Study On Repairing Cartilage Defect With Autologous Osteochondral Transplantation&Epidemiological Investigation On Deep Venous Thrombosis After Artificial Joint Arthroplasty

Chapter 1 Influence of intra-articular administration of trichostatin A on autologous osteochondral transplantation in a rabbit modelObjective:Autologous osteochondral transplantation(AOT)is a method for articular cartilage repair.However,several disadvantages of this method have been reported,such as transplanted cartilage degeneration and the lack of a connection between the grafted and adjacent cartilage.To evaluate the effect of intra-articular administration of TSA on AOT,we conducted a case control study in a rabbit model.Methods:An osteochondral defect(diameter,3.5 mm;depth,3 mm)was created on the patellar groove of the femur in both knees of twenty New Zealand White rabbits and the harvested osteochondral graft from one knee was filled into the defect site in the other knees.After random grouped,each rabbits were injected with either TSA or normal saline into the joints.The animals were sacrificed at 4 weeks(10 rabbits)or 12 weeks(10 rabbits)respectively.The International Cartilage Repair Society(ICRS)Marcoscopic Scores and the Modified O’Driscoll Histology Scores were utilized to evaluate the effect.The influence of TSA on collagen type II,aggrecan,MMPs,ADAMTS-5 expression in absence or present of IL-1β in chondrocytes were investigated in vitro.Results:At 4 weeks,both macroscopic and histological assessment showed that there was no significant difference between the TSA and control groups.However,the mean macroscopic and histological scores for the TSA-treated group were significant higher than the scores for the control group at 12 weeks.TSA was shown to directly reduce collagen type Ⅱ,MMP and ADAMTS-5 expression and to simultaneously repress the upregulation of MMP-3,MMP-9,and MMP-13 levels induced by IL-1β in chondrocytes.Conclusion:TSA,a histone deacetylase(HDAC)inhibitor,may have an effect on protecting the graft of AOT from degeneration,which might be benefit for repair articular cartilage injury.Chapter 2 Deep venous thrombosis in patients with coronary heart disease after total hip arthroplasty and total knee arthroplastyObjective:To identify the incidence and risk factors of DVT and evaluate the safety of thromboprophylaxis in patients with CHD after THA and TKA.Methods:Sixty patients with CHD undergoing THA and TKA were divided into two groups:DVT group and non-DVT group.Venography was utilized as an assessment medium.Results:The incidence of DVT after THA and TKA in patients with CHD was 17.6%and 19.2%,respectively.When comparing parameters between the two groups,no significant difference was found.Conclusion:The prevalence of DVT after THA and TKA in patients with CHD is similar.However,the known risk factors after total joint arthroplasty did not affect the incidence of DVT in these patients.Routine thromboprophylaxis is safe when used in these patients.Chapter 3 Does intermittent pneumatic compression increase the risk of pulmonary embolism in deep venous thrombosis after joint surgery?Objective:The present study is aimed to identify the incidence and risk factors of symptomatic PE and evaluate the safety of early IPC application in patients with DVT after joint surgery.Methods:A total of 144 patients with DVT undergoing joint surgery were divided into two groups according to the appearance of symptomatic PE.Venography and CTPA were utilised as the assessment methods.Results:The total incidence of symptomatic PE was 0.39%after joint surgery.However,the prevalence increased to 3.5%when computed in patients with DVT.Patients with symptomatic PE were older than those without symptomatic PE(69±4 years versus 61 ±15 years,p=0.04).The occurrence rate of symptomatic PE in patients with diabetes mellitus was much higher than in the patients without diabetes mellitus(40.0%versus 8.6%,respectively,p=0.02).Conclusion:The prevalence of symptomatic PE after joint surgery in patients with DVT was not distinctive.Increased age and diabetes mellitus put patients with DVT at risk of suffering symptomatic PE after joint surgery.In addition,early postoperative application of IPC was safe in these patients.Chapter 4 Change in postprandial serum glucose levels perioperatively is related to deep venous thrombosis in diabetic patients undergoing total hip arthroplasty and total knee arthroplastyObjective:To identify the incidence of and risk factors for DVT and the relationship between serum glucose levels and DVT in diabetic patients after THA and TKA.Methods:A total of 116 diabetic patients undergoing THA and TKA were divided into two groups:a DVT group and non-DVT group.Four-point glucose levels were measured throughout each patient’s hospitalization.Venography was performed as an assessment method.Results:The incidence rates of DVT in diabetic patients after THA and TKA were 17.3%and 18.6%,respectively.When comparing normalized risk factors between the two groups,no significant difference was found.None of the mean glucose levels during hospitalization,preoperatively,and at 5 days postoperatively were associated with DVT.By assessing the change in the mean glucose levels,we observed that the change in the mean glucose levels after breakfast was associated with DVT(p=0.04).Conclusion:The prevalence of DVT after THA and TKA in diabetic patients is not distinctive.However,the known risk factors after total joint arthroplasty did not put these patients at risk of DVT.An increased change in postprandial serum glucose levels before and after surgery was related to DVT in these patients.