Partial meniscectomy patients have a greater likelihood for the development of early osteoarthritis (OA). To prevent the onset of early OA, patient-specific treatment algorithms need to be created that predict patient risk to early OA after meniscectomy. The aim of this work was to identify patient-specific risk factors in partial meniscectomy patients that could potentially lead to early OA. Partial meniscectomy patients operated between 01/2017 and 12/2019 were evaluated in the study (n=317). Exclusion criteria were other pathologies or surgeries for the evaluated knee and meniscus (n = 114). Following informed consent, an online questionnaire containing demographics and the “Knee Injury and Osteoarthritis Outcome Score” (KOOS) questionnaire was sent to the patient. Based on the KOOS pain score, patients were classified into “low” (> 75) and “high” (< 75) risk patients, indicating risk to symptomatic OA. The “high risk” patients also underwent a follow-up including an MRI scan to understand whether they have developed early OA. From 203 participants, 96 patients responded to the questionnaire (116 did not respond) with 61 patients considered “low-risk” and 35 “high-risk” patients. Groups that showed a significant increased risk for OA were patients aged > 40 years, females, overweight (BMI >25 kg/m2 ≤ 30 kg/m2), and smokers (*p < 0.05). The “high-risk”-follow-up revealed a progression of early osteoarthritic cartilage changes in seven patients, with the remaining nineteen patients showing no changes in cartilage status or pain since time of operation. Additionally, eighteen patients in the high-risk group showed a varus or valgus axis deviation. Patient-specific factors for worse postoperative outcomes after partial meniscectomy and indicators for an “early OA” development were identified, providing the basis for a patient-specific treatment approach. Further analysis in a multicentre study and computational analysis of MRI scans is ongoing to develop a patient-specific treatment algorithm for meniscectomy patients

The objectives of the study were to investigate demographic, injury and surgery/treatment-associated factors that could influence clinical outcome, following Autologous Chondrocyte Implantation (ACI) in a large, “real-world”, 20 year longitudinally collected clinical data set. Multilevel modelling was conducted using R and 363 ACI procedures were suitable for model inclusion. All longitudinal post-operative Lysholm scores collected after ACI treatment and before a second procedure (such as knee arthroplasty but excluding minor procedures such as arthroscopy) were included. Any patients requiring a bone graft at the time of ACI were excluded. Potential predictors of ACI outcome explored were age at the time of ACI, gender, smoker status, pre-operative Lysholm score, time from surgery, defect location, number of defects, patch type, previous operations, undergoing parallel procedure(s) at the time of ACI, cell count prior to implantation and cell passage number. The best fit model demonstrated that for every yearly increase in age at the time of surgery, Lysholm scores decreased by 0.2 at 1-year post-surgery. Additionally, for every point increase in pre-operative Lysholm score, post-operative Lysholm score at 1 year increased by 0.5. The number of cells implanted also impacted on Lysholm score at 1-year post-op with every point increase in log cell number resulting in a 5.3 lower score. In addition, those patients with a defect on the lateral femoral condyle (LFC), had on average Lysholm scores that were 6.3 points higher one year after surgery compared to medial femoral condyle (MFC) defects. Defect grade and location was shown to affect long term Lysholm scores, those with grade 3 and patella defects having on average higher scores compared to patients with grade 4 or trochlea defects. Some of the predictors identified agree with previous reports, particularly that increased age, poorer pre-operative function and worse defect grades predicted poorer outcomes. Other findings were more novel, such as that a lower cell number implanted and that LFC defects were predicted to have higher Lysholm scores at 1 year and that patella lesions are associated with improved long-term outcomes cf. trochlea lesions

Higher uric acid levels or hyperuricemia is a product of more uric acid production, dysfunctional renal excretion, or a combination of both leading to deposition of urate crystals in the joints and kidneys and has been strongly linked with the development of gout, that is, acute inflammatory arthritis. Uric acid levels have been suggested to depend on multiple factors including lifestyle, diet, alcohol consumption, etc. As these are risk parameters for hyperuricemia and since lifestyle choices vary amongst different Indian communities, we sought to study the prevalence of hyperuricemia in these communities. Also, large-scale data (in terms of gender, age, lifestyle, community) on the prevalence of hyperuricemia in subjects amongst different community populations, Hindu, Muslim, Sikh, and Christian was generated. In a retrospective study conducted at Dr. D. Y. Patil School of Medicine & Research Centre, Navi Mumbai from April 2018 to May 2021, information was gathered from four major communities on a range of indicators including serum uric acid levels followed by a thorough multilevel logistic analysis. We evaluated uric acid levels in 10,378 patients of four different communities. Outcomes were assessed biochemically as well as clinically based on the levels of serum uric acid. The mean serum uric acid levels were highest in Sikhs (7.6 mg%, n=732) followed by Christians (7.3 mg%, n=892) and then by Hindus (5.9 mg%, n=6846) and Muslims (5.6 mg%, n=1908). About 83.7% of Christians consumed meat in a non-vegetarian diet followed by 45.7% Muslims. Percentage of Christians who binge drink were highest whereas percentage of Sikh people in the heavy drinkers’ category were 5.2%. Further, 9.5% Hindus were current smokers followed by 7.8% Sikhs who smoked at present. Overall, our study of 10,378 patients demonstrated that the serum uric acid levels varied from one Indian community to another due to varying external factors like diet, age, lifestyle, and addictions. Thus, lifestyle modification in communities with higher serum uric acid levels is highly advocated and this may reduce the healthcare burden of gouty arthritis in these communities

Fracture related infections (FRI) are debilitating complications of musculoskeletal trauma surgery that can result in permanent functional loss or amputation. This study aims to determine risk factors associated with FRI treatment failure, allowing clinicians to optimise them prior to treatment and identify patients at higher risk. A major trauma centre database was retrospectively reviewed over a six-year period. Of the 102 patients identified with a FRI (66 male, 36 female), 29.4% (n=30) had acute infections (onset <6 weeks post-injury), 34.3% (n=35) had an open fracture. Open fractures were classified using Gustilo-Anderson (GA) classification (type 2:n=6, type 3A:n=16, type 3B:n=10, type 3C:n=3). Patients with periprosthetic infections of the hip and knee joint, those without prior fracture fixation, soft tissue infections, diabetic foot ulcers, pressure sore infections, patients who died within one month of injury, <12 months follow-up were excluded. FRI treatment failure was defined as either infection recurrence, non-union, or amputation. Lifestyle, clinical, and intra-operative data were documented via retrospective review of medical records. Factors with a P-value of p<0.05 in univariate analysis were included in a stepwise multivariate logistic regression model. FRI treatment failure was encountered in 35.3% (n=36). The most common FRI site was the femoral shaft (16.7%; n=17), and 15.7% (n=16) presented with signs of systemic sepsis. 20.6% (n=21) had recurrent infection, 9.8% (n=10) had non-union, and 4.9% (n=5) required an amputation. The mean age at injury was 49.71 years old. Regarding cardiovascular risk factors, 37 patients were current smokers (36.3%), 31 patients were diabetics (30.4%), and 32 patients (31.4%) were obese (BMI≥30.0). Average follow-up time was 2.37 (range: 1.04-5.14) years. Risk factors for FRI treatment failure were BMI>30, GA type 3c, and implant retention. Given that FRI treatment in 35.3% (36/102) ended up in failure, clinicians need to take into account the predictive variables analysed in this study, and implement a multidisciplinary team approach to optimise these factors. This study could aid clinicians to redirect efforts to improve high risk patient management, and prompt future studies to trial adjuvant technologies for patients at higher risk of failure

Our knowledge of primary bone marrow edema (BME) of the knee is still limited. A major contributing factor is that it shares several radiological findings with a number of vascular, traumatic, and inflammatory conditions having different histopathological features and etiologies. BME can be primary or secondary. The most commonly associated conditions are osteonecrosis, osteochondritis dissecans, complex regional pain syndrome, mechanical strain such as bone contusion/bruising, micro-fracture, stress fracture, osteoarthritis, and tumor. The etiology and pathogenesis of primary BME are unclear. Conservative treatment includes analgesics, non-steroidal anti-inflammatory drugs, weight-bearing limitations, physiotherapy, pulsed electromagnetic fields, prostacyclin, and bisphosphonates. Surgical treatment, with simple perforation, fragment stabilization, combined scraping and perforation, and eventually osteochondral or chondrocyte transplant, is reserved for the late stages. This retrospective study of a cohort of patients with primary BME of the knee was undertaken to describe their clinical and demographic characteristics, identify possible risk factors, and assess treatment outcomes. We reviewed the records of 48 patients with primary BME of the knee diagnosed on MRI by two radiologists and two orthopedists. History, medications, pain type, leisure activities, smoking habits, allergies, and environmental factors were examined. Analysis of patients’ characteristics highlighted that slightly overweight middle-aged female smokers with a sedentary lifestyle are the typical patients with primary BME of the knee. In all patients, the chief symptom was intractable day and night pain (mean value, 8.5/10 on the numerical rating scale) with active as well as passive movement, regardless of BME extent. Half of the patients suffered from thyroid disorders; indeed, the probability of having a thyroid disorder was higher in our patients than in two unselected groups of patients, one referred to our orthopedic center (odds ratio, 18.5) and another suffering from no knee conditions (odds ratio, 9.8). Before pain onset, 56.3% of our cohort had experienced a stressful event (mourning, dismissal from work, concern related to the COVID-19 pandemic). After conservative treatment, despite the clinical improvement and edema resolution on MRI, 93.8% of patients described two new symptoms: a burning sensation in the region of the former edema and a reduced ipsilateral patellar reflex. These data suggest that even though the primary BME did resolve on MRI, the knee did not achieve full healing

Background. Smoking has been associated with poor tissue oxygenation and vascularisation, predisposing smokers to a higher risk for postsurgical infections. The aim of this study was to estimate and compare the incidence of prosthetic joint infection (PJI) following primary total joint arthroplasty (TJA) according to smoking status. Methods. A prospective hospital-registry based cohort was used including all primary total knee and hip arthroplasties performed between 03/1996 and 12/2013 and following them until 06/2014. Smoking status at time of surgery was classified in never, former and current smoker. Incidence rates and incidence rate ratios (IRR) for PJI according to smoking status were assessed within the first year and over the whole study period. Adjusted IRRs were obtained using cox regression model. Adjustment was performed for the following baseline characteristics: age, sex, BMI, ASA score, diabetes, arthroplasty site (knee or hip) and surgery duration. Results. We included 8,559 TJAs, 3,361 knee and 5,198 hip arthroplasties. Mean age was 70 years, 61% were women, mean follow-up time was 77 months. 5,722 were never (group 1), 1,315 former (group 2) and 1,522 current (group 3) smokers. Over the study period, 108 PJI occurred. Incidence rates of infection within one year were for group 1, 2 and 3, respectively: 4.7, 10.1 and 10.9 cases/1000 person-year. Comparing ever- vs. never-smokers, the adjusted IRR was 1.84 (95% CI 1.05–3.2). Incidence rates for infection over the whole study period were 1.5, 3.1 and 2.7 cases/1000 person-years for group 1, 2 and 3, respectively. Adjusted IRR for ever- vs. never-smokers was 1.46 (95% CI 0.97–2.19). Conclusions. Smoking was associated with an about 1.5 times higher incidence rate of PJI following TJA. The difference was established already in the first year after surgery and remained thereafter. Level of Evidence. prospective registry based comparative cohort study (level II)

A consensus regarding management of calcaneal fractures eludes orthopaedic surgeons. While operative treatment has gained more acceptance, surgical morbidity remains high. We undertook a retrospective review of early complications and radiological outcomes following internal fixation of calcaneal fractures in our unit over 15 months. A consecutive series of 33 patients who underwent fixation of the Calcaneus was selected. Patient records, X-rays and scans were reviewed. 37 fractures in 33 patients underwent fixation. 81 % were male. Mean age at surgery was 37yrs (19 -59yrs). 35 % were operated within 1 wk of injury and 13% after 2 wks of injury. 43% were Sanders' type III, 18% type II and 13% tuberosity avulsion fractures. 63% had a reversed/zero Bohler's angle. Mean post-op Bohler's angle was 32 degrees. Overall complication rate was 32%, with a combined deep infection rate of 8%. All patients with infection were male, and 70% were smokers. 86% were above 40yrs of age (mean 47yrs). The deep infection rate for intra-articular fractures was 3% and for tuberosity avulsion fractures 40%. Majority of patients with wound complications had been operated within 7 days of injury. Males over 40yrs and smokers seem to be at most risk of wound complications. Time to surgery/delay in surgery up to 2 wks did not seem to have any adverse consequences. Complications increase with fracture complexity and avulsion fractures have highest risk of wound breakdown. Near anatomical restoration of the articular surface is possible in most

Background. Nerve Root compression can lead to severe back pain. Different risk factors like high BMI, smoking, alcohol and psychological history have been identified. The aim of our study was to identify if the incidence of these risk factors was higher in patients with nerve root compression. Patients and methods. We collected data prospectively for 26 consecutive patients admitted between January and March 2011 with severe back pain and had an MRI scan. Demographic details were recorded along with occupation, BMI, smoking status, alcohol intake and psychological history. 12 patients had nerve root compression (Group A) on MRI scan and 14 had normal MRI scan (Group B). Results. The mean age for Group A was 46 years (range-35–67). 6 (50%) were female and 6 male. 2 patients had degenerative disc disease (DDD), 2 had simple falls, and one had tumour. 5 (42%) were employed, 2 (17%) unemployed and 2 (17%) housewives. The mean BMI was 26 (range-14–34). 4 patients (33%) were smokers and 5 were (42%) alcohol users. 2 patients (17%) had associated psychological history of depression. The mean age for Group B was 49 years (range-23–79). 12 (86%)were female and 2(14%)male. 2 had DDD and 1 had trauma. 6(43%)were employed, 2 (14%) unemployed and 3 (21%) housewives. The mean BMI was 25 (range-20–40). 9 patients (64%) were smokers and 9 enjoyed alcohol. 5 patients (36%) had associated psychological history; 3 of anxiety and 2 of depression. Conclusions. More females(86%)were admitted with severe back pain and normal MRI scan and had higher incidence of psychological history(36%), smoking and alcohol problems(64%)as compared to patients with nerve root compression. There was no difference in the mean age, occupation status, predisposing risk factors and BMI in both groups. Females with severe back pain should be routinely assessed for associated psychological history, smoking and alcohol problems before arranging MRI scan and appropriate advice on treatment should be given. Conflicts of Interest. None. Source of Funding. None

To prevent bone loss, OPG/RANK/RANKL signalling pathway is a key in keeping the balance between the action of osteoblasts and osteoclasts. Aim of this study is to assess the influence of long-term nicotine exposure on bone mineral density (BMD) scores, RANKL and OPG levels of plasma and RANKL and OPG immunoreactivities of tissue in rats. In this study, totally 36 Swiss Albino rats (70±10 g) were used in three groups. Whereas normal drinking water was given for the control group (n:12), 0.4 mg/kg/day and 6.0 mg/kg/day nicotine was added to drinking water for low-dose nicotine (LDN) group (n:12) and high-dose nicotine (HDN) group (n:12), respectively for 12 months. At the end of 12. th. month, BMD scores were measured via X-ray absorptiometry and then bone turnover was assessed via measuring both RANKL, OPG levels in plasma and RANKL, OPG immunoreactivities in tail vertebrae of all rats. Lumbar spine and femoral regions BMD scores of the control group and the nicotine groups were not significantly difference. In HDN group, OPG levels of plasma were found significantly higher when compared with the control and LDN groups (p=0.001) unlike RANKL levels of plasma. RANKL and OPG immunoreactivities of tissue were found significantly lower in both LDN and HDN groups (p<0.001, p=0.004, respectively) in comparison to control group. No correlation was found between plasma levels and tissue immunoreactivities of RANKL and OPG. As a result, this study indicates that nicotine is not primarily responsible for the decline of BMD frequently seen in smokers

Complex Regional Pain Syndrome (CRPS) is regarded as an uncommon clinical complication to orthopaedic surgery. Few have looked into its prevalence in foot and ankle surgery. This is a retrospective cohort study of all patients undergoing foot and ankle surgery, operated on by the foot and ankle team in our department in 2009. The objectives of this study was to determine the prevalence CRPS in these patients post-operatively and to examine the associated factors. 17 patients from 390 (4.4%) were identified as meeting the IASP (International Association for the Study of Pain) criteria for the diagnosis of CRPS. Of these, the majority were female (n = 14, 82.4%) and the average age was 47.2 (SD 9.7). All were elective patients. The majority involved operating on the forefoot (n = 9, 52.9%), followed by the hindfoot and ankle (3 cases each, 17.6%). Most of these patients had new onset CRPS (n = 12, 70.6%), with no previous history of the condition. 3 patients (17.6%) had documented nerve damage and therefore suffered from CRPS Type 2. Blood results were available for 14 (82.4%) patients at a minimum of 3 months post-operatively, and none had elevated inflammatory markers. 5 of the patients (29.4%) were smokers and 8 (47.1%) had a pre-existing diagnosis of anxiety or depression. At present, based on our findings, we recommend that middle-aged women, with a history of anxiety or depression, undergoing elective foot surgery be specifically counselled on the risk of developing CRPS at consenting. We recommend similar studies to be undertaken in other West of Scotland orthopaedic units

Background and Purpose. Most information regarding adverse events (AEs) following osteopathic treatment is anecdotal; empirical data are limited. We explored the feasibility of online questionnaires to capture AEs prospectively within an osteopathic teaching clinic, and explored associations between a priori selected variables and reporting AEs. Methods and Results. We piloted a prospective patient-completed online questionnaire rating (‘none’/‘mild’/‘moderate’/‘severe’/‘don't know’) 14 symptoms (e.g. ‘pain’, ‘headaches’, ‘dizziness’, ‘nausea’, ‘tingling’) at five time-points within one week post-treatment. We recruited patients presenting with a new complaint. Additional data on concomitant symptoms, demographics, and treatment approach were obtained. Using logistic regression we explored associations between reporting an event at 24 hours and age, gender, high-velocity-low-amplitude-thrust and smoking status. ‘Pain’ (82%), ‘stiffness’ (40%) and ‘lack of mobility’ (28%) were the main presenting complaints, and ‘lower back’ (39%), ‘head/neck’ (26%) and ‘upper limb’ (14%) the commonest regions affected. AEs were reported by 83% of patients; ‘pain’ (74%), ‘stiffness’ (58%) and ‘unexpected tiredness’ (10%) were the most frequently reported. These peaked at 24, 48 and 24 hours respectively and were commonly rated as ‘mild’. There was no evidence for age, gender, HVLAT in crude or adjusted models; there were very weak/weak suggestions smoking cessation may be associated with reporting AEs; adjusted OR for ex-smokers versus never-smokers was 3.50 (0.66–18.40; P=0.14); ex-smokers versus smokers was 5.67 (0.85–37.80; P=0.07)). Conclusion. Using online questionnaire is feasible within a teaching clinic. Over 80% of patients reported one or more mild adverse events post-treatment. A larger study may be warranted testing the hypothesis smoking status predicts reporting of adverse events. No conflicts of interest. Sources of funding: The European School of Osteopathy. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting

Objectives

To explore the therapeutic potential of combining bone marrow-derived mesenchymal stem cells (BM-MSCs) and hydroxyapatite (HA) granules to treat nonunion of the long bone.

Objectives

To review the systemic impact of smoking on bone healing as evidenced within the orthopaedic literature.

Objectives

We have observed clinical cases where bone is formed in the overlaying muscle covering surgically created bone defects treated with a hydroxyapatite/calcium sulphate biomaterial. Our objective was to investigate the osteoinductive potential of the biomaterial and to determine if growth factors secreted from local bone cells induce osteoblastic differentiation of muscle cells.

Objectives

The aim of this study was to examine whether asymmetric loading influences macrophage elastase (MMP12) expression in different parts of a rat tail intervertebral disc and growth plate and if MMP12 expression is correlated with the severity of the deformity.

This study was designed to test the hypothesis that the sensory innervation of bone might play an important role in sensing and responding to low-intensity pulsed ultrasound and explain its effect in promoting fracture healing. In 112 rats a standardised mid-shaft tibial fracture was created, supported with an intramedullary needle and divided into four groups of 28. These either had a sciatic neurectomy or a patellar tendon resection as control, and received the ultrasound or not as a sham treatment. Fracture union, callus mineralisation and remodelling were assessed using plain radiography, peripheral quantitative computed tomography and histomorphology.

Daily ultrasound treatment significantly increased the rate of union and the volumetric bone mineral density in the fracture callus in the neurally intact rats (p = 0.025), but this stimulating effect was absent in the rats with sciatic neurectomy. Histomorphology demonstrated faster maturation of the callus in the group treated with ultrasound when compared with the control group. The results supported the hypothesis that intact innervation plays an important role in allowing low-intensity pulsed ultrasound to promote fracture healing.

We carried out a cross-sectional study with analysis of the demographic, clinical and laboratory characteristics of patients with metal-on-metal hip resurfacing, ceramic-on-ceramic and metal-on-polyethylene hip replacements. Our aim was to evaluate the relationship between metal-on-metal replacements, the levels of cobalt and chromium ions in whole blood and the absolute numbers of circulating lymphocytes. We recruited 164 patients (101 men and 63 women) with hip replacements, 106 with metal-on-metal hips and 58 with non-metal-on-metal hips, aged < 65 years, with a pre-operative diagnosis of osteoarthritis and no pre-existing immunological disorders.

Laboratory-defined T-cell lymphopenia was present in13 patients (15%) (CD8⁺ lymphopenia) and 11 patients (13%) (CD3⁺ lymphopenia) with unilateral metal-on-metal hips. There were significant differences in the absolute CD8⁺ lymphocyte subset counts for the metal-on-metal groups compared with each control group (p-values ranging between 0.024 and 0.046). Statistical modelling with analysis of covariance using age, gender, type of hip replacement, smoking and circulating metal ion levels, showed that circulating levels of metal ions, especially cobalt, explained the variation in absolute lymphocyte counts for almost all lymphocyte subsets.

External fixation of distal tibial fractures is often associated with delayed union. We have investigated whether union can be enhanced by using recombinant bone morphogenetic protein-7 (rhBMP-7).

Osteoinduction with rhBMP-7 and bovine collagen was used in 20 patients with distal tibial fractures which had been treated by external fixation (BMP group). Healing of the fracture was compared with that of 20 matched patients in whom treatment was similar except that rhBMP-7 was not used.

Significantly more fractures had healed by 16 (p = 0.039) and 20 weeks (p = 0.022) in the BMP group compared with the matched group. The mean time to union (p = 0.002), the duration of absence from work (p = 0.018) and the time for which external fixation was required (p = 0.037) were significantly shorter in the BMP group than in the matched group. Secondary intervention due to delayed healing was required in two patients in the BMP group and seven in the matched group.

RhBMP-7 can enhance the union of distal tibial fractures treated by external fixation.

We studied the effect of vitamin C on fracture healing in the elderly. A total of 80 elderly Osteogenic Disorder Shionogi rats were divided into four groups with different rates of vitamin C intake. A closed bilateral fracture was made in the middle third of the femur of each rat. Five weeks after fracture the femora were analysed by mechanical and histological testing. The groups with the lower vitamin C intake demonstrated a lower mechanical resistance of the healing callus and a lower histological grade. The vitamin C levels in blood during healing correlated with the torque resistance of the callus formed (r = 0.525). Therefore, the supplementary vitamin C improved the mechanical resistance of the fracture callus in elderly rats. If these results are similar in humans, vitamin C supplementation should be recommended during fracture healing in the elderly.