The Relationship Between Joint Function And Prosthesis Position Parameters After Total Hiparthroplasty

ObjectiveThis study was conducted to observe and summarize the conditions of hip prosthesis reconstruction and to probe into the relationship of the joint function and the safe range of the prosthesis position parameters. It was also aimed to clarify the different groups of syndrome patterns of TCM and to explore whether there was some links between the different groups of syndrome patterns of TCM and the recovery conditions of the hip joint function after the total hip arthroplasty through retrospective study. It was expected to apply some instruction for the clinic.MethodsThis study was retrospectively analyzed608cases patients performed total hip arthroplasty from February2010to February2013in Guangdong hospital of TCM, from which we obtained234cases imaging data and179cases clinical following-up. The basic information (Name, sex, age, diagnosis, TCM syndrome type and date of surgery) and the recovery condition after the surgery (intraoperative blood loss, postoperative flow and blood transfusion, perioperative red blood cell, HB and HCT, down time) of the patients were obtained from the case system Guangdong hospital of TCM. The prosthesis position parameters (acetabulum abducent angles, acetabulum anteversion angles, femoral head rotation center position, femoral eccentricity) were measured by Huahai imaging system. The improved Harris functional score was observed in the last follow-up. And then we made comparisons between the parameters of the prosthesis position interpreted in Guangdong hospital of TCM and the safety margin of that recommended by the experts. According to the parameters of the prosthesis position, we made different groups and implemented the statistics of the mean and the excellent and good rate among the groups according to the improved Harris functional score. We made statistics of intraoperative blood loss, postoperative flow and blood transfusion, perioperative red blood cell, HB and HCT, down time and the improved Harris functional score. PASW Statistical software18.0was employed to analyze the data between different groups to figure out whether there was a significant difference. Measurement data:using t test between the two groups for normal distribution data, using the analysis of variance between k groups independent with each other. If they were not normal distribution data, then rank-sum test was adopted. Count data:using the X2test (P<0.05as the test standard).Results1.234cases patients with total hip replacement for imaging follow-up: Dislocation rate was1.28%. The patients with reconstruction abduction angle (35°-55°) account for77.4%. The patients with reconstruction anteversion angle (5°-25°) account for71.36%. There were statistically significant differences between operation side and contralateral in the position of femoral head rotation center and eccentricity. The restruction distance of operation side eccentricity which was not more than10%that of contralateral accounted for47.9%.2. Clinical follow-up of patients after total hip replacement were179cases and the mean follow-up time were25months. The mean score of improved Harris functional score in the last follow-up was90.35±8.67and the good rate87.2%.3. There were no statistically significant differences between different groups in anteversion angle of the acetabular, the horizontal position of rotation centers of femoral heads according to the improved Harris functional score. There were statistical differences between different groups in the acetabulum abduction angle, the vertical position of rotation centers of femoral heads and the femoral eccentric distance. However, there were no statistical differences in good rate.4. There were no statistically significant differences between the different TCM syndrome type groups in intraoperative blood loss, postoperative flow, the rate of intraoperative blood transfusion, postoperative added red blood cell rate, postoperative added plasma rate, postoperative down time and the mean score of the improved Harris function. There were statistically differences in the patient ages between different groups of TCM syndrome. There were also statistically differences in the red blood cells, HB and HCT between the first time when admitted to the hospital, the first day after the surgery and the day before discharged from hospital.Conclusion1. There was some difficulty in the situ reconstruction of acetabulum prosthesis position after total hip replacement. Though the center position of the femoral head rotation and femoral eccentricity is not100%anatomic reconstruction, it may not influence on patients postoperative functional recovery.2. Based on the total hip replacement acetabulum prosthesis position parameters between groups mean Harris function score and the fine rate of statistics and analysis:The acetabulum abduction angle should not be more than55°. The vertical position of rotation centers of femoral heads should not more than50%of the contralateral distance. The femoral eccentric distance is unfavorable to more than20%of the contralateral distance. Moreover, if the data above are beyoud the limit, the hip joint function recovery of patients will be affected.3. We still need to increase the sample size for the study in that when acetabulum abduction angle were less than35°and the distance of the femoral eccentricity were reduced more than20%that of the contralateral, it may affect the joint function recovery.4. It is not believed that there is a difference in the influence of the acetabulum abduction angle and the horizontal position of rotation centers of femoral heads on the postoperative Harris functional score.5. We should not believe that there are differences between different group patients of TCM syndromes in bleeding, blood transfusion, early postoperative down time, the function recovery. of hip Hospitalized patients between different bleeding and blood transfusion, early postoperative down time and the function recovery of hip. The patients ages in the liver and kidney deficiency and qi stagnation and blood stasis group are significantly higher than that of the other two groups, while red blood cells, HB and HCT are significantly lower than the other two groups. Therefore, the perioperative patients need more attention to the observation of the change of the blood picture in the liver and kidney deficiency and qi stagnation and blood stasis to control the perioperative risk.