ObjectiveTo investigate the clinical outcome of application of joint prosthesis in limb salvage treatment of mildmalignant tumor at the articular ends of femurs, with severe osteolysis. Methods The treatment of 15 cases of mildmalignant tumor at the articular ends of femurs with severe bone destruction, from 1978 to 1999, was reviewed. There were 10 cases of giant-cell bone tumor and 5 cases of chondrosarcoma, among which there were 5 cases at the stage ofⅠA, 9 cases at ⅠB, and 1 case at ⅡA, with 4 cases at the proximal end and 11cases at the distal end. The tumor was totally removed, with a massive bone defect left at the foci, and then the prosthesis replacement was performed to reconstruct the articular joint. All of the 15 patients were followed up for 9 monthsto 20 years, 4 years and 3 months on average, before clinical evaluation. Results All of the wound healed well, with primary healing. Local relapse occurred in one case and the patient died of lung metastasis; the amputation of the replaced knee joint was performed in one case due to severe infection after trauma; radiograph showed there was slight sunk of the prosthesis in 2 cases after replacement. The other 11 cases recovered well with satisfactory function. Conclusion The limb salvage treatment of mildmalignant tumor at the articular ends of femurswould be available, especially for those with massive bone destruction, when the tumor is removed by whole and rationally marginal resection, followed by properlyutilization of prosthesis and general post-operative exercise.
Objective To explore the method of surgical treatment and endoluminal repairs of infrarenal abdominal aortic aneurysm (AAA)so as to improve the safety of surgical treatment. Methods The information of surgical treatment was analysed restrospectively in 195 cases of infrarenal AAA treated from January 1981 to December 2004. Of the patients, 155 were males, 40 were females with a mean age of 56.5 years. The diametersof the aneurysm were larger than 5 cm in 183 patients (93.8%) and 4 to 5 cm in12 patients (6.2%). Of the 175 patients who underwent selective operation, graft replacements were performed in 139 and endovascular aneurysmal repairs in 36. Twenty patients (10.3%) suffering from aneurysm rupture were given emergency operation. Results There were 6 deaths in the patients underdingselective operation(6/175, 4.3%) and in those undergoing emergengcy surgery (6/20, 30%) respectively within 30 days. The other patients were followed up from 1 month to 21 years ( 8.7 years on average), and there were 16 deaths (8.9%) during the follow-up. Nodeath was found in the endoluminal repaired group. Endoleak occurred in 8 patients, including 5 cases of type Ⅰand 3cases of type Ⅱ. After 6 months, CT scan showed that endoleak disappeared in 6 and rernained in 2. Late type Ⅱ endoleak occurred in 1 and endoleak disappearedafter endoluminal embolization. Conclusion With improvement of vascular surgical technique and development of endogafting, the safety of AAA both on surgicaland interventional means would be improved.
From June, 1987 through June, 1994, 126 cases of injuries of major arteries of the extremities were treated, in which Nationedmade Teflon artificial vascular prosthesis was used to repair in 20 cases. Eighteen of the twenty cases were operated immediately after initial injury and the other two had secondary operation. The sites of the original injuries were as follows: the external iliac artery in 1, femoral artery in 15, popliteal artery in 2 and the brachial artery in 2. The length of the defect of the artery was measured from 3 to 12cm. In 2 of 20 cases, the artificial vascular prosthesis was used because of the failurs of primary repair from autogenous saphaneous vein graft. The shortterm patency rate was 100 per cent and the longterm patency rate was 95 per cent. The diagnosis of vascular injury, the properties of the artificial vascular prosthesis and the points important in operation were discussed.
Objective To observe the posterior condylar offset (PCO) changes and anteroposterior femorotibial translation, to investigate the influence of them on the maximum knee range of flexion (ROF) in patients with posterior cruciatesacrificingself al ignment bearing total knee arthroplasty (TKA). Methods The cl inical data were analyzed retrospectively from 40 patients (40 knees) undergoing primary unilateral TC-PLUSTM SB posterior cruciate-sacrificing self al ignment andbearing TKA for osteoarthritis between January 2007 and June 2009. There were 18 males and 22 females with an average age of 70.6 years (range, 56-87 years). The disease duration was 5-14 years (mean, 9.1 years). The locations were the left side in 11 cases and the right side in 29 cases. Preoperative knee society score (KSS) and ROF were 48.0 ± 5.5 and (77.9 ± 9.0)°, respectively. The X-ray films were taken to measure PCO and anteroposterior femorotibial translation. Multi ple regression analysis was performed based on both the anteroposterior femorotibial translation and PCO changes as the independent variable, and maximum knee flexion as the dependent variable. Results All incisions healed by first intention. The patients were followed up 12-19 months (mean, 14.7 months). At last follow-up, there were significant differences in the KSS (91.9 ± 3.7, t=— 77.600, P=0.000), the ROF [(102.0 ± 9.3)°, t=— 23.105, P=0.000] when compared with preoperative values. Significant difference was observed in PCO (t=3.565, P=0.001) between before operation [(31.6 ± 5.5) mm] and at last follow-up [(30.6 ± 5.9) mm]. At ast follow-up, the anteroposterior femorotibial translation was (— 1.2 ± 2.1) mm (95%CI: — 1.9 mm to — 0.6 mm); femoral roll forward occurred in 27 cases (67.5%), no roll in 1 case (2.5%), and femoral roll back in 12 cases (30.0%). By multiple regression analysis (Stepwise method), the regression equation was establ ished (R=0.785, R2=0.617, F=61.128, P=0.000). Anteroposterior femorotibial translation could be introducted into the equation (t=7.818, P=0.000), but PCO changes were removed from the equation (t=1.471, P=0.150). Regression equation was y=25.587+2.349x. Conclusion Kinematics after TC-PLUSTM SB posterior cruciate-sacrificing self al ignment bearing TKA with posterior cruciate l igament-sacrificing show mostly roll forwardof the femur relative to the tibia, which have a negative effect on postoperative range of motion. There is no correlation between PCO changes and postoperative change in ROF in TC-PLUSTM SB posterior cruciate-sacrificing self al ignment bearing TKA.
ObjectiveTo explore the effectiveness of UC ultra-congruent rotating platform prosthesis in the treatment of knee osteoarthritis by comparing with fixed-bearing implant. MethodsThe clinical data were retrospectively analyzed, from 98 patients (98 knees) with knee osteoarthritis undergoing primary total knee arthroplasty between January 2011 and December 2012. The UC ultra-congruent rotating platform prosthesis was used in 56 cases (mobile-bearing group) and fixed-bearing implant was used in 42 cases (fixed-bearing group). There was no significant difference in gender, age, side, weight, disease duration, grading of arthritis, the number of varus and valgus malformation, preoperative range of motion of the knee, the Knee Society Score (KSS) score, the visual analogue scale (VAS) score, femorotibial angle, tibial angle, and articular surface angle between 2 groups (P>0.05). The operation time (including anesthetic time), intraoperative blood loss, hospitalization time, total hospitalization expenses, postoperative range of motion of the knee, the KSS score, and the VAS score were compared. The femorotibial angle, tibial angle, and articular surface angle were measured on the basis of anteroposterior and lateral X-ray films, and prosthesis loosening was observed. ResultsThere was no significant difference in the operation time, intraoperative blood loss, and hospitalization time between 2 groups (P>0.05), while the total hospitalization expenses of fixed-bearing group were significantly lower than those of the mobile-bearing group (t=8.506, P=0.000). The patients were followed up 16-30 months in the mobile-bearing group, and for 16-38 months in the fixed-bearing group. Postoperative complications occurred in 3 cases (7.14%) of the fixed-bearing group (1 case of fat liquefaction of incision, 1 case of joint stiff, and 1 case of anterior knee pain), and in 3 cases (5.36%) of the mobile-bearing group (1 case of delayed wound healing, and 2 cases of anterior knee pain); there was no significant difference in the complication rate between 2 groups (χ2=0.133, P=0.516). At last follow-up, the KSS score, VAS score, range of motion of the knee, femorotibial angle, tibial angle, and articular surface angle were superior significantly to those before operation in both groups (P<0.05), but no significant difference was found between 2 groups (P>0.05). No radiographic signs of radiolucent line, prosthetic dislocation, patellar dislocation, prosthetic loosening, and fracture was found. ConclusionUC ultra-congruent rotating platform prosthesis in the treatment of knee osteoarthritis can effectively improve the knee joint function and relief pain, which has the same short-term effectiveness to fixed-bearing implant.
ObjectiveTo investigate the reasons and managements of implant-related complications after hinge knee replacement for tumors around the knee. MethodsA retrospective analysis was made on the clinical data of 96 patients undergoing hinge knee replacement between January 2000 and December 2012. There were 64 males and 32 females with the mean age of 31.0 years (range, 15-72 years). The most common tumor type was osteosarcoma (72 cases), and the second was giant cell tumor (15 cases). The tumor located at the distal femurs in 52 cases and at the proximal tibias in 44 cases. Fifteen hinge and 81 rotating hinge prostheses were used. The recurrence, metastasis, and survival were recorded. The implant-related complications were observed. ResultsThe median follow-up time was 43.5 months (range, 10-156 months). Complications were observed in 21 patients (25 implant-related complications);13 complications located at the femur and 12 complications at the tibia. The complications included aseptic loosening (8 cases), deep infection (7 cases), prosthetic breakage (4 cases), peri-prosthetic fracture (2 cases), and dislocation (4 cases). Most deep infection occurred within 12 months after operation (6/7), and most aseptic loosening after 40 months of operation (6/8). The rate of limb salvage was 90.6% (87/96) and the amputation rate was 9.4% (9/96). The overall survival rate of the prosthesis was 76.7% (5-year) and 47.2% (10-year). The 5-year survival rate was 82.9% for femoral prosthesis and 71.0% for tibial prosthesis, showing no significant difference (P=0.954). ConclusionHinge knee prosthesis still has a high rate of complications. Deep infection is main reason to decrease short-term prosthetic survival rate, and aseptic loosening shortens the long-short prosthetic survival time.
Objective To analyze the outcomes and complications after total knee replacement(TKR) with posterior stabilized prosthesis(PS) and to investigate the influencing factors relating to outcomes. Methods From January 1998 to August2004, 60 cases (74 knees) of osteoarthritis underwent TKR with PS. The outcomeswere evaluated according to the HSS(hospital for special surgery) scoring. The difference in outcomes between patients with post-operative complications and without complications were compared. Pearson correlation was used to analyze post-operative outcomes and the pre-operative factors relating to patients. Results All 74 knees werefollowed up 42.5months(24 to 94 months). The scores for HSS, pain, function, ROM muscle strength, flexion deformity and stability of knees after operation were 84.2±14.2, 25.7±6.9, 17.9±4.3,13.1±2.0，9.2±0.8，8.1±0.4 and 9.3±0.1 respectively. They were improved to some extents, especially pain alleviation was remarkable. The excellent and good rate for outcome assessment was 90.5%. Among 74 knees, 10 cases suffered from postoperative complications, including 1 case of common peroneal nerve paralysis, two cases of wound faulty union, one case of wound infection, one case of joint infection, one case of stiff knee, two cases of deep vein thrombosis and 2 cases of patellofemoral joint complications. The excellent and good rate of outcome in patients with complications(60%) was much lower than that in patients without complication(95.3％),and there was significant difference betweenthem (P＜0.05). Analysis for correlation showed that postoperative HSS score was positively correlative with the postoperative HSS score, pain and function score of knees. The correlation value was 0.523，0.431 and 0.418 respectively(Plt;0.01). Whereas, postoperative HSS score was not correlative with ROM, muscle strength, flexion deformity, stability of knee, age, weight andbody mass index(P＞0.05). Conclusion TKR with PS is an effective method for severe osteoarthritis. The outcomes after TKR have a positive correlation with the HSS score, pain and function score of knees before surgery. Complicationsassociating with surgery have a negative influence on outcomes.
Objective To summarize the research progress of the artificial wrist joint prosthesis. Methods Domestic and abroad literature concerning artificial wrist joint prosthesis was reviewed and analyzed thoroughly. Results Artificial wrist joint prosthesis has been developed to the 4th generation. The artificial wrist joint arthroplasty has advantages of pain relief and functional improvement and can achieve ideal short-term effectiveness. But there are some problems, such as loosening, subsidence, fracture, and dislocation of prosthesis. The long-term effectiveness of the 3rd and 4th generation prosthesis still need to be followed up. Conclusion The biomechanics of wrist joint is extremely complicated, which results in less application and slow development of artificial wrist joint prosthesis. Early-term effectiveness of artificial wrist joint arthroplasty is basically satisfactory, but there are still some long-term complications. So the artificial wrist joint prosthesis remains to be developed.
Objective To investigate the effectiveness of three-dimensional (3D)-printed hemi-pelvic prosthesis for revision of aseptic loosening or screw fracture of modular hemi-pelvic prosthesis. MethodsBetween February 2017 and January 2020, 11 patients with aseptic loosening or screw fracture of modular hemi-pelvic prosthesis were revised using 3D-printed hemi-pelvic prostheses. There were 7 males and 4 females with an average age of 44 years (range, 25-60 years). In the first operation, all patients underwent total tumor resection, modular hemi-pelvic prosthesis reconstruction, and autologous femoral head transplantation. According to the Enneking pelvic partition system, 8 cases were resected in zones Ⅰ+Ⅱ and 3 cases in zones Ⅰ+Ⅱ+Ⅲ. The interval from the initial operation to this revision ranged from 14.3-66.2 months, with an average of 35.8 months. The operation time, the amount of intraoperative bleeding, and the occurrence of complications were recorded. At 6 months after the first operation, before revision, and at last follow-up, the American Musculoskeletal Tumor Society (MSTS) score and Harris score were used to evaluate the recovery of lower limb function. The pain-free walking distance of patients without brace assistance was recorded at last follow-up. X-ray films were taken at 1 month after the first operation, before revision, and at 1 month after revision, the acetabulum position was assessed by the differences in weight arm and cup height between bilateral hip joints. At last follow-up, the digital X-ray tomography was taken to evaluate the prosthesis-bone integration and the occurrence of aseptic loosening. Results The operation time was 182.6-238.0 minutes (mean, 197.4 minutes). The amount of intraoperative bleeding was 400-860 mL (mean, 550.0 mL). All incisions healed by first intention with no infection, hip dislocation, nerve damage, or vascular-related adverse events. The MSTS score and Harris score at last follow-up were significantly higher than those at 6 months after the first operation and before revision (P<0.05), while the score before revision was significantly lower than that at 6 months after the first operation (P<0.05). At last follow-up, the patients were able to walk more than 1 000 meters painlessly without brace assistance. Imaging review showed that the difference of cup height at 1 month after revision was significantly lower than that at 1 month after the first operation and before revision, and at 1 month after the first operation than before revision operation, and the differences were significant (P<0.05). There was no significant difference in the difference of weight arm among three time points (P>0.05). All prostheses were well integrated, and no aseptic loosening of the prosthesis or screw fracture occurred. Conclusion Revision with 3D-printed hemi-pelvic prostheses benefited in reconstructing stable pelvic ring and natural bodyweight transmission for patients encountering the aseptic loosening or screw fracture of modular hemi-pelvic prosthesis. Early postoperative rehabilitation training can maximize the recovery of patient limb function, reduce pain during walking, and reduce the incidence of complications.
ObjectiveTo summarize the research progress of the difference between high-flexion prosthesis and conventional prosthesis in total knee arthroplasty, so as to offer a reference for clinical choice of prosthesis. MethodsThe relevant literature on high-flexion prosthesis and conventional prosthesis in recent years was extensively reviewed and analyzed. ResultsThere are some controversies in range of motion and complications between high-flexion prosthesis and conventional prosthesis; while no obvious difference is found in knee function and satisfaction. ConclusionComprehensive evaluation should be considered when high-flexion prosthesis is selected; and the effectiveness needs further follow-up.