To assess
Osteoarthritis (OA) is characterized by persistent destruction of articular cartilage. It has been found that microRNAs (miRNAs) are closely related to the occurrence and development of OA. The purpose of the present study was to investigate the mechanism of miR-486 in the development and progression of OA. The expression levels of miR-486 in cartilage were determined by quantitative real-time polymerase chain reaction (qRT-PCR). The expression of collagen, type II, alpha 1 (COL2A1), aggrecan (ACAN), matrix metalloproteinase (MMP)-13, and a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS4) in SW1353 cells at both messenger RNA (mRNA) and protein levels was determined by qRT-PCR, western blot, and enzyme-linked immunosorbent assay (ELISA). Double luciferase reporter gene assay, qRT-PCR, and western blot assay were used to determine whether silencing information regulator 6 (SIRT6) was involved in miR-486 induction of chondrocyte-like cells to a more catabolic phenotype.Aims
Methods
Acetabular edge-loading was a cause of increased wear rates in metal-on-metal hip arthroplasties, ultimately contributing to their failure. Although such wear patterns have been regularly reported in retrieval analyses, this study aimed to determine their in vivo location and investigate their relationship with acetabular component positioning. 3D CT imaging was combined with a recently validated method of mapping bearing surface wear in retrieved hip implants. The asymmetrical stabilizing fins of Birmingham hip replacements (BHRs) allowed the co-registration of their acetabular wear maps and their computational models, segmented from CT scans. The in vivo location of edge-wear was measured within a standardized coordinate system, defined using the anterior pelvic plane.Aims
Methods
We report the outcomes of 20 patients (12 men,
8 women, 21 feet) with Charcot neuro-arthropathy who underwent correction
of deformities of the ankle and hindfoot using retrograde intramedullary
nail arthrodesis. The mean age of the patients was 62.6 years (46
to 83); their mean BMI was 32.7 (15 to 47) and their median American
Society of Anaesthetists score was 3 (2 to 4). All presented with
severe deformities and 15 had chronic ulceration. All were treated
with reconstructive surgery and seven underwent simultaneous midfoot
fusion using a bolt, locking plate or a combination of both. At
a mean follow-up of 26 months (8 to 54), limb salvage was achieved
in all patients and 12 patients (80%) with ulceration achieved healing
and all but one patient regained independent mobilisation. There was
failure of fixation with a broken nail requiring revision surgery
in one patient.
Radiostereometric analysis (RSA) can detect early
micromovement in unstable implant designs which are likely subsequently
to have a high failure rate. In 2010, the Articular Surface Replacement
(ASR) was withdrawn because of a high failure rate. In 19 ASR femoral
components, the mean micromovement over the first two years after implantation
was 0.107 mm (. sd. 0.513) laterally, 0.055 mm (. sd. 0.204)
distally and 0.150 mm (. sd. 0.413) anteriorly. The mean backward
tilt around the x-axis was -0.08° (. sd. 1.088), mean internal
rotation was 0.165° (. sd. 0.924) and mean varus tilt 0.238°
(. sd. 0.420). The baseline to two-year varus tilt was statistically
significant from zero movement, but there was no significant movement
from one year onwards. We conclude that the ASR femoral component achieves initial stability
and that early
The Birmingham hip resurfacing (BHR) arthroplasty is a metal-on-metal prosthesis for which no medium- or long-term results have been published. Despite this, it is increasing in popularity as an alternative to stemmed prostheses for younger patients. Since the fixation of the socket is conventional, the major concern is long-term failure of the femoral component. This can be predicted by the use of roentgen stereophotogrammetric analysis (RSA). We have therefore undertaken such a study of the BHR femoral component over a period of two years. Twenty patients (22 hips) underwent a standard BHR procedure.
To establish our early clinical results of a new total knee arthroplasty (TKA) tibial component introduced in 2013 and compare it to other designs in use at our hospital during the same period. This is a retrospective study of 166 (154 patients) consecutive cemented, fixed bearing, posterior-stabilized (PS) TKAs (ATTUNE) at one hospital performed by five surgeons. These were compared with a reference cohort of 511 knees (470 patients) of other designs (seven manufacturers) performed at the same hospital by the same surgeons. There were no significant differences in age, sex, BMI, or follow-up times between the two cohorts. The primary outcome was revision performed or pending.Aims
Methods
Cementless knee arthroplasty has seen a recent resurgence in popularity due to conceptual advantages, including improved osseointegration providing biological fixation, increased surgical efficiency, and reduced systemic complications associated with cement impaction and wear from cement debris. Increasingly younger and higher demand patients are requiring knee arthroplasty, and as such, there is optimism cementless fixation may improve implant survivorship and functional outcomes. Compared to cemented implants, the National Joint Registry (NJR) currently reports higher revision rates in cementless total knee arthroplasty (TKA), but lower in unicompartmental knee arthroplasty (UKA). However, recent studies are beginning to show excellent outcomes with cementless implants, particularly with UKA which has shown superior performance to cemented varieties. Cementless TKA has yet to show long-term benefit, and currently performs equivalently to cemented in short- to medium-term cohort studies. However, with novel concepts including 3D-printed coatings, robotic-assisted surgery, radiostereometric analysis, and kinematic or functional knee alignment principles, it is hoped they may help improve the outcomes of cementless TKA in the long-term. In addition, though cementless implant costs remain higher due to novel implant coatings, it is speculated cost-effectiveness can be achieved through greater surgical efficiency and potential reduction in revision costs. There is paucity of level one data on long-term outcomes between fixation methods and the cost-effectiveness of modern cementless knee arthroplasty. This review explores recent literature on cementless knee arthroplasty, with regards to clinical outcomes, implant survivorship, complications, and cost-effectiveness; providing a concise update to assist clinicians on implant choice. Cite this article:
There are several techniques for the accurate measurement of the
Twenty patients were examined by standard radiography and roentgen stereophotogrammetric analysis (RSA) during a two-year period after total hip arthroplasty. Eleven of the acetabular components migrated cranially and three femoral components migrated distally. This
Using dried bones which could be tilted and rotated, we assessed the accuracy of published radiographic methods for measuring the
A growing number of fractures progress to delayed or nonunion, causing significant morbidity and socioeconomic impact. Localized delivery of stem cells and subcutaneous parathyroid hormone (PTH) has been shown individually to accelerate bony regeneration. This study aimed to combine the therapies with the aim of upregulating fracture healing. A 1.5 mm femoral osteotomy (delayed union model) was created in 48 female juvenile Wistar rats, aged six to nine months, and stabilized using an external fixator. At day 0, animals were treated with intrafracture injections of 1 × 106 cells/kg bone marrow mesenchymal stem cells (MSCs) suspended in fibrin, daily subcutaneous injections of high (100 μg/kg) or low (25 μg/kg) dose PTH 1-34, or a combination of PTH and MSCs. A group with an empty gap served as a control. Five weeks post-surgery, the femur was excised for radiological, histomorphometric, micro-CT, and mechanical analysis.Aims
Methods
We report the long-term results of revision total
hip replacement using femoral impaction allografting with both uncemented
and cemented Freeman femoral components. A standard design of component
was used in both groups, with additional proximal hydroxyapatite
coating in the uncemented group. A total of 33 hips in 30 patients received
an uncemented component and 31 hips in 30 patients a cemented component.
The mean follow-up was 9.8 years (2 to 17) in the uncemented group
and 6.2 years (1 to 11) in the cemented group. Revision procedures
(for all causes) were required in four patients (four hips) in the
uncemented group and in five patients (five hips) in the cemented
group. Harris hip scores improved significantly in both groups and
were maintained independently of the extent of any
We report the long-term radiological results of 58 total hip arthroplasties (THA) using the Charnley offset-bore acetabular socket. Wear was measured at four sites and radiolucent lines and possible
This study assesses patient barriers to successful telemedicine care in orthopaedic practices in a large academic practice in the COVID-19 era. In all, 381 patients scheduled for telemedicine visits with three orthopaedic surgeons in a large academic practice from 1 April 2020 to 12 June 2020 were asked to participate in a telephone survey using a standardized Institutional Review Board-approved script. An unsuccessful telemedicine visit was defined as patient-reported difficulty of use or reported dissatisfaction with teleconferencing. Patient barriers were defined as explicitly reported barriers of unsatisfactory visit using a process-based satisfaction metric. Statistical analyses were conducted using analysis of variances (ANOVAs), ranked ANOVAs, post-hoc pairwise testing, and chi-squared independent analysis with 95% confidence interval.Aims
Methods
We investigated the radiographic and clinical course of 31 patients in whom a bulk acetabular allograft had been used during the cementless revision of a total hip replacement. Two patients died and two were lost to follow-up within 24 months, but of the remaining 27 acetabular components, 12 (44%) showed radiographic evidence of instability at a mean of 46 months. Five of these have been revised. In the 12 failures, signs of instability had been noted at an average of 29 months (1 to 60). Failures during the first 24 months were usually due to technical errors, later failures to gradual
There are few reports describing the technique
of managing acetabular protrusio in primary total hip replacement. Most
are small series with different methods of addressing the challenges
of significant medial and proximal
Progressive retroversion of a cemented stem is
predictive of early loosening and failure. We assessed the relationship
between direct post-operative stem anteversion, measured with CT,
and the resulting rotational stability, measured with repeated radiostereometric
analysis over ten years. The study comprised 60 cemented total hip
replacements using one of two types of matt collared stem with a
rounded cross-section. The patients were divided into three groups
depending on their measured post-operative anteversion (<
10°,
10° to 25°, >
25°). There was a strong correlation between direct
post-operative anteversion and later posterior rotation. At one
year the <
10° group showed significantly more progressive retroversion
together with distal