ObjectiveTo evaluate short-term effectiveness of revision total knee arthroplasty (TKA) with porous-coated metaphyseal Sleeve and MBT implant.MethodsA clinical data of 23 patients (24 knees) who underwent revision TKA by using porous-coated metaphyseal Sleeve combined with MBT implant between March 2015 and April 2017 was retrospectively analyzed. There were 8 males (8 knees) and 15 females (16 knees). The age ranged from 48 to 85 years (mean, 65.4 years). The cause of revision TKA included infection in 14 knees, aseptic loosening in 8 knees, instability in 1 knee, and stiff knee in 1 knee. Bone defects were classified according to the Anderson Orthopaedic Research Institute (AORI) bone defect classification. The femoral defect was rated as type ⅡA in 5 knees, type ⅡB in 17 knees, and type Ⅲ in 2 knees; the tibial defect was rated as type ⅡA in 2 knees, type ⅡB in 20 knees, and type Ⅲ in 2 knees. The mean time between primary TKA and revision TKA was 30.6 months (range, 6-86 months). The preoperative range of motion (ROM) was (56.0±24.9)°. The preoperative Hospital for Special Surgery (HSS) total score was 41.9±14.2; and the pain and function scores were 8.5±5.2 and 33.4±13.5, respectively.ResultsAll patients were followed up 12-39 months (mean, 25.6 months). The mean operation time was 2.2 hours (range, 1.6-2.9 hours). The mean intraoperative blood loss was 580 mL (range, 400-1 000 mL). There were 2 knees (8.3%) of intraoperative fracture associated with Sleeve insertion and 1 knee (4.2%) of acute postoperative infection at 25 days after revision TKA. All incisions healed by first intention. No deep venous thrombosis of lower extremity occurred. X-ray film showed that all implants were stable. At last follow-up, slight discomfort after exercise occurred in 4 knees (16.7%); end-of-stem pain in the tibia occurred in 1 knee (4.2%). The ROM was (114.6±5.1)°, which had significant improvement compared with the preoperative result (t=11.698, P=0.000). The HSS total score (89.0±10.9), pain score (26.9±6.6), and function score (62.1±5.8) also had significant improvement compared with the preoperative results (t=15.616, P=0.000; t=12.522, P=0.000; t=10.076, P=0.000).ConclusionThe porous-coated metaphyseal Sleeve combined with MBT implant in revision TKA has a significant improvement in short-term effectiveness and no signs of implant loosening.
Objective To evaluate the clinical valueof the revision of total hip replacement(THR), to analyse the reason of the rev isions, and to discuss the main difficulties and measures to manage it.Methods From June 1998 to January 2002, 15 cases (15 hips) were revised on totalhip replacement. The reasons for revision in the cases were as follows:failure of primary operative techenique, loosening and sinking of the components, displacement of the prosthesis, erosion of the acetabulum, as well as fracture of the femoral stem. The main difficulties of the revision were:poor health condition of the patients; the remove of the prosthesis of the primary THR,especially the broken femoral stem and the cements; the loss of localbone. The measures to remove the broken femoral stem were described.ResultsAll cases were followed up 2.4 years on average: 2 patients died from heart disease and cerebrovascular disease respectively, while the good results were achieved in the others.No infection, dislocation, loosening, and other complications occurred. The good effects were related with following factors:mild degree of illness; no severe bone defect; most of the first femoral head replacement.Conclusion The revision of THRis a more difficult operation, so that the special instrument and equipment andoperative experience are required.
ObjectiveTo explore the clinical outcomes of acetabular revision using a metal reconstruction cage. MethodsBetween October 2006 and October 2013, 16 patients (16 hips) underwent acetabular revision with a metal reconstruction cage. There were 4 males and 12 females, with the mean age of 62.7 years (range, 49-78 years). The time from total hip arthroplasty to revision was 3-15 years (mean, 8.2 years). The causes for revision were aseptic acetabular loosening in 15 cases, and femoral periprosthetic fracture (Vancouver type B3) in 1 case. According to the American Academy of Orthopaedic Surgeons (AAOS) classification, there were 12 cases of type III and 4 cases of type IV; according to the Paprosky classification, there were 12 cases of type IIIA and 4 cases of type IIIB. Harris score was used for hip function evaluation, and visual analogue scale (VAS) for pain in the thigh. X-ray films were taken for imaging evaluation. ResultsHealing of incision by first intention was obtained in all patients. Deep venous thrombosis occurred in 1 patient, and was cured after anticoagulation therapy. No complications of infection, neurovascular injury, and prosthetic dislocation were found. Sixteen patients were followed up 6.8 years on average (range, 2-9 years). The Harris score was significantly increased from preoperative 42.44±4.66 to 91.88±3.28 at last follow-up (t=–106.30, P=0.00). Two patients had mild pain in the thigh, but pain disappeared at 1 year after operation. At immediate after operation, the abduction angle was 37-54° (mean, 42.9°). The distance between acetabular rotation centre and teardrop line was (33.67±12.19) mm for preoperative value and was (20.67±9.63) mm for postoperative value, showing significant difference (t=–9.60, P=0.00). The distance between acetabular rotation centre and lateral teardrop was (34.98±12.30) mm for preoperative value and was (40.04±6.61) mm for postoperative value, showing significant difference (t=–3.15, P=0.00). X-ray film results showed bony fusion at the osteotomy sites at 4 to 12 months after operation. No continuous radiolucent line, prosthetic dislocation, or osteolysis was found, and bony ingrowth was observed in all patients. No patient received re-revision due to prosthetic loosening. ConclusionThe metal reconstruction cage for acetabular revision can achieve good effectiveness for patients with serious bone defect.
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 study the effect of vancomycin-loaded polymethylmethacrylate (VCMPMMA) in the treatment of an experimental hemiprosthetic hip infectionof rabbits. Methods The infected hemiprosthetic hip joints of the rabbits underwent debridement and one-stage revision arthroplasty. Requested by the “fixed” method, 24 rabbits were equally divided into 2 groups: the control group and theexperimental group. The prostheses were fixed with PMMA in the control group, but with VCM-PMMA in the experimental group. X-ray films were taken immediately after operation, and then 4, 8, and 12 weeks after operation. The C reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were measured before operation, then measured 1, 3, and 7 days after operation, and then 2, 4, 8, and 12 weeks after operation, i.e., they were measured at the above 8 time points. All the rabbits were sacrificed 12 weeks later. The cure rate of the infection was determined by the blood culture for the corresponding bacteria and the Rhodamine-labeled anti-Staphylococcus epidermidisimmune serum staining. Results The X-ray films revealed that6 hemiprosthetic hip joints were dislocated in the control group, but 3 in the experimental group; 58.3% and 16.7% of the hemiprosthetic hip joints were reinfected in the control group and the experimental group, respectively. At 8 weeks in the control group, the serum CRP level decreased to a greater extent than that measured at the time of debridement, but in the experimental group just at 2 weeks （Plt;0.01）. ESR remained elevated in the control group, but at 4 weeks ESR were significantly lowered compared with that measured at the time of debridement（Plt;0.01）. The test results for the pathogenic organisms revealed that the re-infection incidences were respectively 58.3% (7/12) and 16.7% (2/12) in the control group and the experimental group, with the successful revision rates of 41.7% and 83.3% respectively in the above 2 groups. The light microscopy revealed that therewas a heavy infiltration by the inflammatory cells in the reinfected tissues, but there was a proliferation of the fibrocytes in the tissues of the cured patients. Conclusion Onestage revision arthroplasty can significantly promote the control of the hemiprosthetic hip joint infection in rabbits by the use of VCM-PMMA.
fter total hip replacement ,massive bone defect occured freqently due to wearing and loosening of the prcathesis.The use of deep-freezing allograft to su pport a new implant was an attractive solution. Deep-freezing decreased the immune antigenicity of the transplanted allograft.From 1972 to 1990. the deep-freezing allografts were used in rcvision total hip replacement in 212 cases,in which 187 cases(198 hips) were followed-up for over 1 year.The general effective rate was 85%....
Objective To investigate the effectiveness of acetabular revision using jumbo cementless cups. Methods Between May 1996 and May 2011, 35 patients (35 hips) underwent an acetabular revision with jumbo cementless cups, and the clinical data were retrospectively analyzed. There were 12 males and 23 females, with an average age of 64.8 years (range, 47-79 years). The time from hip arthroplaty to revision was 1-15 years (mean, 9.7 years). The causes for revision were aseptic loosening in 32 cases, femoral periprosthetic fracture (Vancouver type B3) in 2 cases, and low toxicity infection in 1 case. According to the classification of acetabular bony deficiencies of the American Association of Orthopedic Surgeon (AAOS), 6 cases were classified as type I, 9 cases as type II, and 20 cases as type III; according to the classification proposed by Paprosky, 5 cases were rated as type II A, 9 cases as type II B, 13 cases as type II C, and 8 cases as type III A. The primary hip arthroplasty cups had an outside diameter of 46-52 mm (mean, 49.6 mm), and the revision cups had an outside diameter of 56-68 mm (mean, 60.4 mm). Harris score was used for hip function evaluation, and X-ray films were taken for imaging evaluation. Results Healing of incision by first intention was obtained in all patients; without infection or neurovascular injury. Prosthetic dislocation was observed in 1 case at 20 days after operation, and was cured after expectant treatment. One patient died at 6 years after operation, and the other 34 patients were followed up 2-14 years (mean, 8.4 years). The Harris score was significantly increased from 46.4 ± 13.4 at preoperation to 90.4 ± 3.6 at last follow-up (t=18.76, P=0.00). The distance between acetabular rotation centre and teardrop line was significantly decreased, and the distance between acetabular rotation centre and lateral teardrop was significantly increased when compared with preoperative ones (P lt; 0.05). Only 1 patient received second revision for aseptic loosening after 10 years; no continuous radiolucent line, prosthetic dislocation, and osteolysis was found, and bony ingrowth was shown in the other patients. Conclusion Jumbo cementless cup for acetabular revision can achieve good effectiveness for having the advantages of simple operation, less bone grafts, and good recovery of the acetabular rotation centre.
Objective To evaluate the medium-term results of uncemented acetabular revision with impacted deep frozen morsell ized allografts. Methods From April 1995 to December 2001, 58 cases (62 hips) were performed acetabularrevision by use of deep frozen morsel ized allograft firmly impacted into local ized defects as well as the entire acetabular cavity, followed by insertion of a uncemented cup with supplementary screw fixation. There were 32 males (34 hips) and 26 females (28 hips), with age of (49.6 ± 15.4) years old. Among 62 hips, 32 hips involved in left side and 30 hips involved in right side. The cause of revision was aseptic loosening of the cup in 56 hips, septic loosening of the cup in 3 hips, and polyethylene l iner dislodging with severe acetabular osteolysis in 3 hips. The average interval between the primary total hip arthroplasty and the revision was (10.1 ± 3.9) years. According to the American Academy of Orthopaedic Surgeons classification, 42 hips belonged to type II and 20 hi ps to type III acetabular defects. The cl inical and radiographic results were analyzed postoperatively. Results All wounds healed by first intention. No deep venous thrombosis and infection occurred postoperatively. All patients were followed up 6-13 years (average 8.1 years). The Harris score was improved from 61.1 ± 10.2 preoperatively to 92.0 ± 7.3 postoperatively, showing significant difference between preoperation and postoperation (P lt; 0.05). The results were excellent in 46 hips, good in 10 hips, fair in 4 hips, and poor in 2 hips, the excellent and good rate was 90.3%. The time for allograft incorporation was (12.5 ± 4.4) months after operation. The annual polyethylene l iner wear rate was (0.13 ± 0.09) mm. Linear and cavitary osteolysis was observed in 2 and 12 hips, respectively. Heterotopic ossification developed in 7 hi ps (11.3%); 3 hi ps were rated as grade I, 3 as grade II, and 1 as grade III according to Brooker classification. One cup underwent revision for asepticloosening and 2 were defined as radiographic failures. Kaplan-Meier survival rate of the cup was 94.2% ± 3.3% at 8 years after operation. Conclusion The combination of uncemented cup component with deep frozen morsel ized allografts seems to be a rel iable solution for restoring bone stock, relocating the hip center, and stabil izing the cup in acetabular revision, and provides favorable medium-term cl inical and radiographic results.
From 1974 to 1991, two hundred and sixty-four cases of hip replacement were performed. These cases composed of 150 cases of artificial femoral head prosthesis replacement and 114 cases of total hip replacement. Fifteen cases were revised after the first replacement in 7.4 years average (5-16 years). The revision rate was 5.7%. The causes of revision were loose or subside of prosthesis, wear and tear of acetabulum, dislocation of artificial hip joint, etc, which caused pain and dysfunction. The revision cases were followed up for 4.7 years average with good result. To prevent revision, The medully canal shonld not be too wide and in osteoporosis cases, bone cement was suggested to apply. The chondrium of acetabulum should be removed completely.