Femoral anterior condyle height decreases as the distal anteroposterior size increases in total knee arthroplasty: A comparative study.

PURPOSE: The anterior flange height of the current femoral component increases with an increasing distal femoral anteroposterior dimension. During total knee arthroplasty (TKA), we have observed that a large femur may have a thinner anterior condyle, whereas a small femur may have a thicker anterior condyle. The first purpose of this study was to examine whether the femoral anterior condyle height decreases as the distal femoral anteroposterior size increases and whether gender differences exist in anterior condyle height. METHODS: A total of 1218 knees undergoing TKA intraoperative and computed tomography scans from 303 healthy knees were used to measure the anterior lateral condylar height (ALCH), anterior medial condylar height (AMCH), and the lateral anteroposterior (LAP) and medial anteroposterior (MAP) dimensions of distal femurs. The LAP and MAP measurements were used for adjustments to determine whether gender differences exist in anterior condyle heights. Linear regression analysis was performed to determine correlations between ALCH and LAP or between AMCH and MAP. RESULTS: There were significant differences between males and females in ALCH in both the CT and TKA groups and AMCH in the CT group (all P<0.01). After adjusting for LAP and MAP, there were significant gender differences in the lateral and medial condylar heights in both groups (P<0.01). There were significant negative correlations between ALCH and LAP values and between AMCH and MAP values in both CT and TKA measurements, with the LAP and MAP values increasing as ALCH and AMCH decreased. CONCLUSIONS: The results demonstrate that femoral anterior condylar height decreased with increasing anteroposterior dimension in both the medial and lateral condyle. In addition, this study also showed that anterior condylar heights are highly variable, with gender differences. The data may provide an important reference for designing femoral anterior flange thickness to precisely match the natural anterior condylar anatomy.

Three-dimensional morphometric differences of resected distal femurs and proximal tibias in osteoarthritic and normal knees.

BACKGROUND: There is a paucity of data concerning the morphological differences of resected distal femurs and proximal tibias in osteoarthritic (OA) and normal knees. The objective of this study was to determine whether morphometric differences in the surfaces of resected distal femurs and proximal tibias exist between OA and normal knees in a Chinese population. METHODS: Ninety-four OA knees and ninety-five normal knees were evaluated in Chinese individuals. Computed tomography was used to measure the femoral mediolateral (fML), medial anteroposterior (fMAP), lateral anteroposterior (fLAP), medial condylar width (fMCW), lateral condylar width (fLCW), medial posterior condylar curvature radii (fMCR), lateral posterior condyle curvature radii (fLCR), fML/fMAP aspect ratio, tibial mediolateral (tML), middle anteroposterior (tAP), medial anteroposterior (tMAP), and lateral anteroposterior (tLAP) tML/tMAP aspect ratio to determine the morphologic differences between OA and normal knees. RESULTS: The average fMCW and tMAP dimensions of OA knees were larger than those of normal knees in both male and female (p <0.05). The fMAP/fML aspect ratio and tMAP/tML aspect ratio were also significantly different in both sexs (p <0.05). OA knees have an oval-shaped distal femur with a wider ML length and more spherical-shaped proximal tibiae with relatively narrow ML dimensions. CONCLUSIONS: The study revealed the morphological differences in fMCW, tMAP, fMAP/fML and tMAP/tML between OA and normal knees in both males and females. These findings may provide guidelines that can be used to design better knee implants that are more size-matched for OA knees.

Long-term outcomes of arthroscopic debridement of the knee in adults with Kashin-Beck disease: an 18-year follow-up.

OBJECTIVE: Kashin-Beck disease (KBD) is an endemic degenerative joint disease with a high disability rate. We retrospectively evaluated the 18-year clinical follow-up outcomes of adult patients with KBD who underwent arthroscopic debridement for knee osteoarthritis. METHODS: Thirty-one patients with KBD (31 knees) underwent arthroscopy for knee osteoarthritis. The visual analog scale (VAS) score, walking distance, knee mobility, and patients' self-evaluated improvement in clinical symptoms were retrospectively evaluated before and 18 years after the operation. RESULTS: The patients' self-evaluated clinical symptoms showed considerable improvement at 2, 6, and 8 years after surgery but deteriorated at 10 and 18 years after surgery. Knee mobility was greater after than before arthroscopy but decreased from 6 to 18 years postoperatively. The VAS score for knee pain was high before the operation, decreased at 2 years postoperatively, increased at 6 years postoperatively, and was significantly lower at 18 years postoperatively than before surgery. The walking distance was significantly longer at 2, 6, and 8 years postoperatively than preoperatively. CONCLUSIONS: Arthroscopic treatment may be an effective therapy for adult patients with KBD who develop knee osteoarthritis. In this study, arthroscopy had a long-term effect on patients with KBD who had Kellgren-Lawrence grade

Outcomes of total knee arthroplasty in the adult Kashin-Beck disease with severe osteoarthritis.

PURPOSE: Kashin-Beck disease (KBD) is an endemic osteoarthropathy, and the severe knee pain and functional limitations were seriously affecting the quality of life in patients with end-stage KBD. We retrospectively evaluated the clinical outcomes and the quality of life in KBD patients with total knee arthroplasty (TKA). METHODS: A total of 22 subjects (25 knees) suffered KBD with severe knee pain and underwent primary TKA. Knee pain was measured by visual analogue scale (VAS), and the knee function was evaluated by Knee Society Clinical Rating System Score (KSS). KBD Quality of Life (KBDQOL) was used to evaluate the quality of life in KBD patients before and after TKA. RESULTS: There were no major complications after TKA. The levels of VAS score were obviously deceased in post-operation than that in pre-operation. The levels of KSS score were increased in one year after TKA compared with the pre-operative values, and it maintained a higher level on three years after TKA. The average KBDQOL score level of each domain in pre-operation and one and three years after TKA was increased accordingly. The average scores of physical function, activity limitation, support of society, mental health, and general health in one year after TKA were significantly higher than those in pre-operation. CONCLUSIONS: TKA can reduce knee pain, improve knee function, and improve the quality life in KBD patients. KBDQOL questionnaire may be a promising instrument for assessing the quality life in KBD patients.

[Efficacy evaluation of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in treating lumbar disc herniation with lumbar instability].

OBJECTIVE: To evaluate the clinical effects of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in the treatment of lumbar disc herniation with lumbar instability. METHODS: The clinical data of 146 patients with unilateral lumbar disc herniation with lumbar instability underwent surgical treatment from March 2008 to March 2013 were retrospectively analyzed. Patients were divided into two groups according to osteotomy replantation pattern. There were 77 patients in the traditional group (underwent traditional lamina osteotomy replantation), including 42 males and 35 females with an average age of (49.4±18.5) years;the lesions occurred on L4,5 in 46 cases, on L55S1 in 31 cases. There were 69 patients in modified group (underwent modified lamina osteotomy replantation), including 37 males and 32 females with an average age of (49.8±17.9) years;the lesions occurred on L4,5 in 40 cases, on L5S1 in 29 cases. The operation time, intraoperative blood loss, complication rate during operation, lamina healing rate, recurrence rate of low back and leg pain were compared between two groups. Visual analogue scales (VAS) and Japanese Orthopadic Association (JOA) scores were used to evaluate the clinical effects. RESULTS: The operation time and intraoperative blood loss were similar between two group (P>0.05). There was significantly different in nerve injury rate(5.80% vs 16.9%) and dural injury rate(1.45% vs 9.09%) between modified group and traditional group(P<0.05). The recurrent rate of low back pain of modified group was higher (91.30%, 63/69) than that of traditional group (76.62%, 59/77), and the intervertebral fusion rate of modified group was lower(8.70%, 6/69) than that of traditional group (29.9%, 23/77) at 3 years after operation. Postoperative VAS scores of all patients were significantly decreased at 6 months, 1, 2, 3 years, and JOA scores were obviously increased (P<0.05). At 1, 2, 3 years after operation, VAS scores of modified group were significantly lower than that of traditional group(P<0.05), and JOA scores of modified group were higher than that of traditional group(P<0.05). CONCLUSIONS: Modified lamina osteotomy replantation has better long-term efficacy(in the aspect of recurrent rate of low back pain, intervertebral fusion rate, VAS and JOA score at three years follow-up) in treating lumbar disc herniation with instability.

Exendin-4 inhibits glioma cell migration, invasion and epithelial-to-mesenchymal transition through GLP-1R/sirt3 pathway.

GLP-1 analogue exendin-4, a glucagon-like peptide 1 receptor (GLP-1R) agonist which shares 53% sequence with GLP-1, plays an essential role in human tumors. However, the function and mechanisms underlying the effects of exendin-4 on glioma cell migration, invasion and epithelial-to-mesenchymal transition are still obscure. Firstly, we demonstrated that GLP-1R was expressed in all glioma cell lines including U87, U251, U373 and A172. Exendin-4 treatment inhibited glioma cell survival, proliferation, migration and invasion. Also, exendin-4 inhibited epithelial-to-mesenchymal transition through positively regulating the expression of E-cadherin (epithelial marker), and negatively regulating the level of Vimentin (mesenchymal marker). Interestingly, we next demonstrated that exendin-4 elevated sirt3 expression dependent on the high level of GLP-1R in U87 and 251 cells. Finally, we confirmed that depletion the level of GLP-1R or sirt3 both reversed the inhibitory action of exendin-4 on glioma cell migration and invasion. These findings demonstrate that exendin-4 treatment suppressed the migration and invasion of glioma cells through GLP-1R/sirt3 pathway and exendin-4 plays an inhibitory effect on glioblastoma cell migration and invasion.

[Association of FasL-844T/C gene polymorphism with FasL expression in the nucleus pulposus of degenerative lumbar intervertebral discs].

OBJECTIVE: To investigate the association of FasL-844T/C gene polymorphism with the magnetic resonance imaging (MRI) findings and FasL expression in the nucleus pulposus of degenerative lumbar intervertebral discs. METHODS: Lumbar MRI data, venous blood and nucleus pulposus were collected from 105 patients with lumbar disc herniation. The genotypes of FasL-844T/C gene of the patients were determined using matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Immunohistochemistry was used to detect the expression of FasL in the nucleus pulposus of the degenerative lumbar intervertebral discs. RESULTS: Compared with CC genotype, TT genotype of FasL-844T/C gene was associated with a significantly increased score of lumbar disc degeneration (P=0.003) as observed in MRI scan. FasL expression in the nucleus pulposus differed significantly between patients of FASL-844CC genotype and those of FASL-844TT genotype (P=0.048), but not between those of FASL-844CC and FASL-844CT genotypes (P=0.264). No significant association was found between MRI findings and FasL expression in the nucleus pulposus of the lumbar intervertebral discs. CONCLUSION: FasL-844T/C gene polymorphism is correlated with the expression of FasL in the nucleus pulposus of the intervertebral disc in patients with lumbar disc herniation. MRI findings of the lumbar intervertebral discs do not correlate with the expression of FasL in the nucleus pulposus of the intervertebral discs.

[Case-control study of the risk factors of lumbar intervertebral disc herniation in 5 northern provinces of China].

OBJECTIVE: To explore the risk factors of lumbar intervertebral disc herniation in the 5 northern provinces of China. METHODS: A total of 2010 patients with established diagnosis of lumbar disc herniation by CT and/or MRI and 2170 control subjects without a history of low back pain or sciatica were randomly selected from the community population and hospitalized patients. The family history of lumbar disc herniation, occupations, smoking status, and occupational psychosocial factors were investigated. RESULTS: The positivity of family history of lumbar disc herniation was the highest risk factor (OR=3.551) followed by lumbar load (OR=2.132) and hard work (OR=1.763). Physical exercises (OR=0.435) were significantly related with the disease, and the OR of the type of bed was 0.364. CONCLUSION: A family history of lumbar disc herniation, lumbar load and hard work are the major risk factors for lumbar disc herniation, and physical exercises and sleeping not in soft bed might be a protective factor against the disease.