A novel intraoperative acetabular reaming center locating method in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip: a retrospective cohort study.

PURPOSE: Although the principles of hip reconstruction are consistent, due to lack of reliable anatomical landmarks, how to decide the acetabular cup reaming centre intraoperatively in Crowe IV patients with developmental dysplasia of the hip (DDH) remains unclear. This study aims to address this question. METHODS: Fifty-eight Crowe IV patients were enrolled from 2017 to 2019. By examining our previous clinical data, we analyzed the anatomical morphology of Crowe IV acetabulum and proposed a method of locating intraoperative reaming centering for implantation of a standard-sized acetabular cup, which is the upper two thirds of the posterior border of the true acetabulum. All patients included in this study were reamed according to this method. The average postoperative follow-up was 4.1 years (3-5 years). The position of the centre of rotation (COR), cup coverage (CC), and optimal range of joint motion (ROM) were examined by 3D computer simulation measurement. Postoperative complications and hip Harris score were collected and analyzed. RESULTS: The morphology of the type IV DDH true acetabulum was mostly triangular. The intraoperative reaming centre were centered on the upper two thirds of the posterior border of the true acetabulum. The postoperative 3D CC was 80.20% ± 7.63% (64.68-90.24%, 44-48-mm cup size). The patients' mean Harris score improved from 39.7 ± 20.4 preoperatively to 91.5 ± 8.12 at the last follow-up. CONCLUSION: Our study demonstrated that satisfactory CC and clinical results could be achieved by implanting a standard-sized cup with the reaming centre on the upper two thirds of the posterior border of the true acetabulum.

Shape-memory sawtooth-arm embracing clamp used in complex femoral revision hip arthroplasty for stem stability: average 9-year follow-up study.

BACKGROUND: Nickel-Titanium shape-memory sawtooth-arm embracing clamps (SSECs) have been used in revision total hip arthroplasties (rTHAs) to protect stem stability. This study was to introduce this technique and report its mid to long-term clinical and radiographic outcomes. METHODS: We retrospectively reviewed all patients implanted with SSECs in our department from January 2008 to December 2015. 41 patients (41 hips) were finally included. Radiographs and Harris hip scores (HHS) were collected. Radiographs were blindly analyzed for evidence of loosening, subsidence and stress shielding. HHS were compared to previous records by student's t tests. The average follow-up period was 9.3 years. RESULTS: All stems were stably fixed with no signs of loosening. The mean stem subsidence was 0.9 mm (range, 0 to 3 mm). Only one patient (2.4%) demonstrated the fourth degree of stress shielding, with the others none or minor bone resorption. The mean HHS at the final follow-up was 84.2 (range, 81 to 91), which was improved from 17.4 (range, 0 to 37) before surgery. No implant failures or re-revisions occurred. Dislocation occurred in 1 case during the follow-up period. CONCLUSIONS: The SSEC protected stem fixation and achieved favorable clinical and radiographic outcomes in this 9-year follow-up study. It offered an additional extramedullary fixation option for surgeons to choose from in treating complex femoral revision arthroplasties.

Exploring expectations of Chinese patients for total knee arthroplasty: once the medicine is taken, the symptoms vanish.

BACKGROUND: Preoperative expectations of total knee arthroplasty (TKA) outcomes are important determinants of patient satisfaction. However, expectations of patients in different countries are affected by cultural background. The general goal of this study was to describe Chinese TKA patients' expectations. METHODS: Patients scheduled for TKA were recruited in a quantitative study(n = 198). The Hospital for Special Surgery Total Knee Replacement Expectations Survey Questionnaire was used for survey TKA patients' expectations. Descriptive phenomenological design was used for the qualitative research. Semi-structured interviews were conducted with 15 TKA patients. Colaizzi's method was used for interview data analysis. RESULTS: The mean expectation score of Chinese TKA patients was 89.17 points. The 4 highest score items were walk short distance, remove the need for walker, relieve pain and make knee or leg straight. The 2 lowest score items were employed for monetary reimbursement and sexual activity. Five main themes and 12 sub-themes emerged from the interview data, including multiple factors raised expectations, expectations of physical comfort, expect various activities back to normal, hope for a long joint lifespan, and expect a better mood. CONCLUSIONS: Chinese TKA patients reported a relatively high level of expectations, and differences across cultures result in different expectation points than other national populations, requiring adjustment of items when using assessment tools across cultures. Strategies for expectation management should be further developed. LEVEL OF EVIDENCE: Level IV.

Paxlovid accelerates cartilage degeneration and senescence through activating endoplasmic reticulum stress and interfering redox homeostasis.

BACKGROUND: The COVID-19 pandemic has become a huge threat to human health, infecting millions of people worldwide and causing enormous economic losses. Many novel small molecule drugs have been developed to treat patients with COVID-19, including Paxlovid, which block the synthesis of virus-related proteins and replication of viral RNA, respectively. Despite satisfactory clinical trial results, attention is now being paid to the long-term side effects of these antiviral drugs on the musculoskeletal system. To date, no study has reported the possible side effects, such as osteoarthritis, of Paxlovid. This study explored the effects of antiviral drug, Paxlovid, on chondrocyte proliferation and differentiation. METHODS: In this study, both in vitro and in vivo studies were performed to determine the effect of Paxlovid on chondrocyte degeneration and senescence. Furthermore, we explored the possible mechanism behind Paxlovid-induced acceleration of cartilage degeneration using transcriptome sequencing and related inhibitors were adopted to verify the downstream pathways behind such phenomenon. RESULTS: Paxlovid significantly inhibited chondrocyte extracellular matrix protein secretion. Additionally, Paxlovid significantly induced endoplasmic reticulum stress, oxidative stress, and downstream ferroptosis, thus accelerating the senescence and degeneration of chondrocytes. In vivo experiments showed that intraperitoneal injection of Paxlovid for 1 week exacerbated cartilage abrasion and accelerated the development of osteoarthritis in a mouse model. CONCLUSIONS: Paxlovid accelerated cartilage degeneration and osteoarthritis development, potentially by inducing endoplasmic reticulum stress and oxidative stress. Long-term follow-up is needed with special attention to the occurrence and development of osteoarthritis in patients treated with Paxlovid.

Reliability and validity test of a novel three-dimensional acetabular bone defect classification system aided with additive manufacturing.

BACKGROUND: Accurate assessment of acetabular defects and designing precise and feasible surgical plans are essential for positive outcomes of hip revision arthroplasty. Additive manufacturing (AM) is a novel technique to print physical object models. We propose a three-dimensional acetabular bone defect classification system aided with AM model, and further assess its reliability and validity under blinded conditions. METHODS: We reviewed 104 consecutive patients who underwent hip revision arthroplasty at our department between January 2014 and December 2019, of whom 45 had AM models and were included in the reliability and validity tests. Three orthopedic surgeons retrospectively evaluated the bone defects of these 45 patients with our proposed classification, made surgical plans, and repeated the process after 2 weeks. The reliability and validity of the classification results and corresponding surgical plans were assessed using the intra-class correlation coefficient or kappa correlation coefficient. RESULTS: The reliability and validity of the classification results were excellent. The mean initial intra-class correlation coefficient for inter-observer reliability was 0.947, which increased to 0.972 when tested a second time. The intra-observer reliability ranged from 0.958 to 0.980. Validity of the classification results also showed a high kappa correlation coefficient of 0.951-0.967. When considering corresponding surgical plans, the reliability and validity were also excellent, with intra-class correlation coefficients and kappa correlation coefficients measuring all over 0.9. CONCLUSIONS: This three-dimensional acetabular defect classification has excellent reliability and validity. Using this classification system and AM models, accurate assessment of bone defect and reliable surgical plans could be achieved. This classification aided with AM is a promising tool for surgeons for preoperative evaluation.

Application of a novel osteotomy instrumentation as a substitute tool in total hip arthroplasty.

BACKGROUND: Mechanical failure, power shortage, and inadvertent contamination of the oscillating saw occasionally occurs in actualizing femoral neck osteotomy during total hip arthroplasty (THA); however, no appropriate alternative solution is currently available. This study aimed to introduce a novel osteotomy instrumentation (fretsaw, jig, cable passer hook) as a substitute tool while the oscillating saw was unavailable during THA. METHODS: This study included 40 patients (40 hips) who underwent femoral neck osteotomy during primary THA using the new osteotomy instrumentation (n = 20) and the oscillating saw (n = 20). Clinical data and intraoperative findings of all patients were evaluated. RESULTS: The mean osteotomy time was 22.3 ± 3.1 s (range, 17-30 s) and 29.4 ± 3.7 s (range, 25-39 s) in the oscillating saw group and in the new osteotomy instrumentation group, respectively (P < 0.001). The Harris Hip Score (HHS) improved in both groups; the mean HSS was 82.3 ± 2.5 and 83.3 ± 3.5 in the oscillating saw group and new osteotomy instrumentation group at 6 months after surgery, respectively (P = 0.297). CONCLUSIONS: The original osteotomy instrumentation can be an ideal substitute tool for femoral neck osteotomy in THA, especially when the oscillating saw is unavailable or malfunctioning.

Positive Correlation Between the Femur Neck Shaft and Anteversion Angles: A Retrospective Computed Tomography Analysis in Patients With Developmental Dysplasia of the Hip.

BACKGROUND: This study aimed to explore the anatomical correlation between the femoral neck shaft angle (NSA) and femoral anteversion angle (AA) in patients with developmental dysplasia of the hip based on the Crowe classification and provide a novel method to estimate the femoral AA on anteroposterior pelvic radiographs. METHODS: A total of 208 patients with dysplastic hips who underwent total hip arthroplasty at our institution were retrospectively included. Preoperative physiological AA and NSA were determined via 3-dimensional computed tomography. Linear regressions and Pearson's coefficients were calculated to assess the correlation between the femoral NSA and femoral AA. RESULTS: A total of 416 hips were divided into 5 subgroups: 99 normal, 143 type I, 71 type II, 63 type III, and 40 type IV hips following the Crowe classification. Dysplastic femurs had significantly higher AAs than normal hips (25.2° vs 31.4° vs 33.3° vs 35.5° vs 41.7°). Significant positive correlations between the AA and NSA were observed in normal (r = 0.635), type I (r = 0.700), type II (r = 0.612), and type III (r = 0.638) hips (P < .001); however, no meaningful correlation was observed in type IV hips (r = 0.218, P = .176). CONCLUSION: The NSA and AA correlated positively and significantly in the normal and dysplastic Crowe type I-III hips. The relationship between the NSA and AA indicates torsion of the proximal femur and offers an opportunity for straightforward estimation of AA based on NSA.

The severity of developmental dysplasia of the hip does not correlate with the abnormality in pelvic incidence.

BACKGROUND: The purpose of this study was to investigate the association between the severity of Developmental dysplasia of the hip (DDH) and the abnormality in pelvic incidence (PI). METHODS: This was a retrospective study analyzing 53 DDH patients and 53 non-DDH age-matched controls. Computed tomography images were used to construct three-dimensional pelvic model. The Crowe classification was used to classify the severity of DDH. The midpoint of the femoral head centers and sacral endplates were projected to the sagittal plane of the pelvis. The PI was defined as the angle between a line perpendicular to the sacral plate at its midpoint and a line connecting this point to the axis of the femoral heads. Independent sample t-tests were used to compare the differences between the PI of DDH group and the non-DDH controls group. Kendall's coefficient of concordance was used to determine the correlation between the severity of DDH and PI. RESULTS: Patients with DDH had a significantly (p = 0.041) higher PI than the non-DDH controls (DDH 47.6 ± 8.2°, normal 44.2 ± 8.8°). Crowe type I patients had a significantly (p = 0.038) higher PI (48.2 ± 7.6°) than the non-DDH controls. No significant difference between the PI in Crowe type II or III patients and the PI in non-DDH controls were found (Crowe type II, 50.2 ± 9.6°, p = 0.073; Crowe type III, 43.8 ± 7.2°, p = 0.930). No correlation was found between the severity of DDH and the PI (r = 0.091, p = 0.222). CONCLUSIONS: No correlation was found between the severity of DDH and the PI. The study confirmed that the PI in DDH (Crowe type I) group was higher than that of the non-DDH control group, while the PI does not correlate with the severity of DDH.

Prediction of Postoperative Stem Anteversion in Crowe Type II/III Developmental Dysplasia of the Hip on Preoperative Two-Dimensional Computed Tomography.

BACKGROUND: Preoperative planning is fundamental for total hip arthroplasty. This study investigated the optimal femoral neck level for measuring femoral anteversion to predict postoperative stem anteversion in developmental dysplasia of the hip and determined the predictive role of average anteversion based on the sagittal 3-point fixation. METHODS: Sixty-two Crowe type II/III dysplastic hips that underwent total hip arthroplasty were retrospectively analyzed. Preoperative and postoperative anteversion was measured via 2-dimensional computed tomography. Anterior and posterior cortex anteversions were measured at 6 levels of the proximal femur. Femoral anteversion at each level was calculated. Average anterior (lesser trochanter) and posterior cortex anteversions (femoral neck) were calculated based on the sagittal 3-point fixation. RESULTS: From the lesser trochanter to head-neck junction, femoral anteversion decreased gradually from more to less than stem anteversion. For hips with femoral neck height ≥10 mm, femoral anteversion at the 10-mm level above the lesser trochanter proximal base showed no significant difference with stem anteversion, with a good correlation for the single-wedge and an excellent correlation for the double-wedge stem. Average anterior (lesser trochanter proximal base) and posterior cortex anteversions (femoral neck at 10 mm above the lesser trochanter proximal base) showed no significant difference from stem anteversion, with excellent correlations. CONCLUSION: For Crowe type II/III hips with femoral neck height ≥10 mm, the 10-mm level above the lesser trochanter proximal base is an optimal choice for measuring femoral anteversion to predict postoperative stem anteversion. The average of anterior cortex anteversion at the lesser trochanter and posterior cortex anteversion at the femoral neck has a predictive role.

Mechanical strain promotes osteogenic differentiation of mesenchymal stem cells on TiO2 nanotubes substrate.

Previous studies demonstrated cycle mechanical strain induced osteogenic differentiation of MSCs. But in general, MSCs are typically seeded on a flexible membrane or within a soft matrix. TiO2 nanotubes substrate topography plays a critical role in promoting the MSCs response and affects MSCs fate. Titanium implants surface modified by TiO2 nanotubes topography provides the opportunity to improve osseointegration by additionally regulating the MSCs fate. Titanium is one of most commonly used materials in the orthopedics and can undergo elastic deformation under certain mechanical stress. Therefore, for clinic trails, it is necessary to investigate the effect of mechanical strain on osteogenesis of MSCs on TiO2 nanotubes modified titanium substrate. But until now, there has been no research focused on the relationship between mechanical strain and osteogenesis of MSCs on the TiO2 nanotubes topography substrate. Here, we firstly applied the mechanical stress to the TiO2 nanotubes modified titanium specimen to investigate the effects of mechanical strain on the biological behaviors of MSCs. Our present study showed that mechanical strain promoted cell proliferation, spreading and increased vinculin expression of MSCs on the TiO2 nanotubes substrate. Additionally, mechanical strain enhanced the ALP activity and osteogenesis genes expression such as Runx2, BSP, ALP, OPN and OCN. Our results preliminarily demonstrated that mechanical strain enhanced the osteogenic differentiation of MSCs through the FAK-Erk1/2-Runx2 pathway on the TiO2 nanotubes substrate.

Direct Leverage for Reducing the Femoral Head in Total Hip Arthroplasty Without Femoral Shortening Osteotomy for Crowe Type 3 to 4 Dysplasia of the Hip.

BACKGROUND: A number of methods for reduction in high hip dislocation in total hip arthroplasty (THA) are time-consuming and laborious, and require great surgical skills. This study aimed to introduce a new reduction technique to achieve rapid, safe, and easy reduction in high hip dislocation. METHODS: We retrospectively reviewed 74 THA patients (82 hips; 44 women, 30 men) with severe hip dysplasia who underwent direct leverage using a Hohmann retractor into the anatomical acetabulum without femoral shortening osteotomy between September 2007 and January 2014. Forty-nine hips were classified as Crowe III and 33 hips were classified as Crowe IV. The mean follow-up period was 5.1 years (range 2-8). RESULTS: Mean Harris Hip Score increased from 42.1 (range 24-71) before surgery to 89.9 (range 76-100) at final follow-up examination. The legs were lengthened by a mean of 3.0 cm (range 1.1-5.5) and 2.5 cm (range 1.1-3.5) in Crowe III hips and 3.6 cm (range 1.9-5.5) in Crowe IV hips postoperatively. The average leg-length discrepancy at the final follow-up examination was 0.4 cm (standard deviation 0.5 cm). One greater trochanteric fracture occurred during the hip reduction process. One patient developed femoral nerve palsies and recovered completely at 3 weeks postoperatively. CONCLUSION: Direct leverage using the Hohmann retractor for the reduction in high hip dislocation in THA without femoral shortening osteotomy is simple, safe, and effective.

Three-Dimensional Host Bone Coverage in Total Hip Arthroplasty for Crowe Types II and III Developmental Dysplasia of the Hip.

BACKGROUND: Recommendations for minimum cup coverage based on anteroposterior radiographs are widely used as an intraoperative guide in total hip arthroplasty for patients with developmental dysplasia of the hip. The purpose of this study was to examine the validity of two-dimensional (2D) measurement of coverage with three-dimensional (3D) coverage and to identify parameters for determining the 3D coverage during surgery. METHODS: We developed a technique to accurately reproduce the intraoperative anatomic geometry of the dysplastic acetabulum and measure the 3D cup coverage postoperatively. With this technique, we retrospectively analyzed the difference and correlation between 2D and 3D measurements of native bone coverage in 35 patients (45 hips) with Crowe II or III DDH. Linear regression analysis was performed to examine the intraoperative parameters related to coverage. The mean follow-up period was 7.64 years (range, 6.1-9.5 years). RESULTS: There was a significant difference and a fair correlation between 2D and 3D measurements. The 2D measurement underestimated the 3D cup coverage by approximately 13%. An excellent linear relationship was noted between the 3D coverage/uncoverage and the height of the uncovered portion (R2 = 0.8440, P < .0001). There was no case of loosening or revision during the follow-up. CONCLUSION: Current minimum cup coverage recommendations based on 2D radiograph measurements should not be used as a direct intraoperative guide. The height of the uncovered portion is a useful parameter to determine the 3D coverage during surgery.

Comparison of Total Hip Arthroplasty With and Without Femoral Shortening Osteotomy for Unilateral Mild to Moderate High Hip Dislocation.

BACKGROUND: This study compares the outcome between THA with and without femoral shortening osteotomy for unilateral mild to moderate high hip dislocation in developmental dysplasia of the hip patients. METHODS: The data on 42 hips in 42 patients who had undergone THA for unilateral mild to moderate high hip dislocation were retrospectively reviewed after being prospectively collected. In 22 patients, hips were reduced by soft tissue release and direct leverage using an elevator, without the osteotomy. The remaining 20 patients were treated with a subtrochanteric transverse shortening osteotomy. The mean follow-up of patients was 5 years (standard deviation = 1.0) for the nonosteotomy group and 6.2 years (standard deviation = 1.6) for the osteotomy group. RESULTS: The Harris Hip Score significantly improved in both groups. In the nonosteotomy group, we observed a lower leg length discrepancy compared with the osteotomy group (0.4 cm and 2.2 cm, respectively). Four patients (18.2%) in the nonosteotomy group and 15 patients (75%) in the osteotomy group developed a limp (P < .0001). Three patients (13%) developed femoral nerve palsy in the nonosteotomy group, but they all recovered completely within 6 months after the surgery. Nineteen patients in the nonosteotomy group showed knee valgus deformity immediately after the surgery but only 4 cases in the osteotomy group. CONCLUSION: Compared with THA with femoral shortening osteotomy, THA without the osteotomy was associated with a lower number of patients who developed a limp at the end of follow-up; however, the rehabilitation was slower and more difficult, and a larger number of patients showed reversible nerve palsy and knee valgus deformity.

Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA With Severe Bone Defects.

BACKGROUND: Revision THA is particularly challenging in hips with severe acetabular bone loss. When the extent or geometry of the acetabular bone loss precludes more-straightforward techniques such as jumbo hemispheric cementless shells, reconstruction with morselized allograft protected by a custom cage may offer an alternative, but, to our knowledge, few series have reported on results with this approach. QUESTIONS/PURPOSES: For patients with severe (Paprosky IIIB) defects, we asked: do individualized custom cages result in (1) improved Harris hip scores; (2) restoration of hip center; and (3) a low incidence of surgical complications? METHODS: Twenty-six patients (26 hips) with a massive acetabular defect were involved in this study from 2003 to 2013. During this period, one patient was lost to followup and one died, leaving 24 patients (eight males, 16 females) in this retrospective analysis. The customized cages were individualized to each patient's bone defect based on rapid-prototype three-dimensional printed models. Mean followup was 67 months (range, 24-120 months). Harris hip scores were assessed before surgery and at each followup. Postoperative radiographs were evaluated for cage position, migration, and graft incorporation. Complications and reoperations were assessed by chart review. RESULTS: The mean Harris hip score improved from 36 (SD, 8; range, 20-49) to 82 (SD, 18; range, 60-96) (p < 0.001). Individualized custom cages resulted in generally reliable restoration of the hip center. No rerevisions have been performed. None of the cups showed radiographic migration, but one cage was believed to be loose, based on a circumferential 2-mm radiolucent line. Cancellous allografts appeared to be incorporated in 23 of 24 patients. One deep infection and one superficial infection were observed and treated with irrigation, débridement, and vacuum-sealing drainage. One dislocation and one suspected injury of the superior gluteal nerve also were observed and treated conservatively. CONCLUSIONS: Individualized custom cages using rapid prototyping and three-dimensional printing appeared to provide stable fixation and improved hip scores at short-term followup in this small, single-center series. As further improvements in the design and manufacturing process are made, future studies should evaluate larger patient groups for longer times, and, ideally, compare this approach with alternatives for these complex bone defects. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Nickel-Titanium Shape-Memory Sawtooth-Arm Embracing Clamp for Complex Femoral Revision Hip Arthroplasty.

PURPOSES: To examine the clinical outcomes of patients treated with a nickel-titanium shape-memory sawtooth-arm embracing clamp (Ni-Ti SSEC) in complex femoral revision surgery. METHODS: We retrospectively evaluated the outcomes for 21 complex femoral revision hip arthroplasties that we treated using an Ni-Ti SSEC. The Ni-Ti SSEC was used for various procedures, including the fixation of extremely long cortical windows (11 patients), femoral shaft osteotomy (4 patients), an extended trochanteric osteotomy (3 patients), and protection of a penetrated femoral cortex by a primary stem (3 patients). All patients received follow-up care for an average of 48.2 months. RESULTS: The mean time of Ni-Ti SSEC insertion intraoperatively was 6 minutes. The mean Harris Hip Score improved from 21.2 points before revision surgery to 83.1 points at the most recent examination. No implant failures or malunions occurred. Dislocation and deep infection occurred in 1 case during the follow-up period. CONCLUSIONS: Our results show that the embracing clamp is a simple and valid method for fixing osteotomies in treating complex femoral revision surgery.

Posterosuperior Placement of a Standard-Sized Cup at the True Acetabulum in Acetabular Reconstruction of Developmental Dysplasia of the Hip With High Dislocation.

BACKGROUND: We sought to evaluate posterosuperior placement of the acetabular component at the true acetabulum during acetabular reconstruction in patients with Crowe type-IV developmental dysplasia of the hip. METHODS: Using pelvic computed tomography and image processing, we developed a two-dimensional mapping technique to demonstrate the distribution of preoperative three-dimensional cup coverage at the true acetabulum, determined the postoperative location of the acetabular cup, and calculated postoperative three-dimensional coverage for 16 Crowe type-IV dysplastic hips in 14 patients with a mean age of 52 years (33-78 years) who underwent total hip arthroplasty. Mean follow-up was 6.3 years (5.5-7.3 years). RESULTS: On preoperative mapping, the maximum three-dimensional coverage using a 44-mm cup was 87.31% (77.36%-98.14%). Mapping enabled the successful replacement of 16 hips using a mean cup size of 44.13 mm (42-46 mm) with posterosuperior placement of the cup. Early weight-bearing and no prosthesis revision or loosening during follow-up were achieved in all patients. The postoperative two-dimensional coverage on anteroposterior radiographs and three-dimensional coverage were 96.15% (89.49%-100%) and 83.42% (71.81%-98.50%), respectively. CONCLUSION: This technique may improve long-term implant survival in patients with Crowe-IV developmental dysplasia of the hip undergoing total hip arthroplasty by allowing the use of durable bearings, increasing host bone coverage, ensuring initial stability, and restoring the normal hip center.

System Review about Function Role of ESCC Driver Gene KDM6A by Network Biology Approach.

Background. KDM6A (Lysine (K)-Specific Demethylase 6A) is the driver gene related to esophageal squamous cell carcinoma (ESCC). In order to provide more biological insights into KDM6A, in this paper, we treat PPI (protein-protein interaction) network derived from KDM6A as a conceptual framework and follow it to review its biological function. Method. We constructed a PPI network with Cytoscape software and performed clustering of network with Clust&See. Then, we evaluate the pathways, which are statistically involved in the network derived from KDM6A. Lastly, gene ontology analysis of clusters of genes in the network was conducted. Result. The network includes three clusters that consist of 74 nodes connected via 453 edges. Fifty-five pathways are statistically involved in the network and most of them are functionally related to the processes of cell cycle, gene expression, and carcinogenesis. The biology themes of clusters 1, 2, and 3 are chromatin modification, regulation of gene expression by transcription factor complex, and control of cell cycle, respectively. Conclusion. The PPI network presents a panoramic view which can facilitate for us to understand the function role of KDM6A. It is a helpful way by network approach to perform system review on a certain gene.

Range of Hip Joint Motion in Developmental Dysplasia of the Hip Patients Following Total Hip Arthroplasty With the Surgical Technique Using the Concept of Combined Anteversion: A Study of Crowe I and II Patients.

The combined anteversion surgical technique has been proposed and used in clinical practice. To more objectively evaluate the feasibility of this surgical technique using combined anteversion concept for DDH patients, we studied 34 DDH patients (40 hips) in this research. Every patient underwent pelvic CT scans before and after surgery and the HHSs were recorded. Optimal range of joint motion was measured using a three-dimensional reconstruction technique and a dynamic measurement technique. The results revealed that joint function met the requirements of daily life and the range of motion was not over-limited by impingement between the prosthesis and the skeleton. Moreover, the combined anteversion was found to be the most critical parameter in this study.

The use of customized cages in revision total hip arthroplasty for Paprosky type III acetabular bone defects.

PURPOSE: Revision total hip arthroplasty (THA) is challenging if severe periacetabular bone loss is present. Here we describe a method that uses a customised cage to reconstruct an acetabulum with a massive bone defect. METHODS: Designed with the aid of the rapid prototyping technique, a customised cage with a hook, crest and flange or braids was made, and then utilized to reconstruct severe compromised acetabulum in revision THA since 2001. Twenty-two patients (23 hips) were included in this study. The mean patient age at the time of surgery was 60.9 years (range, 38-80 years). Three hips had massive acetabular bone defects of Paprosky type IIIA and 20 of type IIIB. The Harris hip score was used to evaluate hip function. Radiographs were taken to evaluate loosening of the cage and resorption of allograft bone. RESULTS: The average follow up was 81.6 ± 24.9 months. The mean Harris hip score improved from 39.6 pre-operatively to 80.9 at the final follow-up. There were no instances of deep infection, severe venous thrombosis, and nerve palsy. One patient who had an intra-operative rupture of the superior acetabular artery was successfully treated using the haemostatic suturing technique. Two patients experienced dislocation at post-operative days four and six, respectively, and both were treated with closed reduction and skin traction for three weeks. CONCLUSIONS: The present study demonstrates that a customised cage may be a promising option for THA revision of severely compromised acetabula. Extended follow-up is necessary to evaluate the long-term performance of this approach.

Meta-analysis of sonication fluid samples from prosthetic components for diagnosis of infection after total joint arthroplasty.

This meta-analysis included 12 studies that evaluated sonication fluid cultures (SFC) for the diagnosis of prosthetic joint infection (PJI). The pooled sensitivity and specificity were 0.80 (95% confidence interval [CI], 0.74 to 0.84) and 0.95 (CI, 0.90 to 0.98), respectively. Subgroup analyses showed that a 14-day anaerobic culture may improve sensitivity, the use of centrifugation or vortexing may improve specificity, and the use of 400 to 500 ml of Ringer's solution for containers may improve sensitivity and specificity. The best SFC cutoff was ≥5 CFU. In conclusion, SFC has high sensitivity and very high specificity for diagnosing PJI.