Objective To compare the effectiveness of one-stage bilateral total hip arthroplasty by direct anterior approach (DAA) and by posterolateral approach, and to investigate the application value of DAA in one-stage bilateral total hip arthroplasty. Methods The clinical data of 65 patients who underwent one-stage bilateral total hip arthroplasty by DAA or posterolateral approach between June 2010 and November 2015 were analyzed retrospectively. DAA was used in 34 cases (group A) and posterolateral approach was used in 31 cases (group B). There was no significant difference in the gender, age, body mass index, preoperative hemoglobin level, etiology, disease duration, preoperative Harris score, and preoperative visual analogue scale (VAS) score between 2 groups (P>0.05) with comparability. The incision length, operation time, intraoperative blood loss, total blood transfusion volume, hospitalization time, early postoperative complications, Harris score, and VAS score were recorded and compared between 2 groups. The simple Likert scale method was applied to evaluate the patient satisfaction, and the imaging evaluation was used. Results The incision length, operation time, intraoperative blood loss, total blood transfusion volume, and hospitalization time of group A were significantly less than those of group B (P<0.05). The patients were followed up 15-48 months (mean, 25.3 months) in group A and 12-51 months (mean, 27.6 months) in group B. The overall incidence of complications related to surgery in group A (10.29%) was significantly lower than that of group B (19.35%) (χ2=8.769, P=0.023). The acetabular anteversion and abduction angle were in the normal range of 2 groups except 1 hip (1.47%) of group A had a higher acetabular anteversion than normal value. Unstable fixed prosthesis happened in 1 hip of groups A and B respectively, and the remaining femoral calcar had no obvious bone resorption and fixed stably. The Harris score and VAS score at each time point after operation of 2 groups were significantly improved when compared with preoperative scores (P<0.05), and the differences between the time points after operation were also significant (P<0.05). The Harris score at 1 and 3 months after operation and the VAS score at 3 days after operation of group A were significantly better than those of group B (P<0.05), but no significant difference was found at last follow-up between 2 groups (P>0.05). According to the simple Likert scale method to analyze patient satisfaction, comprehensive satisfaction of group A (97.1%, 33/34) was significantly higher than that of group B (67.7%, 21/31) (χ2=10.343, P=0.001). Conclusion The application of DAA in one-stage bilateral total hip arthroplasty can significantly relieve the pain, accelerate the recovery of hip joint function, and improve the patient satisfaction. But in clinical application, more attentions should be paid to strictly grasp the indications and prevent the early complications. The long-term effectiveness needs to be further observed.
ObjectiveTo explore the feasibility and effectiveness of total hip arthroplasty (THA) with acetabulum structural bone grafting using autogenous femoral head through direct anterior approach (DAA) in lateral decubitus position in the treatment of Crowe type Ⅲ and Ⅳ developmental dysplasia of the hip (DDH). Methods Between June 2016 and July 2020, 12 patients with Crowe type Ⅲ and Ⅳ DDH were treated with THA with acetabulum structural bone grafting using autogenous femoral head through DAA in lateral decubitus position. There were 2 males and 10 females with an average age of 60.2 years (range, 50-79 years). Crowe classification was type Ⅲ in 10 hips and type Ⅳ in 2 hips. The preoperative Harris score of hip joint was 48.8±7.5, the difference in length of both lower extremities was (3.0±0.7) cm, and the visual analogue scale (VAS) score during activity was 7.2±0.9. The surgical incision length, operation time, intraoperative blood loss, and complications were recorded; the position and press-fitting of acetabulum and femoral prosthesis were observed after operation, and the difference in length of both lower extremities was measured; the horizontal coverage of acetabular cup and bone graft were measured, the healing with the host bone and the loosening of the prosthesis were evaluated; Harris score was used to evaluate hip joint function, and VAS score was used to evaluate patients’ pain during activity. Results The average surgical incision length was 9.3 cm, the average operation time was 117 minutes, and the average intraoperative blood loss was 283 mL. Two patients (16.7%) received blood transfusion during operation. There was no acetabular and femoral fractures during operation. All incisions healed by first intention, without dislocation, periprosthetic infection, sciatic nerve injury, deep venous thrombosis, and other complications. One patient had lateral femoral cutaneous nerve injury after operation. X-ray films at discharge showed a total acetabular cup level coverage of 93%-100%, with an average of 97.8%, and a bone graft level coverage of 25%-45%, with an average of 31.1%. All the 12 patients were followed up 22-71 months, with an average of 42.2 months. At last follow-up, the Harris score of hip joint was 89.7±3.9, the difference in length of both lower extremities was (0.9±0.4) cm, and the VAS score during activity was 1.1±0.6, which were significantly different from those before operation (P<0.05). During follow-up, there was no patient who needed hip revision surgery because of prosthesis loosening. At last follow-up, there was no translucent line between the graft and the host bone, the graft was fused, the position was good, and there was no obvious movement. One patient had one screw fracture and bone resorption at the outer edge of the graft, but the bone graft did not displace and healed well. ConclusionTHA with acetabulum structural bone grafting using autogenous femoral head through DAA in lateral decubitus position in the treatment of Crowe type Ⅲ and Ⅳ DDH is safe and reliable, and has satisfactory short-term effectiveness.
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 analyze the impact of robot assistance on the restoration of limb length and offset distance in total hip arthroplasty (THA). Methods A retrospective analysis was conducted on the clinical data of 316 patients who underwent unilateral primary THA between September 2019 and August 2023. Among them, 117 patients underwent robot-assisted THA (group A), and 199 patients underwent conventional THA (group B). There was no significant difference between the two groups in the gender, age, or side of the hip replacement (P>0.05); but there was a significant difference in the preoperative diagnosis (P<0.05). The leg length discrepancy (LLD) and global offset (GO) dfference were measured on preoperative anteroposterior pelvic X-ray films, and absolute values were used for comparison between groups. Results The operations in both groups were successfully completed. Postoperative imaging measurements showed that the LLD and GO dfference in group A were significantly lower than those in group B (P<0.05). Among them, group A had 32 cases (27.4%), 5 cases (4.3%), and 0 case (0) of LLD>3 mm, >5 mm, and >10 mm, respectively, while group B had 115 cases (57.8%), 75 cases (37.7%), and 22 cases (11.1%), respectively; and the differences in above indicators between groups were significant (P<0.05). Group A had 40 cases (34.2%), 3 cases (2.6%), and 0 case (0) of GO dfference>5 mm, >10 mm, and >20 mm, respectively; group B had 103 cases (51.8%), 54 cases (27.1%), and 7 cases (3.5%), respectively. There was no significant difference in the proportion of patients with GO>20 mm between groups (P>0.05), while there were significant differences in other indicators between groups (P<0.05). Conclusion Compared with traditional THA, robot assisted THA has more advantages in restoration of limb length and offset distance.
Objective To investigate the long-term effectiveness of primary total hip arthroplasty (THA) in treatment of Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods A clinical data of Crowe type Ⅳ DDH patients treated with primary THA between January 2002 and August 2008 and followed up more than 13 years was retrospectively analyzed. Forty-two patients (45 hips) met the selection criteria and were enrolled in this study. There were 13 males and 29 females with an average age of 43.5 years (range, 18-65 years). There were 39 patients of unilateral hip and 3 of bilateral hips. The preoperative Harris score was 38.3±10.7 and leg length discrepancy of the patients treated with unilateral THA was (50.52±24.51) mm. During operation, 19 hips underwent subtrochanteric shortening osteotomy, with an average length of 25 mm (range, 15-35 mm). The Harris score, subjective satisfaction, prosthesis survival rate, complications, and related imaging indicators were summarized. Results All patients were followed up 13.0-19.6 years (mean, 15.0 years). The complications included 1 hip of femoral nerve palsy, 2 hips of dislocation, 1 hip of periprosthetic fracture, 1 hip of periprosthetic joint infection. At last follow-up, the Harris score was 82.1±9.3, which significantly improved when compared with preoperative one (t=−21.885, P=0.000). The subjective satisfaction was evaluated as very dissatisfactory in 3 hips, dissatisfactory in 1 hip, generally in 4 hips, satisfactory in 17 hips, and very satisfactory in 20 hips. X-ray films showed that the height of the greater trochanter of affected side was 3.01-51.60 mm (mean, 23.22 mm); the descending distance of greater trochanter was 3.95-98.06 mm (mean, 48.20 mm); the affected limb lengthened 3.95-61.63 mm (mean, 34.92 mm); the leg length discrepancy of patients treated with unilateral THA was (12.61±8.56) mm, which was significantly shorter than that before operation (t=11.721, P=0.000). The vertical distance between the center of rotation of the affected side and the teardrop line was (14.65±6.16) mm, and the difference was not significant when compared with (15.60±4.99) mm of the healthy side (t=−0.644, P=0.525); the horizontal distance was (22.21±5.14) mm, and the difference was significant when compared with (34.48±5.63) mm of the healthy side (t=−12.973, P=0.000). Except for the non-union of 1 hip subtrochanteric shortening osteotomy, the other subtrochanteric osteotomies healed well. During follow-up, all the femoral stems obtained bone ingrowth fixation without radiolucent line or radiopaque line. With any reoperation and aseptic loosening as the endpoint, the prosthetic survival rates were 88.64% [95%CI (63.73%, 96.82%)] and 89.19% [95%CI (65.61%, 96.94%)], respectively. Conclusion For Crowe type Ⅳ DDH patients, primary THA combined with subtrochanteric shortening osteotomy if necessary, can obtain satisfactory long-term effectiveness and prosthetic survival rate.
Objective To explore the effectiveness of the combined anteversion angle technique in total hip arthroplasty (THA) for treating ankylosing spondylitis (AS) affecting the hip joint. Methods A retrospective analysis was conducted on the clinical data of 73 patients with AS affecting the hip joint who underwent THA between August 2018 and August 2021. According to whether the combined anteversion angle technique was used in THA, the patients were divided into study group (37 cases, combined anteversion angle technique was used in THA) and control group (36 cases, traditional THA). There was no significant difference in baseline data such as gender, age, body mass index, disease duration, preoperative Harris score, range of motion (ROM), acetabular anteversion angle, acetabular abduction angle, femoral anteversion angle, and combined anteversion angle between the two groups (P>0.05). The operation time, hospital stay, and complications of the two groups were recorded and compared. The Harris score and hip ROM were compared between the two groups before operation, at 1, 3, 6, 12 months after operation, and at last follow-up. The acetabular component anteversion angle, femoral component anteversion angle, acetabular component abduction angle, and component combined anteversion angle were measured postoperatively. ResultsThe operation time in the study group was significantly shorter than that in the control group (P<0.05), and there was no significant difference in hospital stay between the two groups (P>0.05). There was no intraoperative complication such as acetabular and proximal femoral fractures, neurovascular injuries in both groups, and the incisions healed by first intention. All patients were followed up 2-3 years, with an average of 2.4 years; there was no significant difference in the follow-up time between the two groups (P>0.05). During the follow-up period, there was no complication such as hip dislocation, wound infection, delayed wound healing, deep venous thrombosis, and hip dislocation in both groups. The hip Harris score and ROM of the two groups gradually increased with time after operation, and the differences were significant when compared with those before operation (P<0.05); the above two indicators of the study group were significantly better than those of the control group at each time point after operation (P<0.05). Extensive bone ingrowth on the surface of the components could be observed in the anteroposterior X-ray films of the hip joint of the two groups at 12 months after operation, and the acetabular components was stable without femoral stem subsidence, osteolysis around the components, and heterotopic ossification. At last follow-up, the acetabular component anteversion angle, femoral component anteversion angle, and component combined anteversion angle in the study group were significantly superior to those in the control group (P<0.05), except that there was no significant difference in the acetabular component abduction angle between the two groups (P>0.05). Conclusion For patients with AS affecting the hip joint, the use of the combined anteversion angle technique during THA effectively promotes the recovery of hip joint function and enhances the postoperative quality of life of patients when compared to traditional THA.
Objective To explore the cause of haematoma after the cemented total hip arthroplasty (THA) and find out the way to decrease the incidence of haematoma perioperatively. Methods From March 2000 to October 2006, 103 patientswere treated with the cemented THA. Among the patients, 44 were males and 59 were females with their ages ranging from 36 to 89 years, averaged 55.3 years.The femoral neck fracture (Garden 4) was found in 49 patients, avascular necrosis of the femoral head (Ficat 4) in 26, and osteoarthritis of the hip joint (Tonnis 3) in 28. Their illness course ranged from 1 day to 8 years. The average Harris score preoperatively was 36 (range, 1948). The patients were divided into Group A (n=43) and Group B (n=60). The patients in Group A underwent the conventional surgical operations from March 2000 to December 2003; the patients in Group Bunderwent the same surgical procedures combined with additional procedures (e.g., ligation of the external rotators before incision, use of plastic bandage after the drainage tube was pulled out, prolonged stay period in bed postoperatively) from January 2004 to October 2006. Results In Group A, postoperative haematoma occurred in 9 patients and the averaged 317.8±75.3 ml(range,110-410 ml) of the accumulated blood was drained with a syringe. An average amount for the firstdrainage of the accumulated blood was 86.7±30.7 ml(range, 50-125 ml)， and an average drainage time was 4.2(range, 2-7). In Group B, postoperative haematoma occurred in 2 patients, with an amount of 110 ml and 160 ml of the accumulated blood and an amount of 40 ml and 60 ml of the drained blood at thefirst drainage. There was statistical difference in the amount of heamotoma between two groups(P＜0.05). The followup of 91 patients (39 in Group A, 52 in Group B) for 1.2-5.5 years (average, 3.7 years) revealed that the Harris scores were 78 in Group A and 85 in Group B on average.The Harris score for pain was 44 (Grade A) in 16 patients, 40 (Grade B) in 24 patients, and 30 (Grade C) in 3 patients in Group A; Grade A in 48 patients,Grade B in 12 patients, and Grade C in none of the patients in Group B. There was no statistical difference in Harris score between the two groups (P＞0.05). Conclusion Additional surgical procedures for the cemented THA, such as ligation of the external rotators before incision, use of plastic bandage afterthe drainage tube is pulled out, and prolonged stay in bed postoperatively, can greatly help to reduce the incidence of postoperative haematoma and the amount of the accumulated blood.
Objective To systematically evaluate the difference in leg length discrepancy (LLD) between robot-assisted total hip arthroplasty (THA) and traditional THA. Methods The Cochrane Library, PubMed, Web of Science, EMbase, CNKI, Wanfang, VIP, and CBM databases were searched by computer to collect cohort studies of robot-assisted and traditional THAs from inception to August 11th, 2021. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 high-quality cohort studies were included. The results of Meta-analysis showed that compared with traditional THA, LLD after robot-assisted THA was smaller [MD=−1.64, 95%CI (−2.25, −1.04), P<0.001], Harris scores at 3 and 12 months after operation were higher [MD=1.50, 95%CI (0.44, 2.57), P=0.006; MD=7.60, 95%CI (2.51, 12.68), P=0.003]. However, the operative time was longer [MD=8.36, 95%CI (4.56, 12.17), P<0.000 1], and the postoperative acetabular anteversion angle was larger [MD=1.91, 95%CI (1.43, 2.40), P<0.001]. There was no significant difference in Harris score at 6 months, amnesia index (Forgotten joint score, FJS), postoperative acetabular abduction angle, and incidence of complication between the two groups (P>0.05). Conclusion Robot-assisted THA is superior to traditional THA in postoperative LLD.
Objective To explore the short-term effectiveness of hip revision surgery guided by artificial intelligence preoperative planning (AIHIP) system. Methods The clinical data of 22 patients (23 hips) who were admitted between June 2019 and March 2023 and met the selection criteria were retrospectively analyzed. There were 12 males and 10 females with an average age of 69.7 years (range, 44-90 years). There were 19 hips in the first revision, 3 hips in the second revision, and 1 hip in the third revision. The causes of revision included 12 hips with prosthesis loosening, 4 hips with acetabular cup loosening, 3 hips with osteolysis, 2 hips with acetabular dislocation, 1 hip with postoperative infection, and 1 hip with prosthesis wear. There were 6 hips in stage ⅡA, 9 hips in stage ⅡB, 4 hips in stage ⅡC, 3 hips in stage ⅢA, and 1 hip in stage ⅢB according to Paprosky staging of acetabular bone defect. The replacement of prosthesis type, operation time, hospitalization stay, ground active condition, and postoperative infection, fracture, prosthesis loosening, and other adverse events were recorded. The function of the affected limb was evaluated by Harris score before operation, at 1 week and 6 months after operation, and the range of motion of the hip joint was compared before operation and at 6 months after operation. Results The operation time was 85-510 minutes, with an average of 241.8 minutes; the hospitalization stay was 7-35 days, with an average of 15.2 days; the time of disassociation from the walker was 2-108 days, with an average of 42.2 days. All the 22 patients were followed up 8-53 months (mean, 21.7 months). No adverse events such as prosthesis loosening or infection occurred in the rest of the patients, except for postoperative hematoma of the thigh in 1 patient and dislocation of the hip in 1 hip. The matching degree of acetabular cup was completely matched in 22 hips and mismatched in 1 hip (+2), the matching rate was 95.65%. The matching degree of femoral stem was completely matched in 22 hips and generally matched in 1 hip (−1), and the matching rate was 100%. The Harris scores were 55.3±9.8 and 89.6±7.2 at 1 week and 6 months after operation, respectively, which significantly improved when compared with before operation (33.0±8.6, P<0.05), and further improved at 6 months after operation than at 1 week after operation (P<0.05). The function of hip joint was evaluated by Harris score at 6 months after operation, and 21 hips were good and 2 hips were moderate, which could meet the needs of daily life. The range of motion of hip joint was (111.09±10.11)° at 6 months after operation, which was significantly different from (79.13±18.50)° before operation (t=−7.269, P<0.001). Conclusion AIHIP system can improve the accuracy of revision surgery, reduce the difficulty of surgery, and achieve good postoperative recovery and satisfactory short-term effectiveness.
ObjectiveTo compare the effectiveness of three different fixation methods after subtrochanteric shortening osteotomy (SSO) in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods A clinical data of 63 patients (78 hips) with Crowe type Ⅳ DDH, who underwent THA with SSO between November 2014 and May 2019, was retrospectively analyzed. Among them, 18 patients (20 hips) obtained stability by intramedullary pressure provided by the S-ROM modular prostheses (group A); 22 patients (30 hips) underwent prophylactic binding by stainless steel wire after osteotomy and before stem implantation (group B); 23 patients (28 hips) were fixed with autogenous cortical strut grafts and stainless steel wire or cables (group C). There was no significant difference in gender, age, body mass index, affected limb side, and preoperative Harris score between groups (P>0.05). The operation time, complications, imaging results, hip functional score of the three groups were recorded and compared. Results There was no significant difference in the operation time between groups (P>0.05). All incisions healed by first intention. All patients were followed up, and the follow-up time was 2.5-4.0 years (mean, 3.1 years) in group A, 1.5-5.5 years (mean, 3.2 years) in group B, and 1.0-5.0 years (mean, 1.6 years) in group C. There was no significant difference in Harris score or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between groups at 4 and 12 months after operation (P>0.05). X-ray films showed that there was no significant difference in osteotomy healing rate at 4, 8, and 12 months after operation and the osteotomy healing time between groups (P>0.05). There was no complications such as joint dislocation, prosthesis loosening, prosthetic joint infection, or heterotopic ossification during follow-up, except for the distal femoral fracture of 1 hip during operation in group B. Conclusion In THA for patients with Crowe type Ⅳ DDH, the stainless steel wire binding alone and autogenous cortical strut grafts combined with stainless steel wire or cable binding can not significantly promote the osteotomy healing compared with femoral prosthesis intramedullary compression fixation. For patients with nonmatched medullary cavity after SSO, it is recommended to apply autogenous cortical strut grafts with wire or cables for additional fixation.