Coronavirus disease 2019 pandemic: should we delay cartilage regenerative procedures and accept the consequences, or can we find a new normality?

Osteonecrosis as a manifestation of Long-COVID Syndrome: a systematic review

Purpose SARS-CoV-2 is an RNA virus responsible for COVID-19 pandemic. Some authors described the set of persistent symptoms COVID-related as "Long-COVID Syndrome." Several cases of post-COVID-19 osteonecrosis (ON) are described. Our primary aim was to study the hypothetical correlation between SARS-CoV-2 infection and ON; our secondary aim was to understand if ON can be considered part of Long-COVID. Materials and methods We performed a systematic review following the Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines. Because COVID-19 is a recently described disease, we included all levels of evidence studies. We excluded studies lacking specification regarding the use of corticosteroids (CCS) and studies not related to COVID-19. The variables extracted were age, sex, risk factors, affected joints, signs and symptoms, magnetic resonance imaging (MRI) and X-ray features, histology, treatment of COVID-19, dose and duration of treatment with CCS, treatment of ON, follow-up, and treatment outcome. Results A total of 13 studies were included, involving 95 patients and 159 joints. Time between the diagnosis of COVID-19 and the onset of symptoms related to ON was 16 weeks on average. Time between the onset of symptoms and the MRI was 6 weeks. An average of 926.4 mg of prednisolone equivalent per patient were administered. On average, CCS were administered for 20.6 days. Conclusions Patients with a history of COVID-19 infection developed osteonecrosis prematurely and with a lower dose of CCS than usually reported in the literature. Symptoms of osteonecrosis occur within the interval of the period described as Long-COVID. Surgeons should not underestimate the persistence of arthralgia when a history of SARS-CoV-2 infection and use of CCS is reported.

COVID-19 (SARS-CoV-2) lymphocyte responses are associated with inflammatory biomarkers in total joint replacement surgery candidates pre-operatively

Background

Recent studies indicate that, in addition to antibody production, lymphocyte responses to SARS-CoV-2 may play an important role in protective immunity to COVID-19 and a percentage of the general population may exhibit lymphocyte memory due to unknown/asymptomatic exposure to SARS-CoV-2 or cross-reactivity to other more common coronaviruses pre-vaccination. Total joint replacement (TJR) candidates returning to elective surgeries (median age 68 years) may exhibit similar lymphocyte and/or antibody protection to COVID-19 prior to vaccination

Methods

In this retrospective study, we analyzed antibody titters, lymphocyte memory, and inflammatory biomarkers specific for the Spike and Nucleocapsid proteins of the SARS-CoV-2 virus in a cohort of n=73 returning TJR candidates (knees and/or hips) pre-operatively.

Results

Peripheral blood serum of TJR candidate patients exhibited a positivity rate of 18.4% and 4% for IgG antibodies specific for SARS-CoV-2 nucleocapsid and spike proteins, respectively. 13.5% of TJR candidates exhibited positive lymphocyte reactivity (SI > 2) to the SARS-CoV-2 nucleocapsid protein and 38% to the spike protein. SARS-CoV-2 reactive lymphocytes exhibited a higher production of inflammatory biomarkers (i.e., IL-1β, IL-6, TNFα, and IL-1RA) compared to non-reactive lymphocytes.

Conclusions

A percentage of TJR candidates returning for elective surgeries exhibit pre-vaccination positive SARS-CoV-2 antibodies and T cell memory responses with associated pro-inflammatory biomarkers. This is an important parameter for understanding immunity, risk profiles, and may aid pre-operative planning.

Trial registration

Retrospectively registered.

COVID-19 Impact on Musculoskeletal Regenerative Medicine Research: Maintaining Lab Continuity

BACKGROUND

Research in the fields of musculoskeletal tissue engineering and regenerative medicine may suffer a slowdown during the ongoing COVID-19 pandemic emergency. This is likely to harm the development of new therapeutic strategies and their translation into the clinic in the long term. Recently, the need to maintain continuity in research activities in those fields has assumed even greater importance due to the accumulation of data concerning the effects of SARS-CoV-2 on the musculoskeletal system. This study is aimed at the identification of a series of safe handling practices against COVID-19 diffusion to apply in a research environment, thus allowing the maintenance of research lab activities.

METHODS

The control measures to apply to mitigate the COVID-19 risk were identified and categorized utilizing the Hierarchy of Controls. We also compared our analysis with that assessed before the pandemic to consider the additional risk of COVID-19.

RESULTS

Results highlighted that the most relevant implemented measures to control SARS-CoV-2 were based on protecting people through engineering (e.g., ventilation and social distancing), and administrative (e.g., hand sanitization, work shifts) measures or Personnel Protective Equipment, rather than eliminating hazards at the source (e.g., smart working).

CONCLUSIONS

Work continuity in research labs during the COVID-19 emergency should be guaranteed by ensuring the protection of researchers in the workplace and considering the physical environment, the type of operators and work activity, and the proven ability of workers to face biological risks. The increased knowledge and awareness on lab' risks should be useful to prevent and mitigate future viral outbreaks.