人工全髋关节置换术治疗化脓性髋关节炎后遗骨关节病的研究进展

目的总结人工全髋关节置换术(total hip arthroplasty,THA)治疗化脓性髋关节炎后遗骨关节病的研究进展。方法广泛查阅国内外近年相关文献,就THA治疗化脓性髋关节炎后遗骨关节病的时机、髋臼侧及股骨侧处理方法以及假体类型选择等方面进行总结分析。结果THA是治疗化脓性髋关节感染后遗骨关节病的有效手段,为避免感染复发,建议感染静止期达10年以上时手术。此类患者可能存在髋臼侧发育不良,髋臼覆盖率差,行THA时可选择高位造臼、髋臼内陷截骨、结构性植骨、Cage、钽金属垫块或3D打印假体等方式处理;股骨侧可能存在股骨髓腔细小、股骨颈前倾角增大、颈干角增大、大转子延长和骨质差等问题,行THA时可通过股骨截骨及选择合适型号假体进行处理。化脓性髋关节炎后遗骨关节病患者多较年轻,为获得更好的远期假体生存率,首选非骨水泥型假体。结论THA可有效治疗化脓性髋关节炎后遗骨关节病,但手术难度大、手术并发症相对较多,术者应有充分认识。     

Assessment of hip abductors by MRI after total hip arthroplasty and effect of fatty atrophy on functional outcome

Objectives

The aim of this study was to evaluate how fatty atrophy (FA) of the hip abductors in operated and non-operated hips affected the functional outcome following arthroplasty.

Outcome of total hip arthroplasty in patients with failed open reduction and internal fixation of acetabular fractures

BackgroundThe problem of failed acetabulum fracture fixation is increasing due to increased incidence of high-velocity injury and a large number of patients are being operated on in the past few years. Limited evidence is available regarding results of Total hip arthroplasty (THA) in patients with failed acetabulum fracture fixation surgery. We assessed the clinical, radiological and postoperative complications. Besides this, we also evaluated functional outcome and quality of life following THA in failed open reduction and internal fixation of acetabular fractures.MethodThe current retrospective study was performed at the tertiary center from 2015 to 2020. Eighteen patients of failed acetabulum fracture fixation surgery (14 males and 4 females) were included with a mean follow-up period of 2.4 years. Postero-lateral approach was done in all cases. Clinico-radiological outcome, functional outcomes were recorded according to Harris Hip score (HHS) and quality of life was assessed by using the 12-Item Short Form Health Survey (SF-12) score. Postoperative complications were also assessed.ResultsThe age of patients ranged from 20 years to 68 years with a mean age of 44.7 years. 16 of the patients (88.9%) had a united acetabular fracture while 2 of them (11.1%) presented with un-united acetabular fracture. The THA implant was found to be stable in all 18 cases. The Harris Hip score of the study ranged from 82 to 95 with a mean of 89.72 ± 4.24 while the SF-12 score ranged from 40.0 to 49.4 with a mean of 44.29 ± 2.95. Out of 18 cases, 11 (61.1%) returned with excellent outcomes while the rest 7 (38.9%) returned with good outcomes as per Harris Hips score criteria. The correlation and regression analysis shows between HHS and SF-12 was positive and statistically significant (r = 0.592, p = 0.010).ConclusionTHA in patients with failed acetabulum fracture fixation surgery provides a reliable option with satisfactory outcomes along with a better quality of life.     

Magnetic resonance imaging in the diagnosis and management of hip pain after total hip arthroplasty

Evaluation of pain following total hip arthroplasty (THA) can be challenging in the absence of radiographic pathology. This study aimed to examine the diagnostic utility of magnetic resonance imaging (MRI) in the evaluation of enigmatic hip pain following THA. We reviewed a series of patients who were evaluated with MRI after presenting with enigmatic hip pain following THA. MRI was able to demonstrate pathology in the periprosthetic tissues in all hips with minimal artifact. Patients underwent a range of conservative and operative interventions depending on the underlying pathology. If used discriminately in situations where pathology cannot be detected by conventional methods, MRI is a highly effective modality that can aid in the diagnosis of a wide range of disorders thereby allowing the clinician to determine the most appropriate intervention.     

Thromboembolic disease in patients with rheumatoid arthritis undergoing joint arthroplasty: Update on prophylaxes

The risk of venous thromboembolism (VTE) in rheumatoid arthritis (RA) and the higher incidence of RA patients undergoing major orthopedic surgery is well recognized. The objective of the present study is to describe the incidence of VTE and discuss the correct prophylaxis in RA patients undergoing knee or hip replacement. A systematic review of studies on thromboprophylaxis in RA patients undergoing major orthopedic surgery was performed. Detailed information was extracted to calculate the rate of VTE in RA orthopedic patients and analyze the thromboprophylaxis performed and bleeding complications. Eight articles were eligible for full review. No difference in the overall rate of VTE was observed between RA patients and controls. No significant differences were found in RA patients in terms of bleeding complications. The data on the optimal prophylaxis to be used in RA patients were insufficient to recommend any of the several options available. In the absence of dedicated guidelines for the care of RA patients undergoing orthopedic surgery, management must be individualized to obtain favorable patient outcome, weighing up all the factors that might put the patient at risk for higher bleeding and thrombotic events.     

A comparison of outcomes in morbidly obese,obese and non-obese patients undergoing primary total knee and total hip arthroplasty

Background

Obesity is a growing public health issue with the prevalence of morbid obesity, (Body Mass Index (BMI) ≥ 40 kg/m²) increasing. There is some evidence these patients have more peri- and post-operative complications and poorer outcomes when undergoing arthroplasty procedures. This audit aimed to determine and compare the outcomes of non-obese, obese and morbidly obese patients undergoing arthroplasty at our institution.

Magnetic resonance imaging in the evaluation of suspected hip sepsis in children

Background:Rapid and accurate diagnosis of musculoskeletal infection in children is critical to enable appropriate, targeted surgical interventions. Distinguishing between septic arthritis, myositis, and osteomyelitis around the hip can be difficult using clinical criteria and ultrasound scan alone.Materials and methods:We performed a retrospective 5-year observational review of selective magnetic resonance imaging scanning for hip sepsis in a pediatric tertiary referral center. Included were children with atraumatic hip pain with symptom duration <2 weeks, minimum of two positive modified Kocher’s criteria, and a hip effusion on ultrasound. All cases were followed up to discharge. We evaluated hip ultrasound and magnetic resonance imaging findings, operative procedures, microbiology results, duration of treatment, outcomes, and complications.Results:Fifty-one patients, 55% male, with a mean age 6.4 (0–16) years were included. Thirty-nine underwent magnetic resonance imaging scan for suspected septic arthritis of the hip; 24 prior to surgical washout (pre-emptive), and 15 afterwards (postoperative). In the pre-emptive group, 1/24 had septic arthritis, 7/24 had osteomyelitis, 6/24 had myositis, 5/24 had osteomyelitis and myositis, and 5/24 had no evidence of infective pathology. In the postoperative group, 3/15 had myositis, 3/15 had osteomyelitis, 3/15 had re-accumulation of the hip effusion requiring repeat washout, 3/15 had myositis and osteomyelitis, and 1/15 had septic arthritis of a contiguous joint.Conclusion:Pre-emptive magnetic resonance imaging scanning avoided unnecessary hip washout in 23 cases and enabled targeted drainage of an alternative focus in four of those. Magnetic resonance imaging scanning after hip washout indicated that four cases required further surgery to drain a different focus of infection.     

Optimisation of imaging parameters during CT guided interventional procedures in patients with total hip arthroplasty

ObjectiveTo determine the optimal KV and mAs settings during CT guided injections in the presence of a total hip arthroplasty so that image quality is maintained whist keeping the dose as low as reasonably achievable.MethodsA total hip arthroplasty phantom with needles with differing gauges was scanned using different CT parameters (from low dose to high dose) and evaluating if this had any effect on needle conspicuity. Conspicuity was graded from 1 to 3 by 2 independent blinded reviewers.ResultsIrrespective of the CT settings used (high dose or low dose parameters) needle conspicuity was not adversely affected by the THA for either scorer, therefore a kVp of 100 mA and a. In addition the needle gauge did not affect the conspicuity of the needle.ConclusionCT guided injections in this total hip arthroplasty phantom model can be performed without any adverse effect on the conspicuity of the needle tip on low dose CT settings.Advancement in knowledgeThis paper enables one to optimise the kV and mA while performing interventional procedures.     

Revision total hip arthroplasty with an uncemented primary stem in 79 patients

INTRODUCTION: Revision in THA continues to be a technical challenge because of difficulties in fixation of the femoral component in mostly deficient bone in the proximal femur. In cases with minor cortical defects, the use of primary stems in revision surgery has also been described by some authors. MATERIALS AND METHODS: Seventy-nine patients with minor femoral bone defects were reviewed retrospectively (mean follow-up 6.8 +/- 3.9 years), who underwent a femoral component revision surgery using the uncemented primary Bicontact stem (Aesculap, Tuttlingen, Germany). Furthermore, the radiographs (anteroposterior and lateral) before, after surgery and at latest follow-up were analysed concerning femoral defects, proximal bone loss, and to determine the quality of bony fixation. RESULTS: The average Harris hip score (HHS) was 42.2 +/- 20.8 preoperative and improved to 78.9 +/- 12.5 at latest follow-up (p < 0.001). Motion Score increased significantly from 2.7 +/- 1.9 to 3.5 +/- 1.4 (p < 0.05) and pain score decreased significantly from 5.7 +/- 2.9 to 3.6 +/- 2.4 (p = 0.005). During follow-up there were only four re-revisions within 2 years after revision. The results and clinical outcome of this study correspond to those published before, using primary cementless stems in cases of revision. CONCLUSION: Therefore, the primary uncemented Bicontact stem appears to be a good alternative to other revision systems in well-selected femoral revision cases with minor defects.     

西藏高原全髋关节置换22例临床分析

目的 分析西藏高原地区全髋关节置换术后疗效.方法 应用全髋关节置换术治疗髋关节类风湿性关节炎、股骨头缺血性坏死、股骨颈陈旧性骨折等.结果 本组22例病例经全髋关节置换术治疗,治愈19例(86.4%),并发症2例(9.1%),1例感染(4.5%).结论 随着手术方法、材料、临床应用等方面的不断完善,全髋关节置换术在西藏高原同样取得了良好的效果.     

Results of total hip arthroplasty with bone graft and support ring for protrusio acetabuli in rheumatoid arthritis

We evaluated 19 hips of 15 rheumatoid arthritis patients with protrusio acetabuli that had been surgically treated with total hip arthroplasty (THA) using a support ring; four hips were replaced with a TACT cup supporter, one hip with a Kerboull plate, six hips with a Ganz ring, and eight hips with a Müller ring. The average age was 60.2 years (range 48–75 years), and the average follow-up was 38 months (range 6–74 months). Two patients (three hips) died before the final follow-up, and two patients (two hips) underwent revision owing to loosening of the Ganz ring. Hip functions were rated according to the evaluation chart of hip joint functions of the Japanese Orthopaedic Association (JOA score). The mean total JOA score was 25.2 ± 8.6 preoperatively and 55.6 ± 8.7 postoperatively. Radiographically, 17 hips (minus the two revised hips) showed satisfactory incorporation of bone graft and no loosening of the support ring. The mean depth of protrusio acetabuli for these 17 hips was 3.5 ± 4.1mm before operation, 2.8 ± 5.1mm just after operation, and 2.3 ± 3.9mm at the final follow-up (no significant difference at the critical rate of 5%). Our study indicated the usefulness of THAs using a bone graft and a support ring in RA patients with protrusio acetabuli.     

Metal-cancellous Lübeck total hip arthroplasty in hemodialysis patients

We report the results of total hip arthroplasty (THA) in patients on hemodialysis (HD). The metal-cancellous cementless Lübeck (MCCL) prosthesis was used in a series of consecutive 17 patients between April 1996 and March 2000. The patients were evaluated clinically and radiographically, and data were recorded during prospective follow-up. We reviewed the 17 patients after follow-up for more than two years (mean, 3.7 years). At the latest review the mean Merle d`Aubigne and Postel total hip score had improved to 15.9 from a preoperative value of 7.8. Radiologically, there was no evidence of loosening. The revision rate was 6% (one hip) for the acetabular component and 6% (one hip) for the femoral component, which both occurred in the same patient due to deep infection. The complication rate was low, with no cases of intraoperative fracture or symptomatic deep venous thrombosis, but there was a 6% (one hip) rate of deep infection and a 6% (one hip) rate of dislocation. These findings demonstrate that good short-term results can be obtained using the MCCL prosthesis for HD patients. However, further follow-up is needed to determine the long-term outcome of this prosthesis. Received: 30 August 2002, Accepted: 2 September 2002 Correspondence to: T. Nakai     

全髋关节置换术治疗化脓性髋关节炎后遗关节畸形的临床研究

目的探讨人工全髋关节置换术（THA）治疗化脓性髋关节炎后遗关节畸形的近期临床疗效。方法 21例（22髋）化脓性髋关节炎后遗关节畸形行THA治疗。比较术前与末次随访时髋关节功能Harris评分,并随访观察假体稳定性。结果所有患者均获得平均45（24-58）个月随访。手术切口均一期愈合,无关节脱位、深静脉血栓形成、坐骨神经损伤或感染复发等并发症。所有患者均未出现〉2 mm的透亮带,无假体松动。临床症状及髋关节功能明显改善,末次随访时髋关节功能Harris评分平均89.5（73-97）分,较术前平均45.3（25-62）分明显提高,差异有统计学意义（t=13.642,P〈0.001）。结论 THA治疗化脓性髋关节炎后遗关节畸形的近期疗效良好。     

艾司氯胺酮与右美托咪定在中老年患者全髋关节置换术中的比较

目的 比较艾司氯胺酮与右美托咪定在中老年患者全髋关节置换术中的应用效果。
方法 选择择期行单侧全髋关节置换术的中老年患者60例,男17例,女43例,年龄60～80岁,BMI 18～28 kg/m²,ASA Ⅱ或Ⅲ级。将患者随机分为两组：右美托咪定组（D组,n=30）和艾司氯胺酮组（S组,n=30）。选择L2-3间隙行腰-硬联合麻醉（CSEA）,维持平面T₆—T₁₀。D组：静脉注射咪达唑仑0.04 mg/kg,5 min后静脉注射右美托咪定0.25 μg/kg,后维持0.2～0.7 μg·kg^-1·h^-1。S组：静脉注射咪达唑仑0.04 mg/kg,5 min后静脉注射艾司氯胺酮0.35 mg/kg,后维持0.3～0.4 mg·kg^-1·h^-1。记录入室时、椎管内麻醉10 min后、静注咪达唑仑后10、30、60 min的HR和MAP。记录术中血管活性药物使用情况。记录静注咪达唑仑30、90 min以及开始缝皮时的Ramsay镇静评分。记录术中及术后不良反应的发生情况。
结果 与D组比较,静注咪达唑仑后30、60 min,S组HR明显增快（P＜0.05）,术中麻黄碱、阿托品、去甲肾上腺素的使用率明显降低（P＜0.05）。两组不同时点Ramsay镇静评分、术中及术后不良反应发生率差异均无统计学意义。
结论 艾司氯胺酮与右美托咪定均可安全有效地应用于中老年患者全髋关节置换术,但艾司氯胺酮术中血流动力学更加稳定,且不增加不良反应的发生。     

Outcome of primary total hip arthroplasty in Charnley Class C patients with juvenile idiopathic arthritis: a case series

The outcome and complications of 37 primary total hip arthroplasties by one surgeon in 24 patients with Charnley Class C juvenile idiopathic arthritis with up to 19.6 years follow-up are reported. Twenty-six femoral components were cementless; all acetabular components were cementless with screws. Age at operation averaged 22.6 years. Two patients (3 hips) have died. Twelve hips in 9 patients have failed. Six cementless acetabular components with conventional polyethylene were revised because of osteolysis after 5.5 to 14.5 years. All 3 cementless C2 femoral stems with minimal porous coating failed. One of eight cemented AML Bantam stems loosened at 3.5 years; 2 of 23 cementless AML Bantam stems loosened at 9.5 and 19.6 years. Pain relief and functional improvement are dramatic after total hip arthroplasty in juvenile idiopathic arthritis; however, the long-term outcome is guarded.     

C反应蛋白增高患者行全髋关节置换术后临床疗效观察

目的探讨C反应蛋白增高患者行全髋关节置换（THA）术后的临床疗效。方法选择自2005-02—2012-01符合纳入标准的23例C反应蛋白增高且衙行THA的患者进行常规THA手术,术后进行随访观察。结果本组均获得随访12～48个月．平均26．4个月。1例出现感染,但无假体松动,予行保留假体的关节清理术后症状消失。末次随访时髋关节功能Harris评分平均91．3分,其中优13例,良8例,可2例,优良率91．3％。结论严格掌握手术指征,C反应蛋白增高患者行THA术后的临床效果满意。     

Anterior muscle sparing approach for total hip arthroplasty

The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach (DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched and specific claims investigated including improved early outcomes, speed of recovery, component placement, dislocation rates, and complication rates. Recent literature is positive regarding the effects of total hip arthroplasty with the anterior approach. While the data is not definitive at present, patients receiving the anterior approach for total hip arthroplasty tend to recover more quickly and have improved early outcomes. Component placement with the anterior approach is more often in the “safe zone” than with other approaches. Dislocation rates tend to be less than 1% with the anterior approach. Complication rates vary widely in the published literature. A possible explanation is that the variance is due to surgeon and institutional experience with the anterior approach procedure. Concerns remain regarding the “learning curve” for both surgeons and institutions. In conclusion, it is not a matter of should this approach be used, but how should it be implemented.     

术前口服多维碳水化合物对老年患者全髋关节置换术围术期应激反应的影响

目的 探讨术前口服多维碳水化合物饮品(术能)对老年患者全髋关节置换术(THA)围术期应激反应的影响。方法 选择择期全身麻醉下行THA老年患者88例,男50例,女38例,年龄65～80岁,BMI 18.5～30.0 kg/m²,ASAⅠ或Ⅱ级。采用随机数字表法分为三组：对照组(C组,n=29)、温水观察组(W组,n=29)和术能观察组(O组,n=30)。C组常规术前禁饮6 h,禁食8 h; W组术前2 h口服温水5 ml/kg; O组术前2 h口服术能5 ml/kg。采集口服液体前(T₀)、麻醉前10 min(T₁)、入麻醉恢复室苏醒后(T₂)、术后次日晨8:00(T₃)静脉血检测血糖、促肾上腺皮质激素(ACTH)浓度。记录麻醉前和苏醒后的口渴评分和饥饿评分,以及反流误吸、恶心呕吐的发生情况。结果与O组比较,C组和W组T₁时血糖浓度明显降低(P<0.05),T₂、T₃时血糖及ACTH浓度明显升高(P<0...     

Single-incision minimally invasive anterior approach in total hip arthroplasty: surgical technique and literature review

Abstract The single-incision minimally invasive anterior approach to the hip with complete preservation of the musculotendinous structures offers excellent surgical exposure of both the acetabulum and the femur for the purpose of total hip replacement. Acetabular exposure corresponds to a modified and limited Smith-Petersen approach with intrinsic peculiarities. Femoral exposure in external rotation, adduction and extension of the leg is unusual for replacement purposes and is accomplished by the use of a traction table and a specially designed hook. Anterior single-incision exposure combines the advantage of intrinsic articular stability of anterior approaches with the advantages of preservation of lateral pelvitrochanteric and posterior myotendinous structures. An adequate learning curve must be overcome due to peculiar adaptations during the course of operation. A large variety of femoral components may be implanted by this approach; metaphyseal anchoring stems and femoral neck-preserving stems are particularly suited to this technique, combining both issues of minimally invasive surgery in total hip replacement: bone preservation and minimal surgical invasiveness. This article describes the surgical technique that we adopted in 2003 and compares it to other minimally invasive surgical techniques.