Application of enhanced recovery after surgery in perioperative nursing care of elderly patients with hip and knee arthroplasty: A systematic review and meta-analysis.

BACKGROUND: To collect data from randomized controlled trials (RCTs) to evaluate the effects of enhanced recovery after surgery on postoperative recovery of elderly patients who underwent hip or knee arthroplasty. METHODS: The search was limited to studies published prior to January 1, 2023, in the electronic databases of Cochrane, Embase, Ovid Medline, Proquest, PubMed, Scopus, Web of Science, and Chinese databases, including China National Knowledge Internet (CNKI) and SinoMed. All relevant data were collected from the studies that met the inclusion criteria. The outcome variables were recovery of joint function and incidence of complications. STATA software (version 14.0) was used for the meta-analysis. RESULTS: A total of 44 published studies met the inclusion criteria. The cumulative data included 2203 cases receiving enhanced recovery after surgery (ERAS), and 2173 cases receiving traditional recovery after surgery (non-ERAS). The meta-analysis showed that the VAS score was significantly lower in the ERAS group than in the non-ERAS group (P < .01), and there were fewer incidences of complications in the ERAS group than in the control group (P < .01). CONCLUSIONS: ERAS significantly reduced pain and the incidence of complications in elderly patients who had undergone joint replacement surgery.

Effect of residual volume after surgery of the discoid lateral meniscus on tibiofemoral joint biomechanics: a finite element analysis.

BACKGROUND: The purpose of this study was to investigate the influence of different residual meniscus volume on the biomechanics of tibiofemoral joint after discoid lateral meniscus (DLM) surgery by finite element analysis. METHODS: A knee joint model was established based on CT and MRI imaging data. The DLM model was divided into five regions according to conventional meniscectomy, with volumes of 15%, 15%, 15%, 15%, 15%, and 40% for each region. Additionally, the DLM model was divided into anterior and posterior parts to obtain ten regions. The DLM was resected according to the design scheme, and together with the intact discoid meniscus, a total of 15 models were obtained. Finite element analysis was conducted to assess shear and pressure trends on the knee joint. RESULTS: The study observed significant changes in peak shear stress and compressive stress in the lateral meniscus and lateral femur cartilage. As the meniscus volume decreased, there was an increase in these stresses. Specifically, when the meniscus volume reduced to 40%, there was a sharp increase in shear stress (302%) and compressive stress (152%) on the meniscus, as well as shear stress (195%) and compressive stress (157%) on the lateral femur cartilage. Furthermore, the model grouping results showed that preserving a higher frontal volume in the meniscus model provided better biomechanical advantages. CONCLUSION: The use of finite element analysis has demonstrated that preserving more than 55% of the meniscus volume is necessary to prevent a significant increase in joint stress, which can potentially lead to joint degeneration. Additionally, it is crucial to preserve the front volume of the DLM in order to achieve improved knee biomechanical outcomes.

Effect of mesenchymal stromal cells transplantation on the outcomes of patients with knee osteoarthritis: A systematic review and meta-analysis.

Cell therapy has been explored as a new regenerative treatment for osteoarthritis in the field of regenerative medicine. However, the efficacy of stem cell transplantation from different sources for the treatment of knee osteoarthritis (KOA) remains controversial. This study integrates and evaluates the previously published data of stem cell transplantation for KOA to explore the curative effect of different stem cells. We conducted a meta-analysis of randomized controlled trials on stem cell therapy for KOA. Measures of efficacy included Visual Analog Scale (VAS), Lequesne index, Lysholm Knee Scoring Scale (LKSS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Joint injury was evaluated through the Whole-Organ Magnetic Resonance Imaging Score (WORMS) system. We analyzed 16 studies involving 875 KOA patients. The stem cell treatment showed significant VAS reduction from the third month onwards. Subgroup analysis suggested the most significant pain relief at different postoperative months came from adipose-derived and umbilical cord-derived stem cells. Autologous adipose tissue resulted in better pain alleviation compared with allogenic. However, autologous bone marrow stem cells did not show increased pain relief over allogeneic ones. Combination therapy (HA and/or PRP) showed no effect. Autologous adipose-derived stem cells demonstrate the most effective recovery of knee joint function. In WORMS assessment, there was no significant difference between the stem cell group and control. Stem cell transplantation proved safe and effective for KOA treatment. Different sources stem cells have a good effect on alleviating knee joint pain, restoring knee joint function, and minimizing patient trauma.

Mechanism of TNF- α inducing apoptosis and autophagy of chondrocytes by activating NF- κ B signal pathway.

This study aimed to explore the mechanism of apoptosis and autophagy of chondrocytes induced by tumor necrosis factor α (TNA-α) by activating the NF-κB signal pathway. For this purpose, 24 SD rats were selected for feeding. The knee cartilage was cut by ophthalmology and the chondrocytes were extracted. The chondrocytes were randomly divided into a control group (CG) and an observation group (OG). TNF-α of 50ng/mL was added before the beginning of the study, while the control group did not receive any treatment. The levels of IL-1, IL-6, IL-12, autophagy markers (Atg5, Atg7, LC3II/I), apoptosis-related indexes (Bax, Bcl-2), NF-κB signal pathway-related indexes (p-p65, p65, IκBα) protein expression, mRNA expression and apoptosis rate in chondrocytes were compared in each group. Results showed that the levels of IL-1, IL-6 and IL-12 in the OG were raised than those in the CG. The expression levels of autophagy markers Atg5, Atg7, LC3II/I and mRNA in the OG were reduced than those in the CG. The apoptosis rate and the expression of BaxmRNA and protein in the OG were higher than those in the CG, while the expression of Bcl-2mRNA and protein were lower than those in the CG. The p-p65, p65, IκBα protein and mRNA related to NF-κB signal pathway in the OG were raised than those in the CG. In conclusion, TNF-α can induce apoptosis and autophagy of chondrocytes by activating the NF-κB signal pathway.

[Clinical anatomical study on high congenital dislocation of hip in adults].

OBJECTIVE: To investigate the morphological anatomical abnormalities of high congenital dislocation of hip in adults and provide anatomical basis for the total hip arthroplasty (THA). METHODS: From May 1997 to July 2008, 49 patients (57 hips) with high congenital dislocation of hip (Hartofilakidis type III) were treated. There were 6 males and 43 females with an average age of 29.4 years old (18-56 years old). The locations were left in 24 hips and right in 33 hips. The morphological parameters (including femoral length, isthmus, height of femoral head center, neck-shaft angle, medial head offset, anteversion angle, canal flare index, anteroposterior diameter of the true acetabulum, posterior thickness of the true acetabulum, depth of the true acetabulum) of suffering hips (dislocation group, n=57) were measured by preoperative X-ray, CT and intraoperative clinical observation and were compared with those of contralateral hips (control group, n=41). The intraoperative situations of hip were observed. RESULTS: The height of dislocation was (45.41 +/- 2.15) mm. The length difference of both lower extremities was (40.41 +/- 2.02) mm. In dislocation group, isthmus was shortened; height of femoral head center, neck-shaft angle and medial head offset were decreased; and anteversion angle was increased. CT showed that the canal flare index was larger than 4.7, femoral shape was funnel-shaped according to Noble classification. Anteroposterior diameter of the true acetabulum became smaller, posterior thickness of the true acetabulum became thicker, and depth of the true acetabulum was shallower. There were statistically significant differences in the morphological parameters of femur and acetabulum between two groups (P < 0.05). The intraoperative measurements showed that the anteroposterior diameter of acetabulum was (32.98 +/- 1.02) mm and the depth of acetabulum was (14.21 +/- 0.56) mm. There was no statistically significant difference between intraoperative measurements and preoperative measurements (P > 0.05). The acetabulum was full of fat and fibrous tissues. Running of the sciatic nerve in 40 cases were changed and it ran upward and laterally. CONCLUSION: When high congenital dislocation of the hip in adults is treated with THA, anatomical variation must be fully taken into account. The acetabulum is expanded toward posterosuperior, excessive reamed should be avoided to prevent femoral fractures, and appropriate or tailor-made prosthesis was selected.