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BACKGROUND: More and more patients received the total hip arthroplasty, and the acetabular loosening occurrence is increasing day and day. Commonly used operative methods include structural bone graft, morselized bone grafting and titanium mesh reconstruction, tantalum metal pads reconstruction, Jumbo cup and Cup-Cage technology. OBJECTIVE: To summarize the clinical effect of the individual biological acetabular cup application in acetabular loosening after total hip arthroplasty and supply a feasible method for the hip revision. METHODS: Eleven patients with acetabular loosening after the total hip arthroplasty undergoing acetabular revision used individual biological acetabular cups admitted at Pingdingshan Medical District Second Department of Orthopedics, the 989 Hospital of Chinese People’s Liberation Army Joint Logistics Support Force between March 2017 and March 2019 were included in this study. Of them, there were 7 men and 4 women, with the age of 55-71 years. The individual biological cups were used in the hip revision surgery and followed up for 3 years. Harris score, visual analogue scale score and absolute length difference of both lower limbs were recorded preoperatively and at final follow-up. X-ray films were observed to assess hip functional recovery and bone ingrowth. RESULTS AND CONCLUSION: (1) All patients were underdone by the same doctor, followed up for 3 years and none lost. Among them, one case had symptoms of sciatic nerve, orally took mecobalamin tablets and recovered in 6 months. (2) Harris score, visual analogue scale score and absolute length difference of both lower limbs were significantly improved during the last follow-up (P < 0.05). (3) Last X-ray films showed good bone ingrowth. (4) These results imply that the individual biological acetabular cup application in acetabular loosening after total hip joint arthroplasty can restore the primary stability, restore ideal joint function and better bone ingrowth, and provide a feasible method for hip revision. [ABSTRACT FROM AUTHOR]

BACKGROUND: In total hip replacement surgery for high dislocation developmental dysplasia of the hip, the advantages and disadvantages of using integrated Wagner cone prosthesis and combined S-ROM prosthesis after low femoral neck osteotomy are currently unclear. OBJECTIVE: To explore the advantages and disadvantages of low femoral neck osteotomy combined with integrated prosthesis or combined prosthesis in the treatment of Crowe type III-IV developmental dysplasia of the hip patients. METHODS: The clinical data of 36 patients with Crowe type III-IV developmental dysplasia of the hip in Affiliated Hospital of Southwest Medical University from September 2015 to August 2019 were analyzed retrospectively, including 5 males and 31 females, aged from 27 to 64 years. There were 19 cases on the left and 17 cases on the right. All underwent total hip replacement treatment. Among them, 18 patients were treated with Wanger cone prosthesis and 18 patients with S-ROM prosthesis. During follow-up, Harris score and visual analog score of hip joint function were compared between the two groups. Through imaging examination, differences in the prosthesis loosening, subsidence, length of the lower limbs, heterotopic ossification and osteolysis, and stress shielding of the proximal femur were observed in both groups. RESULTS AND CONCLUSION: (1) All patients were followed up for 15 months and above in both groups. All incisions healed by first intention after surgery, and there was no dislocation of the prosthesis, aseptic loosening, infection around the prosthesis, osteolysis or heterotopic ossification. (2) There were 15 cases of I degree stress shielding effect in the proximal femur and 3 cases of II degree in the S-ROM group; 12 cases of I degree stress shielding effect and 6 cases of II degree in the proximal femur in the Wagner cone group; no significant difference was found between the two groups (P > 0.05). One patient in the S-ROM group with a shortened limb of 6.7 cm developed symptoms of femoral nerve palsy, and one patient in the Wagner cone group developed peroneal vein thrombosis after surgery; there was no significant difference in the length of the shortened limb between the two groups (P > 0.05). (3) There was no significant difference in the Harris score and visual analog score of hip joint function between the two groups at 15 months after operation (P > 0.05). (4) It is concluded that for patients with Crowe type III-IV developmental dysplasia of the hip, low femoral neck osteotomy combined with S-ROM prosthesis or integrated Wagner cone prosthesis can achieve satisfactory short-term results, but attention should be paid to the initial stability of the proximal cuff of S-ROM prosthesis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Avascular necrosis of the femoral head has always been a problem that is difficult to solve in orthopedics, and it is still difficult to be completely cured with the development of medicine. The development of the disease is irreversible, and the treatment is relatively difficult. For patients with early pain, the characteristic treatment of traditional Chinese medicine is effective and has unique advantages. However, the development of individualized treatment of hip protection methods requires a more comprehensive grasp, to evaluate the impact of other potential adverse factors, and to improve the overall grasp of the clinical treatment of femoral head necrosis rate. OBJECTIVE: To follow-up literature on the relationship between traditional Chinese medicine (TCM) syndromes of femoral head necrosis and hip joint morphology, to evaluate the conservative treatment for the prognosis of femoral head necrosis. METHODS: Using “femoral head necrosis TCM syndrome type; hip joint morphology” as Chinese search terms and “TCM syndrome type of femoral head necrosis; hip morphology” as English search terms, articles were searched in CNKI, VIP, Wanfang, and PubMed databases from 2012 to 2020. The related articles on the relationship between TCM syndromes of femoral head necrosis and hip joint morphology were explored. RESULTS AND CONCLUSION: (1) At present, surgical methods are mostly used for the occurrence of femoral head necrosis. However, abnormal symptoms such as pain before femoral head necrosis should be treated in time to save the femoral head and delay the development of the disease. If it is not taken seriously, it will seriously affect the hip joint and cause hip arthritis, so only hip replacement surgery can be performed. (2) By consulting the literature, we learned that the TCM syndromes of femoral head necrosis are divided into kidney deficiency and blood stasis type, qi stagnation and blood stasis type, and phlegm and blood stasis blocking collaterals type. (3) Hip joint morphology changes mainly include central edge angle, acetabular angle (Sharp angle), acetabular depth, acetabular anteversion angle, acetabular abduction angle, acetabular diameter, acetabular diameter, anteroposterior diameter and other data indicators. (4) The diagnosis method is closely integrated, taking advantage of the advantages together, so as to provide more powerful support for the improvement of the clinical efficacy of hip-preserving treatment of avascular necrosis of the femoral head. [ABSTRACT FROM AUTHOR]

BACKGROUND: With the gradual deepening of the concept of enhanced recovery after surgery, orthopedists have put forward higher requirements for the efficacy of total hip replacement. The traditional posterolateral surgical approach is traumatic, with slow postoperative recovery. Minimally invasive total hip replacement surgery provides a new option for orthopedic surgeons. OBJECTIVE: To compare the clinical effects of Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach and conventional posterolateral approach for one-stage bilateral total hip arthroplasty. METHODS: A retrospective study was conducted on 25 patients (50 hips) with one-stage bilateral total hip arthroplasty in the First Affiliated Hospital of Soochow University from April 2016 to April 2018. In terms of surgical approach conducted, 12 patients (24 hips) had total hip arthroplasty performed by SuperPATH approach, while remaining 13 patients (26 hips) underwent total hip arthroplasty with posterolateral approach. The length of incision, operation time, intraoperative blood loss, postoperative blood transfusion, hemoglobin difference, and length of stay were compared between the two groups. Harris score (pain, function, deformity, range of motion), visual analogue scale score and complications were compared between the two groups after surgery. The differences in abduction angle, anteversion angle, and length of both lower limbs were compared between the two groups. RESULTS AND CONCLUSION: (1) All the patients entered in the enhanced recovery after surgery management process during the perioperative period. Totally 25 patients had operation performed smoothly. (2) Comparison of the related indexes of the two sets of approaches showed that SuperPATH approach group had smaller surgical incision, less postoperative blood transfusion, and less hemoglobin difference compared with the posterolateral approach group (P < 0.05). However, operation time was longer in the SuperPATH approach group (255.17±38.57) minutes than that in the posterolateral approach group (188.15±30.84) minutes (P < 0.01). (3) The Harris score of SuperPATH approach group at 3 and 7 days after operation was significantly higher than that in the posterolateral approach group (P < 0.05). The visual analogue scale score at 1 and 3 days after operation was significantly lower in SuperPATH approach group compared to the posterolateral approach group (P < 0.05). (4) There was no statistically significant difference in the length of lower limps, anteversion and abduction angle of the acetabular prosthesis (P > 0.05). (5) The results show that under the guidance of the concept of enhanced recovery after surgery, SuperPATH minimally invasive in phase I bilateral total hip arthroplasty was safe and effective, with advantages of shorter incision length, less postoperative blood transfusion, less recessive blood loss, faster hip function recovery and less pain. [ABSTRACT FROM AUTHOR]

BACKGROUND: Heterotopic ossification is a common complication of acetabular fracture. Its pathogenesis is still not completely clear, and it is mainly caused by skeletal muscle trauma, hip surgery or nervous system injury. From the research in the past 10 years, the risk factors for ectopic ossification after acetabular fracture surgery are numerous, but its prevention and treatment are controversial. OBJECTIVE: To summarize the relevant literature on the diagnosis, prevention and treatment of ectopic ossification after acetabular fracture surgery in recent years and the risk factors that may affect the prognosis, so as to provide a basis for the clinical prevention and treatment of ectopic ossification after acetabular fracture surgery. METHODS: The databases of Wanfang Medical Network, CNKI and PubMed were searched using computer. The key words were “heteropic ossification; acetabular fractures surgery; NSAIDs; risk factors; radiotherapy; treatment” in Chinese and English. According to the inclusion and exclusion criteria, 67 related articles were finally included and summarized. RESULTS AND CONCLUSION: (1) Although the etiology of heterotopic ossification is not fully understood, it is generally accepted that the formation of heterotopic ossification is determined by both systemic factors and local tissue changes. The risk factors of heterotopic ossification are various, and some preventive measures should be taken for high-risk patients. (2) The prevention of heterotopic ossification after acetabular fracture surgery mainly includes drug, radiotherapy and combined prevention, among which drug prevention, especially non-steroidal anti-inflammatory drugs, is still the most economical and effective prevention method. (3) The treatment of heterotopic ossification is mainly ectopic bone resection and hip arthroplasty. The corresponding treatment methods based on the biomolecular mechanism are still in the stage of animal experimental research, but it points out the direction for the treatment of heterotopic ossification. (4) Among the existing treatment methods, surgery is recognized as the most effective treatment. [ABSTRACT FROM AUTHOR]

Objective: To explore the application method and effect of ultrasound-guided epidural block in elderly hip replacement surgery. Methods: From June 2017 to May 2020, 112 cases of elderly patients who underwent hip replacement surgery in our hospital were selected as the research object, and the patients were divided into study group and control group of 56 cases in each groups accorded to the random number table method. The study group was given ultrasound-guided epidural block, and the control group was given traditional intravenous continuous analgesia. The two groups were given general anesthesia induction and maintenance, and the analgesic effects and patient's postoperative recovery were recorded. Results: There were no significant difference in gender, age, anesthesia time, operation time and intraoperative bleeding compared between the two groups (P>0.05). The postoperative hospital stay in the study group were significantly shorter than that in the control group (P<0.05). The visual analogue scale/score (VAS) scores of pain in the two groups at 1 d, 3 d and 7 d after surgery were significantly lower than those at 1d before operation, and the study groups were lower than the control group(P<0.05). The hip joint mobility of the study group at 1 d, 3 d and 7 d after surgery were significantly higher than that of the control group (P<0.05). The contents of Substance P (SP) and Prostaglandin E2 (Prostaglandin E2, PGE2) in the two groups at 1 d, 3 d and 7 d after surgery were significantly higher than those at 1 d before operation, and the study groups were lower than the control group(P<0.05). Conclusion: The application of ultrasound-guided epidural block in elderly hip replacement surgery can inhibit the release of serum SP and PGE2, can relieve postoperative pain, promote the recovery of hip function, and shorten the recovery time of patient [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of different concentrations of ropivacaine combined spinal-epidural anesthesia on artificial hip replacement surgery on patients' anesthesia effect and postoperative motor function. Methods: From February 2017 to December 2019, 84 cases of patients underwent artificial hip replacement surgery in our hospital were selected and were equally divided into observation group and control group accorded to random number table method. Both groups were given combined spinal-epidural anesthesia. The control group were anesthetized with conventional concentration of 0.5 % ropivacaine. The observation group were anesthetized with low concentration of 0.375 % ropivacaine. Results: The duration of anesthesia, motor recovery time and sensorimotor time in the observation group were significantly shorter than those in the control group (P<0.05). The Bromage scores of the observation group at 10 min, 30 min, and 60 min after anesthesia were lower than those of the control group (P<0.05). The incidence of low blood pressure, nausea and vomiting, dizziness and headache, urinary retention and other adverse reactions in the observation group were 7.1 % at 7 days after operation, which were significantly lower than 19.0 % in the control group (P<0.05). The breathing and heart rate of all patients in the two groups at 2 h, 4 h and 24 h postoperatively fluctuated within the normal range, and there were no statistically significant difference compared between the groups and within the group (P>0.05). Conclusion: Low-concentration ropivacaine combined spinal-epidural anesthesia for artificial hip replacement surgery can improve the patient's anesthesia and motor function, improve the anesthesia effect, it does not affect the patient 's vital signs, and it can reduce the incidence of postoperative adverse reactions. [ABSTRACT FROM AUTHOR]

To investigate the effects of different concentrations of ropivacaine combined spinal-epidural anesthesia on artificial hip replacement surgery on patients' anesthesia effect and postoperative motor function. From February 2017 to December 2019, 84 cases of patients underwent artificial hip replacement surgery in our hospital were selected and were equally divided into observation group and control group accorded to random number table method. Both groups were given combined spinal-epidural anesthesia. The control group were anesthetized with conventional concentration of 0.5 % ropivacaine. The observation group were anesthetized with low concentration of 0.375 % ropivacaine. The duration of anesthesia, motor recovery time and sensorimotor time in the observation group were significantly shorter than those in the control group (P<0.05). The Bromage scores of the observation group at 10 min, 30 min, and 60 min after anesthesia were lower than those of the control group (P<0.05). The incidence of low blood pressure, nausea and vomiting, dizziness and headache, urinary retention and other adverse reactions in the observation group were 7.1 % at 7 days after operation, which were significantly lower than 19.0 % in the control group (P<0.05). The breathing and heart rate of all patients in the two groups at 2 h, 4 h and 24 h postoperatively fluctuated within the normal range, and there were no statistically significant difference compared between the groups and within the group (P>0.05). Low-concentration ropivacaine combined spinal-epidural anesthesia for artificial hip replacement surgery can improve the patient's anesthesia and motor function, improve the anesthesia effect, it does not affect the patient 's vital signs, and it can reduce the incidence of postoperative adverse reactions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Three-dimensional (3D) printing technology is a new rapid prototyping technology, which has been initially applied in orthopedics, especially in the clinical application of hip replacement surgery. OBJECTIVE: To summarize the application status, existing problems and future development direction of 3D printing technology in hip arthroplasty. METHODS: The relevant articles published between January 2000 and March 2019 were retrieved from PubMed, CNKI and WanFang databases. The keywords were "3D printing, rapid prototyping, additive manufacturing, computer aided, computer-assisted, hip, hip replacement, hip arthroplasty, revision hip arthroplasty" in English and Chinese, respectively. Initially, 1833 articles were retrieved, and finally 105 eligible articles were included for result analysis in accordance with the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) In the clinical application of hip replacement surgery, 3D printing technology is mainly used to make anatomical models for clinical teaching or preoperative plan, patient-specific surgical guides, customized implants or prostheses. (2) The advantages of 3D printing technology can make up for the deficiency of traditional treatment, and n can help to optimize the surgical plan, shorten the operation time, decrease the bleeding, reduce postoperative complications, improve the accuracy of surgery and clinical results. (3) Individualized treatment with 3D printing technology will become a new direction in hip arthroplasty. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hip arthroplasty is now an effective method of effectively solving the problem of femoral neck fracture in the elder1y, but there is a risk of big trauma, high joint dislocation and postoperative complications. OBJECTIVE: To explore the application value of 30 printing guide plate in hip arthroplasty in the elderly by retrospective study and literature retrieval. METHODS: (1) Clinical data of 25 elderly patients with femoral neck fracture undergoing hip arthroplasty from February 2017 to October 2018 in Liaoning Jinqiu Hospital were retrospectively analyzed. In the guide plate group, 13 patients received hip arthroplasty using 30 printing guide plate. In the non-guide plate group, printing guide plate was not used in 12 cases. The application value of SuperPATH technique with 30 printing guide plate in hip arthroplasty in the elderly was observed. (2) Wanfang database was retrieved by the first author for studies published from 2000 to 2019. The key words were "3D, hip". According to the inclusion criteria, 31 articles were selected to analyze the application value of 3D printing guide plate in hip arthroplasty in the elderly. RESULTS AND CONCLUSION: (1) The results of retrospective analysis showed that the operation time and the times of X-ray fluoroscopy were less in the guide plate group than those in the non-guide plate group (P < 0.05). Intraoperative blood loss and Harris score of hip function at the final follow-up were not significantly different between the two groups (P > 0.05). (2) Literature search results showed that 3D guide plates could be used to compensate for some defects of surgery in hip arthroplasty. There are many approaches to implement joint arthroplasty. Bath conventional and minimally invasive approaches have direct anterior approach and posterolateral approach. According to several literature analysis, direct anterolateral approach can reduce trauma, and minimally invasive approach can reduce the risk of surgery. (3) The above results show that the use of 3D printing guide plate in elderly hip arthroplasty can reduce the operation time and the times of intraoperative X-ray fluoroscopy, and the effect is better. 3D guide plate has application value in hip arthroplasty, and it has advantages in combination with minimally invasive techniques. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of femoral nerve block anesthesia combined with local infiltration anesthesia for the elderly patients with hip replacement surgery. Methods: Eighty-five patients who admitted to our hospital from January 2016 to June 2018 and underwent hiparthroplasty were randomly divided into the two groups according to the parity of the member. 42 patients in the control group underwent local infiltration anesthesia, and 43 patients in the observation group were treated with femoral nerve block anesthesia combined with local infiltration anesthesia. The anesthetic effect, analgesic effect, postoperative opioid use, hospital stay and time of getting out of bed were compared between tw groups. Results: The sensory block time and recovery pain time were significantly longer in the observation group than in the control group (P::0.0 5). The VAS scores was significantly lower in the observation group at 12 h after operation(P::0.0 5), but there was no significant difference between the two groups at 6 hand 1 d(P>0.05). The dose of opioids in the observation group was significantly lower than that in the control group at 1 day after operation (P<0.05), but there was no significant difference between the two groups at 2 day after operation (P>0.05). The time of hospital stay and the time of getting out of bed were significantly shorter than that of the control group (P<0.05). Conclusion: Femoral nerve block combined with local infiltration anesthesia has a good analgesic effect on the elderly patients undergoing hip replacement surgery, and the dose of opioid analgesics is reduced after surgery, the hospitalization time and time to get out of bed are improved. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hip and knee arthroplasty has been widely carried out in various levels of hospitals. The amount of hip and knee joint surgery has increased year by year. The surgical methods and techniques have reached a difficult time. Promoting the clinical pathway is an effective method to improve the treatment effect. OBJECTIVE: To systemically evaluate the difference between the clinical pathways and conventional pathways in total hip arthroplasty and total knee arthroplasty. METHODS: Clinical trials about the comparison of conventional and clinical pathways in total hip arthroplasty and total knee arthroplasty were searched in MEDLINE, Cochrane Library, EMbase, and CNKI. Study selection, data collection and evaluation of methodological quality were undertaken by two reviewers independently. The Cochrane Collaboration's RevMan 5.0 was used for data analyses. RESULTS AND CONCLUSION: (1) Totally 17 clinical trials meeting research design criteria were included in this analysis, including 13 semi-randomized controlled trials and 4 randomized controlled trials. (2) The incidence of complications in the traditional method group was higher than that in the clinical pathway group [OR=0.63, 95%CI(0.53, 0.74), P < 0.000 01]. (3) Pain visual analogue scale score [MD=1.49, 95%CI(0.69, 2.85), P=0.001], postoperative Harris hip score [MD=19.31, 95%CI(-13.98, -4.92), P < 0.000 1], and 5-year prosthesis survival rate [OR=0.59, 95% Cl (0.36, 0.98), P=0.04] were better in the clinical pathway group than in the traditional method group. (4) There was no significant difference in postoperative mean deviation of mechanical axes of lower limbs after total knee arthroplasty in both groups [MD=0.00, 95%CI(-0.14, 0.14), P=0.99]. (5) Results showed that compared with traditional technique, hip and knee arthroplasty patients who entered the clinical pathway had better clinical efficacy, fewer complications and better joint function after operation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Total hip arthroplasty has been widely used in clinical practice, and achieved good clinical efficacy. However, with the yearly increased number of patients receiving primary arthroplasty, the number of revision hip arthroplasty patients has increased. However, hip arthroplasty is one of the most difficult hip surgery, and it is challenging. OBJECTIVE: To review the causes of femoral revision of the hip arthroplasty, the classification of the femoral bone defect, and the type of prosthesis available in the clinical revision, and the clinical effect of the different prosthesis, so as to provide reference for femoral revision. METHODS: CNKI, Web of Science, and PubMed were searched for the literatures published between January 1975 and August 2017 with the key words of “Revision total hip arthroplasty, Femur revision, Cemented femoral revision, Cemenless femoral revision Reoperation, Porous-coated stems, Modular, tapered stem, Wagner SL revision Stem”. RESULTS AND CONCLUSION: (1) A total of 1 041 articles were retrieved. After reading the abstract, unrelated and repeated studies were excluded. Finally, 109 studies were included. Of them, there were 106 English studies and 3 Chinese studies. Femoral revision was analyzed and summarized. (2) Femoral revision of the hip is still the future challenges facing the joint surgeon. We continue to strive to overcome the direction. Although the current material science and surgical technology are now rapidly developed, only the analysis of the reasons for the revision of the femoral side, identifying the femoral side bone defect classification, mastering the treatment of different defects and the application of the principle of prosthesis type, making reasonable femoral revision program is the key to success according to the patient's age and activity. [ABSTRACT FROM AUTHOR]

Recently, the incidence of revision total hip arthroplasty following primary total hip arthroplasty has increased. However, revision after primary total hip arthroplasty is usually much more difficult than the first time, and the results are typically not as satisfactory as that after most primary total hip arthroplasty procedures. Therefore, thoughtful and thorough preoperative planning will certainly provides the patient with the best opportunity for long-term success. In particular, location and size of acetabular bone defects dictate the type of acetabular component in revision in total hip arthroplasty. For most defects, a porous-coated hemispherical shell secured to host bone with multiple screws is the implant of choice. This reconstruction is feasible provided that at least 50% of the implant is in contact with host bone. When such contact is not possible, and there is adequate medial and peripheral bone, techniques using alternative uncemented implants can be used for acetabular reconstruction. Defects with greater bone loss or compromised columns require the use of either modular augments combined with a hemispherical shell, reconstruction cages, structural allografts, or impaction allograft. Therefore, we attempt to introduce the most commonly-adopted system for classification of acetabular defects and the necessary preoperative evaluation, intraoperative detail, and reported results of these acetabular revisions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the usefulness of our method, which estimated femoral stem alignment using a c-arm when the broach was inserted, for prevention of femoral stem malalignment. Materials and Methods: A total of 103 hips were enrolled in this study. All patients underwent primary hip arthroplasty from October 2011 to February 2013. The study was conducted retrospectively. Intraoperative estimated femoral stem alignments and final femoral stem alignments were classified into three groups. Multinomial logistic regression analysis was performed for analysis of factors (age, sex, diagnosis, body mass index, femoral stem size, osteoporosis, and proximal demur geometry) that might affect intraoperatively estimated femoral stem alignment. Results: The distribution of intraoperative estimated femoral stem alignment was 80(78%) in the neutral group, 18(17%) in the varus group, and 5(5%) in the valgus group. The distribution of final femoral stem alignment was 100(97%) in the neutral group, 2(2%) in the varus group, and 1(1%) in the valgus group. There was no statistically significant factor affecting the intraoperatively estimated femoral stem alignment. Conclusion: Intraoperative estimated femoral stem alignment using a c-arm is an effective method for prevention of femoral stem malalignment [ABSTRACT FROM AUTHOR]