Resurfacing Procedures Research Articles

In Vivo Histological Study Evaluating Non-Ablative Fractional 1940-nm Laser.

Non-ablative fractional lasers (NAFL) have increased in demand compared to ablative laser treatments as they provide lesser down time, fewer side-effects, and are safer to use. Non-ablative fractional treatment with lasers ranging from 1320 to 1927-nm have been shown to be safe and effective for skin resurfacing procedures. The objective of this study is to investigate healing of the 1940-nm NAFL-induced microthermal treatment zones (MTZs) in human skin from a histologic perspective. Three subjects received 1940-nm NAFL treatment to test areas on the abdomen at various timepoints during the study. The minimum 5 mJ/MTZ and maximum 20 mJ/MTZ energy settings were used at 20% coverage. Biopsies were taken coinciding with immediately posttreatment, 1, 3, 7 days, and 6 weeks posttreatment. Blinded analysis of hematoxylin and eosin stained slides was performed to measure the width and depth of the MTZs and evaluate the inflammatory and healing response of the skin over time (immediately to 6 weeks posttreatment). Safety was evaluated by assessing local skin responses and adverse events immediately after treatment and at all study visits. Histological analysis of tissue following NAFL 1940-nm treatments showed mild early inflammatory response (presence of lymphotic infiltrate) in some test areas and zones of necrosis and coagulation having widths and depths (immediately-3 days posttreatment) that scaled with the 1940-nm pulse energy. Signs of healing such as presence of dermal mucin, evidence of fibrosis, and absence of necrosis were observed long-term (7 days to 6 weeks posttreatment). Evidence of the MTZ persisted beyond the 6-week study and was predicted to last for 100 days. All local clinical skin responses healed within 6 weeks and were limited to mild, transient erythema and edema which resolved in less than 12-24 h following treatment. No serious adverse events occurred during the study. NAFL 1940-nm treatments are safe for inducing small fractional coagulation and necrosis zones in abdominal skin. NAFL 1940-nm laser creates fractional columns of injury with sufficient depth and coverage that suggest effective skin resurfacing, like other non-ablative fractional lasers.

LONG-TERM SURVIVORSHIP OF METAL-ON-METAL HIP RESURFACING ARTHROPLASTY: COMPARATIVE COHORT STUDY AT 15 YEARS

In 1997 the Birmingham Hip Resurfacing was introduced to address the needs of young active patients. Alternative designs were introduced to try and improve wear performance. The aim of this study was a comparative cohort study of two types of metal-on-metal bearing to determine the mechanism of failure at 15 years.The study reviewed 91 Brimingham Hip Resurfacings (BHR) (Smith and Nephew) and 715 DUROM hip resurfacing (Zimmer) procedures in prior to 2009. Failure was defined as revision of either component for any reason. Kaplan-Meyer survivorship analysis performed. Routine follow-up with serum metal ion levels and radiographs.Mean follow-up was 17.9 years (range 15.2 – 25.1). The mean age at operation was 51.6 years (SD 8.6, range 20.7 to 70.2), including 299 women (37.1%). The Birmingham resurfacing demonstrated 92.3% survivorship at 15 years (SE 2.8, 95% CI 3.9 – 7.8) and 90.0% at latest follow-up (SE 3.5, 95% CI 4.9 to 9.4). By comparison, the DUROM survivorship at 15 years was 89.1% at 15 years (SE 1.2, 95% CI 2.0 to 2.5) and 87.4% (SE 1.3, 95% CI 2.5 to 2.3) at latest follow-up. There was no statistically significant difference in survivorship between groups (p= 0.32). Survival in male patients was 92.7% compared to 80.0% in females. The reported failures occurred from Adverse Reaction to Metal Debris (32 patients), periprosthetic femoral neck fracture (6) and aseptic loosening (41), PJI (12) and undiagnosed pain (6). The mean cobalt and chromium levels at last follow-up were 33.4 nmol/L and 36.5 nmol/L respectively.This study demonstrates two differently designed metal-on-metal hip resurfacing provided a durable alternative to total hip replacement, particularly in younger male patients with osteoarthritis. Differences in design did determine the reason for revision with acetabular fixation being one of the principal failure mechanisms for the DUROM compared to elevated ion levels.

Femoral cartilage thickness measured on MRI varies amongindividuals: Time to deepen one of the principles of kinematic alignment in total knee arthroplasty. A systematic review.

Kinematically aligned total knee arthroplasty (KA TKA), as a pure resurfacing procedure, is based on matching implant thickness with bone cut and kerf thickness, plus cartilage wear. However, the assumption of a consistent 2 mm femoral cartilage thickness remains unproven. This study aimed to systematically review the available literature concerning magnetic resonance imaging (MRI) assessment of femoral cartilage thickness in non-arthritic patients. Our hypothesis was that cartilage thickness values would vary significantly amongindividuals, thereby challenging the established KA paradigm of 'one-cartilage-fits-all'. Systematic literature searches (Pubmed, Scopusand Cochrane Library) followed PRISMA guidelines. English-language studies assessing distal and posterior femoral cartilage thickness using MRI in non-arthritic adults were included. Studies lacking numerical cartilage thickness data, involving post-operative MRI, considering total femoro-tibial cartilage thickness, or failing to specify the compartment of the knee being studied were excluded. Overall, 27 studies comprising 8170 MRIs were analysed. Weighted mean femoral cartilage thicknesses were: 2.05 ± 0.62 mm (mean range 1.06-2.6) for the distal medial condyle, 1.95 ± 0.4 mm (mean range 1.15-2.5) for the distal lateral condyle, 2.44 ± 0.5 mm (mean range 1.37-2.6) for the posterior medial condyleand 2.27 ± 0.38 mm (mean range 1.48-2.5) for the posterior lateral condyle. Femoral cartilage thickness varies significantly across patients. In KA TKA, relying on a fixed thickness of 2 mm may jeopardize the accurate restoration of individual anatomy, leading to errors in implant coronal and rotational alignment. An intraoperative assessment of cartilage thickness may be advisable to express the KA philosophy at its full potential. Level IV.

Patellar Resurfacing and Assessment of Total Knee Arthroplasty in Patients in King Abdullah Bin Abdulaziz University Hospital

The most effective surgical procedure for treating advanced knee osteoarthritis is total knee arthroplasty. On radiographs, knee osteoarthritis was present in about 37% of individuals over the age of 60. This study, a retrospective cohort study, compared the anterior knee pain, range of motion, and abnormal sound among patients who underwent total knee replacement surgery with or without postoperative patellar resurfacing. The King Abdullah bin Abdulaziz University Hospital in Riyadh, Saudi Arabia, has an orthopedic department where the study will be carried out. This study included 80 patients who had undergone total knee replacement surgery, either with or without patellar resurfacing.
 They were chosen in accordance with specific inclusion criteria, including being elderly patients (over 50) with knee osteoarthritis that was not responding to conservative treatment. Total knee arthroplasty is an effective treatment for advanced knee arthritis, particularly when the contentious patellar resurfacing procedure is used. Non-patellar resurfacing total knee arthroplasty demonstrated in compression a high rate of pain and an inability to achieve full range of motion. Our research supports our main goal, and numerous studies have agreed that patellar resurfacing provides painless treatment and better outcomes for people with knee arthritis.

Hip Resurfacing in Teenagers

BackgroundThe goals of hip resurfacing are to relieve pain, restore function, and preserve future reconstructive options. Hip resurfacing is an attractive and sometimes the only option when the femoral canal is blocked, making total hip arthroplasty (THA) difficult. Hip resurfacing also can be an attractive option for a teenager on the rare occasion when a hip implant is needed. MethodsA cementless ceramic-coated femoral resurfacing implant matched with a highly cross-linked polyethylene acetabular bearing was used in 105 patients (117 hips) aged 12 to 19 years. The mean follow-up was 14 years (range, 5 to 25). No patients were lost to follow-up before 19 years. Osteonecrosis, residuals of trauma, developmental dysplasia, and childhood hip diseases were the common reasons requiring surgery. Patients were evaluated using patient-reported outcomes, patient acceptable symptom states (PASS), and implant survivorships. Radiographs and retrievals were also examined. ResultsThere were 2 revisions (polyethylene liner exchange at 12 years and femoral revision for osteonecrosis at 14 years). The mean postoperative Hip Disability Osteoarthritis Outcome Score (HOOS) was 94 points (range, 80 to 100) and the mean Harris Hip Score (HHS) score was 96 points (range, 80 to 100). All patients achieved Minimal Clinically Important Difference improvement in their HHS and HOOS scores. There were 99 (85%) hip resurfacing procedures achieving a satisfactory PASS and 72 (69%) patients were active in sports. ConclusionHip resurfacing is a highly technical procedure. Careful implant selection is required. The meticulous preoperative planning, careful extensile surgical exposure, and exacting implant placement in this study likely contributed to the favorable results achieved. Hip resurfacing allows THA as a future option in patients where the lifetime revision rate is a major consideration.

Low local curvature index and history of previous surgery are risk factors for revision in focal metallic inlay implants

BackgroundFocal chondral defects are debilitating lesions with poor healing potential. Focal metallic inlay implants were developed as a salvage procedure, whose reoperation causes and risk factors for revision are still debatable. The aim of this study is to analyze the local subchondral curvature matching of focal metallic inlay implants and its effects on survival and clinical results. MethodsPatients operated with a knee focal metallic inlay resurfacing implant between 2014 and 2017 were eligible. Surgery was indicated for painful, focal, full-thickness cartilage lesions that had failed alternative treatments. Inclusion criteria were patients treated for a lesion ≤ 5 cm2 in the femoral condyle, aged 40–65 years, with complete surgical records and a knee CT scan. The curvature index (Kindex) was calculated as the ratio of the mean curvature of the implant (K1) to the mean curvature of the subchondral bone (K2). ResultsSixty-nine patients were included, of which 60.9% were female. Mean age was 54.8 ± 6.0. Seven patients (10.1%) underwent revision surgery. When adjusted for age and sex, lesion size was not significantly correlated to revision in a multivariate regression model, while previous surgery and smaller K index were. A positive history for previous surgery was significantly correlated with worse clinical outcomes in surviving patients. ConclusionA positive history of previous knee surgery and a low local curvature index are risk factors for revision after focal metallic inlay implant resurfacing. Patients with a history of knee surgery should be counseled on the advantages and disadvantages before undergoing a focal resurfacing procedure.

Case Report on Painful Patellar Crepitation Following a Knee Replacement with Preserved Patella

Patellar clunk crepitation is a well-known complication following knee replacement surgery and is associated with posterior stabilized knee replacement surgery and surgical technique. Currently, patellar clunk or crepitation management following knee replacement surgery with preserved patella remains unclear. The purpose of this case report is to discuss whether patellar clunk or crepitation management should include debridement with patellar resurfacing or debridement alone. This case describes a patellar crepitation after knee replacement surgery with the preserved patella. The surgery went uneventfully using the standard medial parapatellar approach. However, the patient was still unsatisfied with the chronic left knee pain (>3 months) and crepitation that developed following the surgery, and the patient was diagnosed with patellar clunk and crepitation (PCC). A patellar resurfacing procedure was performed with a satisfactory clinical outcome. Replicating the original joint line level and placing the tibial component posteriorly play a pivotal role in preventing PCC. Debridement and patellar resurfacing procedures are recommended in this type of case to overcome the valgus knee alignment and the placement of the tibial component.

Identification of protective and 'at risk' HLA genotypes for the development of pseudotumours around metal-on-metal hip resurfacings.

Hip resurfacing remains a potentially valuable surgical procedure for appropriately-selected patients with optimised implant choices. However, concern regarding high early failure rates continues to undermine confidence in use. A large contributor to failure is adverse local tissue reactions around metal-on-metal (MoM) bearing surfaces. Such phenomena have been well-explored around MoM total hip arthroplasties, but comparable data in equivalent hip resurfacing procedures is lacking. In order to define genetic predisposition, we performed a case-control study investigating the role of human leucocyte antigen (HLA) genotype in the development of pseudotumours around MoM hip resurfacings. A matched case-control study was performed using the prospectively-collected database at the host institution. In all, 16 MoM hip resurfacing 'cases' were identified as having symptomatic periprosthetic pseudotumours on preoperative metal artefact reduction sequence (MARS) MRI, and were subsequently histologically confirmed as high-grade aseptic lymphocyte-dominated vasculitis-associated lesions (ALVALs) at revision surgery. 'Controls' were matched by implant type in the absence of evidence of pseudotumour. Blood samples from all cases and controls were collected prospectively for high resolution genetic a nalysis targeting 11 separate HLA loci. Statistical significance was set at 0.10 a priori to determine the association between HLA genotype and pseudotumour formation, given the small sample size. Using a previously-reported ALVAL classification, the majority of pseudotumour-positive caseswere found to have intermediate-grade group 2 (n = 10; 63%) or group 3 (n = 4; 25%) histological findings. Two further patients (13%) had high-grade group 4 lesions. HLA-DQB1*05:03:01 (p = 0.0676) and HLA-DRB1*14:54:01 (p = 0.0676) alleles were significantly associated with a higher risk of pseudotumour formation, while HLA-DQA1*03:01:01 (p = 0.0240), HLA-DRB1*04:04:01 (p = 0.0453), HLA-C*01:02:01 (p = 0.0453), and HLA-B*27:05:02 (p = 0.0855) were noted to confer risk reduction. These findings confirm the association between specific HLA genotypes and the risk of pseudotumour development around MoM hip resurfacings. Specifically, the two 'at risk' alleles (DQB1*05:03:01 and DRB1*14:54:01) may hold clinical value in preoperative screening and prospective surgical decision-making.

Radiographic Sigmoid Sinus Wall Abnormalities and Pulsatile Tinnitus: A Case-Control Study.

Compare incidence of sigmoid sinus wall abnormalities (SSWAs) and other radiographic abnormalities in patients with pulsatile tinnitus (PT) versus controls. Retrospective case-control. Tertiary referral center. Adults with PT and high-resolution computed tomography imaging were compared with adults undergoing cochlear implant workup including high-resolution computed tomography imaging. Incidence of SSWA in PT cohort (n = 141) compared with control (n = 149, n = 298 ears). Secondary outcome measures included differences in demographics and in other radiographic abnormalities between cohorts. Patients with PT had a higher incidence of SSWA (34% versus 9%, p < 0.001) and superior canal dehiscence (23% versus 12%, p = 0.017) than controls. Spearman product component correlations demonstrated that ipsilateral PT was weakly associated with SSWA ( r = 0.354, p < 0.001). When SSWA was present in the PT cohort (n = 48 patients, n = 59 ears), in 31 cases (64.6%), the SSWA correlated with PT laterality (e.g., left SSWA, left PT); in 12 (25.0%), SSWA partially correlated with PT laterality (e.g., bilateral SSWA, right PT); and in 5 (10.4%), the SSWA did not correlate with PT laterality (e.g., right SSWA, left PT). For our patients with both PT and SSWA, the SSWA is likely a contributing factor in approximately 65% of cases. For a third of patients with PT and concomitant SSWA, the association between the two is either not causative or not solely causative. Surgeons counseling patients with PT and SSWA may be optimistic overall regarding sigmoid resurfacing procedures but must appreciate the possibility of treatment failure, likely because of untreated comorbid conditions.

Revision Surgery After Failed Index Synthetic Cartilage Implant Resurfacing for Hallux Rigidus: Single-Surgeon 5-Year Experience.

While metatarsophalangeal joint (MTPJ) arthrodesis is regarded as the gold standard treatment option for end-stage hallux rigidus (HR), synthetic cartilage implant (SCI) resurfacing has gained popularity. This study aimed to identify the SCI resurfacing failure rate for a single surgeon, while also comparing clinical outcomes of patients who underwent SCI replacement or MTPJ arthrodesis after failed index SCI resurfacing. Health records were queried from 2016 to 2021 for patients with HR who were treated with SCI resurfacing by a single surgeon. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, and hallux valgus angles were compared. A subgroup analysis was performed on patients who underwent revision with SCI replacement or MTPJ arthrodesis. SCI replacement included the use of bone graft, bone putty, or a custom 3D printed baseplate to prevent implant subsidence. A total of 219 SCI resurfacing procedures were performed by a single surgeon, including 23 revisions. When analyzing index procedures, an 8.2% revision rate was determined. The revision cohort (n = 23) consisted of 19 female patients and presented with a mean body mass index of 29.5 ± 5 kg/m2, mean age of 52.8 ± 11 years, mean follow-up duration of 22.3 (range, 3-54) months, and mean time to a revision surgery of 12.1 ± 12 (range, 1-50) months. Specifically, 12 procedures resulted in an SCI replacement, while 11 procedures resulted in arthrodesis. While all patients experienced significant improvement in their VAS pain scores (P < .001), the arthrodesis cohort experienced a greater improvement than the SCI revision cohort (P = .04). When analyzing SCI revision procedures, MTPJ arthrodesis reduced pain more significantly than SCI replacement. Level IV: Retrospective case series.

Utilization of ex vivo tissue model to study skin regeneration following microneedle stimuli

Microneedling is a popular skin resurfacing and rejuvenation procedure. In order to develop better adjunct products for consumers, there is a scientific need to establish greater understanding of the mechanism in which microneedling stimulates regeneration within skin. The purpose of this study is to develop a physiologically relevant ex vivo tissue model which closely mimics the actual microneedling procedure to elucidate its mechanism of action. In this study, human ex vivo skin was subjected to microneedling treatment and cultured for 6 days. Histological analysis demonstrated that the ex vivo skin was able to heal from microneedling injury throughout the culture period. Microneedling treatment stimulated proliferation and barrier renewal of the skin. The procedure also increased the levels of inflammatory cytokines and angiogenic growth factors in a dynamic and time dependent fashion. The tissue demonstrated hallmark signs of epidermal regeneration through morphological and molecular changes after the treatment. This is one of the first works to date that utilizes microneedled ex vivo skin to demonstrate its regenerative behavior. Our model recapitulates the main features of the microneedling treatment and enables the evaluation of future cosmetic active ingredients used in conjunction with microneedling.

Revision Surgery after Failed Index Synthetic Cartilage Implant Resurfacing for Hallux Rigidus: Single Surgeon Five-Year Experience

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) of the first metatarsophalangeal joint (MTPJ) is a prevalent arthritic disease which causes pain and stiffness. While MTPJ arthrodesis is regarded as the gold standard treatment option for HR (Grade II and III), synthetic cartilage implant (SCI) resurfacing has gained popularity since it demonstrates similar biomechanical properties as native cartilage, eliminates pain, and preserves MTPJ motion. However, recent studies have reported variable failure rates on SCI treatment, with implant subsidence most commonly leading to a revision. The purpose of this study was to identify the SCI resurfacing failure rate by a single surgeon, while also comparing clinical outcomes of patients who underwent SCI replacement or MTPJ arthrodesis after failed index SCI resurfacing. Methods: Electronic health records were queried from 2016 to 2021 for patients who were experiencing symptomatic HR and were treated with SCI (Synthetic Cartilage Implant) by a single surgeon. Patient demographics, body mass index (BMI), medical comorbidities, American Society for Anesthesiologists (ASA) physical status, past surgical history and followup periods were recorded. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, hallux valgus (HV) angles, and x- ray imaging were compared. Subgroup analysis was performed on patients who underwent revision with either a SCI replacement or MTPJ arthrodesis. SCI replacement included the use of bone graft and/or a custom 3D-printed baseplate to prevent implant subsidence. Descriptive and univariate statistics were used to analyze data. Results: A total of 219 SCI resurfacing procedures were performed by a single surgeon, including 23 revisions. When only analyzing index procedures, a revision rate of 8.2% was determined. The revision cohort (n=23) consisted of 19 females, and presented with a mean BMI of 29.5+-5 Kg/m2, mean age of 52.8+-11 years, and mean followup of 22.3 (range, 3-54) months. Patients underwent revision surgery at an average of 12.1+-12 (range, 1-50) months after index SCI resurfacing. Specifically, 12 procedures resulted in an SCI replacement, while 11 procedures resulted in arthrodesis. There was significantly lower postoperative pain VAS (P=0.04) and a significant improvement from preoperative to postoperative pain VAS for the arthrodesis cohort (P&lt;0.001) (Table 1). Conclusion: Eight percent of index SCI resurfacing procedures performed by a single surgeon resulted in failure. When revising a failed index SCI resurfacing procedure, MTPJ arthrodesis was found to reduce pain more significantly compared to SCI replacement procedures. Future prospective studies should be performed to expand upon the limited clinical outcomes data comparing SCI revision procedures such as joint arthrodesis and SCI replacement.

Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review.

Introduction Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a contraindication to PRC; however, PRC with modifications are proposed to circumvent this contraindication. PRC modifications can be broadly grouped into capitate resurfacing (CR) and capsular interposition (CI) procedures which could expand PRC indications. Our primary question was to characterize the outcomes achievable with various PRC modifications. Our secondary question was to determine which PRC modification was the optimal procedure when capitate arthritis was present. Methods A systematic review was conducted to examine the outcomes of modified PRC procedures. Independent reviewers appraised multiple databases for PRC studies with modifications for capitate arthritis in adult patients (age >18 years) with a minimum of three cases and extractable outcomes. Modified PRC procedures included capsular/allograft interposition, resurfacing capitate pyrocarbon implants, and osteochondral grafting. Pertinent outcomes included patient demographics, range-of-motion, grip strength, patient-reported outcomes, and complications, including salvage rates. Results Overall, 18 studies met the inclusion criteria-10 studies ( n = 147) on CI and 8 studies on CR ( n = 136). PRC with CI had the greatest flexion-extension arc and grip strength. Complications were marginally higher in the CR group (4%), while the CI group had a higher conversion to total wrist arthrodesis (10%). Conclusion Techniques to address capitate arthritis center around resurfacing or soft tissue interposition. PRC modifications with CI produces better range-of-motion and grip strength but higher conversion to total wrist arthrodesis. Higher conversion rates may be attributable to longer follow-up periods in studies examining CI compared with CR. Level of Evidence This is a Level III study.

Stokes Shift Engineered Mn:CdZnS/ZnS Nanocrystals as Reabsorption‐Free Nanoscintillators in High Loading Polymer Composites

AbstractPlastic scintillators are gaining attention as alternatives to inorganic scintillator crystals owing to their low fabrication cost, customable shape/size, and substantially lighter weight that make them suitable for various radiation detection technologies. These include scintillation panels for national security and industrial monitoring, radiation screens for medical diagnostics, and calorimeters for high energy physics. Because of their low density, plastic scintillators are typically doped with high atomic number (Z) sensitizers that enhance the interaction probability with ionizing radiation and excite molecular emitters. Although effective, such a two‐component design suffers from incomplete sensitization, intrinsically limited efficiency due to multiple radiative steps with non‐unity quantum yield, detrimental phase segregation effects and the fragility of organic emitters to ionizing radiation. In this work, an alternative single‐component scheme is proposed based on high‐Z reabsorption‐free CdZnS/ZnS semiconductor nanocrystals (NCs) doped with manganese embedded in a polyvinyltoluene (PVT) waveguide. Optical‐grade nanocomposites free from optical reabsorption of the scintillation light and with performance comparable to commercial products are obtained through a post‐synthesis resurfacing procedure that maximizes the compatibility between the NCs and PVT and preserves their optical properties upon curing.

Expert opinion on current trends in hyperpigmentation management: Indian perspective

&lt;p class="abstract"&gt;Hyperpigmentation is a common pigmentary disorder characterized by increased production of melanin. It is present in Asian skin phototypes, with a higher prevalence in the Indian population. Skin heterogeneity is seen in more than 80% of individuals of all age groups and genders in several cities across India. In children, the prevalence of hyperpigmentary disorders accounts for 1.54 per 1000 children.Sixty expert dermatologists participated in expert group meetings via teleconference webinar to elaborate on the current trends in the management of hyperpigmentary disorders. The major reasons for hyperpigmentary disorders in India include melanocyte function followed by exposure to ultraviolet radiation, race, ethnicity, use of medications, pregnancy, and use of cosmetic. There are wide varieties of skin-lightening or depigmenting agents and skin resurfacing procedures that aid in the management of hyperpigmentation. However, treatment becomes challenging due to compliance issues related to affordability, complexity of prescriptions, and treatment duration. Compliance increases only if the patient sees any improvement or discontinues treatment due to higher expectations. Hence, the success of the treatment lies in patient adherence. This article summarizes expert opinions on identifying, diagnosing, and managing hyperpigmentation with the help of topical depigmenting agents in the Indian scenario. It also emphasizes treatment adherence issues along with the role of patient counseling and education regarding disease awareness and treatment strategies.&lt;/p&gt;

Patient-specific resurfacing implant knee surgery in subjects with early osteoarthritis results in medial pivot and lateral femoral rollback during flexion: a retrospective pilot study

PurposeMetallic resurfacing implants have been developed for the treatment of early, small, condylar and trochlear osteoarthritis (OA) lesions. They represent an option for patients who do not fulfill the criteria for unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) or are too old for biological treatment. Although clinical evidence has been collected for different resurfacing types, the in vivo post-operative knee kinematics remain unknown. The present study aims to analyze the knee kinematics in subjects with patient-specific episealer implants. This study hypothesized that patient-specific resurfacing implants would lead to knee kinematics close to healthy knees, resulting in medial pivot and a high degree of femoral rollback during flexion.MethodsRetrospective study design. Fluoroscopic analysis during unloaded flexion–extension and loaded lunge was conducted at > 12 months post-surgery in ten episealer knees, and compared to ten healthy knees. Pre- and post-operative clinical data of the episealer knees were collected using a visual analog scale (VAS), the EQ 5d Health, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaires.ResultsA consistent medial pivot was observed in both episealer and healthy knees. Non-significant differences were found in the unloaded (p = 0.15) and loaded (p = 0.51) activities. Although lateral rollback was observed in both groups, it was significantly higher for the episealer knees in both the unloaded (p = 0.02) and loaded (p = 0.01) activities. Coupled axial rotation was significantly higher in the unloaded (p = 0.001) but not in the loaded (p = 0.06) activity in the episealer knees. Improved scores were observed at 1-year post-surgery in the episealer subjects for the VAS (p = 0.001), KOOS (p = 0.001) and EQ Health (p = 0.004).ConclusionAt 12 month follow-up, a clear physiological knee kinematics pattern of medial pivot, lateral femoral rollback and coupled axial external femoral rotation during flexion was observed in patients treated with an episealer resurfacing procedure. However, higher femoral rollback and axial external rotation in comparison to healthy knees was observed, suggesting possible post-operative muscle weakness and consequent insufficient stabilization at high flexion.

Airborne particulate concentration during non-thermal nano-pulse stimulation wart clearance is negligible compared to thermal modalities.

ObjectivesAs clinicians continue to implement safety protocols amid the global pandemic, considerations to mitigate potential viral transmission of airborne particulates (plume) generated from certain dermatologic procedures are of growing interest. This study intended to measure the change in airborne particulate matter using a non‐thermal energy modality called nano‐pulse stimulation (NPS) and compare levels of concentration to common thermal modalities (CO2 laser and electrocautery). NPS is a new non‐thermal modality that applies nanosecond pulses of electrical energy to induce regulated cell death in cellular structures while sparing the surrounding acellular structure of the dermis.Materials and MethodsThe study used a Condensation Particle Counter during four types of dermatologic procedures: (1) using non‐thermal NPS for the clearance of cutaneous, nongenital warts; (2) an electrocautery treatment of warts; (3) a CO2 laser for facial resurfacing; and (4) an electrocautery procedure for a facelift. Four subjects and a total of 11 warts were treated with NPS while a particle counter was used to detect the average particles per cubic centimeter once per second. The same particle counter was used, for comparison, during a wart removal procedure using electrocautery for comparison, and for control, during a skin resurfacing procedure with a CO2 laser and a facelift in which electrocautery was used.ResultsOnly one of the 11 NPS wart procedures generated any detectable change in the particulate concentration and that change was negligible in comparison to the increase in particulate concentration measured during the CO2 laser resurfacing and the electrocautery use during a facelift procedure.ConclusionsProcedures using non‐thermal NPS technology do not generate significant plume when applied to eliminate warts, suggesting it is unlikely that this new energy modality would release viral DNA into the air.

Endoscopic Resection and Mucosal Reconstitution With Epidermal Grafting: A Pilot Study in Idiopathic Subglottic Stenosis.

To describe technical aspects and surgical outcomes of endoscopic resection and mucosal reconstitution with epidermal grafting (ie, the Maddern procedure) in the treatment of idiopathic subglottic stenosis. Medical record abstraction. Johns Hopkins Hospital. Retrospective series of 9 adults with idiopathic subglottic stenosis who underwent the Maddern procedure by a single surgeon over a 5-year period. Prespecified outcomes included (1) perioperative outcomes (Clavien-Dindo grade 4/5 complications, need for staged tracheostomy, hospital length of stay), (2) postoperative outcomes (peak expiratory flow rate [PEFR], need for subsequent airway surgery, tracheostomy at follow-up), and (3) patient-reported quality-of-life outcomes (Clinical COPD Questionnaire, Voice Handicap Index-10, Eating Assessment Tool-10, and 12-Item Short Form Version 2). Wilcoxon matched-pairs signed rank test and Kaplan-Meier analysis were performed. There were no Clavien-Dindo grade 4/5 complications; 2 patients required unplanned staged tracheostomy; and the median length of stay was 3 days. Following endoscopic resection and stent removal, a median of 2 laser resurfacing procedures were required. Two patients developed recurrent stenosis requiring cricotracheal resection (CTR). There were significant improvements in PEFR, Clinical COPD Questionnaire, and Voice Handicap Index-10, without significant difference in Eating Assessment Tool-10. The 12-Item Short Form Version 2 approximated the population norm. Kaplan-Meier analysis demonstrated significant improvement in time to surgery after the final laser resurfacing. The Maddern procedure has a low complication rate and offers durable physiologic improvement in PEFR, limiting need for additional procedures. Risks included need for CTR salvage, temporary tracheostomy, phlegm accumulation, and laryngospasm. It is a surgical option for patients with short dilation intervals who prefer to avoid the risks of CTR.

Maturation process of regenerated tissues after single-stage simultaneous autologous particulated cartilage implantation and open wedge high tibial osteotomy for articular cartilage defects with medial osteoarthritis of bilateral knees: a case report

BackgroundOpen wedge high tibial osteotomy (OWHTO) is an effective treatment option for young and middle-aged active patients with medial unicompartmental knee osteoarthritis (OA). In addition, particulated cartilage implantation has been developed as a simple procedure for cartilage regeneration. Thus, to improve the OWHTO outcomes, a single-stage, simultaneous bilateral knee arthroscopic particulated cartilage implantation with OWHTO was performed.Case presentationA 60-year-old male patient presented with severe bilateral knee pain, with grade 2 varus knee OA of the Kellgren–Lawrence classification. Primary arthroscopic evaluations based on the International Cartilage Repair Society grading system showed grade 3c articular cartilage defects of 1.5 cm in diameter at the center of the bilateral medial femoral condyles. Following bilateral OWHTO, the healthy cartilage tissue was harvested from the lateral wall of the unilateral femoral intercondylar notch and minced with the cartilage processor. Then, subchondral drillings and cartilage fragment implantations into the bilateral defects were performed arthroscopically. One year postsurgery, second-look arthroscopy findings revealed that the defects were filled with cartilage-like tissues. The maturation process of the regenerated tissues was confirmed with T2 mapping magnetic resonance imaging during the 3-year follow-up period. The patient could walk without a cane, and all Knee Injury and Osteoarthritis Outcome Score parameters were improved without any correction loss in 3 years.ConclusionsThis is the first report to evaluate the maturation process of the implanted particulated cartilage tissue with T2 mapping magnetic resonance imaging for 3 years. The effect of chondral resurfacing procedure with OWHTO remains unclear; however, the implantation of arthroscopic particulated cartilage fragments is a single-stage and less-invasive procedure. This treatment could regenerate cartilage-like tissue in the present case. Therefore, this additional procedure could potentially improve the long-term outcomes of OWHTO.

Pinless Navigation in Unicompartmental Knee Arthroplasty.

Purpose: In contrast to total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) is a true resurfacing procedure, as none of the ligaments are replaced or released, and the pre-arthritic leg alignment is the major goal. As such, the alignment of the tibial component plays a crucial role in postoperative knee function and long-term survival. Pinless navigation has shown reliable results in total knee arthroplasty. To the best of our knowledge, the use of pinless navigation has not been investigated for UKA. Therefore, the present study investigated whether implantation of the tibial component in 3° varus, which is closer to the anatomical axis, is feasible with a pinless optical navigation system. Methods: 60 patients with the diagnosis of an unicompartmental arthritis, were eligible for UKA and treated with implantation in 3° varus alignment of the tibial component. Two groups were established. In the treatment group the tibial component was aligned using a pinless navigation technique. In the control group, a conventional extramedullary alignment guide was used. A clinical and radiographic follow up took place within 1 year of operation. Results: 57 Patients were eligible for analysis. No clinical incidents were noted in the follow up period. The desired target value, the position of the tibial component, was accurately achieved with an average of 3° medial inclination using the pinless navigation as well as using the conventional technique. Mean incision to suture time was negligible between the two techniques. The mean suture time was 43.2 min with pinless navigation and 42.7 min with the conventional technique. Conclusions: With pinless navigation in UKA, a method was presented that made it possible to achieve sled prosthesis alignment at the level of a high-volume surgeon. These results were achieved with an irrelevant increase of surgical time and without placement of pins.