Improving Tibial Component Coronal Alignment During Total Knee Arthroplasty with the Use of a Double-Check Technique.

OBJECTIVE: To compare the efficacy of the restoration of tibial component coronal alignment with a double-check technique and the conventional surgical technique during total knee arthroplasty (TKA) in knee osteoarthritis patients, and to investigate the distribution of the medial proximal tibial angle (MPTA) after TKA. METHODS: A retrospective review was performed of 151 patients (179 knees) with knee osteoarthritis undergoing primary TKA in Beijing Chaoyang Hospital, Capital Medical University from February 2013 to January 2015 to evaluate the differences in MPTA in patients undergoing the conventional TKA and those undergoing a modified TKA with a double-check technique after the surgery. All patients were evaluated by MPTA, range of motion (ROM), Knee Society Clinical Rating System (KSS) clinical scores, and KSS functional scores. An MPTA deviation of 3° or greater was considered malalignment. RESULTS: A total of 130 TKA procedures in 119 patients were included in the study: 64 knees treated with conventional TKA and 66 knees treated with the double-check technique TKA. The mean postoperative MPTA was 88.6° ± 2.2° in the conventional TKA group and 89.1° ± 1.5° in the double-check TKA group. The mean postoperative MPTA between the two groups was not significantly different. In the conventional TKA group, 79.7% (51 knees) had a postoperative MPTA deviation within 3° and 20.3% (13 knees) had a MPTA deviation greater than 3°. In the double-check TKA group, 93.9% (62 knees) had a postoperative MPTA deviation within 3°and 6.1% (4 knees) had a MPTA deviation greater than 3°. The postoperative MPTA deviation within 3° showed a statistically significant difference between the two groups. In the double-check TKA group, a 21.2% (14 knees) tibial malalignment was detected after the first check and a 9.1% (6 knees) tibial malalignment was detected after the second check. The mean postoperative ROM was 118.1° ± 9.2° in the conventional TKA group and 115.7° ± 10.1° in the double-check TKA group. The mean postoperative KSS clinical score was 89.3 ± 3.5 in the conventional TKA group and 89.0 ± 3.7 in the double-check TKA group. The mean postoperative KSS functional score was 84.8 ± 10.0 in the conventional TKA group and 84.9 ± 9.0 in the double-check TKA group. The mean postoperative ROM, KSS clinical scores, and KSS functional scores between the two groups were not statistically significantly different. CONCLUSION: Malalignment of the tibial component can occur after conventional TKA, and the double-check technique is an effective method to improve tibial component coronal alignment.

Protective Effects of Prunasin A against the Differentiation of Osteoclasts and Destruction of Cartilage via the Receptor Activator of Nuclear Factor-Kappa-Β Ligand/Mitogen-Activated Protein Kinase/Osteoprotegerin Pathway in a Rat Model of Arthritis.

The present study evaluated the protective effects of pseurotin A against inflammation and the destruction of cartilage in a rat model of rheumatoid arthritis (RA). RA was induced by intradermal injections of Freund's complete adjuvant (1 mg/mL), and the treatment with pseurotin A (50 and 100 mg/kg, p.o.) was administered over 1 week. The effects of pseurotin A were assessed by estimating hind paw volume (HPV) and determining the levels of inflammatory mediators in the serum and synovial fluid of collagen-induced arthritis (CIA)-induced RA rats. Western blot and histopathological assays were performed to assess changes in synovial tissues. Additionally, in vitro analyses of receptor activator of nuclear factor-kappa-Β ligand (RANKL)-stimulated RAW264.7 cells treated with pseurotin A at different concentrations (1, 10, and 100 µg/mL) were conducted to assess the effects of pseurotin A on apoptosis ratio, real-time polymerase chain reaction data, and tartrate-resistant acid phosphatase staining. Compared to the RA group, treatment with pseurotin A significantly decreased HPV and reduced the levels of inflammatory mediators in the synovial fluid and blood. Additionally, pseurotin A ameliorated the protein expressions of osteoprotegerin, nuclear factor of activated T-cells, nuclear factor-kappa beta (NF-κB), IκBα, extracellular signal regulated kinase, and P38 as well as histopathological changes in the synovial tissue of CIA-induced RA rats. The in vitro findings revealed that pseurotin A treatment did not alter the apoptosis ratio in RANKL-stimulated RAW264.7 cells but significantly reduced the mRNA expressions of calcitonin receptor, NF-κB, and matrix metallopeptidase-9. The present findings suggest that pseurotin A ameliorated the differentiation of osteoclasts and the destruction of cartilage in RA rats via regulation of the mitogen-activated protein kinase/RANKL/NF-kB pathway.

Mechanistic evaluation of anti-arthritic activity of ß-methylphenylalanine in experimental rats.

Arthritis is a common chronic joint disorder, with general symptoms including stiffness and joint pain. ß-methylphenylalanine is a well-known non-proteogenic unnatural amino acid. This study analyzes the anti-arthritic activity of ß-methylphenylalanine in experimental rats. The experimental groups were as follows: group I, sham; group II, control; group III, 100 mg/kg of ß-methylphenylalanine; and group IV, 200 mg/kg of ß-methylphenylalanine. Lipid peroxidation, glutathione peroxidase (Gpx), reduced glutathione (GSH), superoxide dismutase (SOD), catalase, prostaglandin E2 (PGE2), matrix metalloproteinase-3 (MMP-3), ceruloplasmin, zinc, copper, mRNA, and protein expression of inducible nitric oxide synthase (iNOS) and nuclear factor-kappa B (NF-κB) were determined. Supplementation with ß-methylphenylalanine significantly reduced lipid peroxidation, copper, PGE2 and MMP-3 levels, whereas GSH, Gpx, catalase, SOD and zinc levels were increased. Supplementation with ß-methylphenylalanine significantly reduced NF-κB mRNA expression by 26% and 47.8% in groups III and IV, respectively (P < 0.045), while iNOS mRNA expression was reduced by 14.3 and 47.6% in groups III and IV, respectively. NF-κB and iNOS protein expression increased by 160% and 120% respectively, in the control rats compared to the sham rats. However, supplementation with ß-methylphenylalanine significantly reduced NF-κB protein expression by 27% and 50% in groups III and IV, respectively, while iNOS protein expression was reduced by 22.7% and 45.4% in groups III and IV, respectively. Taken together, our data show that supplementation of ß-methylphenylalanine was effective against arthritis in a rat model.

Selenium Nanoparticles Dispersed in Phytochemical Exert Anti-Inflammatory Activity by Modulating Catalase, GPx1, and COX-2 Gene Expression in a Rheumatoid Arthritis Rat Model.

BACKGROUND Literature shows that serum selenium concentration is low in rheumatoid arthritis (RA) patients. Biochemical properties of nanoparticles (NPs) are depend in its medium dispersed. Biochemical properties could effectively alter the therapeutic potential of NPs. Phytochemicals could serve as suitable medium for dispersion of NPs. P-Coumaric acid (CA) known to have anti-inflammatory activity. MATERIAL AND METHODS In the present experiment, we investigated the anti-inflammatory effect of SeNPs dispersed in 1% CA against Complete Freund's adjuvant induced RA. Celecoxib was used as a reference drug. RESULTS Selenium NPs (SeNPs) size is maintained in 1% CA solution. We observed that supplementation with 500 µg/Kg body weight (b.w.) eNPs significantly restored the levels of thiobarbituric acid reactive substances, COX-2 activity, different antioxidant enzyme activities, and inflammatory cytokines (TNF-α, IL-1ß, IL-6, and MCP-1) in RA rats. The mRNA expression of antioxidant enzymes such as MnSOD, Cu/ZnSOD, ECSOD, CAT, and GPx1 was found to be downregulated, whereas COX-2 was upregulated in RA rats; however, the mRNA expression of CAT, GPx1, and COX-2 reverted back to near normal levels in SeNPs-treated animals. CONCLUSIONS The therapeutic potential of SeNPs was confirmed through histological observation of angle joints in different experimental animals. Our results collectively suggest that SeNPs dispersed in CA can be an effective therapeutic agent for inflammatory disorders like acute gouty arthritis.

Intact, pie-crusting and repairing the posterior cruciate ligament in posterior cruciate ligament-retaining total knee arthroplasty: A 5-year follow-up.

BACKGROUND: The posterior cruciate ligament (PCL) is important for cruciate-retaining (CR) total knee arthroplasty (TKA). Whether the entire PCL should be retained during CR-TKA is controversial. AIM: To evaluate the clinical outcomes of PCL preservation in CR-TKA and the methods used to deal with the PCL during surgery. METHODS: A retrospective review of patients with osteoarthritis undergoing primary CR-TKA (176 patients, 205 knees) in our institution between March 2012 and March 2014 was performed. A PCL protector was used to preserve the intact PCL bone block. The status of the PCL was recorded during surgery. Intact PCL preserved, pie-crusting and repairing were used to balance the tension of the PCL. Range of motion (ROM) and the Knee Society Clinical Rating system (KSS) were evaluated preoperatively and at the endpoint of follow-up. RESULTS: The mean ROM of the knee was 103.2 ± 17.2°, KSS clinical score was 47.6 ± 9.5 and KSS functional score was 46.3 ± 11.9 before surgery. The mean ROM of the knee was 117.5 ± 9.7°, KSS clinical score was 89.2 ± 3.6 and KSS functional score was 84.6 ± 9.8 at 5 years follow-up. ROM, KSS clinical scores and KSS functional scores were significantly improved after surgery (P < 0.01). Thirty-two (23.7%) TKAs involved PCL pie-crusting and 18 (13.3%) involved PCL repair. Eighty-five (63.0%) TKAs applied standard operating procedures and preserved intact PCL. At 5 years follow-up, in the intact PCL group, the mean ROM of the knee was 118.0 ± 8.3°, KSS clinical score was 89.1 ± 3.7 and KSS functional score was 84.9 ± 9.6. In the PCL pie-crusting group, mean ROM of the knee was 114.0 ± 13.5°, KSS clinical score was 88.8 ± 3.4 and KSS functional score was 83.8 ± 10.5. In the PCL repair group, mean ROM of the knee was 120.3 ± 7.0°, KSS clinical score was 89.0 ± 3.6 and KSS functional score was 89.4 ± 4.5. There were no significant differences in ROM, KSS clinical scores and KSS functional scores among the three groups (P > 0.05). CONCLUSION: The clinical outcomes of preserving the PCL in CR-TKA are encouraging. Pie-crusting and PCL repair do not affect the function. The PCL protector effectively protected the PCL bone block.

Open Patellar Tendon Tenotomy and Debridement Combined with Suture-bridging Double-row Technique for Severe Patellar Tendinopathy.

OBJECTIVE: To create a new surgical procedure for chronic severe patellar tendinopathy and to evaluate its clinical efficacy. METHODS: In this retrospective study, the data of 12 patients with severe patellar tendinopathy in 14 knees who had undergone surgical treatment at Beijing Chao-Yang Hospital between 1 March 2009 and 1 August 2013 were analyzed. Inclusion criteria included severe patellar tendinopathy (Phase III), conservative therapy for more than 6 months, American Society of Anesthesiology status Grade I-II, and body mass index <30. Patients with severe osteoporosis, complete tendon disruption (Phase IV) and those who were unable to cooperate were excluded. There were 8 men (10 knees) and 4 women (4 knees) cases. The patients' ages ranged from 38 to 54 years (mean, 45.3 years). All surgeries had been performed by the same physician. Surgical treatment comprised incising open patellar midline tenotomy, complete debridement and suture-bridging double-row fixation. Isotonic and kinetic chain exercises were implemented after the second post-operative week. A gradual increase to full weight-bearing was allowed after the third post-operative week and a gradual return to unrestricted use of the leg after the eighth post-operative week. Preoperative and postoperative visual analogue scale (VAS) scores and Lysholm knee scores were obtained from the medical records or at recent postoperative follow-up visits and the results compared using Student's two-tailed paired t-test. RESULTS: VAS scores decreased by a mean of 6.7 points (range, 1.1-7.8 points) during follow-up (minimum duration 14 months; range, 14-44 months) and Lysholm scores increased from 55.7 ± 6.5 points to 90.4 ± 6.2 points. Three cases (4 knees) achieved excellent outcomes (≥95 points) and 9 cases (10 knees) good outcomes (range, 86-94 points). No intraoperative or postoperative complications occurred. There were significant differences between preoperative and postoperative VAS and Lysholm scores (P < 0.01). CONCLUSIONS: All study patients achieved good or excellent outcomes. No patellar tendon rupture or suture fixation failure occurred during follow-up. Suture-bridging double-row fixation is a simple and reliable method that not only improves patients' clinical symptoms, but also restores knee joint function.