Bony Ankylosis Research Articles

Sternoclavicular Graft Versus Costochondral Graft For Reconstruction ankylosed Temporomandibular joint in a child (Clinical and radiographic comparative study)

Aim: To evaluate the feasibility of using sternoclavicular graft ( SCG) versus costochondral graft for TMJ reconstruction in TMJ ankylosis in child. Patients and methods: A total of 20 patients having unilateral bony TMJ ankylosis underwent gap arthroplasty then reconstruction of TMJ with SCG (Group I) or CCG (Group II). Pre-operative and post-operative clinical and radiographic evaluation were done to assess maximum mouth opening, range of mandibular movements, ramus height, donor and recipient sites complications for 24 month follow up at least . Results: Statistical analysis shows that postoperative measurements of different mouth movements increased comparing preoperative measurements in both groups without any significant difference between groups . While postoperative complications occurrence were higher in Group II than group I in pleural tear ,pain, overgrowth ,and facial asymmetry aspects with high statistical significant difference for pleural tear complication (p 0.05). Conclusion : The present study concludes SCG is a versatile and simple alternative graft to the traditional CCG for TMJ reconstruction with minimal complications in children with TMJ ankylosis.

Microarray Analysis of Differential Gene Expression Between Traumatic Temporomandibular Joint Fibrous and Bony Ankylosis in a Sheep Model.

BackgroundThe type of traumatic temporomandibular joint (TMJ) ankylosis depends on the degree of severity of TMJ trauma. Here, we performed comprehensive differential molecular profiling between TMJ fibrous and bony ankylosis.Material/MethodsSix sheep were used and a bilateral different degree of TMJ trauma was performed to induce fibrous ankylosis in one side and bony ankylosis in the other side. The ankylosed calluses were harvested at days 14 and 28 postoperatively and analyzed by Affymetrix OviGene-1_0-ST microarrays. DAVID was used to perform the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis for the different expression genes (DEGs). The DEGs were also typed into protein–protein interaction (PPI) networks to get the interaction data. Ten DEGs, including 7 hub genes from PPI analysis, were confirmed by real-time PCR.ResultsWe found 90 and 323 DEGs at least 2-fold at days 14 and 28, respectively. At day 14, bony ankylosis showed upregulated DEGs, such as TLR8, SYK, NFKBIA, PTPRC, CD86, ITGAM, and ITGAL, indicating a stronger immune and inflammatory response and cell adhesion, while genes associated with anti-adhesion (PRG4) and inhibition of osteoblast differentiation (SFRP1) had higher expression in fibrous ankylosis. At day 28, bony ankylosis showed increased biological process related to new bone formation, while fibrous ankylosis was characterized by a prolonged immune and inflammatory reaction.ConclusionsThis study provides a differential gene expression profile between TMJ fibrous and bony ankylosis. Further study of these key genes may provide new ideas for future treatment of TMJ bony ankylosis.

Sacralization in the Mary Rose and Kronan assemblages: An inconsistently recorded anomaly

AbstractThis study aims to promote consistent observations of sacralization, a relatively common form of lumbosacral transitional vertebrae (LSTV). Sacralization can inform on genetic affiliation. There are four types, ranging from enlarged transverse processes to bony ankylosis. Complete sacralization reportedly occurs in 1.5%–14% of archeological and modern populations, yet clinical studies can conflate types, resulting in rates as high as 46%. Archeologically obtained sacra and lower lumbar vertebrae from two historical shipwrecks (16th century English warship Mary Rose and 17th century Swedish warship Kronan) are compared via gross observation. These semi‐documented individuals, fit enough to be on a warship during battle, have a documented cause, manner, and date of death. The assemblages yield 120 sacra; complete sacralization is compared between the crews. Both crude and true prevalence of bony ankyloses are recorded with χ2 analyses testing significance. Both samples have 16.7% true prevalence of complete sacralization, with 38.3% of Mary Rose sacra and 26.7% of Kronan sacra showing some variant of LSTV. It is possible the high rates of sacralization shown in both crews are related to the samples being drawn from similar populations: a Swedish clinical study finds a similar rate of 13.9% for “complete” sacralization. However, reported rates of less than 1.0% in other archeological samples suggest that true sacralization is inconsistently recognized. Finally, clinical and archeological studies either conflate all types or fail to state their diagnostic criteria, reducing the ability to accurately compare findings.

Mid-term results of bilateral synchronous total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis

BackgroundTotal hip arthroplasty (THA) for bony ankylosis is technically challenging in patients with ankylosing spondylitis (AS). This study aimed to determine the mid-term results of bilateral synchronous THA for bony ankylosis in patients with AS.MethodsNineteen cases of bony ankylosis in patients with AS who received bilateral synchronous THA were included in this study (17 males and 2 females, mean age 49.2 years). Disease duration was 5–38 years (mean 18 years and 6 months). All patients received cementless THA. Intraoperative blood loss, visual analog scale (VAS) score, and complications were assessed. Harris hip scores evaluated the clinical effect.ResultsPatients were followed up for 62–98 months (mean 82.5 months). VAS score decreased from 7.42 ± 0.92 to 2.42 ± 0.83, Harris hip score improved from 21.8 ± 7.2 to 80.3 ± 6.5, and the flexion-extension range of the hip improved from 0 to 142.3 ± 6.2°. One patient with septum bronchiale had a fracture intraoperatively and was treated with wire strapping. One patient had a traction injury of the femoral nerve postoperatively and recovered 1 year after the operation. Loosening and subsidence were not observed in all patients. Heterotopic bone formation was noted in 3 patients. No complications such as joint dislocation, acute infection, and deep vein thrombosis were found.ConclusionBilateral synchronous THA was effective for bony ankylosis of the hip in patients with AS because it improved patients’ quality of life and had satisfactory mid-term outcomes.

Simultaneous Gap Arthroplasty and Distraction Osteogenesis in the Management of Unilateral Bony TMJ Reankylosis – A Case Report

Temporomandibular Joint ankylosis is the adhesion of the condyle of the mandible to the base of the skull. It is the most common cause of hypoplasia of the mandible and eventual facial asymmetry. This case report describes the management of unilateral bony re-ankylosis of temporomandibular joint after the failure of a costochondral graft in an eight-year-old girl. The management of temporomandibular ankylosis presents a major challenge due to its increased reoccurrence rate. In the present case, simultaneous gap arthroplasty and distraction osteogenesis were performed to separate the ankylotic mass and lengthen the ramus-condyle unit. The one year follow-up of the patient showed adequate mouth opening. We recommend concomitant gap arthroplasty and distraction osteogenesis for effectively managing temporomandibular joint bony ankylosis.

Analysis for different functional results of TMJ ankylosis management by comparing ramus-condyle unit reconstruction using vertical ramus osteotomy and interpositional gap arthroplasty

The objective of the present study was to analyze the functional results of temporomandibular joint (TMJ) range; that is, trismus index, lateral excursion, protrusion, retrusion, occlusion, masticatory efficiency), reestablishment of the anatomic relationship of the TMJ, aesthetics to improve quality of life, and complications in terms of ramus shortening on the affected side, deviation, facial asymmetry, neurologic deficits, and reankylosis. Sixteen patients with unilateral bony ankylosis were included and randomly divided into 2 groups with 8 patients in each group. Group I was treated with interpositional gap arthroplasty followed by reconstruction of the ramus-condyle unit using vertical ramus osteotomy. Group II was treated with interpositional gap arthroplasty. In both groups, a pedicled flap made up of fascia, temporalis muscle, and pericranium was used as an interpositional material. The functional range of the mandible was analyzed pre- and postoperatively. Group I improved significantly more than group II in terms of TMJ range; that is, trismus index, lateral excursion, protrusion, retrusion, reestablishment of the normal anatomic relationship of the TMJ, aesthetics, and masticatory efficiency. The reestablishment of anatomic relationship showed better result in mastication significantly. No reankylosis was reported in any of the groups. The functional results and aesthetics with TMJ reconstruction are significantly better.

Temporomandibular joint ankylosis: A tertiary center-based epidemiological study.

Introduction:Limitation of mouth opening can be caused by bony or fibrous ankylosis of the temporomandibular joint (TMJ) as a sequel to trauma, infection, or autoimmune diseases. The incidence of TMJ ankylosis differs significantly in different parts of the world. The purpose of this study was to analyze the etiological incidence of TMJ ankylosis at our tertiary-level center, which covers a huge population from parts of Bihar and eastern Uttar Pradesh.Materials and Methods:This study was conducted from July 2016 to April 2019, and a total of 1607 children were screened in the duration of 33 months. Participants were included in this study as per the inclusion and exclusion criteria.Results:After screening of the 1607 children, 128 TMJ ankylosis cases were identified. Out of the 128 cases of TMJ ankylosis, 33 cases were bilateral and 95 cases were unilateral (48 left sided and 47 right sided). Most of the patients (83.5%) were in the 10–15-year-old age group (mean age was 12.1 ± 2.83 years). There was a female preponderance, and the male-to-female ratio was 7:10. Overall, the most common cause of ankylosis was found to be childhood trauma.Conclusion:The major etiologic factor of TMJ ankylosis was found to be birth/childhood trauma. TMJ ankylosis cases were detected in significant numbers in this study. This increased prevalence may be due to the lack of knowledge about this pathological entity among the general population and health-care professionals at primary level, which leads to poor initial management.

Comparative Evaluation of Surgical Treatment of Post-traumatic Ankylosis of Temporomandibular Joint Using Conventional Rotary Bur technique and Piezosurgery Unit

Introduction: The temporomandibular joint (TMJ) is the most active joint of the body. Limitations of the mouth opening can be caused by bony or fibrous ankylosis of the TMJ as a sequela to trauma, infection, autoimmune disease or failed surgery. A significant effect of TMJ ankylosis is obstructive sleep apnea (OSA) which can progressively worsen and the symptoms associated with OSA can dominate sidelining the primary disorder itself. Aim/Objectives: The purpose of this study was to investigate and compare the use of conventional rotary bur technique and piezosurgery unit for gap arthroplasty in TMJ ankylosis. Method Used: Twenty patients were examined clinically and radiologically for the treatment. Out of the twenty patients, ten patients were operated using conventional rotary bur technique (Group A) and the remaining ten patients were operated using piezosurgery unit (Group B). Two major parameters that is blood loss and duration of surgery were evaluated intraoperatively and other parameters like pain, mouth opening, swelling and paraesthesia were evaluated on Post Operative Day (POD)-1, 5, 10, 15. Result: We observed that there was a significant reduction in blood loss intraoperatively with the piezosurgery unit though the operating time was prolonged. Post-operative physiotherapy had increased the inter-incisal distance in both groups. Pain levels and swelling were significantly higher in Group A. Other complications like paresthesia were not observed in either of the groups. Conclusion: This comparative study suggests piezosurgery can be a valuable alternative method to the bur technique due to its efficacy in the evaluated parameters.

Case report on long-term temporomandibular joint ankylosis secondary to trauma

The word “ankylosis” is derived from a Greek word meaning “Stiff.” Temporomandibular joint (TMJ) ankylosis is the bony or fibrous union of the joint and its components. The characteristic feature is the limitation in mouth opening. It affects the speck, mastication, facial growth, and appearance. The article describes a case report on severe bony ankylosis TMJ ankylosis secondary to trauma.

Multidetector computed tomography in preoperative planning for temporomandibular joint ankylosis: A pictorial review and proposed structured reporting format.

Ankylosis of the temporomandibular joint (TMJ) is a disabling disease resulting from fibrous or bony fusion of the mandibular condyle and the glenoid fossa. Early diagnosis and surgical treatment are essential to prevent facial deformity and other complications. Conventional radiography has limitations in demonstrating the true extent of ankylosis. It is important for surgeons to be aware of the size and degree of bony ankylosis in order to perform complete resection of the ankylotic mass. In addition, a detailed evaluation of the relationship with adjacent vital structures such as the internal maxillary artery, inferior alveolar nerve canal, external auditory canal, and skull base are crucial to avoid iatrogenic injury. Multidetector computed tomography (MDCT) is the current imaging modality of choice for preoperative assessments. Herein, the authors propose a structured CT reporting template for TMJ ankylosis to strengthen the value of the preoperative imaging report and to reduce the rates of intraoperative complications and recurrence.

SNP-adjacent super enhancer network mediates enhanced osteogenic differentiation of MSCs in ankylosing spondylitis.

Ankylosing spondylitis (AS) is a rheumatic disease with pathological osteogenesis that causes bony ankylosis and even deformity over time. Mesenchymal stem cells (MSCs) are multipotent stem cells that are the main source of osteoblasts. We previously demonstrated that enhanced osteogenic differentiation of MSCs from AS patients (ASMSCs) is related to pathological osteogenesis in AS. However, the more concrete mechanism needs further exploration. Super enhancers (SEs) are dense clusters of stitched enhancers that control cell identity determination and disease development. Single-nucleotide polymorphisms (SNPs) regulate the formation and interaction of SEs and denote genes accounting for AS susceptibility. Via integrative analysis of multiomic data, including histone 3 lysine 27 acetylation (H3K27ac), chromatin immunoprecipitation sequencing (ChIP-seq), SNPs and RNA sequencing (RNA-seq) data, we discovered a transcription network mediated by AS SNP-adjacent SEs (SASEs) in ASMSCs and identified key genes, such as Toll-like receptor 4 (TLR4), interleukin 18 receptor 1 (IL18R1), insulin-like growth factor binding protein 4 (IGFBP4), transportin 1 (TNPO1) and proprotein convertase subtilisin/kexin type 5 (PCSK5), which are pivotal in osteogenesis and AS pathogenesis. The SASE-regulated network modulates the enhanced osteogenic differentiation of ASMSCs by synergistically activating the PI3K-Akt, NF-kappaB and Hippo signaling pathways. Our results emphasize the crucial role of the SASE-regulated network in pathological osteogenesis in AS, and the preferential inhibition of ASMSC osteogenic differentiation by JQ1 indicates that SEs may be attractive targets in future treatment for new bone formation in AS.

Platelet-Derived Growth Factor B Is a Key Element in the Pathological Bone Formation of Ankylosing Spondylitis.

Enthesophyte formation plays a crucial role in the development of spinal ankylosis in ankylosing spondylitis (AS). We aimed to investigate the role of platelet-derived growth factor B (PDGFB) in enthesophyte formation of AS using in vitro and in vivo models and to determine the association between PDGFB and spinal progression in AS. Serum PDGFB levels were measured in AS patients and healthy controls (HC). Human entheseal tissues attached to facet joints or spinous processes were harvested at the time of surgery and investigated for bone-forming activity. The impact of a pharmacological agonist and antagonist of platelet-derived growth factor B receptor (PDGFRB) were investigated respectively in curdlan-treated SKG mice. PDGFB levels were elevated in AS sera and correlated with radiographic progression of AS in the spine. Mature osteoclasts secreting PDGFB proteins were increased in the AS group compared with HC and were observed in bony ankylosis tissues of AS. Expression of PDGFRB was significantly elevated in the spinous enthesis and facet joints of AS compared with controls. Moreover, recombinant PDGFB treatment accelerated bone mineralization of enthesis cells, which was pronounced in AS, whereas PDGFRB inhibition efficiently reduced the PDGFB-induced bone mineralization. Also, PDGFRB inhibition attenuated the severity of arthritis and enthesophyte formation at the joints of curdlan-treated SKG mice. This study suggests that regulating PDGFB/PDGFRB signaling could be a novel therapeutic strategy to block key pathophysiological processes of AS. © 2022 American Society for Bone and Mineral Research (ASBMR).

STAT3 phosphorylation inhibition for treating inflammation and new bone formation in ankylosing spondylitis.

AS is a rheumatic disease characterized by chronic inflammation and bony ankylosis. This study was to evaluate whether a signal transducer and activator of transcription 3 phosphorylation inhibitor (stat3-p Inh) could treat both chronic inflammation and bone formation in AS. Primary AS osteoprogenitor cells and spinal entheseal cells were examined for osteogenic differentiation. SF mononuclear cells (SFMCs) and lamina propria mononuclear cells (LPMCs) were obtained from AS patients. Inflammatory cytokine-producing cells were analysed using flow cytometry and ELISA. Female SKG mice were treated with stat3-p Inh, IL-17A blocker or vehicle. Inflammation and new bone formation were evaluated using immunohistochemistry, PET and micro-CT. In the SKG mouse model, stat3-p Inh significantly suppressed arthritis, enthesitis, spondylitis and ileitis. In experiments culturing SFMCs and LPMCs, the frequencies of IFN-γ-, IL-17A- and TNF-α-producing cells were significantly decreased after stat3-p Inh treatment. When comparing current treatments for AS, stat3-p Inh showed a comparable suppression effect on osteogenesis to Janus kinase inhibitor or IL-17A blocker in AS-osteoprogenitor cells. Stat3-p Inh suppressed differentiation and mineralization of AS-osteoprogenitor cells and entheseal cells toward osteoblasts. Micro-CT analysis of hind paws revealed less new bone formation in stat3-p Inh-treated mice than vehicle-treated mice (P = 0.005). Hind paw and spinal new bone formation were similar between stat3-p Inh- and anti-IL-17A-treated SKG mice (P = 0.874 and P = 0.117, respectively). Stat-3p inhibition is a promising treatment for both inflammation and new bone formation in AS.

Clinical and Radiological Outcome of Patients Undergoing Bilateral Simultaneous Total Hip Arthroplasty in Patients with Ankylosing Spondylitis with Bony Ankylosis of Both Hips and Spinopelvic Deformity Using 3D Model Based Protocol vs Conventional Technique: A Single Blind Cluster Randomized Controlled Trial

Clinical and Radiological Outcome of Patients Undergoing Bilateral Simultaneous Total Hip Arthroplasty in Patients with Ankylosing Spondylitis with Bony Ankylosis of Both Hips and Spinopelvic Deformity Using 3D Model Based Protocol vs Conventional Technique: A Single Blind Cluster Randomized Controlled Trial

Burden of cases with large joints bony ankylosis following open injuries in rural region: A hospital based cross-Sectional observation

Background: Normal large joint anatomy is important for mobility, function and overall quality of life. Trauma or diseases like various forms of arthritis may alter normal joint architecture and physiology leading to secondary arthritis. Infection within the joint leading to septic arthritis is another catastrophic disorder that may irreversibly damage the human articular cartilage. The resultant bony ankylosis in certain cases is a serious complication of septic arthritis. There has been limited data regarding the burden of people living with post-infective ankylosis of one or more major joint and its other variables. Materials and Methods: Details of all consecutive cases coming to hospital out-patient department for the related or other complaints with one or more major joint found completely ankylosed in the radiographs were noted in separate file. The clinical complaints for which they present either related with the condition or other were also noted. Key demographic details like age, sex, laterality, history of causative factor, time living with the deformity, other co-morbidities were also recorded. The relevant details of the ankylosed joint following confirmation on radiographs were clinically confirmed with presence of no apparent movement of the affected joint. Results: A total of 21 (17 males and 3 females) patients with mean age of 32.1 years were part of the study. The ankle joint was most commonly involved followed by hip, knee and elbow in 13, 6, 2 and 1 case respectively. Our study attempts to know the burden of people living with ankylosed joint as a result of open injuries in the past. Conclusion: Relevant demographic data and the type of joint involvement in adults living in rural areas with one or more major ankylosed joints shall help draft preventive and treatment strategy in this regard.

Silicon Interpositional Arthroplasty for Temporo-mandibular Joint Ankylosis.

Temporo-mandibular joint (TMJ) ankylosis is characterized by a decreased mouth opening which affects mastication, speech, and facial aesthetic. Interpositional arthroplasty using autologous tissue is accepted treatment for TMJ Ankylosis; however, harvesting autologous tissue is associated with additional morbidity. In this article we report our results of silicon interpositional arthroplasty for TMJ ankylosis. 20 patients with TMJ ankylosis were included in the study. All patients underwent standard operative procedure using preauricular incision for release of TMJ ankylosis by excision of at least 1cm of bony block and insertion of 2cm thick silicon block in the joint space. Postoperatively early mobilization of TMJ was advised from 3rd day onwards. Post operative result was evaluated by assessing the mouth opening as inter incisor distance (IID). 20 patients (27 joints) of TMJ ankylosis were included in the study. There were 8 male and 12 female patients with age ranged from 3-35years. According to Sawhney classification bony ankylosis was present as Type-IV (n = 13 joints), Type-III (n = 12 joints) and Type-II (2 joints). Preoperative mean IID was 7.15mm and post operative mean IID was 43.5. There was no facial nerve paresis, malocclusion or recurrence but infection and extrusion of implant occurred in 1 case each. Silicon interpositional arthroplasty is an effective procedure for the treatment of TMJ Ankylosis; as it restores mouth opening and function, maintains the vertical ramus height, and prevents re-ankylosis without any donor site morbidity.

Computer-guided gap arthroplasty: a new approach to the execution of preplanned osteotomies for the treatment of bony ankylosis of the temporomandibular joint.

The purpose of this study was to assess the efficacy of 3-dimensional, printed, patient-specific guides to direct virtual gap arthroplasties that were designed for five patients with advanced unilateral ankylosis of the temporomandibular joint. The guides were used to mimic the intraoperative creation of five preplanned osteotomies, as well as simulating the width and depth of the bone cleavage. The accuracy of the devices in guiding the surgical simulation was assessed by superimposing the preoperative and postoperative computed tomographic scans. The devices were easily put in place with smooth uniform surgical bone cleavage, and favourable postoperative outcomes. The statistical analysis between the planned and surgical gaps, showed that the difference in dimensions was not significant (p=0.1018). The patient-specific gap arthroplasty was neither too near the skull base nor did it jeopardise the height of the mandibular ramus.

P1446DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS IN PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS

Abstract Background and Aims Diffuse idiopathic skeletal hyperostosis (DISH) is an idiopathic degenerative disease characterized by ossification of spinal ligaments and entheses, especially in the anterior longitudinal ligament. The ankylosed spine is prone to fracture with minor trauma and may result in spinal cord injury. It is usually asymptomatic and often diagnosed incidentally by computed tomography or other imaging methods. Several reports have revealed DISH as a risk factor for stroke, cardiovascular disease, and metabolic disorders, such as diabetes mellitus, hyperinsulinemia, obesity, dyslipidemia, and hyperuricemia. However, there are few reports of DISH in patients with end stage kidney disease (ESKD) requiring hemodialysis. Epidemiology, etiology and risk factors of DISH in patients with ESKD are unknown. We aimed to examine the prevalence and predictors of DISH in maintenance hemodialysis patients. Method This was a case-control study using patients who received maintenance hemodialysis in our hospital in December 2018. The prevalence of DISH at enrollment was evaluated according to Resnick and Niwayama criteria by computed tomography (CT). The criteria is defined as follows: (1) Flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, (2) Relative preservation of intervertebral disc height in the involved segment, (3) Absence of apophyseal joint bony ankylosis and sacroiliac joint erosion. We excluded patients who could not receive chest CT or with a history of thoracic spine surgery. Fisher exact tests were used to evaluate the relationships between categorical variables, and Kruskal-Wallis or Mann-Whitney U tests were used to evaluate continuous variables. We performed logistic regression analyses to identify variables that had a statistically significant association with DISH, as measured by the estimated odds ratio (OR) with the 95% confidence interval (CI). Results A total of 395 consecutive patients were treated with maintenance hemodialysis in our hospital in December 2018. After excluding 4 patients who could not receive chest CT and 2 patients with a history of thoracic spine surgery, the remaining 389 patients were analyzed. The median age was 70 years, and 61.2% of patients were men. One hundred and twenty-three (31.6%) patients were diagnosed with DISH. We assigned them to the DISH group and other 266 patients to the control group. The patients with DISH were significantly more likely to have advanced age, male sex, high body weight, high bone mineral density, prior vertebral fracture, and diabetic nephropathy. Multivariate analysis showed that having DISH was significantly associated with advanced age (OR 1.06, 95%CI 1.03-1.09, P<0.001), high bone mineral density (OR1.02, 95%CI 1.00-1.03, P=0.03), prior vertebral fracture (OR3.22, 95%CI 1.23-8.41, P=0.017), diabetic nephropathy (OR 2.00, 1.03-3.90, P=0.041). Conclusion The prevalence of DISH in maintenance hemodialysis patients was high. Advanced age, male sex, high body weight, high bone mineral density, prior vertebral fracture, and diabetic nephropathy were identified as a risk factor for DISH. Physicians involved in hemodialysis treatment should be aware of the existence of DISH as one of the comorbidities in the elderly ESKD patients.

Negative Regulation of Osteoclast Commitment by Intracellular Protein Phosphatase Magnesium-Dependent 1A.

Increased protein phosphatase magnesium-dependent 1A (PPM1A) levels in patients with ankylosing spondylitis regulate osteoblast differentiation in bony ankylosis; however, the potential mechanisms that regulate osteoclast differentiation in relation to abnormal bone formation remain unclear. This study was undertaken to investigate the relationship of PPM1A to osteoclast differentiation by generating conditional gene-knockout (PPM1Afl/fl ;LysM-Cre) mice and evaluating their bone phenotype. The bone phenotypes of LysM-Cre mice (n = 6) and PPM1Afl/fl ;LysM-Cre mice (n = 6) were assessed by micro-computed tomography. Osteoclast differentiation was induced by culturing bone marrow-derived macrophages in the presence of RANKL and macrophage colony-stimulating factor (M-CSF), and was evaluated by counting tartrate-resistant acid phosphatase-positive multinucleated cells. Levels of messenger RNA for PPM1A, RANK, and osteoclast-specific genes were examined by real-time quantitative polymerase chain reaction, and protein levels were determined by Western blotting. Surface RANK expression was analyzed by fluorescence flow cytometry. The PPM1Afl/fl ;LysM-Cre mice displayed reduced bone mass (P < 0.001) and increased osteoclast differentiation (P < 0.001) and osteoclast-specific gene expression (P < 0.05) compared with their LysM-Cre littermates. Mechanistically, reduced PPM1A function in osteoclast precursors in PPM1Afl/fl ;LysM-Cre mice induced osteoclast lineage commitment by up-regulating RANK expression (P < 0.01) via p38 MAPK activation in response to M-CSF. PPM1A expression in macrophages was decreased by Toll-like receptor 4 activation (P < 0.05). The Ankylosing Spondylitis Disease Activity Score was negatively correlated with the expression of PPM1A in peripheral blood mononuclear cells from patients with axial spondyloarthritis (SpA) (γ = -0.7072, P < 0.0001). The loss of PPM1A function in osteoclast precursors driven by inflammatory signals contributes to osteoclast lineage commitment and differentiation by elevating RANK expression, reflecting a potential role of PPM1A in dynamic bone metabolism in axial SpA.

3D Printed Patient-Specific Acetabular Jig for Cup Placement in Total Hip Arthroplasty.

IntroductionAcetabular cup placement is an important modifiable factor determining complication rates like aseptic loosening and hip dislocation related to faulty cup placement, which by standard method is largely dependent upon eyeballing and surgeon’s judgment. We evaluated a self-designed, low-cost, patient-specific acetabular jig to guide cup placement in total hip arthroplasty in comparison to conventional technique.MethodsIt was a prospective randomized control study. Thirty-six patients were categorized into group-A & group-B. In group-A, virtually designed acetabular jig was 3 Dimensional (3D) printed and used intra-operatively to guide cup placement. In group-B, the standard method of cup placement was used. Acetabular cup placement was evaluated on post-operative x-rays and compared between two groups.ResultsIn group-A, angle of anteversion were significantly in centre of range of safe zone as compared to group B in which hip is maximally stable with more precision in creating hip centre as compared to group-B without any significant(p = 0.325) increase in surgical time or blood loss.ConclusionComputed tomography (CT) scan based virtual pre-operative templating and cup placement guided by virtually designed, patient-specific acetabular jig is a low-cost tool with a short learning curve which can be designed and made available easily. It is a useful tool in decreasing chances of malpositioning of cup and recreates hip centre close to anatomical one especially in cases where anatomy has been distorted such as bony ankylosis and developmental dysplasia of hip.