Replacement Arthroplasty: Zhang W

Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP, Hauselmann HJ, Herrero-Beaumont G, Jordan K, Kaklamanis P, Leeb B, Lequesne M, Lohmander S, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Swoboda B, Varatojo R, Verbruggen G, Zimmermann-Gorska I, Dougados M, Anonymous00408. · Academic Rheumatology, University of Nottingham, UK. · Ann Rheum Dis. · Pubmed #15471891 links to  free full text

Abstract: OBJECTIVE: To develop evidence based recommendations for the management of hip osteoarthritis (OA). METHODS: The multidisciplinary guideline development group comprised 18 rheumatologists, 4 orthopaedic surgeons, and 1 epidemiologist, representing 14 European countries. Each participant contributed up to 10 propositions describing key clinical aspects of hip OA management. Ten final recommendations were agreed using a Delphi consensus approach. Medline, Embase, CINAHL, Cochrane Library, and HTA reports were searched systematically to obtain research evidence for each proposition. Where possible, outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. Effect size, rate ratio, number needed to treat, and incremental cost effectiveness ratio were calculated. The quality of evidence was categorised according to the evidence hierarchy. The strength of recommendation was assessed using the traditional A-D grading scale and a visual analogue scale. RESULTS: Ten key treatment propositions were generated through three Delphi rounds. They included 21 interventions, such as paracetamol, NSAIDs, symptomatic slow acting disease modifying drugs, opioids, intra-articular steroids, non-pharmacological treatment, total hip replacement, osteotomy, and two general propositions. 461 studies were identified from the literature search for the proposed interventions of efficacy, side effects, and cost effectiveness. Research evidence supported 15 interventions in the treatment of hip OA. Evidence specific for the hip was strikingly lacking. Strength of recommendation varied according to category of research evidence and expert opinion. CONCLUSION: Ten key recommendations for the treatment of hip OA were developed based on research evidence and expert consensus. The effectiveness and cost effectiveness of these recommendations were evaluated and the strength of recommendation was scored.

Cao J, Shen Y, Yang D, Ding W, Meng X, Zhang W, Li Z. · Department of Spinal Surgery, Third Affiliated Hospital of Hebei Medical University, Shijiazhuang Hebei 050051, PR China. · Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. · Pubmed #18979878 No free full text.

Abstract: OBJECTIVE: To explore the neck axial symptom (AS) after Bryan cervical disc arthroplasty traditional anterior cervical discectomy and fusion, and to make contrastive analysis. METHODS: From October 2004 to April 2006, 22 patients, 13 males and 9 females, aged 33-54 years old (43.3 on average), underwent Bryan cervical disc placement (group A). Among them, there were 16 cases of cervical spondylotic myelopathy and 6 of nerve root cervical syndrome, with 20 of single segment replacement and 2 of two segments replacement. The courses of disease were 1-21 months (6 months on average). Meanwhile, 30 patients, 17 males and 13 females, aged 35-64 years old (50.3 on average) underwent traditional anterior cervical discectomy and fusion (group B). Among them, there were 19 cases of cervical spondylotic myelopathy and 11 of nerve root cervical syndrome, with 26 of single segments replacement and 4 of two segments replacement. The course of disease was 1-23 months (7 months on average). In both groups, the neurologic recovery rate, the change of cervical curvature of the operated segments and total range of motion (ROM), and incidence of neck axial symptoms were recorded and compared. RESULTS: All the patients were followed up for 24-42 months (30.6 months on average). There was no graveness complication happening during and after operation in both groups. There were no complications of prosthesis bit shifting and amotio in group A, and group B exhibited a bony fusion on X-ray films 6 months after operation, without plate and bolt loose or broken. The patients' clinical symptoms of radiculopathy were obviously relieved and the curative effect was satisfactory in two groups of nerve root cervical syndrome. In both groups of cervical spondylotic myelopathy, the patients' JOA scores at the postoperative follow-up increased obviously than preoperative (P < 0.01), and there was no significant difference between the two groups before the operation and at the end of the follow-up (P > 0.05). The rate of sagittal alignment of the operated segment with kyphosis increased obviously in group B, higher than in group A (P < 0.05). The total ROM of group B was obviously lower than preoperative (P < 0.01), and the pre- and postoperative difference of group A was not statistically significant (P > 0.05). The rate of postoperative neck AS was 18.18% in group A and 46.67% in group B, and the difference was statistically significant (P < 0.05). CONCLUSION: Compared with traditional anterior cervical discectomy and fusion, the use of Byran disc arthroplasty for cervical syndrome is associated with good outcomes. At the same time, it can maintain the cervical motion and curvature of operated segments, avoid the decrease of total ROM and lower the incidence of the postoperative neck AS.

Gu GS, Wang G, Sun DH, Qin DM, Zhang W. · 1st Department of Bone and Joint Surgery, First Teaching Hospital, Jilin University, Changchun 130021, China. · Chin J Traumatol. · Pubmed #18230285 No free full text.

Abstract: OBJECTIVE: To observe the clinical result and assess clinical value of cemented bipolar hemiarthroplasty with a novel cerclage cable technique for treatment of unstable intertrochanteric hip fractures in senile patients. METHODS: Forty-eight consecutive patients with unstable intertrochanteric fractures were treated in our hospital from March 2001 to March 2006 (Evans type III in 11 cases, Evans type IV in 25 cases and Evans type V in 22 cases). All the cases were evaluated by Zuckerman functional recovery score (FRS) and operative risk assessment software 1 (ORAS1), which were based on the patients' physical and laboratory examinations preoperatively. Seventeen cases (19 hips) were treated with cemented bipolar hemiarthroplasty. There were 5 male cases (5 hips) and 12 female cases (14 hips, including 2 patients who suffered from additional slight injuries and resulted in contralateral hip fracture and were treated with the same procedure 3 months after the first operation). The average age was 85 years (78-95 years). All the operations were carried out under general anesthesia, through Southern incision and lateral approach by the same orthopaedic surgeon. All prostheses consisted of Link SPII femoral stem and bipolar femoral head. All patients were followed up for more than 30 days. RESULTS: The operative risks of all the 17 cases (19 hips) were calculated by ORAS1 preoperatively. The average preoperative FRS was 81.7 (80.7-82.7). The average predictive value of operative morbidity was 10% (7%-15%). The average predictive value of mortality was 2.97% (2.1%-3.2%). The average operation time was 1.5 hours. The average blood transfusion was 400 ml. There were no operative or anesthetic complications and no deaths within 30 days after operation. Sitting up was permitted 3 to 4 days after operation, and partial weight bearing was permitted 5 to 7 days after operation. Patients were allowed to walk with a walker 10 days after operation. The average FRS was 78.7 at 30 days postoperatively. No patient died during at least one year follow-up. CONCLUSIONS: Although the value of the technique of cemented bipolar hemiarthroplasty in the treatment of unstable intertrochanteric hip fracture is not widely recognized, we have consistently achieved satisfactory results with strict preoperative risk assessment, strict indication selection and systematic postoperative rehabilitation.