BACKGROUND:Although cementation of polyethylene liner into a wel-fixed metal shel during the revision surgery has several advantages compared to total acetabular revision, there are some disputes about its clinical outcomes, especialy regarding the re-revision rate and the prosthetic survivorship. OBJECTIVE:To evaluate the clinical outcomes and safety of cementation of polyethylene liner into a wel-fixed acetabular cup in the revision after total hip arthroplasty with retained stable cup. METHODS:Between March 2012 and November 2014, nine patients underwent revision after total hip arthroplasty with cementation of polyethylene liner into a wel-fixed acetabular cup. There were 1 male and 8 females, aged 43.7 years on average. The time was 9.4 years on average from the primary total hip arthroplasty to revision. Harris Hip Score and prosthesis X-ray films were compared after revision. The effects and safety of cementation of polyethylene liner into a wel-fixed acetabular cup were further evaluated. RESULTS AND CONCLUSION:Nine patients were folowed up for 8-37 months. The Harris hip scores before revision was (49.54±18.28) points previously, and (84.82±10.59) points during final folow-up (t=6.377, P < 0.05). One patient had re-revision surgery because of recurrent dislocation. There were not complications in other patients, resulting in failure rate of 11%. These results indicated that polyethylene liner cementation technique is safe and effective when the wel-positioned and wel-fixed acetabular cup retained.

Objective To investigate the feasibility and clinical effect of one-stage total knee arthroplasty for old femoral condyle fractures combined with knee osteoarthritis.Methods From January 2003 to December 2010,11 patients with old femoral condyle fracture combined with knee osteoarthritis,including 4males and 7 females,aged from 38 to 77 years (average,58.3 years),underwent one-stage total knee arthroplasty.There were 8 cases of supracondylar fracture,and 3 cases of intercondylar fracture.Moreover,there were 2 cases of knee fibrous ankylosis with mild amyotrophy,3 cases of collateral ligaments injury of the knee,2 cases of fibrous union,and 2 cases of infective nonunion.Results All patients were followed up for 6 to 72 months (average,41.3 months).The HSS score improved from preoperative 6.65±7.01 (range,0-13)to 88.5±6.18 (range,81-95) at final follow-up.The range of motion of the knee improved from preoperative 32.7°±17.6° (range,0°-50°) to 101.3°±9.8° (range,85°- 115°) at final follow-up.One case underwent knee disarticulation 6 years after operation owing to infection.For other patients,there were no complications such as infection,deep vein thrombosis,knee instability,component loosening and inequality of lower limb.Conclusion One-stage total knee arthroplasty is a technically difficult but effective method for patients with old femoral condyle fracture and knee osteoarthritis.

Objective To study the indication,surgical technique and clinical results of the uncemented hip arthroplasty for unstable intertrochanteric fractures in elderly patients.Methods Twenty-three elderly patients with unstable interthochanteric fractures were treated with uncemented hip arthroplasty,including 6 males and 17 females with an average age of 77.6 years (range,73-95 years).According to the Evans-Jensen classification,there were 2 cases of type ⅡA,9 of type ⅡB,and 12 of type Ⅲ.Osteoporosis was classified according to the Singh index,there were 2 cases of Ⅳ,8 of Ⅲ,12 of Ⅱ and 1 of Ⅰ.Results All patients were followed up with an average of 31 months (range,12-64 months).The average Harris score improved from 33.1 1±6.58 points preoperatively to 87.12±5.05 points at the time of the last follow-up.Radiologically,there were 16 cases of fixation by bone ingrowth; nonunion of lesser trochante fracture was noted in 3 cases; proximal displacement of greater trochante was found in one patient.Intraoperative proximal femoral fracture was encountered in two cases; deep venous thrombosis was found in three cases and one case died of pulmonary embolism.One case who experienced acute left ventricular failure recovered by medical treatment.There was no aseptic loosening,peri-prosthetic infections,dislocation or ectopic ossification.Conclusion The short-term results of uncemented hip arthroplasty in elderly patients with unstable intertrochanteric fractures were satisfactory.

Objective To investigate the surgical methods and clinical effects of total knee arthroplasty (TKA) in patients with severe valgus knee deformity.Methods From January 2007 to December 2012,22 patients with 23 severe valgus knee deformity underwent TKA by means of medial parapatellar approach,standard osteotomy and only lateral soft tissue release with posterior stabilized implants were retrospectively analyzed.They were 7 males and 15 females,aged from 41 to 78 years,with an average age of 65 years.Tibiofemoral angle (angle between the femur and tibia anatomic axis) was 22°-50°,with an average of 34.6±2.4°.Among them,17 cases were osteoarthritis,5 cases were rheumatoid arthritis,3 cases complicated with patella dislocations,1 case complicated with medial instability,3 cases of 4 knees complicated with flexion contracture.Posterior stabilized prosthesis were used in 21 cases of 22 knees,constrained prosthesis were used in 1 case of 1 knee,5 cases accepted intraoperative patellar replacement.Clinical and radiographic evaluations including range of motion (ROM),the Hospital for Special Surgery (HSS)knee score and the tibial and femur angle (T-F angle) were performed at follow-up.Results The duration of follow-up averaged 30.5 months.The average HSS score improved from 19.6±4.7 points preoperatively to 89.7±3.6 points at the time of the last follow up.The average ROM improved from 43.7°-±5.8° preoperatively to 110.6°±7.5°.The average T-F angle was 8.6°±0.8°.We had 5 patella replacements,2 medial instability cured by using articular branches,2 palsies of nervus peroneus communis recovering after 3 months.No complications such as infection,DVT,or component loosening.Conclusion The techniques of medial parapatellar approach,standard osteotomy and only lateral soft tissue release with posterior stabilized implants can deal with a severe valgus knee deformity very successfully in patients undergoing primary total knee arthroplasty,and provide excellent results.

Objective To evaluate the feasibility and clinical results of one-stage total knee arthroplasty in patients with extra-articular deformity and osteoarthritis of the knee. Methods From June 2006 to April 2010, 9 patients with osteoarthritis of the knee and extra-articular deformity underwent one-stage total knee arthroplasty, including 2 males and 7 females with an average age of 51 years (range, 34-69). These deformities were in the tibia in 4 patients and in the femur in 5. The deformity resulted from fracture malunion in 8 cases and dysplasia in one. There were 6 uniplanar and 3 biplanar deformities. The average angle of the femoral deformities was 13.3° in the coronal plane (ranged from 8° to 22°) and 11.3° in the sagittal plane (ranged from 6° to 15°). One femur had a 10° deformity of external rotation. The average angle of the tibial deformities was 16° in the coronal (ranged from 11° to 22°), One was 21° in the sagittal plane. Results The mean follow-up period was 29 months (range, 7-54) after surgery. The average HSS score improved from 18.7 points preoperatively to 89.8 points at the time of the last follow-up. The average arc of knee motion improved from 46.7° preoperatively to 100.6° postoperatively. The average deviation of mechanical axis of knee was improved from 11.8° of excursion preoperatively to 1° of excursion at the time of the last follow-up. One patient had an unsatisfactory clinical result from delayed union at the esteotomy site. No complications such as infection, DVT, ligament instability, patella problem or component loosening. Conclusion One-stage total knee arthroplasty is a technically difiicult but effective treatment for patients with osteoarthritis of the knee and extra-articular deformity. We recommend that if feasible total knee arthroplasty with intra-articular bone resection and soft-tissue balancing for these patients.

BACKGROUND: Studies have shown that the increase of bone resorption in osteoclasts over-activates transforming growth factor beta 1 (TGF-ß1), and uncouples bone resorption and bone formation, ultimately leading to a hardened phenotype of the subchondral bone In an animal model of osteoarthritis. Progression of osteoarthritis can be attenuated by inhibiting TGF-ß1 signaling pathway. OBJECTIVE: To detect whether osteoarthritis progression can be delayed by the local Injection of halofuglnone In Beagle models of osteoarthritis. METHODS: Eighteen male Beagle dogs were randomized into a sham (control) group, a model (osteoarthritis) group, or a treatment (halofuglnone) group. Animal models of osteoarthritis were made by anterior cruciate ligament transection in the latter two groups. Animals In the treatment group were given local injection of halofuglnone (37.8 ng) Into the subchondral bone. Serum levels of type II collagen C-terminal peptide (CTX-II) and type X collagen a1 chain (COLI 0A1) were measured at 4, 8,12, and 16 weeks after modeling. The Beagle dogs were sacrificed at the 16th week after surgery, and the alterations of microarchitecture of the subchondral bone were detected by micro-CT. Articular cartilage degeneration was graded using safranin О and fast green staining combined with the Osteoarthritis Research Society International (OARSI)-modified Manklng criteria. Immunostaining analyses were conducted to detect the expression levels of TGF-ß1 and matrix metalloprotelnase 13. The study protocol was approved by the Animal Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University, with the approval No. IACUC20160304-07. RESULTS AND CONCLUSION: The COL10A1 level In the model group was higher than that in the control group and the treatment group at 8 and 12 weeks after modeling (P< 0.01). The levels of CTX-II in the model group were higher than that in the control group and the treatment group at 8,12, and 16 weeks after modeling (P < 0.05). Micro-CT examination showed that compared with the control and treatment groups, the bone volume fraction of the subchondral bone was Increased in the model group, while the subchondral bone trabecular separation and the trabecular model factor were decreased significantly (all P < 0.05). The OARSI-modified Manking score was significantly higher in the model group than in the control group and the treatment group (both P < 0.01). Immunohlstochemistry results showed that the expression levels of matrix metalloprotelnase 13 and TGF-ß1 In the model group were significantly higher than those In the control group and the treatment group (all P < 0.01). No significant differences in the above-mentioned indexes were found between the control group and the treatment group (all P > 0.05). Overall, local Injection of halofuginon attenuates anterior cruciate ligament transection-lnduced osteoarthritis by inhibiting abnormally elevated TGF-ß1 In the subchondral bone and blocking abnormal bone remodeling. Therefore, local Injection of halofuginon may be a new therapeutic alternative for osteoarthritis.