Objective To investigate the causes and managements of acetabular fracture during primary total hip arthroplasty (THA). Methods Between May 2005 and July 2008, 9 patients (9 hi ps) suffered from acetabular fractures during primary THA. There were 1 male and 8 females with an average age of 63.3 years (range, 41-73 years), including 4 cases of developmental dysplasia of the hip, 2 cases of rheumatoid arthritis, 1 case of old femoral neck fracture, 1 case of avascular necrosis of femoral head, and 1 case of ankylosing spondyl itis. Three left hips and 6 right hips were involved. The preoperative Harris score was 40.4 ± 2.9. All the patients underwent cementless THA. Among nine acetabular fractures, 8 fractures were stable (2 anterior wall fractures and 6 posterior wall fractures), which were fixed by additional augmentation screws in 7 cases and accepted no special treatment in 1 case; 1 fracture was unstable (posterior wall fracture with posterior column incomplete fracture), which was treated by bone grafting and additional screws. Results The postoperative X-ray films showed that the position of the prosthesis were favorable. All incisions healed by first intention without early compl ication. Nine patients were followed up 1-4 years (mean, 2 years and 7 months). The Harris score was 87.8 ± 3.9 at last follow-up, showing significant difference when compared with the preoperative score (t=44.904, P=0.000). The X-ray films showed fracture heal ing at 8 weeks. No loosening occurred. Conclusion When primary THA is performed, the preoperative X-ray film should be studied and measured carefully, operation should be accurate and violence should be avoided. The diameter of the acetabular component should be equal to the diameter of a drill or not larger than 2 mm. In patients with severe osteoporosis, the diameter of the acetabular components should be the same diameter as a drill and additional screws are used to fix, or cemented cup is used. Once an acetabular fracture occurs during the primary THA, additional screw or bone grafting with additional screws should be chosen according to the fracture type and stabil ity, and good cl inical results can be expected.
Objective To evaluate the usefulness of minimal incision technique in total knee arthroplasty (TKA) by comparing the early compl ications after minimal incision TKA and those after traditional incision. Methods From May 2004 to July 2005, 38 patients (46 knees) underwent TKA using the minimal incision technique (minimal incision group), and 43 patients (54 knees) underwent TKA using the traditional incision technique at the same period (traditional incision group). The inimal incision group included 12 male patients (12 knees) and 26 female patients (34 knees), and their ages ranged from 52 to 76 years. Twenty-four patients (28 knees) had osteoarthritis and 14 patients (18 knees) had rheumatic arthritis. The varus deformity of the knee was found in 30 patients (34 knees) and valgus deformity was found in 8 patients (12 knees). TheAmerican Knee Society Score (AKSS) score was 37.5 ± 12.6, and the disease course was (7.5 ± 2.3) years. The raditional incision group included 15 male patients (19 knees) and 28 female patients (35 knees), and their ages ranged from 55 to 82 years. Thirtytwo patients (37 knees) had osteoarthritis and 11 patients (17 knees) had rheumatic arthritis. Varus deformity of the knee was found in 34 patients (41 knees) and valgus deformity was found in 9 patients (13 knees). The AKSS score was 31.1 ± 10.2, and the disease course was (10.1 ± 4.2) years. There were no statistically significant differences in the general data between two groups (P gt; 0.05). Results The incision length, the operation time and the drainage flow were (12.6 ± 1.2) cm, (95 ± 15) minutes and (650.1 ± 10.0) mL in the minimal incision group and (18.7 ± 2.3) cm, (63 ± 11) minutes and (300.0 ± 20.0) mL in the traditional incision group; showing statistically significant differences between two groups (P lt; 0.05). In the minimal incision group, 4 patients (4 knees) developed infections at the operated knees, including 2 early infection and 2 late infection, which were all cured by corresponding treatment. Deep vein thrombosis occurred in 1 patient on the third day after operation and was managed successfully by thrombolytic therapy. Cutaneous necrosis was found in 2 patients on the seventh and ninth postoperative day separately, which healed uneventfully after intensive local treatment. On the twelfth postoperative month, 1 patient had femoral fractured at the site of supracondylar region after a careless fall, but the prosthesis was stable. The fracture was fixed by a plate and healed uneventfully. In the traditional incision group, only 1 patient (1 knee) developed early infection at the operated knee on the tenth postoperative day, which was managed by corresponding treatment. And there were no periprosthetic fracture, cutaneous necrosis or deep vein thrombosis. The patients were followed up for (3.7 ± 0.4) years in the minimalincision group and (3.9 ± 0.6) years in the traditional incision group. At the latest follow-up, the AKSS scores were 78.2 ± 6.7 in the minimal incision group and 81.2 ± 7.3 in the traditional incision group, showing statistically significant ifferences (P lt; 0.05) when compared with those before operation and no statistically significant difference between two groups (P gt; 0.05). Conclusion Minimally invasive TKA has relatively higher compl ication rate than traditional incision. Strict patient inclusion criteria, competent surgery skill, proper instrument and intensive perioperative management are essential to success.
Objective To investigate the operative methods, cl inical outcomes and compl ications of total hi p arthroplasty (THA) in the treatment of patient with hi p joint flexion rigidity due to ankylosing spondyl itis (AS). Methods From May 1992 to July 2004, 56 patients (32 left hips and 39 right hips) with AS received THA through a modified anterolateral approach, including 52 males (67 hips) and 4 females (4 hips) aged 17-48 years with an average of 35.5 years. All the hips were ankylosed in (43.1 ± 7.2)° of flexion and 15 patients had bilaterally ankylosed hips. Preoperatively, Harris hip score was (42.6 ± 5.3) points and all the hips were classified as stage IV according to the standard of American College of Rheumatology (ACR). And the course of disease was 3-11 years. Results Intraoperatively, 1 patient suffering from proximal femur fracture due to severe osteoporosis was treated with titanium wire fixation, and the fracture was healed 6 weeks later. All the patients were followed up for 3-15 years (average 5.3 years). Postoperatively, 1 patient (1 hip) got subcutaneous soft tissue infection at 8 days, 1 patient (1 hip) got wound disunion at 11 days, 2 patients (2 hips) got infection at 11 months and 3 years, respectively. All the infections were healed after symptomatic treatment. The wounds of the rest 52 patients were healed by first intention without joint infections. The postoperative X-rays demonstrated that 4 hips (5.6%) had loose acetabulum prosthesis, 3 hips (4.2%) had loose femoral prosthesis and 5 hips had loose acetabulum and femoral prosthesis (7.0%), and the total loosening rate was 16.8%. Among which, 8 hips received revision resulting in satisfactory therapeutic effects, and the rest 4 hips had no further treatment. Fifteen hips (21.1%) had heterotopic ossification, which was rel ieved after taking nonsteroidal anti-inflamatory drugs. Harris hip score at final follow-up was (82.7 ± 4.1) points, indicating there was a significant difference between before and after operation (P lt; 0.05). Ten hips were evaluated as excellent, 43 hips good, 14 hips fare, and 4 hips bad, and the excellent and good rate was 74.7%. Conclusion THA through the anterolateral approach is effective for the treatment of patient with hip joint flexion rigidity caused by AS.