Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis

Bone Health in Women

Bone health is critical to overall health and quality of life. Although genetic factors play a key role in bone formation, there are several external factors that can be modified to preserve bone health. Diet, exercise, menstrual irregularities, medications, disease states, weight, and environmental factors can all affect fracture risk. Osteoporosis is characterized by decrease in bone mass and microarchitectural changes in the bone that increases fracture risk. Screening for osteoporosis may help facilitate treatment before fractures occur. Preventing fractures needs patient and physician understanding of bone health to improve and requires a team effort.

Identifying and managing non-complex fractures

Helen Chilvers, Senior Lecturer in Nursing, University of Lincoln, HChilvers@lincoln.ac.uk , emphasises the importance of understanding the bone-healing process and describes the care of patients with bony injuries.

From the Clinical Problem to the Basic Research-Co-Culture Models of Osteoblasts and Osteoclasts

Bone tissue undergoes constant remodeling and healing when fracture happens, in order to ensure its structural integrity. In order to better understand open biological and clinical questions linked to various bone diseases, bone cell co-culture technology is believed to shed some light into the dark. Osteoblasts/osteocytes and osteoclasts dominate the metabolism of bone by a multitude of connections. Therefore, it is widely accepted that a constant improvement of co-culture models with both cell types cultured on a 3D scaffold, is aimed to mimic an in vivo environment as closely as possible. Although in recent years a considerable knowledge of bone co-culture models has been accumulated, there are still many open questions. We here try to summarize the actual knowledge and address open questions.

Concise Review: The Deleterious Effects of Cigarette Smoking and Nicotine Usage and Mesenchymal Stem Cell Function and Implications for Cell-Based Therapies

Stem cell sources for cell‐based therapeutics are often screened for infectious agents and genetic diseases prior to implantation; however, there are other risk factors that are often overlooked, which may ultimately lead to less efficacious clinical outcomes. One such risk factor is exposure of mesenchymal stem cells (MSCs) to cigarette smoke or nicotine. Recent data have shown that exposure to cigarette smoke or nicotine leads to decreased regenerative potential, namely decreased proliferation, decreased migration, and decreased differentiation potential of exposed MSCs. This review provides a brief introduction into MSCs and their respective niches and a summary regarding the interactions of cigarettes and nicotine with MSCs populations. Specifically, the effects of cigarette smoke and nicotine on the regenerative potential of MSCs (i.e., proliferation, migration, and differentiation) will be covered with an emphasis on considerations for the development of future cell‐based clinical trials and therapies. stemcellstranslationalmedicine2017;6:1815–1821

Survivorship of medial opening wedge high tibial osteotomy in the elderly: two to ten years of follow up

BACKGROUND AND PURPOSE

Medial opening wedge high tibial osteotomy (MOWHTO) is a well-accepted procedure, which has been widely used for pain relief and varus deformity correction in the osteoarthritic (OA) knee, especially in the young patient. However, in the elderly patient, the efficacy of this procedure is still unknown. Therefore, this study aims to evaluate the survivorship of MOWHTO in elderly patients as the primary outcome. The secondary outcome is to evaluate the loss of correction angle that is the common complication after MOWTHO.

MATERIALS AND METHOD

A retrospective study of 50 elderly patients (≥ 60 years) was conducted to track survivorship of MOWHTO. All patients were diagnosed with varus OA knee and underwent MOWHTO at our institute. The patients who had previous knee surgery or incomplete data were excluded. Medical records and radiographs of eligible patients were reviewed for recruiting the data. Survivorship of MOWHTO was analyzed using Kaplan-Meier curves. The starting point was the time of operation and the end point was the time of subsequent TKA. The loss of correction angle was defined as the change of medial proximal tibial angle (MPTA) between three months and one year post-operatively.

RESULTS

The mean age of patients was 66 ± 5.0 years. The majority of patients were female (74%). The mean correction angle was 10.6 ± 3.6 degrees. The union rate of osteotomy site was 100%. In survival analysis, the median follow-up time was 6.0 ± 3.0 years. Two patients required subsequent conversions to TKA. The survivorship of MOWHTO at four years was 95.5% (95%CI, 96.0 to 98.0). For radiographic assessment, the loss of correction angle was 1.0 ± 0.5 degrees at one year post-operatively.

CONCLUSION

This study proved that MOWHTO in patient ≥60 years had good mid-term survivorship with acceptable complications. This procedure can be the alternative option for the treatment of varus OA knee in the elderly.