BACKGROUND:Skin preparation before surgery has been described as a preventive measure for reducing infections following total knee arthroplasty.OBJECTIVE:To investigate the prophylactic effect of skin preparation on the infections after total knee arthroplasty.METHODS:A total of 422 patients (493 knees) who were candidate for primary total knee arthroplasty,including 98 males and 327 females.They were from 40 years old to 84 years old,averaging 60 years old.According to the different ways of preoperative skin preparation,the patients were divided into 3 groups,razor skin preparation group (n=290 patients,331 knees),dehairing agent skin preparation group (n=74 patients,88 knees),and skin cleaning on the surgical morning group (n=61 patients,74 knees);the limb infections after replacement were observed.RESULTS AND CONCLUSION:All patients were followed up for 0.5-5.5 years,with an average of 3.9 years.The infection incidence after total knee arthroplasty in the razor skin preparation group,dehairing agent skin preparation group,skin cleaning on the surgical morning group were 1.81%,2.27%,1.35%,respectively.It is indicated that there is no significant difference in the infection rate of skin preparation by different methods following total knee arthroplasty.

Objective To find out the character of the its strain distribution. Methods We use five fresh cadaver sacroiliac joints of male adults. We fixed the samples in the CT. We chose the same point of the joints and measure the CT values . Result The bone CT values of the sacroiliac joints and the same slide distributes in a curve from the anterior of the joint to the posterior. Conclusion The density of the bones are directly related with the strains. So the strain distribution on the sacroiliac joint surface is similar to the CT value distribution. This is similar to the result we get with tri- dimentional finite elements study of the sacroiliac joint.

Objective To detect fat emboli in cardiac chamber of the patients undergoing total knee arthroplasty(TKA) by transesophageal echocardiography(TEE), and to discuss the relevant clinical value.Methods Eleven female patients with 12 osteoarthritis(OA) knees were underwent TKA. According to whether using tourniquet or not,12 knees were divided into 2 groups at random:tourniquet-related group (6 knees) and control group(6 knees). Echo intensity and ultrasonic characteristics of fat emboli in cardiac chamber were studied dynamically by multiplane TEE in various periods of the whole operation. Results All of the patients were implanted knee prostheses successfully. In different periods of TKA, fat emboli appeared as isoechoic or hyperechoic particles, which were found in right atrium, but nothing could be found in left heart. The imaging of the particles was flowing with duration time of 10～600s, like dots, lines, "moving star" or "shower". While femur expanding(0～3mins),the particles in right atrium and ventricle became more and more, and the echo intensity became significantly higher than those in other periods. After releasing tourniquet(0～5mins),most particles with highest echo intensity were observed in right heart,showing like "snowstorm" in tourniquet-related group, and more emboli were still detected at the end of monitoring (10 min after releasing tourniquet) by TEE,compared to the control group. No patient suffered from fat embolism syndrome(FES) with clinical manifestation. Conclusions Fat emboli in cardiac chamber can be observed sensitively by real-time TEE dynamically during TKA. It should be encouraged and promoted to analyze ultrasonic characteristics to facilitate the early detection, early diagnosis and early clinical intervention for the subclinical type of FES.

BACKGROUND:Calcium phosphate has the similar mineral component of natural bones with good bioactivity, osteoconductivity and degradability. It has been widely used in bone defect repair and coatings of implants. OBJECTIVE:To review the major properties of different-phase calcium phosphate and to summarize the application of calcium phosphate in scaffolds for osteochondral tissue engineering. METHODS:A computer-based search of PubMed, CNKI and VIP database was performed for relevant articles published from January 2000 to February 2015 with the key words of “osteochondral; calcium phosphate (including hydroxyapatite, tricalcium phosphate, calcium polyphosphate); tissue engineering” in Chinese and English, respectively. RESULTS AND CONCLUSION:Since the calcium phosphate has a variety of phases and crystaline types, a variety of materials with different structure and size can be obtained using different techniques, such as hydroxyapatite, tricalcium phosphate, calcium polyphosphate, amorphous calcium phosphate. These materials have some differences in their biological and mechanical properties, and hydroxyapatite is the most widely used. Biocomposite scaffolds with calcium phosphates appeared to have promising potential in osteochondral tissue engineering.

AIM: To evaluate the analgesic effects of combining application of low-dose morphine and diprospan in intra-articular injection after knee arthroscopy.METHODS: ① A total of 100 patients with knee arthroscopy were selected from the Surgery of Joint, Department of Orthopaedics, Changzheng Hospital, the Second Military Medical University of Chinese PLA from February 2002 to January 2003, including 52 males and 48 females aged from 16 to 56 years. All of them did not have a history of administration of pain-killer before operation. Patients were classified from grade Ⅰ to grade Ⅱ based on American Society of Anesthesiologists (ASA) before operation. Meanwhile, all the patients did not have obvious histories of heart,lung and liver diseases, and all patients provided informed consent. ② All patients were randomly divided into two groups, including combination group and morphine group with 50 in each group. Patients in the combination group were given intra-articular injection with 1 mg morphine hydrochloride and 1 mL compound diprospan [Xianling Baoya Pharmaceutical Factory, Belgian; batch number: 4JBBKA35A; qualification: 1 mL (5 mg/2 mg)/ampoule] after operation.In addition, patients in morphine group were injected with 1 mg morphine hydrochloride [the First Pharmaceutical Factory, Shenyang; batch number: 020316; qualification: 1 mL (10 mg)/ampoule]. ③ At 8 and 24 hours after administration, when patients maintained the status of standing with both feet and unfolding knee joint, analgesic effect was evaluated by visual analogue scale (VAS). Scores ranged from 0 to 10. The higher the scores were, the severer the painfulness was. Moreover, various side effects were observed at 48 hours after operation. ④ Differences of data were compared with one-way analysis of variance and deep differences between the two groups were compared with q test.RESULTS: A total of 100 patients received knee arthroscopy were involved in the final analysis. ① Visual analogue scale: At 8 hours after administration, scores were similar in combination group to those in morphine group, and the scores were 1.41 ±0.74 and 1.52±0.65, respectively (q =2.72, P ＞ 0.05). At 24 hours after administration, scores were remarkably lower in combination group than those in morphine group, and the scores were 1.46±0.61 and 2.53±1.24,respectively (q =3.42, P ＜ 0.05). ② Adverse events and side effects: Side effects, which were always found out in the application of morphine in vein, were not observed in both combination group and morphine group.CONCLUSION: Combining application of low-dose morphine and compound diprospan has an excellent analgesic effect with intra-articular injection, which is superior to that of the single application of morphine. Meanwhile, the combining application of low-dose morphine and compound diprospan is safe.

BACKGROUND:Signal transducer and activator of transcription 3 (STAT3) is an important cytokine signaling pathway, which plays an important role in inflammatory diseases. However, it is unclear whether gene polymorphism of STAT3 is associated with rheumatoid arthritis in the Chinese Han population. OBJECTIVE: To explore the association of gene polymorphism of STAT3 with rheumatoid arthritis in the Chinese Han population. METHODS:Four tag-single-nucleotide polymorphisms (tag-SNPs) in STAT3 were selected from the Chinese Han population of HapMap database. The study was performed with 228 rheumatoid arthritis cases and 228 normal controls. Four tag-SNPs (rs12601982, rs2293152, rs8078731 and rs9912773) were examined by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry. RESULTS AND CONCLUSION:The frequency of GG genotype at rs9912773 was 18.9% and 10.5% respectively in rheumatoid arthritis and control groups, and there was a significant difference between the two groups (P < 0.05). These results indicate the possible association between the STAT3 gene polymorphism at rs9912773 and the susceptibility of rheumatoid arthritis in the Chinese Han population.

BACKGROUND:Postoperative acute mental disorders refer to patients without mental disorders suffer from neurological dysfunction after surgery. OBJECTIVE:To analyze the association between psychological resilience and postoperative acute mental disorders after total knee arthroplasty (TKA). METHODS:Convenience sampling, the Chinese Version of Connor and Davidson's resilience scale (CD-RISC), was used to measure the levels of psychological resilience in 832 patients undergoing TKA. The questionnaire covered three dimensions:tenacity, self-improvement and optimism. The incidence of postoperative acute mental disorders was observed after operation. RESULTS AND CONCLUSION:(1) The CD-RISC scores of the patients with TKA surgery were (57.64±10.07), lower than the average scores of the elderly community in China. 20 (2.4%) patients had postoperative acute mental disorders. (2) Pearson correlation analysis demonstrated the negative correlation between the levels ofresilience and the incidence of postoperative acute mental disorders (r=-2.43, P<0.05). (3) Patients with lower psychological resilience levels had a higher incidence of postoperative acute mental disorders. Developing psychological resilience may become an important strategy to reduce the occurrence of postoperative acute mental disorders.

Objective To compare the early results of total knee arthroplasty using high flexion (HF) versus standard posterior-stabilized (PS) prosthesis tibial insert. Methods From February 2005 to July 2008, 203 patients (216 knees) underwent total knee arthroplasty using Genesis Ⅱ prosthesis and were randomly distributed into group A (98 patients with 107 knees, HF insert) or group B (105 patients with 109 knees, PS insert). There were no significant differences between the two groups in the preoperative Knee Society score (KSS) knee score, KSS function score, and range of motion. They were followed-up for 1 year and compared using KSS knee score, KSS function score and range of motion. Results 91 patients (98 knees)were followed up in group A, and 94 patients (96 knees) were followed up in group B. The postoperative knee active range of motion was 121.1°±6.9° in group A, and was 118.6°±8.1° in group B. The improvement of knee active range of motion was 17.1°±13.3° in group A, and was 16.1°±18.8° in group B. The postoperative range of passive motion of group A and group B were 127.2°±7.1° and 121.0°±7.8° respectively. The postoperative KSS knee score was 86.9±7.6 in group A, and was 87.5±6.8 in group B. The postoperative KSS function score was 91.2±8.7 in group A, and was 90.1±9.3 in group B. The range of passive motion of groupA was better than that of group B (P ＜0.05). There were no significant differences between the two groups in other aspects. Complications include deep vein thrombosis (DVT), 4 patients in group A and 3 in group B,wound fat liquefaction, 3 patients in group A and 5 in group B, synarthrophysis, 2 patients in group A and 3 in group B. Conclusion This prospective randomized clinical trial demonstrates no differences between PS and HF in early clinical outcomes, except the range of passive flexion.

Clinical data of 53 patients (69 knees), who were treated at the Division of Joint Surgery, Department of Orthopaedics, Changzheng Hospital from January 1998 to December 2006, were retrospectively analyzed. These patients suffered from wound-healing complications following total knee arthroplasty. Wound skin problems included skin flare, disruption of wound, local hematoma, skin necrosis and deep infection. Local wound care was performed in 58 knees, debridement and secondary closure in 6 kness, and primary management of the soft tissue defect was achieved with local muscle flaps in 3 knees, with the fasciocutaneous flap in 1 knee, and with fasciocutaneous flap and skin grafting in 1 knee. Mean follow-up was 1.9 years. All wound was healed well. It is indicated that corresponding management should be used for treating wound-healing complications following total knee arthroplasty.

BACKGROUND: Previous artificial ligament is easy to break for material fatigue and to appear synonitis for materialbiocompatibility.OBJECTIVE: To observe the application effect of ligament advanced reinforcement system (LARS) artificial ligament inreconstruction of anterior cruciate ligament via follow-up.DESIGN, TIME AND SETTING: An own control, follow-up observation was performed between August 2004 andJanuary 2007 at the Department of Orthopedics and Joint Surgery, Shanghai Changzheng Hospital, Shanghai, China.PARTICIPANTS: Twenty-eight patients with anterior cruciate ligament injury, including 16 with sport injury and 12 withvehicle accident injury.MATERIALS: The main component of LARS artificial ligament (Laboratoire d'Applieation et de Recherche Scientifique,France) is the high-tenacity polyester fiber polyethylene terephthalate.METHODS: Twenty-eight patients with anterior cruciate ligament injury were performed arthroscopic reconstruction of theligament with LARS artificial ligament and were averagely followed up for 20 months.MAIN OUTCOME MEASURES: Patients' anterior drawer test, Lysholm score, range of motion prior to transplantationand in follow-up.RESULTS: The knee unstable symptom of 28 patients disappeared, anterior drawer test was negative, joint function wasgood with the flexion of 5.71 to 129.64 degrees. Average Lysholm score raised from (45.7±9.82) points prior totransplantation to (86.5±6.44) points after transplantation (P < 0.001). All patients resumed normal activities at 2 monthsafter transplantation, without acute or chronic synovitis and host response to materials.CONCLUSION: LARS artificial ligament is a relatively safe transplantation material and especially suitable to reconstructanterior cruciate ligament with sport injury. Mid-/short-term follow-up shows good result.