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Wu S, Liu S, Huang M, Liu Z, Shi J, Ling M. Different radius of curvature at the talus trochlea from northern Chinese population measured using 3D model. J Orthop Surg Res 2024; 19:266. [PMID: 38671519 PMCID: PMC11055296 DOI: 10.1186/s13018-024-04751-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND To analyze the curvature characteristics of the talus trochlea in people from northern China in different sex and age groups. METHODS Computed tomography scanning data of talus from 61 specimens were collected and constructed as a three-dimensional model by Materialise's Interactive Medical Image Control System(MIMICS) software, anteromedial(AM), posteromedial(PM), anterolateral(AL), and posterolateral(PL) edge, anterior edge of medial trochlea, posterior edge of medial trochlea and anterior edge of lateral trochlea were defined according to the anatomical landmarks on trochlear surface. The curvature radii for different areas were measured using the fitting radius and measure module. RESULTS There were significant differences among the talus curvatures in the six areas (F = 54.905, P = 0.000), and more trends in the analytical results were as follows: PM > PL > MP > AL > MA > AM. The average PL radius from specimens aged > 38 years old was larger than that from specimens aged < = 38 years (t=-2.303, P = 0.038). The talus curvature of the AM for males was significantly larger than that for females (t = 4.25, P = 0.000), and the curvature of the AL for males was larger than that for females (t = 2.629, P = 0.010). For observers aged < = 38 years, the AM curvature of the right talus in the male group was significantly larger than that in the female group (P < 0.01). In age < = 38years group, the MA curvature of right talus in male was significantly larger than in female group(P < 0.01), fitting radius of talus for male (21.90 ± 1.97 mm) was significantly greater than female of this(19.57 ± 1.26 mm)(t = 6.894, P = 000). The average radius of the talus in the male population was larger than that in the female population. CONCLUSION There was no significant relationship between age and talus curvature for males and females. The radius of curvature in the posterior area was significantly larger than that in the anterior area. We recommend that this characteristic of the talus trochlea should be considered when designing the talus component in total ankle replacement (TAR).
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Affiliation(s)
- Shixun Wu
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi, 710068, China
- Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi'an, Shaanxi, 710068, China
| | - Shizhang Liu
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi, 710068, China
- Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi'an, Shaanxi, 710068, China
| | - Minggang Huang
- Department of CT, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Zhe Liu
- Department of CT, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Jiyuan Shi
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi, 710068, China
- Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi'an, Shaanxi, 710068, China
| | - Ming Ling
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi, 710068, China.
- Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi'an, Shaanxi, 710068, China.
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Tetsworth KD, Welyczko ZH, Quinnan SM. Indications for Nonbiological Reconstruction of Posttraumatic Bone Defects About the Knee. J Orthop Trauma 2024; 38:S23-S29. [PMID: 38502600 DOI: 10.1097/bot.0000000000002764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 03/21/2024]
Abstract
SUMMARY 3D printing and modeling has continued to grow in popularity over the past decade because the technology has matured and become more affordable and widely available. The main indications for nonbiological reconstruction of large bone defects are principally those patients where the candidate is unlikely to be successful if reconstructed by other means. Bespoke, custom, patient-specific implants can be designed to very effectively address bone loss, incorporating design elements that are particular to the needs of any given unique clinical condition. These implants are generally designed as titanium scaffolds that encourage bony incorporation at the host implant junction both proximal and distal. These scaffolds are typically considered a cellular solid, with high porosity that also promotes bone ingrowth directly into the substance of the body of the implant. Titanium scaffolds of this type have become a useful treatment alternative for large segmental bone defects around the knee, especially distal femoral defects. These are often adult patients with local or systemic compromise, or instead they may be too young to be considered candidates for reconstruction using a megaprosthesis. The process requires careful evaluation of individual patients, then matching that patient with the best treatment option, while recognizing the expectations and demands specific to that particular patient. Several cases are presented here to illustrate the variety of indications that can be successfully addressed with this technology, highlighting the quality of the clinical outcome that can be achieved despite the complexity of the pathology encountered.
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Affiliation(s)
- Kevin D Tetsworth
- Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Australia
- Orthopaedic Research Centre of Australia, Brisbane, Australia
- Herston Biofabrication Institute, Brisbane, Australia
| | - Zhenya H Welyczko
- Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Australia
- Department of Orthopaedic Surgery, The Princess Alexandra Hospital, Brisbane, Australia; and
| | - Stephen M Quinnan
- The Paley Orthopedic and Spine Institute, St. Mary's Medical Center, West Palm Beach, FL
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Pinzur MS, Schiff AP, Hamid K, LeDuc R. Preliminary Experience With Commercially Available Trabecular Metal Tibial Cones Combined With a Retrograde Locked Intramedullary Nail for Bony Defects in Tibiotalocalcaneal Arthrodesis. Foot Ankle Spec 2024:19386400241236664. [PMID: 38501276 DOI: 10.1177/19386400241236664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Critical sized bone defects in the ankle are becoming increasingly more common in patients undergoing limb reconstruction with tibiotalocalcaneal arthrodesis. Bulk allografts have not fared well over time. There have been scattered preliminary reports using custom spinal cages or 3D-printed Titanium Implants to address the critical bony defect; however, the cost of these devices is prohibitive in many clinical practice settings. The purpose of this investigation is to report the preliminary experience using a commercially available Trabecular Metal (Zimmer-Biomet) tibial metaphyseal cone combined with a retrograde locked intramedullary nail to address this challenging problem. Eight consecutive patients underwent tibiotalocalcaneal arthrodesis using a commercially available Trabecular Metal tibial metaphyseal cone combined with a retrograde locked intramedullary nail. Five developed bone loss secondary to neuropathic (Charcot) bony resorption and 3 underwent surgery for failed total ankle arthroplasty. All 8 patients eventually achieved clinical and radiographic healing and were able to ambulate with standard footwear. One patient developed a postoperative wound infection at the site of calcaneal locking screws, which resolved with debridement and parenteral antibiotic therapy. Critical bone defects about the ankle have successfully addressed with custom 3D titanium implants. This small series suggests that similar clinical outcomes can be achieved with the use of a commercially available porous tantalum metaphyseal spacer borrowed from our arthroplasty colleagues, combined with the use of a retrograde locked intramedullary nail.Levels of Evidence: Level 4: Retrospective case series.
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Affiliation(s)
- Michael S Pinzur
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System and Loyola University Medical School, Maywood, Illinois
| | - Adam P Schiff
- Loyola University Health System and Loyola University Medical School, Maywood, Illinois
| | - Kamran Hamid
- Loyola University Health System and Loyola University Medical School, Maywood, Illinois
| | - Ryan LeDuc
- Loyola University Health System and Loyola University Medical School, Maywood, Illinois
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Randers E, Kibsgård T, Nogueira LP, Kjensjord T, Röhrl SM, Nordsletten L, Stuge B. Osseointegration of minimally invasive sacroiliac joint fixation implants-A human retrieval study. J Orthop Res 2024. [PMID: 38433320 DOI: 10.1002/jor.25820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
Minimally invasive sacroiliac joint fusion has become increasingly prevalent and is described to reduce pain and improve function. In some patients, pain can recur several months after primary surgery. Lack of early implant osseointegration might be a cause of pain and hence an indication for revision surgery. Triangular titanium implants are the most documented implant for minimally invasive sacroiliac joint fusion. There is, however, no knowledge of how triangular titanium implants osseointegrate in humans and whether fusion is induced over the sacroiliac joint. During planned revision surgery due to recurrent pain, six triangular titanium implants were retrieved from six different patients at median 9 months from primary surgery. All six implants were scanned using microcomputed tomography. The presence or absence of bone in-growth, on-growth, and through-growth of the implants was evaluated as an indication of implant osseointegration. Three of six implants showed no or minor signs of osseointegration. Of the three remaining implants, one showed partial osseointegration and two implants showed high degrees of osseointegration. This study showed that triangular titanium implants can osseointegrate into host bone in humans. When osseointegration occurs, triangular titanium implants can give fusion across the sacroiliac joint.
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Affiliation(s)
- Engelke Randers
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas Kibsgård
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liebert P Nogueira
- Oral Research Laboratory, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Trygve Kjensjord
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Britt Stuge
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Ferrao PNF, Saragas NP, Naude JJ. Outcomes of Total Ankle Arthroplasty After Periprosthetic Cyst Curettage and Bone Grafting. Foot Ankle Clin 2024; 29:123-143. [PMID: 38309797 DOI: 10.1016/j.fcl.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Total ankle arthroplasty (TAA) has become a popular management option for ankle arthritis. Periprosthetic osteolysis is one of the most common causes for reoperation in TAA. A CT scan should be done in all suspected osteolysis cases to confirm location, quantify size and aid in surgical planning. These patients are often asymptomatic with limited evidence regarding appropriate management. Smaller lesions should be monitored for progression in size. Periprosthetic cysts measuring 10-15mm in all three axes should be considered for debridment and curettage with autogenous bone grafting. The authors believe that bone grafting of large asymptomatic periprosthetic cysts could prevent implant failure.
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Affiliation(s)
- Paulo N F Ferrao
- The Orthopaedic Foot & Ankle Unit, Netcare Linksfield Hospital, 303 Linksfield Medical Centre, 24 12th Avenue, Linksfield West, 2192, South Africa; Department of Orthopaedic Surgery, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Nikiforos P Saragas
- The Orthopaedic Foot & Ankle Unit, Netcare Linksfield Hospital, 303 Linksfield Medical Centre, 24 12th Avenue, Linksfield West, 2192, South Africa; Department of Orthopaedic Surgery, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Jaco J Naude
- The Orthopaedic Foot & Ankle Unit, Netcare Linksfield Hospital, 303 Linksfield Medical Centre, 24 12th Avenue, Linksfield West, 2192, South Africa; Life Wilgers Hospital, Denneboom road, Wilgers ext 14, Pretoria, 0040, South Africa
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Zhang J, Zhuang Y, Sheng R, Tomás H, Rodrigues J, Yuan G, Wang X, Lin K. Smart stimuli-responsive strategies for titanium implant functionalization in bone regeneration and therapeutics. Mater Horiz 2024; 11:12-36. [PMID: 37818593 DOI: 10.1039/d3mh01260c] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
With the increasing and aging of global population, there is a dramatic rise in the demand for implants or substitutes to rehabilitate bone-related disorders which can considerably decrease quality of life and even endanger lives. Though titanium and its alloys have been applied as the mainstream material to fabricate implants for load-bearing bone defect restoration or temporary internal fixation devices for bone fractures, it is far from rare to encounter failed cases in clinical practice, particularly with pathological factors involved. In recent years, smart stimuli-responsive (SSR) strategies have been conducted to functionalize titanium implants to improve bone regeneration in pathological conditions, such as bacterial infection, chronic inflammation, tumor and diabetes mellitus, etc. SSR implants can exert on-demand therapeutic and/or pro-regenerative effects in response to externally applied stimuli (such as photostimulation, magnetic field, electrical and ultrasound stimulation) or internal pathology-related microenvironment changes (such as decreased pH value, specific enzyme secreted by bacterial and excessive production of reactive oxygen species). This review summarizes recent progress on the material design and fabrication, responsive mechanisms, and in vitro and in vivo evaluations for versatile clinical applications of SSR titanium implants. In addition, currently existing limitations and challenges and further prospective directions of these strategies are also discussed.
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Affiliation(s)
- Jinkai Zhang
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China.
| | - Yu Zhuang
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China.
| | - Ruilong Sheng
- CQM-Centro de Quimica da Madeira, Universidade da Madeira, Campus da Penteada, 9020-105, Funchal, Madeira, Portugal.
| | - Helena Tomás
- CQM-Centro de Quimica da Madeira, Universidade da Madeira, Campus da Penteada, 9020-105, Funchal, Madeira, Portugal.
| | - João Rodrigues
- CQM-Centro de Quimica da Madeira, Universidade da Madeira, Campus da Penteada, 9020-105, Funchal, Madeira, Portugal.
| | - Guangyin Yuan
- School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Xudong Wang
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China.
| | - Kaili Lin
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China.
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7
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Abar B, Vail E, Mathey E, Park E, Allen NB, Adams SB, Gall K. A bending model for assessing relative stiffness and strength of orthopaedic fixation constructs. Clin Biomech (Bristol, Avon) 2024; 111:106135. [PMID: 37948989 DOI: 10.1016/j.clinbiomech.2023.106135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The purpose of this study is to develop a simple and reproducible bending model that is compatible with a wide range of orthopaedic fixation devices and 3D printed spacers. METHODS A robust 4-point bending model was constructed by securing sawbones blocks with different orthopaedic fixation device constructs. Stress strain curves derived from a fundamental mechanics model were used to assess the effect of bone density, type of hardware (staple vs intramedullary beam), the use of dynamic compression, orientation of staples (dorsal vs plantar), and the use of 3D printed titanium spacers. FINDINGS The high throughput 4-point bending model is simple enough that the methods can be easily repeated to assess a wide range of fixation methods, while complex enough to provide clinically relevant information. INTERPRETATIONS It is recommended that this model is used to assess a large initial set of fixation methods in direct and straightforward comparisons.
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Affiliation(s)
- Bijan Abar
- Duke University, Department of Mechanical Engineering and Material Sciences, USA; Duke University, Department of Orthopaedic Surgery, USA
| | - Elijah Vail
- Duke University, Department of Mechanical Engineering and Material Sciences, USA
| | - Elizabeth Mathey
- University of Colorado Denver, Department of Mechanical Engineering, USA
| | - Ella Park
- Duke University, Department of Mechanical Engineering and Material Sciences, USA
| | | | | | - Ken Gall
- Duke University, Department of Mechanical Engineering and Material Sciences, USA.
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Noble DM, Sumpter A, Small B, Ruland JR, Cooper MT, Park JS, Perumal V. Clinical, Radiographic, and Patient-Reported Outcomes of First Metatarsophalangeal Interposition Arthrodesis Using Porous Titanium Wedges. Foot Ankle Spec 2023:19386400231218337. [PMID: 38130108 DOI: 10.1177/19386400231218337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND First metatarsophalangeal (MTP) arthrodesis is a common surgical procedure for addressing hallux MTP pathology. In the setting of revision procedures with significant bone loss, porous titanium wedges may provide an alternative to structural bone autograft or allograft. OBJECTIVE The purpose of this study is to report the clinical and radiographic outcomes achieved in first MTP interposition arthrodesis using porous titanium wedges. METHODS A retrospective analysis of 9 patients with a mean age 65.4 years (45-82 years) who underwent first MTP interposition arthrodesis with the use of porous titanium wedges from February 2014 to September 2017 was performed. Outcomes were assessed using both plain-film radiographs and computed tomography (CT) scans, as well as patient-reported outcome measures, including Foot and Ankle Ability Measure (FAAM) (Sports and Activities of Daily Living), pain Visual Analogue Scale (VAS), and 36-Item Short Form Survey (SF-36). Average follow-up time was 34.2 months (14-72 months). RESULTS At final follow-up, the average FAAM score was 91.1 ± 14.7 (75.1 ± 5.3 FAAM Activities of Daily Living; 17.9 ± 9.9 FAAM Sports). Average pain VAS score was 1.9 ± 1.7. Postoperative computed tomography (CT) imaging was obtained for 5 patients, all of which demonstrated good bony apposition or osseous integration of the wedge. Four patients underwent subsequent surgical procedures, including 3 isolated dorsal fixation revisions, and 1 complete MTP arthrodesis revision. CONCLUSION To our knowledge, this study represents the first reported clinical and radiographic outcomes in patients undergoing first MTP interposition arthrodesis with use of porous titanium wedges. While we found this technique to be a viable alternative to bone grafting for this difficult problem, further research should focus on comparative data with other commonly performed operative techniques. LEVEL OF EVIDENCE Level IV: Case series.
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Affiliation(s)
- David M Noble
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Anna Sumpter
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Benjamin Small
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Jeffrey R Ruland
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - M Truitt Cooper
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Joseph S Park
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Venkat Perumal
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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Strydom A, Saragas NP, Ferrao PN. The use of a 3D printed titanium implant for arthrodesis in the management of large osseous defects in the ankle. Foot Ankle Surg 2023; 29:576-583. [PMID: 37833130 DOI: 10.1016/j.fas.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 05/01/2023] [Accepted: 05/13/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Large osseous defects (LOD) in the ankle occur because of multiple aetiologies. Advancement in 3-dimensional (3D) printing technologies has led to the use of custom implants and instrumentation their management. A 3D printed patient-specific porous titanium cage which allows for peripheral osteo-integration and autogenous bone-grafting could be an ideal implant in these cases. METHODS Retrospective review of a multi-centre, multi-surgeon consecutive cohort of patients requiring either TTC or AA for a large osseous defect between June 2019 - August 2020. A custom titanium prosthesis was 3D-printed according to CT measurements for implantation. RESULTS Mean follow up was 19.5 months (range 12-24 months). Plain radiographs and CT scans at 12 months confirmed osseointegration (stability) in 11of 13 patients (84%). Two patients developed late infection, one requiring revision surgery. CONCLUSIONS 3D-Printed titanium implants in the management of LODs in the ankle offer a comparable success rate to other reported procedures, with unlimited geometric possibilities in the design allowing for accurate length correction. Their structural stability may offer an advantage over conventional bone graft techniques and limits the amount of bone-graft required. LEVELS OF EVIDENCE LOE III.
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Affiliation(s)
- Andrew Strydom
- Consultant Foot and Ankle Surgeon, Suite 3A, -2 Level, Westwing, Netcare Sunninghill Hospital, Cnr Nanyuki & Witkoppen Road, Sunninghill, 2157, South Africa.
| | - Nikiforos P Saragas
- The Orthopaedic Foot and Ankle Unit, Suite 303 Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, 2192, Johannesburg, South Africa; Honorary Adjunct Professor and Head, Foot and Ankle Unit, Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Paulo Nf Ferrao
- The Orthopaedic Foot and Ankle Unit, Suite 303 Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, 2192, Johannesburg, South Africa; Foot and Ankle Unit, Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Hu Y, Yang K, Liu H, Wang L, Wang S, Zhang X, Qu B, Yang H. 3D-printed custom implant for the management of "locked" posterior dislocation of the shoulder joint with reverse Hill-Sachs lesion: a case report. Front Bioeng Biotechnol 2023; 11:1259255. [PMID: 37877040 PMCID: PMC10590887 DOI: 10.3389/fbioe.2023.1259255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/19/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction: Irregular bone defects of the humerus are common in clinical practice, but there are fewer reported cases of irregular humeral defects accompanied by shoulder joint "locking" dislocation and reverse Hill-Sachs injury caused by an electric shock. The choice of treatment for such cases is closely related to the extent of shoulder joint function recovery. This is a case report of a 60-year-old male patient who suffered from a shoulder joint "locking" dislocation with accompanying reverse Hill-Sachs injury due to muscle contraction after being electrically shocked at work. The patient was treated with a 3D-printed custom humeral head prosthesis for the treatment of the shoulder joint "locking" dislocation and reverse Hill-Sachs injury. Case presentation: A 60-year-old male patient, working as a construction worker, presented to our emergency department with right shoulder pain and restricted movement for more than 30 min after an electric shock. Right humeral CT revealed a comminuted fracture of the right humeral head. D-dimer levels were significantly elevated at 3239.00 ng/mL, and oxygen partial pressure was slightly decreased at 68 mmHg. Treatment included emergency wound debridement and dressing for the electrical injury, cardioprotective measures, anticoagulation, and symptomatic management. After stabilizing the patient's condition, the patient underwent 3D-printed custom prosthesis-assisted partial replacement of the right humeral head and rotator cuff repair in the orthopedic department. Postoperatively, the patient's right shoulder joint wound healed well, and mobility was restored. Conclusion: This case report demonstrates that the use of a 3D-printed custom prosthesis for the treatment of irregular humeral bone defects caused by specific injury mechanisms, especially cases involving shoulder joint "locking" dislocation and reverse Hill-Sachs injury, can achieve precise bone defect repair, minimize surgical trauma, and provide superior outcomes in terms of postoperative functional rehabilitation.
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Affiliation(s)
| | | | | | | | | | | | - Bo Qu
- Department of Orthopedics, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China
| | - Hongsheng Yang
- Department of Orthopedics, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China
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Lerch RJ, Gulati A, Highlander PD. Revision of Subtalar Joint Arthrodesis: Considerations for Bone Grafting, Fixation Constructs, and Three-Dimensional Printing. Clin Podiatr Med Surg 2023; 40:633-648. [PMID: 37716742 DOI: 10.1016/j.cpm.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Subtalar joint arthrodesis is a commonly used procedure for numerous pathologic conditions in the foot and ankle. Although rarely performed in isolation, this procedure can provide successful resolution of various lower-extremity complaints. There are traditional approaches to isolated subtalar joint arthrodesis; however, when these fail, the authors recommend alternatives to enhance the success of revisional surgery. These include the use of intramedullary nailing, larger harvest of autograft, and metallic wedge.
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Affiliation(s)
- Ryan J Lerch
- The Reconstruction Institute, The Bellevue Hospital, 1400 West Main Street, Bellevue, OH 44811, USA
| | - Amar Gulati
- Progressive Feet, 611 South Carlin Springs Road, Suite 508, Arlington, VA 22204, USA
| | - Peter D Highlander
- The Reconstruction Institute, The Bellevue Hospital, 1400 West Main Street, Bellevue, OH 44811, USA.
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Sebag JA, Clements RC, Togher CJ, Connolly EC. The First Metatarsophalangeal Joint: Updates on Revision Arthrodesis and Malunions. Clin Podiatr Med Surg 2023; 40:569-580. [PMID: 37716737 DOI: 10.1016/j.cpm.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
First metatarsophalangeal joint (MPJ) arthrodesis procedures are a mainstay of forefoot surgery and are associated with high rates of patient satisfaction for addressing a multitude of first ray pathologic conditions. This procedure is often also used as a fallback option for the revision of poor outcomes after other surgical procedures involving the first ray. Despite its successes, there remain instances of complications that can develop after primary first MPJ arthrodesis. This article reviews first MPJ arthrodesis as a procedure for revisional surgery of the first ray, and potential surgical options after failed primary first MPJ arthrodesis.
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Affiliation(s)
- Joshua A Sebag
- Coastal Orthopaedic & Sports Medicine Center, 5158 Southwest Anhinga Avenue, Palm City, FL 34990, USA.
| | | | - Cody J Togher
- Joint Replacement Institute, 3466 Pine Ridge RD, Suite A, Naples, FL 34109, USA
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Cook HR, Strand G, Messerly C, Nowak J. The Ankle Joint: Management of Significant Bone Loss with Arthrodesis. Clin Podiatr Med Surg 2023; 40:711-724. [PMID: 37716747 DOI: 10.1016/j.cpm.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Segmental bone loss of the distal tibia and/or talus presents a challenge to successful reconstruction for the foot and ankle surgeon. When conservative care has been exhausted, multiple surgical treatment options are available including bone transport, bulk allografts, bulk autografts, titanium cages, and external fixation techniques. The primary goals of surgical correction include restoration of limb length as well as a plantigrade, stable lower extremity.
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Affiliation(s)
- Helene R Cook
- Shasta Orthopaedics and Sports Medicine, 1255 Liberty Street, Redding, CA 96001, USA
| | - Garret Strand
- Shasta Orthopaedics and Sports Medicine, 1255 Liberty Street, Redding, CA 96001, USA
| | - Collin Messerly
- Town Center Orthopedics, 44095 Pipeline Plaza, Suite 370, Ashburn, VA 20147, USA
| | - Jason Nowak
- Shasta Orthopaedics and Sports Medicine, 1255 Liberty Street, Redding, CA 96001, USA.
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Laubach M, Hildebrand F, Suresh S, Wagels M, Kobbe P, Gilbert F, Kneser U, Holzapfel BM, Hutmacher DW. The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective. J Funct Biomater 2023; 14:341. [PMID: 37504836 PMCID: PMC10381286 DOI: 10.3390/jfb14070341] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
The treatment of bone defects remains a challenging clinical problem with high reintervention rates, morbidity, and resulting significant healthcare costs. Surgical techniques are constantly evolving, but outcomes can be influenced by several parameters, including the patient's age, comorbidities, systemic disorders, the anatomical location of the defect, and the surgeon's preference and experience. The most used therapeutic modalities for the regeneration of long bone defects include distraction osteogenesis (bone transport), free vascularized fibular grafts, the Masquelet technique, allograft, and (arthroplasty with) mega-prostheses. Over the past 25 years, three-dimensional (3D) printing, a breakthrough layer-by-layer manufacturing technology that produces final parts directly from 3D model data, has taken off and transformed the treatment of bone defects by enabling personalized therapies with highly porous 3D-printed implants tailored to the patient. Therefore, to reduce the morbidities and complications associated with current treatment regimens, efforts have been made in translational research toward 3D-printed scaffolds to facilitate bone regeneration. Three-dimensional printed scaffolds should not only provide osteoconductive surfaces for cell attachment and subsequent bone formation but also provide physical support and containment of bone graft material during the regeneration process, enhancing bone ingrowth, while simultaneously, orthopaedic implants supply mechanical strength with rigid, stable external and/or internal fixation. In this perspective review, we focus on elaborating on the history of bone defect treatment methods and assessing current treatment approaches as well as recent developments, including existing evidence on the advantages and disadvantages of 3D-printed scaffolds for bone defect regeneration. Furthermore, it is evident that the regulatory framework and organization and financing of evidence-based clinical trials remains very complex, and new challenges for non-biodegradable and biodegradable 3D-printed scaffolds for bone regeneration are emerging that have not yet been sufficiently addressed, such as guideline development for specific surgical indications, clinically feasible design concepts for needed multicentre international preclinical and clinical trials, the current medico-legal status, and reimbursement. These challenges underscore the need for intensive exchange and open and honest debate among leaders in the field. This goal can be addressed in a well-planned and focused stakeholder workshop on the topic of patient-specific 3D-printed scaffolds for long bone defect regeneration, as proposed in this perspective review.
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Affiliation(s)
- Markus Laubach
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Sinduja Suresh
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Michael Wagels
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia;
- The Herston Biofabrication Institute, The University of Queensland, Herston, QLD 4006, Australia
- Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, QLD 4102, Australia
- Department of Plastic and Reconstructive Surgery, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia
- The Australian Centre for Complex Integrated Surgical Solutions, Woolloongabba, QLD 4102, Australia
| | - Philipp Kobbe
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Boris M. Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Dietmar W. Hutmacher
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Max Planck Queensland Centre (MPQC) for the Materials Science of Extracellular Matrices, Queensland University of Technology, Brisbane, QLD 4000, Australia
- ARC Training Centre for Cell and Tissue Engineering Technologies (CTET), Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
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Kisby C. A New Dimension in Pessary Care. Urogynecology (Phila) 2023; 29:307-308. [PMID: 37093573 DOI: 10.1097/spv.0000000000001360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Affiliation(s)
- Cassandra Kisby
- From the Division of Urogynecology, Department of Ob/Gyn, Duke Hospital, Durham, NC
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Hembree WC, Tarka MC, Pasternack JB, Mathew SE, Guyton GP. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2023; 105:737-743. [PMID: 36888693 DOI: 10.2106/jbjs.22.01382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
- Walter C Hembree
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
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