Benefits of early ambulation within 24 h after total knee arthroplasty:a multicenter retrospective cohort study in China

Background:Postoperative care has been evolving since the concept of enhanced recovery after surgery(ERAS)was introduced in China.This study aimed to evaluate the effects of early ambulation within 24h after unilateral total knee arthroplasty(TKA)on postoperative rehabilitation and costs in a Chinese population.Methods:This cohort study of patients with knee osteoarthritis who had undergone TKA at 24 large teaching hospitals between January 2014 and November 2016 involved 2687 patients who began ambulating within 24h(Group A)and 3761 patients who began ambulating later than 24h(Group B).The outcome measurements,such as length of stay(LOS),total hospitalization costs,dynamic pain level,knee flexion range of motion(ROM),results of the 12-Item Short Form Survey(SF-12),incidence of thromboembolic events and other complications,were recorded and compared.Results:The early ambulation group(Group A)had a shorter LOS and lower hospitalization costs and pain levels than the late ambulation group(Group B).There was a favorable effect in enhancing ROM for patients in Group A compared with patients in Group B.In Group A,patients had significantly higher postoperative SF-12 scores than those in Group B.The incidence of deep venous thrombosis(DVT)and pulmonary infection was significantly lower in Group A than in Group B.The incidence of pulmonary embolism(PE)and other complications did not differ between the two groups.Conclusions:Early ambulation within 24h after TKA was associated with reduced LOS,improved knee function,lower hospitalization costs and lower incidence of DVT and pulmonary infection in the Chinese population.

Expression of miRNA-140 in Chondrocytes and Synovial Fluid of Knee Joints in Patients with Osteoarthritis

Objective To investigate the expression of miRNA-140 in chondrocytes and synovial fluid of osteoarthritis(OA) patients, and explore the relationship between the miRNA-140 expression and OA severity. Methods This study enrolled 30 OA patients who underwent total knee arthroplasty for chondrocytes sampling and 30 OA patients who underwent intra-articular injection for synovial fluid sampling. All OA patients were grouped into mild [Kellgren and Lawrence(KL) grade 1-2], moderate(KL grade 3) and severe(KL grade 4), with 10 in each subgroups for each sampling purposes. 7 non-OA patients and 10 patients with knee injury were collected for cartilage and synovial fluid sampling respectively as control groups. Chondrocytes were isolated from the cartilage tissue and cultured in vitro. Quantitative real time PCR for miRNA-140 in chondrocytes and synovial fluid were performed, and the U6 sn RNA was used as internal control. The expression difference of miRNA-140 among groups and correlation between the expression and the KL grade of OA were analysed using one-way ANOVA and Spearman test respectively. Results The expression of miRNA-140 in chondrocytes of knees in OA patients was reduced than that in normal knees, and the between-group difference was statistically significant(F=305.464, P<0.001). miRNA-140 could be detected in synovial fluid of both normal knees and OA knees, its relative expression level was reduced in synovial fluid of OA group compared with normal group, and the between-group difference was statistically significant as well(F=314.245, P<0.001). The relative expression level of miRNA-140 in both chondrocytes and synovial fluid were negatively correlated with the KL grade of OA(r=-0.969, P<0.001; r=-0.970, P<0.001). Conclusion miRNA-140 could be detected in chondrocytes and synovial fluid of OA patients, and its expression was negatively correlated with the severity of OA.

Accuracy of a Simple Digital Templating in Primary Uncemented Total Hip Arthroplasty

Objective To introduce a simple preoperative digital templating in uncemented total hip arthroplasty(THA) and to determine its accuracy for preoperative size selection of the prostheses.Methods A prospective study of digital planned THAs was performed on 90 hips with different types of prostheses from August 2013 to Angust 2014.The plastic templates of different types of prostheses were scanned for desired digital templating and the scanned images were then processed to the transparent,digital templates using Photoshop software.We calibrated the scales of the digital templates with the preoperative radiographs,and then selected the right size of the component.The preoperatively digital planned component sizes were compared to the actual sizes used in the operation,as well as the preoperatively traditional planned sizes.Results In either cup or stem templating,no difference was found among the groups with different types of prostheses,and the accuracy of digital templating was statistically higher than traditional templating.In cup templating,digital planned and implanted cup sizes were identical in 43.33% of the cases,78.89% of the cup sizes were predicted within 1 size(± 2mm) and 95.56% were predicted within 2 sizes(±4 mm),all significantly higher than the results of traditional planned sizes(30.00%,P=0.044;61.11%,P=0.007;82.22%,P=0.004).The exact femoral stem size was predicted in 40.00% of cases using the digital templating,84.44% of stem sizes were predicted within 1 size,and 93.33% within 2 sizes,better than using traditional templating(25.56%,P=0.028;53.33%,P<0.001;77.77%,P=0.003).Conclusion This simple digital preoperative templating is an accurate and reproducible process to preoperatively predict the implant size of uncemented THA.

Treatment of osteoporotic intertrochanteric fractures by zoledronic acid injection combined with proximal femoral nail anti-rotation

Objective： To observe the clinical results of proximal femoral nail anti-rotation （PFNA） combined with zoledronic acid injection in the treatment of osteoporotic intertrochanteric fractures in the elderly. Methods： 60 elderly patients with osteoporotic intertrochanteric fractures were diagnosed using a dual energy X-ray bone density instrument. Patients were randomly divided into treatment or control groups （30 cases in each group）. Patients in both groups were treated by closed/open reduction and internal fixation using PFNA. In the treatment group, patients received one zoledronic phosphonic acid injection of 5 mg/100 ml via intravenous drip, in addition to 600 mg of Cakrate D （qd） and 0.25 μg of alpha ossification alcohol （qd）. The control group received 600 mg of Caltrate D （qd） and 0.25 μg of alpha ossification alcohol （qd）. The oral drugs were administered for 12 months. Bone pain relief was observed, and changes in the bone mineral density （BMD） of the lumbar and health-side hip were recorded. Clinical results were evaluated using the Visual Analogue Scale （VAS）, Harris joint function score, and Osteo- porosis Quality of Life Scale （OQOLS）. Results： Compared with the control group, bone pain symptoms wene significantly alleviated （p 〈 0.05） in the treatment group. In the treatment and control groups, both between-group and within-group differences in BMD were significantly increased in L1-4, femoral neck and trochanter （p 〈 0.05）. No significant differences were found between the two groups in regard to the involved hip or the total rate of improvement at the end of the follow-up period, although cases in the treatment group had higher OQOLS scores than those of the controls （p = 0.04）. Cases in the treatment group healed more quickly than those in the control group [（13 ± 3.2） weeks vs （15 ± 4.6） weeks, p = 0.02]. During the follow^up period, cases in the treatment group had no new fractures, whereas 2 new cases of hip fracture and 2 cases of distal radial fractures were observed among the controls. Conclusion： Zoledronic acid injection combined with PFNA is a favorable treatment option for the elderly patients with osteoporotic intertrochanteric fracture. It can effectivelly relieve bone pain, increase bone density, improve quality of life, reduce the occurrence of new fractures and promote fracture healing.

Roles of microRNA and signaling pathway in osteoarthritis pathogenesis

Osteoarthritis （OA） is a common chronic degenerative joint disease, with complicated pathogenic factors and undefined pathogenesis. Various signaling pathways play important roles in OA pathogenesis, including genetic expression, matrix synthesis and degradation, cell proliferation, differentiation, apoptosis, and so on. MicroRNA （miRNA） is a class of non-coding RNA in Eukaryon, regulating genetic expression on the post-transcriptional level. A great number of miRNAs are involved in the development of OA, and are closely associated with different signaling pathways. This article reviews the roles of miRNAs and signaling pathways in OA, looking toward having a better understanding of its pathogenesis mechanisms and providing new therapeutic targets for its treatment.