The effect of total hip arthroplasty on sagittal spinal-pelvic-leg alignment and low back pain in patients with severe hip osteoarthritis.

PURPOSE: Sagittal spinopelvic malalignment has been reported in spinal disorders such as low back pain (LBP), and restoration of normal alignment is targeted when treating these disorders. Abnormal sagittal spinal-pelvic-leg alignment has been reported in patients with severe hip osteoarthritis (OA), who have a high prevalence of associated LBP. This prospective longitudinal study aimed to investigate changes in sagittal spinal-pelvic-leg alignment after total hip arthroplasty (THA) in patients with severe hip OA, and whether these changes contribute to LBP relief. METHODS: Patients undergoing primary THA due to severe unilateral hip OA were recruited. Physical examination and X-ray films were taken to rule out any spinal disorder. Sagittal alignment of pelvis, hip, and spine was analyzed on lateral radiographs taken before (baseline) and 1 year after (follow-up) THA. Functional instruments were completed by patients including: visual analog scale (VAS) for LBP, Roland-Morris Disability Questionnaire (RMDQ), and Harris Hip Score (HHS). Comparisons were carried out at baseline and follow-up, and between patients with and without LBP. RESULTS: The recruited 69 patients showed significantly reduced hip flexion and improved global spinal balance at follow-up compared with baseline. LBP was reported by 39 patients (56.5 %) before surgery; at follow-up, 17 reported complete resolution, while 22 reported significant relief. Significant decreases in VAS and RMDQ scores in lumbar spine and increase in hip HHS were observed. CONCLUSIONS: THA in patients with severe hip OA could help correct abnormal sagittal spinal-pelvic-leg alignment and relieve comorbid LBP. Improvements in hip flexion and global spinal balance might be involved in the mechanism of LBP relief.

Characteristics of sagittal spine-pelvis-leg alignment in patients with severe hip osteoarthritis.

PURPOSE: The interaction between the sagittal alignment of the spine and pelvis and the compensatory mechanism in patients suffering from spinal disorders has been well documented. However, in patients with hip osteoarthritis (HOA), few studies have explored how the hip joint pathology could affect the sagittal alignment of the hip, pelvis and spine, and no reports have investigated whether these changes are involved in the pathogenesis of low back pain in these patients. The aims of this case-control study were to investigate the sagittal spine-pelvis-leg alignment in patients suffering from severe HOA and to understand whether the alignment was related to the occurrence of low back pain and the health-related quality of life in these patients. METHODS: Fifty-eight patients with severe HOA and 64 asymptomatic controls were studied. Digital lateral X-rays of the spine, pelvis and proximal femur were obtained with the patients placed in upright positions. The following radiographic parameters were measured to examine the sagittal alignment of the pelvis, hip and spine: pelvic incidence (PI), pelvic tilting (PT), sacral slope (SS), pelvic femoral angle (PFA), femoral inclination (FI), lumbar lordosis (LL), spino-sacral angle (SSA), C7 tilt (C7T) and T1 spinal-pelvic inclination (T1-SPI). The global balance patterns of spinal-pelvic alignment were classified as normal balance, slight unbalance and severe unbalance according to the relative position of the C7 plumb line to the sacrum and femoral heads. Short Form-36 questionnaire was carried out in the patients. Comparisons were carried out between the patients with HOA and the controls and between the HOA patients with or without low back pain. Correlation analysis was used to measure relationships between the HOA patients' parameters. RESULTS: There were no significant differences in the age and gender distribution between the HOA patients and control. Compared with the controls, the patients with HOA showed significantly higher SS and lower PT, similar PI in the pelvis, significantly smaller C7T, larger T1-SPI but comparable LL and SSA in the spine, and significantly smaller PFA but larger FI in the hip joint. In addition, the patients with HOA had a significantly greater incidence of severe unbalanced spinal-pelvic alignment than did the controls (22.4 vs 3.1 %, respectively). In patients with HOA, the PFA was significantly correlated with SS, SSA and FI but not with PI, LL or C7T; while the physical component score of short form-36 was significantly correlated with T1-SPI, C7T and FI. A comparison between the HOA patients with or without low back pain, however, showed no significant differences in the radiographic parameters, global sagittal balance patterns and Short Form-36. CONCLUSIONS: The sagittal morphology of the pelvis in patients with severe HOA was normal and might not be involved in the development and progression of this disorder. Although the whole spine was involved in compensating for the flexed hip joint, the poor ability resulted in severely unbalanced spinal-pelvic alignment in these patients. The forward inclined spine and retroverted femur would contribute to the poor physical activities in these patients. However, the abnormal sagittal spine-pelvis-leg alignment in patients with severe HOA might not be involved in the pathogenesis of low back pain.

Sacrum pubic incidence and sacrum pubic posterior angle: two morphologic radiological parameters in assessing pelvic sagittal alignment in human adults.

PURPOSE: The morphology and position of pelvis are critical in regulating the biomechanical organization of spine-pelvis-leg in the sagittal plane. Several radiological parameters have been developed to present the sagittal morphology of the pelvis such as pelvic incidence (PI) and Jackson's angle (PRS1). In addition, the femoral sacral posterior angle (FSPA) was developed for patients with a dome-shaped deformity in the upper plate of the sacrum. The identification of hip axis, which was represented by the line connecting the centers of femoral heads in normal subjects, was important for these parameters measurement. However, in subjects with fused hip joint or deformed femoral heads, the accurate localization of hip axis become imprecise. Herein, the upper edge of the pubic symphysis, which is easy to identify on the lateral X-ray film, was selected as an alternative landmark of the hip axis, and two morphologic parameters, the sacrum pubic incidence (SPI) and sacrum pubic posterior angle (SPPA), were proposed accordingly. The present study aimed to understand the reliability of these two parameters and their value in predicting PI, PRS1 and FSPA. METHODS: Upright standing spine and pelvis radiographs of 60 normal adults (30 male and 30 female) with an average age of 38.5 years were obtained. Two independent observers then measured the following radiological parameters on the films: PI, PRS1, FSPA, SPI, SPPA, sacral slope, pelvic tilt and lumbar lordosis. The SPI is the angle between the line perpendicular to the superior plate of the first sacral vertebra at its midpoint and the line connecting this point to the upper edge of the pubic symphysis, while the SPPA is the angle between the line extending from the posterior upper edge of the sacrum to the upper edge of the pubic symphysis and the posterior side of the first sacral vertebral body. The intra-observer and inter-observer reliabilities of the parameters were analyzed using intraclass correlations. The correlations between parameters were analyzed by Pearson's correlation coefficients. Regression analysis was carried out to establish formulas to predict the values of PI, PRS1 and FSPA using the SPI and SPPA. A p < 0.05 was considered statistically significant. RESULTS: The SPI was 64.4° ± 9.5° and 68.3° ± 9.4°, and the SPPA was 77.7° ± 7.5° and 78.7° ± 9.4° in males and females, respectively. These radiological parameters showed excellent intra- and inter-observer reliabilities, with an intraclass correlation >0.8. No gender differences were identified in these morphologic and positional radiological parameters. The SPI demonstrated strong correlation with PI and PRS1 (R (2) > 0.9, p < 0.001). In addition, strong correlation was also found between SPPA and FSPA (R (2) > 0.9, p < 0.001). Furthermore, both SPPA and FSPA showed close correlations with the other morphologic and positional parameters. Linear regression analysis established equations to predict PI and PRS1 using SPI and to predict FSPA by SPPA with significantly high reliability. CONCLUSIONS: Both SPI and SPPA are reliable parameters for determining the morphology of the pelvis. The SPI is precise in predicting PI and PRS1, while SPPA is reliable in predicting FSPA. The SPI and SPPA will allow further study on lateral spinal-pelvic alignment in patients with hip joint abnormalities.

P16INK4A drives RB1 degradation by UTP14A-catalyzed K810 ubiquitination.

P16INK4A expression is inversely associated with RB1 expression in cancer cells, and P16INK4A inhibits CDK4-catalyzed RB1 phosphorylation. How P16INK4A and RB1 coordinately express and regulate the cell cycle remains to be studied. In the present study, we found that P16INK4A upregulated the E3 ligase UTP14A, which led to the ubiquitination of RB1 at K810 and RB1 degradation. P16INK4A loss consistently disrupted the UTP14A-mediated degradation of RB1 and caused RB1 accumulation. Functionally, P16INK4A loss inhibited RB1 ubiquitination in a cell cycle progression-independent fashion and inhibited proteome-scale ubiquitination in a cell cycle progression-dependent manner. Our findings indicate that there is a negative feedback loop between P16INK4A and RB1 expression and that disruption of this loop may partially rescue the biological outcomes of P16INK4A loss. We also revealed a hitherto unknown function for P16 INK4A in regulating proteome-scale ubiquitination by inhibiting cell proliferation, which may be useful for the development of anticancer drugs.

Cross-talk of RNA modification "writers" describes tumor stemness and microenvironment and guides personalized immunotherapy for gastric cancer.

BACKGROUND: RNA modifications, TME, and cancer stemness play significant roles in tumor development and immunotherapy. The study investigated cross-talk and RNA modification roles in the TME, cancer stemness, and immunotherapy of gastric cancer (GC). METHODS: We applied an unsupervised clustering method to distinguish RNA modification patterns in GC. GSVA and ssGSEA algorithms were applied. The WM_Score model was constructed for evaluating the RNA modification-related subtypes. Also, we conducted an association analysis between the WM_Score and biological and clinical features in GC and explored the WM_Score model's predictive value in immunotherapy. RESULTS: We identified four RNA modification patterns with diverse survival and TME features. One pattern consistent with the immune-inflamed tumor phenotype showed a better prognosis. Patients in WM_Score high group were related to adverse clinical outcomes, immune suppression, stromal activation, and enhanced cancer stemness, while WM_Score low group showed opposite results. The WM_Score was correlated with genetic, epigenetic alterations, and post-transcriptional modifications in GC. Low WM_Score was related to enhanced efficacy of anti-PD-1/L1 immunotherapy. CONCLUSIONS: We revealed the cross-talk of four RNA modification types and their functions in GC, providing a scoring system for GC prognosis and personalized immunotherapy predictions.

[Correlation between spatial inclination of Blumensaat line and anterior cruciate ligament injury based on EOS biplanar 3D imaging system].

OBJECTIVE: To explore correlation between femoral mechanical axis and Blumensaat line (FMBL) angle of knee joint (angle between Blumensaat line and femoral mechanical axis), α angle (angle between Blumensaat line and axis of distal femur in sagittal plane) on EOS biplane imaging and non-contact anterior cruciate ligament(ACL) injury, and evaluate angle for its accuracy in predicting the populations prone to non-contact ACL injury. METHODS: From February 2018 to October 2020, EOS imaging and clinical data from 88 patients (176 knees) with unilateral non-contact ACL injury were retrospectively analyzed, including 53 males and 35 females, aged from 18 to 45 years old with an average of (30.3±6.2) years old, 48 patients on the left side and 40 patients on the right side. The patients were divided into ACL-affected group and ACL-health group according to side of ACL injuries, and 51 patients (51 knees) with non-ACL identified from EOS database were included in normal control group, including 28 males and 23 females, aged from 20 to 44 years old with an average of (31.6±5.5) years old, 26 patients on the left side and 25 patients on the right side. Full-length EOS imaging of skeleton extremitatis inferioris among three groups were reconstructed to 3D images of skeletal system with EOS software, and then FMBL angle and α angle were measured on the images. Univariate binary Logistic regression analysis was performed to determine the influence of the univariate(FMBL angle or α angle) on ACL status(normal or torn). And the angle cutoff value for univariate was selected based on receiver operating characteristics curve (ROC) to got the best accuracy. RESULTS: There was no statistically significant difference in age, gender and side distribution between ACL-injured group and normal control group(P>0.05). Statistical analyses (one-way ANOVA) indicated no significant difference in FMBL angle between ACL-injured knee group (32.8±2.3)° and ACL-injured contralateral knee group(32.5±2.3)°(P>0.05), but the values between two groups were significantly lower than that in normal control group (37.0±2.0)°(P<0.001). There was no statistically significant difference in α angle among three groups (P>0.05). Univariate binary Logistic regression analysis demonstrated that FMBL angle was risk factor for non-contact ACL injury[OR=0.433, 95%CI(0.330, 0.569), P<0.001]. The area under ROC curve for FMBL angle was 0.909[95%CI(0.861, 0.958), P<0.001], and the sensitivity and specificity were 70.5% and 98.0% respectively, cut-off value was 33.7°. CONCLUSION: FMBL angle formed by Blumensaat line and femoral mechanical axis is one of the risk factors for non-contact ACL injury and has good predictive accuracy. The general population with FMBL angle below 33.7° may be increased risk for ACL injury.

[Revision total hip arthroplasty using a cementless prosthesis].

OBJECTIVE: To assess the operative technique and results with the usage of cementless prosthesis in hip revision. METHODS: Retrospective study was done on revision of total hip arthroplasty with cementless prosthesis in 72 patients (41 males and 31 females) with an average age of 65.7 years (28-82 years) from January 2004 to December 2009. The reason for revision was 2 infection, 54 aseptic loosening, 4 periprosthetic fractures, 5 fracture of femoral stems and 7 cases of acetabular abrasion after hemi-arthroplasty. The operation time, bleeding loss, complications of infection, dislocation, periprosthetic fractures and loosening were evaluated. The Harris score were used for hip function evaluation. RESULTS: The average operation time was (146±47) minutes (70-280 minutes) and bleeding loss during the operation was (970±540) ml (200-2500 ml). Bacterium cultivation during operation demonstrated infection in 2 patients. Bone windows at the lateral femoral were opened in 4 patients and extend trochanteric osteotomy was done in 7 patients. Fracture of the proximal femur occurred in 8 cases. Twenty-nine patients were treated with bone graft including 18 autografts and 11 allografts. Sixty-seven patients were followed up for an average time of 66 months (20-92 months). Additional revisions were performed in 3 cases including 2 dislocations and 1 infection. There were no death, no damage of major blood vessels and nerves. The bone graft healed during 3-5 months. The survival rates of the femoral prosthesis and the acetabulum prostheses were 95.5% and 98.4%. The mean Harris score was 86±8 (55-95 points). Osteolysis were seen in 13 hips but migration was seen in only 1 patient. CONCLUSIONS: The cementless prosthesis is useful in revision total hip arthroplasty and the perfect clinical results are related to the reliable primary fixation.

Abnormal femur rotation in patients with recurrent patellar dislocation: A study on upright standing three-dimensionally reconstructed EOS images.

BACKGROUND: The measurements of lower extremity rotational deformities in patients with recurrent patellar dislocation (RPD) in the standing position are available with the application of the EOS imaging system. The aim of our case-control study was to identify the differences on the femur rotation between the supine and standing positions, and to investigate the differences of anatomical and functional femur rotation between RPD patients and controls. METHODS: Thirty-five lower extremities affected by RPD from 30 patients and 27 intact lower extremities from 27 controls with acute meniscus tear or anterior cruciate ligament injury were recruited. Anatomical femoral anteversion (AFA), functional femoral anteversion (FFA), femorotibial rotation (FTR) and distal femoral torsion (DFT) of all subjects were measured with the EOS imaging system. Computed tomography scans were carried out to analyze the AFA and FFA in the supine position in PRD patients. The differences in FFA between supine and standing position and in AFA, FTR and DFT between RPD and controls were analyzed. The predictor importance of each variable on RPD was observed after cluster analysis. RESULTS: The EOS images were available in all subjects. The FFA was significantly smaller in the standing position than in the supine position (P < 0.05) in RPD patients. When comparing with the controls, RPD patients showed higher AFA, FTR and DFT (P < 0.05) but comparable FFA (P < 0.05). The cluster model prompted that FTR and DFT had higher predictor importance than AFA. CONCLUSION: Larger AFA but comparable FFA in patients with RPD than the controls in an upright standing position suggested more internally rotated distal femur in the RPD patients. AFA may be inadequate and FFA should also be considered while planning the treatment for RPD. DFT and FTR should be taken into consideration when evaluating the abnormalities in femur rotation in RPD patients.

Secreted frizzled-related protein 5 (SFRP5) protects ATDC5 cells against LPS-induced inflammation and apoptosis via inhibiting Wnt5a/JNK pathway.

BACKGROUND: Secreted frizzled-related protein 5 (SFRP5) is an endogenous inhibitor of Wnt5a (wingless-type family member 5a), which has been implicated in anti-inflammatory response. In this study, we aimed to investigate whether SFRP5 could protect chondrocytes against LPS-induced inflammation and apoptosis. METHODS: ATDC5 cells that overexpressed with SFRP5 or not were challenged with LPS to observe the effects of SFRP5 overexpression on LPS-triggered inflammation and apoptosis as well as Wnt5a/JNK activation. Wnt5a was elevated in ATDC5 cells in the presence of SFRP5 overexpression, to determine whether Wnt5a/JNK signaling was involved in the actions of SFRP5. RESULTS: The mRNA and protein levels of SFRP5 was significantly reduced by LPS in a concentration-dependent manner. Overexpression of SFRP5 in ATDC5 cells inhibited LPS-induced inflammation and apoptosis, as evidenced by decreased production of TNF-α, IL-1ß, IL-6, and ROS, together with a reduced ratio of TUNEL-positive cells, a lower expression of Bax and cleaved caspase 3, but a higher expression of Bcl-2. Meanwhile, SFRP5 overexpression also repress Wnt5a and phosphorylated JNK expression. However, the overexpression of Wnt5a considerably weakened the inhibitory effect of SFRP5 on LPS-triggered inflammation and apoptosis. Besides, the level of Wnt5a and JNK phosphorylation, which was inhibited by SFRP5 overexpression, was also partially recovered by Wnt5a overexpression. CONCLUSION: SFRP5 could alleviate LPS-induced ATDC5 cell inflammation and apoptosis; these actions may rely on repressing Wnt5a/JNK activation.

Cross-cultural translation and validation of the Chinese Oxford Knee Score and the Activity and Participation Questionnaire.

OBJECTIVE: To cross-culturally translate and validate the Chinese versions of the Oxford Knee Score (OKS) and the Activity and Participation Questionnaire (APQ) in patients with end-stage knee osteoarthritis who are also candidates for knee replacement. METHODS: The Chinese version of the OKS and APQ was completed by standard forward-backward translation and adaption. The feasibility was validated by a pretest in 30 patients. The final version together with the Short Form-36 (SF-36), EQ-5D, and EQ visual analog scale were assessed in 150 patients, and the OKS and APQ were repeated in 30 patients after a 2-week interval. The psychometric properties of the OKS and APQ were evaluated for test-retest reliability using intraclass correlation coefficients (ICCs), internal consistency using Cronbach's α, and construct validity using Spearman's correlation analysis. RESULTS: All patients were able to understand and complete both the OKS and APQ without difficulty (i.e. no missing data). The ICCs were 0.959 for the OKS, 0.956 for the APQ for total scores, and >0.7 for each item. Cronbach's α was greater than 0.7, and the corrected item-total correlation was greater than 0.4 for each item of both questionnaires. The OKS and APQ showed better correlations with questions from the pain and function domains than with those from the mental status domains of the SF-36 and EQ-5D. No floor or ceiling effect was identified in either questionnaire. CONCLUSIONS: The Chinese versions of the OKS and APQ are easy to understand and complete and showed good reliability and validity. They can be used to assess patient-reported outcomes after undergoing knee replacement in mainland China.

[Effect of pelvic rotation on the placement angle of acetabular prosthesis in total hip arthroplasty].

OBJECTIVE: To study the effect of pelvic rotation in three-dimensional direction on the actual placement angle of acetabular prosthesis in total hip arthroplasty. METHODS: Pelvic CT imaging data of normal adults were collected, and three-dimensional reconstruction of pelvic acetabulum was performed with computer software to simulate the rotation of the pelvis around X, Y and Z axes perpendicular to the sagittal, transverse and coronal planes of the human body. Radiographic inclination(RI) and radiographic anteversion (RA) of the acetabular cup were measured when the acetabular prosthesis was implanted at a standard angle. The correlation analysis was used to quantify the relationship between the rotation angle of each axis and the actual angle of acetabulum. RESULTS: The pelvic rotation along the X-axis and Y-axis had little effect on the RA of the acetabulum, but had a great influence on the RI and showed a linear correlation. The regression equations were RA=0.682 4X+10.256(r²=0.308 4) and RA=-0.714 1Y+10.424(r²=0.999 8). The pelvic rotation along the Z-axis had little effect on the RA, but had a linear correlation with the RI, and the regression equation was RI=1.0Z+46(r²=1.0). CONCLUSIONS: The anteroposterior rotation of the pelvis or the longitudinal rotation along the body significantly affected the acetabular anteversion, but had little effect on the abduction angle. On the contrary, the left and right deviation of the pelvis on the coronal plane could significantly affect the acetabular anteversion angle, but did not affect its anteversion angle.

[Introduction of EOS imaging system and its current research status in evaluating clinical value of lower limb force line].

The principle and technical background of EOS imaging system are introduced. Combining with the publicity of this technology and the existing literature reports, it is known that low dose EOS technology can reduce radiation dose by 5 to 10 times in the course of examination, and micro dose EOS can even reduce radiation dose by 45 times. The image quality is only high or low; the system has EOS 2D and 3D workstations, which can help clinicians to measure and evaluate coronal and sagittal force lines of lower limbs easily. The tilt and torsion of limbs can be measured three-dimensional after three-dimensional model reconstruction in the three-dimensional workstation. Using these results, preoperative evaluation can be carried out. It is helpful for clinicians to evaluate and improve preoperative planning and post-operative measurement and evaluation of surgical effect. In terms of measurement accuracy, a large number of literatures reported that the accuracy of EOS 2D measurement is comparable to that of general radiology measurement, while the accuracy of EOS 3D reconstruction measurement is comparable to that of CT and MRI. Based on the technical characteristics and advantages of EOS, this paper reviews the literature reports and research progress of EOS in evaluating the accuracy of lower limb alignment.

Orexin A may suppress inflammatory response in fibroblast-like synoviocytes.

Orexins are peptides found in the hypothalamus and other peripheral tissues including adipose tissue, the endocrine cells of the gut, adrenal gland testis, and the pancreas. They play important roles in neuro-protection by inhibiting oxidative stress and inflammatory response via their type 1 and 2 receptors (OX1R and OX2R). The expressions of OX1R and OX2R were detected and the physiological function of orexin A in fibroblast-like synoviocytes (FLSs) was investigated in this study. Only OX1R was found on FLSs and the expression of OX1R was decreased in fibroblast-like synoviocytes in rheumatoid arthritis (RA-FLSs) and tumor necrosis factor-α (TNF-α)-treated FLSs. Orexin A exhibited an anti-inflammatory effect on TNF-α treated FLSs. Particularly, orexin A treatment reduced the secretions of interleukin-1ß (IL-1ß), interleukin-6 (IL-6), and interleukin-8 (IL-8) as well as the production of reactive oxygen species (ROS). Importantly, we showed that orexin A ameliorated the expression of matrix metalloproteinase-3 (MMP-3) and matrix metalloproteinase-13 (MMP-13). Mechanistically, we found that orexin A inhibited TNF-α-induced activation of the nuclear factor-κB (NF-κB) signaling pathway. The current study provides a basis for the potential application of orexin A in the clinical treatment of RA.

Patterns of Compartment Involvement in End-stage Knee Osteoarthritis in a Chinese Orthopedic Center: Implications for Implant Choice.

OBJECTIVES: Knee osteoarthritis (OA) is a prevalent disease in the elderly, causing pain and contributing to poor quality of life. Surgical intervention, such as knee arthroplasty, can be used in those with end-stage knee OA. Total knee arthroplasty (TKA) is one of the most common surgical procedures for end-stage knee OA, with promising clinical outcomes. However, a large proportion of patients with isolated compartment OA can be treated with unicompartmental knee arthroplasty (UKA) instead. UKA has shown better patient-reported functional outcomes, and lower mortality and major complication rates than TKA. The percentage of UKA in knee arthroplasty varied in different orthopedic centers, and we believed that the requirement for UKA was underestimated in many centers. A retrospective study was carried out on our Chinese patient population presenting for knee arthroplasty; it aimed to identify the proportion of patients that might be suitable for UKA. METHODS: A retrospective cross-sectional study of 155 consecutive patients (168 knees) awaiting TKA for end-stage primary OA was performed. The pattern and grade of OA was recorded from preoperative weight-bearing anteroposterior and non-weight-bearing lateral radiographs. The medial, lateral, patellofemoral compartment was given an individual Kellgren-Lawrence grade on the radiographs, and those grade ≥3 were defined as end-stage OA. The compartments involvement was established then. The integrity of the anterior cruciate ligament (ACL) was determined by the modified Keyes classification on lateral radiographs. The applicability for total or partial knee arthroplasty was determined according to the compartments involvement. RESULTS: Medial compartment involvement was found in 154 (91.7%) knees, while the involvement of the lateral compartment and patellofemoral joint was found in 54 (32.1%) and 57 (33.9%) knees, respectively. Eighty-one (48.2%) of the knees showed medial compartment OA with or without patellofemoral joint involvement, and modified Keyes classification grade 1, indicating an intact ACL, and, hence, potential suitability for medial UKA. Isolated lateral OA indicating possible suitability for lateral UKA was identified in 11 knees (6.5%). No patients showed isolated patellofemoral joint OA. The other 76 (45.2%) knees could be treated by TKA. CONCLUSIONS: The medial compartment was the most commonly affected in our Chinese patients indicated for knee arthroplasty. More than half of the patients in this group could be treated by either medial or lateral UKA.

[Extraforaminal lumbar disc herniation: anatomical study and surgical treatment].

OBJECTIVES: To provide the anatomical basis for surgical treatment of extraforaminal lumbar disc herniation (EFLDH) by paraspinous muscle splitting approach and to investigate the effect of its application. METHODS: The relationship among the intertransverse processes, lateral margin of the pars interarticularis, anterior ramus of the lumbar nerve, and anterior ramus of the lumbar artery was studied in 34 cadaveric specimens. From October 1993 to October 1999, eleven cases of extraforaminal lumbar disc herniation were treated by paraspinous muscle splitting approach and retroperitoneal approach. RESULTS: In the extraforaminal region, the anterior ramus of the lumbar artery and venus locate ventrally to the superior half of the intertransverse space, and the anterior ramus of the lumbar artery runs downward behind the nerve. The distance from the lateral margin of the pars interarticularis to the nerve root and the angle between the nerve root and midline sagittal plane were 1.0 - 2.0 cm and 7 degrees - 25 degrees respectively which increased gradually from L(1) to L(5). The period of follow up in 10 of 11 cases was 23 - 98 months. Evaluation according to Low Back Outcome Score showed excellent results in 8 cases, and good in 2. CONCLUSION: Surgical treatment of EFLDH by paraspinous muscle splitting approach is safe, effective and minimal invasive.

[Preoperative analgesia in orthopaedic surgery].

Orthopaedic postoperative pain not only brings a lot of side effects to patients, but also directly affects early rehabilitation after surgery. Effective preoperative pain management mainly includes three-stage individual pattern analgesia, which refers to preoperative, intraoperative and postoperative analgesia. The purpose is to reduce pain in multiple planes and three-dimension, strengthen the effect of analgesics and reduce dosage and side effect of single drug. This paper summaries new progress on individual-multiple-pattern analgesics, pain assessment method and various therapies.

[Metaphase outcome of total hip arthroplasty with Zweymuller system in treating developmental dysplasia of the hip].

OBJECTIVE: To analyze the metaphase outcome of total hip arthroplasty with Zweymuller system and deepening acetabulum technique in treating DDH. METHODS: From Jan.1998 to Dec. 2004,56 patients (62 hips) with DDH (secondary osteoarthritis) were treated with total hip arthroplasty with Zweymuller system. There were 14 males (15 hips) and 42 females (47 hips) with an average age of 48.6 years,ranged from 30 to 67 years. All patients had pain of hip joint and functional disturbance before operation. Observation items included postoperative complications,imaging and function of hip joint. The function of hip joint was analyzed according to Harris scoring. RESULTS: All patients were followed up from 5 to 11 years with an average of 6.5 years. X-rays showed that the acetabular cup was in the position of true acetabulum, which combined tightly with the peripheral bone, the abduction angle of the acetabular cup was from 35 degrees to 45 degrees, introversion and extroversion of the femoral prosthesis was within 3 degrees, operated legs were shorter with a mean of (0.5 +/- 0.2) cm. The complications were as following:deep vein thrombosis in 20 cases,which were improved after thrombolysis;hip dislocation in 1 case,which was treated with reduction and immobilization for 3 weeks; ectopic ossification in 4 patients,all were Brook II type; no found infection or nerve injury. The Harris scoring was 87.4 +/- 3.5 postoperative,which was significant higher than that preoperative (43.2 +/- 6.7). CONCLUSION: The metaphase outcome of total hip arthroplasty with Zweymuller system and deepening acetabulum technique in treating DDH can obtain good result.

Clinical outcome of Zweymüller total hip arthroplasty for patients with high congenital hip dislocation.

Treatment of high congenital dislocation of the hip (CDH) remains controversial. We report the outcome of hip arthroplasty using a cementless threaded cup and a cementless straight stem in patients with high congenital hip dislocation. Between January 2001 and August 2004, 17 patients with high congenital hip dislocation were treated. During surgery, at least 25% of the cup was anchored in bone. By monitoring somatosensory-evoked potentials (SEPs) of the common peroneal nerve we were able to reduce the femoral head into position in the true acetabulum by releasing soft tissues. A bulk autogenous femoral head bone graft was implanted in 5 patients to achieve at least 75% bony coverage of the acertabular component. Follow-up ranged from 48 months to 91 months with an average of 69.7 months. The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (P<0.001). Radiographic analysis showed bony union of the bone graft in all cases.