Objective To discuss the clinical application of preserving femoral neck in total hip arthroplasty and to analyze the early stage results.Methods From January 1999 to June 2001, 12 patients underwent total hip arthroplasty with preservation of femoral neck. We cut off the femoral head in infra-head position with improved Moore micro-incisions to reserve intact neck of femur. Thensuitable size of extra cup was selected and placed at 55° eversion angle. The internal cup, made from ultra high polymer poly thene and with ultra radius design, was placed at 45°eversion angle. Harris scores were recorded before operation, after operation and during the follow-up. During the follow-up, the X-rayfilms were taken to assess position, loosening of the prosthesis and ectopic ossification.Results All 12 patients were followed up 2-4.5years with an average of 3.1 years. The mean Harris score of hip elevated from 54 scores before operation to 92 scores of the last follow-up. Mild ectopic ossification occurred in 3 cases. There was no prosthesis loosening and femoral prosthesis setting, and only onepatient had mild bone absorption around femoral prosthesis.Conclusion Total hip arthroplasty with femoral neck preservation is a good option for the patients who need total hip arthroplasty for variable reasons, which is indicated for the patients whose femoral neck is intact with no osteoporosis.
Objective To summarize the application progress of three-dimensional (3D) printed metal prosthesis in joint surgery. Methods The related literature was extensively reviewed. The effectiveness of 3D printed metal prosthesis in treatment of joint surgery diseases were discussed and summarized, including the all key issues in prosthesis transplantation such as prosthesis stability, postoperative complications, bone ingrowth, etc. Results 3D printed metal prosthesis has good matching degree, can accurately reconstruct and restore joint function, reduce operation time, and achieve high patient satisfaction in short- and medium-term follow-up. Its application in joint surgery has made good progress. Conclusion The personalized microporous structure prostheses of different shapes produced by 3D printing can solve the problem of poor personalized matching of joints for special patients existing in traditional prostheses. Therefore, 3D printing technology is full of hope and will bring great potential to the reform of orthopedic practice in the future.
Objective To introduce the concept and clinical applications of rotational alignment of the femoral prosthesis in total knee arthroplasty (TKA) so as to avoide the postoperative complications caused by rotational alignment. Methods The clinical and experimental research literature about rotational alignment of the femoral prosthesis in TKA was extensively reviewed and analyzed. Results Femoral prosthesis malrotation can lead to flexion gap unbalanced and undesirable patellar track. Rotation alignment of the femoral prosthesis is defined with radiological and computer assisted technique at pre- and post-operation, which can make the rotation alignment of the femoral prosthesis and the function of the knee favorable. Conclusion In recent years, many surgical skills and new techniques of defining the rotational alignment are developed, and good clinical results are achieved.
ObjectiveTo investigate the femoral bone remodeling and long-term effectiveness of total hip arthroplasty (THA) with anatomic medullary locking (AML) prosthesis.MethodsThe clinical data of 24 cases (26 hips) who were treated with THA with AML prosthesis between November 1997 and January 2003 were retrospectively analyzed. There were 12 males and 12 females with an age of 32-69 years (mean, 53.7 years). There were 5 cases (5 hips) of avascular necrosis of the femoral head, 6 cases (7 hips) of secondary osteoarthritis of the hip dysplasia, 6 cases (6 hips) of femoral neck fracture, 2 cases (2 hips) of primary osteoarthritis, 3 cases (3 hips) of revision surgery, 1 case (2 hips) of ankylosing spondylitis, 1 case (1 hip) of femoral head fracture. The patients were followed up at immediate, 6 weeks, 3 months, 6 months, 1 year, and then every year after operation for imaging evaluation (X-ray film was taken immediately after operation to evaluate the femoral isthmus compression, Engh standard was used to evaluate the biological fixation of the femoral shaft prosthesis, and Brooker method was used to evaluate the occurrence of heterotopic ossification); bone reconstruction evaluation [reconstruction of prosthesis and bone interface (type of bone reaction, Gruen zone, incidence, and occurrence time were recorded), reconstruction of bone around prosthesis (proximal femur stress shielding bone absorption was evaluated according to Engh and Bobyn methods, and bone mineral density change rate was measured)]; clinical efficacy evaluation [Harris score for efficacy, visual analogue scale (VAS) score for thigh pain].ResultsAll patients were followed up 15 years and 2 months to 20 years and 4 months, with a median of 16 years and 6 months. At immediate after operation, 24 hips (92.3%) had good femoral isthums compression, 24 hips (92.3%) had good bone ingrowth. Heterotopic ossification occurred in 2 patients with degree 1, 2 patients with degree 2, and 1 patient with degree 3 at 3-6 months after operation. Hyperplastic bone reactions were more common in Gruen 2, 3, 4, 5, 6, 10, 11, and 12 zones, mainly occurring at 6-20 months after operation, with the incidence of 3.8%-69.2%, with the highest incidence of spot welding. All absorptive bone reactions were osteolysis, which was common in Gruen 1 and 7 zones, and mainly occurred at 8 years after operation, with an incidence of 42.3%. No clear line (area) or enlarged sign of medullary cavity was observed. Twenty-one hips (80.8%) had 1 degree stress shieding, and 5 hips (19.2%) had 2 degree stress shieding. It mainly occurred at 10-24 months after operation in Gruen 1 and 7 zones. Dual energy X-ray absorptiometry showed that bone mineral density mainly decreased in Gruen 1, 2, 6, and 7 zones, mainly increased in Gruen 3, 4, and 5 zones. Bone mineral density loss progressed slowly after 2 years of operation, and it was stable in 5-8 years, but decreased rapidly in 8-9 years, and stabilized after 10 years. The Harris score increased from 51.1±6.2 before operation to 88.3±5.1 at last follow-up (t=–21.774, P=0.000). Mild thigh pain occurred in only 2 cases (7.7%) with the VAS score of 2. No aseptic loosening or revision of femoral prosthesis occurred during the follow-up.ConclusionThe application of AML prosthesis in THA has a good bone remodeling and a good long-term effectiveness.
ObjectiveTo evaluate the effect of the surgeon’s handedness on the distribution of prosthesis during primary total knee arthroplasty (TKA).MethodsA retrospective analysis was performed on 86 patients (100 knees) with primary TKA completed by the same right-handed surgeon between December 2016 and December 2018, including 72 cases of single knee and 14 of bilateral knees. The patients were divided into dominant group (right side) and non-dominant group (left side) according to the operating position of the surgeon and each group had 50 knees. There was no significant difference in gender, age, body mass index, disease duration, clinical diagnosis, preoperative Hospital for Special Surgery (HSS) score, and other general data between the two groups (P>0.05). The operation time and complications were recorded in both groups. The function of knee was evaluated by HSS score. Hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were measured by using X-ray film of full-length lower extremity before TKA and at 2 weeks after TKA that were used to evaluate the coronal position of the prosthesis. Posterior distal femoral angle (PDFA) and posterior proximal tibial angle (PPTA) were measured by using lateral X-ray films at 3 months after operation that were used to evaluate the sagittal position of the prosthesis.ResultsThere was no significant difference in operation time between the two groups (t=−1.128, P=0.262). One case of posterior tibial artery thrombosis occurred in the dominant group, and 1 case of poor healing of the incision occurred in each of the dominant group and the non-dominant group. Patients in both groups were followed up 12-34 months with an average of 22.0 months. The HSS scores at last follow-up were 87.2±4.3 in the dominant group and 86.8±5.0 in the non-dominant group. There was no significant difference between the two groups (t=0.471, P=0.639). No complications such as periprosthetic infection, prosthetic loosening, or periprosthetic fracture occurred during follow-up. There was no significant difference in the HKA, mLDFA, and mMPTA between the two groups before and after operation (P>0.05). The differences in the incidence of sagittal femoral prosthesis malposition and PDFA between the two groups were significant (P<0.05); however, there was no significant difference in the PPTA, the rate of femoral prosthesis distributed in the neutral position, the incidence of over-flexed femoral prosthesis, and the incidence of anterior femoral notch (P>0.05).ConclusionThe surgeon’s handedness is one of the factors affecting the placement of the sagittal femoral prosthesis in primary TKA. The incidence of sagittal femoral prosthesis malposition could increase when the surgeon performs on the non-dominant side.
Objective To discuss the stabil ity and practical ity of temporomandibular joint replacement by establ ishing goats artificial temporomandibular joint replacement model. Methods Six healthy mature goats were selected, the male and female being half and weighing 35.3-37.0 kg. According to the parameters from X-ray films of goat’ s temporomandibular joint and the shape of the same kind goat’s skull, the total temporomandibular joint prosthesis was prepared. The one side temporomandibular joints of six goats were replaced by prosthesis randomly as the experimental group (n=6, fossa and condyle according to replacement location) and the other side by titanium plate as the control group (n=6). At 4,8, and 12 weeks, the histological observation, scanning electron microscope (SEM) observation were carried out for observing structural changes in the interface. The mechanical test and histochemistry test were used for observing the combination degree of interface and the alkal ine phosphatase (ALP) activity. Results All animals were al ive to the end of experiment with normal open mouth, good recovery of masticatory function, and normal eating. At 4, 8, and 12 weeks, implants were stable in 2 groups without loosening. The histological observation and SEM observation showed the amount of osteoblasts in interface increased over times. There were significant differences in the shearing force and the ALP activity between fossa in experimental group and control group at 4 weeks (P lt; 0.05), but there was no significant difference between other groups (P gt; 0.05). Conclusion The total temporomandibular prosthesis has good stabil ity in temporomandibular joint reconstruction of goat after replacement.
ObjectiveTo explore the feasibility of establishment of a artificial joint aseptic loosening mouse model by cobalt-chromium particles stimulation.MethodsTwenty-four 8-week-old male severe combined immunodeficient (SCID) mice were divided into experimental group (n=12) and control group (n=12). The titanium nail was inserted into the tibial medullary cavity of mouse in the two groups to simulate artificial joint prosthesis replacement. And the cobalt-chromium particles were injected into the tibial medullary cavity of mouse in experimental group. The survival of the mouse was observed after operation; the position of the titanium nail and the bone mineral density of proximal femur were observed by X-ray film, CT, and Micro-CT bone scanning; and the degree of dissolution of the bone tissue around the tibia was detected by biomechanical test and histological staining.ResultsTwo mice in experimental group died, and the rest of the mice survived until the experiment was completed. Postoperative imaging examination showed that there was no obvious displacement of titanium nails in control group, and there were new callus around the titanium nails. In experimental group, there was obvious osteolysis around the titanium nails. The bone mineral density of the proximal tibia was 91.25%±0.67%, and the maximum shear force at the tibial nail-bone interface was (5.93±0.85) N in experimental group, which were significantly lower than those in control group [102.07%±1.87% and (16.76±3.09) N] (t=5.462, P=0.041; t=3.760, P=0.046). Histological observation showed that a large number of inflammatory cells could be seen around the titanium nails in experimental group, while there was no inflammatory cells, and obvious bone tissue formation was observed in control group.ConclusionThe artificial joint aseptic loosening mouse model can be successfully established by cobalt-chromium particles stimulation.
Objective To summarize the early results and clinical experience of using the J-Valve for transcatheter valve-in-valve implantation in patients with degenerated bioprosthesis at different anatomic positions. Methods A retrospective analysis was conducted to evaluate the short-term outcomes of 39 consecutive patients who underwent transcatheter valve-in-valve implantation using the J-Valve System in the Department of Cardiac Surgery of Guangdong Provincial People’s Hospital from April 2020 to August 2021 due to bioprosthetic degeneration at different anatomic positions. Among them, 35 patients underwent transcatheter mitral valve-in-valve (TMViV) implantation, 1 transcatheter aortic valve-in-valve (TAViV) implantation, 1 transcatheter tricuspid valve-in-valve (TTViV) implantation, 1 TMViV implantation with simultaneous TAViV implantation, and another one TMViV implantation with simultaneous transcatheter aortic valve replacement (TAVR) and perivalvular leakage (PVL) closure. Results Among the 35 patients who underwent isolated TMViV implantation, 17 were male and 18 were female with a mean age of 72.6±10.8 years. Mean duration between two operations was 10.5±2.7 years. The mean Society of Thoracic Surgeons and EuroSCORE Ⅱ scores were 12.95%±9.61% and 13.91%±8.94%, respectively. The device success rate was 97.1% and no death occured during the operation. One patient was transferred to thoracotomy due to device displacement, 1 was re-opened for uncontrolled bleeding, and 1 presented left ventricular outflow tract obstruction. One patient underwent craniotomy due to intracranial hemorrhage within 30 days after surgery, and no other complications occurred including death, stroke, permanent pacemaker implantation, cardiac tamponade, or re-hospitalization. The mean follow-up time was 6.0±4.4 months, the mean mitral valve gradient was significantly improved (10.4±2.0 mm Hg vs. 5.5±1.2 mm Hg, P<0.05), and the New York Heart Association class≤Ⅱ in all the patients at the last follow-up. Among the other 4 patients who did not undergo isolated TMViV implantation, the transapical TAViV implantation and the trans-right atrium TTViV implantation were successful without intra- or post-operative complications. The patient who underwent TMViV and TAViV implantation simultaneously via transapical approach died of severe pulmonary hemorrhage and multiple organ failure 16 days after surgery. The other patient who underwent transapical TMViV combined with TAVR and PVL closure died of septic shock 10 days after the surgery. Conclusion Transcatheter valve-in-valve implantation using the J-Valve system is shown to be a safe and effective procedure to treat mitral, aortic and tricuspid bioprosthetic valve dysfunction in high-risk patients, providing a new alternative to surgical surgery for degenerated bioprosthesis at different anatomic positions. However, simultaneous different valves intervention should be very cautious.
The heart valve prosthesis must have excellent hydrodynamic performance which is usually tested in vitro, not in vivo. This paper comprehensively introduced the principles and methods of hydrodynamic performance in vitro testing, helping clinicians to understand valve performance parameters, evaluate valve applicability, and reduce clinical risk of the valve prosthesis. In vitro testing not only serves as the "gold standard" for valve prosthesis assessment, but also provides detailed data for design and optimization of the prosthesis. ISO 5840 defines the items and methods for valve in vitro testing, which consists of three parts: (1) pulsatile flow testing, which reproduces the pulsating flow of the valve prosthesis after implantation in the human body; (2) steady flow testing, which assesses valve forward flow resistance; (3) durability testing, which evaluates the durability of the valve prosthesis and determines the expected failure mode. In addition, the paper presented the differences between atrioventricular and aortic valve testing, the method of mitral valve testing, the differences between transcatheter and surgical valve testing, and the method of valve flow visualization.
In recent years, the field of cardiovascular surgery has undergone revolutionary changes and made rapid progress in various aspects, bringing more hope and possibilities for the health and well-being of patients. The constant emergence of new technologies brings new opportunities and hope, as well as constant challenges to past concepts. This article aims to provide a comprehensive overview of the latest developments in cardiovascular surgery in recent years, especially since 2023. It introduces cutting-edge knowledge and technologies in the field of cardiovascular surgery, including lifelong management of aortic valve disease, artificial valves, mitral valves, treatment options for hypertrophic obstructive cardiomyopathy, heart transplantation, left ventricular assist, coronary artery surgery, cardiac structural interventions for chronic heart failure, aortic dissection, and comprehensive surgical treatment of atrial fibrillation. It also analyzes and explores future development directions in depth, aiming to provide useful references and inspiration for cardiovascular doctors and jointly promote the continuous progress of cardiovascular surgery in China.