Macrophages Modulate the Function of MSC- and iPSC-Derived Fibroblasts in the Presence of Polyethylene Particles

Fibroblasts in the synovial membrane secrete molecules essential to forming the extracellular matrix (ECM) and supporting joint homeostasis. While evidence suggests that fibroblasts contribute to the response to joint injury, the outcomes appear to be patient-specific and dependent on interactions between resident immune cells, particularly macrophages (Mφs). On the other hand, the response of Mφs to injury depends on their functional phenotype. The goal of these studies was to further explore these issues in an in vitro 3D microtissue model that simulates a pathophysiological disease-specific microenvironment. Two sources of fibroblasts were used to assess patient-specific influences: mesenchymal stem cell (MSC)- and induced pluripotent stem cell (iPSC)-derived fibroblasts. These were co-cultured with either M1 or M2 Mφs, and the cultures were challenged with polyethylene particles coated with lipopolysaccharide (cPE) to model wear debris generated from total joint arthroplasties. Our results indicated that the fibroblast response to cPE was dependent on the source of the fibroblasts and the presence of M1 or M2 Mφs: the fibroblast response as measured by gene expression changes was amplified by the presence of M2 Mφs. These results demonstrate that the immune system modulates the function of fibroblasts; furthermore, different sources of differentiated fibroblasts may lead to divergent results. Overall, our research suggests that M2 Mφs may be a critical target for the clinical treatment of cPE induced fibrosis.

Pseudotumor Associated with Dall-Miles Cable Breakage Following Revision Total Hip Arthroplasty: A Case Report

A pseudotumor is a benign granulomatous or cystic lesion associated with the deposition of metal debris in joint arthroplasties. To the best of our knowledge, this is the first report on a pseudotumor caused by the breakage of the Dall-Miles cable grip system, a multifilament cable used to fix the trochanteric osteotomy in revision total hip arthroplasty. This rare case demonstrates that pseudotumor formation can be caused by various types of orthopedic materials and implant components. When encountering a palpable mass around an orthopedic implant, a pseudotumor should be considered along other differential diagnoses. To treat pseudotumors and also prevent recurrence, its complete resection and sufficient removal of orthopedic materials are necessary.

Perioperative prognosis of infectious complications after total hip and knee arthroplasties. Part I

Introduction The number of total joint arthroplasties performed globally has increased over time, and the projected growth for total knee arthroplasty (TKA) and total hip arthroplasty (THA) in 2030-2050 is associated with an increase in the number of surgical complications, such as periprosthetic joint infection (PJI). Perioperative modifiable risk factors can be altered to help improve rates of the devastating scenario. The purpose of the review was to systematize information on modifiable risk factors for PJI after THA and TKA and the ways to improve them. Material and methods Scientific literature search was performed via web-based services of PubMed, eLibrary, Scopus, Dimensions. The search depth was 30 years. Results Modifiable risk factors were shown to be associated with the patient's condition, medical history, current status, intraoperative and postoperative surgical options. Well-established modifiable risk factors include tobacco use, alcohol consumption, excess body weight, obesity, malnutrition, duration of surgery, postoperative wound hematoma. Discussion Timely diagnosed modifiable risk factors for PJI can be improved at the preparation stage, perioperatively and postoperatively. The interaction of inpatient and outpatient hospital services in the perioperative period is essential for reducing the risk of PJI after THA and TKA.

Update on Novel Non-Operative Treatment for Osteoarthritis: Current Status and Future Trends

Osteoarthritis (OA) is a leading cause of pain and disability which results in a reduced quality of life. Due to the avascular nature of cartilage, damaged cartilage has a finite capacity for healing or regeneration. To date, conservative management, including physical measures and pharmacological therapy are still the principal choices offered for OA patients. Joint arthroplasties or total replacement surgeries are served as the ultimate therapeutic option to rehabilitate the joint function of patients who withstand severe OA. However, these approaches are mainly to relieve the symptoms of OA, instead of decelerating or reversing the progress of cartilage damage. Disease-modifying osteoarthritis drugs (DMOADs) aiming to modify key structures within the OA joints are in development. Tissue engineering is a promising strategy for repairing cartilage, in which cells, genes, and biomaterials are encompassed. Here, we review the current status of preclinical investigations and clinical translations of tissue engineering in the non-operative treatment of OA. Furthermore, this review provides our perspective on the challenges and future directions of tissue engineering in cartilage regeneration.

Combining Aesthetic Septorhinoplasty With Bioabsorbable Implants for Nasal Valve Insufficiency

This case report demonstrates the usage of a bioabsorbable nasal implant (BNI) in conjunction with an aesthetic septorhinoplasty. The authors uniquely chose to use this allograft due to inadequate autologous tissue secondary to previously performed temporomandibular joint arthroplasties. In addition to evaluating our case of a 22-year-old woman who received a BNI with an aesthetic septorhinoplasty, the authors performed a comprehensive literature review on the topic. Spanning 3 databases (Scopus, PubMed, and Cochrane), this review revealed 4 primary studies, totaling 349 patients. Each utilized nasal obstruction symptom evaluation (NOSE) scores to subjectively measure symptomatic improvement. We chose to use the NOSE questionnaire on our patient both preoperatively and postoperatively, in order to help demonstrate subjective improvement. The patient’s functional and aesthetic concerns were addressed in the operating room at Parkland Memorial Hospital under general anesthesia. Notably, the patient had previously had conchal cartilage harvested bilaterally, had insufficient septal cartilage for adequate grafting, and did not desire to undergo costal cartilage harvest. Therefore, all parties agreed to use a BNI to complete the functional component of the patient’s septorhinoplasty. This day-surgery first focused on the aesthetic septorhinoplasty followed by the placement of the BNI bilaterally. Following an uneventful postoperative course, our patient endorsed not only an aesthetic improvement but also an 88% functional improvement based on her NOSE score within 4 months of surgery. The authors were able to successfully integrate functional as well as aesthetic septorhinoplasty techniques under the constraints of having both limited autologous tissue and limited accepted options from the patient. For the patient and provider team, this newer allograft was confirmed to be effective and efficient. With the correct patient selection, this is an excellent adjunct procedure that can be quickly and safely performed either in conjunction with surgical rhinoplasty or as a standalone procedure by facial surgeons.

Early Results of Total Cementless Hip Joint Arthroplasty with the Anatomical Stem

Background. The aim of this study is to present the early results of hip joint arthroplasty with the EXCEPTION anatomical stem (BIOMET). Materials and methods. The study enrolled 173 patients (110 women and 63 men) who underwent a total of 190 hip joint arthroplasties with the EXCEPTION anatomical stem. The mean age of the patients at surgery was 58.2 years (range: 28-82 years). The mean follow-up period was 7.3 years (range: 5-10.1 years). Results. Pre-operative Merle d’Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.7 points. The outcomes were classified as excellent in 131 cases, good in 39, satisfactory in 13 and poor in 7 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 14 cases (7.4%). According to the Kaplan-Meier estimator, 5 years’ survival probability was 96.31% for the whole implant and 99.47% for the stem alone. Conclusions. 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the EXCEPTION anatomical stem affords excellent clinical and functional results. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Due to the relatively short duration of follow-up, there may be more cases of loosening (mainly of the acetabular cup) over time, requiring regular long-term follow-up.

Long-Term Results of Joint Arthroplasty with Total Prosthesis for Trapeziometacarpal Osteoarthritis in Patients over 65 Years of Age

Trapeziometacarpal osteoarthritis (TMCOA) is a highly prevalent disease in the older population. Many different types of surgical treatments are possible, depending on the degree of joint involvement, the personal and professional circumstances of the patient and the preferences of the orthopedic surgeon. This paper evaluated the clinical and radiological results of consecutive cohorts of patients over 65 years old treated with total joint arthroplasties (TJA) of the ball and socket type (B&S) for TMCOA, with a minimum of 10 years follow-up. The survival rate (Kaplan–Meier) of the functional prostheses at 10 years was 92.2% (95% CI (89.1%, 96.1%). These functional arthroplasty patients, after 10 years of follow-up, showed little or no pain, good function and good key pinch, without radiological alterations. TJAs of the B&S type are a long lasting, effective and reliable alternative to surgical treatment of TMCOA in patients over 65 years of age, when they are performed with the patient selection criteria and surgical technique described throughout this study.

Appropriateness of transthoracic echocardiography in preoperative elective joint arthroplasty patients

Elective joint arthroplasty is a commonly performed procedure with postoperative cardiovascular complications occurring in up to 3% of elderly patients. Preoperative cardiac evaluation, including transthoracic echocardiography, may improve risk stratification and optimise perioperative outcomes in patients having non-cardiac surgery. This study aimed to investigate the frequency, indications, appropriateness and consequences of preoperative transthoracic echocardiography in elective joint arthroplasty patients. A one-year retrospective audit was conducted for patients who had elective joint arthroplasties performed at St Vincent's Hospital Melbourne. Patient demographics, transthoracic echocardiography indication, time between transthoracic echocardiography being ordered, performed and its impact on date of surgery were obtained via database and manual chart review. Appropriateness of transthoracic echocardiography was determined in accordance with international guidelines. This study analysed 609 elective joint arthroplasties. Of these, 116 (19%) already had a recent transthoracic echocardiography. Of the remaining 493 patients, 192 (39%) received a resting transthoracic echocardiography. Only 92 (48%) of the transthoracic echocardiography’s ordered were deemed appropriate. Transthoracic echocardiography resulted in a significant delay of 31 days in time to surgery. This study indicates that almost 40% of elective joint arthroplasty patients with no recent echocardiogram are having a resting transthoracic echocardiography as part of their preoperative assessment. In 52% of cases, these are not clearly appropriate and result in delays to surgery.