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Previous articles about MAKO robotic-assisted total hip replacement (THR) were mainly in patients with comparatively normal anatomy.From July 2020 to June 2021, we performed MAKO robotic-assisted THR in three hip-fused patients. We assessed the accuracy of prostheses implantation, collected clinical data, and discussed the value of this technique in this kind of patients.All three patients achieved good leg length and prostheses position. A patient got femoral artery injury during the surgery. Moreover, she developed a thrombus. All three patients got acceptable Visual Analogue Scale scores and function recovery 6 months later.MAKO robotic-assisted THR achieved excellent prosthesis position in hip fused patients. More cases are needed to confirm this advantage. The function recovery was acceptable. Caution should be paid to protect the surrounding abnormal arteries, especially in a limited surgical field.

To study clinical effects of double plating through different approaches for communicated and obvious osteoporosis periprosthetic femoral fracture following total knee arthroplasty(TKA).From July 2010 to June 2017, 21 patients with periprosthetic femoral fracture following TKA were divided into two groups according to operative approach. Fifteen patients in medial and lateral double approaches group, including 5 males and 10 females aged from 63 to 79 years old with an average of (67.2±5.9) years old; 11 patients were type 33-A2 and 4 patients were type 33-A3 according to AO-OTA classification; 12 patients injured by falling down and 3 patients by traffic accident; treated with double plating. Six patients in medial parapatellar approach group, including 3 males and 3 females, aged from 61 to 74 years old with an average of (64.6±6.0) years old; 3 patients were type 33-A2 and 3 patients were type 33-A3 according to AO-OTA classification; 5 patients injured by falling down and 1 patient by traffic accident; treated with double plating. Operative time, blood loss, postoperative drainage, fracture healing time were compared between two groups; HSS score and radiology at 3 and 12 months were compared between two groups.All patients were followed up, and the follow-up time of bilateral approaches group ranged from 12 to 18 months with an average of (14.2±2.6 ) months, while the follow-up time of single approach group ranged from 12 to 16 months with an average of (12.6±2.5) months, and there was no statistical difference between two groups. The operative time and postoperative drainage in bilateral approaches group were (107.2±10.4) min and (213.9±30.4) ml, while in sigle approach group was (95.4±12.8) min and (256.8±34.2) ml, and the differences were significant(Double plating technique for communicated and obvious osteoporosis periprosthetic femoral fracture following TKA could obtain good function of knee joint. The medial parapatellar approach has shorter operative time, while the bilateral approaches had less drainage.

BACKGROUND AND PURPOSE: Aseptic prosthesis loosening, caused by wear particles, is one of the most common causes of arthroplasty failure. Extensive and over‐activated osteoclast formation and physiological functioning are regarded as the mechanism of prosthesis loosening. Therapeutic modalities based on inhibiting osteoclast formation and bone resorption have been confirmed to be an effective way of preventing aseptic prosthesis loosening. In this study, we have investigated the effects of sophocarpine (SPC, derived from Sophora flavescens) on preventing implant loosening and further explored the underlying mechanisms. EXPERIMENTAL APPROACH: The effects of SPC in inhibiting osteoclastogenesis and bone resorption were evaluated in osteoclast formation, induced in vitro by the receptor activator of NF‐κB ligand (RANKL). A rat femoral particle‐induced peri‐implant osteolysis model was established. Subsequently, micro‐CT, histology, mechanical testing and bone turnover were used to assess the effects of SPC in preventing implant loosening. KEY RESULTS: In vitro, we found that SPC suppressed osteoclast formation, bone resorption, F‐actin ring formation and osteoclast‐associated gene expression by inhibiting NF‐κB signalling, specifically by targeting IκB kinases. Our in vivo study showed that SPC prevented particle‐induced prosthesis loosening by inhibiting osteoclast formation, resulting in reduced periprosthetic bone loss, diminished pseudomembrane formation, improved bone‐implant contact, reduced bone resorption‐related turnover and enhanced stability of implants. Inhibition of NF‐κB signalling by SPC was confirmed in vivo. CONCLUSION AND IMPLICATIONS: SPC can prevent implant loosening through inhibiting osteoclast formation and bone resorption. Thus, SPC might be a novel therapeutic agent to prevent prosthesis loosening and for osteolytic diseases.

The recovery of indium from waste indium tin oxide (ITO) target has great significance for the economy and environment. Based on our previous study on the optimization of acid leaching technique, the present study focuses on tin removal via zinc substitution and indium recovery from a tin-free leach solution. The results show that when the amount of added zinc powder and reaction time increase, the tin removal effect can be improved. The optimal conditions obtained are as follows: additional content of zinc powder from 20 g/L to 25 g/L, reaction temperature of 60 °C, and reaction time from 3 h to 4 h. Under this condition, the tin removal rate exceeds 98%, and the tin content in the tin removal solution is lower than 0.05 g/L. After tin removal, the substitution time could be reduced from 3–5 d to 1–2 d by neutralizing the residual acid by using alkaline residue and maintaining the pH value less than 2. The indium recovery rate is also improved when this condition is used. The indium content in the tin residue is reduced to lower than 0.1% and the acid-insoluble β-SnO2 could be obtained via the strong nitric acid leaching of the indium-containing tin residue. Indium could be recovered from ITO with a high purity of 99.995% via electrorefining.

To retrospectively study medium-term follow-up outcomes of total hip arthroplasty (THA) for patients with ankylosing spondylitis (AS).From January 2000 to December 2008, 67 patients (88 hip joints) with AS were treated with all ceramic interface THA. And 55 patients (74 hips) were finally followed up. Among them, there were 30 males and 25 females, with an average age of 32.6 (ranged 19 to 58) years old. Sixty-one hips were treated with biological prosthesis and 13 hips were treated with hybrid prosthesis. Fifty-five patients were followed up at least 5 years, with an average of (75.2 +/- 8.6) months. Clinical symptoms and radiography information were evaluated after follow-up.Harris hip score were significantly improved from 30.8 +/- 7.0 preoperatively to 85.2 +/- 5.5 at the last follow-up (P0.01). The hip movement range increased from (21.2 +/- 8.5) degrees preoperatively to (142.0 +/- 10.2) degrees postoperatively (P0.01). The 5-year survival of prosthesis was 95.9%. One patient were renovated because of internal wall broken caused by injury, 1 was renovated for infection, 1 was renovated for fracture arround femoral stem prostheses, and 1 was treated with conservative treatment by dislocation. Three cases with abnormal sound were cured with non-operation. 7 cases with heterotopic ossification were not treated, 2 cases with thigh pain received conservative treatment. Bone dissolve around prosthesis, loose and sink of femur and acetabulum prosthesis were occurred in other cases.THA for the treatment of AS is a reliable method, which has a satisfied medium-term follow-up outcomes.

Ceramic bearing surfaces have been introduced to prevent osteolysis after total hip arthroplasty (THA), but little is known about the difference in clinical and radiological results between pure alumina and sandwich alumina bearings. The purpose of this study was to analyze the results obtained with third-generation alumina-on-alumina THA with two different designs both in liner and femoral stem fixation after a minimum follow-up of 4.2 years.The results of 195 primary alumina-on-alumina THAs in 167 patients were evaluated. The procedures were performed between January 1998 and October 2006. Three patients died and 11 patients were lost to follow-up, leaving a total of 153 patients (181 hips) available for study. In the 88 group A patients, 107 hips were implanted using pure alumina bearings with cementless femoral stems. These patients were followed for (6.84 ± 1.49) years. In the 65 group B patients, 74 hips were implanted using sandwich alumina ceramic bearings with cemented femoral stems. These patients had a follow-up period of (7.73 ± 1.60) years. Patients in both groups were evaluated clinically and radiographically.One ceramic liner fracture occurred in group A and five took place in group B (P0.05), four of them revised for liner fracture. In each group, one acetabular shell migration happened without liner breakage and two hips developed deep infections, and all these six hips received revisions. Nine femoral components loosened in group B, with seven undergoing revisions. Kaplan-Meier survivorship at 5 years for revision of any component for any reason in group A was 96.26% compared to 90.54% in group B (P0.05). Better function was determined in group A (average Harris hip scores: 92.13 ± 2.85) than in group B (average Harris hip scores: 86.03 ± 4.21) and the difference was significant (P0.05). Squeaking was not recorded in either group.The sandwich design of the acetabular bearings can not reduce the migration rate in ceramic bearings but increase the liner fracture rate compared to pure ceramic liners. The high loosening rate in fluted and taped designed cemented stems with sandwich liners warrant caution to their use.

To explore the intermediate outcomes of third-generation alumina-on-alumina total hip arthroplasty (THA).A consecutive series of 165 primary alumina-on-alumina total hip arthroplasties were performed in 135 patients. Three patients died and 13 patients lost follow-up so that a total of 119 patients (146 hips) were available for study. The mean patient age was 53.4 ± 11.0 years old (range: 26 - 79). Hydroxyapatite. (HA)-coated press-fit acetabular cups were used in all cases. At femoral side, 123 cases were implanted with HA-coated uncemented stems and 23 cases implanted with high polished double taped cemented stems. All patients were evaluated clinically and radiographically after a minimal follow-up duration of 60 months.The preoperative mean Harris hip score of 49.6 ± 7.9 points improved to 91.7 ± 3.0 points at the last follow-up (P0.05). The 5-year survival for any reason lead to revision was 96.6%. Five hips were under revision, 1 for acetabular shell loosening and migration, 1 for Vancouver B2 periprosthetic fracture, 1 for fracture of pure alumina liner and 2 for infections. All other prostheses demonstrated no radiographic evidence of loosening. No periprosthetic osteolysis was found. There were 2 cases of dislocations and 2 patients presented postoperatively with "squeaking-like" hips.The clinical and radiographic outcomes after primary THA with third-generation ceramic-on-ceramic bearing surfaces are favorable after a minimal follow-up duration of 5 years. The modified alumina-on-alumina bearing implants offer a better option for younger and active patients.

Periprosthetic femoral fractures following total hip arthroplasty are getting more prevalent. The aim of this study was to evaluate the clinical results of combined use of uncemented extensively porous coated femoral components with onlay cortical strut allografts in revision of Vancouver type B2 and B3 periprosthetic femoral fractures.Thirteen hips after total hip arthroplasty in 13 patients who suffered a Vancouver B2 or B3 periprosthetic fracture were treated with an uncemented extensively porous coated femoral component combined with onlay cortical strut allografts. Each patient was assigned a Harris hip score, and a visual analog scale (VAS) score for pain and satisfaction. Radiographs were examined for component stability, fracture site and allograft-host union and allograft reconstruction.At an average of 5.3-year follow-up, no patient required repeat revision. The average Harris hip score was (71.8 +/- 6.3) points, the pain VAS score was (16.6 +/- 4.3) points, and the patient satisfaction VAS score was (81.5 +/- 5.7) points. Radiographic examination showed no detectable loosening of the prostheses, and 12 cases were presented fixation by osseointegration and the other one was stable fibrous ingrown fixation. All fractures united for (5.2 +/- 1.4) months in average. And all onlay strut allografts united to host bone for about (11.5 +/- 2.6) months.Combined use of uncemented, long stemmed, extensively porous coated implant with cortical onlay strut allografts can achieve good clinic results and high rate of union for both fracture site and allograft-host bone junction. This technique could be used routinely to augment fixation and healing of Vancouver B2 and B3 periprosthetic fractures.

To evaluate the clinical and functional outcomes of infected nonunion of the tibia by internal bone transport using the LRS mono-lateral external fixation.From June 2003 to October 2005, twenty-eight patients who underwent internal bone transport for infected nonunion in the tibia were reviewed. Twenty-three cases were open fractures: grade IIIA, 5 cases; grade IIIB, 11 cases; grade IIIC, 7 cases. The other five cases were infected nonunion after internal fixation. The results were evaluated by the classification of the Association for the Study and Application of the Method of Ilizarove (ASAMI) which divided into bone and functional categories.Mean follow-up was 16 months. All the cases got primary bone union, and infection was controlled. Bone results were 14 excellent, 9 good, 2 fair and 3 poor. And functional results were 10 excellent, 13 good, 2 fair and 3 poor. The mean length of time in healing for all patients were 9 months. The mean length of regenerate bone were 6.6 cm. The most common complication was pin infection, and 2 cases refractured at the docking site.Tibial infected nonunion can be successfully treated using the internal bone transport technique.

To determine the variation in femoral stress after insertion of Elite cemented femoral prosthesis.Three-dimentional finite element models of the normal human femur and Elite femoral prosthesis were developed through CT scan. With the application of hip joint loading, quantitatively measure stress changes of an intact femur with corresponding femur inserted with Elite implants were measured.Compared with intact femur, insertion of Elite implants into the femoral canal decreased the proximal femoral stresses level, especially in calcar femoral, femur wall and tuberositas. However, the stress in the prosthesis distal end.Insertion of Elite implants induced significant stress shielding in the proximal femur, especially at calcar femoral, femur wall and tuberositas. However, stress concentrates in the prosthesis distal end.