Shoulder arthritis in the young adult is a deceptive title. The literature is filled with articles that separate outcomes based on an arbitrary age threshold and attempt to provide recommendations for management and even potential criteria for implanting one strategy over another using age as the primary determinant. However, under the age of 50, as few as one out of five patients will have arthritis that can be accurately classified as osteoarthritis. Other conditions such as post-traumatic arthritis, post-surgical arthritis including capsulorrhaphy arthropathy, and rheumatoid arthritis create a mosaic of pathologic bone and soft tissue changes in our younger patients that distort the conclusions regarding “shoulder arthritis” in the young adult. In addition, we are now seeing more patients with unique conditions that are still poorly understood, including arthritis of the pharmacologically performance-enhanced shoulder. Early arthritis in the young adult is often recognised at the time of arthroscopic surgery performed for other preoperative indications. Palliative treatment is the first option, which equals “debridement.” If the procedure fails to resolve the symptoms, and the symptoms can be localised to an intra-articular source, then additional treatment options may include a variety of cartilage restoration procedures that have been developed primarily for the knee and then subsequently used in the shoulder, including microfracture, and osteochondral grafting. The results of these treatments have been rarely reported with only case series and expert opinion to support their use. When arthritis is moderate or severe in young adults, non-arthroplasty interventions have included arthroscopic capsular release, debridement, acromioplasty, distal clavicle resection, microfracture, osteophyte debridement, axillary nerve neurolysis, and bicep tenotomy or tenodesis, or some combination of these techniques. Again, the literature is very limited, with most case series less than 5 years of follow-up. The results are typically acceptable for pain relief, some functional improvement, but not restoration to completely normal function from the patient's perspective. Attempts to resurface the arthritic joint have resulted in limited benefits over a short period of time in most studies. While a few remarkable procedures have provided reasonable outcomes, they are typically in the hands of the developer of the procedure and subsequently, other surgeons fail to achieve the same results. This has been the case with fascia lata grafting of the glenoid, dermal allografts, meniscal allografts, and even biologic resurfacing with large osteochondral grafts for osteoarthritis. Most surgical interventions that show high value in terms of improvement in quality of life require 10-year follow-up. It is unlikely that any of these arthroscopic procedures or resurfacing procedures will provide outcomes that would be valuable in terms of population healthcare; they are currently used on an individual basis to try to delay progression to arthroplasty, with surgeon bias based on personal experience, training, or expert opinion. Arthroplasty in the young adult remains controversial. Without question, study after study supports total shoulder arthroplasty over hemiarthroplasty once the decision has been made that joint replacement is the only remaining option

Osteomyelitis is usually related to trauma, surgery, immunocompromised patients, IV drug abuse, poor vascular supply, diabetes, sickle cell disease or peripheral neuropathy. We report an unusual case of femur osteomyelitis without any of these risk factors. A 31 years old male, light smoker, presented at the Emergency Room for pain in the left thigh for about a month, without any previous event. He had 2 previous visits to the hospital with similar diffuse complaints interpreted as irradiated low back pain. He was pale, feverish but no signs of local inflamation. His left knee ROM was 30°-15°-0°. He had no neurologic deficits. Blood tests showed high WBC count and PCR (400mg/L). After contrasted CT showing an 1,2×6×2,5cm abcess the patient was taken to the OR for irrigation and debridment. The day after the patient did a MRI that showed extended femur osteomyelitis and adjacent myositis (images). He underwent new surgery for a more extensive irrigation and debridment, femur medular canal included, from where a large pus quantity erupted. The hemocultures and bone biopsys, revealed a Multissensible Strep. Alfa-hemolitic (S. anginosus) and appropriate antibiotherapy was implemented (Amoxicillin/Clavulanate). He slowed improve till 11th day when he showed rise of PCR and a new MRI showed the same inflammatory process. He underwent new surgery but no pus was visible. He gradually improved, started hyperbaric oxygen therapy and was discharged on the 28th day after the first surgery, continuing antibiotherapy at home for a total of 8 weeks. Transthoracic Ecography was normal, as well Brucella, HIV, and other serologies. Three weeks later, the patient again presented to the ER with fever and rise of inflammatory markers in blood, consistent with recurrence of the infection. The patient was taken to the OR for surgical debdridment and irrigation, but this time the cultures showed a multissensible Gemella haemolysans, possible contamination during the hyperbaric oxygen therapy sessions. This is the case of a healthy young adult with an idiopathic femur osteomyelitis, initially misinterpreted for irradiated low back pain, that recurred after the first medical and surgical successful treatment, with an unusual agent

Introduction. Intracapsular fractures of the femoral neck in young adults are a surgical emergency. Recent literature reviews have questioned whether the timing of surgery reduces the incidence of avascular necrosis, non-union and revision. A study was performed to determine how many patients met a 12-hour target for operative fixation with this injury. Possible sources of delay to theatre were reviewed. Methods. A Fractures Outcomes Research Database was used to identify patients aged 18–64 who were admitted to the Royal Victoria Hospital in Belfast between 1. st. Jan 2008 and 31. st. Dec 2009. Intracapsular fractures of the femoral neck which were treated with a 2-hole dynamic hip screw were included. Time of injury, time of presentation in A&E, time of admission to fracture ward, operation time, demographic data, and the mechanism of injury were extracted from the database. Results. 81 patients were identified who met the inclusion criteria. Median age was 56 years (range 26–64y). 64 injuries were low energy. 16 patients were alcoholics, 34 smoked cigarettes. 31 of 81 operations were performed within 12 hours of the injury. Of the delayed 50 patients, 25 sustained their injury between 1700–2359. 51 of 81 operations were performed on daytime lists (0900–1659), 23 in the evening (1700–2359) and 7 overnight (0000–0859). Median time from injury to presentation at A&E was 1 hour 39 minutes. Time from A&E presentation to ward admission was 4 hours. Time from ward admission to surgery was 8 hours 13 minutes. Conclusions. The time from ward admission to arrival in theatre accounted for the greatest delay, and is modifiable. Injuries which occur in the evening are often operated on the next day. The majority of the patients had low energy injuries, and a minority smoke cigarettes and abuse alcohol. The long-term implications of this delay will require further work

Abstract

90% of young patients that develop DJD of the hip have an underlying structural problem, most frequently hip dysplasia. The structural problem results in decreased contact area, increased contact stresses about the anterior and lateral acetabulum and femoral head and results in labral pathology, early cartilage damage and if left untreated leads to end stage hip arthritis.

Despite the optimism of alternative bearing surfaces and highly cross linked polyethylene, THA should still be discouraged in young patients. Many patients with symptomatic hip dysplasia in the absence of arthritis will benefit from joint preservation. The goal of treatment should be restoration of anatomy as close to normal as possible. The Bernese PAO is the preferred technique in many centres in North America and Europe because of its balance between minimal exposure, complications, and ability to provide optimal correction. The ideal patient for a PAO is young, has no arthritis, is not obese (BMI <30) and has poorly covered femoral head where congruency is possible. A PAO has advantages over other osteotomies and include: 1)

Performed through one incision without violation of the abductors

The results of the osteotomy have been encouraging with up to 60% survivorship free from total hip arthroplasty at 20 years. Most studies show improvement in pain and function, improvement in radiographic coverage of the femoral head with no improvement in range of motion. Treatment should be individualised to each patient based on radiographic findings, age and cartilage status and restoration of anatomy as close to normal as possible should be the ideal treatment, most commonly in the form of a periacetabular osteotomy.

Patient selection has always been considered an important criterion in determining the success or failure of a TKA. In the early days of TKA, orthopaedic surgeons and patients were both uncertain as to the long-term outcomes and most TKAs were performed in patients >65 years of age. Since that time, a number of peer-reviewed studies have provided Level III evidence indicating that TKA was a reliable procedure with 91% to 99% survivorship during the first decade and 85% to 97% during the second decade of follow-up. These encouraging TKA results have prompted a growth in TKA utilisation, particularly in younger patients and a move away from procedures such as osteotomy and UKA which have been associated with higher re-operation rates. As a result, over the past decade, the fastest growing TKA patient cohorts have been in the 45–54 (337% increase for females, 271% for males) and 55–64 (260% increase for females and 213% for males) year old patient groups!

The Swedish Knee Arthroplasty Register has followed Swedish TKA patients since 1975 and has provided useful insights with regards the use of knee arthroplasties in younger patients (i.e. an encouraging TKA revision risk reduction from 1976 to 2009, a higher revision rate for UKAs and higher revision rates for both TKAs and UKAs in younger patients). The Australian National Joint Replacement Registry has also found that age adversely affects knee arthroplasty revision rates, noting higher cumulative, ten-year revision rates for both UKA and TKA patients <55 years of age (UKA 25%, TKA 13%) and 55–64 years of age (UKA 17%, TKA 8%) and a 6X greater revision rate for TKA patients <55 compared to those >75 years of age! In addition, although mobile-bearing TKAs have often been promoted for use in younger patients, higher cumulative revision rates were noted for mobile-bearing TKAs (7%) as compared to fixed-bearing TKAs (5%) at 10 years.

In summary, although TKA outcomes have improved with time, the lack of long-term supporting data should prompt surgeons to be cautious in offering TKA to patients with 20 to 40 more years of life expectancy. New TKA bearing couple technologies (ie. cross-linked polyethylenes and improved femoral counterfaces) should be encouraged, but their introduction should not be based on laboratory tests alone, but also supported by safety and efficacy studies in patients and long-term post-market surveillance data.

Femoroacetabular impingement (FAI) is a condition of the hip where there is a mismatch of the femoral head and hip acetabulum. This mismatch creates abnormal contact between the bones and causes hip pain which can lead to damage, and eventually osteoarthritis of the hip. The diagnosis and treatment of FAI has become one of the most popular clinical scenarios in orthopaedic surgery, with hip arthroscopy procedures increasing exponentially over the past five years. Surgical intervention usually involves correcting the existing deformities by reshaping the ball and socket (“osteoplasty” or “rim trimming”) so that they fit together more easily while repairing any other existing soft tissue damage in the hip joint (e.g. labral repair). Although correction of the misshaped bony anatomy and associated intra-articular soft tissue damage of the hip is thought to appease impingement and improve pain and function, the current evidence is based on small, observational, and low quality studies. A lack of definitive evidence regarding the efficacy of osteochondroplasty in treating FAI fueled the design and execution of the FIRST randomized controlled trial (RCT). FIRST evaluated the impact of surgical correction of the hip impingement morphology with arthroscopic osteochondroplasty versus arthroscopic lavage on pain, function, and quality of life in adults aged 18–50 years diagnosed with non-arthritic FAI at one year.

FIRST was a large definitive RCT (NCT01623843) enrolling patients with FAI requiring surgical intervention across 11 international clinical sites. Participants were randomized to either arthroscopic osteochondroplasty (shaving of bone) or lavage (washing the joint of painful inflammation debris). The primary outcome was patient-reported pain within one year of the initial surgery measured using the Visual Analogue Scale (VAS). Secondary outcomes included function, health utility, and health-related quality of life using several general and hip-centric health questionnaires. An independent, blinded adjudication committee evaluated the quality of surgery, re-operations, and other patient complications. Patients and data analysts were blinded to the treatment groups.

Two-hundred and twenty participants were enrolled into the FIRST trial over a six-year period (pilot phase: N=50, from 2012–2013 and definitive phase: N=170, from 2015–2018) at 11 clinical sites in Canada, Finland, and Denmark. The FIRST results will be released at the ISAKOS annual meeting as follows. The absolute difference in rate of pain reduction between groups was XX (95% CI: YY-YY, p=X). The mean differences of the Short-Form 12 (SF-12, MCS and PCS), Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and EuroQol 5-Dimensions (EQ-5D) between groups are XX (95% CI: YY-YY, p=X)…, respectively. Reoperations occurred in XX of 220 (X%) patients over the one-year follow up period (OR:XX, 95% CI: YY-YY, p=X) and the patients treated with arthroscopic osteochondroplasty conferred the following risk of reoperation within one-year compared to arthroscopic lavage (RR:XX, 95% CI: YY-YY, p=X).

This RCT represents major international efforts to definitively identify the optimal treatment strategy for FAI. The results of this trial will change practice, being used to prevent chronic hip pain and loss of function caused by hip osteoarthritis.

Background

Autologous chondrocyte implantation (ACI) and mosaicplasty (MP) are two methods of repair of symptomatic articular cartilage defects in the adult knee. This study represents the only long-term comparative clinical trial of the two methods.

Fractures of the ankle are common, and they mostly affect young adults. Wound complications are not uncommon following the fixation of these fractures. This study evaluated the impact of HIV on wound healing after plate osteosynthesis in patients with closed ankle fractures. This is an observational retrospective study of patients operated on at a tertiary level hospital. We reviewed hospital records for patients above 18 years of age who presented with wound breakdown following ankle open reduction and internal fixation. The patients’ hospital records were retrieved to identify all the patients treated for closed ankle fractures and those who developed wound breakdown. Patients with Pilon fractures were excluded. The National Health Laboratory System (NHLS) database was accessed to retrieve the CD4 count, viral load, haematology study results, and biochemistry results of these patients at the time of surgery and subsequent follow-up. The x-rays were retrieved from the electronic picture archiving system (PACS) and were assessed for fracture union at a minimum of 3 months follow-up. We reviewed the medical records of 172 patients with closed ankle fractures treated from 2018 to 2022. Thirty-one (18.0%) developed wound breakdown after surgery, and they were all tested for HIV. Most of the patients were male (58.0%), and the average age of the cohort was 43.7 years (range: 21 years to 84 years). Ten of these patients (32.2%) were confirmed HIV positive, with CD4 counts ranging from 155 to 781. Viral load levels were lower than detectable in 40% of these patients. All patients progressed to fracture union at a minimum of 3 months follow-up. We observed no difference between HIV-positive and HIV-negative patients in terms of wound breakdown and bone healing post-plate osteosynthesis for closed ankle fractures

The influence of patient age on functional outcomes after periacetabular osteotomy (PAO) for acetabular dysplasia remains unclear, with previous studies utilising scores developed for older, arthritic patients. The purpose of this study is to assess the influence of patient age on International Hip Outcome Tool (iHOT-12) scores, two years after PAO. Eighty-six patients (72 female, 14 male; mean age 26.9 years) who underwent PAO by a single surgeon and had completed a minimum of two years follow up were identified. Patients were categorised into three groups according to age at the time of surgery: adolescent (11–20 years; n=29), young adult (21–30 years; n=29), and mature (≥31 years; n=28). The three groups were compared with respect to baseline variables and functional outcomes (iHOT-12, EQ-5D quality of life score, University of California Los Angeles (UCLA) activity score, pain visual analogue score (VAS)). Multivariate regression was undertaken to assess for independent predictors of two-year iHOT-12 score. The adolescent group demonstrated a lower BMI (p=0.004) while the mature group had a greater American Society of Anaesthesiology (ASA) score (p=0.049). There were otherwise no significant differences in baseline variables between the three groups (all p>0.05). The three groups demonstrated significant post-operative improvements across all functional outcome measures. There were no significant differences in two-year iHOT-12, EQ-5D, UCLA score or pain VAS between the three groups (all p>0.05). Regression modelling found that patient age at the time of surgery did not have an independent effect on two-year iHOT-12 score (p=0.878). We found that patient age at the time of surgery did not influence functional outcomes two years after PAO. Our results suggest that patient age should not be considered in isolation as an indication or contraindication for PAO

Management of the young adult hip pathologies is a special entity in orthopaedic surgical practice that needs special emphasis and consideration. A wide range of pathological and traumatic conditions occur in the young adult hip that lead to functional disability and the development of premature osteoarthritis. Proper surgical interference when the hip is still in the pre-arthritic stage restores function to the young hip and protects it from early degenerative changes, and hence the anticipated need for future joint replacement surgery is prevented. Accurate estimation of the biomechanical error combined with careful understanding of the hip joint biology is the cornerstone of success of any hip preservation surgery ever performed to save the young adult hip. Safe surgical hip dislocation approach was adopted as one of the tools in the hands of the hip preservation surgeon to treat a broad spectrum of intra-articular hip pathologies like Perthes disease and severe forms of slipped capital femoral epiphysis (SCFE). Osteo-chondroplasty at the head-neck junction with relative femoral neck lengthening for Perthes disease, and Subcapital re-orientation of severe SCFE based on its retinacular vascular pedicle are often performed via the surgical hip dislocation approach. The approach is also useful with certain types of acetabular fractures that enables fixation of dual-column fractures via single approach with intra-articular visualization for the accuracy of reduction and hardware placement. The 4 cm mini-open direct anterior approach is ideal for the surgical treatment of cases with cam and/or pincer types of femoro-acetabular impingement. Peri-articular osteotomies performed either on the acetabular or the femoral sides of the hip joint are extremely useful in the correction of the biomechanical error that led to an existing hip pathology. Periacetabular osteotomies are commonly performed to treat dysplasia of the young hip. Proximal femoral osteotomies are commonly performed to treat a wide range of hip pathologies including non-unions of femoral neck fractures in the young adult. Correction of the biomechanical error at the proper timing ensures normalization of the hip joint loading conditions and range of motion that leads to reversal of the pathologic process and prevention of osteoarthritis. A hip joint replacement would have an unknown but certainly a finite life, whereas a young hip that has healed after hip preservation surgery would definitely last for a lifetime

Introduction. Orthopaedic rehabilitation of adolescences and young adults with high dislocation of the femur is rather challenging. The role of palliative salvage procedures is controversial enough in the cohort of patients. Materials and Methods. Treatment outcomes of 10 patients with congenital hip dislocation were analyzed. Mean age at intervention was 17,8 years (15–22). The grade of dislocation were assessed according to Eftekhar: type C − 2, type D − 8. The mean baseline shortening was 4.7±0.36 cm. All subjects underwent PSO with the Ilizarov method. Another osteotomy for lengthening and realignment was produced at the boundary of the upper and middle third of the femur. The mean time in the Ilizarov frame was 5.3 months. Results. The mean follow-up was 2.6±.1 years (range, 15 to 32 years). Limb shortening of 1 cm to 1. 1. /. 2. cm was observed in four cases. Functional outcomes according to d'Aubigne-Postel were: Pain 4,4±0,15 points. ROM − 4,1±0,3 points. Walking ability − 4,5±0,2 points. Two cases had good results (15–17 points), and seven patients had fair outcomes (12–14 points). A poor result (7 points) was recorded in one female patient 28 years after PSO followed by THA. Conclusions. Hip reconstruction with the Ilizarov method can be used in specific clinical situations as an alternative salvage procedure to delay THR in young patients with high dislocation of the femur

Background. The cruciate ligaments are important structures for biomechanical stability of the knee. For total knee arthroplasty (TKA), understanding of the exact function of the (PCL) and anterior (ACL) cruciate ligament during walking is important in the light of recent designs of bicruciate TKAs. However, studies evaluating in vivo function of the PCL during daily activities such as walking are scarce. We aimed to assess the role of the PCL during gait by measuring kinematics and kinetics of individuals with PCL deficiency and compare them with individuals with ACL deficiency and healthy young adults. Methods. Individuals with unilateral PCL deficiency (PCLD; n=9), unilateral ACL deficiency (n=10) and healthy young adults performed (n=10) 10 walk trials (5 for each leg) in which they walked over a force platform. Motion analysis (Vicon Motion Capture System) was used to calculate joint angles and internal moments around the knee, hip and ankle in the sagittal plane. Joint angles and moments of the injured knee (in PCLD and ACLD) or left knee (in HYA) were compared between groups at weight acceptance, mid-stance and push-off phases (see Fig. 1). Clinical assessment included passive knee laxity (Kneelax) for anterior (in 20–30° knee flexion) and posterior tibia translation (in 70–90° knee flexion) and Lysholm questionnaires. Results. Lysholm scores were significantly lower in PCLD and ACLD individuals compared to HYA (p's ≤ .001). PCLD subjects had more passive anterior (p = .001) and posterior tibia translation (p = .041) compared to HYA, but no significant differences were found in both directions between ACLD and HYA (p's > .10). During gait, knee angles at weight acceptance, late stance and around toe-off were not significantly different between the PCLD and HYA, and between ACLD and HYA (all p's > .06). However, the knee extension moment during mid-stance was significantly lower in the PCLD group when compared to the HYA group (p = .001; Fig. 2). Interestingly, the knee moment in the PCLD group remained positive (i.e. extension moment) throughout the stance phase, whereas HYA and ACLD groups created a substantial flexion moment around the knee at this instant. We did not observe any significant differences in hip and ankle joint angles and moments between groups. Discussion. We observed a difference in gait pattern in individuals with PCL deficiency compared to HYA, that was confined to an absence of knee flexion moments during the mid-stance phase. We hypothesize that this difference reflects a compensation strategy employed by individuals with PCL deficiency to avoid external knee (hyper)extension moments. Gait adaptations related to PCL deficiency might also have implications for design of total knee prosthesis and calls for careful evaluation of gait patterns after TKA with a specific focus on the role of the PCL. For any figures or tables, please contact the authors directly

Introduction. A deep squat (DS) is a challenging motion at the level of the hip joint generating substantial reaction forces (HJRF). As a closed chain exercise, it has great value in rehabilitation and muscle strengthening of hip and knee. During DS, the hip flexion angle approximates the functional range of hip motion risking femoroacetabular impingement in some morphologies. In-vivo HJRF measurements have been limited to instrumented implants in a limited number of older patients performing incomplete squats (< 50° hip flexion and < 80° knee flexion). On the other hand, total hip arthroplasty is being increasingly performed in a younger and higher demanding patient population. These patients clearly have a different kinetical profile with hip and knee flexion ranges going well over 100 degrees. Since measurements of HJRF with instrumented prostheses in healthy subjects would be ethically unfeasible, this study aims to report a personalised numerical solution based on inverse dynamics to calculate realistic in-silico HJRF values during DS. Material and methods. Thirty-five healthy males (18–25 years old) were prospectively recruited for motion and morphological analysis. DS motion capture (MoCap) acquisitions and MRI scans with gait lab marker positions were obtained. The AnyBody Modelling System (v6.1.1) was used to implement a novel personalisation workflow of the AnyMoCap template model. Bone geometries, semi-automatically segmented from MRI, and corresponding markers were incorporated into the template human model by an automated procedure. A state of-the-art TLEM 2.0 dataset, included in the Anybody Managed Model Repository (v2.0), was used in the template model. The subject-specific MoCap trials were processed to compute kinematics of DS, muscle and joint reaction forces in the entire body. Resulting hip joint loads were compared with in-vivo data from OrthoLoad dataset. Additionally, hip and knee joint angles were computed. Results. An average HJRF of 274%BW (251.5 – 297.9%BW; 95% confidence interval) was calculated at the peak of DS. The HJRF on the pelvis was directed superior, medial and posterior throughout the DS. Peak knee and hip flexion angles were 112° (108.1° – 116.5°) and 107° (104.6° – 109.4°) on average. Discussion and conclusions. A comprehensive approach to construct an accurate personalised musculoskeletal model from subject-specific MoCap data, bone geometries, and palpatory landmarks was presented. Consistently higher HJR forces during DS in young adults were demonstrated as opposed to the Orthoload dataset. Similarly, knee and hip flexion angles were much higher, which could cause the increase in HJRF. It can be concluded that DS kinetics in young adults differ from the typical total hip arthroplasty population. These models will enable further in-silico joint biomechanics studies, and could serve the purpose of a virtual test bed for implant design

Osteosarcoma (OS) is the most prevalent bone tumor in children and young adults. Most tumors arise from the metaphysis of the long bones and easily metastasize to the lungs. Current therapeutic strategies of osteosarcoma are routinely surgical resection and chemotherapy, which are limited to the patients suffering from metastatic recurrence. Therefore, to investigate molecular mechanisms that contribute to osteosarcoma progression is very important and may shed light on targeted therapeutic approach to improve the survival of patients with this disease. Several miRNAs have been found expressed differentially in osteosarcoma (OS), In this study, we found that miR-144 significantly suppresses osteosarcoma cell proliferation, migration andinvasion ability in vitro, and inhibited tumor growth and metastasisin vivo. The function and molecular mechanism of miR-144 in Osteosarcoma was further investigated. Tissue samples from fifty-one osteosarcoma patients were obtained from Shanghai Ninth People's Hospital. The in vitro function of miR-144 in Osteosarcoma was investigated by cell viability assay, wound healing assay, invasion assay, the molecular mechanism was identified by Biotin-coupled miRNA capture, Dual-luciferase reporter assays, etc. the in vivo function of miR-144 in osteosarcoma was confirmed by osteosarcoma animal model and miR-144−/− zebrafish model. Mechanically, we demonstrated that Ras homolog family member A (RhoA) and its pivotal downstream effector Rho-associated, coiled-coil containing protein kinase 1 (ROCK1) were both identified as direct targets of miR-144. Moreover, the negative co-relation between downregulated miR-144 and upregulated ROCK1/RhoA was verified both in the osteosarcoma cell lines and clinical patients' specimens. Functionally, RhoA with or without ROCK1 co-overexpression resulted a rescue phenotype on the miR-144 inhibited cell growth, migration and invasion abilities, while individual overexpression of ROCK1 had no statistical significance compared with control in miR-144 transfected SAOS2 and U2-OS cells. This study demonstrates that miR-144 inhibited tumor growth and metastasis in osteosarcoma via dual-suppressing of RhoA and ROCK1, which could be a new therapeutic approach for the treatment ofosteosarcoma

Purpose. Factors contributing to chronic postoperative pain (CPOP) are poorly defined in young people and developmental considerations are poorly understood. With over 5 million children undergoing surgery yearly and 25% of adults referred to chronic pain clinics identifying surgery as the antecedent, there is a need to elucidate factors that contribute to CPOP in young people. The present study includes patients undergoing hip preservation surgery at a children's hospital. Methods. The HOOS and the SF-12 Health Survey were administered to 614 patients prior to surgery with 422 patients completing follow-up data (6-months, 1-year, and 2-years post-surgery). Examining baseline characteristics for those who completed follow-up versus those who did not, the only significant difference was that patients with more than one surgery were less likely to complete follow-up measures. Pain, quality of life, and functioning across time were examined using SAS PROC TRAJ procedure, a mixture model that estimates a regression model for each discrete group within the population. Longitudinal pain trajectories were empirically grouped. Baseline preoperative characteristics of age, gender, preoperative pain, quality of life, functioning, and mental health that could potentially distinguish trajectory groups were examined. Results. A three trajectory model (low pain, pain improvement, and high pain) emerged indicating three different treatment responders. Pain trajectory groups did not differ significantly on gender, presurgical age, BMI, prior hip surgery, surgical type, joint congruence, or Tönnis grade. The pain trajectory groups differed significantly from each other on presurgical pain, pain chronicity, quality of life, and functioning. Those in the high pain group and pain improvement group endorsed having presurgical depression at significantly higher rates and lower presurgical quality of life compared to those in the low pain group (p<.01). Similarly, those in the high pain group reported significantly worse functioning prior to surgery compared to the pain improvement group (p<.0001) and those in the low pain group (p<.0001). Conclusions. Chronic pain is a common problem and surgery can be a trigger. There may be a subset of hip preservation surgery patients who are predisposed to chronic pain independent of hip health. The results demonstrate the need for preoperative screening prior to hip preservation surgery. A prospective, interventional study to identify patients at risk for a poor pain trajectory is underway. Significance. This is the largest study to date to examine longitudinal pain, quality of life, and functioning trajectories for adolescent and young adults undergoing hip preservation surgery. Chronic pain is a serious public health concern, with the United States spending $19 billion annually on pain-related disability. Identifying predictors of poor long-term outcomes in adolescents and young adult samples with postoperative pain may prevent the development of chronic pain into adulthood as well as inform presurgical preparation and postsurgical care

Developmental dysplasia of the hip (DDH) is the most common paediatric hip condition and is a major cause of hip replacement or osteoarthritis in young adults. Due to potential impact on quality of life, every child is checked at birth for unstable hips. Should instability be detected, or the infant has other DDH risk factors, they are referred for an ultrasound exam and orthopaedic surgeon consultation. Since the implementation of a DDH screening program at our institution, the Radiology Department has seen a dramatic increase in hip ultrasounds performed. While helping prevent the complications of missed DDH diagnoses, this program has placed strain on radiology resources, and often families must attend multiple appointments before receiving a diagnosis and beginning treatment. To mitigate this, we have implemented a pilot point-of-care DDH clinic, where an ultrasound technician performs hip ultrasound exams using a portable ultrasound in the orthopaedic clinic in conjunction with surgeon consultation. The aim of this clinic is to enable diagnosis and treatment in one appointment, reduce referral-to-treatment delays, wait times, and decrease costs and travel time for families while also alleviating strain on radiology resources. A point-of-care DDH test clinic was implemented in the Orthopaedic Department at our institution. Patients referred with suspected/confirmed DDH attended a single orthopaedic clinic appointment. An ultrasound technician was present to perform scans in conjunction with the orthopaedic surgeon's clinical assessment. Surveys were distributed at the end of the appointment to collect feedback on the family's satisfaction with the program, as well as other pertinent demographic information (i.e. occupation, geographic location, travel time to hospital). To date, 40 patients have attended the pilot clinic. Families spent an average 61.3 minutes (range 15–420 minutes) traveling to the hospital for an appointment (122.6 minutes round-trip). This program reduced the number of hospital visits for DDH screening from three (initial consultation, radiology, follow-up) to one per patient, saving an average 245.2 minutes of travel time to/from the hospital per family. Appointment time averaged 35.9 minutes and families rated their satisfaction with appointment length an average of 9.6/10 (35/40 families rated satisfaction 10/10, 1 = very unsatisfied, 10 = very satisfied). Additionally, 33/40 families were also asked to rate their satisfaction with check-in/check-out processes (average 9.4/10), ultrasound screening (average 9.9/10), and time with specialist (average 9.9/10). Satisfaction scores did not differ based on variables such as survey taker's gender, occupation, or geographic location. The pilot point-of-care ultrasound DDH clinic has considerably reduced the number of clinic visits and travel time for families, reduced aggregate clinic wait times, and has resulted in high family satisfaction. This specialized clinic may have potential to free up hospital staff time and resources, possibly decreasing wait times in other clinical areas, ultimately improving quality of care for patients and families across our institution

Introduction. Intracapsular hip fractures in young adults are treated with internal fixation, often as a surgical emergency to reduce the vascular insult to the femoral head. Avascular necrosis and non-union often require revision surgery. Methods. A prospective trauma database was retrospectively searched from 1. st. August 2008 to 31. st. December 2010. Intracapsular hip fracture admissions to the Regional Trauma Centre, in adults under sixty-five years, were studied. Ninety-eight intracapsular fractures internally fixed with sliding hip screw underwent radiographic review for quality of fixation, and evidence of complications at a mean of thirteen months. Co-morbid medical conditions and quality of fixation were assessed for association with revision rates. Results. Avascular necrosis developed in eighteen fractures, and seven proceeded to non-union. Seventeen of ninety-eight fractures underwent revision to total hip arthroplasty. Three individuals were deceased at final review. Six of thirty-four fractures (18%) fixed within twelve hours of injury required revision, compared with eleven of sixty-four (17%) fixed after twelve hours. None of the four fractures fixed within six hours required revision, although this was not statistically significant (p=0.32). Revision was required for three of six individuals with chronic respiratory disease (50%) excluding asthma, one of two with rheumatoid arthritis (50%), and three of six with varus reduction (50%), and each were significant on multiple regression. Residual translation and eccentric screw placement approached significance on chi-squared analysis. Only two of twenty (10%) fractures fixed using an additional anti-rotation screw required revision. Conclusions. Internal fixation of intracapsular hip fractures within twelve hours in young adults did not statistically reduce revision rates. Accurate reduction and internal fixation is paramount, and anti-rotation screws may reduce complication rates. Certain co-morbid conditions predict revision, and should be taken into consideration when selecting the primary operative procedure

Treatment of the femoral head necrosis with severe extensive collapse in young adults and adolescents are still challenging. We thought preserve the joint and bone stock were important factor for the treatment of femoral head necrosis in young patients. We reviewed the posterior rotational osteotomy for younger patients with severe osteonecrosis. The advantages of posterior rotational osteotomy are; the necrotic area is moved to non-weight bearing portion. The posterior column artery is shifted medially without vascular damage by rotation. Postoperative uncollapsed anterior viable areas are moved to the loaded portion below the acetabular roof in flexed positions. Eighty five hips of 66 young adults (less than 50 years old, mean age; 31 years) with extensive necrosis treated by posterior rotational osteotomy were reviewed with more than 5 year follow up with a mean of 9 years. Results of 13 hips of 12 adolescents (mean age; 14 years) with extensive collapsed necrosis treated by this procedure were also studied with a mean of 6.5 years. A mean degree of posterior rotation was 121. Recollapse was prevented in 77 hips (91%) of adults, and all 13 hips of adolescents on final AP radiographs. Collapsed lesion was remodeled well and resphericity of the postoperative transferred medial collapsed femoral head on final AP radiographs was observed. However, some of the cases were out of indication of the joint preserving procedure showing extensive lesion. In these cases, we performed the MAYO conservative stem for preserving bone stock. Radiological results of 26 hips with osteonecrosis treated by MAYO stem (mean age 42 years, minimum 5 year follow-up. mean; 6.7 years) showed that 2 mm subsidence in one, osteointegration of zone 2, 6 in 93%, no entire lucent line. No hips were revised for late loosening associated with osteolysis. CT imaging indicated that spot welds of zone 2, 6 were found in 100ï¼ï¿½, stress shielding of zone 1, 5 (23.5ï¼ï¿½). These operations were useful particularly for younger patients

The surgical treatment of young adults with end-stage hip disease has been a challenge. Inferior THA survival in the young, perceived advantages of hip resurfacing versus THA and advancements in tribology, led to the introduction of 3rd generation Metal-on-Metal-Hip-Resurfacing-Arthroplasty (MoMHRA). To-date, thousands of such prostheses have been implanted worldwide in younger patients, yet little is known regarding long-term outcome. The only studies reporting greater than 10 year outcome come from designer centres with survivorship varying between 88.5–96% at 12 years. Arthroplasty Registries (AR) have reported less favourable survivorships with female gender and size having a negative effect on survival. In our independent hip resurfacing centre in Ghent, Belgium, a single surgeon has implanted more than 3500 HRA over more than 12 years. A cohort of 149 patients who received a Birmingham Hip Resurfacing (BHR) at a mean age of 50 years at surgery have now reached a minimum 10 years follow-up. The overall 12-year survival in these young adults is 93.1% (95% CI: 88.3–98.0), 99% in males and 87.3% in females. These survivorship data are superior to registry reported figures of THA amongst young patients and correspond well with previous reports from designer centres. The long-term survivorship and clinical outcome of the BHR are excellent in men, uninfluenced by preoperative diagnosis or age. However, survivorship in women is inferior and usually related to increased wear and reactions to metal debris. Malpositioning of components with associated wear-induced soft tissue fluid collections is the most frequent factor leading to failure of a HRA. In our experience, mid-term outcome following revision is good and complication and re-revision rates can be low. Surgical experience, early intervention in cases of mal-positioned implants, clinical use of ion levels, implantation of larger ceramic-on-ceramic THA femoral heads and patient education are factors in improving outcome and reducing complication and re-revisions following HRA revision