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Background Periprosthetic femoral fractures are challenging complications of hip arthroplasty. They are supposed to be a rare complication, but their incidence is rapidly increasing. Surgical treatment aims to achieve early mobilization and avoid the complications of prolonged bed rest. Aim of this study is to evaluate the clinical outcomes of surgical treatment comparing two surgical approaches: revision arthroplasty (RA) versus open reduction and internal fixation (ORIF). Methods Authors retrospectively reviewed a series of 117 patients with total hip arthroplasty treated for periprosthetic femur fractures in the period between January 2013 and March 2018 at a single tertiary referral center. Of these, 70 patients satisfied strict inclusion criteria. Patients were classified according to the Unified Classification System (UCS) and distributed in two groups according to surgical treatment. Clinical outcomes were assessed using the Oxford Hip recorded preoperatively and post operatively, Barthel Score, CIRS score (Cumulative illness rating scale), type of fracture and post-operative complications with a minimum follow up of 1 year. Results Nominal univariate statistical analysis revealed significant differences between the post and pre-operative Oxford Hip Score (Δ Oxford) and the surgical treatment ( p  = 0.008) and CIRS score ( p  = 0.048). Moreover, we observed a significant relationship between type of treatment and type of fracture ( p  = 0.0001). Multivariate analyses revealed that CIRS score was independently associated with Oxford Score improvement after surgery ( p  = 0.024). Conclusions Data from this case series confirmed that surgical treatment was correlated to type of fracture, according to UCS classification. Patients treated by RA had a better functional outcome than patients treated with ORIF, but these results are strongly influenced from the patients’ age, Barthel index and CIRS score. Also, authors found a correlation between functional outcome and comorbidities evaluated by CIRS score. Based on these data we suggest a multimodal approach to these patients, like those used for proximal femoral fractures.

Extremely low-frequency and low-intensity electromagnetic fields show positive effects on the treatment of several osteoarticular diseases, such as osteoarthritis, and are currently applied in the clinical setting with promising results on tissue regeneration. However, the biological mechanisms underlying the beneficial effects triggered by this type of physical stimulation still need to be deciphered. We tested the hypothesis that ultra-low complex electromagnetic fields stimulation using an innovative medical device could enhance chondrogenesis in human adipose-derived stem cells (ADSCs), and analyzed its biological effects. Chondrogenic lineage markers, like ACAN, SOX9, RUNX2, COL2A1, and COL10A1, were evaluated after 21 days of treatment. Thus far, we have provided preliminary evidence that a dedicated pattern of ultra-weak complex electromagnetic sequences emitted by a cutting-edge technology can promote cartilage regeneration, inducing the chondrogenic differentiation and maturity of ADSCs.

Background Intraarticular extension of a tumor requires a conventional extraarticular resection with en bloc removal of the entire knee, including extensor apparatus. Knee arthrodesis usually has been performed as a reconstruction. To avoid the functional loss derived from the resection of the extensor apparatus, a modified technique, saving the continuity of the extensor apparatus, has been proposed, but at the expense of achieving wide margins. In tumors involving the joint cavity, the entire joint complex including the distal femur, proximal tibia, the full extensor apparatus, and the whole inviolated joint capsule must be excised. We propose a novel reconstructive technique to restore knee function after a true extrarticular resection. Description of Technique The approach involves a true en bloc extraarticular resection of the whole knee, including the entire extensor apparatus. We performed the reconstruction with a femoral megaprosthesis combined with a tibial allograft-prosthetic composite with its whole extensor apparatus (quadriceps tendon, patella, patellar tendon, and proximal tibia below the anterior tuberosity). Patients and Methods We retrospectively reviewed 14 patients (seven with bone and seven with soft tissue tumors) who underwent this procedure from 1996 to 2009. Clinical and radiographic evaluations were performed using the MSTS-ISOLS functional evaluation system. The minimum followup was 1 year (average, 4.5 years; range, 1–12 years). Results We achieved wide margins in 13 patients (two contaminated), and marginal in one. There were three local recurrences, all in the patients with marginal or contaminated resections. Active knee extension was obtained in all patients, with an extensor lag of 0° to 15° in primary procedures. MSTS-ISOLS scores ranged from 67% to 90%. No patients had neurovascular complications; two patients had deep infections. Conclusions Combining a true knee extraarticular resection with an allograft-prosthetic composite including the whole extensor apparatus generally allows wide resection margins while providing a mobile knee with good extension in patients traditionally needing a knee arthrodesis. Level of Evidence Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

IntroductionThe gold standard of Acetabular fractures treatment is open reduction and internal fixation (ORIF). Our purpose is to assess the short- to medium-term outcomes and complications of surgically treated acetabular fractures. We analysed factors influencing clinical outcomes, incidence of complications and predictors of conversion in total hip arthroplasty (THA).Materials and methodsWe retrospectively analysed 102 patients with acetabular fracture surgically treated between December 2017 and September 2020. We evaluated the quality of reduction with x-ray measuring residual displacement, classified into 3 groups (Matta Radiological Score). At the final follow-up, radiographs were graded according to Matta’s Radiological Outcome Grading, and the clinical outcomes were graded using Oxford Hip Score (OHS).Results62 patients were enrolled. OHS was influenced by quality of reduction (p = 0.031), injury severity score (ISS) (p = 0.003) and BMI > 30 (p < 0.0001). The late sequelae were heterotopic ossification (HO) in 13 patients, osteoarthritis (OA) in 22 and avascular necrosis (AVN) in 4. HO was significantly affected by posterior approach and ISS > 15. The analysis showed a correlation between AVN and posterior hip dislocation. OA had a correlation with postoperative quality of reduction (p = 0.014). Eight patients required THA with a significant correlation between THA and posterior dislocation, isolated posterior wall fracture and ISS > 15. ConclusionA high rate of patients with acetabular fractures still develop complications and require THA. Identification of predictors for poor outcome may help to inform surgical decision-making regarding options of plate osteosynthesis or ‘Fix and Replace’, to avoid poor outcomes and early revision surgery.

Purpose The purpose of our study is to describe the rationale, the surgical technique and the early clinical and radiographic results of the treatment of patients with early stage osteonecrosis of the femoral head (ONFH) by performing: core decompression, injection of autologous bone marrow concentrate and the use of a new composite injectable bone substitute (PRO-DENSE ® ), as a mechanical supplementation associated with decompression. Methods The study included 37 hips (31 patients, 14 females, 17 males; mean age 43.9 years, range 24–56 years) with stages IC–IIIA ONFH. The outcome was determined by the changes in the Harris hip score (HHS), by progression in radiographic stages and by the need for hip replacement. The mean follow-up was 20.6 months (range 12–32 months). Results At final follow-up the mean HHS increased from 68 points pre-operatively to 86 points post-operatively. The radiological results showed that 29 hips (78.4  %) improved or had no further collapse. The overall clinical success rate of the procedure was 86.5 %, with three conversions to THA, and a failure rate of only 3.3 % in the pre-collapse group. Conclusions We are encouraged by these early results using core decompression, injection of the autologous bone marrow concentrate and backfilling the defect with an injectable bioceramic for the treatment of early stages of ONFH; as far as a conclusion can be drawn from the current data, this treatment seems to relieve hip pain and prevent the progression of ONFH in the majority of the cases.

The use of modular endoprostheses is a viable option to manage both tumor resection and severe bone loss due to nonneoplastic conditions such as fracture sequelae, failed osteoarticular grafts, arthroplasty revisions, and periprosthetic fractures. We sought to investigate both midterm complications and failures occurred in 87 patients who underwent a megaprosthetic reconstruction in a nonneoplastic setting. After a mean follow-up of 58 (1–167) months, overall failure-free survival was 91.5% at 1 year, 80% at 2 years, 71.6% at 5 years, and 69.1% at 5 and 10 years. There was no significant difference in the survival rate according to the diagnosis at the index procedure (p=0.921), nor to the reconstruction site (p=0.402). The use of megaprostheses in a postneoplastic setting did not affect survival rate in comparison with endoprosthetic reconstruction of pure nonneoplastic conditions (p=0.851). Perimegaprosthetic infection was the leading complication, occurring in 10 (11.5%) patients and implying a megaprosthetic revision in all but one case. Physicians should consider these results when discussing with patients desired outcomes of endoprosthetic reconstructions of a nonneoplastic disease.

We assessed the occurrence of long-bone fracture and other side effects in a group of 214 consecutive patients who underwent radical excision for soft-tissue sarcoma of the limb followed by postoperative irradiation. Two hundred fourteen patients underwent postoperative irradiation after radical excision of soft-tissue sarcoma of the limb; 156 (73%) received postoperative brachytherapy (BRT) plus external-beam radiation therapy (EBRT), and 58 (27%) underwent postoperative EBRT only. All patients were followed-up for a median time of 4.5 years (range 3 months to 10 years). Seven patients developed bone fracture, which is considered severe morbidity; time between surgery and occurrence of fracture ranged between 10 and 72 months (average 31). Severe sclerosis with impairment of limb function was diagnosed in 5 and peripheral nerve damage in 3 patients. Wound complications were detected in 8 patients. In our series, no statistically significant correlation between bone fracture and clinical features or “technical” parameters was found, but all of the patients who experienced bone fracture (7 of 7) were postmenopausal women >55 years old.

Wounds are common in equine practice, and often lead to complications such as infections, delayed healing and hypertrophic scarring, which can be costly and difficult to manage. Developing affordable and effective treatments has become an increasingly important focus in veterinary research. Equine advanced-platelet-rich fibrin plus (A-PRF+) demonstrates regenerative properties comparable to its human counterpart, but cellular-level investigations exploring its molecular mechanisms remain limited. This study aimed to investigate the in vitro effects of equine A-PRF + on primary fibroblast cell cultures. The secretome analysis of A-PRF + revealed a complex protein profile involved in matrix remodelling, cell proliferation, and inflammation. Treatment with this platelet concentrate resulted in increased cell proliferation, enhanced migration, and significant changes in cell cycle progression compared to control groups. Reactive oxygen species production and organelles metabolism stimulation were observed, indicating active cellular responses, as well as an increase in genes and proteins associated with cell proliferation and wound regeneration. Proteomic analysis of treated fibroblasts confirmed the differential expression of key proteins associated with extracellular matrix dynamics and tissue regeneration processes. These findings provide insights into the molecular profile and functional responses of equine fibroblasts exposed to A-PRF + , contributing to our understanding of its cellular effects, supporting further exploration of this product in regenerative medicine applications.

Purpose Large osteochondral defects involve two different tissues characterized by different intrinsic healing capacity. Different techniques have been proposed to treat these lesions with results still under discussion. The aim of the study is to evaluate the clinical outcome of 19 patients treated with a type I collagen–hydroxyapatite nanostructural biomimetic osteochondral scaffold at minimum follow-up of 2 years. Methods Twenty lesions, 19 patients were treated with this scaffold implantation. The lesions size went from 4 to 8 cm 2 (mean size 5.2 ± 1.6 cm 2 ). All patients were clinically evaluated using the International Repair Cartilage Society score, the Tegner Score and EQ-VAS. MRI was performed at 12 and 24 months after surgery and then every 12 months and evaluated with magnetic resonance observation of cartilage repair tissue scoring scale. Results The IKDC subjective score improved from a mean score of 35.7 ± 6.3 at the baseline evaluation to 67.7 ± 13.4 at 12-month follow-up ( p  < 0.0005). A further improvement was documented from 12 to 24 months (mean score of 72.9 ± 12.4 at 24 months) ( p  < 0.0005). The IKDC objective score confirmed the results. The Tegner activity score improvement was statistically significant ( p  < 0.0005). The EQ-VAS showed a significant improvement from 3.15 ± 1.09 to 7.35 ± 1.14 ( p  < 0.0005) at 2-year follow-up. The lesion’ site seems to influence the results showing a better outcome in the patients affected in the medial femoral condyle. Conclusions The use of the MaioRegen scaffold is a good procedure for the treatment for large osteochondral defects where other classic techniques are difficult to apply. It is an open one-step surgery with promising stable results at medium follow-up. Level of evidence IV.

Postmortem cadaveric changes are commonly used to estimate the postmortem interval (PMI) in humans and animals. However, these modifications have been poorly investigated in animals of interest to veterinary forensic pathology. The aim of this study was to investigate the potential use of muscle proteins (desmin and dystrophin) as biomarkers for estimating the PMI in dogs. For this study, 10 dead adult dogs were evaluated for 4 days in a temperature-controlled room at 19 ± 1 °C. For each animal, at 3, 24, 48, 72, and 96 h after death, a 1 × 1 × 1 cm cube of muscle tissue was removed from the vastus lateralis and triceps brachii. Protein expression levels were analyzed by immunohistochemical examination and immunoblot analysis. The obtained results showed rapid dystrophin degradation, with complete disappearance at 72 h after death. In contrast, desmin-positive fibers and desmin protein bands detected by immunoblot were observed on all 4 days of observation. Our findings suggest the potential use of muscle proteins as biomarkers for estimating the PMI in dogs.