Objective To investigate the relationship between the initial stabil ity and infected loosening of the total hip arthroplasty (THA) prosthesis. Methods From January 2000 to December 2008, 110 cases (110 hips) were treated with THA revision. Among them, 15 cases (15 hips) were confirmed infected loosening. There were 8 males and 7 females with anaverage age of 62 years (range 42-75 years). The infected signs were found from 6 months to 2 years after initial THA. All of them had Tsukayama type IV and late infection, including 6 cases of acetabular infected loosening (5 cases of one-stage and 1 case of two-stage acetabular revision), 7 cases of simple infected loosening of femoral prosthesis (4 cases of one-stage and 3 cases of twostage femoral prosthesis revision), and 2 cases of joint capsule infection and sinus without prosthesis loosening (debridement and continuous irrigation). Results All incisions healed by first intention. Fifteen patients were followed up for 12 to 36 months (average 24 months). In 13 cases of revision, postoperative X-ray films showed that femoral acetabular prostheses were in good position, and had no cl inical and imaging infective signs of loosening. In 2 cases of joint capsule infection, sinus recurred 6 months postoperation without hip joint pain, the function of weight-bearing and walking of hip joint was normal. Harris score increased from preoperative average of 42 to postoperative average of 85; the results were excellent in 4 cases, good in 7 cases, and fair in 4 cases. Conclusion The infection of THA may occur in the whole joint, half-joint or just in joint capsule. The initial stabil ity of the prosthesis would affect the long-term survival of the prothesis. If the prosthesis initial stabil ity is obtained, even if there are infective factors, infections would also be l imited.
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 explore the method of acetabular orientation determination in total hip arthroplasty (THA) for bony ankylosed hip and the accuracy of the postoperative evaluation. MethodsBetween January 2009 and March 2013, 33 consecutive patients (49 hips) underwent THA. There were 25 males and 8 females with a mean age of 35.8 years (range, 18-69 years). The left hip was involved in 10 cases, the right hip in 7 cases, and bilateral hips in 16 cases. The causes were ankylosing spondylitis in 18 patients, tuberculosis in 6 patients, traumatic arthritis in 6 patients, osteoarthritis in 2 patients, and suppurative infection in 1 patient. The disease duration was 7-15 years with an average of 10.8 years. The acetabular orientation was determined with periacetabular bone marks (the upper margin of the obturator foramen, acetabular notch etc.) and soft tissue signs (acetabulum transverse ligament etc.). The hip or pelvic radiograph was taken to measure the acetabular prosthesis anteversion and abduction angle, and upward or downward, inward or outward acetabular migration degree. The acetabular anteversion angle of 15 degrees, the abduction angle of 45 degrees, and upward or downward, inward or outward acetabular migration degree of 0 served as a reference value to evaluate the accuracy of acetabular position. ResultsThere was no complications of neurovascular injury, fracture, joint dislocation, and infection. All of patients were followed up 13-63 months (mean, 30.3 months). The anteversion angle and abduction angle were (13.904±4.034)° and (42.898±7.474)° at last follow-up, showing no significant difference when compared with reference value (t=1.386, P=0.178; t=1.969, P=0.055). The inward or outward and upward or downward acetabulum migration degree were (2.530±2.261) mm and (3.886±3.334) mm respectively, showing significant differences when compared with reference value (t=7.830, P=0.000; t=8.159, P=0.000); it was less than 5 mm in 29 hips, 5-10 mm in 18 hips, and more than 10 mm in 2 hips; the acetabulum center coincidence rate was 59.2%. ConclusionFor bony ankylosed hip having loss of normal anatomy structure, intraoperative residues and permanent anatomical structure should be used for acetabular positioning.
Objective To compare the effectiveness between SuperPATH approach and posterolateral approach in total hip arthroplasty (THA). Methods Between January 2016 and December 2016, 84 patients with hip disease were included in the study and randomly divided into 2 groups. Forty patients were treated with THA via SuperPATH approach (SuperPATH group), and 44 patients were treated with THA via posterolateral approach (PSA group). There was no significant difference in gender, age, body mass index, the type of disease, the complicating diseases, and preoperative thrombosis of lower extremity and Harris score between 2 groups (P>0.05). The operation time, intraoperative blood loss, length of incision, postoperative drainage volume, unloaded activity time, Harris score, and short-form 36 health survey scale (SF-36) score were compared. The postoperative X-ray films were used to observe the position of joint prosthesis. Results All patients were followed up 6-18 months (mean, 10.3 months). The operation time, intraoperative blood loss, length of incision, postoperative drainage volume, and unloaded activity time in SuperPATH group were significantly superior to those in PSA group (P<0.05). The Harris score at 2 weeks and 1 month after operation were significantly higher in SuperPATH group than that in PSA group (P<0.05). But there was no significant difference in the Harris scores at 3 and 6 months after operation between 2 groups (P>0.05). At last follow-up, the SF-36 scores were higher in SuperPATH group than those in PSA group (P<0.05). Postoperative X-ray films showed the joint prosthesis was in good position. Conclusion THA via SuperPATH approach has the advantages of minimal invasion, safe, and rapid recovery, which is better than THA via posterolateral approach.
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.
ObjectiveTo study the early out-of-bed activities of patients after Mako robotic-assisted total hip arthroplasty.MethodsWe prospectively included inpatients planned to undergo primary unilateral total hip arthroplasty in the Department of Orthopaedics of the First Affiliated Hospital of Chongqing Medical University from April to July 2020. Using a randomized numerical table, the patients were divided into trial group to undergo robotic-assisted total hip arthroplasty and control group to undergo traditional total hip arthroplasty, and both groups received the same nursing measures and instructions for training to get out of bed after surgery. Postoperative active pain (assessed with Visual Analogue Scale), the proportion of patients willing to get out of bed within 24 h after surgery, the time and duration for the first out of bed activity, the proportion of patients with a walking distance ≥5 m for first activity, and the level of activity in the first 3 d after surgery between the two groups were compared.ResultsA total of 38 patients were included in this study, with 17 patients in the trial group and 21 patients in the control group. There was no statistical significance in the baseline demographics between the two groups (P>0.05). There were statistically significant differences in postoperative 6-hour and 24-hour Visual Analogue Scale scores between the two groups (P<0.05). Two hours after oral administration of perioperative energy preparations on the day of surgery, the proportion of patients who were willing to get out of bed early in the trial group was higher than that in the control group (100.0% vs. 57.1%, P<0.05). The first time to get out of bed ［(4.39±0.17) vs. (8.74±4.70) h］, the duration of getting out of bed ［(10.89±3.60) vs. (8.37±3.31) h］, and the proportion of patients with a walking distance ≥5 m for first activity (94.1% vs. 61.9%) were better than those of the control group (P<0.05). There were statistically significant differences between the trial group and the control group in the average level in the first 3 days after surgery, postoperative first-day level, and postoperative second-day level of getting out of bed (P<0.05). There were no falls, dislocation of the prosthesis, fractures around the prosthesis, or deep vein thrombosis in the two groups of patients during their hospitalization.ConclusionThe precise surgery method with the help of Mako orthopedic robot-assisted system can help promote patients to get out of bed early after surgery, and can providea reference for how to improve the rehabilitation of patients after traditional total hip replacement in the future.
ObjectiveTo investigate the effects of the femoral head size on the linear wear rate of highly crosslinked polyethylene (HXLPE) l iner in total hip arthroplasty (THA). MethodsA retrospective analysis was performed on the cl inical data of 41 patients (43 hi ps) who underwent primary THA with HXLPE liner and different sizes of femoral heads between January 2004 and December 2007 for hip diseases. There were 22 males (23 hi ps) and 19 females (20 hi ps) with a mean age of 60.2 years (range, 35-89 years), including femoral neck fracture (26 hi ps), avascular necrosis of femoral head (8 hi ps), osteoarthritis (5 hi ps), rheumatoid arthritis (2 hi ps), and congenital hip dysplasia (2 hi ps). According to the size of the femoral head, the patients were divided into 2 groups: standard head size (26 and 28 mm) was used in 25 cases (26 hi ps, group A) and big head size (32, 36, and 40 mm) in 16 cases (17 hi ps, group B). The cumulative penetration of the femoral head, linear wear rate, and effectiveness were evaluated and compared between 2 groups. ResultsAll the incisions healed by first intention, no complications of infection, deep vein thrombosis, or nerve injury occurred. The patients were followed up 5-9 years (mean, 5.7 years). No two-stage revision was needed. Harris score was significantly improved at 3 months, 6 months, and 1, 2, 3, 4, and 5 years after operation when compared with preoperative score in each group (P < 0.05), but no significant difference was found between different time points after operation in 2 groups (P > 0.05), and between 2 groups at each time point (P > 0.05). Acetabular abduction angle was (31.4±3.8)° in group A and (32.3±4.1)° in group B, showing no significant difference (t=0.482, P=0.621). At last follow-up, no radiographic or cl inical loosening was observed in each group. At 5 years after operation, X-ray results of acetabular components showed radiolucent line ( < 1 mm) in 1 case (1 hi p) and 1 case (1 hi p) of 2 groups respectively; but X-ray results of femoral components showed no radiolucent line. There was no significant difference in the cumulative penetration of the femoral head between 2 groups at 1, 2, 3, 4, and 5 years after operation (P > 0.05). The linear wear rate was (0.026±0.007) mm/year in group A and (0.025±0.007) mm/year in group B, showing no significant difference between 2 groups (t=0.708, P=0.483). ConclusionNo association is found between femoral head size and the linear wear rate of HXLPE liner. It is an ideal interface of THA because of its low linear wear rate.
Objective To explore the related factors of femoral stem anteversion (FSA) after total hip arthroplasty (THA), so as to provide reference for clinical design of FSA before operation and reduce the risk of hip dislocation after arthroplasty. Methods Ninty-three patients (103 hips) who underwent THA between October 2021 and September 2022 and met the selection criteria were selected as the study subjects. Among them, there were 48 males and 45 females with an average age of 58.5 years (range, 25-88 years). Body mass index was 18.00-37.84 kg/m2, with an average of 24.92 kg/m2. There were 51 cases (57 hips) of osteonecrosis of femoral head, 35 cases (39 hips) of hip osteoarthritis, and 7 cases (7 hips) of congenital hip dysplasia. Based on CT images, the following indicators were measured: preoperative femoral neck anteversion (FNA), preoperative femoral rotation angle (FRA), preoperative acetabular anteversion (AA), and preoperative combined anteversion (CA; the sum of preoperative FNA and AA); postoperative FSA and the change in femoral anteversion angle (the difference between postoperative FSA and preoperative FNA). Based on preoperative X-ray films, the following indicators were measured: femoral cortical thickness index (CTI) and canal flare index (CFI), the proximal femoral medullary cavity was classified according to Noble classification (champagne cup type, normal type, chimney type), neck-shaft angle (NSA), and femoral offset (FO). Pearson correlation analysis, one-way ANOVA, and Point-biserial correlation analysis were used to investigate the correlation between postoperative FSA, postoperative change in femoral anteversion angle, and patient diagnosis, proximal femoral medullary cavity anatomy type, gender, age, as well as preoperative FNA, FRA, AA, CA, NSA, FO, CTI, and CFI. FSA was used as the dependent variable and the independent variables that may be related to it were included for multiple linear regression analysis. Results Based on CT image measurement, preoperative FNA was (15.96±10.01)°, FRA (3.36±10.87)°, AA (12.94±8.83)°, CA (28.9±12.6)°, postoperative FSA (16.18±11.01)°, and postoperative change in femoral anteversion angle was (0.22±9.98)°. Based on preoperative X-ray films measurements, the CTI was 0.586±0.081; the CFI was 4.135±1.125, with 23 hips classified as champagne cup type, 68 hips as normal type, and 12 hips as chimney type in the proximal femoral medullary cavity anatomy; NSA was (132.87±7.83)°; FO was (40.53±10.11) mm. There was no significant difference between preoperative FNA and postoperative FSA (t=−0.227, P=0.821). Pearson correlation analysis showed that postoperative FSA was positively correlated with preoperative FNA, preoperative CA, postoperative change in femoral anteversion angle, and age (P<0.05), while negatively correlated with preoperative FRA (P<0.05). The postoperative change in femoral anteversion angle were positively correlated with preoperative FRA and postoperative FSA (P<0.05), and negatively correlated with preoperative CA and FNA (P<0.05). One-way ANOVA analysis showed that the above two indicators were not correlated with diagnosis and the proximal femoral medullary cavity anatomy type (P>0.05). Multiple linear regression analysis showed a linear correlation between FSA and FNA, CA, age, and FRA (F=10.998, P<0.001), and the best fit model was FSA=0.48×FNA–2.551. Conclusion The factors related to FSA after THA include patient’s age, preoperative FNA, CA, FRA and postoperative femoral anteversion, of which preoperative FNA is the most closely related. When designing a surgical plan before surgery, attention should be paid to the patient’s preoperative FNA, and if necessary, CT around the hip joint should be scanned to gain a detailed understanding of the proximal femoral anatomical structure.
ObjectiveTo investigate the short-term effectiveness of one-stage radical debridement and total hip arthroplasty (THA) in the treatment of active tuberculosis of the hip. MethodsBetween January 2006 and June 2011,one-stage radical debridement and THA were performed on 12 cases (12 hips) of active tuberculosis of the hip.There were 7 males and 5 females,aged 18-60 years (mean,46.3 years).The disease duration ranged from 6 to 24 months (mean,10.5 months).According to Babhulkar and Pande staging criteria,5 cases were at stage Ⅲ and 7 cases were at stage IV.One case had sinus,and 2 cases had previous pulmonary tuberculosis.Preoperative hip range of motion was (35.83±9.25)°; hip Harris score was 36.83±6.44.Erythrocyte sedimentation rate (ESR) was 45-90 mm/1 h (mean,62.4 mm/1h); C-reactive protein (CRP) was 19-50 mg/L (mean,33.6 mg/L).Perioperatively all the patients accepted the regular anti-tuberculous medication. ResultsThe results of histopathological examination and PCR detection were positive for tuberculosis bacillus.Postoperatively the incisions healed primarily.All the patients were followed up 25-60 months (mean,40.8 months).The ESR and CRP returned to normal level with no liver injury.Tuberculosis recurrence occurred in 1 patient at 4 months after operation,which was cured after revision.X-ray film showed no prosthesis shift,prosthesis loosening,or sinus tract.At 18-24 months after operation,the bilateral sides had the same bone density,which was similar to that at the final follow-up.Hip range of motion was significantly improved to (107.08±13.56)° (t=14.571,P=0.000).Hip Harris score was significantly increased to 88.00±10.78 (t=16.750,P=0.000). ConclusionA combination of one-stage radical debridement and THA is a safe method to treat active tuberculosis of the hip,which can relief symptoms and improve hip function,with low recurrence and satisfactory short-term effectiveness.
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.