Current advancements in therapeutic approaches in orthopedic surgery: a review of recent trends

Patients prefer In-Office Needle Arthroscopy (IONA) over traditional surgical arthroscopy

Purpose

In-Office Needle Arthroscopy (IONA) is an emerging technology that has been primarily studied as a diagnostic tool. Recent evidence shows that it is a cost-effective alternative to hospital- and community-based MRI with comparable accuracy. Although exciting for surgeons and administrators, little is known about patients' perceptions of IONA. Level IV evidence shows that patients with claustrophobia or contra-indications to sedation prefer IONA to MRI for diagnostic purposes. However, no study to date has examined patients' preferences regarding IONA and traditional surgical arthroscopy. Therefore, this study was conceived with the purpose of gathering patients' perspectives on IONA as an alternative to traditional surgical arthroscopy through semi-structured interviews. A secondary outcome was to determine the real-life financial impact with respect to profit and cost of introducing IONA at an academic mid-sized Canadian hospital.

Method

All patients undergoing arthroscopic non-ligamentous knee surgery within a three-month period at a mid-sized academic hospital were approached for this study. A trained researcher conducted telephone interviews regarding patient experience with the entire surgical process, including diagnosis and treatment, suffering an injury, referral for MRI and sports surgeon, and booking arthroscopic surgery. Participants were provided information on IONA, including risks and benefits as an alternative to traditional arthroscopy, and were asked about their likelihood of choosing IONA as an alternative to their treatment pathway. Thematic and quantitative analysis was conducted based on interview results, with quantitative analysis conducted using a 5-point Likert scale. Financial analysis was conducted by observing the propensity to choose IONA via patients' response to the 5-point Likert scale and then modeled for cost effectiveness.

Results

Twenty-one patients were interviewed. The mean age was 32.3 (SD: 9.8) years old with 12 (57.1 %) females. Mean time from surgery to interview was 10.2 weeks (SD: 11.4). In general, patients' perceptions of IONA were favorable. When asked how likely they would have been to opt for IONA over traditional arthroscopy, the mean response was "very likely" (4.10 [1.26]). The mean likelihood for males to select IONA was higher than females (4.78 versus 3.58). Common reasons for wanting IONA were to speed up the time between injury and surgery (n = 9), avoiding a general anesthetic/intubation and associated complications (n = 7), and avoiding the fear/anxiety of surgery (n = 6). Most patients listed the lack of primary data on the effectiveness, pain, revision rate, and PROMs as the primary hesitation (n = 6). Financial analysis revealed that IONA would reduce costs by $21,832.66 (p < 0.0001), resulting in an increase in profit of $21,468.80 (p < 0.0001).

Conclusion

The most significant finding in this study is that IONA may be preferable by patients in a publicly funded healthcare system with limitations to operating room access. Patients believe that IONA can accelerate the diagnosis and treatment of meniscal injuries, allowing patients to avoid surgery via the traditional route of the operating room. Furthermore, it is shown to be a cost-effective alternative to MRI with similar diagnostic accuracy at a mid-sized Canadian institution.

Efficacy and safety of laser-assisted techniques in orthopedic surgery: a meta-analysis of randomized controlled trials

In orthopedic surgery, laser-assisted procedures have shown great promise as adjuncts, with the potential to enhance patient outcomes, decrease tissue damage, and increase precision. However, a thorough evaluation of their safety and effectiveness is essential. The purpose of this meta-analysis is to thoroughly assess the data from randomized controlled trials (RCTs) to ascertain the possible dangers and clinical advantages of using laser-assisted techniques during orthopedic procedures. We conducted a comprehensive literature search across PubMed, Cochrane Library, Embase, and Web of Science, covering publications until April 2024. RCTs evaluating laser-assisted techniques in orthopedic surgery were included if they reported on operative time, blood loss, postoperative pain, functional outcomes, complication rates, or patient satisfaction. Data were extracted by two independent reviewers and analyzed using SPSS software. Methodological quality was assessed using the Cochrane Risk of Bias tool. Twenty-three RCTs, involving a total of 2,032 patients, met the inclusion criteria. Laser-assisted techniques significantly reduced operative time (MD - 15.32 min; 95% CI - 22.45 to - 8.19; p < 0.001) and postoperative pain (MD - 1.27; 95% CI - 1.91 to - 0.63; p < 0.001). Although the reduction in blood loss did not reach statistical significance (MD - 52.18 mL; 95% CI - 114.32 to 9.96; p = 0.10), the trend suggested potential benefits. Functional outcomes and patient satisfaction were significantly improved, while complication rates were comparable to conventional methods (RR 0.98; 95% CI 0.82 to 1.17; p = 0.84). Publication bias was assessed and found to be minimal. Significant decreases in operating time and postoperative pain, as well as enhanced patient satisfaction and functional results, are linked to laser-assisted orthopedic surgery procedures. The trend points to a possible benefit even though the decrease in blood loss was not statistically significant. These results demonstrate the advantages and safety of laser technology and justify its use in orthopedic surgery. To standardize procedures and improve these methods in various surgical settings, more study is required.

Impact of insurance and implant coverage on arthroscopic shoulder surgery patients: a prospective multicenter analysis

BACKGROUND

Advances in implant technology for arthroscopic shoulder surgery allow patients to achieve similar success rates as traditional approaches with reduced morbidity and quicker recovery. However, in the U. S. health care system, insurance coverage for these implants remains variable. Unlike commercial carriers, patients with governmental insurance typically do not have coverage for arthroscopic shoulder implants. How this disparity impacts the health care of patients with shoulder pathology remains unclear.

METHODS

We performed a prospective multicenter study analyzing the effects of insurance type and implant coverage on patients undergoing arthroscopic shoulder surgery. Patients were selected upon confirmation of surgery. Each case was documented for patient age, American Society of Anesthesiologists score, body mass index, race, and sex. Each case was then categorized based on insurance carrier (traditional Medicare, managed Medicare, commercial plans, Medicaid, workers' compensation, cash, or other governmental insurance). The timing for surgery, primary surgical indication, whether a primary or revision surgery, number of anchors used, site of service (freestanding ambulatory surgery centers (ASCs) vs. hospital-based operating room), and utilization of biologic or structural grafts were all then tracked.

RESULTS

A total of 326 cases from 6 participating states were analyzed. In comparison to ASCs, patients having surgery in hospital settings were older (56.8 vs. 52.0 years), had a higher body mass index (31.3 vs. 29.0), had higher American Society of Anesthesiologists scores (2.4 vs. 1.9), and were more likely to be non-white (41.2% vs. 31.5%). (P < .05) After controlling for comorbidities, patients with Medicare Advantage (71%), Traditional Medicare (55%), and Medicaid/Cash (66%) were more likely to have their surgery in the hospital setting than patients with commercial plans (42%) (P < .05). Hospital patients waited significantly longer before surgery in comparison to ASC patients (45.9 days vs. 34.4 days) (P < .05). No statistically significant difference was identified between the number of anchors used and the insurance carrier (P = .58). A higher percentage of surgeries in the hospital (19.6%) included biologics vs. those in an ASC (10.4%) (P = .03).

CONCLUSION

Patients with governmental insurance plans were less likely to undergo arthroscopic shoulder surgery at an ASC than at a hospital-based facility. Patients who had their surgery at a hospital facility had a longer wait until surgery. Insurance carrier and implant coverage might influence where and when a patient receives care. Equal coverage of surgical implants for arthroscopic shoulder surgery would improve timely access and care for shoulder pathology. Legislatures should closely consider these findings when developing insurance policies.

From Bone To Blood Flow: Tissue Engineering In Orthopedics - A Narrative Review

Musculoskeletal injuries and degenerative conditions necessitate advanced regenerative solutions. Tissue engineering has emerged as a pivotal field in orthopedic care, particularly in vascularized bone and cartilage regeneration. This narrative review examines the latest advancements in vascular tissue engineering, including scaffold design, cell-based techniques, and growth factor delivery. A comprehensive literature search was conducted using PubMed, ScienceDirect, and Google Scholar, focusing on innovations and challenges in the field. Vascularized bone grafts (VBGs) outperform non-vascularized counterparts in promoting healing and integration. Advances in scaffold materials, such as smart scaffolds and hybrid biomaterials, enhance osteogenesis and angiogenesis. Cellular therapies, utilizing mesenchymal stem cells and induced pluripotent stem cells, synergistically improve vascularization and bone regeneration. Growth factors like VEGF and bone morphogenic protein (BMP-2), integrated with innovative delivery systems, enable sustained angiogenic stimulation and scaffold integration. While significant strides have been made, challenges persist in achieving full vascular integration and replicating native tissue architecture. Innovations in scaffold technology and vascular surgery techniques hold promise for transforming orthopedic tissue engineering and improving patient outcomes.

Surgical interventions in Severe Osteoarthritis: Pros and Cons

Severe osteoarthritis (OA) is a debilitating condition that often necessitates surgical intervention when conservative treatments fail. We carefully reviewed the literature on the pros and cons of surgical options for severe OA, focusing on total joint arthroplasty (TJA) and other surgical techniques. Total joint arthroplasty, including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is the most established surgical option for severe OA, providing significant pain relief, functional restoration, and improved quality of life. The American College of Rheumatology and the American Association of Hip and Knee Surgeons recommend proceeding to TJA without delay in patients with symptomatic moderate-to-severe OA unresponsive to nonoperative therapy. Osteotomies and cartilage repair procedures are less commonly performed and have limited evidence supporting their long-term efficacy in reducing OA progression. Arthroscopic interventions, such as lavage and debridement, do not alter disease progression and are not recommended for routine treatment of OA. While TJA is highly effective, it is associated with risks such as postoperative complications, revisions, and reoperations. The cost-effectiveness of TJA is well-documented, making it a favorable option for managing end stage OA. However, patient selection is crucial, and factors such as age, comorbidities, and obesity must be considered to optimize outcomes. Total joint arthroplasty remains the gold standard for surgical management of severe OA, offering substantial benefits in pain relief and functional improvement. Other surgical options, such as osteotomies and arthroscopy, have limited roles and should be considered based on individual patient factors and disease severity. Evidence-based guidelines support the timely use of TJA to enhance patient outcomes and quality of life.

Innovative 3D printing technologies and advanced materials revolutionizing orthopedic surgery: current applications and future directions

Three-dimensional (3D) printing has rapidly become a transformative force in orthopedic surgery, enabling the creation of highly customized and precise medical implants and surgical tools. This review aims to provide a more systematic and comprehensive perspective on emerging 3D printing technologies-ranging from extrusion-based methods and bioink printing to powder bed fusion-and the broadening array of materials, including bioactive agents and cell-laden inks. We highlight how these technologies and materials are employed to fabricate patient-specific implants, surgical guides, prosthetics, and advanced tissue engineering scaffolds, significantly enhancing surgical outcomes and patient recovery. Despite notable progress, the field faces challenges such as optimizing mechanical properties, ensuring structural integrity, addressing regulatory complexities across different regions, and considering environmental impacts and cost barriers, especially in low-resource settings. Looking ahead, innovations in smart materials and functionally graded materials (FGMs), along with advancements in bioprinting, hold promise for overcoming these obstacles and expanding the capabilities of 3D printing in orthopedics. This review underscores the pivotal role of interdisciplinary collaboration and ongoing research in harnessing the full potential of additive manufacturing, ultimately paving the way for more effective, personalized, and durable orthopedic solutions that improve patient quality of life.

Investigation into Application of AI and Telemedicine in Rural Communities: A Systematic Literature Review

Recent advances in artificial intelligence (AI) and telemedicine are transforming healthcare delivery, particularly in rural and underserved communities.

BACKGROUND/OBJECTIVES

The purpose of this systematic review is to explore the use of AI-driven diagnostic tools and telemedicine platforms to identify underlying themes (constructs) in the literature across multiple research studies.

METHOD

The research team conducted an extensive review of studies and articles using multiple research databases that aimed to identify consistent themes and patterns across the literature.

RESULTS

Five underlying constructs were identified with regard to the utilization of AI and telemedicine on patient diagnosis in rural communities: (1) Challenges/benefits of AI and telemedicine in rural communities, (2) Integration of telemedicine and AI in diagnosis and patient monitoring, (3) Future considerations of AI and telemedicine in rural communities, (4) Application of AI for accurate and early diagnosis of diseases through various digital tools, and (5) Insights into the future directions and potential innovations in AI and telemedicine specifically geared towards enhancing healthcare delivery in rural communities.

CONCLUSIONS

While AI technologies offer enhanced diagnostic capabilities by processing vast datasets of medical records, imaging, and patient histories, leading to earlier and more accurate diagnoses, telemedicine acts as a bridge between patients in remote areas and specialized healthcare providers, offering timely access to consultations, follow-up care, and chronic disease management. Therefore, the integration of AI with telemedicine allows for real-time decision support, improving clinical outcomes by providing data-driven insights during virtual consultations. However, challenges remain, including ensuring equitable access to these technologies, addressing digital literacy gaps, and managing the ethical implications of AI-driven decisions. Despite these hurdles, AI and telemedicine hold significant promise in reducing healthcare disparities and advancing the quality of care in rural settings, potentially leading to improved long-term health outcomes for underserved populations.

Clinical predictors of surgical selection for individuals with neck pain

BACKGROUND

Neck pain is one of the leading causes of disability in the United States. However, the nature of cervical spine surgery is multi-factorial and often based upon clinical opinions, leaving clinical indications still to be clearly defined.

OBJECTIVE

To predict which clinical variables most influenced trends toward surgical or conservative management for individuals with neck pain.

DESIGN

Retrospective analysis on prospectively collected data.

METHODS

Two-hundred seventy individuals participated in the study. A retrospective chart review was performed to identify qualifying participants. Variables captured during data collection included the following: patient demographic information, physical examination (e.g., neurologic examination), physical performance measures, patient-reported outcome measures (Numeric Pain Rating Scale and Neck Disability Index), and chronicity of symptoms. Group allocation was determined by referring physician's medical diagnosis. A forward step-wise multiple logistic regression analysis was used to develop a final predictor model with p < 0.05 considered significant.

RESULTS

The model showed older age (beta = 0.022; Exp(beta) = 1.022; p = 0.037), longer chronicity of symptoms (beta = 0.000; Exp(beta) = 1.000; p = 0.012), and greater neck disability (beta = 0.027; Exp(beta) = 1.028; p < 0.001) were significant predictors of the operative group. Most notably, patients with a positive neurologic examination were almost four times more likely to be referred to surgery (beta = 1.368; Exp(beta) = 3.927; p < 0.001).

CONCLUSION

In general neck pain patients, older age, longer chronicity of symptoms, greater disability, and a positive neuro exam are clinical predictors of surgical selection, with positive neuro exam increasing the likelihood of surgery four-fold.

Comparative analysis of the parapatellar and subpatellar approaches in reducing peripheral knee pain post-intramedullary tibial fracture surgery

INTRODUCTION

Intramedullary tibial nailing is a standard treatment for tibial shaft fractures. Postoperative knee pain significantly impacts functional recovery; however, studies on this issue are limited. This study evaluated the effect of the parapatellar approach for intramedullary nailing on postoperative knee pain.

MATERIALS AND METHODS

A total of 29 patients with tibial shaft fractures treated with intramedullary nails from March 2019 to January 2022 were divided into two groups based on the surgical approach: the semi-extended lateral parapatellar approach and the conventional subpatellar ligament split approach. Recorded metrics included operation time, intraoperative fluoroscopy count, intraoperative bleeding volume, Visual Analog Scale (VAS) scores for knee pain at 24 h, 72 h, 1 week, and 1 month postoperatively, fracture healing time and Lysholm knee functional scores at 12 months.

RESULTS

Both groups completed the operation without significant differences in operation time, intraoperative bleeding, fracture healing time, or intraoperative fluoroscopy (P > 0.05). The parapatellar group showed significantly better VAS scores for knee pain at 24 h, 72 h, and 1 week postoperatively compared to the control group (P < 0.05), with no significant difference at 1 month. After 12 months, Lysholm scores indicated no significant differences in knee support, locking, and swelling (P > 0.05); however, the parapatellar group showed significant improvements in lameness, instability, stair climbing, squatting, and pain (P < 0.05). Overall, the parapatellar group outperformed the control group (P = 0.01). Additionally, long-term follow-up revealed potential advantages of the parapatellar approach in improving long-term functional outcomes.

CONCLUSIONS

Using the parapatellar approach for tibial intramedullary nailing avoids splitting the patellar ligament and entering the joint cavity, minimizing knee joint impact and effectively reducing postoperative knee pain, with potential benefits in long-term functional recovery.

The Effects of the Addition of Strontium on the Biological Response to Calcium Phosphate Biomaterials: A Systematic Review

Strontium is known for enhancing bone metabolism, osteoblast proliferation, and tissue regeneration. This systematic review aimed to investigate the biological effects of strontium-doped calcium phosphate biomaterials for bone therapy. A literature search up to May 2024 across Web of Science, PubMed, and Scopus retrieved 759 entries, with 42 articles meeting the selection criteria. The studies provided data on material types, strontium incorporation and release, and in vivo and in vitro evidence. Strontium-doped calcium phosphate biomaterials were produced via chemical synthesis and deposited on various substrates, with characterization techniques confirming successful strontium incorporation. Appropriate concentrations of strontium were non-cytotoxic, stimulating cell proliferation, adhesion, and osteogenic factor production through key signaling pathways like Wnt/β-catenin, BMP-2, Runx2, and ERK. In vivo studies identified novel bone formation, angiogenesis, and inhibition of bone resorption. These findings support the safety and efficacy of strontium-doped calcium phosphates, although the optimal strontium concentration for desired effects is still undetermined. Future research should focus on optimizing strontium release kinetics and elucidating molecular mechanisms to enhance clinical applications of these biomaterials in bone tissue engineering.

Virtual Reality as a Pain Control Adjunct in Orthopedics: A Narrative Review

Orthopedic surgeons typically prescribe opioids for postoperative pain management as they are effective in managing pain. However, opioid use can lead to issues such as overdose, prescription excess, inadequate pain management, and addiction. Virtual reality (VR) therapy is an alternative route for postoperative pain management that has grown in popularity over the years. VR therapy involves immersing patients in a virtual 3D experience that is anticipated to alleviate pain. In this review article, we summarized the findings of numerous PubMed studies on the effectiveness of VR therapy for postoperative pain control. VR therapy is beneficial for reducing anxiety, pain, and opioid use after surgical procedures across various specialties. Further studies should explore VR therapy in orthopedic procedures.

Orthopedic Research Funding: Assessing the Relationship between Investments and Breakthroughs

Orthopedic research plays a crucial role in improving patient outcomes for musculoskeletal disorders. This narrative review explores the intricate interplay between funding patterns and the trajectory of breakthroughs achieved in this dynamic field. A meticulous search strategy identified studies illuminating the diverse sources of orthopedic research funding, including public funding (government agencies), philanthropic organizations, private sector investment, and international funding bodies. The review further delved into the spectrum of breakthroughs, encompassing fundamental scientific discoveries, technological advancements, and personalized medicine approaches. Public funding emerged as a significant pillar, supporting foundational research that lays the groundwork for future advancements. Philanthropic organizations addressed specific musculoskeletal disorders, often focusing on patient-centric applications. International funding bodies played a role in supporting research in low- and middle-income countries. Breakthroughs extended beyond cutting-edge prosthetics and minimally invasive surgeries, encompassing fundamental discoveries in areas like gene therapy and biomaterials science. Technological advancements included brain-computer interface prosthetics and 3D-printed implants. Personalized medicine offered the potential for tailored treatments based on individual needs and genetic profiles. This review underscores the complex interplay between funding patterns and breakthroughs in orthopedic research. A multifaceted approach is essential for continued progress. Fostering collaboration, optimizing funding models, and prioritizing both foundational and translational research hold the key to unlocking the true potential of orthopedic research and transforming the lives of patients suffering from musculoskeletal disorders.

Complications and Revision Surgery in Orthopedics Focusing on Traumatology

BACKGROUND

Orthopedic traumatology, a vital component of orthopedic surgery, poses significant challenges in managing complications and necessitating revision surgeries. These challenges impact clinical outcomes, healthcare economics, and patient well-being.

OBJECTIVE

This study aimed to provide insights that informed clinical decision-making and improved patient outcomes by thoroughly examining the range of complications encountered in orthopedic traumatology. Specifically, the research focused on the indications, techniques, and outcomes of revision surgeries.

METHODOLOGY

This retrospective cohort research looked at orthopedic traumatology complications and revision procedures over a thorough two-year period from March 2021 to March 2023 at Hayatabad Medical Complex in Peshawar, Pakistan. The following information was gathered from 316 patients receiving orthopedic surgery for traumatic injuries: demographics, kinds of trauma, surgical methods, complications, indications, methods, and results of revision surgery. For data analysis, chi-square tests and descriptive statistics were used, with the goal of finding patterns and correlations within the research population.

RESULTS

The average age of the 316 patients was 42.5 years, and 64.76% of them were male (n = 192). The most frequent kind of trauma (n = 218; 69.01%) was fractures, which were mostly brought on by falls (n = 147; 46.52%). The most common surgical method (n = 138; 43.67%) was found to be internal fixation, which was followed by external fixation (n = 67; 21.20%). The most common complication (n = 78; 24.68%) was surgical site infection, which resulted in revision procedures mostly for infection (n = 68; 21.52%) and implant failure (n = 56; 17.72%). Debridement was the most often used revision approach (n = 95; 30.10%), and it was substantially correlated with surgical outcomes, such as increased function (31%) and full resolution (36%).

CONCLUSION

This research emphasizes the need to maximize patient outcomes for improved well-being and highlights the crucial role that careful care plays in managing complications and revision operations in orthopedic traumatology.

Short-Term Effects of Two COX-2 Selective Non-Steroidal Anti-Inflammatory Drugs on the Release of Growth Factors and Cytokines from Canine Platelet-Rich Gel Supernatants

(1) Background: There is a lack of knowledge about how a single dose of COX-2 selective non-steroidal anti-inflammatory drugs (NSAIDs) might affect the release of growth factors (GFs) and cytokines from canine platelet-rich gels (PRGs) and other hemocomponents. (2) Methods: A crossover study was conducted in six adult mongrel dogs. Animals were randomized to receive a single dose of either carprofen or firocoxib. PRG, temperature-induced platelet lysate (TIPL), chemically induced PL (CIPL), and plasma hemocomponents were obtained from each dog before (1 h) and after (6 h) the treatments. Platelet and leukocyte counts and determination of the concentrations of platelet-derived growth factor-BB, (PDGF-BB), transforming growth factor beta-1 (TGF-β1), interleukin 1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α) and IL-10 concentrations were assayed by ELISA in all hemocomponents. (3) Results: Both platelet and leukocyte counts and PDGF-BB concentrations were not affected by NSAIDs and time. Total TGF-β1 concentrations were not affected by NSAIDs; however, the release of this GF was increased in PRG supernatants (PRGS) at 6 h. IL-1β and TNF-α concentrations were significantly (p < 0.001) lower in both firocoxib PRGS and plasma at 6 h, respectively. IL-10 concentrations were significantly (p < 0.001) lower at 6 h in all hemocomponents treated with both NSAIDs. (4) Conclusions: The clinical implications of our findings could indicate that these drugs should be withdrawn from patients to allow their clearance before the clinical use of PRP/PRG. On the other hand, the prophylactic use of NSAIDs to avoid the inflammatory reactions that some patients might have after PRP/PRG treatment should be performed only in those animals with severe reactive inflammation to the treatment.

Innovations in Hybrid Laparoscopic Surgery: Integrating Advanced Technologies for Multidisciplinary Cases

Combining conventional laparoscopic techniques with cutting-edge technologies, such as robotics, improved imaging, and flexible equipment, hybrid laparoscopic techniques represent a revolutionary advancement in minimally invasive surgery. These methods have several benefits, such as increased accuracy, quicker healing periods, and fewer complications, which makes them especially useful in complicated multidisciplinary situations. The historical evolution, uses, benefits, and drawbacks of hybrid laparoscopic procedures are examined in this narrative review, which also covers urological, gastrointestinal, cardiothoracic, and gynecological surgery. The review focuses on how these methods promote interdisciplinary cooperation and creativity by enabling more accurate and successful surgical operations. It also discusses the equipment needs, integration difficulties, and technical difficulties that need to be resolved to reach the full potential of hybrid laparoscopic surgery. For hybrid laparoscopic procedures to become more widely used and effective in the future, there is a need for specialized training programs, interdisciplinary research collaborations, and ongoing technological advancements.