Comparison of the status of STAT4 tyrosine phosphorylation in peripheral T-lymphocytes induced by IL-12 in rheumatoid arthritis and osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To compare the levels of STAT4 tyrosine phosphorylation in peripheral T-lymphocytes induced by IL-12 in rheumatoid arthritis (RA) and osteoarthritis (OA).</p><p><b>METHODS</b>From May 2007 to August 2009, peripheral blood mononuclear cells (PBMCs) were isolated from RA patients [RA group, all the cases were female, the age was from 28 to 55 years with an average of (45.0 +/- 13.0) years] and OA patients [OA group, all the cases also were female; the age was from 55 to 75 years with an average of (67.0 +/- 9.6) years]. The purity of T-lymphocytes from PBMCs was accredited by flow cytometry. The IL-12 of 50 ng/ml added in T-lymphocytes, the levels of STAT4 tyrosine phosphorylation were detected by western blot after different time intervals (0, 10, 30, 60 min).</p><p><b>RESULTS</b>The purity of T-lymphocytes were above 91% through diremption and depuration for peripheral blood monouclear cells. The levels of STAT4 tyrosine phosphorylation in T-lymphocytes from RA induced by IL-12 were higher than that from OA in the different times (10, 30, 60 min); after 30 min, its levels from RA and OA achieved to crest value.</p><p><b>CONCLUSION</b>STAT4 in peripheral T-lymphocytes of rheumatoid arthritis was more easily to be activated than osteoarthritis.</p>

Medium and long-term clinical results of using Zweymüller cup to treat protrusio acetabuli / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss long-term clinical results of using Zweymüller cup to treat protrusio acetabuli.</p><p><b>METHODS</b>From May 1998 to September 2006, 31 patients with 39 hips diagnosed protrusio acetabuli were treated with Zweymüller cup in total hip arthroplasties or revisions. There were 12 men and 19 women with average age of 57.6 years (from 30 to 82 years). The reasons causing protrusio acetabuli were as followed: rheumatoid arthritis 3 cases 6 hips, osteoarthritis followed femoral head necrosis 7 cases 12 hips, acetabular wear after hemi-arthroplasty 11 cases 11 hips and acetabular component loosening 10 cases 10 hips. During all operations, Zweymüller cup was used to fix the acetabular part.</p><p><b>RESULTS</b>All cases were followed up 6 months and one year after operations. Two patients with 3 hips were died for lung cancer and acute myocardial infarction respectively. Twenty-four cases with 31 hips got recent follow-up with average 7.4 years (from 5.0 to 11.5 years). The average Harris score improved from 31.0 (from 14 to 61) preoperatively to 84.7 (from 70 to 95) postoperatively. There was one infection in right hip after bilateral hip arthroplasty treating by removal prosthesis and cement spacer insert. But until now this patient still did not get revision for her internal medicine. One rheumatoid arthritis patient with two-stage bilateral hip arthroplasty was found slight internal migration and loosening line of left acetabular component, but the patient had no pain with good hip function. All other cases had good hip functions and were very satisfied with clinical results.</p><p><b>CONCLUSION</b>Using Zweymüller cup to treat protrusion acetabuli can get strong fixations and perfect medium and long-term clinical results for over 7.4 years.</p>

Effects of primary deep venous valvular incompetence of lower limb in deep vein thrombus after total knee replacement / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of primary deep venous valvular incompetence of lower limb (PDVI) to the occurrence of deep vein thrombosis (DVT) after human total knee replacement (TKR).</p><p><b>METHODS</b>One hundred and twenty-six patients who planed to receive TKR were examined by color doppler flow imaging (CDFI). The patients were divided into 2 groups depending on whether they were found backstreaming in femoral vein or not. When the refluxing time > 1 s, the patients were included in PDVI group; When the refluxing time < or = 1 s, the patients were included in without PDVI group. In 7 d after operation all the patients were re-examined by CDFI to find if there was DVT. The results were tested by chi2 statistical analysis.</p><p><b>RESULTS</b>Among the 126 patients, 54 had PDVI, and 72 without PDVI. Fifty patients had DVT, total incidence rate 39.7% (50/126). In PDVI group 33 patients had DVT (61.1%, 33/54); In without PDVI group 17 patients had DVT (23.6%, 17/72), which was lower than PDVI group (chi2 = 21.227, P < 0.05).</p><p><b>CONCLUSIONS</b>PDVI may be a risk for occurrence of DVT after TKR.</p>

Total knee arthroplasty in Charcot arthritis patients / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the results of total knee arthroplasty undertaken for Charcot arthritis patients.</p><p><b>METHODS</b>Between September 2000 and January 2007, 4 consecutive patients (2 men and 2 women; 5 TKAs) with Charcot arthritic knees were treated. At the time of surgery, the mean age of the patients was 67.3 years (64 to 72 years). One had bilateral and 2 had unilateral TKA and one had ipsilateral total hip and total knee arthroplasty. The mean knee society score before operation was 33.75 points.</p><p><b>RESULTS</b>The mean follow-up was 65 months (19 to 96 months). The mean knee society score post-operation had improved to 95.25 points in 5 TKAs with no occurrence of infection and loosening. All 4 patients were very satisfactory with the clinical results at the last follow-up.</p><p><b>CONCLUSIONS</b>The midterm follow-up data indicated that total knee arthroplasty to treat Charcot arthritis could get good clinical results. The postoperative results in Charcot arthritis were closed related with the proper prosthesis and surgical technique.</p>

Total knee arthroplasty for extension ankylosing deformity / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the outcomes and complications of total knee arthroplasty (TKA) for extension ankylosing deformity of the knee.</p><p><b>METHODS</b>From January 1996 to June 2006, total knee arthroplasty was performed on 8 patients (9 knees) with extension ankylosing deformity. The preoperative ROM of all patients was 0 degrees . Preoperative knee and function score of KSS were 44 points (from 10 to 68) and 17 points (from -10 to 55) respectively.</p><p><b>RESULTS</b>The complications of all TKAs included patellar tendon avulsion in 1 knee, partial fracture of inferior patella in 1 knee, hematoma in 1, superficial infection in 1. All patients were followed up for an average of 40.4 months (from 7.0 to 120.0). The average postoperative ROM was 89 degrees (from 50 degrees to 120 degrees ). Postoperative knee and function score of KSS were 81 points (from 55 to 93) and 79 points (from 50 to 90) respectively. Extension lag occurred in 2 knees, one was 10 degrees and the other was 25 degrees . One knee had undergone re-revision of changing the thicker tibial spacer for the reason of instability of joint 1 year after revision.</p><p><b>CONCLUSIONS</b>TKA performed in extension ankylosing deformity can get less satisfactory clinical results comparing with fixed flexion deformity. Exposure of the knee joint and separation of the fused bones, providing a mobile joint space plays crucial procedure for the next step of surgery. Preservation of sufficient bone stock of patella, protection of patellar tendon and blood supply of the knee and proper soft tissue balance are the key to TKA for extension ankylosing deformity.</p>

Total knee arthroplasty and perioperative management of hemophilic arthritis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical results and perioperative management of primary total knee arthroplasty (TKA) in hemophilic patients.</p><p><b>METHODS</b>From February 1997 to February 2006, the data of 6 total knee arthroplasty performed in 4 hemophilic patients was reviewed retrospectively. The values of coagulation factor were maintained at suitable level by monitoring the activity of the factors and their inhibitors during perioperative period. The mean follow-up time was 4.4 years, knee society score and the last postoperative radiographs were recorded.</p><p><b>RESULTS</b>After TKA, the hemophilic patients felt pain of knee relieved, the knee function was improved, but the range of motion increased limitedly. At the early post-operative stage, 3 knees in 2 patients with hemarthrosis or muscle bleeding, 1 of the 2 patients complicated with formation of inhibitor of factor VIII and healing problem in 1 knee after TKA, 1 patient with transient paralysis of the common peroneal nerve, 1 patient with venous circulation insufficiency crisis, but no compartment syndrome. In the late stage after TKA, 1 patient with hemarthrosis of both elbows, but no late infection, loosening, displacement and fracture of the prosthesis in the 6 knees.</p><p><b>CONCLUSIONS</b>Total knee arthroplasty could alleviate knee pain and improve joint function in advanced severe hemophilic arthritic patients. It is important to monitor the activity and inhibitors of coagulation factor VIII or IX, which could decrease the early and late postoperative complications.</p>

The second stage revision for infected total hip arthroplasty using antibiotic-loaded cement prosthesis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of two-stage revision for infected total hip arthroplasty (THA) using antibiotic-loaded cement prosthesis.</p><p><b>METHODS</b>From June 1999 to October 2004, 14 patients who admitted for infected primary total hip arthroplasty surgeries were performed revision surgery with antibiotic-loaded cement prosthesis in two-stage. The mean Harris score of pre-operation was 23. In the first stage operation, the following steps were performed, complete debridement, removal of infected prosthesis, implantation of cement spacer with antibiotics, treatment involved concomitant administration of 3 weeks of intravenous (IV) and 1 month of oral. After 6 months, antibiotic-loaded prosthesis was implanted in the second stage.</p><p><b>RESULTS</b>The mean follow-up was 18 months (7 - 26 months), no recurrent infection occurred in all 14 patients. The mean post-operation Harris score was 70.</p><p><b>CONCLUSIONS</b>The success of the protocol to control the delayed infection after THA are complete debridement, enough interval and using antibiotic-loaded cement prosthesis in two stage revision.</p>

Influence of preoperative range of motion on the early clinical outcome of total knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To retrospectively analyze the influence of preoperative range of motion (ROM) and maximal flexion degree on the early clinical outcome of total knee arthroplasty (TKA).</p><p><b>METHODS</b>From January 2000 to December 2003, 97 knees of 65 patients that were underwent total knee arthroplasty with Scorpio posterior-stabilized knee prosthesis were reviewed. There were 55 osteoarthritis patients (81 knees), and 10 rheumatoid arthritis (16 knees). Thirty-three patients were underwent unilateral TKA, 32 patients were underwent bilateral TKA. According to the preoperative ROM of knee, these patients were divided into two groups, one <or= 90 degrees (range, 5 degrees - 90 degrees ) and the other > 90 degrees (range, 95 degrees - 140 degrees ). Finally the clinical outcomes of two groups (include ROM, maximal flexion degree, KSS score and function score) were evaluated. Three days later after operation, continuous passive motion (CPM) and active functional exercise of the knee were begun, and the wound healed well in all patients. All these operations were primary total knee arthroplasty.</p><p><b>RESULTS</b>The patients were followed up for average 2 years 5 months (range, 10 months to 3 years 8 months). The average ROM of knee was improved to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation from 84.2 degrees (range, 5 degrees - 140 degrees ) before operation (P = 0.000); the average maximal flexion degree was decreased from 103.5 degrees (range, 25 degrees - 140 degrees ) before operation to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation (P = 0.439); KSS of knee joint was improved to 78.8 points after operation (range, 50 - 95 points) from 19.5 points (-24 - 62 points) before operation (P = 0.000). There was statistically difference between the clinical outcomes (ROM, maximal flexion degree, KSS score and function score) in the two groups before and after operation. Those knees with good preoperative ROM tend to lose flexion, while those with poor preoperative ROM gain flexion after TKA. No revision and deep infection happened.</p><p><b>CONCLUSIONS</b>TKA is a complex operation, the clinical outcome of TKA is mainly determined by the good operation skill, abundant clinical experience and the familiarity with the prosthesis of the surgeon. At the same conditions such as same surgeon, same prosthesis and same physical therapy, preoperative range of motion of knee influence on the early clinical outcome of total knee arthroplasty, knees that have good preoperative ROM have better clinical outcomes postoperatively than those with poor preoperative ROM.</p>

Total knee replacement in valgus knee / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the methods and clinical results of total knee replacement (TKA) in patients with valgus knee deformity.</p><p><b>METHODS</b>Between January 1996 and August 2004, 87 TKAs were performed by means of medial parapatellar approach, standard osteotomy and only lateral soft tissue release with posterior stabilized implants on 74 patients (11 men and 63 women) with valgus deformity. The average age at the time of operation was 62.93 years (range, 26-80 years). Clinical and radiographic evaluations including range of motion (ROM), Knee Society Score System (KSS) and the tibial and femur angle (T-F angle) were performed at follow-up.</p><p><b>RESULTS</b>After a mean follow-up of 33.8 months (range, 5 months-9 years), the average ROM improved from 91 degrees (range, 70 degrees-120 degrees) preoperatively to 112.4 degrees (range, 80 degrees-130 degrees) postoperatively, the average KSS improved from 22.7 points (0-48 points) preoperatively to 81.7 points (range, 71-93 points) postoperatively. The average function score improved from 26.5 points preoperatively to 86.3 points postoperatively, the average T-F angle was corrected from 21.59 degrees (range, 12 degrees-40 degrees) of valgus preoperatively to 8.7 degrees (0 degrees-11 degrees) of valgus postoperatively. One knee had lightly instability at follow-up, one knee with patellar dislocation preoperatively had subdislocation postoperatively, no other complication occurred.</p><p><b>CONCLUSIONS</b>The techniques of medial parapatellar approach, standard osteotomy and only lateral soft tissue release with posterior stabilized implants can correct a fixed valgus deformity very successfully in patients undergoing primary total knee replacement, and provides excellent results.</p>

Clinical risk factors for deep vein thrombosis after total hip and knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical risk factors for deep vein thrombosis (DVT) after total hip and knee arthroplasty in Chinese patients who received prophylactic treatment for DVT.</p><p><b>METHODS</b>We evaluated 128 total hip arthroplasty (THA) and total knee arthroplasty (TKA) in 95 patients performed at our center from April 2004 to August 2004, which included 48 THAs in 43 patients and 80 TKAs in 52 patients. There were 27 men and 68 women with a mean age of 59.77 years (range, 23-78 years). All patients had been given low-molecular-weight heparin before operation and for 7-10 days post-operation to prevent DVT. Color Doppler ultrasonography was used to detect DVT of bilateral lower extremities in all patients before operation and at 7-10 days after operation. Nineteen clinical factors were examined preoperation and 7-10 days post-operation in order to analyze their influences on DVT formation after surgery.</p><p><b>RESULTS</b>There were 45 patients who developed DVT after operation. The incidence of DVT in all patients was 47.4% (45/95) and the incidence of proximal DVT was 3.2%. There were more asymptomatic DVT (57.8%, 26/45) than symptomatic ones, and some patients without DVT (14%, 7/50) presented some of the DVT symptoms. Logistic regression analysis demonstrated a definite association of female, obesity (representative by BMI), cement usage and diagnosed RA with DVT with odds ratio of 10.008, 3.094, 8.887, and 0.194 respectively. Other clinical factors had no statistically significant association with DVT.</p><p><b>CONCLUSIONS</b>Female, obesity, and cement usage were the risk factors for DVT after THA and TKA, and diagnosed RA was the protecting factors for DVT after THA and TKA. Other clinical factors such as age, OA, type of implant, monolateral or bilateral operation, duration of anesthesia, surgery and bandage usage for blood control, time for immobilization et al were not the risk factors for DVT.</p>

Revision hip arthroplasty with the cementless prosthesis: 4 years follow-up study / 中华外科杂志

<p><b>OBJECTIVE</b>To examine the two to eight-year results associated with the use of this hip system.</p><p><b>METHODS</b>Between November 1996 and January 2001, 56 revision total hip arthroplasties with insertion of a Zweymüller BICON-PLUS cup and a cementless SLR-PLUS stem were performed in 55 consecutive patients (average age, fifty-nine years old, range, thirty to eighty years old).</p><p><b>RESULTS</b>At the time of the latest follow-up, 23 patients (24 hips) had lost to follow-up, leaving 32 patients for a minimum of 2 years of clinical and radiographical follow-up. The mean follow-up time was 4 years. Only 3 peri-operative complications occurred, including 1 great trochanter fracture during implant removal, 1 dislocation 2 d after operation with successful closed reduction, and 1 deep wound infection which necessitated reentry and debridement. No femoral stems or cups needed re-revision surgery. The average Harris hip score increased from 40.6 points preoperatively to 80.4 points at final follow-up. Radiographic analysis demonstrated that the position of stems and cups was unchanged and all showed radiographic evidence of bone ingrowth.</p><p><b>CONCLUSION</b>The favourable medium-term clinical results with the cementless Zweymüller hip system show that it is suitable as a revision system for total hip failures of both cemented and cementless primary fixation.</p>

Significance and role of increased expression of extracellular matrix metalloproteinase induced in the aseptic loosening of prostheses / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of extracellular matrix metalloproteinase induced (EMMPRIN) in the interface tissue, and explore the role of EMMPRIN in the aseptic loosening of prostheses.</p><p><b>METHODS</b>Immunohistochemistry was performed to characterize the EMMPRIN-expressing cells at sites of interface tissue around aseptic loosened hip prostheses in 16 cases. Reverse transcription-polymerase chain reaction (RT-PCR) was performed to study the existence of EMMPRIN mRNA in interface tissue samples. And it was followed up by computer assisted image analysis in order to detect the A values of their expression. Synovium of hip joint of 8 femoral neck fracture were in control group.</p><p><b>RESULTS</b>Strong immunostaining of EMMPRIN was found in the macrophages and fibroblasts of lining-like layers and vascular endothelium of synovial membrane-like interface tissue around loosened prostheses. Expression of EMMPRIN was significantly higher in interface tissue than the control synovium (z=-3.252, P=0.001). RT-PCR of interface tissue samples disclosed the presence of EMMPRIN mRNA of 14 cases. In interface tissue, the A value of EMMPRIN increased significantly compared to control synovium (P<0.01).</p><p><b>CONCLUSION</b>Over-expression of EMMPRIN up-regulates the production of matrix metalloproteinase (MMPs) in the interface tissue. And it can promote the bone destruction around prostheses. Thereby it may be one of methods to prevent and treat aseptic loosening of prostheses by repression the biology activity of EMMPRIN.</p>

Early diagnosis and treatment of pulmonary embolism after total joint replacement: report of five cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the early diagnosis and treatment of pulmonary embolism (PE) after total joint replacement (TJR).</p><p><b>METHODS</b>>From April 1987 to December 2001, we performed 1,336 total knee replacements (TKR(s)) in 926 patients and 1,745 total hip replacements (THR(s)) in 1,566 patients. In this group there were 5 PE patients after operation. Two patients died (all after TKR), and 3 patients salvaged successfully (2 after TKR, 1 after THR).</p><p><b>RESULTS</b>The total incidence of PE after TJR was 0.2% (5/2,492), the incidence of PE after TKR was 0.4% (4/926), and the incidence of PE after THR was 0.06% (1/1,556). In the patients who suffered PE, 2 died. The incidence of PE before 2000 was 0%.</p><p><b>CONCLUSIONS</b>Death after total joint replacement is due to pulmonary embolism (PE), especially massive PE. The incidence of PE after TKR is higher than that after THR. Pulmonary angiography is the gold standard for the diagnosis of PE. With more understanding on PE and more popularity of joint replacement, the diagnosis of PE after TJR is increased. More attention should be paid to PE in the patients with high risk after TJR.</p>