Saran Tantavisut

Dickkopf-1 (Dkk-1) in plasma and synovial fluid is inversely correlated with radiographic severity of knee osteoarthritis patients

BackgroundOsteoarthritis (OA) is a common degenerative joint disease causing pain, stiffness, reduced motion, swelling, crepitus, and disability. Dickkopf-1 (Dkk-1) is a critical mediator of osteoblastogenesis and regulates the joint remodeling. The aim of this study was to examine plasma and synovial fluid Dkk-1 levels of patients with primary knee OA and to investigate their relationship with disease severity.MethodsThirty-five patients aged 55-83 years with knee OA and 15 healthy individuals were recruited into this study. Disease severity was determined using weight-bearing anteroposterior radiographs of the affected knee. The radiological grading of OA in the knee was performed according to the Kellgren-Lawrence grading system. Dkk-1 levels in both plasma and synovial fluid were evaluated using enzyme-linked immunosorbent assay.ResultsThe average concentration of circulating Dkk-1 in the knee OA patients was remarkably lower than that of healthy controls (396.0 ± 258.8, 95%CI 307.1-484.9 vs 2348.8 ± 2051.5, 95%CI 1164.3-3533.3 pg/ml, p < 0.0001). Dkk-1 levels in synovial fluid were significantly lower than in paired plasma samples (58.6 ± 31.8, 95%CI 47.7-69.6 vs 396.0 ± 258.8, 95%CI 307.1-484.9 pg/ml, p < 0.001). Furthermore, both plasma and synovial fluid Dkk-1 levels were inversely correlated with radiographic severity (r = -0.78, p < 0.001 and r = -0.42, p = 0.01, respectively). Plasma Dkk-1 levels were also significantly correlated with synovial fluid Dkk-1 levels (r = 0.72, p < 0.001).ConclusionsDkk-1 levels in plasma and synovial fluid are inversely related to the severity of joint damage in knee OA. Dkk-1 could serve as a biochemical marker for determining disease severity and might play a potential role in the pathogenesis of the degenerative process of OA.

Plasma and synovial fluid connective tissue growth factor levels are correlated with disease severity in patients with knee osteoarthritis

Background: Connective tissue growth factor (CTGF) has been implicated in development of osteoarthritis (OA). Objective: To determine the correlation between plasma and synovial fluid CTGF levels and the severity in knee osteoarthritis patients. Methods: A total of 100 subjects were recruited into this study (75 OA patients and 25 controls). CTGF concentrations in plasma and synovial fluid were analyzed by enzyme-linked immunosorbent assay. Results: Plasma and synovial fluid CTGF concentrations were correlated with radiographic severity. There was a positive correlation between plasma and synovial fluid CTGF levels. Conclusion: CTGF could be useful for monitoring the severity and progression of OA.

Oxidative Stress, Vitamin E, and Antioxidant Capacity in Knee Osteoarthritis

BACKGROUND Osteoarthritis (OA) is a chronic progressive degenerative joint disorder which is characterised by strongly age-related regressive changes in articular cartilage. The objective of this study was to evaluate oxidative stress and antioxidant parameters in plasma and synovial fluid of patients with primary knee osteoarthritis. MATERIAL AND METHODS Thirty-five OA patients and 35 healthy controls were recruited for this study. Nitrite, malondialdehyde (MDA), vitamin E, Trolox Equivalent Antioxidant Capacity (TEAC), and Ferric Reducing Antioxidant Power (FRAP) levels in plasma and synovial fluid were determined. RESULTS Plasma nitrite levels in OA patients were significantly higher than those in healthy controls (p = 0.037). Furthermore, plasma MDA levels were significantly higher in OA patients than those in healthy controls (p < 0.001). Moreover, plasma vitamin E levels in OA patients were significantly lower than those in healthy controls (p < 0.001). Synovial fluid vitamin E levels of OA patients were significantly lower than paired plasma samples (p < 0.001). The total antioxidant capacities, as were measured by TEAC and FRAP assays in plasma of OA patients, were significantly lower than those in healthy controls (p < 0.01). MDA concentrations were positively correlated with nitrite concentrations but they were negatively associated with vitamin E and TEAC levels in synovial fluid of OA patients. CONCLUSION The increased plasma levels of nitrite and MDA and the decreased plasma levels of vitamin E, TEAC, and FRAP indicated that oxidative stress was present in OA patients. These findings suggest that oxidative stress plays a potential role in pathophysiology of knee osteoarthritis.

Association of plasma and synovial fluid interferon-γ inducible protein-10 with radiographic severity in knee osteoarthritis

OBJECTIVES The objective of this study was to investigate interferon-γ inducible protein-10 (IP-10) concentrations in plasma and synovial fluid of patients with knee osteoarthritis (OA) and to analyze their relationship with disease severity. DESIGN AND METHODS Forty OA patients and 15 healthy controls were enrolled in this study. OA grading was performed according to the Kellgren-Lawrence criteria. IP-10 levels in plasma and synovial fluid were assessed using enzyme-linked immunosorbent assay. RESULTS Plasma IP-10 levels in the knee OA patients were significantly lower than those of controls (P=0.006). IP-10 levels in plasma were markedly higher with regard to paired synovial fluid (P<0.001). Furthermore, IP-10 concentrations in plasma and synovial fluid displayed significant inverse correlation with radiographic severity (r=-0.713, P<0.001 and r=-0.561, P<0.001, respectively). Subsequent analysis revealed that plasma IP-10 levels were positively correlated with synovial fluid IP-10 levels (r=0.424, P=0.006). CONCLUSIONS IP-10 levels in both plasma and synovial fluid were inversely associated with the severity of knee OA. Accordingly, IP-10 could serve as a biomarker for determining disease severity and might play a possible role in the pathophysiology of osteoarthritis.

Gap changes after popliteus-tendon resection in PS-TKA: A cadaveric study in Thai female knees

Popliteus-tendon injury during total knee arthroplasty (TKA) may result in imbalanced soft-tissue tension; however, it is unclear whether complete popliteus-tendon resection is a factor which contributes to knee instability following TKA. We performed an isolated complete resection of the popliteus tendon during a standard posterior stabilised TKA (PS-TKA) in 14 normal knees of Thai female cadavers and measured gap differences in both knee flexion and extension. In addition, we measured the distance from the femoral attachment of the popliteus tendon to the femoral condyles including the distance from the most distal femoral attachment of the popliteus tendon to the distal lateral femoral condyle (DFa-DLFC), and the distance from the most posterior femoral attachment of the popliteus tendon to the posterior lateral femoral condyle (PFa-PLFC). After completion of bone cuts, static flexion and extension gaps were measured with a tension of 98 N under intact and complete tendon resection, respectively. The mean DFa-DLFC and PFa-PLFC distances were 8.9 mm (range, 6.4-10.5mm) and 11.5mm (range, 9.5-14.0mm), respectively. Of 14 cadaveric knees, 35.7% had a DFa-DLFC distance <9 mm. Flexion and extension gaps significantly increased in both medial and lateral sides after complete popliteus resection with a similar mean increased value of 1.85 mm. The clinical evaluation of gap changes after popliteus resection on knee stability should be further investigated. A routine 9-mm distal femoral bone cut may injure the popliteus tendon during TKA conducted on small knees.

Spontaneous Acetabular Periprosthetic Fracture in a Patient Continuously Having Zoledronic Acid

Zoledronic acid has been used for prevention of osteolytic and osteoblastic bone metastasis. This case report illustrates an undesirable consequence from prolonged usage of zoledronic acid in bone metastasis prevention. Periprosthetic acetabular fracture in a patient treated with zoledronic acid for 7 years was reported. The clinical presentation, radiographic and pathological results were described. This is a rare complication after total hip arthroplasty which should not be ignored especially in patients who received long term bisphosphonate.

Accuracy of computer-assisted total knee arthroplasty related to extra-articular tibial deformities.

Abstract Objective: To compare the accuracy of postoperative mechanical alignment in computer-assisted total knee arthroplasties (CAS-TKA) related to various degrees of extra-articular tibial deformity. Methods: We performed CAS-TKA on 30 knee models in which extra-articular proximal tibial deformities were preset to have malalignments ranging from 30° of varus to 30° of valgus. The knees were assigned to two groups, designated Group A (knees with ≤15° preoperative malalignment) and Group B (knees with >15° preoperative malalignment), and the postoperative mechanical alignment in the two groups was compared using a computer-assisted surgery (CAS) system. Resected bone pieces from the distal femurs and proximal tibias were measured with a digital Vernier caliper and the results compared with the CAS calculations to evaluate the execution accuracy of the bone resection. Results: There was no outlier in either group when a ±3° deviation from neutral mechanical alignment was set as the acceptance criterion. Interestingly, Group B showed significantly more outliers when the acceptance criterion was a deviation of ±2° (26.67%, p = 0.0317) or ±1° (6.67%, p = 0.0007) from neutral alignment. There was no statistical difference between the groups in terms of the execution accuracy of the bone resection. Discussion: The CAS-TKA approach provided significantly less alignment accuracy in tibia with greater preoperative frontal deformity, despite there being no outliers beyond ±3°.

Different effect of percutaneous plate insertion via anteromedial vs anterolateral approach on intracompartmental pressure of the leg: A cadaveric study

BACKGROUND Currently Minimally Invasive Plate Osteosynthesis (MIPO) technique for tibial shaft fracture management has gained wide attention. However, an increased intracompartmental pressure after the plate insertion may result in postoperative acute compartment syndrome. We reported the difference of immediate effect of percutaneous plate insertion using 2 approaches of MIPO technique on anterior compartment pressure of the legs. MATERIALS AND METHODS Eight soft cadaveric legs (one female and three males) without previous history of skeletal trauma or surgery were infused with normal saline to create the sustained intracompartmental pressure of 20mm Hg in all four compartments. The Synthes® 4.5mm 11-hole Narrow Locking Compression Plate was inserted via anteromedial and anterolateral approach. Anterior compartment pressure was measured by portable digital monitoring device through side-port needle (Stryker® Intracompartmental Monitoring Device) before and after plate insertion for each approach. RESULTS By using anteromedial approach, a mean of anterior compartment pressure was increased by 0.375mm Hg after plate insertion (5 of 8 legs had no change in pressure and the remaining 3 resulted in 1mm Hg pressure elevation). For anterolateral plate insertion, all of the 8 legs had an elevation of anterior compartment pressure with a mean of 3.5mmHg (ranged from 2 to 6mm Hg). CONCLUSIONS When both approaches were compared to each other, the anterolateral plate insertion resulted in higher intracompartmental pressure elevation of the anterior compartment than the anteromedial approach. Surgeon should be more aware of acute compartment syndrome when considering the anterolateral approach in treating close tibial fracture. However, in patients with suspected acute compartment syndrome, close observation and continuous monitoring of the intracompartmental pressure is still imperative for all healthcare provider.

Clinical report. Atypical acetabular bone loss in chronic septic total hip arthroplasty loosening

Abstract Background: When a periprosthetic infection is diagnosed, the surgical treatment is usually performed as soon as possible to avoid further bone damage or life threatening complications. There is no report on the radiographic change in patients with untreated infected total hip arthroplasty (THA) for several years. Objective: Report radiographic change in patients with untreated infected THA. Method: Two patients presented with chronic septic loosening of cemented acetabular fixation after total hip replacement at King Chulalongkorn Memorial Hospital. Both patients had mild hip pain and had been lost for follow-up until the bone destruction became very severe. Serial radiographs after the surgeries were evaluated. The Paprosky’s acetabular bone loss classification was used to classify the radiographic findings. Results: Based on the Paprosky’s classification for acetabular bone loss, there were two similar atypical radiographic findings found in both patients. These included pelvic discontinuity from extensive medial acetabular bone loss beyond the Kohler’s line, and minimal superior and inferior acetabular bone loss. Conclusion: These atypical radiographic findings were rarely observed in septic acetabular loosening patients, as infection usually causes patients to present earlier. Following the septic acetabular loosening of THA, surgical procedure should be performed before massive bone damage was demonstrated.