Effectiveness of combined anteversion angle technique in total hip arthroplasty for treatment of ankylosing spondylitis affecting hip joint / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of the combined anteversion angle technique in total hip arthroplasty (THA) for treating ankylosing spondylitis (AS) affecting the hip joint.@*METHODS@#A retrospective analysis was conducted on the clinical data of 73 patients with AS affecting the hip joint who underwent THA between August 2018 and August 2021. According to whether the combined anteversion angle technique was used in THA, the patients were divided into study group (37 cases, combined anteversion angle technique was used in THA) and control group (36 cases, traditional THA). There was no significant difference in baseline data such as gender, age, body mass index, disease duration, preoperative Harris score, range of motion (ROM), acetabular anteversion angle, acetabular abduction angle, femoral anteversion angle, and combined anteversion angle between the two groups ( P>0.05). The operation time, hospital stay, and complications of the two groups were recorded and compared. The Harris score and hip ROM were compared between the two groups before operation, at 1, 3, 6, 12 months after operation, and at last follow-up. The acetabular component anteversion angle, femoral component anteversion angle, acetabular component abduction angle, and component combined anteversion angle were measured postoperatively.@*RESULTS@#The operation time in the study group was significantly shorter than that in the control group ( P<0.05), and there was no significant difference in hospital stay between the two groups ( P>0.05). There was no intraoperative complication such as acetabular and proximal femoral fractures, neurovascular injuries in both groups, and the incisions healed by first intention. All patients were followed up 2-3 years, with an average of 2.4 years; there was no significant difference in the follow-up time between the two groups ( P>0.05). During the follow-up period, there was no complication such as hip dislocation, wound infection, delayed wound healing, deep venous thrombosis, and hip dislocation in both groups. The hip Harris score and ROM of the two groups gradually increased with time after operation, and the differences were significant when compared with those before operation ( P<0.05); the above two indicators of the study group were significantly better than those of the control group at each time point after operation ( P<0.05). Extensive bone ingrowth on the surface of the components could be observed in the anteroposterior X-ray films of the hip joint of the two groups at 12 months after operation, and the acetabular components was stable without femoral stem subsidence, osteolysis around the components, and heterotopic ossification. At last follow-up, the acetabular component anteversion angle, femoral component anteversion angle, and component combined anteversion angle in the study group were significantly superior to those in the control group ( P<0.05), except that there was no significant difference in the acetabular component abduction angle between the two groups ( P>0.05).@*CONCLUSION@#For patients with AS affecting the hip joint, the use of the combined anteversion angle technique during THA effectively promotes the recovery of hip joint function and enhances the postoperative quality of life of patients when compared to traditional THA.

Retrospective clinical study of hip replacement in the treatment of traumatic arthritis secondary to acetabular fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of total hip replacement (THA) in the treatment of traumatic arthritis secondary to acetabular fracture.@*METHODS@#From October 2019 to June 2022, 15 patients with secondary traumatic arthritis of acetabulum fracture were treated with THA. There were 8 males and 7 females, aged from 40 to 76 years old with an average of (59.20±9.46) years old. Prosthesis loosening, dislocation of hip joint, range of motion of hip joint, nerve injury and other conditions were recorded before and after surgery. Harris score, visual analogue scale (VAS) and imaging were used to evaluate hip joint function and surgical effect.@*RESULTS@#Follow-up time ranged 6 to 39 months with an average of (18.33±9.27) months. All the 15 patients successfully completed the operation, no nerve and blood vessel injury during the operation, postoperative wound healing was stageⅠ, no infection, one case of acetabular side prosthesis loosening at half a year after operation, and recovered well after revision surgery, one case of hip dislocation was cured after open reduction treatment, no adverse consequences. Harris score at the last postoperative follow-up was (88.60±4.01) points, compared with the preoperative (47.20±11.77) points, the difference was statistically significant (P<0.05), and VAS at the lateat postoperative follow-up was 1 (1) points, compared with the preoperative 8 (2) points, the difference was statistically significant (P<0.05). At the last follow-up, the pain symptoms were relieved or disappeared, and the joint function was satisfactory. The imaging data of the latest follow-up showed joint was well pseudoradiated, no abnormal ossification occurred, and the prosthesis was not loose.@*CONCLUSION@#THA is effective in the treatment of traumatic arthritis secondary to acetabular fracture and can effectively improve the quality of life of patients. Preoperative comprehensive evaluation and bone defect evaluation of patients, and intraoperative management of acetabulum, femur, internal fixation and bone defect are key factors for the success of surgery.

Effect of pericapsular nerve group block with wound infiltration on postoperative analgesia after total hip arthroplasty / 中国现代医生

Objective To investigate the effect of pericapsular nerve group(PENG)block with wound infiltration(WI)on postoperative analgesia after total hip arthroplasty(THA).Methods A total of seventy-eight patients who were scheduled to undergo THA in the Third Affiliated Hospital of Anhui Medical University from December 2021 to October 2022 were selected.According to random number table method,they were divided into PENG block group and PENG block +WI group,39 cases in each group.Numerical rating scale(NRS)score of postoperative rest and exercise,incidence of postoperative movement block,first walking time,incidence of rescue analgesia and adverse reactions were compared between two groups.Results At 6h and 12h after surgery,NRS scores at rest in PENG block +WI group were significantly lower than those in PENG block group(P<0.05),and at 6h,12h and 24h after surgery,NRS scores at exercise in PENG block +WI group were significantly lower than those in PENG block group(P<0.05).The first walking time of patients in PENG block +WI group was significantly shorter than that in PENG block group[(22.48±4.00)h vs.(24.73±1.94)h,t=3.150,P=0.003].There were no significant differences in incidence of rescue analgesia,movement block at different time points,nausea and vomiting,and postoperative agitation between two groups(P>0.05).Conclusion PENG block +WI can reduce the postoperative pain of THA patients,and is conducive to early activity,which is in line with the concept of enhanced recovery after surgery.

Development of a predictive model for perioperative blood transfusion in elderly patients undergoing unilateral total hip arthroplasty / 基础医学与临床

Objective To analyze risk factors for perioperative blood transfusion in elderly patients undergoing uni-lateral primary total hip arthroplasty and develop a prediction model.Methods The study retrospectively collected 467 elderly patients receiving unilateral primary total hip arthroplasty between January 2013 and October 2021 at Peking Union Medical College Hospital.The 70%of the data were used as the training set and the 30%of the data were used as the testing set.Patients were divided into the transfusion and no-transfusion groups based on the presence or absence of perioperative blood transfusion.Univariate analysis and multivariable logistic regression were conducted to analyze patient demographic characteristics,surgical information,and preoperative laboratory tests for identifying risk factors.Clinical experience was combined to establish a prediction model and draw the nomogram.The receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the model in the tes-ting set.Results A total of 91 patients(19.5%)received perioperative blood transfusion.Multivariable logistic re-gression suggested the history of coronary artery disease,prolonged operation time,and lower preoperative hemoglo-bin were risk factors for perioperative blood transfusion(P＜0.05).The prediction model was constructed based on the results of statistical analysis and clinical experience,including the history of coronary artery disease,operation time,preoperative hemoglobin,age,and American Society of Anesthesiologists(ASA)physical status＞Ⅱ.The area under the receiver operating characteristic curve(AUC)of the model was 0.809.Conclusions The prediction model for perioperative blood transfusion in elderly patients undergoing unilateral total hip arthroplasty had a good performance and could assist in clinical practice.

Effect of ultrasound-guided iliopsoas plane block on quality of postoperative recovery in patients un-dergoing hip arthroplasty / 临床麻醉学杂志

Objective To observe the effect of ultrasound-guided iliopsoas plane block(IPB)on the quality of postoperative recovery in patients undergoing hip arthroplasty.Methods Sixty patients who underwent hip arthroplasty were selected,37 males and 23 females,aged 40-79 years,BMI 18-30 kg/m2,ASA physical status Ⅰ-Ⅲ.The patients were divided into two groups by random number table method:the iliopsoas plane block group(group IPB)and the femoral nerve block(FNB)group(group FNB),30 pa-tients in each group.Before anesthesia induction,IPB was performed with 0.5%ropivacaine 10 ml and lat-eral femoral cutaneous nerve block was performed with 0.5%ropivacaine 5 ml in group IPB.And FNB was performed with 0.5%ropivacaine 10 ml and lateral femoral cutaneous nerve block was performed with 0.5%ropivacaine 5 ml in group FNB.The dosages of propofol,remifentanil,and cis-atracurium during operation were recorded.The quality of recovery-15(QoR-15)scale was evaluated preoperatively and postoperatively 1 day,2 and 3 days.The max VAS(VASmax)pain score and manual muscle test(MMT)score of quadri-ceps muscle were recorded 12,24,and 48 hours after surgery.The time of getting out of bed for the first time,opioid dosage,and patient satisfaction were recorded.The incidence of nerve injury,vascular injury,puncture site infection,and local anesthetic poisoning were recorded.The postoperative complications of diz-ziness,nausea and vomiting,deep vein thromboses,and elirium were also recorded.Results There was no significant difference in the dosage of propofol,remifentanil,and cis-atracurium between the two groups.Compared with group FNB,the QoR-15 scale score in group IPB was significantly higher 1 day,2 and 3 days after operation(P＜0.05).Compared with group FNB,the MMT scores of quadriceps muscle was sig-nificantly higher in group IPB 12 and 24 hours after surgery(P＜0.05),and the first time of getting out of bed was shortened in group IPB(P＜0.05).However,there were no significant differences in the VASmax pain score,MMT score of quadriceps muscle 48 hours after surgery,opioid dosage,and patient satisfaction between the two groups.No nerve block related complications were found in both groups.There were no sig-nificant differences in postoperative complications between the two groups.Conclusion The iliopsoas plane block can improve the quality of postoperative recovery and accelerate the recovery of patients with hip re-placement,and the effect is better than that of femoral nerve block.

A preliminary study on automatic measurement of abduction angle after total hip arthroplasty using artificial intelligence algorithm on antero-posterior radiographs / 实用放射学杂志

Objective To explore the feasibility of automating the measurement of abduction angle after total hip arthroplasty(THA)on postoperative radiographs by using deep learning algorithms.Methods The data were retrospectively collected.A total of 381 cases were used to develop deep learning model.Two radiologists annotated the key points on the images(lateral-superior point and medial-inferior point of acetabular cups,tear drops).The data was split into training dataset(304 cases),tuning dataset(38 cases),and test dataset(39 cases).A 2D U-net model was trained to segment the key points and the abduction angle were automatically meas-ured.After development of the model,an external validation dataset was collected(143 cases).Dice similarity coefficient(DSC)and mean absolute error(MAE)were used to evaluate the prediction efficiency of the model in the test dataset and the external validation dataset.Bland-Altman test was used to analyze the agreement between the abduction angle measured automatically by the model and the physician measurement.Results The DSC were 0.870-0.905 and 0.690-0.750 in the test dataset and the external validation dataset,and the corresponding MAE were 0.311-0.561 and 0.951-1.310.For the result of Bland-Altman analysis,only 6.52％(3/46)and 2.08％(3/144)of the abduction angle measurements in the test dataset and external validation dataset were outside the 95％limit of agreement(LoA).In the qualitative evaluation of the abduc-tion angle,the agreement of the model with the physician were 97.8％and 90.3％in the test dataset and the external validation dataset.Conclusion It is feasible to use deep learning algorithms to automatically measure the abduction angle after THA on X-ray images,achieving similar accuracy to that of physician.

Role and significance of artificial intelligence preoperative planning in total hip arthroplasty / 中国组织工程研究

BACKGROUND:The preoperative planning of traditional X-ray films is often inaccurate,which can lead to some intraoperative and postoperative complications,increase the operation time and intraoperative blood loss,and to some extent affect the surgical outcome of total hip arthroplasty. OBJECTIVE:To investigate the accuracy and effectiveness of artificial intelligence preoperative planning in total hip arthroplasty. METHODS:Sixty patients who underwent primary total hip arthroplasty on the affected side were selected.30 of them used artificial intelligence 3D preoperative planning(trial group)and 30 used conventional X-ray film 2D preoperative planning(control group),and there were no statistically significant differences between the two groups in terms of gender,age,condition and other general data(P>0.05).The actual intraoperative prosthesis placement and preoperative planning prosthesis matching,intraoperative operation time,intraoperative blood loss,bilateral femoral eccentric distance difference,bilateral joint eccentric distance difference and bilateral lower limb length difference,and Harris score at 3 months after operation were compared between the two groups,and the accuracy and application effect of the two preoperative plans were analyzed. RESULTS AND CONCLUSION:(1)Patients in both groups were followed up for 4-6 months postoperatively.One patient in the control group had a posterior dislocation of the prosthesis at 5 days postoperatively,which recovered after performing manual repositioning without re-dislodgement.The rest of the patients did not have postoperative complications or postoperative death.(2)Complete matching rate of the prosthesis on the acetabular side and femoral side was significantly better in the trial group than that in the control group(P<0.05).(3)Operation time and intraoperative blood loss were significantly less in the trial group than those in the control group(P<0.05).(4)The difference in bilateral lower limb length between the two groups was statistically significant(P<0.05),and the difference in bilateral femoral eccentric distance and bilateral joint eccentric distance was not statistically significant(P>0.05).(5)Harris score of patients in the trial group was significantly higher than that in the control group 3 months after operation(P<0.05).(6)These results confirm that compared with traditional film planning,artificial intelligence preoperative planning can predict the prosthesis type more accurately,shorten the operation time,reduce intraoperative blood loss,diminish the occurrence of postoperative bilateral lower limb inequality,and accelerate postoperative recovery.

Accuracy and influencing factor of artificial intelligence planning system in patients undergoing total hip arthroplasty / 中国组织工程研究

BACKGROUND:Artificial intelligence planning system can automatically establish a three-dimensional model and generate planning schemes,but its accuracy in predicting the prosthesis size has not been fully verified. OBJECTIVE:To investigate the accuracy of artificial intelligence planning system in predicting prosthesis size before total hip arthroplasty and its influence on clinical prognosis,and further analyze the risk factors affecting the accuracy of planning. METHODS:Clinical data of patients with unilateral initial total hip arthroplasty who were admitted to the Department of Orthopedics of Affiliated Hospital of Xuzhou Medical University from January 2021 to June 2022 were prospectively collected.The patients were randomly divided into the artificial intelligence planning system group(n=80)and the conventional template group(n=79).Intraoperative use of prostheses and preoperative planning of prosthesis matching were compared between the two groups.Postoperative follow-up Harris scores and the occurrence of complications such as leg length discrepancy,dislocation and prosthesis loosening were recorded in both groups.The effects of demographic indicators,preoperative diagnosis,and Dorr typing on the accuracy of femoral stem planning were explored using univariate and multivariate Logistic regression analyses. RESULTS AND CONCLUSION:(1)The prediction of the prosthesis size on the acetabular side and femoral side was 50%(40/80)and 55%(44/80)in the artificial intelligence planning system group,compared to 34%(27/79)and 37%(29/79)in the conventional template group,with statistically significant differences(P＜0.05).(2)The artificial intelligence planning system group had an accuracy rate within one size difference for the acetabular and femoral side prostheses of 91%(73/80)and 86%(69/80),compared to 82%(65/79)and 72%(58/79)in the conventional template group,with differences statistically different only on the femoral side(P＜0.05).(3)No dislocation or prosthesis loosening occurred in the two groups during postoperative follow-up.The difference in lower limb length between the artificial intelligence planning system and conventional template groups was(3.56±2.32)mm and(3.52±2.41)mm.At the last follow-up,the Harris scores of the artificial intelligence planning system and conventional template groups were(92.74±3.08)and(91.81±3.52),respectively;there was no significant difference in the above differences(P＞0.05).(4)Univariate analysis results showed that preoperative diagnosis as developmental dysplasia of the hip and osteonecrosis of the femoral head,and Dorr type B and C femurs had a significant effect on the accuracy of predicted prosthesis size using an artificial intelligence planning system(P＜0.05).(5)Multivariate logistic regression analysis showed that preoperative diagnosis of developmental dysplasia of the hip(OR=18.233,95%CI:2.662-124.888)was an independent risk factor for the prediction of femoral stem size by artificial intelligence planning system.(6)The artificial intelligence planning system has a higher accuracy in predicting prosthetic size than traditional two-dimensional templates,and there is not a significant difference in the risk of postoperative complications or joint function.The accuracy of the artificial intelligence planning system in patients with developmental dysplasia of the hip was low due to anatomical deformities and acetabular anatomical position reconstruction.

Body weight support Tai Chi footwork improves balance function after total hip arthroplasty / 中国组织工程研究

BACKGROUND:Most balance disorders after total hip arthroplasty require a variety of rehabilitation methods to improve.Body weight support Tai Chi footwork can be used as a safe and effective balance training method. OBJECTIVE:To observe the effect of body weight support Tai Chi footwork on the balance function of patients after total hip arthroplasty. METHODS:Totally 74 subjects undergoing total hip arthroplasty were recruited and randomly divided into a control group(n=37)and a trial group(n=37).The control group received 30 minutes of body weight support walking training and 60 minutes of routine rehabilitation training;the trial group received 30 minutes of body weight support Tai Chi footwork training and 60 minutes of routine rehabilitation training,once a day,5 times a week,for 12 consecutive weeks.Before the intervention,4,8,and 12 weeks after intervention,the Berg balance scale and the dynamic balance ability test were used to evaluate the balance function.Harris score was used to evaluate the hip joint function,and the fall risk index was used to evaluate the fall risk. RESULTS AND CONCLUSION:(1)The four observation indicators all showed significant time effects(P<0.001).(2)Berg balance scale,Harris score and fall risk index all had an interaction effect(P<0.001),and there was a significant inter-group difference after 12 weeks of intervention(P<0.001),and the effect of the trial group was better than that of the control group.(3)After 12 weeks of intervention,there was an interaction and group effect in the scores of the front and left directions of the dynamic balance test(P<0.001),and there were significant group differences in the scores of the overall,front,left and right directions(P<0.001).(4)The results showed that after 12 weeks of intervention,the balance functions of the trial group and the control group were improved,and the improvement effect of body weight support Tai Chi footwork training was better than body weight support walking training on patients after total hip arthroplasty.

Comparison of gait and hip ambulation ability after total hip arthroplasty through different approaches / 中国组织工程研究

BACKGROUND:In the selection of minimally invasive total hip arthroplasty approaches,there is considerable debate about whether direct anterior and posterior approaches differ in postoperative gait,limb balance,and hip motor capacity,and therefore further investigation is warranted. OBJECTIVE:To assess the gait and hip ambulation ability of direct anterior and posterior approaches for primary unilateral total hip arthroplasty with a prospective randomized controlled study. METHODS:A total of 61 patients with unilateral avascular necrosis of the femoral head in Qingdao Municipal Hospital from January 2019 to June 2020 were included in the study.There were 40 males and 21 females,at a mean age of(64.83±5.52)years.All the patients were randomly divided into a direct anterior approach group(n=28)and a posterior approach group(n=33),and received initial total hip arthroplasty by direct anterior approach and posterior approach,respectively.Gait analysis(gait time-space parameters such as stride length,stride frequency,single-leg support time,and plantar pressure difference)and hip ambulation ability(standing-walking timing test and 2-minute walking test)were performed before and 1,3 and 6 months after operation. RESULTS AND CONCLUSION:(1)With the extension of postoperative time,gait time-space parameters in both groups were gradually improved.The stride length,stride frequency,single-leg support time,and plantar pressure difference in the direct anterior approach group were significantly better than those in the posterior approach group 1 month after surgery(P<0.01).The stride frequency,single-leg support time,and plantar pressure difference in the direct anterior approach group were significantly better than those in the posterior approach group 3 months after surgery(P<0.05).The plantar pressure difference in the direct anterior approach group was significantly better than that in the posterior approach group 6 months after surgery(P<0.01).(2)With the extension of postoperative time,the results of the standing-walking timing test and 2-minute walking test were gradually improved in both groups.The results of the standing-walking timing test and 2-minute walking test 1 and 3 months after operation in the direct anterior approach group were better than those in the posterior approach group(P<0.05).(3)The results have indicated that the recovery of postoperative gait and hip ambulation ability of the two groups is inconsistent.The direct anterior approach group has some advantages in the improvement of postoperative gait and hip ambulation ability compared with the posterior approach group in the early postoperative period.

Mid-and long-term state after total hip arthroplasty versus hemiarthroplasty for femoral neck fractures in the elderly:evaluation using propensity score matching method / 中国组织工程研究

BACKGROUND:Arthroplasty is the primary treatment for displaced femoral neck fractures in the elderly,and the choice of total hip arthroplasty versus hemiarthroplasty is currently the subject of considerable debate. OBJECTIVE:To compare the mid-and long-term survival status of total hip arthroplasty versus hemiarthroplasty under a direct anterior approach for displaced femoral neck fractures in the elderly based on the propensity score matching method. METHODS:One hundred and forty-seven elderly patients(≥65 years of age)with displaced femoral neck fractures were admitted from January 2016 to January 2021,of whom 88 had total hip arthroplasty(total hip arthroplasty group)and 59 had artificial femoral head replacement(hemiarthroplasty group).For the patients'preoperative comorbidities,the age-corrected Charlson Comorbidity Scale was used to quantify the scores and calculate patient frailty.The propensity score matching method was used to match the two groups 1:1 and to compare the operation time,bleeding,postoperative hospitalization time,hospitalization cost,nutritional index,postoperative complications,and mortality between the two groups after matching.Postoperative survival time was determined by Kaplan-Meier Survival analysis. RESULTS AND CONCLUSION:(1)After propensity score matching,a total of 42 matched pairs were successful in both groups,and the preoperative data of patients in both groups were balanced and comparable after matching(P>0.05).(2)Compared with the hemiarthroplasty group,operation time(79.71 minutes vs.59.07 minutes,P<0.001),bleeding volume(839.64 mL vs.597.83 mL,P=0.001),and hospitalization cost(56 508.15 yuan vs.41 702.85 yuan,P<0.001)were significantly higher in the total hip arthroplasty group.However,the mortality rate was lower in the total hip arthroplasty group than in the hemiarthroplasty group(36%vs.57%,HR=0.44,95%CI:0.23-0.87,P=0.018),and the mean survival time was longer in the total hip arthroplasty group than in the hemiarthroplasty group(59.4 months vs.43.7 months,P=0.024).(3)There were no statistically significant differences in postoperative hospitalization time,preoperative and postoperative nutritional indicators,and overall postoperative complication rate between the two groups(P>0.05).However,in terms of postoperative pain,the incidence of pain was significantly higher in the hemiarthroplasty group than that in the total hip arthroplasty group(24%vs.7%,P=0.035).(4)Overall,total hip arthroplasty has a better prognosis for survival,while hemiarthroplasty is more appropriate for patients with poor physical fitness.At the same time,postoperative pain may largely affect the quality and survival time of patients after hip arthroplasty.

Factor analysis of pelvic tilt outcome after primary unilateral total hip arthroplasty / 中国组织工程研究

BACKGROUND:Pelvic tilt,which is often seen in hip diseases,is also a common functional problem after total hip arthroplasty. OBJECTIVE:To investigate the mechanism of occurrence and recovery of pelvic tilt after unilateral total hip arthroplasty in patients with femoral head necrosis. METHODS:The clinical data of 100 patients with femoral head necrosis who underwent unilateral total hip arthroplasty in the Department of Femoral Head Necrosis,Bone Injury Center of First Affiliated Hospital of Guangzhou University of Chinese Medicine were collected retrospectively from June 2021 to February 2023.The patients were divided into three groups,namely,groups A(<2°,n=48),B(2°-3°,n=34),and C(>3°,n=18),according to the severity of pelvic tilt on postoperative 3 day.Statistical data were collected and compared between the pre-and postoperative periods of patients of these three groups in terms of the angle of the coronal plane of the pelvis tilt,the length of the gluteus medius muscles of the bilateral sides,the heights of the rotational centers of the femoral heads,the difference in the lengths of the gluteus medius muscles of the bilateral sides and the heights of the rotational centers of the femoral heads,and the ratio of changes in the angle of the pelvic tilt.Pearson correlation coefficient was used to examine the correlation between pelvic tilt angle and other indexes. RESULTS AND CONCLUSION:(1)Pelvic tilt aggravation occurred in the short term after surgery.(2)The ratio of change in pelvic tilt angle from postoperative 3 days to postoperative 1 month time period differed between the groups,with group C>group B>group A.There was a difference between group C and the other groups in the time period from postoperative 1 to postoperative 3 months,with the ratio of change being the smallest in group C.There was no difference in the ratio of change between the groups in the time period from postoperative 3 days to postoperative 3 months.(3)The difference in bilateral gluteus medius muscles decreased gradually after surgery,and there was no difference in the comparison of bilateral gluteus medius muscles in the time period from postoperative 3 months.(4)The difference between bilateral centers of rotation increased after surgery,and the difference between bilateral heights at 3 months after surgery was smaller than that before surgery.(5)The pelvic tilt angle at 3 days after surgery,the duration of the disease and the pelvic tilt angle at 3 months after surgery were significantly correlated(all P=0.000),and the difference between bilateral gluteus medius muscles before surgery and the pelvic tilt angle at 3 days after surgery was significantly correlated(P=0.006)(6)The functional pelvic tilt occurred in the patients with femoral head necrosis after total hip arthroplasty.Correction of the pelvic tilt after surgery was based on the adaptive restoration of the functional pelvic tilt angle after surgery.Functional pelvic tilt arises as a compensatory adaptation of the organism based on the short-term postoperative reconstruction of bony structures and the survival of cumulative soft tissue damage.

Relationship between low back pain and spinal-pelvic sagittal parameter changes in patients with hip-spine syndrome after total hip arthroplasty / 中国组织工程研究

BACKGROUND:Many studies have shown that total hip arthroplasty will improve low back pain in patients with hip-spine syndrome.However,there are few studies on the relationship between postoperative low back pain improvement and changes in spinal-pelvic sagittal parameters.This study aims to reveal their connections between the two. OBJECTIVE:To explore the relationship between the improvement of low back pain and changes in the spinal-pelvic sagittal parameters in patients with hip-spine syndrome after total hip arthroplasty. METHODS:A retrospective analysis was performed on the clinical and imaging data of 93 end-stage hip disease patients who underwent primary total hip arthroplasty and combined with low back pain and were admitted to Affiliated Hospital of Xuzhou Medical University from January 2019 to January 2022.Spinal-pelvic sagittal parameters were measured on lateral lumbar X-rays before surgery and 1 year at the last follow-up:pelvic incidence,pelvic tilt,sacral slope,lumbar lordosis,pelvic incidence-lumbar lordosis(difference between pelvic incident angle and lumbar lordosis angle).Visual analog scale score,Oswestry disability index,and hip Harris score were recorded before and 1 year after arthroplasty.The patients were divided into two groups according to whether the change in visual analog scale scores 1 year after surgery reached the minimal clinically important difference for low back pain treatment,including 45 cases in the low back pain unimproved group and 48 cases in the low back pain improved group.The preoperative general data of patients,differences in spinal-pelvic sagittal parameters,Oswestry Disability Index and hip Harris score before and after surgery were compared between the two groups. RESULTS AND CONCLUSION:(1)There was no significant difference in age,gender,surgical side,body mass index,and etiology between the two groups(P>0.05),and they were comparable.(2)There was no significant difference in visual analog scale scores before surgery(P>0.05).The visual analog scale scores of the low back pain improved group were lower than those of the low back pain unimproved group 1 year after surgery(P<0.01).(3)At 1 year after surgery,the lumbar lordosis of the low back pain unimproved group was significantly smaller than that before surgery,while the lumbar lordosis of the low back pain improved group was significantly smaller than that before surgery(P<0.01).At the same time,the pelvic incidence-lumbar lordosis mismatch in the low back pain unimproved group was greater than before surgery,while the pelvic incidence-lumbar lordosis mismatch in the low back pain improved group was smaller than before surgery,with significant differences between the two groups(P<0.01).There was no significant difference in the changes of other spinal-pelvic sagittal parameters between the two groups(P>0.05).(4)Preoperative lumbar Oswestry disability index and hip Harris score were not significantly different between the two groups(P>0.05).At 1 year after surgery,Oswestry disability index of the low back pain improved group was lower than that of the low back pain unimproved group and the hip Harris score was higher than that of the low back pain unimproved group(P<0.05).(5)The results showed that the improvement of low back pain was related to changes in spinal-pelvic sagittal parameters in patients with hip-spine syndrome after total hip arthroplasty,showing reduced lumbar lordosis and pelvic incidence-lumbar lordosis mismatch.Moreover,patients with improved low back pain after surgery had better functional scores,indicating that total hip arthroplasty improved spinal alignment and spinal-pelvic sagittal balance.For patients with hip-spine syndrome,a total hip arthroplasty performed before the onset of lumbar disease can have a favorable effect on the lumbar spine.

Comparison of effects of low-dose esketamine and sufentanil on perioperative analgesia for hip arthroplasty / 局解手术学杂志

Objective To compare the application effects of low-dose esketamine and sufentanil on perioperative analgesia in patients undergoing hip arthroplasty(HA).Methods A total of 124 patients who underwent HP in our hospital were divided into the control group and the observation group according to random number table,with 62 cases in each group.Patients in the control group were given sufentanil for analgesia,and patients in the observation group were given low-dose esketamine for analgesia.The hemodynamics changes of the heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP)and oxygen saturation(SpO2)of patients before anesthesia(T1),at the time of incising skin(T2),after 30 minutes of anesthesia(T3)and at the end of surgery(T4)in both groups were observed.The visual analogue scale(VAS)scores of patients in resting state and active state before surgery(T5),6 hours after surgery(T6),12 hours after surgery(T7)and 24 hours after surgery(T8)were recorded.The number of postoperative analgesic pump compression,need of supplemental analgesic drugs and occurrence of adverse reactions during surgery and 24 hours after surgery of patients in the two groups were recorded.Results There was no statistically significant difference in HR,MAP or RR at T1 of patients between the two groups(P>0.05).The levels of HR,MAP and RR at T2,T3 and T4 of patients in the observation group were higher than those in the control group(P<0.05).There was no statistically significant difference in SpO2 at each time points between the two groups(P>0.05).There was no statistically significant difference in the VAS scores at T5 of patients in resting state or active state(P>0.05).The VAS scores at T6,T7 and T8 of patients in resting state and active state in the observation group were lower than those in the control group(P<0.05).The number of postoperative analgesic pump compression and the proportion of patients with the need of supplemental analgesic drugs in the observation group were less/lower than those in the control group(P<0.05).There was no statistically significant difference in the incidence of intraoperative and postoperative adverse reactions of patients between the two groups(P>0.05).Conclusion Compared with sufentanil,low-dose esketamine has better analgesic effect for IA patients,with milder perioperative pain degree,more stable intraoperative hemodynamics,and better safety.

Effects of esketamine combined with sufentanil on postoperative analgesia and depression after hip arthroplasty / 局解手术学杂志

Objective To evaluate the effects of ketamine combined with sufentanil on postoperative analgesia and depression in patients undergoing hip arthroplasty.Methods A total of 60 patients who underwent elective hip arthroplasty were selected and divided into the S group,the SK1 group and the SK2 group according to the patient-controlled intravenous analgesia regimen,with 20 cases in each group.Patients in the S group were received 2 μg/kg of sufentanil for postoperative analgesia,patients in the SK1 group were received 1 mg/kg of esketamine and 2 μg/kg of sufentanil for postoperative analgesia,and patients in the SK2 group were received 2 mg/kg of esketamine and 2 μg/kg of sufentanil for postoperative analgesia.At 1,4,24,and 48 hours after surgery,the analgesic effect of patients was evaluated using the numeric rating scale(NRS),and the sedation effect of patients was evaluated using the Ramsay sedation score.Depression of patients before and 48 hours after surgery was assessed by self-rating depression scale(SDS).The adverse reactions such as nausea and vomiting,dizziness and headache,respiratory depression,and mental symptoms within 48 hours after surgery of patients were recorded.Results The NRS scores 1,4,and 24 hours after surgery of patients in the SK1 group and the SK2 group were lower than those in the S group(P<0.05);there was no statistically significant difference in the NRS scores 48 hours after surgery of patients among the three groups(P>0.05);there was no statistically significant difference in the NRS scores at different postoperative points of patients between the SK1 and SK2 groups(P>0.05).The SDS scores 48 hours after surgery of patients in each group were lower than those before surgery(P<0.05).There was no statistically significant difference in the Ramsay scores at different postoperative points of patients among the three groups(P>0.05).The incidence of adverse reactions 48 hours after surgery in the SK2 group was higher than those in the S group and the SK1 group(P<0.05).Conclusion Using 1 mg/kg of esketamine combined with 2 μg/kg of sufentanil after hip arthroplasty has a good analgesic effect without obvious increase of adverse reactions or significant effect on improving depression of patients.

Evaluation of core decompression outcome in systemic lupus erythematosus with hip osteonecrosis: a retrospective cohort study

Abstract Background Osteonecrosis is a major cause of morbidity for patients with systemic lupus erythematosus (SLE). Although core decompression is an approved and trusted technique to prevent further joint deterioration, this surgical method seems to be less beneficial for SLE patients. We aimed to evaluate the outcomes of core decompression in SLE patients with primary stages of femoral head osteonecrosis. Methods In this study, 23 patients (39 affected hip joints) with osteonecrosis of the femoral head with stage II of the disease, based on the Ficat-Arlet classification system, underwent core decompression. Also, patients demographic characteristics, clinical data, medication history, comorbidities, immunological findings, hip plain radiographs, history of total hip arthroplasty after core decompression, and patients satisfaction with joint function according to the Oxford hip score questionnaire were obtained. Results In the study, 53.8% of affected joints showed signs of radiographic deterioration in follow-up imaging. Sixty-one and a half percent (61.5%) of patients had unsatisfactory joint performance. A third (33.3%) of affected hip joints underwent total hip arthroplasty up to 5 years from core decompression. SLE patients with a history of receiving bisphosphonate were 83.2% less dissatisfied with their joint function than patients without a history of bisphospho-nate use (P < 0.02). Of the 23 studied cases, the mean cumulative dose of prednisolone before and after core decompression surgery was 46.41 mg and 14.74 mg respectively. Besides, one case (2.6%) that had a high anti-phospholipid antibodies level during follow-up did not have any radiographic deterioration, and 9 cases (23.1%) had some degrees of radiographic deterioration. Conclusions The patients group that used bis-phosphonate, had a higher level of satisfaction with joint function after core decompression. Patients with high-level anti-phospholipid antibodies are related to a poor prognosis after core decompression.

Minimum effective concentration of ropivacaine for ultrasound-guided transmuscular quadratus lumborum block in total hip arthroplasty: a randomized clinical trial

Abstract Objective: This trial aimed to identify the Minimum Effective Concentration (MEC90, defined as the concentration which can provide successful block in 90% of patients) of 30 mL ropivacaine for single-shot ultrasound-guided transmuscular Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA). Methods: A double-blind, randomized dose-finding study using the biased coin design up-and-down sequential method, where the concentration of local anesthetic administered to each patient depended on the response from the previous one. Block success was defined as a Numeric Rating Scale (NRS) score during motion ≤ 3 at 6 hours after arrival in the ward. If the block was successful, the next subject received either a 0.025% smaller dose (probability of 0.11) or the same dose (probability of 0.89); otherwise, the next subject received a 0.025% higher ropivacaine concentration. MEC90, MEC95 and MEC99 were estimated by isotonic regression, and the corresponding 95% Confidence Intervals (95% CIs) were calculated by the bootstrapping method. Results: Based on the analysis of 52 patients, MEC90, MEC95, and MEC99 of ropivacaine for QLB were estimated to be 0.352% (95% CI 0.334-0.372%), 0.363% (95% CI 0.351-0.383%), and 0.373% (95% CI 0.363-0.386%). The concentration of ropivacaine at 0.352% in a volume of 30 ml can provide a successful block in 90% of patients. Conclusions: For ultrasound-guided transmuscular QLB in patients undergoing THA, 0.352% ropivacaine in a volume of 30 ml can provide a successful block in 90% of patients. Further dose-finding studies and large sample size are required to verify the concentration.

Artroplastia total de cadera por abordaje anterior directo (Hueter)

Introducción: La artroplastia de cadera se considera un tratamiento exitoso en ortopedia. El abordaje anterior directo, a través del intervalo de Hueter, evita la disección de inserciones musculares del hueso y disminuye la alteración de los tejidos blandos alrededor de la cadera. Objetivos: Presentar los resultados de artroplastias totales de cadera primarias, realizadas por abordaje anterior directo. Métodos: Se realizó un estudio descriptivo-prospectivo, tipo serie de casos, con pacientes intervenidos por artroplastia total de cadera primaria no cementada a través de abordaje anterior directo. Resultados: Predominaron el sexo femenino y los grupos etarios de 45 y 60 años. El índice de masa corporal resultó bajo y hubo escaso riesgo anestésico. El tiempo quirúrgico superó las dos horas, con escaso sangrado operatorio. La correcta colocación del componente acetabular y el femoral permitió que la deambulación iniciara en menos de tres días. Las complicaciones fueron escasas y se resolvieron con el tratamiento adecuado. Conclusiones: El empleo de abordaje anterior directo para artroplastias totales de cadera primarias ofrece resultados muy satisfactorios.

Introduction: Hip arthroplasty is considered a successful treatment in Orthopedics. The direct anterior approach, through Hueter interval, avoids the dissection of muscular attachments to the bone and decreases the alteration of the soft tissues around the hip. Objectives: To report the results of primary total hip arthroplasties, performed by direct anterior approach. Methods: A descriptive-prospective case series study was carried out with patients who underwent primary uncemented total hip arthroplasty through a direct anterior approach. Results: The female sex and the age groups of 45 and 60 years predominated. The body mass index was low and there was little anesthetic risk. Surgical time exceeded two hours, with little operative bleeding. The correct placement of the acetabular and femoral components allowed ambulation to begin in less than three days. Complications were rare and resolved with appropriate treatment. Conclusions: The use of the direct anterior approach for primary total hip arthroplasties offers very satisfactory results.

Artroplastia total de cadera en dos instituciones ortopédicas de Cuba

Introducción: La artroplastia total de cadera se considera un procedimiento seguro y eficaz que alivia el dolor, y mejora la salud física y la calidad de vida en los pacientes. Objetivos: Caracterizar la artroplastia total de cadera en pacientes intervenidos en el Hospital Ortopédico Docente "Fructuoso Rodríguez" y el Complejo Científico Ortopédico "Frank País". Métodos: Estudio descriptivo retrospectivo de pacientes intervenidos con artroplastia total de cadera en el Hospital Ortopédico Docente "Fructuoso Rodríguez" y el Complejo Científico Ortopédico "Frank País", entre septiembre de 2019 y marzo de 2021. Resultados: Predominaron el sexo femenino y las edades entre 60 y 62 años, con lateralidad izquierda. El principal diagnóstico preoperatorio resultó la coxartrosis. El tamaño de la copa acetabular y la cabeza del componente femoral fueron similares. La prótesis acetabular se fijó por presión. Conclusiones: Se encontraron grandes semejanzas en cuanto a la edad, el sexo, la lateralidad, el tamaño de los componentes acetabular y cabeza femoral, el tipo de fijación del componente acetabular y la cantidad de tornillos empleados. En el diagnóstico preoperatorio prevaleció la artrosis de cadera.

Introduction: Total hip arthroplasty is considered a safe and effective procedure that relieves pain and improves physical health and quality of life in patients. Objectives: To characterize the patients who underwent total hip arthroplasty at Fructuoso Rodríguez Teaching Orthopedic Hospital and Frank País Orthopedic Scientific Complex. Methods: A retrospective descriptive study was conducted with patients who underwent total hip arthroplasty at Fructuoso Rodríguez Teaching Orthopedic Hospital and Frank País Orthopedic Scientific Complex, from September 2019 to March 2021. Results: The female sex and the ages between 60 and 62 years predominated, with left laterality. The main preoperative diagnosis was coxarthrosis. The size of the acetabular cup and the head of the femoral component were similar. The acetabular prosthesis was fixed by pressure. Conclusions: Great similarities were found in terms of age, sex, laterality, the size of the acetabular components and femoral head, the type of fixation of the acetabular component and the number of screws used. Osteoarthritis of the hip prevailed In the preoperative diagnosis.

EVALUATION OF FUNCTIONAL OUTCOME OF DUAL MOBILITY CUPS IN TOTAL HIP ARTHROPLASTY IN ARTHRITIS HIP AND FEMORAL NECK FRACTURES

Background- Osteoarthritis hip and femoral neck fractures in old age can be treated by total hip arthroplasty using dual mobility cup designs. The posterior approach (Kocher-Langenbeck) was used earlier however, lateral (Harding) and anterior approach (Smith-Petersen) are more often used. Evaluation of functional outcomes of total h Aim- ip arthroplasty using dual mobility cups in patients with osteoarthritis hip and femur neck fractures in terms of time of surgery, re-operation rate and mortality in 1 year, length of hospital stay and post-operative complications, using Harris Hip Score (HHS). Study Design- Hospital based prospective cohort study. Material and Methods- 40 cases were include in the study of which, 20 cases are of osteoarthritis hip and 20 cases are of femur neck fracture managed by dual mobility total hip arthroplasty. Clinical and functional outcome was graded using HHS. Anatomical reduction was assessed at 8 weeks, 3months, 6 months and 9 months. The mean HHS at 8 weeks, 3months, 6 months and 9 mont Result- hs in osteoarthritis hip was 56.40, 69.80, 80.90 and 91.50 and in femur neck fractures was 51.10, 63.50, 74.60 and 84.50, achieved. Better result was found in osteoarthritis hip. Conclusion- We concluded that using dual mobility total hip arthroplasty in osteoarthritis hip is far better than femur neck fractures due to better clinical and functional outcome, better anatomical reduction.