TGFßi is involved in the chondrogenic differentiation of mesenchymal stem cells and is dysregulated in osteoarthritis.

OBJECTIVE: Transforming growth factor-ß (TGFß) is a major regulator of cartilage homeostasis and its deregulation has been associated with osteoarthritis (OA). Deregulation of the TGFß pathway in mesenchymal stem cells (MSCs) has been proposed to be at the onset of OA. Using a secretome analysis, we identified a member of the TGFß family, TGFß-induced protein (TGFßi or ßIGH3), expressed in MSCs and we investigated its function and regulation during OA. DESIGN: Cartilage, bone, synovium, infrapatellar fat pad and bone marrow-MSCs were isolated from patients with OA or healthy subjects. Chondrogenesis of BM-MSCs was induced by TGFß3 in micropellet culture. Expression of TGFßi was quantified by RT-qPCR, ELISA or immunohistochemistry. Role of TGFßi was investigated in gain and loss of function experiments in BM-MSCs and chondrocytes. RESULTS: TGFßi was up-regulated in early stages of chondrogenesis and its knock-down in BM-MSCs resulted in the down-regulation of mature and hypertrophic chondrocyte markers. It likely occurred through the modulation of adhesion molecules including integrin (ITG)ß1, ITGß5 and N-cadherin. We also showed that TGFßi was upregulated in vitro in a model of OA chondrocytes, and its silencing enhanced the hypertrophic marker type X collagen. In addition, TGFßi was up-regulated in bone and cartilage from OA patients while its expression was reduced in BM-MSCs. Similar findings were observed in a murine model of OA. CONCLUSIONS: Our results revealed a dual role of TGFßi during chondrogenesis and pointed its deregulation in OA joint tissues. Modulating TGFßi in BM-MSCs might be of interest in cartilage regenerative medicine.

Radioscapholunate fusion for posttraumatic osteoarthritis with consecutive excision of the distal scaphoid and the triquetrum: A comparative study.

The aim of this study was to assess the clinical and radiographic outcomes after radioscapholunate (RSL) fusion for posttraumatic osteoarthritis. This was a retrospective, dual-center study of all patients who underwent RSL fusion between 1995 and 2015 for posttraumatic radiocarpal osteoarthritis. Patients were assessed at the final review to determine clinical (pain, wrist range of motion and strength), self-reported (QuickDASH, PRWE and MWS scores) and radiological (degenerative osteoarthritis in the scaphotrapeziotrapezoid (STT) or midcarpal joint and radiocarpal fusion) outcomes. We analyzed three groups: RSL fusion alone, RSL fusion with distal scaphoid excision (DSE) and RSL fusion with DSE and triquetrum excision (TE). Eighty-five patients were included; 10 were lost to follow-up and 11 required conversion to total wrist fusion before the final review. Finally, 64 patients had both clinical and radiographic evaluations. The mean follow-up was 9.1 years (range 1-21.4). RSL fusion alone was performed in 29 patients, RSL fusion with DSE in 23 and RSL fusion with DSE and TE in 12. At the final follow-up, the three groups did not differ in their pain or wrist motion. Overall, 47 (73%) patients were satisfied or very satisfied with the procedure. DSE significantly decreased STT osteoarthritis and radiocarpal non-union. The total wrist osteoarthritis rate after RSL fusion was 55%. RSL fusion is an effective procedure to preserve some motion in wrists with posttraumatic radiocarpal osteoarthritis. DSE prevents STT osteoarthritis by removing bony impingement and increases the fusion rate. LEVEL OF EVIDENCE: Level IV, Case series, Therapeutic studies.

Quality of life after total knee arthroplasty.

Total knee arthroplasty (TKA) results in a high degree of patient satisfaction, as it provides patients with considerable medium- and long-term benefits in terms of quality of life, pain relief and function. Nevertheless, the literature reports that up to 30% of patients are dissatisfied. This dissatisfaction is directly related to the patients' quality of life, which they deem insufficient. Their quality of life depends on many physical, behavioural, social and psychological factors that are not taken into account by functional outcome scores. After describing the principles of quality of life evaluation after TKA, we will assess the effects of patient-related factors, the surgical technique and postoperative program through an exhaustive review of the literature. Patient expectations after TKA will then be outlined, particularly return to work and return to sports.

The CJOrtho app: A mobile clinical and educational tool for orthopedics.

The need for modern patient evaluation tools continues to grow. A dependable and reproducible assessment provides objective follow-up and increases the validity of collected data. This is where mobile apps come into play, as they provide a link between surgeons and patients. They also open the possibility of interacting with other healthcare staff to exchange common scientific reference systems and databases. The CJOrtho app provides fast access to 65 classification systems in orthopedics or trauma surgery, 20 clinical outcome scores and a digital goniometer. The development of free mobile apps is an opportunity for education and better follow-up, while meeting the demands of patients.

Global fit concept in revision hip arthroplasty for cementless press-fit femoral stems.

A revision stem may be required after a femoral extended trochanteric osteotomy (ETO) is made during revision hip arthroplasty. The two main complications of straight cementless femoral stems are subsidence due to inadequate osteointegration and stress-shielding. We will describe an original revision method with ETO that uses a straight cementless stem. The goal of this method was to achieve the most extensive press-fit possible during stem implantation to improve the transmission of stresses to the bone and to prevent reduction in bone density. The intramedullary preparation was done after closure and fixation of the ETO, which allows impaction of the revision stem with metaphyseal and diaphyseal press-fit. We report encouraging results with preservation of periprosthetic bone stock and good osteointegration of these revision stems at the final follow-up. Pronounced sagittal curvature or large bone defects are contraindications for this technique.

Sequential 3D analysis of patellofemoral kinematics from biplanar x-rays: In vitro validation protocol.

BACKGROUND: Developing criteria for assessing patellofemoral kinematics is crucial to understand, evaluate, and monitor patellofemoral function. The objective of this study was to assess a sequential 3D analysis method based on biplanar radiographs, using an in vitro protocol. HYPOTHESIS: Biplanar radiography combined with novel 3D reconstruction methods provides a reliable evaluation of patellofemoral function, without previous imaging. MATERIAL AND METHODS: Eight cadaver specimens were studied during knee flexion cycles from 0° to 60° induced by an in vitro simulator. The protocol was validated by investigating sequential and continuous motion using an optoelectronic system, evaluating measurement accuracy and reproducibility using metallic beads embedded in the patella, and comparing the 3D patellar geometry to computed tomography (CT) images. RESULTS: The differences in position between the sequential and continuous kinematic analyses were less than 1mm and 1°. The protocol proved reliable for tracking several components of knee movements, including patellar translations, flexion, and tilt. In this analysis, uncertainty was less than 2 mm for translations and less than 3° for rotations, except rotation in the coronal plane. For patellar tilt, uncertainty was 5°. Mean difference in geometry was 0.49 mm. DISCUSSION: Sequential analysis results are consistent with continuous kinematics. This analysis method provides patellar position parameters without requiring previous CT or magnetic resonance imaging. A clinical study may deserve consideration to identify patellofemoral kinematic profiles and position criteria in vivo. LEVEL OF EVIDENCE: IV, experimental study.