Conventional Stem Research Articles

Effects on Wound Healing of Human-Induced Pluripotent Stem Cell-Derived Cells Similar to Endothelial Colony-Forming Cells

Background: Human-induced pluripotent stem cells (hiPSCs) complement the disadvantages of conventional embryonic stem cells and adult stem cells, and have the advantages of simplicity of production and pluripotency. Some recent studies have applied hiPSC in cell therapy.Methods: In this study, we examined the effect of cells similar to cord blood endothelial colony-forming cells (CB-ECFCs), differentiated from induced pluripotent stem cells, on angiogenesis and granulation tissue formation in the proliferative phase of wound healing. For cell transfer, we used methacrylated gelatin (GelMA)-co-poly(styrene sulfonate) (PSS) cryogel, which has better bioactivity than conventional hydrogels and excellent mechanical properties and swelling capacity. Two full-thickness skin defects, 0.8 cm in diameter, were made in each of our 12 experimental mice. Wound splinting models were used to prevent contraction of the wounds. In each of the experimental animals, 5×10<sup>5</sup> cells were applied with GelMA-co-PSS cryogel in one of the two wounds, while only a culture medium with cryogel was applied to the other wound.Results: Wound reduction rates in the experimental side showed increases compared to the control side in 3 days, but there was no statistical significance. The histological score was significantly increased (P<0.05), and histologic examination showed that angiogenesis and granulation formation were also increased in the experiment side.Conclusion: In conclusion, CB-ECFCs-like cells differentiated from hiPSCs were effective in promoting formation of angiogenesis and granulation tissue in a mouse wound healing model.

Pulp stem cells derived from human permanent and deciduous teeth: Biological characteristics and therapeutic applications.

Human pulp stem cells (PSCs) include dental pulp stem cells (DPSCs) isolated from dental pulp tissues of human extracted permanent teeth and stem cells from human exfoliated deciduous teeth (SHED). Depending on their multipotency and sensitivity to local paracrine activity, DPSCs and SHED exert therapeutic applications at multiple levels beyond the scope of the stomatognathic system. This review is specifically concentrated on PSC‐updated biological characteristics and their promising therapeutic applications in (pre)clinical practice. Biologically, distinguished from conventional mesenchymal stem cell markers in vitro, NG2, Gli1, and Celsr1 have been evidenced as PSC markers in vivo. Both perivascular cells and glial cells account for PSC origin. Therapeutically, endodontic regeneration is where PSCs hold the most promises, attributable of PSCs' robust angiogenic, neurogenic, and odontogenic capabilities. More recently, the interplay between cell homing and liberated growth factors from dentin matrix has endowed a novel approach for pulp‐dentin complex regeneration. In addition, PSC transplantation for extraoral tissue repair and regeneration has achieved immense progress, following their multipotential differentiation and paracrine mechanism. Accordingly, PSC banking is undergoing extensively with the intent of advancing tissue engineering, disease remodeling, and (pre)clinical treatments.

Is the strain pattern of conventional stems negatively affected by a previously short stem THA? An experimental study in cadavaric bone.

A short stem hip arthroplasty can be revised in many cases using a conventional stem. Furthermore, in some cases the implantation of a short stem is intended, but intraoperatively reasons may lead to the decision to implant a conventional stem after previous preparation of a short stem. In both cases it is questionable if the anchorage of a conventional stem is negatively affected by the previous preparation of a short stem. In clinical practice mid- or long-term follow up for these special cases hardly exist. The strain patterns for the conventional Bicontact stem in primary implantation and after preparation of the proximal femur for a METHA short stem were tested biomechanically in three pairs of cadaveric femora. The strain patterns for the conventional Bicontact after preparation of the METHA short stem were similar to conditions after testing the conventional stem in primary conditions. These data lead to the consequence that in clinical practise the implantation of a conventional stem after preparation of a short stem and even after revision of a short stem is possible without increased risk of loosening or long-term stress-shielding.

Cystine transporter expression is a marker to identify a subpopulation of canine adipose-derived stem cells.

Adipose-derived stem cells (ADSCs) are promising cell sources for regenerative medicine due to the simplicity of their harvest and culture; however, their biological properties are not completely understood. Moreover, recent murine and human studies identified several functional subpopulations of ADSCs varying in differentiation potential; however, there is a lack of research on canine ADSCs. Cystine transporter (xCT) is a stem cell marker in gastric and colon cancers that interacts with CD44 to enhance cystine uptake from the cell surface and subsequently accelerates intercellular glutathione levels. In this study, we identified a ~5% functional subpopulation of canine ADSCs with xCT+ expression (xCTHi). Compared with those of the xCT− subpopulation (xCTLo), the xCTHi subpopulation showed a significantly higher proliferation rate, higher expression of conventional stem cell markers (SOX2, KLF4, and c-Myc), and higher expression of adipogenic markers (FABP4 and PPARγ). By contrast, the xCTLo subpopulation showed significantly higher expression of osteogenic markers (BMP1 and SPP) than xCTHi cells. These results suggest xCT as a candidate marker for detecting a functional subpopulation of canine ADSCs. Mechanistically, xCT could increase the adipogenic potential while decreasing the osteogenic differentiation potential, which could serve as a valuable target marker in regenerative veterinary medicine.

PENGARUH PEMOTONGAN TANGKAI METODE “CANGKEM BUAYA” TERHADAP PENINGKATAN KUALITAS TANDAN BUAH SEGAR

The low percentage fruit set will impact on the percentage of fruit to bunch and weight of Bunch. Fruit set is low causing the formation of partenokarpi fruit/coat so that the harvest process is involved in loading, carrying and processing. To solve the problem, the management of post-harvest Bunis is necessary. Comparing the "V" (conventional) stem cutting, which is often referred to as the “Cangkem Kodok” (CK) as it is usually applied in the plantation and the treatment of bunches (stalk) and base of bunches/stalks that have no fruit/ brondolan called a “Cangkem Buaya" (CB). This research was conducted on oil palm plantation year 2015 planting in the Plantation of Bah Birung Ulu PTP. Nusantara IV. Five Month research time, namely in February-June year 2019. This research uses a descriptive analysis method that is the primary data retrieval analyzed with Analysis of Variance (ANOVA) and then conducted advanced test using the smallest real difference (BNT) at 5% as well as correlation of several parameters Observation. The results showed that the weight of the stem garbage waste with a higher CB treatment compared with CK treatment and with the treatment of CB can save the garbage that does not fit, transport and sports per bunch in Afdeling 1 by 5.59%, Afdeling 2 8.02% and Afdeling 3 7.63%. With the treatment of stem cutting and base of the fruit bunching (Brondolan) or called the treatment of crocodile hoe can increase the percentage of Fruit to a bunch average of 6%. The oil extraction were 27%.

Atomic Spatial and Temporal Imaging of Local Structures and Light Elements inside Zeolite Frameworks.

Identifying the atomic structures of porous materials in spatial and temporal dimensions by (scanning) transmission electron microscope ((S)TEM) is significant for their wide applications in catalysis, separation and energy storage. However, the sensitivity of materials to electron beams made it difficult to reduce the electron damage to specimens while maintaining the resolution and signal-to-noise ratio. It is therefore still challenging to capture multiple images of the same area in one crystal to image the temporal changes of lattices. Usings integrated differential phase contrast (iDPC) STEM, atomic-resolution imaging of beam-sensitive zeolite frameworks is achieved with an ultralow dose of 40 e- Å-2 , 2-3 orders of magnitude lower than that of conventional STEM. Based on the iDPC technique, not only the atomic 3D architecture of ZSM-5 crystals but also the changes of frameworks are observed during in situ experiments. Local structures and light-element aromatics in ZSM-5 crystals can also be revealed directly under iDPC-STEM. These results provided not only an efficient tool to image beam-sensitive materials with ultralow beam current but also a new strategy to observe and investigate the hydrocarbon pools in zeolite catalysts at the single-molecule scale.

A comparison of patient-reported outcome measures (PROMs) between short and conventional stem hip replacements: a systematic review and meta-analysis.

Short stem hip replacements may allow preservation of proximal bone stock and minimise soft tissue disruption, easing future revision surgery. However patient satisfaction with these implants must be determined before widespread use. We aimed to compare patient reported outcome measures (PROMs) between short and conventional stem hip replacements. A systematic review was conducted according to PRISMA guidelines for studies comparing short and conventional stem hip replacements with validated PROMs. Meta-analyses were performed for studies reporting Harris Hip and WOMAC scores. Study bias was assessed with the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. 24 studies, incorporating 2593 total hip replacements were included for qualitative analysis. 17 studies were included in the meta-analyses. Of the 7 excluded, 1 study reported the Japanese Orthopaedic Association score and 2 others reported the Oxford Hip score. All three showed no difference between the stems. A meta-analysis of 17 studies reporting Harris hip scores showed no statistically significant difference between short and conventional stems (standard mean difference (SMD) -0.06, 95% CI -0.20-0.07, p = 0.35). 6 studies reported WOMAC scores with higher scores indicating worse outcome. No difference was seen between the two groups (SMD 0.21, 95%CI, -0.01-0.42, p = 0.06). 4 studies reported higher WOMAC scores as better. Once again, a meta-analysis showed no statistically significant difference between the stems (SMD 0.28, 95% CI -0.07-0.63, p = 0.12). Our systematic review showed no difference in PROMs between short and conventional stem total hip replacements. This is in keeping with previous evidence but is a more comprehensive analysis. Short stems may have an important role in younger individuals as they allow preservation of proximal femoral bone, minimal access surgery and are amenable to abnormal anatomy. The current literature is hindered by non-uniform methodologies and outcome assessments across studies. Further, standardised, high quality evidence is required before widespread changes in practice.

Wnt Inhibition Facilitates RNA-Mediated Reprogramming of Human Somatic Cells to Naive Pluripotency.

SummaryIn contrast to conventional human pluripotent stem cells (hPSCs) that are related to post-implantation embryo stages, naive hPSCs exhibit features of pre-implantation epiblast. Naive hPSCs are established by resetting conventional hPSCs, or are derived from dissociated embryo inner cell masses. Here we investigate conditions for transgene-free reprogramming of human somatic cells to naive pluripotency. We find that Wnt inhibition promotes RNA-mediated induction of naive pluripotency. We demonstrate application to independent human fibroblast cultures and endothelial progenitor cells. We show that induced naive hPSCs can be clonally expanded with a diploid karyotype and undergo somatic lineage differentiation following formative transition. Induced naive hPSC lines exhibit distinctive surface marker, transcriptome, and methylome properties of naive epiblast identity. This system for efficient, facile, and reliable induction of transgene-free naive hPSCs offers a robust platform, both for delineation of human reprogramming trajectories and for evaluating the attributes of isogenic naive versus conventional hPSCs.

IPSC-derived MSC therapy induces immune tolerance and supports long-term graft survival in mouse orthotopic tracheal transplants

BackgroundLung transplantation is a life-saving surgical replacement of diseased lungs in patients with end-stage respiratory malfunctions. Despite remarkable short-term recovery, long-term lung survival continues to face several major challenges, including chronic rejection and severe toxic side effects due to global immunosuppression. Stem cell-based immunotherapy has been recognized as a crucial immunoregulatory regimen in various preclinical and clinical studies. Despite initial therapeutic outcomes, conventional stem cells face key limitations. The novel Cymerus™ manufacturing facilitates production of a virtually limitless supply of consistent human induced pluripotent stem cell (iPSC)-derived mesenchymal stem cells, which could play a key role in selective immunosuppression and graft repair during rejection.MethodsHere, we demonstrated the impact of iPSC-derived human MSCs on the development of immune tolerance and long-term graft survival in mouse orthotopic airway allografts. BALB/c → C57BL/6 allografts were reconstituted with iPSC-derived MSCs (2 million/transplant/at d0), and allografts were examined for regulatory T cells (Tregs), oxygenation, microvascular blood flow, airway epithelium, and collagen deposition during rejection.ResultsWe demonstrated that iPSC-derived MSC treatment leads to significant increases in hTSG-6 protein, followed by an upregulation of mouse Tregs and IL-5, IL-10, and IL-15 cytokines, which augments graft microvascular blood flow and oxygenation, and thereby maintained a healthy airway epithelium and prevented the subepithelial deposition of collagen at d90 post transplantation.ConclusionsCollectively, these data confirmed that iPSC-derived MSC-mediated immunosuppression has potential to establish immune tolerance and rescue allograft from sustained hypoxic/ischemic phase, and subsequently limits long-term airway epithelial injury and collagen progression, which therapeutically warrant a study of Cymerus iPSC-derived MSCs as a potential management option for immunosuppression in transplant recipients.

Midterm outcomes of total hip arthroplasty with a modular Birmingham head.

Birmingham Hip Resurfacing (BHR) implants may be combined with a conventional femoral stem to create a modular metal-on-metal total hip arthroplasty (BHR MoM THA). There is little outcome data regarding this construct. This study examines midterm outcomes of BHR MoM THA compared to oxidised zirconium total hip arthroplasty (THA). A retrospective institutional review identified all patients receiving BHR MoM THA between April 2005 and February 2011 and a matched control cohort of zirconium THA patients. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and SF-12 Health status scores were obtained. Revisions and complications were collected from clinical records. Radiographs were assessed for evidence of component malposition, loosening, osteolysis, or heterotopic ossification. 63 modular BHR MoM THA were identified in 61 patients (36 with BHR cups, 27 with R3 cups) and 63 zirconium THA in 58 matched controls. Mean follow-up was 58 months. 14 BHR MoM THA hips (22.2%) were revised (4 infections, 1 dislocation, 9 soft tissue reactions) compared to 3 (4.8%) zirconium THA (all infections). At latest follow-up, 18.4% of surviving BHR MoM THA hips were painful compared to 0.5% of zirconium THA controls (p < 0.001). WOMAC, HHS, and SF-12 did not differ significantly between surviving members of the 2 groups. BHR MoM THA demonstrated a high revision rate, largely for adverse local soft tissue reaction and pain. Among those not revised, many reported some residual pain despite similar quality of life measures to those who received zirconium THA.

A Combined HOTS-Based Assessment/STEM Learning Model to Improve Secondary Students’ Thinking Skills: A Development and Evaluation Study

An integrated STEM education has been used for a long time to improve Higher Order Thinking Skills (HOTS) of students. This skills covered the capability to analyze, evaluate, and create which can be enhanced by implementing a right learning model, materials, and assessment. This study aims to develop and evaluate a combined HOTS-based assessment/STEM learning model to improve the students’ thinking skills. A proposed model was designed by following the seven steps of Borg &amp;amp; Gall research and development. The impact of this model was evaluated by analyzing the average gain of pretest-posttest and Tukey signification difference test compared to a conventional STEM model. The result showed a significant difference between two treatments (t-value = 4.63; p &amp;lt; 0.001). It also conform a better improvements of students’ thinking skills by our model based on the analysis of gain score distribution. Keywords: STEM learning model, HOTS-based assessment, research and development, secondary students

Epigenetic Regulation of Transition Among Different Pluripotent States: Concise Review.

The extraordinary progress of pluripotent stem cell research provides a revolutionary avenue to understand mammalian early embryonic development. Besides well-established conventional mouse and human embryonic stem cells, the discoveries of naive state human stem cell, two-cell-like cell, and the newly defined "extended pluripotent" stem cell and "expanded potential" stem cell with bidirectional chimeric ability have greatly broadened the horizons of more pluripotent states recaptured and maintained in dish, infinitely approaching the totipotent blastomere state. Although all these pluripotent cell types can self-renew and have the ability to differentiate into all the three germ layers, accumulating evidence suggests that these pluripotent states display distinct epigenetic characters. More strikingly, epigenetic reprogramming, including DNA methylation, histone modification, and chromatin remodeling, is required to reset the cell fate commitment, suggesting that epigenetic mechanisms may play an active and important role in the maintenance and transition among these pluripotent states. Here, we have reviewed studies on various pluripotent states, with a highlight on the epigenetic regulation during the interconversion. Stem Cells 2019;37:1372-1380.

Hematopoietic stem cell-independent hematopoiesis and the origins of innate-like B lymphocytes

The current paradigm that a single long-term hematopoietic stem cell can regenerate all components of the mammalian immune system has been challenged by recent findings in mice. These findings show that adult tissue-resident macrophages and innate-like lymphocytes develop early in fetal hematopoiesis from progenitors that emerge prior to, and apparently independently of, conventional long-term hematopoietic stem cells. Here, we discuss these recent findings, which show that an early and distinct wave of hematopoiesis occurs for all major hematopoietic lineages. These data provide evidence that fetal hematopoietic progenitors not derived from the bona fide long-term hematopoietic stem cells give rise to tissue-resident immune cells that persist throughout adulthood. We also discuss recent insights into B lymphocyte development and attempt to synthesize seemingly contradictory recent findings on the origins of innate-like B-1a lymphocytes during fetal hematopoiesis.

The Anti-Inflammatory, Anti-Oxidative, and Anti-Apoptotic Benefits of Stem Cells in Acute Ischemic Kidney Injury.

Ischemia-reperfusion injury (IRI) plays a significant role in the pathogenesis of acute kidney injury (AKI). The complicated interaction between injured tubular cells, activated endothelial cells, and the immune system leads to oxidative stress and systemic inflammation, thereby exacerbating the apoptosis of renal tubular cells and impeding the process of tissue repair. Stem cell therapy is an innovative approach to ameliorate IRI due to its antioxidative, immunomodulatory, and anti-apoptotic properties. Therefore, it is crucial to understand the biological effects and mechanisms of action of stem cell therapy in the context of acute ischemic AKI to improve its therapeutic benefits. The recent finding that treatment with conditioned medium (CM) derived from stem cells is likely an effective alternative to conventional stem cell transplantation increases the potential for future therapeutic uses of stem cell therapy. In this review, we discuss the recent findings regarding stem cell-mediated cytoprotection, with a focus on the anti-inflammatory effects via suppression of oxidative stress and uncompromised immune responses following AKI. Stem cell-derived CM represents a favorable approach to stem cell-based therapy and may serve as a potential therapeutic strategy against acute ischemic AKI.

Establishment of induced pluripotent stem cells from common marmoset fibroblasts by RNA-based reprogramming

The common marmoset (marmoset; Callithrix jacchus) shows anatomical and physiological features that are in common with humans. Establishing induced pluripotent stem cells (iPSCs) from marmosets holds promise for enhancing the utility of the animal model for biomedical and preclinical studies. However, in spite of the presence of some previous reports on marmoset iPSCs, the reprogramming technology in marmosets is still under development. In particular, the efficacy of RNA-based reprogramming has not been thoroughly investigated. In this study, we attempted RNA-based reprogramming for deriving iPSCs from marmoset fibroblasts. Although we failed to derive iPSC colonies from marmoset fibroblasts by using a conventional RNA-based reprogramming method previously validated in human fibroblasts, we succeeded in deriving colony-forming cells with a modified induction medium supplemented with a novel set of small molecules. Importantly, following one-week culture of the colony-forming cells in conventional embryonic stem cell (ESC) medium, we obtained iPSCs which express endogenous pluripotent markers and show a differentiation potential into all three germ layers. Taken together, our results indicate that RNA-based reprogramming, which is valuable for deriving transgene-free iPSCs, is applicable to marmosets.

Restoring femoral offset and leg length; the potential of a short curved stem in total hip arthroplasty

BackgroundTotal hip arthroplasty (THA) is a very successful procedure in orthopedics. Still polyethylene wear and gait deficits are limiting the clinical success.It is important to reconstruct leg length (LL) and femoral offset (FO) anatomically in order to have the best possible result of a THA. Gait deficits can arise due to leg length discrepancy as well as changes in the abductor moment arm. In THA, LL and FO are strongly determined by the orientation, size and geometry of the femoral stem. MethodsThis radio-anatomical study used the data of a prospective cases series of 112 patients who underwent 126 primary THAs and had completed a 1-year follow-up examination. FO and LL were compared between the conventional straight stem in vivo and a computed simulated implantation of a short curved stem, using the pre- and postoperative pelvic radiographs of the same patients. ResultsIn this simulation of the short curved stem statistically significantly restored native FO (p = 0.010) and LL (p = 0.000) better, compared to the conventional straight stem. ConclusionsThus, the short curved stem restores FO and LL better, and could potentially prevent gait deficits.

High contrast STEM imaging for light elements by an annular segmented detector

Annular bright-field scanning transmission electron microscopy (ABF STEM) has been actively used to directly observe the light element atoms inside materials and devices. However, the detector angle condition for conventional ABF STEM has been empirically selected and thus is not always optimized for observing ultra-light element atoms such as hydrogen and lithium atoms. In this study, the detector conditions for ABF STEM were reexamined by calculating a new type of phase contrast transfer function (PCTF) for an annularly segmented detector to maximize the image contrast of ultra-light element atoms such as lithium. Using this new PCTF, an improved detector geometry for observing lithium atoms is demonstrated, which is confirmed by the image simulations and experiments in several types of lithium cathode materials.

Non-fracture stem vs fracture stem of reverse total shoulder arthroplasty in complex proximal humeral fracture of asian elderly.

Fracture stem of the reverse total shoulder arthroplasty (RTSA) was designed for better tuberosity bone healing for the proximal bone defect of complex proximal humeral fractures (PHF). Our purpose was to compare the clinical and radiological outcomes of patients using fracture stem vs non-fracture (conventional) stem of RTSA in complex PHF of elderly patients. Between 2008 March and 2017 June, 48 patients who had undergone an RTSA with non-fracture or fracture stem for complex PHF with a minimum 18months of follow-up were evaluated. Finally, total 45 patients with a mean age of 80 ± 7years (65-92years) were enrolled because three patients were excluded due to age related mortality. We divided them into two groups: 25 patients using non-fracture stem (non-fracture stem group) in the early period of this study, and consecutive 20 patients using fracture stem (fracture stem group) in the later period. Between two groups, we compared clinical and radiologic outcomes such as tuberosity failure, heterotopic ossification (HO), dislocation, acromion fracture, notching, loosening and periprosthetic fracture. In all patients, clinical outcomes were improved significantly and tuberosity failure was found in 62% (28/45). Between two groups, there were no statistically significant differences on clinical outcomes and radiologic outcomes except UCLA score. As complications, two humeral stem revision was performed due to tuberosity failure related HO and stem loosening with subsequent periprosthetic fracture in non-fracture stem group. Compared to non-fracture stem, fracture stem usage of RTSA in complex PHF of elderly patients has no significant different impact on clinical and radiological outcomes. However, tuberosity failure related secondary HO of non-fracture stem might be responsible for stem loosening and periprosthetic fracture in the RTSA for complex PHF of elderly patients. Level IV, case series study.

Techniques of Insertion and Early Clinical Impressions with a Short Curved Tissue Sparing Implant for Total Hip Arthroplasty (The French Experience)

Background: Total hip arthroplasty (THA) is one of the most effective orthopedic procedures, providing consistently high success rates across all population segments as measured by pain relief, improved function, and patient satisfaction. However clinical outcomes have been less favorable in young active patients, that lead to the re-development of metal on metal hip resurfacing (HR), with the most successful being the Birmingham Hip Replacement (BHR) introduced in 1997. Evolving complications due to increased metal ion debris has lead to a great reduction of use for all metal on metal (MOM) HR designs, leading many surgeons and patients to look for an alternative surgical selection. This search has focused on the development and use of short stems for THA. One such style of short stems is curved neck preserving designs. This paper will review our French experience with one of those designs.Materials and Methods: This is a retrospective review of four surgeons series of a short curved tissue sparing cementless femoral implant (TSI™ Hip Stem, Signature Orthopaedics) for THA. The femoral component was used with two different cementless acetabular styles (Mathys RM Pressfit, and Zimmer Biomet Allofit®). Results on the cups will not be revived in this paper. 150 TSI™ Stems by four surgeons at the same institution utilizing the posterior surgical approach since September 2016. 40% women, average age 66 years with extremes of 27 to 78 years. 10 cases of dysplastic hips, 6 cases of aseptic osteonecrosis, 1 fracture, 1 rheumatoid coxitis, and the rest primary coxathosis, with 7 patients operated on both hips at the same time. 23.3 % have been Dorr type A canal shape.Results: There has been no aseptic loosing, three femoral components have been explanted due to postoperative infection. There was one intra-operative femoral distal fracture in a Dorr type A bone profile during stem insertion. One posterior dislocation; there has been two patients with thigh pain with pathological bone scan, and one with low back pain and no leg length discrepancies greater than plus or minus 5 mm.Conclusion: This short curved tissue sparing implant has demonstrated excellent initial short-term results, with excellent implant stability, excellent medial calcar bone remodeling with one dislocated stem, two thigh pain and one patient with low back pain. One distal intra-operative fracture in a Dorr type A bone. This has now been addressed with the use of distal sizing gauges and the use of flexible reamers to open the distal canal prior to stem insertion. Removal of the infected stems demonstrated implant stability with early bone attachment in the proximal porous surface. The high neck resection allows for ease of revision and conversion implanting a new primary conventional length cementless stem design.There is a short but definitive learning curve in fitting the implant to the femoral neck versus the standard metaphyseal and diaphyseal conventional style stems.

Secondary osteoarthritis hip in young individuals managed with primary uncemented total hip replacement using ha-coated conventional stem and acetabular component

Background: The management of young individuals seeking medical attention due to progressive hip pain as a result of secondary osteoarthritis and who want active and pain-free hip was challenging in past. The actual incidenece of secondary osteoarthritis is difficult to ascertain. Young individuals with secondary osteoarthritis hip due to developmental dysplasia of hip, coxa plana (Legg-Calvé-Perthes disease), post-traumatic, slipped capital femoral epiphysis, Paget disease, Haemophilia, Avascular necrosis of femoral head, and so on can be effectively managed with primary uncemented total hip replacement (THR) with good functional outcome in short-term follow-up. This will increase the revision THR rate later. Long-term follow-up is required to watch for prosthesis-related complications Materials and Methods: Material includes 64 patients who attended our OPD from Oct 2013 to Dec2017 and all of them were diagnosed to have secondary osteoarthritis hip with poor hip function as assessed by Harris hip score. All of them underwent uncemented total hip replacement (THR) through posterior/anterolateral approach to hip. Conventional HA-coated stem and acetabular components were used. They were post-operatively assessed at regular intervals with Harris hip score and were found to have excellent functional outcome with high level of patient satisfaction. Result: All patients have excellent Harris hip scorepost-operatively. Patients became independent and were able to carry out day-to-day activities with ease. No complications were noticed. The dramatic change in their hip function was appreciable even on the day of surgery itself. Conclusion: We conclude that uncemented THR using conventional HA-coated components is an excellent surgical modality for the management of secondary osteoarthritis in young individuals with poor hip function. The functional outcome is promising and makes patient independent and pain free. The said procedure is cost-effective and reliable based on excellent hip function achieved in immediate post-operation. Long-term follow-up is recommended.