Patients Undergoing Joint Replacement Surgery Research Articles

The Role of Potentially Retrievable Inferior Vena Cava Filters in High-Risk Patients Undergoing Joint Arthroplasty.

Some patients undergoing total joint arthroplasty are at increased risk for venous thromboembolism (VTE). The aim of the present study was to evaluate the safety and efficacy of prIVCF in preventing PE in patients undergoing joint replacement surgery who are at high-risk for VTE. In this prospective, IRB-approved study, prIVCF were placed in consecutive patients who met specific high-risk criteria (history of VTE or hypercoaguable state) prior to total joint arthroplasty. Patients were followed until the IVC filter was removed. Outcomes and complications were recorded per Society of Interventional Radiology guidelines. One hundred and nine potentially retrievable IVC filters were placed in 105 patients, who all subsequently underwent joint arthroplasty. One hundred eight IVC filters (98.9%) were retrieved successfully in a mean time of 44.1 days (range 13-183 days). There was 1 failed IVC filter retrieval attempt (0.9%) at 46 days post implantation. Two patients (1.9%) presented with recurrent PE and were successfully treated with anticoagulation prior to IVC filter retrieval. There were no fatalities from perioperative PE. In 1 patient (0.9%), a fractured filter leg had embolized during retrieval. Potentially retrievable IVC filters are safe and effective for prophylaxis against PE in patients at high-risk for VTE undergoing joint arthroplasty.

The need for caution in the selection and interpretation of measures of function for patients with severe hip and knee problems

The need for caution in the selection and interpretation of measures of function for patients with severe hip and knee problems

THU0007 Analysis of protein acetylation and histone deacetylase expression in the synovial tissue reveals complex relationships between epigenetic regulatory mechanisms and inflammation in rheumatoid arthritis

BackgroundEpigenetic mechanisms, including reversible acetylation and methylation of histones, play a pivotal role in regulating cellular inflammatory responses. Aberrant activity and expression of histone deacetylases (HDACs) contributes to pathology in...

SAT0326 Coordinated Expression of the Genes Associated with Cell Growth (Mtor), Collagen Degradation (Cathepsin K), and Lipid Metabolism (Fatty Acid Synthase) in the Peripheral Blood and Articular Cartilage of the End-Stage Osteoarthritic Patients

BackgroundProgression of osteoarthritis (OA) produces loss of articular cartilage that may culminate in pain, loss of joint function, and disability. Therefore, identification of new biomarkers that predict patients at risk...

AB0021 Identification of novel acpa targets in rheumatoid arthritis synovial tissues using 2d gel electrophoresis and mass spectrometry.

BackgroundRheumatoid arthritis (RA) is an inflammatory autoimmune disease characterised by synovial joint inflammation and pannus formation that leads to degradation of cartilage and the underlying bone. Presence of anti-citrullinated protein/peptide...

OP0256 SIRT1 Regulates Cigarette Smoke-Induced IL8 Expression and TNFA-Mediated Il6 Release in Rheumatoid Arthritis Synovial Fibroblasts

BackgroundCigarette smoking is a recognised environmental risk factor not only for the development of rheumatoid arthritis (RA), but also for the severity of established RA. Specifically, smoking is associated with...

AB0028 Smoking induces expression of mic ligands of the activating immune receptor nkg2d

BackgroundEven though it is well known that smokers have an increased risk to develop rheumatoid arthritis (RA) and other autoimmune diseases, nothing is known about the molecular mechanisms that lead...

An assessment of the impact of behavioural cognitions on function in patients partaking in a trial of early home-based progressive resistance training after total hip replacement surgery

Background: Control cognitions have been directly related to positive engagement with rehabilitation regimes. The impact of such cognitions on recovery following surgery is not well understood. Purpose: To assess whether perceived control cognitions predict function 9–12 months following total hip replacement (THR). Methods: Prospective cohort study performed as part of a randomised controlled trial. Behavioural cognitions (BC) (recovery locus of control (RLOC); perceived external behavioural control (PEBC))) and subjective functional outcome measures (Oxford hip score (OHS) and a reduced version of the Western Ontario and McMasters University Osteoarthritis Function scale (rWOMAC PF)) were administered pre-operatively and up to 12 months post-operatively to 50 patients randomised to home-based progressive resistance training (N = 26) or standard rehabilitation (N = 24), post-THR. Regression analysis investigated variance in functional scores. Results: Group randomisation had no effect on BC. RLOC and OHS (6 months) correlated significantly with 12-month OHS, with 6-month OHS predicting 62.3% of the variance in 12-month OHS. 12-month rWOMAC PF was determined by each of its three previous assessments (pre-operative 8.8%, 6 weeks 17.8% and 6 months 67.3%). Variance in functional gain at 12 months (OHS and rWOMAC PF) was explained by pre-operative OHS and rWOMAC PF (63.7% and 63.8%, respectively). Conclusions: BC had no impact on functional outcome in this population. Subjectively assessed function at 12 months, as well as the levels of functional gain over time, was best explained by the patients’ earlier functional status.Implications for RehabilitationIt is important to assess psychological factors such as poor pre-operative mental health and pain catastrophising in patients undergoing joint replacement surgery as these factors have an adverse effect on subjective patient outcomes.Pre-operative behavioural cognitions appear to have no impact on subjective functional outcome at 12 months post-THR.The pre-existing functional status of the patient appears to be most predictive of subjective function at 12 months post-THR, implying that perhaps earlier surgery may be optimal before the onset of a decline in function.

A10.14 Identification of Novel ACPA Targets in Rheumatoid Arthritis Synovial Tissues Using 2D Gel Electrophoresis and Mass Spectrometry

Background and Objectives Rheumatoid arthritis (RA) is an inflammatory autoimmune disease characterised by synovial joint inflammation and pannus formation that leads to degradation of cartilage and the underlying bone. Presence of anti-citrullinated protein/peptide antibodies (ACPA) in 60–70% of patients with RA is one of the major characteristics of the disease and associates with a more aggressive disease course, suggesting a direct pathogenic involvement of ACPA in disease initiation and progression. ACPA recognises several citrullinated proteins like fibrinogen, α-enolase, vimentin, and collagen II. In this study, we aim for the identification of novel ACPA targets in synovial tissues of patients with RA. Materials and Methods RA synovial tissues were obtained from patients undergoing joint replacement surgery for rheumatoid arthritis of the knee or elbow at the Karolinska University Hospital, Stockholm, Sweden. Synovial tissues were frozen in liquid nitrogen shortly after resection and stored at –80°C. All procedures were approved by Northern Stockholm Ethical Review Board and tissues were obtained with informed patient consent. Proteins, extracted from pulverised frozen synovial tissues and solubilised in lysis buffer, were resolved in 2D PAGE. Separated proteins were directly transferred to a nitrocellulose membrane and probed with human ACPA pool obtained using CCP2 affinity columns, kindly provided by Euro-Diagnostica, as described previously. [1] Human IgG and CCP2 flow-through fraction were used as control antibodies. Silver stained gel spots, corresponding to WB signals, were extracted from 2D gels, in-gel digested using Lys-C, and resulting peptides were identified using mass spectrometry. Results By combining 2D gel electrophoresis with mass spectrometry, we have identified several novel potential ACPA targets as well as already characterised proteins. It remains to demonstrate if these proteins are citrullinated. Conclusions Here we demonstrate an extensive ACPA reactivity against novel proteins in RA synovial membranes. The results encourage further exploration of the role of these proteins/peptides in rheumatoid arthritis both as additional biomarkers as well as their potential roles in the pathogenesis of RA. Reference Ossipova E, Cerqueira C, Reed E, et al , Affinity purification and characterization of anti-citrullinated protein/peptide antibodies from plasma and synovial fluids of patients with rheumatoid arthritis (submitted).

Nitric oxide compounds have different effects profiles on human articular chondrocyte metabolism

IntroductionThe pathogenesis of osteoarthritis (OA) is characterized by the production of high amounts of nitric oxide (NO), as a consequence of up-regulation of chondrocyte-inducible nitric oxide synthase (iNOS) induced by inflammatory cytokines. NO donors represent a powerful tool for studying the role of NO in the cartilage in vitro. There is no consensus about NO effects on articular cartilage in part because the differences between the NO donors available. The aim of this work is to compare the metabolic profile of traditional and new generation NO donors to see which one points out the osteoarthritic process in the best way.MethodsHuman healthy and OA chondrocytes were isolated from patients undergoing joint replacement surgery, and primary cultured. Cells were stimulated with NO donors (NOC-12 or SNP). NO production was evaluated by the Griess method, and apoptosis was quantified by flow cytometry. Mitochondrial function was evaluated by analysing respiratory chain enzyme complexes, citrate synthase (CS) activities by enzymatic assay, mitochondrial membrane potential (Δψm) by JC-1 using flow cytometry, and ATP levels were measured by luminescence assays. Glucose transport was measured as the uptake of 2-deoxy-[3H]glucose (2-[3H]DG). Statistical analysis was performed using the Mann-Whitney U test.ResultsNOC-12 liberates approximately ten times more NO2- than SNP, but the level of cell death induced was not as profound as that produced by SNP. Normal articular chondrocytes stimulated with NOC-12 had reduced activity from complexes I, III y IV, and the mitochondrial mass was increased in these cells. Deleterious effects on ΔΨm and ATP levels were more profound with SNP, and this NO donor was able to reduce 2-[3H]DG levels. Both NO donors had opposite effects on lactate release, SNP diminished the levels and NOC-12 lead to lactate accumulation. OA chondrocytes incorporate significantly more 2-[3H]DG than healthy cells.ConclusionsThese findings suggest that the new generation donors, specifically NOC-12, mimic the OA metabolic process much better than SNP. Previous results using SNP have to be considered prudently since most of the effects observed can be induced by the interactions of secondary products of NO.

Identification of the pathogenic pathways in osteoarthritic hip cartilage: commonality and discord between hip and knee OA

Purpose: To define for the first time the transcriptome of normal and end-stage osteoarthritic (OA) hip cartilage and to identify novel pathogenic pathways involved in the disease. Methods: RNA was isolated from articular cartilage samples obtained from consented patients undergoing joint replacement surgery due to either end-stage hip OA or neck of femur fracture (NOF). Illumina HumanHT-12 V3 whole genome expression arrays were used to profile gene expressions. Raw data was analyzed and differentially expressed genes identified using the Agilent Gene Spring GX 11 package. P-values were corrected for multiple testing using the Benjamini-Hochberg method. Gene Set Enrichment Analysis (GSEA) and Ingenuity Pathway Analysis (IPA) were used to investigate functions and pathways associated with these genes, respectively. Protein interaction networks were predicted using STRING and visualized with Medusa 3.0. Differentially expressed genes were verified by real-time PCR. Results: In total we identified 1151 differentially expressed genes (fold change ≤ -1.5 or ≥1.5, P-value ≤ 0.01) between NOF (n=10) and OA hip (n=9) cartilage. Sixty canonical pathways (P-value ≤ 0.05) were identified as associated with these genes. A comparison between a published comparable knee dataset only identified 183 genes similarly differentially expressed but remarkably 35 canonical pathways overlapped between the experiments. wnt/β-catenin signalling, PI3K/AKT signalling and IL-17 signalling pathways were identified in common between both studies. Pathways such as glycosaminoglycan degradation (P-value=0.044), HIF1α signalling (P-value=0.007) and interferon signalling (P-value=0.003), were specific to our hip OA study, while IGF-1 signalling, clathrin-mediated endocytosis signalling and HMGB1 signalling were only associated with the differentially expressed genes from knee OA cartilage. Conclusions: This is the first study to report a comprehensive gene expression analysis of human hip OA cartilage compared to control (neck of femur fracture) cartilage at the whole human genome level. Our differential gene expression dataset shows excellent correlation with similar defined studies using comparable tissue but reveals discord between hip and knee OA in the behavior of individual genes although commonality with respect to the molecular pathways involved.

Deleterious interaction between BMP2 and TGF-beta signaling in articular chondrocytes: harmful role for BMP2 in OA?

Purpose: TGF-beta signaling via Smad2/3 is crucial for cartilage maintenance. Smad2/3 maintains a healthy chondrocyte phenotype by inhibiting chondrocyte hypertrophy. We have previously shown that loss of Smad2/3 signaling is a hallmark of both ageing and OA. BMP2, a TGF beta family member, signals via Smad1/5/8 instead of Smad2/3. During OA we found that BMP2 is elevated near lesions. We have investigated whether BMP2, and as a consequence Smad1/5/8 signaling, affects Smad2/3 signaling and what are the biological consequences of this. Methods: Primary bovine chondrocytes were exposed to BMP2 followed by Western blotting for Smad2/3P after 60, 180 and 420 minutes. To study whether the observed effects were reproducible in vivo we injected Ad-BMP2 i.a. into murine knee joints; Ad-luc was used as a control. We isolated knee joints after 3 days for immunohistochemistry on Smad2/3P. To address biological relevance of decreased Smad2/3P, human OA cartilage explants obtained from patients undergoing joint replacement surgery after informed consent were exposed to the Smad2/3P inhibitor SB-505124. After 48 hours RNA was isolated to investigate MMP13 levels as a marker for hypertrophy and OA marker. In addition, we exposed primary bovine chondrocytes to BMP2 and evaluated whether that had an effect on MMP13 levels as well.As we observed that BMP2 reduced Smad2/3P signaling and stimulated MMP13 expression we wanted to investigate whether this effect could be reversed by extra stimulation of the Smad2/3 route. Therefore chondrocytes were exposed to a combination of BMP2 and TGF-beta. Moreover, human OA cartilage explants were exposed to TGF-beta to investigate whether this reduced MMP13 expression. Results: Exposing primary bovine chondrocytes to 15 or 50 ng BMP2 led to a decrease in Smad2/3 phosphorylation on Western Blot already after 60 minutes and that was sustained until at least 420 minutes compared to non-stimulated controls. We confirmed this effect in vivo as over expression of BMP2 in murine knee joints led to decreased Smad2/3P positive cells in both patella and tibia by 55% and 43% respectively. To investigate the functional consequence of decreased Smad2/3 signaling we cultured human OA cartilage explants in the presence of SB-505124. This led to a significant increase in MMP13 expression of 13,6 fold (p<0.02). A similar increase in MMP13 expression was also observed in cultures of primary bovine chondrocytes 48 hours after stimulation with BMP2. Interestingly, the effect of either 15 or 50 ng BMP2 could be prevented by addition of TGF-beta, which prevented the decrease in Smad2/3P levels, but only when a dose of 10 ng/ml TGF-beta was used. A lower dose of 0.5 ng/ml TGF-beta was insufficient to overcome the BMP2-induced Smad2/3P decrease. This indicates that TGF-beta can overcome the BMP2 effect in a dose-dependent manner. Even in human OA cartilage that had spontaneously reduced Smad2/3P levels addition of 10ng/ml TGF-beta could still decrease MMP13 expression by 6.6 fold (p<0.005). Conclusions: Our data confirm that BMP2 down regulates Smad2/3 signaling in articular chondrocytes both in vitro and in vivo. A decreased Smad2/3 signaling in turn results in up regulated levels of MMP13 expression suggesting that BMP2 up regulation, as found adjacent to OA lesions, is deleterious for articular cartilage. Moreover, we show that this negative effect of BMP2 can be overcome by addition of TGF-beta, thereby raising levels of Smad2/3P. Even in human OA cartilage that has naturally high levels of MMP13 and low levels of Smad2/3P, TGF-beta addition can still reduce MMP13 expression levels. Overall our data suggest that BMP2 induces OA-like effects in articular cartilage, down regulating Smad2/3P and up regulating MMP13, which can be overcome by enhanced TGF-beta signaling.

Hemostatic Outcomes of Hip and Knee Joint Replacement Surgery in Von Willebrand Disease (VWD) Patients: A Single Center Study

Abstract▪2279▪This icon denotes a clinically relevant abstractSurgery for patients with von Willebrand disease (VWD) is increasingly common, however there is a paucity of data on hemostatic outcomes for VWD patients undergoing joint replacement surgery when compared to patients without bleeding disorders. The aim of this study was to evaluate hemostatic prophylaxis and outcomes in VWD patients who underwent hip or knee joint replacement, with comparison to matched case control patients. Methods: We retrospectively reviewed medical records of VWD patients who underwent total hip (THA) or total knee (TKA) arthroplasty between February 1993 and January 2011 at Mayo Clinic Rochester. Outcomes for each VWD patient were compared with two case controls matched for age, gender, surgeon and surgery. For VWD patients the hemostatic prophylaxis regimen during and following surgical procedures was evaluated including results of serial monitoring of plasma levels of VWF:RCo, VWF:Ag and FVIII:C. We compared VWD and control cases for bleeding complications (major and minor), transfusion requirements, DVT (deep vein thrombosis) prophylaxis and occurrence, duration of hospitalization, and other complications. Results: Twelve VWD patients (7 female) underwent 12 TKA and 7 THA surgeries; the median age was 62 (range 42–76) years. Seven had Type 1 VWD, one had Type 3 and four had Types 2A, 2B or 2M VWD. The 19 surgical episodes were matched to 38 control surgeries. Indications for arthroplasties were mainly degenerative joint disease in both subject groups. The median BMI was 30 (range 21–45) in the VWD patients and 31.9 (20–53) in controls. Three patients with mild Type 1 VWD received during 5 surgeries only one preoperative dose of DDAVP (desmopressin 0.3μg/kg body weight). Infusions of VWF/FVIII concentrates (Humate-P or occasionally Koate-DVI) were prescribed for twelve procedures, with median preoperative dose 52 IU/kg (range 19–71). Postoperative maintenance doses were infused once or twice daily usually for up to 7 days (more than 7 days only for one Type 3 and one Type 2A VWD patient), with median ranges 22 to 38 IU/kg, and highest dose 90 IU/kg and lowest dose 11 IU/kg (typically when treatment was administrated twice daily). These substantial ranges may be explained by dose adjustments based on monitoring postoperative plasma levels of VWF:RCo and FVIII:C. The median number of infusions per procedure was 5.5 (range 1–13). One hour after the preoperative dose the median of all factors was more than 110 IU/dL, specifically VWF:RCo 154 UI/dL (range 72–277), VWF:Ag 178 IU/dL (range 101–307), and FVIII:C 114 IU/dL (range 64–290). The lowest factor levels measured during daily postoperative follow-up are represented in Figure 1. Assessment of red blood cell transfusion requirements showed no difference between baseline and D1 blood hemoglobin levels for VWD and control groups (decline of 3.0 g/dL). During follow-up, hemoglobin levels and total blood losses were also not different between both groups. However, the number of patients transfused was twice as high for the VWD group (63% vs 32% for controls, respectively), and the mean number of RBC units transfused was higher in VWD patients than in controls (1.5 vs. 0.6 units, respectively). DVT prophylaxis (low molecular weight heparin (LMWH) injections or warfarin), was administrated to 58% of VWD patients vs. 97% of controls. No postoperative thrombotic events were identified in either group. Finally, the median duration of hospitalization for VWD patients and controls was not different: 5 days (range 3–13) and 5 days (range 3–7) respectively. Conclusions: Few data are available in published literature analyzing treatment regimens and hemostatic outcomes for patients with VWD undergoing THA or TKA, a relatively common treatment for advanced degenerative joint disease. This is the first large retrospective study which reports the effectiveness of prophylactic regimens specifically in joint replacement for patients with VWD. Our results support that, as recommended in the 2008 NHLBI/NIH treatment guidelines, monitoring of plasma VWF and FVIII levels at least once daily allows for efficient and relatively low dose maintenance administration. Further, our study helps identify an adequate duration of treatment for these major surgeries, without substantively increased blood loss for VWD patients compared with controls. Disclosures:No relevant conflicts of interest to declare.

Hsp90β inhibition modulates nitric oxide production and nitric oxide-induced apoptosis in human chondrocytes

BackgroundHsp90β is a member of the Hsp90 family of protein chaperones. This family plays essential roles in the folding, maturation and activity of many proteins that are involved in signal transduction and transcriptional regulation. The role of this protein in chondrocytes is not well understood, although its increase in osteoarthritic cells has been reported. The present study aimed to explore the role of Hsp90β in key aspects of OA pathogenesis.MethodsHuman OA chondrocytes were isolated from cartilage obtained from patients undergoing joint replacement surgery, and primary cultured. Cells were stimulated with proinflammatory cytokines (IL-1β or TNF-α) and nitric oxide donors (NOC-12 or SNP). For Hsp90β inhibition, two different chemical inhibitors (Geldanamycin and Novobiocin) were employed, or siRNA transfection procedures were carried out. Gene expression was determined by real-time PCR, apoptosis was quantified by flow cytometry and ELISA, and nitric oxide (NO) production was evaluated by the Griess method. Indirect immunofluorescence assays were performed to evaluate the presence of Hsp90β in stimulated cells.ResultsHsp90β was found to be increased by proinflammatory cytokines. Inhibition of Hsp90β by the chemicals Geldanamycin (GA) and Novobiocin (NB) caused a dose-dependent decrease of the NO production induced by IL-1β in chondrocytes, up to basal levels. Immunofluorescence analyses demonstrate that the NO donors NOC-12 and SNP also increased Hsp90β. Chemical inhibition or specific gene silencing of this chaperone reduced the DNA condensation and fragmentation, typical of death by apoptosis, that is induced by NO donors in chondrocytes.ConclusionsThe present results show how Hsp90β modulates NO production and NO-mediated cellular death in human OA chondrocytes.

Comparison of rheumatoid articular adipose and synovial tissue reactivity to proinflammatory stimuli: contribution to adipocytokine network

Objectives(1) To compare spontaneous and stimuli-induced adipocytokine secretion by articular adipose tissue (AAT) and synovial membrane (SM) explants obtained from patients with rheumatoid arthritis (RA). (2) To investigate the biological...

Patient satisfaction with an orthopaedic pre-operative assessment clinic

Summary This study explores patient satisfaction with an orthopaedic pre-operative assessment clinic. A quantitative exploratory approach was adopted using a pre-validated questionnaire. The introduction of pre-operative assessment clinics (POAC) has been recommended as a quality initiative to reduce surgical cancellations and enhance the patient journey to surgery. Yet patient satisfaction with this service has not yet been evaluated within an Irish context. A sample of 91 patients who attended the POAC were invited to participate in the study and a response rate of 88% was achieved. A modified version of the Leeds Satisfaction Questionnaire was administered to patients no sooner than four days post surgery. The findings suggest that in general patients were satisfied with the care provided in the POAC, but areas for improvement were identified in the matters of providing individualised care and information to patients. Recommendations for future research include further exploration into the information needs of patients undergoing joint replacement surgery and an evaluation of the importance of individualised care from the patients' perspective.

New oral anticoagulants in venous thromboembolism prophylaxis in orthopaedic patients: Are they really better?

Prophylaxis against venous thromboembolism (VTE) is considered standard of care. Appropriate chemoprophylaxis for VTE has been mandated by the United States government agencies and consumer groups. However, controversies exist regarding the most clinically relevant and safe chemoprophylaxis protocols in patients undergoing joint replacement surgery. Thus, this paper reviews the clinical efficacy and safety of newer oral anticoagulants. A literature search was performed for oral anticoagulants in advanced stages of development using PubMed and abstracts from thrombosis meetings. Most clinical trial data have demonstrated equal or superior efficacy in venographic endpoints in comparison to low-molecular-weight heparins (LMWH). However, bleeding complications have been reported to occur with oral anticoagulants as frequently as or more frequently than with LMWH. Other potential complications reported include liver enzyme elevation and cardiac irregularities. It remains to be established whether newer oral anticoagulants will be better alternatives to the current standard-of-care in real-life medical clinical practice.

Elevated number of recently activated T cells in bone marrow of patients with rheumatoid arthritis: a role for interleukin 15?

Objectives(1) To compare the absolute T-cell numbers in bone marrow (BM) isolated from patients with rheumatoid arthritis (RA) and osteoarthritis (OA); (2) to measure the levels of soluble interleukin 15...

Effects of (−)-epigallocatechin-3-gallate on cyclooxygenase 2, PGE2, and IL-8 expression induced by IL-1β in human synovial fibroblasts

The objective of this study was to examine the effects of (-)-epigallocatechin-3-gallate (EGCG) on cyclooxygenase 2 (COX-2), prostaglandin E(2) (PGE(2)), and interleukin 8 (IL-8) expression induced by IL-1beta in human synovial fibroblasts. Cells were enzymatically isolated from synovial tissue taken from patients undergoing joint replacement surgery for osteoarthritis. Reverse transcriptase-polymerase chain reaction, immunocytochemistry, and western blotting were used to assess the COX-2 gene and protein expression with the associated mechanisms. PGE(2) and IL-8 secretion into the culture medium was assayed by enzyme-linked immunosorbent assay. COX-2 upregulation in synovial fibroblasts induced by IL-1beta was significantly suppressed by EGCG in a dose-dependent manner. PGE(2) and IL-8 secretion was also induced by IL-1beta stimulation and significantly suppressed by EGCG. The mechanism was associated with the phosphorylation of IKKbeta. EGCG may inhibit the expression of inflammatory mediators, such as COX-2, PGE(2), and IL-8, induced by IL-1beta in human synovial fibroblasts. EGCG may be of value in the treatment of synovial inflammation.

Prevalence of Osteopenia and Osteoporosis in Patients Undergoing Joint Replacement Surgery

Prevalence of Osteopenia and Osteoporosis in Patients Undergoing Joint Replacement Surgery