ObjectiveTo compare the effectiveness between histoacryl topical skin adhesive and traditional method for wound closure in total hip arthroplasty (THA). MethodsA total of 159 patients undergoing THA were divided into 2 groups between January and October in 2015. Subcuticular suture and histoacryl topical skin adhesive (cyanoacrylate adhesive) were used in 80 patients (100 hips) (test group), and traditional method (skin staples and wound drainage) was used in 79 patients (100 hips) (control group) for wound closure. There was no significant difference (P > 0.05) in gender, age, body mass index, and etiology between 2 groups. The operation time, length of stay, incision pain visual analogue scale (VAS) score and healing of incision, and incision satisfaction evaluation, and classification were compared between 2 groups. ResultsAll patients were followed up 3-6 months (mean. 4.7 months). There was no significant difference in operation time between 2 groups (Z=-0.527, P=0.598); but the length of stay of test group was less than that of control group (Z=-2.004, P=0.045). Incision exudation and dehiscence occurred in 1 case (1 hip) and 1 case (1 hip) of test group respectively; incision swollen, persistent wound exudation, exudation, and sutured drainage tube occurred in 2 cases (2 hips), 2 cases (2 hips), 4 cases (4 hips), and 1 case (1 hip) of control group. No statistically significant difference was found in VAS score between 2 groups at 15 days after operation (Z=-0.125, P=0.901), but wound healing score of test group was significantly higher than that of control group (Z=-2.943, P=0.003). Wound healing was class A in 98 hips and class B in 2 hips in test group, and was class A in 92 hips and class B in 8 hips in control group, and difference was statistically significant (χ2=3.789, P=0.048). The incision satisfaction of test group was significantly higher than that of control group (Z=-2.626, P=0.009). ConclusionCompared with traditional method, histoacryl topical skin adhesive has decreased wound complication rate, and it is an easy and safe method with high satisfaction.
ObjectiveTo investigate the clinical characteristic differences of cementless total hip arthroplasty (THA) between with and without subtrochanteric femoral shortening osteostomy in Crowe type IV developmental dysplasia of the hip (DDH). MethodsBetween January 2006 and March 2012, 21 patients (21 hips) with Crowe type IV DDH who underwent primary THA were enrolled according to inclusion criteria. According to whether subtrochanteric femoral shortening osteostomy was performed during THA or not, the patients were divided into 2 groups: THA with osteostomy group (n=9) and THA without osteotomy group (n=12). There was no significant difference in gender, age, body mass index, and hip Harris score between 2 groups (P>0.05) except leg length discrepancy (t=-3.170, P=0.005). The operation time, blood loss, postoperative drainage, complications, and radiography data were compared to evaluate the clinical characteristics. ResultsThe operation time, blood loss, and postoperative drainage of osteotomy group were all significantly greater than those of no osteotomy group (P<0.05). All patients achieved primary healing of incision; 1 patient (1 hip) had transient sciatic nerve symptom in osteotomy group. The average follow-up time was 53 months (range, 28-88 months). The X-ray films showed good fracture healing at 3-6 months after operation in osteostomy group. No prosthetic loosening or dislocation was found. The hip Harris score was 90.67±4.06 in osteostomy group and 92.17±3.27 in no osteostomy group, showing no significant difference between 2 groups (t=-0.938, P=0.360). The leg length discrepancy was (0.22±0.26) cm in osteostomy group and (0.18±0.27) cm in no osteostomy group, showing no significant difference (t=107.000, P=0.546). The leg length discrepancy was found in 6 patients of osteotomy group and 5 patients of no osteotomy group. One patient complained of thigh pain in osteotomy group; 2 patients had slight limp (Trendelenburg +) in no osteotomy group. ConclusionTHA can improve joint function and increase limb length in the treatment of Crowe type IV DDH. Subtrochanteric shortening osteotomy is an effective treatment which can be performed according to preoperative template measurement, leg length shortening, and the soft tissue tension.
ObjectiveTo establish an rabbit model of early steroid-induced avascular necrosis of the femoral head (SANFH) and evaluate its validity with MRI and pathological examination. MethodsTwenty 6-month-old rabbits (weighing, 2-3 kg) were randomly divided into 2 groups (control group and model group), 10 rabbits in each group. Dexamethasone sodium phosphate solution (10 mg/kg) was injected into bilateral gluteus in model group, and the same amount of saline was injected in control group, every 3 days for 14 times. General observation was done after modelling. Osteonecrosis was verified by pathological observation and MRI findings at 6 weeks. ResultsAfter 6 weeks, rabbits did not show obvious changes in control group; increased hair removal, decreased food intake, and slight limp were observed in model group. The MRI results showed normal shape of the bilateral femoral head and no abnormal signals in control group; irregular shape of the bilateral femoral head and a slice of irregular abnormal signals were observed, and necrosis and cystolization of the subchondral bone and sparse changes of trabecular bone were shown in model group. General observation from coronal section of femoral head showed smooth red cartilage surface in control group; on the contrary, the cartilage surface of the femoral head became dull, thin even visible hemorrhage under articular cartilage and necrosis of the femoral head were observed. The histopathological examination indicated that trabecular bone of the femoral head in control group was massive, thick, and close, and osteocytes in the bone lacunae had normal shapes. The osseous trabecular became thinner and broken; karyopyknosis of osteocytes and bone empty lacunae could be obviously seen in model group. The rates of empty lacunae were 8.0%±0.5% in control group and 49.0%±0.3% in model group, showing significant difference (t=21.940, P=0.000). ConclusionEstablishing a model of early SANFH through injecting shortterm, shock, and high dose of dexamethasone, and it can been evaluated effectively with MRI and pathological examination.