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Epanomeritakis IE, Khan WS. Adipose-derived regenerative therapies for the treatment of knee osteoarthritis. World J Stem Cells 2024; 16:324-333. [PMID: 38690511 PMCID: PMC11056639 DOI: 10.4252/wjsc.v16.i4.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/15/2024] [Accepted: 03/01/2024] [Indexed: 04/25/2024] Open
Abstract
Knee osteoarthritis is a degenerative condition with a significant disease burden and no disease-modifying therapy. Definitive treatment ultimately requires joint replacement. Therapies capable of regenerating cartilage could significantly reduce financial and clinical costs. The regenerative potential of mesenchymal stromal cells (MSCs) has been extensively studied in the context of knee osteoarthritis. This has yielded promising results in human studies, and is likely a product of immunomodulatory and chondroprotective biomolecules produced by MSCs in response to inflammation. Adipose-derived MSCs (ASCs) are becoming increasingly popular owing to their relative ease of isolation and high proliferative capacity. Stromal vascular fraction (SVF) and micro-fragmented adipose tissue (MFAT) are produced by the enzymatic and mechanical disruption of adipose tissue, respectively. This avoids expansion of isolated ASCs ex vivo and their composition of heterogeneous cell populations, including immune cells, may potentiate the reparative function of ASCs. In this editorial, we comment on a multicenter randomized trial regarding the efficacy of MFAT in treating knee osteoarthritis. We discuss the study's findings in the context of emerging evidence regarding adipose-derived regenerative therapies. An underlying mechanism of action of ASCs is proposed while drawing important distinctions between the properties of isolated ASCs, SVF, and MFAT.
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Affiliation(s)
- Ilias E Epanomeritakis
- Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Wasim S Khan
- Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, United Kingdom.
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Ranmuthu CKI, Ranmuthu CDS, Wijewardena CK, Seah MKT, Khan WS. Evaluating the Effect of Hypoxia on Human Adult Mesenchymal Stromal Cell Chondrogenesis In Vitro : A Systematic Review. Int J Mol Sci 2022; 23:ijms232315210. [PMID: 36499531 PMCID: PMC9741425 DOI: 10.3390/ijms232315210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/18/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Human adult mesenchymal stromal cells (MSCs) from a variety of sources may be used to repair defects in articular cartilage by inducing them into chondrogenic differentiation. The conditions in which optimal chondrogenic differentiation takes place are an area of interest in the field of tissue engineering. Chondrocytes exist in vivo in a normally hypoxic environment and thus it has been suggested that exposing MSCs to hypoxia may also contribute to a beneficial effect on their differentiation. There are two main stages in which MSCs can be exposed to hypoxia, the expansion phase when cells are cultured, and the differentiation phase when cells are induced with a chondrogenic medium. This systematic review sought to explore the effect of hypoxia at these two stages on human adult MSC chondrogenesis in vitro. A literature search was performed on PubMed, EMBASE, Medline via Ovid, and Cochrane, and 24 studies were ultimately included. The majority of these studies showed that hypoxia during the expansion phase or the differentiation phase enhances at least some markers of chondrogenic differentiation in adult MSCs. These results were not always demonstrated at the protein level and there were also conflicting reports. Studies evaluating continuous exposure to hypoxia during the expansion and differentiation phases also had mixed results. These inconsistent results can be explained by the heterogeneity of studies, including factors such as different sources of MSCs used, donor variability, level of hypoxia used in each study, time exposed to hypoxia, and differences in culture methodology.
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Mak CCH, To K, Fekir K, Brooks RA, Khan WS. Infrapatellar fat pad adipose-derived stem cells co-cultured with articular chondrocytes from osteoarthritis patients exhibit increased chondrogenic gene expression. Cell Commun Signal 2022; 20:17. [PMID: 35151341 PMCID: PMC8841120 DOI: 10.1186/s12964-021-00815-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022] Open
Abstract
Aim The variable results in clinical trials of adipose tissue-derived stem cells (ASCs) for chondral defects may be due to the different ex vivo culture conditions of the ASCs which are implanted to treat the lesions. We sought to determine the optimal in vitro chondrocyte co-culture condition that promotes infrapatellar fat pad-derived (IFPD) ASC chondrogenic gene expression in a novel co-culture combination. Methods In our study, we utilized an in vitro autologous co-culture of IFPD ASCs and articular chondrocytes derived from Kellgren–Lawrence Grade III/IV osteoarthritic human knee joints at ASC-to-chondrocyte seeding log ratios of 1:1, 10:1, and 100:1. Gene expression following in vitro co-culture was quantified by RT-qPCR with a panel comprising COL1A1, COL2A1, COL10A1, L-SOX5, SOX6, SOX9, ACAN, HSPG2, and COMP for chondrogenic gene expression. Results The chondrogenic gene expression profiles from co-cultures were greater than would be expected from an expression profile modeled from chondrocyte and ASC-only monocultures. Additionally, chondrogenic gene expression decreased with increasing ASC-to-chondrocyte seeding ratios. Conclusions These findings provide insight into the mechanisms underlying clinical ASC therapies and signifies that IFPD ASCs pre-conditioned by chondrocyte co-culture may have improved chondrogenic potential for cartilage repair. This model can help further understand IFPD ASCs in chondral and osteochondral repair and the chondrogenic pathways involved. Video Abstract
Supplementary Information The online version contains supplementary material available at 10.1186/s12964-021-00815-x.
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Abstract
BACKGROUND Tendinopathy is common, presents with pain and activity limitation, and is associated with a high risk of recurrence of the injury. Tendinopathy usually occurs as a results of a disrupted healing response to a primary injury where cellular and molecular pathways lead to low grade chronic inflammation. MAIN FINDINGS There has been a renewed interest in investigating the role of Inflammation in the pathogenesis of tendinopathy, in particular during the initial phases of the condition where it may not be clinically evident. Understanding the early and late stages of tendon injury pathogenesis would help develop new and effective treatments addressed at targeting the inflammatory pathways. CONCLUSION This review outlines the role of low-grade Inflammation in the pathogenesis of tendinopathy, stressing the role of proinflammatory cytokines, proteolytic enzymes and growth factors, and explores how Inflammation exerts a negative influence on the process of tendon healing.
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Affiliation(s)
| | - Laura Rehak
- Athena Biomedical Innovations, Florence, Italy
| | - Wasim S Khan
- Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy.
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy.
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK.
- School of Medicine, Institute of Science and Technology in Medicine, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, UK.
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Vahedi P, Moghaddamshahabi R, Webster TJ, Calikoglu Koyuncu AC, Ahmadian E, Khan WS, Jimale Mohamed A, Eftekhari A. The Use of Infrapatellar Fat Pad-Derived Mesenchymal Stem Cells in Articular Cartilage Regeneration: A Review. Int J Mol Sci 2021; 22:ijms22179215. [PMID: 34502123 PMCID: PMC8431575 DOI: 10.3390/ijms22179215] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
Cartilage is frequently damaged with a limited capacity for repair. Current treatment strategies are insufficient as they form fibrocartilage as opposed to hyaline cartilage, and do not prevent the progression of degenerative changes. There is increasing interest in the use of autologous mesenchymal stem cells (MSC) for tissue regeneration. MSCs that are used to treat articular cartilage defects must not only present a robust cartilaginous production capacity, but they also must not cause morbidity at the harvest site. In addition, they should be easy to isolate from the tissue and expand in culture without terminal differentiation. The source of MSCs is one of the most important factors that may affect treatment. The infrapatellar fat pad (IPFP) acts as an important reservoir for MSC and is located in the anterior compartment of the knee joint in the extra-synovial area. The IPFP is a rich source of MSCs, and in this review, we discuss studies that demonstrate that these cells have shown many advantages over other tissues in terms of ease of isolation, expansion, and chondrogenic differentiation. Future studies in articular cartilage repair strategies and suitable extraction as well as cell culture methods will extend the therapeutical application of IPFP-derived MSCs into additional orthopedic fields, such as osteoarthritis. This review provides the latest research concerning the use of IPFP-derived MSCs in the treatment of articular cartilage damage, providing critical information for the field to grow.
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Affiliation(s)
- Parviz Vahedi
- Department of Anatomical Sciences, Maragheh University of Medical Sciences, Maragheh 78151-55158, Iran;
| | - Rana Moghaddamshahabi
- Faculty of Pharmacy, Eastern Mediterranean University, Famagusta 99628, North Cyprus, Turkey;
| | - Thomas J. Webster
- Department of Chemical Engineering, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA;
| | - Ayse Ceren Calikoglu Koyuncu
- Materials and Metallurgical Engineering Department, Faculty of Technology, Marmara University, Istanbul 34722, Turkey;
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, Istanbul 34722, Turkey
| | - Elham Ahmadian
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz 51666-15731, Iran;
| | - Wasim S. Khan
- Division of Trauma & Orthopaedic Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
- Correspondence: (W.S.K.); (A.E.)
| | - Ali Jimale Mohamed
- Department of Pharmacology, Faculty of Medicine, Somali National University, Mogadishu 801, Somalia;
| | - Aziz Eftekhari
- Department of Toxicology and Pharmacology, Maragheh University of Medical Sciences, Maragheh 78151-55158, Iran
- Department of Synthesis and Characterization of Polymers, Polymer Institute, Slovak Academy of Sciences (SAS), Dúbravská cesta, 9, 845 41 Bratislava, Slovakia
- Correspondence: (W.S.K.); (A.E.)
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Crowley CA, Smith WPW, Seah KTM, Lim SK, Khan WS. Cryopreservation of Human Adipose Tissues and Adipose-Derived Stem Cells with DMSO and/or Trehalose: A Systematic Review. Cells 2021; 10:cells10071837. [PMID: 34360005 PMCID: PMC8307030 DOI: 10.3390/cells10071837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 02/05/2023] Open
Abstract
Adipose tissue senescence is implicated as a major player in obesity- and ageing-related disorders. There is a growing body of research studying relevant mechanisms in age-related diseases, as well as the use of adipose-derived stem cells in regenerative medicine. The cell banking of tissue by utilising cryopreservation would allow for much greater flexibility of use. Dimethyl sulfoxide (DMSO) is the most commonly used cryopreservative agent but is toxic to cells. Trehalose is a sugar synthesised by lower organisms to withstand extreme cold and drought that has been trialled as a cryopreservative agent. To examine the efficacy of trehalose in the cryopreservation of human adipose tissue, we conducted a systematic review of studies that used trehalose for the cryopreservation of human adipose tissues and adipose-derived stem cells. Thirteen articles, including fourteen studies, were included in the final review. All seven studies that examined DMSO and trehalose showed that they could be combined effectively to cryopreserve adipocytes. Although studies that compared nonpermeable trehalose with DMSO found trehalose to be inferior, studies that devised methods to deliver nonpermeable trehalose into the cell found it comparable to DMSO. Trehalose is only comparable to DMSO when methods are devised to introduce it into the cell. There is some evidence to support using trehalose instead of using no cryopreservative agent.
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Affiliation(s)
- Conor A. Crowley
- Australasian College of Cosmetic Surgery, Parramatta, NSW 2150, Australia;
| | - William P. W. Smith
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK;
| | - K. T. Matthew Seah
- Division of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK;
- Correspondence:
| | - Soo-Keat Lim
- The Ashbrook Cosmetic Surgery, Mosman, NSW 2088, Australia;
| | - Wasim S. Khan
- Division of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK;
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Seah KTM, Rammanohar J, Sutton J, To K, Khan WS. The Effectiveness of Anti-Nerve Growth Factor Monoclonal Antibodies in the Management of Pain in Osteoarthritis of the Hip and Knee: A PRISMA Systematic Review and Meta-Analysis. Pain Med 2021; 22:1185-1204. [PMID: 33616179 DOI: 10.1093/pm/pnaa441] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of the efficacy of anti-nerve growth factor (NGF) monoclonal antibodies in osteoarthritis pain (hip and knee). DESIGN Grade the evidence for anti-NGF use. METHODS An interdisciplinary work group conducted a literature search for anti-NGF use in osteoarthritis. The systematic review was performed in accordance with methods described by the Cochrane collaboration. General inclusion criteria included all osteoarthritis trials studying any monoclonal anti-NGF antibody at any dose/phase. Excluded studies were those where participants received NSAIDs or analgesics other than anti-NGF antibodies. The Jadad Scale score was used to assess the quality of the included studies. RESULTS Thirteen studies were included in the analysis, involving 8145 participants with a diagnosis of hip and/or knee osteoarthritis. Anti-NGF antibody treatment was associated with a significant improvement in all Western Ontario and McMaster Universities Arthritis Index (WOMAC) indices when compared to placebo. These agents were not associated with a significantly increased incidence of serious adverse events but were associated with significant increases in therapy discontinuation due to adverse events or side effects (e.g., peripheral neuropathy). CONCLUSIONS Future randomized clinical trials are needed to characterize the overall risk-to-benefit ratio of anti-NGF antibodies in managing pain associated with OA, particularly with long-term use, in order to verify their efficacy and safety in clinical practice.
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Affiliation(s)
- K T Matthew Seah
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, UK
| | | | - James Sutton
- School of Clinical Medicine, University of Cambridge, UK
| | - Kendrick To
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, UK
| | - Wasim S Khan
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, UK
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Crush J, Hussain A, Seah KTM, Khan WS. Bioactive Glass: Methods for Assessing Angiogenesis and Osteogenesis. Front Cell Dev Biol 2021; 9:643781. [PMID: 34195185 PMCID: PMC8236622 DOI: 10.3389/fcell.2021.643781] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
Biomaterials are playing an increased role in the regeneration of damaged or absent bone tissue in the context of trauma, non-union, infection or congenital abnormality. Restoration of not only the physical scaffold that bone provides, but also of its homeostatic functions as a calcium store and hematopoietic organ are the gold standards of any regenerative procedure. Bioactive glasses are of interest as they can bond with the host bone and induce further both bone and blood vessel growth. The composition of the bioactive glasses can be manipulated to maximize both osteogenesis and angiogenesis, producing a 3D scaffolds that induce bone growth whilst also providing a structure that resists physiological stresses. As the primary endpoints of studies looking at bioactive glasses are very often the ability to form substantial and healthy tissues, this review will focus on the methods used to study and quantify osteogenesis and angiogenesis in bioactive glass experiments. These methods are manifold, and their accuracy is of great importance in identifying plausible future bioactive glasses for clinical use.
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Affiliation(s)
- Jos Crush
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Ali Hussain
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, United Kingdom
| | - K T M Seah
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Wasim S Khan
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, United Kingdom
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Kamaraj A, Kyriacou H, Seah KTM, Khan WS. Use of human induced pluripotent stem cells for cartilage regeneration in vitro and within chondral defect models of knee joint cartilage in vivo: a Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic literature review. Cytotherapy 2021; 23:647-661. [PMID: 34059422 DOI: 10.1016/j.jcyt.2021.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 03/16/2021] [Accepted: 03/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AIMS Articular cartilage has limited regenerative ability when damaged through trauma or disease. Failure to treat focal chondral lesions results in changes that inevitably progress to osteoarthritis. Osteoarthritis is a major contributor to disability globally, which results in significant medical costs and lost wages every year. Human induced pluripotent stem cells (hiPSCs) have long been considered a potential autologous therapeutic option for the treatment of focal chondral lesions. Although there are significant advantages to hiPSCs over other stem cell options, such as mesenchymal and embryonic stem cells, there are concerns regarding their ability to form bona fide cartilage and their tumorgenicity in vivo. METHODS The authors carried out a systematic literature review on the use of hiPSCs to produce differentiated progeny capable of producing high-quality cartilage in vitro and regenerate cartilage in osteochondral defects in vivo in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight studies were included in the review that used hiPSCs or their derived progeny in xenogeneic transplants in animal models to regenerate cartilage in osteochondral defects of the knee joint. The in vitro-differentiated, hiPSC-derived and in vivo defect repair ability of the hiPSC-derived progeny transplants were assessed. RESULTS Most studies reported the generation of high-quality cartilage-producing progeny that were able to successfully repair cartilage defects in vivo. No tumorigenicity was observed. CONCLUSIONS The authors conclude that hiPSCs offer a valuable source of cartilage-producing progeny that show promise as an effective cell-based therapy in treating focal chondral lesions.
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Affiliation(s)
- Achi Kamaraj
- Division of Trauma and Orthopedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Harry Kyriacou
- Division of Trauma and Orthopedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - K T Matthew Seah
- Division of Trauma and Orthopedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
| | - Wasim S Khan
- Division of Trauma and Orthopedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Rammanohar J, Sutton J, Seah KTM, Khan WS, To K. P108 Anti-nerve growth factor (anti-NGF) antibodies as analgesia in the management of osteoarthritis. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Aims
Osteoarthritis is a major cause of morbidity and disability. Much of this comes from joint pain, which is exacerbated by movement and exercise. Pharmacological analgesia therefore not only has the obvious benefit of alleviating pain, but in doing so, it also facilitates exercise (a pillar of conservative management). Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are currently the main analgesics used in this context. However, these agents can cause unwanted side effects and are contraindicated in some patients. We thus conducted a systematic review and meta-analysis using the Cochrane collaboration criteria to evaluate the efficacy of anti-nerve growth factor (anti-NGF) antibodies as potential alternative analgesics in osteoarthritis of the hip and/or knee. Whilst tanezumab has been studied extensively and monoclonal anti-NGF antibodies have been reviewed in other pain states, this is the first systematic review of three key anti-NGF antibodies: tanezumab, fulranumab and fasinumab in symptomatic hip and/or knee osteoarthritis.
Methods
An interdisciplinary work group conducted a literature search across seven electronic databases for the use of anti-NGF antibodies in osteoarthritis. All hip/knee osteoarthritis studies investigating anti-NGF antibodies regardless of dose regimen or phase of trial were included. Studies in which participants received NSAIDs or analgesics other than anti-NGF antibodies, or studies in which the only intervention was the administration of anti-NGF antibodies in combination with NSAIDs or other analgesics were excluded. The Jadad Scale score was used to assess the quality of each study.
Results
Thirteen studies involving 8,145 patients with a diagnosis of hip and/or knee osteoarthritis were analysed. Demographic information including duration of disease and Kellgren-Lawrence grades were also extracted. Anti-NGF antibodies showed significant improvements compared to placebo as rated on the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scales for pain (SMD= -0.50, 95% CI -0.71 to -0.28, P < 0.00001; I2 = 88%), physical function (SMD= -0.82, 95% CI -1.09 to -0.55, P < 0.00001; I2 = 94%) and stiffness (SMD= -0.88, 95% CI -1.22 to -0.54, P < 0.00001; I2 = 95%). These agents were not associated with a significant increase in serious adverse events but were associated with a significant increase in discontinuation due to adverse events, abnormal peripheral sensations and peripheral neuropathy.
Conclusion
Anti-NGF antibodies appear very promising with regard to alleviating osteoarthritic hip/knee pain but more studies are needed to determine the optimal dosage and the overall risk-to benefit ratio, particularly with long-term use.
Disclosure
J. Rammanohar: None. J. Sutton: None. K. Seah: None. W.S. Khan: None. K. To: None.
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Affiliation(s)
| | - James Sutton
- University of Cambridge, School of Clinical Medicine, Cambridge, UNITED KINGDOM
| | - K T Matthew Seah
- University of Cambridge, Division of Trauma and Orthopaedic Surgery, Cambridge, UNITED KINGDOM
| | - Wasim S Khan
- University of Cambridge, Division of Trauma and Orthopaedic Surgery, Cambridge, UNITED KINGDOM
| | - Kendrick To
- University of Cambridge, Division of Trauma and Orthopaedic Surgery, Cambridge, UNITED KINGDOM
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Abstract
Ankle fractures are common injuries that have many physical and psychosocial complications. As a result, it is important to be aware of how these patients present and are managed perioperatively. Detailed guidelines from NICE and the British Orthopaedic Association have been produced on this topic, including recent developments such as the decision to weight-bear early after surgery and the use of virtual fracture clinics. This article provides an overview of the key perioperative factors that need to be considered in cases of ankle fracture and the relevant clinical guidelines.
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Affiliation(s)
- Harry Kyriacou
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Benjamin M Davies
- Department of Trauma & Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | - Wasim S Khan
- Department of Trauma & Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
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Hourston GJ, Barrett MP, Khan WS, Vindlacheruvu M, McDonnell SM. New drug, new problem: do hip fracture patients taking NOACs experience delayed surgery, longer hospital stay, or poorer outcomes? Hip Int 2020; 30:799-804. [PMID: 31020851 DOI: 10.1177/1120700019841351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Neck of femur fractures are common in the comorbid, often anticoagulated, elderly. Non-vitamin K antagonist oral anticoagulants (NOACs) may affect patient outcomes. We aimed to evaluate whether hip fracture patients admitted on warfarin or NOAC therapy were at risk of operative delay, prolonged length of stay, or increased mortality. METHODS We collected data for 845 patients admitted to our centre between October 2014 and December 2016. Multivariable linear regression analysis was performed to test the association between warfarin and NOAC therapy on time to surgery and length of stay. Variables in the regression model were age, sex, admission AMTS, pre-fracture mobility, ASA score, fracture type, and operation type. Fisher's exact test was used to evaluate whether warfarin or NOAC therapy delayed surgery beyond 36 or 48 hours, or decreased 30-day, 6-month, or 12-month survival. RESULTS Time to surgery was delayed in anticoagulated patients (p = 0.028). NOAC therapy was independently associated with increased time to surgery beyond 36 hours (p = 0.001), although not beyond 48 hours (p = 0.355), whereas warfarin therapy was not associated with either. Anticoagulation did not increase length of stay (p = 0.331). Warfarin therapy significantly reduced 30-day survival (p = 0.007), but NOAC therapy did not (p = 0.244). Neither warfarin nor NOAC therapy affected further survival. CONCLUSIONS NOAC therapy delays time to surgery beyond the NHS England 'Best Practice Tariff' in hip fracture patients. We aim to prospectively investigate long-term outcomes. Without a NOAC antidote, policy must change to ensure time-appropriate surgery for patients on NOACs. Preoperative involvement of the haematology team is essential.
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Affiliation(s)
| | - Michael P Barrett
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | - Wasim S Khan
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | | | - Stephen M McDonnell
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
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Kamaraj A, To K, Seah KTM, Khan WS. Modelling the cost-effectiveness of total knee arthroplasty: A systematic review. J Orthop 2020; 22:485-492. [PMID: 33093759 PMCID: PMC7566842 DOI: 10.1016/j.jor.2020.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/04/2020] [Indexed: 12/26/2022] Open
Abstract
Objective Osteoarthritis causes a significant healthcare burden and the number of total knee arthroplasty (TKA) procedures is predicted to increase significantly in the coming years. We conducted a systematic review to assess the scope and quality of all current TKA cost-effectiveness analysis (CEA) studies, identify trends, and identify areas for improvement. Methods An electronic database search of MEDLINE, Embase, the CEA registry and Scopus was used to identify all CEA studies where TKA was used with a comparator. Studies were included from January 1, 1997 to February 2, 2020. The Quality of Health Economic Analysis Studies (QHES) instrument was used to assess their quality. Thirty-three studies were included that offered both a QALY and cost calculation. The main findings, incremental-cost effectiveness ratios and other important study characteristics were then ascertained, and trends identified. Results Certain surgical interventions were suggested to be more cost-effective than TKA. This included unicompartmental knee arthroplasty for unicompartmental osteoarthritis, computer-assisted TKA compared to conventional TKA, and resurfacing the patella compared to no resurfacing. TKA was more cost-effective compared to non-operative management regardless of specific patient variables. Conclusions The analyses of the CEAs included in the study have to be interpreted with caution. Overall, certain surgical methods within TKA and alternative methods to TKA appear to be favoured for treating particular knee osteoarthritic conditions due to their suggested greater cost-effectiveness but this should be interpreted within local contexts. Our results should help guide future policy-making as healthcare associated costs continue to rise.
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Affiliation(s)
- Achi Kamaraj
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Kendrick To
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - KT Matthew Seah
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Wasim S. Khan
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
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14
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Abstract
Pelvic fractures are complex injuries with a range of different presentations depending on the mechanism of trauma. Due to the morbidity and mortality of pelvic fractures, patients require thorough investigation and timely management with multidisciplinary input. Various surgical and non-surgical techniques can be used to treat pelvic fractures, as well as any associated visceral injuries. Following repair, it is important to remain vigilant for postoperative complications such as infection, sexual and urinary dysfunction, chronic pain and adverse psychological health. This article summarises the relevant UK guidance and literature and presents them in a format that follows the patient’s journey. In doing so, it highlights the key perioperative factors that need to be considered in cases of pelvic fracture.
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Affiliation(s)
| | - Harry Kyriacou
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Wasim S Khan
- Department of Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
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15
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Chisari E, Rehak L, Khan WS, Maffulli N. The role of the immune system in tendon healing: a systematic review. Br Med Bull 2020; 133:49-64. [PMID: 32163543 DOI: 10.1093/bmb/ldz040] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The role of the immune system in tendon healing relies on polymorphonucleocytes, mast cells, macrophages and lymphocytes, the 'immune cells' and their cytokine production. This systematic review reports how the immune system affects tendon healing. SOURCES OF DATA We registered our protocol (registration number: CRD42019141838). After searching PubMed, Embase and Cochrane Library databases, we included studies of any level of evidence published in peer-reviewed journals reporting clinical or preclinical results. The PRISMA guidelines were applied, and risk of bias and the methodological quality of the included studies were assessed. We excluded all the articles with high risk of bias and/or low quality after the assessment. We included 62 articles assessed as medium or high quality. AREAS OF AGREEMENT Macrophages are major actors in the promotion of proper wound healing as well as the resolution of inflammation in response to pathogenic challenge or tissue damage. The immune cells secrete cytokines involving both pro-inflammatory and anti-inflammatory factors which could affect both healing and macrophage polarization. AREAS OF CONTROVERSY The role of lymphocytes, mast cells and polymorphonucleocytes is still inconclusive. GROWING POINTS The immune system is a major actor in the complex mechanism behind the healing response occurring in tendons after an injury. A dysregulation of the immune response can ultimately lead to a failed healing response. AREAS TIMELY FOR DEVELOPING RESEARCH Further studies are needed to shed light on therapeutic targets to improve tendon healing and in managing new way to balance immune response.
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Affiliation(s)
- Emanuele Chisari
- University of Catania, Department of General Surgery and Medical Specialities, Via Santa Sofia 78, Catania 95123, Italy
| | - Laura Rehak
- Athena Biomedical innovations, Viale Europa 139, Florence, 50126, Italy
| | - Wasim S Khan
- Division of Trauma & Orthopaedics, Addenbrooke's Hospital, University of Cambridge, Hills Rd, Cambridge CB2 0QQ, UK
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Via Salvator Allende 23, Baronissi, 89100 Salerno, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Largo Città di Ippocrate, Salerno, 84131 Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.,School of Pharmacy and Bioengineering, Keele University of School of Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, UK
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16
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Ranmuthu CDS, Ranmuthu CKI, Russell JC, Singhania D, Khan WS. Evaluating the Effect of Non-cellular Bioactive Glass-Containing Scaffolds on Osteogenesis and Angiogenesis in in vivo Animal Bone Defect Models. Front Bioeng Biotechnol 2020; 8:430. [PMID: 32478053 PMCID: PMC7240009 DOI: 10.3389/fbioe.2020.00430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/15/2020] [Indexed: 12/12/2022] Open
Abstract
The use of bone scaffolds to replace injured or diseased bone has many advantages over the currently used autologous and allogeneic options in clinical practice. This systematic review evaluates the current evidence for non-cellular scaffolds containing bioactive glass on osteogenesis and angiogenesis in animal bone defect models. Studies that reported results of osteogenesis via micro-CT and results of angiogenesis via Microfil perfusion or immunohistochemistry were included in the review. A literature search of PubMed, EMBASE and Scopus was carried out in November 2019 from which nine studies met the inclusion and exclusion criteria. Despite the significant heterogeneity in the composition of the scaffolds used in each study, it could be concluded that scaffolds containing bioactive glass improve bone regeneration in these models, both by osteogenic and angiogenic measures. Incorporation of additional elements into the glass network, using additives, and using biochemical factors generally had a beneficial effect. Comparing the different compositions of non-cellular bioactive glass containing scaffolds is however difficult due to the heterogeneity in bioactive glass compositions, fabrication methods and biochemical additives used.
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Affiliation(s)
| | | | - Jodie C. Russell
- Cambridge Clinical School, University of Cambridge, Cambridge, United Kingdom
| | - Disha Singhania
- Cambridge Clinical School, University of Cambridge, Cambridge, United Kingdom
| | - Wasim S. Khan
- Division of Trauma and Orthopaedics, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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17
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Bojanic C, To K, Zhang B, Mak C, Khan WS. Human umbilical cord derived mesenchymal stem cells in peripheral nerve regeneration. World J Stem Cells 2020; 12:288-302. [PMID: 32399137 PMCID: PMC7202926 DOI: 10.4252/wjsc.v12.i4.288] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/15/2020] [Accepted: 03/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Peripheral nerve injury can occur as a result of trauma or disease and carries significant morbidity including sensory and motor loss. The body has limited ability for nerve regeneration and functional recovery. Left untreated, nerve lesions can cause lifelong disability. Traditional treatment options such as neurorrhaphy and neurolysis have high failure rates. Surgical reconstruction with autograft carries donor site morbidity and often provide suboptimal results. Mesenchymal stem cells (MSCs) are known to have promising regenerative potential and have gained attention as a treatment option for nerve lesions. It is however, unclear whether it can be effectively used for nerve regeneration.
AIM To evaluate the evidence for the use of human umbilical cord derived MSCs (UCMSCs) in peripheral nerve regeneration.
METHODS We carried out a systematic literature review in accordance with the PRISMA protocol. A literature search was performed from conception to September 2019 using PubMed, EMBASE and Web of Science. The results of eligible studies were appraised. A risk of bias analysis was carried out using Cochrane’s RoB 2.0 tool.
RESULTS Fourteen studies were included in this review. A total of 279 subjects, including both human and animal were treated with UCMSCs. Four studies obtained UCMSCs from a third-party source and the remainder were harvested by the investigators. Out of the 14 studies, thirteen conducted xenogenic transplantation into nerve injury models. All studies reported significant improvement in nerve regeneration in the UCMSC treated groups compared with the various different controls and untreated groups.
CONCLUSION The evidence summarised in this PRISMA systematic review of in vivo studies supports the notion that human UCMSC transplantation is an effective treatment option for peripheral nerve injury.
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Affiliation(s)
- Christine Bojanic
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, United Kingdom
| | - Kendrick To
- Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Bridget Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Christopher Mak
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Wasim S Khan
- Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
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18
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Abstract
Hip fractures are common injuries in the elderly and are associated with significant morbidity and mortality. There are multiple perioperative factors that must be considered when managing these patients. These include analgesia, timing of surgery, choice of operation, type of anaesthesia, postoperative complications and comorbidities. Guidelines from The National Institute for Health and Care Excellence and the National Hip Fracture Database have been updated to reflect many of the above, but the importance of psychosocial factors is still emerging. This article focuses on the evidence for the key perioperative factors in hip fracture management and the tools available to predict hip fracture outcome.
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Affiliation(s)
- Harry Kyriacou
- University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Wasim S Khan
- Division of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, Cambridge, UK
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19
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Chisari E, Rehak L, Khan WS, Maffulli N. Tendon healing in presence of chronic low-level inflammation: a systematic review. Br Med Bull 2019; 132:97-116. [PMID: 31838495 DOI: 10.1093/bmb/ldz035] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tendinopathy is a common musculoskeletal condition affecting subjects regardless of their activity level. Multiple inflammatory molecules found in ex vivo samples of human tendons are related to the initiation or progression of tendinopathy. Their role in tendon healing is the subject of this review. SOURCES OF DATA An extensive review of current literature was conducted using PubMed, Embase and Cochrane Library using the term 'tendon', as well as some common terms of tendon conditions such as 'tendon injury OR (tendon damage) OR tendonitis OR tendinopathy OR (chronic tendonitis) OR tendinosis OR (chronic tendinopathy) OR enthesitis' AND 'healing' AND '(inflammation OR immune response)' as either key words or MeSH terms. AREAS OF AGREEMENT An environment characterized by a low level of chronic inflammation, together with increased expression of inflammatory cytokines and growth factors, may influence the physiological tendon healing response after treatment. AREAS OF CONTROVERSY Most studies on this topic exhibited limited scientific translational value because of their heterogeneity. The evidence associated with preclinical studies is limited. GROWING POINTS The role of inflammation in tendon healing is still unclear, though it seems to affect the overall outcome. A thorough understanding of the biochemical mediators of healing and their pathway of pain could be used to target tendinopathy and possibly guide its management. AREAS TIMELY FOR DEVELOPING RESEARCH We require further studies with improved designs to effectively evaluate the pathogenesis and progression of tendinopathy to identify cellular and molecular targets to improve outcomes.
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Affiliation(s)
- Emanuele Chisari
- University of Catania, Departmento of General Surgery and Medical Specialities, Via Santa Sofia 78, Catania 95123, Italy
| | - Laura Rehak
- Athena Biomedical Innovations, Viale Europa 139, Florence, 50126, Italy
| | - Wasim S Khan
- Division of Trauma and Orthopaedics, Addenbrooke's Hospital, University of Cambridge, Hills Rd, Cambridge CB2 0QQ, United Kingdom
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Via Salvador Allende, 43, 84081 Baronissi SA, Italy, Salerno, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Largo Città di Ippocrate, Salerno, 84131, Italy.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, England.,School of Medicine, Institute of Science and Technology in Medicine, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, England
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20
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Yaghmour KM, Chisari E, Khan WS. Single-Stage Revision Surgery in Infected Total Knee Arthroplasty: A PRISMA Systematic Review. J Clin Med 2019; 8:jcm8020174. [PMID: 30717420 PMCID: PMC6406500 DOI: 10.3390/jcm8020174] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/23/2019] [Accepted: 01/29/2019] [Indexed: 02/06/2023] Open
Abstract
Periprosthetic joint infection in total knee arthroplasty is a significant complication that is a common reason for revision surgery. The current standard of care is two-stage revision surgery. There is however increasing evidence to support the use of single-stage revision surgery. We conducted a PRISMA systematic review of the current evidence on the use of single-stage revision for infected total knee arthroplasty. Four databases (PubMed, Embase, Science Direct, and Cochrane Library) were systematically screened for eligible studies. The risk bias of each study was identified using ROBINS-I tool, and the quality of evidence was assessed using the GRADE criteria. Sixteen articles were retained after applying the inclusion and exclusion criteria that evaluated 3645 knee single-stage revision surgeries. Our review reveals satisfactory outcomes for single-stage revision in the management of infected total knee arthroplasty. The reinfection rates in the studies included in our review varied however the majority reported low reinfection rates and good functional outcomes. Although strict patient selection criteria have yielded successful results, good results were also reported when these criteria were not applied. The greater use of risk factors in identifying patients likely to have a successful outcome needs to be balanced with the practical benefits of performing a single stage procedure in higher risk patients. Future large clinical randomized control trials are required to confirm our results.
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Affiliation(s)
- Khaled M Yaghmour
- Division of Trauma & Orthopaedic Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Emanuele Chisari
- Division of Trauma & Orthopaedic Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico, University of Catania, 95123 Catania, Italy.
| | - Wasim S Khan
- Division of Trauma & Orthopaedic Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
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21
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Ranmuthu CDS, Ranmuthu CKI, Russell JC, Singhania D, Khan WS. Are the Biological and Biomechanical Properties of Meniscal Scaffolds Reflected in Clinical Practice? A Systematic Review of the Literature. Int J Mol Sci 2019; 20:ijms20030632. [PMID: 30717200 PMCID: PMC6386938 DOI: 10.3390/ijms20030632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/18/2019] [Accepted: 01/18/2019] [Indexed: 12/14/2022] Open
Abstract
The aim of this PRISMA review was to assess whether the CMI and Actifit scaffolds, when used in clinical practice, improve clinical outcomes and demonstrate the ideal biological and biomechanical properties of scaffolds: being chondroprotective, porous, resorbable, able to mature and promote regeneration of tissue. This was done by only including studies that assessed clinical outcome and used a scale to assess both integrity of the scaffold and its effects on articular cartilage via MRI. A search was performed on PubMed, EMBASE, Scopus and clinicaltrials.gov. 2457 articles were screened, from which eight studies were selected: four used Actifit, three used CMI and one compared the two. All studies reported significant improvement in at least one clinical outcome compared to baseline. Some studies suggested that the scaffolds appeared to show porosity, mature, resorb and/or have possible chondroprotective effects, as assessed by MRI. The evidence for clinical translation is limited by differences in study methodology and small sample sizes, but is promising in terms of improving clinical outcomes in the short to mid-term. Higher level evidence, with MRI and histological evaluation of the scaffold and articular cartilage, is now needed to further determine whether these scaffolds exhibit these useful properties.
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Affiliation(s)
- Chanuka D S Ranmuthu
- School of Clinical Medicine, Addenbrooke's Hospital, University Of Cambridge, Cambridge CB2 0SP, UK.
| | - Charindu K I Ranmuthu
- School of Clinical Medicine, Addenbrooke's Hospital, University Of Cambridge, Cambridge CB2 0SP, UK.
| | - Jodie C Russell
- School of Clinical Medicine, Addenbrooke's Hospital, University Of Cambridge, Cambridge CB2 0SP, UK.
| | - Disha Singhania
- School of Clinical Medicine, Addenbrooke's Hospital, University Of Cambridge, Cambridge CB2 0SP, UK.
| | - Wasim S Khan
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, UK.
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22
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Archer DE, Mafi R, Mafi P, Khan WS. Preclinical Studies on Biomaterial Scaffold use in Knee Ligament Regeneration: A Systematic Review. Curr Stem Cell Res Ther 2018; 13:691-701. [PMID: 30091417 DOI: 10.2174/1574888x13666180809093343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/08/2018] [Accepted: 08/09/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Knee joint trauma may result in damage of the intra-articular ligaments, with rupture of the anterior cruciate ligament (ACL) a common and troublesome injury due to poor capabilities for spontaneous regeneration. Autograft and allograft surgical reconstructions are the mainstay of treatment, but have associated risks of failure, therefore tissue-engineering techniques aiming to regenerate the native ACL are being researched as a potential alternative treatment. OBJECTIVES This article aims to review the current evidence produced by ex vivo and in vivo studies investigating biomaterial scaffolding and mesenchymal stem cell (MSC) techniques in orthopaedic tissue engineering of ACL injuries. METHODS Databases searched were Ovid MEDLINE, Cochrane Library, Embase, Elsevier Scopus, Web of Science and NCBI PubMed, with search terms 'ligament', 'scaffold', 'mesenchymal stem cell' and 'tissue engineering'. RESULTS 1132 articles were identified, with 19 articles suitable for review inclusion. Of the eligible studies, 10 used biologic scaffold material, 6 used synthetic constructs, and hybrid scaffolds were employed in the remaining 3 studies. CONCLUSIONS A large amount of preclinical evidence for viability of MSC seeded biomaterial scaffolds in ACL regeneration exists. Studies show that with stimulation, MSCs adhere and proliferate well on various scaffold materials ranging from silk to engineered polymers. Hybrid scaffolds are particularly promising, and with further research, the best features from strong natural substances such as silk, and biologically inert synthetic materials could be combined. Currently, there are few plans to begin human clinical trials, but preclinical studies are moving into larger animal models.
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Affiliation(s)
- Danielle E Archer
- The Hull York Medical School, Heslington, York, North Yorkshire YO10 5DD, United Kingdom
| | - Reza Mafi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Windmill Road, Oxford, OX3 7LD, United Kingdom
| | - Pouya Mafi
- St Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, United Kingdom
| | - Wasim S Khan
- Addenbrooke`s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge CB2 0QQ, United Kingdom
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23
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Ardakani AHG, Khan WS. The Influence of Ageing and Gender in Musculoskeletal Stem Cell. Curr Stem Cell Res Ther 2018; 13:432-437. [PMID: 29380704 DOI: 10.2174/1574888x13666180129164411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 01/14/2018] [Accepted: 01/21/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multipotent Mesenchymal Stromal Cells (MSCs) are the most common type of stem cell used in the regeneration of skeletal tissue. These cells have multipotent, angiogenic, paracrine, anti-fibrotic and immunological properties. They are readily available, easily isolated and have many therapeutic applications. The ageing population is on the increase and with this comes an upsurge in medical conditions that may benefit from novel stem cell-based therapies to treat ageingassociated diseases. Given that autologous implantations have shown to be beneficial in these targeted therapies, questions are raised regarding the effect of ageing and gender on the efficacy of stem cells. OBJECTIVE In this review, we look at the ageing process and look at the effects of ageing and gender on the characterization, proliferation and differentiation of mesenchymal stem cells. We also discuss future therapeutic strategies that may be used to overcome these effects and cell senescence. CONCLUSION Advancements in modern technology and experimental techniques have provided an insight into how ageing affects properties of MSCs. However, it is evident that further work needs to be conducted due to many mixed reviews and conflicting data. Given that the human life expectancy is expected to increase the topic of cell ageing and therapeutic applications will remain a hot topic in years to come.
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Affiliation(s)
- Amir H Gahanbani Ardakani
- University College London Institute for Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| | - Wasim S Khan
- University College London Institute for Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
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24
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Ranmuthu CDS, Ranmuthu CKI, Khan WS. Evaluating the Current Literature on Treatments Containing Adipose-Derived Stem Cells for Osteoarthritis: a Progress Update. Curr Rheumatol Rep 2018; 20:67. [PMID: 30203213 DOI: 10.1007/s11926-018-0776-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Recent studies have investigated the effect of treatments containing adipose-derived mesenchymal stem cells (ADMSCs) on human osteoarthritis. These have mostly used biologic adjuvants which may influence results. Thus, the purpose of this systematic review is to evaluate the current literature on these treatments when used in isolation. RECENT FINDINGS Five studies in this review used cultured ADMSCs, while four studies used stromal vascular fraction and three used micro-fragmented adipose tissue to deliver ADMSCs. No studies reported serious treatment-related adverse effects and all reported improvements in clinical measures for at least one dose. This was not necessarily reflected in imaging evaluations nor were improvements always maintained. Current low-level evidence is limited due to variability in study methodology but indicates that treatments containing ADMSCs, when used in isolation, are safe and have the potential to reduce pain and improve function. Randomized controlled trials are now needed.
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Affiliation(s)
| | | | - Wasim S Khan
- University of Cambridge, Cambridge, UK. .,Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
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25
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Lin DD, Picardo NE, Adesida A, Khan WS. Clinical Studies Using Biological and Synthetic Materials for Meniscus Replacement. Curr Stem Cell Res Ther 2018; 12:348-353. [PMID: 27133081 DOI: 10.2174/1574888x11666160429123110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/13/2016] [Accepted: 04/19/2016] [Indexed: 11/22/2022]
Abstract
Meniscal injury is a common problem among sportsmen and increasingly seen in the older and more active population. The traditional treatment options include a partial meniscectomy, which provides good mechanical and pain relief to the patient. However, the focus of treatment is shifting towards repairing meniscal tears where possible and replacement of the lost meniscal tissue where appropriate. Replacement can be total or partial. Total meniscal replacement using an allograft, is usually reserved for young patients, who meet certain criteria and who have undergone several subtotal meniscectomies or a single stage total meniscectomy and are still symptomatic. Partial meniscal replacement can be utilized in conjunction with a partial meniscectomy to fill the resulting space left by the resection. Collagen based implants and synthetic scaffolds have entered the European market but have demonstrated mixed results in clinical trials. Tissue engineering to create an implant that mimics the biomechanical properties holds much potential for future research.
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Affiliation(s)
- David D Lin
- Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, United Kingdom
| | - Natasha E Picardo
- Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, United Kingdom
| | - Adetola Adesida
- University of Alberta, 16 St & 85 Ave, Edmonton, AB T6G 2R3, United Kingdom
| | - Wasim S Khan
- Division of Trauma & Orthopaedics, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
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26
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Killington K, Mafi R, Mafi P, Khan WS. A Systematic Review of Clinical Studies Investigating Mesenchymal Stem Cells for Fracture Non-Union and Bone Defects. Curr Stem Cell Res Ther 2018; 13:284-291. [DOI: 10.2174/1574888x12666170915121137] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/09/2016] [Accepted: 03/13/2016] [Indexed: 11/22/2022]
Affiliation(s)
- Kieran Killington
- Hull York Medical School, Heslington, York, YO10 5DD, United Kingdom
| | - Reza Mafi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Pouya Mafi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Wasim S. Khan
- Division of Trauma and Orthopaedics, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 2QQ, United Kingdom
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27
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Riley TC, Mafi R, Mafi P, Khan WS. Knee Ligament Injury and the Clinical Application of Tissue Engineering Techniques: A Systematic Review. Curr Stem Cell Res Ther 2018; 13:226-234. [PMID: 28914209 DOI: 10.2174/1574888x12666170915120135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/09/2016] [Accepted: 03/13/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The incidence of knee ligament injury is increasing and represents a significant cost to healthcare providers. Current interventions include tissue grafts, suture repair and non-surgical management. These techniques have demonstrated good patient outcomes but have been associated graft rejection, infection, long term immobilization and reduced joint function. The limitations of traditional management strategies have prompted research into tissue engineering of knee ligaments. OBJECTIVE This paper aims to evaluate whether tissue engineering of knee ligaments offers a viable alternative in the clinical management of knee ligament injuries. A search of existing literature was performed using OVID Medline, Embase, AMED, PubMed and Google Scholar, and a manual review of citations identified within these papers. RESULTS Silk, polymer and extracellular matrix based scaffolds can all improve graft healing and collagen production. Fibroblasts and stem cells demonstrate compatibility with scaffolds, and have been shown to increase organized collagen production. These effects can be augmented using growth factors and extracellular matrix derivatives. Animal studies have shown tissue engineered ligaments can provide the biomechanical characteristics required for effective treatment of knee ligament injuries. CONCLUSION There is a growing clinical demand for a tissue engineered alternative to traditional management strategies. Currently, there is limited consensus regarding material selection for use in tissue engineered ligaments. Further research is required to optimize tissue engineered ligament production before clinical application. Controlled clinical trials comparing the use of tissue engineered ligaments and traditional management in patients with knee ligament injury could determine whether they can provide a cost-effective alternative.
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Affiliation(s)
- Thomas C Riley
- Hull York Medical School, Heslington, York, YO10 5DD, United Kingdom
| | - Reza Mafi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Pouya Mafi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Wasim S Khan
- Division of Trauma and Orthopaedics, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, United Kingdom
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Borakati A, Mafi R, Mafi P, Khan WS. A Systematic Review And Meta-Analysis of Clinical Trials of Mesenchymal Stem Cell Therapy for Cartilage Repair. Curr Stem Cell Res Ther 2018; 13:215-225. [DOI: 10.2174/1574888x12666170915120620] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/12/2016] [Accepted: 03/13/2016] [Indexed: 11/22/2022]
Affiliation(s)
- Aditya Borakati
- The Hull York Medical School, Hertford Building, University of Hull, HU6 7RX, United Kingdom
| | - Reza Mafi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Pouya Mafi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Wasim S. Khan
- Division of Trauma and Orthopaedics, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, United Kingdom
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Pillai DS, Dhinsa BS, Khan WS. Tissue Engineering in Achilles Tendon Reconstruction; The Role of Stem Cells, Growth Factors and Scaffolds. Curr Stem Cell Res Ther 2017; 12:506-512. [DOI: 10.2174/1574888x12666170523162214] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 03/12/2016] [Accepted: 03/13/2016] [Indexed: 11/22/2022]
Affiliation(s)
- Dilip S. Pillai
- Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, United Kingdom
| | - Baljinder S. Dhinsa
- Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, United Kingdom
| | - Wasim S. Khan
- Division of Trauma & Orthopaedics, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
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Malik AA, Robinson S, Khan WS, Dillon B, Lovell ME. Assessment of Range of Movement, Pain and Disability Following a Whiplash Injury. Open Orthop J 2017; 11:541-545. [PMID: 28839498 PMCID: PMC5543694 DOI: 10.2174/1874325001711010541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/06/2017] [Accepted: 04/24/2017] [Indexed: 11/30/2022] Open
Abstract
Background: Whiplash has been suggested to cause chronic symptoms and long term disability. This study was designed to assess long term function after whiplash injury. Material & Methods: A random sample of patients in the outpatient clinic was interviewed, questionnaire completed and clinical examination performed. Assessment was made of passive cervical range of movement and Visual Analogue Scale pain scores. One hundred and sixty-four patients were divided into four different groups including patients with no whiplash injury but long-standing neck pain (Group A), previous symptomatic whiplash injury and long-standing neck pain (Group B), previous symptomatic whiplash injury and no neck symptoms (Group C), and a control group of patients with no history of whiplash injury or neck symptoms (Group D). Results: Data was analyzed by performing an Independent samples t-test and ANOVA, with level of significance taken as p<0.05. Comparing the four groups using a one-way ANOVA showed a significant difference between the groups (p<0.001). There were significant differences when comparing mean ranges of movement between Group A and Group D, and between Group B and Group D. There was no significant difference between Group C and Group D. similar differences were also seen in the pain scores. Conclusion: We conclude that osteoarthritis in the cervical spine, and whiplash injury with chronic problems cause a significantly decreased cervical range of movement with a higher pain score. Patients with shorter duration of whiplash symptoms appear to do better in the long-term.
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Affiliation(s)
- Atif A Malik
- University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, London; HA7 4LP, UK
| | - Simon Robinson
- University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, London; HA7 4LP, UK
| | - Wasim S Khan
- University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, London; HA7 4LP, UK
| | - Bernice Dillon
- University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, London; HA7 4LP, UK
| | - Martyn E Lovell
- University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, London; HA7 4LP, UK
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Shaikh N, Seah MKT, Khan WS. Systematic review on the use of autologous matrix-induced chondrogenesis for the repair of articular cartilage defects in patients. World J Orthop 2017; 8:588-601. [PMID: 28808630 PMCID: PMC5534408 DOI: 10.5312/wjo.v8.i7.588] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/22/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To systematically review the results of studies looking at autologous matrix-induced chondrogenesis (AMIC) in humans.
METHODS A literature search was performed, adhering to the PRISMA guidelines, to review any studies using such techniques in humans. Our initial search retrieved 297 articles listed on MEDLINE, Google Scholar, CINHal and EMBASE. From these studies, 15 studies meeting the eligibility criteria were selected and formed the basis of our systematic review.
RESULTS The study designs, surgical techniques and outcome measures varied between the studies. Although all studies reported improvements in patient outcome measures, this was not necessarily correlated with magnetic resonance imaging findings. Although there were many additional procedures performed, when AMIC was performed in isolation, the results tended to peak at 24 mo before declining.
CONCLUSION Although short-term studies suggest improved patient reported outcomes with a variety of scaffolds, surgical techniques and rehabilitation regimes, the literature remains equivocal on whether the defect size and location, and patient factors affect the outcome. Patient benefit appears to be maintained in the short-to-medium term but more high level studies with extensive and robust validated outcome measures should be conducted to evaluate the medium- and long-term effect of the AMIC procedure.
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Khwaja MK, Khan WS, Ray P, Park DH. A Retrospective Study Comparing Crossed and Lateral Wire Configurations in Paediatric Supracondylar Fractures. Open Orthop J 2017; 11:432-438. [PMID: 28660001 PMCID: PMC5470067 DOI: 10.2174/1874325001711010432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/23/2017] [Accepted: 04/24/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Supracondylar fractures are common in children and are associated with significant morbidity. The purpose of our study was to assess and compare the clinical and radiological outcome of management of supracondylar fractures by both wire configurations, along with identifying factors that predispose to complications. Materials & Methods: We retrospectively reviewed all paediatric cases admitted with a supracondylar fracture over a five year period. We reviewed case notes, theatre records and radiographs to determine the age of the patient, classification of fracture, treatment method, delay to theatre, duration of surgery, wire configuration, Baumann´s angle, radiocapitellar alignment, anterior humeral alignment and complications. Results: During the five year period we admitted 132 patients and complete notes were available for 123 patients for analyses. For all the patients managed with wire stabilisation 23% developed complications, including 13% with significant complications including nerve injuries and fracture displacements. All five nerve injuries had crossed wires, whereas all for fracture displacements had lateral wires. Baumann´s angle was 76.7 degrees in the group with no complication and 72.2 degrees in the significant complication group (p=0.02). Radiocapitellar line and anterior humeral line were not satisfactory in 5% and 15% of the group with no complications, and 17% and 33% of the group with significant complications. Conclusion: We found more complications in lateral pinning configurations, although all nerve injuries were in patients with crossed wire configurations. The factors we believe are associated with a higher likelihood of complications are inadequate post-operative radiological appearance.
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Affiliation(s)
- Murtaza K Khwaja
- Department of Trauma and Orthopaedics, Royal Free Hospitals NHS Trust, Barnet Hospital, Barnet, London, UK
| | - Wasim S Khan
- Department of Trauma and Orthopaedics, Royal Free Hospitals NHS Trust, Barnet Hospital, Barnet, London, UK
| | - Pinak Ray
- Department of Trauma and Orthopaedics, Royal Free Hospitals NHS Trust, Barnet Hospital, Barnet, London, UK
| | - Derek H Park
- Department of Trauma and Orthopaedics, Royal Free Hospitals NHS Trust, Barnet Hospital, Barnet, London, UK
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Szostakowski B, Smitham P, Khan WS. Plaster of Paris-Short History of Casting and Injured Limb Immobilzation. Open Orthop J 2017; 11:291-296. [PMID: 28567158 PMCID: PMC5420179 DOI: 10.2174/1874325001711010291] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/02/2017] [Accepted: 03/09/2017] [Indexed: 12/03/2022] Open
Abstract
Various materials have been used since ancient times to help immobilise fractures. In this review, we discuss the history and developments of these materials as well as plaster of Paris. There has been a recent trend away from non-operative management of fractures, and skills in the use of plaster of Paris are declining. For the successful treatment of patients, it is important to appreciate how plaster works, how it should be used, and what can go wrong. In this review, we also discuss principles of applications and complications of plaster of Paris.
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Affiliation(s)
- B Szostakowski
- University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, London, UK
| | - P Smitham
- University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, London, UK
| | - W S Khan
- University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, London, UK
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Sinclair KL, Mafi P, Mafi R, Khan WS. The Use of Growth Factors and Mesenchymal Stem Cells in Orthopaedics: In particular, their use in Fractures and Non-Unions: A Systematic Review. Curr Stem Cell Res Ther 2017; 12:312-325. [DOI: 10.2174/1574888x11666160614104500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 11/22/2022]
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Williams RL, Ayre WN, Khan WS, Mehta A, Morgan-Jones R. Acetic Acid as Part of a Debridement Protocol During Revision Total Knee Arthroplasty. J Arthroplasty 2017; 32:953-957. [PMID: 27776909 DOI: 10.1016/j.arth.2016.09.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/25/2016] [Accepted: 09/06/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Thorough debridement is mandatory in revision for infected total knee arthroplasties (TKA). We investigated a novel adjuvant chemical debridement strategy using acetic acid (AA) that seeks to create a hostile environment for microorganisms. We report the first orthopedic in vivo series using an AA soak in infected TKAs. We also investigated the in vitro efficacy of AA against bacteria isolated from these knees. METHODS Twenty-three patients with infected TKA were treated with a standard debridement protocol and chemical debridement with a 20-minute AA soak. In parallel, bacteria from infected TKAs were cultured for in vitro susceptibility testing with AA solutions of different concentrations to understand its potential mechanism of action. RESULTS Intraoperatively, there were no physiological responses during the AA soak or on release of the tourniquet. Postoperatively, there was no increase in analgesic requirements or wound or soft-tissue complications. Clinical follow-up continued for 24 months to monitor recurrent infection. In vitro, zones of inhibition were formed on less than 40% of the organisms, demonstrating that AA was not directly bactericidal against the majority of the isolates. However, when cultured in a bacterial suspension, AA completely inhibited the growth of the isolates at concentrations as low as 0.19% vol/vol. CONCLUSION This study has shown that the use of 3% AA soak, as part of a debridement protocol is safe in patients. While the exact mechanism of action is yet to be determined, AA concentrations as low as 0.19% vol/vol in vitro are sufficient to completely inhibit bacterial growth.
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Affiliation(s)
- Rhodri L Williams
- Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, United Kingdom
| | - Wayne N Ayre
- Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, United Kingdom
| | - Wasim S Khan
- Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, United Kingdom
| | - Amisha Mehta
- Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, United Kingdom
| | - Rhidian Morgan-Jones
- Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, United Kingdom
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Abstract
A systematic review of the clinical and radiological outcomes of locking plates in proximal humeral fractures in the current English literature was performed using Medline, CINAHL, AMED and EMBASE electronic databases to July 2009 via Ovid. There were 1266 proximal humeral fractures included in the review. The mean age of the patients was 61.7 years and there were 70.3% women. Based on the Neer classification, the review included 27% two-part, 39.5% three-part and 23.6% four-part fractures. At final follow-up, the Constant score was in the range 59 to 80, and the Disabilities of the Arm, Shoulder and Hand scores were in the range 15.2 to 51.8. The most frequent postoperative complication described was intra-articular screw perforation in 8.5% of fractures. Other complications included avascular necrosis (5.1%), subacromial impingement (3.1%), loss of reduction (3.7%) and implant failure (3.15%). Unplanned secondary surgical procedures were undertaken in 14.2% of cases. This systematic review has demonstrated that locking plate systems are suitable for stabilizing proximal humeral fractures. The current evidence base presents a number of methodological weaknesses and randomized controlled trials at independent centres reporting long-term results are required to compare locking plate systems with alternative fixation techniques used in the treatment of proximal humeral fractures.
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Affiliation(s)
| | - Wasim S. Khan
- Department of Statistical Science, University College London, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | | | - Philip M. Ahrens
- Department of Trauma and Orthopaedics, Royal Free Hospital, London, UK
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Khozoee B, Mafi P, Mafi R, Khan WS. Mechanical Stimulation Protocols of Human Derived Cells in Articular Cartilage Tissue Engineering - A Systematic Review. Curr Stem Cell Res Ther 2017; 12:260-270. [PMID: 27306401 DOI: 10.2174/1574888x11666160614103840] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/18/2016] [Accepted: 05/26/2016] [Indexed: 11/22/2022]
Abstract
Mechanical stimulation is a key factor in articular cartilage generation and maintenance. Bioreactor systems have been designed and built in order to deliver specific types of mechanical stimulation. The focus has been twofold, applying a type of preconditioning in order to stimulate cell differentiation, and to simulate in vivo conditions in order to gain further insight into how cells respond to different stimulatory patterns. Due to the complex forces at work within joints, it is difficult to simulate mechanical conditions using a bioreactor. The aim of this review is to gain a deeper understanding of the complexities of mechanical stimulation protocols by comparing those employed in bioreactors in the context of tissue engineering for articular cartilage, and to consider their effects on cultured cells. Allied and Complementary Medicine 1985 to 2016, Ovid MEDLINE[R] 1946 to 2016, and Embase 1974 to 2016 were searched using key terms. Results were subject to inclusion and exclusion criteria, key findings summarised into a table and subsequently discussed. Based on this review it is overwhelmingly clear that mechanical stimulation leads to increased chondrogenic properties in the context of bioreactor articular cartilage tissue engineering using human cells. However, given the variability and lack of controlled factors between research articles, results are difficult to compare, and a standardised method of evaluating stimulation protocols proved challenging. With improved standardisation in mechanical stimulation protocol reporting, bioreactor design and building processes, along with a better understanding of joint behaviours, we hope to perform a meta-analysis on stimulation protocols and methods.
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Affiliation(s)
- Baktash Khozoee
- University of Edinburgh, College of Medicine and Veterinary Medicine, 47 Little France Crescent, Edinburgh. United Kingdom
| | - Pouya Mafi
- Whipps Cross University Hospital, Barts Health NHS Trust, Whipps Cross Road, United Kingdom
| | - Reza Mafi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Wasim S Khan
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, United Kingdom
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Mace J, Wheelton A, Khan WS, Anand S. The Role of Bioreactors in Ligament and Tendon Tissue Engineering. Curr Stem Cell Res Ther 2016; 11:35-40. [PMID: 26337379 DOI: 10.2174/1574888x10666150904113827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/19/2015] [Accepted: 09/02/2015] [Indexed: 11/22/2022]
Abstract
Bioreactors are pivotal to the emerging field of tissue engineering. The formation of neotissue from pluripotent cell lineages potentially offers a source of tissue for clinical use without the significant donor site morbidity associated with many contemporary surgical reconstructive procedures. Modern bioreactor design is becoming increasingly complex to provide a both an expandable source of readily available pluripotent cells and to facilitate their controlled differentiation into a clinically applicable ligament or tendon like neotissue. This review presents the need for such a method, challenges in the processes to engineer neotissue and the current designs and results of modern bioreactors in the pursuit of engineered tendon and ligament.
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Affiliation(s)
| | | | - Wasim S Khan
- University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, UK.
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Khan WS, Smart A. Outcome of surgery for chronic patellar tendinopathy: A systematic review. Acta Orthop Belg 2016; 82:610-326. [PMID: 29119904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There is no consensus on how to best surgically treat chronic patellar tendinopathy. This systematic review investigates the surgical treatment for chronic patellar tendinopathy, and the outcomes. A database search was performed to identify all relevant articles, to which exclusion criteria were then applied. Data was extracted from 24 studies, and the outcomes were then systematically reviewed. The results showed that the success rate of surgery for patellar tendinopathy is generally over 77%. Return to sports rates are better for proximal tendon patients who undergo bony procedures. Patients return to sports faster if they undergo arthroscopic procedures, and fewer complications are described. Studies that did not involve any procedure on the proximal tendon did not produce a different result to studies where the tendon was operated on. We found no effect of post-operative immobilisation on outcome. Based on the included studies, surgery gives satisfactory results in the treatment of patellar tendinopathy. There is a lack of high-quality evidence on the effects of surgery and post-operative rehabilitation regime on chronic patellar tendinopathy, as well as lack of objective outcome measures.
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Wheelton A, Mace J, S. Khan W, Anand S. Biomaterials and Fabrication to Optimise Scaffold Properties for Musculoskeletal Tissue Engineering. Curr Stem Cell Res Ther 2016. [DOI: 10.2174/1574888x11666160614101037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wheelton A, Mace J, Khan WS, Anand S. Biomaterials and Fabrication to Optimise Scaffold Properties for Musculoskeletal Tissue Engineering. Curr Stem Cell Res Ther 2016:CSCRT-EPUB-76503. [PMID: 27297035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 05/01/2016] [Indexed: 06/06/2023]
Abstract
Tissue engineering has emerged as a promising scientific field potentially yielding in vitro developed tissue to replace degenerative or injured tissues in vivo, thus avoiding the donor site morbidity associated with reconstructive surgery. Integral to the process is the role of scaffolds and the biomaterials used to form them. This review explores the concept of scaffold based tissue engineering and design considerations. The scaffold needs to have certain mechanical and architectural properties, it needs to be biocompatible and biodegradable, and allow combination with bioactive molecules. We also discuss scaffolding techniques, different biomaterial options and fabrication technologies, and future areas of development.
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Affiliation(s)
| | | | - W S Khan
- Clinical Lecturer, University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, UK.
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Abbas AMI, Williams RLL, Khan WS, Ghandour A, Morgan-Jones RL. Tibial Crest Osteotomy in Extensile Knee Exposure-A Modified, Low-Energy, Suture Technique. J Arthroplasty 2016; 31:383-8. [PMID: 26427939 DOI: 10.1016/j.arth.2015.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/17/2015] [Accepted: 08/25/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tibial crest osteotomy is an established extensile knee approach. Complications include mal-union, non-union, and fixation problems.We have designed a technique aimed at reducing complications through the principles of low-energy osteotomy and suture repair. METHODS We reviewed our clinical and radiological results in 159 consecutive patients 181 osteotomies with a mean age of 66 years, and an average follow up of 22 months. RESULTS Union occurred in all osteotomies (100%) at a mean period of 11 weeks. Proximal migration averaging 11.5 mm occurred in 6 osteotomies (3%). Crest fragmentation occurred in 11 osteotomies (6%), with all cases resulting in uncomplicated union. No extensor mechanism failure or complications related to the suture material occurred. CONCLUSION We conclude that this technique results in satisfactory outcomes whilst avoiding hardware-related problems.
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Affiliation(s)
- Ammar M I Abbas
- Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, United Kingdom
| | | | - Wasim S Khan
- Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, United Kingdom
| | - Adel Ghandour
- Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, United Kingdom
| | - Rhidian L Morgan-Jones
- Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, United Kingdom
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Wheelton A, Mace J, Khan WS, Anand S. Biomaterials and Fabrication to Optimise Scaffold Properties for Musculoskeletal Tissue Engineering. Curr Stem Cell Res Ther 2016; 11:578-584. [PMID: 27306403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 04/24/2016] [Accepted: 05/01/2016] [Indexed: 06/06/2023]
Abstract
Tissue engineering has emerged as a promising scientific field potentially yielding in vitro developed tissue to replace degenerative or injured tissues in vivo, thus avoiding the donor site morbidity associated with reconstructive surgery. Integral to the process is the role of scaffolds and the biomaterials used to form them. This review explores the concept of scaffold based tissue engineering and design considerations. The scaffold needs to have certain mechanical and architectural properties, it needs to be biocompatible and biodegradable, and allow combination with bioactive molecules. We also discuss scaffolding techniques, different biomaterial options and fabrication technologies, and future areas of development.
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Affiliation(s)
| | | | - Wasim S Khan
- University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, UK
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Pengas IP, Khan WS, Bennett CA, Rankin KS. Impact of Weekend Physiotherapy Service on the Cost Effectiveness of Elective Orthopaedic Hip and Knee Arthroplasty. Open Orthop J 2015; 9:515-9. [PMID: 26587071 PMCID: PMC4645972 DOI: 10.2174/1874325001509010515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 12/03/2022] Open
Abstract
We performed a prospective correlational study to evaluate the efficiency and cost effectiveness of weekend
physiotherapy in accelerating rehabilitation, reducing hospital stay as well as hospital costs for joint arthroplasty patients
in a busy Scottish district general hospital. Patients that underwent elective hip (470) and knee (321) arthroplasty were
analysed over a 12 month period. A four month period with weekend physiotherapy provision was arranged to ascertain
its effectiveness on the length of stay and the achievement of set physiotherapy milestones. Data collected included length
of stay and progression in a defined set of physiotherapy milestones. The relationship between time to discharge,
mobilisation with sticks, straight leg raise, 90º knee flexion and cost effectiveness of service were used to determine the
correlation, and analysis of the interactions of these factors separately. Our Outcome data demonstrate a statistical
significance for the time to mobilisation with two sticks for hip (p=0.0030) and knee (p= 0.0037) arthroplasty patients.
There was a trend towards earlier discharge times for all patients receiving weekend physiotherapy, but this was not
statistically significant. We conclude that the provision of a continuous programme of weekend physiotherapy for all
arthroplasty patients has the potential benefit of a quicker rehabilitation that would results in a cost saving.
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Affiliation(s)
- I P Pengas
- Department of Orthopaedics, Perth Royal Infirmary, Perth, Scotland PH1 1NX, UK
| | - W S Khan
- University College London Institute of Orthopaedics & Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, London HA7 4LP, UK
| | - C A Bennett
- Department of Physiotherapy, Perth Royal Infirmary, Perth, Scotland PH1 1NX, UK
| | - K S Rankin
- Department of Orthopaedics, Perth Royal Infirmary, Perth, Scotland PH1 1NX, UK
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Rashid MA, Parnell M, Khan WS, Khan A. First Metatarsalphalangeal Joint Arthrodesis: A Retrospective Comparison of Two Methods of Fixation. Open Orthop J 2015; 9:480-2. [PMID: 26587065 PMCID: PMC4645895 DOI: 10.2174/1874325001509010480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/03/2015] [Accepted: 05/22/2015] [Indexed: 12/02/2022] Open
Abstract
First metatarsalphalangeal joint arthrodesis is a well established and successful treatment; however there still remains controversy over the best choice of construct. We performed a retrospective study of patients undergoing first metatarsalphalangeal fusion over eighteen months (n=52) using either dorsal non-locking plate with additional compression lag screw fixation or dorsal non-locking plate alone. We found when assessing clinical criteria, patients with dorsal non-locking plates and additional compression lag screw fixation had a significantly higher rate of fusion (100% vs 77.8%), significantly higher rate of fusion within the first two months (55.6% vs 83.3%), significantly earlier time to fusion (52.2 days vs 75.6 days), and significantly lower rate of non-union (0% vs 22.2%). When blindly assessing radiographic criteria, the patients treated with the plate and compression screw had a significantly higher rate of fusion and lower rate of non-union (0% vs 33%). There was no statistically significant difference between the frequencies of complications in the groups. We believe that the interfragmentary compression is a crucial factor in achieving good union rates and recommend the use of non-locking pre-contoured plating with additional interfragmentary compression screw as the fixation method of choice for these procedures.
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Affiliation(s)
- M A Rashid
- Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK
| | - M Parnell
- Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK
| | - W S Khan
- Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK
| | - A Khan
- Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK
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Affiliation(s)
- W S Khan
- University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - U G Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
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Chew E, Khan WS, Agarwal S, Morgan-Jones R. Single Stage Knee Arthroplasty Revision Surgery: A Systematic Review of the Literature. Open Orthop J 2015; 9:504-10. [PMID: 26587070 PMCID: PMC4645866 DOI: 10.2174/1874325001509010504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/23/2015] [Accepted: 05/27/2015] [Indexed: 01/04/2023] Open
Abstract
Total Knee Arthroplasty is an increasingly common procedure and revision surgery, particularly for infection, is associated with significant morbidity and healthcare costs. The current gold standard is a two stage revision procedure but single stage revision is increasingly being used in some departments to improve patient outcomes. We conducted a systematic review of the literature to determine the up-to-date evidence underlying the use of a single stage knee approach in revision surgery. A total of 12 studies were included in this review amounting to 433 revision surgeries. This is the largest review of single stage knee revision surgery. The procedures described were heterogenous and included the 'two-in-one' technique as well as other single stage revision procedures. There were also differences in implants and antibiotic regimens. The mean re-infection rates described in 10 studies was 9.4% (range 0-19.2%) after a mean follow-up of 40.3 months (range 7-180 months). The re-infection rates in the studies published over the last 30 years are falling, and this is not accounted for by any significant change in duration of follow-up during this period. The outcome scores varied, but patients generally showed an improvement. The Knee Society Score and the Oxford Knee Score were the most commonly used in five and three studies respectively. We conclude that the current evidence for single stage revision is variable and there is a lack of good quality evidence to address whether single stage revisions is thorough enough to eradicate deep infection and is able to restore adequate function. There is a need for larger prospective studies with standardised procedures and protocol, and with adequate follow-up. Till then, patients considered for a single stage approach should be thoroughly assessed and the surgery should be performed by a senior surgeon with experience in single stage knee revisions.
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Affiliation(s)
- E Chew
- Department of Trauma and Orthopaedics, Royal Free Hospital, Hampstead, London, NW3 2QG, UK
| | - W S Khan
- Cardiff & Vale Orthopaedic Centre, Llandough University Hospital, Cardiff & Vale NHS Trust, Cardiff, CF5 2LD, UK
| | - S Agarwal
- Cardiff & Vale Orthopaedic Centre, Llandough University Hospital, Cardiff & Vale NHS Trust, Cardiff, CF5 2LD, UK
| | - R Morgan-Jones
- Cardiff & Vale Orthopaedic Centre, Llandough University Hospital, Cardiff & Vale NHS Trust, Cardiff, CF5 2LD, UK
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James M, Khan WS, Nannaparaju MR, Bhamra JS, Morgan-Jones R. Current Evidence for the Use of Laminar Flow in Reducing Infection Rates in Total Joint Arthroplasty. Open Orthop J 2015; 9:495-8. [PMID: 26587068 PMCID: PMC4645891 DOI: 10.2174/1874325001509010495] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/23/2015] [Accepted: 05/22/2015] [Indexed: 11/22/2022] Open
Abstract
Since the introduction of laminar air flow in orthopaedic theatres by Sir John Charnley, it has widely become accepted as the standard during orthopaedic procedures such as joint arthroplasty. We present a review of available current literature for the use of laminar flow operating theatre ventilation during total joint arthroplasty and examines the effectiveness of laminar flow ventilated operating theatres in preventing post-operative wound infection. Results of our findings suggest that while bacterial and air particulate is reduced by laminar air flow systems, there is no conclusive effect on the reduction of post-operative wound infections following total joint arthroplasty. We conclude that a combination of strict aseptic technique, prophylactic antibiotics and good anaesthetic control during surgery remains crucial to reduce post-operative surgical infections.
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Affiliation(s)
- M James
- Cardiff & Vale Orthopaedic Centre, Llandough University Hospital, Cardiff & Vale NHS Trust, Cardiff, UK
| | - W S Khan
- Cardiff & Vale Orthopaedic Centre, Llandough University Hospital, Cardiff & Vale NHS Trust, Cardiff, UK
| | - M R Nannaparaju
- Cardiff & Vale Orthopaedic Centre, Llandough University Hospital, Cardiff & Vale NHS Trust, Cardiff, UK
| | - J S Bhamra
- Cardiff & Vale Orthopaedic Centre, Llandough University Hospital, Cardiff & Vale NHS Trust, Cardiff, UK
| | - R Morgan-Jones
- Cardiff & Vale Orthopaedic Centre, Llandough University Hospital, Cardiff & Vale NHS Trust, Cardiff, UK
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Putnis SE, Wartemberg GK, Khan WS, Agarwal S. A Literature Review of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis: Perioperative Considerations and Outcome. Open Orthop J 2015; 9:483-8. [PMID: 26587066 PMCID: PMC4645831 DOI: 10.2174/1874325001509010483] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/14/2015] [Accepted: 05/22/2015] [Indexed: 12/17/2022] Open
Abstract
Ankylosing spondylitis is a spondyloarthropathy affecting the sacro-iliac joints with subsequent progression to the spine and the hip joints. The hip joints are affected by synovitis, enthesial inflammation, involvement of medullary bone, progressive degeneration and secondary osteoarthritis. Clinical presentation is usually in the form of pain and stiffness progressing to disabling fixed flexion contractures and in some instances, complete ankylosis. Hip arthroplasty should be considered for hip pain, postural and functional disability, or pain in adjacent joints due to hip stiffness. We conducted a literature review to determine peri-operative considerations and outcome in ankylosing spondylitis patients undergoing hip arthroplasty. In this review, we have discussed pre-operative surgical planning, thromboprophylaxis, anaesthetic considerations and heterotopic ossification. Outcomes of arthroplasty include range of movement, pain relief, survivorship and complications.
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Affiliation(s)
- S E Putnis
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - G K Wartemberg
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - W S Khan
- University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - S Agarwal
- Cardiff & Vale Orthopaedic Centre, Llandough University Hospital, Cardiff & Vale NHS Trust, Cardiff, CF5 2LD, UK
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Affiliation(s)
| | | | | | - Vincenzo Denaro
- University College London Institute of Orthopaedics and Musculoskeletal Science Royal National Orthopaedic Hospital Stanmore Middlesex HA7 4LP United Kingdom.
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