Effect of alendronate sodium plus vitamin D3 tablets on knee joint structure and osteoarthritis pain: a multi-center, randomized, double-blind, placebo-controlled study protocol.

BACKGROUND: Osteoarthritis (OA) is a major cause of pain and disability worldwide. Despite the relatively high burden of the disease, the currently available non-surgical treatment options are directed towards symptomatic relief. Therefore, we propose the use of alendronate as a disease modifying agent to help slow and prevent OA. In addition, this study will utilize Whole-Organ Magnetic Resonance Imaging Score (WORMS) to evaluate the structural integrity of cartilage in the study population. High-quality evidence, limited to a few well-conducted randomized trials, highlights contradictory results on the effect of bisphosphonates on knee function and progression of OA. Therefore, a placebo-controlled, randomized trial is needed to evaluate the combined effect of alendronate and vit D on the structure of cartilage utilizing the WORMS score and its ability to treat knee pain in OA patients. METHODS: This multicenter, randomized, double-blinded, placebo-controlled study will evaluate the efficacy and safety of alendronate in early OA. Patients will undergo a 1:1 double-blinded randomization to receive a one-year course of either alendronate sodium vitamin D3 or placebo. The primary outcome is to compare WORMS score of knee joint at 6 and 12 months between both groups. Secondary endpoints will include WORMS score at 24 months, knee pain, radiographic progression of OA, severity of OA, quality of life, and serum inflammatory biomarkers at different assessment timepoints. To detect a 2.2% difference in cartilage loss between both groups with power of 80%, a sample size of 60 (30 per group) is proposed. DISCUSSION: This trial will give helpful and high-quality evidence regarding the potential therapeutic role of alendronate sodium vitamin D3, as compared to placebo, in the management of patients with knee OA regarding its role on cartilage loss, radiographic progression of OA, severity of OA, knee pain, quality of life, and inflammatory biomarkers. If proven effective, this intervention would be a great option for providing beneficial outcomes with a reduced cost in this patient population. TRIAL REGISTRATION: This trial was registered on clinicaltrials.gov (registration number: NCT04739592 ).

Possible Risk Factors for Severe Complications Occurring after Primary Total Knee Arthroplasty.

Objective Total knee arthroplasty is one of the most common orthopedic surgeries. Readmission due to severe complications after total knee arthroplasty is a grave concern to surgeons. In this study, we evaluated the risk factors for severe complications after primary total knee arthroplasty. Methods We retrospectively collected clinical data of 2,974 patients who underwent primary total knee arthroplasty from July 2013 to June 2019 in our hospital. Postoperative complication ≥ grade Ⅲ was defined as severe complication according to Clavien-Dindo classification system. Binary logistic regression was used to identify the predictive risk factors for severe complications. Results The complication rate after primary total knee arthroplasty was 6.8% and severe complication rate was 2.5%. Male (OR = 2.178, 95%CI: 1.324-3.585, P= 0.002), individuals above 75 years old (OR = 1.936, 95%CI: 1.155-3.244, P= 0.012), arrhythmia (OR = 2.913, 95%CI: 1.350-6.285, P= 0.006) and cerebrovascular disease (OR = 2.804, 95%CI: 1.432-5.489, P= 0.003) were predictive risk factors for severe complications after primary total knee arthroplasty. Conclusion Advanced age, male, arrhythmia, and cerebrovascular disease might be patients-related risk factors for postoperative severe complications after primary total knee arthroplasty. Special attention should be paid to patients with risk factors.

[Clinical Characteristics of 68 Patients with Osteoarticular Tuberculosis].

Objective To analyze the clinical features of patients with osteoarticular tuberculosis. Method This retrospective study included a cohort of 68 osteoarticular tuberculosis patients hospitalized in Peking Union Medical College Hospital from January 2013 to December 2020.Results The patients included 42(61.8%)males and 26(38.2%)females,with a median age of 56 years.Tuberculosis pathogen was detected in 39(57.4%)patients,and 29(42.6%)patients were diagnosed by clinical manifestations.The median time from onset to diagnosis was 4 months.The most common manifestations were pain and dysfunction(86.8%),followed by fever(47.1%),weight loss(36.8%),and night sweats(13.2%).Concomitant active tuberculosis in other organs was observed in 27(39.7%)patients.Unifocal and multifocal osteoarticular tuberculosis occurred in 51(75.0%)patients and 17(25.0%)patients,respectively,which mainly attacked thoracic and lumbar spines.Tuberculosis T cell test was positive in 92.7% patients.All the bone biopsies revealed epithelioid granuloma with/without necrosis,with 75.0% positive for mycobacterial DNA,55.1% positive for mycobacterial culture,and 20% positive for acid-fast staining.The risk of developing multifocal osteoarticular tuberculosis in the patients with weight loss was 5.333 times(P=0.013)that of the patients with stable weight.Conclusions The diagnosis of osteoarticular tuberculosis is difficult and tuberculosis T cell test is an effective means.Bone biopsy is the key to diagnosis,and the PCR of mycobacterial DNA shows the highest positive derection rate.Multifocal osteoarticular tuberculosis is not rare,especially in the patients with weight loss.Thus,a comprehensive imaging evaluation is recommended to avoid missed diagnosis.

[Research Advances of Human Homologue of Mouse Progressive Ankylosis Protein and Bone and Joint Diseases].

The human homologue of mouse progressive ankylosis protein(ANKH)is an inorganic pyrophosphate transport regulator,which regulates tissue mineralization by controlling the level of inorganic pyrophosphate.It plays an important role in the pathogenesis and development of bone and joint diseases,such as ankylosing spondylitis,craniometaphyseal dysplasia,and articular cartilage calcification.This review summarizes the progress of research on ANKH and the above-mentioned diseases.

[Expert consensus on clinical application of Wangbi Tablets in treating rheumatoid arthritis and knee osteoarthritis].

Wangbi Tablets are widely used in the treatment of rheumatoid arthritis, knee osteoarthritis and other diseases at pre-sent. Long-term clinical application and research have shown that this drug has a good effect in reducing the pain of related diseases and improving symptoms. Due to the lack of guidance in the instructions and currently no relevant norms to guide the clinical application of Wangbi Tablets, in order to further improve clinicians' understanding of the drug and fully tap the clinical advantages of the drug, the Professional Committee of Orthopedics and Traumatology Drug Research of China Association of Chinese Medicine organized experts in the fields of rheumatism, orthopedics, pharmacy and methodology in Chinese and western medicine to develop expert consensus on Chinese patent medicines in accordance with the relevant requirements of the consensus methodology. Based on full consideration of clinical research evidence and expert experience, the clinical issues were summarized in the consensus, and for those clinical problems supported by evidences, the internationally recognized recommendation evaluation and formulation method GRADE was used to evaluate the evidence and form recommendations; for those clinical issues not supported by evidences, a consensus was reached through the nominal group method to form consensus recommendations. The consensus adopted a concise and clear format to form re-commendations or reach consensus suggestions on the medication regimen, medication characteristics, intervention timing, usage and dosage, course of use and safety issues for the treatment of rheumatoid arthritis and knee osteoarthritis with Wangbi Tablets. It is suggested that its application will better improve the efficacy of Wangbi Tablets in the treatment of rheumatoid arthritis and knee osteoarthritis, at the same time provide a reference for clinicians to use Wangbi Tablets in a standardized, reasonable and safe manner.

Perioperative Safety of Patients Undergoing Unilateral or Simultaneous Bilateral Total Knee Arthroplasty.

Objective To analyze the perioperative safety of patients undergoing unilateral or simultaneous bilateral total knee arthroplasty(TKA). Methods Totally 500 patients who had undergone unilateral or simultaneous bilateral TKA between December 2014 to December 2015 were retrospectively reviewed. They were divided into two groups:unilateral group(n=310)and bilateral group(n=190).The general data,perioperative transfusion,and complications were compared between these two groups. Results Patients in unilateral group had significantly higher ASA scores(χ2=8.344,P=0.015) and NYHA grade(χ2=7.537,P=0.023)than in bilateral group.Patients in bilateral group had significantly higher posterior drainage volume(t=44.984,P=0.000). Transfusion rate(χ2=42.896,P=0.000) was significantly higher and the lowest postoperative hemoglobin was significantly lower(t=0.006,P=0.000)in the bilateral group. The episodes of transfusion(χ2=1.025,P=0.599) and the amount of transfused packed red blood cells(χ2=3.836,P=0.429) were similar between two groups. There was no significant difference in the length of postoperative hospital stay(t=0.310,P=0.756),admission to intensive care unit(χ2=0.317,P=0.895),and incidences of complications(χ2=0.047,P=0.475). Conclusions For patients with low ASA scores and NYHA grade,simultaneous bilateral TKA is recommended. For older patients with high ASA score,poor cardiac function,and high incidences of complications,unilateral TKA is recommended.

Anesthesia Strategies and Perioperative Optimization for Patients with Ankylosing Spondylitis Undergoing Total Hip Replacement Surgery.

Objective To identify the characteristics of anesthesia and perioperative management for ankylosing spondylitis (AS) patients undergoing total hip arthroplasty (THA). Methods Totally 63 patients scheduled for single THA in PUMC Hospital from January 1st 2013 to June 1st 2015 were included in this retrospective analysis,among whom 21 patients were diagnosed of AS. The perioperative clinical data included:demographic data,American Society of Anesthesiologists (ASA) classification,medical history,airway assessment,preoperative laboratory examinations,electrocardiogram,pulmonary function tests,intubation information,operation time,intraoperative intake and output volume,postoperative hospital stay,and postoperative complications. Results Significantly fewer AS patients undergoing THA were evaluated as ASA classification I than non-AS patients (9.5% vs. 33.3%,P=0.041). AS patients had significantly higher level of preoperative high-sensitivity C-reactive protein [(17.0±14.8)mg/L vs.(4.3±7.1)mg/L,P<0.001],platelets [(275.0±71.3)×10(9)/L vs. (237.7±68.0)×10(9)/L,P=0.048] and neutrophils [(4.7±1.7)×10(9)/L vs. (3.9±1.4)×10(9)/L,P=0.044] and higher incidence of pulmonary function abnormality (42.9% vs.16.7%,P=0.024).More AS patients were induced with scoline (14.3% vs.0,P=0.012). More AS patients underwent THA with Mallampati classification 3 (28.6% vs.7.1%,P=0.022),reduced neck extension(47.6% vs.2.4%,P<0.001),Cormack-Lehane classification2(56.3% vs.15.4%,P=0.002)and 3 (18.8% vs.0,P=0.005),while much fewer AS patients had Cormack-Lehane classification1 (25.0% vs.84.6%,P<0.001).A variety of difficult airway tools were used in intubation (AS group:Macintosh laryngoscope:14%,Macintosh laryngoscope with stylet:38%,visualization laryngoscope:24%,visualization stylet:10% and fiber bronchoscope:14%;non-AS group:57%,24%,12%,5% and 2%,respectively). The use of intraoperative autologous blood transfusion (33.3% vs.11.9%,P=0.041) and postoperative 24 h drainage (61.9% vs.31.0%,P=0.019) were more common in AS group. However,no statistical difference existed in the success rate of first intubation,postoperative hemoglobin,postoperative hematocrit,and postoperative hospitalization(all P>0.05). Conclusions AS patients undergoing THA have elevated preoperative inflammatory markers,with high incidence of pulmonary function abnormality and difficult airway. In consideration of high risk of surgery and anesthesia,adequate airway evaluation and optimization of perioperative management are needed to ensure the patients' safety.

Establishment and assessment of rat models of glucocorticoid-induced osteonecrosis.

OBJECTIVE: To establish the rat models of glucocorticoid-induced osteonecrosis and evaluate the osteonecrosis by high-resolution micro-CT and histomorphology. METHODS: Totally 30 Sprague-Dawley male adult rats (age:12 weeks; body weight:400-450 g) were randomized into two groups:one group received two doses of intraperitoneal injection of lipopolysaccharide (20 µg/kg) at an interval of 24 hours, 24 hours later, the rats received three doses of intramuscular injection of methylprednisolone (40 mg/kg) at an interval of 24 hours; in the control group,the rats received same amount of normal saline. Four weeks later, 5 rats in each group were sacrificed randomly.Eight weeks later, all the remaining rats were sacrificed and the femur specimens were scanned by micro-CT. The trabeculae parameters of the femoral head were calculated. The hematoxylin and eosin staining were performed to calculated the success rate. RESULTS: The incidence of osteonecrosis was 80% in the experimental group. The micro-CT demonstrated broken and cystic degeneration. The quantitative analysis showed that the bone volume/total volume (experimental group:0.55 ± 0.13 vs. CONTROL GROUP: 0.68 ± 0.12;P<0.05), bone surface area / bone volume (experimental group:20.45 ± 5.13 vs. CONTROL GROUP: 24.00 ± 5.20;P<0.05), and trabeculae number(experimental group: 5.67 ± 0.50 vs. CONTROL GROUP: 6.24 ± 0.96; P<0.05) were significantly lower in experimental group than those in control group. CONCLUSIONS: A rat model of glucocorticoid-induced osteonecrosis was successfully established by lipopolysaccharide and methylpredniso- lone. High-resolution micro-CT is useful for the qualitative and quantitative analyses of the morphology and structure of trabeculae, showing good consistence with the histomorphological findings.

Outcome of the treatment of osteonecrosis of femoral head using the core decompression with bone impaction grafting.

OBJECTIVE: To evaluate the outcome of core decompression with bone impaction grafting for the treatment of osteonecrosis of femoral head. METHODS: Totally 39 cases (46 hips) of osteonecrosis of femoral head were treated with core decompression and impaction bone grafting. According to the Association Research Circulation Osseous (ARCO) system, 3 hips were graded for stage 1,16 for stage 2a,7 for 2b,11 for 2c, and 9 for 3.The Harris hip score (HHS) was evaluated before operation and at the latest follow-up. RESULTS: In all these patients, 22 hips had hormone-related lesions, 11 had alcohol-related lesions, and 13 had idiopathic lesions. The average HHS was changed from (66 ± 6.6) before surgery to (80.2 ± 9.7) after surgery during an average follow-up of 26 months(from 9 to 48 months). The postoperative HHS showed no significant difference among osteonecrosis of femoral head due to different etiologies.Also,the postoperative HHS and clinical effectiveness were not significantly different among patients with different preoperative stages.The postoperative outcome was excellent in 7 cases, good in 23 cases, mild in 4 cases,and poor in 12 cases. The rate of excellent and good was 65% in this series,with 78% for patients with early stages and 52.6% for those with grade 2c or higher lesions. The femoral head collapsed in 7 cases,and 5 of which were preoperatively graded as in stage 2c and higher. The postoperative complications included intertrochanteric fracture (n=1) and infection (n=1). Four hips were converted to total hip arthroplasty. All of other hips had no obvious progression of osteonecrosis. CONCLUSIONS: Core decompression with bone impaction allografting is effective for the treatment of osteonecrosis of femoral head. Patients with lesions in earlier ARCO stages can have better outcomes.

Surgical treatment of diffuse pigmented villonodular synovitis of the knee.

OBJECTIVE: To compare the roles of open synovectomy and arthroscopic synovectomy in the treatment of diffuse pigmented villonodular synovitis (D-PVNS). METHODS: Forty-seven patients suffered from D-PVNS of knee joint who underwent surgical treatment with complete follow-up data from March 1994 to October 2013 were retrospectively analyzed. All patients were divided into two groups as open synovectomy group (n=17) and arthroscopic synovectomy group (n=30) according to the surgical procedure. Routine radiation therapy was applied in both groups after the surgery. The mean follow-up period wa s(15.7 ± 16.3) months (range:10-30 month). The range of motion, International Knee Documentation Committee (IKDC) score and Lysholm score before the surgery and at the final follow-up were compared respectively. RESULTS: Recurrence was noted in 8 patients (17.0%), among whom 3 were from the open synovectomy group and 5 from the arthroscopic synovectomy group, resulting a recurrence rate of 17.6% and 16.7%, respectively, in these two groups (P>0.05). The range of motion,IKDC score, and Lysholm score at final follow-up and before the operation were (97.5 ± 14.3)℃ vs.(69.7 ± 12.6)℃, (74.5 ±6.1) vs. (38.6 ± 5.4) scores, and (77.5 ± 5.8) vs. (42.4 ± 4.6)scores, respectively, in the open synovectomy group,and were (128.6 ± 13.9)℃ vs. (64.9 ± 13.2)℃, (87.4 ± 6.7) vs. (37.2 ± 4.9)scores, and (86.2 ± 6.2) vs. (41.9 ± 5.3) cores, respectively, in the arthroscopic synovectomy group (all P<0.05). Obviously,the range of motion,IKDC score, and Lysholm score at the final follow-up were significantly superior to the pre-operative findings, and were also significantly better in the arthroscopic synovectomy group than in the open synovectomy group (P<0.05). CONCLUSIONS: Open synovetomy and arthroscopic synovetomy have similar recurrent rates in treating D-PVNS of the knee joint, while the latter has better postoperative range of motion and functional scores. Thus, arthroscopic synovectomy is a better option for the surgical treatment of D-PVNS.

[Comparison of Clinical Influence of Intramedullary versus Extramedullary Alignment Guides on Total Knee Arthroplasty].

UNLABELLED: Objective: To compare the clinical influence of intramedullary versus extramedullary alignment guides on total knee arthroplasty (TKA) in terms of alignment of the lower limbs,intraoperative tourniquet time,and postoperative complications. METHODS: We retrospectively analyzed the clinical data of 105 patients(210 knees)undergoing bilateral TKA from February 2012 to November 2013. All patients were divided to two groups:40 [age:(66.65 ± 9.57)years] were implanted using intramedullary guides on the tibia and 65 [age:(65.29±9.27)years] were implanted using extramedullary guides on the tibia. Alignment of lower limb,tibial component angle in the sagittal plane,tourniquet time,and postoperative complications were compared. RESULTS: The gender ratio,age,height,weight,body mass index,and preoperative alignment of lower limbs were not significantly different between these two groups (all P>0.05). The average coronal alignment of lower extremity was (179.69 ± 2.91)° in the intramedullary guides group and (178.26 ± 3.38)° in the extramedullary guides group (P=0.002). The alignment of lower limbs on neutral and valgus position were found in 68 cases(85.00%)in the intramedullary group and in 94 cases (72.31%) in extramedullary group (P=0.033) ;the tourniquet time was (79.46 ± 12.06) min in the intramedullary group and (84.68 ± 8.02) min in the extramedullary group (P=0.001); the postoperative complication rate was 6.25% in intramedullary group and 3.07% in extramedullary group (P=0.279). CONCLUSION: Alignment and tourniquet time can be significantly improved by the intramedullary instrumentation,while the incidence of complications associated with intramedullary instrumentation is higher than extramedullary instrumentation.

Meta-analysis of circumferential fusion versus posterolateral fusion in lumbar spondylolisthesis.

STUDY DESIGN: Literature review and meta-analysis. SUMMARY OF BACKGROUND DATA: Posterolateral fusion (PLF) and circumferential fusion (CF) were widely used in the treatment of lumbar spondylolisthesis. There was a great controversy over the preferred fusion method. OBJECTIVE: We performed a meta-analysis for determining which fusion method was better in lumbar spondylolisthesis. METHODS: A systematic search was conducted in MEDLINE, EMBASE, and the Cochrane Collaboration Library from January 1960 to December 2013. Comparative studies were selected according to eligibility criteria. Weighed mean differences (WMDs) and risk differences were calculated. The final strength of evidence was expressed as different levels recommended by the GRADE Working Group. RESULTS: Eight comparative studies were identified. There was less evidence that no significant difference was found between CF and PLF for clinical satisfaction [odds ratio (OR), 0.63; 95% confidence interval (95% CI), 0.30, 1.32; P=0.22)] and for complication rate (OR, 0.64; 95% CI, 0.23, 1.76; P=0.39). The PLF was more effective than the CF for the reduction of complication rate for patients with isthmic spondylolisthesis (OR, 0.44; 95% CI, 0.23, 0.86; P=0.02). There was no significant difference for fusion rate, reoperation rate, operating time, and blood loss. Subanalysis showed that the CF can increase the fusion rate of patients with isthmic spondylolisthesis (OR, 0.12; 95% CI, 0.01, 1.00; P=0.05). PLF was more effective than CF for the reduction in operating time (WMD=-75.68; 95% CI, -99.00, -52.37; P<0.00001), and CF was more effective than PLF for the restoration of segment lordosis, disk height, and spondylolisthesis. CONCLUSIONS: There was really no difference for clinical satisfaction, complication rate, fusion rate, reoperation rate, operating time, and blood loss. PLF can reduce complication rate and operating time. CF can improve fusion rate for individuals with isthmic spondylolisthesis and restore lumbar alignment. The level of evidence was low.

Drainage does not promote post-operative rehabilitation after bilateral total knee arthroplasties compared with nondrainage.

UNLABELLED: OBJECTIVE To assess the effects of suction drainage versus nondrainage on the post-operative rehabilitation of patients receiving primary bilateral total knee arthroplasties (TKA). METHODS: A prospective study including 40 patients was conducted. These patients were diagnosed with osteoarthritis and underwent primary bilateral TKA between October 2007 and September 2009 with the same operation team. A suction drainage was placed by randomization in only one knee for each patient, while the other knee as self-control. Pain visual analogue scale score, extremity swelling, wound healing, range of motion and incidence of early post-operative complications between the drained and nondrained group were compared statistically. RESULTS: Each patient was followed up for 12 months. Placing drainage did not relieve the pain, extremity swelling, ecchymosis, or reduce the incidence of early complications (all P>0.05). CONCLUSIONS: Suction drainage in TKA does not exhibit substantial advantages in promoting post-operative rehabilitation after unsophisticated TKA, compared with nondrainage. On the other hand, it might complicate the surgical operation, and increase the incidence of post-operative hemorrhage and retrograde infection. Thus we do not recommend suction drainage in unsophisticated TKA.

[The microbiology and antimicrobial susceptibility of the infected knee arthroplasty].

OBJECTIVES: To describe the microbiology, antimicrobial susceptibility of patients proven prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA)and to provide reference for the diagnosis and treatment of this complication. METHODS: The medical data of the patients with infected knee arthroplasty, who were managed with revision surgery between January 1995 to December 2011 were reviewed. Twenty-nine cases were identified and majority of the patients were female (23/29). Diagnosis of PJI after primary TKA was between 1 week and 10 years (average 24.3 months). The microbiology and antimicrobial susceptibility were analyzed. RESULT: The overall positive rate of cultures was 65.5% (19/29). The most common organisms identified were Coagulase-negative Staphylococcus (CNS) (7/19) and Staphylococcus Aureus (SA) (5/19). Rare pathogens of Mycobacterium (2/19) and fungi (1/19) were also identified. Vancomycin was the most effective antibiotics with overall sensitivity rates of 100%.Resistant and rare pathogens were all in type IV infection. CONCLUSIONS: Gram-positive bacterias are the main pathogen, resistant and rare pathogens should be payed attention to. Antibiotic treatment for infected TKA should be based on the results of drug susceptibility. Vancomycin allows infected knee arthroplasties before the result.

[Analysis of clinical results and complications of growing rod technique for congenital scoliosis].

OBJECTIVE: To evaluate clinical outcomes of growing rod technique in treating young children with congenital scoliosis. METHODS: From August 2002 to October 2009, 34 patients with congenital scoliosis underwent growing rod procedures including 12 male and 22 female patients. Four patients underwent posterior correction surgeries with single growing rod (single growing rod group), 30 patients underwent posterior correction surgeries with dual growing rod(dual growing rod group). The average age at initial surgery was 6.9(2-13) years. Five patients with severe rigid deformity or kyphosis had an osteotomy at apex vertebra with short segmental fusion followed by dual growing rod technique. The analysis included age at initial surgery and final fusion (if applicable), number and frequency of lengthenings, and complications. Radiographic evaluation including scoliosis, trunk translation, length of T1-S1, thoracic kyphosis and lumbar lordosis was conducted. RESULTS: The follow-up was 40.5 (24-110) months. In single growing rod group, the mean scoliosis Cobb angle improved from 80.9°to 59.5°after initial surgery and was 65.3°at the latest follow-up. T1-S1 length increased from average 24.3 cm to 26.0 cm after initial surgery, and to 31.1 cm at latest follow-up with an increase of 1.05 cm per year. The space available for lung ratio(SAL) in patients with thoracic curves improved from 0.81 to 0.92 at the latest follow-up. Three patients reached final fusion. Four complications occurred in 3 of the 4 patients. In dual growing rod group, the mean scoliosis Cobb angle improved from 72° ± 22°to 35 ± 14° after initial surgery and was 35 ± 17°at the last follow-up or post-final fusion. T1-S1 length increased from (25 ± 5) cm to (29 ± 5)cm after initial surgery and to (33 ± 5)cm at latest follow-up with an average T1-S1 length increase of 1.49 cm per year. The SAL in patients with thoracic curves improved from 0.84 ± 0.08 to 0.96 ± 0.06 at the latest follow-up. Three patients reached final fusion. Complications occurred in 7 of the 30 patients, and they had a total of 13 complications. CONCLUSIONS: Growing rod technique is a safe and effective choice for young children of long, complex congenital scoliosis. It maintains correction achieved at initial surgery while allowing spinal growth to continue. Implants-related complications remain the biggest challenge.

A Retrospective, Long-term Follow-up of the Clinical Outcomes and Cost-effectiveness of Single-anesthetic Multiple Total Joint Procedures in Hemophilic Arthropathy.

OBJECTIVE: Although total joint replacement (TJR) procedures are efficacious, perioperative high-dose factors replacement therapy (FRT) to avoid catastrophic bleeding represents a significant hurdle, particularly for patients with multiple joint affection. Double simultaneous bilateral TJRs were reported as safe and cost-effective. However, little is known about multiple TJRs. The feasibility and effects remain debatable. Surgeons need to weigh the high cost of FRT against safety. Accordingly, we aimed to evaluate the clinical outcomes and cost-effectiveness of single-anesthetic multiple-joint procedures of lower limbs in end-stage hemophilic arthropathy. METHODS: Our retrospective cohort study retrieved data from an inpatient database of patients with hemophilia who underwent total knee arthroplasty (TKA), total hip arthroplasty (THA), and/or ankle arthrodesis from January 2000 to April 2016. Complications, hospital stays, transfusion, doses of clotting factor, medical costs, range of motion (ROM), Harris hip scores (HHSs) and Hospital for special surgery knee scores (HSSs) were recorded. A P value < 0.05 was considered significant. RESULTS: A total number of 81 patients were included in this study, among which 89 TKAs and 52 THAs were performed. Compared to the single TJR group, the simultaneous multiple TJR group showed a significantly higher rate of blood transfusions (P < 0.05). But no significant differences were found in the length of hospital stays, factor consumption, hospitalization costs excluding prosthesis expenses, and total complication rates. Finally, similar postoperative ROM, HHS, and HSS were witnessed in two groups (P value > 0.05). CONCLUSION: Our data indicated that simultaneous multiple TJRs are a safe and cost-effective choice for treating hemophilic patients with multiple HA-affected lower limb joints.

[Comparison of blood loss during total knee arthroplasty between haemophilic arthropathy and osteoarthritis].

OBJECTIVE: To evaluate the amount of blood loss and the efficacy of clotting factor in controlling blood loss during total knee arthroplasty. METHODS: The medical documents of 18 patients with haemophilic arthritis (HA) secondary to haemophilia A and 19 patients with osteoarthritis (OA) were retrospectively reviewed. Demographic data,functional and hematological test results,the amount of blood loss and transfusion,and complications were analyzed. RESULTS: The median amounts of total and external blood loss were 2240 ml(1892-3415 ml) and 1326 ml(934-2256 ml)in the HA group, which were significant higher than those in the OA group [1746 ml(1259-2246 ml)and 846 ml (504-1217 ml), respectively]. The median amounts of external blood loss in the two groups were 680 ml(370-1330 ml)and 730 ml(200-1190 ml)and there was no significant difference(p=0.620). Moreover, more patients in the HA group required blood transfusion (84.2% vs. 47.4%), and more red cells were transfused per patient in the HA group (2.3 U vs. 0 U). CONCLUSIONS: The total blood loss and hidden blood loss are higher in the HA patients than in OA patients during total knee arthroplasty, although the external blood loss is basically the same. Management with more clotting factor may decrease the blood loss in HA patients.

[The mid-term effects of Bryan cervical disc prosthesis on sagittal alignment of overall cervical spine and the functional spinal unit].

OBJECTIVE: To investigate the mid-term radiological outcome of sagittal alignment of overall cervical spine and the functional spinal unit after replacement surgery with Bryan cervical disc prosthesis. METHODS: Eighteen patients with cervical disc disorder were performed cervical disc replacement with 20 Bryan discs from November 2005 to May 2010, including single-level 16 cases and bi-level 2 cases. The patient consisted of 13 males and 5 females with age ranging from 38 to 59 years (average, (47 ± 6) years). Fourteen cases with overall cervical lordotic alignment and segmental lordotic alignment per-operatively (group 1) and 4 others with segmental kyphotic alignment and overall cervical kyphotic alignment per-operatively (group 2). The overall sagittal alignment (C(2-7)) and segmental sagittal alignment were measured pre-operatively, post-operatively and at final follow-up to evaluate the outcome. RESULTS: All cases obtained the follow-up with an average of (24 ± 5) months (range 12 to 53 months). To the mean overall cervical alignment, there were 9.9° ± 1.9° per-operatively, 12.8° ± 2.1° post-operatively and 11.6° ± 1.8° at final follow-up in group 1 and -1.8° ± 0.8° per-operatively, 7.3° ± 1.3° post-operatively and 5.0° ± 2.1° at final follow-up in group 2. There were statistical significance between per-operatively and post-operatively (t = -2.987 and -5.058, P < 0.05) and no statistical significance between post-operatively and final follow-up (P > 0.05) in both groups. To the mean segmental alignment there were 2.6° ± 0.8° per-operatively, 5.4° ± 1.0° post-operatively and 4.3° ± 0.9° at final follow-up in group 1 and -3.0° ± 0.8° per-operatively, 3.8° ± 1.3° post-operatively and 0.3° ± 2.8° at final follow-up in group 2. There were statistical significance between per-operatively and post-operatively in both groups (t = -3.829 and -4.086, P < 0.05) and between post-operatively and final follow-up in group 1 (t = 2.630, P < 0.05)but not in group 2 (P > 0.05). CONCLUSIONS: The Bryan cervical disc prosthesis has a good mid-term outcome for maintaining sagittal alignment of overall cervical spine and the functional spinal unit. Long-term follow-up should be needed to assess the long-term functionality of the prosthesis.

The Effect of a Local Injection of Flurbiprofen Ester Microspheres on Systemic Inflammatory Model Rats With a Closed Femoral Shaft Fracture.

Background: Periarticular injections with a combination of local anesthetics, non-steroidal anti-inflammatory analgesics (NSAIDs), and epinephrine are becoming increasingly popular in the perioperative analgesia of artificial joint replacement. However, data on the efficacy and safety of local injection NSAIDs are still scarce. The purpose of this study was to investigate the efficacy and safety of a local injection of Flurbiprofen Ester Lipid microspheres into the inflammatory model of femoral shaft closed fractures in rats. Methods: A systemic inflammatory model was induced in SD rats (60) by closed femoral shaft fracture; 12 non-fractured rats were used as the blank control group (group A). The systemic inflammation model of 60 rats was divided into 5 groups (12 in each group); Group B: intramuscular injectionof the same amount of normal saline at different time points as a negative control; Group C: intravenous injection of Flurbiprofen Ester microspheres (4.5 mg/kg) at different time points; Group D: intramuscular injection of Flurbiprofen Ester microspheres (2.25 mg/kg) at different time points; Group E: intramuscular injection of Flurbiprofen Ester microspheres (4.5 mg/kg) at different time points; Group F: intramuscular injection of Flurbiprofen Ester microspheres (9 mg/kg) at different time points. The behavioral test observed the behavior of the rats. Then, the inflammation factors of CRP, IL-6, COX-1, COX-2 and TNF-αby ELISA were recorded. Results: Through the behavioral test it could be found that the effect of the intramuscular and intravenous injections of Flurbiprofen Ester microspheres was similar. Fracture rats with a local injection of Flurbiprofen Ester microspheres showed lower inflammation levels measured by COX-1, CRP, and TNF-α compared with the control group. Pathological sections at 24, 48, and 96 h after surgery did not display any local muscle necrosis at the local injection site. These findings suggested that a Flurbiprofen Ester microsphere muscular injection exhibited a similar effect to an intravenous injection. Conclusion: The local injection of Flurbiprofen Ester microspheres significantly reduced the inflammatory response in fracture rats and did not increase the risk of muscle necrosis, suggesting its feasibility in local injection analgesia.

Primary clinical evaluation of the joint replacement for the treatment of the first metatarsophalangeal arthritis.

OBJECTIVE: To retrospectively assess the primary clinical results of a cohort of the first metatarsophalangeal joint replacement with double-stemmed hinge silicone implant. METHODS: A total of 12 patients (15 feet) received the joint replacement with double-stemmed hinge silicone implant. There were 2 males and 10 females with a mean age of 61.4 (range, 56-75) years old. Of them, 9 cases (11 feet) were hallux valgus with osteoarthritis; 1 case (2 feet) was rheumatic arthritis; 2 cases (2 feet) were traumatic arthritis. The subjective and objective results were evaluated during follow-up. RESULTS: All of the patients were followed up regularly with an average of 24.7 months, ranging from 12 to 38 months. Ten patients were completely satisfied with the operation; 1 patient showed partial satisfaction, and 1 patient was not satisfied because of the first matatarsophalangeal joint pain due to severe hyperosteogeny surrounding the cut bone surface 3 years after the operation. Osteolysis around the implant occurred in 2 cases without clinical symptoms, and no special treatment was given. CONCLUSION: The joint replacement is a preferable method in alleviating pain and improving walking function with proper indication.