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Peripheral inflammation and gait speed alterations are common in several neurological disorders and in the aging process, but the association between the two is not well established. The aim of this systematic literary review is to determine whether proinflammatory markers are a positive predictor for gait impairments and their complications, such as falls in older adults, and may represent a risk factor for slow gait speed and its complications. The systematic review was performed in line with the Preferred Report Items for Systematic Review and Meta-Analyses (PRISMA). A protocol for literature searches was structured a priori and designed according to the International Perspective Register of Systemic Review (PROSPERO: CRD42023451108). Peer-reviewed original articles were identified by searching seven electronic databases: Excerpta Medica Database (EMBASE), SciVerse (ScienceDirect), Scopus, PubMed, Medline, Web of Science, and the Cochrane Library. The search strategy was formulated based on a combination of controlled descriptors and/or keywords related to the topic and a manual search was conducted of the reference lists from the initially selected studies to identify other eligible studies. The studies were thoroughly screened using the following inclusion criteria: older adults, spatiotemporal gait characteristics, and proinflammatory markers. A meta-analysis was not performed due to the heterogeneity of the studies, and the results were narratively synthesized. Due to the clinical and methodological heterogeneity, the studies were combined in a narrative synthesis, grouped by the type of biomarkers evaluated. A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, spatiotemporal gait parameters such as gait velocity, and proinflammatory markers such as TNF-α, high sensitivity C-reactive (CRP) proteins, and IL-6. We included 21 out of 51 studies in our review, which examined the association between inflammatory biomarkers and gait impairment. This review highlights the role of TNF-α, CRP, and IL-6 in gait impairment. Biomarkers play an important role in the decision-making process, and IL-6 can be an effective biomarker in establishing the diagnosis of slow gait speed. Further longitudinal research is needed to establish the use of molecular biomarkers in monitoring gait impairment.

Human gait is usually studied in clinical environments, but wearable devices have extended gait analysis beyond traditional assessments. Older adults tend to walk differently indoors and outdoors; however, most gait assessments are conducted on indoor surfaces. It is therefore important to evaluate gait in various outdoor environments. Insights gained from these assessments significantly enhance our understanding of the impact of environmental factors on gait performance and ensure that clinical evaluations are effectively aligned with everyday locomotion. A total of 100 participants with foot pain, 38 young (18–45 years) and 62 older adults (65–80 years), completed a 10-Metre Walk Test (10MWT) in three randomised conditions at their typical, comfortable walking pace, including (1) 10MWT of indoor walking, (2) 10MWT of outdoor walking on grass and (3) 10MWT of outdoor walking on a sidewalk. Wearable inertial sensors recorded gait data and the magnitudes of the following gait measures: gait speed, cadence, stride length, stride duration and asymmetry. A statistical analysis using ANOVA and post hoc comparisons revealed a significantly lower gait speed (p < 0.001), lower stride length (p < 0.001) and lower asymmetry (p < 0.001) indoors compared to outdoors, demonstrating that environmental factors significantly affect spatio-temporal gait parameters. Wearable sensor-based gait analysis performed in controlled clinical settings may underestimate real-life conditions. Some important spatio-temporal parameters, useful in detecting people with gait impairment and at risk of falling, are significantly affected by environment and individual postural ability more than demographic factors.

Foot and ankle disorders are a very common diseases, represent a risk factor for falls in older people, and are associated with difficulty performing activities of daily living. With an increasing demand for cost-effective and high-quality clinical services, wearable technology can be strategic in extending our reach to patients with foot and ankle disorders. In recent years, wearable sensors have been increasingly utilized to assess the clinical outcomes of surgery, rehabilitation, and orthotic treatments. This article highlights recent achievements and developments in wearable sensor-based foot and ankle clinical assessment. An increasing number of studies have established the feasibility and effectiveness of wearable technology tools for foot and ankle disorders. Different methods and outcomes for feasibility studies have been introduced, such as satisfaction and efficacy in rehabilitation, surgical, and orthotic treatments. Currently, the widespread application of wearable sensors in clinical fields is hindered by a lack of robust evidence; in fact, only a few tests and analysis protocols are validated with cut-off values reported in the literature. However, nowadays, these tools are useful in quantifying clinical results before and after clinical treatments, providing useful data, also collected in real-life conditions, on the results of therapies.

Background: Dynamic balance plays a key role in high-impact sports, such as CrossFit, where athletes are required to maintain balance in various weightlifting exercises. The loss of balance in these sport-specific movements may not only affect athlete performance, but also increase the risk of injuries. Objectives: The aim of the study is to achieve greater insight into the balance and athlete position during the CrossFit training by means of inertial sensors, with a particular focus on the role of different custom foot orthoses (CFOs) in order to detect correlations with the role of the cavus foot. Methods: A total of 42 CrossFit® athletes, aged 25 to 42 years, were enrolled in this study. One-way ANOVA tests with post-hoc analysis of variance were used to compare foot posture groups and effects of different types of customized foot orthoses. Results: When comparing the effects of CFOs with the respective balance basal level during the pistol squat exercise, we observed a significant (p = 0.0001) decrease in the sway area, antero-posterior displacement (APD) and medio-lateral displacement (MLD) compared to the basal using both types of CFOs. Conclusion: No significant positive effects of CFOs were observed in some static tests. On the contrary, positive effects of CFOs and, in particular, postural insoles, are relevant to dynamic balance.

Hydroxyapatite (HA) is the main inorganic mineral that constitutes bone matrix and represents the most used biomaterial for bone regeneration. Over the years, it has been demonstrated that HA exhibits good biocompatibility, osteoconductivity, and osteoinductivity both in vitro and in vivo, and can be prepared by synthetic and natural sources via easy fabrication strategies. However, its low antibacterial property and its fragile nature restricts its usage for bone graft applications. In this study we functionalized a MgHA scaffold with gold nanorods (AuNRs) and evaluated its antibacterial effect against S. aureus and E. coli in both suspension and adhesion and its cytotoxicity over time (1 to 24 days). Results show that the AuNRs nano-functionalization improves the antibacterial activity with 100% bacterial reduction after 24 h. The toxicity study, however, indicates a 4.38-fold cell number decrease at 24 days. Although further optimization on nano-functionalization process are needed for cytotoxicity, these data indicated that Au-NRs nano-functionalization is a very promising method for improving the antibacterial properties of HA.

BackgroundStem choice in total hip arthroplasty (THA) for hip dysplasia is still controversial. The aims of the study were to evaluate (1) which stem design provided the highest percentage of adequate reconstructions in THA for dysplasia and (2) any correlation between the reconstructions provided by the stems and the native femoral morphology.Materials and methods150 CT scans including 200 adult dysplastic hips were randomly selected. Using the 3D CT-based software Hip-Op for surgical planning, the native hip anatomy was studied. Then, a single wedge tapered stem, an anatomical stem and a conical tapered stem were simulated in every hip. An adequate reconstruction of hip biomechanics was obtained when combined anteversion, offset restoration, coronal and sagittal tilt, canal filling and leg lengthening were inside the normal ranges.ResultsConical stems achieved the highest percentage of adequate reconstructions (87%, p < 0.0001). The anatomical stem was the worst performer. Single wedge and anatomical stem acceptability was mainly influenced by the combined anteversion. Stem anteversion was correlated with the femoral anteversion (fair correlation), the calcar femorale (fair) and the mediolateral femoral diameter at isthmus (poor). When the femoral anteversion was ≥ 25°, combined anteversion was very acceptable for the conical stem (99.2%), whereas the rate of acceptable combined anteversion for the single wedge tapered stem was 71.4%, and that for the anatomical stem was 51.6% (p < 0.0001).ConclusionsStem choice in developmental hip dysplasia is mainly driven by appropriate combined anteversion, which is dependent on the coronal and axial femoral morphologies. As a rule of thumb, tapered stems are adequate when femoral anteversion is < 25°; conical stems should be adopted for higher anteversions.Level of evidenceIV.

BackgroundIn total hip arthroplasty (THA), the outcomes of single taper (ST) and dual taper (DT) versions of the same stem design have been scarcely studied. A registry study comparing ST and DT versions of the same stem design was designed, aiming to assess: (1) the survival rates and the hazard ratios for failure; (2) the survival rates and the hazard ratios for failure using stem-focused endpoints.Material and methodsA regional arthroplasty registry was interrogated about stem designs with ST and DT versions in cementless THAs performed for primary osteoarthritis. Only the same cup and ceramic-on-ceramic bearings were included: the DT stems had a titanium-on-titanium modularity. Demographic and implant features were recorded. Survival rates and hazard ratios were evaluated and compared. Stem-focused endpoints were also investigated.ResultsA total of 5359 THAs were included, with three stem designs. The two versions of every stem showed different demographics and implant-related features: ST versions were preferentially implanted in heavier young men. For each stem, the two versions had similar survival rates at 5 years (p = 0.076; p = 0.319; p = 0.616) and similar adjusted hazard ratios for failures (p = 0.084; p = 0.308; p = 0.729). When stem-focused endpoints were adopted, the ST and DT versions of the three stems achieved similar survival rates (p = 0.710; p = 0.784; p = 0.983) and similar adjusted hazard ratios (p = 0.647; p = 0.858; p = 0.787). Three neck breakages occurred (0.0007% of all the modular implants).ConclusionsST and DT versions of the same stem design did not show any differences in terms of survival rates and hazard ratios for failures at 5 years.LEVEL OF EVIDENCE: IV.

Total hip arthroplasty (THA) has significantly improved the lives of patients with degenerative hip disorders. The direct anterior approach (DAA) is favored for its minimally invasive nature, leading to less postoperative pain and a faster recovery. The bikini incision (BI) approach was developed to enhance aesthetic outcomes while maintaining the clinical and functional benefits of the DAA. Despite its advantages, the BI technique presents challenges, controversies persist regarding its efficacy and safety, and there is no consensus within the medical community about its overall benefits. Incisions aligned with Langer’s lines, like the BI, promote better healing and minimal scarring. Studies indicate that BI patients report higher satisfaction with scar appearance and texture compared to traditional DAA patients. However, the BI carries a higher risk of lateral femoral cutaneous nerve (LFCN) injury, although most symptoms resolve within 6 months. For obese patients, the BI is associated with fewer complications, such as infections and delayed healing, compared to the conventional DAA, making it a safe and effective option. BI patients also experience better aesthetic outcomes and functional recovery, with reduced pain and itching. The BI technique in THA represents a significant advancement, offering improved aesthetic and wound-healing outcomes. The shift from the traditional DAA to the BI aligns with patient preferences for scars that are less visible and conspicuous. Despite the steep learning curve and risks, careful patient selection and refined surgical techniques can enhance the BI’s benefits. Future research should focus on long-term outcomes and comparative studies to further establish the BI’s efficacy and safety. As patient demand for aesthetically favorable surgeries grows, the BI is likely to become a preferred approach in THA.

IntroductionRecurrent dislocations are still the most frequent reason for revision in total hip arthroplasty (THA). The impact of bearing surfaces on dislocations is still controversial. We hypothesized that: (1) bearing surfaces influence the revisions due to dislocations; (2) ceramic-on-ceramic reduced the revisions for dislocations in adjusted models; (3) Delta-on-Delta bearings reduced the revisions for dislocations in comparison to surfaces with cross-linked polyethylene.Materials and methodsThe regional arthroplasty registry was enquired about bearing surfaces and revisions for dislocations and instability. Unadjusted and adjusted rates were provided, including sex, age (<65 years or ≥65 years), head diameter (≤28 mm or >28 mm; <36 mm or ≥36 mm) as variables. 44,065 THAs were included.ResultsThe rate of revisions for dislocations was significantly lower in ceramic-on-ceramic and metal-on-metal bearings (unadjusted rates). After adjusting for age, sex, and head size (36 and 28 mm), hard-on-hard bearings were protective (p < 0.05): ceramic-on-ceramic had a lower risk of revisions due to dislocation than ceramic-on-polyethylene (HR 1.6, 95% CI 1.2–2.2 p = 0.0009). The rate of revisions for dislocation was similar in bearings with cross-linked polyethylene and Delta-on-Delta articulations, in unadjusted and adjusted models.ConclusionBearings with conventional polyethylene were more predisposed to dislocations. Currently adopted bearings exerted no significant influence on revisions due to dislocations. These findings could be primarily related to wear, but due to the time distribution, soft tissue envelopes and surface tension may also play a role. Pre-clinical biomechanical evaluations and prospective matched cohort studies are required to draw definitive conclusions.

Acetabular bone defect quantification and classification is still challenging. The objectives of this study were to suggest and define parameters for the quantification of acetabular bone defects, to analyze 50 bone defects and to present the results and correlations between the defined parameters. The analysis was based on CT-data of pelvises with acetabular bone defects and their reconstruction via a statistical shape model. Based on this data, bone volume loss and new bone formation were analyzed in four sectors (cranial roof, anterior column, posterior column, and medial wall). In addition, ovality of the acetabulum, lateral center-edge angle, implant migration, and presence of wall defects were analyzed and correlations between the different parameters were assessed. Bone volume loss was found in all sectors and was multidirectional in most cases. Highest relative bone volume loss was found in the medial wall with median and [25, 75]-percentile values of 72.8 [50.6, 95.0] %. Ovality, given as the length to width ratio of the acetabulum, was 1.3 [1.1, 1.4] with a maximum of 2.0, which indicated an oval shape of the defect acetabulum. Lateral center-edge angle was 30.4° [21.5°, 40.4°], which indicated a wide range of roof coverage in the defect acetabulum. Total implant migration was 25.3 [14.8, 32.7] mm, whereby cranial was the most common direction. 49/50 cases showed a wall defect in at least one sector. It was observed that implant migration in cranial direction was associated with relative bone volume loss in cranial roof (R = 0.74) and ovality (R = 0.67). Within this study, 50 pelvises with acetabular bone defects were successfully analyzed using six parameters. This could provide the basis for a novel classification concept which would represent a quantitative, objective, unambiguous, and reproducible classification approach for acetabular bone defects.