Background. Innovative developments for total knee arthroplasty enhanced anatomical design and fixation in order to decrease particle-induced aseptic implant loosening. As hypersensitivity reactions to metallic implant materials have been recognized to possibly cause premature implant failure, ceramic materials might constitute a proper alternative solution. The aim of this prospective short-term study was the initial comparison of a completely metal-free ceramic with a geometrically identical metallic arthroplasty over a one-year follow-up period. Methods. Eighty patients requiring primary total knee arthroplasty were enrolled within this open-label prospective comparative study. Patients were randomly divided among two groups to either undergo implantation of a completely metal-free system using a composite matrix material containing aluminum oxide (Al2O3) and zirconium oxide (ZrO2) (n=40), or an anatomically identical metallic knee system made of a cobalt-chromium alloy (Co28Cr6Mo) (n=40) produced by the same manufacturer. Clinical assessment was performed preoperatively, and during follow-up at three and twelve months using the Knee Society Score, Oxford Knee Score and EQ-5D-VAS. For radiological evaluation, standard preoperative and postoperative standardized radiographs were taken at mentioned follow-up visits. Results. Demographical data were not significantly different among our two study groups, and no patient has been lost to follow-up. The postoperative clinical scores improved significantly at three and twelve month follow-ups, but did not differ statistically among groups. The radiologically evaluated mean postoperative mechanical and anatomical axes showed proper alignment within both groups at all times. Notably, no revision surgery had to be performed, and no complications were recorded whatsoever. Conclusion. To our knowledge, this is the first study comparing a total ceramic metal-free knee system with a geometrically identical metallic TKR. Within the short-term follow-up of minimally one year, no significant differences could be demonstrated clinically or radiologically, therefore making this ceramic knee system a suitable option for patients with a known hypersensitivity to metal. Mid-term and long-term studies will be required to demonstrate the overall efficiency of this TKR to potentially expand its medical indication

Total knee arthroplasty is a well established treatment for degenerative joint disease with good clinical results. However, complications may occur due to a biological response to polyethylene wear particles, leading to osteolysis and aseptic loosening, as well as local and systemic hypersensitivity reactions triggered by metal ions and particles such as chromium, cobalt and molybdenum. Moreover, there is an increasing demand on the performance of these implants, as this treatment is also performed in heavier, younger and middle-aged adults who have a significant physical activity and higher life expectancy. The purpose of the following study was to compare the wear characteristics and performance of a zirconium nitride (ZrN) coated knee implant, designed for patients with metal ion hypersensitivity, against the clinically established cobalt-chromium (CoCr) version under a high demanding activities wear simulation. Medium size AS Columbus® DD (Aesculap AG, Tuttlingen, Germany) femoral and tibial components with a ZrN surface were tested in comparison with the cobalt-chromium version Columbus® DD. For both groups, ultra-high-molecular weight polyethylene (UHMWPE) gliding surfaces (size T3, high 10 mm) were used. Wear simulation was performed on a load controlled 4 station knee wear simulator (EndoLab GmbH, Thansau, Germany) capable of reproducing loads and movement of daily activities measured in vivo (Bergmann et al, 2014) on 8 patients and normalized to a patient weight of 100 kg (Schwiesau et al, 2014). The load profiles were applied for 5 million cycles in a combination of 40% stairs up, 40% stairs down, 10% level walking, 8% chair raising and 2% deep squatting. Test serum was changed every 0.5 million cycles and all the components were cleaned and analyzed according to ISO 14243-2:2009(E). The gliding surfaces were evaluated for gravimetric wear and wear patterns, femur components analyzed for scratches and the test medium analyzed for metal ion concentration (cobalt, chromium, molybdenum and zirconium) using ICP-MS according to ISO 17294-2. The present study showed a wear rate reduction for the ZrN group (1.01 ± 0.29 mg/million) in comparison with the CoCr group (2.40 ± 1.18 mg/million cycles). The articulation surface of the ZrN coated femurs remained polished after the testing period, whereas the uncoated femurs showed wear scratches. Furthermore, the metal ion release from the ZrN coated implants was reduced orders of magnitude in comparison with the CoCr implants through the entire test. These results demonstrate the efficiency of ZrN coated knee implants to reduce wear as well as to prevent metal ion release in the knee joint

A rat model of lumbar root constriction with an additional sympathectomy in some animals was used to assess whether the sympathetic nerves influenced radicular pain. Behavioural tests were undertaken before and after the operation. On the 28th post-operative day, both dorsal root ganglia and the spinal roots of L4 and L5 were removed, frozen and sectioned on a cryostat (8 μm to 10 μm). Immunostaining was then performed with antibodies to tyrosine hydroxylase (TH) according to the Avidin Biotin Complex method. In order to quantify the presence of sympathetic nerve fibres, we counted TH-immunoreactive fibres in the dorsal root ganglia using a light microscope equipped with a micrometer graticule (10 x 10 squares, 500 mm x 500 mm). We counted the squares of the graticule which contained TH-immunoreactive fibres for each of five randomly-selected sections of the dorsal root ganglia. The root constriction group showed mechanical allodynia and thermal hyperalgesia. In this group, TH-immunoreactive fibres were abundant in the ipsilateral dorsal root ganglia at L5 and L4 compared with the opposite side. In the sympathectomy group, mechanical hypersensitivity was attenuated significantly. We consider that the sympathetic nervous system plays an important role in the generation of radicular pain

Introduction. Today TKR is considered one of the most successful operative procedures in orthopedic surgery. Nevertheless, failure rates of 2 – 10% depending on the length of the study and the design are still reported. This provides evidence for further development in knee arthroplasty. Particularly the oxide ceramics used now in THA show major advantages due to their excellent tribological properties, their significantly reduced third-body wear as well as their high corrosion resistance. A further advantage of ceramic materials is their potential use in patients with metal allergy. Metallic wear induces immunological reactions resulting in hypersensitivity, pain, osteolysis and implant loosening. The purpose of our study was to examine the safety of the tibial component of a novel all-ceramic TKR. Materials and Methods. We tested the tibial components of the primary knee implant BPK-S Integration Ceramic. Both the tibial and the femoral component consist of BIOLOX®delta ceramic The standards ISO 14879-1 and ASTM F1800-07 describe the test set-up for the experimental fatigue strength testing of tibial components from knee implants. We conducted the testing with a significantly increased maximum load of 5,300 N (900 N are required). A final burst strength test was carried out after the fatigue load testing in the same embedding and with the same test set-up. Results. No specimen failed during fatigue load testing. The subsequent post-fatigue burst strength testing showed a maximum strength against fracture of at least 9.7 kN for size 3 and at least 12.1 kN for size 6. Discussion. The good results of the strength testing of the tibial component of the BPK-S Integration Ceramic tibial plateau supported the good initial clinical outcome without any implant specific complications of this knee design. Further clinical studies have to show if this design fulfills the high expectations over long periods of time

Introduction. The management of adolescent hallux valgus (AHV) remains controversial, with reservations about both conservative and surgical treatments. Non-operative management has a limited role in preventing progression. Surgical correction of AHV has, amongst other concerns, been associated with a high prevalence of recurrence of deformity after surgery. We conducted a systematic review to assess clinical and radiological outcomes following surgery for AHV. Methods & Materials. A comprehensive literature search was performed in the Cochrane Library, CINAHL, EMBASE, Google Scholar, and Pubmed. The study was performed in accordance with the recommendations of the PRISMA guidelines. Demographic data, radiographic parameters, and results of validated clinical scoring system were analysed. Results. Nine contemporary studies reporting on 201 osteotomies in 140 patients were included. The female to male ratio was 10:1. Mean age at operation was 14.5 years (10.5–22). Mean follow-up was 41.6 months (12–134). The mean post-operative AOFAS score was 85.8 (sd ±7.38). The mean AOFAS patient satisfaction showed that 86% (sd ± 11.27) of patients satisfied or very satisfied with their outcome. On the DuPont BRS, 90% rated their outcome as good or excellent. There was a statistically significant improvement in the IMA (p=0.0003), HVA (p<0.0001), and DMAA (p=0.019). The main complication was persistent pain (12%); others included infection (2%), scar hypersensitivity (4.5%), and non-union, metatarsalgia, and CRPS (each at 0.5%), and no reports of metatarsal head AVN. Conclusion. Based on the most current published evidence, surgery for AHV shows excellent clinical and radiological outcomes, with high patient satisfaction. The rates of recurrence and other complications are lower than the historically reported figures. There is, however, a need for high level, multi-centre collaborative studies with prospective data to establish the long-term outcomes and optimal surgical procedure(s)

Hip resurfacing procedures have gained increasing popularity for younger, higher demand patients with degenerative hip pathologies. However, with concerns regarding revision rates and possible adverse metal hypersensitivity reactions with metal-on-metal articulations, some authors have questioned the hypothesised superiority of hip resurfacing over total hip arthroplasty. The purpose of this meta-analysis was to compare the clinical and radiological outcomes and complication rates of these two procedures. A systematic review was undertaken of all published and unpublished research up to January 2010. The primary search was of the databases Medline, CINAHL, AMED and EMBASE, searched via Ovid using MeSH terms and Boolian operators ‘hip’ AND ‘replacement’ OR ‘arthroplasty’ AND ‘resurfacing’. A secondary search of unpublished literature was conducted using the databases SIGLE, the National Technical Information Service, the National Research Register (UK), the British Library's Integrated Catalogue and Current Controlled Trials databases using the same search terms as the primary search. All included studies were critically appraised with the CASP appraisal tool. In total, 46 studies were identified from 1124 citations. These included 3799 hip resurfacings and 3282 total hip arthroplasties. On meta-analysis, functional outcomes for subjects following hip resurfacing were better than or the same as subjects with a total hip arthroplasty, with significantly higher WOMAC score (Mean Difference (MD)=−2.41; 95% Confidence Interval (CI): −3.88, −0.94; p=0.001), and significantly better Harris Hip Score (range of motion component) (MD=−0.05; 95% CI: (−0.07, −0.03; p<0.0001) and overall Harris Hip Score (MD=2.51; 95% CI: 1.24, 3.77; p=0.0001) in the hip resurfacing compared to total hip arthroplasty cohorts. However, there were significantly greater incidences of heterotopic ossification (Risk Ratio (RR)=1.62; 95% CI: 1.23, 2.14; p=0.006), aseptic loosening (RR=3.07; 95% CI:1.11, 8.50;p=0.03) and revision surgery (RR=1.72; 95% CI: 1.20, 2.45; p=0.003) with hip resurfacing compared to total hip arthroplasty. The evidence-base presented with a number of methodological inadequacies such as the limited use of power calculations and poor or absent blinding of both patients and assessors, potentially giving rise to assessor bias. In respect to these factors, the current evidence-base, whilst substantial in its size, may be questioned in respect to its quality in determining superiority of hip resurfacing over total hip arthroplasty

Objectives

Osteoporosis has become an increasing concern for older people as it may potentially lead to osteoporotic fractures. This study is designed to assess the efficacy and safety of ten therapies for post-menopausal women using network meta-analysis.

Objectives

Thermal stability is a key property in determining the suitability of an antibiotic agent for local application in the treatment of orthopaedic infections. Despite the fact that long-term therapy is a stated goal of novel local delivery carriers, data describing thermal stability over a long period are scarce, and studies that avoid interference from specific carrier materials are absent from the orthopaedic literature.

Objectives

The effects of disease progression and common tendinopathy treatments on the tissue characteristics of human rotator cuff tendons have not previously been evaluated in detail owing to a lack of suitable sampling techniques. This study evaluated the structural characteristics of torn human supraspinatus tendons across the full disease spectrum, and the short-term effects of subacromial corticosteroid injections (SCIs) and subacromial decompression (SAD) surgery on these structural characteristics.

We have previously shown that joint distraction and movement with a hinged external fixation device for 12 weeks was useful for repairing a large articular cartilage defect in a rabbit model. We have now investigated the results after six months and one year. The device was applied to 16 rabbits who underwent resection of the articular cartilage and subchondral bone from the entire tibial plateau. In group A (nine rabbits) the device was applied for six months. In group B (seven rabbits) it was in place for six months, after which it was removed and the animals were allowed to move freely for an additional six months. The cartilage remained sound in all rabbits. The areas of type II collagen-positive staining and repaired soft tissue were larger in group B than in group A. These findings provide evidence of long-term persistence of repaired cartilage with this technique and that weight-bearing has a positive effect on the quality of the cartilage.

The effects of the method of fixation and interface conditions on the biomechanics of the femoral component of the Birmingham hip resurfacing arthroplasty were examined using a highly detailed three-dimensional computer model of the hip. Stresses and strains in the proximal femur were compared for the natural femur and for the femur resurfaced with the Birmingham hip resurfacing. A comparison of cemented versus uncemented fixation showed no advantage of either with regard to bone loading. When the Birmingham hip resurfacing femoral component was fixed to bone, proximal femoral stresses and strains were non-physiological. Bone resorption was predicted in the inferomedial and superolateral bone within the Birmingham hip resurfacing shell. Resorption was limited to the superolateral region when the stem was not fixed. The increased bone strain observed adjacent to the distal stem should stimulate an increase in bone density at that location. The remodelling of bone seen during revision of failed Birmingham hip resurfacing implants appears to be consistent with the predictions of our finite element analysis.

Human bone-marrow mesenchymal stem cells have an important role in the repair of musculoskeletal tissues by migrating from the bone marrow into the injured site and undergoing differentiation. We investigated the use of autologous human serum as a substitute for fetal bovine serum in the ex vivo expansion medium to avoid the transmission of dangerous transfectants during clinical reconstruction procedures.

Autologous human serum was as effective in stimulating growth of bone-marrow stem cells as fetal bovine serum. Furthermore, medium supplemented with autologous human serum was more effective in promoting motility than medium with fetal bovine serum in all cases. Addition of B-fibroblast growth factor to medium with human serum stimulated growth, but not motility. Our results suggest that autologous human serum may provide sufficient ex vivo expansion of human bone-marrow mesenchymal stem cells possessing multidifferentiation potential and may be better than fetal bovine serum in preserving high motility.