Objective:. Total elbow joint arthroplasty has limited longevity and is therefore not appropriate for younger rheumatoid arthritis patients. Arthroplasty using an inter-positional membrane may be another surgical option for this population. However, clinical results for joint arthroplasty using the inter-positional membrane have not traditionally been favorable because rheumatoid activity could not be controlled. Today, rheumatoid activity can be controlled with biologics; therefore, the utility of the inter-positional membrane procedure was re-evaluated. Methods:. An 8×6 cm sheet of fascia was detached from the patient's tensor fascia lata muscle to produce a JK membrane. The fascia was stretched on a frame and kept in a 2% chromic acid potassium solution for 24 hours. Then, the fascia was exposed to direct sunlight in order to reduce the dichromic acid. The fascia was washed out in running water for 24 hours and was then stored in phenol with the addition of 70% alcohol. Elbow arthroplasties were performed on three elbow joints in two young female patients. The first case had a significantly damaged right elbow joint with severe joint dysfunction. A JK membrane arthroplasty was done for the first case in 2003, when this patient was 34 years old. Biologics were administered with methotrexate after the surgery. The second case demonstrated bilateral ankylosed elbows due to idiopathic juvenile arthritis. Bilateral JK membrane arthroplasties were performed in 2010, when this patient was 32 years old. Several operative and manual manipulations were necessary in order to increase the range of motion following surgery. Biologics were administered with cyclosporine. Results:. Joint function was significantly improved in all three joints without pain after the JK membrane elbow arthroplasties. In case one, the JOA (Japan Orthopaedic Association) elbow score improved from 21 points before surgery to 85 points after surgery and active elbow flexion improved to 110 degrees following surgery. In case two, the JOA elbow score was 55 and 82 points in the right elbow and 52 and 83 points in left elbow before and after surgery, respectively. In case two, active flexion improved to 120 degrees for the right elbow and 110 degrees for the left elbow following surgery. RA was well controlled in both patients. Conclusion:. Elbow arthroplasty using an inter-positional membrane appears to be useful in young patients when RA activity is controlled with biologics

Introduction

Patients with rheumatoid arthritis (RA) have a higher risk of surgical site infection (PJI) than patients with osteoarthritis (OA). Disease modifying therapy is in widespread use in RA patients, and biologic medications may increase Staphylococcus aureus colonization rates. Because S. aureus colonization likely increases risk of surgical infection, perioperative assessments and therapies to decrease the risk of invasive S.aureus infections may be warranted. The objective of this study was to determine if there was a difference in S. aureus carriage among patients with RA, OA, and RA on biologics (RA+B).

Objectives

Biologic agents (BIO) drastically changed the rheumatoid arthritis (RA) therapy from starting to use biologics at 2003 in Japan. The rate of orthopaedic surgery, especially total joint arthroplasty (TJA) may reflect trends in disease severity, management and health outcomes.

Aims

The use of biologics in the treatment of musculoskeletal injuries in Olympic and professional athletes appears to be increasing. There are no studies which currently map the extent, range, and nature of existing literature concerning the use and efficacy of such therapies in this arena. The objective of this scoping review is to map the available evidence regarding the use of biologics in the treatment of musculoskeletal injuries in Olympic and professional sport.

Cell therapies hold significant promise for the treatment of injured or diseased musculoskeletal tissues. However, despite advances in research, there is growing concern about the increasing number of clinical centres around the world that are making unwarranted claims or are performing risky biological procedures. Such providers have been known to recommend, prescribe, or deliver so called ‘stem cell’ preparations without sufficient data to support their true content and efficacy. In this annotation, we outline the current environment of stem cell-based treatments and the strategies of marketing directly to consumers. We also outline the difficulties in the regulation of these clinics and make recommendations for best practice and the identification and reporting of illegitimate providers.

Cite this article: Bone Joint J 2020;102-B(2):148–154

Introduction. Chronic recurrent multifocal osteomyelitis (CRMO) is a rare condition characterised by bony pain and swelling which may be initially mistaken for bacterial osteomyelitis. The episodic course of the disease may confound the diagnosis and potentially be mistaken for a partial response to antimicrobial therapy. It is an orphan disease and consequently results in many unclear aspects of diagnosis, treatment and follow up for patients. The aim of this study is to evaluate a national tertiary centre's experience with the clinical condition and present one of the largest cohorts to date, emphasizing the vast array of clinical spectrum, course and response to treatment. Methods. We retrospectively evaluated all children identified with CRMO from the period 2000–2022 within Wales. Demographic data and clinical parameters were selectively identified through the utilisation of a national clinical platform (Welsh Clinical Portal). The diagnosis was based on clinical findings, radiological images, histopathological and microbiological studies. Results. A total of 21 patients were identified as suitable for inclusion. The mean age of diagnosis was 9.4 ±2 years. The age range of children being diagnosed was 6–14 years. Of the 21 patients, only 2 reported feeling unwell prior to their first presentation with generalized coryzal illness reported. The most common presenting site for CRMO was knee (33%) followed by back pain (28%). 19% of the included cases at initial presentation had localised warmth and had nocturnal pain. 4 of the patients went on to have dermatological conditions of which psoriasis was the most common (14%). Bilateral symptoms developed in 38% of the included patients. Biochemical investigations revealed only 19% of patients had a raised C-reactive protein level and erythrocyte sedimentation rate whilst 9/21 patients went on to have a bone biopsy to aid diagnosis. 100% of patients had MRI whilst whole body MRI was utilised in 8/21 patients. NSAID's were utilised for 81%, Pamidronate for 33% and methotrexate for 14%. Biologics were utilised for a further 24% of the total population in failed medical therapy. Surgical intervention was utilised for a single individual in this cohort of patients in the form of posterior spinal stabilisation. The most common referring speciality for these patients was Rheumatology (71%) followed by Orthopaedics (33%). Discussion. CRMO represents a challenging diagnosis to make with such varied clinical and biochemical presentations for this condition. The absence of diagnostic Radiological features on X-ray could argue over early MRI imaging. The utilisation of whole body-MRI can now identify multifocal disease burden which may facilitate a timely diagnosis and ensure that effective medical treatment is started promptly without delay. This study is the largest cohort of CRMO patients conducted in this country. Future work will serve to build upon a framework and national referral pathway so that these patients can be seen by the appropriate specialist in a timely manner

Introduction. In rheumatoid (RA) patients undergoing total joint arthroplasty, evidence suggests methotrexate should be continued without increase in post-operative infection. Prednisolone increases post-operative infection risk, but cannot be stopped without risk of Addisonian events. Insufficient evidence exists to clarify perioperative biologic agent management. We currently stop biologics 2 weeks prior to operation and reintroduced following wound healing. Patients/Materials & Methods. This service evaluation reviewed infection rates and length of stay in RA patients following lower-limb arthroplasty, on various anti-rheumatoid therapies across a 28-month period. Results. Forty cases were identified: 15% on no anti-rheumatoid treatment, 45% on mono-therapy (8 on methotrexate, 8 on prednisolone, 2 on biologics)) and 40% on combination-therapy. The total population post-operative infection rate was 18% (all superficial wound). Mean length of stay was 8.0 days (SD=6.8). Methotrexate takers had an infection rate of 5% versus 33% in non-methotrexate takers (p=0.017), and a length of stay of 6.5 days versus 9.9 days in non-MTX takers (p=0.005). Prednisolone takers had an infection rate of 37% versus 0% in non-prednisolone takers (p=0.002) and length of stay was 12.0 days versus 4.7 days in non-prednisolone takers days (p=0.006). Biologics takers had similar infection rates of 9% versus 21% in non-biologic takers (p>0.05), and a similar length of stay of 6.6 days versus 8.6 days in non-biologic takers (p>0.05). Discussion. This data supports current evidence that methotrexate should be continued without detriment to infection risk and length of stay. Biologic agents stopped 2 weeks prior to operation appear to have no effect on infection rate and length of stay. Patients on prednisolone should be identified as at a higher risk of infection and should plan for a longer length of stay. Conclusion. Larger scale cohort studies are required to determine whether biologic agents should be continued per-operatively

Background. Infection is one of the most severe comlications of the total arthroplasty. We sometimes encounter cases, which are very hard to finish repeated recurrence. Usage of steroids, immunosuppressants, and biologics would possibly effect to the incidence of the prosthetic infection and to the result of its treatment. Biologics have drastically decreased the number of the total arthoplasic patients, on the other hand, we must be more careful about the infectious conditions. For the infection two stage revision surgery; first removal and antibiotics cement spacer insertion then reimplantation later; is often chosen but sometimes one time antibiotics cement spacer cannot stop the infection and requires multi times spacer insertion. In those cases the dead spaces, poor blood supply and tight skin could be the cause of the recurrence. For these cases we had been performing musclo-cutaneal flap and successfully finish the infection. Objectives. Our objectives are to review infection cases treated with musclo-cutaneal flap and compare with treatment without it. Methods: Since 2004 to 2013, 6 infection cases were treated. Our standard policy is 2-staged revision. In the first surgery, the prosthesis was removed and cement spacer was inserted. If no evidence of the remained infection was found reimplantation would be done in the second surgery. Otherwise debridement and cement spacer were repeated. In 3 cases, the infection could be finished without musclo-cutaneal flap but in 3 cases musclo-cutaneal flap was finally done then the infection was finished. The clinical courses were reviewed. Results. Case 1. After right hip revision, fistula formation was occurred. Later, enterococcus fecalis was detected. Six times cement spacer insertion was performed. But fistula was remained. Musclo-cutaneal flap of sartorius muscle was performed. No fistula was seen after that. Case 2. Fistula was appeared 3 years after hip replacement. The culture was negative. New prosthesis insertion was done after one time spacer treatment then the infection was controlled. Case 3. Six weeks after primary hip replacement, fistula was appeared. MRSA was found. Three times antibiotic spacer insertions were done then re-implantation was successfully done. Case 4. Three weeks after total knee replacement, the wound became lose and MRSA was found. The wound was communicated with the joint and the patient had general weakness, so musclo-cutaneal flap was done in one time. No recurrence was seen. Case 5. Two weeks after total hip replacement, MRSA superficial infection was found. Wound washing and both injection and oral antibiotics were used. Case 6. This patient was sent from a certain hospital after 3 times open debridement. MRSA was still positive. One time antibiotics spacer was done, and then revision with musculo-cutaneal flap of lateral vastus muscle was performed. No recurrence is seen so far. In all flap cases, infection was finished in our case. On the other hand, the surgical invasion was much bigger. So we can take musculo cutaneal flap into consideration to overcome the recurent infection

Long-term stability of total hip arthroplasty (THA) depends on the integration between osseous tissue and the biomaterial implant. Integrity of the osseous tissue requires the contribution of mesenchymal stem cells and their continuous differentiation into an osteoblastic phenotype. Some studies, like Wang ML et al., show that chronic exposure to titanium and zirconium oxide wear debris may contribute to decreased bone formation at the bone/implant interface by reducing the population of viable human mesenchymal stem cells (hMSCs) and compromising their differentiation into functional osteoblasts. On the basis of our good experience in the use of Exeter technique in revision surgery of THA, two years ago we started to utilize bone grafts mixed with growth factors in order to improve grafts incorporation and implant fixation. At the moment we are studying the use of hMSCs during hip revision surgery, employing polyethylene cup to reduce the possible titanium and zirconium oxide debris. hMSCs are obtained with MarrowsStim Concentration Kit (Biomet Biologics Europe) by 60 ml of patient’s bone marrow. Clinical outcomes and quality of life are evaluated on the basis of Harris Hip Score, Womac score and SF-36 score, while bone graft incorporation features are assessed with post operative computed tomography (CT) examination and further CT controls at two, four and eight months after surgery

Aims

Orthopaedic surgery requires grafts with sufficient mechanical strength. For this purpose, decellularized tissue is an available option that lacks the complications of autologous tissue. However, it is not widely used in orthopaedic surgeries. This study investigated clinical trials of the use of decellularized tissue grafts in orthopaedic surgery.

Aims

Periprosthetic joint infection (PJI) is a debilitating condition with a substantial socioeconomic burden. A novel autologous blood glue (ABG) has been developed, which can be prepared during surgery and sprayed onto prostheses at the time of implantation. The ABG can potentially provide an antimicrobial coating which will be effective in preventing PJI, not only by providing a physical barrier but also by eluting a well-known antibiotic. Hence, this study aimed to assess the antimicrobial effectiveness of ABG when impregnated with gentamicin and stem cells.

Aims

For cementless implants, stability is initially attained by an interference fit into the bone and osteo-integration may be encouraged by coating the implant with bioactive substances. Blood based autologous glue provides an easy, cost-effective way of obtaining high concentrations of growth factors for tissue healing and regeneration with the intention of spraying it onto the implant surface during surgery. The aim of this study was to incorporate nucleated cells from autologous bone marrow (BM) aspirate into gels made from the patient’s own blood, and to investigate the effects of incorporating three different concentrations of platelet rich plasma (PRP) on the proliferation and viability of the cells in the gel.

Objectives

To assess the structure and extracellular matrix molecule expression of osteogenic cell sheets created via culture in medium with both dexamethasone (Dex) and ascorbic acid phosphate (AscP) compared either Dex or AscP alone.