Joint Changes Research Articles

Experience of total hip arthroplasty in a patient with post-traumatic aseptic necrosis of the femoral head

A hip fracture is a common injury in old age. It can be noted that the number of fractures is several times higher in women compared to men. Without surgical treatment, this pathology is highly likely to lead to complications and death of the patient within a year. High mortality rates in elderly people who have sustained a hip fracture can be attributed to various reasons. Due to prolonged forced bed rest in such patients, the risk of developing respiratory and cardiovascular complications, thrombosis, bleeding and infection significantly increases. In modern clinical practice, all fractures of the femoral neck are the reason for surgical intervention, according to vital indications. The only exception is the general severe condition of the patient in case of disruption of the normal functioning of the cardiovascular and respiratory systems, multiple organ failure and oncological diseases in the stage of decompensation.Purpose of a study: to demonstrate successful total arthroplasty of the left hip joint in elderly patient with posttraumatic avascular necrosis.Data from the medical documentation of the trauma hospital, data from instrumental research and the results of dynamic observation were used to write the article. The results were obtained using the equipment of the Center for Collective Use of Scientific Equipment of Tambov State University named after G.R. Derzhavin.As a result of total hip arthroplasty, the function of the patient's limb was restored.Conclusion. Total arthroplasty is an effective treatment method for patients with post-traumatic changes in the hip joint, allowing to restore the patient’s motor activity and prevent the development of hypostatic complications.

Increased kinematic changes in ascending compared with descending biplanar cut in open wedge high tibial osteotomy—a multibody simulation

BackgroundThe ascending or descending extended biplanar tibial cut in open wedge high tibial osteotomy (owHTO) not only changes the lower limb anatomy in the coronal plane but also leads to different three-dimensional (3D) changes in the patellofemoral joint. This study aimed to perform a comprehensive analysis of the dynamic biomechanical changes in the knee joint using a multibody simulation model.MethodsThirteen 3D computer models derived from lower limb computer tomography scans were used for owHTO. Osteotomies with ascending or descending biplanar cut were simulated for each wedge height from 6 to 12 mm (in 1-mm intervals). Multibody simulation was used to analyze differences in patellar shift, patellar tilt, mediolateral patellar rotation, and tibiofemoral rotation during a squat simulation from 5° to 100° knee flexion.ResultsThe main effects of an ascending compared with a descending extended biplanar cut in owHTO were characterized by an increase in lateralization of the patella and rotation, along with reduced tilt. Linear mixed models revealed statistically significant effects of both wedge height and cut variant on knee kinematics at 100° knee flexion, with the influence of the cut variant (ascending/descending) being higher on all analyzed kinematic parameters.ConclusionsSignificant differences in the changes in patellofemoral shift, tilt, rotation, and tibiofemoral rotation were observed when performing owHTO with an ascending versus a descending biplanar cut. Apart from tibiofemoral rotation, the resulting kinematic changes were greater with an ascending cut.

Significance of three-dimensional turbo spin-echo magnetic resonance imaging with semiquantitative assessment of knee osteoarthritis: correlation to two-dimensional routine magnetic resonance imaging

BackgroundAs one of the most prevalent chronic degenerative diseases, knee osteoarthritis (KOA) is associated with the progressive degradation of articular cartilage, meniscus, synovium, ligaments, bone, muscles, and tendons. Knee osteoarthritis affects the quality of life and can cause chronic disability worldwide. Magnetic resonance imaging (MRI) is a crucial imaging modality for the morphological assessment of cartilage and all other joint tissues involved in osteoarthritis. The objective of this study was to evaluate the effectiveness of the three-dimensional (3D) turbo spin-echo (TSE) MRI and to compare its relevance to two-dimensional (2D) routine MRI in adding additional information and in the early detection of KOA.ResultsTotal agreement between the two techniques ranged between 82.7% (cartilage degeneration), 91.4% (osteophytes), 98.3% for bone marrow edema and periarticular cyst up to 100% of other several features regarding meniscal injury and ligamentous tear.ConclusionsWhen compared to standard 2D TSE MRI, 3D TSE MRI demonstrates substantial to almost complete agreement and high accuracy for semiquantitative assessment of knee osteoarthritis (OA). 3D TSE MRI also takes less time, which is important for large OA studies and can be used for the detection of early knee joint changes.

Evaluating tibial rotation in recurrent patellar dislocation with four-dimensional computed tomography.

This study is to investigate the three-dimensional (3D) kinematic changes in the knee joint in patients with recurrent patellar dislocation using four-dimensional computed tomography (4DCT) imaging and the 3D-3D surface registration technique. Ten knees from nine patients with recurrent patellar dislocation and seven knees from seven controls (unaffected side of patients with unilateral anterior cruciate ligament injury) were analyzed using 4DCT. The patients were asked to extend their knees from 60° of flexion to full extension for 10s in the CT gantry. We used the 3D-3D registration technique, and the 3D angles of the patella and tibia relative to the femur were evaluated. In the dislocation group, the patellar lateral tilt increased as the knee extended. Significant differences were found between the two groups at 0°-20° of knee flexion. The tibia rotated externally as the knee extended in the dislocation group. Significant differences between the two groups were found at 0°-10° of knee flexion. This study demonstrated significant differences in the timing and magnitude of tibial external rotation between patients with recurrent patellar dislocation and controls. Specifically, the tibia began to externally rotate during the early phase of knee extension in the dislocation group. These findings provide new insights into knee kinematics that may inform future treatment strategies for patellar dislocation.

Kinetic Recovery of the Patient with Gonarthrosis

Osteoarthritis of the knee, also known as gonarthrosis, is indeed a common and growing concern, particularly as factors like increased life expectancy and rising obesity rates contribute to its prevalence. A few key points to highlight from the statistics you've provided: About 13% of women and 10% of men over the age of 60 are diagnosed with gonarthrosis; The prevalence significantly rises in people over the age of 70, where it affects 40% of this population. This reflects the impact of aging on joint degeneration; Gonarthrosis is more common in women than men. While exact reasons aren't fully clear, hormonal factors, differences in joint anatomy, and possibly physical activity differences may play a role in this disparity; Despite radiographic evidence of osteoarthritis, only a portion of individuals’ experience symptoms. This emphasizes that structural joint changes don't always equate to pain or functional limitations; One study suggests that only 15% of patients with radiographic evidence of gonarthrosis have symptoms, indicating that many individuals may have osteoarthritis without knowing it; The overall incidence of symptomatic gonarthrosis is about 240 cases per 100,000 people per year, making it a significant public health issue. [4]

Association Between Postoperative Medial-Middle Intercuneiform Joint Widening and Recurrence Rates in Hallux Valgus Treated With Modified Lapidus Procedure.

Although an association between intercuneiform (C1-C2) joint instability and the recurrence of hallux valgus (HV) deformity after the modified Lapidus procedure has been suggested, there is currently no radiographic evidence to support it. This study aims to investigate radiographic changes in the C1-C2 joint after the modified Lapidus procedure for HV correction, using weightbearing computed tomography (WBCT). This retrospective cohort study included 52 feet (50 patients) with HV who underwent modified Lapidus procedure and had preoperative and postoperative WBCT. Patients who had an additional transfixation screw between the first and second ray were excluded. The preoperative and average 6.5 months postoperative C1-C2 distance, C1-C2 angle, and C1-ground angle were measured on coronal multiplanar reconstructed WBCT images. Radiographic parameters between the recurrence group (n = 9) and nonrecurrence group (n = 43) were compared. Recurrence of HV deformity was characterized by a postoperative hallux valgus angle (HVA) greater than 20 degrees. Nine of 52 patients (17.3%) had recurrence of their HV deformity. The recurrence group had greater changes in the C1-C2 distance; the median widening in the recurrence group was 0.7 mm (IQR, 0.6-0.8), whereas the nonrecurrence group was 0.3 mm (IQR, 0.1-0.4, P < .001). Regression analysis showed that increase in the C1-C2 distance were significantly associated with recurrence (odds ratio, 1.79; 95% CI, 1.18-3.77; P = .0015). Although no preoperative imaging parameters were associated with a change in the C1-C2 distance, increasing postoperative sesamoid position (r = 0.32, P = .022) and HVA (r = 0.28, P = .046) were correlated with a greater change in the C1-C2 joint gapping. Our study results suggest a possible association between early postoperative widening of the C1-C2 joint and the recurrence of the HV deformity following a modified Lapidus procedure. This raises, but does not answer, the question as to whether the routine stabilization of intercuneiform joint directly or indirectly may help reduce the rate of hallux valgus recurrence when performing the modified Lapidus procedure.

The haemophilia joint health score for the assessment of joint health in patients with haemophilia.

The haemophilia joint health score (HJHS) is a tool used to assess joint changes in patients with haemophilia. There is lack of consensus on the interpretation of HJHS scores and their clinical relevance. To evaluate available literature reporting HJHS changes over time and assess a possible cut-off value for clinically relevant outcomes and the ideal follow-up for a meaningful score change. We conducted a literature search of studies published between 2011 and 2023 where the HJHS version 2.1 had been adopted to detect changes in joint health in patients with haemophilia. We focused on studies that assessed clinical relevance of HJHS changes, evaluated the use of cut-off values and reported a follow-up over time. Our search identified 213 publications of which 53 (25%) were deemed relevant for this review. Of these, 33 (62%) publications reported the total HJHS score and 20 (38%) reported a single joint HJHS score, while the way of reporting HJHS scores/change was highly variable. Ten publications (19%) assessed clinical relevance, but their methods of calculation differed (defining a cut-off score, measuring standardised response mean or minimal detectable change). The follow-up duration varied from 2weeks to 8years in these 10 studies. High variability in assessing HJHS change over time is the primary consequence of its low sensitivity, and the lack of consensus on interpretation and clinical relevance of the score. Therefore, more sensitive tools should be used alongside HJHS to better define the joint health status of patients with haemophilia.

Intra-Articular Injection of Human Umbilical Cord-Derived Mesenchymal Stromal Cells Reduces Radiographic Osteoarthritis in an Ovine Model.

To determine if mesenchymal stromal cells (MSCs) derived from human umbilical cords (hUC) could reduce degeneration developing when injected into the knee of a large animal model of osteoarthritis (OA). Ten million culture-expanded UC-MSCs (pooled from 3 human donors) were injected in 50 μL of tissue culture medium into the left stifle joints of 7 sheep whose medial meniscus was transected 4 weeks previously. Seven other sheep had only 50 μL of medium injected as the no treatment "control" group. After 8 weeks the sheep underwent euthanasia, the joints were excised and examined macroscopically, via x-ray and magnetic resonance imaging (MRI), both via histology for degenerative and inflammatory changes and immunohistochemically to identify any human cells within the joint tissues. Activity monitoring both before meniscus transection and euthanasia was also undertaken. There was a significant reduction in the Kellgren-Lawrence x-ray score for joints injected with hUC-MSCs compared with the control joints. Likewise, macroscopic, MRI, synovitis and OARSI histology scores were all lower (better) in the joints injected with hUC-MSCs than in the control arm, but not significantly. Activity levels and synovitis scores were similar in both groups of animals. hUC-MSCs appear to modify and reduce the development of osteoarthritic changes in the ovine stifle joint after meniscal destabilization, an injury which commonly leads to OA in humans. These results are encouraging for the potential benefit of culture expanded UC-MSCs as an allogeneic cell therapy in patients who may have early OA following a meniscal injury of the knee.

Analysis of changes in lower limb joints of athletes during the movement of wild horses’ mane parting based on biomechanics

In the era of fitness, more and more young people are familiar with Taijiquan, a kind of physical fitness exercise. By conducting biomechanical analyses of the movements of Taijiquan, it is possible to exercise the body better. Numerous techniques in Taijiquan make it difficult to study each individually. Therefore, this paper studied the movement of “wild horses’ mane parting” in terms of biomechanics by analyzing the joint angle, stiffness, and impulse during this movement. Twenty male athletes were selected as subjects and divided into a professional group and a beginner group according to their training periods. High-speed cameras were used to shoot the “wild horses’ mane parting” movement. The angles of lower limb joints in these athletes were measured to calculate joint impulse and stiffness. The results showed that, compared with the professional group, there were significant differences in the adduction and abduction angle and the internal and external rotation angle between the beginner group and the professional group in the single-leg support movement stage (P&lt; 0.05). There were also significant differences in joint impulse and stiffness (P&lt; 0.05). Compared with beginners, long-term professional practitioners can make their movements more standardized. By comparing movements and data analysis, beginners can make their movements more standardized when practicing Taijiquan and avoid the risk of sports injury. The novelty of this article lies in the use of high-speed cameras to capture athletes’ movements, enabling accurate analyses of their joints and providing effective references for precise training.

Effects of moxibustion in improving synovitis in adjuvant arthritis rats by regulating synovial GPR43 and peripheral blood Th17/Treg balance

To observe the effects of moxibustion on G protein-coupled receptor 43 (GPR43) and helper T cell 17 (Th17)/regulatory T cell (Treg) balance in rats with adjuvant arthritis (AA), so as to investigate the partial mechanism of moxibustion therapy on rheumatoid arthritis (RA). A total of 24 Wistar rats were randomly divided into a normal group, a model group and a moxibustion group, with 8 rats in each group. The AA rat model was replicated using wind, cold and moisture environmental factors + Freund's complete adjuvant (CFA) injection method. In the moxibustion group, moxibustion was performed on bilateral "Zusanli" (ST36) and "Shenshu" (BL23) for 20 min/time, once daily, for 21 d. The changes of joint swelling degree (JSD) and arthritis index (AI) were observed in each group of rats. Transmission electron microscopy and HE staining were used to examine changes in the cellular structure of the ankle joint synovial tissue in each group. Western blot analysis was employed to detect the expression levels of GPR43 in the synovial tissue of the ankle joints. Flow cytometry was used to measure the percentages of Treg and Th17 in peripheral blood. ELISA was used to determine the contents of interleukin-10 (IL-10) and transforming growth factor-β 1 (TGF-β1) in serum. Compared with the normal group, the JSD and AI in the model group increased before and after treatment (P<0.01), with significant synovial pathological and ultrastruct ural injury observed. Additionally, compared with the normal group, the expression of GPR43 in the synovial tissue decreased (P<0.01), the Treg percentage in peripheral blood decreased (P<0.01) and the Th17 percentage increased (P<0.01), serum IL-10 and TGF-β1 contents decreased in the model group (P<0.01). Compared with the model group, the moxibustion group exhibited a significant reduction in JSD and AI after treatment (P<0.01), the degree of pathological and ultrastruct ural damage in the synovium decreased, the expression of GPR43 in the synovial tissue increased (P<0.05), the Treg percentage in peripheral blood increased (P<0.01) and the Th17 percentage decreased (P<0.01), serum IL-10 and TGF-β1 contents increased (P<0.01). The relative expression of GPR43 in synovial tissue was positively correlated with the percentage of Treg in peripheral blood (r=0.967, P<0.01). Moxibustion can significantly improve the inflammatory response in the synovial membrane of AA rats. The mechanism may be related to moxibustion restoring the Th17/Treg balance through regulating GPR43.

Atomistic insights into cold welding process of high-entropy alloy nanowires

This research applied molecular dynamics (MD) simulations to investigate the influences of contact pressure, temperature, crystal orientation, and chemical composition on the characteristics of the cold welding joints of CoNiCrFeMn high-entropy alloy (HEA) nanowires. The findings indicate that defect-free cold welded joints can be successfully formed within a contact pressure range of 10 to 10,000 Pa. In addition, changing the contact orientation could cause a significant change in the structure transformation level. The dislocation distribution is continuous when the top and lower blocks are oriented in the same direction. Dislocation lines, on the other hand, stop at the interfacial area and have a discontinuous shape when the weld joints are formed from different orientations. Furthermore, creating from the same orientations leads to a higher ultimate tensile strength (UTS) value than the different orientation cases. In the temperature range of 150 K–350 K, the deformation behaviors of the cold weld joint are stable. Besides, there was no noticeable change in the weld joint when the composition changed. Because of the strong crystal structure of the cold welding joints, the UTS values of the cold-welded joints range from 13.2 to 17.4 GPa, comparable to the bulk samples.

Clinical and radiological assessment of the Polish modification of the Ilizarov external fixator for the treatment of intra-articular calcaneal fractures.

There is currently no established gold standard for the treatment of calcaneal fractures. To conduct a clinical and radiological evaluation of patients following intra-articular calcaneal fractures treated with the Polish modification of the Ilizarov method. This was a 2-center retrospective study. We evaluated 27 patients (2 women and 25 men) aged 28-73 years (mean age 50.5 years) after treatment of intra-articular calcaneal fractures with the Polish modification of the Ilizarov method. We assessed pain using a visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) scores, patient satisfaction with treatment, use of analgesics, duration of Ilizarov treatment, length of hospital stay, duration of surgery, patient's declared willingness to choose the same treatment again, complications, degenerative changes, Böhler angle, inflection angle, and Gissane angle. The mean follow-up period was 3 years and 2 months. Following treatment, the mean VAS pain score was 2.3. Prior to surgery, all patients were taking analgesics in comparison with only 2 patients (7.4%) at long-term follow-up. The treatment was rated as satisfactory by 11 patients, with 16 patients rating it as highly satisfactory. The mean post-treatment AOFAS score was 76.6 points. The Ilizarov fixator was removed after a mean period of 88 days. The mean duration of hospital stay was 7.4 days. The mean duration of the procedure was 44 min. All patients would choose the same treatment again. Complications were observed in 5 patients. The long-term follow-up visit revealed degenerative changes in the talocalcaneal joint in 8 patients. The median Böhler angle was 5.5° preoperatively and 28.5° postoperatively, p < 0.001. The median preoperative inflection angle of 160° decreased to 145°, p < 0.001. The median preoperative Gissane's angle of 119° increased significantly to a median postoperative value of 143°, p < 0.001. The patients achieved good clinical and radiological outcomes.

Combining Temperature and Precipitation to Constrain the Aerosol Contribution to Observed Climate Change

Abstract Using the past to improve future predictions requires an understanding and quantification of the individual climate contributions to the observed climate change by aerosols and greenhouse gases (GHGs), which is hindered by large uncertainties in aerosol forcings and responses across climate models. To estimate historical aerosol responses, we apply detection and attribution methods to attribute a joint change in temperature and precipitation to forcings by combining signals of observed changes in tropical wet and dry regions, the interhemispheric temperature asymmetry, global mean temperature (GMT), and global mean land precipitation (GMLP). Fingerprints representing the climate response to aerosols (AERs) and the remaining external forcings (noAER; mostly GHG) are derived from large ensembles of historical single- and ALL-forcing simulations from three models in phase 6 of the Coupled Model Intercomparison Project and selected using a perfect model study. Results from an imperfect model study and a hydrological sensitivity analysis support combining our choice of temperature and precipitation fingerprints into a joint study. We find that diagnostics including temperature and precipitation slightly better constrain the noAER signal than diagnostics based purely on temperature or GMT-only and allow for the attribution of AER cooling (even when GMT is not included in the fingerprint). These results are robust across fingerprints from different climate models. Estimated contributions for AER and noAER agree with other published estimates including those from the most recent IPCC report. Finally, we attribute the best estimate of 0.46 K ([−0.86, −0.05] K) of aerosol-induced cooling and 1.63 K ([1.26, 2.00] K) of noAER warming in 2010–19 relative to 1850–1900 using the combined signals of GMT and GMLP. Significance Statement Aerosols are small liquid or solid airborne particles. They are predominantly the secondary result of emissions of aerosol precursor gases emitted via industrial or natural processes. While greenhouse gases warm the climate, aerosols can have a cooling effect on the climate system, thus offsetting some of the greenhouse gas–related warming. We expect greenhouse gas concentrations in the atmosphere to continue to increase, while aerosol concentrations are likely going to decline due to their impacts on human health. Our study uses observed temperature and precipitation changes to quantify how much aerosols have offset warming from past greenhouse gas emissions. This can help constrain future predictions of global warming.

Observation of dynamic position and morphological changes of temporomandibular joint discs under Angle's classification

Objective: To observe the dynamic changes of the temporomandibular joint (TMJ) disc in joint movement under different Angle's classification, providing reference for understanding joint functional movement and providing a basis for more accurate clinical imaging diagnosis. Methods: A total of 30 patients (13 males and 17 females) with temporomandibular disorders who were admitted to Beijing Friendship Hospital, Capital Medical University and General Hospital of the People's Liberation Army from January 2022 to April 2024 were enrolled. Thirty adults (13 males and 17 females) with different Angle's classification, with an average age of (34.4±8.5) years, were subjected to dynamic imaging of their TMJ from the closed position to the maximum opening position, and then to the closed position using MRI. The position and morphological changes of the articular discs were observed. Results: The results showed that volunteers with no displacement of the articular disc in class Ⅰ, Ⅱ, and Ⅲ relationships had different shapes of the articular disc during open and closed mouth movements. However, in the maximum opening position, the articular disc were all located directly below the maxillary nodules, and their shape is double concave. In terms of irreversible anterior displacement of the articular disc, in class Ⅰ Angle, the posterior zone of the disc contacts the anterior inclined plane of condyle from the maximum opening position back to the front of the closing position. In class Ⅱ, the posterior zone of the disc contacts the anterior inclined plane of condyle from the beginning of opening position to maximum opening position. In class Ⅲ, the posterior zone of the disc is always in contact with the anterior inclined plane of condyle throughout the entire movement process. And among them, the articular disc presents a forward displacement state at the closing position, its morphology undergoes folding phenomenon. When the openness is 2.5 cm, the articular disc moves up to a certain extent, and is closer to the anterior inclined plane of condyle, and its shape is also partially changed. When the openness is 4.3 cm, the shape of the articular disc, located between the anterior inclined plane of the joint node and the posterior inclined plane of the condyle, is typical double concave, which is sufficient to show that the articular disc is reversible when maximum opening position is reached. In terms of reversible anterior disc displacement, in class Ⅰ Angle, the posterior zone of the disc contact with the anterior inclined plane of condyle at the beginning of the opening position and the end of the closing position. In classⅡ Angle, the posterior zone of the articular disc is not in contact with the anterior inclined plane of condyle. In class Ⅲ Angle, the posterior zone of the articular disc contact with the anterior inclined plane of condyle at the end of the closing position. Conclusions: Multi level dynamic MR imaging data of the temporomandibular joint can dynamically observe the movement of the temporomandibular joint, intuitively and accurately display the position and shape of the articular disc during movement, and can serve as a useful supplement to static conventional MR imaging of the TMJ. The patient's TMJ needs to reach the maximum opening position in order to determine whether the joint disc displacement can be reversible or not.

АНАЛІЗ РОЗПОДІЛУ КОНТАКТНИХ НАПРУЖЕНЬ У ДВОЗРІЗНОМУ БОЛТОВОМУ З'ЄДНАННІ КОМПОЗИТНИХ ТА МЕТАЛЕВИХ ЕЛЕМЕНТІВ

Bolted joining technique is the dominant joining method for CFRP load-carrying structures in aircraft. However, the weak point of such structures are the areas located in the vicinity of the fastener holes, which are the areas of increased stress concentration. In addition, drilling the holes results in structural discontinuities due to cutting material fibers. Among all failure modes of composite bolted joint, bearing failure is one of the most common type of damage. This failure is caused by the local compressive stresses acting normal to the contact surface, that leads to delamination of material due to insufficient strength of matrix. Therefore, it is extremely important to optimize the design of composite bolted joints in order to enhance the entire composite structure. To increase the load-carrying capacity of the composite joint structural parts and protect the hole walls from damage, a method for installing titanium bushing with glue into the holes of composite plate is proposed. The paper presents the results of numerical analysis of the impact of stacking sequence on the distribution of contact stresses in a double-shear bolted joint of composite plate to steel cover plates. Using the finite element method and ANSYS Workbench 2019 R3 software, a three-dimensional finite element model of a double-shear bolted joint was created, which enables to analyze the impact of the stacking sequence on the distribution of contact stresses at the bolts to titanium bushings interface in the case of uniaxial tension of the middle composite plate at the level of tensile stresses in the gross section of 100 MPa. The obtained result explains the fundamental difference in the behavior of composite and metal materials: due to the change in the orientation and sequence stacking, the stiffness of the composite element of the joint changes, which affects the ovalization of the holes and the level of local deformations of the bushings, which in turn leads to a change in the maximum contact stresses and their concentration. By optimizing stacking sequence, it was possible to reduce the level of maximum contact stresses by 1.1 times. At the same time, the degree of unevenness of the distribution of contact stresses decreased by 1.21 times. The optimal stacking sequence was one in which 37.5% of the fibers oriented at an angle of 0°, 50% of the fibers oriented at angles of ±45°, and 12.5% of the fibers oriented at an angle of 90°

Efficacy comparison of robot-assisted versus freehand fluoroscopy-assisted minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spinal diseases

Objective: To compare the clinical and radiographic outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) and fluoroscopy-assisted MIS-TLIF (FA MIS-TLIF) in patients with degenerative lumbar spinal diseases. Methods: The clinical data of 114 patients with lumbar degenerative diseases who underwent MIS-TLIF in Qilu Hospital of Shandong University from January 2019 to March 2022 were analyzed retrospectively. Fifty-eight patients underwent RA MIS-TLIF (robot group) and 56 patients received FA MIS-TLIF (freehand group). There were 16 males and 42 females in the robot group, with a mean age of (56.7±8.1) years. And there were 19 males and 37 females in the freehand group, with a mean age of (57.2±8.6) years. The clinical outcome parameters were the visual analog scale (VAS) of pain, Oswestry Disability Index (ODI) score, operative time, number of intraoperative fluoroscopies, blood loss, postoperative hospital stay and complications. The radiographic change measures were the accuracy of screw placement, facet joint violation (FJV), fusion status, and change in disc height at the proximal adjacent segment. All the patients were followed-up for 2-5 years. Results: There was no significant differences in the VAS and ODI scores, blood loss, or postoperative hospital stay between the two groups (all P>0.05). The operative time was longer in robot group than freehand group [(158.5±12.1) min vs (146.4±15.4) min, P<0.001]. There was no significant difference in the number of intraoperative fluoroscopies for patients between robot group and freehand group (P>0.05). The number of intraoperative fluoroscopies for the surgeon was significantly lower in robot group than freehand group (13.8±3.9 vs 74.7±6.8, P<0.001). The rate of a perfect screw position (grade A) was higher in robot group than freehand group [87.5%(203/232) vs 70.1%(157/224), P<0.001]. However, there was no significant difference in the proportion of clinically acceptable screws (grades A and B) between the two groups [98.3%(228/232) vs 96.9%(217/224), P=0.330]. The FJV grade was significantly higher in freehand group than robot group (0.43±0.68 vs 0.13±0.43, P<0.001). During at 2-year postoperative follow-up, there was no significant difference in the fusion status between the two groups (P>0.05); however, the decrease in disc height at the proximal adjacent segment was significantly less in robot group than freehand group [(0.63±0.38) mm vs (0.92±0.35) mm, P=0.001]. In the robotic group, a pedicle screw penetrated the outer wall of the vertebral pedicle in one patient, which was adjusted during surgery. In the freehand group, two screws were inserted too deeply and penetrated the anterior cortex, resulting in mild abdominal discomfort postoperatively, which resolved by the third day after surgery. Conclusions: Robot-assisted percutaneous pedicle screw placement is a safer and more accurate alternative to conventional freehand fluoroscopy-assisted pedicle screw insertion in MIS-TLIF. Compared with freehand MIS-TLIF, robot-assisted MIS-TLIF increases the operation time, but the accuracy of screw placement is higher, and the intraoperative radiation dose and the degree of adjacent segment degeneration are reduced.

RETRACTION: Environmental Disruption of Circadian Rhythm Predisposes Mice to Osteoarthritis-Like Changes in Knee Joint.

R. Kc, X. Li, R. M. Voigt, M. B. Ellman, K. C. Summa, M. H. Vitaterna, A. Keshavarizian, F. W. Turek, Q.-J. Meng, G. S. Stein, A. J. van Wijnen, D. Chen, C. B. Forsyth, and H.-J. Im, "Environmental Disruption of Circadian Rhythm Predisposes Mice to Osteoarthritis-Like Changes in Knee Joint," Journal of Cellular Physiology 230, no. 9 (2015): 2174-2183, https://doi.org/10.1002/jcp.24946. The above article, published online on 5 February 2015 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Robert Heath; and Wiley Periodicals LLC. The retraction has occurred due to concerns related to the data presented in the article raised by the Office of Research Compliance at Rush University Medical Center following an investigation jointly conducted by Rush University and the Jesse Brown Veterans Affairs Medical Center (JBVAMC). Specifically, image elements of the experimental data in Figure 4 A were found to have been used by the same author(s) for publication elsewhere in a different scientific context. The corresponding author, Dr. Hee-Jeong Im Sampen, has been informed of the decision to retract but did not agree with it, as she is confident that any errors in the publication do not impact the reliability of the paper's findings. She also advised the editors that she stands ready to cooperate fully to make any necessary corrections. However, the article is retracted as the editors lost trust in the accuracy of the data and consider the conclusions invalid.

Clinical and radiological outcomes of flexible flatfoot correction with double calcaneal osteotomy

BackgroundAlthough double calcaneal osteotomy (medial displacement calcaneal osteotomy with lateral column lengthening) is widely regarded as an effective treatment option for flexible flatfoot, limited studies have extensively analyzed the degree of deformity correction in three dimensions following double calcaneal osteotomy. This study was performed to evaluate the radiographic and clinical effectiveness of double calcaneal osteotomy to correct flexible flatfoot deformities.MethodsThirty-one patients who had 44 symptomatic flexible flatfeet and underwent double calcaneal osteotomy were examined retrospectively with a mean follow-up of 50 months. Visual analog scale, foot and ankle activity measure, and other clinical data were obtained from medical records. Various radiographic variables for assessing flatfoot and osteoarthritic change in tarsal joints were analyzed from weightbearing radiographs.ResultsClinical scores and radiographic variables were significantly improved postoperatively. The mean values of medial sliding and lateral lengthening were 7.6 and 8.7 mm, respectively. No osteoarthritic changes were observed.ConclusionsDouble calcaneal osteotomy could be used to correct flatfoot deformities effectively and sustainably and provide symptomatic relief and patient satisfaction.Level of evidenceLevel 4, retrospective case series.

Comparison of Gait in Women with Degenerative Changes of the Hip Joint and Healthy Women Using the MoKA System-A Pilot Study.

Osteoarthritis (OA) is a global problem. There are few reports in the literature regarding the temporal and spatial parameters of gait in people with OA. The aim of this study was to determine spatiotemporal parameters for the pelvis and lower limbs during walking in women with OA and to compare these parameters with healthy people. For this purpose, a 6 min walking test (6MWT) was carried out. OA subjects had worse outcomes compared to the control group (p < 0.05). Data were collected using IMU sensors integrated into the MoKA system and mounted on indicator points on the body. Limited mobility of the pelvis in the frontal plane was observed in the study group, which influenced walking strategy. For the comparison with the control group at each minute, p < 0.05. IMU sensors attached to the body and integrated in one application provide extensive research and diagnostic capabilities.

The Stress Effects of Mandibular Movements on the Temporomandibular Joint With Sagittal Split Ramus Osteotomy.

The aim of this study was to evaluate the stress changes in the temporomandibular joint (TMJ) after sagittal split ramus osteotomy (SSRO) with finite element analysis (FEA). 5 and 10mm mandibular setback and advancement were applied to models by using SSRO and a control model without osteotomy evaluated. The articular disc was modeled as superelastic, and the stresses on the articular fossa, disc, and condyle were evaluated. The stresses on the cartilage were 1.150 MPa on the 5mm advancement model and 1.506 MPa on the 10mm advancement model. The stresses on the disc were 11.56 MPa on the 5mm advancement model, 7.94 MPa on the 10mm advancement model and the amount were significantly higher than other models. The stress, especially in the cartilage, increased with the amount of advancement. In the setback models, the stresses on the condylar cartilage and the disc were higher than in the control model, and the stress in the condylar cartilage increased with the amount of setback. SSRO increases the stresses in the TMJ components and stresses increase depending on the amount of advancement and setback and may cause the development of joint problems.