Objective To summarize the surgical technique and the effectiveness of Becker V-shaped lateral rotation osteotomy in total hip arthroplasty (THA) for Crowe type IV development dislocation of the hip (DDH). Methods Between January 2000 and December 2009, 18 patients (22 hips) with Crowe type IV DDH underwent THA. There were 3 males and 15 females with an average age of 54 years (range, 41-75 years). The unilateral hip was involved in 14 cases and bilateral hips in 4 cases. All patients had over anteversion of the femoral neck, with the acetabular anteversion angle of (21.28 ± 4.87)°, the femoral neck anteversion angle of (59.06 ± 1.44)°, and combined anteversion angle of (80.33 ± 1.55)°. All the patients had limb-length discrepancy, ranged from 1.0 to 3.5 cm (mean, 2.5 cm). Before operation, gluteus medius muscle strength was grade 2 in 17 hips and grade 3 in 5 hips; severe or moderate claudication was observed in 13 and 5 patients, respectively. Trendelenburg sign was positive in all patients. Preoperative Harris score was 30.00 ± 6.32. Cementless prosthesis was used. Becker V-shaped lateral rotation osteotomy and subtrochanteric shortening with overlapping femoral resection were performed, and proximal femoral shaft splitting was performed on 21 hips having narrow bone marrow cavity. Results All the cases achieved primary healing of incision. No complication of anterior dislocation, deep infection, nerve traction injury, or femoral uncontrolled fracture occurred. All the cases were followed up 3-12 years (mean, 8 years). Postoperative X-ray films showed that the initial fixation result of femoral prosthesis was excellent in 18 hips and good in 4 hips. Bone healing of osteotomy stump was obtained at 3-6 months (mean, 5 months) after operation. Affected limb prolonged for 2.5-3.5 cm (mean, 3.0 cm ) at 1 year after operation; limb-length discrepancy was 0.5-1.5 cm (mean, 1.0 cm). The gluteus medius muscle strength was restored to grade 4 in 5 hips and grade 5 in 17 hips. At last follow-up, 13 patients had no claudication, and 5 patients had mild claudication; Trendelenburg sign was negative in 15 cases and was positive in 3 cases; the Harris score was significantly improved to 91.89 ± 3.22; all showing significant difference when compared with preoperative ones (P lt; 0.05). At last follow-up, the acetabular anteversion angle, the femoral neck anteversion angle, and combined anteversion angle were (19.33 ± 4.49), (13.33 ± 5.70), and (32.67 ± 5.35)°, respectively, all showing significant differences when compared with preoperative ones (P lt; 0.05). No aseptic loosening, osteolysis, or rediolucent line was found around the femoral component. No implant subsidence, stem varus, or revision occurred. Conclusion Becker V-shaped lateral rotation osteotomy is a safe and predictable method to treat type Crowe type IV DDH.
Objective To improve the accuracy of the acetabular component placement using the nonimage based surgical navigation system. Methods Twenty-three patients (14 males, 9 females; age, 28-55 years;26 hips）with hip disease underwent the total hip arthroplasty (THA) using the nonimage based surgicalnavigation system from February 2004 to April 2006. Rheumatoid arthritis was found in 3 patients (3 hips), necrosis of the femoral head in 6 patients (6 hips), and osteoarthritis in 14 patients (16 hips). All the patients were randomly divided into the following 2 groups: the navigated group (11 patients, 13 hips), treated by THA using the nonimage based surgical navigation system; and the control group (12 patients, 13 hips), treated by the traditional THA. According to thedesign of the study, the acetabular component was placed in the best inclination angle (45°) and the anteversion angle (15°). The postoperative component position was examined. Results No fracture, dislocation, infection or injury to the sciatic nerve was found. In the navigated group, the inclination and the anteversion reached 15.4±1.4° and 45.5±1.3°, respectively. In the control group,the inclination and the anteversion were 13.9±7.6° and 43.7±6.4°, respectively. The inclination difference was considered statistically significant (Plt;0.01). All the patients were followed up for 10-40 months,averaged 26 months. In the navigated group, the postoperative average Harris hip score was 95 (range,85-110), with an excellent result in 11 hips and a good result in 2 hips. In the control group, the postoperative average Harris hip score was 92 (range,75-110), with an excellent result in 9 hips, a good result in 3 hips, and a fair result in 1 hip. The Harris hip score difference was considered statistically significant (Plt;0.05). There was a significantly better result obtained in the navigated group than in the control group. Conclusion The acetabular component can be implanted accurately by the nonimage based surgical navigation system, which can reduce the incidence of the loosening of the prostheses and has an important value in clinical practice.
ObjectiveTo evaluate mid-term results of total hip arthroplasty (THA) for treatment of osteoarthritis secondary to hip sepsis. MethodsBetween February 2003 and January 2009, 62 patients (62 hips) with osteoarthritis secondary to hip sepsis underwent THA. There were 32 males and 30 females with an average age of 39.9 years (range, 18-67 years). The original infection included pyogenic arthritis in 40 hips and tuberculosis in 22 hips. After infection, 35 patients underwent non-operative treatment, and 27 patients received operative management. The average time interval between initial infection and THA was 28.7 years (range, 12-53 years). The preoperative Harris hip score was 24.6±9.2. The Trendelenburg sign was positive in all hips. Leg discrepancy was observed in 25 cases, and the mean discrepancy of bilateral lower extremities was 3.8 cm (range, 2.6-6.5 cm) preoperatively. All hips had no evidence of active hip sepsis. ResultsAll patients were followed up 72 months on average (range, 54-115 months). Intraoperative complications included sciatic nerve injury (2 cases) and femoral shaft fractures (2 cases); postoperative complications included hip anterior dislocation (1 case) and periprosthetic infection (1 case). At last follow-up, 1 hip, 5 hips, 18 hips, and 38 hips were found to have severe pain, moderate pain, slight pain, and no pain respectively. Claudication occurred in 30 patients (mild in 19, moderate in 8, and severe in 3). The Trendelenburg sign was positive in 18 hips. After THA, only 5 patients had a leg length discrepancy of 2.9 cm on average (range, 2.6-3.5 cm). The Harris score was significantly increased to 82.3±11.4 at last follow-up when compared with preoperative one (t=-31.241, P=0.000). The results of subjective satisfaction were very satisfactory in 43 cases, satisfactory in 12 cases, unsatisfactory in 4 cases, and unsatisfactory at all in 3 cases. No sign of aseptic loosening of prosthesis was found during follow-up period. Roentgenographic results showed no radiolucent line or osteolysis in the other patients except 2 patients having local radiolucent. After THA, 12 hips had heterotopic ossification. ConclusionThe mid-term clinical and radiographic results of THA for treatment of osteoarthritis secondary to hip sepsis are good, with the advantages of high satisfactory rate, good function recovery, and low complication incidence.
Objective To evaluate the strength of polyethylene l inercement interface when cementing a new linerinto a fixed acetabular cup in revision. Methods Twenty-five pairs of metal acetabular cups with polyethylene l iners were randomly divided into 5 groups: 1 group with standard locking device as control group (group A), other l iners were cemented into acetabular cups as 4 experimental groups. According to different intersection angles of metal acetabular cups with polyethylene liners and the polyethylene l iners with or without metal ball, the 4 experimental groups were no ball 0° group (group B), 0° group (group C), 10° group (group D), and 20° group (group E), metal acetabular cups intersected with polyethylene liners without metal ball in group B, with metal ball in groups C, D, and E, respectively. The lever-out biomechanical test reproduced in vivo failure mechanism was then performed to evaluate the lever-out failure strength of l iner-cement-metalcup interface. Results The values of l iver-out failure force were (626.68 ± 206.12), (915.04 ± 197.49), (449.02 ± 119.78),(814.68 ± 53.89), and (1 033.05 ± 226.44) N in groups A, B, C, D, and E, respectively, showing significant differences forcomparison among groups (F=8.989，P=0.000). The values of l iver-out failure force in groups B and E were significantlyhigher than that in group A (P lt; 0.05), but no significant difference was found between groups C, D and group A (P gt; 0.05).Conclusion Cementation of polyethylene l iner into a malposition shell meeting within 20° can provide enough fixed strength.
The basic stress pathway above the acetabular dome is important for the maintenance of implant stability in acetabular reconstruction of total hip arthroplasty (THA). The purpose of this study was to describe the basic stress pathway to provide evidence for clinical acetabular reconstruction guidance of THA. A subject-specific finite element (FE) model was developed from CT data to generate 3 normal hip models and a convergence study was conducted to determine the number of pelvic trabecular bone material properties using 5 material assignment plans. In addition, in the range of 0 to 20 mm above the acetabular dome, the models were sectioned and the stress pathway was defined as two parts, i.e. 3D trabecular bone stress distribution and quantified cortical bone stress level. The results showed that using 100 materials to define the material property of pelvic trabecular bone could assure both the accuracy and efficiency of the FE model. Under the same body weight condition, the 3D trabecular bone stress distributions above the acetabular dome were consistent, and especially the quantified cortical bone stress levels were all above 20 MPa and showed no statistically significant difference (P>0.05). Therefore, defining the basic stress pathway above the acetabular dome under certain body weight condition contributes to design accurate preoperative plan for acetabular reconstruction, thus helping restore the normal hip biomechanics and preserve the stability of the implants.
Objective To systematically review the clinical efficiency and safety after topical administration of tranexamic acid in total hip arthroplasty. Methods Relevant randomized controlled trials were identified from databases such as Cochrane Library, PubMed, Embase and CNKI from the establishment of the database to August, 2017. A systematic review was performed to compare total blood loss, the rate of transfusion and thromboembolism events between the tranexamic acid group and the control group. And the patients in tranexamic acid group were treated with tranexamic acid for hemorrhage after total hip arthroplasty, while the patients in the control group were not treated with tranexamic acid or used isotonic saline. Analysis was carried out using Review Manager version 5.2.0 software. Results Eight studies were incorporated into the Meta-analysis. The results of Meta-analysis showed that there was significant difference in total blood loss between two groups [weighted mean difference (WMD)=–360.27 mL, 95% confidence interval (CI) (–412.68, –307.87) mL, P<0.000 01]. There was significant difference in the rate of transfusion between two groups [ (odds ratio,OR)=0.22, 95%CI (0.14, 0.33), P<0.000 01]. There was no significant difference in complications between two groups [OR=1.48, 95%CI (0.41, 5.34), P=0.55]. Conclusion Topical administration of tranexamic acid could significantly reduce total blood loss and transfusion requirements in primary total hip arthroplasty, and would not increase thromboembolic complications.
ObjectiveTo compare the effectiveness of three different fixation methods after subtrochanteric shortening osteotomy (SSO) in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods A clinical data of 63 patients (78 hips) with Crowe type Ⅳ DDH, who underwent THA with SSO between November 2014 and May 2019, was retrospectively analyzed. Among them, 18 patients (20 hips) obtained stability by intramedullary pressure provided by the S-ROM modular prostheses (group A); 22 patients (30 hips) underwent prophylactic binding by stainless steel wire after osteotomy and before stem implantation (group B); 23 patients (28 hips) were fixed with autogenous cortical strut grafts and stainless steel wire or cables (group C). There was no significant difference in gender, age, body mass index, affected limb side, and preoperative Harris score between groups (P>0.05). The operation time, complications, imaging results, hip functional score of the three groups were recorded and compared. Results There was no significant difference in the operation time between groups (P>0.05). All incisions healed by first intention. All patients were followed up, and the follow-up time was 2.5-4.0 years (mean, 3.1 years) in group A, 1.5-5.5 years (mean, 3.2 years) in group B, and 1.0-5.0 years (mean, 1.6 years) in group C. There was no significant difference in Harris score or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between groups at 4 and 12 months after operation (P>0.05). X-ray films showed that there was no significant difference in osteotomy healing rate at 4, 8, and 12 months after operation and the osteotomy healing time between groups (P>0.05). There was no complications such as joint dislocation, prosthesis loosening, prosthetic joint infection, or heterotopic ossification during follow-up, except for the distal femoral fracture of 1 hip during operation in group B. Conclusion In THA for patients with Crowe type Ⅳ DDH, the stainless steel wire binding alone and autogenous cortical strut grafts combined with stainless steel wire or cable binding can not significantly promote the osteotomy healing compared with femoral prosthesis intramedullary compression fixation. For patients with nonmatched medullary cavity after SSO, it is recommended to apply autogenous cortical strut grafts with wire or cables for additional fixation.
Objective To evaluate the effect of reconstruction withautograft implantation in total hip arthroplasty(THA) with regional acetabular deficiency. Methods From 1991 to 2000, 39 cases of THA with acetabular deficiency were conducted. Autogenous bone implantation was used to reconstruct the deficient acetabulum. Of the 39 patients, 25 were males and 14 were females. The age ranged from 34 to 62(45.2 on average). There were21 cases of developmental dysplasia resulted deficiency, 14 cases of fracture of femoral neck complicated with head necrosis(10 hips) and fracture of acetabulum(4 hips). The resected femoral heads or autologous ilium were made the wedgeshaped graft and implanted into the deficient acetabulum, which included 12 cases with cement THA and 27 with cementless THA.Of all the cases, 24 were followed up 2 to 10 years(6.7 years on average). Harris scores before operation were 18 to 50(38.1 on average). Results The limbs were lengthened by 2.4 cm on average. No serious complications were observed in these patients. Comparedwith the scores before the operation, the average Harris scores after the operation were 92.1(Plt;0.01)and 86.3(Plt;0.05) in the one-year and the latest follow-up respectively. The rates for the good were 91.7% and 83.3% in the one-year and the latest follow-up respectively.Conclusion The acetabular reconstruction with autograft in THA will bring better stability in those patients with acetabular deficiency. It is of significance in maintaining a long-term function in the replaced hip.
Objective To explore the effect of minimally invasive and mini-incision surgery (MIS) in total hip arthroplasty (THA) on late osteonecrosis of femoral head (ONFH). Methods From March 2003, Eighteen patients (22 hips) with ONFH underwent MIS in THA. Their ages ranged from 24to 57 years, including 13 males and 5 females. The mean body mass index ranged from 17.1 to 30.1(24.6 on average). The Harris hip score was 46 points before operation. Modified posterior-lateral approach was adopted, and the MIS THA was performed by cementless prosthesis. As a comparison, 18 patients (22 hips) were performed by conventional THA at the same period. The data, including bleeding volume during operation, incision length, operative time, and postoperative function recovery, were compared. Results Follow-ups were done for 6 to 20 months (11 months on average). Dislocation occurred in one patient that underwent conventional THA 2 days after operation. No complication occurred in MIS THA group. The incision lengths ranged from 8.7 to 10.5 cm (9.3 cm on average) in MIS THA group, being statistically different (Plt;0.01). There was no significant difference in Harris scoring of the function between the two groups both before the operation and after the operation (Pgt;0.05). The operative time was almost the same, but the bleeding volume in MIS THA group was less (Plt;0.05). The function recovery was faster in MIS THA group.Conclusion The MIS THA is an alternative to the treatment of late ONFH. The advantages of MIS THA are fewer trauma, less bleeding volume, and faster recovery. The MIS THA should be performed by surgeons with rich experiences in THA and hospitals with necessary instruments.
Objective To investigate the effectiveness of subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip (DDH). Methods Between January 2004 and December 2010, 37 patients (44 hips) with Crowe type IV DDH underwent subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty with cementless prosthesis. There were 15 males (18 hips) and 22 females (26 hips) with an average age of 42 years (range, 24-46 years). Unilateral hip was involved in 30 cases and bilateral hips in 7 cases. Preoperative X-ray films showed complete dislocation of the femoral head and hypoplasia of the acetabulum and proximal femur. Before operation, the leg discrepancy was (5.5 ± 1.1) cm, and the Harris score was 32.1 ± 5.2. Results The mean operation time was 4.3 hours (range, 3-6 hours); the mean blood loss was 760 mL (range, 600-1 000 mL). All patients obtained primary healing of incision. The patients were followed up 1-8 years (mean, 6.7 years). Pain relief was achieved; 6 cases had mild claudication; 3 cases had femoral nerve palsy; and no stretch injury of sciatic nerve was observed. X-ray films showed that acetabular cups were in normal position. The healing time of fracture was 3-6 months (mean, 3.7 months). The leg discrepancy was (1.5 ± 1.0) cm at 1 day after operation, showing significant difference when compared with preoperative one (t=16.45, P=0.00). The Harris score was 94.3 ± 3.8 at 3 months after operation, showing significant difference when compared with preoperative score (t=59.15, P=0.00). No revision of acetabular and femoral prostheses was performed during follow-up. Conclusion Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty is a safe method of restoring the anatomic hip center in Crowe type IV DDH in adults. It can avoid reduction difficulty caused by soft tissue contracture and injuries of sciatic nerve and femoral nerve caused by limb lengthening.