General Orthopaedics
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Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Purpose
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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
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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
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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
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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.
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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.
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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.
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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.
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Repeated investigations into the function of a specific miRNA are infrequent and yield inconsistent results, possibly because of variable experimental conditions.
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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.
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Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Purpose
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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
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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
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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
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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.
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Department of Orthopedics, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan Province, People’s Republic of China
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Department of Orthopedics, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan Province, People’s Republic of China
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The pathogenesis of steroid-induced osteonecrosis of the femoral head (SONFH) remains unclear; however, emerging evidence suggests that mitochondrial injury plays a significant role.
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This review aims to elucidate the involvement of mitochondrial dysfunction in SONFH and explore potential therapeutic targets.
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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.
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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.
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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.
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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.
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Sport Traumatology and Biomechanics Unit, Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznań, Poznań, Poland
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Mixed reality refers to the integration of virtual reality into the real-world environment. This digital content can be interacted with in real time.
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The emergence of mixed reality technology has been made possible by the introduction of head-mounted displays, which are being utilized across multiple surgical specialties. In upper extremity surgery, mixed reality has widespread applications in trauma, corrective surgery, arthroplasty, arthroscopy, and oncology.
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Preoperatively, mixed reality allows for complex 3D planning.
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Intraoperatively, surgeons can access this 3D data in a sterile environment. While in its infant stages, mixed reality is likely to become a powerful tool for intraoperative guidance and navigation.
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Mixed reality can change the paradigm of communication, as it allows the sharing of visual data from the surgeon’s perspective, enabling remote assistance and participation.
Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Murcia, Spain
Harvard T.H. Chan School of Public Health, Boston, USA
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Purpose
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Different deep-learning models have been employed to aid in the diagnosis of musculoskeletal pathologies. The diagnosis of tendon pathologies could particularly benefit from applying these technologies. The objective of this study is to assess the performance of deep learning models in diagnosing tendon pathologies using various imaging modalities.
Methods
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A meta-analysis was conducted, with searches performed on MEDLINE/PubMed, SCOPUS, Cochrane Library, Lilacs, and SciELO. The QUADAS-2 tool was employed to assess the quality of the studies. Diagnostic measures, such as sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratios, area under the curve, and summary receiver operating characteristic, were included using a random-effects model. Heterogeneity and subgroup analyses were also conducted. All statistical analyses and plots were generated using the R software package. The PROSPERO ID is CRD42024506491.
Results
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Eleven deep-learning models from six articles were analyzed. In the random effects models, the sensitivity and specificity of the algorithms for detecting tendon conditions were 0.910 (95% CI: 0.865; 0.940) and 0.954 (0.909; 0.977). The PLR, NLR, lnDOR, and AUC estimates were found to be 37.075 (95%CI: 4.654; 69.496), 0.114 (95%CI: 0.056; 0.171), 5.160 (95% CI: 4.070; 6.250) with a (P < 0.001), and 96%, respectively.
Conclusion
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The deep-learning algorithms demonstrated a high level of accuracy level in detecting tendon anomalies. The overall robust performance suggests their potential application as a valuable complementary tool in diagnosing medical images.
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Purpose
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The aim of this systematic review and meta-analysis is to explore the effect of topical vancomycin powder (VP) in surgical site infection (SSI) prevention and adverse events after joint arthroplasty and to provide a specific theoretical basis for clinical treatment.
Methods
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The review process was conducted according to the PRISMA guidelines. Two independent researchers meticulously screened the literature based on predefined inclusion and exclusion criteria, evaluated the quality of the selected studies, and extracted relevant data. Data analysis was conducted using RevMan 5.4 software.
Results
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This meta-analysis included 24 studies encompassing a total of 34 811 patients. The pooled analysis showed that the topical administration of VP significantly reduced the incidence of SSI. Subgroup analyses by doses, type of joint (hip and knee), and type of surgery (primary and revision) confirmed that vancomycin consistently lowered SSI rates. Moreover, the incidence of SSI caused by gram-negative germs and gram-positive germs decreased following the use of VP, although the reduction was not significant for infections caused by MRSA. However, the use of VP was associated with a significant increase in sterile complications at the incision site and delayed incision healing.
Conclusion
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The topical application of VP is effective in reducing the incidence of infections following joint arthroplasty. Despite an increased risk of complications such as delayed healing of incisions, the pros and cons should be weighed in clinical decision-making. However, it should not be discarded due to side effects.
Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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Trauma Orthopaedic Research Copenhagen Hvidovre (TORCH), Department of Orthopaedic Surgery, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
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Advanced therapies are expected to play a crucial role in supporting repair after injury, halting the degeneration of musculoskeletal tissue to enable and promote physical activity.
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Despite advancements, the progress in developing advanced therapies in orthopaedics lags behind specialties like oncology, since innovative regenerative treatment strategies fall short of their expectations in musculoskeletal clinical trials.
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Researchers should focus on understanding the mechanism of action behind the investigated target before conducting clinical trials.
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Strategic research networks are needed that not only enhance scientific exchange among like-minded researchers but need to include early on commercial views, companies and venture perspectives, regulatory insights and reimbursement perspectives. Only in such collaborations essential roadblocks towards clinical trials and go-to-patients be overcome.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
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Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea
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National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Objective
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The aim of the study was to evaluate the efficacy and safety of teriparatide compared to other treatments for postmenopausal osteoporosis.
Methods
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A review of studies from 2000 to January 2023 analyzed randomized controlled trials on postmenopausal women treated with teriparatide (PTH 1–34), comparing it to placebo or other osteoporosis treatments. The analysis focused on bone mineral density (BMD), bone turnover markers, and clinical outcomes, employing Review Manager 5.4.1 and the RoB 2 tool for bias assessment.
Results
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Our analysis of 23 randomized controlled trials (RCTs) found that PTH (134) treatment significantly increased lumbar spine BMD (mean difference (MD) = 0.02, 95% CI: 0.01–0.03) and femoral neck BMD (MD = 0.01, 95% CI: 0.00–0.01). However, there were no significant changes in total hip and radial bone BMD among the 3536 and 2046 participants, respectively. We also found that PTH (1–34) increased P1NP in a larger cohort (n = 1415) when compared to osteocalcin (n = 206). Although the risk of adverse events increased (relative risk (RR) = 1.65, 95% CI: 1.32–2.07), the incidence of fractures decreased significantly (RR = 0.57, 95% CI: 0.45–0.072), with no significant difference observed in mortality rates between treatment and control groups.
Conclusion
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Teriparatide improves lumbar spine and femoral neck BMD in postmenopausal women. Particularly notable is the novel finding regarding its effect on radius BMD, an area less explored in previous research. Despite an uptick in adverse events, the marked decrease in fracture incidence confirms its clinical utility for high-risk osteoporosis patients, highlighting the necessity for ongoing investigations into its full skeletal effects.
