Objective To evaluate the clinical valueof the revision of total hip replacement(THR), to analyse the reason of the rev isions, and to discuss the main difficulties and measures to manage it.Methods From June 1998 to January 2002, 15 cases (15 hips) were revised on totalhip replacement. The reasons for revision in the cases were as follows:failure of primary operative techenique, loosening and sinking of the components, displacement of the prosthesis, erosion of the acetabulum, as well as fracture of the femoral stem. The main difficulties of the revision were:poor health condition of the patients; the remove of the prosthesis of the primary THR,especially the broken femoral stem and the cements; the loss of localbone. The measures to remove the broken femoral stem were described.ResultsAll cases were followed up 2.4 years on average: 2 patients died from heart disease and cerebrovascular disease respectively, while the good results were achieved in the others.No infection, dislocation, loosening, and other complications occurred. The good effects were related with following factors:mild degree of illness; no severe bone defect; most of the first femoral head replacement.Conclusion The revision of THRis a more difficult operation, so that the special instrument and equipment andoperative experience are required.
Revision of anterior cruciate ligament (ACL) reconstruction is more challenging than primary ACL reconstruction and often yields less favorable outcomes. The European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) has established a consensus regarding preoperative diagnosis, assessment, and selection criteria for ACL revision surgery. This consensus addresses 18 key issues that are most pertinent to clinical practice, providing guiding recommendations aimed at improving the prognosis of ACL revisions.
Objective To investigate the effectiveness of slope-reducing tibial osteotomy and anterior cruciate ligament (ACL) revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased posterior tibial slope (PTS). Methods The clinical data of 9 patients with primary ACL reconstruction failure and abnormally increased PTS (≥17°) who met the selection criteria between January 2018 and January 2020 were retrospectively analyzed. There were 8 males and 1 female; the age ranged from 21 to 42 years, with a median age of 30 years. Lachman test was positive in 9 patients. Pivot-shift test was negative in 6 cases, degree Ⅰ positive in 2 cases, and degree Ⅱ positive in 1 case. The PTS was (17.78±1.09)° and the anterior tibial translation (ATT) was (11.58±1.47) mm. The International Knee Documentation Committee (IKDC) score was 51.0±3.8, Lysholm score was 49.7±4.6, and Tegner score was 3.7±0.7. The time from primary reconstruction to revision was 12-33 months, with an average of 19.6 months. Slope-reducing tibial osteotomy and ACL revision were performed. The improvement of knee function was evaluated by IKDC score, Lysholm score, and Tegner score; Lachman test and Pivot-shift test were used to evaluate the stability of knee joint. PTS and ATT were measured to observe the morphological changes of knee joint. Results All the incisions healed by first intention, and there was no complication such as incision infection, fat liquefaction, necrosis, deep vein thrombosis of lower extremities, and neurovascular injury. All 9 patients were followed up 12-36 months, with an average of 25.8 months. At last follow-up, Lachman test and pivot-shift test were negative. IKDC score was 85.0±4.0, Lysholm score was 87.7±2.8, Tegner score was 6.8±0.7, PTS reduced to (9.89±0.60)°, and ATT shortened to (0.91±0.29) mm, which were significantly improved when compared with those before operation (P<0.05). ConclusionSlope-reducing tibial osteotomy and ACL revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased PTS has a satisfactory short-term effectiveness. It can improve the stability of knee joint and maintain the normal shape of knee joint.
Objective To explore the short-term effectiveness of hip revision surgery guided by artificial intelligence preoperative planning (AIHIP) system. Methods The clinical data of 22 patients (23 hips) who were admitted between June 2019 and March 2023 and met the selection criteria were retrospectively analyzed. There were 12 males and 10 females with an average age of 69.7 years (range, 44-90 years). There were 19 hips in the first revision, 3 hips in the second revision, and 1 hip in the third revision. The causes of revision included 12 hips with prosthesis loosening, 4 hips with acetabular cup loosening, 3 hips with osteolysis, 2 hips with acetabular dislocation, 1 hip with postoperative infection, and 1 hip with prosthesis wear. There were 6 hips in stage ⅡA, 9 hips in stage ⅡB, 4 hips in stage ⅡC, 3 hips in stage ⅢA, and 1 hip in stage ⅢB according to Paprosky staging of acetabular bone defect. The replacement of prosthesis type, operation time, hospitalization stay, ground active condition, and postoperative infection, fracture, prosthesis loosening, and other adverse events were recorded. The function of the affected limb was evaluated by Harris score before operation, at 1 week and 6 months after operation, and the range of motion of the hip joint was compared before operation and at 6 months after operation. Results The operation time was 85-510 minutes, with an average of 241.8 minutes; the hospitalization stay was 7-35 days, with an average of 15.2 days; the time of disassociation from the walker was 2-108 days, with an average of 42.2 days. All the 22 patients were followed up 8-53 months (mean, 21.7 months). No adverse events such as prosthesis loosening or infection occurred in the rest of the patients, except for postoperative hematoma of the thigh in 1 patient and dislocation of the hip in 1 hip. The matching degree of acetabular cup was completely matched in 22 hips and mismatched in 1 hip (+2), the matching rate was 95.65%. The matching degree of femoral stem was completely matched in 22 hips and generally matched in 1 hip (−1), and the matching rate was 100%. The Harris scores were 55.3±9.8 and 89.6±7.2 at 1 week and 6 months after operation, respectively, which significantly improved when compared with before operation (33.0±8.6, P<0.05), and further improved at 6 months after operation than at 1 week after operation (P<0.05). The function of hip joint was evaluated by Harris score at 6 months after operation, and 21 hips were good and 2 hips were moderate, which could meet the needs of daily life. The range of motion of hip joint was (111.09±10.11)° at 6 months after operation, which was significantly different from (79.13±18.50)° before operation (t=−7.269, P<0.001). Conclusion AIHIP system can improve the accuracy of revision surgery, reduce the difficulty of surgery, and achieve good postoperative recovery and satisfactory short-term effectiveness.
Objective To investigate the effectiveness of two-stage revision of infected total knee arthroplasty (TKA) using an antibiotic-impregnated articulating cement spacer. Methods The clinical data were analyzed from 23 patients (23 knees) undergoing two-stage revision for late infection after primary TKA between January 2007 and December 2009. There were 15 males and 8 females, aged from 43 to 75 years (mean, 65.2 years). Infection occurred at 13-52 months (mean, 17.3 months) after TKA. The time interval between infection and admission ranged from 15 days to 7 months (mean, 2.1 months). One-stage operation included surgical debridement and removal of all knee prosthesis and cement, then an antibiotic-impregnated articulating cement spacer was implanted. The re-implantation of prosthesis was performed after 8-10 weeks when infections were controlled. The American Hospital for Special Surgery (HSS) score and Knee Society Score (KSS) were used to compare the function of the knee between pre- and post-revision. The rate of infection control and complication were analyzed. Results All incisions healed primarily. Re-infection occurred in 2 cases after two-stage revision, and infection was controlled in the other 21 cases, with an infection control rate of 91.3%. The patients were followed up 2-5 years (mean, 3.6 years). The HSS score was increased from 60.6 ± 9.8 at pre-revision to 82.3 ± 7.4 at last follow-up, the KSS score was increased from 110.7 ± 9.6 at pre-revision to 134.0 ± 10.5 at last follow-up, all showing significant differences (P lt; 0.01). Radiographs showed that prosthesis had good position with no loosening, fracture, or periprosthetic radiolucent. Conclusion Two-stage revision using an antibiotic-impregnated articulating cement spacer is an effective method to control infected TKA and to restore the function of affected knee.
ObjectiveTo investigate the short-term effectiveness of three-dimensional (3D) printed trabecular metal pads for Paprosky type Ⅲ acetabular defect in hip revision.MethodsBetween August 2014 and December 2015, the 3D printed trabecular metal pads were used to repair Paprosky type Ⅲ acetabular defects and reconstruct the annular structure of the acetabulums in 5 cases of primary hip revision. There were 3 males and 2 females, aged from 50 to 72 years, with an average age of 66 years. The time from initial replacement to revision was 10 to 18 years, with an average of 14.4 years. The types of prostheses in primary replacement were non-cemented in 3 cases and cemented in 2 cases. The types of acetabular bone defects were Paprosky type ⅢA in 3 cases and Paprosky type ⅢB in 2 cases. The preoperative Harris score was 34.23±11.67. The height of rotation center of affected hip was (38.17±8.87) mm and the horizontal position was (35.62±9.12) mm.ResultsThe operation time was 120-180 minutes, with an average of 142 minutes. The intraoperative bleeding volume was 800-1 700 mL, with an average of 1 100 mL. Five patients were followed up 18-24 months (mean, 21 months). At last follow-up, the Harris score was 79.82±8.70, which was significantly higher than that before operation (t=16.991, P=0.000). At 1 week after operation, the abduction angle of acetabular cup was 38-42° (mean, 39.4 °) and the anteversion angle was 13-18 ° (mean, 14.6°). The height and horizontal position of rotation center of affected hip were (22.08±8.33) mm and (29.03±6.28) mm, respectively, showing significant differences when compared with those before operation (P<0.05); there was no significant difference when compared with those of healthy hip [(28.62±7.73), (27.29±4.22) mm] (P>0.05). During the follow-up, there was no complication such as prosthesis loosening, dislocation, or periprosthetic fracture.ConclusionIn hip revision, 3D printed trabecular metal pads can repair Paprosky type Ⅲ acetabular defect, reconstruct the structure of acetabulum, provide a stable supporting structure for the acetabular cup, reconstruct the relatively normal rotation center of the hip joint, avoid iatrogenic bone loss, and achieve satisfactory functional recovery of the hip. The long-term effectiveness needs further follow-up.