Research

11 pages, 3658 KiB

Open AccessArticle

Assessment of Spinal Stability after Discectomy Followed by Annulus Fibrosus Repair and Augmentation of the Nucleus Pulposus: A Finite Element Study

by Chang-Jung Chiang, Yueh-Ying Hsieh, Fon-Yih Tsuang, Yueh-Feng Chiang and Lien-Chen Wu

Appl. Sci. 2022, 12(23), 11906; https://0-doi-org.brum.beds.ac.uk/10.3390/app122311906 - 22 Nov 2022

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Abstract

Lumbar disc herniation (LDH) is a common condition which can lead to back pain. Although surgical treatments for LDH are well established, complications such as spinal instability and narrowing of adjacent facet joints are still frequently reported. The purpose of this study was [...] Read more.

Lumbar disc herniation (LDH) is a common condition which can lead to back pain. Although surgical treatments for LDH are well established, complications such as spinal instability and narrowing of adjacent facet joints are still frequently reported. The purpose of this study was to use finite element models to evaluate the stability of the L3–L4 segment after conservative or aggressive percutaneous transforaminal endoscopic discectomy (PTED) with and without an artificial material filler to correct LDH. Compared to the intact model, aggressive PTED reduced the stability of the segment (increased ROM) and narrowed the space between facet joints in the medial/lateral (ML) direction during flexion (maximum 6.7 degrees change in ROM and 90.5% spacing between facet joints), extension (maximum 2.1 degrees and 38.6%), and axial rotation (maximum 4.2 degrees and 90.1%). Aggressive PTED had a similar effect in the anterior/posterior (AP) direction during lateral bending (maximum 2.0 degrees and 44.2%). Augmenting the nucleus pulposus with a polyurethane filler after aggressive PTED improved spinal stability in both the ML and AP directions in all simulated motions, with results similar to the intact model. However, using a hydrogel filler did little to stabilize the spine, likely because the material is too soft to support the heavy, sustained loading. In conclusion, this study found that if an aggressive discectomy is required, augmenting the nucleus pulposus with a PU filler provides sufficient support to stabilize the spine, while hydrogel fillers offer little support. Full article

(This article belongs to the Special Issue Frontiers in Orthopedic Surgery)

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12 pages, 2137 KiB

Open AccessArticle

Alendronate Prevents Early Periprosthetic Bone Loss in Cementless Total Hip Arthroplasty Better Than Simvastatin

by Dragos Apostu, Daniel Oltean-Dan, Alexandru Mester, Andrei Maxim, Adrian Bogdan Tigu, Horea Rares Ciprian Benea, Dan Cosma and Doina Piciu

Appl. Sci. 2022, 12(16), 8054; https://0-doi-org.brum.beds.ac.uk/10.3390/app12168054 - 11 Aug 2022

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Abstract

Background and Objectives: Cementless total hip arthroplasty leads to an early periprosthetic bone loss, which can impair the osseointegration process and lead to a femoral implant migration during early weight-bearing. An altered osseointegration process can lead to aseptic loosening, which is the [...] Read more.

Background and Objectives: Cementless total hip arthroplasty leads to an early periprosthetic bone loss, which can impair the osseointegration process and lead to a femoral implant migration during early weight-bearing. An altered osseointegration process can lead to aseptic loosening, which is the most frequent late complication in these surgical procedures. The objective of this study was to compare the effect of alendronate and simvastatin in the prevention of early periprosthetic bone loss found in osteoporotic patients. This can lead to earlier weight-bearing in patients, as well as reduce the rate of aseptic loosening. Materials and Methods: Forty-five patients undergoing cementless total hip arthroplasty were equally distributed into three groups: group I (alendronate), group II (simvastatin), and group III (control). The alendronate group received 5 mg of alendronate postoperatively, daily for 8 weeks, and the simvastatin group received 20 mg daily for 4 weeks postoperatively, followed by 40 mg daily for 4 weeks. We determined bone mineral density (BMD), as well as bone serum markers beta cross-laps (β-CTx) and alkaline phosphatase (ALPL) preoperatively, 4 weeks postoperatively, and 8 weeks postoperatively. All patients were not allowed to fully bear weight for 6 weeks postoperatively. Results: Alendronate statistically significantly increases the BMD at one month postoperatively compared to the control group in Gruen zones 5 and 6 (p = 0.042 and p = 0.039). Overall, the BMD was higher in the alendronate group compared to the control group at one month postoperatively (p = 0.043). Alendronate decreased β-CTx bone serum marker compared to control at one month and two months (p = 0.024 and p = 0.012). Moreover, alendronate showed a higher decrease in β-CTx compared to simvastatin at both timelines (p = 0.028 and p = 0.03, respectively). Conclusions: The study shows that alendronate administration following cementless total hip arthroplasty offers better protection against periprosthetic bone loss compared to simvastatin. Full article

(This article belongs to the Special Issue Frontiers in Orthopedic Surgery)

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13 pages, 3405 KiB

Open AccessArticle

Bone Tissue Condition during Osteosynthesis of a Femoral Shaft Fracture Using Biodegradable Magnesium Implants with an Anticorrosive Coating in Rats with Experimental Osteoporosis

by Yuliya V. Maistrovskaia, Vera A. Nevzorova, Liyudmila G. Ugay, Sergey V. Gnedenkov, Evgeny A. Kotsurbei, Ekaterina A. Moltyh, Roman E. Kostiv and Sergey L. Sinebryukhov

Appl. Sci. 2022, 12(9), 4617; https://0-doi-org.brum.beds.ac.uk/10.3390/app12094617 - 04 May 2022

Cited by 3 | Viewed by 1382

Abstract

Today, osteoporosis has become a major global health issues. The World Health Organization declares that 320 billion people have osteoporosis now, and more than 1.5 billion osteoporosis traumatic events occur every year. Bones become fragile and fracture risk is high; thus, it is [...] Read more.

Today, osteoporosis has become a major global health issues. The World Health Organization declares that 320 billion people have osteoporosis now, and more than 1.5 billion osteoporosis traumatic events occur every year. Bones become fragile and fracture risk is high; thus, it is crucial to choose the right biodegradable implants in order to minimize reoperations of patients with systemic osteoporosis. This investigation aimed to carry out a morphological assessment of the state of bone tissue with osteosynthesis of a femoral fracture in rats, using a model of osteoporosis with the installation of magnesium alloy implants coated with hydroxyapatite and sealed with polytetrafluoroethylene. According to this study, the indicators of angiogenesis and bone formation in experimental animals were significantly higher when an implant coated with hydroxyapatite sealed with polytetrafluoroethylene was used, compared to an implant coated only with hydroxyapatite and in rats without an implant. Based on the data obtained, it is possible to consider a magnesium implant coated with hydroxyapatite and sealed with polytetrafluoroethylene as a promising material for fracture therapy in patients with reduced bone density. Full article

(This article belongs to the Special Issue Frontiers in Orthopedic Surgery)

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8 pages, 2535 KiB

Open AccessArticle

Assessment of Nerve Repair Augmented with Adipose-Derived Mast Cells in an Animal Model

by Vlad Bloanca, Horia Haragus, Anca-Maria Campean, Andrei Cosma, Tiberiu Bratu and Zorin Crainiceanu

Appl. Sci. 2021, 11(20), 9465; https://0-doi-org.brum.beds.ac.uk/10.3390/app11209465 - 12 Oct 2021

Cited by 1 | Viewed by 1118

Abstract

We aimed to analyze the involvement of adipose-sourced mast cells in nerve repair. Sixteen Wistar rats underwent complete transection of the sciatic nerves followed by either direct neurorrhaphy or neurorrhaphy and processed abdominal fat. Four animals were used as controls. Specimens were obtained [...] Read more.

We aimed to analyze the involvement of adipose-sourced mast cells in nerve repair. Sixteen Wistar rats underwent complete transection of the sciatic nerves followed by either direct neurorrhaphy or neurorrhaphy and processed abdominal fat. Four animals were used as controls. Specimens were obtained at 4 and 10 weeks and analyzed using luxol fast blue stain, mast cell tryptase and CD34 (for angiogenesis) per microscopic field ×200. When assessed by luxol fast blue, normal nerves showed an average of 2–3 mast cells/field. At 4 weeks, there were 9.25 for the simple nerve sutures and 16 for the augmented repairs. At 10 weeks, there were 23 and 27.6. When assessed by mast cell tryptase, there were no positives in the controls. At 4 weeks, we found an average of 4 in the simple sutures and 2.5 in the augmented repairs. At 10 weeks, there were 4.5 and 0.2. In controls, there were 1–2 CD34+ blood vessels per field. At 4 weeks, simple repairs showed an average of 4 and, in those with adipose addition, 5.5. At 10 weeks, there were 7 and 12. Mechanically processed adipose tissue augmented nerve repair does not seem to increase mast cell expression but may support angiogenesis in an experimental model. Full article

(This article belongs to the Special Issue Frontiers in Orthopedic Surgery)

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Review

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19 pages, 9295 KiB

Open AccessFeature PaperReview

Extraction of Broken Interlocking Tibial Nails: A Review of Surgical Techniques and Practical Management

by Mihai Dan Roman, Sorin Radu Fleacă, Cosmin Ioan Mohor, Ciprian Bacila, Dan Bratu, Adrian Teodoru, Bogdan-Axente Bocea and Adrian Gheorghe Boicean

Appl. Sci. 2023, 13(3), 1645; https://0-doi-org.brum.beds.ac.uk/10.3390/app13031645 - 27 Jan 2023

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Abstract

Breakage of tibial interlocking nails is a rare complication and is associated with tibial nonunion. The distal part of a broken tibial nail is difficult to extract and can be a real challenge. Preoperative planning is important, as the retrieval techniques of broken [...] Read more.

Breakage of tibial interlocking nails is a rare complication and is associated with tibial nonunion. The distal part of a broken tibial nail is difficult to extract and can be a real challenge. Preoperative planning is important, as the retrieval techniques of broken implants are not routine operations. There are various techniques and instruments described by different authors with none being uniformly successful. Therefore, surgeons should know as many methods as possible to choose the most suitable one. Minimally invasive retrieval techniques should be favored because of their reduced morbidity, while fenestration extraction methods should be used as the second intention. Cannulated intramedullary nails are more prone to benefitting from minimally invasive retrieval techniques than solid ones. This paper reviews and describes the present techniques used to extract the distal part of broken tibial nails, to serve as a quick guide for surgeons who need it. Full article

(This article belongs to the Special Issue Frontiers in Orthopedic Surgery)

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11 pages, 331 KiB

Open AccessReview

Meniscal Tear Management Associated with ACL Reconstruction

by Mihai Dan Roman, Cosmin Ioan Mohor, Petru Razvan Melinte, Radu Chicea, Vlad Alexandru Georgeanu, Adrian Hasegan, Adrian Gheorghe Boicean and Sorin Radu Fleacă

Appl. Sci. 2022, 12(12), 6175; https://0-doi-org.brum.beds.ac.uk/10.3390/app12126175 - 17 Jun 2022

Cited by 1 | Viewed by 3745

Abstract

Meniscal lesions often occur in association with anterior cruciate ligament (ACL) tears at the moment of the injury or, secondarily, as a consequence of knee instability. Both ACL and meniscus lesions are associated with a higher risk of osteoarthritis. Adequate treatment of these [...] Read more.

Meniscal lesions often occur in association with anterior cruciate ligament (ACL) tears at the moment of the injury or, secondarily, as a consequence of knee instability. Both ACL and meniscus lesions are associated with a higher risk of osteoarthritis. Adequate treatment of these lesions reduces the rate of degenerative changes in the affected knee. Meniscal tears should be addressed concomitantly with ACL reconstruction and the treatment must be oriented towards preserving the meniscal tissue anytime this is possible. Several options for approaching a meniscus tear are available. The meniscal suture should always be considered, and, if possible, meniscectomy should be the last choice. “Masterly neglect” is a valuable option in selected cases. Full article

(This article belongs to the Special Issue Frontiers in Orthopedic Surgery)

14 pages, 662 KiB

Open AccessReview

How to Prevent Aseptic Loosening in Cementless Arthroplasty: A Review

by Dragos Apostu, Doina Piciu, Daniel Oltean-Dan, Dan Cosma, Ondine Lucaciu, Catalin Popa, Alexandru Mester and Horea Benea

Appl. Sci. 2022, 12(3), 1571; https://0-doi-org.brum.beds.ac.uk/10.3390/app12031571 - 01 Feb 2022

Cited by 4 | Viewed by 4682

Abstract

Aseptic loosening is the main late postoperative complication of cementless total hip arthroplasties (THAs), leading to pain and functional impairment. This article aims to update the orthopedic surgeon on the various methods by which the aseptic loosening rate can be reduced. We performed [...] Read more.

Aseptic loosening is the main late postoperative complication of cementless total hip arthroplasties (THAs), leading to pain and functional impairment. This article aims to update the orthopedic surgeon on the various methods by which the aseptic loosening rate can be reduced. We performed a systematic review by searching the PubMed database for hip aseptic loosening. We included meta-analysis, randomized controlled trials, reviews, and systematic reviews in the last 10 years, which provided information on techniques that can prevent aseptic loosening in total hip arthroplasty. From a total of 3205 articles identified, 69 articles (2%) met the inclusion criteria, leading to a total of 36 recommendations. A lot of research has been conducted in terms of septic loosening in the last decade. Currently, we have various techniques by which we can reduce the rate of aseptic loosening. Nevertheless, further randomized clinical trials are needed to expand the recommendations for aseptic loosening prevention. Full article

(This article belongs to the Special Issue Frontiers in Orthopedic Surgery)

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14 pages, 2494 KiB

Open AccessReview

Potential New Treatments for Knee OA: A Prospective Review of Registered Trials

by Marius Ioniţescu, Dinu Vermeşan, Bogdan Andor, Cristian Dumitrascu, Musab Al-Qatawneh, Vlad Bloanca, Andrei Dumitrascu and Radu Prejbeanu

Appl. Sci. 2021, 11(22), 11049; https://0-doi-org.brum.beds.ac.uk/10.3390/app112211049 - 22 Nov 2021

Cited by 2 | Viewed by 1795

Abstract

We aimed to evaluate potential new treatments for knee osteoarthritis (OA). The National Institute of Health ClinicalTrials.gov database was searched for “Osteoarthritis, Knee”. We found 565 ongoing interventional studies with a total planned enrollment of 111,276 subjects. Ongoing studies for knee OA represent [...] Read more.

We aimed to evaluate potential new treatments for knee osteoarthritis (OA). The National Institute of Health ClinicalTrials.gov database was searched for “Osteoarthritis, Knee”. We found 565 ongoing interventional studies with a total planned enrollment of 111,276 subjects. Ongoing studies for knee OA represent a very small fraction of the registered clinical trials, but they are over a quarter of all knee trials and over two thirds of all OA studies. The most researched topic was arthroplasty, with aspects such as implant design changes, cementless fixation, robotic guidance, pain management, and fast track recovery. Intraarticular injections focused on cell therapies with mesenchymal stem cells sourced from adipose tissue, bone marrow, or umbilical cord. We could see the introduction of the first disease modifying drugs with an impact on knee OA, as well as new procedures such as geniculate artery embolization and geniculate nerve ablation. Full article

(This article belongs to the Special Issue Frontiers in Orthopedic Surgery)

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Other

Jump to: Research, Review

12 pages, 1282 KiB

Open AccessSystematic Review

The Use of Tranexamic Acid in Anterior Cruciate Ligament Reconstruction: A Systematic Review

by Radu Prejbeanu, Mihail Lazar Mioc, Bogdan Deleanu, Andrei Balanescu, Musab Al Qatawneh and Daniel Malita

Appl. Sci. 2021, 11(23), 11518; https://0-doi-org.brum.beds.ac.uk/10.3390/app112311518 - 05 Dec 2021

Cited by 1 | Viewed by 1609

Abstract

Background: There are several papers that investigate the use of tranexamic acid (TXA) in anterior cruciate ligament reconstructions (ACLR) or other arthroscopic procedures that show favorable results and little to no complications. We aimed to perform a systematic review of all published randomized [...] Read more.

Background: There are several papers that investigate the use of tranexamic acid (TXA) in anterior cruciate ligament reconstructions (ACLR) or other arthroscopic procedures that show favorable results and little to no complications. We aimed to perform a systematic review of all published randomized controlled trials (RCTs) that wanted to determine the effectiveness of intravenous use of TXA in ACLR. Methods: Data collection was performed independently by two authors via a previously created spreadsheet. They extracted information such as: first author name, publication year, lot size, TXA protocol, surgical protocol, outcome measures and follow-up duration. Results: After applying the screening process and the inclusion criteria, we were left with a total six RCTs. The selected studies included a total of 699 randomized patients. Statistical significance regarding a lower pain score (VAS) in the intervention groups was mostly reported for the early postoperative period (2 weeks). A statistically significant decrease in hemarthrosis grade was reported for the first 2–3 weeks. Conclusions: in our study, we show that TXA use in arthroscopic ACLR decreases postoperative blood loss and pain. Some evidence of improvement in functional scores was observed, but we believe that this needs to be addressed in specific long-term result studies. Full article

(This article belongs to the Special Issue Frontiers in Orthopedic Surgery)

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