Objective Using the mono-energy reconstruction images and X-ray films to investigate whether the ABG Ⅱ short-stem could improve the filling ratio, stability, and alignment in the Dorr type C femur, compared with the Corail long-stem. MethodsAmong patients who were with Dorr type C femurs and treated with total hip arthroplasty between January 2006 and March 2012, 20 patients with a Corail long-stem (Corail group) and 20 patients with an ABG Ⅱ short-stem (ABG Ⅱ group) were randomly selected. The differences in gender, age, body mass index, and preoperative diagnoses between the two groups were not significant (P>0.05). The ABG Ⅱ group was with a mean follow-up of 142 months (range, 102-156 months), and the Corail group was with a mean follow-up of 107 months (range, 91-127 months). There was no significant difference in the Harris score and subjective satisfaction score between the two groups at last follow-up (P>0.05). At last follow-up, dual-energy CT scans with mono-energy image reconstruction were used to calculate the prosthetic filling ratio and to measure the alignment of the prosthesis in the coronal and sagittal positions. Stability assessment was performed based on X-ray films, and the subsidence distance was measured using EBRA-FCA software. ResultsX-ray film observation showed that the prostheses in the two groups were stable and no signs of loosening was found. The incidence of pedestal sign was significantly lower in the ABGⅡ group than in the Corail group (P<0.05), and the incidence of heterotopic ossification was significantly higher in the ABGⅡ group than in the Corail group (P<0.05). The subsidence distance of femoral stem in ABG Ⅱ group was significantly greater than that in Corail group (P<0.05), and the subsidence speed of femoral stem in ABG Ⅱ group was also greater than that in Corail group, but the difference was not significant (P>0.05). The overall prosthesis filling ratio was significantly higher in the ABG Ⅱ group than in the Corail group (P<0.05), while the coronal filling ratio at the lesser trochanter, 2 cm below the lesser trochanter, and 7 cm below the lesser trochanter were not significant (P>0.05). The results of prosthesis alignment showed that there was no significant difference in the sagittal alignment error value and the incidence of coronal and sagittal alignment error >3° between the two groups (P>0.05), while the coronal alignment error value in the ABG Ⅱ group was significantly greater than that in the Corail group (P<0.05). Conclusion Although the ABG Ⅱ short-stem avoids the distal-proximal mismatch of the Corail long-stem in the Dorr type C femur and thus achieves a higher filling ratio, it does not appear to achieve better alignment or stability.
Objective To explore the effective method and the feasibil ity of the accurate l imb length equal ization in patients undergoing total hip arthroplasty (THA). Methods From September 2006 to September 2008, 52 patients underwentunilateral THA, including 36 males and 16 females, with an average age of 61.5 years (range, 46-76 years). Among these cases, there were 22 cases of avascular necrosis of the femoral head, 12 cases of hip osteoarthritis, 11 cases of femoral neck fracture, 4 cases of congenital dislocation of hip, and 3 cases of acetabular dysplasia. Forty cases had leg length discrepancy, and the shortened length of the legs was in the range of 10 mm to 35 mm with an average of 20 mm. The mean Harris score before operation was 45 points (range, 36-58 points). Based on the cl inical measurement and radiographic examination, the surgical protocols were designed, the type of the hip prosthesis was chosen, and the neck length of the femoral prosthesis, and the position of osteotomy were estimated. By the proper wearing of the acetabula, the best rotation point was found out. The cut plane of the femoral neck was adjusted according to the results of the radiographic and other examinations. The neck length was readjusted after the insertion of the prosthesis so as to achieve intended leg-length equal ization. The discrepancy of the leg length was measured and evaluated after operation. Results The incision healed by first intention in all patients. One patient had ischiadic nerve palsy and achieved full restoration after 5 months of symptomatic management. Forty-four patients were followed up 16 months on average (7-32 months). The mean Harris score was 87.5 points (80-91 points), showing significant difference (P lt; 0.05) whencompared with that before operation. The l imb length equal ization were got in 35 patients (equal ization rate was 79.5%). Seven patients had the prolong leg (from 10 mm to 18 mm), 2 patients had the shortened legs (15 mm and 25 mm, respectively). Conclusion By measurement of leg-length and radiographic examination before and during operation, the problem of unequal leg - length can be solved during the THA.
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.
【Abstract】 Objective To evaluate the flexibil ity of the treatment of osteoarthritis secondary to acetabular dysplasiaby total hip arthroplasty (THA) , in which the acetabular component is placed in the true acetabulum and femoral osteotomy is not performed. Methods From January 1999 to December 2005, 35 THA procedures were performed in 32 patients with 35 hips, including 6 males with 7 hips and 26 females with 28 hips, with the average age of 53 years (ranging from 28 years to 72 years). On the basis of Crowe classification, type I included 10 patients with 11 hips, type II included 14 patients with 15 hips, type III included 5 patients with 6 hips, and type IV included 3 patients with 3 hips. All patients experienced severe pain and dysfunction. In 19 cases, the leg length discrepancy was from 3 cm to 6 cm. The Harris score was 41.49 ± 10.13 before the operation. In all procedures, the soft tissue was released entirely and the acetabular component was placed in the true acetabulum, but femoral osteotomy was not performed. Results The average operation time of unilateral THA was 50 minutes. All patients were given transfusion from 2 U to 4 U. All incisions healed at the first stage. After the operation, the leg was lengthened 2-6 cm, and the two legs were equally long. The follow-up lasted for 12 to 60 months. The Harris score was 84.71 ± 9.34 after the operation, showing statistically significant differece (P lt; 0.05). According to cl inical outcomes and X-ray films, no dislocation, femoral fracture, femoral or sciatic nerve palsy was detected. Conclusion It is effective to use THA procedures for osteoarthritis secondary to acetabular dysplasia. If the soft tissue is released entirely, the leg will be lengthened 4-6 cm without nerve palsy.
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.
ObjectiveTo evaluate the early effectiveness of the robot-assisted total hip arthroplasty (THA) via direct superior approach (DSA).MethodsBetween March 2021 and April 2021, 11 patients (11 hips) were treated with a robot-assisted THA via DSA. There were 7 males and 4 females, with an average age of 55 years (range, 26-73 years). There were 5 patients of osteoarthritis secondary to hip dysplasia and 6 patients of osteonecrosis of femoral head. Preoperative hip Harris score was 55.8±6.3. The operation time, volume of blood loss, length of incision, postoperative blood transfusion and hospital stay, and the incidence of surgical complications were recorded. The visual analogue scale (VAS) score and Harris score were used to evaluate hip joint pain and function. The leg length discrepancy (LLD) was measured on the X-ray films. The inclination angle and anteversion angle of the acetabular component were also measured, and the difference between the planned and actual values were compared.ResultsOne THA was performed via conventional posterolateral approach finally because of poor exposure. The rest of 10 THAs were performed with assistance of robotic arm via DSA. The average operation time was 89 minutes (range, 65-120 minutes); the average length of incision was 10.5 cm (range, 9-13 cm); and the average blood loss was 400 mL (range, 110-740 mL). One patient was given a blood transfusion for 2 unit. All incisions healed by first intention and no neurovascular injury, deep vein thrombosis, or fracture occurred. The length of hospital stay after operation was 2-6 days (mean, 4.4 days). The duration of follow-up was 1-3 months (mean, 2.1 months). The VAS score was 0 in 9 patients and 2 in 1 patient at the day of discharge. At last follow-up, the hip Harris score was 84.9±6.7, showing significant difference when compared with that before operation (t=−8.717, P=0.000). The inclination and anteversion angles were (37.4±2.0)° and (17.1±4.5)°, respectively, and there was no significant difference when compared with the planned values [(38.2±1.6)°, (16.6±3.7)°] (t=1.809, P=0.104; t=–1.103, P=0.299). The LLD ranged from –2 to 4 mm. No complication such as dislocation, aseptic loosening, or periprosthetic joint infection occurred. ConclusionThe robot-assisted THA via DSA has encouraged early effectiveness.
ObjectiveTo investigate the effect of platelet rich plasma (PRP) in promoting wound healing of total hip arthroplasty (THA). MethodsBetween January 2011 and January 2012, 80 patients scheduled for THA and accorded with the inclusion criteria were divided into 2 groups:wounds were treated with PRP in 40 patients (PRP group) and with normal saline in 40 patients (control group). There was no significant difference in gender, age, disease duration, injury causes, sides, fracture type, and preoperative Harris hip scores between 2 groups (P>0.05). Routine drainage and functional exercise were performed after operation. ResultsThe postoperative drainage volume of PRP group[(137±26) mL] was significantly lower than that of control group[(424±39) mL] (t=38.726, P=0.000). At 4 days after operation, no inflammatory reaction was observed in 34 cases of PRP group and in 30 cases of control group, mild inflammatory reaction in 5 cases of PRP group and in 6 cases of control group, moderate inflammatory reaction in 1 case of PRP group and in 4 cases of control group; there was no significant difference between 2 groups (χ2=2.141, P=0.343). Wound healed by first intention in 40 patients of PRP group and in 39 patients of control group, showing no significant difference between 2 groups (P=1.000). The average follow-up period was 9 months (range, 6-12 months). The Harris hip scores of PRP group (90.2±2.5) and control group (89.3±3.1) at last follow-up were significantly better than those before operation (39.6±8.9 and 39.2±9.2 respectively) (t=34.618, P=0.000; t=32.638, P=0.000), but no significant difference was found between 2 groups (t=1.429, P=0.153). ConclusionUsing PRP in THA wound can reduce postoperative drainage volume, improve the healing of operation incision. It is a safe, effective, and promising procedure in treatment of THA wound.
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.
ObjectiveTo evaluate the accuracy of using smartphone to measure the angle of acetabular component in total hip arthroplasty (THA). MethodsBetween June 2012 and September 2015, the acetabular abduction and anteversion angles were measured in 50 patients undergoing THA. There were 24 males and 26 females, aged 37 to 83 years (mean, 71 years). The left hip was involved in 22 cases and the right hip in 28 cases. Of 50 patients, 34 suffered from fracture of the femoral neck, and 16 suffered from avascular necrosis of the femoral head. Acetabular dysplasia was excluded in all cases. A smartphone was used to measure the acetabular abduction and anteversion angles during operation; standard Picture Archiving and Communication Systems (PACS) was used to measured the acetabular abduction and anteversion angles on the X-ray film at 1 week after operation. It was defined as positive that the component angle values by PACS measurement were greater than those by the smartphone measurement, whereas as negative. The two measurement methods were compared, and intra-observer variability was assessed by analyzing the intraclass correlation coefficient (ICC), the Mann-Whitney U-test was used to analyze difference. ResultsThe ICC was 0.84 in the acetabular component angles by smartphone and PACS measurement methods. The acetabular component abduction angle was (44.02±1.33)° and the anteversion angle was (17.62±2.20)° by smartphone measurement. The acetabular component abduction angle was (44.74±4.05)° and the anteversion angle was (17.22±5.57)° by PACS measurement. There was no significant difference between two measurement methods (Z=-1.977, P=0.482; Z=-0.368, P=0.713). The acetabular component angle was in the safe zone in 44 cases; and the acetabular component anteversion angle was beyond safe range of 1 to 5°, and the abduction angle was beyond safe range of 1 to 3° in 6 cases. Intra-measurement variability was -21 to +10° for the anteversion angle and -10 to + 9° for the abduction angle, indicating that the acetabular component anteversion angle by smartphone measurement was greater than that by the PACS measurement, and the abduction angle was less than that by PACS measurement. ConclusionSmartphone is a convenient tool to measure the acetabular component angle in THA.
ObjectiveTo explore the surgical technique and the effectiveness of reconstructing the hip center in total hip arthroplasty (THA) for developmental dysplasia of hip (DDH). MethodsBetween January 2004 and January 2010, 29 patients (32 hips) with DDH underwent THA. There were 6 males (6 hips) and 23 females (26 hips), aged 45-67 years (mean, 50.6 years). The locations were left side in 22 hips and right side in 10 hips. According to Crowe classification, 12 hips were rated as Crowe I and 20 hips as Crowe II. The patients had limb length discrepancy of 1.9-4.4 cm. The Harris score was 50.7 ± 8.6. ResultsAll incisions healed by first intension. Posterior hip dislocation occurred in 1 case (1 hip) after operation. All patients were followed up 2 years-4 years and 6 months (mean, 2.3 years). The lower limbs were lengthened by 0.5-5.8 cm (mean, 2.5 cm). The Harris score was 87.7 ± 5.9 at 1 year after operation, showing significant difference when compared with preoperative score (t=21.77, P=0.00). X-ray films showed loosening of acetabular component in 1 case (1 hip) and displacement of acetabular component with too large abduction angle in 1 case (1 hip); no loosening and subsidence of acetabular or femoral components occurred in the other patients during follow-up. The horizontal location of hip center, the vertical distance between teardrop and the hip center, the vertical acetabular abduction angle, and the femoral offset were better than those before operation (P lt; 0.05). ConclusionFor DDH patients, reconstructing the hip center in THA can lengthen the limb, improve the joint function, and reduce the failure rate of joint replacement.