Joint Preservation Using Orthobiologic Therapies in Osteoarthritis

Osteoarthritis is estimated to be the most prevalent musculoskeletal disorder in the world. Estimates show that the disease is prevalent in 18% and 10% in women and men that are aged >60 years old. The quality of life of the affected patients can also be significantly impacted due to the associated morbidities and functional loss. Many interventions have been proposed to preserve the joint and enhance the functional outcomes in patients with osteoarthritis. In the present literature review, we have discussed the different orthobiologic therapies for patients with osteoarthritis for joint preservation and subsequent improvement in the functional and pain outcomes. Variable modalities that have been proposed in the literature include Bone Marrow Aspirate Concentrate (BMAC), gene therapy and platelet rich plasma (PRP). All of these modalities were reported with favorable outcomes and minimal complications. PRP has been reported to have a clinical efficacy that is boosed when co-administered with hyaluronic acid. However, it should be noted that the clinical efficacy is limited in the long term, and administration is continuously required. On the other hand, gene therapy is a promising technique that offers maintained favorable outcomes with no adverse events. However, further studies are still needed to indicate the effectiveness and cost-efficacy of this approach.

Comparative observation of two types of limb salvage surgery on limb function and quality of life in patients with knee joint osteosarcoma

Background We compared the differences of Joint-preservation Limb Salvage (JPLS) and Joint-prosthesis Replacement Surgery (JPRS) on limb function and quality of life in patients with osteosarcoma in the knee. Methods This retrospective study evaluated the postoperative outcomes of patients treated with JPLS and JPRS for osteosarcoma around the knee between November 2000 and January 2019. All patients were followed up at 1 year postoperatively. Patients' lower extremity function, knee function, and quality of life were evaluated during follow-up using the MSTS score, IKDC score, and SF-36 score. Results The patients were divided into two groups: the joint-preservation group (16) and the prosthetic-replacement group (19). All 35 patients received a successful operation, and all incisions healed in one stage after surgery. At 12 months after the operation, the median MTST score in the joint-preservation group was 27(range 24 to30), higher than 24(range 13 to 30) in the prosthetic-replacement group (P < 0.05, Table 2). The median IKDC score in the joint-preservation group was 82.5(range 53 to 95), higher than the 60(range 41 to 80) in the prosthetic- replacement group (P < 0.05, Table 2). The SF-36 scores of physiological and social functions were higher in the joint-preserving group than those in the prosthetic-replacement group (P < 0.05), and there were no significant differences between the groups in the other indexes (P > 0.05). Comparing the distribution of each item in the MSTS and IKDC scoring criteria between the joint-preservation and the prosthetic-replacement group revealed that the limb function, pain, satisfaction, support assistance, and the walking and gait of the joint-preservation group were superior to those of the prosthetic-replacement group (P < 0.05). There was no significant difference in knee flexion between the two groups (P > 0.05). However, the joint-preservation group performed superior to the prosthesis-replacement group in terms of pain, swelling, twisting, softening of the leg, movement downstairs, sitting up from a chair, kneeling, squatting, running straight, jumping up with the injured leg and landing, and quickly stopping or starting (P < 0.05). Conclusion Compared with joint-prosthesis replacement surgery, joint-preservation limb salvage performed better joint function and quality of life. The findings provide a signal of superiority for JPLS to JPRS but further investigation is warranted in multicentre trials.

Specificity of Multispiral Computed Tomography in the Diagnosis of Avascular Necrosis of the Femoral Head

In the span of 6 years 350 patients that were clinically and radiologically diagnosed with avascular necrosis of the femoral head, at different stages, were examined. Patients were examined using comprehensive radiation examination including radiography and multispiral computed tomography (MSCT) of the hip joints, with the aim to diagnosis avascular necrosis of the femoral head at an earlier stage. According to the results of the examination, 121 patients were diagnosed with an earlier stage of avascular necrosis of the femoral head, on 99 patients was performed core decompression via drilling, 22 patients underwent a joint preservation procedure with the removal of the necrosis tissue following with a bone-graft using bonesubstituting bioresorbable material.