Objective To investigate the effect of dynamic compression and rotation motion on chondrogenesis of the 3rd passage cell-loaded three-dimensional scaffold in a joint-specific bioreactor in vitro so as to provide theoretical basis of the autologous chondrocyte transplantation in clinical practice. Methods Primary chondrocytes were isolated and cultured from the knee cartilage of 3-4 months old calves. The 3rd passage cells were seeded onto fibrin-polyurethane scaffolds (8 mm × 4 mm). Experiment included 5 groups: unloaded culture for 2 weeks (group A), direct load for 2 weeks (group B), unloaded culture for 4 weeks (group C), direct load for 4 weeks (group D), and unload for 2 weeks followed by load for 2 weeks (group E). The cell-scaffold was incubated in incubator (unload) or in a joint-specific bioreactor (load culture). At different time points, the samples were collected for DNA and glycosaminoglycan (GAG) quantification detect; mRNA expressions of chondrogenic marker genes such as collagen type I, collagen type II, Aggrecan, cartilage oligomeric matrix protein (COMP), and superficial zone protein (SZP) were detected by real-time quantitative PCR; and histology observations were done by toluidine blue staining and immunohistochemistry staining. Results No significant difference was found in DNA content, GAG content, and the ratio of GAG to DNA among 5 groups (P gt; 0.05). After load, there was a large number of GAG in the medium, and the GAG significantly increased with time (P lt; 0.05). The mRNA expression of collagen type I showed no significant difference among 5 groups (P gt; 0.05). The mRNA expression of collagen type II in group B was significantly increased when compared with group A (P lt; 0.01), and groups D and E were significantly higher than group C (P lt; 0.01); the mRNA expression of Aggrecan in groups D and E were significantly increased when compared with group C (P lt; 0.01), and group E was significantly higher than group D (P lt; 0.01); the mRNA expression of COMP in group B was significantly increased when compared with group A (P lt; 0.01), and group E was significantly higher than group C (P lt; 0.01); and the mRNA expression of SZP in group E was significantly increased when compared with groups C and D (P lt; 0.05). The toluidine blue staining and immunohistochemistry staining displayed that synthesis and secretion of GAG could be enhanced after load; no intensity changes of collagen type I and collagen type II were observed, but intensity enhancement of Agrrecan was seen in groups D and E. Conclusion Different dynamic loads can promote chondrogenesis of the 3rd passage chondrocytes. Culture by load after unload may be the best culture for chondrogenesis, while the 3rd passage chondrocytes induced by mechanical load hold less capacity of chondrogenesis.
ObjectiveTo review and evaluate the research progress of the robot-assisted joint arthroplasty.MethodsThe domestic and foreign related research literature on robot-assisted joint arthroplasty was extensively consulted. The advantages, disadvantages, effectiveness, and future prospects were mainly reviewed and summarized.ResultsThe widely recognized advantages of robot-assisted joint arthroplasty are digital and intelligent preoperative planning, accurate intraoperative prosthesis implantation, and quantitative soft tissue balance, as well as good postoperative imaging prosthesis position and alignment. However, the advantages of effectiveness are still controversial. The main disadvantages of robot-assisted joint arthroplasty are the high price of the robot system, the prolonged operation time, and the increased radioactive damage of the imaging-dependent system.ConclusionCompared to traditional arthroplasty, robot-assisted joint arthroplasty can improve the accuracy of the prosthesis position and assist in the quantitative assessment of soft tissue tension, and the repeatability rate is high. In the future, further research is needed to evaluate the clinical function and survival rate of the prosthesis, as well as to optimize the robot system.
ObjectiveTo provide the evidence for diagnosis and treatment of the complication by describing the distribution and drug sensitivity of pathogens in patients with prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA). MethodsBetween January 2003 and June 2013,65 cases (65 knees) with PJI after primary TKA were treated.There were 28 males and 37 females with an average age of 63.2 years (range,37-80 years).The median interval between PJI and primary TKA was 2.8 years (range,2 weeks to 11 years),including 29 left knees and 36 right knees.Prosthesis loosening could be found in 27 cases by X-ray examination.The average value of C-reactive protein and erythrocyte sedimentation rate was 37.4 mg/L (range,12.5-197.0 mg/L) and 63.2 mm/1 h (range,29.3-73.8 mm/1 h) respectively.Preoperative and intraoperative synovial fluid as well as intraoperative tissue samples should be submitted for aerobic and anaerobic culture.The four types of infections were made according to the Tsukayama et al.classification standards. ResultsThe patients were all diagnosed as having PJI.There were 5(7.69%) type I infections,4(6.15%) type ⅡA,8(12.31%) type ⅡB,3(4.62%) type Ⅲ,and 45(69.23%) type IV according to the Tsukayama et al.classification standard.Bacterial culture results were negative in 12 cases and positive in 53 cases,the main pathogen was Gram-positive cocci (39/53).The most common organism identified was Coagulase-negative Staphylococcus (24/53) followed by Staphylococcus Aureus (12/53).Resistant bacterium accounted for 61.11%(22/36) of Staphylococcus.These bacterium were all sensitive to vancomycin,linezolid,meropenem,and fluconazole;and highly resistant to erythrocin,penicillin,and cefoxitin.The main pathogenic bacteria of Coagulase-negative Staphylococcus and Staphylococcus aureus had highest resistant rate to penicillin. ConclusionGram-positive cocci is the main pathogen in patients with PJI after primary TKA,which is highly resistant to penicillin and macrolides.Antibiotic treatment of this complication should be based on the result of drug sensitivity test,vancomycin and linezolid may be used before the result of drug sensitivity test.It is important to pay attention to rare and multiple resistant bacteria.
ObjectiveTo explore the clinical characters and histopathologic differences between patients with culture-positive and culture-negative prosthetic joint infection (PJI). MethodsBetween January 2012 and July 2013, 66 PJI patients in accord with diagnostic criteria were enrolled. According to the results of preoperative aspiration and intraoperative cultures, the patients were divided into culture-negative group (CN group, n=21) and culture-positive group (CP group, n=45). There was no significant difference in gender, age, height, weight, and body mass index between 2 groups (P>0.05). Preoperative C reactive protein (CRP), erythrocyte sedimentation rate (ESR), and prosthesis survival time were compared between 2 groups. Intraoperative frozen sections and paraffin sections were both performed to identify infections, and histological typing was performed according to Morawietz's methods. ResultsThe preoperative CRP was (1.29±1.84) mg/ dL in CN group and (5.08±9.57) mg/dL in CP group, showing significant difference (t=2.094, P=0.038). The preoperative ESR was (22.86±28.42) mm/1 h in CN group and (36.74±31.26) mm/1 h in CP group, showing significant difference (t=7.761, P=0.000). The median survival time of prosthesis was 72 months (range, 8-504 months) in CN group and 25 months (range, 15 days-300 months) in CP group, showing significant difference (U=2.231, P=0.026). Morawietz's histological typing results showed that 2 cases were rated as type I, 7 cases as type II, and 12 cases as type III in CN group; 6 cases were rated as type I, 25 cases as type II, 13 cases as type III, and 1 case as type IV in CP group. The positive culture rate was 68.18% (45/66), and pathogenic bacteria was dominated by Staphylococcus, accounting for 68.89%. ConclusionThe patients with culture-negative PJI have slow onset and mild inflammatory response, so comprehensive diagnosis should be made based on pathological detection, laboratory examination, and intraoperative cultures.
ObjectiveTo evaluate the inflammatory markers in patients with ankylosing spondylitis (AS) or non-inflammatory diseases undergoing total hip arthroplasty (THA) and to ascertain the variation trend of perioperative inflammatory markers and the influence of inflammation markers after THA. MethodsBetween January 2013 and December 2014, 153 consecutive patients with AS were included. According to the range of motion (ROM), the patients were divided into ankylosis group (ROM: 0°; group A, n=92) and stiff group (ROM: 3-46°; group B, n=61); 120 noninflammatory diseases patients having no bacterial infection and undergoing primary THA served as non-inflammatory group (group C). The inflammatory markers including C-reactive protein (CRP), interleukin-6 (IL-6), and erythrocyte sedimentation rate (ESR) concentrations were measured before operation and at 1, 3, 5, and 7 days after operation, and the complication was observed. ResultsPerioperative serum CRP, IL-6, and ESR increased at first after operation, and then decreased in 3 groups. There were significant differences in CRP and ESR between at pre- and post-operation (P<0.05); the IL-6 at 1, 3, and 5 days after operation were significantly higher than that at preoperation (P<0.05), but no significant difference was found between at 7 days and at preoperation (P>0.05). CRP, IL-6, and ESR of group B were significantly higher than those of group A at preoperation (P<0.05); CRP and IL-6 of groups A and B were significantly higher than those of group C at preoperation and at 1 day after operation (P<0.05); ESR of groups A and B was significantly higher than that of group C at preoperation, and at 1 day and 3 days after operation (P<0.05); and no significant difference was shown among 3 groups at the other time points (P>0.05). No inflammatory activity or increased complication was observed. ConclusionAS and non-inflammatory diseases show similar change trend of inflammatory markers at preand post-operation. The inflammatory activity of AS has no significant effect on the changes of inflammation markers and does not increase the incidence of postoperative complications.
ObjectiveTo investigate the effectiveness of total knee arthroplasty (TKA) with or without patellar resurfacing.MethodsBetween March 2013 and August 2015, 30 patients (60 knees) with osteoarthritis who met the inclusion criteria were recruited in the study. Of 30 cases, 24 were male and 6 were female with an average age of 57.2 years (range, 37-65 years). The body mass index ranged from 19.5 to 40.3 kg/m2 (mean, 28.2 kg/m2). According to Kellgren-Lawrence grading, there were 8 cases at grand Ⅲ and 22 cases at grand Ⅳ. All patients underwent primary bilateral TKA. The patellar resurfacing was done at the unilateral knee randomly (resurfacing side); the opposite treatment was done at the other side (non-resurfacing side). The indexes of 2 groups were recorded and compared, including the intraoperative blood loss, operation time, knee society score (KSS), " Forgotten Joint” scale (FJS), anterior knee pain, anterior patellar spirant, knee constraint feeling, anterior patellar clunk, muscle power of knee extension, and ability of up and down stairs, weight-bearing flexion, squatting down, cross-legged, knee down, knee extension, and patient satisfaction. Radiographic examination was used to analyze the prosthesis position.ResultsThe operation time were (126±14) minutes and (112±11) minutes in resurfacing side and non-resurfacing side, respectively, showing significant difference between two sides (t=5.103, P=0.030); and there was no significant difference in intraoperative blood loss between two sides (t=3.431, P=0.800). All patients were followed up 2-4 years (mean, 2.6 years). There was no significant difference (P>0.05) between two sides in KSS clinical and functional scores at preoperation and 6 weeks, 6 months, and 2 years after operation; in visual analogue scale (VAS) score of anterior knee pain at preoperation and 6 weeks after operation; in incidences of anterior patellar spirant, knee constraint feeling, anterior patellar clunk, and muscle power of knee extension at 6 weeks, 6 months, and 2 years after operation; in incidences of disability of up and down stairs, weight-bearing flexion, squatting down, cross-legged, knee down, and knee extension at 6 weeks, 6 months, and 2 years after operation; in ratio of FJS score at 2 years after operation. The VAS scores at 6 months and 2 years after operation in resurfacing group were significantly lower than those in non-resurfacing group (Z=–1.997,P=0.046; Z=–2.197,P=0.028). Patient satisfaction of resurfacing side was superior to the non-resurfacing side at 6 weeks after operation (χ2=4.271, P=0.039). Radiographic examination showed no prosthesis loosing occurred.ConclusionThe effectiveness of TKA with patellar resurfacing is better than that with non-resurfacing in patients satisfaction.
ObjectiveTo investigate the mid-term effectiveness of debridement with prosthesis retention for periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA), and analyze the influence factors that affected the effectiveness.MethodsA clinical data of 45 cases with PJI after THA (16 cases) and TKA (29 cases) that were treated with debridement with prosthesis retention between January 2011 and January 2015 were collected and analyzed. There were 19 males and 26 females with a mean age of 58.4 years (range, 23-78 years). PJI occurred after primary joint arthroplasty in 40 cases and after revision in 5 cases. The mean time interval between the performance of infection symptoms and the arthroplasty or revision was 15.5 months (range, 0.5-72.0 months). The time interval between the performance of infection symptoms and debridment was 35 days (range, 3-270 days). There were early postoperative infections in 13 cases, acute hematogenous infections in 24 cases, and late chronic infections in 8 cases. X-ray films showed that the location of prosthesis was good. The results of bacilli culture showed that 28 cases were positive and 17 were negative. Twelve cases had sinuses. Length of stay, Hospital for Special Surgery (HSS) score, and Harris score were recorded to evaluate risk factors by using a multivariate logistic regression.ResultsThe mean length of stay was 22.6 days (range, 5-79 days). All patients were followed up 24-74 months (mean, 52 months). There were 33 cases that retained the prosthesis without further evidence of infection with the success rate was 73.3%. There were significant differences in Harris score and HSS score between pre- and post-operation (P<0.05). The univariate analysis results showed that the failure of debridement with prosthesis retention had a significant correlation with sinus developing and duration of infection symptoms more than 14 days (P<0.05). Multivariate logistic regression analysis results showed that sinus developing was an independent risk factor of failure (P<0.05).ConclusionDebridement with prosthesis retention plays an important role in treating PJI after THA and TKA. These patients with sinus performing and duration of infection symptoms more than 14 days have higher risk to develop infection again.
ObjectiveTo develop an artificial intelligence based three-dimensional (3D) preoperative planning system (AIHIP) for total hip arthroplasty (THA) and verify its accuracy by preliminary clinical application.MethodsThe CT image database consisting of manually segmented CT image series was built up to train the independently developed deep learning neural network. The deep learning neural network and preoperative planning module were assembled within a visual interactive interface—AIHIP. After that, 60 patients (60 hips) with unilateral primary THA between March 2017 and May 2020 were enrolled and divided into two groups. The AIHIP system was applied in the trial group (n=30) and the traditional acetate templating was applied in the control group (n=30). There was no significant difference in age, gender, operative side, and Association Research Circulation Osseous (ARCO) grading between the two groups (P>0.05). The coincidence rate, preoperative and postoperative leg length discrepancy, the difference of bilateral femoral offsets, the difference of bilateral combined offsets of two groups were compared to evaluate the accuracy and efficiency of the AIHIP system.ResultsThe preoperative plan by the AIHIP system was completely realized in 27 patients (90.0%) of the trial group and the acetate templating was completely realized in 17 patients (56.7%) of the control group for the cup, showing significant difference (P<0.05). The preoperative plan by the AIHIP system was completely realized in 25 patients (83.3%) of the trial group and the acetate templating was completely realized in 16 patients (53.3%) of the control group for the stem, showing significant difference (P<0.05). There was no significant difference in the difference of bilateral femoral offsets, the difference of bilateral combined offsets, and the leg length discrepancy between the two groups before operation (P>0.05). The difference of bilateral combined offsets at immediate after operation was significantly less in the trial group than in the control group (t=−2.070, P=0.044); but there was no significant difference in the difference of bilateral femoral offsets and the leg length discrepancy between the two groups (P>0.05).ConclusionCompared with the traditional 2D preoperative plan, the 3D preoperative plan by the AIHIP system is more accurate and detailed, especially in demonstrating the actual anatomical structures. In this study, the working flow of this artificial intelligent preoperative system was illustrated for the first time and preliminarily applied in THA. However, its potential clinical value needs to be discovered by advanced research.
ObjectiveTo investigate the clinical characteristic differences of cementless total hip arthroplasty (THA) between with and without subtrochanteric femoral shortening osteostomy in Crowe type IV developmental dysplasia of the hip (DDH). MethodsBetween January 2006 and March 2012, 21 patients (21 hips) with Crowe type IV DDH who underwent primary THA were enrolled according to inclusion criteria. According to whether subtrochanteric femoral shortening osteostomy was performed during THA or not, the patients were divided into 2 groups: THA with osteostomy group (n=9) and THA without osteotomy group (n=12). There was no significant difference in gender, age, body mass index, and hip Harris score between 2 groups (P>0.05) except leg length discrepancy (t=-3.170, P=0.005). The operation time, blood loss, postoperative drainage, complications, and radiography data were compared to evaluate the clinical characteristics. ResultsThe operation time, blood loss, and postoperative drainage of osteotomy group were all significantly greater than those of no osteotomy group (P<0.05). All patients achieved primary healing of incision; 1 patient (1 hip) had transient sciatic nerve symptom in osteotomy group. The average follow-up time was 53 months (range, 28-88 months). The X-ray films showed good fracture healing at 3-6 months after operation in osteostomy group. No prosthetic loosening or dislocation was found. The hip Harris score was 90.67±4.06 in osteostomy group and 92.17±3.27 in no osteostomy group, showing no significant difference between 2 groups (t=-0.938, P=0.360). The leg length discrepancy was (0.22±0.26) cm in osteostomy group and (0.18±0.27) cm in no osteostomy group, showing no significant difference (t=107.000, P=0.546). The leg length discrepancy was found in 6 patients of osteotomy group and 5 patients of no osteotomy group. One patient complained of thigh pain in osteotomy group; 2 patients had slight limp (Trendelenburg +) in no osteotomy group. ConclusionTHA can improve joint function and increase limb length in the treatment of Crowe type IV DDH. Subtrochanteric shortening osteotomy is an effective treatment which can be performed according to preoperative template measurement, leg length shortening, and the soft tissue tension.
Objective To investigate the effectiveness of total hip arthroplasty with double-tapered cementless femoral stem for hip bony fusion by comparing with anatomical cementless femoral stem. Methods A retrospective analysis was made on clinical data of 50 cases (80 hips) of hip bony fusion undergoing total hip arthroplasty between October 1999 and January 2008. The patients were divided into 2 groups: 31 cases (49 hips) using BetaCone double-tapered cementless femoral stem (trial group), and 19 cases (31 hips) using Ribbed anatomical cementless femoral stem (control group). There was no significant difference in gender, age, disease duration, preoperative Harris score, and abduction angle of the hip between 2 groups (P gt; 0.05). After operation, X-ray films were used to calculate the ratio of force arm of abductor (a) to the force arm of gravity (b) and analyze the stability of the prosthesis. The abduction angle of the hip and Harris score were measured during follow-up. Results Fracture occurred during operation in 9 hips of 9 cases (5 in trial group and 4 in control group), and was cured after fixation. The mean follow-up time was 49 months (range, 12-98 months) in trial group and was 53 months (range, 6-105 months) in control group. The ratio of a/b was 0.65 ± 0.25 in trial group and was 0.56 ± 0.37 in control group, showing significant difference (t=2.19, P=0.03). The abduction angle of hip was (34.49 ± 7.58)° in trial group and was (30.97 ± 7.24)° in control group at 6 months after operation, which was significantly improved when compared with preoperative value in 2 groups (P lt; 0.05), and significant difference was found between 2 groups (t=2.06, P=0.04). Postoperative Harris score was significantly improved in 2 groups when compared with preoperative score (P lt; 0.05); trial group was better than control group in Harris score at 1 month after operation (t=3.62, P=0.01), but no significant difference was found between 2 groups at last follow-up (t=1.61, P=0.11). At last follow-up, X-ray films showed stabilized prosthesis in 2 groups. Grade I or II ectopic ossification occurred in 12 cases (14 hips) of trial group and 8 cases (9 hips) of control group at 2 years after operation. Conclusion The total hip arthroplasty with both double-tapered and anatomical cementless femoral stems for hip bony fusion can obtain satisfactory effectiveness, while the double-tapered cementless femoral stem has better abduction angle of hip.