ObjectiveTo explore the clinical outcome of alendronate in the treatment of bone marrow edema syndrome of the hip.MethodsA retrospective analysis of 8 cases (10 hips) of bone marrow edema syndrome of the hip treated with alendronate between December 2017 and January 2020 was conducted. Harris score and MRI exam of hip were used to assess the clinical and radiographical outcomes. Clinical cure rate and length of treatment period were used to evaluate whether alendronate was benefitial for the treatment of bone marrow edema syndrome of the hip.ResultsAll the cases were followed up for at least 3 months and got complete clinical data, the mean follow-up period was (5.2±1.2) months. Seven cases (9 hips) in 8 cases (10 hips) had clinical cure, with a clinical cure rate of 90%. The length of treatment period was 1 to 2 months with a mean value of (1.7±0.2) months. The Harris score increased from 57.8±6.3 before treatment to 98.6±1.0 at the last follow-up, and the difference was statistically significant (t=18.299, P<0.001). One case (1 hip) developed osteonecrosis of femoral head at one month after the initiation of alendronate therapy, who received continuous combination therapy of alendronate, calcium and aspirin, and no collapse or expansion of necrosis was found after 12 months follow-up.ConclusionsBone marrow edema syndrome of the hip is not a self-limiting disease completely, some patients maybe develop osteonecrosis of femoral head. Alendronate is benefitial for alleviating clinical symptom, accelerating bone edema disappearance, and shortening the course of disease.
ObjectiveTo review the role of dendritic cells (DC) in immune metabolism of rheumatoid arthritis (RA). MethodsLiterature on the role of DC in the immune metabolism of RA was extensively reviewed in recent years, and the metabolic characteristics of RA, the role of DC in RA, the correlation between the immune metabolism of DC and pathogenesis of RA, and the treatment were summarized and analyzed. Results DC promotes the progression of RA under hypoxia, increased glycolysis, inhibition of oxidative phosphorylation, and decreased lipid metabolism. Moreover, many DCs (especially conventional DC and monocyte-derived DC) have different functions and phenotypic characteristics in RA, which are closely related to the occurrence and development of RA. Conclusion DC plays an important role in the immune metabolism of RA, and immunometabolism therapy based on DC can provide targeted therapy for the treatment of RA.
ObjectiveTo summarize the characteristics of the occurrence and development of osteonecrosis of the femoral head (ONFH), and to review the important regulatory role of immune cells in the progression of ONFH. MethodsThe domestic and foreign literature on the immune regulation of ONFH was reviewed, and the relationship between immune cells and the occurrence and development of ONFH was analyzed. ResultsThe ONFH region has a chronic inflammatory reaction and an imbalance between osteoblast and osteoclast, while innate immune cells such as macrophages, neutrophils, dendritic cells, and immune effector cells such as T cells and B cells are closely related to the maintenance of bone homeostasis. ConclusionImmunotherapy targeting the immune cells in the ONFH region and the key factors and proteins in their regulatory pathways may be a feasible method to delay the occurrence, development, and even reverse the pathology of ONFH.
ObjectiveTo introduce the etiology and prevention of bone cement implantation syndrome (BCIS). Methods The literature about BCIS at home and abroad in recent years was extensively reviewed, and the incidence, clinical manifestations, etiology, and prevention of BCIS were summarized and analyzed. Results The clinical manifestations of BCIS are diverse. The etiology of BCIS is not completely clarified, and it may be related to circulating methyl methacrylate-mediated model, embolus-mediated model, histamine release and hypersensitivity response, complement activation and multimodal model. BCIS prevention begins with the identification of high-risk patients in preoperative evaluation and communication between surgeon and anesthesiologist about the choice of implant type, surgical procedure, and technique to minimize the risk of cardiovascular complications in high-risk patients with multiple or severe risk factors or comorbidities. Preoperative assessment and optimization of a patient’s cardiovascular reserve is also critical to prevent BCIS. ConclusionBCIS is a possible complication after hip joint arthroplasty, and its pathogenesis needs to be further research in order to provide new ideas for prevention and treatment.
ObjectiveTo compare the clinical and radiographic results between primary total knee arthroplasty (TKA) via mini-subvastus or conventional approach through a prospective randomized controlled study.MethodsNinety-four patients (104 knees) undergoing primary TKA between January 2011 and April 2012 were evaluated and randomly divided into 2 groups. Forty-six patients (52 knees) underwent TKA via conventional approach (conventional approach group), and 48 patients (52 knees) underwent TKA via mini-subvastus approach (mini-subvastus approach group). In these patients, 45 cases (51 knees) in conventional approach group and 45 cases (49 knees) in mini-subvastus approach group were followed up and recruited in the final analysis. There was no significant difference in age, gender, body mass index, sides, osteoarthritis grading, American Knee Society Score (KSS), Hospital for Special Surgery (HSS) score, visual analogue scale (VAS), range of motion (ROM) of knee between 2 groups (P>0.05). The clinical indexes were recorded and analyzed, including the operation time, length of incision, total blood loss, blood transfusion after operation, hospital stay time, the time of performing straight leg raise, incision condition, VAS score, ROM of knee, HSS score, and KSS score, hip-knee-ankle angle (HKA), femoral anatomic axis and the femoral prosthesis joint angle (femoral angle), tibia anatomic axis and tibial prosthesis joint angle (tibial angle), femoral prosthesis flexion angle (FPFA), and posterior slope angle (PSA) of the tibial plateau.ResultsAll patients were followed up. The average follow-up time was 66.4 months (range, 60.0-72.5 months) in conventional approach group and 65.6 months (range, 60.0-71.2 months) in mini-subvastus approach group. Compared with the conventional approach group, the incision of mini-subvastus approach group shortened, the operation time prolonged, and the time when patients started straight leg raise exercises was earlier; showing significant differences between 2 groups (P<0.05). There was no significant difference in hospital stay time, total blood loss, and numbers of blood transfusion between 2 groups (P>0.05). The complication rate was 8.2% (4/49) in mini-subvastus approach group and 0 in conventional approach group, showing no significant difference between 2 groups (P=0.054). At 1 and 3 days, the VAS and the ROM of knee in mini-subvastus approach group were significantly better than those in conventional approach group (P<0.05); but there was no significant difference in above indexes between 2 groups at 14 day (P>0.05). There was no significant difference in HSS and KSS scores between 2 groups at the 1, 3, 6, 12 months and 3, 5 years (P>0.05). X-ray film showed no aseptic loosening in all cases. There was no significant difference in the measured values and incidence of abnormal patient of HKA, femoral angle, tibial angle, FPFA, and PSA at last follow-up between 2 groups (P>0.05).ConclusionTKA via mini-subvastus approach is helpful to the early function recovery of knee, but the long-term effectiveness is consistent with TKA via conventional approach. As the limited exposure, TKA via mini-subvastus spproach may has high risk of operative complications.
Objective To summarize research progress on application of Cup-cage reconstruction in revision of chronic pelvic discontinuity (CPD) in patients undergoing total hip arthroplasty (THA). Methods Relevant literature at home and abroad in recent years was reviewed to summarize the principles of the Cup-cage reconstruction, preoperative patient assessment, intraoperative skills, clinical and radiological effectiveness, limitations, and postoperative complications. Results For the treatment of CPD, the Cup-cage reconstruction achieved long-term acetabular cup bone ingrowth, CPD healing, and biologic fixation of the prosthesis by restoring pelvic continuity. Preoperative evaluation of the surgical site and general condition is necessary. The main intraoperative objectives are to reconstruct pelvic continuity, restore the center of rotation of the hip, and avoid neurovascular injury. Current studies have demonstrated significant clinical and radiological effectiveness as well as acceptable prosthesis survival rates after operation. Nevertheless, there is a lack of evidence regarding the staging of CPD, the optimal surgical approach and internal fixation, and the factors influencing postoperative prosthesis survival remain undefined. Conclusion Cup-cage reconstruction can be an effective treatment for CPD after THA, but there is still a need to explore CPD staging, Cup-cage approach and internal fixation, and influencing factors on prosthesis survival.
ObjectiveTo explore the therapeutic effect of total hip arthroplasty (THA) and hip adductor amputation (HAA) in the surgical treatment of osteonecrosis of femoral head. MethodsA total of 74 patients with osteonecrosis of femoral head with hip adduction deformity were included between June 2011 and May 2012. Among them, 38 patients had undergone THA, and 36 patients had undergone THA+HAA. Statistics about hip abductor function and Harris scores before and 1 week and 12 months after the surgery were recorded. SPSS 19.0 was used for statistical analysis. ResultsThe patients' wounds had the Ⅰ-stage healing in both of the two groups. Two patients had scrotum swelling in THA+HAA group, who left the hospital after treating. One week after the surgery, the hip passive abduction angles increased (32.1±2.8) and (19.7±3.3)°, respectively in the THA+HAA group and THA group, while the Harris hip score increased 45.8±2.8 and 40.9±2.3, respectively; 12 months postoperatively, the hip passive abduction angles increased (32.2±0.9) and (26.8±2.8)°, respectively in the THA+HAA group and THA group, while the Harris hip score increased 52.7±7.2 and 49.4±4.4, respectively. The above comparative differences was statistically significant (P<0.05). ConclusionThe surgical method of adductor amputation can improve the range of motion of the hip, raise the quality of life of the patients with osteonecrosis of the femoral head after the surgery.
Objective To systematically review the effectiveness and safety of total hip arthroplasty (THA) vs. total hip resurfacing arthroplasty (THRA) in patients with osteoarthritis of the hip joint. Methods We electronically searched databases including PubMed, The Cochrane Library (Issue 3, 2012), EMbase, PloS, national institutes of clinical test library of the United States, national joint replacement registration network of Australia, British national joint registration network, British orthopaedic association network (BOA), Canada orthopaedic association (COA), American Academy of Orthopedic Surgeons network (AAOS), German Institute of Medical Documentation and Information network (DIMDI) for randomized controlled trials (RCTs) on the comparison between THA and THRA for osteoarthritis of the hip joint from inception to November, 2012. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Six RCTs (10 articles) involving 518 cases of surgery (THA: n=259; THRA: n=259) were identified. The risk of bias of 8 articles was moderate and that of the other 2 articles was low. The results of meta-analysis showed that, compared to THRA, THA brings greater improvements of femoral offset within 2 years after surgery (MD=6.60, 95%CI 5.53 to 7.68, P=0.25). There were no significant differences between the two groups in Merle d’Aubigné Postel, WOMAC score, UCLA score, SF-36 Health Survey Questionnaire, walking speed, step length, walking cadence, postoperative leg length discrepancy, and complication rates. All these conclusions are based on early postoperative results. Conclusion Current evidence shows that, THA brings greater improvements of femoral offset than THRA, and no significant differences between the two groups were found in the other indicators.
ObjectiveTo explore the surgical technique and effectiveness of sliding osteotomy of medial femur condyle in handling soft tissue balance of severe valgus deformity in total knee arthroplasty (TKA). MethodsBetween June 2008 and February 2014, 18 cases (19 knees) of severe valgus knees undergoing sliding osteotomy of medial femur condyle in primary TKA were included. Of the 18 patients, 6 were male and 12 were female with an average age of 52.3 years (range, 29-72 years), including 3 cases (3 knees) of osteoarthritis, 11 cases (12 knees) of rheumatoid arthritis, 3 cases (3 knees) of post-traumatic arthritis, and 1 case (1 knee) of deformities in skeletal dysplasia. Before surgery, the tibial-femur angle (TFA) was (33.0±2.9)°; the Hospital for Special Surgery (HSS) score was 41.6±7.7; the Knee Society Score (KSS) lateral stability score was 6.0±5.4. All cases were rated as type II according to Krackow classification of valgus knee. During primary TKA, sliding osteotomy of medial femur condyle was performed via a medial parapatellar approach. ResultsIncision healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient, which was cured after 6 months of conservative treatment. Eighteen cases were followed up 19 months to 7 years, with an average of 5.7 years. All patients had no complications of deep vein thrombosis, deep infection, and prosthesis loosening. X-ray films showed that bone healing was achieved in all cases at 6 months. At last follow-up, the TFA was (4.8±1.8)°, showing significant difference when compared with preoperative value (t=62.61, P=0.00). The HSS score was 87.2±10.5 and the KSS lateral stability score was 12.4±3.1, all showing significant differences when compared with preoperative scores (t= —33.35, P=0.00; t= —6.83, P=0.00). ConclusionSliding osteotomy of medial femur condyle is effective for correcting severe valgus knee deformity during TKA. Satisfactory joint function and stability may be achieved.
目的 探讨髋或膝关节置换术（THR/TKR）并存甲状腺功能减退症（甲减）患者围手术期的处理策略。方法 2009年1月－2011年12月收治30例行THR/TKR并存甲减患者，其中男8例，女22例，平均年龄62.4岁。处理要点包括术前纠正甲状腺激素水平；术中缩短手术时间，减少出血量，选择性应用糖皮质激素；术后补充甲状腺激素，预防感染及深静脉血栓形成，改善胃肠功能。评价指标包括围手术期血压、心率变化，胃肠功能状况，切口愈合时间，甲状腺功能水平，黏液性水肿昏迷等并发症发生率；术前及术后Harris及特种外科医院评分系统（HSS）评分等。 结果 术后心率变化大，非致命性心律失常者20例；血压控制平稳；术后甲状腺功能变化不明显，无黏液性水肿昏迷、心包积液及呼吸窘迫等严重并发症发生。随访1个月，术前HSS评分平均28分，术后86分；术前Harris评分平均32分，术后87分。 结论 术前控制血清促甲状腺素在0.5～3.0 mU/L以内，总甲状腺素、游离甲状腺素至正常水平，是有效预防甲减患者THR/TKR围手术期并发症的关键；综合应用左甲状腺素片、糖皮质激素和抗凝治疗是安全渡过围手术期的重要保证。