An oleuropein-based dietary supplement may improve joint functional capacity in older people with high knee joint pain: findings from a multicentre-RCT and post hoc analysis.

OBJECTIVES: To investigate a 6-month intervention with an olive leaf extract (OLE) on knee functionality and biomarkers of bone/cartilage metabolism and inflammation. DESIGN: This randomized, double-blind, placebo-controlled, multi-centric trial included 124 subjects with knee pain or mobility issues. Subjects received twice a day one capsule of placebo or 125 mg OLE (Bonolive™, an OLE containing 50 mg of oleuropein) for 6 months. The co-primary endpoints were Knee injury and Osteoarthritis Outcome Score (KOOS) and serum Coll2-1NO2. The secondary endpoints were the subscales of the KOOS, knee pain VAS at rest and at walking, OARSI core set of performance-based tests and multiple inflammatory and bone or cartilage remodeling serum biomarkers and concentration of oleuropein's metabolites in urine. RESULTS: At 6 months, OLE group was not efficient on global KOOS score, changes of inflammatory and cartilage remodeling biomarkers compared to placebo. Post hoc analyses demonstrated a large and significant treatment effect of OLE in a sub-group of subjects with high walking pain at baseline (p = 0.03). This was observed at 6 months for the global KOOS score, and each different subscale and for pain at walking (p = 0.02). OLE treatment was well tolerated. CONCLUSION: OLE was not effective on joint discomfort excepted in a sub-group of subjects with high pain at treatment initiation. As oleuropein is well tolerated, OLE can be used to relieve knee joint pain and enhance mobility in subjects with articular pain.

Good midterm results after Birmingham hip resurfacing and total hip arthroplasty.

The aim of this study is to determine the functional outcome and midterm survival rates of the Birmingham Hip Resurfacing and Birmingham Total Hip Arthroplasty. This retrospective, observational study included 150 surgeries (46 resurfacing procedures and 104 arthroplasty procedures) performed in 127 patients from 2005 to 2012. The Resurfacing and Arthroplasty study groups were evaluated with clinical (Harris Hip Score and Hip Disability and Osteoarthritis Outcome Score) and radiological follow-up. Cobalt and chromium levels were measured via blood samples. No revisions were required in either study group. Femoral stem osteolysis was observed in three patients in the Arthroplasty group. No osteolysis was observed in the Resurfacing group. Significantly higher clinical scores were observed in the Resurfacing group (p=0.04 and p=0.04, respectively). The average level of metal ions were similar in both groups. Both groups showed excellent midterm clinical and radiographic results with 100 percent survival rates. Additional follow-up is required to monitor future changes in blood metal ion levels.

Patient-specific instruments: industry's innovation with a surgeon's interest.

PURPOSE: The aim of this study was (1) to survey the orthopaedic companies about the volume of patient-specific instruments (PSI) used in Europe and worldwide; (2) to survey a group of knee arthroplasty surgeons on their acceptance of PSI and finally; (3) to survey a medico-legal expert on PSI-related issues. METHODS: Seven orthopaedic implant manufacturers were contacted to obtain their sales figures (in volume) of PSI in Europe and worldwide for the 2011 and 2012 period. During the Open Meeting of the Belgian Knee Society, a survey by a direct voting system was submitted to a selection of knee surgeons. Finally, a number of medico-legal 'PSI-related' questions were submitted to an adult reconstruction surgeon/legal expert. RESULTS: The total volume, for all contacted companies, of PSI in Europe for 2012 was 17,515 total knee arthroplasty (TKA) and 82,556 TKA worldwide. Biomet (Warsaw, USA) was the number one in volume, both in Europe as worldwide with their Signature system. Biomet represented 27 % of the market share in PSI worldwide. Stryker preferred not to reply to the survey because of the FDA class 1 recall on ShapeMatch cutting guides. Eighty per cent of the Belgian knee surgeons expressed a great interest in PSI and especially, for 58 % of them, if it would increase their surgical accuracy. They valued it even more in unicompartmental arthroplasty, and 55 % was ready to use single-use instruments. Surprisingly, 47 % of surgeons thought it was the company's responsibility if something goes wrong with a PSI-assisted case. The medico-legal expert concluded that PSI is a complex process that exposes surgeons to new risks in case of failure and stated that companies should not produce surgical guides without validation of the planning by the surgeon. CONCLUSION: Patient-specific instruments is of great interest if it can proof to increase the surgical accuracy in knee arthroplasty to the level surgeons are expecting and if in the same time it would make the surgical process more efficient. LEVEL OF EVIDENCE: V.

Failure of the titanium trochanteric gamma nail in ununited metastatic fractures.

Metastatic lesions often occur in the trochanteric region of the femur with a risk for pathologic fractures, requiring aggressive surgical treatment. We present two cases of mechanical failure of the Titanium Gamma 3 Nail 180 used for treatment of impending pertrochanteric pathologic fractures. Metallurgic and low power optical examination findings are presented. Treatment with intramedullary nailing devices has proven its efficacy. However in cases of delayed union or non-union, a fatigue fracture due to dynamic overload should be expected sooner of later. If there is no evidence of healing within six months postoperatively a hardware exchange or another therapeutic option should be considered.

Arterial graft occlusion after total knee arthroplasty treated by prompt thrombectomy.

We describe the case of an 83-year-old woman with a patent extra-anatomic femoropopliteal bypass who developed graft thrombosis during total knee arthroplasty. Reperfusion was achieved as a result of prompt diagnosis and thrombectomy. Arterial graft occlusion is a rarely reported complication of total knee arthroplasty, although it can be limb-threatening. Early diagnosis and treatment are important.