Backgroud: Aseptic prosthetic loosening is one of main factor producing poor prognosis of limb function after joint replacement and requiring troublesome revision surgery. It is featured by wear particle–induced periprosthetic osteolysis mediated by excessive osteoclasts activated in inflammatory cell context. In our previous study, some natural compounds showing anti-osteoclast trait with high cost-efficiency and few side effects. Tussilagone (TUS), as the main functional extract from Tussilago Farfara precedently used for relieving cough, asthma and eliminating phlegm in traditional medicine, has been proved to appease several RAW264.7-mediated inflammatory diseases via suppressing osteoclast-related signaling cascades. However, whether and how TUS can improve aseptic prosthetic loosening via modulating osteoclast-mediated bone resorption still need to be answered. Methods: We established a murine calvarial osteolysis model to detect the preventative effect of TUS on osteolysis in vivo. Micro-CT scanning and histomorphometric analysis were used to determine the variation of bone resorption and osteoclastogenesis in samples. The anti-osteoclast-differentiation and anti-bone-resorption bioactivities of TUS in vitro were investigated using bone slice resorption pit evaluation and interference caused by cytotoxicity of TUS was excluded according to CCK-8 assay. Quantitative PCR analysis was applied to prove the decreased expression of osteoclast-specific genes after TUS treatment. The inhibition effect of TUS on NF-κb and p38 MAPK signaling pathways was testified by western blotting and NF-κB-linked luciferase reporter gene assay.Results: TUS demonstrated bone protective effect against osteolysis in murine calvarial osteolysis model with reduced osteoclasts compared to the control group. Following studies in vitro witnessed that TUS exert anti-osteoclastogenesis and anti-bone-resorption effects in both BMMs and RAW264.7 cells, as evidenced by the decline of osteoclast specific genes according to quantative PCR. Western blotting revealed that TUS-treated demonstrated inhibited IκBα degradation and p38 phosphorylation.Conclusions: Collectively, for the first time our studies prove that TUS inhibits osteoclastogenesis by suppressing the NF-κb and p38 MAPK signaling pathways, therefore serving as a potential natural compound to treat periprosthetic osteolysis-induced aseptic prosthetic loosening.

Background Periacetabular malignant tumor seriously endangers the life and health of patients. Hemipelvic replacement provides a good method for patients who want complete resection of the tumor while retaining or restoring the function of the affected limb. Objective To investigate the performance and clinical application of the new adjustable modular hemipelvic prosthesis and to compare the effects of three kinds of hemipelvic prosthesis. Methods In this study, 23 patients, with an average age of 44.6 years (21–75 years), were collected, who received hemipelvic replacement with new adjustable, modular, and screw-rod system hemipelvic prosthesis. Preoperative preparation was conducted on them, and operative complications were recorded. Postoperative functional follow-up was performed regularly. Results The average operation time was 319 min (170–480 min), and the average blood loss was 2813 ml (1000 mL-8000 ml). The incidence of complications was 47.8%, and type A (wound-related complications) had the highest incidence (34.8%). Postoperative dislocation occurred in 3 cases (13.0%), and no dislocation occurred in the new adjustable modular hemipelvic prosthesis group. The average MSTS score of the patients was 18.6 (10–23), and the average Harris score was 73.7 (53–87). Conclusions The new adjustable modular hemipelvic prosthesis has the feasibility of reconstruction and good functional outcome, making it ideal for periacetabular tumors. Furthermore, preoperative tumor-feeding artery embolization and abdominal aortic balloon implantation may be an effective choice to reduce intraoperative blood loss and facilitate the operation of tumor resection.

Exercise intervention (EI) is a promising and economical way for elderly patients with hip fracture, but it is unclear which type of exercise is optimal. To assess the effectiveness of different EIs and identify the optimal EI of improving the prognosis for elderly patients with hip fracture. We searched Medline (via PubMed), Web of Science, Embase, Cochrane Central Register of Controlled Trials, CINAHL, CNKI, Wan Fang, VIP and CBM from their earliest records to June 2022. The included randomized controlled trials (RCT) included at least one type of exercise for patients with hip fracture. The methodological quality of these trials was assessed using the Cochrane Collaboration Risk of Bias Tool, Stata 14.0 software was used for NMA. The primary outcome was hip function, and the secondary outcomes were activity of daily living (ADL), walking capacity and balance ability of the patients. This study included 46 RCTs involving 3,286 patients. Based on the recovery of patients' hip function, resistance exercise (RE) ([MD]: -11.07, [Crl]: -15.07 to -7.08) showed significant benefits over the control group (CG). RE ([MD]: -8.86, [Crl]: -15.01 to -2.71) ([MD]: -9.09, [Crl]: -14.20 to -3.98) showed significant benefits over the weight-bearing exercise and aerobic exercise. In addition, RE (surface under cumulative ranking curve values [SUCRA]: 94.8%) and balance exercise (BE) ([SUCRA]: 81.1%) were most likely to be the optimal exercise methods for hip function recovery. BE may be the most effective exercise in improving ADL([SUCRA]: 98.4%) and balance ability([SUCRA]: 88.4%). These results suggest that RE and BE might be the best approach to improve prognosis for elderly patients with hip fracture. More well-designed and high-quality RCTs are needed to verify the conclusions drawn from this study.

This article has been corrected: Due to errors in image processing, the representative image of TRAP staining in RANKL+HP d1 is incorrect. The proper Figure 1 is shown below. The authors declare that these corrections do not change the results or conclusions of this paper.