Objective To assess the efficacy of medial wedged proximal tibial osteotomy for treating knee osteoarthritis with varus deformity. Methods From July 1996 to September 1999, 19 patients with knee osteoarthritis accompanied by varus deformity were treated by medial wedged proximal tibial osteotomy combined with internal fixation. Full-length anteriorposterior radiographs were taken preoperatively, 8 weeks and 2 years postoperatively. The parameters including the femorotibial angle, the tibial angle, the femoral angle, the femoral condyletibial plateau angle, and the medial joint space, were measured from these radiographs. The function of knee was evaluated according to the 100point rating scale standard of knee.Results Themean postoperative score had been significantly improved from 48.6±16.6 pointsto 81.7±14.8 points after 2 years of operation. The medial joint spacehad been increased from 2.2±1.6mm to 4.9±1.5 mm and the femoral condyle-tibial anglehad been decreased from 7.4°±3.1° to 1.7°± 3.1°. There were complications in 3 cases: 2 casesof superficial wound infections and 1 case of intraarticular fracture. There were no delayed union and recurrence of varus deformity. Conclusion Medial wedged proximal tibial osteotomy combined with internal fixation provides an efficacious approach to treat knee osteoarthritis with varus deformity.
Objective Melatonin (MLT) can increase the expression of cartilage-derived growth factor and stimulate the synthesis of cartilage matrix. To investigate the prevention and treatment effects of MLT on damaged cartilage through observing the expressions of bone morphogenetic protein 2 (BMP-2) and interleukin 1β (IL-1β) in articular cartilage of the rats with osteoarthritis (OA). Methods Forty SPF 4-week-old male SD rats (weighing 120-150 g) were randomly divided into 4 groups (n=10): normal control group (group A), OA group (group B), OA/pinealectomy group (group C), and OA/ pinealectomy/MLT group (group D). The rats of group A served as a control without treatment. The rats of groups B, C, andD underwent left knee joint injection of 0.2 mL 4% papain solution 1 time every other day for 2 weeks for establ ishing OAmodel. Two weeks after papain injection, the rats of groups C and D were exposed to continuous l ight for 24 hours (intensity of illumination: 500 lx) for creating pinealectomy models. And at the next day after pinealectomy model establ ishing, the rats of group D were treated with intra-articular injections of 0.2 mL 20 mg/mL MLT solution 4 times a week for 4 weeks. At 1 week after last MLT injection, the venous blood samples were taken in groups A, B, and C to test the level of serum MLT by ELISA, respectively, and then the specimens of left cartilage of femoral condyle were harvested for macroscopic, histological, and immunohistochemical examinations in 4 groups. Results The OA and pinealectomy models of rats were successfully establ ished, and all rats survived. There were significant differences in the serum MLT level among groups A, B, and C, and among different time points at the same group (P lt; 0.05). In group A, articular cartilage surface was smooth and elastic, and chondrocytes arranged regularly. In groups B and C, articular cartilage surface was rough, cartilage defects and subchondral bone exposure were observed in some areas, and chondrocytes arranged irregularly. In group D, cartilage surface was more smooth than that in groups B and C, and the degrees of cartilage defect and subchondral bone exposure decreased with regular arrangment of chondrocytes. There were significant differences in Mankin scores and integral absorbance values among 4 groups (P lt; 0.05). Conclusion Exposure to continuous l ight can accelerate degeneration process of articular cartilage of OA rats. Injections of 0.2 mL MLT solution (20 mg/mL) by intra-articular for 4 weeks can inhibit the progress of cartilage defects. Upregulationof anabol ic factor of BMP-2 as well as down-regulation of catabol ic factors of IL-1β is associated with cartilage repairin the pathological features of OA.
The osteoarthritis of knee is a common disorder but no always to be treated satisfactorily. Between 1988 and 1992, the method, a high tibial osteotomy to correct the genu varum combined with autogenous periosteal or perichondrial graft to deal with the chondromalacia patella was used. Thirty-two patients (51 knees) were treated by this method and the patients were followed up for an average of 5.1 years. The excellent and good results were obtained in 90.2%. This method was obviously better than any other simple high tibial osteotomy. Therefore, this method was considered to be effective for treatment of osteoarthritis of knee with varum deformity and chondromalcia patella.
Objective To review the progress of mechanism of parathyroid hormone (PTH) and parathyroid hormone-related protein (PTHrP) on normal and osteoarthritis (OA) cartilage and subchondral bones. Methods Recent 1iterature about the effects of PTH and PTHrP on normal and OA cartilage was reviewed. Results PTH and PTHrP can repress the hypertrophic differentiation and apoptosis of chondrocytes and promote their prol iferation, which has a protection effect on chondrocytes of OA; osteoblasts from subchondral bone of OA show a decreased reaction to PTH. Conclusion PTHand PTHrP may delay and protect the progression of OA, which involves in regulating cartilage degeneration and subchondral bone remodl ing through many kinds of signal pathway.
Objective To evaluate the short-term results of reconstruction of stiff elbow under arthroscopy technique in patients with elbow osteoarthritis. Methods Between March 2006 and March 2009, 38 cases of elbow osteoarthritis with contracture were treated under arthroscopy technique. There were 26 males and 12 females with an average age of 47.8 years (range, 26-66 years). Unilateral side was affected in all cases, including 13 cases at the left side and 25 at the right side with 30 patients on the dominant side. The disease duration was more than 6 months. X-ray examination showed that 31 patients had free body, and 28 had osteophytosis. Seven patients had ulnar neuritis. The arthroscopy functional reconstruction was performed including synovectomy, free body removal, and osteocapsular arthroplasty. Results All incisions healed by first intention. All patients were followed up 6-10 months (mean, 8 months). Transient radial nerve injury occurred in 1 case, re-adhesion of elbow joint in 1 case, and heterotopic ossification of brachial ulnar joint in 1 case at 6 months after operation. In 1 patient compl icated by ulnar neuritis, the disorder of ulnar nerve was not improved, nervous symptoms disappeared after the re-operation of ulnar nerve relaxation after 2 months. The range of motion, Mayo Elbow Performance Score (MEPS), and visual analogue scale (VAS) for pain at 3 and 6 months had significant differences when compared with those before operation (P lt; 0.05), but had no significant difference between two time points after operation (P gt; 0.05). According to MEPS functional criteria, the results were classified as excellent in 20 cases, good in 15 cases, fair in 2 cases, and poor in 1 case at 6 months after operation, and the excellent and good rate was 92.1%. No new free body or osteophytosis occurred after operation by X-ray examination. Conclusion The arthroscopy is an effective technique to reconstruct the function of stiff elbow, which can obviously improve the range of motion and the function of elbow joint, and has good short-term results.
ObjectiveTo systematically review the efficacy and safety of traditional Chinese medicine (TCM) therapies versus non-steroidal anti-inflammatory drugs (NSAIDs) for knee osteoarthritis (KOA). MethodsWe electronically searched databases including PubMed, The Cochrane Library (Issue 5, 2015), EMbase, CNKI, CBM, VIP and WanFang Data from inception to 14 June 2015, to collect randomized controlled trials (RCTs) about TCM therapies for KOA. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then network meta-analysis was performed using Stata 12.0 and WinBUGS 1.4.3 softwares. ResultsA total of 56 RCTs involving 7256 patients were included, in which 19 different treatment strategies were investigated. All were short-term efficacy studies. Our work yielded 33 direct and 138 indirect comparisons, among which 76 were demonstrated statistically significant. The result of meta-analysis showed that, the TCM-based therapy group had lower complication rates, compared with the NSAIDs group. TCM internal application+acupuncture+fumigation, internal application+fumigation+moxibustion, acupuncture+massage, TCM extra-apply+massage, massage+fumigation+moxibustion, and massage+fumigation were the top six in terms of treatment effect. NSAIDs ranked 18th. ConclusionThe safety and effectiveness of TCM therapies are generally better than NSAIDs except moxibustion, particularly more remarkable for the top six TCM therapies. TCM comprehensive therapies are superior over mono-modality therapies. Due to the limitation of the present studies, the long-term efficacy of TCM therapies needs further investigation, and our findings also need to be verified by large-scale and well-designed RCTs.
【Abstract】 Objective To make the young patients with osteoarthritis and genu varum of knee delay total knee arthroplasty,to observe the cl inical effect of mosaicplasty of femoral medial condyle, patellar-plasty and high tibial osteotomy inthe treatment of osteoarthritis of knee with varum. Methods From June 2004 to February 2006, 8 patients with osteoarthritisof knee with varum(10 knees) were treated with combined operation such as mosaicplasty of femoral medial condyle, patellarplastyand high tibial osteotomy. There were 2 males with 3 knees, and 6 females with 7 knees,with an average age of 50 years(42-56 years). The left knees and right knees were involved in 3 cases respectively and bilateral knees in 2 cases. All patients hadknee ache after walk or long-time standing. The X-ray showed hyperosteogeny at peri-patella and circum ferential femur-tibialjoint，especially in the medial. The gap between patella and femur narrowed or disappeared，especially in the medial femurtibialjoint. The femoral tibial angel (FTA) was 185-200°(mean 190°). The HSS score of knee was 55-75(mean 60). The history ofknee ache was 1-12 years(mean 5 years). Results All patients were followed up for 7-24 months (mean 15 months). All theincisions healed by first intention, no early compl ication occurred. The cl inical bone heal ing time was 8-11 weeks(mean 9 weeks).Rectification of FTA was 15-30°(mean 20°). Normal weight-loading al ignment was recovered. The valgus angle of knee was 10°.The range of motion of knee was 100-120° after operation, increasing by 5-20° (mean 10°) when compared with preoperation.The X-ray of postoperation showed that genu varum was corrected obviously and that no displacement, loosening and breakageoccurred. The mean score of HSS was 80 (75-88), increasing by 20 when compared with preoperation. Conclusion Mosaicplastyof femoral medial condyle can make articular cartilage repair in certain degrees, patellar-plasty can rel ieve ache of fore region of knee effectively, and high tibial osteotomy can recover normal weight-loading al ignment. The curative effect is good withthe combined methods.
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 review the research progress of cartilage ol igomeric matrix protein (COMP). Methods Domestic and abroad l iterature about COMP was reviewed and summarized. Results COMP was one of the osteoarthritis (OA) biomarkers of being widely studied. Most studies in recent years could draw the conclusion that COMP was associated with OA. COMP was the foremost biomarker among investgated biomarkers. It could been continuously expressed and predicted knee OA progression. Conclusion Precisely what role COMP plays in OA pathogenesis remains unclear, using COMP as a tool to early diagnose OA more studies would be needed.
ObjectiveTo investigate the causal association between metabolic syndrome (MetS) components and osteoarthritis of the knee (KOA) by using Mendelian randomization analysis. MethodsThe genome-wide association study database (GWAS) was mined, in which the exposure factors were MetS components, namely waist circumference (WC) level, triglyceride (TG) level, high-density lipoprotein cholesterol (HDL-C) level, hypertension (HBP), and type 2 diabetes (T2DM), and the outcome factor was KOA. Mendelian randomization analysis was performed using regression models of inverse-variance weighted (IVW), MR-Egger, Simple Mode, Weighted Median, and Weighted Mode methods. ResultsIVW showed a causal relationship between WC level and KOA with a positive correlation (OR=3.088, 95%CI 2.574 to 3.704, P<0.01), and HDL-C level had a causal relationship with KOA with a negative correlation (OR=0.877, 95%CI 0.779 to 0.989, P<0.05). IVW did not show a causal relationship between TG levels, HBP, and T2DM with KOA (P>0.05). The results of the ME-Egger intercept test were not multiplicative (P>0.05), indicating that Mendelian randomization was a valid method for causal inference in this study. ConclusionCentral obesity and low HDL-C disorder are independent risk factors for KOA. The causal relationship between TG level, HBP, and T2DM with KOA is still uncertain.