Objective To evaluate the mid-term effectiveness of two-stage hip prosthesis revision in the treatment of infection after hip arthroplasty. Methods Between April 2002 and November 2006, 12 cases of infection after hip arthroplasty were treated. There were 5 males and 7 females, aged from 47 to 72 years (mean, 59.8 years). The femoral head arthroplasty wasperformed in 2 cases and total hip arthroplasty in 10 cases. Infection occurred 1 to 67 months after arthroplasty. According to the Segawa classification criteria, infections included type 2 in 1 case, type 3 in 2 cases, and type 4 in 9 cases. The preoperative Harris score was 36.7 ± 6.1. Nine cases had elevated C reactive protein and 10 cases had elevated erythrocyte sedimentation rate. The results of bacterial culture were positive in 8 cases and negative in 4 cases. After the removal of the infected prosthesis and thorough debridement, antibiotic-loaded cement spacers or infected therapeutic temporary prosthesis were used as placeholders, and then the anti-infection treatments were given after operations; two-stage hip prosthesis revisions were performed 3 to 10 months after debridement. Results In 1 patient who failed to control infection after debridement, infection was controlled after the second debridement and the antibiotic-loaded cement spacer as placeholder. Other patients achieved heal ing of incision by first intention, and no compl ication such as deep venous thrombosis and nerve injury occurred. All patients were followed up 3 to 8 years after revision (mean, 5.4 years). During the follow-up, no infection recurrence and joint dislocation occurred. Dull pain was present in 2 cases during activity and mild claudication in 3 cases at last follow-up. The Harris score was 81.6 ± 4.5, showing significant difference (t=52.696, P=0.000) when compared with preoperative score. The X-ray films showed that noprosthesis loosening and obvious subsidence were observed, and bone graft healed. Conclusion The two-stage hip prosthesis revision has good infection control rate and mid-term effectiveness in treatment of infection after hip arthroplasty.
Objective To review progress of clinical application ofmorselized bone and to investigate relative exploration on it.Methods The recent articles on morselized bone in the field of clinicand experimental research were extensively reviewed, and relative examination of morselized bone referring to method and mechanism were investigated carefully.Results Morselized bone worked well clinically, especially inrevision ofartificial total hip joint, and it was proved effective with lots of advantages.Conclusion Morselized bone functions well clinically. Although its mechanism requires a further research, it still has a promising value in clinical application.
Objective To evaluate the effectiveness of acetabulum reinforcement ring (Cage) with allograft bone for reconstructing acetabular defects in hip revision. Methods Between February 2006 and August 2010, 14 patients (14 hips) with serious acetabular bone defects after total hip arthroplasty underwent acetabular reconstruction by using Cage with allograft bone. There were 6 males and 8 females with a mean age of 59.2 years (range, 45-76 years). The mean time between first replacement and revision was 7.2 years (range, 5-12 years). The revision causes included infection in 8 cases, osteolysis and aseptic loosening in 6 cases. The hip function Harris score was 37.7 ± 5.3. According to America Association of Orthopedic Surgeon (AAOS) standard, the acetabular defect was classified as type III in 8 cases and as type IV in 6 cases. Results All incisions healed by first intention, and no complication occurred. The patients were followed up 14-62 months (mean, 44 months). The pain was relieved or disappeared. At last follow-up, the Harris score was 89.7 ± 3.2, showing significant difference when compared with preoperative score (t= — 44.40, P=0.04). No loosening of the acetabular component or osteolysis was found in 14 hips. No absorption or collapse of the allograft was observed in all patients. Conclusion Cage with allograft bone is a useful method of reconstructing acetabular bone defects in hip revision. Further follow-up is needed to assess the long-term effectiveness.
ObjectiveTo investigate revision reasons and prosthesis selection of Crowe Ⅳ developmental dysplasia of the hip (DDH) after total hip arthroplasty (THA). MethodsA clinical data of 14 patients (15 hips) with Crowe Ⅳ DDH, who underwent a revision hip arthroplasty between January 2008 and May 2018, was retrospectively reviewed. There were 1 male (1 hip) and 13 females (14 hips). The age ranged from 27 to 63 years (mean, 45.0 years). There were 7 cases of left hip, 6 cases of right hip, and 1 case of bilateral hips. The prosthetic interfaces of primary THA were metal-on-polyethylene (MOP) in 9 hips, ceramic-on-ceramic (COC) in 4 hips, ceramic-on-polyethylene (COP) in 1 hip, and ceramic-on-metal in 1 hip. The time from primary THA to revision was 3-204 months (mean, 65.0 months). The causes of revision included aseptic loosening in 7 hips, dislocation in 3 hips, periprosthetic joint infection in 2 hips, osteolysis in 1 hip, nonunion of osteotomy in 1 hip, and a small-angle of femoral anteversion in 1 hip. Preoperative Harris score was 54.1±17.8 and the range of motion (ROM) of flexion was (92.7±20.2)°. Preoperative X-ray films showed the acetabular bone defect in 11 hips and osteolysis of femoral side in 4 hips. During the revision, the prostheses with COP and COC interfaces were used in 5 hips and 10 hips, respectively. Both acetabular and femoral revisions were performed in 11 hips and only femoral revision was performed in 4 hips.ResultsThe mean operation time was 3.7 hours (range, 1.5-6.0 hours). The mean intraoperative blood loss was 940.0 mL (range, 200-2 000 mL). All patients were followed up 16-142 months (mean, 73.9 months). Postoperative X-ray films showed no difference in inclination and anteversion between primary THA and revision (P>0.05). The height of rotation center and offset after revision were higher than those after primary THA, and the difference in offset was significant (P<0.05). At last follow-up, the Harris score and ROM of flexion were 85.0±7.3 and (115.0±17.0)°, respectively, which were significantly higher when compared with those before revision (t=8.909, P=0.000; t=4.911, P=0.000). Three hips underwent a re-revision operation. All protheses were fixed well and no radiolucent line, loosening, or subsidence was observed at last follow-up.ConclusionThe most common reason for revision in patients with Crowe Ⅳ DDH after THA was aseptic loosening. Due to high activity demand of this population, the prosthesis with MOP interface should be prevented and the prosthesis with COC interface could be alternative. Metal block, cup-cage, and reinforcement ring were reasonable solutions for reconstruction of acetabulum with severe bone defects and have satisfactory effectiveness. S-ROM prosthesis should be the preferred stem for neither primary THA or revision.
ObjectiveTo review research progress on the design, manufacturing, and clinical application of three-dimensional (3D) printed customized prosthesis in acetabular reconstruction of hip revision surgery. MethodsThe related research literature on 3D printed customized prosthesis and its application in acetabular reconstruction of hip revision surgery was searched by key words of “3D printed customized prosthesis”, “revision hip arthroplasty”, “acetabular bone defect”, and “acetabular reconstruction” between January 2013 and May 2024 in Chinese and English databases, such as CNKI, Wanfang database, PubMed, etc. A total of 34 271 articles were included. After reading the literature titles, abstracts, or full texts, the literature of unrelated, repetitive, low-quality, and low evidence level was screened out, and a total of 48 articles were finally included for analysis and summary. ResultsThe bone growth and mechanical properties of 3D printed customized prosthesis materials are better than those of non-3D printed customized prosthesis, which further solves the problem of elastic modulus mismatch between the implant and natural bone caused by “stress shielding”; the porous structure and antibacterial coating on the surface of 3D printed customized prosthesis have good anti-bacterial effect. 3D printed customized prosthesis can perfectly match the patient’s individual acetabular anatomical characteristics and defect type, thus improving the accuracy of acetabular reconstruction and reducing the surgical time and trauma. Conclusion3D printed customized prosthesis can be used for precise and efficient individualized acetabular reconstruction in hip revision surgery with good early- and mid-term effectiveness. More optimized production technics and procedures need to be developed to improve the efficiency of clinical application and long-term effectiveness.
Revision of anterior cruciate ligament (ACL) reconstruction is more challenging than primary ACL reconstruction and often yields less favorable outcomes. The European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) has established a consensus regarding preoperative diagnosis, assessment, and selection criteria for ACL revision surgery. This consensus addresses 18 key issues that are most pertinent to clinical practice, providing guiding recommendations aimed at improving the prognosis of ACL revisions.
ObjectiveTo assess the mid-term effectiveness of anterior cruciate ligament (ACL) revision and to analyze the relevant factors that may affect the surgical outcomes.MethodsThe clinical data of 24 patients who underwent ACL revision surgery between April 2009 and July 2018 and were followed up for more than 2 years were retrospectively analyzed. There were 20 males and 4 females with a median age of 30 years [interquartile distance (IQR) was (25, 36) years]. The median body mass index was 24.45 kg/m2 and IQR was (22.93, 25.93) kg/m2. The median time between ACL revision and reconstruction was 41 months and IQR was (15, 85) months. The direct cause of the failure of reconstruction surgery included 14 cases of trauma, 8 cases of no obvious cause, and 2 cases of infection. During the revision operation, 14 patients had a poor bone tunnel position, all of which were drilled with new tunnels, the remaining 10 patients were freshly modified on the basis of the original bone tunnel. Seventeen patients used autogenous tendon revision, 7 patients used LARS ligament; 16 patients had cartilage injury. The Lysholm score, the International Knee Documentation Committee (IKDC) score, and the Tegner sports rating score were used for functional evaluation before operation, at 1 year after operation, and at last follow-up. The Likert satisfaction score was recorded at last follow-up.ResultsPatients were followed up with a median time of 47 months and IQR was (32, 61) months. The Lysholm score, IKDC score, and Tegner sports rating score were significantly improved at 1 year after operation and at last follow-up when compared with preoperative scores (P<0.05). There was no significant difference between at last follow-up and at 1 year after operation (P>0.05). At last follow-up, the median Likert satisfaction score was 4.0 and IQR was (3.0, 4.5). According to the presence or absence of cartilage damage and the type of graft, the above scores at last follow-up were compared between the groups, and the differences were not significant (P>0.05). At last follow-up, 2 patients had graft fractures due to trauma again, and autogenous iliac bones were taken to fill the bone tunnel, and the second stage was revised; the rest of the patients recovered satisfactorily.ConclusionWith preoperative identification of the cause of ACL reconstruction failure, the stability and function of knee joint can be significantly improved by selecting appropriate bone tunnels and grafts during the revision and by active rehabilitation exercises.
ObjectiveTo investigate the influence of buried thread nasal augmentation on dorsal soft tissue of nose and revision rhinoplasty. Methods A clinical data of 29 patients requesting revision rhinoplasty after buried thread nasal augmentation, who were admitted between July 2017 and July 2019 and met the selection criteria, was retrospectively analyzed. All patients were female with an average age of 26.8 years (range, 18-43 years). The patiens were admitted to the hospital at 3-48 months after buried thread nasal augmentation (median, 15 months). Among them, there were 18 cases of insufficient nasal tip projection, 22 cases of insufficient nasal root projection, 7 cases of threads ectasia, 5 cases of threads exposure, 3 cases of infection, and 10 cases with two or more conditions. There were 9 cases of combined short nose deformity, 1 case of spherical hypertrophy of the nasal tip, 3 cases of deviation of the nasal columella, 3 cases of excessive width of the nasal base, and 1 case of nasal hump. Three infected patients only underwent threads removal and debridement. The rest patients underwent revision rhinoplasty, and the dorsum of the nose was made with polytetrafluoroethylene expansion; the tip of the nose was reshaped by taking autologous rib cartilage and alar cartilage in 16 cases, and by taking autologous septal cartilage and alar cartilage in another 10 cases. The threads and surrounding tissue specimens removed during operation were subjected to histologic observation. Nasal length and nasal tip projection were measured after revision rhinoplasty and the ratio was calculated to evaluate the nasal morphology; patient satisfaction was evaluated using the Likert 5-grade scale. ResultsPatients were followed up 12-48 months (mean, 18 months). Inflammation was controlled in 3 patients with infections caused by buried thread nasal augmentation. The remaining 26 patients had satisfactory results immediately after revision rhinoplasty. Before revision rhinoplasty and at 7 days and 6 months after revision rhinoplasty, the nasal length was (4.11±0.34), (4.36±0.25), and (4.33±0.22) cm, respectively; the nasal tip projection was (2.34±0.25), (2.81±0.18), and (2.76±0.15) cm, respectively; and the nasal tip projection/nasal length ratio was 0.57±0.08, 0.65±0.05, and 0.64±0.04, respectively. There were significant differences in the nasal length and the nasal tip projection between time points (P<0.05). There was a significant difference in the nasal tip projection/nasal length ratio between pre- and post-operation (P<0.05), but there was no significant difference between 7 days and 6 months after operation (P>0.05). The Likert score for satisfaction ranged from 1.5 to 5.0 (mean, 4.05). During follow-up period of 26 patients, no nasal prosthesis was exposed, and the shape of the nose was stable, and the nasal skin of 5 patients with exposed threads could be seen with different degrees of scarring; there was no infection, cartilage resorption, and no cartilage deformation, displacement, or exposure. Histological observation showed that absorbable threads were not only absorbed after implantation, but also with the prolongation of time, the inflammatory changes in the surrounding tissues caused by decomposition and absorption of the threads showed a gradual aggravation of the first, the heaviest inflammatory reaction in 6 to 12 months, and then gradually reduce the trend. Conclusion After implantation of the absorbable thread into the subcutaneous tissue of the nasal dorsum, the nature of the thread is different from the body’s own tissue, which will affect the soft tissue compliance of the nasal dorsum. The degradation and absorption of the thread will stimulate the infiltration of inflammatory cells and the proliferation of fibroblasts in the surrounding tissue and then form scar tissue, which will affect the design and effect of revision rhinoplasty.
Objective To investigate the effectiveness of slope-reducing tibial osteotomy and anterior cruciate ligament (ACL) revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased posterior tibial slope (PTS). Methods The clinical data of 9 patients with primary ACL reconstruction failure and abnormally increased PTS (≥17°) who met the selection criteria between January 2018 and January 2020 were retrospectively analyzed. There were 8 males and 1 female; the age ranged from 21 to 42 years, with a median age of 30 years. Lachman test was positive in 9 patients. Pivot-shift test was negative in 6 cases, degree Ⅰ positive in 2 cases, and degree Ⅱ positive in 1 case. The PTS was (17.78±1.09)° and the anterior tibial translation (ATT) was (11.58±1.47) mm. The International Knee Documentation Committee (IKDC) score was 51.0±3.8, Lysholm score was 49.7±4.6, and Tegner score was 3.7±0.7. The time from primary reconstruction to revision was 12-33 months, with an average of 19.6 months. Slope-reducing tibial osteotomy and ACL revision were performed. The improvement of knee function was evaluated by IKDC score, Lysholm score, and Tegner score; Lachman test and Pivot-shift test were used to evaluate the stability of knee joint. PTS and ATT were measured to observe the morphological changes of knee joint. Results All the incisions healed by first intention, and there was no complication such as incision infection, fat liquefaction, necrosis, deep vein thrombosis of lower extremities, and neurovascular injury. All 9 patients were followed up 12-36 months, with an average of 25.8 months. At last follow-up, Lachman test and pivot-shift test were negative. IKDC score was 85.0±4.0, Lysholm score was 87.7±2.8, Tegner score was 6.8±0.7, PTS reduced to (9.89±0.60)°, and ATT shortened to (0.91±0.29) mm, which were significantly improved when compared with those before operation (P<0.05). ConclusionSlope-reducing tibial osteotomy and ACL revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased PTS has a satisfactory short-term effectiveness. It can improve the stability of knee joint and maintain the normal shape of knee joint.
ObjectiveTo explore the correlation between the Barthel index score and other factors with the preoperative occurrence of deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA) revision surgery. MethodsA retrospective analysis was conducted on clinical data from 122 patients who met the inclusion criteria and underwent THA revision surgery between April 2017 and November 2020. Among them, 61 were male and 61 were female, with an age range of 32-85 years (mean, 65.3 years). The reasons for revision included prosthetic joint infection in 7 cases, periprosthetic fracture in 4 cases, prosthetic dislocation in 6 cases, and aseptic loosening in 105 cases. The Barthel index score was 76.4±17.7, with 10 cases classified as level 1, 57 as level 2, 37 as level 3, and 18 as level 4. Univariate analysis was performed on variables such as age, gender, body mass index, Barthel index score, preoperative D-dimer positivity, history of diabetes, hypertension, cancer, cerebral infarction, smoking, and thrombosis in patients with and without preoperative DVT. Furthermore, logistic regression was used to identify risk factors for preoperative DVT in THA revision surgery. The incidence of preoperative DVT was compared among different Barthel index score groups. ResultsPreoperative DVT was detected in 11 patients (9.02%), all of whom had intermuscular venous thrombosis. Among them, 1 had prosthetic joint infection, 1 had periprosthetic fracture, 1 had prosthetic dislocation, and 8 had aseptic loosening. Univariate analysis showed significant differences between the two groups in terms of age, gender, and Barthel index score (P<0.05). logistic regression further revealed that female, age ≥70 years, and Barthel index score<60 were independent risk factors for preoperative DVT in patients undergoing THA revision surgery (P<0.05). The incidence of preoperative DVT in patients with Barthel index scores of levels 1, 2, 3, and 4 were 0 case (0%), 2 cases (3.5%), 3 cases (8.1%), and 6 cases (33.3%), respectively. A significant correlation was found between Barthel index score classification and the incidence of preoperative DVT in patients undergoing THA revision surgery (χ2=10.843, P=0.001). ConclusionIn patients undergoing THA revision surgery, older age, female, and lower Barthel index scores are associated with higher preoperative DVT incidence. For patients with low preoperative Barthel index scores, preoperative thrombosis screening should be emphasized.