Objective To summarize the cl inical appl ication of minimally invasive percutaneous locking compression plate (LCP) internal fixation in the treatment of tibial fractures and to evaluate its cl inical effects. Methods From September 2005 to September 2007, 13 patients with tibial fractures were treated with indirect reduction and minimally invasive percutaneous LCP internal fixation, 8 males and 5 females, aged 18-35 years old (27 on average). Among them, the fractures were caused by traffic accidents in 3 cases, by fall ing in 5 cases, by fall ing from height in 4 cases and by bruise in 1 case. The fractures were located at 1/3 upper tibia in 2 cases, at 1/3 medium tibia in 6 cases and at 1/3 lower tibia in 5 cases. All fracture were closed ones. According to the AO classification, 4 cases were type A, 7 type B and 2 type C. The time between fractures and operation was from 3 hours to 5 days (2.5 days on average). Results All incisions obtained heal ing by first intention. All patients were followed up for 10-18 months (13 months on average). All fractures reached cl inical heal ing, and the heal ing time was 12-20 weeks (16 weeks on average). There was no delayed fracture heal ing, nonunion, infection and internal fixation failure. No compl ications such as rotation, crispatura deformity and internal fixation loosening were found. According to the HSS scoring, the function of the knee joint was graded 85-95 (90 on average), and the range of motion was 100-130° (120° on average). According to the AOFAS Ankie Hindfoot Scoring, the function of the ankle joint was graded 80-95 (92.4 on average). Nine cases were excellent, 4 good, and the choiceness rate was 100%. Conclusion Minimally invasive percutaneous LCP internal fixation is in accord with biological set principles and beneficial for tibial fracture heal ing and reconstruction of soft tissues.
Objective To compare the effectiveness and linear wear rates between high cross-linked polyethylene cup liner and traditional polyethylene cup liner. Methods A retrospective analysis was made on the clinical data of 61 patients (64 hips) who underwent primary total hip arthroplasty (THA) between January 2005 and March 2007. According to the type of cup liner, 61 patients (64 hips) were divided into 2 groups: high cross-linked polyethylene cup liner was used in 30 cases (31 hips, trial group), and traditional polyethylene cup liner in 31 cases (33 hips, control group). There was no significant difference in gender, age, body weight, etiological factor, and preoperative Harris score between 2 groups (P gt; 0.05). Complication was observed after operation; Harris score was used to assess hip function; X-ray film analysis was done to observe osteolysis and prosthesis loosening, and to measure cumulative penetration of the femoral head and linear wear rate. Results All incisions healed by first intention without complication. All patients were followed up. The mean follow-up was 6.3 years (range, 5-7 years) in trial group, and was 6.5 years (range, 4-7 years) in control group. There was no significant difference in Harris score between 2 groups at the 3 months after operation and last follow-up (P gt; 0.05). Osteolysis was observed in 3 cases (3 hips) of control group, but no osteolysis in trial group. X-ray films showed no aseptic loosening in the patients of 2 groups. The mean cumulative penetration of trial group were significantly lower than those of control group at 1-7 years after operation (P lt; 0.05). Linear wear rate of trial group [(0.025 ± 0.002) mm/year] was significantly lower than that of control group [(0.086 ± 0.005 ) mm/year] (Z=6.804, P=0.000). Conclusion High cross-linked polyethylene cup liner has the similar effectiveness as traditional polyethylene cup liner, but it has lower linear wear rate than the traditional polyethylene cup liner.
Objective To investigate the effectiveness of acetabular revision using jumbo cementless cups. Methods Between May 1996 and May 2011, 35 patients (35 hips) underwent an acetabular revision with jumbo cementless cups, and the clinical data were retrospectively analyzed. There were 12 males and 23 females, with an average age of 64.8 years (range, 47-79 years). The time from hip arthroplaty to revision was 1-15 years (mean, 9.7 years). The causes for revision were aseptic loosening in 32 cases, femoral periprosthetic fracture (Vancouver type B3) in 2 cases, and low toxicity infection in 1 case. According to the classification of acetabular bony deficiencies of the American Association of Orthopedic Surgeon (AAOS), 6 cases were classified as type I, 9 cases as type II, and 20 cases as type III; according to the classification proposed by Paprosky, 5 cases were rated as type II A, 9 cases as type II B, 13 cases as type II C, and 8 cases as type III A. The primary hip arthroplasty cups had an outside diameter of 46-52 mm (mean, 49.6 mm), and the revision cups had an outside diameter of 56-68 mm (mean, 60.4 mm). Harris score was used for hip function evaluation, and X-ray films were taken for imaging evaluation. Results Healing of incision by first intention was obtained in all patients; without infection or neurovascular injury. Prosthetic dislocation was observed in 1 case at 20 days after operation, and was cured after expectant treatment. One patient died at 6 years after operation, and the other 34 patients were followed up 2-14 years (mean, 8.4 years). The Harris score was significantly increased from 46.4 ± 13.4 at preoperation to 90.4 ± 3.6 at last follow-up (t=18.76, P=0.00). The distance between acetabular rotation centre and teardrop line was significantly decreased, and the distance between acetabular rotation centre and lateral teardrop was significantly increased when compared with preoperative ones (P lt; 0.05). Only 1 patient received second revision for aseptic loosening after 10 years; no continuous radiolucent line, prosthetic dislocation, and osteolysis was found, and bony ingrowth was shown in the other patients. Conclusion Jumbo cementless cup for acetabular revision can achieve good effectiveness for having the advantages of simple operation, less bone grafts, and good recovery of the acetabular rotation centre.
Objective To evaluate the mid-term effectiveness of cerclage wires fixation in treating Mallory typeⅡperiprosthetic femoral fractures associated with primary hip arthroplasty. Methods A retrospective analysis was made in the data of 14 patients (14 hips) with Mallory typeⅡ periprosthetic femoral fractures associated with primary hip arthroplasty and treated with cerclage wires fixation between January 2010 and June 2011 (fracture group). Twenty-eight patients (28 hips) without periprosthetic femoral fractures associated with primary hip arthroplasty at the same stage were chosen as control group. The uncemented femoral prosthesis were used in 2 groups. There was no significant difference in gender, age, body mass index, and primary disease between 2 groups (P>0.05). The operation time, intraoperative blood loss, and the complications were recorded. The Harris score was used to evaluate the hip function and the visual analogue scale (VAS) score was used to evaluate the pain degree of hip. According to the postoperative X-ray films of hips, Enghet al. standard was used to evaluate the fixed and stable status of the femoral prosthesis; the heterotopic ossification was observed; the time of fracture union was recorded. Results The operation time of fracture group was significantly longer than that of control group (t=–3.590, P=0.001). There was no significant difference in the intraoperative blood loss between 2 groups (t=–1.276, P=0.209). All patients were followed up 64-75 months (mean, 69.5 months). Hip dislocation after operation occurred in 1 case of fracture group; delirium symptom and nonunion of incision occurred in 1 case and 1 case of control group, respectively. There was no significant difference in the Harris score and VAS score at 6 months and 5 years between 2 groups (P>0.05). X-ray films showed that all fractures healed and the mean time of fracture union were 6.1 months (range, 3-12 months). There was no fracture nonunion or malunion evidently. There was no significant difference in X-ray score at 6 months and 5 years between 2 groups (P>0.05). At last follow-up, cerclage wires displacement or breakage did not occur. Heterotopic ossification occurred in 2 cases of fracture group and in 1 case of control group. Conclusion Cerclage wires fixation can achieve the good mid-term effectiveness in treating Mallory typeⅡintraoprative periprosthetic femoral fractures associated with primary hip arthroplasty.
ObjectiveTo evaluate the effect of the surgeon’s handedness on the distribution of prosthesis during primary total knee arthroplasty (TKA).MethodsA retrospective analysis was performed on 86 patients (100 knees) with primary TKA completed by the same right-handed surgeon between December 2016 and December 2018, including 72 cases of single knee and 14 of bilateral knees. The patients were divided into dominant group (right side) and non-dominant group (left side) according to the operating position of the surgeon and each group had 50 knees. There was no significant difference in gender, age, body mass index, disease duration, clinical diagnosis, preoperative Hospital for Special Surgery (HSS) score, and other general data between the two groups (P>0.05). The operation time and complications were recorded in both groups. The function of knee was evaluated by HSS score. Hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were measured by using X-ray film of full-length lower extremity before TKA and at 2 weeks after TKA that were used to evaluate the coronal position of the prosthesis. Posterior distal femoral angle (PDFA) and posterior proximal tibial angle (PPTA) were measured by using lateral X-ray films at 3 months after operation that were used to evaluate the sagittal position of the prosthesis.ResultsThere was no significant difference in operation time between the two groups (t=−1.128, P=0.262). One case of posterior tibial artery thrombosis occurred in the dominant group, and 1 case of poor healing of the incision occurred in each of the dominant group and the non-dominant group. Patients in both groups were followed up 12-34 months with an average of 22.0 months. The HSS scores at last follow-up were 87.2±4.3 in the dominant group and 86.8±5.0 in the non-dominant group. There was no significant difference between the two groups (t=0.471, P=0.639). No complications such as periprosthetic infection, prosthetic loosening, or periprosthetic fracture occurred during follow-up. There was no significant difference in the HKA, mLDFA, and mMPTA between the two groups before and after operation (P>0.05). The differences in the incidence of sagittal femoral prosthesis malposition and PDFA between the two groups were significant (P<0.05); however, there was no significant difference in the PPTA, the rate of femoral prosthesis distributed in the neutral position, the incidence of over-flexed femoral prosthesis, and the incidence of anterior femoral notch (P>0.05).ConclusionThe surgeon’s handedness is one of the factors affecting the placement of the sagittal femoral prosthesis in primary TKA. The incidence of sagittal femoral prosthesis malposition could increase when the surgeon performs on the non-dominant side.