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Objective: This study aimed to observe the analgesic effect of the cocktail formulation with diprospan during total hip arthroplasty (THA)., Methods: From September 2018 to April 2019, 120 patients undergoing primary unilateral THA were included in this prospective, randomized, observer-blinded study. Patients were randomized into three groups, according to the different local infiltration analgesia (LIA) strategies: LIA with ropivacaine (the ropivacaine group, n = 40), LIA with a new cocktail containing ropivacaine, diprospan, and morphine (the cocktail group, n = 40), and the control group (n = 40). The primary outcomes included postoperative pain scores. The resting visual analogue scale (VAS) scores were measured at 2, 6, and 12 h after the surgery (a.m. and p.m.) on postoperative day (POD) 1, POD2, and the day of discharge. Movement VAS scores were assessed at 6 h, 12 h after the operation (a.m. and p.m.) on POD1, POD2, and the day of discharge. The secondary outcomes included opioid consumption, postoperative hospital stay, range of motion of the hip at discharge, patient satisfaction, and the results of the follow-up., Results: After the screening, 120 patients were randomized into three groups (40 patients in each group). All of the patients completed the trial. The resting VAS scores in the ropivacaine group and cocktail group at 2 h were lower than those in the control group (P < 0.001 and P < 0.001, respectively, F = 17.054), and the same trend was also postoperatively found at 6 h (p = 0.005 and P = 0.002, F = 6.212). Twelve hours after the operation, the pain score in the cocktail group was lower than that in the other two groups, but only the difference between the cocktail group and the control group was statistically significant (P = 0.018, F = 3.144). From the morning of the first postoperative day to the a.m. on POD 2, the VAS scores in the cocktail group were significantly lower than those in the ropivacaine group and the control group. Furthermore, the movement VAS scores in the ropivacaine group and the cocktail group were better than those in the control group at 6 and 12 h post-operation (P < 0.05). The per capita opioid consumption in the cocktail group was less than that in the ropivacaine group and the control group within 24 h post-operation. There were no significant differences in the comparison of additional indicators among the three groups., Conclusion: The new cocktail with diprospan had a better result and longer duration time for early postoperative pain control in primary THA via the posterolateral approach under general anesthesia, especially for treating resting pain., (© 2022 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Objective: The aim of the present study was to evaluate the 10-year outcomes of cementless total hip arthroplasty (THA) in adult patients with the late sequelae of septic arthritis of the hip., Methods: We followed 166 consecutive patients (168 hips) who underwent cementless THA between March 2001 and December 2011. There were 79 men and 87 women, with a mean age of 50.4 years (range 21-76 years) at the time of index THA, all of whom had hip osteoarthritis secondary to hip pyogenic infection. The average duration of follow up was 10.6 years (range 6.9-17.2 years). Preoperative and postoperative clinical ratings were evaluated, including the hip dysfunction and osteoarthritis outcome score (HOOS), the Harris hip score (HHS), range of motion, a 100-point visual analog scale for hip pain, and the severity of limp and limb length discrepancy (LLD). The anteroposterior and lateral radiographs of the hip and full-length view of the lower extremities were obtained to assess the position of the components, radiolucent lines, osteolysis, loosening of components, and heterotopic ossification. The intraoperative and postoperative complications were also recorded., Results: The mean HSS and hip pain score were 44.2 points (range 29-66 points) and 42.5 points (range 32-64 points), respectively, before the index surgery and significantly improved to 88.1 points (range 78-96 points) and 15.1 points (range 10-26 points), respectively, at final follow-up examination. The HOOS and range of motion also improved significantly. The mean limb length discrepancy was reduced from 2.6 to 0.8 cm. The limp at last follow-up examination was moderate in 3 cases because of hip osteoarthritis in the other limb, slight in 26, and absent in 137. A radiolucent line was observed in 12 hips (7.1%) around the acetabular or femoral components. A progressive radiolucent line around the undersized femoral stem in all zones was seen in 1 hip, resulting in aseptic loosening and breakage of the femoral component. There were 8 cases of intraoperative fracture, 7 cases of dislocation, and 7 cases of transient nerve palsy. Recurrence of infection occurred in 2 hips. Revision surgery was conducted in 2 hips because of isolated loosening of the acetabular cup and the femoral stem, respectively. Kaplan-Meier survival was 97% at 10 years, with revision for any reason with any component as an end-point., Conclusion: Improved surgical techniques and development of components with various sizes provided favorable results for cementless THA conducted for late sequelae of sepsis in these young and active patients. Although the incidence of complications was relatively high, the complications were treated successfully., (© 2021 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)

The diagnostic potential of D-dimer and fibrinogen to detect periprosthetic joint infection (PJI) of the hip and knee is not well-understood. The aim of this study was to determine whether D-Dimer and fibrinogen can be used as effective biomarkers to screen PJI. A systematic review of the literature indexed in Web of Science, PubMed, Cochrane Library, Embase, and Google Scholar databases was performed. All studies using D-dimer levels in serum or plasma, or fibrinogen levels in plasma, for the diagnosis of PJI were included. Meta-analysis estimates, including sensitivity, specificity, diagnostic odds ratios (DOR), and the area under the summary receiver operating characteristic curve (AUSROC), were calculated using a random-effects model, and used to assess the diagnostic accuracy of these biomarkers. A total of nine studies were analyzed, and their quality was considered to be acceptable. D-dimer gave a limited diagnostic value if serum and plasma combined: sensitivity (0.77, 95% confidence interval [CI] [0.63 to 0.87]), specificity (0.67, 95% CI [0.54 to 0.78]), DOR (6.81, 95% CI [2.67 to 17.37]), and AUSROC (0.78, 95% CI [0.74 to 0.82]). Plasma D-dimer levels were associated with less satisfactory sensitivity (0.65, 95% CI 0.57 to 0.71), specificity (0.58, 95% CI 0.50 to 0.66), DOR (2.52, 95% CI 1.64 to 3.90), and AUSROC (0.65, 95% CI 0.61 to 0.69). Serum D-dimer levels showed higher corresponding values of 0.89 (95% CI 0.79 to 0.94), 0.76 (95% CI 0.55 to 0.89), 24.24 (95% CI 10.07 to 58.32), and 0.91 (95% CI 0.88 to 0.93). Plasma fibrinogen showed acceptable corresponding values of 0.79 (95% CI 0.70 to 0.85), 0.73 (95% CI 0.57 to 0.85), 10.14 (95% CI 6.16 to 16.70), and 0.83 (95% CI 0.79 to 0.86). Serum D-dimer may be an effective marker for the diagnosis of PJI in hip and knee arthroplasty patients, and it may show higher diagnostic potential than plasma fibrinogen. Plasma D-dimer may have limited diagnostic potential., (© 2021 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)

Objective: To assess the safety and effectiveness of one-stage total joint arthroplasty (TJA) or revision for seronegative infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA)., Methods: This retrospective study included a total of 495 patients who had undergone one-stage total joint (hip or knee) arthroplasty or revision with a diagnosis of osteoarthritis secondary to sepsis, osteoarthritis or osteonecrosis of the femoral head (ONFH) secondary to internal fixation surgery of the hip joint, and one-stage revision for prosthesis loosening after THA or TKA from January 2012 to December 2016. Bacterial cultures were taken from all patients (from joint fluid or articular cavity fluid and four to six different parts of soft tissues) during the operation. If the cultures were positive, patients received antibiotic treatment. Microbiology results from surgical samples, clinical evaluations, SF-12 score (physical component summary [PCS] and mental component summary [MCS]), Harris hip score (HHS) or Hospital for Special Surgery (HSS) score, and patients' satisfaction was recorded at every follow-up session., Results: A total of 24 patients had a positive result for bacterial culture (4.85%). The bacterial culture results showed that there were 19 cases (79.16%) of gram-positive cocci (Staphylococcus aureus), 4 cases (16.67%) of gram-negative bacilli, and 1 case (4.17%) of fungi. For at least 24 months (mean 35 months) follow-up, no reinfection was discovered. The mean HHS or HSS score improved significantly from 36.29 points preoperatively to 84.21 points postoperatively (P < 0.001). The mean PCS score improved from 10.15 preoperatively to 20.34 postoperatively, and the mean MCS from 13.22 preoperatively to 21.76 postoperatively, with significant differences. Most of the patients were satisfied., Conclusion: One-stage arthroplasty or revision with exhaustive debridement, adequate dosage, and duration of sensitive antibiotics is safe and effective for patients who have seronegative infection of hip or knee joints., (© 2019 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)

Background: The aim of this study was to evaluate the influence of total hip arthroplasty on axial alignment of the lower limb in adults with unilateral developmental hip dysplasia (Crowe type IV)., Methods: We retrospectively reviewed medical records of 50 adults who underwent total hip arthroplasty, in which the acetabular cup was placed in the anatomical position. The following parameters were measured before surgery, immediately after surgery, and two years later: mechanical axis deviation (MAD), tibiofemoral angle (TFA), femoral offset, hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (LDFA), mechanical medial proximal tibial angle, height of medial femoral condyle, height of lateral femoral condyle, and leg lengthening. Length of the resected femoral segment was also recorded from medical records., Results: Preoperative MAD, TFA, HKA, and LDFA of the ipsilateral lower limb showed significant valgus deformity. MAD of the ipsilateral lower limb and valgus inclination were significantly smaller immediately after surgery than before, while TFA, HKA, femoral offset, and LDFA were significantly larger (P < 0.05). These parameters did not differ significantly between immediately after surgery and two years later (P > 0.05). Ipsilateral extremities were extended by a mean of 2.54 cm (range, 0 to 5.35 cm). The mean length of the femoral resected segment was 3.56 cm (range, 2.03 to 5.74 cm). The contralateral lower limb showed marginally smaller MAD and medial proximal tibial angle after surgery than before, but larger LDFA, TAF, and HKA., Conclusions: In patients with developmental hip dysplasia who underwent total hip arthroplasty with placement of the acetabular component at the level of the anatomic hip center, axial alignment of the ipsilateral lower limb was immediately altered, and valgus inclination was significantly reduced. The procedure only slightly altered the axial alignment of the contralateral lower limb., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The purpose of this study is to analyze the 10-year outcomes of cementless, modular total hip arthroplasty (THA) in adult patients who had high dislocation secondary to childhood pyogenic arthritis., Methods: We retrospectively followed 56 consecutive patients who underwent cementless, modular THA for the late sequelae of childhood septic arthritis of the hip from 2001 to 2011. There were 23 men and 33 women with a mean age of 47 years (24 to 68). Of the 56 hips, 25 were classified as Crowe type III and 31 as type IV. Mean follow-up was 10.7 years., Results: One hip with a quiescent period of 23 years had recurrence of infection. Revision surgery was performed in 2 patients because of loosening and breakage of femoral stem and new infection with no correlation with childhood sepsis, respectively. The mean Harris hip scores improved from 44.2 points preoperatively to 87.5 points at final follow-up. Similarly, the Hip dysfunction and Osteoarthritis Outcome Score and hip pain also significantly improved at the latest follow-up. The mean acetabular cup abduction was 40.8° and the mean anteversion 27.8°, respectively. There were 5 cases of transient nerve palsy and 5 cases of intraoperative fracture., Conclusion: THA can reliably restore the abnormal anatomy and provide good results in these young and active patients who had high hip dislocation secondary to childhood pyogenic arthritis with a relatively high incidence of complications. However, these complications can be treated., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The lower limb joints, including hip and knee, are the most commonly involved joints in haemophilic arthropathy. With a higher risk of transfusion, total hip and knee arthroplasty (THA and TKA) are still the first choice after failure of conservative treatment. In the present study, we aimed to analyze clinical outcomes and complications rate after total joint arthroplasty of the lower limbs using tranexamic acid (TXA) or not., Methods: Thirty-four patients with haemophilia A undergoing 24 TKA and 18 THA were evaluated in this retrospective study (No. 201302009). Based on using TXA or not, they were divided into either TXA (12 knees and 10 hips) or Non-TXA groups (12 knees and 8 hips). Total blood loss, intraoperative blood loss, total amount of FVIII usage, range of motion, inflammatory biomarkers, joint function, pain status, complication rate and patient satisfaction were assessed and compared at a mean follow-up of 68 months., Results: Usage of TXA can decrease not only the perioperative blood loss (p = 0.001), transfusion rate (p = 0.017) and supplemental amount of FVIII (p < 0.001) but also swelling ratio, surgical joint pain. Moreover, compared with non-TXA group, the patients in TXA group had a lower level of inflammatory biomarkers and better joint function., Conclusion: The hemophiliacs treated with TXA had less perioperative blood loss, hidden blood loss, transfusion rate, a lower ratio of postoperative knee swelling, less postoperative joint pain, lower levels of inflammatory biomarkers and better joint function. Further studies need performing to assess the long-term effects of TXA in these patients.

Background: Previous studies have confirmed that, compared with intravenous and intra-articular formulations, oral tranexamic acid (TXA) provides equivalent reduction in blood loss, at a substantially reduced cost and greater ease of administration. However, the optimal oral dosage regimen to achieve maximum blood-loss reduction remains unclear. The aim of this study was to assess the efficacy of a regimen of multiple doses of oral TXA on blood loss in primary total hip arthroplasty., Methods: In this randomized controlled trial, 200 patients were randomized to 1 of 4 interventions. Group A received a single dose of 2.0 g of TXA orally at 2 hours preoperatively. In addition to this same preoperative dose, Group B received 1.0 g of TXA orally at 3 hours postoperatively, Group C received 1.0 g of TXA orally at 3 and 9 hours postoperatively, and Group D received 1.0 g of TXA orally at 3, 9, and 15 hours postoperatively. All patients received a 1.0-g topical dose of TXA. The primary outcome was total blood loss. Secondary outcomes included hemoglobin reduction, transfusion rate, thromboembolic complications, and adverse events., Results: The mean total blood loss (and standard deviation) was significantly less in Groups B, C, and D (792.2 ± 293.0, 630.8 ± 229.9, and 553.0 ± 186.1 mL, respectively) than in Group A (983.6 ± 286.7 mL) (p < 0.001). Moreover, Groups C and D had a lower mean reduction in hemoglobin than did Groups A and B. However, no differences were identified between Groups C and D for blood loss and hemoglobin reduction. Additionally, no differences were observed among the groups regarding thromboembolic complications and transfusions., Conclusions: The multiple postoperative doses of oral TXA further reduced blood loss compared with a single preoperative bolus. The regimen of a preoperative dose and 3 postoperative doses of oral TXA produced maximum effective reduction of blood loss in total hip arthroplasty., Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Tranexamic acid (TXA) reduces surgical blood loss and alleviates inflammatory response in total hip arthroplasty. However, studies have not identified an optimal regimen. The objective of this study was to identify the most effective regimen of multiple-dose oral TXA in achieving maximum reduction of blood loss and inflammatory response based on pharmacokinetic recommendations. We prospectively studied four multiple-dose regimens (60 patients each) with control group (group A: matching placebo). The four multiple-dose regimens included: 2-g oral TXA 2 hours pre-operatively followed by 1-g oral TXA 3 hours post-operatively (group B), 2-g oral TXA followed by 1-g oral TXA 3 and 7 hours post-operatively (group C), 2-g oral TXA followed by 1-g oral TXA 3, 7 and 11 hours post-operatively (group D) and 2-g oral TXA followed by 1-g oral TXA 3, 7, 11 and 15 hours post-operatively (group E). The primary endpoint was estimated blood loss on post-operative day (POD) 3. Secondary endpoints were thromboelastographic parameters, inflammatory components, function recovery and adverse events. Groups D and E had significantly less blood loss on POD 3, with no significant difference between the two groups. Group E had the most prolonged haemostatic effect, and all thromboelastographic parameters remained within normal ranges. Group E had the lowest levels of inflammatory cytokines and the greatest range of motion. No thromboembolic complications were observed. The post-operative four-dose regimen brings about maximum efficacy in reducing blood loss, alleviating inflammatory response and improving analgaesia and immediate recovery., Competing Interests: None declared., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Tranexamic acid (TXA), delivered intravenously or topically, has been shown to reduce blood loss, the need for transfusion, and relevant healthcare costs when administered in primary standard total hip arthroplasty (THA). Whether the same is true of oral TXA is unclear, the purpose of this study was to determine if oral tranexamic acid is equivalent to intravenous TXA in the case of patients undergoing THA via the direct anterior approach., Methods: In this prospective randomized controlled trial, 120 patients undergoing primary THA by the direct anterior approach were randomized to receive oral TXA (two doses of 20 mg/kg), intravenous TXA (two doses of 15 mg/kg), or no TXA. Primary outcomes were haemoglobin drop, haematocrit levels, total blood loss, intra-operative blood loss, need for transfusion, and volume transfused. Secondary outcomes included thromboembolic events, wound complications, the length of post-operative hospital stay, and 30-day readmission., Results: Demographic characteristics were similar among the three patient groups (p > 0.05, n = 40 per group). Haemoglobin drop, haematocrit levels, total blood loss, and intra-operative blood loss were similar in the oral and intravenous groups (p > 0.05), and significantly smaller than in the control group (p < 0.05). Transfusions were given to significantly fewer patients in the oral group (3%) and intravenous group (6%) than in the control group (27%, p = 0.01). Costs of TXA and transfusions were significantly lower in the oral group than the intravenous group (p < 0.05). The three groups were similar in thromboembolic events, wound complications, the length of post-operative hospital stay, and 30-day readmission (p > 0.05)., Conclusion: Oral TXA shows similar efficacy and safety as intravenous TXA for reducing haemoglobin drop, haematocrit levels, total blood loss, and transfusion rate following THA by the direct anterior approach. Therefore, the much less-expensive oral formulation may be superior to the intravenous form.

Purpose: To compare the efficacy of multiple doses of oral tranexamic acid (TXA) with topical TXA administration in reducing blood loss following total hip arthroplasty (THA)., Patients and Methods: In this double-blinded trial, 117 patients undergoing primary THA were randomized to receive 2 g TXA orally 2 h preoperatively, and two doses of 1 g TXA postoperatively (oral group) or 3 g of TXA topical administration in the operating room (topical group). The primary outcome was a reduction in hemoglobin concentration. Other outcomes-such as blood loss, TXA-related cost (¥), length of hospital stay (days), complications such as pulmonary thromboembolism (PE), deep vein thrombosis (DVT), and infection, blood coagulation and fibrinolysis, and hip function-were recorded., Results: The mean reduction in hemoglobin level was similar between the oral and topical groups (3.07 g/dL compared with 3.12 g/dL; p = 0.85). Similarly, there was no significant difference in the mean total blood loss between oral and topical administration (863 mL compared with 902 mL; p = 0.62). Three patients received an allogeneic blood transfusion, including one patient in the oral group and two patients in the topical group (p = 0.55). The oral group had a significantly lower TXA-related cost than the topical group: ¥944 and ¥4359, respectively (p = 0.01). No PE, DVT, cardiac infarction or renal failure occurred during the 90-day follow-up. The coagulation and fibrinolysis parameters were similar between the two groups., Conclusion: Oral TXA is equivalent to topical TXA administration in the reduction of blood loss in the setting of primary THA without drainage., (Copyright © 2018. Published by Elsevier Ltd.)

Background: Tranexamic acid (TXA) has demonstrated efficacy in reducing blood loss, reduction in hemoglobin, and blood transfusion requirements in primary total hip arthroplasty (THA). The optimal mode of TXA administration for patients undergoing primary THA is unclear. The purpose of this randomized controlled trial is to determine whether oral administration of TXA was superior to intravenous or topical routes in these patients., Methods: In this double-blinded, placebo-controlled trial, patients undergoing primary THA were randomized to oral (2 g TXA orally 2 hours preoperatively), intravenous (20 mg/kg intravenous TXA bolus 5 minutes before the incision), or topical (2 g TXA applied topically) TXA groups. The primary outcome was the reduction in hemoglobin. Secondary outcomes included blood loss, transfusion rate, cost of TXA (Chinese yuan (¥); in 2017, ¥1 = $0.147), and adverse events., Results: One hundred eighty patients were randomized into the 3 groups. Demographic characteristics were similar among the groups. The mean reduction in hemoglobin was similar among the oral, intravenous, and topical groups (3.48 ± 1.32, 3.58 ± 1.07, and 3.66 ± 1.26 g/dL, respectively). Similarly, the mean total blood loss did not differ significantly among the 3 groups. The oral group incurred the lowest TXA cost (¥480) compared with that in the intravenous (¥3329.28) and topical (¥3540) groups (P = .01). None of the patients sustained a deep venous thrombosis, pulmonary embolism, or an infection., Conclusion: The blood-sparing efficacy of oral TXA is comparable to that of the intravenous and topical forms. Oral TXA is recommended because of its cost-benefit superiority and ease of administration., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: To evalute the efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty (THA)., Methods: One hundred ten patients received two-dose of 10 mg IV-dexamethasone (group dexa) or IV-isotonic saline (group placebo). The level of C-reactive protein (CRP) and interleukin-6 (IL-6), pain at rest and during mobilization, incidence of post-operative nausea and vomiting (PONV), intensity of nausea, post-operative fatigue, consumption of analgesic and antiemetic rescue, range of motion (ROM), post-operative length of stay (post-operative LOS), wound problems and complications were recorded and compared., Results: The level of inflammation markers (CRP, IL-6) in group dexa was lower than group placebo at 24, 48, 72 hours post-operatively. Dynamic pain VAS score at 24 hours was lower in group dexa (P = 0.002), however, there was no significant effect on pain at rest. In group dexa, patients had a lower incidence of PONV (P = 0.003), as well as a lower VAS score of nausea (P = 0.044). The post-operative fatigue (P < 0.001) was relieved and the consumption of analgesic and antiemetic rescues were reduced. Furthermore, patients had better maximum hip flexion (P < 0.001) and abduction (P = 0.017), with shorter post-operative LOS (P = 0.006). There is no difference between groups in wound problems. No surgical site infection or gastrointestinal haemorrhage was detected in both groups., Conclusions: The administration of two low-dose peri-operative dexamethasone can effectively reduce the post-operative level of CRP and IL-6, provide additional pain and nausea control, ameliorate post-operative fatigue, enhance mobility, and shorten post-operative LOS following THA, without increasing the risk of infection and gastrointestinal hemorrhage., Level of Evidence: I.

Background: Given the lack of studies of acetabular defect reconstruction in primary total hip arthroplasty (THA) using tantalum augments, this study aims to evaluate clinical and radiographic results for treatment with tantalum augments to reconstruct acetabular defects in primary THA., Methods: We retrospectively reviewed 19 patients (19 hips) with acetabular defects who underwent primary THA using tantalum augments, with a minimum follow-up of 2 years. Clinical, radiographic, and surgical data were retrospectively evaluated., Results: Mean follow-up was 5.1 years (range 2.5-7.6). Harris Hip Score improved from 35.8 (range 19-56) preoperatively to 85.3 (63-98) at last follow-up (P < .01). Oxford Hip Score, University of California Los Angeles activity scale, and Short Form-12 score also improved significantly from presurgery to last follow-up. Mean operation time and blood loss were 124.7 minutes and 530 mL, respectively. Mean hip center position was 2.97 cm (range 2.35-3.58) horizontally and 2.06 cm (1.29-2.92) vertically, and mean acetabular inclination was 38.9° (range 27°-47°) at last follow-up. These parameters were not significantly different from those recorded immediately postoperatively (P > .05). There was no aseptic loosening, cup and augment migration, screw breakage, or presence of hip infection at last follow-up. All hips were radiographically stable., Conclusion: Porous tantalum augments combined with titanium shells lead to satisfactory clinical and radiographic outcomes for the reconstruction of acetabular defect in primary THA at a mean 5.1 years of follow-up. This approach confers anatomical cup placement, simple operation, and a high rate of stable fixation., (Copyright © 2017. Published by Elsevier Inc.)

Background: To investigate the differences in the perioperative serum cortisol, C-reactive protein (CRP) and interleukin-6 (IL-6) levels between aged and middle-aged patients undergoing total hip arthroplasty (THA)., Methods: Sixty patients (30 aged and 30 middle-aged) undergoing THA for osteoarthritis between August 2016 and January 2017 participated in this study. Blood samples were collected preoperatively and at 6 hours, 24 hours and 3 days after surgery to measure the cortisol, CRP and IL-6 concentrations. The clinical outcomes were assessed using the visual analogue scale (VAS) pain score and Harris hip score (HHS)., Results: No significant differences were found between the two groups before the operation in the cortisol, IL-6 and CRP levels; the VAS score; or the HHS. Cortisol was significantly lower at 6 hours after surgery in the aged group than in the middle-aged group (P < 0.05). IL-6 at 6 and 24 hours after surgery, CRP at 3 days after surgery and the VAS score at 6 and 24 hours after surgery in the aged group were significantly higher than those in the middle-aged group (P < 0.05). In the aged group, weak correlations were found between the cortisol concentration 6 hours after THA and the IL-6 level 24 hours after THA (r = -0.37, P = 0.04) and between the IL-6 level 6 hours after THA and the VAS score 24 hours after THA (r = 0.42, P = 0.02)., Conclusion: Aged patients showed lower cortisol levels at 6 hours after surgery and higher IL-6 levels at 6 and 24 hours after surgery than middle-aged patients undergoing THA.

Background: This retrospective study was designed to determine complications, functional and radiographic results of transverse subtrochanteric osteotomy during cementless, modular total hip arthroplasty (THA) in a series of active patients younger than 45 years with Crowe Type-III or IV developmental dysplasia of the hip (DDH)., Methods: We followed 49 patients (56 hips) with DDH who were treated with cementless THA, where the acetabular cup was positioned in the anatomic hip center and where a simultaneous transverse femoral osteotomy was performed. Complication rate evaluation and clinical outcomes were measured by validated clinical scores and radiographic evaluation were performed at a mean follow up of 10 years (range, 4.8-14.3 years)., Results: The mean limb-length discrepancy was reduced from 4.2 cm to 1.1 cm (P < 0.01). The mean Harris hip score (HSS) significantly improved from 40.6 points to 87.4 points (P < 0.01). Similarly, severity of low back pain, modified MAP, HOOS, and SF-12 also showed significant improvement (P < 0.01). There were 3 cases of postoperative dislocation, 3 cases of transient nerve palsy, 2 cases of nonunion, and 4 cases of intraoperative fracture. At 10 years follow-up, the estimated survival rate with any component revision as end points was 92%., Conclusion: The cementless THA combined with transverse subtrochanteric osteotomy is a reliable technique with restoration of a more normal limb, satisfactory clinical outcomes, and mid-term survival of components.

Background: Controversy exists as to whether early functional outcomes differ after total hip arthroplasty performed using the direct anterior approach (DAA) or the posterolateral approach (PLA)., Methods: One hundred twenty patients were enrolled in this study and were divided into 2 groups based on surgical approach. Group A included patients who had a total hip arthroplasty with a DAA, whereas group B included those with a PLA. Patients were randomized into the DAA or PLA groups (n = 60), and perioperative and postoperative outcomes were recorded., Results: When compared with the PLA, the DAA had a shorter incision length (9.1 vs 13.1 cm; P < .01), shorter hospital stay (2.8 vs 3.3 days, P = .04), and lower self-reported pain. Both serum inflammatory and muscle damage markers were lower in the DAA group. However, the PLA had shorter operative times (65.5 vs 83.3 min, P = .03) and less intraoperative blood loss (123.8 vs 165.9 mL, P = .04). The DAA had significantly lower variance in cup inclination and anteversion. Similar rates of intraoperative complications were identified in the 2 groups. The DAA was associated with better functional recovery at 3 months based on the Harris hip score, University of California Los Angeles activity score, and gait analysis; however, functional recovery at 6 months was similar between the 2 groups., Conclusion: We found functional advantages in early recovery after the DAA compared with the PLA. The DAA can offer rapid functional recovery with less muscle damage, greater pain relief, and lower variance in cup inclination and anteversion. However, no functional difference was found at 6 months follow-up., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to evaluate 10-year outcomes in cementless monobloc total hip arthroplasty (THA) in a group of hips with Legg-Calve-Perthes disease (LCPD)., Methods: We reviewed 71 patients (88 hips) who underwent cementless THA with a diagnosis of LCPD from 2003 to 2009. From the total of 71 patients, 34 men and 37 women with an average age of 49.94 years were included. The mean follow-up period was 10 years., Results: The mean Harris Hip Score improved significantly from 46.42 to 89.70. Similarly, the postoperative range of motion, hip dysfunction and osteoarthritis outcome score and SF-12 score also significantly improved. The mean leg lengthening was 22.1 mm. During the follow-up, eight complications were noted, including two cases of intraoperative femoral fractures, two cases of sciatic nerve paralysis, two cases of heterotrophic ossifications, one case of thigh pain and one case of dislocation. One revision was conducted for a periprosthetic fracture, and the survivorship at 10 years was 98.3%., Conclusions: These data suggest that the monobloc stem can lead to satisfactory outcomes for clinical function, radiological evaluation, restoration of the normal limb lengths, complications, and survivorship among LCPD patients undergoing total hip arthroplasty.

Objective: Although there are still some controversies, large previous studies have confirmed that intravenous (i.v.) tranexamic acid (TXA) can effectively reduce blood loss and transfusions in total hip arthroplasty (THA) without increasing the risk of deep venous thrombosis. However, few studies have investigated the combination of i.v. and topical application of TXA in primary THA. The purpose of our current study is to examine whether i.v. combined with topical administration of TXA decreases postoperative blood loss and transfusion rates after THA., Methods: From December 2013 to May 2014, all adult patients undergoing primary THA at our arthroplasty center were considered for inclusion in the present study. Included patients were randomly assigned to two groups by computer-generated list number: a TXA group and a placebo group. Patients in the TXA group received i.v. (15 mg/kg) combined with topical administration (1.0 g) of TXA during the THA procedure, and patients in the other group received the same dosage of normal saline both i.v. and topically. Our primary outcome measures were total blood loss (calculated using Gross's equation), hemoglobin, hematocrit and platelet concentration changes on the third postoperative day, the amount of drainage, the amount of intraoperative blood loss, the frequency of transfusion, and the number of blood units transfused. Secondary outcome measures were the length of postoperative stay, range of hip motion (measured by goniometer), Harris hip scores (HHS), and any perioperative complications or events such as infection, DVT or PE. Range of motion and HHS were measured at 3 week follow-up and compared with preoperative values., Results: This trial included 100 patients (50 in each group). Patients in the TXA group had significantly higher postoperative hemoglobin (103 vs 87.7 g/dL, P < 0.01), lower hemoglobin changes (32.2 vs 44.9 g/dL, P < 0.01), higher postoperative hematocrit (0.32 vs 0.27 L/L, P < 0.01), lower hematocrit changes (0.1 vs 0.14 L/L, P < 0.01), lower total blood loss (822 vs 1100 mL, P = 0.004), lower drainage (117.8 vs 242.4 mL, P < 0.01), lower intraoperative blood loss (193.8 vs 288.2 mL, P < 0.01), and lower transfusion rate (2% vs 34%, P < 0.01) compared with those in the placebo group. No statistical difference was found in postoperative platelets between the two groups. There were no differences in perioperative complications or venous thromboembolism (VTE) events., Conclusions: The combined administration of i.v. and topical TXA resulted in a clinically relevant reduction in blood loss, compared with placebo group. No thromboembolic complications were observed. This randomized controlled trial supports the combined i.v. and topical administration of TXA in primary THA., (© 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)

Background: When surgeons reconstruct hips with a high dislocation related to severe developmental dysplasia of the hip (DDH) in total hip arthroplasty (THA), archiving long-term stable implant fixation and improving patient function and satisfaction remain challenging. The purpose of this study was to evaluate the 10-year outcomes of transverse subtrochanteric shortening osteotomy in cementless, modular THA in Crowe type IV-Hartofilakidis type III DDH., Methods: We reviewed 62 patients (76 hips) who underwent cementless THA with transverse subtrochanteric shortening osteotomy from 2002-2010. There were 49 women and 13 men with a mean age of 38.8 years, all of whom had Crowe type IV DDH. Mean follow-up period was 10 years. The acetabular cup was implanted in placement of the anatomical hip center in all hips., Results: The mean Harris Hip Score significantly improved from 38.8 points to 86.1 points. Similarly, modified Merle d'Aubigne and Postel Hip Score, Hip dysfunction and Osteoarthritis Outcome Score, and SF-12 also significantly improved. The mean limb length discrepancy was reduced from 4.3 cm to 1.0 cm. At mean follow-up of 10 years, there were 3 cases of postoperative dislocation, 2 cases of transient nerve palsy, 1 case of nonunion, and 4 cases of intraoperative fracture. Revision surgery was performed in 2 patients due to isolated loosening of acetabular component and femoral stem, respectively., Conclusion: Our data demonstrated that the cementless, modular THA combined with transverse subtrochanteric shortening osteotomy was an effective and reliable technique with high rates of successful fixation of the implants and satisfactory clinical outcomes., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To analyze the incidence and anatomic distribution of venous thrombosis after total hip and knee arthroplasty by using the data of the patients with primary total hip and knee replacement., Methods: From December 2013 to December 2014, total hip and knee arthroplasty were performed in 1 686 patients, of which 928 were THA and 758 were TKA. Before and after discharge, all patients were routinely performed double lower limb vein color Doppler ultrasound, the conventional use of anti fibrinolytic drugs, postoperative anticoagulation for 14 d. The types and distribution of thrombosis after operation were statistical analysis., Results: Among 928 cases of primary total hip arthroplasty, there were 30 cases of thrombosis, 27 cases of isolated muscle vein thrombosis, followed by the involvement of the anterior or posterior tibial vein thrombosis, no central thrombosis. Among 758 cases of primary total knee arthroplasty, there were 87 cases of thrombosis, 81 cases peripheral thrombosis, 4 cases of thrombus of center type, the remaining 2 cases for mixed thrombus;74 patients with thrombosis involving a single vein, 65 cases involved muscle vein, 4 cases of femoral vein, 3 cases of posterior tibial vein, 2 cases of superficial vein; 13 cases of thrombosis involving multiple veins, involving muscle vein, posterior tibial veins, the peroneal veins and popliteal vein in 2 or 3 branches. The comparison results showed that the incidence of thrombosis after total knee arthroplasty was higher, the difference was statistically significant ( P <0.001), and more prone to central thrombosis and multiple venous involvement., Conclusions: The incidence of thrombosis in patients with primary hip and knee replacement is low, and the incidence and anatomic distribution of the patients with primary hip and knee replacement are different., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Introduction: This study aimed to evaluate whether the combination of erythropoietin (EPO) and tranexamic acid (TXA) exerted any additional benefits on the number of blood transfusions required and haematological parameters compared with TXA alone following primary bilateral simultaneous total hip arthroplasty., Materials and Methods: We conducted a single-centre, prospective, randomised, and controlled trial at our hospital. Group EPO + TXA (n = 30) received daily subcutaneous injections EPO (10,000 IU) on preoperative days 1-4 and postoperative days 1-3. Additionally, these patients were administered TXA (15 mg/kg) 10 min prior to the incision. Group TXA (n = 32) received only TXA (15 mg/kg) 10 min prior to the incision. The primary outcomes were the haematological parameters and number of blood transfusions required. The secondary outcomes were total blood loss, drainage volume, and postoperative complications., Results: The total amount of blood transfusion and mean blood transfusion per patient was lower in group EPO + TXA than in group TXA (p = 0.039, p = 0.023; respectively). In the postoperative period, patients in group EPO + TXA had higher haematological parameters (haemoglobin, haematocrit, and reticulocyte count) than patients in group TXA. No significant differences were found in total blood loss, drainage volume, and DVT or PE between the 2 groups., Conclusions: This study showed that administrating EPO + TXA in combination can increase haematological parameters and reduce the need for blood transfusion without increasing the risk of DVT or PE compared with TXA alone.

Objective: To introduce a simple preoperative digital templating in uncemented total hip arthroplasty (THA) and to determine its accuracy for preoperative size selection of the prostheses., Methods: A prospective study of digital planned THAs was performed on 90 hips with different types of prostheses from August 2013 to Angust 2014. The plastic templates of different types of prostheses were scanned for desired digital templating and the scanned images were then processed to the transparent, digital templates using Photoshop software. We calibrated the scales of the digital templates with the preoperative radiographs, and then selected the right size of the component. The preoperatively digital planned component sizes were compared to the actual sizes used in the operation, as well as the preoperatively traditional planned sizes., Results: In either cup or stem templating, no difference was found among the groups with different types of prostheses, and the accuracy of digital templating was statistically higher than traditional templating. In cup templating, digital planned and implanted cup sizes were identical in 43.33% of the cases, 78.89% of the cup sizes were predicted within 1 size (± 2mm) and 95.56% were predicted within 2 sizes (± 4 mm), all significantly higher than the results of traditional planned sizes (30.00%, P=0.044; 61.11%, P=0.007; 82.22%, P=0.004). The exact femoral stem size was predicted in 40.00% of cases using the digital templating, 84.44% of stem sizes were predicted within 1 size, and 93.33% within 2 sizes, better than using traditional templating (25.56%, P=0.028; 53.33%, P<0.001; 77.77%, P=0.003)., Conclusion: This simple digital preoperative templating is an accurate and reproducible process to preoperatively predict the implant size of uncemented THA.

Introduction: The outcomes of using a ceramic-on-ceramic (CoC) vs ceramic-on-polyethylene (CoP) bearing surface for primary total hip arthroplasty (THA) are much debated. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) to compare and evaluate the outcomes of these 2 bearing surfaces., Materials and Methods: Electronic databases (PubMed/Medline, CENTRAL, Embase and Web of Science) were systematically searched for RCTs investigating the association between bearing surfaces and outcomes following primary THA. Two investigators independently reviewed studies for eligibility, assessed the risk of bias, extracted and analysed the data., Results: In total, 13 RCTs including a total of 2,488 THAs were identified. The Harris Hip Score appeared to be similar between CoC and CoP THAs. The acetabular liner wear rate was lower in CoC than CoP THA, but the meta-analysis showed that the incidence of component-related noise and overall ceramic fracture in CoC group were 14.73 times and 6.02 times higher than CoP THA, respectively. There were no statistically significant differences in rates of radiolucent line formation (&gt;1 mm), osteolysis, loosening, revision with follow-up ≥ 5 years, intraoperative femoral fracture, dislocation, deep infection, deep venous thrombosis and leg length discrepancy between CoC and CoP THAs., Conclusions: There appears to be no clear evidence favouring the use of either a CoC or CoP bearing surfaces in primary THA, further studies with high-quality and longer term follow-up to provide more evidence on this topic are still required.

Background: Risk factors for venous thromboembolism (VTE) of total joint arthroplasty (TJA) have been examined by many studies. A comprehensive systematic review of recent findings of high evidence level in this topic is needed., Methods: We conducted a PubMed search for papers published between 2003 and 2013 that provided level-I and level-II evidences on risk factors for VTE of TJA. For each potential factors examined in at least three papers, we summarize the the number of the papers and confirmed the direction of statistically significant associations, e.g. "risk factor" "protective factor" or "controversial factor"., Results: Fifty-four papers were included in the systematic review. Risk factors found to be associated with VTE of both total hip arthroplasty and total knee arthroplasty included older age, female sex, higher BMI, bilateral surgery, surgery time > 2 hours. VTE history was found as a VTE risk factor of THA but an controversial factor of TKA. Cemented fixation as compared to cementless fixation was found as a risk factor for VTE only of TKA. TKA surgery itself was confirmed as a VTE risk factor compared with THA surgery., Conclusions: This systematic review of high level evidences published in recent ten years identified a range of potential factors associated with VTE risk of total joint arthroplasty. These results can provide informations in this topic for doctors, patients and researchers.

Objective: To investigate the effect of acetabular component orientation on the basic stress path above the acetabular dome in the recommended safe zone., Methods: A subject-specific normal hip finite element model was generated and a convergence study carried out to determine the number of material properties for trabecular bone using a normal hip model. Four abduction angles (35°, 40°, 45° and 50°) and four anteversion angles (10°, 15°, 20° and 25°) from the recommended safe zone of acetabular cup orientation were chosen to simulate acetabular reconstruction. The distribution and level of periacetabular stress was assessed using a normal hip model as a control and 16 reconstructed acetabula in simulated single-legged stances., Results: The error of the average stress between plans four and five (50 and 100 materials for trabecular bone respectively) was 4.8%, which is less than the previously defined 5% error. The effect of acetabular component orientation on stress distribution in trabecular bone was not pronounced. When the acetabular component was at 15° anteversion and the abduction angle was 40° or 45°, the stress level on posterolateral cortical bone above the acetabular dome was as stable as that in the normal hip model., Conclusions: Acetabular component orientation affects the basic stress path above the acetabular dome. Thus, orientation should be considered when attempting to restore normal biomechanics in the main load-bearing area., (© 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.)

Objective: To determine the rate of curing the infection and mid- to long-term outcomes of using extensively coated non-modular stems in two-stage revision for infected total hip arthroplasty (THA)., Methods: The clinical data of 33 patients (33 hips) in whom extensively coated non-modular stems had been used in two-stage revision THA for deep infection were retrospectively analyzed. All operations received two-stage reimplantation, which included resection arthroplasty, thorough debridement, insertion of a hand-molded antibiotic-impregnated cement spacer with stainless steel reinforcement, a course of intravenous antibiotics, and delayed reimplantation. Microorganism-specific antibiotics had been chosen according to the results of microbiological studies performed postoperatively. All patients received i.v. antimicrobial therapy for 4 weeks and oral antibiotics to which their organisms were sensitive for a further 6 weeks. Harris hip score (HHS) and plain X-ray films were used to perform clinical and radiological evaluations., Results: During follow-up for a minimum of 5 years, no reinfection or loosening were found. Cultures of samples taken during the second stage were all negative for infection. The mean HHS improved from 42 preoperative to 89 at the final follow-up. All granular bones had fused well with the host bones by 12 months after the surgery., Conclusion: Using extensively coated non-modular stems combined with intramedullary allografts in two-stage revision for treating infected THAs can achieve satisfactory outcomes., (© 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.)

Objective: To assess whether computed tomography (CT)-based 3-dimensional (3D) computerized pre-operative planning is accurate and reliable in patients with high-riding dislocation developmental dysplasia of the hip (DDH) undergoing total hip arthroplasty (THA)., Methods: Between September 2009 and February 2011, a prospective study with an inbuilt means of comparing predictive techniques in 20 patients (20 hips) with high-riding dislocation DDH was undertaken. All patients had pre- and post-operative CT scans, data from which were transferred digitally to Mimics software. 3D pre-operative planning to predict the acetabular component size, hip rotation center position and acetabular component coverage was performed using Mimics software. The results and post-operative course were compared with those of the traditional acetate templating technique., Results: Using 3D computerized planning, 14/20 components (70%) were predicted exactly and 6/20 (30%) within one size, whereas with the conventional acetate templating technique, 5/20 components (25%) were predicted exactly, 9/20 (45%) within one size and 6/20 (30%) within two or more sizes. There was a strong correlation between the 3D computerized planned acetabular component size, hip rotation center distance, acetabular component host coverage and that found postoperatively. Five patients were considered to need structural bone graft on the basis of 3D computerized planning; this was highly coincident with the intraoperative findings in all five cases., Conclusion: CT-based 3D computerized pre-operative planning using Mimics software is an accurate and reliable technique for patients with high-riding dislocation DDH undergoing THA., (© 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.)

Objective: To assess the difference between drainage and non-drainage after total hip arthroplasty (THA) in Chinese subjects by evaluating post-operative complications and joint function., Methods: One hundred and sixty-eight patients undergoing THA were randomly allocated into drainage (83 patients) and non-drainage groups (85 patients). All surgeries were performed by one surgical team using the same pre-, intra-, and postoperative techniques. Measured items included: hemoglobin (Hb), superficial and deep wound infection, volume of blood transfusion, wound hematoma thickness, range of motion (ROM) of the hip, wound healing time, ecchymosis and tension vesicles around the wound., Results: Early after THA, the Hb decreased significantly in the drainage group. There was no significant difference between non-drainage and drainage groups in need for or volume of blood transfusions (9.6% vs 8.2%, P = 0.100; 3.8 units vs 2.9 units, P = 0.089, respectively). In the non-drainage group, the incidence of superficial infection, ecchymosis and tension vesicles was significantly higher than in the drainage group (10.6% vs 2.4%, P = 0.031; 12.9% vs 3.6%, P = 0.026; 16.5% vs 4.8%, P = 0.013, respectively). In addition, the non-drainage group had a greater volume of hematomas (P = 0.000). Patients in the non-drainage group had smaller ROMs early after surgery but the final ROMs did not differ significantly between groups. No deep infection occurred in either group., Conclusion: Non-drainage may reduce postoperative blood loss but has no benefits regarding blood transfusion or deep infection. It may cause more post-operative complications because of restriction of early postoperative exercise by pain and swelling. Therefore we suggest routine use of drainage after THA., (© 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.)

Our aim was to investigate the changes in bone mineral density (BMD) of acetabulum and proximal femur after total hip resurfacing arthroplasty. A comparative study was carried out on 51 hips in 48 patients. Group A consisted of 25 patients (26 hips) who had undergone total hip resurfacing and group B consisted of 23 patients (25 hips) who had had large-diameter metal-on-metal total hip arthroplasty (THA). BMDs around the acetabulum and proximal femur were measured using dual-energy x-ray absorptiometry (DEXA) at 2 weeks, 6 months, 1 year and annually thereafter during the 3 years after surgery. At final follow-up, the acetabular net mean BMD decreased by 11% in group A and 10% in group B with no differences between two groups (P = .35). For the femoral side, in Gruen zone 1, the mean BMD increased by 4% in group A, whereas it decreased by 11% in group B (P = .029). In Gruen zone 7, the mean BMD increased by 8% at the final follow-up in group A, whereas it decreased by 13% in group B (P = .02). In both groups the mean BMD increased by 3% in Gruen zones 3, 4, 5, and 6. Stress-related bone loss of the acetabulum was comparable for MOM THA and resurfacing devices, but proximal femoral bone density increased in the resurfacing group and decreased in the THA group., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To compare the clinical efficacy and serum concentrations of cobalt, chromium metal ion in three different hard-on-hard bearings after total hip arthroplasty at 2-years postoperatively., Methods: Ninety (90) THA patients were divided into ceramic-on-ceramic (COC), ceramic-on-metal (COM), metal-on-metal (MOM) group (n = 30 in each group). At preoperative and 3, 6, 12, 24 months postoperative 5 time points, serum concentrations of cobalt and chromium metal ion were measured, Harris hip score was evaluated, X-rays and color doppler ultrasound examination of the ipsilateral hip also were observed., Results: The excellent rates of Harris hip score were 100% in three groups. Continuous X-rays showed no radiolucent line around the acetabular component, no osteolysis, and no inflammatory pseudotumor. After the THA operation, the metal ion levels in COM and MOM groups increased rapidly, and stabilized at 12 months, then showed a downward trend, but the chromium ion level of MOM continued to rise at 24 months, with a significant difference when compared with that at 12 months (an increase of 0.48 microg/L, P = 0.021). The serum concentrations of metal ion in COC group were relatively constant at all time points, and the cobalt, chromium ion levels of MOM group were significantly higher than those of COC and COM group., Conclusion: The postoperative functional recovery of the three hard-on-hard bearings all were good, and no inflammatory pseudotumor and osteolysis were found. The serum levels of cobalt, chromium ion of COM were lower than those of MOM, but higher than those of COC.

Objective: To evaluate clinical and radiographic results and influencing factors of hybrid total hip arthroplasty (THA)., Methods: Totally 126 patients (135 hips) from January 1999 to December 2001 accepted hybrid THA were followed up. Components migration, periprosthetic bone changes, the polyethylene wear rate were measured radiologically. Kaplan-Meier analysis was performed to evaluate the survival of the acetabular and femoral components. End point was obvious radiological loosening or revision either or both of the acetabular and femoral components for aseptic loosening, infection or osteolysis debridement surgery., Results: A total of 79 cases (85 hips) had been given follow-up. Using revision as the end point, the survival rate of acetabular was 95.2%, cemented femoral components was 98.8%. Using loosening as the end point for failure, the survival rate of acetabular was 97.6%, cemented femoral components was 100%., Conclusions: The hybrid total hip prosthesis long-term survival rate was satisfactory, especially in the femoral side. As a result of third-cement technology, the long-term survival rate of the femoral components was close to the modern cementless prosthesis.

Objective: To retrospectively analyze the clinical and radiological results of the impaction morselized allografting combined with cementless long stem for femoral component revision in patients with significant bone loss., Methods: From July 2003 to June 2009, 27 patients (27 hips) underwent revision hip arthroplasty in femurs with bone defect using impaction allografting and cementless components. There were 15 male and 12 female with mean age of 67 years. According to the Paprosky classification system, the bone defects in femur were classified into type II in 3 cases, type III in 21 cases and type IV 3 cases. The patients were followed up postoperatively to observe the clinical and radiological results, and if there had the stem subsidence, periprosthetic fracture, infection and other complications., Results: Twenty-three patients were followed up. The mean follow-up time was 26 months. Harris score improved from 43 points pre-revision to 83 points at the final follow-up. No femoral stem loosening and failure occurred. There were 4 stem with a mean 3.3 mm subsidence. One case had an acute infection after revision and treated successfully by debridement and drainage, antibiotics. No stem need further revision. Radiographic analysis showed all the revised stem was stable, and graft incorporation was seen in at least 1 zone in 100% of the femurs., Conclusion: The results of this study demonstrates that femoral support and vigorous impaction grafting combined with cementless long stem results in an good intermediated-term clinical effects.

Objective: To analyze the results of cortical windowing of the femoral diaphysis for well-fixed cement/plug removal during hip revision surgery., Methods: From May 2005 to June 2009, 14 patients (14 hips) were undergone revision total hip arthroplasty (THA), window was cut into the cortex of the femur, and the well-fixed cement/plug distal to the window was removed under the direct vision. After reimplanted the cementless revision stem, the cortical lids were replanted and fixed with 2 to 3 cerclage wires. Six patients who had suffered from osteoporosis were undergone morselized bone graft to the osteotomy site. Postoperatively, the patients were maintained at partial weight-bearing (touchdown) for 6 weeks and then advanced as they were able., Results: The length of the cortical windows varied from 2.5 to 6.0 cm (mean, 3.4 cm), the width ranged from 0.8 to 1.4 cm (mean, 1.2 cm). In one patient the window was enlarged during the procedure to facilitate the cement/plug removal. The mean radiologically healing time for the windows was 19 weeks. There was no intraoperative femoral perforation during cement/plug removal. One femoral fracture during the revision stem was implanted. No postoperative periprosthetic fracture and other complications such as infection, implant subsidence occurred during the fellow-up. There was no femoral thigh pain or implant loosening with femoral window., Conclusion: The cortical windowing technique is very helpful to facilitate the well-fixed cement/plug distal to the prosthesis tip removal and the windows heal rapidly and decrease the femoral complications associated with revision THA.

This study was designed to evaluate the midterm results of hybrid total hip arthroplasty in a consecutive series of 45 Chinese patients with osteoarthritis secondary to dysplastic hip. The average follow-up was 6.6 years. A total of 24 hips were classified as dysplasia, 20 hips as low dislocation, and 13 hips as high dislocation. The preoperative Harris score was 46.19 +/- 18.01, which improved to 91.78 +/- 3.52 at the final follow-up. The rate of polyethylene liner wear was 0.27 mm/y. Osteolysis was identified around 5 acetabular components and 13 femoral components. With the use of loosening or revision as the end point for failure, the survival rate was 1.0. We suggest that hybrid total hip arthroplasty in Chinese developmental dysplasia of hip patients has favorable results at midterm follow-up, even though their lifestyle includes more deep flexion of the hip. There is no significant difference of postoperative Harris score with increasing severity of dysplasia.

Objective: To analyze the clinical and radiographic results of the extended trochanteric osteotomy in revision total hip arthroplasty procedure., Methods: The data of 27 patients (27 hips) of the clinical and radiographic results were reviewed between January 1998 and June 2005. There were 16 men and 11 women, and the mean age at the time of revision surgery was 63 years (range 42 to 78 years). Indications for use of the trochanteric osteotomy were removal of well-fixed femoral implants. Clinical evaluation included Harris and WOMAC scores. The radiological evaluation included stem subsidence, trochanteric fragment fractures and stem position change., Results: Nineteen patients (19 hips) were followed up for an average of 5.3 years. All osteotomy sites healed by 16 months,with an average time to union of 16 weeks. No intraoperative fracture at the osteotomy site occurred. There was only one dislocation postoperatively. Three femoral components were subsidence at a mean of 3.4 mm (range 3-7 mm) in the first 6 weeks postoperatively; It united within 6 months without further migration., Conclusions: The extended trochanteric osteotomy facilitates the removal of well-fixed femoral implants, allows reliable reattachment of the trochanteric fragment and results an excellent rate of healing and implant stability in revision total hip arthroplasty during mid-term follow-up. Long-term follow-up is needed.

The purpose of this study was to evaluate midterm clinical and radiographic outcomes associated with hybrid total hip arthroplasty in a consecutive series of 86 Chinese patients (93 hips) with osteonecrosis of the femoral head, which revealed that the mean Harris hip score increased from 39 +/- 6.0 points before operation to 90.4 +/- 4.6 points at the latest follow-up. There was pelvic osteolysis in one hip (1%), which required revision, and some small focal areas of femoral osteolysis in 12 hips (13%) were observed. The mean linear wear rate was 0.143 +/- 0.05 mm/y (0.02-0.45 mm/y). No loosening of the components was observed radiographically. The survival rate of the acetabular and femoral components for revision was 98% (95% confidence interval, 0.96-1.0) and 100% (95% confidence interval, 0.95-1.0). Hybrid total hip arthroplasty in patients with osteonecrosis of the femoral head had a satisfactory clinical and radiographic outcome at a minimum 5 years of follow-up. Because polyethylene wear and osteolysis cannot be avoided, the long-term effect should be further studied.

Total hip resurfacing arthroplasty (THRA) is being performed with increasing frequency for osteonecrosis of femoral head (ONFH). To evaluate femoral bone remodeling in ONFH after THRA and determine the impact of stem-neck angle (SNA) of inserted femoral component on bone remodeling, we monitored the changes in BMD in proximal femur in 23 patients with ONFH after surgery. Patients were divided into group A (SNA >or= 5 degrees ) and group B (SNA < 5 degrees ). The BMD was measured in seven Gruen zones and two neck zones using dual-energy X-ray absorptiometry preoperatively, then at 3, 6, 12, and 24 months after surgery. At all ROIs, the BMD decreased significantly by 3 months postoperatively. The BMD ceased to decrease and reversed by 6 months. The BMD in neck increased significantly in group A, compared with group B at 24 months. The BMD increased 2% at ROI1 at 24 months in both groups, and at ROI7, the BMD in group A reversed to baseline value by 6 months and increased 5.81% at 24 months. These findings implied that the bone stock of proximal femur in ONFH can be well reserved after total hip resurfacing arthroplasty with valgus positioning of the femoral component.

This study evaluated the 5- to 19-year clinical and radiographic results of cementless acetabular revision. Between 1986 and 1998, 130 hips (125 patients) underwent cementless acetabular revisions. Ten patients were lost to follow-up; 6 patients died. One hundred nine patients (114 hips) were reviewed at a mean follow-up of 8.8 years. The mean Harris hip score improved from 62.1 to 90.7 at final follow-up. Two hips underwent repeat revision. Twenty-two hips developed cavitary osteolysis. Kaplan-Meier survivorship at 121 months was 98.2% with repeat revision for any reason as the end point and 89.5% with repeat revision or radiographic loosening as the end point. Cementless acetabular revision provides favorable clinical and radiographic results, and the initial disease and age may adversely affect the outcomes.

Objective: To evaluate the changes of periprosthetic bone mineral density in femur after hip resurfacing arthroplasty., Methods: From July 2002 to June 2005, a comparative study was carried out on 52 hips in 52 patients. Twenty-six patients (26 hips) who underwent Birmingham hip resurfacing arthroplasty (group BHR), and 26 patients (26 hips) who performed cementless total hip arthroplasty with Versys System stem (group THA). The periprosthetic bone mineral density of the femur was measured through dual energy X-ray absorptiometry of the Gruen zones at pre-operation, post-operation 3, 6, 12 and 24 months in patients from both group BHR and group THA. The bone mineral density of femoral neck in group BHR was measured too. Changes of bone mineral density ratio in proximal femur between pre-operation and post-operation were compared and analyzed., Results: The mean ratio of bone mineral density of the proximal femur in group BHR reduced by 5.8%, 4.9%, 2.6% and 0.4%, in group THA reduced by 7.0%, 10.6%, 1.0% and 4.1% at 3, 6, 12 and 24 months respectively. In group BHR, the mean ratio of bone mineral density in range of interest 1 decreased to 89.7% at 6 months and increased to 103.8% at 24 months, in range of interest 7 decreased to 95.1% at 6 months and increased to 103.7% at 24 months. In group THA, the mean ratio of bone mineral density in range of interest 1 decreased to 90.8% at 6 months, 94.4% at 24 months and in range of interest 7 decreased to 94.2% at 3 months, 96.7% at 24 months. In group BHR, the bone mineral density of femoral neck was restored to the pre-operation level at 6 months. The bone mineral density in superior-lateral zone of femoral neck decreased to 97.1% at 3 months and increased to 107.4% at 24 months respectively. The bone mineral density in inferior-medial zone of femoral neck increased to 117.9% at 24 months., Conclusion: The bone stock of proximal femur can be well preserved and recovered quickly after hip resurfacing arthroplasty.

Objective: To investigate the surgical indications and surgical techniques of revision total hip arthroplasty for the failed hemiarthroplasty., Methods: From June 1997 to June 2000, 56 cases (31 males and 25 females) of failed hemiarthroplasty received the revision total hip arthroplasty. The age was from 64 - 75 years (mean 68 years). Among them, there were 29 cases with acetabular erosion, 14 cases with acetabular erosion and central dislocation of femoral head, 12 cases with stem loosening and 1 case with stem fracture. All the cases were revised in one stage, and bone grafts were adopted when necessary., Results: Forty-nine cases were followed up for 5 - 8 years (mean, 7 years), and 7 cases had lost. The mean Harris score increased from 37 (rang, 28 - 40) preoperatively to 88 (rang, 84 - 90) at last follow-up. No wound infection and neurovascular injury happened. Only 5 perioperative complications occurred, including 3 deep venous thrombosis, 1 dislocation and 1 cortical fracture. No cups or femoral stems needed re-revision. Radiographic analysis showed that the position of the artificial prosthesis was unchanged, and no loosening sign existed., Conclusions: The acetabular erosion and central dislocation of femoral head are the main reasons for revision total hip arthroplasty after hemiarthroplasty. The medium-term follow-up results show that the clinical effects are encouraging if the surgical indications and surgical techniques are suitable.

Objective: To investigate the factors affecting the fixation, loosening and therapeutic effect of cementless acetabular prosthesis through following up the patients with total hip arthroplasty clinically and radiographically., Methods: From February 1998 to May 1999, 139 patients (148 hips) underwent total hip arthroplasty with cementless acetabular prosthesis in our department. In this study, the clinical therapeutic effect and the anteroposterior radiographs of the pelvis and anteroposterior and lateral radiographs of the hips of 109 patients (116 hips) made before operation, at 1 week, 3, 6, and 12 months after operation and annually thereafter were analyzed retrospectively. The clinical therapeutic effects were evaluated with Harris hip score. Radiographs were used to observe the position of prostheses and the bone changes around the implant, and to measure the wearing speed and direction of the acetabular cup. All evaluations were made by an independent examiner who did not participate in the operation. The patients were followed up for 5-6 years., Results: The mean Harris score was 44 points (range, 10-70 points) before operation, but it increased to 92.4 points (range, 80-100 points) at the latest review after operation, which was significantly higher than that before operation (P<0.05). No acetabular component was revised because of infection or aseptic loosening. And no acetabular component migrated. There was no revision of fixed acetabular component because of pelvic osteolysis secondary to polyethylene wear. The mean linear wear rate was 0.15 mm per year. All the acetabular prostheses were classified as stable on the radiographs., Conclusions: In terms of fixation, total hip arthroplasty with cementless acetabular components was successful. Although there is no aseptic loosening and a low incidence of osteolysis at the latest follow-up evaluation, polyethylene wear cannot be avoided and can lead to expansile osteolysis near the cups. This kind of osteolysis usually had no obvious clinical symptoms but it can be diagnosed early on radiographs. So radiographical follow-up for cementless acetabular components is very important.

Objective: To summarize the surgical experience of acetabular reconstruction of total hip replacement in the treatment of dysplastic hip., Methods: From April 1998 to April 2002, 96 adult cases with osteoarthritis secondary to dysplastic hip were adopted in the study. Among them, there were 89 females and 7 males, age from 27 approximately 68 years. According to Hartofilakidis classification system, there were dysplasia in 73 hips, low dislocation in 18 hips and high dislocation in 21 hips. All patients received total hip replacement, 16 cases with bilateral replacement and 80 cases with unilateral replacement. Kocher-LangenBeck approach was used during operation and all the acetabular cups were reconstructed at the original anatomic location. The fixation methods were as follows: cement cup for 16 hips, cementless cup for 96 hips and bone graft in 11 hips. The reconstructive methods were as follows: regular replacement for 83 hips; installing a smaller cup after deeper reaming the acetabulum for 27 hips; installing a smaller cup after autofemoral grafting on the superior lip for 2 hips., Results: The incision healed primarily and no infection or nerve injury occurred. Follow-up for 1 approximately 5 years (average for 3.5 years) in 85 patients, the Harris score increased from 33.9 preoperatively to 89.3 postoperatively, and 95 hips had good or excellent clinical results. Radiographically, the positions of the prostheses were normal, the average abduction angle of the cup was 44 degrees, the average superolateral bone coverage of the hips was 96.6%, no radiolucent line was observed at the acetabular side. All the bone grafts fused with the host bone successfully., Conclusions: Total hip replacement is an effective operation in the treatment of osteoarthritis secondary to dysplastic hip. The four specific factors that should be considered in acetabular reconstruction are: (1) the surgical approach, (2) the reconstructive position of the acetabulum, (3) the reconstructive method of the acetabulum, (4) the leg-length discrepancies. It's a challenging to the orthopaedic surgeon. Careful preoperative preparation is recommended.