OBJECTIVE: To investigate the surgical techniques and clinical outcomes of total hip replacement for patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip. METHODS: From May 2004 to March 2008, a total of 36 total hip replacements were performed in 32 patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip. The acetabulum cup was reconstructed in the corresponding anatomical position in all cases. Cemented components were used in 16 hips, and cementless components in the other 20 hips. The mean follow-up was 31.3 months. Clinical outcomes were determined with Harris hip score. Radiographs were taken after the surgery and in every follow-up examination for further reference. RESULTS: All patients postoperatively gained a limb lengthening with an average of (3.4+/-1.3) cm. Three patients had complications, 2 had nondisplaced fractures of the proximal part of the femur,and 1 sciatic nerve palsy which disappeared after 3 months. There was no infection, dislocation and symptomatic deep vein thrombosis. Compared with preoperation, the mean Harris hip scores on the 3rd day, the 14th day after the operation and at the last follow-up were all improved significantly (all P<0.05). There was no loosening, migration, heterotopic ossification radiographically, and no revision during the follow-up. CONCLUSION Total hip replacement is an effective treatment for patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip. The key is to place the acetabulum cup in the corresponding anatomical position, and choose proper prosthesises during the surgery.
Adult ; Arthroplasty, Replacement, Hip ; adverse effects ; methods ; Female ; Hip Dislocation, Congenital ; complications ; surgery ; Humans ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Osteoarthritis ; etiology ; surgery ; Treatment Outcome

Antegrade transmalleolar drilling method is one of the options for the treatment of osteochondral lesion of talus (OLT). We present five patients who underwent tibial drilling for treatment of OLT and later developed distal tibial cystic formation induced by cartilage opening or heat necrosis during drilling. Antegrade transmalleolar drilling can be a possible option for the treatment of OLT if the lesion is not easily reachable; however, other viable treatment should be considered due to its possibility of distal tibial pathologic change.
Adult ; Ankle Joint/surgery ; Cartilage, Articular/*surgery ; Female ; Humans ; *Iatrogenic Disease ; Male ; *Musculoskeletal Diseases/etiology/surgery ; *Orthopedic Procedures/adverse effects/methods ; Talus/*surgery ; *Tibia/injuries/surgery ; Young Adult

OBJECTIVETo design transoralpharyngeal atlantoaxial reduction plate (TARP), evaluate its biomechanical performance and observe its preliminary clinical effect.

METHODSA brand-new TARP system was designed, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operation instruments. Twelve fresh occipital bone-C(3) specimen were designed for biomechanical test including range of motion (ROM) (n = 6) and screw pull-out strength (n = 12). Preliminary clinical application of TARP was reported.

RESULTSThe reduction mechanism of the TARP system was designed cleverly. TARP had equal effect with Magerl + Brooks and it was more stable than the other three clinically widely used atlantoaxial fixators: Magerl, Brooks and anterior transarticular screw fixation through C(2) vertebral body. TARP's C(1) and C(2) screws were strong enough for atlantoaxial arthrodesis and their antipull-out performance was excellent. Clinical application on irreducible atlantoaxial dislocation proved that TARP had the function of instant reduction, the operation was feasible and the operation effect was significant.

CONCLUSIONTARP's design is novel and it has excellent biomechanical performance. The operation procedure is simple and reasonable. Furthermore, instant reduction could be completed during the operation and the fixation is strong. Above all, TARP is creative and will have excellent prospect.

Adolescent ; Adult ; Atlanto-Axial Joint ; surgery ; Equipment Design ; standards ; Equipment and Supplies ; adverse effects ; standards ; Female ; Humans ; Joint Dislocations ; etiology ; surgery ; Male ; Orthopedic Procedures ; methods ; Pharynx ; surgery ; Treatment Outcome

BACKGROUND: To prevent risk of life-threatening stent thrombosis, all patients need to undergo dual antiplatelet therapy (DAPT) for at least 6 weeks to 12 months after stent implantation. If DAPT is continued during noncardiac surgery, there is a risk of severe bleeding at the surgical site. Our study was to assess the risk of bleeding in patients with continued DAPT during orthopedic surgery. METHODS: The clinical data of 78 patients with coronary heart disease who underwent orthopedic surgery from February 2006 to July 2018 were retrospectively analyzed. Prior to orthopedic surgery, DAPT was continued in 16 patients (group I), 24 patients were treated with single antiplatelet therapy (group II), and 26 patients received low-molecular-weight heparin therapy for more than 5 days after the discontinuation of all antiplatelet therapies (group III). Twelve patients were excluded, as they had undergone minimally invasive surgery such as transforaminal endoscopy and vertebroplasty. The perioperative blood loss of each patient was calculated using Nadler's formula and Gross' formula. The intraoperative bleeding volume, total volume of intraoperative bleeding in addition to postoperative drainage, and total blood loss were compared between groups. The level of significance was set at P < 0.05. RESULTS: There were no significant differences between the three groups in age, intraoperative bleeding volume, total volume of intraoperative bleeding in addition to postoperative drainage, and total perioperative blood loss calculated by Nadler's formula and Gross' formula (all P > 0.05). Six patients experienced postoperative cardiovascular complications due to the delayed restart of antiplatelet therapy; one of these patients in group III died from myocardial infarction. CONCLUSIONS Continued DAPT or single antiplatelet treatment during orthopedic surgery does not increase the total intraoperative and perioperative bleeding compared with switching from antiplatelet therapy to low-molecular-weight heparin. However, the discontinuation of antiplatelet therapy increases the risk of serious cardiac complications.
Aged ; Aged, 80 and over ; Female ; Hemorrhage ; epidemiology ; etiology ; Humans ; Male ; Middle Aged ; Orthopedic Procedures ; adverse effects ; Orthopedics ; methods ; Platelet Aggregation Inhibitors ; therapeutic use ; Postoperative Complications ; Retrospective Studies

BACKGROUND: Due to the anatomical nature of the radial nerve, dissection and attainment of an adequate operative field in mid to distal humerus fracture is dangerous and limited. We devised a combined anterolateral and lateral approach that ensures protection of the radial nerve. This is achieved by performing bimodal dissection of the proximal humerus anteriorly and the distal humerus laterally. METHODS: Thirty-five consecutive patients were treated using a combined anterolateral and lateral approach for a minimum follow-up period of 24 months. We analyzed time to bony union, time to return to daily work, range of motion, elbow joint function as assessed by the Mayo elbow performance index and complications. RESULTS: Radiologic bony union was observed at 11.2 weeks (range, 8 to 20 weeks) on average. Four cases of incomplete radial nerve palsy before surgery all recovered. Time to return to work was 10.2 weeks (range, 2 to 32 weeks) on average. The average range of motion of the elbow was 3.3degrees (range, 0degrees to 10degrees) of extension and 135.9degrees (range, 125degrees to 145degrees) of flexion. There were 21 cases of excellent and 13 cases of good or better recovery, comprising over 97.1% on the Mayo elbow performance index. There were no complications of radial nerve palsy, non-union, mal-union, or infection. CONCLUSIONS: Our a modified combined anterolateral and lateral approach is a clinically effective surgical method of achieving protection of the radial nerve and securing easy and firm internal fixation.
Adolescent ; Adult ; Aged ; Female ; Humans ; Humeral Fractures/radiography/*surgery ; Male ; Middle Aged ; Orthopedic Fixation Devices ; Orthopedic Procedures/adverse effects/instrumentation/*methods ; Pain, Postoperative ; Prospective Studies ; Range of Motion, Articular ; Return to Work ; Treatment Outcome

Acromioclavicular joint (ACJ) injury is a common shoulder injury. There are various techniques of ACJ reconstruction. Superficial infection after ACJ reconstruction is not an uncommon complication. However, osteomyelitis post ACJ reconstruction has never been highlighted as a possible complication. Our patient is a 31-year-old male who sustained a Rockwood 5 ACJ dislocation and had anatomical ACJ reconstruction with autogenous gracilis and semitendinosus graft. Our technique involved the anatomical reconstruction of the ACJ and the coracoclavicular ligament with the usage of two bioscrews and the temporary stabilisation of the ACJ with two k-wires. As in any orthopaedic surgery, infection is often disastrous especially when the surgery involves implants. It can be disastrous with high morbidity to the patient as well as a costly complication to treat. Therefore, we wish to highlight this case as despite its rarity, osteomyelitis can be devastating to the patient and should be prevented if possible.
Acromioclavicular Joint ; injuries ; surgery ; Adult ; Anti-Bacterial Agents ; administration & dosage ; Bone Screws ; adverse effects ; Bone Wires ; adverse effects ; Gracilis Muscle ; transplantation ; Hamstring Muscles ; transplantation ; Humans ; Joint Dislocations ; surgery ; Male ; Orthopedic Procedures ; adverse effects ; methods ; Osteomyelitis ; etiology ; prevention & control ; therapy ; Postoperative Complications ; etiology ; prevention & control ; therapy ; Prognosis ; Reconstructive Surgical Procedures ; adverse effects ; methods

OBJECTIVETo explore the category and its clinical value of extravertebral cement leakage complicated by percutaneous vertebroplasty and kyphoplasty.

METHODSAfter collecting clinical data of 56 patients underwent surgery of PVP or PKP between August 2001 and March 2005, extravertebral cement leakage was classified according to anatomical position, and its clinical value was analysed.

RESULTSEighteen vertebraes presented cement leakage in all 43 vertebraes in PVP group. There were 15 vertebraes with one-place leakage, 6 vertebraes with perivertebral leakage, 5 spinal canal leakage, 2 intraforaminal leakage, 1 intradical leakage and 1 paravertebral soft tissues leakage respectively among them; and there were 3 vertebraes with two-place leakage. Four vertebraes presented cement leakage in all 22 vertebraes in PKP group. All 4 vertebraes had one-place leakage including 2 vertebraes with perivertebral leakage, 1 spinal canal leakage and 1 intraforaminal leakage. Five patients with cement leakage presented new symptoms including peritoneal irritation signs and spinal cord or nerve root injury, 3 patients recovered after conservative treatment, whereas the other 2 patients need decompression surgery.

CONCLUSIONSThe types of perivertebral leakage and spinal canal leakage are common among extravertebral cement leakage followed by percutaneous vertebroplasty and kyphoplasty. The minority of patients with cement leakage presents new symptoms, and the majority of them has the same therapeutic effect except patients with spinal canal leakage on one day after surgery.

Aged ; Bone Cements ; adverse effects ; therapeutic use ; Extravasation of Diagnostic and Therapeutic Materials ; classification ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Orthopedic Procedures ; adverse effects ; methods ; Retrospective Studies ; Thoracic Vertebrae ; surgery

OBJECTIVE: To analyze the etiology and prevention of complications related to the pedicle screw technique in the treatment of thoracic scoliosis. METHODS: There were 183 thoracic deformity patients 110 idiopathic scoliosis, 32 adult scoliosis, 28 congenital kyphoscoliosis, 8 Marfan syndrome with scoliosis, and 6 others. All patients' Cobb angles were evaluated preoperatively, intraoperatively, and postoperatively by roentgenograms. The deformity correction rate was calculated. All radiographic evaluations were carried out in a double-blind fashion. The complication rate was analyzed perioperatively and postoperatively. RESULTS: The deformity correction rate was 72%, better than others treated with hook-rod system. The perioperation complication rate was 8.4% (pedicle fracture 1.5%, infection 3.8%, pneumothorax and plural effusion 1.6%, transitory neurological damage 0.5%, and over-bleeding shock 1%). The complication rate at follow-up was 3.6% (infection 0.5%, fatigue fracture 1%, loss of deformity correction 1.6%, and transitory neurological damage 0.5%). Compared with those treated with hook-rod system, the perioperation complication rate, loss of deformity correction, permanent damage, and complications related to the internal fixation were all low. CONCLUSION The complication rate of pedicle screw fixation system was low in the treatment of thoracic deformity. When surgeons are thoroughly familiar with the technique and related pathoanatomy, and with the spinal cord function wardship by SEP, complications related to the pedicle screw technique in the treatment of thoracic scoliosis will be well controlled.
Adolescent ; Adult ; Bone Screws ; adverse effects ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Internal Fixators ; adverse effects ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Postoperative Complications ; epidemiology ; prevention & control ; Scoliosis ; surgery ; Spinal Fusion ; instrumentation ; Thoracic Vertebrae ; surgery ; Young Adult

The two-stage exchange arthroplasty (one- or two-stage) is believed to be the gold standard for the management of infections following total knee arthroplasty. We herein report a novel two-stage exchange arthroplasty technique using an antibiotic-impregnated cement intramedullary nail, which can be easily prepared during surgery using a straight thoracic tube and a Steinmann pin, and may provide additional stability to the knee to maintain normal mechanical axis. In addition, there is less pain between the period of prosthesis removal and subsequent reimplantation. Less soft tissue contracture, less scar adhesion, easy removal of the cement intramedullary nail, and successful infection control are the advantages of this technique.
Aged ; Anti-Bacterial Agents/*administration & dosage ; *Arthroplasty, Replacement, Knee ; *Bone Cements ; *Bone Nails ; *Device Removal ; Female ; Gentamicins/administration & dosage ; Humans ; Knee Prosthesis/*adverse effects ; Orthopedic Procedures/methods ; Prosthesis-Related Infections/*therapy ; Reoperation ; Vancomycin/administration & dosage

OBJECTIVETo assess the effect of the anterior surgical approach for thoracolumbar spine tuberculosis and analyzed the causes of the surgical complications and the countermeasures.

METHODSFrom Jan 1996 to Dec 2005, 120 patients with thoracolumbar spine tuberculosis underwent operations through the anterior approach either following the primary diagnosis (115 cases) or for recurrence (5 cases).

RESULTSIntraoperative pleural rupture occurred in 4 cases, and rupture of the external iliac vein occurred 1 case. Three patients had damages of the T12 dorsal ramus. One patient developed venous embolism of the lower extremity after the operation, two had paralytic ileus and 1 had false diabetes insipidus. Of the 5 recurrent patients, 1 died due to alcoholic cirrhosis and acute liver failure, 1 received a third operation for loosened internal fixation, and 1 had recurrence due to extensive drug resistance (XDR).

CONCLUSIONStandardized antituberculous therapy is fundamental for preventing the recurrence of tuberculosis, and individualized antituberculous therapy adjustment according to the results of bacterial culture and drug sensitivity tests can be the most effective means for preventing drug resistance and reducing tuberculosis recurrence.

Adolescent ; Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Orthopedic Procedures ; adverse effects ; methods ; Pleura ; injuries ; Postoperative Complications ; etiology ; prevention & control ; Retrospective Studies ; Thoracic Vertebrae ; surgery ; Tuberculosis, Spinal ; surgery ; Young Adult