Intraoperative femurofibular angle combined with tibiofibular angle measurement has fewer correction errors in open-wedge high tibial osteotomy

AIM

This study aimed to verify the accuracy of intraoperative femurofibular angle combined with tibiofibular angle (FFA-TFA) measurement and compare it with traditional alignment line methods in open-wedge high tibial osteotomy (OWHTO).

METHODS

A total of 174 knees of 122 patients undergoing OWHTO and using an alignment line or FFA-TFA measurement as an index of optimal correction were included in this retrospective study. The intraoperative alignment line passed through the targeted weight-bearing line (WBL) of the tibial plateau in the alignment line group. The intraoperative FFA-TFA aligned to the preplanned FFA-TFA angle in the FFA-TFA group. WBL, FFA, TFA, and knee joint-line convergence angle of the femur and tibia were assessed as radiological results preoperatively and one year after surgery. The Knee Society Score and the Western Ontario and McMaster Universities were assessed as objective clinical results.

RESULTS

Postoperative WBL in the FFA-TFA group was closer to the target WBL than in the alignment line group (FFA-TFA vs alignment line group: 1.43 ± 1.20% vs 3.82 ± 3.29%; P < 0.001). The FFA-TFA group had fewer over-correction and under-correction rates than the alignment line group (28.7% and 12.6% vs 11.5% and 3.40%; P < 0.001). No significant differences were observed in the clinical results between the two groups one year after surgery (P > 0.05).

CONCLUSIONS

The intraoperative measurement of FFA-TFA had fewer complications in terms of under-correction and over-correction compared with the alignment line measurement. No significant differences between the two methods were observed in clinical results one year after surgery.

Lead exposure induced lipid metabolism disorders by regulating the lipophagy process in microglia

Environmental lead (Pb) pollution is a worldwide public health problem and causes various diseases, especially neurodegenerative diseases. It is increasingly recognized that microglia-mediated neuroinflammation plays a crucial role in lead neurotoxicity, but the underlying mechanisms remain to be further explored. Recent studies indicated that cell metabolism, especially lipid metabolism, regulates many microglial functions, including cytokine secretion and phagocytosis. Whether lipid metabolism is involved in Pb-induced neuroinflammation is still unknown. In the current studies, we investigated the effects of Pb on microglial lipid metabolism by utilizing lipidomics. Histochemistry staining and oxygen consumption rate (OCR) were used to validate lipidomics results. Fenofibrate (FEN), a peroxisome proliferator-activated receptor-α (PPAR-α) agonist, was applied to investigate whether lipid metabolism regulation mitigated Pb's neuroinflammatory response. Microglial autophagic proteins were detected to investigate the role of lipophagy in Pb's effect on lipid metabolism. Our results showed that Pb exposure increased concentrations of various lipid metabolites and induced lipid metabolism disorders, especially in fatty acid metabolism. Pb caused lipid droplet (LD) accumulation and slightly enhanced fatty acid oxidation (FAO) in microglia. FEN pretreatment markedly inhibited Pb's effects on LDs and further mitigated Pb-induced inflammatory response by reducing pro-cytokines' expression and enhancing phagocytosis function. FEN intervention also inhibited Pb's neurotoxicity by improving cognition-related behaviors. Pb exposure induced an abnormal increase of autophagic proteins, but the FEN addition partially neutralized Pb's effects on autophagy. Our data indicate that the Pb-induced neuroinflammation is regulated by fatty acid metabolism via the lipophagy process. Therapies focusing on lipid metabolism regulation are powerful tactics in Pb toxicity prevention and treatment.