ObjectiveTo compare the effectiveness of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in the treatment of severe medial compartment osteoarthritis (OA).MethodsA clinical data of 69 patients (69 knees), who underwent joint replacement due to severe medial compartment OA between February 2015 and September 2018 and met the selection criteria, was retrospectively analyzed. Among them, 38 cases were treated with UKA (UKA group) and 31 cases with TKA (TKA group). There was no significant difference in gender, age, body mass index, course of disease, lesion side, and preoperative visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Feller score, range of motion of knee, physiological and psychological scores of short-form 12 health survey scale (SF-12) between the two groups (P>0.05). The femorotibial angle (FTA) of TKA group was bigger than that of UKA group, and hip-knee-ankle angle (HKA) was smaller, showing significant differences (P<0.05). The operative time, incision length, blood loss, time for flexion 90°, ambulation time, hospital stay, and incidence of deep venous thrombosis of lower extremity were recorded and compared between the two groups. The VAS score, HSS score, WOMAC score, Feller score, range of motion, and physiological and psychological scores of SF-12 were used to evaluate patients’ quality of life. FTA, HKA, and prosthesis looseness were observed by X-ray films. Kaplan-Merier survival analysis was used to evaluate the survival rate of prosthesis.ResultsAll operations were successfully completed in both groups. Compared with TKA group, UKA group had shorter incision length, longer operative time, and less blood loss (P<0.05). There was no significant difference in time for flexion 90°, ambulation time, hospital stay, and the incidence of deep venous thrombosis of lower extremity between the two groups (P>0.05). The incisions in both groups healed by first intention. During follow-up, 3 patients in the UKA group and 1 patient in the TKA group developed mild anterior knee pain. Patients were followed up (30.7±9.6) months in the UKA group and (34.9±8.7) months in the TKA group, and the difference was not significant (t=–1.832, P=0.071). At last follow-up, there were significant differences in the HSS score, Feller score, WOMAC score, range of motion, VAS score, and physiological and psychological scores of SF-12 between pre- and post-operation (P<0.05). The range of motion in the UKA group was bigger than that in the TKA group (Z=–2.666, P=0.008), and there was no significant difference in the other indexes between the two groups (P>0.05). X-ray films showed that the alignment of the two groups recovered well, and the FTA and HKA of the two groups were improved at 1 week after operation (P<0.05). No radiolucency was found around the prosthesis during follow-up, no prosthesis loosening and meniscal bearing dislocation occurred. The survival rates of the prostheses in the two groups were 100%.ConclusionFor severe medial compartment OA, the early survival rates of the two prostheses are similar, but UKA has less traumatic, can preserve the normal structure of the knee, and the range of motion of the knee after operation is significantly better than TKA.
Rheumatoid arthritis (RA) is a chronic autoimmune disease remarkably characterized by synovitis of joints, whose pathogenesis is complicated and not yet fully elucidated. A variety of cells, cytokines and intercellular signaling pathways are involved in the occurrence and development of RA. The mitogen activation protein kinase (MAPK) signaling pathway is closely related to the pathogenesis of RA, and plays an important role in the formation of pannus, synovitis, and bone destruction. This paper reviews the research progress of MAPK signaling pathway in RA from the aspects of the interaction of MAPK signaling pathway with a variety of key cells and cytokines in the pathogenesis of RA, in order to provide a direction and theoretical basis for anti-RA drug therapy research.
ObjectiveTo investigate the short-term effectiveness of INBONETM Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis. MethodsThe clinical and radiographic data of patients with moderate to severe varus-type ankle arthritis, who were admitted between May 2017 and November 2021 and treated with total ankle arthroplasty (TAA) using INBONETM Ⅱ prosthesis, was retrospectively analyzed. A total of 58 patients (58 ankles) met the selection criteria and were included in the study. Among them, there were 24 males and 34 females, with an average age of 62.6 years (range, 41-85 years). According to the preoperative tibiotalar angle (TTA), the patients were divided into a moderate varus group (group A, TTA 5°-15°, n=34) and a severe varus group (group B, TTA>15°, n=24). There was no significant difference in gender, side, etiology, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle dorsiflexion, plantarflexion, and total range of motion, and tibial lateral surface angle (TLS) between the two groups (P>0.05). Yet the patients in group A were younger than group B, the degrees of oesteoarthritis (Takakura stage) and ankle pain [visual analogue scale (VAS) score] were milder, and the TTA, talar tilt angle (TT), hindfoot alignment angle (HAA) were smaller while the tibial articular surface angle (TAS) was larger, showing significant differences (P<0.05). The pre- and post-operative VAS score, AOFAS score, the occurrence of early and late complications, the radiographic parameters of the ankle (TTA, TAS, TT, HAA, TLS), ankle dorsiflexion, plantarflexion, and total range of motion were recorded and compared. ResultsAll patients were followed up 19-72 months, with an average of 38.9 months. Compared with the preoperative data, the VAS score of all patients significantly decreased (P<0.05); the AOFAS score, ankle dorsiflexion range of motion, and total range of motion significantly increased (P<0.05); and the TTA, TAS, TT, HAA, and TLS significantly improved at last follow-up (P<0.05); but there was no significant difference in plantarflexion range of motion (P>0.05). Early complications occurred in 13 patients, and only 1 patient underwent revision surgery due to a larger size of the talar component. At last follow-up, there was no significant difference in the difference of clinical parameters before and after operation between the two groups (P>0.05); there was a significant difference in the difference of other radiographic parameters (P<0.05) except TLS. No significant difference in the incidence of complications between the two groups was found (P>0.05). ConclusionTAA using the INBONETM Ⅱtotal ankle prosthesis is an effective treatment for moderate or severe varus-type ankle arthritis, and good clinical and radiographic results can be obtained. Correcting bony deformities and balancing soft tissue are the keys to successful surgery.
Objective To carry out a comprehensive and objective evaluation of viscosupplementation, so as to provide the actual judgments of effectiveness, development trends, and direction. Methods The related l iterature was reviewed, and the keys were the assessments from the international relevant advisory bodies and insurance companies and the evidence-based medicine on cl inic. Results Viscosupplementation has been gradually accepted. Although there are many different cl inical views of the viscosupplementation in the molecular weight of hyaluronan, injection dose, and the indications, intra-articular injection of hyaluronan for the treatment of osteoarthritis is well accepted. ConclusionViscosupplementation is one of the methods of treating osteoarthritis. As it has been already verified that hyaluronan iseffective in treating osteoarthritis of the knee and the periarthritis of shoulder, the hip joint injection is gradually recognized,and other small joints are going gradually.
Objective To introduce the concept and clinical applications of rotational alignment of the femoral prosthesis in total knee arthroplasty (TKA) so as to avoide the postoperative complications caused by rotational alignment. Methods The clinical and experimental research literature about rotational alignment of the femoral prosthesis in TKA was extensively reviewed and analyzed. Results Femoral prosthesis malrotation can lead to flexion gap unbalanced and undesirable patellar track. Rotation alignment of the femoral prosthesis is defined with radiological and computer assisted technique at pre- and post-operation, which can make the rotation alignment of the femoral prosthesis and the function of the knee favorable. Conclusion In recent years, many surgical skills and new techniques of defining the rotational alignment are developed, and good clinical results are achieved.
Objective To examine the effects of alendronate (ALN) on IL-1β-stimulated chondrocyte of rabbit in vitro and on cartilage and subchondral bone in rabbit osteoarthritis (OA) induced by anterior cruciate l igament transection (ACLT). Methods The chondrocytes from articular surface of healthy 3-month-old Japanese White rabbits were obtained by the method of enzyme digestion and cultured in vitro. The third generation chondrocytes were assigned into three groups: thechondrocytes were cultured in DMEM medium with 10 ng/mL IL-1β for 2 days, subsequently with (ALN group, group A1) orwithout (IL-1β group, group B1) 1 × 10-6 mol/L ALN for 3 days; the chondrocytes in vacant group (group C1) were cultured in DMEM medium for 5 days. The expression of Col II and MMP-13 were analyzed by immunocytochemical staining observation and real time RT-PCR test. Another twenty-four 3-month-old male Japanese White rabbits were randomized into three groups (n=8 per group). The OA model was made by ACLT in ACLT+ALN group (group A2) and ACLT group (group B2); the joint cave was sutured after exposure of ACL in sham group (group C2). After 4 days, the rabbits of group A2 received the subcutaneous injection of ALN at a dosage of 10 μg/(kg·d) for 8 weeks. Rabbits of group B2 and C2 received equal normal sal ine treatment. After 8 weeks, the rabbits were executed. The macro-pathologic changes of right knee joints were observed, so were the histological changes of femoral condyles. Expression levels of Col II and MMP-13 were detected by immunohistochemical staining. The bone histomorphometry analysis was appl ied to subchondral bone of proximal tibia. Results In vitro, the Col II immunocytochemical staining showed intensely positive staining in group C1, and the intensity of staining was sl ightly decreased in group A1, but the intensity of Col II immunocytochemical staining was extremely lower in the group B1. The integrated absorbance (IA) value for Col II in group A1 was significantly higher than that of group B1 (P lt; 0.05), but there was no significant difference between group A1 and group C1 (P gt; 0.05). Immunocytochemical detection of MMP-13 showed intense staining in group B1, and the intensity of staining was sl ightly decreased in group A1, but no MMP-13 expression was detected in the group C1. The IA value for MMP-13 in group A1 was significantly lower than that of group B1 (P lt; 0.05), but significantly higher than that of group C1 (P lt; 0.05). The real time RT-PCR analysis showed significantly higher mRNA levels of Col II in group A1 than in group B1 (P lt; 0.05), but there was no significant difference between group A1 and group C1 (P gt; 0.05). The MMP-13 mRNA level of the chondrocytes in group A1 was significantly lower than that of group B1 (P lt; 0.05), but significantly higher than that of group C1 (P lt; 0.05). In vivo, the gross appearance of surface of knee joint showed that there was no ulcer in group C2, and there was some ulcers in group A2, but many and all layers ulcers in group B2. Mankin score of group A2 was significantly lowerthan that of group B2 (P lt; 0.05), but significantly higher than that of group C2 (P lt; 0.05). Immunohistochemical staining showed that Col II in articular cartilage was intensely staining in group C2, the intensity of staining was sl ightly decreased in group A2, and the intensity of Col II immunohistochemical staining was extremely low in group B2, but there was no significant difference between group A2 and group C2 (P gt; 0.05..........
Objective To compare the mid- and long-term effectiveness of patellar resurfacing versus non-resurfacing in primary total knee arthroplasty (TKA). Methods Twenty-six patients who underwent bilateral TKA between March 2013 and September 2015 were selected as the study subjects. One side was randomly chosen for patellar resurfacing (resurfacing group), and the other side was not (control group). There were 4 males and 22 females, the age ranged from 51 to 65 years, with an average of 59 years. According to Kellgren-Lawrence classification, there were 21 cases of grade Ⅳ and 5 cases of grade Ⅲ in both knees. There was no significant difference in the surgical side, and preoperative clinical and functional scores of the Knee Society Score (KSS), visual analogue scale (VAS) score, and the composition ratio of anterior knee pain localization points between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, and the occurrence of complications were recorded and compared. Patient subjective evaluations included Forgotten Joint Score (FJS) and the degree of difficulty in high-level knee activities (including flexion with load bearing, going upstairs, going downstairs, squatting and standing up, kneeling, knee extension, and crossing legs for 7 items); KSS clinical/functional scores and VAS scores were used to evaluate the recovery of knee joint function, and the location of anterior knee pain was determined by a localization diagram. Results The operation time of the resurfacing group was significantly longer than that of the control group (P<0.05), and there was no significant difference in intraoperative blood loss between the two groups (P>0.05). All patients’ incisions healed by first intention; the hospital stay ranged from 8 to 23 days, with an average of 12.6 days. All patients were followed up 9-11 years, with an average of 9.7 years. Except for 1 case who died of multiple organ failure due to internal diseases at 9 years after operation and 5 cases with incomplete radiological data, the rest 20 patients were assessed radiologically and found that 1 side of the knee joint in the control group had patellar dislocation; the remaining patients had no prosthetic failure (fracture, loosening, displacement, etc.), patellar fracture, patellar necrosis, patellar instability, patellar tendon rupture, prosthetic revision, etc. No patients had reoperations due to patellar-related complications or anterior knee pain in both knee joints. At 2 years postoperatively and at last follow-up, there was no significant difference in the incidence of abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, the incidence of high-level knee activity difficulty, and the composition ratio of anterior knee pain localization between the two groups (P>0.05). The KSS clinical scores, functional scores, and VAS scores of both groups significantly improved compared to preoperative ones (P<0.05); there was no significant difference in the comparison between the two groups at the two time points postoperatively (P>0.05). At 2 years postoperatively and at last follow-up, there was no significant difference in FJS scores between the two groups (P>0.05). ConclusionPatellar resurfacing or not has similar mid- and long-term effectiveness in primary TKA.
Objective To evaluate the effectiveness of one-stage total knee arthroplasty (TKA) for femoral supracondylar fracture combined with knee osteoarthritis. Methods Between January 2012 and March 2015, a total of 19 patients (19 knees) with femoral supracondylar fracture and knee osteoarthritis were treated with one-stage TKA. Of 19 cases, 8 were male and 11 were female with an average age of 69.6 years (range, 60-85 years). The mean body mass index was 22.6 kg/m2 (range, 22.0-27.5 kg/m2). The left knee was involved in 13 cases, and the right knee in 6 cases. The causes of femoral supracondylar fracture were falls in 10 cases, traffic accidents in 8 cases, and other injury in 1 case. All fractures were classified as type A according to AO/Association for the Study of Internal Fixation (AO/ASIF) classification. The interval of injury and operation was 4-13 days (mean, 8.6 days). The disease duration of osteoarthritis ranged from 30 to 90 months (mean, 52.6 months). During follow-up, the knee society score (KSS) and the range of motion (ROM) were used to evaluate the knee function; anteroposterior and lateral X-ray films of the knee were used to observe the position of the prosthesis. Results All the incisions healed at the first stage, and there was no early complication such as pulmonary infection, pressure ulcer, and urinary tract infection. All patients were followed up 2-4 years with an average of 2.6 years. The ROM and KSS functional scores and clinical scores were significantly improved at 15 days and 2 years after operation, showing significant differences when compared with those before operation (P<0.05). There were significant differences in the ROM and KSS functional scores and clinical scores between two time points after operation (P<0.05). X-ray films showed the fracture bone healing, good alignment, no loosening of prosthesis at 2 years after operarion. Conclusion One-stage TKA for femoral supracondylar fracture combined with knee osteoarthritis can achieve good effectiveness. It can not only reconstruct joint function, but also cure osteoarthritis and fracture at the same time, shorten the healing time, reduce the incidence of related complications.
The incidence of depression in patients with rheumatoid arthritis is higher. The concomitant depression will increase medical expense, reduce drug efficacy, lower its compliance, increase the incidence of complication, and affect the cure of rheumatoid arthritis. The influence of depression to rheumatoid arthritis is usually ignored in clinical work. In recent years, the pertinence between depression and immune disease in pathogenesis is found in research: depression will increase the risk of immune diseases in activate inflammation as well as extend and promote the release of inflammatory factors. This article reviews research progress of correlation between depression and rheumatoid arthritis.