Objective:To examine the clinical effects of the treatment of knee osteoarthritis patients with kinematic alignment technique of total knee replacement (KA-TKA) assisted by patient-specific instrumentation (PSI).Methods:The clinical data of 14 patients with knee osteoarthritis treated with unilateral KA-TKA assisted by PSI at Department of Orthopaedic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from May 2018 to August 2019 were analyzed retrospectively. There were 6 males and 8 females, aged 66.6 years (range: 56 to 79 years), 9 left knees and 5 right knees. The operation time, soft tissue release and extra varus or valgus osteotomy were recorded. The data of osteotomy blocks were measured and compared with the corresponding position of the prostheses. The hip knee ankle angle (HKA), the mechanical distal femoral lateral angle (mLDFA) and the proximal tibial medial angle (MPTA) were measured before and 3 months after the operation. The knee joint functional score (KS-F) , knee joint clinical score (KS-C) and the Western Ontario McMaster (WOMAC) Osteoarthritis Index were recorded and compared by paired t test or Wilcoxon non-parametric test. Results:The operation time was (81.8±16.9) minutes (range: 60 to 115 minutes), 2 cases were manually increased varus osteotomy by 2 mm and 1 patient received lateral retinaculum release. There was no extra medial or lateral soft tissue release. Intraoperative measurement of the resection showed that the femoral side mismatch was within 2 mm. The medial and lateral condyle, the medial and lateral posterior condyles were relatively overcut by 0.50 mm, 0.21 mm, 0.93 mm, and 0.71 mm, respectively. The tibial side mismatch was within 1.5 mm, the medial and lateral plateau were relatively undercut by 0.43 mm and 0.32 mm. HKA was corrected from (8.8±5.6) ° to (1.6±4.3) ° ( t=20.723, P=0.000) .KS-C improved from 28.21±13.47 preoperative to 78.07±8.01 postoperative ( t=-16.570, P=0.000); KS-F improved from 41.00±15.25 preoperative to 84.93±10.85 postoperative ( t=-14.675, P=0.000).WOMAC Osteoarthritis Index decreased from 53.5 (25.75) ( M( QR)) preoperative to 5.5 (5.25) postoperative ( Z=-3.297, P=0.001) .No statistically significant difference was found in mLDFA and MPTA before and after surgery. No significant patellofemoral complication was recorded during follow-up time. Conclusions:PSI assisted TKA resection has high accuracy. KA-TKA aims to restore the native anatomy of the knee joint, only corrects the malalignment of lower extremities caused by articular cartilage wear, with less interference to soft tissues, easy to obtain satisfactory knee joint laxity and has a promising early clinical effect.

Objective:To examine the clinical effects of the treatment of knee osteoarthritis patients with kinematic alignment technique of total knee replacement (KA-TKA) assisted by patient-specific instrumentation (PSI).Methods:The clinical data of 14 patients with knee osteoarthritis treated with unilateral KA-TKA assisted by PSI at Department of Orthopaedic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from May 2018 to August 2019 were analyzed retrospectively. There were 6 males and 8 females, aged 66.6 years (range: 56 to 79 years), 9 left knees and 5 right knees. The operation time, soft tissue release and extra varus or valgus osteotomy were recorded. The data of osteotomy blocks were measured and compared with the corresponding position of the prostheses. The hip knee ankle angle (HKA), the mechanical distal femoral lateral angle (mLDFA) and the proximal tibial medial angle (MPTA) were measured before and 3 months after the operation. The knee joint functional score (KS-F) , knee joint clinical score (KS-C) and the Western Ontario McMaster (WOMAC) Osteoarthritis Index were recorded and compared by paired t test or Wilcoxon non-parametric test. Results:The operation time was (81.8±16.9) minutes (range: 60 to 115 minutes), 2 cases were manually increased varus osteotomy by 2 mm and 1 patient received lateral retinaculum release. There was no extra medial or lateral soft tissue release. Intraoperative measurement of the resection showed that the femoral side mismatch was within 2 mm. The medial and lateral condyle, the medial and lateral posterior condyles were relatively overcut by 0.50 mm, 0.21 mm, 0.93 mm, and 0.71 mm, respectively. The tibial side mismatch was within 1.5 mm, the medial and lateral plateau were relatively undercut by 0.43 mm and 0.32 mm. HKA was corrected from (8.8±5.6) ° to (1.6±4.3) ° ( t=20.723, P=0.000) .KS-C improved from 28.21±13.47 preoperative to 78.07±8.01 postoperative ( t=-16.570, P=0.000); KS-F improved from 41.00±15.25 preoperative to 84.93±10.85 postoperative ( t=-14.675, P=0.000).WOMAC Osteoarthritis Index decreased from 53.5 (25.75) ( M( QR)) preoperative to 5.5 (5.25) postoperative ( Z=-3.297, P=0.001) .No statistically significant difference was found in mLDFA and MPTA before and after surgery. No significant patellofemoral complication was recorded during follow-up time. Conclusions:PSI assisted TKA resection has high accuracy. KA-TKA aims to restore the native anatomy of the knee joint, only corrects the malalignment of lower extremities caused by articular cartilage wear, with less interference to soft tissues, easy to obtain satisfactory knee joint laxity and has a promising early clinical effect.

Objective: To investigate the microbiological test, antibiotic sensitivity and surgical treatment of periprosthetic joint infection(PJI) cases in post total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients. Methods: A retrospective cross-sectional survey was conducted on 318 patients who underwent THA or TKA in 9 clinical centers in Beijing from January 2014 to December 2016.The data of microbiology, antibiotic sensitivity and surgical treatment were collected.The average age of patients was (62.3±13.1) years old (range: 21-86 years old), including 145 males and 173 females.The body mass index was (25.6±3.8) kg/m ² (range: 15.6-38.1 kg/m²). Results: In total, 318 patients had microorganisms detected by periprosthetic tissue culture or synovial fluid culture, 209 cases (65.7%) had Gram-positive bacteria, 29 cases (9.1%) had Gram-negative bacteria, 10 cases (3.1%) had fungi, 3 cases (0.9%) had non-tuberculous mycobacteria, 72 cases (22.6%) were negative, 69 cases (21.7%) had methicillin-resistant bacteria. The antibiotic sensitivity results showed that the overall resistance rate of penicillin, cefuroxime, amoxicillin+clavulanic acid was 79.9%, 69.9%, and 68.1%, respectively; meropenem, vancomycin, and linezolid resistance rate was 0. For the treatment methods of hip and knee PJI, two-stage revision surgery acounted for 72.9% (108/148) and 64.1% (109/170), respectively. One-stage revision surgery accounted for 21.6% (32/148) and 7.6% (13/170), and open debridement surgery accounted for 4.7%(7/148) and 26.4% (45/170). Conclusions Gram-positive bacteria was still the main pathogen of PJI.The methicillin-resistant bacteria and rare bacteria should be payed attention to. The Majority of hip and knee PJI cases were treated by two-stage revision surgery.

Objective To compare the anatomical differences of tibia osteotomy between Han and Uygur populations and to analysis their compatibility with imported prosthesis component.Methods Two hundred patients (400 knees) were selected from the outpatients and healthy volunteers of the non-knee joint disease from September 1,2012 to December 1,2014,with 86 men (172 knees) and 114 women (228 knees).The average age is 44.64-10.8 years (range 21-68 years old).According to the populations,the subjects were divided into Han group and Uygur group.Furthermore,each group was divided into male subgroup and female subgroup.A full-length CT scan of the lower limb was conducted to reconstruct the knee joint in the workstation.The tibial osteotomy was simulated in total knee arthroplasty.The transverse diameter of the tibial cross section,the longitudinal depth of the medial platform and the depth of the lateral platform were measured.The front and back diameter and aspect ratio of the osteotomy were calculated.There parameters were compared between the Han and Uygur groups.Five mm tolerance range method was used to analysis the cover rate of the following three kinds of commercially imported prosthesis,namely Depuy,Link and Zimmer.Results The mean value of the tibial cross section were 72.3±4.3 mm,50.7±3.1 mm,47.8±3.0 mm,49.3±2.9 mm and 0.682±0.021 in Han group,while those were 74.5±4.8 mm,51.4±3.0 mm,48.6±2.8 mm,50.0±2.9 mm and 0.672±0.020 in Uygur group,respectively.Except the aspect ratio,the average value of each parameter in Uygur group was greater than that in the Han group with statistically significant differences between the two populations.The cover rate of the three kinds of prosthesis tibial component were 53.0％,37.0％ and 40.0％ for Han group,but 61.0％,43.0％ and 42.5％ for Uygur group.Depuy prosthesis was fit for the Uygur population better.Conclusion The geometry and anatomy of proximal tibia in Chinese showed significant difference between Han and Uygur populations.The mean covering rates of the imported tibial components were low in the dimensions of the resected surface.We can improve the prosthesis and the matching degree by adjusting the parameters or increasing the model set.

Objective To explore the role of fibrogenic cytokines and inflammatory cytokines in the pathogenesis of frozen shoulder. Methods From September, 2014 to April, 2016, 20 patients with frozen shoulder accepted arthroscopic surgery were included, ten of them were diagnosed as primary frozen shoulder (group A), the other ten were secondary frozen shoulder (group B). Other ten patients undergo-ing shoulder arthroscopy for instability (4 cases), rotator cuff injury (3 cases) and subacromial impingement (3 cases) were as the controls (group C). The mRNA levels of matrix metalloproteinase (MMP) 1, MMP3, tumour necrosis factor-α (TNF-α), interleukin (IL)-1, IL-6, IL-8, granulocyte-macrophage colony stimulating factor (GM-CSF) and M-CSF in synovium were analyzed with quantitative polymerase chain reaction. Results The expression of mRNA of MMP1, MMP3, TNF-α, IL-1, IL-6, IL-8, GM-CSF and M-CSF were more in group A and group B than in group C (P<0.05). There was no significant difference between group A and group B (P>0.05). Conclusion The fibro-genic cytokines and inflammatory cytokines may play a role in the pathogenesis of frozen shoulder.

BACKGROUND: For the orthopedic surgeon, the postoperative functional recovery after total knee arthroplasty, in which the reconstruction of posterior femoral condylar offset plays an important role, is an important goal.OBJECTIVE: To understand the anatomic characteristics of the femoral condylar offset and the mechanism how posterior condylar offset influences the functional recovery of knee joint after total knee arthroplasty.METHODS: The author searched PubMed database and Wanfang database for articles about posterior femoral offset and knee range of motion. The key words were arthroplasty; replacement; knee; femur; posterior condylar offset; range of motion. A total of 96 articles were retrieved, and 38 articles met the inclusion criteria.RESULTS AND CONCLUSION: Posterior condylar offset had differences in gender, ethnics and medial and lateral condyles. To restore the biomechanics of the knee joint, the design of knee prosthesis should consider the difference in genders, ethnics, medial and lateral condyles. The influence mechanism is the femur-tibia impingementand gap balance. However, further clinical research is needed, for contradictory results regarding whether posterior condylar offset has an effect on knee flexion after total knee arthroplasty.

BACKGROUND:It is important to maintain the height of joint line in total knee arthroplasty or renovation. Foreign scholars have reported the parameters of the distance from different landmarks to knee joint line, but there is stil a lack of relevant data for Chinese people. OBJECTIVE:To explore the relationships of the knee anatomic landmarks and joint line in normal Chinese, thereby providing clinical evidence for primary total knee replacement and knee renovation. METHODS:Totaly 746 normal knee joints of 409 healthy volunteers from North China and Southwest China were randomly enroled, including 214 males and 195 females, with a mean age of 37.7 years. CT scan was used to reconstruct the three-dimensional knee joint, and the distance between the anatomic landmarks and the joint line was measured using Mimics software. RESULTS AND CONCLUSION:The distance from the center of femoral medial sulcus to the joint line was (25.72±2.52) mm. The distance from the center of lateral femoral condyle prominence to the joint line was (26.30±2.65) mm. The distance from the adduction muscle tubercle to the joint line was (44.60±4.32) mm. The distance from the peak of the tibial tubercle to the joint line was (21.50±3.57) mm. These parameters in male group were significantly higher than those in female group (P < 0.05). In conclusion, these findings provide anatomic evidence for the recovery of joint line in knee replacement or renovation; the variability of the distance from the center of femoral medial sulcus, lateral femoral condyle prominence and adductor tubercle to the joint line is smaler, and therefore, these landmarks have more reference values in total knee arthroplasty.

Objective To investigate the effect of Buyanghuanwu decoction(BYHWD) on the expression of growth-associated protein 43(GAP-43) and synaptophysin(SYP) after focal cerebral ischemia in mice.Methods Focal cerebral ischemia was induced by 30 min of middle cerebral artery occlusion followed by reperfusion.BYHWD (20 g/kg) was administered orally 24 h after ischemia and once a day.The neurological score and the corner test were used to evaluate sensorimotor function on 1,3,7,and 14 days after ischemia.The expression of GAP-43 and SYP in the ischemic boundary zone was determined by immunohistochemistry 14 days after ischemia.Results Compared with the model group,BYHWD significantly ameliorated neurological dysfunction at 3,7 and 14 days and reduced the number of right turn at 7 and 14 days after ischemia(P ＜ 0.05).The average optical density of GAP-43 and SYP was 0.217 ±0.012 and 0.278 ±0.019 at the boundary zone in model group 14 days after ischemia,respectively.BYHWD also significantly increased the immunoreactivity of GAP-43 (0.250 ± 0.013)and SYP(0.323 ± 0.017) (P＜ 0.01).Conclusion BYHWD promotes axonal regeneration and synaptic plasticity in the ischemic boundary zone,which may contribute to functional recovery after focal cerebral ischemia.

Objective To investigate the effects of autologous platelet-rich plasma in the treatment of refractory wound.Methods Fifteen cases with refactory wound ( 1 1 males and 4 females) involving six cases with diabetic ulcer,five with post-surgical ulcer wounds and four with pressure sore were enrolled into the study.The autologous platelet-rich gel was applied to the wounds after debridement and dressing change was done every week.The results of wound bacterial culture were regularly detected and the growth of granulation was observed.Skin graft or flap graft surgery was performed to close the wound when the wound condition was permitted.Results Of all,three patients had spontaneous healing after the change of dressing,four got healing after flap graft and eight attained healing after skin graft.There was no recurrence or sinus after treatment.Conclusion Autologous platelet-rich gel accelerates wound healing,improves wound condition,and raises success rate of surgical closure of the wound.