【Abstract】 Objective To explore the flexibil ity and rel iabil ity of cementless total knee arthroplasty (TKA) without patellareplacement through a retrospective study of the mid-term therapeutic effect of the treatment of the patients. Methods FromJune 1997 to March 2000, a consecutive series of 152 (152 knees) cementless TKA performed in Hessing-Stiftung was studied. Among them, there were 63 males and 89 females, with 70 left knees and 82 right knees. Their ages ranged from 51 years to 72 years, with an average of 59 years. There were 146 cases of osteoarthritis and 6 cases of traumatic arthritis. The course of the disease lasted for 1.0 years to 3.5 years. The EFK prostheses of German Plus company were used in all the cases. The HSS score before the operation was 41.5 ± 12.3, and the average range of motion was 55º (ranging from 30º to 90º). Results Five patients underwent anterior knee pain, and the pain was released after the appropriate treatment. No deep infection happened in all cases. A total of 145 patients (145 knees) were followed up for 5 years to 8 years. The HSS score was 87.5 ± 8.2 at the end of the follow-up, showing significant difference (P lt; 0.05). The average range of motion was 95º (ranging from 90º to 110º). Partial radiolucencies occurred at the tibia side in 18knees 3 to 6 months after the operation. Among them, the width was less than 2 mm in 15 knees without symptom, and more than 2 mm in 3 knees. There were 2 of the 3 knees which were revised at the tibia side because of the aseptic loosing, while 1 patient had only mild pain in the knee during the follow-up, with no sign of loosing. Conclusion The mid-term effect of cementless TKA is satisfactory. The ingrowth of femur and tibial bones is rel iable. The early stage migration of the component is the main reason of loosing. Satisfying outcomes can also be achieved without patella replacement during TKA.
Objective Use the method of Cochrane systematic review to evaluate the difference of two fixation methods of femoral component in hip arthroplasty in order to choose the most appropriate fixation method. Methods Searches was applied to the following electronic databases: Chinese Bimedical Database (CBM) (1979 to Dec. 2004), MEDLINE (1966 to Feb. 2005), EMBASE (1984 to 2004) and The Cochrane Library (Issue 4, 2004). We handsearched Chinese Journal of Orthopaedy, the Journal of Bone and Joint Injury and Orthopaedic Journal of China (from establishment to Feb. 2005). Randomized controlled trials (RCT) were indentified and we applied RevMan 4.2 for statistical analysis. Results Nine RCTs involving 1 075 hips were included. The combined results of meta-analysis showed that the embolization occurred more commonly in the first and second generation cemented group (OR 0.02, 95%CI 0 to 0.11, P＜0.000 01), but this difference was not seen between the third generation cemented group and uncemented group (OR 0.80, 95%CI 0.36 to 1.78, P=0.58); The subsidence of femoral component (OR 12.20, 95%CI 3.58 to 41.54, P＜0.000 1) and the cortical hypertrophy (OR 69.97, 95%CI 27.88 to 175.57, P＜0.000 01) were more commonly found in uncemented group; the thigh pain occurrence, the revision for the femoral component’s cause and heterotopic ossification were found no significant difference in the two groups. Conclusions Compared with noncemented group, we found that cemented fixation may be more associated with embolism in the first and second generation cemented technique and less with femoral subsidence and cortical hypertrophy. There was no significant difference in embolization between the third generation cemented technique group and noncemented group. However, more randomized controlled trials to evaluate the occurrence of the postoperative thigh pain, revision and heterotopic ossification are needed.
Objective To explore the cause of haematoma after the cemented total hip arthroplasty (THA) and find out the way to decrease the incidence of haematoma perioperatively. Methods From March 2000 to October 2006, 103 patientswere treated with the cemented THA. Among the patients, 44 were males and 59 were females with their ages ranging from 36 to 89 years, averaged 55.3 years.The femoral neck fracture (Garden 4) was found in 49 patients, avascular necrosis of the femoral head (Ficat 4) in 26, and osteoarthritis of the hip joint (Tonnis 3) in 28. Their illness course ranged from 1 day to 8 years. The average Harris score preoperatively was 36 (range, 1948). The patients were divided into Group A (n=43) and Group B (n=60). The patients in Group A underwent the conventional surgical operations from March 2000 to December 2003; the patients in Group Bunderwent the same surgical procedures combined with additional procedures (e.g., ligation of the external rotators before incision, use of plastic bandage after the drainage tube was pulled out, prolonged stay period in bed postoperatively) from January 2004 to October 2006. Results In Group A, postoperative haematoma occurred in 9 patients and the averaged 317.8±75.3 ml(range,110-410 ml) of the accumulated blood was drained with a syringe. An average amount for the firstdrainage of the accumulated blood was 86.7±30.7 ml(range, 50-125 ml)， and an average drainage time was 4.2(range, 2-7). In Group B, postoperative haematoma occurred in 2 patients, with an amount of 110 ml and 160 ml of the accumulated blood and an amount of 40 ml and 60 ml of the drained blood at thefirst drainage. There was statistical difference in the amount of heamotoma between two groups(P＜0.05). The followup of 91 patients (39 in Group A, 52 in Group B) for 1.2-5.5 years (average, 3.7 years) revealed that the Harris scores were 78 in Group A and 85 in Group B on average.The Harris score for pain was 44 (Grade A) in 16 patients, 40 (Grade B) in 24 patients, and 30 (Grade C) in 3 patients in Group A; Grade A in 48 patients,Grade B in 12 patients, and Grade C in none of the patients in Group B. There was no statistical difference in Harris score between the two groups (P＞0.05). Conclusion Additional surgical procedures for the cemented THA, such as ligation of the external rotators before incision, use of plastic bandage afterthe drainage tube is pulled out, and prolonged stay in bed postoperatively, can greatly help to reduce the incidence of postoperative haematoma and the amount of the accumulated blood.
Objective To summarize the clinical outcome of the Ribbed anatomic cementless total hip arthroplasty (THA) in the treatment of hip-joint disease. Methods From January 2001 to June 2005, 34 patients(38 hips) with hip-joint disease were treated with Ribbed anatomic cementless THA. Their ages ranged from 29 to 55 years with an average age of 42.7 years.The disease course was from 3 to 18 years. Among these cases, there were 7 cases (7 hips) of femoral neck fracture, 5 cases(5 hips) of traumatic arthritis after fracture of acetabulum, 15 cases(16 hips) of necrosis of the femoral head and 7 cases(10 hips) of ankylosing spondylitis. Four patients were operated on both hip joints. The average Harris hip score was 38.6(25-57) before operation. Results Twenty-one patients(23 hips) were followed up 861 months with an average of 35 months. The Harris hip score was 76-98 after operation with an average of 92.3, showing significant difference when compared with that before operation(Plt;0.05). The excellent and good result was achieved in 93.5 % of patients. Radiographs showed no prosthetic osteolysis and no evidence of loosening. Pain in the thigh occurred in 4 patients,and it can be relieved by using nonsteroid antiinflammatory drug. Conclusion Ribbed anatomic cementless THA has good clinical and radiographic results in treating patients with hip-joint disease.
ObjectiveTo investigate the current problems and corresponding solutions regarding the use of antibiotic-impregnated cement spacer for the treatment of periprosthetic joint infection (PJI). MethodsA retrospective analysis was made on the clinical data of 27 patients with PJI who underwent two-stage revision with antibiotic-impregnated cement spacer between January 2001 and January 2013. There were 12 males and 15 females, with an average age of 62.7 years (range, 25-81 years). All arthroplasties were unilateral, including 19 hip PJI and 8 knee PJI. The mean duration from primary arthroplasty to PJI was 25 months (range, 3-252 months). After infection was controlled with the antibiotic-impregnated cement spacer combined with systematic antibiotics treatment, two-stage revision was performed. The effectiveness was evaluated. ResultsOne patient died of myocardial infarction at 2 days after surgery. Infection was controlled, and two-stage revision was successfully performed in 19 patients; deep venous thrombosis occurred in 1 of 3 patients who experienced hip spacer fractures, which was cured after conservative management. The spacers were removed and bacteria-sensitive antibiotics was used because of recurrent infections after the first-stage surgery in 7 patients; 3 patients gave up treatment because infection was not controlled, 4 patients received revision after infection was controlled. Twenty-three patients were followed up 1-5 years (mean, 2.3 years). The average Harris hip score and KSS score at 1 years after revision were significantly improved when compared with preoperative ones (P<0.05). In the 8 patients with gram-negative or fungus infection, 7 were found to have recurrent infection after the first-stage surgery; in the 12 patients with gram-positive infection, no recurrent infection was found. Failed treatment was observed in 1 patient with gram-positive and gram-negative infections and 2 with fungus infection, respectively. ConclusionAntibiotic-impregnated cement spacer has a satisfactory effectiveness for PJI. However, complication of spacer fracture should be noted, especially hip spacers. If the pathogen is gram-negative bacteria or fungus, the implanted spacer may increase the possibility of recurrent infection.
ObjectiveTo investigate the risk factors of cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). MethodsBetween March 2011 and March 2012, 98 patients with single level OVCF were treated by PVP, and the cl inical data were analyzed retrospectively. There were 13 males and 85 females, with a mean age of 77.2 years (range, 54-95 years). The mean disease duration was 43 days (range, 15-120 days), and the mean T score of bone mineral density (BMD) was-3.8 (range, -6.7--2.5). Bilateral transpedicular approach was used in all the patients. The patients were divided into cement leakage group and no cement leakage group by occurrence of cement leakage based on postoperative CT. Single factor analysis was used to analyze the difference between 2 groups in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, preoperative vertebral body wall incompetence, cement volume, and volume ratio of intravertebral bone cement to vertebral body. All relevant factors were introduced to logistic regression analysis to analyze the risk factors of cement leakage. ResultsAll procedures were performed successfully. The mean operation time was 40 minutes (range, 30-50 minutes), and the mean volume ratio of intravertebral bone cement to vertebral body was 24.88% (range, 7.84%-38.99%). Back pain was alleviated significantly in all the patients postoperatively. All patients were followed up with a mean time of 8 months (range, 6-12 months). Cement leakage occurred in 49 patients. Single factor analysis showed that there were significant differences in the volume ratio of intravertebral bone cement to vertebral body and preoperative vertebral body wall incompetence between 2 groups (P < 0.05), while no significant difference in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, and cement volume (P > 0.05). The logistic regression analysis showed that the volume ratio of intravertebral bone cement to vertebral body (P < 0.05) and vertebral body wall incompetence (P < 0.05) were the risk factors for occurrence of cement leakage. ConclusionThe volume ratio of intravertebral bone cement to vertebral body and vertebral body wall incompetence are risk factors of cement leakage in PVP for OVCF. Cement leakage is easy to occur in operative level with vertebral body wall incompetence and high volume ratio of intravertebral bone cement to vertebral body.
Objective To compare the short-term effectiveness between primary cemented and uncemented total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) after renal transplantation. Methods The clinical data were retrospectively analyzed from 18 patients (21 hips) with ONFH after renal transplantation undergoing cemented THA in 11 cases (13 hips) (cemented group) and uncemented THA in 7 cases (8 hips) (uncemented group) between February 2005 and February 2012. There was no significant difference in gender, age, disease duration, ONFH stage, preoperative Harris score, and bone density between 2 groups (P gt; 0.05). Postoperative complications were observed in 2 groups; the hip function was assessed based on Harris scores; X-ray film was used to observe the prosthetic situation. Results All the wounds healed by first intention. The patients were followed up 6-77 months (mean, 46 months) in the cemented group, and 4-71 months (mean, 42 months) in the uncemented group. Femoral prosthesis infection occurred in 1 case (1 hip) respectively in each group; hip dislocation, femoral prosthesis loosening, and acetabular prosthesis loosening occurred in 1 case (1 hip) of the cemented group, respectively. At last follow-up, the incidences of postoperative complications and revision rate of the cemented group were 30.7% (4/13) and 23.1% (3/13) respectively, which were significantly higher than those of the uncemented group [12.5% (1/8) and 0 (0/8)] (P=0.047, P=0.040). Harris score was significantly increased to 94.1 ± 3.7 in the uncemented group and 90.0 ± 4.2 in the cemented group, showing significant differences compared with the preoperative scores in 2 groups (P lt; 0.05), but there was no significant difference between 2 groups (t=1.815, P=0.062). Postoperative X-ray films showed that the initial position of the prosthesis was satisfactory. At last follow-up, the bone fixation, fibrous stability, and loosening of the femoral prosthesis and loosening of acetabular prosthesis occurred in 9 hips, 3 hips, 1 hip, and 1 hip of the cemented group, respectively; bone fixation of the femoral prosthesis and stability of acetabular prosthesis were observed in all hips of the uncemented group. There was no heterotopic ossification in 2 groups. Conclusion Uncemented THA after renal transplantation can obtain satisfactory short-term effectiveness, and uncemented THA is better than the cemented THA; however, the middle- and long-term effectivenesses need further observation．
Objective To explore the correlative factors affecting the compl ications resulting from cement leakage after percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral body compression fractures (OVCF). Methods From February 2005 to October 2008, 71 patients with OVCF were treated by PKP and were retrospectively analyzed. There were 16 males and 55 females, and the average age was 71.5 years (range, 52-91 years). The average duration of disease was 5.7 months (range, 1-11 months). A total of 171 vertebra were involved in fracture including 19 cases of single vertebral fractures, 21 cases of double vertebral fractures, 20 cases of three vertebral fractures, and 11 cases of more than three vertebral fractures. All the treated vertebra were divided into acute (86 vertebra) or subacute (85 vertebra) state based on changes in MRI signal intensity. There was no radiculopathy or myelopathy. The average injected cement volumewas 4.6 mL (range, 1.5-6.5 mL). The treatment efficacy was assessed by observing the change in anterior and middle vertebral column height, Cobb angle, visual analogue scale (VAS) and Oswestry functional score at preoperation, 3 days after operation and last follow-up. The patients were divided into cement leakage group and no cement leakage group. All the compl ications were recorded, and then the correlative factors affecting the compl ications were analyzed. Results All the cases had rapid and significant improvement in back pain following PKP. All patients were followed up for 14 months (range, 7-18 months). There was no cement extravasation resulting in radiculopathy or myelopathy. Four patients (5.63%) had lung-related compl ications. During the follow-up, 9 recurrence vertebral fractures were observed in 6 patients (8.45%). The anterior and middle vertebral column height, Cobb angle, VAS and Oswestry score were significantly improved when compared with preoperation (P lt; 0.05). Cement leakage occurred in 17 (9.94%) vertebral bodies; of 17 cases, the cement leaked into the paravertebral space in 7 cases, intervertebral space in 6 cases, channel of needl ing insertion in 3 cases, and spinal canal in 1 case. Univariate analysis showed statistically significant differences (P lt; 0.05) in preoperative anterior and middle vertebral column height, injected cement volume and vertebral body wall incompetence between the cement leakage group and no cement leakage group. There were no significant differences (P gt; 0.05) in preoperative Cobb angle, freshness of vertebral fracture, location of operative vertebrae and operative approach between the two groups. Multiple logistic regression analysis showed that the injected cement volume [odds ratio (OR)=3.105, 95% confidence interval (CI)=1.674-5.759, P lt; 0.01] and vertebral body wall incompetence (OR=11.960, 95%CI=3.512-40.729, P lt; 0.01) were the predominant variable associated with the compl ications resulted fromcement leakage. Conclusion The injected cement volume and vertebral body wall incompetence were the factors affecting the compl ications. The improvement of surgical technique is the capital factor that may reduce the compl ications in the PKP.
Objective To investigate the causes and managements of acetabular fracture during primary total hip arthroplasty (THA). Methods Between May 2005 and July 2008, 9 patients (9 hi ps) suffered from acetabular fractures during primary THA. There were 1 male and 8 females with an average age of 63.3 years (range, 41-73 years), including 4 cases of developmental dysplasia of the hip, 2 cases of rheumatoid arthritis, 1 case of old femoral neck fracture, 1 case of avascular necrosis of femoral head, and 1 case of ankylosing spondyl itis. Three left hips and 6 right hips were involved. The preoperative Harris score was 40.4 ± 2.9. All the patients underwent cementless THA. Among nine acetabular fractures, 8 fractures were stable (2 anterior wall fractures and 6 posterior wall fractures), which were fixed by additional augmentation screws in 7 cases and accepted no special treatment in 1 case; 1 fracture was unstable (posterior wall fracture with posterior column incomplete fracture), which was treated by bone grafting and additional screws. Results The postoperative X-ray films showed that the position of the prosthesis were favorable. All incisions healed by first intention without early compl ication. Nine patients were followed up 1-4 years (mean, 2 years and 7 months). The Harris score was 87.8 ± 3.9 at last follow-up, showing significant difference when compared with the preoperative score (t=44.904, P=0.000). The X-ray films showed fracture heal ing at 8 weeks. No loosening occurred. Conclusion When primary THA is performed, the preoperative X-ray film should be studied and measured carefully, operation should be accurate and violence should be avoided. The diameter of the acetabular component should be equal to the diameter of a drill or not larger than 2 mm. In patients with severe osteoporosis, the diameter of the acetabular components should be the same diameter as a drill and additional screws are used to fix, or cemented cup is used. Once an acetabular fracture occurs during the primary THA, additional screw or bone grafting with additional screws should be chosen according to the fracture type and stabil ity, and good cl inical results can be expected.
ObjectiveTo investigate the clinical characteristic differences of cementless total hip arthroplasty (THA) between with and without subtrochanteric femoral shortening osteostomy in Crowe type IV developmental dysplasia of the hip (DDH). MethodsBetween January 2006 and March 2012, 21 patients (21 hips) with Crowe type IV DDH who underwent primary THA were enrolled according to inclusion criteria. According to whether subtrochanteric femoral shortening osteostomy was performed during THA or not, the patients were divided into 2 groups: THA with osteostomy group (n=9) and THA without osteotomy group (n=12). There was no significant difference in gender, age, body mass index, and hip Harris score between 2 groups (P>0.05) except leg length discrepancy (t=-3.170, P=0.005). The operation time, blood loss, postoperative drainage, complications, and radiography data were compared to evaluate the clinical characteristics. ResultsThe operation time, blood loss, and postoperative drainage of osteotomy group were all significantly greater than those of no osteotomy group (P<0.05). All patients achieved primary healing of incision; 1 patient (1 hip) had transient sciatic nerve symptom in osteotomy group. The average follow-up time was 53 months (range, 28-88 months). The X-ray films showed good fracture healing at 3-6 months after operation in osteostomy group. No prosthetic loosening or dislocation was found. The hip Harris score was 90.67±4.06 in osteostomy group and 92.17±3.27 in no osteostomy group, showing no significant difference between 2 groups (t=-0.938, P=0.360). The leg length discrepancy was (0.22±0.26) cm in osteostomy group and (0.18±0.27) cm in no osteostomy group, showing no significant difference (t=107.000, P=0.546). The leg length discrepancy was found in 6 patients of osteotomy group and 5 patients of no osteotomy group. One patient complained of thigh pain in osteotomy group; 2 patients had slight limp (Trendelenburg +) in no osteotomy group. ConclusionTHA can improve joint function and increase limb length in the treatment of Crowe type IV DDH. Subtrochanteric shortening osteotomy is an effective treatment which can be performed according to preoperative template measurement, leg length shortening, and the soft tissue tension.