Weight-bearing Ability Research Articles

Early Postoperative Weight-Bearing Ability after Total Hip Arthroplasty versus Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture.

Background: Femoral neck fractures are among the most common types of fractures and particularly affect elderly patients. Two of the most common treatment strategies are total hip arthroplasty (THA) and bipolar hemiarthroplasty (BA). However, the role of the different treatment strategies in the postoperative weight-bearing ability in the early postoperative phase is still not entirely clear. Methods: Patients who underwent either THA or BA were consecutively included in our prospective cohort study. Gait analysis was performed during the early postoperative period. The gait analysis consisted of a walking distance of 40 m coupled with the turning movement in between. During the gait analysis, the duration of the measurement, the maximum peak force and the average peak force were recorded. Results: A total of 39 patients were included, 25 of whom underwent BA and 14 of whom underwent THA. The maximum peak force during the gait analysis was, on average, 80.6% ± 19.5 of the body weight in the BA group and 78.9% ± 21.6 in the THA group. The additionally determined average peak force during the entire gait analysis was 66.8% ± 15.8 of the body weight in the BA group and 60.5% ± 15.6 in the THA group. Conclusions: Patients with femoral neck fractures undergoing THA and BA can achieve sufficient weight bearing on the operated leg in the early postoperative period. In our study, BA did not allow for a significantly higher average and maximum loading capacity compared with THA.

Catastrophic Talar Bone Loss from High Velocity Trauma Treated with Structural Tricorticate Fibula Autograft, Compression Frame and Midfoot Distraction Arthroplasty

Osteonecrosis is caused by the interruption of subchondral blood supply and can affect various bones in the human body. This case study details the treatment of a 37-year-old male with comminuted foot fractures, post-traumatic osteonecrosis, and previous surgeries who regained full weight-bearing ability and returned to work duties through a variety of techniques. Following the diagnosis of the disease through MRI scans, a surgical plan was devised for the patient: Pan-Talar Fusion Anterior Plate Reflect Anterior Flap Fibula Structural Autograft, lateral approach Complex frame compress ankle and distract mid-foot Distraction arthroplasty of midfoot The patient successfully achieved full weight-bearing and returned to work 11 months post-surgery. X-rays confirmed progressive bone healing and no hardware complications. This case demonstrates a successful treatment approach for complex hindfoot fractures, enabling full weight-bearing and return to work. Further research is needed to explore long-term outcomes and potential improvements in the surgical technique.

Reconstruction of plantar foot defects with free super-thin anterolateral thigh flap.

In the repair of plantar foot defects, it is important that the reconstructed area is compatible with surrounding tissue while weight-bearing ability continues. In our study, we present long-term results of plantar foot reconstruction with super-thin ALT flaps in patients that required reconstruction with free tissue transfer. We evaluated 11 patients with plantar foot defects that underwent reconstruction with a super-thin ALT flap. Patients were evaluated for postoperative ulceration, ability to wear normal shoes, time to return to work/school, LEFS score and satisfaction with aesthetic results. No bone defects were observed in the patients included in our study, except for the phalanges and distal metatarsals. Defects with soft tissue loss were reconstructed. The mean flap thickness was 4.9 mm (range 3-6 mm). Follow-up period ranged from 16 to 59 months. One patient required grafting for partial flap necrosis and recovered totally. Another patient required debulking surgery. Two patients had superficial ulceration postoperatively, which responded well to conservative therapy. The mean VAS score for cosmetic satisfaction was 8 of 10 (range, 6-9). Eight patients were satisfied with the flap contour, while three others were fairly satisfied. Mean time to return to work/school after surgery was 2.5 months. The preoperative LEFS score increased from 32.03 ± 15.2 to 58.7 ± 10.6 in the postoperative period, this difference was statistically significant (P<0.01). We consider that the advantageous features of super-thin ALT flaps such as proper tightening, reduced postoperative atrophy, and better contouring features make these flaps suitable for plantar foot defects.

Bone Defect Replacement in Diabetic Neuropathic Osteoarthropathy (Charcot Foot): Review

Background. The number of patients with diabetes mellitus, including those with its severe complications such as Charcot neuropathic osteoarthropathy, is increasing worldwide. Restoration of weight bearing ability and creation of conditions for ulcer healing is challenging for trauma and orthopedic surgeons, especially because of the need to restore bone tissue defects.&#x0D; Aim of the review to compare modern methods of replacement of large bone tissue defects of the distal segment of the lower limb in patients with Charcot neuropathic osteoarthropathy.&#x0D; Methods. The articles were searched in PubMed/MEDLINE, Google Scholar, Scopus, eLIBRARY, CyberLeninka databases. The search was performed using the following keywords and word combinations: Charcot foot, diabetic neuropathic osteoarthropathy and bone grafting. Full-text articles in Russian and English were selected. The search was carried out without chronological limitations due to the small number of published studies and specific subject of research.&#x0D; Results. The possibilities of bone defect replacement in Charcot foot are poorly described in the world literature. The narrow specificity and relative infrequency of this pathology is the probable reason for the small number of publications and the lack of studies with a high level of evidence.&#x0D; Conclusion. Bone autografting for lesions of the medial or lateral midfoot column and Ilizarov tibial lengthening to compensate for limb shortening after reconstructive surgeries at the level of the hindfoot and ankle joint are the most commonly used methods of bone defect replacement in patients with Charcot foot. Free bone autografting (possibly with demineralized bone matrix) is the method of choice for small defects of the lateral or medial column of the midfoot.

Early pain in females is linked to late pathological features in murine experimental osteoarthritis.

Osteoarthritis (OA) is a progressive joint disease and a major cause of chronic pain in adults. The prevalence of OA is higher in female patients, who tend to have worse OA outcomes, partially due to pain. The association between joint pain and OA pathology is often inconclusive. Preclinical research studies have largely overlooked sex as a potential determinant in joint pain during OA. This study aimed to investigate the role of sex in joint pain in the collagenase-induced OA (CiOA) model and its link with joint pathology. Multiple aspects of pain were evaluated during identically executed experiments of CiOA in male and female C57BL/6J mice. Cartilage damage, osteophyte formation, synovial thickness, and cellularity were assessed by histology on day 56. The association between pain and pathology was investigated, disaggregated by sex. Differences in pain behavior between sexes were found in the majority of the evaluated pain methods. Females displayed lower weight bearing ability in the affected leg compared to males during the early phase of the disease, however, the pathology at the end stage was comparable between sexes. In the second cohort, males displayed increased mechanical sensitivity in the affected joint compared to females but also showed more cartilage damage at the end stage of the model. Within this cohort, gait analysis showed varied results. Males used the affected paw less often and displayed dynamic weight-bearing compensation in the early phase of the model. These differences were not observed in females. Other evaluated parameters displayed comparable gait behavior between males and females. A detailed analysis of individual mice revealed that seven out of 10 pain measurements highly correlated with OA histopathology in females (Pearson r range: 0.642-0.934), whereas in males this measurement was only two (Pearson r range: 0.645-0.748). Our data show that sex is a determinant in the link between pain-related behavior with OA features. Therefore, to accurately interpret pain data it is crucial to segregate data analysis by sex to draw the correct mechanistic conclusion.

Correlation of the degenerative stage of a disc with magnetic resonance imaging, chemical content, and biomechanical properties of the nucleus pulposus.

Intervertebral disc degeneration (IDD) is closely related to changes in the intervertebral disc (IVD) composition and the resulting viscoelastic properties. IDD is a severe condition because it decreases the disc's ability to resist mechanical loads. Our research aims to understand IDD at the cellular level, specifically the changes in the viscoelastic properties of the nucleus pulposus (NP), which are poorly understood. This study employed a system integrating nanoindentation with Raman spectrometry to correlate biomechanics with subtle changes in the biochemical makeup of the NP. The characterization was, in turn, correlated with the degenerative severity of IVD as assessed using magnetic resonance imaging (MRI) of different patients with spinal stenosis, degenerative spondylolisthesis, and degenerative scoliosis. It is shown that there is an increase in the crosslinking ratio in collagen, a reduction in proteoglycan, and a build-up of minerals upon the rise in the severity level of the disc damage in the NP. Assessment of mechanical characteristics reveals that the increasing disc degeneration makes the NP lose its elasticity, becoming more viscous. This shows that the tissue undergoes abnormalities in weight-bearing ability, which contributes to spinal instability. The correlation of the individual discs shows that grades III and IV have similarities in the changes of Amide I and III toward the storage modulus. In contrast, grades IV and V correlate with mineralization toward the storage modulus. Reduction of proteoglycan has the highest impact on the changes of the storage modulus in all grades of IDD. Connecting compositional alterations to IVD micromechanics at various degrees of degeneration expands our understanding of tissue behavior and provides critical insight into clinical diagnostics, treatment, and tissue engineering.

Relationship between the progression of posterosuperior rotator cuff tear size and shoulder abduction function: A cadaveric study via dynamic shoulder simulator.

Posterosuperior rotator cuff tear (PSRCT) is one of the most common shoulder disorders in elderly people’s daily life; however, the biomechanical relationship between PSRCT and shoulder abduction function is still controversial. In this study, a total of twelve freshly frozen cadaveric shoulders were included and tested in five conditions: intact rotator cuff, 1/3 PSRCT, 2/3 PSRCT, entire PSRCT, and global RCT. In each condition, extra load (0%, 45%, and 90% failure load) was sequentially added to the distal humerus, and the function of the remaining rotator cuff was mainly evaluated via the middle deltoid force (MDF) required for abduction. It is found that the peak MDF is required for abduction did not differ among the three PSRCT conditions (1/3 PSRCT: 29.30 ± 5.03 N, p = 0.96; 2/3 PSRCT: 29.13 ± 9.09 N, p = 0.98; entire PSRCT: 28.85 ± 7.12 N, p = 0.90) and the intact condition (29.18 ± 4.99 N). However, the peak MDF significantly differed between the global RCT (76.27 ± 4.94 N, p < 0.01) and all PSRCT and intact conditions. Under 45% failure load, the MDF of the entire PSRCT and global tear conditions were significantly increased compared with another status. With the 90% failure load, only the 1/3 PSRCT condition maintained the same shoulder function as the intact rotator cuff. These biomechanical testing jointly suggested that the weight-bearing ability of the shoulder significantly decreased as PSRCT progressed.

Immediate full weight bearing after pelvic percutaneous fixation by screw for simple acetabular and pelvic ring fractures in patients older than sixty fiveyears.

The aim of this study was to assess the walking and weight-bearing abilities of patients older than 65years with a simple acetabular or pelvic ring fracture treated with pelvic percutaneous screwing (PPS). This study included 27 patients. This was a retrospective, single-centre observational study conducted in a level 1 trauma centre from September 2019 to April 2021. All patients older than 65years who underwent PPS for an acetabular or pelvic ring fracture were included. All patients were able to walk and bear weight at oneday after PPS. The mean walking distance increased from 19.4m the day after the operation to 59.8m, 497.8m, and 1402m at discharge, three and sixweeks after the operation, respectively. The average pain visual analog scale scores before and after the operation were 4.1 (range, 3.6-5.1; standard deviation [SD], 0.63) and 0.9 (range, 0.5-1.2; SD, 0.25), respectively (p < .0001). The average daily dose of paracetamol used before and after the operation was 2.2 (range, 1.7-3.1; SD, 0.59) g/d and 1.3 (range, 0.6-1.7; SD, 0.40) g/d, respectively (p = .0232). The average daily dose of morphine used before and after the operation was 5.7 (range, 4.7-6.7; SD, 0.76) mg/d and 1.6 (range, 0.5-2.9; SD, 1.09) mg/d, respectively (p = .0001). All included patients were able to walk at one day after PPS. PPS was associated with reduced pain as well as a reduction in paracetamol and morphine use.

Effect of Yijinjing Training on Balance Function and Plantar Pressure of Stroke Patients

<bold>Objective</bold> To observe the effect of Yijinjing training on static balance function and plantar pressure of stroke patient under the condition of eyes opened or closed. <bold>Methods</bold> A total of 48 stroke patients who were treated in the Second Rehabilitation Hospital of Shanghai from January to August 2021, which were randomly divided into the control group and the observation group according to the random number table method, with 24 cases in each groups. The control group received routine rehabilitation therapy, including exercise therapy, occupational therapy, electrotherapy and acupuncture therapy, once a day, five days a week, continuous treatment for four weeks. The observation group received Yijinjing training on the basis of the control group, 30 minutes a time, once a day, five days a week, continuous treatment for four weeks. Before and after treatment, the Berg balance scale (BBS) was used to evaluate balance function; the plantar pressure analysis system was used to evaluate the plantar pressure parameters under the condition of eyes opened or closed, the percentage of plantar pressure of the hemiplegic side and envelope ellipse parameters (long axis length, short axis length and area) were obtained through the analysis of the system; the adverse reactions such as falls, muscle pain, abnormal blood pressure and heart rate of the two groups were recorded. <bold>Results</bold> There was no significant difference in BBS score, percentage of plantar pressure on the hemiplegic side and envelope ellipse parameters of the two groups before treatment,the difference was no statistically significant (<italic>P</italic>&gt;0.05). Compared with before treatment, the BBS score of the two groups after treatment were significantly increased, and the percentage of plantar pressure on the hemiplegic side of the observation group after treatment were significantly increased, while the envelope ellipse parameters of the observation group after treatment were significantly decreased under the condition of eyes open and closed,the difference was statistically significant (<italic>P</italic>&lt;0.05). Compared with the control group, the BBS score and the percentage of plantar pressure on the hemiplegic side under the condition of eyes opened and closed were significantly increased, and the envelope ellipse parameters under the condition of eyes open were significantly lower in the observation group after treatment,the difference was statistically significant (<italic>P</italic>&lt;0.05). There were no adverse events in both groups. <bold>Conclusion</bold> Yijinjing training is helpful to improve the weight-bearing ability of the hemiplegic limb and the stability of center of gravity control of stroke patients, and effectively improve their balance function, which is worthy of clinical application and promotion.

Preliminary results of iliosacral screws and plate combination in the management of tile B3 pelvic fractures: A retrospective case series.

The aim of this study was to present preliminary results and experience with iliosacral screws and plate combination (horizontal triangular osteosynthesis, HTO) in the management of Tile B3 pelvic fractures. In this retrospective study, 26 patients (18 male, 8 female; mean age = 46, age range = 31-58 years) who were treated with horizontal triangular osteosynthesis using the combination of bilateral percutaneous iliosacral screws and transiliac plates due to Tile B3 pelvic fractures in our institution were included. The accompanying symptoms, blood loss, operation time , fracture healing time, and postoperative complications were observed and recorded. Patients were followed up retrospectively with routine post-operation visits for clinical and radiographic examination. The reduction quality was evaluated according to Matta criterion. Clinical and nerve function outcomes were evaluated by Majeed and Gibbons criterion. The mean follow-up time was 15 months (range = 12-21 months). The mean blood loss and operation time were 24.6 ± 6.7mL and 30.5 ± 3.47 mins, respectively. Patients experienced early weight-bearing ability and no fracture reduction loss. Due to Matta criterion for fracture reduction, the results were excellent in 16 cases, good in 9 cases, and fair in 1 case. Due to Majeed functional scoring at the last follow-up, the results were excellent in 17 cases, good in 9 cases. Of 3 patients in whom neurologic impairment was detected preoperatively, 2 achieved complete recovery, and 1 achieved partial improvement postoperatively. As a new surgical concept in the management of Tile B3 pelvic fractures, HTO seems to provide the following advantages: horizontal triangular fixation, minimally invasive incisions, less blood loss, and permitting early weight-bearing ability. However, there still exist several problems regarding the technique and the option of implants. Level IV, Therapeutic Study.

Transposition of the fibula on the supplying vascular pedicle for plasty of defects in the distal femur

After preliminary experimental study the bone plasty with vascularised fibular graft was performed to 9 patients with distal femur defects from 1 to 18 cm. Taking into account the advantages and shortcoming of the procedure several variants for transposition of vascularised fibular grafts were elaborated. They included gradual lengthening of vascular pedicle, use of doubled fibular graft to increase the mechanical strength. In all patients the restoration of weight-bearing ability of the limb was achieved by 1 year after surgery.

Pain monitoring to determine the optimal timing of activation of patients after reconstructive surgery for transverse flatfoot

In 30 patients with flat foot and hallux valgus reconstructive operations by CITO and Shev- rons techniques were performed on both feet. Pain monitoring using Card of pain audit was carried out at rest and under load. In 15 patients feet loading was started on the 6 postoperative day and in other 15 patients on the 4 day. Pain audit showed that the optimum time for the patient activization was the 4th postoperative day with use of special postoperative shoes and without plaster dressing and additional support. Use of computer system Balance test was shown to be a perspective for the objective evaluation of postoperative weight-bearing ability, efficacy of patient activization as well as for the acceleration of patient adaptation to postoperative loads.

A new technique of hindfoot reconstruction in chronic calcaneal osteomyelitis using the Ilizarov apparatus - a case series.

Calcaneal osteomyelitis (OM) is a challenging disease. Traditional surgical management has a limited success in preservation of the foot. The surgery proposed with the use of the Ilizarov apparatus for calcaneal OM aims to preserve the function, shape, and stability of the foot. Five patients between the age of 21 and 36 years, with isolated total and subtotal calcaneal OM, were treated with this technique in Royal Jordanian Medical Services (RJMS) institutions. Complex treatment included two stages: 1) radical sequestrectomy, and fixation of the foot in a favourable position with the Ilizarov fixator; 2) arthrodesis, reconstruction of the foot in order to fill in the bone defect. The patients were followed-up in the immediate (one month) and long-term (from one to six years) periods after treatment. The infection process was arrested and no recurrence was encountered. Weight-bearing ability was recovered. The shape of the hind foot was maximally close to natural. The patients reported high satisfaction.

Особенности хирургической тактики в лечении переломов проксимального отдела бедренной кости у геронтологических пациентов

The paper is dedicated to improving the treatment outcomes and consequences in elderly patients with femoral neck fracture by improving the diagnostics, osteosynthesis and total hip arthroplasty. The main causes and factors influencing the complication rates and final treatment outcomes in elderly patients with femoral neck fracture were identified. The evidence based diagnostic and treatment algorithm for such patients was designed. The proposed treatment system helped to reduce lethality, general and local complication rates among these patients. The active surgery helps to solve massive healthcare problems by easing the pain in elderly patients, restoring the hip joint mobility and weight bearing ability of extremity, enhancing independent living skills, and improving vitality and psychological state.

Traumatic Hip Dislocation in an NCAA DI Football Player with Occult Sequelae: A Case Report.

Background and PurposeAmerican football generates the most sports-related injuries in the United States, with tackling as the leading injury mechanism. Overall injury rate at the collegiate level has been reported as 8.61 per 1,000 athlete exposures (AEs) – twice the rate of high school levels; competition injury rates are reported as high as 36.94/1000 AEs. Traumatic hip dislocation is an uncommon injury typically arising from high-energy axial impact with only 2-5.5% occurring during sports activities.Case DescriptionA 22-year-old NCAA Division I football defensive back who experienced extreme left hip pain following contact with another player with his hip flexed during a game was diagnosed with a type 1 posterior hip dislocation, a grade 1 medial collateral ligament sprain with concomitant posterior thigh and hip muscle strains. Key impairments were limited left lower extremity motor performance, range of motion deficits, left hip pain, and diminished function and weight-bearing ability.OutcomesThe athlete reintegrated into typical defensive back off-season training approximately four to five months post injury without restrictions, however presented with new anterior hip pain seven months post injury revealing occult sequelae requiring surgical intervention. He was able to return to full play the following football season.DiscussionThis case report describes the successful return to sport of a Division I football player who sustained a traumatic posterior hip dislocation and complicated course including surgical intervention secondary to associated sequelae.Level of Evidence5

Early Weight-Bearing Recovery of Older Adults After Hip Surgery

<h3>Research Objectives</h3> To describe older adults' ability to bear weight post hip surgery using a wearable pressure insole sensor. It was hypothesized that the pressure insole sensor would detect a decrease in weightbearing ability as pain increased. <h3>Design</h3> This descriptive study detailed the weight-bearing ability of older adults for up to 14 postoperative days. <h3>Setting</h3> The study was conducted at a hip fracture unit located in an inpatient hospital setting. <h3>Participants</h3> Ten older adults who had sustained either neck of femur or intertrochanteric fracture and had undergone hemiarthroplasty or proximal femoral nail antirotation surgery participated in this study. All participants had a premorbid score of 100 on the Modified Barthel Index and had no cognitive impairment. <h3>Interventions</h3> The older adults were asked to wear a pair of pressure insole sensors once a day during their daily therapy session for up to 14 postoperative days. The maximum and mean weight-bearing load were measured during standing and walking. <h3>Main Outcome Measures</h3> Weight-bearing ability was measured by wearing a wireless device system consisting of (a) an air-filled sensor pad worn as a sandal, (b) a logger unit connected to the sensor pad via an air tube and secured to the calf using Velcro, and (c) a computer software that processed data transmitted wirelessly from the logger unit and recorded the weight-bearing load graphically in weight units across each step during ambulation. <h3>Results</h3> Three older adults, who had undergone a hemiarthroplasty, tolerated a maximum load close to 100% of their body weight, and was able to progress from walking with a walking frame to a quad stick. Although a high maximum load was achieved, older adults' mean weight-bearing load on their injured limb remained lower compared to their non-injured limb especially in those who had reported more pain. <h3>Conclusions</h3> Early weight-bearing recovery of older adults can be monitored using pressure insole sensor and facilitated through better pain control and enhanced therapy intervention. <h3>Author(s) Disclosures</h3> The author declares no conflict of interest.

Replicated Risk Index of Patient Functional Status Prior to Allogeneic Hematopoietic Cell Transplantation Predicts Healthcare Utilization and Survival

Poor physical functioning is associated with adverse outcomes after allogeneic hematopoietic cell transplantation (alloHCT). Analytic tools to predict mortality in alloHCT recipients include the HCT Comorbidity Index (HCT-CI) based on comorbidities and the Disease Risk Index (DRI) based on disease and disease status. We developed and replicated a risk model for overall survival (OS), early mortality (ie, death from any cause at or before day +100), initial hospital length of stay (LOS), and percentage of inpatient days within the first year post-alloHCT. In this study, we incorporated a physical therapy (PT) assessment with the HCT-CI and DRI to improve outcome predictions. The well-defined and feasible measure of functional status for assessing risk includes (1) the number of sit-to-stands performed in 30 seconds, (2) performance of 25 step-ups on the right/left side with (3) oxygen saturation recovery and (4) heart rate recovery, (5) weight-bearing ability, (6) assistance with ambulation, (7) motor and grip strength, (8) sensory and coordination impairment (eg, self-reported peripheral neuropathy, imbalance), (9) self-reported pain, and (10) limited endurance (ie, inability to complete step-ups and/or sit-to-stands). Our training cohort (TC) included 349 consecutive alloHCT recipients at Roswell Park treated between 2010 and 2016 and a subsequent replication cohort (RC; n=163) treated between 2016 and 2019. Four of the 10 metrics-self-reported pain, limited endurance, self-reported neuropathy, and <10 sit-to-stands in 30 seconds-were identified as significant predictors and were included in the multivariable models with the HCT-CI and DRI to create a new risk index (HCT-PCDRI: HCT-physical, comorbidity, and DRI) for outcomes. Models were tested in the RC. Shorter OS was associated with self-reported pain, limited endurance, higher HCT-CI, and higher DRI. At a median follow-up of 34 months, the 3-year OS based on the HCT-PCDRI was 30% for the very-high-risk group, 54% for the high-risk group, 49% for the intermediate-risk group, and 80% for the low-risk group. The number of patients identified as very high risk increased from 55 using HCT-CI alone to 120 with the new HCT-PCDRI, whereas the number in the low-risk group decreased from 91 to 45. Early mortality and a higher percentage of inpatient days within the first year post-alloHCT (a proxy for poor quality of life and high healthcare utilization) were associated with self-reported pain, higher HCT-CI, and higher DRI. A shorter initial LOS (ie, initial low healthcare utilization) was associated with performance of >10 sit-to-stands in 30 seconds, no self-reported neuropathy, and lower HCT-CI. These PT metrics combined with the HCT-CI and DRI created the HCT-PCDRI, which resulted in more patients being categorized accurately as high risk versus low risk. The HCT-PCDRI results were replicated in an independent cohort. Pre-alloHCT PT metrics with self-reported symptoms (pain and neuropathy) were associated with survival post-alloHCT and prolonged hospital LOS. The HCT-PCDRI scoring system for risk stratification of alloHCT recipients more accurately identifies patients at potential risk of poor outcomes. The HCT-PCDRI can be tested in <15 minutes to identify patients for intervention before or during treatment to potentially improve outcomes.

Discoidin Domain Receptors 1 Inhibition Alleviates Osteoarthritis via Enhancing Autophagy.

We recently reported that the chondrocyte-specific knockout of discoidin domain receptors 1 (Ddr1) delayed endochondral ossification (EO) in the growth plate by reducing the chondrocyte hypertrophic terminal differentiation, and apoptosis. The biologic and phenotypic changes in chondrocytes in the articular cartilage with osteoarthritis (OA) are similar to the phenomena observed in the process of EO. Additionally, autophagy can promote chondrocyte survival and prevent articular cartilage from degradation in OA. On this basis, we explored the effect of Ddr1 inhibition on OA prevention and further investigated the roles of autophagy in treating OA with a Ddr1 inhibitor (7 rh). The anterior cruciate ligament transection (ACLT)–OA model was used to investigate the role of 7 rh in vivo. Forty 8-week-old mice were randomly assigned to four groups, including the sham group, ACLT group, and two treated groups (ACLT with 7 rh 6.9 nM or 13.8 nM). According to the study design, normal saline or 7 rh were intra-articular (IA) injected into studied knees 3 times per week for 2 weeks and then once per week for 4 weeks. The results showed that 7 rh treatment significantly improved the functional performances (the weight-bearing ability and the running endurance), decreased cartilage degradation, and also reduced the terminal differentiation markers (collagen type X, Indian hedgehog, and matrix metalloproteinase 13). Moreover, 7 rh decreased chondrocyte apoptosis by regulating chondrocyte autophagy through reducing the expression of the mammalian target of rapamycin and enhancing the light chain 3 and beclin-1 expression. These results demonstrated that the IA injection of 7 rh could reduce the chondrocyte apoptosis and promote chondrocyte autophagy, leading to the attenuation of cartilage degradation. Our observations suggested that the IA injection of 7 rh could represent a potential disease-modifying therapy to prevention OA progression.

Acute Total Hip Arthroplasty for the Treatment of Acetabular Fractures: A Retrospective Study With a Six-Year Follow-Up

ObjectivesWhile open reduction and internal fixation is considered the gold standard for the treatment of acetabular fractures, it is associated with significant complications due to prolonged immobilization for elderly patients. The aim of this study was to investigate the clinical and radiological outcomes in elderly patients treated with an acute total hip arthroplasty (THA).Patients and methodsThis retrospective study included 16 patients (10 women and 6 men) with a mean age of 80.1 years suffering from a displaced acetabular fracture after a low-energy trauma. Primary THA was performed in all cases, by the same surgeon, within a three-week period after the fracture. The Burch-Schneider reinforcement ring with a cemented cup was used in 10 patients and a jumbo acetabular cup was used in 6 patients, whereas autologous bone graft was used in all cases.ResultsWith a mean follow-up of 72 months, one dislocation occurred that was treated with close reduction, and one patient developed superficial site infection that was managed conservatively with antibiotics. No periprosthetic fractures, deep infections, or other adverse events were observed. One case of asymptomatic radiographic loosening was reported and treated conservatively. And autologous bone graft was well incorporated. Clinical scores were significantly improved, and all patients were able to walk independently.ConclusionsAcute THA for the treatment of displaced acetabular fractures in elderly patients seems to be a safe option with good functional and radiological outcomes and low complication rates, offering early mobilization and weight-bearing ability to elderly patients.

Posttraumatic deformities of the bones, forming knee joint: general evaluation and treatment tactics

The aim of paper: to provide modern approach to diagnostics and treatment of deformities localized around knee joint and developed after distal metadiaphysis of femur and proximal metadiaphysis of tibia fractures. It was shown, that formed deformities provoke development of secondary adaptive changes in articular surfaces of knee and its stabilizers, thigh and shin muscles. It also impairs walking. The planning of treatment should be based on proper investigation: radiologic assessment of malaligned extremity and its computer tomography, ultrasound investigation of tendons and muscles, that provide function of knee joint, assess anatomic-functional characteristics of knee joint itself (range of motion, stability, osteoarthritic changes) and malfunction of whole extremity with malaligned segment, including walking ability. Standardized technique of roentgenographic investigation and standard parameters for proper image analysis are provided. The necessity to take into consideration all changes of impaired extremity and segment, but not only the results of roentgenograms assessment, for the working-out of treatment is emphasized. The main treatment goals are: restoration of weight-bearing ability, anatomic or almost anatomic realignment to restore three-dimension orientation of articular surfaces, improvement of walking function. The main types of treatment are: different osteotomies followed with fragments fixation using extrafocal or buried osteosynthesis (intramedullary nailing or plating), restoration of ligamentous structures, arthroplasty or arthrodesis. Main indications for every variant of surgical intervention are listed.