Objective To demonstrate the clinical results of the patients with failed cemented femoral component due to aseptic loosening with extensive porous-coated femoral implants. Methods Be-tween 1998 and 2003, twenty hips (20 patients) with a failed cemented femoral component were revised us-ing extensive porous-coated femoral components and allograft. There were 12 males and 8 females. The mean age of the patients at the time of revision was 64 years (41-77 years). All of the revised femoral com-ponents were cemented stems,with first-generation cement technique in 18 hips and second-generation ce-ment technique in 2 hips. The indications for hip arthroplasty included osteonecrosis of the femoral head in 14 hips and femoral neck fracture in 6 hips. The interval from primary hip arthroplasty to revision surgery ranged from 5 to 17 years, with an average of 11.5 years. There were 4 re-revisions in this group. Based on Paprosky classification for bone deficiency, 3 hips were of type I, 6 of type II and 11 of type IIIA. The com-ponents implanted included AML (DePuy) in 5 cases , Solution (DePuy)in 7, full-coated (Zimmer)in 6 and Perfecta Extend Stems (Wright Med) in 2. The postoperative stability was evaluated according to the Engh criteria. The patients were followed for an average of 40 months (18-60). Results At the latest fol-low-up, the mean Harris score was improved from 40 to 85 points postoperatively. The bony ingrowths were found in 17 hips and the fibrosis stability in 3 on postoperative radiographic evaluation. There were no re-revisions in this group. The bone remodeling was observed in all osteolytic zones. Conclusion In the pres-ence of bone loss in the proximal metaphyseal region of the femur, the extensive porous-coated femoral com-ponents may provide a bypass for the deficient proximal bone. It may further obtain initial optimizing pros-thesis-bone fitting and an axial anti-rotational stability in the relatively normal diaphyseal region of the fe-mur to allow the reliable biological fixation with bony ingrowths.

Objective To analyze the risk factors related to intraoperative femur fracture in hip replacement and discuss the treatment countermeasures. Methods The medical records and radiographs of 38 patients with intraoperative femur fracture who were treated at Tianjin Orthopedic Hospital from December 2002 to December 2009 were retrospectively studied. Fractures were classified according to the Amstutz system or AAOS standard and the treatment methods were selected accordingly. Reduction and fixation was performed in 25 patients including 14 patients treated with interfragmentary or cerclage fixation, five with plate fixations and six with cortical strut graft. Shank prosthesis was replaced in 12 patients. Results The mean follow up period was 4.5 years, which showed successful union of the fractures in 36 patients and delayed union in two. Replacement of the prosthesis was needed in one patient for prosthesis loosening four years postoperatively. Conclusions Osteoporosis, violence, abnormal femur canal and over large prosthesis are the main causes of intraoperative femur fracture in hip replacement.Proper selection of treatment method according to fracture types may attain fracture union with a stable implant.

Osteoarthritis (OA) is the main reason of joint pain and dysfunction in the elderly in China, and its incidence is increasing year by year. In addition to the joint peripheral osteophyte formation and degeneration of articular cartilage, in?flammation, as one of the dominant pathological changes in OA, is causing more and more attention. Pro-inflammatory cyto?kines (PIC) are important mediators of inflammation. The increased level of PIC in OA can lead to systemic and local inflam?mation, results in further destruction of many kinds of tissues in joint (such as cartilage), and accelerates the development of OA. Besides, the severity of inflammation is closely related to the clinical symptoms of OA. Therefore, it is important to un?derstand the role of PIC in the pathogenesis of OA. From the perspective of the relationship between pro-inflammatory fac?tors and OA and the molecular mechanism, this article reviews the research progress in this field, which provides new con?cepts for diagnose and treatment of OA.

Objective To explore the reasonability of posterior approach incision length in an unselected patient cohort with minimally invasive total hip arthroplasty (THA) and compare the clinical results of different incision lengths. Methods A consecutive unselected 256 patients who underwent primary unilateral THA between March 2001 and December 2007 were studied prospectively. Prior to the operation, the incision length was not deliberately selected for the patients. A posterior approach was used for all procedures with minimally invasive surgical techniques. The patients were divided into three groups according to the incision length at the end of surgery: mini-incision group ( ＜ 10 cm, 99 patients) , moderate incision group (10-14 cm, 112 patients) and standard incision group ( ＞ 14 cm, 45 patients). The in-hospital data including age, sex, diagnosis,body mass index (BMI),operation duration, intraoperative blood loss, total blood loss, preservation of the external rotators, anatomic repair of the capsule as well as postoperative radiographs were collected for analysis of the intraoperative and postoperative complications. The pain was estimated by using the individual visual analog scale (VAS) and the functional outcome evaluated by Harris hip score preoperatively and postoperatively. Results All the patients were followed up for an average period of 6.1 years (2.5-9.2 years). The incision length was shortened and optimized ( ＜ 14 cm) in 211 patients. There showed decrease of BMI, less intraoperative blood loss, less pain, satisfactory outcome but higher proportion of abnormal abduction angle of the acetabular prosthesis in the early postoperative period in the mini-incision group, with statistical difference compared with the other two groups (P ＜ 0.05). The preservation of the piriformis tendon, anatomic repair of the joint capsule, operation duration and Harris score at 6th postoperative week in the moderate incision group were similar to those in the mini incision group but showed statistical difference in comparison with the standard incision group ( P ＜0. 05). Conclusions Minimally invasive THA with a smaller posterior incision can attain safe and effective curative effect for the unselected patient cohort. A smaller but not necessarily miniincision may allow minimal soft tissue trauma for the surgeon to perform the procedure well and ensure a long-term clinical results.

ObjectiveTo study the indications and mid-term outcomes of periacetabular osteotomy on adult patients of developmental dysplasia of the hip (DDH). MethodsTwenty-five adult patients with DDH underwent periacetabular osteotomies through modified Smith-Peterson approach. There were 19 females and 6 males with an average age of 25.5 years(range, 18-45). Every patient had a single dysplasia hip, including 14 hips in the left, and the other 11 in the right. Three cases were operated formerly, 2 of them received Chari osteotomy and 1 received Salter osteotomy. Before operation 13 hips were T(o)nnis Grade 0 osteoarthritis, 9 hips were Grade Ⅰ , 3 hips were Grade Ⅱ. The Shenton line of 18 hips was broken. The lateral center-edge angle was 4.57°±7.39°, the anterior center-edge angle was 0.95°±6.02°, the horizontal tilt angle was 32.50°±5.96°, the femoral head extrusion index was 38.11％±5.70％, the Harris hip score was 75.32±7.51 points. Changes of the indexes mentioned above were observed during the period of follow-up.ResultsAll patients were followed up for average 4.5 years(range, 2.0-7.5). Compared with the preoperative radiographic severity at the latest follow-up, 3 hips of T(o)nnis Grade Ⅰ improved to Grade 0, 2 hips of Grade Ⅱ improved to Grade Ⅰ, 1 hip of Grade Ⅰ changed into Grade Ⅱ. The incident of the break of Shenton line decreased to 10 hips. The lateral center-edge angle improved to 29.07°±5.81° the anterior centeredge angle improved to 29.52°±4.51°, the horizontal tilt angle decreased to 19.17°±4.95°, the femoral head extrusion index decreased to 24.20％±4.83％, the Harris hip score increased to 84.88±4.88 points. The major complication included 16 cases of lateral femoral cutaneous nerve palsy(7 cases of them didn't recover forever) and 1 case of ectopic ossification of Brooker Ⅰ . ConclusionPeriacetabular osteotomy through a modified Smith-Peterson approach were performed to the dysplasia hip of adults, it can increase congruence,improve hip function; it can also prevent subchondral sclerosis and cysts forming, preserve joint space and delay the occurrence of osteoarthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease. Joint deformity and dysfunction can occur in the late stage of the disease,which is seriously harmful to human health. Anti-inflammatory factors (AIC), as a protective factor, together with pro-inflammatory factors (PIC) play important roles in the pathogenesis and progression of RA. It is widely accepted by the majority of scholars that the decrease of AIC and the increase of PIC in RA can aggravate the systemic and local inflammatory reactions and accelerate the articular cartilage and subchondral bone destruction, resulting in further progress of RA. A new generation of biological therapy for RA targeting at AIC is in the ascendant. Therefore ,it is important to understand the role of AIC in the pathogenesis of RA. From the perspective of the relationship between AIC and RA and the mechanism, this article reviews the research progress in this field, which provides new concepts for the diagnosis and treatment of RA.