The Clinical and Radiological Outcomes of Subtrochanteric Osteotomy in Crowe Type IV Hip Dysplasia: A Comparison of Three Different Stem Designs.

AIMS: The purpose of this study was to determine whether there are differences in clinical and radiographic outcomes among three different stem designs for subtrochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH). METHODS: A retrospective analysis of prospectively collected data was undertaken from a consecutive series of 37 Crowe type IV DDHs treatment of noncemented total hip arthroplasty with chevron subtrochanteric osteotomy in 30 patients. Patients are divided into three groups, including Ribbed group (using Link Ribbed stem; n = 14), Synergy group (using Synergy stem; n = 9), and Link Classic Uncemented (LCU) group (using LCU stem; n = 14), according to the design of the stem. The clinical and radiographic outcomes were evaluated. RESULTS: All patients were followed for 36 months. The time of bone union of the LCU stem was significantly longer than that of the Synergy stem (P = 0.02) and the Ribbed stem (P > 0.05); the time of bone union of the Ribbed stem was longer than that of the Synergy stem (P > 0.05). The length of stem in the distal femur of the Ribbed stem (P = 0.000) and the Synergy stem (P = 0.001) is significantly longer than that of the LCU stem. There were three hips with malunion, stem loosening, and varus alignment, which were observed in the LCU stem. None of these were observed in Ribbed and Synergy stems. In total hip arthroplasty with a noncemented stem combined with subtrochanteric femoral osteotomy for Crowe IV DDH, 89.2% hips (33/37) can achieve good and excellent clinical outcomes. There were three hips (1 hip in the Ribbed stem and two in the LCU stem) with fair clinical outcomes and one hip (LCU stem) with poor clinical outcomes. CONCLUSIONS: Although Ribbed, Synergy, and LCU stems have similar clinical outcomes, the LCU stem has a tendency to a varus position, longer union time, malunion, and stem loosening, when compared with the Ribbed and Synergy stems. We recommend against adoption of the LCU stem for Crowe IV DDH with subtrochanteric femoral osteotomy. LEVEL OF EVIDENCE: Level III, therapeutic study.

A new internal fixation technique for acetabular fractures involving the quadrilateral plate.

BACKGROUND: The treatment of acetabular fracture involving the quadrilateral plate is a technical challenge, and the optimal management of the fracture remains controversial. We have designed a new implant (named acetabular fracture reduction internal fixator, AFRIF) for acetabular fractures involving the quadrilateral plate. This use of this new device was not investigated therefore we conducted a retrospective study aiming to determine whether the AFRIF can achieve satisfactory clinical and radiological outcomes for quadrilateral plate fracture. HYPOTHESIS: The AFRIF for quadrilateral plate fracture is an acceptable option to treat acetabular fracture involving the quadrilateral plate. MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected data on 24 patients (15 males and 9 females) with acute displaced quadrilateral plate fractures of the acetabulum who were treated by the AFRIF between August 2011 and May 2015. The mean age of the patients was 61.5±9.2 years (range, 31-82 years). All hips had protrusion of the femoral head, of these 5 hips with associated articular impaction of the medial roof. The type of fractures included anterior column in 4, anterior column+posterior hemitransverse in 3, associated both column in 11, T-shaped in 6 patients. The approaches included Limited Ilioinguinal (5 patients) and Limited Standard-Ilioinguinal combined with Kocher-Langenbeck (19 patients). Quality of reduction was evaluated and graded as anatomical (0mm to 1mm of displacement), imperfect (2mm to 3mm displacement) or poor (more than 3mm displacement) according to the residual displacement as defined by Matta. The final follow-up clinical outcome was classified as excellent (18 points), good (15-17 points), fair (13-14 points) or poor (<13 points) in terms to the modified Merle d'Aubigné-Postel score, and radiological outcomes evaluation were as excellent, good, fair, or poor based on Matta score. RESULTS: The mean duration of follow-up was 45.7±13.0 months (range, 24-60 months). Average operative time and bleeding amount was 110.3±30.8min (range, 105-210min) and 950.6±348.6ml (range, 300-1500ml), respectively. There was anatomical reduction in 17 patients (17/24, 70.8%), imperfect in 5 patients (5/24, 20.8%), and poor in 2 patients (2/24, 8.3%). All of the quadrilateral plate fractures achieved anatomical except one imperfect reduction. No re-protrusion of the femoral head was observed at the final follow-up. The mean modified Merle d'Aubigné-Postel score was 16.9±2.0 points (range, 10-18 points), and 83.3% (20 of 24) have good or excellent radiological outcomes. DISCUSSION: The findings suggest that the AFRIF for quadrilateral plate fractures may prevent protrusion of the femoral head and achieve good to excellent clinical and radiological outcomes. LEVEL OF EVIDENCE: IV, retrospective study.

Cementless distal fixation modular stem without reconstruction of femoral calcar for unstable intertrochanteric fracture in patients aged 75 years or more.

INTRODUCTION: Hemiarthroplasty (HA) using standard-length femoral stem with reconstruction of femoral calcar or using calcar replacing prosthesis for unstable intertrochanteric fractures in elderly patients is a viable option. However, both of the techniques increase the complexity of procedure, operative trauma and complication. This study evaluated the clinico-radiological results of the MP-Link cementless distal fixation modular prosthesis without reconstruction of femoral calcar for unstable intertrochanteric fracture in patients aged 75 years or more. HYPOTHESIS: Bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures in patients aged 75 years or more, do not need to reconstruct the femoral calcar. MATERIALS AND METHODS: Forty-two patients (42 hips) underwent bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures from January 2008 to January 2012. Five (11.9%) patients were lost to follow-up. The 37 remaining patients (37 hips) were available for evaluation. The mean age was 83.9±5.2 years. Their clinico-radiological data were prospectively gathered. RESULTS: All of 37 patients, 4 patients (10.8%) died within 1 year postoperatively. At the final follow-up, 31 (83.8%) out of 37 patients were regained preoperative ambulatory status; the mean Harris hip score (HHS) of the 15 patients who died during the follow-up period of 7-59 months, was 84.5±2.4 points; the 22 healthy patients were followed for 68.6±14.7 months, with mean HHS of 84.6±2.8 points. Radiologically, none of stems had evidence of loosening; 16 stems had subsidence of 2-3mm without clinical significance; the bone in-growth fixation was achieved in 24 patients and stable fibrous fixation in 13 patients. DISCUSSION: Bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures in patients aged 75 years or more, without reconstruction of the femoral calcar, may achieve a satisfactory clinico-radiological outcome, and could regain preoperative ambulatory status in most patients (83.3%). LEVEL OF EVIDENCE: IV, Retrospective study.

Synergistic effects of titania nanotubes and silicon to enhance the osteogenic activity.

In this study, titania nanotubes (TNTs) incorporating silicon (Si) were formed on Ti disks using anodization and electron beam evaporation (EBE) technology to improve the osteogenic activity. The amount of Si was exquisitely adjusted by controlling the duration of EBE to optimize the biofunctionality. As the Si was incorporated, the samples exhibited hydrophilic surfaces. Long lasting and controllable Si release was observed from the EBE-modified samples without cytotoxicity. Moreover, initial cell adhesion, spreading, proliferation and osteogenic differentiation of MC3T3-E1 cells were evaluated. The results showed a notable enhancement of spreading, osteogenesis and differentiation of cells on silicon-coated TNTs (Si-TNTs). In particular, samples with highest amount of silicon (∼5.93% Si) displayed greatest augmentation of ALP activity, osteogenic-related gene expression and mineralization compared to the others in the present study. It was indicated that the modification with TNTs and appropriated Si content resulted in enhanced osteoblastic spreading, proliferation and differentiation, and therefore has the potential for future applications in the field of orthopedics.

Delayed total hip arthroplasty after failed treatment of acetabular fractures: an 8- to 17-year follow-up study.

BACKGROUND: Delayed total hip arthroplasty (THA) is a reliable procedure following failed treatment of acetabular fractures. The aim of the present study was to evaluate the influence of the type of fracture treatment and modern ceramic bearing on the clinical outcomes of delayed THA. METHODS: Between January 1997 and January 2008, 33 patients (33 hips) underwent cementless THA after failed acetabular fractures. Twenty-one were initially treated by open reduction internal fixation (ORIF) and 12 had non-ORIF. Joint articulation was either conventional metal-on-polyethylene (MOP) or ceramic-on-ceramic (COC). Intraoperative measures and preoperative and follow-up clinical, radiological, and functional outcomes were compared between the ORIF and non-ORIF groups. RESULTS: Surgery duration, blood loss, and transfusion requirement were greater in the ORIF group than in the non-ORIF group (p < 0.05). Significant improvement in Harris Hip Scores was seen post-surgery in both groups. However, a significant difference in the mean Harris Hip Score was not observed between the two groups (p = 0.57). Six patients in the ORIF group required acetabular reconstructive procedures to address bony defects compared to seven patients in the non-ORIF group (p = 0.09). The rate of anatomical restoration was 58.3% (7/12) in the non-ORIF group and 42.9% (9/21) in the ORIF group (p = 0.12). Radiolucent lines were observed in the MOP group and none in the COC group. Overall survival rate was similar in both groups (p = 0.85): 89.3% in the ORIF group and 87.5% in the non-ORIF group. CONCLUSION: Delayed THA with previous acetabular fractures is a challenging procedure. Initial fracture treatment does not influence the outcome of delayed THA, and modern ceramic bearing has promising results in the long-term follow-up.

[Comparison of Chemical Components Characteristics of PM2.5 Between Haze and Clean Periods During Summertime in Lin'an].

PM2.5 samples were collected at a background site of the Yangtze River Delta in China, during summertime, of which the carbonaceous components, i.e., OC and EC, and water-soluble inorganic ions, including sulfate, nitrate, and ammonium, were quantified. The average concentrations of OC and EC in PM2.5 during summer at Lin'an were (14.3±3.95) µg·m-3 and (3.33±1.47) µg·m-3, respectively. Compared to an urban site, the correlation between OC and EC during summertime in Lin'an, which was a rural site, was relatively weak (R2=0.31, P<0.01). The concentrations of secondary inorganic aerosols (sulfate as SO42-, nitrate as NO3-, and ammonium as NH4+) were much higher than those of other water-soluble inorganic ions, with average values of (8.70±5.66), (2.04±1.07), and (3.25±2.29) µg·m-3, respectively. Based on long-term intensive observations, combined with the analysis of back trajectory and fire spots observations, it was revealed that regional transport and stable synoptic conditions both play important roles in controlling the variations in aerosol chemical components. During the transition from clean to hazy days, the EC and POC fractions showed no obvious variation; in contrast, the SOC fraction decreased obviously. Unlike for SOAs, relative contributions of sulfate and ammonia to PM2.5 increased during hazy days, suggesting enhanced chemical production via other pathways for these two secondary inorganic ions, probably through heterogeneous reactions.

Clinical and radiographic outcomes of treatment of comminuted Mason type II radial head fractures with a new implant.

This study aims to evaluate the clinical and radiographic treatment outcomes of comminuted Mason type II radial head fractures, which underwent open reduction and internal fixation (ORIF) using a new implant (mother-child screw, MCS).This study included 16 patients (7 male and 9 female patients; mean age: 40.9 years, age range: 19-68 years), who were treated with ORIF, followed by MCS fixation for comminuted type II radial head fractures. The clinical results were evaluated using the Mayo Elbow Performance Score (MEPS). Radiographs, which included the quality of fracture reduction, stability, osteoarthritis, and heterotopic ossification of the elbow, were investigated. The mean follow-up period was 23.4 months.Anatomical reduction and bone union were achieved in all patients treated with MCS, and mean union time was 6.2 weeks. The average flexion-extension arc of elbow motion was 135.6° (range: 125°-150°), and the average arc of forearm rotation was 155.3° (range: 145°-170°). Furthermore, MEPS was 94.1 (range: 85-100), and the rate of excellent and good was 100%. All patients returned to preinjury work within a mean period of 11.7 weeks. No heterotopic ossification and joint stiffness of the elbow were encountered. Two patients had mild arthritic changes (grade I), but none of these patients complained of pain.The use of MCS fixation for comminuted type II radial head fractures resulted in good clinical and radiographic outcomes.

Interleukin-1ß induces apoptosis in annulus fibrosus cells through the extracellular signal-regulated kinase pathway.

PURPOSE: The loss of intervertebral disc (IVD) cells due to excessive apoptosis induced by inflammatory cytokines is a major cause of IVD degeneration. This study aims to explore the mechanism of interleukin-1ß (IL-1ß)-induced apoptosis of annulus fibrosus cells (AFCs). It's hypothesized that IL-1ß induces apoptosis through the extracellular signal-regulated kinase (ERK) pathway in AFCs. METHODS: The mRNA and protein expression levels of apoptosis-associated genes were analyzed by quantitative real-time PCR and Western blotting. The apoptotic rate was measured by flow cytometry. Three experimental groups were established, including Control, IL-1ß, and IL-1ß+U0126 groups, respectively. RESULTS: Increase in the expression of apoptosis-associated genes including B-cell lymphoma-2 associated X (Bax), caspase-3, and caspase-9, and meanwhile, decrease in the expression of B-cell lymphoma-2 (Bcl-2) gene were found in patients with degenerative IVDs. In in vitro tests, both apoptosis and phosphorylated ERK expression in rat AFCs decreased in the IL-1ß+U0126 group compared with the IL-1ß group. The expression levels of Bax, caspase-3, and caspase-9 in AFCs decreased significantly in the IL-1ß+U0126 group compared with those in the IL-1ß group. The expression level of Bcl-2, on the other hand, significantly increased. CONCLUSIONS: Findings from this study suggest that IL-1ß induces apoptosis in AFCs through the ERK pathway, and therefore, ERK inhibition may provide certain protection against the adverse effects of IL-1ß.

Influence of age on results following surgery for displaced acetabular fractures in the elderly.

BACKGROUND: Elderly patients have more special medical needs when compared with young ones; thus, the results of open reduction and internal fixation (ORIF) for acetabular fractures should be stratified by age in these patients. This study seeks to determine whether the age of the patient influences the results of the ORIF for acetabular fractures. METHODS: We performed a retrospective analysis of prospectively collected data on 53 elderly patients with displaced acetabular fractures who underwent ORIF between May 2004 and May 2011. Patients were divided into two groups by age: young-old group (60-74 years) and old-old group (75-90 years). The number of patients in each group was 28 and 25. The reduction quality and clinical function was evaluated using the Matta criteria and modified Postel Merle D'Aubigne Score, respectively. Operative time, bleeding amount, and complications were recorded. RESULTS: Patients in old-old group had significantly lower anatomical reduction rate (p = 0.024), less operative time (p = 0.021), and less bleeding amount (p = 0.016) than those in the young-old group. The reduction quality in the young-old group was strongly associated with clinical function (p < 0.05). However, no difference in clinical function was detected among the different reduction qualities in the old-old group (p > 0.05). Moreover, no significant difference in clinical functions (p = 0.787) and complications (p = 0.728) was detected between the two groups. CONCLUSIONS: Old-old patients may expect comparable clinical functions and complications with young-old patients. The reduction quality in old-old patients may be not significantly associated with clinical function. Different treatment strategies may be applied for acetabular fractures with ORIF in different age groups.

[Sources and Characteristics of Regional Background PM1 in North China During the Autumn and Winter Polluted Period].

The campaign of investigating the chemical compositions and particle size distributions of NR-PM1(non-refractory PM1) was conducted by using a High Resolution Time of Flight Aerosol Mass Spectrometer(HR-ToF-AMS) at the Shangdianzi(SDZ) regional atmospheric background site(117.07°E, 40.39°N), northeast of Beijing, from October 17th 2015 to January 27th 2016. The results showed that organics was the main component of PM1, and the proportion of nitrate was higher than that of sulfate in autumn and winter. The mean mass-resolved size distributions for the main components displayed accumulation mode. The wider organic peak shape and larger nitrate peak size indicated that the organics contributed to both small and large particles at the beginning of the particle formation, growth and aging processes, while most of nitrate particles preferred to grow into large particles during the aging process. The ratios of elements between OM and OC, O/C and H/C were calculated as 1.91, 0.58 and 1.58 respectively. The slope of Van Krevelen diagram of organic aerosols during polluted episode was -0.21, whose oxidation state was higher than those of other city sites. Nitrate was the major contributor of NR-PM1 during the polluted period, while organics was significantly higher than that during clean period. The results of back trajectories analysis demonstrated that the air masses were complex during the pollution episode. The northwest wind from central Inner Mongolia and Siberia dominated the clean episodes, which was conducive to the spread of pollutants.

[Physico-chemical Characteristics of Individual Aerosol Particles in Marine Atmosphere on South Hemisphere].

During the 29th Chinese National Antarctic Research Expedition (CHIANRE), individual particle samples were collected from South China to Antarctic during November 2012 to April 2013. A transmission electron microscopy with energy-dispersive X-ray spectrometry (TEM-EDS) was employed to analyze the morphology, mixing state, composition, and relative abundances of individual aerosol particles. Atmospheric particles were classified into four types:sea salt, mineral, S-rich and C-rich. Sea salt aerosols (SSA) were dominant in the marine particles from South China to Antarctic, and they were further divided into three sub-types:fresh SSA, partially aged SSA, and fully aged SSA. Partially and fully aged SSA accounted for 86% of total SSA number. Interestingly, surface of partially aged SSA and fully aged SSA contained abundant rod-like Na2SO4. Mineral dust particles increased in the coastal areas which were influenced by continental air. In addition, we found that S-rich particles were abundant at two sampling sites (the middle eastern of Indian Ocean and Antarctic inland). The back trajectories of air masses indicated that these S-rich particles were mainly formed via the oxidation of dimethyl sulfide (DMS) emitted from the marine phytoplanktons. Our study suggests that the SSA aging process in the South Hemisphere atmosphere was controlled by the DMS which is different from the SSA aging under the influence of anthropogenic pollutants in the North Hemisphere.

Results of Lateral Retinacular Release Plus Circumpatellar Electrocautery in Total Knee Arthroplasty without Patellar Resurfacing.

Anterior knee pain (AKP) is integral to the overall success of total knee arthroplasty (TKA) without patellar resurfacing. Numerous studies have evaluated various factors that may contribute to AKP, including patellofemoral design, surgical technique, characteristics of the patient, and degree of chondromalacia. This study aims to explore whether patients who received lateral retinacular release (LRR) plus circumpatellar electrocautery (CE) in TKA attain a low incidence of AKP and whether the LRR plus CE increases postoperative complications. Between February 2001 and February 2009, all patients undergoing TKA without patellar resurfacing and LRR plus CE were evaluated. In total, 286 TKAs in 259 (88.7%) patients were available for assessment, with a mean of 9.3 ± 2.5 years (range: 6-14 years) after the index TKA. The patients were evaluated with a VAS and the Kujala patellofemoral score (KPS) for AKP and the Knee Society's clinical scoring system (KSS) for the clinical function. Satisfaction and LRR-related complications were also assessed. The mean KPS and KSS improved from 45.2 ± 12.9 and 75.4 ± 26.8 points preoperatively to 82.8 ± 10.0 and 151.6 ± 17.3 points at the final follow-up (p < 0.001), respectively. Subjectively, 5.6% (16 of 286) of patients suffered from AKP and 88.1% (252 of 286) were satisfied or very satisfied. Postoperative complications occurred in 15 (5.2%) patients, but these complications were mild and did not require reoperation. None of patients exhibited aseptic and septic prosthesis loosening and required revision surgery in the final follow-up. LRR plus CE appears to be a reasonable option in TKA without patellar resurfacing. It may achieve adequate mid-term results, with a low incidence of AKP and postoperative complications.The level of evidence of the study is therapeutic level IV.

[Imageology and significances of rotational axes of distal femur on Chinese adults with total knee arthroplasty].

OBJECTIVE: To explore clinical significance of rotational axis of distal femur on Chinese adults in total knee arthroplasty (TKA). METHODS: There were 86 Chinese adults (106 normal knees) including 47 males (53 knees) and 39 females (53 knees), 54 knees were on left and 52 on right. The CT scan was employed in the distal femur. The scan direction was aligned to be on the plane perpendicular to the mechanical axis of the femoral. The CT images of cross sections across lateral and medial femoral epicondyle were moved to personal computer,lateral angle between anterior posterior line (APL) and surgical transepicondylar axis (STEA) (ATA),lateral angle between posterior condylar line (PCL) and APL (APA), angle between perpendicularity of APL and PCL (A-PA), posterior condylar angle (PCA), condylar twist angle (CTA), angle between clinical transepicondylar axis (CTEA) and STEA (CSA) were measured. These values were divided into different groups according to gender and side, the values of CTA, PCA, A-PA, angle PT (varus of tibia plateau), constant 3, ATA, APA and constant 90° were compared by statistically. A-PA and PCA, and CTA were analysed statistically with the liner regression, the relationship among CTEA, STEA ,PCL, APL and PLP were performed to assess by liner regression. RESULTS: ATA was (89.79 ± 1.22)°, APA was (84.84 ± 1.83)°, A-PA was (5.16 ± 1.83)°, PCA was (4.80 ± 1.23)°, CTA was (8.23 ± 1.40), CSA was (3.45 ± 0.68)°. All the parameters had no differences on sex and side,but CSA had difference on male and female. There was no difference among angle PT, PCA, A-PA. There was significant difference in CAT, constant 30 and angle PT, PCA,A-PA. There was no difference between ATA and constant 90°, but there was difference between APA and constant 90°. There was relativity between PCA and CTA, and also PCA and A-PA, CTA and A-PA. There was significant relativity between STEA and CTEA, between STEA and APL, between STEA and PCL, and also between APLP, APL and PCL, but there was no significant relativity between PCL and CTEA. CONCLUSION: TKA for Chinese, the section of femoral posterior condyle should be external 5° to obtain the optimum rotational orientation. The property is different entirely between STEA and CTEA, the rotational alignment is not performed according to parallel to the CTEA in distal femur. Among STEA, APL, PCL, the STEA is the most reliable mark ofrotational alignment of the distal femur, and the PCL is the less reliable mark.

Mid term results of total hip arthroplasty using polyethylene-ceramic composite (Sandwich) liner.

BACKGROUND: Ceramic-on-ceramic (COC) couplings are an attractive alternative bearing surfaces that have been reported to eliminate or reduce problems related to polyethylene wear debris. However, the material in total hip arthroplasty (THA) remains one of the major concern regarding the risk of fracture. The present study aims at reporting the fracture rate of bearings in a series of COC THAs with the use of a sandwich liner and attempt to detect the relative risk factors, the possible cause and assess the clinical results. MATERIALS AND METHODS: We retrospectively evaluated 153 patients (163 hips) using the sandwich liner COC THA between 2001 and 2009. Patient assessment was based on demographic factors, including age, weight, gender and body-mass index (BMI). All patients were evaluated clinically and radiographically or using computed tomography viz-a-viz dislocation, osteolysis, periprosthetic fracture, infection, loosening and implant fracture. RESULTS: Three ceramic sandwich liners fracture (1.84%) were observed at an average of 7.3 years' followup. The factors which were found to be non-significant to the ceramic liner fracture, included age (P = 0.205), weight (P = 0.241), gender (P = 0.553), BMI (P = 0.736), inclination (P = 0.199) and anteversion (P = 0.223). The overall survival was 91.4% at 12-year with revision as the endpoint. Other complications included osteolysis in 4 (2.45%), dislocation in one and periprosthetic fracture in one. In no hip aseptic loosening of the implants was seen. CONCLUSIONS: Our experience with the ceramic-polyethylene sandwich liner acetabular component has been disappointing because of the high rate of fracture and osteolyis. We have discontinued the use of this device and recommend the same.

Medial Protrusio Technique in Cementless Total Hip Arthroplasty for Developmental Dysplasia of the Hip: A Prospective 6- to 9-Year Follow-Up of 43 Consecutive Patients.

BACKGROUND: The medial protrusio technique may be used during total hip arthroplasty (THA) on patients with developmental dysplasia. However, studies have yet to determine whether a cementless cup can be sufficiently stable to withstand loading forces. This study aimed to assess the clinical and radiographic outcomes of this technique. Furthermore, we sought to determine the relationship between the rate of medial protrusion and the incidence of cup loosening. METHODS: Thirty-nine patients (43 hips) underwent cementless THA between April 2006 and March 2009 by using the medial protrusio technique. These patients participated in a 6- to 9-year follow-up. Their clinical and radiographic data were gathered prospectively. RESULTS: The average Harris Hip Score improved from 43.1 ± 15.4 points preoperatively to 91.9 ± 12.8 points at the final follow-up (P < .001). The mean height of hip center and the distance of hip center medialization were 2.4 ± 0.6 and 2.5 ± 0.9 cm, respectively. The rate of medial protrusion and the rate of cup coverage were 42.1 ± 12.4% and 96.8 ± 5.1%, respectively. The rate of medial protrusion ranged from 18.3% to 58.3% in 38 hips (group A) and from 61.3% to 68.9% in 5 hips (group B). None of the cups in group A loosened or failed, 2 failures occurred in group B (0% vs 40.0%; P = .011). CONCLUSIONS: Developmental dysplasia was treated through THA using the medial protrusio technique, which easily achieves a sufficient superolateral host bony coverage of the cup and promotes socket reconstruction at the true acetabulum. The rate of medial protrusion of <60% may be necessary to obtain excellent clinical and radiographic midterm results.

Ceramic-on-ceramic bearings total hip arthroplasty in young patients.

BACKGROUND: The results of ceramic-on-ceramic (CoC) total hip arthroplasty (THA) in younger patients were not univocal. This study aims to evaluate the results of CoC bearing THA in patients younger than 50 years. METHODS: A total of 90 younger patients performed CoC THAs during March 2003 and May 2008 were included in this study. Hip function and activity were evaluated with Harris hip score and University of California Los Angeles activity score. We had discussed survival rates, radiological findings of component loosening or osteolysis, and ceramic-related complications in these patients. RESULTS: The mean Harris hip score increased from 46.3 ± 12.0 points (range, 28-70 points) before surgery to 92.5 ± 5.6 points (range, 78-100 points) at the final follow-up. The mean preoperative University of California Los Angeles activity score was 4.2 ± 1.1 points (range, 2-6 points), which improved to a mean of 7.2 ± 1.3 points (range, 4-10 points). At the time of the last follow-up, there was found to be 1 occurrence of hip dislocation, 1 squeaking, and 2 "sandwich" ceramic liners fractured during normal activity of daily living. No hips showed osteolysis or required revision for aseptic loosening. Kaplan-Meier survivorship with revision due to loosening or osteolysis was 100% and with revision due to ceramic fracture was 97.3% (95% confidence interval, 93.7%-100%) at a mean of 9.4 years. CONCLUSIONS: This study with the use of CoC bearings THAs in younger patients have shown promising results and higher rate of survivorship without evidence of osteolysis.

Proliferative Constituents from the Leaves of Micromelum integerrimum.

Two new compounds, 5-O-methyl-4-desmethyl-myricanol (1) and 6-formyl-5-isopropyl-3-hydroxymethyl-7-methyl-1H-indene (2), were isolated from the leaves of Micromelum integerrimum. Their structures were determined by spectroscopic methods. Additionally, compound 1 could stimulate the growth of NIH3T3 cells and promote cell migration. Compound 1 might exert its effects through increasing the protein expression of connective tissue growth factor.

A novel fixation system for acetabular quadrilateral plate fracture: a comparative biomechanical study.

This study aims to assess the biomechanical properties of a novel fixation system (named AFRIF) and to compare it with other five different fixation techniques for quadrilateral plate fractures. This in vitro biomechanical experiment has shown that the multidirectional titanium fixation (MTF) and pelvic brim long screws fixation (PBSF) provided the strongest fixation for quadrilateral plate fracture; the better biomechanical performance of the AFRIF compared with the T-shaped plate fixation (TPF), L-shaped plate fixation (LPF), and H-shaped plate fixation (HPF); AFRIF gives reasonable stability of treatment for quadrilateral plate fracture and may offer a better solution for comminuted quadrilateral plate fractures or free floating medial wall fracture and be reliable in preventing protrusion of femoral head.

Analysis of risk factors for femoral head necrosis after internal fixation in femoral neck fractures.

Femoral head necrosis is a rare but devastating complication following femoral neck fracture. The reported incidence of avascular necrosis after femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. The aim of this study was to analyze the risk factors for femoral head necrosis after internal fixation in femoral neck fracture. This retrospective study included 166 patients with femoral neck fractures treated with surgical reduction and internal fixation at the authors' institution from January 2004 to December 2008. Eight patients died for reasons unrelated to the surgery, and 12 patients were lost to follow-up. The remaining 146 patients (146 fractures) were followed until union or until conversion to total hip arthroplasty. The patients included 61 males and 85 females with an average age of 47.5 years (range, 18-68 years). The authors analyzed the following factors: age, sex, Garden classification, reduction quality, surgical methods, injury-to-surgery interval, preoperative traction, weight-bearing time, and implant removal. All patients were followed for a mean of 52 months (range, 6-90 months). The incidence of femoral head necrosis was 14.4% (21/146). Garden classification (P=.012), reduction quality (P=.008), implant removal (P=.020), and preoperative traction (P=.003) were significantly associated with femoral head necrosis. Patient age (P=.990), sex (P=.287), injury-to-surgery interval (P=.360), weight-bearing time (P=.868), and surgical methods (P=.987) were not significantly associated with femoral head necrosis. In multivariate logistic regression analysis, implant removal was not a significant risk factor for femoral head necrosis development (P=.498). Garden classification, reduction quality, and preoperative traction had a significant effect on femoral head necrosis development.

Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective, randomized study.

PURPOSE: Anterior knee pain is a major cause of complaint in total knee arthroplasty (TKA) without patellar resurfacing. The concept of improved patellar tracking and decreased retropatellar contact pressure for lateral retinacular release theoretically suggests that patients with lateral retinacular release in TKA would achieve a lower incidence of anterior knee pain when compared without lateral retinacular release. We sought to determine (1) whether those patients who received a routine lateral retinacular release in TKA would attain lower incidence of anterior knee pain as compared to patients who received TKA without lateral retinacular release and (2) whether lateral retinacular release would increase the lateral retinacular release-related complications. METHODS: A total of 148 patients who underwent TKA with the use of the Gemini MK II mobile bearing were randomized to receive either routine lateral retinacular release (intervention group) or not (control group). Patients were assessed by the visual analogue scale for anterior knee pain, the Knee Society clinical scoring system of knee score and function score, and patellar score for clinical function. Patients' satisfaction and lateral retinacular release-related complications were also evaluated. RESULTS: The overall incidence of anterior knee pain in the intervention group at 18 months follow-up was 5.6%, while that of the control group was 20.6% (p = 0.009). No statistical difference was detected between the two groups in terms of lateral retinacular release-related complications (n.s.), patients' satisfaction (n.s.), knee score (n.s.), function score (n.s.), and patellar score (n.s.) at 18 months follow-up. CONCLUSION: The present study suggests that routine lateral retinacular release can reduce anterior knee pain and does not increase lateral retinacular release-related complications, in TKA with the use of the Gemini MK II mobile bearing without patellar resurfacing. LEVEL OF EVIDENCE: Therapeutic, Level I.