Growth in musculoskeletal pathology worldwide: the role of Société Internationale de Chirurgie Orthopédique et de Traumatologie and publications

Composition design and performance analysis of binary and ternary Mg-Zn-Ti alloys for biomedical implants

Magnesium-based implants are highly valued in the biomedical field for biocompatibility and biodegradability, though their inherent low strength in body fluids is a limitation. This study addresses this by alloying magnesium with zinc and titanium to enhance its properties. Mechanical alloying was used to synthesize binary (Mg-Zn, Mg-Ti) and ternary (Mg-Zn-Ti) alloys, which were then compacted and sintered. The alloy powders, composed of 10 wt% Zn and 5 wt% Ti, were milled at 360 rpm for 10 h. Microstructural analysis revealed uniformly dispersed particles, with SEM confirming spherical and fine particles alongside laminates. XRD identified intermetallic compound formation. The ternary alloy demonstrated superior micro-hardness and Young's modulus similar to human bone, making it particularly promising for biomedical applications. Incorporating zinc and titanium into the magnesium matrix resulted in a ternary alloy that outperformed its binary counterparts.

Trends and Themes in the Study of Value in Orthopedic Surgery: A Systematic Review

Background

The study of value in orthopedic surgery aims to maximize health outcomes gained per unit cost through various health economic tools but is fragmented across various subspecialties and geographies. Therefore, it is difficult to ascertain whether this research methodology is being used to its full potential across all orthopedic subspecialties and geographies.

Purpose

We sought to assess the distribution of prior health economics literature in orthopedic surgery across subspecialties and geographies. The secondary aim was to identify pertinent methodologic trends that may affect the conclusions drawn.

Methods

A systematic review utilizing 3 electronic databases (Medline, Embase, and Web of Science) was performed. Inclusion criteria included prior systematic reviews assessing economic analyses across all orthopedic surgery subspecialities published between 2010 and April 24, 2021. The quality of evidence was assessed using the Assessment of Multiple Systematic Review tool. Data were qualitatively analyzed.

Results

In the 44 studies included, arthroplasty (36.4%) and spine (31.8%) were the most represented subspecialties. Almost half of studies originated from the United States (45.5%), followed by the United Kingdom (18.2%). Health economic models were most commonly from the perspective of the health care or hospital system (40.5%), followed by the societal perspective (23.5%), and the payer perspective (14.8%).

Conclusions

The study of value in orthopedic surgery is not uniformly leveraged across all subspecialties and geographies. Methodologically, the societal perspective was inadequately represented, despite orthopedic pathologies often incurring significant indirect costs (eg, time off work, rehabilitation expenses).

Impacts of post-operation loading and fixation implant on the healing process of fractured tibia

Healing of tibia demonstrates a complex mechanobiological process as it is stimulated by the major factor of strains applied by body weight. The effect of screw heads and bodies as well as their pressure distribution is often overlooked. Hence, effective mechanical conditions of the healing process of tibia can be categorized into the material of the plate and screws, post-operation loadings, and screw type and pressure. In this paper, a mathematical biodegradation model was used to simulate the PGF/PLA plate-screw device over 8 weeks. The effect of different post-operation loading patterns was studied for both locking and non-locking screws. The aim was to reach the best configuration for the most achievable healing using FEA by computing the healing pattern, trend, and efficiency with the mechano-regulation theory based on deviatoric strain. The biodegradation process of the plate and screws resulted in 82% molecular weight loss and 1.05 GPa decrease in Young's modulus during 8 weeks. The healing efficiency of the cases ranged from 4.72% to 14.75% in the first week and 18.64% to 63.05% in the eighth week. Finally, an optimal case was achieved by considering the prevention of muscle erosion, bone density reduction, and nonunion, according to the obtained results.

Insight into antibacterial effect of titanium nanotubular surfaces with focus on Staphylococcus aureus and Pseudomonas aeruginosa

Materials used for orthopedic implants should not only have physical properties close to those of bones, durability and biocompatibility, but should also exhibit a sufficient degree of antibacterial functionality. Due to its excellent properties, titanium is still a widely used material for production of orthopedic implants, but the unmodified material exhibits poor antibacterial activity. In this work, the physicochemical characteristics, such as chemical composition, crystallinity, wettability, roughness, and release of Ti ions of the titanium surface modified with nanotubular layers were analyzed and its antibacterial activity against two biofilm-forming bacterial strains responsible for prosthetic joint infection (Staphylococcus aureus and Pseudomonas aeruginosa) was investigated. Electrochemical anodization (anodic oxidation) was used to prepare two types of nanotubular arrays with nanotubes differing in dimensions (with diameters of 73 and 118 nm and lengths of 572 and 343 nm, respectively). These two surface types showed similar chemistry, crystallinity, and surface energy. The surface with smaller nanotube diameter (TNT-73) but larger values of roughness parameters was more effective against S. aureus. For P. aeruginosa the sample with a larger nanotube diameter (TNT-118) had better antibacterial effect with proven cell lysis. Antibacterial properties of titanium nanotubular surfaces with potential in implantology, which in our previous work demonstrated a positive effect on the behavior of human gingival fibroblasts, were investigated in terms of surface parameters. The interplay between nanotube diameter and roughness appeared critical for the bacterial fate on nanotubular surfaces. The relationship of nanotube diameter, values of roughness parameters, and other surface properties to bacterial behavior is discussed in detail. The study is believed to shed more light on how nanotubular surface parameters and their interplay affect antibacterial activity.

Evolution of orthopaedic diseases through four thousand three hundred years: from ancient Egypt with virtual examinations of mummies to the twenty-first century

PURPOSE

This study conducts a comprehensive comparative analysis of bone pathologies between ancient Egypt and today. We aim to elucidate the prevalence, types, and potential aetiological factors influencing skeletal disorders in these two distinct temporal and cultural contexts.

METHODS

The research employs a multidisciplinary approach, integrating osteological, paleopathological, and historical data to understand bone pathologies in mummies and the actual world. Applying radiographs and CT scans as noninvasive techniques has shed new light on past diseases such as fractures, dysplasia, osteoarthritis, surgery, and tuberculosis. Virtual inspection has almost replaced classical autopsy and is essential, especially when dealing with museum specimens.

RESULTS

Findings indicate no significant disparities in the prevalence and types of bone pathologies through 4300 years of evolution. Moreover, this study sheds light on the impact of sociocultural factors on bone health. Examination of ancient Egypt's burial practices and associated cultural beliefs provides insights into potential behavioral and ritualistic influences on bone pathologies and the prevalence of specific pathologies in the past and present.

CONCLUSION

This comparative analysis illuminates the dynamic of bone pathologies, highlighting the interplay of biological, cultural, and environmental factors. By synthesizing archeological and clinical data, this research contributes to a more nuanced understanding of skeletal health's complexities in ancient and modern societies, offering valuable insights for anthropological and clinical disciplines.

In Vivo Application of Silica-Derived Inks for Bone Tissue Engineering: A 10-Year Systematic Review

As the need for efficient, sustainable, customizable, handy and affordable substitute materials for bone repair is critical, this systematic review aimed to assess the use and outcomes of silica-derived inks to promote in vivo bone regeneration. An algorithmic selection of articles was performed following the PRISMA guidelines and PICO method. After the initial selection, 51 articles were included. Silicon in ink formulations was mostly found to be in either the native material, but associated with a secondary role, or to be a crucial additive element used to dope an existing material. The inks and materials presented here were essentially extrusion-based 3D-printed (80%), and, overall, the most investigated animal model was the rabbit (65%) with a femoral defect (51%). Quality (ARRIVE 2.0) and risk of bias (SYRCLE) assessments outlined that although a large majority of ARRIVE items were “reported”, most risks of bias were left “unclear” due to a lack of precise information. Almost all studies, despite a broad range of strategies and formulations, reported their silica-derived material to improve bone regeneration. The rising number of publications over the past few years highlights Si as a leverage element for bone tissue engineering to closely consider in the future.