Wei-Hsiu Hsu

Comparison of Computer-Assisted Navigation and Conventional Instrumentation for Bilateral Total Knee Arthroplasty

This prospective study analyzed computer-assisted surgery (CAS) navigation and conventional instrumentation in bilateral total knee arthroplasty. Sixty patients underwent CAS navigation in 1 knee and conventional instrumentation in the contralateral knee randomly. The target zone resided in the reconstructed mechanical axis within a range of 3 degrees varus or valgus. The reconstructed mechanical axes in the CAS navigation group were significantly closer to planned axes than those in the conventional group. Average blood loss in the CAS navigation group was lower, whereas mean tourniquet time was longer than in the conventional group. No surgery-related complications existed in either group. The results indicate that, despite longer operative time, CAS navigation total knee arthroplasty is a safe procedure and outperforms conventional technique in accuracy of leg axes.

Effect of shock‐wave therapy on patellar tendinopathy in a rabbit model

This study investigated the effect of shock‐wave therapy (SWT) on collagenase induced tendinopathy in the rabbit patellar tendon. Eighteen rabbits were treated by ultrasonography‐guided injection of 0.025 ml collagenase into the patellar tendon in both knees. After tendinopathy was confirmed at 3 weeks post‐treatment by the histological examination, SWT was initiated to the right patellar tendon involving 1500 cycles at 0.29 mJ/mm2 in two separated weekly courses from 4 weeks post‐treatment. The rabbits were randomly divided into two groups, which were sacrificed at the 4th and 16th week after SWT, respectively. The histological examination, the mechanical and biochemical tests then were performed. The ultimate tensile load in the SWT tendon increased 7.03% at 4 week and 10.34% at 16 week after treatment as compared to the sham group. Hydroxyproline concentrations increased in the SWT tendons over both the 4 and 16 weeks after treatment. Moreover, the pyridinoline concentration increased at the 4th week but decreased at 16th week as compared to the sham group. The histological examination demonstrated increased blast‐like tenocyte at the 4th week, while more mature tenocyte with neovasculization at the 16th week. The result obtained here validates the effectiveness of the SWT in the established tendinopathy. SWT may increase collagen synthesis and collagen crosslink formation during early healing process.

Enhancing mechanical strength during early fracture healing via shockwave treatment: an animal study

OBJECTIVEnThis investigation aims to determine (1) whether shockwave treatment helps fracture healing and (2) whether the effect of shockwave treatment on fracture healing is dose dependent.nnnDESIGNnShockwave was applied over tibial osteotomy in an animal model to assess its effect on the healing of the fracture.nnnMETHODOLOGYnBilateral tibial diaphyseal transverse osteotomy was conducted on 42 rabbits, dividing into experimental and control group, immobilized using an external skeletal fixator, with one leg tested with shockwave therapy and the contralateral leg acting as the control without therapy. Serial radiography and measurement of bone mineral density via dual-energy X-ray absorptiometry were performed to assess the fracture healing. The experimental animals had two or three sessions of shockwave therapy (5000 impulses, 0.32 mJ/mm(2), Orthopedic) over the osteotomy sites on day 7, 21 and 35; while the control group did not receive any treatment. The animals were sacrificed on day 42 or 56. Then, bilateral tibias were harvested and sent for mechanical tests as well as the histological examination. The pertinent statistic methods were applied to analyze the results.nnnBACKGROUNDnShockwave therapy has become a useful alternative approach in treating various orthopedic conditions, but the mechanism which it works remains unclear. Thus far, shockwave therapy has been found effective in treating long bone pseudoarthrosis, but whether it can benefit fresh fracture healing continues to be debated.nnnRESULTSnHigher union rates occurred during the early but not the late stages in the experimental group, while mechanical strength was higher in the experimental group than in the control group. No significant dose-dependent response occurred between the second and third applications of shockwave treatment. No significant difference in mechanical strength occurred between the experimental groups at 4 weeks and the control group at 6 weeks, or between the experimental groups at 6 and 8 weeks. Furthermore, no significant correlation occurred between the absolute values of maximum torque and bone mineral density.nnnCONCLUSIONnBased on this investigation, shockwave treatment has a positive effect on early fracture healing while its long term effects require further investigation.nnnRELEVANCEnShockwave therapy can be a useful alternative adjunct modality in the treatment of fresh long bone fracture.

Improved Antibiotic Impregnated Cement Prosthesis for Treating Deep Hip Infection: A Novel Design Using Hip Compression Screw

A 2-stage revision arthroplasty has been suggested as the optimal treatment for deep infections in the hip joint. Improvement of the surgical technique to increase the interim function is subject to investigation. From 2004 to 2007, we collected a cohort of 15 consecutive patients who were treated by a novel design augmented with a modified hip compression screw. No fracture of the cement spacer occurred. We believe the modified hip compression screw is a good alternative for the functional endoskeleton of an antibiotic loaded cement prosthesis in the treatment of deep hip infection.

Injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head: A 5-year follow-up.

Background: Osteonecrosis of the femoral head can lead to destruction of the hip joint and disabling arthritis in young adults, if left untreated. Among the salvage procedures, core decompression combined with bone graft substitutes is a viable option for joint preservation. The purpose of this study was to review the outcomes of using synthetic bone graft substitute (calcium sulfate and calcium phosphate) for the treatment of late-stage osteonecrosis of the femoral head. Methods: From November 2008 to May 2009, 19 hips in 18 patients with osteonecrosis of the femoral head [6 hips in Association Research Circulation Osseous (ARCO) stage IIC and 13 hips in stage IIIA] were treated with core decompression combined with PRO-DENSE™ (Injectable Regenerative Graft). The average age of the patients at the time of surgery was 48 years (range 25-67 years). Twelve patients (13 hips) overused alcohol, four patients (4 hips) were idiopathic, one patient (1 hip) used corticosteroids, and one patient (1 hip) was post-traumatic. The clinical failure was defined as conversion to total hip arthroplasty or progression in head collapse. Results: At the conclusion of the study, 3 in the 6 stage IIC hips and 8 in the 13 stage IIIA hips were converted to total hip arthroplasty in an average of 8.5 months (range 4-30 months) postoperatively. Advanced collapse of the femoral head awaiting for total hip arthroplasty was observed in the other six hips. Of the 19 hips, only 2 hips (10.5%) survived without further collapse in the 5-year follow-up. This resulted in 89.5% failure rate with early resorption of the grafting in an average of 5.3 months. Conclusions: Core decompression combined with an injectable calcium sulfate and calcium phosphate composite graft (PRO-DENSE) were associated high failure rates in the early postoperative period. It is not recommended for the treatment of ARCO stage IIC and IIIA osteonecrosis of the femoral head.

The relationship between health-related fitness and quality of life in postmenopausal women from Southern Taiwan.

Background Health-related fitness has been reported to be associated with improved quality of life (QoL) in the elderly. Health-related fitness is comprised of several dimensions that could be enhanced by specific training regimens. It has remained unclear how various dimensions of health-related fitness interact with QoL in postmenopausal women. Objective The purpose of the current study was to investigate the relationship between the dimensions of health-related fitness and QoL in elderly women. Methods A cohort of 408 postmenopausal women in a rural area of Taiwan was prospectively collected. Dimensions of health-related fitness, consisting of muscular strength, balance, cardiorespiratory endurance, flexibility, muscle endurance, and agility, were assessed. QoL was determined using the Short Form Health Survey (SF-36). Differences between age groups (stratified by decades) were calculated using a one-way analysis of variance (ANOVA) and multiple comparisons using a Scheffé test. A Spearman’s correlation analysis was performed to examine differences between QoL and each dimension of fitness. Multiple linear regression with forced-entry procedure was performed to evaluate the effects of health-related fitness. A P-value of <0.05 was considered statistically significant. Results Age-related decreases in health-related fitness were shown for sit-ups, back strength, grip strength, side steps, trunk extension, and agility (P<0.05). An age-related decrease in QoL, specifically in physical functioning, role limitation due to physical problems, and physical component score, was also demonstrated (P<0.05). Multiple linear regression analyses demonstrated that back strength significantly contributed to the physical component of QoL (adjusted beta of 0.268 [P<0.05]). Conclusion Back strength was positively correlated with the physical component of QoL among the examined dimensions of health-related fitness. Health-related fitness, as well as the physical component of QoL, declined with increasing age.

Effects of circuit exercise and Tai Chi on body composition in middle-aged and older women

To investigate the impact of circuit exercise and Tai Chi exercise on body composition in middle‐aged and older women.

The effect of renal function on surgical outcomes of intracapsular hip fractures with osteosynthesis

AbstractBackgroundnChronic kidney disease (CKD) affects many physiologic systems, including bone quality, nutrition, and cardiovascular condition. Femoral neck fractures in patients on dialysis are associated with frequent complications and a high risk of mortality. However, the effect of CKD on clinical outcomes of patients with hip fractures treated with osteosynthesis remains unclear.MethodsnOne hundred and thirty patients with 130 femoral neck fractures treated with internal fixation were divided into two groups and the data were then analyzed. Group 1 consisted of 98 patients (98 hip fractures) with normal renal function (estimated glomerular filtration rate, or eGFR, ≥60xa0ml/min/1.73xa0m2). Group 2 was composed of 32 patients (32 hip fractures) with CKD (eGFR <60xa0ml/min/1.73xa0m2) without dialysis. Clinical outcomes as well as early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were then compared.ResultsIn Group 1, 32 complications (32.6xa0%) occurred in 98 hips, including 5 cases of nonunion and 16 cases of osteonecrosis. In Group 2, 24 complications (75xa0%) developed in 32 hips; these included 8 cases of nonunion and 3 cases of osteonecrosis. The mean duration of follow-up was 32xa0months. The overall mortality rate was 11.5xa0%. No difference was noted in early, late, or overall mortality rate between two groups. Patient with CKD had a higher nonunion rate (ORxa0=xa05.9, Pxa0=xa00.023). Meanwhile, CKD and displaced fracture pattern were independent predictors for revision surgery (ORxa0=xa03.0, Pxa0=xa00.032; ORxa0=xa06.9, Pxa0=xa00.001, respectively).ConclusionsnOsteosynthesis is a safe and effective treatment for femoral neck fractures; however, patients with femoral neck fracture and CKD have a higher risk of nonunion and subsequent surgical revision.Level of relevancePrognostic studies, Level III.

Cellular senescence occurring in the rabbit medial collateral ligament during healing.

Medial collateral ligament (MCL) healing proceeds in a temporally ordered fashion after injury. Despite the critical roles of fibroblasts during ligament repair, the phenotypic features of these healing fibroblasts have not been well characterized. Here, we show that healing MCL fibroblasts obtained from rabbits at 3‐week postinjury exhibited higher rates of senescent phenotypes and produced higher levels of TGF‐β1, collagens, α‐SMA, and matrix metalloproteinases (MMPs), than the corresponding fibroblasts from sham‐operated MCLs. Mechanical stretch further enhanced the cellular senescence and the expression of TGF‐β1, collagens, α‐SMA, and MMPs in both sham and healing MCL fibroblasts. In addition to MCL fibroblasts at 3‐week postinjury, the increased cellular senescence was also detected in healing MCL fibroblasts obtained at 4‐ and 6‐week postinjury. Most importantly, the association between the cellular senescence and ligament healing was confirmed in tissue sections by the senescence‐associated β‐galactosidase (SA‐β‐gal) staining. Using a recombinant TGF‐β1 and a neutralizing antibody, we found that those phenotypic changes, such as cellular senescence and the expression of collagens and MMPs, in MCL fibroblasts under mechanical loading conditions were regulated through TGF‐β1. Taken together, our results propose that cellular senescence and turnover of extracellular matrixes regulated by TGF‐β1 in MCL fibroblasts are critical for ligament healing.

Chronic kidney disease is associated with a risk of higher mortality following total knee arthroplasty in diabetic patients: a nationwide population-based study

Diabetes and chronic kidney disease (CKD) are associated with a higher rate of complications in patients undergoing total knee arthroplasty (TKA). The purpose of this study was to determine the effects of CKD and diabetes in patients after TKA. Diabetic patients who received unilateral primary TKA between January 2008 and December 2011 were enrolled. The follow-up period was more than 6 months. The primary outcome was a TKA-related infection and the secondary outcome was all-cause mortality. The study cohort included 13844 patients who were followed for a mean period of 2 years, of whom 1459 (10.5%) had CKD. The patients with CKD were older than those without CKD (71.6 versus 70.3 years, P<0.0001) and had higher rates of hypertension, gouty arthritis, ischemic heart disease, chronic pulmonary obstructive disease, pulmonary embolism and deep vein thrombosis (all P<0.0001). After adjustment of comorbidities, the CKD group had a higher incidence of urinary tract infections (OR: 1.61, 95% CI: 1.19-2.17). There were no significant differences in wound infections, pneumonia, pulmonary embolism or in-hospital death between the two groups. After adjustment of confounders, the CKD group had higher rates of myocardial infarction (HR: 2.06, 95% CI: 1.26–3.39) and mortality (HR: 1.99, 95% CI: 1.59–2.48). The risk of TKA-related infection during follow-up was comparable between the two groups (HR: 1.31, 95% CI: 0.94–1.82). In conclusion, CKD is associated with increased risks of urinary tract infections, myocardial infarction and all-cause mortality after TKA. Surgeons should be aware of this when evaluating TKA patients with renal disease.