Objective To observe expression of Caspase-3 and apoptosis around the prosthesis and explore the relationship of the expression and the apoptosis with the periimplant osteolysis. Methods From April 2001 to August 2006, 16 patients (10 males, 6 females) underwent the revision total hip arthroplasty surgery, who had the primary total hip arthroplasty at the ages of 45-67 years and had the revision total hip arthroplasty at the ages of 55-78 years, with the implantation duration of 7-13 years. According to their preoperative X-ray films andthe findings during the operation, the patients were divided into two groups: theloose/osteolytic group (n=8) and the loose/non-osteolytic group (n=8). The interface tissues were obtained from the peri-implant region in the patients. The synovial samples were taken from another 6 patients (2 males, 4 females; age, 54-68years; illness course, 9-15 years), who underwent the primary total hip arthroplasty for osteoarthritis. These 6 patients were used as controls. The tissues were prepared for the immunohistochemical assays to determine the expression of Caspase-3. The TUNEL assays were performed to quantify the apoptotic cells. The quantitative analysis on the positive cells and the correlation with the presence of the particulate wear debris and the severity of osteolysis were also performed. Results The level of the expression for Caspase-3 and the apoptosis index inthe loose/osteolytic group were significantly increased when compared with those in the loose/non-osteolytic group and the control group (P＜0.01). The polyethylene particles were surrounded by more positive cells than the metal particles. The positive cells were present at a higher level in the tissue sections where the high-wear status was present when compared with the areas where the low-wear status was present (P＜0.05). Conclusion There is a statistical correlation of the Caspase-3 expression to the apoptosis index and to the presence of the particulate wear debris and the severity of osteolysis, which may be one of the key points for the bone reconstruction inhibition and the bone resorption at the boneimplant interface under the stimulation of the wear debris. The apoptosis is involved in the pathogenesis of the aseptic loosening, which is closely related to the signal transportation of Caspase-3.
Objective To explore the effect of minimally invasive and mini-incision surgery (MIS) in total hip arthroplasty (THA) on late osteonecrosis of femoral head (ONFH). Methods From March 2003, Eighteen patients (22 hips) with ONFH underwent MIS in THA. Their ages ranged from 24to 57 years, including 13 males and 5 females. The mean body mass index ranged from 17.1 to 30.1(24.6 on average). The Harris hip score was 46 points before operation. Modified posterior-lateral approach was adopted, and the MIS THA was performed by cementless prosthesis. As a comparison, 18 patients (22 hips) were performed by conventional THA at the same period. The data, including bleeding volume during operation, incision length, operative time, and postoperative function recovery, were compared. Results Follow-ups were done for 6 to 20 months (11 months on average). Dislocation occurred in one patient that underwent conventional THA 2 days after operation. No complication occurred in MIS THA group. The incision lengths ranged from 8.7 to 10.5 cm (9.3 cm on average) in MIS THA group, being statistically different (Plt;0.01). There was no significant difference in Harris scoring of the function between the two groups both before the operation and after the operation (Pgt;0.05). The operative time was almost the same, but the bleeding volume in MIS THA group was less (Plt;0.05). The function recovery was faster in MIS THA group.Conclusion The MIS THA is an alternative to the treatment of late ONFH. The advantages of MIS THA are fewer trauma, less bleeding volume, and faster recovery. The MIS THA should be performed by surgeons with rich experiences in THA and hospitals with necessary instruments.
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 investigate the application value of acetabular centralization technology for correction of leg-length inequality in total hip arthroplasty (THA). MethodsBetween June 2001 and January 2012, 147 cases of abnormal acetabular center were treated. Of them, 68 cases underwent routine THA (control group), and 79 cases underwent acetabular reconstruction by fossae ovalis oriented centralized technology in THA (test group). There was no significant difference in gender, age, side, pathogeny, acetabular rotation center indexs, difference of relative and absolute leg-length, and Harris score between 2 groups before operation (P>0.05). The hip joint function was evaluated by Harris score; the difference of relative leg-length was measured by tape; the difference of absolute leg-length and the horizontal and vertical distances of actual and true rotation center were also measured on the X-ray films by software. ResultsThe patients were followed up 8-26 months (mean, 8.3 months) in the test group, and 6-33 months (mean, 9.7 months) in the control group. Sciatic nerve injury occurred in 2 cases (1 in each group, respectively), lower extremity deep venous thrombosis in 7 cases (3 in test group and 4 in control group), and hip joint dislocation in 2 cases (control group); the other patients had no related complications. The difference of relative leg-length and Harris score in test group were significantly better than in control group (P<0.05), and significant difference was also found when compared with preoperative one in 2 groups (P<0.05). The horizontal and vertical distances of actual and the true rotation center in test group was significantly better than those in control group at immediate after operation on the X-ray films (P<0.05); and significant differences were also found when compared with preoperative ones in 2 groups (P<0.05). At 6 months after operation, the absolute leg-length difference in test group was significantly better than that in control group (P<0.05); and significant difference was also found when compared with preoperative one in 2 groups (P<0.05). ConclusionThe fossae ovalis oriented acetabular centralized technology in THA can significantly correct abnormal hip center of rotation, thus reduce the relative and absolute leg-length inequality and improve the life quality of the patients.
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 evaluate the surgical procedure of reinforced acetabular cage with caudal flange in reconstruction of pelvic defect after acetabular tumor resection. Methods Between June 2003 and December 2009, 25 patients with Harrington class III pelvic defect underwent reconstruction with a reinforced acetabular cage with caudal flange and total hip arthroplasty (THA). There were 13 males and 12 females with an average age of 51.2 years (range，13-73 years). The main cl inical manifestations included hip pain and buttock pain, with a median disease duration of 6 months (range, 1-96 months). Pathological findings showed 18 cases of metastasis, 3 cases of multiple myeloma, 1 case of non-Hodgkin’s lymphoma, 1 case of grade I chondrosarcoma, 1 case of giant cell tumor, and 1 case of chondroblastoma. For the patient with chondroblastoma, THA with LINK RIBBED system was used. An artificial total hip system made in China was used in 6 patients and LINK SP II system was used in the other 18 patients. Results No patients died perioperatively. Deep infection and hip dislocations occurred in 1 and 2 patients, respectively. At last follow-up, 8 of 18 patients with metastasis died of cancer and the average survival time was 11 months. The other 10 who were al ive were followed up 15 months on average. One patient with multiple myeloma died of pulmonary infection at 21 months after operation and the other 2 with multiple myeloma and 1 with lymphoma were al ive with an average follow-up of 17 months. The patient with grade I chondrosarcoma and patient with chondroblastoma were followed up 58 and 12 months, respectively, without recurrence. Recurrence occurred in the patient with giant cell tumor at 19 months afteroperation. Loosening of implant occurred in 3 patients because of local tumor recurrence. For the 23 patients at 6 months after operation, the mean Musculoskeletal Tumor Society (MSTS) 93 score was 81% (range, 57%-93%). Conclusion Reinforced acetabular cage with caudal flange could be used together with THA for reconstruction of Harrington class III pelvic defects after acetabular tumor resection, and low incidence of postoperative compl ication and good functional outcome could be expected.
ObjectiveTo evaluate the clinical results of uncemented total hip arthroplasty (THA) for ultimate hip disease combined with proximal femoral deformity. MethodsBetween February 2005 and June 2013, 48 cases (51 hips) of ultimate hip disease combined with proximal femoral deformity were treated with uncemented THA and osteotomy. There were 14 males (16 hips) and 34 females (35 hips), with an average age of 52 years (range, 19-83 years). Unilateral hip was involved in 45 cases, and bilateral hips in 3 cases. There were 36 cases (39 hips) of developmental dysplasia of hip, 3 cases (3 hips) of traumatic arthritis, 1 case (1 hip) of previous intertrochanteric valgus osteotomy, 4 cases (4 hips) of internal fixation failure, 3 cases (3 hips) of tuberculosis, and 1 case (1 hip) of suppurative infection. Preoperative Trendelenburg sign was positive in all hips. The discrepancy of limbs was observed in 19 patients. According to Berry classification system, deformity located at the greater trochanter in 4 hips, at the femoral neck in 39 hips, at the femur metaphysis in 7 hips, and at femoral shaft in 1 hip. The Harris score was 34.28±3.28 before operation. ResultsHealing of incision by first intention was obtained in all patients. Deep venous thrombosis occurred in 1 patient, and no complications of infection, neurovascular injury, or prosthetic dislocation were found. Forty-seven patients (50 hips) were followed up 3.8 years on average (range, 1-9 years). At last follow-up, the Harris hip score was 92.87±4.57, showing significant difference when compared to preoperative score (t=-213.19, P=0.00). Postoperative Trendelenburg sign was positive in 6 hips. Normal gait was shown in 39 cases, and slight limp in 8 cases. X-ray film results showed complete correction of deformity and bony fusion at the osteotomy sites at 3 to 6 months (mean, 4.4 months) after operation. At last follow-up, all the femoral and acetabulum components showed radiographic evidence of bone ingrowth. Osteolysis was observed in Gruen zones 1 and 7 around the femoral prosthesis of 2 cases. There was no case of prosthesis loosening. ConclusionThe biological fixation of the femoral stem prosthesis combined with corrective osteotomy can attain satisfactory result for ultimate hip disease combined with proximal femoral deformity in THA.
ObjectiveTo systematically review the efficacy of total hip arthroplasty by direct anterior approach (DAA) and direct lateral approach (DLA). MethodsCNKI, WanFang Data, VIP, CBM, EMbase, PubMed, The Cochrane Library, ClinicalTrials.gov and PROSPERO databases or websites were electronically searched to collect randomized controlled trials (RCTs) of DAA and DLA for THA from inception to August 6th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 9 RCTs were included. The results of meta-analysis showed that at 3 months post-operation, the Harris hip score (HHS) of the DAA group was higher than the DLA group (MD=4.83, 95%CI 2.09 to 7.56, P=0.000 5). Besides, compared with the DLA group, the DAA group showed shorter incision length (MD=−2.35, 95%CI −3.90 to −0.79, P=0.003), less intraoperative bleeding (MD=−68.24, 95%CI −119.07 to −17.41, P=0.009), and shorter hospital stay (MD=−0.84, 95%CI −1.54 to −0.15, P=0.02). However, no significant differences were found between DLA and DAA in operation duration and HHS at 6 weeks after operation. ConclusionsCurrent evidence shows that DAA can provide better HHS at 3 months post-operation, shorter incision length, less intraoperative bleeding, and shorter hospitalization length than DLA. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To compare heterotopic ossification between femoral head reconstruction and total hip arthroplasty(THA) in patients with ischemic necrosis of femoral head(INFH). Methods Between June 1994 and December 2004, the femoral heads were repaired in 1 005 patients with INFH,the total hip was replaced in 485 patients with INFH. The rate of heterotopic ossification was observed in 74 (Ficat Ⅲ to Ⅳ stages) of 1 005 patients and 80 of 485 patients given THA to compared the results of the two methods. Results These patients were followed up 2 to 10 years(6.5 years on average). The rates of heterotopic ossification were 5.4%(4/74) and 22.5%(18/80), respectively. There was statistically significant difference between two operative methods (Plt;0.01). Conclusion The rate of heterotopic ossification of femoral head reconstruction is lower than that of THA, so femoral head reconstruction is a better operative method for young patients and THA is suitable for old patients.