ObjectiveTo investigate the method and effectiveness of selectively upward placement of acetabular implants in patients with anatomically abnormal acetabulum during total hip arthroplasty (THA). MethodsTwenty-six cases (26 hips) of anatomically abnormal acetabulum received THA between January 2005 and December 2010, including 22 cases of developmental dysplasia of the hip, 3 cases of osteonecrosis of the femoral head, and 1 case of post-traumatic arthritis. There were 5 males and 21 females with an average age of 52.3 years (range, 35-67 years). The left hip was involved in 11 cases and the right hip in 15 cases. The preoperative Harris score was 45.85±10.04. The anteroposterior X-ray films and CT scan of the pelvis, anteroposterior and lateral X-ray films of the femur, and TraumaCad analysis were performed routinely before operation. The principles of acetabular implants were that more than 70% of the bone-implant interface was covered, and the upward distance of acetabular implant was less than 15 mm. ResultsAcetabular implants were placed within 5 mm from the anatomical rotation center in 11 cases. The upward distance of acetabular implant was 5-10 mm in 8 cases and was 10-15 mm in 7 cases. No bone fracture or nerve injury was observed intraoperatively. All incisions healed by first intention, and no infection or lower limb deep venous thrombosis occurred. One case had dislocation at 3 days after operation, and was cured after reduction and conservative treatment. The follow-up time ranged from 15 to 71 months (mean, 34 months). The Harris score was 91.42±3.59, showing significant difference when compared with preoperative score (t=20.099, P=0.000). The Harris scores were 92.09±4.04 in patients having less than 5 mm upward distance, 91.25±2.82 in patients having 5-10 mm upward distance, and 90.57±3.95 in patients having 10-15 mm upward distance, showing no significant difference (F=0.377, P=0.690). No loosening or subsidence of the implant was observed by X-ray film during the follow-up. ConclusionThe acetabular implants should be placed as close to anatomical rotation center as possible according to the principle. However, appropriate upward distance of the acetabular implants (≤15 mm) could be acceptable to meet 70% coverage of bone-implant interface and the implant stability. A satisfactory mid-term effectiveness can be obtained, but long-term effectiveness should be further investigated.
ObjectiveTo investigate the microRNA (miRNA) expression profile during chondrogenic differentiation of human adipose-derived stem cells (hADSCs), and assess the roles of involved miRNAs during chondrogenesis. MethodshADSCs were harvested and cultured from donors who underwent elective liposuction or other abdominal surgery. When the cells were passaged to P3, chondrogenic induction medium was used for chondrogenic differentiation. The morphology of the cells was observed by inverted phase contrast microscopy. Alcian blue staining was carried out at 21 days after induction to access the chondrogenic status. The expressions of chondrogenic proteins were detected by ELISA at 0, 7, 14, and 21 days. The miRNA expression profiles at pre- and post-chondrogenic induction were obtained by microarray assay, and differentially expressed miRNAs were verified by real-time quantitative PCR (qRT-PCR). The targets of the miRNAs were predicted by online software programs. ResultshADSCs were cultured successfully and induced with chondrogenic medium. At 21 days after chondrogenic induction, the cells were stained positively for alcian blue staining. At 7, 14, and 21 days after chondrogenic induction, the levels of collogen type Ⅱ, Col2a1, aggrecan, Col10a1, and chondroitin sulfate in induced hADSCs were significantly higher than those in noninduced hADSCs (P<0.05). Eleven differentially expressed miRNAs were found, including seven up-regulated and four down-regulated. Predicted target genes of the differentially expressed miRNAs were based on the overlap from three public prediction algorithms, with the known functions of regulating chondrogenic differentiation of stem cells, selfrenewal, signal transduction, intracellular signaling cascade, and cell cycle control. ConclusionA group of miRNAs and their target genes are identified, which may play important roles in regulating chondrogenic differentiation of hADSCs. These results will facilitate the initial understanding of the molecular mechanism of chondrogenic differentiation in hADSCs and subsequently control hADSCs differentiation, and provide high performance seed cells for cartilage tissue engineering.
ObjectiveTo investigate the expressions of cartilage degenerative related genes in meniscus, and to evaluate the potential effect of meniscal damage on cartilage degeneration, and to analyze the relationship between microRNAs (miRNAs) expression and cartilage degeneration. MethodsMeniscal tissue was collected from 5 patients undergoing partial meniscectomy between September 2012 and October 2013 (experimental group), and normally meniscal tissue without tearing from amputees was used as controls (control group). Pathological changes of menisci were observed; and real-time fluorescent quatitative PCR was performed to examine the relative expression levels of cartilage degenerative related genes and miRNAs:Aggrecan (ACAN), type X collagen (COL10A1), matrix metalloproteinases 13 (MMP-13), CCAAT enhancer binding protein β (CEBP-β), a disintegrin and metalloproteinase with thrombospondinmotif 5 (ADAMTS-5), miR-193b, miR-92a, and miR-455-3p in meniscus. ResultsThere were varying degrees of degenerative pathological changes in torn meniscus of experimental group. Compared with normal meniscus of control group, the expression of ACAN was decreased, while the expressions of COL10A1, CEBP-β, ADAMTS-5, and MMP-13 were increased in torn meniscus of experimental group; and significant difference was found (P<0.05) except ACAN and MMP-13 (P>0.05). The expressions of miR-92a, miR-455-3p, and miR-193b in torn meniscus of experimental group were significantly higher than those in normal meniscus of control group (P<0.05). ConclusionMeniscal tissue has the intrinsic tendency of degeration after meniscus tear. The torn meniscus has greater stimulative impact on cartilage degeneration than normally morphological meniscus without tearing. The cartilage degenerative related miRNAs, including miR-193b, miR-92a, and miR-455-3p may contribute to the up-regulation of osteoarthritis.
ObjectiveTo investigate the influence of the degree of acetabular deformity and the learning-curve on the acetabular cup positions in total hip arthroplasty (THA) for adults with developmental dysplasia of hip (DDH). MethodsBetween January 2008 and December 2015, 130 patients (144 hips) with DDH underwent primary THA, and the clinical data were analyzed retrospectively. Fifty-three patients (59 hips) were admitted before 2012, and 77 patients (85 hips) were treated after 2012. There were 32 males and 98 females, aged from 31 to 83 years (mean, 61). Unilateral replacement was performed in 116 cases and bilateral replacement in 14 cases. Of 144 hips, 48 hips were rated as Crowe type I, 57 hips as type II, and 39 hips as type of III/IV. The standard pelvic radiograph was taken within 1 week after operation. The mediCAD software was adopted to measure the angle of anteversion and abduction, bony coverage, and the distance between true rotating center and optimal rotating center to the connection of teardrops and the horizontal distance between two centers to evaluate the qualified rate of acetabular cup positions. ResultsCompared with the patients with the same type in 2013-2015 group, the anteversion angle and qualified rate of acetabular cup position significantly decreased in patients with Crowe I (P < 0.05); the horizontal distance significantly increased and qualified rate of acetabular cup position significantly decreased in patients with Crowe II (P < 0.05); and the anteversion angle significantly decreased and the horizontal distance significantly increased in patients with Crowe III/IV (P < 0.05) in 2008-2012 group. But no significant difference was shown in the other indexes (P > 0.05). In all Crowe types, the vertical distance between the true rotating center and the optimal rotating center increased with the degree of acetabular deformity in both 2008-2012 group and 2013-2015 group, showing significant difference (P < 0.05), but no significant difference was found in the other indexes (P > 0.05). ConclusionFor adults with acetabular dysplasia, there are high potential risks for unsatisfactory acetabular cup positions during primary THA. So it is necessary to evaluate acetabular deformities and to sum up operative experience so as to improve the accuracy of cups installation.