Haishan Wu

We evaluated the compensatory change in ankle alignment due to knee malalignment and its relationship with varus knee deformities, as well as sex differences in compensation. From October 2016 to September 2017, 103 patients with end-stage knee osteoarthritis underwent primary total knee arthroplasty (TKA). Ninety-five knees (78 patients) were included. The hip-knee-ankle angle (HKA) and ankle alignment and tilt were evaluated with full-leg standing anteroposterior radiographs. The ankle alignment was estimated according to the tibiotalar angle, tibial anterior surface angle (TAS), and lateral distal tibial angle. The talar tilt angle (TT), anatomical talocrural angle, angle between the tibial plateau and distal tibial plafond, angles between the ground and distal tibial plafond, and angles between the ground and upper talus were measured to evaluate ankle tilt. The patients were separated into two sex-based groups; correlations between the HKA and ankle parameters were estimated. The mean HKA in men and women was 8.16 ± 4.36° and 7.69 ± 5.93°, respectively. The relative tilt of the talus and distal tibia plafond to the ground was increased when varus knee deformities progressed. In women, there was a positive correlation between the knee alignment and TAS (r = − 0.295, p = 0.016). As the knee mechanical axis became more varus, the distal tibia plafond became more valgus. In women, a negative correlation was observed between the HKA and TT (r = − 0.359, p = 0.003). Compensatory changes in the ankle alignment and TT to knee alignment were not observed in men. Compensatory ankle changes should be considered before TKA.

To assess the efficacy of a therapeutic protocol composed of arthroscopic lateral retinacular release, medial retinacular plication, and partial medial tibial tuberosity transfer for patients with recurrent patellar dislocation. 71 patients, 11 males and 60 females and a total of 77 knees, with recurrent dislocation of the patella were enrolled between 1998 and 2012. The average age of the patients was 19.5 years and 67 of them had previous knee trauma history. Tibial tubercle avulsion fractures were all surgically treated without complications like dysplasia in the femoral trochlear groove or valgus deformity. The Q angle, sulcus angle, patella-femoral trochlear congruence angle and lateral patellofemoral angle were measured on X-ray, while tibial tubercle-trochlear groove (TT-TG) distance was measure on CT scans, before the arthroscopic operation. 69 patients were followed-up for 2-16 years (average of 7.2 years), while 2 patients were lost during follow-up. Among the patients with follow-up, one patient had recurrent patella dislocation two months after the operation. Q angle decreased from 13.2° to 9.2° in male patients (P < 0.05) and from 21.0° to 15.4° in female patients (P < 0.05). On average, the patella-femoral trochlear congruence angle decreased from 24.2 ± 6.8° to -2.1 ± 5.8° (P < 0.05) and the lateral patellofemoral angle increased from -2.0 ± 5.2° to 10.9 ± 4.0° (P < 0.05). TT-TG distance decreased from 19.8 ± 2.1 mm to 13.6 ± 1.8 mm (P < 0.01). Mean Lysholm score increased from 45.6 ± 4.8 to 92.3 ± 10.8 (P < 0.05) and, IKDC score increased from 48.3 ± 6.8 to 94.3 ± 8.4 (P < 0.05). As evidenced by minimal trauma and markedly improved knee joint function, the proposed therapeutic protocol demonstrated clear benefits for patients with recurrent patella dislocation.

Objective: We aimed to assess the efficacy of applying a two-stage primary total knee arthroplasty (TKA) with an antibiotic-laden cement spacer block to treat infected osteoarthritic knees. Methods: This retrospective study included 17 cases of severely infected osteoarthritic knees treated with two-stage primary TKA. Open debridement and irrigation with insertion of a well-designed antibiotic cement spacer was performed as the first stage. Systemic antibiotics were used in the interval period. Two-stage TKAs were performed after elimination of infection. The pre- and post-operative Hospital for Special Surgery Knee (HSS) score as well as range of motion (ROM) were assessed. Results: Elimination of infection was achieved in 16 patients. C-reactive protein returned to normal levels in an average of 3.4 wks (range, 1–7 wks), whereas erythrocyte sedimentation rate (ESR) recovered in an average of 11.4 wks (range, 6–19 wks). The average interval between the two-stage operations was 16.8 wks (range, 10–27 wks). Compared with the pre-operative level, the mean HSS score had a substantial increase after the first-stage and second-stage surgery (pConclusions: Two-stage TKA with open debridement, irrigation, and insertion of a well-designed antibiotic-laden cement spacer at the first stage could provide effective pain relief and function restoration as well as infection control in the interval. This treatment protocol provided an encouraging final clinical outcome, which could be a reliable alternative for patients with infected osteoarthritic knees.

Introduction: Platelet-rich plasma (PRP) is widely used to treat tendon injuries in clinics. These PRP preparations often contain white blood cells or leukocytes, and the precise cellular effects of leukocyte-rich PRP (L-PRP) on tendons are not well defined. Therefore, in this study, we determined the effects of L-PRP on tendon stem/progenitor cells (TSCs), which play a key role in tendon homeostasis and repair. Methods: TSCs isolated from the patellar tendons of rabbits were treated with L-PRP or P-PRP (pure PRP without leukocytes) in vitro, followed by measuring cell proliferation, stem cell marker expression, inflammatory gene expression, and anabolic and catabolic protein expression by using immunostaining, quantitative real-time polymerase chain reaction, Western blot, and enzyme-linked immunosorbent assay, respectively. Results: Cell proliferation was induced by both L-PRP and P-PRP in a dose-dependent manner with maximum proliferation at a 10 % PRP dose. Both PRP treatments also induced differentiation of TSCs into active tenocytes. Nevertheless, the two types of PRP largely differed in several effects exerted on TSCs. L-PRP induced predominantly catabolic and inflammatory changes in differentiated tenocytes; its treatment increased the expression of catabolic marker genes, matrix metalloproteinase-1 (MMP-1), MMP-13, interleukin-1beta (IL-1β), IL-6 and tumor necrosis factor-alpha (TNF-α), and their respective protein expression and prostaglandin E₂ (PGE₂) production. In contrast, P-PRP mainly induced anabolic changes; that is, P-PRP increased the gene expression of anabolic genes, alpha-smooth muscle actin (α-SMA), collagen types I and III. Conclusions: These findings indicate that, while both L-PRP and P-PRP appear to be “safe” in inducing TSC differentiation into active tenocytes, L-PRP may be detrimental to the healing of injured tendons because it induces catabolic and inflammatory effects on tendon cells and may prolong the effects in healing tendons. On the other hand, when P-PRP is used to treat acutely injured tendons, it may result in the formation of excessive scar tissue due to the strong potential of P-PRP to induce inordinate cellular anabolic effects.

E its relationship with sex and type of arthroplasty. Methods: This is a prospective cohort study, including 107 patients receiving TKA or THA without allogeneic blood transfusion. There were 54 males and 53 females, with a mean age of 69.42 years. Levels of Hb and Hct were examined preoperatively and during the 6 months follow-up after operation. Results: Levels of Hb and Hct decreased postoperatively and reached their minimum points on postoperative day 4. Thereafter, Hb and Hct recovered to their preoperative levels within 6–12 weeks. No significant differences in the levels of Hb and Hct were noticed between different sexes. THA patients showed significantly greater drop in Hb and Hct than TKA patients in the first 4 days postoperatively (P < 0.05). Conclusions: Levels of Hb and Hct decreased during the first 4 days after arthroplasty and gradually returned to their normal levels within 6–12 weeks postoperatively. THA may be associated with higher postoperative blood loss than TKA....