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BackgroundTotal two-stage exchange is commonly used in clinical practice as a treatment for infected total hip arthroplasty (THA); however, this approach involves considerable limitations, including significant bone loss and severe trauma. This retrospective cohort study was conducted to evaluate clinical outcomes following the use of partial two-stage exchange (PTE) for infected THA.MethodsWe performed a retrospective analysis of 28 patients with infected THA who were treated by PTE between September 2000 and June 2019. Eligibility for PTE was limited to patients with a well-fixed femoral stem prosthesis. In the first stage of the operation, the femoral stem prosthesis was preserved; subsequently, the acetabular prosthesis, liner, and head were replaced with an antibiotic-loaded spacer. The new prosthesis was then implanted into patients and monitored for at least 3 months to ensure freedom from infection.ResultsPatients were followed for an average of 4 years (range, 2–11 years), with an overall success rate of 85.7% (24/28). The mean Harris hip score at the final follow-up was 76.2 ± 11.7 points.ConclusionsThe findings of this study suggest that PTE could be an acceptable option for a subset of patients with infected THA, offering a satisfactory infection control rate and clinical outcomes comparable to those of total two-stage exchange, but with less harm.

External fixation is a common, efficient technique used for humeral shaft stabilization and elbow fractures. There are reports of radial nerve injuries associated with this procedure. In this study, we investigated the course and variability of the radial nerve along the lateral humerus in relation to the elbow joint to determine a relatively safe zone for lateral pin placement in external fixation. Twenty upper extremities from 10 cadavers were studied. The nerve branches and course of the radial nerve along the lateral humerus were carefully dissected. Straight lines (a, b, and c) were made connecting three landmarks (the acromion, coracoid process, and anterior wall of the axilla) in the proximal upper extremity to the lateral condyle (LC) of the humerus; their intersections with the radial nerve (A, B, and C) were marked. We analyzed whether the intersection positions were correlated with the connecting line lengths. The mean lengths of the connecting lines were (a) 27.24 ± 2.57, (b) 26.18 ± 2.79, and (c) 20.95 ± 1.44 cm; the distance between the intersection points and the LC of the humerus were (Aa) 7.56 ± 1.31, (Bb) 6.90 ± 2.27, and (Cc) 5.01 ± 0.83 cm; and the measured intersection points of the radial nerve in the lateral aspect of the humerus were (A) 18.48%-34.82%, (B) 13.48%-40.00%, and (C) 19.27%-28.05% of the lengths of lines a, b, and c, respectively. Our data provide a more reliable reference to predict the course of the radial nerve on the lateral humerus and define a safe zone for pin placement. Clin. Anat., 33:637-642, 2020. © 2019 Wiley Periodicals, Inc.

Background: The mechanical properties of bone grafts used to reconstruct defects during revision surgery, and their long-term reliability, are important in terms of treatment outcomes. However, few relevant studies have appeared. Herein, we use a new method, the Weibull distribution, to evaluate reliability.Methods: We created impacted bone grafts of two distinct sizes (7–10 mm and small slurry) using an impacting apparatus. The elastic moduli were evaluated in vitro and the Weibull moduli (m values) were calculated.Results: The elastic moduli fitted the Weibull distribution well. Large bone grafts (7–10 mm) exhibited high elastic moduli but low Weibull moduli, suggestive of poor reliability.Conclusions: The Weibull distribution was useful to evaluate the reliability of bone graft mechanical properties. A high Weibull modulus indicated high reliability and thus low variability. Both the values and reliability of mechanical properties must be considered when contemplating bone grafting.

Over-activated osteoclastogenesis, which is initiated by inflammation, has been implicated in osteoporosis. Corilagin, a natural compound extracted from various medicinal herbaceous plants, such as Cinnamomum cassia, has antioxidant and anti-inflammatory activities. We found that Corilagin suppressed osteoclast differentiation in a dose-dependent manner, significantly decreased osteoclast-related gene expression and impaired bone resorption by osteoclasts. Moreover, phosphorylation of members of the nuclear factor-kappaB (NF-κB) and PI3K/AKT signalling pathways was reduced by Corilagin. In a murine model of osteoporosis, Corilagin inhibited osteoclast functions in vivo and restored oestrogen deficiency-induced bone loss. In conclusion, our findings suggested that Corilagin inhibited osteoclastogenesis by down-regulating the NF-κB and PI3K/AKT signalling pathways, thus showing its potential possibility for the treatment of osteoporosis.

Compared to pure poly(L-lactic acid) (PLLA), PLLA/nano-sized β-tricalcium phosphate (PLLA/nβ-TCP) composites show both superior interfacial compatibility and osteoinductive, and consequently hold great potential for bone defect repair applications. However, their dismal osteointegration limits their further development in bone regeneration, adding the need for tailored modification. In this study, a bioinspired modification approach was proposed to construct gelatinhydroxyapatite (GEL/HAP) coating onto PLLA/nβ-TCP composites by combining chemical grafting with in situ reaction methods. The incorporation of the biomimetic GEL/HAP coating substantially improved MC3T3-E1 cell adhesion, proliferation and osteogenic differentiation, as demonstrated by morphological observation. Cell Counting Kit-8 (CCK-8) assay, alkaline phosphate activity test (ALP), and quantitative real-time polymerase chain reaction (qRT-PCR) analysis. Furthermore, GEL/HAP-PLLA/nβ-TCP composites and their control counterparts (i.e., bare PLLA/nβ-TCP) were synchronously implanted into femoral condylar defects of an identical rabbit. Characterizations including microcomputed tomography (micro-CT), histological analysis and the push-out test revealed that the biomimetic coating not only improved osteointegration but also significantly promoted bone regeneration. Overall, for the first time, bioinspired surface modification of the PLLA/nβ-TCP composite with GEL/HAP coating was demonstrated to be an efficient strategy for enhancing the osteointegration and osteogenesis functions of bone implants.

// Lei Feng 1 , Deng Cai 2 , Alanuer Muhetaer 3 , Yin-Long Yang 4 , Fei Ren 5 , Mumingjiang Yishake 6 , Hao Zhang 7 , Yuan Fang 8 and Alimujiang Wushou 1 1 Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, China 2 Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China 3 Department of Gynaecology, Zhongshan Hospital, Fudan University, Shanghai 200000, China 4 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China 5 Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China 6 Department of Orthopedics Surgery, Zhongshan Hospital, Fudan University, Shanghai 200000, China 7 Department of Epidemiology and Biostatistics, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, China 8 Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200000, China Correspondence to: Alimujiang Wushou, email: wushoua@fudan.edu.cn Keywords: spindle cell carcinoma, SEER analysis, prognostic factors Received: February 20, 2017 Accepted: April 17, 2017 Published: May 19, 2017 ABSTRACT Background: Owing to the rarity, the general demographics, basic clinico-pathologic features, management, outcome and prognostic factors of spindle cell carcinoma (SpCC) were unexplored. Methods: A SEER analysis was performed with 2336 cases (1973-2016). Results: A peak incidence occurred at 70~80 years without any gender predominance and 83.13% occurred in white people. The respiratory system was mostly affected tumor site (35%). Significant overall survival (OS) and disease specific survival (DSS) were found differentiated in gender, age, marital status, primary tumor location, AJCC stage, T stage, N stage, M stage, pathologic grade and treatment modality. In the multivariate Cox model, the age > 69 years (Hazard ratio [HR] = 1.427 for OS, P = 0.01 and HR = 1.491 for DSS, P = 0.003; Reference [Ref] age ≤ 69 years), tumor location in respiratory system (HR = 1.550 for OS, P = 0.041 and HR = 1.561 for DSS, P = 0.04; Ref: digestive system), N2 stage (HR = 1.962 for OS, P = 0.006 and HR = 1.982 for DSS, P = 0.004; Ref: N0 stage) and AJCC stage IV (HR = 4.601 for OS, P = 0.000 and HR = 5.107 for DSS, P = 0.000; Ref: stage I) were independently associated with worse OS and DSS. Conclusions: SpCC mostly occurred in white people at 70~80 years old without predominance in any gender. The respiratory system was mostly affected site. The patient’s age, primary tumor location, AJCC stage were independent prognostic indicators for both DSS and OS of SpCC.

Compared to pure poly(L-lactic acid) (PLLA), PLLA/nano-sized β-tricalcium phosphate (PLLA/nβ-TCP) composites show both superior interfacial compatibility and osteoinductive, and consequently hold great potential for bone defect repair applications. However, their dismal osteointegration limits their further development in bone regeneration, adding the need for tailored modification. In this study, a bioinspired modification approach was proposed to construct gelatinhydroxyapatite (GEL/HAP) coating onto PLLA/nβ-TCP composites by combining chemical grafting with in situ reaction methods. The incorporation of the biomimetic GEL/HAP coating substantially improved MC3T3-E1 cell adhesion, proliferation and osteogenic differentiation, as demonstrated by morphological observation. Cell Counting Kit-8 (CCK-8) assay, alkaline phosphate activity test (ALP), and quantitative real-time polymerase chain reaction (qRT-PCR) analysis. Furthermore, GEL/HAP-PLLA/nβ-TCP composites and their control counterparts (i.e., bare PLLA/nβ-TCP) were synchronously implanted into femoral condylar defects of an identical rabbit. Characterizations including microcomputed tomography (micro-CT), histological analysis and the push-out test revealed that the biomimetic coating not only improved osteointegration but also significantly promoted bone regeneration. Overall, for the first time, bioinspired surface modification of the PLLA/nβ-TCP composite with GEL/HAP coating was demonstrated to be an efficient strategy for enhancing the osteointegration and osteogenesis functions of bone implants.

There has been no study regarding the effect of a combination of teriparatide (TPTD) and zoledronic acid (ZA) on vertebral fusion. In this study, we investigate the effect of single and combined TPTD and ZA treatment on lumbar vertebral fusion in aged ovariectomized (OVX) rats. Sixty two-month-old female Sprague-Dawley rats were ovariectomized and underwent bilateral L4-5 posterolateral intertransverse fusion after ten months. The OVX rats received vehicle (control) treatment, or ZA (100µg/kg, once), or TPTD (60µg/kg/2 d for 42 d), or ZA + TPTD until they were euthanized at six weeks following lumbar vertebral fusion. The lumbar spine was harvested. Bone mineral density (BMD), bone fusion, bone volume (BV), and bone formation rate (BFR)were analyzed by dual-energy X-ray absorptiometry (DXA), radiography, micro-computed tomography, and histomorphometry. Compared with vehicle (control) treatment, ZA and TPTD monotherapy increased bone volume (BV) at fusion site, and ZA + TPTD combined therapy had an additive effect. Treatment with TPTD and ZA + TPTD increased the bone fusion rate when compared with the control group. ZA monotherapy did not alter the rate of bone fusion. The TPTD and ZA + TPTD treatment groups had increased mineral apposition rate (MAR), mineralizing surfaces/bone surface ((MS/BS) and BFR/BS compared with the OVX group. Our experiment confirm that the monotherapy with TPTD and combination therapy with ZA + TPTD in an OVX rat model of osteopenia following lumbar vertebral fusion surgery increased bone fusion mass and bone fusion rate, and ZA + TPTD combined therapy had an additive effect on bone fusion mass. This article is protected by copyright. All rights reserved

There has been no study regarding the effect of a combination of teriparatide (TPTD) and zoledronic acid (ZA) on vertebral fusion. In this study, we investigate the effect of single and combined TPTD and ZA treatment on lumbar vertebral fusion in aged ovariectomized (OVX) rats. Sixty two-month-old female Sprague-Dawley rats were ovariectomized and underwent bilateral L4-L5 posterolateral intertransverse fusion after 10 months. The OVX rats received vehicle (control) treatment, or ZA (100 µg/kg, once), or TPTD (60 µg/kg/2 d for 42 d), or ZA + TPTD until they were euthanized at 6 weeks following lumbar vertebral fusion. The lumbar spine was harvested. Bone mineral density (BMD), bone fusion, bone volume (BV), and bone formation rate (BFR)were analyzed by dual-energy X-ray absorptiometry (DXA), radiography, micro-computed tomography, and histomorphometry. Compared with vehicle (control) treatment, ZA and TPTD monotherapy increased bone volume (BV) at fusion site, and ZA + TPTD combined therapy had an additive effect. Treatment with TPTD and ZA + TPTD increased the bone fusion rate when compared with the control group. ZA monotherapy did not alter the rate of bone fusion. The TPTD and ZA + TPTD treatment groups had increased mineral apposition rate (MAR), mineralizing surfaces/bone surface ((MS/BS), and BFR/BS compared with the OVX group. Our experiment confirm that the monotherapy with TPTD and combination therapy with ZA + TPTD in an OVX rat model of osteopenia following lumbar vertebral fusion surgery increased bone fusion mass and bone fusion rate, and ZA + TPTD combined therapy had an additive effect on bone fusion mass. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:937-944, 2018.

Nucleus pulposus (NP) cells experience hyperosmotic stress in spinal discs; however, how these cells can survive in the hostile microenvironment remains unclear. Autophagy has been suggested to maintain cellular homeostasis under different stresses by degrading the cytoplasmic proteins and organelles. Here, we explored whether autophagy is a cellular adaptation in rat notochordal cells under hyperosmotic stress. Hyperosmotic stress was found to activate autophagy in a dose- and time-dependent manner. SQSTM1/P62 expression was decreased as the autophagy level increased. Transient Ca(2+) influx from intracellular stores and extracellular space was stimulated by hyperosmotic stress. Activation of AMPK and inhibition of p70S6K were observed under hyperosmotic conditions. However, intercellular Ca(2+) chelation inhibited the increase of LC3-II and partly reversed the decrease of p70S6K. Hyperosmotic stress decreased cell viability and promoted apoptosis. Inhibition of autophagy led to SQSTM1/P62 accumulation, reduced cell viability, and accelerated apoptosis in notochordal cells under this condition. These evidences suggest that autophagy induction via the Ca(2+)-dependent AMPK/mTOR pathway might occur as an adaptation mechanism for notochordal cells under hyperosmotic stress. Thus, activating autophagy might be a promising approach to improve viability of notochordal cells in intervertebral discs.

Background Prosthetic joint infection (PJI) is the most common cause of total joint arthroplasty failure and revision surgery. Genetic polymorphisms could be determinant factors for PJI. Methods We performed a systematic research of Medline, Pubmed, Embase, Cochrane Library, and Google Scholar, and identified 11 studies with 34 kinds of gene polymorphisms, were included in the synthesis. Results Our data suggest that the C allele and genotype C/C for MBL-550 SNP, genotype A/A for MBL-54 SNP and G allele for MBL-221 SNP increase the risk of PJI, while G allele and genotype G/G for MBL-550 SNP decrease the risk of PJI in Caucasian populations. Several other genes reported by single-center studies also contribute to the genetic susceptibility to septic PJI. No definitive conclusions could be achieved due to the small amount of data in the included studies. Conclusion Several genes contribute to the genetic susceptibility to PJI following total joint arthroplasty. Further studies will enhance the understanding of PJI, and may inform and direct early interventions.