We evaluated the use of surgical stabilisation for atlantoaxial subluxation after a follow-up of 24 years in 50 rheumatoid patients who had some degree of pain but no major neurological deficit. The mortality of patients treated by atlantoaxial fusion was significantly lower than for those who received conservative treatment. The deaths resulted from infection or comorbid conditions. The significantly high relative risks of mortality from conservative treatment compared with surgical treatment were mutilating disease and susceptible factors on both of the HLA-DRB1 alleles. Relief from pain and neurological and functional recovery were better, and the radiological degree of atlantoaxial translocation was less in those who were surgically treated compared with those who were not. Two patients had superficial local infections after surgery. We conclude that prophylactic atlantoaxial fusion is better than conservative treatment in these patients.
The aim of the study was to evaluate THA using Robodoc system for osteoarthritis of the hip joint. The Robodoc system consists of: 1. the Orthodoc computer workstation that simultaneously displays computerised tomography images of patient’s femur and a selected prosthesis, 2.a five-axis robot, 3.the operating room display, 4. the control cabinet. Follow up were 3months and 1 year on 27cases (Male 5, Female 22). Selected stems: Zimmer anatomic, 13, Versis 14(VSS,7, VSL,7). Mean age 57.9. Among 27 cases of osteoarthritis, one is after osteotomy and two are after osteonecrosis. Pain, ROM, Radiographs and ADL were evaluated using JOA hip score system. Sockets were fixed with cementless conventional technique. Mean operating time, 2 hours and 40min.; Mean bleeding, 455 ml; Mean Ant. Version, 29.26 degree (22.0–39.7); Level of osteotomy of the femur neck, Mean, 9.19 mm from the trochanter minor. JOA hip score after THA, 82.20. In one case, 5 mm sinking occurred 5 days after the operation. No intraoperative femoral fractures and varus or valgus insertion of stems occurred in 27cases. The thigh pains were nothing. The patients were discharged at 4weeks after the operation with one crutch. The results showed statistically better fit and fill of the femoral component in the Robodoc system. The Robodoc system is thought to be safe and effective in producing radiographically superior implant fit and positioning without fractures and other complication. Precise fit of the implant may be increase bone-to-implant contact, providing stress transfer from prosthesis to bone and more bone growth into prosthesis.
We studied 99 patients who were undergoing total knee arthroplasty (TKA) to determine the optimum protocol for the administration of tranexamic acid (TNA) in order to reduce blood loss. It decreased by more than 40% after the administration of TNA. The haemostatic effect was greatest when TNA was given preoperatively and on deflation of the tourniquet. There was no increase in the incidence of adverse affects in the patients receiving TNA, compared with a control group. We conclude that two injections of TNA, one given preoperatively and one on deflation of the tourniquet, significantly reduce blood loss without increasing the risk of thromboembolic complications.
