Objective To compare the efficiency of secondary total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) after failed internal fixation of femoral neck fracture and the primary THA for non-traumatic ONFH and to evaluate if the two groups have significant difference. Methods From June 2004 to July 2007, 203 cases of ONFH were treated by THA. In group A, 83 patients (83 hips) with ONFH after failed internal fixation included 56 males (56 hips) and 27 females (27 hips) with an average age of 58.3 years (range 45-75 years). According to Ficat classification, there were 61 cases atstage III and 22 cases at stage IV. The Harris score was 37.6 ± 2.0. The disease course was 1-6 years with an average of 2.6 years. In group B, 120 patients (167 hips) with non-traumatic ONFH included 67 males (94 hips) and 53 females (73 hips) with an average age of 52.6 years (range 41-67 years). According to Ficat classification, there were 56 cases (83 hips) at stage III and 64 cases (84 hips) at stage IV. The Harris score was 38.2±1.0. The disease course was 1.5-5.0 years with an average of 2.6 years. There were no significant differences in general data between two groups (P gt; 0.05). Results All 203 cases were followed up for 2 to 5 years (average 3.4 years). There were no significant differences in the operation time of single-hip, the blood loss, the blood transfusion between two groups (P gt; 0.05). Intraoperative fractures occurred in 4 hips (4.8%) of group A and 2 hips (1.2%) of group B, showing significant difference (P lt; 0.05). There were no significant differences (P gt; 0.05) in the incidence of dislocation [3 hips (3.6%) in group A and 1 hip (0.6%) in group B], continuous femoral pain [2 hips (2.4%) in group A and 1 hip (0.6%) in group B] and infection [1 hip (0.6%) in group B] between two groups. There were no significant differences (P gt; 0.05) in acetabular abduction, anteversion, femoral anteversion, and combined anteversion angles as well as the recovery rate of acetabular rotational center between two groups. The Harris scores of groups A and B after 2 years were 79.4 ± 2.1 and 84.2 ± 3.5.There was no significant difference between two groups (P gt; 0.05). The Harris score postoperation had significant differences compared with preoperation (P lt; 0.05). Conclusion Compared to the primary THA to non-traumatic ONFH, secondary THA to ONFH after failed internal fixation has no significant increase in operative difficulty, the postoperative hip function isgood, but the incidence of intraoperative fracture is higher.
Objective To evaluate the safety and efficacy of total hip arthroplasty (THA) in patients with end stage renal disease (ESRD). Methods Between December 2009 and May 2016, 30 THAs were performed in 28 patients with dialysis-dependent renal failure (18 patients) or renal transplantation (10 patients). A retrospective case control study was carried out to compare these 28 ESRD patients (ESRD group) with a matched cohort of 28 nonrenal patients (control group). There was no significant difference in gender, age, hip side, American Society of Anesthesiology (ASA) classification, comorbidities, and preoperative Harris score and hemoglobin (Hb) level between 2 groups (P>0.05). The complications during hospitalization, Hb level changes, perioperative transfusion rate, hospital stay, and hospitalization costs in 2 groups were evaluated; and the creatinine changes of dialysis patients in ESRD group were evaluated. During the follow-up period, 90 days readmissions, periprosthetic infection, prosthesis loosening, hip Harris score, and deaths were recorded. Results There was no loss of follow-up. The mean postoperative follow-up of ESRD group was 3.4 years (range, 1.0-7.4 years) and control group was 3.5 years (range, 1.0-7.4 years). Differences in hospital stay and the drop of Hb was not significant between 2 groups (P>0.05). The hospitalization costs and perioperative transfusion rate were significantly higher in ESRD group than in control group (P<0.05). There was no significant difference in creatinine value of dialysis patients in ESRD group between pre- and post-operation (t=1.804, P=0.089). At last follow-up, the Harris score was significantly higher than preoperative score in both groups (P<0.05); however, there was no significant difference in Harris score between groups (t=1.278, P=0.207). In ESRD group, 5 patients presented complications, 1 patient was readmitted to hospital, and 2 patients died during the follow-up. In control group, 1 patient presented complications, and there was no 90 days readmission and no death. During the follow-up period, there was no loosening or revision in 2 groups and the prosthesis was in good position. Conclusion THA can improve joint function and life quality of ESRD patients, but the risks of operation, perioperative complications, transfusion rate, and cost are high. Correct perioperative evaluation and management can help ESRD patients safely go through the perioperative period.
Objective To explore the surgical technique and effectiveness of autologous femoral head bone graft in total hip arthroplasty (THA) for Crowe type Ⅲ developmental dysplasia of the hip (DDH) with acetabular bone defect. Methods Between July 2012 and September 2015, 12 cases (12 hips) of Crowe type Ⅲ DDH with acetabular bone defect were included. Of the 12 patients, 2 were male and 10 were female, with an average age of 54.3 years (range, 37-75 years). The Harris score before operation was 41.08±7.90. The preoperative leg length discrepancy was 0.53-4.28 cm, with an average of 2.47 cm. Autologous femoral head bone graft and cancellous screw fixation were used in all cases to reconstruct acetabula in THA. Four cases were performed with subtrochanteric shortening osteotomy at the same time. Results All incisions healed by first intention. Twelve cases were followed up 1 year and 10 months to 5 years, with an average of 3.0 years. X-ray films showed that bone healing was observed in all cases at 6 months to 1 year after operation. There was no bone graft osteolysis, absorption, bone graft collapse, and acetabular prosthesis loosening. At last follow-up, the Harris score was 89.50±2.78, showing significant difference when compared with preoperative value (t=–25.743, P=0.003). The length discrepancy was 0-1.81 cm at last follow-up with an average of 0.76 cm. Conclusion Autologous femoral head bone graft is effective for Crowe type Ⅲ DDH with acetabular bone defect, which has advantages of restoring pelvic bone stock, obtaining satisfied prosthetic stability and mid-term effectiveness.
Objective To investigate the impact of joint capsule repair and external rotators suture on the prognosis in primary total hip arthroplasty (THA) by posterolateral approach. Methods Between January 2006 and June 2009, 159 patients with femoral neck fracture underwent primary THA by posterolateral approach, and were divided into 4 groups according to different treatments: joint capsule repair and external rotators suture were given in group A (n=38), only joint capsule repair in group B (n=39), only external rotators suture in group C (n=41), and no joint capsule repair or external rotators suture in group D (n=41). There was no significant difference in gender, age, cause of injure, disease duration, type of fracture, combined medical disease, or prosthesis selection among 4 groups (P gt; 0.05). The bleeding volume, drainage, postoperative hip dislocation rate, hip Harris score, and the hip range of motion (ROM) in internal rotation and external rotation were compared. Results There was no significant difference in operative time, bleeding volume, or drainage among 4 groups (P gt; 0.05). Postoperative hip dislocation occurred in 0, 0, 4 (9.8%), and 4 (9.8%) cases of groups A, B, C, and D, respectively, showing significant difference in incidence of postoperative hip dislocation among 4 groups (χ2=7.910, P=0.048). The hip Harris scores were significantly improved after operation when compared with preoperative scores in 4 groups (P lt; 0.05). Significant differences were found in hip Harris score at 6 weeks and 6 months after operation among 4 groups (P lt; 0.05); group D was significantly lower than groups A, B, and C, and groups B and C were significantly lower than group A (P lt; 0.05). There was no significant difference in the hip ROM in internal rotation among 4 groups at 6 weeks and 6, 12 months after operation (P gt; 0.05); but the hip ROM in external rotation were significantly bigger in groups A and C than in groups B and D at 6 weeks and 6 months after operation (P lt; 0.05). Conclusion Joint capsule repair and external rotators suture in primary THA by posterolateral approach do not increase the bleeding volume and drainage, but can reduce the early postoperative hip dislocation risk, increase the Harris score, and recover the external rotation function of involved hip. So joint capsule and external rotators should be repaired in THA by posterolateral approach.
Objective To summarize the clinical outcome of the Ribbed anatomic cementless total hip arthroplasty (THA) in the treatment of hip-joint disease. Methods From January 2001 to June 2005, 34 patients(38 hips) with hip-joint disease were treated with Ribbed anatomic cementless THA. Their ages ranged from 29 to 55 years with an average age of 42.7 years.The disease course was from 3 to 18 years. Among these cases, there were 7 cases (7 hips) of femoral neck fracture, 5 cases(5 hips) of traumatic arthritis after fracture of acetabulum, 15 cases(16 hips) of necrosis of the femoral head and 7 cases(10 hips) of ankylosing spondylitis. Four patients were operated on both hip joints. The average Harris hip score was 38.6(25-57) before operation. Results Twenty-one patients(23 hips) were followed up 861 months with an average of 35 months. The Harris hip score was 76-98 after operation with an average of 92.3, showing significant difference when compared with that before operation(Plt;0.05). The excellent and good result was achieved in 93.5 % of patients. Radiographs showed no prosthetic osteolysis and no evidence of loosening. Pain in the thigh occurred in 4 patients,and it can be relieved by using nonsteroid antiinflammatory drug. Conclusion Ribbed anatomic cementless THA has good clinical and radiographic results in treating patients with hip-joint disease.
【Abstract】 Objective To explore the methods and appl ication value of surface shaded display (SSD) and multiplanarreconstruction (MPR) in the evaluation of acetabular morphology in patients with developmental dysplasia of the hip (DDH) before total hip arthroplasty (THA). Methods From October 2003 to November 2006, 17 patients (3 males and 14 females, aging from 35 years to 61 years) with osteoarthritis secondary to DDH were scanned with spiral CT preoperatively. According to the Crowe standard, 19 dysplasia hips were classified as type I in 4 hips, type II in 9 hips, type III in 6 hips. The obtained hip CT data were developed with SSD and MPR to observe spational position and bone stock of the acetabula. Results The dislocated extent was 25%-89% in these dysplasia hips according to the Crowe method and their sharp angles all exceeded 45°. Bone defect occurred to each of the acetabula, among which it was located in anterosuperior acetabulum in 5 hips, in superolateral acetabulum in 11 hips and in posterosuperior acetabulum in 3 hips. The hip images made with MPR showed that the minimum thickness of the medial wall of acetabula ranged from 2.0 mm to 10.9 mm. Among 15 unilateral dysplasia patients, the opening difference anddepth difference between the dysplasia acetabulum and the contralateral one ranged from 2.7 mm to 19.1 mm and from 2.3 mm to 13.1 mm, respectively. Conclusion SSD and MPR of spiral CT are effective methods in evaluating acetabular morphology preoperation and contribute to intraoperative acetabular reconstruction in patients with DDH performed THA.
Total hip arthroplasty is an end-stage treatment for hip diseases such as hip osteoarthritis and osteonecrosis of the femoral head. Traditional surgery models are still mostly used in China, and related day surgery models abroad have shown that day surgery for total hip arthroplasty is as safe and feasible as traditional pattern without increase in complications and readmission. It can also shorten the length of hospitalization for patients, reduce hospitalization costs, thereby speeding up bed turnover and increasing the utilization of medical resources. This article reviews the patient admission, perioperative management, anesthesia and surgical techniques, post-discharge rehabilitation and nursing care of patients undergoing day surgery for total hip arthroplasty, and aims to providea reference for the development of day surgery for total hip arthroplasty in China.
Objective To explore the cause of haematoma after the cemented total hip arthroplasty (THA) and find out the way to decrease the incidence of haematoma perioperatively. Methods From March 2000 to October 2006, 103 patientswere treated with the cemented THA. Among the patients, 44 were males and 59 were females with their ages ranging from 36 to 89 years, averaged 55.3 years.The femoral neck fracture (Garden 4) was found in 49 patients, avascular necrosis of the femoral head (Ficat 4) in 26, and osteoarthritis of the hip joint (Tonnis 3) in 28. Their illness course ranged from 1 day to 8 years. The average Harris score preoperatively was 36 (range, 1948). The patients were divided into Group A (n=43) and Group B (n=60). The patients in Group A underwent the conventional surgical operations from March 2000 to December 2003; the patients in Group Bunderwent the same surgical procedures combined with additional procedures (e.g., ligation of the external rotators before incision, use of plastic bandage after the drainage tube was pulled out, prolonged stay period in bed postoperatively) from January 2004 to October 2006. Results In Group A, postoperative haematoma occurred in 9 patients and the averaged 317.8±75.3 ml(range,110-410 ml) of the accumulated blood was drained with a syringe. An average amount for the firstdrainage of the accumulated blood was 86.7±30.7 ml(range, 50-125 ml)， and an average drainage time was 4.2(range, 2-7). In Group B, postoperative haematoma occurred in 2 patients, with an amount of 110 ml and 160 ml of the accumulated blood and an amount of 40 ml and 60 ml of the drained blood at thefirst drainage. There was statistical difference in the amount of heamotoma between two groups(P＜0.05). The followup of 91 patients (39 in Group A, 52 in Group B) for 1.2-5.5 years (average, 3.7 years) revealed that the Harris scores were 78 in Group A and 85 in Group B on average.The Harris score for pain was 44 (Grade A) in 16 patients, 40 (Grade B) in 24 patients, and 30 (Grade C) in 3 patients in Group A; Grade A in 48 patients,Grade B in 12 patients, and Grade C in none of the patients in Group B. There was no statistical difference in Harris score between the two groups (P＞0.05). Conclusion Additional surgical procedures for the cemented THA, such as ligation of the external rotators before incision, use of plastic bandage afterthe drainage tube is pulled out, and prolonged stay in bed postoperatively, can greatly help to reduce the incidence of postoperative haematoma and the amount of the accumulated blood.
Objective To study the effectiveness and acetabular prosthesis selection of the total hip arthroplasty (THA) for Crowe type IV congenital dysplasia of the hip with dislocation in adults. Methods Between June 2008 and May 2012, 8 adult patients (8 hips) with Crowe type IV congenital dysplasia of the hip with dislocation underwent THA. They were all female, aged 20-35 years with a mean age of 25 years. The left hip was involved in 5 cases and the right hip in 3 cases. The Harris score of involved hip was 53.9 ± 6.6. The shortened length of involved extremity was 4-6 cm (mean, 4.8 cm). The X-ray films showed complete dislocation in all cases. The acetabular prosthesis with diameter of 42-44 mm and S-ROM femoral prosthesis were used in THA. Results The incisions healed by first intention. There was no hip dislocation events and sciatic nerve injury during the follow-up. Femoral nerve injury occurred in 1 case and asymptomatic venous thrombosis of the leg muscle occurred in 2 cases. All the patients were followed up 1-5 years (mean, 3 years). All cases showed obvious improvement of claudication and could restore to work. At 6 months after operation, the mean length difference between affected and contralateral extremities was 0.4 cm (range, — 1.0-0.6 cm); the Harris score was significantly increased to 87.6 ± 0.3 (t=1.77, P=0.00). The X-ray films showed that all cases got bony union at 3-6 months after operation and stable interface between acetabular prosthesis and bone. No revision was involved during the follow-up. Conclusion THA with small acetabular cup and subtrochanteric osteotomy is an effective method in the treatment of Crowe type IV congenital dysplasia of the hip with dislocation in adults. The early effectiveness is satisfactory. The long-term survival rate of prosthesis needs to be followed up.
ObjectiveTo analyze the methods of offside reconstruction in total hip arthroplasty (THA) for severe osteoarthritis. MethodsBetween July 2009 and June 2011,18 cases (18 hips) of severe osteoarthritis of the hip were treated by THA,including 14 males and 4 females with a mean age of 55.4 years (range,47-72 years).The disease duration was 11-74 months (mean,33.6 months).The left hip was involved in 11 cases and the right hip in 7 cases.The hip Harris score was 34.6±5.3.The lower limb discrepency was observed in 15 cases.Thomas sign,Patrick sign,and Trendelenburg sign were positive in all cases.All patients received THA; during operation,standard femoral neck osteotomy was performed and the correct rotation center was chosen to reconstruct offside. ResultsAll the incisions healed primarily.Common peroneal nerve injury occurred in 1 case and was cured after symptomatic treatment for 3 months,and the other patients had no complication.The mean follow-up period was 43.5 months (range,30-53 months).All patients achieved pain relief,and returned to normal gait.The X-ray films showed no dislocation of the hip or prosthetic loosening.Lower limb discrepency was observed in 6 cases.The mean offside difference between normal and ipsilateral side was 0.4 mm (range,0.1-0.7 mm).At last follow-up,the hip Harris score was 83.0±7.1,showing significant difference when compared with preoperative score (t=-22.96,P=0.01); the hip range of motion was significantly increased when compared with preoperative one (P<0.05). ConclusionThe offside reconstruction can accurately be carried out by making precise template and vernier caliper measurement,selecting suitable prosthesis preoperatively,maintaining the proper femoral calcar length,adjusting the length of the neck and neck-shaft angle,releasing the soft tissue reasonably during THA for severe osteoarthritis,and the short-term effectiveness is satisfactory.