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Tobias Winkler Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
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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Sven Geissler 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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Tazio Maleitzke Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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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Carsten Perka Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany

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Georg N Duda Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
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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Alexander Hildebrandt Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany

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. Today, regenerative therapy approaches – although initially introduced in orthopaedics – lag today behind other medical fields such as oncology. In 2024, 283 U.S. Food and Drug Administration (FDA)-approved and 207 European Medicines Agency (EMA

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Fan Wu Experimental Surgery and Regenerative Medicine, Department of Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany

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Michael Nerlich Department of Trauma Surgery, University Regensburg Medical Center, Regensburg, Germany

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Denitsa Docheva Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Center, Regensburg, Germany and Department of Medical Biology, Medical University-Plovdiv, Plovdiv, Bulgaria

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elucidated Kohler at al 30 Bi et al 31 Perivascular cell Pericyte Tendon mesenchymal stem cell (TMSC) Vessel, paratenon, epitenon, tendon sheets Regulation of stem cells; regeneration of various tissues; immunomodulation Tempfer et al

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Hélder Pereira Orthopedic Department of Póvoa de Varzim - Vila do Conde Hospital Centre, Vila do Conde, Portugal
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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Ibrahim Fatih Cengiz 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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Sérgio Gomes International Centre of Sports Traumatology of the Ave, Vila do Conde, Portugal

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João Espregueira-Mendes 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
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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Pedro L. Ripoll Ripoll y De Prado Sports Clinic, Murcia-Madrid, FIFA Medical Centre of Excellence, Madrid, Spain

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Joan C. Monllau Orthopaedic Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain

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Rui L. Reis 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
The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, Barco, Guimarães, Portugal

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J. Miguel Oliveira 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
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

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Ilse Degreef Institute for Orthopedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium

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Kira Vande Voorde Institute for Orthopedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium

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Maarten Van Nuffel Institute for Orthopedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium

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://doi.org/10.1177/1753193420903624 ) 8. Radhamony NG Nair RR Sreenivasan S Walkay S Soni A & Kakkar R . Residual deformity versus recurrence following Dupuytren’s palmar fasciectomy-a long term follow-up of 142 cases . Annals of Medicine and

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Mara Meyer Günderoth Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany

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Alexandra Bannach-Brown Berlin Institute of Health at Charité – Universitätsmedizin Berlin, QUEST Center for Responsible Research, Berlin, Germany

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Tobias Winkler Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany

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Johannes Keller Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

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Robert Karl Zahn Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany

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Tazio Maleitzke Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
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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collagen and proteoglycan in cartilage tissue, CT exerts a regenerative effect on bone and cartilage in arthritic joints, which is why it has been discussed as a treatment for RA and OA therapy ( 19 , 20 , 21 ). There is in vivo evidence for an

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Shankar Aissvarya Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia

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King-Hwa Ling Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Genetics & Regenerative Medicine Research Group, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor, Malaysia

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Manohar Arumugam Department of Orthopaedics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
School of Medicine, Faculty of Medicine and Health Sciences, Taylor's University, Selangor, Malaysia

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Karuppiah Thilakavathy Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Genetics & Regenerative Medicine Research Group, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor, Malaysia

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Medicine 2011 365 307 – 317 . ( https://doi.org/10.1056/NEJMoa1101029 ) 33 Van Beuge MM Ten Dam EJPM Werker PMN & Bank RA . Wnt pathway in Dupuytren disease: connecting profibrotic signals . Translational Research: the Journal of Laboratory

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Vasileios F Pegios Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
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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Eustathios Kenanidis Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
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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Stavros Tsotsolis Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Thessaloniki, Greece
Department of Trauma and Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

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Michael Potoupnis Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
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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Eleftherios Tsiridis Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
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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trials . Frontiers in Medicine 2021 8 801282 . ( https://doi.org/10.3389/fmed.2021.801282 ) 21. Morita A Kobayashi N Choe H Ike H Tezuka T Higashihira S & Inaba Y . Effect of switching administration of alendronate after teriparatide

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Eustathios Kenanidis Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Hellas, Greece
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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Konstantinos Kapriniotis 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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Panagiotis Anagnostis 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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Michael Potoupnis Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Hellas, Greece
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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Panayiotis Christofilopoulos Hôpital de la Tour, Geneva, Switzerland

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Eleftherios Tsiridis Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Hellas, Greece
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.

  • This systematic review evaluated the revision rate, functional outcomes and complications of THA in sicklers.

  • A systematic search was conducted according to the PRISMA guidelines, using four search engines from inception to May 2019.

  • Fifteen studies with 971 THAs were included. There were 437 cemented and 520 uncemented THAs.

  • There were 164 revision THAs (16.8%); 52 uncemented and 105 cemented THAs.

  • Forty-two infections were recorded; 16 infections for cemented and 23 for uncemented THAs.

  • 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.

  • All studies demonstrated the functional improvement of patients.

  • There were 109 medical complications (14.3%). Sickle cell crises (SCC) and transfusion reactions were most usually recorded.

  • Forty-six intraoperative complications (4.7%) were reported; 18 femoral fractures, four acetabular and 18 femoral perforations. Seventeen femoral fractures occurred during uncemented THA.

  • 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

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Heri Suroto Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia
These authors contributed equally to this work

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Brigita De Vega Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
Cell & Tissue Bank-Regenerative Medicine Centre, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
These authors contributed equally to this work

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Fani Deapsari Cell & Tissue Bank-Regenerative Medicine Centre, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

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Tabita Prajasari Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia

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Pramono Ari Wibowo Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia

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Steven K. Samijo Department of Orthopaedics and Traumatology Zuyderland Medisch Centrum, Heerlen, the Netherlands

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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.

  • 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.

  • 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).

  • 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

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Eustathios Kenanidis Hôpital de la Tour, Geneva, Switzerland
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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George Kyriakopoulos Hôpital de la Tour, Geneva, Switzerland
Gennimatas General Hospital, Cholargos, Athens, Greece

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Rajiv Kaila Hôpital de la Tour, Geneva, Switzerland

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Panayiotis Christofilopoulos Hôpital de la Tour, Geneva, Switzerland

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lesions; however, further advancement is needed in treatment protocols. The advantages of corticosteroid injections over other conservative treatment, the effectiveness of regenerative treatments such as PRP and the superiority of open vs. endoscopic

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