Clinical Efficacy of Preoperative CT-Assisted Planning for Primary Total Knee Arthroplasty: A Pilot Randomized Clinical Trial.

This study aims to determine the mean posterior condylar angle (PCA) in the included population and its relation to coronal alignment; and to know the clinical importance of the use of preoperative computed tomography (CT) scan in total knee arthroplasty (TKA). We randomized 50 patients with primary knee osteoarthritis into 2 groups. We used CT scan axial images to measure the PCA. In the first group we followed the CT scan plan (group 1), but in the second we did not follow the plan and adjusted rotation to the standard three degrees (group 2). The mean age of the included patients was 63 years. The radiological data of the included patients showed 5 patients with valgus deformity and 45 patients with varus deformity with the mean coronal alignment of 7.5 degrees. CT scan showed the mean PCA of 3.7 degrees (1.3 degrees). The axial knee postoperative X-ray showed the mean patellar tilt angle of 2.1 degrees (0.5 degrees) and 1.9 degrees (0.5 degrees) in groups 1 and 2, respectively. The congruence angle was 4 degrees (2.6 degrees) in group 1 and 5.5 degrees (3.2 degrees) in group 2. The median Knee Society functional score in group 1 was 85 (12), while it was 84 (7.5) in group 2. The median postoperative Western Ontario and McMaster Universities Arthritis Index score in group 1 was 84 (18.6) whereas 80.2 (13.6) in group 2. The median postoperative Bartlett score in group 1 was 30 (5), while it was 30 (6) in group 2. The use of preoperative CT scan did not improve the patient functional scores after TKA.

Solving the enigma of posterolateral tibial plateau fractures, the clue protocol.

The study aim is to evaluate functional and radio- logical outcomes following a suggested protocol based on the four-column classification for management of posterolateral column tibial plateau fractures. A prospective cohort study was performed in level I academic center on 42 patients with mean age of 36 years (22-59). Eleven patients had isolated posterolateral column fractures whereas 31 patients had associated columns fractures. According to the suggested protocol, all cases of isolated posterolateral column fracture started treatment via arthroscopic evaluation of soft tissue injuries (menisci and liga- ments), arthroscopically assisted reduction and inter- nal fixation by rafting screws followed by ORIF if plating was needed. If associated with other columns fractures, columns were fixed sequentially in an anti-clockwise direction starting from anteromedial column. Average follow up was 26 months. Mean time to union was 16.3 (12-22) weeks. No radiological evidence of loss of coronal or sagittal alignment was detected at final follow up. Five patients had an average depression of 5 millimeters that did not need further intervention at this short-term follow up. Mean KOOS was 81 (72- 88). The average knee range of motion was (0° - 127°). One patient had temporary common peroneal nerve injury, one patient had deep infection and two had superficial wound infection. implementing the suggested protocol gives good to excellent radiological and functional results as regard posterolateral tibial plateau fracture. A larger study group with longer follow up is needed.

Potential emerging roles of the novel adipokines adipolin/CTRP12 and meteorin-like/METRNL in obesity-osteoarthritis interplay.

BACKGROUND: Several insights into obesity-osteoarthritis (OA) relationship have been recently highlighted. Adipolin and metrnl are new adipokines also secreted by chondrocytes. However, their role in OA, and obesity-OA interplay hasn't been elucidated. Therefore, this study was designed to investigate the circulating as well as synovial fluid (SF) levels of adipolin and metrnl in osteoarthritic-patients compared to non-osteoarthritic subjects, and to study their association with OA-severity, dyslipidemia and insulin resistance (IR). METHODS: Patients with osteoarthritis and obesity (n = 30), and subjects with obesity not suffering OA (n = 25) were enrolled in the current study. Circulating and SF-levels of adipolin, metrnl, and insulin, as well as SF-levels of matrix-metalloproteinase-13 (MMP-13) were measured by ELISA. Knee-radiographs using X-ray were done to determine OA-severity, and investigate its association with adipokines' levels. RESULTS: Serum and SF-adipolin levels showed tendency to be lower in OA-patients compared to non-OA-subjects; serum: 0.64 [0.45-0.85] and 0.73 [0.62-0.78] ng/ml, p = 0.174, and SF: 0.53 [0.34-0.69] and 0.63 [0.44-0.74] ng/ml, p = 0.353, respectively. Additionally, serum adipolin showed negative-association with SF-MMP-13. However, when stratifying OA-patients into various severity grades, serum adipolin levels did not show a significant difference between them. Regarding serum metrnl, it was significantly lower in OA-patients compared to non-OA-subjects; 19.68 [10.40-53.40] and 48.83 [20.80-86.60] pg/ml, respectively, p = 0.018. Surprisingly, SF-metrnl levels were higher in OA-patients compared to non-OA-subjects; 912 [367-1524] and 315 [125-484] pg/ml, respectively, p = 0.007. SF-metrnl showed positive-association with insulin resistance, and negative-association with SF-MMP-13. Moreover, higher serum metrnl levels were found to be slightly associated with lower likelihood of OA in subjects with obesity; OR = 0.978, CI (0.960- 0.996), p = 0.02, and its levels were also found to be relatively lower in grade-4 compared to the less severe OAgrades. CONCLUSIONS: Metrnl, and to a lesser extent adipolin seem to be interrelated with OA. Different in-context regulatory mechanisms for metrnl production from various tissues are strongly suggested. Importantly, the findings of the current study shed lights on metrnl as a potential novel mediator and therapeutic target to consider in obesity-OA interplay.

Insight into the possible role of miR-214 in primary osteoporosis via osterix.

Osteoporosis is a bone disease characterized by chronic pain and recurrent fractures. Osterix is a transcription factor regulating bone formation. miR-214 was found to have a role in skeletogenesis. Our goal was to investigate the possible role of miR-214 in primary osteoporosis through osterix. Their expression was determined in bone samples obtained from primary osteoporotic patients (n = 26) and age- and sex-matched controls (n = 14). Additionally, their expression was correlated to the laboratory and clinical parameters of the study participants. Differential expression of osterix and miR-214 was detected in the osteoporotic group compared to controls. While miR-214 was significantly higher, osterix was significantly lower. In primary osteoporotic patients, relative quantification value of osterix was positively correlated with sex, body mass index, and ionized calcium and negatively correlated with miR-214 and C-reactive protein. Thus, the role of miR-214 in primary osteoporosis could be through inhibiting osterix expression in bones and therefore both miR-214 and osterix could be targets for future therapeutic intervention.

Autophagy in osteoporosis: Relation to oxidative stress.

Impaired autophagy and oxidative stress are implicated in the development of many diseases. This study aimed to investigate the involvement of autophagy represented by autophagy-related gene 7 (Atg7) and oxidative stress represented by superoxide dismutase 2 (SOD2) gene expression and enzyme activity in the pathogenesis of osteoporosis. Atg7 and SOD2 gene relative expression were evaluated by SYBR green quantitative real-time-polymerase chain reaction in the osteoporotic group (n = 26) versus the osteoporosis free group (n = 14). SOD2 enzyme activity was evaluated by colorimetric method in both study groups. Both Atg7 and SOD2 relative expression showed highly significant decrease (P < 0.01) between both groups. However, SOD2 enzyme activity showed no significant difference between the two groups. There was a significant direct correlation between Atg7 and SOD2 gene expression in both study groups. Atg7 relative expression showed significant ( P < 0.01) direct correlation with vitamin D serum levels and body mass index in osteoporotic group. In conclusion, both genes are involved in the pathogenesis of osteoporosis and this could be amenable to future therapeutic intervention.

Single-Incision Double-Plating Approach in the Management of Isolated, Closed Osteoporotic Distal Femoral Fractures.

INTRODUCTION: Distal femoral fractures in elderly population had recorded an increase in incidence in the last 2 decades. Lateral distal femoral locking plating is considered one of the best options especially when dealing with comminuted fractures but varus collapse of the medial femoral condyle occurs frequently in patients with osteoporosis. Anatomical reduction of the fracture with stable rigid fixation using double-plating approach allows early mobilization of geriatric population and prevents varus collapse minimizing the comorbidities in such fractures. PATIENTS AND METHODS: Between September 2014 and January 2017, a prospective study on 23 patients with comminuted osteoporotic distal femoral fractures managed through the double-plating approach through a single parapatellar approach has been conducted. Only osteoporotic geriatric patients with isolated distal femoral fractures were included. Polytraumatized, open fractures, and fracture type 33-A1, 33-A2, and 33-B were excluded. The mean age was 69.6 years (61-80). All patients have been evaluated as regard duration of procedure, time to union, EQ-5D-5L score, the need of autologous bone grafts, range of knee motion, and presence of complications. RESULTS: The average follow-up was 14.1 months. The majority of fractures were type 33-C2 (13 patients). Average procedure time was 148 minutes (117-193 minutes). Mean EQ-5D-5 L score was 83.8 (72-82). Average time to union was 9 months (3-12 months). Four (17.4%) cases needed autologous bone graft after 6 months. No loss of reduction in any of the cases was evident, although 6 (26%) cases had screw breakage or cutout in one of the plate fixation. Two (8.7%) patient developed superficial wound infection and 1 (4.3%) developed DVT. DISCUSSION: This study aimed at evaluation of the success of double plating of distal femoral fractures in geriatric population. different fixation methods were studied for reduction and fixation of such a fracture such as external fixation, intramedullary nails and lateral plating. the quality of fracture reduction, functional and radiological outcomes, time to union, the need for bone grafting and complication are the main debatable issues. CONCLUSION: Single-incision double-plating approach for distal femoral osteoporotic fractures is effective and provides stable construct without reduction loss allowing early rehabilitation. Delayed union and the need for bone graft are the major drawbacks for this technique.

Expression of nucleostemin gene in primary osteoarthritis.

INTRODUCTION: The identification of genes associated with osteoarthritis can help reveal underlying biological mechanisms that may lead to development of new therapeutic targets or biomarkers for early detection and risk stratification. Nucleostemin (GNL3) is a nucleolar GTPase initially identified in the nucleolus of rat neural stem cells. The current study was conducted to determine the expression of nucleostemin gene in the synovium and synovial fluid of patients with primary osteoarthritis and to correlate its expression to the different clinicopathological factors of the disease. PATIENTS AND METHODS: It included 31 patients with primary knee osteoarthritis and 25 osteoarthritis free patients served as a control group. Synovial tissue and synovial fluid samples were obtained directly from each patient for real time PCR of GNL3. RESULTS: Relative expression of GNL3 in synovial tissue and fluid samples was significantly higher in the osteoarthritic group as compared to the non-osteoarthritic group. GNL3 relative expression in both samples showed a significant difference among different BMI categories and among different radiographic grades of osteoarthritis. A high significant correlation was found between GNL3 relative expression levels in synovial tissue samples and those of synovial fluid samples with concordance of 85.7%. CONCLUSION: Nucleostemin could serve as a powerful prognostic marker for clinical use in osteoarthritis and its usefulness needs to be standardized and validated in a large-scale prospective multicentric study.