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Osman AE, El-Adly W, Haroun KM, Khaled M, Khalifa AA. Locally obtained autologous bone grafts are effective for achieving arthrodesis while managing foot and ankle charcot's neuroarthropathy: short to mid-term results from a specialized north African foot and ankle surgery unit. J Orthop Surg Res 2024; 19:570. [PMID: 39285265 PMCID: PMC11406869 DOI: 10.1186/s13018-024-05036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 08/27/2024] [Indexed: 09/19/2024] Open
Abstract
PURPOSE We aimed to report the union rate after only utilizing a locally obtained autologous bone graft while correcting the deformity and performing joint arthrodesis in patients with foot and ankle Charcot neuropathy (CN) and to report on the radiographic, functional, complications incidence outcomes at a minimum of two years of follow up. METHODS We included 24 patients having a mean age of 55.4 ± 10.1 years diagnosed with CN of the foot, ankle, or both. Seven (29.2%) cases were classified as Brodsky type 1, 11 (45.8%) as type 3 A, and six (25%) were type 4. Hindfoot and Midfoot bi-columnar arthrodesis was performed in 70.8% and 29.2% of the patients, respectively. Eight (33.3%) cases had preoperative ulcers. Functional outcomes were evaluated using a modified AOFAS score. Arthrodesis site union was assessed clinically and radiographically. All patients were available for a mean follow up of 35.7 ± 9.5 (24-54) months. RESULTS Arthrodesis site union was achieved in 23 (95.8%) cases after a mean of 4 ± 1.7 (2-7.5) months. The mean modified AOFAS score was 72.4 ± 10.41 (46-83) points; 79.2% achieved excellent and good scores. Ulcers healed in 87.5% of the patients. Twenty-two (91.7%) patients were satisfied with their functional results. Infection incidence was 12.5%, and no patients required revision or amputation. CONCLUSION Foot and ankle Charcot neuroarthropathy deformity correction by arthrodesis of the affected joint as a salvage management option resulted in acceptable clinical and radiological outcomes. To enhance the local environment for arthrodesis consolidation, locally obtained autografts led to higher union rates and avoided the drawbacks of using other graft types.
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Affiliation(s)
| | - Wael El-Adly
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
| | | | - Mohamed Khaled
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed A Khalifa
- Orthopaedic Department, Qena faculty of medicine and University Hospital, South Valley University, Qena, Egypt.
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Bolia IK, Covell DJ, Tan EW. Comparative Studies of Bone Graft and Orthobiologics for Foot Ankle Arthrodesis: A Critical Review. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00004. [PMID: 38704857 PMCID: PMC11068146 DOI: 10.5435/jaaosglobal-d-23-00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/03/2024] [Indexed: 05/07/2024]
Abstract
Graft materials available to supplement hindfoot and ankle arthrodesis procedures include autologous (autograft) or allogeneic bone graft (allograft) but also bone graft substitutes such as demineralized bone matrix, calcium sulfate, calcium phosphate, and tricalcium phosphate/hydroxyapatite. In addition, biologic agents, such as recombinant human bone morphogenetic protein-2 or recombinant human platelet derived growth factor-BB (rhPDGF-BB), and preparations, including platelet-rich plasma or concentrated bone marrow aspirate, have been used to facilitate bone healing in ankle or hindfoot arthrodesis. The purpose of this review was to summarize the available clinical evidence surrounding the utilization and efficacy of the above materials and biological agents in ankle or hindfoot arthrodesis procedures, with emphasis on the quality of the existing evidence to facilitate clinical decision making.
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Affiliation(s)
- Ioanna K Bolia
- From the Department of Orthopeadic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA (Dr. Bolia, and Dr. Tan), and the Danville Orthopeadics and Sports Medicine, Danville, KY (Dr. Covell)
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Knapp G, Pawelke J, Heiss C, Elmas S, Vinayahalingam V, ElKhassawna T. Traumatic Fracture Treatment: Calcium Phosphate Bone Substitute Case-Control Study in Humerus, Radius, Tibia Fractures-Assessing Efficacy and Recovery Outcomes. Biomedicines 2023; 11:2862. [PMID: 37893234 PMCID: PMC10604612 DOI: 10.3390/biomedicines11102862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
To date, insufficient investigation has been carried out on the biocompatibility of synthetic bioactive bone substitute materials after traumatically induced bone fractures in clinical conditions. This study encompasses the safety, resorption, healing process, and complications of surgical treatment. Our current hypothesis posits that calcium phosphate-based bone substitutes could improve bone healing. In this retrospective case-control study, over 290 patients who underwent surgical treatment for acute fractures were examined. Bone defects were augmented with calcium phosphate-based bone substitute material (CP) in comparison to with empty defect treatment (ED) between 2011 and 2018. A novel scoring system for fracture healing was introduced to assess bone healing in up to six radiological follow-up examinations. Furthermore, demographic data, concomitant diseases, and complications were subjected to analysis. Data analysis disclosed significantly fewer postoperative complications in the CP group relative to the ED group (p < 0.001). The CP group revealed decreased risks of experiencing complications (p < 0.001), arthrosis (p = 0.01), and neurological diseases (p < 0.001). The fracture edge, the fracture gap, and the articular surface were definably enhanced. Osteosynthesis and general bone density demonstrated similarity (p > 0.05). Subgroup analysis focusing on patients aged 64 years and older revealed a diminished complication incidence within the CP group (p = 0.025). Notably, the application of CP bone substitute materials showed discernible benefits in geriatric patients, evident by decreased rates of pseudarthrosis (p = 0.059). Intermediate follow-up evaluations disclosed marked enhancements in fracture gap, edge, and articular surface conditions through the utilization of CP-based substitutes (p < 0.05). In conclusion, calcium phosphate-based bone substitute materials assert their clinical integrity by demonstrating safety in clinical applications. They substantiate an accelerated early osseous healing trajectory while concurrently decreasing the severity of complications within the bone substitute cohort. In vivo advantages were demonstrated for CP bone graft substitutes.
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Affiliation(s)
- Gero Knapp
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.H.); (S.E.)
| | - Jonas Pawelke
- Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (J.P.); (V.V.); (T.E.)
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.H.); (S.E.)
| | - Sera Elmas
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.H.); (S.E.)
| | - Vithusha Vinayahalingam
- Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (J.P.); (V.V.); (T.E.)
| | - Thaqif ElKhassawna
- Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (J.P.); (V.V.); (T.E.)
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Loveland JD. A retrospective review of recombinant human platelet-derived growth factor with beta-tricalcium phosphate bone graft substitute use in hindfoot and/or ankle arthrodesis. J Orthop 2023; 44:93-98. [PMID: 37727282 PMCID: PMC10505666 DOI: 10.1016/j.jor.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023] Open
Abstract
Background Nonunion following foot and ankle arthrodesis can cause chronic pain and disability, poor patient satisfaction, and increased healthcare costs. Nonunion rates are reported in 10%-12% of primary foot and/or ankle arthrodesis procedures, with significantly greater rates among patients with high-risk factors such as smoking, diabetes, obesity, or Charcot neuroarthropathy. Recombinant human platelet-derived growth factor BB-homodimer with beta-tricalcium phosphate (rhPDGF-BB/β-TCP) is a bone graft substitute that has demonstrated efficacy in foot and ankle fusion rates that are comparable to autograft. Methods Charts and radiographs were retrospectively reviewed on consecutive adult patients undergoing talonavicular, calcaneal-cuboid, subtalar, and/or ankle arthrodesis utilizing rhPDGF-BB/β-TCP bone graft substitute. The primary outcome measures were rate of and mean time to fusion, mean time to return to function, and incidence of adverse events. Results This study reviewed133 patients who underwent 209 hindfoot and/or ankle joint arthrodesis procedures with a mean follow-up 20.34 ± 11.05 months. The overall fusion rate was 92.82% (194/209 joints) with a mean time to fusion of 13.14 ± 2.52 weeks and return to function of 16.56 ± 3.26 weeks. Overall, there were 7 (5.26%) patients who experienced an adverse event (AE) with 15 (7.18%) joints experiencing a nonunion. Conclusion Fusion rates with rhPDGF-BB/β-TCP bone grafting material compared favorably to autograft controls when used in hindfoot and/or ankle arthrodesis. No AEwas related to rhPDGF-BB/β-TCP. This study suggests that using rhPDGF-BB/β-TCP is effective in hindfoot and/or ankle arthrodesis, even among patients with comorbidities who are at a higher risk of developing a nonunion. Level of clinical evidence 3.
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Affiliation(s)
- Jeffrey D. Loveland
- Central Tennessee Foot and Ankle Center, 415 Sewell Road, Sparta, TN, 38583, USA
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Galagali DA, Bhatia A, Kumar P. A, Ajoy SM. Fresh Fractures: A New Indication for Use of Bone Allografts-A 10-Year Data Analysis. Indian J Orthop 2023; 57:1490-1496. [PMID: 37609015 PMCID: PMC10441971 DOI: 10.1007/s43465-023-00953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
Background Tissue banking includes the process starting from procurement to the distribution and usage of allograft tissues. The use of bone bank in orthopaedics is not widely seen. Our objective is to describe the 10-year allograft donor and recipient data from a fully functioning tissue bank in India, analyse the types of grafts used, indications and demand for various grafts. This will show the need for a tissue bank in a tertiary care orthopaedic setup. Methods Analysis of donor and recipient data for allografts of a tissue bank in an Indian tertiary care setup was done from 2012 to 2022. The number of grafts procured and used were analysed. The recipient and donor sites were also analysed. Results In 10 years, the tissue bank provided 2776 grafts and received 1962 donations. Slices procured after total knee replacements were the most commonly used allografts (28.03%). Acute fracture with bone loss or severe comminution (23.11%) being the most common indication of bone grafting was a major result of our study. Among these, proximal tibia (27.79%) was the most frequent recipient site. Tissue bank has also served patients in neurosurgery, ophthalmology, oromaxillofacial surgery, otorhinolaryngology, urology and wound care. Conclusion A tissue bank is a useful setup in tertiary care orthopaedic hospitals. Allografts were most widely used for acute trauma management. Allografts provide large graft quantity and reduce surgical time. Hence a tissue bank is not only an asset to the establishment but also to the surrounding hospitals, to which the grafts can be supplied.
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Affiliation(s)
- Dev Anand Galagali
- Department of Orthopaedics, Ramaiah Medical College and Hospitals, Mathikere, Bangalore, Karnataka 560054 India
| | - Aanchal Bhatia
- Department of Orthopaedics, Ramaiah Medical College and Hospitals, Mathikere, Bangalore, Karnataka 560054 India
| | - Ashok Kumar P.
- Department of Orthopaedics, Ramaiah Medical College and Hospitals, Mathikere, Bangalore, Karnataka 560054 India
| | - S. M. Ajoy
- Department of Orthopaedics, Ramaiah Medical College and Hospitals, Mathikere, Bangalore, Karnataka 560054 India
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Tokeshi S, Fukawa T, Itadera E, Akazawa T, Fujiyoshi T, Takaso M, Nakagawa K, Yamauchi T, Osada N, Ohtori S. Efficacy and Safety of Beta-Tricalcium Phosphate/Polylactic-Co-Glycolic Acid for Implantation of Bone Defects. Cureus 2023; 15:e43597. [PMID: 37719590 PMCID: PMC10504055 DOI: 10.7759/cureus.43597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Bone defects are often observed after surgery for fractures and bone tumors. Their treatment is technically difficult and sometimes results in negative clinical and economic outcomes. To repair bone defects, a bone graft is implanted by selecting a transplant material from an autologous or artificial bone. Each method has its advantages and disadvantages. Compared to the gold standard of autologous bone graft, bone graft substitutes are not limited by the amount of harvested graft and avoid complications at the donor site. ORB-03 is a new cotton-like bone graft substitute composed of beta-tricalcium phosphate (β-TCP) and a bioabsorbable polymer, polylactic-co-glycolic acid (PLGA). ORB-03 is easy to mold and can fill various bone defect shapes, and its three-dimensional microfiber scaffold can enhance the differentiation of osteoblasts and promote osteogenesis. We investigated the efficacy, ease of handling, and safety of ORB-03 as a bone graft substitute. A multicenter, open-label, single-group study was conducted at six institutions. METHODS Between July 2018 and August 2019, 60 patients with bone defects caused by fracture, benign tumors, or an iliac donor site from bone harvesting were enrolled in this study; 54 patients were finally included for the safety analysis and 48 patients for the image analysis. During surgery, ORB-03 was mixed with the patient's blood and molded into a bone defect. To evaluate the efficacy of ORB-03, radiography and computed tomography (CT) were performed at intervals until 24 weeks after surgery. RESULTS The effective rate and its accurate bilateral 95% confidence interval (CI) were calculated based on the efficacy criteria at 24 weeks postoperatively. The ease with which ORB-03 could be handled in surgery was evaluated. Adverse events that occurred after surgery were evaluated, and those associated with ORB-03 were examined. Bone fusion was good in all cases, and the radiography and CT effective rates were 100.0% and 91.5%, respectively. Handling was easy in all cases. There were four adverse events, none of which were clinically problematic. CONCLUSIONS ORB-03 was found to be easy to handle, safe, and effective as a bone graft substitute for bone defects.
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Affiliation(s)
- Soichiro Tokeshi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
| | | | | | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University, Kawasaki-City, JPN
| | | | - Masashi Takaso
- Orthopaedic Surgery, Kitasato University, Sagamihara, JPN
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, JPN
| | | | - Naoki Osada
- Orthopaedics, ORTHOReBIRTH Co., Yokohama, JPN
| | - Seiji Ohtori
- Orthopaedics, Chiba University Hospital, Chiba, JPN
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
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Kavarthapu V, Giddie J, Kommalapati V, Casey J, Bates M, Vas P. Evaluation of Adjuvant Antibiotic Loaded Injectable Bio-Composite Material in Diabetic Foot Osteomyelitis and Charcot Foot Reconstruction. J Clin Med 2023; 12:jcm12093239. [PMID: 37176679 PMCID: PMC10179343 DOI: 10.3390/jcm12093239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
The management of diabetic foot osteomyelitis (DFO) is extremely challenging with high amputation rates reported alongside a five-year mortality risk of more than fifty percent. We describe our experience in using adjuvant antibiotic-loaded bio-composite material (Cerament) in the surgical management of DFO and infected Charcot foot reconstruction. We undertook a retrospective evaluation of 53 consecutive patients (54 feet) who underwent Gentamicin or Vancomycin-loaded Cerament application during surgery. The feet were categorised into two groups: Group 1, with infected ulcer and DFO, managed with radical debridement only (n = 17), and Group 2, requiring reconstruction surgery for infected and deformed Charcot foot. Group 2 was further subdivided into 2a, with feet previously cleared of infection and undergoing a single-stage reconstruction (n = 19), and 2b, with feet having an active infection managed with a two-stage reconstruction (n = 18). The mean age was 56 years (27-83) and 59% (31/53) were males. The mean BMI was 30.2 kg/m2 (20.8-45.5). Foot ulcers were present in 69% (37/54) feet. At a mean follow-up of 30 months (12-98), there were two patients lost to follow up and the mortality rate was 11% (n = 5). The mean duration of post-operative systemic antibiotic administration was 20 days (4-42). Thirteen out of fifteen feet (87%) in group 1 achieved complete eradication of infection. There was a 100% primary ulcer resolution, 100% limb salvage and 76% bony union rate within Group 2. However, five patients, all in group 2, required reoperations due to problems with bone union. The use of antibiotic-loaded Cerament resulted in a high proportion of patients achieving infection clearance, functional limb salvage and decrease in the duration of postoperative antibiotic therapy. Larger, preferably randomised, studies are required to further validate these observations.
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Affiliation(s)
- Venu Kavarthapu
- Department of Orthopedic Surgery, King's College NHS Foundation Trust, London SE5 9RS, UK
| | - Jasdeep Giddie
- Department of Orthopedic Surgery, King's College NHS Foundation Trust, London SE5 9RS, UK
| | - Varun Kommalapati
- Department of Orthopedic Surgery, King's College NHS Foundation Trust, London SE5 9RS, UK
| | - Joanne Casey
- Diabetes Foot Clinic, King's College NHS Foundation Trust, London SE5 9RS, UK
| | - Maureen Bates
- Diabetes Foot Clinic, King's College NHS Foundation Trust, London SE5 9RS, UK
| | - Prashanth Vas
- Diabetes Foot Clinic, King's College NHS Foundation Trust, London SE5 9RS, UK
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Oloff LM, Wilhelm I, Vora NS. Orthobiologic Use in Sports Injuries. Clin Podiatr Med Surg 2023; 40:169-179. [PMID: 36368841 DOI: 10.1016/j.cpm.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Orthobiologics have gained much popularity in recent years but there has not been a large amount of clinical evidence to support their use. In the limited research that has been published, they have been shown to be effective and safe. They can assist in earlier return to activity with the avoidance of surgery. They can also augment current surgical practice to aid in healing and return to sport with few complications. With new medical innovation, there is unfortunately a higher cost for these products. The use of orthobiologics will only grow and so will the need for high-level clinical evidence.
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Affiliation(s)
- Lawrence M Oloff
- Saint Mary's Medical Center, 450 Stanyan Street, San Francisco, CA 94117, USA.
| | - Isaac Wilhelm
- Saint Mary's Medical Center, 450 Stanyan Street, San Francisco, CA 94117, USA
| | - Nishit S Vora
- 1501 Trousdale Drive, Suite 115, Burlingame, CA 94010, USA
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Cardoso DV, Veljkovic A. General Considerations About Foot and Ankle Arthrodesis. Any Way to Improve Our Results? Foot Ankle Clin 2022; 27:701-722. [PMID: 36368793 DOI: 10.1016/j.fcl.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nonunion and adjacent joint osteoarthritis (OA) are known complications after a fusion procedure, and foot and ankle surgeons are commonly exposed to such disabling complications. Determining who is at risk of developing nonunion is essential to reducing nonunion rates and improving patient outcomes. Several evidenced-based modifiable risk factors related to adverse outcomes after foot and ankle arthrodesis have been identified. Patient-related risk factors that can be improved before surgery include smoking cessation, good diabetic control (HbAc1 <7%) and vitamin D supplementation. Intraoperatively, using less invasive techniques, avoiding joint preparation with power tools, using bone grafts or orthobiologics in more complex cases, high-risk patients, nonunion revision surgeries, and filling in bone voids at the arthrodesis site should be considered. Postoperatively, pain management with NSAIDs should be limited to a short period (<2 weeks) and avoided in high-risk patients. Furthermore, early postoperative weight-bearing has shown to be beneficial, and it does not seem to increase postoperative complications. The incidence of surrounding joint OA after foot and ankle fusion seems to increase progressively with time. Owing to its progression and high probability of being symptomatic, patients must be informed consequently, as they may require additional joint fusions, resulting in further loss of ankle/foot motion. In patients with symptomatic adjacent joint OA and unsatisfactory results after an ankle arthrodesis, conversion to total ankle arthroplasty (TAA) has become a potential option in managing these complex and challenging situations.
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Affiliation(s)
- Diogo Vieira Cardoso
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland.
| | - Andrea Veljkovic
- Division of Orthopaedics and Trauma Surgery, British Columbia University, Vancouver, Canada
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Does Demineralized Bone Matrix Affect the Nonunion Rate in Arthroscopic Ankle Arthrodesis? J Clin Med 2022; 11:jcm11133893. [PMID: 35807177 PMCID: PMC9267684 DOI: 10.3390/jcm11133893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Demineralized bone matrix (DBM) has been shown to have positive effects on union rates in many orthopedic subspecialties; however, minimal evidence exists about bone graft substitutes in foot and ankle surgery. The purpose of this study is to compare nonunion rates in arthroscopic ankle arthrodesis in patients receiving DBM with those without. We hypothesized DBM to be associated with a decreased risk of nonunion. This retrospective review includes 516 consecutive ankle arthrodesis cases from March 2002 to May 2016. Of these, 58 ankles (56 patients) that underwent primary arthroscopic ankle arthrodesis met the inclusion criteria, and 31 of these ankles received DBM, while 27 did not. Nonunion was assessed by clinical examination and routine postoperative radiographs. If nonunion was suspected, a computed tomography (CT) scan was performed. The primary outcome measure was nonunion rate. Secondary outcome measures included wound complications, return to operating room (OR), and rate of postoperative deep vein thrombosis (DVT) or pulmonary embolism (PE). From the study cases, 58 were available for final follow-up. The average age was 55.9 years (±17.4), and mean follow-up was 43.0 months (range 6.3–119.4). There was no difference in nonunion rate in patients who received DBM (4/31, 12.9%) versus those who did not (4/27, 14.8%) (p = 0.83). Similarly, when comparing the two groups, there were no statistically significant differences in superficial wound complications (6.5% vs. 3.7%, p = 1.0) or rate of return to OR (29% or 0.037/person-years vs. 37% or 0.099/person-years; p = 0.20). No major complications including deep wound infections, DVTs, or PEs occurred. This is the largest study to directly compare nonunion rates and complications for patients receiving DBM versus those who did not in primary arthroscopic ankle arthrodesis. No significant association was found between DBM usage and risk of nonunion, wound complications, return to OR, or postoperative DVT or PE development.
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Attia AK, Robertson GAJ, McKinley J, d'Hooghe PP, Maffulli N. Surgical Management of Jones Fractures in Athletes: Orthobiologic Augmentation: A Systematic Review and Meta-analysis of 718 Fractures. Am J Sports Med 2022:3635465221094014. [PMID: 35612823 DOI: 10.1177/03635465221094014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of orthobiologics is expanding. However, the use of orthobiologic augmentation in primary fracture fixation surgery remains limited. Primary fracture fixation of the fifth metatarsal (Jones) in athletes is one of the rare situations where primary orthobiologic augmentation has been advocated. PURPOSE To determine the effect of orthobiologic augmentation on the outcome of surgically managed Jones fractures in athletes. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, and ClinicalTrials.gov through March 2021 to identify studies reporting on surgically managed Jones fractures of the fifth metatarsal exclusively in athletes. The primary outcomes were the return to play (RTP) rate and time to RTP, whereas the secondary outcomes were time to union, union rate, and refractures. Data were presented by type of treatment (biologically augmented fixation or fixation alone). RESULTS In the biologically augmented fixation group, successful RTP was reported in 195 (98.98%) of 197 fractures (odds ratio [OR], 97.5%; 95% CI, 95.8%-100%; I2 = 0), with a mean time to RTP of 10.3 weeks (95% CI, 9.5-11.1 weeks; I2 = 99%). In the group that received fixation without biological augmentation, successful RTP was reported in 516 (99.04%) of 521 fractures (OR, 98.7%; 95% CI, 97.8%-99.7%; I2 = 0], with a mean time to RTP of 9.7 weeks (95% CI, 7.84-11.53 weeks; I2 = 98.64%]. In the biologically augmented fixation group, fracture union was achieved in 194 (98.48%) of 197 fractures (OR, 97.6%; 95% CI, 95.5%-99.7%; I2 = 0%), with a mean time to fracture union of 9.28 weeks (95% CI, 7.23-11.34 weeks; I2 = 98.18%). In the group that received fixation without biological augmentation, fracture union was achieved in 407 (93.78%) of 434 fractures (OR, 97.4%; 95% CI, 96%-98.9%; I2 = 0%), with a mean time to fracture union of 8.57 weeks (95% CI, 6.82-10.32 weeks; I2 = 98.81%). CONCLUSION Orthobiologically augmented surgical fixation of Jones fractures in athletes is becoming increasingly common, despite the lack of comparative studies to support this practice. Biologically augmented fixation of Jones fractures results in higher fracture union rates than fixation alone but similar rates of RTP and time to RTP. Although the current evidence recommends primary surgical fixation for the management of Jones fractures in athletes, further high quality comparative studies are required to establish the indication for orthobiologic augmentation.
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Affiliation(s)
| | | | | | | | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Italy
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Role of Implantable Drug Delivery Devices with Dual Platform Capabilities in the Prevention and Treatment of Bacterial Osteomyelitis. Bioengineering (Basel) 2022; 9:bioengineering9020065. [PMID: 35200418 PMCID: PMC8869141 DOI: 10.3390/bioengineering9020065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022] Open
Abstract
As medicine advances and physicians are able to provide patients with innovative solutions, including placement of temporary or permanent medical devices that drastically improve quality of life of the patient, there is the persistent, recurring problem of chronic bacterial infection, including osteomyelitis. Osteomyelitis can manifest as a result of traumatic or contaminated wounds or implant-associated infections. This bacterial infection can persist as a result of inadequate treatment regimens or the presence of biofilm on implanted medical devices. One strategy to mitigate these concerns is the use of implantable medical devices that simultaneously act as local drug delivery devices (DDDs). This classification of device has the potential to prevent or aid in clearing chronic bacterial infection by delivering effective doses of antibiotics to the area of interest and can be engineered to simultaneously aid in tissue regeneration. This review will provide a background on bacterial infection and current therapies as well as current and prospective implantable DDDs, with a particular emphasis on local DDDs to combat bacterial osteomyelitis.
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Xu Y, Zhang F, Zhai W, Cheng S, Li J, Wang Y. Unraveling of Advances in 3D-Printed Polymer-Based Bone Scaffolds. Polymers (Basel) 2022; 14:566. [PMID: 35160556 PMCID: PMC8840342 DOI: 10.3390/polym14030566] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023] Open
Abstract
The repair of large-area irregular bone defects is one of the complex problems in orthopedic clinical treatment. The bone repair scaffolds currently studied include electrospun membrane, hydrogel, bone cement, 3D printed bone tissue scaffolds, etc., among which 3D printed polymer-based scaffolds Bone scaffolds are the most promising for clinical applications. This is because 3D printing is modeled based on the im-aging results of actual bone defects so that the printed scaffolds can perfectly fit the bone defect, and the printed components can be adjusted to promote Osteogenesis. This review introduces a variety of 3D printing technologies and bone healing processes, reviews previous studies on the characteristics of commonly used natural or synthetic polymers, and clinical applications of 3D printed bone tissue scaffolds, analyzes and elaborates the characteristics of ideal bone tissue scaffolds, from t he progress of 3D printing bone tissue scaffolds were summarized in many aspects. The challenges and potential prospects in this direction were discussed.
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Affiliation(s)
- Yuanhang Xu
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Affiliated Hospital of Hebei University, Baoding 071000, China; (Y.X.); (F.Z.); (W.Z.); (S.C.)
| | - Feiyang Zhang
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Affiliated Hospital of Hebei University, Baoding 071000, China; (Y.X.); (F.Z.); (W.Z.); (S.C.)
| | - Weijie Zhai
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Affiliated Hospital of Hebei University, Baoding 071000, China; (Y.X.); (F.Z.); (W.Z.); (S.C.)
| | - Shujie Cheng
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Affiliated Hospital of Hebei University, Baoding 071000, China; (Y.X.); (F.Z.); (W.Z.); (S.C.)
| | - Jinghua Li
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Affiliated Hospital of Hebei University, Baoding 071000, China; (Y.X.); (F.Z.); (W.Z.); (S.C.)
| | - Yi Wang
- Basic Research Key Laboratory of General Surgery for Digital Medicine, Affiliated Hospital of Hebei University, Baoding 071000, China; (Y.X.); (F.Z.); (W.Z.); (S.C.)
- National United Engineering Laboratory for Advanced Bearing Tribology, Henan University of Science and Technology, Luoyang 471000, China
- Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China
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14
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Norbertczak HT, Fermor HL, Edwards JH, Rooney P, Ingham E, Herbert A. Decellularised human bone allograft from different anatomical sites as a basis for functionally stratified repair material for bone defects. J Mech Behav Biomed Mater 2021; 125:104965. [PMID: 34808451 DOI: 10.1016/j.jmbbm.2021.104965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/06/2021] [Accepted: 11/06/2021] [Indexed: 12/12/2022]
Abstract
Tissue engineered bone solutions aim to overcome the limitations of autologous and allogeneic grafts. Decellularised tissues are produced by washing cellular components from human or animal tissue to produce an immunologically safe and biocompatible scaffold, capable of integration following implantation. A decellularisation procedure utilising low concentration sodium dodecyl sulphate (0.1% w/v) was applied to trabecular bone from human femoral heads (FH) and tibial plateaus (TP). Biological (histology, DNA quantification), biomechanical (compression testing) and structural (μCT) comparisons were made between decellularised and unprocessed cellular tissue. Total DNA levels of decellularised FH and TP bone were below 50 ng mg-1 dry tissue weight and nuclear material was removed. No differences were found between cellular and decellularised bone, from each anatomical region, for all the biomechanical and structural parameters investigated. Differences were found between cellular FH and TP and between decellularised FH and TP. Decellularised FH had a higher ultimate compressive stress, Young's modulus and 0.2% proof stress than decellularised TP (p = 0.001, 0.002, 0.001, Mann Whitney U test, MWU). The mineral density of cellular and decellularised TP bone was significantly greater than cellular and decellularised FH bone respectively (cellular: p = 0.001, decellularised: p < 0.001, MWU). The bone volume fraction and trabecular thickness of cellular and decellularised FH bone were significantly greater than cellular and decellularised TP bone respectively (cellular: p = 0.001, 0.005; decellularised: p < 0.001, <0.001, MWU). Characterisation of decellularised trabecular bone from different anatomical regions offers the possibility of product stratification, allowing selection of biomechanical properties to match particular anatomical regions undergoing bone graft procedures.
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Affiliation(s)
- Halina T Norbertczak
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom.
| | - Hazel L Fermor
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Jennifer H Edwards
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Paul Rooney
- NHS Blood and Transplant Tissue and Eye Services, Liverpool, United Kingdom
| | - Eileen Ingham
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Anthony Herbert
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, United Kingdom
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15
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Loveland JD, McMillen RL, Cala MA. A Multicenter, Retrospective, Case Series of Patients With Charcot Neuroarthropathy Deformities Undergoing Arthrodesis Utilizing Recombinant Human Platelet-derived Growth Factor With Beta-Tricalcium Phosphate. J Foot Ankle Surg 2021; 60:74-79. [PMID: 33158722 DOI: 10.1053/j.jfas.2020.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 05/20/2020] [Accepted: 08/31/2020] [Indexed: 02/03/2023]
Abstract
Charcot neuroarthropathy has traditionally been treated using both nonsurgical and surgical strategies. Recently, orthobiologics have been used to promote arthrodesis in Charcot reconstructions, obviating the need for bone graft in some cases. Recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) in combination with beta-tricalcium phosphate scaffold (β-TCP) is a bone graft substitute shown to have comparable efficacy to autograft in incidence of foot and ankle fusion. This multicenter, consecutive case series analyzed patients undergoing Charcot reconstructions utilizing rhPDGF-BB/β-TCP for joint fusion. In this cohort, 98 patients (62.24% male) with a mean age of 62.82 ± 10.28 years (range 40-87) had a fusion incidence of 217 of 223 joints (97.31%) with a mean time to fusion of 13.09 ± 4.87 weeks (range 6-30). There were 6 nonunions in the patient population. Fusion was defined as ≥50% osseous bridging based on computed tomography and/or radiographic consolidation, in addition to clinical findings. With an overall complication rate of 26.53% (26/98), adverse events occurring in more than 1 patient limb included hardware failures (n = 7, 7.14%), infection (n = 4, 4.08%), wound dehiscence (n = 4, 4.08%), amputation (n = 3, 3.06%), and death (n = 2, 2.04%). There were no adverse events related to the grafting material. From this review, we found rhPDGF-BB/β-TCP to be a safe and effective graft material that can be considered a viable alternative to autograft, even in high-risk patients such as those with Charcot neuroarthropathy.
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Affiliation(s)
- Jeffrey D Loveland
- Foot and Ankle Surgeon, Central Tennessee Foot and Ankle Center, Sparta, TN.
| | - Ryan L McMillen
- Foot and Ankle Surgeon, Allegheny Health Network, Pittsburgh, PA
| | - Mario A Cala
- Foot and Ankle Surgeon, PerfectFeetCare Podiatry Centers, Miami, FL
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16
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Kayalı C, Ozan F, Altay T, Karahan HG, Yamak K, Özdemir S. Efficacy of calcium phosphate cementing in the surgical treatment of Sanders Type II and III calcaneal fractures using screw fixation with sinus tarsi approach. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2021; 55:265-270. [PMID: 34100369 PMCID: PMC10566355 DOI: 10.5152/j.aott.2021.20188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/05/2020] [Accepted: 11/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to determine the effectiveness of calcium phosphate cementing in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach. METHODS In this retrospective study, 85 feet of 84 patients (74 males, 10 females; mean age 43 [17-61] years) in whom screw fixation was performed using the sinus tarsi approach for Sanders type II or III calcaneal fractures were included. The mean follow-up was 28 (14-39) months. Patients were categorized into 2 groups on the basis of whether calcium phosphate cement (CPC) was used. Group 1 had 37 patients with CPC (38 calcaneal fractures) and group 2 had 47 patients without CPC (47 calcaneal fractures). In the clinical assessment, the American Orthopedic Foot Ankle Society (AOFAS) hind foot score and the Maryland Foot Score (MFS) were used at the final follow-up. In the radiological assessment, Bohler's angle on plain radiograph and posterior facet step-off on computed tomography were measured pre-and postoperatively. RESULTS At the final follow-up, the mean Bohler's angle was 26.2° (20°-33°) in group 1 and 26° (17°-30°) in group 2 (P = 0.85). The mean posterior facet step-off was 1.6 (0-5) mm in group 1 and 1.5 (0-5) mm in group 2 (P = 0.85). The mean AOFAS score was 83.8 (59-100) in group 1 and 85.8 (60-100) in group 2 (P = 0.5). The mean MFS was 86.3 (66-100) in group 1 and 87.7 (66-100) in group 2 (P = 0.62). CONCLUSION Evidence from this study have shown that CPC may have no significant effect on clinical and radiological outcomes in the surgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach.
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Affiliation(s)
- Cemil Kayalı
- Department of Orthopaedics and Traumatology, University of Health Sciences, Bozyaka Training and Research Hospital, İzmir,
Turkey
| | - Fırat Ozan
- Department of Orthopaedics and Traumatology, Kayseri City Hospital, Kayseri,
Turkey
| | - Taşkın Altay
- Department of Orthopaedics and Traumatology, University of Health Sciences, Bozyaka Training and Research Hospital, İzmir,
Turkey
| | - Hüseyin Gökhan Karahan
- Department of Orthopaedics and Traumatology, University of Health Sciences, Bozyaka Training and Research Hospital, İzmir,
Turkey
| | - Kamil Yamak
- Department of Orthopaedics and Traumatology, University of Health Sciences, Bozyaka Training and Research Hospital, İzmir,
Turkey
| | - Soner Özdemir
- Department of Orthopaedics and Traumatology, University of Health Sciences, Bozyaka Training and Research Hospital, İzmir,
Turkey
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17
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Jiang N, Dusane DH, Brooks JR, Delury CP, Aiken SS, Laycock PA, Stoodley P. Antibiotic loaded β-tricalcium phosphate/calcium sulfate for antimicrobial potency, prevention and killing efficacy of Pseudomonas aeruginosa and Staphylococcus aureus biofilms. Sci Rep 2021; 11:1446. [PMID: 33446860 PMCID: PMC7809051 DOI: 10.1038/s41598-020-80764-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022] Open
Abstract
This study investigated the efficacy of a biphasic synthetic β-tricalcium phosphate/calcium sulfate (β-TCP/CS) bone graft substitute for compatibility with vancomycin (V) in combination with tobramycin (T) or gentamicin (G) evidenced by the duration of potency and the prevention and killing efficacies of P. aeruginosa (PAO1) and S. aureus (SAP231) biofilms in in vitro assays. Antibiotic loaded β-TCP/CS beads were compared with antibiotic loaded beads formed from a well characterized synthetic calcium sulfate (CS) bone void filler. β-TCP/CS antibiotic loaded showed antimicrobial potency against PAO1 in a repeated Kirby-Bauer like zone of inhibition assay for 6 days compared to 8 days for CS. However, both bead types showed potency against SAP231 for 40 days. Both formulations loaded with V + T completely prevented biofilm formation (CFU below detection limits) for the 3 days of the experiment with daily fresh inoculum challenges (P < 0.001). In addition, both antibiotic loaded materials and antibiotic combinations significantly reduced the bioburden of pre-grown biofilms by between 3 and 5 logs (P < 0.001) with V + G performing slightly better against PAO1 than V + T. Our data, combined with previous data on osteogenesis suggest that antibiotic loaded β-TCP/CS may have potential to stimulate osteogenesis through acting as a scaffold as well as simultaneously protecting against biofilm infection. Future in vivo experiments and clinical investigations are warranted to more comprehensively evaluate the use of β-TCP/CS in the management of orthopaedic infections.
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Affiliation(s)
- Nan Jiang
- Department of Microbial Infection and Immunity, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.,Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou, 510515, Guangdong, China
| | - Devendra H Dusane
- Center for Clinical and Translational Research, The Ohio State University Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Jacob R Brooks
- Department of Microbial Infection and Immunity, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Craig P Delury
- Biocomposites Ltd., Keele Science Park, Keele, Staffordshire, ST5 5NL, UK
| | - Sean S Aiken
- Biocomposites Ltd., Keele Science Park, Keele, Staffordshire, ST5 5NL, UK
| | - Phillip A Laycock
- Biocomposites Ltd., Keele Science Park, Keele, Staffordshire, ST5 5NL, UK
| | - Paul Stoodley
- Department of Microbial Infection and Immunity, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. .,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. .,National Centre for Advanced Tribology at Southampton (nCATS) and National Biofilm Innovation Centre (NBIC), Department of Mechanical Engineering, University of Southampton, Southampton, SO17 1BJ, UK.
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18
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McWilliams GD, Yao L, Simonet LB, Haysbert CW, Giza E, Kreulen CD, Boutin RD. Subchondroplasty of the Ankle and Hindfoot for Treatment of Osteochondral Lesions and Stress Fractures: Initial Imaging Experience. Foot Ankle Spec 2020; 13:306-314. [PMID: 31315447 DOI: 10.1177/1938640019863252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:To describe the imaging findings of patients treated with subchondroplasty (SCP) of the ankle and hindfoot. Materials and Methods: Eighteen patients (10 men, 8 women; age mean 43.1 years [range 20.1-67.7 years]) underwent ankle and hindfoot SCP at a single center over a 14-month period. Imaging data were reviewed retrospectively by 2 radiologists by consensus interpretation, including preoperative radiography (18), computed tomography (CT) (11), and magnetic resonance imaging (MRI) (13) and postoperative radiography (10), CT (4), and MRI (6). Follow-up imaging was acquired 1 month to 1.6 years following SCP. Results: Indications for SCP included symptomatic bone marrow lesions (BMLs) secondary to an osteochondral lesion (OCL) (16/18) or stress fracture (2/18). While focal radiodensity related to the SCP procedure was retrospectively identifiable on postoperative radiography in all except 1 case (10/11), postprocedural findings were not described by the interpreting radiologist in 6/11 cases. On CT, the average injected synthetic calcium phosphate (CaP) volume was 1.15 cm3 (SD = 0.33 cm3); mean CT attenuation of the injectate was 1220 HU (range 1058-1465 HU). In all patients who had pre- and postoperative MRI (5/18), BML size decreased on follow-up MRI. Extra-osseous extrusion of CaP was not seen on postoperative radiography, CT, or MRI. Conclusion: Physicians should be aware of the expanding preoperative indications and postoperative imaging findings of SCP, which is being performed with increasing frequency in the ankle and hindfoot.Levels of Evidence: Diagnostic, Level III: Retrospective cohort study.
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Affiliation(s)
- Geoffrey D McWilliams
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
| | - Lawrence Yao
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
| | - Luke B Simonet
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
| | - Connor W Haysbert
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
| | - Eric Giza
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
| | - Christopher D Kreulen
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
| | - Robert D Boutin
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California (GDM, LBS, RDB).,Radiology and Imaging Sciences, CC-NIH, Bethesda, Maryland (LY).,University of California Davis School of Medicine, Sacramento, California (CWH).,Foot and Ankle Service, Department of Orthopaedic Surgery University of California Davis, Sacramento, California (EG, CDK)
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Abstract
Union rates vary for arthrodesis sites and bone healing in foot and ankle surgery. The ultimate goal is to achieve complete bone healing within a reasonable time. There are many factors that surgeons cannot control, such as the patient's compliance and ability to heal. However, surgeons can control osseous preparation, stable fixation, preservation of soft tissue, and the osseous fusion initial healing environment. Modification of the healing environment can be achieved with the use of bone graft and orthobiologics. This article discusses the grafts and orthobiologics that can be used in bone healing for the foot and ankle.
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Affiliation(s)
- Sean T Grambart
- Des Moines University, College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA; Unitypoint Health - Iowa Methodist Medical Center, 1200 Pleasant Street, Des Moines, IA 50309, USA.
| | - Danika S Anderson
- Des Moines University, College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA
| | - Travis Drew Anderson
- Des Moines University, College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA
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20
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Grecu AF, Reclaru L, Ardelean LC, Nica O, Ciucă EM, Ciurea ME. Platelet-Rich Fibrin and its Emerging Therapeutic Benefits for Musculoskeletal Injury Treatment. ACTA ACUST UNITED AC 2019; 55:medicina55050141. [PMID: 31096718 PMCID: PMC6572609 DOI: 10.3390/medicina55050141] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022]
Abstract
New therapies that accelerate musculoskeletal tissue recovery are highly desirable. Platelet-rich fibrin (PRF) is a leukocyte- and platelet-rich fibrin biomaterial that acts as a binding site for both platelets and growth factors. Through increasing the local concentration of growth factors at specific tissues, PRF promotes tissue regeneration. PRF has been frequently used in combination with bone graft materials to reduce healing times and promote bone regeneration during maxillofacial surgery. However, its benefits during muscle repair and recovery are less well-documented. Here, we perform a narrative review on PRF therapies and muscle injuries to ascertain its beneficial effects. We reviewed the factors that contribute to the biological activity of PRF and the published pre-clinical and clinical evidence to support its emerging use in musculoskeletal therapy. We include in vitro studies, in vivo animal studies and clinical articles highlighting both the success and failures of PRF treatment. PRF can promote the healing process when used in a range of orthopaedic and sports-related injuries. These include cartilage repair, rotator cuff surgery and anterior cruciate ligament surgery. However, conflicting data for these benefits have been reported, most likely due to inconsistencies in both PRF preparation protocols and dosing regimens. Despite this, the literature generally supports the use of PRF as a beneficial adjuvant for a range of chronic muscle, tendon, bone or other soft tissue injuries. Further clinical trials to confirm these benefits require consistency in PRF preparation and the classification of a successful clinical outcome to fully harness its potential.
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Affiliation(s)
- Alexandru Florian Grecu
- PhD Researcher - University of Medicine and Pharmacy Craiova, str. Petru Rares no.2, 200349, Craiova, Romania.
| | - Lucien Reclaru
- Varinor Matériaux SA, 7 St-Georges str, CH 2800, Delémont, Switzerland.
| | - Lavinia Cosmina Ardelean
- "Victor Babes" University of Medicine and Pharmacy from Timisoara, Dept. of Technology of Materials and 9 Devices in Dental Medicine,2 Eftimie Murgu sq, 300041 Timisoara, Romania.
| | - Oliviu Nica
- PhD Researcher - University of Medicine and Pharmacy Craiova, str. Petru Rares no.2, 200349, Craiova, Romania.
| | - Eduard Mihai Ciucă
- Department of Oro-Maxilo-Facial Surgery ⁻ University of Medicine and Pharmacy Craiova, str. Petru Rares, no.2, 200349 Craiova, Romania.
| | - Marius Eugen Ciurea
- Department of Plastic Surgery - University of Medicine and Pharmacy of Craiova, str. Petru Rares, no.2, 200349 Craiova, Romania.
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21
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Viñuela-Prieto JM, Soria-García AM, González-Romero M, Candel FJ. Bacterial contamination rate and associated factors during bone and tendon allograft procurement from Spanish donors: exploring the contamination patterns. J Hosp Infect 2019; 102:287-294. [PMID: 30772451 DOI: 10.1016/j.jhin.2019.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/08/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Allograft contamination during extraction represents a major limiting factor for tissue bank availability. Contamination rates remain persistently high independent of the hospital, country or year considered. AIM To analyse the factors associated with contamination of bone and tendon samples extracted from Spanish donors. METHODS Data for 1162 bone and tendon samples extracted from 102 donors between 2014 and 2017 were collected retrospectively from the hospital database. Descriptive statistics, potentially associated factors and correlation of contamination between samples extracted from different anatomical locations of the same donor were analysed. FINDINGS In total, 227 (19.54%) of the extracted samples [131 (18.49%) bone samples and 96 (20.92%) tendon samples] rendered positive cultures and were discarded. Male sex [odds ratio (OR) 2.023; P=0.019], extraction of >10 samples per donor (OR 1.997; P<0.001) and extraction time >240 min (OR 1.755; P=0.001) were factors independently associated with a higher contamination rate. Meanwhile, the tissue sample type 'bone-patellar tendon-bone' was associated with a significantly lower contamination rate (OR 0.446; P=0.001). Significant correlation between certain localization of contaminated samples and the concordance of bacterial species was also observed. CONCLUSION Factors related to the extraction procedure, such as total extraction time, extraction sequence, number of samples extracted and anatomical location of extracted samples, play a major role in allograft contamination. Further optimization of procedures, guided by the contamination patterns analysed in this study, should help to increase tissue bank availability.
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Affiliation(s)
- J M Viñuela-Prieto
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain; School of Medicine, Complutense University, Madrid, Spain.
| | - A M Soria-García
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain
| | - M González-Romero
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain
| | - F J Candel
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain; Health Research Institute, Hospital Clínico San Carlos, Madrid, Spain
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22
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Zhao E, Carney D, Chambers M, Ewalefo S, Hogan M. The role of biologic in foot and ankle trauma-a review of the literature. Curr Rev Musculoskelet Med 2018; 11:495-502. [PMID: 30054808 DOI: 10.1007/s12178-018-9512-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The use of biologics in orthopedics is becoming increasingly popular as an adjuvant in healing musculoskeletal injuries. Though many biologics involved in the management of foot and ankle injuries are used based on physician preference, reports of improved outcomes when combined with standard operative treatment has led to further clinical interest especially in foot and ankle trauma. RECENT FINDINGS The most recent studies have shown benefits for biologic use in patients predisposed to poor bone and soft tissue healing. Biologics have shown benefit in treating soft tissue injuries such as Achilles ruptures as well as the complications of trauma such as non-unions and osteoarthritis. Biologics have shown some benefit in improving functional and pain scores, as well as reducing time to heal in foot and ankle traumatic injuries, with particular success shown with patients that have risk factors for poor healing. As the use of biologics continues to increase, there is a need for high-level studies to confirm early findings of lower level reports.
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Affiliation(s)
- Emily Zhao
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Dwayne Carney
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Monique Chambers
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Samuel Ewalefo
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - MaCalus Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA.
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23
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Hirao M, Ebina K, Etani Y, Tsuboi H, Noguchi T, Tsuji S, Hashimoto J, Yoshikawa H. Use of autologous bone grafting from the calcaneus and interconnected porous hydroxyapatite ceramic for bone transplantation in rheumatoid foot surgery. SAGE Open Med Case Rep 2018; 6:2050313X18784413. [PMID: 30013786 PMCID: PMC6041860 DOI: 10.1177/2050313x18784413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 05/31/2018] [Indexed: 11/27/2022] Open
Abstract
Cancellous bone grafts from the calcaneus have been used for the foot and ankle
as well as iliac bone graft; however, there is a sparse report for calcaneal
bone transplantation in the field of rheumatoid foot surgery. In this study,
safety and usefulness of calcaneal bone grafts, and combination with
interconnected porous hydroxyapatite ceramic, was evaluated in rheumatoid
arthritis foot surgeries. Of six rheumatoid arthritis cases, three
(talo-navicular joint fusion) used a calcaneal bone graft alone, and the
remaining three cases (subtalar joint and talo-navicular joint fusion) used a
combination of calcaneal bone graft and interconnected porous hydroxyapatite
ceramic augmented with dense calcium hydroxyapatite for subtalar bony defect
(1.5–2.0 cm) after the correction. Pre- and postoperative Japanese Society for
Surgery of the Foot rheumatoid arthritis foot ankle scale scores were obtained
for the clinical assessment. As radiographic assessment, tibio-calcaneal angle,
calcaneal pitch, talo-1st metatarsal angle, and pronated foot index were also
evaluated. After starting weight-bearing or walking, there was no pain and skin
trouble at the fusion and harvesting sites. All cases achieved bony fusion
within 6–10 weeks. Japanese Society for Surgery of the Foot rheumatoid arthritis
foot ankle score was improved in all six cases. Furthermore, tibio-calcaneal
angle, talo-1st metatarsal angle, and pronated foot index were also improved at
latest follow-up in all cases. In conclusion, autologous bone grafting from the
calcaneus was safe and convenient even in rheumatoid foot surgeries. For larger
bony defects (1.5–2.0 cm), combination use with interconnected porous
hydroxyapatite ceramic augmented with dense calcium hydroxyapatite was also
useful.
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Affiliation(s)
- Makoto Hirao
- Department of Orthopaedics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kosuke Ebina
- Department of Orthopaedics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuki Etani
- Department of Orthopaedics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hideki Tsuboi
- Department of Orthopaedics, Osaka Rosai Hospital, Sakai, Japan
| | - Takaaki Noguchi
- Department of Orthopaedics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Shigeyoshi Tsuji
- Department of Orthopaedics/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, Japan
| | - Jun Hashimoto
- Department of Orthopaedics/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedics, Graduate School of Medicine, Osaka University, Suita, Japan
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24
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Magnus MK, Iceman KL, Roukis TS. Living Cryopreserved Bone Allograft as an Adjunct for Hindfoot Arthrodesis. Clin Podiatr Med Surg 2018; 35:295-310. [PMID: 29861013 DOI: 10.1016/j.cpm.2018.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Hindfoot arthrodesis is a frequently performed procedure by foot and ankle surgeons. The relatively high nonunion rate associated with these procedures has led surgeons to use adjunctive bone graft to help augment osseous union. Cellular bone allografts are a specific type of graft that incorporates osteoconductive, osteoinductive, and osteogenic properties while also eliminating the common disadvantages of autografts and traditional allografts. This article discusses the role of cellular bone allografts in hindfoot arthrodesis procedures, a review of current literature, and a comparison of available products.
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Affiliation(s)
- Mark K Magnus
- Gundersen Medical Foundation, Mail Stop: CO3-006A, 1900 South Avenue, La Crosse, WI 54601, USA
| | - Kelli L Iceman
- Gundersen Medical Foundation, Mail Stop: CO3-006A, 1900 South Avenue, La Crosse, WI 54601, USA
| | - Thomas S Roukis
- Orthopaedic Center, Gundersen Healthcare System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA.
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