Aims. Transcription factor nuclear factor kappa B (NF-κB) plays a major role in the pathogenesis of chronic inflammatory diseases in all organ systems. Despite its importance, NF-κB targeted drug therapy to mitigate chronic inflammation has had limited success in preclinical studies. We hypothesized that sex differences affect the response to NF-κB treatment during chronic inflammation in bone. This study investigated the therapeutic effects of NF-κB decoy oligodeoxynucleotides (ODN) during chronic inflammation in male and female mice. Methods. We used a murine model of chronic inflammation induced by continuous intramedullary delivery of lipopolysaccharide-contaminated polyethylene particles (cPE) using an osmotic pump. Specimens were evaluated using micro-CT and histomorphometric analyses. Sex-specific osteogenic and osteoclastic differentiation potentials were also investigated in vitro, including alkaline phosphatase, Alizarin Red, tartrate-resistant acid phosphatase staining, and gene expression using reverse transcription polymerase chain reaction (RT-PCR). Results. Local delivery of NF-κB decoy ODN in vivo increased osteogenesis in males, but not females, in the presence of chronic inflammation induced by cPE. Bone resorption activity was decreased in both sexes. In vitro osteogenic and osteoclastic differentiation assays during inflammatory conditions did not reveal differences among the groups. Receptor activator of nuclear factor kappa Β ligand (Rankl) gene expression by osteoblasts was significantly decreased only in males when treated with ODN. Conclusion. We demonstrated that NF-κB decoy ODN increased osteogenesis in male mice and decreased bone resorption activity in both sexes in preclinical models of chronic inflammation. NF-κB signalling could be a therapeutic target for chronic inflammatory diseases involving bone, especially in males. Cite this article: Bone Joint Res 2024;13(1):28–39

Objectives. Up to 10% of fractures result in undesirable outcomes, for which female sex is a risk factor. Cellular sex differences have been implicated in these different healing processes. Better understanding of the mechanisms underlying bone healing and sex differences in this process is key to improved clinical outcomes. This study utilized a macrophage–mesenchymal stem cell (MSC) coculture system to determine: 1) the precise timing of proinflammatory (M1) to anti-inflammatory (M2) macrophage transition for optimal bone formation; and 2) how such immunomodulation was affected by male versus female cocultures. Methods. A primary murine macrophage-MSC coculture system was used to demonstrate the optimal transition time from M1 to M2 (polarized from M1 with interleukin (IL)-4) macrophages to maximize matrix mineralization in male and female MSCs. Outcome variables included Alizarin Red staining, alkaline phosphatase (ALP) activity, and osteocalcin protein secretion. Results. We found that 96 hours of M1 phenotype in male cocultures allowed for maximum matrix mineralization versus 72 hours in female cocultures. ALP activity and osteocalcin secretion were also enhanced with the addition of IL-4 later in male versus female groups. The sex of the cells had a statistically significant effect on the optimal IL-4 addition time to maximize osteogenesis. Conclusion. These results suggest that: 1) a 72- to 96-hour proinflammatory environment is critical for optimal matrix mineralization; and 2) there are immunological differences in this coculture environment due to sex. Optimizing immunomodulation during fracture healing may enhance and expedite the bone regeneration response. These findings provide insight into precise immunomodulation for enhanced bone healing that is sex-specific. Cite this article: K. Nathan, L. Y. Lu, T. Lin, J. Pajarinen, E. Jämsen, J-F. Huang, M. Romero-Lopez, M. Maruyama, Y. Kohno, Z. Yao, S. B. Goodman. Precise immunomodulation of the M1 to M2 macrophage transition enhances mesenchymal stem cell osteogenesis and differs by sex. Bone Joint Res 2019;8:481–488. DOI: 10.1302/2046-3758.810.BJR-2018-0231.R2

Low back pain is more common in women than men, yet most studies of intervertebral disc (IVD) degeneration do not address sex differences. In humans, there are sex differences in spinal anatomy and degenerative changes in biomechanics, and animal models of chronic pain have demonstrated sex differences in pain transduction. However, there are few studies investigating sex differences in annular puncture IVD degeneration models. IVD puncture is known to result in progressive biomechanical alterations, but whether these IVD changes correlate with pain is unknown. This study used a rat IVD injury model to determine if sex differences exist in mechanical allodynia, biomechanics, and the relationship between them, six weeks after IVD injury. Procedures were IACUC approved. 24 male & 24 female four-month-old Sprague-Dawley rats underwent a sham or annular puncture injury surgery (n=12 male, 12 female). In injury groups, three lumbar IVDs were each punctured three times with a needle, and injected with tumor necrosis factor-alpha. Mechanical allodynia was tested biweekly using von Frey filaments. Six weeks after IVD injury, rats were euthanized and motion segments were dissected for non-destructive axial tension-compression and torsional rotation biomechanical testing. Two-way ANOVA with Bonferroni corrections identified statistically significant differences (p < 0 .05) and correlations used Pearson's coefficient. Annular puncture injury induced a significant increase in mechanical allodynia compared to sham in male but not female rats up to six weeks after injury. There was a significant sex effect on both torque range and torsional stiffness, with males exhibiting greater stiffness and torque range than females. Tensile stiffness, compressive stiffness, and axial range of motion showed no sex difference. Males and females showed similar patterns of correlation between variables when sham and injury groups were analyzed together, but correlations were stronger in males. Most correlations were clustered within testing approach: axial biomechanics negatively correlated, torsional biomechanics positively correlated, and von Frey thresholds positively correlated. Surprisingly, mechanical allodynia did not correlate with any biomechanics after injury, and the axial and torsional biomechanics showed little correlation. This study demonstrates that males and females respond to IVD injury differently. Given the absence of correlation between pain and biomechanics, pain cannot be attributed completely to biomechanical changes. This may explain why spinal fusion surgery, an intervention limited to the spine, has produced inconsistent results and is controversial for patients with low back pain. Thus, in addressing low back pain, we must consider both spinal tissues and the nervous system. Further, the limited correlation between axial and torsional biomechanics indicates that IVD injury may have distinct effects on nucleus pulposus and annulus fibrosus. Biomechanics did not differ between sham and injury at week six, suggesting healing after injury. It remains possible that acute biomechanical changes may initiate chronic pain pathogenesis. We conclude that the observed sex differences demonstrate the need for inclusion of both males and females in IVD injury and pain studies, and suggest that males and females may require different treatments for conditions that appear similar

As treatments of knee osteoarthrosis are continually refined, increasingly sophisticated methods of evaluating their biomechanical function are required. Whilst TKA shows good preoperative pain relief and survivorship, functional outcomes are sub-optimal, and research focus has shifted towards their improvement. Restoration of physiological function is a common design goal that relies on clear, detailed descriptions of native biomechanics. Historical simplifications of true biomechanisms, for example sagittal plane approximation of knee kinematics, are becoming progressively less suitable for evaluation of new technologies. The patellar tendon moment arm (PTMA) is an example of such a metric of knee function that usefully informs design of knee arthroplasty but is not fully understood, in part due to limitations in its measurement. This research optimized PTMA measurement and identified the influence of knee size and sex on its variation. The PTMA about the instantaneous helical axis was calculated from optical tracked positional data. A fabricated knee model facilitated calculation optimization, comparing four data smoothing techniques (raw, Butterworth filtering, generalized cross-validated cubic spline-interpolation and combined filtering/interpolation). The PTMA was then measured for 24 fresh-frozen cadaveric knees, under physiologically based loading and extension rates. Sex differences in PTMA were assessed before and after size scaling. Large errors were measured for raw and interpolated-only techniques in the mid-range of extension, whilst both raw and filtered-only methods saw large inaccuracies at terminal extension and flexion. Combined filtering/interpolation enabled sub-mm PTMA calculation accuracy throughout the range of knee flexion, including at terminal extension/flexion (root-mean-squared error 0.2mm, max error 0.5mm) (Figure 1). Before scaling, mean PTMA throughout flexion was 46mm; mean, peak, and minimum PTMA values were larger in males, as was the PTMA at terminal flexion, the change in PTMA from terminal flexion to peak, and the change from peak to terminal extension (mean differences ranging from 5 to 10mm, p<0.05). Knee size was highly correlated with PTMA magnitude (r>0.8, p<0.001) (Figure 2). Scaling eliminated sex differences in PTMA magnitude, but peak PTMA occurred closer to terminal extension in females (female 15°, male 29°, p=0.01) (Figure 3). Improved measurement of the PTMA reveals previously undocumented characteristics that may help to improve the functional outcomes of knee arthroplasty. Knee size accounted for two-thirds of the variation in PTMA magnitude, but not the flexion angle at which peak PTMA occurred, which has implications for morphotype-specific arthroplasty and musculoskeletal models. The developed calculation framework is applicable both in vivo and vitro for accurate PTMA measurement and might be used to evaluate the relative performance of emerging technologies. For any figures or tables, please contact the authors directly

Traumatic acute or chronic tendon injuries are a wide clinical problem in modern society, resulting in important economic burden to the health system and poor quality of life in patients. Due to the low cellularity and vascularity of tendon tissue the repair process is slow and inefficient, resulting in mechanically, structurally, and functionally inferior tissue. Tissue engineering and regenerative medicine are promising alternatives to the natural healing process for tendon repair, especially in the reconstruction of large damaged tissues. The aim of TRITONE project is to develop a smart, bioactive implantable 3D printed scaffold, able to reproduce the structural and functional properties of human tendon, using FDA approved materials and starting from MSC and their precursor, MPC cell mixtures from human donors. Total cohort selected in the last 12 months was divided in group 1 (N=20) of subjects with tendon injury and group 2 (N=20) of healthy subject. Groups were profiled and age and gender matched. Inclusion criteria were age>18 years and presence of informed consent. Ongoing pregnancy, antihypertensive treatment, cardiovascular diseases, ongoing treatment with anti-aggregants, acetylsalicylic-acid or lithium and age<18 years were exclusion criteria. Firstly, we defined clinical, biological, nutritional life style and genetic profile of the cohort. The deficiency of certain nutrients and sex hormonal differences were correlated with tendon-injured patients. It was established the optimal amount of MPC/MSC human cell (collected from different patients during femoral neck osteotomy). Finally, most suitable biomaterials for tendon regeneration and polymer tendon-like structure were identified. Hyaluronic acid, chemical surface and soft-molecular imprinting (SOFT-MI) was used to functionalize the scaffold. These preliminary results are promising. It will be necessary to enroll many more patients to identify genetic status connected with the onset of tendinopathy. The functional and structural characterization of smart bioactive tendon in dynamic environment will represent the next project step

Neoangiogenesis drives the replacement of mineralised cartilage by trabecular bone during bone growth regulated by molecules like e.g. VEGF, OPG and RANKL. The Heparan sulfate proteoglycan Syndecan-1 (Sdc1) plays a role in the interaction of osteoclasts and osteoblasts and the development of blood vessels. We expected Sdc1 to have an influence on bone structure and vessel development. Therefore, bone structure and angiogenesis at the growth plate in mice was compared and the influence of Syndecan-1 deficiency was characterised. Animals: Femura of male and female C57BL/6 WT (5♀, 6♂) and Sdc1-/- (9♀, 5♂) mice were used for native bone analysis at 4 month age. Histology: Bone structure was analysed using microCT scans with a resolution of 9µm. Vascularisation was visualised using an anti-Endomucin antibody in 80µm thick cryosections. In vitro angiogenesis: Bone marrow isolates were used to generate endothelial progenitor cells by sequential cultivation on fibronectin. Microvessel development was analysed 4h after plating on matrigel. Bone structure in male Sdc1 deficient mice was significantly reduced compare to male WT, whereas female mice of both genotypes did not differ. Sdc1 deficient mice at the age of 4 month showed a high decrease in the number of vessel bulbs at the chondro-osseous border (growth plate) compared to WT mice. However, no sex related differences were shown. Quantification of microvessel outgrowth of endothelial cells revealed a decreased amount of sprouting, but increased length of microvessels of Sdc1-/- cells compared to WT. Syndecan-1 has a significant impact on neoangiogenesis at the chondro-osseous border of the native bone, but the impact of Syndecan-1 deficiency on the loss of bone structure was significantly higher in male mice. This emphasises the importance to further characterise the function of Syndecan-1 regulated processes during enchondral ossification in a sex dependent manner

Introduction and Objective. Klinefelter Syndrome (KS, karyotype 47,XXY) is the most frequent chromosomal aneuploidy in males, as well as the most common cause of infertility in men. Patients suffer from a lack of testosterone, i.e. hypergonadotropic hypogonadism provoking infertility, but KS men also show an increased predisposition to osteoporosis and a higher risk of bone fracture. In a mouse model for human KS, bone analysis of adult mice revealed a decrease in bone mass that could not be rescued by testosterone replacement, suggesting a gene dosage effect originating from the supernumerary X-chromosome on bone metabolism. Usually, X chromosome inactivation (XCI) compensates for the dosage imbalance of X-chromosomal genes between sexes. Some studies suggested that expression of genes that escape silencing of the supernumerary X-chromosome (e.g. androgen receptor) has an impact on sex differences, but may also cause pathological changes in males. As a promising new such candidate for a musculoskeletal escape gene, we identified the integral membrane protein (ITM) 2a, which is encoded on the X-chromosome and related to enchondral ossification. The aim of the project was to characterize systemic bone loss in the course of aging in our KS mouse model, and whether the supernumerary X-chromosome causes differences in expression of genes related to bone development. Materials and Methods. Bone structure of 24 month (=aged) old male wild type (WT) and 41, XXY mice (B6Ei.Lt-Y) were analysed by μCT. Afterwards bones were paraffin embedded and cut. In addition, tissue of brain, liver, kidney, lung and heart were also isolated and embedded for IHC staining. Using an anti-ITM2a antibody, expression and cellular localization of ITM2a was evaluated. IHC was also performed on musculoskeletal tissue of WT embryos (E18.5) and neonatal mice to determine possible age-related differences. Results. In 24 month old mice, the analysis of the lumbar vertebrae revealed a significantly lower BV/TV, trabecular bone volume and trabecular number in the XXY- group compared to WT. Trabecular thickness appeared lower but did not reach significance, with the cortical thickness being significantly higher in the XXY- group. High expression of ITM2a was detected in bone slices of both karyotypes in the chondrocytes inside the growth plate, as well as in megakaryocytes and leucocytes as well as endothelial cells of blood vessels inside the bone marrow. Osteocytes, along with erythrocytes and erythropoetic stem cells were negative for ITM2a. Other organs that showed ITM2a positive staining were kidney (blood vessels), heart (muscle) and brain (different structures). Liver and lung tissue were negative for ITM2a. No obvious difference in the intensity of the ITM2a-expression was observed between the WT and the XXY-karyotype. Analyses of embryotic bone tissue (WT) showed high expression of ITM2a in proliferating, hypertrophic and resting chondrocytes in the growth plates of tibia and femur. In comparison, the neonatal animals (WT) did not show any protein-expression in chondrocytes. Furthermore, within the metaphysis of both, embryotic and neonatal bones, endothelial cells and osteoblasts were ITM2a-positive. Further analyses of bones and tissues from young mice (4–6 month) are ongoing. Conclusions. Bone analyses revealed a significant reduction in trabecular bone mass along with fewer and thinner trabeculae in XXY mice compared to the WT, especially in the spine. ITM2a expression was visible in different cell types inside the bone, and in addition, different expression patterns at different stages of development (embryonic/neonatal) were observed. However, we have not found a significant difference in the quantity of ITM2a between tissues of XXY-karyotypes and WT. Further analyses of X-chromosomal encoded and therefore dysregulated modulators in XXY-karyotype mice and patients may reveal new sex chromosomal effector proteins in bone metabolism

Distal radius fractures are the most common upper extremity injury, and are increasingly being treated surgically with pre-contoured volar-locking plates. These plates are favored for their low-profile template while allowing for rigid anatomic fixation of distal radius fractures. The geometry of the distal radius is extremely complex, and little evidence within the medical literature suggests that current implant designs are anatomically accurate. The main objective of this study is to determine if anatomic alignment of the distal radii corresponds accurately with modern volar-locking plate designs. Additionally, this study will examine sex-linked differences in morphology of the distal radius. Segmented CT models of ten female cadaver (mean age, 88.7 ± 4.57 years, range, 82 – 97) arms, and ten male cadaver (mean age, 86 ± 3.59 years, range, 81 – 91) arms were created. Micro CT models were obtained for the DePuy Synthes 2.4mm Extra-articular (EA) Volar Distal Radius Plate (4-hole and 5-hole head), and 2.4mm LCP Volar Column (VC) Distal Radius Plate (8-hole and 9-hole head). Plates were placed onto the distal radii models in a 3D visualization software by a fellowship-trained orthopaedic hand surgeon. The percent contact, volar cortical angle (VCA), border and overlap of the watershed line (WSL) were measured. Both sexes showed an increase in the average VCA measure from medial to lateral columns which was statistically significant. Female VCA ranged from 28 – 36 degrees, and 38 – 45 degrees for males. WSL overlap ranged from 0 – 34.7629% for all specimens without any statistical significance. The average border distance for females was 2.58571 mm, compared to 3.52411 mm for males, with EA plates having a larger border than VC plates. The border distances had statistically significant differences between the plate types, and was approaching significance between sexes. Lastly, a maximum percent contact of 21.966 % was observed in specimen F4 at a 0.3 mm threshold. No statistical significance between plate or sex populations was observed. This study investigated the incoherency between the volar cortical angle of the distal radius, and the pre-contoured angle of volar locking plates. It was hypothesized that if the VCA measures between plate and bone were unequal then there would be an increase in watershed line overlap, and decrease in percent contact between the surfaces. Our results agreed with literature, indicating that the VCA of bone was larger than that of the EA and VC pre-contoured plates examined in this study. With distal radius fracture incidences and prevalence on the rise for elderly female patients, it is a necessity that volar locking plates be re-designed to factor in anatomical features of individual patients with a particular focus on sex differences. New designs should focus on providing smaller head sizes that are more accurately tailored to the natural contours of the volar distal radius. It is recommended that future studies incorporate expertise from multiple surgeons to diversify and further understand plate placement strategies

Introduction. For anatomical reconstruction in shoulder arthroplasty, it is important to understand normal glenohumeral geometry. Unfortunately, however, the details of the glenohumeral joint in Asian populations have not been sufficiently evaluated. There is a racial difference in body size, and this difference probably results in a difference in glenohumeral size. The purpose of this study was to evaluate three-dimensional geometry of the glenohumeral joint in the normal Asian population and to clarify its morphologic features. Methods. Anthropometric analysis of the glenohumeral joint was performed using computed tomography scans of 160 normal shoulders from healthy volunteers in age from 20 to 40 years. Using OsiriX MD, Geomagic Studio, and AVIZO software, the dimensions of humeral head width, humeral head diameter, glenoid height, glenoid width, and glenoid diameter were analyzed three-dimensionally (Figure 1). In diameter analyses, the humeral head was assumed to be a sphere and the glenoid was to fit a sphere (Figure 2–3). Sex differences in height, humeral length, humeral head width, humeral head diameter, glenoid height, glenoid width, and glenoid diameter were compared using Mann-Whitney U tests. The correlations between sides and among the respective parameters in the glenohumeral dimensions were evaluated with Spearman rank correlation tests. The significance level was set at 0.05 for all analyses. Results. Average height and humeral length of the volunteers were 164.7 ± 9.7 cm and 29.1 ± 1.8 cm respectively. The normal Asian glenohumeral joint has average humeral head width of 41.4 ± 3.7 mm, humeral head diameter of 42.9 ± 3.6 mm, glenoid height of 31.5 ± 2.8 mm, glenoid width of 23.1 ± 2.4 mm, and glenoid diameter of 62.0 ± 6.8 mm. The humeral head and glenoid were significantly larger in males than in females (p<0.001 in all analyses). The average radius difference between the glenoid and the humeral head was 9.6 ± 2.8 mm, and there was no sex difference (p=0.359). The average ratio of the glenoid radius to the humeral head radius was 144.9% ± 12.2%, and the ratio was significantly larger in females than in males (p=0.026). The glenohumeral size was well correlated between the two sides, and there were direct correlations among the heights, humeral length, humeral head size, and glenoid size (p<0.001 in all analyses). Conclusions. The present study revealed that the values of glenohumeral dimensions were uniform in both males and females with a strong correlation between the dominant shoulder and the nondominant shoulder. Since there are direct correlations among height, humeral length, and the size of the glenohumeral joint, we can also predict the glenohumeral size of patients from their respective heights. The present results would be useful to determine the size of implants and to improve clinical outcomes of shoulder arthroplasty for glenohumeral joints of Asian patients. The size of the Asian glenohumeral joint was obviously smaller than that reported in the past literature including black and Caucasian populations. Some shoulder prostheses that are designed in Europe or America and are widely used worldwide could be oversized for small females

Aims

Adenosine, lidocaine, and Mg²⁺ (ALM) therapy exerts differential immuno-inflammatory responses in males and females early after anterior cruciate ligament (ACL) reconstruction (ACLR). Our aim was to investigate sex-specific effects of ALM therapy on joint tissue repair and recovery 28 days after surgery.

Aims

Lumbar spinal stenosis (LSS) is a common skeletal system disease that has been partly attributed to genetic variation. However, the correlation between genetic variation and pathological changes in LSS is insufficient, and it is difficult to provide a reference for the early diagnosis and treatment of the disease.

Aims

The antidiabetic agent metformin inhibits fibrosis in various organs. This study aims to elucidate the effects of hyperglycaemia and metformin on knee joint capsule fibrosis in mice.

Aims

To test the hypothesis that reseeded anterior cruciate ligament (ACL)-derived cells have a better ability to survive and integrate into tendon extracellular matrix (ECM) and accelerate the ligamentization process, compared to adipose-derived mesenchymal stem cells (ADMSCs).

Aims

As has been shown in larger animal models, knee immobilization can lead to arthrofibrotic phenotypes. Our study included 168 C57BL/6J female mice, with 24 serving as controls, and 144 undergoing a knee procedure to induce a contracture without osteoarthritis (OA).

Aims

The volume of ambulatory total hip arthroplasty (THA) procedures is increasing due to the emphasis on value-based care. The purpose of the study is to identify the causes for failed same-day discharge (SDD) and perioperative factors leading to failed SDD.

Aim. This study aimed to evaluate the impact on length of hospital stay from dedicated infectious diseases input for orthopaedic infection patients compared to sporadic infection specialist input. Method. We conducted an observational cohort study of 157 adults with orthopaedic infections at a teaching hospital in the UK. The orthopaedic infections included were: osteomyelitis, septic arthritis, infected metalwork and prosthetic joint infections, and adults were aged 18 years or more. Prior to August 2016, advice on orthopaedic infection patients was adhoc with input principally from the on-call infectious diseases registrar and phone calls to microbiology whereas after August 2016 these patients received regular input from dedicated infectious diseases doctor(s). The dedicated input involved bedside reviews, medical management, correct antimicrobial prescribing, managing adverse drug reactions, increased use of outpatient parenteral antimicrobial therapy (OPAT) services especially self-administration of intravenous antibiotics and shared decision-making for treatment failure, whilst remaining under orthopaedic team care. Orthopaedic patients operated on for management of their infection between 29/8/16 and 15/3/17 were prospectively identified and orthopaedic operation records were used to retrospectively identified patients between 29/8/15 and 15/3/16. The length of stay was compared between the 2 groups. Results. There were 83 patients in the dedicated infectious diseases input group (dedicated group) and 74 patients in the sporadic infection specialist input group (sporadic group). The dedicated group were significantly younger: median 58 years versus 69years (p<0.001), and there was a trend to significant differences in the breakdown of diagnosis (p=0.06), but no significant sex difference. The median length of stay for the sporadic group was 20 days (interquartile range (IQR) 13–29 days) compared to 14 days (IQR 9–27 days) for the dedicated group, with a trend to significance (p=0.06) but no effect from age or diagnosis. Our hospital values one day in hospital at £864, therefore over the 6.5 months trial period of the dedicated infectious diseases input there was a cost saving of £430,272 (£864 × 6 days × 83 patients). Conclusions. Dedicated infectious diseases input would be expected to improve patient care but by additionally reducing median length of stay for orthopaedic infection patients, this encourages investment to achieve both. In this era of increased scrutiny of health budgets demonstrating value for money, not just improved quality of patient care, is essential

Background. Total Hip Arthroplasty (THA) has long been the standard treatment for cases in which non-surgical alternatives have failed to improve pain and function in hip osteoarthritis (OA) patients. Outcomes from THA have improved over time with better surgical techniques and improved implant designs. While conventional neck-sacrificing implants have been associated with favorable outcomes, there is evidence to suggest biomechanical advantages of newer, femoral neck-preserving short-stem implants, including the Corin MiniHip. However, there is a still a gap of knowledge regarding the potential benefits of the MiniHip stem over conventional neck-sacrificing stems in regards to patient-reported outcomes (PROs). In this study, we investigated the differences between a neck-sacrificing stem design and neck-preserving short-stem design (MiniHip, Corin Inc.) arthroplasty concerning PROs, and considering the known features of the short stem design, we hypothesized that MiniHip THA would be associated with improved PROs in comparison to a neck-sacrificing implant system. We further sought to investigate gender effects related to MiniHip or conventional stem surgery. Methods. Neck-sacrificing implant patients (n=90, age 57±7.9 years, female=58, male=32) and a matched (matching criteria: follow-up period, BMI, age) cohort group of MiniHip patients (n=105, age 55.16±9.88 years, female: 25, male: 80) reported both pre-operative and post-operative Hip disability and Osteoarthritis Outcome Scores (HOOS) at a minimum interval of 6 months post-operatively and up to three years postoperatively. We applied MANCOVA analysis to compare patient-reported outcome subscores from each group using follow-up period as a covariate and employing gender as an additional grouping factor to evaluate gender effects. Statistical significance was set at α=0.05 and Bonferroni corrections were applied to account for multiple comparisons. Results. There was a main effect of time, showing that all HOOS subscores of both groups increased significantly after surgery (p<0.001). There was a main effect of surgery for subscores Symptoms (p=0.038), ADL (p=0.046), and Sports and Recreation (p=0.039). There was a gender effect only for the subscore Symptoms (p=0.007). There were significant time by surgery interactions for HOOS subscores Symptoms (p=0.002), Pain (p=.009), Sports and Recreation (p=0.004), and QOL (p<0.001) subscores. We also observed a significant time by gender interaction effect for all HOOS subscores (p<0.001). Discussion. The interaction effects regarding most HOOS subscores and surgery/implant type indicate an advantage of MiniHip surgery regarding post-operative reported outcomes. The observed results may be due to previously described improved physiological loading and native hip structure preservation with neck-preserving short-stem designs. While longer-term studies are required for further investigation, evidence suggests the MiniHip may provide a significant benefit to primary THA patients. The additional gender/time interaction effect observed in our study highlights the necessity to consider potential sex differences regarding both the potential/expected improvement in PROs from THA and the requirement to account for such differences when designing osteoarthritis outcome studies based on PROs

Aims

The frequency of severe femoral retroversion is unclear in patients with femoroacetabular impingement (FAI). This study aimed to investigate mean femoral version (FV), the frequency of absolute femoral retroversion, and the combination of decreased FV and acetabular retroversion (AR) in symptomatic patients with FAI subtypes.

Aims

Insufficient treatment response in rheumatoid arthritis (RA) patients requires novel treatment strategies to halt disease progression. The potential benefit of combination of cytokine-inhibitors in RA is still unclear and needs further investigation. To explore the impact of combined deficiency of two major cytokines, namely interleukin (IL)-1 and IL-6, in this study double deficient mice for IL-1αβ and IL-6 were investigated in different tumour necrosis factor (TNF)-driven inflammatory bone disorders, namely peripheral arthritis and sacroiliitis, as well as systemic bone loss.

Background. Glenoid baseplate fixation for reverse shoulder arthroplasty relies on the presence of sufficient bone stock and quality. Glenoid bone may be deficient in cases of primary erosions or due to bone loss in the setting of revision arthroplasty. In such cases, the best available bone for primary baseplate fixation usually lies within the three columns of the scapula. The purpose of this study was to characterise the relationship of the three columns of the scapula independent of glenoid anatomy and to establish the differences between male and female scapular anatomy. Methods. Fifty cadaveric scapulae (25 male, 25 female) were analysed using CT-based imaging software. The surface geometries of the coracoid, scapular spine and inferior scapular column were delineated in the sagittal plane. A linear best-fit line was drawn to establish the long axis of each column independent of the glenoid. The width of the glenoid was measured and points marked at the midpoint of each measurement. A best-fit line starting at the supra glenoid tubercle passing through the midpoints was chosen as the superior inferior (SI) axis of the glenoid. An orthogonal plane to the scapular plane was developed parallel to the glenoid face. The axis representing each of the three columns of the scapula and the SI axis of the glenoid, were projected onto this plane. The relationship between each column was analysed with respect to each other and with respect to the SI glenoid axis. Thus, measurements obtained gave the relationships of the three columns of the scapula (independent of the glenoid) and their relationships to the long axis of the glenoid (dependant on the glenoid). Comparisons were made between males and females using the independent t-tests. Results. The mean angle between the scapular spine and the coracoid column was 93±13° with no significant difference between males (91±15°) and females (95±10°) (p=0.29). The angle between the inferior scapular column and the scapular spine was 6.5° greater (p=0.03) in females (134±10°) than in males (128±11°). Similarly, the angle between the inferior scapular column and the coracoid column was 11° greater (p=0.009) in males (141±15°) than in females (130±12°). No significant sex difference was found between the acromion and inferior scapular pillar with respect to the SI glenoid axis. However, the female coracoid was found to be more horizontal than the male coracoid in relation to the SI axis of the glenoid (p=0.037). Conclusion. This study demonstrates that the relationship between the scapular spine and the coracoid column is independent of sex. However, sex has significant effects on the positions of the scapular spine and coracoid columns with respect to the inferior scapular column. The inferior scapular column is noted to be positioned more anterior (closer to the coracoid) in females than in males. Sex variations may be important when directing screws for baseplate fixation in bone deficient glenoids undergoing reverse shoulder arthroplasty