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World Journal of Orthopedics Jun 2024Dual mobility (DM) bearings have gained significant attention in the field of total hip arthroplasty (THA) as a valid treatment option in cases of revision for... (Review)
Review
Dual mobility (DM) bearings have gained significant attention in the field of total hip arthroplasty (THA) as a valid treatment option in cases of revision for instability after THA whereas its use in primary THA is still a matter of debate. This manuscript explores the pathology, incidence, diagnosis, treatment options, prognosis, ongoing studies in the literature, and future perspectives related to the use of DM bearings employed in primary THA. DM bearings are primarily designed to address one of the major concerns in THA: Instability of the prosthetic hip. Instability is both for the surgeon and the patient a devastating postoperative complication, leading to significant pain and subsequent apprehension by the patient and may require revision surgeries. The use of DM implants poses the worry of wear-related complications, such as accelerated polyethylene wear and osteolysis, which also pose challenges to long-term implant survival. This technique has seen a steady rise in recent years, with multiple studies reporting favorable outcomes. The incidence of their utilization varies among institutions and surgeons, reflecting differing preferences and patient populations. The diagnosis of instability and wear-related complications in THA often involves clinical assessment, imaging modalities such as X-rays, computed tomography scans, and sometimes advanced imaging techniques like magnetic resonance imaging. DM bearings can be considered as an option when patients present neurologic pathologies such as Parkinson's disease or recurrent dislocations after THA. DM bearings provide an additional articulation point within the implant, facilitating a greater range of motion and inherent stability. This design allows for reduced risk of dislocation and improved functional outcomes. Various implant manufacturers offer different designs and sizes of DM bearings to suit individual patient needs. Current literature suggests that the use of DM bearings in primary THA has demonstrated promising outcomes in terms of enhanced stability, reduced dislocation rates, and improved patient satisfaction. However, long-term studies with larger patient cohorts are necessary to establish the durability and longevity of these implants. Several ongoing studies are investigating the role of DM bearings in primary THA. These studies focus on evaluating long-term implant survivorship, assessing wear patterns, analyzing patient-reported outcomes, and comparing the effectiveness of DM bearings with traditional THA designs. The future of DM bearings in primary THA holds potential for further advancements. Research efforts are aimed at refining implant materials, optimizing designs, and studying the influence of surgical techniques on implant performance. Additionally, continued investigation into the long-term outcomes and cost-effectiveness of DM bearings will play a crucial role in shaping their future use. While further research is warranted, the current evidence supports their potential as a beneficial solution in improving surgical outcomes and patient satisfaction.
PubMed: 38947268
DOI: 10.5312/wjo.v15.i6.512 -
Arthroplasty Today Jun 2024Mild ligament imbalance is often encountered in the mediolateral plane during complex primary total knee arthroplasty. A constrained (CP) polyethylene insert compatible...
PURPOSE
Mild ligament imbalance is often encountered in the mediolateral plane during complex primary total knee arthroplasty. A constrained (CP) polyethylene insert compatible with the primary femur is useful to manage these cases without the need to fall back on revision implants. The aim of the study was to define the correct indications of the use of a CP insert based on objective data from computer assisted surgery and to compare the early results of a CP insert with a standard posterior stabilized (PS) insert through one-to-one propensity score matching.
METHODS
This is a retrospective case study from a prospectively collected database. One-to-one matching without replacement was used with a caliper width of 0.2 to match the scores between CP (N = 64) and PS groups (N = 1624), resulting in equal covariate matching of PS (N = 64) and CP (N = 64) cohorts. Patients were assessed radiographically and functionally at a minimum follow-up of 3 years.
RESULT
Average coronal and sagittal plane deformities were similar in both the group CP (varus 13.1 ± 5.2 valgus 13 ± 7.9) and the group PS (varus 13.4 ± 4.6 valgus 10.9 ± 8.6). The average residual medial lateral gap difference was significantly higher in group CP (3.8 ± 1.8) in comparison to group PS (1.3 ± 1) ( < .05). A CP insert was chosen where mild ligament imbalance of 3-5 mm persisted after medial soft tissue releases in a varus knee and in cases with residual medial collateral ligament laxity in valgus knees.
CONCLUSIONS
Constrained insert used with the primary femoral component is a valuable option to handle mild ligamentous instability in complex primary total knee arthroplasty after mechanical alignment is achieved with computer navigation.
LEVEL OF EVIDENCE
III.
PubMed: 38946924
DOI: 10.1016/j.artd.2024.101423 -
Arthroplasty Today Jun 2024Immunoglobulin A (IgA) nephropathy in the presence of a metal-on-metal (MoM) hip arthroplasty is a rare condition that requires close monitoring. A 61-year-old male with...
Immunoglobulin A (IgA) nephropathy in the presence of a metal-on-metal (MoM) hip arthroplasty is a rare condition that requires close monitoring. A 61-year-old male with bilateral hip osteoarthritis underwent resurfacing hip arthroplasty with MoM articulating surfaces. Prior to his four-year postoperative visit, the patient was diagnosed with IgA nephropathy. During this visit, the patient reported clicking in the left resurfacing hip arthroplasty, and serum metal ions were significantly elevated. Consequently, the patient underwent conversion to bilateral ceramic-on-cross-linked polyethylene total hip arthroplasty, which resulted in the restoration of metal ion levels to normal. This case highlights that IgA nephropathy played a critical role in impeding the clearance of metal ions. Routine metal ion counts are warranted in patients with MoM articulating interfaces and a newly diagnosed nephropathy.
PubMed: 38946922
DOI: 10.1016/j.artd.2024.101407 -
International Journal of Nanomedicine 2024Mitochondrial oxidative stress is an important factor in cell apoptosis. Cerium oxide nanomaterials show great potential for scavenging free radicals and simulating...
PURPOSE
Mitochondrial oxidative stress is an important factor in cell apoptosis. Cerium oxide nanomaterials show great potential for scavenging free radicals and simulating superoxide dismutase (SOD) and catalase (CAT) activities. To solve the problem of poor targeting of cerium oxide nanomaterials, we designed albumin-cerium oxide nanoclusters (TPP-PCNLs) that target the modification of mitochondria with triphenyl phosphate (TPP). TPP-PCNLs are expected to simulate the activity of superoxide dismutase, continuously remove reactive oxygen species, and play a lasting role in radiation protection.
METHODS
First, cerium dioxide nanoclusters (CNLs), polyethylene glycol cerium dioxide nanoclusters (PCNLs), and TPP-PCNLs were characterized in terms of their morphology and size, ultraviolet spectrum, dispersion stability and cellular uptake, and colocalization Subsequently, the anti-radiation effects of TPP-PCNLs were investigated using in vitro and in vivo experiments including cell viability, apoptosis, comet assays, histopathology, and dose reduction factor (DRF).
RESULTS
TPP-PCNLs exhibited good stability and biocompatibility. In vitro experiments indicated that TPP-PCNLs could not only target mitochondria excellently but also regulate reactive oxygen species (ROS)levels in whole cells. More importantly, TPP-PCNLs improved the integrity and functionality of mitochondria in irradiated L-02 cells, thereby indirectly eliminating the continuous damage to nuclear DNA caused by mitochondrial oxidative stress. TPP-PCNLs are mainly targeted to the liver, spleen, and other extramedullary hematopoietic organs with a radiation dose reduction factor of 1.30. In vivo experiments showed that TPP-PCNLs effectively improved the survival rate, weight change, hematopoietic function of irradiated animals. Western blot experiments have confirmed that TPP-PCNLs play a role in radiation protection by regulating the mitochondrial apoptotic pathway.
CONCLUSION
TPP-PCNLs play a radiologically protective role by targeting extramedullary hematopoietic organ-liver cells and mitochondria to continuously clear ROS.
Topics: Cerium; Animals; Mitochondria; Reactive Oxygen Species; Mice; Apoptosis; Hematopoiesis; Oxidative Stress; Cell Survival; Radiation-Protective Agents; Humans; Radiation Protection; Cell Line
PubMed: 38946882
DOI: 10.2147/IJN.S459607 -
Orthopaedic Surgery Jul 2024Mobile bearing fracture is a rare long-term complication of unicompartmental knee arthroplasty (UKA), and relevant reports are sparse. Hence, its treatment options need...
BACKGROUND
Mobile bearing fracture is a rare long-term complication of unicompartmental knee arthroplasty (UKA), and relevant reports are sparse. Hence, its treatment options need further exploration.
CASE PRESENTATION
This study presents the case of fracture of a polyethylene insert that occurred 12 years after mobile bearing medial UKA in a 75-year-old overweight woman who then underwent surgical intervention at our institution. However, we encountered significant challenges in removing the fragments from the broken bearing, resulting in retention of the remaining one-third of the fragment. We solved this problem by replacing the fractured insert with thicker mobile bearing. During the 1-month postoperative follow-up, the patient achieved good range of motion and excellent satisfaction, with no reported complications and a Knee Society Score of 90. Additionally, we reviewed the literature on the treatment for mobile bearing fractures after UKA.
CONCLUSIONS
Bearing fracture is a rare cause of failure of mobile bearing UKA. This case highlights the challenges of UKA fracture bearing retrieval and underscores that mobile bearing replacement can be an effective intervention. The case we report shows that when removal of a residual meniscal bearing in a posterior dislocation is difficult to achieve, compromise may be an appropriate option because it does not cause additional complaints to the patient. This case emphasizes the importance of the surgeon having a thorough preoperative understanding of the location and potential pitfalls of fracture fragments in such situations.
PubMed: 38946660
DOI: 10.1111/os.14138 -
Journal of Indian Prosthodontic Society Jul 2024This study investigates the interaction of zirconia and polyetheretherketone (PEEK) with indirect composite in fixed dental prostheses. This investigation aimed to... (Comparative Study)
Comparative Study
Comparative evaluation of bond strength and color stability of polyetheretherketone and zirconia layered with indirect composite before and after thermocycling: An in vitro study.
AIM
This study investigates the interaction of zirconia and polyetheretherketone (PEEK) with indirect composite in fixed dental prostheses. This investigation aimed to assess the shear bond strength (SBS) and color stability of zirconia and PEEK before and after aging, addressing critical concerns in dental restorative applications.
SETTINGS AND DESIGN
The current in vitro study used 96 samples, 48 of which were divided into two groups, zirconia and PEEK, before and after thermocycling. A dual-axis chewing simulator was used for thermocycling. SBS was measured using a universal testing machine, and color stability was checked using a reflective spectrophotometer.
MATERIALS AND METHODS
Ninety-six samples were categorized into zirconia and PEEK groups, each with subgroups undergoing thermocycling. Samples were prepared using computer-aided design/computer-aided manufacturing milling and veneered with composite resin. Thermocycling involved 10,000 cycles, simulating stress levels equivalent to approximately 1 year of clinical use. SBS was assessed using standardized tests. Stereomicroscopic analysis was performed to evaluate the type of failure. Color stability of the core materials with indirect composite was done using a spectrophotometer before and after aging.
STATISTICAL ANALYSIS USED
Statistical analysis included paired t-tests and independent t-tests in SPSS software.
RESULTS
The results revealed that SBS values for composite on PEEK decreased from 13.86 ± 0.164 MPa before thermocycling to 13.46 ± 0.185 MPa after thermocycling, with a significant difference (P < 0.005). However, both pre- and postthermocycling values for PEEK were higher than zirconia. The t-test confirmed the lower bond strength of composite to zirconia, with a noteworthy improvement after aging. Stereomicroscopic images revealed adhesive failure for the zirconia group and mixed (adhesive and cohesive) failure for the PEEK group. ΔE values were 3.21 ± 0.127 and 2.93 ± 0.142 for zirconia and PEEK groups, respectively (P < 0.005).
CONCLUSION
Within the limitations of this study, it can be deduced that PEEK is a feasible substitute for zirconia when used in conjunction with indirect composite for the fabrication of dental prostheses.
Topics: Benzophenones; Zirconium; Ketones; Polyethylene Glycols; Polymers; Composite Resins; In Vitro Techniques; Dental Bonding; Color; Materials Testing; Shear Strength; Dental Materials; Dental Stress Analysis; Humans
PubMed: 38946508
DOI: 10.4103/jips.jips_36_24 -
Journal of Indian Prosthodontic Society Jul 2024Synthetic inorganic materials are commonly used as reinforcing agents in polyetheretherketone (PEEK) composite, whereas natural organic plant-based reinforcing agents... (Comparative Study)
Comparative Study
Comparative evaluation on surface nanohardness, surface microhardness, surface roughness, and wettability of plant-based organic nanoparticle reinforced polyetheretherketone as an implant material - An in vitro study.
AIM
Synthetic inorganic materials are commonly used as reinforcing agents in polyetheretherketone (PEEK) composite, whereas natural organic plant-based reinforcing agents are negligible. Surface hardness, roughness, and wettability are indicative factors of osseointegration behavior to be used as an implant material. This study evaluated micro surface hardness (MSH), nano surface hardness (NSH), surface roughness (SR), and contact angle (CA) of PEEK-Azadirachta indica reinforced at 10 wt%, 20 wt%, and 30 wt%.
SETTINGS AND DESIGN
This was an in vitro study.
MATERIALS AND METHODS
Neem (A. indica) leaf nanoparticles were prepared and reinforced with PEEK powder at 10%, 20%, and 30% weight ratios by injection molding. Sixty specimens underwent the microhardness and CA testing using a digital microhardness tester, and CA goniometer, respectively, and later nanoindentation test to analyze the nanohardness and SR.
STATISTICAL ANALYSIS USED
A one-way ANOVA test with a 95% confidence interval for MSH and NSH, SR, and CA was performed on the samples. A post hoc Bonferroni test was conducted (α = 0.05) to compare the groups.
RESULTS
There was a significant increase in nanohardness (P = 0.000) with zero difference in microhardness (P = 0.514). The addition of 10 wt%, 20 wt%, and 30 wt% nanoparticles increased the SR value of the pure PEEK from 273.19 nm to 284.10 (3.99%), 296.91 (8.68%), and 287.54 (5.24%), respectively. In the analysis of the CA, CA 20% shows the lowest angle (63.69) with the highest for control specimens (82.39). There is an increase in the PEEK composite SR with a decrease in CA.
CONCLUSIONS
The addition of plant-derived nanoparticles into the PEEK matrix has a significant impact on the hardness and hydrophobicity enhancing cell growth and osteoblastic differentiation during osseointegration of dental implants.
Topics: Benzophenones; Polyethylene Glycols; Polymers; Ketones; Nanoparticles; Surface Properties; Wettability; Hardness; In Vitro Techniques; Dental Implants; Materials Testing; Plant Leaves
PubMed: 38946507
DOI: 10.4103/jips.jips_511_23 -
Journal of Oleo Science 2024Handwashing represents an important personal hygiene measure for preventing infection. Herein, we report the persistence of antibacterial and antiviral effects after...
Handwashing represents an important personal hygiene measure for preventing infection. Herein, we report the persistence of antibacterial and antiviral effects after handwashing with fatty acid salt-based hand soap. To this end, we developed a new in vitro test method to measure persistence, utilizing coacervation formed by anionic surfactants and cationic polymers to retain highly effective soap components against each bacterium and virus on the skin. Coacervation with fatty acid salts and poly diallyldimethylammonium chloride (PDADMAC) as a cationic polymer allowed the persistence of antibacterial and antiviral effects against E. coli, S. aureus, and influenza virus even 4 h after handwashing. Furthermore, we confirmed an increase in the number of residual components effective against each bacterium and virus on the skin. In summary, the current findings describe an effective approach for enhancing the protective effects of handwashing.
Topics: Soaps; Escherichia coli; Hand Disinfection; Quaternary Ammonium Compounds; Anti-Bacterial Agents; Staphylococcus aureus; Antiviral Agents; Polyethylenes; Skin; Surface-Active Agents; Humans; Fatty Acids; Time Factors; Orthomyxoviridae
PubMed: 38945924
DOI: 10.5650/jos.ess23266 -
The Bone & Joint Journal Jul 2024Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but... (Comparative Study)
Comparative Study
AIMS
Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but the feasibility and early outcomes when using this technology for revision surgery remain unknown. The objective of this study was to compare the outcomes of robotic arm-assisted revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) versus primary robotic arm-assisted TKA at short-term follow-up.
METHODS
This prospective study included 16 patients undergoing robotic arm-assisted revision of UKA to TKA versus 35 matched patients receiving robotic arm-assisted primary TKA. In all study patients, the following data were recorded: operating time, polyethylene liner size, change in haemoglobin concentration (g/dl), length of inpatient stay, postoperative complications, and hip-knee-ankle (HKA) alignment. All procedures were performed using the principles of functional alignment. At most recent follow-up, range of motion (ROM), Forgotten Joint Score (FJS), and Oxford Knee Score (OKS) were collected. Mean follow-up time was 21 months (6 to 36).
RESULTS
There were no differences between the two treatment groups with regard to mean change in haemoglobin concentration (p = 0.477), length of stay (LOS, p = 0.172), mean polyethylene thickness (p = 0.065), or postoperative complication rates (p = 0.295). At the most recent follow-up, the primary robotic arm-assisted TKA group had a statistically significantly improved OKS compared with the revision UKA to TKA group (44.6 (SD 2.7) vs 42.3 (SD 2.5); p = 0.004) but there was no difference in the overall ROM (p = 0.056) or FJS between the two treatment groups (86.1 (SD 9.6) vs 84.1 (4.9); p = 0.439).
CONCLUSION
Robotic arm-assisted revision of UKA to TKA was associated with comparable intraoperative blood loss, early postoperative rehabilitation, functional outcomes, and complications to primary robotic TKA at short-term follow-up. Robotic arm-assisted surgery offers a safe and reproducible technique for revising failed UKA to TKA.
Topics: Humans; Arthroplasty, Replacement, Knee; Male; Female; Prospective Studies; Robotic Surgical Procedures; Aged; Middle Aged; Reoperation; Treatment Outcome; Range of Motion, Articular; Follow-Up Studies; Length of Stay; Postoperative Complications; Knee Prosthesis; Aged, 80 and over; Osteoarthritis, Knee
PubMed: 38945538
DOI: 10.1302/0301-620X.106B7.BJJ-2023-0943.R2 -
International Journal of Pharmaceutics Jun 2024Rhein, a natural anthraquinone compound derived from traditional Chinese medicine, exhibits potent anti-inflammatory properties via modulating the level of Reactive...
Rhein, a natural anthraquinone compound derived from traditional Chinese medicine, exhibits potent anti-inflammatory properties via modulating the level of Reactive oxygen or nitrogen species (RONS). Nevertheless, its limited solubility in water, brief duration of plasma presence, as well as its significant systemic toxicity, pose obstacles to its in vivo usage, necessitating the creation of a reliable drug delivery platform to circumvent these difficulties. In this study, an esterase-responsive and mitochondria-targeted nano-prodrug was synthesized by conjugating Rhein with the polyethylene glycol (PEG)-modified triphenyl phosphonium (TPP) molecule, forming TPP-PEG-RH, which could spontaneously self-assemble into RPT NPs when dispersed in aqueous media. The TPP outer layer of these nanoparticles enhances their pharmacokinetic profile, facilitates efficient delivery to mitochondria, and promotes cellular uptake, thereby enabling enhanced accumulation in mitochondria and improved therapeutic effects in vitro. The decline in RONS was observed in IL-1β-stimulated chondrocyte after RPT NPs treating. RPT NPs also exert excellent anti-inflammatory (IL-1β, TNF-α, IL-6 and MMP-13) and antioxidative effects (Cat and Sod) via the Nrf2 signalling pathway, upregulation of cartilage related genes (Col2a1 and Acan). Moreover, RPT NPs shows protection of mitochondrial membrane potential and inhibition of chondrocyte apoptosis. Moreover, These findings suggest that the mitochondria-targeted polymer-Rhein conjugate may offer a therapeutic solution for patients suffering from chronic joint disorders, by attenuating the progression of osteoarthritis (OA).
PubMed: 38945463
DOI: 10.1016/j.ijpharm.2024.124397