Robotic-assisted medial unicompartmental knee arthroplasty restored prearthritic alignment and led to superior functional outcomes compared with conventional techniques.

PURPOSE: Robotic-assisted medial unicompartmental knee arthroplasty (UKA) can ensure precise preoperative planning, minimise soft tissue damage and restore native coronal alignment. However, few studies have investigated how these advantages translate into differences in early postoperative outcomes. This study aimed to compare differences in early outcomes between conventional UKA (C-UKA) and robotic-assisted UKA (R-UKA). METHODS: This retrospective study investigated two groups of patients who underwent medial UKA: C-UKA group (n = 35) and R-UKA group (n = 35). We assessed (1) serum indicators (hemoglobin, creatine kinase and C-reactive protein) and pain visual analogue scale (VAS) at postoperative days (PODs) 1, 2, 4 and 6; (2) radiologic parameters including joint line height change and arithmetic and mechanical hip-knee-ankle angle (aHKA and mHKA); (3) patient-reported outcomes including Knee Society Scores, Western Ontario and Mcmaster Universities Arthritis Index (WOMAC) and Forgotten Joint Score-12 (FJS-12) at 1-year follow-up. RESULTS: Despite similar serum indicator results, pain VAS was lower in the R-UKA group than in the C-UKA group at PODs 2 (2.5 ± 1.3 vs. 3.6 ± 1.2, p = 0.02), 4 (2.4 ± 0.9 vs. 3.3 ± 1.0, p = 0.03) and 6 (1.9 ± 1.1 vs. 3.1 ± 1.1, p < 0.01). The joint line height change was significantly lower in the R-UKA group than in the C-UKA group (0.9 mm ± 0.6 mm vs. 2.0 mm ± 1.3 mm, p = 0.02). The equivalence test for preoperative aHKA and postoperative mHKA revealed equivalence in only the R-UKA group (p < 0.01). The R-UKA group showed better WOMAC and FJS-12 compared to C-UKA group at 1-year follow-up. CONCLUSION: R-UKA led to lower pain VAS in the early postoperative period compared with C-UKA. Additionally, R-UKA effectively restored the joint line and prearthritic lower limb alignment, resulting in superior functional outcomes at 1-year follow-up compared with C-UKA. LEVEL OF EVIDENCE: Level III.

Large Osteophytes over 10 mm at Posterior Medial Femoral Condyle Can Lead to Asymmetric Extension Gap Following Bony Resection in Robotic Arm-Assisted Total Knee Arthroplasty with Pre-Resection Gap Balancing.

Robotic arm-assisted total knee arthroplasty (TKA) involves a pre-resection gap balancing technique to obtain the desired gap. However, the expected gap may change owing to the soft-tissue release effect of unreachable osteophytes. This study evaluated the effect of unreachable osteophytes of the posterior medial femoral condyle on gap changes following bony resection. We retrospectively analysed 129 robotic arm-assisted TKAs performed for varus knee osteoarthritis. Knees were classified according to the size of osteophytes on the posterior medial femoral condyle using preoperative computed tomography measurement. After the removal of reachable osteophytes, the robotic system measured pre- and post-resection medial extension (ME), lateral extension (LE), medial flexion (MF), and lateral flexion (LF) gaps. No extension gap changes were observed for 25 (19.4%), and no flexion gap changes were observed 41 (31.8%) knees, following bone cuts. ME, LE, MF, and LF gaps increased with the osteophyte size (p < 0.05). For osteophytes <10 mm, all the gaps increased symmetrically. However, for osteophytes >10 mm, the ME gap increased asymmetrically more than LE, MF, and LF gaps (p < 0.05). The gap changes due to bony resection were correlated to the osteophyte sizes of the posterior medial femoral condyle. Surgeons should plan a slightly tight medial extension gap to attain the desired gaps for >10 mm osteophytes.

Effectiveness of Robotic Arm-Assisted Total Knee Arthroplasty on Transfusion Rate in Staged Bilateral Surgery.

The transfusion rate in staged bilateral total knee arthroplasty (TKA) remains high despite the application of blood management techniques. The potential of robotic arm-assisted TKA (R-TKA) in reducing the transfusion rate in staged bilateral surgery has not yet been investigated. Therefore, we aimed to evaluate the effectiveness of R-TKA on transfusion reduction compared with conventional TKA (C-TKA) in staged bilateral surgery. This retrospective study involved two groups of patients who underwent 1-week interval staged bilateral TKA-the C-TKA group and the R-TKA group-using MAKO SmartRobotics (Stryker, Kalamazoo, MI, USA). Each group comprised 53 patients after propensity score matching and was compared in terms of nadir hemoglobin (Hb) level and transfusion rate after each stage of surgery. Both groups showed no significant differences in the propensity-matched variables of age, sex, body mass index, American Society of Anesthesiologists physical status score, and preoperative Hb level. The R-TKA group showed a significantly higher nadir Hb level than the C-TKA group after the second TKA (p = 0.002). The transfusion rate was not significantly different between the two groups after the first TKA (p = 0.558). However, the R-TKA group showed a significantly lower transfusion rate in the TKA (p = 0.030) and overall period (p = 0.023) than the C-TKA group. Patients who undergo staged bilateral R-TKA have lower transfusion rate than those who undergo C-TKA. R-TKA may be effective in minimizing unnecessary allogeneic transfusions in staged bilateral surgery.

The Association of Intravenous Iron Administered the Day before Total Knee Arthroplasty with Postoperative Anemia and Functional Recovery.

Background and Objectives: Total knee arthroplasty (TKA) involves blood loss, increasing the risk of postoperative anemia and delayed functional recovery. Intravenous (IV) iron supplementation limits postoperative anemia; however, the effectiveness of IV iron, administered one day before TKA, on postoperative anemia and functional recovery has scarcely been studied. Materials and Methods: We conducted a retrospective cohort study with propensity score matching using two consecutive groups of patients who underwent TKA using tranexamic acid: the iron group received 500 mg ferric derisomaltose intravenously one day before surgery (n = 46); the non-iron group did not (n = 46). Hemoglobin (Hb) level was determined at postoperative days (PODs) 2, 4, 6, 14, and 30. Ferritin, transferrin saturation (TSAT), and functional iron deficiency anemia (IDA) rate were measured at PODs 2, 4, 6, and 14. Length of hospital stay and transfusion rate were also evaluated. Results: The iron group had higher Hb levels at PODs 6, 14, and 30 and higher ferritin and TSAT at PODs 2, 4, 6, and 14. The functional IDA rate was significantly higher in the non-iron group at PODs 2, 4, 6, and 14. Length of hospital stay was significantly shorter in the iron group; however, the rate of transfusion did not differ between the two groups. Conclusions: IV iron administered one day before TKA was associated with postoperative anemia recovery and length of hospital stay; however, it did not lower the postoperative transfusion rate.

Learning curve of robot-assisted total knee arthroplasty and its effects on implant position in asian patients: a prospective study.

BACKGROUND: Robot-assisted total knee arthroplasty (r-TKA) can reportedly achieve more accurate implant positioning than conventional total knee arthroplasty (c-TKA), although its learning curve is controversial. Moreover, few studies have investigated r-TKA in Asians, who have different anatomical characteristics. This study aimed to determine the learning curve for r-TKA and compare implant positions between r-TKA and c-TKA according to the learning curve in Asian patients. METHODS: This prospective study included 50 consecutive c-TKAs (group C), followed by 50 consecutive r-TKAs conducted using the MAKO robotic system (Stryker, USA). Cumulative summation analyses were performed to assess the learning curve for operative time in r-TKA. Accordingly, the r-TKA cases were divided into the initial (group I) and proficiency cases (group P). The femoral and tibial component positions in the coronal, sagittal, and axial planes and lower limb alignment were compared among the three groups. RESULTS: r-TKA was associated with a learning curve for operative time in 18 cases. The operative time was significantly shorter in groups C and P than that in group I, with no significant difference between groups C and P. Groups I and P demonstrated fewer outliers with respect to lower limb alignment, femoral component coronal position, axial position, and tibial component sagittal position than those in group C, with no significant difference between groups I and P. CONCLUSION: The operative time did not differ significantly between r-TKA and c-TKA after the learning curve. Surgeons could expect more accurate and reproducible lower limb alignment and implant positioning with r-TKA in Asian patients, irrespective of the learning curve.

Do Preoperative Vastus Medialis Volume and Quality Affect Functional Outcomes after Total Knee Arthroplasty?

BACKGROUND: Vastus medialis function has been implicated in the development and progression of knee osteoarthritis; however, studies evaluating the influence of its preoperative volume and quality on functional outcomes following total knee arthroplasty (TKA) remain scarce. This study aimed to determine the association between vastus medialis volume, quality, and clinical outcomes after TKA. METHODS: Among the patients who underwent unilateral TKA, 92 who had undergone magnetic resonance imaging (MRI) before TKA were included. Preoperative vastus medialis volume and quality were assessed using the cross-sectional area (CSA) and fat infiltration ratio on MRI. Clinical outcomes were evaluated using the Knee Society knee score (KSKS) and Knee Society function score (KSFS) at baseline and 1 year after surgery. The relationships between preoperative CSA, fatty infiltration ratio, and clinical outcomes were analyzed using univariate and multivariate linear regression. RESULTS: Only the fatty infiltration ratio was significantly associated with postoperative KSFS in the univariate linear regression analysis. In the multivariate linear regression analysis, age and fatty infiltration ratio were significantly associated with postoperative KSFS. CONCLUSIONS: Increased vastus medialis fat infiltration is associated with worse functional outcomes after TKA. Preserving vastus medialis quality could improve functional outcomes, and surgeons should encourage patients to perform quadriceps strengthening exercises before surgery.

How I do it? Extraforaminal lumbar interbody fusion assisted with biportal endoscopic technique.

BACKGROUND: The biportal endoscope-assisted unilateral foraminal approach is an option for various foraminal pathologies. Lumbar interbody fusion is the standard treatment for foraminal stenosis because both direct and indirect neural decompressions can be obtained. METHOD: We used the biportal endoscopic technique for extraforaminal lumbar interbody fusion (BE-EFLIF) and have described the steps, with discussion regarding the indications, advantages, possible complications, and ways to overcome complications. CONCLUSION: BE-EFLIF achieves direct neural decompression of lateral spinal canal under endoscopic visualization. It achieves indirect neural decompression using a large footprint lordotic interbody cage, while preserving the lumbar posterior arch as much as possible.

Does adding corticosteroids to periarticular injection affect the postoperative acute phase response after total knee arthroplasty?

BACKGROUND: Periarticular injection (PAI) can reduce pain and improve early outcomes following total knee arthroplasty (TKA). Although corticosteroid PAI has been reported to be safe and effective, investigations on the postoperative acute phase response (APR) are scarce. METHODS: This retrospective cohort study with propensity score matching investigated two groups of patients after TKA: the steroid group (n = 50) received an intraoperative corticosteroid PAI (methylprednisolone 40 mg); the non-steroid group (n = 50) did not receive the corticosteroid. To evaluate the APR, C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR) were determined preoperatively and on postoperative day (POD) 2, 4, 6, 14, and 28. A visual analogue scale (VAS) was used to measure pain on the night of surgery and on POD 1, 2, 4, and 6. Maximal flexion at discharge (POD 7), morphine equivalent dose (MED), and complications were also evaluated. RESULTS: The steroid group showed significantly lower CRP levels on POD 2 (P < .05) and POD 4 (P < .05) but a higher CRP level on POD 6 (P < .05). However, ESR levels did not differ between the two groups in all measurements. Peak values in CRP and ESR in the steroid group (POD 4 and 6) appeared two days later compared with the non-steroid group (POD 2 and 4). The VAS pain score was significantly lower in the steroid group on POD 2 (P < .05). Maximal flexion on discharge, MED and complication rate were similar in the two groups. CONCLUSIONS: Adding a corticosteroid to the PAI following TKA attenuated the APR, and also provided significant pain relief.

Decreased muscle mass in Korean subjects with intracranial arterial stenosis: The Kangbuk Samsung Health Study.

BACKGROUNDS AND AIMS: Intracranial arterial stenosis (ICAS) is a common cause of ischemic stroke in Asians. Decreased muscle mass is one of the major causes of chronic disease in adults. The purpose of this study was to analyze the relationship between muscle mass and ICAS in Korean adults. METHODS: For this study, we selected a total of 10,530 participants (mean age, 43.3 years; 8558 men) in a health screening program, for whom transcranial Doppler (TCD) ultrasound was used to detect >50% ICAS based on criteria modified from the stroke outcomes and neuroimaging of intracranial atherosclerosis trial. Body composition was evaluated by bioelectrical impedance analysis (BIA). Skeletal muscle index (SMI) was calculated with muscle mass/weight (kg) * 100. RESULTS: Among the total patient population, 322 (3.1%) subjects had ICAS. Subjects with ICAS were older, and had higher mean values for fasting glucose, body mass index and blood pressure compared with those without ICAS. Subjects with ICAS had significantly lower muscle mass, SMI and higher percent body fat compared with those without ICAS. In logistic regression analysis, the subjects in the highest tertile of muscle mass had the lowest odds ratio for ICAS with the lowest tertile group of muscle mass as the reference group even after adjusting for age, systolic blood pressure, fasting blood glucose, sex, smoking and exercise (OR 0.650, 95% CI 0.442-0.955). CONCLUSIONS: Subjects with ICAS had significantly decreased muscle mass compared with those without ICAS in Korean adults. The risk for ICAS was lower in subjects with higher muscle mass.

Instrumental evaluation of anti-aging effects of cosmetic formulations containing palmitoyl peptides, Silybum marianum seed oil, vitamin E and other functional ingredients on aged human skin.

Anti-aging cosmetics are widely used for improving signs of aged skin such as skin wrinkles, decreased elasticity, low dermal density and yellow skin tone. The present study evaluated the effects of cosmetic formulations, eye cream and facial cream, containing palmitoyl peptides, Silybum marianum (S. marianum) seed oil, vitamin E and other functional ingredients on the improvement of facial wrinkles, elasticity, dermal density and skin tone after 4 weeks period of application on aged human skin. Healthy volunteers (n=20) with aged skin were recruited to apply the test materials facially twice per day for 4 weeks. Skin wrinkles, elasticity, dermal density and skin tone were measured instrumentally for assessing the improvement of skin aging. All the measurements were conducted prior to the application of test materials and at 2 and 4 weeks of treatment. Crow's feet wrinkles were decreased 5.97% after 2 weeks of test material application and 14.07% after 4 weeks of application in comparison of pre-application. Skin elasticity was increased 6.81% after 2 weeks and 8.79% after 4 weeks. Dermal density was increased 16.74% after 2 weeks and 27.63% after 4 weeks. With the L* value indicating skin brightness and the a* value indicating erythema (redness), the results showed that brightness was increased 1.70% after 2 weeks and 2.14% after 4 weeks, and erythema was decreased 10.45% after 2 weeks and 22.39% after 4 weeks. Hence, the test materials appear to exert some degree of anti-aging effects on aged human skin. There were no abnormal skin responses from the participants during the trial period. We conclude that the facial and eye cream containing palmitoyl peptides and S. marianum seed oil, vitamin E and other ingredients have effects on the improvement of facial wrinkles, elasticity, dermal density and skin tone.

Arctiin blocks hydrogen peroxide-induced senescence and cell death though microRNA expression changes in human dermal papilla cells.

BACKGROUND: Accumulating evidence indicates that reactive oxygen species (ROS) are an important etiological factor for the induction of dermal papilla cell senescence and hair loss, which is also known alopecia. Arctiin is an active lignin isolated from Arctium lappa and has anti-inflammation, anti-microbial, and anti-carcinogenic effects. In the present study, we found that arctiin exerts anti-oxidative effects on human hair dermal papilla cells (HHDPCs). RESULTS: To better understand the mechanism, we analyzed the level of hydrogen peroxide (H2O2)-induced cytotoxicity, cell death, ROS production and senescence after arctiin pretreatment of HHDPCs. The results showed that arctiin pretreatment significantly inhibited the H2O2-induced reduction in cell viability. Moreover, H2O2-induced sub-G1 phase accumulation and G2 cell cycle arrest were also downregulated by arctiin pretreatment. Interestingly, the increase in intracellular ROS mediated by H2O2 was drastically decreased in HHDPCs cultured in the presence of arctiin. This effect was confirmed by senescence associated-beta galactosidase (SA-ß-gal) assay results; we found that arctiin pretreatment impaired H2O2-induced senescence in HHDPCs. Using microRNA (miRNA) microarray and bioinformatic analysis, we showed that this anti-oxidative effect of arctiin in HHDPCs was related with mitogen-activated protein kinase (MAPK) and Wnt signaling pathways. CONCLUSIONS: Taken together, our data suggest that arctiin has a protective effect on ROS-induced cell dysfunction in HHDPCs and may therefore be useful for alopecia prevention and treatment strategies.

Serum levels of LL-37 and inflammatory cytokines in plaque and guttate psoriasis.

Psoriasis is a chronic inflammatory skin disease. It is assumed that the plaque phenotype of psoriasis is associated with T helper (Th) 1 immune response activation, while the guttate phenotype is associated with the Th17 immune response. Previous investigations of differences in the serum levels of cytokines relative to the clinical psoriatic phenotype have yielded conflicting results. This study compared the levels of circulating inflammatory cytokines and LL-37 relative to the morphological phenotype in patients with psoriasis. Seventy-four age-matched patients with psoriasis (32 with guttate psoriasis and 42 with plaque psoriasis) and 12 healthy controls were included. A multiplex cytokine assay and enzyme-linked immunosorbent assay were used to measure levels of Th1- and Th17-derived cytokines and LL-37, respectively. Circulating levels of interferon- (IFN)-γ, interleukin- (IL)-1RA, IL-2, and IL-23, and LL-37 were significantly higher in patients with psoriasis than in healthy controls. However, the serum levels of inflammatory cytokines (IL-7, IL-22, and IL-23) and LL-37 did not differ significantly between the guttate and plaque phenotypes of psoriasis. There was a positive correlation between serum inflammatory cytokine levels and the Psoriasis Area and Severity Index score. The findings of this study suggest that the serum levels of inflammatory cytokines reflect the disease activity rather than determine the morphological phenotype.

MicroRNA-1290 promotes asiatic acid­induced apoptosis by decreasing BCL2 protein level in A549 non­small cell lung carcinoma cells.

Asiatic acid, a triterpenoid derived from Centella asiatica, is a putative anticancer agent in several types of cancer cells. Investigations of its biological role in negative regulation of cell growth have focused on the extent of induction of apoptosis in a cell-type-specific manner. In this study, we identified an important regulator of asiatic acid-induced cell death, microRNA (miR)-1290, which sensitizes cells to asiatic acid-induced cytotoxicity and negatively regulates BCL2 expression. Asiatic acid significantly upregulated miR-1290, and asiatic acid-induced cell death was shown to be dependent on miR-1290 activity. Molecular assays demonstrated that BCL2 mRNA is a direct target of miR-1290-mediated RNA interference. The results of functional studies suggest that miR-1290 suppresses cell viability and cell cycle progression. These data provide insight into miR-1290-mediated cellular mechanisms in asiatic acid-treated A549 non-small cell lung carcinoma cells.

Identification of dermatophytes by polymerase chain reaction-restriction fragment length polymorphism analysis of metalloproteinase-1.

BACKGROUND: Transgenic research on metalloproteinase-1 is an emerging field in the area of plant molecular biology. The new method reported here can similarly be applied in fungal molecular biology to identify different dermatophytes. Our method is more accurate than traditional methods such as molecular analyses. OBJECTIVE: To identify Trichophyton rubrum, T. mentagrophytes var. mentagrophytes, T. tonsurans, T. mentagrophytes var. interdigitale, Microsporum canis and M. gypseum, by using the restriction fragment length polymorphism (RFLP) analysis and polymerase chain reaction (PCR) to detect polymorphisms in the metalloproteinase-1 gene (MEP1). METHODS: From each fungal strain, we isolated genomic DNA and performed PCR to amplify the region coding for metalloproteinase-1. Primers for the metalloproteinase-1 gene were designed based on the sequence in NCBI GenBank. Subsequently, we purified the amplified PCR product and performed RFLP analysis. After restriction enzyme digestion, BsrDI (NEB, England), the samples were subjected to electrophoresis. Four different patterns of DNA fragments were observed among 6 fungal species. RESULTS: The DNA fragments for T. mentagrophytes var. mentagrophytes, T. mentagrophytes var. interdigitale and T. tonsurans showed similar patterns on electrophoresis and were not distinguishable, whereas T. rubrum, M. canis, and M. gypseum showed different patterns. CONCLUSION: To our knowledge, it is the first study to introduce the analysis of the nucleotide sequence of metalloproteinase-1 enzyme to study differentiation in dermatophytes. Based on our results, more accurate differentiation and subtyping of T. rubrum and T. mentagrophytes var. interdigitale might be possible. This might contribute to better understanding of the epidemiology and pathogenesis of dermatophyte.

Arctiin blocks hydrogen peroxide-induced senescence and cell death though microRNA expression changes in human dermal papilla cells

BACKGROUND: Accumulating evidence indicates that reactive oxygen species (ROS) are an important etiological factor for the induction of dermal papilla cell senescence and hair loss, which is also known alopecia. Arctiin is an active lignin isolated from Arctium lappa and has anti-inflammation, anti-microbial, and anti-carcinogenic effects. In the present study, we found that arctiin exerts anti-oxidative effects on human hair dermal papilla cells (HHDPCs). RESULTS: To better understand the mechanism, we analyzed the level of hydrogen peroxide (H2O2)-induced cytotoxicity, cell death, ROS production and senescence after arctiin pretreatment of HHDPCs. The results showed that arctiin pretreatment significantly inhibited the H2O2-induced reduction in cell viability. Moreover, H2O2-induced sub-G1 phase accumulation and G2 cell cycle arrest were also downregulated by arctiin pretreatment. Interestingly, the increase in intracellular ROS mediated by H2O2 was drastically decreased in HHDPCs cultured in the presence of arctiin. This effect was confirmed by senescence associated-beta galactosidase (SA-ß-gal) assay results; we found that arctiin pretreatment impaired H2O2-induced senescence in HHDPCs. Using microRNA (miRNA) microarray and bioinformatic analysis, we showed that this anti-oxidative effect of arctiin in HHDPCs was related with mitogen-activated protein kinase (MAPK) and Wnt signaling pathways. CONCLUSIONS: Taken together, our data suggest that arctiin has a protective effect on ROS-induced cell dysfunction in HHDPCs and may therefore be useful for alopecia prevention and treatment strategies.

Comparison of Physicochemical and Sensory Properties between Cholesterol-removed Gouda Cheese and Gouda Cheese during Ripening.

This study was performed to compare physicochemical and sensory properties of cholesterol-removed Gouda cheese (CRGC) and Gouda cheese made in the laboratory during ripening. Composition, short-chain free fatty acids (SCFFA), texture, color, and sensory properties were measured. In chemical composition analyses, moistures were significantly different between control cheeses (42.86%) and sample cheese (48.32%) (p<0.05). But fat and protein in the control and the sample were 32.77, 22.45 and 31.35, 20.39%, respectively, and were not significantly different (p>0.05). The amount of cholesterol in control was 82.52 mg/100 g and the percentage of cholesterol removal was 90.7%. SCFFA increased gradually during ripening and its level of CRGC increased and significantly different from that of control (p<0.05). The texture, hardness, gumminess, and chewiness were significantly increased, but cohesiveness and springiness were not increased in both cheeses during ripening periods (p>0.05). In comparison of the control and sample cheeses, hardness, and springiness were not significantly different, but cohesiveness, gumminess, and chewiness were different (p<0.05). In color measurement, all color values were not different between CRGC and control (p>0.05). However, L* value decreased, while a* and b* values tended to increase significantly (p<0.05). In sensory properties, appearance, aroma, flavor and taste, and texture were significantly increased except buttery and nutty in aroma and sweetness in taste in both cheeses, and were not significantly different between the control and sample cheeses during ripening (p>0.05). Therefore, this study suggests that the quality of cholesterol-removed Gouda cheese is not different from the control cheese.