Joint Replacement Group Research Articles

Hip Abductor Muscle Strength Recovery: A Comparison Between Joint Replacement Surgery and Internal Fixation Surgery.

Introduction Proximal femoral fractures are common fractures of the hip that are considered a major healthcare concern globally; these include subtrochanteric, intertrochanteric, and theneck of the femur fractures. Internal fixation surgery and joint replacement surgery are the two most common intervention techniques used to treat these fractures. Consequently, weakness in the hip abductor muscle post-surgery may lead to implant loosening, necessitating revision of the surgery. In light of this, this study aimed to compare hip abductor strength recovery outcomes between joint replacement surgery and internal fixation surgery. Methodology A comparative study was performed over six months at the Department of Orthopaedics and Physiotherapy. Based on the inclusion and exclusion criteria and anticipating potential dropouts, a total of 56 patients were included in thestudy, and their hip abductor strength was measured using a sphygmomanometer. The patients were classified into two groups: Group A or Group B as per the type of hip surgery. Group A included 29 patientswho underwent joint replacement surgeries involving either cemented or uncemented total hip arthroplasty (THA) or hip hemiarthroplasty (HHA). Group B comprised 27 patientswho were operated on using either proximal femoral nail (PFN) or dynamic hip screw (DHS). Results The cohort consisted of 36 males and 20 females, with a mean age of51.71 years. The overall mean value of hip abductor muscle strength at postoperative day (POD) three in the internal fixation group was 65.06 ±5.98, which progressed to 107.51 ±24.76 after six months; in the joint replacement surgery group, it was 70.03 ±12.46 at POD three, which progressed to 113.11 ±21.27 after six months. The age-wise distribution demonstrated that the patients in the age group of 18-50 years demonstrated progressive results: from 65.33 ±4.9 at POD three to 105.95 ±22.71 after six months in the internal fixation group;from 66.82 ±7.72 at POD three to 109.59 ±22.54 after six months in the joint replacement group. Moreover, patients aged above 50 yearsshowed progression from 64.80 ±6.98 at POD three to 103.33 ±27.30 after six months in the internal fixation group, and from 69.58 ±14.75 at POD three to 108.22 ±20.62 after six months in the joint replacement group. Conclusions Our findings revealed thatjoint replacement surgery resulted in greater improvements in the hip abductor muscle strength compared to internal fixation surgery in the immediate postoperative period and during follow-ups. Additionally, younger patients exhibited better strength-related outcomes in comparison to the elderly population regardless of the type of surgery.

Does joint-sparing tumor resection jeopardize oncologic and functional outcomes in non-metastatic high-grade osteosarcoma around the knee?

BackgroundWe previously reported joint-sparing tumor resection for osteosarcoma with epiphyseal involvement in which transepiphyseal osteotomy went through the in situ ablated epiphysis. However, we do not know whether this is a safe approach when compared with joint-sacrificed tumor resection. Our objective was to compare oncologic and functional outcomes between patients who underwent joint preservation (JP) and joint replacement (JR) tumor resection. Furthermore, we identified the risk factors of local recurrence, metastasis and survival.MethodsEighty-nine patients with non-metastatic high-grade osteosarcoma around the knee were treated with limb-salvage surgery (JP in 47 and JR in 42). Age, gender, tumor location, pathologic fracture, plain radiographic pattern, limb diameter change, perivascular space alteration, surgical margin, local recurrence, metastasis, death, and the Musculoskeletal Tumor Society (MSTS)-93 scores were extracted from the records. Univariate analysis was performed to compare oncologic and functional outcomes. Binary logistic and cox regression models were used to identify predicted factors for local recurrence, metastasis, and survival.ResultsLocal recurrence, metastasis and overall survival were similar in the JP and JR group (p = 0.3; p = 0.211; p = 0.143). Major complications and limb survival were also similar in the JR and JP group (p = 0.14; p = 0.181). The MSTS score of 27.06 ± 1.77 in the JP group was higher than that of 25.88 ± 1.79 in the JR group (p = 0.005). The marginal margin of soft tissue compared with a wide margin was the only independent predictor of local recurrence (p = 0.006). Limb diameter increase and perivascular fat plane disappearance during neoadjuvant chemotherapy were independent predictors for metastasis (p = 0.002; p = 0.000) and worse survival (p = 0.000; p = 0.001).ConclusionsJoint-sparing tumor resection with the ablative bone margin offers advantage of native joint preservation with favorable functional outcomes while not jeopardizing oncologic outcomes compared with joint-sacrificed tumor resection. Surgeon should strive to obtain adequate soft tissue surgical margin decreasing risk of local recurrence. Novel drug regimens might be reasonable options for patients with obvious limb diameter increase and perivascular fat disappearance during chemotherapy.

A Novel Rat Model to Study Postsurgical Pain After Joint Replacement Surgery.

PurposeThe mechanisms underlying chronic postsurgical pain after joint replacement (JR) are complex, and it has been suggested that chronic postsurgical pain can develop as a result of inadequate acute pain management. Few studies have addressed acute pain after JR using specific animal models. This study aimed to develop a novel JR model focused on postsurgical pain assessment and the time course of pain recovery.Materials and MethodsRats were allocated to the following three groups: sham (joint exposure), joint destruction (JD; resection of the femoral head), and JR (femoral head replacement using an originally developed implant). The time course of postsurgical pain behavior was measured using a dynamic weight-bearing apparatus, along with radiological assessments. The expression of calcitonin gene-related peptide-immunoreactive (CGRP-IR) neurons in the dorsal root ganglion (DRG) was evaluated by immunohistochemistry on days 28 and 42.ResultsThe ratio of weight-bearing distribution in the JR group gradually recovered from day 14 and reached the same level as that in the sham group on day 42, which was significantly greater than that in the JD group after day 7 (p<0.05). Radiologically, no significant issues were found, except for transient central migration of the implant in the JR group. The percentage of CGRP-IR DRG neurons in the JR group was significantly lower than that in the JD group on day 28 (mean, 37.4 vs 58.1%, p<0.05) and day 42 (mean, 32.3 vs 50.0%, p<0.05).ConclusionOur novel JR model presented acute postsurgical pain behavior that was successfully recovered to the baseline level at day 42 after surgery. Difference of the pain manifestation between the JR and JD groups could be supported by the expression of CGRP-IR in DRG neurons. This model is the first step toward understanding detailed mechanisms of post-JR pain.

Kidney transplant outcomes among recipients with post-transplant hip or knee joint replacement surgery.

Patients with end-stage renal disease (ESRD) are at a higher risk of needing hip or knee replacement (joint replacement) surgery due to the high prevalence of degenerative joint disease and other conditions. However, there remains a large debate about the timing of joint replacement surgery and whether it should be pre- vs post-transplant. We conducted a retrospective study analyzing all adult kidney transplant recipients (KTRs) at our university hospital who had undergone subsequent joint replacement between 2001 and 2017. Transplant-specific outcomes of acute rejection, death censored graft failure (DCGF), and patient death post-joint replacement surgery were outcomes of interest. Controls were selected at a 1:3 ratio based on the incidence density sampling of post-transplant interval. There were 101 KTRs in the joint replacement group and were compared with 281 controls. In the multivariate analysis, the need for joint replacement was not associated with acute rejection (HR: 1.59; 95% CI: 0.77-3.29; P=0.21); DCGF (HR: 0.89; 95% CI: 0.49-1.60; P=0.70) or patient death (HR: 0.84, 95% CI: 0.55-1.38, P=0.42). In selected KTRs, joint replacement surgery was not associated with detrimental transplant-specific outcomes.

660 Trapeziectomy Versus Joint Replacement for First Carpometacarpal (CMC-1) Joint Osteoarthritis: A Systematic Review and Meta-Analysis

Abstract Aim The challenge of managing first carpometacarpal (CMC-1) joint osteoarthritis is the lack of guidance on which surgical intervention is superior. This systematic review and meta-analysis compares joint replacement (JR) and trapeziectomy techniques to provide an update. Method In August 2020, MEDLINE, Embase and Web of Science were searched for eligible studies that compared these two techniques for the treatment of CMC-1 joint osteoarthritis (PROSPERO registration ID: CRD42020189728). Primary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH and pain visual analogue scale (VAS) scores. Secondary outcomes, such as total complication, dislocation, and revision surgery rates, were also measured. Results From 1909 studies identified, 14 studies (1005 patients) were eligible. Our meta-analysis found that post-operative QuickDASH score was lower for patients in the JR group, indicating decreased disability following this technique (5 studies, p = 0.0002). However, pain VAS scores were similar between the two groups (5 studies, p = 0.22). Interestingly, JR techniques had significantly greater odds of overall complications (12 studies; OR 2.27; 95% CI 1.17-4.40, p = 0.02) and significantly greater odds of revision surgery (9 studies; OR 5.14; 95% CI 2.06-12.81, p = 0.0004). Conclusions Overall, based on low to moderate quality evidence, we found that JR treatments may result in better function with less disability with comparable pain (VAS) scores; however, JR has greater odds of complications and greater odds of requiring revision surgery. More robust RCTs that compare JR and TRAP with standardised outcome measures and long-term follow-up would add to the overall quality of evidence.

Trapeziectomy with Ligament Reconstruction and Tendon Interposition versus Trapeziometacarpal Joint Replacement for Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis.

Background The trapeziometacarpal articulation in the thumb is a joint that is second-most commonly affected by osteoarthritis, and this can lead to considerable hand pain and disability. Currently, there is a multiplicity of surgical options available to address this problem, yet none has proven to be significantly superior to the others. Objective This study aims to compare the outcome of trapeziectomy with ligament reconstruction and tendon interposition versus trapeziometacarpal joint replacement for thumb carpometacarpal osteoarthritis. Materials and Methods A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. The NICE Healthcare Databases Advanced Search (HDAS) tool was used to search articles. One randomized controlled trial (RCT), one prospective cohort study and two retrospective cohort studies were identified. Results Our results demonstrate a significant difference in the Quick Disabilities of the Arm Shoulder and Hand (QDASH) score between the trapeziectomy with ligament reconstruction and tendon interposition (LRTI) and Joint Replacement groups with the joint replacement group exhibiting better QDASH scores than the LRTI group. We also found that those who had a joint replacement had a significantly better thumb opposition than those in the LRTI group, as demonstrated by a superior Kapandji score. However, the complication rate of joint replacement appears to be higher. Conclusion Our study reveals that while both treatment options are valid, the limited body of evidence currently available shows that joint replacement carries more risks and thus should not replace the current standard treatment of trapeziectomy with LRTI. This study highlights the need for more trials to be performed to more accurately compare the two treatment modalities. For the time being, we advocate that joint replacement is only performed by surgeons who perform this procedure regularly to reduce the risk of complications.

Trapeziectomy with LRTI or joint replacement for CMC1 arthritis, a randomised controlled trial

We compared an uncemented joint replacement (Elektra) with trapeziectomy (with ligament reconstruction and tendon interposition, LRTI) for the treatment of primary osteoarthritis in the first carpometacarpal joint (CMC1) in a randomised controlled trial. Forty patients were included (20 in each group) and followed for 2 years. The median age in the groups was 64 and 61, respectively, with 14 females in each. At final follow-up, there was no difference in the primary outcome measure (the quick disabilities of the arm, shoulder and hand score, QDASH), but the joint replacement group had significantly better motion and strength during the early rehabilitation period and significantly better range of thumb abduction and extension at the last follow-up. There were more complications in the joint replacement group with revision of prosthetic components in five cases, two of them due to cup loosening. Radiologically, lucency zones were seen around either cup or stem in 15 patients. Most were small, but two cases with major osteolysis resulted in revision. Shortening of the thumb ray was observed after trapeziectomy.Trial registration: ClinicalTrials.gov identifier: NCT02556515.

Satisfaction After Joint-preservation Surgery in Patients With Musculoskeletal Knee Sarcoma Based on Various Scores.

At our institute, we prioritize joint-preservation whenever possible in cases of musculoskeletal knee sarcoma. This study aimed to evaluate patient satisfaction after joint-preservation surgery using different scales. Surveys were mailed to 62 patients with musculoskeletal knee sarcoma. We analyzed the responders' data based on the Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), and three component scores (physical, mental, and role/social) of the 36-Item Short-Form Health Survey according to whether they belonged to patients in the joint-preservation or in the joint-replacement groups. The survey response rate was 67.7%. MSTS and TESS scores were higher in the patients in the joint-preservation group than in the joint-replacement group, although the differences lacked statistical significance. Better physical outcomes improve patient satisfaction, as demonstrated by the high satisfaction in the group with joint-preservation.

Curative effect of micro-strip line anchors combined with posterior capsulorrhaphy in the treatment of first metacarpophalangeal joint dislocation in rheumatoid arthritis

Objective To study the short-term and medium-term effects of mini- strip anchor and capsulotomy in the treatment of first metacarpophalangeal joint dislocation in rheumatoid arthritis(RA). Methods From January 2015 to December 2016, fifty-eight RA patients with first metacarpophalangeal joint dislocation were randomly divided into study group (20 cases), joint replacement group (19 cases) and non-operation group (19 cases). Postoperative evaluation indexes: the wound healing was observed in accordance with trial standard of functional evaluation of upper limbs of Chinese Medical Association Hand Surgery Society . The surgical outcomes of the three groups were compared.The hand function and quality of life were assessed by Michiga Hand Outcomes Questionnaire (MHQ) and arthritis impact measurement scale 2 (AIMS2) before treatment, 6 months after treatment and 12 months after treatment. Results All the patients in the study group and the joint replacement group healed by first intention without any early complications.According to the criteria of upper extremity functional evaluation of Chinese Medical Association, the curative effect of the operation was evaluated.In the study group, 15 cases were excellent, 3 cases were good, 2 cases were poor, the excellent and good rate was 90.0%.In the joint replacement group, 15 cases were excellent, 3 cases were good, 1 case was poor, and the excellent and good rate was 94.7%.After treatment for 6months, the MHQ scores were improved significantly in the three groups ((48.36±8.24) vs.(73.06±10.55); (47.56±7.75) vs.(81.42±8.54); (48.75±8.85) vs.(65.91±8.26)) (F=33.19, 35.12, 28.42, P 0.05). At 6 and 12 months after treatment, AIMS2 scores of each group were significantly improved, but AIMS2 scores of study group ((216.51±35.28) points, (230.28±23.51) points) and arthroplasty group ((221.45±31.63) points, (234.15±21.42) points) were significantly higher than those of non-operation group ((192.69±41.31) points, (200.43 ±28.42) points) (P 0.05). Conclusion Micro-strip line anchors combined with posterior capsulorrhaphy in the treatment of first metacarpophalangeal joint dislocation in rheumatoid arthritis can achieve good stability of articular reduction, significantly improve the joint function and quality of life and have ideal short-term and mid-term effect. Key words: Micro-strip line anchors; Posterior capsulorrhaphy; Metacarpop halangeal joint dislocation; Rheumatoid arthritis; Short-term and mid-term effect

Hemiarthroplasty for the treatment of complicated femoral intertrochanteric fracture in elderly patients

To discuss the hemiarthroplasty for the threatment of femoral intertrochanteric fracture in elderly patients. From August 2013 to January 2017, 66 elderly patients with complicated femoral intertrochanteric fracture were treated including 20 males and 46 females with an average age of 85 years old ranging from 80 to 95. According to improve Evans classification, 33 cases were type III, 24 cases were type IV, 9 cases were type V. History included 31 cases of hypertension, 10 cases of diabetes, 12 cases of severe osteoporosis, 5 cases of atrial fibrillation, 3 cases of pulmonary heart disease, and 1 case of multiple myeloma. Hip hemiarthroplasty was used in 34 cases and internal fixation in 32 cases. The bleeding volume, complications and Harris scores of the two groups were observed and compared. The amount of blood loss during and after operation were(320±20) ml and(200±25) ml in the joint replacement group, and (350±30) ml and(250±30) ml in the internal fixation group, and there was no statistical difference between the two groups(P>0.05). All patients were followed up for an average of 2 years. The Harris score of the joint replacement group was 85.0±6.4, which was higher than that of the internal fixation group (72.0±3.4)(P<0.05). The difference of complications between the two groups was statistically significant (P<0.05). The elderly patients with femoral intertrochanteric fractures have many basic diseases, and the expected survival time is short. Using artificial bipolar femoral head prosthesis can restore the hip function early and to the maximum degree, make the patients get down in the bed early, effectively reduce the complications caused by internal fixation, improve the patient's quality of life and satisfaction, and early treatment. It is a kind of supplemental treatment, which conforms to the theory of rapid rehabilitation surgery and injury control, but should not expand the indication and strengthen the management of the perioperative period.

Serum periostin levels following small bone fractures, long bone fractures and joint replacements: an observational study

BackgroundIn asthma, serum periostin may potentially be used as a biomarker in the management of patients with Type-2 eosinophilic airway inflammation. However, serum periostin may be influenced by factors other than Type 2 inflammation, potentially confounding its interpretation. We aimed to measure change in periostin following bone injury.Methods102 adults without asthma were recruited into three groups: joint replacement surgery, long bone fracture, short bone fracture. Participants underwent seven measurements of serum periostin over 26 weeks after bone injury, and prior to surgery in the joint replacement group. Differences in periostin were measured using a ratio of geometric mean (RGM), with comparison made with pre-surgery (joint replacement) or 26 week (long and short fracture) reference measurements.ResultsIn the joint replacement group, periostin fell within 48 h (RGM 0.80, 95% CI 0.75–0.86), then increased to a maximum at 8 weeks (RGM 1.89, 1.77–2.02) and by 26 weeks remained above the reference measurement (RGM 1.27, 1.19–1.36). In the long bone fracture group, periostin was reduced at 48 h (RGM 0.76, 0.71–0.83) and then progressively increased to a maximum at 8 weeks (RGM 1.15, 1.06–1.23) compared with the reference measurement. In the short bone fracture group, periostin was reduced at 48 h (RGM 0.9, 0.85–0.95) but was not different from after week 1 compared with the reference measurement.ConclusionsSerum periostin levels are influenced by bone injury. The timing and extent of bone injury needs consideration if periostin is used as a biomarker in the management of eosinophilic asthma.Trial registration This trial was prospectively registered with the Australia New Zealand Trials Registry on Feb 7 2014, (ACTRN12614000151639: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363881).

Surgical treatment for knee osteoarthritis subsequent to previous femur fractures

Objective To investigate the indications and clinical outcomes of total knee arthroplasty or osteotomy for knee osteoarthritis subsequent to previous femur fractures. Methods Six patients (three male and three female) with knee osteoarthritis subsequent to previous femur fractures were analyzed retrospectively between February 2006 and February 2017. The average age of patients was 58.2±10.3 years old, ranged from 51 to 79 years. Four patients underwent total joint replacement and two underwent osteotomy. The average age of patients in joint replacement group was 60.5±12.3 years old. The age of the two patients in the osteotomy group was 51 and 55 years old, respectively. The extra-articular deformity angle of the coronal plane of the femur, lateral distal femur angle of mechanical axis, hip-knee-ankle angle (HKA) of preoperative and postoperative were determined on long-standing radiography. The mean angle of the extra-articular deformity in the joint replacement group was 17.0±7.7 degrees. The angle of the extra-articular deformity in the osteotomy group was 34 and 20 degrees. Lateral distal femur angle of mechanical axis in the joint replacement group was within the range of 87±7 degrees. Lateral distal femur angle of mechanical axis in the osteotomy group was out of the range of 87±7 degrees. The mean preoperative HKA of the joint replacement group was 161.8±8.0 degrees. The preoperative HKA of the osteotomy group was 155 and 160 degrees, respectively. Knee function was estimated according to knee range of motion and Knee Society Score (KSS). The results of postoperative hip-knee-ankle angle, knee range of motion (ROM) and knee society score were compared between the two groups. Results The mean HKA of the joint replacement group reached 176.0±2.8 degrees at one year postoperatively. The HKA of the osteotomy group improved to 177 and to 175 degrees at one year postoperatively. The average preoperative knee ROM improved significantly from 71±16 degrees preoperatively to 113±5 degrees postoperatively. The mean knee ROM of the joint replacement group was 113.0±6.8 degrees. The knee ROM of two patients in the osteotomy group was 110 and 115 degrees, respectively. The average preoperative KSS score improved significantly from 46±3 preoperatively to 88±3 postoperatively. The mean KSS of the joint replacement group was 88.8±3.0, while the KSS of the osteotomy group was 85 and 82. No bone nonunion was observed in the two patients in osteotomy group. Conclusion For patients with knee osteoarthritis subsequent to previous femur fractures, satisfactory short-term clinical outcomes could be obtained by total knee arthroplasty or osteotomy with the strict selection of proper operative indications. Key words: Femoral fractures; Osteoarthritis; Arthroplasty, replacement, knee

Tissue evacuated during joint replacement procedure as a source of mononuclear cells

BackgroundDifferent cell populations from bone marrow were used in various clinical trials for cardiac diseases during last decade. Four clinical studies are ongoing in our institution and enroll patients with cardiac diseases, coronary disease, type 2 diabetes, and osteoarthritis. The density gradient is used to separate bone marrow mononuclear cells. Joint replacement procedures were associated with significant loss of tissue. Usually, excess tissue as bone marrow, peripheral blood and fat are removed to clean operation site. The aim of this study is to prove whether removed tissue during joint replacement procedure can be considered as a significant source of mononuclear cells.MethodsExcised tissue obtained during joint replacement procedure was collected by AutoLog system. Bone marrow tissue was collected by iliac crest puncture. Mononuclear cells from both sources were isolated by using Ficoll density gradient centrifugation. Flow cytometry was used to detect mononuclear cell, CD34+ population counts and cell viability. Tissue processing yields between the group of joint replacement and iliac crest puncture group were compared.ResultsTogether, 34 bone marrow tissue processings were performed. On average, samples contained 46.31 ± 9.35 ml of bone marrow solution. Average cell yield in final product was 28.64 ± 9.35 × 106 MNCs and 0.77 ± 1.51 × 106 CD34+ population. In case of tissue removed during joint replacement nine processings were performed. On average samples contained 450 ± 157.69 ml of tissue solution. Average cell yield in final product was 76.67 ± 35.42 × 106 MNCs and 1.33 ± 0.97 × 106 CD34+ population.ConclusionsTissue processing analysis shows that tissue removed during joint replacement procedure can be assumed as a significant source of mononuclear cells. Methods used for bone marrow-derived mononuclear cell extraction can be applied to the excess tissue.

Selection of Surgical Methods in the Treatment of Upper Tibia Osteosarcoma and Prognostic Analysis

Background: We aimed to explore the clinical effects and prognosis of different surgical methods in upper tibia osteosarcoma. Methods: Among 112 patients with proximal upper tibia osteosarcoma, 40 patients were treated with amputation, 20 patients were treated with massive osteoarticular allograft, and the remaining 52 cases were treated with tumor resection and artificial joint replacement. Results: Recurrence was observed in 2 cases (5%) in the amputation group, in 6 cases (30%) in the massive osteoarticular allograft group, and in 6 cases (12%) in the tumor resection and artificial joint replacement group (P = 0.021). The lung metastasis rates were 40% in the amputation group, 40% in the massive osteoarticular allograft group, and 38% in the tumor resection and artificial joint replacement group (P = 0.986). The survival rates at 1, 3, and 5 years were 95%, 75%, and 45%, respectively, in the amputation group, 95%, 75%, and 35%, respectively, in the massive osteoarticular allograft group, and 92.3%, 78.8%, and 53.8%, respectively, in the tumor resection and artificial joint replacement group (P > 0.05). Conclusions: The selection of the optimal surgical method for upper tibia osteosarcoma should be made according to the individual circumstances of the patient. Our study has significance for reducing the incidence of surgical complications and improving the quality of postoperative life.

Effects of different methods of using pneumatic tourniquet in patients undergoing total knee arthroplasty: a randomized control trial.

The goal of this work was to investigate the effects of different methods of using pneumatic tourniquet on reducing blood loss in patients undergoing cemented total knee arthroplasty (TKA). One hundred and fifty patients undergoing unilateral cemented TKA were randomly divided into three groups (50 patients per group). The tourniquet was used during the entire operation (Group A), used from the beginning of operation to the completion of joint replacement (Group B), and from the beginning of osteotomy to the completion of arthroplasty (Group C). The following parameters were recorded: intraoperative blood loss (IBL), postoperative blood loss (PBL), hidden blood loss (HBL), and total blood loss (TBL); operation time and tourniquet time; incidence of postoperative complications; and hospital for special surgery (HSS) score. IBL, HBL, and TBL in group C was significantly less than that in group B (all P<0.05). Tourniquet time in group C was significantly less than that in groups A and B (all P<0.05). The incidence of tourniquet-related complications in group C (6%) was relatively lower than that in group A (10%) during hospitalization (P>0.05). Post-operative HSS scores at 2weeks after the operation in group C was significantly higher than that in group A and group B (all P<0.05). Our results suggest that using a tourniquet from the beginning of osteotomy to the completion of arthroplasty could significantly reduce TBL in TKA, and decrease the incidence of complications; thereby facilitating early post-operative functional recovery.

Temporomandibular Joint Condylar Osteochondroma: Complete Condylectomy and Joint Replacement Versus Low Condylectomy and Joint Preservation

Recommended treatment for patients with osteochondromas of the mandibular condyle is to perform complete condylectomy with joint replacement. Low condylectomy with joint preservation has recently been proposed as a treatment option. This study compared the outcomes of these treatment options in patients with condylar osteochondromas. Patients were divided into 2 groups: patients who underwent complete condylectomy and joint replacement (group A, n= 13) and patients who underwent low condylectomy and joint preservation (group B, n= 8). To optimize occlusion, function, and esthetics, maxillary and mandibular orthognathic procedures were performed as necessary to re-establish vertical ramus height. Outcomes were measured clinically and radiographically. The 2 groups showed significant clinical improvement (P < .05), with no tumor recurrence. Group A had increased operating room (OR) time and donor-site complications in those who received autogenous joint reconstruction compared with alloplastic joint replacement. Group B had a shorter OR duration with quicker postoperative recovery. Orthognathic procedures were stable in all cases. Complete and low condylectomies are viable options for the surgical management of osteochondromas of the mandibular condyle. If temporomandibular joint (TMJ) reconstruction is required, patient-fitted TMJ replacements provide similar clinical outcomes as autogenous reconstruction, but have the advantages of eliminating donor-site morbidity and decreasing operating time.

Comparison of Arthrodesis, Resurfacing Hemiarthroplasty, and Total Joint Replacement in the Treatment of Advanced Hallux Rigidus

The purpose of the present study was to compare the functional results of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in hallux rigidus. The data from patients treated from 2006 to 2010 for advanced stage hallux rigidus were retrospectively reviewed. A total of 38 patients who had at least 2 years (range 24 to 66 months, mean 31.1) of follow-up were included in the present study. Of the 38 patients, 12 were included in the total joint replacement group (group A), 14 in the resurfacing hemiarthroplasty group (group B), and 12 in the arthrodesis group (group C). At the last follow-up visit, the functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scale, visual analog scale (VAS), and metatarsophalangeal range of motion. Significant improvements were seen in the AOFAS-HMI score, with a decrease in the VAS score in all 3 groups. According to the AOFAS-HMI score, no significant difference was found between groups A and B. However, in group C, the AOFAS-HMI scores were significantly lower than in the other groups owing to the lack of motion. According to the final VAS scores, no significant difference was found between groups A and B; however, the VAS score had decreased significantly more in group C than in the other groups. No major complications occurred in any of the 3 groups. After 2 years of follow-up, all the groups had good functional outcomes. Although arthrodesis is still the most reliable procedure, implant arthroplasty is also a good alternative for advanced stage hallux rigidus.

Joint Replacement in Femoral Neck Fractures

Results of joint replacement in femoral neck fractures have been analyzed. During the period from 1994 to 2003 total hip replacement was performed to 399 patients with subcapital fractures including 372 patients in whom the operation was performed as a primary intervention. From 2002 to 2004 the total number of 290 hemiarthroplasty operations with use of module native implant was performed in 286 patients aged 76-101 years. In total joint replacement group intrahospital lethality made up 2% due to the following causes: pulmonary thrombembolia - 3 cases, acute cardiac insufficiency - 1 case, deep decubitus ulcers resulting in sepsis - 2 cases, polyorganic insufficiency on the background of severe concomitant pathology - 1 case. In the early postoperative period the following complications were noted: implant dislocation (5.2% of cases), intraoperative femoral fracture (3.5%). Infectious complications developed in 2 patients and in both cases removal of the implant was required. With mean-term follow-up native implants showed mean-term survival of 92-94% in 272 patients. Mean evaluation by Harris was the following: biometric «Sinko» and «ESI» implants - 83.1 points, PF «Sinko» implants - 89.3 points, combination of «Mathys» friction pair with native femoral component - 91.2 points. «Mathys» implants showed 94.6 points. Results of ЯРТЕЗ joint replacement were evaluated during the period from 1 to 3 years in 183 patients. Intrahospital lethality made up 1.8%. Excellent and good results were achieved in 53.7% of patients. Revision was required in 1.5% of cases. As concluded total hip replacement in femoral neck fracture was the effective treatment technique. It was reasonable both cement and cementless fixation with various implants for the optimum choice of implant in every specific patient. Use of modern module implants enabled to expand the indications for application of arthroplasty in elderly patients.

Comparison of three different procedures in the treatment of senile femoral neck fracture

Objective To compare internal fixation and arthroplasty in curative effects for the femoral neck fractures in the aged population. Methods All the 182 old patients with femoral neck fracture who had been treated from January 1999 to August 2007 in our department were reviewed. Of them, 42 cases received internal fixation (Group A), 64 femoral head arthroplasty (Group B) and 76 total hip joint replacement (Group C) . The 3 groups were similar in age, fracture classification and preoperative health condition. Their average follow-up was 38 (25 to 65) months. Comparisons were made between the 3 groups in hospitalization, operating duration, intraoperative bleeding, ambulation time, postoperative complications, secondary surgery, and functional recovery. Results Group A had less operating duration and blood loss, a healing rate of 90.5% (38/42), a rate of avascular femoral head necrosis of 23.8% (10/42), and a re-operation rate of 26. 2% (11/42). In Groups B and C, the re-operation rate was 7.8% (5 cases) and 5.3% (4 cases) respectively. The good-to-excellent rates of functional recovery were 85.9% (55/64), 89.5% (68/76) and 61.9% (26/42) respectively in Groups B, C, and A. In operating duration, blood loss, ambulation time, complications, secondary surgery and functional recovery, there was a significant difference (P 0.05). Conclusions In treatment of femoral neck fracture of Garden Ⅰ and Ⅱ in patients older than 60 years, internal fixation may be the first choice, and arthroplasty may be suitable for patients older than 65 years or those with fractures of Garden Ⅲ and Ⅳ. Key words: Femoral fractures; Fracture fixation, internal; Arthroplasty, replacement, hip; Aged

Radiosynoviorthesis in Osteoarthritis and Other Disorders with Concomitant Synovitis in Comparison to Rheumatoid Arthritis

The aim of this study was to evaluate the effectiveness of radiosynoviorthesis (RSO) in osteoarthritis and other disorders with concomitant synovitis versus rheumatoid arthritis by means of a standardized questionnaire. Eight-hundred and three RSO treatments were monitored in 691 patients by seven centers in three countries, using standardized questionnaires. Patients were assigned to three groups according to their age (20-40, 41-60, and 61-80 years). Additionally, the data was analyzed separately for patients with rheumatoid arthritis (group A) and those with osteoarthritis, psoriasis arthritis, pigmental villonodular synovitis, or persistent effusions after joint replacement (group B). Quality of life improved in 78% of group A and 59% of group B (p < 0.01). Ameliorations of joint pain, swelling/effusion, or flexibility were found in 80% of group A and 56% of group B (p < 0.01). The response rate was similar for small- and large-sized joints in group A, but was significantly higher for large-sized joints in group B (p < 0.01). The positive effects on joint pain, swelling/effusion, or flexibility lasted longer in group A (p < 0.01). Repeated RSOs were as effective as initial RSOs. The clinical outcome was not influenced by age, gender, or transient immobilization for 48 hours after RSO. Although slightly more efficient in rheumatoid arthritis, RSO represents an effective treatment option also in osteoarthritis and other disorders with concomitant synovitis.