Tourniquet use in bilateral TKA can reduce intraoperative time but was associated with a higher incidence of wound complications and larger postoperative knee swelling.

No abstract

Background:The traditional management for osteonecrosis of the femoral head (ONFH) includes core decompression (CD) and quadratus femoris muscle pedicle bone graft (QF-MPBG). The aim of this study was to investigate the effects of CD and QF-MPBG on the patients with nontraumatic ONFH in an early stage.Materials and Methods:39 patients (47 hips) with ONFH in an early stage (Ficat Stage I or II) were randomly divided into two groups according to random number table method. One group was treated with CD and cancellous bone grafting. Another group was treated QF-MPBG with cancellous bone grafting. The hip function was evaluated using Harris hip score (HHS). The repair of the femoral head was estimated through X-ray, computed tomography (CT), or magnetic resonance imaging (MRI). The surgical time and intraoperative blood loss was calculated.Results:All patients were followed for an average 2.5 years (range from 1.5 to 4 years). Two hips in CD group progressed into stage 3 and three hips in QF-MPBG group processed into stage 3. No patient accepted the THA at the last followup. The HHSs significantly increased in both groups after surgery (P < 0.05). No statistical differences were found between CD and QF-MPBG groups in postoperative HHSs at last followup (P > 0.05). X-ray and CT showed that the femoral head did not progress to collapse after operation in both groups. In addition, MRI showed that the edema signals decreased. However, the surgical time was longer in QF-MPBG group than that in CD group (P < 0.05). The intraoperative blood loss was more in QF-MPBG than that in CD group (P < 0.05).Conclusion:The CD with bone graft could relieve hip pain, improve hip function with much lesser surgical trauma compared to QF-MPBG. Hence, the CD with bone graft should be generally used for the treatment of patients with an early stage (Ficat Stage I or II) ONFH.

Tissue-engineered bone improved osteogenesis in vivo and enhanced the ability to repair critical-sized bone defects in large animals.

The purpose of this study was to investigate the possible use of resveratrol (Res) to reverse abnormal osteogenesis/osteoclastogenesis activity that occurs during femoral head osteonecrosis and to explore the detailed mechanisms. Application of Res to bone marrow–derived mesenchymal stem cells in vitro promoted survival, inhibited apoptosis, and downregulated expression of reactive oxygen species expression. Moreover, Res application was associated with elevated microRNA‐146a (miR‐146a) expression, osteogenic differentiation, and suppressed osteoclastic differentiation, which were markedly reversed by miR‐146a inhibitor. Histopathological observations and micro‐computed tomography scanning results indicated that the Res‐treated group had lower incidence of osteonecrosis and better bone microstructure than the untreated group. Res inhibited osteoclastogenesis through altering the levels of sirtuin1 (Sirt1), nuclear transcription factor‐κB (NF‐κB), and receptor activator of NF‐κB ligand (RANKL). Simultaneously, Res treatment improved bone formation and increased β‐catenin and runt‐related transcription factor 2 (Runt2) expression levels, while reducing forkhead box class O (FOXO) family protein levels. The results of our study suggest that Res prevents steroid‐induced osteonecrosis by upregulating miR‐146a, and thereby stabilizes osteogenesis/osteoclastogenesis homeostasis via Wnt/FOXO and Sirt1/NF‐κB pathways.