简介：BackgroundEnd阶段脚关节关节炎损害联合功能和病人活动性。全部的脚关节代替是一个外科的过程对待严重脚关节关节炎。SaltoTalaris解剖脚关节TM(STAA)被设计模仿正常脚关节解剖和脚关节运动的屈曲/扩展。这研究的目的是与结束阶段在gait.MethodsFive病人期间在脚关节关节功能和力学上检验STAA脚关节代替的效果单方的脚关节关节炎被招募。病人们执行了水平在2个场合上走在一个实验室背景，在以前并且在STAA脚关节手术以后的3个月。美国矫形的脚和脚关节社会(AOFAS)hindfoot分数被获得。A12照相机运动俘获系统被用来执行走的分析。步法temporo空间的参数和脚关节关节力学被评估。配对的学生t测试和非参量的Wilcoxon匹配测试被执行在在外科前和外科以后的走conditions.ResultsCompared之间的biomechanical变量检验差别到pre外科的条件，在3月post-STAA外科，病人们在AOFAShindfoot经历了更大的改进分数(p=0.0001)；STAA脚关节证明31%在脚关节关节旅行(p=0.045)增加，22%在脚关节plantarflexor时刻(p=0.075)增加，60%尽最大努力增加吸收(p=0.023)，并且68%尽最大努力增加生产(p=0.039)。病人们也证明26%在走速度(p=0.005)增加，迈进长度(p=0.013)的20%增加，在两倍支持时间(p=0.043)的15%减少，和在全部的位置的5%减少预定(p=0.055)在手术以后的.ConclusionThree月，STAA病人在脚关节功能和步法参数经历了改进。STAA脚关节在象走那样的每日的活动期间表明了改进脚关节力学。

简介：客观：为王牌探索起作用的指示和主要全部的新潮的关节造形术的起作用的方法平坦骨折并且观察临床的药品effect.Methods：我们回顾地总结了并且分析创伤的条件，破裂类型，复杂并发症，起作用的时间，起作用的技术，和11patients的短期的药品效果(10男性和1女性，与42的吝啬的年龄。4年)与王牌平坦骨折经历了主要全部的新潮的关节造形术。结果；病人被跟随在上面为6-45月(吝啬的=28月)。他们手术后的新潮的关节的普通哈里斯分数是78。结论：指示的Understrict控制，有平坦骨折可以经历的王牌的病人主要全部的新潮的关节造形术，而是稳定的王牌平坦部件应该被做。

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简介：AbstractProsthetic infection is one of the severe postoperative complications of arthroplasty. Mixed bacterial-fungal prosthetic infection is rare but can be disastrous. This case was a 76-year-old female suffered from prosthetic infection following total hip replacement due to femoral neck fracture and underwent multiple debridements. The culture of periprosthetic tissue was bacteriologically sterile following the first debridement, while the Staphylococcus hominis was identified in the second debridement in the previous hospitalization where fungal infection had not been considered. Thus the pathogen spectrum of anti-infection therapy failed to contain fungus. Ultimately, the culture result of our sampled periprosthetic tissue during the third debridement was Candida albicans without bacterium in our hospital. The fungal prosthetic infection was successfully treated by a two-stage revision with antifungal drugs. Accurate diagnosis and standardized treatment is the key to the therapy of infection after hip arthroplasty, especially for mixed bacterial-fungal prosthetic infection.

简介：AbstractAnterior tibiofemoral dislocation after total knee arthroplasty is an extremely rare and serious event. Amongst English-published papers, we found only 15 relevant cases, 3 of which presented vascular complications. This manuscript aims to present a 77-year-old woman with a TC-Plus (Smith & Nephew) cruciate-retaining type in first time of knee prosthesis, who suffered an anterior tibiofemoral dislocation and were admitted to our hospital. The clinical management and outcome were evaluated. Furthermore, a review of literature was performed. We concluded that early detection and surgical intervention of vascular injury is the key in the survival of the limbs. If there is still knee instability after acute recovery, it seems that revision surgery with constrained total knee arthroplasty can bring about good clinical and functional results.

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简介：AbstractBackground:Synovectomy has been introduced into total knee arthroplasty (TKA) with the aim of relieving pain and inflammation of the synovium. However, there are no long-term, comparative data to evaluate the effect of synovectomy in TKA. This study was aimed at assessing pain, function, and complications in patients undergoing synovectomy during TKA for osteoarthritis (OA) at long-term follow-up.Methods:This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA. Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA. The overall efficacy of both strategies was evaluated by determination of blood loss, the Knee Society score (KSS), and knee inflammation conditions during a 3-month postoperative period. The postoperative pain, range of motion (ROM), and complications were sequentially evaluated to compare the two groups until 10 years after surgery.Results:At the 10-year follow-up, both groups had a similarly significantly improved ROM (114.88 ± 9.84° vs. 114.02 ± 9.43°, t = 0.221, P = 0.815) and pain relief with no differences between the two groups (1.0 [1.0] vs. 1.0 [1.5], U = 789.500, P = 0.613). Similar changes in total blood loss, KSS, and knee inflammation were found in both groups during 3 months postoperatively (P > 0.05). Additionally, there was no significant difference regarding complications and satisfaction between the two groups (P > 0.05).Conclusions:Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain, ROM, and satisfaction during a 10-year follow-up. In addition, it may not result in more blood loss and increased incidence of long-term complications. Based on our long-term findings, it should not be performed routinely.Trial registration:Chinese Clinical Trial Registry, ChiCTR-INR-16008245; https://www.chictr.org.cn/showproj.aspx?proj= 13334.

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简介：Objective:Toevaluatetheoutcomeoftotalhiparthroplasty(THA)withcementlesscupsandfemoralheadautograftsforpatientswithhipdysplasiaandosteoarthritis.Methods:Between1995and2002,weimplanted23cementlesscupsandfemoralheadautograftsin20patientswithhipdysplasiaandosteoarthritis.Inthisstudy,aretrospectivestudywasmadeon21hipsin20patients(18femalesand2males,aged50yearsonanaverage)withdevelopmentalhipdysplasiatreatedbyTHAwithacementlesscupandfemoralheadautograft.Theacetabularcupwasplacedatthelevelofthetrueacetabuinmandallthepatientsrequiredautogenousfemoralheadgraftsduetoacetabulardeficiency.Theaveragerateoftheacetabularcupcoveredbythefemoralheadautograftwas31%(rangingfrom10%to45%).Eighthipshadlessthan25%cupcoverageandthirteenbetween25%and50%.Theaveragefollow-upperiodwas4.7years(range,1-8years).ThereplacingoutcomewasevaluatedbymodifiedHarrishipscore.Preoperativeandfollow-upradiographsweremade.Results:Alltheautograftswereunitedtothehostbones.Noautograftwascollapsedornocomponentfromthehipwasloosedinallthepatients.AccordingtothemodifiedHarrishipscore,theaveragehipscoreincreasedfrom46beforeoperationto89atthefinalreview.Beforeoperation,theleg-lengthdiscrepancywasgreaterthan2cminallthepatientsexceptonewithbilateralhipdysplasia.Afteroperation,only2outof20patientshadaleg-lengthdiscrepancygreaterthan1cm.Threehipsshowedminorboneresorptioninthelateralportionofthegraft,whichdidnotsupportthecup.ThreehipsdevelopedGrade1BrookerheterotopicossificationandonedevelopedGrade2.Conclusions:THAwithacementlesscupandafemoralheadautograftforpatientswithosteoarthritisresultedfromhipdysplasiacanresultinfavorableoutcomes.Thismethodcanprovidereliableacetabularfixationandrestoretheacetabularbonestockinpatientswithdevelopmentalhipdysplasiawhenthe

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简介：AbstractPurpose:The treatment and outcome of tibial stress fractures concomitant with knee osteoarthritis (OA) are complicated. The aim of this study was to evaluate the functional and radiological outcome of total knee arthroplasty with long tibial stem as a treatment for patients having knee OA and tibial stress fracture.Methods:Patients who were diagnosed to have proximal tibia stress fracture along with knee OA at our institution between June 2013 and November 2018 were included in our study. All patients underwent total knee arthroplasty with long tibial stem. Preoperative and postoperative functional assessments were done according to range of movement of the knee joint, knee society score and knee injury and OA outcome score. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Results:Twelve patients were included in the study. All patients were found to have stress fractures in the proximal half of tibia and extra-arthrosis. Four patients had non-union/delayed union, and 8 patients had acute fractures. The average preoperative range of movement was 88.1°, which improved to 116.3° at 3 months following surgery. It was found that the fracture has healed in all cases. Mean knee society score improved from 32.9 preoperatively to 89.3 at 1 year follow-up. Knee injury and OA outcome score improved from a mean score of 28.3 preoperatively to 81.1 at 1 year follow-up.Conclusion:Stress fractures can occur in the proximal tibia in patients with knee OA. Total knee arthroplasty with tibial stem provides a suitable solution for both conditions. Additional plating or bone graft is unlikely to be required.

简介：AbstractBackground:Total ankle replacement (TAR) is a viable option for the treatment of end-stage ankle arthritis. In China, the INBONE-II implant is the only total ankle prosthesis approved since 2016. The purpose of this study is to report a large sample of findings for the TAR with INBONE-II prosthesis.Methods:A total of 64 patients with end-stage ankle arthritis, who underwent primary TAR using INBONE-II by the same surgeon from 2016 to 2019, at a single institution were included in this retrospective, single-center study. Clinical data, radiographic findings, survival rate, and complications were recorded and assessed pre-operatively and at the most recent follow-up.Results:A total of 64 patients were available for follow-up at least 2 years after surgery; the mean follow-up duration for clinical outcomes was 37.9 months (24–59 months), and for radiographic findings was 22.8 months (12–59 months). There were significant improvements (P < 0.01) in the American Orthopedic Foot and Ankle Society hindfoot scale, the visual analog scale for pain, and the Short Form-36. There were statistically significant differences between pre-operative and post-operative comparisons of the talar tilt angle (TT) and the tibial lateral surface angle (TLS) in the radiographic findings (TT from 4.7 ± 4.3° to 1.3 ± 1.3°, TLS from 80.4 ± 7.7° to 87.4 ± 2.3°, P < 0.01). There was no statistically significant difference in improvement of the tibial anterior surface angle (P = 0.14). Ten complications (all low grade) were recorded according to the Glazebrook classification system. The survivorship of the prosthesis was 100% (64/64).Conclusion:Patients who underwent TAR with INBONE-II prosthesis demonstrated significant improvements in all measures of pain and function as well as in radiographic findings. High survival and a low incidence of complications were observed in this study.

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简介：AbstractBackground:Intravertebral and general anesthesia (GA) are two main anesthesia approaches but both have defects. This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-controlled infusion (TCI) on blood loss and transfusion for total hip arthroplasty (THA) in elderly patients in comparison with combined spinal-epidural anesthesia (CSEA) or GA.Methods:Totally, 240 patients (aged ≥65 years, American Society of Anesthesiologists [ASA] I-III) scheduled for posterior THA were enrolled from September 1st, 2017 to March 1st, 2018. All cases were randomly divided into three groups to receive CSEA (group C, n = 80), GA (group G, n = 80), or subarachnoid anesthesia and propofol TCI (group T, n= 80), respectively. Primary outcomes measured were intra-operative blood loss, autologous and allogeneic blood transfusion, mean arterial pressure at different time points, length of stay in post-anesthesia care unit (PACU), length of hospital stay, and patient satisfaction degree. Furthermore, post-operative pain scores and complications were also observed. The difference of quantitative index between groups were analyzed by one-way analysis of variance, repeated measurement generalized linear model, Student-Newman-Keuls test or rank-sum test, while ratio index was analyzed by Chi-square test or Fisher exact test.Results:Basic characteristics were comparable among the three groups. Intra-operative blood loss in group T (331.53 ± 64.33 mL) and group G (308.03 ± 64.90 mL) were significantly less than group C (455.40 ± 120.48 mL, F = 65.80, P < 0.001). Similarly, the autologous transfusion of group T (130.99 ± 30.36 mL) and group G (124.09 ± 24.34 mL) were also markedly less than group C (178.31 ± 48.68 mL, F= 52.99, P < 0.001). The allogenetic blood transfusion of group C (0 [0, 100.00]) was also significantly larger than group T (0) and group G (0) (Z = 2.47, P = 0.047). Except for the baseline, there were significant differences in mean arterial blood pressures before operation (F= 496.84, P < 0.001), 10-min after the beginning of operation (F = 351.43, P < 0.001), 30-min after the beginning of operation (F = 559.89, P < 0.001), 50-min after the beginning of operation (F = 374.74, P < 0.001), and at the end of operation (F= 26.14, P < 0.001) among the three groups. Length of stay in PACU of group T (9.41 ± 1.19 min) was comparable with group C (8.83 ± 1.26 min), and both were significantly shorter than group G (16.55 ± 3.10 min, F = 352.50, P < 0.001). There were no significant differences among the three groups in terms of length of hospitalization and post-operative visual analog scale scores. Patient satisfaction degree of group T (77/80) was significantly higher than group C (66/80, χ2= 7.96, P = 0.004) and G (69/80, χ2 = 5.01, P = 0.025). One patient complained of post-dural puncture headache and two complained of low back pain in group C, while none in group T. Incidence of post-operative nausea and vomiting in group G (10/80) was significantly higher than group T (3/80, χ2 = 4.10, P = 0.043) and group C (2/80, χ2 = 5.76, P = 0.016). No deep vein thrombosis or delayed post-operative functional exercise was detected.Conclusions:Single subarachnoid anesthesia combined with propofol TCI seems to perform better than CSEA and GA for posterior THA in elderly patients, with less blood loss and peri-operative transfusion, higher patient satisfaction degree and fewer complications.

简介：AbstractPurpose:By comparing the outcomes of total hip arthroplasty with hemiarthroplasty in elderly patients with a femoral neck fracture to investigate the one-year mortality, dislocation, infection, reoperation rate, and thromboembolic event.Methods:The PubMed, EMBASE databases, and Cochrane library were systematically searched from the inception dates to April 1, 2020 for relevant randomized controlled trials in English language using the keywords: "total hip arthroplasty" , "hemiarthroplasty" and "femoral neck fracture" to identify systematic reviews and meta-analyses. Two reviewers independently selected articles, extracted data, assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’ stools, and discussed any disagreements. The third reviewer was consulted for any doubts or uncertainty. We derived risk ratios and 95% confidence intervals. Mortality was defined as the primary outcome. Secondary outcomes were other complications, dislocation, infection, reoperation rate, and thromboembolic event.Results:This meta-analysis included 10 studies with 1419 patients, which indicated that there were no significant differences between hemiarthroplasty and total hip arthroplasty in reoperation, infection rate, and thromboembolic event. However, there was a lower mortality and dislocation rate association with total hip arthroplasty at the one-year follow-up.Conclusion:Based on our results, we found that total hip arthroplasty was better than hemiarthroplasty for a hip fracture at one-year follow-up.

简介：AbstractBackground:Physical therapy is regarded as an essential aspect in achieving optimal outcomes following total knee arthroplasty (TKA). The coronavirus disease 2019 (COVID-19) pandemic has made face-to-face rehabilitation inaccessible. Virtual reality (VR) is increasingly regarded as a potentially effective option for offering health care interventions. This systematic review and meta-analysis investigate VR-based rehabilitation’s effectiveness on outcomes following TKA.Methods:From inception to May 22, 2021, PubMed/Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, Scopus, PsycINFO, Physiotherapy Evidence Database, China National Knowledge Infrastructure, and Wanfang were comprehensively searched to identify randomized controlled trials (RCTs) evaluating the effect of VR-based rehabilitation on patients following TKA according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions.Results:Eight studies were included in the systematic review, and seven studies were included in the meta-analysis. VR-based rehabilitation significantly improved visual analog scale (VAS) scores within 1 month (standardized mean difference [SMD]: -0.44; 95% confidence interval [CI]: -0.79 to -0.08, P = 0.02), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) within 1 month (SMD: -0.71; 95% CI: -1.03 to -0.40, P < 0.01), and the Hospital for Special Surgery Knee Score (HSS) within 1 month and between 2 months and 3 months (MD: 7.62; 95% CI: 5.77 to 9.47, P < 0.01; MD: 10.15; 95% CI: 8.03 to 12.27, P < 0.01; respectively) following TKA compared to conventional rehabilitation. No significant difference was found in terms of the Timed Up and Go (TUG) test.Conclusions:VR-based rehabilitation improved pain and function but not postural control following TKA compared to conventional rehabilitation. More high-quality RCTs are needed to prove the advantage of VR-based rehabilitation. As the COVID-19 pandemic continues, it is necessary to promote this rehabilitation model.

简介：<正>Purpose:Thepurposeofthisstudywastoexamineeffectsofasportversionofasemi-rigidanklebrace(ElementTM)andasoftanklebrace（ASO）onanklebiomechanicsandgroundreactionforces（GRFs）duringadroplandingactivityinsubjectswithchronicankleinstability(CADcomparedtohealthysubjectswithnohistoryofCAI.Methods:Tenhealthysubjectsand10subjectswhohadmultipleanklesprainsparticipatedinthestudyasthecontrolandunstablesubjects,respectively.TheCAIsubjectswereage,bodymassindexandgendermatchedwiththecontrolsubjects.Thearchindexandanklefunctionsofthesubjectsweremeasuredinasubjectscreeningsession.Duringthebiomechanicaltestsession,participantsperformedfivetrialsofdroplandingfrom0.6m,wearingnobrace（NB）.Element?braceandASObrace.Simultaneousrecordingofthree-dimensionalkinematic（240Hz）andGRF（1200Hz）datawereperformed.Results:TheCAIsubjectshadloweranklefunctionalsurveyscores.ThearchindexanddeformityresultsshowedgreaterarchdeformityofElementTMagainstastaticloadthaninNBandASOduetogreaterinitialarchpositionheldbythebrace.CAIparticipantshadgreatereversionvelocitythanhealthycontrols.TheASObracereducedthefirstpeakverticalGRFwhereasElementTMincreased2ndpeakverticalGRF.ElementTMbracereducedeversionrangeofmotion（ROM）andpeakeversionvelocitycomparedtoNBandASO.Inaddition,ElementTMreduceddorsiflexionROMandincreasedpeakplantarflexionmomentcomparedtoNBandASO.Conclusion:Resultsofstaticarchmeasurementsanddynamicanklemotionsuggestthattherestrictionsofferedbybothbracesareinpartduetomoredorsiflexedanklepositionsatcontact,andhigherinitialarchpositionandstifferankleforElementTM.

简介：AbstractBackground:Aspirin has demonstrated safety and efficacy for venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA); however, inconsistent dose regimens have been reported in the literature. This study aimed to evaluate and compare the safety and efficacy of 100 mg aspirin twice daily with rivaroxaban in VTE prophylaxis following THA.Methods:Patients undergoing elective unilateral primary THA between January 2019 and January 2020 were prospectively enrolled in the study and randomly allocated to receive 5 weeks of VTE prophylaxis with either oral enteric-coated aspirin (100 mg twice daily) or rivaroxaban (10 mg once daily). Medication safety and efficacy were comprehensively evaluated through symptomatic VTE incidence, deep vein thrombosis (DVT) on Doppler ultrasonography, total blood loss (TBL), laboratory bloodwork, Harris hip score (HHS), post-operative recovery, and the incidence of other complications.Results:We included 70 patients in this study; 34 and 36 were allocated to receive aspirin and rivaroxaban prophylaxis, respectively. No cases of symptomatic VTE occurred in this study. The DVT rate on Doppler ultrasonography in the aspirin group was not significantly different from that in the rivaroxaban group (8.8% vs. 8.3%, χ2 = 0.01, P = 0.91), confirming the non-inferiority of aspirin for DVT prophylaxis (χ2 = 2.29, P = 0.01). The calculated TBL in the aspirin group (944.9 mL [658.5-1137.8 mL]) was similar to that in the rivaroxaban group (978.3 mL [747.4-1740.6mL]) (χ2 = 1.55, P = 0.12). However, there were no significant inter-group differences in HHS at post-operative day (POD) 30 (Aspirin: 81.0 [78.8-83.0], Rivaroxaban: 81.0 [79.3-83.0], χ2 = 0.43, P = 0.67) and POD 90 (Aspirin: 90.0 [89.0-92.0], Rivaroxaban: 91.5 [88.3-92.8], χ2 = 0.77, P = 0.44), the incidence of bleeding events (2.9% vs. 8.3%, χ2 = 0.96, P = 0.33), or gastrointestinal complications (2.9% vs. 5.6%, χ2 = 1.13, P = 0.29).Conclusion:In terms of safety and efficacy, the prophylactic use of 100 mg aspirin twice daily was not statistically different from that of rivaroxaban in preventing VTE and reducing the risk of blood loss following elective primary THA. This supports the use of aspirin chemoprophylaxis following THA as a less expensive and more widely available option for future THAs.Trial Registration:Chictr.org, ChiCTR18000202894; http://www.chictr.org.cn/showproj.aspx?proj=33284