Objective This study proposes a system for classifying the aseptic loosening of distal femoral endoprostheses and discusses reconstruction methods for revision surgery, based on different classification types. Methods We retrospectively analyzed the data of patients who received revision surgery for aseptic loosening in distal femoral tumor endoprosthesis from January 2008 to December 2020 at 3 bone tumor treatment centers in China. Based on the patient imaging data, we proposed a classification system for the aseptic loosening of distal femoral endoprostheses and discussed its revision surgery strategy for various bone defects. Results A total of 31 patients were included in this study, including 21 males and 10 females aged 15–75 y (average: 44.3 y). First-revision surgery was performed on 24 patients, whereas second-revision surgery was conducted on 7 patients. The 31 patients were classified into different types based on the degree of aseptic loosening: Type I, 12 patients (38.7%); Type IIa, 7 patients (22.5%); Type IIb, 7 patients (22.5%); Type III, 4 patient (12.9%); and Type IV, 1 patient (3.2%). For type I, 11 patients underwent revisions with standard longer-stem prostheses (one with the original prosthesis), and one patient had the original prosthesis plus cortical allograft strut. For type II (a and b), 10 patients underwent revisions with original prosthesis or longer-stem prosthesis and 4 patients combined with cortical allograft strut. For type III, one patient underwent revision with a longer-stem prosthesis and the other 3 patients with a custom short-stem prosthesis. For type IV, only one patient underwent revision with a custom short-stem prosthesis. Conclusions Aseptic loosening of the distal femoral prosthesis can be divided into 4 types: type I, type II (a, b), type III and type IV. The reconstruction methods of our centers for different types of bone defects can offer some reference value in the revision of aseptic loosening.

Background Tumor prostheses of the distal femur after revision surgery is associated with high rates of aseptic loosening, which has introduced great challenges to the survival of patients, but only a few studies have evaluated their X-ray imaging. The purpose of this study was to analyze the risk factors for recurrence of aseptic loosening and make recommendations to reduce the incidence of aseptic loosening after revision surgery of tumor prostheses in the distal femur. Method A retrospective analysis was performed on 23 patients who had revision surgery for distal femur prostheses due to aseptic loosening between June 2002 and June 2021. They were divided into two groups based on the condition of the prostheses after revision surgery: loosening group (9 patients) and control group (14 patients). Following the initial replacement, the length and diameter of the prosthetic intramedullary stem were measured through the standard full-length anteroposterior X-ray imaging of both lower limbs. The osteotomy length, femoral length and diameter, femoral intramedullary stem diameter, hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and so on were measured as well. Following that, statistical analysis was performed. Results Patients in the loosening group had statistically significant differences in the ratio of prostheses length to femur length (71.89 ± 6.62) and the ratio of intramedullary stem diameter to femoral diameter (25.50 ± 6.90) (P < 0.05), when compared to the control group. The HKAA (175.58 ± 2.78), mLDFA (94.42 ± 2.57), and the deviation angle between the lower limb alignment and the tibial prostheses force line (2.23 ± 1.09) in the loosening group were significantly different from those in the control group (P < 0.05) on postoperative radiographs of the entire length of the lower limbs. The lowest score in intramedullary manubrium I indicated less osteolysis, while the highest score in intramedullary manubrium III indicated the most serious osteolysis, and the difference was statistically significant (P < 0.05). Conclusions Our study suggests that the use of longer and thicker intramedullary stems can effectively decrease the occurrence of aseptic loosening. Additionally, it is important to avoid using the original prostheses and reconstruct the standard line of lower limb force to further reduce the incidence of aseptic loosening. It is crucial to closely monitor the distal segment of the intramedullary stem for osteolysis after surgery.

Objective This study proposes a system for classifying the aseptic loosening of distal femoral prostheses and discusses reconstruction methods for revision surgery, based on different classification types. Methods We retrospectively analyzed the data of patients who received revision surgery for aseptic loosening in distal femoral tumor endoprosthesis from January 2008 to December 2018 at 3 bone tumor treatment centers in China. On the basis of the patient imaging data, we proposed a classification system for the aseptic loosening of distal femoral endoprostheses and discussed its revision surgery strategy for various bone defects. Results A total of 29 patients were included in this study, including 20 males and 9 females aged 15–64 y (average: 43.2 y). First-revision surgery was performed on 25 patients, whereas second-revision surgery was conducted on 4 patients. The 29 patients were classified into different types based on the degree of aseptic loosening: Type Ia, 5 patients (17.2%); Type Ib, 7 patients (24.1%); Type IIa, 9 patients (31.0%); Type IIb, 7 patients (24.1%); and Type IIIb, 1 patient (3.4%). Four Type Ia patients used the longer-stem rotating hinge prosthesis, and 1 Type Ia patient used the original prosthesis. Six Type Ib patients used a longer-stem rotating hinge, and 1 Type Ib patient used the original prosthesis plus bone grafting with an allograft bone plate for revision. Eight Type IIa patients underwent revision with a longer-stem rotating hinge prosthesis, and 1 Type IIa patient received revision surgery with the original prosthesis plus bone grafting with an allograft bone plate. Meanwhile, 5 Type IIb and 1 Type IIIb patients used a longer-stem rotating hinge prosthesis, and 2 Type IIb patients used the original prosthesis for revision. Conclusions Aseptic loosening of the distal femoral prosthesis can be divided into 4 types and 8 subtypes. Different types of bone defect can be repaired with the appropriate reconstruction.

BackgroundWe compared the effects of two surgical procedures on limb function and quality of life in patients with osteosarcoma in the knee.MethodsThis retrospective study evaluated the postoperative outcomes of patients treated with JPLS and JPRS for osteosarcoma around the knee between November 2000 and December 2019. All patients were followed up for at least one year. Patients' lower extremity function, knee function, and quality of life were evaluated during follow-up using the MSTS score, IKDC score, and SF-36 score.ResultsAll 38 patients received a successful operation, and all incisions healed in one stage after surgery. At 12 months after the operation, the MSTS score in the prosthetic-replacement group (22.79±5.22) was lower than that in the joint-preservation group (27.05±1.62)(P=0.002). The IKDC score was lower in the prosthetic-replacement group (59.89±11.22) than in the joint-preservation group (76.84±9.42)( P <0.001). After 12 months, the SF-36 scores of physiological and social function in the joint-preserving group were higher than those in the prosthetic-replacement group (P <0.05), and there were no significant differences among the other indexes (P >0.05). Comparing the distribution of each item in the MSTS and IKDC scoring criteria between the joint-preservation and the prosthetic-replacement group revealed that the limb function, pain, satisfaction, support assistance, and the walking and gait of the joint preservation group were superior to those of the prosthetic-replacement group (P < 0.05). There was no significant difference in knee flexion between the two groups (P > 0.05). However, the joint preservation group was superior to the prosthesis replacement group in terms of pain, swelling, twisting, softening of the leg, movement downstairs, sitting up from a chair, kneeling, squatting, running straight forward, jumping up with the injured leg and landing, and quickly stopping or starting (P < 0.05).ConclusionCompared with joint-prosthesis replacement surgery, joint-preservation limb salvage leads to better joint function and quality of life. To improve the limb function and quality of life of patients with long-term survival osteosarcoma, joint-preservation limb salvage should be carried out according to the principles of Operation Indication, neoadjuvant and effective chemotherapy.

Background: This study aimed to observe the clinical effects of Xiao-xian decoction combined with acupoint application therapy (AAT) for treating pediatric adenoid hypertrophy (AH). Methods: We randomly divided 93 AH children into 3 groups: AAT alone; Xiao-xian decoction + AAT; control: Montelukast oral therapy. All participants were treated for a month. We used the traditional Chinese medicine syndrome score to evaluate the clinical efficacy and the obstructive sleep apnea-18 scale to evaluate the quality of life. Results: The major symptoms (nasal congestion, open mouth breathing, snoring, and tongue image) and secondary symptoms of patients treated with Xiao-xian decoction + AAT significantly improved compared to before treatment. The pairwise comparison between groups showed that snoring, tongue, secondary symptoms, and total effective rate of the combined treatment group were better than the control and AAT alone. Additionally, the open-mouth breathing, quality of life, and recurrence rate did not differ after treatment. Conclusion: Oral Xiao-xian decoction combined with AAT significantly improved the symptoms and signs of nasal congestion, open-mouth breathing, snoring, tongue, and quality of life of AH children and may be used as a long-term treatment for AH.