Analysis of the Early Clinical Effect of Simultaneous Ipsilateral Total Hip and Knee Arthroplasty in the Treatment of End-stage Hemophilic Arthritis

ObjectiveTo evaluate the clinical efficacy of simultaneous ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) in the treatment of advanced hemophilic arthritis. Methodthe clinical data of 8 patients with advanced hemophilic arthritis, with ages of 31.6±6.2 years (ranging from 25-38 years, who underwent ipsilateral THA and TKA at the ** Hospital from January 2018 to May 2021 were retrospectively analyzed. There were 6 cases of hemophilia A and 2 cases of hemophilia B. The preoperative level of coagulation factor VIII was 1.8(±1.3)%，activated partial prothrombin time (aPTT) was 131.2 (±35.3) s. A comparison of the Harris score before and 0.3-1 year after operation was performed to evaluate hip function, American hospital for special surgery (HSS) knee score and American Knee society score (KSS) score. ResultDuring the follow-up period of 1.4 (± 1.1) years, no intra-articular bleeding and skin dehiscence were found in the early postoperative period, and no joint infection, bleeding, prosthesis loosening and sinking were found in the last follow-up visit. The Harris score increased from 16.8 (± 4.4) preoperatively to 77.6 (± 7.1) postoperatively, HSS knee score increased from 41.8 (± 4.2) preoperatively to 76.0 (± 5.8) postoperatively, the clinical KSS increased from 35.6 (± 10.8) preoperatively to 79.2 (± 6.9) postoperatively. The KSS increased from 22.8 (± 8.4) preoperatively to 72.0 (± 5.9) postoperatively at the last follow-up visit. The differences were statistically significant (P < 0.05).ConclusionsIpsilateral THA and TKA in the treatment of advanced hemophilic arthritis can effectively relieve pain, and improve hip and knee joint function, as well as the quality of life, and can thus be recommended as a safe and effective measure for the treatment of advanced hemophilic arthritis.

Application Value of Musculoskeletal Ultrasound in DAA-THA with Conjoined Tendon Repair

Objective: To observe the ultrasonographic characteristics of conjoined tendon repair in direct anterior approach for total hip arthroplasty (DAA-THA), and to evaluate the efficacy of musculoskeletal ultrasound in determining the healing after joint tendon repair. Methods: A total of 60 patients who required primary total hip arthroplasty in Yulin Orthopedic Hospital of Chinese and Western Medicine from July 2020 to July 2021 were selected; the patients were divided into two groups, an observation group, group A (n = 30), and a control group, group B (n = 30), according to different intraoperative methods. There was no significant difference in gender, age, and diagnosis between the two groups. Direct anterior approach was used for both the groups. For group A, the joint capsule and conjoined tendon (superior gemellus, obturator internus, and inferior gemellus) were repaired in situ, whereas for group B, only the joint capsule was repaired in situ, while the conjoined tendon was not repaired. The healing of the tendon was observed. Results: (1) in terms of diagnosis, after conjoined tendon repair, 26 cases in group A showed good tendon continuity, good tension, and a small amount of effusion echo around, three cases showed partial interruption of tendon echo, low echo, or no echo inside with insufficient structural clarity, and a case showed complete interruption; in group B, all 30 cases had continuous interruption, poor tension, tendon retraction, and thickening; the healing rate of group A’s conjoined tendon repair was 96.67%; (2) in terms of prognostic assessment, one month after the surgery, the Harris score of group A was significantly higher than that of group B (P < 0.05); however, there was no significant difference in the terms of the Harris score between the two groups 3-6 months after surgery (P > 0.05); the effective tension of conjoined tendon and the effective muscle strength of group A were significantly higher than those of group B (P < 0.05). Conclusion: Musculoskeletal ultrasound has high diagnostic value in the healing of conjoined tendon and provides dynamic clinical observation after conjoined tendon repair in DAA-THA; it is proven that DAA-THA with conjoined tendon repair on the premise of reconstructing the joint capsule can well restore its tension, enhance its muscle strength, significantly improve early joint stability and joint function, as well as facilitate the rapid recovery of patients.

Application Effect of Case Management Mode Combined with ERAS in Elderly Patients with Hip Fracture

Objective. To explore the effect of the case management mode combined with enhanced recovery after surgery (ERAS) in elderly patients with hip fracture. Methods. A total of 102 elderly hip fracture patients admitted to our hospital from June 2018 to December 2019 were selected. The patients with hip fracture were divided into the control group (n = 51) and the observation group (n = 51) by the random number table method. The control group adopts the conventional nursing mode, and the observation group adopts the case management mode combined with ERAS. The bed activity time, hospitalization time, total hospitalization expenses, and the satisfaction of patients were observed. The numeric rating scale (NRS) was used to assess the patient’s pain before treatment and at 1, 3, and 5 days after treatment. The Harris score was used to assess the patient’s joint motor function before treatment and at the 8th week after treatment. The perioperative complications of the two groups were compared. Result. After treatment, the observation group was better than the control group in terms of out of bed activity time, hospitalization time, total hospitalization expenses, and the satisfaction of patients ( P < 0.05 ). Before treatment, there was no significant difference in NRS scores between the two groups ( P > 0.05 ). After treatment, the NRS scores of the two groups were lower than before treatment, and on days 1, 3, and 5 after treatment, the NRS scores of the observation group were lower than those of the control group ( P < 0.05 ). Before treatment, there was no difference in the Harris score between the two groups ( P > 0.05 ). At the 8th week after treatment, the Harris scores of the two groups were higher than those before treatment, and the Harris scores of the observation group were higher than those of the control group ( P < 0.05 ). The total incidence of perioperative complications in the observation group (4/51) was lower than that in the control group (13/51) ( P < 0.05 ). Conclusion. The application of the case management mode combined with ERAS nursing in elderly patients with hip fracture can improve the clinical symptoms of patients, improve the therapeutic effect, and reduce the occurrence of complications, which is worthy of clinical application.

Effect of Etanercept Combined with Synovectomy on Function and Serum Levels of Associated Factors in AS Patients with Coexisting Coxarthrosis

Objective To investigate the clinical effect and value of etanercept combined with arthroscopic synovectomy in the treatment of ankylosing spondylitis (AS) complicated with coxarthrosis. Methods 66 patients with AS complicated with coxarthrosis admitted in our hospital were taken as the study objects and were randomly divided into two groups with random number table: test group (n = 33) and control group (n = 33). The arthroscopic synovectomy was given to both groups. The control group was given basic anti-inflammatory and analgesic measures, promoting blood circulation and detumescent measures after surgery, and the test group was added with etanercept on the basis of the control group. Changes in scores of coxae function, serum transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) at different time after operation were compared between the two groups. Results There was no significant difference in Harris score between the test group and the control group before operation (P>0.05). The Harris score of the test group was higher than that of the control group 3 months after operation and 6 months after operation (P<0.05). There was no statistically significant difference in the determination of flexion angle and abduction angle of coxae between the test group and the control group before operation (P>0.05). The flexion angle and abduction angle of coxae of the test group were higher than that of the control group 6 months after operation (P<0.05). The difference of measured values of serum levels TGF-β1, TNF-α, IL-6, CRP and ESR in the test group and the control group had no statistical significance (P>0.05). The determination values of serum levels TGF-β1, TNF-α, IL-6, CRP and ESR in the test group were lower than those in the control group at 3 months after operation (P<0.05). Conclusion Etanercept combined with arthroscopic synovectomy for the treatment of AS complicated with coxarthrosis is beneficial to regulate the level of related cytokines and promote the recovery of postoperative joint function.

Management of a Pipkin Type III Femoral Head Fracture Via Ganz Approach with a Cannulated Lag Screw & Herbert Screw

Objective: To evaluate the medium - to long-term efficacy of a Ganz approach and cannulated lag screw combined with Herbert screw, in the management of a Pipkin type III femoral head fracture.Methods:Retrospective analysis was performed on 11 patients (6 males, 5 females) who sustained Pipkin type III femoral head fractures and were managed with a cannulated lag screw, combined with Herbert screw, inserted using the Ganz approach and who were admitted to our department between June 2018 to June 2020. Perioperative indicators, postoperative function and follow-up complications at 9 months after surgery, Harris score at 6 and 9 months after surgery, Thompson-Epstein score, hip femoral head necrosis and incidence of post traumatic hip arthritis were analysis.Results:10 patients completed follow-up, with an average follow-up time of (13.7 ± 2.1) months. The mean operative time was (100.3 ± 23.67) minutes, intraoperative blood loss was (138.6 ± 50.18) ml, peripheral blood hemoglobin (Hb) was (105.6 ± 18.94) g/L 24 hours after surgery, and the complication rate was 1/10 2 weeks after surgery. The Harris Hip Scores for joint function at 6 and 9 months after the operation were (68.6 ± 5.49) points and (88.8 ± 5.77) points respectively. The excellent and good rate in the last follow-up was 80% (Thompson-Epstein score). The complication rate was 10%.Conclusion:A cannulated lag screw combined with a Herbert screw and inserted via the Ganz approach, is an effective method for the treatment of Pipkin type III fractures.

AB0720 HIP INVOLVEMENT IN A COHORT OF EGYPTIAN JUVENILE IDIOPATHIC ARTHRITIS PATIENTS

Background:The hip joint is frequently involved in Juvenile Idiopathic Arthritis (JIA). It is more common with polyarticular, systemic and enthesitis-related forms and with severe uncontrolled disease. Chronic hip arthritis leads to irreversible joint damage with marked impairment of quality of life and functional limitation [1]. Unilateral or bilateral hip arthritis occurs in 30- 50% of children with JIA [2].Objectives:The aim of this study is to assess the pattern of hip involvement in a cohort of Egyptian JIA patients in terms of epidemiological aspects, JIA pattern, bilateralism, associated extra-articular manifestations, radiological features, treatment and prognosis.Methods:We included 179 patients who fulfilled the International league against rheumatism criteria for JIA. Epidemiological, clinical, radiological, and therapeutic parameters were assembled and analyzed. Hip involvement was assessed using a semi-quantitative score of pain and tenderness for the hip, CARSH radiographic score of the hip, and Harris functional hip score. JADAS-27 was used for assessment of disease activity.Results:We included 113 girls and 66 boys; with a female: male ratio of nearly 2:1. The age at onset mean was 8.8±3 years (8.9±2.9 for females and 8.6±3.1 for males). The mean age at the study time was 13.3±4.1 years. The disease duration mean was 4.5±2.9 years.Clinically; 20.1% of the cases had hip involvement (12.8% unilateral and 7.3% bilateral), while by imaging, around 30.7% of the cases have hip involvement (19.6% unilateral and 11.2% bilateral). The mean age for cases with hip involvement was 14.1±4.3, compared to 12.9±4 among those with no hip involvement. The mean disease duration for those with hip arthritis (either clinical or by imaging) was 5.5±2.9 years, compared to 4.1±2.9 among those with no hip involvement (Figure 1).Figure 1.Difference between JIA cases with and without hip involvement.The Mean JADAS-27 was 13.5±6.2 and for those with hip involvement was 16.3±6.3. The commonest pattern of JIA with hip arthritis was polyarticular followed by enthesitis-related arthritis. There was a strong significant correlation between JADAS-27 and hip involvement at one hand and Harris score, semi-quantitative score for pain and tenderness at the other hand. Further, disease duration was significantly correlated with hip involvement as well. Among cases with hip involvement, 25% demonstrated destructive changes and 30% showed growth abnormalities.Conclusion:Hip arthritis in JIA is related to polyarticular and enthesitis-related pattern. Longer disease duration, seropositive polyarticular pattern were related to poor prognosis for hip arthritis.References:[1]Singh JA, Cleveland JD. Juvenile idiopathic arthritis is associated with higher healthcare utilization after total knee or hip replacement. Scandinavian journal of rheumatology 2021; 50: 34-9.[2]Rostom S, Amine B, Bensabbah R, Abouqal R, Hajjaj-Hassouni N. Hip involvement in juvenile idiopathic arthritis. Clinical rheumatology 2008; 27: 791-4.Disclosure of Interests:None declared

Clinical study on the Minimally Invasive Treatment of Early Necrosis of the Femoral Head with Hydroxyapatite Coated Hollow Titanium Rod Supporting the Femoral Head to Prevent Collapse

Background: To investigate the treatment effect of minimally invasive treatment of early osteonecrosis of femoral head (ONFH) with hydroxyapatite coated hollow titanium rod. Methods: From 1, January 2003 to 1, January 2019, 72 patients with ONFHⅡ Stage were selected. There were 50 males and 20 females, aged from 28 to 56. Onset time was 8~28 months. Lesion site: 18 left, 38 right, 16 bilateral. Causes of ONFH: 30 alcohol, 28 hormone, 9 trauma and 5 idiopathic patients. ARCO stage: 14 IIA, 33 IIB, 25 IIC. All patients underwent arthroscopic assisted minimally invasive percutaneous core decompression and bone grafting with hydroxyapatite coated titanium rod surgery. Visua Analogue Scales (VAS), Harris score and Images were used for assessing pain, hip joint function and the stability, respectively. Hip replacement was performed finally. Results: 16 patients with heavy hormone use history and femoral head collapse underwent Total Hip Resurfacing Arthroplasty (THRA) at the last follow-up. 24 months later, 8 ⅡB cases progressed to ⅡC, 2 cases were stable at ⅡC, 6 cases increased to Ⅲ, and underwent THRA. 12ⅡC cases progressed to Ⅲ, 2 cases were stable at Ⅲ, and 10 cases had articular cartilage surface collapse. THRA was administered 30 months after surgery. VAS score of individual patients increased and Harris score decreased 24 months after surgery, but there was no significant difference between the scores of 12 months and 24 months. The clinical effect of the last follow-up showed that the postoperative improvement rate of this group was 76.13%, among which the best was 100% in IIA, 79.48% in IIB, and the lowest was 58.06 in IIC. Both the patients with IIB or IIC, cases with aggravation and without change were hormonal ONFH. Conclusion: The treatment of ONFH with hydroxyapatite coated hollow titanium rod supporting the femoral head to prevent collapse is feasible. In addition to the Glucocorticoid-induced ONFH stage ⅡC outside, this method to other Ⅱ period lesions in improving the curative effect and preventing the collapse of femoral head articular surface is good and safe.

The Role of X and CT Image Measurement in Hip Arthroplasty in Patients with Parkinson's Disease

Objective: The study aims at evaluating if X-ray and spiral CT imaging is efficient in patients with Parkinson's disease after total hip arthroplasty (THA). Method: 76 patients with Parkinson combined with hip disease were selected as the study subjects, and grouped into the control group and the experimental group. Before surgery, X-ray and spiral CT were used to detect the data of abduction angle and the front rake of the healthy side of the patient, so as to perform THA as the reference value. In addition, Harris score was adopted to evaluate hip function 3 months after surgery in both groups. Also, the progression of Parkinson after operation was evaluated by Hoehn-Yahr grading method, and the complications were analyzed. Results: The results showed that the abduction angle measured by X-ray was 48.39 ± 4.15°, and the front rake was 13.83 ± 6.27°. In the experimental group, the abduction angle obtained by spiral CT measurement was 46.26 ± 3.92°, and the front rake was 12.44 ± 4.52°. The unequal length of limb was 1.10 ± 0.42 cm in the control group and 0.42 ± 0.21 cm in the experimental group. Moreover, the unequal length of limb in the two groups was significantly smaller than that before surgery (P < 0.01). The hip joint score of the two groups after surgery was apparently higher (P < 0.01), and the experimental group had significantly higher hip joint score (P < 0.05). Additionally, the experimental group had obviously higher Harris score of Parkinson's disease progression (P < 0.05). The occurrence rate of postoperative complications in the control group and the experimental group was 9.09% and 7.69%, respectively, which was not greatly different (P > 0.05). Conclusion: THA based on the data of spiral CT image measurement can achieve better postoperative results, which is conducive to recovering hip joint function and treating Parkinson's disease, and provides experimental basis for the diagnosis and treatment of Parkinson's disease in later clinical.

Outcomes of Open and Endoscopic Repairs of Chronic Partial- and Full-Thickness Proximal Hamstring Tendon Tears: A Multicenter Study With Minimum 2-Year Follow-up

Background: The preponderance of literature on the repair of proximal hamstring tendon tears focuses on the acute phase (<4 weeks). As such, there is a paucity of data reporting on the outcomes of chronic proximal hamstring tears. Purpose: To report minimum 2-year postoperative patient-reported outcome (PRO) scores, visual analog scale (VAS) for pain, and patient satisfaction from patients who underwent open or endoscopic repair of partial- and full-thickness chronic proximal hamstring tendon tears. Study Design: Case series study; Level of evidence, 4. Methods: Between April 2002 and May 2017, prospectively collected data from 3 tertiary care institutions were retrospectively reviewed for patients who underwent open and endoscopic repair of partial- and full-thickness chronic proximal hamstring tendon tears. Patients were included only if they had a chronic proximal hamstring tear (defined as ≥4 weeks from symptom onset to surgery). Patients were excluded if they had a tear treated <4 weeks after injury, underwent hamstring reconstruction, or claimed workers’ compensation. Patients who reported minimum 2-year follow-up for VAS, patient satisfaction, and the following PROs had their outcomes analyzed: the modified Hip Harris Score, Non-arthritic Hip Score, iHOT-12 (International Hip Outcome Tool), and Hip Outcome Score–Sports Specific Subscale. Results: Fifty patients (34 females and 16 males) were included in this study. There were 19 endoscopic repairs and 31 open repairs. Within the cohort, 52.0% had a full-thickness tendon tear on magnetic resonance imaging, and 48.0% had a partial tear. Average follow-up time was 58.07 ± 37.27 months (mean ± SD; range, 24-220 months). The mean age and body mass index of the group were 46.13 ± 13 years and 25.43 ± 5.14. The average time from injury to surgery was 66.73 weeks (range, 5.14-215.14 weeks). Average postoperative PROs were as follows: modified Hip Harris Score, 91.94 ± 9.96; Non-arthritic Hip Score, 91.33 ± 9.99; iHOT-12, 87.17 ± 17.54; Hip Outcome Score–Sports Specific Subscale, 87.15 ± 18.10; and VAS, 1.16 ± 1.92. Patient satisfaction was 8.22 ± 1.20. Conclusion: Patients who underwent open and endoscopic repairs for chronic partial- and full-thickness proximal hamstring tendon tears reported high PROs and satisfaction at a minimum 2-year follow-up with low rates of complications.

Extracorporeal shock wave therapy for bone marrow edema syndrome in patients with osteonecrosis of the femoral head: a retrospective cohort study

Background There is now ample evidence suggesting that extracorporeal shock wave therapy (ESWT) can improve hip mobility and reduce pain in patients with osteonecrosis of the femoral head (ONFH). The ability of ESWT to cure bone marrow edema syndrome (BMES) in patients with ONFH, 12 weeks after the initial course of ESWT, needs to be verified further and more relevant clinical research-based evidence should be consolidated. This study aimed to evaluate the efficacy of ESWT for BMES caused by ONFH. Methods This retrospective cohort study included 67 patients with BMES caused by ONFH who were participating in a rehabilitation program as outpatients. Before and after ESWT, the area of femoral bone marrow edema was evaluated by magnetic resonance imaging (MRI), and the Harris score and Charnley score were evaluated as hip pain and function indicators. Results After ESWT, MRI revealed that the area of bone marrow edema decreased from 984.6 ± 433.2 mm2 to 189.7 ± 214.4 mm2 (P < 0.0001). The Harris score increased from 42.2 ± 9.1 to 77.7 ± 10.8 points (P < 0.0001). The Charnley score increased from 7.3 ± 1.4 to 12.0 ± 1.7 (P < 0.0001). ESWT was effective in treating BMES in 98.5% of the cases. Conclusions This study demonstrated that ESWT can effectively treat BMES caused by ONFH and can aid in pain relief and functional recovery in patients with ONFH. Thus, ESWT should be included in the classic physical therapy regimen for patients with ONFH and BMES.