Bone Coverage Research Articles

Comparing Three-dimensional Radiologic Outcomes Between Early Versus Late Secondary Alveolar Bone Grafting.

Secondary alveolar bone grafting (SABG) during mixed dentition is the standard of care for patients with complete cleft of lip and palate. Early SABG (E-SABG; 4 to 7y) occurs before the eruption of lateral incisors, whereas late SABG (L-SABG; 8 to 12y) occurs before the eruption of maxillary permanent canines. This study compares outcomes of E-SABG versus L-SABG among patients with unilateral cleft of lip and palate (UCLP). A prospective cohort study was conducted evaluating nonsyndromic patients with UCLP who underwent SABG from April 2018 to January 2020, 48 consecutive patients with UCLP were included. Preoperative and 6 to 10-month postoperative cone beam computed tomography imaging were obtained to assess graft and periodontal outcomes. Among 48 patients with UCLP, of which 21 were in the E-SABG group (6.9 ± 1.1y), and 28 were in the L-SABG cohort (10.4 ± 1.6y). The initial alveolar cleft width is significantly smaller in the E-SABG cohort compared with the L-SABG cohort (5.1 ± 1.5 versus 6.5 ± 2.0mm, P = 0.008). Compared with the L-SABG cohort, the E-SABG cohort had higher rates of bony bridge formation (77.3% versus 65.4%, P= 0.367), thicker bony bridges (5.7 ± 2.1 versus 3.9 ± 1.5mm, P= 0.004), lower Bergland scores [1.5 (interquartile range: 1 to 2) versus 2.25 (interquartile range: 1.5 to 3.5), P= 0.026], and greater alveolar bone coverage (79.8 ± 16.7% versus 67.9 ± 18.1%, 0.024). The authors' findings suggest that patients who undergo E-SABG at ∼7 years may have better graft outcomes and benefits to the periodontal bone support on cleft-adjacent incisor compared with L-SABG at 11 years.

Impacted third molar surgery in older patients—Is patient´s age really a risk factor for complications?

ObjectivesThe aim of this study was to analyze the influence of patients´ age on perioperative complications in impacted third molar surgery and how established risk factors are affected by age.Materials and methodsThe clinical findings, digital panoramic radiographs and perioperative data of 200 patients (554 impacted third molars) that had been subjected to tooth extraction, from July 2023 until July 2024, were analyzed. Perioperative complications (Inferior alveolar nerve (IAN) hypesthesia, oroantral communication (OAC), lingual nerve (LN) hypesthesia, postoperative bleeding, postoperative infection) as well as impaction patterns and risk factors (angulation type, bone coverage, depth- and risk scores) were analyzed by age (cut-off 30 years).ResultsThe population was divided into two groups by age (Group A = ≥ 30 years (n = 52) vs. Group B = < 30 years (n = 148)). Upper third molars showed significantly deeper bone coverage, higher depth scores, higher risk scores and different angulation types in patients aged < 30 years. Mandibular third molars showed significantly deeper bone coverage, higher depth scores, higher risk scores according and different angulation types in patients aged ≥ 30 years. However, IAN hypesthesia, LN hypesthesia, postoperative bleeding and postoperative infection did not show any significant differences regarding patients’ age.ConclusionThe current findings suggest that age (cut-off 30 years) does not statistically correlate with a higher risk for postoperative complications in impacted third molar surgery in contrast to recent publications.Clinical relevanceIn contrast to recent publications, the present study falsified a positive correlation between patients’ age and the occurrence of postoperative complications in impacted third molar surgery. Therefore, other risk factors should be investigated in order to minimize these procedure specific complications.

Midterm Results of Severe Hip Dysplasia after Using a Cementless Acetabular Component with Bulk Bone Graft in Total Hip Arthroplasty: A Minimum Five-Year Follow-Up Study.

In patients with severe hip dysplasia, total hip arthroplasty (THA) using bulk bone graft (BBG) enhances anatomic cup positioning and provides early structural support. This study assesses the mid-term outcomes of THA with BBG in patients with over 50% graft bone coverage. Among 1951 patients who underwent THA between 2003 and 2007, 183 had BBG. After excluding early dropouts and infections, 151 patients remained. They were classified into uncovered (<50% coverage, 79 patients) and covered (>50% coverage, 72 patients) groups. The efficacy of cup fixation was compared between these groups. After ten years, the survival rate for not needing THA revision was 98% in the uncovered group and 100% in the covered group, while the rate for radiographic stability was 93% versus 99%, respectively. Although the cutoff value for the uncovered portion could not be clarified in this study, the mid-term results for 50% to approximately 70% uncovered were comparable to those for 50% or lesser, which have previously been expected to perform well. Recently, biomechanically advantageous bone grafting techniques have been identified, and based on the results of this study, it may be possible to expand the indications for THA with bone grafting for developmental dysplasia of the hip.

Assessment of Incomplete Apical Bone Coverage of Maxillary Premolar and Molar Roots Using Cone Beam Computed Tomography in 161 Dogs.

This retrospective study assessed maxillary premolar and molar teeth and identified roots with incomplete apical bone coverage using cone beam computed tomography in 161 dogs. The associated dorsal anatomic sites that the roots communicated with were the ventral nasal meatus, maxillary recess, infraorbital canal, and pterygopalatine fossa. The study found that all roots of the maxillary premolar and molar teeth have the potential for incomplete apical bone coverage, with 26.7% having incomplete apical bone coverage. No significant association with sex was found. A significant association with weight was found, and this lowered with increasing body weight. Facial index, as a determinate of skull shape, was found to be significant in only 35.7% of roots in univariate and 14.2% of roots in multivariate modeling. Knowledge of the anatomy of these roots plays an important role in safe and effective extraction techniques, in reducing iatrogenic trauma, and in understanding the potential local effects of periodontal and endodontic disease.

Nanosilicate-reinforced GelMA-PEGDA hydrogel promotes angiogenesis for bone regeneration

Bone tissue engineering has emerged as a pivotal field addressing the critical clinical needs of bone fractures. This study focused on developing multi-composite hydrogels by synergizing biocompatible GelMA macromolecules with synthetic PEGDA and reinforcing them with nanosilicates (SN). The incorporation of SN introduces crucial trace elements such as silicon, magnesium, and lithium, promoting both angiogenesis and osteogenesis. Characterizations revealed that PEGDA significantly reinforced the composite hydrogels' stability, while SN further enhanced the mechanical integrity of the GelMA-PEGDA-SN (GPS) hydrogels. Cell studies designated that GPS improved cell proliferation and migration, angiogenic VEGF/eNOS expression and osteogenic differentiation. In vivo experiments showed that GPS hydrogels effectively enhanced calvarial bone healing, with the GPS-2 formulation (2 % SN) displaying superior bone coverage and increased vascular formation. Assessments of osteogenic formation and the angiogenic marker CD31 validated the comprehensive bone regeneration potential of GPS hydrogels. These findings highlight the significant promise of GPS hydrogels in fostering bone healing with promoted angiogenesis.

Prevalence and Associated Factors of Nonunion in Open Tibial Shaft Fracture among Patients Treated with External Fixation in Tibebe Ghion Specialized Hospital

Background: The definitive treatment of open tibial shaft fractures remains challenging and nonunion after treatment of open tibial shaft fractures with external fixation complicates a significant proportion of cases. There are varying rates of occurrence of nonunion and the prevalence is not well known in Ethiopia. The objective of the study is to assess the prevalence and associated factors of nonunion in open tibial shaft fractures treated with EX FIX in TGSH. Methods: The study was conducted using a cross-sectional study in patients with open tibial shaft fractures who were admitted and treated with external fixation in the Tibebe Ghion Specialized Hospital orthopedics department from January 1, 2019, to January 29, 2021. The study involved 75 patients, which was the total number of cases in the study period and fulfilled the inclusion criteria. Bivariate and multiple variable logistic regression analyses were used to analyze the association between variables. The degree of association between variables was determined at the p-value of &lt;0.05. Results: The overall prevalence of nonunion in open tibial shaft fractures treated with external fixation in TGSH was 21.3%. The severity of the injury, presence of wound infection, and treatment factors affect the occurrence of nonunion. It occurs in 9 of 19 (47.4%) Gustilo-Anderson grade IIIB fractures and 6 of 48 (12.5%) Gustilo-Anderson grade IIIA fractures. A delay in soft tissue covering of Gustilo-Anderson grade IIIB fracture of 15 days or more increases the nonunion rate to 72.7%. Nonunion occurred in 41.7% of cases with SSI and 11.8% of cases without SSI. Gustilo-Anderson grade (AOR=4.85, CI 95%: 1.31-18.01), surgical site infection (AOR=4.12, CI 95%: 1.11-15.26), and time until coverage of bone of Gustilo-Anderson grade IIIB fracture (AOR=18.23, CI 95%: 1.17-284.8) have statistically significant association with nonunion. Conclusion and Recommendation: External fixation use for definitive treatment of open tibial fractures should be disfavored as the prevalence of nonunion in open tibial shaft fractures treated with EX FIX is higher than other previous studies done in European and Asian countries. Gustilo-Anderson grade of injury, surgical site infection, and time from injury to bone coverage of Gustilo-Anderson grade IIIB fractures were found to be statistically significantly associated with the occurrence of nonunion. Therefore, attention should be given to early soft tissue reconstruction of exposed bones to establish a favorable environment for bone healing and to make treatment with internal fixations possible. Better management of wounds to minimize surgical site infections is required for better healing of open tibial shaft fractures. Prospective studies are also recommended on the issue.

Personalized digital simulation‑assisted acetabular component implantation in revision hip arthroplasty.

The number of artificial total hip revision arthroplasties is increasing yearly in China, and >50% of these cases have acetabular defects. Accurately locating and quantifying the bone defect is one of the current challenges of this surgery. Thus, the objective of the present study was to simulate acetabular implantation with the aid of Mimics 17.0 software (Materialise NV) in patients with loosened acetabular prosthesis, to evaluate the 'ideal acetabular center' and the 'actual acetabular center' to guide the choice of prosthesis and surgical method. From January 2017 to June 2021, the present study included 10 hips from 10 patients [seven men (seven hips) and three women (three hips)]. In all patients, the Mimics software was applied to simulate the dislocation of the femoral prosthesis and acetabular prosthesis implantation before surgery; calculate the height difference between the 'ideal acetabular center' and the 'actual acetabular center' to assess the bone defect; confirm the size of the acetabular prosthesis, abduction angle, anteversion angle and bone coverage of the acetabular cup; and measure the intraoperative bleeding and postoperative follow-up Harris score of the hip joint. After statistical analysis, the present study revealed that digital simulation assistance could improve the accuracy of hip revision acetabular prosthesis implantation, reduce postoperative shortening of the affected limb, especially for surgeons with relatively little experience in hip revision surgery, and greatly reduce the occurrence of complications such as hip dislocation because of poor postoperative prosthesis position.

Risk factor analysis for perioperative complications in impacted third molar surgery - a single center experience.

The surgical removal of impacted third molars is usually carried out by an oral/maxillofacial surgeon. Two specific risks of surgical removal of impacted third molars are oroantral communication (OAC) when extracting ​​upper third molars and hypesthesia of the inferior alveolar nerve (IAN) ​​when extracting lower third molars. The aim of this study is to determine the distribution of complications in deeply impacted third molar surgery, to identify specific risk factors influencing the most common perioperative (OAC, IAN hypesthesia) and to compare these results with other studies. The clinical findings, digital panoramic radiographs, intra- and postoperative data of 80 patients with a total of 232 impacted third molars that had been subjected for tooth extraction, from December 2022 and August 2023, were collected and analyzed. Perioperative complications (IAN hypesthesia, OAC, hypesthesia lingual nerve, postoperative bleeding, postoperative infection) were identified. A risk analysis for OAC and IAN hypesthesia was performed regarding perioperative data. Overall, the rate of OAC for the right upper third molar was 12.8% and for the left upper third molar 15.6%. The complication rates regarding transient hypesthesia were 8.1% for the left IAN and 7.3% for the right IAN. The distance to maxillary sinus, the depth score according to Pell and Gregory, the bone coverage score, the operation time, the tooth's angulation and the type of surgeon (oral surgeon, DMD) were identified as significant risk factors for the occurrence of OAC. The minimum distance to IAN, the bone coverage score, the total operation time and the operation by an oral surgeon (DMD) were identified as significant risk factors for hypesthesia of the IAN. Next to the risk factors from above, the present study is one of the first showing that patients who were primarily operated on by an oral surgeon (DMD) and not a maxillofacial surgeon (MD, DMD) showed higher rates of OAC and IAN hypesthesia in impacted third molar extraction. The results of this study can serve as a baseline for further studies to investigate complication patterns in impacted third molar surgery.

Computer simulation study of cementless cup placement for dysplastic hip osteoarthritis using subluxation percentage of Crowe classification.

It is often difficult to achieve adequate bone coverage of the cup in total hip arthroplasty in cases of severe developmental dysplasia of the hip (DDH). This study aimed to evaluate the relationship between subluxation percentage of Crowe classification and cup center-edge (cup-CE) angle to investigate whether subluxation percentage according to the Crowe classification is a useful indicator for cementless cup placement. Cementless cup placement was simulated in 77 women with DDH in 91 hips (Crowe I, 35 hips; Crowe II, 35 hips; and Crowe III, 21 hips) using computed tomography-based computer simulation software. The cups were placed at the anatomic hip center (AHC) and 10-mm high hip center (HHC). The relationship between the subluxation percentage and cup-CE angle was evaluated using Spearman's rank correlation coefficient. In addition, the cutoff values for the subluxation percentage that satisfied a cup-CE angle ≥0° were determined using the receiving operating characteristic curve. The cup-CE angle was negatively correlated with the subluxation percentage in both AHC and 10-mm HHC (correlation coefficient ρ = -0.542 [p < 0.01] and -0.704 [p < 0.01], respectively). The cutoff values for subluxation percentage that satisfied a cup-CE angle ≥0° were 56.1% and 73.6% for AHC and 10-mm HHC, respectively. Cementless cup placement in AHC is difficult in cases with the subluxation percentage ≥56.1%, and HHC reconstruction or femoral structural autograft technique should be considered as an alternative. Moreover, placement at 10 mm above AHC is difficult in cases with subluxation percentage ≥73.6%.

[Translated article] Total hip arthroplasty with shelf acetabuloplasty in dysplastic coxarthrosis, mean follow-up of 7 years

IntroductionDevelopmental dysplasia of the hip is the cause of approximately one third of secondary coxarthrosis. Anatomy alterations make it difficult to place a total hip prosthesis in its anatomical position and for it to be stable in the long term; there are several techniques to achieve this goal. In the present work, we used autograft of the femoral head (shelf graft or reinforced roof), to improve the coverage of the acetabular component with favourable results. Materials and methodsSixteen cases were included in 14 patients with a diagnosis of developmental dysplasia of the hip (13 women and one man), the mean age was 44.3 years (range 35–68 years), with a mean follow-up of 7 years (range 1–15 years). All the cases were evaluated clinically and radiographically, to demonstrate the osseointegration of the graft and the functional results in the medium term. ResultsAll the acetabular components were placed in anatomical position (Ranawat technique), the mean percentage of host bone coverage was 54.53% (range 43.28–79.05%), obtaining additional coverage with the bone graft of 45.13%. Osseointegration of the graft of 100% at 12 weeks, resorption of the graft from the sixth month, stabilising in the third postoperative year. Only one case of dislocation is reported, no cases of infection, loosening, heterotopic ossification or revision. ConclusionThis procedure has shown good functional results in the medium term with 100% osseointegration, despite cases of severe bone resorption of the graft that does not compromise the stability of the prosthesis.

Distribution and impaction patterns of third molars in a sample of German population: Retrospective analysis in a high turnover maxillofacial department

BackgroundThe surgical removal of impacted third molars is considered a routine procedure for oral and maxillofacial surgeons. However, the distribution of impacted molars varies among different populations. A study into impaction patterns in the German population is currently not described. The aim of this retrospective study is to determine patterns of impacted third molars in a sample of German population, to identify gender and age specific differences as well as further risk factors for impacted molar extraction and to compare these results with other studies. Materials and methodsThe clinical findings and digital panoramic radiographs of 84 patients with a total of 243 impacted third molars that had been subjected for tooth extraction, from January to September 2023, were collected and analyzed. All third molars were analyzed according to Winter´s angulation, Pell and Gregory Score of depth and relationship to ramus. Furthermore, inferior alveolar nerve and maxillary sinus proximity were identified through a newly developed risk score and an analysis of patient´s gender and age regarding impaction patterns was performed. ResultsNo significant gender specific differences were found regarding the impaction patterns. Third molar angulations significantly differed regarding patient´s age (cut-off 26 years). In comparison, third molar depth, bone coverage, nerve approximity and angulation patterns differed from the results of other populations. ConclusionThe results of this study can serve as a baseline for further studies of third molar impactions in the German population to minimize perioperative complications in impacted third molar surgery.

Tomographic diagnosis of alveolar bone coverage impact in orthodontic planning: cross-sectional study.

Alveolar bone coverage can be diagnosed through cone beam computed tomography (CBCT) and this information can prevent orthodontic tooth movement beyond the biological limit. This study evaluated the impact of the bone coverage (BC) diagnosis by CBCT in the orthodontists' planning. One hundred fifty-nine Brazilian orthodontists suggested treatment plans for six patients at two different times, using two sequential questionnaires. The first questionnaire consisted of extra and intra-oral photographs, one panoramic radiograph; one lateral cephalometric radiograph with Steiner and Tweed analysis, and the patient chief complaint. The second questionnaire included the same presentations of cases with tomographic images and the radiologist's report. The McNemar test assessed the difference between the first and the second treatment plans. In all six cases, most participants changed the treatment plan after evaluating the CBCT images and the radiologist's report (93.7% in case 5, 78.6% in case 4, 74.2% in case 3, 69.8% in case 6, 66% in case 2 and 61% in case 1; p≤0.01). The evaluation of bone coverage through CBCT images has a substantial impact on the orthodontic diagnosis and planning of the Brazilian orthodontists.

Reducing the prosthesis modulus by inclusion of an open space lattice improves osteogenic response in a sheep model of extraarticular defect.

Introduction: Stress shielding is a common complication following endoprosthetic reconstruction surgery. The resulting periprosthetic osteopenia often manifests as catastrophic fractures and can significantly limit future treatment options. It has been long known that bone plates with lower elastic moduli are key to reducing the risk of stress shielding in orthopedics. Inclusion of open space lattices in metal endoprostheses is believed to reduce the prosthesis modulus potentially improving stress shielding. However, no in vivo data is currently available to support this assumption in long bone reconstruction. This manuscript aims to address this hypothesis using a sheep model of extraarticular bone defect. Methods: Initially, CT was used to create a virtual resection plan of the distal femoral metaphyses and to custom design endoprostheses specific to each femur. The endoprostheses comprised additively manufactured Ti6Al4V-ELI modules that either had a solid core with a modulus of ∼120GPa (solid implant group) or an open space lattice core with unit cells that had a modulus of 3-6GPa (lattice implant group). Osteotomies were performed using computer-assisted navigation followed by implantations. The periprosthetic, interfacial and interstitial regions of interest were evaluated by a combination of micro-CT, back-scattered scanning electron microscopy (BSEM), as well as epifluorescence and brightfield microscopy. Results: In the periprosthetic region, mean pixel intensity (a proxy for tissue mineral density in BSEM) in the caudal cortex was found to be higher in the lattice implant group. This was complemented by BSEM derived porosity being lower in the lattice implant group in both caudal and cranial cortices. In the interfacial and interstitial regions, most pronounced differences were observed in the axial interfacial perimeter where the solid implant group had greater bone coverage. In contrast, the lattice group had a greater coverage in the cranial interfacial region. Conclusion: Our findings suggest that reducing the prosthesis modulus by inclusion of an open-space lattice in its design has a positive effect on bone material and morphological parameters particularly within the periprosthetic regions. Improved mechanics appears to also have a measurable effect on the interfacial osteogenic response and osteointegration.

Masquelet Technique: Visualization of Cement Spacer Utilizing Methylene Blue

Masquelet Technique: Visualization of Cement Spacer Utilizing Methylene Blue

Auto-dentin platelet-rich fibrin matrixis an alternative biomaterial for different augmentation procedures: A retrospective case series report.

Autologous dentin grafts derived from extracted teeth have shown promise as bone graft materials for promoting bone regeneration. This retrospective case series aimed to evaluate clinical, radiographic, and histologic outcomes of using autologous dentin matrices in various bone regeneration procedures. This case series included 26eligible patients and encompassed 4 socket preservation cases, 5 cases of guided tissue regeneration, 5 cases of guided bone regeneration (GBR), 10 cases of sinus augmentation procedures, 2 immediate placement implants, and 2 socket shields. Dentin grafts were prepared from extracted teeth, cleaned, and processed. These grafts were combined with platelet-rich fibrin (PRF) to create adhesive dentin matrices, then covered with collagen membranes for simultaneous guided bone augmentation cases. Cone beam computed tomography (CBCT) scans were conducted before surgery and 4 months postoperatively to assess ridge dimensions. Histologic evaluation was performed through bone core biopsies for socket preservation cases at the 4-month mark. A total of 42implants were placed in 26 patients, with an average follow-up of 32 months. Notably, two implant failures occurred following lateral maxillary sinus augmentation. CBCT scans at the 4-month interval revealed bone coverage over implant platforms in the majority of cases. Histologic analysis from two cases of socket preservation demonstrated dentin granules enveloped by newly formed bone undergoing continuous remodeling. The quantitative histomorphometric assessment revealed a bone area of 42.8 ± 3.56%, a remaining graft area of 19.05 ± 4.58%, and a viable bone of 38.15 ± 7.84%. The utilization of autologous dentin particles mixed with PRF proved effective as an alternative to conventional bone graft materials in GBRand maxillary sinus augmentation procedures. Larger controlled clinical trials are recommended to further substantiate these findings.

Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty using a Revision Ankle System

Category: Ankle Arthritis; Ankle Introduction/Purpose: With the growing popularity of total ankle arthroplasty (TAA), revision surgeries are inevitable and expected to significantly increase over the next decade. Revision TAA remains a significant challenge with high complication rates. No previous study has reported on outcomes following revision TAA using an implant designed specifically for revisions. Theoretical benefits of a revision-specific ankle system include tibial and talar fixation/stability, restoration of joint height, coverage of bone loss/defects, and maximal talar coverage. The purpose of this study was to investigate radiographic and clinical outcomes at a minimum of 2 years following revision TAA using a revision-specific ankle system. Methods: Patients who underwent a revision TAA using a revision-specific ankle system (Invision, Stryker, Kalamazoo, MI) between January 2016 and December 2020 were eligible to be included in this study. Patients with less than 2-year follow-up and unwilling to return to clinic were excluded. Overall, 25 patients met inclusion criteria. Indications for revision TAA (Table 1) included talar loosening (n = 6), tibial loosening (n = 7), talar subsidence (n = 6), re-implant after infection (n = 4), instability (n = 3), periprosthetic fracture (n = 2), and severe osteolysis (n = 2). Medians and interquartile ranges (IQRs) were reported since the data was not normally distributed. Clinical and radiographic outcomes, complications, reoperations, and implant survival was recorded. Results: Implant survival was noted in 80% of patients (20/25) at a median of 3.8 years following revision TAA. Index revision was most commonly performed for implant loosening (tibia 28%, talus 24%), talar subsidence (24%), or re-implant after infection (16%). Foot and Ankle Ability Measure (FAAM) Activities of Daily Living and Sports scores were 53.9 (IQR 46.4, 71.4) and 37.5 (IQR 21.9, 46.9), respectively at final follow-up. There was evidence of talar loosening in 3 patients (12%) and talar subsidence in 5 patients (20%) on final radiographs. Reoperation rate at final follow-up was 48%, most commonly for talar loosening/subsidence (n= 2), tibial loosening (n = 3), septic TAA (n = 1), medial/lateral gutter impingement (n = 2), and instability (n = 2). Conclusion: At a minimum follow-up of 2 years, 80% of patients retained their metal revision TAA, but reoperation rates were high with 48% of patients requiring an additional procedure most commonly for implant loosening, talar subsidence, gutter impingement, or instability. Revision TAA using a revision-specific ankle system is a viable option for patients with a failed TAA. Physicians and patients should be aware that revision TAA remains a significant challenge with a high risk of complication and reoperation rates.

The Validation of Two-Dimensional and Three-Dimensional Radiographic Measurements of Host Bone Coverage in Total Hip Arthroplasty for Hip Dysplasia: A Comparison with Intra-Operative Measurements.

Several methods have been introduced to measure the host bone coverage of the acetabular component after total hip arthroplasty (THA). The aims of this study were (1) to validate two-dimensional- and three-dimensional-based host bone coverage measurements by comparing intra-operative measurements, and (2) to determine the minimum host bone coverage for achieving stable cup fixation after THA in hip dysplasia. The clinical outcomes of each patient were evaluated during their final follow-up period using the Harris Hip score (HHS). The coverage of the host bone was analyzed by comparing 2D-based, 3D-based, and intraoperative assessments. The mean HHS was increased significantly from 60.84 ± 14.21 pre-operatively to 93.13 ± 4.59 (p < 0.0001). The host bone coverage ratio measured intraoperatively was 83.67 ± 3.40%, while the ratio measured by 3D CT reconstruction was 82.72 ± 3.59%. There was a strong positive correlation between the intra-operative host bone coverage and the 3D-based one (r = 0.826, p < 0.0001). It is recommended that 3D-based measurements are used to evaluate the host bone coverage after THA in patients with hip dysplasia. In addition, achieving a minimum host bone coverage of 75% is recommended for the attainment of stable cup fixation.

Tibial implant design in primary TKA: retrospective comparison of two designs for the occurrence of radiolucent lines and aseptic loosening.

The purpose of this retrospective study was to study the effect of tibial implant design on the occurrence of radiolucent lines (RLLs) and aseptic loosening (AL) by comparing two different total knee arthroplasty (TKA) designs. Two types of total knee arthroplasty,different for tibial shape, size andkeeldesign were compared, 255 for the first and 774 for the second. The occurrence of RLLs and radiological signs of micro- and macro-mobility and aseptic looseningwas analyzed. Demographic data were compared, as well as the type and rate of RLLs, occurrence of aseptic loosening and the presence of potential risk factors. The first implant designis morphometric and has a squarer keel than the second implant TKA. The overall rate of RLLs was similar(21%vs 23%), despite of a significantly lower rates of radiological signs of macro-mobility of the tibial component with the first implant(2% vs 17%). Survivorship of both designs was overall comparable(99.6% vs 98.8 %) the first implantgroup had more potential risk factors for poor bone quality than the secondgroup (p<0.05). A morphometric design is more anatomic and offers better bone coverage of the epiphyseal tibial surface. RLLs, as a sign of implant micro-mobility, were equally present in both designs. Radiological signs of macro-mobility at the metaphysiswere less frequently observed in squared keel design. The morphometric implant did not show improved survivorship compared with a symmetric implant. III.

Highly Malleable Personalized Prostheses with Hierarchical Microstructure Boost the Long‐Term Osteointegration in Irregular Craniofacial Reconstruction

AbstractThe desired clinical bone prostheses should achieve satisfactory interface integration and osteoinduction, as well as good surgical convenience. Here, a highly malleable 3D printed prosthesis with compressive strength at 13 MPa is constructed by dopamine, polyvinyl alcohol, and micro‐sized hydroxyapatite (86 wt%) as composite bioinks, which is endowed with good plasticity and can quickly match irregular defects by easily trimming. Spatially decorated collagen and hyaluronan greatly enriched the hierarchical microstructure and biological activity of malleable prosthesis. This prosthesis accelerates the proliferation and osteogenic differentiation of stem cells, regulates M2 polarization of macrophage, and promotes endogenous stem cell recruitment and early angiogenesis. Meanwhile, it significantly reinforces biomineralized deposition and vascularization, reaches full coverage of new bone in the rabbit cranial defect after 15 weeks (Φ = 10 mm), and achieves well osseointegration capacity with interfacial binding strength at 71.2% of the natural skull. This osteoinductive prosthesis provides a new design idea for bone filling.

MDCT of Dehiscent or Thin Bone Coverage over the Superior Semicircular Canal: Assessment of Prevalence by Age and Contralateral Canal Bone Thickness

Objective: Superior semicircular canal dehiscence (SSCD) describes the presence of a defect in the superior bone coverage of the membranous SSC. The etiology of the defect is not known and its reported CT prevalence is variable. This study primarily aimed to report MDCT prevalences of SSCD and thin bone coverage over SSC among different age groups. A secondary aim was to assess for any association between SSCD and the thickness of contralateral bone coverage over SSC.&#x0D; Materials and Methods: Temporal bone MDCTs were retrospectively evaluated for SSCD and the thickness bone coverage over SSC. The prevalences of SSCD and thin bone coverage over SSC among different age groups, and the thickness of bone over SCC in SSCD and non-SSCD subjects were analyzed.&#x0D; Results: 509 subjects were included in the study. Age-adjusted models did not demonstrate a significant association between the age groups and the prevalence of SSCD (p=0.63) or between the age groups and the prevalence of thin bone coverage over SSC (p=0,81). Unilateral SSC roof thickness of ≤ 0.5 mm was significantly associated with increased prevalence of contralateral SSCD (p=0.05 and p=0.04). In subjects without radiological evidence of SSCD, right-or left-sided thin bone coverage over SSC was significantly associated with contralateral thin bone coverage (p