From 1974 to 1991, two hundred and sixty-four cases of hip replacement were performed. These cases composed of 150 cases of artificial femoral head prosthesis replacement and 114 cases of total hip replacement. Fifteen cases were revised after the first replacement in 7.4 years average (5-16 years). The revision rate was 5.7%. The causes of revision were loose or subside of prosthesis, wear and tear of acetabulum, dislocation of artificial hip joint, etc, which caused pain and dysfunction. The revision cases were followed up for 4.7 years average with good result. To prevent revision, The medully canal shonld not be too wide and in osteoporosis cases, bone cement was suggested to apply. The chondrium of acetabulum should be removed completely.
ObjectiveTo observe the changing patterns of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and serum amyloid A protein (SAA) levels before and after hip replacement surgery, and explore their clinical significances. MethodsNinety-seven consecutive patients enrolled in clinical pathway in our hospital for hip replacement from April 2011 to May 2013 were included in the present study. ESR, CRP and SAA levels were investigated preoperatively and post-operatively at day 1, 3, 5, 7, 14, Month 1 and 3. All the cases were followed up, among which there were 14 cases of total hip replacement, 56 cases of cementless hemianthroplasty, and 27 cases of biotype hemianthroplasty. ResultsAll three of ESR, CRP and SAA levels were elevated post-operatively. Levels of CRP and SAA peaked at day 3 after surgery, and then subsided gradually to pre-operative levels after 1 month. ESR level peaked at day 7 postoperatively, and then subsided gradually to pre-operative levels after 3 months. There was a significant correlation between levels of CRP and levels of SAA. ConclusionCompared with ESR and SAA, CRP appears to be a faster and more sensitive parameter. Cementless hemianthroplasty is associated with changes of SAA levels but not with CRP levels. Close monitoring of evolutionary changes in ESR, SAA and CRP levels may help to diagnose and treat early infection after hip replacement surgery.
ObjectiveTo investigate whether parecoxib sodium preemptive analgesia reduces inflammatory cytokines and stress hormones production in elderly patients after total hip replacement. MethodSixty patients with American Society of Anesthesiologists Classification Ⅰ-Ⅱ undergoing total hip replacement for femoral neck fracture or aseptic necrosis of the femoral head, aged between 60 and 90 years with a body weight more than 50 kg, were randomly divided into preemptive analgesia group (group P, n=30) and control group (group C, n=30). The patients in group P received parecoxib sodium 40 mg intravenously 30 min before skin incision, and another 20 mg 8 hours after the first administration. All the patients in the two groups received the administration of patient-controlled analgesia sufentanyl. We recorded blood levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), cortisol (COR), adrenaline (AD) and noradrenaline (NAD) 30 min before skin incision, and 1 hour, 6 hours, 12 hours and 24 hours postoperatively. ResultsThe blood levels of IL-6, TNF-α, COR, AD and NAD in group P at 1 hour, 6 hours, 12 hours or 24 hours postoperatively were significantly lower than those in group C (P<0.05). ConclusionsParecoxib sodium preemptive analgesia reduces postoperative inflammatory cytokines and stress hormones production in elderly patients undergoing total hip replacement.
ObjectiveTo explore the effect of dexmedetomidine-parecoxib sodium on early postoperative cognitive function in elderly patients undergoing general anesthesia. MethodsFrom August 2013 to October 2014, 120 elderly patients underwent hip replacement surgical procedures. The patients were randomly divided into four groups (with 30 patients in each group):dexmedetomidine-parecoxib sodium group (group C), dexmedetomidine group (group D), parecoxib sodium group (group P), and saline group (group S). Cognitive function was assessed preoperatively, on the first, 3rd and 7th postoperative day by using mini-mental state examination (MMSE) scale. ResultsCompared with the MMSE scores before the surgery, the scores in the four groups on the first postoperative day decreased obviously (P<0.05); the scores in group D, P, and S on the 3rd postoperative day were obviously lower than those before the surgery (P<0.05); the scores in group C on the 3rd postoperative day didn't differ much from that before the surgery (P>0.05); and the scores in group C on the first and 3rd operative day were obviously higher than those in the other 3 groups (P<0.05). The differences in MMSE scores on the 7th operative day among the 4 groups were not significant (P>0.05). After the surgery, the incidence of cognitive dysfunction in group C was significantly lower than those in the other three groups (P<0.05); the incidences of cognitive dysfunction in group D and P were obviously lower than that in group S (P<0.05) while the difference between group D and P was not significant (P>0.05). ConclusionDexmedetomidine-parecoxib sodium can decrease the incidence of early cognitive dysfunction in elderly patients undergoing hip replacement surgery, whose therapeutic effect is better than using dexmedetomidine or parecoxib sodium alone.
Objective To systematically review the incidence and risk factors of postoperative urinary retention (POUR) in patients undergoing hip or knee arthroplasty, and provide a theoretical basis for medical staff to assess and identify high-risk groups in advance. Methods PubMed, Embase, the Cochrane Library, Medline, China National Knowledge Infrastructure, Wanfang Data, VIP database, and SinoMed were electronically searched from the establishment of the databases to January 2023, for literature on the incidence and risk factors of POUR in patients undergoing hip or knee arthroplasty. Two researchers independently screened studies, extracted data, and assessed study quality. Meta-analysis was performed using Stata 14.0 software. Results A total of 21 articles were included, including 9041 patients undergoing hip or knee arthroplasty. The results of meta-analysis showed that the incidence of POUR in patients undergoing hip or knee arthroplasty was 26% [95% confidence interval (CI) (19%, 32%)]. Age [odds ratio (OR)=1.03, 95%CI (1.00, 1.05), P=0.03], male [OR=2.68, 95%CI (1.72, 4.18), P<0.001], infusion volume [OR=2.17, 95%CI (1.08, 4.35), P=0.030], spinal anesthesia [OR=1.72, 95%CI (1.29, 2.30), P<0.001], history of urinary retention/urethral stricture [OR=1.84, 95%CI (1.35, 2.49), P<0.001], use of analgesic pump [OR=4.73, 95%CI (2.29, 9.78), P<0.001], use of glycopyrronium bromide [OR=2.79, 95%CI (1.53, 5.11), P=0.001] were risk factors for POUR in patients undergoing hip or knee arthroplasty. Conclusions The incidence of POUR in patients undergoing hip or knee arthroplasty is relatively high. Age, male, infusion volume, spinal anesthesia, history of urinary retention/urethral stenosis, use of analgesia pump, and use of glycopyrronium bromide are causes of POUR. It is suggested that medical staff should identify the risk of related factors and take early intervention to reduce the occurrence of POUR.
Objective To integrate augmented reality (AR) into the whole process of health management and observe its application effect in hip replacement patients. Methods Patients undergoing hip replacement in the Department of Orthopedic Surgery of West China Hospital, Sichuan University between April and September 2022 were selected. According to the random number table method, patients were divided into a trial group and a control group. The trial group adopted the whole process AR health management mode, and the control group adopted the conventional health education mode. The joint function score, functional exercise compliance, coping difficulties after discharge, Huaxi Emotional-distress Index and satisfaction of the two groups at different time points were compared. Results A total of 80 patients were included, with 40 patients in each group. At each follow-up time point after surgery, the scores of Harris Hip Score and Post-Discharge Coping Difficulty Scale among trial group patients were better than those of the control group patients (P<0.05). There was no statistically significant difference in the Huaxi Emotional-distress Index scores between the two groups (P>0.05). The compliance rate of functional exercise in the trial group (P=0.025) and the patient satisfaction were higher than those in the control group (Z=−4.918, P<0.05). Conclusions The AR-based whole process health management can make it easier for patients to grasp functional exercise (preoperative pre-exercise, postoperative rehabilitation), post-hospital health guidance and other educational knowledge. This new health management is conducive to enhancing patients’ exercise compliance, strengthening joint function recovery, daily living ability and patient satisfaction.It can be promoted and applied in clinical practice.