Arthroplasty ; methods ; China ; Hip ; surgery ; Humans ; Knee ; surgery

Objective To determine the therapeutic effect of recombined rat insulin-like growth factory 1 gene and transforming growth factor beta-1(TGF-?_1)gene on anterior cruciate ligament transection(ACLT)- induced osteoarthritis-like changes in NZW rabbit knee joints.Methods Eighteen NZW rabbits were divided into 3 groups randomly after osteoanhritis was established by ACLT and another six rabbits were used as normal control group(group 1).Chondrocytes which had been transfected with IGF-1 gene,co-transfected with TGF-?_1 and IGF-1 gene(group 3,4)were injected into the rabbits knee joints.Experimental control group(group 2)only had ACLT bul was not transfected.After 4,8 weeks,rabbits were sacrificed and their joints were evaluated by morphological grades,histological examination,in situ hybridization examination,immunohistochemistry exami- nation,and transmission electron microscopy examination(TEM).Results The morphological grades showed that the normal control group had a very significant difference with the experimental control group(P

OBJECTIVETo evaluate the amount of blood loss and the efficacy of clotting factor in controlling blood loss during total knee arthroplasty.

METHODSThe medical documents of 18 patients with haemophilic arthritis (HA) secondary to haemophilia A and 19 patients with osteoarthritis (OA) were retrospectively reviewed. Demographic data,functional and hematological test results,the amount of blood loss and transfusion,and complications were analyzed.

RESULTSThe median amounts of total and external blood loss were 2240 ml(1892-3415 ml) and 1326 ml(934-2256 ml)in the HA group, which were significant higher than those in the OA group [1746 ml(1259-2246 ml)and 846 ml (504-1217 ml), respectively]. The median amounts of external blood loss in the two groups were 680 ml(370-1330 ml)and 730 ml(200-1190 ml)and there was no significant difference(p=0.620). Moreover, more patients in the HA group required blood transfusion (84.2% vs. 47.4%), and more red cells were transfused per patient in the HA group (2.3 U vs. 0 U).

CONCLUSIONSThe total blood loss and hidden blood loss are higher in the HA patients than in OA patients during total knee arthroplasty, although the external blood loss is basically the same. Management with more clotting factor may decrease the blood loss in HA patients.

Adolescent ; Adult ; Arthritis ; etiology ; surgery ; Arthroplasty, Replacement, Knee ; Hemophilia A ; complications ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Postoperative Hemorrhage ; Retrospective Studies ; Young Adult

OBJECTIVETo explore the possible effect of transforming growth factor-beta(1) (TGF -beta(1)) on the development of renal fibrosis in human mesengial proliferative glomerulonephritis (MsPGN).

METHODSImmunohistochemistry method, sirius red staining polarization microscopy and the computer imaging analysis system were used to detect the expression of TGF-beta(1), the distribution of collagen I, collagen III and collagen IV.

RESULTIn MsPGN with renal fibrosis, collagen IV was increased markedly,and collagen I and collagen III appeared in the expanded mesengial matrix abnormally. Collagen III and collagen IV were increased markedly in tubulointerstitium. TGF-beta(1) expression was positively correlated with the expression of collagen I, collagen III and collagen IV in tubulointerstitium (r=0.82 0.92,P<0.01), and negatively correlated with I/III, I/IV and III/IV (r=-0.83,-0.92, P<0.001).

CONCLUSIONAbnormal increase of TGF-beta(1) may be one of the important factors associated with glomerular sclerosis and tubulointerstitial fibrosis through the increment and abnormal distribution of collagen I, collagen III and collagen IV.

Collagen ; analysis ; Fibrosis ; Glomerulonephritis, Membranoproliferative ; metabolism ; pathology ; Humans ; Immunohistochemistry ; Kidney ; pathology ; Transforming Growth Factor beta ; analysis ; Transforming Growth Factor beta1

Spinal instrumentation is a common method for the treatment of spinal disorders, but it can lead to the changes of spine biomechanics. Because of the stress changes, accelerated degeneration of the adjacent segment may occur as time goes by, namely adjacent segment disease. The accelerated degeneration can lead to secondary spinal stenosis, articulated joint degeneration, acquired spondylolisthesis, and spine instability, and some patients may have to receive surgery again. In recent years, the researchers gradually recognized the importance of this disease, and began to investigate its pathogenesis and management.
Humans ; Joint Instability ; etiology ; prevention & control ; Postoperative Complications ; diagnosis ; prevention & control ; Spinal Diseases ; surgery ; Spinal Fusion ; adverse effects ; instrumentation ; Spinal Stenosis ; etiology ; prevention & control ; Spondylolisthesis ; etiology ; prevention & control

OBJECTIVETo evaluate the short-term clinical and radiographic results of modular fully porous-coated stem in revision operation of total hip arthroplasty.

METHODSFrom May 2001 to November 2002, ten cases with twelve hips received revision total hip arthroplasty using modular Profemur R with fully porous-coated stem. There were three males and seven females and the average age was 54.2 years (35 to approximately 71 years). The reasons for revision operation included aseptic loosing in eleven hips and septic loosing in one hip. All the patients were evaluated radiographically and clinically. Radiographic evaluation included the classification of bone loss, leg discrepancy, offset and antiversion before and after revision and bone in-growth postoperatively. Clinical evaluation were based on Harris score system.

RESULTSThe average follow-up period is 13.5 months (range: 6 to approximately 24 months). Leg discrepancy from more than 2 cm in six cases were restored to less than 1 cm postoperatively. Femoral offset, antiversion angle and neck-shaft angle were also restored to normal limitation. All the patients were allowed to full weight-bearing 3 to approximately 5 months later and pain relief occurred in all involved hips. At the last follow-up, bone in-growth occurred in eleven hips and solid fibrous fixation only in one case. Harris score was improved from a mean of 25 to 72. Complications mainly consisted of femoral shaft fracture in three cases but no infection or dislocation was found postoperatively.

CONCLUSIONSSatisfactory results of short-term radiographic and clinical follow-up can be achieved using modular fully porous-coated stem for revision total hip arthroplasty.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Bone Cements ; Cementation ; Coated Materials, Biocompatible ; therapeutic use ; Female ; Follow-Up Studies ; Hip Joint ; diagnostic imaging ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Prosthesis Failure ; Radiography ; Reoperation

OBJECTIVETo investigate the methods of restoring normal level of rotation center of the hip and limb length in patients with osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) using total hip arthroplasty (THA).

METHODSFrom January 2000 to January 2003, total hip arthroplasties were performed for 21 patients (26 hips) with OA secondary to DDH. There were 19 females and 2 males with an average age of 51 years (range from 40 to 66 years). Based on radiographic classification of Crowe, there were 12 in type I, 5 in type II, 2 in type III and IV respectively. In addition to the standard procedure of THA, the methods of restoring normal level of rotating center of the hip included structural bone autografting and medialization of the cup. The methods of limb length restoration included carefully preoperative planning and intraoperative soft tissue release. During the follow-up period at 3, 6, 12 months postoperatively and then annually thereafter, rotation center of the hip and limb length were assessed radiographically. Harris score system (HSS) was used for clinical evaluation.

RESULTSAll the patients were followed up for a mean time of 26.4 months (range from 12 to 48 months). All the patients had restoration of the normal level of rotation center of the hip. At the latest follow-up, Harris score was improved from preoperative 35 points (range from 12 to 68 points) to postoperative 94 points (range from 74 to 100 points).

CONCLUSIONIn addition to standard procedure, the restoration of normal level of rotation center of the hip could be achieved by structural bone autografting and medialization of the cup in THA for patients with DDH. Careful preoperative planning and intraoperative soft tissue release could restore limb length.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Female ; Follow-Up Studies ; Hip Dislocation, Congenital ; complications ; surgery ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip ; etiology ; surgery ; Treatment Outcome

OBJECTIVETo assess the influences of continuous femoral nerve block (CFNB) and patient-controlled intravenous analgesia (PCIA) on postoperative pain scores,knee rehabilitation,and stress response after total knee arthroplasty (TKA).

METHODSTotally 32 adult patients scheduled for elective total knee arthroplasty were equally randomized into CFNB group or PCIA group. Intraoperative hemodynamics and fentanyl dose were recorded. Pain was assessed at rest and during continuous passive motion (CPM) using a visual analog scale at post-anesthesia care unit (PACU) and 4, 8, 12, 24, and 48 hours postoperatively. Morphine consumption was also recorded. As indicators of stress and inflammatory response,the leukocyte count, serum lactic acid, blood glucose, serum C-reactive protein (CRP), and serum cortisol were determined on admission, to operation room, immediately after skin incision, before extubation,on post-operation day 1 (POD1), and on POD2.

RESULTSCFNB group showed significantly lower heart rate compared with PCIA group 60 minutes and 90 minutes intraoperatively (Pü0.05). Intraoperative consumption of fentanyl was significantly lower in CFNB group (137.5∓44.4) μg than in PCIA group (264.1∓67.1) μg (Pü0.01). The CFNB group showed significantly lower VAS scores both at rest and during CPM compared with PCIA group at all time points (Pü0.05). Morphine consumption was significantly lower in CFNB group than in PCIA group at different time points (Pü0.05 or Pü0.01). The maximal continuous passive motion amplitude of CFNB group were significantly larger than that of PCIA group on POD1 [(55.0∓9.4) vs.(44.6∓9.9), P[(76.3∓11.0) vs. (67.5∓10.3), P<0.05]. The incidences of somnolence and nausea/vomiting in CFNB group were 37.5% and 37.5%, respectively,which were significantly lower than those of PCIA group (75.0% and 81.3%) (Pü0.05). Patient satisfaction scores on anesthesia and post-operative analgesia was significantly higher in CFNB group than in PCIA group (93.1∓7.9 vs. 79.1∓11.9, respectively) (Pü0.05).

CONCLUSIONAfter TKA,CFNB technique provides more stable intraoperative hemodynamics than PCIA, with better pain relief,faster postoperative knee rehabilitation,less side effects,and higher patient satisfaction.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analgesia, Patient-Controlled ; methods ; Arthroplasty, Replacement, Knee ; Female ; Femoral Nerve ; Humans ; Male ; Middle Aged ; Nerve Block ; methods ; Young Adult

OBJECTIVETo investigate the gene expression and potential functions of transforming growth factor-beta1 in osteophyte development.

METHODSA total of 25 specimens were obtained from individuals undergoing total knee arthroplasty due to severe primary osteoarthritis. Tissue samples were embedded in paraffin wax and made into sections. Hematoxylin and eosin and toluidine blue stainings were performed. The expressions of collagen I, IIa, IIb, and X were detected by immunohistochemistry. Based on the histomorphology of cellularity and matrix abundance, the glycosaminoglycans content, and the differential expressions of collagen I, IIa, IIb, and X, the osteophytic tissues were classified. For each different type of osteophyte, expressions of transforming growth factor-beta1 were detected by immunohistochemistry and in situ hybridization, and results were analyzed using the image analysis system.

RESULTSFive different types of osteophytes were identified as type I, type II, type III, type IV, and type V. Transforming growth factor-beta1 mRNA was more and intensely expressed in chondrocytes of type II and III osteophytes, and was less in other types of osteophytes. The difference was significant (P<0.05, P<0.01).

CONCLUSIONTransforming growth factor-beta1 mRNA is mainly expressed in early-mid stages of osteophytes and may play an important role in promoting the proliferation and differentiation of chondrocytes in the early stages of osteophyte development.

Chondrocytes ; metabolism ; pathology ; Humans ; Osteoarthritis, Knee ; metabolism ; pathology ; Osteophyte ; metabolism ; pathology ; RNA, Messenger ; biosynthesis ; Transforming Growth Factor beta1 ; biosynthesis ; genetics

The human homologue of mouse progressive ankylosis protein(ANKH)is an inorganic pyrophosphate transport regulator,which regulates tissue mineralization by controlling the level of inorganic pyrophosphate.It plays an important role in the pathogenesis and development of bone and joint diseases,such as ankylosing spondylitis,craniometaphyseal dysplasia,and articular cartilage calcification.This review summarizes the progress of research on ANKH and the above-mentioned diseases.
Ankylosis ; Humans ; Hyperostosis ; Hypertelorism ; Joint Diseases ; Mice ; Mutation