Total Joint Replacement Surgery Research Articles

Do non-steroidal anti-inflammatory drugs cause osteoarthritis progression, a systematic review and meta analysis

Do non-steroidal anti-inflammatory drugs cause osteoarthritis progression, a systematic review and meta analysis

IL37 ameliorates experimental murine osteoarthritis

Purpose: Osteoarthritis (OA) is the world’s most common degenerative joint disorder and leads to pain and disability. Currently, no disease-modifying drugs are available, resulting in a large unmet clinical need. Recently, we have shown that the anti-inflammatory cytokine IL37 lowers pro-inflammatory cytokine production, MMP3 expression and sulfated glycosaminoglycan loss in ex vivo cultured chondrocytes and human OA cartilage explants. In this study, we further explored the ability of IL37 to ameliorate OA pathology by studying its effects both in vitro on synovial fibroblasts and in vivo in experimental OA in mice. Methods: Primary human synovial fibroblasts were obtained by enzymatic digestion of synovial biopsies of 10 patients undergoing total joint replacement surgery. IL37 was overexpressed in these fibroblasts using an adenovirus (Ad-IL37) and subsequently cells were challenged with IL1β or OA-synovium conditioned medium (OAS-cm). Experimental OA was induced by a single intra-articular injection of 3 units of collagenase type VII in the right knee joint of 10 weeks old female C57BL/6J mice, i.e. collagenase-induced OA (CiOA). Four days after collagenase injection, Ad-IL37 or Ad-Luc (= control) was injected in the same joint, and after two weeks this injection was repeated. Mice were sacrificed on day 7, 28 and 42 after collagenase injection. Synovial thickening, cartilage damage (OARSI score) and osteophyte formation (size) were measured histologically. IL37, MMP3 and VDIPEN expression were investigated by immunohistochemistry. Results: In primary synovial fibroblasts, IL1β- and OAS-cm-induced expression of MMP1, MMP3, IL1B and IL6 was reduced by more than 50% by IL37. Prolonged (28 days) overexpression of IL37 in naïve knee joints did not lead to synovial thickening, cartilage damage or osteophyte formation and no overt immune response was detected. Strikingly, at day 7 of CiOA, IL37 overexpression significantly reduced synovial thickness, whereas in cartilage MMP3 protein and the presence of the metalloproteinase-generated aggrecan-degradation neoepitope VDIPEN was reduced. At day 28 of CiOA, cartilage damage was significantly reduced by IL37 treatment at both the lateral and medial side of the femur by 46% and 41%, respectively. Furthermore, osteophyte size at the medial femur was reduced by 70%. At day 42 of CiOA, IL37 overexpression could no longer be detected, in contrast to day 7 and 28. Osteophyte size formation at the medial femur was still significantly reduced by 46%, but only a trend (p = 0.06) towards reduced cartilage damage was observed on both femur and tibia at this time point. Conclusions: Our results show that IL37 inhibits the production of catabolic mediators in OA synovial fibroblasts, similar to what we previously observed in cartilage and chondrocytes. Furthermore, IL37 clearly lowered synovial thickening and ameliorated cartilage damage and osteophyte formation in murine experimental OA. These results indicate that IL37 acts on multiple OA-related processes in multiple joint tissues, which supports IL37 as a potential therapeutic agent for OA.

Delirium following total joint replacement surgery.

Postoperative delirium (POD) is a common complication associated with increased resource utilization, morbidity and mortality. Our institution screens all postsurgical patients for postoperative delirium. The study aim was to perform an automated interrogation of the electronic health records to estimate the incidence of and identify associated risk factors for POD following total joint arthroplasty (TJA). Adult patients who underwent TJA with a multimodal analgesia protocol, including peripheral nerve blockade, from 2008 through 2012, underwent automated chart review. POD was identified by routine nursing assessment and administrative billing codes. Of 11,970 patients, 181 (1.5%) were identified to have POD. Older age (odds ratio, 95% CI 2.20, 1.80-2.71 per decade, p < 0.001), dementia (7.44, 3.54-14.60, p < 0.001), diabetes mellitus (1.70, 1.1.5-2.47, p = 0.009), renal disease (1.68, 1.03-2.65, p = 0.039), blood transfusions (2.04, 1.14-3.52, p = 0.017), and sedation during anesthesia recovery (1.76, 1.23-2.51, p = 0.002) were associated with POD. Anesthetic management was not associated with POD risk. Patients who developed POD required greater healthcare resources. Dementia is strongly associated with POD. The association between POD and transfusions may reflect higher acuity patients or detrimental effect of blood. Postoperative sedation should be recognized as a warning sign of increased risk.

Development of Total Hip Joint Replacement Prostheses Made by Local Material: An Introduction

Total Hip Joint Replacement Surgery is the procedure of surgical removal of cartilage in the hip joints damaged by disease osteoarthritis to replaced with artificial components. Total Hip Joint Replacement has been indicated to relieve pain in the pelvis due to degenerative joint disease. In Indonesia, this procedure has been practised, but due to the cost of expensive products resulting in limited only to upper classify patients. The high prices caused by importing prostheses products, the technological capabilities and the difficulty to meet the standards of medical devices. The regulation of the Minister of Health of the Republic of Indonesia Number 52, 2016 for standard rates in organising health services Health Assurance Program, explained that the action of these operations entered into the insurance claims BPJS program, but not for the prostheses. This paper discusses the introduction of the development of the hip joint prostheses made from a local material that’s SS 316L, PEEK and Ceramic Dental Stone. The result of this development is the product of the hip joint prostheses has a reasonable price with good quality so that it can become affordable for middle to lower patients.

Higher offset cross-linked polyethylene acetabular liners: is wear a significant clinical concern?

Total hip arthroplasty (THA) is the 2nd most common total joint replacement surgery in the United States. However, not all THA devices perform well and need revised for several reasons including dislocation. Higher offset acetabular liners reduce this problem by creating a more anatomically/biomechanically natural hip joint, increasing soft-tissue tension, and accommodating larger femoral heads in smaller acetabular cups via increased polyethylene thickness. To our knowledge, however, in vivo wear (another failure mode) performance of offset acetabular liners remains unknown. 2 cohorts of 40 individuals (0-mm, 4-mm offset acetabular liners, respectively) from a single surgeon's consecutive caseload were assessed. 6-week/5-year post-op radiographs were compared using a validated method using SolidWorks software to assess in vivo linear and volumetric wear rates. Resultant surgical offset was also quantified using this method. Linear wear rate for 0-mm and 4-mm offset cohorts were 0.01 ± 0.09 mm/year and 0.08 ± 0.12 mm/year, respectively. Volumetric wear rate for 0-mm and 4-mm offset cohorts were 30.4 ± 20.4 mm3/year and 61.6 ± 42.1 mm3/year, respectively. Both of these were statistically significant. Neither linear nor volumetric wear rate was correlated with resultant surgical offset. To our knowledge, this is the 1st study to compare in vivo wear performance of 0-mm and 4-mm offset acetabular liners. Although linear and volumetric wear rates were different between cohorts, neither reached previously established osteolysis thresholds. Moreover, wear rates were not correlated with resultant surgical offset. Finally, no patients in either cohort showed signs of osteolysis nor needed revision. As such, the clinical relevance of the wear rate differences is potentially less significant.

A Retrospective Study of Patient Outcomes After Temporomandibular Joint Replacement With Alloplastic Total Joint Prosthesis at Massachusetts General Hospital

Disorders of the temporomandibular joint (TMJ) occur frequently, with a prevalence of 15 to 18%. Total joint replacement (TJR) surgery is indicated for severe joint damage associated with impaired function, pain, or occlusal change for which other treatments have been unsuccessful. The aim of this study was to assess changes in pain and range of motion (ROM), as well as postoperative complications and comorbidities, in patients receiving TJR surgery at Massachusetts General Hospital (MGH). This study is a retrospective review that describes the clinical variables in patients after alloplastic TMJ reconstruction performed at MGH from 2000 to 2015. Clinical variables included primary diagnosis; number of previous surgical procedures; comorbidities; preoperative and postoperative pain; preoperative, intraoperative, and postoperative ROM; and complications. Data were obtained from 95 patients undergoing a total of 108 surgical procedures, with an average follow-up period of 4.48±3.38years. The most common primary indications for TJR were ankylosis (44%) and inflammatory disease (23%). The maximum interincisal opening improved by a mean of 7.7±10.27mm, and pain decreased by a mean of 1.5±3.29 points on a visual analog scale. Transient facial nerve palsy (25%) was the most common postoperative complication; however, long-term complications were rare. The most frequent comorbidities were psychiatric disorders (56%) and gastrointestinal disease (46%). Psychiatric patients had similar preoperative pain scores (6.0±2.90) but significantly higher postoperative pain scores (4.7±2.58) compared with nonpsychiatric patients. Twenty-eight percent of patients had prior failed TMJ implant materials, specifically Proplast-Teflon (Vitek, Houston, TX). These patients were significantly older (50.4±8.26years) and had smaller preoperative ROM (21.7±8.85mm) and smaller postoperative ROM (28.3±9.59mm). Patients showed a statistically significant (P<.01) increase in ROM and reduction in pain. TJR is an effective treatment option in patients with limited mouth opening or severe pain.

Standardization of Acrylic Bone Cement Mixing Protocols for Total Knee Arthroplasty Results in Cost Savings.

Cost reduction is important in total joint replacement surgery. Bone cement is used to fixate implants in most knee replacement procedures. The authors instituted a 4-pronged approach to reduce the cost of cement. Their approach included reducing the cost of the cement powder, changing the type of mixing method, using less antibiotic cement, and decreasing the amount of cement required for smaller implants. The authors evaluated the implementation of this program and measured the overall costs of cementation during knee replacement. A retrospective review of total knee replacement cementation technique and cost was performed before and after the cost-reduction program was implemented. The type of cement and cement mixing equipment used, the amount of cement used, and the cost of cement and cement mixing equipment were examined. The authors also reported the short-term complication rate including 90-day readmission rate and 30-day revision rate. The program resulted in an overall decrease in cement-related costs from approximately $310 to $105 per case. Reductions in the amount of cement used and the use of antibiotic cement were shown. Among the 3 surgeons, adoption of the program varied. Bone cement is an expense of modern total knee replacement. Implementing a cost-reduction program can reduce cement costs without changing quality of cementation. [Orthopedics. 2018; 41(5):e671-e675.].

Surgical Management of Idiopathic Condylar Resorption: Orthognathic Surgery Versus Temporomandibular Total Joint Replacement.

Young females with retruded and hyperdivergent mandibles, class II openbite malocclusions, and steep occlusal planes with or without TMJ symptoms are at higher risk for Idiopathic Condylar Resorption (ICR). Such patients undergoing orthodontic and /or surgical treatment should be informed of possible relapse due to ICR. Orthognathic Surgery with Total joint replacement or Orthognathic surgery alone may both be acceptable options for management of the facial deformity and the malocclusion that ensues from ICR. Proper patient selection is key to achieving a successful outcome. Current trends and the evidence in the literature suggest that orthognathic surgery with alloplastic joint replacement may be the preferred approach.

Acute Coronary Artery Thrombus After Tranexamic Acid During Total Shoulder Arthroplasty in a Patient With Coronary Stents: A Case Report.

Tranexamic acid (TXA), an antifibrinolytic, is routinely used to decrease transfusion rates in total joint replacement surgery. While recent publications have indicated a low risk of TXA-associated thromboembolic events in this orthopedic population, few studies specifically address the safety of TXA administration in high-risk patients. We present a case of acute coronary thrombus requiring emergent intervention in a patient with indwelling coronary stents who underwent shoulder arthroplasty with TXA administration.

Race and gender disparities in physical function before and after total hip arthroplasty: a retrospective analysis

Purpose: Race and gender disparities in rates of total joint replacement surgery in the United States have been well-documented, and it appears that socioeconomic status plays a role in the generation of such disparities. However, little research exists regarding whether disparities persist amongst those who undergo arthroplasty surgery. The purpose of this study was to investigate physical function in a database of individuals who underwent total hip arthroplasty (THA) and identify potential disparities by race, gender, and socioeconomic status. Methods: We retrospectively analyzed electronic chart data of individuals who underwent THA with a single surgeon at a large urban hospital between January 2013 and March 2016. Individuals were included who underwent unilateral THA for a primary diagnosis of osteoarthritis. For those who received staged bilateral THAs during the study period, data from their first arthroplasty surgery only were included. Demographic data were retrieved, including age, sex, race, ethnicity, health insurance status, and census tract of residence. The proportion of households with incomes below the United States federal poverty level (FPL) in each individual's census tract of residence was used as a marker for socioeconomic status. Medical comorbidities were collected and summed using the Functional Comorbidity Index (FCI). Self-reported physical function was measured using the Harris Hip Score (HHS) pre-operatively and at six months post-operatively. Descriptive statistics were used to summarize sample demographics. T-tests were used to compare pre-operative and post-operative physical function between men and women, between white/Caucasian and black/African-American patients, and between patients living in low-poverty and high-poverty census tracts. Low-poverty census tracts were defined as those in which fewer than 20% of household incomes are below the federal poverty level (FPL), and high-poverty census tracts were defined as those in which greater than 20% of household incomes fall below FPL. Results: The sample of 271 individuals contained an even distribution of men (49.4%) and women (49.4%). On average, patients were slightly less than retirement age (mean age 63.2 years, SD 11.9) and had relatively low number of comorbidities (mean FCI 3.3, SD 1.8). A majority of patients (60.1%) had private health insurance, with smaller proportions using Medicare (22.1%), Medicaid (5.5%), or other types of insurance (12.2%). 86.7% of patients in the sample were white/Caucasian and non-Hispanic; 11.1% were black/African-American and non-Hispanic; fewer than one percent were Hispanic ethnicity and/or any other race. 83.0% (n = 225) of patients lived in low-poverty neighborhoods, while 10.7% (n = 29) lived in high-poverty neighborhoods (census tracts of residence for the remaining 17 patients were unable to be determined from electronic chart data). At baseline, men (mean HHS 46.3, SD 11.5) were functioning significantly better than women (mean 42.4, SD 13.7), P = .03. However, this difference was no longer significant at six-month follow-up (mean HHS for men 79.8, SD 16.7; mean HHS for women 77.5, SD 16.3), P = .41. At baseline, black patients (mean HHS 38.8, SD 13.3) were functioning significantly poorer than white patients (mean HHS 45.3, SD 12.4), P = .02. This difference persisted at six-month follow-up: mean HHS 79.7 (SD 15.8) for white patients and 68.0 (SD 1.92) for black patients, P = .03. There were no statistically significant differences between patients living in high-poverty neighborhoods and those in low-poverty neighborhoods at baseline (high-poverty mean HHS 39.1, SD 15.7; low-poverty mean HHS 45.2, SD 12.0) or at six-month follow-up (high-poverty mean HHS 69.4, SD 20.2; low-poverty mean HHS 79.8, SD 15.7). However, the relatively low proportion of patients residing in low-poverty census tracts resulted in low statistical power to detect such differences. Conclusions: In this sample of 271 individuals who underwent unilateral THA, women and black patients were functioning significantly poorer than men and white patients pre-operatively. At six months post-operatively, the significant difference in physical function between white and black patients persisted. Medical and rehabilitation providers and community organizations should be aware that undergoing THA surgery may not fully resolve existing disparities in physical function in this population.

Implication of 14-3-3epsilon as a potential alarmin in bone/cartilage communication in osteoarthritis

Purpose: Osteoarthritis (OA) is the most frequent and disabling joint disease. OA is now considered as a whole-joint disease characterized by cartilage degradation, synovial inflammation and bone remodeling. Our team identified 14-3-3ε as a novel soluble mediator critical in the communication between subchondral bone and cartilage in OA. This protein acts as a potent MMP-3 and MMP-13-stimulatory factor in chondrocytes leading to catabolic phenotype. 14-3-3ε seems to share common characteristics with alarmins, endogenous molecules with intracellular functions that are released in the extracellular media after infection or tissue damage. Alarmins (such as S100 and HMGB1 involved in cartilage degradation) bind to receptors expressed on the surface of cells engaged in host defense and tissue repair. These receptors include the Toll-like receptors, TLR2 and TLR4, as well as RAGE. Moreover, innate alarmins can stimulate the activation of resident immune cells, particularly macrophages. Our aim is to investigate the interactions between 14-3-3ε and its potential receptors, TLR2, TLR4 and RAGE and his role as an alarmin particularly as a new molecular mediator determining macrophage polarization in OA joint. Methods: Primary cultures of chondrocytes were performed from murine cartilage of the C57BL/6J mice (5 days old), and from human cartilage samples, obtained from OA patients undergoing total joint replacement surgery. The receptors TLR2, TLR4 and RAGE were blocked by monoclonal antibodies and pharmacologic inhibitors in chondrocytes (15mn) and then stimulated by recombinant 14-3-3ε during 24h. Immunocytochemistry was realized on murine chondrocytes with receptors antibodies. Chondrocyte gene expression and release of MMP-3, MMP-13 and IL-6 were evaluated by RT-PCR and ELISA. The direct interaction of 14-3-3ε and TLR2 was measured using SPR on a Biacore 3000 instrument. The potential 14-3-3ε-binding sites on receptors were investigated by in silico computational analysis PyMOL. Polarisation M1/M2 of marcrophages was performed by activating THP1 cells (ATCC) with PMA during 24h and stimulating them 24h hours with IL-4, LPS or 14-3-3ε. Different markers of the M1/M2 types were analysed by ELISA and RT-qPCR to identify the polarisation of macrophages (M1: TNF, IL-6, IL-1b, MCP1, Nos2, M2: IL-10, TGFb, Arg-1, FIZZ1, YM2). Results: TLR2, TLR4 and RAGE receptors were found on murine articular chondrocytes by immunocytochemistry using monoclonal antibodies. Invalidation of TLR2, TLR4 or RAGE receptors by blocking antibody in articular chondrocytes reduced significantly mRNA expression and protein release of MMP-3, MMP-13 and IL-6 induced by 14-3-3ε. For MMP3 mRNA expression, the inhibition rate reached 78% with blocking antibodies and 98% with OxPAPC, a TLR2/TLR4 inhibitor. The inhibition rate reached 65% (blocking antibodies), 98% (OxPAPC) for MMP13 and 74% (blocking antibodies) and 93% (OxPAPC) for IL-6. ELISA experiments showed an inhibition rate of 84% (blocking antibodies) and 97% (OxPAPC) for MMP3. Similar rates are observed for IL-6 secretion (83% and 97%). These results should be confirmed on cultures of human chondrocytes. Human recombinant TLR2 and TLR4 were covalently immobilized on CM5 chip. Results showed a direct interaction between recombinant TLR2 and 14-3-3ε (83 RU) and between TLR4 and 14-3-3ε (41 RU). Modeling experiments seems to show a direct interaction between 14-3-3ε and TLR2 receptor through a phosphorylated residue (TYR). Polarization of macrophages stimulated by recombinant 14-3-3ε is ongoing and expression of M1 type is expected. Conclusions: We have discovered 14-3-3ε, a new catabolic factor, produced by the subchondral bone and able to induce a catabolic phenotype of chondrocytes. Taking together, our results could designate 14-3-3ε as a novel alarmin to be explored in OA either for therapeutic or for prognostic purposes and its interaction with receptors could be a novel target in OA.

Recent Insights into the Contribution of the Changing Hypertrophic Chondrocyte Phenotype in the Development and Progression of Osteoarthritis.

Osteoarthritis (OA) is an extremely prevalent age-related condition. The economic and societal burden due to the cost of symptomatic treatment, inability to work, joint replacement, and rehabilitation is huge and increasing. Currently, there are no effective medical therapies that delay or reverse the pathological manifestations of OA. Current treatment options are, without exception, focused on slowing down progression of the disease to postpone total joint replacement surgery for as long as possible and keeping the associated pain and joint immobility manageable. Alterations in the articular cartilage chondrocyte phenotype might be fundamental in the pathological mechanisms of OA development. In many ways, the changing chondrocyte phenotype in osteoarthritic cartilage resembles the process of endochondral ossification as seen, for instance, in developing growth plates. However, the relative contribution of endochondral ossification to the changing chondrocyte phenotype in the development and progression of OA remains poorly described. In this review, we will discuss the current knowledge regarding the cartilage endochondral phenotypic changes occurring during OA development and progression, as well as the molecular and environmental effectors driving these changes. Understanding how these molecular mechanisms determine the chondrocyte cell fate in OA will be essential in enabling cartilage regenerative approaches in future treatments of OA.

Comparison of air exhausts for surgical body suits (space suits) and the potential for periprosthetic joint infection

Periprosthetic joint infection is a major complication of total joint replacement surgery and is associated with significant morbidity, mortality and financial burden. Surgical body suits (space suits), originally designed to reduce the incidence of infection, have paradoxically been implicated in increased periprosthetic joint infection rates recently. Air exhausted from space suits may contribute to this increased rate of periprosthetic joint infection. To investigate the flow of air exhausted from space suits commonly used in modern operating theatres. The exhaust airflow patterns of four commercially available space suit systems were compared using a fog machine and serial still photographs. The space suit systems tested all air exhausted into the operating room. The single fan systems with a standard surgical gown exhausted air laterally from the posterior gown fold at approximately the level of the surgical field. The single fan system with a dedicated zippered suit exhausted air at a level below the surgical field. The dual fan system exhausted air out of the top of the helmet at a level above the surgical field. Space suit systems currently in use in joint replacement surgery differ significantly from traditional body exhaust systems; rather than removing contaminated air from the operating environment, modern systems exhaust this air into the operating room, in some cases potentially towards the sterile instrument tray and the surgical field.

Development of a patient-specific temporomandibular joint prosthesis according to the Groningen principle through a cadaver test series

ObjectivesPatients suffering from osteoarthritis, ankylosis (e.g. post-trauma or tumour) in the temporomandibular joint (TMJ) can present with symptoms such as severely restricted mouth opening, pain or other dynamic restrictions of the mandible. To alleviate the symptoms, a total joint prosthesis can be indicated, such as the Groningen TMJ prosthesis. This was developed as a stock device with a lowered centre of rotation for improved translational and opening capacity. This study aimed to improve the design of the prosthesis, and produce a workflow for a customized Groningen TMJ prosthesis, in order to make it more accurate and predictable. MethodsThe fossa and mandibular components of the Groningen TMJ prosthesis were customized. A series of five human cadavers was operated and bilateral TMJ prostheses were placed using custom cutting and drilling guides. Placement accuracy was evaluated based on post-operative CT data. ResultsA total of N = 10 prostheses were placed and analysed. The average Euclidean distance deviation from planned to actual position was 0.81 mm (SD 0.21). All prostheses were placed according to the routine surgical approaches and had an excellent alignment with the bony structures. ConclusionThe newly developed custom Groningen TMJ prosthesis can be placed with great accuracy and is the first step for improving TMJ total joint replacement surgery.

High bacterial contamination rate of electrocautery tips during total hip and knee arthroplasty.

The aim of the study was to quantify the bacterial contamination rate of electrocautery tips during primary total joint replacement (TJR), as well as during aseptic and septic revision TJR. A total of 150 electrocautery tips were collected between April and July 2017. TJR surgeries were divided into three groups: (1) primary, (2) aseptic and (3) septic revisions. In each group, a total of 50 electrocautery tips were collected. A monopolar electrocautery with a reusable stainless-steel blade tip was used in all cases. The rate of bacterial contamination was determined for all groups. Correlation of exposure time and type of surgery was analyzed. The overall bacterial contamination rate was 14.7% (95% CI 9.4 to 21.4%). The highest contamination rate occurred in the septic revision group (30.0%; 95% CI 17.9 to 44.6%), followed by the primary cases group (10.0%; 95% CI 3.3 to 21.8%) and the aseptic revision group (4.0%; 95% CI 0.5 to 13.7%). Exposure time did not affect the bacterial contamination rate. In 12 out of 15 (80%) contaminations identified in the septic group, we found the same causative microorganism of the prosthetic joint infection on the electrocautery tip. The bacterial contamination of the electrocautery tips is relatively high, especially during septic hip revision arthroplasty. Electrocautery tips should be changed after debridement of infected tissue.

Cortistatin Binds to TNF-α Receptors and Protects Against Osteoarthritis

Osteoarthritis (OA) is a common degenerative disease worldwide, and tumor necrosis factor (TNF-α) is known to play critical roles in OA. Cortistatin (CST) is a recently discovered neuropeptide that plays a vital role in inflammatory reactions. However, it is unknown whether CST is involved in cartilage degeneration and OA development. This study investigated the interaction between CST and TNF-α receptors, revealing that CST competitively bound to TNFR1 as well as TNFR2. In addition, primary chondrocyte experiments showed that CST suppressed the proinflammatory function of TNF-α. Moreover, both spontaneous and surgically induced OA models were established in wild-type and CSTknockout mice. Deficiency of CST led to an accelerated OA-like phenotype, while exogenous CST attenuated OA development in vivo, causing alterations of cartilage destruction and expression of degenerative biomarkers. Furthermore, TNFR1- and TNFR2-knockout mice were used for analysis and indicated that TNFRs might be involved in the protective role of CST in OA. Additionally, experiments in primary chondrocytes and NF-κB luciferase reporter gene mice revealed that CST inhibited activation of the NF-κB signaling pathway in OA. Overall, this study provides new insight into the pathogenesis and potential therapeutic targets for cartilage degenerative diseases, including OA. Funding Statement: This work was supported by Key Research and Development Projects of Shandong Province (No. 2015GSF118115), the Natural Science Foundation of Shandong Province (BS2014YY048 and BS2015SW028 to Yunpeng Zhao, and ZR2016HM53 to Yuhua Li), the Cross-disciplinary Fund of Shandong University (Grant No. 26010178611010) and the National Natural Science Foundation of China (81501880 to Yunpeng Zhao and 81602761 to Weiwei Li). Declaration of Interests: The authors have declared that no conflict of interest exists. Ethics Approval Statement: All the experiments were agreed by the ethical review committee of Qilu Hospital, Shandong University, and additionally, the prior informed consent of the patients. Samples of human cartilage were collected from total knee joint replacement surgery patients for OA, with the detection of MOAKS, according to the agreement of the ethical review committee of Qilu Hospital, Shandong University, and the prior informed consent of the patients. All experiments were conducted in compliance with the relevant guidelines and regulations.

Do aggressive course of the disease predicts total joint replacement surgery in patients with rheumatoid arthritis?

Do aggressive course of the disease predicts total joint replacement surgery in patients with rheumatoid arthritis?

Evaluation of the prevalence of periodontal disease as a non-classical risk factor in the group of patients undergoing hip and/or knee arthroplasty.

Periodontal disease is a chronic disease causing an inflammatory process that affects various organs and is as-sociated with an increased risk of many diseases, including bone and cardiovascular disease. The aim of this study was to establish the prevalence of periodontal disease in continuous patients scheduled for hip or knee replacement surgery. The study was a prospective, epidemiological analysis performed in consecutive patients scheduled for total joint (hip or knee) replacement surgery. Patients enrolled into the study were screened for classical risk factors and had a dental evaluation performed for the diagnosis of periodontal disease. The study population consisted of 228 patients. A total of 137 (60.1%) patients were scheduled for a hip replace-ment surgery, while 91 (39.9%) had a knee replacement. The mean age of the study population was 66.8 ± 12.2 years, and 83 (36.4%) patients were male. A clinically significant disease was present in 65 (28.5%) cases, while all (100%) of the patients had at least minimal signs of periodontal disease. In patients with periodontal disease the percentage of tartar involvement of the teeth was 33.1 ± 26.8%, mean dental plaque coverage was 48.1 ± 29.8%, and bleeding occurred at a rate of 35.4 ± 29%. As for the hygiene level, it was generally poor in the majority of patients with periodontal disease. No differences in terms of baseline risk factors were present between patients with and without periodontal disease. In conclusion, periodontal diseases are highly prevalent in patients undergoing hip and/or knee replacement surgery. The presence of the periodontal disease is possibly associated with a worse prognosis and should be treated.

Sport nach Knie- und Hüftendoprothetik

The introduction of new materials and better implant coatings seems to provide the prerequisites for more intense physical activities after total joint arthroplasties of the lower extremity. Despite recent advances in implant design and materials, recommendations for sport after total joint arthroplasty have not been updated over the past 20 years. The introduction of modern uncemented fixation as well as highly cross-linked polyethylene into total hip arthroplasty allow for a more active life-style without an increased risk of loosening or complications. This publication reviews the literature and presents the current knowledge to provide guidelines for orthopaedic surgeons treating patients after total joint replacement surgery.

Articular and subcutaneous adipose tissues of rheumatoid arthritis patients represent equal sources of immunoregulatory mesenchymal stem cells

Adipose-derived mesenchymal stem cells (ASCs) have immunoregulatory properties, but their activity is dependent on signals provided by the local microenvironment. It is likely that highly inflammatory milieu of rheumatoid joint affects ASCs activity. To test this hypothesis, the function of rheumatoid ASCs derived from articular adipose tissue (AT-ASCs) and ASCs derived from subcutaneous adipose tissue (Sc-ASCs) has been analysed. Articular adipose tissue (infrapatellar fat pad) and subcutaneous adipose tissue (from the site of skin closure with sutures) were obtained from rheumatoid arthritis (RA) patients undergoing total knee joint replacement surgery. ASCs were isolated accordingly to the routinely applied procedure, expanded and treated or not with IFNγ and TNF (10 ng/ml). To evaluate immunomodulatory properties of AT- and Sc-ASCs, co-cultures with peripheral blood mononuclear cells (PBMCs) from healthy donors have been set. Proliferation of activated PBMCs (3H-thymidine incorporation method), secretion of IL-10 and IL-17A in co-culture supernatants (specific ELISA tests) and T regulatory FoxP3+ cells (Tregs) percentage have been evaluated (flow cytometry). Performed experiments demonstrated that ASCs from both sources have comparable properties. They suppress proliferation of activated PBMCs to the similar extent, induce IL-10 secretion by resting PBMCs and moderately induce generation of FoxP3+ Treg cells. Interestingly, both AT-ASCs and Sc-ASCs cause increase of IL-17A secretion by activated PBMCs as well as induce up-regulation of IL-6 concentration in co-culture supernatants. We demonstrated that AT-ASCs and Sc-ASCs obtained from RA patients possess similar immunomodulatory properties despite different localization and distinct cytokine milieu of tissue of origin. Our results indicate that ASCs derived from rheumatoid adipose tissues are not strongly immunosuppressive in vitro and that they may contribute to the pathogenesis of RA due to IL-17A secretion enhancement.