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The Bone & Joint Journal May 2024Obtaining solid implant fixation is crucial in revision total knee arthroplasty (rTKA) to avoid aseptic loosening, a major reason for re-revision. This study aims to...
AIMS
Obtaining solid implant fixation is crucial in revision total knee arthroplasty (rTKA) to avoid aseptic loosening, a major reason for re-revision. This study aims to validate a novel grading system that quantifies implant fixation across three anatomical zones (epiphysis, metaphysis, diaphysis).
METHODS
Based on pre-, intra-, and postoperative assessments, the novel grading system allocates a quantitative score (0, 0.5, or 1 point) for the quality of fixation achieved in each anatomical zone. The criteria used by the algorithm to assign the score include the bone quality, the size of the bone defect, and the type of fixation used. A consecutive cohort of 245 patients undergoing rTKA from 2012 to 2018 were evaluated using the current novel scoring system and followed prospectively. In addition, 100 first-time revision cases were assessed radiologically from the original cohort and graded by three observers to evaluate the intra- and inter-rater reliability of the novel radiological grading system.
RESULTS
At a mean follow-up of 90 months (64 to 130), only two out of 245 cases failed due to aseptic loosening. Intraoperative grading yielded mean scores of 1.87 (95% confidence interval (CI) 1.82 to 1.92) for the femur and 1.96 (95% CI 1.92 to 2.0) for the tibia. Only 3.7% of femoral and 1.7% of tibial reconstructions fell below the 1.5-point threshold, which included the two cases of aseptic loosening. Interobserver reliability for postoperative radiological grading was 0.97 for the femur and 0.85 for the tibia.
CONCLUSION
A minimum score of 1.5 points for each skeletal segment appears to be a reasonable cut-off to define sufficient fixation in rTKA. There were no revisions for aseptic loosening at mid-term follow-up when this fixation threshold was achieved or exceeded. When assessing first-time revisions, this novel grading system has shown excellent intra- and interobserver reliability.
Topics: Humans; Arthroplasty, Replacement, Knee; Reoperation; Female; Male; Knee Prosthesis; Aged; Middle Aged; Prosthesis Failure; Aged, 80 and over; Reproducibility of Results; Prospective Studies; Femur; Tibia; Follow-Up Studies
PubMed: 38688505
DOI: 10.1302/0301-620X.106B5.BJJ-2023-0944.R1 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Apr 2024Bone infarction has a low incidence in clinical practice and mostly occurs in the metaphysis and diaphysis.Few studies report the advanced imaging technique for bone...
Bone infarction has a low incidence in clinical practice and mostly occurs in the metaphysis and diaphysis.Few studies report the advanced imaging technique for bone infarction.Here we reported the fast field echo resembling a CT using restricted echo-spacing and calcium-suppressed spectral CT imaging for a case of multifocal bone infarcts in both lower extremities,aiming to provide diagnostic experience for clinical practice.
Topics: Humans; Male; Calcium; Infarction; Lower Extremity; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Adult
PubMed: 38686729
DOI: 10.3881/j.issn.1000-503X.15724 -
Zhonghua Yi Xue Yi Chuan Xue Za Zhi =... May 2024To explore the clinical features and genetic etiology of a child with SPONASTRIME dysplasia (SD).
OBJECTIVE
To explore the clinical features and genetic etiology of a child with SPONASTRIME dysplasia (SD).
METHODS
A 9-month-old female who had presented at the Linyi People's Hospital in August 2022 for short stature was selected as the study subject. Clinical data of the child were collected, and whole exome sequencing (WES) was carried out. Sanger sequencing was used for validating the candidate variants.
RESULTS
The child has manifested short stature, mid-face hypoplasia, joint laxity, internal knee rotation, irregularities in the metaphysis of long bones, and flat and concave lumbar vertebrae. WES revealed that she has harbored compound heterozygous variants of the TONSL gene, namely c.3088G>T (p.Glu1030*) and c.3053G>A (p.Arg1018His), which were inherited from her phenotypically normal parents. Neither variant was reported previously. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the c.3088G>T variant was classified as likely pathogenic (PVS1+PM2_Supporting), whilst the c.3053G>A was classified as a variant of uncertain significance (PM2_Supporting+PM3+PP3).
CONCLUSION
The c.3088G>T and c.3053G>A compound heterozygous variants of the TONSL gene probably underlay the pathogenesis in this patient. Above finding has facilitated the clinical diagnosis and genetic counseling for her family.
Topics: Humans; Female; Heterozygote; Infant; Exome Sequencing; Mutation; Dwarfism; Phenotype; Matrilin Proteins
PubMed: 38684304
DOI: 10.3760/cma.j.cn511374-20230426-00244 -
Scandinavian Journal of Medicine &... May 2024Osgood-Schlatter disease (OSD) is the most common knee pain complaint among adolescents playing sports. Despite this, there remains controversy over the pathophysiology...
A comprehensive MRI investigation to identify potential biomarkers of Osgood Schlatter disease in adolescents: A cross sectional study comparing Osgood Schlatter disease with controls.
BACKGROUND
Osgood-Schlatter disease (OSD) is the most common knee pain complaint among adolescents playing sports. Despite this, there remains controversy over the pathophysiology and whether specific anatomical characteristics are associated with OSD.
PURPOSE
This study aimed to systematically and comprehensively characterize adolescents with OSD using magnetic resonance imaging (MRI) compared to pain-free controls, including both tissue abnormalities that may be associated with OSD, as well as anatomical characteristics. A secondary objective was to identify potential imaging biomarkers associated with pain.
STUDY DESIGN
Cross-sectional study.
METHODS
Adolescents with OSD and controls were recruited from 2020 to 2022. Following a clinical exam, demographics, pain, sports participation, and Tanner stage were collected. Knee MRI was conducted on the participants' most symptomatic knee (OSD) or the dominant leg (controls).
RESULTS
Sixty-seven adolescents (46 with OSD and 30 controls) were included. 80% of participants with OSD had at least one tissue alteration compared to 54% of controls. Compared to controls, OSD had 36.3 (95%CI 4.5 to 289.7) higher odds of bony oedema at the tibial tuberosity, and 32.7 (95%CI 4.1 to 260.6) and 5.3 (95%CI 0.6 to 46.2) higher odds of bony oedema at the tibial epiphysis and metaphysis respectively. Participants with OSD also had higher odds of fluid/oedema at the patellar tendon (12.3 95%CI 3.3 to 46.6), and superficial infrapatellar bursitis (7.2). Participants with OSD had a more proximal tendon attachment (mean tibial attachment portion difference, -0.05, 95% CI: -0.1 to 0.0, p = 0.02), tendon thickness (proximal mean difference, -0.09, 95% CI: -0.4 to 0.2, p = 0.04; distal mean difference, -0.6, 95% CI: -0.9 to -0.2, p = 0.01). Those with bony/tendon oedema had 1.8 points (95% CI: 0.3 to 3.2) higher pain on palpation than those without (t = -2.5, df = 26.6, p = 0.019), but there was no difference between these groups in a functional single leg pain provocation.
CONCLUSION
Adolescents with OSD present with tissue and structural abnormalities on MRI that differed from age-matched controls. The majority had findings in the patellar tendon and bone, which often co-occurred. However, a small proportion of OSD also presents without alterations. It appears these findings may be associated with clinical OSD-related pain on palpation of the tibial tuberosity.
CLINICAL RELEVANCE
Our highlight the pathophysiology on imaging, which has implications for understanding the mechanism and treatment of OSD.
Topics: Humans; Cross-Sectional Studies; Magnetic Resonance Imaging; Adolescent; Male; Female; Osteochondrosis; Biomarkers; Knee Joint; Case-Control Studies; Edema; Tibia; Child
PubMed: 38682790
DOI: 10.1111/sms.14634 -
Bone Reports Jun 2024Osteoporosis occurs in every third individual after simultaneous pancreas kidney transplantation (SPKT). Currently used bone measures insufficiently predict their...
Osteoporosis occurs in every third individual after simultaneous pancreas kidney transplantation (SPKT). Currently used bone measures insufficiently predict their fracture risk. Lumbar spine Trabecular bone score (TBS) and distal radius areal and volumetric bone mineral density (BMD) were monitored for the first time in patients with type 1 diabetes and chronic renal failure after SPKT with steroid-sparing protocol. In 33 subjects (mean age 43.4 ± 9.8 years), dual-energy X-ray absorptiometry and peripheral quantitative computed tomography were performed just after SPKT (baseline) and one and three years later. While TBS -scores increased (-1.1 ± 1.2 and -0.3 ± 1.0; p˂0.001, at baseline and year three, respectively), trabecular volumetric BMD -scores at distal radius metaphysis did not change during the study (-1.3 ± 1.3 and -1.3 ± 1.0; = 0.38). Similarly, areal BMD -scores increased at lumbar spine, total hip and femoral neck (all < 0.01), but not at the distal radius. SPKT induced bone measures' improvement at lumbar spine and hip but not at distal radius. Before suggesting changes in current clinical care, predictive value of individual bone measures or its combination for fracture risk assessment remains to be elucidated.
PubMed: 38681747
DOI: 10.1016/j.bonr.2024.101764 -
Emergency Radiology Jun 2024The diagnosis of an osteochondroma in the short bones of the extremities is atypical and the presentation in infancy is unusual. A 3-month-old female presented for...
The diagnosis of an osteochondroma in the short bones of the extremities is atypical and the presentation in infancy is unusual. A 3-month-old female presented for evaluation of radial deviation of the right index finger present since birth. Radiographs showed a broad-based osseous outgrowth with the usual features of an osteochondroma arising from the base of middle phalanx. Initial corrective surgery at 22 months was followed by recurrence of the lesion. Another resection at 4 years confirmed a final diagnosis of BPOP (bizarre parosteal osteochondromatous proliferation). The subsequent pathologic diagnosis of BPOP appears to support the hypotheses concerning the etiology of BPOP as possibly arising from repeated trauma to the metaphysis.
Topics: Humans; Female; Osteochondroma; Infant; Bone Neoplasms; Radiography; Diagnosis, Differential
PubMed: 38652206
DOI: 10.1007/s10140-024-02231-3 -
Journal of Orthopaedic Research :... Apr 2024Immobilization-induced skeletal unloading results in muscle atrophy and rapid bone loss, thereby increasing the risk of falling and the need for implant therapy in...
Immobilization-induced skeletal unloading results in muscle atrophy and rapid bone loss, thereby increasing the risk of falling and the need for implant therapy in patients with extended bed rest or neuromuscular injuries. Skeletal unloading causes bone loss by altering bone growth and resorption, suggesting that implant performance might be affected. To test this, we focused on early events in implant osseointegration. We used the rat sciatic neurectomy-induced disuse model under two different settings. In Study 1, 16 Sprague Dawley rats (SD) were separated into control, sham operated+cast immobilization, and sciatic neurectomy+casting groups; titanium implants with multiscale microtextured topography and hydrophilic chemistry (modSLA) were inserted in the distal femoral metaphysis. Neurectomy surgeries and casting were performed at the same surgical setting as implant placement; rats were euthanized 4 weeks post-implantation. In Study 2, we established the unloaded condition before implantation. A total of 12 SD rats were divided into control and sciatic+femoral neurectomy groups. A total of 24 days after sciatic and femoral neurectomy surgery, rats received implants. Study 2 rats were euthanized at 4 weeks post-implantation. MicroCT and histomorphometry showed that trabecular bone and osseointegration were reduced when disuse was established before implantation. Osteoblasts isolated from Study 1 sciatic neurectomy tibial bones exhibited impaired differentiation on modSLA culture disks, revealing a possible mechanism responsible for the decreased osseointegration observed in the Study 2 rats. This study addressed the importance of considering the mechanical unloading and muscle function history before implant insertion and suggests that implant performance was reduced due to poor cellular ability to regenerate.
PubMed: 38644051
DOI: 10.1002/jor.25843 -
Effect of bone density on the drill-hole diameter made by a cannulated drill bit in cancellous bone.Journal of Orthopaedic Science :... Apr 2024When a pilot hole is made prior to a screw's insertion into bone, the same drill bit is used irrespective of the bone quality. However, osteoporotic bone is fragile and...
BACKGROUND
When a pilot hole is made prior to a screw's insertion into bone, the same drill bit is used irrespective of the bone quality. However, osteoporotic bone is fragile and this may affect the hole diameter, which is of particular concern in cancellous bone. In this study, the relationship between bone density and drill-hole diameter was investigated assuming a pre-drilling process in screw-only osteosynthesis in the metaphysis and epiphysis.
METHODS
Two types of drill bit (triple-flute [T] and quadruple-flute [Q]) with different shapes and diameters were prepared: type T bits with 3.5 mm and 4.4 mm diameters, and type Q bits with 3.5 mm and 4.2 mm diameters. Drilling was performed manually in simulated bones with four densities: 5, 10, 15, and 20 pounds per cubic foot. We measured the hole diameters with a coordinate measuring machine and analyzed the relationship between the drill-hole diameters and the densities of the simulated bones. We then compared the screw pull-out strength between the two 3.5-diameter drill bits.
RESULTS
In all cases, the diameters of the drill holes were larger than those of the drill bits. The relationship between the drill-hole diameters and the bone densities was a negative linear correlation. Enlarging the hole diameter decreased the screw pull-out strength.
CONCLUSIONS
For cannulated drill bits of 3.5, 4.2 and 4.4 mm diameter, the diameter of the drill hole in cancellous bone obtained by the manual drilling technique tends to be larger in low-density (e.g., osteoporotic) compared to high-density (e.g., healthy) bone.
PubMed: 38637192
DOI: 10.1016/j.jos.2024.04.001 -
Cureus Mar 2024Osteosarcoma is a malignant mesenchymal tumour. This primarily manifests in the formation of immature osteoid cells by tumour cells. Osteosarcoma is the most common...
Osteosarcoma is a malignant mesenchymal tumour. This primarily manifests in the formation of immature osteoid cells by tumour cells. Osteosarcoma is the most common primary bone tumour in children and adolescents. It tends to occur in the metaphysis of long shafts, shows osteoblastic differentiation, and produces malignant osteoid material. We present the case of a 17-year-old male who presented to our clinic who had left knee pain for a few days. An initial radiograph of the knee joint revealed a lytic lesion in the proximal tibia and further imaging was advised. During a follow-up visit, the patient had worsening pain and had a computerized tomography scan of the left knee, confirming osteosarcoma on the lateral side of the left tibia. He was referred to the orthopaedic department, where a biopsy was performed, to confirm the diagnosis of osteosarcoma. The patient was commenced on chemotherapy due to metastatic disease and has so far tolerated therapy well.
PubMed: 38633972
DOI: 10.7759/cureus.56366 -
International Journal of Implant... Apr 2024Osteoporotic individuals who have dental implants usually require a prolonged healing time for osseointegration due to the shortage of bone mass and the lack of initial...
PURPOSE
Osteoporotic individuals who have dental implants usually require a prolonged healing time for osseointegration due to the shortage of bone mass and the lack of initial stability. Although studies have shown that intermittent teriparatide administration can promote osseointegration, there is little data to support the idea that pre-implantation administration is necessary and beneficial.
METHODS
Sixty-four titanium implants were placed in the bilateral proximal tibial metaphysis in 32 female SD rats. Bilateral ovariectomy (OVX) was used to induce osteoporosis. Four major groups (n = 8) were created: PRE (OVX + pre-implantation teriparatide administration), POST (OVX + post-implantation administration), OP (OVX + normal saline (NS)) and SHAM (sham rats + NS). Half of rats (n = 4) in each group were euthanized respectively at 4 weeks or 8 weeks after implantation surgery, and four major groups were divided into eight subgroups (PRE4 to SHAM8). Tibiae were collected for micro-CT morphometry, biomechanical test and undecalcified sections analysis.
RESULTS
Compared to OP group, rats in PRE and SHAM groups had a higher value of insertion torque (p < 0.05). The micro-CT analysis, biomechanical test, and histological data showed that peri-implant trabecular growth, implants fixation and bone-implant contact (BIC) were increased after 4 or 8 weeks of teriparatide treatment (p < 0.05). There was no statistically difference in those parameters between PRE4 and POST8 subgroups (p > 0.05).
CONCLUSIONS
In osteoporotic rats, post-implantation administration of teriparatide enhanced peri-implant bone formation and this effect was stronger as the medicine was taken longer. Pre-implantation teriparatide treatment improved primary implant stability and accelerated the osseointegration process.
Topics: Female; Animals; Rats; Rats, Sprague-Dawley; Teriparatide; Osseointegration; Dental Implants; Embryo Implantation; Saline Solution
PubMed: 38625587
DOI: 10.1186/s40729-024-00536-z