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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: Previous reports have shown that percutaneous tripod acetabular support surgery can quickly improve the pain of pelvic metastases and restore the function of hip joint. OBJECTIVE: To further explore the clinical efficacy and biomechanical mechanism of percutaneous tripod acetabular support surgery. METHODS: This study retrospectively included four patients with five acetabular metastases from the First Affiliated Hospital of Guangzhou University of Chinese Medicine, and used Eastern Cooperative Oncology Group (ECOG) and visual analogue scale scores to evaluate the efficacy. Three-dimensional finite element model of pelvis-proximal femur was constructed using three-dimensional finite element technology. The normal group was set as the normal acetabulum; the model group as the affected side acetabulum; and the treatment group as postoperative acetabulum on the affected side. The stress areas of the three groups were observed to analyze the biomechanical principles and mechanisms of percutaneous tripod acetabular support surgery. RESULTS AND CONCLUSION: (1) Data analysis: Postoperative ECOG and visual analogue scale pain scores were significantly improved (P < 0.05) in four patients. Among the four patients, one case could walk freely; two cases changed from bed rest to walking with crutches and walkers, and one case still used walkers to walk. (2) Finite element analysis: Compared with the blank group, the local stress of the acetabulum in the two-legged standing position in the model group increased (P < 0.05), indicating that the stability of the affected acetabulum was poor; the stress concentration was obvious, and the bearing stress effect was not good after the bone in the tumor area was destroyed. Compared with the model group, the stress in the acetabulum in the two-foot standing position in the treatment group decreased (P < 0.05), indicating that the tripod in the affected area of the acetabulum could bear the stress and relieve the stress concentration in the acetabulum and tumor area. Comparing the blank group and the treatment group, it could be seen that the stress concentration of the acetabulum was relieved after operation, and the support brought by the tripod structure was able to achieve the support stress effect of normal bone (P > 0.05). (3) It is concluded that tripod surgery is a new technique for providing safe and effective pain relief for acetabular metastases. This technique provides stable mechanical support for the acetabulum, but its long-term clinical efficacy still needs long-term follow-up evaluation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Subspine impingement caused by low anterior inferior iliac spine is often neglected, resulting in missed diagnosis or poor treatment effect in some patients. OBJECTIVE: To compare and analyze the difference of hip joint of patients with anterior inferior iliac spine impingement and those without impingent, to investigate whether conventional X-ray and CT examination can directly or indirectly judge the existence of the low anterior inferior iliac spine. METHODS: Totally 15 patients diagnosed with anterior inferior iliac spine impingement and undergoing hip arthroscopic surgery in First Affiliated Hospital of Jinzhou Medical University from January 2016 to June 2019 were selected as trial group. Fifteen patients with non-iliac anterior inferior iliac spine impingement who underwent standard anteroposterior pelvic X-ray and three-dimensional CT examination of the pelvis were selected as control group. The angle α, the center-edge angle of the hip joint, the Tönnis angle, the neck shaft angle, the anteversion angle of the acetabulum, and the horizontal and vertical distance between the anterior inferior iliac spine and the acetabular anterior edge, and the width of the anterior inferior iliac spine were compared between the two groups using X-ray film and CT examination. Finite element analysis was used to simulate the physiological activities of the hip joint in patients with anterior inferior iliac spine, and to observe the absence and presence of local pressure change. RESULTS AND CONCLUSION: (1) The center-edge angle and the vertical distance of the anterior inferior iliac spine from the acetabular anterior edge of the trial group were smaller than those of the control group, but only the difference of vertical distance value between the groups was statistically significant (P < 0.05). The measured values of other indicators of the patients were slightly greater in the trial group than those in the control group, but the difference was not significant (P > 0.05). (2) Three-dimensional reconstruction of type II anterior inferior spinal impingement showed that anterior inferior iliac spine was proliferative, hypertrophic, and extends downward, but did not protrude to the acetabular anterior edge. The anterior inferior iliac spine gap disappeared. Moreover, the protruding hypertrophic part of the anterior inferior iliac spine did not make obvious contact with the proximal femur during the entire exercise loading process. (3) It is not possible to infer or judge whether there is a low anterior inferior iliac spine through X-ray and CT scans. The imaging diagnosis of the low anterior inferior iliac spine still mainly depends on three-dimensional reconstruction. Patients with anterior inferior iliac spine may not have abnormal contact between the distal end of the anterior inferior iliac spine hypertrophy and the proximal femur. [ABSTRACT FROM AUTHOR]

BACKGROUND: The coverage of acetabular cup is used to evaluate the inclusiveness and stability of the acetabular cup after total hip arthroplasty. Plain radiograph examination of the hip is a common method to detect acetabular cup coverage during or after total hip arthroplasty. Different perspective angles may affect the measurement and evaluation of acetabular cup coverage. OBJECTIVE: To explore the relationship between the coverage of the acetabular cup under different perspectives after total hip arthroplasty. METHODS: Five three-dimensional printed synthetic pelvic specimens were taken, and 52 mm diameter acetabular cup prosthesis was placed by polishing the right acetabulum to prepare different acetabular cup coverage models. The prepared pelvis model was fixed with the right acetabulum as the center under the C-arm machine for fluoroscopy. By rotating the C-arm machine, the right hip joint was seen through the front view, 15°, 30°, and 45° axial position films and left 15°, 30°, and 45° oblique films. The coverage of the acetabular cup under different perspective angles was calculated by Photoshop2019 software to compare the difference between the acetabular cup coverage under the different angles of the axial and oblique films and the orthographic film. RESULTS AND CONCLUSION: (1) In the test of the acetabular cup coverage of the axial film, as the axial perspective angle was tilted upward; the coverage of the acetabular cup gradually increased, and was significantly higher in the upper 45° axial film group than that in the hip orthographic film group [increased (6.72±1.57)%, P=0.009]. (2) In the oblique film acetabular cup coverage test, as the perspective angle tilted to the left, the coverage rate showed a downward trend. The coverage was significantly lower in the left 45° oblique film group than that in the hip joint orthographic film group [decreased (5.56±1.91)%, P=0.021]. (3) Results confirm that there are differences in the coverage of the acetabular cup under different oblique perspective angles. The greater the upward axial tilt angle, the greater the cup coverage, and the greater the contralateral tilt angle, the less cup coverage. It is indicated that for patients undergoing total hip arthroplasty, attention should be paid to the intraoperative fluoroscopy angle. For complicated types of total hip arthroplasty patients, 45° oblique films can be shown during or after the operation to further evaluate the position and coverage of the cup. [ABSTRACT FROM AUTHOR]

BACKGROUND: Revision total hip arthroplasty with serious bone defect of acetabulum is complicated problem with technical challenges to joint surgeons, because of prosthetic installation difficulties, poor initial stability, postoperative prosthesis loosening. OBJECTIVE: To evaluate the effectiveness of structural bone grafting in revision total hip arthroplasty with Paprosky IIIA acetabular defect. METHODS: Between January 2010 and January 2018, 15 patients (15 hips) with Paprosky IIIA acetabular defect underwent revision total hip arthroplasty by structural bone grafting. All patients underwent revision total hip arthroplasty, with intramedullary reconstruction of the acetabulum with allogeneic femoral head during operation and weight-bearing walking in strict accordance with the rehabilitation program after operation. Standardized hip radiographs were assessed postoperatively 7 days, and at 6 months, 1 year and annually thereafter. The following outcomes were assessed: acetabulum cup coverage, bone graft coverage, the height and horizontal distance of center of hip rotation, bone graft healing and absorption, bone ingrowth, cup loosening, periprosthetic osteolysis, and Harris hip score. RESULTS AND CONCLUSION: (1) All patients were followed up for 2.5-10.0 years. The Harris score of the hip joint at the last follow-up was (83.2±5.8) points; compared with the preoperative data (25.3±5.3) points, the difference was significant (t=28.739, P=0.000). (2) The coverage rate of the acetabular cup was 91.7%-100% at postoperative 7 days, with an average of (95.6±2.2)%. The coverage rate of the bone graft at postoperative 7 days was 21.5%-53.2%, with an average of (37.4±10.0)%. (3) The horizontal displacement of the hip joint rotation center at postoperative 7 days was (5.8±1.7) mm; compared with the preoperative data (8.2±3.9) mm, the difference was significant (t=-2.128, P=0.042). At postoperative 7 days, vertical displacement of the center of rotation was (4.8±2.1) mm; compared with (22.2±4.2) mm before operation, the difference was significant (t=-14.321, P=0.000). (4) From 6 months to 1 year after surgery, 4 cases (4 hips) had mild absorption of allogeneic femoral heads, and the absorption was all located in the lateral non-stress distribution area, and did not affect the stability of the acetabular cup. In 15 cases (15 hips), trabecular bone connection could be found in allogeneic femoral head and acetabular bone junction. At the last follow-up, allogeneic femoral head and acetabular bone presented bone union, no nonunion. (5) Fifteen patients (15 hips) showed bone ingrowth into acetabula cup, and no acetabular loosening occurred at latest follow-up. No osteolysis was observed in acetabular zone. There were no complications in all patients, without deep vein thrombosis, infection, neurological damage, or dislocation. (6) It is concluded that structural bone grafting in revision total hip arthroplasty with Paprosky IIIA acetabular defect can effectively restore acetabular bone defects and reconstruct acetabulum. The eccentricity and rotation center of the hip joint recovered well; the hip joint function was good after operation; and good prosthesis stability was obtained; the early and mid-term clinical efficacy was satisfactory, but the long-term efficacy needs further clinical follow-up observation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Conservative treatment for acetabular fractures involving quadrilateral areas was usually adopted, but with the in-depth research on the acetabular fractures and the development of orthopedic implants, surgical treatment is currently advocated. The anterior acetabular surgical approach includes the iliac-groin approach, the modified Stoppa approach, and the pararectus abdominis approach. It is of great clinical significance to select a more reasonable surgical approach. OBJECTIVE: To compare the clinical efficacy and biocompatibility of the low-profile reconstruction plate through the pararetus approach and through the ilioinguinal approach for acetabular fractures involving quadrilateral areas. METHODS: Clinical data of 41 patients with acetabular fracture involving quadrilateral area treated in Zhangjiagang Hospital Affiliated to Soochow University from January 2015 to October 2019 were retrospectively analyzed. All patients were assigned to pararetus approach group (n=21) and ilioinguinal approach group (n=20), and received low-profile reconstruction plate fixaiton. Relevant clinical indicators during perioperative period were recorded in the two groups. During follow-up, Matta imaging assessment criteria were used to evaluate the effect of fracture reduction. Modified Merle d’Aubigné-Postel criteria were used to assess the function of affected hips, and visual analogue scale was used to evaluate the pain degree of hip joint, and statistical analysis was conducted. RESULTS AND CONCLUSION: (1) Totally 41 patients were followed up for more than 6 months. (2) The pararetus approach group was significantly better than the ilioinguinal approach group in incision length, fracture exposure time, operation time, blood loss and postoperative complications (P < 0.05). (3) Visual analogue scale scores were significantly lower in both groups at postoperative 6 months than that at postoperative 3 months (P < 0.05). The visual analogue scale scores in the pararetus approach group were significantly better than those in the ilioinguinal approach group during the follow-up of 3 and 6 months (P < 0.05). (4) The modified Merle d’Aubigné-Postel score was significantly higher in both groups at postoperative 6 months than that at postoperative 3 months (P < 0.05). The modified Merle d’Aubigné-Postel score was significantly higher in the pararetus approach group than that of the ilioinguinal approach group at the follow-up of 3 and 6 months (P < 0.05). (5) The difference of fracture healing time and satisfaction degree of fracture reduction had no statistical significance between two groups (P > 0.05). (6) Both anterior acetabular approaches with low-profile reconstruction plate can achieve good biocompatibility for acetabular fractures involving quadrilateral area. It is indicated that for acetabular fractures involving quadrilateral area, the placement of low-profile reconstruction plates through the pararectus approach has less trauma, higher safety, easier operation and better clinical efficacy. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are a variety of reference standards for the placement of acetabular prosthesis in hip arthroplasty at present. Many surgeons only rely on visual measurement of standard anteversion abduction angle when fixing acetabular prosthesis. The transverse acetabular ligament was used as a reference point in this study. OBJECTIVE: To study the value of transverse acetabular ligament as a marker of acetabular anteversion in total hip arthroplasty. METHODS: The anatomic descriptive study of transverse acetabular ligament was carried out on fresh hip joint specimens to determine its course and position of starting and ending points, so as to provide the basis for the reconstruction of transverse acetabular ligament in three-dimensional reconstruction. Totally 192 adults (384 hips) with normal joints undergoing hip CT scan were selected, including 84 males and 108 females, at the age of > 18 years. A radiologist and an orthopedic surgeon diagnosed that bilateral acetabulum morphology was normal, without tumor, deformity, or severe osteophyte. Acetabular transverse ligament anteversion was measured in CT digital three-dimensional reconstruction. The results were compared with those of Lewinnek safe area and bony acetabulum. RESULTS AND CONCLUSION: (1) Transverse acetabular ligament bridged the acetabular notch to form a complete circle. When the highest point of acetabulum was defined as 12 o'clock, transverse acetabular ligament was roughly located between 6 o'clock and 9 o'clock (taking the left side as an example). (2) The mean anteversion angle of transverse acetabular ligament was (12.9 ± 3.3)°, and the anteversion angle of three hips (6%) was beyond the safe area defined by Lewinnek (15±10)°. The average acetabular anteversion was (17.7±3.8)°, which was 4.7° larger than that of transverse acetabular ligament. (3) There was a significant correlation between transverse acetabular ligament anteversion and acetabular anteversion (r=0.759, P < 0.01). (4) It is concluded that in the hip joint with normal acetabular morphology, the alignment of transverse acetabular ligament anteversion and acetabular anteversion is not completely consistent, but there is an obvious correlation between them. Therefore, transverse acetabular ligament can be used as an anatomical marker for locating acetabular cup anteversion in total hip arthroplasty. [ABSTRACT FROM AUTHOR]

BACKGROUND: Short-segment fixation has been increasingly used in the treatment of thoracolumbar burst fractures. The procedure has been proven to have good clinical, functional and radiologic results. However, Kyphosis may recur after short-segment fixation and has been paid more and more attention by surgeons. OBJECTIVE: To summarize the classification of thoracolumbar fractures, indication of short-segment fixation, failure of short-segment fixation and the improved method of operation, so as to provide help for clinical treatment. METHODS: By searching CNKI, Wanfang, PubMed, Web of Science and other Chinese and English databases for articles published from 1983 to 2020, the Chinese search terms were “thoracolumbar fractures, short segment fixation, kyphosis” and the English search terms were “thoracolumbar fractures, short segment fixation, kyphosis”. Through the inclusion and exclusion criteria, 63 articles were finally included for induction and summary. RESULTS AND CONCLUSION: (1) For almost all type A and type B fractures of the non-ankylosing ridge column, posterior short-segment fixation can achieve good clinical results. Short-segment fixation is associated with a risk of recurrent kyphosis due to collapse of adjacent discs, and the clinical significance of recurrent kyphosis is not clear. (2) The posterior short-segment distraction reduction can effectively reduce the fractured vertebral body and promote the absorption and recovery of the bone mass in the vertebral canal through indirect traction, but it is not effective for the “inverted bone mass”. (3) The use of posterolateral fusion in conjunction with short-segment instrumentation is questionable. It has nothing to do with improving the clinical outcome, nor does it prevent recurrence of kyphosis or failure of internal fixation. (4) The use of load-sharing classification to quantify vertebral comminution and predict posterior fixation failure remains controversial. (5) The strategies for short-term fixation failure mainly focus on strengthening or enhancing the biomechanical strength of the rear structure in front. Transpedicular fixation in the strategy of increasing biomechanical strength of the posterior structure improved the effectiveness of the short-segment instrumentation and significantly reduced the implant failure rate, which is the current mainstream surgery in treatment of thoracolumbar fractures. (6) The surgical results of posterior short-segment fixation combined with transpedicular bone grafting or vertebroplasty for the reduction of fractured vertebrae need more clinical validation. (7) Minimally invasive percutaneous short-segment pedicle screw internal fixation is gradually applied in the treatment of the fracture of the ridge column, which can make the fracture well reduced and fixed in the early postoperative period, and is helpful for the recovery of the patient, and is the direction of development of short-segment fixation. [ABSTRACT FROM AUTHOR]

BACKGROUND: For Sanders type III calcaneal fractures, the classic “L-type” large incision often causes postoperative skin necrosis and other complications. Some scholars have shown that the use of mini plate through the tarsal sinus incision can significantly reduce the incision problems and achieve the same curative effect. However, there is still a lack of biomechanical verification. OBJECTIVE: Biomechanical tests were carried out on Sanders III cadaveric model to verify the effectiveness and reliability of posterior facet screw fixation combined with lateral column screw fixation. METHODS: Sanders III intra-articular calcaneal fracture models were established on five adult cadaveric lower limb specimens. The high flexible F3 plate system was used to fix the posterior articular surface, and two cannulated screws were used to support the inner and outer columns respectively. At the same time, the anterior calcaneal bone mass (block A), the medial posterior articular surface bone mass (bone block M), the lateral posterior articular surface bone mass (bone block L), and the posterior calcaneal bone block (bone block P) were labeled with rigid body. The relative distances between the bone fragments were marked as AM, AL, AP, ML, MP, LP. Then, 800 N cyclic load test and 2 000 N ultimate load test were carried out on the biomechanical test platform. Simultaneously, the displacement between the rigid bodies of each bone block was tracked by using the Qualisys motion capture system, and the data were recorded and analyzed by using the software of Qualisys track manager. RESULTS AND CONCLUSION: (1) In 800 N cyclic load test, the median displacements of AM, AL, AP, ML, MP and LP were 1.60, 1.68, 2.45, 2.20, 1.20 and 2.00 mm, and the average values were 1.99, 2.05, 2.05, 2.48, 1.17 and 1.97 mm. (2) Under the limit load of 2 000 N, the median displacements of AM, AL, AP, ML, MP and LP were 2.10, 1.85, 2.40, 2.10, 1.50 and 1.70 mm, and the average values were 2.09, 1.88, 2.44, 2.10, 1.59 and 1.69 mm. (3) The internal fixation system of all specimens withstood the load and maintained its integrity and reliability in both tests. There was no broken nail, no screw withdrawal or plate bending. Only one hollow nail was slightly bent in one case. (4) The internal fixation effect and biomechanical strength of the posterior facet screw fixation combined with lateral column screw fixation meet the design expectations. It is a reliable and effective method to treat sanders III calcaneal fractures with minimally invasive treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Total hip arthroplasty is the most effective method for the treatment of middle and late developmental dysplasia of the hip. The anatomical structure of developmental dysplasia of the hip patients is malformed, and acetabulum reconstruction is the difficulty of operation. At present, three-dimensional (3D) printing technology is used to reconstruct the pelvis model and guide the preoperative planning, but the direction and depth of the file have not been well solved. Thus, we will further mine the CT scan data of pelvis, and make a guide device using 3D printing technology to guide the direction of the file. OBJECTIVE: To investigate the clinical effect of 3D-printing assisted individualized total hip arthroplasty for adult developmental dysplasia of the hip. METHODS: Thirty patients with developmental dysplasia of the hip were included and randomly divided into two groups (n=15 per group). In the observation group, 3D pelvis model and operation guide plate were made through 3D printing technology to develop individual operation plan. In the control group, the operation was completed according to the routine operation process. The operation time, intraoperative blood loss, and Harris score of hip joint in the last follow-up were compared between the two groups, and the difference of abduction angle, vertical and horizontal distance with the design value was compared to evaluate the accuracy of acetabular prosthesis placement. RESULTS AND CONCLUSION: (1) There was no significant difference in the abduction angle, Harris score during the last follow-up and horizontal distance between the two groups after surgery (P > 0.05). (2) The operation time and intraoperative blood loss of the observation group were significantly less than those of the control group (P < 0.05). (3) The vertical difference between the two groups was statistically significant (P < 0.05), and the design deviation of the observation group was smaller. (4) It is indicated that with the help of 3D printing technology, preoperative observation of personalized 3D model was used to enhance the understanding of the anatomical variation of developmental dysplasia of the hip. During the operation, the guiding function of acetabular prosthesis was used to improve the accuracy of acetabular prosthesis placement, shorten the operation time and reduce the amount of intraoperative blood loss. [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]

BACKGROUND: For patients with Crowe II and III developmental dysplasia of hip combined with severe hip osteoarthritis, total hip arthroplasty is still controversial whether to choose acetabular anatomical reconstruction or high hip rotation center reconstruction. OBJECTIVE: To compare the differences in gait characteristics between the reconstruction technique of the high hip center and the anatomical hip center during total hip arthroplasty. METHODS: Forty patients with Crowe II-III developmental dysplasia of hip with unilateral hip disease from January 2014 to July 2017 were selected. All patients received total hip arthroplasty, of which 20 cases underwent acetabular anatomical reconstruction, and another 20 patients underwent high hip center reconstruction. The patients were followed up for more than 2 years after arthroplasty for gait analysis. The study was approved by Ethics Committee of Affiliated Hospital of Xuzhou Medical University. RESULTS AND CONCLUSION: (1) Spatiotemporal parameters: The pace, stride frequency, step length, single leg support time, single leg swing time, and double leg support time of the two groups of surgical side and non-surgical side were similar. There was no significant difference in pace, stride frequency, step length, one-leg support time, one-leg swing time, and two-leg support time between the two groups (P > 0.05). (2) Kinematic parameters: The maximum extension of the hip joint on the surgical side of the high reconstruction group was lower than that on the non-surgical side (P < 0.01). The maximum hip flexion and hip flexion and extension range of the two groups on the surgical side were lower than those on the non-surgical side (P=0.01). The maximum extension of the hip joint and hip flexion and extension range in the high reconstruction group were lower than those in the anatomical reconstruction group (P < 0.05). The maximum flexion of the hip joint, maximum knee flexion, knee flexion and extension range, and maximum dorsiflexion of the ankle, the maximum plantar flexion of the ankle, and the range of ankle dorsiflexion were not significantly different between the two groups (P > 0.05). (3) Kinetic parameters: The longitudinal peak of the plantar reaction force on the surgical side of the high reconstruction group was higher than that of the anatomical reconstruction group (P < 0.05). There was no significant difference between the internal and external peaks of the plantar reaction force and the front and back peaks of the two groups on the surgical side (P > 0.05). (4) The results show that in patients with developmental dysplasia of hip, total hip arthroplasty using high hip center reconstruction can obtain gait parameters similar to anatomical hip center reconstruction. However, compared with patients undergoing anatomical hip rotation center reconstruction, patients with high hip center reconstruction had limited hip flexion and extension range movement and greater longitudinal force on the hip. [ABSTRACT FROM AUTHOR]

BACKGROUND: Currently, surgical treatment for acetabular labrum injury includes debridement, repair, refixation and acetabular labrum reconstruction. Labrum reconstruction is a newly developed surgical method which uses autograft or allograft to repair labrum defect . At. present, there are many options for graft repair, and the recent follow-up shows that this method can well restore the structure and function of the labrum, and has certain advantages over debridement, excision, and repair. However, no study has shown the long-term effect of reconstruction, and which situation and which graft are more suitable. OBJECTIVE: To review graft selection of acetabular labrum reconstruction under arthroscopy. METHODS: Pub Med and GeenMedica databases were retrieved for studies on ace tabular labrum reconstruction published from 2000 to 2019, especially in the past 10 years. The key words were "labrum, reconstruction, graft, hip, acetabulum". RESULTS AND CONCLUSION: (1) There are a number of options tor graft repair, including autograft (iliotibial band, gracilis and semitendinosus, quadriceps tendon, rectus femoris tendon, joint capsule) and allograft (peroneus brevis, tensorfascia lata). Recent follow-up shows that these grafts can restore labrum structures and hip movement (2) However, as an emerging surgical procedure, there is currently a lack of long-term follow-up and prospective comparative studies to prove the long-term effects of reconstruction and prove which grafts are more suitable in which conditions. (3) In future studies, we need to compare the medium and long-term efficacy of different grafts for clinical selection. With the development of science and technology, the problem of artificial composite materials has been solved, and will become a more promising alternative. [ABSTRACT FROM AUTHOR]

BACKGROUND: The accuracy of acetabular prosthesis placement during total hip arthroplasty has a direct effect on postoperative hip function, stability and service life. Unreasonable placement of the cup may lead to adverse events, so CT imaging should be emphasized. OBJECTIVE: To analyze the differences of acetabular parameters in hip arthroplasty between the horimntal and true pelvic planes on CT images, and to determine the possible impact on surgery outcomes. METHODS: Seventy-two cases of pelvic soft tissue disease were selected. All patients signed the informed consents, and the study was approved by the hospital ethics committee. The anteversion angle, acetabular angle, acetabular depth, acetabular width, femoral head midpoint-acetabular margin angle, abduction angle between the true pelvic plane and the horizontal plane were measured by CT positioning film and its scanning image. CT software was selected to reconstruct the three-dimensional image, and then scanned vertically with the true pelvic plane. The above parameters were measured in the same way. The differences of parameters between left and right acetabulum and two planes were compared by paired t test. Spearman correlation analysis was used to analyze the correlation between the angles between the two reference planes and the difference between the measured parameters. RESULTS AND CONCLUSION: (1) There was no significant difference in the values of the left and right acetabular parameters between the horimntal plane and the true pelvic plane (P > 0.05). {2) The pelvic tilt angle was positively correlated with the femoral head midpoint-acetabular margin angle and the acetabular anteversion angle between the two reference surfaces, and negatively correlated with the acetabular angle and acetabular depth. (3) Our results suggest that during the CT scan of the supine position, the pelvis is accompanied by a rotation condition. The parameters of the true pelvis plane as a reference are inaccurate with the directly measured acetabular parameters. Therefore, attention should be paid to the preparation of the surgical plan before surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hip arthroplasty is most effective method to treat hip diseases such as femoral head necrosis, osteoarthritis, hip dysplasia and femoral neck fracture in the elderly. Therefore, it is necessary to study the biomechanical behaviors of hip arthroplasty. OBJECTIVE: To simulate the contact stress and Von Mise stress values and distributions of trabecular acetabular cup and solid acetabular cup by finite element analysis method, and to predict its effects on prosthesis and hip joint. METHODS: Two hip joint component models with different structures, trabecular acetabular cup and solid acetabular cup were designed in 3-Matic Research 11.0 software. The well-designed models were imported to Hypermesh 14.0 software to divide meshes and assign material properties. Finite element analysis software Abaqus 6.13 was used to simulate the stress values and distributions of both models. RESULTS AND CONCLUSION: The results of this study showed that the stress of the trabecular acetabular cup was scattered and distributed widely. The solid acetabular cup is prone to stress concentration, and the stress distribution is concentrated near the point of stress. Compared with the solid acetabular cup and the trabecular acetabular cup, the latter has larger contact area of stress distribution and more uniform stress distribution, which can reduce the wear between hip prostheses and the risk of aseptic loosening of hip prostheses. [ABSTRACT FROM AUTHOR]

BACKGROUND: For patients with acetabular defect, it may be difficult to place the prosthesis in total hip replacement because of insufficient coverage. Structural bone graft reconstruction of acetabulum can make the prosthesis achieve coverage and stability, but how to obtain better coverage of bone graft is the key to affect the curative effect.OBJECTIVE: To observe the curative effect of structural bone graft reconstruction for total hip arthroplasty in patients with developmental dysplasia of hips and severe acetabular defects, and to assess the effect of bone graft coverage on repair. METHODS: Totally 80 patients(100 hips) with severe acetabular defects and hip dysplasia admitted to Department of Bone and Joint Surgery, Gaozhou City Hospital of Traditional Chinese Medicine from February 2010 to February 2016 were selected as the research objects. All patients underwent total hip arthroplasty, with intramedullary reconstruction of the acetabulum with autologous femoral head during operation. The pelvis was examined by X-ray during follow-up. Harris scores were compared between preoperative, postoperative 1 and 2 years. Group allocation was conducted according to graft coverage(≥ 70%, 65%-69%, < 65% in the groups Ⅰ, Ⅱ and Ⅲ, respectively). RESULTS AND CONCLUSION:(1) Postoperative X-ray evaluation showed that the position of acetabular prosthesis was ideal and the healing of acetabular bone graft was good. Among them, 8 cases had slight bone resorption at the outer edge of acetabular prosthesis, but no prosthesis loosening was found during follow-up.(2) Harris scores 1 year and 2 years after surgery were significantly higher than those before surgery(P=0.000).(3) Host bone coverage was(73.25±1.40)%, and bone graft coverage was(26.75±0.94)% in the Ⅰ group. In the Ⅱ group, there were 32 cases(38 hips) with host bone coverage from 65% to 69%; the host bone coverage was(67.15±0.57)%, and bone graft coverage(32.75±0.46)%. In the Ⅲ group, there were 20 cases(27 hips) with host bone coverage < 65%; the host bone coverage was(55.22±1.10)%, and bone graft coverage(44.78±0.85)%. There was no significant difference in Harris score between Ⅰ group andⅡ group at 1 and 2 years after operation. Harris scores were lower in the Ⅲ group than in the Ⅰ and Ⅱ groups(P=0.000).(4) For patients with developmental dysplasia of hips and severe acetabular defects, reconstruction of the acetabulum with total hip arthroplasty may get a more satisfactory effect. This study was approved by the Ethics Committee of Gaozhou City Hospital of Traditional Chinese Medicine on January 12, 2019(approval No. GZSZYY83741002). [ABSTRACT FROM AUTHOR]

An innovative 3D modeling method for the hip joint and reparative modeling for femoral head based on CT images and the reverse engineering is proposed. The processing scheme consists of the following steps: first, detecting bone tissues from CT images and segmenting the femoral head and acetabulum respectively by model based on segmentation method. Then, the contours of femur and acetabulum are recorded as the style of points. After being reduced, the part point data of femoral head and acetabulum are extracted respectively and fitted by the way of the least square. Accurate reparative results are achieved from two collapsed femoral head of ANFH patients by the proposed method. Experiments show that the new method can reconstruct hip joint model and regain femoral head of patients perfectly. It can be developed to other joints or bone tissues too. The method affords theoretical model for accurate operation position fixed in orthopedics clinic and biomechanics analyses, and it also provides more effective ways for the individually manufacturing of artificial hip joint. [ABSTRACT FROM AUTHOR]