Conservative treatment of congenital radial head subluxation and non-traumatic elbow locking: A case report.

Congenital radial head subluxation is relatively rare and may be overlooked due to mild symptoms. The diagnosis mainly relies on imaging and history. Observation is an option for those with insignificant symptoms, while surgical intervention, such as ulnar osteotomy or arthroscopy, is often required when dysfunction exists. A 30-year-old man was admitted with congenital radial head dislocation, which was treated with manipulative repositioning. During follow-up, the patient regained the original mobility of the elbow joint and had no recurrence of dislocation. In conclusion, in adults with congenital dislocation of the radial head, we recommend conservative treatment as a first step.

Total knee arthroplasty in Ranawat II valgus deformity with enlarged femoral valgus cut angle: A new technique to achieve balanced gap.

BACKGROUND: Nearly 10% of patients undergoing primary total knee arthroplasty (TKA) have valgus deformity (VD) of the knee. For severe VD of the knee, a more lateral structural release is needed to achieve balance between medial and lateral space and neutral femorotibial mechanical axis (FTMA), which is challenging and technical. AIM: To introduce a new surgical technique of resection, soft tissue release, and FTMA for Ranawat type-II VD with a 5-year follow-up. METHODS: A retrospective study was conducted on patients who underwent TKA from December 2011 to December 2014. Hip-knee-ankle (HKA), range of motion (ROM), Oxford knee score (OKS), and knee society score (KSS) were used to assess the joint activity of patients in the new theory TKA group (NT-TKA) and were compared with those of the conventional TKA group (C-TKA). RESULTS: A total of 103 people (103 knees) were included in this study, including 42 patients with an average follow-up period of 83 mo in the C-TKA group and 61 patients with an average follow-up period of 76 mo in the NT-TKA group. Six patients had constrained prosthesis, one had common peroneal nerve injury, and two had joint instability in the C-TKA group, but none of these occurred in the NT-TKA group. There were significant statistical differences in constrained prosthesis usage and complications between the groups (P = 0.002 and P = 0.034, respectively). The KSS at 1 mo post-operation for the C-TKA and NT-TKA groups were 11.2 ± 3.8 and 13.3 ± 2.9, respectively, with a significant difference (P = 0.007). However, the data of HKA, ROM, OKS KSS, and prosthesis survival rate were insignificant (P > 0.05) in both the preoperative and follow-up periods. CONCLUSION: Adopting 5°-7° valgus cut angle for VD and sacrificing 2° neutral FTMA for severe VD which cannot be completely corrected during TKA can reduce the need for soft tissue release, maintain early joint stability, reduce the use of constrained prostheses, and minimize postoperative complications.

Bilateral synchronous total hip arthroplasty for end-stage arthropathy in hemophilia A patients: A retrospective study.

Total hip arthroplasty (THA) has been an effective tool of advanced hemophiliac hip arthritis. There are only limited data of bilateral synchronous THA for end-stage arthropathy in hemophilia A patients. The aim of this retrospective study was to analyze clinical outcome and complication rate of bilateral THA for hemophilia A patients with end-stage arthropathy of hip and review the operative strategy. From August 2012 to July 2016, 48 hips of 24 patients with hemophilia A patients underwent THA by a single experienced chief orthopedic surgeon. Clinical and radiological evaluations were included of operation time, blood loss, the quantity of blood transfusion, clotting factor consumption, duration of hospitalization, modified Harris hip score, complication rate, and radiographic assessment. All the 24 patients successfully completed the operation, followed up for 5 to 8 years, and the mean time was 6.5 years. The average operation time was 140 minutes (range, 120-180 minutes). The average total blood loss was 225 mL (range, 150-400 mL). The mean red blood cell transfusion amount was 2.4 U (range, 0-6 U). the mean hospitalization time was 24 days (range, 16-46 days). The mean amount of clotting factor VIII used in the perioperative period for management of hemophilia A was 30,600 U (range, 18,000-52,000 U). Average modified Harris hip score increased from 46.6 (range 28-70) points preoperatively to 90.2 (range 75-98) points at final follow-up, complications were few. With excellent operative techniques and hematological management, bilateral synchronous THA for end-stage arthropathy in hemophilia A patients can provide satisfactory outcomes.

Concealed mesenteric ischemia after total knee arthroplasty: A case report.

BACKGROUND: In critical care medicine, mesenteric ischemia (MI) is a life-threatening disease that can be present in both critically ill patients and those undergoing major surgery. For the first time, we report a case of concealed MI with a long course after knee arthroplasty. CASE SUMMARY: A male patient underwent left total knee arthroplasty for gouty arthritis and developed a persistent fever and persistently high levels of serum infection markers after surgery. He was considered to have a periprosthetic site infection and treated with antibiotics and colchicine, periprosthetic debridement was performed, and the spacer was replaced, but no improvement was seen. At 54 d after arthroplasty, the patient developed gastrointestinal symptoms of nausea and vomiting, abdominal distention, and subsequently, cloudiness of consciousness, and hypotensive shock. Finally, the patient was diagnosed with ascending colonic mesentery ischemia with necrosis after laparotomy, which improved after right hemicolectomy. CONCLUSION: Concealed MI without gastrointestinal symptoms after major surgery is rare and easily misdiagnosed. Orthopedic surgeons need to be aware of this complication.

Subchondral bone as a novel target for regenerative therapy of osteochondritis dissecans: A case report.

BACKGROUND: Osteochondritis dissecans (OCD) is a rare disease of unclear cause characterized by subchondral bone damage and overlying cartilage defects. The current report presents the results of subchondral bone as a novel target for implantation of peripheral blood stem cells (PBSCs) in the treatment of OCD. CASE SUMMARY: A 16-year-old patient diagnosed with OCD underwent subchondral bone implantation of PBSCs. Four months later, the patient's visual analog scale scores, Western Ontario and McMaster University osteoarthritis index, and whole-organ magnetic resonance imaging score improved significantly, and regeneration of cartilage and subchondral bone was observed on magnetic resonance imaging. CONCLUSION: This is the first case of OCD treated with subchondral bone as an implantation target of PBSCs, which highlights the importance of subchondral bone for cartilage repair. This treatment could be a potential option for articular cartilage and subchondral bone recovery in OCD.

Promotion of Bone Formation by Red Yeast Rice in Experimental Animals: A Systematic Review and Meta-Analysis.

OBJECTIVE: To systematically evaluate the effects of red yeast rice (RYR) and its extract on bone formation in experimental animals and to provide reference data for clinical research on the treatment of osteoporosis. METHODS: Chinese and English language databases, including Web of Science, PubMed, the Cochrane Library, Elsevier, Google Scholar, SpringerLink, Embase, China National Knowledge Infrastructure (CNKI), Weipu Chinese Sci-tech periodical full-text database (VIP), and Wanfang Data Knowledge Service Platform (Wanfang), were searched from their establishment to February 2020 using the following terms: "hongqu," "red yeast rice," "Monascus purpureus-fermented rice," "bone mineral density," "osteoblast," "osteoporosis," and "animal models." After excluding nonrelevant articles, Review Manager 5.2 was used to evaluate article quality and to analyze the data. Outcome indicators included bone mineral density (BMD), osteoblast proliferation, and the expression of alkaline phosphatase (ALP). RESULTS: A total of 11 randomized controlled trials were included in the meta-analysis, all of which were animal studies. Six studies included data on BMD, five on osteoblast proliferation, and six on the expression of ALP. The results of the meta-analysis showed that RYR can significantly improve BMD (standardized mean difference (SMD) = 3.12, 95% confidence interval (CI) 1.41 to 4.83, P = 0.0003), promote osteoblast proliferation (SMD = 1.64, 95% CI 1.04 to 2.23, P < 0.00001), and increase ALP expression in rats (SMD = 1.25, 95% CI 0.69 to 1.80, P < 0.00001). CONCLUSIONS: RYR can promote bone formation in experimental animals and may be useful for the treatment of osteoporosis.

[Cannulated screw internal fixation for sustentaculum tali fractures with articular surface].

OBJECTIVE: To explore clinical efficacy of cannulated screw internal fixation in treating sustentaculum tali fractures with articular surface. METHODS: From August 2012 to June 2017, 13 sustentaculum tali fracture patients with articular surface were treated by cannulated screw internal fixation, including 10 males and 3 females, aged from 26 to 58 years old. Joint plane flatness was evaluated by calcaneal width, clearance distance of middle-range and posterior talar articular surface on coronal position of CT scan before operation and 1 year after operation. AOFAS score at 1 year after operation was applied to evaluate clinical efficacy. RESULTS: All patients were followed up from 9 to 70 months. The fractures were healed well from 8 to 16 weeks. No subtalar arthritis and tenosynovitis occurred. Calcaneal width before operation was from 46.2 to 52.7 mm, and decreased from 35.2 to 39.2 mm after operation; clearance distance of middle-range before operation was from 4.5 to 4.8 mm, and decreased from 1.9 to 2.2 mm after operation; clearance distance of posterior talar articular surface before operation was from 2.4 to 2.8 before operation, and decreased from 1.9 to 2.3 mm after operation. AOFAS score at 1 year after operation ranged from 77 to 94, and 1 got excellent result and 12 moderate. CONCLUSIONS: The clinical efficacy of two cannulated screws with cross internal fixation for sustentaculum tali fractures with articular surface is satisfactory, sustentaculum tali fracture could obtain good reduction, recover smooth of middle talar articular surface, and the function of feet were improved.

[Comparison of core decompression with stem cell transplantation and tantalum rod implanting in treating stage II non-traumatic osteonecrosis of femoral head].

OBJECTIVE: To compare clinical effects of core decompression with stem cell transplantation and tantalum rod implanting in treating stage II non-traumatic osteonecrosis of femoral head. METHODS: From March 2012 to September 2012, 45 patients(55 hips)with stage ARCO II non-traumatic osteonecrosis of femoral head were treated and divided into core decompression with stem cell transplantation group(group A) and tantalum rod implanting group(group B) according to number table. In group A, there were 23 cases(28 hips) , including 12 males and 11 females aged from 23 to 51 years old with an average of (36.87±9.52) years, the courses of disease ranged from 2 to 28 months with an average of (17.13±7.74) months, preoperative Harris score was for 35 to 70 with an average of(54.74±11.81), treated with core decompression with stem cell transplantation. In group B, there were 22 cases(27 hips), including 11 males and 11 females aged from 26 to 46 years old with an average of (35.59±7.39) years, the courses of disease ranged from 3 to 26 months with an average of(16.00±7.46) months, preoperative Harris score was for 35 to 76 with an average of (57.18±12.95), treated with core tantalum rod implanting. Operative time, blood loss, hospital stays, hospitalization expenses were observed and compared after treatment between two groups, the clinical effects were evaluated according to Harris criteria. RESULTS: All patients were followed up from 6 to 12 months with an average of 10.8 months. There were significant difference in hospitalization expenses between two groups(P<0.05), while there was no significant statistical difference in blood loss and hospital stay (P>0.05). At the final following-up, Harris score in group A was(83.04±8.97), 6 cases obtained excellent results, 14 good, 2 good and 1 poor;while Harris score in group A was(84.41±9.94), and 9 cases obtained excellent results, 9 good, 3 good and 1 poor; there was no statistical meaning differences between two groups(P>0.05). CONCLUSIONS: Core decompression with stem cell transplantation and tantalum rod implanting could both improve function of hip joint, while core decompression with stem cell transplantation had advantages of shorter operation time, less cost, and higher potency ratio. It is suitable for stage ARCO II non-traumatic femoral head necrosis.

[Effects and mechanism of low-intensity pulsed ultrasound on extracellular matrix in rabbit knee osteoarthritis].

OBJECTIVE: To observe the effects of low-intensity pulsed ultrasound (LIPUS) on repairing extracellular matrix in rabbit knee osteoarthritis and analyze its mechanism. METHODS: Sixty adult female rabbits with an average weight of (2.0 ± 0.2) kg, were divided randomly into two groups (experimental group and control group, 30 rabbits in each group). All rabbits were replicated in right knees by Hulth method for knee osteoarthritis model. Two weeks after operation, the rabbits in experimental group were treated with LIPUS, and the ultrasonic frequency was (800 ± 5%)KHz and the maximum intensities of spatially averaged and time averaged (SATA) was (50 ± 10%) mw/cm2, for 1 time a day and every time 20 min, while the rabbits in control group were treated with sham LIPUS,the same operation with experimental group but without energy output. At the 2, 4, 8 weeks after treatment, 10 rabbits in each group were randomly killed for each time. The general changes of cartilage and its histopathological changes by HE staining were observed; the expression of collagen type II, proteoglycan, MMP-3, 7, 13 in cartilage were analyzed by immunohistochemical and RT-PCR technique; and the expression of NO in cartilage was analyzed by nitrate reduction method. RESULTS: On the same observed time point, the damage degree of cartilage in experimental group was slighter than that of control group (P < 0.01), the expression of MMP-3, 7, 13 and NO in cartilage in experimental group was lower than that of control group (P < 0.01) while collagen type II and proteoglycan was higher than that of control group (P < 0.01). CONCLUSION: Low-intensity pulsed ultrasound can repair the damaged cartilage by reducing the expression of MMP-3, 7, 13, inhibiting the secretion of NO and promoting the synthesis of collagen type II and proteoglycan in cartilage.

[Short-term curative effects of Tantalum rod treatment in early avascular necrosis].

OBJECTIVE: To explore the recent clinical curative effect of Tantalum rod in treating the early avascular necrosis. METHODS: From January 2008 to November 2008, the 25 patients (39 hips) with early avascular necrosis accepted tantalum rod placement and included 9 males (11 hips) and 16 females (28 hips) with an average age of 37 years old ranging from 18 to 74 years old. Four patients (6 hips) caused by Alcoholic, 6 patients (8 hips) by hormone, 2 cases (2 hips) by traumatic, 13 cases (23 hips) by idiopathic. Steinberg preoperative stage involved 7 hips in period I, 24 hips in period II, 8 hips in period III. Curative effect analysis included preoperative and postoperative Harris score, radiographic changes and hip replacement for follow-up to accept the end of the femoral head survival rate. RESULTS: All patients were followed up for 6 to 47 months (averaged 37.4 months). All 12 hips imaging appeard progress,including tantalum rod exit in 1 hip, hip hemiarthroplasty collapse in 3 hips, the area increased to avascular necrosis in 8 hips. Six hips accepted total hip replacement, including imaging progress in 5 hips (41.7%, 5/12), no imaging progress in 1 hip (3.7%,1/27). All hips' Kaplan-Meier survival curves showed 6-month survival rate was (97.4 +/- 2.5)% after tantalum stick insertion, 1-year survival rate was (94.7 +/- 3.6), and 2-year survival rate was (88.6 +/- 5.4)%, 3-year survival rate was (72.5 +/- 11.2). CONCLUSION: It is effective for treatment of avascular necrosis of femoral head in Steinberg I and II by Tantalum rod, and it can effectively relieve femoral head replacement time.

Auricular acupressure for analgesia in perioperative period of total knee arthroplasty.

OBJECTIVE: We examined whether auricular acupressure (AA) can alleviate postoperative pain and decrease narcotic consumption and its adverse effects for osteoarthritis patients after total knee arthroplasty (TKA). DESIGN: A prospective, randomized, sham control trial comparing AA and a sham control. SETTING: Department of Orthopedics, the first Hospital affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou, China. SUBJECTS: Ninety patients with degenerative osteoarthritis undergoing TKA. INTERVENTIONS: The AA group received true AA by embedding vaccaria seeds at four specific AA points (knee joint, shenmen, subcortex, sympathesis) ipsilateral to the surgery site, while the control group received four nonacupuncture points on the auricular helix. OUTCOME MEASURES: Visual analog scale (VAS), the consumption of analgesic via patient-controlled analgesia, the incidence of analgesia-related adverse effects, Hospital for Special Surgery scores (HSS), and range of motion (ROM) were recorded. RESULTS: VAS scores were similar at 12, 24, 36, and 48 h postsurgery (P > 0.05), but AA group scores were lower than those of the control group at 3, 4, 5, and 7 days (P < 0.05). Patients in the AA group consumed lower doses of analgesic than those in the control group after surgery (P < 0.05). The incidence of analgesia-related adverse effects in the AA group was lower than that in the control group (P < 0.05). Although HSS scores were similar in the two groups preoperatively and at 3 months postoperatively (P > 0.05), HSS scores 2 weeks postoperatively were higher in the AA group than in the control group (P < 0.05), but there was no difference between groups in ROM (P > 0.05). CONCLUSIONS: Applying auricular acupoint acupressure in the perioperative period of TKA is favorable for alleviating postoperative pain, decreasing opioid consumption and its adverse effects, and promoting early rehabilitation. Also, this intervention has the advantage of lower costs, fewer complications, simple application, and high safety.

[Effect of HSP70 on apoptotic of cartilage cells in knee osteoarthritis].

OBJECTIVE: To investigate the expression and relationship between HSP70 and caspase-3 in knee osteoarthritis. METHODS: Forty adult SD rats were divided into experimental group and control group. Thirty rats in experimental group, anterior cruciate ligament transaction (ACLT) was cut off and partial meniscectomy of 1/3 inside incision were performed to reproduce knee osteoarthritis (KOA) model according to Hulth methos, and the other 10 rats was treated with nothing as control group. The rats were sent to the cage and free to move. At 1, 2 and 4 weeks later, the arthritis cartilage of femoral and tibial end were observed through immunohistochemistry staining and light microscope. Meanwhile, Mankin scale system was adopted for histomorphology evaluation. RESULTS: Changes of KOA such as hyperplastic synovium,erosion on the surface of cartilage and so on were found in experiment group, the expression of HSP70 was augmentation all the time, but the expression of caspase-3 was reduction 1 week later; no similar changes were found in control group. Mankin scale system showed that there were significant differences in the first week as compared with the second week and 4th week (both P < 0.01). CONCLUSION: Heat shock protein inhibit the apoptosis of cartilage cells and protect the cartilage cells in knee osteoarthritis, the conservative treatment for clinical provide objective scientific basis.