The mid-term follow-up of revision total knee athroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the mid-term follow-up results of revision of total knee arthroplasty and compare the different strategies for infective revisions.</p><p><b>METHODS</b>All of 45 patients (47 operated knees) lived in Beijing were treated from April 1989 to October 2010 in Arthritis Clinic and Research Center, Peking University People's Hospital. There were 6 male and 39 female patients, who aged from 31 to 77 years (mean (62 ± 11) years). The function of knee, satisfaction and imaging then were compared retrospectively. American Knee Society Scores (KSS), Western Ontario & McMaster University Osteoarthritis Index (WOMAC), the medical outcomes study item short form health survey (SF-36) scales and satisfaction/pain visual analogue scales (VAS) of patients were evaluated. The patients were divided into infection group (33 patients, 34 knees) and non-infection group (12 patients, 12 knees) according to the indication of revision of total knee arthroplasty and compared by t-tests.</p><p><b>RESULTS</b>The time from operation to follow-up was 1 year and 2 months to 17 years. The mid-term follow-up time was 8 years 3 months. There were significant improvements of KSS clinical and function scores (from 66.9 ± 28.0 and 44.4 ± 37.6 to 25.4 ± 24.2 and 10.0 ± 24.8, t = 7.043 and 3.797, both P = 0.001). Patients of infection group had lower KSS clinical and function scores than non-infection group before operation, and lower Society Function (t = 2.225, 3.520 and 2.885, P = 0.035, 0.002 and 0.007). About the septic group, the II-stage group had significant better post-operation KSS function scores, Society Function, physical component summary, WOMAC functional score and WOMAC score than I-stage group (t = 2.160-3.268, P = 0.004-0.042). The 1-year, 2-year, 6-year, 17-year survival rate were 83.6%, 78.7%, 62.1%, 44.5%.</p><p><b>CONCLUSIONS</b>Revision total knee arthroplasty is an effective method for solving the failure of primary total knee arthroplasty. It can improve the pain and activity difficulty following the failure of primary total knee arthroplasty, and partially improve function along with quality of life. The results of non-infection group are better than infection group. There may be better results for II-stage revision total knee arthroplasty than I-stage revision. Both I-stage and II-stage revision total knee arthroplasty are effective.</p>

Working conditions of bipolar radiofrequency on human articular cartilage repair following thermal injury during arthroscopy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The thermal injury during bipolar radiofrequercy results in chondrocyte death that limits cartilage repair. The purpose was to determine the effects of various factors of bipolar radiofrequency on human articular cartilage after thermal injury, offering suitable working conditions for bipolar radiofrequency during arthroscopy.</p><p><b>METHODS</b>Osteochondral explants from 28 patients undergoing total knee arthroplasty (TKA) in Department of Orthopaedic, Peking University Reople's Hospital from October 2013 to May 2014, were harvested and treated using bipolar radiofrequency in a light contact mode under the following conditions: various power setting of levels 2, 4 and 6; different durations of 2 seconds, 5 seconds and 10 seconds; irrigation with fluids of different temperatures of 4°C, 22°C, and 37°C; two different bipolar radiofrequency probes ArthroCare TriStar 50 and Paragon T2. The percentage of cell death and depth of cell death were quantified with laser confocal microscopy. The content of proteoglycan elution at different temperatures was determined by spectrophotometer at 530 nm.</p><p><b>RESULTS</b>Chondrocyte mortality during the treatment time of 2 seconds and power setting of level 2 was significantly lower than that with long duration or in higher level groups (time: P = 0.001; power: P = 0.001). The percentage of cell death after thermal injury was gradually reduced by increasing the temperature of the irrigation solutions (P = 0.003), the depth of dead chondrocytes in the 37°C solution group was significantly less than those in the 4°C and 22°C groups (P = 0.001). The proteoglycan elution was also gradually reduced by increasing the temperature (P = 0.004). Compared with the ArthroCare TriStar 50 group, the percentage of cell death in the Paragon T2 group was significantly decreased (P = 0.046).</p><p><b>CONCLUSIONS</b>Thermal chondroplasty with bipolar radiofrequency resulted in defined margins of chondrocyte death under controlled conditions. The least cartilage damage during thermal chondroplasty could be achieved with lower power, shorter duration, suitable temperature of irrigation solutions and chondroprotective probes. The recommendations for the use of bipolar radiofrequency to minimize cartilage damage could be achieved with a power setting of level 2, treatment duration of 2 seconds, suitable fluid temperature (closer to body temperature of 37°C) and chondroprotective Paragon T2 probes.</p>

Sensation disorders of lateral skin of the incision after total knee arthroplasty / 中华骨科杂志

ObjectiveTo investigate the sequelae and relative factors of sensation disorders of lateral skin of the incision after total knee arthroplasty (TKA) and to explore its effect on knee function.MethodsThirty-six patients (53 knees) who underwent TKA were continuously selected in this study.The length of the incision and the area of sensation disorders of skin around the incision were measured 1 week postoperatively.The area of sensation disorders of skin around the incision was measured again 1.5 years postoperatively,and the range of motion of the knee and the knee society score (KSS) were recorded.ResultsAll of the patients presented with objective hypesthesia of lateral skin of the incision.Twenty-six (72％) patients existed subjective numbness,whose areas of hypesthesia were larger than those of patients without subjective numbness.The average area of hypopselaphesia and average area of hypalgesia were(36.43±14.71) cm2 and (69.62±23.48) cm2,respectively.Both of them had positive correlation with the length of the incision (r=0.303,P=0.04; r=0.318,P=0.03).One and a half years postoperatively,besides 5 patients recovered completely,all other patients existed no hypopselaphesia,and the average area of hypalgesia was(8.55±4.56)cm2,which was statistically different with that 1 week postoperatively(t=2.553,P=0.012).The KSS score was lower in patients with subjective numbness than that in patients without subjective numbness (t=2.066,P=0.044).ConclusionThe hypesthesia of lateral skin of the incision is common after TKA,which can recover partially or completely over time.All patients should be advised of this complication as part of their informed consent before TKA.

Role of phosphatase PTEN in the activation of extracellular signal-regulated kinases induced by estradiol in endometrial carcinoma cells / 中华医学杂志(英文版)

<p><b>OBJECTIVES</b>To study extracellular signal-regulated kinase (ERK) activation in the endometrial carcinoma cell line Ishikawa with stimulation by 17-beta-estradiol, and to elucidate the role of phosphatase and tensin homologue (PTEN) and estrogen receptor (ER) subtype on the activation of ERKs.</p><p><b>METHODS</b>Western blot was used to examine the expression of PTEN and PTEN (G129E) in Ishikawa cells after stable transfection as well as ERK activation in Ishikawa-EGFP, Ishikawa- PTEN and Ishikawa- PTEN (G129E) stimulated with various doses of 17-beta-estradiol for different lengths of time. Western blot was also used for examining the expression of ERalpha and ERbeta in NIH3T3 fibroblasts after transient transfection of pCXN2hERalpha and pCXN2hERbeta. Then, ERK activation was examined after stimulation with 17-beta-estradiol.</p><p><b>RESULTS</b>17-beta-estradiol activated ERK cascades (mainly ERK2) in Ishikawa cells. The activation of ERK increased gradually as concentration of 17-beta-estradiol also increased. The maximal activation of ERK2 took place 5 min after stimulation with 17-beta-estradiol. The activation of ERK2 was inhibited markedly by PTEN, but not by PTEN (G129E). 17-beta-estradiol activated ERK cascades in NIH3T3 fibroblasts after transient transfection of pCXN2hERalpha.</p><p><b>CONCLUSIONS</b>17-beta-estradiol activate ERK cascades in Ishikawa cells by integrating with ERalpha. Lipid phosphatase PTEN has an inhibitory role on the activation of ERK stimulated by 17-beta-estradiol in Ishikawa cells.</p>