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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_1 | Pages 88 - 88
2 Jan 2024
Kim M Kim, K
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There is still no consensus on which concentration of mesenchymal stem cells (MSCs) to use for promoting fracture healing in a rat model of long bone fracture.

To assess the optimal concentration of MSCs for promoting fracture healing in a rat model.

Wistar rats were divided into four groups according to MSC concentrations: Normal saline (C), 2.5 × 106 (L), 5.0 × 106 (M), and 10.0 × 106 (H) groups. The MSCs were injected directly into the fracture site. The rats were sacrificed at 2 and 6 자 post-fracture. New bone formation [bone volume (BV) and percentage BV (PBV)] was evaluated using micro-computed tomography (CT). Histological analysis was performed to evaluate fracture healing score. The protein expression of factors related to MSC migration [stromal cell-derived factor 1 (SDF-1), transforming growth factor-beta 1 (TGF-β1)] and angiogenesis [vascular endothelial growth factor (VEGF)] was evaluated using western blot analysis. The expression of cytokines associated with osteogenesis [bone morphogenetic protein-2 (BMP-2), TGF-β1 and VEGF] was evaluated using real-time polymerase chain reaction.

Micro-CT showed that BV and PBV was significantly increased in groups M and H compared to that in group C at 6 wk post-fracture (P = 0.040, P = 0.009; P = 0.004, P = 0.001, respectively). Significantly more cartilaginous tissue and immature bone were formed in groups M and H than in group C at 2 and 6 wk post-fracture (P = 0.018, P = 0.010; P = 0.032, P = 0.050, respectively). At 2 wk post fracture, SDF-1, TGF-β1 and VEGF expression were significantly higher in groups M and H than in group L (P = 0.031, P = 0.014; P < 0.001, P < 0.001; P = 0.025, P < 0.001, respectively). BMP-2 and VEGF expression were significantly higher in groups M and H than in group C at 6 wk postfracture (P = 0.037, P = 0.038; P = 0.021, P = 0.010). Compared to group L, TGF-β1 expression was significantly higher in groups H (P = 0.016). There were no significant differences in expression levels of chemokines related to MSC migration, angiogenesis and cytokines associated with osteogenesis between M and H groups at 2 and 6 wk post-fracture.

The administration of at least 5.0 × 106 MSCs was optimal to promote fracture healing in a rat model of long bone fractures.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_5 | Pages 34 - 34
1 Apr 2018
Kim H Kim M Yoo J Kim K
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Isolated liner and head exchange procedure has been an established treatment method for polyethylene wear and osteolysis when the acetabular component remains well-fixed. In this study, its mid-term results were evaluated retrospectively in 34 hips.

Among the consecutive patients operated upon from September 1995, 2 patients (3 hips) were excluded because of inadequate follow-up and the results of remaining 34 hips of 34 patients were evaluated. They were 20 men and 14 women with a mean age of 49 years at the time of index surgery. Conventional polyethylene liner was used in 26 cases and highly cross-linked polyethylene liner was used in 8 cases. In 3 cases, liner was cemented in the metal shell because compatible liner could not be used. After a minimum follow-up of 5 years (range, 5∼20.2), re-revision surgery was necessary in 10 cases (29.4%); 8 for wear and osteolysis, 2 for acetabular loosening. In all re-revision cases, conventional polyethylene was used. There was no failure in the cases in which highly cross-linked polyethylene was used. There was no case complicated with dislocation.

The results of this study suggest more promising results with the use of highly cross-linked polyethylene in isolated liner exchange.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_2 | Pages 59 - 59
1 Jan 2016
Ikawa T Hiratsuka M Takemura S Kim M Kadoya Y
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INTRODUCTION

Although the most commonly used method of femoral component alignment in total knee arthroplasty (TKA) is an intramedullary (IM) guides, this method demonstrated a limited degree of accuracy. The purpose of this study was to assess whether a portable, accelerometer-based surgical navigation system (Knee Align 2 system; Orth Align, Inc, Aliso Viejo, Calif) improve accuracy of the post-operative radiographic femoral component alignment compared to conventional IM alignment guide.

MATERIALS & METHODS

Since February 2014, 44 consecutive patients (39 female, 5 male) with primary arthritis of the knee were enrolled in this prospective, randomized controlled study. 24 patients underwent TKA (Vanguard RP or PS, Biomet Japan) using the navigation device for the distal femoral resection (Navigated Group), and 20 patients with conventional femoral IM alignment guide. The proximal tibial resection was performed using an extramedullary guide. All the operation was performed by a single senior surgeon (YK) with the same gap balancing technique except for the use of the navigation system for the femur. Accuracy of femoral implant positioning was evaluated on 2 weeks postoperative standing anteroposterior (AP) hip to ankle radiographs.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_2 | Pages 85 - 85
1 Jan 2016
Kadoya Y Tsujimoto T Ikawa T Kim M
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INTRODUCTION

Rotational alignment of the femoral and tibial component in total knee arthroplasty (TKA) are separately determined based on the anatomy of each bone. Popular references are the transepicondylar axis (TEA) for femoral component, and medial one-third of the tibial tubercle for the tibial component. It was reported that these references are not in accordance with each other in osteoarthritic (OA) knees and rotational mismatch could occur even when the components were accurately aligned. There has been, however, a paucity of data as for the rotational mismatch after TKA for OA knees. The purpose of this study was to evaluate the rotational mismatch between the femoral and tibial component after TKA for OA knees.

SUBJECTS & METHODS

Eighty-four knees which underwent primary TKA for the varus osteoarthritis of the knee were analyzed. Those knees were chosen by the retrospective confirmation of the precise rotational alignments of both femoral and tibial components by postoperative computed tomography (with ±3 degrees to the targeted reference lines described below). The femoral reference line was the surgical epicondylar axis and the tibial reference line was Akagi's line; a line connecting the midpoint of the tibial insertion of the posterior cruciate ligament and the medial border of patellar tendon. Intraoperative, dynamic evaluations of the rotational mismatch between femoral and tibial components was performed with a special device attached to the mobile-bearing trials at full extension and in neutral, passive external rotation and passive internal rotation.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVIII | Pages 73 - 73
1 May 2012
Papanna MMC Yasin MN Sundararajan MS Kim M
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Objective of the study

To determine if the location and pattern of knee pain as described by the patients using the knee pain map was comparable with the intra articular pathology found on arthroscopy as well as to facilitate diagnosis based on pain.

Methods

There were Sixty consecutive patients with acute and chronic knee pain participating in the study and they subsequently underwent arthroscopy of the knee joint as therapeutic or diagnostic procedure in day surgery.

Those patients with extra articular pathologies, referred pain hip, back and foot were excluded from the study.

All the participants were consented for the study; subjective data was recorded on the standardised knee pain map that included visual analogue pain scale preoperatively on the day of admission for arthroscopy.

The findings of the arthroscopy including EUA were recorded on the on standard arthroscopy forms used in our department by the operating surgeon.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 592 - 592
1 Nov 2011
Hoang-Kim M Bhandari M Beaton DE Schemitsch EH
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Purpose: Today, numerous functional outcome tools exist to assess the patient’s ability to carry out basic and instrumental activities of daily living. Furthermore, the increase in range of mobility measures reflect differences in rating scales, scores, administration and scoring options which make outcome results difficult to assess across trials. Because of the lack of consensus among investigators, we wanted to identify the citation patterns of the functional outcomes tools used by investigators in hip fracture RCTs. We believed that the lack of proper citation is an underlying factor in the diverse usage of outcome tools.

Method: We extracted the citations of disability tools from 59 Level 1 hip fracture RCTs. Disability was defined using the WHO classification (ICF). We excluded measures assessing body structure. The text and reference lists of the identified articles were screened in order to compile relevant literature on the instrument used in the RCT. Disability tools which were cited in the references were also compared to original development articles.

Results: Overall 68 different instruments were identified that measured disability in the hip fracture literature. According to ICF, 47 tools measured body function alone, 13 tools evaluated activity limitations and participation restriction and 8 were composite scoring systems. We found that 34.2% of the trials did not provide any citations to the tools assessing body function. In trials measuring activity and participation, 23.2% provided instrument citations. In trials using composite scoring systems, 19.4% of the trials provided instrument citations. All of the instrument citations when provided by the investigators were found to correspond to original development articles or trials.

Conclusion: The appropriate choice of a functional outcome instrument is fundamental in order to ensure that the results that are obtained reflect the patient. However, if citations of the indices and scales themselves are lacking, trial methodology and results could be informative but not replicated. In the future, we recommend that rigor in quality reporting include proper instrument citations.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 414 - 414
1 Nov 2011
Yang J Seo J Kim M Moon Y Kim J
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We aimed to analyze the clinical results of the patients according to joint line change who underwent navigation assisted cruciate ligament retention type mobile bearing total knee arthroplasty.

From September 2004 to January 2006, cruciate ligament retention type mobile bearing total knee arthroplasties using navigation system(Orthopilot®, Aesculap) were performed for 50 knees in 45 patients (2 men, 43 women). The mean follow up period was 46(39~55) months and the mean age was 65. There was one case with rheumatoid arthritis and all other were degenerative arthritic cases. All surgeries were performed using navigation system. Proximal tibia resection was performed at the sclerotic level of medial tibial plateau. The distance from the lowest point of lateral tibial plateau (registered point) to the proximal resection plane was measured. Clinical outcome were compared between joint line elevation with more than 3 mm(20cases) and less than 3mm (30cases).

The mean joint line elevation was 1.93 mm (range −1~5mm). There were no significant difference in the clinical results according to the joint line change (p> 0.05). It may be suggested that the change of joint line in the range of −1 to 5mm in cruciate ligament retention type mobile bearing total knee arthroplasty result in satisfactory clinical outcome.


TGF-β1 and BMP-2 are abundant proteins in bone matrix, their interaction in controlling osteoblastic differentiation is, however, not clearly understood. To gain more insight into the role of TGF-β1 in the control of osteoblastic differentiation, murine and human bone marrow stromal cells were transduced with an adenovirus carrying the human TGF-β1 cDNA or LacZ gene. The transduced cells assessed for alkaline phosphatase(ALP) activity, cell proliferation and matrix synthesis. The murine TGF-β1 transduced cells synthesized and secreted about 25 ng/ml of TGF-β1, while the human cells secreted about 120 ng/ml of TGF-β1 over 24h. Both the murine and human TGF-β1 transduced cells failed to respond to rhBMP-2 as indicated by non-expression of ALP activity, while the LacZ transduced cells expressed ALP activity under similar conditions. Treatment of the bone stromal cells with the human TGF-β1 protein in presence of BMP-2 demonstrated that the inhibition of the ALP activity expression is dose dependent.