Objective:To assess the clinical efficacy and infection control outcomes of two-stage revision in managing periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA) utilizing either a low or high constrained prosthesis.Methods:A retrospective analysis was performed on 40 patients who underwent revision TKA in the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from February 2019 to February 2022. According to the type of prosthesis selected in primary TKA, they were divided into low constrained prosthesis group and high constrained prosthesis group. There were 28 patients (28 knees) in the low constrained group, including 12 males and 16 females, aged 69.0(63.0, 74.0) years, with a body mass index of 25.18±0.55 kg/m 2. And there were 12 patients (12 knees) in the high-constrained group, including 5 males and 7 females, aged 66.5(65.0, 71.5) years, with a body mass index of 23.94±0.51 kg/m 2. All patients underwent two-stage revision surgery, with RHK used in 1 case and LCCK in 27 cases in the low-constrained prosthesis group. In the high-constrained prosthesis group, 3 patients were treated with RHK, 1 patient with PFC Sigma MBT, and 8 patients with LCCK. The preoperative and postoperative range of motion (ROM), Knee Society score (KSS), and postoperative infection control rate were compared between the two groups. Results:All patients were followed up. The follow-up time was 22.79±8.02 months in the low-constrained prosthesis group and 23.92±7.04 months in the high-constrained prosthesis group, with no significant difference between the two groups ( t=0.426, P=0.680). At the last follow-up, the KSS and ROM in the low-constrained prosthesis group were 77.96±9.74 and 93.48°±7.45°, respectively, significantly higher than 38.93±8.01 and 68.89°±9.44° before the operation ( P<0.05). The KSS score and ROM in the high-constrained prosthesis group were 67.83±8.31 and 80.08°±5.89° at the last follow-up, which were also significantly higher than those before operation (34.25±6.31 and 66.50°±10.48°, P<0.05). There was no significant difference in KSS and ROM between the two groups before operation ( P>0.05), but the KSS score and ROM in the low-constrained prosthesis group were significantly higher than those in the high-constrained prosthesis group at the last follow-up ( P<0.05). Bacterial culture results revealed that the primary infectious agents were coagulase-negative Staphylococcus and Staphylococcus aureus, with an overall infection control rate of 80% (32/40). The infection control rate was 89% (25/28) in the low-constrained prosthesis group and 58% (7/12) in the high-constrained prosthesis group, but the difference between the two groups was not statistically significant (χ 2=3.283, P=0.070). Conclusion:Two-stage revision effectively controls PJI, and the clinical outcomes of two-stage revision for PJI after primary TKA with a high-constrained prosthesis are inferior to those with a low-constrained prosthesis. Further exploration is needed to enhance efficacy.

Objective:To analyze the factors affecting the relative height change of the patella after primary robotic-assisted total knee arthroplasty (R-TKA).Methods:The data of 97 patients with osteoarthritis of the knee treated with R-TKA admitted from June 2021 to March 2022 were retrospectively analyzed, including 15 males and 82 females, aged 70.0±5.4 years (range, 58-80 years). The bone resection parameters of the robotic system were recorded intraoperatively, including the bone resection amount of the medial and lateral distal femur, medial and lateral posterior femoral condyle and medial and lateral tibial plateau. The Blackburne-Peel index (BPI) and Caton-Deschamps index (CDI) were used to measure the preoperative and postoperative relative patellar height on lateral radiographs, as well as the posterior tibial slope (PTS) and the change in patellar ligament length before and after surgery. The relationship between the change in relative patellar height and the variables of interest was analyzed using partial correlation and multiple linear regression.Results:The mean postoperative CDI was lower than preoperatively (0.79±0.15 vs. 0.91±0.13, t=9.69, P<0.001), and the percentage of patients with postoperative CDI<0.6 was higher than preoperatively (9.3% vs. 0; χ 2=12.92, P<0.001); the differences in mean postoperative BPI and percentage of patients with postoperative BPI<0.45 were not statistically significant compared to preoperatively (0.69±0.13 vs. 0.71±0.17, t=1.35, P=0.182; 11.3% vs. 17.5%, χ 2=1.50, P=0.220). The mean patellar ligament length on the first postoperative day was 2.29 mm shorter than preoperatively, there was a statistically significant difference ( t=5.90, P<0.001). Partial correlation analysis showed that the amount of patellar ligament length change was positively correlated with the amount of BPI and CDI change ( r=0.84, P<0.001; r=0.70, P<0.001), and the amount of PTS change and the mean distal femoral bone resection were negatively correlated with the amount of BPI ( r= -0.41, P<0.001; r=-0.32, P=0.002) and CDI ( r=-0.23, P=0.029; r=-0.25, P=0.017) change. In contrast, the amount of posterior femoral condyle bone resection and tibial plateau bone resection did not correlate with the change of BPI and CDI. Multiple linear regression analysis showed that the amount of patellar ligament length change, PTS change and the distal femoral bone resection were factors influencing the change of BPI ( β=0.03, P<0.001; β=-0.01, P<0.001; β=-0.02, P=0.021) and CDI ( β=0.02, P<0.001; β=-0.01, P=0.001; β=-0.02, P=0.008). Conclusion:Amount of patellar ligament length change, PTS change and the distal femoral bone resection are factors affecting the BPI. In order to obtain a better relative patellar height in the primary R-TKA, attention should be paid to the adjustment of the distal femoral bone resection and PTS, while taking the necessary measures to reduce the postoperative patellar ligament length changes.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective To study the preventive effects of prevention monitoring form for reducing enteral nutrition complications. Methods From January 2013 to December 2013, 58 patients were divided into control group which were used traditional nursing method. From January 2014 to December 2014, 61 cases were in intervention group undergoing prevention monitoring nursing method based on traditional nursing. We compared the differences between these two groups in body quality, C-reactive protein, albumin, prealbumin, complications and patient satisfaction before and after 10 d surgery. Results There were no differences between body quality, C-reactive protein, albumin, prealbumin in these two groups before surgery (P > 0. 05). Compared with the 10th day after surgery, there were significantly higher level of body quality, albumin, prealbumin in the intervention group than those of the control group (P<0. 05), while higher level C-reactive protein in the control group (P<0. 05). The incidences of abdominal pain, diarrhea, nausea, vomiting, gastric retention, reflux, aspiration and aspiration pneumonia, the proportion of blocking pipe were lower in the intervention group than the control group. Patient′s satisfaction rates were 98. 4% and 81. 0% in the intervention group and control group (P<0. 05). Conclusions Prevention monitoring form can decrease the rate of enteral nutrition complications, and improve nutrition, biochemical indexes and patients satisfaction.

Objective To investigate the relationship between pelvic asymmetry and Crowe classification of unilateral developmental dysplasia of the hip in adults. Methods According to the inclusion criteria, 100 cases of unilateral DDH in adults were collected, including 78 females and 22 males, with an average age of 56.3 years old (range, 21-79 years). In terms of Crowe classification, there were 30 cases of Crowe typeⅠ, 24 cases of Crowe typeⅡ, 23 cases of Crowe typeⅢ, and 23 cases of CroweⅣ. The normal?side and affected?side pelvic vertical height (the distance from the highest point of the ischial tuberosity to the iliac crest peak) were measured via the radiogram of anteroposterior pelvis. Furthermore, we compared the affected?side pelvic vertical height with the normal?side and analyzed the relationship between Crowe classification and the difference in pelvic verti?cal height. Results The average pelvic vertical height was 23.38±1.46 cm in the normal?side and 22.41±1.38 cm in the affected?side. The average D?value of pelvic vertical height between two sides is 0.98 ± 0.76 cm. From Crowe typeⅠto Ⅳ, the average heights of the normal?side were 22.89±1.09 cm, 23.23±2.07 cm, 23.75±1.16 cm, 23.79±1.22 cm, while those of the affected?side were 22.70 ± 0.98 cm, 22.41 ± 1.98 cm, 22.47 ± 1.12 cm and 21.92 ± 1.32 cm. The average D?values in each group were 0.19 ± 0.37 cm, 0.82±0.43 cm, 1.28±0.32 cm, 1.87±0.59 cm. The differences between the normal?side and the affected?side in each type were statistically significant. The average D?value increased significantly with Crowe type increased, and there was a positive correla?tion between the D?value of bilateral pelvic vertical height and the degree of hip dislocation. Conclusion The pelvic asymmetry does exist in adult patients with unilateral developmental dysplasia of the hip. Moreover, the asymmetry has positive correlation with the degree of hip dislocation.

Objective To explore the application and effect of risk management in clinical surgical nursing management .Methods Surgical patients in Chinese and western combined hospital of Taizhou were divided into control group(n=468) and observation group(n=436) according to the time of entrance hospital. Control group received routine nursing , while observation group received risk management .Then, the risk incidence , nursing quality and patients satisfaction were observed and analyzed .Results After the implementation of nursing risk management in clinical surgical nursing , nursing risk incidence was reduced from 9.40%to 3.44%,and the difference was statistically difference (χ2 =13.149,P<0.01).And the patients satisfaction scores were significantly improved [(98.3 ±6.1) vs(85.2 ±5.9);t=32.545,P<0.01)].Before and after the implementation of risk management quality scores comparison difference had statistical significance ( P<0.01 ) .Conclusions Nursing risk management can effectively reduce the nursing risk incidence , improve the nursing quality and patients satisfaction .

Objective To respectively analyze the results and complications of hip arthroplasty for failed intertrochanteric hip fractures treating with internal fixation.Methods From July 2004 to June 2006,32 patients(24 males and 8 females)were treated with hip arthroplasty after the failed internal fixation of intertrochanteric fractures.The mean age was 71 years(range,57-81 years)at the time of the hip arthroplasty.The average interval from fracture to arthroplasty was 40 months(range,5-70 months).Fifteen patients had been treated with sliding hip screw,10 with intramedullary nail,5 with plate and screws,2 with multiple screws.The failure modes were nonunion in 8 patients,implant cut out from the femoral head in 9,avascular necrosis of the femoral head in 7,and traumatic arthritis in 8 patients.Cemented stems were used in 12 hips,and uncemented stems in 20 hips.Standard prostheses were used in 25,long-stem prostheses in 7.Results Twenty-eight patients were followed up for a minimum of 4 years after the hip arthroplasty,with the mean period of 5 years(range,4-6 yeas).For these 28 patients,the average preoperative Harris Hip Score was 37(range,32-45),and 88(range,84-95)at the latest follow-up.The average acetabular inclination was 44°(range,42°-48°).No loosing was found in cotyloid components.Nine of 10 cemented femoral components had cementation rated as grade C,and 1 as grade A.Three had heterotopic bone six months postoperatively,and 2 were Brooker type Ⅱ,one was type Ⅲ.Conclusion Hip arthroplasty is an effective salvage procedure after the failed treatment of an intertrochanteric fracture in an older patient.

Objective To evaluate the analgesic effect of parecoxib in total knee arthroplasty (TKA) and total hip arthroplasty (THA).Methods The study was a prospective,randomized and double-blind trial and was operated by the same group of surgeons in 101 patients with TKA and 105 patients with THA.According to analgesic protocol,the patients were divided into three groups:Group One ( intravenous injection with parecoxib),Group Two ( periarticular injection with parecoxib) and Group Three ( the control group).The postoperative visual analog scores (VAS),range of motion ( ROM),the ability of straight leg raising and the incidence of nausea and vomiting complications were examined and compared between the three groups.Results There were no significant differences in VAS (6,12,24,36,48,72 hours after operation),ROM ( 24 hours after operation) and the ability of straight leg raising between Group One and Group Two ( P ＞ 0.05 ),but all of them were significantly higher than those in Group Three ( P ＜ 0.05 ).Nausea,vomiting and other adverse effects did not significandy increase with the use of parecoxib.Conclusions Both intraoperative intravenous injection and periarticular injection with parecoxib have a good analgesia effect on TKA and THA,which are beneficial to the rapid recovery of joint function in patients.The simple and practical method provides an effective adjunct to a multimodal analgetic approach in improving the postoperative course of TKA and THA.

Objective To compare gait patterns in patients with metal-on-metal resurfacing hip arthroplasty(RHA)and big-femoral-head total hip arthroplasty(BHA)at one year postoperatively.Methods From June 2006 to March 2009,two groups of 30 RHA and BHA patients participated in the study.Gait parameters,knee and hip joint range of motions(ROMs)in gait cycles were measured at one year postoperatively by Vicon gait analysis system,and the values were used to calculate affected/unaffected ratios of patients themselves.Results No significant difference were found in affected/unaffected ratios of cadence,single limb support time,foot off,peak value of vertical ground reaction force,the hospital for special surgery score and the university of California at Los Angeles activity assessment between the two groups.However,several ROM affected/unaffected ratios in RHA group(hip range of flexion/extension,abduction/adduction,and rotation were 1.0323,0.9747,and 1.0558,respectively.The knee range of flexion/extension for affected/unaffected ratios was 1.0027)were significantly higher than those in BHA group(the corresponding values were 0.8615,0.7824,0.8162,0.9472,respectively).The P values were 0.007,0.005,0.006,and 0.037,respectively.Conclusion(1)Gait parameters of patients who underwent RHA and BHA were close to normal values at one year postoperatively.(2)At the follow up time point,joint ROMs of RHA patients are larger than those of BHA patients during gait cycle.(3)RHA can retain enough bone stock for future revision option,moreover,it can achieve maximum recovery of joint function.

Objective To analyze the literatures on arthroplasty treating femoral neck fracture in the elderly so as to evaluate the value of arthroplasty in treating femoral neck fracture in the elderly. Methods The literatures published from 1991 to 2007 on arthroplasty treating femoral neck fracture in the elderly were retrieved via PubMED and Ovid database to compare the mortality. Dislocation, revision and Harris score after operation. The heterogeneity was tested and the data dealt by meta-ana]ysis. Then, we talculated the OR value and 95% confidence interval. Results The study included 10 related pa-pers involving hemi-arthroplasty(HA)and total hip arthroplasty(THA)treating femoral neck fracture in the elderly. There was no statistical difference between HA and THA in aspect of mortality. No heteroge-neity existed in dislocation and revision, with the Q value of 4. 03 and 2. 78 respectively(P>0. 1). THA had a high dislocation rate but lower incidence of revision, in comparison with HA. The heterogeneity of Harris score was confirmed with the Q value of 23. 94(P<0. 1), with relative risk(RR) of 0. 79, OR of 0. 35 and 95% CI of 0. 23-0. 53. Conclusions As for hip function recovery, THA is better than he-mi-arthroplasty and THA should be the first choice for femoral neck fracture. However, for patients who can not tolerate operation or have anticipated life span less than 5 years, hemi-arthroplasty should be cho-sen.