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Zhao Z, Wang P, Li Z, Wei X, Li S, Lu X, Dai S, Huang B, Man Z, Li W. Targeted lipid nanoparticles distributed in hydrogel treat osteoarthritis by modulating cholesterol metabolism and promoting endogenous cartilage regeneration. J Nanobiotechnology 2024; 22:786. [PMID: 39707367 DOI: 10.1186/s12951-024-02965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Accepted: 10/31/2024] [Indexed: 12/23/2024] Open
Abstract
Osteoarthritis (OA) is the most common disease in aging joints and has characteristics of cartilage destruction and inflammation. It is currently considered a metabolic disease, and the CH25H-CYP7B1-RORα axis of cholesterol metabolism in chondrocytes plays a crucial catabolic regulatory role in its pathogenesis. Targeting of this axis in chondrocytes may provide a therapeutic approach for OA treatment. Here, in this study, we propose to use a combination of stem cell-recruiting hydrogels and lipid nanoparticles (LNPs) that modulate cholesterol metabolism to jointly promote a regenerative microenvironment. Specifically, we first developed an injectable, bioactive hydrogel composed of self-assembling peptide nanofibers that recruits endogenous synovial stem cells (SMSCs) and promotes their chondrogenic differentiation. At the same time, LNPs that regulate cholesterol metabolism are incorporated into the hydrogel and slowly released, thereby improving the inflammatory environment of OA. Enhancements were noted in the inflammatory conditions associated with OA, alongside the successful attraction of mesenchymal stem cells (MSCs) from the synovial membrane. These cells were then observed to differentiate into chondrocytes, contributing to effective cartilage restoration and chondrocyte regeneration, thereby offering a promising approach for OA treatment. In summary, this approach provides a feasible siRNA-based therapeutic option, offering a potential nonsurgical solution for treatment of OA.
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Affiliation(s)
- Zhibo Zhao
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People's Republic of China
| | - Peng Wang
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People's Republic of China
| | - Ziyang Li
- Department of Sports Medicine & Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310058, People's Republic of China
| | - Xingchen Wei
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People's Republic of China
| | - Shishuo Li
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China
| | - Xiaoqing Lu
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China
| | - Shimin Dai
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China
| | - Benzhao Huang
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China
| | - Zhentao Man
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People's Republic of China.
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China.
- College of Sports Medicine and Rehabilitation, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250021, People's Republic of China.
- Endocrine and Metabolic Diseases Hospital of Shandong First Medical University, Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, 250062, People's Republic of China.
| | - Wei Li
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People's Republic of China.
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People's Republic of China.
- College of Sports Medicine and Rehabilitation, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, 250021, People's Republic of China.
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Leal J, Wellman SS, Jiranek WA, Seyler TM, Bolognesi MP, Ryan SP. Continuing Home Oral Hypoglycemic Medications Was Associated With Superior Postoperative Glycemic Control Versus Initiating Sliding Scale Insulin After Total Hip Arthroplasty. Orthopedics 2024; 47:276-282. [PMID: 38935846 DOI: 10.3928/01477447-20240619-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND This retrospective study investigated the impact of continuing vs discontinuing home oral hypoglycemic medications for patients with diabetes undergoing total hip arthroplasty. MATERIALS AND METHODS Patients who were not exclusively receiving home oral hypoglycemic regimens were excluded. Additionally, patients whose diabetes was not managed inpatient postoperatively were excluded. Included patients were retrospectively evaluated for early postoperative glycemic control, renal function, and metabolic abnormalities. Patients were then compared based on whether their home oral hypoglycemic regimen was continued vs discontinued in favor of initiating insulin while inpatient and analyzed using multivariable regression analysis. RESULTS A total of 532 patients undergoing total hip arthroplasty met inclusion criteria, with 78.6% continuing their home oral hypoglycemic regimen. Those who continued showed significantly lower median maximum inpatient blood glucose (178.5 mg/dL vs 249.5 mg/dL; P<.001) and median average inpatient blood glucose (138.4 mg/dL vs 178.6 mg/dL; P<.001). Linear regression analysis, adjusting for various potential confounding factors, revealed a positive correlation between discontinuation of home hypoglycemic medications and higher maximum in-patient blood glucose (β=70.15 [95% CI, 59.27-81.03]; P<.001). Patients in the continuation group had lower proportions of acute kidney injury (18.7% vs 41.2%; P<.001) and metabolic acidosis (4.3% vs 17.5%; P<.001), along with a shorter length of stay (1.0 vs 2.0 days; P<.001). CONCLUSION These findings suggest that continuing a home oral hypoglycemic regimen for patients with diabetes after total hip arthroplasty is associated with superior glycemic control without exacerbating renal abnormalities or increasing metabolic complications. [Orthopedics. 2024;47(5):276-282.].
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Hanna J, Rashid R, Hanna M, Elkomos BE, Ebeidallah G. Aspirin Compared to Other Thromboprophylactic Agents in Patients Following Total Hip Arthroplasty: A Literature Review. Cureus 2024; 16:e65645. [PMID: 39205760 PMCID: PMC11351391 DOI: 10.7759/cureus.65645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Total hip arthroplasty (THA) is a common but major surgery performed in the United Kingdom and around the globe. THA is associated with several postoperative complications, with one of the most common being venous thromboembolism (VTE) in the form of deep venous thrombosis (DVT) or pulmonary embolism (PE). VTE following orthopaedic surgery can have major consequences in terms of patient morbidity and may even cause mortality. It carries a significant cost to the health service, and thromboprophylactic agents are used to decrease the risk. Several different options are available for chemical thromboprophylaxis, including aspirin, low-molecular-weight heparin (LMWH), direct oral anticoagulants (DOACs), and warfarin. This study aims to review the literature to determine if aspirin is less superior to the other available chemical thromboprophylaxis in postoperative patients following THA. The primary outcome assessed in this review is rates of symptomatic 90-day VTE in the form of PE or DVT. A literature review was conducted using PubMed, Scopus, and Google Scholar using the following terms: 'Aspirin AND (low molecular weight heparin OR LMWH OR Enoxaparin OR Apixaban OR DOAC OR direct oral anticoagulant OR warfarin) AND (orthopaedic OR orthopedic) AND (Total hip replacement OR THR OR THA OR total hip arthroplasty) AND ('venous thromboembolism' OR VTE).' Aspirin appears to have promising results as thromboprophylaxis in cases of THA. However, it is still up for debate as to whether it is non-inferior to other forms of thromboprophylaxis.
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Affiliation(s)
- Joseph Hanna
- Trauma and Orthopaedics, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Rahel Rashid
- General and Colorectal Surgery, Arrowe Park Hospital, Wirral, GBR
| | - Mark Hanna
- Vascular Surgery, Countess of Chester Hospital, Chester, GBR
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Napierkowski E, Lee J, Thapa N, Brown E, Salama Y, Allam E. Trunnionosis and prosthesis dissociation after total hip arthroplasty. Radiol Case Rep 2024; 19:1506-1508. [PMID: 38283736 PMCID: PMC10810739 DOI: 10.1016/j.radcr.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024] Open
Abstract
Femoral neck trunnion dissociations are rare complications of total hip replacements. This hardware failure is often due to underlying trunnionosis which is important to recognize. We present a case of a patient with dissociation at the femoral head-neck junction of a total hip arthroplasty (THA) with a Stryker Accolade TMZF femoral stem. There was no significant preceding trauma. The complication was visualized on radiography and confirmed during revision arthroplasty.
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Affiliation(s)
- Eva Napierkowski
- Loyola University Medical Center and Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153 USA
| | - Juhyun Lee
- Loyola University Medical Center and Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153 USA
| | - Nihal Thapa
- Loyola University Medical Center and Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153 USA
| | - Erin Brown
- Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112 USA
| | - Yustina Salama
- Loyola University Medical Center and Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153 USA
| | - Emad Allam
- Loyola University Medical Center and Loyola University Chicago, 2160 S First Ave, Maywood, IL 60153 USA
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Miao M, Zhao GQ, Zhou Q, Chao YQ, Zou CC. Orthopedic manifestations in children with Prader-Willi syndrome. BMC Pediatr 2024; 24:118. [PMID: 38355440 PMCID: PMC10865681 DOI: 10.1186/s12887-024-04603-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare genetic disease often associated with bone problems, mainly scoliosis and hip dysplasia (HD). This study aimed to analyze the clinical characteristics of orthopedic deformities in patients with PWS. METHODS A retrospective study was conducted on 175 patients up to March 2023. The Cobb angle(CA) of the spine, the alpha angle of the hip joint, and the acetabular index (AI) were measured. This study aimed to evaluate the relationship between demographic parameters and bone deformities. RESULTS Scoliosis was found in 66 patients (43.7%), including 52 (78.8%) with mild scoliosis, 10 (15.2%) with moderate scoliosis, and 4 (6.1%) with severe scoliosis. Only seven patients received orthopedic treatment (10.6%). The median age of scoliosis was 4.5 years old, and the prevalence of scoliosis increased rapidly at the age of 5 years and adolescence. The mean CA in this study increased gradually with age. HD was found in 47 patients (38.2%), and 6 patients received orthopedic treatment (12.7%). The median age at HD was 1.8 years old. The mean AI of the study population decreased with age. The prevalence of HD treated with recombinant human growth hormone (rhGH) was low. No significant differences were observed in sex, genotype, body mass index (BMI), obesity rate, or onset of scoliosis and HD. CONCLUSION The prevalence of scoliosis and HD was higher in patients with PWS. The onset age and developmental trends of the different skeletal malformations were different. Early diagnosis and treatment are important for the prognosis and treatment of orthopedic diseases in patients with PWS.
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Affiliation(s)
- Miao Miao
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, No. 3333, Binsheng Road, Hangzhou, 310052, China
| | - Guo-Qiang Zhao
- Department of Emergency Trauma, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Qiong Zhou
- Hangzhou Children's Hospital, No. 195 Wenhui Road, Hangzhou, 310000, China
| | - Yun-Qi Chao
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, No. 3333, Binsheng Road, Hangzhou, 310052, China
| | - Chao-Chun Zou
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, No. 3333, Binsheng Road, Hangzhou, 310052, China.
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Sabatini FM, Cohen-Rosenblum A, Eason TB, Hannon CP, Mounce SD, Krueger CA, Gwathmey FW, Duncan ST, Landy DC. Incidence of Rapidly Progressive Osteoarthritis Following Intra-articular Hip Corticosteroid Injection: A Systematic Review and Meta-Analysis. Arthroplast Today 2023; 24:101242. [PMID: 37941925 PMCID: PMC10630590 DOI: 10.1016/j.artd.2023.101242] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 11/10/2023] Open
Abstract
Background The American Academy of Orthopedic Surgery recommends intra-articular corticosteroid injections (CSIs) for managing hip osteoarthritis (OA) based on short-term, prospective studies. Recent retrospective studies have raised concerns that CSIs may lead to rapidly progressive OA (RPOA). We sought to systematically review the literature of CSIs for hip OA to estimate the incidence of RPOA. Methods MEDLINE, Embase, and Cochrane Library were searched to identify original research of hip OA patients receiving CSIs. Overall, 27 articles involving 5831 patients published from 1988 to 2022 were included. Study design, patient characteristics, CSI details, follow-up, and cases of RPOA were recorded. Studies were classified by their ability to detect RPOA based on follow-up. Random effects meta-analysis was used to calculate the incidence of RPOA for studies able to detect RPOA. Results The meta-analytic estimate of RPOA incidence was 6% (95% confidence interval, 3%-9%) based on 10 articles classified as able to detect RPOA. RPOA definitions varied from progression of OA within 6 months to the presence of destructive changes. These studies were subject to bias from excluding patients with missing post-CSI radiographs. The remaining 17 articles were classified as unable to detect RPOA, including all of the studies cited in the American Academy of Orthopedic Surgery recommendation. Conclusions The incidence of RPOA after CSIs remains unknown due to variation in definitions and follow-up. While RPOA following CSIs may be 6%, many cases are not severe, and this may reflect selection bias. Further research is needed to understand whether clinically significant RPOA is incident enough to limit CSI use.
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Affiliation(s)
- Franco M. Sabatini
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY
| | | | - Travis B. Eason
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY
| | - Charles P. Hannon
- Department of Orthopedic Surgery, Washington University, St. Louis, MO
| | - Samuel D. Mounce
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY
| | - Chad A. Krueger
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
| | - F. Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Stephen T. Duncan
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY
| | - David C. Landy
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY
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Nicholas E, Cheng J, Moley PJ. Non-operative Treatment Options for Osteoarthritis in the Hip. HSS J 2023; 19:486-493. [PMID: 37937095 PMCID: PMC10626931 DOI: 10.1177/15563316231204437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 11/09/2023]
Abstract
With the increased disability associated with osteoarthritis (OA) progression, and the significant socioeconomic burden of joint replacement surgeries, there is a need for more reliable conservative treatments for patients presenting with hip OA. Most studies of OA treatments involve the knee. We conducted a literature search and reviewed non-operative hip OA treatment recommendations by the Osteoarthritis Research Society International, the American College of Rheumatology, American Academy of Orthopedic Surgeons, and European Alliance of Associations for Rheumatology, as well as Cochrane Reviews. Non-steroidal anti-inflammatory drugs and corticosteroid injections are the most supported and recommended options for hip OA; other medications with potential benefits for short-term pain relief include acetaminophen and tramadol. Most societies recommend against the use of glucosamine, typical opioids, and viscosupplementation injections. Platelet-rich plasma has potential benefits, but evidence of its effectiveness is incomplete. Further research is needed to better inform and guide clinicians who create treatment plans for patients with symptomatic hip OA.
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Affiliation(s)
- Erin Nicholas
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | - Peter J Moley
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
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Xiong B, Yang P, Lin T, Xu J, Xie Y, Guo Y, Liu C, Zhou QI, Lai Q, He W, Wei Q, Zhang Q. Changes in hip joint contact stress during a gait cycle based on the individualized modeling method of "gait-musculoskeletal system-finite element". J Orthop Surg Res 2022; 17:267. [PMID: 35568957 PMCID: PMC9107226 DOI: 10.1186/s13018-022-03094-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To construct a comprehensive simulation method of "gait-musculoskeletal system (MS)-finite element (FE)" for analysis of hip joint dynamics characteristics and the changes in the contact stress in the hip throughout a gait cycle. METHODS Two healthy volunteers (male and female) were recruited. The 3D gait trajectories during normal walking and the CT images including the hip and femur of the volunteers were obtained. CT imaging data in the DICOM format were extracted for subjected 3D hip joint reconstruction. The reconstructed 3D model files were used to realize the subject-specific registration of the pelvis and thigh segment of general musculoskeletal model. The captured marker trajectory data were used to drive subject-specific musculoskeletal model to complete inverse dynamic analysis. Results of inverse dynamic analysis were exported and applied as boundary and load settings of the hip joint finite element in ABAQUS. Finally, the finite element analysis (FEA) was performed to analyze contact stress of hip joint during a gait cycle of left foot. RESULTS In the inverse dynamic analysis, the dynamic changes of the main hip-femoral muscle force with respect to each phase of a single gait cycle were plotted. The hip joint reaction force reached a maximum value of 2.9%BW (body weight) and appeared at the end of the terminal stance phase. Twin peaks appeared at the initial contact phase and the end of the terminal stance phase, respectively. FEA showed the temporal changes in contact stress in the acetabulum. In the visual stress cloud chart, the acetabular contact stress was mainly distributed in the dome of the acetabulum and in the anterolateral area at the top of the femoral head during a single gait cycle. The acetabular contact area was between 293.8 and 998.4 mm2, and the maximum contact area appear at the mid-stance phase or the loading response phase of gait. The maximum contact stress of the acetabulum reached 6.91 MPa for the model 1 and 6.92 MPa for the model 2 at the terminal stance phase. CONCLUSIONS The "Gait-MS-FE" technology is integrated to construct a comprehensive simulation framework. Based on human gait trajectories and their CT images, individualized simulation modeling can be achieved. Subject-specific gait in combination with an inverse dynamic analysis of the MS provides pre-processing parameters for FE simulation for more accurate biomechanical analysis of hip joint.
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Affiliation(s)
- Binglang Xiong
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,The Lab of Orthopaedics of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,Department of Joint Orthopaedic, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Peng Yang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,The Lab of Orthopaedics of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,Department of Joint Orthopaedic, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,Second People's Hospital of Shenzhen, Shenzhen, 518000, Guangdong, China
| | - Tianye Lin
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,The Lab of Orthopaedics of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,Department of Joint Orthopaedic, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Jingli Xu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,The Lab of Orthopaedics of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,Department of Joint Orthopaedic, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Yong Xie
- Guangzhou University, Guangzhou, 510006, Guangdong, China
| | - Yongliang Guo
- Brain Hospital Affiliated to Jinan University, Guangzhou, 510510, Guangdong, China
| | - Churong Liu
- Brain Hospital Affiliated to Jinan University, Guangzhou, 510510, Guangdong, China
| | - QIzhao Zhou
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,The Lab of Orthopaedics of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,Department of Joint Orthopaedic, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Qizhong Lai
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,The Lab of Orthopaedics of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.,Department of Joint Orthopaedic, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Wei He
- The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510240, Guangdong, China.
| | - Qiushi Wei
- The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510240, Guangdong, China.
| | - Qingwen Zhang
- The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510240, Guangdong, China.
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Ultrasound-guided injection with hyaluronic acid in hip osteoarthritis: efficacy and safety in a real-life setting. Clin Rheumatol 2022; 41:2491-2498. [PMID: 35389116 DOI: 10.1007/s10067-022-06154-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND For knee OA, EULAR has included hyaluronic acid (HA) intra-articular injection in the 2003 recommendations, making the intra-articular injection a sound therapeutic option. The ultrasound-guided intra-articular injections (USGIAI) have been demonstrated to be more efficient and safe in comparison to the blind procedure. Our objectives were to evaluate the short- and medium-term efficacy and safety of USGIAI of HA in moderate hip OA and patients' additional NSAIDs/pain killer intake. PATIENTS AND METHODS Patients with hip OA (KLG II/III), that failed standard of care therapy, received 3 consecutive HA-USGIAI (case group) while other patients (KLG II/III) treated according to current guidelines were chosen as a control group. Demographic data, comorbidities and medication intake were recorded. VAS pain scale and WOMAC score were performed at baseline and at 3 months. In the case group, they were additionally scored at 6 months. At baseline and at 6 months, hip X-ray assessment was also made. Ultrasound evaluation was made at each visit. RESULTS In the case group, 15 patients were enrolled and 28 hip joints were injected. The control group consisted of 17 hip OA patients. In the case group, pain evaluated by VAS score and WOMAC score were significantly and progressively decreased (p < 0.0001) from baseline up to 3 and 6 months, respectively. Indeed, the case group showed a significantly lower NSAIDs/pain killer median intake at 3 months from baseline (p < 0.05). CONCLUSION Our data suggest that HA-USGIAI may be an effective and safe treatment for moderate hip OA with short- and medium-term benefits. Key Points • US hip evaluation before interventional maneuvers may identify capsular distension suggestive for concomitant septic involvement, microcrystal arthropathy or incipient hip osteonecrosis. • USGIAI may be fundamental to achieve an efficacious and safe injection. • HA-USGIAI may be an effective and safe treatment for moderate hip OA with short- and medium-term benefits.
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Sag AA, Patel P. CT-Guided Cooled Radiofrequency Denervation for Chronic Arthritis Pain of the Hip and Shoulder. Semin Intervent Radiol 2022; 39:150-156. [PMID: 35781997 DOI: 10.1055/s-0042-1745796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The paradigm in the treatment of arthritis pain is shifting for previously open surgical denervations of the hip and shoulder, as it already has for the geniculate nerves in knee arthritis. Interventional radiology is poised to contribute to this space with the use of CT guidance to provide safe, fast, and effective targeting of the target nerves for unequivocal diagnostic nerve block and definitive cooled radiofrequency denervation. The authors provide the background of which nerves are targeted for hip and shoulder denervation and the normal CT appearance of these blocks.
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Affiliation(s)
- Alan Alper Sag
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Preet Patel
- Duke University School of Medicine, Durham, North Carolina
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11
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Research Progress on the Pharmacological Action of Schisantherin A. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6420865. [PMID: 35190748 PMCID: PMC8858060 DOI: 10.1155/2022/6420865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/23/2021] [Accepted: 01/21/2022] [Indexed: 11/18/2022]
Abstract
Schisantherin A (Sch A) is a dibenzocyclooctadiene lignan monomer isolated from the fruit of Schisandra chinensis (Turcz.) Baill. (S. chinensis). At present, many studies have shown that Sch A has a wide range of pharmacological effects, including its anti-Parkinson and anti-inflammatory effects and ability to protect the liver, protect against ischemia-reperfusion (I/R) injury, suppress osteoclast formation, and improve learning and memory. Its mechanism may be related to the antioxidant, anti-inflammatory, and antiapoptotic properties of Sch A through the MAPK, NF-κB, AKT/GSK3β, and PI3K/AKT pathways. This is the first review of the recent studies on the pharmacological mechanism of Sch A.
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Macheras G, Stasi S, Sarantis M, Triantafyllou A, Tzefronis D, Papadakis SA. Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients: A randomized controlled trial. World J Orthop 2021; 12:877-890. [PMID: 34888148 PMCID: PMC8613681 DOI: 10.5312/wjo.v12.i11.877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/27/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The increased prevalence of obesity has resulted in orthopedic surgeons being likely to face many patients with a high body mass index (BMI) who warrant total hip arthroplasties (THAs) over the coming years. Studies' findings considered the postoperative clinical, and functional outcomes in these patients are controversial, and selecting the most appropriate surgical approach remains debatable.
AIM To compare pain-levels, functionality, and quality-of-life in obese and nonobese osteoarthritic patients who have undergone primary total hip arthroplasty through either direct-anterior-approach (DAA) or Hardinge-approach.
METHODS One hundred and twenty participants (> 50 years) were divided into four groups according to the surgical approach (DAA or Hardinge) and patients' BMI (nonobese < 30 kg/m2 vs obese ≥ 30 kg/m2). Outcomes were measured preoperatively and postoperatively (6th and 12th week). Pain was measured with Face Pain Scale-Revised (FPS-R). Functionality was measured with Timed Up & Go (TUG) test and Modified Harris Hip Score-Greek version (MHHS-Gr). Quality-of-life was evaluated with the 12-item-International Hip Outcome Tool-Greek version (iHOT12-Gr) (Clinical Trial Identifier: ISRCTN15066737).
RESULTS DAA vs Hardinge: (week 6) DAA-patients showed 12.2% less pain, more functionality (14.8% shorter TUG-performance time, 21.5% higher MHHS-Gr), and 38.16% better quality-of-life (iHOT12-Gr) compared to Hardinge-patients (all P values < 0.001). These differences were further increased on week 12 (all P values ≤ 0.05)]. DAA-obese vs Hardinge–obese: (week 6) DAA-obese patients had less pain, shorter TUG-performance time, better MHHS-Gr and iHOT12-Gr scores than Hardinge-obese (all P values < 0.01). (Week 12) Only the TUG-performance time of DAA-obese was significantly shortened (22.57%, P < 0.001). DAA-nonobese vs DAA-obese: no statistically significant differences were observed comparing the 6th and 12th weeks' outcomes.
CONCLUSION DAA-groups reported less pain, more functionality and better quality-of-life, compared to the Hardinge-groups. The DAA benefited obese and nonobese patients, similarly yet faster, suggesting that it should be the more preferred choice for obese patients, instead of Hardinge. However, more comparative studies with more extended follow-up periods are needed to confirm our results and better evaluate all patients' long-term outcomes.
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Affiliation(s)
- George Macheras
- 4th Orthopaedic Department, “KAT” General Hospital of Attica, Athens 14561, Kifissia, Greece
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), Physiotherapy Department, University of West Attica, Athens 12243, Egaleo, Greece
| | - Sophia Stasi
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), Physiotherapy Department, University of West Attica, Athens 12243, Egaleo, Greece
| | - Michail Sarantis
- 4th Orthopaedic Department, “KAT” General Hospital of Attica, Athens 14561, Kifissia, Greece
| | - Athanasios Triantafyllou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), Physiotherapy Department, University of West Attica, Athens 12243, Egaleo, Greece
| | - Dimitrios Tzefronis
- 4th Orthopaedic Department, “KAT” General Hospital of Attica, Athens 14561, Kifissia, Greece
| | - Stamatios A Papadakis
- 2nd Orthopaedic Department, “KAT” General Hospital of Attica, Athens 14561, Kifissia, Greece
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13
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Hermena S, Tawfeek W, Latimer P. Intraprosthetic Dislocation of Dual-Mobility Total Hip Arthroplasty: The Unforeseen Complication. Cureus 2021; 13:e19858. [PMID: 34963863 PMCID: PMC8705880 DOI: 10.7759/cureus.19858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/05/2022] Open
Abstract
Total hip arthroplasty (THA) is one of the most successful and widely accepted orthopedic procedures. Instability after THA is one of the most significant postoperative complications. Dual-mobility THA components were introduced in 1974 to overcome the risk of instability by increasing the jump distance. Dual-mobility bearings couple two articulations, namely, one between a 22-28 mm prosthetic head and polyethylene liner and another larger articulation between the polyethylene liner and the metal cup. Dislocation of the polyethylene liner and the consequent direct articulation between the prosthetic head and metal cup is recognized as intraprosthetic dislocation (IPD). This mode of THA failure is specific to dual-mobility implants. Despite the reduced incidence of IPD in modern dual-mobility implants compared to the early designs, iatrogenic IPD can occur during closed reduction of dislocated polyethylene liner-metal cup articulation. IPD requires timely diagnosis and early surgical intervention to minimize the necessity of major revision surgeries. This study presents a comprehensive review for dual-mobility-bearing THA, including the history and biomechanics, and focuses on the pathomechanics, diagnosis, and management of IPD.
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Affiliation(s)
- Shady Hermena
- Trauma and Orthopaedics, Yeovil District Hospital NHS Foundation Trust, Yeovil, GBR
| | - Waleed Tawfeek
- Trauma and Orthopaedics, Yeovil District Hospital NHS Foundation Trust, Yeovil, GBR
| | - Paul Latimer
- Trauma and Orthopaedics, Yeovil District Hospital NHS Foundation Trust, Yeovil, GBR
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14
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Buehler C, Koller W, De Comtes F, Kainz H. Quantifying Muscle Forces and Joint Loading During Hip Exercises Performed With and Without an Elastic Resistance Band. Front Sports Act Living 2021; 3:695383. [PMID: 34497999 PMCID: PMC8419330 DOI: 10.3389/fspor.2021.695383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/21/2021] [Indexed: 01/13/2023] Open
Abstract
An increase in hip joint contact forces (HJCFs) is one of the main contributing mechanical causes of hip joint pathologies, such as hip osteoarthritis, and its progression. The strengthening of the surrounding muscles of the joint is a way to increase joint stability, which results in the reduction of HJCF. Most of the exercise recommendations are based on expert opinions instead of evidence-based facts. This study aimed to quantify muscle forces and joint loading during rehabilitative exercises using an elastic resistance band (ERB). Hip exercise movements of 16 healthy volunteers were recorded using a three-dimensional motion capture system and two force plates. All exercises were performed without and with an ERB and two execution velocities. Hip joint kinematics, kinetics, muscle forces, and HJCF were calculated based on the musculoskeletal simulations in OpenSim. Time-normalized waveforms of the different exercise modalities were compared with each other and with reference values found during walking. The results showed that training with an ERB increases both target muscle forces and HJCF. Furthermore, the ERB reduced the hip joint range of motion during the exercises. The type of ERB used (soft vs. stiff ERB) and the execution velocity of the exercise had a minor impact on the peak muscle forces and HJCF. The velocity of exercise execution, however, had an influence on the total required muscle force. Performing hip exercises without an ERB resulted in similar or lower peak HJCF and lower muscle forces than those found during walking. Adding an ERB during hip exercises increased the peak muscle and HJCF but the values remained below those found during walking. Our workflow and findings can be used in conjunction with future studies to support exercise design.
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Affiliation(s)
- Callum Buehler
- Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Willi Koller
- Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Florentina De Comtes
- Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Hans Kainz
- Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
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15
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Castro CM, Corciulo C, Friedman B, Li Z, Jacob S, Fenyo D, Cronstein BN. Adenosine A2A receptor null chondrocyte transcriptome resembles that of human osteoarthritic chondrocytes. Purinergic Signal 2021; 17:439-448. [PMID: 33973110 PMCID: PMC8410926 DOI: 10.1007/s11302-021-09788-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Adenosine signaling plays a critical role in the maintenance of articular cartilage and may serve as a novel therapeutic for osteoarthritis (OA), a highly prevalent and morbid disease without effective therapeutics in the current market. Mice lacking adenosine A2A receptors (A2AR) develop spontaneous OA by 16 weeks of age, a finding relevant to human OA since loss of adenosine signaling due to diminished adenosine production (NT5E deficiency) also leads to development of OA in mice and humans. To better understand the mechanism by which A2AR and adenosine generation protect from OA development, we examined differential gene expression in neonatal chondrocytes from WT and A2AR null mice. Analysis of differentially expressed genes was analyzed by KEGG pathway analysis, and oPOSSUM and the flatiron database were used to identify transcription factor binding enrichment, and tissue-specific network analyses and patterns were compared to gene expression patterns in chondrocytes from patients with OA. There was a differential expression of 2211 genes (padj<0.05). Pathway enrichment analysis revealed that pro-inflammatory changes, increased metalloprotease, reduced matrix organization, and homeostasis are upregulated in A2AR null chondrocytes. Moreover, stress responses, including autophagy and HIF-1 signaling, seem to be important drivers of OA and bear marked resemblance to the human OA transcriptome. Although A2AR null mice are born with grossly intact articular cartilage, we identify here the molecular foundations for early-onset OA in these mice, further establishing their role as models for human disease and the potential use of adenosine as a treatment for human disease.
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Affiliation(s)
- Cristina M. Castro
- Department of Medicine, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA USA
| | - Carmen Corciulo
- Division of Translational Medicine, NYUGSOM, New York, NY USA
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutritional, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Benjamin Friedman
- Department of Medicine, Division of Rheumatology, NYUGSOM, New York, NY USA
| | - Zhi Li
- Institute for Systems Genetics, NYU Langone Health, New York, NY USA
- Department of Biochemistry and Molecular Pharmacology, NYU Langone Health, New York, NY USA
| | - Samson Jacob
- Institute for Systems Genetics, NYU Langone Health, New York, NY USA
| | - David Fenyo
- Institute for Systems Genetics, NYU Langone Health, New York, NY USA
- Department of Biochemistry and Molecular Pharmacology, NYU Langone Health, New York, NY USA
| | - Bruce N. Cronstein
- Department of Medicine, Division of Rheumatology, NYUGSOM, New York, NY USA
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16
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Yue S, Su X, Teng J, Wang J, Guo M. Cryptotanshinone interferes with chondrocyte apoptosis in osteoarthritis by inhibiting the expression of miR‑574‑5p. Mol Med Rep 2021; 23:424. [PMID: 33878859 PMCID: PMC8047883 DOI: 10.3892/mmr.2021.12063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/26/2021] [Indexed: 12/20/2022] Open
Abstract
Chondrocyte apoptosis is an important factor in the development and progression of osteoarthritis (OA). Cryptotanshinone (CTS) can inhibit chondrocyte apoptosis, but the specific mechanism remains unknown. The aim of the present study was to explore how CTS may affect chondrocyte apoptosis. Reverse transcription-quantitative PCR and western blotting were used to validate microRNA (miR)-574-5p, YY1-associated factor 2 (YAF2), Bcl-2 and Bax expression levels. H&E, Safranin O and TUNEL staining assays were used to evaluate the apoptosis of arthritic chondrocytes in vivo. A Cell Counting Kit-8 assay and flow cytometry were performed to detect cell proliferation and apoptosis of chondrocytes in vitro. The methylation level of the miR-574-5p promoter was measured via methylation specific PCR. The degree of chondrocyte apoptosis and the expression levels of YAF2 and Bcl-2 were decreased in the mice with OA, and were increased in the OA + CTS mice, while the expression levels of miR-574-5p and Bax showed opposite changes. Furthermore, the degree of chondrocyte apoptosis and the expression levels of the aforementioned key factors in chondrocytes were consistent with those observed in vivo. The methylation degree of the miR-574-5p promoter was increased by the addition of CTS, and was reduced after the addition of a methylation inhibitor, 5-aza-CdR, indicating that CTS could regulate the methylation of miR-574-5p promoter. The present study suggested that CTS could downregulate the expression of miR-574-5p by regulating its methylation, and thus, could improve YAF2 expression and affect chondrocyte apoptosis.
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Affiliation(s)
- Songtao Yue
- Department of Osteoarthrosis, Luoyang Orthopedic‑Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou, Henan 450000, P.R. China
| | - Xiaochuan Su
- Health Management Center, Luoyang Orthopedic‑Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou, Henan 450000, P.R. China
| | - Junyan Teng
- Health Management Center, Luoyang Orthopedic‑Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou, Henan 450000, P.R. China
| | - Jiangyi Wang
- Department of Osteoarthrosis, Luoyang Orthopedic‑Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou, Henan 450000, P.R. China
| | - Malong Guo
- Department of Osteoarthrosis, Luoyang Orthopedic‑Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou, Henan 450000, P.R. China
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Abstract
Osteoarthritis (OA), one of the most common motor system disorders, is a degenerative disease involving progressive joint destruction caused by a variety of factors. At present, OA has become the fourth most common cause of disability in the world. However, the pathogenesis of OA is complex and has not yet been clarified. Long non-coding RNA (lncRNA) refers to a group of RNAs more than 200 nucleotides in length with limited protein-coding potential, which have a wide range of biological functions including regulating transcriptional patterns and protein activity, as well as binding to form endogenous small interference RNAs (siRNAs) and natural microRNA (miRNA) molecular sponges. In recent years, a large number of lncRNAs have been found to be differentially expressed in a variety of pathological processes of OA, including extracellular matrix (ECM) degradation, synovial inflammation, chondrocyte apoptosis, and angiogenesis. Obviously, lncRNAs play important roles in regulating gene expression, maintaining the phenotype of cartilage and synovial cells, and the stability of the intra-articular environment. This article reviews the results of the latest research into the role of lncRNAs in a variety of pathological processes of OA, in order to provide a new direction for the study of OA pathogenesis and a new target for prevention and treatment. Cite this article: Bone Joint Res 2021;10(2):122-133.
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Affiliation(s)
- Chao Peng He
- Department of Orthopedics, The Second Affiliated Hospital, Hunan Normal University, Hunan, China
| | - Xin Chen Jiang
- Department of Orthopedics, The Second Affiliated Hospital, Hunan Normal University, Hunan, China
| | - Cheng Chen
- Department of Orthopedics, The Second Affiliated Hospital, Hunan Normal University, Hunan, China
| | - Hai Bin Zhang
- Department of Orthopedics, The Xiangya Hospital of Central South University Changsha, Hunan, China
| | - Wen Dong Cao
- Department of Orthopedics, The Second Affiliated Hospital, Hunan Normal University, Hunan, China
| | - Qi Wu
- Department of Orthopedics, The Second Affiliated Hospital, Hunan Normal University, Hunan, China
| | - Chi Ma
- Department of Orthopedics, The First Affiliated Hospital (People’s Hospital of Xiangxi Autonomous Prefecture), Jishou University, Jishou, China
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18
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Schiavi P, Calderazzi F, Pedrini MF, Tacci F, Vaienti E, Pogliacomi F. Efficacy and safety of viscosupplementation with hyaluronic acid for hip osteoarthritis: results from a cross-sectional study with a minimum follow-up of 4 years. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020032. [PMID: 33559627 PMCID: PMC7944698 DOI: 10.23750/abm.v91i14-s.11110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: Osteoarthritis is the most common cause of disability in elderly. Hip osteoarthritis is the second most frequent form affecting a large joint and the social and economic impact on society of its related disability is expected to increase. The purpose of this study was to verify the efficacy and safety of ultrasound-guided viscosupplementation with high weight hyaluronic acid in hip osteoarthritis. Methods: 183 patients with painful hip OA (Kellgren-Lawrence 1-2-3) were treated from January 2014 to December 2016 with viscosupplementation. Patients were evaluated before injection (T0) and after 1,2,3,4 (T1-T2-T3-T4) years through the VAS scale and Harris Hip Score (HHS). Patients who underwent to subsequent injections were followed and assessed. Subjects who underwent prosthesis were analyzed for a minimum of 6 months in order to detect any early postoperative complication. Results: The mean improvement of HHS and VAS between T0 and T1 was statistically significant. Patients who underwent subsequent injections showed a higher improvement even if statistical significance was not observed. Results showed that patients with grade 2 of osteoarthritis had the higher change in the scores. No adverse effects were registered. No early complications were reported in those patients who needed prosthesis. Discussion and Conclusions: Results observed confirm that ultrasound-guided viscosupplementation with high weight hyaluronic acid could be a possibility in the treatment of hip osteoarthritis, especially in patients with Kellgren-Lawrence grade 2 of disease. Subsequent injections are not characterized by similar positive effects. Outcomes of prosthetic surgery are not influenced by viscosupplementation.
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Affiliation(s)
- Paolo Schiavi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Filippo Calderazzi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | | | - Fabrizio Tacci
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Enrico Vaienti
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Francesco Pogliacomi
- PARMA UNIVERSITY DEPARTMENT OF SURGICAL SCIENCES ORTHOPAEDIC AND TRAUMATOLOGY SECTION.
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19
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Ejnisman L, Ricioli Júnior W, Queiroz MC, Vicente JRN, Croci AT, Polesello GC. Femoroacetabular Impingement and Acetabular Labral Tears - Part 1: Pathophysiology and Biomechanics. Rev Bras Ortop 2020; 55:518-522. [PMID: 33093713 PMCID: PMC7575372 DOI: 10.1055/s-0040-1702964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/12/2019] [Indexed: 11/02/2022] Open
Abstract
Femoroacetabular impingement (FAI) is an important cause of hip pain, and the main etiology of hip osteoarthritis in the young population. Femoroacetabular impingement is characterized by subtle alterations in the anatomy of the acetabulum and proximal femur, which can lead to labrum tearing. The acetabular labrum is essential to the stability of the hip joint. Three types of FAI were described: cam (anespherical femoral head), pincer (acetabular overcoverage) and mixed (characteristics of both cam and pincer). The etiology of FAI is related to genetic and environmental characteristics. Knowledge of this condition is essential to adequately treat patients presenting with hip pain.
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Affiliation(s)
- Leandro Ejnisman
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Walter Ricioli Júnior
- Grupo de Quadril, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Marcelo Cavalheiro Queiroz
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Jose Ricardo Negreiros Vicente
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alberto Tesconi Croci
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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20
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Tatani I, Megas P, Panagopoulos A, Diamantakos I, Nanopoulos P, Pantelakis S. Comparative analysis of the biomechanical behavior of two different design metaphyseal-fitting short stems using digital image correlation. Biomed Eng Online 2020; 19:65. [PMID: 32814586 PMCID: PMC7437017 DOI: 10.1186/s12938-020-00806-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/04/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The progressive evolution in hip replacement research is directed to follow the principles of bone and soft tissue sparing surgery. Regarding hip implants, a renewed interest has been raised towards short uncemented femoral implants. A heterogeneous group of short stems have been designed with the aim to approximate initial, post-implantation bone strain to the preoperative levels in order to minimize the effects of stress shielding. This study aims to investigate the biomechanical properties of two distinctly designed femoral implants, the TRI-LOCK Bone Preservation Stem, a shortened conventional stem and the Minima S Femoral Stem, an even shorter and anatomically shaped stem, based on experiments and numerical simulations. Furthermore, finite element models of implant-bone constructs should be evaluated for their validity against mechanical tests wherever it is possible. In this work, the validation was performed via a direct comparison of the FE calculated strain fields with their experimental equivalents obtained using the digital image correlation technique. RESULTS Design differences between Trilock BPS and Minima S femoral stems conditioned different strain pattern distributions. A distally shifting load distribution pattern as a result of implant insertion and also an obvious decrease of strain in the medial proximal aspect of the femur was noted for both stems. Strain changes induced after the implantation of the Trilock BPS stem at the lateral surface were greater compared to the non-implanted femur response, as opposed to those exhibited by the Minima S stem. Linear correlation analyses revealed a reasonable agreement between the numerical and experimental data in the majority of cases. CONCLUSION The study findings support the use of DIC technique as a preclinical evaluation tool of the biomechanical behavior induced by different implants and also identify its potential for experimental FE model validation. Furthermore, a proximal stress-shielding effect was noted after the implantation of both short-stem designs. Design-specific variations in short stems were sufficient to produce dissimilar biomechanical behaviors, although their clinical implication must be investigated through comparative clinical studies.
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Affiliation(s)
- I Tatani
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece.
| | - P Megas
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece
| | - A Panagopoulos
- Orthopaedic Department, University Hospital of Patras, Papanikolaou 1, Rio-Patra, 26504, Patras, Greece
| | - I Diamantakos
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
| | - Ph Nanopoulos
- Department of Computer Engineering & Informatics, University of Patras, Patras, Greece
| | - Sp Pantelakis
- Laboratory of Technology and Strength of Materials, Department of Mechanical Engineering and Aeronautics, University of Patras, Patras, Greece
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21
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Fox OJK, Cairns SL, Jarman PG. Recurrent and radiographically unrecognized iatrogenic intra-prosthesis hip dislocations. J Am Coll Emerg Physicians Open 2020; 1:419-422. [PMID: 33000065 PMCID: PMC7493521 DOI: 10.1002/emp2.12050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/23/2020] [Accepted: 02/26/2020] [Indexed: 11/26/2022] Open
Abstract
Hip dislocation is a common complication after total hip arthroplasty surgery. Newer prosthetic implants aim to reduce the risk of dislocation. The new dual mobility implant has a unique design that may result in intra-prosthetic dislocation. We report a case of a recurrently missed iatrogenic intra-prosthetic dislocation following closed reduction efforts in the emergency department (ED). Emergency physicians must be aware of the design, pitfalls, and management of this new prosthetic hip design.
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Affiliation(s)
- Olivia J K Fox
- School of Medicine University of Notre Dame Darlinghurst New South Wales Australia
| | - Stephanie L Cairns
- Department of Orthopaedics Shoalhaven District Memorial Hospital Nowra New South Wales Australia
| | - Paul G Jarman
- Department of Orthopaedics Shoalhaven District Memorial Hospital Nowra New South Wales Australia
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22
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Ethical and Practical Considerations for Integrating Cellular ("Stem Cell") Therapy into Clinical Practice. Curr Rev Musculoskelet Med 2020; 13:525-529. [PMID: 32468421 DOI: 10.1007/s12178-020-09647-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Cellular therapies, also known as "stem cell" interventions (SCI), have undergone a rapid popularization in the USA and worldwide. The current review aimed at outlining (1) the ethical challenges facing the implementation of SCI; (2) the applicability of the currently available SCI; and (3) recommendations to achieve ethical, well-regulated incorporation of SCI in the clinical setting. RECENT FINDINGS Concerns regarding the inadequate characterization, poor adverse effects disclosure, and unorthodox, often inappropriate, market practices have engendered a genuine concern regarding the SCI compliance with ethical standards. Six instances of litigation on the basis of misrepresentation or inappropriate informed consent were recorded between 2012 and 2018. Such concerns have been furthered by the loopholes in the regulatory aspect governing the use of SCI coupled with the unclear literature-reported efficacy and diverse spectrum of profess indications. Similarly, the application of SCI in the clinical field is yet to prove its value. The uncertain efficacy, coupled with obscure true-costs of utilization, impedes a value-based assessment. A multidisciplinary approach involving legislative and medical professional societies should continue to advance regulations that govern SCI. A well-regulated system that allows for the ethical integration of SCI with appositely evidenced-based described benefits and risks should be sought.
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23
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Harbison GJ, Andrews SN, Nakasone CK. Safety of Single-Stage Bilateral Direct Anterior Approach Total Hip Arthroplasty Performed in All Eligible Patients at a Honolulu Hospital. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:71-74. [PMID: 32190838 PMCID: PMC7061030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Total hip arthroplasty (THA) is a commonly performed surgery, with candidates often requiring bilateral replacement. Simultaneous, single-stage bilateral THA offers several advantages and the direct anterior approach (DAA) for THA is well-suited for this procedure. In Hawai'i, single-stage bilateral DAA THA has yet to be adopted as a primary practice, and currently, there is limited research on patient outcomes following single-stage bilateral DAA THA in heterogeneous patient populations. In this study, we present our experience regarding intraoperative and 90-day complication rates encountered in a consecutive, all-inclusive cohort of single-stage bilateral DAA THA performed at the Straub Medical Center in Honolulu, Hawai'i, from January 2016 to May 2018. A total of 99 patients were included with a mean age of 64.7 ± 10.1 (mean ± standard deviation) years. The sample consisted of 43 (43.4%) males. Mean BMI was 27.0 ± 5.3 kg/m2. The racial composition consisted of 50 (50.5%) Asian, 37 (37.4%) Caucasian, 8 (8.1%) Hawaiian/Pacific Islander, 1 (1.0%) African-American, 3 (3.0%) undisclosed. Mean operating time was 180 ± 23 minutes. Mean intraoperative blood loss was 386 ± 75 mL, and 11 (11.1%) patients received a postoperative allogenic blood transfusion. There were no major intraoperative complications. The only major local complication observed was one patient who developed high-grade heterotopic ossification requiring surgery. No major systemic complications occurred. The overall complication rate was 0.5%. In conclusion, we demonstrate that single-stage bilateral DAA THA is a safe option for the treatment of bilateral hip pathology in a wide spectrum of patients.
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Affiliation(s)
| | - Samantha N. Andrews
- Department of Orthopedics, Straub Clinic & Hospital, Honolulu, HI (CKN, SNA)
| | - Cass K. Nakasone
- Department of Orthopedics, Straub Clinic & Hospital, Honolulu, HI (CKN, SNA)
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Judd DL, Cheuy VA, Forster JE, Christiansen CL, Stevens-Lapsley JE. Incorporating Specific Functional Strength Integration Techniques to Improve Functional Performance for Veterans After Total Hip Arthroplasty: Protocol for a Randomized Clinical Trial. Phys Ther 2019; 99:1453-1460. [PMID: 31392991 PMCID: PMC8284176 DOI: 10.1093/ptj/pzz109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/02/2018] [Accepted: 04/06/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Total hip arthroplasty (THA) is a common procedure, yet persistent deficits in functional performance exist after surgery. These deficits may be related to movement compensations observed after THA, which negatively affect quality of life and may increase morbidity and health care utilization, including in the veteran population. However, the best rehabilitative approach to remediating movement compensations and physical function deficits has not been determined. OBJECTIVE The objective is to determine if a functional strength integration intervention (FSI), as part of a post-THA rehabilitation program, improves movement compensation, physical function, muscle strength, and self-reported outcome measures more than a control group (CON) undergoing a standard of care exercise program. DESIGN This is a 2-arm randomized, controlled clinical trial. SETTING The Veteran Affairs outpatient physical therapy clinics and academic research laboratory will be the settings. PARTICIPANTS One hundred veterans undergoing THA for hip osteoarthritis will be included in the study. INTERVENTIONS Participants will be randomized to either the FSI or CON group and participate in visits of physical therapy over 8 weeks. The FSI protocol will include targeted exercise to improve muscular control and stability around the hip and trunk to minimize movement compensation during daily activity combined with progressive resistance exercise. The CON protocol will include patient education, flexibility activity, and low load resistance exercise. MEASUREMENTS Functional performance, muscle strength and endurance, and self-reported outcomes will be measured at baseline (prior to surgery), midway through intervention (6 weeks after surgery), at the end of intervention (10 weeks after surgery), and 26 weeks after THA. LIMITATIONS The inability to blind treating therapists to study arm allocation is a limitation. CONCLUSIONS The proposed study aims to determine if targeted FSI can affect movement compensation to improve functional outcomes after THA more than traditional rehabilitation paradigms.
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Affiliation(s)
- Dana L. Judd
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 East 17th Avenue, Room 3116, Aurora, CO 80045 (USA)
| | - Victor A. Cheuy
- Department of Physical Therapy and Rehabilitation Science and Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Jeri E. Forster
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus; and Rocky Mountain Mental Illness, Research, Education and Clinical Center, US Department of Veterans Affairs, Denver, Colorado
| | - Cory L. Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus; and Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, Colorado
| | - Jennifer E. Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus; and Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System
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Zhang H, Chen C, Cui Y, Li Y, Wang Z, Mao X, Dou P, Li Y, Ma C. lnc-SAMD14-4 can regulate expression of the COL1A1 and COL1A2 in human chondrocytes. PeerJ 2019; 7:e7491. [PMID: 31534838 PMCID: PMC6727836 DOI: 10.7717/peerj.7491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/16/2019] [Indexed: 01/21/2023] Open
Abstract
Osteoarthritis (OA) is the most common motor system disease in aging people, characterized by matrix degradation, chondrocyte death, and osteophyte formation. OA etiology is unclear, but long noncoding RNAs (lncRNAs) that participate in numerous pathological and physiological processes may be key regulators in the onset and development of OA. Because profiling of lncRNAs and their biological function in OA is not understood, we measured lncRNA and mRNA expression profiles using high-throughput microarray to study human knee OA. We identified 2,042 lncRNAs and 2,011 mRNAs that were significantly differentially expressed in OA compared to non-OA tissue (>2.0- or < - 2.0-fold change; p < 0.5), including 1,137 lncRNAs that were upregulated and 905 lncRNAs that were downregulated. Also, 1,386 mRNA were upregulated and 625 mRNAs were downregulated. QPCR was used to validate chip results. Gene Ontology analysis and the Kyoto Encyclopedia of Genes and Genomes was used to study the biological function enrichment of differentially expressed mRNA. Additionally, coding-non-coding gene co-expression (CNC) network construction was performed to explore the relevance of dysregulated lncRNAs and mRNAs. Finally, the gain/loss of function experiments of lnc-SAMD14-4 was implemented in IL-1β-treated human chondrocytes. In general, this study provides a preliminary database for further exploring lncRNA-related mechnisms in OA.
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Affiliation(s)
- Haibin Zhang
- Department of Orthopedics, The NO.921 Hospital of the People’s Liberation Army Joint Support Force, The Second Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Cheng Chen
- Department of Orthopedics, The NO.921 Hospital of the People’s Liberation Army Joint Support Force, The Second Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Yinghong Cui
- Department of Pharmaceutical Sciences, Hunan Normal University, changsha, Hunan, China
| | - Yuqing Li
- Department of Orthopedics, Changsha central hospital, Changsha, Hunan, China
| | - Zhaojun Wang
- Department of Traumatology, Shanxi Fenyang Hospital, The Fenyang Hospital of Shanxi Medical University, Fenyang, Shanxi, China
| | - Xinzhan Mao
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Pengcheng Dou
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yihan Li
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chi Ma
- Department of Orthopedics, People’s Hospital of Xiangxi Autonomous Prefecture, Jishou, Hunan, China
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Feldman G, Kappes D, Mookerjee-Basu J, Freeman T, Fertala A, Parvizi J. Novel mutation in Teneurin 3 found to co-segregate in all affecteds in a multi-generation family with developmental dysplasia of the hip. J Orthop Res 2019; 37:171-180. [PMID: 30273960 DOI: 10.1002/jor.24148] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/04/2018] [Indexed: 02/04/2023]
Abstract
DDH is a debilitating condition characterized by incomplete formation of the acetabulum leading to dislocation of the hip, suboptimal joint function and accelerated wear of the articular cartilage resulting in early onset crippling arthritis of the hip in 20-40 year olds. Current diagnostic tests in newborns using physical manipulation of the femur or ultrasound either under or over-diagnose this condition. Developing an accurate, cost effective diagnostic test is a goal of this study. To better understand the biologic pathways involved in acetabular development, DNA from severely affected individuals in a four generation family that showed inter-generational transmission of the disorder was isolated and whole exome sequenced. A novel A to C transversion at position 183721398 on human chromosome four was found to co-segregate with the affected phenotype in this family. This mutation encodes a glutamine to proline change at position 2665 in the Teneurin 3 (TENM3) gene and was judged damaging by four prediction programs. Eight week old knock-in mutant mice show delayed development of the left acetabulum and the left glenoid fossa as shown by the presence of more Alcian blue staining on the socket rims of both the hip and the shoulder. We hypothesize that mutated TENM3 will slow chondrogenesis. MMP13 has been shown to impair extracellular matrix remodeling and suppress differentiation. Bone marrow cells from the knock-in mouse were found to overexpress MMP13 with or without BMP2 stimulation. This variant may elucidate pathways responsible for normal hip development and become part of an accurate test for DDH. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- George Feldman
- Thomas Jefferson University Division of Orthopaedic Research, Philadelphia, Pennsylvania
| | | | | | - Theresa Freeman
- Thomas Jefferson University Division of Orthopaedic Research, Philadelphia, Pennsylvania
| | - Andrzej Fertala
- Thomas Jefferson University Division of Orthopaedic Research, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Thomas Jefferson University Division of Orthopaedic Research, Philadelphia, Pennsylvania.,Rothman Institute of Orthopaedics, Philadelphia, Pennsylvania
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Rollmann MF, Holstein JH, Pohlemann T, Herath SC, Histing T, Braun BJ, Schmal H, Putzeys G, Marintschev I, Aghayev E. Predictors for secondary hip osteoarthritis after acetabular fractures—a pelvic registry study. INTERNATIONAL ORTHOPAEDICS 2018; 43:2167-2173. [DOI: 10.1007/s00264-018-4169-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
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Rhee C, Amar E, Glazebrook M, Coday C, Wong IH. Safety Profile and Short-term Outcomes of BST-CarGel as an Adjunct to Microfracture for the Treatment of Chondral Lesions of the Hip. Orthop J Sports Med 2018; 6:2325967118789871. [PMID: 30116764 PMCID: PMC6088484 DOI: 10.1177/2325967118789871] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Acetabular cartilage lesions are a common abnormality found in patients undergoing hip arthroscopic surgery and may cause pain and functional limitations. Several strategies have been developed to treat chondral defects, with no overwhelming success. Recently, BST-CarGel has gained interest as a scaffolding material that can be injected into the microfracture site to stabilize the clot and facilitate cartilage repair. Purpose To perform a retrospective analysis of prospectively collected data to evaluate the safety profile and short-term clinical and radiographic outcomes of patients treated arthroscopically with BST-CarGel for acetabular chondral defects in conjunction with microfracture. Study Design Case series; Level of evidence, 4. Methods A retrospective chart review was performed on all patients who underwent hip arthroscopic surgery by the senior surgeon to identify those who had BST-CarGel applied to their hip from November 2014 to July 2016, and basic demographic information for those patients was obtained. Operative reports and patient charts were reviewed to assess intraoperative and postoperative complications as well as to obtain the details of surgery, including lesion size and treatment method of the labrum (repair vs reconstruction). All patients filled out self-reported questionnaires, including the international Hip Outcome Tool (iHOT), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sports Profile (HOS-SP) at the time of consultation and at 1 year postoperatively, and results were used to assess the clinical outcomes of surgery. Results Thirty-seven patients (37 hips) with a mean age of 36.19 years at the time of the index procedure were evaluated. There were 30 male patients, and 20 procedures were performed on the right hip. The minimum follow-up was 1 year, with a mean follow-up of 12.72 months. There were no major adverse events of deep vein thrombosis, blood vessel or nerve damage, hemarthrosis, arthralgia, or device-related adverse events. Two patients (5.4%) were readmitted because of pain, probably resulting from an inflammatory reaction to BST-CarGel. At 1 year postoperatively, there were statistically significant improvements in the iHOT (40.4 to 59.1; P < .001), HOS-ADL (60.6 to 71.4; P = .02), and HOS-SP (36.9 to 51.6; P = .01) scores. When the patients were subdivided based on the chondral defect size, the iHOT score improved for all chondral defect sizes, and the HOS-SP score improved in patients with medium (2-4 cm2) and very large (>6 cm2) chondral defects. In addition, the iHOT score improved whether the patients had their labrum repaired or reconstructed (P < .001 and P = .02, respectively). Conclusion The arthroscopic treatment of chondral acetabular defects with BST-CarGel demonstrates a satisfactory safety profile, with statistically significant improvement in patient-reported clinical outcome scores, even for those with very large chondral defect sizes.
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Affiliation(s)
- Chanseok Rhee
- Department of Orthopaedic Surgery, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Eyal Amar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark Glazebrook
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Catherine Coday
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan H Wong
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Louer CR, Pashos G, Clohisy JC, Nepple JJ. A Prospective Analysis of the Contralateral Hip Among Patients With Femoroacetabular Impingement: What Are the Risk Factors for Disease Progression? Am J Sports Med 2018; 46:2486-2491. [PMID: 30015502 PMCID: PMC6997933 DOI: 10.1177/0363546518786246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The pathophysiology of femoroacetabular impingement (FAI) remains to be better understood, including factors affecting symptom development and disease progression. PURPOSE (1) To determine rates of initial and subsequent symptom development in the contralateral hip of patients with symptomatic FAI and (2) to identify predictors of the development of symptomatic contralateral FAI. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This prospective study cohort included the contralateral hip of 179 consecutive patients undergoing primary surgical treatment of FAI. At presentation and follow-up time points, patients recorded the presence of symptoms in the contralateral hip. Patients with a minimum 1-year follow-up were included in the final cohort. Univariate analysis compared the patient characteristics and FAI imaging characteristics (cam and pincer) of initially asymptomatic patients who developed symptoms and those who remained asymptomatic. Kaplan-Meier survival curves were calculated to demonstrate symptom development over time. RESULTS A total of 148 patients (83%) were followed for at least 1 year (mean, 2.9 years). Thirty-four (23%) patients had symptoms in the contralateral hip at the time of the initial presentation. An additional 27 hips (24% of the initially asymptomatic) developed symptoms during the follow-up period at a mean 2.0 years from presentation. Head-neck offset ratio on the anteroposterior pelvis radiograph was significantly lower among hips that developed symptoms (0.153 vs 0.163 asymptomatic group, P = .027). Maximum alpha angle ( P = .503), lateral center edge angle ( P = .975), and crossover sign ( P = .865) were not predictive of the development of symptoms. Patients developing contralateral hip symptoms were less likely to have a UCLA (University of California, Los Angeles) activity score of 9 or 10 at presentation (18.2% vs 43.8%, P = .032). The total arc of rotation in flexion (internal rotation in 90° of flexion + external rotation in flexion) was significantly decreased in hips developing symptoms (39.4º vs 50.4º, P = .012). Kaplan-Meier survival analysis demonstrated that 72%, 67%, 56%, and 48% of all patients remained asymptomatic at 1, 2, 3, and 4 years, respectively. CONCLUSION Approximately 1 in 4 patients with FAI presents with symptoms in the contralateral hip, and an additional 1 in 4 patients develops significant symptoms in the following 4 years. Several factors, including low activity level, less hip rotational motion, and decreased head-neck offset ratio, were significantly associated with the development of symptoms, while the alpha angle and crossover sign were not.
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Affiliation(s)
- Craig R. Louer
- Department of Orthopaedic Surgery, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Gail Pashos
- Department of Orthopaedic Surgery, School of Medicine, Washington University, St Louis, Missouri, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Jeffrey J. Nepple
- Department of Orthopaedic Surgery, School of Medicine, Washington University, St Louis, Missouri, USA,Corresponding Author: Jeffrey J. Nepple, MD, Washington University Orthopedics, Campus Box 8233, 660 S Euclid Ave, St Louis, MO 63110, USA ()
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Mauro GL, Sanfilippo A, Scaturro D. The effectiveness of intra-articular injections of Hyalubrix ® combined with exercise therapy in the treatment of hip osteoarthritis. ACTA ACUST UNITED AC 2017; 14:146-152. [PMID: 29263723 DOI: 10.11138/ccmbm/2017.14.1.146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Osteoarthritis (OA) is the most common joint disorder in the elderly, causing significant pain which negatively affects mobility and quality of life. The aim of the study was to assess the effectiveness of ultrasound image-guided intra-articular injections of Hyalubrix® combined with exercise therapy in the treatment of hip osteoarthritis. Methods This was a single site, prospective, open-label, Investigator-initiated study. Forty patients were enrolled and received three ultrasound image-guided injections of Hyalubrix®, 45 days apart, combined with three sessions a week of physical therapy (proprioceptive rehabilitation of the lower limbs; gait training; balance training) up to a total of 30 sessions (10 weeks), starting from one week after the first injection. Results The primary objective was to achieve a lasting reduction in OA symptoms related to pain during activity. During the course of the study the pain perceived by the patient during activity dropped from a mean value of 6.94 cm to a mean value of 1.46 cm and showed a statistically significant decrease from visit 1 compared to baseline (p < 0.05) which was confirmed at all the subsequent time points. Significant improvements were also observed in the evaluation of the secondary objectives: hip disability; OA-related pain at rest; daily functioning and NSAIDs intake. Conclusions Results from this study including 40 patients for a total of 65 treated hips demonstrate a significant improvement in OA-related pain, hip disability, and patient's daily functioning as well as a reduction in NSAIDs intake. Patients suffering from hip OA seem to benefit from the treatment with Hyalubrix® injections plus exercise therapy.
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Affiliation(s)
- Giulia Letizia Mauro
- Department of Physical and Rehabilitative Medicine, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy
| | - Antonino Sanfilippo
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy
| | - Dalila Scaturro
- Department of Physical and Rehabilitative Medicine, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy
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Campbell TM, Churchman SM, Gomez A, McGonagle D, Conaghan PG, Ponchel F, Jones E. Mesenchymal Stem Cell Alterations in Bone Marrow Lesions in Patients With Hip Osteoarthritis. Arthritis Rheumatol 2017; 68:1648-59. [PMID: 26866940 PMCID: PMC4941540 DOI: 10.1002/art.39622] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 02/02/2016] [Indexed: 01/16/2023]
Abstract
Objective In patients with osteoarthritis (OA), bone marrow lesions (BMLs) are intimately linked to disease progression. We hypothesized that aberrant multipotential stromal cell (also known as mesenchymal stem cell [MSC]) responses within bone tissue contributes to BML pathophysiology. The aim of this study was to investigate BML and non‐BML native subchondral bone MSCs for numeric, topographic, in vitro functional, and gene expression differences. Methods Ex vivo 3T magnetic resonance imaging (MRI) of the femoral heads of 20 patients with hip OA was performed. MRI‐determined BML and non‐BML regions were excised and enzymatically treated to extract cells and quantify MSCs using flow cytometry and colony‐forming unit–fibroblast (CFU‐F) assay. Immunohistochemical analysis was performed to determine in vivo CD271+ MSC distribution. Culture‐expanded CD271+ cells were analyzed for tripotentiality and gene expression. Results BML regions were associated with greater trabecular bone area and cartilage damage compared with non‐BML regions. The proportion of CD45−CD271+ MSCs was higher in BML regions compared with non‐BML regions (median difference 5.6‐fold; P < 0.001); the CFU‐F assay showed a similar trend (median difference 4.3‐fold; P = 0.013). Immunohistochemistry revealed CD271+ cell accumulation in bone adjacent to cartilage defects and areas of osteochondral angiogenesis. BML MSCs had lower proliferation and mineralization capacities in vitro and altered expression of TNFSF11/RANKL and CXCR4/stromal cell–derived factor 1 receptor. OA MSCs showed up‐regulated transcripts for CXCR1 and CCR6 compared with MSCs derived from healthy or osteoporotic bone. Conclusion This study is the first to show numeric and topographic alterations in native MSCs in the diseased bone of patients with hip OA. Given the associated functional perturbation of MSCs, these data suggest that subchondral bone MSC manipulation may be an OA treatment target.
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Affiliation(s)
| | - Sarah M Churchman
- University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Alejandro Gomez
- University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Dennis McGonagle
- University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Philip G Conaghan
- University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Frederique Ponchel
- University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Elena Jones
- University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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Xue Y, Zhang R, Deng Y, Chen K, Jiang T. A preliminary examination of the diagnostic value of deep learning in hip osteoarthritis. PLoS One 2017; 12:e0178992. [PMID: 28575070 PMCID: PMC5456368 DOI: 10.1371/journal.pone.0178992] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 05/22/2017] [Indexed: 12/15/2022] Open
Abstract
Hip Osteoarthritis (OA) is a common disease among the middle-aged and elderly people. Conventionally, hip OA is diagnosed by manually assessing X-ray images. This study took the hip joint as the object of observation and explored the diagnostic value of deep learning in hip osteoarthritis. A deep convolutional neural network (CNN) was trained and tested on 420 hip X-ray images to automatically diagnose hip OA. This CNN model achieved a balance of high sensitivity of 95.0% and high specificity of 90.7%, as well as an accuracy of 92.8% compared to the chief physicians. The CNN model performance is comparable to an attending physician with 10 years of experience. The results of this study indicate that deep learning has promising potential in the field of intelligent medical image diagnosis practice.
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Affiliation(s)
- Yanping Xue
- Department of Radiology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | | | | | | | - Tao Jiang
- Department of Radiology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
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Martín-Fernández J, Gray-Laymón P, Molina-Siguero A, Martínez-Martín J, García-Maroto R, García-Sánchez I, García-Pérez L, Ramos-García V, Castro-Casas O, Bilbao A. Cross-cultural adaptation and validation of the Spanish version of the Oxford Hip Score in patients with hip osteoarthritis. BMC Musculoskelet Disord 2017; 18:205. [PMID: 28532445 PMCID: PMC5440982 DOI: 10.1186/s12891-017-1568-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/10/2017] [Indexed: 01/07/2023] Open
Abstract
Background Osteoarthritis (OA) of the hip is a disease that entails a major burden for patients and the society as a whole. One way of measuring this burden for the patient is through impact on Health-related Quality of Life (HRQL). The Oxford Hip Score (OHS) is a well-known tool to measure HRQL in patients with OA of the hip. This study aims to assess the psychometric properties of the Spanish-adapted version of the OHS, including its reliability, validity, and sensitivity to change. Methods Prospective observational study that included 361 patients diagnosed with hip OA (according to the criterion of the American College of Rheumatology) from 3 different Spanish regions. Their HRQL was assessed using a generic questionnaire, the EQ-5D-5 L, and two specific ones (the Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC, and the OHS) adapted to Spanish. There was a follow-up period of 6 months, and the acceptability, psychometric properties, presence of ceiling and floor effects, validity, reliability, and sensitivity to changes of the OHS were measured. Results The OHS was fully answered in 99.4% of cases with no indication of ceiling or floor effects. Its factor structure can be explained in a single dimension. Its discriminative capacity was very good compared to the groups generated by the WOMAC and the EQ-5D-5 L. The correlation between the OHS and dimensions of the WOMAC or EQ-5D-5 L utilities was ≥0.7. Excellent test-retest reliability (ICC = 0.992; CI95%: 0.994–0.998) and internal consistency (Cronbach’s α = 0.928) were observed. The minimal clinically important difference (MCID) was 7.0 points, and the minimum detectable change (MDC) was 5.5 points. The effect size for moderate improvement in perceived HRQL was 0.73, similar to that of WOMAC dimensions and higher than the EQ-5D-5 L. Conclusions The Spanish-adapted version of the OHS is a useful, acceptable tool for the assessment of perceived HRQL in patients with hip OA, and has psychometric properties similar to those of the WOMAC that allow for discriminating both a patient’s condition at a given moment and changes that can occur over time. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1568-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jesús Martín-Fernández
- C° Villamanta (C.S. Navalcarnero). Gerencia Asistencial de Atención Primaria. Servicio Madrileño de Salud, Madrid, Spain. .,Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain. .,Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Madrid, Spain.
| | - Pedro Gray-Laymón
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Antonio Molina-Siguero
- C.S. Presentación Sabio, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Javier Martínez-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Fundación Alcorcón, Madrid, Madrid, Spain
| | - Roberto García-Maroto
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Clínico San Carlos, Servicio Madrileño de Salud, Madrid, Spain
| | - Isidoro García-Sánchez
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Galdakao-Usansolo (Osakidetza), Galdakao (Bizkaia), Spain
| | - Lidia García-Pérez
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Santa Cruz de Tenerife, Spain.,Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Santa Cruz de Tenerife, Spain
| | - Vanesa Ramos-García
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Santa Cruz de Tenerife, Spain
| | - Olga Castro-Casas
- C° Villamanta (C.S. Navalcarnero). Gerencia Asistencial de Atención Primaria. Servicio Madrileño de Salud, Madrid, Spain
| | - Amaia Bilbao
- Unidad de Investigación, Hospital Universitario Basurto (Osakidetza) - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao (Bizkaia), Spain
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Park JH, Hong JY, Han K, Suh SW, Park SY, Yang JH, Han SW. Prevalence of symptomatic hip, knee, and spine osteoarthritis nationwide health survey analysis of an elderly Korean population. Medicine (Baltimore) 2017; 96:e6372. [PMID: 28328825 PMCID: PMC5371462 DOI: 10.1097/md.0000000000006372] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Osteoarthritis is prominent among the elderly, with symptoms originating from multiple parts of the body. A cross-sectional study of a nationwide survey was performed to describe the prevalence of and identify factors related to symptomatic hip, knee, and spine osteoarthritis.This cross-sectional study collected data from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V-5; 2010-2012). After excluding ineligible subjects, there were 8976 subjects in this study (3830 males and 5146 females). All subjects reported symptoms and disabilities related to osteoarthritis. Plain radiographs of the spine, hip, and knee were taken in all subjects.Overall, 9.3% of male participants and 28.5% of female participants were diagnosed with symptomatic osteoarthritis according to survey criteria. Women showed a significantly higher prevalence in all age groups (P < 0.05). Multiple-joint osteoarthritis was diagnosed in 10.8% of male patients and 22.8% of female patients with osteoarthritis. Several demographic and lifestyle variables were related to osteoarthritis morbidity. Anthropometric and laboratory measurements were also related to osteoarthritis morbidity. In addition, mental distress and quality of life were significantly compromised in osteoarthritis. There were more significant relationships for these factors among women with a higher prevalence of multijoint osteoarthritis.A significant proportion of the elderly with single- or multiple-joint osteoarthritis had a variety of pain origins that were closely related. Osteoarthritis was also significantly related to several factors, including mental distress and quality of life.
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Anthropometry
- Cross-Sectional Studies
- Female
- Health Surveys
- Humans
- Korea/epidemiology
- Life Style
- Male
- Middle Aged
- Osteoarthritis, Hip/diagnostic imaging
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/psychology
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/psychology
- Osteoarthritis, Spine/diagnostic imaging
- Osteoarthritis, Spine/epidemiology
- Osteoarthritis, Spine/psychology
- Prevalence
- Quality of Life
- Socioeconomic Factors
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Affiliation(s)
- Jung-Ho Park
- Department of Orthopedics, Korea University Ansan Hospital, Ansan
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Ansan
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, Catholic University
| | - Seung-Woo Suh
- Department of Orthopedics, Korea University Guro Hospital
| | - Si-Young Park
- Department of Orthopedics, Korea University Anam Hospital, Seoul, South Korea
| | - Jae-Hyuk Yang
- Department of Orthopedics, Korea University Guro Hospital
| | - Seung-Woo Han
- Department of Orthopedics, Korea University Ansan Hospital, Ansan
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Duchman KR, Miller BJ. Are Recently Trained Tumor Fellows Performing Less Tumor Surgery? An Analysis of 10 Years of the ABOS Part II Database. Clin Orthop Relat Res 2017; 475:221-228. [PMID: 27511202 PMCID: PMC5174043 DOI: 10.1007/s11999-016-5023-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 08/03/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The majority of orthopaedic trainees pursue additional subspecialty training at the conclusion of residency. Although national trends indicate that fellowship-trained surgeons are more frequently performing cases in their defined subspecialties, this may not be the case for recently trained tumor fellows. Prior work has established that low tumor case volume is a significant stressor for recently trained tumor fellows. Given the relative rarity of musculoskeletal tumors, it is important for prospective trainees to have clear expectations for the proportion of specialty-specific procedures early during their careers. In addition, knowledge of anticipated specialty case volume is important to optimize fellowship training and to provide guidance for meeting the public health requirements for orthopaedic oncology. QUESTIONS/PURPOSES We wished to determine (1) the number of examinees who self-reported tumor fellowship training during the last decade; (2) how many tumor fellowship-educated surgeons did an additional fellowship(s) in other subspecialties; (3) the number and proportion of tumor, trauma, adult reconstruction, and other procedures performed by tumor-trained fellows; and (4) changes in the proportion of procedures performed by tumor-trained fellows during the 10-year period of the study. METHODS The American Board of Orthopaedic Surgery Part II database was used to identify examinees who reported tumor fellowship training between 2004 and 2013. All submitted procedures were broadly categorized as "tumor," "trauma," "adult reconstruction," or "other." Annual procedure volumes were calculated and univariate analysis allowed comparison of categorized procedures during the duration of the study. RESULTS The median annual number of candidates reporting tumor fellowship training was 12.5 (range, 7-16). There were 28 of 118 (24%) candidates who reported additional fellowship training. A total of 14,718 procedures were performed by all candidates with tumor fellowship training during the 10-year period of the study, 42% of which were categorized as tumor procedures. Overall, only 36% of candidates reported tumor procedures making up greater than 50% of their case volume. Between 2004 to 2005 and 2012 to 2013, the proportion of tumor procedures decreased (45% versus 36%; p < 0.001), whereas the number of adult reconstruction procedures increased (9% versus 19%; p < 0.001). CONCLUSIONS Between 2004 and 2013, only one-third of recently trained tumor fellows had practices with tumor procedures accounting for greater than 50% of their total case volume. Furthermore, the proportion of tumor cases performed by recently trained tumor fellows decreased during the same time. The proportion of specialty-specific procedures is lower in orthopaedic oncology than other orthopaedic subspecialties, which is important information for current trainees interested in orthopaedic oncology fellowship training and for orthopaedic oncology educators. The findings in this study should serve as an initial platform for further discussion regarding the optimal number of fellowship-trained orthopaedic oncologists required to meet regional and national needs for an accessible and proficient work force.
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Affiliation(s)
- Kyle R. Duchman
- grid.214572.70000000419368294Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, IA 52242 USA
| | - Benjamin J. Miller
- grid.214572.70000000419368294Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, IA 52242 USA
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Gabarre S, Herrera A, Ibarz E, Mateo J, Gil-Albarova J, Gracia L. Comparative Analysis of the Biomechanical Behaviour of Two Cementless Short Stems for Hip Replacement: Linea Anatomic and Minihip. PLoS One 2016; 11:e0158411. [PMID: 27391328 PMCID: PMC4938462 DOI: 10.1371/journal.pone.0158411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/15/2016] [Indexed: 12/18/2022] Open
Abstract
A comparative study between two stems (Linea Anatomic and Minihip) has been performed in order to analyse the differences in their biomechanical behaviour, concerning stem micromotions and load transmission between stem and bone. From the corresponding finite element models, a parametric study was carried out to quantify ranges of micromotions taking into account: friction coefficient in the stem-bone interface, press-fit and two types of gait cycle. Micromotions were evaluated for each stem at six different levels along repeated gait cycles. An initial and marked stem subsidence at the beginning of the simulation was observed, followed by an asymptotic decrease due to friction forces. Once migration occurs, a repeated reversible cyclic micromotion is developed and stabilized as gait cycle times are simulated. The general motion pattern exhibited higher amplitude of micromotion for Minihip compared to Linea stem. The load transmission mechanism was analyzed, identifying the main internal forces. The results show higher local forces for Minihip stem up to 80% greater than for Linea stem. The differences of design between Minihip and Linea conditioned different distributions of load, influencing the posterior stress-shielding. Consequently, short stems require high bone stock and quality should, being indicated for young patients with high bone quality.
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Affiliation(s)
- Sergio Gabarre
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragón Institute for Engineering Research, Zaragoza, Spain
| | - Antonio Herrera
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
- * E-mail:
| | - Elena Ibarz
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragón Institute for Engineering Research, Zaragoza, Spain
| | - Jesús Mateo
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Jorge Gil-Albarova
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón Health Sciences Institute, Zaragoza, Spain
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis Gracia
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragón Institute for Engineering Research, Zaragoza, Spain
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Hofstede SN, Gademan MGJ, Vliet Vlieland TPM, Nelissen RGHH, Marang-van de Mheen PJ. Preoperative predictors for outcomes after total hip replacement in patients with osteoarthritis: a systematic review. BMC Musculoskelet Disord 2016; 17:212. [PMID: 27184266 PMCID: PMC4869370 DOI: 10.1186/s12891-016-1070-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This systematic review examines which patient related factors influence functional and clinical outcomes after total hip arthroplasty (THA) in patients with hip osteoarthritis (OA). METHODS We performed a systematic review according to the PRISMA guidelines. We searched databases and trial registries for prospective studies including OA patients who underwent primary THA. Studies with preoperative measurements on predictors, with at least 1 year follow-up were included. Risk of bias and confounding was assessed for two domains: follow-up rate and looking at independent effects. RESULTS Thirty-five studies were included (138,039 patients). Only nine studies (29 %) had low risk of bias for all domains thus suggesting an overall low quality of evidence. Studies were heterogeneous in the predictors tested and in the observed directions of the associations. Overall, preoperative function (13 studies (37 %), 2 with low risk of bias) and radiological OA (6 studies (17 %), 1 with low risk of bias) were predictors with the most consistent findings. Worse preoperative function and more severe radiological OA were associated with larger postoperative improvement. However, these patients never reached the level of postoperative functioning as patients with better preoperative function or less severe radiological OA. For age, gender, comorbidity, pain and quality of life the results of studies were conflicting. For BMI, some studies (n = 5, 2 with low risk of bias) found worse outcomes for patients with higher BMI. However, substantial improvement was still achieved regardless of their BMI. CONCLUSION There is not enough evidence to draw succinct conclusions on preoperative predictors for postoperative outcome in THA, as results of studies are conflicting and the methodological quality is low. Results suggest to focus on preoperative function and radiological osteoarthritis to decide when THA will be most effective. The present mapping of current evidence on the relationship between patient related factors and outcomes provides better information compared to individual studies and may help to set patient expectations before surgery. In addition, these findings may contribute to discussions on how to achieve the best possible postoperative outcome for specific patient groups. TRIAL REGISTRATION This systematic review was registered in Prospero, registration number RD42014009977 .
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Affiliation(s)
- Stefanie N Hofstede
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Medical Decision Making, J10-S, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300 RC, The Netherlands.
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Schwaiger BJ, Gersing AS, Lee S, Nardo L, Samaan MA, Souza RB, Link TM, Majumdar S. Longitudinal assessment of MRI in hip osteoarthritis using SHOMRI and correlation with clinical progression. Semin Arthritis Rheum 2016; 45:648-55. [PMID: 27162009 DOI: 10.1016/j.semarthrit.2016.04.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/26/2016] [Accepted: 04/04/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess the evolution of MR imaging findings in normal volunteers and subjects with hip osteoarthritis (OA) over 1.5 years described by the semi-quantitative Scoring Hip OA with MRI (SHOMRI) scoring system and their correlation with the evolution of clinical parameters. MATERIALS AND METHODS Hip MRI studies of 18 subjects with [Kellgren-Lawrence (KL) score = 2/3; mean age = 54.4 ± 11.2 years; 27.8% women] and 36 controls without radiographic OA [KL = 0/1; mean age = 43.7 ± 12.8 years; 50.0% women] were assessed at baseline and after 1.5 years by using SHOMRI, and their clinical status was evaluated by using Harris Hip Score and Hip Disability and Osteoarthritis Outcome Score (HOOS). Imaging and clinical parameters at baseline and their change over time were compared between groups using Mann-Whitney U and Fisher׳s exact tests. Spearman׳s rank correlations and generalized linear models adjusted for age, sex, BMI, and KL were used to assess associations between imaging and clinical findings. RESULTS At baseline, OA subjects had significantly higher SHOMRI total scores than controls [median (IQR): 12.5 (6-19.5) vs. 7 (4-13.5); p = 0.024]. Over 1.5 years, only the progression rate of subchondral cysts was significantly higher in OA subjects than in controls (16.7% vs. 0.0%; p = 0.033), while no significant differences were found for any of the other SHOMRI subscales. Baseline bone-marrow edema pattern (BMEP) was significantly associated with worsening pain (HOOS subscale; p = 0.018) and hip-related quality of life (HOOS subscale; p = 0.044). Progression of subchondral cysts was significantly associated with worsening symptoms other than pain (HOOS subscale, p = 0.030). Baseline KL did not significantly correlate with worsening of any clinical symptoms (each, p > 0.05). CONCLUSION In this relatively young study population without or with mild to moderate radiographic hip OA, only minimal differences were found between groups regarding the progression of hip abnormalities as assessed by SHOMRI over 1.5 years. However, BMEP predicted clinical worsening and subchondral cyst progression was associated with worsening symptoms. Although longer follow-up periods are required, this suggests that SHOMRI is a useful tool to monitor hip abnormalities and their progression longitudinally.
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Affiliation(s)
- Benedikt J Schwaiger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107.
| | - Alexandra S Gersing
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Sonia Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Lorenzo Nardo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Michael A Samaan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Richard B Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco 185 Berry St., Suite 350, San Francisco, CA 94107
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Hong JY, Han K, Shin DH, Chun EM. Quality of Life Analysis and Smoking Correlation in Symptomatic Spine Osteoarthritis: A Nationwide Health Survey Analysis of an Elderly Population with EQ-5D. PLoS One 2016; 11:e0151315. [PMID: 26991429 PMCID: PMC4798754 DOI: 10.1371/journal.pone.0151315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/26/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives To analyze quality of life in people with symptomatic spine osteoarthritis (OA) using the results of a cross-sectional, nationwide survey. Materials and Methods This study used data from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V-5; 2010–2012). After excluding ineligible subjects, the total number of subjects in the study was 8,963, including 4,091 males and 4,872 females. All participants reported disabilities related to spine OA. Plain radiographs of the spine were taken for all participants. Results Age, sex, smoking, drinking, education, and income level were significantly related to spine OA morbidity (P<0.05). OA morbidity was significantly higher in female ex-smokers (OR; 2.94, P<0.05). Quality of life (EQ-5D: L1~5) was significantly compromised in the group with spine OA compared to the group without spine OA (P<0.05). Overall, LQ 1, 2, 3, 4, and 5 domain scores were significantly higher in the group with spine OA (P<0.05). In the group with spine OA, quality of life was reduced on more than three questions for 34.3% of the group (EQ-5D: grade≥2); on two questions, for 18.5% of the group; and on one question, for 11.1% of the group. Mental stress, melancholy, and suicidal thinking were also more common in the group with spine OA (P<0.05). The group with radiographic spine OA but without symptoms did not have compromised EQ-5D scores, whereas the group with radiographic OA and symptoms showed a significantly reduced quality of life. Conclusions Quality of life was significantly reduced in the group with symptomatic spine OA in a large cross-sectional analysis. Physicians should consider quality of life in the treatment of patients with spine OA
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Affiliation(s)
- Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Ansan, South Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, Catholic University, Seoul, South Korea
| | - Dong-Hyup Shin
- Department of Orthopedics, Korea University Ansan Hospital, Ansan, South Korea
| | - Eun Mi Chun
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
- * E-mail:
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Judd DL, Winters JD, Stevens-Lapsley JE, Christiansen CL. Effects of neuromuscular reeducation on hip mechanics and functional performance in patients after total hip arthroplasty: A case series. Clin Biomech (Bristol, Avon) 2016; 32:49-55. [PMID: 26802531 PMCID: PMC4779395 DOI: 10.1016/j.clinbiomech.2015.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 11/25/2015] [Accepted: 12/22/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Following total hip arthroplasty, patients demonstrate compensatory movement strategies during activities of daily living such as walking and stair climbing. Movement compensations are important markers of functional decline in older adults and are related to poor functional capacity. Despite increased utilization of hip arthroplasty, persistent movement compensation, and functional performance deficits, no consensus on postoperative rehabilitation exists. Neuromuscular reeducation techniques offer a strategy to improve movement quality by emphasizing hip abductor performance and pelvic stability. This case series illustrates changes in movement strategy around the hip in response to targeted neuromuscular reeducation techniques after hip arthroplasty. METHODS Five participants received an 8-week exercise program following total hip arthroplasty, emphasizing targeted neuromuscular reeducation techniques hallmarked by specific, weight-bearing exercise to improve hip abductor performance and pelvic stability. Five additional participants were supervised and followed for comparison. FINDINGS Participants in the neuromuscular reeducation program improved their internal hip abductor moments and vertical ground reaction forces during walking and stair climbing. They also improved their functional performance and hip abductor strength outcomes. INTERPRETATION Targeted neuromuscular reeducation techniques after total hip arthroplasty provided a positive effect on biomechanical outcomes, functional performance, and muscle strength. Through focused use of the hip abductor muscles, increased internal hip abductor moments were observed. This intervention potentially promotes pelvic stability, and may contribute to improved performance on tasks such as stair climbing, fast walking, and balance. The results suggest that neuromuscular reeducation offers a unique effect on movement strategy and function for patients following total hip arthroplasty.
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Affiliation(s)
- Dana L. Judd
- University of Colorado Anschutz Medical Campus, Physical Therapy Program, 13121 E. 17 Ave, Mail Stop C244, Aurora, CO 80045, USA
| | - Joshua D. Winters
- University of Colorado Anschutz Medical Campus, Physical Therapy Program, 13121 E. 17 Ave, Mail Stop C244, Aurora, CO 80045, USA
| | - Jennifer E. Stevens-Lapsley
- University of Colorado Anschutz Medical Campus, Physical Therapy Program, 13121 E. 17 Ave, Mail Stop C244, Aurora, CO 80045, USA
| | - Cory L. Christiansen
- University of Colorado Anschutz Medical Campus, Physical Therapy Program, 13121 E. 17 Ave, Mail Stop C244, Aurora, CO 80045, USA
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Mayers W, Schwartz B, Schwartz A, Moretti V, Goldstein W, Shah R. National trends and in hospital outcomes for total hip arthroplasty in avascular necrosis in the United States. INTERNATIONAL ORTHOPAEDICS 2016; 40:1787-92. [DOI: 10.1007/s00264-015-3089-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/21/2015] [Indexed: 01/07/2023]
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Gallo J, Raska M, Konttinen YT, Nich C, Goodman SB. Innate immunity sensors participating in pathophysiology of joint diseases: a brief overview. J Long Term Eff Med Implants 2015; 24:297-317. [PMID: 25747032 DOI: 10.1615/jlongtermeffmedimplants.2014010825] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The innate immune system consists of functionally specialized "modules" that are activated in response to a particular set of stimuli via sensors located on the surface or inside the tissue cells. These cells screen tissues for a wide range of exogenous and endogenous danger/damage-induced signals with the aim to reject or tolerate them and maintain tissue integrity. In this line of thinking, inflammation evolved as an adaptive tool for restoring tissue homeostasis. A number of diseases are mediated by a maladaptation of the innate immune response, perpetuating chronic inflammation and tissue damage. Here, we review recent evidence on the cross talk between innate immune sensors and development of rheumatoid arthritis, osteoarthritis, and aseptic loosening of total joint replacements. In relation to the latter topic, there is a growing body of evidence that aseptic loosening and periprosthetic osteolysis results from long-term maladaptation of periprosthetic tissues to the presence of by-products continuously released from an artificial joint.
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Affiliation(s)
- Jiri Gallo
- Department of Orthopedics, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc 775 20, Czech Republic
| | - Milan Raska
- Department of Immunology, Faculty of Medicine & Dentistry, Palacky University, Hnevotinska 3, 775 15 Olomouc, Czech Republic
| | - Yrjo T Konttinen
- Department of Clinical Medicine, University of Helsinki and ORTON Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland
| | - Christophe Nich
- Laboratoire de Biomecanique et Biomateriaux Osteo-Articulaires - UMR CNRS 7052, Faculte de Medecine - Universite Paris 7, Paris, France; Department of Orthopaedic Surgery, European Teaching Hospital, Assistance Publique - Hopitaux de Paris
| | - Stuart B Goodman
- Department of Orthopaedic Surgery Stanford University Medical Center Redwood City, CA
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Abstract
INTRODUCTION Osteoarthritis (OA) is the most prevailing form of joint disease, with symptoms affecting 10 - 12% of the adult population with a projection of a 50% increase in prevalence in the next two decades. The disease characteristics are defined by articular cartilage damage, low-grade synovial inflammation and hypertrophic bone changes, leading to pain and functional deterioration. To date, available pain treatments are limited in their efficacy and have associated toxicities. No structural disease modification agents have been approved by regulatory agencies for this indication. AREAS COVERED We reviewed drugs in Phase II - III for OA pain and joint structure modification. Different aspects of structure modification are divided into targets of inflammatory pathway, cartilage catabolism and anabolism, and subchondral bone remodeling. EXPERT OPINION Further insight into the pathophysiology of the disease will allow for development of novel target classes focusing on the link between symptomatology and structural changes. Given the complexity of OA, one single therapy is unlikely to be universally and uniformly effective. Promising therapies are under development, but there are obstacles in the translation of treatment from preclinical models and trial designs need to be cognizant of the complex reasons for previous trial failures.
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Affiliation(s)
- Shirley Pei-Chun Yu
- a 1 Royal North Shore Hospital, Department of Rheumatology , St. Leonards, NSW 2065, Sydney, Australia
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Agricola R, Leyland KM, Bierma-Zeinstra SMA, Thomas GE, Emans PJ, Spector TD, Weinans H, Waarsing JH, Arden NK. Validation of statistical shape modelling to predict hip osteoarthritis in females: data from two prospective cohort studies (Cohort Hip and Cohort Knee and Chingford). Rheumatology (Oxford) 2015; 54:2033-41. [PMID: 26139655 DOI: 10.1093/rheumatology/kev232] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To prospectively investigate whether hip shape variants at baseline are associated with the need for future total hip replacement (THR) in women and to validate the resulting associated shape variants of the Cohort Hip and Cohort Knee (CHECK) cohort and the Chingford cohort. METHODS Female participants from the CHECK cohort without radiographic OA (Kellgren-Lawrence score <2) at baseline were included (1100 hips); 22 hips had a THR within 5 years of follow-up. For the Chingford cohort, with only female participants, hips without radiographic OA at baseline were selected and a nested case-control design was used, with 19 THR cases within 19 years of follow-up and 95 controls matched 5 to 1 for age and BMI. Hip shape on baseline anteroposterior pelvic radiographs was assessed by statistical shape modelling (SSM) using the same model for both cohorts. RESULTS In the CHECK and Chingford cohorts, the respective mean age was 55.8 (s.d. 5.1) and 53.6 (s.d. 5.4) and the BMI was 26.14 (s.d. 4.3) and 25.7 (s.d. 3.3), respectively. Multiple shape variants of the hip were significantly (P < 0.05) associated with future THR in both the CHECK (modes 4, 11, 15, 17 and 22) and Chingford (modes 2 and 17) cohorts. Mode 17 [odds ratio (OR) 0.51 (95% CI 0.33, 0.80) in the CHECK cohort], representing a flattened head-neck junction and flat greater trochanter, could be confirmed in the Chingford cohort [OR 0.41 (95% CI 0.23, 0.82)]. Modes 4 and 15 of the CHECK cohort also showed non-significant trends in the Chingford cohort. CONCLUSION Several baseline shape variants are associated with the future need for THR within a cohort. Despite differences in participant characteristics, radiographic protocol and follow-up time, we could validate at least one shape variant, suggesting that SSM is reasonably transferable between cohorts.
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Affiliation(s)
- Rintje Agricola
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands, Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis,
| | - Kirsten M Leyland
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sita M A Bierma-Zeinstra
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands, Department of General Practice, Erasmus University Medical Centre, Rotterdam
| | - Geraint E Thomas
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Pieter J Emans
- Department of Orthopaedics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Timothy D Spector
- Department of Twin Research and Genetic Epidemiology, King's College, London, UK
| | - Harrie Weinans
- Department of Orthopaedics and Department of Rheumatology, University Medical Centre Utrecht, Utrecht and Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Jan H Waarsing
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nigel K Arden
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Dyment NA, Hagiwara Y, Jiang X, Huang J, Adams DJ, Rowe DW. Response of knee fibrocartilage to joint destabilization. Osteoarthritis Cartilage 2015; 23:996-1006. [PMID: 25680653 PMCID: PMC4757847 DOI: 10.1016/j.joca.2015.01.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/16/2015] [Accepted: 01/28/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A major challenge to understanding osteoarthritis (OA) pathology is identifying the cellular events that precede the onset of cartilage damage. The objective of this study is to determine the effect of joint destabilization on early changes to fibrocartilage in the joint. DESIGN/METHODS The anterior cruciate ligament was transected in collagen reporter mice (Col1CFP and ColXRFP). Mineralization labels were given every 2 weeks to measure new mineralized cartilage apposition. Novel fluorescent histology of mineralized tissue was used to characterize the changes in fibrocartilage at 2 and 4 weeks post-injury. RESULTS Changes in fibrocartilaginous structures of the joint occur as early as 2 weeks after injury and are well developed by 4 weeks. The alterations are seen in multiple entheses and in the medial surface of the femoral and tibial condyles. In the responding entheses, mineral apposition towards the ligament midsubstance results in thickening of the mineralize fibrocartilage. These changes are associated with increases in ColX-RFP, Col1-CFP reporter activity and alkaline phosphatase enzyme activity. Mineral apposition also occurs in the fibrocartilage of the non-articular regions of the medial condyles by 2 weeks and develops into osteophytes by 4 weeks post-injury. An unexpected observation is punctate expression of tartrate resistant acid phosphatase activity in unmineralized fibrochondrocytes adjacent to active appositional mineralization. DISCUSSION These observations suggest that fibrocartilage activates prior to degradation of the articular cartilage. Thus clinical and histological imaging of fibrocartilage may be an earlier indicator of disease initiation and may indicate a more appropriate time to start preventative treatment.
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Affiliation(s)
- N A Dyment
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine and Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT 06032, USA.
| | - Y Hagiwara
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine and Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT 06032, USA; Department of Orthopedic Surgery, Nippon Medical School Hospital, Tokyo 113, Japan.
| | - X Jiang
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine and Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT 06032, USA.
| | - J Huang
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine and Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT 06032, USA.
| | - D J Adams
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine and Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT 06032, USA.
| | - D W Rowe
- Center for Regenerative Medicine and Skeletal Development, School of Dental Medicine and Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT 06032, USA.
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Kumar D, Wyatt C, Chiba K, lee S, Nardo L, Link TM, Majumdar S, Souza RB. Anatomic correlates of reduced hip extension during walking in individuals with mild-moderate radiographic hip osteoarthritis. J Orthop Res 2015; 33:527-34. [PMID: 25678302 PMCID: PMC4376613 DOI: 10.1002/jor.22781] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 10/30/2014] [Indexed: 02/04/2023]
Abstract
To identify radiographic and MR features of hip osteoarthritis (OA) related to reduced hip extension during walking. Sixty six subjects, were stratified into those with (n = 36, KL = 2, 3) and without (n = 30, KL = 0, 1) radiographic hip OA. Cartilage and labrum lesions were graded semi-quantitatively on hip MRI. Alpha angle and lateral center edge (LCE) angle were measured. Sagittal kinematics and kinetics were calculated during walking at speed of 1.35 m/s using 3-D motion capture. All subjects completed Hip disability and Osteoarthritis Outcome Score (HOOS), timed up and go, and 6 min walk tests. Variables were compared between the two groups using one-way ANOVA (adjusting for age). Correlations of radiographic and MR parameters with peak hip extension were calculated. The OA group was older, had greater pain, and limitation of function. They also had lower peak hip extension and higher peak hip flexion; and worse acetabular and femoral cartilage lesions. Peak hip extension and flexion correlated with KL grade, cartilage lesions in the inferior and posterior femur. Reduced hip extension and greater hip flexion during walking are present in high functioning (HOOS > 85%) individuals with mild-moderate hip OA, and are associated with cartilage lesions.
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Affiliation(s)
| | - Cory Wyatt
- 1700 4 St, Suite 203, Byers Hall, Mission Bay, University of California, San Francisco, CA 94158
| | - Ko Chiba
- Department of Orthopedic Surgery, Nagasaki University School of Medicine
| | - Sonia lee
- 185 Berry St, Suite 350, UCSF China Basin, San Francisco, CA, 94107
| | - Lorenzo Nardo
- 185 Berry St, Suite 350, UCSF China Basin, San Francisco, CA, 94107
| | - Thomas M. Link
- 185 Berry St, Suite 350, UCSF China Basin, San Francisco, CA, 94107
| | - Sharmila Majumdar
- 1700 4 Street, Suite 203, Byers Hall, UCSF Mission Bay, San Francisco, CA 94158
| | - Richard B. Souza
- 185 Berry St, Suite 350, UCSF China Basin, San Francisco, CA, 94107
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Outcomes after primary open or endoscopic abductor tendon repair in the hip: a systematic review of the literature. Arthroscopy 2015; 31:530-40. [PMID: 25442666 DOI: 10.1016/j.arthro.2014.09.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/12/2014] [Accepted: 09/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to systematically appraise the evidence on primary open and endoscopic abductor tendon repair. METHODS A systematic review of the literature was performed to (1) identify the demographic undergoing abductor tendon repair, (2) summarize the overall outcomes after primary surgical abductor tendon repair, (3) identify the type of tear most commonly encountered intraoperatively, (4) summarize the repair methods used, and (5) identify the published complication and tendon retear rates. RESULTS A total of 8 articles were identified as eligible for inclusion. All studies were Level IV Evidence. Of the patients undergoing surgical repair, 90% were women. As assessed by a variety of outcome measures, most patients reported good to excellent functional outcomes and pain reduction after open or endoscopic repair. Intraoperatively, tears of the gluteus medius and partial-thickness tears were encountered most often. Tears involving both the gluteus medius and minimus occurred 29% of the time. Complication rates were low for both the open and endoscopic approaches. No tendon retears were documented after endoscopic repair, whereas the retear rate after open repair was 9%. CONCLUSIONS Patients undergoing surgical repair for partial- and full-thickness tears are mostly women. Intraoperatively, tears almost always include the gluteus medius, with concomitant tearing of the gluteus minimus in approximately one-third of cases. Both open and endoscopic techniques are viable surgical approaches to repairing abductor tendon tears in the hip that produce good to excellent functional results and reduce pain; however, endoscopic repair appears to result in fewer postoperative complications including tendon retear. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Fibroblast growth factor 18 increases the trophic effects of bone marrow mesenchymal stem cells on chondrocytes isolated from late stage osteoarthritic patients. Stem Cells Int 2014; 2014:125683. [PMID: 25544847 PMCID: PMC4269084 DOI: 10.1155/2014/125683] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 01/01/2023] Open
Abstract
Coculture of mesenchymal stem cells with chondrocytes increases production of cartilaginous matrix. Chondrocytes isolated from late stage osteoarthritic patients usually lost their phenotype of producing cartilaginous matrix. Fibroblast growth factor 18 is believed to redifferentiate OA chondrocyte into functionally active chondrocytes. The aim of this study is to investigate the supportive effects of MSCs on OA chondrocytes and test if FGF18 could enhance the responsiveness of OA chondrocytes to the support of MSCs in a coculture system. Both pellet and transwell co-cultures were used. GAG quantification, hydroxyproline assay, and qPCR were performed. An ectopic models of cartilage formation was also applied. Our data indicated that, in pellets coculture of MSCs and OA chondrocytes, matrix production was increased in the presence of FGF18, comparing to the monoculture of chondrocytes. Results from transwell coculture study showed that expression of matrix producing genes in OA chondrocytes increased when cocultured with MSCs with FGF18 in culture medium, while hypertrophic genes were not changed by coculture. Finally, coimplantation of MSCs with OA chondrocytes produces more matrix than chondrocytes only. In conclusion, FGF18 can restore the responsiveness of OA chondrocytes to the trophic effects of MSCs. Coimplantation of MSCs and OA chondrocytes treated with FGF18 may be a good alternative cell source for regenerating cartilage tissue that is degraded during OA pathological changes.
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Abstract
Hip and groin pain is commonly experienced by athletes. The differential diagnosis should include both intra-articular and extra-articular sources for pain and dysfunction. A comprehensive history and physical examination can guide the evaluation of hip pain and the potential need for further diagnostics. Treatment of athletes with hip disorders includes education, addressing activities of daily living, pain-modulating medications or modalities, exercise and sports modification, and therapeutic exercise. Surgical techniques for prearthritic hip disorders are expanding and can offer appropriate patients a successful return to athletic endeavors when conservative measures are not effective.
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Affiliation(s)
- Heidi Prather
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA.
| | - Berdale Colorado
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA
| | - Devyani Hunt
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA
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