Orthopedic Reconstructive Surgery Research Articles

Trifocal versus Pentafocal bone transport in segmental tibial defects: a matched comparative analysis for posttraumatic osteomyelitis treatment

PurposeThe objective of this study was to evaluate and compare the effectiveness and clinical results of trifocal bone transport (TBT) and pentafocal bone transport (PBT) in treating distal tibial defects > 6 cm resulting from posttraumatic osteomyelitis, highlighting the potential advantages and challenges of each method.MethodsA retrospective assessment was conducted on an overall population of 46 eligible patients with distal tibial defects > 6 cm who received treatment between January 2015 and January 2019. Propensity score analysis was used to pair 10 patients who received TBT with 10 patients who received PBT. The outcomes assessed included demographic information, external fixation time (EFT), external fixation index (EFI), bone and functional outcomes assessed using the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system, and postoperative complications evaluated using the Paley classification.ResultsThe demographic and baseline data of the two groups were comparable. Following radical debridement, the average tibial defect was 7.02 ± 0.68 cm. The mean EFT was significantly shorter in the PBT group (130.9 ± 16.0 days) compared to the TBT group (297.3 ± 14.3 days). Similarly, the EFI was lower in the PBT group (20.67 ± 2.75 days/cm) than in the TBT group (35.86 ± 3.69 days/cm). Both groups exhibited satisfactory postoperative bone and functional results. Pin site infection was the most common complication and the rates were significantly different between the groups, with the PBT group demonstrating a higher incidence.ConclusionBoth TBT and PBT effectively treat posttraumatic tibial defects greater than 6 cm, with PBT offering more efficient bone regeneration. However, PBT is associated with a higher rate of pin site infections, highlighting the importance of careful management in these complex procedures and emphasizing the need for expert surgical execution and tailored treatment approaches in orthopedic reconstructive surgery.

Intraoperative live measurement of femoral head size for acetabular cup sizing: simple, accurate, and green!

Templating is the first step in achieving a successful total hip arthroplasty. We hypothesize that native head size is highly correlated with implanted cup size. Therefore, the purpose of this study is to look for a correlation between sizes of the intra-operative measurement of the femoral head and the implanted cup. This is a monocentric observational study conducted from December 2018 till January 2023. All patients admitted for a primary total hip arthroplasty were included and retrospectively reviewed. Intra-operative femoral head measurement, radiographic femoral head diameter, templated (planned) cup size, and definitive implanted cup size were recorded. The sample included 154 patients (85 female and 69 males) with a mean age of 66.2 ± 10.4years. There were 157 THA cases; 82 on the right side and 75 on the left side. The native head size and acetate template on digital radiographs were the most significantly positively correlated with cup size (P < 0.0001) while the radiological head size was significantly negatively correlated with cup size (P = 0.009). The implanted cup was on average 2 ± 2mm bigger than the native head size measured intra-operatively. The native femoral head diameter measured intra-operatively is a simple and reliable tool to help the surgeons choose the proper size of the acetabular cup, preventing complications during surgery hence optimizing results post operatively. This technique would contribute to a more ecofriendly orthopaedic reconstructive surgery.

High accuracy of positioning custom triflange acetabular components in tumour and total hip arthroplasty revision surgery.

Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions. A multicentre observational cohort study in Australia between February 2017 and March 2021 included consecutive patients undergoing acetabular reconstruction with CTACs in rTHA (Paprosky 3A/3B defects) or tumour resection (including Enneking P2 peri-acetabular area). Of 103 eligible patients (104 hips), 34 patients (35 hips) were analyzed. CTAC positioning was generally accurate, with minor deviations in cup inclination (mean 2.7°; SD 2.84°), anteversion (mean 3.6°; SD 5.04°), and rotation (mean 2.1°; SD 2.47°). Deviation of the hip centre of rotation (COR) showed a mean vector length of 5.9 mm (SD 7.24). Flange positions showed small deviations, with the ischial flange exhibiting the largest deviation (mean vector length of 7.0 mm; SD 8.65). Overall, 83% of the implants were accurately positioned, with 17% exceeding malpositioning thresholds. CTACs used in tumour resections exhibited higher positioning accuracy than rTHA cases, with significant differences in inclination (1.5° for tumour vs 3.4° for rTHA) and rotation (1.3° for tumour vs 2.4° for rTHA). The use of intraoperative navigation appeared to enhance positioning accuracy, but this did not reach statistical significance. This study demonstrates favourable CTAC positioning accuracy, with potential for improved accuracy through intraoperative navigation. Further research is needed to understand the implications of positioning accuracy on implant performance and long-term survival.

Limb lengthening and deformity correction in patients with severe fibular hemimelia: experience of the children's university hospital in Belgrade

Background Fibular hemimelia (FH) is a congenital disease manifested by valgus deformity and instability of the knee joint, shortening and deformity of the tibia, hypoplasia and deformities of the foot and ankle.The aim of this paper was to determine the efficacy of the strategy of separate reconstruction of the foot along with correction of tibia deformity, and then tibial lengthening in patients with FH of types 3 and 4 according to Paley.Methods This retrospective study is based on an analysis of the treatment of 12 children with severe FH. The patients, aged no older than 24 months, were treated for foot reconstruction along with correction of tibial deformity followed by a separate stage of tibial lengthening. Tibial lengthening was performed in the age 4.6 ± 1.2 years. The long-term result of treatment was evaluated at least 1 year after the end of tibial lengthening. Evaluation criteria after tibia lengthening were external osteosynthesis index, amount of lengthening, assessment of outcomes according to Lascombes. Walking ability was assessed using Gillette questionnaire.Results The approach we used gave excellent and good results in 83 % of cases after the first reconstructive stage. Complications and recurrences of deformities encountered during the first stage were eliminated during subsequent planned limb lengthening. The average magnitude of lengthening was 6.4 ± 2.4 cm (37.2 ± 12.4 % of the initial segment length). The index of external osteosynthesis was 22.9 ± 12.2 days/cm. Monofocal distraction osteosynthesis was used in 9 cases and bifocal osteosynthesis in three cases. The results of lengthening were classified by Lascombes as IA in 7 cases, IB in four cases, 2B in one case.Discussion In severe FH, the question of reconstruction or early amputation remains open. There are two opinions on the staging of reconstructive orthopedic surgery and tibial lengthening in young children with severe FH.Conclusion The strategy of reconstruction of the foot and ankle joint at an early age (16-24 months) in children with severe FH followed by lengthening of the lower leg (at the age of 4-6 years) proved to be effective and can be used when it is chosen by the patient's parents. In 3C type cases, the use of external fixation to correct the deformity and simultaneously lengthen the tibia at the first stage is an alternative reasonable strategy option.

Turning the young and healthy patient into an elderly faster: A cascade of complications related to immobility

A 42-year-old individual presented with a ruptured left patellar ligament after playing basketball. After undergoing reconstructive orthopedic surgery, he sustained a posterior shoulder dislocation while using crutches, necessitating additional surgery. This combination of orthopedic injuries rendered the patient immobile and bedridden for several months, and immobility-related complications began to develop. Immobilism is a condition that physicians typically associate with elderly and neuropathic patients; however, little is said about this pathology when young and healthy patients who have experienced acute diseases are considered. With a review of the relevant literature, this article describes a peculiar succession of immobility-related complications.

A novel bi-planar calibration method for digital templating in total hip arthroplasty

In total hip arthroplasty and reconstructive orthopedic surgery, pre-operative digital templating is essential for surgical treatment optimization, risk management, and quality control. Calibration is performed before templating to address magnification effects. Conventional methods including fixed calibration factors, individual marker-based calibration and dual-scale marker methods are not reliable. A novel bi-planar calibration method is described aiming to reduce the error below clinical significance. The bi-planar calibration method requires two conventional orthogonal radiographs and a standard radiopaque marker ball. An algorithm computes the hip plane height parallel to the detector in the antero-posterior radiograph. Foreseeable errors (i.e., patient rotation and misplaced markers or lateral offset) are considered in a correction algorithm. Potential effects of errors are quantified in a standard model. Influence of rotation in lateral radiographs and lateral offset of marker on the calibration factor are quantified. Without correction, patient rotation in the lateral radiograph of 30° results in absolute calibration error of 2.2% with 0 mm offset and 6.5% with 60 mm lateral offset. The error is below the threshold of 1.5% for rotation less than 26° with 0 mm offset and 10° with 60 mm offset. The method is supposed to be reliable in precisely predicting the hip plane and thereby the calibration factor. It may be superior to other methods available. In theory, the method allows correction of clinically relevant rotation of at least 30° and marker displacement without impacting the computed calibration factor.

Clinical Outcome of the Latissimus Dorsi Muscle Flap in Orthopedic Reconstruction

Introduction. The latissimus dorsi muscle has been the “workhorse” of reconstructive surgery because of its predictable neurovascular anatomy and ability to perform both wound coverage and restoration of function.Objectives. We determined the flap viability, complications, and muscle function (if used as muscle transfer) of our latissimus dorsi flaps for orthopedic reconstruction.Methods. This is a retrospective review of all cases done in the Microsurgery Unit of the Philippine General Hospital and The Medical City from January 2005 to present using the latissimus dorsi muscle for reconstructive surgery. All patients were followed-up for six months.Results. There were 14 patients who had reconstructive surgeries using the latissimus dorsi muscle. Three patients had traumatic brachial plexus injuries where the latissimus dorsi muscle was used for the reconstruction of elbow flexion. Eleven patients required coverage of a large defect, where seven were secondary to tumor resection and four were secondary to trauma. Of the fourteen patients, nine were pedicled flaps and five were free flaps. We had one failure (free flap group/tumor resection). The rest of the flaps survived completely. The smallest flap was 10 x 8 cm, and the largest flap was 28 x 24 cm.Conclusion. The latissimus dorsi muscle remains to be a versatile muscle in the field of orthopedic reconstructive surgery.&#x0D; &#x0D; &#x0D; &#x0D;

Multi-Stage Platform for (Semi-)Automatic Planning in Reconstructive Orthopedic Surgery.

Intricate lesions of the musculoskeletal system require reconstructive orthopedic surgery to restore the correct biomechanics. Careful pre-operative planning of the surgical steps on 2D image data is an essential tool to increase the precision and safety of these operations. However, the plan’s effectiveness in the intra-operative workflow is challenged by unpredictable patient and device positioning and complex registration protocols. Here, we develop and analyze a multi-stage algorithm that combines deep learning-based anatomical feature detection and geometric post-processing to enable accurate pre- and intra-operative surgery planning on 2D X-ray images. The algorithm allows granular control over each element of the planning geometry, enabling real-time adjustments directly in the operating room (OR). In the method evaluation of three ligament reconstruction tasks effect on the knee joint, we found high spatial precision in drilling point localization () and low angulation errors for k-wire instrumentation () on 38 diagnostic radiographs. Comparable precision was demonstrated in 15 complex intra-operative trauma cases suffering from strong implant overlap and multi-anatomy exposure. Furthermore, we found that the diverse feature detection tasks can be efficiently solved with a multi-task network topology, improving precision over the single-task case. Our platform will help overcome the limitations of current clinical practice and foster surgical plan generation and adjustment directly in the OR, ultimately motivating the development of novel 2D planning guidelines.

Allograft Transplantation and Reconstruction of Bones after Malignant Tumor Resections.

Reconstruction surgery after the excision of musculoskeletal tumors has advanced greatly in the last few decades. After resection of a large piece of bone, limb reconstruction (when is necessary) can be easily achieved with mechanical reconstruction with metallic prosthesis, or biological reconstruction with bone. The use of bone in reconstructive orthopedic surgery is to repair skeletal defects and accelerate bone healing. Bone grafts can be used to achieve this. Those can be allografts and autografts.&#x0D; The standard in bone grafting consists of tissue harvested from the patient, autograft, usually from the iliac crest or distal femur and tibia. Allografts are taken from donors or cadavers and they serve as alternatives to autograft in bone reconstruction. In our case, the patients were treated with wide resection of the bone segment. The defect was reconstructed with intercalary bone and osteosynthesis was made with locking plates. A cadaveric graft was used. Autogenous bone is generally used as an optimal graft because it integrates faster and with fewer complications. Allogenous bone can carry the risk of viral infection for the recipient. Anyhow, allografts can serve as the only therapeutic options, besides endoprosthesis devices for large size reconstruction.

Initial Experience with a Bioresorbable Polymer Anchor

Category:Ankle; Ankle ArthritisIntroduction/Purpose:Anchors are frequently used in reconstructive orthopedic surgery to achieve fixation of soft tissue to bone. Anchors vary with respect to material composition, configuration, and methods of fixation at the site of attachment. The fixation component of anchoring devices has generally evolved from metal-fabricated implants to various types of bioresorbable anchors. The SonicAnchorTM (Stryker, Kalamazoo, MI USA) polymer implant provides a unique form of anchor fixation using SonicFusionTM technology to achieve interdigitation within cancellous bone while being radiolucent and providing a small footprint.Methods:During a four-year period, 116 patients underwent a reconstructive orthopedic foot and ankle surgical procedure with the use of at least one bioresorbable polymer anchor (SonicAnchor implant). There were 59 males and 57 females, with an average age of 42 years (range: 12-83 years).Results:A total of 233 bioresorbable anchor (SonicAnchor) implants were used in 116 patients. Of the 116 patients, 108 (93.1%) achieved successful clinical healing of their surgery at their most recent follow-up. The average follow-up duration was 309 days (range: 14-1,429 days). Eight (6.9%) patients were lost to follow-up prior to clinical healing. Two (1.7%) patients underwent reoperation. Also, 65 (56%) patients had at least six months of follow-up and 36 (31%) had at least one year of follow-up.Conclusion:This preliminary clinical trial of patients undergoing soft tissue repair or reconstruction with a bioresorbable polymer appears to perform comparably to other commercially available devices. The lack of adverse events, mechanical failures, or infections further supports the safety of this device.

Periprosthetic joint infections: a 20 years retrospective epidemiological study in a single european accademic hospital

Introduction: Periprosthetic Joint infections (PJIs) still represent one of the most challenging complications in orthopaedic reconstructive surgery. The aim of our work is to present a retrospective observational analysis with 20 years of follow up of PJIs referred to a single center equipped with a regional referral infectious diseases department. Materials and methods: 368 case of deep PJIs following a primary or revision hip and knee arthroplasty procedure referred to our center between January 1996 and December 2016 were included in the study. Criteria of inclusion in the study was a primary PJI entirely managed in our hospital. We collected demographic data, risk factors, microbiology (identification pathogenic agent), previous surgical treatments, type of implant, diagnostic criteria of infection, type of infection and medical or surgical treatments performed in our institution Results: A total of 200 (54,3%) infection occurs in hip arthroplasty and 168 (45,7%) in knee arthroplasty. Mean age was 64,7 years. The majority were late infections (58,8%). Respectively polymicrobial infections was identified in 83 (22,6%) cases and in 54 (14,7%) patients no isolation was possible. S. Aureus was the most frequently identified pathogen. The major risk factors were hypertension in 254 (69,1%), cardiovascular diseases in 167 (45,7%), obesity in 97 (26,5%) and diabetes mellitus in 92 (25%). Discussion: Epidemiological analysis of PJI in our hospital which collects data relating to the last 20 years, has permitted to obtain a summary of our scenario. Ideal PJI management should include an accurate patient history considering carefully risk factors, patients conditions, and previous surgical procedures ideally in a multispecialist enviroment.

Genetic Algorithm-Based Optimization for the Geometric Design of a Novel Orthopedic Implant.

A tendon-transfer is a reconstructive orthopedic surgery where tendons are re-routed from a non-functioning muscle and attached a functioning muscle. Prior work has shown that using a passive implanted device in the ECRL-to-FDP tendon-transfer surgery significantly improves hand grasping function. However, it is still unclear how hand-function improvement, measured by finger joint range of motion and torque, is dependent on the implant's geometry and location within the tendon network. This paper presents a genetic algorithm that determines the device's optimal geometry and location. Hand biomechanical simulation platform was developed to model hand function and also model the tendon-transfer surgery with and without the implant. Finger kinematics and joint torque were used to develop three unique objective functions to optimize the implant's parameters. The optimized device resulted in an 11X increase in finger kinematics with only a 0.9% decrease in joint torque when compared with the biomechanical function enabled by the current suture-based surgery. Designing implantable devices that modify musculoskeletal function is challenging. Factors like tendon routing and joint kinematics create a complex nonlinear system when considering biomechanical function. A genetic algorithm is an effective tool to tackle these nonlinear landscapes to produce optimized designs. The state-of-the-art surgical procedure to repair high median-ulnar nerve palsy leads to poor hand function and severely limits the patient's ability to perform activities of daily life. This work provides a method for defining relevant objective functions for hand biomechanical function and then uses those objective functions with genetic algorithms to optimize the geometry of an orthopedic implant across multiple variables. The achieved biomechanical function is significantly better than hand function enabled by current surgical procedure.

Initial Experience With a Bioresorbable Polymer Anchor.

BackgroundAnchors are frequently used in reconstructive orthopedic surgery to achieve fixation of soft tissue to bone. Anchors vary with respect to material composition, configuration, and methods of fixation at the site of attachment. The fixation component of anchoring devices has generally evolved from metal-fabricated implants to various types of bioresorbable anchors. The SonicAnchorTM (Stryker, Kalamazoo, MI USA) polymer implant provides a unique form of anchor fixation using SonicFusionTM technology to achieve interdigitation within cancellous bone while being radiolucent and providing a small footprint.MethodsDuring a four-year period, 116 patients underwent a reconstructive orthopedic foot and ankle surgical procedure with the use of at least one bioresorbable polymer anchor (SonicAnchor implant). There were 59 males and 57 females, with an average age of 42 years (range: 12-83 years).ResultsA total of 233 bioresorbable anchor (SonicAnchor) implants were used in 116 patients. Of the 116 patients, 108 (93.1%) achieved successful clinical healing of their surgery at their most recent follow-up. The average follow-up duration was 309 days (range: 14-1,429 days). Eight (6.9%) patients were lost to follow-up prior to clinical healing. Two (1.7%) patients underwent reoperation. Also, 65 (56%) patients had at least six months of follow-up and 36 (31%) had at least one year of follow-up.ConclusionsThis preliminary clinical trial of patients undergoing soft tissue repair or reconstruction with a bioresorbable polymer appears to perform comparably to other commercially available devices. The lack of adverse events, mechanical failures, or infections further supports the safety of this device.

Chemokine SDF1 Mediated Bone Regeneration Using Biodegradable Poly(D,L-lactide-co-glycolide) 3D Scaffolds and Bone Marrow-Derived Mesenchymal Stem Cells: Implication for the Development of an "Off-the-Shelf" Pharmacologically Active Construct.

There is an increasing need for bone substitutes for reconstructive orthopedic surgery following removal of bone tumors. Despite the advances in bone regeneration, the use of autologous mesenchymal stem cells (MSC) presents a significant challenge, particularly for the treatment of large bone defects in cancer patients. This study aims at developing new chemokine-based technology to generate biodegradable scaffolds that bind pharmacologically active proteins for regeneration/repair of target injured tissues in patients. Primary MSC were cultured from the uninvolved bone marrow (BM) of cancer patients and further characterized for "stemness". Their ability to differentiate into an osteogenic lineage was studied in 2D cultures as well as on 3D macroporous PLGA scaffolds incorporated with biomacromolecules bFGF and homing factor chemokine stromal-cell derived factor-1 (SDF1). MSC from the uninvolved BM of cancer patients exhibited properties similar to that reported for MSC from BM of healthy individuals. Macroporous PLGA discs were prepared and characterized for pore size, architecture, functional groups, thermostability, and cytocompatibility by ESEM, FTIR, DSC, and CCK-8 dye proliferation assay, respectively. It was observed that the MSC+PLGA+bFGF+SDF1 construct cultured for 14 days supported significant cell growth, osteo-lineage differentiation with increased osteocalcin expression, alkaline phosphatase secretion, calcium mineralization, bone volume, and soluble IL6 compared to unseeded PLGA and PLGA+MSC, as analyzed by confocal microscopy, biochemistry, ESEM, microCT imaging, flow cytometry, and EDS. Thus, chemotactic biomacromolecule SDF1-guided tissue repair/regeneration ability of MSC from cancer patients opens up the avenues for development of "off-the-shelf" pharmacologically active construct for optimal repair of the target injured tissue in postsurgery cancer patients, bone defects, damaged bladder tissue, and radiation-induced skin/mucosal lesions.

A novel, multi-level approach to assess allograft incorporation in revision total hip arthroplasty

The successful use of allografts in reconstructive orthopedic surgery, including revision total hip arthroplasty (THA), has been outlined repeatedly. Nonetheless, as previous studies were primarily based on clinical follow-ups, we aimed to create an algorithm that accurately determines the extent of allograft incorporation in the acetabulum and femur using a suite of high-resolution imaging techniques. This study is based on a large patient database including > 4,500 patient data with previous revision THA and simultaneous use of allografts. While the database was continuously matched with the deceased individuals at the local forensic medicine department, complete hips were retrieved in case of a positive match. A positive match was achieved for n = 46 hips at a mean follow-up of 11.8 ± 5.1 years. Comprehensive imaging included contact radiography, high-resolution computed tomography (HR-pQCT), undecalcified histology of ground sections and quantitative backscattered electron imaging (qBEI). We here define a histomorphometric toolkit of parameters to precisely characterize the incorporation of structural (bulk) and morselized (chip) allografts in the acetabulum (n = 38) and femur (n = 8), including the defect area and interface length, microstructural and cellular bone turnover parameters as well as overlap and fibrosis thickness. This collection of samples, through its unique study design and precise definition of incorporation parameters, will provide the scientific community with a valuable source for further in-depth investigation of allograft incorporation and, beyond that, the regenerative potential of this osteoconductive scaffold.

Combined technique of titanium telescopic rods and external fixation in osteogenesis imperfecta patients: First 12 consecutive cases

IntroductionThe major limitation of any intramedullary telescopic system is rotational and longitudinal instability. The combination of telescopic system with an external fixator in patients with osteogenesis imperfecta (OI) demonstrated advantages of stability, early weight-bearing and rehabilitation. This study aimed to examine the outcomes of deformity correction by combined technique uniting titanium telescopic rod and reduced Ilizarov frame in children with types III or IV of OI with a minimum 1-year follow-up. Material and methodsThe study included 12 children with OI who underwent femoral deformity correction (20 segments) or tibial deformity correction (4 segments) by combined technique. The children ranged in age between 2 years and 3 months and 12 years and 4 months (mean: 8.9 ± 2.02 years) at the time of the rodding. Parameters of surgery, clinical examination data, data of 3D gait analysis were assessed in the study. ResultsExternal fixation lasted 35.8 ± 13.2 days in average. Neither loss of threaded fixation in the distal femoral and tibial epiphyses and apophysis of the greater trochanter nor migration of the rod into the knee and ankle joints were observed in follow-up. No secondary rotational or longitudinal bone displacement was noted. Telescoping gain related to spontaneous growth assessed at one-year follow-up control was 13.7 mm in the tibia and 15.9 mm in the femur. There were no deep infection or neurologic complications. The alignment measured by radio anatomical reference angles was maintained throughout the follow-up period.Gait abnormalities in postoperative period were caused by bulk and weight of EF: external hip rotation, slight external angle of foot progression, increased stride width and increased hip abduction angle. The second feature was reduced ROM in sagittal plane at all levels associated with significantly reduced ankle plantarflexion, hip and knee joint moments in comparison to kinetics of limb without EF. These abnormalities resolved by the one-year assessment. ConclusionThe combination of titanium telescopic rod with reduced external fixation is reliable advantage in reconstructive orthopaedic surgery for OI children. Reduced external fixation allows to overcome inconveniencies of longitudinal and rotational instability of telescopic systems. Children were able to walk with weight-bearing since early postoperative period because of external fixation. Gait temporary changes were influenced by external device size and by strategy to reduce pin site pain.

Morphology and morphometry of the semitendinosus distal tendon in adults and foetuses.

The distal tendon of the semitendinosus is often used as a graft in orthopedic reconstructive surgery. Knowledge of the exact morphology of this tendon, and also the ability to predict its morphometric data are certainly helpful when planning the procedure of surgery. Comparison of the semitendinosus distal tendon anatomy in adults and foetuses may be scientifically relevant. There are no scientific reports on this tendon anatomy in foetuses. Seventy semitendinosus muscles from cadavers were obtained using standard dissection techniques (50 muscles were obtained from adults and 20 from foetuses). Moreover, ultrasound examinations of 20 muscles were performed in living individuals. Two main parts of the distal tendon were distinguished - the external part not covered with muscle fibres and the internal part, which is partially or entirely hidden within the muscle belly (venter). The average length of the distal tendon was 32.34 cm, while the average lengths of the external and internal parts were 9.65 cm and 12.59 cm, respectively. The external part was solid and cylindrical. The internal part was flat and rolled like a trough, thus making the tendon a poor transplant material. Similarly, the distal tendon in foetuses consisted of two parts, including the external and internal part. The proportions between the lengths of different muscle parts were very similar in adults and foetuses.

Implant Associated Local Recurrence in Primary Bone Sarcoma

Hydroxyapatite (HA) covered implants are widely used in orthopedic reconstructive surgery. Their biological benefits were highlighted by several studies in the past decades in which the most important ones are the osteoconductive and osteoinductive capacity, which enhances osteoblast adherence, proliferation and bone extracellular matrix formation. In bone sarcomas the micro-environmental changes are crucial for tumor growth, new bone formation especially in osteoblastic osteosarcomas (OS). Nowadays limb sparing surgery and maintaining the quality of patient�s life are the main two goals in bone sarcoma treatment. The survival rate of patients with OS has been significantly improved in the past 3-4 decades due to the advanced chemotherapy protocols. The prognosis still depends on the early diagnosis and the histological type of the sarcoma. Tumor removal and reconstruction is a crucial moment for prognosis, studies showed that high grade sarcomas have a greater potential for local recurrence and early distant metastases. Metastasis can occur in early stages, even if there are not detectable at the time of surgery. Furthermore, the micro-environmental changes can facilitate sarcoma cell proliferation even if the tumor resection was performed in macroscopically normal bone tissue. We present a case of osteosarcoma in which local recurrence has occurred despite of chemotherapy and wide resection of the tumor. We can ask the following question can an implant increases the risk of local recurrence in sarcoma surgerys The aim of the study was to understand the underlying molecular pathway for sarcoma cell proliferation in HA covered implants.

Results after Using Bioactive Glass S53P4 in Reconstructive Orthopaedic Surgery - A 36 - Month Follow-up Clinical Study

Osteocartilaginous tissue normally has the capability of regeneration, which means that many osteoarticular problems or bony defects will heal spontaneously, not needing important interventions. Although the high regenerative capacity of this tissue, large osseous defects encountered difficulties in optimal healing process and remain a clinical challenge, demanding surgical procedures. This aim of this study was to evaluate clinical and radiological outcomes using bioactive glass S53P4 (BonAlive�) as a synthetic bone substitute material in some specific orthopedic pathologies like prosthesis revision surgery, and pseudarthrosis.

Functionalization of Ceramic Coatings for Enhancing Integration in Osteoporotic Bone: A Systematic Review

Background: The success of reconstructive orthopaedic surgery strongly depends on the mechanical and biological integration between the prosthesis and the host bone tissue. Progressive population ageing with increased frequency of altered bone metabolism conditions requires new strategies for ensuring an early implant fixation and long-term stability. Ceramic materials and ceramic-based coatings, owing to the release of calcium phosphate and to the precipitation of a biological apatite at the bone-implant interface, are able to promote a strong bonding between the host bone and the implant. Methods: The aim of the present systematic review is the analysis of the existing literature on the functionalization strategies for improving the implant osteointegration in osteoporotic bone and their relative translation into the clinical practice. The review process, conducted on two electronic databases, identified 47 eligible preclinical studies and 5 clinical trials. Results: Preclinical data analysis showed that functionalization with both organic and inorganic molecules usually improves osseointegration in the osteoporotic condition, assessed mainly in rodent models. Clinical studies, mainly retrospective, have tested no functionalization strategies. Registered trademarks materials have been investigated and there is lack of information about the micro- or nano- topography of ceramics. Conclusions: Ceramic materials/coatings functionalization obtained promising results in improving implant osseointegration even in osteoporotic conditions but preclinical evidence has not been fully translated to clinical applications.