Arthroplasty of the hip in patients with aplastic anemia

Study of the curative effect of Zhang's Xibi formula and its underlying mechanism involving inhibition of inflammatory responses and delay of knee osteoarthritis

OBJECTIVE

To verify the clinical efficacy of Zhang's Xibi formula (ZSXBF) and explain the mechanism underlying its therapeutic effect.

METHODS

Preliminary elucidation of the clinical efficacy of ZSXBF in treating KOA in self-control studies, exploration of its mechanism of action with network pharmacology methods, and validation in animal experiments.

RESULTS

In clinical studies, ZSXBF administration effectively improved patient quality of life and reduce pain. Network pharmacology was used to explore the possible mechanisms underlying its treatment effect, and after verification in clinical experience and animal experiments, it was found that ZSXBF regulated the expression of immune-related proteins such as IL-17, ERK1, and TP53 in mouse knee joints.

CONCLUSION

ZSXBF, which is a traditional Chinese medicine compound that is used to clear heat and detoxify, can effectively improve the clinical symptoms of KOA patients, and its underlying mechanism includes the regulation of human immune-related proteins.

Total Hip Arthroplasty in Patient with Aplastic Anemia

Purpose

Patients with aplastic anemia (AA) are now living longer and therefore are at increased risk for the development of osteonecrosis of the hip. However, studies on the results of total hip arthroplasty (THA) are lacking. The purpose of this study is to present the result of THA in patients with AA.

Materials and Methods

We retrospectively reviewed the data for a group of 29 patients (45 hips) with AA who presented to our institution for THA between May 2008 and May 2012. All hips were replaced because of osteonecrosis of the femoral head. A specific prospective protocol was followed for the perioperative transfusion of platelets and blood. The clinical and radiographic evaluations were done, and the minimum follow-up period was 3 years (mean, 49.2 months; range, 36 to 84 months).

Results

Three hips had excessive perioperative bleeding and hematoma formation, and then hematoma evacuations were done; one hip was finally revised because of infection of acetabular component. One patient with poorly controlled AA died due to delayed infection on the hip joint. All hips showed stable fixation, and the mean Harris hip score was improved from 54.2 points (range, 42 to 69 points) preoperatively to 90.8 points (range, 73 to 97 points) at the time of the latest follow-up.

Conclusion

In the present study, the durability of implant fixation was maintained and the clinical results demonstrated a sustained increase in function of the hip. Postoperatively, paying attention to bleeding and infection should be needed.

Acetabular prosthetic protrusion and sepsis: case report and review of the literature

Acetabular prosthetic protrusio is an unusual complication of total hip arthroplasty that develops from erosion of the medial acetabular wall and intrapelvic migration of the implant. This report reviews 3 cases of severe intrapelvic prosthetic migration where acute or chronic sepsis was associated with the condition. All subjects were female and involved the left hip. In each case, debridement of the intrapelvic implant was required with an intra-abdominal approach. After successful eradication of infection, 2 patients have a well-functioning reimplanted prosthesis, and 1 was left with a Girdlestone arthroplasty. Literature review revealed that 11 of 16 similar prosthetic protrusion cases had chronic sepsis, of which, 10 were female and 9 involved the left hip. Chronic infection should be considered when intrapelvic prosthetic migration occurs after total hip arthroplasty.