Bone marrow stromal cell-derived exosomal circular RNA improves diabetic foot ulcer wound healing by activating the nuclear factor erythroid 2-related factor 2 pathway and inhibiting ferroptosis.

BACKGROUND: Diabetic foot ulcer (DFU) remains a serious chronic diabetic complication that can lead to disability. CircRNA-itchy E3 ubiquitin protein ligase (circ-ITCH) was observed to be down-regulated in diabetic retinopathy and diabetic nephropathy, and overexpression of circ-ITCH could inhibit the processes of these diseases. However, the detailed physiological and pathological functions of circ-ITCH in wound healing of DFU remain undetermined. METHODS: Exosomes derived from bone marrow stromal cells (BMSCs) were isolated and identified. Cell viability and angiogenesis of human umbilical vein endothelial cells (HUVECs) were evaluated by cell counting kit-8 (CCK-8) and tube formation assays, respectively. The interplays of circ-ITCH, TATA-Box-binding protein associated factor 15 (TAF15) and nuclear factor erythroid 2-related factor 2 (Nrf2) mRNA were analysed by RNA immunoprecipitation (RIP), fluorescence in situ hybridization (FISH) combined immunofluorescent staining and RNA pull-down assays. qRT-PCR, western blot or immunohistochemistry (IHC) were used to measure the expression of circ-ITCH, TAF15, Nrf2, vascular endothelial growth factor (VEGFR) and ferroptosis-related makers. The mice DFU model was established to verify the in vitro results. RESULTS: Circ-ITCH was down-regulated in in vitro and in vivo models of DFU. Deferoxamine (DFO), an iron chelating agent, improved the viability and angiogenic ability of high glucose (HG)-treated HUVECs. Overexpression of circ-ITCH or co-cultured with exosomal circ-ITCH from BMSCs could alleviate HG-induced ferroptosis and improve the angiogenesis ability of HUVECs. Circ-ITCH in HUVECs recruited TAF15 protein to stabilize Nrf2 mRNA, thus activating the Nrf2 signalling pathway and suppressing ferroptosis. Exosomal circ-ITCH from BMSCs also accelerated the wound healing process by inhibiting ferroptosis in the DFU mice in a time-dependent manner. CONCLUSION: Exosomal circ-ITCH from BMSCs inhibited ferroptosis and improved the angiogenesis of HUVECs through activation of the Nrf2 signalling pathway by recruiting TAF15 protein, ultimately accelerating the wound healing process in DFU.

Comparison of Clinical and Radiological Outcomes between Calibratable Patient-Specific Instrumentation and Conventional Operation for Medial Open-Wedge High Tibial Osteotomy: A Randomized Controlled Trial.

Background: High tibial osteotomy (HTO) is an effective surgery in treating medial compartment knee osteoarthritis (KOA) combined with varus deformity. An accurate orthopaedy is the key and challenge to the success of HTO. Therefore, we designed a calibratable patient-specific instrumentation (PSI) to assist surgery and evaluated its accuracy and clinical outcomes by comparing with conventional operation (CO). Materials and Methods: 37 patients (39 knees) with medial compartment KOA were randomly divided into the PSI and CO groups and underwent medial open-wedge high tibial osteotomy (MOWHTO) from September 2020 to May 2021. The postoperative radiological outcomes were compared with the preoperative measurements or target values to evaluate the accuracy of correction in the two groups. The American Knee Society Score (AKSS), complication rate, number of intraoperative radiation exposures, blood loss volume, and operative duration were analysed to evaluate the clinical outcomes in the two groups. Results: The designed target values were better achieved in the PSI group than in the CO group. The mean absolute difference between the postoperative measurements and preoperative targets was significantly lower in the PSI group than in the CO group (weight-bearing line (WBL) ratio, 1.97 ± 1.83% vs.5.42 ± 4.41%, P = 0.002; hip-knee-ankle (HKA) angle, 1.12 ± 0.86° vs. 2.27 ± 1.97°, P = 0.018). The operative duration was significantly shorter (P = 0.014), and the number of radiation exposures (P < 0.001) and volume of intraoperative blood loss (P = 0.003) were significantly lower in the PSI group than in the CO group. The clinical AKSS score at 3 and 6 months postoperatively and the functional AKSS score at 3 months postoperatively were significantly higher in the PSI group than in the CO group (P = 0.042, 0.040, and 0.034, respectively). Conclusion: For patients with medial compartment KOA, calibratable PSI can assist the surgeon in MOWHTO with superior accuracy and clinical efficacy. This study was conducted under Randomized Controlled Trial Details (RCT) with Registry Number ChiCTR2000038619.

A waterproof, low-cost dressing system reduces postoperative wound dressing changes in primary total hip arthroplasty: An efficacy study.

Backgrounds: Postoperative wound complication is a major risk factor for the development of Periprosthetic joint infection. We innovatively invented a new dressing system to reduce the occurrence of postoperative wound complications and improve the quality of life of patients after total hip arthroplasty. Methods: A total of 120 patients who underwent primary unilateral total hip arthroplasty were enrolled in this study. The data collected included the number of dressing changes, costs of the dressings, postoperative hospital stay, The Visual Analogue Scale (VAS) score, The Harris Hip Score (HHS), ASEPSIS score, The Stony Brook Scar Evaluation Scale (SBSES), wound complications, the frequency of showers and satisfaction. Data were statistically analyzed. Results: The average number of dressing changes was 0.74 ± 0.46, while the average postoperative hospital stay was 3.67 ± 0.97 days. The average cost of the new dressings throughout a treatment cycle was 57.42 ± 15.18 dollars. The VAS score decreased from 5.63 ± 1.09 before the operation to 0.88 ± 0.54 one month after the operation. The HHS score increased from 70.18 ± 7.84 before the operation to 80.36 ± 4.08 one month after the operation. The results of the four indexes of the ASEPSIS score were all 0. The SBSES score was 3.55 ± 0.61 at two weeks after the operation, and 4.38 ± 0.71 at one month after the operation. No wound complications were recorded until one month after the operation when the satisfaction rate was 92.53 ± 3.62%. Conclusion: In this study, we have invented a new dressing system for surgical wounds after total hip arthroplasty and confirmed its efficacy. Chinese Clinical Trial Registry: ChiCTR2000033822, Registered 13/ June/2020.

Mixed Reality Technology in Total Knee Arthroplasty: An Updated Review With a Preliminary Case Report.

Background: Augmented reality and mixed reality have been used to help surgeons perform complex surgeries. With the development of technology, mixed reality (MR) technology has been used to improve the success rate of complex hip arthroplasty due to its unique advantages. At present, there are few reports on the application of MR technology in total knee arthroplasty. We presented a case of total knee arthroplasty with the help of mixed reality technology. Case Presentation: We presented a case of a 71-year-old woman who was diagnosed with bilateral knee osteoarthritis with varus deformity, especially on the right side. After admission, the right total knee arthroplasty was performed with the assistance of MR technology. Before the operation, the three-dimensional virtual model of the knee joint of the patient was reconstructed for condition analysis, operation plan formulation, and operation simulation. During the operation, the three-dimensional virtual images of the femur and tibia coincided with the real body of the patient, showing the osteotomy plane designed before the operation, which can accurately guide the completion of osteotomy and prosthesis implantation. Conclusions: As far as we know, this is the first report on total knee arthroplasty under the guidance of mixed reality technology.

A New Dressing System Reduces the Number of Dressing Changes in the Primary Total Knee Arthroplasty: A Randomized Controlled Trial.

Purpose: We devised a novel dressing system to accelerate the recovery after total knee arthroplasty (TKA). The purpose of this study was to assess the clinical outcomes and economic expenses of the new dressing system. Methods: In this randomized and controlled trial, we enrolled 98 patients who underwent the first unilateral TKA between September 2020 and June 2021. The patients were randomly assigned to one of two groups: the intervention (the new dressing system group) or the control (the traditional gauze dressing) group. We gathered and evaluated patient data including age, gender, body mass index, surgical side, number of dressing changes, post-operative hospital stay, dressing-related expense, satisfaction, pain and function scores, wound scores and wound-related complications. Results: The number of dressing changes and post-operative hospital stay in the intervention group were significantly less than in the control group (p = 0.000, p = 0.002). Satisfaction in the intervention group was significantly higher than in the control group's (p = 0.000). There were no significant differences between the two groups in dressing-related expense, pain and function scores. During the one month follow-up, the intervention group's Stony Brook Scar Evaluation Scale (SBSES) was considerably higher than the control group's (p = 0.012). Conclusion: The new dressing system can reduce the number of dressing changes and post-operative hospital stays while increasing patient satisfaction with no difference in medical costs in TKA. This wound dressing system has potential for application in TKA. Clinical Trial Registration: https://clinicaltrials.gov, identifier ChiCTR2000033814.

[Clinical application of split three-dimensional printing patient-specific instrumentation in medial open-wedge high tibial osteotomy].

OBJECTIVE: To investigate the accuracy of split three-dimensional (3D) printing patient-specific instrumentation (PSI) in medial open-wedge high tibial osteotomy (MOWHTO) and its effectiveness in treating medial knee osteoarthritis. METHODS: Clinical data of 14 patients with medial knee osteoarthritis and treated with split 3D printing PSI-assisted MOWHTO between August 2019 and August 2020 were retrospectively analyzed. There were 5 males and 9 females with an average age of 61 years (range, 43-68 years). The disease duration ranged from 1 to 16 years, with an average of 4.7 years. Preoperative Kellgren-Lawrence grading of knee osteoarthritis included grade Ⅰ in 2 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 6 cases. The Hospital for Special Surgery (HSS) score was 59.1±4.9. The weight bearing line ratio (WBL), hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), and actual correction angle of the lower limbs were measured on postoperative imaging data, and compared with the preoperative measurements and the designed target values to evaluate the accuracy of the PSI-assisted surgery. The patients' knee function were evaluated with the HSS score at 3 and 6 months postoperatively, and at last follow-up. RESULTS: One patient suffered from an incision exudation at 2 weeks postoperatively, and the incision healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 7-19 months (mean, 14.8 months). There was no neural injuries, hinge fracture, plate or screw fractures, loosening, or other complications. The WBL was maintained at the postoperative level according to the X-ray examination during the follow-up period. The WBL, HKA, MPTA, and PTSA were all within a satisfactory range after operation. The WBL, HKA, and MPTA were significantly improved when compared with the preoperative measurements ( P<0.05). There was no significant difference between preoperative and postoperative PTSA ( P>0.05). The differences in postoperative WBL, HKA, MPTA, and correction angle compared with the preoperative designed target values were not significant ( P>0.05). The HSS scores were 69.2±4.7, 77.7±4.3, and 88.1±5.4 at 3 and 6 months postoperatively, and last follow-up, respectively. The differences between time points were significant ( P<0.05). CONCLUSION: For patients with medial knee osteoarthritis, the split 3D printing PSI can assist the surgeon in MOWHTO with accurate osteotomy orthopedics and achieve favorable effectiveness.

Simulated operation combined with patient-specific instrumentation technology is superior to conventional technology for supramalleolar osteotomy: a retrospective comparative study.

OBJECTIVE: Over the past seven years, our team has designed a simulated operation combined with patient-specific instrumentation (SO-PSI) assisted supramalleolar osteotomy (SMOT) method and applied it in the clinic. This study aimed to evaluate the differences between SO-PSI technology and conventional operation (CO) technology for SMOT in preoperative planning, intraoperative application, and postoperative curative effect. METHODS: We retrospectively analyzed SMOT data collected from our hospital between October 2014 and December 2018. Patients (n = 28) were enrolled and divided into CO (n = 17) and SO-PSI (n = 11) groups; mean follow-up time was 33.4 (range, 13 to 59) months. We statistically analyzed and compared perioperative data, accuracy of preoperative planning, intraoperative application, difference between pre- and post-operative radiologic ankle angles, changes in American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of ankle motion, and Takakura stage after surgery. RESULTS: All ankle alignments and positions were recovered for both groups. Compared with the CO group, the SO-PSI group had a shorter mean operating time and postoperative hospital stay, a decreased number of fluoroscopy examinations, lower albumin reduction, longer preoperative planning time and preoperative hospital stay, and increased hospitalization expenses. In the SO-PSI group, comparison of ankle angles at preoperative planning and postoperatively revealed good correlation, while this was not the case in the CO group. Mean tibial ankle center discrepancy for the SO-PSI group was 1.86 ± 1.06 mm. On follow-up, all radiologic parameters for the two groups improved significantly; however, the improvement of the tibial anterior surface angle and tibiotalar tilt angle for the SO-PSI group were more obvious than those for the CO group. AOFAS score, VAS score, ankle range of motion, and Takakura stage improved after surgery in both groups; however, the improvements in the SO-PSI group were greater than those in the CO group overall. CONCLUSIONS: SO-PSI technology can facilitate accurate and rapid preoperative planning for SMOT. In general, compared with conventional technology, SO-PSI has advantages for preoperative planning, intraoperative application, and postoperative curative effect.

Circular RNA AFF4 modulates osteogenic differentiation in BM-MSCs by activating SMAD1/5 pathway through miR-135a-5p/FNDC5/Irisin axis.

Bone marrow-derived mesenchymal stem cells (BM-MSCs), the common progenitor cells of adipocytes and osteoblasts, have been recognized as the key mediator during bone formation. Herein, our study aim to investigate molecular mechanisms underlying circular RNA (circRNA) AFF4 (circ_AFF4)-regulated BM-MSCs osteogenesis. BM-MSCs were characterized by FACS, ARS, and ALP staining. Expression patterns of circ_AFF4, miR-135a-5p, FNDC5/Irisin, SMAD1/5, and osteogenesis markers, including ALP, BMP4, RUNX2, Spp1, and Colla1 were detected by qRT-PCR, western blot, or immunofluorescence staining, respectively. Interactions between circ_AFF4 and miR-135a-5p, FNDC5, and miR-135a-5p were analyzed using web tools including TargetScan, miRanda, and miRDB, and further confirmed by luciferase reporter assay and RNA pull-down. Complex formation between Irisin and Integrin αV was verified by Co-immunoprecipitation. To further verify the functional role of circ_AFF4 in vivo during bone formation, we conducted animal experiments harboring circ_AFF4 knockdown, and born samples were evaluated by immunohistochemistry, hematoxylin and eosin, and Masson staining. Circ_AFF4 was upregulated upon osteogenic differentiation induction in BM-MSCs, and miR-135a-5p expression declined as differentiation proceeds. Circ_AFF4 knockdown significantly inhibited osteogenesis potential in BM-MSCs. Circ_AFF4 stimulated FNDC5/Irisin expression through complementary binding to its downstream target molecule miR-135a-5p. Irisin formed an intermolecular complex with Integrin αV and activated the SMAD1/5 pathway during osteogenic differentiation. Our work revealed that circ_AFF4, acting as a sponge of miR-135a-5p, triggers the promotion of FNDC5/Irisin via activating the SMAD1/5 pathway to induce osteogenic differentiation in BM-MSCs. These findings gained a deeper insight into the circRNA-miRNA regulatory system in the bone marrow microenvironment and may improve our understanding of bone formation-related diseases at physiological and pathological levels.

Circ-ITCH sponges miR-214 to promote the osteogenic differentiation in osteoporosis via upregulating YAP1.

Osteoporosis is the most prevailing primary bone disease and a growing health care burden. The aim of this study was to clarify the functional roles and mechanisms of the circ-ITCH regulating osteogenic differentiation of osteoporosis. Circ-ITCH and yes-associated protein 1 (YAP1) levels were downregulated, but the miR-214 level was upregulated in osteoporotic mice and patients. Knockdown of circ-ITCH inhibited the alkaline phosphatase (ALP) activity, mineralized nodule formation, and expression of runt-related transcription factor 2 (RUNX2), osteopontin (OPN), and osteocalcin (OCN) during osteogenic induction. Furthermore, miR-214 was a target of circ-ITCH, knockdown of miR-214 could impede the regulatory effects of sh-circ-ITCH on osteogenic differentiation. Moreover, miR-214 suppressed hBMSCs osteogenic differentiation by downregulating YAP1. Finally, in vivo experiments indicated that overexpression of circ-ITCH could improve osteogenesis in ovariectomized mice. In conclusion, circ-ITCH upregulated YAP1 expression to promote osteogenic differentiation in osteoporosis via sponging miR-214. Circ-ITCH could act as a novel therapeutic target for osteoporosis.

Patient-specific total hip arthroplasty is superior to conventional methods for Crowe III and IV adult developmental hip dysplasia: a randomized controlled trial.

BACKGROUND: Restoration of the acetabulum during total hip arthroplasty in adults with developmental dysplasia of the hip (DDH-THA) and resumption of hip function remain major challenges. Herein, a new patient-specific instrument (PSI) was developed that uses the superolateral rim of the acetabulum as a positioning marker to assist surgeons in adult DDH-THA. METHODS: From January 2017 to October 2018, 104 adult DDH patients were randomized to either the PSI group or conventional operation (CO) group, and further divided into eight subgroups by stratified random sampling using Crowe's classification. Complications, Harris hip scores (HHS), and X-ray results were recorded at 3 and 12 months after surgery. RESULTS: With the exception of anteversion in CO-Crowe II group patients, there was no difference in the accuracy of cup placement and orientation between the PSI and CO groups in Crowe I and II DDH patients. With the exception of percentage of acetabular cup coverage (PACC) and the qualification rate of Crowe IV PACC patients, among all Crowe III and IV DDH groups, all postoperative indexes of cup orientation and positioning exhibited significant differences between the PSI and CO groups; however, no significant differences were observed in Crowe I and II DDH patients. CONCLUSIONS: Compared with conventional methods, the new PSI-assisted surgical method improved the accuracy of placement and orientation of the acetabulum and cup prosthesis, optimized the surgical process, reduced complications, and contributed to quicker recovery of hip function after surgery in adults with Crowe III and IV DDH-THA, but little difference was noted for those with Crowe I and II DDH.

LncRNA DANCR and miR-320a suppressed osteogenic differentiation in osteoporosis by directly inhibiting the Wnt/ß-catenin signaling pathway.

Our study aimed to determine how lncRNA DANCR, miR-320a, and CTNNB1 interact with each other and regulate osteogenic differentiation in osteoporosis. qRT-PCR and western blotting were performed to determine the expression of DANCR, miR-320a, CTNNB1, and the osteoporosis- or Wnt/ß-catenin pathway-related markers T-cell factor 1 (TCF-1), runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), osteocalcin (OCN), and osteopontin (OPN). Interactions between CTNNB1, DANCR, and miR-320a were predicted by bioinformatics approaches and validated using a luciferase assay. Osteoblastic phenotypes were evaluated by ALP staining, ALP activity assay and Alizarin Red staining. The bilateral ovariectomy method was used to establish an in vivo osteoporosis model. Bone morphological changes were examined using hematoxylin and eosin (H&E) and Alcian Blue staining. The expression levels of DANCR and miR-320a in BMSCs derived from osteoporosis patients were upregulated, whereas CTNNB1 expression was downregulated compared with that in healthy controls. Importantly, we demonstrated that miR-320a and DANCR acted independently from each other and both inhibited CTNNB1 expression, whereas the inhibitory effect was additive when miR-320a and DANCR were cooverexpressed. Moreover, we found that DANCR overexpression largely abrogated the effect of the miR-320a inhibitor on CTNNB1 expression and the Wnt/ß-catenin signaling pathway in BMSCs during osteogenic differentiation. We further confirmed the results above in BMSCs derived from an osteoporosis animal model. Taken together, our findings revealed that DANCR and miR-320a regulated the Wnt/ß-catenin signaling pathway during osteogenic differentiation in osteoporosis through CTNNB1 inhibition. Our results highlight the potential value of DANCR and miR-320a as promising therapeutic targets for osteoporosis treatment.

Surgery simulation teaching based on real reconstruction aid versus traditional surgical live teaching in the acquisition of an adult total hip arthroplasty surgical technique for developmental dysplasia of the hip: a randomized comparative study.

BACKGROUND: A simulation and model (SM) teaching aid using 3D printing was developed to improve a training course for total hip arthroplasty of adult developmental dysplasia of the hip (adult DDH-THA). We named this new method Surgery Simulation Teaching based on a Real Reconstruction Aid (RRA-SST). A prospective randomized comparison was performed with the traditional surgical live teaching method to evaluate the training effectiveness of RRA-SST for adult DDH-THA. METHODS: Twenty-six trainees, who were already practicing but were not experienced, participated in the study. We randomly divided the trainees into two groups: Group A (n = 13) received RRA-SST and group B (n = 13) received traditional surgical live teaching. A surgery simulation test and a questionnaire were used for evaluation. Next, each group received training with the other teaching method, and then the test and questionnaire were used again for evaluation. RESULTS: After the first test, the RRA-SST method was shown to produce better results than the traditional surgical live teaching method. After the second test, the results showed the training effect in both groups reached the same level, which was level as Group A RRA-SST results. Analysis of the questionnaire results showed that the training effect of RRA-SST was higher than that of traditional surgical live teaching, from multiple perspectives. CONCLUSIONS: The use of RRA-SST improved participant performance according to simulation assessment. RRA-SST can be helpful for trainees who are already practicing but not experienced when developing proficiency in adult DDH-THA surgical techniques.

Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study.

BACKGROUND: Traditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan. METHODS: We retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available. RESULTS: Mean intraoperative fluoroscopy time was 3.95 ± 1.78 h; IFAU in 16 patients (16 ft) was the same as the preoperative plan; mean surgery time was 28.16 ± 10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2% ± 2.3%. AOFAS scores increased with time, with significant differences in the score at each time point. CONCLUSIONS: The newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.

Pseudogene PTENP1 sponges miR-214 to regulate the expression of PTEN to modulate osteoclast differentiation and attenuate osteoporosis.

BACKGROUND AIMS: Osteoporosis (OP) is a common bone metabolic disease with a high incidence. Our study aimed to explore the pseudogene PTENP1/miR-214/PTEN axis to modulate the osteoclast differentiation in osteoporosis. METHODS: Patients with osteoporosis were recruited in our study, and RANKL-induced osteoclast differentiation and ovariectomy-induced osteoporosis mouse model were established in vitro and in vivo, respectively. RESULTS: Pseudogene PTENP1 and PTEN were significantly down-regulated and miR-214 was up-regulated in osteoporosis patients. In addition, overexpression of PTENP1 or silence of miR-214 inhibited the expression levels of osteoclast specific markers and osteoclast differentiation induced by RANKL. Overexpression of PTENP1 or silence of miR-214 also inhibited the levels of phosphorylation of PI3K and AKT, p65 nuclear translocation, IκBα degradation and the expression level of NFATc1. AlsoSilence of PTENP1 or overexpression of miR-214 induced the osteoclast differentiation under normal physiological condition. Pseudogene PTENP1 sponged miR-214 to regulate the expression of PTEN. CONCLUSIONS: In an ovariectomy-induced osteoporosis mouse model, obvious pathological changes in bone tissues were found, and bone marrow mononuclear cells in this group were more likely to differentiate into osteoclasts. Therefore, pseudogene PTENP1 sponged miR-214 to regulate the expression of PTEN to inhibit osteoclast differentiation and attenuate osteoporosis by suppressing the PI3K/AKT/NF-κB signaling pathway.

Effect of patient-specific instrument on lowering threshold for junior physicians to perform total hip arthroplasty on developmental dysplasia of the hip patients.

PURPOSE: To create a patient-specific instrument (PSI) in lowering the surgical experience requirement for junior physicians to perform total hip arthroplasty (THA) on developmental dysplasia of the hip (DDH) patients. METHODS: Combined with rapid prototyping technology, we created a PSI and established DDH hip model in vitro. We enrolled 48 junior physicians and randomly assigned them into two groups. After creation of the PSI, they performed simulated THA surgery on a full-scale hip model with or without PSI on DDH models. The planned prothesis orientation, post-operative prothesis orientation, and surgery time were recorded. RESULTS: The final cup inclination was 42.0 ± 0.8° in PSI group and 37.8 ± 2.0° in control group, while final cup anteversion was 16.0 ± 0.7° in PSI group and 24.7 ± 3.5° in control group. The △inclination in PSI group was smaller than that in control group (4.2 ± 0.5° vs 9.5 ± 1.4°, P < 0.01), so does △inclination (2.9 ± 0.4° in PSI group vs 15.2 ± 2.5° in control group, P < 0.01). The outlier percent was 8.3% in PSI group and 70.8% in control group (P < 0.01). At the same time, the PSI group did not prolong the operation time (P = 0.551). CONCLUSION: The PSI can greatly increase the accuracy of placing the cup orientation and lower the threshold for junior physicians to perform THA on DDH patients. It could be a training tool for them to increase their THA surgical skills.

A comparison between arthroscopic and open surgery for treatment outcomes of chronic lateral ankle instability accompanied by osteochondral lesions of the talus.

BACKGROUND: This study aimed to examine the efficacy and safety of the arthroscopic treatment of osteochondral lesion of talus (OLT) and lateral ankle instability. It was hypothesized that the outcome of all-arthroscopic surgery was no worse than that of the combined open and arthroscopic surgery for treating chronic lateral ankle instability accompanied by OLT. METHODS: The patients diagnosed of chronic lateral ankle instability accompanied by OLT, who were surgically treated between May 2015 and May2017, were targeted for inclusion. Specifically, patients who received the arthroscopic treatment of OLT and lateral ankle instability were enrolled in the all-arthroscopic group, while patients who received the arthroscopic treatment of OLT and open lateral ankle stabilization were enrolled in the combined open and arthroscopic group. All the patients were followed up in terms of the Karlsson Ankle Functional Score, visual analog scale (VAS) score, Tegner activity score, and American Orthopaedic Foot & Ankle Society (AOFAS) score. Meanwhile, the satisfaction and complication rates were evaluated and compared. RESULTS: This retrospective study included a total of 67 patients, including 32 patients in the all-arthroscopic group and 35 patients in the combined group. At a minimum of 24-month follow-up, the functional outcomes were significantly improved in both groups in relation to the preoperative condition. However, the two groups did not differ significantly from each other in terms of the Karlsson score (83.1 ± 8.2 vs 81.7 ± 9.1; P = 0.89), the VAS score (1.8 ± 1.6 vs 2.1 ± 1.7; P = 0.73), the Tegner score (5.5 ± 2.3 vs 5.0 ± 2.1; P = 0.72), and the AOFAS score (87.7 ± 7.6 vs 86.9 ± 7.3; P = 0.77). In addition, the satisfaction and complication rates exhibited no significant differences between the two groups. CONCLUSION: In comparison with the open lateral ankle stabilization and arthroscopic treatment of OLT, the all-arthroscopic procedure showed no difference in clinical outcomes at a minimum of 24-month follow-up. Despite the benefits of minimally invasive arthroscopic procedure combined with a relatively aggressive postoperative rehabilitation protocol, the clinical outcomes for patients with chronic lateral ankle instability accompanied by OLT did not yield significant improvement. TRIAL REGISTRATION: The present study was carried out with the approval issued by the Institutional Review Board of Xiangya Hospital (no. 202002010).

Arthroscopic ankle fusion only has a limited advantage over the open operation if osseous operation type is the same: a retrospective comparative study.

BACKGROUND: A great deal of research suggests that arthroscopic ankle fusion (AAF) has advantages over open ankle fusion (OAF), but these outcomes would be imprecise because of a selection bias. The purpose of this study is to verify which is better for ankle fusion, AAF or OAF. We regrouped the OAF group into two subgroups according to whether the osseous operation type is the same as AAF group. The goal is to minimize the impact of disease severity, thereby reducing selection bias to some extent. METHODS: We retrospectively analyzed the data of ankle fusion in our hospital between July 2015 and October 2018. Forty-three patients were enrolled and divided into AAF group (n = 17) and OAF group (n = 26). In order to eliminate selection bias, we divided OAF group into complex osseous operation subgroup (COO subgroup) (n = 15) and simple osseous operation subgroup (SOO subgroup) (n = 11). The osseous operation type of SOO subgroup is the same as AAF group. Then, we compared the differences between these groups. All patients were followed up at least 1 year after operation. We analyzed data, including etiology composition, surgical time, intra-op blood loss, reduction of albumin, total hospital stays, union time, fusion situation, complications, radiological examination, functional score, and questionnaire survey. Then we performed statistical analyses. RESULTS: We found that the etiological components of AAF group and OAF group were different; the etiological components of AAF group and SOO subgroup were similar. We found that AAF group has advantages over OAF group and COO subgroup in general. However, except in terms of surgical trauma, hospital stays, and short-term complications occurred, the AAF group has not obvious advantages over SOO subgroup, including intra-op blood loss, fusion condition, postoperative function score, and postoperative patient satisfaction; and AAF group need more surgical time than the SOO subgroup. CONCLUSIONS: The arthroscopic ankle fusion can bring a good curative effect; however, if the osseous operation type is the same, the arthroscopic ankle fusion only has a limited advantage over the traditional open operation in perioperative soft tissue protection and enhanced recovery after surgery.

A Comparative Study of Patients' Subjective Feelings Toward Total Hip Arthroplasty with Patient-Specific Instruments and Traditional Total Hip Arthroplasty.

OBJECTIVE: To determine whether differences exist in patients' subjective feelings, daily life, and surgical satisfaction between those who underwent surgery for developmental dysplasia of the hip (DDH) using patient-specific instruments (PSIs) and those who underwent traditional surgical total hip arthroplasty (THA). METHODS: We selected 30 adult patients with various types of DDH who underwent surgery during 2016-2017 at our hospital. The patients were divided into PSI surgery group and the traditional surgery group. All patients underwent follow-up, and we collected data on the Harris Hip Score, Oxford University Hip Score (OHS), Forgotten Joint Score (FJS-12), Visual Analogue Scale (VAS) score, patient satisfaction score, intraoperative surgical time, amount of bleeding and postoperative complications incidence for both groups. We then performed statistical analyses on the data. RESULTS: The Harris Hip Score, OHS, VAS score, patient satisfaction score, and mean bleeding volume did not differ statistically significantly (t-tests, P > 0.05). No statistically significant differences were found between surgical groups in the incidence of complication and sub-trochanteric osteotomy, or in the surgical side (chi-square tests, P > 0.05). For the experimental group, the FJS-12 score was 80.0 ± 12.0, and for the control group the score was 68.5 ± 16.1. The operative time of the experimental group was 138.4 ± 32.2 min, while that of the control group was 88.9 ± 26.8 min. The values of these data differed significantly (t-tests, P < 0.05). CONCLUSIONS: The novel PSI designed by our group has certain advantages for the short-term subjective feelings of patients after THA, but it may cause prolonged operative times.

Mixed Reality Combined with Three-Dimensional Printing Technology in Total Hip Arthroplasty: An Updated Review with a Preliminary Case Presentation.

Three-dimensional (3D) printing technology, virtual reality, and augmented reality technology have been used to help surgeons to complete complex total hip arthroplasty, while their respective shortcomings limit their further application. With the development of technology, mixed reality (MR) technology has been applied to improve the success rate of complicated hip arthroplasty because of its unique advantages. We presented a case of a 59-year-old man with an intertrochanteric fracture in the left femur, who had received a prior left hip fusion. After admission to our hospital, a left total hip arthroplasty was performed on the patient using a combination of MR technology and 3D printing technology. Before surgery, 3D reconstruction of a certain bony landmark exposed in the surgical area was first performed. Then a veneer part was designed according to the bony landmark and connected to a reference registration landmark outside the body through a connecting rod. After that, the series of parts were made into a holistic reference registration instrument using 3D printing technology, and the patient's data for bone and surrounding tissue, along with digital 3D information of the reference registration instrument, were imported into the head-mounted display (HMD). During the operation, the disinfected reference registration instrument was installed on the selected bony landmark, and then the automatic real-time registration was realized by HMD through recognizing the registration landmark on the reference registration instrument, whereby the patient's virtual bone and other anatomical structures were quickly and accurately superimposed on the real body of the patient. To the best of our knowledge, this is the first report to use MR combined with 3D printing technology in total hip arthroplasty.

Nonanatomic versus anatomic techniques in spring ligament reconstruction: biomechanical assessment via a finite element model.

BACKGROUND: Several approaches to spring ligament reconstruction have been reported. However, a comparative study of nonanatomic and anatomic techniques with respect to biomechanical responses, such as kinematics and contact characteristics, has not been previously performed via a finite element analysis. The purpose of this study was to evaluate the biomechanical results of such spring ligament reconstructions via a finite element analysis. METHODS: A three-dimensional finite element model of the foot was developed and validated, and four reconstruction methods were simulated. The talonavicular dorsiflexion and abduction, hindfoot valgus, and contact characteristics in the Chopart joints were quantified in each model. RESULTS: Nonanatomic reconstructions corrected the talonavicular and hindfoot deformities to a greater extent than the anatomic reconstructions. The anatomic techniques also corrected the abduction and dorsiflexion deformities, although they presented insufficient power to correct for hindfoot valgus. None of the procedures restored the contact characteristics of the talonavicular and calcaneocuboid joints to those of a normal condition. CONCLUSION: Nonanatomic reconstruction of the spring ligament complex provided the greatest correction for midfoot and hindfoot misalignments in flatfoot. Severe deformities with large amounts of midfoot pronation and hindfoot valgus may be better treated with nonanatomic reconstruction methods. The spring ligament reconstruction method may mitigate the need for nonanatomic bony procedures associated with complications and allows for the preservation of the triple joint complex.