Objective To evaluate the results of using focus clearance and morselized bone graft to treat a well-fixed socket osteolysis after total hip arthroplasty (THA) during cementless acetabular revisions.Methods From March 2006 to March 2009, 23 patients (23 hips) who had an acetabular revision hip arthroplasty of well-fixed socket for osteolysis were retrospectively reviewed, including 13 males and 10 females with an average age of 46.6 years (range, 39-54), and the mean interval from primary to revision THA was 5.5 years (range, 4.6-7.4). The preoperative Harris hip score was 74. The operative technique included debridement of soft tissues with removal of granulomata and packed tightly with morselized cancellous allograft through ilioinguinal approach, and exchanging the liner and femoral head through the posterior-lateral approach of the hip. Results The mean duration of follow-up after revision was 28 months (range, 8-38). At final follow-up, all hip were functioning well and the average Harris hip score was 93.8. Osteogenesis in bone graft were well-developed in 16 patients. Twelve bone grafts were completely incorporated into surrounding bone through creeping substitution. All acetabular components remain radiographically well-fixed and no loosening and shifting. There were no new osteolytic lesions, ectopic ossification, deep venous thrombosis, hip dislocation or infection during follow-up. Conclusion Our revision strategies included debridement and bone grafting, a revision of femoral heads and polyethylene liner and retention of the cups and femoral stems. The method can reduce the amount of the wear particle from polyethylene. The short-term outcome is excellent.

Objective To retrospectively analyze the short-term clinical effects of the two-stage cementless total hip arthroplasty in the treatment of chronic infection after the internal fixation of the adult proximal femoral fracture.Methods From June 2006 to June 2011,9 patients who had suffered a chronic infection after an internal fixation of the proximal femoral fracture,including 8 males and 1 female,aged from 31 to 74 years (average,52.6 years),were treated with two-stage cementless total hip arthroplasty.There were 3 cases of femoral neck fracture,and 6 cases of intertrochanteric fracture.In the first stage,after surgical debridement and thorough removal of all the implants,an antibiotic-loaded cement spacer was implanted.All patients postoperatively underwent intravenous and oral antibiotics,and the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were tested.When the values of ESR and CRP become normal,the second stage operation using cementless components was performed.Results The presence of infection was confirmed by a positive culture of joint fluid obtained intraoperatively in two cases;one case was staphylococcus aureus and another one was staphylococcus epidermidis.The second stage arthroplasty was performed 6-14 months (average,9 months) after the first stage operation.All 9 patients were followed up for an average of 23.2 months (range,6 to 50 months).No recurrent infection,component loosening,bone osteolysis and cement spacer or component dislocation occurred.The Harris score improved from 74.6 (range,64 to 86) before the first stage operation to 90.9 (range,86 to 97) at the final follow-up.Conclusion The two-stage cementless total hip arthroplasty is an effective strategy for the treatment of chronic infection after the internal fixation of the adult proximal femoral fracture.

Objective To retrospectively analyze the diagnosis and treatment of the extra-articular inflammatory pseudotumor after well-fixed metal-polyethylene total hip arthroplasty (THA).Methods From March 2006 to June 2011,7 patients (7 hips) who presented with a progressive pain and/or swelling,discomfort in groin or upper thigh after metal-polyethylene THA were admitted to our hospital.There were 2 males and 5 females,with an average age of 48.8 years (range,32-65 years).All 7 patients were identified with a periprosthetic osteolysis at the acetabular and/or femoral components and a mass in the iliac fossa or the thigh; however,the components were all well-fixed.The masses were confirmed by CT scanning and/or ultrasound examination.The revision procedures were done through ilioinguinal approach and posterior-lateral approach,and the pseudotumors were excised and osteolytic lesions were debrided and packed tightly with morselized cancellous allograft.The liner and femoral head were also exchanged at the same time.Clinical and radiographic outcomes of revision THA were evaluated.Results All 7 patients were followed up for 3-42 months (average,30 months).At final follow-up,all hips were functioning well and the average Harris hip score was 92.4.All acetabular components remained radiographically well-fixed.All cavitary defects had complete radiographic incorporation of the bone grafts.There were no new pseudotumor or osteolytic lesions identified,and no revision of the components.Conclusion The presence of abdominal or pelvic pseudotumor in patient with a THA may be associated with polyethylene wear.Once the extra-articular pseudotumor and the periprosthetic osteolysis are identified,the surgical treatment,including pseudotumor excise,osteolytic lesion debride and bone defect grafting and bearing surface exchange,can achieve retention of well-fixed components.

Objective To investigate the middle-term results of anti-protrusio cage combining with allograft bone graft for revision arthroplasty of Paprosky type Ⅲ acetabular bone defect.Methods A retrospective analysis was done for 19 patients (20 hips) with Paprosky type Ⅲ acetabular bone defect who received acetabular revisions using anti-protrusio cage from January 2002 to December 2009.There were 11 males and 8 females,aged from 42 to 76 years (average,57.4 years).There were 7 hips (35％) of Paprosky type ⅢA acetabular bone defect,and 13 hips (65％) of type ⅢB.The follow-up time was (5.8±2.4) years.Hip function of patients was judged by Harris hip scores pre-and post-operation.The outcome of acetabular prostheses and bone grafts were assessed by radiologic evaluation.The five-year cage failure-free survival rate was assessed by Kaplan-Meier survivorship analysis.Results The Harris hip scores improved from preoperative 14.6±4.3 to 83.5±7.9 at the final follow-up.Lower limb discrepancy improved from preoperative (26.3±9.1) mm to postoperative (1.2±3.4) mm.The hip rotation center was reconstructed from preoperative(23.6±7.4) mm up-toward and (4.4±14.7) mm lateral-toward dislocation to inside Ranawat triangle.All the allograft bone was incorporated with host bone.None of cage displacement,screw fracture,progressive radiolucency and cement fracture was observed.Mild allograft bone resorption was observed in 3 hips (15％).There was no moderate or severe bone resorption found at the final follow-up.The five-year cage failure-free survival rate was 100％ (95％ CI,0.95-1.00).Conclusion The revision using anti-protrusio cage combined with allograft bone graft shows satisfying middle-term clinical and radiological results in the treatment of Paprosky type Ⅲ acetabular bone defect.

Objective To compare the kinematics of the knee joint of normal Chinese people and people after fixed-bearing posterior stabilized total knee arthroplasty while doing weight-bearing deep knee-bending using fluoroscopy analysis.Methods From June to December 2010,ten volunteers and ten patients with fixed-bearing posterior stabilized total knee arthroplasty (TKA) were required to perform weight-bearing deep knee-bending activity under surveillance of roentgenization,motion between femur and tibia was analyzed with interval of 15° according to two-to three-dimensional (2D-3D) registration technique.Results During weight-bearing deep knee-bending,the average weight-bearing maximal flexion was 136° in the normal group,which was significantly higher than the 125° in the TKA group.All 10 normal knees present posterior translation of femoral condyle during deep knee-bending,posterior translation of the lateral condyle was greater than medial condyle,thereby creating a medial pivot type of axial rotational pattern in which the tibia internally rotates relative to the femur as flexion increased.The average amount of posterior femoral translation of the medial condyle was 7.3±1.2 mm,whereas the lateral condyle translated posteriorly 19.3±3.1 mm.All knees experienced tibia rotated internally during progressive flexion,and the average amount of axial rotation for the ten subjects from 0° to 135° was 23.8±3.4°.From extension to maximal flexion,the average amount of posterior translation of medial condyle was 1.4±0.6 rmm,whereas the lateral condyle translated 6.4±1.7 mm in the posterior direction in the fixed-bearing posterior-stabilized TKA.The average amount of tibial internal rotation was 8.5°±3.4°.Conclusion In normal Chinese people,during knee flexion activities the lateral condyle experiences significantly more amount of posterior translation than the medial condyle,leading to the tibia present medial pivot internal rotation relative to the femur,and the PFC-Sigrna fixed-bearing posterior stabilized designs has the similar kinematics with normal knee,but the posterior condylar translation and tibial axial rotation are much less than the normal.

Objective To evaluate the efficacy and safety of local infiltration analgesia in the multimodal analgesia protocol.Methods Sixty patients who were scheduled to undergo TKA were randomly divided two groups:local infiltration analgesia (LIA) group (n=30) or the non-local infiltration analgesia (N-LIA) group (n=30).All patients were given Celecoxib 200 mg bid,3 days preoperative,and a single-injection femoral nerve block (SFNB) half an hour before the surgery (ropivacaine 3.3 g/L,30 ml).The LIA group was given local infiltration analgesia with ropivacaine (2.5 g/L,60 ml) and 0.1 mg epinephrine before suture the operative incision.The N-LIA group didn't do the LIA.Both of the two groups didn't use the patient controlled analgesia.The VAS scores,the knee joint range of motion,the muscle strength of quadriceps femoris and the side effects and complications were recorded.Results The VAS scores were lower in LIA group than in the N-LIA group,these scores at 2 h to 48 h after surgery at rest and after 24 h at motion had statistical significance.The range of motion and the muscular strength of quadriceps femoris in the LIA group were better than in the N-LIA group.In the LIA group the use of opioids was less and the side effects were lower.The average length of hospital stay after the operation was shorter in the LIA group than the N-LIA group.Conclusion This multimodal perioperative analgesia protocol that include SFNB and LIA offered improved pain control and minimal side effects to patients undergoing TKA.

Objective To study whether 3D computerized pre?operative planning is accuracy and reliability in CroweⅣtype developmental dysplasia of the hip (DDH) patients undergoing total hip arthroplasty (THA). Methods Between September 2009 and February 2011, 20 CroweⅣtype DDH patients (20 hips) were included in this study. The 3D pre?operative planning was performed using Mimics software to predict the acetabular component size, acetabular component abduction angle, hip rota?tion center position, the acetabular component coverage and number of patients received structural bone graft. The results were compared with traditional acetate templating technique and post?operative results. Results 70%(14/20) components were pre?dicted exactly and 30%(6/20) components were predicted with one size using 3D computerized planning, comparing with 25%(5/20) components were exactly, 45%(9/20) components were with one size and 30%(6/20) were with two size or more using conven?tional acetate templating technique. Statistically analysis revealed that 3D planning was more accuracy than templating technique regarding acetabular component prediction (t=-4.66, P=0.00). There was no significant difference between the 3D computerized planned acetabular component abduction angle (3D plan 41.10°±4.87°, postoperative 44.98°±10.83°, t=0.88, P=0.42), hip rota?tion center distance (horizontal distance:3D plan 77.51 ± 7.78 mm, postoperative 79.85 ± 8.61 mm, t=-1.95, P=0.11;vertical dis?tance:3D plan 42.79±8.22 mm, postoperative 44.98±10.83 mm, t=-1.27, P=0.26), acetabular component host coverage (3D plan 77.73%± 10.51%, postoperative 78.98%± 10.24%, t=-1.84, P=0.09), and that found post?operatively. Five patients were consid?ered to need structural bone graft according to 3D computerized planning, which was highly coincident with the intraoperative find?ings in all five cases. Conclusion 3D computerized pre?operative planning using Mimics software is an accurate and reliable technique in treating CroweⅣtype DDH patients undergoing THA.

Objective To explore the perioperative efficiency and safety of different regimen of tranexamic acid (TXA) in total knee arthroplasty (TKA).Methods From February 2013 to May 2013,150 female patients with knee osteoarthritis underwent unilateral TKA were randomly divided into three groups,50 cases in each group.Patients received 10 mg/kg TXA by fast intravenous infusion before closing the wound in first group (single dose group),patients in second group received two doses of 10 mg/kg TXA before closing the wound and 3 hours postoperation (repeated dose group),patients in the third group didn't receive TXA (control group).The postoperative blood loss via drainage,the total blood loss,the hidden blood loss,the postoperative hemoglobin concentration at different times and the numher of patients need blood transfusion were recorded.All patients were observed for detecting deep vein thrombosis (DVT) by the color doppler ultrasonography within 5 days postoperation,and the symptomatic DVT and pulmonary embolism (PE) were observed within 90 days postoperation.Results The blood loss via drainage was significantly less in the single dose group (273.6±99.6 ml) and repeated dose group (168.5±80.8 ml) compared with the control group (447.2±101.9 ml),and it was significantly less in the repeated dose group than the single dose group; the total blood loss was significantly less in the single dose group (959.1±291.7 ml) and repeated dose group (818.7±206.9 ml) compared with the control group (1 100.8±288.3 ml),and it was significantly less in the repeated dose group than in the single dose group; there was no differ ences about the hidden blood loss among the three groups.The hemoglobin concentration was significantly higher in the single dose group and repeated dose group than in the control group in day 1,3 and 5 postoperation; and it was significantly higher in the repeated dose group compared with the single dose group.The ratio of transfusion was significantly less in the single and repeated dose groups than in the control group,but no differences exists between the single dose group and repeated dose group.There was no DVT in all of the three groups within 5 days postoperation,and there was no symptomatic DVT and PE in all of the three groups within 90 days.Conclusion 10 mg/kg of TXA infused intravenous before closing the wound is effective and safe in TKA,another dose 3 hours postoperation is much more effective and will not increase the danger of DVT and PE.

Homogeneous bone allograft is most commonly used to treat bone defect. Immune elimination and sterilization are necessary measures to improve the outcome and to secure the reliability of homogeneous bone allografts. In this paper, we have given a brief introduction to the major methods of immune elimination and sterilization as well as the current researches on this subject.
Animals ; Bone Transplantation ; immunology ; methods ; Bone and Bones ; immunology ; Freeze Drying ; Graft Rejection ; prevention & control ; Humans ; Sterilization ; methods ; Transplantation, Homologous

Objective To evaluate mid?term clinical outcomes associated with total hip arthroplasty using metal?on?met?al prosthesis with large diameter femoral head. Methods From March 2007 to December 2009, 153 patients (177 hips) with ad?vanced hip diseases undergoing large diameter femoral head metal?on?metal total hip arthroplasty in our hospital were retrospec?tively analyzed in this study. Clinical physical examination and radiographic examination were used to evaluate hip function and the incidence of complications (implant loosening and inflammatory pseudotumor);ICP?MS method was used to determine serum cobalt ion and chromium ion levels and compare with normal values;revision was set as the prosthesis endpoint to evaluate the five year survival rate of implant. Results A total of 145 patients (169 hips) were followed up for average 72.4 months (67-80 months), the follow?up rate was 94.8% (145/153). For the involved patients, 85 were male (104 hips), 60 were female (65 hips);age 20-78 years old, average 49.3±12.6 years old. All patients received ASRTM?XL large femoral head metal?on?metal to?tal hip arthroplasty operation. At the end of follow?up, the average Harris hip score improved from 44.2±12.6 points preopera?tively to 91.5±5.7 points. A total of 8 patients received revision, 3 for acetabular implant spinout?out and 5 for hip inflammato?ry pseudotumor. The prosthetic survival rate 5 years after operation was 95.3% (161/169) for revision. Serum cobalt (2.89 μg/L) and chromium (3.31 μg/L) ion levels were significantly increased compared with normal value (<0.5 μg/L). Conclusion For the fixation and friction interface disadvantages, acetabular implant spinout?out and inflammatory pseudotumor might occur for patient receiving large femoral head metal?on?metal THA. The mid?term prosthetic survival rate was also low, with metal ion levels increased significantly. For primary THA, large femoral head metal?on?metal prosthesis cannot be the first choice.