We found that adipose stem cells are poorly differentiated into bone and that their ability to differentiate into bone varies from cell line to cell line. The osteogenic differentiation ability of the adipose stem cell lines was distinguished through Alzarin Red Staining, and the cell lines that performed well and those that did not were subjected to RNA-seq analysis. The selected gene GSTT1 (glutathione S-transferase theta-1) gene is a member of a protein superfamily that catalyzes the conjugation of reduced glutathione to a variety of hydrophilic and hydrophobic compounds. The purpose of this study is to treat avascular necrosis and bone defect by improving bone regeneration with adipose stem cells introduced with a new GSTT1 gene related to osteogenic differentiation of adipose stem cells. In addition, the GSTT1 gene has the potential as a genetic marker that can select a specific cell line in the development of an adipose stem cell bone regeneration drug. Total RNA was extracted from each sample using the TRIzol reagent. Its concentration and purity were determined based on A260 and A260/A280, respectively, using a spectrophotometer. RNA sequencing library of each sample was prepared using a TruSeq RNA Library Prep Kit. RNA-seq experiments were performed for hADSCs. Cells were transfected with either GSTT1 at 100 nM or siControl (scramble control) by electroporation using a 1050 pulse voltage for 30 ms with 2 pulses using a 10 μl pipette tip. The purpose of this study is to discover genetic markers that can promote osteogenic differentiation of adipose stem cells (hADSCs) through mRNA-seq gene analysis. The selected GSTT1 gene was found to be associated with the enhancement of osteogenic differentiation of adipose stem cells. siRNA against GSTT1 reduced osteogenic differentiation of hADSCs, whereas GSTT1 overexpression enhanced osteogenic differentiation of hADSCs under osteogenic conditions. In this study, GSTT1 transgenic adipose stem cells could be used in regenerative medicine to improve bone differentiation. In addition, the GSTT1 gene has important significance as a marker for selecting adipose stem cells with potential for bone differentiation in the development of a therapeutic agent for bone regeneration cells.
Surgical debridement for medial epicondylitis (ME) is indicated for patients with refractory ME. The clinical efficacy of simple debridement has not been studied sufficiently. Moreover, authors experienced surgical outcome of ME was not as good as lateral epicondylitis. In this regard, authors have combined the atelocollagen injection in the debridement surgery of ME. The purpose of study was to compare clinical outcomes between simple debridement and debridement combined with atelocollagen injection in the ME. Twenty-five patients with refractory ME and underwent surgical debridement were included in the study. Group A (n=13) was treated with isolated debridement surgery, and group B (n=12) was treated with debridement combined with 1.0 mL of type I atelocollagen. Pain and functional improvements were assessed using visual analogue scale, Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (DASH) scale respectively before surgery, at 3, 6 months after surgery and at the final follow-up. Demographic data did not show significant difference between two groups before surgical procedures. Both groups showed improvement in pain and functional score postoperatively. However, at the 3 months after surgery, group B showed significantly better improvement as compared to group A(VAS 3.1 / 2.0, MEPS 71/82 qDASH 29/23). At the 6 months after surgery and final follow-up, both groups did not show any difference. Surgical debridement combined with atelocollagen is effective treatment option in refractory ME and showed better short-term outcomes compared to isolated surgery.
Olecranon plates used for the internal fixation of complex olecranon fractures are applied directly over the triceps tendon on the posterior aspect of the olecranon. The aim of the study is to describe the relationship of the plates and screws to the triceps tendon at the level of the olecranon. Eight cadaveric elbows were used. Dimensions of the triceps tendon at the insertion and 1cm proximal were measured. A long or a short olecranon plate was then applied over the olecranon and the most proximal screw applied. The length of the plate impinging on the tendon and the level of the screw tract on the tendon and bone were measured. The mean olecranon height was 24.3cm (22.4-26.9cm) with a tip-to-tendon distance of 14.5cm (11.9-16.2cm). The triceps tendon footprint averaged 13.3cm (11.7-14.9cm) and 8.8cm (7.6-10.2cm) in width and length, respectively. The mean width of the central tendon 1 cm proximal to the footprint was 6.8 cm. The long olecranon plate overlay over more movable tendon length than did the short plate and consequently the superior screw pierced the triceps tendon more proximally with the long plate. Using the Mann-Whitney U test, the differences were significant. The long olecranon plates encroach on more triceps tendon than short plates. This may be an important consideration for olecranon fractures with regards implant loosening or triceps tendon injury.
The present study investigated the five-year interval changes in pseudotumours and measured serum metal ions at long-term follow-up of a previous report of 28 mm diameter metal-on-metal (MoM) total hip arthroplasty (THA). A total of 72 patients (mean age 46.6 years (37 to 55); 43 men, 29 women; 91 hips) who underwent cementless primary MoM THA with a 28 mm modular head were included. The mean follow-up duration was 20.3 years (18 to 24). All patients had CT scans at a mean 15.1 years (13 to 19) after the index operation and subsequent follow-up at a mean of 20.2 years (18 to 24). Pseudotumour volume, type of mass, and new-onset pseudotumours were evaluated using CT scanning. Clinical outcomes were assessed by Harris Hip Score (HHS) and the presence of groin pain. Serum metal ion (cobalt (Co) and chromium (Cr)) levels were measured at the latest follow-up.Aims
Patients and Methods
Suture anchor have been used in surgical procedure of tendon or ligament repair. Recently, there has been developed an all suture anchor (soft anchor) which can be used even when the insertion area is narrow. But, the stability of soft anchors due to narrow zone has not been elucidated. This purpose of this study was to investigate stability of soft anchors with respect to their fixation intervals. Polyurethane foams with two different bone densities (10 pcf; 0.16g / cm³, 20 pcf; 0.32g / cm³) were used. All suture anchors and conventional suture anchors were fixed at 10mm, 5mm, and 2.5mm intervals. The failure load was measured using a mechanical testing machine. The average load to failure of conventional suture anchor
The posterolateral or posterior approach for total hip arthroplasty has the advantages of preserving the hip abductor musculature and providing good visualization during femoral preparation and component insertion. Although posterolateral approach is one of the popular approaches in hip arthroplasty, it has been reported high dislocation rate as a drawback. To compensate the drawback the repair of short external rotator of hip is thought to be important. Therefore, we investigated incidence of failed repaired short external rotator muscles, dislocation rate and time of failure between tendon to tendon and tendon to bone repair technique through prospective study more than 1 year follow up. We performed 213 hip arthroplasties in 202 patients from May 2012 to January 2015. After exclusion of 15 hips due to follow-up loss(9 hips), death(2 hips), greater trochanteric fragment displacement(3 hips) and severe contracted short external rotator(1 hip), we investigated 198 hips in 187 patients. 57 patients were male and 130 patients were female. The mean age of patient was 70.4 (32–98) years. Reattachment short external rotator with posterior capsule to postero-superior aspect of greater trochanter(tendon to bone group, 111 hips) or to the tendon(tendon to tendon group, 87 hips) was performed. Two No.26 metal wire markers were fixed at the greater trochanter tip and short external rotator tendon respectively with a distance less than 1.2cm, and the distance between two wire markers was observed at postoperative 1 day, 2 weeks, 3 months, and annually radiographs in neutral position. When the distance was more than 2.5cm or one of the wire markers was invisible, we defined them the failure of short external rotator repair. The mean follow up period was 28.8 (12–45) months.Purpose
Materials and methods
Suture anchor have been used in surgical procedure of tendon or ligament repair. Recently, there has been developed an all suture anchor (soft anchor) which can be used even when the insertion area is narrow. But, the stability of soft anchors due to narrow zone has not been elucidated. This purpose of this study was to investigate stability of soft anchors with respect to their fixation intervals. Polyurethane foams with two different bone densities (10 pcf; 0.16g / cm³, 20 pcf; 0.32g / cm) were used. All suture anchors and conventional suture anchors were fixed at 10mm, 5mm, and 2.5mm intervals. The failure load was measured using a mechanical testing machine.Introduction
Methods
Circulating cobalt and chromium from metal-on-metal implants cause rare but fatal autopsy-diagnosed cardiotoxicity. Concern exists that milder cardiotoxicity may be common and under-recognized. Unacceptably high failure rates of metal-on-metal hip implants have prompted regulatory authorities to issue worldwide safety alerts. Despite this, approximately 1 million patients continue to live with metal-on-metal implants, putting them at risk of systemic toxicity. Although blood cobalt and chromium levels are easily measured and track local toxicity, no non-invasive tests for organ deposition exist. We recently demonstrated the utilisation of a T2* protocol (cardiovascular MRI) to detect cobalt and chromium deposition within the liver of a patient with elevated blood cobalt levels (confirmed by liver biopsy tissue analysis and X-ray fluorescence spectroscopy). We sought to detect and constrain the correlation between blood metal ions and a comprehensive panel of established markers of early cardiotoxicity. In addition we applied T2* protocols with the aim of detecting cardiac metal deposition. 90 patients were recruited through RNOH clinics into this prospective single centre blinded study. Patients were divided into 3 age and gender-matched groups according to type of implant and blood metal ion levels as follows: [Group A] Non-metal bearing hip implants; [Group B] Metal-on-metal implants, low blood metal ion levels (<7ppb); and [Group C] Metal-on-metal implants, high blood levels (>7ppb). All underwent detailed cardiovascular phenotyping using cardiac MRI (with T2*, T1 and ECV mapping, in addition to LV size and ejection fraction), advanced echocardiography (LV size and ejection fraction), and cardiac blood biomarker (Troponin and BNP) sampling in the same sitting at the Heart Hospital London. Primary outcomes were pre-specified. See study flow diagram – figure 1. (The study was registered with Blood cobalt levels were significantly different between groups (0.17ppb (range 0·10–0·47, SD 0·08) vs. 2·47 (0·72–6·9, SD 1·81) vs. 30·0 (7·54–118.0, SD 29·1) respectively for groups A, B and C). No significant between-group differences were found for LV size, ejection fraction (CMR or echocardiography), LA size, T1, T2*, ECV, BNP or troponin, with all results within normal ranges. There was no relationship between blood cobalt levels and either left ventricular ejection fraction or T2* (r=-0·022 and r=-0·108 respectively). Although small, the study was sufficiently powered to detect, as a minimum, a difference in ejection fraction of 4.8% (Cohen's d effect size 0·8). Using best available technologies, exposure of patients with metal-on-metal hip implants to high (but not extreme) blood cobalt and chromium levels has no detectable effect on the heart. We believe these findings will offer reassurance to one million patients worldwide living with a metal-on-metal hip implant and will support clinicians caring for such patients. For any figures or tables, please contact the authors directly by clicking on ‘Info & Metrics’ above to access author contact details.
Proper positioning of the baseplate and optimal screw placement are necessary to avoid loosening or failure of the glenoid component in RTSA. Several in vitro and anatomic studies have documented ideal number, size, length and angulation of baseplate screws. However, such fixation can often be tenuous, as the anatomy of scapula bone varies. Furthermore, it can be difficult to identify regions with the best bone stock intraoperatively even though surgeons have an understanding of scapular anatomy with potential screw trajectories in mind. This often leads to variable screw lengths and angulations in the clinical setting. The purpose of this study was to measure optimal screw lengths and angles to reach ideal regions in cadaveric scapulae and to compare the clinical experiences of three surgeons with each other and against a cadaveric model with screw lengths and angulations. Seven cadaveric scapulae were used as the template for optimal screw angulation and length for baseplate implantation. Total 21 cases (seven cases of each 3 surgeons) of reverse total shoulder arthroplasty using the Aequalis®-Reversed shoulder prosthesis (Tornier, France) were included. Measurement of screw angulation was done on the AP and axillary views to account for the superior-inferior and the antero-posterior angulations, respectively. The screw lengths used on each scapula was recorded prior to insertion in cadavers and retrieved from the operative records in clinical cases. Screws directed anteriorly and superiorly were recorded as positive values while posteriorly and inferiorly directed screws were designated negative values. The significant differences in degrees of screw angulation and screw lengths among the 3 surgeon groups were calculated using the ANOVA, with the p value at 0.05. The Mann-Whitney U test was performed to evaluate the cadaver group against the surgeon groups.Introduction
Materials and Methods
The aims of this study were to evaluate the clinical and radiological
outcomes of instrumented posterolateral fusion (PLF) performed in
patients with rheumatoid arthritis (RA). A total of 40 patients with RA and 134 patients without RA underwent
instrumented PLF for spinal stenosis between January 2003 and December
2011. The two groups were matched for age, gender, bone mineral
density, the history of smoking and diabetes, and number of fusion
segments. The clinical outcomes measures included the visual analogue scale
(VAS) and the Korean Oswestry Disability Index (KODI), scored before
surgery, one year and two years after surgery. Radiological outcomes
were evaluated for problems of fixation, nonunion, and adjacent
segment disease (ASD). The mean follow-up was 36.4 months in the RA
group and 39.1 months in the non-RA group.Aims
Methods
Proper positioning of the baseplate and optimal screw placement are necessary to avoid loosening or failure of the glenoid component in RTSA. Several in vitro and anatomic studies have documented ideal number, size, length and angulation of baseplate screws. However, such fixation can often be tenuous, as the anatomy of scapula bone varies. Furthermore, it can be difficult to identify regions with the best bone stock intraoperatively even though surgeons have an understanding of scapular anatomy with potential screw trajectories in mind. This often leads to variable screw lengths and angulations in the clinical setting. The purpose of this study was to measure optimal screw lengths and angles to reach ideal regions in cadaveric scapulae and to compare the clinical experiences of three surgeons with each other and against a cadaveric model with screw lengths and angulations. Seven cadaveric scapulae were used as the template for optimal screw angulation and length for baseplate implantation. Total 21 cases (seven cases of each 3 surgeons) of reverse total shoulder arthroplasty using the Aequalis®-Reversed shoulder prosthesis (Tornier, France) were included. Measurement of screw angulation was done on the AP and axillary views to account for the superior-inferior and the antero-posterior angulations, respectively. The screw lengths used on each scapula was recorded prior to insertion in cadavers and retrieved from the operative records in clinical cases. Screws directed anteriorly and superiorly were recorded as positive values while posteriorly and inferiorly directed screws were designated negative values. The significant differences in degrees of screw angulation and screw lengths among the 3 surgeon groups were calculated using the ANOVA, with the p value at 0.05. The Mann-Whitney U test was performed to evaluate the cadaver group against the surgeon groups.Introduction
Materials and Methods
One of advantages of single-radius femoral design was to offer better ligament stability based on a maintained isometry of extensor muslce during the whole range of motion. The purpose of this study was to compare intraoperative varus-valgus laxities from 0° to 90° of flexion in patients that received TKA using either a single-radius femoral design or multiradius femoral design. 56 TKAs with a single-radius femoral design (SR group) and 59 TKAs with multiradius femoral design (MR group) were included in this study. We measured and compared varus-valgus laxities at 0°, 30°, 60°, 90° of flexion using the navigation system and manual force between the 2 groups.Background
Methods
The rigid fixation of glenoid base plate is essential for the prevention of dissociation of the construct in the reverse total shoulder arthroplasty. For the rigid fixation, ideal placement of fixation screw is crucial but it is difficult to determine the best direction and length of screws. The purpose of this study was to determine configuration of optimal screw in cadaveric scapulae and compare with that in patient who underwent reverse total shoulder arthroplasty. Seven scapulae were used and implanted using a variable angle base plate with four directions screws. Optimal screw placement was defined as that which maximized screw length, accomplished far cortical purchase. Insertion angle and length of every screw was measured from AP and axial radiograph taken after the screws fixation. In a similar manner, the insertion angles of screws were measured from radiographs of 7 postoperative patients who underwent reverse total shoulder arthroplasty. The averages of length and insertion angle of 4 screws from two groups were compared.Backgrounds
Materials and methods
We carried out a retrospective study to assess the clinical results of lengthening the fourth metatarsal in brachymetatarsia in 153 feet of 106 patients (100 female, six males) using three different surgical techniques. In one group lengthening was performed by one-stage intercalary bone grafting secured by an intramedullary Kirschner-wire (45 feet, 35 patients). In the second group lengthening was obtained gradually using a mini-external fixator after performing an osteotomy with a saw (59 feet, 39 patients) and in the third group lengthening was achieved in a gradual manner using a mini-external fixator after undertaking an osteotomy using osteotome through pre-drilled holes (49 feet, 32 patients). The mean age of the patients was 26.3 years (13 to 48). Pre-operatively, the fourth ray of the bone-graft group was longer than that of other two groups (p <
0.000). The clinical outcome was compared in the three groups. The mean follow-up was 22 months (7 to 55). At final follow-up, the mean lengthening in the bone-graft group was 13.9 mm (3.5 to 23.0, 27.1%) which was less than that obtained in the saw group with a mean of 17.8 mm (7.0 to 33.0, 29.9%) and in the pre-drilled osteotome group with a mean of 16.8 mm (6.5 to 28.0, 29.4%, p = 0.001). However, the mean time required for retention of the fixation in the bone-graft group was the shortest of the three groups. Patients were dissatisfied with the result for five feet (11.1%) in the bone-graft group, eight (13.6%) in the saw group and none in the pre-drilled osteotomy group (p <
0.000). The saw group included eight feet with failure of bone formation after surgery. Additional operations were performed in 20 feet because of stiffness (n = 7, all groups), failure of bone formation (n = 4, saw group), skin maceration (n = 4, bone-graft group), malunion (n = 4, bone-graft and saw groups) and breakage of the external fixator (n = 1, saw group). We conclude that the gradual lengthening by distraction osteogenesis after osteotomy using an osteotome produces the most reliable results for the treatment of fourth brachymetatarsia.
We reviewed 22 children with cubitus varus who had been treated by a reverse V osteotomy and fixation by cross-pinning and wiring. The mean pre-operative humeral-elbow-wrist angle was −16.9° (−25° to +9°) and at the latest follow-up it was +7.3° (−2° to +14°). No child had a lateral prominence greater than 5 mm after correction. An excellent result was achieved in 20 children and a good result in two. We believe that this osteotomy has the advantages of better inherent stability, the avoidance of a prominent lateral condyle after correction and firm fixation allowing early movement.
