Resurfacing Procedures Research Articles

A Multi-Component Reaction Peptide Augmenting the Anti-Aging Benefits of Non-Ablative Laser Procedure.

Laser resurfacing is one of the most popular aesthetic procedures that address a wide range of skin conditions and overall skin rejuvenation. To reduce downtime and improve the clinical efficacy of the procedures, it is important to design post-procedure care routines to complement them. Towards fulfilling that consumer need, a peptide synthesized from multi-component reaction (MCP) has been developed.  The objective of this study is to investigate the functionalities of MCP as a regenerative active that enhances the healing kinetics and anti-aging performance following non-ablative fractional laser resurfacing procedures.  To fulfill the objective, a single-center, split-face design, double-blinded, randomized clinical study was conducted. Study participants received a full face non-ablative fractional laser procedure followed by treatment with two topical products, MCP formula or Aquaphor Healing Ointment®or AHO (Beiersdorf Inc, Wilton, CT) as a standard of care topical agent. Both products were applied immediately after the laser procedure and continued two times daily for 28 days. Clinical evaluation and expert grading of healing and aging, instrument measurement of skin barrier function, optical coherence tomography and standardized digital imaging were performed.  Clinical evaluation results showed that the MCP formula promoted post-procedure skin healing at a comparable level as Aquaphor Healing Ointment®. However, the MCP formula demonstrated faster kinetics and enhanced level of improvement in multiple anti-aging parameters when compared with the benchmark control. Results from this clinical study demonstrate that the use of MCP formula post non-ablative fractional laser treatment is efficacious in promoting skin healing and enhancing the anti-aging benefits provided by the procedure. J Drugs Dermatol. 2025;24(2):188-195. doi:10.36849/JDD.8066R1.

Degenerative gluteal tears associated with hip arthroplasty

BackgroundUnrepaired chronic abductor tears may be a cause of residual pain and weakness after hip arthroplasty, but the current incidence is unclear.MethodsFrom 1994 to 2009, the senior surgeon performed 1628 hip resurfacing and 864 total hip arthroplasties without identifying any gluteal tears. We recognized our first case of concomitant abductor tear during a hip resurfacing procedure in April 2009. After this, we began following a protocol to identify and repair abductor tears in the next 5601 consecutive primary hip arthroplasties (5429 hip resurfacings and 172 total hips).ResultsWomen over 60 were the highest-risk group for abductor tear, with a 3.6% rate of tears identified. All tears were repaired. We found no differences in mean HHS and VAS pain score in patients with repair gluteal tears versus a control group of cases without a tear. Patients without a tear had higher postoperative UCLA activity scores at 2 years postoperative. The majority (98.1%) of hip arthroplasty patients with a gluteal tear repair at time of surgery presented with 4 or 5 abductor strength at their 2-year postoperative physical exam. Of our abductor tear cohort, 70.3% had no limp and 21.9% had a slight limp at 2 years postoperative.ConclusionsIn a large group of hip arthroplasty cases (n = 4507), we identified gluteal tears in 3.6% of women and 1.0% of men. All reported clinical outcomes (excluding mean HHS) in our cohort of hip arthroplasty patients did not differ significantly between cases without abductor tears and those that had gluteal repair at time of surgery. These results suggest abductor tears may be repaired at time of hip arthroplasty surgery without forgoing desirable functional outcomes.Level of evidenceLevel 3 Retrospective Cohort Study.

Cartilage thickness can be accurately measured intraoperatively in total knee arthroplasty: A step further in calipered kinematic alignment.

Kinematic alignment (KA) in total knee arthroplasty (TKA) is by definition a pure femoral resurfacing procedure aiming to restore the individual prearthritic anatomy. However, when a 2 mm compensation is systematically used on the worn side, the variability in cartilage thickness in the unworn compartment might alter the accuracy of the technique. This study aimed to validate two intraoperative femoral cartilage thickness measurement techniques by comparing them to the photographic method, which measures cartilage thickness through pixel analysis of bone-cut images. The study hypothesized that the two intraoperative methods are comparable and similarly accurate within 0.5 mm of the photographic method. Seventy cartilage thickness measurements from seventy patients with end-stage knee osteoarthritis were prospectively collected. Two intraoperative techniques were evaluated: the electrocautery tip method (Method A) and the ruler method (Method B), performed before and after distal femoral bone resections, respectively. The postoperative photographic analysis (Method C) served as the reference method. Measurements were rounded to the nearest 0.5 mm for consistency. Data were analyzed using Kruskal-Wallis test, Wilcoxon rank-sum tests, Spearman's rank correlation, percentage of agreement and intraclass correlation coefficients (ICCs). No significant differences were observed between Method A and Method B in measuring femoral cartilage thickness. Agreement with Method C was 100% for Method B and 85% for Method A. In the 15% of discordant cases, Method A overestimated the measurements by one category of 0.5 mm compared to Method C. Correlation coefficients between the methods were high (ρ = 0.88-1.0). Intra- and interobserver reliability was high for all methods (ICCs 0.91-0.95). Both intraoperative methods are reliable and comparable to the photographic method when rounded to the closest 0.5 mm, with no significant differences among them. The electrocautery method has the added advantage of measuring cartilage thickness before bone cuts are performed. Level IV.

An Economic Analysis of Metal-on-Metal Versus Ceramic-on-Ceramic Hip Resurfacing: Costs and Clinical Implications

Background: Ceramic may be an alternative bearing surface that could be used to deal with the negative sequalae associated with the use of metal-on-metal (MoM) hip resurfacing implants, keeping the benefits of hip resurfacing without the risks. The aim of this study is to evaluate the additional financial and logistical implications that MoM hip resurfacing has, in comparison to its ceramic-on-ceramic (CoC) counterpart. Methods: Two different follow up protocols were analysed, according to current practice guidance, on how to follow up with hip resurfacing procedures. Reference costs were identified using the latest national cost collection data and data from the local biochemistry department. The results incorporated the number of hip resurfacings performed nationally. Results: The non-MoM protocol yielded a per operation lifetime follow up cost of £802.50, whereas the MoM protocol yielded a cost of £2132.83 at 25 years. Nationally, according to the 2023 data, this amounted to £561,750 versus £1,492,981 per year, respectively. MoM hip resurfacing is 2.6 times more expensive to be followed up with when compared to the standard protocol. Conclusion: The cost of the follow up of MoM bearings far exceeds that of non-MoM bearings. If CoC hip resurfacing is as clinically effective as MoM hip resurfacing, then the economics favour CoC bearing for resurfacing.

Expert Roundtable on Skin Care Integration After Aesthetic Procedures: Consensus Recommendations.

Currently, available technologies and procedures enable aesthetic dermatologists to provide their patients with beneficial treatment outcomes for a wide variety of skin conditions. These treatments range from laser resurfacing and radiofrequency procedures to chemical peels and microneedling. The concept of integrated skincare is based on the application of adjunct therapies before, during, or after cosmetic medical procedures to promote healing, minimize discomfort, shorten down-time, and enhance overall aesthetic outcomes. Numerous peer-reviewed studies have demonstrated the benefit of combining a variety of adjunct treatments with cosmetic procedures. The concurrent application of integrated skincare can improve these skin-related issues and provide patients with greater global outcomes. The primary objective of the following consensus roundtable was to discuss best practices for aesthetic providers with or without dermatological training when treating patients with aging skin complaints and review considerations for evaluating patients interested in cosmetic procedures with concomitant skin issues, such as skin dyschromias, lines, and wrinkles. A roundtable discussion was held by several notable experts in their field during a special addition to the Thriving in Diversity webinar series on Saturday, July 8, 2023. The discussion included four leading dermatologists, one oculoplastic surgeon, and one facial plastic surgeon who provided their clinical experience and consensus recommendations for applying integrated skincare in the aesthetic medical practice. J Drugs Dermatol. 2025;24(1):47-53. doi:10.36849/JDD.7999.

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.

Stemless anatomic and reverse shoulder arthroplasty in patients under 55 years of age with primary glenohumeral osteoarthritis: an analysis of the Australian Orthopedic Association National Joint Replacement Registry at 5 years

BackgroundPrimary glenohumeral osteoarthritis in young patients poses challenging treatment decisions. Arthroplasty options have different failure profiles and implant survivorship patterns. This registry study aims to analyze the cumulative per cent revision rate (CPR) of different types of arthroplasties conducted for primary osteoarthritis in patients under 55 years of age. MethodsThis comparative observational national registry study included all shoulder arthroplasty for osteoarthritis in patients under 55 years of age undertaken between January 1st, 2005, and December 31st, 2022. Partial hemi resurfacing and hemi stemless procedures were excluded. The cumulative percentage of revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazard models adjusted for gender. Reasons for revision of each type of arthroplasty and cumulative incidence of revision diagnoses were analyzed. Results2111 primary shoulder arthroplasties were compared. Glenoid erosion is the predominant cause of revision for humeral resurfacing (29.8%) and hemiarthroplasty (35.5%). Instability is the predominant cause of revision for stemmed anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA), while loosening is the predominant cause of revision for stemless ATSA. The 6-year CPR is 12.8% for humeral resurfacing (HRA), 14.1% for hemiarthroplasty (HA), 12.4% for stemmed (ATSA), 7.0% for stemless ATSA, and 6.5% for (RTSA). Stemmed ATSA had a higher revision rate than RTSA (entire period HR=2.04 (95% confidence interval (CI) 1.16, 3.57), p=0.012). In contrast, the revision rate of stemless ATSA was not different from RTSA (HR =1.05 (95% CI 0.51, 2.19), p=0.889). Males outnumber females for all shoulder arthroplasty categories. DiscussionRTSA and stemless ATSA are viable options in young patients with primary osteoarthritis. Their short—to medium-term revision rates are comparable to those of older patients and lower than those associated with HRA, HA, and stemmed ATSA. ConclusionIn the predominantly male patient population under the age of 55, reverse shoulder arthroplasty and stemless ATSA have a lower short-term revision risk than stemmed ATSA.

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.