bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPACT OF TRANSFORAMINAL LUMBAR INTERBODY FUSION ON ROD LOAD: A COMPARATIVE BIOMECHANICAL ANALYSIS BETWEEN A CADAVERIC INSTRUMENTATION AND SIMULATED BONE FUSION
Authors: Heumann M. , Feng C. , Benneker L. , Spruit M. , Mazel C. , Buschbaum J. , Gueorguiev B. , Ernst M.
Published: November 2024

Introduction

In daily clinical practice, progression of spinal fusion is typically monitored during clinical follow-up using conventional radiography and Computed Tomography scans. However, recent research has demonstrated the potential of implant load monitoring to assess posterolateral spinal fusion in an in-vivo sheep model. The question arises to whether such a strain sensing system could be used to monitor bone fusion following lumbar interbody fusion surgery, where the intervertebral space is supported by a cage. Therefore, the aim of this study was to test human cadaveric lumbar spines in two states: after a transforaminal lumbar interbody fusion (TLIF) procedure combined with a pedicle-screw-rod-construct (PSR) and subsequently after simulating bone fusion. The study hypothesized that the load on the posterior instrumentation decreases as the segment stiffens due to simulated fusion.

Method

A TLIF procedure with PSR was performed on eight human cadaveric spines at level L4-L5. Strain sensors were attached bilaterally to the rods to derive implant load changes during unconstrained flexion-extension (FE), lateral bending (LB) and axial rotation (AR) loads up to ±7.5Nm. The specimens were retested after simulating bone fusion between vertebrae L4-L5. In addition, the range of motion (ROM) was measured during each loading mode.

Result

The ROM decreased in the simulated bone fusion state in all loading directions (p≤0.002). In both states, the measured strain on the posterior instrumentation was highest during LB motion. Furthermore, the sensors detected a significant decrease in the load induced rod strain (p≤0.002) between TLIF+PSR and simulated bone fusion state in LB.

Conclusion

Implant load measured via rod strain sensors can be used to monitor the progression of fusion after a TLIF procedure when measured during LB of the lumbar spine. However, further research is needed to investigate the influence of daily loading scenarios expected in-vivo on the overall change in implant load.
AN OSTEOPOROTIC CO CULTURE STUDY: DOES ADDING CERAMICS IMPROVE THE OSTEOGENIC POTENTIAL OF POLYMER SCAFFOLDS?
Authors: Tiplady S. , Heinemann C. , Kruppke B. , Manda K. , Clarke S. , Lennon A. , Larrañeta E. , Buchanan F.
Published: November 2024

Introduction

The incidences of fragility fractures, often because of osteoporosis, are increasing. Research has moved towards bioresorbable scaffolds that provide temporary mechanical stability and promote osteogenesis. This research aims to fabricate a 3D printed composite Poly (l-lactic-co-glycolic acid)-strontium doped tricalcium phosphate (PLGA-SrTCP) scaffold and evaluate in an in vitro co culture study containing osteoporotic donor cells.

Method

PLGA, PLGA TCP, and PLGA SrTCP scaffolds were produced using Fused Filament Fabrication (FFF). A four-group 35-day cell culture study was carried out using human bone marrow derived mesenchymal stem cells (hMSCs) from osteoporotic and control donors (monoculture) and hMSCs & human monocytes (hMCs) (Co culture). Outcome measures were biochemical assays, PCR, and cell imaging. Cells were cultured on scaffolds that had been pre-degraded for six weeks at 47°C prior to drying and gamma sterilisation.

Result

3D printed scaffolds were successfully produced by FFF. All groups in the study supported cell attachment onto the scaffolds, producing extracellular matrices as well as evidence of osteoclast cell structures. Osteoporotic cells increased CTSK activity and CAII activity and decreased ALP activity compared to controls. In control cultures, the addition of bTCP and bTCP/Sr to the PLGA reduced TRAP5b, CAII and ALP activity compared to PLGA alone. The addition of Sr did not show any differences between donors.

Conclusion

This study details suitability of 3D printed polymer scaffolds for use in bone tissue applications. Both composite and pure polymer scaffolds promote osteogenesis in vitro. The introduction of ceramic filler and ion doping does not beneficially effect osteogenic potential and can reduce its ability compared to pure polymer. This study suggests the behaviour of control and osteoporotic cells are different and that osteoporotic cells are more prone to bone resorption. Therefore, it is important to design bone scaffolds that are specific to the patient as well as to the region of fracture.
COMPARATIVE EFFECTIVENESS OF SILVER-COATED IMPLANTS IN PERIPROSTHETIC INFECTION PREVENTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Bulut H. , Giray Batibay S. , Kanay E. , Özkan K.
Published: November 2024

Introduction

Despite the implementation of numerous preventive measures in recent years, the persistent challenge of periprosthetic infections remains. Among the various strategies, metallic modification of implants, particularly with silver, has emerged as a promising avenue. Silver's antimicrobial properties, coupled with its low human toxicity, render it an appealing option. However, ongoing debate surrounds its comparative efficacy in infection prevention when contrasted with titanium-coated prostheses.

Methods

The PubMed database was systematically searched up to March 2024. Studies in English that met predetermined inclusion/exclusion criteria and utilized “Megaprosthesis AND infection” and “ silver-coated AND infection “ as key terms were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) statement guided the article selection process.

Results

From a pool of 1892 potential papers after literature screening, 11 studies with a total of 1419 patients were meticulously selected for analysis. Among these patients, 638 were treated with silver-coated implants, while 781 received titanium-coated implants, resulting in 166 recorded cases of infection. Remarkably, the infection rate stood at 9.2% for the silver-coated group, contrasting with 13.4% for the titanium-coated group. The subsequent analysis unveiled a notable discrepancy in proportions (P difference = -0.0473, 95%CI: -0.088 to -0.006), signaling a statistically significant decrease in infections within the silver-coated cohort. Furthermore, the I2 statistic, denoting heterogeneity in effect sizes, stood at 21.8% (95%CI: 0.0-66.9), indicating a modest degree of variability among the studies.

Conclusion

In conclusion, our systematic review and meta-analysis shed light on the potential of silver-coated implants in mitigating periprosthetic infections. Despite the persistent challenge posed by such infections, our findings suggest a statistically significant decrease in infection rates among patients treated with silver-coated implants compared to those with titanium-coated ones.
NAIL VERSUS PLATE IN TIBIOCALCANEAL ARTHRODESIS: A BIOMECHANICAL STUDY
Authors: Dhillon M. , Klos K. , Lenz M. , Zderic I. , Gueorguiev B.
Published: November 2024

Introduction

Tibiocalcaneal arthrodesis with a retrograde intramedullary nail is an established procedure considered as a salvage in case of severe arthritis and deformity of the ankle and subtalar joints [1]. Recently, a significant development in hindfoot arthrodesis with plates has been indicated. Therefore, the aim of this study was to compare a plate specifically developed for arthrodesis of the hindfoot with an already established nail system [2]

Method

Sixteen paired human cadaveric lower legs with removed forefoot and cut at mid-tibia were assigned to two groups for tibiocalcaneal arthrodesis using either a hindfoot arthrodesis nail or an arthrodesis plate. The specimens were tested under progressively increasing cyclic loading in dorsiflexion and plantar flexion to failure, with monitoring via motion tracking. Initial stiffness was calculated together with range of motion in dorsiflexion and plantar flexion after 200, 400, 600, 800, and 1000 cycles. Cycles to failure were evaluated based on 5° dorsiflexion failure criterion

Result

Initial stiffness in dorsiflexion, plantar flexion, varus, valgus, internal rotation and external rotation did not differ significantly between the two arthrodesis techniques (p ≥ 0.118). Range of motion in dorsiflexion and plantar flexion increased significantly between 200 and 1000 cycles (p < 0.001) and remained not significantly different between the groups (p ≥ 0.120). Cycles to failure did not differ significantly between the two techniques (p = 0.764).

Conclusion

From biomechanical point of view, both tested techniques for tibiocalcaneal arthrodesis appear to be applicable. However, clinical trials and other factors, such as extent of the deformity, choice of the approach and preference of the surgeon play the main role for implant choice.

Acknowledgements

This study was performed with the assistance of the AO Foundation.
INVESTIGATING THE DIAGNOSTIC ACCURACY OF ULTRASONOGRAPHY IN DETECTION OF MEDICAL MENISCAL EXTRUSION IN KNEE OSTEOARTHRITIS PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Fallahy M.T.P. , Shaker F. , Ghanbari F. , Aslani M. A. , Mohammadi S. , Behrouzieh S.
Published: November 2024

Introduction

Knee Osteoarthritis (KOA) is a prevalent joint disease requiring accurate diagnosis and prompt management. The condition occurs due to cartilage deterioration and bone remodeling. Ultrasonography has emerged as a promising modality for diagnosing KOA. Medial meniscus extrusion (MME), characterized by displacement of medial meniscus beyond the joint line has been recognized as a significant marker of KOA progression. This study aimed to explore potentials Ultrasound findings in timely detection of MME and compare it to magnetic resonance imaging (MRI) as a reference standard.

Method

A comprehensive literature search was performed in 4 databases from inception to May 1 2024. Two independent reviewers, initiated screening protocols and selected the articles based on inclusion and exclusion criteria and then extracted the data. Meta-analysis was conducted using R 4.3.2 packages mada and metafor.

Result

A total of 2500 articles from 4 databases was retrieved; however, following the application of inclusion and exclusion criteria 23 articles were finally extracted. These studies collectively encompassed a total of 777 patients with mean age of 53.2±7.4. The mean BMI calculated for patients was 28.31 ± 2.45. All patients underwent non-weight bearing knee ultrasonography in supine position with 0° flexion. The reported medial meniscus extrusion was 2.58 mm for articles using MRI and 2.65 mm for those using Ultrasound (MD: 0.05 ± 0.12, P= 0.65, I2: 54%). Our meta-analysis revealed insignificant difference between US and MRI. (SMD: 0.03, 95% CI: -0.18 _0.23, P= 0.77, I2: 56%) Meta analysis for diagnostic accuracy measures yielded a pooled sensitivity and specificity of 90.8% and 77% (95% CI: 84.2% – 94.8%, 35.5% – 95.3%, respectively, I2: 44%).

Conclusion

Our results indicate a close alignment in the accuracy of measurements obtained using Ultrasound modality. The narrow range suggests a minimal discrepancy in MME values between MRI and ultrasound, highlighting their comparable precision in diagnostic assessments.
COMPREHENSIVE ANALYSIS OF GENETICAL ETIOLOGY OF CONGENITAL SCOLIOSIS: FROM GENES TO PATHWAYS
Authors: Bulut H. , Abasova F. , Basaran T. , Balaban P.
Published: November 2024

Introduction

Congenital scoliosis is a prevalent congenital spinal deformity, more frequently encountered than congenital lordosis or kyphosis. The prevailing belief is that most instances of congenital scoliosis are not hereditary but rather stem from issues in fetal spine development occurring between the 5th and 8th weeks of pregnancy. However, it has been linked to several genes in current literature. Our goal was to explore potential pathways through an exhaustive bioinformatics analysis of genes related to congenital scoliosis.

Method

The literature from the 1970s to February 2024 was surveyed for genes associated with CS, and 63 genes were found to be associated with AIS out of 1743 results. These genes were analyzed using DAVID Bioinformatics

Result

Our pathway analysis has unveiled several significant associations with congenital scoliosis. Notably, “Glycosaminoglycan biosynthesis - chondroitin sulfate / dermatan sulfate” (P-Value:8.8E-3, Fold Enrichment: 20.6), “Central carbon metabolism in cancer” (P-Value:1.3E-3, Fold Enrichment: 10.3), and “Lysine degradation” (P-Value: 9.0E-3, Fold Enrichment: 9.1) emerge as statistically significant pathways. Additionally, “Endocrine resistance” (P-Value:4.4E-3, Fold Enrichment:7.4) and”EGFR tyrosine kinase inhibitor resistance” (P-Value: 1.7E-2, Fold Enrichment:7.3) pathways are noteworthy. These findings suggest a potential involvement of these pathways in the biological processes underlying congenital scoliosis. Furthermore, “Signaling pathways regulating pluripotency of stem cells” (P-Value:4.0E-4, Fold Enrichment:7.1), “Notch signaling pathway” (P-Value:6.7E-2, Fold Enrichment: 7.0), and “TGF-beta signaling pathway” (P-Value:6.2E-3, Fold Enrichment: 6.7) exhibit a less pronounced yet intriguing association that may warrant further investigation.

Conclusion

In conclusion, our comprehensive analysis of the genetic etiology of congenital scoliosis has revealed significant associations with various pathways, shedding light on potential underlying biological mechanisms. While further research is needed to fully understand these associations and their implications, our findings provide a valuable starting point for future investigations into the management and treatment of congenital scoliosis.
ESTABLISHING A HUMAN OSTEOCYTE-STAPHYLOCOCCUS EPIDERMIDIS INFECTION MODEL TO REVEAL MECHANISMS OF CHRONIC BONE AND JOINT INFECTIONS
Authors: Siverino C. , Sun Q. , Yang D. , Solomon B. , Moriarty F. , Atkins G.
Published: November 2024

Introduction

Bone and joint infection (BJI) is often characterized by severe inflammation and progressive bone destruction. Osteocytes are the most numerous and long-lived bone cell type, and therefore represent a potentially important long-term reservoir of bacterial infection. Staphylococcus aureus is known to establish stable intracellular osteocytic infections, however, little is known about the less virulent yet second most prevalent BJI pathogen, S. epidermidis, associated with late-diagnosed, chronic BJI. Thus, this study sought to establish an in vitro model to study the infection characteristics of S. epidermidis in human osteocyte-like cells.

Methods

SaOS2 cells (1 ×104 cells/cm2) were grown to confluence either without differentiation, representing an osteoblast-like (OB) state (SaOS2-OB) or differentiated to an osteocyte-like stage (SaOS2-OY), using established methods. Four S. epidermidis strains used (ATCC-12228, ATCC-14990, ATCC-35984 and a clinical osteomyelitis strain RAH-SE1) were tested to be Lysostaphin-resistant, necessitating antibiotic (Levofloxacin) control of extracellular bacteria. Infection of host cells (OB or OY) was tested at three multiplicities of infection (MOI: 10, 100 and 1000). Extracellular bacteria were controlled by overnight incubation at a 10X minimum inhibitory concentration (MIC) of Levofloxacin and thereafter at 1XMIC. At each time point (days 1, 3, 5) viable intra- and extracellular bacteria were quantified.

Result

All strains displayed similar intracellular infection and persistence capabilities in SaOS2-OB and SaOS2-OY. Independent of MOI, intracellular bacteria in SaOS2-OB decreased over time, becoming non-culturable by day 5. In contrast, SaOs2-OY displayed enhanced intracellular bacterial persistence at each time point. In the presence of increased Levofloxacin concentration (10XMIC), S. epidermidis could persist intracellularly for at least 14 days.

Conclusion

This study showed for the first time that S. epidermidis can infect human osteocytes and persist intracellularly. Additionally, even a 10xMIC antibiotic concentration failed to eradicate intracellular bacteria, suggesting that persistence within osteocytes could contribute to treatment failure and establishment of chronic BJI.
DYNAMIC UNLOADING OF HEALTHY BOVINE TAIL DISCS: BIOMECHANICS AND BIOLOGY SUGGEST FACILITATED WATER UPTAKE
Authors: Soubrier A. , Kasper H. , Alini M. , Jonkers I. , Grad S.
Published: November 2024

Introduction

Intervertebral disc degeneration has been associated with low back pain (LBP) which is a major cause of long-term disability worldwide. Observed mechanical and biological modifications have been related to decreased water content.

Clinical traction protocols as part of LBP management have shown positive outcomes. However, the underlying mechanical and biological processes are still unknown.

The study purpose was to evaluate the impact of unloading through traction on the mechanobiology of healthy bovine tail discs in culture.

Method

We loaded bovine tail discs (n=3/group) 2h/day at 0.2Hz for 3 days, either in dynamic compression (-0.01MPa to -0.2MPa) or in dynamic traction (-0.01MPa to 0.024MPa). In between the dynamic loading sessions, we subjected the discs to static compression loading (-0.048MPa). We assessed biomechanical and biological parameters.

Result

Over the 3 days of loading, disc height decreased upon dynamic compression loading but increased upon unloading. The neutral zone was restored for all samples at the end of the dynamic unloading. Upon dynamic compression, the stiffness increased over time while the hysteresis decreased. Upon dynamic unloading, sulfated glycosaminoglycan (sGAG) release in the medium was lower at the endpoint. In the outer annulus fibrosus (AFo), we saw a higher water/sGAG of at least 30%. In the nucleus pulposus, COL2 mRNA was expressed more highly upon dynamic unloading while MMP3, iNOS and TRPV4 expression levels were lower. In the AFo of the unloading group, COL2 expression was higher but COL1 was lower.

Conclusion

The biomechanical and biological results consistently indicate that dynamic unloading of healthy bovine discs in culture facilitates water uptake and promotes an anti-catabolic response which reflects a function optimization of the disc.

This work combines biomechanical and biological results and opens the door to evidence-based improvement of regenerative protocols for degenerated discs and conservative LBP management.

This study is funded by AO Foundation and AO Spine.
IS ASSESSING HUMERAL HEAD MIGRATION IN A SUPINE POSITION ASSOCIATED WITH ITS ASSESSMENT IN FUNCTIONALLY RELEVANT ARM POSITIONS?
Authors: Daneshvarhashjin N. , Debeer P. , Andersen M. S. , Verhaegen F. , Scheys L.
Published: November 2024

Introduction

Assessment of the humeral head translation with respect to the glenoid joint, termed humeral head migration (HHM), is crucial in total shoulder arthroplasty pre-operative planning. Its assessment informs current classification systems for shoulder osteoarthritis as well as the evaluation of surgical correction. In current clinical practice, HHM assessment relies on computed-tomography (CT) imaging. However, the associated supine position might undermine its functional relevance as it does not reflect the weight-bearing condition with active muscle engagement associated with the upright standing position of most daily activities. Therefore, we assessed to what extent HHM in a supine position is associated with HHM in a range of functional arm positions.

Method

26 shoulder osteoarthritis patients and 12 healthy volunteers were recruited. 3D shapes of the humerus and scapula were reconstructed from their respective CT scans using an image processing software3, and their CT-scan-based HHMs were measured. Furthermore, all subjects underwent low-dose biplanar radiography 4 in four quasi-static functional arm positions while standing: relaxed standing, followed by 45 degrees of shoulder extension, flexion, and abduction. Using a previously validated method implemented in the programming platforms5, 3D shapes were registered to the pairs of biplanar images for each arm position and the corresponding functional HHM was measured. Bivariate correlations were assessed between the CT-based HHM and each functional arm position.

Result

HHM in 45 degrees of flexion and extension both showed significant and strong correlations (r>0.66 and P<0.01) with HHM assessed in the supine position. However, such a high correlation was not found for relaxed standing and 45 abduction.

Conclusion

Although HHM in a supine position correlates with HHM in 45-degree extension and flexion, it is poorly associated with the HHM in abduction and relaxed standing. These results may suggest the inclusion of more functionally-relevant patient positioning toward better-informed shoulder arthroplasty planning.

Acknowledgement

Funding from PRosPERos-II Project.
METASTRA: COMPUTER-AIDED EFFECTIVE FRACTURE RISK STRATIFICATION OF PATIENTS WITH VERTEBRAL METASTASES FOR PERSONALIZED TREATMENT THROUGH ROBUST COMPUTATIONAL MODELS VALIDATED IN CLINICAL SETTINGS
Authors: Cristofolini L. , bròdano B. B. , Dall’Ara E. , Ferenc R. , Ferguson S. J , García-Aznar J. M. , Lazary A. , Vajkoczy P. , Verlaan Jorrit-Jan , Vidacs L.
Published: November 2024

Introduction

Patients (2.7M in EU) with positive cancer prognosis frequently develop metastases (≈1M) in their remaining lifetime. In 30-70% cases, metastases affect the spine, reducing the strength of the affected vertebrae. Fractures occur in ≈30% patients. Clinicians must choose between leaving the patient exposed to a high fracture risk (with dramatic consequences) and operating to stabilise the spine (exposing patients to unnecessary surgeries). Currently, surgeons rely on their sole experience. This often results in to under- or over-treatment. The standard-of-care are scoring systems (e.g. Spine Instability Neoplastic Score) based on medical images, with little consideration of the spine biomechanics, and of the structure of the vertebrae involved. Such scoring systems fail to provide clear indications in ≈60% patients.

Method

The HEU-funded METASTRA project is implemented by biomechanicians, modellers, clinicians, experts in verification, validation, uncertainty quantification and certification from 15 partners across Europe. METASTRA aims to improve the stratification of patients with vertebral metastases evaluating their risk of fracture by developing dedicated reliable computational models based on Explainable Artificial Intelligence (AI) and on personalised Physiology-based biomechanical (VPH) models.

Result

The METASTRA-AI model is expected to be able to stratify most patients with limited effort end cost, based on parameters extracted semi-automatically from the medical files and images. The cases which are not reliably stratified through the AI model, are examined through a more detailed and personalised biomechanical VPH model. These METASTRA numerical tools are trained through an unprecedentedly large multicentric retrospective study (2000 cases) and validated against biomechanical ex vivo experiments (120 specimens).

Conclusion

The METASTRA decision support system is tested in a multicentric prospective observational study (200 patients). The METASTRA approach is expected to cut down the indeterminate diagnoses from the current 60% down to 20% of cases.

METASTRA project funded by the European Union, HEU topic HLTH-2022-12-01, grant 101080135
EFFICACY OF ARTIFICIAL INTELLIGENCE-BASED MODELS FOR SHOULDER ARTHROPLASTY IMPLANT DETECTION AND CLASSIFICATION USING UPPER LIMB RADIOGRAPHS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Asgari A.M. , Shaker F. , Fallahy M. T. P. , Soleimani M. , Shafiei S. H. , Fallah Y.
Published: November 2024

Introduction

Shoulder arthroplasty (SA) has been performed with different types of implants, each requiring different replacement systems. However, data on previously utilized implant types are not always available before revision surgery, which is paramount to determining the appropriate equipment and procedure. Therefore, this meta-analysis aimed to evaluate the accuracy of the AI models in classifying SA implant types.

Methods

This systematic review was conducted in Pubmed, Embase, SCOPUS, and Web of Science from inception to December 2023, according to PRISMA guidelines. Peer-reviewed research evaluating the accuracy of AI-based tools on upper-limb X-rays for recognizing and categorizing SA implants was included. In addition to the overall meta-analysis, subgroup analysis was performed according to the type of AI model applied (CNN (Convolutional neural network), non-CNN, or Combination of both) and the similarity of utilized datasets between studies.

Results

13 articles were eligible for inclusion in this meta-analysis (including 138 different tests assessing models’ efficacy). Our meta-analysis demonstrated an overall sensitivity and specificity of 0.891 (95% CI:0.866-0.912) and 0.549 (95% CI:0.532,0.566) for classifying implants in SA, respectively. The results of our subgroup analyses were as follows: CNN-subgroup: a sensitivity of 0.898 (95% CI:0.873-0.919) and a specificity of 0.554 (95% CI:0.537,0.570), Non-CNN subgroup: a sensitivity of 0.809 (95% CI:0.665-0.900) and specificity of 0.522 (95% CI:0.440,0.603), combined subgroup: a sensitivity of 0.891 (95% CI:0.752-0.957) and a specificity of 0.547 (95% CI:0.463,0.629).

Studies using the same dataset demonstrated an overall sensitivity and specificity of 0.881 (95% CI:0.856-0.903) and 0.542 (95% CI:0.53,0.554), respectively. Studies that used other datasets showed an overall sensitivity and specificity of 0.995 (95% CI:969,0.999) and 0.678 (95% CI:0.234, 0.936), respectively.

Conclusion

AI-based classification of shoulder implant types can be considered a sensitive method. Our study showed the potential role of using CNN-based models and different datasets to enhance accuracy, which could be investigated in future studies.
DOES WEIGHT LOSS THROUGH BARIATRIC SURGERY REDUCE BIOMECHANICAL RISK FACTORS OF OSTEOARTHRITIS?
Authors: Hudson P. , Federer S. , Dunne M. , Pring C. , Smith N.
Published: November 2024

Introduction

Weight is a modifiable risk factor for osteoarthritis (OA) progression. Despite the emphasis on weight loss, data quantifying the changes seen in joint biomechanics are limited. Bariatric surgery patients experience rapid weight loss. This provides a suitable population to study changes in joint forces and function as weight changes.

Method

10 female patients undergoing gastric bypass or sleeve gastrectomy completed 3D walking gait analysis at a self-selected pace, pre- and 6 months post-surgery. Lower limb and torso kinematic data for 10 walking trials were collected using a Vicon motion capture system and kinetics using a Kistler force plate. An inverse kinematic model in Visual 3D allowed for no translation of the hip joint centre. 6 degrees of freedom were allowed at other joints. Data were analysed using JASP with a paired samples t-test.

Result

On average participants lost 28.8±7.60kg. No significant changes were observed in standing knee and hip joint angles. Walking velocity increased from 1.10±0.11 ms-1 to 1.23±0.17 ms-1 (t(9)=-3.060, p = 0.014) with no change in step time but a mean increase in stride length of 0.12m (SE: 0.026m; t(9)=-4.476, p = 0.002). A significant decrease of 21.5±4.2% in peak vertical ground reaction forces was observed (t(9)=12.863, p <0.001). Stride width significantly decreased by 0.04m (SE: 0.010m; t(9)=4.316, p = 0.002) along with a decrease in lateral impulse of 21.2Ns (SE: 6.977Ns; t(7), p = 0.019), but no significant difference in knee joint angles were observed. Double limb support time also significantly reduced by 0.02s (SE: 0.006s; t(9) = 3.639, p=0.005)

Conclusion

The reduction in stance width and lateral impulse suggests a more sagittal compass-gait walk is being achieved. This would reduce valgus moments on the knee reducing loading in the medial compartment. The reduction in peak ground reaction force would reduce knee contact forces and again potentially slow OA progression.
MESENDODERMAL PROGENITORS IN COMBINATION WITH A SYNTHETIC HYDROGEL (NPGEL) IN A SHEEP MODEL OF LOW BACK PAIN: A SAFETY STUDY
Authors: Cicione C. , Tilotta V. , Ascione A. , Giacomo G. D. , Russo F. , Tryfonidou M. , Noel D. , Camus A. , Maitre C. L. , Vadalà G.
Published: November 2024

Introduction

Low back pain (LBP) is a worldwide leading cause of disability. This preclinical study evaluated the safety of a combined advanced therapy medicinal product developed during the European iPSpine project (#825925) consisting of mesendoderm progenitor cells (MEPC), derived from human induced pluripotent stem cells, in combination with a synthetic poly(N-isopropylacrylamide) hydrogel (NPgel) in an ovine intervertebral disc degeneration (IDD) model.

Method

IDD was induced through nucleotomy in 4 adult sheep, 5 lumbar discs each (n=20). After 5 weeks, 3 alternating discs were treated with NPgel (n=6) or NPgel+MEPC (n=6). Before sacrifice, animals were subjected to: MRI of lumbar spines (disc height and Pfirmann grading); blood sampling (hematological, biochemical, metabolic and lymphocyte/monocytes immunological). After 3 months the sheep were sacrificed. The spines were processed for: macroscopic morphology (Thompson grading), microscopic morphology (Histological grading), and glycosaminoglycan content (GAG, DMMB Assay). Furthermore, at sacrifice biodistribution of human MEPC was assessed by Alu-sequences quantification (qPCR) from three tissue samples of heart, liver, spleen, brain, lungs, and kidneys, and PBMCs collected to assess activation of systemic immune cells. To each evaluation, appropriate statistical analysis was applied.

Result

Flow cytometry showed no induction of systemic activation of T cells or monocytes. Alu quantification did not give detection of any cells in any organ. Disc height index was slightly increased in discs treated with NPgel+MEPC. Pfirmann's and Thompson's classification showed that treatment with NPgel or NPgel+MEPC gave no adverse reactions. Histological grading showed similar degeneration in vertebrae treated with NPgel+MEPC or with NPgel alone. The amount of GAG was significantly increased in the nucleus pulposus following treatment with NPgel+MEPC compared to NPgel alone, in which a decrease was observed compared to untreated discs in both nucleus pulposus and annulus fibrosus.

Conclusion

This study showed the safety of both NPgel+MEPC and NPgel treatments.
PERFORMANCE OF CONVERSION TOTAL HIP ARTHROPLASTY AFTER FIXATION FAILURE WITH CEPHALOMEDULLARY NAILING
Authors: Karjalainen L. , Ylitalo A. , Lähdesmäki M. , Reito A. , Repo J.
Published: November 2024

Introduction

Cephalomedullary nailing (CMN) is commonly used for unstable pertrochanteric fracture. CMN is relatively safe method although various complications can potentially occur needing revision surgery. Commonly used salvage procedures such as renailing, hemiarthroplasty, conservative treatment or total hip arthroplasty (THA) are viable alternatives. The aim was to investigate the rate of THA after CMN and evaluate the performance on conversion total hip arthroplasty (cTHA) after failure of CMN.

Method

Collected data included patients from two orthopedic centers. Data consisted of all cTHAs after CMN between 2014-2020 and primary cementless THA operations between 2013-2023. Primary THA operations were treated as a control group where Oxford Hip Score (OHS) was the main compared variable.

Result

From 2398 proximal femoral hip procedures 1667 CMN procedures were included. Altogether 46/1667 (2.8%) CMNs later received THA. Indications for THA after CMN failure were 13 (28.3%) cut-outs, nine (19.6%) cut-throughs, eight (17.4%) nail breakages, seven (15.2%) post traumatic arthrosis, seven (15.2%) nonunions, one (2.2%) malunion and one (2.2%) collum screw withdrawal. Mean (SD) time to complication after CMN operation is 5.9 (6.8) months. Mean (SD) time from nail procedure to THA was 10.4 (12.0) months. Total complication rate for cTHA after CMN was 17.4%. Reported complications were infection with seven (15.2%) cases and one (2.2%) nerve damage. Mean (SD) time to cTHA complication was 3.6 (6.1) months. One-sample T-test showed OHS to be significantly better (P<.001) for primary cementless THA compared to cTHA after one year.

Conclusion

Altogether 2.8% of CMN were converted to THA. Nearly half (47.8%) of the cTHA procedures were due to CMN cut-out or cut-through. OHS was significantly better in primary cementless THA compared to cTHA. Prosthetic joint infection was the most frequent complication related to cTHA.
THE INFLUENCE OF BEARING SURFACES ON IGFBP-1 SERUM LEVELS IN THA PATIENTS
Authors: Pérez G. V. , Rey E. G. , Quero L. S. , Díaz N. V.
Published: November 2024

Introduction

The identification of biological markers associated to implant failure in THA (total hip arthroplasty) patients remains a challenge in orthopedic surgery. In this search, previous studies have been mainly focused on typical mediators associated to bone metabolism and inflammation. Our group has evaluated changes in serum levels of insulin-like growth factor binding protein-1 (IGFBP-1), a protein which is not directly related to bone homeostasis, in patients undergoing THA.

Method

We assessed IGFBP-1 levels in serum obtained from 131 patients (58% female, 42 % male; age: 68 ± 13 years) who underwent THA in the Orthopedic Surgery and Traumatology Department of our institution. In this cohort, 57% of patients had metal on polyethylene (MoP) as hip-bearing surface combination, 17 % had ceramic on ceramic (CoC) and 26% of them did not have any prosthesis. A test based on an enzyme-linked immunosorbent assay (ELISA) was used to determine IGFBP-1 levels in serum obtained from these patients.

Result

Our results showed a significant increase in IGFBP- 1 levels in MoP group as compared to CoC and control groups, in which no differences in quantified levels were detected. Further analysis revealed no significant differences in IGFBP-1 between cemented and non-cemented MoP bearings. We performed a ROC curve to evaluate the accuracy of serum IGFBP-1 in discriminating MoP from the rest of patients (area under the curve: 0.7; 95% confidence interval: 0,6-0.8; p<0.05) and established a cut-off value of 10.2 ng/ml, according to the Youden´s Index. Logistic regression analysis showed that patients with MoP bearing surfaces had a higher risk of increased IGFBP- 1 levels in serum (p<0.05, Odds Ratio: 6.7, 95% Confidence Interval 3.1 to 14.8).

Conclusion

IGFBP- 1 levels are significantly elevated in THA patients with MoP bearing surfaces, suggesting that this protein might be a reliable biomarker for the outcome of patients implanted with MoP.
DEVELOPMENT AND IMPLEMENTATION OF THE INFORM GUIDELINES FOR THE TREATMENT AND MANAGEMENT OF PROSTHETIC HIP INFECTION
Authors: Moore A. , Whitehouse M. , Wylde V. , Walsh N. , Beswick A. , Jameson C. , Blom A.
Published: November 2024

Introduction

Hip prosthetic joint infection (PJI) is a debilitating complication following joint replacement surgery, with significant impact on patients and healthcare systems. The INFection ORthopaedic Management: Evidence into Practice (INFORM: EP) study, builds upon the 6-year INFORM programme by developing evidence-based guidelines for the identification and management of hip PJI.

Methods

A panel of 21 expert stakeholders collaborated to develop best practice guidelines based on evidence from the previous INFORM research programme. An expert consensus process was used to refine guidelines using RAND/UCLA criteria. The guidelines were then implemented over a 12-month period through a Learning Collaborative of 24 healthcare professionals from 12 orthopaedic centres in England. Qualitative interviews were conducted with 17 members of the collaborative and findings used to inform the development of an implementation support toolkit. Patient and public involvement contextualised the implementation of the guidelines. The study is registered with the ISCRTN (34710385).

Result

The INFORM guidelines, structured around the stages of PJI management, were largely supported by surgeons, although barriers included limited awareness among non-surgical team members, lack of job planning for multidisciplinary teams, and challenges in ensuring timely referrals from primary care. Psychological support for patients was identified as a critical gap. Advanced Nurse Practitioners and multidisciplinary team (MDT) coordinators were seen as potential bridges to address these knowledge gaps. The guidelines were also viewed as a useful tool for service development.

Conclusions

This study presents the first evidence-based guidelines for hip PJI management, offering a comprehensive approach to prevention, treatment, and postoperative care. Effective implementation is crucial, involving wider dissemination amongst primary and community care, as well as non-specialist treatment centres. Further resources are needed to ensure job planning for MDTs and psychological support for patients. Overall, this study lays the foundation for improved PJI management, benefiting patients and healthcare systems.
THE RELATIONSHIP BETWEEN ULNAR FIXATION AND SOCIODEMOGRAPHIC DIVERSITY IN POSTOPERATIVE SATISFACTION FOR DISTAL RADIUS FRACTURES ACCOMPANIED BY ULNA STYLOID FRACTURE
Authors: Davulcu C. D. , Akbaba D.
Published: November 2024

Introduction

This study aims to investigate the relationship between ulnar fixation and postoperative satisfaction among patients with distal radius fractures accompanied by ulna styloid fractures, with a particular focus on how sociodemographic factors influence outcomes.

Method

A retrospective cohort study was conducted involving 120 patients aged 26-53 who underwent surgical treatment for distal radius fractures with concomitant ulna styloid fractures between January 2018 and December 2022. Patients were divided into two groups based on whether ulnar fixation was performed. Sociodemographic data, including age, gender, socioeconomic status, education level, and occupation, were collected. All patients underwent similar physical therapy protocols in the postoperative period, and no complications were observed in any patient. Postoperative satisfaction was assessed using the Patient-Rated Wrist Evaluation (PRWE) and the Disabilities of the Arm, Shoulder, and Hand (DASH) scores at 6 and 12 months post-surgery. Statistical analysis was conducted to evaluate the influence of ulnar fixation and sociodemographic factors on patient satisfaction.

Result

Patients who underwent ulnar fixation (n=60) reported significantly higher satisfaction levels compared to those who did not (n=60), as evidenced by lower PRWE and DASH scores (p < 0.05). Age, gender, and socioeconomic status were significant predictors of postoperative satisfaction. Younger patients, females, and those with higher socioeconomic status exhibited greater improvements in functional outcomes and satisfaction. However, education level and occupation did not significantly influence satisfaction scores.

Conclusion

Ulnar fixation in the surgical treatment of distal radius fractures accompanied by ulna styloid fractures is associated with improved postoperative satisfaction. Sociodemographic factors, particularly age, gender, and socioeconomic status, play a crucial role in patient-reported outcomes. Tailoring postoperative care to address these sociodemographic differences may enhance overall patient satisfaction and recovery.
MINIMALLY INVASIVE SURGICAL TREATMENTS VERSUS NON-SURGICAL TREATMENTS FOR PLANTAR FASCIOPATHY
Authors: Møller S.
Published: November 2024

Introduction

Plantar heel pain, or plantar fasciopathy (PF), is a common musculoskeletal complaint, affecting 39% of lower-extremity tendinopathies in general practice. Conservative management is recommended as the first-line treatment, yet many patients continue to experience symptoms even after ten years. There is a significant lack of high-quality evidence for the effectiveness of various treatments, highlighting the need for more research.

Minimally invasive surgical options, such as endoscopic plantar fascia release and radiofrequency microtenotomy, have shown promise in reducing pain and improving outcomes. This systematic review aims to evaluate the effectiveness of these minimally invasive surgical treatments compared to non-surgical options in managing PF.

Method

The systematic review, registered on PROSPERO (CRD42024490498) and adhering to PRISMA guidelines, searched databases including PubMed, Embase, Cochrane, and others for studies from January 1991 to May 2024. Keywords included plantar fasciitis, plantar fasciopathy, and heel pain. Limited to human trials, the search strategy was refined with an information specialist and found no protocol duplicates.

Result

The systematic review identified eight studies involving 495 patients (56.2% women, average age 46.5 years). The studies compared various treatments, including endoscopic plantar fascia release (EPF), mini-scalpel needle (MSN) treatment, ultrasound-guided pulsed radiofrequency (UG-PRF), and needle electrolysis (NE), to non-surgical interventions and corticosteroid injections (CSI). Primary outcomes focused on pain reduction, with some needle treatments showing superior results (between-group diffence). No severe adverse events were reported.

Conclusion

In conclusion, plantar fasciopathy (PF) remains a prevalent and challenging condition, that can be resistant to conservative treatments. This systematic review highlights the potential of minimally invasive surgical options, such as endoscopic plantar fascia release and needle treatments, in reducing pain and improving functional outcomes. Despite some needle treatments showing superior results, the overall lack of high-quality evidence underscores the need for further research to establish the most effective management strategies for PF.
CONGRUENCY OF ULTRASOUND MEASURE CHANGE AGAINST PATIENT-REPORTED OUTCOME MEASURE IN PATELLAR TENDINOPATHY: A SYSTEMATIC REVIEW WITH META-ANALYSIS
Authors: Parks C.
Published: November 2024

Introduction

Patellar tendinopathy is a highly prevalent clinical diagnosis supported by ultrasound changes. Numerous interventions are targeted at improving both symptoms and structure of dysfunctional tendons, however little is known of the diagnostic value in a changing ultrasound profile whilst patient reported outcome measures determine recovery. The aim of this study was to assess if change in ultrasound measure is congruent with change in Victorian Institute of Sport Assessment – Patella (VISA-P) score and therefore indicates the use of using ultrasound to assess patellar tendinopathy during symptom change.

Method

Four databases (PubMed, Web of Science, Embase, Cinahl) were search in January 2014. Studies selected contained ultrasound and VISA-P scores from ≥ 2 type points. All included studies were quality assessed depending on type and available data underwent meta-analysis.

Result

10 papers of varying study type, of limited to high quality, were synthesised. Meta-analysis indicated that change in ultrasound measure was not congruent with change in VISA-P score.

Conclusion

The variation in study quality, along with significant heterogeneity of ultrasound measure outcomes and reporting may influence the congruency of the data, but the association between gradual structure change and varying vascularity with pain or function is questionable throughout tendinopathy literature.
BIOENGINEERED LIVING FIBRES AS 3D MODELS OF TENDON HEALTH AND DISEASE
Authors: Florit M. G. , Graça A. L. , Domingues R. M. A. , Gomes M. M. E.
Published: November 2024

Introduction

Healthy tendons are mainly composed of aligned collagen hierarchically organized from collagen fibrils to fiber bundles with a scarce cellular population mainly composed of tenocytes and tendon stem/progenitor cells. However, injured tendon acquires a fibrotic state characterized by a loss of ECM alignment and increased cellularization. The lack of reliable 3D models that recreate the organization and microenvironment of healthy and diseased tendons is one of the main obstacles faced by the scientific community.

Method

To recreate the architecture of healthy and diseased tendons, electrospun nanofiber scaffolds with anisotropic and isotropic nanotopography were developed. These scaffolds were coated with a shell consisting of cell-laden hydrogels encapsulating human adipose-derived stem cells (hASCs) to include the living component. To show the versatility of the system, extracellular vesicles (EVs) were encapsulated in the hydrogel as biological cues. The living fibers were characterized by microscopy and morphological analysis. The morphology and phenotype of cells was evaluated using microscopy, gene expression analysis and immunostainings for tendon markers.

Results

Scaffolds mimicked the native hierarchical structure of tendons and size of tendon fascicles. hASCs showed high elongation and cytoskeleton anisotropic organization, typical of tenocytes. Moreover, the bioengineered living fibers supported the tenogenic differentiation of stem cells over time, as indicated by the sustained expression of tenogenic and extracellular matrix markers. Finally, the hydrogel layer acted not only as a hydrated biomimetic environment adequate for cell encapsulation but also as a carrier and delivery system of EVs to cells, which improved their tenogenic commitment.

Conclusion

We bioengineered composite living fibers made of hierarchically organized electrospun fibers, coated with hydrogel encapsulating hASCs and biofunctional EVs. These provide an in vitro system to recreate tendon, allowing for the study of the effects of biophysical cues in tendon microenvironments and the influence of biologics on cells behavior.

Acknowledgments

CP21/00136, PI22/01686, CA22170, 10.54499/2020.03410.CEECIND/CP1600/CT0013, 10.54499/2022.05526.PTDC
STRESS RESPONSE OF ACHILLES TENOCYTES FROM NON-DIABETIC AND DIABETIC RATS EXPOSED TO NORMO- AND HYPERGLYCAEMIA DIFFERS
Authors: Gögele C. L. , Fleischmann Nils , Hofman S. , Frank E. , Werner C. , Kokozidou M. , Tanzil G. S.
Published: November 2024

Introduction

Diabetes mellitus type 2 (DMT2) patients often develop Achilles tendon (AS) degeneration. The ZDF rat model is often used to study DMT2. Hence, this study investigated whether tenocytes isolated from diabetic and non diabetic ZDF rats respond differentially to normo- (NG) and hyperglycemic (HG) conditions in the presence of tumor necrosis (TNF)α.

Method

AS tenocytes isolated from adult diabetic (fa/fa) or lean (fa/+) Zucker Diabetic Fatty (ZDF) rats were treated with 10 ng/mL TNFα either under NG or HG conditions (1 g/L versus 4.5 g/L glucose). Tendons were characterized histopathologically using Movin score. Tenocyte survival, metabolic activity, gene and/or protein expression of the main tendon extracellular matrix (ECM) component collagen type 1, the myofibroblast marker alpha smooth muscle actin (αSMA, Acta2), complement regulatory factors, the antioxidant defense enzyme heme oxygenase-1 (Hmox1), suppressors of cytokine signaling (Socs)1 and Soc3 were analyzed.

Result

Tendons of diabetic rats showed significantly higher Movin score values suggesting tendon degeneration. Tenocyte vitality remained high, but metabolic activity was impaired by HG conditions, irrespectively of tenocyte origin. Higher amounts of αSMA were visualized in tendons/cells of diabetic rats or those exposed to TNFα. Collagen type 1 protein and gene expression was suppressed by TNFα (NG), but only in cells of non diabetic animals. The anaphylatoxin receptor C3aR was higher expressed in tenocytes from diabetic animals. CD46 was suppressed by TNFα (NG) in cells of diabetic rats. Hmox1, Socs1 and Socs3 were induced by HG, but only in tenocytes of diabetic rats (4 h).

Conclusion

The response of tenocytes to TNFα depends on glucose supply and cell origin suggesting their irreversible impairment in DMT2.