Objective:To analyze the short-and medium-term clinical outcomes of Mako robotic-assisted posterior-lateral approach in complex primary total hip arthroplasty (THA).Methods:A retrospective case series analysis was conducted on 29 patients with complex hip conditions who underwent Mako robotic-assisted posterior-lateral approach at Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University School of Medicine from November 2020 to December 2024. The patient cohort included 14 cases of developmental dysplasia of the hip, 8 cases of ankylosed hip, 3 cases of traumatic hip arthritis, 3 cases of sequelae of purulent hip arthritis, and 1 case of synovial chondromatosis. There were 12 males and 17 females, with an age of (62.3±9.4) years (range:44 to 79 years). Surgical time, intraoperative blood loss, vascular and nerve injury, postoperative infection, and other complications were recorded. Preoperative and postoperative lower limb length discrepancy, combined offset difference (ΔCO), acetabular abduction angle, and acetabular anteversion angle were measured. The Harris hip score was recorded at regular follow-ups. Data comparison was conducted using the paired sample t-test. Results:All patients successfully underwent surgery with the Mako robotic system. The surgical time was (107.6±41.5) minutes (range:50 to 235 minutes), and the intraoperative blood loss was (165.5±147.7) ml (range:50 to 800 ml). All patients were followed up for a duration of (27.3±16.7) months (range:3 to 51 months). The planned intraoperative acetabular cup abduction angle was 40.1°±1.6° (range: 36° to 45°), and the measured postoperative acetabular cup abduction angle was 40.2°±3.5° (range: 33° to 54°), with no significant difference ( t=0.231, P=0.819). The planned intraoperative acetabular cup anteversion angle was 19.1°±3.9° (range: 15° to 25°), and the measured postoperative acetabular cup anteversion angle was 18.5°±3.4° (range: 10° to 26°), with no significant difference ( t=1.792, P=0.084). The difference in length of both lower limbs was (-17.6±15.0) mm (range:-50 to 10 mm) before operation and (-1.5±16.0) mm (range:-33 to 53 mm) after operation ( t=6.282, P<0.01)(positive values indicate that the surgical side is longer than the contralateral side). The ΔCO was (4.1±12.0) mm (range:-18 to 30 mm) before operation and (-2.2±13.3) mm (range:-44 to 17 mm) after operation, with statistically significant difference ( t=2.635, P=0.014). One patient experienced vascular injury with embolism postoperatively, while no other complications were observed in the remaining patients. No loosening, dislocation, or fracture of the prosthesis was noted during the follow-up period. The Harris function score was improved from (47.1±8.3) points(range:15 to 62 points) preoperatively to (73.0±5.5) points(range:57 to 83 points) at the three-month postoperative follow-up ( t=22.630, P<0.01). Conclusion:The use of Mako robotic assistance in complex total hip arthroplasty can enhance the accuracy of prosthesis placement, minimize lower limb length discrepancy, and improve hip joint function.

Objective:To analyze the short-and medium-term clinical outcomes of Mako robotic-assisted posterior-lateral approach in complex primary total hip arthroplasty (THA).Methods:A retrospective case series analysis was conducted on 29 patients with complex hip conditions who underwent Mako robotic-assisted posterior-lateral approach at Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University School of Medicine from November 2020 to December 2024. The patient cohort included 14 cases of developmental dysplasia of the hip, 8 cases of ankylosed hip, 3 cases of traumatic hip arthritis, 3 cases of sequelae of purulent hip arthritis, and 1 case of synovial chondromatosis. There were 12 males and 17 females, with an age of (62.3±9.4) years (range:44 to 79 years). Surgical time, intraoperative blood loss, vascular and nerve injury, postoperative infection, and other complications were recorded. Preoperative and postoperative lower limb length discrepancy, combined offset difference (ΔCO), acetabular abduction angle, and acetabular anteversion angle were measured. The Harris hip score was recorded at regular follow-ups. Data comparison was conducted using the paired sample t-test. Results:All patients successfully underwent surgery with the Mako robotic system. The surgical time was (107.6±41.5) minutes (range:50 to 235 minutes), and the intraoperative blood loss was (165.5±147.7) ml (range:50 to 800 ml). All patients were followed up for a duration of (27.3±16.7) months (range:3 to 51 months). The planned intraoperative acetabular cup abduction angle was 40.1°±1.6° (range: 36° to 45°), and the measured postoperative acetabular cup abduction angle was 40.2°±3.5° (range: 33° to 54°), with no significant difference ( t=0.231, P=0.819). The planned intraoperative acetabular cup anteversion angle was 19.1°±3.9° (range: 15° to 25°), and the measured postoperative acetabular cup anteversion angle was 18.5°±3.4° (range: 10° to 26°), with no significant difference ( t=1.792, P=0.084). The difference in length of both lower limbs was (-17.6±15.0) mm (range:-50 to 10 mm) before operation and (-1.5±16.0) mm (range:-33 to 53 mm) after operation ( t=6.282, P<0.01)(positive values indicate that the surgical side is longer than the contralateral side). The ΔCO was (4.1±12.0) mm (range:-18 to 30 mm) before operation and (-2.2±13.3) mm (range:-44 to 17 mm) after operation, with statistically significant difference ( t=2.635, P=0.014). One patient experienced vascular injury with embolism postoperatively, while no other complications were observed in the remaining patients. No loosening, dislocation, or fracture of the prosthesis was noted during the follow-up period. The Harris function score was improved from (47.1±8.3) points(range:15 to 62 points) preoperatively to (73.0±5.5) points(range:57 to 83 points) at the three-month postoperative follow-up ( t=22.630, P<0.01). Conclusion:The use of Mako robotic assistance in complex total hip arthroplasty can enhance the accuracy of prosthesis placement, minimize lower limb length discrepancy, and improve hip joint function.

Objective:To investigate the clinical efficacy of 3D printed metal augment or tibial prosthesis for reconstruction of large bone defects in total knee arthroplasty (TKA) and knee revision surgery.Methods:A total of 7 patients (7 knees) with TKA or knee revision who were admitted to the Department of Orthopaedics of the Second Affiliated Hospital of Zhejiang University School of Medicine with large bone defects from July 2018 to December 2023 were retrospectively analyzed, including 4 patients with TKA and 3 patients with knee revision. There were 3 males and 4 females, aged 58.7±7.6 years (range, 54-68 years), 3 patients with left knee and 4 patients with right knee. All the patients had bone defects in the knee joint (AORI type III), 2 cases had bone defects only in the femur, 4 cases had bone defects only in the tibia, and 1 case had bone defects in both the tibia and femur, which were treated with personalized reconstruction using 3D printing. Hip-knee-ankle angles, American Knee Society score (KSS) before and after surgery were compared, and postoperative complications were observed.Results:All patients successfully completed the operation, and the operation time was 189.3±35.5 min (range, 125-240 min). Complex TKA was performed in 4 cases with surgical times of 175, 195, 210, and 240 min, and revision surgery was performed in 3 cases with surgical times of 125, 180, and 200 min, respectively. Intraoperative blood loss was 114±24.4 ml (range, 100-150 ml). Five cases used 3D printed metal augment, and two used 3D printed one-piece tibial components. All patients were followed up for 2, 2, 5, 6, 7, 20, 57 months, respectively. The KSS of the five patients at 3 months postoperatively were 56, 61, 66, 56, and 56 points, respectively, greater than the preoperative scores of 35, 44, 36, 27, and 41 points. The KSS functional scores of the five patients at 3 months postoperatively were 45, 45, 45, 30, and 45 points, respectively, which were greater than the preoperative scores of 30, 30, 15, 20, and 20 points. The hip-knee-ankle angle was 181.8°±3.4° (range, 177.9° to 188.0°) at the final follow-up and 175.8°±12.4° (range, 153.3° to 192.1°) before surgery, with no significant difference ( t=-1.230, P=0.242). At the final follow-up, the 3D printed component was well integrated with the bone surface, the prosthesis was securely positioned, and the force lines of the lower limbs were normal. There were no postoperative complications such as poor wound healing, infection, fat liquefaction, nerve injury, deep vein thrombosis of lower limbs, knee joint stiffness, periprosthesis infection and loosening. Conclusion:Using 3D printed metal augment or tibial prosthesis to reconstruct the huge bone defect in TKA and revision has a satisfactory early clinical effect, satisfactory joint function and good surgical safety.

OBJECTIVES: Several countries have successfully eliminated measles, and China is making significant strides toward achieving this goal. This study focused on investigating the patterns of measles infections in Zhejiang Province, China, as well as control measures. The objective was to provide valuable insights that could contribute to the development of nationwide elimination strategies. METHODS: We analyzed measles surveillance data from 2005 to 2022 in Zhejiang Province. We utilized a joinpoint regression model to examine trends in measles. Additionally, we employed SaTScan version 9.5 to identify spatial-temporal clusters. Finally, we used an age-period-cohort model to assess the effects of age, period, and cohort. RESULTS: The age-standardized incidence rate (ASIR) of measles infection in Zhejiang Province from 2005 to 2022 was 5.24 per 100,000, showing a consistent and significant downward trend with an annual percentage change of -24.93% (p<0.05). After 2020, the ASIR for measles infection fell to below 0.1 per 100,000. The majority of measles cases occurred in individuals either without an immunization history or with an unknown immunization status, representing 41.06% and 41.40% of the cases from 2010 to 2022, respectively. According to data from the National Measles Surveillance System, the annual rate of discarded measles cases from 2009 to 2014, and the annual rate of discarded measles and rubella cases from 2015 to 2022, were both above 2 per 100,000, indicating the high sensitivity of the measles surveillance system. CONCLUSIONS The significant reduction in measles incidence from 2005 to 2022 demonstrates substantial progress in Zhejiang Province towards the elimination of measles.

OBJECTIVES: Several countries have successfully eliminated measles, and China is making significant strides toward achieving this goal. This study focused on investigating the patterns of measles infections in Zhejiang Province, China, as well as control measures. The objective was to provide valuable insights that could contribute to the development of nationwide elimination strategies. METHODS: We analyzed measles surveillance data from 2005 to 2022 in Zhejiang Province. We utilized a joinpoint regression model to examine trends in measles. Additionally, we employed SaTScan version 9.5 to identify spatial-temporal clusters. Finally, we used an age-period-cohort model to assess the effects of age, period, and cohort. RESULTS: The age-standardized incidence rate (ASIR) of measles infection in Zhejiang Province from 2005 to 2022 was 5.24 per 100,000, showing a consistent and significant downward trend with an annual percentage change of -24.93% (p<0.05). After 2020, the ASIR for measles infection fell to below 0.1 per 100,000. The majority of measles cases occurred in individuals either without an immunization history or with an unknown immunization status, representing 41.06% and 41.40% of the cases from 2010 to 2022, respectively. According to data from the National Measles Surveillance System, the annual rate of discarded measles cases from 2009 to 2014, and the annual rate of discarded measles and rubella cases from 2015 to 2022, were both above 2 per 100,000, indicating the high sensitivity of the measles surveillance system. CONCLUSIONS The significant reduction in measles incidence from 2005 to 2022 demonstrates substantial progress in Zhejiang Province towards the elimination of measles.

OBJECTIVES: Several countries have successfully eliminated measles, and China is making significant strides toward achieving this goal. This study focused on investigating the patterns of measles infections in Zhejiang Province, China, as well as control measures. The objective was to provide valuable insights that could contribute to the development of nationwide elimination strategies. METHODS: We analyzed measles surveillance data from 2005 to 2022 in Zhejiang Province. We utilized a joinpoint regression model to examine trends in measles. Additionally, we employed SaTScan version 9.5 to identify spatial-temporal clusters. Finally, we used an age-period-cohort model to assess the effects of age, period, and cohort. RESULTS: The age-standardized incidence rate (ASIR) of measles infection in Zhejiang Province from 2005 to 2022 was 5.24 per 100,000, showing a consistent and significant downward trend with an annual percentage change of -24.93% (p<0.05). After 2020, the ASIR for measles infection fell to below 0.1 per 100,000. The majority of measles cases occurred in individuals either without an immunization history or with an unknown immunization status, representing 41.06% and 41.40% of the cases from 2010 to 2022, respectively. According to data from the National Measles Surveillance System, the annual rate of discarded measles cases from 2009 to 2014, and the annual rate of discarded measles and rubella cases from 2015 to 2022, were both above 2 per 100,000, indicating the high sensitivity of the measles surveillance system. CONCLUSIONS The significant reduction in measles incidence from 2005 to 2022 demonstrates substantial progress in Zhejiang Province towards the elimination of measles.

OBJECTIVES: Several countries have successfully eliminated measles, and China is making significant strides toward achieving this goal. This study focused on investigating the patterns of measles infections in Zhejiang Province, China, as well as control measures. The objective was to provide valuable insights that could contribute to the development of nationwide elimination strategies. METHODS: We analyzed measles surveillance data from 2005 to 2022 in Zhejiang Province. We utilized a joinpoint regression model to examine trends in measles. Additionally, we employed SaTScan version 9.5 to identify spatial-temporal clusters. Finally, we used an age-period-cohort model to assess the effects of age, period, and cohort. RESULTS: The age-standardized incidence rate (ASIR) of measles infection in Zhejiang Province from 2005 to 2022 was 5.24 per 100,000, showing a consistent and significant downward trend with an annual percentage change of -24.93% (p<0.05). After 2020, the ASIR for measles infection fell to below 0.1 per 100,000. The majority of measles cases occurred in individuals either without an immunization history or with an unknown immunization status, representing 41.06% and 41.40% of the cases from 2010 to 2022, respectively. According to data from the National Measles Surveillance System, the annual rate of discarded measles cases from 2009 to 2014, and the annual rate of discarded measles and rubella cases from 2015 to 2022, were both above 2 per 100,000, indicating the high sensitivity of the measles surveillance system. CONCLUSIONS The significant reduction in measles incidence from 2005 to 2022 demonstrates substantial progress in Zhejiang Province towards the elimination of measles.

Objective:To investigate the safety, economic effect, and short-term clinical efficacy of ambulatory total hip arthroplasty (THA) in the treatment of hip osteopathy within.Methods:This study retrospectively reviewed patients who underwent 48-hour outpatient THA and conventional primary THA from July 2020 to July 2021. Gender, age, body mass index (BMI), clinical diagnosis, place of resident, length of hospital stay, duration of the surgery, hemoglobin, albumin, C-reactive protein (CRP) and D-dimer before and 1 day after surgery, the visual analogue scale (VAS) was obtained postoperative day 2, hip joint modified Harris score before and 1 month after surgery, readmission and reoperation within 1 month after operation as the data of evaluations were extracted and compared in this study.Results:A totally of 150 cases were involved in this study, which including 75 cases with 48-hour outpatient primary THA and 75 cases with conventional primary THA. There was no significant difference between the two groups in terms of age, sex, BMI, education level, preoperative diagnosis, and preoperative Harris score ( P>0.05), but a significant difference was found in term of residence (χ 2=6.29, P=0.043), that the patients in the outpatient group were all from Zhejiang Province and 48% (36/75) of them were from Hangzhou City. While, in the conventional group, 6 patients were from other provinces. The length of stay was 2.13±0.52 days and operation time was 59.73±18.91 minutes in the outpatient group, which were both shorter than those (6.71±1.44 days and 66.91±22.40 min) in the conventional group ( t=25.91, P<0.001 for the length of hospital stay; t=2.12, P=0.036 for operation time). Compared with the conventional group, outpatient group saved the average hospital cost (4.60±0.44 vs. 5.20±0.72 ten thousand yuan, t=6.16, P<0.001). The VAS on the second day after surgery 3.45±0.75 was higher in the outpatient group than in the conventional group (3.45±0.75 vs. 3.16±0.94 points, t=2.09, P=0.039). The modified Harris score was without statistical significance ( t=0.42, P=0.677) 1 month after surgery in both groups. 75 patients in the outpatient group, 7 patients delayed discharge (were not discharge within 48 hours), and the rate of delayed discharge was 9.3%. Reasons for delayed discharge included poor pain control in two cases, one case had postoperative nausea and vomiting, one case had failed to meet rehabilitation standards, hypotension in one case, the intraoperative infection in one case and postoperative fever within 48 hours in one case. Conclusion:Outpatient THA can reduce the length of hospital stay, operative time and total cost of hospitalization. It has similar safety and early clinical efficacy as conventional THA. However, a small proportion of patients would delay discharge.

Objective:To evaluate the detection accuracy of hepatitis B virus (HBV) serological markers among grassroots medical institutions in the demonstration areas of infectious diseases.Methods:A fixed sampling method was used among the followed-up hepatitis B cohort in general population of six infectious disease demonstration areas nationwide. Blood samples of chosen objects were collected, in which HBsAg and anti-HBs were tested by grassroots medical institutions and were also parallely tested by the third-party platform. The test results were compared between the two groups. Statistical analyses were conducted by SAS 9.4 software.Results:A total of 5 756 and 5 263 samples of HBsAg and anti-HBs were successfully tested, respectively. Comparing the results of HBsAg and anti-HBs from grassroots medical institutions with the results from the third platform, the agreement of HBsAg and anti-HBs was 97.13% and 77.33%, respectively. The Kappa value was 0.56 (95% CI 0.50-0.62) for HBsAg and 0.54 (95% CI 0.52-0.56) for anti-HBs, respectively; and the McNemar tests indicated the difference between the results (all P<0.01). There were also significant differences in agreement of testing results with the third platformin among different regions ( P<0.05 or <0.01). The Kappa values indicated that Jiangsu province and Guangdong province had high accordance rates of HBsAg (0.87 and 0.81, respectively), and Gansu province and Guangdong province had high accordance rates of anti-HBs (Both were 0.74). Regarding the results from the third platform as the standard, the sensitivity of HBsAg testing in grassroots medical institutions was moderate (40.51%) and the specificity was well (99.96%). The sensitivity of anti-HBs testing was substantial (73.18%) and the specificity was well (84.31%). Guangdong province (Youden index: 0.69) and Jiangsu province (Youden index: 0.80) had high identification ability for HBsAg, and for indicator of anti-HBs, Gansu province (Youden index: 0.78) and Guangdong province (Youden index: 0.76) had high identification ability. Conclusion:There are certain differences in results of HBV serological markers tests between the grassroots medical institutions in the demonstration areas of infectious diseases and the third platform. Current testing strategies in grassroots medical institutions are suitable for identifying people without hepatitis B infection, while it is necessary to pay attention to the situation of potential false negative error.

Objective: To investigate the clinical effects of primary revision after artificial hip replacement and causes of revision surgery. Methods: A total of 344 patients who underwent revision surgery after total hip arthroplasty (THA) and artificial femoral head replacement from January 2010 to December 2016 were retrospectively analyzed. There were 141 males and 203 fe-males, with a mean age 65.64±10.81 years (28-87 years). A total of 351 hip revisions were performed in 344 patients with 7 pa-tients in bilateral revisions. All patients were followed up for 60.38±22.75 months (24-105 months). All patients with periprosthet-ic infection underwent two-stage revision after prosthesis placement, and all others underwent one-stage revision. The clinical out-comes of revision surgery were assessed with the Harris hip score and the survival rate of the revision prosthesis. According to the duration from artificial hip replacement to revision surgery, all patients were divided into early revision (less than 5 years) and late revision (more than 5 years) groups. They were also divided into two groups according to the age of the patient in revision sur-gery: >55-year-old and ≤55-year-old groups. The causes of revision, hip reoperation and re-revision were recorded. Results: In the 351 hip revisions, a total of 238 (67.8%) had aseptic loosening, 41 (11.7%) periprosthetic fractures, 30 (8.5%) periprosthetic infection, 23 (6.6%) recurrent dislocation and 19 (5.4%) the eccentric liner wear. The infection rate was significantly higher in the early revision group (21.1%) than that in the late revision group (4.2%) (χ²=24.443, P<0.001). The aseptic loosening rate was sig-nificantly higher in the late revision group (72.4%) than that in the early revision group (54.4%) (χ²=9.899, P=0.002). Sixteen pa-tients underwent hip surgery after revision, including 6 recurrent dislocations, 4 aseptic loosening, 3 periprosthetic fractures, and 3 periprosthetic infections. Eight of them underwent revision surgery, including 4 cases of aseptic loosening, 2 cases of periprosthet-ic fractures, and 2 cases of recurrent dislocation. The duration from the primary revision to the second revision was 22.1±10.0 months (1-75 months). The 5-year and 8-year survival rates of the revision prostheses were 99.3%[95%CI(98.3%, 100.3%)] and 92.6% [95%CI(87.1%, 98.1%)], respectively. The proportions of prosthetic infection and eccentric liner wear in the ≤55-year-old group were significantly higher than those in the >55-year-old group (χ²=3.981, P=0.046; χ²=5.226, P=0.022), while the propor-tion of aseptic loosening in the >55-year-old group was significantly higher than that in the ≤55-year-old group (χ²=5.254, P=0.022). The 8-year survival rates of the revision prostheses of ≤55-year-old group and >55-year-old group were 76.8% [95%CI(50.5%, 103.1%)] and 95.4% [95%CI(91.1%, 99.7%)], respectively. Conclusion Young patients have a higher risk of re-revi-sion after revision THA.