Objective To explore the risk factors of collapse of osteonecro si s of the femoral head (ONFH) with a retrospective study, and put forward a treat ment protocol according to this study results. Methods From October 1993 to Apri l 2000, 40 cases (56 hips) were followed-up. The term of follow-up ranged from 1 2 to 68 months (average 29.2 months). The age of patients was from 16 to 60 year s old (average 36.8 years old). Preoperatively, the AP and frog view X-ray film, coronal and sagittal MRI were taken. The staging of ONFH proposed by ARCO was a dopted. Clinically the Harris score was used to assess the clinical outcome. The patients were divided into three groups: 1) Non-operative: 10 cases (14 hips), stage Ⅰin 7 hips(ⅠA 4,ⅠC 3),stageⅡin 7 hips (ⅡA 1,ⅡB 3,ⅡC 3); 2) Core dec ompression with vascularized iliac bone graft (VICBG): 18 cases (24 hips ), stag eⅠin 6 hips (ⅠB 4,ⅠC 2), stageⅡin 16 hips (ⅡA 4,ⅡB 8,ⅡC 4), stageⅢ in 2 hips (ⅢA); 3) Transtrochanteric rotational osteotomy(TRO): 12 cases (18 hips), stageⅡin 1 hip (ⅡC), stageⅢ in 17 hips (ⅢA 8, ⅢB 7,ⅢC 2). Harris score was 46 to 82 (mean 62.9). Results Collapse of the femoral head occurred in 9 hips a mong the 14 hips in the nonoperative group, in 10 hips among the 24 hips in the VICBG group. In TRO group, further deterioration was prevented in all but one hi p. Whether theres surgical intervention or not, no collapse occurred in both s tageⅠA and ⅡA, collapse occurred in both stage ⅠB and ⅡB was 7 hips among 15 hips (46.7%), 13 hips progressed into collapse of the femoral head with ⅠC and ⅡC (100%). The Harris score was 47 to 93(mean 77.4) postoperatively. Conclusio n With MR imaging, it is possible to predict the possibility of collapse of ONFH . The lower risk is below 30 percent of necrotic area, the higher risk is 30 to 60 percent of necrotic area, and the higherest risk is beyond 60 percent of necr otic area. The best results can be obtained if selection of treatment individual ly according to ARCO stage, patient age and necrotic extent.

Objective To explore the value of the percentage of necrotic surface area in predicting collapse of osteonecrosis. Methods 15 hips of avascular necrosis of the femoral head(ANFH) in 9 patients underwent MRI scan. On the MRI films, the percentage of necrotic surface area were calculated. While on the specimens of the 15 hips, the percentage of necrotic surface area were also measured. In 16 hips of 8 patients of ANFH with serials MRI at mean 18.9 months intervals (range, 6-41 months), the percentage of necrotic surface area were calculated and compared. In 38 hips of 27 patients without collapse, the percentage of necrotic surface area and the index of necrosis were calculated on MRI films. Follow-up was terminated when crescentic sign illustrated on X-ray film or CT demonstrated articular facet collapse. Those hips without collapse were followed up more than 24 months. The value of the percentag of necrotic surface area and the index of necrosis in predicting collapse of osteonecrosis was observed. Results The percentage of necrotic surface area were 63.23%?10.16% on specimens and 63.60%?7.78% on MRI films respectively. There were no significant differences between them. The percentage of necrotic surface area on specimens were coincidence with those on MRI. In the 16 hips with serials MRI; the percentage of necrotic surface area were 52.37%?19.91% on the first MRI films, 51.70%?21.29% on the second. There were no significant differences between them. This result revealed that the percentage of necrotic surface area did not vary with the extension of course of disease. In the 38 cases of early necrosis, 28(73.7%) hips collapsed and 10(26.3%) hips did not. The relative risk of the percentage of necrotic surface area was 1.043, and the relative risk of the index of necrosis was 1.020. No significant difference was found in ARCO staging for patients with or without femoral head collapse. It demonstrated that whether ischemic necrotic femoral head collapse or not had no relation with its ARCO stage. Conclusion The percentage of necrotic surface area can be used as more accurate predictor for future collapse.

[Objective]To explore the causes and treatments of recurrent dislocation after total hip replacement.[Method]From July 1999 to January 2007,there were 47 cases of dislocation after total hip replacement.Thirteen cases were recurrent.CT and serial X-rays were taken to observe the position of prosthesis.The strength of their hip abductor was also tested.Stability test was used to value the stability of hip.Closed reduction,modular adjustments and revision were adopted according to patients,willingness,prosthesis and stability.[Result]All of the 13 patients had malposition.Eleven cases were tested with instability.Five cases were successfully treated by closed reduction.Despite dislocation reoccurred 1～2 times every year in 3 patients treated by closed reduction,patients felt satisfactory.In the 4 cases with modular revision procedure,2 cases changed the neck length,1 case used elevated liner and larger neck length,1 cases treated by using larger offset and adjusting abnormal liner.Another one treated by revision.[Conclusion]Malposition is the major causes of recurrent dislocation.The prosthesis test whowed instability.The treatments of recurrent dislocation after THA should use different ways according to the causes of dislocation,stability of prosthesis and the willingness of patients.

Objective To investigate the clinical diagnosis and the results of arthroscopic treatment for acetabular labrale tears. Methods From November 2008 to December 2009, 21 patients with unilateral acetabular labrale tears underwent hip arthroscopy were entered in the study, including 9 males and 12 females with an average age of 37.1 years. Physical examination, X-ray examination and magnetic resonance arthrography (MRA) were carried out preoperatively to make the definite diagnosis. Of 21 cases, including labrale debridement in 14 cases, labrale debridement plus femoral osteoplasty in 5 cases and labrale repair plus osteoplasty in 2 cases. Patients were followed-up either by telephone inquiring or out-patient interview.The visual analogue scale (VAS) and Harris hip score were recorded before operation and 6 months after operation respectively. Results All 21 patients showed a positive Fadir impingement sign on the affected hips,meanwhile 15 cases showed a positive Fabir impingement sign, and positive McCarthy test was observed in 9cases. X-ray film showed 11 cases have cam type impingement, among which 6 combined with pincer type impingement. Two cases had acetabulum retroversion alone. On MRA images, signals of contrast agent infiltration in anterior superior quadrant which indicated labrale tear were observed among all cases. All labrale tears were confirmed under arthroscopy. All patients were followed up for average 11.6 months (range, 6-19).The symptoms were obviously released after operation. The VAS decreased from (5.3±1.3) preoperatively to (1.4±-0.9) 6 months postoperatively. The mean Harris hip score improved from (63±9) preoperatively to (84±10) 6 months postoperatively. All the differences had statistical significance. Conclusion Acetabular labrale injury has a close correlation with femoroacetabular impingement. Impingement test and MRA have a high sensitivity and accuracy on clinical diagnosis of labrale tears. Arthroscopic debridement, repair and osteoplasty for labrale tears give a good early outcomes.

ObjectiveTo evaluate the effectiveness of mesenchymal stem cell (MSC) in osteonecrosis of the femoral head defect(ONFH) repair. MethodsAniaml model of ONFH defect were established with rabbits, which were divided into 3 groups,group A did not infill anything as control, nano Hydroxyapatite/collagen(nHAC) as group B,nHAC+MSC as group C.Histology change were investigated 4,8,12 weeks after operation respectively.Results groups B and C were different with group A. The difference between groups A and C was more significant. ConclusionMesenchymal stem cell has a strong activity of osteoconduction,it has a value in repairing the bone defect of ONFH and the treatment of ONFH.

Objective To investigate the feasibility and accuracy of volumetric measurement of necrotic lesion using CT and MRI,and to assess the value of necrotic lesion volume in predicting collapse of the femoral head in patients with avascular necrosis of the femoral head(ANFH). Methods Comparison among CT,MRI and gross section was performed in 25 femoral heads of 18 patients who underwent total hip replacement for established ANFH.The volume of necrotic lesion was measured using fluid displacement.CT and MRI data were transferred to a computer to calculate the volume of necrotic lesion using software.One way ANOVA was used to compare the volumes of necrotic lesion measured by CT,MRI and gross section.A total of 62 patients (92 hips) who were diagnosed with ANFH but without collapse by CT were followed up 24 months.Student t-test was used to compare the ratio of the volumes of the necrotic lesion and entire femoral head in the hips with and without collapse and ROC curve analysis was carried out.Results CT and MRI coincided with gross section in the necrotic area,proliferative area and extralesional area.The volumes of the necrotic lesion measured by CT,MRI and gross section were ( 20.5 ± 5.2 ),( 21.4 ± 4.8 ),( 20.9 ± 5.2 ) cm3,respectively.There was no significant difference among the necrotic volumes measured by the three methods(F =0.185,P =0.831 ).In fifty-seven out of 92 hips,collapse of the femoral head occurred during the follow-up.The ratio of the volumes of the necrotic lesion and entire femoral head was higher in hips with collapse than in hips without collapse[ (34.5 ±9.3)％ vs.(23.4 ±8.4)％ ;t =5.749,P=0.000].The area under the ROC curve was 0.808. Conclusions The volume of the necrotic lesion plays an important role in the collapse of femoral head in patients with ANFH.Both CT and MRI can identify the shape and location of the necrotic lesion intuitively and stereospecifically and can determine the volume of the necrotic lesion accurately.

OBJECTIVETo analyze the gross features of articular cartilage wear in varus knee osteoarthritis, and discuss the risk factors for lateral compartmental cartilage erosion.

METHODSData prospectively collected from the dissection of 286 total knee arthroplasties (223 patients) with varus knee osteoarthritis from January 2013 to December 2013 were analyzed. At the operation, the gross assessments of articular cartilage, ligament and meniscus were recorded, and then the slices were evaluated for histologic analysis. Parameters of the patients with lateral compartmental cartilage erosion were compared with those without lateral compartmental cartilage erosion using the univariate analysis. Logistic regression analysis was used to analyze the risk factors associated with lateral compartmental cartilage erosion.

RESULTSThere were 223 patients with 286 knees were included,including 37 male patients (47 knees) and 189 female patients (239 knees), with an average age of (66±8) years (range 50-86 years), body mass index (BMI) was (27±5) kg/m2 (18.0-40.0 kg/m2). Varus degree was 8°±4° (1°-34°). Range of motion was 103°±21° (0°-143°), and Hospital for Special Surgery (HSS) score was 53±12 (29-76). Seventy-five knees (60 patients) showed lateral compartmental cartilage wear (26.2%). Environmental factors showed no differences in age, side, gender, BMI, range of motion,and HSS score (P>0.05). Factors significantly increasing the risk of lateral compartmental cartilage wear by univariate analysis included varus degree, activity level, duration of onset, meniscus, Weidow grade, Kellgren-Lawrence grade, collateral ligament and anterior cruciate ligament (P<0.05). Multiple Logistic regression analysis revealed the factors most highly associated with the increase risk for lateral compartmental wear were high activity level (OR=2.843, 95% CI: 1.010-8.002) and longer duration of onset (OR=1.216, 95% CI: 1.115-1.325). However, intact lateral meniscus (OR=0.012, 95% CI: 0.003-0.048) and anterior cruciate ligament (OR=0.406, 95% CI: 0.192-0.857) were associated with the protection of lateral compartmental.

CONCLUSIONSIn varus knee osteoarthritis, the wear incidence of lateral compartmental is low. High activity and increased duration of onset are risk factors of lateral compartmental wear, and intact meniscus and anterior cruciate ligament are protective factors.

Aged ; Aged, 80 and over ; Anterior Cruciate Ligament ; Arthroplasty, Replacement, Knee ; Body Mass Index ; Cartilage, Articular ; pathology ; Female ; Humans ; Knee Joint ; Male ; Menisci, Tibial ; Middle Aged ; Osteoarthritis, Knee ; pathology ; Prospective Studies ; Range of Motion, Articular ; Risk Factors

Objective To evaluate the short-term efficacy,safety and impact on the quality of life of anlotinib in third-line and above treatment for advanced non-small cell lung cancer (NSCLC) patients.Methods All the patients received alotinib 12 mg/d.One cycle was defined as 2 weeks on-treatment followed by 1 week off-treatment until disease progression or treatment intolerance.Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 was used to assess tumor responses.Common Terminology Criteria for Adverse Events (CTCAE) 4.02 was used to assess the adverse events.The European Organization for Research on Treatment of Cancer (EORTC) QLQ-C30 and QLQ-LC13 were used to assess quality of life.Results Among 27 patients in study,no complete response (CR) was found,2 patients (7.4％) achieved partial response (PR),16 patients (59.3％) achieved stable disease (SD),9 patients (33.3％) achieved progressive disease (PD),objective response rate (ORR) was 7.4％,and disease control rate (DCR) was 66.7％.The scores of physical functioning (76.00 ± 10.55 vs.64.44 ± 11.59),emotional functioning (81.67 ± 8.71 vs.76.11 ±6.71) and global health status (48.87 ±7.97 vs.40.56 ± 12.49) of the QLQ-C30 scale after treatment were higher than those before treatment,with statistically significant differences (t =-4.516,P ＜0.001;t=-2.646,P=0.019;t=-3.872,P=0.002).Fatigue (50.37±8.95 vs.40.74±13.86),nausea and vomiting (26.54 ± 16.18 vs.14.20 ± 11.97),loss of appetite [M(QR):33.33 (33.33) vs.33(33.33)] were better than before (t =-2.476,P =0.027;t =-5.036,P ＜0.001;Z =-2.923,P =0.003);pain (28.88 ± 14.23 vs.33.33 ± 13.60) and dyspnea [33.33 (33.33) vs.33.33 (66.67)] scores were lower than before (t =3.674,P =0.003;Z =-3.266,P =0.001).The scores of cough (24.44 ±19.12 vs.45.24 ±20.34),shortness of breath [11.11(22.22) vs.33.33(22.22)] and chest pain [0.00(33.33)vs.33.33 (33.33)] in the QLQ-LC13 scale after treatment were lower than those before treatment,with statistically significant differences (t =4.000,P =0.001;Z =-4.125,P ＜0.001;Z =-1.890,P =0.034);the scores of sore mouth or tongue [0.00(33.33) vs.0.00(0.00)] and hands and feet tingling [33.33(33.33) vs.0.00(0.00)] were higher than before (Z=-2.000,P=0.046;Z=-2.264,P=0.024).Common adverse reactions included hypertension,fatigue,elevated thyroid stimulating hormone,proteinuria,hand-foot syndrome,oral mucositis,hemoptysis,etc,mainly grade 1-2,and they were all improved after the treatments.Conclusion Anlotinib as a third-line and further therapy is positive effected and well tolerated.It can alleviate the clinical symptoms and significantly improve the quality of life of NSCLC patients.

OBJECTIVETo study the outcome and surgical technique of patello-femoral joint arthroplasty (PFJ) for osteoarthritis of the knee.

METHODSFrom January 2010 to June 2012, 17 patients (24 knees) with patello-femoral compartmental osteoarthritis treated by PFJ were reviewed retrospectively. There were 2 male patients (4 knees) and 15 female patients (15 knees), with an average age of (64 ± 9) years (52-77 years) . The mean body mass index was (24 ± 3) kg/m² (18.0-30.1 kg/m²) . Patients were asked to return for follow-up examinations at 3, 6 months and at every year after PFJ. The range of motion (ROM), visual analogue scale(VAS), Hospital for Special Surgery score (HSS score) , Feller patella score, quadriceps muscle strength were evaluated before and after PFJ. The paired sample t-test and one-way analysis of variance (ANOVA) with replicate measures were used to determine whether there were statistically significant differences between the mean data.

RESULTSAll of the patients were followed up for 18-47 months, with a mean time of (29 ± 10) months, 75.0% patients were satisfied with the outcome of this surgical procedure 1 year postoperative, and 87.5% were satisfied 2 years postoperative. HSS score was increased from 61 ± 11 to 90 ± 6 at the final follow-up (t = 12.24, P = 0.000). VAS score was reduced from 6.7 ± 1.0 to 2.4 ± 1.0 (t = 15.84, P = 0.000). The mean post-operative ROM of the knees was 126° ± 7° (t = 3.25, P = 0.003). Feller patella scores were 18.0 ± 3.2 before operation, and 18.5 ± 4.5, 19.7 ± 3.4, 24.0 ± 3.8, 26.0 ± 3.3, 26.6 ± 2.5 at 3, 6, 12, 24 months after operation, final follow-up, respectively. Quadriceps muscle strength were 3.9 ± 0.5 before operation, and 3.7 ± 0.5, 3.9 ± 0.5, 4.2 ± 0.5, 4.3 ± 0.5, 4.3 ± 0.5 at 3, 6, 12, 24 months after operation, final follow-up, respectively. Repeated measures ANOVA found significant time effects for Feller patella scores (F = 38.97, P = 0.000) and quadriceps muscle (F = 6.89, P = 0.000). Feller patella scores and quadriceps muscle strength were low at 3, 6 months after operation, with no significant differences compared with pre-operation data (P > 0.05). The improvements of Feller patella scores and quadriceps muscle strength after 6 months were of significant difference compared with pre-operation and postoperative 6 months data (t = 5.65-10.65 and t = 2.18-2.73, P < 0.05) . Three knee reported continuing pains with quadriceps muscle strength less than 4 level.

CONCLUSIONSPFJ is an effective method for patello-femoral compartmental osteoarthritis with less trauma. The early term outcome of PFJ is encouraging. Quadriceps muscle strength should be enhanced.

Aged ; Arthroplasty, Replacement, Knee ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Patellofemoral Joint ; surgery ; Retrospective Studies ; Treatment Outcome

BACKGROUNDThe incidence of total hip replacement in the younger and more active patients is ever increasing. The ceramic-on-ceramic (COC) bearing was developed to reduce wear debris-induced osteolysis and loosening and to improve the longevity of hip arthroplasties. Few studies have reported the clinical results and complications of the new zirconia-toughened ceramic total hip arthroplasty (THA).

METHODSA consecutive series of 132 young patients (177 hips) that underwent primary cementless THAs between January 2010 and December 2012 were included in this study. These arthroplasties all had fourth-generation COC bearings performed through a posterolateral approach. The average age was (41.8 ± 8.3) years (ranging from 22 to 55 years), and the mean follow-up period was (24.5 ± 9.4) months (ranging from 12 to 47 months). The results were evaluated both clinically and radiographically. Harris hip score (HHS) was determined before surgery and at the time of each follow-up. Presence of postoperative groin or thigh pain and squeaking were recorded. Other complications such as dislocations, periprosthetic fractures, and ceramic components fractures were diagnosed and treated in emergency.

RESULTSThe average HHSs improved from preoperative 60.3 ± 10.7 (ranging from 29 to 76) to 91.0 ± 5.1 (ranging from 74 to 100) at the final follow-up (t = 45.064, P < 0.05), and 97.7% of cases were scored as excellent and good results. At the last follow-up, incidental inguinal pain was found in three hips (1.7%) and thigh pain in 11 hips (6.2%). Radiographs showed a high rate of new bone formation around the acetabular and stem components. No obvious osteolysis or prosthesis loosening was detected. Complications occurred in six hips (3.4%): posterior dislocation in two hips (1.1%), periprosthetic femoral fracture in one hip (0.6%), asymptomatic squeaking in two hips (1.1%), and ceramic liner fracture in one hip (0.6%).

CONCLUSIONSThe fourth-generation COC THA showed excellent clinical results in younger active patients with no osteolysis-related prosthesis failure at a short-term follow-up study. Surgeons should still be aware of the potential risks of complications such as dislocation, periprosthetic fracture, squeaking, and ceramic components fracture.

Adult ; Arthroplasty, Replacement, Hip ; methods ; Ceramics ; Female ; Humans ; Male ; Middle Aged ; Young Adult