menu

appointment
appointment

Archives: Publications

  • Does intraoperative fluoroscopy improve acetabular component positioning and limb-length discrepancy during direct anterior total hip arthroplasty? A meta-analysis

    Abstract

    Background

    The positioning of implant components for total hip arthroplasty (THA) is essential for joint stability, polyethylene liner wear, and range of motion. One potential benefit of the direct anterior approach (DAA) for THA is the ability to use intraoperative fluoroscopy for acetabular cup positioning and limb-length evaluation. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during DAA have reported conflicting results. This meta-analysis aimed to evaluate whether intraoperative fluoroscopy improves component positioning compared to no fluoroscopy during direct anterior total hip arthroplasty.

    Methods

    A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched Web of Science, EMBASE, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving intraoperative fluoroscopy versus no fluoroscopy during direct anterior total hip arthroplasty. Finally, we identified 1262 hips assessed in seven studies.

    Results

    There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.21), ACIA within safe zone rate (P = 0.97), acetabular cup anteversion angle (ACAA, P = 0.26); ACAA within safe zone rate (P = 0.07), combined safe zone rate (P = 0.33), and limb-length discrepancy (LLD, P = 0.21) between two groups.

    Conclusion

    Even though intraoperative fluoroscopy was not related to an improvement in cup location or LDD. With fewer experienced surgeons, the benefit of intraoperative fluoroscopy might become more evident. More adequately powered and well-designed long-term follow-up studies were required to determine whether the application of the intraoperative fluoroscopy for direct anterior total hip arthroplasty will have clinical benefits and improve the survival of prostheses.

  • Influence of axial rotation on measurement of medial proximal tibial angle

    Abstract

    Objective: To measure and compare medial proximal tibial angle (MPTA) of lower limbs under different axial rotation angles(neutral position, 30° internal rotation, 30° external rotation) on the load position radiographs, and explore changes and significance of MPTA measured within and between groups of tibia at different axial rotation positions.

    Methods: From January 2018 to December 2018, 40 patients with knee osteoarthritis (KOA) were selected, with a total of 80 limbs, including 12 males and 28 females, aged from 29 to 73 years old with an average of (59.6±12.7) years old. Full length radiographs of the lower limbs were taken on neutral tibia position, 30° internal rotation and 30° external rotation, respectively. MPTA was measured and the results were compared between groups and within groups.

    Results: MPTA measured on the left lower extremity of neutral tibia, 30° internal rotation and 30° external rotation were (86.08±2.48) °, (88.62±2.94) ° and (83.47±3.10) °, respectively. MPTA measured on the right lower limb were (86.87±1.97) °, (89.02±2.39) ° and (83.80±2.77) °, respectively, and there were no significant difference in MPTA measured between rotation angle group (P>0.05). While there were statistical difference in MPTA on the same limb between groups (P<0.05). On 30° internal rotation, MPTA of left and right lower limbs increased by (2.54±1.74) ° and (2.15±1.78) ° compared with tibia neutral position. On 30° external rotation, MPTA of left and right lower limbs decreased (2.61±2.03) ° and (3.07±1.75) ° compared with tibial neutral position.

    Conclusion: When a full-length X-ray film is taken on the weight-bearing position of both lower limbs, if there is axial rotation or external rotation of tibia, MPTA will increase or decrease compared with neutral position, which may cause a certain degree of deviation in clinical operation based on the accurate measurement of MPTA. However, the extent to which this bias affects the clinical operation effect remains to be verified. In addition, limited by the total number of samples and the number of measurement groups, whether there is a linear relationship between MPTA deviation and tibial axial rotation needs to be further studied.

  • Early Effect of Arthroscopic Fixation for Tibial Avulsion Fracture of Anterior Cruciate Ligament with Tightening Titanium Plate

    Abstract

    Objective

    To investigate the early effect of arthroscopic treatment for tibial avulsion fracture of anterior cruciate ligament (ACL) with tightening titanium plate. Methods: From January 2017 to December 2019, 5 patients with ACL tibial avulsion fracture were treated, including 4 males and 1 female with the average age of (34.2±11.2) years (rang, 21-49 years). All patients underwent arthroscopic tightening titanium plate ligation to reduce and fix fracture blocks. Perioperative complications were evaluated and recorded. Knee joint stability was evaluated by Lachman’s test, anterior drawer test and pivot shift test, and knee joint function was evaluated by International Knee Documentation Committee (IKDC) score and Lysholm score at least one year after operation.

    Results

    The average operation time was (57.2±13.3) min and the average hospitalization period was (6.6±2.1) days. All patients had primary incision healing. All patients were followed up for 12 months. The anterior drawer test, Lachman’s test and pivot shift test were all negative. At 3 months after operation and the last follow-up, the IKDC scores were (84.0±3.2) and (87.6±1.7) respectively, and the Lysholm scores were (89.0±2.2) and (89.4±0.9) respectively, which were significantly higher than those before operation [IKDC score (33.6±5.2), Lysholm score (42.6±3.3), P<0.001]. All patients achieved bone healing at the last follow-up, including 4 cases of anatomical reduction and 1 case close to anatomical reduction. All patients had no complications as poor wound healing, neurovascular injury, lower limb deep vein thrombosis, pulmonary embolism and perioperative death.

    Conclusions

    The treatment of ACL tibial avulsion fracture by arthroscopic tightening titanium plate fixation can effectively restore the stability of knee joint and improve joint function. The early curative effect is satisfactory.

  • Evaluation of knee cartilage based on MRI artificial intelligence reconstruction model of knee joint

    Abstract

    Objective

    To explore the feasibility of the AI intelligent reconstruction model based on knee joint magnetic resonance data developed by Nuctech Company Limited for evaluating knee cartilage injury.

    Methods

    Thirty-three patients (a total of forty-one knees) who were hospitalized with severe knee osteoarthritis in Beijing Tsinghua Changgung Hospital from May 2021 to April 2022 were selected. All of them were planned to be performed total knee arthroplasty (TKA) for the treatment of knee osteoarthritis. Fifteen males with an average age of 71±5 years old and twenty six females with an average age of 71±9 years old were included in this study. There were 19 cases of left knee and 22 cases of right knee. Thin layer MRI examination on the patients’ knee joints was performed before the surgery, and artificial intelligence model based on the thin layer MRI data of the knee joint was reconstructed. The cartilage part of the model was selected and corrected by Principal Component Analysis (PCA) in order to realize model straightening. The tibial plateau cartilage of knee joint which intercepted during operation was classified according to the International Cartilage Repair Society (ICRS). Finally the results were compared with the ICRS classification results of knee artificial intelligence reconstruction model and artificial recognition of knee joint MRI images.

    Results

    Compared with the grade of cartilage injury intercepted during our operation which was according to the ICRS classification, the sensitivity of artificial intelligence reconstruction model for the diagnosis of cartilage injury with ICRS classification grade four was 93.1%. The specificity of artificial intelligence reconstruction model was 91.4%. The positive predictive value (PPV) of artificial intelligence reconstruction model was 92.2%. And the negative predictive value (NPV) of artificial intelligence reconstruction model was 80.3%. The area under ROC curve (AUC) was 0.92. The ICRS classification consistency between artificial intelligence model and physical inspection results was good with kappa value 0.81 (P<0.001) . In the aspect of artificial recognition of cartilage injury grading in MRI images, the sensitivity of artificial recognition was 92.10% compared with the manual identification of cartilage injury classification in MRI images. The specificity of artificial recognition was 91.60%. The positive predictive value (PPV) of artificial recognition was 97.20% and the negative predictive value (NPV) of artificial recognition was 78.8%. The kappa value of the cartilage injury classification in MRI images consistency between artificial recognition and manual identification was 0.79 (P<0.001).

    Conclusion

    Based on the evaluation of cartilage injury by AI reconstruction model of knee joint, the sensitivity and specificity of the diagnosis of ICRS grade IV cartilage injury can be acceptable, but still needs to be improved.

  • Sensor-guided gap balance versus manual gap balance in primary total knee arthroplasty: a meta-analysis

    Abstract

    Background

    Despite Vast improvements in technology and surgical technique in total knee arthroplasty (TKA), approximately 15–25% TKAs, have suboptimal subjective clinical outcomes. Our study sought to evaluate if sensor-guided balancing improves postoperative clinical outcomes compared to a conventional gap balancing technique.

    Methods

    We searched Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in March 2022 to identify studies involving sensor-guided balancing versus conventional gap balancing technique in TKA. Finally, we identified 2147 knees assessed in nine studies.

    Results

    Compared with manual gap balancing, Sensor-guided gap balancing resulted in less rate of Manipulation under anesthesia (MUA) (P = 0.02), however more rate of intraoperative additional procedures (P = 0.0003). There were no significant differences in terms of KSS (P = 0.21), KSS Function score (P = 0.36), OKS (P = 0.61), KOOS (P = 0.78), operative time (P = 0.17), Mechanical axis (P = 0.69) and rate of reoperation between two groups.

    Conclusion

    Compared with conventional manual gap balancing techniques, sensors have more balancing procedures being performed. However, it did result in a reduction in the rate of MUA. More extensive, high-quality RCTs are required to verify our findings further.

  • The combined utilization of predictors seems more suitable to diagnose and predict rotator cuff tears

    Abstract

    Background

    Morphological markers presenting the lateral extension of acromion and the greater tuberosity of humerus were proposed to diagnose and predict rotator cuff tears (RCTs) in recent years, but few studies have addressed the combined performance when using two predictors together. As a presence of a RCT may be associated with the impingement caused by both acromion and the greater tuberosity, we believe a combined utilization of predictors could result in a better diagnostic and predictive performance than using a single predictor. The aim of this study is to (i) explore whether the combination is more efficient to predict and diagnose RCTs; (ii) find out which combination is the most superior screening approach for RCTs.

    Methods

    This was a retrospective study and patients who visited our hospital and were diagnosed with or without partial-thickness or full-thickness RCTs via magnetic resonance imaging from January 2018 to April 2022 were enrolled and classified into two groups respectively. Four predictors, the critical shoulder angle (CSA), the acromion index (AI), the greater tuberosity angle (GTA) and the double-circle radius ratio (DRR) were picked to participate in the present study. Quantitative variables were compared by independent samples t tests and qualitative variables were compared by chi-square tests. Binary logistic regression analysis was used to construct discriminating combined models to further diagnose and predict RCTs. Receiver operating characteristic (ROC) curves were pictured to determine the overall diagnostic performance of the involved predictors and the combined models.

    Results

    One hundred and thirty-nine shoulders with RCTs and 57 shoulders without RCTs were included. The mean values of CSA (35.36 ± 4.57 versus 31.41 ± 4.09°, P < 0.001), AI (0.69 ± 0.08 versus 0.63 ± 0.08, P < 0.001), DRR (1.43 ± 0.10 versus 1.31 ± 0.08, P < 0.001) and GTA (70.15 ± 7.38 versus 64.75 ± 7.91°, P < 0.001) were significantly higher in the RCT group than for controls. Via ROC curves, we found the combined model always showed a better diagnostic performance than either of its contributors. Via logistic regression analysis, we found the values of both predictors over their cutoff values resulted in an increasement (20.169—161.214 folds) in the risk of having a RCT, which is more than that by using a single predictor only (2.815 -11.191 folds).

    Conclusion

    The combined utilization of predictors is a better approach to diagnose and predict RCTs than using a single predictor, and CSA together with DRR present the strongest detectability for a presence of RCTs.

  • Research progress of hip arthroplasty in patients with osteoporosis

    Abstract

    With the increase of the aging population in our country, it is foreseeable that the number of elderly patients who choose to have hip arthroplasty ( HA ) because of osteoarthritis and femoral neck fracture will increase. Osteoarthritis patients who need hip arthroplasty are also high-risk osteoporosis patients. Surgeons will face more and more osteoporotic patients that will have THA surgery. We need to consider several important clinical issues, including the relationship between hip osteoarthritis and osteoporosis, femoral anatomical features, initial osseointegration of the prosthesis, prosthesis selection, clinical outcome of THA with osteoporosis, complications and the use of anti-osteoporosis drugs. This article reviews and analyzes the problems of osteoporosis patients that will have THA.

  • A Feasibility Study of Knee Joint Semantic Segmentation on 3D MR Images

    Abstract

    The segmentation of knee joint is of great significance for diagnosis, guidance and treatment of knee osteoarthritis. However, manual delineation is time-consuming and labor-intensive since various anatomical structures are involved in the 3D MRI volume. Automatic segmentation of the whole knee joint requires no human effort, additionally can improve the quality of arthritis diagnosis and treatment by describing the details more accurately. Existing knee joint segmentation methods in the literature focus on only one or few structures out of many. In this paper, we study the feasibility of knee joint segmentation on MR images based on neural networks and deal with the following challenges: (1) end-to-end segmentation of 15 anatomical structures, including bone and soft tissue, of the whole knee on MR images; (2) robust segmentation of small structures such as the anterior cruciate ligament, accounting for about 0.036% of the volume data. Experiments on the knee joint MR images demonstrate that the average segmentation accuracy of our method achieves 92.92%. The Dice similarity coefficients of 9 structures were above 94%, five structures were between 87% and 90%, and the remaining one was about 76%. 

  • The Double‐Circle System in the Greater Tuberosity: Using Radius to Predict Rotator Cuff Tear

    Abstract

    Objective

    In this study we concerned on the morphological characteristics of the greater tuberosity of humerus and proposed the double-circle radius ratio as a new predictor for the diagnosis of rotator cuff tears.

    Methods

    This was a retrospective study and patients who visited our hospital and were diagnosed with or without rotator cuff tears via magnetic resonance imaging from January 2018 to July 2021 were enrolled and classified into two groups respectively. In a standard anteroposterior view, the radius of the best-fit circle of humeral head and the radius of the concentric circle passing through the most lateral edge of the greater tuberosity were measured in each shoulder. The ratio of these two radiuses was named as the double-circle radius ratio. Angular parameters including the greater tuberosity angle and the critical shoulder angle were also measured in the anteroposterior view. Independent samples t tests and chi-square tests were used to find significant differences between groups. Significant associations between those measured variables and demographic characteristics were analyzed with simple linear regression analysis. Receiver operating characteristic curves were pictured to determine applied cutoff values by using Youden index. Multivariable-adjusted analysis for the occurrence of rotator cuff tears was carried out by using multiple logistic regression analysis. For all tests a p value of <0.05 was considered statistically significant.

    Results

    One hundred and twelve shoulders with rotator cuff tears and 42 shoulders without rotator cuff tears were included. The mean value of the double-circle radius ratio was significantly larger in shoulders with rotator cuff tears (1.42 ± 0.09 vs. 1.30 ± 0.07, P = 0.000). With simple linear regression analysis, the radiuses of the humeral head and the greater tuberosity were significantly associated with heights and weights. In receiver operating characteristic curves, the largest area was found under the curve of the double-circle radius ratio as 0.846 (95% CI, 0.781–0.911; P = 0.000) with an applied cutoff value as 1.38 (sensitivity, 70.5%; specificity, 88.1%). Multivariable-adjusted analysis showed that a value of the double-circle radius ratio >1.38 resulted in 11.252-fold odds of developing rotator cuff tears (95% CI, 3.388–37.368; P = 0.000).

    Conclusion

    The double-circle radius ratio is significantly larger in patients with rotator cuff tears and could be regarded as an eligible predictor for rotator cuff tears.

  • Application of linezolid bone cement in periprosthetic joint infection

    Abstract

    Two-stage revision with antibiotic bone cement spacer has been the gold standard for the treatment of periprosthetic joint infections. Now, the most commonly used antibiotics added to bone cement include gentamicin, tobramycin and vancomycin. However, there are more and more bacteria resistant to these antibiotics. Therefore, drugs other than aminoglycosides and glycopeptides are needed to treat and prevent periprosthetic joint infections. Linezolid is an ideal drug. It has high antibacterial activity to Gram-positive pathogens, which also have good permeability to joint and bones. Linezolid has antibacterial activity against active growth and resting pathogens in biofilms which is very important for treatment of periprosthetic joint infections. Linezolid shows similar or higher efficacy to vancomycin, against staphylococcus producing biofilms. This article reviewed the progress of linezolid bone cement in periprosthetic joint infections.

  • Evaluation of acetabular anteversion after total hip arthroplasty

    ABSTRACT

    Objective

    To investigate whether the anteversion angle of acetabular prosthesis can be evaluated on the antero-posterior X ray film of common double hip joint．

    Methods

    Total 32 patients （ 41 hips ） after total hip arthroplasty were selected ， including 18 males and 14 females ， aged （ 66．2±4．1 ） years． All patients completed the positive X ray film of both hips and plain CT scan of pelvis after operation． Acetabular anteversion was measured by plain CT scan of pelvis ， and measured by Saka and other measurement formulas on X ray film．

    Results

    The acetabular anteversion measured by X ray film was （ 16．2±5．0 ） °and that measured by CT was （ 31．8±9．7 ） °（P＝0．00 ） ． In addition ， there was a significant linear correlation between X ray film and CT （ Pearson correlation coefficient （ r＝0．84 ， P＝0．00 ） ．

    Conclusion

    CT can accurately measure the acetabular anteversion ， but it has obvious disadvantages ， such as large radiation ， high cost ， phantom CT artifact and so on． Although Saka measurement formula can not directly obtain the accurate acetabular anteversion as CT measurement ， it has a high correlation with the acetabular antever- sion measured by CT． Therefore ， the method proposed in this study can also preliminarily evaluate the acetabular anteversion．

  • Meniscus Graft Augmentation for a Midsubstance Tear of the Medial Collateral Ligament during Total Knee Arthroplasty

    Abstracts

    Multiple surgical techniques exist to repair iatrogenic medial collateral ligament (MCL) injury during total knee arthroplasty (TKA). The objective of the study is to confirm the clinical effectiveness of meniscus transfer for treatment of iatrogenic MCL midsubstance transection in which remaining MCL is of poor quality, and there is a persistent gap between both ligament ends during TKA. From January 2015 to November 2019, we treated 11 patients with MCL injuries of 882 primary TKAs by meniscus transfer. Another 24 primary TKAs were recruited as a control group. The two groups of patients were comparable for age, gender, body mass index (BMI), Knee Society scoring (KSS), knee function score (KFS), and type of prosthesis comparison without significant difference (p > 0.05). We reviewed the patient’s stability, as well as objective measures such as KSS and KFS scores, physical examinations, and radiographs. No patient of either group reported impaired wound healing, joint instability on physical examination, pain, radiographic changes, signs of loosening, and other complications. At the final follow-up, there was no significant difference in terms of KSS (p = 0.780) and KFS (p = 0.612) between the injury group and control group at last follow-up. X-ray image review showed no prosthesis loosening or subsidence for both groups. Based on these results, we are cautiously optimistic that midsubstance transections in which the quality of remaining tendon is weak, there is suspicion of stretching, or there is a persistent gap between both ligament ends that can be reconstructed with meniscus autograft transfer augmentation and an unconstrained implant.