Hong-Zhang Guo

To review the primary tracker fixation strategies and associated complications in robot-assisted total knee arthroplasty (RA-TKA), evaluate their respective advantages, limitations, and clinical outcomes, and provide evidence-based references for clinical practice. A comprehensive review of the current literature regarding tracker fixation techniques and related complications in RA-TKA was conducted. The analysis primarily focused on key procedural variables, including the depth of pin penetration (unicortical versus bicortical) and the insertion trajectory (intra-incisional versus independent/percutaneous incision). Current research predominantly centers on two parameters: the number of cortices penetrated by the fixation pins and the spatial relationship between the pin insertion site and the primary surgical approach. Existing evidence indicates that unicortical fixation at the medial epicondylar region of the femur, combined with an independent, small-incision unicortical fixation on the tibial side, yields superior mechanical stability, minimizes intraoperative tracker micro-motion, and demonstrates an excellent safety profile. The overall incidence of tracker-related complications remains low; these primarily include localized pain, soft tissue irritation, pin-tract infections, and, rarely, iatrogenic fractures. The majority of these complications have favorable prognoses. A standardized clinical consensus on tracker fixation protocols in RA-TKA has yet to be established. In clinical practice, surgeons should employ individualized fixation strategies tailored to the patient's bone quality, local anatomy, and surgical expertise. Prioritizing minimally invasive, highly stable, and low-risk fixation options is crucial to mitigating iatrogenic injury without compromising surgical precision.

Osteoarthritis (OA) is a prevalent degenerative joint disease among middle-aged and elderly individuals. Metabolic syndrome (Met S), a group of clinical conditions characterized by abnormal metabolic processes, includes obesity as one of its primary risk factors. Recent studies have demonstrated a significant association between metabolic syndrome and osteoarthritis. Metformin, a classical hypoglycemic agent, is commonly prescribed for patients with type 2 diabetes mellitus who do not achieve adequate control through diet and physical activity alone. Metformin has gradually gained attention in the treatment of OA due to its anti-inflammatory, antioxidant, and metabolic function-enhancing properties. This review summarizes the latest research on metformin by examining recent clinical and animal studies, systematically analyzing its mechanisms, and assessing its clinical potential in treating OA.

Osteoarthritis is a degenerative joint disease that affects the aging population worldwide. It has an underlying inflammatory cause that leads to loss of chondrocytes, reducing the cartilage layer at the affected joints. Compounds with anti-inflammatory properties are potential therapeutic agents for osteoarthritis. Curcumin, derived from species of the Curcuma, is an anti-inflammatory compound. The purpose of this review is to summarize the anti-osteoarthritic effects of curcumin from clinical and preclinical studies. Many clinical trials have been conducted to determine curcumin's effectiveness in osteoarthritis patients. Available studies have shown that curcumin prevents chondrocyte apoptosis and inhibits the release of proteoglycans and metalloproteinases as well as the expression of cyclooxygenase, prostaglandin E-2, and inflammatory cytokines in chondrocytes. The mechanism of action of curcumin also involves multiple cell signaling pathways, including Nuclear factor kappa-B(NF-κB), Mitogen-activated protein kinase (MAPK), Wnt/β-catenin pathway (Wnt/β-catenin), The Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3), Nuclear factor erythroid 2-related factor 2/antioxidant response elements/heme oxygenase-1(Nrf2/ARE/HO-1), and Phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (PI3K/AKT/mTOR) signaling pathways. Curcumin further reduced the release of inflammatory factors and apoptosis by inhibiting the activation of NF-κB. In addition, curcumin modulates the MAPK, Nrf2/ARE/HO-1, and PI3K/Akt/mTOR signaling pathways and affects cell proliferation and apoptosis processes, a series of effects that together promote the healthy state of chondrocytes. In conclusion, curcumin, as a natural plant compound, exhibits significant anti-inflammatory potential by modulating inflammatory factors associated with articular osteoarthritis through multiple mechanisms. Its protective effects on articular cartilage and synovium make it a promising candidate for the treatment of OA. Future studies should further explore the mechanism of action of curcumin and its optimal dosage and therapeutic regimen in clinical applications, to provide more effective therapeutic options for osteoarthritis patients.

Osteoarthritis (OA) is one of the leading causes of joint dysfunction and disability in the elderly, posing serious social problems and a huge socio-economic burden. Existing pharmacological treatments have significant drawbacks, and searching for an effective pharmacological intervention is an urgent priority. Recent studies have demonstrated the chondroprotective, anabolic, and anti-catabolic properties of avocado–soybean unsaponifiable (ASU), a natural plant extract made from avocado and soybean oils, consisting of the remainder of the saponified portion of the product that cannot be made into soap. The main components of ASU are phytosterols, beta-sitosterol, canola stanols, and soya stanols, which are rapidly incorporated into cells. Studies have confirmed the anti-inflammatory, antioxidant, and analgesic properties of phytosterols. ASU slows down the progression of OA primarily by inhibiting pathways involved in the development of OA disease. ASU prevents cartilage degradation by inhibiting the release and activity of matrix metalloproteinases and by increasing the tissue inhibition of these catabolic enzymes; ASU is also involved in the inhibition of the activation of nuclear factor κB (NF-κB) which is a transcriptional inhibitor that regulates the inflammatory response of chondrocytes. NF-κB is a transcription factor that regulates the inflammatory response of chondrocytes, and inhibition of the transfer of the transcription factor NF-κB from the cytoplasm to the nucleus regulates the transcription of many pro-inflammatory factors. By appealing to the mechanism of action and thus achieving anti-inflammatory, anti-catabolic, and pro-synthetic effects on cartilage tissues, AUS is clinically responsive to the reduction of acute pain and OA symptom progression. This paper aims to summarize the studies on the use of avocado–soybean unsaponifiable in the pharmacological treatment of osteoarticular.

S: Purpose: Preoperative anemia increases postoperative morbidity, mortality, and the risk of allogeneic transfusion. However, the incidence of preoperative anemia in patients undergoing total hip arthroplasty and total knee arthroplasty (TKA) and its relationship to postoperative outcomes has not been previously reported.Methods: We conducted a comprehensive literature search through PubMed, Cochrane Library, Web of Sincien, and Embase from inception to July 2023 to investigate the prevalence of preoperative anemia in patients undergoing Total Joint Arthroplasty, comorbidities between anemic and non-anemicpatients before surgery, and postoperative outcomes. postoperative outcomes were analyzed. Overall prevalence was calculated using a random-effects model, and heterogeneity between studies was examined by Cochran's Q test and quantified by theI²statistic. Subgroup analyses and meta-regression analyses were performed to identify sources of heterogeneity. Publication bias was assessed by funnel plots and validated by Egger's test.Results: A total of 21 studies with 369,101 samples were included, all of which were retrospective cohort studies. 3 studies were of high quality and 18 studies were of moderate quality. The results showed that the prevalence of preoperative anemia was 22% in patients awaiting arthroplasty; subgroup analyses revealed that the prevalence of preoperative anemia was highest in patients awaiting revision of total knee arthroplasty; the highest prevalence of preoperative anemia was found in the Americas; preoperative anemia was more prevalent in the female than in the male population; and preoperative anemia with a history of preoperative anemia was more common in the female than in the male population. patients with a history of preoperative anemia; patients with joint replacement who had a history of preoperative anemia had an increased risk of infection, postoperative blood transfusion rate, postoperative blood transfusion, Deep vein thrombosis of the lower limbs, days in hospital, readmission within three months, and mortality compared with patients who did not have preoperative anemia.Conclusion: The prevalence of preoperative anemia in patients awaiting total joint arthroplasty is 22%, and is higher in TKA and female patients undergoing revision, while preoperative anemia is detrimental to the patient's postoperative recovery and will increase the risk of postoperative complications, transfusion rates, days in the hospital, readmission rates, and mortality.

Background Epidemiological evidence suggests that there is an association between rheumatoid arthritis (RA) and Alzheimer’s disease (AD). However, the causal relationship between RA and AD remains unclear. Therefore, this study aimed to investigate the causal relationship between RA and AD. Methods Using publicly available genome-wide association study datasets, bidirectional two-sample Mendelian randomization (TSMR) was performed using the inverse-variance weighted (IVW), weighted median, MR‒Egger regression, simple mode, and weighted mode methods. Results The results of MR for the causal effect of RA on AD (IVW, odds ratio [OR] = 0.959, 95% confidence interval [CI]: 0.941–0.978, P = 2.752E-05; weighted median, OR = 0.960, 95% CI: 0.937–0.984, P = 0.001) revealed a causal association between genetic susceptibility to RA and an increased risk of AD. The results of MR for the causal effect of AD on RA (IVW, OR = 0.978, 95% CI: 0.906–1.056, P = 0.576; weighted median, OR = 0.966, 95% CI: 0.894–1.043, P = 0.382) indicated that there was no causal association between genetic susceptibility to AD and an increased risk of RA. Conclusions The results of this two-way two-sample Mendelian randomization analysis revealed a causal association between genetic susceptibility to RA and a reduced risk of AD but did not reveal a causal association between genetic susceptibility to AD and an increased or reduced risk of RA.

Background Pain is the most common symptom of knee osteoarthritis (KOA), with an incidence of 36.8–60.7%, thereby making it a primary cause that impacts patients’ quality of life and forces them to seek medical treatment. However, the KOA pain mechanisms are complex. The resulting joint degeneration provides stimuli to the central nervous system, thus, initiating several plastic changes under pain stimulation. Hence, nerve function changes enhance the responsiveness of neurons to normal or subliminal afferents, resulting in central sensitization. The development of chronic pain is closely related to the reorganization of brain structure and function. However, recent imaging technologies like resting-state functional magnetic resonance imaging (rs-fMRI) can inhibit the non-specific signals caused by cerebrospinal fluid fluctuations better and detect spontaneous human neural activity with accuracy and sensitivity. Therefore, we intend to explore the characteristics of spontaneous neural activity in KOA patients by utilizing rs-fMRI technology in combination with the changes in clinical-related variables. Our findings might help in revealing the neuropathological mechanism of KOA pain from the perspective of central pain sensitization. Methods Being a cross-sectional study, it will include all KOA patients who will be visiting the Joint Diagnosis and Treatment Center of Gansu Provincial Hospital from September 2023 to September 2024 and healthy volunteers with matching gender, age, and education levels as healthy controls. The clinical data, Central Sensitization Scale (CSI), Visual Analogue Scale (VAS), Western Ontario McMaster University Osteoarthritis Index (WOMAC), and radiological indicators of the two groups will be collected. After processing rs-fMRI scan results by image data processing, the fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) will be calculated for both groups. Based on the variance analysis results, the abnormal brain regions will be superimposed as regions of interest (ROI) for assessing whole-brain functional connectivity (FC). Pearson’s correlation analysis will be employed for analyzing the correlation between the fALFF and FC values of abnormal brain regions as well as the clinical data, rating scales, and radiological indicators of KOA patients. Discussion We will use rs-fMRI technology to analyze the abnormal brain function patterns in KOA patients and imaging data to reveal the specific central pain sensitization mechanisms in KOA. Thus, this study aims to provide reliable and comprehensive evidence for clinical practice and determine a reasonable intervention plan for effectively reducing the discomfort and pain of such patients.

Objective: With the increasing prevalence of osteoarthritis of the hip and knee, total joint replacement, the end-stage treatment, provides pain relief and restoration of function, but is often associated with massive blood loss. Tranexamic acid (TXA) has been reported to reduce perioperative blood loss in hip or knee arthroplasty. However, the optimal dose of TXA administration remains controversial. Therefore, we performed a meta-analysis combining data from 5 trials comparing the efficacy and safety of one fixed dose of 1 g intravenously administered TXA with two doses of 1 g each administered intravenously for hip or knee arthroplasty. Methods: PubMed, Medline, Embase, Web of Science, and The Cochrane Library were searched from January 2000 to February 2023. Our meta-analysis included randomized controlled trials and cohort studies comparing the efficacy and safety of different doses of intravenous TXA (IV-TXA) for THA or TKA. The observation endpoints included total blood loss, postoperative hemoglobin drop, blood transfusion rate, length of hospital stay, incidence of deep venous thrombosis (DVT), and incidence of pulmonary embolism (PE). Meta-analysis was performed according to Cochrane's guidelines and PRISMA statement. The Danish RevMan5.3 software was used for data merging. Results: Five cohort studies involving 5542 patients met the inclusion criteria. Our meta-analysis showed that the two groups were significantly higher in total blood loss (mean difference (MD) = − 65.60, 95% confidence interval (CI) [− 131.46, 0.26], P = 0.05); blood transfusion rate (risk difference (RD) = 0.00, 95% CI [− 0.01, 0.02], P = 0.55); postoperative hemoglobin (MD = 0.02, 95% CI [− 0.09, 0.13], P = 0.31); postoperative hospital stay days (MD = − 0.13), 95% CI [− 0.35, 0.09], P = 0.25); DVT (RD = 0.00, 95% CI [− 0.00, 0.01], P = 0.67); PE (RD = 0.00, 95% CI [− 0.01, 0.00], P = 0.79). There was some inherent heterogeneity due to variance in sample size across each major study. Conclusion: 1 dose of 1 g and 2 doses of 1 g IV-TXA each time have similar effects on reducing blood loss, blood transfusion rate, postoperative hemoglobin level, and postoperative hospital stay after TKA or THA, without increasing the risk of postoperative complications risk. For patients at high risk of thromboembolic events, one dose of 1 g TXA throughout surgery may be preferred. However, higher-quality RCT is needed to explore the optimal protocol dose to recommend the widespread use of TXA in total joint arthroplasty. Trial registration We conducted literature selection, eligibility criteria evaluation, data extraction and analysis on the research program registered in Prospero (CRD42023405387) on March 16, 2023.