Efficacy of Platelet-Rich Plasma Versus Placebo for the Treatment of Greater Trochanteric Pain Syndrome: A Double-Blinded Randomized Controlled Trial

BACKGROUND

Greater trochanteric pain syndrome (GTPS) is a painful condition that can impair a patient's quality of life. If nonoperative measures fail, progressively more invasive treatment options may be required. This clinical trial aimed to evaluate the effectiveness of ultrasound-guided leukocyte-rich platelet-rich plasma (LR-PRP) injections in the treatment of refractory GTPS caused by bursitis and/or gluteal tendinopathy.

METHODS

An ethically approved, adequately powered, double-blinded randomized controlled trial (RCT) was conducted to evaluate the clinical outcomes in randomized LR-PRP and placebo groups using the International Hip Outcome Tool-12 (iHOT-12), a visual analogue scale (VAS) for pain, the modified Harris hip score (mHHS), the EuroQol 5-Dimensions (EQ-5D) questionnaire, and the presence or absence of complications. All injections were performed under ultrasound guidance into the trochanteric bursa and gluteus medius tendon.

RESULTS

The final analysis included 79 patients (39 in the LR-PRP and 40 in the placebo group; 73 female and 6 male; all Caucasian). Both the LR-PRP and the placebo group generally had improvement from baseline that was maintained to 12 months. The only deterioration in scores compared to baseline was seen in the LR-PRP group for the iHOT-12 at 12 months, the EQ-5D index at 3 and 6 months, and the EQ-5D VAS at all follow-up time points. However, there was no significant difference between the 2 groups at any follow-up point (p > 0.05). A multivariable linear regression model, with adjustment for age, sex, body mass index, and preoperative baseline score, did not reveal any significant associations between iHOT-12 and EQ-5D score gains at 12 months and treatment.

CONCLUSIONS

This randomized trial found no significant difference in outcomes between LR-PRP and placebo for the treatment of greater trochanteric pain up to 6 months following the intervention. As a result, we do not support the routine use of PRP for the treatment of this condition.

LEVEL OF EVIDENCE

Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Evaluation of Functional Outcomes, Survivorship and Complications of Hypoallergenic Fixed-Bearing Medial and Lateral Unicompartmental Knee Arthroplasty: A Minimum 2-Year Follow-Up

Background: Unicompartmental knee arthroplasty (UKA) is a viable treatment option for patients with isolated knee osteoarthritis. This study evaluated the clinical outcomes of the JII UK (Smith & Nephew, Memphis, TN, USA) hypoallergenic, fixed-bearing UKA implant in a medium cohort of patients undergoing both medial and lateral procedures with a short-term follow-up. Methods: A retrospective review was conducted on 257 consecutive patients who underwent primary UKA using the JII UK implant between December 2020 and December 2022. Clinical outcomes were assessed using the Knee Society Score (KSS), Knee Society Function Score (KSFS), Oxford Knee Score (OKS), UCLA Activity Score, Forgotten Joint Score (FJS-12), and satisfaction. Survivorship analysis was performed, and complications were recorded. Results: At the 2-year follow-up, the implant survival rate was 99.61%. Statistical significant improvements were observed in all clinical scores, with high patient satisfaction. The mean UCLA Activity Score increased from 4.53 preoperatively to 7.3 at 24 months. Conclusions: This study demonstrates promising short-term clinical outcomes for the hypoallergenic fixed-bearing medial and lateral UKA implant, with high patient satisfaction and a low complication rate. Further studies with longer follow-up periods are warranted to confirm these findings.

Healthcare metaverse in surgery: scoping review

BACKGROUND

The metaverse is an emerging concept in surgery, with much interest in its highly immersive and interactive virtual environment. Despite the growing interest and importance in healthcare, the metaverse is still very much in its early phase of evolution and adoption in surgery, with debate on its definition and components. This scoping review provides a summary of the evidence and current understanding for the use of the metaverse in surgery.

METHODS

Embase and MEDLINE were searched using scoping review methodology with a systematic search strategy, identifying any study examining the role of the metaverse in surgery without time limitation. After data extraction, a narrative synthesis was conducted to identify the components of the metaverse employed within surgery and the domains in which they were applied.

RESULTS

Of 97 articles found through the initial search, 15 studies were eligible for inclusion. Most of the studies were expert opinion pieces (46.6%), urology was the most common specialty (33.3%), and all studies were published after 2020. Studies were widely heterogeneous in study design and outcomes varied. The surgical metaverse was used across four main domains: education (53%), training (80%), operations (67%), and surgical care (53%).

CONCLUSION

Surgery is rapidly moving towards the age of the metaverse. There is great potential; however, evidence is lacking on its effectiveness and there are risks associated with its implementation. Institutions must learn how to understand and safely adopt the metaverse into their domains of education, training, operations, and surgical care.

Balancing form and function: A single-center review of autologous vs. synthetic grafts in cranioplasty

BACKGROUND

Cranioplasty is performed to restore cranial integrity following decompressive hemicraniectomy, with both autologous bone grafts (ABGs) and synthetic grafts (SGs) serving as reconstructive options. While previous studies have examined clinical outcomes, there is a lack of robust data comparing aesthetic outcomes and complication rates between ABGs and SGs. This study evaluates these parameters to guide optimal graft selection.

METHOD

A single-center retrospective review was conducted on patients who underwent cranioplasty with either ABGs or SGs between January 2017 and November 2023. Patient demographics, perioperative variables, and postoperative complications were collected. Aesthetic outcomes were assessed using axial CT scans to measure frontal and parietal asymmetry. Statistical analyses included univariate and multivariate comparisons, adjusting for potential confounders such as age, cerebrovascular accident (CVA) history, hypertension (HTN), atrial fibrillation (AFib), ventriculoperitoneal (VP) shunt status, and insurance type.

RESULTS

Among 200 patients, 82 (41.0%) received ABGs, and 118 (59.0%) received SGs. Frontal and parietal asymmetry scores did not significantly differ between groups (p = 0.321, p = 0.348). Median time to cranioplasty was shorter for ABGs than SGs (106.5 vs. 117 days; p = 0.038). Postoperative complications were significantly higher in the SG group compared to ABGs (30.5% vs. 9.8%; p = 0.001), with infections being more frequent in SGs (p = 0.048). SGs were also associated with a higher rate of revision surgeries.

CONCLUSIONS

ABGs and SGs provide comparable aesthetic outcomes, but SGs carry a significantly higher risk of complications and revisions. Given its lower complication rates and cost-effectiveness, ABGs should be prioritized when feasible. However, SGs remain a viable option in cases where autologous bone is unavailable or contraindicated. Future studies should focus on long-term follow-up and patient-reported outcomes to further refine cranioplasty decision-making.

The Role of Temperature on Inflammation and Coagulation: Should We Apply Temperature Treatments for Hemophilic Arthropathy?

Hemophilic arthropathy (HA) is a complication of hemophilia, which is a genetic disorder characterized by a deficiency in blood clotting factors. HA is characterized by joint damage with inflammatory responses, pain, and movement limitations due to recurrent bleeding in the joints. The inflammatory reactions contribute to the activation of coagulation factors, which can exacerbate bleeding and further damage the affected joints. Therefore, the interaction between inflammation and coagulation plays a crucial role in the progression and complications of HA. Management strategies often focus both on inflammation and coagulation to alleviate symptoms and preserve joint function. Temperature can influence the inflammatory response and coagulation. The aim of this work was to understand how temperature management can positively or negatively influence the HA. We have carried out a narrative review of the available literature. This review explores the impacts of temperature on biological processes, and it discusses the possible clinical implications for the HA treatment. Our research shows that cold exposure has anti-inflammatory and analgesic effects, while heat is linked to pro-inflammatory cytokine release. Both hot and cold treatments are ill-advised for hemophilia patients. Heat stimulates neo-angiogenesis, and cold hampers coagulation, posing risks for increased bleeding in individuals with hemophilia.

Total Knee Replacement Versus Osteosynthesis as Primary Treatment in Older Patients with Tibial Plateau Fracture

Introduction

The treatment of tibial plateau fractures is a challenge in the elderly population due to osteoporosis and associated comorbidities. The choice between open reduction and internal fixation (ORIF) and total knee replacement (TKR) is controversial. The aim of this study is to compare functional outcomes between TKR and ORIF in elderly patients with tibial plateau fractures.

Materials and Methods

A retrospective observational study was conducted on 27 elderly patients with Schatzker type II, III, or IV tibial plateau fractures treated between January 2018 and December 2022, with prior history of osteoporosis or gonarthrosis. 14 patients underwent treatment with TKR, while 15 patients underwent ORIF. Demographic data, pre-operative characteristics, surgical details, post-operative evolution, and functional outcomes were collected and analyzed.

Results

The TKR group consisted mostly of women (92.9%) with a mean age of 76 years, while the ORIF group had a mean age of 68 years. Both groups had similar comorbidity profiles. No significant differences were observed in the mean surgical time (P = 0.18). Significant differences were found between the knee society score (KSS) knee score for total knee arthroplasty (TKA) and ORIF (P = 0.01) and in the KSS function score, with better functional values in the TKA group compared to the ORIF group (P = 0.034). No significant differences were observed in the probability of complications regardless of whether the patients underwent TKA or ORIF (P = 0.6).

Conclusion

Treatment of tibial plateau fractures with TKR achieves superior functional outcomes and lower complication rates compared to open reduction and internal fixation in elderly patients.

Can early treatment of lisfranc injuries without planned re-intervention be safely performed

The Lisfranc complex is a unique combination of ligamentous and osseous relationships between the medial cuneiform and second metatarsal base that is often injured by high energy mechanisms. Fixation for these injuries is often operative; however, the optimal timing of surgical treatment has been debated. All patients who underwent operative fixation of a Lisfranc injury at a single urban tertiary care center were reviewed. Patient were split into two groups based on timing to fixation with one group being less than 24 h from presentation and a second group being greater than 24 h. There were 58 patients who underwent what was planned as final operative stabilization of their Lisfranc injury in less than 24 h and 41 patients who underwent fixation after more than 24 h. The early treatment of Lisfranc injuries did not lead to significant increases in follow up time, infections, time to weight bearing, union rates, or time to union compared patients treated with delayed fixation. There was a higher rate of superficial infection in the early intervention group, but it did not reach statistical significance. We believe our findings demonstrate that delayed fixation is not superior to early treatment of Lisfranc injuries.

Posterior cruciate ligament resection increases intraoperative lateral and medial flexion laxity during total knee arthroplasty

PURPOSE

This study reports the relationship between posterior cruciate ligament (PCL) retention vs resection and soft tissue laxity and balance throughout flexion using a robotically controlled ligament tensioner.

METHODS

55 robotic-assisted TKAs (Total knee arthroplasty) were retrospectively reviewe. The robotic ligament tensioner collected laxity data both before and after PCL resection. Medial and lateral coronal laxity were compared before and after PCL resection at 10°, 45°, and 90° flexion. Gap opening was compared between pre-operative coronal hip-knee-ankle groups.

RESULTS

Lateral laxity was greater after PCL resection at 60° (12.7 ± 2 vs 11.5 ± 3 mm), 75° (13.2 ± 2 vs 11.8 ± 3 mm), and 90° (13.7 ± 2 vs 12.1 ± 3 mm). Medial laxity was significantly greater after PCL resection at 90° (10.1 ± 2 vs 9 ± 2 mm). After PCL resection, laxity in valgus knees increased more compared to neutral/varus knees laterally at 30° (1.2 ± 1 vs 0.3 ± 1 mm), 45° (1.6 ± 1 vs 0.6 ± 1 mm), and 60° (2.1 ± 2 vs 1 ± 1 mm). A similar, but non-significant trend was observed at 90° (2.7 ± 2 vs 1.5 ± 1 mm, p = 0.09).

CONCLUSION

PCL resection increases flexion laxity laterally by up to 1.6 mm and medially by 1.1 mm on average, with valgus knees increasing more than neutral/varus knees. The findings emphasize that surgeons should consider the interplay between PCL resection and coronal deformity when planning and executing TKA procedures.

Comparison of Single Knee Arthroplasty and Bilateral Knee Arthroplasty in Haemophiliacs During a Single Operation: A Systematic Review and Meta-Analysis

BACKGROUND

Arthroplasty is the standard treatment for end-stage haemophilic knee arthritis; however, the choice between single knee arthroplasty (SKA) and bilateral knee arthroplasty (BKA) in a single operation remains controversial due to the risks specific to haemophiliacs.

METHODS

Two independent researchers conducted searches across CNKI, CBM, Wanfang, PubMed, Cochrane Library, Embase, and Web of Science, with the last search performed on 15 October 2024. Study results include joint function, complication and various cost. Literature quality was assessed using the Newcastle-Ottawa Scale (NOS). Outcomes were evaluated with fixed-effects or random-effects models, while heterogeneity and publication bias were also assessed.

RESULTS

Nine studies involving 309 haemophilia patients were included, with 166 in SKA group and 143 in BKA group. No statistically significant differences were observed between the SKA and BKA groups in range of motion (95% CI: -0.22 [-3.57, 3.13], p = 0.90), Hospital for Special Surgery score (95% CI: -2.13 [-4.89, 0.64], p = 0.13), flexion degree (95% CI: -2.38 [-7.22, 2.46], p = 0.33), cost (95% CI: -0.24 [-0.94, 0.45], p = 0.49), complication rate (95% CI: 1.31 [-0.79, 2.17], p = 0.29), hospital stay (95% CI: 0.25 [-2.06, 2.57], p = 0.83), and coagulation factor usage (p = 0.49). However, The SKA group outperformed the BKA group in terms of operative time, postoperative drainage, and transfusion volume (p < 0.001).

CONCLUSIONS

Our study indicates that, apart from differences in operative time, transfusion volume, and blood loss, SKA and BKA show no significant differences in postoperative joint function, complication rates, or costs.

Musculoskeletal Computed Tomography: How to Add Value When Reporting Adult Lower Limb Trauma

ABSTRACT

Computed tomography plays an ever-increasing role in the management of fractures and dislocations due to its capability in efficiently providing multiplanar reformats and 3-dimensional volume rendered images. It can reveal findings that are occult on plain radiography and therefore allow for more accurate decision making with regard to fracture classification and management. Clinical radiologists play a critical role in facilitating the processing of imaging to provide adequate image reformats in the desired planes, producing 3 dimensional images but most crucially identifying pertinent findings, which will contribute between the selection of nonoperative and operative management and potentially influence surgical technique. In an earlier article we have outlined the key findings that the radiologist should search for in major upper limb fractures and dislocations. In this second article we focus on the pelvis, acetabulum, femur, tibia, ankle, and foot and through a case-based approach provide a succinct overview of radiological findings that can play an important role in determining patient management.

A 5-Year Single-center Experience on the Use of Emicizumab Prophylaxis in Children With Severe Hemophilia A With and Without Factor VIII Inhibitors

OBJECTIVE

Emicizumab promotes efficacious hemostasis in persons with hemophilia A persons with hemophilia A with and without inhibitors. Primary analyses of real-world data and clinical trials have shown emicizumab efficacy and safety; however, long-term data are limited.

METHODS

This retrospective study was conducted to assess real-world long-term outcomes of pediatric patients on emicizumab in our hemophilia center between the period of February 2018 and September 2023. Relevant demographic and clinical data were gathered.

RESULTS

Seventy-eight patients were enrolled. Previously untreated patients and minimally treated patients accounted for 14.1% and 10.3% of our recruited patients, respectively. One of 5 patients with active inhibitors experienced a single recombinant activated factor VII-treated bleeding episode while on emicizumab prophylaxis. Twenty-eight (28/78) patients underwent surgical/dental procedures without bleeding complications except for 2 patients (7.1%). Thirty-three patients experienced 62 factor-treated bleeding episodes with only 11 imaging-confirmed joint/muscle bleeding episodes among 8 patients. No major safety concerns were reported in the study and emicizumab was discontinued in 5 patients (2 for antidrug antibody development, 2 for joint bleeding, and 1 for non-compliance).

CONCLUSION

Emicizumab prophylaxis was well tolerated with no new safety concerns, and 45 patients (57.7%) of our cohort exhibited zero-treated bleeds, which was comparable to other published experiences.

Anatomical Repair With Achilles Tendon Allograft Augmentation for Distal Medial Collateral Ligament Ruptures

Several conditions may require medial collateral ligament (MCL) surgery, especially when high physical demands are required. Thus, we described a technique for anatomical repair of distal MCL rupture using a distal anchor and MCL augmentation through Achilles tendon allograft with proximal bone block and interference screw. This procedure fixes an anchor distally at the tibia. Then, the ligament endings are sutured using a continuous simple-type technique. Subsequently, a low-radiated Achilles tendon allograft is attached proximally and fixed through an interference screw. Finally, the allograft is sutured using a continuous simple-type technique. Our anatomical MCL repair and augmentation allows a reinforced anatomical technique to control the valgus instability caused by MCL distal ruptures, considering the MCL axial traction and posterior oblique ligament fiber orientations.

Clinical, Laboratory Aspects and Management of Factor X Deficiency

Coagulation factor X (FX), originally named Stuart-Prower factor, plays a pivotal role in the coagulation cascade, activating thrombin to promote platelet plug formation and prevent excess blood loss. Genetic variants in F10 may lead to FX deficiency and to impaired coagulation. FX variants are phenotypically classified as being type I, with the concomitant reduction of FX coagulant activity and FX antigen levels or type II, corresponding to a reduction in activity with normal antigen plasma levels. Patients affected with FX deficiency tend to be one of the most seriously affected among those with rare bleeding disorders. They show a variable bleeding tendency strongly associated with FX coagulant activity levels in plasma and may present, in the severe form of the deficiency, life-threatening symptoms such as gastrointestinal and umbilical stump bleeding and intracranial hemorrhages or central nervous system bleeding. Treatment of FX deficiency was originally based on the replacement of the missing factor using fresh frozen plasma, cryoprecipitate and prothrombin complex concentrates; however, a plasma-derived concentrate, shown to be safe and effective in clinical trials, is now available. In addition, novel nonreplacement therapy such as small interference RNA, gene therapy, drug repurposing, and gene editing may also represent novel therapeutic approaches for FX deficiency, but further, much focused studies are needed before considering this emerging therapy in such patients.

Total knee arthroplasty in hemophilic knees requires its own learning phase: Lessons learned from 90 cases

BACKGROUND

Intraoperative challenges and complications and their course over experience in total knee arthroplasty (TKA) applications in hemophilic arthropathy have seldom been studied. Our study aimed to analyze the learning dynamics and the evolving perspective of a single arthroplasty surgeon in hemophilic knees.

METHODS

The study encompassed all primary TKAs performed on hemophilic patients by a single experienced arthroplasty surgeon from May 2002 to October 2023. A total of 90 knees from 63 patients were included in the final analysis. Demographic characteristics, range of motion (ROM), degree of flexion contracture, and hip-knee angle (HKA) were noted. Anesthesia type, tourniquet duration, surgical approach, need for bone graft use, and lateral retinacular release (LRR) were also documented. Cases were categorized into three groups: the initial 30 cases (Group A), the subsequent 30 cases (Group B), and the final 30 cases (Group C).

RESULTS

All groups were homogenous in terms of age (P = 0.102), HKA (P = 0.696), ROM (P = 0.582), and degree flexion contracture (P = 0.546). Extended approaches were needed in seven cases (23.3%) in Group A, and in two cases (6.7%) in Group B. There was no need for extended exposure in Group C. LRR application rate and tourniquet time showed no differences across groups (P = 0.401, P = 0.482). The intraoperative problem rate exhibited a statistically significant decrease throughout the series (P = 0.016).

CONCLUSIONS

Arthroplasty in hemophilic knees poses unique challenges which require their own learning process. Intraoperative complication rate and need for utilizing extended approaches decreases after the initial 30 cases and decreases further after the subsequent 30 cases.

Operationalising a Haemophilia Gene Editing Lexicon for Practical Use

INTRODUCTION

Gene editing therapies offer the possibility of substantial improvement in treatment and quality of life for people with haemophilia (PWH) in a landscape of dynamic therapeutic advancement. Developing a common and understandable language to discuss gene editing will be essential to ensure these treatments can be deployed in a safe and effective manner with fully informed and shared decision-making between healthcare professionals (HCPs) and PWH. A lexicon explaining and clarifying key concepts is one potential tool to address these aims. Here we evaluate how a gene editing lexicon could be deployed to maximise impact and improve patient outcomes.

AIM

To operationalise the gene editing lexicon for successful adoption by the haemophilia community.

METHODS

Through an innovative, iterative process, representatives from the haemophilia community, including multidisciplinary HCPs, PWH, and caregivers, with support from language strategy experts, developed a gene editing lexicon and evaluated operational aspects for real-world adoption of this resource.

RESULTS

A gene editing lexicon was developed, including infographics illustrating key concepts. Infographics were adapted from the lexicon to further clarify and communicate these concepts. Infographics were found to be a potentially vital tool for enhancing the practical use of the lexicon to promote shared decision-making and attain informed consent for gene editing therapies.

CONCLUSION

A gene editing lexicon shows promise for improving the understanding of gene editing for all stakeholders in the haemophilia community. Ensuring the lexicon remains up to date with current therapies and appropriate strategies for adoption such as infographics will enable this resource to have maximum impact.

Impact of Systematic Joint Examination (Ultrasound, Functional and Physical) on Treatment Management Decisions in Patients With Haemophilia A in France: Final Data From the Prospective, Observational A-MOVE Study

BACKGROUND

Haemophilia management aims to prevent bleeding and preserve joint function. Changes in patients' joint health may influence physicians' decisions to adjust treatment. The Haemophilia Joint Health Score (HJHS) and Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) score assess joint health but are not routinely used.

AIM

To evaluate whether systematic joint examination with HJHS and/or HEAD-US had an impact on treatment management decisions in France, using final data from the A-MOVE study.

METHODS

A-MOVE (NCT04133883) was a 12-month prospective, multicentre study, which enrolled persons with haemophilia A (all severities, aged 6-40 years) treated prophylactically or on demand with standard/extended half-life FVIII replacement. At baseline, 6 and 12 months, HJHS/HEAD-US and changes in patients' management were assessed.

RESULTS

Eighty-six patients from 20 sites were included in the final analysis; 68 had HJHS/HEAD-US assessments at 12 months. Over 12 months, 24.4% (n = 21/86) of patients experienced an impact on their haemophilia management due to HJHS/HEAD-US scores; these decisions were impacted by HJHS in about half of the patients (52.4%, n = 11/21) and HEAD-US in almost all patients (95.2%, n = 20/21). Both assessments contributed to a change in management decisions in about half of the patients (47.6%, n = 10/21). Twenty-nine patients (33.7%) had haemophilia management decisions impacted by factors other than HJHS/HEAD-US, including physical examination findings (n = 9) and the occurrence of bleeding episodes (n = 8).

CONCLUSIONS

Final data from the A-MOVE study show that systematic joint assessments, through functional/physical examination (HJHS) and ultrasound (HEAD-US), may impact treatment management decisions in persons with haemophilia A.

Systematic Literature Review of Outcomes Associated With Adherence to Haemophilia Drug Therapy

INTRODUCTION

Prophylactic therapy improves clinical and quality of life (QoL) outcomes in patients with haemophilia; however, this effect could be influenced by the degree of treatment adherence. Adherence to therapy may be difficult due to the administration mode and the frequency of self-infusions. There is a need to investigate the effect of treatment adherence on clinical, humanistic and economic outcomes in a real-world setting.

AIM

A systematic literature review (SLR) was performed to describe the impact of adherence to haemophilia drug therapies on clinical, humanistic and economic outcomes.

METHODS

Embase, MEDLINE and the Cochrane Library were searched for English language articles published after 22 June 2013; the search was conducted on 22 June 2023. No geographic limits were applied. Twenty articles met the inclusion criteria.

RESULTS

The studies investigated associations between treatment adherence and bleeding, joint health, inhibitor development, pain, QoL, daily activity/work productivity (WP), cognitive function and healthcare resource use. Fifteen studies reported that better adherence to drug therapy in patients with haemophilia is associated with better outcomes, including a reduction in bleeding risk, improved joint structure and function, less chronic pain, better health-related QoL (HRQoL), lower activity impairment (AI), less school/work absenteeism, higher WP and better cognitive function. Two studies reported mixed results, with adherence being associated with some outcomes but not others. Five studies reported no association.

CONCLUSION

This SLR found associations between greater adherence to haemophilia drug therapies and better results on clinical, humanistic and economic outcomes, indicating that patients with haemophilia would benefit from improvements in treatments that promote adherence.

The potential role of GLP-1 receptor agonists in osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis, affecting over 500 million people globally. Current treatments are primarily symptom-focused, with no approved therapies to halt disease progression. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), widely used in type 2 diabetes (T2D) and obesity, demonstrate significant weight loss and glucose-lowering effects and have been shown to possess anti-inflammatory properties. Given the central role of inflammation and metabolic dysfunction in OA, this review examines the potential utility of GLP-1 RAs in OA management, focusing on both indirect effects, such as weight reduction, and possible direct effects on inflammatory pathways and cartilage preservation. Clinical studies suggest that GLP-1 RAs may benefit people with OA by reducing weight, improving glycemic control, and modulating inflammatory markers relevant to OA progression. Notable findings include significant weight loss and pain reduction in people with knee OA (KOA) treated with semaglutide in the STEP-9 trial. In other studies, GLP-1 RAs have shown potential to lower oxidative stress and pro-inflammatory cytokines, such as tumor necrosis factor (TNF-α) and interleukin (IL)-6, with reductions in OA-related pain and functional impairment observed in some cohorts. However, results vary, with some studies showing limited effects, potentially linked to the degree of weight loss achieved. Although some studies report variability in pain relief, likely influenced by the degree of weight loss achieved, GLP-1 RAs have shown overall promise in reducing both OA symptoms and markers associated with disease progression. This emerging evidence supports the utility of GLP-1 RAs as a potential disease-modifying option for OA, offering a dual benefit in metabolic and joint health. Future research should focus on establishing the long-term efficacy and safety and elucidating the mechanism by which GLP-1 RAs influence OA pathology.

Patient reported outcome scores following traumatic hip dislocations

OBJECTIVE

Traumatic native hip dislocations require immediate orthopaedic attention and have been associated with significant long-term morbidity. Previous studies have reported radiographic outcomes and clinical complication rates, however; evidence evaluating the effect of these injuries on patient-reported outcomes (PROs) is limited. The purpose of our study was to evaluate PRO scores among patients with native hip dislocations.

METHODS

Adult patients with native hip dislocations between 2005 and 2020 at a single academic Level 1 trauma center were retrospectively reviewed. Radiographs and medical records were reviewed for patient demographics and comorbidities, injury characteristics, details of treatment including time to reduction, and complications. Patients were given the PROMIS Physical Function (PROMIS PF) and Short Form-36 (SF-36) via HIPAA compliant electronic data capture. Outcomes were analyzed using Student t-tests and Mann-Whitney U comparisons of means/medians. Floor and ceiling effects were also characterized for the various outcomes scores.

RESULTS

A total of 168 patients with native hip dislocation were identified, 78 (46.4 %) of whom completed all PROs measures. Among responders, mean age was 36.2 years (SD 14.5), mean BMI was 29.2 (SD 6.7), and mean dislocation duration was 8.9 h (SD 5.1). On univariable regression, older age was associated with worse SF-36 Physical scores (p = 0.007). PROMIS PF showed an estimated 2.18 decrease for every one grade increase in Kellgren-Lawrence score (p = 0.01). There were no ceiling or floor effects seen with PROMIS PF, SF-36 Physical Summary, or SF-36 Mental Summary Scores.

CONCLUSIONS

Patients of older age and higher Kellgren-Lawrence score exhibited worse SF-36 Physical Function and PROMIS PF scores, respectively, highlighting the functional impact that native hip dislocations may have. PROMIS PF, SF-36 Physical and Mental Summary Scores were without floor or ceiling effects, rendering this an important tool in the evaluation of patients with traumatic native hip dislocation.

A Comparison of Wound Related Complications Between Intramedullary and Lateral Plate Osteosynthesis After Fibula Osteotomy in the Lateral Approach Total Ankle Replacement

BACKGROUND

Total ankle replacement (TAR) has evolved in the last decade from a procedure rife with complication and failure to a promising alternative to arthrodesis. The ability to maintain ankle joint range of motion is showing great promise in patient-reported outcomes, postsurgical pain, as well as long-term sequalae of joint fusion. Although TAR can be performed via either an anterior or lateral approach both with their own sets of benefits and potential complications, the consensus seems to be that one is no better than the other when performed by high-volume surgeons.

METHODS

Data were gathered over a 6-year period looking at an age- and gender-matched cohort of lateral approach TARs with either plate osteosynthesis or fibula nail fixation in the management of the fibula osteotomy and compared reoperation and infection rates with the working hypothesis that nail fixation would afford better outcomes. Secondary outcomes including rates of fibula union, tourniquet time as an adjunct to procedure length, and patient-reported outcome measures (PROMs) in the form of FAOS Quality scores were included.

RESULTS

A total of 234 TARs were analyzed. Forty-five of these used intramedullary nail fixation (IM), and a control group of 45 plate osteosynthesis (PO) fixation cases was correlated. The Foot & Ankle International guidelines on reporting for complications arising from total ankle arthroplasty that resulted in reoperation were applied to the data set, and it was noted that 13 of 19 reoperations were noted in the PO group, which was statistically significant. Also of note, 12 of 16 patients treated with antibiotics, which included all those cases within the reoperation group, were noted to come from the PO group. This was also of statistical significance. Interestingly, the rate of fibula nonunion in the PO group was lower (8.88%) than that of the IM group (23.25%).

CONCLUSION

Our results confirmed that the rates of reoperation and infection were statistically significantly improved with the use of nail fixation over plate fixation. This was tempered by a concerningly high nonunion rate. This article shows promising results for the use of a simple technique in improving long-term outcomes in ankle arthroplasty.

Assessment of photodynamic therapy efficacy against Escherichia coli-Enterococcus faecalis biofilms using optical coherence tomography

Significance

In orthopedic trauma surgery, spatially structured biofilm ecosystems of bacteria that colonize orthopedic devices account for up to 65% of all healthcare infections, including tens of millions of people affected in the United States. These biofilm infections typically show increased resistance to antibiotics due to their structure and composition, which contributes significantly to treatment failure. Anti-biofilm approaches are needed together with clinically usable microscopic-resolution imaging techniques for treatment efficacy assessment.

Aim

Antimicrobial photodynamic therapy (aPDT) has been recently proposed to combat clinically relevant biofilms (chronic wound infections, dental biofilms, etc.) using photosensitizers excited with visible light to generate reactive oxygen species that can kill bacteria residing within pathogenic biofilms. We aim to assess the efficacy of this treatment for eradication of biofilms typically present on surfaces of orthopedic devices (e.g., intramedullary nails and osseointegrated prosthetic implants).

Approach

In the first phase reported here, we test aPDT in vitro by growing biofilms of Escherichia coli and Enterococcus faecalis bacteria (two of the seven most common pathogens found in orthopedic trauma patients) inside soft lithography-fabricated microfluidic devices. We treat these biofilms with 5-aminolevulinic acid (5-ALA)-based aPDT, evaluate treatment efficacy with optical coherence tomography, and compare with regular clinical antibiotic treatment outcomes.

Results

The antibacterial efficiency of 5-ALA-based aPDT showed nonlinear dependence on the photosensitizer concentration and the light power density, with low parameters ( 30    J / cm 2 light dose, 100    mg / mL 5-ALA concentration) being significantly more effective than antibiotic-treated groups ( p < 0.01 ), reaching 99.98% of bacteria killed at 150    J / cm 2 light dose and 200    mg / mL 5-ALA concentration setting.

Conclusions

Performed experiments enable the translation of this portable treatment/imaging platform to the second phase of the study: aPDT treatment response assessment of biofilms grown on orthopedic hardware.

Body Mass Index Improvement Reduces Total Knee Arthroplasty Complications Among Patients Who Have Extreme, but Not Severe, Obesity

BACKGROUND

While morbid obesity has been associated with increased complication risk in primary total knee arthroplasty (TKA), limited evidence is available to attribute decreased surgical complication rates with body mass index (BMI) reduction.

METHODS

We retrospectively assessed 464 unilateral TKAs performed in morbidly obese patients, including 158 extremely obese (BMI ≥ 45) and 306 severely obese patients (BMI 40 to 44.9). A detailed medical record review identified concurrent modifiable risk factors and successful preoperative BMI reduction, reaching either a contemporary risk target (BMI < 40) or an institutionally accepted threshold (BMI < 45). Postoperative blood glucose levels and 1-year adverse outcomes (periprosthetic joint infection, wound dehiscence, knee manipulation, periprosthetic fracture) were compared to 557 contemporary control subjects with expected slightly lower (moderate obesity, BMI 35 to 39.9) or sufficiently lower complication risk (overweight, BMI 25 to 29.9).

RESULTS

Periprosthetic joint infection and postoperative hyperglycemia were identified more frequently among morbidly obese patients in comparison with a moderately obese control group. Extremely obese patients (BMI ≥ 45) whose BMI improved below 45 had no measurable difference in infection risk from the control group (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.04 to 16.88), while those with a nonimproved BMI had a significantly higher risk (OR 7.70, 95% CI 1.89 to 31.41). No significant differences in the risk for infection were observed between severely obese patients (BMI 40 to 44.9) with preoperative BMI improvement (1.5% rate, OR 1.70, 95% CI 0.17 to 16.57) or nonimprovement (1.7% rate, OR 1.87, 95% CI 0.41 to 8.43).

CONCLUSIONS

Preoperative medical optimization may decrease postoperative TKA complications. The findings of this study support BMI improvement for extremely obese patients (BMI ≥ 45). The assignment of 40 BMI as a threshold for otherwise healthy patients may exclude patients from potential surgical benefits without realizing risk reduction.

Efficacy and Safety of Aspiration and Intra-Articular Injection of Tranexamic Acid in Acute Knee Hemarthrosis of Adult Haemophilic Patients: A Randomized Clinical Trial Study

INTRODUCTION

Hemarthrosis, particularly in the knee, accounts for most bleeding episodes in haemophilia. While joint aspiration has proven effective, the role of intra-articular (IA) tranexamic acid (TXA) in managing acute hemarthrosis remains unexplored.

AIM

To assess the efficacy and safety of knee aspiration followed by IA TXA injection in acute haemophilic knee hemarthrosis.

METHODS

Forty-four adult haemophilia patients with acute knee hemarthrosis (< 24 h) were randomized to undergo joint aspiration with (TXA group) or without (non-TXA group) IA TXA (1.5 g/15 mL) injection. Both groups received 75 mL injections, including 5 mL of 2% lidocaine and additional 0.9% saline. Ultrasound confirmed hemarthrosis, and standardized factor replacement was given pre-procedure. Primary outcomes included knee range of motion (ROM) and visual analogue scale (VAS) for pain. The significance was set at p < 0.05.

RESULTS

Final analysis included 21 and 17 male patients in the TXA and non-TXA groups, respectively. The TXA group showed a significantly greater knee ROM on days 3, 7, and 14 (p < 0.05), with no differences beyond Day 14. VAS pain scores were significantly lower in the TXA group at 24 h, 3 days, and 7 days post-procedure (p < 0.05). TXA patients reported faster return to work (p = 0.004) and higher satisfaction (p = 0.01). Hemarthrosis recurrence was lower in the TXA group (5.9% vs. 14.3% at 6 weeks; 64.7% vs. 90.5% at 6 months), though differences were not statistically significant. No complications were observed.

CONCLUSION

Joint aspiration with IA TXA is safe and effective for short-term ROM improvement and pain relief in acute haemophilic knee hemarthrosis.

Penetration Depth and Tissue Interaction of Focused Extracorporeal Shock Waves: An In-vitro Investigation

INTRODUCTION

Extracorporeal shock wave therapy (ESWT) is a non-invasive therapeutic approach with minimal consequences, extensively utilized for the management of musculoskeletal problems. Focused ESWT (f-ESWT) is known to have regenerative effects on muscle and bone tissues; however, little is known about its penetration and propagation in different tissues.

OBJECTIVE

To assess the reach of f-ESWT in soft tissues and bone tissues.

METHODS

An in-vitro observational study was conducted. A piezoelectric shock wave device was used to evaluate the penetration and visual propagation of shock waves in an aquarium with water in muscle tissues (ham) of different thicknesses, and bone tissues (scapula and femur). High-resolution images and videos were captured to observe the penetration of mechanical waves into the different tissues.

RESULTS

Light beams and air bubbles were observed, consistent with the propagation of f-ESWT through different tissues. The f-ESWT was able to penetrate wide bones such as the femur and thin bones such as the scapula.

CONCLUSION

F-ESWT is capable of penetrating soft tissues and bone tissues depending on the depth. This is an important study for the safe application of f-ESWT by a healthcare professional with prior anatomical knowledge.

Sequential combined bypassing therapy in haemophilia patients with high titer inhibitors: surgical experience

Sequential combination bypass therapy (SCBT) is an effective treatment option for haemophilia patients with inhibitors; however, its safety, efficacy, and cost have largely have yet to be systematically evaluated. To address this question, we retrospectively analyzed the medical records of 14 haemophilia patients with high titer inhibitors who underwent surgery. The patients with high inhibitors were treated with two SCBT regimens by optimizing doses of the recombinant activated factor VII (rFVIIa) and prothrombin complex concentrate (PCC). The effectiveness and safety of the two SCBT regimens were evaluated. In addition, rFVIIa and PCC factor consumption and costs were also compared. The median age of the 14 patients was 30.00 (27.25-42.75) years. They all underwent major surgeries, with 85.71% (12/14) was orthopedic surgeries related to hemophilic arthropathy. Four patients were treated using regimen 1 and ten with regimen 2. Results showed that regimen 2 exhibited a higher haemostatic efficiency (90% vs. 75% intraoperative and 90% vs. 50% postoperative) and a 28.0% reduction in economic costs (863,604.68 RMB vs. 621,756.62 RMB). All patients after surgery had no prothrombin time extension, 7.14% had fibrinogen and platelet count decreases, and 57.14% had D-dimer increases that returned to baseline within 5-7 days after SCBT. The study shows that regimen 2 as an optimized SCBT regimen is an efficient approach to secure haemostasis for haemophilia patients with high titer inhibitors in the perioperative period, rather than regimen 1. The findings can help design future clinical studies and provide more reliable data and implementation advice.

Influence of parkinson's disease on complications and revisions in total hip and knee arthroplasty: insights from a matched pair analysis

PURPOSE

The outcome of elective total joint arthroplasty (TJA) in patients with Parkinson's disease (PD) is controversial due to the concomitant risk profile. This study investigated postoperative complications and revision rates following total hip (THA) and knee arthroplasty (TKA) in patients with PD.

METHODS

Ninety-six patients with PD undergoing THA or TKA were matched 1:1 with non-PD patients using propensity score matching for age, sex and comorbidity (Charlson Comorbidity index, CCI). Rates of revisions, medical and surgical complications were compared. Univariate and multivariate regression analyses were calculated.

RESULTS

PD patients exhibited higher rates of revision-surgeries within 90 days (13.5% vs. 5.2%; p = 0.048), medical complications (68.8% vs. 43.8%; p < 0.001) and surgical complications (40.6% vs. 21.9%; p = 0.005). Multivariate regression analysis confirmed PD as a significant risk factor for complications and long-term revision-surgeries.

CONCLUSION

PD increases the risk of adverse outcomes following THA and TKA. Improvements in pre-operative planning and post-operative care are critical to the improvement of outcomes in this vulnerable population.

How Does a Cyclops Lesion Impact Anterior Cruciate Ligament (ACL) Reconstruction Recovery?

This case explores the complexities of treating a flexion restriction in a patient following anterior cruciate ligament (ACL) reconstruction, medial meniscus repair, and lateral meniscectomy. The aim is to provide insights into the treatment pathway when a flexion restriction develops post-ACL reconstruction and fails to improve with nonoperative measures. The patient, a 16-year-old high school track athlete, sustained a torn right ACL in a car accident and presented with severe knee instability, difficulty climbing stairs, and pain during ambulation. This case highlights the use of various nonoperative treatment strategies to address a flexion restriction that began developing within one month postoperatively. Despite aggressive physical therapy, the use of a knee extension machine, a brace locked in extension, and steroid treatment, the patient exhibited a persistent flexion restriction of five degrees, eventually necessitating surgical intervention. Ultimately, the patient achieved full recovery after undergoing arthroscopic lysis of adhesions and manipulation under anesthesia performed 10 months after the initial ACL reconstruction.

Clinical Outcomes After Arthroscopic Broström-Gould Procedure for Chronic Lateral Ankle Instability

Background Chronic lateral ankle sprains are common injuries that are largely sequelae of inversion injuries of the ankle. These injuries are amenable to surgical intervention, namely, Broström-Gould reconstruction, which is commonly performed for the above injury. Many open and arthroscopic variations of the technique have been described. Arthroscopic Broström-Gould has been shown to have comparable outcomes to the open technique. Analysis of 39 patients who underwent arthroscopic Broström-Gould at a tertiary institution showed excellent outcomes from all three functional scores. Methods Thirty-nine patients underwent arthroscopic Broström-Gould in 2021 at a tertiary institution and were followed up for up to one year postoperatively. All patients had failed conservative treatment and reported pain and chronic instability prior to surgical intervention. Outcomes were measured with functional scores, namely, the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), and Karlsson and Peterson Scoring System (K-P). Other demographics such as age, gender, laterality, and body mass index were also recorded. Statistical analysis was performed with GraphPad Prism (GraphPad Software, San Diego, CA). Outcomes were analysed by paired t-test and statistical significance was set at p < 0.05. Results A total of 39 patients with chronic lateral ankle instability (CLAI) who underwent arthroscopic Broström-Gould were followed up for up to one year postoperatively. Demographics were as follows: 22 males and 17 females, 20 right ankles and 19 left ankles, average age of 36.2 years (19.6-64.8 years), and BMI of 27.4 (19.2-40). At follow-up, functional scores were measured as described in the methods section above. Preoperative VAS scores were 5.87 ± 1.92 (1-10) while postoperative VAS scores were 2.0 ± 2.16 (0-7). Preoperative K-P scores were 43.68 ± 13.2 (7-70) while postoperative K-P scores were 69.21 ± 17.86 (37-100). Preoperative AOFAS scores were 62.53 ± 16.05 (29-83) while postoperative AOFAS scores were 83.8 ± 11.49 (59-100). Conclusions Significant improvement of all three functional scores (VAS, K-P, and AOFAS scores) following arthroscopic Broström-Gould was noted. This shows that the arthroscopic Broström-Gould is an effective method to treat CLAI with good outcomes.

Microfragmented Adipose Tissue Has No Advantage Over Platelet-Rich Plasma and Bone Marrow Aspirate Injections for Symptomatic Knee Osteoarthritis: A Systematic Review and Meta-analysis

BACKGROUND

Microfragmented adipose tissue has been proposed for intra-articular treatment of knee osteoarthritis. There are little data comparing the outcomes of treatment between microfragmented adipose tissue and other biological treatments.

PURPOSE

To perform a systematic review and meta-analysis comparing microfragmented aspirated fat injections to other orthobiologics, hyaluronic acid, and corticosteroid injections for symptomatic knee osteoarthritis.

STUDY DESIGN

Systematic review and meta-analysis; Level of evidence, 2.

METHODS

A systematic review of the literature was performed to identify pertinent publications in the MEDLINE, Embase, Scopus, and Google Scholar databases, including all level 1 to 3 studies from 2000 to 2023. Validated knee scores (visual analog scale [VAS] for pain, Knee injury and Osteoarthritis Outcome Score [KOOS], Lysholm, International Knee Documentation Committee) were included as outcome measures. Risk of bias was assessed using Cochrane tools. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of the body of evidence and the modified Coleman Methodology Score was used to assess study quality. Heterogeneity was assessed using χ2 and I2 statistics.

RESULTS

Five studies were included in the analysis. One study had a high risk of bias; 4 studies had some risk of bias. The overall study quality was fair, and the certainty of evidence was low. The pooled estimate for VAS scores did not demonstrate significant differences at 3, 6, and 12 months. The pooled estimate for the KOOS Pain, Symptoms, Activities of Daily Living, Sport and Recreation, and Quality of Life subscales did not demonstrate significant differences at 3, 6, and 12 months.

CONCLUSION

The results of this systematic review and meta-analysis demonstrated that there were no statistically significant differences for both the clinical outcomes and pain scores between microfragmented adipose tissue and other orthobiologics for the treatment of knee osteoarthritis. However, modest study quality, some risk of bias, and low certainty of evidence reduce external validity, and these results must be viewed with some caution.

A Rare Cause of Infection Following Total Knee Arthroplasty: Abiotrophia defectiva Linked to Recurrent Urinary Tract Infections

Abiotrophia defectiva (A. defectiva) is a rare cause of prosthetic joint infection (PJI), and its role in surgical site infections remains unclear. A 66-year-old female developed an A. defectiva infection two years following primary right total knee arthroplasty (TKA). The patient presented with fever, knee pain, and urinary tract infection (UTI). She had a history of recurrent UTIs, likely contributing to the hematogenous spread of the pathogen. Knee aspiration was initially negative; however, subsequent cultures detected A. defectiva. The PJI was managed with surgical debridement, removal of prosthetic components, and a dynamic antibiotic spacer. We highlight the challenges associated with A. defectiva PJIs. The pathogen's fastidiousness complicates identification, and its biofilm formation on prosthetic materials makes eradication difficult. Despite its rarity, A. defectiva should be considered as a possible cause of PJIs, particularly in patients with recurrent UTIs. Early recognition and aggressive management are crucial.

Efficacy and Safety of Intra-articular Platelet-Rich Plasma (PRP) Versus Corticosteroid Injections in the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Clinical Trials

Osteoarthritis (OA) is a prevalent condition that significantly impacts the quality of life due to pain and associated disability. Platelet-rich plasma (PRP) injections have emerged as a promising alternative treatment, though their efficacy and safety remain debatable. This systematic review aims to evaluate the efficacy and safety of PRP injections in patients with knee OA by analyzing randomized clinical trials (RCTs). A comprehensive search was conducted across PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and the Virtual Health Library (VHL) for studies published from 2019 to 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data extraction and methodological quality assessment were performed using the Cochrane Risk of Bias Tool (RoB 2). Of the 129 studies identified, six met the inclusion criteria. The studies varied in sample size (36-80 patients) and PRP preparation methods. The results suggest that intra-articular (IA) PRP and corticosteroid (CS) injections are safe and effective for treating knee OA, reducing pain and improving symptoms. Some studies indicate that PRP injections may offer prolonged benefits, although there is no consensus on whether one treatment is superior. No serious adverse effects were reported, and the side effects observed were mild, suggesting a favorable safety profile. In conclusion, PRP is a viable therapeutic alternative for managing knee OA, with sustained benefits compared to CS. However, further research is needed to standardize protocols and assess long-term effects.

Economic Burden of Haemophilia from a Societal Perspective: A Scoping Review

INTRODUCTION

Haemophilia is a rare genetic bleeding disorder that leads to musculoskeletal complications. The high cost of haemophilia treatment necessitates a thorough evaluation of its economic burden. However, due to the difficulty of estimating direct non-medical, indirect, and intangible costs, studies often underestimate the actual economic burden of haemophilia. This scoping review aims to summarise economic studies in haemophilia conducted from a societal perspective.

METHODS

A systematic search across eight scholarly databases, grey literature, and reference lists until the 5th of July 2023 was conducted to identify relevant studies. The inclusion criteria encompassed full-text, English-language publications of economic analyses in congenital haemophilia from a societal perspective. Model-based studies and those adopting a payer perspective were excluded. Costs were adjusted to international dollars (I$) and US dollars (US$) in 2022 for comparability.

RESULTS

Out of 2993 potential sources identified, 25 studies met the inclusion criteria, covering 7226 persons with haemophilia across 22 countries. All studies reported direct medical costs, with four excluding the cost of haemostatic therapy. Fifteen studies reported direct formal non-medical costs, while eight reported direct informal non-medical costs. All but one study reported the indirect costs. The average annual costs of haemophilia varied widely based on treatment modality, disease severity, geographical location, and included cost categories. When including the cost of clotting factor replacement therapy (CFRT), the total cost for severe haemophilia without inhibitors ranged from 1566 I$ to 700,070 I$ per person per year (lowest value reported in India and highest in the United States). CFRT represented up to 99.9% of the total cost for those receiving prophylaxis and up to 95.1% for episodic treatment. Haemostatic therapies accounted for 82% of the total cost in patients with inhibitors.

CONCLUSION

There is a significant heterogeneity in defining cost categories required for a comprehensive economic analysis from a societal perspective. While haemostatic therapies constitute a substantial portion of the overall cost, direct non-medical and indirect costs are crucial as they are often paid out-of-pocket and may impede access to treatment. It is essential for haematologists and economists to establish a standardised costing framework for future studies, particularly in the era of novel therapies.

Bone and Hemophilia: The Role of Factor VIII-Systematic Review

Factor VIII (FVIII) is involved in several molecular pathways and biological processes; indeed, it has a role in the coagulative cascade, cardiovascular disease, hypertension, brain and renal function, cancer incidence and spread, macrophage polarization, and angiogenesis. Hemophilic patients usually present an increase in fracture risk, bone resorption, and an excess of osteoporosis as compared to healthy individuals. Several studies have tried to clarify their etiology but unfortunately it is still unclear. This review focuses on the role of FVIII in bone biology by summarizing all the knowledge present in the literature. We carried out a systematic review of the available literature following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Several studies demonstrated that FVIII is involved in different molecular pathways interfering with bone physiology; it exerts interesting effects on OPG/RANK/RANKL pathways and thrombin/PAR1 pathways. These data confirm a relationship between FVIII and bone metabolism; however, there are still many aspects to be clarified. This review highlights the role of the coagulation factor FVIII in bone metabolism, suggesting new hypotheses for future studies both in vitro and in vivo to better understand the important pleiotropic role of FVIII and hopefully to develop new therapeutic agents for skeletal diseases.

Hydrogel-Based Scaffolds: Advancing Bone Regeneration Through Tissue Engineering

Bone tissue engineering has emerged as a promising approach to addressing the limitations of traditional bone grafts for repairing bone defects. This regenerative medicine strategy leverages biomaterials, growth factors, and cells to create a favorable environment for bone regeneration, mimicking the body's natural healing process. Among the various biomaterials explored, hydrogels (HGs), a class of three-dimensional, hydrophilic polymer networks, have gained significant attention as scaffolds for bone tissue engineering. Thus, this review aimed to investigate the potential of natural and synthetic HGs, and the molecules used for its functionalization, for enhanced bone tissue engineering applications. HGs offer several advantages such as scaffolds, including biocompatibility, biodegradability, tunable mechanical properties, and the ability to encapsulate and deliver bioactive molecules. These properties make them ideal candidates for supporting cell attachment, proliferation, and differentiation, ultimately guiding the formation of new bone tissue. The design and optimization of HG-based scaffolds involve adapting their composition, structure, and mechanical properties to meet the specific requirements of bone regeneration. Current research focuses on incorporating bioactive molecules, such as growth factors and cytokines, into HG scaffolds to further enhance their osteoinductive and osteoconductive properties. Additionally, strategies to improve the mechanical strength and degradation kinetics of HGs are being explored to ensure long-term stability and support for new bone formation. The development of advanced HG-based scaffolds holds great potential for revolutionizing bone tissue engineering and providing effective treatment options for patients with bone defects.

The effects of Pistacia atlantica Desf. Fruit oil on primary knee osteoarthritis: A randomized controlled clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

Pistacia atlantica Desf. (Baneh) is a native tree in many areas of Iran such as Zagros mountains and Sistan va Baluchestan Province. It is famous mostly due to its oleo-gum resin and there are many studies on its effects on gastrointestinal disorders and musculoskeletal problems. However, the oil from its fruits is also of use in local communities as a part of their food and for therapeutic purposes such as analgesic effects on joint pains.

AIM OF THE STUDY

Osteoarthritis is a widespread form of joint pain in older adults. This double-blinded randomized clinical trial aimed to compare the effects of Baneh fruit oil on knee osteoarthritis with topical diclofenac.

MATERIAL AND METHODS

Ninety-two patients with primary knee osteoarthritis were randomly divided into two groups and asked to rub a fingertip of Baneh ointment or diclofenac on their knee 3 times a day for four weeks. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale (VAS) were completed at the beginning, fourth and eighth weeks. The data was analyzed in SPSS software and intention to treat (ITT) analysis was performed. A P-value less than 0.05 was considered statistically significant.

RESULTS

After 4 weeks, all parameters improved significantly in both groups but the pain (based on VAS and KOOS), activity, and quality-of-life showed statistically more improvement in the Baneh group (P = 0.001, P < 0.001, and P = 0.009, respectively). Four weeks after stopping the interventions, all parameters in both groups were still significantly better than the baseline (P ≤ 0.05). However, improvement in pain (VAS and KOOS) and activity was stayed better in the Baneh group (P = 0.028, P = 0.001, and P = 018, respectively). Only one case of temporary itching was reported.

CONCLUSION

This study revealed that Baneh oil had a positive effect on relieving the symptoms of knee osteoarthritis, however, more clinical trials with longer duration of treatment and larger sample sizes are recommended.

Efficacy of Bone Morphogenetic Protein-2 Peptide-Modified Nano-Hydroxyapatite Alginate Hydrogel in Vertebral Bone Defect Repair

For the effective treatment of vertebral bone defects (BDs), the authors constructed an innovative hydroxyapatite (HAP) nanoparticle-hyaluronic acid (HA)-alginate (ALG) scaffold loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2). The particle size of HAP was around 80 to 100 nm, and its addition markedly reduced the swelling rate and degradability of the HA-ALG scaffold while enhancing its compression resistance, enabling it to better support the BD site and provide a good proliferation environment for osteoblasts. Furthermore, HAP-HA-ALG effectively extended the half-life of rhBMP-2 by nearly 50-fold, allowing it to exert its osteogenic effects more consistently. In cellular experiments, the authors found that rhBMP-2@HAP-HA-ALG significantly enhanced the activity and migration ability of bone marrow mesenchymal stromal cells, as well as the expression level of related osteogenic proteins in cells, which better exerted osteoinductive and osteoconductive functions. In animal tests, rhBMP-2@HAP-HA-ALG could better facilitate the generation of new bone and bone trabecula at BD sites and markedly enhance the bone density level, thus shortening the repair time of BDs. Therefore, rhBMP-2@HAP-HA-ALG shows great potential in the restoration of vertebral BDs.

Plate Fixation and Hallux Valgus Deformity Impact on Nonunion Rates in First Metatarsophalangeal Arthrodesis A Retrospective Cohort Study

BACKGROUND

The combined effect of fixation type and preoperative deformity together might influence the union rate after the first metatarsophalangeal (MTP) arthrodesis. This study aimed to compare the nonunion and failure rate of dorsal locking plate versus cross-screws for the first MTP arthrodesis considering the preoperative deformity, including hallux valgus versus rigidus. We secondarily aimed to compare the observed nonunion rate with the rate in the systematic reviews.

METHODS

This was a retrospective cohort study including 372 patients and 378 feet. The surgical technique was identical except for the use of a dorsal locking plate in 181 (49%) and cross-screws in 191 (51%) MTP joints. The radiographic union was assessed at 3 months postoperative. Those who did not heal by the 3-month follow-up were categorized as a "symptomatic" versus "asymptomatic" nonunion. Those categorized as nonunion after 3 months were followed until union occurred.

RESULTS

The results demonstrated that dorsal locking plate fixation (OR = 10.1, 95% CI: 1.3-80) and hallux valgus deformity (OR = 4.7, 95% CI: 1.2-18) were significantly associated with a higher nonunion rate. At 3-month follow-up, a total of 19 (5%) patients showed nonunion. Of the total nonunions, 15 (79%) were fixed by the locking plate, and 4 (21%) were fixed by cross-screws. Of the 15 nonunions with plate fixation, 6 (40%) underwent a second surgery due to device failure, while none of the cross-screws required a second surgery. Out of the 6 secondary surgeries, 5 (83%) demonstrated a nonunion with valgus deformity and 1 required removal of hardware due to prominent hardware.

CONCLUSION

Our results support that a dorsal locking plate for the fusion of a hallux valgus deformity is associated with a significantly higher risk of symptomatic nonunion and a secondary surgery compared to cross-screws, possibly due to the failure of the plate in neutralizing the medio-lateral deforming forces.

LEVELS OF EVIDENCE

Level IV, Retrospective Cohort.

Integrating blockchain technology with artificial intelligence for the diagnosis of tibial plateau fractures

PURPOSE

The application of artificial intelligence (AI) in healthcare has seen widespread implementation, with numerous studies highlighting the development of robust algorithms. However, limited attention has been given to the secure utilization of raw data for medical model training, and its subsequent impact on clinical decision-making and real-world applications. This study aims to assess the feasibility and effectiveness of an advanced diagnostic model that integrates blockchain technology and AI for the identification of tibial plateau fractures (TPFs) in emergency settings.

METHOD

In this study, blockchain technology was utilized to construct a distributed database for trauma orthopedics, images collected from three independent hospitals for model training, testing, and internal validation. Then, a distributed network combining blockchain and deep learning was developed for the detection of TPFs, with model parameters aggregated across multiple nodes to enhance accuracy. The model's performance was comprehensively evaluated using metrics including accuracy, sensitivity, specificity, F1 score, and the area under the receiver operating characteristic curve (AUC). In addition, the performance of the centralized model, the distributed AI model, clinical orthopedic attending physicians, and AI-assisted attending physicians was tested on an external validation dataset.

RESULTS

In the testing set, the accuracy of our distributed model was 0.9603 [95% CI (0.9598, 0.9605)] and the AUC was 0.9911 [95% CI (0.9893, 0.9915)] for TPF detection. In the external validation set, the accuracy reached 0.9636 [95% CI (0.9388, 0.9762)], was slightly higher than that of the centralized YOLOv8n model at 0.9632 [95% CI (0.9387, 0.9755)] (p > 0.05), and exceeded the orthopedic physician at 0.9291 [95% CI (0.9002, 0.9482)] and radiology attending physician at 0.9175 [95% CI (0.8891, 0.9393)], with a statistically significant difference (p < 0.05). Additionally, the centralized model (4.99 ± 0.01 min) had shorter diagnosis times compared to the orthopedic attending physician (25.45 ± 1.92 min) and the radiology attending physician (26.21 ± 1.20 min), with a statistically significant difference (p < 0.05).

CONCLUSION

The model based on the integration of blockchain technology and AI can realize safe, collaborative, and convenient assisted diagnosis of TPF. Through the aggregation of training parameters by decentralized algorithms, it can achieve model construction without data leaving the hospital and may exert clinical application value in the emergency settings.

EMMATKA trial: the effects of mobilization with movement following total knee arthroplasty in women: a single-blind randomized controlled trial

BACKGROUND

Mobilization with Movement (MWM) is an examination and management approach for correcting the intra-articular translational and rotational movements to facilitate the active physiological movement. The study aimed to determine the effects of MWM on Total Knee Arthroplasty (TKA) using a randomized controlled trial (RCT) design.

METHODS

The trial is registered (ISRCTN ref: 13,028,992). A blinded examiner assessed patients at pre-surgical (before TKA), post-surgical (at 3-weeks post-TKA), 6-weeks and 6-months post-TKA. Participants were randomly assigned to receive MWM (six sessions, between 3 and 6 weeks post-TKA) plus standard rehabilitation (intervention group) or standard rehabilitation alone (control group) of outpatient rehabilitation including range of motion and strengthening exercises, cycling, gait and stair training. Outcome measures were range of motion (goniometer), pain (visual analogue scales), physical function (Timed Up and Go (TUG)), a 15-m walk test, and health status (Western Ontario and McMaster (WOMAC) Osteoarthritis Index). Change in outcome measures from post-surgical to 6 weeks and 6 months post-TKA were compared between groups. The primary outcome was change in knee flexion range of motion at 6 weeks.

RESULTS

84 women scheduled for TKA were randomly allocated to intervention (n = 42) or control (n = 42); mean ± (SD) age 65.1 ± 7.4 and 66.8 ± 8.9 years, respectively. The intervention group demonstrated significantly greater increase in knee flexion at both 6 weeks (median (IQR) + 10.000 (20.000) compared with + 2.500 (6.250) in the control group) and 6 months (+ 12.500 (15.000) and + 5.000 (10.000) respectively) (both p < 0.05). There were no differences between groups in secondary outcomes.

CONCLUSION

Introducing MWM for TKA rehabilitation has greater benefits for women post-TKA in increasing knee joint flexion range of motion than the standard rehabilitation programs in the short and medium-term. This evidence-based approach offers a promising adjunctive intervention for optimizing recovery and rehabilitation process following TKA in women. Clinicians should consider including MWM approach in post-TKA rehabilitation programs.

LEVEL OF EVIDENCE

I.

Impact of deep learning on pediatric elbow fracture detection: a systematic review and meta-analysis

OBJECTIVES

Pediatric elbow fractures are a common injury among children. Recent advancements in artificial intelligence (AI), particularly deep learning (DL), have shown promise in diagnosing these fractures. This study systematically evaluated the performance of DL models in detecting pediatric elbow fractures.

MATERIALS AND METHODS

A comprehensive search was conducted in PubMed (Medline), EMBASE, and IEEE Xplore for studies published up to October 20, 2023. Studies employing DL models for detecting elbow fractures in patients aged 0 to 16 years were included. Key performance metrics, including sensitivity, specificity, and area under the curve (AUC), were extracted. The study was registered in PROSPERO (ID: CRD42023470558).

RESULTS

The search identified 22 studies, of which six met the inclusion criteria for the meta-analysis. The pooled sensitivity of DL models for pediatric elbow fracture detection was 0.93 (95% CI: 0.91-0.96). Specificity values ranged from 0.84 to 0.92 across studies, with a pooled estimate of 0.89 (95% CI: 0.85-0.92). The AUC ranged from 0.91 to 0.99, with a pooled estimate of 0.95 (95% CI: 0.93-0.97). Further analysis highlighted the impact of preprocessing techniques and the choice of model backbone architecture on performance.

CONCLUSION

DL models demonstrate exceptional accuracy in detecting pediatric elbow fractures. For optimal performance, we recommend leveraging backbone architectures like ResNet, combined with manual preprocessing supervised by radiology and orthopedic experts.

Metaphyseal sleeve and straight stem fixation with or without screws for bone defect in complex primary total knee arthroplasty in Eastern Asian populations

BACKGROUND

Massive bone defects present significant challenges in complex primary total knee arthroplasty (TKA). Previous studies with limited sample sizes have demonstrated the potential of metaphyseal sleeves (MS) in addressing such defects. This study mainly aimed to assess the clinical outcomes and survivorship of MS utilized for reconstructing bone defects in complex primary TKA among East Asian patients, with a secondary focus on the use of scews for tibial residual bone defect.

METHODS

A total of 3,672 primary TKAs were performed between January 2016 and December 2020, of which 106 procedures (87 patients) utilized MS in conjunction with straight stems to address bone defects. Among these, 55 (46 patients) incorporated screws for tibial residual bone defect, while 51 (41 patients) were performed without screws. The mean follow-up period was 57.86 months, during which demographic data, operative details, clinical and radiographic outcomes, complications, and implant survivorship were recorded and analyzed.

RESULTS

All cases demonstrated successful osteointegration, with both the endpoint reoperation and revision implant survival rates reaching 100%. The mean Hospital for Special Surgery (HSS) score significantly improved from 56.98 to 82.36 at the final follow-up, resulting in an overall excellent and good outcome rate of 95.40%. Knee conditions were notably worse in the screw group compared to the non-screw group; however, the clinical and radiographic outcomes between the two groups were comparable. Postoperative tibial end-of-stem pain was reported in 9.8% of the non-screw group, while none (0%) in the screw group, reflecting marginal significance (P = 0.0548).

CONCLUSION

The application of metaphyseal sleeves with straight stems represents a promising strategy for addressing massive bone defects in complex primary TKA among East Asian patients. The cement-screw technique, providing potential biomechanical advantages, emerges as a safe and effective solution for managing residual defects surrounding MS placement in tibial site.

Pathogen Distribution, Drug Resistance, and Postoperative High-Quality Nursing Intervention Effectiveness in Knee Osteoarthritis Patients After Knee Arthroplasty With Postoperative Infection

Objective

To analyze the distribution and drug resistance of pathogens in patients with postoperative infection following knee arthroplasty (TKA) for knee osteoarthritis (KOA) and to explore the effectiveness of high-quality nursing interventions postoperatively.

Methods

A retrospective analysis was conducted on clinical data from 87 KOA patients who underwent TKA and developed postoperative wound infections (infection group) at the first Affiliated Hospital of Harbin Medical University from July 2022 to September 2024. Another 87 patients without postoperative infection during the same period were selected as the control group. Deep wound exudate samples were collected from the infection group for pathogen culture, isolation, and identification. Drug susceptibility testing was performed using the K-B disk diffusion method. Additionally, venous blood samples were collected from both the infection and control groups one week after surgery, and serum levels of inflammatory markers [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), procalcitonin (PCT)] were measured using enzyme-linked immunosorbent assay (ELISA). According to the type of nursing interventions received, the infection group was divided into the conventional care group (n=43, receiving standard orthopedic perioperative care) and the high-quality care group (n=44, receiving comprehensive high-quality care based on routine care). The pain levels [Visual Analog Scale (VAS) scores], knee joint function [Hospital for Special Surgery (HSS) knee scores], activities of daily living (modified Barthel index), and patient satisfaction [Newcastle Satisfaction with Nursing Service (NSNS) scale] were compared between the two groups.

Results

Among the 87 KOA patients with postoperative infection after TKA, 83 patients had a single pathogen infection, and 4 patients had mixed infections with two pathogens, resulting in the cultivation and isolation of 91 pathogens. Of these, 63 (69.23%) were Gram-positive bacteria, primarily Staphylococcus aureus (29.67%) and Staphylococcus epidermidis (17.58%). There were 25 (27.47%) Gram-negative bacteria, primarily Escherichia coli (9.89%) and Pseudomonas aeruginosa (6.59%). Three (3.30%) fungal strains were isolated, all identified as Candida albicans. Gram-positive bacteria showed high resistance to penicillin, benzylpenicillin, ampicillin, erythromycin, clindamycin, ciprofloxacin, and gentamicin, but low resistance to gatifloxacin, and no resistance to vancomycin or teicoplanin. Gram-negative bacteria showed high resistance to ciprofloxacin, levofloxacin, gentamicin, and tobramycin, but low resistance to cefepime, imipenem, meropenem, gatifloxacin, and amikacin. The infection group had significantly higher serum levels of IL-6, TNF-α, and PCT compared to the control group (P<0.05). The VAS scores at 24 hours, 3 days, and 7 days postoperatively were significantly lower in the high-quality care group compared to the conventional care group (P<0.05). The HSS scores and modified Barthel index scores at 3 months postoperatively were higher than preoperative values in both groups, with a greater improvement observed in the high-quality care group (P<0.05). The satisfaction rate in the high-quality care group (93.18%) was significantly higher than in the conventional care group (74.42%) (P<0.05).

Conclusion

The primary pathogens causing postoperative wound infections in KOA patients after TKA are Gram-positive bacteria, with Staphylococcus aureus and Staphylococcus epidermidis being predominant. Serum levels of inflammatory markers are significantly higher in infection patients compared to non-infection patients. High-quality nursing interventions can effectively alleviate postoperative pain, promote recovery of knee joint function, enhance activities of daily living, and improve patient satisfaction.

Prognostic Value of C-Reactive Protein in Primary Total Hip Arthroplasty

Background/Objectives: Periprosthetic joint infections (PJIs) are feared complications in arthroplasty and are associated with an increased mortality rate. PJI prevention is of paramount importance since treatment is difficult. In case of an infection, it is crucial to diagnose it at an early stage in order to initiate adequate therapy. The Musculoskeletal Infection Society (MSIS) proposed a catalog of different major and minor diagnostic criteria in 2011 to define a PJI. They were adapted in the following years. One of these criteria is the blood level of C-reactive protein (CRP). CRP is a non-specific acute-phase protein that also increases in response to various non-infectious inflammatory responses. CRP is also routinely obtained prior to total hip arthroplasty (THA) to screen for possible contraindications for arthroplasty such as an acute infection. The validity of this approach has rarely been investigated. The aim of this study was to evaluate the diagnostic value of perioperative CRP in patients receiving a THA. Methods: A total of 239 patients were included in this study and retrospectively analyzed. CRP values were obtained preoperatively and three values postoperatively. Sensitivity, specificity, area under the curve (AUC) and optimal thresholds were calculated. Results: In the whole group, 10 patients developed a PJI. No significance was demonstrated between patients without and with later PJI in terms of preoperative CRP (p = 0.182), postoperative CRP (p = 0.167), relative CRP increase (p = 0.684) and respective CRP differences (p = 0.456). We were not able to find cut-off values with adequate sensitivity and specificity. Conclusions: Perioperative CRP values do not seem to be helpful in predicting further PJI. Rather, they should be used as a screening tool to detect ongoing infections in the individual patient prior to THA. This trial should encourage studies with more statistical power due to the small effect sizes.

Spatiotemporal regulation of the bone immune microenvironment via a 'Zn2+-quercetin' hierarchical delivery system for bone regeneration

The immunoregulation of tissue-engineered bone has emerged as a prominent area for bone defect repair. While this field demonstrates considerable potential, effectively managing relevant factors and maintaining a balanced immune microenvironment in practical applications remain substantial challenges that require resolution. In this study, we tested a novel comprehensive hierarchical delivery system based on the requirements of a natural immune microenvironment for inflammatory factors, to optimize local immune responses through precise regulation of drug release. Quercetin (Que)-loaded zeolite imidazolate framework-8 (ZIF-8) nanoparticles were embedded in gelatin methacrylate to create a drug-release system featuring a Zn2+ shell and quercetin core. In vivo and in vitro studies demonstrated that this dual sustained-release hydrogel-ZIF-8 system can produce low concentrations of Zn2+ at an early stage, resulting in a mild anti-inflammatory effect and proliferation of bone marrow mesenchymal stem cells. Moreover, as inflammation advances, the release of quercetin works synergistically with Zn2+ to enhance anti-inflammatory responses, reconfigure the local microenvironment, and mitigate the inflammatory response that adversely impacts bone health by inhibiting the Nuclear Factor-kappa B (NF-κB) signaling pathway, thereby promoting osteogenic differentiation. This system is pioneering for sequential microenvironment regulation based on its diverse anti-inflammatory properties, offering a novel and comprehensive strategy for bone immune regulation in the clinical treatment of bone defects.

The sustained-release agent of total flavonoids of Rhizoma drynariae prepared by nano-mesoporous silica can still promote osteogenesis and angiogenesis in vitro

Total flavonoids of Rhizoma drynariae (TFRD) possess the ability to enhance bone formation by promoting the coupling of angiogenesis and osteogenesis. However, the limited duration of serum concentration necessitates frequent oral administration. Designing TFRD as a sustained-release agent could enhance patient's compliance and extend efficacy. Mesoporous silica nanoparticles (MSNPs) were used as a carrier for the preparation of a sustained-release agent containing TFRD (TFRD@MSNPs). Material characterization confirmed the successful loading of TFRD onto MSNPs. Subsequently, HUVECs were treated with varying concentrations of TFRD or TFRD@MSNPs to evaluate their effects on proliferation and migration ability. The secretion levels of VEGF, VCAM-1, EGF, TGF-β1, and type H endothelial markers (CD31 and EMCN) were assessed. BMSCs were cultured in conditioned medium derived from HUVECs induced by either TFRD or TFRD@MSNPs to evaluate their osteogenic potential in vitro. Gene expressions of ALP, OCN, and RUNX2, alkaline phosphatase activity, and calcium deposition were measured. The mass fraction of TFRD in the sustained release system TFRD@MSNP was approximately 60%. An appropriate concentration (< 400 µg/mL) of TFRD promoted the proliferation and migration of HUVECs, inhibited the secretion of TGF-β1, and increased the expression levels of VEGF, VCAM-1, EGF, CD31, and EMCN. The conditioned medium from HUVECs induced by TFRD significantly enhanced the osteogenic differentiation potential of BMSCs. An appropriate concentration of TFRD@MSNPs promoted the proliferation and migration of HUVECs, as well as the expression levels of CD31 and EMCN, but had no significant effect on VEGF, VCAM-1, EGF, or TGF-β1 secretion. The conditioned medium from HUVECs induced by TFRD@MSNPs increased ALP, OCN, and RUNX2 gene expression in BMSCs to varying degrees. Compared to the conditioned medium induced by TFRD in HUVECs, the conditioned medium induced by TFRD@MSNPs resulted in more calcium deposits in BMSCs. The sustained-release agent TFRD prepared by MSNPs can effectively promote the osteogenic differentiation of BMSCs through the coupling effect of angiogenesis and osteogenesis in vitro. These findings suggest that using MSNPs to formulate TFRD as sustained-release agent holds potential for clinical application, but the specific mechanism remains to be elucidated.

How much preoperative ROM and FC is a predictor for poor result after total knee arthroplasty in hemophilic arthropathy?

Aim

We aimed to explore the threshold of preoperative range of motion (ROM) and flxion contacture (FC) as a predictor of Poor knee function after TKA.

Method

A retrospective analysis was conducted on 84 Patients with haemophilia (PWH) (113 knees) who underwent knee arthroplasty in our hospital from January 2010 to December 2020 (mean follow-up 70.7 ± 22.4 months). General information, hemophilia information, surgical information, follow-up information were collected. Knees were divided into two groups: Group poor (41 knees) and Group excellent (72 knees). In the clinical evaluation, the FC, ROM and American Society Knee clinical Score (KSC), American Society Knee functional Score (KSF), Hospital for Special Surgery (HSS) scores were used preoperatively and at the final follow-up visit. Receiver operating characteristics (ROC) analysis was used to analyze the threshold of preoperative ROM and FC as a predictor of Poor knee function after TKA.

Result

Postoperative knee joint KSC, KSF, and HSS scores, as well as ROM and reduction in FC deformities at the last follow-up, improved significantly compared to preoperative levels. A notable correlation was observed between ROM and FC and the outcome of knee arthroplasty. The cutoff value of preoperative fexion contracture and ROM for poor knee function at last-follow up was 16.5° and 61.5°.

Conclusion

The study concludes that the efficacy of knee joint replacement surgery in hemophilia patients is influenced by the pre-ROM and Pre-FC. The better the pre- ROM, the better the knee efficacy. The greater the pre- flexion contracture degree, the worse the knee efficacy.

Chondrocyte-targeted bilirubin/rapamycin carrier-free nanoparticles alleviate oxidative stress and modulate autophagy for osteoarthritis therapy

Osteoarthritis (OA) is a prevalent chronic disease, characterized by the destruction of joint cartilage and synovitis, affects over 7 % of people worldwide. Disease-modifying treatments for OA still face significant challenges. Chondrocytes, as the exclusive cellular component of articular cartilage, play a pivotal role in synthesizing the intricate matrix of cartilage, thereby assuming a critical responsibility in facilitating its renewal and repair processes. However, oxidative stress within chondrocytes and subsequent apoptotic cell death plays significant roles in the progression of OA. Therefore, targeting apoptosis inhibition and mitigation of oxidative stress in chondrocytes represents a promising therapeutic strategy for OA. This study develops a type II collagen-targeting peptide (WYRGRLC) modified bilirubin/rapamycin carrier-free nanoparticle (PP/BRRP) and evaluate its therapeutic potential for OA. The PP/BRRP system exhibits remarkable chondrocyte-targeting ability, enabling the rupture of highly oxidized chondrocytes and subsequent release of bilirubin and rapamycin. This dual payload effectively scavenges reactive oxygen species, triggers autophagy, and suppresses the mTOR pathway, thereby augmenting anti-inflammatory and anti-apoptotic effects. The in vivo experiments further validate the retention and therapeutic efficacy of PP/BRRP in rat joints affected by OA. Overall, PP/BRRP exhibits significant potential for intervention and treatment of OA.

Clinical and epidemiological differences in staphylococcal osteoarticular infections: insights for developing hospital-based infection control interventions

PURPOSE

Osteoarticular infections (OAI) are serious clinical conditions with Staphylococcus aureus and Coagulase-negative Staphylococcus (CoNS) responsible for up to two-thirds of cases. This work aimed to compare the epidemiological, clinical, and microbiological characteristics of OAI caused by S. aureus versus CoNS to aid in clinical management and infection control strategies.

METHODS

A single-centre retrospective study was performed at the Centro Hospitalar e Universitário de Coimbra for the period of January 2011 to December 2021. A total of 458 cases of OAI were gathered. Data was retrieved from medical records and statistical analysis was performed with SPSS.

RESULTS

S. aureus accounted for 60.7% of infections, followed by S. epidermidis (29.9%). Independent risk factors for S. aureus infections included being male (p < 0.001; OR = 0.47) and a history of osteomyelitis (p < 0.001; OR = 0.18). In contrast, CoNS infections were associated with older age (p = 0.018), carrying a prosthetic device (p < 0.001; OR = 2.92), and a prior periprosthetic infection (p = 0.023; OR = 1.86). Both groups exhibited significant antimicrobial resistance, with CoNS showing greater resistance to gentamicin, linezolid, teicoplanin and trimethoprim-sulfamethoxazole, while S. aureus was more commonly resistant to clindamycin.

CONCLUSION

Our findings show the distinct characteristics of OAI caused by S. aureus and CoNS, highlighting the need for targeted risk factor management and tailored empiric antibiotic therapy to reduce incidence and improve outcomes.