In-vivo 3-Dimensional gait symmetry analysis in patients with bilateral total hip arthroplasty

Although three-dimensional (3D) asymmetry has been reported in unilateral THA patients during gait, it is not well understood whether asymmetric hip kinematics during gait persist in bilaterally operated THA patients. The purpose of this study was to compare the in vivo 3D kinematics and component placement between bilateral and unilateral THA patients during gait. Eight bilateral and thirty-three unilateral THA patients were evaluated for both hips during treadmill gait using a validated combination of 3D computer tomography-based modeling and dual fluoroscopic imaging system (DFIS). The in vivo 3D kinematics of the unilateral THA group was first assessed. The magnitudes of kinematics and component placement difference between implanted hips in the bilateral THA group and between the implanted and non-implanted hips in the unilateral THA group were compared. The study results showed asymmetric gait kinematics in the unilateral THA group. Although the magnitude of kinematics differences between sides for both the bilateral and unilateral THA groups did not change significantly for hip rotations (p > 0.05), the bilaterally operated THA group has significantly lower magnitude of hip gait translation difference. Significant reduction in the magnitude of the acetabular cup adduction, stem adduction, and combine hip anteversion and adduction difference was observed in the bilateral THA group (p < 0.05). Our findings demonstrated that despite significant improvements of component placement and reduced magnitude of hip gait translation difference between implanted hips in the bilateral THA group, asymmetric hip kinematic rotations persisted in patients with bilateral THA during gait.     

Ankle and foot power in gait analysis: Implications for science,technology and clinical assessment

In human gait analysis studies, the entire foot is typically modeled as a single rigid-body segment; however, this neglects power generated/absorbed within the foot. Here we show how treating the entire foot as a rigid body can lead to misunderstandings related to (biological and prosthetic) foot function, and distort our understanding of ankle and muscle-tendon dynamics. We overview various (unconventional) inverse dynamics methods for estimating foot power, partitioning ankle vs. foot contributions, and computing combined anklefoot power. We present two case study examples. The first exemplifies how modeling the foot as a single rigid-body segment causes us to overestimate (and overvalue) muscle-tendon power generated about the biological ankle (in this study by up to 77%), and to misestimate (and misinform on) foot contributions; corroborating findings from previous multi-segment foot modeling studies. The second case study involved an individual with transtibial amputation walking on 8 different prosthetic feet. The results exemplify how assuming a rigid foot can skew comparisons between biological and prosthetic limbs, and lead to incorrect conclusions when comparing different prostheses/interventions. Based on analytical derivations, empirical findings and prior literature we recommend against computing conventional ankle power (between shank-foot). Instead, we recommend using an alternative estimate of power generated about the ankle joint complex (between shank-calcaneus) in conjunction with an estimate of foot power (between calcaneus-ground); or using a combined anklefoot power calculation. We conclude that treating the entire foot as a rigid-body segment is often inappropriate and ill-advised. Including foot power in biomechanical gait analysis is necessary to enhance scientific conclusions, clinical evaluations and technology development.     

Metal ion release barrier function and biotribological evaluation of a zirconium nitride multilayer coated knee implant under highly demanding activities wear simulation

Total knee arthroplasty is a well established treatment for degenerative joint disease, which is also performed as a treatment in younger and middle-aged patients who have a significant physical activity and high life expectancy. However, complications may occur due to biological responses to wear particles, as well as local and systemic hypersensitivity reactions triggered by metal ions and particles such as cobalt, chromium and molybdenum. The purpose of the study was to perform a highly demanding activities (HDA) knee wear simulation in order to compare the wear characteristics and metal ion release barrier function of a zirconium nitride (ZrN) coated knee implant, designed for patients with suspected metal ion hypersensitivity, against an uncoated knee implant made out of CoCrMo. The load profiles were applied for 5 million HDA cycles, which represent 15–30 years of in vivo service depending on the activity level of the patient. Results showed a significant wear rate reduction for the coated group (1.01 ± 0.29 mg/million cycles) in comparison with the uncoated group (2.89 ± 1.04 mg/million cycles). The zirconium nitride coating showed no sign of scratches nor delamination during the wear simulation, whereas the uncoated femurs showed characteristic wear scratches in the articulation areas. Furthermore, the metal ion release from the coated implants was reduced up to three orders of magnitude in comparison with the uncoated implants. These results demonstrate the efficiency of zirconium nitride coated knee implants to reduce wear as well as to substantially reduce metal ion release in the knee joint.     

Intra-articular implantation of autologous bone marrow–derived mesenchymal stromal cells to treat knee osteoarthritis: a randomized,triple-blind,placebo-controlled phase 1/2 clinical trial

Background

The intra-articular implantation of mesenchymal stromal cells (MSCs) as a treatment for knee osteoarthritis (OA) is an emerging new therapy. In this study, patients with knee OA received intra-articular implantations of autologous bone marrow–derived MSCs. We sought to assess the safety and efficacy of this implantation.

滑膜炎颗粒联合玻璃酸钠治疗创伤性膝关节滑膜炎的疗效及对患者血清炎症因子水平的影响

目的:探讨滑膜炎颗粒联合玻璃酸钠治疗创伤性膝关节滑膜炎的疗效及对患者血清炎症因子水平的影响。方法:选取2015年2月～2017年12月期间我院收治的创伤性膝关节滑膜炎患者216例为研究对象。根据随机数字表法将患者分为对照组(n=108)与研究组(n=108)。对照组患者给予玻璃酸钠治疗,研究组则在此基础上联合滑膜炎颗粒进行治疗,两组均治疗5周。比较两组治疗5周后(治疗后)的临床疗效及治疗前后血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)水平,采用视觉模拟量表(VAS)评价患者治疗前后膝关节疼痛程度,美国特种外科医院量表(HSS)评价患者治疗前后膝关节功能,同时观察两组治疗期间不良反应发生情况。结果:研究组患者总有效率为92.59%(100/108),高于对照组患者的78.70%(85/108)(P0.05)。两组患者治疗后IL-6、TNF-α以及IL-1β水平均较治疗前降低,且研究组低于对照组(P0.05)。两组患者治疗后VAS评分较治疗前降低,且研究组低于对照组,HSS评分较治疗前升高,且研究组高于对照组(P0.05)。两组患者不良反应发生率对比差异无统计学意义(P0.05)。结论:滑膜炎颗粒联合玻璃酸钠治疗创伤性膝关节滑膜炎安全有效,可显著改善患者血清炎症因子水平以及膝关节功能,并减轻患者疼痛程度,具有一定的临床应用价值。     

大剂量氨甲环酸对全膝关节置换患者术后纤溶活性与炎症因子的影响

目的:探讨大剂量氨甲环酸对全膝关节置换患者术后纤溶活性与炎症因子的影响。方法:回顾性分析在我院行初次全膝关节置换术的180例患者,按照给药方式分为对照组、常规组、大剂量组,每组各60例。对照组患者直接给予生理盐水,常规组给予10 mg/kg氨甲环酸,大剂量组给予15 mg/kg氨甲环酸。比较三组术后总失血量、隐形失血量、术前与术后3天三组凝血功能(纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间)、纤溶活性[纤维蛋白(原)降解产物(FDP)、D-二聚体]以及炎性因子[C-反应蛋白(CRP)、白介素-6(IL-6)]水平变化及术后2周血栓事件的发生情况。结果:大剂量组与常规组的总失血量与隐形失血量均明显低于对照组,大剂量组总失血量与隐形失血量均低于常规组(P0.05);三组患者纤维蛋白原、凝血酶原时间以及活化部分凝血活酶时间相比差异均无统计学意义(P0.05);术后3天,大剂量组和常规组FDP与D-二聚体、CRP、IL-6水平均显著低于对照组,且与常规组相比,大剂量组水平较低(P0.05);术后2周,三组肌间静脉血栓发生率比较均无显著差异(P0.05)。结论:在全膝关节置换术后使用氨甲环酸可进一步减少术后隐形失血量,且不会增加血栓事件的风险,且随着药物剂量的增加,其止血效果越强,同时具有更为显著的抗纤溶作用与抗炎效果。     

氨甲环酸联合利伐沙班对单侧全膝关节置换术后患者出血量、凝血功能以及膝关节功能的影响

目的:探讨氨甲环酸联合利伐沙班对单侧全膝关节置换术后患者出血量、凝血功能及膝关节功能的影响。方法:选取2015年1月-2016年1月在解放军425医院骨科初次行单侧全膝关节置换术的患者66例为研究对象,按照随机数字表法分为治疗组与对照组,每组各33例。治疗组患者在止血带释放前向关节腔内注射氨甲环酸,对照组患者则给予氯化钠注射液进行静脉滴注,在术后6-12h内两组患者均口服利伐沙班。记录并对比两组患者总失血量、隐性出血量、输血率、输血量,对比两组患者手术前后凝血功能指标、膝关节功能评分、膝关节活动度、疼痛视觉模拟评分(VAS),并观察两组患者并发症发生情况。结果:与对照组对比,治疗组患者的总失血量、隐性出血量、输血量及输血率均明显降低(P0.05);治疗组与对照组患者术前与术后3 d的活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FG)水平比较均无显著差异(P0.05);术前两组患者的美国膝关节协会评分(AKSS)及膝关节活动度比较无显著差异(P0.05),术后7 d,治疗组与对照组患者的AKSS评分及膝关节活动度均较术前升高(P0.05),且治疗组患者的AKSS评分及膝关节活动度高于同时期对照组(P0.05);术前两组VAS评分比较无显著差异(P0.05),术后1 d,两组患者的VAS评分比较及与同组术前比较均无显著差异(P0.05),术后7 d,两组患者的VAS评分明显较术前及术后1 d降低(P0.05),但两组之间比较无显著差异(P0.05)。两组患者并发症总发生率对比无显著差异(P0.05)。结论:氨甲环酸联合利伐沙班可有效降低行单侧全膝关节置换术患者的出血量,加快关节功能的恢复,且不影响患者的凝血功能,值得临床推广。     

A Simple Method for Measuring the Changeable Mechanical Action of Unloader Knee Braces for Osteoarthritis

Purpose

Today's orthotics should be designed to apply the external orthosis moment to the knee joint solely during the stance phase instead of the entire gait cycle. The aim of this study was to validate the reliability of a simple device for measuring forces at the leg–orthosis interface and describe the behavior of an innovating dynamic unloader knee brace built to interrupt its mechanical action during large knee flexion (swing phase of gait).

通滞苏润江胶囊联合塞来昔布对早期膝骨关节炎患者血清炎症因子和疼痛介质的影响

摘要 目的：观察通滞苏润江胶囊联合塞来昔布对早期膝骨关节炎（KOA）患者血清炎症因子和疼痛介质的影响。方法：选择2021年6月-2022年12月期间石家庄市人民医院收治的早期KOA患者80例,采用随机数字表法将患者分为对照组（塞来昔布,40例）和观察组（通滞苏润江胶囊联合塞来昔布,40例）。对比两组疗效、疼痛视觉模拟评分（VAS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分、炎症因子和疼痛介质。结果：观察组临床总有效率高于对照组（P<0.05）。两组治疗1个月后VAS、WOMAC评分下降,且观察组低于对照组同时间点（P<0.05）。两组治疗1个月后肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）下降,且观察组低于对照组同时间点（P<0.05）。两组治疗1个月后前列腺素E₂（PGE₂）、P物质（SP）下降,且观察组低于对照组同时间点（P<0.05）。两组不良反应发生率对比未见统计学差异（P>0.05）。结论：塞来昔布和通滞苏润江胶囊联合治疗早期KOA患者,可缓解疼痛,提高临床治疗效果,改善关节功能,同时还可改善血清炎症因子和疼痛介质水平。