Objective:To analyze the clinical efficacy of internal fixation and prosthesis revision in the treatment of periprosthesis fracture after total knee arthroplasty.Methods:A total of 35 patients (35 knees) with periprosthetic fractures after total knee arthroplasty were retrospectively analyzed from January 2008 to January 2022 in the Department of Orthopaedics, West China Hospital, Sichuan University, including 13 males and 22 females, aged 71.4±4.1 years (range, 62-81 years). Left knee 19 cases, right knee 16 cases. There were 20 cases of Rorabeck type II and 15 cases of Rorabeck type III. The initial replacement was performed using a fixed platform post-stabilized knee prosthesis, which was fixed with bone cement. Patients with Rorabeck type II were treated with internal fixation alone (internal fixation group) and patients with Rorabeck type III underwent revision with replacement prosthesis (revision group). The Hospital for Special Surgery (HSS) score, range of motion (ROM) of knee joint, alignment of lower extremity and incidence of postoperative complications were compared between the two groups.Results:All patients successfully completed the operation and were followed up for 5.2±3.6 years (range, 1-12 years). Intraoperative blood loss was 680±102 ml (range, 420-1100 ml). The operative time in the internal fixation group was 105±17 min, which was less than 140±21 min in the revision group, and the difference was statistically significant ( t=-5.450, P<0.001). There was no complication of nerve or blood vessel injury during the operation. Five cases in the internal fixation group had unsatisfactory lower extremity force lines (>3° deviation from normal) after surgery, and all lower extremity force lines in the revision group were satisfied, and the difference in the satisfaction rate of lower extremity force lines between the two groups was not statistically significant ( P=0.057). The fracture healing time, knee ROM and HSS scores at the last follow-up were 5.1±1.3 months, 86°±5° and 84±5 in the internal fixation group and 4.8±1.5 months, 83°±6° and 82±4 in the revision group. One case in the revision group was diagnosed postoperatively with periprosthetic infection with pathogen culture suggestive of Candida albicans, recurrent anterior knee sinus tracts and patellar ectasia, which progressed to osteomyelitis, and mid-thigh amputation was performed 1 year after revision. Conclusion:The stability of prosthesis is an important reference for the treatment of periprosthetic fractures after total knee arthroplasty. Strong internal fixation in patients with unloosened prosthesis and revision with replacement of prosthesis in patients with loose prosthesis can achieve good knee joint function.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

BACKGROUND: Synovectomy has been introduced into total knee arthroplasty (TKA) with the aim of relieving pain and inflammation of the synovium. However, there are no long-term, comparative data to evaluate the effect of synovectomy in TKA. This study was aimed at assessing pain, function, and complications in patients undergoing synovectomy during TKA for osteoarthritis (OA) at long-term follow-up. METHODS: This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA. Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA. The overall efficacy of both strategies was evaluated by determination of blood loss, the Knee Society score (KSS), and knee inflammation conditions during a 3-month postoperative period. The postoperative pain, range of motion (ROM), and complications were sequentially evaluated to compare the two groups until 10 years after surgery. RESULTS: At the 10-year follow-up, both groups had a similarly significantly improved ROM (114.88 ± 9.84° vs. 114.02 ± 9.43°, t  = 0.221, P  = 0.815) and pain relief with no differences between the two groups (1.0 [1.0] vs. 1.0 [1.5], U  = 789.500, P  = 0.613). Similar changes in total blood loss, KSS, and knee inflammation were found in both groups during 3 months postoperatively ( P  > 0.05). Additionally, there was no significant difference regarding complications and satisfaction between the two groups ( P  > 0.05). CONCLUSIONS: Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain, ROM, and satisfaction during a 10-year follow-up. In addition, it may not result in more blood loss and increased incidence of long-term complications. Based on our long-term findings, it should not be performed routinely. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-INR-16008245; https://www.chictr.org.cn/showproj.aspx?proj=13334 .
Humans ; Arthroplasty, Replacement, Knee/methods* ; Synovectomy/methods* ; Osteoarthritis, Knee/surgery* ; Prospective Studies ; Pain, Postoperative ; Inflammation/etiology* ; Range of Motion, Articular ; Knee Joint/surgery* ; Treatment Outcome ; Knee Prosthesis/adverse effects*

  Objective  To understand the current status of surgical treatment for hemophilia osteoarthropathy (HO) in China.  Methods  Using an online questionnaire, select domestic hospitals that partici-pated in the compilation of the 'Guideline for perioperative management of hemophilia patients undergoing orthopaedic surgery in China ', in addition to members of the National Joint Surgery Group, and the Orthopedic Branch of the Chinese Medical Association for targeted investigation and analysis.  Results  A total of 17 domestic hospitals were included, all of which were general hospitals. Hospitals that started HO surgery treatment before 2000 accounted for 35.29%. A total of 3057 surgical cases of HO were reported by those hospitals. The most commonly performed surgical procedures were hip and knee joint replacement. The most commonly used coagulation factor replacement regimen was recombinant coagulation factor preparation. Ten hospitals reported finding patients with transfusion-related infectious diseases. Bleeding and hematoma formation were the most frequently reported surgical complications. Excessive length of hospital stay and high economic costs were the most frequently reported problems.  Conclusions  Surgical treatment for HO in 17 hospitals is mainly carried out in some large comprehensive medical centers in the eastern region. Compared with the patient base, the popularity and number of surgeries are still relatively insufficient. It is necessary to further standardize the treatment system by standardizing factor replacement and strengthening rehabilitation to improve surgical treatment outcomes.

There are differences and inconsistencies to some degree in the radioactive contamination control level of personnel′s body surface availiable in many national standards, thus puzzling the users. Therefore, it is proposed to compare the applicable scope, conditions and differences between relevant national standards, and combine with similar clinical nuclear medicine standards of radiological protection content to presevent recommendations on the contamination control level that should be correctly applied in an event of nuclear and radiological emergency. Based on the discussion of similar standards, the contaminated personnel with α of 0.04-10 Bq/cm 2 and β of 0.4-100 Bq/cm 2 are advised to be treated in the institutions with higher than secondary medical insititution. Both α econtamination control levels less than 0.04 Bq/cm 2 and β levels less than 0.4 Bq/cm 2 could be achivable, if fully decontaminated.

Humans ; Tranexamic Acid ; Atrial Fibrillation ; Antifibrinolytic Agents ; Arthroplasty ; Blood Loss, Surgical ; Arthroplasty, Replacement, Hip

Objective To investigate the results of malformation correction of femoral medullary cavity in hip revision for implant loosening.Methods From January 2010 to December 2016,24 patients (24 hips) were received hip revision arthroplasty using femoral medullary cavity correction technique.Nineteen patients (19 hips) were followed up.Ten patients were male and 9 female with mean age of 69.1 years (range 44-84).The followings are the reasons for revision:15 patients for osteolysis with implant loosening,4 for periprosthetic infection,bone cement implant and stage two revision.Fourteen patients received bone cement implants and 5 received uncemented implants for primary arthroplasty.During revision,13 patients underwent femoral bone cortical windowing and 6 received extended trochanteric osteotomy technique to exposure medullary cavity,grinding sclerotic bone and filling bone defect,correcting cavity to normal morphology and implant anatomic revision stem.The hip function was evaluated with Harris score.Peri-operation complications were also collected.Implant position,fixation condition and implant loosening were evaluated from the supine anteroposterior radiograph of the pelvic and a lateral hip radiograph.Results The mean follow up duration was 58 months (range 17-82).The mean Harris score improved significantly from 41.52±10.94 (range 17-64) preoperatively to 91.63±6.70 (range 72-99) postoperatively.Mild limp occurred in 2 patients (11％,2/19) and intermittent hip pain occurred in 1 patient (5％,1/19).Peri-prosthetic fracture occurred in 1 patient and was treated with double stranded wire fixation.No deep venous thrombosis,dislocation and infection occurred.No revision was performed.For bone cortical windowing patients,the length of the cortical windows varied from 3.0 to 9.0 cm (mean 4.78±1.84),the width ranged from 1.0-3.0 cm (mean 1.82± 0.50).For extended trochanteric osteotomy patient,the length of the osteotomy varied form 12.0-20.0 cm (mean 16.00±3.37),the width ranged from 2.5 to 3.0 cm (mean 2.75±0.29).All the revision stems were in neutral position without varus or valgus.All the osteotomy sites were bone heal and fracture lines were disappeared.Conclusion In order to restore the normal bone cavity morphology and femoral alignment,correction bone cavity technique is required in patients receiving hip revision with femoral cavity malformation and anatomy alignment abnormal.This technique can ensure neutral position of revision stem without peri-prosthetic fracture.

Objective To compare faster rehabilitation of different surgical approaches in total hip arthroplasty (THA)patients using a direct anterior approach or posterolateral approach.Methods Sixty-eight patients (35 in direct anterior THA and 33 in posterolateral THA) from September 2015 to March 2016 were recruited in the present study.The incision length,operation duration,intraoperative blood loss,serum creatinekinase (CK),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),interleukin-6 (IL-6) and visual analogue scale (VAS) pain score were compared between two groups respectively.The Harris hip score,the University of California at Los Angeles (UCLA) pain,walking,and activity scores,postoperative hospital length of stays,gait analysis,component placement and complications were also compared.Results The mean incision length,operation duration,intraoperative blood loss were 11.23±0.97 cm,73.77±9.20 min and 157.15±35.83 ml in the DAA group respectively,while those in PLA group were 15.16±1.12 cm,64.12±13.31 min and 126.97±45.45 ml.The mean incision length of the DAA group were significantly less than that of the PLA group.The DAA group underwent longer operation time that associated with more intraoperative blood loss.The levels of CK and inflammation markers were increased in the PLA group compared with those in the DAA group.The VAS pain score was less in the DAA group than the PLA group within postoperative 72 hours.Functional recovery in the DAA group was faster than that in the PLA group based on the Harris hip score,UCLA scores,and gait analysis up to 3 months.There was no difference in these outcomes between the groups beyond 6 months.The average postoperative hospital length of stay was 2.95±0.24 days and 3.35±0.51 days for the DAA group and PLA group respectively.The patients in DAA group required less postoperative hospital length of stays.The angle of acetabular cup anteversion in the DAA group (16.4°±2.3°) was lesser than that in the PLA group (20.4°±2.8°).There was one intraoperative nondisplaced greater trochanter fracture in the DAA group,whereas no intraoperative complications were occurred in the PLA group.Conclusion The present study showed that using direct anterior approach in THA provided significant benefits for patients in terms of muscle damage,VAS score,hospital length of stays and functional recovery in the early stage postoperatively compared to using posterolateral approach.

Objective To investigate biomechanical effects of different joint line height on unicompartmental knee arthroplasty (UKA) and to provide biomechanical evidence for surgical decision during UKA using finite element analysis (FEA).Methods On the basis of knee joint CT data from a healthy volunteer (male,30 years old,165 cm and 60 kg) and UKA prosthesis 3D scanned data,the 3D models of normal knee and UKA were constructed.Subject-specific finite element models with inhomogeneous material property assignment were constructed for normal knee and UKA with 3 different height of joint line (-3 mm,0 mm and +3 mm).Starting from the tibial articular surface,5 sections were extracted with 2 mm interval.30 nodes were selected in medial and lateral area,respectively on each section.The mean stress value of nodes was defined as the stress level of subchondral bone.Results Mean values of stress on polyethylene upper surface of 0,-3 and+3 mm joint line position were 14.84,26.81and 20.86 MPa,and the difference was statistical significant (t0vs-3=4.896,P0vs-3=0.000;t0vs+3=3.455,P0v+3=0.008;t-3vs+3=2.579,P-3vs+3=0.020).Mean values of stress on tibial prosthesis upper surface of 0,-3 and +3 mm joint line position were 29.69,50.49 and 39.99MPa,respectively,and the difference was statistical significant(t0vs-3=5.675,P0vs-3=0.000;t0vs+3=4.755,P0v+3=0.001;t-3vs+3=4.783,P-3vs+3=0.000).When joint line was in 0 mm height,stress level of subchondral bone was similar to that of normal knee.When joint line was in-3 mm height,significantly increased stress was found on polyethylene (increased 81％) and tibial component (increased 70％) surface compared with that of 0 mm height,while stress on trabecular bone under lateral tibial articular surface also increased by 8.7％.When joint line was in +3 mm height,increased stress on polyethylene (increased 41％) and tibial component (increased by 35％) surface were less than that of-3 mm height.Stress on trabecular bone under lateral articular surface decreased by 55.6％ compared with 0 mm height.Conclusion During UKA,ensuring a normal height of joint line is benefit to keep the stress path of the medial and lateral tibia similar with normal knee and decrease the risk of premature polyethylene wear,tibial component subsidence and periprosthetic fracture.

OBJECTIVETo investigate the effectiveness and safety of post-operative retransfusion drain(PRD) after total hip arthroplasty.

METHODSA systematic literature review based on PubMed, EMBase, the Cochrane Library, China Biology Medicine disc, CNKI, VIP and WanFang Database in any language regarding PRD following total hip arthroplasty was performed.The data was evaluated using modified Jadad score and then analyzed using RevMan 5.2.

RESULTSNine randomized controlled trials totaling 1 824 patients, 913 patients in PRD group and 911 in control group, were eligible for data extraction and Meta-analysis.The results indicated that the use of PRD could reduce the requirement of allogeneic blood transfusion when compared with ordinary vacuum drainage (RR=0.61, 95% CI= 0.47-0.79), but the benefit was not found when compared with no drainage group(RR=1.07, 95% CI=0.67-1.71). And the postoperative hemoglobin level was higher in PRD group(MD=0.14, 95% CI=0.01-0.27, P=0.04). No significant difference was identified regarding transfusion index, length of hospital stay, the incidence of febrile reaction and wound-related complications.

CONCLUSIONSPRD in reducing requirement of blood transfusion following THA is effective and safe when compared with ordinary vacuum drainage, but the benefit is not found when compared with no drainage.And more robust evidence is needed to confirm this result.