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 compare the effectiveness between histoacryl topical skin adhesive and traditional method for wound closure in total hip arthroplasty (THA). MethodsA total of 159 patients undergoing THA were divided into 2 groups between January and October in 2015. Subcuticular suture and histoacryl topical skin adhesive (cyanoacrylate adhesive) were used in 80 patients (100 hips) (test group), and traditional method (skin staples and wound drainage) was used in 79 patients (100 hips) (control group) for wound closure. There was no significant difference (P > 0.05) in gender, age, body mass index, and etiology between 2 groups. The operation time, length of stay, incision pain visual analogue scale (VAS) score and healing of incision, and incision satisfaction evaluation, and classification were compared between 2 groups. ResultsAll patients were followed up 3-6 months (mean. 4.7 months). There was no significant difference in operation time between 2 groups (Z=-0.527, P=0.598); but the length of stay of test group was less than that of control group (Z=-2.004, P=0.045). Incision exudation and dehiscence occurred in 1 case (1 hip) and 1 case (1 hip) of test group respectively; incision swollen, persistent wound exudation, exudation, and sutured drainage tube occurred in 2 cases (2 hips), 2 cases (2 hips), 4 cases (4 hips), and 1 case (1 hip) of control group. No statistically significant difference was found in VAS score between 2 groups at 15 days after operation (Z=-0.125, P=0.901), but wound healing score of test group was significantly higher than that of control group (Z=-2.943, P=0.003). Wound healing was class A in 98 hips and class B in 2 hips in test group, and was class A in 92 hips and class B in 8 hips in control group, and difference was statistically significant (χ2=3.789, P=0.048). The incision satisfaction of test group was significantly higher than that of control group (Z=-2.626, P=0.009). ConclusionCompared with traditional method, histoacryl topical skin adhesive has decreased wound complication rate, and it is an easy and safe method with high satisfaction.
ObjectiveTo evaluate the middle- and long-term effectiveness of primary total hip arthroplasty (THA) in patients with chronic autoimmune inflammatory diseases. MethodsBetween January 1990 and June 2006, 42 patients (51 hips) with chronic autoimmune inflammatory diseases underwent THA. There were 15 males (18 hips) and 27 females (33 hips) with an average age of 36.9 years (range, 22-70 years). The locations were the left side in 29 hips and the right side in 22 hips. Of 42 cases, there were 11 cases of systemic lupus erythematosus (13 hips), 16 cases of rheumatoid arthritis (22 hips), and 15 cases of ankylosing spondylitis (16 hips). The causes of THA included avascular necrosis of the femoral head in 26 cases (34 hips), ankylosis of the hip in 15 cases (16 hips), and fracture of the femoral neck in 1 case (1 hip). The Harris score was 32.49 ± 9.50. The physical component summary (PCS) and mental component summary (MCS) of short form 36 health survey scale (SF-36) scores were 25.53 ± 4.46 and 42.28 ± 6.27, respectively. ResultsAll incisions healed primarily. All 42 patients were followed up 5-21 years (mean, 9.1 years). At last follow-up, the Harris score was 89.25 ± 8.47; PCS and MCS of the SF-36 were 51.35 ± 4.28 and 55.29 ± 8.31, respectively; and significant differences in the scores were found between pre- and post-operation (P lt; 0.05). Complications included limp (4 cases), prosthesis dislocation (2 cases, 2 hips), periprosthetic fracture (1 case, 1 hip), aseptic loosening (2 cases, 2 hips), and ectopic ossification (3 cases, 3 hips). ConclusionTHA seems to be a good choice for patients with chronic autoimmune inflammatory diseases.
Objective To investigate the morphological changes of the proximalfemur and their implication to the total hip arthroplasty in patients with Crowe Ⅱ/Ⅲ developmental dysplasia of the hip (DDH). Methods The experimental gr oup was composed of 15 hips in 14 patients (Crowe Ⅱ, 9 hips; Crowe Ⅲ, 6 hips ) with osteoarthritis secondary to Crowe Ⅱ/Ⅲ DDH (2 males, 12 females; age, 35-61 years). None of the patients had accepted any osteotomy treatment. The control group was composed of 15 normal hips in 15 patients with unilateral DDH (3 males, 12 females; age, 35-57 years). Twelve hips came from the experimental group and the other 3 came from the patients with unilateral Crowe Ⅰ DDH. The femurswere examined with the CT scanning. The following parameters were measured: theheight of the center of the femoral head (HCFH), the isthmus position (IP), theneckshaft angle(NS), the anteversion angle, the canal flare index, and the canal width. Then, the analysis of the data was conducted. Results HCFH and IP in theexperimental group and the control group were 50.1±6.7 mm, 50.1±7.4 mm, and 107.4±21.5 mm, 108.7±18.1 mm，respectively, which had no significant differencebetween the two groups（Pgt;0.05）. In the experimental group and the control group, the NS were 138.3±10.0° and 126.7±5.7°，the anteversion angles were 36.5±15.9° and 18.8±5.4°, and the canal flare indexes were 4.47±0.40and 5.01±0.43. There was a significant difference between the two groups in the above 3 parameters （Plt;0.05）. As for the canal width of the femur, therewasa significant difference in the interior/exterior widths and the anterior/posterior widths at the level of 2 cm above the lesser trochanter and 4 cm belowthe lesser trochanter between the two groups （Plt;0.05）; however, there was nosignificant difference in the canal width of the femur at the isthmus between the two groups（P＞0.05）. Conclusion It is necessary to evaluate the morphology of the proximal femur before the total hip arthroplasty performed in patients with Crowe Ⅱ/Ⅲ DDH. The straight and smaller femoral prosthesis should be chosen and implanted in the proper anteversion position duringoperation.
【Abstract】 Objective To investigate the method to avoid lengthening lower limbs after total hip arthroplasty in patients with congenital short femoral neck. Methods The clinical data were analyzed retrospectively from 38 patients undergoing unilateral total hip arthroplasty between April 2005 and December 2010. There were 26 males and 12 females, aged 45-78 years (mean, 62.3 years). Among these cases, there were 11 cases of avascular necrosis of the femoral head, 17 cases of hip osteoarthritis, and 10 cases of femoral neck fracture. Before operation, 29 cases had leg length discrepancy; and the shortened length of the legs was 10-24 mm with an average of 14.5 mm by clinical measurement, and was 11-25 mm with an average of 14.7 mm by X-ray film measurement. The Harris score before operation was 44.0 ± 3.6. Results At 1 day after operation, 3 cases had legs lengthening by clinical and X-ray film measurement; limb length difference less than 10 mm was regarded as equal limb length in the other 35 patients (92.1%). All incisions healed by first intention, and no complication of infection or lower limb deep venous thrombosis occurred. In 3 patients who had legs lengthening, 1 patient had abnormal gait and slight limping after increasing heel pad because the lower limb was lengthened by 16 mm, and 2 patients had slight limping. The other patients could walk normally and achieved pain relief of hip. Thirty-six patients were followed up 12-68 months (mean, 43.8 months). The Harris score was 86.7 ± 2.3 after 6 months, showing significant difference (t=3.260, P=0.031) when compared with that before operation. The X-ray films showed no prosthetic loosening or subsidence. Conclusion For patients with congenital short femoral neck during total hip arthroplasty, the surgeons should pay attention to osteotomy plane determination, limb length measurement, and use of the prosthesis with collar to avoid the lengthening lower limbs
Objective?To discuss the clinical application of total hip arthroplasty (THA) with collum femoris preserving (CFP) prosthesis and to analyze the mid-term effectiveness.?Methods?Between January 2004 and February 2007, 45 patients (48 hips) underwent THA with CFP prosthesis. There were 29 males (31 hips) and 16 females (17 hips) with an average age of 48.8 years (range, 38-60 years), including 20 left hips, 22 right hips, and 3 bilateral hips. The causes of hip replacement were osteoarthritis (20 cases), avascular necrosis of femoral head (13 cases), dysplasia (4 cases), rheumatoid arthritis (3 cases), post-traumatic osteoarthritis (2 cases), ankylosing spondylitis (2 cases), and Perths disease (1 case). The average disease duration was 6.1 years (range, 2-13 years). Harris scores, visual analogue scale (VAS) score, and the hip range of motion (ROM) were recorded at pre- and post-operation. The X-ray films were taken at pre- and post-operation to observe the position, loosening of the prosthesis, and ectopic ossification. The gait of patients were also evaluated during follow-up. Short-form 36 health survey scale (SF-36) was used to evaluate the life quality of patients.?Results?All 45 patients were followed up 5-8 years with an average of 6.4 years. All the incisions healed by first intention. No infection, hip dislocation, nerve injury, or deep vein thrombosis occurred. Six cleavage fractures (13.3%) of the lateral femoral diaphysis at the distal prosthesis occurred during operation, which healed at 8 months postoperatively without any treatment. Mild ectopic ossification occurred in 4 patients (8.9%) who had no discomfort. Five patients (11.1%) had bone mineral density loss in the region of the proximal femur. The survival rates of the cups and stems were all 100% at last follow-up. The results of Harris score, VAS score, and ROM of the hip joint at 1 year postoperatively and last follow-up were significantly better than preoperative ones (P lt; 0.05). No significant difference was found in VAS score and ROM of the hip joint between at 1 year postoperatively and at last follow-up (P gt; 0.05) except the Harris score (P lt; 0.05). According to Harris functional assessment at last follow-up, the results were excellent in 31 hips, good in 11 hips, and fair in 6 hips with an excellent and good rate of 87.5%. The physiological role, body pain, and total health scores were significantly lower than the reference value of urban men from Sichuan province (P lt; 0.05), but no significant difference was found in the other scores of the SF-36 when compared with the reference value (P gt; 0.05).?Conclusion?THA with CFP prosthesis is a good option for the young patient with complete collum femoris and without osteoporosis, and can achieve good mid-term effectiveness.
Objective To investigate the short-term effectiveness of total hip arthroplasty (THA) with SL-PLUS MIA femoral stem prosthesis by comparing with the SL-PLUS prosthesis. Methods Retrospective analysis was made on the clinical data of 33 patients (38 hips) undergoing THA with SL-PLUS MIA femoral stem prosthesis (trial group) between June and December 2011, which was compared with those of 35 patients (40 hips) with SL-PLUS prosthesis (control group) during the same period. There was no significant difference in gender, age, disease duration, etiology, preoperative range of motion (ROM) of hip, and preoperative Harris score between 2 groups (P gt; 0.05). The incision length, operation time, and intraoperative blood loss were recorded during operation. The improvement of hip joint function was evaluated according to Harris score criteria. The ROM of hip was measured, and the X-ray film was taken to observe the position of prosthesis. Results Trial group had shorter incision length, less operation time, and less intraoperative blood loss than control group, showing significant differences (P lt; 0.05). All wounds healed by first intention. All patients were followed up 10-16 months (mean, 13.6 months). During follow-up, 5 cases (5 hips) of control group and 3 cases (3 hips) of trial group still had pain of hips. At last follow-up, the ROM of hip was (152.48 ± 9.68)° in trial group and (152.16 ± 8.18)° in control group, the Harris score was 91.4 ± 2.9 in trial group and 90.9 ± 1.8 in control group; there were significant differences when compared with preoperative values (P lt; 0.05), but no significant difference was found between 2 groups (P gt; 0.05). X-ray films showed good position of the prosthesis with no displacement, loosening, or subsidence in both groups. Conclusion SL-PLUS MIA femoral stem prosthesis has less surgical trauma and blood loss than SL-PLUS prosthesis during THA. The short-term effectiveness is satisfactory, but the long-term effectiveness still needs further observation.
Objective To evaluate the short-term effectiveness of minimally invasive total hip arthroplasty (THA) by direct anterior approach (DAA). Methods Between January and August 2014, THA was performed on 48 patients (60 hips) by DAA (group A), and on 72 patients (92 hips) by posterolateral approach (group B). There was no significant difference in gender, age, etiology, course, and preoperative visual analogue scale (VAS), Harris hip score (HHS), and hip range of motion (ROM) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, incision healing, and complications were recorded and compared. The acetabular abduction and anteversion were measured on the X-ray films; prosthesis loosening was observed. The VAS score, HHS score, and hip ROM were used to evaluate the hip function. Results The operation time and intraoperative blood loss of group A were significantly higher than those of group B, and the hospitalization time was significantly lower than group B (P<0.05), but no significant difference was found in postoperative drainage between 2 groups (t=0.71,P=0.46). The patients were followed up 2-2.5 years (mean, 2.2 years) in group A, and 2-2.5 years (mean, 2.1 years) in group B. In group A, 3 cases had lateral femoral cutaneous nerve traction injury and 1 case had swelling and exudate, and primary healing of incision was obtained in the other cases of group A and all cases of group B. No periprosthetic joint infection occurred in the others of groups A and B except 1 case of group A at 2 months after operation, and infection was controlled after debridement, irrigation, and intravenous infusion of Vancomycin for 1 month. The X-ray films showed good position of prosthesis and no obvious radiolucent line or prosthesis loosening. There was no significant differences in acetabular abduction and anteversion between groups A and B at last follow-up (P>0.05). The VAS score, HHS score, and hip ROM at 3 months and last follow-up were significantly better than preoperative ones in 2 groups (P<0.05), but no significant difference was found between at 3 months and last follow-up (P>0.05). The VAS score, HHS score, and hip ROM in group A were significantly better than those in group B at 3 months postoperatively (P<0.05). At last follow-up, the hip ROM in group A was significantly better than that in group B (P<0.05), and there was no significant difference in VAS and HHS scores between group A and group B (P>0.05). Conclusion The short-term effectiveness of minimally invasive THA by DAA is satisfactory, with the advantage of little trauma, short hospital stay, and rapid postoperative recovery.
Objective To summarize the occurrence mechanism of backside wear, the method of evaluating backside surface damage, the relationship between backside wear and osteolysis in acetabulum, and the approach to reduce backside wear in total hip arthroplasty with modular acetabulum prosthesis. Methods The recent articles about the backside wear in acetabular liners were extensively reviewed. Results Backside wear in acetabular liners is connected with micromotion between the liner and the shell, rough interface, thickness of the liner, and impingement. The methods to evaluate backside wear damage are only proceeded in revised acetabular liners. Backside wear can generate polyethylene particles that is likely related to the process of osteolysis in acetabulum through the screw holes of metallic shell. To reduce backside wear between the liner and the shell, measures such as improved locking mechanisms, smooth inner metallic shell, maximized shell liner conformity, improving the quality of polyethylene, and reducing impingement can be taken. Conclusion There is no method of evaluating the backside wear in vivo. The relationship between backside wear and osteolysis in acetabulum as well as aseptic loosening of acetabulum prosthesis is controversial.
Objective To explore the effective method and the feasibil ity of the accurate l imb length equal ization in patients undergoing total hip arthroplasty (THA). Methods From September 2006 to September 2008, 52 patients underwentunilateral THA, including 36 males and 16 females, with an average age of 61.5 years (range, 46-76 years). Among these cases, there were 22 cases of avascular necrosis of the femoral head, 12 cases of hip osteoarthritis, 11 cases of femoral neck fracture, 4 cases of congenital dislocation of hip, and 3 cases of acetabular dysplasia. Forty cases had leg length discrepancy, and the shortened length of the legs was in the range of 10 mm to 35 mm with an average of 20 mm. The mean Harris score before operation was 45 points (range, 36-58 points). Based on the cl inical measurement and radiographic examination, the surgical protocols were designed, the type of the hip prosthesis was chosen, and the neck length of the femoral prosthesis, and the position of osteotomy were estimated. By the proper wearing of the acetabula, the best rotation point was found out. 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 intended leg-length equal ization. The discrepancy of the leg length was measured and evaluated after operation. Results The incision healed by first intention in all patients. One patient had ischiadic nerve palsy and achieved full restoration after 5 months of symptomatic management. Forty-four patients were followed up 16 months on average (7-32 months). The mean Harris score was 87.5 points (80-91 points), showing significant difference (P lt; 0.05) whencompared with that before operation. The l imb length equal ization were got in 35 patients (equal ization rate was 79.5%). Seven patients had the prolong leg (from 10 mm to 18 mm), 2 patients had the shortened legs (15 mm and 25 mm, respectively). Conclusion By measurement of leg-length and radiographic examination before and during operation, the problem of unequal leg - length can be solved during the THA.