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 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 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.

HSP90, which is the biomarker of cell stress and endogenous protective protein, functions as a molecular chaperone. Many client proteins of HSP90, including EGFR, Met, Raf-1, IKK and p53, play important roles in the occurrence and development of tumor. Binding of HSP90 inhibitors triggers the deactivation of HSP90, resulting in client protein degradation, and hence inhibits the tumor growth by blocking multiple targets involved in signaling of tumor proliferation. This review summarizes recent development of small molecule inhibitors bound to N-terminal of HSP90.
Antineoplastic Agents ; chemistry ; HSP90 Heat-Shock Proteins ; antagonists & inhibitors ; Humans ; Neoplasms ; Signal Transduction

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 investigate the perioperative management,coagulation factor regulation in total knee arthroplasty (TKA) for hemophilia arthritis and evaluate its short-term clinical efficacy.Methods A retrospective study was performed in hemophilia arthritis patients who had undergone TKA from March,2009 to March,2014.Patients with type A hemophilia received Lyophilized Human Factor Ⅷ,and type B hemophilia patients received Prothrombin Complex.Perioperative accurate dosage of coagulation factor was determined by preliminary test.AORI T1,T2 bone defects were filled with PMMA,and severe contained AORI T3 defects were fixed with impaction allograft and screws,and for non-contained AORI T3 bone defects,structural allografts and stem extension may be considered.Knee function was evaluated by HSS score,and imaging change was evaluated by anteroposterior and lateral radiographs of knee at latest follow-up.Results Eight patients (10 knees) were included with a mean age of 38.3±5.0 years,in which 6 were type A,and the other 2 were type B.Preoperative APTT was 63.9±4.0 s,and coagulation factor activity was 2.6％±0.9％.All the patients had flexion deformity with extension of-12.0°±5.9° and flexion of-88.0°± 11.4°.Three patients (3 knees) had valgus deformity with-3.0°±5.4°,and 2 patients (4 knees) had varus deformity with-4.5°±6.0°.All the 8 patients were followed for a mean of 14.3 months.The range of motion was improved with 0°-98.5°±6.7° at latest follow-up,and the postoperative HSS score was 88.3±4.6 compared with 42.3±10.9 preoperatively.Bone-grafting was survival,and no loosening of prosthesis or screws were detected from X-ray at latest follow-up.Conclusion The early results of TKA in Hemophilia arthritis patients are satisfactory.Preoperative preliminary test was helpful to determine the accurate dosage of coagulation factor.A stable high level of coagulation factor was vital to control bone-cement bleeding and make prosthesis stable.Tibial bone defects involving ＜ 1/3 area and ＜ 1 cm in depth could be filled with PMMA,and impaction allograft and screws could be used to fix severe contained bone defects.For segmental bone defects,except of structural allograft,stem extension was recommended to reduce stress and increase stability.

Objective To determine medium-term curative effect of extensively coated non-modular femoral stems in twostage infection revision after joint replacement.Methods We retrospectively analyzed 33 patients (33 hips) who had a two-stage infection revision after total hip replacement arthroplasty from March 2005 to December 2006.Among of them,there were 20 men (20 hips) and 13 women (13 hips).Their mean age was 66.1±7.2 years with a range from 52 to 80.The two-stage revision protocol consisted of joint prosthesis taken out in the first stage,thorough debridement,hand-molded antibiotic bone cement spacer,and two-stage joint revision after anti-infective therapy.Anti-infective therapy included intravenous antimicrobial therapy for 4 weeks and oral antibiotics for 6 weeks.Harris hip score (HHS) was used to evaluate functions of hip joint.X-ray films were used to perform clinical and radiological evaluations of prosthesis stability,displacement and looseness.Reinfection criteria were the same as the criteria used to diagnose the joint infection.Results Follow-up visit was carried out for all patients for 5-9 years (6.1±1.7 years on the average).No infection or prosthesis looseness happened after two-stage revision.Microculture of samples taken during two-stage revision or pathological examination was negative.Harris hip joint score rose to 89.1 ±8.5 in the last follow-up visit from preoperative 42.3±6.5.30 patients achieved stable bone ingrowths and the remaining three had stable fibrous ingrowths.Impacted bone graft at acetabulum side for 11 patients and all impacted bone graft in marrow cavity were fused well with the host bones.Allogeneic cortical bone plate grafts were used in 10 hips on the femoral side.Nine of these cortical bone plates fused with the host bones after postoperative 1 year,whereas one fused after 2 years.Conclusion Using extensively coated non-modular femoral stems combined with intramedullary allograft in two-stage revision for treating infection can achieve satisfactory medium-term survival rate of prosthesis and infection clearance rate.

Objective To explore clinic value of nuclear myocardiac perfusion imaging (MPI) in perioperative coronary risk assessment in patients with heart diseases planning arthroplasty,and compare the conformity and effect on surgery planning between MPI and coronary computed tomography angiogram (CTA).Methods Prospectively collect clinical data of 228 patients with heart diseases planning joint arthroplasty,all patients had MPI and CTA test to assess perioperative coronary risk.The conformity and effect on surgery planning between the MPI and CTA was analyzed,and the occurrence of cardio-vascular complication was recorded.Results MPI showed that 215 patients had no myocardial ischemia except for 13.CTA showed that 113 cases had no coronary stenosis,51 cases had light coronary stenosis,39 cases had middle coronary stenosis and 12 cases had severe coronary stenosis in patients with no myocardial ischemia.CTA also found that 3 cases had no coronary stenosis,4 cases had light coronary stenosis,3 cases had middle coronary stenosis and 3 cases had severe coronary stenosis in patients with myocardial ischemia.The conformity between MPI and CTA was low.222 patients had completed operation except for 6 cases.MPI rather than CTA had conspicuous effect on surgery planning.There was no angina,myocardial infarction or cardiac death associated with myocardial ischemia.The postoperative cardio-vascular complications included 6 cases of heart failure,4 cases of atrial fibrillation and 1 case of cerebral infarction.Conclusion MPI is a direct index to judge blood supply of the myocardium,which can exactly predict the risk of perioperative myocardial ischemia and the prognosis.It's helpful for preoperative planning,reducing risk of perioperative complications through screening and excluding high-risk patients.

Objective To compare adductor canal block with femoral nerve block under multimodal analgesia for early analgesic effect and rehabilitation after total knee replacement (TKA). Methods Eighty patients who were scheduled to undergo TKA were randomly divided into two groups:adductor canal block (ACB) group and femoral nerve block (FNB) group. All the pa?tients were given Celecoxib (200 mg, bid) three days preoperative. The ACB group was given adductor canal block with ropivacaine (5 g/L, 20 ml) and 0.1 mg epinephrine half an hour before the surgery. The FNB group was given femoral nerve block with ropivacaine (3.33 g/L, 30 ml) and 0.1 mg epinephrine half an hour before the surgery. Both of the two groups were given local infiltration analge?sia with ropivacaine (2.5 g/L, 20 ml) and 0.1 mg epinephrine after click into the prosthesis. After surgery, all the patients were given Diclofenac Sodium (50 mg, q12h, p.o.), oxycodone hydrochloride sustained?release tablets (10 mg, q12 h, p.o.) and Parecoxib (40 mg, q12 h, i.m.) until discharged. The resting and motion Numeric Rating Scales (NRS) scores, the knee joint range of motion, the muscle strength of quadriceps femoris, total Meperidine hydrochloride consumption, postoperative hospital stay and the side effects and complications were recorded. Results The resting and motion NRS scores were similar to the ACB group of FNB group which were not statistically significant. The range of motion (1, 2, 3 days after surgery) and muscular strength of quadriceps femofis (within 24 hours) in the ACB group was better than in the FNB group. The average length of postoperative hospital stay was shorter in the ACB group than it was in FNB group. In the ACB group the range of motion at 14 day, total Meperidine hydrochloride con?sumption and the side effects were similar to the FNB group. Conclusion Under multimodal analgesia, the adductor canal block had similar early analgesia effects with the femoral nerve block when TKA was performed. However, compared with FNB, the ACB was more beneficial to patients regarding the early postoperative rehabilitation to patient.

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.