0.05).[Conclusion]Elbow with fork-like arthroplasty gives good and excellent outcomes in most elbows with different diseases and can provide satisfactory improvement in elbow function for deseased elbows.

BACKGROUND:There are many reports on the clinical effect of total knee arthroplasty in the treatment of advanced rheumatoid arthritis, but the reports on the effect of total knee arthroplasty on the disease activity in patients with rheumatoid arthritis are rare. Therefore, the more clinical evidences are needed for supporting.
OBJECTIVE:To explore the effect of total knee arthroplasty on disease activity in patients with rheumatoid arthritis.
METHODS:109 patients with rheumatoid arthritis were included;48 cases in the replacement group, and received total knee arthroplasty combined with internal medicine medications;the 61 cases in the drug treatment group were treated with simple internal medicine medications. The rheumatoid factor, blood sedimentation rate and C-reactive protein levels of the patients in two groups were measured before treatment, 1 and 2 years after treatment, and the Ishikawa joint function scoring criteria was used to assess the functions.
RESULTS AND CONCLUSION:There were no significant differences in the rheumatoid factor, blood sedimentation rate and C-reactive protein levels between two groups before treatment (P>0.05). At 1 and 2 years after treatment, the indicators in the drug treatment group were higher than those in the replacement group (P<0.05);the indicators in the two groups at 2 years after treatment were significantly lower than those before treatment (P<0.05). The rheumatoid arthritis symptom scores of the affected joints of the patients in two groups were significantly improved, especial y the pain, swel and subjective attitudes, and the replacement group was better than the drug treatment group (P<0.05). The total knee arthroplasty can affect the disease activity of rheumatoid arthritis in short-term, and the effect of total knee arthroplasty is better than simple drug treatment.

Objective To probe the difference in outcome between genders treated by a modern unisex design of total knee replacement. Methods Eighty OA patients treated with unilateral total knee replacement between January 2001 and December 2004 were evaluated retrospectively. There were 40 patients in male and female group each.The inclusion criteria included:age ranged from 53 to 77 years;The flexion deformity was less than 40 degrees, the genu varum or genu valgum deformity was less than 20 degrees. Patients who had a diagnosis other than primary osteoarthritis and who had had previous open knee surgery were excluded. There were 20 patients treated with posterior cruciate ligament-retained mobile-beating prosthesis and 20 patients treated with posterior stabilized fixed-bearing prosthesis in each group. The patients were assessed clinically with use of American Knee Society score (KSS score). Results All patients were followed up, with the mean time of 6.3 years. At the final follow-up, the improvement of KSS knee score was 34.87±27.14 in males and 30.23±26.13 in females (U=0.78, P=0.0519). The improvement of KSS function score was 21.45±19.47 in males and 22.79±17.31 in females (U=0.2, P=0.1635).There was no difference between the genders in terms of improvement in the knee function score and function score. Conclusion There was little difference in outcome between the genders treated by a modem unisex design of total knee replacement in this study.

Objective To analyze the evolution of acetabular morphology changes of different Crowe types among adults with developmental dysplasia of the hip through standard hip 3D CT reconstruction.Methods From June 2010 to January 2013,there were 62 patients with 68 hips (8 hips of 6 male cases,56 female cases of 60 hips) diagnosed as acetabular dysplasia in our hospital,with an average age of 53.7±5.8 years old (range,47-59 years).According to Crowe classification,there were 14 cases (17 hips) of Crowe type Ⅰ,17 cases (17 hips) of Crowe type Ⅱ,15 cases (17 hips) of Crowe type Ⅲ,and 16 cases (17 hips) of Crowe type Ⅳ.Through standard hip 3D CT reconstruction,Harris nest in the pelvic side 3D image was marked,and the coronal and horizontal position of acetabular rotation center was determined by using the cross axis; secondly,in the anteroposterior 3D image (by gray level adjustment to the shape of X ray perspective effect) through Ranwant triangulation,sagittal position of the center of rotation of the hip joint was determined; finally,the acetabular rotation center in the acetabular horizontal reconstruction plane.The bone stock of anterior and posterior columns of acetabular was observed and acetabular anteversion,front cover angle,rear cover angle and medial wall thickness were measured.Results 1) With Crowe type increased,acetabular anteversion angle gradually increased as well,and there was a positive correlation between them with statistically significant (P＜0.05) except in Crowe Ⅰ and Ⅱ group.2) With Crowe type increased,anterior acetabular coverage angle was significantly decreased; the mean anterior acetabular coverage angle of Crowe Ⅲ and Ⅳ groups was less than 50°.3) With Crowe type increased,posterior acetabular coverage angle was decreased significantly as well the mean posterior acetabular coverage angle of Crowe Ⅲ and Ⅳ groups was less than 90°.4) With Crowe type increased,acetabular medial wall thickness was increased significantly.Conclusion Adult acetabular morphology changes between different Crowe types in patients with developmental dysplasia of the hip.For acetabular reconstruction of Crowe Ⅰ and Ⅱ,we could make full use of the acetabular bone stock of anterior and posterior column; for acetabular reconstruction of Crowe Ⅲ and Ⅳ,we could moderately shift the acetabular center superiorly and (or) medially.

Eleven patients underwent acetabulum revision using modified anterolateral approach due to acetabulum loosening but femoral prosthesis in sound fixation following total hip arthroplasty in Department of Joint Surgery,Tianjin Hospital between August 2002 and February 2005. During the mean follow-up of 4.2 years,all 11 patients gained primary stable fixation and good function. One patient underwent another revision due to infection; one developed femoral prosthesis loosening and underwent femoral revision. X-ray of the other patients showed no loosening or dislocation or radiotransparent region surrounding the prosthesis. One patient developed lateral femoral cutaneous nerve injury and relieved 6 months later.

From February 2002 to May 2007,9 cases(9 hips) of periprosthetic fractures during the primary total hip arthroplasty for developmental dysplasia of the hip were selected,including 1 male and 8 females aged 52-69 years.In the primary total hip arthroplasty,femoral prosthesis with the same size as intramedullary reamer and acetabular prosthesis with 2 mm diameter larger than acetabular reamer were used.The pain,function,range of motion and degree of deformity were accessed using the Harris score.The patients were followed for 1-6 years.Among the 9 patients with periprosthetic fractures,4 acetabular fractures were stable which were treated by additional augmentation screws,and 1 fracture was unstable which was treated by structural bone grafting and additional screws.And there was one Vancouver type AG fracture which was treated by cerclage wire,3 Vancouver B1 fractures which were fixed by locking compression plate(LCP) or cerclage wire,and one Vancouver type C fracture which was also fixed by LCP.No component loosening or migration was found in the postoperative X-ray.The mean Harris score was 87.2 at the final follow-up.The results of the study show that during the primary total hip arthroplasty in patients with developmental dysplasia of the hip,the oversize of the acetabular component should be controlled to equal to or less than 2 mm.For patients with severe osteoporosis,acetabular components with the same size to reamer are recommended combined with additional screws,or cemented cup.When an acetebular fracture is found during total hip arthroplasty,we could use additional screws or bone grafting.Once a periprosthetic femoral fracture occurs during the operation,methods of fixation should be selected based on the type of the fracture and stability of the prosthesis.

Objective To investigate relationship between polyethylene wear and decrease of femoral offset after total hip arthroplasty (THA).Methods Ninety patients who had undergone unilateral THA were recruited in this study.Coreldraw 12.0 software was used to measure change of femoral offset on the basis of immediate anteroposterior radiographies of bilateral hip after THA.In the light of the decreasing value of femoral offset (F),all patients were equally into 5 groups:F＜2 mm,2≤F≤4 mm,4＜F≤6 mm,6＜F≤8 mm and 8＜F≤ 10 mm.At final follow up,some parameters about polyethylene wear were measured by using Coreldraw 12.0 software on the basis of anteroposterior radiographies of bilateral hip.Results The linear wear volume was 0.72±0.13 mm in group F＜2 mm,0.78±0.11 mm in group 2≤F≤4 mm,0.87±0.09mm in group 4＜F≤6 mm,0.99±0.09 mm in group 6＜F≤8 mm,and 1.17±0.15 mm in group 8＜F≤10 mm.The linear wear rate was 0.132±0.025 mm/yr in group F＜2 mm,0.139±0.019 mm/yr in group 2≤F≤4 mm,0.159±0.029 mm/yr in group 4＜F≤6 mm,0.183±0.032 mm/yr in group 6＜F≤8 mm,and 0.213±0.023 mm/yrin group 8＜F≤ 10 mm.The linear wear angle was 5.0°±3.5° in group F＜2 mm,3.2°±3.8. in group 2≤F≤4mm,-4.3°±4.9° in group 4＜F≤6 mm,-8.7°±4.1° in group 6＜F≤8 mm,and -13.0°±4.7° in group 8＜F≤ 10mm.For three parameters above,there were significant differences between groups,except between group F＜2 mm and group 2≤F≤4 mm.Conclusion The femoral offset should be restored to its anatomic status in THA to avoide superior lateral displacement of center of the femoral head,which could result in uneven stress distribution and increase polyethylene wear.

Objective To investigate the preliminary clinical outcome following PCL-retaining total knee arthroplasty (TKA) with 0°or 5°posterior tibial slope. Methods From Jan 2008 to Mar 2009, 84 patients (84 knees) with osteoarthritis (OA) underwent primary PCL-retaining TKA operations by the same surgical team. Among them, 27 patients (7 males, 20 females, with the average age of 69.5 years) underwent TKA using a cutting block and intramedullary cutting guide designed to impart a 5° posterior tibial slope (group A); 57 patients (15 males, 42 females, with the average age of 67.4 years) underwent TKA using a cutting block and intramedullary cutting guide designed to impart a 5°posterior tibial slope (group B). The preoperative demographic data and functional data had no statistical differences. The postoperative tibial posterior angle, maximum extension, maximum flexion and Knee Society Score (KSS) were compared between the two groups. Results All patients were followed up 12～24 months with an average of 15.7 months. No paralysis, wound infection, prosthesis dislocation and loosening were found. The postoperative tibial posterior angle was 5.7°±2.1° in group A and 0.9°±0.6°in group B (P＜ 0.05). The postoperative maximum extension was 0.8°±0.3°in group A and 1.2°±0.4°in group B (P ＞0.05). The postoperative maximum flexion was 115.7°±4.8°in group A and 101.1°±5.6°in group B (P＜ 0.05). The postoperative KSS was 87.6±5.9 in group A and 83.3±7.2 in group B (P ＞0.05). Conclusion Increasing tibial posterior slope improved the postoperative maximum flexion, but not the maximum extension and KSS, in PCL-retaining TKA.