fter total hip replacement ,massive bone defect occured freqently due to wearing and loosening of the prcathesis.The use of deep-freezing allograft to su pport a new implant was an attractive solution. Deep-freezing decreased the immune antigenicity of the transplanted allograft.From 1972 to 1990. the deep-freezing allografts were used in rcvision total hip replacement in 212 cases,in which 187 cases(198 hips) were followed-up for over 1 year.The general effective rate was 85%....
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 study the effect of all-coated long stem prosthesis associated with allograft in revision total hip replacement (THR). Methods From January 1997 to January 2004, 20 patients with non-infectious loosened implant after primary THR were treated. There were 12 males and 8 females with a mean age of 65 years (58-77 years). The average period between primary THR and revision THR was 12 years (3-18 years). According to classification of Paprosky, there were10 cases of type II, 6 cases of type IIIA, 3 cases of type IIIB and 1 case of type IV. All-coated long stem prosthesis was used in all cases. Impacting bone grafting was done in 12 cases and impacting bone grafting associated with cortical strut grafting in 8 cases. The mean amount of morsel ized bone was 20 g (5-35 g), the length of cortical bone was 10-22 cm. Results All the incisions got heal ing by first intension. All patients were followed up for an average period of 36 months (16-48 months). Dislocation occurred at 5 days after operation and was cured with closed reduction and traction in 1 case. There was significant difference (P lt; 0.05) in the mean Harris score between preoperation (50.0 ± 2.3) and postoperation (90.0 ± 2.5). The X-ray checking showed that continuous radiolucent l ine of 3 mm occurred in 1 case, prosthesis subsidence of 5 mm and 7 mm in 2 cases and that no bone absorption was observed. Seven cases of cortical bone grafting union was achieved within 3 years except 1 case of cortical bone un-union. Conclusion It can obtained the initial stabil ization of prosthesis to use all-coated long stem prosthesis associated with allograft in revision THR to treat femur bone defect after THR. The short-term effects of the cl inical and X-ray checking are satisfactory, but future effect is to be observed.
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.
Objective To compare the maximum pull-out strength of the upper il iac screw and lower il iac screw with and without polymethylmethacrylate (PMMA) augmentation, and to provide the experimental evidences for the rational use of il iacscrews. Methods Ten intact human il ium from 5 donated cadavers with formal in embalmed were selected. The bone mineral density (BMD) of L1-4 of each cadaver was measured with a dual energy X-ray absorptiometry. The screws placed in the upper and lower il iac column were named as the upper and lower il iac screw, respectively. Using 70 mm length and 7.5 mm diameter screws with and without PMMA augmentation, 4 il iac screw technique models were sequentially establ ished and tested as follows: upper il iac screw (group A), upper il iac screw with PMMA augmentation (group B), lower il iac screw (group C), and lower il iac screw with PMMA augmentation (group D). Each il ium was mounted on a material testing machine with its position similar to standing. Under 2 000 cycl ic compressive loadings of 100-300 N to the screw, the maximum pull-out strength of il iac screw was measured. Results The BMD value of the 5 human cadavers was (0.88 ± 0.06) g/cm2. All the il iac screws were inserted into the screw tracts accurately as expected. No screw penetrations of acetabulum or cortex was not observed through visual inspection. There was no “halo” ring sign surrounding any screw after the 2 000 cycle loading. The maximum pull-out strengths of groupsA, B, C, and D were (964 ± 250), (1 462 ± 266), (1 537 ± 279), and (1 964 ± 422) N, respectively. Group D exhibited the highest maximum pull-out strength among the 4 groups (P lt; 0.05). No significant difference was detected between groups B and C (P gt; 0.05); however, groups B, C showed higher maximum pull-out strength than group A (P lt; 0.05). Conclusion The lower il iac screw offers significantly higher fixation strength than the upper il iac screw; PMMA augmentation could effectively increase the fixation strength of il iac screws and therefore could be appl ied in the salvage of il iac screw loosening.
OBJECTIVE To analyze the indications for revision surgery after limb salvage procedure of malignant bone tumor and summarize the experiences in revision surgery. METHODS From January 1994 to December 1997, 8 cases were re-operated after primary limb salvage procedure. The average survival period with no-tumor occurrence was 8 years. The common causes for the revision were traumatic osteoarthritis, fracture, and bone resorption. The main difficulties in revision were soft tissue contracture and limb discrepancy from limb shortening. RESULTS In this study, there was total hip replacement in 1 case, large segmental allograft for reconstruction of distal femur in 3 cases, total knee replacement upon composite of previously transplanted allograft in 3 cases, removing of intramedullary nail and re-internally fixed with intramedullary nail in 1 cases. The isotopic bone scan before the revision showed active bone metabolism in all 4 transplanted segmental allograft. The pathologic study of the transplanted allograft after revision confirmed new bone formation in allograft. The revision procedure reduced the pain, and improved the limb function. CONCLUSION The main causes of revision surgery after limb salvage procedure of malignant bone tumor are fracture of transplanted allograft segment or devitalized tumor segment, and poor function of the affected joint. Constrained knee prostheses with rotating hinges or semi-constrained ball-axis resurfacing knee prostheses improve the function of knee joint postoperatively.
【Abstract】 Objective To review the progress in the treatment of bone defect by porous tantalum implant. Methods Recent l iterature was extensively reviewed and summarized, concerning the treatment method of bonedefect by porous tantalum implant. Results By right of their unique properties, porous tantalum implants have achievedvery good results in the treatment of certain types of bone defects. Conclusion Porous tantalum implants have their ownadvantages and disadvantages. If the case is meet to its indications, this method can obtain a good effect. Porous tantalum implants provide a new way for the cl inical treatment of bone defects.
Objective To explore the failure cause of posterior approach orthopaedic operation of thoracolumbar hemivertebra, and to summary strategies of revision. Methods The cl inical data from 9 cases undergoing posterior approach orthopaedic operation failure of thoracolumbar hemivertebra between June 2003 and June 2008, were retrospectively analyzed. There were 5 males and 4 females with a median age of 12 years (range, 1 year and 10 months to 24 years). All malformations were identified as fully segmented hemivertebra from the original medical records and X-ray films, including 2 cases in thoracic vertebra, 5 cases in thoracolumbar vertebra, and 2 cases in lumbar vertebra. The preoperative scol iotic Cobb angle was (45.4 ± 17.4)°, and kyphotic Cobb angle was (29.8 ± 22.0)°. The reason of primary surgical failure were analyzed and spinal deformity was corrected again with posterior revision. Results All surgeries were finished successfully. The operation time was 3.0-6.5 hours (mean, 4.5 hours), and the perioperative bleeding was 400-2 500 mL (mean, 950 mL). All incisions healed by first intention; no infection or deep venous thrombosis occurred. Numbness occurred in unilateral lower extremity of 1 case postoperatively, and the symptom was rel ieved completely after treatment of detumescence and neural nutrition. All cases were followed up 12-30 months (mean, 18 months). No pseudoarthrosis and implant failure occurred. The X-ray films showed that the bone grafts completely fused within 8-14 months (mean, 11 months) after operation. The Cobb angles of scol iosis and kyphosis at 1 week after operation and the last follow-up were obviously improved when compared with preoperative ones, showing significant differences (P lt; 0.05). No obvious correction loss was observed either in coronal or sagittal plane. Conclusion The failure causes of posterior approach orthopaedic operation are hemivertebra processing, selection of fixation and fusion range, and selection of internal fixation. If the strategies of revision are made after the above-mentioned failure causes are considered, the cl inical results will be satisfactory.
Objective To discuss the therapeutic effect of distal fixed modular femoral prosthesis for the hip prosthesis revision. Methods Between August 2004 and May 2008, cementless modular femoral prosthesis was used for hip prosthesis revision in 21 cases. There were 9 males and 12 females, aged from 49 to 72 years (mean, 64.6 years). The timefrom revision to total hip arthroplasty was 2 to 18 years (mean, 11.7 years). The causes of revision included aseptic loosening in 19 cases (5 cases were periprosthetic femoral fracture), and deep infection in 2 cases. First revision was given in all patients. Preoperative Harris score was 41.8 ± 3.5; pain visual analogue score (VAS) was 7.62 ± 0.86. Results All patients achieved heal ing of incision by first intention, and no deep venous thrombosis and nerve injury occurred. Twenty-one cases were followed up 2 to 6 years with an average of 4.3 years. No prosthetic loosening or infection occurred. Bone ingrowth was observed around the implant during the follow-up period. At last follow-up, 2 cases had femoral stem subsidence without obvious hip pain and other symptoms, and no special treatment was given. Harris score was 82.7 ± 3.3 and VAS score was 0.19 ± 0.51 at last follow-up, showing significant differences when compared with those before operation (P lt; 0.05). Conclusion The short-term result of modular femoral prosthesis is satisfactory in hip prosthesis revision, and it can improve the hip function and rel ieve the pain greatly.
Objective To evaluate the surgical skill, cause of revision, compl ications, prosthetic survival and postoperative function in revision of custom-made tumor prosthesis replacement of knee joint. Methods The cl inical data of 33 patients who received prosthetic revision surgery between June 2002 and June 2007 were reviewed. There were 17 malesand 16 females with an average age of 33.1 years (range, 16-67 years). The pathological diagnosis included 17 osteosarcomas, 11 giant cell tumors, 2 mal ignant fibrous histocytomas, 1 chondrosarcoma, 1 synovial sarcoma, and 1 l iposarcoma. The involved locations were distal femur in 22 cases and proximal tibia in 11 cases. The average interval between first prosthetic replacement and revision surgery was 45.3 months (range, 6-180 months). The reason for revision included local recurrence in 2 cases, deep infection in 8 cases, aseptic loosening in 7 cases, peri prosthetic fracture in 1 case, prosthetic stem fracture in 6 cases, and prosthetic hinge failure in 9 cases. Six patients with deep infection received two-stage revision surgery, while the other 27 patients received one-stage revision. Cemented prostheses were used in all patients. Allograft prosthetic composite and revisions were used in 2 patients who had deficit of diaphysis for stem fixation. Results In 17 patients who received both primary prosthetic replacement and revision, the operative time was (149.8 ± 40.5) minutes and (189.9 ± 43.8) minutes, and the blood loss was (605.2 ± 308.0) mL and (834.1 ± 429.9) mL for primary prosthetic replacement and revision, respectively; all showing statistically significant differences (P lt; 0.05). The mean time of follow-up was 45.1 months (range, 12-76 months). Heal ing between allograft and host bone was obtained in 2 patients with allograft prosthetic composite and revision after 1.5 years and 2 years, respectively. After revision surgery, 3 patients died of lung metastasis after 12-24 months, and other 3 patients havinglung metastasis were al ive with disease. Nine (30%) compl ications occurred in 30 patients who were al ive at last follow-up. The compl ications included wound infection in 2 patients, deep infection in 5 patients, mechanical problems in 2 patients. Prosthetic failure occurred in 7 patients (23.3%). The 5-year survival rate of revised prosthesis was 68.6%. The Musculoskeletal Tumor Society (MSTS) score at 6 months after revision (73.6% ± 14.4%) was significantly improved (P lt; 0.01) when compared with before revision (57.1% ± 10.6%). Conclusion The main reasons for revision of custom-made tumor prosthesis of knee joint were mechanical problems and deep infection. Although revision surgery of knee is relatively compl icated and has some compl ications, a functional l imb could be maintained in most tumor patients.