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Background: The number of total knee arthroplasty (TKA) procedures performed annually is increasing for reasons not fully explained by population growth and increasing rates of obesity. The purpose of this study was to determine the role of patient functional status as an indication for surgery and to determine if patients are undergoing surgery with a higher level of preoperative function than in the past. Methods: A systematic review and meta-analysis of the MEDLINE, Embase and Cochrane databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Functional status was assessed using the 36-Item Short Form Health Survey's physical component summary (PCS) score. Only primary procedures were included. Articles were screened by 2 independent reviewers, with conflicts resolved with a third reviewer. Meta-regression analysis was performed to determine the effect of time, age and sex on preoperative PCS score. Subgroup analysis was performed to compare results for the United States with those for the rest of the world. Results: A total of 1502 articles were identified, of which 149 were included in the study. Data from 257 independent groups including 57844 patients recruited from 1991 to 2015 were analyzed. The mean preoperative PCS score was 31.1 (95% confidence interval 30.6-31.7) with a 95% prediction interval of 22.8-39.5. The variance across stuthes was found to be significant (p < 0.001) with 99.01% true variance. Year of enrolment, age, the percentage of female patients and geographic region did not have any significant effect on preoperative PCS score. Conclusion: Patients are undergoing TKA with a level of preoperative function similar to their level of function in the past. Patient age, sex and location did not influence the functional status at which patients were considered to be candidates for surgery. Contexte : La hausse du nombre annuel d'interventions pour prothèse totale du genou (PTG) ne peut s'expliquer entièrement par la croissance de la population et l'augmentation du taux d'obésité. Cette étude avait pour but de déterminer dans quelle mesure le statut fonctionnel constitue une indication de la chirurgie et si à présent la chirurgie est effectuée chez des malades plus fonctionnels que par le passé. Méthodes : Une revue systématique et méta-analyse des articles recensés à partir des bases de données MEDLINE, Embase et Cochrane a été effectuée conformément à la Norme de réalisation de revue systématique de la littérature PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Le statut fonctionnel a été établi selon le score du sommaire de la dimension physique (SDP) du questionnaire SF-36. Seules les interventions primaires ont été incluses. Les articles ont été passés en revue par 2 réviseurs indépendants, et tout désaccord était résolu par une troisième personne. Une méta-analyse de régression a été effectuée pour évaluer l'effet du temps, de l'âge et du sexe sur le score préopératoire du SDP. Une analyse de sous-groupes a permis de comparer les résultats entre les États-Unis et les autres pays. Résultats : En tout, 1502 articles ont été recensés, et 149 ont été inclus dans l'étude. Les données de 257 groupes indépendants regroupant 57 844 participants recrutés entre 1991 et 2015 ont pu être analysées. Le score préopératoire moyen du SDP a été de 31,1 (intervalle de confiance de 95% 30,6-31,7), avec un intervalle de prévision de 95% à 22,8-39,5. La variance s'est révélée significative entre les études (p < 0,001) avec une variance vraie de 99,01%. L'année de l'inclusion, le pourcentage de participantes féminin et le lieu géographique n'ont eu aucun effet significatif sur le score préopératoire du SDP. Conclusion : Les PTG sont effectuées chez des participants qui ont un score de fonctionnement similaire aux scores d'autrefois. L'âge, le sexe et le lieu géographique n'ont pas exercé d'influence sur le score de statut fonctionnel à partir duquel les personnes étaient considérées candidates à la chirurgie., Total knee arthroplasty (TKA) is one of the most common orthopedic procedures. It is cost effective in relieving pain and improving function of patients with advanced joint disease, usually due [...]

Emerging evidence indicates periostin (POSTN) is upregulated in patients with OA, and studies have shown that it can induce the activation of inflammatory cytokines and catabolic enzymes, making it a potential therapeutic target. Link N (LN) is a peptide fragment derived from the link protein and has been demonstrated as an anabolic-like factor and anti-catabolic and anti-inflammatory factors both in vitro and in vivo. This study aims to determine if LN can regulate POSTN expression and function in OA cartilage. Articular cartilage was recovered from donors undergoing total knee replacements to isolate chondrocytes and prepare osteochondral explants. Cells and explants were treated with POSTN and LN (1 and 100 μg) and measured for changes in POSTN expression and various matrix proteins, catabolic and proinflammatory factors, and signaling. To determine the effects of POSTN expression in vivo, a rabbit OA model was used. Immunoprecipitation and in silico modeling were used to determine peptide/POSTN interactions. Western blotting, PCR, and immunohistochemistry demonstrated that LN decreased POSTN expression both in vitro and in vivo. LN was also able to directly inhibit POSTN signaling in OA chondrocytes. In silico docking suggested the direct interaction of LN with POSTN at residues responsible for its oligomerization. Immunoprecipitation experiments confirmed the direct interaction of LN with POSTN and the destabilization of its oligomerization. This study demonstrates the ability of a peptide, LN, to suppress the overexpression and function of POSTN in OA cartilage. [ABSTRACT FROM AUTHOR]

Knee kinematics during a drop vertical jump, measured by the Kinect V2 (Microsoft, Redmond, WA, USA), have been shown to be associated with an increased risk of non-contact anterior cruciate ligament injury. The accuracy and reliability of the Microsoft Kinect V2 has yet to be assessed specifically for tracking the coronal and sagittal knee angles of the drop vertical jump. Eleven participants performed three drop vertical jumps that were recorded using both the Kinect V2 and a gold standard motion analysis system (Vicon, Los Angeles, CA, USA). The initial coronal, peak coronal, and peak sagittal angles of the left and right knees were measured by both systems simultaneously. Analysis of the data obtained by the Kinect V2 was performed by our software. The differences in the mean knee angles measured by the Kinect V2 and the Vicon system were non-significant for all parameters except for the peak sagittal angle of the right leg with a difference of 7.74 degrees and a p-value of 0.008. There was excellent agreement between the Kinect V2 and the Vicon system, with intraclass correlation coefficients consistently over 0.75 for all knee angles measured. Visual analysis revealed a moderate frame-to-frame variability for coronal angles measured by the Kinect V2. The Kinect V2 can be used to capture knee coronal and sagittal angles with sufficient accuracy during a drop vertical jump, suggesting that a Kinect-based portable motion analysis system is suitable to screen individuals for the risk of non-contact anterior cruciate ligament injury. [ABSTRACT FROM AUTHOR]

Evaluation and treatment of pain following hip resurfacing arthroplasty can be challenging, even for the most experienced arthroplasty surgeon. As in any total hip replacement, there are a number of investigative tools at the disposal of orthopaedic surgeons to elicit the underlying causes of pain for diagnosis and treatment. A detailed history and physical examination are the most important first steps in the differential diagnosis of the intrinsic and extrinsic etiologies of hip pain. Serial radiographs from the time of surgery also should be reviewed and compared for changes indicative of loosening, migration, and osteolysis, in combination or alone. Diagnostic injections with local anesthetic agents additionally can be performed to localize the origin of pain. Bone scintigraphy hip joint aspiration, and laboratory tests, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), should be requested routinely to exclude an occult infection. The use of ultrasound (US), magnetic resonance imaging (MRI), and even hip arthroscopy has been suggested as potential diagnostic tools when metal sensitivity is suspected. Relative to cause, femoral neck fractures and the possibility of metal hypersensitivity as sources of persistent groin pain should always be considered in metal-on-metal hip resurfacing. Additionally iliopsoas tendinopathy and anterior impingement of the femoral neck are well-recognized causes of pain and should be included in the differential diagnosis. Surface arthroplasty is becoming an acceptable alternative to standard total hip replacement in young patients, it is increasingly essential to recognize the different causes of pain following resurfacing in order to make an accurate diagnosis and initiate timely, appropriate treatment. [ABSTRACT FROM AUTHOR]

This study used computer simulation to endeavor to quantify the relative degree of difficulty of resurfacing femora with pistol-grip deformities compared to relatively normal femora. Computer models of five pistol-grip femora and one relatively normal femur were computed from computed tomography (CT) scans of patients who had undergone computer-assisted hip resurfacing. A computer simulation of positioning the femoral resurfacing component on the femur was performed to count the number of acceptable configurations of the component on the femur. A high number of acceptable configurations implies that the surgeon has greater freedom, or greater margin for error, in implanting the component compared to a femur with a smaller number of acceptable configurations. We found that pistol-grip deformities dramatically reduce the number of acceptable configurations for valgus alignment, and that such configurations result in decreased femoral offset and increased depth of reaming. [ABSTRACT FROM AUTHOR]

Hip resurfacing has recently been offered as an attractive alternative to conventional total hip arthroplasty. This report evaluated the short-term functional outcome and longevity of a newer generation resurfacing device and includes the results of 228 consecutive hip resurfacings in 209 patients at a minimum of two-year follow-up. All resurfacings were performed by a single surgeon using a posterior approach. Excluding infections, there were only three failures (1.3%). The overall survival at 4.6 years was 96.9%. The survival of resurfacing in this study was comparable to that of other published studies of hip resurfacing. Surface hip arthroplasty appears to be an effective alternative to conventional total hip arthroplasty in patients suffering from osteoarthritis. [ABSTRACT FROM AUTHOR]

Thromboembolic disease remains one of the most devastating and potentially lethal complications after elective total knee replacement (TKR) surgery. Studies have shown that 40-85% of patients undergoing TKR will develop venographically confirmed deep vein thrombosis (DVT) if they are not given any type of post-operative thromboprophylaxis and approximately 0.1 to 1.7% will suffer fatal pulmonary embolism (PE). Consequently, there is a general consensus that patients undergoing elective TKR require adequate antithrombotic prophylaxis. The following article reviews current evidence regarding chemical thromboprophylaxis after total knee replacement. Clinical guidelines as described by the American Academy of Orthopaedic Surgeons (AAOS), the American College of Chest Physicians (ACCP) and the UK's National Institute for Health and Clinical Excellence (NICE) are summarized along with the differences between the recommendations. The results of the new oral anticoagulants are reviewed as well as the most recent developments in the search for the most effective venous thromboembolism (VTE) prophylaxis after TKR surgery.