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IntroductionMany studies have reported the clinical outcomes of a jumbo cup in revision total hip arthroplasty (rTHA) with acetabular bone defect. We conducted a systematic review to access the survivorship and clinical and radiological outcomes of a jumbo cup in rTHA.MethodsA systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search from PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was performed with the keywords (“revision” OR “revision surgery” OR “revision arthroplasty”) AND (“total hip arthroplasty” OR “total hip replacement” OR “THA” OR “THR”) AND (“jumbo cup” OR “jumbo component” OR “extra-large cup” OR “extra-large component”). Studies reporting the clinical or radiological outcomes were included. The basic information and radiological and clinical results of these studies were extracted and summarized for analysis.ResultsA total of 19 articles were included in the systematic review. The analysis of clinical results included 953 hips in 14 studies. The re-revision-free survivorship of the jumbo cup was 95.0% at a mean follow-up of 9.3 years. Dislocation, aseptic loosening, and periprosthetic joint infection were the top three complications with an incidence of 5.9%, 3.0%, and 2.1%, respectively. The postrevision hip center was relatively elevated 10.3 mm on average; the mean postoperative leg-length discrepancy was 5.4 mm.ConclusionA jumbo cup is a favorable option for acetabular bone defect reconstruction in rTHA with satisfying survivorship and acceptable complication rates.

Purpose：We aim to figure out the deviation of using ASIS as the reference for femoral anatomical axis (AA) in unicompartmental knee arthroplasty (UKA) and the degree of angle between AA and actual mechanical axis (MA) in the coronal plane for patients with medial compartment knee osteoarthritis (KOA). Patients and Methods： Between December 2017 to December 2019, a total of 120 consecutive knees (104 patients) with severe medial compartment KOA were included in this study. The weight-bearing full-length radiographs of included knees were analyzed using Picture Archiving Communication System (PACS). The lines of AA, operation AA (oAA) and MA were identified. Angles between AA and oAA (Angle 1), AA and MA (Angle 2) were measured on the radiographs. Symbol “+” and ”-” were attached with angles between AA and oAA to describe the situation when oAA lies in the lateral or medial side of AA. The statistical analysis was done using SPSS Version 23.0. A p values＜0.05 were considered to be significant. Results: The deviation angle between AA and oAA in the coronal plane (Angle 1) was (0.91±1.08)° (-2.61°-3.04°). The angle between AA and MA in the coronal plane (Angle 2) was (6.26±1.01）° (3.95°-8.93°). No significant differences of Angle 1 and Angle 2 were found between sexes. For knees with partial thickness cartilage loss (PTCL) (n=39) and full thickness cartilage loss (FTCL) (n=81), Angle 1 was statistically significantly different in the 120 knees (0.61°vs.1.05°;p=0.035). While the Angle 2 for knees with PTCL and FTCL was (6.13±0.80)° (4.83°-7.99°, p=0.326) and (6.32±1.09)° (3.95°-8.93°, p=0.326), respectively. Conclusion：A mean deviation angle of 0.91° was identified between AA and oAA, the value of which could be larger in knees with FTCL. ASIS may not be a reliable reference for AA of femur in UKA patients. And an adjustment of at most 1.0°of varus angle may help achieve better coronal alignment.

Background: Tranexamic acid (TXA) is an antifibrinolytic drug widely used as a blood-sparing technique in total knee arthroplasty (TKA), and it is usually administrated by intravenous or intraarticular injection. Recently, the oral form of TXA has been applied in TKA patients. However, there is no final consensus regarding the effectiveness and safety of oral TXA. The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy and safety of oral TXA versus control for blood loss after TKA. Methods: We searched PubMed, Embase, Medline, Web of Science, and Cochrane Library databases for relevant studies through August 2017. The mean difference (MD) of total blood loss, hemoglobin (Hb) drop, hematocrit (Hct), drain output, and risk difference (RD) of transfusion rate and thromboembolic complications in the TXA and control groups were pooled throughout the study. The outcomes were pooled by Stata 12.0. Results: A total of 5 RCTs (608 patients) were included in this study. All the included studies were randomized and the quality of included studies was relatively high. The pooled results indicated that the oral TXA group had significantly less Hb drop (standardized mean difference [SMD], −0.936; 95% confidence intervals [CI], −1.118,−0.754), Hct drop (SMD, −0.693; 95% CI, −1.113, −0.274), and drain output (SMD, −0.793; 95% CI, −0.959, −0.628) than the control group. No statistically significant differences were found in transfusion rate and the incidence of thromboembolic complications between the 2 groups. Total blood loss could not be evaluated for the insufficient date. Conclusions: Our meta-analysis suggested that the administration of oral TXA provided significantly better results with respect to Hb drop, Hct drop, and drain output without increasing the transfusion rate and the risk of thromboembolic complications after TKA. Nevertheless, our current study with some limitations such as the small sample size only provided limited quality of evidence, confirmation from further meta-analysis with large-scale, well-designed RCTs is required.

Bone marrow edema (BME) represents a reversible but highly painful finding in magnetic resonance imaging (MRI) of patients with knee osteoarthritis. The aim of this retrospective study was to evaluate the efficacy of extracorporeal shock wave treatment (ESWT) on painful BME in osteoarthritis of the knee. This study focuses on people who had early-to-mid stage osteoarthritis with knee pain and MRI findings of BME. Patients who underwent ESWT treatment or prescribed alendronate treatment in our department were analyzed. Knee pain and function were measured using the visual analog scale (VAS) for pain and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), respectively. The degree of BME was measured with MRI scans. A total of 126 patients who received ESWT treatment (Group A, n = 82) or alendronate treatment (Group B, n = 44) were included. All patients were followed up clinically and radiographically for a minimum of 12 months. The mean follow-up was 23.5 months (range, 12–38 months). The VAS and WOMAC score decreased more significantly after treatment in Group A than that in Group B (P

Background: The ability of intraoperative periarticular drug infiltration (PDI) to control pain after total hip arthroplasty (THA) has been studied for many times, but it still remains controversial. Therefore, we undertook a meta-analysis to evaluate the efficacy and safety of PDI on postoperative pain after THA. Methods: Databases, including Pubmed, Medline, Embase, Web of Science, and Cochrane library, were searched to identify randomized controlled trials concerning PDI for pain management in patients undergoing THA. The primary outcomes included pain score with rest or activity and opioid consumption. Secondary outcomes were length of hospital stay and complications (nausea or vomiting). Results: A total of 666 THA patients from 8 randomized controlled trials were subjected to meta-analysis. The results showed that the PDI group had better pain relief, less opioid consumption, and less length of hospital, when compared with the placebo group (P

Blood management is critical in total knee arthroplasty (TKA). In bilateral, single stage TKA, blood loss seems more prominent. We believe it is important to control all potential bleeding within the wound tissue. The purpose of the study was to evaluate a series of topical procedures used to reduce blood loss and transfusion in single-stage bilateral cemented total knee arthroplasty: antifibrinolysis with tranexamic acid, vasoconstriction with epinephrine, sealing of the bone section intraoperatively, and closure of the drainage tube within the first 4 h postoperatively. Patients with osteoarthritis of the knees were randomly divided into two groups. In group A, 5 ml (25 mg/ml) tranexamic acid (TXA) and 5 ml analgesic containing epinephrine (3 μg/ml) solution were injected at several points into the posterior capsule before installation of the prosthesis. The femoral medullar canal was closed with autograft bone and then sealed compressively with cement. Before the tourniquet was released, 10 ml TXA solution and 10 ml analgesic containing epinephrine were injected at several points into the periosteum, synovium, joint capsule, tendons, and deep fascia tissue (injection of analgesic containing epinephrine into subcutaneous fat and dermis was avoided). The residual nail holes in the bone and the uncovered bone section were covered with bone wax. The tourniquet was then removed, and active bleeding points were stanched. TXA solution (20 ml) was injected into the articular cavity after wound closure. The drainage tube was clamped for 4 h, then opened. In group B, injection of analgesic containing epinephrine into soft tissue, control of active bleeding, and clamping of the drainage tube for 4-h, only, were performed. Ninety patients were enrolled in the study. Compared with those in group B, intraoperative blood loss, drainage volume, total postoperative blood loss, and number of patients requiring allogenic blood transfusion were significantly reduced in group A. There was no significant difference between the incidence of complications in the groups. Our topical procedures enable effective and safe reduction of blood loss and the number of patients requiring transfusion in single-stage bilateral osteoarthritic TKA.