[Objective]To explore the efficacy and result of femoral component revision by using impaction bone grafting technique with anatomic cemented stem and freeze-dried allograft.[Method]Anatomic cemented stem combined with freeze-dried allograft were used in IBG for 49 cases of femoral revisions from Jan,2001 to Dec 2005.36 cases(73%)of which had severe bone loss(Paprosky grades ⅢB and Ⅳ).The mean follow-up time was 35.3 months(26~52 months).Harris Hip Score System and radiography were used to evaluate the clinical results.[Result]The mean Harris Hip Score was improved from 44.6 points preoperatively to 88.3 points at final evaluation.Good and excellent scores were about 89.8%.No major femoral stem subsidence was found in our patients.There were one case of dislocation(2%),one case of deep infection(2%)and 3 cases of femoral fractures during operations(6.1%),which were not related to the selection of femoral component and the type of allograft.[Conclusion]The impaction bone grafting technique by using freeze-dried allograft and the anatomic cemented femoral prosthesis for femoral revision was feasible and the short and mid-term result was good.Longer follow-up was needed to evaluate the long term result.

[Objective]To explore the efficacy and results of tibial tubercle osteotomy used in exposure in complicated total knee arthroplasty.[Methods]During the period from Apr.2005 to Apr.2007,the tibial tubercle osteotomy were used in 16 cases of complicated total knee arthroplasty.The mean follow-up time were 20 months(6～26 months).Knee society score(KSS) and radiography were used to evaluate the clinical results.[Results]The mean KSS improved from 46 points preoperatively to 91 points postoperatively.The mean ROM improved to from 53?preoperatively 105?postoperatively.At 3 months after surgery the radiography examines showed all 16 cases had achieved satisfactory healing.The tubercle fragment slided toward proximal 0.7 cm occurred in one case,and finally healed at that position.[Conclusion]Exposure of the knee may be difficult in the total knee arthroplasty,but tibial tubercle osteotomy is a safe and reliable procedure which affords excellent exposure.

[Objective]To evaluate the safety outcome of the 12 patients with simultaneous multiple joint replacement(≥3) in the recent three years.[Method]The complication rates,blood loss,transfusion volume,and hospital stay were analyzed in details.[Result]The mean operating time was 9 hours and 8 minutes(6 hours and 25 minutes to 12 hours).The mean overall volume of blood loss was 3140ml(1 000 ml-5 600 ml.Complications included reactive digestive ulcer in one case,acetabular component position error in one case,and deep infection in one hip of one case.[Conclusion]Simultaneous multiple joint replacement is an alternative protocol to the patients with multiple joint disorders.finished under a single aesthesia and in a single hospital stay.So the overall economical cost will be decreased,and rehabilitation being accelerated.Disadvantages include serious trauma,increased blood loss,and complications may be some how increased.

Objective To assess the adequacy of decompression immediately in anterior cervical surgical procedures with epidurography, and to prevent from leaving compressive materials. Methods After completing primary decompression of anterior cervical intervertebral space by discectomy or corpectomy, posterior longitudinal ligaments were incised or resected, 5-10 ml Omnipaque 300 contrast medium was injected into upper and lower segments of decompressed area through a soft 18# injection needle. Distribution of the contrast medium in front of dura mater was observed by fluoroscopy so as to identify whether the spinal cords were decompressed completely. 64 patients suffered from cervical spondylotic myelopathy, and spinal cords were compressed respectively by giant intervertebral disc prolapse, osteophyte or short segmental OPLL. Intraoperative epidurography was performed after primary anterior decompression. If contrast medium in front of dura mater was discontinued by fluoroscopy, incomplete decompression was judged. 39 of 64 patients were followed up after operation, and in 18 patients of them MRI were taken within 1-12 weeks after operation. Neurological function was compared between preoperation, immediate postoperation and final follow-up by means of JOA scores. Results After completing primary decompression, epidurographs showed that the contrast medium were continuous in front of dura mater in 49 cases(77%), 11 patients of them were examined by MRI during follow-up and the images indicated that cervical cords were free of compression. In 15 cases (23%), the contrast medium was not continuous in front of dura mater, then decompression was performed further until the contrast medium no any interruption. 7 patients of them were confirmed by MRI that cervical cords were no more compressed. 39 patients were followed up postoperatively with a mean follow-up of 13 months. Neurological function was recovered immediately after operation by 52% and 61% at final follow-up. No neurological deficit progressed in all of them. Conclusion Intraoperative epidurography is effective and safe for assessment of decompression during anterior cervical surgical procedures.

[Objective]To review our experience in treatine infection after total knee arthroplasty with debridement and component retention to determine To the feasibility,indication,factors related to success and failure,and the main points of technique.[Method]Since 1990 to 2004,9 patients were treated with debridement and component retention at our department.[Result]Four of 9 patients successfully retained their component at most recent follow-up,without ongoing infection(mean 18 months,range 10～25 months).We have not draw the statistically significant factors that related to successful and failure,but the factors such as acute infection,surfacing replacement,immediate debrided after onset of symptoms,and the bacteria sensitive to antibiotic were relate to success.[Conclusion]Debridement and component retention can be used in acute postoperative infection and later acute hematogenous infection after total knee replacement,but timing and indication must be chosen strictly.

[Objective]To evaluate the role of mobile bearing knee prosthesis in TKA and the clinical results.[Method]A total of 301 TKAs by using mobile bearing knee prosthesis were gotten average 48.7 months follow-up.HSS knee scores and X-ray films were to used to evaluate the results.[Result]The mean HSS score improved from 51.3 before operation to 91.3 after operation.The ROM improved from extension/flexion(-9.5?/64.3?)before operation to extension/flexion(0?/97.5?)after operation.The maximum varus/valgus(25?/15?)before operation were improved to the mean valgus 5.3?.Two cases of septic loosening and 2 cases of femoral fracture were found.[Conclusion]The CR type mobile bearing knee prosthesis not only had advantages in kinematics and wear experiments,but also had achived good clinical result.

Objective Experimental and clinical data suggest that fixed element knee designs a re not able to both supply adequate mobility and eliminate unnecessary constra int forces,as well as provide low contact stresses compatible with pr olonged life of UHMWPE bearing components.The present study investi-gated the preliminary clinical outc ome of TACK(Total Articulating Cementless Knee)system,a new design of mobile-bearing knee prosthesis.Methods Eighty-eight knees in 61patients underwent total knee replace-ment by using TACK were reviewed.Forty-five knees of 31patients were followed-up at least one year.The HSS knee rating score system as well a s X-ray films were used to evaluate th e clinical results with the mean follow-up period of 25.4months.Results At the latest follow-up examination,the rate of good to excellent clinical results was 96.4%.The range of motion was improved from 0-6.5-68.3degrees preoperatively to0-2-88.4degrees at the latest follo w-up.The complications such as oste olysis around the prosthesis,prosthetic loosening and dislocation of meniscus bearings were not found.Conclusion The TACK Knee is a third generation knee system design ed to introduce movable bearings between the metal tibial and femoral components that would reduce the sur face and subsurface stress states at the bearing surfaces and at the bone-implant interfaces by maximiz ing the conformity of the tibial and f emoral components and allowing mo-bility of the bearing surface.In an a verage of more than two years experie nce,it was observed that there was no aseptic loosening of the componen ts.A long term follow-up is obviously necessary to make more precise statement about this knee replaceme nt system.

Objective A two-stage renovation has nowadays been considered as the optimal mode for the treatment of infected total hip joint.Extensive bone defects were often found during the subsequent operation,and they should be repaired by using allograft to attain stability of the implants.The purpose of present study is to investigate the efficacy and safety of employing bone allograft in repairing the femoral defect caused by post-operation infection of hip arthroplasty in the second stage operation.Method From Mar.2001 to Dec. 2006,a total of 20 patients(20 hips)with infected total hip arthroplasty were treated with bone allograft on the femoral side in the second operation.Impaction bone grafting technique was performed for 16 patients using bone allograft combined with cemented stems,and un-ce- mented prosthesis combined with bone strut allograft were used in the other 4 cases.A regular follow-up was done and the outcomes were evaluated using the Harris Hip Score System and radiography.Result All patients were followed-up clinically and radiographically for an average of 20.3 months(4-61 months).No re-infection was found at the last time of follow-up.The mean Harris Hip Score was in- creased from 34.2 before operation to 87.7 after operation.90% of the patients were satisfactory with the results.Conclusion The bone allograft can be used for reconstructing bone defects in the patients after infection of total hip arthroplasty,either with combined with ce- mented stems or non-cemented stems.It is an effective and safe way in dealing with femoral bone defect after infection of total hip arthro- plasty.

Objective To compare the results of one-stage bilateral total hip arthroplasty (THA) and staged bilateral THA, and to determine the safety and efficacy of one-stage simultaneous bilateral THA. Methods The patients who were indicated for with bilateral THA were divided into 2 groups. Gourp A included 87 patients with one-stage simultaneous bilateral THA, and Group B included 31 patients with staged bilateral THA. The operating time, the amount of blood loss, the amount of blood transfusion necessary, post-operation functional scores, and perioperative complications were compared between group A and group B. Result There was no significant difference between group A and group B. Conclusion One-stage simultaneous bilateral total hip arthroplasty was a safe and efficacious procedure.

Objective To discuss the treatment of intraoperative periprosthetic fractures on the femoral side,and to evaluate the results of functional recovery after treatment.Methods Fifty-four cases of intraoperative periprosthetic fractures on the femoral side encountered from July 2002 to December 2006 were retrospectively studied.Fractures on the femoral side were classified by Mallory classification system.X-ray films were taken to evaluate the healing patterns of the fractures.Results Cerclage wires were adequate for stable type I and type Ⅱ fractures,while it could be treated expectantly when the fracture did not involve proximal femur in stable type Ⅱ.Unstable type Ⅱ fractures were taken care of with a long-stem uncementoid component.Type Ⅲ fractures were taken care of with a long-stem uncementoid component or LCP plate.Additional cortical strut allografts were used for the management of unstable fractures and the fractures with poor host bone stock.The average follow-up time was 23.5 months(5-52 months).All fractures were healed as shown by radiography except one case of type I fracture.There was no evidence of loosening or periprosthetic osteolysis on follow up radiograph.The mean postoperative Harris Hip Score was 94.5.Conclusion The treatment of intraoperative periprosthetic fracture around the femoral implant can successfully restore the function of the hip joint in most patients.Cerclage wires,long-stem uncementoid component and additional cortical strut allograft were effective treatment methods for different types of intraoperative periprosthetic fractures on the femoral side.Expectant treatment can achieve satisfactory result in stable type II fractures when the fracture did not destroy proximal femur.