Six year results of the Rebalance mobile bearing total ankle replacement

BackgroundWe report the outcomes of a prospective consecutive series of 267 total ankle replacements (TARs) using a new mobile bearing Rebalance® prosthesis.MethodsBetween April 2011 and December 2018, 267 consecutive Rebalance® prostheses were implanted in 255 patients at 3 different centers. Estimated survival curves with 95% confidence intervals were produced with the Kaplan–Meier method. 110 ankles were followed for at least 5 years and clinical and radiological outcomes were assessed in 92 of these ankles.ResultsTwenty-one ankles were revised at a mean of 34 (7–60) months. The estimated survival was 90% (95% CI 86–95) at 5 years and 88.3% (95% CI 83.–94 at 6 years. The ankles followed for at least 5 years demonstrated a median Likert score of 1 (1–4). Radiolucent zones were detected in 14% and osteolytic cysts in 3%.ConclusionThe survival rate of the Rebalance prosthesis conforms with other reports of similar designs. The satisfaction rate was high. Radiological zones and osteolytic cysts were found at a lower rate than usually reported for mobile bearing TARs. These results favour further use of this implant.     

Self-reported metal hypersensitivity in patients undergoing unicondylar knee arthroplasty

ObjectivesThere is ongoing discussion about arthroplasty surgery of patients with metal hypersensitivity. The aim of this study was to compare the functional outcomes and eosinophil counts of unicondylar knee arthroplasty (UKA) patients with and without a history of metal hypersensitivity.MethodsA retrospective review was made of the medical records of 148 extremities of 140 consecutive patients who underwent primary UKA between January 2016 and December 2017. The patients who met the inclusion criteria were screened for history of metal hypersensitivity using a questionnaire. The functional outcomes of patients and eosinophil levels were evaluated immediately before and at 6 weeks after surgery.ResultsThe mean follow-up period was 37 months (range, 18–48 months). Of the total 128 patients, 13 (10.2%) reported a history of metal hypersensitivity before the operation. There was no statistically significant difference between patients with or without a history of metal hypersensitivity in respect of the functional outcomes or eosinophil counts (p > 0.05).ConclusionsThe results of this study showed that the functional outcomes of patients who underwent UKA using a standard alloy did not change between the groups who reported having or not having a history of metal hypersensitivity. Although the study also showed that the eosinophil counts decreased after surgery compared to the preoperative counts, there was no statistical relationship between the eosinophil count and functional outcomes or metal hypersensitivity history.     

正常颞下颌关节与人工关节假体髁突的运动比较

颞下颌关节髁突的运动对于关节疾病的诊断和治疗有重要意义,髁突运动的测量方法众多,可分为有创性和无创性两大类。文章对有关正常颞下颌关节和人工关节假体髁突运动测量方面的文献进行综述,旨在为自主人工关节假体的设计提供参考。     

Assessment of trans‐aortic pressure gradient using a coronary pressure wire in patients with mechanical aortic and mitral valve prostheses

Accurate evaluation of trans‐aortic valvular pressure gradients is challenging in cases where dual mechanical aortic and mitral valve prostheses are present. Non‐invasive Doppler echocardiographic imaging has its limitations due to multiple geometric assumptions. Invasive measurement of trans‐valvular gradients with cardiac catheterization can provide further information in patients with two mechanical valves, where simultaneous pressure measurements in the left ventricle and ascending aorta must be obtained. Obtaining access to the left ventricle via the mitral valve after a trans‐septal puncture is not feasible in the case of a concomitant mechanical mitral valve, whereas left ventricular apical puncture technique is associated with high procedural risks. Retrograde crossing of a bileaflet mechanical aortic prosthesis with standard catheters is associated with the risk of catheter entrapment and acute valvular regurgitation. In these cases, the assessment of trans‐valvular gradients using a 0.014? diameter coronary pressure wire technique has been described in a few case reports. We present the case of a 76‐year‐old female with rheumatic valvular heart disease who underwent mechanical aortic and mitral valve replacement in the past. She presented with decompensated heart failure and echocardiographic findings suggestive of elevated pressure gradient across the mechanical aortic valve prosthesis. The use of a high‐fidelity 0.014? diameter coronary pressure guidewire resulted in the detection of a normal trans‐valvular pressure gradient across the mechanical aortic valve. This avoided a high‐risk third redo valve surgery in our patient. © 2017 Wiley Periodicals, Inc.     

3D打印技术在肩关节骨性关节炎全肩关节置换术中的应用研究

目的探讨3D打印技术在全肩关节置换术治疗肩关节骨性关节炎的应用价值。 方法2014年5月至2016年5月四川省人民医院骨科收治的肩关节骨关节炎患者12例,其中男4例,女8例;年龄48~81岁,平均（58.5±13.2）岁。累及侧别：左5例,右7例。其中原发性盂肱关节骨关节炎5例,肱骨头缺血性坏死继发盂肱关节骨关节炎4例,创伤性盂肱关节骨关节炎3例。术前应用3D打印技术制备患者双侧肩关节模型,在健侧模型上测定相关解剖学参数,用于假体型号的选择与置入。在患侧模型上观察病变情况,模拟手术过程。记录并与术中情况比较。比较末次随访与术前的肩关节活动度、Constant评分和视觉模拟评分（visual analogue scale,VAS）。采用SPSS 17.0软件对数据进行t检验分析。 结果12例患者均顺利完成人工全肩关节置换术手术,术中选取的假体型号、截骨平面均与模拟手术完全一致。术后影像学资料证实假体组件均按计划精确置入。12例患者术后获随访（16.0±3.8）个月,13~25个月,末次随访Constant评分和VAS与术前对比均有改善,差异具有统计学意义（P <0.05）。末次随访无神经血管损伤,无感染、假体松动,无假体肱骨头上移等严重并发症。 结论3D打印技术用于人工全肩关节置换术治疗原发性和继发性盂肱关节骨关节炎,有助于术前制定手术计划并模拟手术操作,降低手术难度,提高手术质量。