Total knee arthroplasty (TKA) results in a high degree of patient satisfaction, as it provides patients with considerable medium- and long-term benefits in terms of quality of life, pain relief and function. Nevertheless, the literature reports that up to 30% of patients are dissatisfied. This dissatisfaction is directly related to the patients' quality of life, which they deem insufficient. Their quality of life depends on many physical, behavioural, social and psychological factors that are not taken into account by functional outcome scores. After describing the principles of quality of life evaluation after TKA, we will assess the effects of patient-related factors, the surgical technique and postoperative program through an exhaustive review of the literature. Patient expectations after TKA will then be outlined, particularly return to work and return to sports.

Quality of life after total knee arthroplasty.

We explored the literature surrounding whether allergy and hypersensitivity has a clinical basis for implant selection in total knee arthroplasty (TKA). In error, the terms hypersensitivity and allergy are often used synonymously. Although a relationship is present, we could not find any evidence of implant failure due to allergy. There is however increasing basic science that suggests a link between loosening and metal ion production. This is not an allergic response but is a potential problem. With a lack of evidence logically there can be no justification to use 'hypoallergenic' implants in patients who have pre-existing skin sensitivity to the metals used in TKA.

Allergy in total knee arthroplasty: a review of the facts.

Background and purpose — It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction to common metal allergens, and revision surgery in patients who underwent knee arthroplasty.Patients and methods — The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test database from the greater Copenhagen area (n = 27,020).Results — 327 patients were registered in both databases. The prevalence of contact allergy to nickel, chromium, and cobalt was comparable in patients with and without revision surgery. However, in patients with 2 or more episodes of revision surgery, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implan...

https://www.tandfonline.com/doi/pdf/10.3109/17453674.2014.999614

The association between metal allergy, total knee arthroplasty, and revision: study based on the Danish Knee Arthroplasty Register.

Background
There is little data on whether preexisting allergies to implant materials and bone cement have an impact on the outcome of TKA.

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Allergy in Total Knee Replacement. Does it Exist?: Review Article

The purpose of this study was to determine the prevalence of sensitisation to chromium, cobalt, nickel, or a cement component in patients who received endoprosthetic surgery at our institution. Also, we aimed to assess the portion related to allergic reactions in endoprosthetic revisions and to follow-up those patients after allergic reaction related revisions. We selected patients with a pre-operative known sensitisation to chromium, cobalt, nickel, or a cement component for a post-operative allergic reaction. All patients who received revision surgery because of a potential allergic reaction were followed up post revision surgery. Eight hundred fifty-five patients were pre-operative known to have a sensitisation to chromium, cobalt, nickel, or a cement component. Six hundred eighty-two patients (79.8 %) received a primary arthroplasty, and 173 patients (20.2 %) received a revision surgery. Seventeen patients (2.0 %) were revised because of allergic reactions. Allergic reactions were the cause for approximately 0.2 % of all endoprosthetic revisions and for 9.8 % of revisions in patients with sensitisation to one of the reviewed components. Potential allergens were strictly avoided in the replaced prosthesis. Outcome scores improved post-operatively. The allergic patient should be thoroughly informed about potential reactions resulting from implant choice. Our study can serve as risk assessments by quantifying the incidence of allergic reactions due to endoprosthetic treatment.

Allergic reactions in arthroplasty: myth or serious problem?

Purpose
A prospective study was conducted to detect whether a relationship exists between metal allergy and post-operative pain in total hip and knee arthroplasty patients. We postulated that to some extent a relationship does exist between them.

A prospective study concerning the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty

Esophageal squamous cell carcinoma (ESCC) is the most common type of esophageal cancer, and its development, growth, and invasiveness are regulated by the tumor microenvironment (TME). Insulin-like growth factor-binding protein-7 (IGFBP7), which is closely related to various tumors, transforming growth factor-β1 (TGFβ1), which is a key signal mediator in oncogenesis, α-smooth muscle actin (α-SMA), and collagen I are important components of the TME. IGFBP7 can upregulate the expression of TGFβ1 and activate the TGFβ1/SMAD signaling pathway, which leads to an increase in collagen I in hepatic stellate cells (HSCs). However, the contribution of IGFBP7 to TGFβ1 and the TME in the progression of ESCC remains unknown. In the present study, we investigated IGFBP7 expression and its effects on TGFβ1 and the TME in ESCC. A total of 45 patients were divided into three groups: early-tumor group (n=15), advanced-tumor group (n=15), and paracancer control group (n=15). The EC109 cell line was cultured and treated with AdIGFBP7 and LvshTGFβ1, and the expression levels of IGFBP7, TGFβ1, α-SMA, collagen I, and p-SMAD2/3 were determined by immunohistochemical staining and western blotting analysis. IGFBP7, TGFβ1, α-SMA, and collagen I were upregulated in the ESCC samples compared with the control samples (P<0.05), and the values peaked in the advanced-tumor group (P<0.05). Compared with the control group, the TGFβ1, α-SMA, p-SMAD2/3, and collagen I proteins were gradually increased from 24 to 72 h in the EC109 cells treated with AdIGFBP7 (P<0.05). Inhibition of TGFβ1 expression in the EC109 cells treated with AdIGFBP7 gradually reduced the expression of α-SMA, collagen I, and p-SMAD2/3 from 24 to 72 h (P<0.05). These findings suggest that increased IGFBP7 may accelerate the progression of ESCC by upregulating TGFβ1, α-SMA, and collagen I via activating the TGFβ1/SMAD signaling pathway, which could remodel the TME.

/pdf/igfbp7-remodels-the-tumor-microenvironment-of-esophageal-21cwaxkr.pdf

IGFBP7 remodels the tumor microenvironment of esophageal squamous cell carcinoma by activating the TGFβ1/SMAD signaling pathway

[This corrects the article DOI: 10.3892/ol.2022.13371.].

Chuntao Ma

Papers

A prospective study concerning the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty

IGFBP7 remodels the tumor microenvironment of esophageal squamous cell carcinoma by activating the TGFβ1/SMAD signaling pathway

IGFBP7 remodels the tumor microenvironment of esophageal squamous cell carcinoma by activating the TGFβ1/SMAD signaling pathway