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Objective: To evaluate the effects of functional rehabilitation on rheumatoid arthritis patients after the total knee arthroplasty (TKA). Methods: Two hundred rheumatoid arthritis patients (259 knees) were enrolled in this study at Arthritis Clinic and Research Center, Peking University People's Hospital from January 2012 to December 2017. All patients received the primary total knee arthroplasty, followed by a systematic functional rehabilitation. The same procedure of rehabilitation was followed, which consisted of patients' education, resistance training, passive and active range of motion exercise, balance exercise, gait training and daily-activity training. According to the degree of postoperative residual flexion contracture, these patients were divided into three groups: the severe (≥30°), moderate(15°-30°), and mild (≤15°). The outcomes of functional rehabilitation were evaluated among different groups and compared with those before the rehabilitation, which included the active range of motion (AROM), the flexion and extension angle of the knee, pain on the visual analogue scale (VAS). The complications and their impacts on the process of rehabilitation were also studied. Independent t test was applied to compare the data before and after the rehabilitaton. Results: There were 17 males (20 knees) and 183 females (239 knees) in this group, aged (57±13) years with a disease course of (16±10) years. There were significant improvements after the functional rehabilitation, including the flexion angle, the extension angle, AROM and pain VAS (76°±12° vs 112°±9°, 12.9°±10.2° vs 2.4°±4.6°, 63°±15° vs 110°±10° and 3.7±1.2 vs 2.0±0.4, respectively; t= 39.0, 15.1, 41.3, 21.2, all P< 0.01). The residual flexion contracture after the surgery in 259 knees were all improved, among which 195 knees (75.3%) reached a complete correction. Compared with the mild flexion contracture, the moderate and severe group had a lower complete correction rate (80.2% vs 45.9%, χ(2)=20.15, P< 0.05). Total of 141 patients (70.5%) suffered from anemia two days after the surgery. By offering the anti-anemia treatment during the systematic rehabilitation, all cases of anemia were healed. The length of hospital stay was longer in the patients with moderate and severe anemia when compared with that in mild anemia ((13±5) days vs (11±5) days, t= 2.2, P= 0.028). Conclusion: The systematic functional rehabilitation is an effective treatment for rheumatoid arthritis patients after TKA, which can not only help release the pain after surgery, but also assist patients to achieve a better function of the knee.

Introduction: The need for better durability and longevity in total hip arthroplasty for patients with various hip joint diseases remains a challenge. This study aimed to obtain medium-term results at a follow-up of >10 years for Zweymüller-Plus total hip arthroplasty with ceramic-on-polyethylene bearing., Methods: A retrospective study was conducted to review the results after a minimum of 12.4 years of 207 consecutive total hip arthroplasties in 185 patients in Peking University People's Hospital in China using the Zweymüller SL-Plus stem in combination with the Bicon-Plus threaded cup and ceramic-on-polyethylene bearing between October 1994 and April 2000., Results: During the study period, two patients (2 hips) died and 25 patients (28 hips) were lost to follow-up. Two hips were revised for aseptic loosening of the Bicon-Plus cup. The mean clinical and radiological follow-up was 14.1 years (range, 12.4-16.5 years) for the remaining 156 patients (175 hips). The mean (standard deviation) Harris Hip score for the 175 hips increased significantly from 39.3 (3.8) preoperatively to 94.1 (2.5) postoperatively at a mean follow-up of 14.1 years (P<0.05). Focal osteolysis was observed in seven (4.0%) of 175 stems and three (1.7%) of 175 cups. The Kaplan-Meier survival with revision for any reason as the end-point was 99.03% (95% confidence interval, 95%-100%)., Conclusions: The high survival rate of the cementless Zweymüller-Plus system with ceramic-on-polyethylene bearing at mid-term follow-up makes this total hip arthroplasty system reliable for patients with various hip joint diseases.

Objective: To discuss the treatment and clinical result of using titanium cerclage band to teat intra- and post-operative femoral fracture in total hip arthroplasty., Methods: From August 1999 to September 2007, twenty-two patients who suffered from intra-and post-operative femoral oblique fracture in total hip arthroplasty were reviewed among 2186 consecutive total hip arthroplasty patients performed by one surgeon. There were 12 fractures occurred intraoperative and 10 fractures postoperative. There are 9 primary and 13 revision total hip arthroplasty patients including 10 men and 12 women. All fractures are classified as Vancouver B1 type in 15 cases and B2 type in 7 cases. Two to five titanium cerclage bands had been used to fix the fracture followed by open reduction with 13 cases using 2 cerclage bands and 7 cases using 3 bands and 1 case using 4 bands and 1 case using 5 bands. Whether change the original stem or not depended on the classification of fractures and stability of stems. There were 15 cases of type B1 and 1 case of type B2 without changing stems and 6 cases of type B2 changing to revision stems of the same series of original stems., Results: All fractures showed successfully union for 12 - 20 weeks (average 18 weeks) after operation. The average Harris score of the hip improved to 90 points (80 to 95 points) at an average 6.5 years follow-up (4 to 11 years) and the average range of motion of the hip got to 120° (105° - 135°). Femoral prostheses were well-fixed without any subsidence or lucent lines or loosening. All patients were satisfied with the results with well-fixed and good alignment of femoral stem., Conclusions: Strong fixation of the fractures and good initial stability of femoral stem can be obtained using titanium cerclage bands to fix the intra- and post-operative femoral oblique fracture. Original stems should be changed to revision stems in case of type B2 and be retained in case of type B1.

Objective: To discuss long-term clinical results of using Zweymüller cup to treat protrusio acetabuli., Methods: From May 1998 to September 2006, 31 patients with 39 hips diagnosed protrusio acetabuli were treated with Zweymüller cup in total hip arthroplasties or revisions. There were 12 men and 19 women with average age of 57.6 years (from 30 to 82 years). The reasons causing protrusio acetabuli were as followed: rheumatoid arthritis 3 cases 6 hips, osteoarthritis followed femoral head necrosis 7 cases 12 hips, acetabular wear after hemi-arthroplasty 11 cases 11 hips and acetabular component loosening 10 cases 10 hips. During all operations, Zweymüller cup was used to fix the acetabular part., Results: All cases were followed up 6 months and one year after operations. Two patients with 3 hips were died for lung cancer and acute myocardial infarction respectively. Twenty-four cases with 31 hips got recent follow-up with average 7.4 years (from 5.0 to 11.5 years). The average Harris score improved from 31.0 (from 14 to 61) preoperatively to 84.7 (from 70 to 95) postoperatively. There was one infection in right hip after bilateral hip arthroplasty treating by removal prosthesis and cement spacer insert. But until now this patient still did not get revision for her internal medicine. One rheumatoid arthritis patient with two-stage bilateral hip arthroplasty was found slight internal migration and loosening line of left acetabular component, but the patient had no pain with good hip function. All other cases had good hip functions and were very satisfied with clinical results., Conclusion: Using Zweymüller cup to treat protrusion acetabuli can get strong fixations and perfect medium and long-term clinical results for over 7.4 years.

Objective: To investigate the effect of lateral parapatellar approach in total knee arthroplasty (TKA) of valgus knee., Methods: Lateral parapatellar approach of total knee arthroplasty was applied in 8 patients (10 knees) with severe valgus osteoarthritis knee (bilateral in 2 cases and unilateral in 6 cases), with the valgus angle > 15 degrees , 1 male (1 knee) and 7 females (9 knee), aged 68.2 (58 - 79), 7 cases (9 knees) being of the Krackow type I and 1 case (1 knee) of the Krackow type I, I. After incision of the skin through lateral knee, ilio-tibial band was prolonged by apple pie arthroplasty. The joint capsule was cut open laterally 2 - 4 cm from the para-patellar edge. Soft tissue balance was performed by releasing I - T band in Gerdy tubercle, lateral collateral ligament and poster-lateral capsule from the femur and tibial side. Valgus angle of distal femur cutting were five degree. Whiteside line and trans-epicondylar line were used as AP rotational cutting reference. All patellar of the group were resurfaced. Capsule closure is completed with the knee flexed. The expanded deep lateral soft tissue sleeve (coronal Z-plasty) is sutured with the medial retinaculum sleeve (superficial layer). Follow-up was conducted for 19.6 months (1 - 51 months)., Results: Seven cases (9 knees) were replaced by posterior stabilized cemented prostheses (TC-Dynamic, PLUS), one case (1 knee) was replaced by RT prosthesis (RT-PLUS(TM) Solution, PLUS). After operation, the valgus deformity of all patients was corrected and all patients could walk 100 m with or without the help of walking holders. The average range of motion (ROM) was improved from the pre-operative. 95.6 degrees (85 degrees - 110 degrees ) to the post-operative 117.1 degrees (100 degrees - 125 degrees ). The average femorotibial angle (FTA) was corrected from the pre-operative. 27.6 degrees (20 degrees - 40 degrees ) to the post-operative 6.8 degrees (5 degrees - 9 degrees ). The Knee Score System (KSS) score and functional score were improved from the pre-operative 22.7 points (9 - 48 points) and 26.5 points (12 - 55 points) to the post-operative 86.4 points (85 - 95 points) and 89.1 points (80 - 95 points) respectively. Follow-up showed that the FTA remained unchanged and the knee stability of all patients was good., Conclusion: Through lateral approach, "Z" plasty of the capsule can release the lateral structure and decrease the pressure of common peroneal nerve. For TKR with moderate to severe fixed valgus knee, lateral approach is an effective way to correct the deformity.

Objective: To investigate the effect of two-stage revision for infected total hip arthroplasty (THA) using antibiotic-loaded cement prosthesis., Methods: From June 1999 to October 2004, 14 patients who admitted for infected primary total hip arthroplasty surgeries were performed revision surgery with antibiotic-loaded cement prosthesis in two-stage. The mean Harris score of pre-operation was 23. In the first stage operation, the following steps were performed, complete debridement, removal of infected prosthesis, implantation of cement spacer with antibiotics, treatment involved concomitant administration of 3 weeks of intravenous (IV) and 1 month of oral. After 6 months, antibiotic-loaded prosthesis was implanted in the second stage., Results: The mean follow-up was 18 months (7 - 26 months), no recurrent infection occurred in all 14 patients. The mean post-operation Harris score was 70., Conclusions: The success of the protocol to control the delayed infection after THA are complete debridement, enough interval and using antibiotic-loaded cement prosthesis in two stage revision.

Objective: To examine the two to eight-year results associated with the use of this hip system., Methods: Between November 1996 and January 2001, 56 revision total hip arthroplasties with insertion of a Zweymüller BICON-PLUS cup and a cementless SLR-PLUS stem were performed in 55 consecutive patients (average age, fifty-nine years old, range, thirty to eighty years old)., Results: At the time of the latest follow-up, 23 patients (24 hips) had lost to follow-up, leaving 32 patients for a minimum of 2 years of clinical and radiographical follow-up. The mean follow-up time was 4 years. Only 3 peri-operative complications occurred, including 1 great trochanter fracture during implant removal, 1 dislocation 2 d after operation with successful closed reduction, and 1 deep wound infection which necessitated reentry and debridement. No femoral stems or cups needed re-revision surgery. The average Harris hip score increased from 40.6 points preoperatively to 80.4 points at final follow-up. Radiographic analysis demonstrated that the position of stems and cups was unchanged and all showed radiographic evidence of bone ingrowth., Conclusion: The favourable medium-term clinical results with the cementless Zweymüller hip system show that it is suitable as a revision system for total hip failures of both cemented and cementless primary fixation.

Objective: To study the early diagnosis and treatment of pulmonary embolism (PE) after total joint replacement (TJR)., Methods: >From April 1987 to December 2001, we performed 1,336 total knee replacements (TKR(s)) in 926 patients and 1,745 total hip replacements (THR(s)) in 1,566 patients. In this group there were 5 PE patients after operation. Two patients died (all after TKR), and 3 patients salvaged successfully (2 after TKR, 1 after THR)., Results: The total incidence of PE after TJR was 0.2% (5/2,492), the incidence of PE after TKR was 0.4% (4/926), and the incidence of PE after THR was 0.06% (1/1,556). In the patients who suffered PE, 2 died. The incidence of PE before 2000 was 0%., Conclusions: Death after total joint replacement is due to pulmonary embolism (PE), especially massive PE. The incidence of PE after TKR is higher than that after THR. Pulmonary angiography is the gold standard for the diagnosis of PE. With more understanding on PE and more popularity of joint replacement, the diagnosis of PE after TJR is increased. More attention should be paid to PE in the patients with high risk after TJR.

An 8-year follow-up study of 14 cases (22 feet) of titanium total 1st metatarsophalangeal joint arthroplasty with two designs (type I and type II) is reported. The follow-up period average was 5 years with a range of 3 to 8 years. The rate of subjective satisfaction was 72.7% (16/22), the incidence of complications 31.8% (7/22), and the rate of revision 27.3% (6/22). The results implicate that titanium total hallux MTP joint arthroplasty is a suitable procedure for osteoarthritis, rheumatoid arthritis and hallux rigidus of the 1st MTP joint, and that type II prosthesis seems better than type I prosthesis. In addition, prosthetic designing, surgical technique and postoperative complications are also discussed in detail.