General Orthopaedics
You are looking at 1 - 10 of 132 items
Search for other papers by Maximilian M Menger in
Google Scholar
PubMed
Search for other papers by Tina Histing in
Google Scholar
PubMed
Search for other papers by Matthias W Laschke in
Google Scholar
PubMed
Search for other papers by Sabrina Ehnert in
Google Scholar
PubMed
Medical Faculty of Mannheim, University of Heidelberg,
Search for other papers by Tim Viergutz in
Google Scholar
PubMed
Medical Faculty of Mannheim, University of Heidelberg,
Search for other papers by Johann Fontana in
Google Scholar
PubMed
-
Trauma induced by surgery stimulates a neuroendocrine stress response, substantially increasing cortisol levels in the post-surgical setting. This has substantial effects on metabolism, water and electrolyte balance as well as on the cardiovascular, nervous and immune systems.
-
While there are valid data on cortisol level courses in a variety of specific pathologies, such as septic shock, acute respiratory distress syndrome, bacterial meningitis, cardiac arrest, community-acquired pneumonia and influenza, there is a persisting lack of data on the cortisol stress response after musculoskeletal surgery.
-
The present review provides an overview of the current state of research regarding trauma-induced cortisol response after musculoskeletal interventions, including both elective orthopedic surgery and trauma surgery.
-
Trauma induced by musculoskeletal surgery triggers a cortisol response, which varies significantly depending on the type of surgery and its invasiveness. Notably, elective orthopedic procedures demonstrate a smaller range of cortisol levels compared to musculoskeletal trauma and surgery.
-
In the future, high-quality prospective trials need to analyze the factors that may modulate the adequate adrenal response to stress, such as preoperative long-term treatments with glucocorticoids, as well as the potential impact of low cortisol levels and perioperative cortisol substitution therapy on pain management, blood requirements, catecholamine dependency, delirium and mortality after musculoskeletal surgery.
Search for other papers by Lulu Yin in
Google Scholar
PubMed
Search for other papers by Xin Xu in
Google Scholar
PubMed
Search for other papers by Ruiyan Wang in
Google Scholar
PubMed
Search for other papers by Feifei Li in
Google Scholar
PubMed
Search for other papers by Yushan Wang in
Google Scholar
PubMed
Shanghai Shangti Orthopaedic Hospital,
Search for other papers by Lin Wang in
Google Scholar
PubMed
Purpose
-
This systematic review and meta-analysis investigated validity and test-retest reliability of inertial measurement units (IMUs) in gait metrics, static balance and functional mobility performance in community-dwelling older adults.
Methods
-
Spatiotemporal/biomechanical outcomes were meta-analyzed using intraclass correlation coefficients (ICCs) or Pearson correlation coefficients (r) for validity and reliability, respectively.
Results
-
In our systematic review of 56 articles and meta-analysis of 38 articles, the included studies varied in quality from low-to-moderate. During validity analysis, IMU-derived metrics, including walking speed, cadence, step/stride time, step time variability, step/stride length and duration of sit-to-stand (STS) test/timed up, and go test (TUGT) exhibited excellent (ICCs) or good-to-excellent (r values) agreement with gold standards. In terms of reliability, excellent test-retest consistency was found for walking speed, cadence, step/stride time, stance/swing time, step/stride length during gait, individual STS duration, TUGT duration and walking speed during the 6-min walk test.
Conclusions
-
Due to consistently high levels of validity and reliability, the present study supported the use of IMUs for measuring gait spatiotemporal outcomes. However, caution was advised when applying spatiotemporal variability and symmetry metrics. In addition, characterized by moderate-to-good validity and reliability, current review provides evidence of a neutral nature regarding the utilization of IMUs for static balance and functional mobility performance.
Department of Surgery, School of Medicine, Universidad Complutense de Madrid,
Search for other papers by Pablo Sanz-Ruiz in
Google Scholar
PubMed
Orthopaedic Surgery and Traumatology Department, Hospital Clínic de Barcelona,
Search for other papers by José Ramón Caeiro-Rey in
Google Scholar
PubMed
Department of Surgery, School of Medicine, Universidad de Barcelona,
Search for other papers by Juan Carlos Martínez-Pastor in
Google Scholar
PubMed
Search for other papers by José Luis Martín-Alguacil in
Google Scholar
PubMed
Search for other papers by Antonio Murcia-Asensio in
Google Scholar
PubMed
Search for other papers by Jesús Moreta in
Google Scholar
PubMed
-
Wounds in orthopaedic surgery differ from wounds in other surgical fields in various ways.
-
Tissues that are highly affected due to the trauma itself, the presence of an orthopaedic implant and the performance of prosthetic surgery in patients with many comorbidities make these wounds need special consideration.
-
Complications of the surgical wound in orthopaedic surgery are not unusual, being the main cause of medical care and readmission in the first 90 days.
-
There is no consensus on the best way to perform closure in orthopaedic surgery. The national ‘Adequate Wound Management in Orthopaedic Surgery’ survey has shown interindividual variability in wound closure and soft tissue management in orthopaedic surgery at the local level.
-
This consensus document, generated by a group of experts in soft tissue management in orthopaedic surgery, proposes recommendations based on evidence (using the GRADE methodology) to promote best practices in this field.
-
This document considers recommendations for surgical wound closure, dressing management and haemostasis. In addition, some of the 32 questions in the national survey, plus others relevant to the subject, were taken as a starting point for developing the contents.
King’s College London Hospital,
Ludwig Boltzmann Institute of Traumatology,
Search for other papers by Thomas Nau in
Google Scholar
PubMed
Search for other papers by Samira Cutts in
Google Scholar
PubMed
Search for other papers by Nerissa Naidoo in
Google Scholar
PubMed
Purpose
-
Evolving evidence demonstrates the role of epigenetics in the pathogenesis of osteoarthritis (OA), whereas in terms of mechanism, DNA methylation has received the highest attention thus far. This systematic review summarizes the current knowledge of DNA methylation and its influence on the pathogenesis of OA.
Methods
-
A protocol in alignment with the PRISMA guidelines was employed to systematically review eight bibliographic databases between 1 January 2015 and 31 January 2021, to identify associations between DNA methylation and articular chondrocytes in OA.
Results
-
We identified 23 gene-specific studies and 28 genome-wide methylation analyses. Gene-specific studies focused on pro-inflammatory markers in OA, demonstrating that DNA hypomethylation in the promoter region results in overexpression and hypermethylation is linked to gene silencing. Others reported on the association between OA risk genes and DNA methylation. Genome-wide methylation studies reported on differentially methylated regions (DMRs) comparing OA and non-OA chondrocytes. DMRs were seen in hip OA and knee OA chondrocytes.
Conclusion
-
The current body of literature demonstrates the potential and crucial role of DNA methylation in the pathogenesis and progression of OA. This knowledge contributes to the understanding of the pathomechanisms behind OA at gene-specific and genome-wide levels. The observed differences in DNA methylation between healthy and diseased tissues indicate the occurrence of changes in DNA methylation. Based on this, future research in this field that explores the characteristics of potentially reversible changes in DNA methylation may lead to opportunities for causative treatment options for OA.
Department of Orthopaedic Surgery, RWTH University Aachen,
Search for other papers by Khaled Hamed Salem in
Google Scholar
PubMed
Search for other papers by Alyaa Diaa Elmoghazy in
Google Scholar
PubMed
-
Alkaptonuria is an extremely rare disorder of tyrosine metabolism caused by an autosomal recessive enzymatic deficiency of homogentisic acid (HGA) oxidase, causing its accumulation in collagenous structures, especially in hyaline cartilage.
-
It is characterized by a triad of homogentisic aciduria, bluish-black discoloration of connective tissues (ochronosis) and arthropathy of the spine and large weight-bearing joints.
-
Several clinical manifestations were described including coronary and valvular calcification, aortic stenosis, limited chest expansion, and renal, urethral and prostate calculi as well as ocular and cutaneous pigmentation.
-
Skeletal affection usually presents as spondylotic changes of the spine. The knee is the most common peripheral joint to be involved. Enthesopathy or tendon ruptures may occur, and reduced bone density is not unusual.
-
A low-protein diet and ascorbic acid may reduce HGA levels. Nitisinone can safely and effectively reduce HGA production and urinary excretion.
-
In severe ochronotic arthropathy, joint arthroplasty can offer reliable pain relief and excellent functional outcomes. Cementless fixation is successful in young patients.
Search for other papers by Pierre Hoffmeyer in
Google Scholar
PubMed
Search for other papers by Chun-Ching Chen in
Google Scholar
PubMed
Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Search for other papers by Yu-Pin Chen, in
Google Scholar
PubMed
Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Search for other papers by Yi-Jie Kuo in
Google Scholar
PubMed
Search for other papers by Yu-Cheng Liu in
Google Scholar
PubMed
Search for other papers by Shu-Wei Huang in
Google Scholar
PubMed
Purpose
-
Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty, resulting in high morbidity and mortality. The neutrophil-to-lymphocyte ratio (NLR) and albumin-to-globulin ratio (AGR) are novel diagnostic markers for PJI; however, their diagnostic value remains inconsistent.
Methods
-
This meta-analysis was conducted using the PubMed, Embase, and MEDLINE databases to determine the diagnostic accuracy of NLR and AGR for PJI in the knee or hip. Data extraction and quality assessment were independently completed by two reviewers. The pooled sensitivity and specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic curve (sROC), and area under the sROC curve (AUC) were assessed using the univariate meta-analysis framework.
Results
-
Nineteen eligible studies were included in the quantitative analysis. The pooled sensitivity and specificity of NLR for the diagnosis of PJI were 0.73 (95% CI: 0.68–0.77) and 0.72 (95% CI: 0.66–0.77), respectively. Its pooled DOR was 6.89 (95% CI: 5.03–9.43), and AUC was 0.79 (95% CI: 0.75–0.82). The pooled sensitivity and specificity of AGR for the diagnosis of PJI were 0.80 (95% CI: 0.70–0.88) and 0.83 (95% CI: 0.79–0.87), respectively. Its DOR was 17.69 (95% CI: 10.76–29.07), and AUC was 0.88 (95% CI: 0.85–0.91).
Conclusion
-
NLR and AGR can be individually used as reliable serum biomarkers for the detection of PJI. Future research is warranted to determine the diagnostic value of these markers in combination with C-reactive protein levels and erythrocyte sedimentation rates to improve diagnostic accuracy for PJI in clinical practice.
Search for other papers by Chen Xie in
Google Scholar
PubMed
Search for other papers by Xiao Liu in
Google Scholar
PubMed
Search for other papers by Wenbao Li in
Google Scholar
PubMed
Search for other papers by Zhaozhe Yao in
Google Scholar
PubMed
Search for other papers by Hongyue Men in
Google Scholar
PubMed
Search for other papers by Zongyu Li in
Google Scholar
PubMed
-
Fibrodysplasia ossificans progressiva and progressive osseous heteroplasia are genetic forms of heterotopic ossification (HO). Fibrodysplasia ossificans progressiva is caused by ACVR1 gene mutations, while progressive osseous heteroplasia is caused by GNAS gene mutations.
-
Nongenetic HO typically occurs after trauma or surgery, with an occurrence rate of 20–60%. It can also be observed in conditions such as diffuse idiopathic skeletal hyperostosis, spinal ligament ossification, ankylosing spondylitis, and skeletal fluorosis. The exact cause of nongenetic HO is not entirely clear.
-
More than 100 types of miRNAs have been identified as being linked to the development of HO. Some miRNAs are promising potential biomarkers for traumatic HO and ossification of the posterior longitudinal ligament. These findings further emphasize the significant role miRNAs play in the pathogenesis and progression of bone disorders.
-
Repeated investigations into the function of a specific miRNA are infrequent and yield inconsistent results, possibly because of variable experimental conditions.
-
It is hypothesized that miRNAs can enhance osteogenesis for the management of fractures and bone defects. However, further research is required to validate this hypothesis.
Search for other papers by Simone Orazi in
Google Scholar
PubMed
Search for other papers by Angelo Boffa in
Google Scholar
PubMed
Search for other papers by Manuela Salerno in
Google Scholar
PubMed
Search for other papers by Lucia Angelelli in
Google Scholar
PubMed
Search for other papers by Stefano Zaffagnini in
Google Scholar
PubMed
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
Search for other papers by Giuseppe Filardo in
Google Scholar
PubMed
Purpose
-
The association of adipose tissue-derived injectable products with platelet-rich plasma (PRP) has been promoted for osteoarthritis (OA) treatment. The aim of this study was to investigate the preclinical and clinical evidence supporting the potential of this combined approach to treat OA.
Methods
-
A systematic review was performed in January 2024 on five databases (PubMed, Embase, Scopus, Cochrane, and Web-of-Science) to identify preclinical in vivo and clinical studies. Safety, OA biomarker changes, and outcomes in terms of clinical and imaging results were analyzed. The quality of studies was assessed with the SYRCLE’s tool for preclinical studies and the Downs and Black checklist for clinical studies.
Results
-
Ten preclinical studies (223 animals) and 14 clinical studies (594 patients) were included. Preclinical results documented improvements at the cartilage histological and immunohistochemical evaluation and at the biomarkers level. Clinical studies confirmed the procedure’s safety, and the case series suggested satisfactory results in different joints in terms of symptoms and function improvement, with positive findings at the biomarker level. However, the randomized controlled trials did not document any clinical benefit, nor any changes in the imaging analysis. A large heterogeneity and overall poor quality were documented in both preclinical and clinical studies.
Conclusions
-
There is an increasing interest in the use of adipose tissue-derived injectable products associated with PRP for the treatment of OA joints, with preclinical studies showing promising results with this combined approach. However, clinical studies did not confirm the benefits offered by PRP augmentation to adipose tissue-derived injectable products in patients affected by OA.
Search for other papers by Yidan Yang in
Google Scholar
PubMed
Search for other papers by Yi Jian in
Google Scholar
PubMed
Department of Orthopedics, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan Province, People’s Republic of China
Search for other papers by Youwen Liu in
Google Scholar
PubMed
Search for other papers by Maoxiao Ma in
Google Scholar
PubMed
Department of Orthopedics, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan Province, People’s Republic of China
Search for other papers by Jiayi Guo in
Google Scholar
PubMed
Search for other papers by Bin Xu in
Google Scholar
PubMed
Search for other papers by Chen Yue in
Google Scholar
PubMed
-
The pathogenesis of steroid-induced osteonecrosis of the femoral head (SONFH) remains unclear; however, emerging evidence suggests that mitochondrial injury plays a significant role.
-
This review aims to elucidate the involvement of mitochondrial dysfunction in SONFH and explore potential therapeutic targets.
-
A comprehensive literature search was conducted in PubMed, Web of Science, and Elsevier ScienceDirect, focusing on mitochondrial homeostasis, including mitophagy, mitochondrial biogenesis, mitochondrial dynamics, and oxidative stress in SONFH. Ultimately, we included and analyzed a total of 16 studies.
-
Glucocorticoids initially promote but later inhibit mitochondrial biogenesis in osteoblasts, leading to excessive ROS production and mitochondrial dysfunction. This dysfunction impairs osteoblast survival and bone formation, contributing to SONFH progression.
-
Key proteins such as mitochondrial transcription factor A (TFAM) and peroxisome proliferator-activated receptor γ coactivator 1-α (PGC1α) are potential therapeutic targets for promoting mitochondrial biogenesis and reducing ROS-induced damage.
-
Enhancing mitochondrial function and reducing oxidative stress in osteoblasts may prevent or slow the progression of SONFH. Future research should focus on developing these strategies.
