Application of individualized setting of femoral opening point and valgus angle in artificial total knee arthroplasty for patients with external femoral arch / 中国骨伤

OBJECTIVE@#To investigate whether shifting the femoral opening point and setting a personalized femoral valgus angle can improve the lower limb force line of total knee arthroplasty (TKA) patients with external femoral arch.@*METHODS@#From March 2016 to October 2018, 50 patients (55 knees) with osteoarthritis with genu varus deformity combined with external femoral arch for TKA were selected. There were 10 males and 40 females. The age ranged from 63.1 to 80.5 years old, with an average of (67.8±5.8) years old. Forty-five cases were unilateral and 5 cases were bilateral. The osteoarthritis stages of 55 knees were Kellgren-Lawrence grade Ⅲ to Ⅳ; and the course of disease ranged from 2 to 10 years. PreoperativeSpecial Surgery (Hospital for Special Surgery) scores:pain was 15.20±3.52; function was 8.30±2.96;mobility was 10.15±2.85;muscle strength was 4.20±1.95;flexion deformity was 5.50±3.05;stability was 6.15±2.20; total score was 47.93±3.39. The external femoral arch angle ranged from 6.4° to 16.7°, with a mean of (10.63±2.29) °. The tibiofemoral angle ranged from 7.4° to 12.6°, with a mean of (12.04±3.59)°. The anatomical distal femoral angle ranged from 83.10° to 91.20°, with a mean of (84.55± 1.66)°. And the distance from the center of the knee joint to the lower limb line of force ranged from 2.01 to 6.00 cm, with a mean of (3.57±1.12) cm. During the replacement surgery, the femoral opening point and the valgus angle were individually set to obtain a good line of force of the lower limbs.@*RESULTS@#Before the operation, the distance of femoral opening point ranged from 0.24 to 0.74 cm, with a mean of (0.54±0.10) cm. The distance between the internal and external condyles of the femur ranged from 6.86 to 8.12 cm, with a mean of (7.27±0.27) cm. The preoperative valgus correction angle (VCA) ranged from 7.20° to 13.80°, with a mean of (9.38±1.38) °. The post-correction valgus correction angle' (VCA') ranged from 6.10° to 9.50°, with a mean of (7.36±0.82) °. All patients were followed up, and the duration ranged from 3 to 36 months, with an average of (13.5±5.8) months. All patients obtained good knee function after operation. Three months after operation, HSS scores included pain of 25.30±3.05, function of 18.25±2.05, mobility of 16.05±0.75, muscle strength of 6.20±2.10, flexion deformity of 8.80±1.85, stability of 8.20±1.75; and the total score ranged from 90.00 to 93.00, with an average of 91.82±0.98. The total score was higher than that before operation (@*CONCLUSION@#In TKA combined with external femoral arch, good lower limb force line and knee joint function can be obtained by externally shifting the femoral opening point and setting a personalized femoral valgus angle.

Effect of ceramic on ceramic total hip arthroplasty in Crowe IV developmental dysplasia of the hip / 中国骨伤

<p><b>OBJECTIVE</b>To observe the clinical effect of ceramic on ceramic total hip arthroplasty(THA)in Crowe IV developmental dysplasia of the hip(DDH).</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>The mean preoperative Harris score was 56.54±15.67, the mean postoperative Harris score was 88.30±6.86(=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.</p><p><b>CONCLUSIONS</b>Ceramic on ceramic bearing showed an encouraging result in Crowe IV DDH total hip arthroplasty.</p>

Clinical observation on the treatment of periprosthetic infection of coagulase-negative staphylococci by two-stage revision / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the risk factors for the failure in treating periprosthetic infection of coagulase-negative staphylococci by two-stage revision.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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(=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)].</p><p><b>CONCLUSIONS</b>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.</p>

Mechanical complications with self-made, antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement / 中国骨伤

<p><b>OBJECTIVE</b>To study the complications and efficacy of self-made, antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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(<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).</p><p><b>CONCLUSIONS</b>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.</p>

Clinical results in early and mid term of using the S-ROM femoral stem in revision / 中国骨伤

<p><b>OBJECTIVE</b>To investigate and the clinical effect of S-ROM modular stem in femur reconstruction in hip revision arthroplasty.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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 (=11.42,=0.00). The function score improved from (24.01±11.02) points preoperatively to (49.95±5.38) points (=9.73,=0.00). Harris hip score improved from (41.15±14.81) points preoperatively to(91.67±5.83) points(=15.33,=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 (=4.59,=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.</p><p><b>CONCLUSIONS</b>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.</p>

Novel miniature mobile cardiac catheterization laboratory for critical cardiovascular disease following natural disasters: a feasibility study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Natural disasters have been frequent in recent years. Effective treatment of patients with cardiovascular disease following natural disasters is an unsolved problem. We aimed to develop a novel miniature mobile cardiac catheterization laboratory (Mini Mobile Cath Lab) to provide emergency interventional services for patients with critical cardiovascular disease following natural disasters. A feasibility study was performed by testing the Mini Mobile Cath Lab on dogs with ST-elevation myocardial infarction (STEMI) model in a hypothetical natural-disaster-stricken area.</p><p><b>METHODS</b>The Mini Mobile Cath Lab was transported to the hypothetical natural-disaster-stricken area by truck. Coronary angiography and primary percutaneous coronary intervention (PCI) were performed on six dogs with STEMI model. The transportation and transformation of the Mini Mobile Cath Lab were monitored and its functioning was evaluated through the results of animal experiments.</p><p><b>RESULTS</b>The Mini Mobile Cath Lab could be transported by truck at an average speed of 80 km/h on mountain roads during daytime in the winter, under conditions of light snow (-15°C to -20°C/-68°F to -59°F). The average time required to prepare the Mini Mobile Cath Lab after transportation, in a wetland area, was 30 minutes. Coronary angiography, and primary PCI were performed successfully.</p><p><b>CONCLUSION</b>This preliminary feasibility study of the use of the Mini Mobile Cath Lab for emergency interventional treatment of dogs with STEMI indicated that it may perform well in the rescue of critical cardiovascular disease following natural disasters.</p>