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Sundaram K, Warren JA, Klika A, Piuzzi NS, Mont MA, Krebs V. Barbed sutures reduce arthrotomy closure duration compared to interrupted conventional sutures for total knee arthroplasty: a randomized controlled trial. Musculoskelet Surg 2020; 105:275-281. [PMID: 32146687 DOI: 10.1007/s12306-020-00654-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The broad aim of this study was to compare the safety and efficacy of using barbed sutures versus standard-of-care sutures for closure of arthrotomy during total knee arthroplasty. Specifically, we compared the duration of arthrotomy closure, the number of sutures utilized for arthrotomy closure, and 90-day outcomes, including wound-related readmission, reoperation, and complications. MATERIALS AND METHODS A total of 60 patients undergoing primary total knee arthroplasty were enrolled in a prospective, blinded trial and randomized to receive either running closure of the arthrotomy with barbed sutures (n = 30) or interrupted closure with standard-of-care sutures (n = 30). RESULTS Arthrotomy closure time was significantly shorter in the barbed suture group (3 min ± 2 min) versus the standard-of-care group (13 min ± 5 min, p < 0.001). The average suture utilization for arthrotomy closure was 1 suture (range 1-2) versus 3 sutures (range 2-4) in the standard-of-care group (p < 0.001). The overall number of wound-related complications in the barbed suture group was 3/30 (10%) versus 3/30 (10%) in the standard-of-care group (p = 1.00). There was one dehiscence 1/30 (3%) in the standard-of-care group versus zero in the barbed suture group (p = 1.00). The rate of superficial surgical site infection was 1/30 (3%) in barbed suture versus zero in the standard-of-care groups (p = 1.00). CONCLUSION These results suggest barbed suture utilization may be faster and more resource-efficient than the use of standard-of-care sutures for arthrotomy closure in primary total knee arthroplasty without increased complications. CLINICALTRIALS. GOV IDENTIFIER NCT03285529.
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Affiliation(s)
- K Sundaram
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - J A Warren
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - A Klika
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - N S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - M A Mont
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, 10075, USA
| | - V Krebs
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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Mantripragada VP, Piuzzi NS, Bova WA, Boehm C, Obuchowski NA, Lefebvre V, Midura RJ, Muschler GF. Donor-matched comparison of chondrogenic progenitors resident in human infrapatellar fat pad, synovium, and periosteum - implications for cartilage repair. Connect Tissue Res 2019; 60:597-610. [PMID: 31020864 DOI: 10.1080/03008207.2019.1611795] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 02/03/2023]
Abstract
Purpose: There is a clinical need to better characterize tissue sources being used for stem cell therapies. This study focuses on comparison of cells and connective tissue progenitors (CTPs) derived from native human infrapatellar fatpad (IPFP), synovium (SYN), and periosteum (PERI). Materials and Methods: IPFP, SYN, PERI were harvested from twenty-eight patients undergoing arthroplasty. CTPs were quantitatively characterized using automated colony-forming-unit assay to compare total nucleated cell concentration-[Cell], cells/mg; prevalence-(PCTP), CTPs/million nucleated cells; CTP concentration-[CTP], CTPs/mg; proliferation and differentiation potential; and correlate outcomes with patient's age and gender. Results: [Cell] did not differ between IPFP, SYN, and PERI. PCTP was influenced by age and gender: patients >60 years, IPFP and SYN had higher PCTP than PERI (p < 0.001) and females had higher PCTP in IPFP (p < 0.001) and SYN (p = 0.001) than PERI. [CTP] was influenced by age: patients <50 years, SYN (p = 0.0165) and PERI (p < 0.001) had higher [CTP] than IPFP; patients between 60 and 69 years, SYN (p < 0.001) had higher [CTP] than PERI; patients >70 years, IPFP (p = 0.006) had higher [CTP] than PERI. In patients >60 years, proliferation potential of CTPs differed significantly (SYN>IPFP>PERI); however, differentiation potentials were comparable between all three tissue sources. Conclusion: SYN and IPFP may serve as a preferred tissue source for patients >60 years, and PERI along with SYN and IPFP may serve as a preferred tissue source for patients <60 years for cartilage repair. However, the heterogeneity among the CTPs in any given tissue source suggests performance-based selection might be useful to optimize cell-sourcing strategies to improve efficacy of cellular therapies for cartilage repair.
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Affiliation(s)
- V P Mantripragada
- Department of Biomedical Engineering, Lerner Research Institute , Cleveland , OH , USA
| | - N S Piuzzi
- Department of Biomedical Engineering, Lerner Research Institute , Cleveland , OH , USA.,Department of Orthopedic Surgery, Cleveland Clinic , Cleveland , OH , USA.,Department of Orthopaedic Surgery, Instituto Universitario del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - W A Bova
- Department of Biomedical Engineering, Lerner Research Institute , Cleveland , OH , USA
| | - C Boehm
- Department of Biomedical Engineering, Lerner Research Institute , Cleveland , OH , USA
| | - N A Obuchowski
- Department of Quantitative Health Science, Cleveland Clinic , Cleveland , OH , USA
| | - V Lefebvre
- Department of Cellular and Molecular Medicine, Cleveland Clinic , Cleveland , OH , USA
| | - R J Midura
- Department of Biomedical Engineering, Lerner Research Institute , Cleveland , OH , USA
| | - G F Muschler
- Department of Biomedical Engineering, Lerner Research Institute , Cleveland , OH , USA.,Department of Orthopedic Surgery, Cleveland Clinic , Cleveland , OH , USA
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Abstract
There is good scientific rationale to support the use of growth factors to promote musculoskeletal tissue regeneration. However, the clinical effectiveness of platelet-rich plasma (PRP) and other blood-derived products has yet to be proven. Characterization and reporting of PRP preparation protocols utilized in clinical trials for the treatment of musculoskeletal disease is highly inconsistent, and the majority of studies do not provide sufficient information to allow the protocols to be reproduced. Furthermore, the reporting of blood-derived products in orthopaedics is limited by the multiple PRP classification systems available, which makes comparison of results between studies challenging. Several attempts have been made to characterize and classify PRP; however, no consensus has been reached, and there is lack of a comprehensive and validated classification. In this annotation, we outline existing systems used to classify preparations of PRP, highlighting their advantages and limitations. There remains a need for standardized universal nomenclature to describe biological therapies, as well as a comprehensive and reproducible classification system for autologous blood-derived products. Cite this article: Bone Joint J 2019;101-B:891–896.
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Affiliation(s)
- L. A. Rossi
- Department of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - I. R. Murray
- Resident in Orthopaedic Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
- Department of Trauma and Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - C. R. Chu
- Department of Orthopedic Surgery, Stanford University, Stanford, California, USA
- VA Palo Alto, Palo Alto, California, USA
| | - G. F. Muschler
- Director of the Joint Preservation Center, and Director of the Regenerative Medicine Laboratory, Cleveland Clinic, Cleveland, Ohio, USA
| | - S. A. Rodeo
- Tissue Engineering, Regeneration, and Repair Program, Hospital for Special Surgery, New York, New York, USA
- Orthopaedic Surgery, Weill Medical College of Cornell University, New York, New York, USA
- The Hospital for Special Surgery, New York, New York, USA
- New York Giants Football, New York, New York, USA
| | - N. S. Piuzzi
- Cleveland Clinic, Cleveland, Ohio, USA
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Mantripragada VP, Piuzzi NS, Zachos T, Obuchowski NA, Muschler GF, Midura RJ. Histopathological assessment of primary osteoarthritic knees in large patient cohort reveal the possibility of several potential patterns of osteoarthritis initiation. Curr Res Transl Med 2017; 65:133-139. [PMID: 29132902 PMCID: PMC5731834 DOI: 10.1016/j.retram.2017.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The two main objectives of the study include (1) Test the hypothesis that the lateral femoral condyle (LFC) in patients with primary OA and varus knees undergoing total knee arthroplasty (TKA) can be used as a model to better characterize varying histological features of human OA, (2) Correlate characteristic OA features using the established histopathological scoring systems (HHGS and OARSI) to understand potential histopathological patterns of OA initiation. DESIGN Two osteochondral specimens (4×4×8mm) were collected from fifty patient's LFC at the time of TKA (total 100 specimens), who presented preserved lateral knee compartment with joint space width>2mm. Three independent readers graded the sections on three different occasions using HHGS and OARSI systems. The correlation between individual parameters of the two scoring systems and their inter- and intra-reader variability, reliability and reproducibility were estimated. RESULTS All samples in this cohort showed abnormal histopathological features. Total histopathological scores of the LFC ranged from HHGS median=4.6 (range=0 to 11), and OARSI median=5.2 (range=0 to 19.5). The four individual sub-items of HHGS scoring system (structure, cells, safraninO staining, tidemark) were weakly correlated, with the correlation between structure and cellularity being the strongest (r=0.40). Both the scoring systems had similar repeatability and reproducibility coefficients of<21%. CONCLUSIONS OA changes in the LFC are not confined to any one region, and maybe seen in different regions of cartilage, tidemark, subchondral bone, and/or the marrow space vascularity. These variations may point to the possibility of several potential patterns of initiation in OA.
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Affiliation(s)
- V P Mantripragada
- Department of biomedical engineering, Lerner research institute, Cleveland clinic, 9500 Euclid avenue, OH 44195 Cleveland, USA.
| | - N S Piuzzi
- Department of biomedical engineering, Lerner research institute, Cleveland clinic, 9500 Euclid avenue, OH 44195 Cleveland, USA; Department of orthopedic surgery, Cleveland clinic, OH 44195 Cleveland, USA; Instituto Universitario del Hospital Italiano de Buenos Aires, Potosí 4234, C1199ACL Caba, Argentina
| | - T Zachos
- Department of orthopedic surgery, Cleveland clinic, OH 44195 Cleveland, USA
| | - N A Obuchowski
- Department of quantitative health science, Cleveland clinic, OH 44195 Cleveland, USA
| | - G F Muschler
- Department of biomedical engineering, Lerner research institute, Cleveland clinic, 9500 Euclid avenue, OH 44195 Cleveland, USA; Department of orthopedic surgery, Cleveland clinic, OH 44195 Cleveland, USA
| | - R J Midura
- Department of biomedical engineering, Lerner research institute, Cleveland clinic, 9500 Euclid avenue, OH 44195 Cleveland, USA
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Chughtai M, Piuzzi NS, Khlopas A, Jones LC, Goodman SB, Mont MA. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J 2017; 99-B:1267-1279. [PMID: 28963146 DOI: 10.1302/0301-620x.99b10.bjj-2017-0233.r2] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [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] [Received: 02/22/2017] [Accepted: 06/09/2017] [Indexed: 12/24/2022]
Abstract
Non-traumatic osteonecrosis of the femoral head is a potentially devastating condition, the prevalence of which is increasing. Many joint-preserving forms of treatment, both medical and surgical, have been developed in an attempt to slow or reverse its progression, as it usually affects young patients. However, it is important to evaluate the best evidence that is available for the many forms of treatment considering the variation in the demographics of the patients, the methodology and the outcomes in the studies that have been published, so that it can be used effectively. The purpose of this review, therefore, was to provide an up-to-date, evidence-based guide to the management, both non-operative and operative, of non-traumatic osteonecrosis of the femoral head. Cite this article: Bone Joint J 2017;99-B:1267-79.
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Affiliation(s)
| | | | - A Khlopas
- Cleveland Clinic, Cleveland, Ohio, USA
| | - L C Jones
- Johns Hopkins University, Baltimore, Maryland, USA
| | - S B Goodman
- Stanford University, Stanford, California, USA
| | - M A Mont
- Cleveland Clinic, Cleveland, Ohio, USA
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Ayerza MA, Piuzzi NS, Aponte-Tinao LA, Farfalli GL, Muscolo DL. Structural allograft reconstruction of the foot and ankle after tumor resections. Musculoskelet Surg 2016; 100:149-156. [PMID: 27324025 DOI: 10.1007/s12306-016-0413-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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] [Received: 12/21/2015] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Structural allografts have been used to correct deformities or to fill bone defects secondary to tumor excisions, trauma, osteochondral lesions, or intercalary arthrodesis. However, the quality of published evidence supporting the use of allograft transplantation in foot and ankle surgery has been reported as fair. The purpose of this study was to report the overall survival of structural allograft in the foot and ankle after tumor resection, and the survival according to the type of allograft and the complication rates in the medium to long term. MATERIALS AND METHODS From January 1989 to June 2011, 44 structural allograft reconstructions of the foot and ankle were performed in 42 patients (28 men and 14 women) due to musculoskeletal tumor resections. Mean age at presentation was 27 years. Mean follow-up was 53 months. Demographic data, diagnosis, site of the neoplasm, operations performed, operative complications, outcomes after surgery, date of last follow-up evaluation, and local recurrences were reviewed for all patients. Regarding the type of 44 allograft reconstructions, 16 were hemicylindrical allografts (HA), 12 intercalary allografts (IA), 10 osteoarticular allografts (OA), and 6 were total calcaneal allograft (CA). RESULTS The overall allograft survival rate, as calculated with the Kaplan-Meier method, at 5 and 10 years was 79 % (95 % CI 64-93 %). When allocated by type of allograft reconstruction the specific allograft survival at 5 and 10 years was: 83 % for CA, 80 % for HA, 77 % for OA, and 75 % for IA. The complications rate for this series was 36 % including: articular failure, local recurrence, infection, fracture and nonunion. CONCLUSION This study showed that structural allograft reconstruction in the foot and ankle after tumor resection may be durable with a 79 % survival rate at 5 and 10 years. The two types of allografts that showed better survival rate were hemicylindrical allografts (80 %) and calcaneus allografts (83 %). The highest complication rates occurred after calcaneus allografts and osteoarticular allografts. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M A Ayerza
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina.
| | - N S Piuzzi
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina
| | - L A Aponte-Tinao
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina
| | - G L Farfalli
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina
| | - D L Muscolo
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina
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Gallucci GL, Piuzzi NS, Slullitel PAI, Boretto JG, Alfie VA, Donndorff A, De Carli P. Non-surgical functional treatment for displaced olecranon fractures in the elderly. Bone Joint J 2014; 96-B:530-4. [DOI: 10.1302/0301-620x.96b4.33339] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We retrospectively evaluated the clinical and radiological outcomes of a consecutive cohort of patients aged > 70 years with a displaced fracture of the olecranon, which was treated non-operatively with early mobilisation. We identified 28 such patients (27 women) with a mean age of 82 years (71 to 91). The elbow was initially immobilised in an above elbow cast in 90° of flexion of the elbow for a mean of five days. The cast was then replaced by a sling. Active mobilisation was encouraged as tolerated. No formal rehabilitation was undertaken. At a mean follow-up of 16 months (12 to 26), the mean ranges of flexion and extension were 140° and 15° respectively. On a visual analogue scale of 1 (no pain) to 10, the mean pain score was 1 (0 to 8). Of the original 28 patients 22 developed nonunion, but no patients required surgical treatment. We conclude that non-operative functional treatment of displaced olecranon fractures in the elderly gives good results and a high rate of satisfaction. Cite this article: Bone Joint J 2014;96-B:530–4.
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Affiliation(s)
- G. L. Gallucci
- Hospital Italiano Buenos Aires, Dr
Carlos E. Ottolenghi Orthopaedic Service, Buenos Aires, Argentina
| | - N. S. Piuzzi
- Hospital Italiano Buenos Aires, Dr
Carlos E. Ottolenghi Orthopaedic Service, Buenos Aires, Argentina
| | - P. A. I. Slullitel
- Hospital Italiano Buenos Aires, Dr
Carlos E. Ottolenghi Orthopaedic Service, Buenos Aires, Argentina
| | - J. G. Boretto
- Hospital Italiano Buenos Aires, Dr
Carlos E. Ottolenghi Orthopaedic Service, Buenos Aires, Argentina
| | - V. A. Alfie
- Hospital Italiano Buenos Aires, Dr
Carlos E. Ottolenghi Orthopaedic Service, Buenos Aires, Argentina
| | - A. Donndorff
- Hospital Italiano Buenos Aires, Dr
Carlos E. Ottolenghi Orthopaedic Service, Buenos Aires, Argentina
| | - P. De Carli
- Hospital Italiano Buenos Aires, Dr
Carlos E. Ottolenghi Orthopaedic Service, Buenos Aires, Argentina
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