ObjectiveTo explore the method of acetabular orientation determination in total hip arthroplasty (THA) for bony ankylosed hip and the accuracy of the postoperative evaluation. MethodsBetween January 2009 and March 2013, 33 consecutive patients (49 hips) underwent THA. There were 25 males and 8 females with a mean age of 35.8 years (range, 18-69 years). The left hip was involved in 10 cases, the right hip in 7 cases, and bilateral hips in 16 cases. The causes were ankylosing spondylitis in 18 patients, tuberculosis in 6 patients, traumatic arthritis in 6 patients, osteoarthritis in 2 patients, and suppurative infection in 1 patient. The disease duration was 7-15 years with an average of 10.8 years. The acetabular orientation was determined with periacetabular bone marks (the upper margin of the obturator foramen, acetabular notch etc.) and soft tissue signs (acetabulum transverse ligament etc.). The hip or pelvic radiograph was taken to measure the acetabular prosthesis anteversion and abduction angle, and upward or downward, inward or outward acetabular migration degree. The acetabular anteversion angle of 15 degrees, the abduction angle of 45 degrees, and upward or downward, inward or outward acetabular migration degree of 0 served as a reference value to evaluate the accuracy of acetabular position. ResultsThere was no complications of neurovascular injury, fracture, joint dislocation, and infection. All of patients were followed up 13-63 months (mean, 30.3 months). The anteversion angle and abduction angle were (13.904±4.034)° and (42.898±7.474)° at last follow-up, showing no significant difference when compared with reference value (t=1.386, P=0.178; t=1.969, P=0.055). The inward or outward and upward or downward acetabulum migration degree were (2.530±2.261) mm and (3.886±3.334) mm respectively, showing significant differences when compared with reference value (t=7.830, P=0.000; t=8.159, P=0.000); it was less than 5 mm in 29 hips, 5-10 mm in 18 hips, and more than 10 mm in 2 hips; the acetabulum center coincidence rate was 59.2%. ConclusionFor bony ankylosed hip having loss of normal anatomy structure, intraoperative residues and permanent anatomical structure should be used for acetabular positioning.
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.
Objective To improve the accuracy of the acetabular component placement using the nonimage based surgical navigation system. Methods Twenty-three patients (14 males, 9 females; age, 28-55 years;26 hips）with hip disease underwent the total hip arthroplasty (THA) using the nonimage based surgicalnavigation system from February 2004 to April 2006. Rheumatoid arthritis was found in 3 patients (3 hips), necrosis of the femoral head in 6 patients (6 hips), and osteoarthritis in 14 patients (16 hips). All the patients were randomly divided into the following 2 groups: the navigated group (11 patients, 13 hips), treated by THA using the nonimage based surgical navigation system; and the control group (12 patients, 13 hips), treated by the traditional THA. According to thedesign of the study, the acetabular component was placed in the best inclination angle (45°) and the anteversion angle (15°). The postoperative component position was examined. Results No fracture, dislocation, infection or injury to the sciatic nerve was found. In the navigated group, the inclination and the anteversion reached 15.4±1.4° and 45.5±1.3°, respectively. In the control group,the inclination and the anteversion were 13.9±7.6° and 43.7±6.4°, respectively. The inclination difference was considered statistically significant (Plt;0.01). All the patients were followed up for 10-40 months,averaged 26 months. In the navigated group, the postoperative average Harris hip score was 95 (range,85-110), with an excellent result in 11 hips and a good result in 2 hips. In the control group, the postoperative average Harris hip score was 92 (range,75-110), with an excellent result in 9 hips, a good result in 3 hips, and a fair result in 1 hip. The Harris hip score difference was considered statistically significant (Plt;0.05). There was a significantly better result obtained in the navigated group than in the control group. Conclusion The acetabular component can be implanted accurately by the nonimage based surgical navigation system, which can reduce the incidence of the loosening of the prostheses and has an important value in clinical practice.
ObjectiveTo evaluate the accuracy of using smartphone to measure the angle of acetabular component in total hip arthroplasty (THA). MethodsBetween June 2012 and September 2015, the acetabular abduction and anteversion angles were measured in 50 patients undergoing THA. There were 24 males and 26 females, aged 37 to 83 years (mean, 71 years). The left hip was involved in 22 cases and the right hip in 28 cases. Of 50 patients, 34 suffered from fracture of the femoral neck, and 16 suffered from avascular necrosis of the femoral head. Acetabular dysplasia was excluded in all cases. A smartphone was used to measure the acetabular abduction and anteversion angles during operation; standard Picture Archiving and Communication Systems (PACS) was used to measured the acetabular abduction and anteversion angles on the X-ray film at 1 week after operation. It was defined as positive that the component angle values by PACS measurement were greater than those by the smartphone measurement, whereas as negative. The two measurement methods were compared, and intra-observer variability was assessed by analyzing the intraclass correlation coefficient (ICC), the Mann-Whitney U-test was used to analyze difference. ResultsThe ICC was 0.84 in the acetabular component angles by smartphone and PACS measurement methods. The acetabular component abduction angle was (44.02±1.33)° and the anteversion angle was (17.62±2.20)° by smartphone measurement. The acetabular component abduction angle was (44.74±4.05)° and the anteversion angle was (17.22±5.57)° by PACS measurement. There was no significant difference between two measurement methods (Z=-1.977, P=0.482; Z=-0.368, P=0.713). The acetabular component angle was in the safe zone in 44 cases; and the acetabular component anteversion angle was beyond safe range of 1 to 5°, and the abduction angle was beyond safe range of 1 to 3° in 6 cases. Intra-measurement variability was -21 to +10° for the anteversion angle and -10 to + 9° for the abduction angle, indicating that the acetabular component anteversion angle by smartphone measurement was greater than that by the PACS measurement, and the abduction angle was less than that by PACS measurement. ConclusionSmartphone is a convenient tool to measure the acetabular component angle in THA.
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.
ObjectiveTo investigate the femoral bone remodeling and long-term effectiveness of total hip arthroplasty (THA) with anatomic medullary locking (AML) prosthesis.MethodsThe clinical data of 24 cases (26 hips) who were treated with THA with AML prosthesis between November 1997 and January 2003 were retrospectively analyzed. There were 12 males and 12 females with an age of 32-69 years (mean, 53.7 years). There were 5 cases (5 hips) of avascular necrosis of the femoral head, 6 cases (7 hips) of secondary osteoarthritis of the hip dysplasia, 6 cases (6 hips) of femoral neck fracture, 2 cases (2 hips) of primary osteoarthritis, 3 cases (3 hips) of revision surgery, 1 case (2 hips) of ankylosing spondylitis, 1 case (1 hip) of femoral head fracture. The patients were followed up at immediate, 6 weeks, 3 months, 6 months, 1 year, and then every year after operation for imaging evaluation (X-ray film was taken immediately after operation to evaluate the femoral isthmus compression, Engh standard was used to evaluate the biological fixation of the femoral shaft prosthesis, and Brooker method was used to evaluate the occurrence of heterotopic ossification); bone reconstruction evaluation [reconstruction of prosthesis and bone interface (type of bone reaction, Gruen zone, incidence, and occurrence time were recorded), reconstruction of bone around prosthesis (proximal femur stress shielding bone absorption was evaluated according to Engh and Bobyn methods, and bone mineral density change rate was measured)]; clinical efficacy evaluation [Harris score for efficacy, visual analogue scale (VAS) score for thigh pain].ResultsAll patients were followed up 15 years and 2 months to 20 years and 4 months, with a median of 16 years and 6 months. At immediate after operation, 24 hips (92.3%) had good femoral isthums compression, 24 hips (92.3%) had good bone ingrowth. Heterotopic ossification occurred in 2 patients with degree 1, 2 patients with degree 2, and 1 patient with degree 3 at 3-6 months after operation. Hyperplastic bone reactions were more common in Gruen 2, 3, 4, 5, 6, 10, 11, and 12 zones, mainly occurring at 6-20 months after operation, with the incidence of 3.8%-69.2%, with the highest incidence of spot welding. All absorptive bone reactions were osteolysis, which was common in Gruen 1 and 7 zones, and mainly occurred at 8 years after operation, with an incidence of 42.3%. No clear line (area) or enlarged sign of medullary cavity was observed. Twenty-one hips (80.8%) had 1 degree stress shieding, and 5 hips (19.2%) had 2 degree stress shieding. It mainly occurred at 10-24 months after operation in Gruen 1 and 7 zones. Dual energy X-ray absorptiometry showed that bone mineral density mainly decreased in Gruen 1, 2, 6, and 7 zones, mainly increased in Gruen 3, 4, and 5 zones. Bone mineral density loss progressed slowly after 2 years of operation, and it was stable in 5-8 years, but decreased rapidly in 8-9 years, and stabilized after 10 years. The Harris score increased from 51.1±6.2 before operation to 88.3±5.1 at last follow-up (t=–21.774, P=0.000). Mild thigh pain occurred in only 2 cases (7.7%) with the VAS score of 2. No aseptic loosening or revision of femoral prosthesis occurred during the follow-up.ConclusionThe application of AML prosthesis in THA has a good bone remodeling and a good long-term effectiveness.
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 summarize the best evidence for prevention and management of joint dislocation after total hip arthroplasty (THA) and provide evidence-based support for reducing the occurrence of joint dislocation after THA. Methods The databases and websites related to prevention and management of joint dislocation after THA were searched, mainly including clinical decisions, guidelines, expert consensuses, evidence summaries, systematic reviews. The search period was from January 1, 2020 to April 30, 2025. Results Finally, 12 articles were included, including 2 guidelines, 4 systematic reviews, 4 clinical decisions, and 2 evidence summaries. The 5 dimensions of evaluation, preventive measures, early dislocation identification, daily activity recommendations, and health education were summarized and organized into 25 pieces of evidence. Conclusions The overall quality of the evidence related to the prevention and management of joint dislocation after THA summarized in this study is good. Medical staff should selectively apply the evidence based on clinical situations to develop safe, scientific, and personalized anti-dislocation plans for patients, in order to reduce the occurrence of joint dislocation and improve patient prognosis.
Objective To study the effect of simultaneous bilateral total hip arthroplasty in a single procedure. Methods From October 1999 to March 2004, 15 patients (30 hips) underwent simultaneous sequential bilateral total hip arthroplasty (THAs) in a single procedure. Of the 15 patients, 11 were male (22 hips) and 4 were female (8 hips). Their ages ranged from 35 to 70 years. Their courses of disease ranged from 1 year to 50 years (4.8 years on average). The Harris scores of the joint function before the operation ranged from 12 to 45 points (27 points on average). Five were done with Smith-Peterson and 10 were done with Moore. Results The operative time was 3 hours and 25 minutes to 5 hours (4 hours and 10 minutes on average). The volume of blood transfusion during operation was 400 to 2 400 ml (1 160 mlon average). All the 15 patients were followed up for 3 to 35 months (18 monthson average). The Harris scores of the joint function after the operation rangedfrom 70 to 100 points (86 points on average). There was significant difference in the scores between before and after operations (Plt;0.05). There was only 1death within 1 months of the operation and no serious between complications such as infection, pulmonary embolism, and deep vein plug. All the patients were still ambulant in the community and gained significant pain relief. Conclusion Simultaneous bilateral total hip arthroplasty in a single procedure is a safe and effective method. However, the decision of performing singlestage bilateral total hip arthroplasty should be carefully made and preoperative preparation should be sufficiently made.