Application of unicompartmental knee arthroplasty in the treatment of knee osteoarthritis.

OBJECTIVE: For the treatment of medial compartment knee osteoarthritis, unicompartmental knee arthroplasty was chosen on the basis of the clinical effects and the rate of prosthesis survival. A retrospective analysis was performed on 500 patients with osteoarthritis of the medial compartment knee treated by unicompartmental knee arthroplasty between April 2007 and April 2017. The cohort was comprised of 176 males and 324 females, aged (61.12 ± 8.0) years old. The clinical treatment was evaluated in terms of the range of movement (ROM), the Knee Society score (KSS), and the Oxford knee score. RESULTS: The follow-up lasted 1.59-11.60 years. Grouped in terms of age, 133 cases were in the middle-age, 295 were in the old-age group, and 72 in the advanced-age group. Against the Iwano classification of the patellofemoral joint, 104 cases were graded 0-1; 179 were graded 2; 182 were graded 3 and 35 were graded 4. The KSS score improved from (59 ± 5.6) points before the operation to (93 ± 3.5) points after the operation. The OKS score increased from (24 ± 2.4) points before the operation to (45 ± 3.8) points after the operation. The ROM of knee joint was (111 ± 6.8)° before the operation and was (117 ± 9.7)° after the operation. The 10-year survival rate of the prosthesis was 96%. CONCLUSION: UKA is one of the treatments for medial compartmental knee osteoarthritis. The issues, such as age and patellofemoral joint degeneration, can be addressed by careful selection of patients and precise operational manipulation.

Combined thermosensitive in situ gel with AMD3100 in sutureless technique improves the survival and function of kidney transplants in mice.

The mouse is an optimal animal model for kidney transplantation. Recent reports suggest that application of poloxamer 407, a thermosensitive in situ gel, during the sutureless technique significantly increases animal survival, compared to traditional methods. However, further improvement of this technology is greatly needed but remains unexplored. Here, we detected significant inflammation at the region of ureter anastomosis, after kidney transplantation using poloxamer 407. Since chemokines play a pivotal role during inflammation, we implanted an Alzet osmotic pump that gradually releases AMD3100 (a specific inhibitor of the binding of stromal cell-derived factor 1 (SDF-1) to its receptor, CXCR4) at the site of ureter anastomosis in mice that had undergone kidney transplantation. We found that AMD3100 significantly reduced local inflammation, significantly improved animal survival after kidney transplantation, and significantly improved kidney function. Together, these data suggest that inhibition of chemokine signaling at the site of ureter anastomosis may substantially improve animal survival after kidney transplantation through suppression of suturing-related inflammation.

Limb function and quality of life after various reconstruction methods according to tumor location following resection of osteosarcoma in distal femur.

BACKGROUND: We tried to compare the functional and psychosocial outcomes after various reconstruction methods according to tumor location following resection of osteosarcoma in distal femur. METHODS: We retrospectively reviewed 51 patients who underwent limb-salvage surgery of osteosarcoma in distal femur in our institution, 30 males and 21 females with an average age of 21 years (range 13-51 years). We classified osteosarcoma in distal femur into 3 types, and organized affected limb reconstruction methods after wide resection. MSTS and QOL scores were used to analyze the functional and psychological outcomes. RESULTS: After a mean follow-up of 43 months (12-225 months), there is no difference on functional results and QOL scores among three reconstruction groups (p > 0.05) and among three types groups (p > 0.05). No difference could be noticed on tumor-free survival and total survival among three reconstruction groups (p > 0.05) and three type groups (p > 0.05). In ≤2-year, better functional scores could be found in prosthesis group, rather than the other two inactivated-bone groups (p < 0.05). CONCLUSIONS: Biological reconstruction with alcohol-inactivated autograft replantation could avoid prosthesis related complications and achieved comparable results with prosthesis following resection of osteosarcoma in distal femur. Different reconstruction options could be chosen according to tumor location, such as the distance to Insall line.

Alcohol-inactivated autograft replantation with joint preservation in the management of osteosarcoma of the distal femur: a preliminary study.

AIM: To evaluate clinical outcomes in patients who underwent alcohol-inactivated autograft replantation with joint preservation for the treatment of osteosarcoma of the distal femur. PATIENTS AND METHODS: 10 patients (7 men, 3 women; mean age: 20.1 years) were treated. 9 patients had Enneking stage IIb tumors and 1 patient had stage III. The mean follow-up time was 34 months. All patients obtained first-stage healing. RESULTS: 1 patient died of local recurrence and multiple metastases 13 months after surgery; 3 patients died of multiple metastases 9, 12, and 24 months after surgery, respectively. 3 patients required second surgery because of fracture of the inactivated autograft, 1 patient died 6 months later, 1 patient experienced bony healing 4 months later with no further complications, and 1 patient required subsequent open reduction and bone implantation with internal fixation (bony healing was evident 6 months later; however, joint instability and limited knee flexion were apparent). At final follow-up, the mean International Society of Limb Salvage (ISOLS) graft score was 31 (87%), whereas the mean Musculoskeletal Tumour Society (MSTS) function score was 23 (77%). CONCLUSIONS: These preliminary findings indicate that alcohol-inactivated autograft replantation with joint preservation may be effective in treating osteosarcoma of the distal femur in some patients. Larger-scale studies are needed to fully evaluate the efficacy/safety of this approach.

Allotransplanting donor kidneys after resection of a small renal cancer or contralateral healthy kidneys from cadaveric donors with unilateral renal cancer: a systematic review.

This systematic review summarizes evidence on allotransplantation of donor kidneys after resection of a small renal cancer or contralateral healthy kidneys from cadaveric donors with unilateral renal cancer. Eligible studies were identified by screening four bibliographic databases, contacting key authors, and analyzing the bibliographies of included studies. Two reviewers independently assessed the reports for inclusion and extracted data, which were summarized as a narrative review. In the 20 case report or case series studies included in the analysis, there were 97 documented cases of donor kidney transplantation after resection of small renal cancer without pathologically confirmed recurrence, whereas 22 cases used contralateral healthy kidneys from cadaveric donors with unilateral renal cancer with one case of cancer recurrence. These results suggest that the use of donor kidneys after resection of small renal cancer is associated with a relatively low cancer recurrence rate.

Benign and malignant renal cells are differentially inhibited during prolonged organ preservation.

The worry of potential residual renal cancer cells in donor kidney after resection of small renal cancer impedes the extensive use of such controversial donor source. To explore the impacts of organ preservation process on the survival of renal cancer cells, we detected cell proliferation and viability of benign and malignant renal cell lines and clinical renal samples after treated with simulated organ preservation process. It was found that the viability and proliferation of malignant renal cells are inhibited much more than that of benign renal cells during prolonged organ preservation. The inhibition of proliferation in benign renal cells is fully reversible, while in malignant renal cancer cells is not fully reversible after a certain time. So potential residual renal cancer cells could be partly inhibited and eliminated by organ preservation process.

Inactivated autograft-prosthesis composite has a role for grade III giant cell tumor of bone around the knee.

BACKGROUND: Giant cell tumors (GCT) around the knee are common and pose a special problem of reconstruction after tumor excision, especially for grade III GCT. We questioned whether en bloc resection and reconstruction with alcohol inactivated autograft-prosthesis composite would provide (1) local control and long-term survival and (2) useful limb function in patients who had grade III GCT around the knee. METHODS: We retrospectively reviewed eight patients (5 males and 3 females) treated with this procedure with mean age of 31 years (range 20 to 43 years) from Jan 2007 to Oct 2008. 5 lesions were located in distal femur and 3 in proximal tibia. 4 patients were with primary tumor and the other 4 with recurrence. 2 patients showed pathological fracture. RESULTS: Mean Follow-up is 54 months ranging from 38 to 47 months. No recurrence, metastasis, prosthesis loosening were found. The mean healing time between autograft and host bone was 5.5 months. The mean MSTS score was 26.3 (88%) ranging from 25 to 29. The mean ISOLS composite graft score was 32.8 (88.5%) ranging from 28 to 35. Creeping substitution is possibly the main way in bony junction. The healing time in femoral lesion is faster than that in tibial lesion. CONCLUSIONS: The technique of alcohol inactivated autograft-prosthesis composite could be able to achieve satisfactory oncological and functional outcomes in Grade III GCT.

Long-term outcome of giant cell tumor of bone involving sacroiliac joint treated with selective arterial embolization and curettage: a case report and literature review.

BACKGROUND: Giant cell tumor of the sacrum, especially involving the sacroiliac joint, is rare, but is particularly challenging to treat. The long term outcome of a patient was studied with giant cell tumor involving the sacroiliac joint treated with selective arterial embolization and curretage. METHOD: One patient with giant cell tumor involving the sacroiliac joint was treated with selective arterial embolization and curettage in our hospital in October 2002. The curettage and bone grafting was done after two times of selective arterial embolization;1600 ml of blood were transfused and no complications developed during the operation. RESULTS: At the final follow-up of 9 years after the operation, no local recurrence and metastasis developed and she retained normal activity in daily life. CONCLUSION: We think it is an optimal treatment for giant cell tumor involving the sacroiliac joint, with repeated selective arterial embolization and curettage, which has the advantage of less injury, less blood loss and fewer complications.

Effects of simvastatin on osseointegration in a canine total hip arthroplasty model: an experimental study.

Simvastatin was recently demonstrated to stimulate bone morphogenetic protein-2 expression, leading to bone formation. The present study was designed to evaluate whether simvastatin administered by injection could promote osseointegration in a canine total hip arthroplasty model. Fifteen dogs were divided into 3 groups of 5 dogs each: group 1 (high-dosage simvastatin, 6.0 mg/[kg d]), group 2 (low-dosage simvastatin, 3.0 mg/[kg d]), and a control group (isotonic saline, 3.0 mg/[kg d]). Osseointegration was assessed by using the push-out test, scanning electron microscopy, energy-dispersive spectrometer microanalysis, and histomorphometric examination. The results showed higher mechanical strength, greater area of bone covering the femoral component, and higher bone-implant contact in group 1 than in the other 2 groups. Our findings indicate that simvastatin administered by injection could contribute significantly to osseointegration in a canine total hip arthroplasty model.

Long-term outcome of giant cell tumors of bone around the knee treated by en bloc resection of tumor and reconstruction with prosthesis.

OBJECTIVE: To study the long-term outcomes and complications of giant cell tumors around the knee treated with en bloc resection and reconstruction with prosthesis. METHODS: From January 1991 to March 2005, 19 patients (11 men, 8 women, average age 35.4 years) were treated in our hospital with en bloc resection and reconstruction with domestic prosthesis (15 hinge knee and 4 rotating-hinge knee). The distal femur was involved in 12 and the proximal tibia in 7 cases. Nine tumors were primary and 10 recurrent. All cases were Campanacci grade III. The affected limb functions were evaluated by the Musculoskeletal Tumor Society scoring system. RESULTS: All patients underwent operation successfully with no complications. The mean follow-up time was 128.9 months (60 to 216 months). Apart from one patient who underwent amputation because of wound infection two years after reoperation, the range of knee motion of 18 patients was 30°-110°. The mean functional score of the affected limb was 22.7 (15 to 27 points). The length of the lower extremities was equal in nine cases; the affected limb was 2-9 cm shorter in the other ten cases. Prosthesis fracture and loosening developed in one, prosthesis aseptic loosening in three, and delayed deep infection and prosthesis loosening in two cases. The prosthesis loosening rate was 31.6%. One patient developed a proximal femur fracture. CONCLUSION: En bloc resection and reconstruction with prosthesis is a feasible method for treating giant cell tumor of bone around the knee. Complications related to the prosthesis, mainly prosthesis loosening and limb shortening, increase gradually with longer survival time.

[Reoperation after limb salvage surgery with prosthesis for bone tumor].

OBJECTIVE: To analyze the causes and the reoperation therapies after salvage limb surgery with prosthesis for bone tumors. METHODS: The retrospective analysis was performed on 85 patients undergoing the limb salvage operation with prosthetic replacement for tumors from January 1994 to December 2004. Of the patients, 21 (13 males and 8 females, aged 18-58 years) underwent reoperations for various reasons. All the diagnoses were pathologically confirmed (10 patients with osteosarcoma, 4 with chondrosarcoma, 5 with giant cell tumor of the bone, 2 with osteofibrosarcoma). The distal femur was involved in 9 patients, proximal tibia in 8, proximal femur in 2, proximal humerus in 1, and acetabulum in 1. According to the Enneking surgical grading system, there were 5 patients in I B and 16 in II B. The time between the first operation and the reoperation was 2 weeks to 20 years. The common reasons for the reoperation were tumor recurrence in 8 patients, prosthetic loosening in 5, no healing of the incision in 4, joint dislocation in 3, and implant fracture in 1. The amputation and the prosthesis revision were respectively performed on 6 patients, extensive resection of the tumor on 3, the myo-skin flap translocation on 4, internal hemipelvectomy without reconstruction on 1, and open reduction on 1. RESULTS: The follow-up in 18 patients for 1-5 years (average, 3 years and 4 months) revealed that 4 patients died of osteosarcoma with pulmonary metastasis. The other 14 patients had no tumor recurrence or loosening of the prosthesis, and the incisions healed well. The assessment on the joint function was performed on 13 of the 18 patients and the results were as follows: excellent in 2 patients, good in 5, fair in 4, and poor in 2, with a satisfaction rate of the reoperation with limb salvage of 84.6% and an excellent-good rate of 53.8%. CONCLUSION: Tumor recurrence is the most common reason for the reoperation after the limb salvage with prosthesis for tumors, and loosening of the prosthesis is an important reason, too. By the rules of the bone tumor limb savage, the limb salvage operations can also be performed, which can achieve a satisfactory result of the limb function.