A comparative study of clinical effect of total knee arthroplasty in the treatment of primary osteoarthritis and osteoarthritis of Kashin-Beck disease.

OBJECTIVE: To evaluate the clinical efficacy of total knee arthroplasty (TKA) in the treatment of primary osteoarthritis (OA) and osteoarthritis of Kashin-Beck disease (KBD). METHODS: This study enrolled 77 KBD patients (77 knees, KBD-TKA) and 75 OA patients (75 knees, OA-TKA) who underwent TKA from September 2008 to June 2018. Clinical assessments for each patient were performed pre-operatively and last follow-up. The efficacy measures included the visual analogue scale (VAS) pain score, range of motion (ROM), Hospital for Special Surgery (HSS) score, and short form 36 Health Survey (SF-36) as well as related influencing factors between the two groups. RESULTS: All patients were followed up; the follow-up time of KBD-TKA was 14-132 months, with an average of 72.68 ± 37.55 months; OA-TKA was 15-120 months, with an average of 49.2 ± 28.91 months. There was no difference in pre-operative VAS score (7.29 vs. 7.24) and SF-36 (PCS) score (4.87 vs. 5.49) between KBD-TKA and OA-TKA (P > 0.05), while compared with OA, KBD-TKA had significantly worse pre-operative ROM (75.48° vs. 82.87°), HSS score (36.40 vs. 41.84), and SF-36 (MCS) score (26.28 vs. 28.73) (P < 0.05). At the final follow-up, there was no significant difference in VAS score (1.13 vs. 1.16), ROM (105.79 vs. 105.79), and HSS score (92.06 vs. 92.25) between KBD-TKA and OA-TKA (P > 0.05), while compared with OA, KBD-TKA had significantly worse SF-36 (PCS) score (36.90 vs. 42.00) and SF-36 (MCS) score (55.16 vs. 59.70) (P < 0.05). In a multivariate regression, controlling for multiple potential confounders, diagnosis of KBD was associated with poor quality of life after surgery, whereas pre-operative pain was specifically associated with post-operative pain. However, preoperative gender, age, BMI, and the angles of knee prosthesis (before and after surgery) were not associated with post-operative outcome. CONCLUSION: Patients with KBD undergoing primary TKA have excellent outcomes, comparable with OA at the final follow-up, in spite of worse pre-operative ROM, HSS score, and SF-36(MCS) score. However, KBD patients are worse than OA in terms of general health. Pre-operative age, gender, BMI, and the angles of knee prosthesis were not the factors influencing the clinical efficacy of TKA. The diagnosis of KBD was an independent risk factor for poor quality of life after TKA. Pre-operative pain was a clinically important predictor of outcome.

Clinical and radiographic assessment of cementless acetabular revision with morsellised allografts.

The aim of this study was to evaluate the clinical and radiographic results of cementless acetabular revision with deep frozen morsellised allografts. Sixty-one patients (65 hips) underwent acetabular revision using cementless components and deep frozen morsellised allografts. Fifty-seven hips (53 patients) were reviewed at a mean of 105.1 months (range 72-180 months) after revision. The study group included 29 males and 24 females with a mean age of 46.4 years. One cup underwent further revision for aseptic loosening and two were defined as radiographic failures. The mean time for allograft incorporation was 12.5 months (range 6-24 months) after index surgery. The mean Harris hip score of the patients improved from 61.1 points preoperatively to 91.6 points postoperatively. Linear and cavitary osteolysis was observed in two and 12 hips, respectively. The acetabular revision using cementless components with deep frozen morsellized allografts provides favourable clinical and radiographic results, although the initial disease and age may adversely affect the outcomes.

[Increasing alcohol-induced osteogenesis of human bone marrow-derived mesenchymal cells using siRNA transient suppression of peroxisome proliferator activated receptor gamma: an in vitro experiment study].

OBJECTIVE: To investigate the potential of small interfering RNA (siRNA) against human peroxisome proliferator activated receptor gamma (PPARgamma) to suppress the adipogenic effect of alcohol on human bone marrow-derived mesenchymal cells (hBMSCs) and increase osteogenesis. METHODS: hBMSCs collected from joint replacement surgery were cultured, passaged, and transfected with PPARgamma-siRNA by using liposomal-based strategy. Then the cells were maintained in culture and treated with alcohol 50 mmol/L and dexamethasone, an osteogenic inducer, for 24 days. Oil red O staining was used to observe the fat drops in the cells so as to count the number of adipocytes. Histochemistry was performed to detect the protein expression of alkaline phosphatase, osteocalcium, and type 1 collagen on days 24 and 28 after treatment. Real-time PCR and Western blotting were used to detect the mRNA and protein expression of osteoblast-specific transcription factor-2 (Osf2)/core-binding factor alpha subunit 1 (Cbfa1) on day 10. RESULTS: The adipocyte number of the PPARgamma-siRNA group was significantly lower than those of the alcohol-induced group and the controls (adipogenic group, liposomal group, and negative siRNA group) (all P < 0.05). The Calcium nodule formation rate of the PPARgamma-siRNA group was significantly higher than alcohol-induced group and the controls (adipogenic group, liposomal group, and negative siRNA group) (all P < 0.05). PCR and Western blotting showed significantly higher mRNA and protein expression of the human adipocyte-specific markers:Cbfa1, ALP, type 1 collagen, and osteocalcin, than the other groups. CONCLUSION: The adipogenic effect of alcohol on hBMSCs can be inhibited with a concomitant increase in osteogenesis by using siRNA technique to specific targeted human PPARgamma gene in vitro cell culture systems. PPARgamma-siRNA strategy may be a useful tool for studying the mechanisms of alcohol-induced osteoporosis and provides theoretical basis for its genetic therapy.

[Reconstruction of acetabular defect with wire mesh and impacted bone graft in cemented acetabular revision].

OBJECTIVE: To discuss the method of reconstruction of acetabular bone defect with wire mesh, impaction bone-grafting and a cemented cup in acetabular component revision. METHODS: 21 hips in 21 patients, aged 50.1 (31 - 64), 2 hips being of the acetabular defect type I B, 1 hip of type II A, 4 hips of type II B, and 14 hips of type III according to the American Academy of Orthopaedic Surgeons (AAOS) grading system underwent reconstruction with wire mesh, impacted bone grafts and cemented polyethylene acetabular component, and then were followed up for 47 months (36 - 60 months). RESULTS: The mean Harris hip score improved from the preoperative 55.7 points to 92.9 points at the last time of follow-up. Radiographic incorporation between host the bone and allograft was achieved 11.4 months after the operation on average. The mean change of inclination of acetabular components was 2.2 degrees , in which one acetabular component developed a change of 15.5 degrees . The inclination of acetabular components increased by 1.7 degrees on average 3 months after the operation and 2.0 degrees 6 months after the surgery. The acetabular cup migrated medially and superiorly by 3.93 mm and 4.41 mm respectively, peaking in the sixth month after the operation. One hip developed heterotopic ossification (Brooker grade I). One hip received repeat revision because of the aseptic loosening of the acetabular component 25 months after the revision surgery. CONCLUSION: The changes of the position of acetabular cup mainly occur within six months after the reconstruction of severe acetabular bone defect with wire mesh, impacted bone graft and cemented polyethylene acetabular component. To prevent the displacement of the acetabular cup, it is necessary to keep initial stability of the acetabular cups within six months after the index surgery.

[Changes of the bone mineral density of proximal femur after hip resurfacing arthroplasty].

OBJECTIVE: To evaluate the changes of periprosthetic bone mineral density in femur after hip resurfacing arthroplasty. METHODS: From July 2002 to June 2005, a comparative study was carried out on 52 hips in 52 patients. Twenty-six patients (26 hips) who underwent Birmingham hip resurfacing arthroplasty (group BHR), and 26 patients (26 hips) who performed cementless total hip arthroplasty with Versys System stem (group THA). The periprosthetic bone mineral density of the femur was measured through dual energy X-ray absorptiometry of the Gruen zones at pre-operation, post-operation 3, 6, 12 and 24 months in patients from both group BHR and group THA. The bone mineral density of femoral neck in group BHR was measured too. Changes of bone mineral density ratio in proximal femur between pre-operation and post-operation were compared and analyzed. RESULTS: The mean ratio of bone mineral density of the proximal femur in group BHR reduced by 5.8%, 4.9%, 2.6% and 0.4%, in group THA reduced by 7.0%, 10.6%, 1.0% and 4.1% at 3, 6, 12 and 24 months respectively. In group BHR, the mean ratio of bone mineral density in range of interest 1 decreased to 89.7% at 6 months and increased to 103.8% at 24 months, in range of interest 7 decreased to 95.1% at 6 months and increased to 103.7% at 24 months. In group THA, the mean ratio of bone mineral density in range of interest 1 decreased to 90.8% at 6 months, 94.4% at 24 months and in range of interest 7 decreased to 94.2% at 3 months, 96.7% at 24 months. In group BHR, the bone mineral density of femoral neck was restored to the pre-operation level at 6 months. The bone mineral density in superior-lateral zone of femoral neck decreased to 97.1% at 3 months and increased to 107.4% at 24 months respectively. The bone mineral density in inferior-medial zone of femoral neck increased to 117.9% at 24 months. CONCLUSION: The bone stock of proximal femur can be well preserved and recovered quickly after hip resurfacing arthroplasty.

[Use of cortical bone plates allografts for reconstruction of femoral fracture: an experimental study in goats].

OBJECTIVE: To study the outcome of reconstructing goat femoral fracture by use of cortical bone plates allografts that have been kept by deep-freezing at -70 degrees C for 4 weeks after being treated with 48 degrees C ethylene oxide. METHODS: The recipients, sixteen 10-12-month-old goats with fractures of right femur were subjected the operation for transplanting the cortical bone plates allografts in the medial, lateral and back sides of fractured femurs. The goats were sacrificed and the specimens were procured at 3, 6, 12, and 24 weeks after surgery for X-ray photography, Chinese ink perfusion, tetracycline fluorescence labeling and histological observation in order evaluate the healing of fracture and the incorporation of cortical bone plates allografts. RESULTS: The allograft strut was found revascularized at 6 weeks after surgery in the fracture group, whereas at 3 weeks in the control group. The tetracycline fluorescence labeling was poor in the fracture group as compared with that in the control group from 3 weeks to 6 weeks, but it was better in the fracture group than in the control group beyond 6 weeks after surgery. Fracture was healed and bone conjunction between allograft strut and host bone was seen at weeks after operation. The allograft strut was incorporated in host bone, the ability of remodeling of allograft strut and the size of femoral cortex were better in the fracture group than in the control group at 24 weeks after surgery. The fracture was displaced in 19% animals and the allograft bone plates were not fractured. CONCLUSION: The use of allograft strut pre-treated by ethylene oxide sterilization and deep-freezing could underpin fixation and promote healing of femoral fracture, and it can increase bone reservation and augment the strength of femur once the allograft strut is incorporated in the host bone.

Revision hip arthroplasties with use of the modular S-ROM prosthesis.

OBJECTIVE: The aim of this study was to revision hip arthroplasties in ankylosing spondylitis. MATERIALS AND METHODS: We performed 21 revision hip arthroplasty in 16 patients with ankylosing spondylitis (AS) using S-ROM modular femoral stem. At the final follow-up, all patients were able to ambulate without any walking aids. RESULTS: The mean Harris hip score improved from 57.2 (35 to 74) pre-operatively to 90.2 points (73 to 100) post-operatively, and the outcome was classified as good or excellent in 17 hips (81%). Fixation of the femoral component was classified as stable with bone ingrowth in 15 hips (71.4%), stable with fibrous ingrowth in 2 hips (9.5%), and radiolucent loosening in 4 hips (19.1%). Five hips developed a pedestal at the tip of femoral component. Femoral osteolysis was found in 3 hips (14.2%): 3 hips in Gruen zones 1 and 7, one hip in zone 7, and two hips in zone 1. One hip underwent acetabular revision because of breakage of polyethylene liner, and the well-fixed femoral component was left in situ. Thigh pain developed in 1 patient (6.2%). Kaplan-Meier survival was 81% at 64 months, with radiographic loosening as an end-point when two hips were at risk. CONCLUSION: Satisfactory results of midterm clinical and radiographic follow-up can be achieved using S-ROM modular femoral stem for revision of femoral stem in ankylosing spondylitis.

Changes of the bone mineral density in proximal femur following total hip resurfacing arthroplasty in osteonecrosis of femoral head.

Total hip resurfacing arthroplasty (THRA) is being performed with increasing frequency for osteonecrosis of femoral head (ONFH). To evaluate femoral bone remodeling in ONFH after THRA and determine the impact of stem-neck angle (SNA) of inserted femoral component on bone remodeling, we monitored the changes in BMD in proximal femur in 23 patients with ONFH after surgery. Patients were divided into group A (SNA >or= 5 degrees ) and group B (SNA < 5 degrees ). The BMD was measured in seven Gruen zones and two neck zones using dual-energy X-ray absorptiometry preoperatively, then at 3, 6, 12, and 24 months after surgery. At all ROIs, the BMD decreased significantly by 3 months postoperatively. The BMD ceased to decrease and reversed by 6 months. The BMD in neck increased significantly in group A, compared with group B at 24 months. The BMD increased 2% at ROI1 at 24 months in both groups, and at ROI7, the BMD in group A reversed to baseline value by 6 months and increased 5.81% at 24 months. These findings implied that the bone stock of proximal femur in ONFH can be well reserved after total hip resurfacing arthroplasty with valgus positioning of the femoral component.

Cementless hemispheric acetabular component for acetabular revision arthroplasty: a 5- to 19-year follow-up study.

This study evaluated the 5- to 19-year clinical and radiographic results of cementless acetabular revision. Between 1986 and 1998, 130 hips (125 patients) underwent cementless acetabular revisions. Ten patients were lost to follow-up; 6 patients died. One hundred nine patients (114 hips) were reviewed at a mean follow-up of 8.8 years. The mean Harris hip score improved from 62.1 to 90.7 at final follow-up. Two hips underwent repeat revision. Twenty-two hips developed cavitary osteolysis. Kaplan-Meier survivorship at 121 months was 98.2% with repeat revision for any reason as the end point and 89.5% with repeat revision or radiographic loosening as the end point. Cementless acetabular revision provides favorable clinical and radiographic results, and the initial disease and age may adversely affect the outcomes.