Humans ; Arthroplasty, Replacement, Knee/adverse effects* ; Surgical Wound Infection/etiology* ; Retrospective Studies ; Risk Factors ; Arthroplasty, Replacement, Hip/adverse effects* ; Prosthesis-Related Infections/etiology*

Humans ; Arthroplasty, Replacement, Knee/adverse effects* ; Arthroplasty, Replacement, Hip/adverse effects* ; Reoperation ; Prosthesis-Related Infections ; Retrospective Studies

OBJECTIVE: To construct and evaluate nomogram prediction model for periprosthetic fractures in patients undergoing total hip arthroplasty (THA). METHODS: A total of 538 patients who underwent THA from April 2013 to February 2019 were selected as the research subjects, including 318 males and 220 females, aged 40 to 60 years old with an average age of (50.79±6.37) years old. All patients with THA were divided into non-fracture group (506 patients) and fracture group (32 pathents) according to the 3-year follow-up results. Univariate and multivariate Logistic regression analyses were performed to analyze the influencing factors of postoperative periprosthetic fractures in patients with THA. A nomogram prediction model for periprosthetic fractures in patients undergoing THA was constructed, and the validity and discrimination of the prediction model were evaluated. RESULTS: The proportion of patients with osteoporosis, trauma history, and hip revision in the fracture group were higher than those in the non-fracture group(P<0.05), and the proportion of bone cement prosthesis was lower than that in the non-fracture group(P<0.05). The osteoporosis status[OR=4.177, 95%CI(1.815, 9.617), P<0.05], trauma history[OR=7.481, 95%CI(3.104, 18.031), P<0.05], and hip revision[OR=11.371, 95%CI(3.220, 40.153, P<0.05] were independent risk factors for postoperative periprosthetic fractures in patients undergoing THA, cemented prosthesis [OR=0.067, 95%CI(0.019, 0.236), P<0.05] was an independent protective factor for postoperative periprosthetic fractures in patients undergoing THA(P<0.05). Hosmer-Lemeshow goodness of fit test showed that χ²=7.864, P=0.325;the area under the curve (AUC) for periprosthetic fractures in patients undergoing THA was 0.892 with a sensitivity of 87.5% and a specificity of 77.7% by receiver operating characteristic(ROC) curve. CONCLUSION The nomogram prediction model for periprosthetic fractures after THA constructed in this study has good discrimination, which is beneficial to clinical prediction of periprosthetic fractures in patients undergoing THA, and facilitates individualized fracture prevention.
Male ; Female ; Humans ; Adult ; Middle Aged ; Arthroplasty, Replacement, Hip/adverse effects* ; Periprosthetic Fractures/surgery* ; Nomograms ; Reoperation/adverse effects* ; Risk Factors ; Osteoporosis/surgery* ; Retrospective Studies ; Hip Prosthesis

The choice of friction interface has always been a controversial topic in hip arthroplasty. Although the metal-on-metal (MoM) interface has gradually faded out of our vision, its revision is a clinical difficulty. Adverse reactions to metal debris (ARMD) is the most common indication for MoM hip arthroplasty revision, and the clinical results of hip arthroplasty due to ARMD are not satisfactory. At present, the indications and suggestions for revision of ARMD are not uniform. In this article, the clinical diagnosis, indications of revision, risk factors of prognosis, intraoperative suggestions and reasons for revision of ARMD were summarized. This article briefly introduces the diagnosis and treatment strategies and precautions of hip arthroplasty due to ARMD, in order to provide reference for such patients in clinical practice.
Arthroplasty, Replacement, Hip/adverse effects* ; Hip Prosthesis/adverse effects* ; Humans ; Metal-on-Metal Joint Prostheses/adverse effects* ; Prosthesis Design ; Prosthesis Failure ; Reoperation

Prosthetic infection is one of the severe postoperative complications of arthroplasty. Mixed bacterial-fungal prosthetic infection is rare but can be disastrous. This case was a 76-year-old female suffered from prosthetic infection following total hip replacement due to femoral neck fracture and underwent multiple debridements. The culture of periprosthetic tissue was bacteriologically sterile following the first debridement, while the Staphylococcus hominis was identified in the second debridement in the previous hospitalization where fungal infection had not been considered. Thus the pathogen spectrum of anti-infection therapy failed to contain fungus. Ultimately, the culture result of our sampled periprosthetic tissue during the third debridement was Candida albicans without bacterium in our hospital. The fungal prosthetic infection was successfully treated by a two-stage revision with antifungal drugs. Accurate diagnosis and standardized treatment is the key to the therapy of infection after hip arthroplasty, especially for mixed bacterial-fungal prosthetic infection.
Aged ; Anti-Bacterial Agents/therapeutic use* ; Arthroplasty, Replacement, Hip/adverse effects* ; Debridement ; Female ; Fungi ; Hip Prosthesis/adverse effects* ; Humans ; Mycoses/drug therapy* ; Prosthesis-Related Infections/therapy* ; Reoperation ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To analyze and compare the clinical efficacy of different types of surgical treatment of periprosthetic femoral fracture(PFF) after hip arthroplasty (HA). METHODS: From September 2010 to September 2016, 47 patients (47 hips) with periprosthetic fractures after total hip arthroplasty were retrospectively analyzed, including 13 males and 34 females. According to Vancouver classification, there were 2 patients with type AG, 17 patients with type B1, 19 patients with type B2, 7 patients with type B3 and 2 patients with type C. The age of patients ranged from 56 to 94 (71.5±8.3) years. After admission, nutritional risk screening (NRS2002) was used to assess the nutritionalstatus of the patients. Eighteen patients (38%) had malnutrition risk (NRS>3 points). After admission, the patients were given corresponding surgical treatment according to different types. Intraoperative blood loss was recorded. Harris score was used to evaluate the hip function. VAS pain score was performed on admission and after operation. RESULTS: All the 47 patients were followed up for 19 to 62 (34±11) months. The Harris scores were (41.8±12.1) and (89.0±2.6) respectively before and 1 year after operation, and the difference was statistically significant ( CONCLUSION The treatment of hip periprosthetic fracture patients should be based on the general situation of patients, imaging data, intraoperative correction classification, etc. to develop individualized treatment plan in line with patients. For patients with preoperative malnutrition risk, preoperative nutritional intervention may reduce intraoperative bleeding.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/adverse effects* ; Female ; Femoral Fractures/surgery* ; Fracture Fixation, Internal ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Periprosthetic Fractures/surgery* ; Reoperation ; Retrospective Studies ; Treatment Outcome

Periprosthetic infection after hip replacement is a clinical catastrophic disease, which often leads to the failure of the prosthesis. It needs the combination of systemic antibiotics to cure the infection, which brings huge burden to doctors and patients. There are strict indications for debridement and one-stage revision of the prosthesis, and few cases meet the requirements. The second revision is still the gold standard for the treatment of periprosthetic infection. It is suitable for all infection conditions and has a high success rate. On the second phase of renovation, the antibiotic sustained release system plays a key role, and the carrier of antibiotic sustained-release system is the focus of current research, including classic bone cement and absorbable biomaterials. Bone cement has strong mechanical strength, but the antibiotic release shows a sharp decline trend; the absorbable biomaterials can continuously release antibiotics with high concentration, but the mechanical strength is poor, so it could not use alone. The combination of bone cement and absorbable biomaterials will be an ideal antibiotic carrier. PMMA is the most commonly used antibiotic carrier, but the antibiotic release concentration is decreased sharply after 24 hours. It will be difficult to control the infection and increase the risk of bacterial resistance if it is lower than the minimum inhibitory concentration. The biodegradable materials can release antibiotics completely, with long release time and high concentration, but low mechanical strength. Antibiotic spacer plays an important role in the control of infection. In the future, how to further extend the antibiotic release time of antibiotic sustained-release system, increase the amount of antibiotic release and maintain the mechanical strength of the material will be studied.
Anti-Bacterial Agents/therapeutic use* ; Arthroplasty, Replacement, Hip/adverse effects* ; Bone Cements ; Hip Prosthesis ; Humans ; Prosthesis-Related Infections/surgery* ; Reoperation

Arthroplasty, Replacement, Hip ; adverse effects ; Female ; Humans ; Prosthesis Design ; Prosthesis Failure ; Risk Factors

BACKGROUNDPeriprosthetic joint infection (PJI) is the main cause of failure following total joint arthroplasty. Until now, the diagnosis of PJI is still confronted with technical limitations, and the question of whether synovial fluid biomarker, C-reactive protein (CRP), can provide high value in the diagnosis of PJI remains unanswered and, therefore, was the aim of the study.

METHODSFirst, we conducted a systematic review on CRP in the diagnosis of PJI by searching online databases using keywords such as "periprosthetic joint infection", "synovial fluid", and "C-reactive protein". Eligible studies providing sufficient data to construct 2 × 2 contingency tables were then selected based on the list of criteria and the quality of included studies was assessed subsequently. Finally, the reported sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curve, and the area under the SROC (AUSROC) were pooled together and used to evaluate overall diagnostic performance.

RESULTSSeven studies were included in our review, six of which comprising a total of 456 participants were further investigated in our meta-analysis. The pooled sensitivity, specificity, and DOR were 0.92 (95% confidence interval [CI]: 0.86-0.96), 0.90 (95% CI: 0.87-0.93), and 101.40 (95% CI: 48.07-213.93), respectively. The AUSROC was 0.9663 (standard error, 0.0113).

CONCLUSIONSSynovial fluid CRP is a good biomarker for the diagnosis of PJI with high sensitivity and specificity.

Arthroplasty, Replacement, Hip ; adverse effects ; Arthroplasty, Replacement, Knee ; adverse effects ; Biomarkers ; metabolism ; C-Reactive Protein ; metabolism ; Female ; Humans ; Male ; Prosthesis-Related Infections ; diagnosis ; Synovial Fluid ; metabolism

OBJECTIVEThe present study aimed to review the characteristics and influencing factors of squeaking after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) and to analyze the possible mechanisms of the audible noise.

DATA SOURCESThe data analyzed in this review were based on articles from PubMed and Web of Science.

STUDY SELECTIONThe articles selected for review were original articles and reviews found based on the following search terms: "total hip arthroplasty", "ceramic-on-ceramic", "hip squeaking", and "hip noise."

RESULTSThe mechanism of the squeaking remains unknown. The possible explanations included stripe wear, edge loading, a third body, fracture of the ceramic liner, and resonance of the prosthesis components. Squeaking occurrence is influenced by patient, surgical, and implant factors.

CONCLUSIONSMost studies indicated that squeaking after CoC THA was the consequence of increasing wear or impingement, caused by prosthesis design, patient characteristics, or surgical factors. However, as conflicts exist among different articles, the major reasons for the squeaking remain to be identified.

Arthroplasty, Replacement, Hip ; adverse effects ; Ceramics ; therapeutic use ; Hip Prosthesis ; Humans ; Noise ; adverse effects ; Osteoarthritis, Hip ; surgery