Sengkang General Hospital, Singapore
Joint first authors
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Joint first authors
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point to address, especially in a knee injection study, where the placebo effect is even greater as patients perceive that they are receiving a ‘regenerative medicine’ therapy. 68 This effect has been known to affect scores differently, and this is
Ripoll y De Prado Sports Clinic, Murcia-Madrid, FIFA Medical Centre of Excellence, Madrid, Spain
International Centre of Sports Traumatology of the Ave, Vila do Conde, Portugal
3Bs Research Group, I3Bs, Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Barco, Guimarães, Portugal
ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
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ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
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ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal
Orthopedic Department, University of Minho, Braga, Portugal
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ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, Barco, Guimarães, Portugal
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ICVS/3Bs, PT Government Associate Laboratory, Braga/Guimarães, Portugal
Orthopaedic Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, Barco, Guimarães, Portugal
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allografts remain in several countries. 44 , 57 , 58 There are high expectations of tissue engineering and regenerative medicine. Future perspectives include new, more effective, biomaterials, combined with augmentation by means of effective use of
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Thessaloniki, Greece
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Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Thessaloniki, Greece
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Department of Trauma and Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Thessaloniki, Greece
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Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Thessaloniki, Greece
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Purpose
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The main indication of bisphosphonates (BPs) is osteoporosis treatment. However, there is growing interest in the peri- and postoperative use of BPs to mitigate total hip arthroplasty (THA) aseptic loosening (AL) risk. This systematic review aimed to evaluate the implant survival and the AL rate in patients with elective THA receiving BPs compared to those that do not receive BPs. Secondary outcomes included the comparison of revision rate, postoperative complications, and patients’ functional scores.
Methods
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This systematic review was conducted under the PRISMA 2020 guidelines with a pre-registered PROSPERO protocol. Three engines and grey literature were searched up until May 2022. Randomized and nonrandomized controlled trials and comparative cohort studies assessing BP and control therapy impact on THA survival were included.
Results
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Twelve studies embraced the inclusion criteria. A total of 99 678 patients and 99 696 THAs were included; 10 025 patients received BPs (BP group), and 89 129 made up the control group. The overall revision and AL rates were lower in the BP group (2.17% and 1.85%) than in the control group (4.06% and 3.2%). Periprosthetic fracture (PPF) cases were higher in the BP group (0.24%) than in the control group (0.04%); however, the majority of PPF cases were derived from a single study. Further complication risk was similar between groups. Most studies reported comparable functional scores between groups.
Conclusion
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BP treatment after elective THA seems to reduce the overall revision and AL risk. Other complications’ risk and functional scores were similar between groups. Further high-quality studies are needed to validate the results due to the multifactorial AL pathogenesis.
Center of Orthopaedics and Regenerative Medicine (C.O.RE.) – Center of Interdisciplinary Research and Innovation (C.I.R.I.) – Aristotle University Thessaloniki, Balkan Center, Hellas, Greece
Hôpital de la Tour, Geneva, Switzerland
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Center of Orthopaedics and Regenerative Medicine (C.O.RE.) – Center of Interdisciplinary Research and Innovation (C.I.R.I.) – Aristotle University Thessaloniki, Balkan Center, Hellas, Greece
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Center of Orthopaedics and Regenerative Medicine (C.O.RE.) – Center of Interdisciplinary Research and Innovation (C.I.R.I.) – Aristotle University Thessaloniki, Balkan Center, Hellas, Greece
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Total hip arthroplasty (THA) in sickle cell disease (SCD) patients can be a challenging procedure.
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This systematic review evaluated the revision rate, functional outcomes and complications of THA in sicklers.
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A systematic search was conducted according to the PRISMA guidelines, using four search engines from inception to May 2019.
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Fifteen studies with 971 THAs were included. There were 437 cemented and 520 uncemented THAs.
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There were 164 revision THAs (16.8%); 52 uncemented and 105 cemented THAs.
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Forty-two infections were recorded; 16 infections for cemented and 23 for uncemented THAs.
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Fifty-seven cups, 26 stems, eight cup/stem with aseptic loosening that were more frequently cemented were reported. The 28 unspecified aseptic loosening cases were more frequently uncemented THAs.
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All studies demonstrated the functional improvement of patients.
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There were 109 medical complications (14.3%). Sickle cell crises (SCC) and transfusion reactions were most usually recorded.
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Forty-six intraoperative complications (4.7%) were reported; 18 femoral fractures, four acetabular and 18 femoral perforations. Seventeen femoral fractures occurred during uncemented THA.
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THA in SCD is still related to a high risk of complications. The outcomes in properly selected sicklers have been improved. Perioperative adequate hydration, warming, oxygen supply and transfusion protocols are mandated to prevent SCC and transfusion reactions. The surgeon must be prepared to deal with a high rate of intraoperative fractures and have different implant options readily available. No definite conclusion can be made regarding the best fixation mode. Cemented implants demonstrated a higher revision rate and uncemented implants a higher risk for intraoperative complications.
Cite this article: EFORT Open Rev 2020;5:180-188. DOI: 10.1302/2058-5241.5.190038
These authors contributed equally to this work
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Cell & Tissue Bank-Regenerative Medicine Centre, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
These authors contributed equally to this work
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Despite rapid medical technology development, various challenges exist in three- and four-part proximal humeral fracture (PHF) management. This condition has led to a notably increased use of the reverse total shoulder arthroplasty (RTSA); however, open reduction and internal fixation (ORIF) is still the most widely performed procedure. Thus, these two modalities are crucial and require further discussion. We aim to compare the outcomes of three- or four-part PHF surgeries using ORIF and RTSA based on direct/head-to-head comparative studies.
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We conducted a systematic review and meta-analysis based on the Cochrane handbook and PRISMA guidelines. We searched MEDLINE (PubMed), Embase (Ovid), and CENTRAL (Cochrane Library) from inception to October 2020. Our protocol was registered at PROSPERO (registration number CRD42020214681). We assessed the individual study risk of bias using ROB 2 and ROBINS-I tools, then appraised our evidence using the GRADE approach.
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Six head-to-head comparative studies were included, comprising one RCT and five retrospective case-control studies. We found that RTSA significantly improved forward flexion but was comparable to ORIF in abduction (p = 0.03 and p = 0.47, respectively) and more inferior in external rotation (p < 0.0001). Moreover, RTSA improved the overall Constant-Murley score, but the difference was not significant (p = 0.22). Interestingly, RTSA increased complications (by 42%) but reduced the revision surgery rates (by 63%) compared to ORIF (p = 0.04 and p = 0.02, respectively).
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RTSA is recommended to treat patients aged 65 years or older with a three- or four-part PHF. Compared to ORIF, RTSA resulted in better forward flexion and Constant-Murley score, equal abduction, less external rotation, increased complications but fewer revision surgeries.
Cite this article: EFORT Open Rev 2021;6:941-955. DOI: 10.1302/2058-5241.6.210049
Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece
Centre of Orthopaedics and Regenerative Medicine (CORE) – Centre of Interdisciplinary Research and Innovation (CIRI) – Aristotle University Thessaloniki, Greece
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Gennimatas General Hospital, Cholargos, Athens, Greece
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Abductor tendon lesions and insertional tendinopathy are the most common causes of lateral thigh pain. Gluteal tendon pathology is more prevalent in women and frequency increases with age.
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Chronic atraumatic tears result in altered lower limb biomechanics. The chief complaint is lateral thigh pain. Clinical examination should include evaluation of muscle strength, lumbar spine, hip and fascia lata pathology. The hip lag sign and 30-second single leg stance tests are useful in diagnosing abductor insufficiency.
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Magnetic resonance imaging (MRI) is the gold-standard investigation to identify abductor tendon tears and evaluate the extent of muscle fatty infiltration that has predictive value on the outcome of abductor repair.
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Abductor tendinosis treatment is mainly conservative, including non-steroidal anti-inflammatory medications, activity modification, local corticosteroid injections, plasma-rich protein, physical and radial shockwave therapy. The limited number of available high-quality studies on treatment outcomes and limited evidence between tendinosis and partial ruptures make it difficult to provide definite conclusions regarding the best management of gluteal tendinopathy.
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Surgical management is indicated in complete and partial gluteal tendon tears that are unresponsive to conservative treatment.
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There are various open and arthroscopic surgical procedures for direct repair of abductor tendon tears. There is limited evidence concerning surgical management outcomes. Prerequisites for effective tendon suturing are neurologic integrity and limited muscle fatty infiltration. Chronic irreparable tears with limited muscle atrophy and limited fatty infiltration can be augmented with grafts. Gluteus maximus or/vastus lateralis muscle transfers are salvage reconstruction procedures for the management of chronic end-stage abductor tears with significant tendon insufficiency or gluteal atrophy.
Cite this article: EFORT Open Rev 2020;5:464-476. DOI: 10.1302/2058-5241.5.190094
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, Greece
Trauma and Orthopaedics Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, Greece
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Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, Greece
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Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, Greece
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Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, Greece
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Background
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This comprehensive systematic review aims to assess the literature regarding the risk of postoperative complications in patients undergoing total joint arthroplasty (TJA) with concomitant thyroid dysfunction.
Methods
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Studies were identified by searching PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and ClinicalTrials.gov (end of search: May 2022).
Inclusion criteria
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Randomized control and case-control studies, cohort and observational clinical studies were included, which focused on postoperative complications and outcomes of patients undergoing TJA operations of major joints (knee, hip, ankle, elbow). All studies were assessed according to their level of evidence, the number and age of patients, and treatment complications.
Analysis
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Nine studies were included in this review that demonstrated a higher risk of postoperative anemia, perioperative blood loss, hemoglobin decrease, and transfusion rates in hypothyroid patients after TJA.
Results
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Hypothyroidism has been identified as a potential but modifiable risk factor for increased rates of deep venous thrombosis, acute kidney injury, pneumonia, and non-specified cardiac complications among hypothyroid patients who underwent TJA as well as increased rates of periprosthetic joint infection. No significant differences in the prosthesis-related mechanical complication rates have been calculated when comparing hypothyroid and euthyroid patients.
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Tendons connect muscles to bones, ensuring joint movement. With advanced age, tendons become more prone to degeneration followed by injuries. Tendon repair often requires lengthy periods of rehabilitation, especially in elderly patients. Existing medical and surgical treatments often fail to regain full tendon function.
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The development of novel treatment methods has been hampered due to limited understanding of basic tendon biology. Recently, it was discovered that tendons, similar to other mesenchymal tissues, contain tendon stem/progenitor cells (TSPCs) which possess the common stem cell properties.
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The current strategies for enhancing tendon repair consist mainly of applying stem cells, growth factors, natural and artificial biomaterials alone or in combination. In this review, we summarise the basic biology of tendon tissues and provide an update on the latest repair proposals for tendon tears.
Cite this article: EFORT Open Rev 2017;2:332-342. DOI: 10.1302/2058-5241.2.160075
Academic Unit of Bone Metabolism, University of Sheffield Medical School, Sheffield, UK
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Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
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Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
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Parkinson’s disease (PD) poses a significant challenge for the arthroplasty surgeon, owing to excessive muscle tone, higher fracture risk and poor bone quality. Several studies have reported high mortality, early failure and perioperative complications associated with hip fracture surgery in PD; however, no higher-level evidence exists regarding elective hip arthroplasty.
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The aim of our study was to perform a systematic review to evaluate the evidence basis and clinical outcomes pertaining to patients with underlying Parkinson’s disease undergoing elective total hip arthroplasty (THA).
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We searched MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials to identify studies evaluating the safety and clinical outcomes of THA in patients suffering from Parkinson’s. Our review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
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Ten studies encompassing 49,730 patients were included in our systematic review. Qualitative synthesis demonstrated comparable results between PD patients and controls with respect to one-year mortality and surgical site infections. PD patients experienced more medical complications, had a longer hospital stay and worse long-term implant survival. Some studies also reported a higher rate of dislocation, periprosthetic fractures and aseptic loosening.
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Decisions about the optimal articulation, the utilization of cemented components, dual-mobility cups or constrained liners were not uniform among included studies.
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THA in patients with Parkinson’s disease can offer significant functional gains and pain relief. Surgical considerations pertain to the approach and ways to address instability, whereas emphasis should be placed on appropriate counselling and exploring whether potential improvement of life quality outweighs the risks.
Cite this article: EFORT Open Rev 2020;5:856-865. DOI: 10.1302/2058-5241.5.200034
Surgery Department, Hôpital Maisonneuve-Rosemont, Montreal University, Montreal, Québec, Canada
Clinique orthopédique Duval, 1487 Boul des Laurentides, Laval
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Bordeaux Arthroplasty Research Institute - Clinique du Sport Bordeaux-Mérignac 04-06 rue Georges Negrevergne, Mérignac, France
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Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
Clinical Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, University of Basel, Basel, Switzerland
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Department of Surgery, University of California, San Francisco, California, USA
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Although hip and knee joint replacements provide excellent clinical results, many patients still do not report the sensation and function of a natural joint. The perception that the joint is artificial may result from the anatomical modifications imposed by the surgical technique and the implant design. Moreover, the joint replacement material may not function similarly to human tissues.
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To restore native joint kinematics, function, and perception, three key elements play a role: (i) joint morphology (articular surface geometry, bony anatomy, etc.), (ii) lower limb anatomy (alignment, joint orientation), and (iii) soft tissue laxity/tension.
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To provide a ‘forgotten joint’ to most patients, it is becoming clear that personalizing joint replacement is the key solution. Performing a personalized joint replacement starts with patient selection and preoperative optimization, followed by using a surgical technique and implant design aimed at restoring the patient’s native anatomy, creating optimal implant-to-bone stress transfer, restoring the joint’s native articular range of motion without imposed limitations, macro- and micro-stability of the soft tissues, and a bearing whose wear resistance provides lifetime survivorship with unrestricted activities. In addition, the whole perioperative experience should follow enhanced recovery after surgery principles, favoring a rapid and complication-free recovery.
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As a new concept, some confusion may arise when applying these personalized surgery principles. Therefore, the Personalized Arthroplasty Society was created to help structure and accelerate the adoption of this paradigm change. This statement from the Society on personalized arthroplasty will serve as a reference that will evolve with time.
