The Wnt/β-catenin signaling pathway is associated with the pathogenesis of steroid-induced osteonecrosis. Our investigation studied whether aberrant CpG island hypermethylation of the FZD1 gene was present in patients with osteonecrosis of the femoral head (ONFH), which results in Wnt/β-catenin signaling inactivation and subsequent cell dysfunction. Bone marrow was collected from the proximal femurs of patients with steroid-associated ONFH ( n = 21) and patients with new femoral neck fractures ( n = 22), and then mesenchymal stem cells (MSCs) were isolated. We investigated cell viability, the transcription and translation levels of Wnt/β-catenin signaling-related genes, the extent of methylation at CpG islands of the FZD1 promoter, and the osteogenic and adipogenic differentiation abilities of MSCs from the control group and from the ONFH group treated with or without 5′-Aza-dC. According to the results, MSCs from the ONFH group showed a reduced proliferation ability, low transcription and translation levels of FZD1, inhibition of the Wnt/β-catenin signaling pathway, weakened osteogenesis and enhanced adipogenesis ability. Aberrant CpG island hypermethylation of FZD1 was observed in the ONFH group. Treatment with 5’-Aza-dC resulted in de novo FZD1 expression, reactivation of the Wnt/β-catenin signaling pathway and promotion of osteogenesis. Taken together, our study not only provides novel insights into the regulation of the Wnt/β-catenin signaling pathway in this disease but also reveals potential for the use of demethylating agents for the treatment of GC-associated ONFH.
BackgroundOsteopetrosis is an uncommon, inherited disease, characterized by osteosclerosis, obliteration of the medullary canal, calcified cartilage and brittle bone due to impaired osteoclast resorption. Osteoarthritis is common in patients with osteopetrosis. If the patient has pain and dysfunction, total joint arthroplasty is often the treatment of choice but presents many intraoperative and postoperative challenges. Few studies have presented both Total hip arthroplasty (THA) and Total knee arthroplasty (TKA) in one patient. This article describes a case of left hip osteoarthritis and right knee osteoarthritis in a patient with osteopetrosis. We performed THA and TKA in a 59-year-old osteopetrotic patient with painful osteoarthritis in the left hip and right knee.Case presentationA 59-years-old female with osteopetrosis was referred to our department because of a history of left hip pain and bilateral, right greater-than-left, knee pain with activity limitation for 13 years. She had no fracture history. In our hospital the patient underwent THA in the left hip firstly. Six months later, we performed TKA of the right knee. At 15-months follow-up, the components were in good position, and the patient could walk freely and perform activities of daily living with no pain.ConclusionsThis case report demonstrates that total joint arthroplasty is an effective treatment for painful hip and knee osteoarthritis in patients with osteopetrosis.
The present study evaluated the outcomes of internal fixation with a joint line plate in the treatment of tibial plateau fractures caused by hyperextension of the varus. The study included 25 cases (13 males and 12 females; age, 19-71 years) of tibial plateau fracture caused by hyperextension of the varus, which were treated at Puai Hospital, Tongji Medical College (Wuhan, China) between January 2015 and June 2017. Fractures were treated with internal fixations of the inner cortex with a self-clipped joint line plate made of steel. After the surgery, patients were examined immediately and at 3, 6 and 12 months. Healing was evaluated by X-ray examination. All cases were cured during follow-up. After surgery, one patient developed partial necrosis of the skin margin of the incision and recovered after a dressing change. Furthermore, one patient with a concomitant peroneal nerve injury and hypoesthesia recovered after treatment with neurotrophic drugs. No screw loosening, fractures or failure of the internal fixations occurred. According to the X-ray results, there were significant differences in the tibial plateau angle (TPA) and medial posterior slope angle (m-PSA) between the pre-operative stage and 12 months post-operatively (P<0.05). However, no significant differences in either the TPA or m-PSA were present between the immediate post-operative stage and 12 months post-operatively (P>0.05). In conclusion, internal fixation with a joint line plate is an appropriate treatment for tibial plateau fractures involving the anteromedial margin with good clinical efficacy.
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