Radiotherapy is a well-known local treatment for spinal metastases. However, in the presence of postoperative systemic therapy, the efficacy of radiotherapy on local control (LC) and overall survival (OS) in patients with spinal metastases remains unknown. This study aimed to evaluate the clinical outcomes of post-surgical radiotherapy for spinal metastatic non-small-cell lung cancer (NSCLC) patients, and to identify factors correlated with LC and OS. A retrospective, single-centre review was conducted of patients with spinal metastases from NSCLC who underwent surgery followed by systemic therapy at our institution from January 2018 to September 2022. Kaplan-Meier analysis and log-rank tests were used to compare the LC and OS between groups. Associated factors for LC and OS were assessed using Cox proportional hazards regression analysis.Aims
Methods
Dislocation of the hip remains a major complication after periacetabular tumour resection and endoprosthetic reconstruction. The position of the acetabular component is an important modifiable factor for surgeons in determining the risk of postoperative dislocation. We investigated the significance of horizontal, vertical, and sagittal displacement of the hip centre of rotation (COR) on postoperative dislocation using a CT-based 3D model, as well as other potential risk factors for dislocation. A total of 122 patients who underwent reconstruction following resection of periacetabular tumour between January 2011 and January 2020 were studied. The risk factors for dislocation were investigated with univariate and multivariate logistic regression analysis on patient-specific, resection-specific, and reconstruction-specific variables.Aims
Methods
Stem malalignment in total hip arthroplasty (THA) has been associated with poor long-term outcomes and increased complications (e.g. periprosthetic femoral fractures). Our understanding of the biomechanical impact of stem alignment in cemented and uncemented THA is still limited. This study aimed to investigate the effect of stem fixation method, stem positioning, and compromised bone stock in THA. Validated FE models of cemented (C-stem – stainless steel) and uncemented (Corail – titanium) THA were developed to match corresponding experimental model datasets; concordance correlation agreement of 0.78 & 0.88 for cemented & uncemented respectively. Comparison of the aforementioned stems was carried out reflecting decisions made in the current clinical practice. FE models of the implant positioned in varus, valgus, and neutral alignment were then developed and altered to represent five different bone defects according to the Paprosky classification (Type I – Type IIIb). Strain was measured on the femur at 0mm (B1), 40mm (B2), and 80mm (B3) from the lesser trochanter.Abstract
Objectives
Methods
Ring breakage is a rare but significant complication requiring revision surgery and prolonging the course of treatment. We have encountered three cases with Taylor Spatial Frames (TSF) with breakage at the half ring junction of the distal ring. This experimental study examines the strains produced at different locations on the distal ring during loading and the effects of altering the construct in order to develop techniques to minimise the risk of breakage. We mounted different TSF constructs on tibia sawbone models. Construct 1 reproducing the configuration of cases where failure was seen, Construct 2 with different wire and half pin configuration and construct 3 with the distal ring rotated 60 degrees. Strain Gauges were attached to different locations and measurements were collected during loading. Statistical analysis was subsequently performed.Introduction
Materials and Methods
Inflammatory response plays a pivotal role in the pathophysiological process of intervertebral disc degeneration (IDD). A20 (also known as tumour necrosis factor alpha-induced protein 3 (TNFAIP3)) is a ubiquitin-editing enzyme that restricts nuclear factor-kappa B (NF-κB) signalling. A20 prevents the occurrence of multiple inflammatory diseases. However, the role of A20 in the initiation of IDD has not been elucidated. The aim of the study was to investigate the effect of A20 in senescence of TNF alpha (TNF-α)-induced nucleus pulposus cells (NPCs). Immunohistochemical staining was performed to observe the expression of A20 in normal and degenerated human intervertebral discs. The NPCs were dissected from the tail vertebrae of healthy male Sprague-Dawley rats and were cultured in the incubator. In the experiment, TNF-α was used to mimic the inflammatory environment of IDD. The cell viability and senescence were examined to investigate the effect of A20 on TNF-α-treated NPCs. The expression of messenger RNA (mRNA)-encoding proteins related to matrix macromolecules (collagen II, aggrecan) and senescence markers (p53, p16). Additionally, NF-κB/p65 activity of NPCs was detected within different test compounds.Aims
Methods
Substance abuse and dependence is thought to have a strongly negative impact on surgical outcomes. The purpose of this study was to determine the effects of drug misuse on total knee arthroplasty (TKA) revision incidence, revision causes, and time to revision by analyzing the Medicare database between 2005–2012. A retrospective review of the Medicare database within the PearlDiver Supercomputer (Warsaw, IN) for TKA and revisions was performed utilizing Current Procedural Terminology (CPT) and International Classification of Disease (ICD) ninth revision codes. Drug misuse was subdivided into cocaine, cannabis, opioids, sedative/hypnotic/anxiolytic, amphetamines, and alcohol. Time to revision, age, and gender were also investigated.Background
Methods
Aseptic loosening has been reported to be the most common, contemporary mode of total knee arthroplasty failure. It has been suggested that the etiology of revision due to loosening can be attributed, in part, to joint imbalance and the variability inherent in standard surgical techniques. Due to the high prevalence of revision, the purpose of this study was to quantify the change in kinetic loading of the knee joint before versus after the application of the final cement-component complex. Ninety-two consecutive, cruciate-retaining TKAs were performed, between March 2014 and June 2014, by two collaborating surgeons. Two different knee systems were used, each with a different viscosity cement type (either medium viscosity or high viscosity). All knees were initially balanced using a microelectronic tibial insert, which provides real-time feedback of femoral contact points and joint kinetics. After the post-balance loads were captured, and the surgeon was satisfied with joint balance, the final components were cemented into place, and the sensor was re-inserted to capture any change in loading due to cementing technique.Introduction
Methods
Umbilical cord derived stem cell secretion could enhance the osteogenic differentiation of human bone marrow stem cells. It may promote bone, cartilage and tendon regeneration in rat models, but the effect was not significant up to now. Mesenchymal stem cells (MSCs) are multipotent cells that have extensive proliferative capacity. MSCs synthesise various exosomes, growth factors and cytokines. Stem cell secretions were made from serum free conditioned medium of stem cells collected from different human tissues, such as adipose tissue and dental pulp. Our hypothesis is umbilical cord stem cell secretion could promote multiple proliferation and differentiation of MSCs, also enhance the regeneration of musculoskeletal tissues.Summary Statement
Introduction
To assess patient following operative fixation of clavicle fractures. In the literature, the incidence of paraesthesia following operative fixation of clavicle fractures is reported to be between 7–29%. This problem can be bothersome to patients and the degree of disability is poorly documented. All clavicle fractures (67) treated operatively at the Alfred Hospital between 01/06/2003 and 01/06/2006 were included in the study. Patients were asked to complete paper based questionnaires assessing satisfaction, presence of numbness and degree of disability following clavicle operation. Additionally, they were followed up clinically to assess the area of numbness and scarring. The response rate was 65% (43/67). Most of the patients were satisfied with the operation and only 15% reported significant problems with the wound. Majority of patients returned to pre-morbid activities and employment. The degree of paraesthesia varied among respondents and it was associated with the type of incision used. There was little difference in patient satisfaction with regard to various surgical devices utilised. It is important to address wound complications such as scarring and paraesthesia when discussing operative treatments for patients with clavicle fractures. The results suggest that wound related problems can be frequent and a significant percentage of operatively managed patient experience long term numbness. It is possibly an under appreciated problem. Additionally our results suggest that vertical incisions achieve a more favourable outcome compared to horizontal incisions.
