Regeneration of articular cartilage: Scaffold used in orthopedic surgery. A short handbook of available products for regenerative joints surgery

Introduction: Restoring defects of load-bearing connective tissues such as articular cartilage resulting from traumas, degenerative or age-related diseases remains a significant clinical challenge for clinicians due to the limited inherent repair capacity of articular cartilage. Tissue engineering has emerged as a potential alternative to the traditional surgical techniques, as it can be effectively used to regenerate bone, cartilage and the bone-cartilage interface. Several scaffold strategies have been developed and evaluated for osteochondral defect repair. Materials and methods: The classes of polymers (scaffold-based proteins, scaffold-base polysaccharides and synthetic scaffolds) and Hydrogels have been reviewed trough literature and market search. The study focused on their respective properties and analyzed advantages and disadvantages of each of them. Discussion: Clinical studies demonstrated improved cartilage regeneration thanks to the implantation of biomaterials after bone marrow stimulation. New cartilage can be engineered in vivo by transplanting chondrocytes seeded into a three-dimensional scaffold and this novel scaffold has mechanical properties that can be comparable to native cartilage and could be used to repair large osteochondral joints defects. Anyway, there is still space for improvement regarding clinical outcome and tissue quality

How much does saving femoral head cost after acetabular fracture? Comparison between ORIF and THA

Background We performed a prospective study on patients with acetabular fractures treated either with internal fixation either with arthroplasty comparing clinical outcomes, quality of life, economic resources and cost efficacy in the first five years after surgery.MethodsDemographic data, diagnosis, index treatment, costs and subsequent surgeries were recorded. Patients were requested to fulfill Merle d’Aubigné and EQ-5D-5L questionnaires.ResultsClinical differences between treatments are significant only in discharge period. Comparing respectively group with fixation and arthroplasty, cost efficacy was 5483 and 10838 euros/quality-adjusted-life years, mean global costs 23965 and 16878 € and quality of life gained in five years 2.788 and 3.175. Group of arthroplasty showed better quality of life at discharge and at one year. If choice between fixation and arthroplasty should be based only on cost-efficacy, arthroplasty should be suggested but clinical outcomes suggest to consider fixation because results at five years are not different to arthroplasty

Medial Pivot in Total Knee Arthroplasty: Literature Review and Our First Experience

Background: Traditional total knee implants designs, usually, are not able to reproduce the physiological kinematics of the knee, leaving almost 20% of the patients, those who underwent a total knee arthroplasty (TKA), not fully satisfied. Modern inserts are nowadays designed with a fully congruent medial compartment to reproduce the normal medial pivoting biomechanics of the knee. The aim of this article was to evaluate preliminary clinical improvement using the Medial Congruent (MC) insert as specific level of constraint. Materials and methods: A total of 10 consecutive patients have been enrolled in this study and treated using an MC tibial polyethylene insert. The Oxford Knee Score (OKS) and the Knee Society Score (KSS) have been assessed preoperatively and at 3-month, 6-month, and 1-year follow-up (FU) and used as validated measurements to evaluate early clinical improvements. Postoperative radiological examination was reviewed looking for radiolucent lines or loosening of the components. Results: Average improvement in OKS was from 19.5 to 41.2, whereas KSS improved with an average score from 64.7 preoperatively to 167.5 at the final FU showing good to excellent results in 95% of the treated knees. Evaluating the range of motion, the average maximum active movement was 124° and none of the patients needing for a revision surgery or manipulation under anesthesia. No complications were observed at the final FU as septic or aseptic loosening or vascular or neurologic injury. Discussion and conclusions: Medial Congruent insert showed good to excellent clinical results at 1-year FU. Range of motion and subjective outcomes were satisfying and comparable with results obtained in literature using traditional TKA design