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BackgroundMuch effort has been made to optimize the results of total hip arthroplasty and total knee arthroplasty. With the rapid growth of social media use, mobile apps, such as WeChat, have been considered for improving outcomes and patient satisfaction after total hip arthroplasty and total knee arthroplasty. ObjectiveWe aimed to evaluate the effectiveness of a WeChat-based community as an intervention for overall patient satisfaction. MethodsThe study was conducted among discharged in-hospital patients who received hip or knee procedures in the First Affiliated Hospital of the University of Science and Technology of China from April 2019 to January 2020. An educational online social community was constructed with the WeChat app. Participants willing to join the community were enrolled in a WeChat group and received 3 months of intervention and follow-up. Those who were not willing to use the account were included in a control group and received routine publicity via telephone, mail, and brochures. The Danish Health and Medicine Authority patient satisfaction questionnaire was used to score perioperative patient education and overall satisfaction. The contents in the group chat were analyzed using natural language processing tools. ResultsA total of 3428 patients were enrolled in the study, including 2292 in the WeChat group and 1236 in the control group. Participants in the WeChat group had higher overall satisfaction scores than those in the control group (mean 8.48, SD 1.12 vs mean 6.66, SD 1.80, P

Metabolic competition is a zero‐sum game between bacterial biofilms and host immune responses on the surface of medical implants. In an in vitro biofilm‐macrophages co‐culture system, it is found that suppressed lipid metabolic processes in host macrophages in the biofilm microenvironment correlates with immune tolerance and intracellular persistence. Reactivation of immune cells against bacterial infection by reprogramming lipid metabolism through the supply of lipids such as oleic acid (OA) is a promising strategy, but this cannot completely destroy the bacterial biofilms. Nanomaterial‐based zinc ion interference therapy in antibacterial field emerges relying on the outstanding benefits of nanomaterials. Therefore, a targeted nano‐fat HSA‐IR820@OA@ZIF‐8 (HIROZ) with near infrared‐II (NIR‐II) photothermal capacities is developed for the destrcution of the biofilms via zinc ion combined photothermal therapy. The improved cellular compatibility and enhanced intracellular uptake make HIROZ induce intracellular lipid droplets (LDs) formation in macrophages. Photothermal combined zinc ion‐induced metabolic interference augments the antimicrobial effect of LDs and activates lipometabolic reprogramming‐mediated antibacterial immune responses via mitochondrial stress. In the mouse wound biofilm infections model and subcutaneous implant‐associated biofilm infections (IABIs) model, HIROZ demonstrates sustained and thorough biofilm scavenging based on reprogramming of lipid metabolism, providing a new idea for metabolic interference‐centered therapeutic strategies for full‐scale IABIs eliminations. [ABSTRACT FROM AUTHOR]

Inadequate osseointegration at the interface is a key factor in orthopedic implant failure. Mechanistically, traditional orthopedic implant interfaces fail to precisely match natural bone regeneration processes in vivo. In this study, a novel biomimetic coating on titanium substrates (DPA‐Co/GFO) through a mussel adhesion‐mediated ion coordination and molecular clicking strategy is engineered. In vivo and in vitro results confirm that the coating exhibits excellent biocompatibility and effectively promotes angiogenesis and osteogenesis. Crucially, the biomimetic coating targets the integrin α2β1 receptor to promote M2 macrophage polarization and achieves a synergistic effect between immunomodulation and vascularized bone regeneration, thereby maximizing osseointegration at the interface. Mechanical push‐out tests reveal that the pull‐out strength in the DPA‐Co/GFO group is markedly greater than that in the control group (79.04 ± 3.20 N vs 31.47 ± 1.87 N, P < 0.01) and even surpasses that in the sham group (79.04 ± 3.20 N vs 63.09 ± 8.52 N, P < 0.01). In summary, the novel biomimetic coating developed in this study precisely matches the natural process of bone regeneration in vivo, enhancing interface‐related osseointegration and showing considerable potential for clinical translation and applications. [ABSTRACT FROM AUTHOR]

Background: Mobile bearing fracture is a rare long‐term complication of unicompartmental knee arthroplasty (UKA), and relevant reports are sparse. Hence, its treatment options need further exploration. Case Presentation: This study presents the case of fracture of a polyethylene insert that occurred 12 years after mobile bearing medial UKA in a 75‐year‐old overweight woman who then underwent surgical intervention at our institution. However, we encountered significant challenges in removing the fragments from the broken bearing, resulting in retention of the remaining one‐third of the fragment. We solved this problem by replacing the fractured insert with thicker mobile bearing. During the 1‐month postoperative follow‐up, the patient achieved good range of motion and excellent satisfaction, with no reported complications and a Knee Society Score of 90. Additionally, we reviewed the literature on the treatment for mobile bearing fractures after UKA. Conclusions: Bearing fracture is a rare cause of failure of mobile bearing UKA. This case highlights the challenges of UKA fracture bearing retrieval and underscores that mobile bearing replacement can be an effective intervention. The case we report shows that when removal of a residual meniscal bearing in a posterior dislocation is difficult to achieve, compromise may be an appropriate option because it does not cause additional complaints to the patient. This case emphasizes the importance of the surgeon having a thorough preoperative understanding of the location and potential pitfalls of fracture fragments in such situations. [ABSTRACT FROM AUTHOR]

Objective: Total hip arthroplasty (THA) combined with proximal femoral reconstruction is a novel osteotomy technique developed to address severe hip deformities. There is a paucity of robust clinical and radiological evidence regarding the outcomes of this novel osteotomy technique. This study aimed to evaluate the clinical and radiological outcomes of THA combined with proximal femoral reconstruction during the early follow‐up. Methods: This is a retrospective case series of 63 hips who underwent THA combined with proximal femoral reconstruction at a single institution between January 2020 and July 2023. The mean age of patients was 39.6 ± 12.6 years. The mean follow‐up was 25.6 ± 3.8 months. Surgical characteristics and perioperative variables were evaluated to assess the efficacy of this technique. Harris hip score (HHS) was utilized to evaluate hip function. Leg length discrepancy (LLD) was evaluated in X‐ray. The incidence of major adverse events including deep vein thrombosis (DVT), osteolysis, nonunion of the osteotomy, intraoperative femoral fracture, and infection was also evaluated. Paired‐samples t‐test was used to compare preoperative and postoperative HHS and LLD. Results: The mean operative time was 125.1 min. The mean size of the acetabular components used was 45.2 mm, and the stem size was 7.5. The primary friction interface was ceramic‐on‐ceramic, accounting for 92.1% of cases. The average length of hospital stay was 8.5 days. The mean cost of treatment was 46,296.0 Yuan. There was a significant improvement in postoperative HHS (p < 0.001) and LLD (p < 0.001) compared to preoperative values. The incidence of deep venous thrombosis was 4.8%; osteolysis rates for the cup and stem were 4.8% and 6.4%, respectively. The non‐union and dislocation rates were 1.6% and 3.2%, respectively. There was no incidence of postoperative infection. Conclusion: The novel osteotomy surgical procedure yields reliable and impressive clinical and radiological outcomes, with minimal complications. We advocate for its use in complex primary THA cases involving severe proximal femoral deformities. [ABSTRACT FROM AUTHOR]

Extracellular vesicles (EVs) derived from differentiating induced stem cells maintain their original stemness and differentiating trends and possess strong immunoregulatory capability. Biomaterials equipped with EVs are very promising in regenerative medicine. However, surface EV‐decoration on osteoimplants remains a challenge, due to the complexity of traditional molecular conjugations and the fragility of EVs. Here, mussel‐like molecular adhesion is combined with bioorthogonal click conjugation to introduce EVs on titanium (Ti) implants. The biomimetic adhesion and clickable molecular linkage allow mild and stable tethering of pre‐osteogenic mesenchymal stem cell (MSC)‐derived EVs on Ti implants. EV‐decorated implants exhibit significantly enhanced osseointegration on the bone‐implant surface under diabetic conditions, promoting increased expression of osteogenic genes. Modified surfaces impelled phenotypic alterations in macrophage polarization via multi‐pathway regulation, decreasing proinflammatory M1 macrophage formation, which can lead to the promotion of surface osteogenesis. On Ti rods implanted in a diabetic rat model, EV coating inhibited M1macrophages around the prosthesis, resulting in satisfactory long‐term osseointegration. This study offers a new perspective to represent a simple and effective means for surface EV decoration, providing an osteoimmunomodulatory effect to enhance the diabetic osseointegration of implants. [ABSTRACT FROM AUTHOR]

Soft tissue injuries (STIs) are the most common cause of extremity pain and motion dysfunction. Persistent inflammatory activation of immune cells characterized by senescence‐associated secretory phenotype (SASP) and mitochondrial stress are considered the primary causes of STIs, a pathological process also termed inflammaging. Meanwhile, scavenging excessive "cellular waste" in the inflammaging microenvironment and further activating tissue repair processes remain elusive. Herein, an anti‐inflammaging photothermal hydrogel microneedle patch for treating STIs is developed. Taurine‐loaded Prussian blue nanoparticles (Taurine@PB) are encapsulated in a methacrylate‐based hyaluronic acid hydrogel (HAMA) and further fabricated into taurine@PB@HAMA@microneedles (TPH@MN) patches. The acidic microenvironment of chronic inflammation and mild photothermal effects promote taurine release and anti‐inflammaging immunomodulation, inhibiting mitochondrial stress via the SIRT3‐NF‐κB axis to promote glycolytic metabolic microenvironment of neutrophils reprogramming toward oxidative phosphorylation metabolism. Furthermore, TPH@MN activates macrophage efferocytosis and initiates the process of tissue repair. In mouse models of chronic diabetic wounds and tibialis anterior (TA) muscle injury, TPH@MN inhibits SASP expression and promotes STIs healing through thermosensitized anti‐inflammaging immunomodulation. In summary, TPH@MN circumvents the side effects of systemic administration, providing new translatable options in the treatment modalities for patients suffering from STIs worldwide. [ABSTRACT FROM AUTHOR]

This paper investigates physically crosslinked organo-hydrogels for total hip replacement surgery. Current materials in artificial joints have limitations in mechanical performance and biocompatibility. To overcome these issues, a new approach based on hydrogen bonds between polyvinyl alcohol, poly(2-hydroxyethyl methacrylate), and glycerin is proposed to develop bioactive organo-hydrogels with improved mechanical properties and biocompatibility. This study analyzes local pathological characteristics, systemic toxicity, and mechanical properties of the gels. The results show that the gels possess excellent biocompatibility and mechanical strength, suggesting their potential as an alternative material for total hip replacement surgery. These findings contribute to improving patient outcomes in joint replacement procedures. [ABSTRACT FROM AUTHOR]

Traumatic heterotopic ossification (THO) represents one of the most prominent contributors to post‐traumatic joint dysfunction, which currently lacks an effective and definitive preventative approach. Inflammatory activation due to immune dyshomeostasis during the early stages of trauma is believed to be critical in initiating the THO disease process. This study proposes a dual‐homeostatic modulation (DHM) strategy to synergistically prevent THO without compromising normal trauma repair by maintaining immune homeostasis and inducing stem cell homeostasis. A methacrylate‐hyaluronic acid‐based hydrogel spray device encapsulating a curcumin‐loaded zeolitic imidazolate framework‐8@ceric oxide (ZIF‐8@CeO2, CZC) nanoparticles (CZCH) is designed. Photo‐crosslinked CZCH is used to form hydrogel films fleetly in periosteal soft tissues to achieve sustained curcumin and CeO2 nanoparticles release in response to acidity and reactive oxygen species (ROS) in the inflammatory microenvironment. In vitro experiments and RNA‐seq results demonstrated that CZCH achieved dual‐homeostatic regulation of inflammatory macrophages and stem cells through immune repolarization and enhanced efferocytosis, maintaining immune cell homeostasis and normal differentiation. These findings of the DHM strategy are also validated by establishing THO mice and rat models. In conclusion, the CZCH hydrogel spray developed based on the DHM strategy enables synergistic THO prevention, providing a reference for a standard procedure of clinical operations. [ABSTRACT FROM AUTHOR]

Background: The use of unicompartmental knee arthroplasty (UKA) in patients with preoperative synovitis is controversial. This study aimed to investigate the association between synovitis detected by magnetic resonance imaging (MRI) and prognosis after UKA. Methods: Synovitis was graded using the MRI Osteoarthritis Knee Score criteria based on preoperative MRI findings of 132 UKAs performed between June 2020 and August 2021. The Knee Society Knee Score (KS-KS) and the Knee Society Function Score were collected preoperatively and 1 year postoperatively. The relationship between synovitis and the changes in the Knee Society score was analyzed using logistic regression. Results: Univariate logistic regression showed that patients with higher preoperative synovitis scores (odds ratio (OR) = 1.925, 95% confidence interval (CI): 1.482–2.500, P < 0.001) had higher KS-KS changes. After adjusting for confounding variables, synovitis was proven to be an independent factor for KS-KS improvement after UKA in multivariate logistic regression (OR = 1.814, 95% CI: 1.354–2.430, P < 0.001). Before UKA, patients with synovitis had lower pain scores (PS) than patients without synovitis (95% CI: -17.159 – -11.160, t = -9.347, P < 0.001). There was no difference in PS between the two groups after UKA (95% CI: -6.559 – 0.345, t = -1.782, P = 0.077). Conclusions: Patients with synovitis can achieve good improvement of pain symptoms, and the efficacy is not inferior to that of non-synovitis patients after UKA. [ABSTRACT FROM AUTHOR]

Biofilm-infected diabetic wounds (BIDWs) with hyperglycemia and bacterial colonization are characterized by disordered inflammation and abnormal activation ofNLRP3 inflammasome, leading to sustained macrophage M1 polarization and neutrophil extracellular traps (NETs) formation. An immoderate anti-inflammatory treatment that downregulates NLRP3 in turn promotes the persistence of biofilm infections and impairs the healing ofBIDWs. Therefore, reconciling biofilm elimination and immune regulation holds the promise of curing BIDWs. Herein, a novel spatiotemporal on-off immunomodulatory therapy (SOIT) is proposed for treating BIDWs through biphasic regulation of NLRP3. Methacrylate gelatin hydrogels (Gel-MA) incorporated with graphene oxide (GO) and metformin-loaded mesoporous silicone nanospheres are synthesized and photo cross-linked to construct a nanocomposite hydrogel (MGO@GM). First, GO nanosheets released from MGO@GM inhibit bacterial biofilm formation and disrupt mature biofilms under near-infrared irradiation. Meanwhile, GO activates the NLRP3 to induce a macrophage-associated proinflammatory response against biofilms. Afterward, with the subsequent degradation ofMGO@GM, released metformin reduces local hyperglycemia, downregulates NLRP3, and inhibits NETs formation. Furthermore, repolarized M2 macrophages alleviate the inflammatory microenvironment and promote tissue regeneration. Briefly, this SOIT strategy regulates the NLRP3 and rescues impaired innate immunity to facilitate anti-infection and tissue repair, which provides a new perspective for the future clinical treatment of BIDWs. [ABSTRACT FROM AUTHOR]

Background. Bone cement spacers are widely used in two-stage revision surgeries for periprosthetic joint infection (PJI) after total knee arthroplasty. Current spacer design results in insufficient release of drugs; therefore, current spacers have low efficacy. In this study, we explored a set of alternative articular spacer using 3D printing technology. This novel spacer will increase effectiveness of revision surgery for PJI. Methods. The spacer was designed using CAD software and constructed on site using 3D-printed silicone mold during debridement surgery. We carried out a retrospective study among patients undergoing treatment using traditional static and new articular spacers. Infection control rate, bone loss, difficulty of revision surgery, knee joint range of motion, function evaluation, and subjective satisfaction of the patients in the two groups were compared. Results. Forty-two patients undergoing knee revision surgery between Jan 2014 and Nov 2019 were included in this study. Twenty-two patients were treated with static antibiotic cement spacers, whereas the other twenty patients were with treated with 3D printing-assisted antibiotic loaded articulating spacers. Patients in the articular group showed significantly lower bone loss on the femur site and tibial site compared with patients in the static group. In addition, patients in the articular group showed significantly less operation time, intraoperative blood loss, and improved knee function and patient overall satisfaction compared with patients in the static group. Conclusions. The 3D printing-assisted articular spacer provides satisfactory range of motion during the interim period, prevents bone loss, facilitates second-stage reimplantation and postoperative rehabilitation, and results in low reinfection and complication rates. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a highly heritable skeletal muscle disease. However, the genetic mechanisms mediating the pathogenesis of osteoporosis remain unclear. Accordingly, in this study, we aimed to clarify the transcriptional regulation and heritability underlying the onset of osteoporosis. Methods: Transcriptome gene expression data were obtained from the Gene Expression Omnibus database. Microarray data from peripheral blood monocytes of 73 Caucasian women with high and low bone mineral density (BMD) were analyzed. Differentially expressed messenger RNAs (mRNAs) and long non-coding RNAs (lncRNAs) were identified. Differences in BMD were then attributed to several gene modules using weighted gene co-expression network analysis (WGCNA). LncRNA/mRNA regulatory networks were constructed based on the WGCNA and subjected to functional enrichment analysis. Results: In total, 3,355 mRNAs and 999 lncRNAs were identified as differentially expressed genes between patients with high and low BMD. The WGCNA yielded three gene modules, including 26 lncRNAs and 55 mRNAs as hub genes in the blue module, 36 lncRNAs and 31 mRNAs as hub genes in the turquoise module, and 56 mRNAs and 30 lncRNAs as hub genes in the brown module. JUN and ACSL5 were subsequently identified in the modular gene network. After functional pathway enrichment, 40 lncRNAs and 16 mRNAs were found to be related to differences in BMD. All three modules were enriched in metabolic pathways. Finally, mRNA/lncRNA/pathway networks were constructed using the identified regulatory networks of lncRNAs/mRNAs and pathway enrichment relationships. Conclusion: The mRNAs and lncRNAs identified in this WGCNA could be novel clinical targets in the diagnosis and management of osteoporosis. Our findings may help elucidate the complex interactions between transcripts and non-coding RNAs and provide novel perspectives on the regulatory mechanisms of osteoporosis. [ABSTRACT FROM AUTHOR]

Objective: To introduce a modified osteotomy method for proximal femur reconstruction (PFR) in total hip arthroplasty (THA) for high developmental dysplasia of the hip (DDH). Method: A retrospective study was performed in a series of 24 patients (26 hips) with Crowe III/IV DDH who underwent THA and simultaneous PFR. We used an animated video to illustrate and help understand the procedure for this technique. Patients were reviewed clinically and radiographically with an average follow‐up of 31 months. The Harris hip score (HHS) was recorded preoperatively and at 3 and 12 months postoperatively. Results: All patients achieved primary bone union. No revision was needed up to the latest follow‐up. One patient had a dislocation due to self‐fall and received manual reduction under general anesthesia. No patient had intraoperative femoral fractures, sciatic nerve injury, or infection. The mean HHS improved from 33.48 ± 9.06 preoperatively to 84.61 ± 4.78 immediately after surgery and 90.84 ± 4.96 at 12 months. Conclusion: Proximal femur reconstruction is a simple and practical technique for femoral remolding during THA in patients with high DDH. [ABSTRACT FROM AUTHOR]

In this paper, a specific design strategy targeting c-met kinase was reported based on docking modeling and topomer comparative molecular field analysis (Topomer CoMFA). A novel U-shape conformation which is distinct from the literature was demonstrated by molecular docking among 68 U-shape c-met inhibitors. According to the docking results, two Topomer CoMFA models with high predictive ability were established based on the two fragment rule. The results from both docking and topomer CoMFA showed that the π-π stacking interaction with Tyr1230 and the hydrogen bond with hinge region play an important role in inhibitory activity. Furthermore, the flexible linker and the adjacent solvent group would be favorable to stabilize the conformation and to enhance the two interactions mentioned above. Based on our patent, 14 new compounds were designed by our design strategy. The binding mode exhibited as expected and their activities were predicted by topomer CoMFA model. The preliminary biological tests showed most of them have potent activity to c-met kinase. Our study would provide guidelines to design some new U-shaped c-met inhibitors with new scaffolds and optimize the current molecules. [ABSTRACT FROM AUTHOR]