Acupuncture Effect on Analgesic Consumption and Cortisol Levels Following Total Knee Arthroplasty: A Randomized Controlled Trial.

Objective: Pain following total knee arthroplasty (TKA) is common. Various modalities of treating orthopedic postoperative pain (POP) exist; however, the optimal management of POP remains unclear. The purpose of this study was to examine acupuncture's effect on postoperative analgesic consumption and cortisol levels in patients undergoing TKA. Materials and Methods: In this randomized controlled trial, 80 patients scheduled for elective TKA surgery were recruited and randomly assigned to 2 groups: (1) an intervention group, receiving acupuncture treatment on days 1 and 2 in addition to standard POP management (n = 40) and a control group, who received standard POP management only (n = 40). Results: There was no statistical difference between the groups in analgesic consumption on days 1 and 3 postoperatively. On day 5 postoperatively, lower analgesic consumption was seen in the intervention group, compared to the control group. However, this difference was not statistically significant (1.4 versus 2.3, respectively; P = 0.215). There was no statistical difference between the groups in cortisol levels on day 1 postoperatively. In contrast, on day 2 postoperatively, cortisol level was significantly lower in the intervention group, compared to the control group (296 nmol/L versus 400 nmol/L, respectively; P < 0.05). Conclusions: The findings suggest that acupuncture may have some effect on patients' analgesic consumption short-term after TKA. Further studies with larger samples are required for establishing these results.This trial was registered at ClinicalTrials.gov (Registration #: NCT03415204).

Cross-sectional Analysis Study Between SIGMA Knee System and ATTUNE in a Cruciate-Retaining Fixed-Bearing Total Knee Replacement, with no Patellar Resurfacing.

Background: The purpose of our study was to compare the knee implant SIGMA to the ATTUNE knee implant in a cruciate-retaining (CR) fixed-bearing (FB) total knee replacement (TKR) surgery, with no patellar resurfacing. Methods: We examined 40 patients (19 SIGMA; 21 ATTUNE) who underwent a TKR FB CR surgery, without patellar resurfacing, due to osteoarthritis, between August 2013 and July 2017. All surgeries were performed by a single surgeon. We performed a cross-sectional analytical study based on preoperative patient data and data collected in follow-up sessions. All patients were asked to fill a quality-of-life (QOL) questionnaire, SF-36 translated to the Hebrew language. All patients were clinically evaluated using the Knee Society Score (KSS) and the Knee Function Score (KFS). Results: Patients from the SIGMA cohort reported fewer postoperative physical function limitations in the SF-36 (p = 0.01) and the KFS (p = 0.04). Patients who underwent surgery using the SIGMA implant reported increased vitality when compared to the ATTUNE (p = 0.02). No significant differences were found between the groups in other measures of quality of life, ranges of motion, valgus, and postoperative knee stability. The average follow-up period was significantly longer for the SIGMA (p < 0.00001). Conclusion: Significant differences were found in postoperative physical function and vitality scores between SIGMA and ATTUNE knee implants. SIGMA cohort presented superior results. Presumably, these findings are due to the differences in follow-up times.

Computed navigated total knee arthroplasty compared to computed tomography scans.

BACKGROUND: Successful total knee arthroplasty (TKA) includes accurate alignment. Controversy remains as to whether computer-navigated TKA improves the overall result and clinical outcome. Our aim is to compare the limb alignment and prosthesis positioning according to the pre- and postoperative computed tomography (CT) scans with the data collected from the navigation system. METHODS: We compared the pre- and postoperative limb alignments and prosthesis alignment provided by the Orthopilot navigation system, Aesculap®, with CT scans measured by the Traumacad® software of 70 TKAs. RESULTS: A positive correlation with statistical significance (P=0.00001, r=0.874) between the navigation system data and the CT images was found. Mean femoral cut was five degrees (valgus), and mean tibial cut was one degree (varus). Our study revealed that the navigation system assisted the surgeon to implant the prosthesis at a good acceptable alignment. CONCLUSION: We found that the navigation system is accurate and correlates to the pre- and postoperative CT scans. Furthermore, the navigation system can assist the surgeon to achieve good limb alignment and cutting planes of the prosthesis.

Nicotinic modulation of gene expression in osteoblast cells, MG-63.

Exposure to nicotine causes a broad range of biological and molecular effects on osteoblasts which are known to play a crucial role in bone metabolism and fracture healing. Most effects of nicotine on the osteoblasts are long-term adaptations at the genomic level. To identify the nicotine-regulated genes, the Agilent technologies whole human genome gene expression microarray was performed on RNA samples from osteoblast-like cells, MG-63, exposed to 100 µM nicotine. Repeat and cross-controlled microarray analyses revealed 842 genes whose expression was consistently altered at P<0.05 level following nicotine treatment. Gene ontology analysis suggested effects of nicotine on various biological and cellular processes which were associated with survival, proliferation, differentiation and apoptosis processes within the cell. Quantitative real-time reverse transcriptase PCR analysis confirmed altered expression in 7 out of 9 genes tested. The identified genes tested in the current study support our previous report that nicotine regulates the expression of genes that promote osteoblast proliferation and/or anti-apoptosis processes. Furthermore, using nicotinic acetylcholine receptor antagonists blocked the majority of the nicotine effects, indicating that these changes are dependent on nAChR activation. These results established a novel and consistent nicotinic activation of nAChR in osteoblast cells which has a broad role affecting cellular physiology through modulation of gene expression.

Nicotine modulates bone metabolism-associated gene expression in osteoblast cells.

Smoking has a broad range of physiological effects, such as being a risk factor in osteoporosis, bone fracture incidence, and increased nonunion rates. Recent studies showed that nicotine has effects at the cellular level in human osteoblast cells. To identify possible mechanisms underlying nicotine-induced changes in osteogenic metabolism, we defined changes in proliferation and osteocalcin, type I collagen, and alkaline phosphatase gene expression after treating human osteosarcoma cells (MG63), with various concentration of nicotine. Nicotine affects cell proliferation in a biphasic manner, including toxic and antiproliferative effects at high levels of nicotine and stimulatory effects at low levels. Moreover, low levels of nicotine upregulated osteocalcin, type I collagen, and alkaline phosphatase gene expression. The increased cell proliferation and gene upregulation induced by nicotine were inhibited by addition of the nicotinic receptor antagonist D: -tubocurarine. High nicotine concentrations downregulated the investigated genes. Our results demonstrate, for the first time, that the addition of nicotine concentrations analogous to those acquired by a light to moderate smoker yields increased osteoblast proliferation and bone metabolism, whereas the addition of nicotine concentrations analogous to heavy smokers leads to the opposite effect. The inhibition of these effects by D: -tubocurarine suggests that nicotine acts via the nicotinic acetylcholine receptor (nAChR).