Background Recently, the new generation of metal-on-metal total hip resurfacing arthroplasty is well known for preserving the proximal femoral bone stock, minimizing the risk of postoperative dislocation using large f...Background Recently, the new generation of metal-on-metal total hip resurfacing arthroplasty is well known for preserving the proximal femoral bone stock, minimizing the risk of postoperative dislocation using large femoral heads, and expecting low wear of metal-on-metal articulation for longer prosthesis survival. It also has the advantage in biomechanical loading in the proximal femur. The osteoarthritis secondary to developmental dysplasia of the hip （DDH） has been the most common reason for total hip arthroplasty. Most of the patients are young and active, who require improved range of motion of the hip besides relief of the pain, even expect to resume the ability to run and jump after the joint arthroplasty, thus to be allowed an active lifestyle. The objective of the current study was to evaluate the early outcome of resurfacing arthroplasty for the mild DDH cases （Crowe type Ⅰ and Ⅱ）. Methods Between September 2005 and May 2007, twenty-one consecutive patients （twenty-six hips） with the diagnosis of osteoarthritis secondary to DDH underwent metal-on-metal resurfacing arthroplasty. The average age at the time of surgery was 46.5 years （range, 37-59 years）. Six patients （28.6%） were male and fifteen （71.4%） were female. Clinical and radiographic results were observed. The follow-up was performed at 6 weeks, 3, 6, 9 months and then yearly. Results All patients were followed for a mean of 18 months （9-29 months）. During the follow-up period no complications, such as dislocation of hip joints, infection or femoral neck fracture occurred. The clinical outcomes, as rated with the Harris hip score, improved significantly compared with the preoperative ratings. The mean postoperative Harris hip score was 90.7, compared to 35.5 preoperatively. The radiographic analysis showed that all prostheses were fixed with no radiolucencies. All of the patients who had equal limb lengths preoperatively had equal lengths postoperatively. Of the nine patients with preoperative limb-length discrepan展开更多
BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options incl...BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options include serial casting,percutaneous quadriceps recession,and V-Y quadricepsplasty(VYQ).The pathogenesis and hereditary patterns of CKD are not fully understood,with most cases being familial.CKD is usually managed immediately after birth.However,in this report,the patient was neglected for 2 years.CASE SUMMARY A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting;the patient had seizures and limited access to healthcare because of her family’s low socioeconomic status.Her birth was noted for a breech presentation accompanied by oligohydramnios.The delivery took a long time,requiring immediate medical interventions.As an infant,she had chronic diseases,including a small patent ductus arteriole,multicystic dysplastic kidney disease,and epilepsy.She was found to have a bilateral knee dislocation of approximately-90°on hyperextension.A multidisciplinary team was involved,and medical care was optimized.She underwent VYQ plus semitendinosus and sartorius transfer.After four postoperative follow-ups,her knees were regaining mobility,and she could walk for 2-3 steps without assistance.CONCLUSION This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.展开更多
先天性膝关节脱位（congenital dislocation of the knee,CDK）是较为少见的畸形,Katz,Grogono和Soper在研究了155例先天性膝关节脱位后发现,45例合并有先天性髋关节脱位,Nogi和Mac Ewen报道的17例患者中有8例伴有先天性髋关节脱位。201...先天性膝关节脱位（congenital dislocation of the knee,CDK）是较为少见的畸形,Katz,Grogono和Soper在研究了155例先天性膝关节脱位后发现,45例合并有先天性髋关节脱位,Nogi和Mac Ewen报道的17例患者中有8例伴有先天性髋关节脱位。2013年,我院收治1例双侧膝关节脱位合并髌骨脱位,双侧髋关节脱位患儿,临床疗效满意,现报道如下。展开更多
Pelvic osteotomy is commonly used to adjust acetabula dysplasia for congenital dislocation of the hip, whereas congenital insensitivity to pain with anhidrosis(CIPA) is a rare hereditary disease that often has the cha...Pelvic osteotomy is commonly used to adjust acetabula dysplasia for congenital dislocation of the hip, whereas congenital insensitivity to pain with anhidrosis(CIPA) is a rare hereditary disease that often has the characteristics of joint development deformity and easy fracture. This article reports the case involving a CIPA patient who was surgically treated by Chiari pelvic osteotomy and proximal femoral rotation osteotomy for congenital dislocation of the left hip joint and was provided long-term follow-up for redislocation and bilateral femoral head absorption.展开更多
Background The order and mechanism of pathological changes in acetabular dysplasia are still unclear. This study investigated cartilage changes in rabbit acetabular dysplasia models at different ages.Methods Twenty-se...Background The order and mechanism of pathological changes in acetabular dysplasia are still unclear. This study investigated cartilage changes in rabbit acetabular dysplasia models at different ages.Methods Twenty-seven 1-month-old New Zealand rabbits underwent cast immobilization of the left hind limb in knee extension. Serial acetabular dysplasia models were established by assessment of the acetabular index and Sharp＇s angle on radiographs. The thickness of the acetabular cartilage was measured under a microscope, and fibrosis was observed. Ultrastructural changes were investigated with scanning electron microscopy and transmission electron microscopy. The messenger RNA expression of collagen Ⅰ and Ⅱ, β1 integrin, and caspase-9 were measured by real-time fluorescence quantitative polymerase chain reaction.Results In an immature group of rabbits, the acetabular index of the treated hip increased with animal growth. The cartilage on the brim of the left acetabulum was significantly thicker than that on the right side. The collagen fibrils on the surface of the cartilage became gross, and the chondrocytes in the enlargement layer underwent necrosis. In a mature group of rabbits, the left Sharp＇s angle increased in the rabbits with 6-week casting. The cartilage on the brim of the left acetabulum underwent fibrosis. The chondrocytes were weakly stained, and the number of lysosomes was much larger than normal. The messenger RNA expression of collagen Ⅰ and Ⅱ, β1 integrin, and caspase-9 in the cartilage differed significantly at different ages.Conclusions Increasing thickness followed by fibrosis may be the order of pathological cartilage changes in acetabular dysplasia, with changes in ultrastructure and collagen expression contributing to the process.展开更多
文摘Background Recently, the new generation of metal-on-metal total hip resurfacing arthroplasty is well known for preserving the proximal femoral bone stock, minimizing the risk of postoperative dislocation using large femoral heads, and expecting low wear of metal-on-metal articulation for longer prosthesis survival. It also has the advantage in biomechanical loading in the proximal femur. The osteoarthritis secondary to developmental dysplasia of the hip （DDH） has been the most common reason for total hip arthroplasty. Most of the patients are young and active, who require improved range of motion of the hip besides relief of the pain, even expect to resume the ability to run and jump after the joint arthroplasty, thus to be allowed an active lifestyle. The objective of the current study was to evaluate the early outcome of resurfacing arthroplasty for the mild DDH cases （Crowe type Ⅰ and Ⅱ）. Methods Between September 2005 and May 2007, twenty-one consecutive patients （twenty-six hips） with the diagnosis of osteoarthritis secondary to DDH underwent metal-on-metal resurfacing arthroplasty. The average age at the time of surgery was 46.5 years （range, 37-59 years）. Six patients （28.6%） were male and fifteen （71.4%） were female. Clinical and radiographic results were observed. The follow-up was performed at 6 weeks, 3, 6, 9 months and then yearly. Results All patients were followed for a mean of 18 months （9-29 months）. During the follow-up period no complications, such as dislocation of hip joints, infection or femoral neck fracture occurred. The clinical outcomes, as rated with the Harris hip score, improved significantly compared with the preoperative ratings. The mean postoperative Harris hip score was 90.7, compared to 35.5 preoperatively. The radiographic analysis showed that all prostheses were fixed with no radiolucencies. All of the patients who had equal limb lengths preoperatively had equal lengths postoperatively. Of the nine patients with preoperative limb-length discrepan
文摘BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options include serial casting,percutaneous quadriceps recession,and V-Y quadricepsplasty(VYQ).The pathogenesis and hereditary patterns of CKD are not fully understood,with most cases being familial.CKD is usually managed immediately after birth.However,in this report,the patient was neglected for 2 years.CASE SUMMARY A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting;the patient had seizures and limited access to healthcare because of her family’s low socioeconomic status.Her birth was noted for a breech presentation accompanied by oligohydramnios.The delivery took a long time,requiring immediate medical interventions.As an infant,she had chronic diseases,including a small patent ductus arteriole,multicystic dysplastic kidney disease,and epilepsy.She was found to have a bilateral knee dislocation of approximately-90°on hyperextension.A multidisciplinary team was involved,and medical care was optimized.She underwent VYQ plus semitendinosus and sartorius transfer.After four postoperative follow-ups,her knees were regaining mobility,and she could walk for 2-3 steps without assistance.CONCLUSION This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.
文摘先天性膝关节脱位（congenital dislocation of the knee,CDK）是较为少见的畸形,Katz,Grogono和Soper在研究了155例先天性膝关节脱位后发现,45例合并有先天性髋关节脱位,Nogi和Mac Ewen报道的17例患者中有8例伴有先天性髋关节脱位。2013年,我院收治1例双侧膝关节脱位合并髌骨脱位,双侧髋关节脱位患儿,临床疗效满意,现报道如下。
文摘Pelvic osteotomy is commonly used to adjust acetabula dysplasia for congenital dislocation of the hip, whereas congenital insensitivity to pain with anhidrosis(CIPA) is a rare hereditary disease that often has the characteristics of joint development deformity and easy fracture. This article reports the case involving a CIPA patient who was surgically treated by Chiari pelvic osteotomy and proximal femoral rotation osteotomy for congenital dislocation of the left hip joint and was provided long-term follow-up for redislocation and bilateral femoral head absorption.
基金This research was supported, in part, by the Shanghai Commission of Science and Technology （No. 09411963200）, and the National Natural Science Foundation of China （No. 30973138）.
文摘Background The order and mechanism of pathological changes in acetabular dysplasia are still unclear. This study investigated cartilage changes in rabbit acetabular dysplasia models at different ages.Methods Twenty-seven 1-month-old New Zealand rabbits underwent cast immobilization of the left hind limb in knee extension. Serial acetabular dysplasia models were established by assessment of the acetabular index and Sharp＇s angle on radiographs. The thickness of the acetabular cartilage was measured under a microscope, and fibrosis was observed. Ultrastructural changes were investigated with scanning electron microscopy and transmission electron microscopy. The messenger RNA expression of collagen Ⅰ and Ⅱ, β1 integrin, and caspase-9 were measured by real-time fluorescence quantitative polymerase chain reaction.Results In an immature group of rabbits, the acetabular index of the treated hip increased with animal growth. The cartilage on the brim of the left acetabulum was significantly thicker than that on the right side. The collagen fibrils on the surface of the cartilage became gross, and the chondrocytes in the enlargement layer underwent necrosis. In a mature group of rabbits, the left Sharp＇s angle increased in the rabbits with 6-week casting. The cartilage on the brim of the left acetabulum underwent fibrosis. The chondrocytes were weakly stained, and the number of lysosomes was much larger than normal. The messenger RNA expression of collagen Ⅰ and Ⅱ, β1 integrin, and caspase-9 in the cartilage differed significantly at different ages.Conclusions Increasing thickness followed by fibrosis may be the order of pathological cartilage changes in acetabular dysplasia, with changes in ultrastructure and collagen expression contributing to the process.
