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Abstract:In a previous report, we presented our results of forty-two acetabular reconstructions, performed with use of impaction bone-grafting and a cemented polyethylene cup, in thirty-seven patients who were younger than fifty years and had a minimum of fifteen years of follow-up. The present update study shows the results after twenty to twenty-eight years. Eight additional cups had to be revised-four because of aseptic loosening, three because of wear, and one during a revision of the stem. Three additional cups were considered loose on radiographs. Survivorship of the acetabular reconstructions, with an end point of revision for any reason, was 73% after twenty years and 52% after twenty-five years. With revision for aseptic loosening as the end point, survival was 85% after twenty years and 77% after twenty-five years; for signs of loosening on radiographs, survival was 71% at twenty years and 62% at twenty-five years. In conclusion, our previous results have declined but the technique of using impacted morselized bone graft and a cemented cup is useful for the purpose of restoring bone stock in young patients whose acetabular defects require primary or revision total hip arthroplasty.

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Objective: To rescue chondrogenic differentiation of human mesenchymal stem cells (hMSCs) in osteoarthritic conditions by inhibition of protein kinases. Methods: hMSCs were cultured in pellets. During early chondrogenic differentiation, these were exposed to osteoarthritic synovium-conditioned medium (OAS-CM), combined with the Janus kinase ( JAK)-inhibitor tofacitinib and/or the transforming growth factor b-activated kinase 1 (TAK1)-inhibitor oxozeaenol. To evaluate effects on chondrogenesis, the glycosaminoglycan (GAG) content of the pellets was measured at the time that chondrogenesis was manifest in control cultures. Moreover, mRNA levels of matrix molecules and enzymes were measured during this process, using real-time polymerase chain reaction (RT-PCR). Initial experiments were performed with hMSCs from a fetal donor, and results of these studies were confirmed with hMSCs from adult donors. Results: Exposure to OAS-CM resulted in pellets with a much lower GAG content, reflecting inhibited chondrogenic differentiation. This was accompanied by decreased mRNA levels of aggrecan, type II collagen, and Sox9, and increased levels of matrix metalloproteinase (MMP)1, MMP3, MMP13, ADAMTS4, and ADAMTS5. Both tofacitinib ( JAK-inhibitor) and oxozeaenol (TAK1 inhibitor) significantly increased the GAG content of the pellets in osteoarthritis (OA)-like conditions. The combination of both protein kinase inhibitors showed an additive effect on GAG content. In agreement with this, in the presence of OAS-CM, both tofacitinib and oxozeaenol increased mRNA expression of sox9. The expression of aggrecan and type II collagen was also up-regulated, but this only reached significance for aggrecan after TAK1 inhibition. Both inhibitors decreased the mRNA levels of MMP1, 3, and 13 in the presence of OAS-CM. Moreover, oxozeaenol also significantly down-regulated the mRNA levels of aggrecanases ADAMTS4 and ADAMTS5. When combined, the inhibitors caused additive reduction of OA-induced MMP1 mRNA expression. Counteraction of OAS-CM-induced inhibition of chondrogenesis by these protein kinase inhibitors was confirmed with hMSCs of two different adult donors. Both tofacitinib and oxozeaenol significantly improved GAG content in cell pellets from these adult donors. Conclusions: Tofacitinib and oxozeaenol partially prevent the inhibition of chondrogenesis by factors secreted by OA synovium. Their effects are additive. This indicates that these protein kinase inhibitors can potentially be used to improve cartilage formation under the conditions occurring in osteoathritic, or otherwise inflamed, joints.

IL37 is induced by IL1β, and IL37 itself reduced IL1β, IL6 and IL8 production, indicating that IL37 is able to induce a counter-regulatory anti-inflammatory feedback loop in chondrocytes. In addition, IL37 dampens catabolic enzyme expression. This supports IL37 as a potential therapeutic target in OA.

We identified a relationship between IL-37 and reduced sGAG loss in OA cartilage. Most likely, this effect is mediated by inhibition of MMP-3 expression. These results suggest that IL-37 could be applied as therapy in a subgroup of OA patients, in which cartilage degradation is mediated by MMP-3.

We present descriptions of two human Mycobacterium microti infections: one of a patient with pulmonary disease and one of a patient with osteomyelitis of the hip. Both patients had acid-fast bacilli and a positive Mycobacterium tuberculosis complex PCR from clinical specimens, but mycobacterial cultures remained negative. The microbiological diagnosis was established by molecular methods. CASE REPORTSPatient 1 was a 60-year-old human immunodeficiency virusnegative man who was admitted for a diagnostic pulmonary biopsy. One year prior to admission, the patient suffered from a 1-month period of weight loss, high fever, and night sweats. At that time, a chest X ray showed an infiltrate in his right lung and he was treated with a 6-month course of amoxicillin for a presumed pulmonary actinomycosis, which was diagnosed by cytological examination of a bronchoalveolar lavage sample. The infiltrate decreased during therapy and cleared 6 months after therapy. During follow-up, 6 months after cessation of amoxicillin, he developed a new lesion in his left upper lobe suspected of malignancy, with increased 18-fluordeoxyglucose uptake on a positron emission tomography scan. The lesion was resected by thoracotomy for diagnostic purposes. Histopathologic examination revealed granulomatous necrotic inflammatory tissue with acid-fast bacilli (AFB); malignant cells were not found. A Mycobacterium tuberculosis (MTB) complex PCR targeting the IS6110 sequence was positive (10). The lung tissue specimen was cultured in liquid medium (Bactec MGIT; Becton Dickinson [BD], Sparks, MD) and on agar-based media (Middlebrook and Cohn 7H10; BD) and egg-based media (Coletsos plus ossein agar; Bio-Rad, Marnes-la-Coquette, France). All cultures were incubated at 37°C for 8 weeks. After these cultures remained negative, a second attempt at mycobacterial culture was performed on tissue specimens stored at Ϫ20°C using the same media and 9 weeks of incubation. Again, mycobacterial cultures remained negative. Following the positive AFB staining and PCR results from the lung tissue specimens, sputum samples were collected on three separate occasions that were negative for AFB and mycobacterial culture. The patient was treated with isoniazid, rifampin, and ethambutol for a total of 6 months and pyrazinamide for the initial 2 months. One month after completion of therapy, the patient was well and without symptoms.Patient 2 was a 58-year-old man who was admitted for a total hip prosthesis because of avascular necrosis of his right hip. Nineteen months earlier, corticosteroid treatment was started for polymyalgia rheumatica. He developed pain in his right hip and night sweats 7 months before admission and 3 months after cessation of corticosteroids. He reported 30 kg of weight loss since the onset of pain in the hip. He had no pulmonary complaints and no abnormalities on chest X-ray examination.At surgery, a femoral head resection was performed, but no prosthesis was implanted since an infection was suspected intraoperatively. A Girdlestone situation was...

The long-term prognosis of LCPD Catterall type 2 and 3 is relatively benign. However, more than 50% of the patients will develop signs of osteoarthritis between the 4th and 5th decades. At the latest follow-up a strong increase in the number of cases with osteoarthritis was seen. Sphericity of the femoral head is an important predicting factor in the development of osteoarthritis.