BACKGROUND:The number of complications after hip replacement, such as infection, implant loosening, fracture prosthesis wear, osteolysis, and recurrent dislocation, had drastical y increased. These complications would induce the increased occurrence of total hip revision.
OBJECTIVE:To analyze the causes and treatment measures of revision after total hip replacement. METHODS:The reasons for revision, the prosthesis selection, the treatment of bone defect and the postoperative rehabilitation were discussed in 33 cases after total hip replacement. The prosthesis for revision included general metal ring and lining (21 cases), large head and cup (8 cases), polyethylene cup (4 cases), general femoral components (15 cases, including 11 cases fixed by bone cement), and lengthening femoral components (18 cases, including 9 cases fixed by bone cement and 6 cases of combined components).
RESULTS AND CONCLUSION:Al 33 patients were fol owed up for 24-60 months, averagely 36.5 months. After revision, wound healed perfect, and the prosthesis was reliable. No case suffered from infection or dislocation. Hip joint function was greatly improved. Harris score was increased from 37.1 preoperatively to 91.3 postoperatively. Medium-or short-period clinical fol ow-up results demonstrated that if the indication of revision was right, bone defects were handled perfectly, prosthesis was chosen correctly, one-stage total hip revision can get a good clinical efficacy.

BACKGROUND:Vascularuzed fibular graft is one of the effective methods for repair of large segmental bone defects in the extremities OBJECTIVE:To explore the clinical effects of vascularized fibular graft for repairing large segmental bone defects in the extremities. METHODS:Twenty-eight non-malignant patients who received vascularized fibular graft for repairing large segmental bone defects in the extremities and were folowed up for more than 20 months were enroled. After lesion removal, vascularized fibula bone graft was used to repair the bone defects. If cases combined with soft tissue defects, fibula flap or anterolateral thigh flap was adopted. RESULTS AND CONCLUSION: Al patients were folowed up for 20 months to 6 years. The grafted bones were healed with the surrounding bone at 3-8 months after fibula bone grafting. The grafted bone was enlarged near to the diameter of recipient bone at 10-22 months after grafting. Based on the Enneking system, the average score of large segmental tibia bone defects was 24.2 points with 81% limb function recovered and 94.1% patient satisfaction; the average score of large segmental femur bone defects was 26.3 points with 87.7% limb function recovered and 100% patient satisfaction; the average score of large segmental bone defects of the distal radius and ulna was 21.75 points with 72.5% limb function recovered and 100% patient satisfaction. These findings reveal that vascularized fibular graft for repairing large segmental bone defects in extremities can effectively promote bone healing and reduce disability, infection, amputation rate; moreover, patients are satisfied with the postoperative recovery of limb function.