Objective To evaluate the clinical valueof the revision of total hip replacement(THR), to analyse the reason of the rev isions, and to discuss the main difficulties and measures to manage it.Methods From June 1998 to January 2002, 15 cases (15 hips) were revised on totalhip replacement. The reasons for revision in the cases were as follows:failure of primary operative techenique, loosening and sinking of the components, displacement of the prosthesis, erosion of the acetabulum, as well as fracture of the femoral stem. The main difficulties of the revision were:poor health condition of the patients; the remove of the prosthesis of the primary THR,especially the broken femoral stem and the cements; the loss of localbone. The measures to remove the broken femoral stem were described.ResultsAll cases were followed up 2.4 years on average: 2 patients died from heart disease and cerebrovascular disease respectively, while the good results were achieved in the others.No infection, dislocation, loosening, and other complications occurred. The good effects were related with following factors:mild degree of illness; no severe bone defect; most of the first femoral head replacement.Conclusion The revision of THRis a more difficult operation, so that the special instrument and equipment andoperative experience are required.
Objective To investigate the effectiveness of slope-reducing tibial osteotomy and anterior cruciate ligament (ACL) revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased posterior tibial slope (PTS). Methods The clinical data of 9 patients with primary ACL reconstruction failure and abnormally increased PTS (≥17°) who met the selection criteria between January 2018 and January 2020 were retrospectively analyzed. There were 8 males and 1 female; the age ranged from 21 to 42 years, with a median age of 30 years. Lachman test was positive in 9 patients. Pivot-shift test was negative in 6 cases, degree Ⅰ positive in 2 cases, and degree Ⅱ positive in 1 case. The PTS was (17.78±1.09)° and the anterior tibial translation (ATT) was (11.58±1.47) mm. The International Knee Documentation Committee (IKDC) score was 51.0±3.8, Lysholm score was 49.7±4.6, and Tegner score was 3.7±0.7. The time from primary reconstruction to revision was 12-33 months, with an average of 19.6 months. Slope-reducing tibial osteotomy and ACL revision were performed. The improvement of knee function was evaluated by IKDC score, Lysholm score, and Tegner score; Lachman test and Pivot-shift test were used to evaluate the stability of knee joint. PTS and ATT were measured to observe the morphological changes of knee joint. Results All the incisions healed by first intention, and there was no complication such as incision infection, fat liquefaction, necrosis, deep vein thrombosis of lower extremities, and neurovascular injury. All 9 patients were followed up 12-36 months, with an average of 25.8 months. At last follow-up, Lachman test and pivot-shift test were negative. IKDC score was 85.0±4.0, Lysholm score was 87.7±2.8, Tegner score was 6.8±0.7, PTS reduced to (9.89±0.60)°, and ATT shortened to (0.91±0.29) mm, which were significantly improved when compared with those before operation (P<0.05). ConclusionSlope-reducing tibial osteotomy and ACL revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased PTS has a satisfactory short-term effectiveness. It can improve the stability of knee joint and maintain the normal shape of knee joint.
ObjectiveTo summarize the design and the biomechanical characteristics of Sivash-range of motion femoral modular stem (S-ROM) prosthesis and mainly to introduce its clinical use in developmental dysplasia of hip (DDH) and hip revision. MethodsLiterature concerning S-ROM prosthesis was extensively reviewed and analyzed. ResultsThe S-ROM prosthesis based on the modularity feature can reach press-fit in metaphysis and diaphysis of femur concurrently. Additionaly, S-ROM prosthesis can fit for anatomic differences of the DDH femur and is capable of use in correction osteotomy and hip revision. ConclusionModular junctions of S-ROM prosthesis increase the potentials of implant fracture and metallic debris production, so further follow-up study is needed to verify the long-term effectiveness.
ObjectiveTo compare the clinical and radiological effectiveness of oblique lumbar interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) in the treatment of Cage dislodgement after lumbar surgery.MethodsThe clinical data of 40 patients who underwent revision surgery due to Cage dislodgement after lumbar surgery betweem April 2013 and March 2017 were retrospectively analyzed. Among them, 18 patients underwent OLIF (OLIF group) and 22 patients underwent PLIF (PLIF group) for revision. There was no significant difference between the two groups in age, gender, body mass index, intervals between primary surgery and revision surgery, number of primary fused levels, disc spaces of Cage dislodgement, and visual analogue scale (VAS) scores of low back pain and leg pain, Oswestry disability index (ODI), the segmental lordosis (SL) and disc height (DH) of the disc space of Cage dislodgement, and the lumbar lordosis (LL) before revision (P>0.05). The operation time, intraoperative blood loss, hospital stay, and complications of the two groups were recorded and compared. The VAS scores of low back pain and leg pain were evaluated at 3 days, 3, 6, and 12 months after operation, and the ODI scores were evaluated at 3, 6, and 12 months after operation. The SL and DH of the disc space of Cage dislodgement and LL were measured at 12 months after operation and compared with those before operation. CT examination was performed at 12 months after operation, and the fusion of the disc space implanted with new Cage was judged by Bridwell grading standard.ResultsThe intraoperative blood loss in the OLIF group was significantly less than that in the PLIF group (t=−12.425, P=0.000); there was no significant difference between the two groups in the operation time and hospital stay (P>0.05). Both groups were followed up 12-30 months, with an average of 18 months. In the OLIF group, 2 patients (11.1%) had thigh numbness and 1 patient (5.6%) had hip flexor weakness after operation; 2 patients (9.1%) in the PLIF group had intraoperative dural sac tear. The other patients’ incisions healed by first intention without early postoperative complications. There was no significant difference in the incidence of complications between the two groups (χ2=0.519, P=0.642). The VAS scores of low back pain and leg pain, and the ODI score of the two groups at each time point after operation were significantly improved when compared with those before operation (P<0.05); there was no significant difference between the two groups at each time point after operation (P>0.05). At 12 months after operation, SL, LL, and DH in the two groups were significantly increased when compared with preoperative ones (P<0.05); SL and DH in the OLIF group were significantly improved when compared with those in the PLIF group (P<0.05), and there was no significant difference in LL between the two groups (P>0.05). CT examination at 12 months after operation showed that all the operated disc spaces achieved bony fusion. According to the Bridwell grading standard, 12 cases were grade Ⅰ and 6 cases were grade Ⅱ in the OLIF group, and 13 cases were grade Ⅰ and 9 cases were grade Ⅱ in the PLIF group; there was no significant difference between the two groups (Z=–0.486, P=0.627). During follow-up, neither re-displacement or sinking of Cage, nor loosening or fracture of internal fixation occurred.ConclusionOLIF and PLIF can achieve similar effectiveness in the treatment of Cage dislodgement after lumbar surgery. OLIF can further reduce intraoperative blood loss and restore the SL and DH of the disc space of Cage dislodgement better.
Objective To evaluate the medium-term results of uncemented acetabular revision with impacted deep frozen morsell ized allografts. Methods From April 1995 to December 2001, 58 cases (62 hips) were performed acetabularrevision by use of deep frozen morsel ized allograft firmly impacted into local ized defects as well as the entire acetabular cavity, followed by insertion of a uncemented cup with supplementary screw fixation. There were 32 males (34 hips) and 26 females (28 hips), with age of (49.6 ± 15.4) years old. Among 62 hips, 32 hips involved in left side and 30 hips involved in right side. The cause of revision was aseptic loosening of the cup in 56 hips, septic loosening of the cup in 3 hips, and polyethylene l iner dislodging with severe acetabular osteolysis in 3 hips. The average interval between the primary total hip arthroplasty and the revision was (10.1 ± 3.9) years. According to the American Academy of Orthopaedic Surgeons classification, 42 hips belonged to type II and 20 hi ps to type III acetabular defects. The cl inical and radiographic results were analyzed postoperatively. Results All wounds healed by first intention. No deep venous thrombosis and infection occurred postoperatively. All patients were followed up 6-13 years (average 8.1 years). The Harris score was improved from 61.1 ± 10.2 preoperatively to 92.0 ± 7.3 postoperatively, showing significant difference between preoperation and postoperation (P lt; 0.05). The results were excellent in 46 hips, good in 10 hips, fair in 4 hips, and poor in 2 hips, the excellent and good rate was 90.3%. The time for allograft incorporation was (12.5 ± 4.4) months after operation. The annual polyethylene l iner wear rate was (0.13 ± 0.09) mm. Linear and cavitary osteolysis was observed in 2 and 12 hips, respectively. Heterotopic ossification developed in 7 hi ps (11.3%); 3 hi ps were rated as grade I, 3 as grade II, and 1 as grade III according to Brooker classification. One cup underwent revision for asepticloosening and 2 were defined as radiographic failures. Kaplan-Meier survival rate of the cup was 94.2% ± 3.3% at 8 years after operation. Conclusion The combination of uncemented cup component with deep frozen morsel ized allografts seems to be a rel iable solution for restoring bone stock, relocating the hip center, and stabil izing the cup in acetabular revision, and provides favorable medium-term cl inical and radiographic results.
ObjectiveTo investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma.MethodsBetween 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia (stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively.ResultsAll patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively. Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society (MSTS) score was 26, 27, and 25, respectively.ConclusionThe proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.
From 1974 to 1991, two hundred and sixty-four cases of hip replacement were performed. These cases composed of 150 cases of artificial femoral head prosthesis replacement and 114 cases of total hip replacement. Fifteen cases were revised after the first replacement in 7.4 years average (5-16 years). The revision rate was 5.7%. The causes of revision were loose or subside of prosthesis, wear and tear of acetabulum, dislocation of artificial hip joint, etc, which caused pain and dysfunction. The revision cases were followed up for 4.7 years average with good result. To prevent revision, The medully canal shonld not be too wide and in osteoporosis cases, bone cement was suggested to apply. The chondrium of acetabulum should be removed completely.
Objective To evaluate the strength of polyethylene l inercement interface when cementing a new linerinto a fixed acetabular cup in revision. Methods Twenty-five pairs of metal acetabular cups with polyethylene l iners were randomly divided into 5 groups: 1 group with standard locking device as control group (group A), other l iners were cemented into acetabular cups as 4 experimental groups. According to different intersection angles of metal acetabular cups with polyethylene liners and the polyethylene l iners with or without metal ball, the 4 experimental groups were no ball 0° group (group B), 0° group (group C), 10° group (group D), and 20° group (group E), metal acetabular cups intersected with polyethylene liners without metal ball in group B, with metal ball in groups C, D, and E, respectively. The lever-out biomechanical test reproduced in vivo failure mechanism was then performed to evaluate the lever-out failure strength of l iner-cement-metalcup interface. Results The values of l iver-out failure force were (626.68 ± 206.12), (915.04 ± 197.49), (449.02 ± 119.78),(814.68 ± 53.89), and (1 033.05 ± 226.44) N in groups A, B, C, D, and E, respectively, showing significant differences forcomparison among groups (F=8.989，P=0.000). The values of l iver-out failure force in groups B and E were significantlyhigher than that in group A (P lt; 0.05), but no significant difference was found between groups C, D and group A (P gt; 0.05).Conclusion Cementation of polyethylene l iner into a malposition shell meeting within 20° can provide enough fixed strength.
Objective To investigate the effectiveness of acetabular revision using jumbo cementless cups. Methods Between May 1996 and May 2011, 35 patients (35 hips) underwent an acetabular revision with jumbo cementless cups, and the clinical data were retrospectively analyzed. There were 12 males and 23 females, with an average age of 64.8 years (range, 47-79 years). The time from hip arthroplaty to revision was 1-15 years (mean, 9.7 years). The causes for revision were aseptic loosening in 32 cases, femoral periprosthetic fracture (Vancouver type B3) in 2 cases, and low toxicity infection in 1 case. According to the classification of acetabular bony deficiencies of the American Association of Orthopedic Surgeon (AAOS), 6 cases were classified as type I, 9 cases as type II, and 20 cases as type III; according to the classification proposed by Paprosky, 5 cases were rated as type II A, 9 cases as type II B, 13 cases as type II C, and 8 cases as type III A. The primary hip arthroplasty cups had an outside diameter of 46-52 mm (mean, 49.6 mm), and the revision cups had an outside diameter of 56-68 mm (mean, 60.4 mm). Harris score was used for hip function evaluation, and X-ray films were taken for imaging evaluation. Results Healing of incision by first intention was obtained in all patients; without infection or neurovascular injury. Prosthetic dislocation was observed in 1 case at 20 days after operation, and was cured after expectant treatment. One patient died at 6 years after operation, and the other 34 patients were followed up 2-14 years (mean, 8.4 years). The Harris score was significantly increased from 46.4 ± 13.4 at preoperation to 90.4 ± 3.6 at last follow-up (t=18.76, P=0.00). The distance between acetabular rotation centre and teardrop line was significantly decreased, and the distance between acetabular rotation centre and lateral teardrop was significantly increased when compared with preoperative ones (P lt; 0.05). Only 1 patient received second revision for aseptic loosening after 10 years; no continuous radiolucent line, prosthetic dislocation, and osteolysis was found, and bony ingrowth was shown in the other patients. Conclusion Jumbo cementless cup for acetabular revision can achieve good effectiveness for having the advantages of simple operation, less bone grafts, and good recovery of the acetabular rotation centre.