Objective To evaluate the long-term clinical outcomes and survivorship of fixed bearing total knee arthroplasty (TKA) and the risk factor for failure.Methods Between June 1993 and April 2002,285 Chinese patients accepted TKA with cemented fixed bearing platform in our center,and 226 patients (246 knees) were successfully followed up.The age was (62.2±9.4) years at index operation.The survivorship of TKA and the related impact factor were analyzed.The hospital for special surgery (HSS) knee score,range of motion (ROM) and radiological results were studied at the final follow-up.Results One hundred and sixty patients (177 knees) were followed up longer than 10 years.Survival rate was 93.6％±1.7％ at 10years,92.8％±1.8％ at 15 years,with reoperation of the implant as the endpoint.Main reasons for failure were infection and aseptic loosening.There were no statistically difference in survival rate between posterior cruciate ligament retaining and posterior stabilizing group,patellar resurfacing and non-resurfacing,rheumatic arthritis (RA) and osteoarthritis (OA) patients.Meanwhile,RA patients had lower longterm survivorship compared with OA patients.HSS knee score of 96 of the knees increased from 56.58±11.05 preoperatively to 92.29±10.95 postoperatively,and ROM increased from 84.8°±24.0° preoperatively to 99.7°±17.6° postoperatively.Totally,15 knees underwent revision surgery with the relating reason of infection for 10 knees,aseptic loosening for 3,and stiffness for 1 knee.Conclusion Fixed bearing TKA can fulfill satisfactory long-term clinical results,with more than 90％ of 10-year survival rate.The strategy for posterior cruciate ligament,patellar and preoperative diagnosis has no statistically impact on the long-term survivorship.

BACKGROUND: Low back pain and low limb disability are classical symptoms of patients with degenerative lumbar spondylolisthesis who are often treated with operative internal fixation.OBJECTIVE: To observe the improvement of low-back pain and low-limbs disability of patients with degenerative lumbar spondylolisthesis following the treatment with general spine system(GSS).DESIGN: Self control clinical study with patients as subjects.SETTING: Department of Orthopaedics, Peking Union Medical College Hospital.PARTICIPANTS: Sixteen patients with degenerative lumbar spondylolisthesis combined with lumbar stenosis, including 10 males and 6 females with the average age of 58.5 years(ranged from 42 to 72 years) received treatment in our hospital between September 2001 and December 2001. Patients with low back pain were found in 16 cases and low-limb claudication in 15cases; preoperative spondylolisthesis of grade I was observed in 10 cases and grade Ⅱ in 6 cases.METHODS: After receiving lumbar canal decompression by spinal process and GSS for restoring spondylolisthetic vertebra, as well as internalfixation and lumbar fusion operation, patients were followed up at postoperative week 2 and month 1,3,6,12,18,24 for assessing the low-back pain and low-limb disability and meanwhile preoperative spondylolisthesis and postoperative restroration were also assessed with X-ray.RESULTS: Totally 16 patients were followed up for an average of21.2appeared in 15 out of 16 patients, and intermittent claudication resumed to time of follow-up revealed that all spondylolisthetic vertebra were restored with restoring rate of 100% (16/16).CONCLUSION: GSS was proved of satisfactory therapeutic effect in patients with spondylolisthesis by obviously improving their low-back pain and intermittent claudication.

OBJECTIVETo introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes.

METHODSThe preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.

RESULTSPreoperatively, the Cobb's angle on the coronal plane was 55.8 degrees (range 35 degrees to approximately 78 degrees), and 14 degrees postoperatively, with an average correction of 74.8%. The average unfused thoracical curve was 35.9 degrees preoperatively (range 26 degrees to approximately 51 degrees) and 21.8 degrees (10 degrees to approximately 42 degrees) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27.9 degrees and postoperative 25.7 degrees respectively. The trunk shift was 13.4 mm (5 to approximately 28 mm) preoperatively and 3.5 mm (0 to approximately 7 mm) postoperatively. The averaged apic vertebra derivation was 47.8 mm (21 to approximately 69 mm) before operation and 10.8 mm (3 to approximately 20 mm) after operation. The distance of C7 to center sacrum vertical line (CSVL) was 19.5 mm (16 to approximately 42) preoperatively and 11.3 mm (0 to approximately 32 mm) postoperatively. The apical vertebra rotation was 3 degree in 15 patients preoperatively, and were improved to normal in 10 patients, 1 degree in 4 patients, and 2 degree in 1 patients postoperatively. None had neurological injury and infection. Only 1 patient complained a cool feeling in the low extremity of concave side, and the symptom vanished at 3-month followed up.

CONCLUSIONIf used appropriately, TSRH anterior spinal system is a good teatment for low thoracic or thoracic lumbar scoliosis.

Adolescent ; Adult ; Bone Screws ; Child ; Female ; Follow-Up Studies ; Humans ; Internal Fixators ; Lumbar Vertebrae ; diagnostic imaging ; surgery ; Male ; Radiography ; Retrospective Studies ; Scoliosis ; diagnostic imaging ; surgery ; Spinal Fusion ; instrumentation ; Thoracic Vertebrae ; diagnostic imaging ; surgery ; Treatment Outcome

OBJECTIVETo discuss the causes and treatments of wound infections after scoliosis surgery.

METHODSNine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively.

RESULTSAll 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence.

CONCLUSIONWound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.

Adolescent ; Adult ; Anti-Bacterial Agents ; therapeutic use ; Child ; Debridement ; Female ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Scoliosis ; surgery ; Spinal Fusion ; adverse effects ; Staphylococcal Infections ; therapy ; Surgical Wound Infection ; therapy

OBJECTIVETo investigate the treatment of infected total knee arthroplasty (TKA).

METHODSBetween 1983 and 2000, 6 patients with infection after TKAs were treated, including 2 men and 4 women, aged on average 63 years (44 - 75 years). Initial knee arthroplasty was performed for osteoarthritis in 4 patients and for rheumatoid arthritis in 2 knees. The timing of diagnosis of infection after knee arthroplasty averaged 50 months (range, 1 month-11 years). Simple debridement and antibiotic treatment were prescribed for 3 patients, debridement and one-stage reimplantation for 1, debridement and two-stage reimplantation for 1, and athrodesis for 1.

RESULTSOf the 3 patients with simple debridement, one was cured, one failed but underwent athrodesis later, and one lost to follow up. Two patients with reimplantation were cured and had good function recovery. All of the 6 patients were followed up on average for 4 years. No infection recurred except one who lost to follow-up.

CONCLUSIONSManagement of infection after total knee arthroplasty includes antibiotic suppression and debridement with prosthesis retention, insertion of another prosthesis as a one-stage or two-stage exchange technique, knee arthrodesis and amputation. These treatments have specific indications. To treat infection after total knee arthroplasty, suitable method should be taken according to patient's condition. Arthrodesis is the best salvage operation, though it may handicap patients' daily life. Reimplantation of another prosthesis could maintain a functional joint.

Adult ; Aged ; Arthrodesis ; Arthroplasty, Replacement, Knee ; adverse effects ; Debridement ; Female ; Humans ; Infection ; therapy ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Reoperation

OBJECTIVE To clarify whether the thera-peutic effect of escitalopram on depression patients is cor-related with traditional Chinese medicine syndrome types,and to provide a basis for more accurate drug applica-tion.METHODS A total of 235 depression patients were recruited and classified according to traditional Chinese medicine syndrome differentiation into 5 types:liver and qi stagnation(45),liver stagnation and fire transformation(43),liver qi stagnation and spleen deficiency(79),heart and spleen deficiency(20),and liver and kidney deficiency(38).All patients were treated with escitalopram(10 mg·d-1)for eight weeks.The Montgomery Depression Rating Scale(MADRS)and the 17 Hamilton Depression Rating Scale(HAMD-17)were used to score before treatment and 2,4,and 8 weeks after treatment,respectively.RESULTS Compared with before treatment,the MADRS and HAMD-17 scores and remission rates of each syn-drome type significantly improved with increasing medica-tion duration.The MADRS score relief rate of liver and kidney deficiency type was the most significant(69.3%),significantly higher than the other four syndrome types(47.5%-52.6%,P<0.05);The remission rate of HAMD-17 score was significantly higher than that of heart and spleen deficiency(50.7%vs.28.5%,P＜0.05).The remis-sion rate of HAMD-17 score in liver and qi stagnation type(52.2%)was significantly higher than that in liver stagnation and spleen deficiency type(37.0%,P＜0.01)and heart spleen deficiency type(28.5%,P＜0.05).CON-CLUSION Escitalopram may have a more significant therapeutic effect on patients with liver and kidney defi-ciency and liver stagnation depression.This study pro-vides a new approach for the more effective and accu-rate application of traditional Chinese medicine syndrome differentiation in the selection of clinical antidepressants.

BACKGROUNDThe long term outcome of patellar resurfacing in Chinese has not been well described. This study evaluated more than 10-year clinical outcomes and survivorship of patellar resurfacing or nonresurfacing in total knee arthroplasty.

METHODSFrom January 1993 to December 2002, 265 patients accepted total knee arthroplasty in Department of Orthopaedic Surgery, Peking Union Medical College Hospital. Among them, 226 patients (246 knees) were successfully followed up, with 176 knees for patellar resurfacing and 70 knees for nonresurfacing. The survivorship of total knee arthroplasty between two groups and the hospital for special surgery knee score (HSS), patellar score, patellar related complication and radiological results were studied at the latest follow-up.

RESULTSThe HSS knee score increased from 55.9±12.2 preoperatively to 92.0±10.9 postoperatively for patellar resurfacing group and from 56.6±9.9 to 94.2±11.4 for nonresurfacing group after average 11.4-year follow-up. Patellar score increased from 13.93±2.42 preoperatively to 28.33±2.20 for resurfacing group and from 13.55±2.73 to 27.8±2.37 for nonresurfacing group. There was no statistically significant difference for both HSS score, patellar score between the two groups with higher rate of anterior knee pain for nonresurfacing group. Patellar nonresurfacing had higher lateral subluxation than resurfacing group according to radiological evaluation. Patients with rheumatoid arthritis had 5.5 fold patellar related complication than patients with osteoarthritis. The 10-year survival rate was not statistically significant different between the two groups (P = 0.12).

CONCLUSIONSThere was no significant difference of long-term clinical outcome and survivorship between patellar resurfacing and nonresurfacing. Patellar nonresurfacing can be advisable during primary total knee arthroplasty especially in Chinese patients with osteoarthritis. Selective patellar resurfacing for patients with rheumatoid arthritis can achieve lower patella related complication.

Aged ; Arthroplasty, Replacement, Knee ; Asian Continental Ancestry Group ; Female ; Humans ; Male ; Middle Aged ; Patella ; surgery ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo determine the postoperative complications of primary total knee arthroplasty (TKA) within 30 postoperative days, and the different causes for revision surgery during follow-up.

METHODSBetween January 2001 and December 2012, a total of 1 920 patients underwent 2 779 primary TKA with fixed bearing platform in Peking Union Medical College Hospital, with 323 for male and 1 607 for female. The revision surgery at index time and the hemophiliac arthropathy were excluded for this study. The average age was (66 ± 9) years (from 25 to 86 years).Osteoarthritis accounted for 1 720 cases (89.58%), rheumatoid arthritis for 168 cases (8.75%), ankylosing spondylitis for 12 cases (0.63%), secondary arthritis for 20 cases (1.04%). The postoperative complications with 30 postoperative days and revision surgery during follow-up were recorded.

RESULTSFollow-up was concluded at December 2013. Totally, 1 854 patients (2 693 knees) were successfully followed-up.Forty-one patients experienced systemic complication within 30 postoperative days, with the rate of 2.21%. The most common reasons of systemic complication were the respiratory complication and cardiovascular complication in origin, with the rate of 0.49% (9/1 854) and 0.38% (7/1 854) respectively. The average rate of deep venous thrombosis in this group was 3.02% (56/1 854). The local complication rate within 30 days was 1.29% in this group. Totally 59 knees experienced the revision surgeries during average 67 months follow-up. The most common causes for revision surgery in relative values were septic loosening, with the rate of 1.19% (32 in 2 693 knees), followed by postoperative stiffness, with the rate of 0.37% (10 in 2 693 knees).

CONCLUSIONSThe most common reasons of systemic complication with 30 postoperative days after primary TKA procedure are the respiratory complication and cardiovascular complication in origin. The most common reason for revision surgery during mid-term follow-up for primary TKA is septic loosening.

Aged ; Aged, 80 and over ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Knee ; Female ; Follow-Up Studies ; Humans ; Knee ; Knee Prosthesis ; Male ; Middle Aged ; Osteoarthritis ; Postoperative Complications ; Postoperative Period ; Reoperation ; Spondylitis, Ankylosing