Influence of the femoral head size on early postoperative gait restoration after total hip arthroplasty

Background We investigated the effects of using large-diameter femoral heads in total hip prostheses on eady postoperative gait restoration in patients undergoing total hip arthroplasty (THA). Methods We collected data for 19 primary THAs using 28-mm metal-on-polyethylene heads (conventional group) and for 12 THAs (BHR group) using metal-on-metal femoral heads with an average size of 45 mm (range, 40-49 mm). All patients had unilateral femoral head avascular necrosis. All patients underwent Harris Hip Scores evaluation and gait analysis with the IDEEA device at the same 3 time points which were before surgery and then at 1 month and again at 3 months after surgery, and the parameters measured were walking speed, stride length (SL), single limb support (SLS), cycle duration (CD), and swing power (SP). Harris Hip Scores and gait analysis parameters for both groups were compared.Results Intraclass comparison indicated that Harris Hip Scores, speed scores, and gait parameter measures in both groups improved significantly with the passage of time; Interclass comparison showed no significance between Harris1m postop - Harrispreop and Harris3m postop- Harrispreop in both groups. The speed in the BHR group at 1 month and at 3 months after surgery was significantly higher than that of conventional group. At 1 month after surgery, each mean for SLnormal-SLaffected, (SLSnormal - SLSaffected)/CD, and SPnormal - SPaffocted in the BHR group was significantly lower than that for the conventional group. At 3 months after surgery, the differences between means for both groups for SLnormal - SLaffected.(SLSnormal- SLSaffected)/CD, and SPnormal - SPaffected were not significant, but the mean of SPnormal - SPaffected in the BHR group was significantly lower than that in the conventional group.Conclusions Our data suggest that large-diameter femoral heads in THA provide better early gait restoration than conventional-size femoral heads.     

多种工作模式的踝关节活动器的研制

各种原因导致患者长期卧床后将引起严重的并发症:踝关节跖屈畸形。新型踝关节活动器以大扭矩、超低速电机为动力,结合定时控制电路,具有多种工作模式,能使踝关节在被动的情况下背伸20～30°,跖屈40～50°,并能根据患者的个体情况设置不同的运用角度与时间,且能根据需要进行缓慢、连续、往返式运动,这对那些踝关节不能或较难进行主动活动的病人防止踝关节跖屈畸形、踝关节僵硬的及下肢肌肉萎缩有良好的作用。     

血府逐瘀汤治疗髋关节置换术后非感染性发热

[目的]探讨髋关节置换术后非感染性发热的防治。[方法]应用血府逐瘀汤加减辨证论治。[结果]43例患者体温恢复正常,其中36例在3天内体温恢复正常。[结论]该方法对髋关节置换术后非感染性发热有较好作用。     

应用锁骨钩钢板治疗Tossy Ⅲ型肩锁关节脱位

目的探讨锁骨钩钢板治疗TossyⅢ型肩锁关节脱位的临床疗效。方法我们对2003年2月～2007年1月间52例TossyⅢ型肩锁关节脱位的患者均采用锁骨钩钢板复位内固定治疗。所有患者均未进行喙锁韧带缝合修复,但缝合损伤的肩锁关节囊及韧带和三角肌、斜方肌附丽。6～9个月后取出内固定。按Lazzcano法评定肩关节功能。结果52例患者得到随访,随访9～12个月,平均10个月。肩关节功能,取内固定前:优40例,良10例,差2例,优良率96%;取内固定后:优45例,良7例,差0例,优良率100%。肩关节功能取内固定前为良或差的病例在取出内固定后均有不同程度的改善。无切口感染、内固定松脱或断裂及再脱位等并发症。结论锁骨钩钢板是治疗TossyⅢ型肩锁关节脱位的最好治疗方法,具有操作简单,手术时间短,创伤小,可保证百分百复位,固定可靠,符合肩锁关节的生物力学要求,术后可早期功能锻炼,功能恢复好等特点。     

Catastrophic Periprosthetic Osteolysis in Total Hip Arthroplasty at 20 Years: A Case Report and Literature Review

BackgroundPeriprosthetic osteolysis is a serious complication following total hip arthroplasty (THA). However, most orthopedic surgeons only focus on bone loss and hip reconstruction. Thus, it was required to understand the treatment algorithm for periprosthetic osteolysis integrally.Case PresentationA 52‐year‐old Asian male presented with chronic hip pain. A mass appeared on the medial side of the proximal left thigh at more than 20 years after bilateral THA. Radiographs revealed catastrophic periprosthetic osteolysis, especially on the acetabular side. Large amounts of necrotic tissue and bloody fluids were thoroughly debrided during revision THA. A modular hemipelvic prosthesis was used for revision of the left hip. Four years later, the patient presented with right hip pain, where a mass appeared on the medial side of the proximal right thigh. A primary acetabular implant with augment was used for revision of the right hip. Laboratory evaluation of bloody fluid retrieved from surgery revealed elevated levels of inflammatory markers.ConclusionInflammatory responses to polyethylene wear debris can lead to severe bone resorption and aseptic loosening in the long‐term following THA. Therefore, in spite of revision THA, interrupting the cascade inflammatory might be the treatment principle for periprosthetic osteolysis.     

颞下颌关节软骨下骨改建

颞下颌关节改建机制是正畸功能矫形和颞下颌关节紊乱病研究的主要内容。随着研究的深入,软骨下骨作为一个生物力学和生理学特性均有别于关节软骨和骨松质的基本功能单位,其在压力传递和关节改建中的重要性逐步凸现出来。本文就软骨下骨的解剖、功能、特性、病变类型以及与颞下颌关节改建的关系作一综述。     

Three-Dimensional Evaluation of Innominate Bone Rotation in Female Patients with Developmental Dysplasia of the Hip

BackgroundPatients with developmental dysplasia of the hip (DDH) are known to have abnormal pelvic morphologies; however, rotation of innominate bone features remains unclear. Thus, we investigated innominate bone rotation in patients with DDH by measuring the associated angles and distances using three-dimensional (3D) computed tomography.MethodsWe defined four straight lines in pelvic 3D models: from the anterior superior iliac spine to the posterior superior iliac spine, from the anterior inferior iliac spine to the posterior inferior iliac spine, from the pubic tubercle to the ischial spine, and from the pubic tubercle to the ischial tuberosity. Similarly, we measured the angles formed by these lines using the vertical axis of the anterior pelvic plane on the horizontal plane and the horizontal axis on the sagittal plane. Additionally, we measured the distances between the femoral head centers and the acetabular centers in the coronal plane.ResultsThe difference in internal rotation angle between the superior and inferior parts of the iliac bone was significantly lower, by approximately 1.7°, in the DDH group than in the control group (p = 0.007); the difference between the inferior and superior parts of the ischiopubic bone was significantly higher, by approximately 1.5°, in the DDH group (p < 0.001). In the sagittal plane, the sum of the superior aspect of the iliac bone and the inferior aspect of the ischium was significantly lower in the DDH group (p = 0.001) than in the control group. The distances between the femoral heads and the acetabula were significantly greater in the DDH group than in the control group (p = 0.03, p < 0.01, respectively).ConclusionsPatients with DDH had a more internally rotated ilium and ischiopubic bone than normal individuals; however, it should be emphasized that internal rotation was reduced near the acetabulum, and the acetabulum was shifted laterally. Similarly, it was shown that patients with DDH had different rotations of the ilium and ischiopubic bone in the sagittal plane.     

成人下颌偏斜患者颞下颌关节形态及位置的变化

目的：研究下颌偏斜患者颞下颌关节形态及其位置的变化.方法：对21例下颌偏斜患者和20例个别理想[牙合]志愿者拍摄颞下颌关节中位断层片,选择描述髁突位置及髁突和关节窝形态的15个指标进行测量及统计分析.结果：下颌偏斜患者双侧关节结节高度、关节窝指数增大,髁突后斜面与水平基准线的夹角减小;偏斜侧的关节前间隙、关节前后间隙面积比,髁突高度、髁突上部高度减小;对侧的关节上间隙、髁突高度、髁突上部高度、髁突前斜面与水平基准线的夹角、关节窝后斜面与水平基准线的夹角增大.结论：下颌偏斜患者的双侧髁突和关节窝形态及髁突在关节窝中的位置都发生了改变,尤其以非偏斜侧髁突变化较为明显.     

Rapid and Severe Idiopathic Aseptic Necrosis of the Contralateral Femoral Head after Unilateral Total Hip Arthroplasty

BackgroundOsteonecrosis of the femoral head (ONFH) is a multifactorial disease, and agnogenic ONFH, otherwise known as idiopathic ONFH, is rare in clinic. Idiopathic ONFH that exhibits severe necrosis and progresses extremely rapidly is called rapidly destructive hip disease (RDHD). RDHD greatly affects patients but is rarely reported in clinical practice and literature.Case PresentationIn this study, a 64‐year‐old male patient with complete collapse and necrosis of the right femoral head complicated with severe bone destruction at 10 months after left total hip arthroplasty (THA) was reported. The period from the intact structure of the right femoral head to the first discovery of its complete collapse, according to imaging results, was 7 months. The duration from the occurrence of symptoms in the right hip joint to the first discovery of complete collapse and necrosis of the femoral head was only 5 months. At present, the cause has not been determined based on medical history, symptoms, signs, imaging evaluation results, laboratory examination results, and pathological examination results, though it has been identified as severe idiopathic aseptic necrosis of the femoral head with rapid progression, or RDHD. Finally, right THA was performed, and a good outcome was observed in the patient at present.ConclusionsAs a rare hip joint disease, RDHD greatly influences the normal life of patients. RDHD of the contralateral side after unilateral THA is even scarcer. Left THA may be one of the important factors accelerating the necrosis of the right femoral head. Hopefully, with this case report, more attention will be paid to the contralateral hip joint in patients undergoing unilateral THA by clinicians and rehabilitation physicians, and a clinical reference will be provided for the research on RDHD.     

Surgical Management for Chronic Destructive Septic Hip Arthritis: Debridement,Antibiotics, and Single‐Stage Replacement is as Effective as Two‐Stage Arthroplasty

ObjectiveTo compare the surgical outcomes of debridement, antibiotics, and single‐stage total hip replacement (DASR) vs two‐stage arthroplasty (two‐stage arthroplasty) for chronic destructive septic hip arthritis (SHA).MethodsCases of chronic destructive SHA treated by DASR or two‐stage arthroplasty in our department from January 2008 to October 2021 were retrospectively reviewed. Patient demographic information, perioperative inflammation markers, intraoperative blood loss, microbial culture, and metagenomic new generation sequencing results were recorded. The perioperative complications, hospital stay, hospitalization cost, infection recurrence rate, and Harris Hip Score (HHS) at the last follow‐up were compared between the two groups.ResultsA total of 28 patients were included in the study, including 11 patients who received DASR and 17 patients who received two‐stage arthroplasty. There was no significant difference in demographic information, preoperative serum inflammatory markers, synovial fluid white blood cell count, or percentage of polymorphonuclear leukocytes between the two groups. The DASR group demonstrated significantly lower intraoperative blood loss [(368.2 ± 253.3) mL vs (638.2 ± 170.0) mL, p = 0.002], hospital stay [(22.6 ± 8.1) days vs (43.5 ± 13.2) days, p < 0.0001], and hospitalization expenses [(81,269 ± 11,496) RMB vs (137,524 ± 25,516) RMB, p < 0.0001] than the two‐stage arthroplasty group. In the DASR group, one patient had dislocation as a complication. There were no cases with recurrence of infection. In the two‐stage arthroplasty group, there was one case complicated with spacer fracture, one case with spacer dislocation, and one case with deep vein thrombosis of the lower limbs. There were no cases with recurrence of infection. There were no significant differences in the readmission rate, complication rate, or HHS at the last follow‐up between the two groups.ConclusionsBoth DASR and two‐stage arthroplasty achieved a satisfactory infection cure rate and functional recovery for chronic destructive SHA, and DASR demonstrated significantly lower intraoperative blood loss, hospital stay, and hospitalization costs than two‐stage arthroplasty. For appropriately indicated patients, if microbial data are available and a standardized debridement protocol is strictly followed, DASR can be a treatment option.