Ioanna Bolia

Applied nanotechnology and nanoscience in orthopedic oncology

Nanomedicine is based on the fact that biological molecules behave similarly to nanomolecules, which have a size of less than 100 nm, and is now affecting most areas of orthopedics. In orthopedic oncology, most of the in vitro and in vivo studies have used osteosarcoma or Ewing sarcoma cell lineages. In this article, tumor imaging and treatment nanotechnology applications, including nanostructure delivery of chemotherapeutic agents, gene therapy, and the role of nano-selenium-coated implants, are outlined. Finally, the potential role of nanotechnology in addressing the challenges of drug and radiotherapy resistance is discussed. [Orthopedics. 2016; 39(5):280-286.].

Twenty-year Systematic Review of the Hip Pathology, Risk Factors, Treatment, and Clinical Outcomes in Artistic Athletes—dancers, Figure Skaters, and Gymnasts

Objective: To identify (1) the predominant level of evidence of the clinical studies regarding the hip pathology, risk factors, treatment, and clinical outcomes in artistic athletes (dancers, figure skaters, and gymnasts) (2) the most commonly reported hip pathology, risk factors, treatments, and clinical outcomes in dancers, figure skaters, and gymnasts. Methods: To conduct this systematic review PubMed, EMBASE, and Scopus databases were searched for relevant studies and pertinent data were collected from the eligible articles. Included were studies which reported hip injuries in artistic athletes, the risk factors, treatment, and/or the clinical outcomes. We excluded case reports or irrelevant studies. No meta-analysis was performed because of study heterogeneity. The methodical index for nonrandomized studies (MINORS) criteria were used for quality control. Main Results: Thirty-eight studies were included in the analysis. The mean MINORS score was 13.6 ± 4.6 points indicating fair quality of evidence of the included articles. The predominant level of evidence was level IV. Chondrolabral pathology and muscle injuries were the most commonly reported pathologies. We found only 2 risk factor analysis studies; however, many studies reported risk correlation between artistic sports or imaging findings and hip pathology. Treatment strategies were reported in only 7 studies, clinical outcomes are significantly underreported. Conclusion: Chondrolabral pathology was the most commonly reported hip pathology in artistic athletes, however, prospective cohort studies are necessary to really understand these injuries and their associated risk factors. The lack of clinical outcomes is significant and future data collection is required to assess the effectiveness of the various treatments.

Outcomes following arthroscopic hip segmental labral reconstruction using autologous capsule tissue or indirect head of the rectus tendon

ABSTRACT The purpose of this study was to determine the outcomes following segmental labral reconstruction (labral defects measuring <1u2009cm) using a segment of capsular tissue or a segment of the indirect head of rectus femoris tendon. Eleven patients (five females and six males) underwent segmental labral reconstruction using a segment of capsule (eight patients) or indirect head of rectus tendon (three patients) by a single surgeon from March 2005 to October 2012. The average age of the patients was 35u2009years old (range, 20–51u2009years). Data collected included the pre- and post-operative Hip Outcome Score (HOS-ADL and HOS-SS), the modified Harris Hip Score and patient satisfaction rate (1u2009=u2009unsatisfied, 10u2009=u2009very satisfied), complications, necessity of revision hip arthroscopy and conversion to total hip arthroplasty. Average follow-up time was at 62u2009months (range, 9–120u2009months). No patient required revision hip arthroscopy or converted to total hip arthroplasty. The HOS-ADL significantly improved from 73 to 89 (Pu2009<u20090.05). The HOS-SS showed significant improvement from 52 to 79 and the modified Harris Hip Score significantly improved from 66 to 89. Median patient satisfaction rate was 9 out of 10 (range, 3–10). In a small sample, the arthroscopic hip segmental labral reconstruction showed significant improvement in patient-reported outcomes. This treatment provides an option in cases of small labrum defects (<1u2009cm) or deficits in patients while providing improved function and high patient satisfaction.

Denosumab: Current Use in the Treatment of Primary Bone Tumors

Denosumab, a human monoclonal antibody that inhibits bone resorption by binding on the receptor activator of the nuclear factor kappa-β ligand, has recently emerged as an additional option in the treatment of musculoskeletal osteolytic tumors. This article focuses on the recent literature regarding the effectiveness of denosumab in the management of giant cell tumor, multiple myeloma, aneurysmal bone cyst, and osteosarcoma. The mechanism of action of denosumab in the management of these tumors and the associated side effects are discussed in detail. [ Orthopedics. 2017; 40(4):204-210.].

Potential Usefulness of Losartan as an Antifibrotic Agent and Adjunct to Platelet-Rich Plasma Therapy to Improve Muscle Healing and Cartilage Repair and Prevent Adhesion Formation

Postoperative tissue fibrosis represents a major complication in orthopedics. Transforming growth factor beta 1 is a key molecule in the development of postoperative fibrosis. High concentrations of transforming growth factor beta 1 have also been implicated in various diseases. Agents that counteract the actions of transforming growth factor beta 1 have been investigated as potential antifibrotic medications and as adjunct treatment to platelet-rich plasma injections (increased amounts of transforming growth factor beta 1) to improve their effectiveness and/or safety profile. Losartan blocks transforming growth factor beta 1 action and has attracted special interest in orthopedic research that focuses on how to reduce the risk of postoperative fibrosis. [Orthopedics. 2018; 41(5):e591-e597.].

Three-dimensional Technologies in Orthopedics

New 3-dimensional digital technologies are revolutionizing orthopedic clinical practice, allowing structures of any complexity to be manufactured in just hours. Such technologies can make surgery for complex cases more precise, more cost-effective, and possibly easier to perform. Applications include pre-operative planning, surgical simulation, patient-specific instrumentation and implants, bioprinting, prosthetics, and orthotics. The basic principles of 3- dimensional technologies, including imaging, design, numerical simulation, and printing, and their current applications in orthopedics are reviewed. [Orthopedics. 2018; 41(1):12-20.].

Effectiveness of Hyperbaric Oxygen Therapy for the Management of Chronic Osteomyelitis: A Systematic Review of the Literature

Hyperbaric oxygen has been used as an adjunctive measure in the treatment of chronic osteomyelitis. The aim of this systematic literature review was to analyze the outcome and the complications of hyperbaric oxygen for chronic osteomyelitis. Forty-five of 96 studies reporting the use of hyper-baric oxygen for 460 patients with chronic osteomyelitis met the inclusion criteria and were analyzed qualitatively. All patients previously received antibiotics and surgical debridement. Mixed bacterial flora was detected in most of the studies. Staphylococcus aureus was the isolated pathogen in 12 (60%) of the 20 cohort and in 4 (20%) of the 20 case studies. Adjuvant hyperbaric oxygen was effective in 16 (80%) of the 20 cohort and 19 (95%) of the 20 case studies. Overall, 308 (73.5%) of 419 patients with complete data had a successful outcome and no reported relapse. Available evidence supports a potentially beneficial role of adjunctive hyperbaric oxygen, especially in refractory cases of chronic osteomyelitis. [Orthopedics. 2018; 41(4):193-199.].

Current concepts in revision hip arthroscopy

Hip arthroscopy is an evolving procedure and its indications have expanded. The number of patients undergoing this procedure has increased significantly as well as the number of surgeons being trained. This has resulted in a notable increase in post-operative complication rates creating the need to develop advanced hip arthroscopic techniques. Revision hip arthroscopy is often complex and many factors should be considered to achieve a satisfactory clinical outcome. Careful pre-operative planning and agreement of expectations between the physician and patient regarding the procedure are important. This review describes several advanced treatment options that are used mainly in revision or complex primary hip arthroscopy cases. Labral reconstruction or augmentation technique is used in cases of severely deficient acetabular labral tissue to restore the fluid seal mechanism. In cases of symptomatic (often post-operative) adhesion formation, a spacer between the labrum and the joint capsule is useful for pain relief and prevention of future adhesions. Large defects of the capsule due to previous unrepaired capsulotomy or any other cause can be addressed with the capsular reconstruction technique. Ligamentum teres reconstruction using an anterior tibialis allograft is indicated in patients with hip instability and persistent pain after previous debridement or with complete tears of this structure. The senior author’s treatment of choice in cases of previous over-resection of CAM impingement is the remplissage technique to restore the bony defect of the femoral head-neck junction and preserve the joint seal.

Labral Preservation: Outcomes Following Labrum Augmentation Versus Labrum Reconstruction

PURPOSEnThe purpose of this study was to compare the clinical outcomes and patient satisfaction between patients with previous surgeries who underwent hip labral augmentation versus labral reconstruction surgery.nnnMETHODSnFrom 2006 to 2014, all patients with previous labral procedures who underwent subsequent labral augmentation by the senior surgeon were included. Patients with joint space ≤2xa0mm and lateral center edge angle <20° and who refused to participate in follow-up were excluded. Patients who underwent labral augmentation, preserving macroscopically healthy native labral tissue and adding iliotibial band graft to increase labral volume, were compared with a matching group (1:2) of patients who underwent labral reconstruction where damaged or absent native labral tissue was replaced by the graft. Hip Outcome Score-Activity of Daily Living (HOS-ADL) was the primary outcome measure. Secondary outcomes included the modified Harris Hip Score (mHHS), HOS for Sports (HOS-Sport), Short Form-12, Western Ontario and McMaster Universities Osteoarthritis Index, and patient satisfaction with outcome. Nonparametric statistics were used to compare groups.nnnRESULTSnThirty-three patients (12 males, 21 females) who underwent labral augmentation (LA group) were compared with 66 (24 males, 42 females) labral reconstruction patients (LR group). The average age was 29 ± 10xa0years in both groups. Six patients (18%) required revision arthroscopy in the LA group, and 9 patients (14%) in the LR group (Pxa0=xa0.563). One patient (3%) in the LA group required a total hip arthroplasty, and 3 patients in the LR group (4.5%) had a total hip arthroplasty (Pxa0= .99). Of the remaining 26 patients in the LA group and 53 patients in the LR group, minimum 2-year follow-up was available for 21 (81%) and 51 (96%), respectively. Postoperatively the HOS-ADL, HOS-Sport, mHHS, and Western Ontario and McMaster Universities Osteoarthritis Index were significantly higher in the LA group (Pxa0< .05). The percentage of patients who reached minimum clinically important difference was significantly higher in the LA group for HOS-ADL (Pxa0= .002) and HOS-Sport (Pxa0= .008); however, there was no difference for the mHHS (Pxa0= .795). Patient satisfaction was 10 and 8 in the LA group and LR group, respectively (Pxa0= .585).nnnCONCLUSIONSnIn patients with previous procedures, the labral augmentation technique with preservation of macroscopically healthy native labral fibers resulted in significantly better outcomes compared with the segmental labral reconstruction procedure where damaged or previously removed labrum was replaced by a graft.nnnLEVEL OF EVIDENCEnLevel III, comparative case series.

Physiology and Homeostasis of Musculoskeletal Structures, Injury Response, Healing Process, and Regenerative Medicine Approaches

Kaitlyn E. Whitney, Ioanna K. Bolia, Jorge Chahla, Hajime Utsunomiya, Thos A. Evans, Matthew Provencher, Peter J. MilletThe Steadman Clinic and Steadman Philippon Research Institute, Vail, CO, USAJohnny HuardThe Steadman Clinic and Steadman Philippon Research Institute, Vail, CO, USADepartment of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA