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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_7 | Pages 79 - 79
4 Apr 2023
Mao J Ding Y Huang L Wang Q Ding L
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Previous studies showed that telo-peptides degraded from type II collagen, a type of collagen fragments, could induce cartilage damage in bovine stifle joints. We aim to investigate the role of integrins (ITGs) and matrix metalloproteinases (MMPs) in collagen fragment-induced human cartilage damage that is usually observed in osteoarthritis (OA). We hypothesized that N-telopeptide (NT) derived from type II collagen could up-regulate the expression of β1 integrin (ITGB1) and then MMPs that may lead to osteoarthritic cartilage damage.

Human chondrocytes were isolated from femoral head or tibial plateau of patients receiving arthroplasty (N = 24). Primary chondrocyte cultures were either treated with 30 µM NT, or 30 µM scrambled NT (SN), or PBS, or left untreated for 24 hrs. Total proteins and RNAs were extracted for examination of expression of ITGB1 and MMPs-3&13 with Western blotting and quantitative real-time PCR.

Compared to untreated or PBS treated chondrocytes, NT-treated chondrocytes expressed significantly higher levels of ITGB1 and MMPs-3&-13. However, SN also up-regulated expression of ITGB1 and MMP-13.

ITGB1 and MMPs-3&-13 might mediate the catalytic effect of NT, a type of collagen fragments, on human cartilage damage that is a hallmark of OA.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_12 | Pages 19 - 19
1 Dec 2022
Eltit F Wang Q Xu S Satra M Liu D Wang R Charest-Morin R Cox M
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One out of nine Canadian males would suffer prostate cancer (PC) during his lifetime. Life expectancy of males with PC has increased with modern therapy and 90% live >10 years. However, 20% of PC-affected males would develop incurable metastatic diseases. Bone metastases (BM) are present in ~80% of metastatic PC patients, and are the most severe complication of PC, generating severe pain, fractures, spinal cord compression, and death. Interestingly, PC-BMs are mostly osteoblastic. However, the structure of this newly formed bone and how it relates to pain and fracture are unknown. Due to androgen antagonist treatment, different PC phenotypes develop with differential dependency on androgen receptor (AR) signaling: androgen-dependent (AR+), double negative (AR-) and neuroendocrine. How these phenotypes are related to changes in bone structure has not been studied. Here we show a state-of-the-art structural characterization of PCBM and how PC phenotypes are associated to abnormal bone formation in PCBM.

Cadaveric samples (n=14) obtained from metastases of PC in thoracic or lumbar vertebrae (mean age 74yo) were used to analyze bone structure. We used micro-computed tomography (mCT) to analyze the three-dimensional structure of the bone samples. After imaging, the samples were sectioned and one 3mm thick section was embedded in epoxy-resin, ground and polished. Scanning electron microscopy (SEM)/energy-dispersive X-ray spectroscopy (EDS) and quantitative backscattering electron (qBSE) imaging were used to determine mineral morphology and composition. Another section was used for histological analysis of the PC-affected bone. Collagen structure, fibril orientation and extracellular matrix composition were characterized using histochemistry. Additionally, we obtained biopsies of 3 PCBM patients undergoing emergency decompression surgery following vertebral fracture and used them for immunohistological characterization.

By using mCT, we observed three dysmorphic bone patterns: osteolytic pattern with thinned trabecula of otherwise well-organized structures, osteoblastic pattern defined as accumulation of disorganized matrix deposited on pre-existing trabecula, and osteoblastic pattern with minimum residual trabecula and bone space dominated by accumulation of disorganized mineralized matrix. Comparing mCT data with patho/clinical parameters revealed a trend for higher bone density in males with larger PSA increase. Through histological sections, we observed that PC-affected bone, lacks collagen alignment structure, have a higher number of lacunae and increased amount of proteoglycans as decorin.

Immunohistochemistry of biopsies revealed that PC-cells inside bone organize into two manners: i) glandular-like structures where cells maintain their polarization in the expression of prostate markers, ii) diffuse infiltrate that spreads along bone surfaces, with loss of cell polarity. These cells take direct contact with osteoblasts in the surface of trabecula. We define that PCBM are mostly composed by AR+ with some double negative cells. We did not observe neuroendocrine phenotype cells.

PCBMs generate predominantly osteoblastic lesions that are characterized by high lacunar density, lack of collagen organization and elevated proteoglycan content. These structural changes are associated with the infiltration of PC cells that are mostly androgen-dependent but have lost their polarization and contact directly with osteoblasts, perhaps altering their function. These changes could be associated with lower mechanical properties that led to fracture and weakness of the PCBM affected bone.


Bone & Joint Research
Vol. 11, Issue 7 | Pages 513 - 513
22 Jul 2022
Fang X Wang Q Yang X Zhang F Huang C Huang Z Shen H Zhang W


Bone & Joint Research
Vol. 11, Issue 4 | Pages 251 - 251
30 Apr 2022
Wang X Wang D Xia P Cheng K Wang Q Wang X Lin Q Song J Chen A Li X


The Bone & Joint Journal
Vol. 104-B, Issue 2 | Pages 193 - 199
1 Feb 2022
Wang Q Wang H A G Xiao T Kang P

Aims

This study aimed to use intraoperative free electromyography to examine how the placement of a retractor at different positions along the anterior acetabular wall may affect the femoral nerve during total hip arthroplasty (THA) when undertaken using the direct anterior approach (THA-DAA).

Methods

Intraoperative free electromyography was performed during primary THA-DAA in 82 patients (94 hips). The highest position of the anterior acetabular wall was defined as the “12 o’clock” position (middle position) when the patient was in supine position. After exposure of the acetabulum, a retractor was sequentially placed at the ten, 11, 12, one, and two o’clock positions (right hip; from superior to inferior positions). Action potentials in the femoral nerve were monitored with each placement, and the incidence of positive reactions (defined as explosive, frequent, or continuous action potentials, indicating that the nerve was being compressed) were recorded as the primary outcome. Secondary outcomes included the incidence of positive reactions caused by removing the femoral head, and by placing a retractor during femoral exposure; and the incidence of femoral nerve palsy, as detected using manual testing of the strength of the quadriceps muscle.


Bone & Joint Research
Vol. 10, Issue 12 | Pages 790 - 796
1 Dec 2021
Fang X Wang Q Yang X Zhang F Huang C Huang Z Shen H Zhang W

Aims

To explore the effect of different durations of antibiotics after stage II reimplantation on the prognosis of two-stage revision for chronic periprosthetic joint infection (PJI).

Methods

This study involved a retrospective collection of patients who underwent two-stage revision for chronic PJI and continued to use extended antibiotic prophylaxis in two regional medical centres from January 2010 to June 2018. The patients were divided into a short (≤ one month) or a long (> one month) course of treatment based on the duration of antibiotics following stage II reimplantation. The difference in the infection control rate between the two groups was compared, and prognostic factors for recurrence were analyzed.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 62 - 62
1 Dec 2021
Wang Q Goswami K Xu C Tan T Clarkson S Parvizi J
Full Access

Aim

Whether laminar airflow (LAF) in the operating room (OR) is effective for decreasing periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) remains a clinically significant yet controversial issue. This study investigated the association between operating room ventilation systems and the risk of PJI in TJA patients.

Method

We performed a retrospective observational study on consecutive patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) from January 2013-September 2017 in two surgical facilities within a single institution, with a minimum 1-year follow-up. All procedures were performed by five board-certified arthroplasty surgeons. The operating rooms at the facilities were equipped with LAF and turbulent ventilation systems, respectively. Patient characteristics were extracted from clinical records. PJI was defined according to Musculoskeletal Infection Society criteria within 1-year of the index arthroplasty. A multivariate logistic regression model was performed to explore the association between LAF and risk of 1-year PJI, and then a sensitivity analysis using propensity score matching (PSM) was performed to further validate the findings.


Bone & Joint Research
Vol. 10, Issue 10 | Pages 693 - 703
1 Oct 2021
Wang X Wang D Xia P Cheng K Wang Q Wang X Lin Q Song J Chen A Li X

Aims

To evaluate the effect of ultrasound-targeted simvastatin-loaded microbubble destruction (UTMDSV) for alleviation of the progression of osteoarthritis (OA) in rabbits through modulation of the peroxisome proliferator-activated receptor (PPARγ).

Methods

In vitro, OA chondrocytes were treated with ultrasound (US), US-targeted microbubble destruction (UTMD), simvastatin (SV), and UTMDSV on alternate days for four weeks. Chondrocytes were also treated with PPARγ inhibitor, PPARγ inhibitor+ UTMDSV, and UTMDSV. The cholesterol efflux rate and triglyceride levels were measured using an assay kit and oil red O staining, respectively. In vivo, the OA rabbits were treated with a single intra-articular injection of UTMD, SV, and UTMDSV every seven days for four weeks. Cartilage histopathology was assessed by safranin-O staining and the Mankin score. Total cholesterol (TC) and high-density lipoprotein-cholesterol (HDL-C) in rabbit knee synovial fluid were detected by enzyme-marker assay. Aggrecan, collagen II, and PPARγ expression levels were analyzed by Western blotting (WB).


Bone & Joint Research
Vol. 10, Issue 8 | Pages 474 - 487
2 Aug 2021
Duan M Wang Q Liu Y Xie J

Transforming growth factor-beta2 (TGF-β2) is recognized as a versatile cytokine that plays a vital role in regulation of joint development, homeostasis, and diseases, but its role as a biological mechanism is understood far less than that of its counterpart, TGF-β1. Cartilage as a load-resisting structure in vertebrates however displays a fragile performance when any tissue disturbance occurs, due to its lack of blood vessels, nerves, and lymphatics. Recent reports have indicated that TGF-β2 is involved in the physiological processes of chondrocytes such as proliferation, differentiation, migration, and apoptosis, and the pathological progress of cartilage such as osteoarthritis (OA) and rheumatoid arthritis (RA). TGF-β2 also shows its potent capacity in the repair of cartilage defects by recruiting autologous mesenchymal stem cells and promoting secretion of other growth factor clusters. In addition, some pioneering studies have already considered it as a potential target in the treatment of OA and RA. This article aims to summarize the current progress of TGF-β2 in cartilage development and diseases, which might provide new cues for remodelling of cartilage defect and intervention of cartilage diseases.


The Bone & Joint Journal
Vol. 103-B, Issue 5 | Pages 923 - 930
1 May 2021
He R Wang Q Wang J Tang J Shen H Zhang X

Aims

As a proven and comprehensive molecular technique, metagenomic next-generation sequencing (mNGS) has shown its potential in the diagnosis of pathogens in patients with periprosthetic joint infection (PJI), using a single type of specimen. However, the optimal use of mNGS in the management of PJI has not been explored. In this study, we evaluated the diagnostic value of mNGS using three types of specimen with the aim of achieving a better choice of specimen for mNGS in these patients.

Methods

In this prospective study, 177 specimens were collected from 59 revision arthroplasties, including periprosthetic tissues, synovial fluid, and prosthetic sonicate fluid. Each specimen was divided into two, one for mNGS and one for culture. The criteria of the Musculoskeletal Infection Society were used to define PJI (40 cases) and aseptic failure (19 cases).


The Bone & Joint Journal
Vol. 102-B, Issue 12 | Pages 1629 - 1635
1 Dec 2020
Wang Q Sheng N Rui B Chen Y

Aims

The aim of this study was to explore why some calcar screws are malpositioned when a proximal humeral fracture is treated by internal fixation with a locking plate, and to identify risk factors for this phenomenon. Some suggestions can be made of ways to avoid this error.

Methods

We retrospectively identified all proximal humeral fractures treated in our institution between October 2016 and October 2018 using the hospital information system. The patients’ medical and radiological data were collected, and we divided potential risk factors into two groups: preoperative factors and intraoperative factors. Preoperative factors included age, sex, height, weight, body mass index, proximal humeral bone mineral density, type of fracture, the condition of the medial hinge, and medial metaphyseal head extension. Intraoperative factors included the grade of surgeon, neck-shaft angle after reduction, humeral head height, restoration of medial support, and quality of reduction. Adjusted binary logistic regression and multivariate logistic regression models were used to identify pre- and intraoperative risk factors. Area under the curve (AUC) analysis was used to evaluate the discriminative ability of the multivariable model.


Bone & Joint Research
Vol. 8, Issue 11 | Pages 526 - 534
1 Nov 2019
Yang C Wang J Yin Z Wang Q Zhang X Jiang Y Shen H

Objectives

The optimal protocol for antibiotic loading in the articulating cement spacers for the treatment of prosthetic joint infection (PJI) remains controversial. The objective of the present study was to investigate the effectiveness of articulating cement spacers loaded with a new combination of antibiotics.

Methods

A retrospective cohort study involving 114 PJI cases treated with implantation of an articulating cement spacer between 2005 and 2016 was performed. The treatment outcomes of the conventional protocol (i.e. gentamicin and vancomycin (GV protocol)) were compared with those reported using the sophisticated antibiotic-loading protocol (i.e. vancomycin, meropenem, and amphotericin (VMA protocol)).


Bone & Joint Research
Vol. 8, Issue 11 | Pages 526 - 534
1 Nov 2019
Yang C Wang J Yin Z Wang Q Zhang X Jiang Y Shen H

Objectives

The optimal protocol for antibiotic loading in the articulating cement spacers for the treatment of prosthetic joint infection (PJI) remains controversial. The objective of the present study was to investigate the effectiveness of articulating cement spacers loaded with a new combination of antibiotics.

Methods

A retrospective cohort study involving 114 PJI cases treated with implantation of an articulating cement spacer between 2005 and 2016 was performed. The treatment outcomes of the conventional protocol (i.e. gentamicin and vancomycin (GV protocol)) were compared with those reported using the sophisticated antibiotic-loading protocol (i.e. vancomycin, meropenem, and amphotericin (VMA protocol)).


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_20 | Pages 20 - 20
1 Dec 2017
Xu L Chen X Wang H Wang F Wang Q
Full Access

Over the past decades, computer-aided navigation system has experienced tremendous development for minimising the risks and improving the precision of the surgery. Nowadays, some commercially-available and self-developed surgical navigation systems have already been tested and proved successfully for clinical applications. However, all of these systems use computer screen to render the navigation information such as the real-time position and orientation of the surgical instrument, virtual path of preoperative surgical planning, so that the surgeons have to switch between the actual operation site and computer screen which is inconvenient and impact the continuity of surgery. In recent years, Augmented Reality (AR)- based surgical navigation is a promising technology for clinical applications. In the AR system, virtual and actual reality are mixed, offering real-time, high-quality visualisation of an extensive variety of information to the users.

Therefore, in this study, a pilot study of a surgical navigation system for orthopaedics based on optical see-through augmented reality (AR-SNS) is presented, which encompasses the preoperative surgical planning, calibration, registration, and intra-operative tracking. With the aid of AR-SNS, the surgeon wearing the optical see-through head-mounted display can obtain a fused image that the 3D virtual critical anatomical structures are aligned with the actual structures of patient in intra-operative real-world scenario, so that some disadvantages of the traditional surgical navigation are overcome (For example, surgeon is no longer obliged to switch between the real operation scenario and computer screen), and the safety, accuracy, and reliability of the surgery may be improved.


Bone & Joint Research
Vol. 6, Issue 9 | Pages 566 - 571
1 Sep 2017
Cheng T Zhang X Hu J Li B Wang Q

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.

Methods

A retrospective observational study of pre-operative screening for BBPs, including hepatitis B and C viruses (HBV and HCV), human immunodeficiency virus (HIV) and Treponema pallidum (TP), was conducted for sequential patients in the orthopaedic department of a large urban teaching hospital between 01 January 2009 and 30 May 2016. Medical records were analysed to verify the seroprevalence of these BBPs among the patients stratified by age, gender, local origin, type of surgery, history of previous transfusion and marital status.


The Bone & Joint Journal
Vol. 99-B, Issue 7 | Pages 872 - 879
1 Jul 2017
Li Y Zhang X Wang Q Peng X Wang Q Jiang Y Chen Y

Aims

There is no consensus about the best method of achieving equal leg lengths at total hip arthroplasty (THA) in patients with Crowe type-IV developmental dysplasia of the hip (DDH). We reviewed our experience of a consecutive series of patients who underwent THA for this indication.

Patients and Methods

We retrospectively reviewed 78 patients (86 THAs) with Crowe type-IV DDH, including 64 women and 14 men, with a minimum follow-up of two years. The mean age at the time of surgery was 52.2 years (34 to 82). We subdivided Crowe type-IV DDH into two major types according to the number of dislocated hips, and further categorised them into three groups according to the occurrence of pelvic obliquity or spinal curvature. Leg length discrepancy (LLD) and functional scores were analysed.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 6 | Pages 768 - 773
1 Jun 2012
Wang Q Zhang XL Chen YS Shen H Shao JJ

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.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 410 - 410
1 Nov 2011
Wu J Wang Q Khan I
Full Access

Orthopaedic grade ultra-high molecular weight polyethylene (UHMWPE) remains the preferred material for one of the bearing surfaces in total joint prostheses because of its high wear resistance and proven biocompatibility. Since the 1970s, UHMWPE has served as the only widely used bearing material for articulation with metallic components in total knee arthroplasty (TKA). However, polyethylene-related total knee failures have limited the lifetime of total knee joint replacements. The present study is focused on improving material integrity and reducing the probability of material failure. The hypothesis examined here is that there is a correlation between material failure of UHMWPE knee-joint components and the precise time-temperature history employed during fabrication, due to their strong effect on interparticle cohesion. The presence of fusion defects due to incomplete consolidation and incomplete polymer self-diffusion has been implicated in the failure of UHMWPE joints [1, 2]. Computer-aided methodology used in this study allowed quantitative prediction and optimisation of the extent of interparticle cohesion to ensure that inter-particle boundaries are of high integrity during moulding [3]. The current study has investigated the correlation between inter-particle cohesion governed by reputation theory and wear performance.

We have investigated the wear performance of direct compression moulded UHMWPE plates with different degree of inter-particle diffusion. Direct compression moulding was used in the present study because of its uniformly excellent surface finish which is better than machined surfaces. UHMWPE plates (44×24×3mm) were direct compression moulded using GUR1050 powder (Ticona). Various moulding temperature (e.g. 145°C, 150°C, 175°C) and dwell time (e.g. 15mins and 30mins) were investigated.

The wear tests were carried out at 37°C using a Durham four-station multidirectional pin-onplate machine, which generates both reciprocating and rotating motions simultaneously. The material combination of the flat-ended metallic indentors loaded against UHMWPE plates was constructed to mimic conformal contact conditions in knee prostheses. The articulating surfaces were lubricated using 25% diluted bovine serum. Meanwhile the experimental method was validated by evaluating the wear generation under the conventional configuration (i.e. UHMWPE pins on metal plates); results were comparable with the data in the literature [4].

For the direct compression moulded UHMWPE plates, experimental wear factors were determined and found to correlate well with numerically calculated degree of inter-particle diffusion. Increasing moulding temperature and dwell time decreased the wear factors and increased inter-particle diffusion. Surface structures were characterised before and after every 0.5 million cycles. The observed surface features on UHMWPE plates in ESEM and optical microscopy is very similar to those in retrieved knee prostheses [5] and those found in our own recent work with knee wear simulator testing.