[Prognosis of calf deep-vein thrombosis after total knee arthroplasty].

OBJECTIVE: To explore the outcome of deep-vein thrombosis (DVT) in the calf after total knee arthroplasty. METHODS: From June 2009 to June 2011, 159 patients with DVT in the calf after total knee arthroplasty (TKA) were divided into two groups. Group A (active mobilization) included 80 patients and group B (passive mobilization) 79 patients. These patients were checked with ultrasonography 1 week and 4 weeks postoperation. The changes of DVT in the calf, ROM, KSS score and WOMAC score were observed. RESULTS: The disappearance rates of the calf DVT in groups A and B were 35% and 33% 4 weeks postoperation. There was similar DVT disappearance rate in the two groups (P=0.91 ). No patient developed proximal propagation. There was no difference of the ROM (111.9° ± 13.4° vs. 110.5° ± 10.9°, P=0.490), KSS knee score ( 93.5 ± 4.7 vs. 93.9 ± 5.1, P=0.621), KSS function score (83.4 ± 15.1 vs. 82.9 ± 14.5, P=0.513) and WOMAC score (90.9 ± 5.7 vs. 90. 3 ± 6.1, P=0.535) in groups A and B. CONCLUSION: A DVT in the calf after TKA can resorb spontaneously with time. The treatment of a DVT in the calf does not need additional anticoagulation.

[Surgical treatment of recurrent dislocation after total hip arthroplasty: the algorithmic approach and clinical outcome].

OBJECTIVES: To study the surgical techniques and clinical outcomes of the revision surgery to treat recurrent dislocation after total hip arthroplasty. METHODS: From March 1997 to November 2010, 12 patients (12 hips) with revision total hip arthroplasty for recurrent dislocation were reviewed. There were 5 male and 7 female, aged from 20 to 73 years (mean age 52.7 years), whose body mass index (BMI) were 14.8-30.0 kg/m2 (mean 23.6 kg/m2). The Harris score and WOMAC score were registered and analyzed before surgery and at the time of latest follow-up. Any episode of dislocation and other complications such as deep infection, deep vein thrombosis and pulmonary embolism (DVT-PE) events, periprosthetic fracture, or early aseptic loosening were recorded. RESULTS: Twelve patients were successfully followed for 1.0-12.7 years (mean 4.0 years). No further dislocation episodes reported and all the hips were stable at the time of follow-up. No one complicated as deep infection, DVT-PE events, periprosthetic fracture, or early aseptic loosening. The Harris score was greatly improved from 38±21 before surgery to 81±9 at the time of last follow-up with statistic significance (t=-8.616, P<0.05) accompany with the WOMAC score elevation from 54±21 to 82±12 significantly (t=-6.200, P<0.05). CONCLUSION: With a reasonable algorithmic approach, the recurrent dislocated total hip arthroplasty can be treated with a relatively high success rate.

Two Different Total Hip Arthroplasties for Hartofilakidis Type C1 Developmental Dysplasia of Hip in Adults.

BACKGROUND: Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) is more complex than the normal hip, with large replacement risks and many complications. Although nonosteotomy THA is convenient to perform, femoral osteotomy shortening can avoid blood vessel and nerve traction injuries. This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH. METHODS: Data on 48 DDH patients who underwent THA were analyzed retrospectively. The patients were divided into two groups: Group A 29 cases (nonosteotomy), and group B 19 cases (osteotomy). Harris and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, limb length discrepancy (LLD), radiological data on the hip, and claudication were evaluated. Data were analyzed by using paired-sample Student's t-test, independent-sample Student's t-test, and Pearson's Chi-square test; the test level was α =0.05. RESULTS: Postoperative Harris (90.7 ± 5.1) and WOMAC scores (88.0 ± 10.6) were significantly improved compared with preoperative Harris (44.8 ± 5.7) and WOMAC scores (42.0 ± 5.3) in group A (P < 0.05). Postoperative Harris (90.4 ± 2.8) and WOMAC scores (88.2 ± 5.9) were significantly improved compared with preoperative Harris (44.4 ± 4.2) and WOMAC scores (43.2 ± 4.3) in group B (P < 0.05). One case of dislocation occurred in group A; after closed reduction, dislocation did not recur. In group A, 2 patients developed cutaneous branch injury of the femoral nerve, which spontaneously recovered without treatment. Postoperative LLD >2 cm was seen in one case in group A and five cases in group B. Postoperative claudication showed no significant difference between the two groups (P > 0.05). No patients developed infection; postoperative X-rays showed that the location of the prosthesis was satisfactory, and the surrounding bone was not dissolved. CONCLUSIONS: THA is effective and safe for DDH. For unilateral high dislocation DDH patients with limb lengthening ≤4 cm and good tissue conditions, THA without femoral osteotomy may be considered.