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Objective For total knee arthroplasty (TKA) tibial bone resection, various manufacturers provide cutting blocks with fixed angles. But the accuracy of these angles is uncertain. Our aim was to assess the accuracy of the obtained posterior tibial slope (PTS) with a fixed angle cutting block.Methods 247 TKAs in 213 patients were reviewed. We included 104 Legion Prosthesis, 76 U2 Knee Prosthesis, 46 NexGen LPS-Flex Prosthesis, and 21 Vanguard Knee System products. Preoperative and postoperative PTS were measured via expanded lateral tibia radiographs. The tibial component coronal alignment angle (TCCA) was measured on postoperative standing full-length anteroposterior radiographs, and the tibia length was measured on preoperative standing full-length radiographs. Results For postoperative PTS, the Legion group had significantly smaller slopes than the U2 Knee group and Vanguard group. However, there was no significant difference between the Legion and NexGen groups, and no significant difference among the NexGen, U2 Knee, and Vanguard groups. One sample t-test indicated that only the NexGen group showed no statistical difference from the 7° PTS and 90° TCCA it aimed to provide. Multiple linear regression showed that the different tibial lengths and preoperative PTS had statistically significant effect on postoperative PTS. However, there were weak correlations between the tibial length and PTS, and between preoperative and postoperative PTS.Conclusion For TKA, using conventional tibial bone resection technology with different tibial cutting instrumentations provided by various manufacturers can obtain safe PTS. However, the PTS is not completely consistent with the angle of the cutting block.

Steroid‐induced osteonecrosis of the femoral head (SIONFH) has been a common disease following corticosteroid therapy. Presently, we aim to explore the functions of circular RNA (circ) PVT1 in SIONFH rats and the underlying mechanism. Glucocorticoid (GC) was used to treat SD rats and bone marrow‐derived mesenchymal stem cells (BMSCs) to construct SIONFH model in vitro and in vivo, respectively. The pathological injury of the femoral head in the SIONFH rats was detected via haematoxylin‐eosin (HE) staining and immunohistochemistry (IHC). The osteogenic differentiation, proliferation and apoptosis of BMSCs were detected. Western blot was used to detect Smad7, Bax, Bcl2 and Smad2/3. The potential targets of circPVT1 and miR‐21‐5p were validated through luciferase reporter gene assay and RNA pull‐down assay, respectively. We found that CircPVT1 was decreased in the femoral head of SIONFH rats and GC‐treated BMSCs, while miR‐21‐5p was markedly up‐regulated. Overexpressed circPVT1 attenuated the apoptosis and cell viability inhibition of BMSCs induced by GC, while miR‐21‐5p up‐regulation had the opposite effects. What's more, the in vivo experiments confirmed that up‐regulating circPVT1 repressed osteonecrosis in SIONFH rats through repressing apoptosis. Mechanistically, circPVT1 functioned as a ceRNA of miR‐21‐5p, which targeted at the 3'untranslated region of Smad7. CircPVT1 enhancing Smad7 and mitigating GC activated TGFβ/Smad2/3 pathway through inhibiting miR‐21‐5p. In conclusion, CircPVT1 exerts protective effects against SIONFH via modulating miR‐21‐5p‐mediated Smad7/TGFβ pathway.

An injectable hydroxypropyl-β-cyclodextrin (HPβCD) cross-linking of gelatin (Gel) based hydrogel was embedded with BMSC in vivo bone regeneration of femoral head necrosis. This HPβCD-Gel hydrogel possesses quick gelation within 6 min; a high-water uptake resulted in faster biodegradation, high swelling, and a 3D porous network that strengthened its mechanical, surface, and morphological properties. The results indicated that BMSC showed high cell viability (90%) during measurement; HPβCD-Gel hydrogels induced BMSC differentiation into osteocytes within 14 days more efficiently than the osteogenic medium. The HPβCD-Gel/BMSC hydrogels that were injected into the necrosis site of the femoral head in the vessels were measured for 2 weeks. In addition, the vessel density and mean vessel diameters increased in the next 2-8 weeks followed by increased new bone formation, according to the in vivo analysis. Overall, our findings show that this method is a promising strategy for improving femoral head necrosis bone regeneration.

Background The pathogenesis of glucocorticoid (GC)-induced osteonecrosis (ON) of the femoral head remains unclear. Recent research has suggested that it is closely associated with injured bone microvascular endothelial cells (BMECs). However, few studies have used BMECs to perform research pertaining ON of the femoral head. Objectives The objective of this study was to investigate the functional changes of BMECs treated with a GC and to detect the changes in related genes using microarrays. Material and methods Cells were isolated using an enzymatic method and identified with EC markers, such as von Willebrand factor (vWF), CD31 and vascular endothelial cadherin (VE-cadherin). Bone microvascular endothelial cells were treated with 0.1 mg/mL and 0.3 mg/mL of hydrocortisone to establish a GC-damaged model of BMECs. The mRNA microarrays were used to detect the differential expression profiles between BMECs with and without GC damage. Results Primary cells appeared as having a cobblestone-like morphology. Immunofluorescence staining revealed that the cells were 100% positive for vWF and CD31, and near 100% positive for VE-cadherin. It also confirmed that the cells were BMECs. Bone microvascular endothelial cells treated with 0.1 mg/mL of hydrocortisone showed shrinkage, and those treated with 0.3 mg/mL of hydrocortisone mostly showed apoptosis. The mRNA microarray showed that genes associated with endothelial cells, such as endothelin 1 (ET-1) receptor, angiotensin II (AII) receptor, intercellular adhesion molecule 1 (ICAM-1), and plasminogen activator inhibitor 1 (PAI-1), were upregulated, and genes associated with endothelial nitric oxide synthase (eNOS), endothelin 1 (ET-1), prostaglandin I2 (PGI2) synthase, PGI2 receptor, vascular endothelial growth factor (VEGF), prostaglandin E (PGE) synthase, and PGE receptor were downregulated. The results of quantitative polymerase chain reaction (qPCR) validation were consistent with the findings of mRNA microarrays. Conclusions Glucocorticoids promoted BMECs to express vasoconstrictors and procoagulant factors and related receptors, and decreased the expression of vasodilators and their receptors.

Background Although the tip of the greater trochanter is widely used in THA to adjust leg length discrepancy (LLD), its accuracy and reliability are still unknown. The aim of this study was to investigate the reliability of measuring LLD in patients with total hip arthroplasty using the distance from the tip of the greater trochanter to the inter-teardrop line Methods 128 patients who underwent THA in our department with preoperative and postoperative bilateral hips anteroposterior(AP) radiographs were reviewed. The distance between the bilateral anterior superior iliac spine and the medial malleolus (ASIS-MM) was measured before and after the operation. The distances from the vertex of the lesser trochanter to the bi-ischial line(LT-BI), the distance from the vertex of the lesser trochanter to the inter-teardrop line(LT-IT) and the distance from the tip of greater trochanter to the inter-teardrop line(GT-IT) were measured on the bilateral hips AP radiograph preoperatively and postoperatively. Taking X-ray magnification into account when measuring data. Use one-way ANOVA and paired t test to compare the differences between the four methods. The agreements between the four methods was evaluated using Bland-Altman analysis. Results There was no statistical difference between the four methods. Comparing GT-IT with MM-ASIS, ,LT-IT and LT-BI, the preoperative P values were 0.369, 0.581, and 0.402, and the postoperative P values were 0.755, 0.502 and 0.233. Comparing LT-BI with MM-ASIS and LT-IT, the P values were 0.151 and 0.372 preoperatively, and 0.179 and 0.917 postoperatively. Comparing LT-IT with MM-ASIS, the P value was 0.924 before surgery and 0.291 after surgery. Bland-Altman indicated that there were good agreements between GT-IT and LT-IT. Conclusion It is highly reliable to evaluate the LLD of patients with THA by using the difference in the distance between the tip of the greater trochanter and the inter-teardrop line.

Background : Tibial rotation in total knee arthroplasty remains controversial. The aim was to investigate which anatomical reference was closer to SEA in 10 tibial markers in Chinese adult. Methods : The study included 122 normal lower extremities. 10 axes were drawn on the axial sections: transverse axis of tibia(TAT), axis of medial edge of patellar tendon (MEPT), axis of medial 1⁄3 of patellar tendon attachment (M1/3), Akagi line, Insall line, axis of medial border of tibial tubercle(MBTT)，axis of anterior border of the tibia 1-4(ATC1-4). The angles between TAT and SEA as well as the angles between other axes and the perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined using one-way ANOVA and paired t-test. Results : In all the knees, the mean angles of M1/3, Akagi line, Insall line, MBTT, ATC1, ATC2, ATC3, and ATC4 axes compared to perpendicular of projected SEA were 10.2±5.1°, 1.4±5.0°, 11.9±5.4°, 3.6±4.8°, 12.0±6.9°, 7.2±8.6°, 7.1±10.4°, and 6.6±13.5° external rotation, respectively, and the MEPT axis was 1.6±4.5° internal rotation. The TAT was 4.1±5.3° external rotation compared to SEA. The M1⁄3 and Insall line were significantly externally rotated than Akagi line, MEPT, MBTT, TAT, ATC2, ATC3, and ATC4 axes. There was no significant difference between the TAT axis and the MBTT axis, as well as no significant difference between the ATC2, ATC3, and ATC4 axes. Conclusion : Akagi line, MBTT and TAT show good consistency with SEA in axial femorotibial alignment with knee in extension. The middle segment of the anterior tibial crest also has good alignment consistency with SEA in axial femorotibial alignment, it can be reliable reference mark for rotational alignment of the tibial component in TKA.

Osteoarthritis (OA) is the most common joint disease associated with pain and disability. OA patients are at a high risk for venous thrombosis (VTE). Here, we developed an interpretable machine learning (ML)-based model to predict VTE risk in patients with OA. To establish a prediction model, we used six ML algorithms, of which 35 variables were employed. Recursive feature elimination (RFE) was used to screen the most related clinical variables associated with VTE. SHapley additive exPlanations (SHAP) were applied to interpret the ML mode and determine the importance of the selected features. Overall, 3169 patients with OA (average age: 66.52 ± 7.28 years) were recruited from Xi’an Honghui Hospital. Of these, 352 and 2817 patients were diagnosed with and without VTE, respectively. The XGBoost algorithm showed the best performance. According to the RFE algorithms, 15 variables were retained for further modeling with the XGBoost algorithm. The top three predictors were Kellgren–Lawrence grade, age, and hypertension. Our study showed that the XGBoost model with 15 variables has a high potential to predict VTE risk in patients with OA.

One of the common challenges in using glucocorticoid in the long term is the development of femoral head necrosis. To address this challenge, the use of glucocorticoid suppressors like plant polysaccharides has been considered. In this study, Moringa oleifera polysaccharide was isolated through hot water–ethanol precipitation method and purified by DEAE-Sepharose fast flow column. Then, they were characterized by FT-IR, NMR, methylation, and chromatography assays. The polysaccharide biocompatibility was investigated by MTT assay and its effect on osteoblasts was evaluated by controlling gene expression. Also, the effect of polysaccharide on dexamethasone-induced femoral head necrosis in rats was assessed by hydroxyproline, hexosamine and morphometric parameters. The results show that 2 Da molecular weight polysaccharide is mainly composed of Rha, Ara, Fru, Xyl, Man and Gal in the molar ratio of 1.7:2.1:3.4:5.9:5.8:1.3. Meanwhile, MTT results on osteoblasts cells showed polysaccharide biocompatibility, while significantly reducing the negative effects of glucocorticoid. Likewise, polysaccharide significantly reduced the levels of apoptosis and intracellular ROS of glucocorticoid-induced femoral necrosis. Moreover, the results of gene expression indicated a decrease in the expression of TNF-α and IL-6 genes using polysaccharide, which is very effective in preventing apoptotic activity. Also, Polysaccharide increased bone density, bone volume per tissue volume, trabecular thickness, and the hexosamine to hydroxyproline ratio in the rat serum in the presence of glucocorticoids, which are very effective in the process of femoral head necrosis. Furthermore, polysaccharide significantly increases the OCN, RUNX2 and COL-1 genes expression in cartilage tissue, which is in line with the result of morphometric parameters. Overall, this study suggests that the use of polysaccharide could result in the treatment of femoral head necrosis.

The use of steroid drugs such as dexamethasone in long-term treatment poses a challenge called femoral head necrosis. To reduce the destructive effects of dexamethasone, the use of herbal suppressants such as Curculigo orchioides polysaccharides (COPs) is recommended despite the ambiguities in their chemical composition and the effects of each component on the anti-necrosis activity of the femoral head. In this study, after separation of COPs through hot water–ethanol precipitation method and purification through DEAE-Sepharose fast flow column, their properties were explained by FTIR, NMR, methylation and chromatography. Moreover, the COPs biocompatibility and its inhibitory effects against dexamethasone-induced cytotoxicity were evaluated by MTT assay and gene expression on human primary osteoblasts cells. The results exhibit that the 4756 Da molecular weight COPs is generally composed of Rha, Ara, Fru, Xyl, Man, Glc, Gal, Glu A and Gal A. Also, MTT results recognized high biocompatibility of COPs and suppressive effect on dexamethasone. Also, COPs significantly reduced dexamethasone-induced intracellular levels of apoptosis and ROS. Furthermore, the use of COPs has significantly increased ALP activity, collagen content and mineralization, which are very effective in differentiating HPOS cells to repair bone tissue. Meanwhile, the gene expression outcomes indicate an increase in Bcl-2 expression gene and decrease in BAX, Caspase-9 and Caspase-3 gene expression in the presence of COPs, which are important in controlling apoptotic activity and bone regeneration. Overall, this study revealed that COPs can lead to the treatment of femoral head necrosis.

Background This study aimed to explore potential novel genes correlated with osteoarthritis (OA). Methods The gene expression profile of GSE48422 was downloaded from the Gene Expression Omnibus (GEO) database. This dataset included five arthritic cartilage samples and five non-arthritic cartilage samples from five female OA patients. Differentially methylated genes (DMGs) between the two kinds of samples were identified, followed by their functional analysis and protein–protein interaction (PPI) analysis. Furthermore, the Comparative Toxicogenomics Database (CTD) was used to further identify OA-related genes among these DMGs. Results In total, 965 hypermethylated genes and 112 hypomethylated genes were identified in the arthritic cartilage samples. The hypermethylated genes (e.g., ADCY4 and ADCY6 ) were significantly related to the calcium signaling pathway and gonadotropin-releasing hormone signaling pathway, while the hypomethylated genes were implicated in the mammalian target of rapamycin signaling pathway. In the PPI network, several genes had a higher degree, such as ADCY4 , ADCY6 and GPR17 , and they interacted with each other. Additionally, 565 DMGs were predicted to be associated with OA, and five of them (e.g., COMP and EDIL3 ) were previously identified as OA markers. Conclusions The methylation of genes ADCY4 , ADCY6 and GPR17 , as well as the gonadotropin-releasing hormone signaling pathway, was newly found to be potentially associated with OA. They may be novel OA markers.

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease. However, the pathogenesis of RA is not fully understood. Here, we reported that c-Jun NH2-terminal kinase (JNK)/stress-activated protein kinase-associated protein 1 (JSAP1, also known as JNK-interacting protein 3 (JIP3)) was significantly important for collagen-induced arthritis (CIA) in mice. Mice with JIP3 knockout (JIP3-/-) showed a significant decrease in arthritis index and swollen joint count in CIA mice. The histopathology of spleen and joint was markedly alleviated by JIP3 deficiency in CIA mice. Excessive macrophage activation in CIA mice was also inhibited by JIP3 deletion. CIA-induced RANKL/RANK/OPG system mRNA expression was blocked in JIP3-knockout mice. In addition, CIA-triggered cytokine secretion and TLRs/NF-κB activation was inactivated by JIP3-deficiency. In line with the inhibition of inflammation by JIP3-knockout, it also significantly suppressed JNK pathway activation induced by CIA, as evidenced by the down-regulation of p-JNK, p-c-Jun, AFT-2 and Elk-1 in joints. In vitro, RANKL-exposed RAW264.7 cells showed a significant reduction of osteoclast formation using TRAP staining. Moreover, JIP3 inhibition reduced the RANKL-caused expression of osteoclastic genes and inflammatory regulators, as well as activation of TLRs/NF-κB and JNK signaling pathways. Importantly, we found that promoting JNK activity could abrogate JIP3 knockdown-suppressed osteoclastic genes expression, inflammatory response and NF-κB activation. These findings suggested that JIP3 could significantly impede osteoclast formation and function by regulating JNK activation, illustrating a novel therapeutic strategy for managing arthritis and preventing bone destruction.

Background The objective of this study was to evaluate whether apolipoprotein gene polymorphisms confer susceptibility to osteonecrosis of the femoral head (ONFH). Methods The relevant literature was screened from databases of Pubmed, Embase, Wanfang, Weipu and China National Knowledge Internet (CNKI) until May, 2017. In addition, odds ratio (OR) and its corresponding 95% confidence interval (CI) were used as a measure of effect size for calculating effect size. Results Totally, six case-control studies were included in this meta-analysis. It revealed that ApoB-C7623T polymorphism frequency was increased in ONFH group than in control group under three genetic models, including allele model (T vs. C, OR = 4.5149, 95% CI: 1.6968–12.0134); additive model (TC vs. CC, OR = 6.2515, 95% CI: 2.0939–18.6640); and dominant model (TT + TC vs. CC, OR = 5.4998, 95% CI: 1.9246–15.7163). In addition, the increased risk of ONFH were related to ApoA1-rs1799837 polymorphism under additive model (AA vs. GG, OR = 1.4175, 95% CI: 1.0522–1.9096) and recessive model (AA vs. GG + AG, OR = 1.7727, 95% CI: 1.3399–2.3452). However, four ApoB rs1042031, rs693, 3’-VNTR and G12619A polymorphisms under the all genetic models were not associated with susceptibility to ONFH. Conclusion The T allele and TC genotype of ApoB-C7623T and AA genotype of ApoA1-rs1799837 may contribute to increase the risk of ONFH.

Background We aimed to evaluate the role of extracorporeal shockwave therapy (ESWT) in improving osteonecrosis of the femoral head (ONFH). Methods We searched studies focusing on the role of ESWT in ONFH using PubMed, Embase, the Cochrane Library, WanFang, VIP, and CNKI databases updated up to July 28, 2017, without language restriction. Standardized mean difference (SMD) values and 95% confidence intervals (95% CIs) were pooled to compare the pain score and Harris hip score for ESWT treatment and other treatment strategies. Results Four articles, including 230 ONFH patients, were eligible for the meta-analysis. No significant differences were found in the pain score (SMD = − 1.0104; 95% CI − 2.3279–0.3071) and Harris hip score (SMD = 0.3717; 95% CI − 0.3125–1.0559) between the two groups before treatment. After treatment, significant differences were found between the experimental and control groups in the pain score (SMD = − 2.1148; 95% CI − 3.2332–0.9965) and Harris hip score (SMD = 2.1377; 95% CI 1.2875–2.9880). There were no significant differences in pain score before and after treatment between the two groups (SMD = − 0.7353; 95% CI − 2.1272–0.6566), but significant differences were found in the Harris hip score (SMD = 1.2969; 95% CI 0.7171–1.8767). Conclusion For patients at an early stage, ESWT may be safe and effective for relief of pain and improvement of motor function.

To objectively evaluate the clinically curative effect of sidong wubu method on closed fracture of upper limbs.A single-blind randomized controlled trial was used to divide 654 patients with closed fracture of upper limbs at early stage into two groups. 298 patients in the surgical group were treated with open reduction and internal fixation and 356 patients in the treatment group with sidong wubu method for 6 months as a course of treatment.As for short-term curative effect (after 6 courses of treatment), the total effective rate was 97.7% in the treatment group and 92.9% in the control group, and the excellent and good rate was 83.7% and 76.5% respectively. Fracture-healing time, treatment cost, function-recovering time, scores of symptoms and signs obviously declined in both groups with remarkable difference between the two groups. As to long-term curative effect (after follow-up visit for one year to 5 years and 2 months), there was still noticeable difference (chi2= 7.536, P0.05) in total curative effect and in excellent and good rate between the two groups.With low cost, short treatment course, good function and other advantages, sidong wubu method can be first used to treat closed fracture of upper limbs.

ObjectiveTo probe into the mechanism of the Chinese herbs with functions of reinforcing kidney and supplementing qi for preventing knee osteoarthritis of the rabbit.MethodsTotally 72 healthy Japan long-ear white rabbits, aged 4 months, were randomly divided into 6 groups, blank group (A), model group (B), high dose Chinese herb group (C), middle dose Chinese herb group (D), small dose Chinese herb group (E), aminoglucose hydrochloride capsule control group (F), 12 rabbits in each group. All the rabbits in the groups, except the group A, were fixed with plaster cast for six weeks to establish rabbit knee osteoarthritis. At the same time of modeling, the different doses of Juanbi Capsules and aminoglucose hydrochloride capsule were administrated intragastrically in the group C, D, E, F, respectively, for 4 weeks, for preventive treatment. In the group B, the rabbit was administrated intragastrically with equal volume of normal saline to the medication groups, twice each day, in the morning and the evening, and in the group A, nothing was administrated. After modeling for 6 weeks, the joint fluid was taken and TNF-α, IL-1 and IL-6 contents were detected with ELISA method, and the articular cartilage was taken for macroscopic and microscopic examinations.ResultsIn all thepreventive treatment groups, the articular cartilage color changed to varying degrees with formation of osteophyte and bone cyst, superficial erosion on the chondral articular surface, and the cartilage defect reached to the mid layer in a part of specimens with cartilage exfoliation, but which in the extent were significantly lower than those in the model group. There were significant differences between the group A and B in TNF-α, IL-1 and IL-6 contents in the joint fluid (P

The aim of this study was to evaluate the clinical effect of core decompression (CD), lesion clearance, and bone graft in combination with Tongluo Shenggu decoction for the treatment of osteonecrosis of the femoral head (ONFH). A total of 75 patients (92 hips), with ONFH at Association Research Circulation Osseous (ARCO) stages II to IIIA, were studied and divided into treatment group and control group. In control group, patients were treated with the CD in combination with autologous or artificial ceramic bone graft. In treatment group, patients were treated with the above method combined with Tongluo Shenggu decoction. Patients were followed-up at 1 month, 6 months, and 24 months after surgery. The visual analogue scale (VAS) scores, Harris Hip Score (HSS), and total effective rates were measured and recorded. The total effective rate of the treatment group was significantly higher than that of the control group (97.2% vs. 89.9%, P