Bone & Joint Research最新文献

Aims: The aim of the study was to investigate the effect of systematic lumbar traction, applied in 20 sessions over four weeks, on the size of vertebrae, bone mineral density (BMD), and bone turnover markers in women with chronic low back pain (LBP).

Methods: A total of 30 women with low back pain underwent 20 sessions of lumbar traction with a load of 25% to 30% of their body weight. Total body and lumbar spine BMD was measured using dual-energy X-ray absorptiometry, and bone turnover markers were determined using enzyme-linked immunosorbent assay (ELISA) with serum samples collected before the first traction session and 72 hours after the last traction session.

Results: After traction, decreased BMD and T-scores, a decreased mean vertebra width, and an increased mean height of L1-L4 segments were observed. The concentration of cross-linked C-telopeptide of type I collagen (CTXI) increased, while the concentration of receptor activator for nuclear factor κ B ligand (RANKL) decreased significantly after four weeks of traction. Sclerostin and procollagen 1 N-terminal propeptide (P1NP) concentrations remained unchanged.

Conclusion: Our study is the first to show the influence of traction forces on BMD and markers of bone metabolism. Future research with a longer follow-up period after traction is needed to better explore the direction of change.

Aims: To use CT images and segmentation of the skin and muscles of the upper leg to determine a reliable location for measuring thigh circumference (TC) to assess the upper leg muscle volume and cross-sectional area (CSA).

Methods: This research analyzed 140 limbs from 77 patients (22 male and 55 female) who had undergone CT imaging before hip surgery. The skin and individual upper leg muscles were automatically segmented from the CT images to measure the TC and CSA of each upper leg muscle across all axial slices. TC and CSA were measured from the patella upward at 1 cm up to 20 cm intervals, resulting in 21 analyses per limb. The volume of each muscle was calculated by adding the CSAs across all axial slices. Pearson's correlation was used to analyze the relationship between muscle volume and CSA to identify the level with the strongest correlation as the "reliable" level. The correlation coefficient and the regression equation were calculated.

Results: The reliable level for muscle CSAs exhibiting the strongest correlation varied across the muscles, ranging from 9 to 20 cm from the patella. However, strong correlations were found between each muscle's TC, ranging from 0.64 to 0.83. In terms of muscle volume, 10 cm above the patella was found to be the reasonable level for predicting the volume of each muscle from TC. Moderate to strong correlations (ranging from 0.57 to 0.70) were found between the TC. To predict the muscle volume of the whole upper leg (cm³), the following equation was used: (TC at 10 cm from the patella) × 114.7-2,194.9.

Conclusion: TC measurement 10 cm above the patella is suitable for assessing upper leg muscle volume. Modifications in measurement levels across muscles may be needed to assess muscle CSAs.

Aims: This study aimed to investigate the relationship between physical activity (PA) and the risk of osteoarthritis (OA) and its subtypes.

Methods: We included participants from the UK Biobank aged 37 to 73 years from February 2006 to June 2010. Baseline PA levels were categorized as high (≥ 3,000 metabolic equivalent of task (MET)-min/week), moderate (600 to < 3,000 MET-min/week), or low PA (< 600 MET-min/week) based on current public health guidelines. The associations between PA and OA and its main subtypes (hand, hip, and knee OA) were analyzed using Cox-proportional hazard models. The mediating role of BMI was tested under a causal counterfactual framework.

Results: The median follow-up period was 12.50 years, with 25,036 incident total OA cases. Compared to low PA, we found no significant association between moderate PA and total OA risk. However, high PA significantly increased the risk of total OA by 19% (hazard ratio (HR) 1.19, 95% CI 1.15 to 1.23). This result is consistent with knee OA and hip OA, where HR was 1.25 (95% CI 1.19 to 1.31) for knee OA risk and 1.17 (95% CI 1.10 to 1.24) for hip OA risk, respectively. Moderate PA was associated with 14% (HR 0.86, 95% CI 0.76 to 0.97) reduction in the risk of hand OA. Moreover, we found that BMI mediated the association between PA and OA risk, with the mediating proportion for total OA, hand OA, knee OA, and hip OA, at 75.48%, 2.42%, 10.20%, and 51.39%, respectively.

Conclusion: These findings suggest that high levels of PA increased the risk of total OA, as well as knee and hip OA, while moderate levels of PA significantly mitigate the risk of hand OA. BMI appears to mediate the relationship between PA and OA risk. Future research should elucidate the underlying mechanisms.

Aims: Cemented polished taper fit (PTF) stems are the femoral implant of choice for total hip arthroplasty (THA) in many locations worldwide. There is increasing evidence that periprosthetic fracture may be the single major contributor to reoperation with these stems. The aim of this study was to demonstrate how mismatches at the implant-cement interface may occur and the subsequent effect of these incongruities on the contacting area and the forces transmitted to the cement mantle.

Methods: A parametric equation-based model was developed to determine the contact mismatch relative to axial stem rotations. This model was also used to calculate the restoration of contact surface area with stem subsidence for both a dual-taper and triple-taper geometry. A finite element analysis (FEA) was used to compare the effects of reduced contact area due to the incongruent hip implant-cement interface.

Results: The contact model showed a large decrease in surface contact area with even only a small rotation going from 100% at 0° to 50.00% at 2.5° for the dual-taper geometry, and from 100% at 0° to 50.20% at 2.5° for the triple-taper geometry. There was a gradual but small ongoing decrease in contact surface with increasing rotation for both the dual-taper and triple-taper geometries. For both taper designs, there was an increase in contact surface area with an increase in subsidence resulting in contact for up to a 5° mismatch being restored with 2 mm subsidence. FEA showed that with increasing mismatches and consequent contact area reduction, there was an increase in von Mises stress in the implant-cement interface of up to 235%.

Conclusion: With increasing mismatch, there was an increase in maximum stresses, total strain, and subsidence in the cement mantle, highlighting the importance of achieving an optimal implant-cement interface at the time of implantation of cemented PTF femoral stems.

Aims: Polytraumatized patients with severe limb injuries often develop complications, which are influenced by the surgical treatment strategy. For the initial fracture stabilization, Early Total Care (ETC) and Damage Control Orthopedics (DCO) are competing concepts, with the treatment choice depending on the patient's condition. Clear guidance factors remain lacking. Our study aimed to compare the effects of ETC and DCO strategies on fracture healing and functional gait behaviour in a rat multiple-trauma model.

Methods: A standardized rat multiple-trauma model was established, which included haemorrhagic shock, blunt chest trauma, and a femur fracture with subsequent reduction and fixation by group-specific operative strategies. Adult Sprague-Dawley male rats (n = 45) were randomly allocated to three groups: Sham (n = 9), ETC (primary intramedullary nailing (IN); n = 18), and DCO-IN (external fixation with conversion to IN at day 6 after the trauma; n = 18). Postoperative gait changes at different timepoints were analyzed using the CatWalk system. At seven, 21, and 42 days, the animals were euthanized to assess bone formation of the femur fracture histologically and via micro-CT. Biomechanical stability was assessed by a three-point bending test.

Results: Fixation conversion surgery in the DCO-IN group decreased callus formation, resulting in delayed fracture healing with reduced callus quality and poorer biomechanical properties compared to the ETC group. The DCO-IN group also exhibited poorer weightbearing and locomotor-function rehabilitation compared to the ETC group, consistent with the impaired fracture healing process.

Conclusion: These results demonstrate that conversion of the fixation method in the DCO strategy delays the callus formation process up to six weeks after trauma, potentially contributing to delayed rehabilitation and higher risk of nonunion in multiple-trauma patients. DCO should be limited to patients with contraindications for ETC, underlining the need for clear identification factors.

Aims: People with unilateral transfemoral/through-knee amputations (UTF) are at risk of mechanically mediated contralateral knee osteoarthritis (OA). This study aims to identify the mechanical indicators of the development and progression of unamputated knee OA in the UTF population.

Methods: Level-ground gait data were collected from 14 male traumatic UTF participants and 14 uninjured matched controls using optical motion capture systems and force plates. Inverse kinematics, inverse dynamics, and static optimization musculoskeletal modelling simulations were conducted.

Results: UTF demonstrated higher unamputated ankle plantarflexion angles (by 4.9°, p = 0.012), peak-to-peak pelvic obliquity angles (by 2.9°, p = 0.040), and unamputated limb second peak ground reaction force (by 0.1 body weight (BW), p = 0.002) than controls. The UTF unamputated knee maximum loading rate was 0.9 Nm/kg.s higher than controls (p = 0.002). Additionally, UTF presented higher loading of the lateral compartment of the unamputated knee than controls, as characterized by the first peak (by 0.3 BW, p = 0.033), second peak (by 0.8 BW, p = 0.008), and impulse (by 22.0 BW.s/m, p < 0.001).

Conclusion: Traumatic UTF need to adopt new movement strategies to account for the limb loss. Although beneficial for successful ambulation, these compensatory movement strategies increase joint loading in the unamputated knee, which may increase the risk of OA and soft-tissue injuries. Mitigation strategies need to be proposed to improve ambulatory biomechanics with a view to improving long-term musculoskeletal health, while maintaining optimal functional levels.

Aims: Previous studies have reported synovial hypertrophy and synovitis in the ankle joint of patients with chronic ankle instability (CAI) and osteochondral lesion of the talus (OLT). The present study aimed to explore the correlation between pain level, clinical function of CAI patients with or without OLT, and the quantity of neurons and microvessels of synovium in the ankle joint.

Methods: A total of 32 subjects (14 without OLT and 18 with OLT) were included. The Cumberland Ankle Instability Tool (CAIT), American Orthopaedic Foot and Ankle Society (AOFAS), and visual analogue scale (VAS)-pain score of every patient were assessed via questionnaire, and the quantity of their terminal nerve endings and microvessels in the stained synovium section were counted under microscope. Statistical analysis was conducted to determine surgical effects (arthroscopic Broström-Gould and bone marrow stimulation) and to evaluate the association between the quantity of terminal nerve endings and microvessels with function and pain level in the ankle joint.

Results: No significant differences were found in demographics, clinical assessment, and concomitant intra-articular pathologies between the two groups (all p > 0.05). The CAIT, AOFAS, and VAS-pain (respectively at rest and at sport) scores of preoperative patients were significantly poorer than those of postoperative patients (all p < 0.01). Account of neurons was positively correlated with preoperative VAS in sport (r = 0.915, p < 0.001), and negatively correlated with preoperative CAIT (r = -0.677, p < 0.001), postoperative CAIT (r = -0.546, p = 0.001), and preoperative AOFAS (r = -0.615, p < 0.001).

Conclusion: There were no significant differences, either pre- or postoperatively, between CAI patients and CAI with OLT patients in CAIT, AOFAS, and VAS-pain. The CAIT, AOFAS, and VAS-pain were markedly improved after arthroscopic treatment. The quantity of terminal nerve endings was positively correlated with pain level and negatively correlated with clinical function.

Aims: This study investigated the effects of tranexamic acid (TXA) on the efficacy of vancomycin and meropenem against common periprosthetic joint infection (PJI)-associated pathogens in vitro. The aim was to uncover valuable insights that can be used for clinical decision-making and enhanced management of PJI in orthopaedic surgery.

Methods: We evaluated the minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), minimum biofilm inhibitory concentration (MBIC), and minimum biofilm eradication concentration (MBEC) for vancomycin and meropenem, both with and without TXA, against various bacterial strains.

Results: In the planktonic bacterial phase, TXA increased the MIC and MBC of vancomycin for Staphylococcus aureus and Staphylococcus epidermidis, decreased the MIC and MBC of meropenem for S. aureus, and increased the MIC and MBC of vancomycin combined with meropenem for S. aureus. In biofilms, TXA in combination with vancomycin synergistically decreased the MBIC and MBEC values of methicillin-resistant S. aureus (MRSA) and S. aureus.

Conclusion: TXA influences antibiotic efficacy against both planktonic bacteria and biofilms, with effects varying by antibiotic and bacterial strain. These findings underscore the complexity of drug interactions in PJI treatment, highlighting the need for tailored therapeutic strategies based on strain-specific responses.

Aims: Oestrogen drives long-bone development through various oestrogen receptors. G-protein-coupled oestrogen receptor-1 (GPER-1), a membrane oestrogen receptor, mediates longitudinal bone growth during early puberty; however, the underlying mechanisms remain unclear. Therefore, this study elucidated the mechanisms underlying GPER-1-mediated bone growth.

Methods: A GPER-1 agonist (G1), GPER-1 antagonist (G15), and chondrocyte-specific GPER-1 knockout experiment (Col2a1-Cre; GPER-1^f/f, CKO) were used to investigate the role of GPER-1 in growth plate chondrocytes from C57BL/6 mice (total number = 48). We investigated the effects of GPER-1 activation or inhibition on the tibial growth plate and bone growth, including changes in proliferation and hypertrophy, and the expression of parathyroid hormone-related peptide (PTHrP), Indian hedgehog (Ihh), and their ratio (PTHrP/Ihh).

Results: G1 treatment-induced GPER-1 activation increased tibial growth plate thickness, proliferative zone thickness, and chondrocyte proliferation in mice. The hypertrophic zone thickness and type X collagen-stained area decreased in four-week-old G1-treated mice compared with the control group. GPER-1 activation increased the PTHrP/Ihh ratio in the growth plates of four- and eight-week-old mice. In contrast, blocking or deleting GPER-1 decreased the proliferative zones of the growth plate, proliferative chondrocytes, and PTHrP/Ihh. Additionally, the hyperopic zones of the growth plates increased with GPER-1 deficiency. In vitro micromass-3D cultured chondrocyte studies confirmed that G1 treatment increased proliferation, decreased hypertrophy, and increased PTHrP/Ihh protein levels.

Conclusion: This study demonstrates that GPER-1 maintains proliferation but suppresses chondrocyte hypertrophy in growth plates by upregulating PTHrP/Ihh during early puberty in male and female mice. Our findings suggest that GPER-1 may serve as a potential target for therapeutic modulation of linear bone growth during puberty.

Aims: Extendable prostheses have developed rapidly over the decades to solve limb length discrepancy (LLD) following limb salvage surgery in children and adolescents who have suffered primary malignant bone tumours. In this study, we performed a systematic review of the literature on extendable prostheses to investigate their developments and clinical outcomes, to provide evidence-based recommendations for enhancing clinical implementation and refinement.

Methods: A systematic review of 46 studies with 709 invasive cases and 556 noninvasive cases was performed after searching the PubMed, EMBASE, and Web of Science databases. Results of the prosthesis survival rate, functional outcomes, and complications were extracted, recategorized, and analyzed.

Results: With the increase in publication year, there was no significant change in the five-year prosthesis survival rate, while the Musculoskeletal Tumour Society (MSTS) score exhibited an upward trend. Apart from infection, the incidence of mechanical complications increased as follow-up time extended. Failed structure of invasive prosthesis was higher than in those who received a noninvasive extendable prosthesis (25.1% (123/491) vs 15.0% (70/466); p < 0.001, Power = 0.972). The mean number of additional procedures in patients who received an invasive prosthesis was higher than those who received a noninvasive extendable prosthesis (2.4 (1.3 to 3.4) vs 1.4 (0.1 to 2.7); p = 0.021), and there was no obvious clinical difference between invasive prostheses and noninvasive prostheses in infection (15.0% (88/586) vs 13.4% (68/508); p = 0.442, Power = 0.125). Infection (44/361, 12.2%) was the most common complication associated with the Stanmore JTS prosthesis, while the incidence of aseptic loosening (14/296, 4.7%) was the lowest. The mean incidence of complications in the Stanmore Mark I-IV group was higher than that in the Stanmore JTS group (68.9% (104/151) vs 36.6% (49/134); p < 0.001, Power = 0.9998).

Conclusion: Despite decades of progress, extendable prostheses have shown promising results but still face challenges such as high infection rates, requiring further technological innovation for better outcomes.