BackgroundTo analyze the cost-effective ratio of total knee arthroplasty (TKA) in the osteoarthritis (OA) treatment of at a regional medical center in China.MethodsOne hundred thirty-nine patients with osteoarthritis who underwent TKA at the Department of Osteoarthritis in Luhe hospital (Tongzhou, Beijing) from January 2011 to January 2012 were followed up. Their health-related quality of life (HRQoL) was evaluated using Short-Form Health Survey (SF) -36 Chinese version, and compared with those of the normal population to assess quality-adjusted life years (QALYs) gained after surgery for its effectiveness of the treatment. The total expense was the cost of patient hospitalization. The cost per QALY was calculated. The cost-benefit ratio (CBR) was expressed as a ratio of each QALY’s expenditure to per capita gross domestic product (GDP). Factors affecting the cost, including age, gender, length of stay, and ICU experience, were also considered.ResultsThe total hospitalization fee was Ұ8,053,736.68, Ұ57,940.55 in average, of which, 81.59% constituted out-of-pocket expenses. The SF-36 scores were as follows: Physical Function: 25.14, Role Physical: 7.12, Bodily Pain: 9.60, Role emotional: 5.58, Vitality: 19.9, Mental Health: 25.84, Social Function: 9.86 and General Health: 21.15. Compared with normal people of the same age and sex, a total of Ұ2487.74 QALYs and Ұ3237.37/QALY were gained, 10% less than the regional GDP per capita. The cost-effective ratio of TKA for osteoarthritis in China was 1: 10.78. The main cost of the patient was the cost of prosthesis (61.78%). The average cost afforded by patients’ themselves was Ұ47,242.64 after the deduction of government subsidies. There were Ұ31,306.64 difference compared with the annual average income of the local people. The cost might be affected by length of stay and ICU experience. Longer stay caused more cost of treatment. Patients who remained in ICU after surgery had higher overall costs and blood transfusion costs.ConclusionThe factors that affect TKA cost are hospital and postsurgical ICU stay. It is cost-effective for regional medical care center to treat osteoarthritis using TKA economically. However, considering the average income of patients in the area, it is necessary to reduce the cost of the treatment.Electronic supplementary materialThe online version of this article (10.1186/s13561-019-0231-0) contains supplementary material, which is available to authorized users.

Objective To evaluate the effect of hip arthroscopy with or without capsular closure in femoracetabular impingement (FAI) by meta‐analysis. Methods Pertinent studies were identified by searching Pubmed, EMBASE databases with the last search update on 16 February 2020. Studies that reported hip arthroscopy for FAI were collected. Meta‐analysis was performed by the use of Review Manager 5.3 software. The odds ratios (OR) and mean differences (MD) were used to compare dichotomous and continuous variables. Additionally, the I2 was used to assess heterogeneity among studies, and the fixed‐effects model or the random‐effects model was selected for the quantitative analysis. Outcomes were evaluated by forest plots. For statistical analysis, P < 0.05 was considered significant. Results There was no significant difference among the preoperative mHHS (MD = –2.66，95% CI [−7.25, 1.92], I2 = 80%, P = 0.25), preoperative (MD = ‐4.94, 95% CI [−11.56, 1.67], I2 = 50%, P = 0.14) and postoperative HOS‐SSS (MD = ‐1.00, 95% CI [−6.98, 4.98], I2 = 66%, P = 0.74), patient satisfaction (MD = 0.03, 95% CI [−0.25, 0.31], I2 = 19%, P = 0.84; OR = 0.94, 95% CI [0.59, 1.50], I2 = 0%, P = 0.78), complications (OR = 1.23, 95%CI [0.56, 2.67], I2 = 0%, P = 0.61), revisions (OR = 1.77, 95% CI [0.87, 3.60], I2 = 36%, P = 0.11), and surgery time (SMD = –0.38, 95% CI [−1.16, 0.40], I2 = 92%, P = 0.34) between the capsule closure group and the non‐closure group. For the comparison of postoperative mHHS (MD = –2.66, 95% CI [−7.25, 1.92], I2 = 80%, P = 0.25) and HOS‐ADL (MD = ‐4.20, 95% CI [−5.75, −2.65], I2 = 24%, P < 0.00001), the score of the non‐closure group was significantly better than that of the closure group. Conclusions Remain capsule unclosed after hip arthroscopy for FAI may, to some extent, has a better postoperative functional score than the non‐closure treatment.

Objective: To investigate the manifestation, mechanisms, and treatment of isolated partial femoral avulsion fractures of the posterior cruciate ligament (PCL) in adults.Methods: From January 2011 to December 2018, we retrospectively reviewed the clinical data of three patients with isolated partial femoral avulsion fractures of the PCL who were admitted to our institution. All of these patients were admitted to our emergency department within 24 h after injury. After physical examination and radiographs were taken and reviewed, all patients were admitted and underwent surgical treatment. In a 26-yearold man who underwent arthroscopic surgery through the traditional medial and lateral approach before finally converting to open surgery with the posterior approach, the fragment that was finally removed was partially attached to the PCL. In the other two patients, women aged 63 and 68 years, who underwent arthroscopic surgery via the traditional medial and lateral approach, the fragments were large and attached to most fibers of the PCL. We fixed the fragments using hollow screws in arthroscopic view. In addition, in the 63-year-old patient, an anchor was embedded to restore the tension of the PCL. Four weeks after surgery, the patients started to wear long leg braces in full extension with the tibia blocked up by cushion. Physical examinations were conducted and radiographs were taken preoperatively and at 4 weeks and 3 months after surgery to evaluate the condition of the injury. The range of motion and the Lysholm knee scoring scale for the knee joint were compared before and after the surgery.Results: For the three patients, the radiographs taken at 3 months postoperatively showed that the fixation of the screws did not fail, and the subchondral bone was generally normal compared to the preoperative radiographs. CT scanning at 3 months after surgery showed that the fracture healed in the original position of the avulsion site. For all patients, the affected knees presented as stable at physical examination 3 months after surgery; the Lachmann test and the anterior drawer test results were negative. In addition, the flexion-extension, internal rotation, and external rotation were approximately 0 -130 , 0 -30 , and 0 -40 in the 26-year-old patient, respectively. The flexion-extension, internal rotation, and external rotation were approximately 0 -100 , 0 -20 , and 0 -35 for the 63-year-old patient, respectively. The flexion-extension, internal rotation, and external rotation were approximately 0 -100 , 0 -15 , and 0 -20 for the 68-year-old patient, respectively. There was no pain or only little pain 3 months after surgery. There was no swelling or discomfort at the 3-month follow up. The Lysholm knee scores of the 68-year-old, 63-year-old, and 26-year-old patient were 80, 87, and 95 at 3 months after surgery, respectively, which were obviously improved postoperatively. Conclusion:The manifestation of isolated partial femoral avulsion fractures of the PCL in adults is often related to the injury mechanism, and surge...