Introduction: Normal axial alignment of the lower extremity is important to surgeons who perform reconstruction surgery of the knee. The data are, however, not available for Chinese adults. Methods: The axial alignment of the lower extremity of twenty-five adult males and twenty-five adult females of southern Chinese origin was measured by using weight-bearing radiographs of the entire lower limb. The mean age of the male and female volunteers was twenty-four years and twenty-three years respectively. The axial alignment of the lower extremity was measured and the results were compared with two similar studies conducted in the United States. Results: The medial inclination of the tibial plateau in the Chinese volunteers was greater than the commonly cited 3 degrees (with a mean of 5.4 ± 2.5 degrees for females and 4.9 ± 2.3 degrees for males). The extremities in Chinese volunteers were found to have a mean of 2.2 ± 2.5 degrees varus (females) and 2.2 ± 2.7 degrees varus (males). Conclusions and Discussion: The medial inclination (knee joint obliquity) of the Chinese knee joint was significantly larger than Caucasian subjects. The higher knee joint obliquity exposes the cartilage of the Chinese knee to a higher shearing force and subsequently result in osteoarthritis. This may explain the racial difference in the ratio of knee to hip osteoarthritis. When performing total knee arthroplasty, a 5-degree, instead of the commonly cited 3-degree, external rotation of the femoral component may be required to obtain a rectangular flexion gap in total knee arthroplasty in Chinese patients

Objective. The purpose of this study was to compare the proximal femoral morphology between normal Chinese and Caucasian populations by 3D analysis derived from CT data. Materials and Methods. 141 anonymous Chinese femoral CT scans (71 male and 70 female) with mean age of 60.1years (range 20–93) and 508 anonymous Caucasian left femoral CT scans (with mean age of 64.8years (range 20–93). The CT scans were segmented and converted to virtual bones using custom CT analytical software. (SOMA™ V.4.0) Femoral Head Offset (FHO) and Femoral Head Position (FHP) were measured from head center to proximal canal central axis and to calcar or 20mm above Lesser Trochanter (LT) respectively. The Femoral neck Anteversion (FA) and Caput-Collum-Diaphyseal (CCD) angles were also measured. The Medial Lateral Widths(MLW. n. ) of femoral canal were measured at 0, -10, LT, -30, -40, -60, -70 and -100mm levels from calcar. Anterior Posterior Widths (APW. n. ) were measured at 0, -60 and -100mm levels. The Flare Index (FI) was derived from the ratio of widths at 0 and -60mmor FI=W. 0. /W. −60. All measurements were performed in the same settings for both populations. The comparison was analyzed by Student T test. P<0.05 was considered significant. Results. The average FHO and FHP of Chinese were 38.4mm and 25.2mm and were both shorter than 42.1mm and 29.7mm of Caucasian's, P=2.3E-15 and P=1.7E-10. (Figure 1) CCD angle was 130.3° comparing to 127.7° of Caucasian P=1.5E-05. Chinese FA angle was 15.6° and Caucasian's was 14.7°, P=0.31. The average MLW. 1-8. were 43.1, 34.6, 28.5, 23.8, 20.6, 17, 16.2 and 14.4mm for Chinese and 43.7, 35.0, 28.7, 24.0, 20.6, 16.7, 15.7 and 13.5mm for Caucasian. P=9.4E-02, .32, .47, .50, .93, .20, .02 and 1.7E-05 respectively. (Figure 2) The average APW. 1-3. were 35.9, 15.5 and 13.7mm for Chinese and 43.7, 15.2 and 12.5mm for Caucasian. P=4E-62, 0.11 and 7.4E-10. (Figure 3) The total medial/lateral and medial/center FI were 2.5 and 2.8 for Chinese, 2.6 and 2.9 for Caucasian. P=.004 and 4.5E-06. The total anterior/posterior and anterior/center FI were 2.3 and 2.6 for Chinese, 2.9 and 2.5 for Caucasian. P=5.3E-61 and 8.5E-04. Conclusion and Discussion. Chinese had significantly lower FHO, FHP, APW. calcar. , FI. medial, M-L. and FI. A-P. ; significantly higher CCD angle and MLW. isthmus. , APW. isthmus. and FI. anterior. than that of Caucasian population. There were no significant differences in FA and MLW from 10mm above to 50mm bellow LT. The average reduction of 3.7mm in FHO and 4.5mm in FHP for Chinese suggests a necessary adjustment of femoral implant neck length designed for Caucasian population. Due to the findings of the similarity in MLW and dissimilarity in APW, the study suggested the M-L fitting stem will fit well for both populations

Introduction. One of the objectives of total hip arthroplasty is to restore femoral and acetabular combined anteversion. It is desirable to reproduce both femoral and acetabular antevesions to maximize the acetabular cup fixation coverage and hip joint stability. Studies investigated the resultant of implanted femoral stem anteversion in western populations showed that the implanted femoral stems had only a small portion can meet the desirable femoral anteversion angle. 1. , and anteversion angle increases after the implantation of an anatomical femoral stem with anteverted stem neck comparing to anatomical femoral neck. 2. The purpose of this study was to anatomically measure the anteversion angular difference between metaphyseal long axis and femoral neck in normal Chinese population. The metaphyseal long axis represents the coronal fixation plane of modern cementless medial-lateral cortical fitting taper stem. This angular difference or torsion Δ angle provides the estimation of how much the neck antevertion angle of femoral stem would be needed to match for desirable anatomical femoral neck version. Methods. 140 (77 male and 63 female) anonymous normal adult Chinese CT data with average age of 54.6 (male 54.6, female 54.5, P=0.95) were segmented and reconstructed to 3D models in Trauson Orthopeadic Modeling and Analytics (TOMA) program. Femoral head center, femoral neck axis and center point of diaphyseal canal 100mm bellow calcar formed the femoral neck plane. The metaphyseal stem implantation plane was determined by the center point of medial calcar, proximal canal central axis formed by femoral neck plane and the center point of diaphyseal canal 100mm bellow calcar. [Fig. 1] The angle between two planes was the torsion Δ angle between femoral placement plane and anatomical femoral neck. [Fig. 2] The torsion Δ angles were measured for all 140 cases. The traditional anteversion angle for anatomical femoral neck was also measured by Murphy's method. Student T test was perform to compare the angles for male and female. The 98% confidence level was assumed. Results. The average torsion Δ angle for whole population was 4.9°(0.04°-15.6°), SD=3.52°, male: 4.6° (0.42°-13.9°), SD=3.09°; female: 5.3° (0.04°-15.6°), SD=3.98°. There was no statistical significant difference between genders. P=0.28. All metaphyseal stem placement planes were less anteverted than anatomical femoral neck plane. [Fig. 3] The average anatomical femoral neck anteversion angle for total population was 18.6° (0.27°-42.6°), SD=7.54°; male: 18.6° (0.27°-32.9°), SD=7.37°; female: 18.7° (1.74°-42.6°), SD=7.81°. There was no statistical significance between male and female P=0.92. Only 26% of study population or 37 cases with unadjusted implant neck version had normal anteversion angle of 10°-15° (Tönnis). Discussion. The study suggested femoral stem neck anteversion angle adjustments up to 11° was necessary to match anatomical femoral neck for 94% of cases in Chinese population. And the adjustments of 0°-7° represented the 76% majority of population. This finding was in agreement with the published data in western population. 2. . Significance. Variable femoral stem neck anteversion angles up to 11° are necessary to reproduce the anatomical anteversions for 94% of normal Chinese population. For any figures or tables, please contact the authors directly

Aim. Cyclooxygenase-2 (COX-2) enzyme is one of the major mediators during inflammation reactions, and COX-2 gene polymorphisms of rs20417 and rs689466 have been reported to be associated with several inflammatory diseases. However, potential links between the two polymorphisms and risk of developing post-traumatic osteomyelitis remain unclear. The present study aimed to investigate associations between the rs20417 and rs689466 polymorphisms and susceptibility to post-traumatic osteomyelitis in Chinese population. Methods. A total of 189 patients with definite diagnosis of post-traumatic osteomyelitis and 220 healthy controls were genotyped for rs20417 and rs689466 using the genotyping method*. Chi-square test was used to compare differences of genotype distributions as well as outcomes of five different genetic models between the two groups. Results. Significant association was found between rs689466 and post-traumatic osteomyelitis by recessive model (GG vs. AA + AG) (OR = 1.74, 95% CI: 1.098–2.755, P =0.018). Although no statistical differences were identified of rs689466 between the two groups by allele model (P = .098) or homozygous model (P = 0.084), outcomes revealed a tendency that allele G may be a risk factor and people of GG genotype may be in a higher risk to develop post-traumatic osteomyelitis in Chinese population. However, no significant link was found between rs20417 and susceptibility to post-traumatic osteomyelitis in this Chinese cohort. Conclusions. To our knowledge, we reported for the first time that COX-2 gene polymorphism rs689466 may contribute to the increased susceptibility to post-traumatic osteomyelitis in Chinese population. *SNaPshot®

INTRODUCTION:. Successful tibial component placement during total knee arthroplasty (TKA) entails accurate rotational alignment, minimal overhang, and good bone coverage, each of which can be facilitated with a tibial component that matches the resected tibial surface. Previous studies investigated bony coverage of multiple tibial component families on digitized resections. However, these studies were based on manual placement of the component that may lead to variability in overhang and rotational alignment. An automated simulation that follows a consistent algorithm for tibial component placement is desirable in order to facilitate direct comparison between tibia component designs. A simulation has been developed and applied to quantify tibial coverage in multiple ethnicities, including Japanese, Indian, and Caucasian. Here, this approach is taken to evaluate tibial coverage of five contemporary tibial designs in Chinese subjects. METHODS:. Digital models of 100 healthy Chinese tibiae (50 male, 50 female; age 68 ± 3 years; stature 1.65 ± 0.10 m) were virtually resected at 5° posterior slope referencing the anterior border of the proximal tibia, 0° varus/valgus rotation referencing the tibial mechanical axis, and 8 mm off the unaffected plateau (reflecting a 10 mm surgical cut, assuming a cartilage thickness of 2 mm). Neutral internal/external (I/E) alignment axis was derived from the medial third of the tubercle and the PCL attachment site. Five commercial tibial designs (Design A, Deluxe™, Montagne, Beijing, China; Designs B-E contemporary market-established symmetric designs from four US manufacturers) were virtually placed on the resected tibiae following an automated algorithm, which maximizes component size while ensuring proper rotational alignment (within 5° I/E) and minimizing overhang (<1 mm in zones 1–4, Fig 1). Tibial coverage (posterior notch excluded, zone 5 in Fig 1) and distance from the component to the exterior cortex of the tibia in four clinically relevant anatomical zones (anterior medial, anterior lateral, posterior medial, and posterior lateral, zones 1–4, Fig 1) were calculated. Statistical significance was defined at p < 0.05. RESULTS:. Coverage across designs varied between 75% and 96%. All five designs showed comparable means and standard deviations in tibial coverage (Fig. 2). Although statistically higher coverage was found in Designs D-E than Designs A-C (p < 0.04), the difference in means (86–87% for Designs A-C; 88% for both Designs D-E) was clinically not meaningful (Fig. 2). Design A was found to be slightly (0.67 mm, p = 0.02) farther away from the cortex than Design E in the anterior medial zone; no other significant differences were found for distance to cortex between any of the component designs in any of the anatomical zones (Fig. 3). DISCUSSION:. The data suggests comparable tibial coverage, which may reflect the likelihood for component subsidence clinically, is expected between the six contemporay design investigtated when implanted into Chinese patients. Though subsidence is multifactorial, and is dependent on aspects of implant design and surgical technique beyond just tibial tray shape, these results nevertheless provide initial indicators on the expected rate of subsidence or overhang in Chinese patients for Design A relative to the more established Designs B-E

Background. Recent anthropometric studies have suggested that current design of total knee arthroplasty (TKA) does not cater to racial anthropometric differences. The purpose of this study was to investigate the exact sizing and rotational landmarks of the distal femur collected from a large group of healthy Southern Chinese using three dimensional computer tomographic measurements, and then compare these measurements to the known dimensions from Caucasian populations. Methods. This study evaluated distal femoral geometry in 125 healthy Southern Chinese, included 58 women (106 knees) and 67 men (134 knees) with a mean age of 35.2±8.11 years, a mean height of 165.5±7.94 cm, and a mean weight of 61.7±9.56 kg. The width of the articular surface as projected onto the transepicondylar line(ML), anteroposterior dimension (AP), the dimensions from medial/lateral epicondyle to posterior condylar (MEP/LEP)were measured. A characterization of the aspect ratio (ML/AP) was made for distal femur[Fig. 1]. The angles between the tangent line of the posterior condylar surfaces, the Whiteside line, the transepicondylar line, and the trochlear line were measured. The sulcus angle and hip center-femoral shaft angle were also measured. Known dimensions from Caucasian populations were compared with the morphologic data collected in this study[Fig. 2]. In analyzing the data, best-fit lines were calculated with use of least-squares regression. The dimensions are summarized as the mean and standard deviation. The differences of rotational landmarks and sizing between the Southern Chinese and Caucasians were assessed with use of the Student t test. A p value of <0.05 indicated a significant effect. Results. Within the Southern Chineses population, males had larger ML and AP values than females (ML: 70.38±3.09 vs. 62.09±2.52mm, P<0.001; AP: 63.68±2.82 vs. 57.83±2.91mm, P<0.001). The results also showed that Southern Chinese knees were generally smaller than Caucasian (ML: 67.27±4.95 vs. 76.8±7.2mm, P<0.001). The femoral aspect ratio of Southern Chinese was significantly smaller than Caucasian (1.09±0.04 vs. 1.28±0.06, P<0.001). In addition, we found a gradual decrease in the aspect ratio corresponding to an increase in anteroposterior dimension in the distal femur of Southern Chinese, as seen in most other studies. The transepicondylar axis was found to be a reliable landmark to properly rotate the femoral component, so we used the femoral condylar MEP and LEP evaluate posterior condylar offset, the values were respectively 28.62±2.18mm and 22.50±2.19mm. From this study, most of the angles were different from Caucasian. Anteroposterior line minus epicondylar line angle was 90.14±1.30° (Caucasian 90.33±2.44°, P>0.05), anteroposterior line minus posterior condylar line angle was 83.18±1.94° (Caucasian 86.82±2.71°, P<0.001), epicondylar line minus posterior condylar line angle was 7.00±1.70° (Caucasian 3.60±2.02°, P<0.001), trochleoepicondylar angle was 12.45±2.34°(Caucasian 4.95±2.15°, P<0.001), sulcus angle was 147.40±4.69° (Caucasian 139.6±6.96°, P<0.001). The angle between mechanical and anatomic axis of the femur was 5.92±0.47°(Caucasian 6.33±2.42°, P<0.001). Conclusion. Because dimensions of the distal femur and the aspect ratio tend to be smaller in Southern Chinese populations, whereas sulcus angles tend to be larger, designs for knee implants should be modified to improve the outcome of surgical treatment in this population. The Larger epicondylar line minus posterior condylar line angles, and the smaller angle between mechanical and anatomic axis seen in Southern Chinese populations also requires us to pay particular attention to surgical technique, in order to ensure patient safety

Aim. Previous studies had indicated that interleukin-1 beta (IL-1β) gene single nucleotide polymorphisms (SNPs) associate with different inflammatory diseases. However, potential links between these polymorphisms and susceptibility to extremity chronic osteomyelitis (COM) in Chinese population remain unclear. This study aimed to investigate relationships between IL-1β gene polymorphisms (rs16944, rs1143627, rs1143634 and rs2853550) and the risk of developing extremity COM in Chinese population. Method. Altogether 233 extremity COM patients and 200 healthy controls were genotyped for the four tag SNPs of the IL-1β gene using the SNapShot genotyping method. Comparisons were performed regarding genotype distribution, mutant allele frequency and four genetic models (dominant, recessive, homozygous and heterozygous models) of the 4 SNPs between the two groups. Results. Significant associations were identified between rs16944 polymorphism and the risk of developing COM by dominant model (P = 0.026, OR = 1.698, 95% CI 1.065–2.707) and heterozygous model (P = 0.030, OR = 1.733, 95% CI 1.055 – 2.847). Although no statistical differences were found of rs1143627 polymorphism between the two groups, there existed a trend that rs1143627 may be linked to an elevated risk of developing COM by outcomes of dominant (P = 0.061), homozygous (P = 0.080) and heterozygous (P = 0.095) models. However, no statistical correlations were found between rs1143634 and rs2853550 polymorphisms and susceptibility to COM in Chinese population. Conclusions. To our knowledge, we reported for the first time that IL-1β gene rs16944 polymorphism may contribute to the increased susceptibility to extremity COM in Chinese population, with genotype of AG as a risk factor

Objectives. X-linked hypophosphataemic rickets (XLHR) is a disease of impaired bone mineralization characterized by hypophosphataemia caused by renal phosphate wasting. The main clinical manifestations of the disorder are O-shaped legs, X-shaped legs, delayed growth, and bone pain. XLHR is the most common inheritable form of rickets, with an incidence of 1/20 000 in humans. It accounts for approximately 80% of familial cases of hypophosphataemia and serves as the prototype of defective tubular phosphate (PO4. 3+. ) transport, due to extra renal defects resulting in unregulated FGF23 activity. XLHR is caused by loss-of-function mutations in the PHEX gene. The aim of this research was to identify the genetic defect responsible for familial hypophosphataemic rickets in a four-generation Chinese Han pedigree and to analyze the function of this mutation. Methods. The genome DNA samples of all members in the pedigree were extracted from whole blood. We sequenced all exons of the PHEX and FGF23 genes, as well as the adjacent splice site sequence with Sanger sequencing. Next, we analyzed the de novo mutation c.1692 del A of the PHEX gene with an online digital service and investigated the mutant PHEX with SWISS-MODEL, immunofluorescence, and protein stability detection. Results. Through Sanger sequencing, we found a de novo mutation, c.1692 del A, in exon 16 of the PHEX gene in this pedigree. This mutation can make the PHEX protein become unstable and decay rapidly, which results in familial XLHR. Conclusion. We have found a de novo loss-of-function mutation, c.1692 del A, in exon 16 of the PHEX gene that can cause XLHR. Cite this article: J. Huang, X. Bao, W. Xia, L. Zhu, J. Zhang, J. Ma, N. Jiang, J. Yang, Q. Chen, T. Jing, J. Liu, D. Ma, G. Xu. Functional analysis of a de novo mutation c.1692 del A of the PHEX gene in a Chinese family with X-linked hypophosphataemic rickets. Bone Joint Res 2019;8:405–413. DOI: 10.1302/2046-3758.88.BJR-2018-0276.R1

This study was designed to provide normal reference values for the centre-edge angle of Wiberg in the Chinese population by measuring 1494 radiographs according to the criteria of Tönnis. The mean angle was 23.1° (4.7° to 46.4°) in childhood (four to nine years), increasing to 28.9° (6° to 48°) in adolescence (10 to 18 years) and reaching 32.8° (13.7° to 58.8°) in adults. The angle was positively correlated with age, increasing by a mean of 0.78° annually before adulthood and by 0.070° annually in adults. A relative upward tendency after middle age might contribute to degenerative changes. No gender difference was discovered. The change in the angle with age was similar to that observed in other ethnic groups, showing moderate differences in the average of individual age groups, but the ethnic differences are not sufficient to explain the variation of incidence of developmental dysplasia of the hip in different races

With the increasing use of 3D medical imaging, it is possible to analyze 3D patient anatomy to extract features, trends and population specific shape information. This is applied to the development of ‘standard implants’ targeted to specific population groups. INTRODUCTION. Human beings are diverse in their physical makeup while implants are often designed based on some key measurements taken from the literature or a limited sampling of patient data. The different implant sizes are often scaled versions of the ‘average’ implant, although in reality, the shape of anatomy changes as a function of the size of patient. The implant designs are often developed based on a certain demographic and ethnicity and then, simply applied to others, which can result in poor design fitment [1]. Today, with the increasing use of 3D medical imaging (e.g. CT or MRI), it is possible to analyze 3D patient anatomy to extract features, trends and population specific shape information. This can be applied to the development of new ‘standard implants’ targeted to a specific population group [2]. PATIENTS & METHODS. Our population analysis was performed by creating a Statistical Shape Model (SSM) [3] of the dataset. In this study, 40 full Chinese cadaver femurs and 100 full Caucasian cadaver femurs were segmented from CT scans using Mimics®. Two different SSMs, specific to each population, were built using in-house software tools. These SSMs were validated using leave-one-out experiments, and then analyzed and compared in order to enhance the two population shape differences. RESULTS. An SSM is typically represented by an average model and a few independent modes of variation that capture most of the inherent variations in the data. Based on these main modes of variations, the shape features, e.g. length, thickness, curvature neck angle and femoral version, presenting largest variations were determined, and correlations between these features were calculated. Figure 1 represents the Caucasian and Chinese average models, and shows that while the length of these two models was significantly different, the AP and ML dimensions were similar, indicating a difference of morphology (other than a scaling) between the two populations. Figure 2 represents the first mode of variation that illustrates the variation of Chinese femur shape with size. As an example, the neck angle increases of 26° with an increase of 139 mm in femur length, indicative of the effect of changes in loading conditions on geometry as a function of size. CONCLUSION. The advantage of using more advanced statistical analyses is that the 3D data are probed in an unbiased fashion, allowing the most important parameters of variation to be determined. These analyses are thus particularly effective to compare different populations, to evaluate how well existing implant designs fit specific populations, and to highlight the design parameters that need to be adapted for good fitment of specific populations

Background. The purpose of this study was to investigate the morphology characteristic of proximal femur of Chinese people. 170 healthy Southern Chinese hips being measured using 3D computer tomographic, in order to improve prosthesis design and preoperation plan of total hip arthroplasty. Methods. This study measured proximal femoral geometry in 85 healthy Southern Chinese, included 39 women (78 hips) and 46 men (92 hips) (mean age: 33.9 y, mean height: 164.7 cm, mean weight 59.9 kg). Medullary canal morphology measurements, include: the position of isthmus, medial-lateral(ML) and anteroposterior(AP) medullary canal diameter of isthmus and 20 mm, 10 mm, 0 mm, −20 mm, −160 mm, −200 mm upon less trochanter(LT) (medullary canal height, MCH), canal flare index(CFI), aspect ratio(ML/AP), epiphysis-shaft angel (ES angel) (a posterior bow in the metapysis in lateral view). Exterior morphology measurements include: femoral head offset, ML and UD diameter, femoral head position(FHP) from LT, height of the femoral head center from the tip of the great trochanter(GT)(FHCH), femoral neck and head anteversion angle, femoral neck-shaft angle, neck length, neck width, intertrochanteric length (Fig 1, Fig 2). And then we use student's t–test to compare means, linear regression and correlation to analysis these data's relationship, p value <0.05 indicated a significant effect. Results. Males had a larger diameter of medullary canal than females (Fig3). The isthmus position is 117.69±11.95 VS 111.14±13.01 mm (male VS female) (p=0.070) below less trochanter, and it's ML diameter is 9.57±1.52 VS 8.88±1.80 mm (p=0.151), AP diameter is 11.85±2.68 VS 10.53±2.49 mm (p=0.073). The mean medullary canal aspect ratio is 1.38±0.20, 1.30±0.12, 1.15±0.13, 1.03±0.09, 0.84±0.11, 0.87±.011 and 1.04±0.17 respectively at 20 mm, 10 mm, 0 mm, −20 mm, isthmus, −160 mm, −200 mm upon less trochanter. The medullary canal diameter were positively correlated to MCH (R=0.793, p=0.000 VS R=0.790, p=0.000) (ML VS AP). The ES angle is 156.78±4.29 VS 157.90±4.90 degree (p=0.395) (male VS female). The femoral head offset is 39.14±3.87 VS 35.86±3.68 mm (p=0.003), femoral neck, head and comprehensive anteversion angle is 18.34±8.07 VS 17.9±10.64 degree (p=0.872), −2.61±6.47 VS −2.36±5.55 degree (p=0.881) and 15.73±7.26 VS 15.54±8.54 degree (p=0.934). FHP is 51.67±7.82 VS 45.37±5.59 mm (p=0.001), FHCH is −6.77±5.58 VS −6.13±4.87 mm (p=0.665), femoral head diameter is (ML: 43.94±2.62 VS 39.25±2.66 mm (p=0.000), UD: 45.16±1.96 VS 41.26±2.23 mm (p=0.000)). Femoral neck-shaft is 130.10±4.57 VS 130.83±6.40 degree (p=0.652), femoral neck length and width is 21.84±4.87 VS 20.69±3.41 mm (p=0.322) and 34.75±2.26 VS 31.80±2.63 mm (p=0.000), femoral intertrochanteric length is 68.11±4.72 VS 61.27±5.04 mm (p=0.000), most of these dimensions were positively correlated to height. Conclusion. Males had a larger medullary canal than females, the long diameter of medullary canal is transverse at proximal femoral, and it gradually become longitudinal when move to isthmus then become transverse again below isthmus, this may offer valuable revelation for our anti-rotation design and better distal fixation. The medullary canal diameter were positively correlated to MCH. 71% (121 hips) femoral heads had a retroversion angle compare to femoral neck. The femoral head rotation center is below the tip of the GT rather than on the same level that may suggested a shorter neck implants for Southern Chinese patients

Objectives. The objective of this study was to investigate the association of four single-nucleotide polymorphisms (SNPs) of the cannabinoid receptor 2 (CNR2) gene, gene-obesity interaction, and haplotype combination with osteoporosis (OP) susceptibility. Methods. Chinese patients with OP were recruited between March 2011 and December 2015 from our hospital. In this study, a total of 1267 post-menopausal female patients (631 OP patients and 636 control patients) were selected. The mean age of all subjects was 69.2 years (sd 15.8). A generalized multifactor dimensionality reduction (GMDR) model and logistic regression model were used to examine the interaction between SNP and obesity on OP. For OP patient-control haplotype analyses, the SHEsis online haplotype analysis software (. http://analysis.bio-x.cn/. ) was employed. Results. The logistic regression model revealed that the C allele of rs2501431 and the G allele of rs3003336 were associated with increased OP risk, compared with those with wild genotype. However, no significant correlations were found when analyzing the association of rs4237 and rs2229579 with OP risk. The GMDR analysis suggested that the interaction model composed of two factors, rs3003336 and abdominal obesity (AO), was the best model with statistical significance (p-value from sign test (P. sign. ) = 0.012), indicating a potential gene-environment interaction between rs3003336 and AO. Overall, the two-locus models had a cross-validation consistency of 10/10 and had a testing accuracy of 0.641. Abdominally obese subjects with the AG or GG genotype have the highest OP risk, compared with subjects with the AA genotype and normal waist circumference (WC) (odds ratio (OR) 2.23, 95% confidence interval (CI) 1.54 to 3.51). Haplotype analysis also indicated that the haplotype containing the rs3003336-G and rs2501431-C alleles was associated with a statistically increased OP risk. Conclusion. Our results suggested that the C allele of rs2501431 and the G allele of rs3003336 of the CNR2 gene, interaction between rs3003336 and AO, and the haplotype containing the rs3003336-G and rs2501431-C alleles were all associated with increased OP risk. Cite this article: Bone Joint Res 2019;8:544–549

Aim. Previous studies have indicated that TNF-α and lymphotoxin-α (LTA) gene polymorphisms associate with the development of several different inflammatory diseases. However, potential associations of such gene polymorphisms with the susceptibility to extremity chronic osteomyelitis remain unknown. This study aimed to investigate potential links between TNF-α gene polymorphisms (rs1800629, rs361525, rs1799964, rs1800630, rs1799724 and rs1800750) and LTA gene polymorphism (rs909253) and the risk of developing extremity chronic osteomyelitis in Chinese population. Method. A total of 233 patients with extremity chronic osteomyelitis and 200 healthy controls were genotyped for the above 7 polymorphisms of TNF-α and LTA genes using the genotyping method*. Results. Significant difference was found regarding the genotype distribution of rs909253 between patients and healthy controls (P = 0.002). The mutant allele C frequency of rs909253 in patient group was significantly higher than that in control group (P = 0.001). Significant associations were identified between rs909253 and the risk of developing chronic osteomyelitis by dominant model (P = 0.040), recessive model (P = 0.002) and homozygous model (P = 0.001). Additionally, the mutant allele T frequency in rs1799964 in patient group was significantly higher than that in control group (P = 0.035). Significant link was found between rs1799964 and susceptibility to chronic osteomyelitis by recessive model (P = 0.048). However, no significant outcomes were identified regarding other TNF-α gene polymorphisms between the two groups. Conclusions. The present study demonstrated that rs909253 and rs1799964 polymorphisms may associate with the risk of developing chronic osteomyelitis in Chinese population. *SNaPshot

Background. Recent anthropometric studies have suggested that current design of total knee arthroplasty (TKA) does not cater to racial anthropometric differences. The purpose of this study was to investigate the exact sizing and rotational landmarks of the distal femur collected and its gender differences from a large group of healthy Southern Chinese using 3D-CT measurements, and then compare these measurements to the five total knee prostheses conventionally used in China. Methods. This study evaluated distal femoral geometry in 85 healthy Southern Chinese, included 39 females (78 knees) and 46 males (92 knees) with a mean age of 33.9 years，a mean height of 164.7 cm and a mean weight of 59.9 kg. The width of the articular surface as projected onto the transepicondylar line(ML), anteroposterior dimension (AP), the dimensions from medial/lateral epicondyle to posterior condylar (MEP/LEP) were measured. A characterization of the aspect ratio (ML/AP) was made for distal femur. The angles between the tangent line of the posterior condylar surfaces, the Whiteside line, the transepicondylar line, and the trochlear line were measured. The sulcus angle and hip center-femoral shaft angle were also measured [Fig. 1]. The data were compared with the five total knee prostheses conventionally used in China. In analyzing the data, best-fit lines were calculated with use of least-squares regression. The dimensions are summarized as the mean and standard deviation. Comparisons of dimensions between males and females were made with use of the two-sample t test. A p value of <0.05 indicated a significant effect. Results. Within the population, males had larger ML, AP values and aspect ratio than females (ML: 70.44±3.04 vs. 61.40±2.62 mm, P<0.001; AP: 62.26±2.93 vs. 56.49±2.88 mm, P<0.001; 1.06±0.05 vs. 1.11±0.03, P<0.001). In addition, we found a gradual decrease in the aspect ratio corresponding to an increase in AP dimension, as seen in other studies. The transepicondylar axis was a reliable landmark to properly rotate the femoral component, so we used the MEP and LEP evaluate posterior condylar offset, the values were respectively 28.90±3.00 mm and 22.73±2.67 mm. However, most angles were almost the same between males and females. To evaluate the suitability shape of the femoral components currently used in China, we drawed and calculated best-fit lines for the AP, ML dimensions and aspect ratios of the femur and the five prostheses. For females, there was a significant association between the prostheses size and the amount of overhang, the femoral prostheses for females tended to be too large for a given AP dimension, with larger sizes having more overhang, especially in ML dimensions. In males, the morphologic data tended to be bigger than the prosthetic designs in the ML dimension for a given AP dimension, the femoral aspect ratio was higher for smaller knees and proportionally lower for larger knees[Fig. 2, 3]. Conclusion. Because dimensions of the distal femur and the aspect ratio tend to be smaller in Southern Chinese populations, whereas sulcus angles tend to be larger, designs for knee implants should be modified to improve the outcome of surgical treatment in this population

Introduction. Genetic predisposition is a key causal factor in adolescent idiopathic scoliosis (AIS), which is the most common form of spinal deformity. However, common quantitative genetic effect estimates such as hereditability have not been fully evaluated and reported for this disorder. We aimed to determine the sibling recurrent risk and hereditability of AIS in first-degree relatives of 513 Chinese patients with this disorder. Methods. Family members of 513 Chinese patients with AIS attending a scoliosis clinic were assessed. A diagnosis of AIS was made with the criteria of Cobb angle greater than 20°. The evaluation included clinical assessment and physical examination in a health screening centre by medical doctors with use of forward bending test. Any positive screening cases were referred to a scoliosis clinic for follow-up spinal radiograph. All radiographs were assessed by an orthopaedic surgeon in the scoliosis clinic. A population prevalence of scoliosis was obtained from the data of a territory-wide screening campaign. The prevalence of AIS among siblings of probands was measured both overall and divided by sex of siblings. The sibling recurrent risk (λs) was calculated for male and female siblings separately with reported population incidence of AIS. Results. The 513 probands had 640 siblings, and 110 affected siblings were identified (17·2%, 95% CI 14·3–20·1), which was significantly higher than the disease prevalence in the general population (1·39%, p<0·0001). The prevalence of AIS was 11·3% (7·6–14·9) in male siblings and 22·2% (17·8–26·6) in female siblings. The prevalence of AIS in female siblings was significantly higher than that in male siblings (p<0·001). The average sibling recurrent risk ratio (λs) was 12·4. Overall, heritability was estimated to be 87·5%. Conclusions. The results confirmed the prevailing impression of a strong genetic effect on risk of AIS. We provided these standard genetic aggregation estimates and hereditability of AIS for the first time. The estimates allow comparison with other complex diseases such as diabetes mellitus in term of genetic predisposition. Our findings suggest that AIS has a moderate to strong genetic predisposition and it is comparable with other complex traits

Forty-five Chinese patients had below-knee amputation by a sagittal flap technique; 84% for ischaemia. Satisfactory healing was obtained in over 90%, but complications and failure were more common in patients with diabetes mellitus. A modified sagittal flap is recommended

An increasing number of patients with hepatitis B virus (HBV) infection are progressing in age and are undergoing total joint arthroplasty (TJA) surgery in China. Less attention is provided to the special populations. This study aimed to evaluate the effect of HBV on TJAs. We retrospectively reviewed all patients who met the inclusion of undergoing elective primary hip and knee arthroplasties from 2013– 2016. Non-hepatitis B cohort was built to match the case cohort to identify whether HBV infection was a risk factor associated with postoperative complications. A total number of 197 patients who underwent primary TJAs were involved in the study, including 49 patients with hepatitis B and 147 non-hepatitis B subjects. Among all the patients with TJAs, we obtained a 5.5% HBV infection rate for the first time. Compared with patients without hepatitis B, patients with hepatitis B had higher rates (P < 0.01) of total complications (10.2% compared to 4.7%), surgery-related complications (6.1% compared to 3.4%), and general medical complications (4.1% compared to 1.3%) than the non-hepatitis B group. Patients with hepatitis B infection had a 21% increased risk (95% CI, 0.97–1.46; p < 0.01) of total complication compared with non-hepatitis B group. Similar results were obtained for medical and surgical complications. HBV infection had a 31% increased risk (95% CI, 1.02–1.62; p < 0.01) for medical complication and 18% risk (95% CI, 0.95–1.42; p < 0.01) for surgical complication. In the subgroup analysis, no difference was found between the surgical methods and sex, whereas a significant difference of CRP change level (P < 0.01) was found between HBV group and the matched group in the clinical laboratory values. This is the first study of patients with hepatitis B undergoing primary THA or TKA and demonstrates an increased risk of multiple perioperative complications in a Chinese population. In consideration of the large population of HBV infection in China, more attention should be provided to patients with HBV infection who need to undergo TJAs

Functional deficient of the little finger flexor digitorum superficialis (FDS-V) is known to be present in our population. The aim of this study is to evaluate the prevalence of the absence of FDS-V function in the Hong Kong Chinese population. The association between FDS-V absence and various variables (age, gender, hand dominance, occupation, smoking status, plamaris longus absence) were evaluated. The effects on the grip power due to FDS-V absence were analyzed. The anatomical variations were studied by cadaveric study. The clinical and anatomical variations were correlated by MRI study. 152 adult Chinese men and women from age 18 to 65 were recruited randomly. Subjects with congenital abnormalities, history of hand injury, history of upper limb surgery or underlying neuromuscular diseases were excluded. This study has 3 different parts. The first part is a clinical survey to determine the prevalence of the absence of FDS-V function by both the standard test and the modified test. The second part is a cadaveric study to determine the anatomical variations of FDS-V tendon by cadaveric dissection. The third part of this study is to correlate the clinical findings with MRI study. Total 152 subjects were recruited with 51 male and 101 female, average age 37.6. The prevalence of the absence of FDS-V function by the standard test was 40.1% for right hand and 37.5% for left hand (38.8%). The prevalence of the absence of FDS-V function by the modified test was 9.2% on the right hand and 9.9% on the left hand (9.54%). The absence of FDS-V function was found more common to be bilateral than unilateral. This was found that 68.6% were bilateral by the standard test and 61% were bilateral by the modified test. The associations of functional FDS-V absence with various variables were insignificant. The effects of various variables on the grip power were analyzed using the multiple linear regression. Gender was1he only variable that had significant effects on the grip power for both the right and left hand. On either hand, the absence of Palmaris longus tendon and the absence of the FDS-V function had no significant effects on the grip power. Cadaveric study showed that the little finger FDS tendon was present in all 10 cadaveric hands. Abnormal muscle or tendon interconnection was not found. MRI study showed that there was hypoplastic tendon in subjects with absent FDS-V function. The prevalence of the absence of FDS-V function in the Hong Kong Chinese population was 38.8% by the standard test and 9.54% by the modified test. The absence of little finger FDS function has no significant effects on the functional status as quantified by the grip power. We can postulate that patients with little finger FDS tendon injury can have normal range of motion and hand function if the FDP tendon is intact

Objectives

Surgeons face a substantial risk of infection because of the occupational exposure to blood-borne pathogens (BBPs) from patients undergoing high-risk orthopaedic procedures. This study aimed to determine the seroprevalence of four BBPs among patients undergoing joint arthroplasty in Shanghai, China. In addition, we evaluated the significance of pre-operative screening by calculating a cost-to-benefit ratio.

In Northern China, Ca intake and serum vitamin-D level of adolescents are low due to non-dairy-based diets and insufficient sunshine exposure. Maximisation of bone mineral accretion in childhood and adolescence requires adequate dietary calcium (Ca) intake and body vitamin-D status. This study focused on nutritional adaptation in Chinese adolescents under these adversed conditions by determining Ca absorption (CaAbn) and urinary calcium excretion (CaEx). 16 healthy individuals (12 girls, 4 boys) aged 9–17-y were recruited from Beijing during December. CaAbn was determined by a dual stable-isotope technique (44Ca and 42Ca) coupled with a Thermal-Ionization -Mass-Spectrometer. Mean ± . sd. Ca intake, 24-h CaEx, and serum 25-(OH) vitamin D3 were 603 ±158 mg/d, 87.5 ± 59.2 mg/24-h and 13.7 ± 4.8 ng/mL respectively. Mean serum 25-(OH) vitamin D3 reached the lower normal-limit of 11 ng/mL. 24-h-CaEx (< 100 mg/d) reflected a higher efficiency of Ca retention. CaAbn was found 57.4 ± 15.4% which was significantly higher than the U.S. counterparts (25–34%; Ca intake: 925 mg/d), P< 0.05. However, CaAbn in the current study was comparable to a group of healthy Hong Kong children aged 7-y (CaAbn: 54.8%, Ca intake: 862 mg/d, serum 25-(OH) vitamin D3:33.3 ng/mL). The study showed that growing individuals with suboptimal vitamin D status are still capable of enhancing calcium absorption and reducing urinary calcium excretion to allow adequate bone Ca accretion

In this prospective study a total of 80 consecutive Chinese patients with Crowe type I or II developmental dysplasia of the hip were randomly assigned for hip resurfacing arthroplasty (HRA) or total hip replacement (THR).

Three patients assigned to HRA were converted to THR, and three HRA patients and two THR patients were lost to follow-up. This left a total of 34 patients (37 hips) who underwent HRA and 38 (39 hips) who underwent THR. The mean follow-up was 59.4 months (52 to 70) in the HRA group and 60.6 months (50 to 72) in the THR group. There was no failure of the prosthesis in either group. Flexion of the hip was significantly better after HRA, but there was no difference in the mean post-operative Harris hip scores between the groups. The mean size of the acetabular component in the HRA group was significantly larger than in the THR group (49.5 mm vs 46.1 mm, p = 0.001). There was no difference in the mean abduction angle of the acetabular component between the two groups.

Although the patients in this series had risk factors for failure after HRA, such as low body weight, small femoral heads and dysplasia, the clinical results of resurfacing in those with Crowe type I or II hip dysplasia were satisfactory. Patients in the HRA group had a better range of movement, although neck-cup impingement was observed. However, more acetabular bone was sacrificed in HRA patients, and it is unclear whether this will have an adverse effect in the long term.

Although single-stage revision has attracted a lot of attention due to less socioeconomic cost, this technique is not widely used throughout the world due to strict indications. In this situation, we report our outcome on single-stage revision combined with selective direct intra-articular antibiotic infusion for chronic infected THA, especially for patients with culture-negative hip, fungal infections and multidrug-resistant organism.

We retrospectively reviewed 131 patients with chronic infected THA between January 2010 and February 2017 who underwent single-stage revision, including soakage of surgical area with 0.5% aqueous betadine, pouring powdered vancomycin or imipenem into the medullary cavity. For patients with culture-negative hip, fungal infections and multidrug-resistant organism, a direct intra-articular infusion of pathogens-sensitive antibiotics via three-branch catheter were performed postoperatively. Recurrence of infection and clinical outcomes were evaluated.

One hundred and fifteen patients were followed-up for an average of 4.5 years (range, 1.2–8 years). Of the 115 patients, 103 patients (89.6%) required no additional surgical or medical treatment for recurrence of infection. A recurrent infection was observed in 4 of the 23 patients (17.4%) with culture-negative infected hip. One of 4 fungal infections was relapse and the success rate in patients with multidrug-resistant organism was 84.2% (16/19). The mean postoperative Harris hip score was 81 points (63 to 92; p < 0.05) at the most recent assessment.

Treatment of chronic infected THA by single-stage revision combined with selective direct intra-articular antibiotic infusion can be fairly effective, even for patients with relative “contraindication” of this approach.

In patients with shoulder arthritis, the ability to accurately determine glenoid morphological alterations affects the outcomes of shoulder arthroplasty surgery significantly. This study was conducted to determine whether there is a correlation between scapular and glenoid morphometric components. Existence of such a correlation may help surgeons accurately estimate glenoid bone loss during pre-operative planning. The dimensions and geometric relationships of the scapula, scapula apophysis and glenoid were assessed using CT scan images of 37 South African and 40 Chinese cadavers. Various anatomical landmarks were marked on the 77 scapulae and a custom script was developed to perform the measurements. Intra-cohort correlation and inter-cohort differences were statistically analysed using IBM SPSS v28. The condition for statistical significance was p<0.05. The glenoid width and height were found to be significantly (p<0.05) correlated with superior glenoid to acromion tip distance, scapula height, acromion tip to acromion angle distance, acromion width, scapula width, and coracoid width, in both the cohorts. While anterior glenoid to coracoid tip distance was found to be significantly correlated to glenoid height and width in the South African cohort, it was only significantly correlated to glenoid height in the Chinese cohort. Significant (p<0.05) inter-cohort differences were observed for coracoid height, coracoid width, glenoid width, scapula width, superior glenoid to acromion tip distance, and anterior glenoid to coracoid tip distance. This study found correlations between the scapula apophyseal and glenoid measurements in the population groups studied. These morphometric correlations can be used to estimate the quantity of bone loss in shoulder arthroplasty patients

Aims. Rheumatoid arthritis (RA) is a common chronic immune disease. Berberine, as its main active ingredient, was also contained in a variety of medicinal plants such as Berberaceae, Buttercup, and Rutaceae, which are widely used in digestive system diseases in traditional Chinese medicine with anti-inflammatory and antibacterial effects. The aims of this article were to explore the therapeutic effect and mechanism of berberine on rheumatoid arthritis. Methods. Cell Counting Kit-8 was used to evaluate the effect of berberine on the proliferation of RA fibroblast-like synoviocyte (RA-FLS) cells. The effect of berberine on matrix metalloproteinase (MMP)-1, MMP-3, receptor activator of nuclear factor kappa-Β ligand (RANKL), tumour necrosis factor alpha (TNF-α), and other factors was determined by enzyme-linked immunoassay (ELISA) kit. Transcriptome technology was used to screen related pathways and the potential targets after berberine treatment, which were verified by reverse transcription-polymerase chain reaction (RT-qPCR) and Western blot (WB) technology. Results. Berberine inhibited proliferation and adhesion of RA-FLS cells, and significantly reduced the expression of MMP-1, MMP-3, RANKL, and TNF-α. Transcriptional results suggested that berberine intervention mainly regulated forkhead box O (FOXO) signal pathway, prolactin signal pathway, neurotrophic factor signal pathway, and hypoxia-inducible factor 1 (HIF-1) signal pathway. Conclusion. The effect of berberine on RA was related to the regulation of RAS/mitogen-activated protein kinase/FOXO/HIF-1 signal pathway in RA-FLS cells. Cite this article: Bone Joint Res 2023;12(2):91–102

Objectives. Previous genome-wide association studies (GWAS) have reported significant association of the single nucleotide polymorphism (SNP) rs8044769 in the fat mass and obesity-associated gene (FTO) with osteoarthritis (OA) risk in European populations. However, these findings have not been confirmed in Chinese populations. Methods. We systematically genotyped rs8044769 and evaluated the association between the genetic variants and OA risk in a case-controlled study including 196 OA cases and 442 controls in a northern Chinese population. Genotyping was performed using the Sequenom MassARRAY iPLEX platform. Results. We found that the variant T allele of rs8044769 showed no significant association of OA risk (p = 0.791), or association with body mass index (BMI) (pmeta = 0.786) in an additive genetic model. However, we detected a significant interaction between rs8044769 genotypes and BMI on OA risk (p = 0.037), as well as a borderline interaction between rs8044769 genotypes and age on OA risk (p = 0.062). Conclusions. Our findings indicate that rs8044769 in the FTO gene may not modify individual susceptibility to OA or increased BMI in the Chinese population. Further studies are warranted to validate and extend our findings. Cite this article: Prof L. Jiang. No association of the single nucleotide polymorphism rs8044769 in the fat mass and obesity-associated gene with knee osteoarthritis risk and body mass index: A population-based study in China. Bone Joint Res 2016;5:169–174. DOI: 10.1302/2046-3758.55.2000589

Objectives. Given the function of adiponectin (ADIPOQ) on the inflammatory condition of obesity and osteoarthritis (OA), we hypothesized that the ADIPOQ gene might be a candidate gene for a marker of susceptibility to OA. Methods. We systematically screened three tagging polymorphisms (rs182052, rs2082940 and rs6773957) in the ADIPOQ gene, and evaluated the association between the genetic variants and OA risk in a case-controlled study that included 196 OA patients and 442 controls in a northern Chinese population. Genotyping was performed using the Sequenom MassARRAY iPLEX platform. Results. The single nucleotide polymorphism (SNP) rs182052 was found to be potentially associated with knee OA risk (additive model: odds ratio = 1.38; 95% confidence interval 1.07 to 1.76; p = 0.012). Furthermore, a non-significant association was observed for rs182052 and body mass index with regard to OA risk in interaction analyses (p = 0.063). Similarly, no significant interaction was detected for rs182052 and age with regard to OA risk (p = 0.614). Conclusion. These findings suggest that the SNP rs182052 in the ADIPOQ gene may potentially modify individual susceptibility to knee OA in the Chinese population. Further studies are warranted to investigate our findings in more depth. Cite this article: L. Jiang, X. Zhu, J. Rong, B. Xing, S. Wang, A. Liu, M. Chu, G. Huang. Obesity, osteoarthritis and genetic risk: The rs182052 polymorphism in the ADIPOQ gene is potentially associated with risk of knee osteoarthritis. Bone Joint Res 2018;7:494–500. DOI: 10.1302/2046-3758.77.BJR-2017-0274.R1

A painful “dreaded black line” (DBL) has been associated with progression to complete fractures in atypical femur fractures (AFF). Adjacent sclerosis, an unrecognized radiological finding, has been observed in relation to the DBL. We document its incidence, associated features, demographics and clinical progression. We reviewed plain radiographs of 109 incomplete AFFs between November 2006 and June 2021 for the presence of sclerosis adjacent to a DBL. Radiographs were reviewed for location of lesions, and presence of focal endosteal or periosteal thickening. We collected demographical data, type and duration of bisphosphonate therapy, and progression to fracture or need for prophylactic stabilization, with a 100% follow up of 72 months (8 – 184 months). 109 femurs in 86 patients were reviewed. Seventeen sclerotic DBLs were observed in 14 patients (3 bilateral), involving 15.6% of all femora and 29.8% of femora with DBLs. Location was mainly subtrochanteric (41.2%), proximal diaphyseal (35.3%) and mid-diaphyseal (23.5%), and were associated with endosteal or periosteal thickening. All patients were female, mostly Chinese (92.9%), with a mean age of 69 years. 12 patients (85.7%) had a history of alendronate therapy, and the remaining 2 patients had zoledronate and denosumab therapy respectively. Mean duration of bisphosphonate therapy was 62 months. 4 femora (23.5%) progressed to complete fractures that were surgically managed, whilst 6 femora (35.3%) required prophylactic fixation. Peri-lesional sclerosis in DBL is a new radiological finding in AFFs, predominantly found in the proximal half of the femur, at times bilateral, and are always associated with endosteal or periosteal thickening. As a high proportion of patients required surgical intervention, these lesions could suggest non-union of AFFs, similar to the sclerotic margins commonly seen in fractures with non-union. The recognition of and further research into this new feature could shed more light on the pathophysiological progression of AFFs

Lung cancer is the most common cancer diagnosed, the leading cause of cancer-related deaths, and bone metastases occurs in 20–40% of lung cancer patients. They often present symptomatically with pain or skeletal related events (SREs), which are independently associated with decreased survival. Bone modifying agents (BMAs) such as Denosumab or bisphosphonates are routinely used, however no specific guidelines exist from the National Comprehensive Cancer Center or the European Society of Medical Oncologists. Perhaps preventing the formation of guidelines is the lack of a high-quality quantitative synthesis of randomized controlled trial (RCT) data to determine the optimal treatment for the patient important outcomes of 1) Overall survival (OS), 2) Time to SRE, 3) SRE incidence, and 4) Pain Resolution. The objective of this study was to perform the first systematic review and network meta-analysis (NMA) to assess the best BMA for treatment of metastatic lung cancer to bone. We conducted our study in accordance to the PRISMA protocol. We performed a librarian assisted search of MEDLINE, PubMed, EMBASE, and Cochrane Library and Chinese databases including CNKI and Wanfang Data. We included studies that are RCTs reporting outcomes specifically for lung cancer patients treated with a bisphosphonate or Denosumab. Screening, data extraction, risk of bias and GRADE were performed in duplicate. The NMA was performed using a Bayesian probability model with R. Results are reported as relative risks, odds ratios or mean differences, and the I2 value is reported for heterogeneity. We assessed all included articles for risk of bias and applied the novel GRADE framework for NMAs to rate the quality of evidence supporting each outcome. We included 132 RCTs comprising 11,161 patients with skeletal metastases from lung cancer. For OS, denosumab was ranked above zoledronic acid (ZA) and estimated to confer an average of 3.7 months (95%CI: −0.5 – 7.6) increased survival compared to untreated patients. For time to SRE, denosumab was ranked first with an average of 9.1 additional SRE-free months (95%CI: 4.0 – 14.0) compared to untreated patients, while ZA conferred an additional 4.8 SRE-free months (2.4 – 7.0). Patients treated with the combination of Ibandronate and systemic therapy were 2.3 times (95%CI: 1.7 – 3.2) more likely to obtain successful pain resolution, compared to untreated. Meta-regression showed no effect of heterogeneity length of follow-up or pain scales on the observed treatment effects. Heterogeneity in the network was considered moderate for overall survival and time to SRE, mild for SRE incidence, and low for pain resolution. While a generally high risk of bias was observed across studies, whether they were from Western or Chinese databases. The overall GRADE for the evidence underlying our results is High for Pain control and SRE incidence, and Moderate for OS and time to SRE. This study represents the most comprehensive synthesis of the best available evidence guiding pharmacological treatment of bone metastases from lung cancer. Denosumab is ranked above ZA for both overall survival and time to SRE, but both treatments are superior to no treatment. ZA was first among all bisphosphonates assessed for odds of reducing SRE incidence, while the combination of Ibandronate and radionuclide therapy was most effective at significantly reducing pain from metastases. Clinicians and policy makers may use this synthesis of all available RCT data as support for the use of a BMA in MBD for lung cancer

Aims. The aim of this study was to further evaluate the accuracy of ten promising synovial biomarkers (bactericidal/permeability-increasing protein (BPI), lactoferrin (LTF), neutrophil gelatinase-associated lipocalin (NGAL), neutrophil elastase 2 (ELA-2), α-defensin, cathelicidin LL-37 (LL-37), human β-defensin (HBD-2), human β-defensin 3 (HBD-3), D-dimer, and procalcitonin (PCT)) for the diagnosis of periprosthetic joint infection (PJI), and to investigate whether inflammatory joint disease (IJD) activity affects their concentration in synovial fluid. Methods. We included 50 synovial fluid samples from patients with (n = 25) and without (n = 25) confirmed PJI from an institutional tissue bank collected between May 2015 and December 2016. We also included 22 synovial fluid samples aspirated from patients with active IJD presenting to Department of Rheumatology, the first Medical Centre, Chinese PLA General Hospital. Concentrations of the ten candidate biomarkers were measured in the synovial fluid samples using standard enzyme-linked immunosorbent assays (ELISA). The diagnostic accuracy was evaluated by receiver operating characteristic (ROC) curves. Results. BPI, LTF, NGAL, ELA-2, and α-defensin were well-performing biomarkers for detecting PJI, with areas under the curve (AUCs) of 1.000 (95% confidence interval, 1.000 to 1.000), 1.000 (1.000 to 1.000), 1.000 (1.000 to 1.000), 1.000 (1.000 to 1.000), and 0.998 (0.994 to 1.000), respectively. The other markers (LL-37, HBD-2, D-dimer, PCT, and HBD-3) had limited diagnostic value. For the five well-performing biomarkers, elevated concentrations were observed in patients with active IJD. The original best thresholds determined by the Youden index, which discriminated PJI cases from non-PJI cases could not discriminate PJI cases from active IJD cases, while elevated thresholds resulted in good performance. Conclusion. BPI, LTF, NGAL, ELA-2, and α-defensin demonstrated excellent performance for diagnosing PJI. However, all five markers showed elevated concentrations in patients with IJD activity. For patients with IJD, elevated thresholds should be considered to accurately diagnose PJI. Cite this article: Bone Joint J 2021;103-B(1):32–38

Aims. The effect of the gut microbiota (GM) and its metabolite on bone health is termed the gut-bone axis. Multiple studies have elucidated the mechanisms but findings vary greatly. A systematic review was performed to analyze current animal models and explore the effect of GM on bone. Methods. Literature search was performed on PubMed and Embase databases. Information on the types and strains of animals, induction of osteoporosis, intervention strategies, determination of GM, assessment on bone mineral density (BMD) and bone quality, and key findings were extracted. Results. A total of 30 studies were included, of which six studies used rats and 24 studies used mice. Osteoporosis or bone loss was induced in 14 studies. Interventions included ten with probiotics, three with prebiotics, nine with antibiotics, two with short-chain fatty acid (SCFA), six with vitamins and proteins, two with traditional Chinese medicine (TCM), and one with neuropeptide Y1R antagonist. In general, probiotics, prebiotics, nutritional interventions, and TCM were found to reverse the GM dysbiosis and rescue bone loss. Conclusion. Despite the positive therapeutic effect of probiotics, prebiotics, and nutritional or pharmaceutical interventions on osteoporosis, there is still a critical knowledge gap regarding the role of GM in rescuing bone loss and its related pathways. Cite this article: Bone Joint Res 2021;10(1):51–59

Introduction: Understanding the factors in progression of curves in spinal deformities are crucial to the planning of treatment. While clinical and genetic parameters appear to be involved in the progression of adolescent idiopathic scoliosis, it remains very difficult to objectively study this as it is difficult to find pedigree cohorts. We wish to report the difference in progression of adolescent idiopathic scoliosis curves in two essentially homogenous racial groups that utilise our Scoliosis service. Methods and Results: Three hundred and twenty-four patients were treated at the Scoliosis service of our Institute from 1985 to 1998. The aetiology of the curves were as follows: 218 AIS, 37 Neuromuscular, 48 Congenital, 21 other diagnostic type, and 11 aetiology not known. The racial distribution of utilisation of service: 44% Malay, 44.7% Chinese, 2.0% Indian and 9.3% not known or mixed race. The Malay and Chines groups were matched and studied. There was no difference in the menarchal age, curve size at presentation and age at presentation to the service (P=0.3). Patients were analysed in two groups: below 10 years, and above 10 years at presentation. The rate of progress of the AIS curves > 50° were fastest in the Chinese patients with a rate of 14.7°/year; with Malay patients progressing at 8.4°/year. Rates of progression of curves 30–50° were the same for both groups with Chinese at 7.7°/year, and Malays at 6.7°/year. Curves < 30° progressed at the same rate also with Chinese at 5.0°/year and Malays at 7.0°/year. Conclusion: From our data, it appears that race (genetics) does influence the rate of progression of AIS curves

BACKGROUND. Diffuse noxious inhibitory control (DNIC) is impaired in people with chronic pain such as knee osteoarthritis (KOA), which may predict the risk of acute-to-chronic pain transition. Electroacupuncture (EA) is effective in relieving pain in patients with KOA. However, whether EA may inhibit acute-to-chronic pain transition of KOA has not been systematically examined. METHODS. This was a multicenter, three-arm parallel, single-blind randomized controlled trial involving a total of 450 patients with KOA. This study was approved by the Chinese Ethics Committee of Registering Clinical Trials (reference: ChiECRCT-20140035) and registered with Chinese Clinical Trial Registry (ChiCTR-ICR-14005411). Patients were divided into three groups based on EA current intensity: strong EA (>2mA), weak EA (<0.5mA) and sham EA (none acupoint). Treatments consisted of five sessions per week, for two weeks. Primary outcome measures were visual analog scale (VAS) and DNIC function. RESULTS. One week of EA had no clinical important improvement in VAS and DNIC function in all three groups (P>0.05). After 2 weeks” treatment, changes from baseline showed that VAS (strong EA: 2.97, SD 0.10, P<0.0001; weak EA: 2.75, SD 0.15, P <0.0001; sham EA: 1.19, SD 0.14, P<0.0001) and DNIC (strong EA: −14.85, SD 0.16, P<0.0001; weak EA: −4.75, SD 0.28, P<0.0001; sham EA: −1.43, SD 0.24, P<0.0001) were significantly improved in all three groups. Compared with sham EA, weak EA (3.8, 95%CI 3.45 to 4.15) and strong EA (13.54, 95%CI 13.23 to 13.85) were better in improving DNIC function. Compared with weak EA, strong EA were better in enhancing DNIC function (9.73, 95%CI 9.44 to 10.02), as well as in reducing VAS. CONCLUSIONS. In conclusion, EA should be administered 2 weeks to exerting significant effect on KOA. Strong EA was better than weak or sham EA in alleviating the intensity of pain and inhibiting the acute-to-chronic pain transition of KOA

Artificial bone models (ABMs) are commonly used in traumatology and orthopedics for training, education, research and development purposes. The aim of this study was to develop the first evidence-based generic Asian pelvic bone model and compare it to an existing pelvic model. A hundred clinical CT scans of intact adult pelvises (54.8±16.4 years, 161.3±8.3 cm) were acquired. They represented evenly distributed female and male patients of Malay (n=33), Chinese (n=34) and Indian (n=33) descent. The CTs were segmented and defined landmarks were placed. By this means, 100 individual three-dimensional models were calculated using thin plate spline transformation. Following, three statistical mean pelvic models (male, female, unisex) were generated. Anatomical variations were analyzed using principal component analysis (PCA). To quantify length variations, the distances between the anterior superior iliac spines (ASIS), the anterior inferior iliac spines (AIIS), the promontory and symphysis (conjugate vera) as well as the ischial spines (diameter transversa) were measured for the three mean models and the existing ABM. PCA demonstrated large variability regarding pelvic surface and size. Principal component one (PC 1) contributed to 24% of the total anatomical variation and predominantly displayed a size variation pattern. PC 2 (17.7% of variation) mainly exhibited anatomical variations originating from differences in shape. Female and male models were similar in ASIS (225±20 mm; 227±13 mm) and AIIS (185±11 mm; 187±10 mm), whereas differed in conjugate vera (116±10 mm; 105±10 mm) and diameter transversa (105±7 mm; 88±8 mm). Comparing the Asian unisex model to the existing ABM, the external pelvic measurements ASIS (22.6 cm; 27.5 cm) and AIIS (186 mm; 209 mm) differed notably. Conjugate vera (111 mm; 105 mm) and diameter transversa (97 mm; 95 mm) were similar in both models. Low variability of mean distances (3.78±1.7 mm) was found beyond a sample number of 30 CTs. Our analysis revealed notable anatomical variations regarding size dominating over shape and gender-specific variability. Dimensions of the generated mean models were comparatively smaller compared to the existing ABM. This highlights the necessity for generation of Asian ABMs by evidence-based modeling techniques

Summary Statement. Tandem stenosis is a prevalent condition in an Asian population with the narrowest cervical canal diameters and risk factors include advanced age and increased levels of lumbar canal stenosis. Introduction. Tandem spinal stenosis (TSS) is defined as patient with concomitant spinal canal stenosis found in both cervical (C) and lumbar (L) spinal region. Few studies have reported the incidence of TSS is ranged from 5–25%, but these are all noncomparative, small cohort studies. To the best of author knowledge this is the 1st study aims to compare the prevalence of TSS and its risk factors of development in a large multiracial Asian population. Methods. A retrospective review of all mid-sagittal T2MRI whole spine image was carried out at a University hospital in year 2007. Patients with spinal tumour, fracture and congenital stenosis were excluded. Spinal stenosis was defined as canal diameter of ≤10mm, measured from the posterior cervical vertebral/disc wall to anterior surface of the corresponding lamina. Patients were divided into 4 groups, no stenosis(NS), lumbar stenosis only(LS), cervical stenosis only(CS) and TSS. Patients’ demographics, race, co-morbidities and lumbar radiological report data were examined. Potential risk factors for the development of TSS were analyzed using SPSS software. Results. 926 (479 male, 447 female) patients with average age 50 (20–96) yrs were studied. Cervical canal diameters (mm) in TSS patients were the narrowest among the 4groups with C2/3 disc: 11.6, C3/4: 9.7, C4/5: 9.4, C5/6: 8.9, C6/7: 10.0 and C7T1: 11.4mm. The incidence of TSS was 26.2%. The prevalence of TSS in Chinese was 30.7%, Indian 12.5%, Malay 22.5%. The TSS prevalence in patients with 1 level lumbar canal stenosis was 12.5%, 2 levels lumbar stenosis was 6.4% and 3 levels was 4.1%. Multivariate analysis showed patients aged between 40–59 yrs (p=0.000, Exp(B):5.8, 95%CI 2.8–12.0), aged > 60yrs (p=0.000, Exp(B): 10.5, 95%CI 4.8–22.9), Chinese race (p=0.008, Exp(B): 2.5, 95%CI 1.3–4.9), patients with 1 level lumbar stenosis (p=0.000, Exp(B): 63.3, 95%CI 29.2–137.3), 2 levels lumbar stenosis (p=0.000, Exp(B): 67.7, 95%CI 29.4–155.7) and 3 levels lumbar stenosis (p=0.000, Exp(B): 106.6, 95%CI 43.6–260.5) are statistical significant risk factors for TSS development. Conclusion. The incidence of TSS was 26.2%. TSS patients have the narrowest cervical canal measurements among the studied groups. The prevalence of TSS in Chinese is the highest (30.7%). Patients advancing in age or have increased levels of lumbar canal stenosis are at risk of developing TSS

Proximal femur fractures are common in the elderly population. The aim of this study was to determine the relationship between fracture type and proximal femoral geometric parameters. We retrospectively studied the electronic medical records of 85 elderly patients over 60 years of age who were admitted to the orthopedic department with hip fractures between January 2016 and January 2018 in a training and research hospital in Turkey. Age, fracture site, gender, implant type and proximal femoral geometry parameters (neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]) were recorded. Patients with femoral neck fractures and femur intertrochanteric fractures were divided into two groups. The relationship between proximal femoral geometric parameters and fracture types was examined. SPSS 25.0 (IBM Corparation, Armonk, New York, United States) program was used to analyze the variables. Independent samples t test was used to compare the fracture types according to NSA, FHD, FND and FSD variables. A statistically significant difference was found in FSD (p=0,002) and age (p=0,019). FSD and age were found to be greater in intertrochanteric fractures than neck fractures. Gender, site, CEA, FNAL, HAL, NSA, FHD and FND parametres were not significantly different. In the literature, it is seen that different results have been reached in different studies. In a study conducted in the Chinese population, a significant difference was found between the two groups in NSA, CEA and FNAL measurements. In a study conducted in the Korean population, a significant difference was found only in NSA measurements. The FSD is generally associated with bone mineral densitometry in the literature and has been shown to be a risk factor for fracture formation. However, a study showing that there is a relationship between FSD and fracture type is not available in the literature. In this study; FSD was found to be higher in intertrochanteric fractures (p = 0.002). However, for the clinical significance of this difference, we think that larger patient series and biomechanical studies are needed

Introduction & aims. Different racial groups show variations in femoral morphometry. Femoral anteroposterior measurement and mediolateral measurement are key variables in designing femoral implant for TKR. Their aspect ratio determines the shape and mediolateral sizing for the proper patellofemoral tracking and uniform stress distribution over the resected distal femoral surface. Method. We reviewed the current literature in December 2013 in common medical databases including the Cochrane Library, PubMed and Medline. Keywords included combinations of: Anthropometry, Knee, Arthroplasty, Femur, Morphometry, Geometry. We selected papers including femoral morphometric data collected from populations of different ethnic origins. Papers covered populations in the USA, China, Germany, Thailand, Korea, India, Japan and Malaysia. Results. We have analysed femoral morphometry variables among different ethnic groups from the available data. Gross size of the resected femur can be defined in terms of antero-posterior (AP) and medio-lateral (ML) dimensions, an in the aspect ratio of femoral medio-lateral to femoral antero-posterior dimensions (fML/fAP). The Korean population showed the least value of fAP among all the groups, followed by Thai, Japanese, Indian, Malaysian and Chinese showing the increasing order among the sub-groups of Asian Population. American population shows the next higher fAP measurements from Asian population. German follows, and Arab quantify the largest value of this femoral anthropometric variable. fML varies by huge difference among male and female data in all populations. Thai, Indian, Malaysian, Arab, Japanese, Korean, German, Chinese and American; this sequence is the increasing order of fML. More trapezoid-shaped and narrower ML, this variation in female group leads to over-hang the implant for a given fAP. Generally, the aspect ratios are measured higher in these smaller female knees, and lower in larger male knees. Conclusions. Anthropometric data measuring distal femoral segment in different ethnic groups shows that the Asian population requires custom-fit implant design based on the morphological data. It would be more appropriate to introduce several medio-lateral options in sizing the implant for given antero-posterior dimensions

Aims. The incidence of thigh pain with the short stem varies widely across different studies. We aimed to evaluate the incidence and characteristics of post-operative thigh pain after using a particular bladed short stem and its potential risk factors. Patients and Methods. We respectively reviewed 199 consecutive patients who underwent unilateral total hip replacement using the Tri-lock stem from 2013–2016, of which 168 patients were successfully followed up with minimum two year clinical follow-up. All information about thigh pain and pre- and postoperative HHS score were gathered and all preoperative and immediate postoperative radiographs were available for review. Any complications were recorded. Results. Of the 168 patients, 34 (20.2%) patients reported thigh pain at a mean 3.1 years after surgery. Of these, 2 (5.9%) reported severe pain (NRS 5 or more). The pain was persistent (from surgery to final follow-up) in 13 patients (38.2%) and subsided within 2 years in 10 cases (29.4%). The most common site of pain was the lateral thigh (70.6%). The HHS improved from a mean 54.2 points preoperatively to 79.8 postoperatively. In 123 cases with radiographs at more than 2 years follow-up, all femoral stems were well-fixed and no revision surgery was needed at the latest. BMI and CFI were found to be independent risk factors for thigh pain after using this particular stem component. Conclusions. The incidence of thigh pain in Chinese THA patients with a bladed short stem component design is as high as 20%. Among them, nearly 40% will have some disruption in sleep or daily life. More than one-third of the cases of thigh pain were persistent. A larger BMI and patients with a funnel-type morphology of the femoral canal are independent risk factors for thigh pain in the setting of this particular stem component

There is no unified national training system for orthopaedic surgeons in China. With such rapid progress in many aspects of life in China, there is an imminent need for improvement in the training of orthopaedic specialists. Since 2003 the orthopaedic community in Hong Kong has been working in collaboration with their colleagues in mainland China to develop a training system for orthopaedic surgery. We adopted the system from the Royal College of Surgeons of Edinburgh (RCSEd), setting up a trial centre in the Beijing Jishuitan hospital in 2006, with trainers and trainees attaining the standards set by RCSEd and the Hong Kong College of Orthopaedic Surgeons (HKCOS). This trial is ongoing, with the success of two trainees who passed the exit examination in 2010 and became the first Chinese orthopaedic surgeons with a joint fellowship of both the RCSEd and the HKCOS. Following this inaugural success, we are confident that China will develop a training system for orthopaedic surgeons to a consistently high international standard

Objectives. Tranexamic acid (TXA) is an antifibrinolytic agent used as a blood-sparing technique in total knee arthroplasty (TKA), and is routinely administered by intravenous (IV) or intra-articular (IA) injection. Recently, a novel method of TXA administration, the combined IV and IA application of TXA, has been applied in TKA. However, the scientific evidence of combined administration of TXA in TKA is still meagre. This meta-analysis aimed to investigate the efficacy and safety of combined IV and IA TXA in patients undergoing TKA. Materials and Methods. A systematic search was carried out in PubMed, the Cochrane Clinical Trial Register (Issue12 2015), Embase, Web of Science and the Chinese Biomedical Database. Only randomised controlled trials (RCT) evaluating the efficacy and safety of combined use TXA in TKA were identified. Two authors independently identified the eligible studies, extracted data and assessed the methodological quality of included studies. Meta-analysis was conducted using Review Manager 5.3 software. Results. A total of ten RCTs (1143 patients) were included in this study. All the included studies were randomised and the quality of included studies still needed improvement. The results indicated that, compared with either placebo or the single-dose TXA (IV or IA) group, the combination of IV and IA TXA group had significantly less total blood loss, hidden blood loss, total drain output, a lower transfusion rate and a lower drop in haemoglobin level. There were no statistically significant differences in complications such as wound infection and deep vein thrombosis between the combination group and the placebo or single-dose TXA group. Conclusions. Compared with placebo or the single-dose TXA, the combined use of IV and IA TXA provided significantly better results with respect to all outcomes related to post-operative blood loss without increasing the risk of thromboembolic complications in TKA. Cite this article: Z. F. Yuan, H. Yin, W. P. Ma, D. L. Xing. The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty: combined tranexamic acid for TKA. Bone Joint Res 2016;5:353–361. DOI: 10.1302/2046-3758.58.BJR-2016-0001.R2

Joint laxity was quantified by measuring the distance from the thumb tip to the forearm during passive apposition in 500 normal Southern Chinese women. Joint laxity was found to have a normal distribution throughout the population and to decrease with age. When 109 Chinese girls with idiopathic adolescent scoliosis were similarly tested they were found to have significantly more laxity, suggesting that the two conditions are associated

1. The complications following standard tendon transfer to provide active correction of drop foot in Chinese patients with leprosy are reviewed. 2. An alternative method of foot drop correction is described in which reactivation of the remaining distal stump of the tibialis posterior tendon is provided to assist in maintaining the stability of the arch of the foot and to help to prevent dropped toes. 3. A review of thirteen patients is given. The indications are that this method is functionally as good as other methods. So far it has shown none of the complications usual in Chinese patients

Introduction. A good anatomic fit of a Total Knee Arthroplasty is crucial to a good clinical outcome. The big variability of anatomies in the Asian and Caucasian populations makes it very challenging to define a design that optimally fits both populations. Statistical Shape Models (SSMs) are a valuable tool to represent the morphology of a population. The question is how to use this tool in practice to evaluate the morphologic fit of modern knee designs. The goal of our study was to define a set of bone geometries based on SSMs that well represent both the Caucasian and the Asian populations. Methods. A Statistical Shape Model (SSM) was built and validated for each population: the Caucasian Model is based on 120 CT scans from Russian, French, German and Australian patients. The Asian Model is based on 80 CT scans from Japanese and Chinese patients. We defined 7 Caucasian and 5 Asian bone models by using mode 1 of the SSM. We measured the antero-posterior (AP) and medio-lateral (ML) dimensions of the distal femur on all anatomies (input models and generated models) to check that those bone models well represent the studied population. In order to cover the whole population, 10 additional bone models were generated by using an optimization algorithm. First, a combined Asian-Caucasian SSM was generated of 92 patients, equally balanced between male and female, Caucasian and Asian. 10 AP/ML dimensions were defined to obtain a good coverage of the population. For a given AP/ML dimension, Markov chain Monte Carlo sampler was used to find the most average shape with AP/ML dimensions as close as possible to the target dimensions. The difference of the AP/ML dimensions of the generated models to the target dimensions was computed. A chi-squared distribution was used to assess how average the resulting shapes were compared to typical patient shapes. Results. The AP-ML dimensions of the 7 Caucasian bones and the 5 Asian bones well cover the range of the respective populations. For the Caucasian Femur, the AP/ML dimensions range from (53,6/64,9mm) for size 1 to (67,7/80,7mm) for size 7. For the Asian Femur, the AP/ML dimension range from (53,0/62,4mm) for size 1 to (60,5/72,4mm) for size 5. The dimensions of the 10 additionally generated bones differed in average (± 1 standard deviation) by 0,2±0,4mm in AP and 0,5±0,5mm in ML to the target dimensions. The maximal deviation was 0,9mm in AP and 1,0mm in ML. All 10 bones had a P-value of P < 10. -27. according to the chi-squared distribution. Conclusion. The proposed models of 7 Caucasian and 5 Asian bones well represent both populations. The 10 additional geometries enable to get a complete coverage of the population. Since they are very close to average, all these bone models provide more generalized reference shapes compared to individual patients. By performing a virtual implantation on those anatomies, the anatomical fit of implants to these populations can be evaluated. For any figures or tables, please contact authors directly

Great interest in unicompartmental knee arthroplasty (UKA) for medial osteoarthritis has rapidly increased following the introduction of minimally invasive UKA (MI-UKA). This approach preserves the normal anatomy of knee, causes less damage to extensor mechanism and results in a more rapid post-operative recovery. However, experience with this approach is limited in China. The aim of this report was to determine the short-term clinical and radiographic outcomes of MI-UKA in the Chinese, and to identify any features that are unique to this population. Fifty two knees, in forty-eight patients, with medial compartmental osteoarthritis treated by MI-UKA via C-arm intensifier guide (CAIG) from May 2005 to January 2009 were reviewed. Pain and range of motion (ROM) was assessed using the HSS scoring system before and after surgery. Pre- and postoperative alignment of the lower limbs was measured and compared. The mean follow up time was 24 months (12-42 months). In all cases the pain over medial compartment of the knees was relieved or subsided. The post-operative ROM was 0-136 degree (mean 122degree), and the mean alignment was 2degree varus (0- 7degree varus). The HSS score increased from 72(61-82) to 92(72-95). 93% of the postoperative scores were good or excellent. Interestingly, the distribution of femoral component sizes of these patients was XS 2%, Small 83%, Medium 15%, Large 0%, XL 0%; whereas tibial component size was AA 27%, A 55%, B 15%, C 3%, D 0%, E 0%, and F 0%. The optimal fitted match between tibial and femoral size was: tibia AA and A with XS and small femur, tibia B and C with medium femur. The estimated match was: tibia D and E with large femur, tibia F with XL femur. In contrast to the Oxford report, the sizes of these components are smaller and not in correlation with the height, weight and BMI of the patients. We conclude that MI-UKA is an effective method for treating medial compartmental osteoarthritis of the knee in the Chinese population. CAIG is a feasibly intraoperative measure to predict femoral component sizes. However, component sizes and combinations are different from the Oxford guideline

It is common practice in wrist arthroscopy to suspend the patient’s arm using Chinese finger traps and to distract the wrist joint by applying weight to the arm at the elbow. It is possible that this may cause significant pressure to be applied to the fingers, and potentially damage the digital nerves. We examined the pressure applied by finger traps and consider the risk this poses to the digital nerves. Standard finger traps were suspended from a spring balance and the author’s fingers inserted along with a length of rubber tubing. The tubing was filled with saline and connected to a digital compartment pressure monitor. The hanging mass was gradually increased and the pressure in the rubber tubing noted. This pressure was taken as analogous to the pressure affecting the neurovascular bundle. Pressure increases linearly with increasing mass. A pressure of 500mmHg has been suggested as necessary to cause nerve injury1. Using non-invasive technique it was not possible to accurately measure the absolute pressure acting on the digital nerves. However the increase in pressure was noted. Using weight to distract the wrist during arthroscopy has potential to cause nerve injury. We suggest that pressure insufflation combined with Chinese finger traps with minimum weight traction provides a more than satisfactory view at wrist arthroscopy and can avoid potential digital nerve injury. However traction through finger traps for other purposes such as fracture reduction may be used with caution

1. Using the incidence of hip fracture as an indication of senile osteoporosis, the occurrence of this disease is found to vary greatly in different racial groups. The highest reported incidence is in Sweden, followed by Britain, Hong Kong Chinese, Singapore Chinese and South African Bantu, in that order. Likewise, the sex incidence varies, women outnumbering men in Sweden and Britain, men exceeding women in Singapore; an equal sex incidence is found in Hong Kong. 2. In all races and in both sexes the incidence is more closely related to age than any other factor, a progressive increase being noted after forty-five. Ageing is clearly the dominant etiological factor, but this does not explain the different racial incidence. These differences cannot be attributed to hormonal state or to the dietary intake of calcium, but do accord in general with the living standards of the different countries and the degree of physical activity undertaken by the different populations and sexes. 3. Hereditary factors may play a part, but further geographical study of the incidence of senile osteoporosis is necessary before the relative importance of inheritance and environment can be assessed

There have been several studies examining the association between the morphological characteristics seen in acetabular dysplasia and the incidence of the osteoarthritis (OA). However, most studies focus mainly on acetabular morphological analysis, and few studies have scrutinised the effect of femoral morphology. In this study we enrolled 36 patients with bilateral acetabular dysplasia and early or mid-stage OA in one hip and no OA in the contralateral hip. CT scans were performed from the iliac crest to 2 cm inferior to the tibial tuberosity, and the morphological characteristics of both acetabulum and femur were studied. . In addition, 200 hips in 100 healthy volunteer Chinese adults formed a control group. The results showed that the dysplastic group with OA had a significantly larger femoral neck anteversion and a significantly shorter abductor lever arm than both the dysplastic group without OA and the controls. Femoral neck anteversion had a significant negative correlation with the length of the abductor lever arm and we conclude that it may contribute to the development of OA in dysplastic hips. Cite this article: Bone Joint J 2014; 96-B:1586–93

The June 2024 Knee Roundup³⁶⁰ looks at: The estimated lifetime risk of revision after primary knee arthroplasty influenced by age, sex, and indication; Should high-risk patients seek out care from high-volume surgeons?; Stability and fracture rates in medial unicondylar knee arthroplasties; Rethinking antibiotic prophylaxis for dental procedures post-arthroplasty; Evaluating DAIR: a viable alternative for acute periprosthetic joint infection; The characteristics and predictors of mortality in periprosthetic fractures around the knee; Patient health-related quality of life deteriorates significantly while waiting six to 12 months for total hip or knee arthroplasty; The importance of looking for diversity in knee implants.

Objective: Considering the high incidence and misdiag-nostic rate of developmental dysplasia of hip (DDH) in China, some patients suffer from severe pain in the hip at early age, and a total hip arthroplasty would be necessary. To our knowledge, the intermediate-term(equal to or more than five years) results of total hip arthroplasty (THA) in patients with osteoarthritis secondary to developmental dysplasia of the hip has not been studied in China previously. This study evaluated more than five-year clinical and radiographic outcomes associated with total hip arthroplasty (THA) in a consecutive series of patients with osteoarthritis secondary to developmental dysplasia of the hip. Methods: From February 2000 to July 2002, 55 patients (69 hips) underwent THA in our hospital were involved in this study. Clinical outcomes were evaluated according to Harris evaluate score. Components migration, periprosthetic bone changes, the polyethylene wear rate were measured radiologically. Kaplan-Meier analysis was performed to evaluate the survival of the acetabular and femoral component. End point was obvious radiological loosening or revision either or both of the acetabular and femoral component for any reason. Results: Forty-five patients (57 hips) were followed up at least 5 years. The average preoperative Harris hip score was (46.19±18.01) points, which improved to (91.78±3.52) points at final follow-up. There were 48 excellent hips (84.21%), 7 good hips (12.28%), 2 fair hips (3.51%) and no poor hip. There is no significant difference of Harris score between the dysplasia group, the low dislocation group and the high dislocation group (P> 0.05, ANOVA). The mean polyethylene liner wear rate was (0.27±0.14)mm/year. According to the statistical relevant analysis, the wear rate of the polyethylene liner had relationship with the age(r=−0.288, P=0.040), the abnormal abduction angle of the acetabular cup (r=0.317, P=0.023)and the osteolysis rate (r=0.573, P=0.026), while had no significant relationship with the thickness of the polyethylene liner (P=0.326), gender(P=0.097), DDH classification(P=0.958) and the Harris score(P=0.598). There are 5 pelvic osteolysis and 8 proximal femoral osteolysis. Using loosening or revision as the end point for failure, the survival rate of both components was 1.0 (95% confidence interval, 0.98–1.00). Conclusions: In conclusion, improved surgical technique and design in the components provided favorable mid-term results in Chinese patients with osteoarthritis secondary to developmental dysplasia of the hip. Bulk autogenous or allografting is not needed if more than 70% of the acetabular component is covered by host bone. Although the Asia life style includes more squatting and cross-legged, the results of this series in Chinese population are comparable to the satisfactory results of other reported DDH series whose patients are mainly western people. The mid-term results of THA are equivalent in the group of patients with dysplasia, low dislocation, and high dislocation types both in ace-tabular and femoral components. However, the authors continue to be anxious about the high rate of liner wear and osteolysis, which deserve the necessary long-term follow-up

Introduction: Fractures are common with well described morbidities. Few small studies have reported in-hospital mortality of patients with fractures. This study aims to describe the distribution of fractures, the incidence of in-hospital fracture mortality and its risk factors. Materials and Methods: All patients with fractures related to the hip, pelvis, femur, tibia and spine over a 10 year period in a university hospital were identified using the ICD-9 codes upon discharge. Age, gender, race, length of hospital stay and in-hospital mortality data were collected from electronic records. Detailed analysis of the mortality data was performed with statistical analysis using SPSS software. Results: 8709 fractures were identified, of which 30.3% were hip fractures [1422(54%) NOF and 1216(46%) IT fractures], 24.4% were spinal fractures [144 (7%) cervical; 558(26%) thoracic; 1038(49%) lumbar; 47(2.2%) sacral and 335(16%) unclassified spine fractures], 24.1% were tibial fractures [proximal and shaft], 14.4% were femoral fractures [1037(83%) shaft and 215(17%) supracondylar] and 6.9% were pelvic fractures [265(42%) non rami and 351(58%) rami fractures]. 25% of the fractures occurred between age 21–40 years and 65% fractures occurred in patients older than age 41 years. 53% of the patients were male. 69%, 12% and 11% of the fractures were found in Chinese, Malay and Indian respectively. 90% were closed fractures. Overall in-hospital fracture mortality was 1.3% (117 fractures). Fracture specific in-hospital mortality was 2.8% (75 fractures) for hip fractures, 5% (13) for non rami pelvic fractures, 1% (20) for spinal fractures, 0.5% (6) for femoral fractures and near 0%(1) for tibial fractures. In-hospital mortality increased with age (0.4% mortality between 21–40 years, 0.6% between 41–60 years, 0.9% between 61–70 years, 1.7% between 71–80 and 4% between 81–90 years). Infection related causes of death were most common. The mean duration from hospital admission until death was 19 days (SD 20, range 1–34). More hip and spine fractures were seen in Chinese and more femoral and tibial fractures were seen in Malay and Indian patients, and this difference was statistically significant. Logistic regression analysis showed only increased patient age, male gender and fracture type as statistically significant risk factors for increased in-hospital mortality. Subgroup analysis showed a 30 and 20 times increased risk of in-hospital mortality for pelvic (p=0.001, 95% CI 4, 241) and hip (p=0.003, 95% CI 3, 159) fractures respectively. Conclusion: The overall in-hospital fracture mortality was 1.3% (2.8 % for hip and 5% for pelvic fractures). Increased patient age, male gender, hip and pelvic fractures were found to be risk factors for increased mortality

Aims. To address the natural history of severe post-tuberculous (TB) kyphosis, with focus upon the long-term neurological outcome, occurrence of restrictive lung disease, and the effect on life expectancy. . Patients and Methods. This is a retrospective clinical review of prospectively collected imaging data based at a single institute. A total of 24 patients of Southern Chinese origin who presented with spinal TB with a mean of 113° of kyphosis (65° to 159°) who fulfilled inclusion criteria were reviewed. Plain radiographs were used to assess the degree of spinal deformity. Myelography, CT and MRI were used when available to assess the integrity of the spinal cord and canal. Patient demographics, age of onset of spinal TB and interventions, types of surgical procedure, intra- and post-operative complications, and neurological status were assessed. . Results. All except one of the 24 patients were treated with anti-TB chemotherapy when they were first diagnosed with spinal TB. They subsequently received surgery either for neurological deterioration, or deformity correction in later life. The mean follow-up was 34 years (11 to 59) since these surgical interventions. Some 16 patients (66.7%) suffered from late neurological deterioration at a mean of 26 years (8 to 49) after the initial drug treatment. The causes of neurological deterioration were healed disease in nine patients (56.2%), re-activation in six patients (37.5%) and adjacent level spinal stenosis in one patient (6.3%). The result of surgery was worse in healed disease. Eight patients without neurological deterioration received surgery to correct the kyphosis. The mean correction ranged from 97° to 72°. Three patients who were clinically quiescent with no neurological deterioration were found to have active TB of the spine. Solid fusion was achieved in all cases and no patient suffered from neurological deterioration after 42 years of follow-up. On final follow-up, six patients were noted to have deceased (age range: 47 years to 75 years). Conclusion. Our study presents one of the longest assessments of spinal TB with severe kyphosis. Severe post-TB kyphosis may lead to significant health problems many years following the initial drug treatment. Early surgical correction of the kyphosis, solid fusion and regular surveillance may avoid late complications. Paraplegia, restrictive lung disease and early onset kyphosis might relate to early death. Clinically quiescent disease does not mean cure. . Cite this article: Bone Joint J 2017;99-B:1381–8

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Spinopelvic characteristics influence the hip’s biomechanical behaviour. However, to date there is little knowledge defining what ‘normal’ spinopelvic characteristics are. This study aims to determine how static spinopelvic characteristics change with age and ethnicity among asymptomatic, healthy individuals.

INTRODUCTION. Femur is one of the bones in humans that exhibit ethnic, racial, and gender difference. Several basic and clinical studies were conducted to explore these variations. Clinical anthropological studies have dealt with the compatibility of femoral prostheses and osteosythesis and materials with the femur. If there is a misalignment between the Total Knee Arthroplasy (TKA) femoral comportment installation position, Range of Motion (ROM) failure and several problems may arise. The aim of this study was to evaluate anterior bowing of the Japanese femur and to assess the adequacy of TKA femoral comportment installation position. METHODS. We analyzed 76 normal Japanese and 97 TKA patients. (June 2014-June 2015) The average age of the normal subjects was 62.0±20.90 (24–88) years old and the average of TKA subjects was 73.6±7.9 (53–89) years old. First we defined and measured the anterior curvature and the posterior condylar offset (PCO) in normal japanese femurs. Then in TKA patients we set the implant as same angle of the component. Third, we measured the post operative anterior curvature and PCO. Then calculated the anterior curvature difference and PCO differences and preformed statistical analysis with ROM. RESULTS SECTION. The average of anterior curvature in normal subjects was 7.87±6.60 degrees. Among 97 TKA patients, pre-operative anterior curvature was 7.58±0.16 degrees. Further, the angle of component which was set the post operatively was 7.32±0.25. The average of Anterior curvature difference and PCO differences had correlation with ROM. DISCUSSION. Gilbert reported that caucasian femurs are straight compared to asian femurs. Chinese and Japanese showed different anterior curvature because of different life style. The chalenges are when operating on different ethnic patients, Orthopedic Surgeons consider many factors. Previous studies yielded different suggestions for the ideal point of entry. We suggest difference between the curves of the femurs should be considered for TKA femoral comportment installation position. SIGNIFICANCE. 1)Our results gave an anatomical characteristics of Japanese femur. 2)These data will give clinical indication for TKA femoral comportment installation position

Introduction. Total knee arthroplasty (TKA) is an excellent treatment for end-stage osteoarthritis of the knee. In Asian countries, the number of TKA performed has rapidly increased, and is expected to continue so with its 4.4 billion population and increasing life expectancy. Asians' knees are known to be kinematically different to Caucasians after TKA. Controversy exists as to whether multi-radius (MR) or the newer single-radius (SR) TKA has superior outcome. Studies regarding this have been largely based on Caucasian data with few small sample Asian data. Methods. This is a retrospective analysis of prospectively collected institutional registry data between 2004 and 2015. Outcomes of 133 single-radius (SR) (Scorpio NRG, Stryker) and 363 multi-radius (MR) (Nexgen LPS, Zimmer) primary TKA for primary osteoarthritis were compared. All TKA was performed or directly supervised by the senior author. Range of motion (ROM), Oxford Knee Score (OKS), SF-36 physical component score (SF36-PCS), SF-36 mental component score (SF36-MCS), Knee Society Function Score (KS-FS) and Knee Score (KS-KS) were recorded preoperatively and at 2 years post-operation. Results. The mean age in both groups were similar at 66 ± 8 years (p=0.66). Both groups were in majority female (71% and 70% females in SR and MR respectively, p=0.10) and ethnic Chinese (79% and 84% in SR and MR respectively, p=0.53). The preoperative ROM and outcome scores in both groups were similar. MR-TKA achieved significantly greater improvement over 2 years in terms of ROM (7.5º ± 18.2º vs. 3.5º ± 19.3º, p=0.04), KS-KS (49.0 ± 20.9 vs. 42.7 ± 21.1, p=0.01), OKS (17.4 ± 18.4, p=0.03), and SF36-PCS (17.1 ± 12.5, p=0.02). At 2-years follow up, MR-TKA group fared slightly better for SF36-PCS (48 ± 10 vs. 46 ± 10, p=0.032), but the absolute difference was only 2 points. There were no significant differences between SR-TKA and MR-TKA for ROM (115º ± 16º vs. 117º ± 16º, p=0.218), KS-KS (81 ± 16 vs. 85 ± 12, p=0.795), KS-FS (74 ± 21 vs. 75 ± 20, p=0.627), OKS (20 ± 7 vs. 18 ± 6, p=0.099), and SF36-MCS (56 ± 10 vs. 55 ± 10, p=0.324). There were larger proportions of MR-TKA patients who achieved the minimum clinically important difference (MCID) for OKS (95% vs. 82%, p<0.001) and SF36-PCS (67% vs. 55%, p=0.011) at 2-years follow-up. Logistic regression, controlling for all preoperative variables, showed SR-TKA is less likely to achieve MCID for OKS with an odds ratio of 0.275 (95% confidence interval: 0.114 – 0.663, p=0.004), and SF36-PCS with an odds ration of 0.547 (0.316 – 0.946, p=0.031). Discussion and conclusion. SR-TKA and MR-TKA produced similar outcomes, in concordance with current literature. However, SR-TKA has lower odds of achieving MCID in OKS and SF36-PCS, possibly due to its smaller improvement in flexion over 2 years. This subtle difference has a greater impact in the context of Asian patients due to the cultural practice of kneeling and/or squating

The August 2023 Children’s orthopaedics Roundup³⁶⁰ looks at: DDH: What can patients expect after open reduction?; Femoral head deformity associated with hip displacement in non-ambulatory cerebral palsy; Bony hip reconstruction for displaced hips in patients with cerebral palsy: is postoperative immobilization indicated?; Opioid re-prescriptions after ACL reconstruction in adolescents are associated with subsequent opioid use disorder; Normative femoral and tibial lengths in a modern population of USA children; Retrospective analysis of associated anomalies in 636 patients with operatively treated congenital scoliosis; Radiological hip shape and patient-reported outcome measures in healed Perthes’ disease; Significantly displaced adolescent posterior sternoclavicular joint injuries.

The February 2023 Trauma Roundup³⁶⁰ looks at: Masquelet versus bone transport in infected nonunion of tibia; Hyperbaric Oxygen for Lower Limb Trauma (HOLLT): an international multicentre randomized clinical trial; Is the T-shaped acetabular fracture really a “T”?; What causes cut-out of proximal femur nail anti-rotation device in intertrochanteric fractures?; Is the common femoral artery at risk with percutaneous fragility pelvis fixation?; Anterior pelvic ring pattern predicts displacement in lateral compression fractures; Differences in age-related characteristics among elderly patients with hip fractures.

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Open lower limb fracture is a life-changing injury affecting 11.5 per 100,000 adults each year, and causes significant morbidity and resource demand on trauma infrastructures. This study aims to identify what, and how, outcomes have been reported for people following open lower limb fracture over ten years.

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Distal femoral resection in conventional total knee arthroplasty (TKA) utilizes an intramedullary guide to determine coronal alignment, commonly planned for 5° of valgus. However, a standard 5° resection angle may contribute to malalignment in patients with variability in the femoral anatomical and mechanical axis angle. The purpose of the study was to leverage deep learning (DL) to measure the femoral mechanical-anatomical axis angle (FMAA) in a heterogeneous cohort.

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Isolated acetabular liner exchange with a highly crosslinked polyethylene (HXLPE) component is an option to address polyethylene wear and osteolysis following total hip arthroplasty (THA) in the presence of a well-fixed acetabular shell. The liner can be fixed either with the original locking mechanism or by being cemented within the acetabular component. Whether the method used for fixation of the HXLPE liner has any bearing on the long-term outcomes is still unclear.

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Osteoporosis (OP) is a metabolic bone disease, characterized by a decrease in bone mineral density (BMD). However, the research of regulatory variants has been limited for BMD. In this study, we aimed to explore novel regulatory genetic variants associated with BMD.

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Knee osteoarthritis (OA) involves a variety of tissues in the joint. Gene expression profiles in different tissues are of great importance in order to understand OA.

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To assess the alterations in cell-specific DNA methylation associated with chondroitin sulphate response using peripheral blood collected from Kashin-Beck disease (KBD) patients before initiation of chondroitin sulphate treatment.

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A conventional arthroscopic capsuloligamentous repair is a reliable surgical solution in most patients with scapholunate instability. However, this repair does not seem to be sufficient for more advanced injuries. The aim of this study was to evaluate the functional results of a wide arthroscopic dorsal capsuloligamentous repair (WADCLR) in the management of severe scapholunate instability.

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Gram-negative periprosthetic joint infection (PJI) has been poorly studied despite its rapidly increasing incidence. Treatment with one-stage revision using intra-articular (IA) infusion of antibiotics may offer a reasonable alternative with a distinct advantage of providing a means of delivering the drug in high concentrations. Carbapenems are regarded as the last line of defense against severe Gram-negative or polymicrobial infection. This study presents the results of one-stage revision using intra-articular carbapenem infusion for treating Gram-negative PJI, and analyzes the characteristics of bacteria distribution and drug sensitivity.

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The metabolic variations between the cartilage of osteoarthritis (OA) and Kashin-Beck disease (KBD) remain largely unknown. Our study aimed to address this by conducting a comparative analysis of the metabolic profiles present in the cartilage of KBD and OA.

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Giant cell tumour of bone (GCTB) is a locally aggressive lesion that is difficult to treat as salvaging the joint can be associated with a high rate of local recurrence (LR). We evaluated the risk factors for tumour relapse after treatment of a GCTB of the limbs.

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In this study, we aimed to visualize the spatial distribution characteristics of femoral head necrosis using a novel measurement method.

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The involvement of cyclin D1 in the proliferation of microglia, and the generation and maintenance of bone cancer pain (BCP), have not yet been clarified. We investigated the expression of microglia and cyclin D1, and the influences of cyclin D1 on pain threshold.

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The aim of this study was to develop and internally validate a prognostic nomogram to predict the probability of gaining a functional range of motion (ROM ≥ 120°) after open arthrolysis of the elbow in patients with post-traumatic stiffness of the elbow.

Recognized anatomic variations that lead to patella instability include patella alta and trochlea dysplasia. Lateralization of the extensor mechanism relative to the trochlea is often considered to be a contributing factor; however, controversy remains as to the degree this contributes to instability and how this should be measured. As the tibial tuberosity-trochlear groove (TT-TG) is one of most common imaging measurements to assess lateralization of the extensor mechanism, it is important to understand its strengths and weaknesses. Care needs to be taken while interpreting the TT-TG value as it is affected by many factors. Medializing tibial tubercle osteotomy is sometimes used to correct the TT-TG, but may not truly address the underlying anatomical problem. This review set out to determine whether the TT-TG distance sufficiently summarizes the pathoanatomy, and if this assists with planning of surgery in patellar instability.

Cite this article: Bone Jt Open 2022;3(3):268–274.

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Exosomes (exo) are involved in the progression of osteoarthritis (OA). This study aimed to investigate the function of dysfunctional chondrocyte-derived exo (DC-exo) on OA in rats and rat macrophages.

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There is an increasing concern of osteoporotic fractures in the ageing population. Low-magnitude high-frequency vibration (LMHFV) was shown to significantly enhance osteoporotic fracture healing through alteration of osteocyte lacuno-canalicular network (LCN). Dentin matrix protein 1 (DMP1) in osteocytes is known to be responsible for maintaining the LCN and mineralization. This study aimed to investigate the role of osteocyte-specific DMP1 during osteoporotic fracture healing augmented by LMHFV.

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This study aims to estimate economic outcomes associated with 30-day deep surgical site infection (SSI) from closed surgical wounds in patients with lower limb fractures following major trauma.

We report a case of systemic Penicillium marneffei infection in a Chinese woman who presented with multiple osteolytic lesions and radiographic changes similar to those seen in other fungal osteomyelitides. This infection is often misdiagnosed as tuberculosis and has a high mortality rate. The correct diagnosis is important since early antifungal therapy is life-saving

1. Five new cases of Apert's syndrome are presented, and the general features of the disease are discussed and correlated with these. The bony changes in the elbow and the delay in ossification are striking. The incidence in Singapore seems to be higher than elsewhere and the patients are all Chinese males. 2. In Singapore the disease is sporadic but seems to appear about once every three years

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Treatment for delayed wound healing resulting from peripheral vascular diseases and diabetic foot ulcers remains a challenge. A novel surgical technique named ‘tibial cortex transverse transport’ (TTT) has been developed for treating peripheral ischaemia, with encouraging clinical effects. However, its underlying mechanisms remain unclear. In the present study, we explored the potential biological mechanisms of TTT surgery using various techniques in a rat TTT animal model.

1. The cases of six Chinese children affected by so-called congenital fibrosis of the vastus intermedius muscle are described. The reasons for the choice of name are discussed. 2. Reasons for early operation are put forward: in young children simple division of the tendon of the vastus intermedius is adequate. 3. With increasing age severe changes in all the joint tissues occur, notably in the articular cartilage of the patella. These changes are likely to vitiate the result after operation. 4. The importance of getting as much flexion as possible in children of Asiatic race is stressed

Twenty-three patients with thirty hips of slipped capital femoral epiphysis were treated in our department, KK Women's and Children's Hospital, Singapore between 1997 and 2005. Except one patient lost of follow-up, twenty-four SCFEs with more than 2 years (25 to 73 months, average 38.5 months) follow-up were reviewed. This study is to evaluate the effectiveness and outcome of our protocol: Russell traction followed by gentle manipulative reduction with a single screw fixation & spica cast immobilization (for acute-on-chronic cases with unstable and reducible SCFE). In this series, there were 13 boys & 5 girls, mean age 12 year old ranging from 10 to 14 years. Among them 7 were Chinese, 6 Malays & 5 Indians. There were 12 unilateral cases (8 on the left & 4 right, 67%) & 6 bilateral cases (33%), including 2 patients found contralateral SCFE subsequently 1 year postoperatively. Acute-on-chronic SCFE were 16 & chronic SCFE 8. 16 were Grate I & 8 Grate II. Russell traction was on preoperatively with an average of 6 days. Gentle manipulative reduction under general anesthesia was performed in 20 SCFEs (12 GI & 8 GII) and 17 of them were successful. Fixation with a single screw was used for all cases except one hip with 2 screws. Average follow-up was 38.5 months. Good results achieved. All patient were symptom free with good function. No complications of AVN, chondrolysis, screw loosening and reslipping of the affective hips. Our protocol of management for SCFE has been largely successful in term of manipulative reduction and fixation

Fragmentation of SLRPs, including decorin, biglycan, lumican, keratocan and fibromodulin, has been shown to occur in osteoarthritic articular cartilage. We have previously shown an increased expression of lumican and keratocan, in osteoarthritic articular cartilage. The long-term aim of this project is to develop ELISAs for the detection of SLRP metabolites, and validate these potential biomarkers with synovial fluid and serum samples from a large cohort of normal and osteoarthritic patients. Initially, we aimed to determine whether SLRPs could be detected in synovial fluid and whether they were post-translationally modified with glycosaminoglycan (GAG) attachments; and whether bovine nasal cartilage (BNC) would be a plentiful source of native SLRP for ELISA development. Proteoglycans were extracted from BNC in guanidine hydrochloride. BNC extract and bovine synovial fluid was separated on an associative CsCl gradient. BNC CsCl cuts containing sulphated GAG were further purified using anion exchange chromatography. SLRPs in each fraction were detected using Western Blotting. Human recombinant lumican was expressed in Chinese hamster ovary (CHO) cells. Monoclonal antibodies that recognise epitopes on the core protein of human and bovine lumican and decorin were purified from hybridoma media using Protein G and Protein A affinity chromatography respectively. Monoclonal antibody activity against native and recombinant SLRPs was then determined using a direct ELISA. Preliminary tests showed that bovine synovial fluid contains keratocan and lumican with GAG attachments. BNC is a good source of post-translationally modified decorin, keratocan and biglycan but lumican was present predominantly without GAG attachments. Human recombinant lumican was successfully expressed with GAG attachments by CHO cells. Initial tests showed that the mAb against decorin was able to detect native decorin, with GAG attachments, in direct ELISA conditions. We have identified a plentiful source of native SLRP and begun ELISA development to ascertain whether these proteoglycans are potential biomarkers of OA

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Circular RNA (circRNA) S-phase cyclin A-associated protein in the endoplasmic reticulum (ER) (circSCAPER, ID: hsa_circ_0104595) has been found to be highly expressed in osteoarthritis (OA) patients and has been associated with the severity of OA. Hence, the role and mechanisms underlying circSCAPER in OA were investigated in this study.

Introduction. Multifocal osteonecrosis (ON) was defined by Mont et al. as a disease involving three or more anatomic sites. Few papers have been published on the Chinese experience. The purpose of this study was to characterize the experience with multifocal ON in order to make an earlier diagnosis for more patients with this disorder. Methods. From 2003 to 2008, thirty nine patients with multifocal ON were identified in our clinical practice. Among them, thirty seven patients were post-SARS rehabilitating patients and two patients were found in clinic. All patients had a history of high dose corticosteroid therapy. The diagnosis was done by magnetic resonance imaging (MRI) and radiographs. All patients were treated by drug or other joint-salvaging procedure. Three patients had bilateral total hip arthroplasties. Results. Osteonecerotic foci involved three joints (hip, knee, and shoulder) in fifteen patients, three joints (hip, knee, and ankle) in ten patients, four joints (hip, knee, shoulder, and ankle) in six patients, four joints (hip, knee, shoulder, and wrist) in two patients, and five joints (hip, knee, shoulder, ankle, and wrist) in four patients. All 39 patients, except two had femoral head involvement. Overall, 288 joints were involved (7.6 lesions per patients). Bilaterality was common. Corticosteroid dose in patients with multifocal ON was higher than patients with single joint ON. Conclusion. We found that the patients with ON who had peripheral joints (shoulder, elbow, ankle, wrist) involved also were diagnosed hip and knee ON (both or either). Patients with hip or knee joint ON can exist in isolation. Multifocal ON was increased with higher doses of corticosteroid administration. Vigilance is important in the diagnosis of multifocal ON. The MRI is a sensitive and specific method for diagnosing multifocal ON

Routine examination for spinal deformity as part of a school health screening programme was introduced in Singapore in 1981. The three different ethnic groups included in the study provided figures for the prevalence of idiopathic scoliosis in an Asian population. A three-tier system of examination was used and a total of 110744 children in three age groups were studied. In those aged 6 to 7 years the prevalence was 0.12%. The prevalence in those aged 11 to 12 years was 1.7% for girls and 0.4% for boys, a ratio of 3.2 to 1. In girls aged 16 to 17 years the prevalence was 3.1%. In the latter two age groups there was a significantly higher prevalence in Chinese girls as compared with Malay and Indian girls. The optimal age for school screening seemed to be 11 to 12 years, but repeated examinations may be worthwhile

Backgroud:. Periarticular multimodal drug injection (PMDI) during total knee arthroplasty (TKA) has been reported with promising effects, but some results still remain controversial. Therefore, we conducted a systematic review and meta-analysis based on randomized controlled trials (RCTs) to evaluate the efficiency and safety of PMDI technique in TKA. Methods:. We systematically conducted an electronic search in the databases of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (SCI), and the Chinese Biomedical Literature Database (CBM). Two independent reviewers completed data collection and assessment of methodological quality according to the Cochrane Handbook 5.1. The quality of evidence of outcomes was judged using GRADE criteria. Statistical analysis was performed using the RevMan 5.1 software. Results:. Ten studies including eight trials with 1216 TKAs in 835 patients met the inclusion criteria. The short-term results of meta-analysis showed that technique of PMDI in TKA was associated with significantly improved pain scores on the day of surgery and postoperative 1 day [MD = −1.07, 95% CI (−1.43, −0.71), p < 0.01], better straight leg raise[OR = 4.02, 95% CI (2.25, 7.18), p < 0.01], reduced narcotic consumption within postoperative 24 hours [MD = −4.83, 95% CI (−6.61, −3.05), p < 0.01], and less rates of nausea or vomiting, and rash or pruritus [OR = 0.34, 95% CI (0.22, 0.55), p < 0.01]. There were no statistically significant differences in operating time [MD = 0.17, 95% CI (−1.48, 1.82), p = 0.84], hospital stay [MD = −0.20, 95% CI (−1.18, 0.79), p = 0.70], wound complication [OR = 0.79, 95% CI (0.31, 2.04), p = 0.63] and deep vein thrombosis [OR = 0.87, 95% CI (0.42, 1.78), p = 0.69] between both groups. Conclusions:. Periarticular injection with multimodal drugs in TKA has significant short-term advantages in pain relief, functional recovery, and narcotic consumption with fewer rates of complications (nausea or vomiting and rash or pruritus). Further well-designed RCTs are still needed to investigate the long-term efficiency of PMDI in patients undergoing TKA

The total plasma alkaline phosphatase level has long been recognised as an indicator of osteoblastic activity, but lack of specificity makes it an insensitive index of the progress of disease and the response to treatment. Selective precipitation by wheatgerm lectin allows measurement of the plasma bone-specific alkaline phosphatase. We measured the plasma levels of this isoenzyme in 170 normal Chinese adolescents and adults, in 49 adults with fractures of a long bone, in 15 patients with osteosarcoma and in 38 patients with osteolytic metastases. The enzyme activity was also determined in 39 patients with liver disease. Of the patients with fractures, 94% had increased plasma activity during the healing process. The level was also increased in those with osteosarcoma but not in those with osteolytic bone metastases. There was no significant increase in activity in the patients with liver disease. We conclude that the plasma bone-specific alkaline phosphatase activity is a sensitive and reliable measure of osteoblastic activity

Summary Statement. Treatment of non-union is a highly demanding field with respect to bone healing. BMP 7 is a useful, wide-ranged tool in treating non-union of the foot and benign bone tumors. It represents a low-risk procedure with a high level of reliability. Introduction. Treatment of non-union is a highly demanding field with respect to bone healing. Treatment of tibial fracture non-union with the bone morphogenetic protein 7 (BMP-7) has been successfully reported. BMP 7 is a recombinant human protein produced in ovary cells of the Chinese hamster. It is responsible for the differentiation of mesenchymal stem cells from the periost, muscle and sponious bone and stimulates bone formation. It is the aim of our study to investigate the use of BMP 7 for other locations than the tibia, such as the foot and benign bone tumors. We strive for union or revision in each medical case. Patients & Methods. At our clinic we applied BMP-7 to 13 patients (9 patients with non-union, 4 patients with benign bone cysts). 9 patients with non-union of the foot (4 forefoot, 1 midfoot, 3 hindfoot, 1 tibia) were surgically treated by resection, stabilisation, and application of BMP 7. The study included 5 men and 4 women at an average age of 58,4 years (range 33 – 80), 13 previous surgeries had been carried out. The period of follow up was on average 16.3 months (5 – 40 months). The indication for using BMP-7 instead of autologous bone graft was poor local blood supply, poor local soft tissue because of previous interventions and risk factors like smoking and diabetes. Following an indicated open biopsy, the 4 cases of benign bone tumors (1 juvenile bone cyst of the talus, 1 osteofibrose dysplasia of the proximal tibia and 2 juvenile bone cysts of the proximal humerus) were all treated with resection, followed by an application of BMP-7 and external or internal fixation. In addition two received bone grafting and two received cortisone. The average age of the tumor group was 16,75 years (11–24 years, 2 male, 2 female). Results. At follow-up all patients were satisfied with respect to pain and function, no operative complications had occurred and bone fusion had finished in 7 patients after 3 months. One ankle joint had a fibrous fusion but was free of pain. One arthrodesis of the first metatarsophalangeal joint was turned into a resection arthroplasty, today the patient is free of pain and uses a normal shoe. Both bone cysts have the radiological evidence of rehabilitation. At one humeruscyst we removed the TENS-nails without complications. We had no complications like heterotopic ossification, local erythema or pressure sensitivity. Discussion/Conclusion. These results show that BMP 7 is a useful, wide-ranged tool in treating non-union of the foot and benign bone tumors. It represents a low-risk procedure with a high level of reliability

The Gamma nail was introduced for the treatment of peritrochanteric fractures with the theoretical advantage of a load-sharing femoral component which could be implanted by a closed procedure. We report a randomised prospective study of 186 fractures treated by either the Gamma nail or a dynamic hip screw. Gamma nails were implanted with significantly shorter screening times, smaller incisions, and less intraoperative bleeding. The Gamma nail group had a shorter convalescence and earlier full weight-bearing, but there was no significant difference in mortality within six months, postoperative mobility, or hip function at review. More intra-operative complications were recorded in the Gamma nail group, mainly due to the mismatching of the femoral component of the nail to the small femurs of Chinese people. Use of a smaller modified nail reduced these complications. We conclude that with careful surgical technique and the modified femoral component, the Gamma nail is an advance in the treatment of peritrochanteric fractures

We carried out 12 arthroscopies of the first metatarsophalangeal (MTP) joint in 11 patients over a five-year period. Their mean age was 30 years (15 to 58) and the mean duration of symptoms before surgery was eight months (1 to 24). Six patients had an injury to the joint; all had swelling and tenderness with a reduced range of movement. In six patients, radiographs revealed no abnormality. Under general anaesthesia with a tourniquet the hallux is suspended by a large Chinese finger trap to distract the joint. Using a 1.9 mm 30° oblique arthroscope the MTP joint is inspected through dorsomedial and dorsolateral portals with a medial portal if necessary. All patients were found to have intra-articular pathology, which was treated using small instruments. The mean follow-up was 19.3 months (6 to 62) and all patients had no or minimal pain, decreased swelling and an increased range of movement of the affected joint

This study is to evaluate the effectiveness and outcome of our protocol: Russell traction followed by gentle manipulative reduction with a single screw fixation & spica cast immobilization. Twenty-three patients with thirty hips of slipped capital femoral epiphysis were treated in our department, KK Women’s and Children’s Hospital, Singapore between 1997 and 2005. Except one patient lost of follow-up, twenty-four SCFEs with more than 2 years follow-up were reviewed. In this series, there were 13 boys & 5 girls, mean age 12 year old ranging from 10 to 14 years. Among them 7 were Chinese, 6 Malays & 5 Indians. There were 12 unilateral cases (8 on the left & 4 right, 67%) & 6 bilateral cases (33%), including 2 patients found contralateral SCFE subsequently 1 year postoperatively. Acute-on-chronic SCFE were 16 & chronic SCFE 8. 16 were Grate I & 8 Grate II. Russell traction was on preoperatively with an average of 6 days. Gentle manipulative reduction under general anesthesia was performed in 20 SCFEs (12 GI & 8 GII) and 17 of them were successful. Fixation with a single screw was used for all cases except one hip with 2 screws. Average follow-up was 38.5 months. Good results achieved. All patient were symptom free with good function. No complications of AVN, chondrolysis, screw loosening and reslipping of the affective hips. Our protocol of management for SCFE has been largely successful in term of manipulative reduction and fixation. This is a safe, simple and effective management

Aims

Distraction osteogenesis (DO) is a useful orthopaedic procedure employed to lengthen and reshape bones by stimulating bone formation through controlled slow stretching force. Despite its promising applications, difficulties are still encountered. Our previous study demonstrated that pulsed electromagnetic field (PEMF) treatment significantly enhances bone mineralization and neovascularization, suggesting its potential application. The current study compared a new, high slew rate (HSR) PEMF signal, with different treatment durations, with the standard Food and Drug Administration (FDA)-approved signal, to determine if HSR PEMF is a better alternative for bone formation augmentation.

Aims

The COVID-19 pandemic drastically affected elective orthopaedic services globally as routine orthopaedic activity was largely halted to combat this global threat. Our institution (University College London Hospital, UK) previously showed that during the first peak, a large proportion of patients were hesitant to be listed for their elective lower limb procedure. The aim of this study is to assess if there is a patient perception change towards having elective surgery now that we have passed the peak of the second wave of the pandemic.

Introduction: AIS is described as a sex-influenced auto-somal dominantly inherited disorder with females more often affected than males (operative ratio 7F:1M) 1. Two AIS loci have been reported on chromosomes 17p112 and 19p13.33 in the Italian and Chinese populations, respectively. Other susceptibility AIS loci on chromosomes 6p, distal 10q and 18p4, and more recently to chromosomes 6, 9, 16, and 175, and 19p136 have also been reported, in the American population. Purpose: To perform a genome scan for suitable UK multi-generation families and identify new genetic loci for AIS. Method: DNA samples from 208 subjects (116 affected members) from 25 British families with confirmed diagnosis of AIS were selected from our family database, and genotyped for 410 polymorphic markers from the entire genome, spaced at ~10 cM intervals. Using Cyrillic, most likely inherited haplotypes were constructed for each chromosome and family. Statistical analyses were calculated using MLINK and GENEHUNTER, initially for the entire genotypic data, and again for affected meioses only. Results: 170,560 genotypes were obtained and analysed. Our AIS families show no linkage to the X chromosome. Preliminary inspection of inherited haplotypes indicates a number of families may be segregating with several new AIS loci with LOD scores from 1.0–3.64 for markers on 15 different chromosomes. Linkage analysis and saturation mapping of the 2 highest LOD score regions on chromosomes 9q34 and 17q25 were conducted. These regions were successfully refined and candidate genes are being screened. Conclusion: Preliminary evidence already indicates genetic heterogeneity of AIS. Candidate genes from the two highest LOD score loci are at present being screened

Aims

A typical pattern of blood loss associated with total hip arthroplasty (THA) is 200 ml intraoperatively and 1.3 l in the first 48 postoperative hours. Tranexamic acid (TXA) is most commonly given as a single preoperative dose only and is often withheld from patients with a history of thromboembolic disease as they are perceived to be “high-risk” with respect to postoperative venous thromboembolism (VTE). The TRanexamic ACid for 24 hours trial (TRAC-24) aimed to identify if an additional 24-hour postoperative TXA regime could further reduce blood loss beyond a once-only dose at the time of surgery, without excluding these high-risk patients.

Aims

Tert-butylhydroquinone (tBHQ) has been identified as an inhibitor of oxidative stress-induced injury and apoptosis in human neural stem cells. However, the role of tBHQ in osteoarthritis (OA) is unclear. This study was carried out to investigate the role of tBHQ in OA.

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Exosomes derived from bone marrow mesenchymal stem cells (BMSCs) have been reported to be a promising cellular therapeutic approach for various human diseases. The current study aimed to investigate the mechanism of BMSC-derived exosomes carrying microRNA (miR)-136-5p in fracture healing.

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Non-coding microRNA (miRNA) in extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs) may promote neuronal repair after spinal cord injury (SCI). In this paper we report on the effects of MSC-EV-microRNA-381 (miR-381) in a rodent model of SCI.

Aims

Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint infection (PJI), but their diagnostic values are unclear for screening fixation-related infection (FRI) in patients for whom conversion total hip arthroplasty (THA) is planned after failed internal fixation for femoral neck fracture.

Aims

Circular RNAs (circRNAs) are a novel type of non-coding RNA that plays major roles in the development of diverse diseases including osteonecrosis of the femoral head (ONFH). Here, we explored the impact of hsa_circ_0066523 derived from forkhead box P1 (FOXP1) (also called circFOXP1) on bone mesenchymal stem cells (BMSCs), which is important for ONFH development.

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Developmental dysplasia of the hip (DDH) is a complex musculoskeletal disease that occurs mostly in children. This study aimed to investigate the molecular changes in the hip joint capsule of patients with DDH.

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The aim of this study was to determine the differences in spinal imaging characteristics between subjects with or without lumbar developmental spinal stenosis (DSS) in a population-based cohort.

Introduction: Adolescent idiopathic scoliosis (AIS) is described as a sex-influenced autosomal dominantly inherited disorder with females more often affected than males, and operative ratio of 7F:1M (Child et al. 1999). Two AIS loci have been reported on chromosome 17p11 (Salehi et al. 2002) and chromosome 19p13.3 (Chan et al. 2002) in the Italian and Chinese populations, respectively. Three other susceptibility AIS loci on chromosome 6q, distal 10q and 18q (Wise et al. 2000), and more recently primary candidate regions on chromosomes 6, 9, 16, and 17 (Miller et al, 2005) have also been reported. Purpose: o perform a genome scan for suitable UK multiplex families and identify new genetic loci for AIS. Method: NA samples from 208 subjects (134 affected, 17 reduced penetrance members and 79 normal) from 25 multi-generation British families with confirmed diagnosis of AIS were selected from our AIS family database, and genotyped for 410 polymorphic markers from the entire genome, spaced at 10 cM intervals. Genotypic data were exported into Cyrillic to construct the most likely inherited haplotypes for each chromosome and in each family. Two–point LOD scores were calculated using MLINK initially for the entire genotypic data, and again for the affected meioses only, followed by GENEHUNTER for multipoint linkage analysis for each family. Results: Overall, 170 560 genotypes were obtained and analysed. DNA samples from 250 subjects from the 25 families are currently available for further genotyping and saturation mapping. Our AIS families show absence of linkage to the X chromosome as well as previously reported AIS loci, except for chromosome 9q and 17q as reported by Miller et al. (2005). Preliminary inspection of inherited haplotypes indicates that a number of these families may be segregating with several new AIS loci with LOD scores ranging from 1.0 – 3.63 for various DNA markers on 15 different chromosomes. Linkage evaluation and comprehensive saturation mapping of the two loci with the highest LOD scores of 3.63 and 4.08 for chromosomes 9q and 17q respectively were conducted and these regions were successfully refined. Candidate genes are currently being screened. Conclusion: Preliminary evidence already indicates genetic heterogeneity of AIS. Candidate genes from the highest LOD score regions are at present being screened

Aims

Hip arthroplasty does not always restore normal anatomy. This is due to inaccurate surgery or lack of stem sizes. We evaluated the aptitude of four total hip arthroplasty systems to restore an anatomical and medialized hip rotation centre.