Autologous peripheral blood-derived orthobiologics:Different types and their effectiveness in managing knee osteoarthritis

Knees are the most commonly impacted weight-bearing joints in osteoarthritis(OA),affecting millions of people worldwide.With increasing life spans and obesity rates,the incidence of knee OA will further increase,leading to a significant increase in the economic burden.Conventional treatment modalities utilized to manage knee OA have limitations.Over the last decade,the role of various autologous peripheral blood-derived orthobiologics(APBOs)for the treatment of knee OA has been extensively investigated.This editorial provided an overview and focused on defining and shedding light on the current state of evidence based on the most recent published clinical studies concerning the use of APBO for the management of knee OA.While numerous studies have demonstrated promising results for these preparations,a notable gap exists in the comparative analysis of these diverse formulations.This absence of head-to-head studies poses a considerable challenge for physicians/surgeons in determining the optimal preparation for managing knee OA and achieving sustained longterm results.Thus,more adequately powered,multicenter,prospective,doubleblind,randomized controlled trials with longer follow-ups are needed to establish the long-term efficacy and to aid physicians/surgeons in determining the optimal APBO for the management of knee OA.

Effect of weight-adjusted antimicrobial antibiotic prophylaxis on postoperative dosage and surgical site infection incidence in total joint arthroplasty

Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.

Efficacy of stromal vascular fraction for knee osteoarthritis:A prospective,single-centre,non-randomized study with 2 years follow-up

BACKGROUND Current osteoarthritis(OA)treatments focus on symptom relief without addressing the underlying disease process.In regenerative medicine,current treatments have limitations.In regenerative medicine,more research is needed for intra-articular stromal vascular fraction(SVF)injections in OA,including dosage optimization,long-term efficacy,safety,comparisons with other treatments,and mechanism exploration.AIM To compare the efficacy of intra-articular SVF with corticosteroid(ICS)injections in patients with primary knee OA.METHODS The study included 50 patients with Kellgren-Lawrence grades II and III OA.Patients were randomly assigned(1:1)to receive either a single intra-articular SVF injection(group A)or a single intra-articular ICS(triamcinolone)(group B)injection.Patients were followed up at 1,3,6,12,and 24 months.Visual analog score(VAS)and International Knee Documentation Committee(IKDC)scores were administered before the procedure and at all followups.The safety of SVF in terms of adverse and severe adverse events was recorded.Statistical analysis was performed with SPSS Version 26.0,IBM Corp,Chicago,IL,United States.RESULTS Both groups had similar demographics and baseline clinical characteristics.Follow-up showed minor patient loss,resulting in 23 and 24 in groups A and B respectively.Group A experienced a notable reduction in pain,with VAS scores decreasing from 7.7 to 2.4 over 24 months,compared to a minor reduction from 7.8 to 6.2 in Group B.This difference in pain reduction in group A was statistically significant from the third month onwards.Additionally,Group A showed significant improvements in knee functionality,with IKDC scores rising from 33.4 to 83.10,whereas Group B saw a modest increase from 36.7 to 45.16.The improvement in Group A was statistically significant from 6 months and maintained through 24 months.CONCLUSION Our study demonstrated that intra-articular administration of SVF can lead to reduced pain and improved knee function in patients with primary knee OA.More adequately powered,multi-center,double-blinded,randomised clinical trials with longer follow-ups are needed to further establish safety and justify its clinical use.

Characterizing the tumor microenvironment at the single-cell level reveals a novel immune evasion mechanism in osteosarcoma

The immune microenvironment extensively participates in tumorigenesis as well as progression in osteosarcoma(OS).However,the landscape and dynamics of immune cells in OS are poorly characterized.By analyzing single-cell RNA sequencing(sc RNA-seq)data,which characterize the transcription state at single-cell resolution,we produced an atlas of the immune microenvironment in OS.The results suggested that a cluster of regulatory dendritic cells(DCs)might shape the immunosuppressive microenvironment in OS by recruiting regulatory T cells.We also found that major histocompatibility complex class I(MHC-I)molecules were downregulated in cancer cells.The findings indicated a reduction in tumor immunogenicity in OS,which can be a potential mechanism of tumor immune escape.Of note,CD24 was identified as a novel“don’t eat me”signal that contributed to the immune evasion of OS cells.Altogether,our findings provide insights into the immune landscape of OS,suggesting that myeloid-targeted immunotherapy could be a promising approach to treat OS.

Mechanical analysis of the femoral neck dynamic intersection system with different nail angles and clinical applications

BACKGROUND The femoral neck dynamic intersection system(FNS)is mechanically more stable than other internal fixation techniques.Current studies have confirmed that the structural design of FNS has good biomechanical properties in European and American populations.However,whether the suitability of the FNS's 130°main nail angle design for Asian populations has been thoroughly investigated remains unclear.AIM To compare the biomechanical stability differences among different main nail angles of the FNS in the treatment of femoral neck fractures in Asian populations.METHODS Computed tomography data of the femur of healthy adult male volunteers were imported into Mimics software to create a three-dimensional model of the femur.The model was adapted to the curve using Geomagic software and imported into Solidworks software to construct the Pauwels I femoral neck fracture model and design the FNS internal fixation model using different main nail angles.Afterward,the models were assembled with the FNS fracture model and meshed using the preprocessing Hypermesh software.Subsequently,they were imported into Abaqus software to analyze and evaluate the biomechanical effects of different angles of the FNS main nail on the treatment of femoral neck fractures.RESULTS The peak displacement of the proximal femur under different angles of FNS fixation under stress was 7.446 millimeters in the 120°group and 7.416 millimeters in the 125°group;in the 130°,135°,and 140°FNS fixation groups,the peak displacement was 7.324 millimeters,8.138 millimeters,and 8.246 millimeters,respectively.In the 120°and 125°FNS fixation groups,the maximum stresses were concentrated at the main nail and the anti-rotation screw,which intersected the fracture line of the femur neck,resulting in peak stresses of 200.7 MPa and 138.8 MPa,respectively.Peak stresses of 208.8 MPa,219.8 MPa,and 239.3 MPa were observed on the angular locking plate distal to the locking screw in the 130°,135°,and 140°fixation groups.CONCLUSION FNS has significant stress distribution properties,a minimal proximal femoral displacement,and an optimal stability for treating femoral neck fractures in Asian populations when performed with a 130°main nail angle.

Silver nanoparticle technology in orthopaedic infections

The irrational and prolonged use of antibiotics in orthopaedic infections poses a major threat to the development of antimicrobial resistance.To combat antimi-crobial resistance,researchers have implemented various novel and innovative modalities to curb infections.Nanotechnology involves doping ions/metals onto the scaffolds to reach the target site to eradicate the infective foci.In this conno-tation,we reviewed silver nanoparticle technology in terms of mechanism of action,clinical applications,toxicity,and regulatory guidelines to treat ortho-paedic infections.

Machine learning and deep neural network-based learning in osteoarthritis knee

Osteoarthritis(OA)of the knee joint is considered the commonest musculoskeletal condition leading to marked disability for patients residing in various regions around the globe.Application of machine learning(ML)in doing research regarding OA has brought about various clinical advances viz,OA being diagnosed at preliminary stages,prediction of chances of development of OA among the population,discovering various phenotypes of OA,calculating the severity in OA structure and also discovering people with slow and fast progression of disease pathology,etc.Various publications are available regarding machine learning methods for the early detection of osteoarthritis.The key features are detected by morphology,molecular architecture,and electrical and mechanical functions.In addition,this particular technique was utilized to assess non-interfering,non-ionizing,and in-vivo techniques using magnetic resonance imaging.ML is being utilized in OA,chiefly with the formulation of large cohorts viz,the OA Initiative,a cohort observational study,the Multicentre Osteoarthritis Study,an observational,prospective longitudinal study and the Cohort Hip&Cohort Knee,an observational cohort prospective study of both hip and knee OA.Though ML has various contributions and enhancing applications,it remains an imminent field with high potential,also with its limitations.Many more studies are to be carried out to find more about the link between machine learning and knee osteoarthritis,which would help in the improvement of making decisions clinically,and expedite the necessary interventions.

Effect of Lactobacillus rhamnosus HN001 and Bifidobacterium longum BB536 on the healthy gut microbiota composition at phyla and species level: A preliminary study

AIM To evaluate the ability of Lactobacillus rhamnosus HN001 and Bifidobacterium longum BB536 to colonize the intestinal environment of healthy subjects and modify the gut microbiota composition.METHODS Twenty healthy Italian volunteers, eight males and twelve females, participated in the study. Ten subjects took a sachet containing 4 × 109 colony-forming units(CFU) of Bifidobacterium longum BB536 and 109 CFU of Lactobacillus rhamnosus HN001, 30 min before breakfast(pre-prandial administration), while ten subjects took a sachet of probiotic product 30 min after breakfast(post-prandial administration). The ability ofLactobacillus rhamnosus HN001 and Bifidobacterium longum BB536 to colonize human gut microbiota was assessed by means of quantitative real-time PCR, while changes in gut microbiota composition were detected by using Ion Torrent Personal Genome Machine.RESULTS Immediately after 1-mo of probiotic administration, B. longum BB536 and L. rhamnosus HN001 load was increased in the majority of subjects in both preprandial and post-prandial groups. This increase was found also 1 mo after the end of probiotic oral intake in both groups, if compared to samples collected before probiotic consumption. At phyla level a significant decrease in Firmicutes abundance was detected immediately after 1-mo of B. longum BB536 and L. rhamnosus HN001 oral intake. This reduction persisted up to 1 mo after the end of probiotic oral intake together with a significant decrease of Proteobacteria abundance if compared to samples collected before probiotic administration. Whereas, at species level, a higher abundance of Blautia producta, Blautia wexlerae and Haemophilus ducrey was observed, together with a reduction of Holdemania filiformis, Escherichia vulneris, Gemmiger formicilis and Streptococcus sinensis abundance. In addition, during follow-up period we observed a further reduction in Escherichia vulneris and Gemmiger formicilis, together with a decrease in Roseburia faecis and Ruminococcus gnavus abundance. Conversely, the abundance of Akkermansia muciniphila was increased if compared to samples collected at the beginning of the experimental time course CONCLUSION B. longum BB536 and L. rhamnosus HN001 showed the ability to modulate the gut microbiota composition, leading to a significant reduction of potentially harmful bacteria and an increase of beneficial ones. Further studies are needed to better understand the specific mechanisms involved in gut microbiota modulation.

Biologic agents for anterior cruciate ligament healing: a systematic review

AIM To systematically review the currently available literature concerning the application of biologic agents such as platelet-rich plasma(PRP) and stem cells to promote anterior cruciate ligament(ACL) healing.METHODS A systematic review of the literature was performed on the use of biologic agents(i.e., PRP or stem cells) to favor ACL healing during reconstruction or repair. The following inclusion criteria for relevant articles were used: Clinical reports of any level of evidence, written in English language, on the use of PRP or stem cells during ACL reconstruction/repair. Exclusion criteria were articles written in other languages, reviews, or studies analyzing other applications of PRP/stem cells in knee surgery not related to promoting ACL healing.RESULTS The database search identified 394 records that were screened. A total of 23 studies were included in the final analysis: In one paper stem cells were applied for ACL healing, in one paper there was a concomitant application of PRP and stem cells, whereas in the remaining21 papers PRP was used. Based on the ACL injury pattern, two papers investigated biologic agents in ACL partial tears whereas 21 papers in ACL reconstruction.Looking at the quality of the available literature, 17 out of 21 studies dealing with ACL reconstruction were randomized controlled trials. Both studies on ACL repair were case series.CONCLUSION There is a paucity of clinical trials investigating the role of stem cells in promoting ACL healing both in case of partial and complete tears. The role of PRP is still controversial and the only advantage emerging from the literature is related to a better graft maturation over time, without documenting beneficial effects in terms of clinical outcome, bone-graft integration and prevention of bony tunnel enlargement.

Predicting lower limb periprosthetic joint infections: A review of risk factors and their classification

AIM To undertook a systematic review to determine factors that increase a patient's risk of developing lower limb periprosthetic joint infections(PJI).METHODS This systematic review included full-text studies that reviewed risk factors of developing either a hip or knee PJI following a primary arthroplasty published from January 1998 to November 2016. A variety of keywords were used to identify studies through international databases referencing hip arthroplasty, knee arthroplasty, infection, and risk factors. Studies were only included if they included greater than 20 patients in their study cohort, and there was clear documentation of the statistical parameter used; specifically P-value, hazard ratio, relative risk, or/and odds ratio(OR). Furthermore a quality assessment criteria for the individual studies was undertaken to evaluate the presence of record and reporting bias. RESULTS Twenty-seven original studies reviewing risk factors relating to primary total hip and knee arthroplasty infections were included. Four studies(14.8%) reviewed PJI of the hip, 3(11.21%) of the knee, and 20(74.1%) reviewed both joints. Nineteen studies(70.4%) were retrospective and 8(29.6%) prospective. Record bias was identified in the majority of studies(66.7%). The definition of PJI varied amongst the studies but there was a general consensus to define infection by previously validated methods. The most significant risks were the use of preoperative high dose steroids(OR = 21.0, 95%CI: 3.5-127.2, P < 0.001), a BMI above 50(OR = 18.3, P < 0.001), tobacco use(OR = 12.76, 95%CI: 2.47-66.16, P= 0.017), body mass index below 20(OR = 6.00, 95%CI: 1.2-30.9, P = 0.033), diabetes(OR = 5.47, 95%CI: 1.77-16.97, P = 0.003), and coronary artery disease(OR = 5.10, 95%CI: 1.3-19.8, P = 0.017).CONCLUSION We have highlighted the need for the provider to optimise modifiable risk factors, and develop strategies to limit the impact of non-modifiable factors.

Multilevel cervical spondylotic myelopathy treated by anterior cervical decompression in subsection and autograft fusion

Objective:To investigate a novel surgical method for multilevel cervical spondylotic myeIopa- thy(CSM).Methods:Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively.All patients experienced anterior cervical decompression surgery in subsection,autograft fusion and internal fixation.Preoperative,immediate post- operative and follow-up image data,X-rays and semi-quantitative Japanese orthopaedics association(JOA) scores were used to evaluate the restoration of lordosis(Cobb's angle),intervertebral heights,the stabili- ty of the cervical spine and the improvement of neurological impairment.Results:Preoperative symptoms were markedly alleviated or disappeared in most of the patients.According to the JOA scores,the ratio of improvement in neurological function was 72.2%,including excellent in 9 cases(42.9%),good in 7 cases (33.30%),fair in 3 cases(14.3%)and poor in 2 cases(9.5%).Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine(P<0.01).There is no evidence of instrument failure during the mean follow-up period of 14.2 months(9-24 months, P>0.01).Conclusion:Anterior cervical decompression in subsection,autograft fusion and internal fixa- tion is a rational effective method for the surgical treatment of multilevel CSM.

Correction of hypovitaminosis D improved global longitudinal strain earlier than left ventricular ejection fraction in cardiovascular older adults after orthopaedic surgery

BackgroundCardiovascular 疾病和维生素 D 的不够的层次是为不利外科的结果的风险因素，并且他们是在经历整形外科的外科的更老的成年人之中通常在场的两个。给维生素 D 的心血管的效果， hypovitaminosis D 的外科手术前的诊断将是为补充协议的实现的珍贵的步。如果，我们调查了浆液 25 的正规化[哦] D 能改善受不了心血管的 diseases.MethodsWe 的更老的成年人的心脏的性能注册了为主要整形外科的外科安排的 47 个更老的成年人并且受不了 hypovitaminosis D。病人们与开始的剂量经历了 6 月的 calcifediol 补充 50 湩琠敨攠敶瑮的起初手术后的白天吗？

Polymethylmethacrylate bone cements and additives: A review of the literature

Polymethylmethacrylate(PMMA) bone cement technology has progressed from industrial Plexiglass administration in the 1950 s to the recent advent of nanoparticle additives. Additives have been trialed to address problems with modern bone cements such as the loosening of prosthesis, high post-operative infection rates, and inflammatory reduction in interface integrity. This review aims to assess current additives used in PMMA bone cements and offer an insight regarding future directions for this biomaterial. Low index(< 15%) vitamin E and low index(< 5 g) antibiotic impregnated additives significantly address infection and inflammatory problems, with only modest reductions in mechanical strength. Chitosan(15% w/w PMMA) and silver(1% w/w PMMA) nanoparticles have strong antibacterial activity with no significant reduction in mechanical strength. Future work on PMMA bone cements should focus on trialing combinations of these additives as this may enhance favourable properties.

Protein tyrosine phosphatases in skeletal development and diseases

Skeletal development and homeostasis in mammals are modulated by finely coordinated processes of migration, proliferation,differentiation, and death of skeletogenic cells originating from the mesoderm and neural crest. Numerous molecular mechanisms are involved in these regulatory processes, one of which is protein posttranslational modifications, particularly protein tyrosine phosphorylation(PYP). PYP occurs mainly through the action of protein tyrosine kinases(PTKs), modifying protein enzymatic activity, changing its cellular localization, and aiding in the assembly or disassembly of protein signaling complexes. Under physiological conditions, PYP is balanced by the coordinated action of PTKs and protein tyrosine phosphatases(PTPs).Dysregulation of PYP can cause genetic, metabolic, developmental, and oncogenic skeletal diseases. Although PYP is a reversible biochemical process, in contrast to PTKs, little is known about how this equilibrium is modulated by PTPs in the skeletal system.Whole-genome sequencing has revealed a large and diverse superfamily of PTP genes(over 100 members) in humans, which can be further divided into cysteine(Cys)-, aspartic acid(Asp)-, and histidine(His)-based PTPs. Here, we review current knowledge about the functions and regulatory mechanisms of 28 PTPs involved in skeletal development and diseases;27 of them belong to class Ⅰ and Ⅱ Cys-based PTPs, and the other is an Asp-based PTP. Recent progress in analyzing animal models that harbor various mutations in these PTPs and future research directions are also discussed. Our literature review indicates that PTPs are as crucial as PTKs in supporting skeletal development and homeostasis.

无栓子保护装置的颈动脉支架置入术在有症状和无症状病人中的安全性:术后30d的综合不良结果的回顾性分析

目的 回顾性分析无栓子保护装置的颈动脉支架置入术在大宗病例中的结果。方法 本研究经审查委员会批准并获得所有病人的知情同意。术前行彩色多普勒超声、MRI或CT评价狭窄程度（≥70％）。对400例无症状的（n=156，39％）或有症状的（n=244，61％）狭窄病人[男289例，女111例；平均年龄（73±8）岁]行无栓子保护装置的颈动脉支架置入术后的临床表现和30d内并发症发生率进行了分析。

Outcomes assessment of hepatitis C virus-positive psoriatic patients treated using pegylated interferon in combination with ribavirin compared to new Direct-Acting Antiviral agents

AIM To evaluate the outcomes in biological treatment and quality of life of psoriatic patients with chronic hepatitis C(CHC) treated with new Direct-Acting Antiviral agents(DAAs) compared to pegylated interferon-2α plus ribavirin(P/R) therapy.METHODS This is a retrospective study involving psoriatic patients in biological therapy who underwent anti-hepatitis C virus(HCV) treatment at the Department of Dermatology Galeazzi Orthopaedic Institute Milan, Italy from January 2010 to November 2017. The patients were divided into two groups: patients that underwent therapy with DAAs and patients that underwent HCV treatment with P/R. Patients were assessed by a dermatologist for psoriasis symptoms, collecting Psoriasis Area Severity Index(PASI) scores and the Dermatology Quality of Life Index(DLQI). PASI and DLQI scores were evaluated 24 wk after the end of HCV treatment and were assumed as an outcome of the progression of psoriasis. Switching to a different b DMARD was considered as an inadequate response to biological therapy. The dropout of HCV therapy and sustained virological response(SVR) were considered as outcomes of HCV therapy.RESULTS Fifty-nine psoriatic patients in biological therapy underwent antiviral therapy for CHC. Of this, 27 patients were treated with DAAs and 32 with P/R. After 24 wk post treatment, the DLQI and the PASI scores were significantly lower(P < 0.001 and P < 0.005, respectively) in the DAAs group compared with P/R group. None of the patients in the DAAs group(0/27) compared to 8 patients of the P/R group(8/32) needed a shift in biological treatment.CONCLUSION DAAs seem to be more effective and safe than P/R in HCV-positive psoriatic patients on biological treatment. Fewer dermatological adverse events may be due to interferon-free therapy.

Runx1 is a key regulator of articular cartilage homeostasis by orchestrating YAP,TGFβ,and Wnt signaling in articular cartilage formation and osteoarthritis

Runt-related transcription factor 1(Runx1)plays a key role in cartilage formation,but its function in articular cartilage formation is unclear.We generated non-inducible and inducible Runx1-deficient mice(Runx1^(f/f)Col2α1-Cre and Runx1^(f/f)Col2α1-CreER mice)and found that chondrocyte-specific Runx1-deficient mice developed a spontaneous osteoarthritis(OA)-like phenotype and showed exacerbated articular cartilage destruction under OA,characterized by articular cartilage degradation and cartilage ossification,with decreased Col2α1 expression and increased Mmp13 and Adamts5 expression.RNA-sequencing analysis of hip articular cartilage from the Runx1^(f/f)Col2α1-Cre mice compared to that from wild-type mice and subsequent validation analyses demonstrated that Runx1 is a central regulator in multiple signaling pathways,converging signals of the Hippo/Yap,TGFβ/Smad,and Wnt/β-catenin pathways into a complex network to regulate the expression of downstream genes,thereby controlling a series of osteoarthritic pathological processes.RNA-sequencing analysis of mutant knee joints showed that Runx1’s role in signaling pathways in articular cartilage is different from that in whole knee joints,indicating that Runx1 regulation is tissue-specific.Histopathologic analysis confirmed that Runx1 deficiency decreased the levels of YAP and p-Smad2/3 and increased the levels of activeβ-catenin.Overexpression of Runx1 dramatically increased YAP expression in chondrocytes.Adeno-associated virus-mediated Runx1 overexpression in the knee joints of osteoarthritic mice showed the protective effect of Runx1 on articular cartilage damaged in OA.Our results notably showed that Runx1 is a central regulator of articular cartilage homeostasis by orchestrating the YAP,TGFβ,and Wnt signaling pathways in the formation of articular cartilage and OA,and targeting Runx1 and its downstream genes may facilitate the design of novel therapeutic approaches for OA.

National trends in total hip arthroplasty for traumatic hip fractures:An analysis of a nationwide all-payer database

BACKGROUND Hemiarthroplasty(HA)has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures.Ideal treatment for younger,ambulatory patients is not as clear.Total hip arthroplasty(THA)has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.AIM To examine what patient characteristics are associated with undergoing THA or HA.To determine if outcomes differ between the groups.METHODS We queried the Nationwide Inpatient Sample(NIS)for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014.The NIS comprises a large representative sample of inpatient hospitalizations in the United States.International Classifications of Disease,Ninth Edition(ICD-9)codes were used to identify patients in our sample.Demographic variables,hospital characteristics,payer status,medical comorbidities and mortality rates were compared between the two procedures.Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized.RESULTS Of the total 502060 patients who were treated for femoral neck fracture,51568(10.3%)underwent THA and the incidence of THA rose from 8.3%to 13.7%.Private insurance accounted for a higher percentage of THA than hemiarthroplasty.THA increased most in urban teaching hospitals relative to urban non-teaching hospitals.Mean length of stay(LOS)was longer for HA.The mean charges were less for HA,however charges decreased steadily for both groups.HA had a higher mortality rate,however,after adjusting for age and comorbidities HA was not an independent risk factor for mortality.Interestingly,private insurance was an independent predictor for treatment with THA.CONLUSION There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States,most notably in urban hospitals.HA and THA are decreasing in total charges and LOS.

The Effects of Interferential Stimulation on Pain and Motion after Shoulder Surgery: A Prospective Randomized Study

Purpose: The purpose of this study is to determine the effects of interferential stimulation on pain and motion after shoulder surgery. Study Design: Randomized Controlled Trial. Methods: 102 patients undergoing arthroscopic rotator cuff repair or labral repair were prospectively randomized to receive either an interferential stimulation unit immediately after surgery (STIM) or not to receive the unit (NO-STIM). Each patient was measured for the range of motion (ROM) in forward flexion (FF), abduction (ABD), internal rotation (IR) and external rotation (ER). These measurements were taken prior to surgery and at the 6 weeks post-operative time point. Visual Analogue Scale (VAS) scores (0 - 10) and the amount of narcotic taken (standardized to 10 mg equivalents of hydrocodone) were measured and compared between the two groups at 2 days and 4 weeks post-operatively. 51 patients were excluded due to failure to document VAS scores and medication usage, lack of follow-up at the 6 weeks post-operative time point or hospitalization after surgery. This left 27 patients in the STIM group and 24 patients in the NO-STIM group. Results: No difference was found in the amount of narcotic taken after 2 days (STIM 14.37 ± 1.02, NO-STIM 15.88 ± 1.22, p = 0.34) or after 4 weeks (STIM 45.32 ± 4.36, NO-STIM 48.96 ± 5.50, p = 0.60). No difference in mean VAS scores were found at 2 days (STIM 5.56 ± 0.53, NO-STIM 4.63 ± 0.57, p = 0.24) or 4 weeks (STIM 1.68 ± 0.39, NO-STIM 1.38 ± 0.34, p = 0.57). At 6 weeks post-operatively, a difference was found in ER (STIM 62.5 ± 4.09, NO-STIM 50.4 ± 4.09, p = 0.04), and no differences found in FF (STIM 134.2 ± 5.29, NO-STIM 133.3 ± 4.85, p = 0.60), ABD (STIM 124.8 ± 6.22, NO-STIM 119.6 ± 5.42, p = 0.53) or IR (STIM 60.0 ± 3.69, NO-STIM 55.9 ± 3.03, p = 0.39). A post-hoc power analysis performed using an á = 0.05 revealed the study to be 90% powered to identify a difference of one narcotic equivalent between groups and 90% powered to identify a 0.3 difference in VAS scores. Conclusions: The use of an interferential stimulator in the immediate post-operative period had no effect on pain or narcotic usage following arthroscopic rotator cuff repair or labral repair. External rotation was significantly greater in the interferential stimulator group while no differences were found in other motion parameters.

Biomechanical Investigation of Locked Plate Fixation with Suture Augmentation in a Comminuted Three-Part Proximal Humerus Fracture Model

Background: Locked plating of displaced proximal humerus fractures is a reliable fixation method. Greater tuberosity (GT) failure is a known complication that may occur in the early post-operative period. Despite postoperative immobilization, the rotator cuff continues to exert significant forces on fracture fragments. Our hypothesis is that suture augmentation will provide greater stability of the GT than locked plating alone. To prove this we developed a three-part proximal humerus fracture model to test fracture fixation. Methods: A biomechanical study was performed on nine fresh frozen cadaveric humeri, simulating a three-part proximal humerus fracture (Neer Classification). Rotator cuff tendon insertions were preserved to physiologically load the proximal humerus. The fracture was reduced and fixed with a locked plate alone or a locked plate with suture augmentation of the GT to the rotator cuff tendons. Biomechanical testing utilized a materials testing machine and a three-dimensional motion capture system to quantify interfragmentary motion under torsional loading as a function of fixation type. Results: Greater torsional stability was observed in the suture-augmented group compared to the plate only group (p = 0.0012). There were two catastrophic failures in the plate only group while none of the suture reinforced constructs failed. Conclusions: In our model, suture-augmentation of the GT to the rotator cuff provided greater stability than locked plating alone. The current study provides a biome-chanical basis for reinforcing locked plate constructs with sutures. The added stability afforded by suture-augmentation may mitigate rotator cuff forces in the clinical setting, avoiding fracture displacement in the early postoperative rehabilitation period.