Vacuum orthoses are being applied in the care of patients with foot and lower leg conditions, as ankle fractures or sprains. The lower leg is protected and immobilized, which increases mobility. Due to the design, the orthoses lead to a difference in leg length, i.e. the side with the orthosis becomes longer, which changes the gait kinematics. To prevent or mitigate the unfavourable effects of altered gait kinematics, leg length-evening devices (shoe lifts) are offered that are worn under the shoe on the healthy side. Our aim was to evaluate the effect of such a device on the normality of gait kinematics. Gait analysis was conducted with 63 adult, healthy volunteers having signed an informed consent form that were asked to walk on a treadmill at a speed of 4.5km/h in three different conditions:. barefoot - as reference for establishing the normality score baseline. with a vacuum orthosis (VACOPed, OPED GmbH, Germany) and a sport shoe. with a vacuum orthosis and a shoe lift (EVENup, OPED GmbH, Germany). Data was sampled using the gait analysis system MCU 200 (LaiTronic GmbH, Austria). The positions of the joint markers were exported from the software and evaluated for the joint angles during the gait cycle using custom software (implemented in DIAdem 2017, National Instruments). A normality score using a modification of the Gait Profile Score (GPS) was calculated in every 1%-interval of the gait cycle and evaluated with a Wilcoxon signed rank test. The GPS value was reduced by 0.33° (0.66°) (median and IQR) while wearing the shoe lift. The effect was statistically significant, and very large (W = 1535.00, p < .001; r (rank biserial) = 0.52, 95% CI [0.29, 0.70]). The significant reduction of the GPS value indicates a more normal gait kinematics while using the leg length-evening device on the contralateral shoe. This rather simple and inexpensive device thus might improve patient comfort and balance while using the vacuum orthoses

Bi-cruciate stabilized (BCS) TKA is the prosthesis that aims to substitute bi-cruciate ligament with post-cam engagement. We estimated to describe the in vivo kinematics during deep knee bending in BCS and Cruciate retaining (CR) TKA with the same articular geometry. We analyzed 26 knees who agreed to the current investigation under institutional review board approval. 17 knees were implanted with BCS (Journey ∥BCS, Smith & Nephew. Memphis, US) and 9 knees with CR (Journey∥CR). Each patient was asked to perform deep knee bending under weight-bearing condition. To estimate the spatial position and orientation of the TKA, 2D/3D registration technique with single fluoroscopy was used. We evaluated anteroposterior (AP) translation of the nearest point from femoral component to tibial axial plane for medial and lateral sides, femoral external rotation relative to tibial component and post-cam engagement in BCS. Measurement results were analyzed using Wilcoxon test. Values of P<0.05 were considered statistically significant. Medial AP translation indicated 11.7±5.1% posterior movement in BCS and 4.0±6.6% anterior movement in CR from minimum flexion to 130°. Lateral AP translation indicated 28.9±11.4% posterior movement in BCS and 18.3±6.2% posterior movement in CR from minimum flexion to 130°. Femoral external rotation were observed in both group and the amount of rotation were 5.2°±4.5° in BCS and 8.2°±4.0° in CR. Anterior post-cam engagement was not observed in all cases (76.5%). But medial AP translation in BCS was anteriorly in shallow flexion angles compared to CR. It suggested that anterior post-cam engagement couldn't work in valid

In the past decades, titanium-based biomaterials have been broadly used in maxillofacial and periodontology surgery. The main aetiological agents related to complications in this procedures are Porphyromonas gingivalis, a Gram-negative anaerobic bacteria that is also responsible for the development of chronic gingivitis, and Streptococcus oralis, a Gram positive facultative anaerobic bacteria. In previous studies, we have demonstrated that the fluorine doping of titanium-based alloys reduces bacterial adherence. The aim of this study is to evaluate the bacterial adherence on fluorine-doped titanium (TiF) probes compared to chemical polishing titanium (Ti) probes. The P. gingivalis ATCC 33277 and S. oralis ATCC 9811 adherence study was performed by introducing each probe in a well of 6-well plate with 5 ml containing 106 colony forming units (CFU/ml) in sterile 0.9% NaCl and was incubated 37°C 5% CO2 for 90 minutes, in anaerobiosis in the case of P. gingivalis. After incubation, samples were stained with LIVE/DEAD BacLight Bacterial Viability Kit. Proportion of live and dead bacteria was calculated and studied by using ImageJ software. The experiments were performed in triplicate. The statistical data were analyzed by nonparametric Wilcoxon test with a level of statistical significance of 0.05. Our results showed a significant (p<0.0053) 14.41% decrease of the adherence of P. gingivalis on TiF and an increase of 30% of dead cells. For S. oralis we did not get significant results. In conclusion, TiF can be considered a promising approach to prevent and treat infections related to maxillofacial and periodontology surgery

Prosthetic joint infections (PJI) occur infrequently, but they represent the most devastating complication with high morbidity and substantial cost. Staphylococcus aureus and coagulase-negative S. epidermidis are the most commonly infecting agents associated with PJI. Nowadays, Gram-negative species like Escherichia coli and Pseudomonas aeruginosa are gaining relevance. The use of TiO2 conical nanotubular doped with fluorine and phosphorous (FP-cNT) surfaces is an interesting approach to prevent surface bacterial colonization during surgery and favouring the osseointegration. Despite of there are serum markers related with PJI, to date there is described no biomaterial-related marker that allows detecting PJI. Here we describe the adherence and the bactericidal effect of FP-cNT and its capacity of marking the non-fermenting bacteria that have been in contact with it by Al. This metal is delivered by FP-cNT in non-toxic concentrations (between 25 and 29 ng/mL). F-P-cNT layers on Ti6Al4V alloy were produced as described previously by our group. Ti6Al4V chemical polishing (CP) samples without nanostructure were used as control and produced as described previously. S. aureus 15981, S. epidermidis ATCC 35984, E. coli ATCC 25922, and P. aeruginosa ATCC 27853 strains adherence study was performed using the protocol described by Kinnari et al. in 0.9% NaCl sterile saline with a 120 min incubation. After incubation, the samples were stained with LIVE/DEAD BacLight Bacterial Viability Kit. Proportion of live and dead bacteria was calculated and studied by using ImageJ software. The experiments were performed in triplicate. The aluminum concentration was estimated in the supernatant after incubation and in the 0.22 µm filtered supernatant by atomic absorption in graphite furnace. The statistical data were analyzed by nonparametric Kruskal-Walis test and by pairwise comparisons using the nonparametric unilateral Wilcoxon test with a level of statistical significance of p<0.05. The values are cited as medians. Our results show that the bacterial adherence of all tested species significantly decreased on FP-cNT compared to CP except P. aeruginosa ATCC 27853: 19.8% for S. aureus 15981, 45.3% for S. epidermidis ATCC 35984 and 8.1% for E. coli ATCC 25922. The bacterial viability decreased 2-fold for S. aureus 15981, and 5-fold for S. epidemidis ATCC 35984, but increased 95% for P. aeruginosa ATCC 27853 and there no was variation for E. coli ATCC 25922 on FP-cNT compared to CP. Only supernatant P. aeruginosa ATCC 27853 shows significant Al detection after 120 min incubation (p<0.05). In summary, F-P cNT is a promising biomaterial that besides favoring osseointegration and potential usefulness as drug carrier, present bactericidal, non-stick ability (at least for staphylococci and E. coli) and is able to mark P. aeruginosa with Al, which could be potentially monitored in serum and urine in patients with PJI

Subtalar arthrodesis known as talocalcaneal fusion is an end-stage treatment for adult hind foot pathologies. The goal of the arthrodesis is to restrict the relative motion between bones of the subtalar joints, aiming to reduce pain and improve function for the patient. However, the change of the subtalar structures through the fusion is considered a disturbance to the joint biomechanics, which have been suggested to affect the biomechanics of the adjacent joints. However, no quantitative data are available to document this phenomenon. The purpose of the current study was to quantify the effects of subtalar arthrodesis on the laxity and stiffness of the talocrural joint in vitro using a robot-based joint testing system (RJTS) during anterioposterior (A/P) drawer test. Six fresh frozen ankle specimens were used in this study. The lateral tissues of the specimens were removed but the anterior and posterior talofibular ligaments and calcaneofibular ligament were kept intact. A/P drawer tests were performed on each of the specimens at neutral position, 5° and 10° of dorsiflexion, and 5?and 10?of plantarflexion using a robot-based joint testing system (RJTS), before and after subtalar arthrodesis. The RJTS enabled unconstrained A/P drawer testing at the prescribed ankle position while keeping the proximal/distal and lateral/medial forces, and varus/valgus and internal/external moments to be zero. This was achieved via a force-position hybrid control method with force and moment control, which has been shown to be more accurate than other existing force-position hybrid control methods. The target A/P force applied during the A/P drawer test was 100N in both anterior and posterior directions. The stiffness and laxity were calculated from the measured force and displacement data. The anterior and posterior stiffness of the talocrural joint were defined as the slope beyond 30% of the target A/P force, and the peak displacements quantified the laxity of the joint. Comparisons of laxity and stiffness between the intact and fusion ankle specimens were performed using Wilcoxon signed rank test (SPSS 19.0, IBM, USA) and a significance level of 0.05 was set. Subtalar arthrodesis did not lead to significant changes in the stiffness and laxity in both anterior and posterior directions (P>0.05). The mean anterior stiffness before arthrodesis was 9.54±1.17 N/mm and was 10.35±2.40 N/mm after arthrodesis. The mean anterior displacements before and after arthrodesis were 9.68±0.94 mm and 8.97±1.42 mm, respectively. Subtalar arthrodesis did not show significant effects on the A/P laxity and stiffness of the talocrural joint in both anterior and posterior directions. This may imply that the motion of the subtalar joints do not have significant effects on the A/P stability of the talocrural joint, which is the main joint of the ankle complex. This agrees with the anatomical roles of the subtalar joints which provide mainly the varus/valgus motions for the ankle complex. The current study provides a basis for further studies needed to evaluate the effects subtalar arthrodesis on the varus/valgus stability

The benefits of surgical treatments for osteoarthritis (OA) of the knee are well established. There are also advances in non-surgical management techniques that can be used successfully, and these may be particularly suitable for patients with mild to moderate disease, or for those in whom surgery is contra-indicated. Intra-articular viscosupplementation is one such method, and studies have shown that this can give short-term symptomatic relief. Our study looked at the patient perceived benefits of a course of Hylan G-F 20 (Synvisc¯) by comparing the modified Brief Pain Inventory short form (BPI-sf) scores before treatment and after three months. The BPI-sf is a validated, widely used, self-administered questionnaire that measures both sensory and reactive dimensions of the pain using scales of 0-10 or 0-100%. This study included 12 consecutive patients with OA of the knee treated with a course of three Synvisc¯ injections performed a week apart. The data were treated as non-parametric and therefore Wilcoxon signed rank tests were performed. The data are presented as median (IQR). The results showed statistically significant (p<0.05), and clinically significant (reduction >1 point) improvements in worst, best, and average pain scores (over the previous 24 hours) three months following treatment compared to those before treatment. Relief obtained from routinely taken analgesia was significantly improved from 30%(12.5-57.5) to 75%(42.5-100) (p=0.009) following treatment. There were significant reductions in the interference of the pain with: general activity from 6(4.25-8.75) to 2.5(0-6.75), (p=0.006); mood from 6(2-8) to 0(0-5), (p=0.004); walking ability from 7.5(4-8.75) to 3.5(0.25-6), (p=0.004); normal work from 5.5(3.5-8) to 1.5(0-5), (p=0.009); relations with other people from 4(2-8) to 0(0-3.5), (p=0.006); sleep from 6(3.25-9.5) to 1.5(0-5.75), (p=0.004); enjoyment of life from 6(2.75-8.5) to 1.5(0-6), (p=0.005). All patients found the treatment acceptable. We conclude that patients reported significant improvements in pain, physical and emotional functioning, and sleep three months following treatment with this viscosupplementation treatment

Summary Statement. Cross-talk between cells from immune and bone system might play a role in molecular regulation of subchondral bone sclerosis in osteoarthritis. Macrophages, B-lymphocytes and tartrate-resistant acid phosphatase activity are specifically increased in sclerotic subchondral bone of patients with knee osteoarthritis. Background. Recent investigations have provided substantial evidence that distinct molecular and morphological changes in subchondral bone tissue, most notably sclerosis, play an active and important role in the pathogenesis of OA. The cellular and molecular regulation of this pathological process remains poorly understood. Here, we investigated whether osteoimmunology, the reciprocal signaling between cells from the immune and bone system, is involved in OA subchondral bone sclerosis. Patients & Methods. Tibial plateaus and informed consent were obtained from patients undergoing total knee arthroplasty due to end-stage OA. Subchondral bone mineralization distribution was analyzed using computed tomography osteoabsoptiometry (CT-OAM) and standardised cryosections of low (non-sclerotic) and high (sclerotic) bone mineralization were prepared (n=18 each). Cartilage degeneration was graded in Safranin-O-stained sections using the Mankin scoring system. The presence of T-lymphocytes, B-cells and macrophages was assessed using immunohistochemical staining of their respective surface markers CD3, CD20 and CD68. Osteoclast activity was visualised by staining of the enzyme marker tartrate-resistant acid phosphatase (TRAP). Cellular characterization of ex vivo subchondral bone outgrowth cultures was performed using alkaline phosphatase (ALP), TRAP staining. Correlation between histological parameters was assessed using Spearman's rank correlation. Statistical differences were calculated using Wilcoxon signed rank test or paired t-test, where appropriate. Results. CT-OAM revealed a heterogeneous distribution of subchondral bone mineralization in OA tibial plateaus, displaying focal areas of sclerosis that overlapped macroscopically with areas of cartilage damage. These data were confirmed at the histological level by a strong correlation between Mankin score and grade of sclerosis (r=0.7, p<0.001). Immunohistochemistry showed that CD20. +. , but not CD3. +. , lymphocytes and CD68. +. mononuclear (macrophage) and multinucleated (osteoclast) cells were present in subchondral marrow spaces. Notably, the number of CD20. +. lymphocytes and CD68. +. cells was significantly (p<0.05) increased in sclerotic subchondral bone. Enhanced osteoclast activity was confirmed by a significantly increased (p<0.05) number of multinucleated and mononuclear TRAP. +. cells in sclerotic bone. Finally, the number of CD68. +. cells was strongly correlated (p<0.001) with Mankin score (r=0.7), grade of sclerosis (r=0.8), CD20. +. lymphocytes (r=0.8), and TRAP-positive cells (r=0.9). Outgrowth cultures of subchondral bone showed cells of different morphologies including fibroblast-shaped osteoblasts and macrophage-like cells. Expression of ALP was detected in the prior, while TRAP expression was evident in the latter. Corresponding with histological analyses, the number of TRAP. +. cells was increased in ex vivo outgrowth cultures of sclerotic compared to non-sclerotic subchondral bone. Conclusions. Together, our data suggest that osteoimmunological mechanisms, specifically the interaction of CD68. +. macrophages with bone-resident cells, play a - previously unknown - role in regulating subchondral bone sclerosis in progressive OA. Targeting osteoimmunology might hold potential as a disease-modifying treatment for OA

Introduction. The interstitial fluid of bone fluid flow is supplied by flowing blood. Blood flow is determined by three kinds of muscles: cardiac, smooth, and skeletal. Cardiac muscle establishes baseline blood pressure. Smooth muscle controls vessel diameter and skeletal muscle creates intermittent intravascular pressure pulses. For the tibia the relevant skeletal muscle is the gastrocnemius which functions as a muscle pump. This study tested the hypotheses: 1) skeletal muscle-caused pressure pulses increase cortical blood flow, 2) extravasation of vascular fluid and, consequently, interstitial bone fluid flow are enhanced by resultant increased microvascular pressure and 3) bone healing is enhanced by increased bone fluid flow. Methods. Eighteen skeletally mature female New Zealand white rabbits were implanted with bone chamber windows (BCIs) as described previously. The windows were exposed at three weeks and observed weekly until Week 10 using intravital microscopy. During observation, the subject was suspended in prone position in a mesh fabric torso sling jacket so as to eliminate gravity-based reaction forces. Electrodes of a transcutaneous electrical nerve stimulator (TENS) were gel-glued at each rabbits gastroc-soleus position; but activated only in the 11 experimentals. A 4Hz 2.8 ± 1.3V impulse was delivered for 60 minutes. Still and video images were obtained at 0, 2, and 60 minutes following injection of 1μm fluorescent microspheres. Each such injection was followed by injection of 70 kD FITC- or RITC-dextran to define vascularity and capillary filtration. Additional still images were obtained at 5, 30, and 55 minutes. Muscle contraction forces during TENS were obtained acutely following the Week 10 observation with a Futek force transducer cell through an attached nylon suture. Bone mineral density was obtained at Week 3 and Week 10 with a Stratec pQCT and associated software. Data were analyzed statistically using a Wilcoxon signed rank test. Results. All three hypotheses were supported statistically by the data. The average force produced by TENS stimulated gastrocnemius contraction was 18.98 ± 9.42 N/kg muscle. This produced a microstrain of 192μe in bone around the BCI. Bloodflow results are shown in the figure. On average, flow decreased in controls by 12.6% and increased in experimentals by about 2%. Capillary filtration in experimentals was about 34.6% higher than controls after 60 minutes of TENS. Bone formation rate was 62.5% higher with TENS. Conclusion. In order to understand the role of fluid flows in bone physiology, we need to know the how and where of movement. These results suggest the part played by skeletal muscle in bone fluid movement cannot be ignored. As with many evolutionary adaptations, the muscle pump's hydrodynamic contribution to bone may be redundant and merely serve as a backup to percolation from poroelastic deformation. On the other hand, it may be crucial in disuse osteoporosis instigating conditions such as microgravity. The measured increases in capillary filtration and blood flow suggest that intravascular pressure which drives the former and resultant percolation has been increased by the muscle pump. It follows that fluid shear on cortical bone cells also increased. The challenge now is to obtain local flow measurements that would tell us how much

Repeated trauma to the radial head may be one of the causative factors in the genesis of osteochondritis dissecans of the capitellum. We measured the force, contact area and pressure across the radiocapitellar articulation of the elbow before and after radial shortening osteotomy in five fresh-frozen cadaver upper limbs with loads of 45, 90 and 135 N, respectively. Measurements were made on pressure-sensitive film placed in the radiocapitellar articulation with the forearm in the supinated, neutral and pronated positions before and after radial shortening. Radial shortening significantly reduced the mean force and contact area across the radiocapitellar articulation in all positions of the forearm.