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BACKGROUND: To evaluate the clinical and biomechanical results of different types of bone cement distribution post bilateral percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF). METHODS: A retrospective study of 227 single-segment OVCF patients from May 2017 to November 2020 were operated with bilateral percutaneous kyphoplasty and injected with the same material and the same volume of bone cement. According to the postoperative imaging data of the patients, the patients were allocated into two groups according to whether the bilateral bone cement in the vertebral body was connected. Further, establishment of a three-dimensional finite element model to evaluate the mechanical property of vertebral bodies after percutaneous kyphoplasty. Loading the model in five motion states (compression, forward bending, backward extension, rotation and lateral bending) for force analysis, and compare the stress difference between the fractured vertebrae and adjacent vertebrae under the two cement distributions. RESULTS: Of the 227 patients, 217 eventually received an average follow-up of 22 months. The restoration rate of vertebral body height, the improvement of kyphotic angle and the degree of postoperative improvement of the visual analog scale for pain (VAS) of the two groups of patients were similar, and there was no significant difference between the groups (P>0.05). There was no significant difference in the rate of bone cement leakage between the two groups (P>0.05). But there was a significant difference in the incidence of recurrent vertebral fractures (new fractures of adjacent vertebral bodies and re-fractures of injured vertebrae) (P< 0.05). There was a significant difference in the von Mises stress between the fractured vertebral body and the cranial adjacent vertebra under the same conditions between the two groups of vertebral body models (P＜0.05). CONCLUSION：Administration of bone cement in the center of vertebrae without distribution to both edges may reduce the risk of re-collapse of the injured vertebrae and fracture of adjacent vertebral body on the cranial side.

Obesity is a risk factor for total knee arthroplasty (TKA). Wound dehiscence and surgical site infections (SSIs) are the main complications of TKA in patients with obesity. They can profoundly affect patients because they often require readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue. This study aims to assess the incidence of wound dehiscence and SSIs in patients with obesity undergoing TKA after the routine use of NPWT. This sduty enrolled adult patients with obesity who underwent TKA within 8 years. A total of 360 adult patients with obesity (NPWT: 150, non-NPWT: 210) underwent TKA, and the baseline characteristics were similar between the 2 groups. Compared with the non-NPWT group, the NPWT group had a 50% lower incidence of wound dehiscence (3.33% vs 9.52%; P.05) and a significantly lower incidence of SSIs (11.33% vs 25.24%; P.05), including prosthetic joint infection (4.0% vs 10.0%; P.05) and superficial wound infection (7.33% vs 15.24%; P.05). In addition, the NPWT group had a lower need to return to the operating room for new interventions for any reason (2.67% vs 9.05%; P = .0107) than the non-NPWT group. Conventional incision NPWT can significantly reduce the incidence of wound dehiscence and SSIs in patients with obesity after TKA.

Background Hip reduction in total hip arthroplasty for high dislocated hips is difficult. Various femur osteotomy procedures have been used for hip reduction, but these methods increase operative time and risk of nonunion. We investigated the efficacy of a novel partial greater trochanter osteotomy technique for hip reduction in total hip arthroplasty for patients with high hip dislocation. Methods Twenty-one patients (23 hips) with high dislocated hip were treated with total hip arthroplasty that included partial greater trochanter osteotomy, i.e., the upper 2/3 greater trochanter was resected, and the gluteus medius muscle attachment was spared. The clinical outcome was evaluated by comparing the Harris hip scores and radiographic exam results, obtained before surgery and at follow-ups. Results Follow-ups of 21 patients ranged from 13 to 56 months. The mean Harris hip score increased from preoperative 55.0 (36–69) to postoperative 86.1 (71–93; P = 0.00). The average preoperative leg length discrepancy in patients with unilateral high hip dislocation was 46 mm (28–65 mm); postoperatively leg length discrepancy was less than 1 cm in 11 patients, between 1 and 2 cm in 8 patients, and more than 2 cm in 2 patients. The average leg lengthening at the time of surgery was 36 mm (24–54 mm). Trendelenburg’s gait changed from positive to negative in 20 hips by the last follow-up. No nerve injury occurred postoperative. Conclusion Partial greater trochanter osteotomy is an effective method to render hip reduction in total hip arthroplasty for patients with high dislocation of the hip. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-293) contains supplementary material, which is available to authorized users.