A review of the clinical approach to persistent pain following total hip replacement

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Total knee arthroplasty for primary knee osteoarthritis: Changing pattern over the past 10 years

Objective: To review the epidemiology of total knee arthroplasty for primary osteoarthritis and the change of patient characteristics over the last decade. Design: Retrospective review. Setting: A tertiary referral centre for joint replacement surgery in a teaching hospital in Hong Kong. Patients: All patients who underwent primary total knee arthroplasty for primary knee osteoarthritis from January 2000 to December 2009. Results: In all, 1157 total knee arthroplasties (589 left and 568 right) were performed on 588 females and 162 males. The annual number of total knee arthroplasties increased from 91 in 2000 to 181 in 2009. The annual number of patients increased from 58 (46 female, 12 male) in 2000 to 159 (117 female, 42 male) in 2009. When compared yearly results, there were no significant changes in the preoperative Knee Society Knee Score, Knee Society Functional Assessment, and passive range of motion of these patients. However, there was a significant decreasing trend with regard to lower limb mechanical axis mal-alignment, from 15.1° deviation from the neutral axis in 2000, to 14.8° deviation in 2004, and then 12.9° deviation in 2009 (mostly varus deformity). There was no difference between left knees and right knees, and between females and males. The mean age of the patients did not show significant change over the past decade, but the number and proportion of patients over 80 years old showed an increase from 4.8% (2000 to 2004) to 13.8% (2005 to 2009). On the other hand, the number and proportion of patients under the age of 60 years did not change. Conclusions: There was an increasing trend towards total knee arthroplasties, both in terms of number of operations and patients. The number of younger patients having total knee arthroplasty did not increase over the last 10 years, whereas the number of those older than 80 years increased significantly over that period.published_or_final_versio

Review Article: Osteophytes

An osteophyte is a fibrocartilage-capped bony outgrowth that is one of the features of osteoarthritis. This study reviewed the types, risk factors, pathophysiology, clinical presentations, and medical and surgical treatment of osteophytes. Extraspinal osteophytes are classified as marginal, central, periosteal, or capsular, whereas vertebral osteophytes are classified as traction or claw. Risk factors for development of osteophytes include age, body mass index, physical activity, and other genetic and environmental factors. Transforming growth factor β plays a role in the pathophysiology of osteophyte formation. Osteophytes can cause pain, limit range of motion, affect quality of life, and cause multiple symptoms at the spine. Medical treatment involves the use of bisphosphonates and other non-steroidal anti-inflammatory agents. Surgical treatment in the form of cheilectomy for impingement syndromes during joint replacement is recommended.published_or_final_versio

Controlling single-photon transport with three-level quantum dots in photonic crystals

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Commentary on the medium-term results of ceramic-on-polyethylene Zweymüller-Plus total hip arthroplasty

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Commentary: Clinical and financial benefits of intra-articular tranexamic acid in total knee arthroplasty

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Should the patella be resurfaced in distal femoral replacement after distal femoral resection?

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Review article: Venous thromboembolism after total joint replacement

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Comparison of fatty-acid-binding protein 4 and adiponectin levels in infrapatellar fat pad and subcutaneous adipose tissue, synovial fluid and plasma in subjects with knee osteoarthritis

Conference Theme: Defying the Aging Spine: Our Mission ContinuesConcurrent Free Papers 2 - Basic Science/General Orthopaedics: no. 2.8Introduction: It was recently reported that inflammation is involved in the pathogenesis of osteoarthritis (OA). Fattyacid-binding protein 4 (FABP4) and adiponectin are both adipocyte-derived cytokines closely related with inflammation pathways. The FABP4 exhibits a pro-inflammatory property while adiponectin shows anti-inflammatory effect. The study aimed to assess the expression of FABP4 and adiponectin in paired blood and synovial fluid from OA patients, and to examine whether the infrapatellar fat pad (IPFP) from OA subjects would release FABP4 and adiponectin similar to that of donor-matched subcutaneous adipose tissue (ScAT). Materials and Methods: Plasma, synovial fluid, ScAT, and IPFP of 20 OA patients (4 males and 16 females) were collected during total knee arthroplasty. Levels of FABP4 and adiponectin were measured in plasma, synovial fluid, and fat conditioned media using ELISA (AIS, HKU). Results: Levels of FABP4 were significantly higher in IPFP media than ScAT (p = 0.015), while the same were significantly higher in synovial fluid than in plasma (p < 0.001). There were no significant differences of adiponectin levels between IPFP and ScAT media (p = 0.737). Plasma levels of adiponectin were significantly higher than synovial fluid (p < 0.001). Discussion and Conclusion: The OA patients exhibit an inflammatory state in local environment (IPFP and synovial fluid) compared with systemic environment (ScAT and plasma). The IPFP may play a key role in OA inflammation and may be an important resource of inflammatory mediators in synovial fluid.postprin