Objective To observe the clinical outcomes of the surgical management of periprosthetic femoral fractures following hip arthroplasty.Methods Twelve consecutive patients (6 male and 6 female) with the average age of 66.4± 15.0 years old (35 to 86 years old) undergoing surgical operation for periprosthetic femoral fractures between September 2009 and May 2016 were followed up at our center.Nine cases were fractured secondary to the primary hip arthroplasty while the others were patients with earlier revision surgery.The previous fixations of femoral components of 10 cases were cementless while the other two were cemented fixation.The enrolled patients were determined as Vancouver type B 1 (n=2),type B2 (n=7),type B3 (n=1) and type C (n=2) respectively.The occurrences of the fractures were observed at 3 weeks to 17 years post-operation (average 9.0±7.0 years).The patients were treated individually according to different Vancouver types.Type B 1 patients received simple cerclage fixation,as well as revisions with long-stem femoral implants and cerclage band were chosen for type B2 patients.In addition to the treatment for type B2 patients,allogenic cortical bone graft was also required for type B3 patients.Open reduction with locking plate internal fixations were options for patients with Vancouver type C fractures.The following-up included the X-ray images of the hips,Harris hip score and the visual analogue scale (VAS) for the pain of fracture site.The unions of the fractures were determined by both X-ray images and pain intensity of the fracture sites.Results The mean follow-up period was 41.6±26.0 months (range,12-92 months),without patient lost to follow up.VAS scores were 0,implying the clinical union of the fractures.One patients received multiple debridement post-operatively due to the periprosthetic infection.The VAS score of this patient was 6 at the follow up and the X-ray image indicated the nonunion of the fracture.The fracture union rate was 91.7％ (11/12).The Harris hip score was 23-92 (mean score,74.8±18.8),excellent for 2 cases,good for 6 cases,fair for 3 cases and poor for 1 case.The excellent and good rate was 66.7％ (8/12).Post-operative complications were observed in 4 patients (33.3％,4/12).One drainage tube was misplaced and sutured subcutaneously required a further exploration surgery.One periprosthetic infection occurring post-operatively induced the nonunion of the fracture.Aseptic loosing of femoral stem was observed in 2 cases and subsequent revision surgeries were conducted.Conclusion High incidence of complications is observed after the surgical treatment of periprosthetic femoral fractures following hip arthroplasty.Individually customized management regarding to the Vancouver type of periprosthetic femoral fractures leads to the clinical fracture union in 91.7％ of the patients in this case series.The excellent and good rate of the hip function in the early and mid-term stage after operation is 66.7％.

Knee osteoarthritis (KOA) is the main cause of knee pain and disability in the elderly. KOA is a complex disease that is controlled by a variety of pathogenic factors, including general physical factors such as age, gender, obesity, family history, and mechanical factors, and unfavorable mechanical factors to the knee joint, such as trauma, sports injuries, and daily routines. The prevalence of KOA is related to genetic factors. Currently, conservative treatment has limited effects to this disease, and knee joint replacement is usually associated with many complications. Mesenchymal stem cells(MSCs) were first discovered in the bone marrow and subsequently found in peripheral blood, cord blood, skeletal muscle, heart and adipose tissue, which have high plasticity and pluripotency. The discovery of MSCs provides a new method for the treatment of KOA. Due to its powerful cartilage repair and regeneration function, researchers have conducted a large number of experimental studies on the efficacy, safety and mechanism of MSCs in the treatment of KOA in recent years. In this paper, the above studies presented were systematically reviewed.

Objective:To culture UC-MSCs with 3D TableTrix TM stem cell microcarrier and further evaluate the effects on cartilage defect of knee joint in rabbit model. Methods:UC-MSCs were cultured in 3D TableTrix TM system for 7 d. The cell viability was evaluated and characteristics of UC-MSCs were identified. The safety of 3D 3D TableTrix TM system was further evaluated by subcutaneous implantation in nude mice. Twelve New Zealand white rabbits were randomly divided into control group and experimental group. The experimental group was placed in 3D TableTrix TM with UC-MSCs. At 3 and 6 months after the operation, the samples were taken for general observation, HE, toluidine blue, Masson staining for comparative observation. According to the International Cartilage Repair Society (ICRs), general evaluation and histological score was evaluated quantitatively. Results:The UC-MSCs survived well in 3D TableTrix TM system. There was no dead cell with dead/live staining after 7 d culture. UC-MSCs proliferated in 3D TableTrix TM system. After digestion, the UC-MSCs were identified to maintain the characteristics of MSCs. After 28 d of subcutaneous implantation in nude mice, agglomerations were formed and covered with fibrous membrane. HE staining showed that the 3D TableTrix TM scaffold structure was complete and neovascularized. In vivo study, 3D TableTrix TM was used to fill the cartilage defect. At 3 and 6 months after operation, the effects on cartilage repair in the experimental group was better than that in the control group. The overall score of ICRS (3 month, 8.50±0.58 vs 4.50±0.58; 6 months, 11.25±0.96 vs 8.75±0.50, P<0.05) and histological score of the experimental group were higher than that of the control group (3 month, 11.00±2.16 vs 5.25±0.50; 6 month 17.00±0.82 vs 11.25±0.96, P<0.05). Conclusions:3D TableTrix TM microcarrier provides an ideal microenvironment for stem cell culture, and that can be used in the treatment of cartilage defects.

Objective To investigate the species distribution characteristics of nontuberculous mycobacteria(NTM)in acquired immunodeficiency syndrome(AIDS)patients in Shanghai,and to provide evidences for clinical treatment.Methods A total of 775 Mycobacteria strains were isolated from patients(including 129 isolates from AIDS patients and 646 isolates from HIV-negative patients)admitted to Shanghai Public Health Clinical Center during 2015.All the species were identified by the sequence analysis of 16S rRNA gene and hsp65 gene.Differences in the species distribution were compared between patients with and without HIV infection.CD4+T lymphocyte count was detected by flow cytometry and its relation with mycobacteria infection was also analyzed.Chi-square test was used for comparison between groups.Results The ratio of NTM isolation from HIV-negative patients was 15.79%(102/646),while that was 46.51% in AIDS patients(60/129),and the difference was statistically significant(x2=61.38,P <0.01).Among the 60 NTM strains isolated from AIDS patients,mycobacterium avium-intracelluare complex(MAC)and Mycobacterium gordonae were the predominant species(43.33% and 20.00%,respectively).Moreover,five Mycobacterium colombiense strains,which were relatively rare,were also obtained.A total of 102 NTM were identified from HIV-negative patients,of which Mycobacterium gordonae(32 isolates,31.37%)and MAC(30 isolates,29.41%)were the most frequently isolated.In addition,the positive rates of NTM and MAC were significantly higher in patients with CD4+T lymphocyte counts ≤50 cells/μL(58.33% and 76.92%,respectively)than those with CD4+T lymphocyte counts>50 cells/μL(20.00% and 15.38%,respectively)(x2=4.048 and 6.524,respectively,both P<0.05).Four out of five Mycobacterium colombiense infected patients died of disseminated infections,except the remaining one whose CD4+T lymphocyte counts>50 cells/μL.Conclusions The prevalence of NTM isolation is significant higher in AIDS patients than HIV-negative patients in Shanghai,and the most prevalent NTM species is MAC.The NTM infection in AIDS patients is related with low CD4+T lymphocyte counts.

Objective To evaluate the efficacy of high tibial osteotomy(HTO) and unicompartmental knee arthroplasty(UKA) for knee unicompartmental osteoarthrits(KOA) using Meta analysis. Methods The controlled clinical trial literatures of HTO and UKA treating KOA were retrieved, the database including Chinese Biomedical Literature Database, Wanfang Data, CNKI, VIP Data, PubMed, Cochrane Library, EBSCO and Embase, and the search period was limited to the beginning of the database to July 2018. The literature was screened and evaluated, and Review Manager 5.3 software was used for Meta analysis. Results A total of 19 articles including 1359 knee joints were included. Meta analysis results showed that HTO was superior to UKA in range of motion (ROM) (P<0.05). For the indicators, including excellent rate, Lysholm score, visual analogue scale (VAS) score, complications, repair rate, blood loss, length of stay, ambulation time, Hospital for Special Surgery (HSS) score and femorotibial angle (FTA), UKA was superior to HTO (all P<0.05). There was no significant difference in the repair rate between open wedge HTO (OWHTO) and UKA in the sub-group analysis. There were no significant differences in the operation time and Tegner exercise score between HTO and UKA ( all P>0 . 05 ) . Conclusions Both HTO and UKA have their own advantages and disadvantages. It is necessary to properly choose the operation according to the patient's condition and psychological expectation.

Objective:To investigate the orthopedists' cognition on Chinese Osteoarthritis Guideline (2018 Edition).Methods:Questionnaire about Chinese Osteoarthritis Guideline (2018 Edition) was developed and sent to orthopedists via an invitation link to fill out after authorization from Chinese Osteoarthritis Association. The content of the questionnaire included the basic personal information of the physician, the awareness rate of the guidelines, the evaluation of the guidelines, and its application effects. The survey duration was from September 2019 to December 2019. Multivariate logistic regression and linear regression analysis were performed for the guideline awareness rate and comprehensive score, respectively.Results:A total of 628 physicians completed the questionnaire, of which 623 of 628 (99.2%) were available. About 72.4% of the orthopedists knew the guideline. The awareness rate was statistically related to the education of the physicians ( P<0.05). Respondents' overall score for the guideline was 8.39 with methodological score 8.28. A total of 41.2% of orthopedists thought that the guideline was very good compared with the European and American guidelines, and the clinical problem coverage rate was 78.6%. There is a statistically significant difference in the appraisal of the recommendations ( χ2=138.9, P<0.05) . More than 40% of orthopedists believed that the guidelines were of great help to orthopedists and patients, and that the guide could be promoted to the primary hospitals. Conclusion:After one year publication of Chinese Osteoarthritis Guideline (2018 Edition), most orthopedists have understood the present guideline and applied recommendations in clinical practice. However, the guideline need to be further promoted and disseminated in the future.