Diabetes and orthopaedic surgery: a review

Risk factors for nonunion following tibiotalocalcaneal arthrodesis: A systematic review and meta-analysis

BACKGROUND

The goal of this study is to review the literature to identify risk factors for nonunion after tibiotalocalcaneal arthrodesis (TTCA) and stratify them based on strength of evidence.

METHODS

Five databases were searched from inception to May 17th, 2020. Abstracts and full-text articles were screened for those that included risk factors predictive of nonunion following TTCA.

RESULTS

Eight studies involving 624 patients were included and 33 potential risk factors for nonunion were identified. Strong evidence supported prior peripheral neuropathic conditions as risk factors for nonunion following surgery (OR: 2.86, 95% CI: 1.56-5.23).

CONCLUSION

TTCA is an effective salvage procedure but is associated with high nonunion rates. The results of our meta-analysis suggest that prior peripheral neuropathic conditions have strong evidence for failure to achieve union. Surgeons should be cognizant of these risks when performing TTCA and carefully monitor patients with the aforementioned comorbidity to achieve successful results.

Diabetes as a Risk Factor for Orthopedic Implant Surface Performance: A Retrieval and In Vitro Study

Orthopedic devices are often associated with increased risk for diabetic patients due to impaired wound healing capabilities. Adverse biological responses for immunocompromised patients at the implant-tissue interface can lead to significant bone resorption that may increase failure rates. The goal of this study was to characterize the surface of implants removed from diabetic patients to determine underlying mechanisms of diabetes-induced impaired osseointegration. Thirty-nine retrieved titanium and stainless-steel orthopedic devices were obtained from diabetic and non-diabetic patients, and compared to non-implanted controls. Optical Microscopy, Scanning Electron Microscopy, Energy Dispersive X-ray Spectroscopy, and X-ray Photoelectron Spectroscopy revealed changes in morphology, chemical composition, oxidation state, and oxide thickness of the retrieval specimens, respectively. Additionally, titanium disks were immersed for 28 days in simulated in vitro diabetic conditions followed by Inductively Coupled Plasma-Optical Emission Spectroscopy to quantify metal dissolution. Electrochemical testing was performed on specimens from retrievals and in vitro study. Aside from biological deposits, retrievals demonstrated surface discoloration, pit-like formations and oxide thinning when compared to non-implanted controls, suggesting exposure to unfavorable acidic conditions. Cyclic load bearing areas on fracture-fixation screws and plates depicted cracking and delamination. The corrosion behavior was not significantly different between diabetic and non-diabetic conditions of immersed disks or implant type. However, simulated diabetic conditions elevated aluminum release. This elucidates orthopedic implant failures that potentially arise from diabetic environments at the implant-tissue interface. Design of new implant surfaces should consider specific strategies to induce constructive healing responses in immunocompromised patients while also mitigating corrosion in acidic diabetic environments.

Antidiabetic and antihyperlipidemic activities of Cucumis melo var. momordica fruit extract on experimental animals

Background

Diabetes mellitus is a major public health issue related to the irregular metabolism of carbohydrates, protein, and fat. It occurs due to insufficient insulin production and insulin action.Cucumis melopossesses several biological properties including antioxidant, anti-inflammatory, antibacterial, antihypothyroidism, and antiangiogenic activities. The objective of the present study was to determine the antidiabetic and antihyperlipidemic activities ofCucumis melovar.momordicafruit extract on experimental animals.

Result

Results show that treatment withC. melofruit extract and fraction caused a reduction in blood glucose levels.Cucumis melotoluene fraction (CMTF) exhibited a significant (*P< 0.05) reduction of blood glucose level on the 28th day, i.e., 122 mg/dL, in comparison with the positive control group (streptozotocin (STZ)). However, the extract ofC. meloshowed less significant results in comparison with CMTF. Triglyceride, LDL, and VLDL levels were increased chronically due to STZ and were significantly (*P< 0.05) restored to 84.16, 86.97, and 19.73, respectively, by CMTF in comparison with the positive control group (STZ in the dose of 55 mg/kg). The extract-treated groups also showed similar results as CMTF, but their efficacy was lesser than CMTF.

Conclusion

It is can be concluded thatC. melofruits can be used as an effective antidiabetic and antihyperlipidemic drug.

Graphical abstract