Objective To investigate clinical significanceand surgical protocols about the balance of the lower limb lengths in the total hip arthroplasty. Methods Forty-eight patients undergoing the unilateral primary total hip arthroplasty from March 2000 to October 2004 were retrospectively studied. In 12 hips, the prostheses were of the cement type; in 36 hips, of the mixture type. Thirty patients with an equal limb length had a fractured femoral neck, 10 patients had a shortened (1.0-2.0 cm) limb, 6 patients had a shortened (2.0-4.0 cm)limb, and 2 patients had a shortened (4.0-6.0 cm) limb. Based on the clinical measurement and radiographic examination, the surgical protocols were designed, the hip prosthesis type was chosen, and the neck length of the femoral prosthesis and the position of osteotomy were estimated. By the wearing of the acetabula properly, the best rotation point was found out during the operation. 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 an intended limblength equalization. Results All the patients were followed up for 3-42 months.According to the Harris scoring system, clinical results were excellent in 30 patients, good in 12, fair in4, and poor in 2. Of the 30 patients with an equal limb before operation, 5 were lengthened 1.0-2.0 cm in their lower limbs, and 1 lengthened 2.5 cm postoperatively. Of the 18 patients with shortened limbs before operation, 10 returned to the same lengths in their lower limbs, 6 were lengthened 1.0-2.0 cm in their lower limbs, but 2 with seriously-shortened lower limbs for congenital dysplasia of the hipjoint were still shortened 2.0-3.0 cm in the limb length after operation. The Harris hip scores revealed an average of 92.3 points in the patients with an equal limb length, and 88.6 points in the patients with shortened limbs. 〖WTHZ〗Conclusion Many factors, such as surgical protocols, prosthesis type designs, and the management techniques during the operation, can affect the limb length after operation. As the limb length discrepancy will make the patients feel disappointed, the clinical measurements are very important before operation. Application of the comprehensive appraisal methods during the operation, use of the soft tissuebalance method, and skills for obtaining an equal limb length during the total hip arthroplasty are also important for improving the surgical result further.
Objective To summarize the techniques of the total hip arthroplasty in the treatment of osteoarthritis secondary to developmental dysplasia of the hip joint(DDH). Methods Between February 1986 and November2004, a total of 32 hips in 24 patients with advanced osteoarthritis secondary to DDH underwent the total hip arthroplasty. Among the patients, 4 were male and 20 were female, with their ages ranging from33 to 59 years and an average age of 47 years. The bilateral arthroplasty was performed in 8 patients and the unilateral arthroplasty in 16 patients. The patients mainly suffered from pain and claudication. According to the Hartofilakidis classification, semi-dislocation occurred in 2 hips, lowdislocation in 21 hips,and high-dislocation in 9 hips; and the Harris scores before operation were 56.70±2.75, 36.09±4.16, and 29.45±2.16, respectively. Results All the patients were followed up for 6 months to 8 years (averaged 3 yearsand 4 months). The Harris scores after operation were 93.10±2.10，92.7±3.20，and 88.09±3.67，respectively. The differences between peroperation and postoperation were significant(P＜0.01). All the patients were pain-free and there wasno sign of aseptic loosening and subsidence. Conclusion The total hip arthroplasty is an effective method for the treatment of osteoarthritis secondary to DDH. The key techniques for the total hip arthroplasty are as follows: deepening the medial wall of the acetabulum, improving the techniques of the bone graft, and firmly placing the acetabular component in the true acetabulum.
ObjectiveTo evaluate the effectiveness of spinal wedged osteotomy and total hip arthroplasty (THA) for treatment of kyphosis and severe hip flexion contracture caused by ankylosing spondylitis (AS). MethodsBetween December 2008 and November 2011,25 patients (37 hips) with kyphosis and severe hip flexion contracture caused by AS were treated.There were 22 males and 3 females,aged 29-38 years (mean,35.6 years).The disease duration was 8-16 years (mean,13.2 years).Of them,18 cases had complete limitation of hip motion,and 16 cases had severe spine deformity (Cobb's angel ≥60°).All 25 cases underwent spinal wedged osteotomy at first,and then received THA after 8 weeks.The effectiveness was evaluated by Harris hip score,range of motion (ROM) of the hip,visual analogue scale (VAS) score,Cobb's angle,and information and data exchange system (IDES) criteria for aseptic loosening,respectively. ResultsThe patients were followed up 12-14 months (mean,13 months).Spondylolisthesis (Ⅱ degree) occurred in 1 case spinal after wedged osteotomy,and was corrected after second operation.No vascular injury or spinal cord injury was observed.Bony fusion was obtained at osteotomy ends at 6 months after operation.The Cobb's angle was significantly corrected from (83.5±10.4)° preoperatively to (25.4±5.5)° (t=24.63,P=0.00) 12 months postoperatively.One case had traction injury of the femoral nerve after THA,and the muscle function recovered at 9 months after operation.According to IDES criteria,up-displacement of cup (<5 mm) was observed in 1 patient,who had no obvious clinical symptoms; periacetabular osteolysis occurred in 1 patient,with no displacement of cup.No obvious radiolucent was seen in 37 hips.The Harris hip score was significantly improved from (26.87±4.23) preoperatively to (85.92±6.04) (t=28.72,P=0.00) 3 months postoperatively; the VAS score was significantly decreased from (6.71±1.14) preoperatively to (2.31±0.82) (t=42.26,P=0.00) 3 months postoperatively; and the flexion-extension ROM of the hip was significantly improved to 60-100° (mean,72.0°) at post-operation,and the abduction ROM of the hip was improved to 20-40° (mean,28.7°). ConclusionSpinal wedged osteotomy combined with THA is an efficient treatment for kyphosis and severe hip flexion contracture caused by AS.
Objective By comparing with the traditional X-ray template measurement method, to explore the accuracy of artificial intelligence preoperative planning system (AI-HIP) to predict the type of prosthesis and guide the placement of prosthesis before total hip arthroplasty (THA) in adult patients with developmental dysplasia of the hip (DDH). Methods Patients with DDH scheduled for initial THA between August 2020 and August 2022 were enrolled as study object, of which 28 cases (28 hips) met the selection criteria were enrolled in the study. Among them, there were 10 males and 18 females, aged from 34 to 77 years, with an average of 59.3 years. There were 12 cases of the left DDH and 16 cases of the right DDH. According to DDH classification, there were 10 cases of Crowe type Ⅰ, 8 cases of type Ⅱ, 5 cases of type Ⅲ, and 5 cases of type Ⅳ. According to Association Research Circulation Osseous (ARCO) staging of osteonecrosis of the femoral head, 13 cases were in stage Ⅲ and 15 cases in stage Ⅳ. The disease duration was 2.5-23.0 years (mean, 8.6 years). The limb length discrepancy (LLD) was 11.0 (8.0, 17.5) mm. Before operation, the prosthesis types of all patients were predicted by AI-HIP system and X-ray template measurement method, respectively. And the preoperative results were compared with the actual prosthesis type during operation in order to estimate the accuracy of the AI-HIP system. Then, the differences in the acetabular abduction angle, acetabular anteversion angle, femoral neck osteotomy position, tip-shoulder distance, and LLD were compared between preoperative planned measurements by AI-HIP system and actual measurement results after operation, in order to investigate the ability of AI-HIP system to evaluate the placement position of prosthesis. Results The types of acetabular and femoral prostheses predicted based on AI-HIP system before operation were consistent with the actual prostheses in 23 cases (82.1%) and 24 cases (85.7%), respectively. The types of acetabular and femoral prostheses predicted based on X-ray template measurement before operation were consistent with the actual prostheses in 16 cases (57.1%) and 17 cases (60.7%), respectively. There were significant differences between AI-HIP system and X-ray template measurement (P<0.05). There was no significant difference in acetabular abduction angle, acetabular anteversion angle, femoral neck osteotomy position, and tip-shoulder distance between AI-HIP system and actual measurement after operation (P>0.05). LLD after operation was significantly lower than that before operation (P<0.05). There was no significant difference between the LLD predicted based on AI-HIP system and the actual measurement after operation (P>0.05). Conclusion Compared with the traditional X-ray template measurement method, the preoperative planning of AI-HIP system has better accuracy and repeatability in predicting the prosthesis type. It has a certain reference for the prosthesis placement of adult DDH.
Objective To summarize the effectiveness of acetabulum reconstruction with autologous femoral head structural bone graft in total hip arthroplasty (THA) for Hartofilakidis type Ⅱ developmental dysplasia of the hip (DDH). Methods A clinical data of 24 patients (27 hips) with Hartofilakidis type Ⅱ DDH, who underwent acetabulum reconstruction with autologous femoral head structural bone graft in primary THA between October 2012 and October 2020, was retrospectively analyzed. There were 3 males and 21 females, with an average age of 40 years (range, 20-58 years). The body mass index was 19.5-35.0 kg/m² with an average of 25.0 kg/m². There were 21 cases of unilateral hip and 3 cases of bilateral hips. The hip Harris score was 51.1±10.0. The leg length discrepancy of unilateral hip patients was (19.90±6.24) mm. The intraoperative blood loss, wound healing, and complications were recorded. The postoperative bone union, coverage rates of acetabular prosthesis and bone graft, and aseptic loosening of the prosthesis were evaluated based on X-ray films, and the improvement of hip function was observed by Harris score. Results The intraoperative blood loss was 50-1000 mL (median, 350 mL). All incisions healed by first intention, and no fracture, hematoma, infection, or other complications occurred. Sciatic nerve injury occurred in 1 case (1 hip) and deep venous thrombosis occurred in 1 case (1 hip). All patients were followed up 15-103 months (median, 40.5 months). At last follow-up, Harris score was 92.6±4.1 and the difference was significant when compared with preoperative value (t=−28.043, P=0.000). No hip prosthesis needed revision. X-ray films showed that the coverage rate of acetabular prosthesis was 91%-100% (mean, 97.8%), and the coverage rate of bone graft was 13%-46% (mean, 23.8%). The healing time of bone graft was 3-6 months (mean, 4.7 months). At last follow-up, all bone grafts completely healed without any signs of collapse. There was no graft resorption, ectopic ossification or osteolysis, or obvious aseptic loosening of the acetabular and femoral prostheses. The leg length discrepancy of unilateral hip patients was (2.86±2.18) mm, and the difference was significant when compared with preoperative value (t=17.028, P=0.000). Conclusion For Hartofilakidis type Ⅱ DDH patients, if the lateral acetabular prosthesis not covered by the host bone exceeds 5 mm in primary THA, autologous femoral head can be used for structural bone grafting, and the short- and mid-term effectiveness are favorable.
Objective To retrieve and summarize the best evidence for fall prevention after total hip arthroplasty in elderly patients. Methods BMJ Best Practice, UpToDate, JBI evidence-based healthcare center database, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, Cochrane Library, PubMed, Web of Science, EBSCO, International Collaboration of Orthopaedic Nurisng website, American Academy of Orthopaedic Surgeons website, European Society for Trauma and Emergency Surgery website, Medlive, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were systematically searched. The retrieval time was from the establishment of the databases to June 30, 2024. The quality of literature was evaluated, and evidence was extracted, evaluated, and summarized. Results A total of 12 articles were included, including 4 guidelines, 2 randomized controlled trials, 2 cohort studies, and 4 expert consensus studies. A total of 18 pieces of evidence were extracted, including 13 A-level recommendations and 5 B-level recommendations. The evidence covers six major themes of risk factors, assessment, multidisciplinary team support, health education, medication management, safety environment, and assistive devices. Conclusions The fall prevention after total hip arthroplasty in elderly patients involves multiple factors, and the fall prevention should be based on multidisciplinary team cooperation, achieving linkage between the hospital and the family to jointly ensure patient safety. In the future, it is recommended to combine individual patient differences with actual clinical scenarios when applying evidence.
目的 观察强直性脊柱炎髋关节受累强直时行全髋关节置换术的临床疗效。 方法 对2003年1月-2008年1月45例(78髋)强直性脊柱炎患者行全髋关节置换术，其中38例(55髋)进行了平均4.5年（2~7年）的随访。 结果 38例患者术后髋关节功能均明显改善，Harris评分由术前（16.3±1.7）分提高到术后（83.4±4.6）分。髋关节屈曲畸形矫正，55个髋关节总活动度(屈伸、内收、外展、内旋、外旋等6个方向活动总和)由术前（38.7±7.6）°增加至术后（191.2±10.3）°。术后髋关节疼痛消失，膝关节痛、腰骶部疼痛明显改善，步态较术前改善，生活自理。 结论 短期随访全髋关节置换术治疗强直性脊柱炎髋关节受累强直安全、有效。
【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.
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 compare the early rehabilitation effects of total hip arthroplasty (THA) with direct anterior approach (DAA) versus posterior approach (PA). Methods A retrospective analysis was made in the data of 83 patients with unilateral osteonecrosis of the femoral head between March 2014 and May 2017. Forty-eight patients were treated with THA via PA (PA group) and 35 patients were treated with THA via DAA (DAA group). There was no significant difference in gender, age, body mass index, stage of osteonecrosis of the femoral head, and disease duration between 2 groups (P>0.05). The length of incision, operation time, total amount of bleeding, the time of first postoperative walking with crutch, the time of first postoperative walking without crutch, the Harris scores, and the visual analogue scale (VAS) scores of 2 group were recorded and compared. Results All incisions healed primarily and no infection, dislocation, or fracture occurred. All patients were followed up 30.2 months on average (range, 6-44 months). The numbness symptom caused by the lateral femoral cutaneous nerve injury occurred in 2 patients of DAA group and released after symptomatic treatment. The length of incision, total amount of bleeding, the time of first postoperative walking with crutch, and the time of first postoperative walking without crutch of DAA group were significantly superior to those of PA group (P<0.05). The Harris scores of DAA group were significantly higher than those of PA group at 2 weeks and 1 month after operation (P<0.05), while no significant difference was found between 2 groups before operation and at 3 months and 6 months after operation (P>0.05). The VAS scores of DAA group were significantly lower than those of PA group at 1 day, 4 days, 1 week, and 2 weeks after operation (P<0.05), while no significant difference was found between 2 groups before operation (P>0.05). Conclusion DAA is meaningful to enhanced recovery after THA. But it should be chosen carefully because of the disadvantages, such as long learning curve, limited indications, and requirements of specific instruments.