Objective:To investigate the difference in the efficacy of extended trochanteric osteotomy (ETO) and subtrochanteric shortening osteotomy (SSO) in total hip arthroplasty (THA) for Crowe type IV developmental dysplasia of the hip (DDH).Methods:Forty patients (51 hips) who underwent primary THA for Crowe type IV DDH from April 2012 to August 2020 at the First Affiliated Hospital of Soochow University and the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. The patients were classified into ETO (extended greater trochanteric osteotomy) group and SSO(subtrochanteric shortening osteotomy) group. There were 12 patients (14 hips) in the ETO group, with 3 males and 9 females, aged 49.9±16.7 years old (range, 22-75 years old) and 28 patients (37 hips) in the SSO group, with 7 males and 21 females, aged 50.3±14.0 years (range, 22-76 years). In both groups, Harris hip score (HHS), leg length discrepancy, limp, Trendelenburg sign were used to evaluate the functional results and anteroposterior radiographs of the pelvis were taken at each follow-up to assess bone healing at the osteotomy site, periprosthetic osteolysis, bone ingrowth and periprosthetic loosening. Complications were recorded and analyzed.Results:All 51 hips were followed up for at least 24 months. The operative time and total blood loss was 116.8±14.2 vs. 128.3±19.2 min and 650.8±191.4 vs. 808.3±151.3 ml in the ETO group and the SSO group with significant difference ( t=2.04, P=0.047; t=3.08, P=0.003) respectively. At the follow-up of 24 months the HHS of ETO and SSO groups were 94.8±6.3 vs. 93.9±4.9 points and the leg length discrepancy was 4.6±2.2 vs. 5.2±3.0 mm. The positive rate of Trendelenburg's sign was 7% vs. 16% and the incidence of limp was 17% vs. 29% in the ETO group and the SSO group with no significant difference ( t=0.54, P=0.591; t=0.68, P=0.499; P=0.657; P=0.693). The length of femoral shortening in the ETO group and SSO group was 30.8±4.1 vs 35.3±7.9 mm with significant difference ( t=2.02, P=0.049). Time for bone healing at the osteotomy site was 5.8±1.5 vs. 6.0±1.4 months and the incidence of intraoperative femoral fractures was 36% and vs. 65% with no significant difference ( t=0.45, P=0.657; χ 2=3.52, P=0.061). Bone in-growth (or bone on-growth) fixation was obtained for all acetabular and femoral prostheses, with no hips of prosthesis displacement, periprosthetic osteolysis, or dislocation. Conclusion:Total hip arthroplasty for Crowe type IV DDH can achieve satisfactory clinical efficacy with similar functional recovery and rate of complication in extended trochanteric osteotomy and subtrochanteric shortening osteotomy. However, the extended greater trochanter osteotomy can reduce the operation time, blood loss and length of femoral shortening.

Background Ceramic-on-ceramic couplings are attractive alternative bearing surfaces that have been reported to eliminate or reduce problems related to polyethylene wear debris. However, the material in THA still remains one of the major concerns about the risk of fracture, due to its brittleness. Objective The present study aims at reporting the fracture rate of a series of ceramic-on-ceramic THAs with use of the sandwich liner combined with a ceramic femoral head, and attempt to detect the relative risk factors, possible cause and assesse the medium-term clinical results. Methods We retrospectively evaluated 282 patients (300 hips) with use of the sandwich liner ceramic-on-ceramic THA between 2001 and 2009 at three-centers. Patient assessment was based on demographic factors, including age, weight, gender and body-mass index. All patients were evaluated clinically and radio-graphically or computed tomography in consideration of dislocation, osteolysis, periprosthetic fracture, infection, loosening and implant fracture. Results five ceramic sandwich liners fracture (1.7%) were observed at an average of 7.3 years follow-up. These factors were irrelevant to the ceramic liner fracture, including age ( p = 0.205), weight ( p = 0.241), gender ( p = 0.553), body-mass index ( p = 0.736), inclination ( p = 0.727), and anteversion ( p = 0.606). The overall survival was 91.4% at 12 years with revision as the endpoint. Other complications included dislocation in two, perprosthetic fracture in two and osteolysis in eight hips. No hip had aseptic loosening of the implants was seen. Conclusions We found that the sandwich liner may be lead to a high rate of alumina fracture and osteolysis. We have discontinued the use of sandwich liner with THA since 2009.

Cartilage regeneration is still a challenge for clinicians because of avascularity, denervation, load-bearing, synovial movement, and the paucity of endogenous repair cells. We constructed a multilayered osteochondral bionic scaffold and examined its repair capacity using a rabbit osteochondral defect model. The cartilage phase and interface layer of the scaffold were prepared by freeze-drying, whereas the bone phase of the scaffold was prepared by high-temperature sintering. The three-phase osteochondral bionic scaffold was formed by joining the hydroxyapatite (HAp) and silk fibroin (SF) scaffolds using the repeated freeze-thaw method. Different groups of scaffolds were implanted into the rabbit osteochondral defect model, and their repair capacities were assessed using imaging and histological analyses. The cartilage phase and the interface layer of the scaffold had a pore size of 110.13 ± 29.38 and 96.53 ± 33.72 μ m , respectively. All generated scaffolds exhibited a honeycomb porous structure. The polydopamine- (PDA-) modified scaffold released platelet-derived growth factor (PDGF) for 4 weeks continuously, reaching a cumulative release of 71.74 ± 5.38 % . Synovial mesenchymal stem cells (SMSCs) adhered well to all scaffolds, but demonstrated the strongest proliferation ability in the HSPP (HAp-Silk-PDA-PDGF) group. Following scaffold-induced chondrogenic differentiation, SMSCs produced much chondrocyte extracellular matrix (ECM). In in vivo experiments, the HSPP group exhibited a significantly higher gross tissue morphology score and achieved cartilage regeneration at an earlier stage and a significantly better repair process compared with the other groups ( P < 0.05 ). Histological analysis revealed that the new cartilage tissue in the experimental group had a better shape and almost filled the defect area, whereas the scaffold was nearly completely degraded. The new cartilage was effectively fused with the surrounding normal cartilage, and a substantial amount of chondrocyte ECM was formed. The SF/HAp three-layer osteochondral bionic scaffold exhibited favorable pore size, porosity, and drug sustained-release properties. It demonstrated good biocompatibility in vitro and encouraging repair effect at osteochondral defect site in vivo, thereby expected to enabling the repair and regeneration of osteochondral damage.

AIMS:The purpose of this study was to determine whether there are differences in clinical and radiographic outcomes among three different stem designs for subtrochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH). METHODS:A retrospective analysis of prospectively collected data was undertaken from a consecutive series of 37 Crowe type IV DDHs treatment of noncemented total hip arthroplasty with chevron subtrochanteric osteotomy in 30 patients. Patients are divided into three groups, including Ribbed group (using Link Ribbed stem; n = 14), Synergy group (using Synergy stem; n = 9), and Link Classic Uncemented (LCU) group (using LCU stem; n = 14), according to the design of the stem. The clinical and radiographic outcomes were evaluated. RESULTS:All patients were followed for 36 months. The time of bone union of the LCU stem was significantly longer than that of the Synergy stem (P = 0.02) and the Ribbed stem (P > 0.05); the time of bone union of the Ribbed stem was longer than that of the Synergy stem (P > 0.05). The length of stem in the distal femur of the Ribbed stem (P = 0.000) and the Synergy stem (P = 0.001) is significantly longer than that of the LCU stem. There were three hips with malunion, stem loosening, and varus alignment, which were observed in the LCU stem. None of these were observed in Ribbed and Synergy stems. In total hip arthroplasty with a noncemented stem combined with subtrochanteric femoral osteotomy for Crowe IV DDH, 89.2% hips (33/37) can achieve good and excellent clinical outcomes. There were three hips (1 hip in the Ribbed stem and two in the LCU stem) with fair clinical outcomes and one hip (LCU stem) with poor clinical outcomes. CONCLUSIONS:Although Ribbed, Synergy, and LCU stems have similar clinical outcomes, the LCU stem has a tendency to a varus position, longer union time, malunion, and stem loosening, when compared with the Ribbed and Synergy stems. We recommend against adoption of the LCU stem for Crowe IV DDH with subtrochanteric femoral osteotomy. LEVEL OF EVIDENCE:Level III, therapeutic study.

目的 探讨髋臼骨折复位内固定器治疗髋臼方形区骨折的临床疗效.方法 采用髋臼骨折复位内固定器治疗24例髋臼方形区骨折患者.记录手术时间、出血量、术后并发症发生情况.采用Matta标准评估骨折复位质量及影像学结果,采用改良Merle D′Aubigné-Postel评分评估临床疗效.结果 患者均获得随访,时间24～60(45.7±13.0)个月.手术时间105～210(110.3±30.8)min,出血量300～1500(950.6±348.6)ml.切口均一期愈合,术后无股骨头再脱位、神经血管损伤等并发症发生.骨折均愈合,时间3～5(4.3±0.8)个月.术后3 d采用Matta标准评估骨折复位质量:解剖复位17例,复位不良5例,复位差2例.末次随访时,采用改良Merle D′Aubigné-Postel评分评价的临床疗效优良率为21/24;采用Matta标准评估的影像学结果优良率为20/24.结论 采用髋臼骨折复位内固定器治疗髋臼方形区骨折,手术操作相对简单、安全且省时,可预防股骨头再脱位、维持解剖复位,为骨折愈合提供条件,尤其适用于髋臼方形区严重粉碎性骨折.

OBJECTIVE:To investigate the femoral bone remodeling and long-term effectiveness of total hip arthroplasty (THA) with anatomic medullary locking (AML) prosthesis. METHODS:The clinical data of 24 cases (26 hips) who were treated with THA with AML prosthesis between November 1997 and January 2003 were retrospectively analyzed. There were 12 males and 12 females with an age of 32-69 years (mean, 53.7 years). There were 5 cases (5 hips) of avascular necrosis of the femoral head, 6 cases (7 hips) of secondary osteoarthritis of the hip dysplasia, 6 cases (6 hips) of femoral neck fracture, 2 cases (2 hips) of primary osteoarthritis, 3 cases (3 hips) of revision surgery, 1 case (2 hips) of ankylosing spondylitis, 1 case (1 hip) of femoral head fracture. The patients were followed up at immediate, 6 weeks, 3 months, 6 months, 1 year, and then every year after operation for imaging evaluation (X-ray film was taken immediately after operation to evaluate the femoral isthmus compression, Engh standard was used to evaluate the biological fixation of the femoral shaft prosthesis, and Brooker method was used to evaluate the occurrence of heterotopic ossification); bone reconstruction evaluation [reconstruction of prosthesis and bone interface (type of bone reaction, Gruen zone, incidence, and occurrence time were recorded), reconstruction of bone around prosthesis (proximal femur stress shielding bone absorption was evaluated according to Engh and Bobyn methods, and bone mineral density change rate was measured)]; clinical efficacy evaluation [Harris score for efficacy, visual analogue scale (VAS) score for thigh pain]. RESULTS:All patients were followed up 15 years and 2 months to 20 years and 4 months, with a median of 16 years and 6 months. At immediate after operation, 24 hips (92.3%) had good femoral isthums compression, 24 hips (92.3%) had good bone ingrowth. Heterotopic ossification occurred in 2 patients with degree 1, 2 patients with degree 2, and 1 patient with degree 3 at 3-6 months after operation. Hyperplastic bone reactions were more common in Gruen 2, 3, 4, 5, 6, 10, 11, and 12 zones, mainly occurring at 6-20 months after operation, with the incidence of 3.8%-69.2%, with the highest incidence of spot welding. All absorptive bone reactions were osteolysis, which was common in Gruen 1 and 7 zones, and mainly occurred at 8 years after operation, with an incidence of 42.3%. No clear line (area) or enlarged sign of medullary cavity was observed. Twenty-one hips (80.8%) had 1 degree stress shieding, and 5 hips (19.2%) had 2 degree stress shieding. It mainly occurred at 10-24 months after operation in Gruen 1 and 7 zones. Dual energy X-ray absorptiometry showed that bone mineral density mainly decreased in Gruen 1, 2, 6, and 7 zones, mainly increased in Gruen 3, 4, and 5 zones. Bone mineral density loss progressed slowly after 2 years of operation, and it was stable in 5-8 years, but decreased rapidly in 8-9 years, and stabilized after 10 years. The Harris score increased from 51.1±6.2 before operation to 88.3±5.1 at last follow-up ( t=-21.774, P=0.000). Mild thigh pain occurred in only 2 cases (7.7%) with the VAS score of 2. No aseptic loosening or revision of femoral prosthesis occurred during the follow-up. CONCLUSION:The application of AML prosthesis in THA has a good bone remodeling and a good long-term effectiveness.

The treatment of acetabular fracture involving the quadrilateral plate is a technical challenge, and the optimal management of the fracture remains controversial. We have designed a new implant (named acetabular fracture reduction internal fixator, AFRIF) for acetabular fractures involving the quadrilateral plate. This use of this new device was not investigated therefore we conducted a retrospective study aiming to determine whether the AFRIF can achieve satisfactory clinical and radiological outcomes for quadrilateral plate fracture. The AFRIF for quadrilateral plate fracture is an acceptable option to treat acetabular fracture involving the quadrilateral plate. We performed a retrospective analysis of prospectively collected data on 24 patients (15 males and 9 females) with acute displaced quadrilateral plate fractures of the acetabulum, who were treated by the AFRIF between August 2011 and May 2015. The mean age of the patients was 61.5 ± 9.2 years (range, 31–82 years). All hips had protrusion of the femoral head, of these 5 hips with associated articular impaction of the medial roof. The type of fractures included anterior column in 4, anterior column + posterior hemitransverse in 3, associated both column in 11, T-shaped in 6 patients. The approaches included Limited Ilioinguinal (5 patients) and Limited standard Ilioinguinal combined with Kocher-Langenbeck (19 patients). Quality of reduction was evaluated and graded as anatomical (0 mm to 1 mm of displacement), imperfect (2 mm to 3 mm displacement) or poor (more than 3 mm displacement) according to the residual displacement as defined by Matta. The final follow-up clinical outcome was classified as excellent (18 points), good (15–17 points), fair (13–14 points) or poor (< 13 points) in terms to the modified Merle d’Aubigné-Postel score, and radiological outcomes evaluation were as excellent, good, fair, or poor based on Matta score. The mean duration of follow-up was 45.7 ± 13.0 months (range, 24–60 months). Average operative time and bleeding amount was 110.3 ± 30.8 min (range, 105–210 min) and 950.6 ± 348.6 mL (range, 300–1500 mL), respectively. There was anatomical reduction in 17 patients (17/24, 70.8 %), imperfect in 5 patients (5/24, 20.8 %), and poor in 2 patients (2/24, 8.3 %). All of the quadrilateral plate fractures achieved anatomical except one imperfect reduction. No re-protrusion of the femoral head was observed at the final follow-up. The mean modified Merle d’Aubigné-Postel score was 16.9 ± 2.0 points (range, 10–18 points), and 83.3 % (20 of 24) have good or excellent radiological outcomes. The findings suggest that the AFRIF for quadrilateral plate fractures may prevent protrusion of the femoral head and achieve good to excellent clinical and radiological outcomes. IV, Retrospective study.

目的 研究全膝关节置换术治疗膝关节骨性关节炎的临床疗效.方法 选取2015年7月～2018年11月我院进行检查并被确诊为患有膝关节骨性关节炎的50例患者,将上述患者经过随机组合之后分为两组,对照组患者采用临床常规药物治疗方法进行治疗,观察组则是在对照组基础上继续实施全膝关节置换术.经过两种治疗方法处理之后对两组患者的膝关节功能康复情况指标进行对比.结果 结果显示,观察组患者经过全膝关节置换术处理之后能够显著改善膝关节功能,差异有统计学意义(P<0.05).结论 全膝关节置换术对于治疗膝关节骨性关节炎的具有较为显著的临床疗效,适用于临床进一步推广.

背景:后外侧入路是全髋关节置换的最常用手术入路.近年来直接前入路全髋关节置换的临床应用越来越多,并获得了良好的手术效果.目的:比较仰卧位直接前入路与后外侧入路全髋关节置换的临床疗效.方法:纳入2015年4月至2019年4月保定市第一中心医院拟行单侧初次全髋关节置换的患者90例,其中男35例,女55例,年龄35-70岁,利用随机数字表法分为直接前入路组(n=45)和后外侧入路组(n=45).术后随访评估髋关节Harris评分、目测类比评分、假体初始固定质量、髋臼杯安全范围.试验干预及治疗方案获保定市第一中心医院伦理委员会批准.结果 与结论:①90例患者均获得术后随访,随访时间3-51个月,平均14个月;直接前入路组发生2例术中股骨大转子骨折、1例股外侧皮神经损伤、4例股神经损伤、20例阔筋膜张肌损伤,后外侧入路组未发生上述并发症;②直接前入路组术后1个月的髋关节Harris评分、目测类比评分均优于后外侧入路组(P＜0.05),末次随访时两组间髋关节Harris评分、目测类比评分比较差异均无显著性意义(P＞0.05);③直接前入路组44髋股骨假体位于中立位,1髋处于内翻位,全部假体初始固定质量优;后外侧入路组43髋股骨假体位于中立位,2髋处于内翻位,全部假体初始固定质量优,两组间比较差异无显著性意义(P＞0.05);④直接前入路组髋臼杯位于Lewinnek安全范围的比率高于后外侧入路组(100％,82％,P＜0.05);⑤结果表明与后外侧入路相比,仰卧位直接前入路全髋关节置换能显著减轻术后疼痛、促进术后早期快速康复,获得更精准的髋臼假体角度,更有利于获得双下肢等长,是一种安全可靠的手术入路;但该技术操作有一定的技术难度,需要经历学习曲线,同时存在一些不同于其他入路的并发症.

Abstract Objective: Comparisons of mini-midvastus (mMV) with mini-medial parapatellar (mMPP) approach in total knee arthroplasty (TKA) have been performed in the past but were often compromised by variables such as disease, pain tolerance, bone quality, and surgeon. The aim of this study was to minimize the influence of these factors in order to more accurately evaluate these 2 approaches. Methods: Forty-five patients who had bilateral arthritis of the knee with similar deformity and preoperative range of motion (ROM) on both sides agreed to have 1 knee replaced via mMV approach (Group I) and the other via mMPP approach (Group II) were evaluated. Postoperative clinical outcomes, postoperative complications, perioperative parameters, and knee component positioning were analyzed. Results: No significant differences were found between the mMV and mMPP groups with regards to functional assessment, patient satisfaction, postoperative complication, quadricep strength, pain at the point of incision, degree of soft tissue release, as well as ROM. Nor were significant differences found between the 2 groups in terms of perioperative parameters and radiographic component positioning. Conclusion: The present study did not detect any substantive difference between the mMV and mMPP approaches for TKA. The decision between the 2 surgical approaches should be based on surgeon experience and preference. DOI: 10.3944/AOTT.2015.15.0078

Abstract Objective: The aim of the study was to assess the effect of platelet-rich plasma on arthroscopic doublerow rotator cuff repair. Methods: The study included 60 patients with arthroscopic rotator cuff repair. Thirthy patients (mean age: 57.2±7.4; 16 males and 14 females) underwent arthroscopic double-row repair alone (Group 1), another 30 (mean age: 56.9±6.0; 15 males and 15 females) had an injection of platelet-rich plasma (PRP) (Group 2). The groups were compared with DASH as a primary outcome score and Constant-Murley score, visual analog scale, measurement of active forward flexion, and external and internal rotation as secondary outcome measures. Magnetic resonance imaging was used to assess the integrity of the repair at 12 months postoperatively. Results: Primary and secondary outcome measures statistically improved in both groups postoperatively (p<0.05). Overall mean primary and secondary postoperative outcome measures were not significantly different between the 2 groups. A retear was seen in 9 subjects (30%) in Group 1 and 4 subjects (14%) in Group 2 (p<0.05). Conclusion: The local injection of PRP into a primary arthroscopic double-row cuff repair resulted in lower recurrence rates than repairs without the novel biological augmentation material.

Hemiarthroplasty (HA) using standard-length femoral stem with reconstruction of femoral calcar or using calcar-replacing prosthesis for unstable intertrochanteric fractures in elderly patients is a viable option. However, both of the techniques increase the complexity of procedure, operative trauma and complication. This study evaluated the clinicoradiological results of the MP-Link cementless distal fixation modular prosthesis without reconstruction of femoral calcar for unstable intertrochanteric fracture in patients aged 75 years or more. Bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures in patients aged 75 years or more, do not need to reconstruct the femoral calcar. Forty-two patients (42 hips) underwent bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures from January 2008 to January 2012. Five (11.9 %) patients were lost to follow-up. The 37 remaining patients (37 hips) were available for evaluation. The mean age was 83.9 ± 5.2 years. Their clinicoradiological data were prospectively gathered. All of 37 patients, 4 patients (10.8 %) died within 1 year postoperatively. At the final follow-up, 31 (83.8 %) out of 37 patients were regained preoperative ambulatory status; the mean Harris hip score (HHS) of the 15 patients who died during the follow-up period of 7–59 months, was 84.5 ± 2.4 points; the 22 healthy patients were followed for 68.6 ± 14.7 months, with mean HHS of 84.6 ± 2.8 points. Radiologically, none of stems had evidence of loosening; 16 stems had subsidence of 2–3 mm without clinical significance; the bone ingrowth fixation was achieved in 24 patients and stable fibrous fixation in 13 patients. Bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures in patients aged 75 years or more, without reconstruction of the femoral calcar, may achieve a satisfactory clinicoradiological outcome, and could regain preoperative ambulatory status in most patients (83.3 %). IV, Retrospective study.

Objective: To study the method of X-ray diagnosis of unstable pelvic fractures displaced in three-dimensional (3D) space and its clinical application in closed reduction. Methods: Five models of hemipelvic displacement were made in an adult pelvic specimen. Anteroposterior radiographs of the pelvis were analyzed in PACS. The method of X-ray diagnosis was applied in closed reductions. From February 2012 to June 2016, 23 patients (15 men, 8 women; mean age, 43.4 years) with unstable pelvic fractures were included. All patients were treated by closed reduction and percutaneous cannulate screw fixation of the pelvic ring. According to Tile's classification, the patients were classified into type B1 in 7 cases, B2 in 3, B3 in 3, C1 in 5, C2 in 3, and C3 in 2. The operation time and intraoperative blood loss were recorded. Postoperative images were evaluated by Matta radiographic standards. Results: Five models of displacement were made successfully. The X-ray features of the models were analyzed. For clinical patients, the average operation time was 44.8 min (range, 20-90 min) and the average intraoperative blood loss was 35.7 (range, 20-100) mL. According to the Matta standards, 7 cases were excellent, 12 cases were good, and 4 were fair. Conclusions: The displacements in 3D space of unstable pelvic fractures can be diagnosed rapidly by X-ray analysis to guide closed reduction, with a satisfactory clinical outcome.

Background: The treatment of acetabular fracture involving the quadrilateral plate is a technical challenge, and the optimal management of the fracture remains controversial. We have designed a new implant (named acetabular fracture reduction internal fixator, AFRIF) for acetabular fractures involving the quadrilateral plate. This use of this new device was not investigated therefore we conducted a retrospective study aiming to determine whether the AFRIF can achieve satisfactory clinical and radiological outcomes for quadrilateral plate fracture. Hypothesis: The AFRIF for quadrilateral plate fracture is an acceptable option to treat acetabular fracture involving the quadrilateral plate. Materials and methods: We performed a retrospective analysis of prospectively collected data on 24 patients (15 males and 9 females) with acute displaced quadrilateral plate fractures of the acetabulum who were treated by the AFRIF between August 2011 and May 2015. The mean age of the patients was 61.5 +/- 9.2 years (range, 31-82 years). All hips had protrusion of the femoral head, of these 5 hips with associated articular impaction of the medial roof. The type of fractures included anterior column in 4, anterior column + posterior hemitransverse in 3, associated both column in 11, T-shaped in 6 patients. The approaches included Limited Ilioinguinal (5 patients) and Limited Standard-Ilioinguinal combined with Kocher-Langenbeck (19 patients). Quality of reduction was evaluated and graded as anatomical (0 mm to 1 mm of displacement), imperfect (2 mm to 3 mm displacement) or poor (more than 3 mm displacement) according to the residual displacement as defined by Matta. The final follow-up clinical outcome was classified as excellent (18 points), good (15-17 points), fair (13-14 points) or poor (<13 points) in terms to the modified Merle d'Aubigne-Postel score, and radiological outcomes evaluation were as excellent, good, fair, or poor based on Matta score. Results: The mean duration of follow-up was 45.7 +/- 13.0 months (range, 24-60 months). Average operative time and bleeding amount was 110.3 +/- 30.8 min (range, 105-210 min) and 950.6 +/- 348.6 ml (range, 300-1500 ml), respectively. There was anatomical reduction in 17 patients (17/24, 70.8%), imperfect in 5 patients (5/24, 20.8%), and poor in 2 patients (2/24, 8.3%). All of the quadrilateral plate fractures achieved anatomical except one imperfect reduction. No re-protrusion of the femoral head was observed at the final follow-up. The mean modified Merle d'Aubigne-Postel score was 16.9 +/- 2.0 points (range, 10-18 points), and 83.3% (20 of 24) have good or excellent radiological outcomes. Discussion: The findings suggest that the AFRIF for quadrilateral plate fractures may prevent protrusion of the femoral head and achieve good to excellent clinical and radiological outcomes. (C) 2019 Elsevier Masson SAS. All rights reserved.

The ideal orthopedic implant coating is expected to both inhibit microbial infection and promote osseointegration. In this study, Zn ions were immobilized on a Ti substrate via a polydopamine (PDA) chemical surface modification to prepare Ti-PDA-Zn coatings. Scanning electron microscopy (SEM), atomic force microscopy (AFM), energy-dispersive X-ray spectroscope (EDS), X-ray photoelectron spectroscopy (XPS), contact analysis system, and inductively coupled plasma atomic emission spectrometry (ICP-AES) were used to analyze the morphology, composition, wettability, and zinc ions release of the coatings. The Ti-PDA-Zn coatings demonstrated excellent antibacterial activities in vitro against both Staphylococcus aureus and Escherichia coli. The coatings additionally displayed good biocompatibility, as confirmed by cytoskeletal observations and cell viability assays. Furthermore, the in vivo results confirmed the excellent antibacterial properties and improved osseointegration capability of the Ti-PDA-Zn coating in the presence of S. aureus. The present findings indicate that the Ti-PDA-Zn coatings prepared herein have potential application in orthopedic implantation.

INTRODUCTION:Hemiarthroplasty (HA) using standard-length femoral stem with reconstruction of femoral calcar or using calcar replacing prosthesis for unstable intertrochanteric fractures in elderly patients is a viable option. However, both of the techniques increase the complexity of procedure, operative trauma and complication. This study evaluated the clinico-radiological results of the MP-Link cementless distal fixation modular prosthesis without reconstruction of femoral calcar for unstable intertrochanteric fracture in patients aged 75 years or more. HYPOTHESIS:Bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures in patients aged 75 years or more, do not need to reconstruct the femoral calcar. MATERIALS AND METHODS:Forty-two patients (42 hips) underwent bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures from January 2008 to January 2012. Five (11.9%) patients were lost to follow-up. The 37 remaining patients (37 hips) were available for evaluation. The mean age was 83.9±5.2 years. Their clinico-radiological data were prospectively gathered. RESULTS:All of 37 patients, 4 patients (10.8%) died within 1 year postoperatively. At the final follow-up, 31 (83.8%) out of 37 patients were regained preoperative ambulatory status; the mean Harris hip score (HHS) of the 15 patients who died during the follow-up period of 7-59 months, was 84.5±2.4 points; the 22 healthy patients were followed for 68.6±14.7 months, with mean HHS of 84.6±2.8 points. Radiologically, none of stems had evidence of loosening; 16 stems had subsidence of 2-3mm without clinical significance; the bone in-growth fixation was achieved in 24 patients and stable fibrous fixation in 13 patients. DISCUSSION:Bipolar HA using the MP-Link cementless distal fixation modular prosthesis for unstable intertrochanteric fractures in patients aged 75 years or more, without reconstruction of the femoral calcar, may achieve a satisfactory clinico-radiological outcome, and could regain preoperative ambulatory status in most patients (83.3%). LEVEL OF EVIDENCE:IV, Retrospective study.

Purpose: Osteosarcoma (OS) is highly aggressive and confers poor prognosis. Novel immune checkpoint inhibition holds promise for treatment yet the role of PD-L1 in OS remains undetermined. Methods: Paraffinized OS sections were collected and stained with immunohistochemistry (IHC) for PD-L1, Ki-67, and p53. Clinicopathological parameters of corresponding patients were gathered and analyzed statistically for association and correlation. PD-L1 positivity was evaluated using 1% and 5% cutoffs. Results: Ninety-two OS samples, excised between 1997 to 2017, were collected. Sixty-five samples were assessed as PD-L1 positive using 1% cutoff and 50 samples were positive using 5% cutoff. PD-L1 positivity (1%) was significantly associated with trunk location (P=.018), elevated serum lactate dehydrogenase (LDH) (P=.018), advanced clinical stage (P<.001), distant metastasis (P<.001), and poor response to chemotherapy (P<.001). PD-L1 positivity (1%) was not associated with age, gender, tumor size, or serum level of alkaline phosphatase. PD-L1 positivity (5%) was significantly associated with all significant parameters associated with 1% cutoff, with an additional association with larger tumor size (P=.022) and exception of elevated LDH (P=.017). Cutoff of 1% showed significant correlation with expression of Ki-67 (P<.001) and p53 (P=.024). Cutoff of 5%, however, was only correlated with expression of Ki-67 (P<.001). Conclusion: PD-L1 expression is positive in most OS and is associated with a more aggressive phenotype. PD-L1 expression is also associated with poor chemotherapy response and is correlated with Ki-67. The present results support the application of PD-L1 blockade in OS.

Chemoresistance implicates the therapeutic value of cisplatin and remains a primary obstacle to its clinical use. MicroRNAs (miRs) negatively modulate the expression of their target genes and are associated with the occurrence and progression of various types of tumor. The abnormal expression of miR-504 has been reported in certain types of human tumor and has been associated with tumor prognosis. However, the association between miR-504 and cisplatin in human osteosarcoma remains unclear. The present study therefore aimed to assess the in vitro effects and possible mechanism of miR-504 in cell proliferation, apoptosis and cisplatin resistance in MG63 osteosarcoma cells. The results demonstrated that miR-504 was overexpressed in osteosarcoma tissues and cells. This overexpression also induced cell proliferation, as determined by MTT and EdU staining assays. Furthermore, miR-504 suppressed cisplatin-induced apoptosis, which was demonstrated via MTT, cell morphology analysis and flow cytometry. Cisplatin-induced G(1) arrest was also suppressed, which was determined by flow cytometry. The potential target genes of miR-504 were predicted using bioinformatics. p53 was confirmed to be a direct target of miR-504 using a luciferase reporter assay and western blot analysis revealed that miR-504 negatively regulated p53 expression at a molecular level. These results indicate that miR-504 contributes to cisplatin resistance in MG63 osteosarcoma cells by suppressing p53. miR-504 may therefore be a potential biomarker for cisplatin resistance in patients with osteosarcoma.