Jiliang Zhai

Outcome of total knee arthroplasty combined patelloplasty for end-stage type A hemophilic arthropathy

The aim of this study was to retrospectively evaluate the outcome of total knee arthroplasty for end-stage hemophilic arthropathy, based on effectiveness of operation, the specificity of surgical technique, the complications of TKA operation and the strategy of handling of patella. Nineteen patients (25 knees) with type A hemophilic arthropathy were treated with TKA from June 2003 to February 2010. Average patella thickness was 16.3±0.4mm and all patellas were treated by patelloplasty. The patient followed up data was recorded, which included the information of hospital for special surgery knee score(HSS), range of motion(ROM), post-operative complication, and anterior knee pain. The patients were followed for an average post-operative period of 41months (10 to 78months). The mean preoperative HSS score was 51 (31 to 64). Post-operative HSS score was 91 (75 to 110) when followed-up. ROM was modified to 82 degree (60 to 105), compared with 55 degree (5 to 110) preoperatively. Thirteen patients with flexion contracture were corrected from 19 degree (0 to 45) to 2.7 degree (0 to 10). Four patients complained mild but endurable anterior knee pain. The study concludes that TKA is an effective treatment for end-stage hemophilic arthropathy of knee joint, providing good clinical outcome and improving quality of life. Patella of hemophiliac is relatively thin and osteoporotic. Patelloplasty is useful technique for handling of patella during TKA procedure for hemophiliac, with improved knee function, low and acceptable anterior knee pain rate, low reoperation rate.

Perioperative Period of a Hemophilia‐related Osteoarthropathy Therapeutic Regimen and Analysis of Complications

To investigate the effectiveness of our departments therapeutic regimen and treatment of complications during the perioperative period of hemophilia‐related osteoarthropathy.

A Case of Implant Migration Following Bi-level Cervical Disc Arthroplasty

To the Editor: A 48‐year‐old female underwent C4/5 and C5/6 Bryan cervical disc arthroplasty 3 years earlier for right shoulder pain and right arm numbness and weakness. The symptoms resolved postoperatively, and the location of the implant was good 6 weeks after the surgery; however, the range of motion (ROM) of the C4/5 and C5/6 implant were only 1° and 4°, respectively. The patient complained of the right shoulder pain and swallowing difficulty 10 months postoperatively. She experienced no neurological symptoms, and physical examination revealed no abnormal findings. Her symptoms progressively deteriorated, and she began to have difficulty of swallowing solid food. Thirteen months after the surgery, anteroposterior and lateral radiographs showed anterior migration of the C4/5 and C5/6 implants [Figure 1]. Preoperative serum procalcitonin, erythrocyte sedimentation rate, and C‐reactive protein levels were normal. Cervical computed tomography revealed that the C4/5 and C5/6 implants had subsided into the adjacent vertebral endplates. Contrast esophagography suggested that the C5/6 implant contacted, but was not compressing, the posterior esophageal wall. Cervical magnetic resonance imaging demonstrated no spinal cord compression. The chosen surgical procedure was corpectomy of the C5 vertebral body, and autogenous iliac bone graft fusion, revealing that both the C4/5 and C5/6 implants were deformed. There was no bony ingrowth between the C5/6 implant and the adjacent vertebral endplate. Bacterial culture of the resected tissue was negative.

Efficacy of a modified coagulation factor substitution for total hip arthroplasty in patients with end-stage haemophilic arthropathy.

Total hip arthroplasty (THA) is an effective treatment for end-stage haemophilic arthropathy, and substitution therapy plays a key role in the success of THA. The aim of this study was to evaluate the efficacy of a modified coagulation factor substitution regime in THA. Nineteen haemophiliac patients (20 hips) who received primary cementless THA were enrolled. Based on World Federation of Haemophilia (WFH) guideline, a modified coagulation factor substitution regime was adopted. Blood loss, implant survival rates and complications were reviewed, retrospectively. The mean age at surgery was 29.7 years (15–49 years) and the mean follow-up period was 91 months (43–151 months). Mean total blood loss, external blood loss and hidden blood loss were 3543 (1494–7576), 1435 (600–3440), and 2110 ml (534–4402), respectively. Mean intraoperative blood loss and postoperative drainage were 715 (300–2000) and 713 ml (200–2950), respectively. Mean red blood cell transfusion used was 5 U (0–14). All prostheses were found to have bony ingrowth. One patient had hematoma formation in the thigh and one with a lower limb deep vein thrombosis, postoperatively. Other complications included one skin ulcer, one femur splitting fracture, and one transient neuropraxia. Intraoperative blood loss and wound drainage, in our study, were similar to that in haemophiliac patients and nonhaemophilic patients in literature. This supports the efficacy of the modified coagulation factor substitution strategy in our study.

Common complications after arthroplasty in patients with haemophilia – a Chinese experience

with substantial risk of miscarriage, intrauterine growth retardation (IUGR) and premature delivery and should be done only by experienced hands. In an evaluation of data from all over the world of survival rates in multifoetal reduction, a lower survival rate has been reported in case of higher order multiple pregnancies as compared to lower order pregnancies i.e. up to quadruplets [7]. The present case illustrates the feasibility of antenatal diagnosis in the first trimester of pregnancy in genetic disorders like haemophilia, even in carriers with multifoetal pregnancies. In developing countries, funds for management of patients with haemophilia are often unavailable; hence counselling, prenatal diagnosis and possible termination of pregnancy remain important management options. With the advent of technical expertise for preconception prenatal diagnosis and ART [8,9], the argument of not having recourse to abortion in families belonging to certain religious groups can also be properly addressed.

Surgical management of hemophilic pseudotumor complicated by destructive osteoarthropathy

Hemophilic pseudotumor gradually erodes bone and induces fracture or deformity, causing joint dysfunction or destructive osteoarthropathy. Reports about surgery for hemophilic pseudotumor complicated by destructive osteoarthropathy are scarce. The object of this study was to evaluate the results and complications of surgical management for patients of pseudotumor complicated by destructive osteoarthropathy. We retrospectively reviewed records from July 1996 to July 2013, and found eight patients with pseudotumor complicated by destructive osteoarthropathy. We recorded their demographic data, time of surgery, amount of blood loss and transfusion, bone union, and complications. Seven patients were diagnosed with hemophilia A and one with hemophilia B. The mean age at surgery was 31.9 ± 8.3 years. Two of the eight underwent excision of the pseudotumor and metallic fixation, one had amputation, and five underwent autogenous or exogenous bone grafting and fixation with an absorbable screw. The median operating time was 170 min (135–315 min). The median amount of intraoperative blood loss was 1350 ml (100–4000 ml). The amount of red blood cells, plasma, and whole blood transfusion after surgery were 0–24 units, 0–2000 ml, and 0–4600 ml, respectively. After a median follow-up of 75 months, the numbers of pseudotumor recurrence, fracture nonunion, coagulation factor inhibitor formation, and wound complications were one, one, two, and four, respectively. Surgery is an effective treatment for hemophilic pseudotumor complicated by destructive osteoarthropathy. However, the incidences of wound infection, coagulation factor inhibitor formation, hemophilic pseudotumor recurrence, and fracture nonunion are high.

Simultaneous bilateral total knee arthroplasty in patients with end-stage hemophilic arthropathy: a mean follow-up of 6 years

To investigate the safety, cost-effectiveness, and clinical outcomes of simultaneous bilateral total knee arthroplasty (TKA) in hemophilic arthropathy (HA), the requirements for transfusions, complications, costs, hospital stays, Hospital for Special Surgery (HSS) knee scores, knee range of motion (ROM) and revision rates were compared between simultaneous bilateral and unilateral TKA in HA patients. A total of 36 patients and 54 knees were included. Compared to the unilateral group, the bilateral group did not require more transfusions (2.39 ± 3.13 vs 0.83 ± 1.38 units of RBCs, p > 0.05) or consumption of coagulation factors (50091.67 ± 25168.5 vs 46477.78 ± 11348.32 IU, p > 0.05), complications rate (13/36 vs 6/18, p > 0.05), hospital stay (32.39 ± 19.77 vs 29.11 ± 12.67 days, p > 0.05), or costs excluding prostheses (14945.41 ± 6634.35 vs 14742.12 ± 5746.78 US dollars, p > 0.05). Additionally, the two groups exhibited similar medium-term knee HSS scores (83.67 ± 7.11 vs 81.00 ± 10.35, p > 0.05) and ROM (89.39° ± 13.66° vs 88.91° ± 12.90°, p > 0.05). Our data indicate that bilateral TKA is a safe and cost-effective treatment for HA with similar medium-term results compared to unilateral TKA.

Roles and mechanisms of leptin in osteogenic stimulation in cervical ossification of the posterior longitudinal ligament

BackgroundHyperleptinemia is a common feature of obese people, and leptin, an adipocyte-derived cytokine, is believed to be an important factor in the pathogenesis of cervical ossification of the posterior longitudinal ligament(C-OPLL). So this research was to identify the relation between the serum leptin and bone metabolic markers and how the leptin induced osteogenic effect in C-OPLL.MethodsSixty-four samples were selected to determine the concentration of leptin, insulin, and alkaline phosphatase. And the association of leptin with these factors was also examined. We also evaluate the effect of leptin on the development of C-OPLL and further explored the possible underlying mechanism in vitro.ResultsWe found that serum leptin concentrations were higher in females than in males. Serum leptin and ALP concentrations were increased significantly in C-OPLL females compared to non-OPLL females. In OPLL subjects, the serum leptin concentration corrected for body mass index correlated negatively with the ALP concentrations. In C-OPLL cells, leptin treatment led to a significant increase in mRNA expressions of ALP and OCN and formation of mineralized nodule. Our experiments reported here that osteogenic effect of leptin in C-OPLL cells could be mediated via ERK1/2, p38 MAPK, and/or JNK signaling pathways.ConclusionsFrom this research, we got that leptin treatment led to a significant increase in mRNA expressions of ALP and OCN and formation of mineralized nodule. And the osteogenic effect of leptin in C-OPLL cells could be mediated via ERK1/2, p38 MAPK, and/or JNK signaling pathways.

Total Hip Arthroplasty in Hemophilia Patients: A Mid-term to Long-term Follow-up: THA in Hemophilia Patients

To report the results of mid‐term to long‐term follow‐up after primary total hip arthroplasty (THA) in hemophiliacs and to hypothesize that THA can provide satisfactory outcomes in these patients.

Surgical treatment of a giant iliopsoas haemophilic pseudotumour with adjacent structure compressions: A case report

Haemophilia A is an Xlinked recessive congenital bleeding disorder characterized by the absence or decrease in factor VIII (FVIII) procoagulant function. About onethird of the cases present new mutations and are devoid of previous family medical history of haemophilia,1 which causes a diagnostic challenge. The majority of bleeding episodes in haemophilic patients occur within the musculoskeletal system, mainly in the joints. However, approximately 30% occurrence involved the muscles, especially in muscles with a rich blood supply.2,3 Iliopsoas muscle bleeding episodes are not rare, accounting for 0.3%13% in moderate or severe cases.4 Iliopsoas haemorrhage, whether spontaneous or traumatic, is often large in volume and may cause series of complications, including the ultimate formation of pseudotumour (1%2% incidence in individuals with severe FVIII deficiency).5 Haemophilic pseudotumour is also called haemophilic cyst, characterized by an encapsulated and slowly expanding haematoma which may enlarge progressively and become life threatening to the affected individuals.6 Current therapeutic alternatives for this entity include: factor replacement therapy, surgical removal, arterial embolization and radiotherapy.7 The present case report describes a male patient with haemophilia A who had a giant iliopsoas pseudotumour causing obvious compression of blood vessels and other adjacent structures. He was successfully administrated with surgical drainage and resection. A Chinese male patient, 34 years old, was diagnosed with haemophilia A at the age of two due to continuous bleeding upon trauma. Family history was noncontributory. The patient was then treated with multiple infusions of coagulation FVIII. After many years of unremarkable history, a sudden and severe right abdomen pain occurred 3 years ago with no clear trigger. FVIII activity was measured to be <0.1% and the pain could be relieved upon infusion of 1000 U coagulation FVIII. Two years ago, the patient felt a tennis ballsized soft mass with fluctuation in his right side of the abdomen. The mass increased gradually although the patient was put on regular haemostatic supports (infusion of 1000 U coagulation FVIII every 10 days). On 26 December 2013, the patient was admitted to our hospital due to the continuous enlargement of the mass. Physical examination on admission showed a soft mass about 20×20×10 cm over the right side of the abdomen (Figure 1), which was distended, painful on palpation. The maximum flexion of right hip joint was 90°. Consequently, the movement of the right lower extremity was limited. The analytical report presented a haematocrit of 31.5%, with a haemoglobin of 10.3 g/ dL, leucocytes 9530/μL (73.2% neutrophils), platelets 415 000/μL, activated partial thromboplastin time (APTT) 59.9 s, PT 13 s. FVIII analysis revealed 14% of normal activity. Despite previous FVIII transfusions, his FVIII inhibitor level was 0. An ultrasound scan performed on the patient revealed mixed echoes extending from posterior axillary line to across the axillary line to the front, and from the subhepatic area to the groin. The Color Doppler Flow Imaging (CDFI) showed blood stream signals, indicating that haematoma should be first considered. CT scan and reconstruction consistently showed a 19.6×21 cm haematoma with irregular borders, partial calcification and mixed densities areas, displacing the right kidney as well as the right renal vessels upwards and causing deviation of the right iliac vessels towards the left side of the pelvis (Figure 2). No definite feeding artery to the mass was identified by Computed tomography angiography (CTA), precluding the use of preoperative embolization. It appeared certain that the mass would continue to enlarge and would eventually cause blood vessel erosion resulting in a fatal haemorrhage. The surgical indication is clear, but the risks were deemed excessive. The patient was offered the option of surgical excision and counselled about the potential risks of damages to vessels and ureter. Immediately prior to surgery, the patient received an intravenous infusion of FVIII at a dose of 3600 IU for his weight of 75 kg. The operation began with an incision from the twelfth rib to the pubis through the abdominal wall to view the purplish hypertonic pseudotumour whose surface was intimately attached to adjacent tissues and took on onion skin appearance. A 5 cm incision was made into the pseudotumour, followed by drainage of 4600 mL coffeecoloured haemorrhagic