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Objective The purpose of this meta-analysis was to evaluate the postoperative clinical outcomes of elderly patients who underwent the direct anterior approach (DAA) versus those who received posterolateral approach (PLA) for total hip arthroplasty (THA) in the treatment of femoral neck fractures. Methods An electronic search was conducted in databases including PubMed, Embase, Web of Science, the Cochrane Library, and CNKI from their inception to January 2022. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of DAA compared to PLA for the management of total hip arthroplasty (THA) in elderly patients using the dichotomous or continuous method with a random or fixed-effect model. Results 15 studies involving 1284 patients were included; 640 patients receiving DAA and 644 patients receiving PLA. DAA had a longer surgery duration than PLA [WMD = 9.41, 95% CI (4.64, 14.19), I 2 =95.5%]; The amount of postoperative drainage [WMD= −3.88, 95% CI (−5.59, −2.17), I 2 =98.3%], length of incision [WMD= −3.88, 95% CI (−5.59, −2.17), I 2 =98.3%], blood loss [WMD= −3.88, 95% CI (−5.59, −2.17), I 2 =98.3%], hospitalization time [WMD= −3.88, 95% CI (−5.59, −2.17), I 2 =98.3%], and postoperative bedtime [WMD = −5.56,95% CI (−7.11, −4.01), I 2 =99.0%], were similar between the two groups ( p < 0.05). The HHS at 1 month, 12 months postoperatively [WMD = 7.58, 95%CI (5.70,9.46), I 2 =89.5%; WMD= 2.56, 95%CI 0.11,5.00, I 2 =93.2%] and the incidence of LFCN in patients were higher in the DAA group (OR = 2.91, 95% CI 1.26 to 6.71, I 2 =0.0%), while fewer patients in the DAA group suffered from postoperative dislocation than in the PLA group (OR = 0.26, 95% CI 0.11 to 0.60, I 2 =0.0%). No significant difference was observed in HHS at 1 week, 3 months, and 6 months postoperatively, VAS postoperatively at each time point, acetabular anteversion angle, acetabular abduction angle, wound infection, deep vein thrombosis, and intraoperative fracture ( p > 0.05). Conclusions DAA offers a quicker functional recovery and is less invasive with an earlier return to daily activities in older THA patients than PLA. However, DAA was found to be associated with a high incidence of lateral femoral cutaneous nerve injury and a low incidence of postoperative dislocation. Key messages The present study aims to evaluate the clinical outcomes in elderly patients recei...

Cannabidiol (CBD) is a non-intoxicating cannabinoid from cannabis sativa that has demonstrated e cacious against in ammation, which can be considered as a potential drug for arthritis treatment. However, the poor solubility and low bioavailability limit its clinical application. Here, we report an effective strategy to fabricate CBD-loaded poly lactic-co-glycolic acid nanoparticles (CBD-PLGA-NPs). The CBD-PLGA-NPs exhibited a spherical morphology and an average diameter of 238 nm. CBD was sustained release from CBD-PLGA-NPs, which improved the bioavailability of CBD. Primary chondrocytes from rat pups were isolated, and LPS was used to induce in ammation in vitro to simulate osteoarthritis (OA). The CBD-PLGA-NPs effectively protect the damage of LPS to cell viability. What's more, according to the results of CCK-8 assay, hematoxylin-eosin staining, safranin O staining, immuno uorescence staining, and real-time polymerase chain reaction assay, we observed that CBD-PLGA-NPs signi cantly suppressed LPS-induced primary rat chondrocyte expression of in ammatory cytokines, including interleukin 1β (IL-1β), interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α) and matrix metalloproteinase 13 (MMP-13). Remarkably, CBD-PLGA-NPs also showed better therapeutic effects of inhibiting the degradation of the extracellular matrix of chondrocytes than equivalent CBD solution. In general, the fabrication CBD-PLGA-NPs showed good protection of primary chondrocytes in vitro and is a promising system for osteoarthritis treatment.Signi cance of the study Cannabidiol (CBD) is a non-intoxicating cannabinoid from cannabis sativa that has demonstrated e cacious against in ammation, which can be considered as a potential drug for arthritis treatment. In order to improve the poor solubility and low bioavailability of CBD, we described the development of simple and e cient CBD-loaded nanoparticles (CBD-PLGA-NPs) for treating LPS-induced primary chondrocytes of rat pups damaged. The fabricated CBD-PLGA-NPs could effectively enhance the chondroprotective effects of CBD by inhibiting the expression of in ammatory factors, increasing cellularity, and improving structural changes, which can be regarded as a potential system to treat OA.