The considerable hazard posed by periprosthetic joint infections underlines the urgent need for the rapid advancement of in-situ drug delivery systems within joint materials.However,the pursuit of sustained antibacter...The considerable hazard posed by periprosthetic joint infections underlines the urgent need for the rapid advancement of in-situ drug delivery systems within joint materials.However,the pursuit of sustained antibacterial efficacy remains a formidable challenge.In this context,we proposed a novel strategy that leverages swelling and erosion mechanisms to facilitate drug release of drug-loaded ultrahigh molecular weight polyethylene(UHMWPE),thereby ensuring its long-lasting antibacterial performance.Polyethylene oxide(PEO),a hydrophilic polymer with fast hydrating ability and high swelling capacity,was incorporated in UHMWPE alongside the antibacterial tea polyphenol(epigallocatechin gallate,EGCG as representative).The swelling of PEO enhanced water infiltration into the matrix,while the erosion of PEO balanced the release of the encapsulated EGCG,resulting in a steady release.The behavior was supported by the EGCG release profiles and the corresponding fitted release kinetic models.As demonstrated by segmented antibacterial assessments,the antibacterial efficiency was enhanced 2to 3 times in the PEO/EGCG/UHMWPE composite compared to that of EGCG/UHMWPE.Additionally,the PEO/EGCG/UHMWPE composite exhibited favorable biocompatibility and mechanical performance,making it a potential candidate for the development of drug-releasing joint implants to combat prosthetic bacterial infections.展开更多
BACKGROUND Total hip arthroplasty is a safe and effective procedure.To improve survivorship,ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed.Additive antioxidant was deployed to...BACKGROUND Total hip arthroplasty is a safe and effective procedure.To improve survivorship,ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed.Additive antioxidant was deployed to reduce oxidation and consequential wear,loosening,or osteolysis.A unique manufacturing process was utilized for two such hip liners,the Novation®and Alteon®XLE hip liners and this research represents the first large series on this specific material.The study hypothesis was that Novation and Alteon XLE hip liners have similar short-term survivorship as other manufacturers’antioxidant liners according to procedure and outcome data from the American Joint Replacement Registry(AJRR).AIM To demonstrate similar short-term survivorship of XLE antioxidant hip liners compared to all antioxidant hip liners in AJRR.METHODS Utilizing total hip arthroplasty data from the AJRR,a retrospective review was performed for subjects who underwent implantation of Novation XLE(n=461),Alteon XLE(n=989),or any other antioxidant hip liner(termed the aggregate antioxidant group;n=39964)as of March 31,2022.Survivorship at three years and revision rates were compared statistically between the Novation group and the aggregate antioxidant group as well as the Alteon group and the aggregate antioxidant group.RESULTS Survivorship at three years post-surgery was 99.09%for Novation,97.73%for Alteon,and 97.69%for the aggregate antioxidant group.There were no reports of failure due to wear in either the Novation or Alteon groups.Among the revision categories(fracture,infection,aseptic loosening,instability,mechanical complications,wear,pain,hematoma/wound complications,or other),there were no significant differences identified in either comparison.There were also no significant differences in cumulative percent revision rates up to three years post-surgery for the Novation vs aggregate antioxidant group or the Alteon vs aggregate antioxidant group.CONCLUSION Novation and Alteon XLE hip liner revision rate and survivorship are equivalent to other antioxidant hip liners in the short term.展开更多
BACKGROUND Truliant®posterior stabilized(PS)and Truliant cruciate retaining(CR)are two designs used for total knee arthroplasty.Survivorship and reason for revision rates are now available from the American Joint...BACKGROUND Truliant®posterior stabilized(PS)and Truliant cruciate retaining(CR)are two designs used for total knee arthroplasty.Survivorship and reason for revision rates are now available from the American Joint Replacement Registry(AJRR)at short-term time points for both Truliant designs.It was hypothesized that Truliant PS and Truliant CR perform comparably to similar designs in terms of survivorship.AIM To analyze short-term survivorship of Truliant PS or CR total knee arthroplasty relative to non-Truliant PS or CR total knee arthroplasty.METHODS Utilizing data from the AJRR,a retrospective review was performed for subjects who underwent implantation of Truliant PS,Truliant CR,non-Truliant PS,and non-Truliant CR designs as of June 30,2022.Survivorship and reasons for revision were compared statistically between Truliant PS vs non-Truliant PS as well as Truliant CR vs non-Truliant CR groups.Cumulative percent revision rates were compared across three registries,AJRR,Australian Orthopaedic Association National Joint Replacement Registry(AOANJRR),and the United Kingdom National Joint Registry(UK NJR).RESULTS Truliant PS survivorship was 97.95%at the four-year mark,while Truliant CR survivorship was 99.61%at the three-year mark.There were no significant differences in survivorship hazard ratios or reasons for revision for both Truliant groups vs non-Truliant comparison aggregate groups at short-term time points.Cumulative percent revision rate comparisons were made to device appropriate groups from AJRR,AOANJRR,and UK NJR data.Truliant PS cumulative percent revision rates were similar to non-Truliant cumulative percent revision rates in the AJRR and similar to AOANJRR and UKNJR at both one and three years.Truliant CR cumulative percent revision rates were lower than aggregate AJRR,AOANJRR,and UK NJR cumulative percent revision rates at the one-year and three-year marks.CONCLUSION This study demonstrates high survivorship for Truliant PS total knee arthroplasty out to four-years and Truliant CR total knee arthroplasty out to three-years of follow-up.展开更多
The reconstruction of the temporomandibular joint presents a multifaceted clinical challenge in the realm of head and neck surgery,underscored by its relatively infrequent occurrence and the lack of comprehensive clin...The reconstruction of the temporomandibular joint presents a multifaceted clinical challenge in the realm of head and neck surgery,underscored by its relatively infrequent occurrence and the lack of comprehensive clinical guidelines.This review aims to elucidate the available approaches for TMJ reconstruction,with a particular emphasis on recent groundbreaking advancements.The current spectrum of TMJ reconstruction integrates diverse surgical techniques,such as costochondral grafting,coronoid process grafting,revascularized fibula transfer,transport distraction osteogenesis,and alloplastic TMJ replacement.Despite the available options,a singular,universally accepted‘gold standard’for reconstructive techniques or materials remains elusive in this field.Our review comprehensively summarizes the current available methods of TMJ reconstruction,focusing on both autologous and alloplastic prostheses.It delves into the differences of each surgical technique and outlines the implications of recent technological advances,such as 3D printing,which hold the promise of enhancing surgical precision and patient outcomes.This evolutionary progress aims not only to improve the immediate results of reconstruction but also to ensure the long-term health and functionality of the TMJ,thereby improving the quality of life for patients with end-stage TMJ disorders.展开更多
Objective To retrospectively assess the primary clinical results of a cohort of the first metatarsophalangeal joint replacement with double-stemmed hinge silicone implant. Methods A total of 12 patients (15 feet) rec...Objective To retrospectively assess the primary clinical results of a cohort of the first metatarsophalangeal joint replacement with double-stemmed hinge silicone implant. Methods A total of 12 patients (15 feet) received the joint replacement with double-stemmed hinge silicone implant. There were 2 males and l0 females with a mean age of 61.4 (range, 56-75) years old. Of them, 9 cases (11 feet) were hallux valgus with osteoarthritis; 1 case (2 feet) was rheumatic arthritis; 2 cases (2 feet) were traumatic arthritis. The sub)ective and objective results were evaluated during follow-up. Results All of the patients were followed up regularly with an average of 24.7 months, ranging from 12 to 38 months. Ten patients were completely satisfied with the operation; I patient showed partial saris- faction, and 1 patient was not satisfied because of the first matatarsophalangeal joint pain due to severe hy- perosteogeny surrounding the cut bone surface 3 years after the operation. Osteolysis around the implant occurred in 2 cases without clinical symptoms, and no special treatment was given. Conclusion The joint replacement is a preferable method in alleviating pain and improving walking function with proper indication.展开更多
Although the rate of patients reporting satisfaction is generally high after joint replacement surgery, up to 23% after total hip replacement and 34% after total knee arthroplasty of treated subjects report discomfort...Although the rate of patients reporting satisfaction is generally high after joint replacement surgery, up to 23% after total hip replacement and 34% after total knee arthroplasty of treated subjects report discomfort or pain 1 year after surgery. Moreover, chronic or subacute inflammation is reported in some cases even a long time after surgery. Another open and debated issue in prosthetic surgery is implant survivorship, especially when related to good prosthesis bone ingrowth. Pulsed Electro Magnetic Fields(PEMFs) treatment, although initially recommended after total joint replacement to promote bone ingrowth and to reduce inflammation and pain, is not currently part of usual clinical practice. The purpose of this review was to analyze existing literature on PEMFs effects in joint replacement surgery and to report results of clinical studies and current indications. We selected all currently available prospective studies or RCT on the use of PEMFs in total joint replacement with the purpose of investigating effects of PEMFs on recovery, pain relief and patients’ satisfaction following hip, knee or shoulder arthroplasty. All the studies analyzed reported no adverse effects, and good patient compliance to the treatment. The available literature shows that early control of joint inflammation process in the first days after surgery through the use of PEMFs should be considered an effective completion of the surgical procedure to improve the patient’s functional recovery.展开更多
BACKGROUND Joint replacement is a common treatment for older patients with high incidences of hip joint diseases.However,postoperative recovery is slow and complications are common,which reduces surgical effectiveness...BACKGROUND Joint replacement is a common treatment for older patients with high incidences of hip joint diseases.However,postoperative recovery is slow and complications are common,which reduces surgical effectiveness.Therefore,patients require long-term,high-quality,and effective nursing interventions to promote rehabilitation.Continuity of care has been used successfully in other diseases;however,little research has been conducted on older patients who have undergone hip replacement.AIM To explore the clinical effect of continuous nursing on rehabilitation after discharge of older individuals who have undergone joint replacement.METHODS A retrospective analysis was performed on the clinical data of 113 elderly patients.Patients receiving routine nursing were included in the convention group(n=60),and those receiving continuous nursing,according to various methods,were included in the continuation group(n=53).Harris score,short form 36(SF-36)score,complication rate,and readmission rate were compared between the convention and continuation groups.RESULTS After discharge,Harris and SF-36 scores of the continuation group were higher than those of the convention group.The Harris and SF-36 scores of the two groups showed an increasing trend with time,and there was an interaction effect between group and time(Harris score:F_(intergroup effect)=376.500,F_(time effect)=20.090,Finteraction effect=4.824;SF-36 score:F_(intergroup effect)=236.200,Ftime effect=16.710,Finteraction effect=5.584;all P<0.05).Furthermore,the total complication and readmission rates in the continuation group were lower(P<0.05).CONCLUSION Continuous nursing could significantly improve hip function and quality of life in older patients after joint replacement and reduce the incidence of complications and readmission rates.展开更多
BACKGROUND Intertrochanteric fracture of the femur occurs mostly among older people,and seriously affects daily life and quality of life.At present,physical intervention,drug treatment,routine intervention and rehabil...BACKGROUND Intertrochanteric fracture of the femur occurs mostly among older people,and seriously affects daily life and quality of life.At present,physical intervention,drug treatment,routine intervention and rehabilitation training are widely used for prevention of side effects,but it is still inconclusive which intervention has the best effect.AIM To compare the effects of new intervention measures for preventing side effects of artificial joint replacement.METHODS We searched the Chinese and English literatures for comparative studies on the prevention of side effects of new interventions for artificial joint replacement from July 2013 to June 2023 in China HowNet,PubMed,Wanfang,Weipu and other databases.Study quality was evaluated by improved Jadad scoring standard,and the effects of different interventions on preventing different complications were analyzed by meta-analysis of evidence-based medicine with Review Manager 5.0 software.RESULTS Ten articles,including 869 cases,were finally included.The preventive effects of different interventions on the side effects of artificial joint replacement were studied,and valid data were extracted.There were two articles on the preventive effects of drug intervention,four on comparison of the preventive effects of combined and single interventions,and three on the preventive effects of physical intervention,rehabilitation training and routine intervention.Meta-analysis showed that the preventive effect of rivaroxaban was significantly better than low molecular weight heparin calcium[mean difference(MD)=-0.16,95%CI:-0.28 to-0.04,P<0.05].The effect of combined intervention was significantly better than that of single intervention(MD=-0.08,95%CI:-0.16 to-0.01,P<0.001).Physical intervention was significantly better than routine intervention and rehabilitation training(MD=0.26,95%CI:0.16–0.36,P<0.001).CONCLUSION Rivaroxaban combined with rehabilitation training is preferred for preventing deep vein thrombosis after artificial joint replacement.In the prevention of pulmonary embolism,rivaroxaban drug intervention is given priority.The effect of combined intervention is better than that of single intervention.展开更多
The incidence of human immunodeficiency virus(HIV)-infected cases that need total joint replacement(TJR)is generally rising.On the other hand,modern management of HIV-infected cases has enabled them to achieve longevi...The incidence of human immunodeficiency virus(HIV)-infected cases that need total joint replacement(TJR)is generally rising.On the other hand,modern management of HIV-infected cases has enabled them to achieve longevity while increasing the need for arthroplasty procedures due to the augmented degenerative joint disease and fragility fractures,and the risk of osteonecrosis.Although initial investigations on joint replacement in HIV-infected cases showed a high risk of complications,the recent ones reported acceptable outcomes.It is a matter of debate whether HIV-infected cases are at advanced risk for adverse TJR consequences;however,the weak immune profile has been associated with an increased probability of complications.Likewise,surgeons and physicians should be aware of the complication rate after TJR in HIV-infected cases and include an honest discussion of the probable unwelcoming complication with their patients contemplating TJR.Therefore,a fundamental review and understanding of the interaction of HIV and arthroplasty are critical.展开更多
Arthritis, most notably rheumatoid arthritis, can destroy the surfaces of the bones; the ideal solution for this is T JR （total joint replacement）, which would restore joint functionality, maintain correct aesthetic...Arthritis, most notably rheumatoid arthritis, can destroy the surfaces of the bones; the ideal solution for this is T JR （total joint replacement）, which would restore joint functionality, maintain correct aesthetics and eradicate pain for the patient. Current metacarpophalangeal TJR do not provide the normal biomechanical range of motion and functionality. The proposed design attempts to correct this through the use of design geometry and functional anatomy. Numerical analysis is used in conjunction with computational solid modeling to compare a one-piece silicone implant with the proposed T JR. Peak stresses during flexion for the proposed design did not exceed 1.2 MPa, where as soft implants approach 100 MPa to 1,000 MPa for peak stress values. The proposed design, due to high stress tolerances with low deformation, along with functionality and biomechanics, seems to be an appropriate replacement for one-piece silicone implant.展开更多
Objective: to analyze the application effect of high-quality nursing service model in patients undergoing orthopedic artificial joint replacement. Methods: a total of 128 patients who underwent artificial joint replac...Objective: to analyze the application effect of high-quality nursing service model in patients undergoing orthopedic artificial joint replacement. Methods: a total of 128 patients who underwent artificial joint replacement surgery from January 2019 to January 2020 in our department of orthopedics were selected as the research object. They were randomly divided into two groups, two groups, with 64 cases in each group. The reference group adopted the conventional nursing mode, while the experimental group adopted the high-quality nursing mode. The postoperative satisfaction and the incidence of complications of the patients in the two groups were compared under the nursing scheme. Results: through comparison, the patients in the experimental group had a higher satisfaction with nursing care (93.75%) and the patients in the reference group had a satisfaction with nursing care (71.88%). The difference between the experimental group and the reference group was statistically significant (P < 0.05). In addition, the incidence of postoperative complications in the experimental group was 9.38%, and the incidence of postoperative complications in the reference group was 23.44%, which was higher than that in the experimental group. Conclusion: the application effect of high-quality nursing model in orthopedic artificial joint replacement surgery nursing is obvious and has promotional value.展开更多
Objective: to study the effect of artificial joint replacement in the treatment of unstable intertrochanteric femoral fractures in elderly patients. Methods: from February 2016 to December 2020, 60 elderly patients wi...Objective: to study the effect of artificial joint replacement in the treatment of unstable intertrochanteric femoral fractures in elderly patients. Methods: from February 2016 to December 2020, 60 elderly patients with unstable femoral intertrochanteric fracture who came to our hospital for treatment were selected for the study. They were divided into treatment group and comparison group by coin toss, with 30 cases in each group. The contrast group was treated with traditional fixation, while the treatment group was treated with artificial joint replacement. The treatment effect, operation duration and hospitalization duration of the two groups were observed. Results: the total effective rate of the treatment group was better than that of the contrast group, and the difference between them was significant (P < 0.05). The duration of operation and length of hospitalization in the treatment group were significantly different from those in the control group (P < 0.05). Conclusion: the efficacy of artificial joint replacement in the treatment of unstable intertrochanteric fractures in elderly patients is worthy of affirmation. The operation duration is shorter, the safety is improved, the joint function of patients can be improved, and the length of hospital stay can be shortened.展开更多
Objective To study the early diagnosis and treatment of pulmonary embolism (PE) after total joint replacement (TJR). Methods From April 1987 to December 2001, we performed 1 336 total knee replacements (TKR) in 926 pa...Objective To study the early diagnosis and treatment of pulmonary embolism (PE) after total joint replacement (TJR). Methods From April 1987 to December 2001, we performed 1 336 total knee replacements (TKR) in 926 patients and 1 745 total hip replacements (RHRs) in 1 566 patients. In this group there were 5 PE patients after operation. Two patients died (all after TKR), and 3 patients salvaged successfully (2 after TKR, 1 after THR). Results The total incidence of PE after TJR was 0. 2% (5/2 492), the incidence of PE after TKR was 0. 4% (4/926), and the incidence of PE after THR was 0.06% (1/1 556). In the patients who suffered PE, 2 died. The incidence of PE before 2000 was 0%. Conclusion Death after total joint replacement is due to pulmonary embolism ( PE), especially massive PE. The incidence of PE after TKR is higher than that after THR. Pulmonary angiography is the gold standard for the diagnosis of PE. With more understanding on PE and more popularity of joint replacement, the diagnosis of PE展开更多
Former research work about the modeling of hip joint focus on the uppersegment of femoral, and assumes the acetabulum cup is sphere concave, and the acetabulum prosthesesis semisphere. A method of acquiring the point ...Former research work about the modeling of hip joint focus on the uppersegment of femoral, and assumes the acetabulum cup is sphere concave, and the acetabulum prosthesesis semisphere. A method of acquiring the point data on the surface of the hipbone using the reverseengineering technology is presented. After analyzing the acetabulum surface fitting error, arotation ellipsoid CAD model is applied to fit the acetabulum surface, and then optimizationtechnique is used to find the geometric parameters of the model. The fitting error between thesphere and rotation ellipsoid is compared and gets the result that the fitting error of rotationellipsoid is smaller than sphere, and the rotation ellipsoid can describe the shape of theacetabulum better.展开更多
BACKGROUND Periprosthetic joint infection(PJI)is a critical complication after joint arthroplasty and is accompanied by increasing rates of morbidity and mortality.Several studies have aimed at preventing PJI.AIM To r...BACKGROUND Periprosthetic joint infection(PJI)is a critical complication after joint arthroplasty and is accompanied by increasing rates of morbidity and mortality.Several studies have aimed at preventing PJI.AIM To research the knowledge level and attitudes of orthopedic surgeons,who play a key role in both preventing and managing PJI.METHODS We conducted a web-based survey to evaluate orthopedic surgeons'knowledge level and attitudes regarding PJI.The Likert scale survey utilized consisted of 30 questions which were prepared based on the"Proceedings of the International Consensus on Periprosthetic Joint Infection".RESULTS A total of 264 surgeons participated in the survey.Their average age was 44.8,and 173 participants(65.5%)had more than 10 years of experience.No statistically significant relationship was found between the PJI knowledge of the surgeons and their years of experience.However,participants who worked in training and research hospitals demonstrated higher levels of knowledge than the ones in the state hospitals.It was also noticed that surgeons'knowledge concerning the duration of antibiotic therapy and urinary infections was not consistent with their attitudes.CONCLUSION Even though orthopedic surgeons have adequate knowledge about preventing and managing PJI,their attitudes might contradict their knowledge.Future studies are required to examine the causes and solutions of the contradictions between orthopedic surgeons'knowledge and attitudes.展开更多
Objective: to observe the effect of knee arthroplasty on senile knee degenerative osteoarthritis. Methods: 108 elderly patients over 60 years old with knee degenerative osteoarthritis were randomly divided into experi...Objective: to observe the effect of knee arthroplasty on senile knee degenerative osteoarthritis. Methods: 108 elderly patients over 60 years old with knee degenerative osteoarthritis were randomly divided into experimental group (joint replacement) and control group (routine treatment). After treatment, the postoperative knee function score and treatment effect of the two groups were compared. Results: the knee function score and treatment effect of the experimental group were better than those of the control group (P < 0.05). Conclusion: for elderly patients with knee degenerative osteoarthritis, joint replacement can improve the treatment effect, so it has clinical value.展开更多
Total joint replacements(TJR) have been a huge success for orthopaedic surgery in the past century and are gaining increasing importance today due to the aging population. However, the short longevity of artificial jo...Total joint replacements(TJR) have been a huge success for orthopaedic surgery in the past century and are gaining increasing importance today due to the aging population. However, the short longevity of artificial joints is one of the major problems in bioimplant industry and needs to be rectified since an increasing number of young people, with more active lifestyles, must receive TJR. Wear mechanisms are discussed in this paper to describe the root causes of the failures and to give some general ideas to increase the lifespan of artificial joints. The suitable material combination is of great importance for the wear resistance of bioimplants, and bioceramics will exert a crucial effect in their future progress. Other materials, such as metal alloys and polymers, are also discussed in this paper. Surface finish is another factor affecting the tribological performance of bioimplants. In recent years, surface texture technology has fascinated many researchers, and a good design of texture pattern requires a comprehensive understanding of wear mechanisms, material properties, and dynamic fluid theory. This review also covers a summary of in vitro wear tests, including simulators, lubricant, and testing parameters.展开更多
The pathogenesis of orthopedic diseases is intimately linked to blood stasis,frequently arising from damage to primary and secondary blood channels.This disruption can lead to“blood leaving the meridians”or Qi stagn...The pathogenesis of orthopedic diseases is intimately linked to blood stasis,frequently arising from damage to primary and secondary blood channels.This disruption can lead to“blood leaving the meridians”or Qi stagnation,resulting in blood stasis syndrome.Taohong Siwu Decoction(THSWD)is a renowned classical Chinese medicinal formula extensively used to promote blood circulation and mitigate blood stasis.Clinical studies have demonstrated its significant therapeutic effects on various orthopedic conditions,particularly its anti-inflammatory and analgesic properties,as well as its efficacy in preventing deep vein thrombosis post-surgery.Despite these findings,research on THSWD remains fragmented,and its interdisciplinary impact is limited.This review aims to provide a comprehensive evaluation of the efficacy and pharmacological mechanisms of THSWD in treating common orthopedic diseases.Additionally,we employ bibliometric analysis to explore research trends and hotspots related to THSWD.We hope this review will enhance the recognition and application of THSWD in orthopedic treatments and guide future research into its pharmacological mechanisms.展开更多
Hip joint replacements represent the most effective way of treatment for patients suffering from joint diseases.Despite the rapid improvement of implant materials over the last few decades,limited longevity associated...Hip joint replacements represent the most effective way of treatment for patients suffering from joint diseases.Despite the rapid improvement of implant materials over the last few decades,limited longevity associated with wear-related complications persists as the main drawback.Therefore,improved tribological perfor-mance is required in order to extend the service life of replacements.The effect of surface texturing of ultra-high molecular weight polyethylene(UHMWPE)acetabular cup was investigated in the present study.Unique tilling method was utilized for manufacturing the dimples with controlled diameter and depths on the contact surface of the cup.The experiments with four commercial femoral components and two model lubricants were realized.The main attention was paid to a coefficient of friction considering the differences between the original and the dimpled cups.Results showed remarkable lowering of friction,in general.Focusing on the simulated human synovial fluid,friction was reduced by 40%(alumina ceramic),38.8%(zirconia toughened ceramic),25.5%(metal),and 9.9%(oxinium).In addition,the dimples helped to keep the friction stable without fluctuations.To conclude,the paper brings a new insight into frictional behaviour of the hip replacements during running-in phase which is essential for overall implant lifespan.It is believed that proper surface texturing may rapidly improve the life quality of millions of patients and may lead to considerable financial savings.展开更多
First metatarsophalangeal joint （MTPJ） degenerative diseases are not rare pathological changes in adult forefoot.1,2 It mainly includes hallux rigidus,hallux limitus and hallux valgus.3 Its progressive nature makes ...First metatarsophalangeal joint （MTPJ） degenerative diseases are not rare pathological changes in adult forefoot.1,2 It mainly includes hallux rigidus,hallux limitus and hallux valgus.3 Its progressive nature makes it hardly respond well to conservative treatment.4 Traditional surgical techniques,such as cheilectomy,Keller resection and arthrodesis are effective procedures but remain controversial due to none of them can achieve excellent results in all patients especially the end-stage conditions.5-7 Thus,great amount of efforts have been dedicated in MTPJ replacement despite many negative reports.This technique has aroused many controversies over the past decades due to its prematurity.Nevertheless,it has been improved in many aspects such as prosthesis material,design as well as surgical indications.This review would not only update the advancements and recognitions in recent years,but also presented the major disputed areas.展开更多
基金the National Natural Science Foundation of China(No.5220031085)the Postdoctoral Research Project in Henan Province(No.HN2022054)+2 种基金the Key Scientific Research Projects of Colleges and Universities in Henan Province(No.23A430009)the State Key Laboratory of Polymer Materials Engineering(No.sklpme2022-4-03)the Key Technologies R&D Program of Henan Province(No.242102230131)。
文摘The considerable hazard posed by periprosthetic joint infections underlines the urgent need for the rapid advancement of in-situ drug delivery systems within joint materials.However,the pursuit of sustained antibacterial efficacy remains a formidable challenge.In this context,we proposed a novel strategy that leverages swelling and erosion mechanisms to facilitate drug release of drug-loaded ultrahigh molecular weight polyethylene(UHMWPE),thereby ensuring its long-lasting antibacterial performance.Polyethylene oxide(PEO),a hydrophilic polymer with fast hydrating ability and high swelling capacity,was incorporated in UHMWPE alongside the antibacterial tea polyphenol(epigallocatechin gallate,EGCG as representative).The swelling of PEO enhanced water infiltration into the matrix,while the erosion of PEO balanced the release of the encapsulated EGCG,resulting in a steady release.The behavior was supported by the EGCG release profiles and the corresponding fitted release kinetic models.As demonstrated by segmented antibacterial assessments,the antibacterial efficiency was enhanced 2to 3 times in the PEO/EGCG/UHMWPE composite compared to that of EGCG/UHMWPE.Additionally,the PEO/EGCG/UHMWPE composite exhibited favorable biocompatibility and mechanical performance,making it a potential candidate for the development of drug-releasing joint implants to combat prosthetic bacterial infections.
文摘BACKGROUND Total hip arthroplasty is a safe and effective procedure.To improve survivorship,ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed.Additive antioxidant was deployed to reduce oxidation and consequential wear,loosening,or osteolysis.A unique manufacturing process was utilized for two such hip liners,the Novation®and Alteon®XLE hip liners and this research represents the first large series on this specific material.The study hypothesis was that Novation and Alteon XLE hip liners have similar short-term survivorship as other manufacturers’antioxidant liners according to procedure and outcome data from the American Joint Replacement Registry(AJRR).AIM To demonstrate similar short-term survivorship of XLE antioxidant hip liners compared to all antioxidant hip liners in AJRR.METHODS Utilizing total hip arthroplasty data from the AJRR,a retrospective review was performed for subjects who underwent implantation of Novation XLE(n=461),Alteon XLE(n=989),or any other antioxidant hip liner(termed the aggregate antioxidant group;n=39964)as of March 31,2022.Survivorship at three years and revision rates were compared statistically between the Novation group and the aggregate antioxidant group as well as the Alteon group and the aggregate antioxidant group.RESULTS Survivorship at three years post-surgery was 99.09%for Novation,97.73%for Alteon,and 97.69%for the aggregate antioxidant group.There were no reports of failure due to wear in either the Novation or Alteon groups.Among the revision categories(fracture,infection,aseptic loosening,instability,mechanical complications,wear,pain,hematoma/wound complications,or other),there were no significant differences identified in either comparison.There were also no significant differences in cumulative percent revision rates up to three years post-surgery for the Novation vs aggregate antioxidant group or the Alteon vs aggregate antioxidant group.CONCLUSION Novation and Alteon XLE hip liner revision rate and survivorship are equivalent to other antioxidant hip liners in the short term.
文摘BACKGROUND Truliant®posterior stabilized(PS)and Truliant cruciate retaining(CR)are two designs used for total knee arthroplasty.Survivorship and reason for revision rates are now available from the American Joint Replacement Registry(AJRR)at short-term time points for both Truliant designs.It was hypothesized that Truliant PS and Truliant CR perform comparably to similar designs in terms of survivorship.AIM To analyze short-term survivorship of Truliant PS or CR total knee arthroplasty relative to non-Truliant PS or CR total knee arthroplasty.METHODS Utilizing data from the AJRR,a retrospective review was performed for subjects who underwent implantation of Truliant PS,Truliant CR,non-Truliant PS,and non-Truliant CR designs as of June 30,2022.Survivorship and reasons for revision were compared statistically between Truliant PS vs non-Truliant PS as well as Truliant CR vs non-Truliant CR groups.Cumulative percent revision rates were compared across three registries,AJRR,Australian Orthopaedic Association National Joint Replacement Registry(AOANJRR),and the United Kingdom National Joint Registry(UK NJR).RESULTS Truliant PS survivorship was 97.95%at the four-year mark,while Truliant CR survivorship was 99.61%at the three-year mark.There were no significant differences in survivorship hazard ratios or reasons for revision for both Truliant groups vs non-Truliant comparison aggregate groups at short-term time points.Cumulative percent revision rate comparisons were made to device appropriate groups from AJRR,AOANJRR,and UK NJR data.Truliant PS cumulative percent revision rates were similar to non-Truliant cumulative percent revision rates in the AJRR and similar to AOANJRR and UKNJR at both one and three years.Truliant CR cumulative percent revision rates were lower than aggregate AJRR,AOANJRR,and UK NJR cumulative percent revision rates at the one-year and three-year marks.CONCLUSION This study demonstrates high survivorship for Truliant PS total knee arthroplasty out to four-years and Truliant CR total knee arthroplasty out to three-years of follow-up.
基金supported by NSFC(82370932)Research and Develop Program of West China Hospital of Stomatology Sichuan University(RD-03-202102,LCYJ2019-20)Natural Science Foundation of Sichuan Province(2023NSFSC1512,2024NSFSC1588)。
文摘The reconstruction of the temporomandibular joint presents a multifaceted clinical challenge in the realm of head and neck surgery,underscored by its relatively infrequent occurrence and the lack of comprehensive clinical guidelines.This review aims to elucidate the available approaches for TMJ reconstruction,with a particular emphasis on recent groundbreaking advancements.The current spectrum of TMJ reconstruction integrates diverse surgical techniques,such as costochondral grafting,coronoid process grafting,revascularized fibula transfer,transport distraction osteogenesis,and alloplastic TMJ replacement.Despite the available options,a singular,universally accepted‘gold standard’for reconstructive techniques or materials remains elusive in this field.Our review comprehensively summarizes the current available methods of TMJ reconstruction,focusing on both autologous and alloplastic prostheses.It delves into the differences of each surgical technique and outlines the implications of recent technological advances,such as 3D printing,which hold the promise of enhancing surgical precision and patient outcomes.This evolutionary progress aims not only to improve the immediate results of reconstruction but also to ensure the long-term health and functionality of the TMJ,thereby improving the quality of life for patients with end-stage TMJ disorders.
文摘Objective To retrospectively assess the primary clinical results of a cohort of the first metatarsophalangeal joint replacement with double-stemmed hinge silicone implant. Methods A total of 12 patients (15 feet) received the joint replacement with double-stemmed hinge silicone implant. There were 2 males and l0 females with a mean age of 61.4 (range, 56-75) years old. Of them, 9 cases (11 feet) were hallux valgus with osteoarthritis; 1 case (2 feet) was rheumatic arthritis; 2 cases (2 feet) were traumatic arthritis. The sub)ective and objective results were evaluated during follow-up. Results All of the patients were followed up regularly with an average of 24.7 months, ranging from 12 to 38 months. Ten patients were completely satisfied with the operation; I patient showed partial saris- faction, and 1 patient was not satisfied because of the first matatarsophalangeal joint pain due to severe hy- perosteogeny surrounding the cut bone surface 3 years after the operation. Osteolysis around the implant occurred in 2 cases without clinical symptoms, and no special treatment was given. Conclusion The joint replacement is a preferable method in alleviating pain and improving walking function with proper indication.
文摘Although the rate of patients reporting satisfaction is generally high after joint replacement surgery, up to 23% after total hip replacement and 34% after total knee arthroplasty of treated subjects report discomfort or pain 1 year after surgery. Moreover, chronic or subacute inflammation is reported in some cases even a long time after surgery. Another open and debated issue in prosthetic surgery is implant survivorship, especially when related to good prosthesis bone ingrowth. Pulsed Electro Magnetic Fields(PEMFs) treatment, although initially recommended after total joint replacement to promote bone ingrowth and to reduce inflammation and pain, is not currently part of usual clinical practice. The purpose of this review was to analyze existing literature on PEMFs effects in joint replacement surgery and to report results of clinical studies and current indications. We selected all currently available prospective studies or RCT on the use of PEMFs in total joint replacement with the purpose of investigating effects of PEMFs on recovery, pain relief and patients’ satisfaction following hip, knee or shoulder arthroplasty. All the studies analyzed reported no adverse effects, and good patient compliance to the treatment. The available literature shows that early control of joint inflammation process in the first days after surgery through the use of PEMFs should be considered an effective completion of the surgical procedure to improve the patient’s functional recovery.
基金Hebei Provincial Medical Science Research Key Project Plan,No.20181057.
文摘BACKGROUND Joint replacement is a common treatment for older patients with high incidences of hip joint diseases.However,postoperative recovery is slow and complications are common,which reduces surgical effectiveness.Therefore,patients require long-term,high-quality,and effective nursing interventions to promote rehabilitation.Continuity of care has been used successfully in other diseases;however,little research has been conducted on older patients who have undergone hip replacement.AIM To explore the clinical effect of continuous nursing on rehabilitation after discharge of older individuals who have undergone joint replacement.METHODS A retrospective analysis was performed on the clinical data of 113 elderly patients.Patients receiving routine nursing were included in the convention group(n=60),and those receiving continuous nursing,according to various methods,were included in the continuation group(n=53).Harris score,short form 36(SF-36)score,complication rate,and readmission rate were compared between the convention and continuation groups.RESULTS After discharge,Harris and SF-36 scores of the continuation group were higher than those of the convention group.The Harris and SF-36 scores of the two groups showed an increasing trend with time,and there was an interaction effect between group and time(Harris score:F_(intergroup effect)=376.500,F_(time effect)=20.090,Finteraction effect=4.824;SF-36 score:F_(intergroup effect)=236.200,Ftime effect=16.710,Finteraction effect=5.584;all P<0.05).Furthermore,the total complication and readmission rates in the continuation group were lower(P<0.05).CONCLUSION Continuous nursing could significantly improve hip function and quality of life in older patients after joint replacement and reduce the incidence of complications and readmission rates.
文摘BACKGROUND Intertrochanteric fracture of the femur occurs mostly among older people,and seriously affects daily life and quality of life.At present,physical intervention,drug treatment,routine intervention and rehabilitation training are widely used for prevention of side effects,but it is still inconclusive which intervention has the best effect.AIM To compare the effects of new intervention measures for preventing side effects of artificial joint replacement.METHODS We searched the Chinese and English literatures for comparative studies on the prevention of side effects of new interventions for artificial joint replacement from July 2013 to June 2023 in China HowNet,PubMed,Wanfang,Weipu and other databases.Study quality was evaluated by improved Jadad scoring standard,and the effects of different interventions on preventing different complications were analyzed by meta-analysis of evidence-based medicine with Review Manager 5.0 software.RESULTS Ten articles,including 869 cases,were finally included.The preventive effects of different interventions on the side effects of artificial joint replacement were studied,and valid data were extracted.There were two articles on the preventive effects of drug intervention,four on comparison of the preventive effects of combined and single interventions,and three on the preventive effects of physical intervention,rehabilitation training and routine intervention.Meta-analysis showed that the preventive effect of rivaroxaban was significantly better than low molecular weight heparin calcium[mean difference(MD)=-0.16,95%CI:-0.28 to-0.04,P<0.05].The effect of combined intervention was significantly better than that of single intervention(MD=-0.08,95%CI:-0.16 to-0.01,P<0.001).Physical intervention was significantly better than routine intervention and rehabilitation training(MD=0.26,95%CI:0.16–0.36,P<0.001).CONCLUSION Rivaroxaban combined with rehabilitation training is preferred for preventing deep vein thrombosis after artificial joint replacement.In the prevention of pulmonary embolism,rivaroxaban drug intervention is given priority.The effect of combined intervention is better than that of single intervention.
文摘The incidence of human immunodeficiency virus(HIV)-infected cases that need total joint replacement(TJR)is generally rising.On the other hand,modern management of HIV-infected cases has enabled them to achieve longevity while increasing the need for arthroplasty procedures due to the augmented degenerative joint disease and fragility fractures,and the risk of osteonecrosis.Although initial investigations on joint replacement in HIV-infected cases showed a high risk of complications,the recent ones reported acceptable outcomes.It is a matter of debate whether HIV-infected cases are at advanced risk for adverse TJR consequences;however,the weak immune profile has been associated with an increased probability of complications.Likewise,surgeons and physicians should be aware of the complication rate after TJR in HIV-infected cases and include an honest discussion of the probable unwelcoming complication with their patients contemplating TJR.Therefore,a fundamental review and understanding of the interaction of HIV and arthroplasty are critical.
文摘Arthritis, most notably rheumatoid arthritis, can destroy the surfaces of the bones; the ideal solution for this is T JR （total joint replacement）, which would restore joint functionality, maintain correct aesthetics and eradicate pain for the patient. Current metacarpophalangeal TJR do not provide the normal biomechanical range of motion and functionality. The proposed design attempts to correct this through the use of design geometry and functional anatomy. Numerical analysis is used in conjunction with computational solid modeling to compare a one-piece silicone implant with the proposed T JR. Peak stresses during flexion for the proposed design did not exceed 1.2 MPa, where as soft implants approach 100 MPa to 1,000 MPa for peak stress values. The proposed design, due to high stress tolerances with low deformation, along with functionality and biomechanics, seems to be an appropriate replacement for one-piece silicone implant.
文摘Objective: to analyze the application effect of high-quality nursing service model in patients undergoing orthopedic artificial joint replacement. Methods: a total of 128 patients who underwent artificial joint replacement surgery from January 2019 to January 2020 in our department of orthopedics were selected as the research object. They were randomly divided into two groups, two groups, with 64 cases in each group. The reference group adopted the conventional nursing mode, while the experimental group adopted the high-quality nursing mode. The postoperative satisfaction and the incidence of complications of the patients in the two groups were compared under the nursing scheme. Results: through comparison, the patients in the experimental group had a higher satisfaction with nursing care (93.75%) and the patients in the reference group had a satisfaction with nursing care (71.88%). The difference between the experimental group and the reference group was statistically significant (P < 0.05). In addition, the incidence of postoperative complications in the experimental group was 9.38%, and the incidence of postoperative complications in the reference group was 23.44%, which was higher than that in the experimental group. Conclusion: the application effect of high-quality nursing model in orthopedic artificial joint replacement surgery nursing is obvious and has promotional value.
文摘Objective: to study the effect of artificial joint replacement in the treatment of unstable intertrochanteric femoral fractures in elderly patients. Methods: from February 2016 to December 2020, 60 elderly patients with unstable femoral intertrochanteric fracture who came to our hospital for treatment were selected for the study. They were divided into treatment group and comparison group by coin toss, with 30 cases in each group. The contrast group was treated with traditional fixation, while the treatment group was treated with artificial joint replacement. The treatment effect, operation duration and hospitalization duration of the two groups were observed. Results: the total effective rate of the treatment group was better than that of the contrast group, and the difference between them was significant (P < 0.05). The duration of operation and length of hospitalization in the treatment group were significantly different from those in the control group (P < 0.05). Conclusion: the efficacy of artificial joint replacement in the treatment of unstable intertrochanteric fractures in elderly patients is worthy of affirmation. The operation duration is shorter, the safety is improved, the joint function of patients can be improved, and the length of hospital stay can be shortened.
文摘Objective To study the early diagnosis and treatment of pulmonary embolism (PE) after total joint replacement (TJR). Methods From April 1987 to December 2001, we performed 1 336 total knee replacements (TKR) in 926 patients and 1 745 total hip replacements (RHRs) in 1 566 patients. In this group there were 5 PE patients after operation. Two patients died (all after TKR), and 3 patients salvaged successfully (2 after TKR, 1 after THR). Results The total incidence of PE after TJR was 0. 2% (5/2 492), the incidence of PE after TKR was 0. 4% (4/926), and the incidence of PE after THR was 0.06% (1/1 556). In the patients who suffered PE, 2 died. The incidence of PE before 2000 was 0%. Conclusion Death after total joint replacement is due to pulmonary embolism ( PE), especially massive PE. The incidence of PE after TKR is higher than that after THR. Pulmonary angiography is the gold standard for the diagnosis of PE. With more understanding on PE and more popularity of joint replacement, the diagnosis of PE
基金This project is supported by China Post Doctor Science FoundationShanghai Jiaotong University-Shanghai Second Medical University Cooperation Foundation.
文摘Former research work about the modeling of hip joint focus on the uppersegment of femoral, and assumes the acetabulum cup is sphere concave, and the acetabulum prosthesesis semisphere. A method of acquiring the point data on the surface of the hipbone using the reverseengineering technology is presented. After analyzing the acetabulum surface fitting error, arotation ellipsoid CAD model is applied to fit the acetabulum surface, and then optimizationtechnique is used to find the geometric parameters of the model. The fitting error between thesphere and rotation ellipsoid is compared and gets the result that the fitting error of rotationellipsoid is smaller than sphere, and the rotation ellipsoid can describe the shape of theacetabulum better.
文摘BACKGROUND Periprosthetic joint infection(PJI)is a critical complication after joint arthroplasty and is accompanied by increasing rates of morbidity and mortality.Several studies have aimed at preventing PJI.AIM To research the knowledge level and attitudes of orthopedic surgeons,who play a key role in both preventing and managing PJI.METHODS We conducted a web-based survey to evaluate orthopedic surgeons'knowledge level and attitudes regarding PJI.The Likert scale survey utilized consisted of 30 questions which were prepared based on the"Proceedings of the International Consensus on Periprosthetic Joint Infection".RESULTS A total of 264 surgeons participated in the survey.Their average age was 44.8,and 173 participants(65.5%)had more than 10 years of experience.No statistically significant relationship was found between the PJI knowledge of the surgeons and their years of experience.However,participants who worked in training and research hospitals demonstrated higher levels of knowledge than the ones in the state hospitals.It was also noticed that surgeons'knowledge concerning the duration of antibiotic therapy and urinary infections was not consistent with their attitudes.CONCLUSION Even though orthopedic surgeons have adequate knowledge about preventing and managing PJI,their attitudes might contradict their knowledge.Future studies are required to examine the causes and solutions of the contradictions between orthopedic surgeons'knowledge and attitudes.
文摘Objective: to observe the effect of knee arthroplasty on senile knee degenerative osteoarthritis. Methods: 108 elderly patients over 60 years old with knee degenerative osteoarthritis were randomly divided into experimental group (joint replacement) and control group (routine treatment). After treatment, the postoperative knee function score and treatment effect of the two groups were compared. Results: the knee function score and treatment effect of the experimental group were better than those of the control group (P < 0.05). Conclusion: for elderly patients with knee degenerative osteoarthritis, joint replacement can improve the treatment effect, so it has clinical value.
基金support from the Science Foundation Ireland (SFI) (Grant No. 15/ RP/B3208)the National Natural Science Foundation of China (NSFC) (Grant No. 51320105009 & 61635008)
文摘Total joint replacements(TJR) have been a huge success for orthopaedic surgery in the past century and are gaining increasing importance today due to the aging population. However, the short longevity of artificial joints is one of the major problems in bioimplant industry and needs to be rectified since an increasing number of young people, with more active lifestyles, must receive TJR. Wear mechanisms are discussed in this paper to describe the root causes of the failures and to give some general ideas to increase the lifespan of artificial joints. The suitable material combination is of great importance for the wear resistance of bioimplants, and bioceramics will exert a crucial effect in their future progress. Other materials, such as metal alloys and polymers, are also discussed in this paper. Surface finish is another factor affecting the tribological performance of bioimplants. In recent years, surface texture technology has fascinated many researchers, and a good design of texture pattern requires a comprehensive understanding of wear mechanisms, material properties, and dynamic fluid theory. This review also covers a summary of in vitro wear tests, including simulators, lubricant, and testing parameters.
基金supported by the Science and Technology Development Fund,Macao SAR (No.0006/2020/AKP)the Xinglin Scholars Postdoctoral Special Fund (No.BSH2023003)+1 种基金Fujian Maternal and Child Health Hospital Science and Technology Innovation Launch Fund (No.Women and Children YCXY 20-10)Fujian Medical University Sailing Fund (No.2020QH1204).
文摘The pathogenesis of orthopedic diseases is intimately linked to blood stasis,frequently arising from damage to primary and secondary blood channels.This disruption can lead to“blood leaving the meridians”or Qi stagnation,resulting in blood stasis syndrome.Taohong Siwu Decoction(THSWD)is a renowned classical Chinese medicinal formula extensively used to promote blood circulation and mitigate blood stasis.Clinical studies have demonstrated its significant therapeutic effects on various orthopedic conditions,particularly its anti-inflammatory and analgesic properties,as well as its efficacy in preventing deep vein thrombosis post-surgery.Despite these findings,research on THSWD remains fragmented,and its interdisciplinary impact is limited.This review aims to provide a comprehensive evaluation of the efficacy and pharmacological mechanisms of THSWD in treating common orthopedic diseases.Additionally,we employ bibliometric analysis to explore research trends and hotspots related to THSWD.We hope this review will enhance the recognition and application of THSWD in orthopedic treatments and guide future research into its pharmacological mechanisms.
基金The research was.carried out under the project JSPS/OF280,PE17046with financial support from the Japan Society for the Promotion of Science.This research was also supported by the project FSI-S-17-4415with financial support from the Ministry of Education,Youth and Sports of the Czech Republic(MEYS).
文摘Hip joint replacements represent the most effective way of treatment for patients suffering from joint diseases.Despite the rapid improvement of implant materials over the last few decades,limited longevity associated with wear-related complications persists as the main drawback.Therefore,improved tribological perfor-mance is required in order to extend the service life of replacements.The effect of surface texturing of ultra-high molecular weight polyethylene(UHMWPE)acetabular cup was investigated in the present study.Unique tilling method was utilized for manufacturing the dimples with controlled diameter and depths on the contact surface of the cup.The experiments with four commercial femoral components and two model lubricants were realized.The main attention was paid to a coefficient of friction considering the differences between the original and the dimpled cups.Results showed remarkable lowering of friction,in general.Focusing on the simulated human synovial fluid,friction was reduced by 40%(alumina ceramic),38.8%(zirconia toughened ceramic),25.5%(metal),and 9.9%(oxinium).In addition,the dimples helped to keep the friction stable without fluctuations.To conclude,the paper brings a new insight into frictional behaviour of the hip replacements during running-in phase which is essential for overall implant lifespan.It is believed that proper surface texturing may rapidly improve the life quality of millions of patients and may lead to considerable financial savings.
文摘First metatarsophalangeal joint （MTPJ） degenerative diseases are not rare pathological changes in adult forefoot.1,2 It mainly includes hallux rigidus,hallux limitus and hallux valgus.3 Its progressive nature makes it hardly respond well to conservative treatment.4 Traditional surgical techniques,such as cheilectomy,Keller resection and arthrodesis are effective procedures but remain controversial due to none of them can achieve excellent results in all patients especially the end-stage conditions.5-7 Thus,great amount of efforts have been dedicated in MTPJ replacement despite many negative reports.This technique has aroused many controversies over the past decades due to its prematurity.Nevertheless,it has been improved in many aspects such as prosthesis material,design as well as surgical indications.This review would not only update the advancements and recognitions in recent years,but also presented the major disputed areas.
