To investigate the clinical effect of cementless long-stem hip prosthetic replacement for femoral prosthesis loosening with femoral bone defect.

From January 2011 to January 2015, the patients undergoing hip revision procedures in Xinjiang Shaya County People's Hospital were analysed retrospectively. The patients with femoral handle loose, femoral defect and only revision of femoral prosthesis handle were selected. The patients with infection, problem of acetabulum prosthesis, severe medical diseases and osteoporosis were excluded. A total of 104 cases were enrolled. The patients treated by cementless long-stem hip prosthetic were in the observation group (n = 52). The patients treated by cement hip prosthetic were in the control group (n = 52). The operation time, intraoperative blood loss, hospital stay, fracture healing time and relevant functional scores of the two groups were analyzed by t test. The good rates and incidence of complications were calculated and analyzed by chi-square test.

Harris score, activities of daily living (ADL) score and quality of life (QOL) score were increased in the two groups during the follow-up (control group: t=10.045, 18.185, 15.162, all P<0.05)(observation group: t=13.445, 23.741, 17.324, all P<0.05). The visual analogue scale (VAS) scores in the two groups were lower than those before the treatment (control group: t=48.714, P<0.05) (observation group: t=78.556, P<0.05). During follow-up, Harris score, ADL score and QOL score in the observation group were higher than those in the control group(t=5.267, 5.205, 3.976, all P<0.05), and VAS score was lower than that in the control group (t=8.561, P<0.05). Moreover, the length of hospital stay and fracture healing time in the observation group were shorter(t=4.917, 4.398, both P<0.05). The good rate in the observation group (98.1%) was higher than that in the control group (44.2%), and the complication rate in the observation group (1.9%) was lower than that in the control group (13.5%) (χ²=36.728, 4.875, both P<0.05).

The cementless long-stem hip prosthetic is effective in the treatment of femoral prosthesis loosening with bone defect, and it is a feasible prosthetic option, while the long-term efficacy still needs further observation and verification.

To investigate the efficacy and prognostic risk factors of total hip replacement (THR) in the patients with ankylosing spondylitis (AS) involving hip joint lesions.

The clinical data of 84 AS patients with hip joint lesions treated by cementless THR in Linyi Lanshan District People's Hospital from February 2016 to January 2019 were retrospectively analyzed. All the patients met the New York diagnostic criteria and the surgical indications, were accompanied with intolerable hip joint lesions, and accepted the primary THR. Exclusion criteria: allergic history to implants, severe femoral deformity, severe cardiac or renal diseases, incomplete data. Harris hip score, visual analogue scale (VAS score) and range of motion of hip were used to assess the prognosis of the patients. Paired t test was used for pairwise comparison. Univariate analysis of variance was used for multi-groups comparison. Rank sum test was used to analyze the related risk factors such as abnormal erythrocyte sedimentation rate, family history of rheumatism, age of onset and course of disease. Multivariate logistic regression analysis was used to analyze the independent prognostic factors.

The follow-up rate of 84 patients was 100%, and the average follow-up time was (35±6) months. The bone healing time was(3.5±1.2)months, and the excellent and good rate of hip function was 90.48% at the last follow-up. Harris score and total hip motions significantly increased at the last follow-up, VAS score and angles of joint flexion deformity significantly decreased (t=77.490, 54.360, 65.740, 105.100, all P<0.001). Before the treatment, the longer of the disease course, the Harris score was lower in the patients with family history of rheumatism and abnormal erythrocyte sedimentation rate (t=34.240, 4.246, 3.522, all P<0.001). After the treatment, the shorter of the disease course, the Harris score was the higher in the patients without family history of rheumatism and normal erythrocyte sedimentation rate (t=53.190, 8.642, 6.351, all P<0.001). The results of multiple logistic regression analysis showed that abnormal erythrocyte sedimentation rate, family history of rheumatism, onset age ≤50 years, course > five years of the disease were independent risk factors affecting the prognosis of AS patients with hip joint lesions (χ²=4.776, 6.138, 4.875, 4.135, all P<0.05).

Cementless THR can significantly alleviate the pain of AS patients involved hip joint lesions, improve hip function, and has a significant clinical effect. Preoperative abnormal erythrocyte sedimentation rate, family history of rheumatism, low age of onset and long course of disease are independent risk factors affecting the prognosis.

To explore the effect of Narcotrend (Nt) monitoring on postoperative delirium in the elderly after hip and knee replacements.

The patients with unilateral hip or knee arthroplasty in the First Affiliated Hospital of Chongqing Medical University and aged over 60 years were included in the study. They were randomly divided into the Nt monitoring group (n=65, the anesthesia depth was controlled by the Nt index to D1-E0) and the control group (n=71, the anesthesia depth was controlled by the experience of anesthesiologists). The data were recorded, including the operation position, education level, the dosage of general anesthesia, nerve block rate, the postoperative hospital stay, the confusion assessment method(CAM) scores and incidence of postoperative nausea and vomiting on the postoperative first and third day, the level of serum CRP on the first day before operation and the first, third and fifth day after operation, and the level of serum IL-6 on the first day before operation and the third and fifth day postoperation. According to the type of data, independent-sample t test or chi-square test were used to compare the differences between groups. Rank sum test was used to analyze the difference of inflammatory factors. Spearman and binary logistic regression analysis were used for correlation analysis.

When compared with the control group, the POD in the Nt group on the first and third day after operation had no difference 21.1% vs 9.2% (χ²=3.678, P >0.05)on the first postoperative day; 22.5%vs 18.5% on the third postoperative day (χ²=0.344, P >0.05). The dosage of propofol in Nt group was less than that in the control group (245.63±84.48)mg vs (303.64±127.38)mg(t=-3.131, P<0.01). There was no difference in the levels of serum IL-6(U=505, 590, 445, all P>0.05) and CRP(U=2 090, 2 165, 1 687, 505, all P>0.05) after operation between Nt group and the control group. Regression analysis suggested that nerve block and age could independently influence the risk of POD.

Nt monitoring can reduce the dosage of propofol when compared with usual monitoring for the hip and knee replacement in the elderly, but it can not decrease the incidence of POD.