Femur Research Articles

Associations of Habitual Skeletal Loading with Bone Changes During the Menopausal Transition: A Follow-up Study.

While weight-bearing physical activity (PA) benefits bone health, it remains unclear whether PA can counteract hormone-driven menopausal bone deterioration. This secondary analysis of a population-based prospective follow-up study examined changes in bone health indicators around menopause and evaluated whether accelerometer-measured habitual skeletal loading is associated with these changes. A total of 189 initially perimenopausal women without estrogen therapy (mean age 52 [SD 2] years) were followed until they became postmenopausal (mean follow-up time 15 [9] months). Femoral neck bone mineral density (FN BMD) and bone mineral content (BMC) were measured with dual x-ray absorptiometry (DXA). Femoral and tibial shaft volumetric BMD (vBMD), cross-sectional geometry, and stress-strain index (SSI) were assessed using quantitative computed tomography (QCT) in a subset of 61 women. Habitual skeletal loads (mean daily osteogenic index [OI] and low, medium, and high-intensity impact counts) were evaluated with multiple-day free-living accelerometry records. Longitudinal associations of habitual skeletal loads and bone outcomes were analyzed with GEE models. Consistent decreases were observed in FN BMD and BMC, and femoral and tibial shaft vBMD and SSI (p < 0.001) over the follow-up. Slight decreases over the follow-up were also observed in OI and medium impacts in the full sample, and medium and high impact counts in the subsample (p < 0.05). Medium impacts were associated with tibial shaft vBMD and SSI (β = 0.204, 95% CI [0.018, 0.391] and β = 0.077 95% CI [0.000, 0.154], respectively). High impacts were associated with femoral shaft vBMD (β = 0.186 95% CI [0.006, 0.366]. However, no association was observed between habitual skeletal loads and changes in bone characteristics over the follow-up. We observed a rather uniform skeletal response to the menopausal transition at all measured bone sites. Positive associations were found between medium and high-intensity impacts and bone characteristics at the femoral and tibial shafts. However, habitual skeletal loading did not seem to counteract bone deterioration during the menopausal transition.

Functionalized periosteum derived microsphere-hydrogel with sequential release of E7 short peptide/miR-217 for large bone defect repairing

Functionalized periosteum derived microsphere-hydrogel with sequential release of E7 short peptide/miR-217 for large bone defect repairing

A flexible framework for the design and optimization of water-excitation RF pulses using B-spline interpolation.

To implement a flexible framework, named HydrOptiFrame, for the design and optimization of time-efficient water-excitation (WE) RF pulses using B-spline interpolation, and to characterize their lipid suppression performance. An evolutionary optimization algorithm was used to design WE RF pulses. The algorithm minimizes a composite loss function that quantifies the fat-water contrast using Bloch equation simulations. In a first study, B-spline interpolated optimized (BSIO) pulses designed with HydrOptiFrame with durations of 1 and 0.76 ms were generated for 3 T and characterized in healthy volunteers' knees. The femoral bone marrow SNR was compared to that obtained with to 1-1 WE and lipid insensitive binomial off resonant excitation (LIBRE) pulses. In a second study, in the heart at 1.5 T, the water-fat contrast ratio and coronary artery vessel length obtained with a 2.56 ms BSIO pulse was compared to 1-1 WE and LIBRE pulses in free-running cardiovascular MR. The 1 ms BSIO pulse resulted in higher fat suppression and lower contrast ratio (CR)in the bone marrow than the state-of-the-art pulses (4.1 ± 0.2 vs. 4.7 ± 0.4 and 4.4 ± 0.3 for the BSIO, the 1-1 WE and LIBRE respectively, p < 0.05 vs. both) at 3 T. At 1.5 T, the BSIO pulse resulted in a higher blood-epicardial fat CR (3.8 ± 1.3 vs. 1.6 ± 0.6 and 2.4 ± 1.1 for the BSIO, 1-1 WE and LIBRE, respectively, p < 0.05 vs. both) and longer traceable left coronary artery vessel length (8.7 ± 1.4 cm vs. 7.0 ± 1.0 cm [p = 0.04] and 7.5 ± 1.2 cm [p = 0.09]). The HydrOptiFrame framework offers a new opportunity to design WE RF pulses that are robust to B0 inhomogeneity at multiple magnetic field strengths and for variable RF pulse durations.

Improving Femoral Torsion Evaluation in Infants Through Analysis of Variability and Reliability in 2D and 3D Imaging Measurements of the Femoral Neck Axis

Abstract The femoral neck axis serves as a critical parameter in evaluating hip joint health, particularly in the pediatric population. Commonly used metrics for evaluating femoral torsion, such as the femoral neck-shaft and femoral anteversion angles, rely heavily on precise definitions of the position and orientation of the femoral neck axis. Current measurement methods employing radiographs and performing two-dimensional (2D) measurements on computed tomography (CT) scans are susceptible to errors due to their reliance on reader experience and the inherent limitations in 2D measurements. We hypothesized that utilizing volumetric data would mitigate these errors and enable more accurate and reproducible measurements of the femoral neck axis using the femoral anteversion and femoral neck-shaft angles. To test this hypothesis, we analyzed a historical collection of post-mortem infant femoral and pelvic bones (28 hips) aged 0 to 6.5 months, with an average estimated age of 4.68 months ± 1.80 months. Our findings revealed an average neck-shaft angle of 128.00 ± 4.92± and femoral anteversion angle of 35.56 ± 11.68± across all femurs, consistent with literature values. These measurements obtained from volumetric image data were found to be repeatable and reliable compared to conventional methods. Our study suggests that the proposed methodology offers a standardized approach for obtaining repeatable and reproducible measurements, thus potentially enhancing diagnostic accuracy and clinical decision-making in assessing hip developmental conditions in pediatric patients.

Comparison of Low-speed Drilling and Conventional Drilling in Implant Surgery: an Experimental Study.

To compare accuracy, duration of drilling and accumulation of bone chips between low-speed drilling and conventional drilling in freehand implant placement surgery. The implant surgery procedures were performed using identical drill bits on pig ribs in the low-speed drilling group and the conventional drilling group. CBCT images of the preoperative implant design and postoperative implant positions were compared by using the space vector formula to calculate the angular deviation of the implants between the two groups, as well as the horizontal and vertical deviations of the implant necks and roots. The duration of the procedure was recorded, and the bone chips were collected and compared using a screening method and scanning electron microscopy. There were no significant differences in any of the four primary outcome variables relating to accuracy between the low-speed and conventional drilling methods. However, the results revealed that the length of the procedure differed significantly between the two groups and more large bone fragments could be collected when performing low-speed drilling. Low-speed drilling does not affect the accuracy of implant nest preparation, but it can harvest large bone chips which may have better osteogenic activity. Low-speed drilling could be an alternative to conventional drilling.

3D printed β-TCP scaffolds loaded with SVVYGLR peptide for promoting revascularization and osteoinduction

It is crucial for the successful transplantation of large segmental bone defects to achieve rapid vascularization within bone scaffolds. However, there are certain limitations including uncontrolled angiogenesis and inadequate vascular function. Therefore, there is an urgent need to develop bone scaffolds with functional vascular networks. In our study, porousβ-tricalcium phosphate (β-TCP) scaffolds with varying pore sizes were prepared by 3D printing technology, loaded with osteopontin derived peptide Ser-Val-Val-Tyr-Gly-Leu-Arg (SVVYGLR) to induce osteoinduction and angiogenesis.In vitro, the proliferation and migration behaviors of human umbilical vein endothelial cell on scaffolds were assessed by Cell Counting Kit-8, confocal laser scanning microscopy and scanning electron microscopy. And the osteogenic ability of bone marrow mesenchymal stem cells was assessed using alkaline phosphatase staining and Alizarin Red S staining. The messenger ribonucleic acid (mRNA) expression levels of cell adhesion molecule (CD31), vascular endothelial growth factor and hypoxia inducible factor-1αin each group were detected by quantitative real-time fluorescence polymerase chain reaction (PCR) analysis.In vivo, cube scaffolds were subcutaneously implanted on the right hips of Sprague-Dawley (SD) rats for 6 weeks. Hematoxylin and Eosin staining, Masson's trichrome staining, and immunohistochemical analysis of osteocalcin and CD31 were performed on slices for every sample with three sections to explore the effect of SVVYGLR-loaded scaffolds on angiogenesis and osteogenic induction for bone reconstruction. The results indicate that 3D printedβ-TCP scaffolds loaded with the SVVYGLR peptide offer superior revascularization and osteoinduction to the scaffolds without the SVVYGLRin situ. Moreover, scaffolds with a pore size of 400 µm demonstrate higher effectiveness compared to those with a 150 µm pore size. The distinct hollow channel scaffolds and the specific SVVYGLR peptide substantially improve cell adhesion, spreading, and proliferation, as well as promote angiogenesis and bone formation. Furthermore, scaffolds with a pore size of 400 µm may exhibit greater efficacy compared to those with a pore size of 150 µm. The results of this study provide an idea for the development of practical applications for tissue-engineered bone scaffolds.

Senolytic cocktail dasatinib and quercetin attenuates chronic high altitude hypoxia associated bone loss in mice

Chronic high-altitude hypoxia (CHH) induces irreversible abnormalities in various organisms. Emerging evidence indicates that CHH markedly suppresses bone mass and bone strength. Targeting senescent cells and the consequent senescence-associated secretory phenotype (SASP) with senolytics is a recently developed novel therapy for multiple age-related diseases. The combination of dasatinib and quercetin (DQ) has been proven to selectively target senescent cells and attenuate SASP in multiple tissues. In this study, experimental mice were subjected to an environment simulating 5,000 m above sea level for 8 weeks to induce CHH conditions. Our results indicated that DQ supplementation was well-tolerated with negligible toxicity. In vivo, DQ prevented reductions in BMD and BMC and improved bone microarchitecture against CHH-induced changes. Biomechanical testing demonstrated that DQ significantly improved the mechanical properties of femoral bones in CHH-exposed mice. Furthermore, DQ mitigated senescence in LepR + BMSCs and decreased the population of senescent cells, as evidenced by reduced senescence markers and SA-β-Gal staining. An analysis of serum and bone marrow aspirates showed that DQ treatment preserved angiogenic and osteogenic coupling in the bone marrow microenvironment by maintaining type H vessels and angiogenic growth factors. The results suggest that DQ has significant anti-senescence effects on BMSCs and a positive impact on the bone marrow microenvironment, supporting its clinical investigation as a therapeutic agent for CHH-related osteoporosis.

Research Progress on the Application of Nanomaterials in Bone Defect Repair

Bone defects refer to the loss or damage of bone tissue, commonly occurring due to trauma, tumor resection, infection, and non-union fractures. Clinically, bone defects not only affect the patient's function and quality of life but may also lead to chronic pain, mobility impairment, and psychological issues. Repairing large bone defects remains challenging, and traditional treatment methods such as autologous and allogeneic bone grafting face difficulties related to donor site morbidity, postoperative complications, and poor bone healing. Therefore, the development of novel bone repair materials has become a research focus. Nanomaterials, due to their unique physicochemical properties, such as high specific surface area, excellent biocompatibility, and tunable mechanical properties, are increasingly being applied in the field of bone repair. Nanoparticles can enhance the mechanical properties of matrix materials, improving the strength and toughness of bone repair constructs and promoting the proliferation and differentiation of bone cells. Furthermore, nanomaterials can facilitate bone regeneration by releasing bioactive factors or modulating the microenvironment. Consequently, the application of nanomaterials in bone repair holds significant promise. This review aims to summarize the recent research on the application of nanomaterials in the field of bone defect repair.

Bone biochemical markers, bone mineral density, and the risk of osteonecrosis of the femoral head: a Mendelian randomization study

BackgroundAlterations in bone metabolism may play a significant role in the early stages of femoral head necrosis, yet the causal relationship remains unclear. This study utilizes a two-sample Mendelian randomization (MR) approach to explore the genetic causal links between biochemical markers of bone metabolism, bone mineral density, and the risk of femoral head necrosis.MethodsThis study utilizes publicly available genome-wide association study (GWAS) datasets, with exposure factors including biochemical bone markers (25OHD, calcium, and alkaline phosphatase) and bone mineral density (measured at the lumbar spine, heel, femoral neck, and total body). The outcome of interest is osteonecrosis of the femoral head. We selected validated single nucleotide polymorphisms that are strongly associated with the exposure factors as instrumental variables. Mendelian randomization analysis was conducted using inverse variance weighting(IVW), MR-Egger regression, and weighted median estimation. Additionally, we performed analyses for horizontal pleiotropy, heterogeneity, and sensitivity.ResultsA total of 934 SNPs were included in this study. The MR analysis results indicate that the IVW analysis of 25OHD, Ca, and ALP did not reach statistical significance (25OHD OR = 1.006, 95%CI: 0.69–1.47, P = 0.975; Ca OR = 0.856, 95%CI: 0.43–1.70, P = 0.657; ALP OR = 1.022, 95%CI: 0.86–1.21, P = 0.801). However, bone density, including heel, lumbar spine, and total body bone density, showed a protective causal relationship with the onset of ONFH, while the results for femoral neck bone density did not reach statistical significance (lumbar spine BMD OR = 0.662, 95%CI: 0.48–0.91, P = 0.010; heel BMD OR = 0.726, 95%CI: 0.62–0.85, P < 0.001; total body BMD OR = 0.726, 95%CI: 0.62–0.85, P < 0.001; femoral neck BMD OR = 0.748, 95%CI: 0.53–1.05, P = 0.096). Cochran’s Q statistic for IVW and MR-Egger methods indicated no intergenic heterogeneity for all exposure outcomes’ SNPs, and the tests for pleiotropy suggested a low likelihood of pleiotropy in all causal analyses.ConclusionsThe results of this study indicate that there is no genetically mediated causal relationship between serum levels of 25-hydroxyvitamin D, calcium, and alkaline phosphatase and osteonecrosis of the femoral head. However, heel, lumbar spine, and total body bone mineral density can be considered protective factors for the occurrence of ONFH. There is no genetic causality between femoral neck bone mineral density and ONFH development.

Decoding the synergistic potential of herbal medicine and dietary supplements for treating postmenopausal osteoporosis.

The exploration of the combined effects of FLL and quinoa presents an intriguing opportunity to enhance the efficacy of osteoporosis treatment. This study aimed to predict the potential anti-osteoporotic effects of FLL and quinoa using network pharmacology and subsequently verify these predictions through experimental investigation. Thirty rats were divided into five groups: sham operation group (SO), ovariectomized group (OVX), FLL group (FLL), quinoa group (Quinoa), and FLL combined with quinoa group (F&Q). The 12-week experiment involved measurements of bone density and microstructure, histological evaluation of femoral trabeculae and bone cortex, quantification of osteoclasts in the femur, assessment of osteoclast differentiation factor expression (NFATc1 and C-Fos), and measurement of collagen I carboxyl-terminal peptide (CTX-1). Additionally, intestinal flora analysis was performed. The results demonstrated reduced bone mineral density, compromised bone microarchitecture, increased osteoclast numbers and differentiation, and enhanced bone resorption in the OVX group, which were completely ameliorated by FLL, quinoa and F&Q interventions. F&Q exhibited superior improvement in bone density and microarchitecture compared to FLL and quinoa, although no significant differences were observed in their effects on osteoclasts and bone resorption. Gut flora analysis revealed that F&Q was more effective than FLL and quinoa in alleviating OVX-induced intestinal flora disorders, particularly in terms of enhancing intestinal flora diversity and function. The combo of FLL and quinoa was more effective in treating ovariectomy-induced osteoporosis and gut flora dysbiosis than FLL alone.

Foetal Achondroplasia: Prenatal Diagnosis, Outcome and Perspectives

BackgroundAchondroplasia, due to a specific pathogenic variant in FGFR3, is the most common viable skeletal dysplasia and the diagnosis is mostly done in the prenatal period. Since 2021, the use of Vosoritide, a specific treatment for achondroplasia, validated in phase 3 placebo-controlled trials, has been recommended to significantly increase the height of children and infants. In the light of these new therapeutic prospects, a complete understanding of the pathophysiology of skeletal damages occurring from foetal life is required. ObjectivesTo describe foetal imaging and the antenatal and postnatal management of pregnancies complicated by a diagnosis of foetal achondroplasia. MethodsA retrospective and descriptive study, including all pregnant women with a prenatal diagnosis of achondroplasia, was conducted in the prenatal unit of Necker Hospital (Paris, France) between 2009 to 2022. Maternal and obstetric characteristics and foetal imaging (ultrasound and bone CT) were collected. Pregnancy outcomes, paediatric follow-up in the case of live births, and post-mortem examination (PME) data in the case of termination of pregnancy were reported. In addition, we have prospectively developed a specific research protocol using foetal brain MRI to assess the anatomy of the foramen magnum, following the same approach currently recommended in the postnatal period. Results29 cases of achondroplasia were included. Median gestational age at referral was 31+2 weeks’, about 1 week after the suspected diagnosis on routine ultrasound. Shortening of the femoral length and of all the other long bones, macrocephaly, facial abnormalities, increased metaphyseal-diaphyseal angle and tapering of the proximal femoral bone were the five most prevalent ultrasound signs. Foetal diagnosis was done by the identification of the foetal FGFR3 mutation and/or by CT scans (n=15) where specific abnormalities of the long bones, platyspondyly and abnormal profile have been described in 100% of cases. PME revealed: i) on external examinations (n=7) that all fetuses had very short long bones, moderate platyspondyly, small iliac wings with internal spines, macrocrania, and narrow thorax, ii) on internal examination (n=5) all had severe abnormalities in the growth plate and particularities in the temporal cortex and hippocampal region. One foetal MRI was performed at 33 weeks’ and revealed tight stenosis of the foramen magnum and compression of the spinal cord. Of the live-born infants for whom follow-up was known (n=6), 2/6 (including the case who had a foetal MRI) required neurosurgical intervention in the first few months of life for spinal cord compression due to severe stenosis of the foramen magnum. ConclusionA complete mapping of the skeletal features present in fetuses with achondroplasia is reported here, providing a better understanding of the pathophysiology of this condition. New tools such as foetal MRI, to assess the risk of postnatal severe neurological complications, could help improve the care pathway of the affected neonates.

3D-Printed Polymer Scaffolds for Vascularized Bone Regeneration Using Mineral and Extracellular Matrix Deposition

Abstract Purpose Trauma, injury, disease, infection, congenital deformities, and non-union after a fracture can lead to significant loss of bone tissue resulting in large bone defects. If left untreated, this can lead to decreased bone strength, stability, and function as well as long-term malformations. We present a novel, pre-vascularized 3D-printed biodegradable scaffold mimicking the architecture of native bone as a bone graft alternative to promote vascularized bone regeneration. Methods Scaffolds with a highly porous central trabecular section surrounded by an outer cortical section modeled after the bone’s osteons were 3D printed in polylactic acid (PLA). Hydroxyapatite (HA) posts were incorporated to improve mechanical strength. A soak-freeze technique was used to introduce additional porosity to support the recruitment, proliferation, and differentiation of stem cells. Scaffolds were mineralized to provide cues for osteoconduction and osteoinduction. They were also pre-vascularized to promote the differentiation of stem cells along the vascular lineage. Results Compression mechanical testing showed the addition of HA posts improved mechanical strength. Using the soak-freeze technique, micropores in the range of 0–10 µm were introduced. Osteogenic differentiation capability of the scaffolds was verified in vitro through the estimation of osteocalcin (OC) produced by the cells seeded on them and by staining for alkaline phosphatase. Differentiation of stem cells along the vascular lineage within the scaffold was confirmed via the estimation of vascular endothelial growth factor (VEGF-A) and by staining for CD31, a marker for vascular differentiation. Conclusion This novel scaffold incorporated with cues necessary to promote the regeneration of bone and its vasculature shows promise as an alternative to currently used bone grafts. Lay Summary Significant bone loss caused by trauma, infection, or disease results in large defects that are currently treated using bone grafts—autografts (taken from the same patient), allografts and xenografts (donor tissue), or synthetic grafts. We have developed a tissue-engineered alternative that mimics the architecture of natural bone and has cues to promote both the regeneration of bone and its vasculature. These are fabricated using 3D printing (3DP) technology, providing cost-effective, customizable alternatives to conventional bone grafts.

Broken Drill Bits During Surgical Procedures: A Review of 156 Patient Safety Events

Background Broken surgical drill bits pose a risk to patient safety. A routine review of event reports submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) uncovered an increase in the number of event reports related to broken drill bits, prompting an exploration to better understand patterns of drill bit breakage in Pennsylvania. Methods We queried the PA-PSRS database to identify event reports describing a broken drill bit during surgery submitted between January 1, 2021, and December 31, 2023. Event reports were manually coded to identify the procedure, anatomic location of breakage in the patient’s body, timing of discovery, and fragment fate. Results A total of 156 relevant event reports were identified. The procedure being performed was determined in 64 of 156 event reports. Fracture repair procedures were most commonly reported to encounter a broken drill bit (27 of 64; 42.2%). We were able to determine the anatomic location in the patient’s body where the drill bit breakage occurred in 108 of 156 event reports. The most commonly reported anatomic location was the femur (27 of 108; 25.0%). We were able to determine the fate of the broken drill bit in 141 of 156 event reports, and most drill bits were retained in the patient (99 of 141; 70.2%). Conclusion This data analysis provides insight into broken drill bits in Pennsylvania facilities. Because drill bits are commonly broken pieces of equipment and the fragments from these broken pieces are frequently retained, it is important to prevent drill bit breakage to improve patient safety. Table 2 (251188) outlines prevention strategies established by equipment manufacturers and previous research. Implementing these strategies can address breakage across multiple procedures and patients. Plain Language Summary While a rare occurrence, surgical instruments may break during a procedure. In the case of drill bits, which are one of the most frequently broken surgical instruments, pieces that are left inside of a patient could cause harm, and may migrate to other parts of the body. When Patient Safety Authority researchers noted an increased number of events involving broken and retained drill bits during surgery, they analyzed data from the Pennsylvania Patient Safety Reporting System (PA-PSRS) to help decrease the risk of broken drill bits in surgery. In studying cases involving a drill bit breaking during surgery, researchers learned that most of these events occurred during fracture repair procedures and joint replacement surgery, and drill bits most frequently broke in the femur (thigh bone). In most event reports, the broken drill bit was discovered during the procedure, but in 2.6% of event reports (4 out of 156 reports) it was discovered after the operation. Removing drill bit fragments is recommended; however, surgeons may decide to leave them in place if removal risks damage to the surrounding area, and in many event reports broken drill bits were retained following the surgery with no further intervention. Hospitals and surgical facilities should look to existing literature and device manufacturers’ guidelines for prevention strategies, such as recommended surgical techniques; drill bit sterilization, reprocessing, and storage; and general safety measures, some of which are summarized in the article.

Design improvements to enhance mechanical performance of a locking compression plate as a biodegradable implant plate: a finite element analysis

Mg alloy is one of the most suitable biodegradable materials for making modern LCP. This is due to the osseointegration property, low elastic modulus, the presence in the human bone, and the excellent biodegradable nature. But it lacks much-needed strength compared to conventional (Ti, SS alloys) implants due to low strength of biodegradable (Mg, Zn alloys) materials. The problem can be solved by either biodegradable material development or by design improvement of existing LCP. Improving the design is a better way to improve the LCP. This paper aims to improve the design of existing LCP through the addition of features and their implications by analysing the stress distribution across the plates for improved biodegradable implant mechanical performance. Various designs have been developed and each has certain advantages over conventional LCP which ACT and 4PBT have been demonstrated via the FEM. They are best suited for femur bone fracture treatment replacing conventional metal alloys LCP. The CTLCP, SLCP, and SELCP have improved performance at stress concentration regions while STLCP especially has 36.74% less stress generation than conventional LCP along with excellent biodegradable performance. The designs are discussed in detail to analyse the effect of added features in conventional LCP.

Dorsal cortex line is more reliable than transepicondylar axis for rotation in revision total knee arthroplasty with severe bone loss.

The transepicondylar axis is a well-established reference for the determination of femoral component rotation in total knee arthroplasty (TKA). However, when severe bone loss is present in the femoral condyles, rotational alignment can be more complicated. There is a lack of validated landmarks in the supracondylar region of the distal femur. Therefore, the aim of this study was to analyze the correlation between the surgical transepicondylar axis (sTEA) and the suggested dorsal cortex line (DCL) in the coronal plane and the inter- and intraobserver reliability of its CT scan measurement. A total of 75 randomly selected CT scans were measured by three experienced surgeons independently. The DCL was defined in the coronal plane as a tangent to the dorsal femoral cortex located 75 mm above the joint line in the frontal plane. The difference between sTEA and DCL was calculated. Descriptive statistics and angulation correlations were generated for the sTEA and DCL, as well as for the distribution of measurement error for intra- and inter-rater reliability. The external rotation of the DCL to the sTEA was a mean of 9.47° (SD 3.06°), and a median of 9.2° (IQR 7.45° to 11.60°), with a minimum value of 1.7° and maximum of 16.3°. The measurements of the DCL demonstrated very good to excellent test-retest and inter-rater reliability coefficients (intraclass correlation coefficient 0.80 to 0.99). This study reveals a correlation between the sTEA and the DCL. Overall, 10° of external rotation of the dorsal femoral cortical bone to the sTEA may serve as a reliable landmark for initial position of the femoral component. Surgeons should be aware that there are outliers in this study in up to 17% of the measurements, which potentially could result in deviations of femoral component rotation.

In vivo quantitative assessment of proximal femoral cortical bone microstructure using double-echo ultrashort echo time magnetic resonance imaging.

Quantitative assessment of cortical bone microstructure is crucial for the evaluation of osteoporosis, yet current clinical methods such as dual-energy X-ray absorptiometry (DXA) have many limitations. The in vivo quantitative assessment without radiation can be achieved by ultrashort echo time (UTE) magnetic resonance imaging (MRI), where double-echo UTE has high clinical feasibility. However, related studies have mainly focused on distal extremities, and there is a lack of in vivo studies on the proximal femur. This cross-sectional study, as a preliminary study for in vivo quantitative assessment of proximal femoral cortical bone in healthy adults by double-echo UTE MRI, aimed to evaluate the repeatability and explore the impact of potential influencing factors on UTE measurements, thereby providing a reference for the further clinical application of this technique. Healthy volunteers without osteoporosis risk factors were enrolled and underwent double-echo UTE MRI of the proximal femur. Porosity index (PI) and cortical bone thickness (CbTh) were obtained manually by two radiologists independently on double-echo UTE images using image processing software. Repeatability of PI and CbTh measurements were evaluated using intra-class correlation coefficient (ICC) analysis. PI and CbTh of different limbs and sexes were compared, and P<0.05 indicated statistical significance for these analyses. Correlations of PI and CbTh with age and body mass index (BMI) were assessed by Pearson or Spearman correlation coefficient as well as the partial Pearson correlation coefficient. Curve estimation was used to assess non-monotonic variable correlations in scatterplots. For these analyses, P<0.025 indicated statistical significance according to the Bonferroni correction. A total of 52 healthy cases (33 males, 19 females) aged 22-55 years were included for analysis, where no statistical difference in age was found between sexes (P=0.586) and BMI of males was greater than that of females (P=0.007). The repeatability of PI and CbTh measurements was excellent (ICC 0.985 and 0.943, respectively). The proximal femoral cortical PI was greater on the non-dominant side (P<0.001). PI was greater in males than in females (non-dominant: P<0.001, dominant: P=0.032) and CbTh was greater on the non-dominant side in males than in females (P=0.036) after excluding the effect of confounding factor (BMI). PI on the dominant side was positively correlated with BMI in males (r=0.535, P=0.001), and CbTh on the non-dominant side was positively correlated with BMI in males (r=0.482, P=0.005). There was a U-shaped curve trend between dominant side cortical PI and age in females (y = 65.32 - 1.88x + 0.02x2, R2=0.348, P=0.033), although there was no statistical significance after Bonferroni correction. Double-echo UTE MRI enables in vivo quantitative assessment of proximal femoral cortical microarchitecture with excellent repeatability. We identified the effects of limb dominance, sex, age, and BMI on UTE measurements in healthy adults, which can serve as a reference for future in vivo studies on proximal femoral cortical bone and is essential before clinical application.

Changes in the cortical bone reaction around the stem after uncemented total hip replacement using short tapered wedge stem

PurposeThis study examined the relationship between stem alignment and the cortical bone area around the distal end of the femoral component using three-dimensional computed tomography (3D-CT) images after uncemented total hip arthroplasty (THA). MethodsA total of 59 patients who underwent primary THA using an uncemented short tapered wedge stem from 2019 to 2021 were followed for at least 24 months. Patients were divided into groups based on stem position. Changes in stem position and cross-sectional area of femoral cortical bone at the distal end of the stem were examined using 3D-CT at 12 months and 24 months post-operatively and were compared with pre-operative values. ResultsThe 12-month post-operative cortical bone area around the stem showed significant differences compared with the pre-operative area in the anterior, posterior, and lateral zone 1. Differences at these same points were noted when comparing the 24-month post-operative area with the pre-operative area. No significant difference was found in the change in the cortical bone area over time among the neutral, flexed, and extended stem groups. In the varus stem group, a significant increase in cortical bone area over time was observed in lateral zone 2. In the valgus stem group, a significant increase in the cortical bone area over time was observed in medial zone 1. ConclusionsStem alignment may affect periprosthetic cortical bone changes after THA using an uncemented short tapered wedge stem. Cortical bone reaction was revealed laterally to the stem tip in the varus-aligned stem, and medially to the stem tip in the valgus-aligned stem.

Legg-Calvé-Perthes Disease in Clinical Case Studies in Dogs

Abstract Legg-Calvé-Perthes disease (LCPD) is a degenerative disorder of the femoral head bone with a genetic basis which generally occurs in predisposed small dog breeds (up to 12 kg) at a young age (4–10 months). The aim of this study was to present an overview of this disease, the most common clinical symptoms and to describe methods of diagnosis and therapy of LCPD in dogs. This involved a follow-up of patients, dogs (n = 43; 20 males and 23 females) brought to the veterinary clinic in Hungary with suspicion of LCPD, where they were subjected to clinical, orthopaedic and radiographic examination and then to the most suitable conservative or surgical treatment. The most characteristic clinical symptom – lameness ‒ expressed by lameness grade (from 1 to 5), was monitored in all patients, especially those with grade 4 (n = 26). Additional clinical symptoms, such as response to manipulation (n = 42), pain on palpation (n = 33), weight-bearing (n = 2), muscle atrophy (n = 17) and crepitation (n = 24), were checked in the dogs. The prevalence of the unilateral form of LCPD in the pelvic limbs was observed in 38 patients (88.37 %) and the bilateral LCPD form appeared in 5 patients (11.63 %). Based on the Ljunggren’s score the degree of hip joint damage was observed in most LCPD patients with score 4 (n = 22; 51.10 %). Following the diagnosis, it was necessary to decide on the therapy, conservative or surgical (ostectomy), with elimination of painful symptoms and subsequent long-term postoperative rehabilitation as well as the improvement of the patient’s health status.

Optimized Methyl methacrylate embedding of small and large undecalcified bones.

Methyl methacrylate (MMA) plastic embedding has been long established as a technique for the processing and histological assessment of bones. It provides the added benefit over paraffin in that it does not require decalcification of the tissue in order visualize the cellular detail, thus preserving vital information about the amount of unmineralized osteoid present in addition to the degree of mineralization in the bone. It also allows for the incorporation of dynamic histomorphometric analysis through the retention of fluorescent labels incorporated into the bone. Efficient infiltration of hard tissue is essential to the processing of bones and producing quality slides suitable for achieving usable quantifiable histology out the other end. This technique:• Updates previously published MMA embedding protocols to reflect utilization of stabilized acrylamides (over the unstabilized reagents of the past)• Outlines the techniques that are important for embedding both small (mus), medium (rattus), and large (porcine, lagomorph, human) histological samples.• Updates the clearing and infiltration processes utilized and validates quality of the sample preparation though histological staining to confirm preservation of cellular detail, mineralization information, and enzymatic activity

Role of Rosmarinus officinalis Aqueous Extract in Relieving the Complications Associated with Ethylene Glycol-induced Urolithiasis in Male Rats

Background: Rosmarinus officinalis is considered one of the famous plants from ancient times for its therapeutic ability in many diseases, such as headache, spasms, brain disorders, and some pathological conditions associated with toxicity cases in the liver and kidneys. Aim: The current research has aimed, for the first time, to evaluate anti-urolithiatic effect of Rosmarinus officinalis aqueous extract (RMAE) on calcium oxalate stones formation in male rats and its possible therapeutic mechanisms of action. Evaluation of the polyphenols and flavonoid content in the extract was also performed. Methods: A calcium oxalate nephrolithiasis case was established in rats by adding ethylene glycol (1%) to the rats' daily drinking water for a duration of one month. Treatment was achieved by oral co-administration of RMAE to rats administrated ethylene glycol. Results: Phytochemical results showed that LC/MS-MS analysis led to the identification of 37 compounds in the phytoconstituent profile of RMAE. The biochemical results revealed significant improvement in serum kidney functions (urea, creatinine, and uric acid) in addition to restoring the calcium x phosphorous product and parathyroid hormone (PTH) levels in the plant-treated group compared to the non-treated one. The data have been supported by the significant decrease in lactate dehydrogenase enzyme (LDH) expression in the liver tissues, reflecting the decrease in oxalate synthesis in the liver compared to the non-treated group. Kidneys' histological examinations showed the absence of oxalate crystals in the treated group and the immunohistochemical findings of osteopontin (OPN) protein revealed the impact of RMAE on OPN expression in kidney tissues. Improvements in the femur bone fractures and the parathyroid gland in the treated group were also noticed during microscopic examinations. Conclusion: The anti-lithiatic effect of the extract was attributed to its influence on serum phosphate, serum PTH, and OPN levels in kidney tissues and decreasing synthesis of LDH in liver tissues in addition to the prevention of secondary disease incidences, such as secondary hyperparathyroidism and cardiovascular diseases. On the other hand, the plant's considerable content of phenolics and flavonoids has been found to play a role in controlling kidney stone progression episodes.