Objective To analyze the causes and results of treatment of periprosthetic femoral frac-tures after total hip arthroplasty and to explore the best operative methods for fractures. Methods 11 cases treated for periprosthetic femoral fracture after total hip arthroplasty were subjected to a retrospective fol-low-up study from December 1998 to March 2003. There were 8 men and 3 women, the mean age was 56 years (range, 43 to 75 years). There were 2 Vancouver A type fractures, 7 B2 type, 1 B3 type, 1 C type. 5 fractures were treated by nonoperative methods and other 6 by operative methods, including one fracture malunion treated initially by skin traction. There were 5 revisions using long stem supplemented with cortical allograft strut, including 4 uncemented stems with distal fixation and one cemented stem; the remaining one fracture treated by open reduction and internal fixation. Results None was lost for follow-up. The mean follow-up period was 25.6 months (range, 7 to 50 months). 9 fractures united at a mean of 4 months (range, 3 to 6 months). Nonunion was found in 2 fractures, both were treated nonoperatively. All the 6 fractures treated by operative methods united. Up to now, 7 stems were well-fixed, continuous radiolucent line was seen in one revision case, 3 stems were loosened. The function of the patients with well-fixed stems was bet-ter than those with loosened stems, the mean Harris score of the former was 91. All the cortical allograft struts were incorporated with host bone within one year. No strut fracture happened. Conclusion Type A fractures with well-fixed stems can be treated by nonoperative methods, while type B1 and type C fractures should be treated by open reduction and internal fixation, on condition there is no surgical contraindication. For fractures with loosened stems, use of an uncemented long stem with distal fixation supplemented with cortical allograft strut is the best choice.

Objective High tibial osteotomy was an alternative in the management of knee osteoarthritis, it could release the knee pain, correct the mechanical axis of the affected limb, and delay the total knee replacement. We were aimed at measuring the change of posterior slope angle of tibial medial plateau after high tibial osteotomy and probe its clinical consequences. Methods From 1998 to 2001, there were fifty-eight knees of 38 patients with medial unicompartmental osteoarthritis treated with closing-wedge high tibial osteotomy. The present included 8 male and 30 female patients with the average age of 55.2 years ranging 41 to 65 years. The osteotomy line was 2 cm distal to articular surfaces, and the tibia was fixed with Giebel bladed plate and two oblique long screws. The posterior slope angles of tibia and Insall-Salvati index were measured both pre and postoperatively on lateral radiographs. The posterior slope angle of proximal tibia in this study was defined as the angle between vertical line to tibial axis and the surface parallel to subchondral bone. Insall-Salvati index was defined as the ratio of the length of patellar tendon to the largest vertical diameter of patella. The alteration of the above features was calculated and analyzed statistically with paired t test. Results The mean tibial posterior slope angle was 9.4??3.0? preoperatively and 5.6??2.6?postoperatively. The tibial posterior slope angle was averagely decreased about 3.8??2.0?, Insall-Salvati index was 1.05?0.16 and 0.94?0.18 before and after high tibial osteotomy respectively. This index was averagely decreased about 0.15?0.10. Statistical analysis indicated that there was significant difference of posterior slope angle or Insall-Salvati index between pre and post operative(P

Objective To investigate the preliminary results of total ankle replacement with a three components of mobile bearing scandinavian total ankle replacement(STAR). Methods From October 1999 to February 2003, 13 cases of total ankle replacement were performed with STAR system (Waldemar Link, Hamburg, Germany). There were 8 males and 5 females with an average age of 63.4 years (range, 58 to 69 years). The diagnoses were posttraumatic arthritis in 6, osteoarthritis in 3, Kaschin-Beck disease in 2 and rheumatoid arthritis in 2. An anteromedial curve incision extended distally and proximally from the center of ankle joint. After the exposure and osteotomy, the uncemented tibial and talar components were implanted, a suitable sliding nucleus should be checked in order to keep the soft tissue balance. One total ankle arthroplasty was converted to ankle arthrodesis because of fracture of lateral malleolus occurred during operation. Results Among 12 total ankle arthroplasties, 8 had detailed follow-up data. The average period of follow-up was 16 months (range, 6 to 38 months). All the followed-up ankles were scored with Kofoed total ankle scoring system. The average preoperative and postoperative ankle score were 29 (6-49) and 82 (56-99) respectively. None of prosthetic loosening and migration was found radiologically. However, one case of delayed wound healing treated with dressing change for 4 weeks. One case of fractured medial malleolus was internally fixed with K wire, and the stability of tibial component was not compromised. Conclusion With current ankle arthroplasty designs, total ankle replacement is a viable treatment for symptomatic ankle arthritis that has no responses to nonoperative treatment. Although the preliminary results of total ankle arthroplasty are encouraging, there is still need for careful, long term analysis to estimate to what extent current ankle arthroplasty can relieve pain and restore ankle function. Further attention must be paid to more accurate implantation techniques that will result in a well balanced ligament and allow the ligament to act together with the replaced surfaces in a most physiologic manner.

Objective To evaluate the short-term results of total metatarsophalangeal arthroplasty (TMPA) for OA, RA, hallux valgus with severe OA, hallux rigidus, and osteonecrosis of metatarsal heads. Methods From March 2002 to March 2005, total metatarsophalangeal arthroplasty was performed in 30 patients (11 males and 19 females, age from 33 to 77 years old, average 62.5 years old) and 47 feet. Fifteen were bilateral. The preoperative underlying diagnosis was RA in 7, hallux rigidus in 5, hallux valgus with severe OA in 21, avascular osteonecrosis in second metatarsal head in 6, old metatarsophalangeal dislocation in 2, complications after McBride operation in 2 feet. Totally, 33 first metatarsoplangeal joints, 11 second metatarsophalangeal joints, 2 third metatarsophalangeal joints and 1 fourth metatarsophalangeal joint were replaced with metal bushed silicon Swanson prostheses. Two patients (4 feet) with abnormal first-second intermetetarsal angle (19?-20?) received simultaneous proximal metatarsal osteotomy. The osteotomed metatarsal were fixed with Biofix absorbable screws. Two patients (3 feet) received simultaneous metatarsal head (2-5) resection arthroplasty. Twenty-nine (46 feet) were followed-up for average 26.5 (3-36) months with Maryland metatarsal joint scoring system. Oriented by the Maryland scoring system, pain, joint function, and objective messurements were recorded and scored. Results The preoperative and postoperatvie Maryland score was 72 (55-82) and 91 (67-96), respectively. Excellent result was achieved in 41 feet (89.13%), good in 2 feet(4.35%), fair in 2 feet(4.35%), and poor in 1 foot(2.17%). The good-excellent result rate in this group was 93.48%. The complications included: delayed wound union in 2 feet, implant dislocation in 1 foot, reactive synovitis in 1 foot. Conclusion The short-term result of total metatarsophalangeal arthroplasty for treatment of OA, RA, hallux rigidus, old dislocation of metatarsophalangeal and avascular osteonecrosis of metatarsal heads is satisfying.

[Objective]To investigate the method and efficiency of operative femoral supracondylar varus osteotomy combined with new blade plate on treatment of valgus deformity of knees.[Method]Thirty-seven patients with 43 knees with valgus deformity were treated with femoral supercondylar varus osteotomy with Giebel blade plate(Link company/Germany)from Oct.2000 to Oct.2005.The study group consisted of seven men with 8 knees and thirty women with 35 knees,the average age of the patients was 31.2 years(range,fifteen to seventy years).Eleven patients with 13 knees had lateralcompartment osteoarthritis,Ahlback stage Ⅰ eight patients with 10 knees and stage Ⅱ three patients 3 knees.The full-length Ap view of the lower extremity and the weightbearing AP view of the knee were obtained before and after operation,as well as the femoral angle and femoral-tibial angle were evaluated.The Giebel blade plates were taken out average 1.5 year after operation and the patients were followed-up,bone union and the change of the correction angles and the pain of the knees were evaluated.[Result]All deformity of the knees were well corrected,the femoral angle were corrected from 71.7?(62?～75?) to 82.1?(78?～85?),the average correction angle was 10.4?(8?～21?).With average 1.5 year follow-up thirty four patients with 40 knees got good bone union,two knees had non-union and we changed the internal fixationwith bone autc-grafting and got good results,as well as lost follow-up for one knee.The pain relieved in 10 knees with lateral osteoarthritis and disappeared in 3 knees after operation.[Conclusion]Femoral supracondylar varus deformity of the knee,the technique is simple and damage is slight,fixation is safety and effective.

[Objective]To introduce the surgical technique of ceramic-on-ceramic total hip replacement and discuss the difference between two implant design.[Method]From November 2001 to June 2006,123 hip in 101 patients were treated by total hip arthroplasty with Osteonics ABC and Option Hip System.The prosthesis was fixed in strict position following some special technique for ceramic components.The theoretic range of motion of two hip systems were measured from experiment in vitro.The different cup positions which impingement happened were record for each prosthesises.[Result]The clinical score and the radiographic position of implants was good without evidence of wear,loosening,osteolysis and ceramic fracture.One chipping of ceramic insert happened during operation,and two patients had temporary irritation of iliopsoas.No other sever complication were found so far such as dislocation and infection.Experiment result:The deepened cup design obviously decreased the hip range of motion and "safe zone" was narrow than the flat cup design.[Conclusion]Ceramic-on-ceramic hip implant highly demands for surgical technique especially accurate cdp position.The deepened cup design cup should be posited with large anteversion.

[Objective]To investigate the method and effeciency of management massive acetabular bone defect with impaction bone grafting plus mesh in revision total hip arthroplasty[Method]Twenty-one patients 21 hips with massive acetabular bone defect were treated with impaction bone grafting plus mesh during Dec 2001 to Jan 2006,including 6 men and 15 women,the average age were 51.9 years at the revision operation(range,38~77 years).The acetabular defects of the patients in this study group were type III(combined defect)according to the American Academy of Orthopaedic Surgeons(AAOS)classification scheme.At first the combined defect was transformed into cavitary defect with metal mesh,then the contained acetabulum was tightly packed with deep-frozen morselized cancellous allograft chips(size 7~10mm),the anatomy of the hip was reconstructed and the cup was inserted after pressurizing the cement directly onto the graft.The AP view of the hip at 3 days,3 months,1 year and yearly after the operation were obtained,cup migration according to the teardrop and radiolucent line were evaluated,at the same time the Harris hip score were also evaluated.[Result]The mean follow-up time was 2.8 years,the mean Harris hip score improved from 46.4 points preoperatively to 81.3 points at the final evaluation,no cup migration were found,except for one dislocation and one sciatic nerve injury,as well as lost follow-up for one hip.[Conclusion]Impaction bone grafting plus mesh is an effective approach to treat massive acetabular bone defect in revision total hip arthroplasty,it can restore bone stock and help the cup to be placed to the anatomic position,as well as provide execellent prothesis stability.

[Objective]To investigate the method and efficiency of operative modified rotational acetabular osteotomy for treatment of adult acetabular dysplasia. [Methods]Twenty-seven patients with 30 hips with acetabular dysplasia were treated with modified rotational acetabular osteotomy. The study group consisted of three men with 3 hips and twenty-four women with 27 hips,the average age of the patients was 29.4 years(range,fifteen to forty-two years ).The anteroposterior plevis view,lateral and abduction view of bilateral hip were taken,CE angle(center-edge angle) and AC angle(acetabular roof obliquity) were measured,the changes of the rotational center of the hip ,Shenton's line and the degree of osteoarthritis were recorded ,the Harris score was obtained before and after operation.[Results]The femoral head coverage was improved in all patients. On average ,the CE angle was improved from 3.2 (-15?～15?)to 28.5?(20?～40?),the AC angle was declined from 26.6?(15?～38?)to 3.9?(0?～12?). The rotational center of the hip was medialized in 19 hips(63.3%),the discontinuity rate of Shenton's line was declined from 67% to 23%. On average 4.2 years follow-up ,1 case lost follow-up,the degree of osteoarthritis in 28 hips was not aggravated,pain was aggravated in 1 hip ,the Harris score was improved from 82.7(67～96) to 97.8(87～100).Two patients have had Fibre-union of pubic and one patient has had stress fracture of the inferior pubic ramus postoperatively,non-union of iliac and posterior column of the osteotomy or the greater trochanter was not found.[Conclusion]The method of modified rotational acetabular osteotomy for treatment of adult acetabular dysplasia is effective and safety.

Objective To evaluated the result of modified Mitchell operation for treatment of hallux valgus. Methods From March 1998 to October 2001, 39 feet of 20 patients were treated with modified Mitchell procedure. Before operation, HVA averaged 29.5? and IMA averaged 12.5? were measured on standing AP radiographs. The lateral displacement of the capital fragment was depended on the amount of IMA and the capital fragment shifted plantarly 2-3 mm. Fixation was achieved with an absorbable screw. The lateral spike on the distal fragment was not preserved in this operation. Results After follow-up of 11-38 months, patients rated as excellent or good in 97.4%. The average postoperative HVA was 14.5? and IMA was 8.5?, the average HAV correction was 15? and 4? for the IMA. Conclusion The modified Mitchell procedure provides satisfactory deformity correction. The transverse arch of metatarsals is reconstructed since distal part of the first metatarsal is shifted plantarly in this operation.

Objective To investigate the relationship between the levels of proteoglycan and collagen type Ⅱ in serum and severity of knee osteoarthritis, and to determine whether the two markers could reflect the metabolic changes of cartilage after different knee operations. Methods Serum samples and roentgenographic data of 65 patients with knee osteoarthritis and 22 normal persons in controls were collected. Three different operations were performed for 45 patients respectively. These patients were followed up for half a year. The serum levels of proteoglycan and collagen type Ⅱ epitope were analysed using an enzyme-linked immunosorbent assay(ELISA). Results Epitope levels of proteoglycan and collagen type Ⅱ in serum of osteoarthritis patients were higher than those in control group. The serum levels of both markers in the group that the roentgenograph show minor narrowing of joint space were highest. Half a year after total knee replacement, the level of proteoglycan decreased significantly(P