Human osteoarthritis cartilage-derived stromal cells activate joint degeneration through TGF-beta lateral signaling.

Human osteoarthritis cartilage contains chondrocytes (OAC) and mesenchymal stromal cells (OA-MSC). Here, we found that TGF-ß had different effects on OA-MSC and OAC, and revealed its lateral signaling mechanism in OA. RNAseq analysis indicated that OA-MSC expressed the same level of Bone Morphogenetic Protein (BMP) Receptor-1A as OAC but only 1/12 of Transforming Growth Factor beta (TGF-ß) Receptor-1. While TGF-ß specifically activated SMAD2 in OAC, it also activated BMP signaling-associated SMAD1 in OA-MSC. While TGF-ß stimulated chondrogenesis in OAC, it induced hypertrophy, mineralization, and MMP-13 in OA-MSC. Inhibiting TGF-ßR1 suppressed MMP-13 in OA-MSC but stimulated it in OAC. In contrast, by specifically targeting BMPR1A/ACVR1 in both cell types, LDN193189 inhibits cartilage degeneration through suppressing hypertrophy and MMP-13 in a mouse osteoarthritis model. Thus, LDN193189, a drug under development to inhibit constitutive BMP signaling during heterotopic ossification, may be re-purposed for OA treatment.

Cost benefit analysis of topical tranexamic acid in primary total hip and knee arthroplasty.

The purpose of this study was to provide a cost-benefit analysis of topical tranexamic acid (TXA) in primary total hip and knee arthroplasty patients. A retrospective cohort of 591 consecutive patients, 311 experimental and 280 control, revealed a transfusion rate reduction from 17.5% to 5.5%, increased postoperative hemoglobin, and decreased delta hemoglobin without an increase in adverse events (all P < 0.001). This led to saving $83.73 per patient based on transfusion costs alone after accounting for the cost of TXA. Hospital disposition to home compared to subacute nursing facility was also significantly increased by 9.3% (P < 0.02). We conclude that topical TXA reduces transfusion rate, increases home disposition, and reduces cost in primary hip and knee arthroplasty.

An improved method for cable grip fixation of the greater trochanter after trochanteric slide osteotomy.

This study proposes a novel method for reattachment of the trochanteric slide osteotomy. The strength of this new fixation system was compared to established configurations. Fifteen sawbone femurs were used. Our configuration used cables above and below the lesser trochanter with a third cable around the shaft of the femur while passing the loose ends through the inferior hole of the cable grip. Displacement of the trochanter was measured with increasing load. Force required for catastrophic failure was also measured. The 3-cable construct resulted in significantly less displacement with increasing load and required a larger force to cause failure (1 cm and 2 cm). We theorize that our configuration produces a biomechanically stronger construct than previously used methods.

Establishing a center of excellence: the Total Joint Center at the Miriam Hospital.

The Total Joint Center at The Miriam Hospital has been very successful and now serves as a model for other specialties. Key to this program's success is the cooperative relationship between various stakeholders. Leadership is required yet the input and participation of all is necessary to achieve the desired outcome. To achieve efficiencies, there must be a willingness to deeply integrate clinical services. Again, this requires input from sectors that in the past typically did not communicate with each other. Finally, surgeons and staff need to "pledge" and show their willingness to practice based on sound patient data and modify treatment based on this same data. We are extremely proud of the results achieved. Also impressive is how, in a very short period of time, we have been able to bring together an extremely dedicated team of professionals who work cooperatively in a seamless fashion. With this approach we are able to meet our strategic goal of providing state-of-the-art, high quality, patient-centric, efficient healthcare.