Incidence Of Post-traumatic Osteoarthritis Research Articles

Incidence of post-traumatic osteoarthritis in 44B ankle fractures: Analysis of risk factors

ObjectiveThe purpose of this study was to analyse the clinical and radiographic data of a consecutive series of patients treated surgically for AO/OTA 44B ankle fracture at Ferrara University Hospital, Italy, with a view to identifying risk factors contributing to worse clinical and radiographic outcomes with a minium follow up of 6 years. Materials and methodsFor each patient the following data were recorded: gender, age, Body Mass Index (BMI), follow up (months), previous ankle sprains, type of work, Kellgren-Lawrence (K&L) score, AO/OTA classification for ankle fracture, Foot and Ankle Disability Index (FADI score), ankle dislocation, syndesmotic transfixation, quality of reduction. ResultsFADI score in patients with AO/OTA 44B1 fracture was 95.5±7.5, in 44B2 it was 90.0±8.4 and in 44B3 it was 84.0±13.0 (p25 it was 88.6±11.4 (p=0.047 95%I.C. 0.01-8.10). In case of fracture-dislocation there was a statistically significant difference in the FADI (94.4±6.0 vs 85.8±11.98)(P=0.002 95% I.C. 0.01-8.9). In the former group, there was a statistically significant difference in the ​the K&L (1.97±0.65 vs 2.63±0.85) (P=0.006 95% I.C 0.01-1.00).Finally, the quality of the reduction was a statistically significant parameter in both the FADI and K&L (P=0.012 95% I.C. 0.90-10.60 and P=0.012 95%I.C. 0.01-1.00 respectively). ConclusionThe most influential risk factors for worse outcome in AO/OTA 44B ankle fractures were found to be BMI, injury severity, fracture-dislocation and reduction quality.

Incidence of Osteoarthritis Between ACL Reconstruction With Different Graft Types and Between ACL Reconstruction and Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Variation in stiffness, fixation methods, and donor-site morbidity after anterior cruciate ligament reconstruction (ACLR) with different graft types and with anterior cruciate ligament suture repair (ACLSR) can lead to differences in dynamic knee laxity and consequent differences in posttraumatic osteoarthritis (PTOA) development. To compare the incidence of PTOA between different graft types used for primary ACLR and between primary ACLR and ACLSR. It was hypothesized that the incidence of PTOA would vary between ACLR with different autografts and allografts and between ACLR and ACLSR. Systematic review; Level of evidence, 1. A search of the literature was performed to identify all randomized controlled trials (RCTs) comparing radiographic evidence of PTOA after ACLR between different graft types-hamstring tendon (HT) autograft, bone-patellar tendon-bone (BPTB) autograft, quadriceps tendon autograft, and allograft-and between ACLR and ACLSR. The minimum follow-up was 2 years. Study quality was assessed using the modified Coleman Methodology Score. A meta-analysis was performed to determine whether there was a difference in the incidence of PTOA between the different graft types and between ACLR and ACLSR. Eleven randomized controlled trials were included in the meta-analysis-HT: 440 patients (mean follow-up, 9.7 years); BPTB: 307 patients (mean follow-up, 11.8 years); allograft: 246 patients (mean follow-up, 5 years); ACLSR, 22 patients (5 years). No study reporting the incidence after ACLR with quadriceps tendon was included. The study quality ranged from 70 to 88. The meta-analysis indicated no significant difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR (risk ratios: HT vs BPTB, 1.05; HT vs allograft, 0.81; BPTB vs allograft, 0.82; HT vs ACLSR, not estimable [P > .05 for all]). The combined number of patients with PTOA in all studies per graft type showed that patients who underwent ACLR with a BPTB autograft had the highest percentage of PTOA (HT, 23.4%; BPTB, 29.6%; allograft, 8.1%; ACLSR, 0%). However, excluding studies with a follow-up <5 years resulted in similar outcomes for patients with an HT autograft and a BPTB autograft. This meta-analysis reported no difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR. More research is necessary to make a reliable conclusion about which technique is associated with the lowest incidence of PTOA after ACL surgery.

Poster 242: Exploring the Correlation Between Synovial Fluid Cytokine Profiles and Meniscal Treatment Outcomes

Objectives: Meniscal tears are a common injury and have been shown to contribute to the development of posttraumatic osteoarthritis (PTOA) in affected individuals. Research indicates that meniscal repair yields more favorable outcomes compared to partial and subtotal meniscectomies, with a protective effect against the incidence of PTOA. The aim of this study was to investigate whether a distinct synovial fluid profile was associated with meniscal injuries amenable to repair, thereby shedding light on potential biomarkers or factors that may predict treatment selection and improve preoperative patient counseling. Methods: Patients were prospectively recruited between January 2011 and the present and were enrolled on the day of surgery. The operative knee was aspirated aseptically, following skin preparation and patient draping. The synovial fluid was analyzed to determine concentrations of biomarkers. Patients with meniscal injuries and complete synovial fluid results for all 10 cytokines were included: Regulation on Activation Normal T Cell Expressed and Secreted (RANTES), Interleukin 6 (IL-6), Monocyte Chemoattractant Protein 1 (MCP-1), Macrophage Inflammatory Protein-1 beta (MIP-1b), Vascular Endothelial Growth Factor (VEGF), Tissue Inhibitor Matrix Metalloproteinase 1 and 2 (TIMP-1, TIMP-2), Interleukin 1 Receptor Antagonist (IL1-RA), and Matrix Metalloproteinase 3 (MMP-3). Elite athletes were excluded from analysis. Hierarchical clustering was performed on the biomarker concentrations to identify two distinct clusters. The percentage of patients with meniscal tears amenable to repair and synovial fluid levels were compared between the identified clusters using the chi-square test and t test. Results: A total of 183 patients were included, of which 46 underwent a meniscal repair. The average body mass index (BMI) was 27.95 ± 5.63, and the mean age at the time of surgery was 38.48 ± 10.19. The cohort consisted of 58.5% male patients. There was a significantly higher proportion of patients who experienced a bucket handle tear in those who underwent a repair procedure versus a meniscectomy (21.7% vs. 5.1%, p = 0.002). There was no other difference in meniscal tear patterns between the groups (posterior horn, p = 0.062; anterior horn, p = 0.34; radial, p = 0.17; body, p = 1). Through hierarchical clustering, the analysis identified two distinct clusters: cluster 1, comprising 115 patients, and cluster 2, consisting of 68 patients. There were no significant differences in age (38.51 vs. 38.43, p = 0.96), sex (55.7% vs. 63.2% male, p = 0.11) or BMI (27.85 vs. 28.13, p = 0.75) between the 2 clusters. Cluster 1 exhibited a higher rate of meniscal tears amenable to repair as compared to cluster 2 (24.3% vs. 8.8%, p = 0.016). Furthermore, cluster 1 had a higher percentage of reported cartilage injuries (11.3% vs. 1.5%, p = 0.033). Additionally, cluster 1 showed higher log-transformed concentrations of MIP-1b (3.56 vs. 3.18, p = 0.002), TIMP-1 (13.06 vs. 10.08, p &lt; 0.001), and TIMP-2 (10.56 vs. 7.20, p &lt; 0.001), while demonstrating lower concentrations of RANTES (4.08 vs. 4.86, p = 0.008) compared to cluster 2. Stepwise logistic regression was performed to identify the cytokines that are associated with the likelihood of a repairable meniscal tear, controlling for age, sex, BMI, cartilage lesion grade, and meniscal pathology. The resulting model included sex, posterior horn tear, handle tear, radial tear, body tear and bucket handle tear, which is a known confounder for meniscal repair, and revealed statistically significant relationships between certain biomarkers and the odds of encountering a repairable tear. Specifically, MCP-1, TIMP-2, and MMP-3 were significantly associated with the odds of a repairable meniscus. The amenability of meniscal repair decreased by 76% (95% CI: 0.64 - .69, p = 0.017), for each unit increase of pre-operative levels of MCP-1, increased by 74% for TIMP-2 (95% CI: 1.06 – 3.00, p = 0.032), and increased by 88% for MMP-3 (95% CI: 1.18 – 3.34, p = 0.014). Conclusions: The study findings provide insights into the relationship between synovial fluid biomarkers and meniscal tear patterns. The analysis revealed a distinct group of patients (cluster 1) characterized by higher concentrations of anti-inflammatory cytokines (TIMP-1 and TIMP-2) and lower levels of the pro-inflammatory cytokine RANTES, suggesting a potential correlation between a more favorable cytokine profile and the feasibility of meniscal repair. The elevated concentrations of TIMP-1 and TIMP-2 in cluster 1 suggest an enhanced ability to regulate matrix metalloproteinases (MMPs), resulting in reduced degradation of the extracellular matrix and a potentially more favorable environment for meniscal repair. These results provide evidence suggesting that the synovial fluid cytokine profile may represent the likelihood that a meniscal tear is repairable. This knowledge has the potential to inform treatment decisions and enhance preoperative patient counseling by identifying individuals who are more likely to have meniscal pathology amenable to repair as opposed to necessitating partial or subtotal meniscectomy.

Effects of sex differences on osteoarthritic changes after anterior cruciate ligament reconstruction in rats

The prevalence of primary osteoarthritis is higher in females than males. However, it remains unclear if there are sex differences in the incidence of post-traumatic osteoarthritis after anterior cruciate ligament (ACL) reconstruction. In this study, we aimed to investigate the effects of sex on osteoarthritic changes after ACL reconstruction using an animal model. Rats were divided into the following four groups: male control, male ACL reconstruction, female control, and female ACL reconstruction. ACL reconstruction surgery was performed on the right knees of rats in the ACL reconstruction groups, while rats in the control groups did not undergo knee surgery. At 1, 4, and 12 weeks after surgery, cartilage degeneration in the medial tibial plateau and osteophyte formation in the proximal tibia were histologically assessed. After ACL reconstruction, an increase in the Mankin score, cartilage fissures, and osteophyte formation were detected within 12 weeks in both male and female rats, with similar degrees of these changes between males and females. However, changes in cartilage thickness and chondrocyte density after ACL reconstruction differed between males and females. Cartilage thickening was observed in male rats but not in female rats. The increase in chondrocyte density in the anterior region was detected in both males and females but was more pronounced in female rats. In conclusion, osteoarthritic changes were observed after ACL reconstruction in both male and female rats, but differences in changes in cartilage thickness and chondrocyte density were observed between males and females.

Predictors for post-traumatic hip osteoarthritis in patients with transverse acetabular fractures following open reduction internal fixation: a minimum of 2 years’ follow-up multicenter study

BackgroundThe predictors of post-traumatic osteoarthritis (PTOA) in patients with transverse acetabular fractures (TAFs) following open reduction internal fixation (ORIF) remain unclear. This study aimed to investigate the risk factors for PTOA in TAFs after ORIF.MethodsData of TAF patients receiving ORIF were collected from January 2012 and February 2021. Patients suffered PTOA were classified as the osteoarthritis group (OG), while those without PTOA were classified as the non- osteoarthritis group (NG) with a minimum follow-up of 2 years. PTOA was diagnosed according to Tönnis OA classification during the period of follow-up. Univariate analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analyses were used to evaluate demographics, injury-related characteristics, perioperative and post-discharge information.ResultsThree hundred and eleven TAF patients were analyzed in this study, including 261 males and 50 females, with a mean age of 40.4 years (range 18 to 64 years). The incidence of PTOA was 29.6% (92 of 311) during the mean follow-up of 36.8 months (range 24 to 70 months). Several factors of PTOA were found using univariate analysis, including transverse fracture associated with posterior wall acetabular fracture (TPW-AF, p = 0.002), acetabular roof fracture (ARF, p = 0.001), femoral head lesion (FHL, p = 0.016), longer time from injury to surgery (TIS, p＜0.001) and physical work after surgery (PWAS, p＜0.001). Logistic regression analysis showed that TPW-AF (p = 0.007, OR = 2.610, 95%CI: 1.302–5.232), ARF (p = 0.001, OR = 2.887, 95%CI: 1.512–5.512), FHL (p = 0.005, OR = 2.302, 95%CI: 1.283–4.131), TIS (p<0.0001, OR = 1.294, 95%CI: 1.192–1.405) and PWAS (p<0.0001, 3.198, 95%CI: 1.765–5.797) were independent risk factors of PTOA. Furthermore, ROC curve analysis indicated 11.5 days as the cut-off values to predict PTOA.ConclusionsOur findings identified that TPW-AF, ARF, FHL, TIS and PWAS were independent risk factors for PTOA in patients with TAFs following ORIF. It can help orthopedic surgeons to take early individualized interventions to reduce its incidence.

Quadriceps strength and psychological readiness are associated with multiplanar knee kinematics after anterior cruciate ligament reconstruction

BackgroundGait asymmetry, negative psychological factors and quadriceps strength deficits are common after anterior cruciate ligament reconstruction (ACLR). Whether quadriceps strength and psychological factors have impacts on multiplanar knee kinematics remains unclear. Research questionWhat are the relationships of multiplanar knee kinematics during the gait cycle and psychological readiness to quadriceps strength after ACLR? MethodIn total, 45 patients were enrolled in this study at 8.3 ± 1.5 months after ACLR. All patients underwent gait analysis and isokinetic testing. Interlimb differences in the range of motion (ROM) and maximum and initial contact (IC) angles in abduction-adduction, flexion-extension, and internal-external rotation were calculated. The limb symmetry index (LSI) for quadriceps strength was calculated. Psychological readiness was measured using the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale. The paired t test analyzed the differences between contralateral and affected limbs in quadriceps and hamstrings strength. Pearson or Spearman correlation was used to assess relationships between the variables of interest. ResultsSignificant differences between contralateral and affected limbs were observed in isokinetic knee quadriceps strength (P < 0.001) and hamstring strength (P = 0.009). The ACL-RSI score correlated negatively with interlimb differences in the knee flexion angle at IC (r = –0.35, P = 0.02) and ROM in the transverse plane (r = –0.41, P = 0.003). The LSI for quadriceps strength correlated negatively with the peak knee flexion angle (r = –0.37, P = 0.02) and positively with the ACL-RSI score (r = 0.3, P = 0.05). SignificanceGreater psychological readiness and quadriceps strength are associated with more symmetrical multiplanar knee kinematics. The improvement of these parameters may aid the recovery of knee kinematics after ACLR, and reduce the rate of reinjury and incidence of posttraumatic osteoarthritis.

Does temporary bridge plate fixation preserve joint motion after an unstable Lisfranc injury?

BackgroundRecently, temporary bridge plate fixation has gained popularity in the treatment of unstable Lisfranc injuries. The technique aims to reduce the risk of posttraumatic osteoarthritis, and after plate removal, the goal is to regain joint mobility. Here we explore marker-based radiostereometric analysis (RSA) to measure motion in the 1st tarsometatarsal (TMT) joint and asses the radiological outcome in patients treated with this surgical technique. MethodTen patients with an unstable Lisfranc injury were included. All were treated with a dorsal bridge plate over the 1st TMT joint and primary arthrodesis of the 2nd and 3rd TMT joints. The plate was removed four months postoperatively. Non- and weight-bearing RSA images were obtained one and five years postinjury to assess joint mobility and signs of osteoarthritis. ResultsDetectable 1st TMT joint motion was observed in 2/10 patients after one year, and 6/9 patients after five years. At the final follow-up, mean 1st TMT dorsiflexion was 2.0°. Radiologically, the incidence of posttraumatic osteoarthritis was present in 4/10 patients after one year, and 5/9 patients after five years. All patients had observed TMT joint stability throughout the follow-up period. ConclusionPreservation of joint motion can be achieved with a temporary bridge plate fixation over the 1st TMT joint. Type of study/level of evidenceProspective cohort study/Therapeutically level IV.

Influence of associated femoral head fractures on surgical outcomes following osteosynthesis in posterior wall acetabular fractures

BackgroundTo date, no study has compared the surgical outcomes between posterior wall acetabular fractures with and without associated femoral head fractures. Therefore, we evaluated whether an associated femoral head fracture increases the incidence of fracture sequelae, including post-traumatic osteoarthritis (PTOA) and osteonecrosis of the femoral head (ONFH), following osteosynthesis for posterior wall acetabular fractures.MethodsThis retrospective clinical study enrolled 183 patients who underwent osteosynthesis for posterior wall acetabular fractures between 2009 and 2019 at a level-1 trauma center. The incidence of PTOA, ONFH, and conversion to total hip arthroplasty (THA) was reviewed.ResultsThe incidence of PTOA, ONFH, and conversion to THA following osteosynthesis were 20.2%, 15.9%, and 17.5%, respectively. The average time for conversion to THA was 18.76 ± 20.15 months (range, 1–82). The results for the comparison of patients with associated femoral head fractures and isolated posterior wall acetabular fractures were insignificant (PTOA: 27.3% vs. 15.7%, p = 0.13; ONFH: 18.2% vs. 14.3%, p = 0.58; conversion to THA: 20.4% vs. 15.7%, p = 0.52). Upon evaluating other variables, only marginal impaction negatively affected ONFH incidence (odds ratio: 2.90).ConclusionsOur methods failed to demonstrate a significant difference in the rate of PTOA, ONFH, or conversion to THA in posterior wall acetabular fractures with and without an associated femoral head fracture. Beyond femoral head fractures, the marginal impaction of the acetabulum could have led to early sequelae.Level of evidenceLevel III

A pilot study of four-year longitudinal bone changes following anterior cruciate ligament reconstructive surgery using DXA and HR-pQCT

Anterior cruciate ligament reconstructive (ACLR) surgery is an effective and prevalent treatment to restore function following ACL injury. The incidence of post-traumatic osteoarthritis (PTOA) long-term is still a major problem. Longitudinal studies beyond the first year are lacking and no studies have reported high-resolution in vivo bone changes. (1) Determine longitudinal bone changes following surgery in the proximal tibia and distal femur in ACLR and contralateral knees, and (2) determine bone changes at the ACLR tunnel and surrounding region in the injured knee. Participants with acute ACL-injuries (n = 5) had DXA and HR-pQCT imaging at four timepoints: pre-surgery (baseline) and at 2-, 6- and 48-months in the injured and contralateral knees. Areal BMD in peri-articular and epiphyseal regions was evaluated using DXA. Microstructural and vBMD changes of the tibial plateau and femoral condyles and surrounding the ACLR tunnel were determined. Large initial reductions in subchondral density and microstructure within the first year were followed by a period of recovery. Although varying among participants, reduced values in the injured knee remained at 48 months. Substantial adaptations to the surrounding ACLR tunnel bone occurred resulting in a cortex-like thickening and reduced wall diameters at 48 months. Large initial reductions following ACLR surgery followed a similar pattern seen in the first year after injury, indicating the trauma of surgery may reset bone recovery. These longitudinal results are consistent with cross-sectional studies indicating irreversible bone changes following ACLR that may play a role in PTOA initiation and progression. This pilot data suggests that imaging biomarkers are persistent at 48 months, possibly reflecting early PTOA changes.

A possible issue of articular cartilage degeneration in acute phase after anterior cruciate ligament reconstruction

A possible issue of articular cartilage degeneration in acute phase after anterior cruciate ligament reconstruction

The Clinical Radiographic Incidence of Posttraumatic Osteoarthritis 10 Years After Anterior Cruciate Ligament Reconstruction: Data From the MOON Nested Cohort

Background: The incidence of posttraumatic osteoarthritis (PTOA) based on clinical radiographic grading criteria at 10 years after anterior cruciate ligament (ACL) reconstruction (ACLR) has not been well-defined in a prospective cohort of young athletic patients. Hypothesis: Among young athletic patients, there is a high incidence of clinical radiographic PTOA at 10 years after ACLR. Additionally, there is a significant difference in clinical radiographic osteoarthritis (OA) changes (joint space narrowing and osteophyte formation) between ACL-reconstructed and contralateral knees at 10 years. Study Design: Case series; Level of evidence, 4. Methods: The first 146 patients in an ongoing nested cohort study of the Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort presented for a minimum 10-year follow-up. Included patients had a sports-related ACL injury, were aged <33 years at the time of ACLR, had no history of ipsilateral or contralateral knee surgery, and did not undergo revision ACLR before follow-up. Bilateral knee metatarsophalangeal view radiographs were obtained and graded according to International Knee Documentation Committee (IKDC), Osteoarthritis Research Society International (OARSI), and modified Kellgren-Lawrence (KL) criteria by 2 blinded reviewers. The incidence and severity of ipsilateral and contralateral radiographic OA were determined among patients without a contralateral ACL injury before 10-year follow-up (N = 133). Results: Interrater reliability was substantial for the IKDC (Gwet Agreement Coefficient [AC] 1 = 0.71), moderate for the KL (0.48), and almost perfect for the OARSI (0.84) grading systems. Among patients with a contralateral radiographically normal knee, the 10-year incidence of clinical radiographic PTOA after ACLR was 37% as defined by osteophytes and 23% as defined by joint space narrowing. The maximum side-to-side difference in the OARSI osteophyte grade in the medial or lateral compartment was 0 in 65% of patients, 1 in 20%, and ≥2 in 15%. The maximum side-to-side difference in the OARSI joint space narrowing grade was 0 in 77% of patients, 1 in 19%, and ≥2 in 4%. Conclusion: In young active patients, the 10-year incidence of clinical radiographic PTOA after ACLR was 37% as defined by osteophytes and 23% as defined by joint space narrowing. The mean difference in the degree of osteophyte formation (≤1 grade in 85%) and joint space narrowing (≤1 grade in 96%) between the ACL-reconstructed and contralateral knees was small. Registration: NCT02717559 (ClinicalTrials.gov identifier)

The clinical radiographic incidence of post-traumatic osteoarthritis 10 years after anterior cruciate ligament reconstruction: data from the moon nested cohort

Purpose: The incidence of post-traumatic osteoarthritis (PTOA) using clinical radiographic grading criteria at 10 years after anterior cruciate ligament reconstruction (ACLR) has not been well-defined in a prospective cohort of young athletic patients. Among young athletic patients, there is a high incidence of clinical radiographic PTOA at 10 years after ACLR. Additionally, there is a significant difference in clinical radiographic osteoarthritis changes (joint space narrowing [JSN] and osteophyte formation) between the ACL reconstructed and contralateral knees at 10 years.

Effect of infusion irrigation with different irrigating solutions on transient receptor potential vanilloid 5 and intra-articular inflammation in a post-traumatic osteoarthritis rabbit model

BackgroundThe incidence of post-traumatic osteoarthritis (PTOA) after anterior cruciate ligament reconstruction (ACLR) is high, but there is still a lack of intra-operative preventive measures. This study aimed to evaluate the effect of different irrigating solutions continuous irrigation on intra-articular inflammation and cartilage degeneration.Methods 66 New Zealand rabbits were randomly divided into normal (N) group, no treatment (NT) group, sodium chloride (NaCl) group, magnesium sulfate (MgSO4) group, and calcium chloride (CaCl2) group. The right knee joint of the experimental group was utilized to construct the model of PTOA, and the left side was utilized as the normal control group. At different time points postoperatively, the blood concentration of hemoglobin and Mg2 + , the synovial fluid concentration of IL-1 β, TNF-α, tartrate-resistant acid phosphatase-5b (TRAP-5b), and Type II Collagen, the gene expression of IL-1 β and MMP-3, and the protein expression of TRPV5 and CaM were detected. Pearson′s linear correlation was employed to identify the possible relationship between the expression of TRAP-5b and the expression of IL-1β, IL-6, TNF-α, and Type II collagen. The hematoxylin and eosin staining (HE), Masson’s trichrome staining, and Alcian blue staining were performed at postoperative 35 days. Osteoarthritis Scoring (OA score) comprised categories including Alcian blue staining, cartilage histology, the cellular density of cartilage, degree of cell disintegration, and formation of chondrocyte cluster were blindly scored by trained researchers at postoperative 35 days.ResultsThere was no statistical difference (P > 0.05) in the hemoglobin concentration between different groups. The concentration of serum Mg2+ in the MgSO4 group was higher than that of the other three groups (P < 0.05) on the same day of operation, then gradually decreased. The expression of IL-1 β, IL-6, and TRAP-5b in synovial fluid increased 5 days after the operation, decreased at 15 days, and then increased again with time in the NT group, NaCl group, and NT group and NaCl group. At 35 days after the operation, the expression of IL-1 β, IL-6, TRAP-5b, and type II collagen in the MgSO4 group were lower than that in the other three groups (except group N) (P < 0.05).The correlation analysis results showed that the TRAP-5b levels correlated positively with IL-1 β, IL-6, TNF-α, and type II collagen concentrations. The histological examination revealed that the surface smoothness of cartilage, the morphology of chondrocytes, the arrangement of collagen fibers, and the density of proteoglycan in the MgSO4 group were better than those in other experimental groups. At 35 days postoperatively, the gene expression of IL-1 β and MMP-3 and the protein expression of CaM and TRPV5 in synovium in the MgSO4 group was lower than that in the NaCl group and CaCl2 group.ConclusionIntra-operative irrigation with magnesium sulfate solution can inhibit the inflammatory factors and the expression of TRPV5, which can also reduce collagen loss and delay cartilage degeneration. Therefore, the use of magnesium sulfate in intra-operative irrigation may be an ideal choice to prevent PTOA.

Post-traumatic elbow osteoarthritis after radial head arthroplasty: Prevalence and risk factors

BackgroundOne of the treatment options for comminuted radial head fractures is radial head arthroplasty (RHA), especially when the elbow is also dislocated. While the clinical outcomes of RHA have been well documented, the incidence of post-traumatic osteoarthritis after RHA and its risk factors are not well known. ObjectiveTo determine the incidence of post-traumatic elbow osteoarthritis (humeroulnar and humeroradial joints) after RHA and identify its risk factors. MethodsAll patients who underwent RHA at our hospital between 2008 and 2016 were included retrospectively. The inclusion criteria were primary RHA, recent radial head fracture (isolated or associated with elbow dislocation), minimum 1 year of follow-up, clinical and radiographic examination at final assessment. The exclusion criteria were pre-existing elbow osteoarthritis, RHA revision, multiple fractures of the ipsilateral upper limb or polytrauma. The final assessment consisted of a clinical examination [joint range of motion (ROM) and Mayo Elbow Performance Score (MEPS)] and standard radiographs. The correlation between the incidence and severity of osteoarthritis and various risk factors was determined. ResultsSeventy-three patients were included in the analysis with a mean age of 56 years (21–85). The injuries consisted of 41 terrible triad, 15 isolated radial head fractures, 11 Monteggia fractures and 6 transolecranon fracture-dislocations. The mean follow-up was 3.4 years (1–10.9). At the final assessment, osteoarthritis was visible in the humeroulnar compartment in 56% of cases and in the humeroradial compartment in 72% of cases. There was a statistical correlation between the presence of humeroulnar osteoarthritis at the final assessment and ROM in flexion-extension (p=0.003), MEPS (p<0.001), duration of immobilization (p=0.03) and presence of posterior subluxation on immediate postoperative radiographs (p=0.012). The correlation between humeroradial osteoarthritis at the final assessment and ROM in flexion-extension (p=0.0054), RHA implant position (p<0.01), and unipolar configuration (p=0.027) was statistically significant. ConclusionIn our study, elbow osteoarthritis incidence after RHA was 56% in the humeroulnar joint and 72% in the humeroradial joint. RHA implant placement, posterior subluxation immediately postoperative and the duration of immobilization were significantly corelated with osteoarthritis. Level of evidenceIV; case series without control group.

The incidence of post-traumatic osteoarthritis in the knee in active duty military personnel compared to estimates in the general population

The incidence of post-traumatic osteoarthritis in the knee in active duty military personnel compared to estimates in the general population

Hip endoprosthetics in osteoarthritis after acetabular fractures

The incidence of post-traumatic osteoarthritis after acetabular fractures is between 26 and 57%. With total hip arthroplasty (THA), affected patients can achieve a clear functional improvement and pain reduction if specific conditions are heeded. Depending on the degree and localisation of bone defects and deformities, scarring and the presence of remaining osteosynthesis material, different treatment strategies are available. This review gives an overview of current treatment strategies. Review of relevant clinical studies, meta-analyses and presentation of our own approach. The best results regarding to implant survival and clinical outcome, comparable with THA in primary osteoarthritis, can be achieved, when cementless acetabular reconstruction with anatomical restoration of the hip's rotational center and sufficient mechanical support is obtained. Pre-operative planing based on a thorough radiographic examination is essential. Althoug the postoperative complication rate is elevated after THA for posttraumatic arthritis after acetabular fractures compared with primary osteoarthritis, the overall functional results and implant survival are comparable.

Pathogenesis and Prevention of Posttraumatic Osteoarthritis After Intra-articular Fracture

Posttraumatic osteoarthritis (PTOA) occurs after traumatic injury to the joint. It is most common following injuries that disrupt the articular surface or lead to joint instability. The reported risk of PTOA following significant joint trauma is as high as 75%; articular fractures can increase the risk more than 20-fold. Despite recent advances in surgical management, the incidence of PTOA following intra-articular fractures has remained relatively unchanged over the last few decades. Pathogenesis of PTOA after intra-articular fracture is likely multifactorial and may be associated with acute cartilage injury as well as chronic joint overload secondary to instability, incongruity, and malalignment. Additional studies are needed to better elucidate how these factors contribute to the development of PTOA and to develop advanced treatment algorithms that consist of both acute biologic interventions targeted to decrease inflammation and cellular death in response to injury and improved surgical methods to restore stability, congruity, and alignment.

Clinical and biomechanical investigation of an increased articular cavity depth after distal radius fractures: effect on range of motion, osteoarthrosis and loading patterns

After fracture, distal radius malunion with dissociation of the volar and dorsal ulnar fracture fragments can lead to an increased articular cavity. To investigate its clinical impact we retrospectively analyzed the outcome of 81 patients and simulated this form of malunion in a biomechanical experiment with six cadaver specimens in a dynamic loading set-up. In clinics, a higher arthritis stage was significantly correlated with an increased articular cavity depth and an increased anterioposterior distance. In cadaver specimens, a significantly decreased range of motion and significantly altered intraarticular contact characteristics were recognized for an increased cavity. Alterations in contact biomechanics could be one reason for the higher incidence of posttraumatic osteoarthritis when a deeper central impaction of the distal radius is present. From a clinical and experimental point of view, restoration of the normal shape of the distal radius is considered to minimize the risk for posttraumatic radiocarpal osteoarthritis.

Artroplastia Total de Cadera con Copa no Cementada en Secuela de Fractura de Acetabulo

&lt;p&gt;INTRODUCCION: Las fracturas acetabulares pueden causar artrosis degenerativa de la cadera. La incidencia de artrosis post traumática tras fracturas acetabulares ha sido reportada entre el 12% y el 57% y la osteonecrosis cefálica femoral entre un 2% al 40% luego de una luxo fractura de cadera. La fractura acetabular con frecuencia es ocasionada por traumas importantes en accidentes en la vía pública, laborales o deportivos y los pacientes por lo general se presentan para el reemplazo total de cadera (RTC) a una edad mas temprana que la población artrósica general. Se describe y analiza una serie de casos de RTC post fractura de acetabulo, y se la comparó con un grupo de RTC en pacientes con patologías degenerativas.&lt;/p&gt;&lt;p&gt;MATERIALES Y METODOS: Se evaluaron 19 casos tratados en forma quirúrgica de RTC con copa acetabular no cementada secundario a artrosis post traumática como secuela de fracturas de acetábulo. La edad promedio al momento de la artroplastía fue de 52,2 años (19 - 83). La edad al momento de la fractura fue de 47,9 años (16 - 81). El tiempo promedio entre la fractura de acetábulo y el reemplazo total de cadera fue de 52,4 meses (4 - 360). El seguimiento promedio fue de 4,25 años.&lt;/p&gt;&lt;p&gt;RESULTADOS: En los RTC post fracturas acetabulares no se registró ningún tipo de aflojamiento de los componentes protésicos radiográficos. En ningún caso se registró infección. El Score de Harris promedió 89.3 (57 – 99). El grupo control con RTC por patologías degenerativas tuvo un seguimiento de 4,9 años; su Score de Harris fue de 94,1 puntos (78 – 100). En este grupo no encontramos signos de infección ni signos de aflojamientos clínicos ni radiográficos. No hubo diferencias significativas con el Score de Harris (p= 0,24) entre ambos grupos.&lt;/p&gt;&lt;p&gt;CONCLUSION: El RTC para una artrosis post traumática como secuela de una fractura de acetábulo es un procedimiento mas dificultoso que una artroplastía de rutina en un paciente con una enfermedad degenerativa. En un corto plazo no existen diferencias clínicas ni radiográficas en los RTC con copas acetabulares no cementadas en pacientes con artrosis post traumáticas comparadas con pacientes con patologías degenerativas.&lt;/p&gt;

Functional Outcome after Operative Treatment of Displaced Fractures of the Acetabulum: A 12-month to 5-year Follow-up Investigation.

To review our experience with 82 surgically treated displaced acetabular fractures over a 4-year period. Ninety-three consecutive displaced acetabular fractures were consecutively operated on at Level I Trauma Center from January 1, 2000 through December 31, 2003, and 82 were available for review with a minimum of 12-month follow-up. Clinical (Merle D'Aubigné modified by Matta et al.) and radiographic (Matta) outcomes were evaluated. Complications and secondary operative procedures were documented. Anatomical reduction was achieved in 89% of the patients. At follow-up examination 12-60 months postoperatively (mean 32 months), clinical results were satisfactory in 65 patients (79.2% of the cases), with 14 excellent and 51 good results, and roentgenographic results were satisfactory in 70 patients (85.4% of the cases). Complications included a 12.2% incidence of sciatic nerve palsy (10 patients, two postoperative and eight posttraumatic), a 2.4% incidence of intraoperative vascular lesion (one external iliac artery and one external iliac vein), a 1.2% incidence of postoperative loss of reduction, a 1.2% incidence of infection, a 1.2% incidence of Brooker et al. class IV heterotopic ossification, a 2.4% incidence of posttraumatic osteoarthritis, and a 2.4% incidence of osteonecrosis of the femoral head. Operative treatment is an effective method for the management of displaced acetabular fractures. Clinical and roentgenographic results correlate closely with an anatomic reduction. Low complication rate can be expected if adequate preoperative assessment and planning is performed. Strategies to minimize the risk of thromboembolism and heterotopic ossification on the basis of mechanical pneumatic compression and antiinflammatory nonsteroidal drugs, respectively, are reliable techniques for these injuries.