Archives of Bone and Joint Surgery
Volume:11 Issue: 8, Jul 2023

In clinical practice, bone defects that occur alongside tumors, infections, or other bone diseases present significant challenges in the orthopedic field. Although autologous and allogeneic grafts are introduced as common traditional remedies in this field, their applications have a series of limitations. Various approaches have been attempted to treat large and irregularly shaped bone defects; however, their success has been less than optimal due to a range of issues related to material and design. However , in recent years, additive manufacturing has emerged as a promising solution to the challenge of creating implants that can be perfectly tailored to fit individual defects during surgical procedures. By fabrication of constructs with specific designs using this technique, surgeons are able to achieve much better outcomes for patients. Polymers, ceramics, and metals have been used as biomaterials in Orthopedic Surgery fields. Polymeric scaffolds have been used successfully in total joint replacements, soft tissue reconstruction, joint fusion, and as fracture fixation devices. The use of polymeric biomaterials, either in the form of pre-made solid scaffolds or injectable pastes that can harden in situ, shows great promise as a substitute for commonly used autografts and allografts. Polymethyl methacrylate (PMMA) is one of the most widely used polymer cement in orthopedic surgery. The present paper begins with an introduction and will then provide an overview of the properties, advantages/disadvantages, applications, and modifications of PMMA bone cement. Level of evidence: III

Bibliometric analysis is one of the most prevalent methods for analyzing and predicting research trends of particular subjects. Through a bibliometric analysis, the present study sought to look into and depict the hotspots and research trends in hip arthroplasty resear ch over the previous five years.

The Web of Science Core Collection database was used to find studies on hip arthroplasty published between 2018 and 2022. The VOS viewer, Cite Space, and Bibliometrix were used to carry out the bibliometric study and network visualization.

During the last five years, 5,708 hip arthroplasty publications were cited 40,765 times. The United States and the Journal of Arthroplasty were the top countries and journals regarding the number of studies, respectively.The top 10 global high-impact documents were determined using the citation ranking and citation burst. The most frequently referenced research revealed the epidemiological aspects of hip arthroplasty, perioperative care after hip arthroplasty, COVID-19, periprosthetic joint infections, opioid medicines, stability, and osteonecrosis were the hot topics in hip arthroplasty research. Keyword burst analysis showed that the research trends in hip arthroplasty through 2022 were patient-reported outcome measures (PROM), depression, racial disparity, and artificial intelligence (AI). The analysis of the subject areas revealed the close connections and relationships between different subject areas, as demonstrated by the figures.

The hip arthroplasty research community is very productive and highly centralized. Periprosthetic joint infection, dual-mobility cups, spinopelvic mobility, direct anterior approach, outpatient total hip arthroplasty, polyethylene, periprosthetic fracture, acetabular defects, tranexamic acid, developmental dysplasia of the hip, and safety-net hospitals were recent trends in hip arthroplasty research. Patient-reported outcome measures, depression, racial disparities, and AI were research hotspots in hip arthroplasty. Level of evidence: IV

This study investigates outcomes and complications of the pin and plate fixation technique, which was suggested for distal humerus fractures. It also reports the results of its application in nonunions for the first time. Forty-nine fracture and 17 nonunion cases who underwent surgery using the technique and were followed for at least 18 months were assessed through the range of motion (ROM), Quick Disabilities of the Arm, Shoulder, and Hand Score (Quick-DASH), Mayo Elbow Performance Score (MEPS), four-category verbal rating scale (VRS4), and complications. At the last follow-up, the mean scores of flexion, extension deficit, supination, and pronation ranges in fracture cases were 116.7, 22.9, 90.0, and 90.0 degrees, respectively. These values in nonunion cases were 112.2, 26.4, 86.7, and 85.5 degrees, respectively. The average ROM in fracture cases was 93.8, while it was 85.8 degrees in nonunion cases. The mean Quick-DASH in fracture and nonunion patients were 25.2 and 31.1, respectively. According to the MEPS, 77.5% of fracture and 64.7% of nonunion patients had excellent and good results. In fracture cases, the mean scores of VRS-4 at rest, light activity, and hard activity were 1.3, 1.8, and 2.3, respectively. These values in nonunion cases were 1.8, 2.2, and 2.5, respectively. The most common complications were device prominence and ulnar neuropathy. An acceptable union rate and proper elbow function can be expected by using this technique. Owing to the promising results of this study, further high-quality studies are recommended. Hereby this technique is called Persian Fixation. Level of evidence: IV

The kinesiopathology model is a new rehabilitation model classifying, evaluating, and treating patients with non-specific back pain. Sahrmann proposed this model based on movement disorder syndromes. The present cross-sectional study aimed to evaluate the radiograph of the linear and angular displacement of the lumbar spine in patients with lumbar flexion impairment syndrome (LFIS) and lumbar extension impairment syndrome (LEIS). In this study, 50 adults aged 18-46 years were enrolled, including 25 patients with LFIS and 25 with LEIS. The eligible participants were referred to the radiology department for radiography in the common position of neutral, full extension, and full flexion position while standing. The White and Panjabi’s method was used to measure the linear and angular displacements. Moreover, pain intensity was assessed using the visual analogue scale, and functional disability was investigated using a modified Oswestry Disability Questionnaire. The parameter of the linear displacement at the L3-L4 level was significantly different between the two groups (P=0.02). The mean duration of low back pain was longer in the LEIS, compared to the LFIS group (P=0.01). In patients with LEIS, compensatory responses occur that cause less linear displacement at the L3-L4 level, compared to the patients with LFIS. Therefore, it is important to design appropriate exercises to better control the linear displacement at the L3-L4 level during the full range of motion in patients with LFIS. Level of evidence: III

Avascular necrosis of the femoral head typically occurs in the young population. Core decompression in the precollapse stage provides pain relief and preservation of the femoral head. The results of core decompression vary considerably despite the early diagnosis. Clinicians concur that primary treatment should focus on preserving the natural surface of the joint. This study investigated the predictive risk factors of failure in femoral head decompression. We retrospectively reviewed 135 patients and 207 hips (77 male (127 hips) and 58 female (80 hips)) who underwent core decompression (mean age: 34.7 years [age range: 21-71]) from April 2010 to December 2017. All patients were followed by a mean of 57 months. All hips were in the precollapse stage (Ficat I, II).  A total of 207 hips were treated with core decompression surgery, and the overall success rate was 58%. The higher grade of Kerboul, Ficat, ARCO classifications, multifocal avascular necrosis of the femoral head, smoking, opium, and corticosteroids were significantly associated with a higher failure rate after core decompression in univariate analysis. In multivariate logistic regression analysis, the Kerboul and Ficat classifications, alcohol consumption, and multifocal avascular necrosis of the femoral head were significantly correlated with core decompression failure. The most common predictive factors in core decompression failure were Ficat II, Kerboul stage 3, multifocal avascular necrosis of the femoral head, and alcohol consumption.  In conclusion, we had an overall 58 % success rate in core decompression of femoral head avascular necrosis. Based on the results of this study, imaging evaluation and imaging-based classifications are the most valuable predictor factors for the success of core decompression. Consistent with previous reports, corticosteroid was not a significant predictor of core decompression failure.Level of evidence: III

Excessive blood loss is a critical complication of total hip arthroplasty. We intended to determine whether preoperative fibrinogen administration reduces perioperative bleeding and the need for blood transfusion in total hip arthroplasty surgery. In 4 months, 178 patients who underwent total hip arthroplasty were randomly assigned equally to intervention and placebo-control groups in a double-blinded, parallel two-arm randomized controlled trial. Both intravenously, 30 min before the start of the surgery, the intervention group received two grams of fibrinogen concentrate dissolved in 100 ml of distilled water. In contrast, the control group received 100 ml of normal saline solution. The amount of postoperative blood loss served as the main result, and the requirement for blood transfusions served as the secondary outcome. In comparison to the placebo, administering fibrinogen concentrate considerably reduced the amount of blood loss (P=0.001) and the requirement for blood transfusions (P=0.004). Patients who got fibrinogen concentrate experienced no side effects. In addition, patients in the fibrinogen group had significantly lower hemoglobin and higher fibrinogen levels in the recovery room and received lesser blood transfusions (P<0.005) than the placebo group. In total hip arthroplasty, fibrinogen concentrate lessens postoperative bleeding and the requirement for blood transfusions. Level of evidence: II

The management of proximal femoral fractures, especially comminuted subtrochanteric ones, poses a surgical challenge. It is relatively easier to perform the open reduction of these fractures in the lateral position on a standard radiolucent table, but obtaining an accurate lateral view of the femoral head and neck remains difficult. This study presents a method that overcomes the limitations of fluoroscopy in the lateral decubitus position and improves the accuracy of obtaining a true lateral view. The technique involves positioning the patient in the lateral decubitus position with the u naffected hip flexed at a 45°angle. Additionally, the C-arm is tilted 30-35° cephalad, eliminating the need for position changes or leg manipulation. This method reduces the risk of losing reduction, particularly in cases involving obese patients or complex fractures. By simplifying proximal femur fixation in the lateral decubitus position, this technique can potentially improve patient outcomes. Level of evidence: V

Tibia open fractures and lower limb soft tissue injuries are undesired conditions for orthopedic and general surgeons, and there is no ideal procedure for treating recalcitrant ulcers or severe traumatic ulcers. Recently, several novel approaches have been proposed, such as bone marrow stem cells, platelets, fibrin glue, and collagen matrix. The current study was conducted to evaluate the effectiveness of combining platelets, fibrin glue, and a collagen matrix for treating a serious limb -threatening wound in a 33-year-old male with a right lower limb injury. After treatment, the wound was fully closed, tissue granulation was grown, skin grafting was done, and the right leg was saved. In conclusion, the combination of the mentioned components can be utilized to synergistically enhance wound healing and preserve the limb. Level of evidence: V

Conventional central osteosarcoma mainly affects the metaphysis of long bones in young people. The use of megaprostheses in oncological patients has increased in recent years. However, this type of surgery is not exempt from complications, with infections being the most common. In recent years, the presence of biofilm-forming bacteria has increased. Biofilm characteristics allow bacteria to resist hostile environmental conditions. The application of long wave ultrasound (process known as sonication) on the rescued inert material before culture interrupts the biofilm and generates a significantly higher recovery of bacterial growth compared to conventional tissue culture. We present the case of a 12-year-old patient with osteosarcoma of the femur, who, after surgery, developed a prosthetic infection detected by sonication, with negative soft tissue culture. Level of evidence: IV