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
BACKGROUND Oral treatment of glucosamine(GA) combined with chondroitin sulfate(CS) was reportedly effective for pain relief and function improvement in osteoarthritis patients with moderate to severe knee pain in clin...BACKGROUND Oral treatment of glucosamine(GA) combined with chondroitin sulfate(CS) was reportedly effective for pain relief and function improvement in osteoarthritis patients with moderate to severe knee pain in clinical trials. While the effectiveness of GA and CS on both clinical and radiological findings has been demonstrated, only a few high-quality trials exist. Therefore, controversy regarding their effectiveness in real-world clinical practice remains.AIM To investigate the impact of GA + CS on clinical outcomes of patients with knee and hip osteoarthritis in routine clinical practice.METHODS A multicenter prospective observational cohort study included 1102 patients of both genders with knee or hip osteoarthritis(Kellgren & Lawrence grades Ⅰ-Ⅲ) in 51 clinical centers in the Russian Federation from November 20, 2017, to March 20,2020, who had started to receive oral capsules of glucosamine hydrochloride 500 mg and CS 400mg according to the approved patient information leaflet starting from 3 capsules daily for 3 wk,followed by a reduced dosage of 2 capsules daily before study inclusion(minimal recommended treatment duration is 3-6 mo). Changes in subscale scores [Pain, Symptoms, Function, and Quality of Life(QOL)] of the Knee Injury and Osteoarthritis Outcome Score(KOOS)/Hip Disability and Osteoarthritis Outcome Score(HOOS) questionnaires during the observational period(up to 54-64wk with a total of 4 visits). Patients’ treatment satisfaction, data on the combined oral use of glucosamine hydrochloride and CS, concomitant use of non-steroidal anti-inflammatory drugs(NSAIDs), and adverse events(AEs) were also evaluated.RESULTS A total of 1102 patients with knee and hip osteoarthritis were included in the study. The mean patient age was 60.4 years, most patients were women(87.8%), and their average body mass index was 29.49 kg/m2. All subscale scores(Pain, Symptoms, Function, and QOL) of the KOOS and HOOS demonstrated clinically and statistically significant improvements. In patients with knee osteoarthritis, the mean score increases from baseline to the end of Week 64 were 22.87, 20.78,16.60, and 24.87 on Pain, Symptoms, Physical Function(KOOS-PS), and QOL subscales(P < 0.001for all), respectively. In patients with hip osteoarthritis, the mean score increases were 22.81, 19.93,18.77, and 22.71 on Pain, Symptoms, Physical Function(HOOS-PS), and QOL subscales(P < 0.001for all), respectively. The number of patients using any NSAIDs decreased from 43.1% to 13.5%(P < 0.001) at the end of the observation period. Treatment-related AEs occurred in 2.8% of the patients and mainly included gastrointestinal disorders [25 AEs in 24(2.2%) patients]. Most patients(78.1%) were satisfied with the treatment.CONCLUSION Long-term oral GA + CS was associated with decreased pain, reduced concomitant NSAID therapy, improved joint function and QOL in patients with knee and hip osteoarthritis in routine clinical practice.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
BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is s...BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is seen following THA in these hips.The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo.All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day.Modified Harris hip score and ROM were assessed during follow-up.Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at followup.SPSS 22.0 was used for statistical analysis.The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range.The mean flexion in 69 hips improved from 29.35±31.38 degrees to 102.17±10.48 degrees.The mean difference of 72.82 with a P value<0.0001 was significant.In total,45 out of 69 hips had flexion deformity,with 13 hips having a deformity above 30 degrees.The flexion during the follow-up was below 90 degrees in 3 hips.Eleven hips had flexion of 90 degrees at follow-up,while the remaining 55 hips had flexion above 100 degrees.Modified Harris hip score improved from 17.03±6.02 to 90.66±7.23(P value<0.0001).The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11,very good in 20,good in 5,fair in 3,and poor in 1.The mean mental health score was 84.10±11.58.Pain relief was good in all 69 hips.Altogether,28/40 patients(70%)had no pain,9 patients(22%)had occasional pain,and 3 patients(8%)had mild to moderate pain with unusual activity.Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM,Harris hip score,and quality of life indicated by the 36-item and 12-item short form health surveys.展开更多
背景:关节置换是治疗老年移位性股骨颈骨折的主要手段,全髋关节置换与半髋关节置换的选择是目前具有较大争论的焦点。目的:基于倾向性评分匹配法对比直接前入路下全髋与半髋关节置换治疗老年移位性股骨颈骨折的中远期生存状态。方法:选...背景:关节置换是治疗老年移位性股骨颈骨折的主要手段,全髋关节置换与半髋关节置换的选择是目前具有较大争论的焦点。目的:基于倾向性评分匹配法对比直接前入路下全髋与半髋关节置换治疗老年移位性股骨颈骨折的中远期生存状态。方法:选择2016年1月至2021年1月收治的147例老年移位性股骨颈骨折患者(≥65岁),其中88例行全髋关节置换,59例行人工股骨头置换(半髋关节置换)。对于患者术前合并症采用年龄校正Charlson合并症评分表,计算患者虚弱度,并采用倾向性评分匹配法对两组患者进行1∶1匹配,比较匹配后两组患者的手术时间、出血量、术后住院时间、住院费用、营养指标、术后并发症、死亡率和术后生存时间,其中术后生存时间采用Kaplan-Meier生存分析。结果与结论:①倾向性评分匹配后,两组共有42对匹配成功,匹配后两组患者术前资料均衡可比(P>0.05);②与半髋关节置换组相比,全髋关节置换组手术时间(79.71 min vs.59.07 min,P<0.001)、出血量(839.64 mL vs.597.83 mL,P=0.001)、住院费用(56508.15元vs.41702.85元,P<0.001)明显增加,但全髋关节置换组死亡率低于半髋关节置换组(36%vs.57%,HR=0.44,95%CI:0.23-0.87,P=0.018),平均生存时间长于半髋关节置换组(59.4个月vs.43.7个月,P=0.024);③两组患者在术后住院时间、术前术后营养指标、术后整体并发症发生率上,差异均无显著性意义(P>0.05);但在术后疼痛方面,半髋关节置换组疼痛发生率明显高于全髋关节置换组(24%vs.7%,P=0.035);④整体来看,全髋关节置换具有更好的长期预后生存效果,但对于身体素质差的患者则更适合行半髋关节置换;同时,术后的疼痛可能很大程度上会对患者髋关节置换后的生活质量及存活时间产生影响。展开更多
Introduction: Outcomes of total hip arthroplasties in rheumatoid are commonly considered as poor and with high rates of complication. Keeping in mind these conflicts of opinions we are going to analyse the functional ...Introduction: Outcomes of total hip arthroplasties in rheumatoid are commonly considered as poor and with high rates of complication. Keeping in mind these conflicts of opinions we are going to analyse the functional and radiological outcomes of total hip arthroplasty between osteoarthritis and rheumatoid arthtitis. Patients and Method: Retrospective midterm study of thirty four patients who underwent total hip replacement in Sri Ramachandra medical center for rheumatoid and osteoarthritis (primary and secondary). Of the 44 hips, the indications are rheumatoid arthritis in 20 patients and osteoarthritis in 24 patients. We used the Harris hip score (Modified) for clinical and functional evaluation and plain X-ray pelvis with both hips and proximal femur—AP view and X-ray of the operated hip lateral view for radiological evaluation. Mean follow up is 9 years (8-13 years). Results: The mean pre and latest harris hip score are 44 and 88 respectively. The mean harris hip score in 1st, 3rd and 5th years are 86, 87 and 87 respectively. The mean pre and latest harris hip score in osteoarthritis is 49 and 92, in rheumatoid arthritis is 35 and 74. Conclusion: The results in patients who underwent total hip replacement for osteoarthritis are better than those for rheumatoid arthritis, however the gain in harris hip score is the same. As far as complications are concerned there is no difference between rheumatoid and osteoarthritis. Complications are mostly due to the faulty technique. Both uncemented and cemented total hip replacement give good results in non traumatic indications. In bilateral hip diseases there is considerable pain relief and improvement after the first THR, but the optimal improvement is not seen until the second 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
目的:分析并确定ARCO 2-4期股骨头坏死(osteonecrosis of femoral head,ONFH)对Harris评分有影响意义的MR征象。方法:回顾性分析2019年1月至2020年6月34例行常规MR、T2 mapping、3D-SPACE序列检查及Harris评分的ARCO 2-4期ONFH患者,排除...目的:分析并确定ARCO 2-4期股骨头坏死(osteonecrosis of femoral head,ONFH)对Harris评分有影响意义的MR征象。方法:回顾性分析2019年1月至2020年6月34例行常规MR、T2 mapping、3D-SPACE序列检查及Harris评分的ARCO 2-4期ONFH患者,排除3例,最终纳入31例,男23例,女8例,年龄18~62(40.0±10.8)岁;其中21例为双侧ONFH,共计52个ONFH,ARC02期17个,ARCO 3期24个,ARCO 4期11个。在医院数字影像信息系统(picture archiving and communication system,PACS)对MR影像征象(股骨头塌陷深度、ONFH指数、骨髓水肿、股骨头骨质增生、软骨损伤分级、软骨T2值及关节积液)进行评估及测量,在Siemens后处理工作站计算软骨定量参数T2值并测量。采用Pearson相关分析评估MR各征象与Harris评分的相关性,采用多重线性回归分析评估与Harris评分有相关性的MR征象对Harris评分的影响。结果:Pearson相关分析显示股骨头塌陷深度(r=-0.563,P=0.000)、软骨损伤分级(r=-0.500,P=0.000)及关节积液(r=-0.535,P=0.000)与Harris评分呈负相关。多重线性回归分析显示关节积液(β=-6.198,P=0.001)、股骨头塌陷深度(β=-4.085,P=0.014)对Harris评分呈负相关。结论:关节积液、股骨头塌陷深度对Harris评分有显著的负向影响关系,建议影像医师常规对股骨头塌陷深度、关节积液进行定量及等级评估,以高效精准地辅助临床诊疗。展开更多
Background: The present study was conducted to examine the association between various coronary risk factors and clinical parameters, with special emphasis on ankle-brachial index, in predicting the severity and compl...Background: The present study was conducted to examine the association between various coronary risk factors and clinical parameters, with special emphasis on ankle-brachial index, in predicting the severity and complexity of coronary artery disease. Methods: Patients diagnosed with coronary artery disease at our hospital between September-2012 and December-2014 were examined in this study. Selected patients were screened for cardiovascular risk factors including diabetes, hypertension, smoking, and alcohol habits as well as for clinical parameters including body-mass index, waist-hip ratio, ankle-brachial index, and ejection fraction. All patients underwent coronary angiography and were evaluated for severity of coronary artery disease (based on number of vessels involved) and complexity of coronary angiographic lesions (measured by computer-assisted Syntax score calculator). The collected data were analyzed to determine the role of cardiovascular risk factors and clinical parameters as predictors of complexity and severity of coronary artery disease. Results: A total of 211 patients (mean age: 54.64 ± 9.9 years;81% males) with coronary artery disease were analyzed. Findings revealed that diabetes mellitus (p < 0.001), hypertension (p < 0.001), smoking habits (p = 0.036), and low ankle-brachial index (p < 0.001) were independent predictors of complex coronary artery disease as measured by Syntax score. Significant associations were also evident between severity of coronary artery disease and diabetes mellitus (p < 0.001), hypertension (p < 0.001), and ankle-brachial index (p < 0.001). Conversely, other cardiovascular risk factors including body-mass index, alcohol habits, wait-hip ratio, and ejection fraction did not exhibit significant associations with severity and complexity of coronary artery. Conclusions: The early diagnosis of coronary artery can be predicated by evaluating diabetes, hypertension, and smoking habits in patients presenting with acute coronary syndrome. In addition, ankle-brachial index can be used as an effective non-invasive bed-side tool, as an alternative to Syntax score, in predicting the severity and complexity of coronary artery disease.展开更多
Introduction: Early surgical treatment (within 48 hours) has been recommended for femoral neck fractures in order to avoid complications and reduce mortality rate, regardless of presence and severity of comorbidity an...Introduction: Early surgical treatment (within 48 hours) has been recommended for femoral neck fractures in order to avoid complications and reduce mortality rate, regardless of presence and severity of comorbidity and preoperative status (ASA score). However some studies evidenced that early surgery doesn’t always have a beneficial effect on mortality and complications. Therefore further studies could be useful in order to better assess risk related factors of patients requiring surgical treatment for femoral neck fracture. The purpose of this study is to evaluate the effect of preoperative ASA score and timing of surgery on mortality, complications and clinical outcome. Methods: All 336 patients operated in our center from January 2013 to December 2014 were selected for this retrospective study. Patients were divided in three groups as follows: group 1 patients treated within 48 hours;group 2 patients treated between 48 to 96 hours;group 3 patients treated over 96 hours. The preoperative ASA score was recorded for each patient. Complication, clinical outcome and mortality at one-year follow-up were evaluated. At follow-up ambulation was graded as: confined to bed, assisted ambulation, and normal ambulation. Complications both local (infections, malunion, dislocation) and systemic (deep vein thrombosis, pulmonary embolism, lung infections, ischemic disorders of heart) were recorded as well as number of transfusions. Statistical analysis was performed with chi square test and P value Results: 308 patients’ data were fully available for this study. At one-year follow-up return to normal ambulation was higher for patients of group 1 as compared with group 2 and 3 and in group 2 as compared with group 3 (P = 0.04). There was no difference in mortality and return to ambulation between patients with ASA score 1 and 2 (P = 0.06);patients with ASA score ≥ 3 showed a statistically significant higher mortality (P = 0.004) and rate of complications (0.0008) regardless of timing of surgery. There was no statistically significance in blood transfusion among the three groups. Discussion and Conclusion: Clinical outcome, complications and mortality have been previously reported from many authors and most studies agreed that early surgical treatment is recommended regardless of age and preoperative status of the patient. The present study suggests that early surgical treatment is actually able to reduce mortality and complications and to improve clinical outcome in patients with better preoperative conditions, while for patients with ASA score ≥ 3 treatment within 48 hours seems not to prevent mortality and complications and improve clinical outcome.展开更多
文摘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.
文摘BACKGROUND Oral treatment of glucosamine(GA) combined with chondroitin sulfate(CS) was reportedly effective for pain relief and function improvement in osteoarthritis patients with moderate to severe knee pain in clinical trials. While the effectiveness of GA and CS on both clinical and radiological findings has been demonstrated, only a few high-quality trials exist. Therefore, controversy regarding their effectiveness in real-world clinical practice remains.AIM To investigate the impact of GA + CS on clinical outcomes of patients with knee and hip osteoarthritis in routine clinical practice.METHODS A multicenter prospective observational cohort study included 1102 patients of both genders with knee or hip osteoarthritis(Kellgren & Lawrence grades Ⅰ-Ⅲ) in 51 clinical centers in the Russian Federation from November 20, 2017, to March 20,2020, who had started to receive oral capsules of glucosamine hydrochloride 500 mg and CS 400mg according to the approved patient information leaflet starting from 3 capsules daily for 3 wk,followed by a reduced dosage of 2 capsules daily before study inclusion(minimal recommended treatment duration is 3-6 mo). Changes in subscale scores [Pain, Symptoms, Function, and Quality of Life(QOL)] of the Knee Injury and Osteoarthritis Outcome Score(KOOS)/Hip Disability and Osteoarthritis Outcome Score(HOOS) questionnaires during the observational period(up to 54-64wk with a total of 4 visits). Patients’ treatment satisfaction, data on the combined oral use of glucosamine hydrochloride and CS, concomitant use of non-steroidal anti-inflammatory drugs(NSAIDs), and adverse events(AEs) were also evaluated.RESULTS A total of 1102 patients with knee and hip osteoarthritis were included in the study. The mean patient age was 60.4 years, most patients were women(87.8%), and their average body mass index was 29.49 kg/m2. All subscale scores(Pain, Symptoms, Function, and QOL) of the KOOS and HOOS demonstrated clinically and statistically significant improvements. In patients with knee osteoarthritis, the mean score increases from baseline to the end of Week 64 were 22.87, 20.78,16.60, and 24.87 on Pain, Symptoms, Physical Function(KOOS-PS), and QOL subscales(P < 0.001for all), respectively. In patients with hip osteoarthritis, the mean score increases were 22.81, 19.93,18.77, and 22.71 on Pain, Symptoms, Physical Function(HOOS-PS), and QOL subscales(P < 0.001for all), respectively. The number of patients using any NSAIDs decreased from 43.1% to 13.5%(P < 0.001) at the end of the observation period. Treatment-related AEs occurred in 2.8% of the patients and mainly included gastrointestinal disorders [25 AEs in 24(2.2%) patients]. Most patients(78.1%) were satisfied with the treatment.CONCLUSION Long-term oral GA + CS was associated with decreased pain, reduced concomitant NSAID therapy, improved joint function and QOL in patients with knee and hip osteoarthritis in routine clinical practice.
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BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is seen following THA in these hips.The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo.All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day.Modified Harris hip score and ROM were assessed during follow-up.Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at followup.SPSS 22.0 was used for statistical analysis.The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range.The mean flexion in 69 hips improved from 29.35±31.38 degrees to 102.17±10.48 degrees.The mean difference of 72.82 with a P value<0.0001 was significant.In total,45 out of 69 hips had flexion deformity,with 13 hips having a deformity above 30 degrees.The flexion during the follow-up was below 90 degrees in 3 hips.Eleven hips had flexion of 90 degrees at follow-up,while the remaining 55 hips had flexion above 100 degrees.Modified Harris hip score improved from 17.03±6.02 to 90.66±7.23(P value<0.0001).The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11,very good in 20,good in 5,fair in 3,and poor in 1.The mean mental health score was 84.10±11.58.Pain relief was good in all 69 hips.Altogether,28/40 patients(70%)had no pain,9 patients(22%)had occasional pain,and 3 patients(8%)had mild to moderate pain with unusual activity.Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM,Harris hip score,and quality of life indicated by the 36-item and 12-item short form health surveys.
文摘背景:关节置换是治疗老年移位性股骨颈骨折的主要手段,全髋关节置换与半髋关节置换的选择是目前具有较大争论的焦点。目的:基于倾向性评分匹配法对比直接前入路下全髋与半髋关节置换治疗老年移位性股骨颈骨折的中远期生存状态。方法:选择2016年1月至2021年1月收治的147例老年移位性股骨颈骨折患者(≥65岁),其中88例行全髋关节置换,59例行人工股骨头置换(半髋关节置换)。对于患者术前合并症采用年龄校正Charlson合并症评分表,计算患者虚弱度,并采用倾向性评分匹配法对两组患者进行1∶1匹配,比较匹配后两组患者的手术时间、出血量、术后住院时间、住院费用、营养指标、术后并发症、死亡率和术后生存时间,其中术后生存时间采用Kaplan-Meier生存分析。结果与结论:①倾向性评分匹配后,两组共有42对匹配成功,匹配后两组患者术前资料均衡可比(P>0.05);②与半髋关节置换组相比,全髋关节置换组手术时间(79.71 min vs.59.07 min,P<0.001)、出血量(839.64 mL vs.597.83 mL,P=0.001)、住院费用(56508.15元vs.41702.85元,P<0.001)明显增加,但全髋关节置换组死亡率低于半髋关节置换组(36%vs.57%,HR=0.44,95%CI:0.23-0.87,P=0.018),平均生存时间长于半髋关节置换组(59.4个月vs.43.7个月,P=0.024);③两组患者在术后住院时间、术前术后营养指标、术后整体并发症发生率上,差异均无显著性意义(P>0.05);但在术后疼痛方面,半髋关节置换组疼痛发生率明显高于全髋关节置换组(24%vs.7%,P=0.035);④整体来看,全髋关节置换具有更好的长期预后生存效果,但对于身体素质差的患者则更适合行半髋关节置换;同时,术后的疼痛可能很大程度上会对患者髋关节置换后的生活质量及存活时间产生影响。
文摘Introduction: Outcomes of total hip arthroplasties in rheumatoid are commonly considered as poor and with high rates of complication. Keeping in mind these conflicts of opinions we are going to analyse the functional and radiological outcomes of total hip arthroplasty between osteoarthritis and rheumatoid arthtitis. Patients and Method: Retrospective midterm study of thirty four patients who underwent total hip replacement in Sri Ramachandra medical center for rheumatoid and osteoarthritis (primary and secondary). Of the 44 hips, the indications are rheumatoid arthritis in 20 patients and osteoarthritis in 24 patients. We used the Harris hip score (Modified) for clinical and functional evaluation and plain X-ray pelvis with both hips and proximal femur—AP view and X-ray of the operated hip lateral view for radiological evaluation. Mean follow up is 9 years (8-13 years). Results: The mean pre and latest harris hip score are 44 and 88 respectively. The mean harris hip score in 1st, 3rd and 5th years are 86, 87 and 87 respectively. The mean pre and latest harris hip score in osteoarthritis is 49 and 92, in rheumatoid arthritis is 35 and 74. Conclusion: The results in patients who underwent total hip replacement for osteoarthritis are better than those for rheumatoid arthritis, however the gain in harris hip score is the same. As far as complications are concerned there is no difference between rheumatoid and osteoarthritis. Complications are mostly due to the faulty technique. Both uncemented and cemented total hip replacement give good results in non traumatic indications. In bilateral hip diseases there is considerable pain relief and improvement after the first THR, but the optimal improvement is not seen until the second 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.
文摘目的:分析并确定ARCO 2-4期股骨头坏死(osteonecrosis of femoral head,ONFH)对Harris评分有影响意义的MR征象。方法:回顾性分析2019年1月至2020年6月34例行常规MR、T2 mapping、3D-SPACE序列检查及Harris评分的ARCO 2-4期ONFH患者,排除3例,最终纳入31例,男23例,女8例,年龄18~62(40.0±10.8)岁;其中21例为双侧ONFH,共计52个ONFH,ARC02期17个,ARCO 3期24个,ARCO 4期11个。在医院数字影像信息系统(picture archiving and communication system,PACS)对MR影像征象(股骨头塌陷深度、ONFH指数、骨髓水肿、股骨头骨质增生、软骨损伤分级、软骨T2值及关节积液)进行评估及测量,在Siemens后处理工作站计算软骨定量参数T2值并测量。采用Pearson相关分析评估MR各征象与Harris评分的相关性,采用多重线性回归分析评估与Harris评分有相关性的MR征象对Harris评分的影响。结果:Pearson相关分析显示股骨头塌陷深度(r=-0.563,P=0.000)、软骨损伤分级(r=-0.500,P=0.000)及关节积液(r=-0.535,P=0.000)与Harris评分呈负相关。多重线性回归分析显示关节积液(β=-6.198,P=0.001)、股骨头塌陷深度(β=-4.085,P=0.014)对Harris评分呈负相关。结论:关节积液、股骨头塌陷深度对Harris评分有显著的负向影响关系,建议影像医师常规对股骨头塌陷深度、关节积液进行定量及等级评估,以高效精准地辅助临床诊疗。
文摘Background: The present study was conducted to examine the association between various coronary risk factors and clinical parameters, with special emphasis on ankle-brachial index, in predicting the severity and complexity of coronary artery disease. Methods: Patients diagnosed with coronary artery disease at our hospital between September-2012 and December-2014 were examined in this study. Selected patients were screened for cardiovascular risk factors including diabetes, hypertension, smoking, and alcohol habits as well as for clinical parameters including body-mass index, waist-hip ratio, ankle-brachial index, and ejection fraction. All patients underwent coronary angiography and were evaluated for severity of coronary artery disease (based on number of vessels involved) and complexity of coronary angiographic lesions (measured by computer-assisted Syntax score calculator). The collected data were analyzed to determine the role of cardiovascular risk factors and clinical parameters as predictors of complexity and severity of coronary artery disease. Results: A total of 211 patients (mean age: 54.64 ± 9.9 years;81% males) with coronary artery disease were analyzed. Findings revealed that diabetes mellitus (p < 0.001), hypertension (p < 0.001), smoking habits (p = 0.036), and low ankle-brachial index (p < 0.001) were independent predictors of complex coronary artery disease as measured by Syntax score. Significant associations were also evident between severity of coronary artery disease and diabetes mellitus (p < 0.001), hypertension (p < 0.001), and ankle-brachial index (p < 0.001). Conversely, other cardiovascular risk factors including body-mass index, alcohol habits, wait-hip ratio, and ejection fraction did not exhibit significant associations with severity and complexity of coronary artery. Conclusions: The early diagnosis of coronary artery can be predicated by evaluating diabetes, hypertension, and smoking habits in patients presenting with acute coronary syndrome. In addition, ankle-brachial index can be used as an effective non-invasive bed-side tool, as an alternative to Syntax score, in predicting the severity and complexity of coronary artery disease.
文摘Introduction: Early surgical treatment (within 48 hours) has been recommended for femoral neck fractures in order to avoid complications and reduce mortality rate, regardless of presence and severity of comorbidity and preoperative status (ASA score). However some studies evidenced that early surgery doesn’t always have a beneficial effect on mortality and complications. Therefore further studies could be useful in order to better assess risk related factors of patients requiring surgical treatment for femoral neck fracture. The purpose of this study is to evaluate the effect of preoperative ASA score and timing of surgery on mortality, complications and clinical outcome. Methods: All 336 patients operated in our center from January 2013 to December 2014 were selected for this retrospective study. Patients were divided in three groups as follows: group 1 patients treated within 48 hours;group 2 patients treated between 48 to 96 hours;group 3 patients treated over 96 hours. The preoperative ASA score was recorded for each patient. Complication, clinical outcome and mortality at one-year follow-up were evaluated. At follow-up ambulation was graded as: confined to bed, assisted ambulation, and normal ambulation. Complications both local (infections, malunion, dislocation) and systemic (deep vein thrombosis, pulmonary embolism, lung infections, ischemic disorders of heart) were recorded as well as number of transfusions. Statistical analysis was performed with chi square test and P value Results: 308 patients’ data were fully available for this study. At one-year follow-up return to normal ambulation was higher for patients of group 1 as compared with group 2 and 3 and in group 2 as compared with group 3 (P = 0.04). There was no difference in mortality and return to ambulation between patients with ASA score 1 and 2 (P = 0.06);patients with ASA score ≥ 3 showed a statistically significant higher mortality (P = 0.004) and rate of complications (0.0008) regardless of timing of surgery. There was no statistically significance in blood transfusion among the three groups. Discussion and Conclusion: Clinical outcome, complications and mortality have been previously reported from many authors and most studies agreed that early surgical treatment is recommended regardless of age and preoperative status of the patient. The present study suggests that early surgical treatment is actually able to reduce mortality and complications and to improve clinical outcome in patients with better preoperative conditions, while for patients with ASA score ≥ 3 treatment within 48 hours seems not to prevent mortality and complications and improve clinical outcome.
