Silver nanoparticles and their orthopaedic applications

Implant-associated infection is a major source of morbidity in orthopaedic surgery. There has been extensive research into the development of materials that prevent biofilm formation, and hence, reduce the risk of infection. Silver nanoparticle technology is receiving much interest in the field of orthopaedics for its antimicrobial properties, and the results of studies to date are encouraging. Antimicrobial effects have been seen when silver nanoparticles are used in trauma implants, tumour prostheses, bone cement, and also when combined with hydroxyapatite coatings. Although there are promising results with in vitro and in vivo studies, the number of clinical studies remains small. Future studies will be required to explore further the possible side effects associated with silver nanoparticles, to ensure their use in an effective and biocompatible manner. Here we present a review of the current literature relating to the production of nanosilver for medical use, and its orthopaedic applications.

Focal femoral condyle resurfacing

Focal femoral inlay resurfacing has been developed for the treatment of full-thickness chondral defects of the knee. This technique involves implanting a defect-sized metallic or ceramic cap that is anchored to the subchondral bone through a screw or pin. The use of these experimental caps has been advocated in middle-aged patients who have failed non-operative methods or biological repair techniques and are deemed unsuitable for conventional arthroplasty because of their age. This paper outlines the implant design, surgical technique and biomechanical principles underlying their use. Outcomes following implantation in both animal and human studies are also reviewed.

Species composition, monitoring, and feeding injury of stink bugs (Heteroptera: Pentatomidae) in blackberry

Blackberry (Rubus spp.) production in Florida has increased > 100% within the past two decades. and several insect pests, including stink bugs (Heteroptera: Pentatomidae), have been observed feeding on this crop. The objectives for this study were to determine the stink bug species present in blackberry; to develop monitoring tools for stink bugs in blackberry; and to describe feeding injury to blackberries by Euschistus quadrator Rolston, a relatively new stink bug pest to Florida, that has spread throughout the state. In a field survey, E. quadrator was the most abundant stink bug species, followed by Euschistus servus Say, Euschistus obscurus (Palisot de Beauvois), Thyanta custator (F.), Proxys punctulatus (Palisot de Beauvois), and Podisus maculiventris Say. Yellow pyramid traps caught more stink bugs than tube traps with or without the addition of Euschistus spp. pheromone lures. There were no statistical differences between traps baited with a Trécé Pherocon Centrum lure, a Suterra Scenturion lure, and an unbaited trap. These results were supported by Y-tube olfactometer assays with E. quadrator where there were no differences between pheromone baited lures and a control. Injury to berries caused by E. quadrator adults and third instars was similar, and both adults and third instars fed more on green berries compared with turning berries. In addition, adults fed more on green berries compared with ripe fruit. The most common injury to green berries was discoloration. In contrast, misshapen drupelets were commonly seen on turning and ripe berries. The potential for managing stink bugs in blackberries to prevent them from reaching damaging levels is discussed.

Effect of vibration on the shear strength of impacted bone graft in revision hip surgery

We developed a method of applying vibration to the impaction bone grafting process and assessed its effect on the mechanical properties of the impacted graft. Washed morsellised bovine femoral heads were impacted into shear test rings. A range of frequencies of vibration was tested, as measured using an accelerometer housed in a vibration chamber. Each shear test was repeated at four different normal loads to generate stress-strain curves. The Mohr-Coulomb failure envelope from which shear strength and interlocking values are derived was plotted for each test. The experiments were repeated with the addition of blood in order to replicate a saturated environment.

Graft impacted with the addition of vibration at all frequencies showed improved shear strength when compared with impaction without vibration, with 60 Hz giving the largest effect. Under saturated conditions the addition of vibration was detrimental to the shear strength of the aggregate. The civil-engineering principles of particulate settlement and interlocking also apply to impaction bone grafting. Although previous studies have shown that vibration may be beneficial in impaction bone grafting on the femoral side, our study suggests that the same is not true in acetabular revision.

Overuse ankle injuries in professional Irish dancers

BACKGROUND

Overuse ankle injuries have been described in elite athletes and professional ballet dancers however the spectrum of injuries experienced by professional Irish dancers has not been defined.

METHODS

A troupe of actively performing dancers from an Irish-dance show were recruited (eight male, ten female; mean age, 26 years). The prevalence of overuse injuries in the right ankle was determined from magnetic resonance imaging. Foot and ankle self-report questionnaires were also completed (AOFAS and FAOS).

RESULTS

Only three ankles were considered radiologically normal. Achilles tendinopathy, usually insertional, was the most frequent observation (n=14) followed by plantar fasciitis (n=7), bone oedema (n=2) and calcaneocuboid joint degeneration (n=2). There were limited correlations between MRI patterns and clinical scores indicating that many conditions are sub-clinical. Dancers with ankle pain had poor low (p=0.004) and high (p=0.013) level function.

CONCLUSIONS

Overuse ankle injuries are common in Irish dancers. Incorporating eccentric exercises and plantar fascia stretching into a regular training program may benefit this population.

Comparison of acetabular reamings during hip resurfacing versus uncemented total hip arthroplasty

PURPOSE

To compare the quantity of bone removed from the acetabulum during resurfacing hip arthroplasty versus uncemented total hip arthroplasty (THA).

METHODS

62 consecutive patients with osteoarthritis of the hip were prospectively studied. 24 men and 7 women aged 40 to 86 (mean, 59) years underwent Birmingham hip resurfacing. 13 men and 18 women aged 34 to 88 (mean, 61) years underwent uncemented THA using the trident acetabular cup. Obese elderly women at risk of femoral neck fracture and patients with large subchondral pseudocysts or a history of avascular necrosis of the femoral head were assigned to uncemented THA. Acetabular reamings were collected; marginal osteophytes were not included. The reamings were dehydrated, defatted, and weighed.

RESULTS

The mean weight of acetabular reamings was not significantly different between patients undergoing hip resurfacing and uncemented THA (p=0.57).

CONCLUSION

In hip resurfacing, the use of an appropriately small femoral component avoids oversizing the acetabular component and removal of excessive bone stock.

Reticulated platelet values in normal and thrombocytopenic neonates

OBJECTIVES

Reticulated platelets (RPs) are newly synthesized platelets with increased ribonucleic acid content. The percentage of RPs is elevated in adults with thrombocytopenia as a result of increased platelet destruction. The objectives of this study were to determine normal RP values in neonates at birth and to determine whether neonates with thrombocytopenia as a result of increased platelet destruction have an increased percentage of RPs.

STUDY DESIGN

The RP percentages were measured at birth in 89 neonates without thrombocytopenia in three gestational age groups (<30,30 to 36, and >36 weeks), six neonates with immune thrombocytopenia, and one neonate with thrombocytopenia as a result of decreased platelet production.

RESULTS

The RP percentages in neonates without thrombocytopenia >36 weeks and 30 to 36 weeks of gestation were 4.0% +/- 2.4% (mean +/- SD) and 4.6% +/- 1.7%, respectively, similar to values reported in healthy adults. Neonates younger than 30 weeks of gestation had significantly higher RP percentages (8.8% +/- 5.1%) than older neonates (p </= 0.0001). Term neonates with immune thrombocytopenia had significantly higher RP percentages (38.3% +/- 23.1%) than term neonates without thrombocytopenia (p = 0.0001), with no overlap in RP values. A lower RP percentage (1.5%) and significantly lower absolute RP count were measured in the one neonate with decreased platelet production.

CONCLUSIONS

These preliminary data establish normal RP percentages in term and preterm neonates at birth and demonstrate elevated RP percentages in neonates with immune platelet destruction. The RP values may be helpful in evaluating the causes of neonatal thrombocytopenia.

Locus specificity of mutagenicity of 2,4-diaminotoluene in both L5178Y mouse lymphoma and AT3-2 Chinese hamster ovary cells

2,4-Diaminotoluene, a hepatocarcinogenic aromatic amine, was tested for mutagenic potential at both the autosomal tk locus and the sex-linked hgprt locus of both L5178Y 3.7.2C mouse lymphoma cells and Chinese hamster ovary (CHO) AT3-2 cells. This compound was mutagenic in both cell types at the tk locus but not at the hgprt locus. Mutagenic activity was observed in L5178Y cells only in the absence of exogenous metabolic activation, but was observed in CHO-AT3-2 cells both with and without activation.