Cinnamaldehyde attenuates streptozocin-induced diabetic osteoporosis in a rat model by modulating netrin-1/DCC-UNC5B signal transduction.

Background: Cinnamaldehyde (CMD) is a major functional component of Cinnamomum verum and has shown treatment effects against diverse bone diseases. This study aimed to assess the anti-diabetic osteoporosis (DOP) potential of diabetes mellitus (DM) and to explore the underlying mechanism driving the activity of CMD. Methods: A DOP model was induced via an intraperitoneal injection of streptozocin (STZ) into Sprague-Dawley rats, and then two different doses of CMD were administered to the rats. The effects of CMD on the strength, remodeling activity, and histological structure of the bones were assessed. Changes in the netrin-1 related pathways also were detected to elucidate the mechanism of the anti-DOP activity by CMD. Results: CMD had no significant effect on the body weight or blood glucose level of the model rats. However, the data showed that CMD improved the bone strength and bone remodeling activity as well as attenuating the bone structure destruction in the DOP rats in a dose-dependent manner. The expression of netrin-1, DCC, UNC5B, RANKL, and OPG was suppressed, while the expression of TGF-ß1, cathepsin K, TRAP, and RANK was induced by the STZ injection. CMD administration restored the expression of all of these indicators at both the mRNA and protein levels, indicating that the osteoclast activity was inhibited by CMD. Conclusion: The current study demonstrated that CMD effectively attenuated bone impairments associated with DM in a STZ-induced DOP rat model, and the anti-DOP effects of CMD were associated with the modulation of netrin-1/DCC/UNC5B signal transduction.

High tibial lateral closing wedge and opening wedge valgus osteotomy produce different effects on posterior tibial slope and patellar height.

Objective: To compare the clinical outcomes of performing a closed tibial high osteotomy with an open osteotomy and the changes in posterior tibia slope and patellar height. Methods: Methods were collected from three hundred and forty patients (440 knees) with high tibial osteotomy performed from January 2019 to January 2020. Forty patients (50 knees) had a lateral closed wedge tibial osteotomy (LCWHTO), and 300 patients (390 knees) had a medial open wedge tibial osteotomy (MOWHTO). The follow-up periods were 20.5 months and 19.9 months, respectively. At the final follow-up visit, both groups evaluated the Lysholm score and joint range of motion (ROM). Changes in preoperative and postoperative mechanical axis deviation (MAD), proximal medial tibial angle (MPTA), posterior tibial slope (PTS), and M-K index were compared between the two groups of patients. Results: Lysholm scores were 79.6 ± 15.6 preoperatively and 96.0 ± 5.0 postoperatively in the LCWHTO group (p < 0.01); 83.7 ± 16.0 preoperatively and 94.3 ± 9.1 postoperatively in the MOWHTO group (p < 0.01). ROM was 136.0° ± 8.4° preoperatively and 133.2° ± 10.1° postoperatively in the LCWHTO group (p > 0.05); 136.5° ± 8.4° preoperatively and 135.7° ± 9.3° postoperatively in the MOWHTO group (p > 0.05). the MAD was (26.5 ± 4.1) mm preoperatively and 0.3 ± 2.9 mm postoperatively in the LCWHTO group (p < 0.01); 21.8 ± 6.5 mm preoperatively and -0.3 ± 2.6 mm postoperatively in the MOWHTO group (p < 0.01). The MPTA in the LCWHTO group was 75.3° ± 3.2° preoperatively and 89.5° ± 2.4° postoperatively (p < 0.01). 77.1° ± 3.0° preoperatively and 90.6° ± 2.7° postoperatively in the MOWHTO group (p < 0.01). M-K index was 0.78 ± 0.08 preoperatively and 0.79 ± 0.07 postoperatively in the LCWHTO group (p > 0.05). 0.78 ± 0.05 before and 0.75 ± 0.05 after surgery in the MOWHTO. 10.8° ± 3.0° PTS before and 8.1° ± 3.4° after surgery in the LCWHTO group (p < 0.05); 10.2° ± 3.1° preoperatively and 10.9° ± 4.0° postoperatively (p > 0.05). Conclusions: LCWHTO decreases the PTS and has no effect on patellar height; MOWHTO does not affect the PTS but decreases patellar height. The patient should individualize the choice of the osteotomy.

Prediabetes and osteoporotic fracture risk: A meta-analysis of prospective cohort studies.

BACKGROUND: Diabetes confers an increased risk of fracture. However, whether prediabetes is also a risk factor of osteoporotic fracture has not been comprehensively examined. We performed a meta-analysis to evaluate the relationship between prediabetes and osteoporotic fracture risk. METHODS: This meta-analysis included relevant prospective cohort studies from Medline, Embase, and Web of Science databases. A random-effect model after incorporation of the intra-study heterogeneity was selected to pool the results. Subgroup analyses were applied to evaluate the influences of study characteristics on relationship between prediabetes and osteoporotic fracture risk. RESULTS: Eight studies including 33,136 community dwelling adult patients were included, and 7429 (22.4%) patients were prediabetic. Prediabetes was not independently associated with a higher risk of osteoporotic fracture compared with normoglycemia (adjusted risk ratio: 1.03, 95% confidence interval: 0.88-1.21, P = 0.69, I2  = 42%). Sensitivity limited to the elderly population showed consistent results (RR: 1.10, 95% CI: 0.91-1.24, P = 0.15, I2  = 0%). Subgroup analysis suggested that prediabetes defined by HbA1c (approximately 5.7%-6.4%) was associated with a higher risk of osteoporotic fracture (RR: 1.24, 95% CI: 1.01-1.53, P = 0.04), but not that defined by impaired fasting glucose or impaired glucose tolerance (P = 0.60). Sex, follow-up duration, and adjustment of bone mineral density did not significantly affect the outcome. CONCLUSIONS: Current evidence does not support that prediabetes is independently associated with osteoporotic fracture risk. Different definitions of prediabetes may affect the association between prediabetes and osteoporotic fracture risk.

Pre-operative predictive factors of residual varus on the mechanical axis after Oxford unicompartmental knee arthroplasty.

Background: Residual varus after Oxford unicompartmental knee arthroplasty (UKA) happens frequently. This study aims to evaluate the pre-operative contributing factors of residual varus. Methods: A total of 1,002 knees (880 patients, 201 patients were male, and 679 were female) underwent Oxford UKA in the Orthopedic Surgery Department of the Beijing Jishuitan Hospital from March 2018 to April 2021. The mean age of the patient was 64.7 ± 7.7 years. To assess residual varus, the full-length lower extremity is placed upright for EOS imaging, with the knee fully extended. The angle of post-operative residual varus was measured as described by Noyes et al. Of the knees studied, they were either categorized into an under-corrected group (post-operative Noyes angle >5°) or a corrected group (post-operative Noyes angle ≤5°). Age, gender, body mass index (BMI), range of motion (ROM), Clinical American Knee Society Score (Clinical AKSS), and Function American Knee Society Score (Function AKSS) were compared. The following additional parameters were measured: pre-operative Noyes angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), the posterior slope of the proximal tibia angle (PPTA), joint line converge angle (JLCA), and fixed flexion deformity (FFD). Results: There was no statistically significant difference between the two groups in regards to gender (p = 0.428), surgical leg (p = 0.937), age (p = 0.851), BMI (p = 0.064), pre-operative Clinical AKSS (p = 0.206) and Function AKSS (p = 0.100). However, pre-operative ROM statistically differed between the two groups (p < 0.001). The contributing factors of post-operative residual varus were determined to be the following parameters: pre-operative MPTA (p < 0.001, OR = 4.522, 95% CI: 2.927-6.984), pre-operative Noyes (p < 0.001, OR = 3.262, 95% CI: 1.802-5.907) and pre-operative FFD (p = 0.007, OR = 1.862, 95% CI: 1.182-2.934). The effects of pre-operative LDFA (p = 0.146), JLCA (p = 0.942), and pre-operative PPTA (p = 0.899) on the post-operative mechanical axis did not show statistical significance. Conclusions: Patients with severe pre-operative varus, particularly varus deformity mainly from the tibial side or pre-operative FFD, are more prone to get extremity mechanical axis residual varus after UKA with Oxford.

Dynamic changes of coagulation and fibrinolytic biomarkers in peri operaive arthroplasty patients.

OBJECTIVE: To evaluate coagulation and fibrinolytic parameters after total joint arthroplasty (TJA) and provide evidence for optimization of timing of perioperative anticoagulation medicine. METHODS: The prospective study was conducted at the Jishuitan Hospital of Peking University from January to April in 2016, and comprised patients who were scheduled consecutively to undergo primary total knee arthroplasty (TKA) or total hip arthroplasty (THA). Blood samples were obtained at day 1 preoperatively and day1, day 3 postoperatively. Antigenic levels of protein C (PC), endothelial protein C receptor (EPCR), tissue factor pathway inhibitor (TFPI), antithrombin III (AT-III), plasminogen activator inhibitor 1 (PAI-1) and tissue plasminogen activator (tPA) were measured with commercially available enzyme-linked immunosorbent assay kits. RESULTS: Postoperative levels of coagulation parameters TFPI and AT-III were increased compared to preoperative values (118.7±34.6 vs 70.0±20.5 µg/ml for AT-III, and 26.37±7.91vs 16.68±8.92 µg/l for TFPI), while postoperative levels of coagulation parameters PC and EPCR were decreased (0.88±0.30 vs 2.03±0.66 µg/ml for PC, and 100.8±31.0 vs 199.4±57.4 µg/ml for EPCR). Postoperative levels of fibrinolytic parameter tPA was increased compared to preoperative values (2.87±0.83 vs 2.03±1.03 µg/l), while its specific inhibitor PAI-1 was decreased (0.88±0.30 vs 2.03±0.66 µg/l). CONCLUSIONS: These results demonstrated the perturbation of the coagulation and fibrinolytic system of patients undergoing TJA. Hypercoagulation and hyperfibrinolysis were observed in postoperative patients, which suggested anticoagulant therapy is effective and necessary.

Effect of Joint Line Elevation after Posterior-stabilized and Cruciate-retaining Total Knee Arthroplasty on Clinical Function and Kinematics.

BACKGROUND: Joint line (JL) is a very important factor for total knee arthroplasty (TKA) to restore. The objective of this study was to evaluate the early clinical and kinematic results of TKAs with posterior-stabilized (PS) or cruciate retaining (CR) implants in which the JL was elevated postoperatively. METHODS: Data were collected from patients who underwent TKA in our department between April 2011 and April 2014. The patients were divided into two groups based on the prosthesis they received (PS or CR). At 1-year postoperatively, clinical outcomes were evaluated by the American Knee Society (AKS) knee score, AKS function score, and patella score. In vivo kinematic analysis after TKA was performed on all patients and a previously validated three-dimensional to two-dimensional image registration technique was used to obtain the kinematic data. Anteroposterior (AP) translation of the medial and lateral femoral condyles, and axial rotation relative to the tibial plateau, were analyzed. The data were assessed using the Mann-Whitney test. RESULTS: At time of follow-up, there were differences in the AKS knee scores (P = 0.005), AKS function scores (P = 0.025), patella scores (P = 0.015), and postoperative range of motions (P = 0.004) between the PS group and the CR group. In the PS group, the magnitude of AP translation for the medial and lateral condyle was 4.9 ± 3.0 mm and 12.8 ± 3.3 mm, respectively. Axial rotation of the tibial component relative to the femoral component was 12.9 ± 4.5°. In the CR group, the magnitude of AP translation for the medial and lateral condyle was 4.3 ± 3.5 mm and 7.9 ± 4.2 mm, respectively. The axial rotation was 6.7 ± 5.9°. There were statistically different between PS group and CR group in kinematics postoperatively. CONCLUSION: Our results demonstrate that postoperative JL elevation had more adverse effects on the clinical and kinematic outcomes of CR TKAs than PS TKAs.

[Influence of the insert design on clinical results and kinematics of the knee after total knee arthroplasty].

OBJECTIVE: To investigate the influence of the insert design of knee prosthesis on clinical results and kinematics of the knee after total knee arthroplasty (TKA). METHODS: Forty-two knees in 28 patients with knee osteoarthritis undergoing TKA using the GENESIS II from July 2007 to June 2009 were included in this study, mean follow-up of 27.7 months. The cases were divided into 2 groups according to the type of insert, one was high flexion insert group (23 knees) and the other was standard insert group (19 knees). Two groups were compared by clinical ratings of knee function. The motion of flexion and extension of the two groups was observed by cyclic fluoroscopy and the data was analyzed by mapping software. The influence of the insert design of knee prosthesis on kinematics of the knee after TKA was investigated by comparing the parameters of the two groups during the movement of knee joint, including femoral roll back and extensor mechanism arm. RESULTS: The range of motion of standard insert group and high flexion insert group was 120° and 123° respectively with no difference between them. There was no difference of knee society clinical rating system in both groups. Feller score of high flexion insert group was higher than the standard insert group, the difference was significant statistically (P = 0.012). In the imaging measurement, the two groups had no differences in femoral rollback and extensor mechanism arm during the 0 to 120° range of movement. The two groups appeared significant statistically (P = 0.034) in the extensor mechanism arm when flexion extended to 130°. CONCLUSIONS: The high flexion improved design may play a certain role on reducing anterior knee pain and improving knee function after TKA. However, the improved design may be reduced the extensor mechanism arm when high flexion, so that affecting the work ability of quadriceps.

[Radiographic appraisal between metal and bone interosculate backfill after total hip arthroplasty with trabecular metal cup].

OBJECTIVE: To evaluate the bone refilling in the interface between the trabecular metal (TM) acetabular shell and the bone surface according to consecutive X film measuring after surgery. METHODS: From July 2006 to July 2007, 35 patients (40 hips) accepted total hip replacement using trabecular metal monoblock acetabular cup system (TM). The cup was made of a ellipse shaped press fit Tantalum shell and high cross-linked PE liner (Longevity) with 28 mm inner diameter. The patients demography was: 16 male (20 hips), 19 female (20 hips), 5 bilateral hip replacements, age from 41 - 71 (mean 53), including 18 avascular necrosis hips, 16 osteoarthritis hips (including those secondary to a dysplasia hip), 4 avascular necrosis hips after femoral neck fracture, 2 Ankylosis Spondylitis. All the 40 total hip replacements used posterior approach, using hemispherical acetabular reamer and 2 mm press fit of final metal shell without screw fixation. The consecutive X film was taken at the end time of surgery and 2, 6, 12, 24 weeks, and 12 months. The clinical results was evaluate according to Harris scoring system, and the standard pelvis AP X film was measured at the interface between metal shell and the acetabular bone surface, witch was divided into five regions (A, B, C, D, E). RESULTS: Totally 32 patients (37 hips) were followed with average 8.7 months (7 - 12 months). The Harris before surgery was 50.5 (32 - 85), promoted to 91.0 (72 - 100), including 29 excellent, 6 good, 2 fair, and the total excellent and good rate was 94.6%. Complications include 4 patients leg length discrepancy from 1 - 2 cm, 3 patients moderate thigh pain and released after conservative therapy. No infection and dislocation was found. Twenty-one patients (23 hips) were found lucent line at the bone-metal interface from 1 - 5 mm, most common in B region and BC boundary than C, D, and CD boundary. All the patients followed was found the lucent line disappeared and refilled with bone at X film 24 weeks after surgery, however, no patients was found osteolysis and cup migration. CONCLUSION: The trabecular metal has strong capacity of bone conductive and bone inducement.