Management Of Bone Loss Research Articles

Metaphyseal fixation in revision knee arthroplasty: a systematic review of the literature and meta-analysis of mid-long-term outcomes of metaphyseal sleeves and cones.

Metaphyseal augmentation has in recent years formed a key strategy in management of bone loss in revision knee arthroplasty. There are studies reporting excellent short-term results, however long- term data is lacking. There is also a paucity of studies comparing the most frequently utilised augments, metaphyseal sleeves, and cones. We conducted a systematic review and meta-analysis to evaluate and compare the mid to long term outcomes of metaphyseal cones and sleeves. We conducted systematic search of 4 databases (Medline, Embase, CINALH and PubMed). Seventeen studies were found to be eligible for inclusion of which ten investigated metaphyseal sleeves and the remaining seven investigated cones. Mean follow up across all studies was 6.2 years. The total number of patients included in the studies was 1319 and the number of knees operated on was 1431. We noted a higher revision rate of metaphyseal cones when compared to sleeves 10.85% vs 6.31 (p=0.007). Reoperation rates were also higher in cones compared to sleeves, 13.78% vs 3.68% (p<0.001). Prosthetic joint infection was the most common reason for revision. The difference in conversion rates, based on augment location was statistically significant p=0.019. When undertaking further sub-analysis; there was no statistically significant difference when comparing revision rates of; tibial vs femoral augments p=0.108, tibial vs tibial & femur p=0.54 but a difference was seen between femoral vs tibial & femoral augments p=0.007. Based on our data, metaphyseal sleeves demonstrate significantly lower revision rates compared to metaphyseal cones. However overall, both demonstrate reliable mid to long-term outcomes.

Management of Total Frontal Bone Loss After Surgery for Craniosynostosis: The Modified Visor Bone Flap With Brain Cage.

Complications after craniosynostosis surgery occur in 11% to 36% of cases and may be precipitated by poor soft tissue coverage and concomitant exposure of non-sterile regions; sequelae may result in infection, osteomyelitis, and bone loss requiring complex reconstruction. In the pediatric population, autologous cranioplasty remains the gold standard due to growth potential and a more favorable complication profile than synthetic cranioplasty. Virtual surgery planning (VSP) and computer-assisted design (CAD)/computer-assisted manufacturing (CAM) technology can be utilized to create innovative, patient-specific autologous solutions, similar to the approach with synthetic cranioplasty. A novel surgical approach using VSP was used for an 18-month-old female with near total bifrontal bone loss. Surface area measurements were used to determine the amount of bone available to replace the infected frontal bone. VSP was utilized to determine the most efficient construct configuration possible to achieve maximal coverage via calculation of cranial bone surface area measurements. Surgical reconstruction of the defect was planned as a Modified Visor Bone Flap with Posterior Brain Cage. A construct was fashioned from available cranial bone struts to obtain widespread coverage. 3D Recon images from before and after surgery demonstrate almost complete re-ossification of the cranial vault with significant resulting clinical improvement. Reconstruction of total frontal bone loss is possible by utilizing this technique. VSP can improve the safety and efficiency of complex autologous cranial bone reconstructions. We propose a treatment algorithm to address the problem of near total frontal bone loss in young children for whom alloplastic implants are not suitable.

Poster 131: Open Bankart versus arthroscopic Bankart with remplissage for anterior glenohumeral instability with subcritical glenoid bone loss

Objectives:The optimal surgical technique for the management of subcritical glenoid bone loss (GBL) with or without engaging Hill Sachs (HS) lesion is unknown. Open Bankart and arthroscopic Bankart repair with remplissage have been proposed as potential treatments however no comparative studies exists. The goal of this study was to define failure rates and associated risk factors for patients with subcritical GBL undergoing either open Bankart or arthroscopic Bankart with remplissage.Methods:A consecutive series of arthroscopic Bankart stabilizations with remplissage or open Bankart repairs were performed by sports-medicine certified and fellowship trained orthopaedic surgeons from 2010-2019 . Minimum follow up was 2 years, and shoulders with glenoid bone loss <3% or >25%, multidirectional instability or hyperlaxity were excluded. Shoulders were additionally excluded if magnetic resonance imaging (MRI) was not available at the time of preoperative evaluation or the patient was lost to follow-up. All shoulders were evaluated for glenohumeral bone loss using the perfect circle technique on the sagittal en-face MRI as well as for bipolar lesions according to the on/off-track method of Diagacomo et al. The primary outcomes of interest were recurrent instability (subluxation or dislocation) and revision stabilization. A power analysis was conducted based on a projected failure rate of 10%, alpha 0.05, and power of 80% which determined that 28 patients would be needed per group to detect a 4-fold difference in failure rate. Multivariable logistic regression models were used to assess the relationships of outcomes with surgical technique, primary vs revision surgery, and track.Results:Thirty-one patients (31) with open Bankart and twenty eight (28) patients with arthroscopic Bankart and remplissage met inclusion criteria. The mean age was 25.9 years old (18-46) and mean follow-up 4.7 years. There was no difference in baseline age (remplissage 27.8 years, open Bankart 24.5 years), glenoid bone loss (remplissage 13.8%, open Bankart 11.1%), off-track HS (remplissage 13, open Bankart 17) or primary versus revision surgery (primary remplissage 18/28, primary open Bankart 14/31) between cohorts. The failure rate in the open Bankart cohort was 6.5% (2/31) with 2 dislocations, multiple subluxations, resulting in 2 revisions. The failure rate of the arthroscopic Bankart remplissage cohort was 7.1% (2/28), 2 dislocations, multiple subluxations, resulting in 2 revisions. Multivariate regression analysis did not identify age, gender, procedure, GBL, index vs revision surgery, or on/off track as predictors of failure. Subgroup analysis of patients with on- vs off-track HS lesions as well as primary vs revision surgery showed no difference in patient baseline characteristics including GBL, and no difference in failure rates between patients with open Bankart and remplissage.Conclusions:Bankart and arthroscopic Bankart with remplissage are both effective at treating anterior instability with subcritical GBL. No differences in failures or complications was observed between our arthroscopic Bankart with remplissage and open Bankart cohorts.

Cancer Treatment-Induced Bone Loss: Role of Denosumab in Non-Metastatic Breast Cancer.

Chemotherapeutic agents, endocrine therapy and radiotherapy used in the management of breast cancer are known to cause decreased bone mineral density, and thus, increased incidence of fractures. A majority (~60%) of the breast cancer patients in India are either estrogen (ER) or progesterone hormone receptor (PR) positive. Adjuvant treatment with aromatase inhibitors (AIs) is the treatment mainstay for hormone-sensitive disease in postmenopausal (PM) women, with reduced bone mineral density (BMD), which results in increased fracture rates. Zoledronic acid, alendronate, risedronate and denosumab have been the agents of choice for managing bone loss. Denosumab 60 mg is approved for gaining bone mass in women with breast cancer who are at high risk for fracture following adjuvant AI treatment. The phase III HALT-BC data indicate an improvement in BMD with denosumab and a 50% reduction in clinical fractures, with significant improvements seen at the lumbar spine, distal third of the radius, and total hip. Denosumab has several advantages over other bone modifying agents such as subcutaneous self-administration by the patient themselves, no requirement of hospitalization, no dose modifications in renal impairment, and low incidence of acute phase anaphylactic reactions. We review the available evidence of denosumab for managing bone loss in non-metastatic breast cancer patients.

Masquelet–Ilizarov technique for the management of bone loss post debridement of infected tibial nonunion

PurposeMasquelet and Ilizarov techniques have their advantages and shortcomings in the reconstruction of bone defects. The aim of this study was to evaluate the effectiveness of the combination of both techniques for the management of infected tibial nonunion to combine the advantages of both techniques with avoidance of shortcomings of both of them.Patients and methodsA prospective single-centre study was performed during the period from 2012 to 2019. Patients with the infected nonunion of the tibia with bone defect were included. Patients with pathological fractures or non-infected bone loss were excluded. Management protocol for all patients consisted of two stages. The first stage was Masquelet induced membrane technique and the second stage was Ilizarov bone transport. The results were assessed based on both objective (clinical and radiographic evaluation) and subjective criteria (limb function and patient satisfaction).ResultsThirty-two patients were included in this study. The mean size of the defect was 6 cm. Ilizarov bone transport was done through the induced membrane chamber in all cases with an average follow-up of 28 months. Successful reconstruction without recurrence of infection was achieved in 30 cases (94%). No other bone or soft tissue procedure was needed with satisfactory functional outcome in 27 out of 30 cases (90%). Three cases had unsatisfactory results due to leg length discrepancy, joint stiffness, and persistent pain.ConclusionsMasquelet–Ilizarov technique can be used for the management of infected nonunion tibia with high satisfactory results without the need for complex soft tissue procedures.

Correlative Assessment of Interdental and Interradicular Bone Loss in Horizontal and Vertical Bone Defects In Chronic Periodontitis: A Clinical and Radiographic Study

It is important to treat periodontitis before involvement of furcation areas because of their complex anatomy and difficulty of access. Literature confirms that it is difficult to accurately determine the relationship of the amount of bone loss in the interdental areas associated with the interradicular areas and correlate them with the clinical periodontal status. The aim of this study was therefore to assess the existence of such an association, if any, in subjects with chronic periodontitis. The threshold of alveolar bone loss associated with progression of periodontal destruction and involvement of interradicular areas of the furcations is not clearly defined in the literature. The aim of this study was to investigate a correlation, if any between interdental and interradicular bone loss and clinical parameters in patients with chronic periodontitis. Periapical (IOPA) radiographs of mandibular molars were obtained from 193 sites in 33 males and 21 females between the age group of 25 and 55 years having chronic periodontitis. These were then scanned and digital measurement of linear distances was performed using dicom software of height and width of defect (horizontal and vertical), bone defect angle and interradicular bone loss. These measurements were correlated to pocket depth (PD) and clinical attachment loss (CAL) using One-way ANOVA followed by Tukeys HSD post hoc tests. Bone height significantly correlated with probing depth and CAL in horizontal defects (p&lt;0.005) with hardly any furcation involvement (1.55%)whereas both bone height and width showed significant correlation with probing depth and CAL in vertical defects(P&lt;0.001) with nearly 77% of sites showing furcation defects. A strong correlation of clinical parameters with bone defect dimensions suggests that early diagnosis and management of interdental bone loss may be critical to prevent furcation involvement.

Bone Perspectives in Functional Hypothalamic Amenorrhoea: An Update and Future Avenues.

One of the most important and potentially long-lasting detrimental consequences of Functional Hypothalamic Amenorrhoea (FHA) is on skeletal homeostasis. Beyond oestrogen deficiency, FHA is associated with a cascade of additional neuro-endocrine and metabolic alterations, some adaptive, but which combine to disrupt skeletal homeostasis. Ultimately, this leads to a two-fold increased risk of fractures in women with FHA compared to healthy eumenorrhoeic women. Although the cornerstone of management of FHA-related bone loss remains recovery of menses via restoration of metabolic/psychological balance, there is rapidly developing evidence for hormonal manipulations (with a particular emphasis on route of administration) and other pharmacological treatments that can protect or improve skeletal homeostasis in FHA. In this mini-review, we provide an update on the pathophysiology, clinical management and future avenues in the field from a bone perspective.

Midterm Radiographic Results and Reoperations of Tantalum Trabecular Metal Cones in Knee Arthroplasties.

Objective The management of bone loss represents a challenge in revisions of total knee arthroplasty (rTKA) and in complex primary total knee arthroplasties (TKAs). The purpose of the present study was to evaluate the midterm outcomes (5-year minimum follow-up) of knee reconstructions with tantalum trabecular metal (TM) cones on bone defects Anderson Orthopaedics Research Institute (AORI) 2 and 3. Materials and Methods A retrospective analysis of the medical records of patients operated on between July 2008 and November 2014 was performed, collecting the following data: age, gender, laterality, body mass index, etiology of arthrosis, comorbidities, AORI classification of bone defects, causes for revision, readmissions, reoperations, perioperative and postoperative complications, radiographic signs of osteointegration, and maintenance of the TM support. Results A total of 11 patients with a mean follow-up of 7.28 years (standard deviation [SD] = 1.88; range = 5.12–10 years) was evaluated, with 1 patient operated upon for a primary arthroplasty, 6 for revision arthroplasties, and 4 for a second revision arthroplasty (re-revision). There were complications with the surgical wound, injury to the extensor mechanism and loosening of the femoral component in three of the patients that led to the necessity of four procedures due to complications with the surgical wound, injury to the extensor mechanism and loosening of the femoral component. Radiological signs of osteointegration of the trabecular cones were observed in all patients. We did not observe migration of the TM cones or the prosthetic components in the sample.Conclusion The tantalum metaphyseal cones were able to provide efficient structural support to prosthetic implants with radiographic signs of osteointegration in the medium term.

Molecular Pathways and Roles for Vitamin K2-7 as a Health-Beneficial Nutraceutical: Challenges and Opportunities.

Vitamin K2-7, also known as menaquinone-7 (MK-7) is a form of vitamin K that has health-beneficial effects in osteoporosis, cardiovascular disease, inflammation, cancer, Alzheimer’s disease, diabetes and peripheral neuropathy. Compared to vitamin K1 (phylloquinone), K2-7 is absorbed more readily and is more bioavailable. Clinical studies have unequivocally demonstrated the utility of vitamin K2-7 supplementation in ameliorating peripheral neuropathy, reducing bone fracture risk and improving cardiovascular health. We examine how undercarboxylated osteocalcin (ucOC) and matrix Gla protein (ucMGP) are converted to carboxylated forms (cOC and cMGP respectively) by K2-7 acting as a cofactor, thus facilitating the deposition of calcium in bones and preventing vascular calcification. K2-7 is beneficial in managing bone loss because it upregulates osteoprotegerin which is a decoy receptor for RANK ligand (RANKL) thus inhibiting bone resorption. We also review the evidence for the health-beneficial outcomes of K2-7 in diabetes, peripheral neuropathy and Alzheimer’s disease. In addition, we discuss the K2-7-mediated suppression of growth in cancer cells via cell-cycle arrest, autophagy and apoptosis. The mechanistic basis for the disease-modulating effects of K2-7 is mediated through various signal transduction pathways such as PI3K/AKT, MAP Kinase, JAK/STAT, NF-κB, etc. Interestingly, K2-7 is also responsible for suppression of proinflammatory mediators such as IL-1α, IL-1β and TNF-α. We elucidate various genes modulated by K2-7 as well as the clinical pharmacometrics of vitamin K2-7 including K2-7-mediated pharmacokinetics/pharmacodynamics (PK/PD). Further, we discuss the current status of clinical trials on K2-7 that shed light on dosing strategies for maximum health benefits. Taken together, this is a synthetic review that delineates the health-beneficial effects of K2-7 in a clinical setting, highlights the molecular basis for these effects, elucidates the clinical pharmacokinetics of K2-7, and underscores the need for K2-7 supplementation in the global diet.

Safety and Tolerability of SBD111 an Optimized Probiotic/Prebiotic Medical Food Combination Designed for the Dietary Management of Age-Related Bone Loss in Adults.

ObjectivesTo determine the effect of a daily administration of 6.1 × 1010 CFU/d of SBD111 (an optimized probiotic/prebiotic combination) on safety and tolerability in adults in a randomized trial. MethodsParticipants (n = 32) were randomized to either SBD111 or placebo. The primary outcomes were the number, frequency and severity of adverse Gastrointestinal (GI) symptoms over 28-d. Secondary outcomes were the number and severity of all adverse events (AEs). Stool samples were collected at baseline and after 28-d to determine the impact of SBD111 on gut microbial engraftment, diversity and function using shotgun metagenomics. Groups were compared using Incidence Rate Ratios (negative binomial regression), Odds Ratios (logistic regression) and 95%CI (P< 0.05) using intention-to-treat approach. ResultsAt baseline, the mean age was 45(SD:18)y in SBD111 users (n = 5M, 10F) vs 42(SD:14)y in placebo users (n = 5M, 12F). The two groups did not significantly differ in age, BMI, blood pressure and screening labs. After 28-d, the presence of GI symptoms tended to be higher with SBD111 use vs placebo (P = 0.08). The total number, frequency/severity of GI symptoms did not significantly differ between groups and only 1 person withdrew from the placebo group due to side effects. The number of AEs possibly related to the study were significantly higher with SBD111 use vs placebo (P = 0.05), there were no significant differences in the mean number or severity of AEs. The majority of reported AEs were mild, some were moderate, but none were severe. There were no significant differences in Shannon diversity/microbial richness between the two groups at baseline or after 28-d. After 28-d, participants receiving SBD111 but not placebo showed a significant enrichment in metabolic pathways of menaquinone (vitamin K2) production including the superpathway of menaquinol-10. Fragment recruitment analysis identified the genomic signal of the strains comprising SBD111 after 28-d of SBD111 use, but not placebo. SBD111 strains were undetectable at baseline in either group. ConclusionsThe relatively low frequency and mild severity of GI symptoms and AEs suggests that SBD111 at the level tested is safe for human consumption and that SBD111 microbes are able to pass through the intestinal tract, be identified in stool and enrich microbial gene pathways related to bone health. Funding SourcesSolarea Bio Inc.

Effectiveness of Neridronate in the Management of Bone Loss in Patients with Duchenne Muscular Dystrophy: Results from a Pilot Study.

IntroductionBone loss is a major issue in patients affected by Duchenne muscular dystrophy (DMD), a rare musculoskeletal disorder, particularly in those treated with glucocorticoids (GCs). We aimed to assess the effectiveness of neridronate in terms of bone mineral density (BMD) changes in this population.MethodsWe retrospectively reviewed the records of patients affected by DMD receiving GCs referred to our outpatient from 2015 to 2020. All patients were treated with an intramuscular (IM) injection of neridronate (25 mg every month). Bone density was measured at the lumbar spine (LS; L1–L4 tract) using dual-energy x-ray absorptiometry (DXA) (GE Lunar), no more than 4 weeks before (T0) and after 1 year from neridronate treatment (T1).ResultsEight boys with DMD were included with a mean age at diagnosis of 4.75 ± 2.81 years. Six of them were non-ambulant and two of them had previous low-trauma fractures (a distal femur fracture and a vertebral compression fracture, respectively). All patients were receiving deflazacort [median duration of therapy 11.5 years (interquartile range 2–25)]. At the DXA evaluation (T0), the mean L1–L4 BMD value was 0.716 ± 0.164 g/cm2. Six patients (75%) showed an L1–L4 Z-score height-adjusted of less than − 2. The mean age of neridronate initiation was 18.87 ± 6.81 years. All patients were supplemented with calcium carbonate and vitamin D at baseline. After 12 months of treatment (T1), the mean L1–L4 BMD value was 0.685 ± 0.190 g/cm2. Seven patients (87.5%) showed an L1–L4 Z-score of less than − 2. Changes in LS BMD and Z-score were not significant between T0 and T1 in our cohort (p = 0.674 and p = 0.208, respectively) as well as among non-ambulant patients with DMD without previous fragility fractures.ConclusionsIn this study, we reported for the first time that neridronate may slow bone loss in GC-treated patients with DMD at 1-year follow-up.

Management of glenoid bone loss with impaction and structural bone grafting in reverse shoulder arthroplasty.

Glenoid bone loss is a commonly encountered problem in complex primary and revision shoulder arthroplasty. Addressing glenoid bone loss is critical to avoid complications like early loosening, impingement, notching and instability. A large number of techniques like bone grafting using autograft or allograft, eccentric reaming, augmented base plates, patient-specific instrumentations and custom-made implants are available to tackle bone loss. We prospectively collected the data of all patients with glenoid defects undergoing primary or revision reverse shoulder replacement between 2004 and 2017. This included demographic data, ranges of motion, Constant-Murley score and Subjective Shoulder Value(SSV). A pre-operative CT scan was done as well to plan the surgery and calculate the glenoid version. At each follow-up, the clinical function and shoulder scores were assessed. Additionally, the radiographs were assessed for graft incorporation, evidence of lysis and calculation of glenoid version. Between 2004 and 2017, 37 patients underwent glenoid bone grafting during reverse shoulder arthroplasty. Average age was 72years (range 46-88). Indications for surgery were cuff tear arthropathy (6 patients); revision of failed other prosthesis (23); primary osteoarthritis (4); rheumatoid arthritis (3); and second-stage revision for infection (1). The glenoid defect was contained in 24 patients, and therefore, impaction graft with a combination of bone graft substitute and/or humeral head autograft was performed. In 13 patients the glenoid defect was severe and uncontainable and therefore a graft-implant composite glenoid was implanted using humeral head autograft or allograft. Average follow-up was 3.6years (range 1-10). Mean Constant score improved from 34 before surgery to 63 after surgery. Mean SSV score improved from 0.9/10 to 8.3/10. Active movements improved significantly with forward elevation increasing from 54° to 123°; abduction from 48° to 123°; external rotation from 24° to 38°; internal rotation from 57° to 70°. Radiographs at final follow-up showed no radiolucencies around the glenoid component and no evidence of loosening of the implant. In 2 cases there was a grade I notching. There was 100% survivorship at the last follow-up. Impaction bone grafting along with structural grafting when required is an effective and reproducible way of managing severe glenoid bone loss. This technique gives consistent and good clinical and radiological results.

Load Sharing in the Femur Using Strut Allografts: A Biomechanical Study.

BackgroundFemoral strut allografts are used in revision hip arthroplasty for management of bone loss associated with implant failure or periprosthetic fractures. They have also been used to treat unremitting thigh pain in well-fixed cementless femoral stems, to address the differential in structural stiffness between the stem and femoral shaft. Our study used an in vitro biomechanical model to measure the effect of placement of allografts on femoral strains, to determine their load-sharing capacity.Material and methodsThree rosette strain gauges were applied to the femoral surface of each of 6 cadaveric femurs, at the stem tip level on anterior, medial, and lateral cortices. After stem implantation, cortical strut allografts were applied to the lateral femoral shaft and secured with 4 Dall-Miles cables. A fourth gauge was placed on the midpoint of the allograft. Strains were recorded in the intact femur, then the implanted femur with and without the allograft under simulated physiologic loading in a load frame.ResultsReduction in distal femoral principal strains, between 12% and 59%, was seen in all cortices following placement of the allograft. Under axial loading, 30% of the strain in the lateral cortex was borne by the allograft. Greater reductions in strain, by as much as 59%, occurred under axial load and torque.ConclusionThe results of this biomechanical model indicate that by placement of an allograft, cortical strains can be reduced to levels approaching those in an intact femur, supporting this technique for treatment of unremitting thigh pain in well-fixed prostheses.

Pharmacological Prevention and Management of Skeletal-Related Events and Bone Loss in Individuals with Cancer.

To provide a literature review of the clinical efficacy and safety data of various pharmacological agents used to manage bone health in people affected by cancer. Peer-reviewed articles and research publications identified from PubMed and relevant clinical guidelines were used in this evidence synthesis. Individuals with cancers such as breast and prostate cancers, multiple myeloma, and other malignancies are at a high risk of developing skeletal-related events such as bone fracture, bone metastasis, and osteoporosis. Pharmacologic agents such as bisphosphonates and RANK-L inhibitor (denosumab) are the mainstay therapy options for managing bone health in this population. Nurses and nurse practitioners should be aware of the efficacy data of bisphosphonates and denosumab but also should be well-versed in the appropriate administration of these agents, potential side effect profiles, timely assessment, and interventions to optimize quality of life.

Induced membrane technique for acute bone loss and nonunion management of the tibia.

Objectives:To report our experience and clinical results of using the Masquelet technique for the treatment of tibial nonunions and acute traumatic tibial bone defects.Design:Retrospective study of prospectively collected data (Level IV).Setting:Level I trauma center in the UK.Patients/Participants:Consecutive patients with tibial nonunions and open fractures associated with bone loss.Intervention: Two-stage Masquelet Procedure for the tibia.Main Outcome Measurements:Clinical and imaging assessment at 6 weeks, 3,6,9,12 months, or until pain-free mobilization and union.Results:There were 17 eligible patients, with a mean size of bone defect of 6 cm (range, 4–8 cm) and an 88.2% union rate at a mean of 8 months (range 5–18 months). Mean range of motion was 95 degrees of knee flexion (range 80°–130°). All patients but 2 returned to their previous occupation.Conclusions:The Masquelet technique is simple, effective, and has a high rate of success for the management of a variety of situations including acute bone loss or infected nonunions and is associated with a low incidence of complications.

The use of tantalum cones and diaphyseal-engaging stems in tibial component revision: a consecutive series

IntroductionRevision knee arthroplasty presents a number of challenges, including management of bone loss. The goal in managing moderate to large bone defects is fixation that is sufficient enough to allow early weight-bearing. The purpose of this study was to describe the surgical technique and clinical and radiographic outcomes of patients treated with porous tantalum metaphyseal cones in combination with long uncemented diaphyseal-engaging stems to manage tibial bone loss in revision total knee arthroplasty (TKA).Materials and methodsThirty-six aseptic revision TKAs were performed at our institution between 2016 and 2019 by two senior authors. A single trabecular metal tantalum cone combined with a long (100 or 155 mm) press fit, diaphyseal-engaging stem was used in all cases to reconstruct metaphyseal bone defects and to augment tibial fixation. Cemented stems were excluded. The tibiofemoral angle was measured along the tibial and femoral shaft axes on the weight-bearing anteroposterior radiograph at final follow-up (range 15–56 months). All clinical and surgical complications, reoperations, and revisions of any component were recorded. Survivorship free of revision was evaluated at the time of the latest follow-up.ResultsThe mean Knee Society Score (KSS) and Knee Society Function Score (KSS-F) improved significantly from 29.7 points preoperatively (range 11–54 points) to 86 points (range 43–99 points) and from 20.4 points preoperatively (range 0–55 points) to 72.3 points (range 30–90 points) (p < 0.05), respectively. Eleven tibial constructs (30.5%) had incomplete, nonprogressive radiolucent lines (≤ 2 mm). All tibial cones demonstrated osteointegration. One patient underwent a full revision for periprosthetic joint infection, and survivorship free of any component revision was 91.7% at final follow-up.ConclusionsHybrid fixation with uncemented diaphyseal-engaging stems and porous tantalum metaphyseal cones resulted in radiographic lack of osteolysis, good clinical outcomes, and survivorship of 91.7% at a median follow-up of 33 months when considering all-cause revision as the endpoint.

Explainable Artificial Intelligence and Wearable Sensor-Based Gait Analysis to Identify Patients with Osteopenia and Sarcopenia in Daily Life.

Osteopenia and sarcopenia can cause various senile diseases and are key factors related to the quality of life in old age. There is need for portable tools and methods that can analyze osteopenia and sarcopenia risks during daily life, rather than requiring a specialized hospital setting. Gait is a suitable indicator of musculoskeletal diseases; therefore, we analyzed the gait signal obtained from an inertial-sensor-based wearable gait device as a tool to manage bone loss and muscle loss in daily life. To analyze the inertial-sensor-based gait, the inertial signal was classified into seven gait phases, and descriptive statistical parameters were obtained for each gait phase. Subsequently, explainable artificial intelligence was utilized to analyze the contribution and importance of descriptive statistical parameters on osteopenia and sarcopenia. It was found that XGBoost yielded a high accuracy of 88.69% for osteopenia, whereas the random forest approach showed a high accuracy of 93.75% for sarcopenia. Transfer learning with a ResNet backbone exhibited appropriate performance but showed lower accuracy than the descriptive statistical parameter-based identification result. The proposed gait analysis method confirmed high classification accuracy and the statistical significance of gait factors that can be used for osteopenia and sarcopenia management.

Comparison of Glenoid Bone Grafting versus Augmented Glenoid Baseplates in Reverse Shoulder Arthroplasty: A Systematic Review.

Management of bone loss and glenoid deformity can present a significant challenge to surgeons. The purpose of this review was to compare outcomes of reverse shoulder arthroplasty (RSA) using either bone graft or augmented baseplates for the management of glenoid bone loss and deformity. A comprehensive search of MEDLINE, Embase, Cochrane indices was performed for studies reporting clinical outcomes following primary RSA with bone grafting or use of augmented baseplates. Pooled and frequency-weighted means were calculated where applicable. Between-group comparison was also performed. Overall, 19 studies and 652 patients were included in the study. There were no significant differences in age or gender between the bone grafting (70.3 years; 47.8% female) and augmented baseplate (72.9 years; 59.0% female) groups (p=0.166; p=0.659). Overall complication and revision rates were similar for reverse shoulder arthroplasty (RSA) using either bone graft (11.7% complication rate; 4.5% revision rate) or augmented baseplates (11.8% complication rate; 3.7% revision rate) for the management of glenoid bone loss and deformity (p=0.968; p=0.562). Furthermore, range of motion as well as patient-reported and functional outcome scores were similar between both techniques. However, infections (0.7% augmented baseplate; 1.9% bone grafting) and notching (4.7% augmented baseplate; 24.6% bone grafting) were found to be more common in the bone grafting group (p=0.012; p=0.018). Glenoid bone grafting and augmented baseplates have similar overall clinical outcomes, complication rates, and revision rates. However, there were some significant differences between groups with respect to notching and infections which deserve consideration and further exploration.

Proximal femoral replacement in non-neoplastic revision hip arthroplasty : five-year results.

AimsWith increasing burden of revision hip arthroplasty (THA), one of the major challenges is the management of proximal femoral bone loss associated with previous multiple surgeries. Proximal femoral arthroplasty (PFA) has already been popularized for tumour surgeries. Our aim was to describe the outcome of using PFA in these demanding non-neoplastic cases.MethodsA retrospective review of 25 patients who underwent PFA for non-neoplastic indications between January 2009 and December 2015 was undertaken. Their clinical and radiological outcome, complication rates, and survival were recorded. All patients had the Stanmore Implant – Modular Endo-prosthetic Tumour System (METS).ResultsAt mean follow-up of 5.9 years, there were no periprosthetic fractures. Clearance of infection was achieved in 63.6% of cases. One hip was re-revised to pseudo arthroplasty for deep infection. Instability was noted in eight of the hips (32%), of which seven needed further surgery. Out of these eight hips with instability, five had preoperative infection. Deep infection was noted in five of the hips (20%), of which four were primarily revised for infection. One patient had aseptic loosening of the femoral component and awaits revision surgery. The Kaplan-Meier survivorship free of revision of any component for any reason was 72% (95% confidence interval (CI) 51.3% to 92.7%), and for revisions of only femoral component for any reason was 96% (95% CI 86.3% to 105.7%) at five years.ConclusionDislocation and infection remain the major cause for failure, particularly in patients with pre-existing infection. The use of dual mobility cups, silver-coated implants, and less aggressive postoperative rehabilitation regimens would possibly aid in the reduction of complications. PFA performed in patients with periprosthetic fracture seem to fair better. This study supports the judicious use of PFA in non-oncological revision hip arthroplasties, and that they be performed by experienced revision arthroplasty surgeons.Cite this article: Bone Jt Open 2022;3(3):229–235.

The Assessment of the Usefulness of Platelet-Rich Fibrin in the Healing Process Bone Resorption

The main subject of this research was the use of PRF in dental surgery aimed at preventing changes in alveolar height and width after tooth extraction. Due to the large growth factor content, it seems to be particularly useful in bone loss management starting from the simplest loss occurring after tooth extraction through loss resulting from tooth resection ending with loss caused by large bone cysts. The study was performed on 50 patients. The extraction of two maxillary or mandibular homonymous teeth was carried out in each patient, where PRF was placed in one alveolus while the other alveolus was left empty. Then, the alveoli were surgically managed with a split flap technique. On the extraction day, after 10 days, and after 6 months, the alveolar process was measured, soft tissues healing was assessed, and imaging examinations were analyzed. It was proved that the healing of soft tissues in the PRF group was better. In the PRF group after 6 months from surgery, the newly formed bone had higher grayscale values in volumetric tomography (CBCT). Moreover, the reduced atrophy of the alveolar process at the site of the extracted tooth was proved in this study.