Model to Predict Need for Subtrochanteric Shortening Osteotomy During Total Hip Arthroplasty for Crowe Type IV Developmental Dysplasia.

BACKGROUND Indications for subtrochanteric shortening osteotomy (SSOT) during Crowe type IV developmental dysplasia of the hip (DDH) are unclear. The aim of this retrospective study was to create a model to predict the need for performing SSOT. MATERIAL AND METHODS One hundred forty-nine patients (186 hips) with Crowe Type IV DDH who underwent total hip arthroplasty (THA) with S-ROM implants from January 2010 to November 2018 were included in the study. The acetabular components were placed at the true acetabulum and the trial femoral component was inserted. Reduction then was attempted and if it could not be achieved, SSOT was performed. Using multivariable Cox regression analysis, a model was constructed that included age, sex, surgical history, use of a cone- or triangle-shaped sleeve, secondary acetabulum formation, and percentage of dislocation as predictive factors for SSOT. RESULTS SSOTs were performed on 140 of 186 hips. Secondary acetabulum formation was present in 27 hips (58.70%) in which SSOT was not performed 7 (5.00%) in which it was performed. Cone-shaped sleeves were used in 17 hips (36.96%) in which SSOT was not performed versus 15 (10.71%) hips in which it was performed. Dislocation occurred in 31.30±5.80% hips in which SSOT was performed versus 24.05±4.39% of those in which it was not performed. Percentage of dislocation was associated with an increased likelihood of SSOT (odds ratio [OR] 1.24, 95% confidence interval 1.11-1.38), whereas secondary acetabulum formation (OR 0.10, 0.03-0.33) and use of a cone-shaped sleeve (0.18, 0.06-0.53) were associated with decreased likelihood of SSOT. We established a model for prediction of SSOT with a nanogram and the discriminative ability (C statistic) of it was 0.918 (0.79-0.92). CONCLUSIONS Factors that significantly affect likelihood of performing an SSOT were identified and a model with significant ability to predict the need for SSOT in patients with Crowe Type IV DDH was created.

Effect of positive airway pressure on cardiac troponins in patients with sleep-disordered breathing: A meta-analysis.

BACKGROUND: Cardiac troponins are highly sensitive and specific biomarkers for cardiac injury. Previous studies evaluating the effect of positive airway pressure (PAP) on cardiac troponins in patients with sleep-disordered breathing (SDB) have yielded conflicting results. The meta-analysis was performed to examine the effect of PAP on cardiac troponins in SDB patients. METHODS: PubMed, Web of Science, and EMBASE before September 2021 on original English language studies were searched. The data on cardiac troponins in both baseline and post-PAP treatment were extracted from all studies. The data on the change of cardiac troponins in both PAP and control group were extracted from randomized controlled trials. Standardized mean difference (SMD) was used to synthesize quantitative results. RESULTS: A total of 11 studies were included. PAP treatment was not associated with a significant change in cardiac troponin T between the baseline and post-PAP treatment (SMD = -0.163, 95% confidence interval [CI] = -0.652 to 0.326, z = 0.65, p = .514). The pooled estimate of SMD of cardiac troponin I between the pre- and post-PAP treatment was 0.287, and the 95% CI was -0.586 to 1.160 (z = 0.64, p = .519). The pooled SMD of change of cardiac troponin T between the PAP group and control group was -0.473 (95% CI = -1.198 to 0.252, z = 1.28, p = .201). CONCLUSIONS: This meta-analysis revealed that PAP treatment was not associated with any change of cardiac troponin in SDB patients.

[Clinical effect of Corail femoral prosthesis with different offset in total hip arthroplasty].

OBJECTIVE: To explore the early clinical efficacy of primary total hip arthroplasty(THA) with Corail standard stems (KS type) and high offset stems (KHO type), by analyzing the postoperative radiographic parameters of different offset of femoral components with Corail stem which has a neck-shaft angle of 135 ° in unilateral primary THA, by comparing the measurement results on both sides and analyzing the reconstruction of the postoperative femoral offset and the hip joint function recovery. METHODS: A retrospective analysis was made of 186 patients with unilateral hip joint lesions who underwent the first total hip arthroplasty with Johnson & Johnson Corail prostheses from January 2015 to June 2017. According to the use of femoral prostheses with different eccentricities during the operation, the patients were divided into high eccentricity group and standard eccentricity group. In the high eccentricity group, there were 52 cases of Corail high eccentricity prosthesis(KHO type), including 20 females and 32 males;aged 21 to 71 years old with an average of(50.6±13.2) years;body mass index(BMI) was (26.0±4.1) kg/m2. The standard eccentricity group included 134 Corail standard femoral stem prostheses(KS type), 57 females and 77 males;aged 18 to 77 years old with an average of (47.3±14.0) years;BMI was (25.3±3.5) kg/m2. The abduction arm, femoral eccentricity, acetabular eccentricity and the length difference of lower limbs were measured on the postoperatively positive X-ray film of the hip joint. Harris score and related complications were recorded before and after the operation, and the stability of the prosthesis was analyzed. RESULTS: There were significant differences in femoral eccentricity, joint eccentricity and abduction arm between the affected side and the healthy side in the high eccentricity group(P<0.05). There were significant differences in femoral eccentricity and acetabular eccentricity between the affected side and the healthy side in the standard eccentricity group(P<0.05). There were significant differences in combined eccentricity, abduction arm and length of lower limbs between two groups(P<0.05). In the high eccentricity group, the abduction arm of the affected hip joint was positively correlated with the femoral eccentricity, acetabular eccentricity and joint eccentricity(r=0.633, P<0.001;r=0.384, P=0.005;r=0.690, P<0.001). The same results were also obtained in the healthy side(r=0.688, P<0.001;r=0.574, P<0.001;r=0.765, P<0.001). In the standard eccentricity group, the abduction arm of the affected hip joint was positively correlated with the femoral eccentricity, acetabular eccentricity and combined eccentricity(r=0.734, P<0.001;r=0.418, P<0.001;r=0.749, P<0.001). The same results were also obtained in the healthy side(r=0.775, P<0.001;r=0.397, P<0.001;r=0.773, P<0.001). The difference of the length of both lower limbs was significantly correlated with the difference of bilateral joint eccentricity and bilateral abduction arm (r=0.376, P=0.006;r=-0.346, P=0.012). There was no significant correlation between the difference of the length of both lower limbs and the difference of bilateral joint eccentricity and bilateral abduction arm (r=-0.009, P=0.919;r=-0.036, P=0.682). There was no significant difference in Harris score between two groups at the last follow-up(P>0.05). At the last follow-up, Trendelenburg was negative in all patients in both groups, and the prostheses were stable. CONCLUSION: Both Corail standard stem and high offset stem may be effectively reconstruct the femoral offset, reconstruct the anatomical structure and biomechanics of the hip joint, and maintain the length of lower limbs and the stability of the hip joint in the unilateral primary total hip arthroplasty. Although the offset of the femur was not reconstructed normally in some cases, the stability of the components and postoperative function were not affected.

Construction of a multiple-class classifier based on mRNAs and lncRNA FAM66A and PSORS1C3 for predicting distant metastasis in lung adenocarcinoma.

Background: There are several mechanisms believed to be essential for the development of distant metastasis in lung adenocarcinoma (LUAD), but the prediction of distant metastasis is still a challenge. The purpose of the present study was to examine the specific changes in RNA expression, including long non-coding RNAs (lncRNAs) in distant metastasis patients. Methods: We compared differentially expressed genes involved in distant metastasis from otherwise non-metastasis and healthy adults using a gene expression profile. We first ranked gene sets (or gene signatures) that identify each class. An advanced multiple-class classifier was built based on the gene sets. Our classifier consisted of 282 genes and could predict cancer and distant metastasis with error rates of approximately 0.01 and 0.2, respectively. Then, gene networks were built to undermine gene relations to each class. Results: Cytochrome P450 family 4 subfamily F member 12 (CYP4F12) was the first gene in the ranking of the distant metastasis case. Down syndrome cell adhesion molecule (DSCAM) was the top gene in the rank list of the non-metastasis case. Solute carrier family 6 member 4 (SLC6A4) was associated with normal tissues. LncRNA family with sequence similarity 66 member A (FAM66A) and lncRNA PSORS1C3 were found to be associated with tumor metastasis. Conclusions: Our classifier could successfully predict distant metastasis in LUAD patients. LncRNA FAM66A and lncRNA PSORS1C3 in our model could play a role in cancer development.

[Application of high offset Corail femoral stem prosthesis in unilateral primary total hip arthroplasty].

OBJECTIVE: To investigate the application of high offset femoral stem prosthesis in primary total hip arthroplasty. METHODS: From January 2015 to June 2017, 51 patients with unilateral hip diseases who underwent primary total hip arthroplasty with Corail high offset femoral stem prosthesis(KHO type) were selected for retrospective study, including 20 females and 31 males;the age ranged from 21 to 71 years old with an average of(50.8±13.3) years old. The abduction arm, femoral offset, acetabular offset and the length of lower limbs were measured on the positive X-ray film of hip joint after operation. Harris scores before and after operation and related complications were recorded, and the stability of prosthesis was analyzed. RESULTS: The femoral offset, combined offset and abduction arm of the affected side were significantly greater than those of the healthy side(P<0.05). There was no significant difference in acetabular offset between the affected side and the healthy side (P>0.05). The femoral offset of 17 hips (33.3%) was reconstructed normally, of which 15 cases (88.2%) had equal length of both lower limbs. The femoral offset of 34 hips (66.7%) was greater than that of the healthy side, and 34 cases (100%) had equal length of both lower limbs. All 51 patients were followed up for(42.3±7.3) months. The Harris score increased from 38.0±7.6 before operation to 92.1±3.1 at the final follow-up(P<0.001). CONCLUSION: Although the high offset Corail prosthesis can not normally reconstruct the femoral offset in unilateral primary total hip arthroplasty, it does not affect the reconstruction of the length of lower limbs and the stability of the prosthesis.

One-Stage Total Hip Arthroplasty with Modular S-ROM Stem for Patients with Bilateral Crowe Type IV Developmental Dysplasia.

OBJECTIVE: The aim of the present paper was to evaluate the results of one-stage total hip arthroplasty (THA) for patients with bilateral Crowe type IV developmental dysplasia of the hip (DDH). METHODS: Data for 58 patients (116 hips) with bilateral Crowe type IV DDH who had one-stage THA performed by the same surgeon during the period of April 2008 to February 2019 were retrospectively reviewed. The mean age of the patients was 37.3 years; 5 were men and 53 were women. All patients underwent THA through the posterolateral approach using the Pinnacle acetabular cup, a ceramic-on-ceramic bearing, and the modular S-ROM stem. Subtrochanteric shortening osteotomy was performed on 86/116 hips. Intraoperative conditions were recorded. Radiographic and functional outcomes were evaluated, and complications were recorded. RESULTS: All patients were followed up for an average of 71.3 ± 37.6 months (range, 12-140). The mean operative time was 276.5 ± 57.9 min (range, 175-540). The mean intraoperative blood loss was 933.6 ± 400.8 mL (range, 300-2000). The mean transfusion requirement was 1778 ± 798.0 mL (range, 575-4550). The mean length of hospital stay was 8.6 ± 3.7 days (range, 5-22). At the final follow-up, no loosening of acetabular and femoral components was observed. No osteolysis and heterotopic ossification occurred. The mean Harris hip scores were improved from 55.4 ± 14.3 preoperatively to 91.3 ± 4.2 postoperatively (P < 0.001) In terms of complications, no perioperative deaths were recorded. Deep vein thrombosis occurred in 1 hip, with no pulmonary embolism. Intraoperative femur fracture occurred in 3 hips, nerve injury in 1 hip, and leg length discrepancy in 1 patient. Postoperative dislocation occurred in 5 hips and nonunion in 1 hip. CONCLUSION: Our data demonstrated that one-stage bilateral THA for bilateral Crowe type IV DDH is feasible and can effectively restore hip function.

[Effect of ceramic on ceramic total hip arthroplasty in Crowe IV developmental dysplasia of the hip].

OBJECTIVE: To observe the clinical effect of ceramic on ceramic total hip arthroplasty(THA)in Crowe IV developmental dysplasia of the hip(DDH). METHODS: From April 2008 to December 2015, 137 hips of 111 Crowe IV DDH patients received THA using Forte or Delta ceramic on ceramic by one senior surgeon, which consists of 85 unilateral hips and 26 bilateral hips. The average age of the patients was(38.88±10.83) years old ranging from 18 to 68 years old. The mean follow-up was(41.16±21.50) months ranging from 12 to 96 months. All the patients were evaluated by Harris Hip Score. Radiographic evaluations were made preoperatively and during follow-up. Harris scores, the incidence of complications such as ceramic fracture, squeaking, dislocation were observed. RESULTS: The mean preoperative Harris score was 56.54±15.67, the mean postoperative Harris score was 88.30±6.86(P=0.017). Periprosthetic osteolysis was not deteced around any cup. No ceramic fracture occurred. There were 3 cases of revision surgery due to infection, losening of the stem and limb length discrepancy, respectively; 3 cases of dislocation occurred. Seventy-seven patients were recorded the gait and the hip mobility, the hip flexion of 69 patients were above 120 degrees. CONCLUSIONS: Ceramic on ceramic bearing showed an encouraging result in Crowe IV DDH total hip arthroplasty.

[Clinical observation on the treatment of periprosthetic infection of coagulase-negative staphylococci by two-stage revision].

OBJECTIVE: To investigate the risk factors for the failure in treating periprosthetic infection of coagulase-negative staphylococci by two-stage revision. METHODS: From January 2005 to June 2015, 57 patients with periprosthetic hip and knee joint infection of coagulase-negative staphylococcus by two-stage revision were retrospectively reviewed with an average age of (61.3±11.9) years old. According to the drug resistance of methicillin, the patients were divided into methicillin sensitive group(MSCoN) and methicillin resistance(MRCoN) group, 25 cases in MSCoN group(9 knees and 16 hips) included 12 males and 13 females, 32 cases in MRCoN group(11 knees and 21 hips) included 14 males and 18 females. Follow-up for at least 2 years, the inflammatory markers, incidence rate of sinus and the duration of the symptoms, reinfection or persistent infection rate after two-stage revision were compared between two groups. RESULTS: MSCoN group and MRCoN group were followed up(81.7±38.3) months and(65.9±33.8) months, respectively;23 cases and 27 cases were successfully treated;there was no significant difference between two groups(P=0.643). The patients who had surgery history were 4.04 times higher of failure than the patients without a history of surgery[OR=4.04, 95%CI(0.62, 26.5)]. Patients who had sinus were 4.26 times higher of failure than the patients without sinus[OR=4.26, 95%CI(0.7, 25.9)]. CONCLUSIONS: Two-stage revision is an effective procedure in treating patients infected by MSCoN and MRCoN. There is no significant difference of treatment failure rate between MSCoN and MRCoN group by two-stage revision. Surgery history and sinus maybe the risk factors of treatment failure, while methicillin-resistance is not.

[Mechanical complications with self-made, antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement].

OBJECTIVE: To study the complications and efficacy of self-made, antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement. METHODS: Between January 2006 and July 2016, 265 patients (266 hips) received a self-made, antibiotic-loaded cement articulating spacer as part of a two-stage protocol. Among those patients, there were 143 males(144 hips) and 122 females(122 hips). The cement articulating spacers with vancomycin and two Steinman pins were made by a self-made mold system. Meanwhile, another antibiotic was added to the spacers according to the drug sensitivity test. Record if the infected prosthesis was removed, related complication with spacer(breakage and dislocation), Harris score, and control rate of infection. RESULTS: The mean age of two-stage revision operation was(57.4±14.2) years. Thirty-nine patients(14.7%) used extended trochanteric osteotomy(ETO) to remove the infected prosthesis. And 38 patients occurred mentioned complications(14.3%). Spacer breakage occurred in 28 cases(10.5%) and dislocation occurred in 10 cases(3.8%). The mean follow-up time was(83.4±14.6) months. The Harris hip score was from 47.56±14.23 preoperatively to 86.43±12.84 at final follow-up(P<0.05). The infection of 256 cases(96.6%) got control after revision operation. However, during postoperative follow-up, 4 cases occurred re-infection, and they were reoperated, and the infections obtained effective control after the operation. Thus total infection control rate was 95.1%(252/265). CONCLUSIONS: Antibiotic-loaded cement articulating spacer made by a self-made mold system is effective in controling infection caused by hip replacement. Related complication is less with spacer by a mould enclosing two Steinman pins. Using metallic internal fixation or allograft bone combined with spacer does not affect infection control.

[Clinical results in early and mid term of using the S-ROM femoral stem in revision].

OBJECTIVE: To investigate and the clinical effect of S-ROM modular stem in femur reconstruction in hip revision arthroplasty. METHODS: From January 2008 to January 2016, 21 patients received revision hip arthroplasties using S-ROM stems. There were 5 males and 16 females with an average of 48.33 years old(range, 29 to 73 years old). There were 13 cases caused by aseptic loosening, 4 cases by infection, 2 cases by nonunion of sub-tuberosity osteotomy, 1 case for repeated dislocation, 1 case for traumatic great trochanter fracture. Primary THA reasons:12 cases for DDH(9 cases for Crowe IV), 5 cases for femoral neck fracture, 2 cases for necrosis of femoral head, 2 cases for proximal femoral deformity caused by early infection. The femur bone defects included Paprosky II in 11 cases, IIIa in 9, and IIIb in 1. Harris hip score , pain score and hip flexion were recorded before and after operation. The subjective satisfaction was recorded at the last follow-up. RESULTS: The operation time and blood loss were 189 min(125 to 290 min) and 867 ml (200 to 2 000 ml). At the final followup, the pain score improved from (17.14±9.56) points preoperatively to (41.71±2.03) points (t=11.42, P=0.00). The function score improved from (24.01±11.02) points preoperatively to (49.95±5.38) points (t=9.73, P=0.00). Harris hip score improved from (41.15±14.81) points preoperatively to(91.67±5.83) points(t=15.33, P=0.00). The degree of hip flexion increased from (93.10±27.27) points preoperatively to (121.90±16.62) points at the last follow-up (t=4.59, P=0.00). The mean subjective satisfaction was 9.48(10 points system), 14 of which were completely satisfactory. The last follow-up hip X-ray showed 21 cases of bone ingrowth, and other femoral stem without loosening or sinking sign significantly. There were 5 cases with bone anchor syndrome around proximal femoral cuff. There were 5 cases of proximal femur fracture, 3 cases of lesser trochanter fracture, 2 cases of greater trochanter fracture intra-operatively. Due to femoral canal stenosis, there were 4 cases of pre-tied wire at lesser trochanter to prevent fractures. There was 1 case of traumatic femoral fracture around stems with a distal oblique fracture, open reduction and locking plate fixation was performed. Other patients had no nerve stretch injury, dislocation, infection and lower limb deep vein thrombosis and other complications at the final follow-up. CONCLUSIONS: S-ROM prosthesis has satisfactory results in hip revision arthroplasty with Paprosky II and III femoral defects. Especially for patients with Crowe IV DDH and other proximal femoral deformities, it is possible to adapt to the medullary cavity morphology. Excellent initial stability, less complications and long-term biological fixation can be achieved with S-ROM in femur revision.