Xiaowei Xie

The influence of diabetes mellitus on the post-operative outcome of elective primary total knee replacement: a systematic review and meta-analysis

Total knee replacement (TKR) is an effective method of treating end-stage arthritis of the knee. It is not, however, a procedure without risk due to a number of factors, one of which is diabetes mellitus. The purpose of this study was to estimate the general prevalence of diabetes in patients about to undergo primary TKR and to determine whether diabetes mellitus adversely affects the outcome. We conducted a systematic review and meta-analysis according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. The Odds Ratio (OR) and mean difference (MD) were used to represent the estimate of risk of a specific outcome. Our results showed the prevalence of diabetes mellitus among patients undergoing TKR was 12.2%. Patients with diabetes mellitus had an increased risk of deep infection (OR = 1.61, 95% confidence interval (CI), 1.38 to 1.88), deep vein thrombosis (in Asia, OR = 2.57, 95% CI, 1.58 to 4.20), periprosthetic fracture (OR = 1.89, 95% CI, 1.04 to 3.45), aseptic loosening (OR = 9.36, 95% CI, 4.63 to 18.90), and a poorer Knee Society function subscore (MD = -5.86, 95% CI, -10.27 to -1.46). Surgeons should advise patients specifically about these increased risks when obtaining informed consent and be meticulous about their peri-operative care.

Icariin: A promising osteoinductive compound for repairing bone defect and osteonecrosis.

Icariin (Ica), the main active component of Herba Epimedii, has been identified as an osteogenic and angiogenic phytomolecule. To develop a bioactive scaffold for enhancing bone repair, Ica was loaded into porous tricalcium phosphate (TCP) scaffolds, and the obtained porous Ica/TCP composites were investigated for treating osteonecrosis of the femoral head (ONFH) in a rabbit model. ONFH was histopathologically confirmed at two weeks after methylprednisolone acetate injection, and the rabbits were treated with porous Ica/TCP scaffolds (group A), porous TCP scaffolds (group B), and autogenous cancellous bone graft (group C). At 12 weeks, the amount of newly formed bone in group A increased significantly compared with that in group B (P = 0.003). The mean histological and radiological scores for repaired defects in group A were significantly higher than those in group B (P = 0.007, P = 0.029, respectively), but were lower than those in group C (P = 0.032, P = 0.046, respectively). In addition, the expression of vascular endothelial growth factor by immunohistochemical testing and real-time polymerase chain reaction in group A was significantly higher than that in group B (P = 0.002, P = 0.001, respectively), but was lower than that in group C (P = 0.034, P = 0.005, respectively). Therefore, Ica can be a promising osteogenic and angiogenic compound for repairing bone defects and preventing the collapse of the femoral head in ONFH.

Subcutaneous administration of methotrexate at high doses makes a better performance in the treatment of rheumatoid arthritis compared with oral administration of methotrexate: A systematic review and meta-analysis

OBJECTIVES This study was conducted to determine whether subcutaneous (SC) methotrexate (MTX) makes better performance on bioavailability, clinical efficiency, side effects occurrence, and treatment failure in the treatment of RA compared with oral MTX. METHODS The databases PubMed, Web of Science, Embase, and Cochrane Library were systematically searched. Seven studies involving 1335 patients were eligible for data extraction and meta-analysis. The outcomes of meta-analysis were presented as mean difference (MD) or odd ration (OR) with 95% confidence interval (95% CI). RESULTS Meta-analysis showed that SC MTX can significantly increase the AUC0-t (area under plasma concentration curve from administration to last observed concentration at time t) (MD = 506.84; 95% CI: 80.80-932.89), shorten the time to reach maximum observed concentration (Tmax) (MD = -0.13; 95% CI: -0.25 to -0.01) and the apparent terminal elimination half-life (t(1/2)) (MD = -0.39; 95% CI: -0.70 to -0.08), reduce the occurrence of nausea (OR = 0.53; 95% CI: 0.28-0.97) and diarrhea (OR = 0.43; 95% CI: 0.20-0.95), improve the American College of Rheumatology criteria for 20% improvement (ACR20) (OR = 1.68; 95% CI: 1.09-2.61) and ACR70 (OR = 1.52; 95% CI: 1.02-2.26), and relieve the pain (MD = -0.65; 95% CI: -0.93 to -0.37) compared with oral MTX. However, the differences in maximum plasma concentration (Cmax), the occurrence of headache, vomiting and dyspepsia, ACR50, treatment failure were not significant between the two groups. CONCLUSION SC route of MTX at high doses made better performance on improving the bioavailability and clinical efficacy, reducing the GI disorders, but it cannot decrease the treatment failure when compared with oral administration of MTX.

Antigen-free bovine cancellous bone loaded with recombinant human bone morphogenetic protein-2 for the repair of tibial bone defects in goat model.

Antigen-free bovine cancellous bone has good performances of porous network structures and mechanics with antigen extracted. To develop a bioactive scaffold for enhancing bone repair and evaluate its biological property, rhBMP-2 loaded with antigen-free bovine cancellous bone was used to treat tibial bone defect. Twenty-four healthy adult goats were chosen to establish goat defects model and randomly divided into four groups. The goats were treated with rhBMP-2/antigen-free bovine cancellous bone scaffolds (group A), autogenous cancellous bone graft (group B), porous tricalciumphosphate scaffolds (group C) and nothing (group D). Animals were evaluated with radiological and histological methods at 4, 8 and 12 weeks after surgery. The gray value of radiographs was used to evaluate the healing of the defects, which revealed that the group A had a better outcome of defect healing compared with group C at 4, 8 and 12 weeks, respectively (p < 0.05), while the difference between groups A and B was without significance at each time (p > 0.05). The newly formed bone area was calculated from histological sections, and the results indicated that the amount of new bone in group A increased significantly compared with that in group C (p < 0.05) but was similar to that in group B (p > 0.05) at 4, 8 and 12 weeks, respectively. In addition, the expression of collagen I and vascular endothelial growth factor by real-time polymerase chain reaction at 12 weeks in group A was significantly higher than that in group C (p = 0.034, p = 0.032, respectively), but no significant differences were found when compared with that in group B (p = 0.36, p = 0.54, respectively). At the same time, group C presented better results than group D on bone defects healing. Therefore, the composites of antigen-free bovine cancellous bone loaded with rhBMP-2 have a good osteoinductive activity and capacity to promote the repair of bone defects.

Total Hip Arthroplasty for Failed Internal Fixation After Femoral Neck Fracture Versus That for Acute Displaced Femoral Neck Fracture: A Comparative Study

The outcome of total hip arthroplasty (THA) for failed internal fixation after femoral neck fracture (FNF) versus that for acute displaced femoral neck fracture is still controversial. This study retrospectively analyzed a consecutive series of 130 THAs for acute displaced FNF (64, group I) and for failed internal fixation (66, group II). Results showed THAs in group II were more technically demanding procedures with longer operative time and larger amounts of drainage compared to that in group I. Furthermore, multivariate analysis revealed that the associations between THAs (group II) and hip complications were notable (OR=4.15, P=0.017). These increased risks should be paid much attention to, not only for choosing the appropriate treatment option, but also for providing effective perioperative care.

Repair of the calvarial defect in goat model using magnesium-doped porous hydroxyapatite combined with recombinant human bone morphogenetic protein-2

Hydroxyapatite (HA) is a representative bone repairing biomaterial for its similar composition to human bones and teeth. However, pure HA is limited in application for some unwanted characteristic, such as it is brickle and weakness in degradation. In this study, we modified HA by doping magnesium (Mg) to the material and studied its property in vitro. Besides, we also evaluated the calvarial defect repair effect using MgHA combined with rhBMP-2 in goat model. According to our outcomes, HA composited Mg made the scaffold smooth and the pore regular. In vitro study, Mg could increase the Ca releasing, which may reflect a faster degradation property modified by Mg. And then, MgHA improved the cell viability and proliferation. Furthermore, MgHA could increase the expression of ALP, Collagen I and VEGF protein compared with pure HA (p<0.5, respectively). In the vivo study, MgHA showed a better bone defect healing effect in computed tomography (CT) evaluation compared with HA (p<0.05), but it was inferior to the MgHA/rhBMP-2 (p<0.05). Besides, in the histological analysis, MgHA/rhBMP-2 showed the most effective bone formation outcome (p<0.05), and the MgHA group was significant better than the pure HA group on osteogenesis (p<0.05). Furthermore, Collagen I and VEGF mRNA expression at 12 week in MgHA/rhBMP-2 group were also significat higher than other two groups. In conclusion, Mg had effects on bone formation and angiogenesis, and MgHA/rhBMP-2 had improved the bone defect repair effect. It is worthy of being recommended to bone tissue engineering.

The efficacy of statins in preventing glucocorticoid-related osteonecrosis in animal models: A meta-analysis

Objectives The primary purpose of this meta-analysis was to determine whether statin usage could reduce the risk of glucocorticoid-related osteonecrosis in animal models. Methods A systematic literature search up to May 2015 was carried out using the PubMed, Ovid, EBM reviews, ISI Web of Science, EBSCO, CBM, CNKI databases with the term and boolean operators: statins and osteonecrosis in all fields. Risk ratio (RR), as the risk estimate of specific outcome, was calculated along with 95% confidence intervals (CI). The methodological quality of individual studies was assessed using a quantitative tool based on the updated Stroke Therapy Academic Industry Roundtable (STAIR) recommendations. Results A total of 11 eligible studies were included according to predetermined criteria. The pooled data demonstrated that animals with statin usage, either alone or combined with other treatments, were at a decreased risk of developing glucocorticoid-related osteonecrosis (RR = 2.06, 95% confidence interval (CI) 1.71 to 2.50). Moreover, subgroup analysis revealed that compared with statins alone, statins combined with other treatments significantly decreased the risk of osteonecrosis (RR = 1.23, 95% CI 1.02 to 1.47). However, we could find no significant risk difference for different gender, or for different time points. Conclusions The present study suggests that statins combined with other treatments are efficient in preventing the development of glucocorticoid-related osteonecrosis in animals. These results might shed light on clinical practice when glucocorticoids are prescribed, and could be further investigated in high-quality clinical trials. Cite this article: Z. Yang, H. Liu, D. Li, X. Xie, T. Qin, J. Ma, P. Kang. The efficacy of statins in preventing glucocorticoid-related osteonecrosis in animal models: A meta-analysis. Bone Joint Res 2016;5:393–402. DOI: 10.1302/2046-3758.59.2000500.