t=–106.30, P=0.00). Two patients had mild pain in the thigh, but pain disappeared at 1 year after operation. At immediate after operation, the abduction angle was 37-54° (mean, 42.9°). The distance between acetabular rotation centre and teardrop line was (33.67±12.19) mm for preoperative value and was (20.67±9.63) mm for postoperative value, showing significant difference (t=–9.60, P=0.00). The distance between acetabular rotation centre and lateral teardrop was (34.98±12.30) mm for preoperative value and was (40.04±6.61) mm for postoperative value, showing significant difference (t=–3.15, P=0.00). X-ray film results showed bony fusion at the osteotomy sites at 4 to 12 months after operation. No continuous radiolucent line, prosthetic dislocation, or osteolysis was found, and bony ingrowth was observed in all patients. No patient received re-revision due to prosthetic loosening. ConclusionThe metal reconstruction cage for acetabular revision can achieve good effectiveness for patients with serious bone defect.
Objective To study the effect of simultaneous bilateral total hip arthroplasty in a single procedure. Methods From October 1999 to March 2004, 15 patients (30 hips) underwent simultaneous sequential bilateral total hip arthroplasty (THAs) in a single procedure. Of the 15 patients, 11 were male (22 hips) and 4 were female (8 hips). Their ages ranged from 35 to 70 years. Their courses of disease ranged from 1 year to 50 years (4.8 years on average). The Harris scores of the joint function before the operation ranged from 12 to 45 points (27 points on average). Five were done with Smith-Peterson and 10 were done with Moore. Results The operative time was 3 hours and 25 minutes to 5 hours (4 hours and 10 minutes on average). The volume of blood transfusion during operation was 400 to 2 400 ml (1 160 mlon average). All the 15 patients were followed up for 3 to 35 months (18 monthson average). The Harris scores of the joint function after the operation rangedfrom 70 to 100 points (86 points on average). There was significant difference in the scores between before and after operations (Plt;0.05). There was only 1death within 1 months of the operation and no serious between complications such as infection, pulmonary embolism, and deep vein plug. All the patients were still ambulant in the community and gained significant pain relief. Conclusion Simultaneous bilateral total hip arthroplasty in a single procedure is a safe and effective method. However, the decision of performing singlestage bilateral total hip arthroplasty should be carefully made and preoperative preparation should be sufficiently made.
Objective To investigate the impact of joint capsule repair and external rotators suture on the prognosis in primary total hip arthroplasty (THA) by posterolateral approach. Methods Between January 2006 and June 2009, 159 patients with femoral neck fracture underwent primary THA by posterolateral approach, and were divided into 4 groups according to different treatments: joint capsule repair and external rotators suture were given in group A (n=38), only joint capsule repair in group B (n=39), only external rotators suture in group C (n=41), and no joint capsule repair or external rotators suture in group D (n=41). There was no significant difference in gender, age, cause of injure, disease duration, type of fracture, combined medical disease, or prosthesis selection among 4 groups (P gt; 0.05). The bleeding volume, drainage, postoperative hip dislocation rate, hip Harris score, and the hip range of motion (ROM) in internal rotation and external rotation were compared. Results There was no significant difference in operative time, bleeding volume, or drainage among 4 groups (P gt; 0.05). Postoperative hip dislocation occurred in 0, 0, 4 (9.8%), and 4 (9.8%) cases of groups A, B, C, and D, respectively, showing significant difference in incidence of postoperative hip dislocation among 4 groups (χ2=7.910, P=0.048). The hip Harris scores were significantly improved after operation when compared with preoperative scores in 4 groups (P lt; 0.05). Significant differences were found in hip Harris score at 6 weeks and 6 months after operation among 4 groups (P lt; 0.05); group D was significantly lower than groups A, B, and C, and groups B and C were significantly lower than group A (P lt; 0.05). There was no significant difference in the hip ROM in internal rotation among 4 groups at 6 weeks and 6, 12 months after operation (P gt; 0.05); but the hip ROM in external rotation were significantly bigger in groups A and C than in groups B and D at 6 weeks and 6 months after operation (P lt; 0.05). Conclusion Joint capsule repair and external rotators suture in primary THA by posterolateral approach do not increase the bleeding volume and drainage, but can reduce the early postoperative hip dislocation risk, increase the Harris score, and recover the external rotation function of involved hip. So joint capsule and external rotators should be repaired in THA by posterolateral approach.
Objective To explore the treatment of dislocation after total hip replacement. Methods From July 1997 to October 2004, 23 casesof dislocation after total hip replacement were treated,including 9 males and 14 females and aging 5379 years. The CT and serial X-ray films were taken to observe the position of prostheses. The strength of their hip abductor was also tested. In the patients without loosening, closed reduction was attempted at first. The stability of hip was tested. If closed reduction failed, the offset or/and parts of the components was adjusted, then the capsular was repaired. If instabilitystill existed, revision was adopted. Results In 23 cases of dislocation, 10 cases were treated successfully by closed reduction. In 12 patients who failed reduction, 5 were given open reduction combined with capsular repairing; the offset was adjusted by lengthening femoral head in 2 cases; rim liners were elevated in 2 cases; and larger offset was used and abnormal liner was adjusted in 1 case. Revision was used in 1 case having loosening and 2 cases having instability. Allpatients were followed up 1 year to 5 years (1.9 years on average). The Harrisscoring was 7294 (87 on average). Conclusion The treatment of dislocation after total hip replacement should use different ways according to the causes of dislocation and the stability of hip.
Objective To evaluate the effectiveness of the shared decision-making scheme in postoperative out-of-hospital extended care for patients with total hip/knee arthroplasty (THA/TKA). Methods Patients who underwent THA/TKA in the Department of Orthopedic Surgery at West China Hospital of Sichuan University between October 2023 and April 2024 were included using convenience sampling. Patients were divided into the control group (odd-numbered dates) and the intervention group (even-numbered dates) based on the surgical dates. The intervention group was received care guided by a shared decision-making protocol, whereas the control group was followed the standard post-arthroplasty follow-up procedures. Differences between the two groups were compared in terms of decision-making capacity, decision satisfaction, and hip/knee function at the following time points: on the day of discharge, 3 weeks after discharge, 2 months after discharge, and 3 months after discharge. Results A total of 118 patients were included, with 59 cases in each group. There were no significant differences in demographic and clinical characteristics between the two groups (P>0.05). In terms of decision-making, compared with the control group, the experimental group had stronger decision-making ability, lower decision-making conflict, and more satisfaction with the decision-making process (P<0.05). In terms of joint function, the experimental group showed better joint function than the control group at 3 weeks, 2 months, and 3 months after surgery (P<0.05). There was no significant difference in the pain dimension of the Western Ontario and McMaster Universities Osteoarthritis index between the two groups (P=0.199). Conclusions Compared with the traditional follow-up protocol, the shared decision-making protocol can enhance patient engagement in medical decision-making, reduce decisional conflict, improve satisfaction with the decision-making process, and simultaneously promote joint functional recovery and expedite the rehabilitation process.
Objective To improve the accuracy of the acetabular component placement using the nonimage based surgical navigation system. Methods Twenty-three patients (14 males, 9 females; age, 28-55 years;26 hips）with hip disease underwent the total hip arthroplasty (THA) using the nonimage based surgicalnavigation system from February 2004 to April 2006. Rheumatoid arthritis was found in 3 patients (3 hips), necrosis of the femoral head in 6 patients (6 hips), and osteoarthritis in 14 patients (16 hips). All the patients were randomly divided into the following 2 groups: the navigated group (11 patients, 13 hips), treated by THA using the nonimage based surgical navigation system; and the control group (12 patients, 13 hips), treated by the traditional THA. According to thedesign of the study, the acetabular component was placed in the best inclination angle (45°) and the anteversion angle (15°). The postoperative component position was examined. Results No fracture, dislocation, infection or injury to the sciatic nerve was found. In the navigated group, the inclination and the anteversion reached 15.4±1.4° and 45.5±1.3°, respectively. In the control group,the inclination and the anteversion were 13.9±7.6° and 43.7±6.4°, respectively. The inclination difference was considered statistically significant (Plt;0.01). All the patients were followed up for 10-40 months,averaged 26 months. In the navigated group, the postoperative average Harris hip score was 95 (range,85-110), with an excellent result in 11 hips and a good result in 2 hips. In the control group, the postoperative average Harris hip score was 92 (range,75-110), with an excellent result in 9 hips, a good result in 3 hips, and a fair result in 1 hip. The Harris hip score difference was considered statistically significant (Plt;0.05). There was a significantly better result obtained in the navigated group than in the control group. Conclusion The acetabular component can be implanted accurately by the nonimage based surgical navigation system, which can reduce the incidence of the loosening of the prostheses and has an important value in clinical practice.
Objective To investigate the operative methods, cl inical outcomes and compl ications of total hi p arthroplasty (THA) in the treatment of patient with hi p joint flexion rigidity due to ankylosing spondyl itis (AS). Methods From May 1992 to July 2004, 56 patients (32 left hips and 39 right hips) with AS received THA through a modified anterolateral approach, including 52 males (67 hips) and 4 females (4 hips) aged 17-48 years with an average of 35.5 years. All the hips were ankylosed in (43.1 ± 7.2)° of flexion and 15 patients had bilaterally ankylosed hips. Preoperatively, Harris hip score was (42.6 ± 5.3) points and all the hips were classified as stage IV according to the standard of American College of Rheumatology (ACR). And the course of disease was 3-11 years. Results Intraoperatively, 1 patient suffering from proximal femur fracture due to severe osteoporosis was treated with titanium wire fixation, and the fracture was healed 6 weeks later. All the patients were followed up for 3-15 years (average 5.3 years). Postoperatively, 1 patient (1 hip) got subcutaneous soft tissue infection at 8 days, 1 patient (1 hip) got wound disunion at 11 days, 2 patients (2 hips) got infection at 11 months and 3 years, respectively. All the infections were healed after symptomatic treatment. The wounds of the rest 52 patients were healed by first intention without joint infections. The postoperative X-rays demonstrated that 4 hips (5.6%) had loose acetabulum prosthesis, 3 hips (4.2%) had loose femoral prosthesis and 5 hips had loose acetabulum and femoral prosthesis (7.0%), and the total loosening rate was 16.8%. Among which, 8 hips received revision resulting in satisfactory therapeutic effects, and the rest 4 hips had no further treatment. Fifteen hips (21.1%) had heterotopic ossification, which was rel ieved after taking nonsteroidal anti-inflamatory drugs. Harris hip score at final follow-up was (82.7 ± 4.1) points, indicating there was a significant difference between before and after operation (P lt; 0.05). Ten hips were evaluated as excellent, 43 hips good, 14 hips fare, and 4 hips bad, and the excellent and good rate was 74.7%. Conclusion THA through the anterolateral approach is effective for the treatment of patient with hip joint flexion rigidity caused by AS.