How to remove the well fixed cement or cementless prosthesis and get a completely distal cement removal in the rTHR are critical to the outcome of revision. Because of higher rate of union, excellent intraoperative exposure, and adjustment of abductor tension, ETO has been widely applied to rTHR and complicated primary THR by foreign scholars. Furthermore, this technology has wide indications, very few contraindications, high cure rates,and low complications rate. ETO turns out to be a safe and effective revision technology. In the article, the indication, contraindication, complications and advantages of this technique were reviewed.
Arthroplasty, Replacement, Hip ; methods ; Humans ; Osteotomy ; adverse effects ; methods

Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Humans ; Postoperative Complications ; therapy

As an important indicator of total hip arthroplasty (THA) the rate and degree of offset reconstruction play an important role in improving the prognosis and life quality of patients. The reconstruction of femoral offset is closely related to reserved length of calcar femorale, the head and neck length of prosthesis, angle degree of neck shaft and whether lower limb is isometric. Reconstruction strategy includes making a meticulous and standard measurement before the surgery, predicting the reserved length of calcar femorale, selecting a prosthesis with approximate anatomical neck-shaft angle and reconstructing offset by adjusting the head and neck length of the prosthetic during the operation. The aim of this article was to introduce the research progress and influence of offset on hip function, prosthetic wear and postoperative complications such as pain, limp and unequal leg length, and to discuss the reconstruction strategy.
Arthroplasty, Replacement, Hip ; adverse effects ; methods ; Femur ; surgery ; Humans ; Reconstructive Surgical Procedures ; adverse effects ; methods

OBJECTIVETo evaluate the efficacy and safety of tourniquet in total knee arthroplasty.

METHODStudies on comparison between with and without tourniquet in total knee arthroplasty were identified from Medline, PubMed, EMASE, Cochrane Library, CBM, Highwire, CNKI, VIP, Articles Digital Periodicals.All the randomized controlled trials were included for meta-analysis with RevMan 4.2.2 software.

RESULTSNineteen studies involving 15 in foreign languages, 4 in Chinese were identified. There were 1159 cases of knee replacement patients. The results of meta-analysis indicated that there were statistical difference between two groups on intraoperative blood loss (P = 0.000), the number of deep venous thrombosis (P = 0.020), thigh pain (P = 0.000), knee hematoma (P = 0.030), wound infection (P = 0.040), skin ecchymosis area (P = 0.000), and the increasing rate of knee circumference of 3 days after the operation (P = 0.000), while there were no statistical differences with respect to the total blood loss (P = 0.100), the number of blood transfusions (P = 0.150), operation time (P = 0.120), length of hospital stay (P = 0.350), the number of pulmonary embolism (P = 0.310), and skin blisters (P = 0.170).

CONCLUSIONSThe tourniquet for total knee arthroplasty can reduce intraoperative blood loss, but can not reduce total blood loss and the number of blood transfusions transfusion, can not improve operative efficiency, can not shorten the hospitalization time and promote the knee joint functional recovery. Furthermore the tourniquet increases the probability of occurrence on deep vein thrombosis, wound infection, hematoma and ecchymosis knee, it also causes knee swelling and thigh pain. It suggests minimize to use tourniquet in total knee arthroplasty.

Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Humans ; Safety ; Tourniquets ; adverse effects

Objective Total knee arthroplasty is one of the most common orthopedic surgeries. Readmission due to severe complications after total knee arthroplasty is a grave concern to surgeons. In this study, we evaluated the risk factors for severe complications after primary total knee arthroplasty. Methods We retrospectively collected clinical data of 2,974 patients who underwent primary total knee arthroplasty from July 2013 to June 2019 in our hospital. Postoperative complication ≥ grade Ⅲ was defined as severe complication according to Clavien-Dindo classification system. Binary logistic regression was used to identify the predictive risk factors for severe complications. Results The complication rate after primary total knee arthroplasty was 6.8% and severe complication rate was 2.5%. Male (OR = 2.178, 95%CI: 1.324-3.585, P= 0.002), individuals above 75 years old (OR = 1.936, 95%CI: 1.155-3.244, P= 0.012), arrhythmia (OR = 2.913, 95%CI: 1.350-6.285, P= 0.006) and cerebrovascular disease (OR = 2.804, 95%CI: 1.432-5.489, P= 0.003) were predictive risk factors for severe complications after primary total knee arthroplasty. Conclusion Advanced age, male, arrhythmia, and cerebrovascular disease might be patients-related risk factors for postoperative severe complications after primary total knee arthroplasty. Special attention should be paid to patients with risk factors.
Humans ; Male ; Aged ; Arthroplasty, Replacement, Knee/methods* ; Comorbidity ; Retrospective Studies ; Risk Factors ; Postoperative Complications/etiology* ; Arthroplasty, Replacement, Hip/adverse effects*

Total elbow arthroplasty was initially used to manage the rheumatoid arthritis of elbow. With the developement of technology in recent decades, the indication of total elbow arthroplasty include the trauma associated unstable joint, traumatic arthritis and distal humerus fractures in elderly. But the high risk of complications, which includes infection, ulnar nerve deficit and tricep insufficiency, is still an unsolved issue. The most widely used approach nowadays is the Bryan-Morrey approach, while some authors also report triceps on approach recently. This article is an overview in approaches and biomechanical researches of total elbow arthroplasy by reviewing the domestic and overseas involved literatures.
Arthroplasty, Replacement, Elbow ; adverse effects ; methods ; Humans ; Muscles ; physiopathology ; Recovery of Function ; Ulnar Nerve ; injuries

Arthrodesis ; Arthroplasty, Replacement ; adverse effects ; methods ; Contraindications ; Hemiarthroplasty ; Humans ; Metatarsophalangeal Joint ; physiology ; surgery ; Range of Motion, Articular

BACKGROUNDThe imaging evaluation of pain in patients who have had a hip arthroplasty (HA) is challenging, and traditional imaging techniques, including magnetic resonance imaging (MRI) and computerized tomography (CT), are limited by metallic artifact. The purpose of the present study was to investigate the use of modified MRI techniques to visualize periprosthetic soft tissues and the bone-implant interface, and to evaluate the value of MRI for the assessment of patients with painful hip arthroplasty.

METHODSFifty-six painful hips in fifty-six patients following primary HA were assessed using optimized MRI, CT and standardized radiographs. The diagnosis of MRI was correlated with intraoperative findings as well as with microbiological and histological examinations (when available). The sensitivity and the specificity of MRI diagnosis were determined according to final diagnosis. The chi-square test was performed to detect a difference between MRI and final diagnosis.

RESULTSForty-eight patients have received revision surgery and final diagnosis were established. MRI was demonstrated high sensitivity and specificity in detecting aseptic loosening (93% and 95%), periprosthetic infection (94% and 97%), adverse local tissue reaction (100% and 100%) and periprosthetic fracture (100% and 100%). MRI was determined to be the most sensitive technique in detecting implant loosening for any reason, with a sensitivity of 93.8% for acetabular shell and 97.1% for femoral stem, compared to 81.3% and 80.0% on CT, 75.0% and 77.1% on radiographs.

CONCLUSIONSOptimized MRI was effective for the assessment of the periprosthetic soft tissues and bone. The use of modified magnetic resonance imaging parameters provided a useful adjunct to conventional examinations for the evaluation of patients with painful hip arthroplasty.

Arthroplasty, Replacement, Hip ; adverse effects ; Hip Prosthesis ; adverse effects ; Humans ; Magnetic Resonance Imaging ; methods ; Pain ; diagnosis ; etiology ; Prospective Studies

Total wrist arthroplasty are not used as widely as total knee and hip replacement. The functional hands are requiring surgeons to design a durable and functional satisfying prosthesis. This article will list the main reasons that cause the failure of the prosthesis. Some remarkable and representative prostheses are listed to show the devolvement of total wrist prosthesis and their individual special innovations to fix the problems. And the second part we will discuss the part that biomechanical elements act in the total wrist replacement (TWA). Summarize and find out what the real problem is and how we can find a way to fix it.
Arthroplasty, Replacement ; adverse effects ; methods ; Biomechanical Phenomena ; Humans ; Joint Instability ; therapy ; Joint Prosthesis ; adverse effects ; Wrist Joint ; surgery

A goal of total knee arthroplasty is to obtain symmetric and balanced flexion and extension gaps. Controversy exists regarding the best surgical technique to utilize to obtain gap balance. Some favor the use of a measured resection technique in which bone landmarks, such as the transepicondylar, the anterior-posterior, or the posterior condylar axes are used to determine proper femoral component rotation and subsequent gap balance. Others favor a gap balancing technique in which the femoral component is positioned parallel to the resected proximal tibia with each collateral ligament equally tensioned to obtain a rectangular flexion gap. Two scientific studies have been performed comparing the two surgical techniques. The first utilized computer navigation and demonstrated a balanced and rectangular flexion gap was obtained much more frequently with use of a gap balanced technique. The second utilized in vivo video fluoroscopy and demonstrated a much high incidence of femoral condylar lift-off (instability) when a measured resection technique was used. In summary, the authors believe gap balancing techniques provide superior gap balance and function following total knee arthroplasty.
Arthroplasty, Replacement, Knee/adverse effects/*methods ; Fluoroscopy/methods ; Humans ; Knee Joint/physiology/surgery ; Surgery, Computer-Assisted/methods ; Treatment Outcome