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

BACKGROUNDThe aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss (HBL) in primary total knee arthroplasty (TKA).

METHODSA total of 120 patients who had undergone unilateral TKA from August 2012 to May 2013 were retrospectively studied. The Gross formula was used to calculate the amount of HBL. Routine standard anteroposterior (AP) and lateral X-ray films of the knee joint were taken postoperatively and used to measure the percentages of coronal femoral and of coronal and sagittal tibial prosthetic coverage. Then Pearson's correlation analysis was performed to assess the correlations between the percentages of prosthetic coverage for each AP and lateral position and HBL on the first and third postoperative days.

RESULTSThe volumes of HBL on the first and third postoperative days after TKA were (786.5 ± 191.6) ml and (1 256.6 ± 205.1) ml, respectively, and lateral X-ray film measurements of percentages of coronal femoral, tibial coronal, and sagittal prosthetic coverage were (87.9 ± 2.5)%, (88.5 ± 2.2)%, and (89.1 ± 2.3)%, respectively. Pearson's correlation analysis showed statistically significant correlations between percentages of total knee prosthetic coverage for each AP and lateral position and volumes of HBL on the first and third postoperative days (P < 0.05).

CONCLUSIONSHBL after TKA correlates with degree of prosthetic coverage. To some extent, the size of the surfaces exposed by osteotomy determines the amount of HBL. Choice of the appropriate prosthesis can significantly reduce postoperative HBL. Designing individualized prostheses would be a worthwhile development in joint replacement surgery.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; adverse effects ; Female ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Postoperative Hemorrhage ; etiology ; Retrospective Studies

OBJECTIVETo explore the practicability of microskin grafting by spraying in burn management.

METHODSRazor thin autologous skin from pigs or burn patients was harvested and cut to pieces of 0.2 - 0.5 mm in size and suspended in normal saline. The suspension was put into a bottle with outlet and pumping device. The microskin suspended in the saline was sprayed to the burn wound and/or onto the alloskin sheets. The microskin distribution was detected by digital image analysis technique. In animal experiments, the burn wound development and pathomorphological changes after operation were observed. In burn patients who would receive microskin grafting, spraying method was used with the traditional flotation method as control. The treatment results and the operational procedures were compared between these two kinds of operation styles.

RESULTSThe microskin dispersion degree with spraying was much smaller than that with flotating method. In animal experiment with spraying method, the wound healing time was 23.2, 24.5 and 38.3 days in 3 groups, respectively, with the area ratio of donor to wound of 110, 120 and 150. In clinical study, The average operating time was 133.3 min with spraying method and 165.6 min with flotation method respectively (P < 0.05). The area ratio of donor to wound was 118.8 with spraying and 17.6 with flotation methods, respectively (P < 0.01). The one time wound coverage rate was 92.6% with spraying and 79.7% with flotation methods (P < 0.01). The wound healing time was 29.7 days with spraying and 37.3 days with flotating methods, respectively (P < 0.05).

CONCLUSIONSpraying method of microskin grafting might be a good method in major burn treatment. The advantages with this method included well-distributed microskin, simpler handling, saving of donor skin, shortening of operating time and less time needed for the wound healing. It might be recommended for other wound covering materials.

Animals ; Burns ; surgery ; therapy ; Culture Techniques ; Dermatologic Surgical Procedures ; Female ; Humans ; Male ; Rabbits ; Skin ; injuries ; Skin Transplantation ; methods ; Transplantation, Heterologous ; Wound Healing