Daytime hip arthroplasty refers to a medical procedure where a patient undergoes admission, surgery, and discharge all within a single day (24 hours). The establishment of daytime hip arthroplasty centers signifies a significant paradigm shift in the development model of modern hospitals. While numerous nationally accredited large medical institutions are undertaking daytime hip arthroplasty in various forms and scales, there remains a lack of standardized system processes and criteria. In this context, the National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Bone and Joint Specialty Committee of the China Ambulatory Surgery Alliance, Joint Surgery Branch of the Chinese Orthopedic Association, and Osteoarthritis Study Group of the Chinese Association of Orthopedic Surgeons have collaboratively organized experts in the relevant field domestically. Leveraging international experiences in daytime hip arthroplasty and integrating them with the clinical practices of well-established medical institutions conducting daytime surgeries in China, they have arrived at consensus recommendations. These recommendations cover the establishment of daytime hip arthroplasty centers, policies, procedures, and perioperative management. The ultimate goal is to provide reference points and guidance for the standardized implementation of daytime hip arthroplasty.
ObjectiveTo investigate the effectiveness of total elbow arthroplasty (TEA) with preservation of triceps brachii insertion approach.MethodsBetween January 2012 and September 2017, 17 patients with elbow disease were treated with TEA with preservation of triceps brachii insertion approach. There were 3 males and 14 females, with an average age of 65.2 years (range, 48-85 years). The injuries located on left elbow in 5 cases and on right elbow in 12 cases. There were 11 cases of distal humerus fracture (AO type C1 in 2 cases and type C3 in 9 cases); the interval between fracture and operation was 3-10 days (mean, 4.1 days). There were 3 cases of osteoarthritis and 3 cases of rheumatoid arthritis, with the disease duration of 2-26 years (mean, 8.7 years). The postoperative elbow function and pain was assessed by Mayo elbow performance score (MEPS) and visual analogue scale (VAS) score, respectively. The prosthesis position, heterotopic ossification, and periprosthetic fracture were observed by X-ray films.ResultsAll incisions healed by first intention. Sixteen patients were followed up 18-69 months (mean, 40.6 months). Intraoperative ulnar nerve injury occurred in 2 cases, and healed after symptomatic treatment. At last follow-up, the MEPS score was 55-100 (mean, 90.3). The results were excellent in 11 cases, good in 2 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 81.3%. The VAS score was 0-2 (mean, 0.4). X-ray reexamination showed that no polyethylene wear, prosthesis loosening and fracture, abnormal prosthesis position, periprosthetic fracture occurred during the follow-up period, and the prosthesis survival rate was 100%. Heterotopic ossification occurred in 2 and 3 months after operation in 2 cases, respectively.ConclusionThe triceps on approach for TEA are satisfactory for distal humerus fracture, osteoarthritis, and rheumatoid arthritis.
ObjectiveTo compare the effects of piriformis muscle release versus preservation in total hip arthroplasty (THA) via supercapsular percutaneously-assisted total hip (SuperPATH) approach on muscle injury. MethodsForty-nine patients undergoing initial THA via SuperPATH approach between June 2022 and June 2023 were randomly divided into two groups, with 24 patients in trial group and 25 patients in control group. The trial group received piriformis muscle release intraoperatively, whereas the control group underwent muscle preservation. There was no significant difference in baseline data such as gender, age, body mass index, disease type, American Society of Anesthesiologists (ASA) grading, and preoperative muscle infiltration, muscle atrophy, muscle injury serological indicators, Harris score, etc. (P>0.05). The incision length, operation time, intraoperative blood loss, total blood loss, hospital stay, preoperative and postoperative 1-day muscle injury serological indicators [including creatine kinase (CK) and lactic dehydrogenase (LDH)], and incidence of complications between two groups were recorded. Harris score was used to evaluate the recovery of hip joint function. MRI was used to evaluate the extent of hip muscle injuries (gluteus minimus, gluteus medius, piriformis, obturator internus, quadratus femoris), including tendon integrity, degree of muscle fat infiltration, and degree of muscle atrophy preoperative and 1 year postoperatively. ResultsThe operation time, intraoperative blood loss, and total blood loss in the trial group were significantly shorter than those in the control group (P<0.05). There was no significant difference in the incision length and length of hospital stay between the two groups (P>0.05). Both groups showed a significant increase in serum CK and LDH levels on postoperative day 1 compared to preoperative levels (P<0.05), but there was no significant difference between the two groups (P>0.05). All patients were followed up, the follow-up time for the trial group and the control group was (14.8±2.8) and (15.1±3.0) months, respectively, with no significant difference (t=−0.400, P=0.691). Incisions healed by first intention in both groups, with 1 case in the trial group and 2 cases in the control group experiencing venous thrombosis in the calf muscle space. There was no complication such as deep vein thrombosis, pulmonary embolism, hip dislocation, prosthesis loosening, or periprosthetic infection in the lower limbs. There was no significant difference in the incidence of complications between the two groups (P>0.05). At 1 year after operation, both groups of patients showed a significant increase in Harris scores compared to preoperative levels (P<0.05), but there was no significant difference between the two groups (P>0.05). Compared with preoperative results, both groups showed significant fat infiltration in the piriformis and obturator muscles at 1 year after operation (P<0.05), while there was no significant fat infiltration in the gluteus minimus, gluteus medius, and quadratus femoris muscles (P>0.05). At 1 year after operation, except for the higher incidence of piriformis muscle fat infiltration in the control group compared to the trial group (P<0.05), there was no significant difference in the incidence of other muscle infiltrations between the two groups (P>0.05). At 1 year after operation, both groups of piriformis and obturator muscles showed significant muscle atrophy compared to preoperative levels (P<0.05). The gluteus minimus and gluteus medius showed mild atrophy compared to preoperative levels, while the maximum transverse diameter of the quadriceps muscle slightly increased, but the differences were not significant (P>0.05). There was no significant difference in the maximum cross-sectional diameter or cross-sectional area changes of each muscle between the two groups (P>0.05). At 1 year after operation, the continuity of the gluteus medius and quadratus femoris muscles in both groups was intact. Both groups had some patients with incomplete continuity of the piriformis muscle, obturator internus, and gluteus minimus, but the difference was not significant (P>0.05). ConclusionThe SuperPATH approach THA may cause injury to the piriformis, gluteus minimus, and obturator internus. The piriformis muscle release does not increase muscle injury, but it can shorten the operation time and reduce bleeding.
Objective To evaluate the early effectiveness of navigation-free robot-assisted total knee arthroplasty (TKA) compared to traditional TKA in the treatment of knee osteoarthritis combined with extra-articular deformities. Methods The clinical data of 30 patients with knee osteoarthritis combined with extra-articular deformities who met the selection criteria between June 2019 and January 2024 were retrospectively analyzed. Fifteen patients underwent CORI navigation-free robot-assisted TKA and intra-articular osteotomy (robot group) and 15 patients underwent traditional TKA and intra-articular osteotomy (traditional group). There was no significant difference in age, gender, body mass index, affected knee side, extra-articular deformity angle, deformity position, deformity type, and preoperative knee range of motion, American Knee Society (KSS) knee score and KSS function score, and lower limb alignment deviation between the two groups (P>0.05). The operation time, intraoperative blood loss, and complications of the two groups were recorded and compared. The knee range of motion and lower limb alignment deviation were recorded before operation and at 6 months after operation, and the knee joint function was evaluated by KSS knee score and function score. Results There was no significant difference in operation time between the two groups (P>0.05); the intraoperative blood loss in the robot group was significantly less than that in the traditional group (P<0.05). Patients in both groups were followed up 6-12 months, with an average of 8.7 months. The incisions of all patients healed well, and there was no postoperative complication such as thrombosis or infection. At 6 months after operation, X-ray examination showed that the position of the prosthesis was good in both groups, and there was no loosening or dislocation of the prosthesis. The knee joint range of motion, the lower limb alignment deviation, and the KSS knee score and KSS function score significantly improved in both groups (P<0.05) compared to preoperative ones. The changes of lower limb alignment deviation and KSS function score between pre- and post-operation in the robot group were significantly better than those in the traditional group (P<0.05), while the changes of other indicators between pre- and post-operation in the two groups were not significant (P>0.05). Conclusion Compared to traditional TKA, navigation-free robot-assisted TKA for knee osteoarthritis with extra-articular deformities results in less intraoperative blood loss, more precise reconstruction of lower limb alignment, and better early effectiveness. However, long-term effectiveness require further investigation.
Objective To investigate the effectiveness of lateral condyle sliding osteotomy (LCSO) in total knee arthroplasty (TKA) for the treatment of lateral femoral bowing deformity. Methods The clinical data of 17 patients with lateral femoral bowing deformity treated by LCSO during TKA between July 2018 and July 2020 was retrospectively analysed. There were 3 males and 14 females, with an average of 63.2 years (range, 58-68 years). The etiology of lateral femoral bowing deformity included 12 cases of femoral developmental deformity and 5 cases of femoral fracture malunion. Kellgren-Lawrence classification of knee osteoarthritis was 4 cases of grade Ⅲ and 13 cases of grade Ⅳ. The preoperative hip-knee shaft was 9.5°-12.5° (mean, 10.94°). The disease duration was 3-25 years (mean, 15.1 years). The mechanical lateral distal femur angle (mLDFA), hip-knee-ankle angle (HKA), and mechanical axis deviation (MAD) of the distal femur were measured before operation and at last follow-up to evaluate the correction of extra-articular deformities in the joints and the recovery of mechanical force lines of the lower extremities. The knee society score (KSS) knee score and function score, visual analogue scale (VAS) score, knee joint range of motion (ROM) were used to evaluate effectiveness. The knee varus/valgus stress test and osteotomy healing by X-ray films were performed to evaluate the joint stability and the safety of LCSO. Results All incisions of the patients healed by first intention after operation, and there was no early postoperative complication such as infection of the incision and deep vein thrombosis of the lower extremities. All 17 patients were followed up 12-36 months, with an average of 23.9 months. The osteotomy slices all achieved bony healing, and the healing time was 2-5 months, with an average of 3.1 months. After operation, the knee varus/valgus stress tests were negative, and there was no relaxation and rupture of the lateral collateral ligament, instability of the knee joint, loosening, revision and infection of the prosthesis occurred. At last follow-up, mLDFA, HKA, MAD, knee ROM, VAS score, KSS knee score and function score significantly improved when compared with preoperative ones (P<0.05). Conclusion LCSO is effective and safe in TKA with lateral femoral bowing deformity. Extra-articular deformities are corrected intra-articularly. The mechanical force line and joint balance of the lower extremities can be restored simultaneously in an operation.
Objective To systematically evaluate the difference in leg length discrepancy (LLD) between robot-assisted total hip arthroplasty (THA) and traditional THA. Methods The Cochrane Library, PubMed, Web of Science, EMbase, CNKI, Wanfang, VIP, and CBM databases were searched by computer to collect cohort studies of robot-assisted and traditional THAs from inception to August 11th, 2021. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 high-quality cohort studies were included. The results of Meta-analysis showed that compared with traditional THA, LLD after robot-assisted THA was smaller [MD=−1.64, 95%CI (−2.25, −1.04), P<0.001], Harris scores at 3 and 12 months after operation were higher [MD=1.50, 95%CI (0.44, 2.57), P=0.006; MD=7.60, 95%CI (2.51, 12.68), P=0.003]. However, the operative time was longer [MD=8.36, 95%CI (4.56, 12.17), P<0.000 1], and the postoperative acetabular anteversion angle was larger [MD=1.91, 95%CI (1.43, 2.40), P<0.001]. There was no significant difference in Harris score at 6 months, amnesia index (Forgotten joint score, FJS), postoperative acetabular abduction angle, and incidence of complication between the two groups (P>0.05). Conclusion Robot-assisted THA is superior to traditional THA in postoperative LLD.
ObjectiveTo analyse the effectiveness of unicompartmental knee arthroplasty (UKA) for the patients with spontaneous osteonecrosis of the knee (SONK). MethodsBetween January 2012 and December 2016, 31 patients with SONK was admitted and treated with medial UKA. All patients were examined by both plain radiography and magnetic resonance images. The patients were composed of 5 men and 26 women with an average age of 64.3 years (range, 48-79 years), and with 16 left joints and 15 right joints. The average disease duration was 14.7 months (range, 6-26 months). Preoperative visual analogue scale (VAS) was 6.00±1.15, Hospital for Special Surgery (HSS) score was 55.77±11.03, and knee range of motion (ROM) was (114.68±10.40)°. The imaging examinations showed that all the lesions were located in the medial compartment of the knee joint and there were 19 patients with Aglietti stage Ⅳ and 12 patients with Aglietti stage Ⅴ. Preoperative femorotibial angle (FTA) was (177.39±1.63)° and posterior tibial slope (PTS) was (84.05±1.39)°. ResultsAll the incisions healed by first intention. All patients were followed up 14-46 months (mean, 25 months). At last follow-up, VAS score was 2.06±0.72 and HSS score was 86.45±3.67, which both improved significantly when compared with preoperative scores (t=22.73, P=0.00; t=–14.72, P=0.00). ROM was (118.06±3.80)° with no significant difference when compared with preoperative ROM (t=–1.78, P=0.08). The X-ray films showed there was no severe adverse events, such as periprosthetic infection, aseptic loosening, bearing dislocation, and so on. At last follow- up, PTS was (85.30±1.19)° with significant difference compared with preoperative one (t=–4.07, P=0.00); while FTA was (177.51±1.98)° with no significant difference when compared with preoperative FTA (t=–0.38, P=0.71). ConclusionUKA may be an optional management for SONK with minimally invasive, bone-preserving, and rapid recovery.
Objective To investigate clinical significanceand surgical protocols about the balance of the lower limb lengths in the total hip arthroplasty. Methods Forty-eight patients undergoing the unilateral primary total hip arthroplasty from March 2000 to October 2004 were retrospectively studied. In 12 hips, the prostheses were of the cement type; in 36 hips, of the mixture type. Thirty patients with an equal limb length had a fractured femoral neck, 10 patients had a shortened (1.0-2.0 cm) limb, 6 patients had a shortened (2.0-4.0 cm)limb, and 2 patients had a shortened (4.0-6.0 cm) limb. Based on the clinical measurement and radiographic examination, the surgical protocols were designed, the hip prosthesis type was chosen, and the neck length of the femoral prosthesis and the position of osteotomy were estimated. By the wearing of the acetabula properly, the best rotation point was found out during the operation. The cut plane of the femoral neck was adjusted according to the results of the radiographic and other examinations. The neck length was readjusted after the insertion of the prosthesis so as to achieve an intended limblength equalization. Results All the patients were followed up for 3-42 months.According to the Harris scoring system, clinical results were excellent in 30 patients, good in 12, fair in4, and poor in 2. Of the 30 patients with an equal limb before operation, 5 were lengthened 1.0-2.0 cm in their lower limbs, and 1 lengthened 2.5 cm postoperatively. Of the 18 patients with shortened limbs before operation, 10 returned to the same lengths in their lower limbs, 6 were lengthened 1.0-2.0 cm in their lower limbs, but 2 with seriously-shortened lower limbs for congenital dysplasia of the hipjoint were still shortened 2.0-3.0 cm in the limb length after operation. The Harris hip scores revealed an average of 92.3 points in the patients with an equal limb length, and 88.6 points in the patients with shortened limbs. 〖WTHZ〗Conclusion Many factors, such as surgical protocols, prosthesis type designs, and the management techniques during the operation, can affect the limb length after operation. As the limb length discrepancy will make the patients feel disappointed, the clinical measurements are very important before operation. Application of the comprehensive appraisal methods during the operation, use of the soft tissuebalance method, and skills for obtaining an equal limb length during the total hip arthroplasty are also important for improving the surgical result further.
ObjectiveTo evaluate the accuracy of using smartphone to measure the angle of acetabular component in total hip arthroplasty (THA). MethodsBetween June 2012 and September 2015, the acetabular abduction and anteversion angles were measured in 50 patients undergoing THA. There were 24 males and 26 females, aged 37 to 83 years (mean, 71 years). The left hip was involved in 22 cases and the right hip in 28 cases. Of 50 patients, 34 suffered from fracture of the femoral neck, and 16 suffered from avascular necrosis of the femoral head. Acetabular dysplasia was excluded in all cases. A smartphone was used to measure the acetabular abduction and anteversion angles during operation; standard Picture Archiving and Communication Systems (PACS) was used to measured the acetabular abduction and anteversion angles on the X-ray film at 1 week after operation. It was defined as positive that the component angle values by PACS measurement were greater than those by the smartphone measurement, whereas as negative. The two measurement methods were compared, and intra-observer variability was assessed by analyzing the intraclass correlation coefficient (ICC), the Mann-Whitney U-test was used to analyze difference. ResultsThe ICC was 0.84 in the acetabular component angles by smartphone and PACS measurement methods. The acetabular component abduction angle was (44.02±1.33)° and the anteversion angle was (17.62±2.20)° by smartphone measurement. The acetabular component abduction angle was (44.74±4.05)° and the anteversion angle was (17.22±5.57)° by PACS measurement. There was no significant difference between two measurement methods (Z=-1.977, P=0.482; Z=-0.368, P=0.713). The acetabular component angle was in the safe zone in 44 cases; and the acetabular component anteversion angle was beyond safe range of 1 to 5°, and the abduction angle was beyond safe range of 1 to 3° in 6 cases. Intra-measurement variability was -21 to +10° for the anteversion angle and -10 to + 9° for the abduction angle, indicating that the acetabular component anteversion angle by smartphone measurement was greater than that by the PACS measurement, and the abduction angle was less than that by PACS measurement. ConclusionSmartphone is a convenient tool to measure the acetabular component angle in THA.
Objective To review research advances of revision surgery after primary total hip arthroplasty (THA) for patients with Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods The recent literature on revision surgery after primary THA in patients with Crowe type Ⅳ DDH was reviewed. The reasons for revision surgery were analyzed and the difficulties of revision surgery, the management methods, and the related prosthesis choices were summarized. Results Patients with Crowe type Ⅳ DDH have small anteroposterior diameter of the acetabulum, large variation in acetabular and femoral anteversion angles, severe soft tissue contractures, which make both THA and revision surgery more difficult. There are many reasons for patients undergoing revision surgery after primary THA, mainly due to aseptic loosening of the prosthesis. Therefore, it is necessary to restore anatomical structures in primary THA, as much as possible and reduce the generation of wear particles to avoid postoperative loosening of the prosthesis. Due to the anatomical characteristics of Crowe type Ⅳ DDH, the patients have acetabular and femoral bone defects, and the repair and reconstruction of bone defects become the key to revision surgery. The acetabular side is usually reconstructed with the appropriate acetabular cup or combined metal block, Cage, or custom component depending on the extent of the bone defect, while the femoral side is preferred to the S-ROM prosthesis. In addition, the prosthetic interface should be ceramic-ceramic or ceramic-highly cross-linked polyethylene wherever possible. Conclusion The reasons leading to revision surgery after primary THA in patients with Crowe type Ⅳ DDH and the surgical difficulties have been clarified, and a large number of clinical studies have proposed corresponding revision modalities based on which good early- and mid-term outcomes have been obtained, but further follow-up is needed to clarify the long-term outcomes. With technological advances and the development of new materials, personalized prostheses for these patients are expected to become a reality.