This paper is a consecutive series of total hip arthroplasties were performed over 6 years period by the same group surgeons utilizing the Charnley method as well as the lateral approach with trochanteric osteo. tomy. Trochanteric reattachment was accomplished in 285 hips and method of reattachment were basically standard Charnley technique which we used in most of our series. In addition, some modification of original Charnley technique which we used in early this trial were also included for this study. As far as trochanteric complications are concerned, there are 18 cases of hips where there was wire breakage, proximal drift of greater trochanter and 6 established cases of nonunion also reported. By the use of wire mash, we have performed a revisional surgery which has re-inforced of the greater trochanter. This was the case when the greater trocyhanter was very osteoporotic. Finally, biomechanical considerations of the re-attachment of the greater trochanter and new Charnley staple clamp method were introduced with review of our cases and analysed for technical failures.
Arthroplasty ; Femur ; Hip ; Methods ; Surgeons

In total hip arthroplasty (THA), the accurate positioning of implants is the key to achieve a good clinical outcome. Computer-assisted orthopaedic surgery (CAOS) has been developed for more accurate positioning of implants during the THA. There are passive, semi-active, and active systems in CAOS for THA. Navigation is a passive system that only provides information and guidance to the surgeon. There are 3 types of navigation: imageless navigation, computed tomography (CT)-based navigation, and fluoroscopy-based navigation. In imageless navigation system, a new method of registration without the need to register the anterior pelvic plane was introduced. CT-based navigation can be efficiently used for pelvic plane reference, the functional pelvic plane in supine which adjusts anterior pelvic plane sagittal tilt for targeting the cup orientation. Robot-assisted system can be either active or semi-active. The active robotic system performs the preparation for implant positioning as programmed preoperatively. It has been used for only femoral implant cavity preparation. Recently, program for cup positioning was additionally developed. Alternatively, for ease of surgeon acceptance, semi-active robot systems are developed. It was initially applied only for cup positioning. However, with the development of enhanced femoral workflows, this system can now be used to position both cup and stem. Though there have been substantial advancements in computer-assisted THA, its use can still be controversial at present due to the steep learning curve, intraoperative technical issues, high cost and etc. However, in the future, CAOS will certainly enable the surgeon to operate more accurately and lead to improved outcomes in THA as the technology continues to evolve rapidly.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Hip ; Learning Curve ; Methods

Although stems improve initial mechanical stability in revision total knee arthroplasty (TKA), ideal indications, proper lengths and diameters, and appropriate fixation methods remain controversial. The topics of the present article include the indications, selection of lengths and diameters, and fixation methods of stems in revision TKA. The use of a stem in revision TKA can protect the juxta-articular bone. A stem cannot be a substitute for optimal component fixation; it plays an adjunctive role in transferring the loads from the compromised metaphysis to the stronger diaphysis. Proper bone surface preparation and appropriate use of the stem based on a great store of knowledge are required to support the stemmed components effectively in revision TKA. The balance between overshielding and overloading the juxta-articular bone would provide excellent structural protection. The stem length and diameter should be tailored according to patients’ anatomical characteristics and determined fixation strategy. There are two traditional methods of stem fixation including the total cementation technique and the hybrid technique with a cementless press-fit stem. Selection of a cementation technique should be based on thorough consideration of advantages and disadvantages of each technique.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Cementation ; Diaphyses ; Knee ; Methods

PURPOSE: We classified fractures of the greater trochanter (GT) and evaluated fracture fragment stability according to GT type. MATERIALS AND METHODS: A total of 43 patients with an unstable intertrochanteric fracture treated between January 2007 and July 2009 with bipolar hemiarthroplasty were included in this study. GT fractures were classified as type A, B, C, or D and fixed using either cerclage wiring alone, cerclage wiring and non-absorbable suture or a greater trochanteric reattachment (GTR) plate. RESULTS: Type A fractures were fixed using cerclage wiring with non-absorbable suture in two cases, cerclage wiring in six cases and GTR plate in seven cases. Failure occurred in three cases of type A fractures treated with cerclage wiring alone. A total of 11 type B fractures were fixed with cerclage wiring (7), cerclage wiring and non-absorbable suture (3) and GTR plate (1). There was no failure of type B fractures. Type C fractures were fixed using cerclage wiring with non-absorbable suture in one case and GTR plate in three. There was no fixation in three cases. Of 10 type D fractures, six were treated with cerclage wiring and one with GTR plate. Fixation was not performed in three patients. There was no failure in type C and D type fractures. CONCLUSION: Fracture fragment stability differed according to fracture types. Cerclage wiring alone was insufficient to fix type A fractures, so type A fracture required a stronger fixation method.
Arthroplasty* ; Femur* ; Hemiarthroplasty ; Humans ; Methods ; Sutures

Kinematical alignment during total knee arthroplasty is an emerging process, and draws more and more attentions from scholars. Knee joint is close to normal joint after TKA through kinematical alighment, which has good clinical results and functional scores, and not increase failure probility. Thus, it may increase joint stress of patella-femur joint, lead to patellar maltracking and increase abrasion. The paper summarized defination and basical principle, operative method, clinical outcomes and deficiency of kinematical alignment during total knee arthroplasty, in order to choose a better way for kinematical alignment during total knee arthroplasty.
Arthroplasty, Replacement, Knee ; methods ; Biomechanical Phenomena ; Humans

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

To contrast the methodology of measuring cup placement precision utilizing Mimics and Matlab programming, based on clinical CT images of primary THA cases with computer assisted navigated surgery (CANS) and with the traditional manual method (MANS). The method was applied and analyzed to measure cup anteversion, cup abduction of 50 clinical cases with CANS and MANSThe results show that, cup placement precision differences exits between primary THA cases with CANS and MANS; more cases with CANS are within the safe zone contrasting MANS, and there was less variation and less placement error in CANS cases. CANS can improve cup placement precision and reduce the chance of dislocation efficiently.
Arthroplasty, Replacement, Hip ; instrumentation ; methods ; Humans ; Surgery, Computer-Assisted ; methods

OBJECTIVETo systematically review the effectiveness of minimally invasive total hip arthroplasty (MIS-THA) versus traditional total hip arthroplasty (THA) in patients with hip diseases.

METHODSThrough a method of combining Free words and keywords,we searched databases including PubMed,The Cochrane Library, EMbase,Web of Science, CBM , CNKI and Wanfang Data for randomized controlled trials (RCTs) on the comparison between MIS-THA and THA for hip disease from inception to June, 2014. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies according to the "bias risk assessment" tool recommended by Cochrane Handbook 5.0 for Systematic Reviews. Then, meta-analysis was performed using RevMan 5.3 software.

RESULTSThirteen RCTs involving 1 213 cases of surgeries and total 1 284 hips (MIS-THA: n = 631; THA: n = 653) were identified. The results of meta-analysis showed that statistically significant differences were found in Harris hip score on the 3rd month after operation [MD = 8.37, 95% CI (6.02,10.72)], Hematocrit [MD = 0.02, 95% CI (0.01, 0.03)] and Hemoglobin [MD = 0.50, 95% CI (0.16, 0.85)] at the 48th hour after operation, changed value of femoral offset [MD = 0.30, 95% CI (0.04, 0.56)] between two groups. In the change value of femoral offset, THA was better than MIS-THA; There were no statistically significant differences between two groups in Harris hip score at 1st year after operation [MD = 3.26, 95% CI (-3.25, 9.76)], WOMAC score [MD = -0.53, 95% CI (-3.67, 2.60)] and Oxford score [MD = 1.34, 95% CI (-3.46, 6.13)] at the 6th week after operation, Hematocrit at the 8th hour after operation [MD = -0.01, 95% CI (-0.02, 0.00)], the incidence of hip varus [RR = 0.82, 95% CI (0.45,1.52)] and dislocation [RR = 1.40, 95% CI (0.48, 4.12)].

CONCLUSIONTHA brings less trauma, less hemorrhage and better early clinical outcome compared with MIS-THA, but the difference of the complication rates between the two groups is similar.

PURPOSE: This study was performed to determine the usefulness of three-dimensional computed tomography (3D-CT) in measuring periacetabular osteolysis by comparing the real volume of osteolysis in revision surgery. MATERIALS AND METHODS: Twnety-three patients who had undergone revision surgery due to periacetabular osteolysis but not included septic osteolysis and implant loosening. The mean age of patients at the time of surgery was 55.2 years. And the mean time interval between the primary total hip arthroplasty and revision surgery was 13.3 years. We measured the polyethylene wear in plain radiographs using computer assisted vector wear analysis program, the volume of acetabular osteolytic lesions in high-resolution spiral CT scans using Rapidia 3D software version 2.8 algorithms before the revision surgery were performed. Intraoperative real osteolytic volume was calculated as the sum of the volumetric increments of the acetabular cup and impacted allo-cancellous bone volume. RESULTS: Strong correlation was found between the volume of acetabular osteolytic lesions measured on 3D-CT and intraoperative real osteolytic volume which was calculated as the sum of the volumetric increments of the acetabular cup and impacted allo-cancellous bone volume. CONCLUSION: 3D-CT is considered a useful method for assessing and measuring the volume of periacetabular osteolysis before revision surgery.
Acetabulum ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Humans ; Methods ; Osteolysis* ; Polyethylene ; Tomography, Spiral Computed

The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.
Acetabulum* ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Classification ; Hip ; Hip Prosthesis ; Life Expectancy ; Methods ; Reoperation ; Transplants