Peripheral inflammation and gait speed alterations are common in several neurological disorders and in the aging process, but the association between the two is not well established. The aim of this ...systematic literary review is to determine whether proinflammatory markers are a positive predictor for gait impairments and their complications, such as falls in older adults, and may represent a risk factor for slow gait speed and its complications. The systematic review was performed in line with the Preferred Report Items for Systematic Review and Meta-Analyses (PRISMA). A protocol for literature searches was structured a priori and designed according to the International Perspective Register of Systemic Review (PROSPERO: CRD42023451108). Peer-reviewed original articles were identified by searching seven electronic databases: Excerpta Medica Database (EMBASE), SciVerse (ScienceDirect), Scopus, PubMed, Medline, Web of Science, and the Cochrane Library. The search strategy was formulated based on a combination of controlled descriptors and/or keywords related to the topic and a manual search was conducted of the reference lists from the initially selected studies to identify other eligible studies. The studies were thoroughly screened using the following inclusion criteria: older adults, spatiotemporal gait characteristics, and proinflammatory markers. A meta-analysis was not performed due to the heterogeneity of the studies, and the results were narratively synthesized. Due to the clinical and methodological heterogeneity, the studies were combined in a narrative synthesis, grouped by the type of biomarkers evaluated. A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, spatiotemporal gait parameters such as gait velocity, and proinflammatory markers such as TNF-α, high sensitivity C-reactive (CRP) proteins, and IL-6. We included 21 out of 51 studies in our review, which examined the association between inflammatory biomarkers and gait impairment. This review highlights the role of TNF-α, CRP, and IL-6 in gait impairment. Biomarkers play an important role in the decision-making process, and IL-6 can be an effective biomarker in establishing the diagnosis of slow gait speed. Further longitudinal research is needed to establish the use of molecular biomarkers in monitoring gait impairment.
Background
Stem choice in total hip arthroplasty (THA) for hip dysplasia is still controversial. The aims of the study were to evaluate (1) which stem design provided the highest percentage of ...adequate reconstructions in THA for dysplasia and (2) any correlation between the reconstructions provided by the stems and the native femoral morphology.
Materials and methods
150 CT scans including 200 adult dysplastic hips were randomly selected. Using the 3D CT-based software Hip-Op for surgical planning, the native hip anatomy was studied. Then, a single wedge tapered stem, an anatomical stem and a conical tapered stem were simulated in every hip. An adequate reconstruction of hip biomechanics was obtained when combined anteversion, offset restoration, coronal and sagittal tilt, canal filling and leg lengthening were inside the normal ranges.
Results
Conical stems achieved the highest percentage of adequate reconstructions (87%,
p
< 0.0001). The anatomical stem was the worst performer. Single wedge and anatomical stem acceptability was mainly influenced by the combined anteversion. Stem anteversion was correlated with the femoral anteversion (fair correlation), the calcar femorale (fair) and the mediolateral femoral diameter at isthmus (poor). When the femoral anteversion was ≥ 25°, combined anteversion was very acceptable for the conical stem (99.2%), whereas the rate of acceptable combined anteversion for the single wedge tapered stem was 71.4%, and that for the anatomical stem was 51.6% (
p
< 0.0001).
Conclusions
Stem choice in developmental hip dysplasia is mainly driven by appropriate combined anteversion, which is dependent on the coronal and axial femoral morphologies. As a rule of thumb, tapered stems are adequate when femoral anteversion is < 25°; conical stems should be adopted for higher anteversions.
Level of evidence
IV.
Dynamic balance plays a key role in high-impact sports, such as CrossFit, where athletes are required to maintain balance in various weightlifting exercises. The loss of balance in these ...sport-specific movements may not only affect athlete performance, but also increase the risk of injuries.
The aim of the study is to achieve greater insight into the balance and athlete position during the CrossFit training by means of inertial sensors, with a particular focus on the role of different custom foot orthoses (CFOs) in order to detect correlations with the role of the cavus foot.
A total of 42 CrossFit
athletes, aged 25 to 42 years, were enrolled in this study. One-way ANOVA tests with post-hoc analysis of variance were used to compare foot posture groups and effects of different types of customized foot orthoses.
When comparing the effects of CFOs with the respective balance basal level during the pistol squat exercise, we observed a significant (
= 0.0001) decrease in the sway area, antero-posterior displacement (APD) and medio-lateral displacement (MLD) compared to the basal using both types of CFOs.
No significant positive effects of CFOs were observed in some static tests. On the contrary, positive effects of CFOs and, in particular, postural insoles, are relevant to dynamic balance.
Hydroxyapatite (HA) is the main inorganic mineral that constitutes bone matrix and represents the most used biomaterial for bone regeneration. Over the years, it has been demonstrated that HA ...exhibits good biocompatibility, osteoconductivity, and osteoinductivity both in vitro and in vivo, and can be prepared by synthetic and natural sources via easy fabrication strategies. However, its low antibacterial property and its fragile nature restricts its usage for bone graft applications. In this study we functionalized a MgHA scaffold with gold nanorods (AuNRs) and evaluated its antibacterial effect against
and
in both suspension and adhesion and its cytotoxicity over time (1 to 24 days). Results show that the AuNRs nano-functionalization improves the antibacterial activity with 100% bacterial reduction after 24 h. The toxicity study, however, indicates a 4.38-fold cell number decrease at 24 days. Although further optimization on nano-functionalization process are needed for cytotoxicity, these data indicated that Au-NRs nano-functionalization is a very promising method for improving the antibacterial properties of HA.
Background
In total hip arthroplasty (THA), the outcomes of single taper (ST) and dual taper (DT) versions of the same stem design have been scarcely studied. A registry study comparing ST and DT ...versions of the same stem design was designed, aiming to assess: (1) the survival rates and the hazard ratios for failure; (2) the survival rates and the hazard ratios for failure using stem-focused endpoints.
Material and methods
A regional arthroplasty registry was interrogated about stem designs with ST and DT versions in cementless THAs performed for primary osteoarthritis. Only the same cup and ceramic-on-ceramic bearings were included: the DT stems had a titanium-on-titanium modularity. Demographic and implant features were recorded. Survival rates and hazard ratios were evaluated and compared. Stem-focused endpoints were also investigated.
Results
A total of 5359 THAs were included, with three stem designs. The two versions of every stem showed different demographics and implant-related features: ST versions were preferentially implanted in heavier young men. For each stem, the two versions had similar survival rates at 5 years (
p
= 0.076;
p
= 0.319;
p
= 0.616) and similar adjusted hazard ratios for failures (
p
= 0.084;
p
= 0.308;
p
= 0.729). When stem-focused endpoints were adopted, the ST and DT versions of the three stems achieved similar survival rates (
p
= 0.710;
p
= 0.784;
p
= 0.983) and similar adjusted hazard ratios (
p
= 0.647;
p
= 0.858;
p
= 0.787). Three neck breakages occurred (0.0007% of all the modular implants).
Conclusions
ST and DT versions of the same stem design did not show any differences in terms of survival rates and hazard ratios for failures at 5 years.
LEVEL OF EVIDENCE
: IV.
There is a paucity of data regarding the post-operative influence of total hip arthroplasty (THA) on the axial and coronal alignments of the ipsilateral knee. A CT study was designed to assess the ...post-THA changes in axial and coronal knee alignments in low-grade dysplastic hips.
Forty Crowe I-II dysplastic hips in 37 patients were assessed: a pre-operative CT scan from the fourth lumbar vertebra to the tibial plateaus was compared to a similar post-operative CT scan performed after a minimum of 2 years after THA.
THA implantation caused significant post-operative changes in terms of the rotation height (2 mm lowering;
= 0.003); center of rotation medialization (10 mm medialization;
< 0.001); femoral offset (11 mm increase;
< 0.001); femoral antetorsion (22° internal rotation;
< 0.001), and hip internal rotation (9° internal rotation;
< 0.001). The femoral axis angle deviated in the valgus (5.5° ± 1.1°,
< 0.001) and the mechanical lateral distal femoral angle deviated in the varus (86° ± 2.7°,
= 0.001). The pelvic-tibial alignment changed from 88.2° ± 11.7° to 96° ± 9.3° (
< 0.001). Patellar alignment was not influenced.
In conclusion, THA imposes significant changes in low-grade dysplastic hips: all the modifications tend to neutralize the coronal alignment and, mostly, the rotational alignment, without substantial and durable variations of the patellofemoral joint. Large clinical trials should confirm whether radiological changes impact anterior knee pain and patellar stability.
Introduction
Recurrent dislocations are still the most frequent reason for revision in total hip arthroplasty (THA). The impact of bearing surfaces on dislocations is still controversial. We ...hypothesized that: (1) bearing surfaces influence the revisions due to dislocations; (2) ceramic-on-ceramic reduced the revisions for dislocations in adjusted models; (3) Delta-on-Delta bearings reduced the revisions for dislocations in comparison to surfaces with cross-linked polyethylene.
Materials and methods
The regional arthroplasty registry was enquired about bearing surfaces and revisions for dislocations and instability. Unadjusted and adjusted rates were provided, including sex, age (<65 years or ≥65 years), head diameter (≤28 mm or >28 mm; <36 mm or ≥36 mm) as variables. 44,065 THAs were included.
Results
The rate of revisions for dislocations was significantly lower in ceramic-on-ceramic and metal-on-metal bearings (unadjusted rates). After adjusting for age, sex, and head size (36 and 28 mm), hard-on-hard bearings were protective (
p
< 0.05): ceramic-on-ceramic had a lower risk of revisions due to dislocation than ceramic-on-polyethylene (HR 1.6, 95% CI 1.2–2.2
p
= 0.0009). The rate of revisions for dislocation was similar in bearings with cross-linked polyethylene and Delta-on-Delta articulations, in unadjusted and adjusted models.
Conclusion
Bearings with conventional polyethylene were more predisposed to dislocations. Currently adopted bearings exerted no significant influence on revisions due to dislocations. These findings could be primarily related to wear, but due to the time distribution, soft tissue envelopes and surface tension may also play a role. Pre-clinical biomechanical evaluations and prospective matched cohort studies are required to draw definitive conclusions.
Acetabular bone defect quantification and classification is still challenging. The objectives of this study were to suggest and define parameters for the quantification of acetabular bone defects, to ...analyze 50 bone defects and to present the results and correlations between the defined parameters.
The analysis was based on CT-data of pelvises with acetabular bone defects and their reconstruction via a statistical shape model. Based on this data, bone volume loss and new bone formation were analyzed in four sectors (cranial roof, anterior column, posterior column, and medial wall). In addition, ovality of the acetabulum, lateral center-edge angle, implant migration, and presence of wall defects were analyzed and correlations between the different parameters were assessed.
Bone volume loss was found in all sectors and was multidirectional in most cases. Highest relative bone volume loss was found in the medial wall with median and 25, 75-percentile values of 72.8 50.6, 95.0 %. Ovality, given as the length to width ratio of the acetabulum, was 1.3 1.1, 1.4 with a maximum of 2.0, which indicated an oval shape of the defect acetabulum. Lateral center-edge angle was 30.4° 21.5°, 40.4°, which indicated a wide range of roof coverage in the defect acetabulum. Total implant migration was 25.3 14.8, 32.7 mm, whereby cranial was the most common direction. 49/50 cases showed a wall defect in at least one sector. It was observed that implant migration in cranial direction was associated with relative bone volume loss in cranial roof (R = 0.74) and ovality (R = 0.67).
Within this study, 50 pelvises with acetabular bone defects were successfully analyzed using six parameters. This could provide the basis for a novel classification concept which would represent a quantitative, objective, unambiguous, and reproducible classification approach for acetabular bone defects.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A modular head-neck adapter system may help surgeons restore the proximal hip biomechanics in revision hip arthroplasty. However, the clinical and radiographic 5-year outcomes of the system are still ...scarcely reported. The aim of this study is the assessment of (1) complications and survival rates, (2) clinical and (3) radiological outcomes of the modular head-neck adapter system with a ceramic head in revision hip arthroplasty at 5 years.
32 revision hip arthroplasties using a modular head-neck adapter system and a ceramic head were retrospectively recorded. Preoperative demographic and implant features were collected. Clinical and radiographic outcomes, failures and reasons for re-revisions were recorded at the last follow-up.
A mean follow-up of 59.8 ± 26 months was achieved. The survival rate was 90.6% at 5 years. Post-operative complications occurred in nine cases (28.1%): two dislocations (6.2%), one aseptic cup loosening (3.1%) requiring re-revision, one (3.1%) persistent pelvic pseudotumor requiring embolization. No mechanical failures of the adapter or ceramic head occurred. The mean post-operative HHS score was 84.4 points. Thirteen cases (40.6%) showed optimal radiographic cup osseointegration, and 17 hips (53.1%) showed valid stem osseointegration. The mean post-operative femoral offset was 48.84 mm, larger than the contralateral side (
= 0.02). The post-operative lateralization of the hip joint was 38.09 mm, close to the contralateral side (
= 0.4).
In revisions, the modular head-neck adapter system with ceramic head provided good clinical outcomes and acceptable radiographic reconstruction of hip biomechanics, with a survival rate of 87.9% at 5 years.
In the management of bone and soft tissue tumors, accurate diagnosis, using a combination of clinical, radiographic, and histological data, is critical to optimize outcome. On occasion, diagnosis can ...be made by careful history, physical examination, and images alone. However, the ultimate diagnosis usually depends on histologic analysis by an experienced pathologist. Biopsy is a very important and complex surgery in the staging process. It must be done carefully, so as not to adversely affect the outcome. Technical considerations include proper location and orientation of the biopsy incision and meticulous hemostasis. It is necessary to obtain tissue for a histological diagnosis without spreading the tumor and so compromise the treatment. Furthermore, the surgeon does not open compartmental barriers, anatomic planes, joint space, and tissue area around neurovascular bundles. Nevertheless, avoid producing a hematoma. Biopsy should be carefully planned according to the site and definitive surgery and should be performed by an orthopedic surgeon with an experience in musculoskeletal oncology who will perform the definitive surgery. Improperly done, it can complicate patient care and sometimes even eliminate treatment options. Different biopsy techniques are suitable: fine-needle aspiration, core-needle biopsy, and incisional biopsy. The choice of biopsy depends on the size, the location of the lesion, and the experience of the pathologist.
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