Objective To summarize the effect of cartilage progenitor cells (CPCs) and microRNA-140 (miR-140) on the repair of osteoarthritic cartilage injury, and analyze their clinical prospects. Methods The recent researches regarding the CPCs, miR-140, and repair of cartilage in osteoarthritis (OA) disease were extensively reviewed and summarized. Results CPCs possess the characteristics of self-proliferation, expression of stem cell markers, and multi-lineage differentiation potential, and their chondrogenic ability is superior to other tissues-derived mesenchymal stem cells. CPCs are closely related to the development of OA, but the autonomic activation and chondrogenic ability of CPCs around the osteoarthritic cartilage lesion cannot meet the requirements of complete cartilage repair. miR-140 specifically express in cartilage, and has the potential to activate CPCs by inhibiting key molecules of Notch signaling pathway and enhance its chondrogenic ability, thus promoting the repair of osteoarthritic cartilage injury. Intra-articular delivery of drugs is one of the main methods of OA treatment, although intra-articular injection of miR-140 has a significant inhibitory effect on cartilage degeneration in rats, it also exhibit some limitations such as non-targeted aggregation, low bioavailability, and rapid clearance. So it is a good application prospect to construct a carrier with good safety, cartilage targeting, and high-efficiency for miR-140 based on articular cartilage characteristics. In addition, CPCs are mainly dispersed in the cartilage surface, while OA cartilage injury also begins from this layer, it is therefore essential to emphasize early intervention of OA. Conclusion miR-140 has the potential to activate CPCs and promote the repair of cartilage injury in early OA, and it is of great clinical significance to further explore the role of miR-140 in OA etiology and to develop new OA treatment strategies based on miR-140.
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 introduce the characteristics of tetrahedral framework nucleic acids (tFNA), focusing on its application in the treatment of osteoarthritis (OA) and relationship with microRNA (miRNA), and prospect the application of tFNA in the treatment of OA and the new idea of constructing miR-tFNA functional complex to treat OA. Methods Recent studies were extensively reviewed to analyze the mechanism of tFNA and its relationship with OA and miRNA. Results tFNA, a new type of new carrier, can not only play an indirect role in the treatment of OA as a small molecular carrier with therapeutic effect, but also play a direct role through the regulation of chondrocytes. It can bind with the miRNA that can regulate OA. The therapeutic effect of constructing tFNA functional complex loaded with miRNA has been verified in various diseases, and tFNA has advantages compared with other vectors. Conclusion tFNA, a novel framework nucleic acid structure, plays an important role in the treatment of OA. Constructing miR-tFNA functional complex may be an innovative idea in the treatment of OA.
ObjectiveTo review the research progress on finite element analysis (FEA) of unicompartmental knee arthroplasty (UKA) in medial knee compartmental osteoarthritis.MethodsThe FEA research literature on the medial knee UKA at home and abroad was reviewed, and the progress on the aspects of the influences of the prosthesis arrangement and the postoperative joint line on the mechanical distribution of the knee joint, the improvement of the UKA prosthesis, and the related research of different types of prostheses were summarized.ResultsAt present, scholars have conducted a large number of FEA studies on UKA in the medial knee compartmental osteoarthritis. The results of the study show that the recommended coronal alignment and the tibial slope angle of tibial component in medial fixed-bearing UKA are 0° and 5°-7°, respectively; and the coronal alignment and the tibial slope angle of tibial component in mobile-bearing UKA are 4° varus to 4° valgus and 5°-7°, respectively. The femoral component is arranged in the neutral position of the distal femur. The joint line is recommended to be the primary alignment. The anatomical UKA prosthesis can restore the biomechanical properties of the normal knee joint.ConclusionFEA research can clarify the best arrangement and joint line of the medial knee UKA prosthesis based on the mechanical distribution results, and guide the design of UKA prostheses that are more suitable for patients.
Unicompartmental knee arthroplasty (UKA) has a long history and has many advantages in some aspects over total knee arthroplasty (TKA) for patients with suitable indications, but it has not been established as a treatment at the same level with TKA. Therefore, 80 members of the British Association for Surgery of the Knee (BASK) and the European Knee Society (EKS) were invited to attend a joint meeting with the aim of creating an evidence-based consensus statement on UKA, in London, UK (December 2019). A formal consensus process was undertaken at the meeting incorporating a multiple round Delphi exercise, with group discussion of areas of agreement and disagreement between rounds. Five consensus statements were issued: ① UKA should be offered as a successful alternative to TKA in patients undergoing arthroplasty who meet agreed indications. ② When consenting a patient for UKA, information including the benefits and risks that are specific to UKA, should be tailored to and discussed with the individual patient. ③ Evidence suggests that surgeons should avoid low-volume use of UKA to optimise outcomes for their patients. ④ Surgeons should use the contemporary evidence-based indications and contraindications for medial UKA. ⑤ Knee arthroplasty surgeons should have exposure to and training in UKA. On the basis of full study of the consensus, combined with the Expert Consensus on Perioperative Management of Unicompartmental Knee Arthroplasty in China in 2020, this paper elaborates the meaning of the final evidence-based consensus for clinicians’ reference.
ObjectiveTo summarize research progress of the effect of knee flexion position on postoperative blood loss and knee range of motion (ROM) after total knee arthroplasty (TKA).MethodsThe relevant literature at home and abroad was reviewed and summarized from mechanism, research status, progress, and clinical outcome. The differences of clinical results caused by different positions, flexion angles, and keeping time were compared.ResultsKeeping knee flexion after TKA can reduce postoperative blood loss through the angle change of blood vessels and increase knee early ROM by improving flexion muscle strength. When the flexion angle of the knee is large and the flexion position is keeping for a long time, the postoperative blood loss and the knee ROM can be significantly improved. However, the amount of blood loss and ROM are not further improved in the patients with keeping knee flexion for more than 24 hours compared with less than 24 hours.ConclusionKeeping knee flexion after TKA is a simple and effective method to reduce postoperative blood loss and improve knee ROM. However, the optimal knee flexion angle and time are needed to be further explored.
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.
Objective To evaluate early to medium-term effectiveness of total hip arthroplasty (THA) in patients with a history of hip preservation surgery with secondary severe osteoarthritis for developmental dysplasia of the hip (DDH). Methods The clinical data of 25 DDH patients (31 hips) who had severe osteoarthritis after hip preservation surgery and received THA between September 2009 and March 2021 were retrospectively analyzed. There were 1 male and 24 females; the age ranged from 18 to 65 years, with an average age of 43 years; 8 hips were classified into Crowe type Ⅰ, 9 hips were type Ⅱ, 3 hips were type Ⅲ, and 11 hips were type Ⅳ. The time between osteotomy and THA ranged from 31 to 51 years, with an average of 31.96 years. Preoperative hip flexion range of motion was (69.31±29.72)°, abduction range of motion was (24.00±14.79)°; and Harris hip score was 45.3±15.5. Postoperative Harris hip score, hip range of motion, complications, radiographic findings, and implant survival rate were analyzed. Results Patients in both groups were followed up 2-132 months, with an average of 51 months. During the follow-up, periprosthetic fracture occurred in 1 case; there was no complication such as dislocation, periprosthetic infection, nerve palsy, or deep vein thrombosis. At last follow-up, the hip flexion range of motion was (109.52±11.17)°, abduction range of motion was (41.25±5.59)°, showing significant differences when compared with preoperative values (t=8.260, P=0.000; t=6.524, P=0.000). The Harris hip score was 91.5±4.1, and the difference was significant when compared with preoperative score (t=11.696, P=0.000); among them, 13 cases were excellent and 12 cases were good. Radiographic evaluation showed that the center of acetabular rotation moved up 0-18 mm (mean, 6.35 mm). The cup abductor angle was 28°-49° (mean, 37.74°) and the coverage rate was 69.44%-98.33% (mean, 81.04%). All femoral stems were fixed in neutral position without varus or valgus. No osteolysis, radiolucent line, or implant migration was observed. By the end of follow-up, none of the patients underwent revision and the survival rate of prothesis was 100%. ConclusionTHA is still the gold standard for the treatment of DDH patients with secondary osteoarthritis after hip preservation surgery. The postoperative joint function can be rapidly restored, the patients’ quality of life can significantly improve, and the early to medium-term survival rate of the prosthesis is satisfactory.