BACKGROUND The four components that make up the current dual-mobility artificial hip joint design are the femoral head,the inner liner,the outer liner as a metal cover to prevent wear,and the acetabular cup.The acetab...BACKGROUND The four components that make up the current dual-mobility artificial hip joint design are the femoral head,the inner liner,the outer liner as a metal cover to prevent wear,and the acetabular cup.The acetabular cup and the outer liner were constructed of 316L stainless steel.At the same time,the inner liner was made of ultra-high-molecular-weight polyethylene(UHMWPE).As this new dual-mobility artificial hip joint has not been researched extensively,more tribological research is needed to predict wear.The thickness of the inner liner is a significant component to consider when calculating the contact pressure.AIM To make use of finite element analysis to gain a better understanding of the contact behavior in various inner liner thicknesses on a new model of a dual-mobility artificial hip joint,with the ultimate objective of determining the inner liner thickness that was most suitable for this particular type of dual-mobility artificial hip joint.METHODS In this study,the size of the femoral head was compared between two diameters(28 mm and 36 mm)and eight inner liner thicknesses ranging from 5 mm to 12 mm.Using the finite element method,the contact parameters,including the maximum contact pressure and contact area,have been evaluated in light of the Hertzian contact theory.The simulation was performed statically with dissipated energy and asymmetric behavior.The types of interaction were surface-to-surface contact and normal contact behavior.RESULTS The maximum contact pressures in the inner liner(UHMWPE)at a head diameter of 28 mm and 36 mm are between 3.7-13.5 MPa and 2.7-10.4 MPa,respectively.The maximum von Mises of the inner liner,outer liner,and acetabular cup are 2.4–11.4 MPa,15.7–44.3 MPa,and 3.7–12.6 MPa,respectively,for 28 mm head.Then the maximum von Mises stresses of the 36 mm head are 1.9-8.9 MPa for the inner liner,9.9-32.8 MPa for the outer liner,and 2.6-9.9 MPa for the acetabular cup.A head with a diameter of 28 mm should have an inner liner with a thickness of 12 mm.Whereas the head diameter was 36 mm,an inner liner thickness of 8 mm was suitable.CONCLUSION The contact pressures and von Mises stresses generated during this research can potentially be exploited in estimating the wear of dual-mobility artificial hip joints in general.Contact pressure and von Mises stress reduce with an increasing head diameter and inner liner’s thickness.Present findings would become one of the references for orthopedic surgery for choosing suitable bearing geometric parameter of hip implant.展开更多
Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used thro...Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.展开更多
To evaluate the current literature about how successfully periprosthetic hip joint infections can be managed by debridement and prosthesis retention.A literature search was performed through Pub Med until September 20...To evaluate the current literature about how successfully periprosthetic hip joint infections can be managed by debridement and prosthesis retention.A literature search was performed through Pub Med until September 2013.Search terms were"DAIR(debridement,antibiotics,irrigation,and retention)"alone and in combination with"hip"as well as"hip infection+prosthesis retention".A total of 11 studies reporting on 292 cases could be identified.Five different treatment modalities have been described with varying success rates(debridement-21%infection eradication rate;debridement+lavage-75%infection eradication rate;debridement,lavage,with change of modular prosthesis components-70.4%infection eradication rate;debridement,lavage,change of modular prosthesis components+vacuum-assisted closure-92.8%infection eradication rate;acetabular cup removal+spacer head onto retained stem-89.6%infection eradication rate).With regard to the postoperative antibiotic therapy,no general consensus could be drawn from the available data.Debridement,antibiotic therapy,irrigation,and prosthesis retention is an acceptable solution in the management of early and acute hematogenous periprosthetic hip joint infections.The current literature does not allow for generalization of conclusions with regard to thebest treatment modality.A large,multi-center study is required for identification of the optimal treatment of these infections.展开更多
Objective Chromium has many important functions in the human body. For the osseous tissue, its role has not been clearly defined. This study was aimed at determining chromium content in hip joint tissues. Methods A to...Objective Chromium has many important functions in the human body. For the osseous tissue, its role has not been clearly defined. This study was aimed at determining chromium content in hip joint tissues. Methods A total of 91 hip joint samples were taken in this study, including 66 from females and 25 from males. The sample tissues were separated according to their anatomical parts. The chromium content was determined by the AAS method. The statistical analysis was performed with U Mann-Whitney＇s non-parametric test, P〈0.05. Results The overall chromium content in tissues of the hip joint in the study subjects was as follows： 5.73 μg/g in the articular cartilage, 5.33 μ/g in the cortical bone, 27.86 μ/g in the cancellous bone, 5.95 μg/8 in the fragment of the cancellous bone from the intertrochanteric region, and 2.28 μ/g in the joint capsule. The chromium contents were observed in 2 group patients, it was 7.04 μ/g in people with osteoarthritis and 22.59 μ/g in people with fractures. Conclusion The observed chromium content was highest in the cancellous bone and the lowest in the joint capsule. Chromium content was significantly different between the people with hip joint osteoarthritis and the people with femoral neck fractures.展开更多
Seven female patients (mean age of 56 years) with advanced hip joint osteoarthritis underwent total hip replacement. Four days before operation they were given oral tetracycline for two days. During operation specimen...Seven female patients (mean age of 56 years) with advanced hip joint osteoarthritis underwent total hip replacement. Four days before operation they were given oral tetracycline for two days. During operation specimens were taken from the white articular cartilage, the yellowish articular cartilage and the ivory bone together with their subchondral bone tissues. The undecalcified specimens were cut into 10 μm sections and observed under the fluorescence microscope. In all the specimens the following findings could be observed. 1. The osteoarthritic articular cartilage became thinner, with uneven surface and fissures. 2. The superficial and deep surfaces and the central part of the subchondral bone plate showed bright golden yellow fluorescence. It reflected extensive new bone formation. 3. The subchondral bone trabeculae also revealed bright golden yellow fluorescence on their peripheral borders, so trabeculae turned thicker obviously. 4. The marrow tissues between the bone trabeculae exhibited particulate or spherical bright golden yellow fluorescence, reflecting new bone formation in the marrow. The particulate and spherical bright golden yellow fluorescent materials might aggregate, enlarge and merge into large piece of new bone and they also fused with the neighbouring bone trabeculae. The aforementioned changes in the structure of the subchondral bone tissues increased greatly the mass in the osteoarthritic femoral head.展开更多
The scope of this project was to investigate the possibility of application of Image Processing Technique in the field of Shaft Alignment process. Misalignment of shaft using image processing software Visionbuilder wa...The scope of this project was to investigate the possibility of application of Image Processing Technique in the field of Shaft Alignment process. Misalignment of shaft using image processing software Visionbuilder was calculated. The further purpose of this project was to check whether the image processing technique can be used in bone transplant surgery. The model of the hip was used for the experimentation purpose. Image processing software Visionbuilder was used to match the profiles of the bone before implant and bone after implant.展开更多
A hip joint simulator was employed to predict the clinical wear behaviour of carbon/carbon （C/C） composites with needled carbon cloth preform and carbon felt preform. Wear particles generated from the two kinds of C...A hip joint simulator was employed to predict the clinical wear behaviour of carbon/carbon （C/C） composites with needled carbon cloth preform and carbon felt preform. Wear particles generated from the two kinds of C/C composites were isolated and characterised by the size distribution and morphology. The evolvement of wear particles in the hip joint simulator was proposed. The results show that the wear particles from two kinds of C/C composites have a size ranging from submicron to tens of micrometers. The wear particles have various morphologies including broken fiber, fragment fiber, slice pyrolytic carbon and spherical pyrolytic carbon. C/C composites with needled carbon cloth preforms have larger size range and more broken fiber particles and slice pyrolytic carbon particles in comparison with C/C composites with carbon felt preforms. The evolvement of pyrolytic carbon particles is caused by surface regularization, whereas, the evolvement of carbon fiber particles is related to stress direction in the hip joint simulator.展开更多
AIM: To track the short-term neck narrowing changes in Birmingham metal-on-metal hip resurfacing(MOMHR) patients. METHODS: Since 2001, the Center for Hip and Knee Replacement started a registry to prospectively collec...AIM: To track the short-term neck narrowing changes in Birmingham metal-on-metal hip resurfacing(MOMHR) patients. METHODS: Since 2001, the Center for Hip and Knee Replacement started a registry to prospectively collect data on hip and knee replacement patients. From June 2006 to October 2008, 139 MOMHR were performed at our center by two participate surgeons using Birmingham MOMHR prosthesis(Smith Nephew, United States). It is standard of care for patients to obtain low, anteriorposterior(LAP) pelvis radiographs immediately after MOMHR procedure and then at 3 mo, 1 year and 2 year follow up office visits. Inclusion criteria for the present study included patients who came back for follow up office visit at above mentioned time points and got LAP radiographs. Exclusion criteria include patients who missed more than two follow up time points and those with poor-quality X-rays. Two orthopaedic residency trained research fellows reviewed the X-rays independently at 4 time points, i.e., immediate after surgery, 3 mo, 1 year and 2 year. Neck-to-prosthesis ratio(NPR) was used as main outcome measure. Twenty cases were used as subjects to identify the reliability between two observers. An intraclass correlation coefficient at 0.8 was considered as satisfied. A paired t-test was used to evaluate the significant difference between different time points with P < 0.05 considered to be statistically significant.RESULTS: The mean NPRs were 0.852 ± 0.056, 0.839 ± 0.052, 0.835 ± 0.051, 0.83 ± 0.04 immediately, 3 mo, 1 year and 2 years post-operatively respectively. At 3 mo, NPR was significantly different from immediate postoperative X-ray(P < 0.001). There was no difference between 3 mo and 1 year(P = 0.14) and 2 years(P = 0.53). Femoral neck narrowing(FNN) exceeding 10% of the diameter of the neck was observed in only 4 patients(5.6%) at two years follow up. None of these patients developed a femoral neck fracture(FNF). CONCLUSION: Femoral neck narrowing after MOMHR occurred as early as 3 mo postoperatively, and stabilized thereafter. Excessive FNN was not common in patients within the first two years of surgery and was not correlated with risk of FNF.展开更多
AIM: To determine hip joint center(HJC) location on hip arthroplasty population comparing predictive and functional approaches with radiographic measurements.METHODS: The distance between the HJC and the mid-pelvis wa...AIM: To determine hip joint center(HJC) location on hip arthroplasty population comparing predictive and functional approaches with radiographic measurements.METHODS: The distance between the HJC and the mid-pelvis was calculated and compared between the three approaches. The localisation error between the predictive and functional approach was compared using the radiographic measurements as the reference. The operated leg was compared to the non-operated leg.RESULTS: A significant difference was found for the distance between the HJC and the mid-pelvis when comparing the predictive and functional method. The functional method leads to fewer errors. A statistical difference was found for the localization error between the predictive and functional method. The functional method is twice more precise.CONCLUSION: Although being more individualized, the functional method improves HJC localization and should be used in three-dimensional gait analysis.展开更多
Total hip replacement(THR) is a successful and reliable operation for both relieving pain and improving function in patients who are disabled with end stage arthritis.The ageing population is predicted to significantl...Total hip replacement(THR) is a successful and reliable operation for both relieving pain and improving function in patients who are disabled with end stage arthritis.The ageing population is predicted to significantly increase the requirement for THR in patients who have a higher functional demand than those of the past. Uncemented THR was introduced to improve the long term results and in particular the results in younger, higher functioning patients. There has been controversy about the value of uncemented compared to cemented THR although there has been a world-wide trend towards uncemented fixation. Uncemented acetabular fixation has gained wide acceptance, as seen in the increasing number of hybrid THR in joint registries, but there remains debate about the best mode of femoral fixation.In this article we review the history and current worldwide registry data, with an in-depth analysis of the New Zealand Joint Registry, to determine the results of uncemented femoral fixation in an attempt to provide an evidence-based answer as to the value of this form of fixation.展开更多
A biomimetic hip joint simulator that can be used to evaluate the outcome of the cemented total hip replacement has been designed, manufactured and evaluated. The simulator produces motion in the extension/flexion pla...A biomimetic hip joint simulator that can be used to evaluate the outcome of the cemented total hip replacement has been designed, manufactured and evaluated. The simulator produces motion in the extension/flexion plane, with a socket to rotate internal/externally. At the same time a dynamic loading cycle is applied. A validation test was performed on a cemented femoral stem within a novel composite femur. The hone quality has a strong effect on the stem migration and on the integrity of the interfaces. The migration of the stem is a combination of 3-D translation and rotation of the stem. Under the same loading conditions, weak bone allows more stem migration than strong bone. There is a great decrease in the strength of the stem-cement interface after the dynamic test, and the weak bone composite exhibited a greater reduction in interfacial strength than the strong bone composite. The decrease of the interfacial strength indicates that the primary bonding between the stem and the cement mantle had deteriorated and the integrity of stem-cement interface was damaged. The study demonstrates the value of using a hip joint simulator to investigate stem migration and interface integrity within the cemented hip replacement, suggesting that method can be used for in vitro evaluation of the biomaterials used in the cemented hip replacements.展开更多
Background:Dynamic knee valgus(DKV)is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing.Differences in hip and knee kinematic components of D...Background:Dynamic knee valgus(DKV)is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing.Differences in hip and knee kinematic components of DKV may explain the emergence of different pain problems in people who exhibit the same observed movement impairment.Using a secondary analysis of exiting data sets,we sought to determine whether hip and knee frontal and transverse plane angles during a functional task differed between women with patellofemoral pain and women with chronic hip joint pain and the relationship between joint-specific kinematics and pain in these 2 pain populations.Methods:In the original studies,3-dimensional hip and knee kinematics during a single-limb squat were obtained in 20 women with patellofemoral pain and 14 women with chronic hip joint pain who demonstrated visually classified DKV.Pain intensity during the squat was assessed in both groups.For the secondary analysis,kinematic data were compared between pain groups using their respective control groups as a reference.Within each pain group,correlation coefficients were used to determine the relationship between kinematics and pain during the squat.Results:Hip adduction and contralateral pelvic drop were greater in those with chronic hip joint pain compared to those with patellofemoral pain(effect sizes ≥0.40).Greater knee external rotation(r= 0.47,p= 0.04)was correlated with greater knee pain in those with patellofemoral pain,while greater hip adduction(r = 0.53,p = 0.05)and greater hip internal rotation(r = 0.55,p = 0.04)were correlated with greater hip pain in those with chronic hip joint pain.Conclusion:Hip frontal plane motion was greater in those with chronic hip joint pain compared to those with patellofemoral pain.In both groups,greater abnormal movement at the respective joint(e.g.,knee external rotation in the patellofemoral pain group and hip adduction and internal rotation in the chronic hip joint pain group)was associated with greater pain at that joint during a single-limb squat.展开更多
BACKGROUND Periprosthetic joint infections(PJIs)are frequently caused by coagulase-negative Staphylococci(CoNS),which is known to be a hard-to-treat microorganism.Antibiotic resistance among causative pathogens of PJI...BACKGROUND Periprosthetic joint infections(PJIs)are frequently caused by coagulase-negative Staphylococci(CoNS),which is known to be a hard-to-treat microorganism.Antibiotic resistance among causative pathogens of PJI is increasing.Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis.We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature.AIM To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS.METHODS All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included.Patients with CoNS infection were included in the study,including polymicrobial cases.Primary outcome was infection eradication at final follow-up.RESULTS Forty-four patients were included in the study.Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee.At final follow-up after a mean of 37 mo,recurrent or persistent infection was present in eleven patients.CONCLUSION PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance.Infection eradication rate of 70%-80%may be achieved.展开更多
Enhanced recovery after surgery(ERAS)protocols are applied in orthopedic surgery and are intended to reduce perioperative stress by implementing combined evidence-based practices with the cooperation of various health...Enhanced recovery after surgery(ERAS)protocols are applied in orthopedic surgery and are intended to reduce perioperative stress by implementing combined evidence-based practices with the cooperation of various health professionals as an interdisciplinary team.ERAS pathways include pre-operative patient counselling,regional anesthesia and analgesia techniques,post-operative pain management,early mobilization and early feeding.Studies have shown improvement in the recovery of patients who followed an ERAS program after hip or knee arthroplasty,compared with those who followed a traditional care approach.ERAS protocols reduce post-operative stress,contribute to rapid recovery,shorten length of stay(LOS)without increasing the complications or readmissions,improve patient satisfaction and decrease the hospital costs.We suggest that the ERAS pathway could reduce the LOS in hospital for patients undergoing total hip replacement or total knee replacement.These programs require good organization and handling by the multidisciplinary team.ERAS programs increase patient's satisfaction due to their active participation which they experience as personalized treatment.The aim of the study was to develop an ERAS protocol for oncology patients who undergo bone reconstruction surgeries using massive endoprosthesis,with a view to improving the surgical outcomes.展开更多
BACKGROUND Prosthetic joint infection(PJI)is a devastating complication requiring prolonged treatment and multiple operations,leading to significant morbidity for the patient.Patients are routinely tested for methicil...BACKGROUND Prosthetic joint infection(PJI)is a devastating complication requiring prolonged treatment and multiple operations,leading to significant morbidity for the patient.Patients are routinely tested for methicillin-resistant staphylococcus aureus(MRSA)colonisation.MRSA positive patients are given eradication therapy.We hypothesise that patients who are MRSA positive pre-operatively,have increased risk of developing PJI.AIM To identify deep wound infection(PJI)rates in patients who are colonised MRSA positive compared with those who are not colonised;and long term clinical and radiological outcomes.METHODS All patients who underwent total hip and knee replacements(THR/TKR)between December 2009 and December 2019 were identified.Patients who were also identified as being MRSA positive at pre-operative assessment were then selected.Confirmation of prescribing eradication treatment was recorded.Patient records,including consultation letters,operation notes and microbiology results were reviewed retrospectively.Comparison of outcomes for each MRSA positive patient was made with 2 MRSA negative patients undergoing the same operation of a similar age by the same consultant.RESULTS Screening identified 42 knee and 32 hip arthroplasty patients as MRSA positive,84 MRSA negative knee and 64 hip patients were reviewed.Patients were matched with medical co-morbidities in each group.Mean follow up was 5 years.PJI was identified in 4/32(12.5%)of THR MRSA positive and 3/42(7%)of TKR patients.All patients had PJI within one year of surgery.CONCLUSION MRSA positive patients are given eradication therapy routinely.However,no confirmation of eradication is sought.Patients who have MRSA colonisation preoperatively,in our study had a significantly increased risk of PJI,when compared to negative patients.We would recommend establishing true eradication after treatment prior to arthroplasty.展开更多
BACKGROUND Utilizing the large jumbo cup in revision total hip arthroplasty is an effective approach to cure many lacunar and segmental peripheral bone defects.However,with the use of the jumbo cup,the center of the h...BACKGROUND Utilizing the large jumbo cup in revision total hip arthroplasty is an effective approach to cure many lacunar and segmental peripheral bone defects.However,with the use of the jumbo cup,the center of the hip joint may become elevated relative to the primary acetabulum,and the diameter of the large cup is greater.AIM To study the height and the significance of the elevation of the hip joint center.METHODS Eighty-eight patients matched the criteria for this condition and were included in the study.The center height of the hip joint was measured relative to the opposite normal hip joint.The diameter of the jumbo cup was measured and checked according to operation notes,and the diameter of the jumbo cup was measured with a prosthesis label.Then,the horizontal and vertical centers of rotation were measured on the surgical side and opposite side.The average center height of the hip joint on the renovated side and the opposite side and the position of the hip cup relative to the teardrop were compared using a paired t-test.RESULTS Radiometric analysis showed that the average hip joint center was elevated by 7.6 mm.The rotational center height delta of the renovated hip was 7.6±5.6 mm,and there was an obvious difference between the two groups(P=0.00).The difference in horizontal distance was 0.5±5.1 mm(-11.5-14.0 mm),and there was no obvious difference between the two groups(P=0.38).According to the foreign standard,the rotational center height delta of the renovated hip was 7.5±6.2 mm,and there was a significant difference between the two groups(P=0.00).There was no obvious difference between the domestic and foreign standards(P>0.05)between the two groups.CONCLUSION The application of the jumbo cup elevates the rotational center of the hip joint,but it is feasible and effective to use the jumbo cup.展开更多
The purpose of this study was to demonstrate the improvement of hip joint dysregulation, including pain (coxalgia), tension, and restriction of joint mobility, using a dental gold alloy inlay. The subject was a 63-yea...The purpose of this study was to demonstrate the improvement of hip joint dysregulation, including pain (coxalgia), tension, and restriction of joint mobility, using a dental gold alloy inlay. The subject was a 63-year-old man who was suffering from the abovementioned symptoms for several months. On placement of the gold alloy inlay on his chest, the joint flexibility was observed to increase, and the severity of the abovementioned symptoms decreased. When the inlay was placed in his tooth, the flexibility of the joint further increased, and all other symptoms disappeared. No side effects were observed, and the prognosis was good. We believe that these effects may be explained using the electromagnetic waves emitted by the inlay and by the restoration of biting conditions. Future multidisciplinary research focusing on possible underlying mechanisms regarding the relation between electromagnetic waves and dentistry is necessary.展开更多
Hip joint osteoarthritis, a widespread disabling disease with no known cause, produces considerable bouts of intractable pain as a result of multiple disease associated problems. This paper examines some sources of os...Hip joint osteoarthritis, a widespread disabling disease with no known cause, produces considerable bouts of intractable pain as a result of multiple disease associated problems. This paper examines some sources of osteoarthritic hip joint pain, a poorly understood topic at best. Presented in three parts are data retrieved from several sources, including animal models. It is concluded that to improve the effectiveness of treatments designed to minimize hip osteoarthritis pain, a better understanding of the diverse origins of hip joint pain, and hip joint neurology, may permit the development of more precise as well as targeted pain strategies.展开更多
BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg...BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure for preventing acute surgical site infection following primary total hip arthroplasty(THA)and total knee arthroplasty(TKA).AIM To investigate the effectiveness of prophylactic intraoperative application of vancomycin(1000 mg/L;2 L)solution vs.plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.METHODS A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed.These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015(group 1,1018 patients;453 undergoing THA and 565 undergoing TKA)or intrawound irrigation with vancomycin solution(1000 mg/L)before wound closure between January 2016 and December 2019(group 2,1175 patients;512 undergoing THA and 663 undergoing TKA).The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.RESULTS There were no significant demographic differences between the 2 groups.There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure(overall incidence of infection:group 1,2.46%vs group 2,0.09%,P<0.001).There was no significant difference in the incidence of wound healing complications between the two groups.CONCLUSION Prophylactic irrigation with vancomycin solution(1000 mg/L;2 L)significantly decreases the incidence of acute surgical site infection after primary TJA.This strategy is a safe,efficacious,and inexpensive method for reducing the incidence of acute surgical site infection after TJA.展开更多
基金Supported by World Class Research Universitas Diponegoro,No.118-23/UN7.6.1/PP/2021Penelitian Fundamental–Reguler,No.449A-32/UN7.D2/PP/VI/2023.
文摘BACKGROUND The four components that make up the current dual-mobility artificial hip joint design are the femoral head,the inner liner,the outer liner as a metal cover to prevent wear,and the acetabular cup.The acetabular cup and the outer liner were constructed of 316L stainless steel.At the same time,the inner liner was made of ultra-high-molecular-weight polyethylene(UHMWPE).As this new dual-mobility artificial hip joint has not been researched extensively,more tribological research is needed to predict wear.The thickness of the inner liner is a significant component to consider when calculating the contact pressure.AIM To make use of finite element analysis to gain a better understanding of the contact behavior in various inner liner thicknesses on a new model of a dual-mobility artificial hip joint,with the ultimate objective of determining the inner liner thickness that was most suitable for this particular type of dual-mobility artificial hip joint.METHODS In this study,the size of the femoral head was compared between two diameters(28 mm and 36 mm)and eight inner liner thicknesses ranging from 5 mm to 12 mm.Using the finite element method,the contact parameters,including the maximum contact pressure and contact area,have been evaluated in light of the Hertzian contact theory.The simulation was performed statically with dissipated energy and asymmetric behavior.The types of interaction were surface-to-surface contact and normal contact behavior.RESULTS The maximum contact pressures in the inner liner(UHMWPE)at a head diameter of 28 mm and 36 mm are between 3.7-13.5 MPa and 2.7-10.4 MPa,respectively.The maximum von Mises of the inner liner,outer liner,and acetabular cup are 2.4–11.4 MPa,15.7–44.3 MPa,and 3.7–12.6 MPa,respectively,for 28 mm head.Then the maximum von Mises stresses of the 36 mm head are 1.9-8.9 MPa for the inner liner,9.9-32.8 MPa for the outer liner,and 2.6-9.9 MPa for the acetabular cup.A head with a diameter of 28 mm should have an inner liner with a thickness of 12 mm.Whereas the head diameter was 36 mm,an inner liner thickness of 8 mm was suitable.CONCLUSION The contact pressures and von Mises stresses generated during this research can potentially be exploited in estimating the wear of dual-mobility artificial hip joints in general.Contact pressure and von Mises stress reduce with an increasing head diameter and inner liner’s thickness.Present findings would become one of the references for orthopedic surgery for choosing suitable bearing geometric parameter of hip implant.
文摘Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.
文摘To evaluate the current literature about how successfully periprosthetic hip joint infections can be managed by debridement and prosthesis retention.A literature search was performed through Pub Med until September 2013.Search terms were"DAIR(debridement,antibiotics,irrigation,and retention)"alone and in combination with"hip"as well as"hip infection+prosthesis retention".A total of 11 studies reporting on 292 cases could be identified.Five different treatment modalities have been described with varying success rates(debridement-21%infection eradication rate;debridement+lavage-75%infection eradication rate;debridement,lavage,with change of modular prosthesis components-70.4%infection eradication rate;debridement,lavage,change of modular prosthesis components+vacuum-assisted closure-92.8%infection eradication rate;acetabular cup removal+spacer head onto retained stem-89.6%infection eradication rate).With regard to the postoperative antibiotic therapy,no general consensus could be drawn from the available data.Debridement,antibiotic therapy,irrigation,and prosthesis retention is an acceptable solution in the management of early and acute hematogenous periprosthetic hip joint infections.The current literature does not allow for generalization of conclusions with regard to thebest treatment modality.A large,multi-center study is required for identification of the optimal treatment of these infections.
基金financed by the Medical University of Silesia in Katowice(contract No.KNW-1-124/K/4/0)
文摘Objective Chromium has many important functions in the human body. For the osseous tissue, its role has not been clearly defined. This study was aimed at determining chromium content in hip joint tissues. Methods A total of 91 hip joint samples were taken in this study, including 66 from females and 25 from males. The sample tissues were separated according to their anatomical parts. The chromium content was determined by the AAS method. The statistical analysis was performed with U Mann-Whitney＇s non-parametric test, P〈0.05. Results The overall chromium content in tissues of the hip joint in the study subjects was as follows： 5.73 μg/g in the articular cartilage, 5.33 μ/g in the cortical bone, 27.86 μ/g in the cancellous bone, 5.95 μg/8 in the fragment of the cancellous bone from the intertrochanteric region, and 2.28 μ/g in the joint capsule. The chromium contents were observed in 2 group patients, it was 7.04 μ/g in people with osteoarthritis and 22.59 μ/g in people with fractures. Conclusion The observed chromium content was highest in the cancellous bone and the lowest in the joint capsule. Chromium content was significantly different between the people with hip joint osteoarthritis and the people with femoral neck fractures.
文摘Seven female patients (mean age of 56 years) with advanced hip joint osteoarthritis underwent total hip replacement. Four days before operation they were given oral tetracycline for two days. During operation specimens were taken from the white articular cartilage, the yellowish articular cartilage and the ivory bone together with their subchondral bone tissues. The undecalcified specimens were cut into 10 μm sections and observed under the fluorescence microscope. In all the specimens the following findings could be observed. 1. The osteoarthritic articular cartilage became thinner, with uneven surface and fissures. 2. The superficial and deep surfaces and the central part of the subchondral bone plate showed bright golden yellow fluorescence. It reflected extensive new bone formation. 3. The subchondral bone trabeculae also revealed bright golden yellow fluorescence on their peripheral borders, so trabeculae turned thicker obviously. 4. The marrow tissues between the bone trabeculae exhibited particulate or spherical bright golden yellow fluorescence, reflecting new bone formation in the marrow. The particulate and spherical bright golden yellow fluorescent materials might aggregate, enlarge and merge into large piece of new bone and they also fused with the neighbouring bone trabeculae. The aforementioned changes in the structure of the subchondral bone tissues increased greatly the mass in the osteoarthritic femoral head.
文摘The scope of this project was to investigate the possibility of application of Image Processing Technique in the field of Shaft Alignment process. Misalignment of shaft using image processing software Visionbuilder was calculated. The further purpose of this project was to check whether the image processing technique can be used in bone transplant surgery. The model of the hip was used for the experimentation purpose. Image processing software Visionbuilder was used to match the profiles of the bone before implant and bone after implant.
基金Projects (50832004, 51202194) supported by National Natural Science Foundation of ChinaProject (11-BZ-2012) supported by the Research Fund of the State Key Laboratory of Solidification Processing (NWPU), China+1 种基金Project (T201107) supported by Shenzhen Key Laboratory of Special Functional Materials, Shenzhen University, ChinaProject (B08040) supported by 111 Project of China
文摘A hip joint simulator was employed to predict the clinical wear behaviour of carbon/carbon （C/C） composites with needled carbon cloth preform and carbon felt preform. Wear particles generated from the two kinds of C/C composites were isolated and characterised by the size distribution and morphology. The evolvement of wear particles in the hip joint simulator was proposed. The results show that the wear particles from two kinds of C/C composites have a size ranging from submicron to tens of micrometers. The wear particles have various morphologies including broken fiber, fragment fiber, slice pyrolytic carbon and spherical pyrolytic carbon. C/C composites with needled carbon cloth preforms have larger size range and more broken fiber particles and slice pyrolytic carbon particles in comparison with C/C composites with carbon felt preforms. The evolvement of pyrolytic carbon particles is caused by surface regularization, whereas, the evolvement of carbon fiber particles is related to stress direction in the hip joint simulator.
文摘AIM: To track the short-term neck narrowing changes in Birmingham metal-on-metal hip resurfacing(MOMHR) patients. METHODS: Since 2001, the Center for Hip and Knee Replacement started a registry to prospectively collect data on hip and knee replacement patients. From June 2006 to October 2008, 139 MOMHR were performed at our center by two participate surgeons using Birmingham MOMHR prosthesis(Smith Nephew, United States). It is standard of care for patients to obtain low, anteriorposterior(LAP) pelvis radiographs immediately after MOMHR procedure and then at 3 mo, 1 year and 2 year follow up office visits. Inclusion criteria for the present study included patients who came back for follow up office visit at above mentioned time points and got LAP radiographs. Exclusion criteria include patients who missed more than two follow up time points and those with poor-quality X-rays. Two orthopaedic residency trained research fellows reviewed the X-rays independently at 4 time points, i.e., immediate after surgery, 3 mo, 1 year and 2 year. Neck-to-prosthesis ratio(NPR) was used as main outcome measure. Twenty cases were used as subjects to identify the reliability between two observers. An intraclass correlation coefficient at 0.8 was considered as satisfied. A paired t-test was used to evaluate the significant difference between different time points with P < 0.05 considered to be statistically significant.RESULTS: The mean NPRs were 0.852 ± 0.056, 0.839 ± 0.052, 0.835 ± 0.051, 0.83 ± 0.04 immediately, 3 mo, 1 year and 2 years post-operatively respectively. At 3 mo, NPR was significantly different from immediate postoperative X-ray(P < 0.001). There was no difference between 3 mo and 1 year(P = 0.14) and 2 years(P = 0.53). Femoral neck narrowing(FNN) exceeding 10% of the diameter of the neck was observed in only 4 patients(5.6%) at two years follow up. None of these patients developed a femoral neck fracture(FNF). CONCLUSION: Femoral neck narrowing after MOMHR occurred as early as 3 mo postoperatively, and stabilized thereafter. Excessive FNN was not common in patients within the first two years of surgery and was not correlated with risk of FNF.
基金Canadian Institute of Health Science(CIHR)and Zimmer,Warsaw,United States
文摘AIM: To determine hip joint center(HJC) location on hip arthroplasty population comparing predictive and functional approaches with radiographic measurements.METHODS: The distance between the HJC and the mid-pelvis was calculated and compared between the three approaches. The localisation error between the predictive and functional approach was compared using the radiographic measurements as the reference. The operated leg was compared to the non-operated leg.RESULTS: A significant difference was found for the distance between the HJC and the mid-pelvis when comparing the predictive and functional method. The functional method leads to fewer errors. A statistical difference was found for the localization error between the predictive and functional method. The functional method is twice more precise.CONCLUSION: Although being more individualized, the functional method improves HJC localization and should be used in three-dimensional gait analysis.
文摘Total hip replacement(THR) is a successful and reliable operation for both relieving pain and improving function in patients who are disabled with end stage arthritis.The ageing population is predicted to significantly increase the requirement for THR in patients who have a higher functional demand than those of the past. Uncemented THR was introduced to improve the long term results and in particular the results in younger, higher functioning patients. There has been controversy about the value of uncemented compared to cemented THR although there has been a world-wide trend towards uncemented fixation. Uncemented acetabular fixation has gained wide acceptance, as seen in the increasing number of hybrid THR in joint registries, but there remains debate about the best mode of femoral fixation.In this article we review the history and current worldwide registry data, with an in-depth analysis of the New Zealand Joint Registry, to determine the results of uncemented femoral fixation in an attempt to provide an evidence-based answer as to the value of this form of fixation.
文摘A biomimetic hip joint simulator that can be used to evaluate the outcome of the cemented total hip replacement has been designed, manufactured and evaluated. The simulator produces motion in the extension/flexion plane, with a socket to rotate internal/externally. At the same time a dynamic loading cycle is applied. A validation test was performed on a cemented femoral stem within a novel composite femur. The hone quality has a strong effect on the stem migration and on the integrity of the interfaces. The migration of the stem is a combination of 3-D translation and rotation of the stem. Under the same loading conditions, weak bone allows more stem migration than strong bone. There is a great decrease in the strength of the stem-cement interface after the dynamic test, and the weak bone composite exhibited a greater reduction in interfacial strength than the strong bone composite. The decrease of the interfacial strength indicates that the primary bonding between the stem and the cement mantle had deteriorated and the integrity of stem-cement interface was damaged. The study demonstrates the value of using a hip joint simulator to investigate stem migration and interface integrity within the cemented hip replacement, suggesting that method can be used for in vitro evaluation of the biomaterials used in the cemented hip replacements.
基金supported by the Washington University Institute of Clinical and Translational Sciences (No. UL1 TR000448) (Schmidt)the National Center for Advancing Translational Sciences (No. TLl TR000449) (Schmidt)+1 种基金the National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development, and National Institute of Neurological Disorders and Stroke (No. K23 HD067343,K12 HD055931) (Harris-Hayes)the National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development (No. R15HD059080)
文摘Background:Dynamic knee valgus(DKV)is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing.Differences in hip and knee kinematic components of DKV may explain the emergence of different pain problems in people who exhibit the same observed movement impairment.Using a secondary analysis of exiting data sets,we sought to determine whether hip and knee frontal and transverse plane angles during a functional task differed between women with patellofemoral pain and women with chronic hip joint pain and the relationship between joint-specific kinematics and pain in these 2 pain populations.Methods:In the original studies,3-dimensional hip and knee kinematics during a single-limb squat were obtained in 20 women with patellofemoral pain and 14 women with chronic hip joint pain who demonstrated visually classified DKV.Pain intensity during the squat was assessed in both groups.For the secondary analysis,kinematic data were compared between pain groups using their respective control groups as a reference.Within each pain group,correlation coefficients were used to determine the relationship between kinematics and pain during the squat.Results:Hip adduction and contralateral pelvic drop were greater in those with chronic hip joint pain compared to those with patellofemoral pain(effect sizes ≥0.40).Greater knee external rotation(r= 0.47,p= 0.04)was correlated with greater knee pain in those with patellofemoral pain,while greater hip adduction(r = 0.53,p = 0.05)and greater hip internal rotation(r = 0.55,p = 0.04)were correlated with greater hip pain in those with chronic hip joint pain.Conclusion:Hip frontal plane motion was greater in those with chronic hip joint pain compared to those with patellofemoral pain.In both groups,greater abnormal movement at the respective joint(e.g.,knee external rotation in the patellofemoral pain group and hip adduction and internal rotation in the chronic hip joint pain group)was associated with greater pain at that joint during a single-limb squat.
文摘BACKGROUND Periprosthetic joint infections(PJIs)are frequently caused by coagulase-negative Staphylococci(CoNS),which is known to be a hard-to-treat microorganism.Antibiotic resistance among causative pathogens of PJI is increasing.Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis.We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature.AIM To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS.METHODS All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included.Patients with CoNS infection were included in the study,including polymicrobial cases.Primary outcome was infection eradication at final follow-up.RESULTS Forty-four patients were included in the study.Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee.At final follow-up after a mean of 37 mo,recurrent or persistent infection was present in eleven patients.CONCLUSION PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance.Infection eradication rate of 70%-80%may be achieved.
文摘Enhanced recovery after surgery(ERAS)protocols are applied in orthopedic surgery and are intended to reduce perioperative stress by implementing combined evidence-based practices with the cooperation of various health professionals as an interdisciplinary team.ERAS pathways include pre-operative patient counselling,regional anesthesia and analgesia techniques,post-operative pain management,early mobilization and early feeding.Studies have shown improvement in the recovery of patients who followed an ERAS program after hip or knee arthroplasty,compared with those who followed a traditional care approach.ERAS protocols reduce post-operative stress,contribute to rapid recovery,shorten length of stay(LOS)without increasing the complications or readmissions,improve patient satisfaction and decrease the hospital costs.We suggest that the ERAS pathway could reduce the LOS in hospital for patients undergoing total hip replacement or total knee replacement.These programs require good organization and handling by the multidisciplinary team.ERAS programs increase patient's satisfaction due to their active participation which they experience as personalized treatment.The aim of the study was to develop an ERAS protocol for oncology patients who undergo bone reconstruction surgeries using massive endoprosthesis,with a view to improving the surgical outcomes.
文摘BACKGROUND Prosthetic joint infection(PJI)is a devastating complication requiring prolonged treatment and multiple operations,leading to significant morbidity for the patient.Patients are routinely tested for methicillin-resistant staphylococcus aureus(MRSA)colonisation.MRSA positive patients are given eradication therapy.We hypothesise that patients who are MRSA positive pre-operatively,have increased risk of developing PJI.AIM To identify deep wound infection(PJI)rates in patients who are colonised MRSA positive compared with those who are not colonised;and long term clinical and radiological outcomes.METHODS All patients who underwent total hip and knee replacements(THR/TKR)between December 2009 and December 2019 were identified.Patients who were also identified as being MRSA positive at pre-operative assessment were then selected.Confirmation of prescribing eradication treatment was recorded.Patient records,including consultation letters,operation notes and microbiology results were reviewed retrospectively.Comparison of outcomes for each MRSA positive patient was made with 2 MRSA negative patients undergoing the same operation of a similar age by the same consultant.RESULTS Screening identified 42 knee and 32 hip arthroplasty patients as MRSA positive,84 MRSA negative knee and 64 hip patients were reviewed.Patients were matched with medical co-morbidities in each group.Mean follow up was 5 years.PJI was identified in 4/32(12.5%)of THR MRSA positive and 3/42(7%)of TKR patients.All patients had PJI within one year of surgery.CONCLUSION MRSA positive patients are given eradication therapy routinely.However,no confirmation of eradication is sought.Patients who have MRSA colonisation preoperatively,in our study had a significantly increased risk of PJI,when compared to negative patients.We would recommend establishing true eradication after treatment prior to arthroplasty.
文摘BACKGROUND Utilizing the large jumbo cup in revision total hip arthroplasty is an effective approach to cure many lacunar and segmental peripheral bone defects.However,with the use of the jumbo cup,the center of the hip joint may become elevated relative to the primary acetabulum,and the diameter of the large cup is greater.AIM To study the height and the significance of the elevation of the hip joint center.METHODS Eighty-eight patients matched the criteria for this condition and were included in the study.The center height of the hip joint was measured relative to the opposite normal hip joint.The diameter of the jumbo cup was measured and checked according to operation notes,and the diameter of the jumbo cup was measured with a prosthesis label.Then,the horizontal and vertical centers of rotation were measured on the surgical side and opposite side.The average center height of the hip joint on the renovated side and the opposite side and the position of the hip cup relative to the teardrop were compared using a paired t-test.RESULTS Radiometric analysis showed that the average hip joint center was elevated by 7.6 mm.The rotational center height delta of the renovated hip was 7.6±5.6 mm,and there was an obvious difference between the two groups(P=0.00).The difference in horizontal distance was 0.5±5.1 mm(-11.5-14.0 mm),and there was no obvious difference between the two groups(P=0.38).According to the foreign standard,the rotational center height delta of the renovated hip was 7.5±6.2 mm,and there was a significant difference between the two groups(P=0.00).There was no obvious difference between the domestic and foreign standards(P>0.05)between the two groups.CONCLUSION The application of the jumbo cup elevates the rotational center of the hip joint,but it is feasible and effective to use the jumbo cup.
文摘The purpose of this study was to demonstrate the improvement of hip joint dysregulation, including pain (coxalgia), tension, and restriction of joint mobility, using a dental gold alloy inlay. The subject was a 63-year-old man who was suffering from the abovementioned symptoms for several months. On placement of the gold alloy inlay on his chest, the joint flexibility was observed to increase, and the severity of the abovementioned symptoms decreased. When the inlay was placed in his tooth, the flexibility of the joint further increased, and all other symptoms disappeared. No side effects were observed, and the prognosis was good. We believe that these effects may be explained using the electromagnetic waves emitted by the inlay and by the restoration of biting conditions. Future multidisciplinary research focusing on possible underlying mechanisms regarding the relation between electromagnetic waves and dentistry is necessary.
文摘Hip joint osteoarthritis, a widespread disabling disease with no known cause, produces considerable bouts of intractable pain as a result of multiple disease associated problems. This paper examines some sources of osteoarthritic hip joint pain, a poorly understood topic at best. Presented in three parts are data retrieved from several sources, including animal models. It is concluded that to improve the effectiveness of treatments designed to minimize hip osteoarthritis pain, a better understanding of the diverse origins of hip joint pain, and hip joint neurology, may permit the development of more precise as well as targeted pain strategies.
文摘BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure for preventing acute surgical site infection following primary total hip arthroplasty(THA)and total knee arthroplasty(TKA).AIM To investigate the effectiveness of prophylactic intraoperative application of vancomycin(1000 mg/L;2 L)solution vs.plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.METHODS A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed.These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015(group 1,1018 patients;453 undergoing THA and 565 undergoing TKA)or intrawound irrigation with vancomycin solution(1000 mg/L)before wound closure between January 2016 and December 2019(group 2,1175 patients;512 undergoing THA and 663 undergoing TKA).The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.RESULTS There were no significant demographic differences between the 2 groups.There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure(overall incidence of infection:group 1,2.46%vs group 2,0.09%,P<0.001).There was no significant difference in the incidence of wound healing complications between the two groups.CONCLUSION Prophylactic irrigation with vancomycin solution(1000 mg/L;2 L)significantly decreases the incidence of acute surgical site infection after primary TJA.This strategy is a safe,efficacious,and inexpensive method for reducing the incidence of acute surgical site infection after TJA.
