| BackgroundCurrently,artificial hip arthroplasty is a routine orthopedic surgery,which is widely performed all over the world with the purpose of releasing their pain and improving the quality of their lives.According to the statistics,there are millions of cases who accepted artificial hip arthroplasty per year worldwide,and the annual rate is still gradually rising at about 5%.At the same time,there are also some postoperative complications in hip arthroplasty.For severe cases,the revision operations of hip prosthesis are urgently demanded,which,however,also bring great pain and economic burden to patients,and reduces the quality of life of patients.Aseptic loosening is the most common cause of hip revision,which makes it extremely important to analyse the reason why aseptic loosening happens,to decrease the rate of aseptic loosening of prosthesis after arthroplasty,to prolong the service life of artificial prosthesis and to avoid the revision operation for aseptic loosening of prosthesis.However,the mechanism of aseptic loosening of prosthesis after hip arthroplasty,which is relatively complex,is still under continuous exploration.Single factor is not enough to explain the occurrence of aseptic loosening.Many researchers believe that it is closely related to many aspects,such as the patient’s own reasons,surgical techniques,postoperative osteolysis and postoperative activity.The first part of this study is an analysis aiming at exploring the factors causing aseptic loosening of hip prosthesis We took hip joint revision patients in a 3A hospital as research subjects.The differences between patients undergoing revision surgery due to aseptic loosening of prosthesis and patients undergoing revision due to other reasons were compared in terms of demographic data and blood biochemical results,we attempt to explore the factors influencing the occurrence of aseptic loosening of artificial hip joint prosthesis and screen out high-risk groups.In order to take some preventive intervention measures to reduce the occurrence of aseptic loosening of prosthesis,we conducted the second part of the study,namely,the mechanism of coenzyme Q10(Co-Q10)in the treatment of aseptic loosening of joint prosthesis,trying to clarify its mechanism and explore whether Co-Q10 can play a role in the treatment of wear particles induced osteolysis(WPIO)and whether there is any potential prospect of Co-Q10 as a prophylactic drug for aseptic loosening of prosthesis.We expect to design a prospective clinical controlled study in the near future,conduct long-term follow-up,and carry out preventive drug intervention for high-risk groups who are prone to aseptic loosening of prosthesis after total hip replacement.Method1.We collected the cases and related clinical data of hip prosthesis revision in the inpatient department of a 3A hospital from January 1,2012 to December 31,2018,including the demographic data,blood biochemical results,reasons for accepting revision of hip prosthesis,etc.Spss20.0 software was used for data processing and analysis.Chi square test and rank sum test were used to analyze whether there were differences in demographic data between patients with aseptic loosening and patients undergoing revision for other reasons.The variables with differences were included in logistic regression model to analyze the relationship between each variable and aseptic loosening of prosthesis.The difference was statistically significant if p value was less than 0.05 righteousness.2.We constructing the mouse skull osteolysis model,grouping and processing the animal model,judging the bone destruction through CT analysis;at the same time,We extract the primary osteoblasts of mice,and then stimulate it with titanium powder and Co-Q10,In order to investigate the effect of Co-Q10 on osteoblast apoptosis and osteogenic activity,and the effect on nuclear transcription factor(NF-κb)signal pathway in the process of antagonizing inflammation.Results1.A total of 145 cases of revision hip arthroplasty were included in this study,of which 90 cases were due to aseptic loosening of prosthesis,accounting for 62%of the total cases.Chi square and rank sum test results showed that the first replacement age,prosthesis service life,complications with other medical diseases,neutrophil number,neutrophil ratio,lymphocyte number,lymphocyte ratio,erythrocyte sedimentation rate,C-reactive protein in aseptic loosening group were significantly different from those in other causes group;logistic multivariate analysis showed that the number of patients with aseptic loosening of prosthesis was significantly higher than that of patients with other causes The age of first replacement,complications of other medical diseases and lymphocyte ratio were the possible factors influencing aseptic loosening of prosthesis.2.The results of animal model showed that,in the macro bone aspect,in the experimental group added with Co-Q10,although there was still bone destruction in the skull,it was significantly less than that in the control group,the bone surface was more smooth,and the skull and skull suture were relatively complete and clear;in terms of micro cells,the levels of reactive oxygen species(ROS),p65 activation in NF KB signaling pathway and the expression of IL-1β in NF KB signaling pathway were decreased by fluorescence staining;the apoptosis of osteoblasts was alleviated by flow cytometry;and the apoptosis of osteoblasts was observed by transmission electron microscopy(TEM)When Co-Q 10 was added,the mitochondria were more complete,the outer membrane and cristae of mitochondria were clear.Conclusion1.The reason of revision in younger patients with first replacement is that aseptic loosening of prosthesis is more likely than that of older patients,and other medical diseases and increased lymphocyte ratio will also increase the possibility.2.Coenzyme Q10 can delay aseptic loosening of prosthesis by reducing inflammatory reaction and protecting osteoblasts from apoptosis. |
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