Objective To investigate the effectiveness of MAKO robotic-arm assisted total hip arthroplasty (THA) via direct anterior approach (DAA) for bony fused hips in ankylosing spondylitis (AS). Methods Between June 2021 and January 2022, MAKO robotic-arm assisted THA via DAA was applied to treat 10 cases (12 hips) of AS with bony fused hips. There were 7 males and 3 females; the age ranged from 30 to 71 years, with an average age of 42.4 years. The duration of AS was 12-35 years, with an average of 21.4 years. The preoperative hip was ankylosed in flexion in 3 cases, with a flexion angle of 20°, 30°, 35°, respectively; 9 cases were ankylosed in extension. The operation time and complications were recorded; the visual analogue scale (VAS) score, Harris score, and Oxford hip scale (OHS) score before and after operation, and postoperative range of motion (flexion, extension, internal rotation, external rotation, adduction, and abduction) were used to evaluate the recovery of joint function; according to the postoperative anteroposterior X-ray film and CT scan of both hip joints, the abduction angle, anteversion angle, the difference between bilateral combined off-set and the lower limb length discrepancy were measured. Results The operation time ranged from 80 to 190 minutes (mean, 134.6 minutes). All 10 patients were followed up 5-11 months (mean, 7.4 months). There was no serious adverse events such as incision infection, deep vein thrombosis of lower extremities, hip redislocation, aseptic loosening of the prosthesis, or death. At 5 months after operation, the acetabular prosthesis angle of abduction was 37°-45° (mean, 40.3°), anteversion angle was 9°-20° (mean, 15.8°). The difference between bilateral combined off-set was 0-10 mm (mean, 4.3 mm); the lower limb length discrepancy was 0-12 mm (mean, 3.5 mm). At last follow-up, the average range of motion of the hip joint was 89.2° in flexion (range, 80°-100°), 1.7° in extension (range, –5°-10°), 7.1° in internal rotation (range, 0°-15°), 20.4° in external rotation (range, 10°-30°), 7.9° in adduction (range, 0°-20°), and 16.5° in abduction (range, 10°-25°). At last follow-up, the VAS score, Harris score, and OHS score significantly improved when compared with those before operation (P<0.05). ConclusionThe MAKO robotic-arm assisted THA via DAA can achieve satisfactory results in the treatment of AS with bony fused hip, which has the advantages of accurate prosthesis installation, soft tissue release, and less trauma during operation.
Objective To investigate the effectiveness and technical points of posterior open approach combined with suture bridge technique for the treatment of tibial insertion avulsion fractures of posterior cruciate ligament (PCL). Methods A retrospective analysis was conducted on 21 patients with PCL tibial insertion avulsion fractures who underwent posterior open approach combined with suture bridge technique between July 2023 and July 2025. There were 14 males and 7 females, aged 11-68 years (mean, 48.3 years). Fracture displacement ranged from 3.9 to 13.7 mm, with an average of 7.9 mm. Preoperative Lysholm score was 46.1±3.9, International Knee Documentation Committee (IKDC) subjective score was 44.8±4.1, and posterior knee laxity was (4.1±0.5) mm. The time from injury to surgery ranged from 1 to 30 days, with an average of 9.4 days. The operation time and intraoperative blood loss were recorded. Knee function was assessed using Lysholm score and IKDC subjective score. Posterior knee laxity was measured bilaterally using a KT-2000 arthrometer, and the results were expressed as the side-to-side difference. Results All surgeries were successfully completed. The operation time ranged from 40 to 130 minutes (mean, 80.2 minutes), and intraoperative blood loss ranged from 7 to 20 mL (mean, 10.4 mL). All incisions healed by first intention without early complication such as surgery-related infection or neurovascular injury. All 21 patients were followed up 12-20 months, with a mean of 18.3 months. Radiographic examination showed anatomical reduction and bony union in all fractures, with healing time ranging from 8 to 14 weeks (mean, 11.5 weeks). During follow-up, no reduction loss, implant loosening or breakage was observed. At last follow-up, the Lysholm score was 90.3±3.1, IKDC subjective score was 91.0±3.1, and posterior knee laxity was (1.6±0.4) mm, all showing significant differences compared with preoperative values (P<0.05). ConclusionThe posterior open approach combined with suture bridge technique for PCL tibial insertion avulsion fractures offers the dual advantages of reliable reduction under direct vision and robust fixation with suture bridge, demonstrating safety and efficacy. It is particularly suitable for complex cases such as comminuted fractures, old fractures, or those complicated by posterior neurovascular injury.
ObjectiveTo explore the clinical feasibility and effect of minimally invasive treatment of accidentally sutured surgical drains after arthroplasty with orthopedic broken screw hollow saw, in order to provide a safe and convenient solution for clinical practice. Methods Between January 2016 and October 2023, the clinical data of 5 patients with accidentally sutured surgical drains after orthopedic joint replacement were retrospectively analyzed. There were 4 males and 1 female with an average age of 69.6 years ranging from 65 to 75 years. The hollow saw for broken screws in the orthopedic tool kit for broken screws was used to closely follow the drainage tube wall to the suture site for precise cutting operation without additional self-made tools or enlarged incision. By measuring the length of the extracted drainage tube and cross-checking it with the original record, while simultaneously examining the tube’s integrity to confirm the absence of any residue. Results The drainage tubes were successfully removed in 5 patients, and the removal process took 3-8 minutes, with an average of 5.4 minutes (excluding the time of instrument preparation and disinfection). After removal, all the drainage tubes were complete in shape, the measured length was completely consistent with the intraoperative depth record, and no fracture or residue was confirmed; no high-density foreign body shadow was found in the postoperative X-ray examination. There was no exudation or incision dehiscence after operation. All patients were followed up 24 months, and there was no sign of joint dysfunction, chronic pain or infection, and no complications related to delayed foreign body residues. ConclusionThe application of orthopedic broken screw hollow saw in the treatment of accidentally sutured surgical drains after orthopedic joint replacement has the advantages of simple operation, minimally invasive, short time-consuming, high success rate and no need for self-made tools.