Journal of Orthopaedic Surgery and Research最新文献

Background: Total knee arthroplasty (TKA) is an effective treatment for knee osteoarthritis; however, early readmissions due to complications are common. This study assessed the ability of the hemoglobin-to-red cell distribution width ratio (HRR), hemoglobin-to-monocyte ratio (HMR), and hemoglobin-to-leukocyte ratio (HLR) to predict readmission within 14 days after TKA.

Methods: Data from the Chang Gung Medical Research Database (CGRD) from 2014 to 2022 were retrospectively analyzed. Patients ≥ 20 years old who underwent primary TKA were eligible for inclusion. Patients with incomplete data on the indices of interest or follow-up < 14 days were excluded. Patient demographic, clinical, and comorbidity data were collected. Logistic regression was utilized to determine the associations between HRR, HMR, and HLR and 14-day readmission.

Results: Data from 1,137 patients were analyzed. Multivariable analysis revealed that a higher HMR was significantly associated with lower 14-day readmission risk (adjusted OR [aOR] = 0.72, 95% confidence interval [CI]: 0.51-0.997), an HMR ≥ 2.18 (optimal cutoff value) was predictive of a significantly lower 14-day readmission risk (aOR = 0.61, 95% CI: 0.39-0.96). The composite indicator, HRR-HMR-HLR score, derived from the 3 indices assessed, was significantly associated with a lower 14-day readmission risk (score 2 vs. score 0: aOR = 0.51, 95% CI: 0.27-0.98; score 3 vs. score 0: aOR = 0.37, 95% CI: 0.17-0.82).

Conclusions: High HMR and the HRR-HMR-HLR score are independently associated with a lower 14-day readmission risk after TKA. Implementing these indices into clinical practice may enhance postoperative management.

Background: This study aimed to investigate the impact of three-dimensional (3D)-printed guide plate-assisted percutaneous pedicle screw implantation on minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery.

Methods: Overall, 162 patients who underwent MIS-TLIF at Tai'an City Central Hospital were retrospectively reviewed. The studied variables included operative time, volume of intraoperative blood loss, fluoroscopy time, postoperative drainage volume, visual analogue scale (VAS) score, Oswestry disability Index (ODI) score (preoperatively and at 2 weeks, 3 months, 6 months, and 12 months after surgery), and intervertebral fusion rate at 6 months after surgery.

Results: The conventional group included 99 patients who underwent a conventional procedure, while the 3D printing group included 63 patients who underwent 3D-printed guide plate-assisted percutaneous pedicle screw implantation. The conventional group required more times of positioning needle punctures than the 3D printing group (22.2 ± 5.9 vs. 16.1 ± 4.9). The operation and fluoroscopy time were also longer in the former group (183.5 ± 51.1 min vs. 148.8 ± 40.3 min and 30.2 ± 5.9 s vs. 24.1 ± 4.9 s, respectively). In 3D printing group, lower back pain VAS scores and ODI scores at 2 weeks and 3 months after surgery were observed. There were no significant differences in terms of the volumes of intraoperative blood loss; postoperative lower limb pain VAS scores; and interbody fusion rate (P > 0.05).

Conclusion: The novel 3D-printed guide plate-assisted percutaneous pedicle screw implantation can achieve better amelioration of back pain and recovery of function. It also reduced the times of positioning needle puncture and fluoroscopy time during percutaneous screw placement surgery and reduced the duration of surgery.

Background: Knee osteoarthritis (KOA) is a common musculoskeletal disorder. Therapeutic ultrasound (US) is a safe and effective treatment for KOA. It relieves knee pain and enhances function. Metformin (MF) regulates chondrocytes, hence providing chondroprotection. Furthermore, it efficiently reduces knee articular cartilage degeneration and retards the progression of osteoarthritis. However, the localized administration of MF by phonophoresis for KOA has yet to be studied.

Purpose: To assess the possible effects of metformin phonophoresis (MFPH) plus exercise therapy (EX) compared to MFPH alone or the US on knee pain, function, and range of motion (ROM) in chronic KOA patients.

Methods: Seventy-eight patients with unilateral mild to moderate chronic KOA were included. Patients were randomly assigned to three groups: group A (MFPH + EX), group B (MFPH alone), and group C (US). The US group used an acoustic-neutral gel, while the MFPH group used a gel containing 1.2% MF. The exercises included hamstring stretches, calf stretches, and knee strengthening exercises. Treatment in the three groups continued for four weeks (three sessions per week). The Visual Analog Scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the goniometer were used to assess knee pain, function disability, and ROM, respectively. All measures were recorded before, 2 weeks, and 4 weeks after the intervention in all groups. Multivariate Analysis of Variance (MNOVA) was performed to compare the effects within and between groups for knee ROM and function disability. The Kruskal-Wallis test and the Friedman test analyzed the pain intensity.

Results: When the baseline patient characteristics were compared, there were no significant differences in means of age, gender, body mass index (BMI), or lower limb dominance across the three groups (p > 0.05). After 4 weeks of intervention, clinical outcomes significantly improved in all three groups (p < 0.05). However, patients in the MFPH + EX group improved significantly in all outcomes compared to the MFPH and US groups (p < 0.05).

Conclusion: Post-treatment results showed a statistically and clinically significant improvement in pain intensity, knee ROM, and function in the MFPH group; however, combining MFPH with exercises is more beneficial in reducing KOA symptoms.

Trial registration: Clinical Trial Registry at (pactr.samrc.ac.za) database. NO: PACTR202311507335269. Date: November 9, 2023 (retrospectively registered).

Background: Acute compartment syndrome(ACS) is a perilous consequence of trauma. Acute compartment syndrome's precise cause is yet unknown. We performed studies to confirm that acute compartment syndrome can be relieved by suppressing ferroptosis and activating the Nrf2/Hmox1 pathway.

Methods: We generated an ACS rat model and we conducted next-generation sequencing(NGS) of skeletal muscle tissue and identified differentially expressed target genes. Ultimately, we performed in vivo experiments to validate the presence of ferroptosis and the Nrf2/Hmox1 pathway in ACS rats. After the minocycline intervention, the drug was evaluated for its effects on ACS by examining changes associated with ferroptosis.

Results: The bioinformatics analysis identified that the genetic changes in the disease were mostly focused on ferroptosis, with noticeable modifications in Nrf2/Hmox1. Based on the in vivo results, it was observed that ACS rats exhibited significantly elevated levels of ferroptosis compared to the control rats. The suppression of the Nrf2/Hmox1 pathway mediated by minocycline improves outcomes in ACS and reduces tissue damage after intervention.

Conclusion: Minocycline hinders ferroptosis via stimulating the Nrf2/Hmox1 pathway, which slows down the advancement of acute compartment syndrome.

Repair of the damaged meniscus is a scientific challenge owing to the poor self-healing potential of the white area of the meniscus. Tissue engineering provides a new method for the repair of meniscus injuries. In this study, we explored the superiority of 2% hyaluronic acid chitin hydrogel in temperature sensitivity, in vitro degradation, biocompatibility, cell adhesion, and other biological characteristics, and investigated the advantages of hyaluronic acid (HA) and Transforming Growth Factor β1 (TGF-β1) in promoting cell proliferation and a matrix formation phenotype. The hydrogel loaded with HA and TGF-β1 promoted cell proliferation. The HA + TGF-β1 mixed group showed the highest glycosaminoglycan (GAG) content and promoted cell migration. Hydroxypropyl chitin (HPCH), HA, and TGF-β1 were combined to form a composite hydrogel with a concentration of 2% after physical cross-linking, and this was injected into a rabbit model of a meniscus full-thickness tear. After 12 weeks of implantation, the TGF-β1 + HA/HPCH composite hydrogel was significantly better than HPCH, HA/HPCH, TGF-β1 + HPCH, and the control group in promoting meniscus repair. In addition, the new meniscus tissue of the TGF-β1 + HA/HPCH composite hydrogel had a tissue structure and biochemical content similar to that of the normal meniscus tissue.

Background: The risk factors for contralateral hip refracture after primary hip fracture are not fully understood; therefore, this study compared the clinical characteristics of patients with first and second hip fractures and explored and analyzed the risk factors for contralateral refracture after hip fracture in elderly individuals to provide a reference for the clinical prevention of postoperative refracture of hip fracture in elderly individuals.

Methods: A retrospective study was conducted on 458 elderly patients with hip fractures who underwent surgical treatment and were discharged from our hospital from March 2016 to March 2019. The clinical data of the patients were analyzed retrospectively. Patients were divided into a case group (postoperative refracture) and a control group (no postoperative refracture) based on whether they experienced refracture within five years after surgery. The clinical data of the two groups were compared and analyzed via univariate and multivariate logistic regression analyses and receiver operating characteristic (ROC) regression analysis to identify the risk factors for refractures after hip fracture surgery in elderly patients.

Results: Sixty-one patients experienced refracture, with an incidence rate of 13.3%. Age ≥ 80.5 years, female sex, poor knee joint function, FRAX score ≥ 15.5, anemia, visual impairment, osteoporosis, and Alzheimer's disease (AD) were identified as risk factors for refracture after hip fracture surgery in elderly individuals (P < 0.05).

Conclusion: Elderly patients with hip fractures are susceptible to refracture after surgery because of factors such as advanced age, female sex, high FRAX score, poor knee joint function, anemia, osteoporosis, visual impairment, and AD. Targeted interventions should be implemented based on the above risk factors.

Background: We aimed to investigate the compression and ischemic effects of two different tourniquet pressures on tissues during surgery show a clinical difference.

Methods: Patients aged 18-65 years who underwent foot and ankle surgery and applied a tourniquet in a single center between September 2022 and November 2023 were included in this prospective randomized study. Accordingly, tourniquet pressures were applied as limb occlusion pressure (LOP) + 50 mmHg in group 1 (12 patients) and LOP + 100 mmHg in group 2 (12 patients). The time point at which the femoral nerve motor evoked potential (MEP) decreased by 50%, the time point at which the MEP decreased by 100% for all nerves (femoral, tibial, and deep peroneal), and the time point at which all responses returned after the tourniquet was deflated were identified as the time points for analysis.

Results: There were no differences in demographic data (age, body mass index, and sex) between the two groups. The mean tourniquet pressure was 191 ± 16 mmHg in Group 1 and 247 ± 21 mmHg in Group 2 (p < 0.001). A 50% decrease in the femoral nerve MEP value was observed at an average of 47 min in Group 1 and 34 min in Group 2 (p < 0.001). A complete loss of MEP responses for all nerves was observed at an average of 69 min in Group 1 and 56 min in Group 2. After the tourniquet was deflated, all MEP responses returned to baseline values at an average of 8.5 min in Group 1 and 12.6 min in Group 2 (p = 0.007). The results showed that lower limb nerve innervation was affected later and returned to normal earlier after deflation of the tourniquet in Group 1 (low tourniquet pressure group).

Conclusions: The innervations of the lower extremity nerves were affected later in the group in which low tourniquet pressure was applied (average 191 mmHg). Again, in this group (LOP + 50 mmHg), nerve conduction recovered an average of 10 min after deflation and four minutes earlier than in the high tourniquet pressure group.

Level of evidence: Level I, diagnostic study.

Trial registration: NCT05926154.

Background: Osteoarthritis (OA) is marked by the progressive degradation of joint cartilage and subchondral bone. The precise molecular mechanisms driving meniscus deterioration in OA, especially at the single-cell level, remain poorly understood.

Method: We analyzed two datasets from the GEO database, GSE220243 and GSE98918, focusing on meniscus tissue sequencing data from OA and non-OA patients. The standard Seurat procedure was employed to process single-cell data and identify differentially expressed genes (DEGs). Immune cell infiltration was assessed using the Microenvironment Cell Populations (MCP) counter and CIBERSORT algorithms. For the microarray data, DEGs were identified with the limma package, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed using ClusterProfiler. The overlapping DEGs from both datasets were imported into Cytoscape to generate protein-protein interaction (PPI) networks and identify hub genes. Transcription factor (TF) and miRNA interaction networks were analyzed using NetworkAnalyst, and gene-related predictive drugs were enriched through the DSigDB platform.

Result: After quality control, 34,763 cells from the OA patients and 34,145 cells from the healthy controls were analyzed. UMAP identified and SingleR annotated 14 cell clusters. The 10 largest cell clusters were selected for further analysis. The OA group exhibited a notable increase in macrophages and a reduction in cytotoxic lymphocytes and endothelial cells in the meniscus. In GSE98918, 220 DEGs were identified, and the MCODE plug-in in Cytoscape pinpointed a key module containing 12 candidate genes. The MCC methodfiltered the top 20 DEGs in each GSE220243 cluster. Overlapping DEGs from GSE220243 and GSE98918 identified COL1A1, COL3A1, COL5A2, COL6A3, LOX, and VEGFA as significantly decreased in OA, with COL3A1, COL5A2, LOX, and VEGFA upregulated in meniscal chondrocytes. The interaction network highlighted 3 key miRNAs and 13 shared TFs. Ten gene-related predictive drug molecules were identified.

Conclusion: This research highlights crucial genes in the OA meniscus and uncovers their differing regulatory patterns between chondrocytes and non-chondrocytes. These findings enhance our understanding of the molecular mechanisms driving OA pathogenesis and aid in identifying potential drug targets.

Objective: Our study focused on the effects and molecular mechanisms of kaempferol, a major active component of Eucommia ulmoides Oliver (EUO), on the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs).

Methods: Target molecules for EUO, osteoarthritis, and osteogenic differentiation were identified through network pharmacology analysis. BMSCs were isolated and treated with various concentrations of kaempferol. Optimal concentration was determined through MTT assays. Osteogenic differentiation was assessed using alkaline phosphatase (ALP) and Alizarin Red S staining, while osteogenic markers (Collagen I, RUNX2, and OPN) and CAV-1 expression were analyzed using RT-qPCR and Western blot. The effects of combined treatment with kaempferol and an overexpression vector for CAV-1 (oe-CAV-1) on osteogenic differentiation were also observed.

Results: Network pharmacology analysis identified kaempferol as the primary active component influencing CAV-1 targeted in subsequent experiments. It was found that 10 µM kaempferol was optimal for treating BMSCs. Post-treatment, significant increases in ALP activity and calcium deposition were observed, along with elevated expression of osteogenic markers, and decreased CAV-1. Overexpression of CAV-1 significantly reversed the promotive effects of kaempferol on BMSC osteogenic differentiation, effectively inhibiting the process.

Conclusion: Collectively, kaempferol promotes osteogenic differentiation in BMSCs by inhibiting CAV-1 expression.

Introduction: Symptomatic hip osteoarthritis (OA) causes significant morbidity and functional limitations. While corticosteroid injections (CSI) are commonly offered and administered for OA pain relief, it is unknown if they offer any clinically meaningful long-term benefit or reduce the overall need for surgical intervention.

Methods: A cross-sectional retrospective cohort study was performed on primary hip osteoarthritis patients from a single academic tertiary-care center arthroplasty clinic from 2014 to 2019. Patients were divided into three groups. CSI + THA: hip CSI patients who underwent subsequent ipsilateral THA. CSI-noTHA: hip CSI who have not had ipsilateral THA to date. THA-noCSI: a control group of consecutive hip OA patients who underwent primary THA without prior CSI. Demographic variables, injection relief duration, and radiographic arthritis severity were recorded. Time from clinic presentation to injection and/or THA were compared.

Results: 357 patients met inclusion criteria and underwent guided, arthroplasty provider-ordered CSI. Mean duration of relief was 6.7 weeks (SD 8.7). 244 injection patients (67.2%) subsequently underwent THA (CSI + THA). 150 of 390 patients have not undergone THA at mean of 25.5 months follow-up. Mean time from clinic presentation to THA was 8.6 months longer after CSI (16.3, SD 17.8) months in CSI patients compared to 7.7 (SD 10.6) months for patients without CSI (p < 0.001). Of 117 patients in the CSI-noTHA group at mean 25 months follow-up, only 43 (12% of all injection patients) had not had THA because they found injections effective. The remaining 74 (63%) of CSI-noTHA patients have been deemed medically unfit for surgery or are currently scheduled for THA.

Discussion/conclusion: The results of this study suggest the utilization of intra-articular CSI as conservative treatment in an arthroplasty clinic does not prolong time to THA for a clinically important duration. The use of CSI should be reserved for diagnostic purposes and/or short-term pain relief in poor surgical candidates.

Level of evidence: III.