Post hip fracture orthogeriatric care-a Canadian position paper addressing challenges in care and strategies to meet quality indicators.

INTRODUCTION: Osteoporosis is a major disease state associated with significant morbidity, mortality, and health care costs. Less than half of the individuals sustaining a low energy hip fracture are diagnosed and treated for the underlying osteoporosis. OBJECTIVE: A multidisciplinary Canadian hip fracture working group has developed practical recommendations to meet Canadian quality indicators in post hip fracture care. METHODS: A comprehensive narrative review was conducted to identify and synthesize key articles on post hip fracture orthogeriatric care for each of the individual sections and develop recommendations. These recommendations are based on the best evidence available today. CONCLUSION: Recommendations are anticipated to reduce recurrent fractures, improve mobility and healthcare outcomes post hip fracture, and reduce healthcare costs. Key messages to enhance postoperative care are also provided.

Comparative Evaluation of Two Glass Polyalkenoate Cements: An In Vivo Pilot Study Using a Sheep Model.

Poly(methyl methacrylate) (PMMA) is used to manage bone loss in revision total knee arthroplasty (rTKA). However, the application of PMMA has been associated with complications such as volumetric shrinkage, necrosis, wear debris, and loosening. Glass polyalkenoate cements (GPCs) have potential bone cementation applications. Unlike PMMA, GPC does not undergo volumetric shrinkage, adheres chemically to bone, and does not undergo an exothermic setting reaction. In this study, two different compositions of GPCs (GPCA and GPCB), based on the patented glass system SiO2-CaO-SrO-P2O5-Ta2O5, were investigated. Working and setting times, pH, ion release, compressive strength, and cytotoxicity of each composition were assessed, and based on the results of these tests, three sets of samples from GPCA were implanted into the distal femur and proximal tibia of three sheep (alongside PMMA as control). Clinical CT scans and micro-CT images obtained at 0, 6, and 12 weeks revealed the varied radiological responses of sheep bone to GPCA. One GPCA sample (implanted in the sheep for 12 weeks) was characterized with no bone resorption. Furthermore, a continuous bone-cement interface was observed in the CT images of this sample. The other implanted GPCA showed a thin radiolucent border at six weeks, indicating some bone resorption occurred. The third sample showed extensive bone resorption at both six and 12 weeks. Possible speculative factors that might be involved in the varied response can be: excessive Zn2+ ion release, low pH, mixing variability, and difficulty in inserting the samples into different parts of the sheep bone.

In vivo analysis of a proprietary glass-based adhesive for sternal fixation and stabilization using rabbit and sheep models.

Wire cerclage remains the standard method of care for sternal fixation, following median sternotomy, despite being beset with complications. An emerging treatment option has been to augment the wires with an adhesive. A patented ionomeric glass (mole fraction: SiO2:0.48, ZnO:0.36, CaO:0.12, SrO:0.04) has been used to formulate GPC+, a glass polyalkenoate cement (GPC), by mixing it with poly(acrylic) acid (PAA) and de-ionized water. In a human cadaver study, this material, when applied with wire cerclage, was able to significantly reduce sternal instability. However, the material has yet to be tested in pertinent animal models. Here, after a series of physical and mechanical tests to confirm suitability of the experimental material for implantation, three samples of GPC+ were implanted in either the tibia or femur of three different rabbits, alongside sham defects, for two different time modalities. A further seven samples of GPC+ and one poly(methyl methacrylate) control (PMMA) were implanted in either the tibia or femur of two different sheep. The sheep containing the PMMA was sacrificed at 8 weeks and the other at 16 weeks, to evaluate time dependent biological response. Upon sacrifice, microCT images were acquired and histology slides prepared for analysis. All three GPC+ samples implanted in the rabbit model, for the two time modalities, were characterized by minimal bone resorption along with a mild inflammatory response. Five of the seven GPC+ materials implanted in the sheep model (all three implanted for 8 weeks and two of those implanted for 16 weeks) were associated with mild to moderate immune response, comparable to that observed with PMMA, as well as mild bone resorption. The remaining two GPC + materials (implanted in the sheep model for 16 weeks) exhibited no bone resorption or inflammatory response and appeared to stimulate increased bone density at the implant site. These results suggest that GPC + can be a viable bone adhesive for use in hard tissue applications such as sternal fixation and stabilization. Experiments performed to synthesize & test Sr-doped glass adhesive for sternal fixation. (1) Sr-doped ionomeric glass fired, ground down and mixed with aqueous polyacrylic acid to produce the adhesive. (2) Adhesive characterized and tested by a suite of laboratory-based tests to ensure suitability for implantation. (3) Adhesive implanted into a rabbit model (distal femur, 12 weeks post implantation) where micro-CT images confirmed an excellent bone/cement interface, no evidence of bone resorption and some bone remodelling. (4) Adhesive subsequently implanted into a sheep model; at 16-weeks, a continuous bone-adhesive interface is seen suggesting no bone resorption. There was an increase in the peri-implant radiodensity, suggesting enhanced mineral content of the bone surrounding the GPC+ implant.

Osteoporosis treatment rate following hip fracture in a community hospital.

Treatment rates for osteoporosis after a major osteoporotic fracture are unacceptably low. We evaluate the effectiveness of an ortho-geriatric team (OGT) in initiating pharmacologic therapy for osteoporosis post-hip fracture. The OGT was able to achieve a higher treatment rate for patients post-hip fracture in comparison to usual care provided by the primary care hospitalist. Potential reasons for delaying or not proceeding with drug therapy include patient concern regarding potential rare side effects of antiresorptive therapy including osteonecrosis of the jaw and atypical femoral fracture. These events however are rare, and in this study, only 3% of hip fractures were atypical femoral fractures. INTRODUCTION: Currently, a significant care gap for osteoporosis therapy exists post-hip fracture despite advances in pharmacologic therapy. We evaluate the effectiveness of the OGT at the Oakville Trafalgar Memorial Hospital (OTMH), Ontario, Canada, in reducing the care gap and initiating pharmacologic therapy in hip fracture patients prior to hospital discharge. We also evaluated the incidence of atypical femoral fracture (AFF) separately. METHODS: A retrospective chart review of patients 59 years and older with a hip fracture admitted to OTMH from January 1, 2016, to February 1, 2017, was conducted. The primary outcome was the proportion of hip fracture patients discharged from the hospital with appropriate treatment for their underlying osteoporosis. A sub-analysis was completed reporting the incidence of AFF among older adults. RESULTS: A total of 197 patients with a hip fracture were identified, 134/197 (68%) patients were seen by the OGT, 98/134 (73%) of these patients were started on pharmacologic therapy prior to discharge, and 120/134 (89%) of patients seen by the OGT were on treatment within 3 months of discharge following assessment in the complex osteoporosis clinic. Sixty-three patients of the 197 (63/197) (32%) of the hip fracture patients were seen by a hospitalist, and treatment rates prior to discharge were 5%. Only 6/197 patients had experienced an AFF during the study period, and all patients with an atypical femoral fracture had been on long-term bisphosphonate therapy. All of the patients with an AFF had thigh or groin pain for several weeks to months prior to the development of the atypical femoral fracture, providing an opportunity to stop therapy and possibly prevent the development of a complete AFF. CONCLUSION: The OGT was able to initiate anti-osteoporosis therapy in significantly more patients in comparison to usual care, and higher treatment rates are possible with an OGT.

In vitro evaluation of novel titania-containing borate bioactive glass scaffolds.

Titanium-containing borate bioactive glass scaffolds (0, 5, 15, and 20 mol %, identified as BRT0, BRT1, BRT3, and BRT4) with a microstructure similar to that of human trabecular bone were prepared and evaluated in vitro for potential bone loss applications in revision total knee arthroplasty (rTKA). Methyl thiazolyl tetrazolium (MTT) cell viability assays of scaffold ion release extracts revealed that BRT0 scaffolds (0 mol % titanium) inhibited cell proliferation and activity at day 14. At day 30, all scaffold extracts decreased cell proliferation and activity significantly. However, live/dead cell assay results demonstrated that degradation products from all the scaffolds had no inhibitory effect on cell viability. Significant bactericidal efficacies of BRT3 extracts against Escherishia coli (Gram-negative) and BRT1 extracts against Staphylococcus aureus and Staphylococcus epidermidis (both Gram-positive bacteria) were demonstrated. Finally, evaluation of the cell/bioactive glass surface interactions showed well-spread cells on the surface of the BRT3 glass discs and BRT1 and BRT3 scaffolds, when compared to BRT0 and BRT4 scaffolds. The results indicate that by changing the Ti4+ :B3+ ratio, the ion release and consequently cell proliferation could be improved. in vitro results in this study demonstrate that BRT3 scaffolds could be a promising candidate for addressing bone loss in rTKAs; however, in vivo studies would be required to evaluate the effect of a dynamic environment on the cell and tissue response to the fabricated scaffolds.

Calcium sulfate-containing glass polyalkenoate cement for revision total knee arthroplasty fixation.

Poly(methyl methacrylate) (PMMA) bone cement is used as a minor void filler in revision total knee arthroplasty (rTKA). The application of PMMA is indicated only for peripheral bone defects with less than 5 mm depth and that cover less than 50% of the bone surface. Treating bone defects with PMMA results in complications as a result of volumetric shrinkage, bone necrosis, and aseptic loosening. These concerns have driven the development of alternative bone cements. We report here on novel modified glass polyalkenoate cements (mGPCs) containing 1, 5 and 15 wt% calcium sulfate (CaSO4 ) and how the modified cements' properties compare to those of PMMA used in rTKA. CaSO4 is incorporated into the mGPC to improve both osteoconductivity and bioresorbability. The results confirm that the incorporation of CaSO4 into mGPCs decreases the setting time and increases release of therapeutic ions such as Ca2+ and Zn2+ over 30 days of maturation in deionized (DI) water. Moreover, the compressive strength for 5 and 15 wt% CaSO4 addition increased to over 30 MPa after 30 day maturation. Although the overall initial compressive strength of the mGPC (~ 30 MPa) is less than PMMA (~ 95 MPa), the compressive strength of mGPC is closer to that of cancellous bone (~ 1.2-7.8 MPa). CaSO4 addition did not affect biaxial flexural strength. Fourier transform infrared analysis indicated no cross-linking between CaSO4 and the GPC after 30 days. in vivo tests are required to determine the effects the modified GPCs as alternative on PMMA in rTKA.

The Role of Poly(Methyl Methacrylate) in Management of Bone Loss and Infection in Revision Total Knee Arthroplasty: A Review.

Poly(methyl methacrylate) (PMMA) is widely used in joint arthroplasty to secure an implant to the host bone. Complications including fracture, bone loss and infection might cause failure of total knee arthroplasty (TKA), resulting in the need for revision total knee arthroplasty (rTKA). The goals of this paper are: (1) to identify the most common complications, outside of sepsis, arising from the application of PMMA following rTKA, (2) to discuss the current applications and drawbacks of employing PMMA in managing bone loss, (3) to review the role of PMMA in addressing bone infection following complications in rTKA. Papers published between 1970 to 2018 have been considered through searching in Springer, Google Scholar, IEEE Xplore, Engineering village, PubMed and weblinks. This review considers the use of PMMA as both a bone void filler and as a spacer material in two-stage revision. To manage bone loss, PMMA is widely used to fill peripheral bone defects whose depth is less than 5 mm and covers less than 50% of the bone surface. Treatment of bone infections with PMMA is mainly for two-stage rTKA where antibiotic-loaded PMMA is inserted as a spacer. This review also shows that using antibiotic-loaded PMMA might cause complications such as toxicity to surrounding tissue, incomplete antibiotic agent release from the PMMA, roughness and bacterial colonization on the surface of PMMA. Although PMMA is the only commercial bone cement used in rTKA, there are concerns associated with using PMMA following rTKA. More research and clinical studies are needed to address these complications.

Effect of TiO2 doping on degradation rate, microstructure and strength of borate bioactive glass scaffolds.

A titanium-containing borate glass series based on the system (52-X) B2O3-12CaO-6P2O5-14Na2O-16ZnO-XTiO2 with X varying from 0, 5 and 15 mol% of TiO2 incorporated, identified as BRT0, BRT1 and BRT3, respectively, were used in this study. Scaffolds (pore sizes, 165-230 µm and porosity, 53.51-69.51%) were prepared using a polymer foam replication technique. BRT3 scaffolds exhibited higher compressive strength (7.16 ±â€¯0.22 MPa) when compared to BRT0 (6.02 ±â€¯0.47 MPa) and BRT1 (5.65 ±â€¯0.28 MPa) scaffolds with lower, or no, TiO2 content. The solubility of the scaffolds decreased as the TiO2 content increased up to 15 mol% when samples of each scaffold were immersed in DI water and the pH of all these extracts went up from 7.0 to 8.5 in 30 days. The cumulative ion release from the scaffolds showed significant difference with respect to TiO2 content; addition of 5 mol% TiO2 at the expense of borate (B2O3) decreased the ion release remarkably. Furthermore, it was found that for all three scaffolds, cumulative ion release increased with incubation time. The results indicate that the degradation rates and compressive strengths of borate bioactive glass scaffolds could be controlled by varying the amount of TiO2 incorporated, confirming their potential as scaffolds in TKA and rTKA.

A review of materials for managing bone loss in revision total knee arthroplasty.

In 2014-2015, 61,421 total knee arthroplasties (TKAs) were performed in Canada; an increase of about 20% over 2000-2001. Revision total knee arthroplasties (rTKAs) accounted for 6.8% of TKAs performed between 2014 and 2015, and this is estimated to grow another 12% by 2025. rTKAs are typically more complicated than primary TKAs due to the significant loss of femoral and tibial bone stock. The escalating demand and limitations associated with total knee arthroplasty and their revision drives the development of novel treatments. A variety of materials have been utilized to facilitate regeneration of healthy bone around the site of a knee arthroplasty. The selection of these materials is based on the bone defect size and includes bone grafts, graft substitutes and cements. However, all these materials have certain disadvantages such as blood loss, disease transmission (bone grafts), inflammatory response, insufficient mechanical properties (bone graft substitutes) thermal necrosis and stress shielding (bone cement). Recently, the use of metal augments for large bone defects has attracted attention, however they can undergo fretting, corrosion, and stress shielding. All things considered, this review indicates the necessity of developing augments that have structural integrities and biodegradation rates similar to that of human bone. Therefore, the future of bone loss management may lie in fabricating novel bioactive glass augments as they can promote bone healing and implant stability and can degrade with time.

Short-term functional outcomes of computer assisted navigated high tibial osteotomy.

PURPOSE: High tibial osteotomy (HTO) is a surgical procedure performed on patients with knee osteoarthritis (OA). Computer assisted navigated high tibial osteotomy (CAN-HTO) may result in improved outcomes for patients undergoing this procedure. METHODS: Retrospective study involving patients undergoing CAN-HTO. RESULTS: Surveyed thirty-three patients. Average follow-up: 2.3 years. 97% patients reported they would have this procedure performed again, if indicated. Re-operation rate: 6.1% and complication rate: 12.1%. Patients had decreased KOOS for symptoms when compared to non-navigation based HTO (p = 0.000). CONCLUSION: There may be merit with the use of CAN-HTO, with demonstrated patient-reported benefits at 2-year follow-up.

Novel adhesives for sternal fixation and stabilization: A biomechanical analysis.

BACKGROUND: Cerclage wires remain the current standard of care following median sternotomy, despite significant complications including dehiscence and infection. This study uses a human cadaveric model to investigate the use of glass polyalkenoate cements formulated from two glasses, A (mole fraction: SiO2:0.48, ZnO:0.36, CaO:0.12, SrO:0.04) and B (mole fraction: SiO2:0.48, ZnO:0.355, CaO:0.06, SrO:0.08, P2O5:0.02, Ta2O5:0.005), to improve wired sternal fixation. METHODS: Median sternotomies were performed on fifteen cadaveric sterna. Fixation was performed with either traditional wire cerclage or adhesive-enhanced wire cerclage; the adhesive based on either Glass A or Glass B. Cyclic tensile loading of 10 N to 100 N was applied. Every 30 cycles, the maximum load was increased by 100 N up to a maximum of 500 N. Two adhered sterna were tested beyond 500 N. Mid-sternal displacement was measured to assess fixation stability. FINDINGS: Displacement for adhesive-enhanced sternal closures were significantly less (p < 0.05) than standard wire cerclage. There was no significant difference between adhesives. Up to 500 N, no adhesive-enhanced sternum experienced a pathological sternal displacement (>2 mm), while three out of five of traditional wire fixations did. Of the two adhered samples tested beyond 500 N, one showed pathological displacement at 800 N and the other at 1100 N. Failure of adhered sterna appeared to initiate within the trabecular bone rather than in the adhesive. INTERPRETATION: The adhesives were capable of providing immediate bone stability, significantly reducing sternal displacement. In vivo investigations are warranted to determine the effect the adhesives have on bone remodelling.

Novel adhesives for distal radius fixation: A biomechanical analysis.

Wrist fractures can be difficult to treat due to advanced age of the patient, medical co-morbidities, and comminution of the bone. This study examines the effectiveness of two injectable glass polyalkenoate cements (GPCs), derived from two different glasses (A and B), as minimally invasive treatments for distal radius fractures. Twenty-seven fresh cadaveric radial pairs were tested either in compressive fatigue or to quasi-static compressive failure. The radii tested to failure had one pair fixated with a GPC while the other was left intact. The radii tested under fatigue had one pair fixated with a GPC and the other with a volar locking plate. A wedge osteotomy was used to simulate a severely comminuted fracture. When loaded to failure, the radii fixated with a GPC made from glass A or B were found to be, respectively, at least 57% and 62% as strong as their intact biological pair (95% Confidence Interval, Lower). Using a paired t-test, the radii fixated with either adhesive were found to be significantly stiffer than their biological pairs fixated with a volar locking plate for all cycles of fatigue loading. The adhesives under investigation demonstrate promise as treatment for distal radius fractures. In vivo investigations are warranted to determine the effect that the adhesives have on the bone remodelling process.

Are non-steroidal anti-inflammatory drug injections an alternative to steroid injections for musculoskeletal pain?: A systematic review.

BACKGROUND: Given the potential side effect profile of steroids, the need for an alternative injectable anti-inflammatory is needed. The purpose of this systematic review was to compare corticosteroid injections with non-steroidal anti-inflammatory drug (NSAID) injections for musculoskeletal pain. METHODS: Reviewers with methodological and content expertise searched three databases: PUBMED, Medline and EMBASE. Two blinded reviewers searched, screened, and evaluated the data quality. Data was abstracted in duplicate. Agreement and descriptive statistics are presented. RESULTS: Four studies were included. All four studies found no statistically significant differences in improvements on the visual analog scale. The follow-up period within the four studies ranged between 2 weeks and 3 months. No statistically significant differences were demonstrated between the two groups with regards to functional outcomes. INTERPRETATION: The studies reviewed, while limited in quantity, show that compared with corticosteroids, NSAIDs provide equivalent, if not better, pain relief from the musculoskeletal ailments assessed. Further, there is weak evidence supporting a lower recurrence rate of symptoms with NSAIDs when compared to corticosteroids. There is a need for more long-term high-quality studies on this topic. LEVEL OF EVIDENCE: Level II (Systematic review of Level II and III studies).

Percutaneous upper extremity fracture fixation using a novel glass-based adhesive.

OBJECTIVE: To develop a surgical technique for percutaneous upper extremity fracture fixation using a novel glass-based adhesive. METHODS: Three intact upper extremity cadaveric specimens with undisturbed soft tissues were obtained. Two were used to model a wrist fracture, and the third to model a proximal humerus fracture. Fractures were produced using a small osteotome in a percutaneous fashion. Banna Bone Adhesive (BBA) was delivered to the fracture site percutaneously using a 16 gauge needle under bi-planar fluoroscopic guidance. After setting of the adhesive, the specimens were dissected to qualitatively assess BBA delivery and placement. RESULTS: The adhesive could readily be delivered through the 16 gauge needle with an appropriate amount of pressure applied to the syringe. Using the fluoroscope, the adhesive could be seen to flow into the fracture site with minimal extravagation into the surrounding soft tissues. Successful bonding of the fracture fragments was observed. CONCLUSIONS: Percutaneous delivery of BBA into a fracture of the distal radius and proximal humerus may be a feasible fracture fixation technique. Biomechanical testing and animal model testing are required to further develop this procedure.

Titanium addition influences antibacterial activity of bioactive glass coatings on metallic implants.

In an attempt to combat the possibility of bacterial infection and insufficient bone growth around metallic, surgical implants, bioactive glasses may be employed as coatings. In this work, silica-based and borate-based glass series were synthesized for this purpose and subsequently characterized in terms of antibacterial behavior, solubility and cytotoxicity. Borate-based glasses were found to exhibit significantly superior antibacterial properties and increased solubility compared to their silica-based counterparts, with BRT0 and BRT3 (borate-based glasses with 0 and 15 mol% of titanium dioxide incorporated, respectively) outperforming the remainder of the glasses, both borate and silicate based, in these respects. Atomic Absorption Spectroscopy confirmed the release of zinc ions (Zn2+), which has been linked to the antibacterial abilities of glasses SRT0, BRT0 and BRT3, with inhibition effectively achieved at concentrations lower than 0.7 ppm. In vitro cytotoxicity studies using MC3T3-E1 osteoblasts confirmed that cell proliferation was affected by all glasses in this study, with decreased proliferation attributed to a faster release of sodium ions over calcium ions in both glass series, factor known to slow cell proliferation in vitro.

Safety and efficacy of topical ketoprofen in transfersome gel in knee osteoarthritis: A systematic review.

PURPOSE: Topical ketoprofen in Transfersome gel has been used for the alleviation of symptoms in osteoarthritis. Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with various side effects. Topical NSAIDs are known to have a lower side-effect profile when compared with systemic administration. The present systematic review aimed to determine the safety and efficacy of topical ketoprofen in Transfersome gel in knee osteoarthritis (OA). METHODS: A systematic literature review was performed. The electronic databases EMBASE, MEDLINE, HealthStar and PubMed were searched from 1946 to June 2016. A screen of the reference sections of the included studies was also performed. Two blinded reviewers searched, screened, abstracted and evaluated the data quality using the Jadad scale. Studies were included if they contained: at least 50% of participants with knee OA, topical ketoprofen, human subjects and participants from North America or Europe. Study outcomes had to include patient-reported functional outcome scores. RESULTS: Five studies were included, with a total of 3619 participants, and a mean Jadad score of 3.4/5. Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index was the only outcome measure consistent across all of the randomized controlled trials included in the present review (four of the five included studies). All topical ketoprofen in Transfersome gel groups (25 mg, 50 mg and 100 mg) had improvements in pain that were superior to all other treatment arms, and the 50 mg topical ketoprofen in Transfersome gel group had functional gains that were superior to all other treatment arms. The majority of the adverse events were non-serious and related to skin and subcutaneous tissue disorders, with erythema being the most common. The average of all adverse events and gastrointestinal (GI) adverse events was highest in the oral celecoxib group (47.1% and 15.1%, respectively). The average frequency of GI adverse events in the topical ketoprofen groups was comparable with that in the topical placebo treatment arm. A meta-analysis was not feasible due to the heterogeneity among the studies. CONCLUSIONS: Topical ketoprofen in Transfersome gel is an effective means of treating symptoms of knee OA, and is superior to oral celecoxib, oral placebo and topical placebo. The most commonly reported adverse events associated with the use of topical ketoprofen in Transfersome gel were non-severe skin and subcutaneous tissue disorders. Furthermore, as topical ketoprofen in Transfersome gel was associated with fewer adverse events when compared with oral celecoxib, and had rates of GI adverse events comparable with those of topical placebo, it may be ideal for those who are unable to take oral NSAIDs.

Silica-Based and Borate-Based, Titania-Containing Bioactive Coatings Characterization: Critical Strain Energy Release Rate, Residual Stresses, Hardness, and Thermal Expansion.

Silica-based and borate-based glass series, with increasing amounts of TiO2 incorporated, are characterized in terms of their mechanical properties relevant to their use as metallic coating materials. It is observed that borate-based glasses exhibit CTE (Coefficient of Thermal Expansion) closer to the substrate's (Ti6Al4V) CTE, translating into higher mode I critical strain energy release rates of glasses and compressive residual stresses and strains at the coating/substrate interface, outperforming the silica-based glasses counterparts. An increase in the content of TiO2 in the glasses results in an increase in the mode I critical strain energy release rate for both the bulk glass and for the coating/substrate system, proving that the addition of TiO2 to the glass structure enhances its toughness, while decreasing its bulk hardness. Borate-based glass BRT3, with 15 mol % TiO2 incorporated, exhibits superior properties overall compared to the other proposed glasses in this work, as well as 45S5 Bioglass® and Pyrex.

Antibacterial and osteo-stimulatory effects of a borate-based glass series doped with strontium ions.

This work considered the effect of both increasing additions of Strontium (Sr2+) and incubation time on solubility and both antibacterial and osteo-stimulatory effects of a series of glasses based on the B2O3-P2O5-CaCO3-Na2CO3-TiO2-SrCO3 series. The amorphous nature of all the glasses was confirmed by X-ray diffraction. Discs of each glass were immersed in de-ionized water for 1, 7 and 30 days, and the water extracts were used for ion release profiles, pH measurements and cytotoxicity testing. Atomic absorption spectroscopy was employed to detect the release of Na+, Ca2+ and Sr2+ ions from the glasses with respect to maturation, which indicated that the addition of Sr2+ retarded solubility of the glass series. This effect was also confirmed by weight loss analysis through comparing the initial weight of glass discs before and after periods of incubation. The incorporation of Sr2+ in the glasses did not influence the pH of the water extracts when the glasses were stored for up to 30 days. Cytotoxicity testing with an osteoblastic cell line (MC3T3-E1) indicated that glasses with the higher (20 mol% and 25 mol%) Sr2+ incorporation promoted proliferation of osteoblast cells, while the glasses with lower Sr2+ contents inhibited cell growth. The glass series, except for Ly-B5 (which contained the highest Sr2+ incorporation; 25 mol%), were bacteriostatic against S. aureus in the short term (1-7 days) as a result of the dissolution products released.

Navigation versus conventional high tibial osteotomy: systematic review.

INTRODUCTION: One major use for high tibial osteotomy aims at improving alignment in the symptomatic, varus malaligned, medial compartment osteoarthritic knee. The importance of achieving correct alignment is obvious upon considering the increased potential for significant complications with over- or undercorrection in any plane. The aim of this systematic review was to compare navigation and conventional high tibial osteotomy. METHODS: This systematic review searched the MEDLINE and EMBASE databases to compare the short-term clinical and radiological outcomes between patients undergoing either conventional or navigated high tibial osteotomy. RESULTS: We retrieved 71 articles, which ultimately resulted in 14 eligible studies for inclusion. Though heterogeneity prevented statistical analysis, only one study failed to suggest superiority of navigation over conventional techniques. CONCLUSION: Navigated high tibial osteotomy improves accuracy over conventional techniques, though the current best evidence presented herein must be advanced by higher quality studies.

Arthroscopic and computer-assisted high tibial osteotomy using standard total knee arthroplasty navigation software.

Opening-wedge high tibial osteotomy is an increasingly performed procedure for treatment of varus gonarthrosis and correction of malalignment during meniscal transplantation or cartilage restoration. Precise preoperative planning and meticulous surgical technique are required to achieve an appropriate mechanical axis correction. We describe our technique of arthroscopic and computer-assisted high tibial osteotomy using commonly available total knee arthroplasty navigation software as an intraoperative goniometer. We believe that our technique, by providing intraoperative real-time guidance of the degree of correction that is accurate and reliable, represents a useful tool for the surgeon who uncommonly performs high tibial osteotomy.