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1.
Artigo em Inglês | MEDLINE | ID: mdl-32361928

RESUMO

PURPOSE: Periarticular infiltration analgesia (PIA) is widely used to control postoperative pain in patients who underwent total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of adding corticosteroids to the PIA cocktail for pain management in patients who underwent TKA. METHODS: The patients were randomized to the corticosteroid or control group (double-blind). The patients in the corticosteroid group received a periarticular infiltration of an analgesic cocktail of ropivacaine, epinephrine, and dexamethasone. Dexamethasone was omitted from the cocktail in the control group. The primary outcomes were postoperative pain [assessed using a visual analog scale (VAS)], time until the administration of first rescue analgesia, morphine consumption, and postoperative inflammatory biomarkers [C-reactive protein (CRP) and interleukin-6 (IL-6)]. The secondary outcomes were functional recovery, assessed by the range of knee motion, quadriceps strength, and daily ambulation distance. The tertiary outcomes included postoperative adverse effects. RESULTS: The patients in the corticosteroid group had significantly lower resting VAS scores at 6 and 12 h after surgery, lower VAS scores during motion up to 24 h after surgery, and lower levels of inflammatory biomarkers. All the differences in the VAS scores between the two groups did not reach the point to be considered clinically significant. The additional use of corticosteroid significantly prolonged analgesic effects and led to lower rescue morphine consumption. The patients in the corticosteroid group had significantly better functional recovery on the first day after surgery. The two groups had a similar occurrence of adverse effects. CONCLUSIONS: Adding corticosteroids to an analgesic cocktail for PIA could lightly improve early pain relief and accelerate recovery in the first 24 h after TKA. LEVEL OF EVIDENCE: Randomized controlled trial, Level I.

2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 196-199, 2020 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-32030951

RESUMO

Objective: To compare the cost changes of total knee arthroplasty (TKA) before and after the cancellation of medical consumables addition, so as to provide reference for the national medical reform policy. Methods: The patients treated with TKA between September 2018 and February 2019 were admitted as objects of study, and 372 of them met the selection criteria and were finally included in the study. According to the time node of cancelling the medical consumables addition (December 24, 2018), all patients were allocated to pre-cancelling and post-cancelling groups ( n=186). The clinical data of patients (gender, age, length of stay, disease classification), and various treatment costs (the costs of diagnosis and treatment, examination, laboratory, material, anesthesia, bed, nursing, operation, drug, and others) were collected. And the changes of various costs and proportions before and after cancelling the medical consumables addition were compared. Results: There was no significant difference in gender, age, and disease classification between the two groups ( P>0.05); the length of stay after cancelling the medical consumables addition was significantly longer than that before cancelling ( t=2.114, P=0.035). There was no significant difference in the total cost of TKA before and after cancelling the medical consumables addition ( t=0.214, P=0.831). Compared with that before cancelling the medical consumables addition, the cost of material was significantly reduced, and the costs of diagnosis and treatment, anesthesia, nursing, and operation were significantly increased ( P<0.05); the costs of examination, laboratory , bed, drug, and others were basically stable, and the differences were not significant ( P>0.05). Conclusion: The total cost of TKA is stable, the proportion of material cost is significantly reduced, the proportion of diagnosis and treatment cost reflecting the technical content of medical staff is significantly increased, which is in line with the expectation of the national policy of cancelling the medical consumables addition.


Assuntos
Artroplastia do Joelho , Hospitalização , Humanos , Tempo de Internação
3.
Int Orthop ; 44(3): 461-469, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900576

RESUMO

BACKGROUND: The efficacy of partial retention of well-fixed components during two-stage exchange for chronic total hip arthroplasty (THA) infection has remained unknown. METHODS: A total of 14 patients with chronic infected THA were treated with damage control two-stage revision, including selective retention of the well-fixed femoral or acetabular component, aggressive debridement, antibiotic-laden cement spacer, antibiotic therapy, and delayed reimplantation. Indications for this treatment included chronic infected THAs with ingrown femoral or acetabular component and positive microbial growth with sensitive antibiotics. We excluded patients with acute infection; negative microbial growth; positive pathogen with high-virulence bacterial infections and multiple drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, fungi, and Mycobacterium tuberculosis; sinus formation; a prior failure for periprosthetic joint infection (PJI) treatment; and obvious bone resorption in both femoral and acetabulum side. During the study period, this represented 3.3% (14/425) of the patients treated for infected THA. Minimum follow-up was three  years. None of the 14 patients in this series were lost to follow-up. Successful treatment was defined according to a modified Delphi-based international multidisciplinary consensus. RESULTS: No repeated debridement and recurrence of infection occurred during the study period; no patient need chronic antibiotic suppression. Successful treatment of chronic PJI was achieved in all patients. Despite the high peri-operative complication rate, no severe consequences were observed. The mean Harris Hip Score was 86 (range, 82-92; SD, 3.3). CONCLUSIONS: The selective partial implant retention two-stage revision for chronic PJI may be a treatment option in properly selected patients with low virulence bugs.

4.
J Arthroplasty ; 35(3): 652-660, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31761674

RESUMO

BACKGROUND: This study aimed to evaluate the effect of femoral head and neck fenestration combined with compacted autograft (light bulb procedure) through a direct anterior approach for early stage nontraumatic osteonecrosis of the femoral head. METHODS: We conducted a retrospective cohort study investigating 66 hips undergoing the light bulb procedure through the direct anterior approach (light bulb group) and 59 hips undergoing traditional core decompression (control group). Visual analog scale pain scores and range of hip motion were evaluated before discharge to assess the quality of functional recovery. Follow-up was conducted at 6 weeks, 3 months, 6 months, and annually after surgery until 4 years. The clinical effectiveness was evaluated by Harris hip score and the University of California Los Angeles activity-level score. Patients were followed up with postoperative X-ray and computed tomography. Survival was compared between the 2 groups by radiographic progression and receiving total hip arthroplasty. RESULTS: There was no significant difference in quality of functional recovery between the 2 groups. There were no significant differences in clinical outcomes within 1 year after surgery. Patients in the light bulb group had significantly better Harris hip scores and University of California Los Angeles activity-level scores from 2 years after surgery to the end of follow-up. During the 4-year follow-up, significantly fewer patients in light bulb group had radiographic progression (22.7% vs 44.1%) or received total hip arthroplasty (15.2% vs 30.5%). CONCLUSIONS: The light bulb procedure through a direct anterior approach offers significantly better results for the treatment of early stage nontraumatic osteonecrosis of the femoral head compared with traditional core decompression.

5.
Int J Oncol ; 56(1): 206-218, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31746363

RESUMO

Ski, an evolutionary conserved protein, is involved in the development of a number of tumors, such as Barrett's esophagus, leukemia, colorectal cancer, gastric cancer, pancreatic cancer, hemangiomas and melanoma. However, studies on the functions of Ski in osteosarcoma (OS) are limited. In this study, firstly the differential expression of Ski in OS tissues and osteochondroma tissues was detected, and the expression of Ski in both human OS cell lines (MG63 and U2OS) and normal osteoblasts (hFoB1.19) was then detected. The results demonstrated that Ski expression was significantly upregulated in both human OS tissues and cell lines. The results led us to hypothesize that Ski may play an essential role in the pathological process of OS. Thus, Ski specific small interfere RNA (Ski­siRNA) was used. The results revealed that OS cell proliferation was markedly inhibited following the knockdown of Ski, which was identified by CCK8 assay, EdU staining and cell cycle analysis. In addition, OS cell migration was significantly suppressed following Ski knockdown, which was identified by wound healing assay. Moreover, the protein levels of p­PI3K and p­Akt in OS cells declined prominently following Ski knockdown. On the whole, the findings of this study revealed that Ski expression was significantly upregulated in OS tissue and OS cells. The knockdown of Ski decreased OS cell proliferation and migration, which was mediated by blocking the PI3K/Akt signaling pathway. Thus, Ski may act as a tumor promoter gene in tumorigenesis, and Ski may prove to be a potential therapeutic target for the treatment of OS.

6.
J Arthroplasty ; 35(1): 61-68, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31471180

RESUMO

BACKGROUND: Postoperative recovery after total knee arthroplasty (TKA) is associated with postoperative anemia, allogeneic transfusion, and stress immune responses to surgery. Carbazochrome sodium sulfonate (CSS) reduces bleeding through several mechanisms. We assessed the effect of CSS combined with tranexamic acid (TXA) on postoperative anemia, blood transfusion, and inflammatory responses. METHODS: This study was designed as a randomized, placebo-controlled trial of 200 patients undergoing unilateral primary TKA. Patients were divided into 4 groups: group A received TXA plus topical and intravenous CSS; group B received TXA plus topical CSS only; group C received TXA plus intravenous CSS only; group D received TXA only. RESULTS: Total blood loss in groups A (609.92 ± 221.24 mL), B (753.16 ± 247.67 mL), and C (829.23 ± 297.45 mL) was lower than in group D (1158.26 ± 334.13 mL, P < .05). There was no difference in total blood loss between groups B and C. We also found that compared with group D, the postoperative swelling rate, biomarker level of inflammation, visual analog scale pain score, and range of motion at discharge in groups A, B, and C were significantly improved (P < .05). No thromboembolic complications occurred. There were no differences in transfusion rate, intraoperative blood loss, platelet count, or average length of stay among the 4 groups (P > .05). CONCLUSION: CSS combined with TXA was more effective than TXA alone in reducing perioperative blood loss and inflammatory response and did not increase the incidence of thromboembolism complications.

7.
Orthop Surg ; 12(1): 100-107, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31884693

RESUMO

OBJECTIVE: To explore the efficacy and safety of intravenous tranexamic acid for reducing perioperative blood loss and allogeneic blood transfusions in revision surgery for Vancouver type B periprosthetic femoral fractures after total hip arthroplasty (THA). METHODS: We retrospectively reviewed 129 patients who underwent revision surgeries because of Vancouver type B periprosthetic femoral fractures from January 2008 to September 2018. Patients were divided into two groups according to whether they received intravenous tranexamic acid (n = 72) or not (n = 57). The two groups were compared in terms of estimated intraoperative blood loss, visible blood loss, hidden blood loss, the volume of allogeneic blood transfusion and the incidence of symptomatic venous thromboembolism (VTE). Patients were also compared depending on the Vancouver classification (Vancouver type B1, B2, and B3). RESULTS: Regardless of the subtype of Vancouver classification, patients who received tranexamic acid showed significantly lower estimated intraoperative blood loss, visible blood loss, hidden blood loss, and allogeneic blood transfusion volume. Use of tranexamic acid was not associated with significant changes in the incidence of postoperative symptomatic VTE. Similar results were obtained with subgroups of patients who had the Vancouver type B1, B2, or B3 periprosthetic femoral fractures. CONCLUSIONS: The administration of intravenous tranexamic acid can safely and effectively reduce perioperative blood loss and allogeneic blood transfusions in revision surgery for Vancouver type B periprosthetic femoral fractures, without increasing the risk of symptomatic VTE.

8.
Mol Ther Nucleic Acids ; 19: 15-30, 2019 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-31790972

RESUMO

Osteoarthritis (OA) is a major cause of joint pain and disability, and chondrocyte senescence is a key pathological process in OA and may be a target of new therapeutics. MicroRNA-140 (miR-140) plays a protective role in OA, but little is known about its epigenetic effect on chondrocyte senescence. In this study, we first validated the features of chondrocyte senescence characterized by increased cell cycle arrest in the G0/G1 phase and the expression of senescence-associated ß-galactosidase (SA-ßGal), p16INK4a, p21, p53, and γH2AX in human knee OA. Then, we revealed in interleukin 1ß (IL-1ß)-induced OA chondrocytes in vitro that pretransfection with miR-140 effectively inhibited the expression of SA-ßGal, p16INK4a, p21, p53, and γH2AX. Furthermore, in vivo results from trauma-induced early-stage OA rats showed that intra-articularly injected miR-140 could rapidly reach the chondrocyte cytoplasm and induce molecular changes similar to the in vitro results, resulting in a noticeable alleviation of OA progression. Finally, bioinformatics analysis predicted the potential targets of miR-140 and a mechanistic network by which miR-140 regulates chondrocyte senescence. Collectively, miR-140 can effectively attenuate the progression of early-stage OA by retarding chondrocyte senescence, contributing new evidence of the involvement of miR-mediated epigenetic regulation of chondrocyte senescence in OA pathogenesis.

9.
J Orthop Surg (Hong Kong) ; 27(3): 2309499019877522, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31645188
10.
Calcif Tissue Int ; 105(5): 506-517, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31359074

RESUMO

Glucocorticoid (GC)-induced osteonecrosis has been considered as the most serious side effect in long-term or over-dose steroid therapy. The decreased bone mass and increased marrow fat tissue demonstrated that GC can destroy the normal differentiation of bone marrow mesenchymal stem cells (BMSCs), which accelerates adipogenesis but not osteogenesis. However, the underlying mechanisms are still unclear. Ski, an evolutionary conserved protein, is a multifunctional transcriptional regulator that involved in regulating signaling pathways associated with adipogenesis differentiation, but the concrete function remains unclear. In this work, we first established a methylprednisolone (MPS)-induced osteonecrosis of femoral head (ONFH) rabbit model, in which the expression of Ski, PPAR-γ, and FABP4 was up-regulated compared with control group, and then we induced the isolated BMSCs from rabbit with dexamethasone (Dex) in vitro and the results showed that the Ski expression was up-regulated by Dex in a dose- and time-dependent manner. Therefore, we demonstrated that the expression of Ski was up-regulated in glucocorticoid-related osteonecrosis disease in vivo and in vitro. Moreover, the adipogenesis differentiation capacity of BMSCs was enhanced after induced by Dex, which was identified by Oil Red O staining, and the up-regulated PPAR-γ and FABP4 expression. To further study the function of Ski in BMSC after induced by Dex, Ski specific small interfering RNA (Ski-siRNA) was used. Results showed that knockdown of Ski obviously decreased adipogenesis differentiation evident by Oil Red O staining, and the expression of PPAR-γ and FABP4 was down-regulated simultaneously. Collectively, our findings suggest that Ski increased significantly during glucocorticoid-induced adipogenic differentiation of BMSCs, and the expression level was consistent with adipogenic-related proteins including PPAR-γ and FABP4. Based on the above data, we believe that Ski might become a new molecule in the treatment of GC-induced ONFH and our study could provide a basis for further study on the detailed function of Ski in ONFH.

11.
J Orthop Surg (Hong Kong) ; 27(2): 2309499019857653, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31232172

RESUMO

OBJECTIVE: The aim of this study was to evaluate the mid- to long-term outcomes of revision surgery for Vancouver type B2 periprosthetic femoral fractures (PFFs) after total hip arthroplasty using an uncemented extensive porous titanium-coated long femoral stem prosthesis (solution prosthesis) with or without cortical strut allograft. METHODS: A total of 34 patients with Vancouver type B2 PFFs who underwent revision hip arthroplasty using a posterolateral approach and received a solution prosthesis at our institution from December 2006 to January 2014 were retrospectively recruited. Patients were asked to assess their walking ability and pain status using a questionnaire. Limb function, pain, and physical and mental health were assessed using the Harris Hip score, University of California-Los Angeles score, Western Ontario and McMaster Universities osteoarthritis index, and Short Form-12 Health Survey score. Patients were also asked to rate their satisfaction with the surgery. Fracture union and stress shielding were assessed by radiography, and computed tomography was used to assess stem fixation. Single-photon emission computed tomography performed to assess radionuclide distribution in patients given cortical strut allografts. Patients were asked about their condition before PFF and evaluated at 6 weeks, 3 months, 6 months, 1 year, and annually after surgery. Any complications during follow-up were recorded. RESULTS: Of the 34 patients, 29 completed follow-up. There was no significant difference in patient's health before PFF or at the last follow-up. Fracture union was achieved in all patients. Mild-to-moderate stress shielding occurred in three patients, and no patients exhibited femoral stem loosening or obvious subsidence. Radionuclides were concentrated in the cortical strut transplantation area, and the cortical strut was integrated with the host femur. The incidence of postoperative complications was low. CONCLUSIONS: Revision surgery using the solution prosthesis with or without cortical strut allograft is effective in treating Vancouver type B2 PFFs, with satisfactory mid- and long-term clinical and radiological outcomes.

12.
J Arthroplasty ; 34(8): 1650-1655, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31060917

RESUMO

BACKGROUND: Adductor canal block (ACB) may preserve muscle strength and promote faster recovery than other methods of analgesia following total knee arthroplasty (TKA). However, there are contradictory reports on the efficacy of ACB. Here, we evaluated the efficacy of single-shot ACB combined with posterior capsular infiltration (PCI) vs multimodal periarticular infiltration analgesia in treating postoperative pain. METHODS: This study involved patients undergoing unilateral primary TKA at our institution from January 2018 to January 2019. Patients were randomized into 2 groups, one of which was treated with ACB combined with PCI, and the other with periarticular infiltration analgesia. Primary outcomes included postoperative pain as assessed by the visual analog scale (VAS) and consumption of morphine hydrochloride. The secondary outcome was functional recovery, as assessed by range of knee motion, quadriceps strength, and daily ambulation distance. Tertiary outcomes included the duration of hospital stay and postoperative adverse effects. RESULTS: Patients treated with ACB and PCI had lower resting VAS scores at 8 and 24 hours after surgery, and lower VAS scores during motion within 48 hours after surgery. Patients treated with ACB and PCI also consumed less morphine. There was no difference in functional recovery, duration of hospitalization, or incidence of adverse events. CONCLUSION: The ACB combined with PCI can reduce postoperative pain sooner after TKA without affecting postoperative functional recovery and increasing complications.

13.
J Arthroplasty ; 34(10): 2406-2414, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31103361

RESUMO

BACKGROUND: The aim of this study was to evaluate the influence of total hip arthroplasty on axial alignment of the lower limb in adults with unilateral developmental hip dysplasia (Crowe type IV). METHODS: We retrospectively reviewed medical records of 50 adults who underwent total hip arthroplasty, in which the acetabular cup was placed in the anatomical position. The following parameters were measured before surgery, immediately after surgery, and two years later: mechanical axis deviation (MAD), tibiofemoral angle (TFA), femoral offset, hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (LDFA), mechanical medial proximal tibial angle, height of medial femoral condyle, height of lateral femoral condyle, and leg lengthening. Length of the resected femoral segment was also recorded from medical records. RESULTS: Preoperative MAD, TFA, HKA, and LDFA of the ipsilateral lower limb showed significant valgus deformity. MAD of the ipsilateral lower limb and valgus inclination were significantly smaller immediately after surgery than before, while TFA, HKA, femoral offset, and LDFA were significantly larger (P < 0.05). These parameters did not differ significantly between immediately after surgery and two years later (P > 0.05). Ipsilateral extremities were extended by a mean of 2.54 cm (range, 0 to 5.35 cm). The mean length of the femoral resected segment was 3.56 cm (range, 2.03 to 5.74 cm). The contralateral lower limb showed marginally smaller MAD and medial proximal tibial angle after surgery than before, but larger LDFA, TAF, and HKA. CONCLUSIONS: In patients with developmental hip dysplasia who underwent total hip arthroplasty with placement of the acetabular component at the level of the anatomic hip center, axial alignment of the ipsilateral lower limb was immediately altered, and valgus inclination was significantly reduced. The procedure only slightly altered the axial alignment of the contralateral lower limb.

14.
J Arthroplasty ; 34(7): 1470-1475, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30905640

RESUMO

BACKGROUND: The effect of extended trochanteric osteotomy (ETO) with immediate cerclage wire fixation on the scene of chronic periprosthetic joint infection on infection eradication and the osteotomy healing remains unclear. METHODS: One hundred seventeen patients who underwent two-stage revision total hip arthroplasty for chronic periprosthetic joint infection were enrolled in the study. The minimum follow-up was 2 years. Of these, 48 patients had underwent ETO and immediate cerclage wire fixation during the first-stage surgery, while 69 did not undergo ETO or any other osteotomy. In addition, 18 patients had underwent ETO in the second-stage reimplantation surgery. Repeated debridement, curative rate of infection, and complications were compared between the 2 groups. Meanwhile, osteotomy healing between the first and second osteotomy were also compared. RESULTS: The repeated debridement rate and curative rate of infection were 2.1% and 95.8% in the ETO group, compared with 13.0% and 82.6% in the non-ETO group; there were significant difference between the 2 groups in these parameters (P = .037 and .030, respectively). Meanwhile, osteotomy healing rate was 93.8% in first-stage surgery with infection scene and 100% in second-stage surgery without infection; no significant difference was detected in osteotomy healing rate and time to healing (P = .278 and .803, respectively). The rate of complication was similar in both groups. CONCLUSIONS: ETO combined with immediate cerclage wire fixation does not appear to reduce the rate of infection eradication. There was no harmful effect on complication rate and osteotomy healing.

15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(2): 160-165, 2019 02 15.
Artigo em Chinês | MEDLINE | ID: mdl-30739408

RESUMO

Objective: To evaluate the safety and efficacy of total hip arthroplasty (THA) following failed internal fixation of intertrochanteric fractures. Methods: Between January 2007 and January 2016, THAs were performed in 32 patients (33 hips) for failed internal fixation of intertrochanteric fractures. There were 15 males and 17 females, with mean age of 74.0 years old (range, 65-87 years). There were 3 hips of Evans-Jensen type Ⅱ, 10 hips of type Ⅲ, 8 hips of type Ⅳ, and 12 hips of type Ⅴ. The fractures were fixed with dynamic hip screw in 18 hips, proximal femoral nail antirotation in 9 hips, locking plate in 5 hips, and hollow screw in 1 hip. The internal fixation failure caused by fracture displacement and nonunion in 22 patients, traumatic arthritis in 6 patients, fracture nonunion and infection in 3 patients, and avascular necrosis of the femoral head in 2 patients. The mean interval from initial fracture fixation to THA was 20 months (range, 2-48 months). The safety evaluation indicators included operation time, amount of operative bleeding and postoperative drainage, blood transfusion, and perioperative complications. The efficacy indexes included the hip Harris score, the range of motion (ROM), visual analogue scale (VAS) score, and the length difference between both legs; the X- ray films were taken to assess the prosthesis survival condition. Results: The average operation time was 92 minutes (range, 55-135 minutes). The average amount of operative bleeding and postoperative drainage were 480 mL (range, 360-620 mL) and 350 mL (range, 220-520 mL), respectively. Intraoperative proximal femur fissure fracture occurred in 2 hips. After operation, 10 cases received allogeneic blood transfusion, 1 case occurred cerebral infarction, 2 hips experienced dislocation, 1 hip occurred greater trochanter re-fracture and dislocation because of spraining, and 1 case died of myocardial infarction. Twenty-nine patients (30 hips) were followed up 2-10 years (mean, 4.9 years). At last follow-up, there was no infection recurrence in 3 infected hips, and there was no prosthesis loosening, subsidence, or rupture in all cases. The Harris score, ROM, VAS score, and the length difference between both legs were significantly superior to preoperative ones ( P<0.05). Conclusion: THA is an effective salvage procedure after failed internal fixation of intertrochanteric fracture. But its perioperative risks and complications are pretty high. Adequate preoperative evaluation, elaborate and individualized perioperative management are keys to make sure the patient can safely survive the perioperative period.


Assuntos
Artroplastia de Quadril , Fraturas do Quadril , Prótese de Quadril , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
16.
J Orthop Surg Res ; 14(1): 38, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709358

RESUMO

BACKGROUND: Total hip arthroplasty for adult patients with a history of infection of the hip in childhood could be a more technically demanding procedure due to complicated anatomy and the possibility of reinfection. Here, we conducted a mid-term analysis of clinical outcomes in such patients after primary cementless total hip arthroplasty (THA). METHODS: We reviewed 101 patients (101 hips; 51 men; mean age, 52.3 years) who underwent cementless THA between 2008 and 2015, at a mean of 24 years (range, 11-43) since the resolution of childhood hip infection. Patients were followed up for a mean of 6.1 years (range, 2.1-9.6). Clinical outcomes and quality of life after THA were assessed at final follow-up. RESULTS: No cases of infection were reported during the follow-up, and patients showed significant improvement in Harris Hip Score, for which the mean score increased from 48.5 to 90 points; the modified Merle d'Aubigne and Postel (MAP) Hip Score; the Hip Dysfunction and Osteoarthritis Outcome Score; the SF-12; and mean limb length discrepancy, which decreased from 3.4 to 1.1 cm. During follow-up, four cases of prosthesis dislocation, three of transient sciatic paralysis, seven of femoral fracture, five of heterotopic ossification, and 19 of osteolysis were recorded. Revision surgery was performed for two patients, one for isolated loosening of the acetabular component and another for loosening of the femoral stem. CONCLUSION: Cementless THA can effectively treat patients with a quiescent period of infection of the hip of more than 10 years, resulting in good functional outcomes and fewer complications. Risk of infection recurrence after THA in these patients seems extremely low.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril/reabilitação , Adulto , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/estatística & dados numéricos , Feminino , Seguimentos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Adulto Jovem
17.
Biomed Mater ; 14(3): 035013, 2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-30802884

RESUMO

Glucocorticoids-induced osteonecrosis of femoral head (GIONFH) is difficult to treat due to the pathophysiology remains uncertain. Core decompression and bone grafting are regarded as effective measures for treating early GIONFH. Furthermore, commonly used bone graft materials at nowadays are still unsatisfactory. We generated a novel calcium polyphosphate (CPP) composite scaffold, which contains Li and VEGF-loaded gelatin microspheres (LiCPP/GMs/VEGF). The LiCPP/GMs/VEGF scaffold also demonstrated a porosity of 70.5% ± 2.3% with interconnected porous structures, and pore sizes of 100-200 µm and compressive strength of 3.7 MPa. Additionally, bone marrow mesenchymal stem cells (BMSCs) were seeded on scaffolds in vitro. Further characterization showed that the LiCPP/GMs/VEGF scaffolds were biocompatible and enhanced osteogenesis and angiogenesis in vitro. Using a rabbit model of GIONFH, LiCPP/GMs/VEGF scaffolds were implanted into the bone tunnels of core decompression in the femoral head for 12 weeks. Radiographic, histological analysis and western blot analysis demonstrated that the LiCPP/GMs/VEGF scaffolds exhibited good biocompatibility, and osteogenic and angiogenic activity in vivo. Besides, the osteogenic and angiogenic factors were increased along with VEGF release and the activation of factors in Wnt signal pathway. In conclusion, the LiCPP/GMs/VEGF scaffold has an effect on improving the osteogenesis and angiogenesis, which benefited to repair the GIONFH.


Assuntos
Cabeça do Fêmur/patologia , Glucocorticoides/efeitos adversos , Lítio/química , Osteonecrose/tratamento farmacológico , Tecidos Suporte/química , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Materiais Biocompatíveis , Células da Medula Óssea/citologia , Cálcio/química , Força Compressiva , Gelatina/química , Masculino , Células-Tronco Mesenquimais/citologia , Microesferas , Neovascularização Fisiológica , Osteogênese , Osteonecrose/induzido quimicamente , Polifosfatos/química , Porosidade , Pressão , Coelhos , Transdução de Sinais , Estresse Mecânico , Engenharia Tecidual , Proteínas Wnt/metabolismo , Microtomografia por Raio-X
18.
Knee Surg Sports Traumatol Arthrosc ; 27(4): 1075-1082, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30386998

RESUMO

PURPOSE: The aim of this study was to determine the real incidence of symptomatic in-hospital venous thromboembolism (VTE) and identify risk factors for VTEs in Asian patients undergoing total hip (THA) and total knee arthroplasty (TKA). METHODS: A total of 17,660 patients (20,078 hips and knees) undergoing THA and TKA at 78 hospitals were enrolled. The composite incidence of symptomatic in-hospital DVT and PE was identified as the primary effectiveness outcomes. The primary safety outcomes were the incidences of postoperative complications, especially for major or minor bleeding. Secondary analyses were assessed to identify the risk factors for postoperative VTE. RESULTS: The overall rates of symptomatic in-hospital DVT in patients undergoing THA and TKA were 0.21% (19/9022) and 0.36% (31/8638), respectively. Symptomatic PE was confirmed in one TKA patient. Safety analysis showed that the incidence of bleeding during hospital stays in patients undergoing THA and TKA was 0.10% (18/17,660). Increased VTE risks were associated with old age, high BMI index, hypertension, cerebrovascular disease, history of venous thromboembolism and no medical prophylaxis usage. CONCLUSIONS: The incidence of symptomatic VTEs in Asian regions was low compared with that reported in studies targeting Western populations. Approximately 1 in 500 patients undergoing THA and approximately 1 in 300 patients undergoing TKA developed symptomatic VTEs prior to hospital discharge. Old age, high BMI, history of venous thromboembolism, hypertension, cerebrovascular disease, and no medication prophylaxis were risk factors identified in this study. LEVEL OF EVIDENCE: Prospective cohort study; Level 2.


Assuntos
Artroplastia de Quadril/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Tromboembolia Venosa/epidemiologia , Idoso , Anticoagulantes/uso terapêutico , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Estudos Prospectivos , Fatores de Risco , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle
19.
Int J Rheum Dis ; 22(3): 392-398, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30460780

RESUMO

AIM: To prospectively evaluate the long-term efficacy and safety of repeated sodium hyaluronate injections for the treatment of knee pain due to Kashin-Beck disease (KBD). METHODS: A total of 85 patients with KBD-based knee pain were treated with two cycles of a 5-week course of sodium hyaluronate and received clinical assessments with a follow-up period of 24 months after the first cycle. The primary efficacy measure was the visual analogue scale (VAS) pain score. The second efficacy measure included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores; and the patients' and physicians' global assessments. Tolerability was evaluated based on adverse events (AEs). RESULTS: Seventy-one patients (83.5%) completed the final study. The VAS was significantly reduced from 65.06 ± 12.21 mm (mean ± standard deviation [SD]) at baseline to 30.17 ± 11.92 mm at 6 months and was maintained for 24 months (35.79 ± 7.92 mm, P < 0.01 vs baseline). This finding was supported by the secondary variables (the WOMAC A, B and C scores; the total WOMAC scores; and the global assessments of the patients and their physicians at months 6, 12, 18 and 24). The overall incidence of AEs during the first and second cycles was 8 (9.4%) and 7 patients (8.2%), respectively. No serious AEs were reported. CONCLUSIONS: Repeated once yearly cycles of intra-articular sodium hyaluronate injections may improve knee KBD symptoms during the inbetween cycle period as well as exert a significant carry-over effect for at least 1 year after the repeated cycle. Other randomized double-blind studies are needed to confirm the findings from our study.


Assuntos
Artralgia/tratamento farmacológico , Ácido Hialurônico/administração & dosagem , Doença de Kashin-Bek/tratamento farmacológico , Articulação do Joelho/efeitos dos fármacos , Viscossuplementação/métodos , Viscossuplementos/administração & dosagem , Adulto , Idoso , Artralgia/diagnóstico , China , Esquema de Medicação , Feminino , Humanos , Ácido Hialurônico/efeitos adversos , Injeções Intra-Articulares , Doença de Kashin-Bek/diagnóstico , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Viscossuplementação/efeitos adversos , Viscossuplementos/efeitos adversos
20.
Knee Surg Sports Traumatol Arthrosc ; 27(7): 2266-2275, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30430221

RESUMO

PURPOSE: A modified technique referred to as a medial femoral epicondyle upsliding osteotomy was proposed to address severe valgus deformity with unconstrained posterior stabilized (PS) arthroplasty. The study compared the effectiveness of the technique and PS arthroplasty with constrained arthroplasty during primary total knee arthroplasty (TKA). METHODS: Fifty-three patients presenting with valgus knees with a mean valgus angle (VA) greater than 30° were prospectively randomized and divided into two groups, and both groups received primary TKA. Upsliding osteotomy with PS arthroplasty was performed on the knees of 27 patients (group A), while the remaining 26 patients (group B) received a constrained arthroplasty. The Knee Society function score (KSF), Hospital for Special Surgery knee score (HSS), range of motion (ROM), mediolateral stability and hospitalization expenses were recorded. The hip-knee-ankle angle (HKA), femorotibial angle (FTA) and VA were analysed. Complications were also recorded. RESULTS: The patients received follow-up care for more than 50 months. The postoperative KSF, HSS and ROM showed marked improvement in both groups (p < 0.05). Radiological assessments showed that HKA, FTA and VA for group A were restored to (179.9 ± 3.0)°, (173.0 ± 2.4)° and (7.0 ± 2.4)°, respectively. For group B, the HKA, FTA and VA were restored to (181.5 ± 2.3)°, (172.5 ± 2.3)° and (7.5 ± 2.3)°, respectively. Only two patients from group A demonstrated mild medial laxity in their knees, and the remaining patients from both groups were stable medially and laterally. However, the total hospitalization expenses and material expenses of group A were less than those of group B because of the more expensive constrained prosthesis and stems. No late-onset loosening or recurrent valgus deformity was displayed. CONCLUSIONS: Both medial femoral epicondyle upsliding osteotomy with PS arthroplasty and constrained arthroplasty showed good outcomes for the restoration of neutral limb alignment and soft tissue balance, which are demonstrated to be safe and effective techniques for correcting severely valgus knees. Therefore, the clinically important finding of this study is that medial femoral epicondyle upsliding osteotomy with PS arthroplasty can be an alternative method for correcting severe valgus knees. LEVEL OF EVIDENCE: II.


Assuntos
Artroplastia do Joelho/métodos , Retroversão Óssea/cirurgia , Osteotomia/métodos , Idoso , Articulação do Tornozelo , Osso e Ossos/cirurgia , Feminino , Fêmur/cirurgia , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular
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