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Background: The purpose of this study was to compare total complications, complications stratified by type, readmissions, and reoperations at 30 and 90 days after outpatient and standard inpatient total knee and total hip arthroplasty (TKA, THA)., Methods: A literature search was conducted from the PubMed, Cochrane Library, and Embase databases for articles published before 20 August 2021. The types of studies included prospective randomized controlled trials, prospective cohort studies, retrospective comparative studies, retrospective reviews of THA and TKA registration databases, and observational case-control studies. Comparisons of interest included total complications, complications stratified by type, readmissions, and reoperations at 30 and 90 days. The statistical analysis was performed using Review Manager 5.3., Results: Twenty studies with 582,790 cases compared relevant postoperative indicators of outpatient and inpatient total joint arthroplasty (TJA) (TKA and THA). There was a significant difference in the total complications at 30 days between outpatient and inpatient THA ( p  = 0.001), readmissions following TJA ( p  = 0.03), readmissions following THA ( p  = 0.001), stroke/cerebrovascular incidents following TJA ( p  = 0.01), cardiac arrest following TJA ( p  = 0.007), and blood transfusions following TJA ( p  = 0.003). The outcomes showed an obvious difference in 90-day total complications between outpatient and inpatient TJA ( p  = 0.01), readmissions following THA ( p  = 0.002), and surgical-related pain following TJA ( p  < 0.001). We did not find significant differences in the remaining parameters., Conclusion: Outpatient procedures showed comparable and even better outcomes in total complications, complications stratified by type, readmissions, and reoperations at 30 and 90 days compared with inpatient TJA for selected patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Gong, Yi, Wang, Han, Gong, Wang, Shao, Feng and Xu.)

Objective: The purpose of this study was to investigate the value of the lateral point of articular surface of distal tibia (LADT) for anatomical alignment in total knee arthroplasty., Methods: We reconstructed 148 three-dimensional pre-arthritic tibias and measured the tibial component inclination angle corresponding to the distal landmark of LADT. A retrospective study included 81 TKA recipients divided into the AA group and MA group. Clinical assessments including ROM, HSS, WOMAC, satisfaction for surgery, and radiological assessment were evaluated at one-year follow-up., Results: The tibial component varus angle corresponding to the distal landmark of LADT in the male and female groups were 3.4 ± 0.3° (2.6~4.2°) and 3.2 ± 0.3° (2.3~4.0°), respectively ( P <0.05). Using LADT as the distal landmark for extramedullary tibial cutting guidance, the medial proximal tibia angle (MPTA) of the AA group was 87.0±1.2° (85.0~90.0°), and the AA and MA technique showed no difference in improvement in postoperative knee functional recovery at final follow-up., Conclusions: This study preliminarily indicated that LADT can be a reliable and economical landmark for coronal plane alignment of the tibial component., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gong, Wang, Gong, Han, Yi, Wang and Xu.)

Steroid-induced osteonecrosis of femoral head (SONFH) is a common and serious complication caused by long-term and/or excessive use of glucocorticoids (GCs). The decreased activity and abnormal differentiation of bone marrow mesenchymal stem cells (BMSCs) are considered to be one of the major reasons for the onset and progression of this disease. Periostin (POSTN) is a matricellular protein which plays an important role in regulating osteoblast function and bone formation. Sclerostin (SOST) is a secreted antagonist of Wnt signaling that is mainly expressed in osteocytes to inhibit bone formation. However, the exact role of POSTN and SOST in SONFH has not been reported yet. Therefore, we detected the differential expression of POSTN and SOST in BMSCs of SONFH Group patients, and Control Group was patients with traumatic ONFH (TONFH) and developmental dysplasia of the hip (DDH). Furthermore, we used lentiviral transfection to knockdown POSTN expression in BMSCs of patients with SONFH to study the effect of POSTN knockdown on the SOST expression and osteogenic differentiation of BMSCs. The results indicated that the endogenous expression of POSTN and SOST in BMSCs of SONFH Group was upregulated, compared with Control Group. POSTN was upregulated gradually while SOST was downregulated gradually at days 0, 3, and 7 of osteogenic differentiation of BMSCs in Control Group. Contrarily, POSTN was gradually downregulated while SOST was gradually upregulated during osteogenic differentiation of BMSCs in SONFH Group. This could be due to increased expression of SOST in BMSCs, which was caused by excessive GCs. In turn, the increased expression of POSTN in BMSCs may play a role in antagonizing the continuous rising of SOST during the osteogenic differentiation of BMSCs in patients with SONFH. POSTN knockdown significantly attenuated osteo-specific gene expression, alkaline phosphatase activity, and calcium nodule formation in vitro ; thus inhibiting the osteogenic differentiation of BMSCs in patients with SONFH. Besides, POSTN knockdown upregulated SOST expression, increased GSK-3β activity, and downregulated β-catenin. These findings suggest that POSTN have an essential role in regulating the expression of SOST and osteogenic differentiation of BMSCs in patients with SONFH, and POSTN knockdown suppresses osteogenic differentiation by upregulating SOST and partially inactivating Wnt/β-catenin signaling pathway. Therefore, targeting POSTN and SOST may serve as a promising therapeutic target for the prevention and treatment of SONFH., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Han, Gong, Wang, Liu, Wang, Chen, Gong and Xu.)