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Which approach of total hip arthroplasty is the best efficacy and least complication? 被引量:1
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作者 Lertkong Nitiwarangkul Natthapong Hongku +3 位作者 Oraluck Pattanaprateep Sasivimol Rattanasiri Patarawan Woratanarat Ammarin Thakkinstian 《World Journal of Orthopedics》 2024年第1期73-93,共21页
BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications o... BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications. 展开更多
关键词 Total hip arthroplasty Total hip replacement APPROACH Supercapsular percutaneously-assisted total hip Harris hip Score Intra-operative fracture
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Total hip arthroplasty preoperative planning for childhood hip disorders’sequelae:Focus on developmental dysplasia of the hip
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作者 Saran S Gill Valerio Pace 《World Journal of Orthopedics》 2024年第12期1112-1117,共6页
Developmental dysplasia of the hip(DDH)poses significant challenges in both childhood and adulthood,affecting up to 10 per 1000 live births in the United Kingdom and United States.While newborn screening aims to detec... Developmental dysplasia of the hip(DDH)poses significant challenges in both childhood and adulthood,affecting up to 10 per 1000 live births in the United Kingdom and United States.While newborn screening aims to detect DDH early,missed diagnoses can lead to severe complications such as hip dysplasia and early onset osteoarthritis in adults.Treatment options range from less invasive procedures like hip-preserving surgery to more extensive interventions such as total hip arthroplasty(THA),depending on the severity of the condition.Preoperative planning plays a critical role in optimizing surgical outcomes for DDH patients undergoing THA.This includes accurate imaging modalities,precise measurement of acetabular bone stock,assessment of femoral head subluxation,and predicting prosthesis size and leg length discrepancy.Recent advancements artificial intelligence and machine learning offer promising tools to enhance preoperative planning accuracy.However,challenges remain in validating these technologies and integrating them into clinical practice.This editorial highlights the importance of ongoing research to refine preoperative strategies and improve outcomes in DDH management through evidence-based approaches and technological innovations. 展开更多
关键词 Developmental dysplasia of the hip Childhood hip disorders Total hip arthroplasty Total hip replacement Preoperative planning
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Roles of combined femoral and acetabular anteversion in pathological changes of hip dysplasia and hip reconstructive surgery
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作者 Can Liu Zheng Xu +5 位作者 Jian-Fa Zeng Zhen-Qi Song Yu-Yin Xie Zhong-Wen Tang Jie Wen Sheng Xiao 《World Journal of Orthopedics》 2024年第5期390-399,共10页
Combined femoral and acetabular anteversion is the sum of femoral and acetabular anteversion,representing their morphological relationship in the axial plane.Along with the increasing understanding of hip dysplasia in... Combined femoral and acetabular anteversion is the sum of femoral and acetabular anteversion,representing their morphological relationship in the axial plane.Along with the increasing understanding of hip dysplasia in recent years,numerous scholars have confirmed the role of combined femoral and acetabular anteversion in the pathological changes of hip dysplasia.At present,the reconstructive surgery for hip dysplasia includes total hip replacement and redirectional hip preservation surgery.As an important surgery index,combined femoral and acetabular anteversion have a crucial role in these surgeries.Herein,we discuss the role of combined femoral and acetabular anteversion in pathological changes of hip dysplasia,total hip replacement,and redirectional hip preservation surgery. 展开更多
关键词 Combined anteversion Femoral anteversion Acetabular anteversion hip dysplasia hip preservation surgery Total hip replacement
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Specific approach to total hip arthroplasty in patients with childhood hip disorders sequelae
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作者 Katarina Barbaric Starcevic Goran Bicanic Luka Bicanic 《World Journal of Orthopedics》 2024年第12期1118-1123,共6页
Hip arthroplasty in patients with a history of paediatric hip disorders presents a significant challenge for orthopaedic surgeons.These patients are typically younger and have greater functional demands.Therefore,achi... Hip arthroplasty in patients with a history of paediatric hip disorders presents a significant challenge for orthopaedic surgeons.These patients are typically younger and have greater functional demands.Therefore,achieving optimal biomechanical conditions is crucial,involving placement of the acetabulum at the ideal centre of rotation and securing a stable femoral component with good offset to preserve abductor muscle function and restore leg length.The altered anatomy in these cases makes total hip arthroplasty more complex,necessitating thorough preoperative imaging and an individualised surgical approach.Various techniques may be employed to optimise biomechanical outcomes.We propose a modified lateral hip approach,offering exceptional visualisation of the acetabulum and femur while preserving the continuity of the abductor muscles without requiring trochanteric osteotomy.To achieve the most biomechanically advantageous acetabular position,cotyloplasty is our preferred method. 展开更多
关键词 Total hip arthroplasty Pediatric hip sequelae Center of rotation Cotyloplasty hip abductor muscles
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Examining the“revisability”benefit of hip resurfacing arthroplasty
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作者 Jose George Adam J Taylor Thomas P Schmalzried 《World Journal of Orthopedics》 2024年第6期554-559,共6页
BACKGROUND Hip resurfacing arthroplasty(HRA)is an alternative to total hip arthroplasty(THA)that is typically reserved for young active patients because it preserves bone.However,the benefits of HRA only hold true if ... BACKGROUND Hip resurfacing arthroplasty(HRA)is an alternative to total hip arthroplasty(THA)that is typically reserved for young active patients because it preserves bone.However,the benefits of HRA only hold true if conversion THA after failed HRA provides acceptable outcomes.AIM To compare patient reported outcomes for conversion THA after HRA failure to primary THA.METHODS A retrospective review of 36 patients(37 hips)that underwent conversion THA for failed HRA between October 2006 and May 2019 by a single surgeon was performed.Patient reported outcomes[modified Harris Hip Score(mHHS),University of California Los Angeles(UCLA)activity score]were obtained via an email-based responder-anonymous survey.Outcomes were compared to normative data of a primary THA cohort with similar demographics.Subgroup analysis was performed comparing outcomes of conversion THA for adverse local tissue reaction(ALTR)vs all other causes for failure.RESULTS The study group had a lower mHHS than the control group(81.7±13.8 vs 90.2±11.6,P<0.01);however,both groups had similar UCLA activity levels(7.5±2.3 vs 7.2±1.6,P=0.51).Patients that underwent conversion for non-ATLR causes had similar mHHS(85.2±11.5 vs 90.2±11.6,P=0.11)and higher UCLA activity levels(8.5±1.8 vs 7.2±1.6,P<0.01)compared to the control group.Patients that underwent conversion for ATLR had worse mHHS(77.1±14.5 vs 90.2±11.6,P<0.01)and UCLA activity levels(6.1±2.3 vs 7.2±1.6,P=0.05)when compared to the control group.CONCLUSION Patient outcomes equivalent to primary THA can be achieved following HRA conversion to THA.However,inferior outcomes were demonstrated for ALTR-related HRA failure.Patient selection and perhaps further studies examining alternative HRA bearing surfaces should be considered. 展开更多
关键词 Total hip arthroplasty hip resurfacing arthroplasty Conversion total hip arthroplasty Adverse local tissue reaction Patient reported outcome measures
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Technical note for intraoperative determination of proper acetabular cup size in primary total hip arthroplasty
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作者 Panagiotis Karampinas John Vlamis +5 位作者 Athanasios Galanis Michail Vavourakis Anastasia Krexi Evangelos Sakellariou Christos Patilas Spiros Pneumaticos 《World Journal of Methodology》 2024年第1期94-101,共8页
BACKGROUND Selecting the optimal size of components is crucial when performing a primary total hip arthroplasty.Implanting the accurate size of the acetabular component can occasionally be exacting,chiefly for surgeon... BACKGROUND Selecting the optimal size of components is crucial when performing a primary total hip arthroplasty.Implanting the accurate size of the acetabular component can occasionally be exacting,chiefly for surgeons with little experience,whilst the complications of imprecise acetabular sizing or over-reaming can be potentially devastating.AIM To assist clinicians intraoperatively with a simple and repeatable tip in elucidating the ambivalence when determining the proper acetabular component size is not straightforwardly achieved,specifically when surgeons are inexperienced or preoperative templating is unavailable.METHODS This method was employed in 263 operations in our department from June 2021 to December 2022.All operations were performed by the same team of joint reconstruction surgeons,employing a typical posterior hip approach technique.The types of acetabular shells implanted were:The Dynasty®acetabular cup system(MicroPort Orthopedics,Shanghai,China)and the R3®acetabular system(Smith&Nephew,Watford,United Kingdom),which both feature cementless press-fit design.RESULTS The mean value of all cases was calculated and collated with each other.We distinguished as oversized an implanted acetabular shell when its size was>2 mm larger than the size of the acetabular size indicator reamer(ASIR)or when the implanted shell was larger than 4 mm compared to the preoperative planned cup.The median size of the implanted acetabular shell was 52(48–54)mm,while the median size of the preoperatively planned cup was 50(48–56)mm,and the median size of the ASIR was 52(50–54)mm.The correlation coefficient between ASIR size and implanted acetabular component size exhibited a high positive correlation with r=0.719(P<0.001).Contrariwise,intraoperative ASIR measurements precisely predicted the implanted cups’size or differed by only one size(2 mm)in 245 cases.CONCLUSION In our study,we demonstrated that the size of the first acetabular reamer not entering freely in the acetabular rim corroborates the final acetabular component size to implant.This was also corresponding in the majority of the cases with conventional preoperative templating.It can be featured as a valid tool for avoiding the potentially pernicious complications of acetabular cup over-reaming and over-sizing in primary total hip arthroplasty.It is a simple and reproducible technical note useful for confirming the predicted acetabular cup size preoperatively;thus,its application could be considered routinely,even in cases where preoperative templating is unavailable. 展开更多
关键词 Acetabular shell Total hip arthroplasty hip ACETABULUM Acetabular component Primary hip arthroplasty
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Primary Total Hip Arthroplasty on Complex Hips Conditions in a Low-Resource Setting
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作者 Souleymane Ouédraogo Malick Diallo +4 位作者 Sékou Sidibé Massadiami Soulama Adama Sidibé Ousmane Ouermi Patrick W. H. Dakouré 《Open Journal of Orthopedics》 2024年第7期325-333,共9页
Introduction: Total hip arthroplasty of complex morphology is a challenge for the orthopaedic surgeon. Careful analysis of the hip’s anatomy helps to unravel the difficulties and anticipate the procedures to be perfo... Introduction: Total hip arthroplasty of complex morphology is a challenge for the orthopaedic surgeon. Careful analysis of the hip’s anatomy helps to unravel the difficulties and anticipate the procedures to be performed and the implants to be planned. The aim was to identify the types of hip that make first-line THR difficult, specify the technical procedures to be used on these sites, and assess the functional results of the series. Material and Methods: This was a retrospective study that concerned patients operated on for total hip arthroplasty between January 2015 and December 2022 at the medical center “La Grâce” in Bobo-Dioulasso, Burkina Faso. Patients with coxarthrosis (on hip dysplasia, acetabular protrusio, acetabular malunion or neurological hip) and those with ankylosis of the hip, osteonecrosis secondary to neglected dislocation of the hip or hemoglobinopathy were included. Results: A total of 31 total hip replacements were performed in 30 patients. The mean age of patients at the surgery time was 36.2 years with extremes of 17 and 61 years. The male-to-female sex ratio was 1. The main indications for THA were the dysplasic hip osteoarthritis (11 cases) and the neglected hip dislocations (7 cases). In situ femoral neck osteotomy before hip dislocation was performed in seven cases. The acetabulum reconstruction techniques varied from the structural iliac bone graft (n = 3) and cancellous bone graft (n = 4) to the Kerboull plate (n = 1). After 45 months of mean follow-up, all hips were evaluated. The mean PMA score increased from 7.1 [4 - 8] before the surgery to 13.2 [13 - 17]. Conclusion: The large spectrum of challenges in complex hip management requires effective preoperative planning. Preoperative planning minimizes complications and ensures a better outcome. 展开更多
关键词 Primary Total hip Arthroplasty hip Dysplasia Complex hip
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Total hip arthroplasty for sequelae of childhood hip disorders:Current review of management to achieve hip centre restoration 被引量:1
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作者 Anil Thomas Oommen 《World Journal of Orthopedics》 2024年第8期683-695,共13页
Adults requiring total hip arthroplasty(THA)for childhood disorder sequelae present with shortening,limp,pain,and altered gait.THA,which can be particularly challenging due to altered anatomy,requires careful planning... Adults requiring total hip arthroplasty(THA)for childhood disorder sequelae present with shortening,limp,pain,and altered gait.THA,which can be particularly challenging due to altered anatomy,requires careful planning,assessment,and computed tomography evaluation.Preoperative templating is essential to establish the appropriate acetabular and femoral size.Information regarding neck length and offset is needed to ensure the proper options are available at THA.Hip centre restoration must be planned preoperatively and achieved intraoperatively with appropriate exposure,identification,and stable fixation with optimum-size components.Identifying the actual acetabular floor is essential as changes include altered anatomy,distortion of the margins and version changes.Proximal femur changes include anatomical variation,decreased canal diameter,cortical thickness,changes in anteversion,and metaphyseal and diaphyseal mismatch.Preoperative assessment should consist of limb assessment for variations due to prior surgical procedures.Evaluation of the shortening pattern with the relationship of the lesser trochanter to the teardrop would help identify and plan for subtrochanteric shortening osteotomy,especially in high-riding hips.The surgical approach must ensure adequate exposure and soft tissue release to achieve restoration of the anatomical hip centre.The femoral components may require modularity to enable restoration of anteversion and optimum fixation. 展开更多
关键词 Total hip arthroplasty Childhood disorder sequelae TEMPLATING hip centre restoration Soft tissue release Offset
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Conversion hip arthroplasty for failed nailing of intertrochanteric fracture: Reflections on some important aspects
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作者 Fu-Chun Yang 《World Journal of Orthopedics》 2024年第10期997-1000,共4页
In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fracture... In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly pati-ents,entails more complex processes and higher rates of operative complications than primary arthroplasty.Hence,it is important to consider the appropriateness of the primary treatment choice,as well as the adequacy of nailing fixation for intertrochanteric fractures.This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures.It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures. 展开更多
关键词 Intertrochanteric femur fracture Femoral nailing fixation Primary hip arthroplasty Conversion hip arthroplasty Failed internal fixation Treatment reflection
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Intraoperative application of three-dimensional printed guides in total hip arthroplasty: A systematic review
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作者 Tim P Crone Bart M W Cornelissen +2 位作者 Jakob Van Oldenrijk Pieter Koen Bos Ewout S Veltman 《World Journal of Orthopedics》 2024年第7期660-667,共8页
BACKGROUND Acetabular component positioning in total hip arthroplasty(THA)is of key importance to ensure satisfactory post-operative outcomes and to minimize the risk of complications.The majority of acetabular compon... BACKGROUND Acetabular component positioning in total hip arthroplasty(THA)is of key importance to ensure satisfactory post-operative outcomes and to minimize the risk of complications.The majority of acetabular components are aligned freehand,without the use of navigation methods.Patient specific instruments(PSI)and three-dimensional(3D)printing of THA placement guides are increasingly used in primary THA to ensure optimal positioning.AIM To summarize the literature on 3D printing in THA and how they improve acetabular component alignment.METHODS PubMed was used to identify and access scientific studies reporting on different 3D printing methods used in THA.Eight studies with 236 hips in 228 patients were included.The studies could be divided into two main categories;3D printed models and 3D printed guides.RESULTS 3D printing in THA helped improve preoperative cup size planning and post-operative Harris hip scores between intervention and control groups(P=0.019,P=0.009).Otherwise,outcome measures were heterogeneous and thus difficult to compare.The overarching consensus between the studies is that the use of 3D guidance tools can assist in improving THA cup positioning and reduce the need for revision THA and the associated costs.CONCLUSION The implementation of 3D printing and PSI for primary THA can significantly improve the positioning accuracy of the acetabular cup component and reduce the number of complications caused by malpositioning. 展开更多
关键词 Total hip arthroplasty Three-dimensional printing hip replacement surgery Three-dimensional planning Surgical guides
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Regulatory gaps in India’s medical device framework:The case of Johnson and Johnson’s faulty hip implants
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作者 Vidya Menon 《World Journal of Orthopedics》 2024年第12期1124-1134,共11页
The Johnson and Johnson faulty hip implant case represents one of the most significant crises in medical device history,impacting nearly 93000 patients worldwide.In response to alarming failure rates and a global reca... The Johnson and Johnson faulty hip implant case represents one of the most significant crises in medical device history,impacting nearly 93000 patients worldwide.In response to alarming failure rates and a global recall in August 2010,countries such as Australia,the United States,and the United Kingdom quickly implemented revision surgeries and reimbursement programs to protect patient safety.In stark contrast,India's response was alarmingly delayed;defective implants continued to be sold even after the global recall.By the time the import license was revoked,and the Central Drugs Standard Control Organization issued a recall notice,these implants had already been involved in 4700 surgeries across India.This paper explores the systemic weaknesses in India’s medical device regulatory framework that contributed to this delayed action,resulting in many patients suffering from serious health complications.It highlights deficiencies in monitoring and reporting mechanisms,inadequate regulatory oversight,and insufficient approval processes.Furthermore,the inability to trace affected patients and provide necessary compensation underscores significant gaps in regulation.Although subsequent legislative reforms were introduced,this paper argues that substantial loopholes remain,posing risks for future incidents.Thus,urgent,comprehensive,and enforceable regulatory measures are needed to increase patient safety. 展开更多
关键词 Johnson&Johnson faulty hip implants DePuy articular surface replacement hip implants Medical devices rules 2017 Materiovigilance program of India Medical device adverse events Indian medical device regulatory regime
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Dislocation of primary total hip arthroplasty:Analysis of risk factors and preventive options 被引量:1
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作者 Dario Regis Mattia Cason Bruno Magnan 《World Journal of Orthopedics》 2024年第6期501-511,共11页
Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to... Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to be a troublesome complication after THA,as it is a leading cause of revision and is associated with substantial social,health,and economic costs.It is a relatively rare,usually early occurrence that depends on both the patients’characteristics and the surgical aspects.The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility,which is closely related to the incidence of dislocation.Consequently,clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup.Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA.Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size,dual mobility constructs,constrained liners,and modular neck stems. 展开更多
关键词 DISLOCATION Total hip arthroplasty Revision surgery REVIEW Risk factors COMPLICATION
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缺氧微环境中HIP68/RAP1B信号通路对乳腺癌侵袭转移的作用
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作者 屈航英 闫鹏云 +1 位作者 张佳 陈强 《西部医学》 2024年第4期480-488,共9页
目的探讨HIP68/RAP1B信号通路对乳腺癌侵袭转移的作用机制。方法选取西安交通大学第一附属医院2012—2013年乳腺癌组织样本共73例,通过免疫组化标本及临床资料分析HIP68/RAP1B的表达情况及其与病理特征的关系。将体外培养的乳腺癌细胞系... 目的探讨HIP68/RAP1B信号通路对乳腺癌侵袭转移的作用机制。方法选取西安交通大学第一附属医院2012—2013年乳腺癌组织样本共73例,通过免疫组化标本及临床资料分析HIP68/RAP1B的表达情况及其与病理特征的关系。将体外培养的乳腺癌细胞系(MCF-7和MDA-MB-231)构建成缺氧乳腺癌细胞,分别测定缺氧乳腺癌细胞系(MCF-7和MDA-MB-231)及正常乳腺上皮细胞系SK-BR-3中HIP68/RAP1B蛋白表达情况。构建高/低表达HIP68的乳腺癌细胞,观察其对RAP1B蛋白的影响及对乳腺癌细胞生物学行为的影响;沉默/过表达乳腺癌细胞RAP1B,观察其对HIP68蛋白的影响及对细胞生物学行为的影响;免疫共沉淀检测HIP68/RAP1B的结合位点。结果HIP68和RAP1B蛋白在乳腺癌组织中的表达水平高于癌旁组织(P<0.05);HIP68表达与TNM分期、淋巴结转移相关(P<0.05),RAP1B的表达与TNM分期、淋巴结转移、ER、RR状态相关(P<0.05);HIP68表达与RAP1B表达呈正相关(r=0.427,P<0.05)。HIP68/RAP1B在缺氧乳腺癌系细胞中高表达;RAP1B蛋白的表达与HIP68表达呈正相关并且高表达HIP68/RAP1B促进细胞侵袭转移,低表达HIP68/RAP1B抑制细胞侵袭转移;HIP68蛋白不因RAP1B蛋白的高/低表达而改变,但是高表达RAP1B促进乳腺癌细胞增殖及侵袭转移;免疫共沉淀结果显示RAP1B可能为HIP 68基因的下游。结论HIP68/RAP1B信号通路在缺氧乳腺癌组织中高表达并促进乳腺癌细胞迁移和侵袭。 展开更多
关键词 乳腺癌 hip68 RAP1B 侵袭 转移
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Assessment of the effectiveness of weight-adjusted antibiotic administration,for reduced duration,in surgical prophylaxis of primary hip and knee arthroplasty 被引量:1
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作者 Tosan Okoro Michael Wan +6 位作者 Takura Darlington Mukabeta Ella Malev Marketa Gross Claudia Williams Muhammad Manjra Jan Herman Kuiper John Murnaghan 《World Journal of Orthopedics》 2024年第2期170-179,共10页
BACKGROUND Prophylactic antibiotics have significantly led to a reduction in the risk of postoperative surgical site infections(SSI)in orthopaedic surgery.The aim of using antibiotics for this purpose is to achieve se... BACKGROUND Prophylactic antibiotics have significantly led to a reduction in the risk of postoperative surgical site infections(SSI)in orthopaedic surgery.The aim of using antibiotics for this purpose is to achieve serum and tissue drug levels that exceed,for the duration of the operation,the minimum inhibitory concentration of the likely organisms that are encountered.Prophylactic antibiotics reduce the rate of SSIs in lower limb arthroplasty from between 4%and 8%to between 1%and 3%.Controversy,however,still surrounds the optimal frequency and dosing of antibiotic administration.AIM To evaluate the impact of introduction of a weight-adjusted antibiotic prophylaxis regime,combined with a reduction in the duration of administration of post-operative antibiotics on SSI incidence during the 2 years following primary elective total hip and knee arthroplasty METHODS Following ethical approval,patients undergoing primary total hip arthroplasty(THA)/total knee arthroplasty(TKA)with the old regime(OR)of a preoperative dose[cefazolin 2 g intravenously(IV)],and two subsequent doses(2 h and 8 h),were compared to those after a change to a new regime(NR)of a weight-adjusted preoperative dose(cefazolin 2 g IV for patients<120 kg;cefazolin 3g IV for patients>120 kg)and a post-operative dose at 2 h.The primary outcome in both groups was SSI rates during the 2 years post-operatively.RESULTS A total of n=1273 operations(THA n=534,TKA n=739)were performed in n=1264 patients.There was no statistically significant difference in the rate of deep(OR 0.74%(5/675)vs NR 0.50%(3/598);fishers exact test P=0.72),nor superficial SSIs(OR 2.07%(14/675)vs NR 1.50%(9/598);chi-squared test P=0.44)at 2 years postoperatively.With propensity score weighting and an interrupted time series analysis,there was also no difference in SSI rates between both groups[RR 0.88(95%CI 0.61 to 1.30)P=0.46].CONCLUSION A weight-adjusted regime,with a reduction in number of post-operative doses had no adverse impact on SSI incidence in this population. 展开更多
关键词 ANTIBIOTICS Weight-adjusted hip and knee arthroplasty Surgical site infection
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螺杆组合对阻燃HIPS产品性能及能耗影响的研究
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作者 俞长庚 赵宗华 《橡塑技术与装备》 CAS 2024年第7期51-55,共5页
采用不同长径比的双螺杆挤出机制备HIPS阻燃料,对阻燃HIPS的阻燃性能进行了比较,通过测量挤出机的功率来计算其能耗并测试了试样的抗拉强度。结果表明,在一定的长径比范围内,大长径比耗能相对最低,能够节省大量能源,有利于工业化生产。
关键词 hipS 长径比 能耗 螺杆组合
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Osteolysis in total hip arthroplasty in relation to metal ion release: Comparison between monolithic prostheses and different modularities 被引量:1
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作者 Francesco Manfreda Egzon Bufi +4 位作者 Enrico Francesco Florio Paolo Ceccarini Giuseppe Rinonapoli Auro Caraffa Pierluigi Antinolfi 《World Journal of Orthopedics》 2021年第10期768-780,共13页
BACKGROUND Among the various complications associated with total hip arthroplasty(THA)periprosthetic osteolysis and wear phenomena due to the release of metal particles,are two of the most common and have been reporte... BACKGROUND Among the various complications associated with total hip arthroplasty(THA)periprosthetic osteolysis and wear phenomena due to the release of metal particles,are two of the most common and have been reported to be correlated because of inflammatory responses directed towards released particles that generally activate macrophagic osteolytic effects.Therein,new masses known as pseudotumors can appear in soft tissues around a prosthetic implant.To date,there is paucity of reliable data from studies investigating for any association between the above mentioned adverse events.AIM To investigate for the existence of any association between serum and urine concentrations of metal-ions released in THA and periprosthetic osteolysis for modular neck and monolithic implants.METHODS Overall,76 patients were divided into three groups according to the type of hip prosthesis implants:Monoblock,modular with metal head and modular with ceramic head.With an average f-up of 4 years,we conducted a radiological evaluation in order to detect any area of osteolysis around the prosthesis of both the femur and the acetabulum.Moreover,serum and urinary tests were performed to assess the values of Chromium and Cobalt released.Statistical analysis was performed to determine any association between the ion release and osteolysis.RESULTS For the 3 study groups,the monolithic,modular ceramic-headed and modular metal-headed implants had different incidences of osteolysis events,which were higher for the modular implants.Furthermore,the most serious of these(grade 3)were detected almost exclusively for the modular implants with metal heads.A mapping of the affected areas was performed revealing that the highest incidences of osteolysis were evidenced in the pertrochanteric region at the femur level,and in the supero-external region at the acetabular level.Regarding the evaluation of the release of metals-ions from wear processes,serum and urinary chromium and cobalt values were found to be higher in cases of modularity,and even more so for those with metal head.Statistical linear correlation test results suggested positive correlations between increasing metal concentrations and incidences areas of osteolysis.However,no cases of pseudo-tumor were detected.CONCLUSION Future studies are needed to identify risk factors that increase peri-prosthetic metal ion levels and whether these factors might be implicated in the triggering of local events,including osteolysis and aseptic loosening. 展开更多
关键词 Total hip arthroplasty Peri-prosthetic osteolysis METAL-IONS Monolithic total hip arthroplasty Modular ceramic headed total hip arthroplasty Modular metallic headed total hip arthroplasty
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Acetabular cup size trends in total hip arthroplasty
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作者 Daniel Patrick McKenna Alex Price +3 位作者 Timothy McAleese Darren Dahly Paul McKenna May Cleary 《World Journal of Orthopedics》 2024年第1期39-44,共6页
BACKGROUND Total hip arthroplasty(THA)is a common procedure for end stage osteoarthritis.The learning curve for THA is complex and challenging.One of the most difficult skills to master is acetabular reaming.We wish t... BACKGROUND Total hip arthroplasty(THA)is a common procedure for end stage osteoarthritis.The learning curve for THA is complex and challenging.One of the most difficult skills to master is acetabular reaming.We wish to identify if experience in arthroplasty leads to preservation of more bone stock.AIM To investigate if increasing surgeon experience will predict an ever decreasing acetabular cup size.METHODS A retrospective case series of four attending orthopaedic surgeons was completed.All uncemented elective total hip arthroplasties since appointment were selected for inclusion.The size of acetabular cup used was noted and logistic regression was used to identify if a trend to smaller cups existed.RESULTS A total of 1614 subjects were included with a mean age of 64 years.Overall cups were on average 0.18mm smaller per year(95%confidence interval-0.25 to-0.11,P<0.001).Individual surgeon trends showed cup sizes to decrease 0.27 mm/year for surgeon A,0.02 mm/year for surgeon B,0.15 mm/year for surgeon C and 0.29 mm/year for surgeon D.Three of the four surgeons had a more pronounced trend to smaller cups for male subjects than their female counterparts.CONCLUSION We found increasing surgeon experience to be associated with an ever-decreasing acetabular cup size.Smaller acetabular cup size may act as a surrogate marker of surgical proficiency by virtue of decreased acetabular reaming. 展开更多
关键词 hip ARTHROPLASTY ACETABULUM CUP Learning
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Bipolar hip arthroplasty using conjoined tendon preserving posterior lateral approach in treatment of displaced femoral neck fractures
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作者 Ting-Xin Yan Sheng-Jie Dong +1 位作者 Bo Ning Yu-Chi Zhao 《World Journal of Clinical Cases》 SCIE 2024年第6期1076-1083,共8页
BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective man... BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty. 展开更多
关键词 Conjoined tendon preserving Bipolar hip arthroplasty Femoral neck fractures Postoperative dislocation Posterolateral approach
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Offset restoration in total hip arthroplasty:Important:A current review
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作者 Anil Thomas Oommen 《World Journal of Orthopedics》 2024年第8期696-703,共8页
Normal vertical and horizontal offset is essential for hip biomechanics,muscle functioning and gait pattern.Total hip arthroplasty(THA)should aim to restore normal offset with implantation of femoral and acetabular co... Normal vertical and horizontal offset is essential for hip biomechanics,muscle functioning and gait pattern.Total hip arthroplasty(THA)should aim to restore normal offset with implantation of femoral and acetabular components.This would be possible with proper preoperative planning,templating and ensuring implant options are available for offset restoration.Templating is essential for understanding the vertical and horizontal offset change,especially in hip arthritis presenting late with significant limb length discrepancy at THA.Planning should include appropriate soft tissue releases and the use of ideal implants to achieve restoration of horizontal and vertical offset.Under correction of horizontal offset at THA for fracture neck of femur could result in abductor fatigue,limp and increased wear.Restoration of horizontal offset is imperative at THA for a fractured neck of the femur to achieve optimal abductor function.Horizontal offset is necessary for optimal abductor muscle tension and function.Revision THA for acetabular bone loss would require hip center restoration with the acetabular and femoral offset correction to achieve limb length correction and abductor length.The inability to achieve vertical and horizontal offset correction could lead to dislocation or signs of abductor fatigue.Careful vertical and horizontal femur offset restoration is required for normal hip biomechanics,decreased wear and increased longevity. 展开更多
关键词 OFFSET VERTICAL HORIZONTAL Total hip arthroplasty TEMPLATING RESTORATION
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Three-dimensional analysis of age and sex differences in femoral head asphericity in asymptomatic hips in the United States
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作者 Mahad M Hassan Aliya G Feroe +8 位作者 Brenton W Douglass Andrew E Jimenez Benjamin Kuhns Charles F Mitchell Robert L Parisien Daniel A Maranho Eduardo N Novais Young-Jo Kim Ata M Kiapour 《World Journal of Orthopedics》 2024年第8期754-763,共10页
BACKGROUND The sphericity of the femoral head is a metric used to evaluate hip pathologies and is associated with the development of osteoarthritis and femoral-acetabular impingement.AIM To analyze the three-dimension... BACKGROUND The sphericity of the femoral head is a metric used to evaluate hip pathologies and is associated with the development of osteoarthritis and femoral-acetabular impingement.AIM To analyze the three-dimensional asphericity of the femoral head of asymptomatic pediatric hips.We hypothesized that femoral head asphericity will vary significantly between male and female pediatric hips and increase with age in both sexes.METHODS Computed tomography scans were obtained on 158 children and adolescents from a single institution in the United States(8-18 years;50%male)without hip pain.Proximal femoral measurements including the femoral head diameter,femoral head volume,residual volume,asphericity index,and local diameter difference were used to evaluate femoral head sphericity.RESULTS In both sexes,the residual volume increased by age(P<0.05).Despite significantly smaller femoral head size in older ages(>13 years)in females,there were no sex-differences in residual volume and aspherity index.There were no age-related changes in mean diameter difference in both sexes(P=0.07)with no significant sex-differences across different age groups(P=0.06).In contrast,there were significant increases in local aspherity(maximum diameter difference)across whole surface of the femoral head and all quadrants except the inferior regions in males(P=0.03).There were no sex-differences in maximum diameter difference at any regions and age group(P>0.05).Increased alpha angle was only correlated to increased mean diameter difference across overall surface of the femoral head(P=0.024).CONCLUSION There is a substantial localized asphericity in asymptomatic hips which increases with age in.While 2D measured alpha angle can capture overall asphericity of the femoral head,it may not be sensitive enough to represent regional asphericity patterns. 展开更多
关键词 hip Femoral head SPHERICITY Skeletal growth Sex differences
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