A pilot study on preferences from surgeons to deal with an innovative customized and connected knee prosthesis - A discret choice experiment.

Background: To address the increasing global demand for Total Knee Arthroplasty and reduce the need for revisions, several technologies combining 3D planning and artificial intelligence have emerged. These innovations aim to enhance customization, improve component positioning accuracy and precision. The integration of these advancements paves the way for the development of personalized and connected knee implant. Questions/purposes: These groundbreaking advancements may necessitate changes in surgical practices. Hence, it is important to comprehend surgeons' intentions in integrating these technologies into their routine procedures. Our study aims to assess how surgeons' preferences will affect the acceptability of using this new implant and associated technologies within the entire care chain. Methods: We employed a Discrete Choice Experiment, a predictive technique mirroring real-world healthcare decisions, to assess surgeons' trade-off evaluations and preferences. Results: A total of 90 experienced surgeons, performing a significant number of procedures annually (mostly over 51) answered. Analysis indicates an affinity for technology but limited interest in integrating digital advancements like preoperative software and robotics. However, they are receptive to practice improvements and considering the adoption of future sensors. Conclusions: In conclusion, surgeons prefer customized prostheses via augmented reality, accepting extra cost. Embedded sensor technology is deemed premature by them.

Autophagy markers are decreased in bone of osteoporotic patients: a monocentric comparative study.

BACKGROUND: Osteoporosis (OP) is a pathology characterized by bone fragility affecting 30% of postmenopausal women, mainly due to estrogen deprivation and increased oxidative stress. An autophagy involvement is suspected in OP pathogenesis but a definitive proof in humans remains to be obtained. METHODS: Postmenopausal women hospitalized for femoral neck fracture (OP group) or total hip replacement (Control group) were enrolled using very strict exclusion criteria. Western blot was used to analyze autophagy level. RESULTS: The protein expression level of the autophagosome marker LC3-II was significantly decreased in bone of OP patients relative to the control group. In addition, the protein expression of the hormonally upregulated neu-associated kinase (HUNK), which is upregulated by female hormones and promotes autophagy, was also significantly reduced in bone of the OP group. CONCLUSIONS: These results demonstrate for the first time that postmenopausal OP patients have a deficit in bone autophagy level and suggest that HUNK could be the factor linking estrogen loss and autophagy decline. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT03175874, 2/6/2017.

Unicompartmental knee arthroplasty: A French multicenteric retrospective descriptive study from 2009 to 2019 with projections to 2050.

INTRODUCTION: Unicompartmental knee arthroplasty (UKA) is a reliable and reproducible procedure. While some surgeons have incorporated it into their therapeutic armamentarium, others do not use it routinely, leading to a large disparity in practice. The objective of this study was to investigate in France the epidemiology of UKA from 2009 to 2019 to identify: (1) the evolution of growth trends by sex and age, (2) the evolution of the state of comorbidity of patients during the operation, (3) the evolution of trends according to the regions, (4) the projection best suited to the observations at 2050. HYPOTHESIS: Our hypothesis was that in France, an increase would be observed over the period studied, differing according to the characteristics of the population. MATERIALS AND METHOD: The study was conducted in France over the 2009-2019 period for each gender and age group. The data was taken from the NHDS (National Health Data System) database, which includes all the procedures carried out in France. Based on the collection of procedures performed, the incidence rates (per 100,000 inhabitants) and their evolution were deduced, as well as the indirect assessment of the patient's comorbidity status. Using linear, Poisson, and logistic projection models, incidence rates were projected to the years 2030, 2040, and 2050. RESULTS: Between 2009 and 2019, the incidence rate of UKA increased sharply (from 12.76 to 19.57; +53%), the growth was different in men (from 10.78 to 20.34; +89%) and women (from 14.61 to 18.85; +29%). The male/female sex ratio increased from 0.69 in 2009 to 1.0 in 2019. The increase was greatest among men under 65 (from 4.9 to 9.9; +100%) and lowest among women over 75 (from 41.2 to 40.5; -2%). Over the period studied, the proportion of patients with mild comorbidities (HPG1) increased (from 71.7% to 81.1%) at the expense of the other classes with more severe comorbidities. This dynamic was observed for all age groups: 0-64 years (from 83.3% to 90%), 65-74 years (from 81.4% to 88.4%), 75 years and over (38 .2% to 52.6%) regardless of sex. There was a strong disparity between the regions with a change in the incidence rate ranging from -22% (from 29.8 to 23.1) for Corsica to +251% (from 13.9 to 48.7) for Brittany. The proposed projection models suggested an increase in the incidence rate of +18% in logistic regression, +103% in linear regression by 2050. DISCUSSION: Our study showed strong growth in the number of UKAs in France over the period studied, being highest in young men. The proportion of patients with fewer comorbidities increased for all age groups. A disparity in inter-regional practice was identified, with indications that remain ambiguous and differ according to the practitioner. We can expect continued growth in the years to come, adding to the care burden. LEVEL OF EVIDENCE: IV; Descriptive epidemiological study.

Functional safe zone for THA considering the patient-specific pelvic tilts: An ultrasound-based approach.

The usual Lewinnek orientation for cup positioning in total hip arthroplasty is not suitable for all patients as it does not consider the patient mobility. We propose an ultrasound-based approach to compute a Functional Safe Zone (FSZ) considering daily positions. Our goal was to validate it, and to evaluate how the input parameters impact the FSZ size and barycentre. The accuracy of the FSZ was first assessed by comparing the FSZ computed by the proposed approach and the true FSZ determined by 3D modelling. Then, the input parameters' impact on the FSZ was studied using a principal component analysis. The FSZ was estimated with errors below 0.5° for mean anteversion, mean inclination, and at edges. The pelvic tilts and the neck orientation were found correlated to the FSZ mean orientation, and the target ROM and the prosthesis dimensions to the FSZ size. Integrated into the clinical workflow, this non-ionising approach can be used to easily determine an optimal patient-specific cup orientation minimising the risks of dislocation.

Total knee arthroplasty in France: Male-driven rise in procedures in 2009-2019 and projections for 2050.

BACKGROUND: The number of Total Knee Arthroplasty (TKA) procedures has been rising steadily for several decades in Europe and the USA. The increase varies in pace across countries, with a gradual climb in northern and central Europe, a slowing in the USA, and an exponential surge in the UK. In France, a 32.2% rise in the number of TKA and unicompartmental knee arthroplasty procedures was documented between 2012 and 2018. However, no study has focussed specifically on changes in both TKA procedures and the features of TKA patients. The objective of this study was to use the French national healthcare database to evaluate (1) increases in TKA procedures according to sex and age, (2) whether TKA is being performed at increasingly younger ages, (3) whether the comorbidity profile at TKA is changing, and (4) whether the TKA incidence rate will stabilise in the future, with a projection for 2050. HYPOTHESIS: In France, the number of TKA procedures is rising in both males and females but the pace of the increases differs between sexes. MATERIAL AND METHOD: This study used data collected in France in 2009-2019, separately for different age groups and for males and females, in the French national healthcare database (Système national des données de santé, SNDS) that collects information on all surgical procedures performed nationwide. Based on information about the TKA procedures, we determined (1) the TKA incidence rates with their time trends and (2) indirectly, the comorbidity profiles of the patients at TKA. Linear, Poisson, and logistic models were built to predict incidence rates in 2030, 2040, and 2050. RESULTS: Between 2009 and 2019, the TKA incidence rate showed a steeper increase in males than in females (from 71.2 to 122.9 [+73%] vs. 124.2 to 181.0 [+46%], respectively). Although this increase was replicated in all age groups, it was sharper in patients younger than 65 years, in both males and females (from 20.9 to 37.9 [+82%] and 33.6 to 51.3 [+53%], respectively). During the study period, the number and proportion of patients increased in the group with mild comorbidities (from 40 093 to 67 430 TKAs, i.e., from 53.1% to 65.7% of all TKAs) but not in the other comorbidity groups. All projection models were validated. Nonetheless, the most likely scenario, provided by the logistic model, is a 33% rise by 2050 in both males and females (i.e., to 151 575 TKA procedures) with a plateau starting around 2030. CONCLUSION: Although the increase in TKA procedures is more marked in males than in females, the trends are similar in both sexes, with a sharper rise in the group younger than 65 years and a shift toward patients with milder comorbidities. In the longer term, incidence rate trends follow logistic dynamics, with a plateau starting around 2030. To meet the increasing demand, a corresponding development in relevant healthcare resources must be planned. LEVEL OF EVIDENCE: IV, descriptive epidemiological study.

Long-term survival of the Lefèvre retentive cup: 12-year follow-up analysis of 466 consecutive cases.

INTRODUCTION: The Lefèvre retentive cup is a salvage solution for total hip replacement at high risk of dislocation. Only a few studies have reported the medium or long-term survival; most often, only a small number of patients were included in these studies. This led us to conduct a retrospective analysis of a large population to determine: 1) the 10-year survival rate after primary or revision arthroplasty, 2) the complication rate. HYPOTHESIS: The dislocation rate is<5% for revision arthroplasty and<2% for primary arthroplasty. MATERIAL AND METHODS: This single-center retrospective study included 466 consecutive total hip replacements performed with the Lefèvre retentive cup with a 12-year theoretical minimum follow-up (1/1/1998 to 31/8/2006). There were 257 indications for primary arthroplasty and 209 for revision arthroplasty. The cohort had 316 women and the mean age at surgery was 72.9years (30.2-89.9). The mean follow-up was 10.2±5 years (0.1-19.3). A statistical analysis was done based on the Kaplan-Meier survival curves in two subsets of patients: primary and revision surgery. RESULTS: At the final review, 264 patients had died because of reasons unrelated to the procedures (mean 7.8±4.7years after the procedure), 48 were lost to follow-up (mean 3.0±3.3years after the procedure), and 39 patients (8%) had undergone acetabular revision of which 12 were for infection (2.5%), 25 were for loosening (5.4%) (5 femoral loosening only) and 2 were for dislocation (0.4%). In all, there were 10/466 dislocations (2.1%) of which 5/257 (1.9%) were in the primary group and 5/209 (2.4%) were in the revision group: 2 had a cup exchange and 8 were reduced by closed procedures. The probability of survival free of mechanical complications at 10years was estimated at 94.8%±1.6% (95% CI: 91.6%-98.0%) for the primary group and 87.8%±2.7% (95% CI: 82.4%-93.2%) for the revision groups (p=0.0017). There were 39 re-operations in the overall cohort: 1/257 (0.4%) for dislocation, 7/257 (2.7%) for aseptic loosening and 3/257 (1.2%) for infection in the primary group, while in the revision group, 1/209 (0.5%) was for dislocation, 18/209 (8.6%) for aseptic loosening and 9/209 (4.3%) for infection. CONCLUSION: The Lefèvre retentive cup has good long-term survival with a low mechanical complication rate, both in primary and revision surgery. To us, this implant appears to be a reliable salvage procedure for total hip replacement in patients at high risk for dislocation. LEVEL OF EVIDENCE: IV; retrospective study without control group.

A Case-Control Comparison of Single-Stage Bilateral vs Unilateral Medial Unicompartmental Knee Arthroplasty.

BACKGROUND: We aimed to compare postoperative pain, functional recovery, and patient satisfaction among patients receiving one-stage medial bilateral or medial unilateral UKA (unicompartmental knee arthroplasty). Our main hypothesis was that during the first 72 postoperative hours, patients who underwent medial bilateral UKA did not consume more analgesics than those who underwent medial unilateral UKA. METHODS: A prospective case-control study was undertaken involving 148 patients (74 one-stage medial bilateral vs 74 medial unilateral Oxford UKA). The primary outcome was evaluation of the postoperative total consumption of analgesics from 0 to 72 hours. Next, the postoperative evolution of pain scores and functional recovery were assessed. Oxford Knee Scores were assessed preoperatively at 6 and 12 months with the occurrence of clinical or radiological complications. Finally, patient satisfaction was evaluated at the final follow-up. RESULTS: The cumulative sums of analgesic consumption (0-72 hours) calculated in the morphine equivalent dose were 21.61 ± 3.70 and 19.11 ± 3.12 mg in the patient and control groups, respectively (P = .30). Moreover, there were no significant differences in terms of pain scores (P = .45), functional recovery (P = .59, .34), length of stay (P = .18), Oxford Knee Scores (P = .68, .60), complications (P = .50), patient satisfaction (P = .66), or recommendations for intervention (P = .64). CONCLUSION: Patients who undergo one-stage medial bilateral UKA do not experience more pain and do not consume more analgesics than those who undergo medial unilateral UKA. A bilateral procedure is not associated with a lower recovery or a higher rate of complications, as functional outcomes at 6 and 12 months are similar to those of unilateral management.

Navigated total knee arthroplasty: Retrospective study of 600 continuous cases.

INTRODUCTION: Computer-assisted navigation in total knee arthroplasty (TKA) has existed for more than 20 years, although its use has been marginal. Its benefits are still largely debated, especially its efficacy for achieving the desired postoperative alignment. HYPOTHESIS: A neutral hip-knee-ankle (HKA) angle (180°±3°) will be achieved in at least 85% of cases and there will be no difference between the different types of navigation systems used. MATERIAL AND METHODS: In this retrospective, single-center, single-surgeon study, all the TKAs completed between September 2003 and December 2017 were included, giving a total of 753 navigated TKAs: Navitrack group: 196 Natural Knee II implants (Zimmer) with the Navitrack-OS Knee system (Zimmer CAS); Brainlab group: 557 implants (196 Profix, Smith & Nephew and 361 LCS, DePuy) with the Brainlab Vector Vision system. The aim of navigation was independent of the preoperative alignment and was always to achieve a neutral HKA mechanical axis (180°±3°). The primary endpoint was the postoperative HKA angle. This parameter was used to determine whether the navigation objective was achieved, to define how many patients were outliers and to compare navigation systems to each other. The potential influence of sex, body mass index (BMI) and preoperative deformity were secondary aims. Lastly, the final navigation values were compared to radiological data to detect any potential deviations. RESULTS: We analyzed 600 of the cases, 160 in the Navitrack group and 440 in the Brainlab group (152 Profix and 288 LCS). A neutral HKA angle was found in 91% patients: 93% for the Navitrack group and 90% in the Brainlab group (90.8% Profix and 89.6% LCS). There was no significant difference between groups (p=0.68), nor between subgroups (p=0.85). An elevated BMI negatively influenced the ability to achieve a neutral HKA (p=0.015), regardless of the system used. CONCLUSION: In our study of 600 TKA cases done with navigation, the postoperative alignment goal (HKA 180°±3°) was achieved in 91% of cases. There was no difference between navigation systems. Patients with a high BMI were more likely to be outliers (p=0.015). LEVEL OF EVIDENCE: IV.

The Lefèvre retentive cup compared with the dual mobility cup in total hip arthroplasty revision for dislocation.

BACKGROUND: Limiting the risk of dislocation is one of the main aims of both dual mobility and Lefèvre retentive cups. However, these devices have never been compared. The goal of our study was to compare these devices in total hip arthroplasty revisions for instability. The judgement criterion was non-recurrence of dislocation in a follow-up period of eight years. METHODS: This retrospective case-control study compared two continuous paired series of total hip arthroplasty revisions for instability. These series included 63 patients and 159 patients with implantation of a Lefèvre retentive cup and a dual mobility cup, respectively. RESULTS: The success rate at eight years (i.e., no recurrence) was 91 ± 0.05% and 95 ± 0.02% in the Lefèvre retentive cup and dual mobility groups, respectively. The difference was not statistically significant (p = 0.6). CONCLUSION: It seems that the Lefèvre retentive cup provides comparable outcomes with the dual mobility cup in the total hip arthroplasty revisions for instability, avoiding recurrence in long term.

New Instrumentation Improves Patient Satisfaction and Component Positioning for Mobile-Bearing Medial Unicompartmental Knee Replacement.

BACKGROUND: The Oxford unicompartmental knee replacement (OUKR) has achieved excellent functional outcomes and long term survivorship in many single center and single surgeon series. However, in national registries, the failure rates are up to three times higher than total knee replacement. This is at least in part due to difficulty experienced by low-volume surgeons in implanting the prosthesis accurately. A new instrumentation system (Microplasty) was introduced to help surgeons achieve better component positioning, however, it is not known whether the new instruments achieve that goal. This study investigates whether the new system achieves better component positioning and whether it improves the clinical outcomes when compared to the existing instruments. MATERIALS AND METHODS: This retrospective cohort study compared 50 consecutive OUKR implanted using the conventional Phase 3 instrumentation with 100 consecutive OUKR implanted using the new Microplasty instrumentation. Component orientation was measured on postoperative radiographs, and the percentage outside the recommended range was identified. Intraoperative data and retrospectively collected clinical data were also analyzed. RESULTS: Femoral component alignment improved significantly, and there were no outliers in the Microplasty group. Although there were fewer tibial component alignment outliers with Microplasty, the difference was not significant. The intraoperative incidence of tibial recut, patient satisfaction and patient expectations was significantly better in the Microplasty group. The Oxford Knee Scores were also better with Microplasty, however, the difference was not significant. CONCLUSION: Microplasty instrumentation helps the surgeon achieve optimal component positioning and reduces the need for tibial recut. The clinical outcomes are also better with the Microplasty instrumentation.

Single-stage bilateral medial Oxford Unicompartmental Knee Arthroplasty: A case-control study of perioperative blood loss, complications and functional results.

BACKGROUND: The benefits and risks of a single-stage medial UKA remains a subject of debate because of the theoretically higher risk of complications and specifically blood loss. The aim of this study was to evaluate the perioperative blood loss, risks and the functional results of single-stage bilateral medial Oxford Unicompartmental Knee Arthroplasty (OUKA) compared to a standard unilateral medial OUKA procedure (control group). HYPOTHESIS: The blood loss observed during bilateral single-stage medial Oxford UKA is not different from that of the control group. METHODS: In this case-control prospective study, fifty patients (100 knees) who underwent single-stage bilateral medial OUKA (study group) were compared to a hundred patients (100 knees) with unilateral medial OUKA (control group), performed by the same surgeon. The real blood loss (in mL of hematocrit at 100%), incidence of blood transfusions, and complication rates were compared. Clinical results were assessed at 6 month and at a two-year minimum follow-up (FU) using IKS, KOOS and OKS scores, in addition to a satisfaction questionnaire. RESULTS: Groups were deemed comparable. Concerning blood loss, no significant difference was observed compared to the control group (465mL±225 vs. 396±190; p=0.07). No difference was found, either, between groups regarding the complication rates (p=0.36), nor the clinical results (p=0.61) and patient satisfaction (p=0.23) at last FU. CONCLUSION: Single-stage bilateral procedure does not cause increased blood loss compared with controls. Moreover, clinical results were deemed good and excellent in spite of a slightly greater complication rate than those found in the literature but similar to controls. LEVEL OF EVIDENCE: Case-control study, level III.

Safety and Efficacy of Advanced Bipolar Vessel Sealing in Vaginal Hysterectomy: 1000 Cases.

STUDY OBJECTIVE: To determine the safety and efficacy of advanced electrothermal bipolar vessel sealing (EBVS) during vaginal hysterectomy by evaluating urinary complications, overall complications, and reoperation rate. DESIGN: A retrospective cohort (Canadian Task Force classification III). SETTING: High-volume gynecologic surgeon practice, private hospital. PATIENTS: One thousand consecutive patients who have undergone vaginal hysterectomy for benign conditions carried out with EBVS between January 2002 and December 2012. INTERVENTIONS: Vaginal hysterectomy performed using an EBVS device. MEASUREMENTS AND MAIN RESULTS: One thousand consecutive patients underwent vaginal hysterectomy with advanced EBVS between January 2002 and December 2012 with an average age of 51.4 ± 8.9 years (range, 31-88) and mean weight and body mass index of 57.4 ± 7.2 kg (range, 42-105) and 25.8 ± 4.2 kg/m2 (range, 19.1-38.9), respectively. Eighty-five percent of patients (852/1000) were healthy without any severe systemic disease. A single experienced surgeon performed all vaginal hysterectomies with EBVS, specifically by not applying traction during thermofusion to avoid hemorrhage, amputating the cervix to transform the uterus to an apple shape to facilitate a vaginal approach and rotation of the uterus, and placing bi-clamp forceps on the edge of the uterus and not at a 45- or 90-degree angle. Wound closure was completed with a continuous suture. Eleven urinary complications (1.1%) were recorded (10 bladder mechanical injuries and 1 vesicovaginal fistula). This was not statistically different from the rate of .64% previously reported in the FINHYST study (p = .15). The overall rate of complications was 5.3%, and 20 patients (2.0%) required reoperation. The presence of uterine scar tissue (odds ratio, 5.5; 95% confidence interval, 1.6-19.2) and larger uterus size (odds ratio, 2.5; 95% confidence interval, 1.01-19.2) were associated with a higher risk of urinary complications. CONCLUSION: The use of EBVS during vaginal hysterectomy results in urinary and overall complication rates of 1.1% and 5.3%, respectively, statistically similar to previously reported series that did not use EBVS. The use of advanced EBVS is a safe and effective method of achieving hemostasis during vaginal hysterectomy.

Midterm Survivorship of the Lefèvre Constrained Liner: A Consecutive Multisurgeon Series of 166 Cases.

BACKGROUND: Constrained liners are used as part of a salvage procedure to provide stability for patients at high risk for dislocation after a total hip arthroplasty. However, no recent studies exist highlighting their effectiveness and/or limitations. METHOD: This prospective review included 166 consecutive hip arthroplasties, either primary (27%) or revision (73%), with a unique design of a constrained liner: Lefèvre retentive cup. There were 113 females (69%), and the average age at index surgery was 75.9 years (range, 35-94). The mean follow-up was 6.2 years (range, 0.3-11). RESULTS: Twenty patients had a reoperation; 10 for infection (4 acute and 6 chronic joint infection) and 10 for cup failure (5 fixation failure, 3 aseptic loosening, and 2 dislocation). Ten-year survivals for cup revision were 89% (CI, 83-94) and 92% (CI, 89-97) for all revision and revision for noninfectious reasons, respectively. When solely evaluating for dislocation, the survival at 10 years was 99% (CI, 97-100). Considering primary and revision cases, 10-year survivals cup revision for aseptic reasons were 92.4% (CI, 84-100) and 92.5% (CI, 87-98), respectively. CONCLUSIONS: The Lefèvre retentive cup demonstrated excellent 10-year's survivorship. With the rate of aseptic loosening around 2% and a dislocation rate around 1%, the cup is as effective as other available devices and is therefore a cost-effective tool to reduce the risk of dislocation in at-risk patients undergoing hip arthroplasty.

Joint line level in revision total knee replacement: assessment and functional results with an average of seven years follow-up.

INTRODUCTION: It has been shown that the distance between the joint line (JL) and the fibular head is constant in both knees in a given individual. We analysed the influence of the JL level difference between the revised knee and the native knee from the functional outcomes after TKR revision. METHODS: This multicentre study assessed retrospectively a consecutive series of 177 revised total knee replacements. Patients with contralateral knees that had undergone previous major surgery or trauma were excluded. The JL level difference between both knees was measured on Knee's AP standing X-rays and compared to the KSS Knee and Function scores at the final follow-up. RESULTS: Eighty-five cases were analysed at a mean of seven years follow-up. There was a significant increase in KSS Knee and Function scores after surgery. The average elevation of the JL was 2.2 mm (s.d. 2.66 mm) compared with the healthy contralateral knee. When the JL was elevated more than 4 mm this correlated with a decreased KSS Function score and decreased post-operative knee flexion. CONCLUSIONS: Poorer functional results are significantly associated with an elevation in the JL compared to the contralateral healthy knee. In those patients with a suitable contralateral knee the JL level to restore can be assessed by the distance between the femoral condyle and the apex of the fibular head of the contralateral knee.

Third-generation autologous chondrocyte implantation versus mosaicplasty for knee cartilage injury: 2-year randomized trial.

Numerous surgical techniques have been developed to treat osteochondral defects of the knee. A study reported encouraging outcomes of third-generation autologous chondrocyte implantation achieved using the solid agarose-alginate scaffold Cartipatch®. Whether this scaffold is better than conventional techniques remains unclear. This multicenter randomized controlled trial compared 2-year functional outcomes (IKDC score) after Cartipatch® versus mosaicplasty in patients with isolated symptomatic femoral chondral defects (ICRS III and IV) measuring 2.5-7.5 cm(2) . In addition, a histological evaluation based on the O'Driscoll score was performed after 2 years. We needed 76 patients to demonstrate an at least 10-point subjective IKDC score difference with α = 5% and 90% power. During the enrolment period, we were able to include 55 patients, 30 of them were allocated at random to Cartipatch® and 25 to mosaicplasty. After 2 years, eight patients had been lost to follow-up, six in the Cartipatch® group, and two in the mosaicplasty group. The baseline characteristics of the two groups were not significantly different. The mean IKDC score and score improvement after 2 years were respectively 73.7 ± 20.1 and 31.8 ± 20.8 with Cartipatch® and 81.5 ± 16.4 and 44.4 ± 15.2 with mosaicplasty. The 12.6-point absolute difference in favor of mosaicplasty is statistically significant. Twelve adverse events were recorded in the Cartipatch® group against six in the mosaicplasty group. After 2 years, functional outcomes were significantly worse after Cartipatch® treatment compared to mosaicplasty for isolated focal osteochondral defects of the femur.

Biphasic calcium phosphate microparticles for bone formation: benefits of combination with blood clot.

Particulate forms of biphasic calcium phosphate (BCP) biomaterials below 500 µm are promising bone substitutes that provide with interconnected open porosity allowing free circulation of fluids and cells. Dispersion of the particles in the surrounding tissues at the time of implantation is a major drawback preventing from an easy use. We have asked whether blood clot could be a convenient natural hydrogel for handling BCP microparticles, and we hypothesized that blood clot might also confer osteoinductive properties to these particles. We show here that blood clotted around BCP microparticles constitutes a cohesive, moldable, and adaptable biomaterial that can be easily implanted in subcutaneous sites but also inserted and maintained in segmental bone defects, conversely to BCP microparticles alone. Moreover, implantation in bony and ectopic sites revealed that this composite biomaterial has osteogenic properties. It is able to repair a 6-mm critical femoral defect in rat and induced woven bone formation after subcutaneous implantation. Parameters such as particle size and loading into the clot are critical for its osteogenic properties. In conclusion, this blood/BCP microparticle composite is a moldable and osteoinductive biomaterial that could be used for bone defect filling in dental and orthopedic surgery.

Polypropylene as a reinforcement in pelvic surgery is not inert: comparative analysis of 100 explants.

INTRODUCTION AND HYPOTHESIS: Currently, most implants used for reinforcement in surgical treatment of pelvic floor disorders are knitted monofilament polypropylene (PP). While previously recognized as inert, PP is associated with high complication rates. Some recent literature suggests polyester prosthetics based on poly(ethylene terephthalate) (PET), which may be more inert in vivo. METHODS: A sample of 100 implants explanted from patients due to complications was examined to evaluate the relative degradation characteristics of PP and PET prosthetics. Histological, microscopic (scanning electron microscopy, SEM) and chemical analysis (Fourier transform infrared (FTIR) spectroscopy and differential scanning calorimetry (DSC)) were conducted on these explants. RESULTS: Poly(ethylene terephtahlate) explants appeared to sustain less degradation in vivo than the PP explants observed in this cohort. CONCLUSIONS: This is the first study to evaluate synthetic implants used in a vaginal approach for pelvic floor reinforcement. The study provides evidence contrary to published literature characterizing PP as inert in such applications. Additionally, the study suggests the need for clinical trials comparatively investigating the performance of new types of monofilament prosthetics, such as those comprising PET.