The Value of Radionuclide Bone Imaging in Defining Fresh Fractures Among Osteoporotic Vertebral Compression Fractures.

Vertebral fractures are the most common osteoporotic fractures. To perform percutaneous vertebral body cement augmentation, it is essential to accurately identify the affected vertebrae. The study evaluated the role of radionuclide bone imaging in identifying fresh osteoporotic vertebral compression fractures. A prospective study of 39 patients with acute osteoporotic vertebral compression fractures was carried out. All patients underwent magnetic resonance imaging (MRI) and radionuclide bone imaging to determine if the fractures were fresh, followed by percutaneous kyphoplasty for the fresh fractures. The positive rate on radionuclide bone imaging was 92.1% (82/89), and the positive rate on MRI was 93.3% (83/89), with no statistically significant difference (P > 0.05). Eighty-one vertebrae had the same positive identification by both radionuclide bone imaging and MRI, and 5 of the same vertebrae were diagnosed negative by both techniques. One patient with positive radionuclide bone imaging was negative according to MRI, and 2 patients were entirely positive by MRI but negative by radionuclide bone imaging. A kappa test showed good consistency between the 2 methods for detecting the affected vertebrae (Kappa = 0.751, P < 0.01). Radionuclide bone imaging is as sensitive as MRI in the diagnosis of fresh osteoporotic vertebral compression fracture, making it an effective method for detecting affected vertebrae for percutaneous vertebroplasty.

Treatment of comminuted patellar fracture with the nitinol patellar concentrator.

AIM: To evaluate the clinical effect of the nitinol (NiTi)-patellar concentrator (NT-PC) for the treatment of comminuted patellar fractures. MATERIAL AND METHODS: A total of 32 patients with acute comminuted patellar fracture accepted open reduction and internal fixation with the NT-PC, and the curative effects were evaluated using the Böstman clinical grading scale. RESULTS: All fractures were anatomically reduced by surgery and all cases were followed-up for six to 18 months. The mean score of patients according to the Böstman clinical grading scale was 25.6, with 29 of 32 (90.7%) patients achieving excellent or good results. Two patients had traumatic arthritis, one had slippage of the NT-PC, and all patients received pharmacotherapy. CONCLUSIONS: The application of the NT-PC is a satisfactory approach to the treatment of comminuted patellar fractures.

Fabrication of hydroxyapatite on pure titanium by micro-arc oxidation coupled with microwave-hydrothermal treatment.

Porous hydroxyapatite (HA)-containing composite films were prepared by a novel method consisting of micro-arc oxidation (MAO) combined with microwave-hydrothermal (M-H) treatment. The morphology, composition and phase composition of the bioactive films were investigated with scanning electron microscopy with energy dispersive X-ray spectroscopy and X-ray diffraction. MTT assay was carried out to investigate the in vitro effects of the different surfaces on bone integration properties. The prepared MAO films consisted mainly of anatase, rutile and tricalcium phosphate along with amorphous calcium (Ca) and phosphorus (P) phases. The M-H-treated composite films were composed primarily of anatase, rutile and HA. As the time and temperature of the M-H treatment increased, the number of HA crystals gradually increased. Using the M-H method, HA was obtained at a lower temperature and in a shorter period of time compared to the conventional hydrothermal method. The results suggest that the M-H method significantly decreases the hydrothermal reaction temperature and also greatly shortens the reaction time. Due to the nanocrystallinity and porosity of the prepared composite films, the method presented here shows promise for the formation of bioactive materials for medical applications.

Relationship between the Apolipoprotein AI, B gene polymorphism and the risk of non-traumatic osteonecrosis.

BACKGROUND: Previous studies suggested that Apolipoprotein AI (ApoAI) and apolipoprotein B (ApoB) gene polymorphisms may result in lipid metabolism disorders. Genetic polymorphisms in these genes may be associated with the occurrence of osteonecrosis. METHODS: We designed a case-control study including 429 patients of osteonecrosis and 368 age- and sex-matched control subjects. Polymerase chain reaction was used to amplify the DNA fragments in promoter -75 G > A of ApoAI gene and EcoR I, Xba I and 3'-VNTR of ApoB gene in osteonecrosis patients and healthy controls. We utilized polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to genotype these four single nucleotide polymorphisms (SNPs). RESULTS: For -75 G > A polymorphism of ApoAI, AA genotype frequency (0.501) was significantly higher in patients with osteonecrosis than that in control (0.462) subjects (P <0.001), GA genotype frequency (0.170) was significantly lower than that in the control (0.310) group (P <0.0001). In osteonecrosis patients, the odds ratio (OR) of A allele was 3.932 (95% CI: 3.0847 ~ 5.0123), which suggested that subjects carrying A allele of promoter region -75 G > A of ApoAI gene had higher susceptibility to osteonecrosis than G allele carriers. The genotype and allele frequency distributions showed no significant difference in EcoR I, Xba Iand 3'-VNTR loci of ApoB gene between the osteonecrosis group and control group. CONCLUSION: Our study suggested that ApoAI gene -75G > A polymorphism may be associated with susceptibility to osteonecrosis in Chinese population. However, our results need further investigation with large sample size and various populations.

Four-strand hamstring tendon autograft versus LARS artificial ligament for anterior cruciate ligament reconstruction.

This retrospective study compared the results after anterior cruciate ligament (ACL) reconstruction using a four-strand hamstring tendon graft (4SHG) versus Ligament Advanced Reinforcement System (LARS) artificial ligament in 60 patients between January 2003 and July 2004 with a minimum four-year follow-up. The KT-1000 examination, the International Knee Documentation Committee (IKDC) scoring systems and Lysholm knee scoring scale were used to evaluate the clinical results. The mean side-to-side difference was 2.4 +/- 0.5 mm and 1.2 +/- 0.3 mm in the 4SHG group and LARS group, respectively (P = 0.013). Although other results of ACL reconstruction, measured by IKDC evaluation, Lysholm scores and Tegner scores, showed using a LARS graft clinically tended to be superior to using a 4SHG, there were no significant differences calculated. Our results suggest that four years after ACL reconstruction using a LARS ligament or 4SHG dramatically improves the function outcome, while the patients in the LARS group displayed a higher knee stability than those in the 4SHG group.

[Patella reshaping versus resurfacing in total knee arthroplasty: a prospective randomized study].

OBJECTIVE: To investigate the differences in the clinical outcome of total knee arthroplasty according to patellar reshaping or resurfacing. METHODS: From January 2002 to December 2002, 60 patients (60 knees) undergoing primary total knee arthroplasty for the treatment of osteoarthritis were enrolled in a prospective, randomized study. All patients received the same posterior-cruciate-substituting total knee prosthetic components. Patients were randomized to the treatment with reshaping or resurfacing of the patella, and the results were followed up for a mean of 54 months (40-60 months). Evaluations consisted of the determination of a Knee Society Score, range of motion for knees, patient satisfaction, and radiographs. RESULTS: With the numbers available for study, no significant difference was found between the knees that had patellar resurfacing and those that had patellar reshaping with regard to the overall score (P=0.12), the subscore for pain (P=0.90), and patient satisfaction (P=0.22). The results showed that the same prevalence of any anterior knee pain in two groups was 10%, and it did not represent a significant difference. The two groups showed statistical difference with regard to the total function score and range of motion. CONCLUSIONS: It has shown that total knee arthroplasty with patella reshaping or resurfacing dramatically relieves pain and improves the function. It seems that postoperative anterior knee pain is related either to the component design or to the details of the surgical technique, rather than to whether or not the patella is resurfaced.

Comparison of therapeutic effects between drainage blood reinfusion and temporary clamping drainage after total knee arthroplasty in patients with rheumatoid arthritis.

OBJECTIVE: To compare the therapeutic effects between drainage blood reinfusion and temporary clamping drainage after total knee arthroplasty in patients with rheumatoid arthritis to provide a basis for clinical practice. METHODS: Data from 83 patients with rheumatoid arthritis undergoing total knee arthroplasty were retrospectively analyzed. The 83 patients were divided into a drainage blood reinfusion group (DR group, n = 45) and a temporary clamping drainage group (CD group, n = 38). In the DR group, postoperative drainage blood was used for autotransfusion. In the CD group, closed drainage was adopted, and the drainage tube was clamped for 2 h postoperatively followed by patency. The postoperative drainage amount, hemoglobin level, rate and average volume of allogeneic blood transfusion, swelling and ecchymosis of the affected knee joint, time to straight-leg raising and range of active knee flexion were compared between the two groups. RESULTS: The total drainage volume was higher in the DR group than in the CD group (P = 0.000). The average volume of postoperative allogeneic blood transfusion (P = 0.000) and the decrease in the hemoglobin level 24 h after total knee arthroplasty (P = 0.012) were lower in the DR group than in the CD group. Swelling and ecchymosis of the affected knee joint, time to straight-leg raising and the range of active knee flexion were improved in the DR group compared with the CD group (all P<0.05). CONCLUSION: Compared with temporary clamping drainage, drainage blood reinfusion after total knee arthroplasty can reduce the allogeneic blood transfusion volume and is conducive to early rehabilitation in patients with rheumatoid arthritis.

Diagnosis, management, and prevention of prosthetic joint infections.

As the number of joint prosthesis replacements worldwide increases exponentially, prosthetic joint infection (PJI), associated with prosthetic implants, has become a devastating complication associated with high morbidity and substantial cost. Patients who develop PJIs typically require extended hospitalization, additional surgical procedures, and long courses of parenteral antimicrobials. Defining the diagnostic criteria is complicated by patient heterogeneity. No single routinely used clinical test has been shown to achieve the ideal sensitivity, specificity, and accuracy for the diagnosis of PJI. Goals of treatment are to eradicate infection, prevent recurrence, and preserve mechanical joint function. Meanwhile, preventive strategies should be used in a timely and appropriate fashion. The present review will discuss the diagnosis, management, and prevention of PJI.

Patellar reshaping versus resurfacing in total knee arthroplasty - Results of a randomized prospective trial at a minimum of 7 years' follow-up.

OBJECTIVE: To compare the results of primary total knee arthroplasty with patellar reshaping or resurfacing. METHODS: One hundred thirty-three patients were randomized into patellar reshaping group and patellar resurfacing group. Patellar reshaping includes resecting the partial lateral facet of the patella and the osteophytes surrounding the patella, trimming the patella to match the trochlea of the femoral component. The minimum follow-up time was 7 years. The outcome was measured by anterior knee pain rate, Knee Society clinical score, and radiographs. RESULTS: Eight patients in the reshaping group (12.5%) and 10 patients in the resurfacing group (14.7%) complained of anterior knee pain (P=0.712). Meanwhile, there were no significant differences between the two groups in terms of total Knee Society score, Knee Society pain score, Knee Society function score, as well as anterior knee pain rate. CONCLUSIONS: With the numbers available, there was no significant difference between the groups treated with patellar reshaping or patellar resurfacing with regard to the KSS, anterior knee pain rate and radiographs. We prefer reshaping the patella to resurfacing the patella because the former preserves sufficient patellar bone stock and can easily be converted to patellar replacement if patients complain of recurrent anterior knee pain.

Comparison of therapeutic effects between drainage blood reinfusion and temporary clamping drainage after total knee arthroplasty in patients with rheumatoid arthritis

OBJECTIVE: To compare the therapeutic effects between drainage blood reinfusion and temporary clamping drainage after total knee arthroplasty in patients with rheumatoid arthritis to provide a basis for clinical practice. METHODS: Data from 83 patients with rheumatoid arthritis undergoing total knee arthroplasty were retrospectively analyzed. The 83 patients were divided into a drainage blood reinfusion group (DR group, n = 45) and a temporary clamping drainage group (CD group, n = 38). In the DR group, postoperative drainage blood was used for autotransfusion. In the CD group, closed drainage was adopted, and the drainage tube was clamped for 2 h postoperatively followed by patency. The postoperative drainage amount, hemoglobin level, rate and average volume of allogeneic blood transfusion, swelling and ecchymosis of the affected knee joint, time to straight-leg raising and range of active knee flexion were compared between the two groups. RESULTS: The total drainage volume was higher in the DR group than in the CD group (P = 0.000). The average volume of postoperative allogeneic blood transfusion (P = 0.000) and the decrease in the hemoglobin level 24 h after total knee arthroplasty (P = 0.012) were lower in the DR group than in the CD group. Swelling and ecchymosis of the affected knee joint, time to straight-leg raising and the range of active knee flexion were improved in the DR group compared with the CD group (all P<0.05). CONCLUSION: Compared with temporary clamping drainage, drainage blood reinfusion after total knee arthroplasty can reduce the allogeneic blood transfusion volume and is conducive to early rehabilitation in patients with rheumatoid arthritis. .