Objective To investigate the rotational mismatch of total kneereplacement with medial 1/3 of tibial tuberosity as bony landmark in osteoarthritic patients with varus or valgus deformity. Methods Axial images on computed tomography of 62 knees (including 55 varus deformities and 7 valgus deformities) in 32 Chinese osteoarthritic patients who had total knee arthroplasty were analyzed, compared with that of 10 healthy knees. On images of the distal femur, the angle between the lines of surgical epicondylar axis(SEA) and posterior condylar axis was measured as posterior condylar angle (PCA), and on images of the proximal tibia, a baseline for the anteriorposterior axis of each component was drawn based on the SEA for the femur and the medial 1/3 of the tibial tuberosity for the tibia. The angle between these lines (Angle α) was defined as therotational mismatch between the components when they were aligned to the anatomic landmarks of each bone. Results The sulcus of medial epicondyle of femur could be identified on CT images of over 80% osteoarthritic knees; the median value of PCA was +2.36°, with an individual variation of 0° to +7.5°. Angle α was +6.45±3.68°(range, 0° to +11.8°) in 10 healthy knees, which increased significantly to +10.85±10.47°(range, 0° to +28.1°)in 55 varus knees (P＜0.05), which also increased significantly to +11.6±7.3°(range, -6.5° to +26.8°) in 7 valgus knees (P＜ 0.05). Conclusion With the medial 1/3 of the tibial tuberosity as the rotational landmark for the tibial component, there was a tendency to align the tibial component in external rotational position relative to the femoral component in knees with normal alignment, the rotational mismatch increased in Chinese osteoarthritic knees with varus and valgus deformity.
Objective To compare the effectiveness and complications of various surgical techniques in the treatment of the osteoarthritis of the trapeziometacarpal joint. Methods We searched MEDLINE (1966 to 2005), Cochrane Controlled Trials Register (Issue 3, 2005) and CBM (1978 to 2005), and handsearched the references of relevant studies. Only randomized controlled trials were included. We assessed the methodological quality of the included studies, extracted data, and performed quantitative and qualitative analyses. Results Seven studies were included, and all had some methodological shortcomings. There was b evidence that in the short term, ligamentous reconstruction, tendon interposition (LRTI) and trapeziectomy alone provide similar results with regard to pain relief, grip and pinch strength, range of thumb motion, hand function and overall satisfaction of patients, but more complications occur with LRTI than with trapeziectomy alone. Conflicting evidence was found about whether LRTI resulted in less subsidence of the first metacarpal bone than trapeziectomy alone. There was moderate evidence that LRTI and ligament reconstruction without tendon interposition (LR) did not have significant differences in thumb strength, patient satisfaction and subsidence of the first metacarpal bone. Limited evidence showed that LR produced better functional scores than LRTI and similar results in pain relief to LRTI. Conflicting evidence supported that LR resulted in greater motion range of thumb than LRTI. Only limited evidence showed that effectiveness was similar between LRTI and Swanson implant. We did not find randomized controlled trials about other surgical techniques. Conclusion Not enough evidence supports superiority of one technique over another. More high quality randomized controlled trials and long term follow-up are necessary.
ObjectiveTo investigate the effectiveness of distraction therapy assisted by arthroscope in the treatment of ankle traumatic osteoarthritis.
MethodsBetween October 2013 and October 2014, 13 patients with ankle traumatic osteoarthritis were treated, including 8 males and 5 females with an age range of 44-63 years (mean, 55.2 years). The left ankle and the right ankle were involved in 4 and 9 cases respectively. The disease duration was 1.5-10.0 years (median, 5 years). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale score was 51.00±7.09; the short-form 36 health survey scale (SF-36) score was 40.82±4.62. According to Scranton grade system, 9 cases were rated as grade II and 4 cases as grade III. First, ankle hyperplasia osteophytes was removed under arthroscope, then Ilizarov apparatus was used to maintain distraction of 5-10 mm ankle space for 3 months.
ResultsOne case had postoperative pin tract infection after removing the external fixation, and infection was controlled by dressing treatment; no related complications occurred in the other patients. All patients got follow-up of 12-18 months (mean, 14.7 months). Patients achieved disappearance of ankle swelling, pain relief, and were able to walk after rehabilitation. The ankle activity was obviously improved. At last follow-up, AOFAS ankel-hind foot scale score and SF-36 score were significantly increased to 85.23±6.41 and 56.29±6.20 respectively (t=20.756, P=0.025; t=11.647, P=0.018). According to AOFAS scores, the results were excellent in 4 cases, good in 8 cases, and fair in 1 case; the excellent and good rate was 92.3%. Postoperative X-ray film showed normal ankle position and alignment, osteophytes at the edges of the tibia and talus, articular surface sclerosis, normal joint space, and no joint swelling.
ConclusionDistraction therapy assisted by arthroscope is an effective method for treating ankle traumatic osteoarthritis.
Objective To assess the curative effect of the subtalararthrodesis on the serious subtalar joint with the posterior tibial tendon dysfunction.Methods From October 2000 to February 2006, 31 patients (18 males, 13 females; age 23-62 years, averaged 36.4years) with serious subtalar joint osteoarthrisis and stage Ⅱ posterior tibial tendon dysfunction were treated by the subtalar arthrodesis. The tibial tendon dysfunction involved 15 right and 16 left lower extremities, which were caused by retrograde osteoarthritis in 14 patients,sequel of an injury in 8 patients, infection in 7 patients, and anatomic structural abnormity in 2 patients. The treatment course averaged 9.5 months (range, 6-30 months). Before the subtalar arthrodesis, the injured tendons were repaired, and then the bone grafting was performed in the tarsus sinus. All of the patients were assessed before and after operation according to the Hindfoot scores system (American Orthopedics Foot and Ankle Society, AOFAS). Results Among the patients, 28 were followed up on an average of 23.6 months (range, 8-61 months). The AOFAS scores ranged from 45.30±1.08 before operation to 79.60±2.14 afteroperation. The pain indexes ranged from 15.40±2.23 before operation to 38.50±2.61 after operation. The functional indexes of the foot and ankle joint ranged from averaged 21.60±3.01 before operation to averaged 37.40±2.83 after operation. The statistical analysis of the t-test on all the above data showed that there was a significant difference between beforeoperation and after operation (P＜0.01). The angles between the longitudinal line of the talar and the calcaneal bone were 43.70±1.06° before operation and 29.40±0.98° after operation, and the deviation angles between the calcanealline and the talus were 48.20±0.85° before operation and 39.40±1.02° after operation. There was a significant difference between before operation and after operation (P＜0.01). Conclusion The subtalar arthrodesis combined with the bone grafting in the tarsus sinus and the repair of the injured tendons can effectivelycorrect the deformity of the deformity of the metapodium, relieve the pain, retin the adjacent joint motion ability, and this method can be recommended for the adult patient who suffers from serious subtalar osteoarthritis and stage Ⅱ osterior tibial tendon dysfunction.
Objective To study the effect of simultaneous bilateral total hip arthroplasty in a single procedure. Methods From October 1999 to March 2004, 15 patients (30 hips) underwent simultaneous sequential bilateral total hip arthroplasty (THAs) in a single procedure. Of the 15 patients, 11 were male (22 hips) and 4 were female (8 hips). Their ages ranged from 35 to 70 years. Their courses of disease ranged from 1 year to 50 years (4.8 years on average). The Harris scores of the joint function before the operation ranged from 12 to 45 points (27 points on average). Five were done with Smith-Peterson and 10 were done with Moore. Results The operative time was 3 hours and 25 minutes to 5 hours (4 hours and 10 minutes on average). The volume of blood transfusion during operation was 400 to 2 400 ml (1 160 mlon average). All the 15 patients were followed up for 3 to 35 months (18 monthson average). The Harris scores of the joint function after the operation rangedfrom 70 to 100 points (86 points on average). There was significant difference in the scores between before and after operations (Plt;0.05). There was only 1death within 1 months of the operation and no serious between complications such as infection, pulmonary embolism, and deep vein plug. All the patients were still ambulant in the community and gained significant pain relief. Conclusion Simultaneous bilateral total hip arthroplasty in a single procedure is a safe and effective method. However, the decision of performing singlestage bilateral total hip arthroplasty should be carefully made and preoperative preparation should be sufficiently made.
Osteoarthritis (OA) is a degenerative joint disease characterized by redness, swelling, heat, pain, functional impairment, and joint deformities. In severe cases, it can lead to joint disability and affect quality of life. However, the pathogenesis of OA is still unclear, but studies have shown that the signaling pathway dominated by ceramide-1-phosphate can lead to joint pain, inflammation, and degeneration. Therefore, this article summarizes and analyzes the pathogenesis of OA dominated by the ceramide-1-phosphate signaling pathway, aiming to provide references for future research.
ObjectiveTo observe the clinical effect of combined glucosamine hydrochloride and antiosteoporosis drugs in the treatment of senile knee osteoarthritis.
MethodsA total of 120 patients with osteoarthritis of the knee treated from January 2014 to December 2015 were randomly divided into observation group and control group with 60 cases in each. The observation group received not only oral glucosamine hydrochloride, but calcium D3, alfacalcidol, and sodium phosphate for anti-osteoporosis treatment, while the control group was only given oral glucosamine hydrochloride. Lequesne score, curative effect and adverse drug reactions were compared between the two groups 2, 4, and 6 weeks after the beginning of treatment.
ResultsWithin two weeks of treatment, there was no significant difference between the two groups in the effective rate (P ＞ 0.05) . But four and six weeks after treatment, the efficiency in the observation group was significantly higher than that in the control group (χ2=6.806, P ＜ 0.01; χ2=24.762, P ＜ 0.01) . Four and six weeks after treatment, Lequesne score of the observation group was significantly lower than that of the control group (t=2.199, P ＜ 0.05; t=4.748, P ＜ 0.001) . There was no significant difference in terms of adverse reactions between the two groups before and after treatment (χ2=0.617, P ＞ 0.05) .
ConclusionCompared with single hydrochloric amino glucose treatment, glucosamine hydrochloride combined with anti-osteoporosis treatment for senile knee osteoarthritis has better treatment effect without increase in adverse drug reactions, and it is worth of clinical application.
To review the structure and function of the calcified cartilage zone and its role in the pathogenesis of osteoarthritis (OA). Methods Recent l iterature about calcified zone was reviewed and analyzed in terms of architecture, composition, biomechanics, and biological function. Results Calcified zone has particular structure and material properties, and functions as a semi permeable membrane; chondrocytes in the calcified zone retain some characteristics of growth plate cells, which play a crucial role in cartilage function maintenance and pathogenesis of OA. Therefore, reconstructionof the calcified zone at osteochondral conjunction has become one of the hot research in the fields of interface tissue engineering. Conclusion It is necessary to pay more attention to calcified cartilage zone, which is important for both the treatment of OA and the preparation of tissue engineered osteochondral composite.
ObjectiveTo explore the efficacy of calcitonin combined with glucosamine hydrochloride on knee osteoarthritis.
MethodsAccording to Kellgren-Lawrence radiographic scoring system, 156 patients with knee osteoarthritis diagnosed from November 2014 to April 2015 were classified as mild, moderate and severe cases. All of the patients were divided into control group (treated by glucosamine hydrochloride only) and trial group (treated by calcitonin combined with glucosamine hydrochloride) via table of random sampling numbers (with 78 patients in each group). The West Ontario and Manchester University (WOMAC) score was recorded at the 6th week and the 3rd month after the medication treatment.
ResultsIn the patients with mild osteoarthritis, there were significant differences in WOMAC score of both groups at the 6th week and the 3rd month after treatment compared with those before the treatment (P<0.05); there were no significant differences between the two groups at the same time points after the treatment (P>0.05). In the patients with moderate osteoarthritis, WOMAC scores in the control group at the 3rd month differed much from that before the treatment (P<0.05); there were no significant differences between the two groups at the same time points after the treatment (P>0.05). In the patients with serious osteoarthritis, there was no significant difference in WOMAC scores in the control group after the treatment compared with that before the treatment (P>0.05); while in the trial group, the scores at the 3rd month after the treatment differed much from that before the treatment (P<0.05), and also from that in the control group (P<0.05).
ConclusionFor mild knee osteoarthritis, the combined treatment is not superior to the single use of glucosamine hydrochloride. For moderate knee osteoarthritis, the combined treatment has faster effect than the single use of glucosamine hydrochloride. For severe osteoarthritis, the use of single glucosamine hydrochloride is not effective, while the combination of calcitonin and glucosamine hydrochloride is effective at the 3rd month after the treatment.
Objective To assess the efficacy of medial wedged proximal tibial osteotomy for treating knee osteoarthritis with varus deformity. Methods From July 1996 to September 1999, 19 patients with knee osteoarthritis accompanied by varus deformity were treated by medial wedged proximal tibial osteotomy combined with internal fixation. Full-length anteriorposterior radiographs were taken preoperatively, 8 weeks and 2 years postoperatively. The parameters including the femorotibial angle, the tibial angle, the femoral angle, the femoral condyletibial plateau angle, and the medial joint space, were measured from these radiographs. The function of knee was evaluated according to the 100point rating scale standard of knee.Results Themean postoperative score had been significantly improved from 48.6±16.6 pointsto 81.7±14.8 points after 2 years of operation. The medial joint spacehad been increased from 2.2±1.6mm to 4.9±1.5 mm and the femoral condyle-tibial anglehad been decreased from 7.4°±3.1° to 1.7°± 3.1°. There were complications in 3 cases: 2 casesof superficial wound infections and 1 case of intraarticular fracture. There were no delayed union and recurrence of varus deformity. Conclusion Medial wedged proximal tibial osteotomy combined with internal fixation provides an efficacious approach to treat knee osteoarthritis with varus deformity.
