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The Bone & Joint Journal
Vol. 106-B, Issue 1 | Pages 19 - 27
1 Jan 2024
Tang H Guo S Ma Z Wang S Zhou Y

Aims

The aim of this study was to evaluate the reliability and validity of a patient-specific algorithm which we developed for predicting changes in sagittal pelvic tilt after total hip arthroplasty (THA).

Methods

This retrospective study included 143 patients who underwent 171 THAs between April 2019 and October 2020 and had full-body lateral radiographs preoperatively and at one year postoperatively. We measured the pelvic incidence (PI), the sagittal vertical axis (SVA), pelvic tilt, sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis to classify patients into types A, B1, B2, B3, and C. The change of pelvic tilt was predicted according to the normal range of SVA (0 mm to 50 mm) for types A, B1, B2, and B3, and based on the absolute value of one-third of the PI-LL mismatch for type C patients. The reliability of the classification of the patients and the prediction of the change of pelvic tilt were assessed using kappa values and intraclass correlation coefficients (ICCs), respectively. Validity was assessed using the overall mean error and mean absolute error (MAE) for the prediction of the change of pelvic tilt.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_13 | Pages 72 - 72
1 Dec 2022
Lamer S Ma Z Mazy D Chung-Tze-Cheong C Nguyen A Li J Nault M
Full Access

Meniscal tears are the most common knee injuries, occurring in acute ruptures or in chronic degenerative conditions. Meniscectomy and meniscal repair are two surgical treatment options. Meniscectomy is easier, faster, and the patient can return to their normal activities earlier. However, this procedure has long-term consequences in the development of degenerative changes in the knee, potentially leading to knee replacement. On the other hand, meniscal repair can offer prolonged benefits to the patients, but it is difficult to perform and requires longer rehabilitation.

Sutures are used for meniscal repairs, but they have limitations. They induce tissue damage when passing through the meniscus. Furthermore, under dynamic loading of the knee, they can cause tissue shearing and potentially lead to meniscal repair failure.

Our team has developed a new technology of resistant adhesive hydrogels to coat the suture used to repair meniscal tissue.

The objective of this study is to biomechanically compare two suture types on bovine menisci specimens: 1) pristine sutures and 2) gel adhesive puncture sealing (GAPS) sutures, on a repaired radial tear under cyclic tensile testing.

Five bovine knees were dissected to retrieve the menisci. On the 10 menisci, a complete radial tear was performed. They were separated in two groups and repaired using either pristine (2-0 Vicryl) or GAPS (2-0 Vicryl coated with adhesive hydrogels) with a single stitch and five knots.

The repaired menisci were clamped on an Instron machine. The specimens were cyclically preconditioned between one and 10 newtons for 10 cycles and then cyclically loaded for 500 cycles between five and 25 newtons at a frequency of 0.16 Hz. The gap formed between the edges of the tear after 500 cycles was then measured using an electronic measurement device. The suture loop before and after testing was also measured to ensure that there was no suture elongation or loosening of the knot.

The groups were compared statistically using Mann-Whitney tests for nonparametric data. The level of significance was set to 0.05.

The mean gap formation of the pristine sutures was 5.61 mm (SD = 2.097) after 500 cycles of tensile testing and 2.38 mm (SD = 0.176) for the GAPS sutures. Comparing both groups, the gap formed with the coated sutures was significantly smaller (p = 0.009) than with pristine sutures. The length of the loop was equal before and after loading. Further investigation of tissue damage indicated that the gap was formed by suture filament cutting into the meniscal tissue.

The long-term objective of this research is to design a meniscal repair toolbox from which the surgeon can adapt his procedure for each meniscal tear. This preliminary experimentation on bovine menisci is promising because the new GAPS sutures seem to keep the edges of the meniscal tear together better than pristine sutures, with hopes of a clinical correlation with enhanced meniscal healing.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_12 | Pages 66 - 66
1 Dec 2022
Lamer S Ma Z Mazy D Chung-Tze-Cheong C Nguyen A Li J Nault M
Full Access

Meniscal tears are the most common knee injuries, occurring in acute ruptures or in chronic degenerative conditions. Meniscectomy and meniscal repair are two surgical treatment options. Meniscectomy is easier, faster, and the patient can return to their normal activities earlier. However, this procedure has long-term consequences in the development of degenerative changes in the knee, potentially leading to knee replacement. On the other hand, meniscal repair can offer prolonged benefits to the patients, but it is difficult to perform and requires longer rehabilitation.

Sutures are used for meniscal repairs, but they have limitations. They induce tissue damage when passing through the meniscus. Furthermore, under dynamic loading of the knee, they can cause tissue shearing and potentially lead to meniscal repair failure.

Our team has developed a new technology of resistant adhesive hydrogels to coat the suture used to repair meniscal tissue.

The objective of this study is to biomechanically compare two suture types on bovine menisci specimens: 1) pristine sutures and 2) gel adhesive puncture sealing (GAPS) sutures, on a repaired radial tear under cyclic tensile testing.

Five bovine knees were dissected to retrieve the menisci. On the 10 menisci, a complete radial tear was performed. They were separated in two groups and repaired using either pristine (2-0 Vicryl) or GAPS (2-0 Vicryl coated with adhesive hydrogels) with a single stitch and five knots.

The repaired menisci were clamped on an Instron machine. The specimens were cyclically preconditioned between one and 10 newtons for 10 cycles and then cyclically loaded for 500 cycles between five and 25 newtons at a frequency of 0.16 Hz. The gap formed between the edges of the tear after 500 cycles was then measured using an electronic measurement device. The suture loop before and after testing was also measured to ensure that there was no suture elongation or loosening of the knot.

The groups were compared statistically using Mann-Whitney tests for nonparametric data. The level of significance was set to 0.05.

The mean gap formation of the pristine sutures was 5.61 mm (SD = 2.097) after 500 cycles of tensile testing and 2.38 mm (SD = 0.176) for the GAPS sutures. Comparing both groups, the gap formed with the coated sutures was significantly smaller (p = 0.009) than with pristine sutures. The length of the loop was equal before and after loading. Further investigation of tissue damage indicated that the gap was formed by suture filament cutting into the meniscal tissue.

The long-term objective of this research is to design a meniscal repair toolbox from which the surgeon can adapt his procedure for each meniscal tear. This preliminary experimentation on bovine menisci is promising because the new GAPS sutures seem to keep the edges of the meniscal tear together better than pristine sutures, with hopes of a clinical correlation with enhanced meniscal healing.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 115 - 115
1 Mar 2010
Tong P He B Jin H Xiao L Ma Z
Full Access

The purpose is to observe the clinical effects of sodium hyaluronate injection plus herbal fumigation in the treatment of knee osteoarthritis.

58 patients(73knees)were treated by sodium hyaluronate injection plus herbal fumigation with a treatment course of five weeks and after a fellow-up of 6–36 months, the average fellow-up time was 12.1 months, the curative effect showed that 39 patients was excellent (52knees), 11 patients was fine (15knees), 4 patients was midst (5knees), 1 patient was bad (1knees), and the total fineness rate was 91.78%.

Sodium hyaluronate injection plus herbal fumigation in the treatment of early metaphase of knee osteoarthritis, which had a better curative effect, less adverse reaction, and worth to extend clinical application.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 141 - 141
1 Mar 2010
Tong P Qu H He B Ji W Zhang J Jin HT Xiao L Ma Z
Full Access

The purpose of this investigation was to prospective compare the results of artificial femoral head replacement with those of treatment with a DHS internal fixation for unstable intertrochanteric fractures in elderly patients.

Sixty-one cases of aged patients with intertrochanteric fractures were randomized into two treatment groups. All patients were followed for a minimum of four years from 9.1999 to 4.2003, 29 patients were treated with artificial femoral head replacement, the other were treated with DHS internal fixation. The clinical results of two ways for the treatment of aged patients with intertrochanteric fractures were observed.

There were no significant differences between the groups in terms of functional outcomes, blood loss, or units of blood transfused. Patients treated with artificial femoral head replacement had a shorter hospital stay and operative time, less time to weight-bearing, fewer general complications, and lower mortality rate compared with those treated with the DHS internal fixation.

We conclude that in elderly patients with an unstable intertrochanteric femoral fracture, a artificial femoral head replacement provides superior clinical outcomes but no advantage with regard to functional outcome when compared with a DHS internal fixation.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 141 - 141
1 Mar 2010
Tong P He B Jin H Li J Xiao L Ma Z
Full Access

To investigate the effect of bilateral total hip replacement for patients with ankylosed hip joints caused by late ankylosing spondylitis (AS) and to discuss its related pre- and post-operation rehabilitation problems.

Data of 20 patients with ankylosed hip joints caused by late AS undergone total hip replacement (40 hips) were reviewed. Among the total 14 patients (28 hips) undergone bilateral total hip replacement, other 6 patients (12 hips) undergone twice operations. We used Harris score, assessment of the joint pain, range of motion to make sure the curative effect of the operative strategy.

The mean duration of follow-up was 3. 8 years, all hip joints function was improved, and the flexion deformity of the involved hips were disappeared. The range of hip flexion were 75°–105°(average 86. 2°), and the range of hip extension were 5°–15°(average 8. 7°), the average Harris score was from 32.8 pre-operation improved to 88.2 post-operation, the patients experienced no pain on their hips, the pain of the knee and the lower back complained before the treatment were obviously relieved.

Bilateral total hip replacement is an effective treatment for ankylosed hip joint caused by late ankylosing spondylitis, early rehabilitation intervention is useful for the functional recovery of the joints

Bipolar Hemiarthroplasty Using Non-cemented Femoral Stem in Non-traumatic Osteonecrosis of the Femoral Head Nine to Nineteen years Follow-up