Chondroitin sulfate and glucosamine combination in patients with knee and hip osteoarthritis:A long-term observational study in Russia

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.

Decision aids can decrease decisional conflict in patients with hip or knee osteoarthritis: Randomized controlled trial

BACKGROUND The interest in shared decision making has increased considerably over the last couple of decades.Decision aids(DAs)can help in shared decision making.Especially when there is more than one reasonable option and outcomes between treatments are comparable.AIM To investigate if the use of DAs decreases decisional conflict in patients when choosing treatment for knee or hip osteoarthritis(OA).METHODS In this multi-center unblinded randomized controlled trial of patients with knee or hip OA were included from four secondary and tertiary referral centers.Onehundred-thirty-one patients who consulted an orthopedic surgeon for the first time with knee or hip OA were included between December 2014 and January 2016.After the first consultation,patients were randomly assigned by a computer to the control group which was treated according to standard care,or to the intervention group which was treated with standard care and provided with a DA.After the first consultation,patients were asked to complete questionnaires about decisional conflict(DCS),satisfaction,anxiety(PASS-20),gained knowledge,stage of decision making and preferred treatment.Follow-up was carried out after 26 wk and evaluated decisional conflict,satisfaction,anxiety,health outcomes(HOOS/KOOS),quality of life(EQ5D)and chosen treatment.RESULTS After the first consultation,patients in the intervention group(mean DCS:25 out of 100,SD:13)had significantly(P value:0.00)less decisional conflict compared to patients in the control group(mean DCS:39 out of 100,SD 11).The mean satisfaction score for the given information(7.6 out of 10,SD:1.8 vs 8.6 out of 10,SD:1.1)(P value:0.00),mean satisfaction score with the physician(8.3 out of 10,SD:1.7 vs 8.9 out of 10,SD:0.9)(P value:0.01)and the mean knowledge score(3.3 out of 4,SD:0.9 vs 3.7 out of,SD:0.6)(P value:0.01)were all significantly higher in the intervention group.At 26-wk follow-up,only 75 of 131 patients(57%)were available for analysis.This sample is too small for meaningful analysis.CONCLUSION Providing patients with an additional DA may have a positive effect on decisional conflict after the first consultation.Due to loss to follow-up we are unsure if this effect remains over time.

Non-Operative Management of Hip Osteoarthritis

This paper reviews several non-operative and non-pharmacologic management strategies advocated for alleviating the pain and disability experienced by people with hip osteoarthritis. It analyzes whether painful debilitating hip osteoarthritis, which has no effective cure and is often progressive, may be affected positively by non-operative interventions designed to control osteoarthritis pain. Finally, it provides an integrated plan of management for ameliorating hip osteoarthritis pain and disability in light of this knowledge.

Seasonal variation in adult hip disease secondary to osteoarthritis and developmental dysplasia of the hip

AIM To determine if there was a seasonal variation in adults undergoing total hip arthroplasty for end stage hip disease due to osteoarthritis(OA) or sequelae of developmental dysplasia of the hip(DDH).METHODS The total hip registry from the author's institution for the years 1969 to 2013 was reviewed. The month of birth,age,gender,and ethnicity was recorded. Differences between number of births observed and expected in the winter months(October through February) and non-winter mo(March through September) were analyzed with the χ2 test. Detailed temporal variation was mathematically assessed using cosinor analysis.RESULTS There were 7792 OA patients and 60 DDH patients who underwent total hip arthroplasty. There were more births than expected in the winter months for both the DDH(P < 0.0001) and OA(P = 0.0052) groups. Cosinor analyses demonstrated a peak date of birth on 1st October. CONCLUSION These data demonstrate an increased prevalence of DDH and OA in those patients born in winter.

Femoroacetabular impingement is more common in military veterans with end-stage hip osteoarthritis than civilian patients: a retrospective case control study

Background: The purpose of this study was to compare the frequency of femoroacetabular impingement(FAI) between matched groups of military veterans and civilian patients with end-stage hip osteoarthritis(OA).Methods: Patients who underwent a primary total hip arthroplasty(THA) between January 1, 2015 and December 31, 2015 at a single Veteran’s Affairs Hospital were identified. Veterans were then matched 1:2 with civilian patients from our prospective outcome registry. The alpha angle and lateral center-edge angle(LCEA) were measured by a single evaluator. Independent t-tests were used to compare joint angles, and Fisher exact tests were used to compare the prevalence of cam(alpha angle ≥60°), pincer(LCEA ≥40°), or mixed-type pathologies.Results: Twenty-one veterans were matched 1:2 with civilian patients. The mean alpha angle did not significantly differ between groups(P=0.33) nor did the prevalence of cam deformities(P=0.79). The LCEAs were significantly greater in veterans than in civilians(P=0.04), and veterans also demonstrated a significantly greater prevalence of pincer and mixed-type deformities than civilians(P=0.025 and P=0.004, respectively).Conclusions: These results suggest that FAI is perhaps a more common mechanism in the progression of OA in a veteran population than in a civilian population, as pincer and mixed-type deformities were significantly more common among veterans than civilians. The forces borne by the hip during military training exceed normal physiologic conditions. In addition, the time between symptom onset and surgical correction may be 10–12 months longer for active military personnel than for civilians. The combination of increased physical demands and a protracted time to treatment highlights the need for better recognition of FAI in military members. Future studies are necessary to determine whether earlier intervention may prevent or delay the progression to end-stage OA and the need for total hip arthroplasty.

Hip Joint Osteoarthritis Pain Sources and Control

Hip joint osteoarthritis, a widespread disabling disease with no known cause, produces considerable bouts of intractable pain as a result of multiple disease associated problems. This paper examines some sources of osteoarthritic hip joint pain, a poorly understood topic at best. Presented in three parts are data retrieved from several sources, including animal models. It is concluded that to improve the effectiveness of treatments designed to minimize hip osteoarthritis pain, a better understanding of the diverse origins of hip joint pain, and hip joint neurology, may permit the development of more precise as well as targeted pain strategies.

Differential mRNA Expression of <i>COX</i>-2 and Proinflammatory Mediators in Patients with Rotator Cuff Tears and Osteoarthritis of the Hip

Purpose: Bursal inflammation is thought to be a major cause of pain in degenerative rotator cuff tears (RCTs). While the expression of proinflammatory mediators, such as COX-2, TNF-α, IL-1β, and IL-6, is crucial for the pathophysiology of osteoarthritis (OA), their role in degenerative RCTs remains unknown. The aim of this study was to determine the expression of COX-2 and proinflammatory mediators in the development of RCT-induced pain by comparing their levels in patients with hip OA or RCTs. Methods: We included samples obtained from 31 shoulders of 31 patients with RCTs and samples from 30 hips of 27 patients with hip OA. The mRNA levels of COX-2, TNF-α, IL-1β, and IL-6 were determined using RT-PCR, and were compared between the subacromial bursa and hip joints. We also analyzed IL-1β-induced COX-2 expression in the subacromial bursa and synovial blast of the hip. Results: COX-2, IL-1β, and IL-6 expression levels were significantly lower in the subacromial bursa of RCTs than in hip OA samples, while no significant difference was observed for TNF-α. No significant difference in the fold increase was observed between subacromial bursa and hip OA samples, even though IL-1β-induced COX-2 expression increased in both samples. Conclusion: Our findings suggest that the main mechanism underlying pain development differs between patients with RCTs and those with hip OA.

Disabling hip osteoarthritis: gender, body mass, health and functional status correlates

Objective: To examine gender differences in self-reported pain and function before and after hip replacement surgery and the extent to which overweight, comorbidities and muscular status impact pain and function in adults with disabling end-stage hip joint osteoarthritis. Setting: Orthopedic Hospital Setting on the East Coast of the United States. Study Design: Cross-sectional retrospective chart review. Methods: The desired demographic, physical and psychological attributes of 1040 adults with end-stage hip osteoarthritis hospitalized for hip surgery were recorded and subjected to comparison and correlational analyses. These data included gender, self-reported weight, height, numbers and nature of physical and psychological comorbidities, pain intensity, ambulatory capacity and discharge destination. Sub-group analyses of 808 candidates hospitalized for primary unilateral surgery were also conducted using SPSS 16. Results: There were significant (p 【0.05) associations between gender, pain scores, comorbidity numbers and ambulatory capacity. Specifically, women who exhibited higher comorbid disease rates than men, exhibited higher pre-surgery pain levels and greater functional limitations in walking ability before and after surgery than men with the same condition. In sub-group analyses of men and women with the same mean age, comorbid prevalence rates, and body mass indices, women were found to have significantly higher ideal weights on average than men, and those with higher ideal weights recovered more slowly after surgery (p 【0.05). Conclusion: The presentation of hip joint osteoarthritis is not uniform, and may be impacted differentially by gender. Women with high ideal body weights, may be specifically impacted. Whether genetic or other factors account for gender differences in pain and function among adults with disabling hip osteoarthritis observation needs to be examined.

The Correlation between Femoral Anteversion and Femoral Condyle Rotation in Patients with Osteoarthritis of the Hip Joint: Investigation about the Asian Female Patients

An abnormality of femoral anteversion (FA) is often recognized in patients with osteoarthritis of the hip joint (hip OA). And it is considered that rotation abnormality in the knee and the lower leg occurs as compensation, in cases of FA abnormality. The purpose of this study was to assess the magnitude and variability of FA and femoral condyle rotation (FCR) in order to identify the association between FA and FCR in female patients with hip OA who require total hip arthroplasty. A total of 174 hips from 174 hip OA patients undergoing THA were included in this study. All patients were Asian women (average age: 71.1 years). An equilateral correlation was accepted in FA and FCR. It was thought that FA abnormality might be accompanied by morphological rotation abnormalities of the knee joint. Caution is needed in considering femoral anteversion using the posterior condylar line. We must consider FA in patients undergoing THA after having considered the whole leg rotation.

Rose Hip Powder That Contains the Natural Amount of Shells and Seeds Alleviates Pain in Osteoarthritis of the Dominant Hand—A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Clinical Trial

Aim: A standardized preparation of seeds and shells of selected sub-species of Rosa canina L, trade name Hyben Vital, reduces discomfort from osteoarthritis of the knee and hip. This study aims to investigate the impact of the same rose-hip powder (RHP) on discomfort and the consumption of rescue medication, in patients with osteoarthritis of the hand. Methods: The double blind, placebo-controlled, crossover trial included 30 patients with osteoarthritis of the dominant hand. Patients were randomly allocated to treatment with either five gram encapsulated RHP or placebo, for three months (Phase 1), after which they switched to the corresponding treatment for a further three months period (Phase 2). Before entering the study, after 3 weeks and following three months of each of the study phases, scores for pain, stiffness and general feeling of discomfort were evaluated using a 10 step categorical scale, focusing on 16 different daily activities of the hand. The consumption of rescue medication was also calculated at the beginning and at the end of each study phase. Data are based on the intention to treat. Results: At the end of Phase 1, 90% of patients in the group receiving RHP first (group A), showed a reduction in pain, as compared to 36% in the group B initially given placebo (p 0.029). In line with this observation, stiffness and the general feeling of discomfort from the disease declined during RHP treatment (p 0.032). In group A, symptom reduction was still indicated by the study subjects 3 weeks after the switch to placebo. The consumption of rescue medication such as paracetamol, codeine and tramadol also declined significantly in group A when compared to group B (p 0.013). Conclusion: The present data suggest that administration of RHP, containing seeds and shells can reduce symptoms of osteoarthritis of the hand and consumption of rescue medication.

Analysis of Functional and Radiological Outcome of Total Hip Replacements in Rheumatoid and Osteoarthritis Patients

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.

Effect of local blocking on osteoarthritis of the hip

Objective:To provide an effective treatment for the Osteoarthritis of the hip by observing the effect of local blocking of HongHua injection on relieving hip pain.Methods:Methods from June 2015 to May 2017,60 patients with Osteoarthritis of the hip in Wangjing Hospital of Chinese Academy of Sciences were randomly divided into treatment group and control group,30 cases in each group.The treatment group was given local blockingof HongHua injection treatment,control group using Compound Betamethasone Injection local closed treatment.Visual analogue scale(VAS)score,pericoxal local tenderness and hip mobility were used to evaluate the therapeutic effect.The therapeutic indicators at six different time points after 1 days,3 days,7 days,2 weeks and 1 months after treatment were compared.Results:All the 60 cases completed treatment and follow-up,and there were no cases of abscission.There was no significant difference in gender,age,etiology,classification and Harris score before treatment between the two groups(P>0.05),which was comparable.VAS score:There was no significant difference between the two groups on the 1st,3rd,7th and 2nd week after treatment(P>0.05),but the treatment group was lower than the control group on the 1st month after treatment(P<0.01).Hip joint activity:There was no significant difference in hip joint activity between the two groups 1 day,3 days,7 days,2 weeks and 1 month after treatment(P>0.05).Local tenderness around hip:The efficacy of the midpoint inguinal tenderness score was similar between the two groups at 1 day,7 days,2 weeks and 1 month after treatment(P>0.05);the treatment group was lower than the control group at 3 days after treatment(P<0.01);the adductor starting tenderness score had no significant difference at 1 day,3 days,7 days,2 weeks and 1 month after treatment(P>0.05).Conclusion:Local blockingof HongHua injection is effective and effective in treating hip pain in Osteoarthritis of the hip.The HongHua injection has many advantages,such as good safety and wide indications.It is worthy of further clinical application.

Radiographic assessment of leg alignment and grading of knee osteoarthritis:A critical review

Knee osteoarthritis(OA) is a progressive joint disease hallmarked by cartilage and bone breakdown and associated with changes to all of the tissues in the joint,ultimately causing pain,stiffness,deformity and disability in many people.Radiographs are commonly used for the clinical assessment of knee OA incidence and progression,and to assess for risk factors.One risk factor for the incidence and progression of knee OA is malalignment of the lower extremities(LE).The hipknee-ankle(HKA) angle,assessed from a full-length LE radiograph,is ideally used to assess LE alignment.Careful attention to LE positioning is necessary to obtain the most accurate measurement of the HKA angle.Since full-length LE radiographs are not always available,the femoral shaft-tibial shaft(FS-TS) angle may be calculated from a knee radiograph instead.However,the FS-TS angle is more variable than the HKA angle and it should be used with caution.Knee radiographs are used to assess the severity of knee OA and its progression.There are three types of ordinal grading scales for knee OA:global,composite and individual feature scales.Each grade on a global scale describes one or more features of knee OA.The entire description must be met for a specific grade to be assigned.The KellgrenLawrence scale is the most commonly-used global scale.Composite scales grade several features of knee OA individually and sum the grades to create a total score.One example is the compartmental grading scale for knee OA.Composite scales can respond to change in a variety of presentations of knee OA.Individual feature scales assess one or more OA features individually and do not calculate a total score.They are most often used to monitor change in one OA feature,commonly joint space narrowing.The most commonly-used individual feature scale is the OA Research Society International atlas.Each type of scale has its advantages;however,composite scales may offer greater content validity.Responsiveness to change is unknown for most scales and deserves further evaluation.

A TETRACYCLINE LABELING STUDY OF SUBCHONDRAL BONE TISSUES IN OSTEOARTHRITIC HIP JOINT

Seven female patients (mean age of 56 years) with advanced hip joint osteoarthritis underwent total hip replacement. Four days before operation they were given oral tetracycline for two days. During operation specimens were taken from the white articular cartilage, the yellowish articular cartilage and the ivory bone together with their subchondral bone tissues. The undecalcified specimens were cut into 10 μm sections and observed under the fluorescence microscope. In all the specimens the following findings could be observed. 1. The osteoarthritic articular cartilage became thinner, with uneven surface and fissures. 2. The superficial and deep surfaces and the central part of the subchondral bone plate showed bright golden yellow fluorescence. It reflected extensive new bone formation. 3. The subchondral bone trabeculae also revealed bright golden yellow fluorescence on their peripheral borders, so trabeculae turned thicker obviously. 4. The marrow tissues between the bone trabeculae exhibited particulate or spherical bright golden yellow fluorescence, reflecting new bone formation in the marrow. The particulate and spherical bright golden yellow fluorescent materials might aggregate, enlarge and merge into large piece of new bone and they also fused with the neighbouring bone trabeculae. The aforementioned changes in the structure of the subchondral bone tissues increased greatly the mass in the osteoarthritic femoral head.

Total hip arthroplasty with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis

Objective: To evaluate the outcome of total hip arthroplasty (THA) with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis. Methods: Between 1995 and 2002, we implanted 23 cementless cups and femoral head autografts in 20 patients with hip dysplasia and osteoarthritis. In this study, a retrospective study was made on 21 hips in 20 patients (18 females and 2 males, aged 50 years on an average) with developmental hip dysplasia treated by THA with a cementless cup and femoral head autograft. The acetabular cup was placed at the level of the true acetabulum and all the patients required autogenous femoral head grafts due to acetabular deficiency. The average rate of the acetabular cup covered by the femoral head autograft was 31% (ranging from 10% to 45%). Eight hips had less than 25% cup coverage and thirteen between 25% and 50%. The average follow-up period was (4.7) years (range, 1-8 years). The replacing outcome was evaluated by modified Harris hip score. Preoperative and follow-up radiographs were made. Results: All the autografts were united to the host bones. No autograft was collapsed or no component from the hip was loosed in all the patients. According to the modified Harris hip score, the average hip score increased from 46 before operation to 89 at the final review. Before operation, the leg-length discrepancy was greater than 2 cm in all the patients except one with bilateral hip dysplasia. After operation, only 2 out of 20 patients had a leg-length discrepancy greater than 1 cm. Three hips showed minor bone resorption in the lateral portion of the graft, which did not support the cup. Three hips developed Grade 1 Brooker heterotopic ossification and one developed Grade 2. Conclusions: THA with a cementless cup and a femoral head autograft for patients with osteoarthritis resulted from hip dysplasia can result in favorable outcomes. This method can provide reliable acetabular fixation and restore the acetabular bone stock in patients with developmental hip dysplasia when the cementless cup covered by the graft does not exceed 50%.

Comparison of clinical outcomes between total hip replacement and total knee replacement

BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for which remains unknown.This study compares clinical outcomes between THR and TKR.AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures(PROMs).METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre-and post-operatively.RESULTS A total of 131 patients were included in the study which comprised the THR group(68 patients)and the TKR group(63 patients).Both groups demonstrated significant post-operative improvements in all PROM scores(P<0.001).There were no significant differences in post-operative PROM scores between the two groups:Hip and Knee Osteoarthritis Outcome scores(P=0.140),Western Ontario and McMaster Universities Osteoarthritis Index pain(P=0.297)stiffness(P=0.309)and function(P=0.945),Oxford Hip and Knee Score(P=0.076),EuroQol-5D index(P=0.386)and Short-Form 12-item survey physical component score(P=0.106).Subgroup analyses showed no significant difference(P>0.05)between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference(P>0.05)between cemented and uncemented fixation in the THR group.Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.CONCLUSION Contrary to some literature,THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs.The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome.Obesity had a greater influence on the outcome following TKR than that of THR.

基于快速康复理念的线上线下整体优化干预在伴肌少症老年全髋关节置换术患者中的应用效果

目的探讨基于快速康复理念的线上线下整体优化干预在伴肌少症老年全髋关节置换术(THA)患者中的应用效果。方法选取2021年4月—2023年4月收治的104例伴肌少症老年THA,根据干预方法不同分为对照组、观察组,各52例。对照组予以常规围手术期干预,在此基础上,观察组予以基于快速康复理念的线上线下整体优化干预。对比2组住院情况、不良事件发生率、依从性、视觉模拟评分法(VAS)、简易躯体执行能力测试量表(SPPB)、髋关节伤残和骨关节炎问卷(HOOS)、Harris髋关节功能及Barthel指数评分。结果观察组首次下床时间、首次排便时间、住院时间均短于对照组(P<0.01);观察组术后3 d、术后7 d VAS评分均低于对照组(P<0.05);观察组不良事件总发生率3.85%(2/52)低于对照组17.31%(9/52)(P<0.05);观察组总依从度96.15%(50/52)高于对照组78.85%(41/52)(P<0.01);术后1个月、3个月观察组SPPB、HOOS及Harris、Barthel指数评分均较对照组高(P<0.05)。结论基于快速康复理念的线上线下整体优化干预应用于伴肌少症老年THA患者中,可降低患者术后疼痛感,减少不良事件,提升依从性,促进髋关节及躯体功能好转,有助于患者预后恢复。

Current concept in dysplastic hip arthroplasty: Techniques for acetabular and femoral reconstruction

Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty(THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance(especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques availablefor THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments(prefabricated), Custom made acetabular augments(3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique(cotyloplasty) with chisel, Medial protrusion technique(cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author's treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular cup impacting. For femoral side first we peel of all rotators and posterior part of gluteus medius and vastus lateralis from greater trochanter on the very thin flake of bone. This method allows us to adequately shorten proximal femoral stump, with possibility of additional resection of proximal femur. Furthermore, several advantages and disadvantages of this procedure are also discussed.

髋关节置换术后腰椎骨盆矢状位参数变化与小关节源性腰痛的相关性研究

目的探讨髋关节骨性关节炎患者髋关节置换术后腰椎骨盆矢状位参数变化与小关节源性腰痛的关系。方法回顾性分析2019年6月至2020年11月我院骨科收治的30例髋关节骨性关节炎引起小关节源性腰痛且行单侧髋关节置换术治疗患者(观察组)的临床资料;随机选取同期在我院体检中心接受腰椎X射线片检查的50名健康受试者作为对照组。基于X射线片测量腰椎骨盆矢状位参数,包括骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、腰椎前凸角(LL)、骶骨骨盆角(SPI)、骶骨骨盆后角(SPPA)。多元线性回归分析腰椎骨盆矢状位参数变化与小关节源性腰痛的相关性,采用受试者工作特征(ROC)曲线分析其对小关节源性腰痛的诊断效能。结果观察组患者术前及术后1年PI、LL、SPI、SPPA与对照组比较差异无统计学意义(P>0.05)。观察组患者术前PT小于对照组(P<0.05),术前SS大于对照组(P<0.05)。多元线性回归分析显示,术前PT、SS与小关节源性腰痛相关(P<0.05)。术前PT和SS诊断小关节源性腰痛的敏感度分别为50.00%、73.30%,特异度分别为88.00%、78.00%。ROC曲线分析显示,术前PT和SS诊断小关节源性腰痛的曲线下面积分别为0.708(95%CI:0.595~0.822)和0.775(95%CI:0.673~0.877)。结论髋关节骨性关节炎患者的SS明显较大,PT明显较小。髋关节置换术可以减轻腰痛症状,且不影响腰椎和骨盆的矢状位平衡;术前PT、SS与小关节源性腰痛具有相关性,二者在诊断小关节源性腰痛方面具有较高的价值。

不同运动强度与骨关节炎发病风险的效应分析

背景:越来越多的证据表明不同运动强度与骨关节炎风险之间存在关联,但这可能受到混杂和反向因果关系的影响,结论尚未统一。目的:应用孟德尔随机化探索不同运动强度与骨关节炎的因果关联。方法:选取与不同运动强度相关联的全基因组关联研究数据,以阈值P<5×10-8筛选工具变量,采用孟德尔随机化5种分析方法评估暴露与结局风险的因果关系,以逆方差加权法作为主要分析方法。使用选定的工具变量来评估不同运动强度与骨关节炎的因果关联,并进行敏感性分析与反向孟德尔随机化分析。结果与结论:①逆方差加权法分析结果显示,低强度运动对膝骨关节炎的保护效应显著(OR=0.14,95%CI:0.06-0.32,P<0.001),久坐行为(例如电视观看)是膝骨关节炎和髋骨关节炎的危险因素(OR=2.24,95%CI:1.74-2.88,P<0.001;OR=1.34,95%CI:1.01-1.78,P=0.04)。对于骨关节炎与不同运动强度的反向孟德尔随机化分析发现,骨关节炎与低强度运动呈负相关性,与电视观看呈正相关。②分析结果显示,不同运动强度与骨关节炎风险存在双向因果关系。