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A comparison of low-dose teicoplanin-loaded spacer application vs. high-dose vancomycin-and-gentamicin-loaded spacer application in the treatment of periprosthetic knee infection. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221082312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background/purpose In the current study, our aim was to compare the efficacy and biocompatibility of teicoplanin-loaded and vancomycin-and-gentamicin-loaded articulating spacers used in two-stage revision arthroplasty for eradication of periprosthetic knee joint infection. Methods In the current retrospective cohort study, there were 24 patients who were given 2 g or less antibiotics per 40 g of cement in the low-dose teicoplanin group, and 20 patients who were given a total of 3.6 g or more antibiotics per 40 g of cement in the high-dose vancomycin and gentamicin group. Two groups were compared statistically. Results There was no statistically significant difference in the treatment failure between the two groups (p = 0.488). No statistically significant differences were found in spacer fracture rates between the two groups (p = 0.802). Conclusion The current study has demonstrated that low-dose teicoplanin protocol is as effective and safe as high-dose vancomycin and gentamycin protocol.
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Goetz J, Keyssner V, Hanses F, Greimel F, Leiß F, Schwarz T, Springorum HR, Grifka J, Schaumburger J. Animal experimental investigation on the efficacy of antibiotic therapy with linezolid, vancomycin, cotrimoxazole, and rifampin in treatment of periprosthetic knee joint infections by MRSA. Bone Joint Res 2022; 11:143-151. [PMID: 35227086 PMCID: PMC8962855 DOI: 10.1302/2046-3758.113.bjr-2021-0268.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims Periprosthetic joint infections (PJIs) are rare, but represent a great burden for the patient. In addition, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) is increasing. The aim of this rat experiment was therefore to compare the antibiotics commonly used in the treatment of PJIs caused by MRSA. Methods For this purpose, sterilized steel implants were implanted into the femur of 77 rats. The metal devices were inoculated with suspensions of two different MRSA strains. The animals were divided into groups and treated with vancomycin, linezolid, cotrimoxazole, or rifampin as monotherapy, or with combination of antibiotics over a period of 14 days. After a two-day antibiotic-free interval, the implant was explanted, and bone, muscle, and periarticular tissue were microbiologically analyzed. Results Vancomycin and linezolid were able to significantly (p < 0.05) reduce the MRSA bacterial count at implants. No significant effect was found at the bone. Rifampin was the only monotherapy that significantly reduced the bacterial count on implant and bone. The combination with vancomycin or linezolid showed significant efficacy. Treatment with cotrimoxazole alone did not achieve a significant bacterial count reduction. The combination of linezolid plus rifampin was significantly more effective on implant and bone than the control group in both trials. Conclusion Although rifampicin is effective as a monotherapy, it should not be used because of the high rate of resistance development. Our animal experiments showed the great importance of combination antibiotic therapies. In the future, investigations with higher case numbers, varied bacterial concentrations, and changes in individual drug dosages will be necessary to be able to draw an exact comparison, possibly within a clinical trial. Cite this article: Bone Joint Res 2022;11(3):143–151.
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Affiliation(s)
- Julia Goetz
- Department of Orthopaedic Surgery, University Hospital Regensburg - Asklepios Bad Abbach, Regensburg, Germany
| | - Verena Keyssner
- Department of Orthopaedic Surgery, University Hospital Regensburg - Asklepios Bad Abbach, Regensburg, Germany
| | - Frank Hanses
- Department of Infectology, University Hospital Regensburg, Regensburg, Germany
| | - Felix Greimel
- Department of Orthopaedic Surgery, University Hospital Regensburg - Asklepios Bad Abbach, Regensburg, Germany
| | - Franziska Leiß
- Department of Orthopaedic Surgery, University Hospital Regensburg - Asklepios Bad Abbach, Regensburg, Germany
| | - Timo Schwarz
- Department of Orthopaedic Surgery, University Hospital Regensburg - Asklepios Bad Abbach, Regensburg, Germany
| | - Hans-Robert Springorum
- Department of Orthopaedic Surgery, University Hospital Regensburg - Asklepios Bad Abbach, Regensburg, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, University Hospital Regensburg - Asklepios Bad Abbach, Regensburg, Germany
| | - Jens Schaumburger
- Department of Orthopaedic Surgery, University Hospital Regensburg - Asklepios Bad Abbach, Regensburg, Germany
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Fang X, Wang Q, Yang X, Zhang F, Huang C, Huang Z, Shen H, Zhang W. What is the appropriate extended duration of antibiotic prophylaxis after two-stage revision for chronic PJI? Bone Joint Res 2021; 10:790-796. [PMID: 34894718 PMCID: PMC8696522 DOI: 10.1302/2046-3758.1012.bjr-2021-0225.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims To explore the effect of different durations of antibiotics after stage II reimplantation on the prognosis of two-stage revision for chronic periprosthetic joint infection (PJI). Methods This study involved a retrospective collection of patients who underwent two-stage revision for chronic PJI and continued to use extended antibiotic prophylaxis in two regional medical centres from January 2010 to June 2018. The patients were divided into a short (≤ one month) or a long (> one month) course of treatment based on the duration of antibiotics following stage II reimplantation. The difference in the infection control rate between the two groups was compared, and prognostic factors for recurrence were analyzed. Results A total of 105 patients with chronic PJI were enrolled: 64 patients in the short course group and 41 patients in the long course group. For 99 of the patients, the infection was under control during a follow-up period of at least 24 months after two-stage revision. For the short course group, the mean duration of antibiotic prophylaxis after stage II reimplantation was 20.17 days (SD 5.30) and the infection control rate was 95.3%; for the long course group these were 45.02 days (SD 15.03) and 92.7%, respectively. There was no significant difference in infection control rates between the two groups (p = 0.676). Cox regression analysis found that methicillin-resistant staphylococcus infection (p = 0.015) was an independent prognostic factor for recurrence. Conclusion After stage II reimplantation surgery of two-stage revision for chronic PJI, extended antibiotic prophylaxis for less than one month can achieve good infection control rate. Cite this article: Bone Joint Res 2021;10(12):790–796.
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Affiliation(s)
- Xinyu Fang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qiaojie Wang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Xurong Yang
- Department of Orthopaedic Surgery, Jiangle County General Hospital, Sanming, China
| | - Feiyang Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Changyu Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zida Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Hao Shen
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Wenming Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Wang LH, Feng YD, Zhang XW, Jin L, Zhou FL, Xu GH. Elution and Biomechanical Properties of Meropenem-Loaded Bone Cement. Orthop Surg 2021; 13:2417-2422. [PMID: 34734478 PMCID: PMC8654665 DOI: 10.1111/os.13139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/13/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate the biomechanical and elution properties of meropenem‐loaded bone cement. Methods Bone cement (Palacos LV) with 5% (2 g/4 0g), 10% (4 g/40 g), and 15% (6 g/40 g) meropenem; 5% (2 g/40 g) and 10% (4 g/40 g) vancomycin; and blank bone cement were prepared in a total of six groups named A2, A4, A6, B2, B4, and A0 (antibiotic‐free). 36 cylinder specimens (6‐mm diameter and 12‐mm height) of all six groups were molded for a compression test. After the compression test, because of mechanical properties below the ISO standard requirements, groups B2, B4 were not subjected to a bending test. So a total of 24 rectangular strip specimens (10‐mm width, 75‐mm length, and 3.3‐mm thickness) for groups A2, A4, A6 and A0 were molded for the bending test. Between‐group differences of compressive strength, bending strength and bending modulus were analyzed. The meropenem standard was prepared as a series of standard solutions to calculate the standard curve. At a constant temperature of 37 °C, separately, meropenem‐loaded bone cement cylinder specimens (12 mm in diameter and 17 mm in length) of A2, A4 and A6 were serially immersed in saline solution without stirring. The eluent drug concentration at 24, 48, 72 h and 6, 12, 24 days was measured and the drug concentration‐time curve of meropenem was constructed. Results With the exception of groups B2 and B4, all cements compressive strength values were well above the minimum requirement of the ISO 5833 standard (70 MPa). The compressive strength and bending strength values of group A4 were higher than those of group A0 (P < 0.05), but no difference was found between the A0, A2 and A6 groups (P > 0.05). There were no intergroup differences of bending modulus between the A0, A2, A4 and A6 groups (P > 0.05). A standard curve of meropenem was obtained and a regression equation was constructed: Y = 15.0265 X + 13.5218, r = 1.00. At 37 °C, the release of meropenem was rapid during the first 48 h for all A2, A4, A6 samples, and subsequent release continued to decrease. Conclusion When adding up to 15% (6 g/40 g) meropenem to the bone cement, the biomechanical properties were not reduced, and bone cement with 10% (4 g/40 g) meropenem had the best performance. At a constant temperature of 37°C, meropenem can be released from bone cement for up to 24 days.
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Affiliation(s)
- Li-Hong Wang
- Department of Orthopaedics, Dongyang People's Hospital, Wenzhou Medical University, Dongyang, China
| | - Ya-Dong Feng
- Department of Orthopaedics, Dongyang People's Hospital, Wenzhou Medical University, Dongyang, China
| | - Xiao-Wei Zhang
- Department of Pathology, Dongyang People's Hospital, Wenzhou Medical University, Dongyang, China
| | - Long Jin
- Department of Pharmacy, Dongyang People's Hospital, Wenzhou Medical University, Dongyang, China
| | - Fang-Lun Zhou
- Department of Orthopaedics, Dongyang People's Hospital, Wenzhou Medical University, Dongyang, China
| | - Guo-Hong Xu
- Department of Orthopaedics, Dongyang People's Hospital, Wenzhou Medical University, Dongyang, China
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Cephalomedullary Nail as a Definitive Antibiotic Spacer for Multidrug Resistant Periprosthetic Infection of a Proximal Femoral Endoprosthesis. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Shao-Ting Jerry Tsang
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK.,Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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Ramalhete R, Brown R, Blunn G, Skinner J, Coathup M, Graney I, Sanghani-Kerai A. A novel antimicrobial coating to prevent periprosthetic joint infection. Bone Joint Res 2020; 9:848-856. [PMID: 33275031 PMCID: PMC9021900 DOI: 10.1302/2046-3758.912.bjr-2020-0157.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aims Periprosthetic joint infection (PJI) is a debilitating condition with a substantial socioeconomic burden. A novel autologous blood glue (ABG) has been developed, which can be prepared during surgery and sprayed onto prostheses at the time of implantation. The ABG can potentially provide an antimicrobial coating which will be effective in preventing PJI, not only by providing a physical barrier but also by eluting a well-known antibiotic. Hence, this study aimed to assess the antimicrobial effectiveness of ABG when impregnated with gentamicin and stem cells. Methods Gentamicin elution from the ABG matrix was analyzed and quantified in a time-dependent manner. The combined efficiency of gentamicin and ABG as an anti-biofilm coating was investigated on titanium disks. Results ABG-gentamicin was bactericidal from 10 μg/ml and could release bactericidal concentrations over seven days, preventing biofilm formation. A concentration of 75 μg/ml of gentamicin in ABG showed the highest bactericidal effect up to day 7. On titanium disks, a significant bacterial reduction on ABG-gentamicin coated disks was observed when compared to both uncoated (mean 2-log reduction) and ABG-coated (mean 3-log reduction) disks, at days 3 and 7. ABG alone exhibited no antimicrobial or anti-biofilm properties. However, a concentration of 75 μg/ml gentamicin in ABG sustains release over seven days and significantly reduced biofilm formation. Its use as an implant coating in patients with a high risk of infection may prevent bacterial adhesion perioperatively and in the early postoperative period. Conclusion ABG’s use as a carrier for stem cells was effective, as it supported cell growth. It has the potential to co-deliver compatible cells, drugs, and growth factors. However, ABG-gentamicin’s potential needs to be further justified using in vivo studies. Cite this article: Bone Joint Res 2020;9(12):848–856.
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Affiliation(s)
- Rita Ramalhete
- Institute of Orthopaedics and Musculoskeletal Science, Department of Materials & Tissue, University College London, London, UK
| | - Robyn Brown
- Institute of Orthopaedics and Musculoskeletal Science, Department of Materials & Tissue, University College London, London, UK
| | - Gordon Blunn
- Institute of Orthopaedics and Musculoskeletal Science, Department of Materials & Tissue, University College London, London, UK.,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - John Skinner
- Institute of Orthopaedics and Musculoskeletal Science, Department of Materials & Tissue, University College London, London, UK
| | - Melanie Coathup
- Institute of Orthopaedics and Musculoskeletal Science, Department of Materials & Tissue, University College London, London, UK.,College of Medicine, University of Central Florida, Orlando, Florida, USA
| | | | - Anita Sanghani-Kerai
- Institute of Orthopaedics and Musculoskeletal Science, Department of Materials & Tissue, University College London, London, UK
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Tsang STJ, Eyre DW, Atkins BL, Simpson AHRW. Should modern molecular testing be routinely available for the diagnosis of musculoskeletal infection? Bone Joint J 2020; 102-B:1274-1276. [DOI: 10.1302/0301-620x.102b10.bjj-2020-1496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- S-T. Jerry Tsang
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David W. Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Bridget L. Atkins
- Bone Infection Unit, Nuffield Orthopaedic Hospital, Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Zamora T, Garbuz DS, Greidanus NV, Masri BA. An articulated spacer made of new primary implants in two-stage exchange for infected total knee arthroplasty may provide durable results. Bone Joint J 2020; 102-B:852-860. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1443.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Our objective is to describe our early and mid-term results with the use of a new simple primary knee prosthesis as an articulating spacer in planned two-stage management for infected knee arthroplasty. As a second objective, we compared outcomes between the group with a retained first stage and those with a complete two-stage revision. Methods We included 47 patients (48 knees) with positive criteria for infection, with a minimum two-year follow-up, in which a two-stage approach with an articulating spacer with new implants was used. Patients with infection control, and a stable and functional knee were allowed to retain the initial first-stage components. Outcomes recorded included: infection control rate, reoperations, final range of motion (ROM), and quality of life assessment (QoL) including Western Ontario and McMaster Universities osteoarthritis index, Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score, 12-Item Short-Form Health Survey questionnaire, and University of California Los Angeles (UCLA) activity score and satisfaction score. These outcomes were evaluated and compared to additional cohorts of patients with retained first-stage interventions and those with a complete two-stage revision. Mean follow-up was 3.7 years (2.0 to 6.5). Results Eight knees failed directly related to lack of infection control (16%), and two patients (two knees) died within the first year for causes not directly related, giving an initial success rate of 79% (38/48). Secondary success rate after a subsequent procedure was 91% (44/48 knees). From the initially retained spacers, four knees (22%) required a second-stage revision for continuous symptoms and one (5%) for an acute infection. There were no significant differences regarding the failure rate due to infection, ROM, and QoL assessment between patients with a retained first-stage procedure and those who underwent a second-stage operation. Conclusion Our protocol of two-stage exchange for infected knee arthroplasties with an articulating spacer and using new primary knee implants achieves adequate infection control. Retained first-stage operations achieve comparable results in selected cases, with no difference in infection control, ROM, and QoL assessment in comparison to patients with completed two-stage revision surgery. Cite this article: Bone Joint J 2020;102-B(7):852–860.
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Affiliation(s)
- Tomas Zamora
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Donald S. Garbuz
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Nelson V. Greidanus
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Bassam A. Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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Chang Y, Hsiao YM, Hu CC, Chang CH, Li CY, Ueng SWN, Chen MF. Synovial Fluid Interleukin-16 Contributes to Osteoclast Activation and Bone Loss through the JNK/NFATc1 Signaling Cascade in Patients with Periprosthetic Joint Infection. Int J Mol Sci 2020; 21:ijms21082904. [PMID: 32326301 PMCID: PMC7215706 DOI: 10.3390/ijms21082904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022] Open
Abstract
Because of lipopolysaccharide (LPS)-mediated effects on osteoclast differentiation and bone loss, periprosthetic joint infection (PJI) caused by Gram-negative bacteria increases the risk of aseptic loosening after reimplantation. Synovial fluid interleukin-16 (IL-16) expression was higher in patients with PJI than in patients without joint infection. Thus, we explored the effects of IL-16 on bone. We investigated whether IL-16 modulates osteoclast or osteoblast differentiation in vitro. An LPS-induced bone loss mice model was used to explore the possible advantages of IL-16 inhibition for the prevention of bone loss. IL-16 directly activated p38 and c-Jun N-terminal kinase (JNK)/mitogen-activated protein kinase (MAPK) signaling and increased osteoclast activation markers, including tartrate-resistant acid phosphatase (TRAP), cathepsin K, and nuclear factor of activated T cells 1 (NFATc1). IL-16 directly caused monocytes to differentiate into TRAP-positive osteoclast-like cells through NFATc1 activation dependent on JNK/MAPK signaling. Moreover, IL-16 did not alter alkaline phosphatase activity or calcium deposition during osteoblastic differentiation. Finally, IL-16 inhibition prevented LPS-induced trabecular bone loss and osteoclast activation in vivo. IL-16 directly increased osteoclast activation through the JNK/NFATc1 pathway. IL-16 inhibition could represent a new strategy for treating infection-associated bone loss.
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Affiliation(s)
- Yuhan Chang
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (Y.C.); (C.-C.H.); (C.-H.C.); (C.-Y.L.); (S.W.N.U.)
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Yi-min Hsiao
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (Y.C.); (C.-C.H.); (C.-H.C.); (C.-Y.L.); (S.W.N.U.)
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chih-Chien Hu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (Y.C.); (C.-C.H.); (C.-H.C.); (C.-Y.L.); (S.W.N.U.)
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chih-Hsiang Chang
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (Y.C.); (C.-C.H.); (C.-H.C.); (C.-Y.L.); (S.W.N.U.)
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Cai-Yan Li
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (Y.C.); (C.-C.H.); (C.-H.C.); (C.-Y.L.); (S.W.N.U.)
| | - Steve W. N. Ueng
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (Y.C.); (C.-C.H.); (C.-H.C.); (C.-Y.L.); (S.W.N.U.)
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Mei-Feng Chen
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (Y.C.); (C.-C.H.); (C.-H.C.); (C.-Y.L.); (S.W.N.U.)
- Correspondence:
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