A 30-year-old man presented with pain and limitation of movement of the right hip. The symptoms had failed to respond to conservative treatment. Radiographs and CT scans revealed evidence of impingement between the femoral head-neck junction and an abnormally large anterior inferior iliac spine. Resection of the hypertrophic anterior inferior iliac spine was performed which produced full painless restoration of function of the hip. Hypertrophy of the anterior inferior iliac spine as a cause of femoro-acetabular impingement has not previously been described.

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We used samples from rheumatoid arthritis (RA) patients to examine whether Anti-citrullinated protein antibodies (ACPAs) alter macrophage subset distribution and promote RA development. Macrophage subset distributions and interferon regulatory factor 4 (IRF4) and IRF5 expressions were analyzed. ACPAs were purified by affinity column. After RA and osteoarthritis (OA) patients' macrophages were cocultured with ACPAs, macrophage subsets and IRF4 and IRF5 expressions were measured. Small interfering RNAs (siRNAs) were transfected into ACPA-activated cells to suppress IRF4 or IRF5. Fluorescence-activated cell sorting (FACS), Western blot, and immunohistochemistry were performed. Macrophage subset disequilibrium occurred in RA patient synovial fluids. IRF4 and IRF5 were all expressed in the synovial fluid and synovium. ACPAs (40 IU/ml) could induce macrophages to polarize to M1 subsets, and the percentage of increased M1/M2 ratio of RA patients was higher than that of the OA patients. ACPAs also induce IRF4 and IRF5 protein expressions. IRF5 siRNA transfection impaired ACPA activity significantly. We demonstrated that macrophage subset disequilibrium occurred in RA patients. ACPAs induced IRF5 activity and led to M1 macrophage polarization.

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CCL13 levels in serum and SF were correlated with the radiographic severity of OA. CCL13 levels in serum and SF may serve as a biomarker for the progression of OA.

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Background: We report the removal of a large metallic foreign body and review the relevant literature. Methods: A 28 y old woman was admitted with left knee swelling, pain, and limitation of activity resulting from an accident 7 d earlier. Radiography revealed a 3 × 1 cm foreign body at the mid-tibial plateau. As the foreign body may have been metallic, it was not possible to perform magnetic resonance imaging to determine whether damage to the cruciate ligaments was present. Finally, the foreign body was retrieved. Results: A 3 × 4 × 5 cm triangular broken knife blade was removed from the joint cavity. We excised the lateral meniscus, which had been damaged by the foreign body, and debrided the hyperplastic synovial membrane. Recovery was favorable with no complications. The patient was followed up at 6 months after surgery. Conclusions: While foreign bodies in the knee are not uncommon, the presence of a large object is rare. When foreign bodies are small, most can be removed arthroscopically with a minimum of difficulty. In contrast, large foreign bodies within the knee joint cavity require an incision to open the joint for adequate exposure and removal of the object. Such a procedure can result in severe complications, such as infections and joint deformities. The decision to use one or the other approach requires careful consideration regarding the condition of the patient along with the skill, knowledge, and experience of the health care team.