Osteosynthesis development with collagenic nanobiostructures

Universitatea de Medicină şi Farmacie ”Iuliu Haţieganu”, Clinica de Ortopedie şi Traumatologie Cluj-Napoca, Secţia a II-a, Conferinţa a XI-a Naţională a ortopezilor-traumatologi din Republica Moldova “POLITRAUMATISME – CONCEPŢII CONTEMPORANE DE DIAGNOSTIC ŞI TRATAMENT”Cercetările în sfera biomaterialelor şi a biomecanicii reprezintă puncte cheie ale progresului în nanomedicină. Nanobiostructurile sunt de mare interes în chirurgia ortopedică în tratamentul unor variate leziuni osteoarticulare: fracturi, pseudartroze, fracturi pe teren patologic (tumori osoase sau osteoporoză), infecţii osoase, artroze etc. Nanobiostructurile conţin colagen, cu sau fără alt polimer, hidroxiapatită nanostructurată, unele peptide (factori de creştere), fosfat de calciu, bisfosfonaţi şi alţi ingredienţi auxiliari. Aplicarea nanobiostructurilor pe diferite suporturi (plăci, tije) favorizează procesele biologice ale consolidării osoase, osteogeneza şi remodelarea osoasă, în condiţiile unei stabilităţi mecanice asigurate prin fixarea internă a fracturii. Aplicabilitatea clinica a tehnologiilor poate contribui in mod semnificativ la dezvoltarea tratamentelor multor boli musculoscheletale. The research in the field of biomaterials and biomechanics represents the key-point of progress in nanomedicine. Nanobiostructures are at high interest in the surgical treatment of various orthopedic conditions: fractures, non-unions, pathologic fractures (bone tumors or osteoporosis), bone infections, osteoarthritis etc. Nanobiostructures are made of collagen, with or without other polymer, nanostructured hydroxyapatite, some peptides (growth factors), calcium phosphate, bisphosphonates and other ingredients. The addition of nanobiostructures to various implants (plates, rods) enhances the biological processes of bone healing, bone growth and remodeling, being protected by the mechanical stability of the internal fixation of fractures. Clinical applicability of the technologies can significantly contribute to improvement of the treatment of several muscular and skeletal diseases

Hip arthroplasty complete revision

Universitatea de Medicină şi Farmacie ”Iuliu Haţieganu”, Clinica de Ortopedie şi Traumatologie Cluj-Napoca, Secţia a II-a, Conferinţa a XI-a Naţională a ortopezilor-tramatologi din Republica Moldova “Politraumatisme – concepţii contemporane de diagnostic şi tratament”, 21 mai 2009, Chișinău, Republica MoldovaArtroplastia totală de şold este descrisă ca una dintre cele mai importante realizări în asigurarea stării de sănătate. Durata medie de viaţă a crescut, tot mai mulţi pacienţi dezvoltând leziuni degenerative ale articulaţiei şoldului care impun o intervenţie de artroplastie. În prezent un număr tot mai mare de pacienţi beneficiază de o artroplastie primară de şold, mulţi dintre ei sperând în continuare la menţinerea unui nivel ridicat de activitate. Din aceste motive chiar şi cu o rată de succes foarte mare a intervenţiilor chirurgicale primare, numărul reviziilor este în continuă creştere. Acest studiu face o analiză a cauzelor insuccesului artroplastiei primare şi ia în calcul şi posibilitatea efectuării artroplastiei şoldului cu o proteză de revizie şi în alte afecţiuni în afara coxartrozei, cum ar fi fracturile trohanteriene după eşecul fixării interne, cu pierdere mare de masă osoasă.Total hip arthroplasty is considered one of the most important achievements in healthcare. Life span has extended and thus more and more patients develop degenerative osteoarthritis lesions of the hip that require arthroplasty intervention. Nowadays a growing number of patients benefit from primary total hip replacement, many of them expecting to maintain an increased level of activity. Even with a high rate of success of the primary surgery, due to this reason the number of revisions is still growing. The present study analyses the causes of primary arthroplasty failure and discusses the possibility of using revision hip arthroplasty in other affections, for example in trochanteric fractures after failure of internal fixation with great bone mass loss

Enhancement of bone consolidation using high-frequency pulsed electromagnetic fields (HF-PEMFs): An experimental study on rats

In vitro studies showed that high-frequency pulsed electromagnetic fields (HF-PEMFs) increase the activity/expression of early and late osteogenic markers and enhance bone mineralization. The main aim of this study was to investigate the in vivo effects of HF-PEMFs on fracture healing using a rat model. A femur fracture was established by surgery in 20 male Wistar rats. Titanium nails were implanted to reduce and stabilize the fracture. After surgery, 20 rats were equally divided into untreated control and treated group (from the first postoperative day HF-PEMFs at 400 pulses/sec [pps] were applied for 10 minutes/day, for two weeks). Quantitative and qualitative assessment of bone formation was made at two and eight weeks following surgery and included morphological and histological analysis, serological analysis by ELISA, micro-computed tomography (micro-CT), and three-point bending test. At two weeks in HF-PEMF group, soft callus was at a more advanced fibrocartilaginous stage and the bone volume/total tissue volume (BV/TV) ratio in the callus area was significantly higher compared to control group (p = 0.047). Serum concentration of alkaline phosphatase (ALP) and osteocalcin (OC) was significantly higher in HF-PEMF group (ALP p = 0.026, OC p = 0.006) as well as the mechanical strength of femurs (p = 0.03). At eight weeks, femurs from HF-PEMF group had a completely formed woven bone with dense trabeculae, active bone marrow, and had a significantly higher BV/TV ratio compared to control (p = 0.01). HF-PEMFs applied from the first postoperative day, 10 minutes/day for two weeks, enhance bone consolidation in rats, especially in the early phase of fracture healing

Clinical outcomes after arthroscopically assisted talus fracture fixation

International audiencePurpose: The purpose of this article is to describe the novel technique of arthroscopic-assisted reduction and internal fixation (ARIF) of talar neck fractures, presenting also the outcomes of this treatment method in a series of four patients. Methods: Between 2011 and 2019, we have treated in our service a number of four patients with talar neck fractures, by the arthroscopic technique. The surgical intervention consists in arthroscopic exploration of tibiotalar and subtalar joints, arthroscopic lavage and debridement, reduction, and osteosynthesis with two cannulated screws under both arthroscopic and fluoroscopic control. Post-operative care consists in non-weightbearing immobilization for 6 weeks, followed by partial loading under the protection of a walking brace for the next six weeks and ROM exercises. The patients were followed up at three months, when a CT scan was performed, and at one year, when X-ray images showed the consolidation of fractures. Results: Normal or slightly reduced ROM of the ankle and hindfoot was noted in three out of four patients, absence of any pain, or disability (3 patients). The AOFAS’ Ankle-Hindfoot scale showed good and excellent results; mean score was 92.75 points (86–98p) at one year after the surgery. Conclusion: Arthroscopic-assisted management of talar fractures offers the advantages of minimally invasive surgery combined with good visualization of the fracture, good control of anatomic reduction, and the possibility to treat associated lesions. Main disadvantages of the method are technical difficulties, requires a prolonged learning curve, and offers limited fixation alternatives

Finite Element Analysis of Different Osseocartilaginous Reconstruction Techniques in Animal Model Knees

Lesions of the articular cartilage are frequent in all age populations and lead to functional impairment. Multiple surgical techniques have failed to provide an effective method for cartilage repair. The aim of our research was to evaluate the effect of two different compression forces on three types of cartilage repair using finite element analysis (FEA). Initially, an in vivo study was performed on sheep. The in vivo study was prepared as following: Case 0—control group, without cartilage lesion; Case 1—cartilage lesion treated with macro-porous collagen implants; Case 2—cartilage lesion treated with collagen implants impregnated with bone marrow concentrate (BMC); Case 3—cartilage lesion treated with collagen implants impregnated with adipose-derived stem cells (ASC). Using the computed tomography (CT) data, virtual femur-cartilage-tibia joints were created for each Case. The study showed better results in bone changes when using porous collagen implants impregnated with BMC or ASC stem cells for the treatment of osseocartilaginous defects compared with untreated macro-porous implant. After 7 months postoperative, the presence of un-resorbed collagen influences the von Mises stress distribution, total deformation, and displacement on the Z axis. The BMC treatment was superior to ASC cells in bone tissue morphology, resembling the biomechanics of the control group in all FEA simulations

How to Prevent Aseptic Loosening in Cementless Arthroplasty: A Review

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

Low-Molecular-Weight Heparins (LMWH) and Synthetic Factor X Inhibitors Can Impair the Osseointegration Process of a Titanium Implant in an Interventional Animal Study

Background and objectives: Cementless total hip arthroplasty is a common surgical procedure and perioperative thromboprophylaxis is used to prevent deep vein thrombosis or pulmonary embolism. Osseointegration is important for long-term implant survival, and there is no research on the effect of different thromboprophylaxis agents on the process of osseointegration. Materials and Methods: Seventy rats were allocated as follows: Group I (control group), Group II (enoxaparin), Group III (nadroparin), and Group IV (fondaparinux). Ovariectomy was performed on all subjects, followed by the introduction of an intramedullary titanium implant into the femur. Thromboprophylaxis was administered accordingly to each treatment group for 35 days postoperatively. Results: Group I had statistically significantly lower anti-Xa levels compared to treatment groups. Micro-CT analysis showed that nadroparin had lower values compared to control in bone volume (0.12 vs. 0.21, p = 0.01) and percent bone volume (1.46 vs. 1.93, p = 0.047). The pull-out test showed statistically significant differences between the control group (8.81 N) compared to enoxaparin, nadroparin, and fondaparinux groups (4.53 N, 4 N and 4.07 N, respectively). Nadroparin had a lower histological cortical bone tissue and a higher width of fibrous tissue (27.49 μm and 86.9 μm) at the peri-implant area, compared to control (43.2 μm and 39.2 μm), enoxaparin (39.6 μm and 24 μm), and fondaparinux (36.2 μm and 32.7 μm). Conclusions: Short-term administration of enoxaparin, nadroparin, and fondaparinux can reduce the osseointegration of titanium implants, with nadroparin having the most negative effect. These results show that enoxaparin and fondaparinux are preferred to be administered due to a lesser negative impact on the initial implant fixation