Negative-pressure wound therapy(NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound h...Negative-pressure wound therapy(NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trialsincluding single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections.展开更多
Objective To investigate the methods to maintain leg equalization for patients undergoing primary total hip joint replacement. Methods 40 patients,45 hips with various diseases were treated by total hip joint replacem...Objective To investigate the methods to maintain leg equalization for patients undergoing primary total hip joint replacement. Methods 40 patients,45 hips with various diseases were treated by total hip joint replacement from Jan 2000 to Sep 2001.Before operation, the perpendicular length from center of femoral head to the summit of great tuberosity and the tip of less tuberosity to the line of bilateral ischial tuberosity were measured; the length from anterior superior iliac spine to medial malleolus were measured at same time.Leg length was decided and corrected according to these lines. Results Before operation, shortening of limbs were presented in 39 hips, 1 to 4 cm, average 2.4 cm.After operation, discrepancy of both legs was 0～0.8 cm.Apparent limps were not observed in all patients. Conclusion This measurement is a useful method to maintain and recover leg length in total hip joint replacement.展开更多
Background: Asian cultures require floor-seated positions demanding a high range of motion (ROM). Ceramic-On-Ceramic (COC) interface allowed the use of larger head with reduced wear debris generation and adverse tissu...Background: Asian cultures require floor-seated positions demanding a high range of motion (ROM). Ceramic-On-Ceramic (COC) interface allowed the use of larger head with reduced wear debris generation and adverse tissue reactions. This study was conducted to analyze 6-year clinical-radiological outcome with large head fourth generation DeltaMotion®ceramic-on-ceramic (COC) hip articulation, with special emphasis on postoperative ROM, ability to sit cross-legged, stability, hip noise and revision surgery. Material and Methods: 150 consecutive hips were operated for primary cementless Total Hip Replacement (THR) using DeltaMotion®at a tertiary care center in Mumbai, India, between January 2010 and January 2015. Clinico-radiological outcome was assessed using the Harris Hip Score (HHS) and radiographs at 6 weeks, 6 months, and annually thereafter. Results: 108 (74.5%) patients were males and 37 (25.5%) were females with an average age of 50.87 years. Mean follow-up was 54 months (range: 37 - 86 months). The mean ROM was 120° in flexion, 10° in extension, 30° in adduction, 45° in abduction, 25° in internal rotation and 25° in external rotation. The mean HHS showed a statistically significant improvement of 64.5% (from 54.66 ± 6.42 pre-operatively to 89.95 ± 4.32 post operatively) (p-value: 0.001). 92% of patients were able to sit in squatting position and 92% were able to sit cross-legged on the floor at last follow-up. 0.7% joints (1 hip) had squeaking. Considering no revision surgery as the end point, 6-year prosthesis survivorship was 100%. Complications (superficial infection) occurred in three hips (2%). All patients reported to be satisfied with their outcome after surgery. Conclusion: We infer that DeltaMotion large head COC bearing allows scope for using larger head size in relatively smaller Indian hips due to factory fitted ceramic lining. At 6-year follow-up, high activity level was observed with excellent clinical-radiological outcomes and component longevity in relatively young Indian population.展开更多
Objectives: The assessment of the radio clinical results of sixty one total hip arthroplasties was performed among young and active patients, with follow-up for ankylosing spondylitis, in order to evaluate the effect ...Objectives: The assessment of the radio clinical results of sixty one total hip arthroplasties was performed among young and active patients, with follow-up for ankylosing spondylitis, in order to evaluate the effect of surgery on the quality of life of these patients. Methods: For the functional improvement of the patients, we relied on the scores of Devane, Harris and that of Postel Merle d’Aubeigné. The radiological analysis was based on the coxometry. Results: The study confirms the notable functional gain and consequently the improvement of the quality of life of the patients. However, the longevity of the implants remains difficult to envisage due to our limited and insufficient hindsight. Conclusion: The total hip arthroplasty transforms the life of the young patients’ carriers of the disabling coxitis on the stiffening spondylarthritis, by getting them the laziness and the mobility wished for.展开更多
<strong>Background:</strong> The main purpose of the present study was to assess the short term performance of a cementless femoral stem in total hip replacement. <strong>Methods:</strong> Cros...<strong>Background:</strong> The main purpose of the present study was to assess the short term performance of a cementless femoral stem in total hip replacement. <strong>Methods:</strong> Cross-sectional observational study of a 48-patient cohort with Phenom? femoral stems implanted between June 1, 2014 and September 1, 2018, to determine clinical performance, stability, and radiographic osseointegration. Patients were followed-up from 13 to 76 months (mean: 44.5 months) and assessed using the Harris Hip Score-HHS, the Hip Disability and Osteoarthritis Outcome Score-HOOS and radiographs. <strong>Results:</strong> All stems were radiologically stable. Mean Harris Hip Score was 89.8 and the HOOS was 80.4. No statistical differences were observed among patients with different diagnoses. <strong>Conclusions:</strong> The short-term results revealed satisfactory clinical outcomes and radiological signs of implant stability in all cases. Using two functional scores was useful in detecting biases and a low to moderate agreement was found between the scores.展开更多
AIM: To evaluate a possible association between thevarious levels of obesity and peri-operative characteristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints. METHO...AIM: To evaluate a possible association between thevarious levels of obesity and peri-operative characteristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints. METHODS: We hypothesized that obese patients were treated for later stage of osteoarthritis, that more conservative implants were used, and the intraand perioperative complications increased for such patients. We evaluated all patients with body mass index(BMI) ≥ 25 who were treated in our institution from January 2011 to September 2013 for a primary total hip arthroplasty(THA) or total knee arthroplasty(TKA). Patients were split up by the levels of obesity according to the classification of the World Health Organization. Average age at the time of primary arthroplasty, preoperative Harris Hip Score(HHS), Hospital for Special Surgery score(HSS), gender, type of implanted prosthesis, and intra-and postoperative complications were evaluated.RESULTS: Six thousand and seventy-eight patients with a BMI ≥ 25 were treated with a primary THA or TKA. Age decreased significantly(P < 0.001) by increasing obesity in both the THA and TKA. HHS and HSS were at significantly lower levels at the time of treatment in the super-obese population(P < 0.001). Distribution patterns of the type of endoprostheses used changed with an increasing BMI. Peri- and postoperative complications were similar in form and quantity to those of the normal population. CONCLUSION: Higher BMI leads to endoprosthetic treatment in younger age, which is carried out at significantly lower levels of preoperative joint function.展开更多
Objective：In order to achieve accurate implantation of the acetabular prosthesis in total hip arthroplasty（THA）,we designed individual templates based on a three-dimensional（3D） model generated from computed tomo...Objective：In order to achieve accurate implantation of the acetabular prosthesis in total hip arthroplasty（THA）,we designed individual templates based on a three-dimensional（3D） model generated from computed tomography（CT） scans.Methods：Individual templates were designed for 12 patients who underwent THA.A physical template was designed to conform to the contours of the patient＇s acetabulum and to confirm the rotation of the acetabular center.This guided the acetabular component orientation.Results：The preoperative and postoperative X-ray and CT scans were obtained to assess the location with respect to the accuracy of the acetabular component.For all patients,the abduction angle of the acetabular component was 46.7°to 54.3°and the anteversion angle was 11.3°to 18.5°Conclusions：The assessment of postoperative CT scans demonstrated higher accuracy of the acetabular component bore when used with the individual template.Therefore,the individual template can be an alternative to the computer-assisted navigation systems,with a good cost-performance ratio.展开更多
It is a research which could enter into contradiction with the current trend concerning the hip implants. It is known as sliding friction, which is characteristic of present artificial hip joints, is higher than in th...It is a research which could enter into contradiction with the current trend concerning the hip implants. It is known as sliding friction, which is characteristic of present artificial hip joints, is higher than in the case of rolling friction. The paper reports the studies of the functioning mode of a novel spherical bearing MoM （metal on metal） with rolling friction, with potential application for an artificial hip joint obtained by introducing a number of balls between the femoral head and the acetabular cup. After over 15 years of research upon the functional principle and constructive solution, a version that offered a coefficient of minimum friction in the hip joint came to light. This version was based on a constructive solution of motion with lower friction, ＂Omnitrack~ movement solutions＂, which has been modified and rebuilt to be used as a joint of a total hip prosthesis--MOMJ. The joint was built entirely in stainless steel, SS316L medical grade. Tests have been carried out on the experimental laboratory devices that showed very low values of the coefficient of friction （μ = 0.0225）. For validation, the prosthesis had to be put through tests for 500,000 cycles, in terms of physiological motion and dynamic loading, according to ISO 14242-3. Testing was conducted on a multiaxial dynamics machine, MTS Bionix, equipped with system for hip implant testing. The testing results of this total hip prosthesis with rolling friction have been successful in signing up for a friction moment of 0.525 kNmm which means a coefficient of friction la = 0.0143, for a joint with femoral head diameter 28 mm.展开更多
目的:探讨生物型全髋关节置换术(total hip arthroplasty,THA)联合打压植骨治疗类风湿关节炎(rheumatoid arthritis,RA)继发髋臼内陷症的手术技巧及临床疗效。方法:自2012年1月至2020年10月,采用生物型假体行人工全髋关节置换术治疗20例...目的:探讨生物型全髋关节置换术(total hip arthroplasty,THA)联合打压植骨治疗类风湿关节炎(rheumatoid arthritis,RA)继发髋臼内陷症的手术技巧及临床疗效。方法:自2012年1月至2020年10月,采用生物型假体行人工全髋关节置换术治疗20例(28髋)RA继发髋臼内陷患者,男5例(8髋),女15例(20髋),年龄45~64(55.10±4.96)岁。术前髋臼内陷深度8.43~16.29(11.91±2.59)mm。根据Sotello-Garza和Charnley分型:Ⅱ型(内陷6~15mm)15例(23髋)、Ⅲ型(内陷>15 mm)5例(5髋)。术中采用自体股骨头颗粒骨和(或)同种异体骨打压植骨重建髋臼,采用压配方式固定生物型多孔髋臼杯。术后随访评估髋关节的活动功能、双下肢长度差、视觉模拟评分(visual analogue scale,VAS)及Harris评分;X线片评估植骨愈合情况、髋臼旋转中心恢复情况及假体松动情况。结果:20例获随访,时间2~10(5.45±2.50)年。手术时间75~160(103.32±18.18)min;术中出血量150~650(319.64±122.61)ml。术中均未发生神经血管及其他并发症。末次随访时,髋关节旋转中心的水平移位由术前(11.40±1.85)mm增加到(25.99±2.56)mm(P<0.01);髋关节旋转中心的垂直移位由术前(89.36±5.20)mm增加到(71.84±3.55)mm(P<0.01);髋关节屈伸活动度由术前(44.43±10.57)°增加到(98.75±12.52)°(P<0.01);髋关节的外展活动度由术前(12.50±6.01)°增加到(32.82±5.39)°(P<0.01);双下肢长度差由术前(19.39±5.93)mm减少到(6.64±2.87)mm(P<0.01);VAS由术前(5.36±0.78)分降低到(1.82±0.86)分(P<0.01);Harris评分由术前(41.39±7.77)分增加到(89.00±4.67)分(P<0.01)。末次随访的患者均可在不借助辅助下自主活动。其中,2例(2髋)患者活动后髋部疼痛不适,1例(1髋)因摔倒致假体周围骨折。结论:采用自体股骨头颗粒植骨重建髋臼,恢复髋关节旋转中心,联合生物型多孔钽/钛金属髋臼杯治疗RA继发髋臼内陷取得良好的近中期疗效。展开更多
全髋关节置换术(total hip arthroplasty,THA)治疗终末期骨性关节炎及股骨头坏死等髋关节疾病有着较为显著的疗效,髋臼假体的准确定位成为手术的关键,诸多学者提出以髋臼横韧带为参考定位髋臼假体能降低术后脱位的发生率,这种定位方法...全髋关节置换术(total hip arthroplasty,THA)治疗终末期骨性关节炎及股骨头坏死等髋关节疾病有着较为显著的疗效,髋臼假体的准确定位成为手术的关键,诸多学者提出以髋臼横韧带为参考定位髋臼假体能降低术后脱位的发生率,这种定位方法无需额外器械辅助,具有简便、快速、经济的优点,能够避免高BMI及术中骨盆旋转对假体安置的影响,帮助初学者快速掌握全髋关节置换术中髋臼假体安置的技术要领。本文将阐述髋臼横韧带的基础解剖,并从髋臼假体的角度、覆盖率及旋转中心等方面对髋臼横韧带在全髋关节置换术中对髋臼假体的定位意义进行综述。展开更多
文摘Negative-pressure wound therapy(NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trialsincluding single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections.
文摘Objective To investigate the methods to maintain leg equalization for patients undergoing primary total hip joint replacement. Methods 40 patients,45 hips with various diseases were treated by total hip joint replacement from Jan 2000 to Sep 2001.Before operation, the perpendicular length from center of femoral head to the summit of great tuberosity and the tip of less tuberosity to the line of bilateral ischial tuberosity were measured; the length from anterior superior iliac spine to medial malleolus were measured at same time.Leg length was decided and corrected according to these lines. Results Before operation, shortening of limbs were presented in 39 hips, 1 to 4 cm, average 2.4 cm.After operation, discrepancy of both legs was 0～0.8 cm.Apparent limps were not observed in all patients. Conclusion This measurement is a useful method to maintain and recover leg length in total hip joint replacement.
文摘Background: Asian cultures require floor-seated positions demanding a high range of motion (ROM). Ceramic-On-Ceramic (COC) interface allowed the use of larger head with reduced wear debris generation and adverse tissue reactions. This study was conducted to analyze 6-year clinical-radiological outcome with large head fourth generation DeltaMotion®ceramic-on-ceramic (COC) hip articulation, with special emphasis on postoperative ROM, ability to sit cross-legged, stability, hip noise and revision surgery. Material and Methods: 150 consecutive hips were operated for primary cementless Total Hip Replacement (THR) using DeltaMotion®at a tertiary care center in Mumbai, India, between January 2010 and January 2015. Clinico-radiological outcome was assessed using the Harris Hip Score (HHS) and radiographs at 6 weeks, 6 months, and annually thereafter. Results: 108 (74.5%) patients were males and 37 (25.5%) were females with an average age of 50.87 years. Mean follow-up was 54 months (range: 37 - 86 months). The mean ROM was 120° in flexion, 10° in extension, 30° in adduction, 45° in abduction, 25° in internal rotation and 25° in external rotation. The mean HHS showed a statistically significant improvement of 64.5% (from 54.66 ± 6.42 pre-operatively to 89.95 ± 4.32 post operatively) (p-value: 0.001). 92% of patients were able to sit in squatting position and 92% were able to sit cross-legged on the floor at last follow-up. 0.7% joints (1 hip) had squeaking. Considering no revision surgery as the end point, 6-year prosthesis survivorship was 100%. Complications (superficial infection) occurred in three hips (2%). All patients reported to be satisfied with their outcome after surgery. Conclusion: We infer that DeltaMotion large head COC bearing allows scope for using larger head size in relatively smaller Indian hips due to factory fitted ceramic lining. At 6-year follow-up, high activity level was observed with excellent clinical-radiological outcomes and component longevity in relatively young Indian population.
文摘Objectives: The assessment of the radio clinical results of sixty one total hip arthroplasties was performed among young and active patients, with follow-up for ankylosing spondylitis, in order to evaluate the effect of surgery on the quality of life of these patients. Methods: For the functional improvement of the patients, we relied on the scores of Devane, Harris and that of Postel Merle d’Aubeigné. The radiological analysis was based on the coxometry. Results: The study confirms the notable functional gain and consequently the improvement of the quality of life of the patients. However, the longevity of the implants remains difficult to envisage due to our limited and insufficient hindsight. Conclusion: The total hip arthroplasty transforms the life of the young patients’ carriers of the disabling coxitis on the stiffening spondylarthritis, by getting them the laziness and the mobility wished for.
文摘<strong>Background:</strong> The main purpose of the present study was to assess the short term performance of a cementless femoral stem in total hip replacement. <strong>Methods:</strong> Cross-sectional observational study of a 48-patient cohort with Phenom? femoral stems implanted between June 1, 2014 and September 1, 2018, to determine clinical performance, stability, and radiographic osseointegration. Patients were followed-up from 13 to 76 months (mean: 44.5 months) and assessed using the Harris Hip Score-HHS, the Hip Disability and Osteoarthritis Outcome Score-HOOS and radiographs. <strong>Results:</strong> All stems were radiologically stable. Mean Harris Hip Score was 89.8 and the HOOS was 80.4. No statistical differences were observed among patients with different diagnoses. <strong>Conclusions:</strong> The short-term results revealed satisfactory clinical outcomes and radiological signs of implant stability in all cases. Using two functional scores was useful in detecting biases and a low to moderate agreement was found between the scores.
文摘AIM: To evaluate a possible association between thevarious levels of obesity and peri-operative characteristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints. METHODS: We hypothesized that obese patients were treated for later stage of osteoarthritis, that more conservative implants were used, and the intraand perioperative complications increased for such patients. We evaluated all patients with body mass index(BMI) ≥ 25 who were treated in our institution from January 2011 to September 2013 for a primary total hip arthroplasty(THA) or total knee arthroplasty(TKA). Patients were split up by the levels of obesity according to the classification of the World Health Organization. Average age at the time of primary arthroplasty, preoperative Harris Hip Score(HHS), Hospital for Special Surgery score(HSS), gender, type of implanted prosthesis, and intra-and postoperative complications were evaluated.RESULTS: Six thousand and seventy-eight patients with a BMI ≥ 25 were treated with a primary THA or TKA. Age decreased significantly(P < 0.001) by increasing obesity in both the THA and TKA. HHS and HSS were at significantly lower levels at the time of treatment in the super-obese population(P < 0.001). Distribution patterns of the type of endoprostheses used changed with an increasing BMI. Peri- and postoperative complications were similar in form and quantity to those of the normal population. CONCLUSION: Higher BMI leads to endoprosthetic treatment in younger age, which is carried out at significantly lower levels of preoperative joint function.
文摘Objective：In order to achieve accurate implantation of the acetabular prosthesis in total hip arthroplasty（THA）,we designed individual templates based on a three-dimensional（3D） model generated from computed tomography（CT） scans.Methods：Individual templates were designed for 12 patients who underwent THA.A physical template was designed to conform to the contours of the patient＇s acetabulum and to confirm the rotation of the acetabular center.This guided the acetabular component orientation.Results：The preoperative and postoperative X-ray and CT scans were obtained to assess the location with respect to the accuracy of the acetabular component.For all patients,the abduction angle of the acetabular component was 46.7°to 54.3°and the anteversion angle was 11.3°to 18.5°Conclusions：The assessment of postoperative CT scans demonstrated higher accuracy of the acetabular component bore when used with the individual template.Therefore,the individual template can be an alternative to the computer-assisted navigation systems,with a good cost-performance ratio.
文摘It is a research which could enter into contradiction with the current trend concerning the hip implants. It is known as sliding friction, which is characteristic of present artificial hip joints, is higher than in the case of rolling friction. The paper reports the studies of the functioning mode of a novel spherical bearing MoM （metal on metal） with rolling friction, with potential application for an artificial hip joint obtained by introducing a number of balls between the femoral head and the acetabular cup. After over 15 years of research upon the functional principle and constructive solution, a version that offered a coefficient of minimum friction in the hip joint came to light. This version was based on a constructive solution of motion with lower friction, ＂Omnitrack~ movement solutions＂, which has been modified and rebuilt to be used as a joint of a total hip prosthesis--MOMJ. The joint was built entirely in stainless steel, SS316L medical grade. Tests have been carried out on the experimental laboratory devices that showed very low values of the coefficient of friction （μ = 0.0225）. For validation, the prosthesis had to be put through tests for 500,000 cycles, in terms of physiological motion and dynamic loading, according to ISO 14242-3. Testing was conducted on a multiaxial dynamics machine, MTS Bionix, equipped with system for hip implant testing. The testing results of this total hip prosthesis with rolling friction have been successful in signing up for a friction moment of 0.525 kNmm which means a coefficient of friction la = 0.0143, for a joint with femoral head diameter 28 mm.
文摘全髋关节置换术(total hip arthroplasty,THA)治疗终末期骨性关节炎及股骨头坏死等髋关节疾病有着较为显著的疗效,髋臼假体的准确定位成为手术的关键,诸多学者提出以髋臼横韧带为参考定位髋臼假体能降低术后脱位的发生率,这种定位方法无需额外器械辅助,具有简便、快速、经济的优点,能够避免高BMI及术中骨盆旋转对假体安置的影响,帮助初学者快速掌握全髋关节置换术中髋臼假体安置的技术要领。本文将阐述髋臼横韧带的基础解剖,并从髋臼假体的角度、覆盖率及旋转中心等方面对髋臼横韧带在全髋关节置换术中对髋臼假体的定位意义进行综述。
