Publications by authors named "William Xiang"

9 Publications

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Use of elevated liners in primary total hip arthroplasty: a systematic review of the literature.

Eur J Orthop Surg Traumatol 2021 May 29. Epub 2021 May 29.

Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10021, USA.

Purpose: Instability remains one of the most frequent complications requiring revision surgery after primary total hip arthroplasty (THA). Elevated liners are often utilized to reduce the risk of dislocation; however, the literature is inconclusive, with no systematic reviews summarizing the data. Thus, this systematic review aimed to establish a consensus for the efficacy of elevated liners in primary THA by determining rates of overall revision and revision specifically for recurrent dislocation.

Materials And Methods: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible randomized-controlled trials and observational studies reporting on the use of elevated liners in primary total hip arthroplasty were identified through May 2020. A random effects model meta-analysis was conducted, and the I statistic was used to assess for heterogeneity.

Results: Eight studies met inclusion criteria, and overall, 26,507 patients undergoing primary THA with use of an elevated liner were included. In aggregate, the most common cause of revision was recurrent hip dislocation (1.3%, N = 82/6,267) followed by joint infection (1.2%, N = 45/3,772) and acetabular loosening (0.3%, N = 10/3,772). Notably, elevated liners were associated with a lower risk of revision for recurrent dislocation compared to neutral liners (HR: 0.74; 95% CI: 0.55-1.00; p = 0.048).

Conclusion: This review found that after primary THA with the use of elevated liners, hip dislocation and prosthetic joint infection continued to be the most frequent reasons for revision surgery. However, elevated liners had a lower risk of revision for recurrent dislocation compared to neutral liners.
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http://dx.doi.org/10.1007/s00590-021-03023-yDOI Listing
May 2021

Total knee arthroplasty in dialysis patients: Is it safe? A systematic review of the literature.

J Orthop 2021 May-Jun;25:199-206. Epub 2021 May 14.

Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA.

Purpose: This systematic review characterizes the safety and efficacy of total knee arthroplasty (TKA) in end stage renal disease (ESRD) patients due to the unique challenges they face.

Results: The cumulative complication rate for 3684 patients on dialysis for ESRD after primary TKA was 25%(N = 925/3702), with incidence rates of 2.5%(N = 92/3702) for periprosthetic joint infection, 3.7%(N = 71/1895) for reoperations, and 2.5%(N = 90/3578) for mortality.

Conclusion: Patients on dialysis for ESRD face significant mortality rates after primary TKA, in addition to other major complications. Careful counseling regarding risks and benefits should be provided prior to TKA in this population.
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http://dx.doi.org/10.1016/j.jor.2021.05.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144102PMC
May 2021

High variability and lack of standardization in the evaluation of return to sport after ACL reconstruction: a systematic review.

Knee Surg Sports Traumatol Arthrosc 2021 May 12. Epub 2021 May 12.

Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA.

Purpose: Return to sport (RTS) after ACL reconstruction (ACLR) has been recognized as an important outcome, which is associated with success of the surgery. This study aimed to assess the methods used to determine return to sport after ACLR in the published literature, report on variability of methods and evaluate their strength in establishing accurate RTS data.

Methods: Electronic databases (PubMed, Cochrane Library and Embase) were searched via a defined search strategy with no limits, to identify relevant studies from January 2008 to December 2020 for inclusion in the review. Defined eligibility criteria included studies specifically measuring and reporting on return to sport after ACLR with a clear methodology. Each included study was assessed for the definition of successful RTS, successful return to pre-injury level of sport and for methods used to determine RTS.

Results: One hundred and seventy-one studies were included. Of the included studies, six studies (4%) were level of evidence 1 and seventy-two studies (42%) were level of evidence 4. Forty-one studies (24%) reported on return to a specific sport and 130 studies (76%) reported on return to multiple sports or general sport. Sixteen studies (9%) reported on RTS in the pediatric population, 36 (21%) in the adult population and 119 (70%) reported on a mixed-aged population. The most commonly used definition of successful RTS was return to the same sport (44 of 125 studies, 35%). The most common method used to determine RTS was a non-validated study-specific questionnaire (73 studies, 43%), which was administered in various ways to the patients. Time of RTS assessment was variable and ranged between 6 months and 27 years post-surgery.

Conclusion: This review demonstrates high variability in defining, evaluating and reporting RTS following ACLR. The findings of this study reveal low reliability and unproven validity of methods used to evaluate RTS and highlight the challenges in interpreting and using RTS data reported in literature.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-021-06594-9DOI Listing
May 2021

How Does Contact Length Impact Titanium Tapered Splined Stem Stability: A Biomechanical Matched Pair Cadaveric Study.

J Arthroplasty 2021 Apr 22. Epub 2021 Apr 22.

Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY.

Background: Titanium tapered stems (TTS) achieve fixation in the femoral diaphysis and are commonly used in revision total hip arthroplasty. The initial stability of a TTS is critical, but the minimum contact length needed and impact of implant-specific taper angles on axial stability are unknown. This biomechanical study was performed to better guide operative decision-making by addressing these clinical questions.

Methods: Two TTS with varying conical taper angles (2° spline taper vs 3.5° spline taper) were implanted in 9 right and left matched fresh human femora. The proximal femur was removed, and the remaining femoral diaphysis was prepared to allow for either a 2 cm (n = 6), 3 cm (n = 6), or 4 cm (n = 6) cortical contact length with each implanted stem. Stepwise axial load was then applied to a maximum of 2600N or until the femur fractured. Failure was defined as either subsidence >5 mm or femur fracture.

Results: All 6 femora with 2 cm of stem-cortical contact length failed axial testing, a significantly higher failure rate (P < .02) than the 4 out of 6 femora and all 6 femora that passed testing at 3 cm and 4 cm, respectively, which were not statistically different from each other (P = .12). Taper angle did not influence success rates, as each matched pair either succeeded or failed at the tested contact length.

Conclusion: 4 cm of cortical contact length with a TTS demonstrates reliable initial axial stability, while 2 cm is insufficient regardless of taper angle. For 3 cm of cortical contact, successful initial fixation can be achieved in most cases with both taper angle designs.
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http://dx.doi.org/10.1016/j.arth.2021.04.013DOI Listing
April 2021

Highly cross-linked polyethylene in primary total knee arthroplasty is associated with a lower rate of revision for aseptic loosening: a meta-analysis of 962,467 cases.

Arch Orthop Trauma Surg 2021 Apr 13. Epub 2021 Apr 13.

Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA.

Background: The evolution in total knee arthroplasty (TKA) includes the highly cross-linked polyethylene (HXLPE) which has been reported as an effective manner to reduce the wear of the polyethylene and the osteolysis. The purpose of the present study is to synthesize the results of comparative studies between HXLPE and conventional polyethylenes and determine their effect in primary TKA.

Methods: The US National Library of Medicine (PubMed/MEDLINE) and the Cochrane Database of Systematic Reviews were queried for publications utilizing the following keywords: "cross-linked", "polyethylene", "HXLPE", "conventional", "total knee arthroplasty", "TKA", "total knee replacement" and "TKR" combined with Boolean operators AND and OR.

Results: Ten studies met the inclusion criteria and were included in the present meta-analysis with 962,467 patients. No significant difference was found regarding the revision rate for any reason between the patients who received HXLPE and those with conventional liner (OR 0.67; 95% CI 0.39-1.18; I: 97.7%). In addition, there was no difference regarding the radiolucent lines between the two types of liners (OR 0.54; 95% CI 0.20-1.49; I: 69.4%). However, with data coming from seven studies enrolling a total of 411,543 patients, it was demonstrated that patients who received HXLPE were less likely to be revised due to aseptic loosening compared to the patients with conventional liners (OR 0.35; 95% CI 0.31-0.39; I: 0.0%).

Conclusion: The present meta-analysis showed that regarding the overall revision rate and radiographic outcomes there was no significant difference between the two types of liners. On the other hand, the significantly less revision rate due to loosening supports the routine continued use of HXLPE in primary TKA.
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http://dx.doi.org/10.1007/s00402-021-03887-zDOI Listing
April 2021

Heterotopic Ossification Negatively Influences Range of Motion After Revision Total Knee Arthroplasty.

J Arthroplasty 2021 Mar 11. Epub 2021 Mar 11.

Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York.

Background: The incidence of heterotopic ossification (HO) after total knee arthroplasty (TKA) varies and is of unclear clinical significance. This study aimed to identify the incidence of HO in patients undergoing revision TKA for either stiffness or aseptic loosening/instability and determine if the presence of HO is associated with inferior absolute range of motion (ROM) and ROM gains.

Methods: Eighty-seven patients were prospectively enrolled and separated into 2 cohorts to evaluate ROM after revision TKA (2017-2019). Group 1 (N = 40) patients were revised for stiffness, while group 2 (N = 47) patients were revised for either aseptic loosening or instability. Goniometer-measured ROM values were obtained preoperatively and at 6 weeks, 6 months, and 1 year postoperatively. Statistical analysis included a Fisher's exact test to assess for an association between preoperative HO and final ROM at 1 year after revision TKA.

Results: HO was identified on preoperative radiographs in 17 patients (20%). There was a significantly higher rate of preoperative HO in patients revised for stiffness compared to patients revised for instability or loosening (30% vs 11%; P = .03). Five cases of HO qualitatively identified as most clinically severe were associated with lower ROM at each time point compared to the remainder of HO cases in this study cohort (P < .02).

Conclusion: The presence of HO is greater in patients undergoing revision TKA for stiffness. Additionally, HO severity appears to have a major effect on preoperative and postoperative ROM trajectory. This information should help guide patient expectations and highlight the need for a comprehensive, standardized classification system for HO.
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http://dx.doi.org/10.1016/j.arth.2021.03.023DOI Listing
March 2021

Time interval affects physical activity scores: a comparison of the Marx Activity Rating Scale and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale.

Knee Surg Sports Traumatol Arthrosc 2020 Aug 19;28(8):2619-2625. Epub 2020 Feb 19.

Sports Medicine Institute, Hospital for Special Surgery, 541 E 71st St, New York, 10021, USA.

Purpose: The Marx Activity Rating Scale (Marx Scale) is a commonly used activity-related patient-reported outcome which evaluates the highest activity level within the last year, whereas the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) assesses highest activity level within the last month. This study aims to determine whether the different timeframes used for the common items of Marx Scale and HSS Pedi-FABS affect scores, and if so, to determine whether age or injury status affect this difference.

Methods: The Marx Scale and four analogous items on the HSS Pedi-FABS were administered in random order to patients being evaluated for knee injuries and in addition to healthy controls to enroll an uninjured comparison group. Responses to each question were scored from 0 to 4 for a maximum overall score of 16. Paired and independent-sample t tests were used to determine mean differences between groups.

Results: The final cohort included 88 participants of which 47% were children (ages 10-17) and 51% had a knee injury. All participants except for healthy adults scored significantly lower on the HSS Pedi-FABS than the Marx Scale (p < 0.05). On the HSS Pedi-FABS activity scale, healthy participants scored significantly higher than injured participants (p < 0.01), but there were no significant differences based on age. Conversely, on the Marx Scale, children scored higher than adults (p ≤ 0.001), but there were no significant differences based on injury.

Conclusion: Physical activity level differs when evaluated with the Marx Scale or the analogue part of HSS Pedi-FABS with timeframe being the only difference between the two. The lower scores on the HSS Pedi-FABS are likely due to seasonal changes in activity which do not affect the Marx Scale. HSS Pedi-FABS analyzes a shorter window and it is more likely to capture changes in physical activity due to a recent injury than the Marx Scale which is better suited for assessing general physical activity level unaffected by seasonality or recent injury. Understating the differences between these physical activity scales can better guide clinicians when using them and interpreting scores.

Level Of Evidence: II.
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http://dx.doi.org/10.1007/s00167-020-05895-9DOI Listing
August 2020

Dual regulation of decorin by androgen and Hedgehog signaling during prostate morphogenesis.

Dev Dyn 2018 05 19;247(5):679-685. Epub 2018 Feb 19.

University of Wisconsin Madison, Department of Urology, Madison, Wisconsin.

Background: Prostate ductal branching morphogenesis involves a complex spatiotemporal regulation of cellular proliferation and remodeling of the extracellular matrix (ECM) around the developing ducts. Decorin (Dcn) is a small leucine-rich proteoglycan known to sequester several growth factors and to act as a tumor suppressor in prostate cancer.

Results: Dcn expression in the developing prostate paralleled branching morphogenesis and was dynamically regulated by androgen and Hedgehog (Hh) signaling. DCN colocalized with collagen in the periductal stroma and acellular interstitium. Exogenous DCN decreased epithelial proliferation in ex vivo organ cultures of developing prostate, whereas genetic ablation of Dcn resulted in increased epithelial proliferation in the developing prostate.

Conclusions: Dcn expression and localization in the developing prostate is consistent with a primary role in organizing collagen around the developing ducts. Regulation of Dcn expression appears to be complex, involving both androgen and Hh signaling. The growth inhibitory effect of Dcn suggests a unique linkage between a structural proteoglycan and epithelial growth regulation. This may serve to coordinate two elements of the morphogenetic process: ductal growth and organization of the collagen matrix around the nascent duct. Developmental Dynamics 247:679-685, 2018. © 2018 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/dvdy.24619DOI Listing
May 2018

Retrograde double-labeling demonstrates convergent afferent innervation of the prostate and bladder.

Prostate 2016 Jun 4;76(8):767-75. Epub 2016 Mar 4.

Department of Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.

Background: Prostatic inflammation is a common histologic finding in men with lower urinary tract symptoms (LUTS). It has been postulated that prostatic inflammation could sensitize afferent neurons innervating the bladder and thereby produce changes in voiding behavior. In support of this, we demonstrate an anatomic basis for pelvic cross-talk involving the prostate and bladder.

Methods: Retrograde labeling was performed by an application of a neuro-tracer Fast Blue (FB) to one side of either the anterior prostate (AP), dorsal lateral prostate (DLP)/ventral prostate (VP), bladder, or seminal vesicle (SV).

Results: Examination of dorsal root ganglion (DRG) neuron labeling revealed shared afferent innervation of the prostate and bladder at spinal segments of T13, L1, L2, L6, and S1. Dual labeling was performed by an application of FB and 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyaine perchlorate (DiI) to the AP and bladder, respectively. We observed double-labeled DRG neurons at T13, L1, L2, L6, and S1--a finding that proves convergent innervation of prostate and bladder.

Conclusions: Our observations demonstrate the potential for neural cross-talk between the prostate and bladder and support a postulated mechanism that prostatic inflammation may induce hyper-sensitization of bladder afferents and produce irritative LUTS.
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http://dx.doi.org/10.1002/pros.23170DOI Listing
June 2016