Objective To investigate the relationship between the initial stabil ity and infected loosening of the total hip arthroplasty (THA) prosthesis. Methods From January 2000 to December 2008, 110 cases (110 hips) were treated with THA revision. Among them, 15 cases (15 hips) were confirmed infected loosening. There were 8 males and 7 females with anaverage age of 62 years (range 42-75 years). The infected signs were found from 6 months to 2 years after initial THA. All of them had Tsukayama type IV and late infection, including 6 cases of acetabular infected loosening (5 cases of one-stage and 1 case of two-stage acetabular revision), 7 cases of simple infected loosening of femoral prosthesis (4 cases of one-stage and 3 cases of twostage femoral prosthesis revision), and 2 cases of joint capsule infection and sinus without prosthesis loosening (debridement and continuous irrigation). Results All incisions healed by first intention. Fifteen patients were followed up for 12 to 36 months (average 24 months). In 13 cases of revision, postoperative X-ray films showed that femoral acetabular prostheses were in good position, and had no cl inical and imaging infective signs of loosening. In 2 cases of joint capsule infection, sinus recurred 6 months postoperation without hip joint pain, the function of weight-bearing and walking of hip joint was normal. Harris score increased from preoperative average of 42 to postoperative average of 85; the results were excellent in 4 cases, good in 7 cases, and fair in 4 cases. Conclusion The infection of THA may occur in the whole joint, half-joint or just in joint capsule. The initial stabil ity of the prosthesis would affect the long-term survival of the prothesis. If the prosthesis initial stabil ity is obtained, even if there are infective factors, infections would also be l imited.
ObjectiveTo evaluate the short-term effectiveness of a visual treatment solution (VTS)-assisted total hip arthroplasty (THA) in patients with Crowe type Ⅲ-Ⅳ developmental dysplasia of the hip (DDH). MethodsA retrospective analysis was conducted on the clinical data of 43 patients with Crowe type Ⅲ-Ⅳ DDH who were treated between June 2023 and December 2024 and met the eligibility criteria. Of these, 22 patients underwent conventional THA (traditional group), and 21 underwent VTS-assisted THA (VTS group). There was no significant difference (P>0.05) between the two groups in baseline data, including gender, age, side, Crowe classification, preoperative visual analogue scale (VAS) score, or Harris score. The operation time, intraoperative blood loss, postoperative drainage volume, length of hospital stay, and postoperative complications were recorded and compared between the two groups. Functional recovery and pain relief were assessed using the Harris score preoperatively and at 1 week, 3 months, and 6 months postoperatively, as well as the VAS score preoperatively and at 1 week and 1 month postoperatively. The acetabular cup anteversion and abduction angles were measured, and cup position was assessed with reference to the Lewinnek safe zone. Limb length discrepancy was measured, and acetabular coverage as well as the matching rates between the preoperatively planned and actually implanted prosthesis sizes were calculated. ResultsThe operation time, intraoperative blood loss, and postoperative drainage volume were all significantly lower in the VTS group than in the traditional group (P<0.05), whereas no significant difference was found in length of hospital stay (P>0.05). All patients were followed up 6-9 months, with a mean time of 7.4 months. Primary wound healing was achieved in both groups, and no poor wound healing or neurovascular injury occurred. Deep venous thrombosis developed in 2 patients in the VTS group and 4 patients in the traditional group; 1 patient in the traditional group experienced prosthetic dislocation. No other complication, including dislocation or thrombosis, was observed during follow-up. There was no significant difference in the overall complication incidence between the two groups (P>0.05). In both groups, acetabular anteversion and abduction angles were within the Lewinnek safe zone, but their distributions were more concentrated in the VTS group than in the traditional group. Compared with the traditional group, the VTS group showed significantly smaller postoperative limb length discrepancy and significantly greater anteversion angle and acetabular coverage (P<0.05). No significant difference was found between the two groups in abduction angle, acetabular prosthesis matching rate, or femoral stem prosthesis matching rate (P>0.05). Harris scores at 3 and 6 months postoperatively and VAS scores at 1 week and 1 month postoperatively were significantly better in the VTS group than in the traditional group (P<0.05), whereas no significant difference was observed at the other time points (P>0.05). ConclusionVTS-assisted THA for Crowe type Ⅲ-Ⅳ DDH yields favorable short-term effectiveness by improving implant positioning accuracy, reducing surgical trauma, and promoting early pain relief and functional recovery.
