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 investigate the effect ofestrogen on osteoarthritis in female rats.Methods Forty female rats were divided into four groups. In group Ⅰ, the rats were not given any treatment as a control. Ingroups Ⅱ, Ⅲ and Ⅳ, the rats received fixing left knee joint on extension position. Meanwhile, therats received ovariectomy in group Ⅲ; ovariectomy and diethylstilbestrol treatment in group Ⅳ, respectively. After 4 weeks, histological observation and serum BGP examination were done.Results In groups Ⅱ, Ⅲ andⅣ, the levels of serum BGP were 3.50±0.39, 5.72±0.64 and 3.95±0.44, respectively. The pathologic grades of cartilage and synovium were 10.83±4.35 and 4.21±2.03; 15.32±3.42 and 7.62±3.42; and 12.65±2.73 and 5.46±1.23, respectively. Conclusion Estrogen may play an important role in delaying the development of osteoarthritis.
ObjectiveTo explore the efficacy of calcitonin combined with glucosamine hydrochloride on knee osteoarthritis. MethodsAccording to Kellgren-Lawrence radiographic scoring system, 156 patients with knee osteoarthritis diagnosed from November 2014 to April 2015 were classified as mild, moderate and severe cases. All of the patients were divided into control group (treated by glucosamine hydrochloride only) and trial group (treated by calcitonin combined with glucosamine hydrochloride) via table of random sampling numbers (with 78 patients in each group). The West Ontario and Manchester University (WOMAC) score was recorded at the 6th week and the 3rd month after the medication treatment. ResultsIn the patients with mild osteoarthritis, there were significant differences in WOMAC score of both groups at the 6th week and the 3rd month after treatment compared with those before the treatment (P<0.05); there were no significant differences between the two groups at the same time points after the treatment (P>0.05). In the patients with moderate osteoarthritis, WOMAC scores in the control group at the 3rd month differed much from that before the treatment (P<0.05); there were no significant differences between the two groups at the same time points after the treatment (P>0.05). In the patients with serious osteoarthritis, there was no significant difference in WOMAC scores in the control group after the treatment compared with that before the treatment (P>0.05); while in the trial group, the scores at the 3rd month after the treatment differed much from that before the treatment (P<0.05), and also from that in the control group (P<0.05). ConclusionFor mild knee osteoarthritis, the combined treatment is not superior to the single use of glucosamine hydrochloride. For moderate knee osteoarthritis, the combined treatment has faster effect than the single use of glucosamine hydrochloride. For severe osteoarthritis, the use of single glucosamine hydrochloride is not effective, while the combination of calcitonin and glucosamine hydrochloride is effective at the 3rd month after the treatment.
Objective To summarize the role of chondrocytes mitochondrial biogenesis in the pathogenesis of osteoarthritis (OA), and analyze the applications in the treatment of OA. Methods A review of recent literature was conducted to summarize the changes in mitochondrial biogenesis in the course of OA, the role of major signaling molecules in OA chondrocytes, and the prospects for OA therapeutic applications. Results Recent studies reveales that mitochondria are significant energy metabolic centers in chondrocytes and its dysfunction has been considered as an essential mechanism in the pathogenesis of OA. Mitochondrial biogenesis is one of the key processes maintaining the normal quantity and function of mitochondria, and peroxisome proliferator-activated receptor-gamma coactivator 1 alpha (PGC-1α) is the central regulator of this process. A regulatory network of mitochondrial biogenesis with PGC-1α as the center, adenosine monophosphate-activated protein kinase, sirtuin1/3, and cyclic adenosine monophosphate response element-binding protein as the main upstream regulatory molecules, and nuclear respiratory factor 1, estrogen-related receptor α, and nuclear respiratory factor 2 as the main downstream regulatory molecules has been reported. However, the role of mitochondrial biogenesis in OA chondrocytes still needs further validation and in-depth exploration. It has been demonstrated that substances such as puerarin and omentin-1 can retard the development of OA by activating the damaged mitochondrial biogenesis in OA chondrocytes, which proves the potential to be used in the treatment OA. ConclusionMitochondrial biogenesis in chondrocytes plays an important role in the pathogenesis of OA, and further exploring the related mechanisms is of great clinical significance.
OBJECTIVE To assess the treatment effect of sodium hyaluronate (HA) on experimental temporomandibular joint (TMJ) osteoarthritis of rabbits in comparison with prednisolone (PS). METHODS The upper compartments of both TMJs of 12 Japanese White Ear Rabbits were injected with 0.2 ml of 1.6% papain, 3 days after the right TMJs were injected again with same amount of papain to induce osteoarthritis with different severity levels. Except 1 rabbit was died accidentally. After one week from final injection of papain, the upper compartments of both TMJs of 6 rabbits were injected with HA 1.3 mg, 5 rabbits with PS 1.6 mg weekly for 4 times. At 3, 5 and 7 weeks after the final injection, the rabbits were sacrificed and the TMJs were pathologically examined. RESULTS The TMJs receiving PS showed predominant structural disorganization, and the right TMJs had much severe pathology. The manifestations were fibrillation, thinner or flaking of the articular cartilage of the temporal part of the joint, and the articular surface was covered with fibrous tissue. Whereas the TMJs receiving HA injections demonstrated limited changes of cartilage, less fibrillation, only local loss of cartilage on outside layer of the surface. In vicinity of the defect area, cluster of the chondrocytes appeared. Pathological scores of the TMJs receiving HA were significantly less than those of the TMJs revieving PS. CONCLUSION The results suggest that hyaluronate have effect of cartilaginous reparation and protection for the osteoarthritis of rabbit. While prednisolone has no help or worsened for articular cartilage reparation.
ObjectiveTo investigate the clinical effect of combined air pressure wave and oral glucosamine in the treatment of knee osteoarthritis. MethodsWe chose 200 patients with knee osteoarthritis treated in the Department of Rehabilitation between April 2013 and March 2015 as our research subjects. The patients were randomly divided into observation group and control group with 100 in each. The control group accepted conventional physical therapy, while the observation group underwent normal physical therapy in combination with air pressure wave and oral glucosamine treatment. We compared the two groups in terms of curative effects. ResultsThe total effective rate was not significantly different between the two groups (P＞0.05) , but in terms of efficiency rate, the observation group (85.0%) was significantly superior to the control group (73.0%) (P ＜ 0.05) . ConclusionCombined air pressure wave and oral glucosamine treatment for knee osteoarthritis is high efficient, which is worthy of being popularized.
Objective To assess the effect of medial distal femoral osteotomy combined with interlocking nailing on the treatment of knee osteoarthritis with valgus deformity. Methods From May 1996 toAugust 2000, 16 patients with knee osteoarthritis accompanied by valgus deformity were treated by medial wedged distal femoral osteotomy combined with interlocking nailing. Full-length radiographs were taken before operation and 8 weeks and 2 years after operation. The parameters, including the femorotibial angle, the tibial angle, the femoral angle, the femoral condyletibial plateau angle, and the lateral joint space, were measured by these radiographs. The function of knee was evaluated by the 100 point rating scale standard of knee. Results The mean postoperative score was significantly improved from 50.4±15.9 points to 78.5±12.9 points 2 years after the surgery. The lateraljoint space was increased from 2.1±1.8 mm to 4.7±1.7 mm and the femoral condyletibial angle decreased from 5.6±2.9° to 1.6±3.4°. There were complications in 2 cases: 1 case of delayed union and 1 case of superficial wound infection. Conclusion Medial distal femoral osteotomy combined with interlocking nailing proves to be an effective approach to treat knee osteoarthritis with valgus deformity.
ObjectiveTo explore the effectiveness of UC ultra-congruent rotating platform prosthesis in the treatment of knee osteoarthritis by comparing with fixed-bearing implant. MethodsThe clinical data were retrospectively analyzed, from 98 patients (98 knees) with knee osteoarthritis undergoing primary total knee arthroplasty between January 2011 and December 2012. The UC ultra-congruent rotating platform prosthesis was used in 56 cases (mobile-bearing group) and fixed-bearing implant was used in 42 cases (fixed-bearing group). There was no significant difference in gender, age, side, weight, disease duration, grading of arthritis, the number of varus and valgus malformation, preoperative range of motion of the knee, the Knee Society Score (KSS) score, the visual analogue scale (VAS) score, femorotibial angle, tibial angle, and articular surface angle between 2 groups (P>0.05). The operation time (including anesthetic time), intraoperative blood loss, hospitalization time, total hospitalization expenses, postoperative range of motion of the knee, the KSS score, and the VAS score were compared. The femorotibial angle, tibial angle, and articular surface angle were measured on the basis of anteroposterior and lateral X-ray films, and prosthesis loosening was observed. ResultsThere was no significant difference in the operation time, intraoperative blood loss, and hospitalization time between 2 groups (P>0.05), while the total hospitalization expenses of fixed-bearing group were significantly lower than those of the mobile-bearing group (t=8.506, P=0.000). The patients were followed up 16-30 months in the mobile-bearing group, and for 16-38 months in the fixed-bearing group. Postoperative complications occurred in 3 cases (7.14%) of the fixed-bearing group (1 case of fat liquefaction of incision, 1 case of joint stiff, and 1 case of anterior knee pain), and in 3 cases (5.36%) of the mobile-bearing group (1 case of delayed wound healing, and 2 cases of anterior knee pain); there was no significant difference in the complication rate between 2 groups (χ2=0.133, P=0.516). At last follow-up, the KSS score, VAS score, range of motion of the knee, femorotibial angle, tibial angle, and articular surface angle were superior significantly to those before operation in both groups (P<0.05), but no significant difference was found between 2 groups (P>0.05). No radiographic signs of radiolucent line, prosthetic dislocation, patellar dislocation, prosthetic loosening, and fracture was found. ConclusionUC ultra-congruent rotating platform prosthesis in the treatment of knee osteoarthritis can effectively improve the knee joint function and relief pain, which has the same short-term effectiveness to fixed-bearing implant.
ObjectiveTo investigate the clinical effect of arthroscopic microfracture surgery combined with oral glucosamine hydrochloride in the treatment of early knee osteoarthritis. MethodsWe retrospectively analyzed the clinical data of 172 patients with knee osteoarthritis treated between March 2007 and August 2013. The patients were divided into observation group (n=82) and control group (n=90) according to their treatment. Patients in the control group only underwent arthroscopic debridement and cartilage defect microfracture surgery, while those in the observation group underwent arthroscopic microfracture surgery combined with oral glucosamine hydrochloride. The Lysholm knee functional scores, the Lequesne index and X ray image were used to compare the clinical efficacy between the two groups. ResultsThe postoperative symptoms of both the two groups were significantly alleviated. The Lequesne index was not significantly different between the two groups before surgery, and 1 and 3 months after surgery (P>0.05), but it was significantly difference between the two groups 6, 12, 18 and 24 months after surgery (P<0.05). Before surgery, the Lysholm score was not significantly different between the two groups (P>0.05), and the score increased significantly after surgery in both the two groups (P<0.05). One and 3 months after surgery, the Lysholm score was not significantly different between the two groups (P>0.05), but it was significantly higher in the observation group 6, 12, 18 and 24 months after surgery. ConclusionArthroscopic microfracture surgery combined with oral glucosamine hydrochloride is effective in treating patients with early knee osteoarthritis, and the clinical efficacy becomes more significant with the time of treatment.
Objective To introduce the research progress on the relationship between gut microbiota dysbiosis and osteoarthritis (OA), focus on the possible mechanism of gut microbiota dysbiosis promoting OA, and propose a new therapeutic direction. Methods The domestic and foreign research literature on the relationship between gut microbiota dysbiosis and OA was reviewed. The role of the former in the occurrence and development of OA and the new ideas for the treatment of OA were summarized. Results The gut microbiota dysbiosis promotes the development of OA mainly in three aspects. First, the gut microbiota dysbiosis destroys intestinal permeability and causes low-grade inflammation, which aggravate OA. Secondly, the gut microbiota dysbiosis promotes the development of OA through metabolic syndrome. Thirdly, the gut microbiota dysbiosis is involved in the development of OA by regulating the metabolism and transport of trace elements. Studies have shown that improving gut microbiota dysbiosis by taking probiotics and transplanting fecal microbiota can reduce systemic inflammation and regulate metabolic balance, thus treating OA. Conclusion Gut microbiota dysbiosis is closely related to the development of OA, and improving gut microbiota dysbiosis can be an important idea for OA treatment.