Femoral offset restoration affects the early outcome of revision in patients with periprosthetic femoral fractures of Vancouver B2 - a single-center retrospective cohort study.

BACKGROUND: Femoral offset (FO) restoration plays an important role in improving the prognosis and quality of life of patients undergoing hip replacement. However, it is not given enough attention in revisions among patients with periprosthetic femoral fractures (PPFFs); instead, more attention is given to reduction, fixation of fractures and stabilizing prostheses. The primary objective of this study was to evaluate the effect of FO restoration on the function of the hip joint in revisions of patients with PPFF of Vancouver B2. Moreover, we studied whether there is a difference in FO restoration between modular and nonmodular stems. METHODS: A retrospective review of 20 patients with PPFF of Vancouver B2 revised with a tapered fluted modular titanium stem and 22 patients with PPFF of Vancouver B2 revised with a tapered fluted nonmodular titanium stem from 2016 to 2021 was conducted. Based on the difference between the FO of the affected side and that of the healthy side, 26 patients were allocated into Group A (difference ≤ 4 mm), and 16 patients were allocated into Group B (difference > 4 mm). The postoperative Harris Hip Score (HHS), range of motion of the hip joint, length of both lower limbs and dislocation were compared between Group A and Group B. The proportions of patients with FO restoration (difference ≤ 4 mm) and stem subsidence were compared between the modular and nonmodular groups. RESULTS: The mean follow-up time was 34.3 ± 17.3 months, and all cases achieved fracture healing at the last visit. Patients in Group A had a higher HHS, larger range of abduction, fewer dislocations and less limb length discrepancy (LLD). Patients in the modular group had a higher proportion of FO restoration and less subsidence. CONCLUSION: FO restoration improves postoperative hip joint function and reduces dislocation and LLD in revisions of patients with PPFF of Vancouver B2. Compared with nonmodular prostheses, modular prostheses tend to be easier for FO restoration under complex circumstances.

A bioactive material with dual integrin-targeting ligands regulates specific endogenous cell adhesion and promotes vascularized bone regeneration in adult and fetal bone defects.

Significant progress has been made in designing bone materials capable of directing endogenous cells to promote vascularized bone regeneration. However, current strategies lack regulation of the specific endogenous cell populations for vascularized bone regeneration, thus leading to adverse tissue formation and decreased regenerative efficiency. Here, we engineered a biomaterial to regulate endogenous cell adhesion and promote vascularized bone regeneration. The biomaterial works by presenting two synthetic ligands, LLP2A and LXW7, explicitly targeting integrins α4ß1 and αvß3, respectively, expressed on the surfaces of the cells related to bone formation and vascularization, such as mesenchymal stem cells (MSCs), osteoblasts, endothelial progenitor cells (EPCs), and endothelial cells (ECs). In vitro, the LLP2A/LXW7 modified biomaterial improved the adhesion of MSCs, osteoblasts, EPCs, and ECs via integrin α4ß1 and αvß3, respectively. In an adult rat calvarial bone defect model, the LLP2A/LXW7 modified biomaterial enhanced bone formation and vascularization by synergistically regulating endogenous cells with osteogenic and angiogenic potentials, such as DLX5+ cells, osteocalcin+ cells, CD34+/CD45- cells and CD31+ cells. In a fetal sheep spinal bone defect model, the LLP2A/LXW7 modified biomaterial augmented bone formation and vascularization without any adverse effects. This innovative biomaterial offers an off-the-shelf, easy-to-use, and biologically safe product suitable for vascularized bone regeneration in both fetal and adult disease environments.

Andrographolide suppresses osteoarthritis progression by regulating circ_Rapgef1/miR-383-3p/NLRP3 signaling axis.

BACKGROUND: Andrographolide (AD) has been reported to play a potential anti-arthritic role by facilitating the proliferation and inhibiting the apoptosis of chondrocytes. However, the molecular mechanism underlying the protective role of AD in osteoarthritis (OA) remains to be elucidated. METHODS: OA mice model was established via anterior cruciate ligament transection (ACLT) operation. OA cell model was established through treating mice primary chondrocytes with LPS (1 µg/mL, 24 h). Enzyme-linked immunosorbent assay (ELISA) was performed to measure the concentrations of inflammatory cytokines in the supernatant. Cell proliferation was assessed by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and 5-Ethynyl-2'-deoxyuridine (EdU) assay. Cell apoptosis was evaluated by flow cytometry. The intermolecular interaction was verified by dual-luciferase reporter assay. RESULTS: AD administration reduced the infiltration of inflammatory cells in the synovial tissues of ankle joint and suppressed the inflammatory response in OA mice model in vivo. Lipopolysaccharide (LPS) stimulation suppressed the proliferation and induced the apoptosis and inflammation of chondrocytes, and AD treatment protected chondrocytes from LPS-induced dysfunction. Circular RNA (circRNA) Rap guanine nucleotide exchange factor 1 (circ_Rapgef1) overexpression attenuated AD-mediated protective effects in OA cell model. Circ_Rapgef1/microRNA-383-3p (miR-383-3p)/Nod-like receptor pyrin domain 3 (NLRP3) axis was identified in this study for the first time. Circ_Rapgef1 overexpression-mediated effects were partly reversed by the overexpression of miR-383-3p in chondrocytes. NLRP3 silencing partly overturned miR-383-3p knockdown-mediated effects in chondrocytes. Circ_Rapgef1 overexpression up-regulated the expression of NLRP3 partly by targeting miR-383-3p in chondrocytes. CONCLUSION: Circ_Rapgef1 suppressed AD-mediated protective effects in OA partly by regulating miR-383-3p/NLRP3 signaling.

[Clinical effects of tranexamic acid in arthroscope for femoroacetabular impingement].

OBJECTIVE: To evaluate the clinical effects of tranexamic acid in arthroscope for femoroacetabular impingement. METHODS: Totally 34 patients (34 hips) with femoroacetabular impingement underwent hip arthroscopy from June 2016 to December 2018, were randomly divided into two groups named as tranexamic acid group and control group, 17 patients in each group. In TXA group, there were 10 males and 7 females, aged from 20 to 49 years old with an average of (32.1±7.6) years old;15 mg/kg TXA was intravenous drops before operation incision performed at 10 min. In control group, there were 11 males and 6 females, aged from 20 to 49 years old with an average of (30.9±6.2) years old;100 ml normal saline was intravenous drops before operation incision performed at 10 min. Introopertaive and total bloodloss between two groups were compared. Visual analogue scale (VAS) at 3 and 7 days after opertaion were used to evaluate pain relief of hip joint. Modified Harris Hip Score(mHHS) of hip joint at 3, 6, 9 and 12 weeks after oeprtaion were applied to evaluate clinical effects. RESULTS: All patients were obtained follow up over 12 weeks. Incision healed well without infection and deep vein thrombosis. There were no statistical difference in opertaion time bewteen two groups(P>0.05) . Total blood loss and introopertaive blood loss in TXA group were (0.47±0.20) L and (0.18±0.08) L, while (0.66±0.22) L and (0.24±0.01) L in control group;there were statical differences between two groups (P<0.05). There were no dierences in VAS before opertaion and 7 days after opertaion between two groups (P>0.05);VAS at 3 days after opertaion in TXA group was 2.35±1.12 and 3.12±0.70 in control group, and had difference (P< 0.05). There were significance in VAS at 3 and 7 days after opertaion compared with preopertaive between two groups (P< 0.05). Postopertaive mHHS in TXA group at 3 and 6 weeks were 87.72±1.95 and 91.92±2.32, respectively;while 84.08±1.21 and 89.77±3.30 in control group;there were difference between two groups at 3 and 6 weeks after operation (P<0.05);there were no significant difference in mHHS between two groups at 9 and 12 weeks after operation(P>0.05). CONCLUSION: Preoperative application of tranexamic acid could effectively reduce blood loss in arthroscopy for femoroacetabular impingement, thereby improving surgical field of vision, reducing difficulty of surgical operation, which could promote early and rapid rehabilitation of hip function.

Autologous platelet lysates local injections for treatment of tibia non-union with breakage of the nickelclad: a case report.

BACKGROUND: Nonunions of the tibia represent challenging orthopedic problems, which require the surgeon to analyze numerous factors and choose an appropriate treatment. This article presents a case report of tibia and fibula fracture patient who failed the internal fixation surgery and successfully recovered after one course of percutaneous autologous platelet lysates injection. CASE DESCRIPTION: The patient received an internal nickelclad breakage at 9 months post-surgery but reluctant to accept a second surgery, then autologous platelet lysates (APL) injection which is a less invasive method was recommended. The injections were carried once a week for three times. Radiologic evaluation was conducted every month until recovery. DISCUSSION AND EVALUATION: To the best of our knowledge, this is the first reported case of tibia delayed union with breakage of the plate resolved with APL injection. Improved clinical evidence was observed at 4 and 6 months after injection. The patient got good bony union at 8 months post-injection. The patient didn't feel any discomfort postinjection, no complications such as infection, refracture etc. were observed. CONCLUSIONS: APL percutaneous injection could be a new therapeutic option for the treatment of nonunion or delayed healing fractures.

Autologous platelet lysate local injections for the treatment of refractory lateral epicondylitis.

BACKGROUND: The purpose of this study was to investigate the efficacy and safety of autologous platelet lysate (APL) local injections in reducing pain and improving function in patients with refractory lateral epicondylitis. METHODS: A total of 56 patients with refractory lateral epicondylitis were enrolled in this study. All the patients received three injections in one course of treatment. Subjective assessments include visual analog scale (VAS) pain score and Mayo elbow score before injection (baseline) and at 1, 6, and 12 months after injection. RESULTS: Significant differences were observed in VAS and Mayo scores at baseline and at 1, 6, and 12 months after injection. Overall, the injections of APL improved local symptoms and all the patients recovered to normal elbow function with 12 months follow-up. CONCLUSIONS: Local injections of APL resulted in favorable clinical outcomes for the treatment of lateral epicondylitis. APL could be clinically effective in the treatment of lateral epicondylitis.

Improved workability of injectable calcium sulfate bone cement by regulation of self-setting properties.

Calcium sulfate hemihydrate (CSH) powder as an injectable bone cement was prepared by hydrothermal synthesis of calcium sulfate dihydrate (CSD). The prepared materials showed X-ray diffraction peaks corresponding to the CSH structure without any secondary phases, implying complete conversion from CSD phase to CSH phase. Thermogravimetric (TG) analyses showed the crystal water content of CSH was about 6.0% (wt.), which is near to the theoretic crystal water value of CSH. From scanning electron microscopy (SEM) micrographs, sheet crystal structure of CSD was observed to transform into rod-like crystal structure of CSH. Most interesting and important of all, CSD as setting accelerator was also introduced into CSH powder to regulate self-setting properties of injectable CSH paste, and thus the self-setting time of CSH paste can be regulated from near 30 min to less than 5 min by adding various amounts of setting accelerator. Because CSD is not only the reactant of preparing CSH but also the final solidified product of CSH, the setting accelerator has no significant effect on the other properties of materials, such as mechanical properties. In vitro biocompatibility and in vivo histology studies have demonstrated that the materials have good biocompatibility and good efficacy in bone regeneration. All these will further improve the workability of CSH in clinic applications.

Core decompression and implantation of calcium phosphate cement/Danshen drug delivery system for treating ischemic necrosis of femoral head at Stages I, II and III of antigen reactive cell opsonization.

OBJECTIVE: To introduce a new method using calcium phosphate cement/Danshen drug delivery system for treating ischemic necrosis of the femoral head and evaluate its curative effect. METHODS: From May 2000 to June 2005, 48 adult patients (54 hips) with ischemic necrosis of the femoral head at Stages I, II and III of antigen reactive cell opsonization (ARCO) were treated with implantation of calcium phosphate cement/Danshen drug delivery system in the involved femoral head. The operation consisted of removal of the necrotic bone under weight-loading cartilage and the implantation of phosphate cement/Danshen drug delivery system, and all manipulations were made percutaneously through a bone tunnel in the trochanter. The functions of the hip joint were evaluated and X-ray films were taken preoperatively and postoperatively. RESULTS: Postoperative follow-up was 45.5 months on average, ranging from 27 to 78 months. According to the evaluation criterion of "Dandong 1995" for therapeutic effect of adult ischemic necrosis of the femoral head, the therapeutic effects were excellent in 33 hips, good in 17, fair in 3 and poor in 1, with the excellent and good rate of 92.6%. CONCLUSIONS: This method is relatively simple with little invasion. It not only improves the microcirculation of the femoral head by local application of traditional Chinese medicine, but also provides mechanic buttress in the weight-loading area to prevent collapse during repairing, which is beneficial to repair and reconstruction of femoral head. It may be a choice of minimal invasion surgery for ischemic necrosis of the femoral head at Stages I, II and III of ARCO.

[Clinical study on the early reconstruction of complex acetabular fractures].

OBJECTIVE: To explore the best opportunity of structure reconstruction for complex acetabular fracture in order to provide the accurate time for clinical operative treatment. METHODS: Complex acetabular fracture patients were divided into experimental group (93 cases, 96 hips) and control group (98 cases, 101 hips) randomly according to the operative time. The operation of patients were done respectively at the 7th, 10th day after injury in experimental group and control group. The operative time, the excellent and good rate of reduction,the postoperative complications,the joint function (ache to walk,joint activity),the SF-36 were evaluated. RESULTS: (1) The operative time of experimental group was obviously shorter than control group according to different fracture classification. (2) According to the standard of Matta' joint function and X-ray, the experimental group was better than control group. (3) The excellent and good rate of reduction in experimental group was obviously higher than control group, according to CT scan before operation and after operation. CONCLUSION: The early structure reconstruction of complex acetabular fracture can obviously decrease operative time and complications, increase the rate of operative reduction.

[Implantation of calcium phosphate cement/Danshen drug delivery system for avascular necrosis of femoral head].

OBJECTIVE: To introduce a new method using calcium phosphate cement/Danshen drug delivery system for avascular necrosis of femoral head and to evaluate its clinical outcome. METHODS: From May 2000 to June 2005, 48 patients (54 hips) with avascular necrosis of femoral head were treated with calcium phosphate cement/Danshen drug delivery system implantation in the involved femoral head. There were 32 males (36 hips) and 16 females (18 hips) with an average age of 38.7 years (26-62 years). Twenty-one cases had the history of drinking or smoking, 15 cases had the history of receivihg hormonotherapy and 2 had the history of injury in hip joint. The disease course was 2-32 months. According to standard of Association Research Circulation Osseous (ARCO) staging, 9 hips were classified as stage I, 31 as stage II and 14 as stage III The operation consisted of removal of necrotic bone under weight-loading cartilage and the implantation of calcium phosphate cement/Danshen drug delivery system, all manipulations were done through a bone tunnel in trochanter. The function of hip joint were evaluated and X-ray films were taken pre- and post-operatively. RESULTS: No phlebothrombosis of leg and foreign body action occurred in all cases, and incision healed by first intention. The postoperative follow-up averaged 42.5 months, ranging from 22 to 73 months. According to the evaluation criterion of Dandong 1995 for adult avascular necrosis of femoral head, the results were excellent in 33 hips, good in 17, fair in 3 and poor in 1, the excellent and good rate was 92.6%. CONCLUSION: This method is relatively simple with less invasion, it not only improves the microcirculation of femoral head by local application of traditional Chinese medicine, but also provide mechanic buttress in the weight-loaded area, which is beneficial to repair and reconstruction of femoral head. It may be a choice of minimally invasion surgery for femoral head necrosis.

[Physicochemical properties and drug release rate of calcium phosphate cement containing Danshen composite injection].

OBJECTIVE: To investigate the physicochemical properties of the calcium phosphate cement (CPC) containing Danshen composite injection and its drug release rate. METHODS: This experiment included 4 groups and each group contained 6 specimens. CPC (2 g) was mixed with the setting solution that served as the control group; 0.1, 0.5 and 1.0 ml of Danshen composites injection (concentration, 1 000 mg/ml; pH, 7.35) were respectively added to CPC (2 g), which were used as the experimental groups 1, 2 and 3. The resulting specimens were investigated by the X-ray diffraction (XRD), the fourier transformed infrared spectroscopy (FTIR), and the scanning electron microscope (SEM). RESULTS: The XRD analysis showed that the control group had a typical diffraction pattern of the hydroxypatite (HAP), which was consistent with the standard pattern of HAP. When more Danshen was added in the experimental groups, the diffraction peaks of HAP gradually decreased; when the diffraction angle 2theta was about 25.92 degrees, the HAP peaks disappeared. Based on the FTIR analysis, with an increase of the drug concentration, the absorption peak of the hydroxy groups decreased. The SEM showed that the size of the CPC particle was related to the drug concentration; with an increase of the drug concentration, the CPC particle increased in number, resulting in an increasing trend of coacervation. The elution test showed that the drug-release rate and capacity varied with the different concentrations of Danshen. The initial release rate was relatively great, but after 96 hours the rate slowed down, lasting for a long time. CONCLUSION: The physicochemical properties of CPC do not change when a proper dose (0.1 ml/2 g) of Danshen is added to CPC. The Danshen composite can be effectively released from CPC, and so CPC can be used as an ideal drug-delivery carrier for Danshen composite.