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Objective:To evaluate the early clinical outcomes of 5G remote telesupervised robot assisted total hip arthroplasty in the treatment of Kaschin-Beck disease with hip problems in Tibet through retrospective analysis of the hip surgery cohort.Methods:According to the operation procedure, 55 Kaschin-Beck disease patients (59 hips) undergoing total hip arthroplasty from November 2020 to November 2021 in the Karub District People's Hospital in Qamdo were divided into the conventional THA group (cTHA) and the 5G remote telesupervised robot assisted THA group (rTHA). Two of them underwent cTHA on both hips, while the other two patients underwent cTHA and rTHA separately of each hip, and the rest underwent single hip surgeries. In the cTHA group, there were 30 patients (32 hips), 16 males (17 hips) and 14 females (15 hips), aged 56.56±9.33 years (range, 36-76 years); In the rTHA group, there were 27 patients (27 hips), 10 males and 17 females, aged 55.41±10.90 years (range, 24 to 79 years). Before operation, Harris hip score was recorded and femoral offset (FO) and leg length difference (LLD) were measured via X-ray images. The operation time was collected during the hip surgery and an average network delay of 172.28±36.58 ms and a 1.08% data packet loss ratio is obtained during telesupervision. 24 hours post-operatively, the FO and LLD were both measured via the X-ray images, as well as the inclination and anteversion of the acetabular cup. The Harris scores were collected in the following up. The operation time, FO, LLD, inclination, anteversion and Harris score were compared between the two groups.Results:All cases in both groups were followed up for an average of 9.39±2.43 months (range, 6-19 months). There were no significant differences in pre-operative FO and LLD, preoperative Harris scores or average follow-up time between the two groups. The operation time in rTHA group was 126.41±12.78 min, which is significantly longer than the time 88.81±8.83 min in cTHA group ( t=13.31, P<0.001). After operation, the FO was significantly increased and the LLD was significantly decreased ( P<0.05). The postoperative LLD was 0.63±0.65 cm in the robot group and 1.15±0.71 cm in the conventional group, the difference was statistically significant ( t=2.88, P=0.006). However, there was no significant difference in the FO, inclination and anteversion between the two groups post-operatively ( P>0.05). The Harris scores of both groups were significantly improved compared with that before the operation. Additionally, the Harris score of the two groups was significantly higher than that before surgery, and the postoperative Harris score of the rTHA was 69.00±12.33 higher than that of the cTHA (62.31±11.87), with statistical significance ( t=2.12, P=0.039). The ratio of excellence of Harris score was 19% (5/27) in the rTHA and 9% (3/32) in the cTHA, with no significant difference between groups (χ 2=1.05, P=0.522). Conclusion:Compared to conventional surgery, 5G remote telesupervised robot assisted total hip arthroplasty has more advantages in improving the joint functions in the treatment of hip problems caused by Kashin-beck disease in Tibet Autonomous Region, and facilitates more accurate adjustment of lower limb length difference, even though it consumes more operation time.
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Many people doubt about its clinical significance, such as prolonged operation duration, longer learning curve , increased medical expenses and robot related complications. On the contrary, with the popularization of technology, the above unfavorable factors also tend to change. Therefore, improving the scientific understanding of robot assisted arthroplasty can promote the development and intersection of related disciplines in this area. The present paper investigated the following advantages of robot in assisting arthroplasty from two aspects, improving the accuracy of prosthesis placement and realizing personalized preoperative planning. Further, the possible shortcomings were discussed in the learning curve, economic factors and related complications. Finally, based on the current clinical situation, the future application direction was pointed out.
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Kashin-Beck disease is a chronic, endemic and deformable osteoarthropathy that mainly occurs in children and adolescents in many areas of China, whose main pathological changes are multiple symmetrical degeneration, necrosis, and secondary degeneration of epiphyseal cartilage, epiphyseal plate cartilage and articular cartilage. Patients with Kashin-Beck disease mainly present with joint pain, thickening, deformation, restricted movement, and muscle atrophy. In severe cases, Kashin-Beck disease can cause short fingers, short limbs, and even short deformities. However, there is no specific treatment for Kashin-Beck disease currently. Common treatment methods include non-steroidal anti-inflammatory drugs, cartilage protecting drugs, traditional Chinese medicine, arthroscopy and arthroplasty. This article reviews the treatment methods and research progress of Kashin-Beck disease, aiming to provide a more comprehensive reference for the treatment of Kashin-Beck disease.
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Objective:To evaluate the long-term effect of structured patient education and exercise therapy for knee osteoarthritis (KOA).Methods:Prospective cohort study, 162 patients with KOA were consecutively recruited from May 2016 to December 2019 to receive structured patient education and exercise therapy and were followed up 3 years after the recruitment. All the patients received two 1-hour educational courses and exercise therapy twice per week for six weeks under the supervision of physicians or physical therapists. Knee injury and osteoarthritis score (KOOS), visual analog score of pain (VAS), intermittent and constant OA pain (ICOAP), self-efficacy for arthritis were queried at 3-month and 36-month follow-up visit. We fitted linear mixed-effects models to examine the difference in scores between baseline and 3-month and 36-month visits.Results:109(67.3%) patients finished both 3-month and 36-month follow-up visits. The KOOS pain score increased from 70.8±1.7 at baseline to 79.7±1.8 at 36 months ( P<0.05). The KOOS symptom score increased from 66.8±2.0 at baseline to 74.9±2.1 at 36 months ( P<0.05). The KOOS daily function score increased from 81.7±1.4 at baseline to 87.0±1.5 at 36 months ( P<0.05). KOOS motor function score increased from 47.4±2.8 at baseline to 55.0±2.9 at 36 months ( P<0.05). The quality of life score of KOOS increased from 46.6±2.1 at baseline to 63.5±2.2 at 36 months ( P<0.05). Compared with the baseline data, there were statistically significant improvements in all subscales of KOOS in 36 months after exercise therapy intervention ( F=14.548, 8.102, 11.394, 5.687 and25.942, P<0.05). VAS pain score of left knee, VAS pain score of right knee, ICOAP score, self-efficacy pain score and other symptoms were also significantly improved ( F=17.643, 26.791, 8.290, 4.052 and 3.654, P<0.05). Conclusion:Structured patient education and exercise therapy are effective in improving knee pain and function as well as self-efficacy until as long as 36 months.
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Clinical practice guideline (CPG) for pain management of osteoarthritis in China contains 14 recommendations in treating patients with symptomatic osteoarthritis (OA) who are considering pharmaceutical and non-pharmaceutical treatments. Compared with the other consensus on diagnosis and treatment for OA, this clinical practice guideline (CPG) proposed by Chinese Orthopedics Association has some advantages in terms of methodology selection and recommendation. Therefore, it is necessary for us to interpret this CPG to speed up the understanding and application of the CPG. The ultimate aim were: to strengthen the normative and understanding of non-surgical or surgical treatment of OA; to enhance the understanding this CPG for clinicians to treat OA; to speed up the development of guideline methodologies in our country; to provide methodological guidance for the development of CPG based on the current situation in our country.
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Objective:To culture UC-MSCs with 3D TableTrix TM stem cell microcarrier and further evaluate the effects on cartilage defect of knee joint in rabbit model. Methods:UC-MSCs were cultured in 3D TableTrix TM system for 7 d. The cell viability was evaluated and characteristics of UC-MSCs were identified. The safety of 3D 3D TableTrix TM system was further evaluated by subcutaneous implantation in nude mice. Twelve New Zealand white rabbits were randomly divided into control group and experimental group. The experimental group was placed in 3D TableTrix TM with UC-MSCs. At 3 and 6 months after the operation, the samples were taken for general observation, HE, toluidine blue, Masson staining for comparative observation. According to the International Cartilage Repair Society (ICRs), general evaluation and histological score was evaluated quantitatively. Results:The UC-MSCs survived well in 3D TableTrix TM system. There was no dead cell with dead/live staining after 7 d culture. UC-MSCs proliferated in 3D TableTrix TM system. After digestion, the UC-MSCs were identified to maintain the characteristics of MSCs. After 28 d of subcutaneous implantation in nude mice, agglomerations were formed and covered with fibrous membrane. HE staining showed that the 3D TableTrix TM scaffold structure was complete and neovascularized. In vivo study, 3D TableTrix TM was used to fill the cartilage defect. At 3 and 6 months after operation, the effects on cartilage repair in the experimental group was better than that in the control group. The overall score of ICRS (3 month, 8.50±0.58 vs 4.50±0.58; 6 months, 11.25±0.96 vs 8.75±0.50, P<0.05) and histological score of the experimental group were higher than that of the control group (3 month, 11.00±2.16 vs 5.25±0.50; 6 month 17.00±0.82 vs 11.25±0.96, P<0.05). Conclusions:3D TableTrix TM microcarrier provides an ideal microenvironment for stem cell culture, and that can be used in the treatment of cartilage defects.
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Objective:To investigate the orthopedists' cognition on Chinese Osteoarthritis Guideline (2018 Edition).Methods:Questionnaire about Chinese Osteoarthritis Guideline (2018 Edition) was developed and sent to orthopedists via an invitation link to fill out after authorization from Chinese Osteoarthritis Association. The content of the questionnaire included the basic personal information of the physician, the awareness rate of the guidelines, the evaluation of the guidelines, and its application effects. The survey duration was from September 2019 to December 2019. Multivariate logistic regression and linear regression analysis were performed for the guideline awareness rate and comprehensive score, respectively.Results:A total of 628 physicians completed the questionnaire, of which 623 of 628 (99.2%) were available. About 72.4% of the orthopedists knew the guideline. The awareness rate was statistically related to the education of the physicians ( P<0.05). Respondents' overall score for the guideline was 8.39 with methodological score 8.28. A total of 41.2% of orthopedists thought that the guideline was very good compared with the European and American guidelines, and the clinical problem coverage rate was 78.6%. There is a statistically significant difference in the appraisal of the recommendations ( χ2=138.9, P<0.05) . More than 40% of orthopedists believed that the guidelines were of great help to orthopedists and patients, and that the guide could be promoted to the primary hospitals. Conclusion:After one year publication of Chinese Osteoarthritis Guideline (2018 Edition), most orthopedists have understood the present guideline and applied recommendations in clinical practice. However, the guideline need to be further promoted and disseminated in the future.
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Objective@#To investigate the microbiological test, antibiotic sensitivity and surgical treatment of periprosthetic joint infection(PJI) cases in post total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients.@*Methods@#A retrospective cross-sectional survey was conducted on 318 patients who underwent THA or TKA in 9 clinical centers in Beijing from January 2014 to December 2016.The data of microbiology, antibiotic sensitivity and surgical treatment were collected.The average age of patients was (62.3±13.1) years old (range: 21-86 years old), including 145 males and 173 females.The body mass index was (25.6±3.8) kg/m 2 (range: 15.6-38.1 kg/m2).@*Results@#In total, 318 patients had microorganisms detected by periprosthetic tissue culture or synovial fluid culture, 209 cases (65.7%) had Gram-positive bacteria, 29 cases (9.1%) had Gram-negative bacteria, 10 cases (3.1%) had fungi, 3 cases (0.9%) had non-tuberculous mycobacteria, 72 cases (22.6%) were negative, 69 cases (21.7%) had methicillin-resistant bacteria. The antibiotic sensitivity results showed that the overall resistance rate of penicillin, cefuroxime, amoxicillin+clavulanic acid was 79.9%, 69.9%, and 68.1%, respectively; meropenem, vancomycin, and linezolid resistance rate was 0. For the treatment methods of hip and knee PJI, two-stage revision surgery acounted for 72.9% (108/148) and 64.1% (109/170), respectively. One-stage revision surgery accounted for 21.6% (32/148) and 7.6% (13/170), and open debridement surgery accounted for 4.7%(7/148) and 26.4% (45/170).@*Conclusions@#Gram-positive bacteria was still the main pathogen of PJI.The methicillin-resistant bacteria and rare bacteria should be payed attention to. The Majority of hip and knee PJI cases were treated by two-stage revision surgery.
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At present, several clinical practice guidelines for osteoarthritis have been developed. Although contradictions about some recommendations are still in dispute, large number of clinical practice guidelines recommended core treatments, namely education, weight loss and exercise therapy. Thus, the diagnosis and treatment of primary osteoarthritis should focus on the above three treatments. However, we have to develop the clinical practice guidelines for osteoarthritis in primary hospital, based on the characteristics of osteoarthritis in China, the burden of disease, the health literacy of patients and the clinical decision-making of diagnosis and treatment of primary osteoarthritis in primary medical care.We suggest to formulate guidelines for the diagnosis and treatment of osteoarthritis in primary medical care to regulate primary interventions.
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Objective@#To investigate the quality of life (QOL) and risk factors for progression of knee osteoarthritis.@*Methods@#A prospective study of knee OA was conducted from April 2015 to August 2016. Two hundred and fifty patients with knee OA were recruited in this study and followed up for 18 months, during which there were five visits, i.e. baseline, 1st month, 6th month, 12th month and 18th month. QOL was assessed by the Arthritis Impact Measurement Scale 2 (AIMS2), which includes five dimensions (physical function, symptom, affect, social interaction and social role). Trajectories of QOL change were identified from a group-based trajectory model (PROC TRAJ). Risk factors associated with the QOL of OA were analyzed using chi square test followed by a multivariate logistic regression.@*Results@#Two hundred and thirty-nine participants had at least two follow-up visits. Each dimension of AIMS2 has deteriorated over time (Lower score indicates better health status): Physical function (1.9 points, (95%CI, 0.1 to 3.9; P=0.011), Symptom (2.0 points, 95%CI, 0.2 to 3.8; P=0.045), Affect (1.5 points, 95%CI 0.3 to 2.5; P=0.01), Social interaction (0.7 points, 95%CI, -0.1 to 1.5; P=0.065) and Social role (1.6 points, 95%CI, 0.5 to 2.7; P=0.01). Three trajectories of QOL were identified. Participants in Subgroup 1 (poor QoL; n=153) displayed bad QOL at baseline and deteriorated over time. Participants in Subgroup 2 (moderate QOL; n=65) developed or displayed moderate QOL over time. Participants in Subgroup 3 (good QOL; n=21) displayed good QOL at baseline and developed slightly better outcome over time. Baseline characteristics such as: female, higher body mass index, greater knee pain, longer duration of disease, lower education level, lower yearly income and more comorbidities were associated with the deterioration of QOL of knee OA.@*Conclusion@#Knee OA had impacts on patients' QOL. We identified three distinct trajectories of QOL change: good QOL group, moderate QOL group and poor QOL group. Baseline characteristics such as: female, higher body mass index, greater knee pain, longer duration of disease, lower education level, lower yearly income and more comorbidities were associated with the deterioration of QOL of OA.
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To investigate the quality of life (QOL) and risk factors for progression of knee osteoarthritis. Methods A prospective study of knee OA was conducted from April 2015 to August 2016. Two hundred and fifty patients with knee OA were recruited in this study and followed up for 18 months, during which there were five visits, i.e. baseline, 1st month, 6th month, 12th month and 18th month. QOL was assessed by the Arthritis Impact Measurement Scale 2 (AIMS2), which includes five dimensions (physical function, symptom, affect, social interaction and social role). Trajectories of QOL change were identified from a group?based trajectory model (PROC TRAJ). Risk factors associated with the QOL of OA were analyzed using chi square test followed by a multivariate logistic regression. Results Two hundred and thirty?nine participants had at least two follow?up visits. Each dimension of AIMS2 has deteriorated over time (Lower score indicates better health status): Physical function (1.9 points, (95% CI, 0.1 to 3.9; P=0.011), Symptom (2.0 points, 95% CI, 0.2 to 3.8; P=0.045), Affect (1.5 points, 95% CI 0.3 to 2.5; P=0.01), Social interaction (0.7 points, 95% CI,-0.1 to 1.5; P=0.065) and Social role (1.6 points, 95% CI, 0.5 to 2.7; P=0.01). Three trajectories of QOL were identified. Participants in Subgroup 1 (poor QoL; n=153) displayed bad QOL at baseline and deteriorated over time. Participants in Subgroup 2 (moderate QOL; n=65) developed or displayed moderate QOL over time. Participants in Sub?group 3 (good QOL; n=21) displayed good QOL at baseline and developed slightly better outcome over time. Baseline characteris?tics such as: female, higher body mass index, greater knee pain, longer duration of disease, lower education level, lower yearly in?come and more comorbidities were associated with the deterioration of QOL of knee OA. Conclusion Knee OA had impacts on patients' QOL. We identified three distinct trajectories of QOL change: good QOL group, moderate QOL group and poor QOL group. Baseline characteristics such as: female, higher body mass index, greater knee pain, longer duration of disease, lower educa? tion level, lower yearly income and more comorbidities were associated with the deterioration of QOL of OA.
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The present study shows the case of a patient with acetabular protrusions secondary to rheumatoid arthritis progressing to femoral neck fracture.The patient,a 64 years female,had a history of rheumatoid arthtitis for 38 years.The left hip pain and abnormal sound occurred when hip flexion for picking up.She was diagnosed with rheumatoid arthritis secordary to acetabular pelvic retraction and left femoral neck fracture by medical history,physical examination and imaging.Total hip arthroplasty was performed after preoperative examination.Hip dislocation,femoral head removal,acetabular reconstruction;cup fixation,and bone mass assessment are technical challenges during surgery.Based on literature review,this case is belonging to secondary acetabular pelvic retraction,which may be related to acetabular softening caused by rheumatoid arthritis.Whenthe stress from the femoral head exceeds the endurance of the softened acetabulum,the acetabulum protrudes into the pelvis and gradually wraps around the femoral head.Based on the pathological characteristics,itis speculated that the cause of femoral neck fracture is the direct hit of the femoral neck-acetabular rim during hip flexion.In this case,spiral cup prosthesis was used to achieve both the initial stability of the prosthesis and saving bone mass around the acetabulum.The patient was followed up for 3 months with satisfactory position of prosthesis and joint function.
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Objective To evaluate and to identify osteoarthritis (OA) study trends in China based on bibliometrics.Methods To search OA studies in OA research,the Web of Science Core Collection" database was used to search for publication data,which encompassed any published articles published from 2013 to 2017.The keyword "osteoarthritis" was used to identify articles for the purposes of the present study.In order to include all published items,the database was searched using the Basic Search method.The included items were indexed according to countries,document types,organization,publication years and conference titles.The characteristics of OA literatures conducted in China and US were compared in following aspects:h-index,average citation per item,sum of times cited and number of citing articles.Excel software was used for data analysis.Results A total of 2 894 publications on OA in China,published from number of 345 in 2013 to number of 817 in 2017 (with the number of publications increasing annually),were retrieved from the database.While the number of OA studies published by Chinese institutes was ranked second in the world,just after U.S.,the average citation per article and h-index of Chinese studies were far below those of U.S.,scoring at 4.08 versus 6.26 and 32 versus 64 respectively.Universities and its affiliated institutions are the main body of OA research in China.OA researchers in China preferred to publish their studies in specialized journals and conferences.Conclusion Although great advances in OA study are developed in China past 5 years,most efforts are still required to improve our quality,influence and novelty in the field of OA.
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Objective To investigate the effects of chemokine like factor 1 (CKLF1) gene on the proliferative activities and osteogenic potentials of hip ligaments of ankylosing spondylitis (AS) in situ and in vitro. Methods Normal and AS hip ligament specimens were collected from 6 patients with femoral neck fracture and 4 AS patients with severe hip deformities. Ligament specimens were exposed to type Ⅱ colla-genase and obtained a single cell suspension, while phase contrast microscopy and anti-vimentin immuno- fluorescence staining (IFC) were applied to observe the cells. The specimens and fibroblasts were divided and cultured in situ and in vitro respectively, and the recombinant adeno-associated virus (rAAV)-lacZ (E. coli beta-galactosidase gene)and rAAV-hCKLF1 (human CKLF1 cDNA cloned in rAAV-lacZ in place of lacZ) were transduced for 21 days. Cell proliferation (cellularity), secretion of pro-inflammatory cytokines, expression of CKLF1 and CCR4 genes were detected by the water-soluble tetrazolium (WST-1) assay and Hoechst 33258 test (DNA content), enzyme-linked immunosorbent assay (ELISA), IFC test and fluorescent quantitative reverse transcription polymerase chain reaction (RT-PCR), respectively. Statistical analysis significance was conducted using the Student's t test and one-way analysis of variance (ANOVA) (LSD) test where appropriate. Results The second passage of normal and AS cells were positive for anti-vimentin, indicating that the cells were fibroblasts. After transducing with rAAV-hCKLF1 for 21 days, cellularity, WST-1 and Hoechst 33258 assays illustrated that CKLF1 gene transfer promoted cell proliferation (compared with the non-viral transduction and lacZ groups, F=6.98, 64.32, 115.91, P<0.05 or P<0.01). Overexpression of CKLF1 gene enhanced the secretion of pro-inflammatory cytokines (interleukin-6 and tumor necrosis factor-alpha) and the expression of bone-specific extracellular matrix proteins (osteopontin and osteocalcin) (F=34.57, 8.89, P<0.05 or P<0.01). Similar results were observed in fluorescent quantitative RT-PCR test. Conclusion Overexpression of CKLF1 promotes the proliferation of fibroblasts, the secretion of pro-inflammatory cytokines and the expression of osteogenic related target genes, suggesting that CKLF1 might be involved in the pathological ossification of AS.
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At present, several clinical practice guidelines for the treatment of osteoarthritis have been developed by institutes or societies. The ultimate purpose of developing clinical practice guidelines is to formulate the process in the treatment of osteoarthritis effectively. However, the methodologies used in developing clinical practice guidelines may place an influence on the transformation and application of that in treating osteoarthritis. The present study summarized the methodological features of individual clinical practice guideline and presented the tools for quality evaluation of clinical practice guideline. The limitations of current osteoarthritis guidelines of China are also indicated. The review article might help relevant institutions improve the quality in developing guide and clinical transformation.
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Objective To observe the clinical outcomes of the surgical management of periprosthetic femoral fractures following hip arthroplasty.Methods Twelve consecutive patients (6 male and 6 female) with the average age of 66.4± 15.0 years old (35 to 86 years old) undergoing surgical operation for periprosthetic femoral fractures between September 2009 and May 2016 were followed up at our center.Nine cases were fractured secondary to the primary hip arthroplasty while the others were patients with earlier revision surgery.The previous fixations of femoral components of 10 cases were cementless while the other two were cemented fixation.The enrolled patients were determined as Vancouver type B 1 (n=2),type B2 (n=7),type B3 (n=1) and type C (n=2) respectively.The occurrences of the fractures were observed at 3 weeks to 17 years post-operation (average 9.0±7.0 years).The patients were treated individually according to different Vancouver types.Type B 1 patients received simple cerclage fixation,as well as revisions with long-stem femoral implants and cerclage band were chosen for type B2 patients.In addition to the treatment for type B2 patients,allogenic cortical bone graft was also required for type B3 patients.Open reduction with locking plate internal fixations were options for patients with Vancouver type C fractures.The following-up included the X-ray images of the hips,Harris hip score and the visual analogue scale (VAS) for the pain of fracture site.The unions of the fractures were determined by both X-ray images and pain intensity of the fracture sites.Results The mean follow-up period was 41.6±26.0 months (range,12-92 months),without patient lost to follow up.VAS scores were 0,implying the clinical union of the fractures.One patients received multiple debridement post-operatively due to the periprosthetic infection.The VAS score of this patient was 6 at the follow up and the X-ray image indicated the nonunion of the fracture.The fracture union rate was 91.7％ (11/12).The Harris hip score was 23-92 (mean score,74.8±18.8),excellent for 2 cases,good for 6 cases,fair for 3 cases and poor for 1 case.The excellent and good rate was 66.7％ (8/12).Post-operative complications were observed in 4 patients (33.3％,4/12).One drainage tube was misplaced and sutured subcutaneously required a further exploration surgery.One periprosthetic infection occurring post-operatively induced the nonunion of the fracture.Aseptic loosing of femoral stem was observed in 2 cases and subsequent revision surgeries were conducted.Conclusion High incidence of complications is observed after the surgical treatment of periprosthetic femoral fractures following hip arthroplasty.Individually customized management regarding to the Vancouver type of periprosthetic femoral fractures leads to the clinical fracture union in 91.7％ of the patients in this case series.The excellent and good rate of the hip function in the early and mid-term stage after operation is 66.7％.
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With the increasing number of hip arthroplasty and the extension of implant survival,the risk of periprosthetic femoral fractures are gradually growing.The technical challenge of the surgical management of periprosthetic femoral fractures leads to poor functional outcome,implant survival and patient satisfaction compared to primary hip arthroplasty.The risk factors of periprosthetic femoral fractures involve both of the bone quality of the patient and the surgical techniques of the primary surgery,including age and gender of the patient,osteoporosis,previous surgical history and the type of the components.In order to avoid the occurrence of periprosthetic fractures,precautions including the assessment of the patient status and bone quality as well as the selection of proper prosthesis and surgical procedures should be taken before the primary surgery.During the primary surgery,more attention should be paid to prevent the damage of host bone and make sure the correct placement of the implants.The aseptic loosening should be detected and treated as early as possible in the regular post-operative follow up.The diagnosis of periprosthetic femoral fracture mainly bases on the detailed history,symptoms,signs and serial X-rays after operation.The most extensively used classification system of the periprosthetic femoral fracture is the Vancouver classification.For the treatment of different types of fractures,conservative therapy is recommended for most Vancouver type A fractures.The surgical management is the best choice for most Vancouver type B fractures.Whether the stem revision is necessary or not depends on the stability the component.The treatment of Vancouver type C fractures should be in accordance with the principles of regular femur fractures.However,more attention should be paid to choose proper device according to the existence of the femoral component in the proximal part of the fracture.Through the analysis of the pathogenesis and risk factors of periprosthetic femoral fractures and the discussion of the diagnosis,classification and treatment principles,we expect to provide a standard treatment protocol for the periprosthetic femoral fractures following hip arthroplasty.
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Objective To investigate the effects of chemokine like factor 1 (CKLF1) gene on the proliferative activities and osteogenic potentials of hip ligaments of ankylosing spondylitis (AS) in situ and in vitro. Methods Normal and AS hip ligament specimens were collected from 6 patients with femoral neck fracture and 4 AS patients with severe hip deformities. Ligament specimens were exposed to type Ⅱ colla-genase and obtained a single cell suspension, while phase contrast microscopy and anti-vimentin immuno- fluorescence staining (IFC) were applied to observe the cells. The specimens and fibroblasts were divided and cultured in situ and in vitro respectively, and the recombinant adeno-associated virus (rAAV)-lacZ (E. coli beta-galactosidase gene)and rAAV-hCKLF1 (human CKLF1 cDNA cloned in rAAV-lacZ in place of lacZ) were transduced for 21 days. Cell proliferation (cellularity), secretion of pro-inflammatory cytokines, expression of CKLF1 and CCR4 genes were detected by the water-soluble tetrazolium (WST-1) assay and Hoechst 33258 test (DNA content), enzyme-linked immunosorbent assay (ELISA), IFC test and fluorescent quantitative reverse transcription polymerase chain reaction (RT-PCR), respectively. Statistical analysis significance was conducted using the Student's t test and one-way analysis of variance (ANOVA) (LSD) test where appropriate. Results The second passage of normal and AS cells were positive for anti-vimentin, indicating that the cells were fibroblasts. After transducing with rAAV-hCKLF1 for 21 days, cellularity, WST-1 and Hoechst 33258 assays illustrated that CKLF1 gene transfer promoted cell proliferation (compared with the non-viral transduction and lacZ groups, F=6.98, 64.32, 115.91, P<0.05 or P<0.01). Overexpression of CKLF1 gene enhanced the secretion of pro-inflammatory cytokines (interleukin-6 and tumor necrosis factor-alpha) and the expression of bone-specific extracellular matrix proteins (osteopontin and osteocalcin) (F=34.57, 8.89, P<0.05 or P<0.01). Similar results were observed in fluorescent quantitative RT-PCR test. Conclusion Overexpression of CKLF1 promotes the proliferation of fibroblasts, the secretion of pro-inflammatory cytokines and the expression of osteogenic related target genes, suggesting that CKLF1 might be involved in the pathological ossification of AS.
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<p><b>OBJECTIVE</b>To evaluate long-term result of Scorpio posterior-stabilized total knee arthroplasty.</p><p><b>METHODS</b>There were 160 patients (240 knees) underwent Scorpio posterior-stabilized total knee arthroplasty between December 1998 and December 2000, which were performed by the same surgeon. Patients were followed up from June 2013 to December 2013. Knee Society Scoring (KSS), Hospital for Special Surgery (HSS) patellofemoral scoring, standard weight-bearing anteroposterior and patellar tangential radiographs were assessed. Satisfaction of outcome was requested. Alignment of components and presence of radiolucent lines were assessed by the radiographic scoring system of knee society. Paired t-test was used compared to the data between preoperation and the time of last follow-up.</p><p><b>RESULTS</b>Ninety-five patients (141 knees) (59.4%) were followed up. Average follow-up duration was 13.3 years (range 12 to 15 years). Eight knees were revised due to periprosthetic infection (4 knees), aseptic loosening of tibial tray (3 knees) and wear-out of polyethylene insert (1 knee). Compared with preoperative ones, KSS knee score, KSS functional score and range of motion improved significantly (pre-operation: 26±16, 34±18, 87°±25°; follow-up time: 93±8, 78±27, 114°±22°) (t=45.55, 15.60, 13.03, all P<0.01). In terms of KSS knee score and HSS patellofemoral score, 106 knees were rated as excellence respectively. Ninety-five knees had satisfaction with outcome for maximum. The presences of radiolucent lines occurred around 5 femoral and 11 tibial components with range less than 2 mm. The survival rate at 10 years was 94.5% with revision for any reason as the end point.</p><p><b>CONCLUSION</b>The long-term study indicates that Scorpio posterior-stabilized knee system shows favorable clinical and radiological results.</p>
Assuntos
Humanos , Artroplastia do Joelho , Métodos , Fêmur , Diagnóstico por Imagem , Seguimentos , Articulação do Joelho , Cirurgia Geral , Prótese do Joelho , Patela , Diagnóstico por Imagem , Polietileno , Radiografia , Amplitude de Movimento Articular , Reoperação , Tíbia , Diagnóstico por Imagem , Resultado do TratamentoRESUMO
<p><b>OBJECTIVE</b>To compare and estimate the diagnostic value and characteristic of different diagnostic methods (blood laboratory test, histological analysis, synovial fluid cytological test and microbiological examination) in detecting the presence of periprosthetic joint infection.</p><p><b>METHODS</b>Data of 52 patients underwent hip or knee joint revision in Peking University People's Hospital Arthritis Clinic and Research Center between July 2013 and March 2015 were analyzed retrospectively. For each patient, results of blood laboratory tests(peripheral-blood white blood cell, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (Hs-CRP)), histological analysis, synovial fluid white cell count (SWCC), microbiological examinations (synovial fluid, tissue and prosthetic joint sonication fluid) were collected. Data were analyzed by t-test, independent sample median test or χ(2) test, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for each method were calculated and compared by receiver operating characteristic curve.</p><p><b>RESULTS</b>There were 30 female and 22 male patients. Twenty-one patients (40.4%) were diagnosed as PJI. The levels of CRP, ESR, IL-6 and Hs-CRP in patients with PJI were higher than that in aseptic failure patients (Z=23.084, 13.499, 5.796, 17.045, all P<0.05). The sensitivities of CRP, ESR, IL-6 and Hs-CRP were 90.5%, 81.0%, 95.0% and 90.0%. The sensitivities of histological analysis and SWCC were 55.0% and 70.6%, while they had high specificity as 89.7% and 85.7%. The sensitivity of sonication fluid culture was 90.0%, which was higher than that of tissue culture (71.4%) and synovial fluid culture (65.0%) (χ(2) = 5.333, 6.400, all P<0.05).</p><p><b>CONCLUSIONS</b>The tests of CRP, ESR, IL-6 and Hs-CRP have good value in detecting PJI preoperatively. Histological analysis and SWCC have high specificity, which could help to exclude PJI. Sonication fluid culture has a higher sensitivity than tissue culture and synovial fluid culture.</p>