Felix Yao

A comparison of three methods of wound closure following arthroplasty: a prospective, randomised, controlled trial.

We carried out a blinded prospective randomised controlled trial comparing 2-octylcyanoacrylate (OCA), subcuticular suture (monocryl) and skin staples for skin closure following total hip and total knee arthroplasty. We included 102 hip replacements and 85 of the knee.OCA was associated with less wound discharge in the first 24 hours for both the hip and the knee. However, with total knee replacement there was a trend for a more prolonged wound discharge with OCA. With total hip replacement there was no significant difference between the groups for either early or late complications. Closure of the wound with skin staples was significantly faster than with OCA or suture. There was no significant difference in the length of stay in hospital, Hollander wound evaluation score (cosmesis) or patient satisfaction between the groups at six weeks for either hips or knees. We consider that skin staples are the skin closure of choice for both hip and knee replacements.

The Risk of HIV, HBV, HCV and HTLV Infection Among Musculoskeletal Tissue Donors in Australia

In Australia, there are no current national estimates of the risks of transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) or human T‐lymphotrophic virus (HTLV) by musculoskeletal tissue transplantation. We determined the prevalence rates of antibodies against HIV (anti‐HIV), HCV (anti‐HCV) and HTLV (anti‐HTLV) and Hepatitis B surface antigen (HBsAg) for 12 415 musculoskeletal tissue donors from three major bone tissue banks across Australia for the period 1993–2004. The prevalence (per 100  000 persons) was 64.44 for anti‐HIV, 407.13 for HBsAg, 534.63 for anti‐HCV and 121.88 for anti‐HTLV. The estimated probability of viremia at the time of donation was 1 in 128  000, 1 in 189  000, 1 in 55  000 and 1 in 118  000, respectively. With the addition of nucleic acid amplification testing (NAT), the probability of donor viremia would be reduced to 1 in 315  000 for HIV, 1 in 385  000 for HBV and 1 in 500  000 for HCV. The prevalence of HIV, HBV, HCV and HTLV although low, are higher among musculoskeletal tissue donors than among first‐time blood donors. The risks associated with musculoskeletal donation will be reduced with NAT, though further cost analysis is required prior to its implementation.

Comparison of the risk of viral infection between the living and nonliving musculoskeletal tissue donors in Australia

Screening of musculoskeletal tissue donors with nucleic acid testing (NAT) for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) has been implemented in the United States and other developed nations. However, in contrast to the donor demographics in the United States, the majority of Australian musculoskeletal tissue donations are primarily from living surgical donors. The objective of our study was to determine and compare the risk of viral infection associated with musculoskeletal tissue donation from living and nonliving donors in Australia. We studied serum samples from 12 415 consecutive musculoskeletal tissue donors between 1993 and 2004. This included 10 937 surgical donations, and 1478 donations obtained from postmortem organ donation patients and cadaveric donors. Current mandatory retesting of surgical donors 6 months postdonation reduces the risk of viral infection by approximately 95% by eliminating almost all donors in the window period. The addition of nucleic acid amplification testing for nonliving donors would similarly reduce the window period, and consequently the residual risk by approximately 50% for hepatitis B virus, 55% for HIV, and 90% for HCV. NAT, using appropriately validated assays for nonliving donors, would reduce the residual risk to levels comparable to that in living donors (where the 95% reduction for quarantining pending the 180‐day re‐test is included).

Evaluation of insoluble bone gelatin as a carrier for enhancement of osteogenic protein-1-induced intertransverse process lumbar fusion in a rabbit model.

Study Design. Postero-lateral lumbar fusion in a rabbit model was performed to compare the bone induction potential of autograft, insoluble bone gelatin (ISBG), osteogenic protein-1 (OP-1), and the combination of ISBG and OP-1. Objective. To evaluate the efficiency of ISBG as a carrier/enhancer for OP-1 in a rabbit spinal fusion model. Summary of Background Data. OP-1 or recombinant human BMP-7 has been shown to be effective in inducing new bone formation in surgical applications such as spinal arthrodesis. However, the lack of an ideal carrier contributes to its associated comorbidities (e.g., uncontrolled bone growth, local inflammatory over-response, nonfusion) and limits its use clinically. Methods. Adult New Zealand white rabbits (n = 32) underwent bilateral lumbar intertransverse process fusion procedures at L5 to L6 and were randomized to receive: (1) autograft; (2) ISBG; (3) OP-1; or (4) ISBG in combination with OP-1 (ISBG + OP-1). Spinal fusion masses were evaluated by manual palpation, biomechanical testing, radiographic assessment, microcomputer tomography scanning and histologic examination at 6 weeks after surgery. Results. Treatment of ISBG + OP-1 resulted in higher spinal fusion rates (7 of 7, 100%) than that of autograft (3 of 7, 43%), ISBG (2 of 8, 25%), and OP-1 (2 of 7, 29%) based on manual palpation (P < 0.01). Greater fusion rates in the ISBG + OP-1 group were also evidenced by radiographic examination (P < 0.01), microcomputer tomography bone volume analysis (P < 0.01), and biomechanical testing (P < 0.05). Histologic assessment demonstrated that treatment of ISBG + OP-1 induces new contiguous bone formation in the interval between the transverse processes which was absent in the other groups. Conclusion. In this study, ISBG + OP-1 resulted in more effective lumbar intertransverse process fusion than autograft, OP-1 putty or ISBG alone. ISBG is capable of enhancing OP-1-induced bone formation.

Coupling factors and exosomal packaging microRNAs involved in the regulation of bone remodelling

Bone remodelling is a continuous process by which bone resorption by osteoclasts is followed by bone formation by osteoblasts to maintain skeletal homeostasis. These two forces must be tightly coordinated not only quantitatively, but also in time and space, and its malfunction leads to diseases such as osteoporosis. Recent research focusing on the cross‐talk and coupling mechanisms associated with the sequential recruitment of osteoblasts to areas where osteoclasts have removed bone matrix have identified a number of osteogenic factors produced by the osteoclasts themselves. Osteoclast‐derived factors and exosomal‐containing microRNA (miRNA) can either enhance or inhibit osteoblast differentiation through paracrine and juxtacrine mechanisms, and therefore may have a central coupling role in bone formation. Entwined with angiocrine factors released by vessel‐specific endothelial cells and perivascular cells or pericytes, these factors play a critical role in angiogenesis–osteogenesis coupling essential in bone remodelling.