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Biodegradable materials, including natural and synthetic polymers and hydrolyzable metals, constitute the main components of temporary, implantable medical devices. Besides the intrinsic properties of the materials, the most critical factor determining the successful clinical outcome of implantable and degradable devices is the host response, particularly the immune response, which largely depends on the material features and degradation mechanisms. In this Review, we first survey the state of the art in terms of materials options for use in biodegradable medical devices, focusing on degradation mechanisms and their control. In particular, we highlight silk, which is emerging as an important polymer, owing to its mechanical robustness, bioactive component sequestration, degradability without problematic metabolic products and biocompatibility. We then discuss the host response to these biodegradable materials in terms of dynamic tissue–implant interfaces. Next, we examine the clinical translation of three leading biodegradable material systems — natural and synthetic biodegradable polymers and biodegradable metals — and the related challenges in the context of orthopaedic fixation devices, cardiovascular stents and biodegradable electronic devices. Looking to the future, we propose updated material design strategies to improve the clinical outcomes for these biodegradable medical devices. Clinical outcomes with implantable and degradable devices largely depend on host response. This Review surveys material options and degradation mechanisms relevant to host responses to biodegradable devices, examines clinical translation of leading biodegradable materials and proposes updated material-design strategies to improve device performance.

Purpose This systematic review aims to provide an overview of the current knowledge on the role of the metaverse, augmented reality, and virtual reality in reverse shoulder arthroplasty. Methods A systematic review was performed using the PRISMA guidelines. A comprehensive review of the applications of the metaverse, augmented reality, and virtual reality in in-vivo intraoperative navigation, in the training of orthopedic residents, and in the latest innovations proposed in ex-vivo studies was conducted. Results A total of 22 articles were included in the review. Data on navigated shoulder arthroplasty was extracted from 14 articles: seven hundred ninety-three patients treated with intraoperative navigated rTSA or aTSA were included. Also, three randomized control trials (RCTs) reported outcomes on a total of fifty-three orthopedics surgical residents and doctors receiving VR-based training for rTSA, which were also included in the review. Three studies reporting the latest VR and AR-based rTSA applications and two proof of concept studies were also included in the review. Conclusions The metaverse, augmented reality, and virtual reality present immense potential for the future of orthopedic surgery. As these technologies advance, it is crucial to conduct additional research, foster development, and seamlessly integrate them into surgical education to fully harness their capabilities and transform the field. This evolution promises enhanced accuracy, expanded training opportunities, and improved surgical planning capabilities.

Monitoring shoulder kinematics, including the scapular segment, is of great relevance in the orthopaedic field. Among wearable systems, magneto-inertial measurement units (M-IMUs) represent a valid alternative for applications in unstructured environments. The aim of this systematic literature review is to report and describe the existing methods to estimate 3D scapular movements through wearable systems integrating M-IMUs. A comprehensive search of PubMed, IEEE Xplore, and Web of Science was performed, and results were included up to May 2023. A total of 14 articles was included. The results showed high heterogeneity among studies regarding calibration procedures, tasks executed, and the population. Two different techniques were described, i.e., with the x-axis aligned with the cranial edge of the scapular spine or positioned on the flat surface of the acromion with the x-axis perpendicular to the scapular spine. Sensor placement affected the scapular motion and, also, the kinematic output. Further studies should be conducted to establish a universal protocol that reduces the variability among studies. Establishing a protocol that can be carried out without difficulty or pain by patients with shoulder musculoskeletal disorders could be of great clinical relevance for patients and clinicians to monitor 3D scapular kinematics in unstructured settings or during common clinical practice.

We present a computational model that integrates mechanobiological regulations, angiogenesis simulations and models natural callus development to simulate bone fracture healing in rodents. The model inputs include atomic force microscopy values and micro-computed tomography on the first-day post osteotomy, which, combined with detailed finite element modeling, enables scrutinizing mechanical and biological interactions in early bone healing and throughout the healing process. The model detailed mesenchymal stem cell migration patterns, which are essential for tissue transformation and vascularization during healing, indicating the vital role of blood supply in the healing process. The model predicted bone healing in rodents ( n  = 48) over 21 days, matching daily tissue development with histological evidence. The developed computational model successfully predicts tissue formation rates and stiffness, reflecting physiological callus growth, and offers a method to simulate the healing process, potentially extending to humans in the future.

Prosthetic joint infections (PJIs) are a serious complication of orthopedic surgery. Bacteriophage (phage) therapy shows promise as an adjunctive treatment but requires further study, particularly in its pharmacokinetics. Consequently, we performed a pharmacokinetic assessment of phage therapy for PJIs using a Staphylococcus epidermidis Kirschner wire-based prosthesis rat model. We used 52 male Sprague–Dawley rats in four groups: negative controls (no phage, sterile implant), PJI controls (bacteria, no phage), sterile phage (phages given, sterile implant), and PJI (bacteria, phages given). The PJI groups were inoculated with ~106 CFU of S. epidermidis. The groups receiving phage were intra-articularly injected with ~108 PFU of vB_SepM_Alex five days post-implantation. The rats were euthanized between 30 min and 48 h post-injection. The measured phage concentrations between the PJI rats and the sterile controls in periarticular tissues were not significantly different. In a noncompartmental pharmacokinetic analysis, the estimated phage half-lives were under 6 h (combined: 3.73 [IQR, 1.45, 10.07]). The maximum phage concentrations were reached within 2 h after administration (combined: 0.75 [0.50, 1.75]). The estimated phage mean residence time was approximately three hours (combined: 3.04 [1.44, 4.19]). Our study provides a preliminary set of pharmacokinetic parameters that can inform future phage dosing studies and animal models of phage therapy for PJIs.

Fragility hip fractures and their associated morbidity and mortality pose a global healthcare problem. Several pharmaceutical products have been postulated to alter bone architecture and contribute to fragility hip fractures. We searched four electronic databases from inception to September 2017. Inclusion criteria were the following: (1) adult patients with fragility hip fractures, (2) full text in English, (3) minimum one-year follow-up, and (4) reporting of at least one risk factor. To minimize heterogeneity among the studies, we performed subgroup analyses. Whenever heterogeneity remained significant, we employed random effect meta-analysis for data pooling. Thirty-eight studies were included, containing 1,244,155 subjects and 188,966 cases of fragility hip fractures. Following medications were significantly associated with fragility hip fractures: Antidepressants (OR 2.07, 95% CI 1.98–2.17), antiparkinsonian drugs (OR 2.21, 95% CI 1.15–4.24), antipsychotic drugs (OR 2.0, 95% CI 1.50–2.66), anxiolytic drugs (OR 1.44, 95% CI 1.19–1.75), benzodiazepines (OR 1.84, 95% CI 1.26–2.69), sedatives (OR 1.33, 95% CI 1.14–1.54), systemic corticosteroids (OR 1.65, 95% CI 1.37–1.99), H 2 antagonists (OR 1.21, 95% CI 1.18–1.24), proton pump inhibitors (OR 1.41, 95% CI 1.16–1.71), and thyroid hormone (OR 1.29, 95% CI 1.13–1.47). Hormone replacement therapy with estrogen (HRT) was associated with decreased risk of hip fracture (OR 0.80, 95% CI 0.65–0.98). There are several medications associated with sustaining a fragility hip fracture. Medical interventions should be considered for patients on these medications, including information about osteoporosis and fracture prevention.

Osteoporosis represents a major health problem, resulting in substantial increases in health care costs. There is an unmet need for a cost-effective technique that can measure bone properties without the use of ionizing radiation. The present study reports design, construction, and testing of a safe, and easy to use radiofrequency device to detect osteoporotic bone conditions. The device uses novel on-body antennas contacting the human wrist under an applied, operator-controlled pressure. For the dichotomous diagnostic test, we selected 60 study participants (23–94 years old, 48 female, 12 male) who could be positively differentiated between healthy and osteopenic/osteoporotic states. The band-limited integral of the transmission coefficient averaged for both wrists, multiplied by age, and divided by BMI has been used as an index. For a 100 MHz frequency band centered about 890–920 MHz, the maximum Youden’s J index is 81.5%. Both the sensitivity and specificity simultaneously reach 87% given the calibration device threshold tolerance of ±3%. Our approach correlates well with the available DXA measurements and has the potential for screening patients at risk for fragility fractures, given the ease of implementation and low costs associated with both the technique and the equipment. The inclusion of radiofrequency transmission data does add supplementary useful information to the available clinical risk factors.

Background Bone healing process includes four phases: inflammatory response, soft callus formation, hard callus development, and remodeling. Mechanobiological models have been used to investigate the role of various mechanical and biological factors on bone healing. However, the effects of initial healing phase, which includes the inflammatory stage, the granulation tissue formation, and the initial callus formation during the first few days post-fracture, are generally neglected in such studies. Methods In this study, we developed a finite-element-based model to simulate different levels of diffusion coefficient for mesenchymal stem cell (MSC) migration, Young’s modulus of granulation tissue, callus thickness and interfragmentary gap size to understand the modulatory effects of these initial phase parameters on bone healing. Results The results quantified how faster MSC migration, stiffer granulation tissue, thicker callus, and smaller interfragmentary gap enhanced healing to some extent. However, after a certain threshold, a state of saturation was reached for MSC migration rate, granulation tissue stiffness, and callus thickness. Therefore, a parametric study was performed to verify that the callus formed at the initial phase, in agreement with experimental observations, has an ideal range of geometry and material properties to have the most efficient healing time. Conclusions Findings from this paper quantified the effects of the initial healing phase on healing outcome to better understand the biological and mechanobiological mechanisms and their utilization in the design and optimization of treatment strategies. It is also demonstrated through a simulation that for fractures, where bone segments are in close proximity, callus development is not required. This finding is consistent with the concepts of primary and secondary bone healing.

IntroductionAmong the various hip fracture predictors explored to date, modifiable risk factors warrant special consideration, since they present promising targets for preventative measures. This systematic review and meta-analysis aims to assess various modifiable risk factors.Material and methodsWe searched four online databases in September 2017. We included studies that reported on modifiable lifestyle risk factors for sustaining fragility hip fractures. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS).The inclusion criteria consisted of (1) adult patients with osteoporotic hip fracture, (2) original study, (3) availability of full text articles in English, and (4) report of a modifiable lifestyle risk factor.ResultsThirty-five studies, containing 1,508,366 subjects in total, were included in this study. The modifiable risk factors that were significantly associated with an increased risk of hip fracture were the following: weight < 58 kg (128 lbs) (pooled OR 4.01, 95% CI 1.62–9.90), underweight body mass index (BMI) (< 18.5) (pooled OR 2.83, 95% CI 1.82–4.39), consumption of ≥ 3 cups of coffee daily (pooled OR 2.27, 95% CI 1.04–4.97), inactivity (pooled OR 2.14, 95% CI 1.21–3.77), weight loss (pooled OR 1.88, 95% CI 1.32–2.68), consumption of ≥ 27 g (approx. > 2 standard drinks) alcohol per day (pooled OR 1.54, 95% CI 1.12–2.13), and being a current smoker (pooled OR 1.50, 95% CI 1.22–1.85). Conversely, two factors were significantly associated with a decreased risk of hip fracture: obese BMI (> 30) (pooled OR 0.58, 95% CI 0.34–0.99) and habitual tea drinking (pooled OR 0.72, 95% CI 0.66–0.80).ConclusionModifiable factors may be utilized clinically to provide more effective lifestyle interventions for at risk populations. We found that low weight and underweight BMI carried the highest risk, followed by high coffee consumption, inactivity, weight loss, and high daily alcohol consumption.

Partial-thickness rotator cuff tears are a common cause of pain and disability and are central to developing full-thickness rotator cuff tears. However, limited knowledge exists regarding the alterations to the mechanical environment due to these lesions. Computational models that study the alterations to the mechanical environment of the supraspinatus tendon can help advance clinical management to avoid tear progression and provide a basis for surgical intervention. In this study, we use three-dimensional validated finite element models from six intact specimens to study the effects of low- and high-grade tears originating on the articular and bursal surfaces of the supraspinatus tendon. Bursal-sided tears generally had a lower failure load, modulus, and strain than articular-sided tears. Thus, caution should be taken when managing bursal-sided tears as they may be more susceptible to tear progression.