Aged ; Arthroplasty, Replacement, Knee ; methods ; Female ; Femur ; surgery ; Humans ; Osteoarthritis ; surgery ; Osteotomy ; methods

OBJECTIVETo analyze the clinical and radiographical result of acetabular revisions with wire mesh, impacted irradiated frozen allografts and cemented cups.

METHODSFrom February 2006 to January 2009, a total of 20 patients with 21 acetabular revisions were performed with wire mesh, impacted irradiated frozen allografts and cemented cups. Eighteen cases (19 hips) were followed up. There were 5 hips in 4 males and 14 hips in 14 females. The average age of patients was 64.4 years (43 to 81 years). Acetabular bone defects were classified according to Paprosky classification. There were Paprosky II B in 4 hips, Paprosky II C in 8 hips, Paprosky IIIA in 5 hips and Paprosky IIIB in 2 hips. Wire mesh was used to converted segmental defects into cavity defects. Irradiated frozen allografts were impacted and cemented cup was inserted to complete the revision. Patients were followed up regularly with clinical and radiographical assessment. Harris score, migration and loosening of prosthesis grafts integration and complications were observed.

RESULTSThe average follow-up time was 22.4 months (12 - 48 months). Harris score improved from 42.5 points (31 - 56 points) pre-operation to 88.6 points (82 - 96 points) at the final follow up. Pain score was 14.4 point (10 - 20 point) before revision and 42.3 points (40 - 44 point) at the final follow up.

COMPLICATIONSthere was 1 infection and healing after debridement. One patient had weakness of quadriceps and returned to normal after 1 year. Greater trochanter fracture occurred in 1 patient. Cup migration and loosening were observed in 1 Paprosky IIIB patients. There was no cup migration more than 1 mm or change of abduction angle in the remaining 18 hips. Grafts incorporation defined as the presence of trabecular bone crossing the graft-host bond could also be seen in these 18 hips.

CONCLUSIONSImpacted bone grafting technique combined with wire mesh and cemented cup is an effective method for biological acetabular revision. Irradiated frozen allografts implanted with impaction bone grafting technique can integrate with the surrounding host bone.

Acetabulum ; surgery ; Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Bone Cements ; Bone Transplantation ; methods ; Female ; Follow-Up Studies ; Freezing ; Humans ; Male ; Middle Aged ; Prosthesis Failure ; Reoperation ; Surgical Mesh ; Transplantation, Homologous ; Treatment Outcome

OBJECTIVETo study the clinical results of metal on metal hip resurfacing arthroplasty for developmental dysplasia patients.

METHODSFrom March 2005 to December 2006, 34 cases of developmental dysplasia patients (Crowe I, Crowe II) were attempted to have metal on metal hip resurfacing arthroplasty. There were 29 females (32 hips), 5 males (5 hips). The average age was 45 (26 - 57) years old. Radiographic and clinical evaluations were taken at 6 weeks, 3 months, 1 year and then once a year postoperatively. The average Harris score was 35 (25 - 44). Hip flexion was 101 degrees , abduction 24 degrees , adduction 15 degrees .

RESULTSThree patients were turned to total hip arthroplasty during operations. Thirty-one patients (34 hips) received hip resurfacing surgery. These 31 patients were followed for average 21.4 months (12 - 33 months). The average Harris score was 94 (82 - 100) at the latest follow-up, and there was statistical difference compared with the preoperative score (P < 0.01). Hip flexion increased to 133 degrees , abduction to 48 degrees , adduction to 26 degrees . No radiolucency line was found at both acetabular and femoral sides in all the patients. The average abduction angle of acetabular cup was 43 degrees (40 degrees - 53 degrees ), and the average stem shaft angle was 139 degrees (130 degrees - 145 degrees ).

CONCLUSIONSThe short term result is excellent. While the mid to long term results for hip resurfacing arthroplasty in developmental dysplasia patients are still looking forward, and the meticulous surgical technique and strict patient selection are the key of the good results.

Adult ; Arthroplasty, Replacement, Hip ; methods ; Female ; Follow-Up Studies ; Hip Dislocation, Congenital ; surgery ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo evaluate the short term clinical results of minimally invasive total knee arthroplasty (MIS-TKA) through a quadriceps sparing (QS) approach compared with a standard TKA using a medial parapatellar exposure.

METHODSBetween March 2005 and March 2006, 26 consecutive unilateral primary MIS-TKA through a QS approach were performed. It was compared that the short term clinical results of this group with an age-matched and sex-match cohort of total knee arthroplasty done with a standard medial parapatellar approach. Length of incision, tourniquet time, blood loss, flexion degree, visual analog scale (VAS) score, Knee Society score, tibiofemoral angle and the ability to do a straight leg raising maneuver were evaluated respectively.

RESULTSThe mean follow-up time were 17 months (range 12-23 months). The average length of incision was (9.5+/-1.5) cm in the QS group and (14.0+/-2.3) cm in the standard group (P<0.05). Average tourniquet times were (83+/-16) minutes in the QS group and (55+/-11) minutes for the standard group (P<0.05). Postoperative tibiofemoral angles averaged (5.7+/-1.5) degrees valgus in the QS group knees and (6.0+/-1.4) degrees valgus in the standard group knees (P>0.05). The average VAS scores were significantly lower at the first, the third and the seventh postoperative days in the QS group compared with that of the standard group, and the difference was not significant after 6 weeks between two groups. Mean flexion at one week was greater for the QS group (107+/-12) degrees than that in the standard group (95+/-11) degrees. Improved ROM also was seen 6 and 12 weeks postoperatively in the QS group with significant difference. There were no differences in ROM between the two groups in 12 months. The ability to straight leg raised at one week postoperatively was better in the QS group (23/26, 88%) than that of the standard group (21/33, 64%). At the 6 weeks follow-up, the average knee score was (78+/-15) points in the QS group and (71+/-20) points for the standard group (P<0.05). Deep vein thrombosis were found in 1 case of the QS group and 3 cases for the standard group. One patient in the QS group developed superficial wound necrosis that healed uneventfully. There were no other complications such as deep infection, neurovascular injury and so on.

CONCLUSIONSThe MIS-TKA through a QS approach is associated with a more rapid functional recovery and improves range of motion. But higher specifications and more restrictive indications are of importance with the QS technique.

Arthroplasty, Replacement, Knee ; methods ; Follow-Up Studies ; Humans ; Minimally Invasive Surgical Procedures ; methods ; Quadriceps Muscle ; Treatment Outcome

OBJECTIVETo investigate the cognition and health education needs on child neglect among parents/carers to the preschool children in Guangdong Province.

METHODSA total of 621 parents/carers of preschool children aged 3-6 years from four cities (Dongguan, Huizhou, Zhongshan, and Foshan) in Guangdong Province completed self-designed questionnaires concerning the cognition and health education needs on child neglects.

RESULTSOnly 5.4% of the parents/carers had a good knowledge of child neglect, and 55.9% had never heard about this term. About 90.5%-90.7%of the surveyed parents/carers were willing to learn more about child neglect and 94.6%-97.4% of them agreed that education on child neglect was necessary. It was found that normal brochures, books, newspapers, and magazines were the preferred way of education for parents/carers (77.0%); also nearly half of the parents/carers welcomed courses (55.6%) or lectures (49.1%). Most of them believed that awareness raising activities should be carried out in kindergarten (70.5%), public places (61.4%) or by providing collective training for teachers in kindergarten (59.6%).

CONCLUSIONSMost parents/carers of preschool children in Guangdong Province have a poor knowledge of child neglect. Efforts should be made to strengthen awareness raising activities on this topic via appropriate pathways.

Caregivers ; Child Abuse ; Child, Preschool ; Cognition ; Cross-Sectional Studies ; Health Education ; Humans ; Parents

BACKGROUNDProper rotational alignment during total knee arthroplasty (TKA) is important for adequate postoperative patellofemoral and tibiofemoral kinematics, as well as for achieving balanced flexion space at 90. The effects of computer navigation-assisted total knee replacement and conventional total knee arthroplasty on rotational alignment, mechanical axis, component position and clinical outcomes were compared.

METHODSTwo methods were used in 82 patients and the rotation of the femoral and tibial components in the transverse plane, the combined rotation of the two components, the mismatch between them, and the mechanical axis of the lower limb were analyzed. All of these parameters were measured from postoperative radiographs and computed tomography images. Functional outcomes were compared at 6 weeks and 6 months postoperatively.

RESULTSSignificant differences were found between the two techniques (P < 0.05) in the following parameters: average rotation of the femoral component ((1.51 ± 3.55)° vs. (-0.63 ± 3.04)°); combined rotation of the femoral and tibial components (2.85 ± 4.07)° vs. (0.28 ± 3.43)°); and mismatch between the femoral and tibial components ((1.44 ± 4.55)° vs. (-0.43 ± 2.86)°). Differences in the rotation of the tibial component were not statistically significant. The prevalence of outliers (malalignment > ± 3° internal/external rotation) of the femoral component (31.7% vs. 12.5%) and the tibial component (36.6% vs. 15%) were significantly reduced when the navigation system was used (P < 0.05). In addition, while patients in the navigation group had significantly better mechanical axis and functional outcomes at 6 weeks after surgery (P < 0.05), there was no significant difference between the two groups (P > 0.05) with respect to functional outcomes at 6 months.

CONCLUSIONThe navigation system exhibited higher accuracy than the conventional technique in the transverse and coronal plane, and provided better early functional outcomes.

Arthroplasty, Replacement, Knee ; methods ; Female ; Femur ; diagnostic imaging ; surgery ; Humans ; Knee Joint ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Prospective Studies ; Radiography ; Range of Motion, Articular ; Surgery, Computer-Assisted ; methods ; Tibia ; diagnostic imaging ; surgery

BACKGROUNDThe aim of this research was to evaluate long-term pulmonary sequelae on paired inspiration-expiration thin-section computed tomography (CT) scans 3 years after influenza A (H1N1) virus-associated pneumonia, and to analyze the affecting factors on pulmonary fibrosis.

METHODSTwenty-four patients hospitalized with H1N1 virus-associated pneumonia at our hospital between September 2009 and January 2010 were included. The patients underwent thin-section CT 3 years after recovery. Abnormal pulmonary lesion patterns (ground-glass opacity, consolidation, parenchymal bands, air trapping, and reticulation) and evidence of fibrosis (architectural distortion, traction bronchiectasis, or honeycombing) were evaluated on follow-up thin-section CT. Patients were assigned to Group 1 (with CT evidence of fibrosis) and Group 2 (without CT evidence of fibrosis). Demographics, rate of mechanical ventilation therapy, rate of intensive care unit admission, cumulative prednisolone-equivalent dose, laboratory tests results (maximum levels of alanine aminotransferase, aspartate transaminase [AST], lactate dehydrogenase [LDH], and creatine kinase [CK]), and peak radiographic opacification of 24 patients during the course of their illness in the hospital were compared between two groups.

RESULTSParenchymal abnormality was present in 17 of 24 (70.8%) patients and fibrosis occurred in 10 of 24 (41.7%) patients. Patients in Group 1 (10/24; 41.7%) had a higher rate of mechanical ventilation therapy (Z = -2.340, P = 0.019), higher number of doses of cumulative prednisolone-equivalent (Z = -2.579, P = 0.010), higher maximum level of laboratory tests results (AST [Z = -2.140, P = 0.032], LDH [Z = -3.227, P = 0.001], and CK [Z = -3.345, P = 0.019]), and higher peak opacification on chest radiographs (Z = -2.743, P = 0.006) than patients in group 2 (14/24; 58.3%).

CONCLUSIONSH1N1 virus-associated pneumonia frequently is followed by long-term pulmonary sequelae, including fibrotic changes, in lung parenchyma. Patients who need more steroid therapy, need more mechanical ventilation therapy, had higher laboratory tests results (maximum levels of AST, LDH, and CK), and had higher peak opacification on chest radiographs during treatment are more likely to develop lung fibrosis.

Adult ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; pathogenicity ; Influenza, Human ; complications ; virology ; Lung ; diagnostic imaging ; pathology ; virology ; Male ; Middle Aged ; Pneumonia ; complications ; diagnostic imaging ; microbiology ; Tomography, X-Ray Computed ; methods

OBJECTIVETo evaluate the treatment and effect of a technique using single femoral posterior longitudinal strip osteotomy in revision total hip arthroplasties.

METHODSBetween September 2005 and December 2009, 35 hips of 35 patients underwent a revision total hip arthroplasties (THA) in conjunction with extraction of femoral components. Among them, 23 cases were with uncemented, and 12 cases were with cemented femoral components. Those cases being followed up were chosen by two standards described as follows: one was the examination of preoperative radiographs, which showed that there was difficult in the extraction of the femoral components; Another followed was the trying with routine procedure to remove the stem. If these were unsuccessful, a single longitudinal strip osteotomy was performed, whose length was about 11 - 14 cm, and width was about 1 cm. Then the femoral component was disimpact. The osteotomy was fixed with wires or cables. If there was cortical deficiency or insufficient cancellous bone, grafting was performed. A cementless composite revision prosthesis of the Lima-Lto with a tapered modular distal fixation stem was used. All the patients were evaluated with preoperative and postoperative Harris score, the length of limb and radiographs.

RESULTSAll cases were followed up with 5 to 55 months, average 15 months. Compared with preoperative, the average Harris score increased from 30 (range, 19 - 40 points) to 85 points (range, 80 - 92 points). All pains of hip joint were alleviated from the mean 12 points (range, 10 - 20 points) before the operation to 40 points (range, 30 - 44 points) after the operation. All the femoral osteotomy and bone grafting were healing ultimately. And on average, the healing began in 20 weeks (range, 10 - 32 weeks). All the cases remain the same length of lower limbs. There was no hip joint dislocation, loosening or infection.

CONCLUSIONSThe femoral posterior longitudinal strip osteotomy facilitates the exposure and extraction of the femoral stem, the clear up of medullary cavity and then the femoral reconstruction in revision total hip arthroplasties. It has satisfactory short-term radiographic evaluation and clinical effect as a simple, effective and reliable technique.

Aged ; Arthroplasty, Replacement, Hip ; Device Removal ; Female ; Femur ; surgery ; Follow-Up Studies ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Osteotomy ; methods ; Reoperation ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo determine the clinical outcomes of two-staged cementless revision arthroplasty for the treatment of deep periprosthetic infection after total hip arthroplasty.

METHODSTwenty-three patients with deep periprosthetic infection treated with a standard protocol of two-staged cementless revision hip arthroplasty were enrolled in this study. There were 9 male patients and 14 female patients with an average age of 64 years (range, 52-78 years). In all cases, antibiotics-loaded cement spacers were implanted after removal of all the prosthetic components and thorough debridements had been done. All patients had a minimum of 2 weeks of intravenous antibiotics followed by 4 weeks of oral antibiotics after implant removal. After a mean interval of 6.7 months (3-28 months), revision arthroplasties were carried out with cementless femoral components followed by 2 weeks of intravenous antibiotics and 4 weeks of oral antibiotics.

RESULTSThe mean follow-up period was (4.3±3.5) years. There were 2 cases of recurrent infections in this study. Intraoperative periprosthetic fractures were observed in 3 patients. One patient had dislocation of the implanted spacer during the interval period and 2 patients had hip dislocation after reimplantation. Mild subsidence of femoral component occurred in 1 patient. There were no cases of loosening of femoral components and cementless acetabular components in patients without infection recurrence. The Harris hip score increased from a preoperative mean of 36±13 to 85±13 at 12 months after reimplantation.

CONCLUSIONSUsing cementless prostheses in two-staged revisions of hip periprosthetic infections can provide low rate of infection recurrence and good implant stability, but cautions must be taken when treating patients with infection caused by multidrug-resistant organisms.

Aged ; Anti-Bacterial Agents ; administration & dosage ; Arthroplasty, Replacement, Hip ; instrumentation ; methods ; Female ; Follow-Up Studies ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Prosthesis-Related Infections ; surgery ; Retrospective Studies

OBJECTIVETo investigate the molecular epidemiologic characteristics and genotypes of norovirus in children less than 5 years of age in Lulong area from 2008 to 2009.

METHODS325 stool specimens and epidemiological data from hospitalized children with diarrhea less than 5 years of age were collected. Rotavirus was detected by using the ELISA kit. Norovirus, adenovirus and astrovirus were detected by multiple reverse transcription-polymerase chain reaction (RT-PCR). Partial norovirus strains were sequenced and the tree was conducted by using the phylogenetic analyses.

RESULTSNorovirus was detected in 37 out of 325 (11.3%) specimens,ranked only second to rotavirus (48.6%), and higher than adenovirus (6.5%) and astrovirus (4.3%). Norovirus predominantly infected children less than 2 years of age and the season peak of norovirus occurred in November. Phylogenetic analysis showed that the predominant strain was the GII. 4/2006b variant. Interestingly, a novel unreported GII-4 variant was found in this study.

CONCLUSIONNorovirus was one of the most important pathogens causing acute gastroenteritis from 2008 to 2009 in Lulong area. The GII. 4/2006b vairant was still the predominant strain. It is important to keep on monitoring the novel GII. 4 variant.

Acute Disease ; Child, Preschool ; China ; epidemiology ; Enzyme-Linked Immunosorbent Assay ; Female ; Hospitalization ; Humans ; Infant ; Infant, Newborn ; Male ; Norovirus ; classification ; isolation & purification ; Phylogeny ; Reverse Transcriptase Polymerase Chain Reaction ; Time Factors