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Objective: To investigate the influence of the degree of acetabular deformity and the learning-curve on the acetabular cup positions in total hip arthroplasty (THA) for adults with developmental dysplasia of hip (DDH)., Methods: Between January 2008 and December 2015, 130 patients (144 hips) with DDH underwent primary THA, and the clinical data were analyzed retrospectively. Fifty-three patients (59 hips) were admitted before 2012, and 77 patients (85 hips) were treated after 2012. There were 32 males and 98 females, aged from 31 to 83 years (mean, 61). Unilateral replacement was performed in 116 cases and bilateral replacement in 14 cases. Of 144 hips, 48 hips were rated as Crowe type I, 57 hips as type II, and 39 hips as type of III/IV. The standard pelvic radiograph was taken within 1 week after operation. The mediCAD software was adopted to measure the angle of anteversion and abduction, bony coverage, and the distance between true rotating center and optimal rotating center to the connection of teardrops and the horizontal distance between two centers to evaluate the qualified rate of acetabular cup positions., Results: Compared with the patients with the same type in 2013-2015 group, the anteversion angle and qualified rate of acetabular cup position significantly decreased in patients with Crowe I ( P <0.05); the horizontal distance significantly increased and qualified rate of acetabular cup position significantly decreased in patients with Crowe II ( P <0.05); and the anteversion angle significantly decreased and the horizontal distance significantly increased in patients with Crowe III/IV ( P <0.05) in 2008-2012 group. But no significant difference was shown in the other indexes ( P >0.05). In all Crowe types, the vertical distance between the true rotating center and the optimal rotating center increased with the degree of acetabular deformity in both 2008-2012 group and 2013-2015 group, showing significant difference ( P <0.05), but no significant difference was found in the other indexes ( P >0.05)., Conclusions: For adults with acetabular dysplasia, there are high potential risks for unsatisfactory acetabular cup positions during primary THA. So it is necessary to evaluate acetabular deformities and to sum up operative experience so as to improve the accuracy of cups installation.

Objective: To investigate the expressions of cartilage degenerative related genes in meniscus, and to evaluate the potential effect of meniscal damage on cartilage degeneration, and to analyze the relationship between microRNAs (miRNAs) expression and cartilage degeneration., Methods: Meniscal tissue was collected from 5 patients undergoing partial meniscectomy between September 2012 and October 2013 (experimental group), and normally meniscal tissue without tearing from amputees was used as controls (control group). Pathological changes of menisci were observed; and real-time fluorescent quatitative PCR was performed to examine the relative expression levels of cartilage degenerative related genes and miRNAs: Aggrecan (ACAN), type X collagen (COL10A1), matrix metalloproteinases 13 (MMP-13), CCAAT enhancer binding protein β (CEBP-β), a disintegrin and metalloproteinase with thrombospondinmotif 5 (ADAMTS-5), miR-193b, miR-92a, and miR-455-3p in meniscus., Results: There were varying degrees of degenerative pathological changes in torn meniscus of experimental group. Compared with normal meniscus of control group, the expression of ACAN was decreased, while the expressions of COL10A1, CEBP-β, ADAMTS-5, and MMP-13 were increased in torn meniscus of experimental group; and significant difference was found (P < 0.05) except ACAN and MMP-13 (P > 0.05). The expressions of miR-92a, miR-455-3p, and miR-193b in torn meniscus of experimental group were significantly higher than those in normal meniscus of control group (P < 0.05)., Conclusion: Meniscal tissue has the intrinsic tendency of degeration after meniscus tear. The torn meniscus has greater stimulative impact on cartilage degeneration than normally morphological meniscus without tearing. The cartilage degenerative related miRNAs, including miR-193b, miR-92a, and miR-455-3p may contribute to the up-regulation of osteoarthritis.

Objective: To investigate the microRNA (miRNA) expression profile during chondrogenic differentiation of human adipose-derived stem cells (hADSCs), and assess the roles of involved miRNAs during chondrogenesis., Methods: hADSCs were harvested and cultured from donors who underwent elective liposuction or other abdominal surgery. When the cells were passaged to P3, chondrogenic induction medium was used for chondrogenic differentiation. The morphology of the cells was observed by inverted phase contrast microscopy. Alcian blue staining was carried out at 21 days after induction to access the chondrogenic status. The expressions of chondrogenic proteins were detected by ELISA at 0, 7, 14, and 21 days. The miRNA expression profiles at pre- and post-chondrogenic induction were obtained by microarray assay, and differentially expressed miRNAs were verified by real-time quantitative PCR (qRT-PCR). The targets of the miRNAs were predicted by online software programs., Results: hADSCs were cultured successfully and induced with chondrogenic medium. At 21 days after chondrogenic induction, the cells were stained positively for alcian blue staining. At 7, 14, and 21 days after chondrogenic induction, the levels of collogen type II, Col2a1, aggrecan, Coll0a1, and chondroitin sulfate in induced hADSCs were significantly higher than those in non-induced hADSCs (P<0.05). Eleven differentially expressed miRNAs were found, including seven up-regulated and four down-regulated. Predicted target genes of the differentially expressed miRNAs were based on the overlap from three public prediction algorithms, with the known functions of regulating chondrogenic differentiation of stem cells, self-renewal, signal transduction, intracellular signaling cascade, and cell cycle control., Conclusion: A group of miRNAs and their target genes are identified, which may play important roles in regulating chondrogenic differentiation of hADSCs. These results will facilitate the initial understanding of the molecular mechanism of chondrogenic differentiation in hADSCs and subsequently control hADSCs differentiation, and provide high performance seed cells for cartilage tissue engineering.

Objective: To investigate the method and effectiveness of selectively upward placement of acetabular implants in patients with anatomically abnormal acetabulum during total hip arthroplasty (THA)., Methods: Twenty-six cases (26 hips) of anatomically abnormal acetabulum received THA between January 2005 and December 2010, including 22 cases of developmental dysplasia of the hip, 3 cases of osteonecrosis of the femoral head, and 1 case of post-traumatic arthritis. There were 5 males and 21 females with an average age of 52.3 years (range, 35-67 years). The left hip was involved in 11 cases and the right hip in 15 cases. The preoperative Harris score was 45.85 +/- 10.04. The anteroposterior X-ray films and CT scan of the pelvis, anteroposterior and lateral X-ray films of the femur, and TraumaCad analysis were performed routinely before operation. The principles of acetabular implants were that more than 70% of the bone-implant interface was covered, and the upward distance of acetabular implant was less than 15 mm., Results: Acetabular implants were placed within 5 mm from the anatomical rotation center in 11 cases. The upward distance of acetabular implant was 5-10 mm in 8 cases and was 10-15 mm in 7 cases. No bone fracture or nerve injury was observed intraoperatively. All incisions healed by first intention, and no infection or lower limb deep venous thrombosis occurred. One case had dislocation at 3 days after operation, and was cured after reduction and conservative treatment. The follow-up time ranged from 15 to 71 months (mean, 34 months). The Harris score was 91.42 +/- 3.59, showing significant difference when compared with preoperative score (t = 20.099, P = 0.000). The Harris scores were 92.09 +/- 4.04 in patients having less than 5 mm upward distance, 91.25 +/- 2.82 in patients having 5-10 mm upward distance, and 90.57 +/- 3.95 in patients having 10-15 mm upward distance, showing no significant difference (F = 0.377, P = 0.690). No loosening or subsidence of the implant was observed by X-ray film during the follow-up., Conclusion: The acetabular implants should be placed as close to anatomical rotation center as possible according to the principle. However, appropriate upward distance of the acetabular implants (< or = 15 mm) could be acceptable to meet 70% coverage of bone-implant interface and the implant stability. A satisfactory mid-term effectiveness can be obtained, but long-term effectiveness should be further investigated.

Objective: To evaluate the effect of preoperative digital planning in acetabular reconstruction of total hip arthroplasty (THA) for development dysplasia of the hip (DDH)., Methods: A prospective study was performed on 42 patients with DDH undergoing primary THA between January 2009 and December 2011. The patients were divided into 2 groups according to whether preoperative digital planning was made or not; before operation, conventional imaging method was used in 23 cases (group A), and TraumaCad software was used for preoperative digital planning in 19 cases (group B). There was no significant difference in gender, age, body mass index, DDH classification, and preoperative Harris score between 2 groups (P > 0.05). The operation time, amount of bleeding, and postoperative complication were observed. After 7 days of operation, X-ray films were done to measure the vertical location, horizontal location, radiographic anteversion angle, radiographic inclination angle, and prosthesis size by TraumaCad software. The qualified rate of cup placement was compared between 2 groups. Coincidence rate of cup size between preoperative predicted by the digital planning and actually implanted in group B also was calculated., Results: The operation time and the amount of bleeding were (119.25 +/- 47.16) minutes and (410.00 +/- 200.39) mL in group A and were (155.31 +/- 84.03) minutes and (387.50 +/- 251.99) mL in group B respectively, showing no significant difference between 2 groups (P > 0.05). Incision infection and prosthetic anterior dislocation occurred in 1 case of group A respectively, prosthetic posterior dislocation in 1 case of group B. The patients were followed up 1 year and 1 month to 4 years and 1 month (mean, 2 years and 8 months ) in group A, and 1 year and 3 months to 4 years (mean, 2 years and 7 months) in group B. At last follow-up, the Harris scores were 91.09 +/- 5.35 in group A and 91.72 +/- 3.48 in group B, which were significantly increased when compared with preoperative scores (P < 0.05), but no significant difference was found between 2 groups (t=0.41, P=0.69). The qualified rate of cup placement of group B (78.95%, 15/19) was significantly higher than that of group A (43.48%, 10/23) (chi2=5.43, P=0.02); the coincidence rate of the cup size between preoperative predicted by the digital planning and actually implanted was 68.42% (13/19)., Conclusion: Preoperative digital planning can further optimize the acetabular reconstruction in THA for DDH.

Objective: To evaluate the middle- and long-term effectiveness of primary total hip arthroplasty (THA) in patients with chronic autoimmune inflammatory diseases., Methods: Between January 1990 and June 2006, 42 patients (51 hips) with chronic autoimmune inflammatory diseases underwent THA. There were 15 males (18 hips) and 27 females (33 hips) with an average age of 36.9 years (range, 22-70 years). The locations were the left side in 29 hips and the right side in 22 hips. Of 42 cases, there were 11 cases of systemic lupus erythematosus (13 hips), 16 cases of rheumatoid arthritis (22 hips), and 15 cases of ankylosing spondylitis (16 hips). The causes of THA included avascular necrosis of the femoral head in 26 cases (34 hips), ankylosis of the hip in 15 cases (16 hips), and fracture of the femoral neck in 1 case (1 hip). The Harris score was 32.49 +/- 9.50. The physical component summary (PCS) and mental component summary (MCS) of short form 36 health survey scale (SF-36) scores were 25.53 +/- 4.46 and 42.28 +/- 6.27, respectively., Results: All incisions healed primarily. All 42 patients were followed up 5-21 years (mean, 9.1 years). At last follow-up, the Harris score was 89.25 +/- 8.47; PCS and MCS of the SF-36 were 51.35 +/- 4.28 and 55.29 +/- 8.31, respectively; and significant differences in the scores were found between pre- and post-operation (P < 0.05). Complications included limp (4 cases), prosthesis dislocation (2 cases, 2 hips), periprosthetic fracture (1 case, 1 hip), aseptic loosening (2 cases, 2 hips), and ectopic ossification (3 cases, 3 hips)., Conclusion: THA seems to be a good choice for patients with chronic autoimmune inflammatory diseases.

Objective: To investigate the in vivo degradable properties of new calcium phosphate cement (CPC) containing poly lactic-co-glycolic acid (PLGA) so as to lay a foundation for the future clinical application., Methods: A novel CPC containing PLGA (CPC/PLGA) was prepared according to a ratio of 45% dicalcium phosphate anhydrous: 45% partially crystallized calcium phosphates: 10% PLGA. Thirty-two adult New Zealand rabbits (weighing 2.2-3.0 kg, male or female in half) were divided into the experimental group (n = 17) and the control group (n = 15). The bone defect models of the bilateral femoral condyles (4.5 mm in diameter and 1.5 cm in depth) were made by drilling hole. Defect at the right side was repaired with CPC/PLGA in the experimental group and with CPC in the control group, while defect at the left side was not treated as blank control. The general condition of rabbits was observed after operation; the histological observation and bone histomorphometric analysis were performed at 2, 4, 8, 16, and 24 weeks; and scanning electronic microscope (SEM) observation was performed at 8 and 16 weeks after operation., Results: All rabbits survived to the end of experiment. The histological observation showed: CPC/PLGA degraded gradually, and the new-born bone trabecula ingrew; bone trabeculae became rough and strong; and CPC/ PLGA almost biodegraded at 24 weeks in the experimental group. The CPC degradation was much slower in the control group than in the experimental group. The total bone tissue percentage was 44.9% +/- 23.7% in the experimental group, and 25.7% +/- 10.9% in the control group, showing significant difference between 2 groups (t = 3.302, P = 0.001); and the bone tissue percentage showed significant difference between 2 groups at 8, 16, and 24 weeks (P < 0.05). The results of SEM observation showed that the pore size was 100-300 microm at 8 weeks after operation, new-born bone trabecula grew into the pores and combined strongly with residual cement in the experimental group., Conclusion: Novel CPC/PLGA has good in vivo degradable properties, and it can be an ideal bone substitute in future clinical application.