Postoperative Bisphosphonates Use is Associated with Reduced Adverse Outcomes After Primary Total Joint Arthroplasty of Hip and Knee: A Nationwide Population-Based Cohort Study.

Bisphosphonates have been associated with a decreased risk of revision surgery after total joint arthroplasty of the hip or knee (TJA) because of their effects on decreased periprosthetic bone loss and prosthetic migration. However, the results in the early literature are inconsistent, and the influence of bisphosphonates on associated complications and subsequent TJA remains unknown. This study investigated the association between the use of bisphosphonates and the risk of adverse outcomes after primary TJA. This matched cohort study utilized the National Health Insurance Research Database in Taiwan to identify patients who underwent primary TJA over a 15-year period (January 2000-December 2015 inclusive). Study participants were further categorized into two groups, bisphosphonate users and nonusers, using propensity score matching. The Kaplan-Meier curve analysis and adjusted hazard ratios (aHRs) of revision surgery, adverse outcomes of primary surgery and subsequent TJA were calculated using Cox regression analysis. This study analyzed data from 6485 patients who underwent total hip arthroplasty (THA) and 20,920 patients who underwent total knee arthroplasty (TKA). The risk of revision hip and knee arthroplasty was significantly lower in the bisphosphonate users than in the nonusers (aHR, 0.54 and 0.53, respectively). Furthermore, the risk of a subsequent total joint arthroplasty, adverse events and all-cause mortality were also significantly reduced in the bisphosphonate users. This study, involving a large cohort of patients who underwent primary arthroplasties, revealed that bisphosphonate treatment may potentially reduce the risk of revision surgery and associated adverse outcomes. Furthermore, the use of bisphosphonates after TJA is also associated with a reduced need for subsequent arthroplasty.Research Registration Unique Identifying Number (UIN): ClinicalTrials.gov Identifier-NCT05623540 ( https://clinicaltrials.gov/show/NCT05623540 ).

Precise joint preserving surgery by using Three-Dimensional Printing Technology for metastatic periacetabular bone tumor: A technique note and preliminary report.

BACKGROUND/PURPOSE: Complex arthroplasties for periacetabular metastatic lesions can result in complications including infection and prosthesis loosening owing to poor bone quality. A new surgical protocol has been developed as a joint-sparing surgery to avoid complications after arthroplasties. The main surgical steps are: (a) conservative and accurate tumor resection with aid of 3D printing model-assisted preoperative resection simulation and preparation of pre-contour plate, (b) reconstruction with structural bone graft through the sandwich technique for augmentation of subchondral bone. METHODS: This retrospective study consisted of 6 patients (5 with metastatic bone tumors and one with multiple myeloma). The pelvic bone resection as defined by Enneking and Dunham were typed I + II in 2 patients and type II in 4 patients. The medical records, images, musculoskeletal tumor society (MSTS) score and visual analogue scale (VAS) were used for evaluation. RESULTS: The mean operative time was 234 minutes, and the average surgical blood loss was 1408 mL. The mean follow-up period was 21 months. The mean VAS significantly decreased at postoperative 1-week and 1-year follow-up. There were no intraoperative or early postoperative complications. The median MSTS score during the final follow-up was 26 points (range, 14-28 points). Except for one case who experienced severe joint destruction, all the other five cases were classified as excellent or good (>15). CONCLUSION: With precise tumor resection and reconstruction with sandwich procedure, the joint-sparing surgery can be performed in selected patients with metastatic periacetabular tumors.

Incidence of bone metastases in patients with organ-specific cancers: A nationwide population-based cohort study.

BACKGROUND: Bones are the third most common site of metastasis, although bone metastasis (BM) incidence varies widely. This study investigated the incidence of BM in the most common cancers in Taiwan to present the recent treatment landscape in patients with organ-specific cancers. METHODS: Data from the National Health Insurance Research Database of Taiwan were used to identify adult patients diagnosed with organ-specific cancers between January 1, 2000 and December 31, 2015. Kaplan-Meier analysis was used to quantify cumulative BM incidence at follow-up. BM incidences associated with different cancers were calculated comprehensively and stratified by sex, age group and follow-up periods, and age- and sex-adjusted hazard ratios (HRs) of BM were calculated using multivariate Cox regression analysis. RESULTS: Among 938 776 participants (mean follow-up, 9.2 years), liver (19.6%), colorectal (17.1%) and lung (15.1%) cancers were most commonly associated with BM. The mean interval between a primary cancer diagnosis and BM was 2 years. BM incidence varied widely among cancers; lung cancer (3213 per 105 person-years) was associated with the highest BM risk, followed by oesophageal, prostate and breast cancer. HRs of BM were significantly higher for lung cancer (HR = 8.1) than for other cancers. CONCLUSION: The estimated BM incidence provided insight into oncological clinical practice trends in the Asia-Pacific region. BM incidence may vary among populations. Understanding the principles of clinical evaluation in patients with cancer of unknown primary origin can facilitate appropriate treatment recommendations.

Early fixation failure of locked plating in complex distal femoral fractures: Root causes analysis.

BACKGROUND/PURPOSE: Orthopaedic Trauma Association (OTA) C-type distal femoral fractures can be very challenging to treat effectively. While locked plating is widely used in the complex distal femoral fracture, failure of locked plate fixation is not uncommon. First, we tried to determine the risk factor related to early failure of multiplanar OTA C-type fracture in the distal femur after fixation with lateral locked plate. Second, we tried to provide a strategy for surgeons to prevent pitfalls of early failure in the complex distal femoral fractures treated with lateral locked plating. METHODS: We retrospectively reviewed 44 adults with OTA C-type fractures of the distal femur treated with locked plate fixation between 2010 and 2016 at Tri-Service General Hospital. Average length of follow-up was 27.6 months (range, 12-54 months). Univariate and multivariate logistic regression were used to determine the association of variables on early failure of fixation. A p-value < 0.05 in univariate and multivariate analyses were considered significant. RESULTS: There were six patients experiencing early failure, and the early failure rate was 13.6%. The risk factors associated with early failure of complex distal femoral fracture identified by univariate analysis included sagittal oblique fracture pattern, longer working length and post-operative sagittal malalignment (odds ratio [OR] and 95% confidence intervals [CI]: 90.00 (6.85-1183.33), 0.55 (0.31-0.98) and 8.63 (1.077-69.075) respectively). The multivariate analysis showed only sagittal oblique fracture pattern was associated with early failure [OR: 52.348 (3.06-895.23)]. CONCLUSION: Sagittal oblique fracture was more likely to result in early postoperative failure. Early recognition of the fracture pattern should be considered to avoid catastrophic results.

Midshaft clavicle fracture following osteosynthesis with a hook plate: a retrospective case analysis.

PURPOSE: The clavicle hook plate has been commonly used to treat distal clavicle fractures and acromioclavicular (AC) joint dislocations; however, midshaft clavicle fracture at the medial end of the hook plate remains an underestimated complication. We aimed to discover the risk factors for this complication and the influence of these risk factors on patients and to suggest preventive surgical techniques. METHODS: We retrospectively reviewed the records of 150 patients with acute distal clavicle fractures or acute AC joint dislocations treated by internal fixation with a clavicle hook plate. The patient demographics, the occurrence of midshaft clavicle fracture at the medial end of the hook plate, and functional outcomes were analyzed. The functional outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) Shoulder Score and grading of the Constant shoulder score after the hook plate was removed. RESULTS: In total, 17 patients had complicating midshaft clavicle fractures at the medial end of the hook plate. Elderly patients had a higher risk of developing this complication than young patients. The odds ratio was 4.4 (p < 0.05). The average ASES score and grading of Constant score of these patients were 74.1 and 16.3 points, respectively, which were significantly inferior to those of patients without complications (p < 0.001). CONCLUSION: The incidence of midshaft clavicle fractures following osteosynthesis with a clavicle hook plate was not negligible, especially in elderly patients. This complication may impair shoulder function and quality of life. Awareness of this complication and the risk factors for this complication reminds us to perform such operations with caution.

Conventional plate fixation method versus pre-operative virtual simulation and three-dimensional printing-assisted contoured plate fixation method in the treatment of anterior pelvic ring fracture.

PURPOSE: Treating pelvic fractures remains a challenging task for orthopaedic surgeons. We aimed to evaluate the feasibility, accuracy, and effectiveness of three-dimensional (3D) printing technology and computer-assisted virtual surgery for pre-operative planning in anterior ring fractures of the pelvis. We hypothesized that using 3D printing models would reduce operation time and significantly improve the surgical outcomes of pelvic fracture repair. METHODS: We retrospectively reviewed the records of 30 patients with pelvic fractures treated by anterior pelvic fixation with locking plates (14 patients, conventional locking plate fixation; 16 patients, pre-operative virtual simulation with 3D, printing-assisted, pre-contoured, locking plate fixation). We compared operative time, instrumentation time, blood loss, and post-surgical residual displacements, as evaluated on X-ray films, among groups. Statistical analyses evaluated significant differences between the groups for each of these variables. RESULTS: The patients treated with the virtual simulation and 3D printing-assisted technique had significantly shorter internal fixation times, shorter surgery duration, and less blood loss (- 57 minutes, - 70 minutes, and - 274 ml, respectively; P < 0.05) than patients in the conventional surgery group. However, the post-operative radiological result was similar between groups (P > 0.05). The complication rate was less in the 3D printing group (1/16 patients) than in the conventional surgery group (3/14 patients). CONCLUSION: The 3D simulation and printing technique is an effective and reliable method for treating anterior pelvic ring fractures. With precise pre-operative planning and accurate execution of the procedures, this time-saving approach can provide a more personalized treatment plan, allowing for a safer orthopaedic surgery.

Pre-operative virtual simulation and three-dimensional printing techniques for the surgical management of acetabular fractures.

PURPOSE: Surgical treatment of acetabular fractures with plate fixation is challenging for orthopaedic surgeons because of variations of the surface curvature and complex fracture patterns of the acetabulum. We present our experience with pre-operative computer-assisted virtual simulation and three-dimensional (3D) printing techniques for the surgical treatment of acetabular fractures, especially in terms of operative time and surgical outcomes. METHODS: Twenty-nine patients with acetabular fractures treated with locking plates were included in this retrospective study (conventional locking plate fixation, n = 17; 3D-printing-assisted precontoured locking plate fixation, n = 12). Fracture types were classified according to the Letournel-Judet classification. Surgical duration, instrumentation time, blood loss, post-operative fracture reduction quality, and complication rates were compared between the two surgical groups. RESULTS: The 3D-printing group had a significantly shorter total surgical duration and instrumentation time for fractures with posterior wall or posterior column involvement (222.75 ± 48.12 and 35.75 ± 9.21 minutes, respectively; P < 0.05) and significantly shorter instrumentation time and less blood loss for fractures with anterior column involvement (43.40 ± 10.92 minutes and 433.33 ± 317.28 mL, respectively; P < 0.05) than those in the control group. The post-operative radiological results (assessed by consensus) were similar for both groups (good/fair: 14/3 vs. 11/1; P = 0.622). The complication rate was lower in the 3D-printing group than in the conventional group (16.67 vs. 29.41%). CONCLUSIONS: The 3D printing is a reliable method for treating acetabular fractures, and can reduce the surgical duration, instrumentation time, and blood loss.

Modified Essex-Lopresti procedure with percutaneous calcaneoplasty for comminuted intra-articular calcaneal fractures: a retrospective case analysis.

BACKGROUND: The ideal treatment for comminuted intraarticular calcaneal fractures is still debated. Open reduction and internal fixation (ORIF) is the most popular surgical procedure; however, wound complications, implant choice, and infection remain major concerns. This study aimed to demonstrate the results of an innovative, minimally invasive surgical procedure, namely, a closed reduction technique using large-diameter Steinmann pins and percutaneous calcaneoplasty using injectable calcium sulfate cement (MIIG X3, Wright Medical Technology, Inc., Arlington, TN), in patients with comminuted calcaneal fractures. METHODS: From January 2012 to January 2014, 20 patients (three women, 17 men) with comminuted calcaneus fractures (Sanders classification type III and Essex-Lopresti classification joint-depression type fracture) were included. Plain films and CT scans were obtained preoperatively in all patients. The operation was performed within three days post-injury, and patients were not allowed to bear weight until three months postoperatively. During this period, the patients were educated on how to perform bed exercises for joints above the surgical site, including muscle strengthening and body conditioning. Early active range of motion exercises for the ankle and forefoot began 3 to 6 weeks postoperatively. All patients were followed up regularly. The results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and Böhler's angle of the calcaneus. RESULTS: After an average follow-up of two years, none of the patients required further surgery or experienced soft tissue complications. The clinical results were rated good to excellent on the AOFAS scale in 80% of the cases (16 of 20 patients), and most patients had pain relief and returned to their former daily activities at the same level as before the injury. CONCLUSIONS: A modified Essex-Lopresti procedure with percutaneous calcaneoplasty appears to be a safe and effective procedure to treat comminuted calcaneal fractures with acceptable functional results. Long-term outcomes and additional cases using this technique are required to support our conclusion.

Significantly reducing the presurgical preparation time for anterior pelvic fracture surgery by faster creating patient-specific curved plates.

BACKGROUND: To shorten the preoperative preparation time, reconstruction plates were designed using the computed tomography (CT)-based three-dimensional (3D) medical imaging surgical planning software OOOPDS. In addition, 3D printing was used to generate curved plates for anterior pelvic fracture surgeries. METHODS: This study analyzed two groups with the same 21 patients who underwent surgery for traumatic anterior pelvic ring fractures. In Group 1, the direct reconstruction plates were preoperatively contoured according to the anatomical 3D-printed pelvic model. In Group 2, the fixation plates were contoured according to the 3D printed plate templates, which were created based on the simulated plate templates by the OOOPDS software. The processing time, including the 3D printing time for the pelvic models in Group 1, the 3D printing time for the fixation plate templates in Group 2, and the pre-contouring time for the plates in both groups, was recorded. RESULTS: The mean time of pre-contouring for the curved reconstruction plates in Group 2 was significantly less than in Group 1 (-55 min; P < 0.01). The mean time of 3D printing for the 3D plate template model in Group 2 was significantly less than that for the 3D pelvic model in Group 1 (-869 min; P < 0.01). Experimental results showed that the printing time for the plate pre-contouring and the 3D plate templates could be effectively reduced by approximately 93% and 90%, respectively. CONCLUSION: This method can shorten the preoperative preparation time significantly.

Effects of malnutrition on outcomes of patients with femoral head osteonecrosis undergoing total hip arthroplasty: A population-based study.

BACKGROUND: This study aimed to evaluate the impact of malnutrition on in-hospital outcomes in patients undergoing total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH). METHODS: This population-based retrospective study extracted data of patients undergoing THA for ONFH in the US National Inpatient Sample between 2005 and 2018. Factors associated with in-hospital mortality, medical and surgical complications, unfavorable discharge, and prolonged hospital stay were determined by logistic regression analysis. RESULTS: A total of 72,304 adults ≥18 years old with nontraumatic ONFH admitted for primary THA were included. Malnutrition was detected in 7152 (9.9%) patients using validated discharge codes. In-hospital mortality was 0.8% vs 0.1% for patients who were malnourished vs nonmalnourished. After adjusting for confounders, malnutrition was significantly associated with an increased risk of in-hospital death (adjusted odds ratio [aOR], 4.67; 95% CI, 2.43-8.97), medical complications (aOR, 1.49; 95% CI, 1.32-1.68), surgical complications (aOR, 1.78; 95% CI, 1.61-1.96), unfavorable discharge (aOR, 1.24; 95% CI, 1.11-1.39), and prolonged hospital stay (aOR, 1.90; 95% CI, 1.67-2.16) compared with adequate nutrition. Malnutrition was also associated with higher total hospital costs (adjusted ß = $9620; 95% CI, 7.87-11.36). Furthermore, the association between malnutrition, any medical or surgical complications, and unfavorable discharge was stronger in patients younger than 50 years than those ≥50 years old. CONCLUSIONS: In US patients undergoing primary THA for ONFH, malnutrition increases the risk of unfavorable in-hospital outcomes. This patient subgroup may require special attention and better strategies to improve perioperative care.

Traditional versus Minimally Invasive Spinopelvic Fixation for Sacral Fracture Treatment in Vertically Unstable Pelvic Fractures.

PURPOSE: Numerous different fixation techniques are used to treat vertical shear sacral fractures. We report our experience with spinopelvic fixation using a minimally invasive technique. METHODS: Thirty-eight patients with vertical pelvic and sacral fractures were treated with spinopelvic fixation (traditional open method, n = 21; minimally invasive technique, n = 17). Intergroup comparisons and statistical analysis were performed for intraoperative blood loss, operative time, post-operative radiographic grading, post-operative functional score, and complication rates. RESULTS: Patients treated with the minimally invasive technique had a significantly shorter operative time (-52 min, p = 0.022), reduced blood loss volume (-287 mL, p < 0.001), and better cosmetic appearance (p < 0.05) than those in the traditional open group. There were no significant intergroup differences in post-operative radiographic grading (p = 0.489) or post-operative functional scores (p = 0.072). The complication rate was lower in the minimally invasive group (1/17 patients) than in the traditional open group (2/21 patients). CONCLUSIONS: Minimally invasive spinopelvic fixation is a viable treatment for sacral fractures and can reduce blood loss and operative time.

Association between 3D Printing-Assisted Pelvic or Acetabular Fracture Surgery and the Length of Hospital Stay in Nongeriatric Male Adults.

Pelvic and acetabular fractures are challenging for orthopedic surgeons, but 3D printing has many benefits in treating these fractures and has been applied worldwide. This study aimed to determine whether 3D printing can shorten the length of hospital stay (LHS) in nongeriatric male adult patients with these fractures. This is a single-center retrospective study of 167 nongeriatric male adult participants from August 2009 to December 2021. Participants were divided into two groups based on whether they received 3D printing assistance. Subgroup analyses were performed. Pearson's correlation and multivariable linear regression models were used to analyze the LHS and the parameters. Results showed that 3D printing-assisted surgery did not affect LHS in the analyzed patients. The LHS was positively correlated with the Injury Severity Score (ISS). Initial hemoglobin levels were negatively associated with LHS in patients aged 18−40 and non-major trauma (ISS < 16) patients. In 40−60-year-old and non-major trauma patients, the duration from fracture to admission was significantly associated with LHS. This study indicates that 3D-assisted technology for pelvic or acetabular fracture surgery for nongeriatric male adults does not influence the LHS. More importantly, the initial evaluation of patients in the hospital was the main predictor of the LHS.

Multimodal Analgesia with Extended-Release Dinalbuphine Sebacate for Perioperative Pain Management in Upper Extremity Trauma Surgery: A Retrospective Comparative Study.

INTRODUCTION: Patients undergoing upper extremity fracture surgery (UEFS) commonly suffer from unbearable acute pain. Opioids remain the mainstay of moderate to severe pain alleviation, although there is a growing concern regarding the increasing trend in misuse and abuse. This study aimed to observe the safety and efficacy of dinalbuphine sebacate (DS), a novel extended-release analgesic, along with multimodal analgesia (MMA) for post-UEFS pain control. METHODS: We retrospectively reviewed the records of patients undergoing UEFS between August 2020 and January 2021. Eligible patients were included and divided into two groups, depending on the analgesic regimen. In the DS group, 150 mg DS was administered intramuscularly at least 12 h pre-operatively, while in the conventional analgesia (CA) group, 40 mg parecoxib was given within 3 h before surgery. Intraoperative fentanyl administration was guided by the Analgesia Nociception Index System in both groups. For breakthrough pain, fentanyl was used as rescue medicine in the postanaesthesia care unit while tramadol and parecoxib were administered in the ward. RESULTS: Forty-nine patients were allocated to the DS group and 60 patients were allocated to the CA group. In comparison with the CA group, the proportion of patients requiring opioids for breakthrough pain post-operatively was significantly lower in the DS group (fentanyl: 31% vs. 68%, p < 0.001; tramadol: 27% vs. 70%, p < 0.001). The DS group also consumed lower amounts of post-operative rescue opioids. Furthermore, both mean worst and least pain scores were significantly lower in the DS group from post-operative day (POD) 1 to POD 5. There was no significant difference in intraoperative consumption of fentanyl or incidence of adverse events. CONCLUSION: This result suggests that extended-release DS is a suitable analgesic incorporated in MMA and a promising solution to the misuse and abuse of opioids.

Deep Learning to Detect Triangular Fibrocartilage Complex Injury in Wrist MRI: Retrospective Study with Internal and External Validation.

OBJECTIVE: To use deep learning to predict the probability of triangular fibrocartilage complex (TFCC) injury in patients' MRI scans. METHODS: We retrospectively studied medical records over 11 years and 2 months (1 January 2009-29 February 2019), collecting 332 contrast-enhanced hand MRI scans showing TFCC injury (143 scans) or not (189 scans) from a general hospital. We employed two convolutional neural networks with the MRNet (Algorithm 1) and ResNet50 (Algorithm 2) framework for deep learning. Explainable artificial intelligence was used for heatmap analysis. We tested deep learning using an external dataset containing the MRI scans of 12 patients with TFCC injuries and 38 healthy subjects. RESULTS: In the internal dataset, Algorithm 1 had an AUC of 0.809 (95% confidence interval-CI: 0.670-0.947) for TFCC injury detection as well as an accuracy, sensitivity, and specificity of 75.6% (95% CI: 0.613-0.858), 66.7% (95% CI: 0.438-0.837), and 81.5% (95% CI: 0.633-0.918), respectively, and an F1 score of 0.686. Algorithm 2 had an AUC of 0.871 (95% CI: 0.747-0.995) for TFCC injury detection and an accuracy, sensitivity, and specificity of 90.7% (95% CI: 0.787-0.962), 88.2% (95% CI: 0.664-0.966), and 92.3% (95% CI: 0.763-0.978), respectively, and an F1 score of 0.882. The accuracy, sensitivity, and specificity for radiologist 1 were 88.9, 94.4 and 85.2%, respectively, and for radiologist 2, they were 71.1, 100 and 51.9%, respectively. CONCLUSIONS: A modified MRNet framework enables the detection of TFCC injury and guides accurate diagnosis.

Risk Factors Associated with Cartilage Defects after Anterior Cruciate Ligament Rupture in Military Draftees.

This study aimed to evaluate the different clinical results and factors associated with cartilage defects in military draftees who underwent different treatments after anterior cruciate ligament (ACL) rupture. Overall, 105 patients who had sustained ACL rupture were military draftees who underwent a conscription examination for physical status assessment from January 2012 to December 2020. Patients were divided into three groups: conservative treatment after ACL rupture, status post-anterior cruciate ligament reconstruction (ACLR), but graft rupture, and status post-ACLR with graft intact. Inter-group comparisons and statistical analyses were performed for age, body mass index (BMI), thigh circumference difference, side-to-side difference in anterior knee translation by KT-2000, meniscus tear, and cartilage defect. Multivariate logistic regression analysis was used to determine the factors associated with cartilage defects. The multivariable regression model showed that BMI (odds ratio OR: 1.303; 95% CI: 1.016-1.672; p = 0.037), thigh circumference difference (OR: 1.403; 95% CI: 1.003-1.084; p = 0.034), tear of lateral meniscus (LM) and medial meniscus (MM) (OR: 13.773; 95% CI: 1.354-140.09; p = 0.027), and graft rupture group (OR: 5.191; 95% CI: 1.388-19.419; p = 0.014) increased the risk of cartilage defects. There was no correlation between cartilage defects and age, KT-2000 difference, tear of LM or MM, or graft intact group. Progression of osteoarthritis was concerned after ACL rupture, and this study identified several factors of post-ACLR graft rupture, greater thigh circumference difference, BMI, and meniscus tear of both LM and MM affecting cartilage defects, which represent early degenerative osteoarthritis changes of the knee. The results of this study should be customized for rehabilitation and military training, especially in military draftees with ACL injuries.

Does 3D Printing-Assisted Acetabular or Pelvic Fracture Surgery Shorten Hospitalization Durations among Older Adults?

Acetabular or anterior pelvic ring fractures are rare but extremely complicated and challenging injuries for orthopedic trauma surgeons. Three-dimensional (3D) printing technology is widely used in the management of these two fracture types for surgical benefits. Our study aimed to explore whether 3D printing-assisted acetabular or pelvic surgery is beneficial in terms of shortening the length of hospital stay (LHS) and intensive care unit (ICU) stay (ICU LS) for older patients. This retrospective study included two groups of 76 participants over 60 years old who underwent operations with (n = 41) or without (n = 35) guidance by 3D printing. The Mann-Whitney U test was used to analyze continuous variables. Chi-square analysis was applied for categorical variables. Univariable and multivariable linear regression models were used to analyze the factors associated with LHS. The median LHS in the group without 3D printing assistance was 16 (12-21) days, and the median ICU LS was 0 (0-2) days. The median LHS in the group with 3D printing assistance was 17 (12.5-22.5) days, and the median ICU LS was 0 (0-3) days. There was no significant difference in LHS associated with 3D printing assistance vs. that without 3D printing among patients who underwent open reduction and internal fixation for pelvic or acetabular fractures. The LHS positively correlated with the ICU LS whether the operation was 3D printing assisted or not. For fracture surgery in older patients, in addition to the advancement of surgical treatment and techniques, medical teams require more detailed preoperative evaluations, and more personalized medical plans regarding postoperative care to achieve the goals of shortening LHS, reducing healthcare costs, and reducing complication rates.

Preparation and Characterization of Extracellular Matrix Hydrogels Derived from Acellular Cartilage Tissue.

Decellularized matrices can effectively reduce severe immune rejection with their cells and eliminated nucleic acid material and provide specific environments for tissue repair or tissue regeneration. In this study, we prepared acellular cartilage matrix (ACM) powder through the decellularization method and developed ACM hydrogels by physical, chemical, and enzymatic digestion methods. The results demonstrated that the small size group of ACM hydrogels exhibited better gel conditions when the concentration of ACM hydrogels was 30 and 20 mg/mL in 1N HCl through parameter adjustment. The data also confirmed that the ACM hydrogels retained the main components of cartilage: 61.18% of glycosaminoglycan (GAG) and 78.29% of collagen, with 99.61% of its DNA removed compared to samples without the decellularization procedure (set as 100%). Through turbidimetric gelation kinetics, hydrogel rheological property analysis, and hydrogel tissue physical property testing, this study also revealed that increasing hydrogel concentration is helpful for gelation. Besides, the ex vivo test confirmed that a higher concentration of ACM hydrogels had good adhesive properties and could fill in cartilage defects adequately. This study offers useful information for developing and manufacturing ACM hydrogels to serve as potential alternative scaffolds for future cartilage defect treatment.

Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in limb-salvage surgery for osteosarcoma: A retrospective analysis.

Previous studies have demonstrated that anesthetic techniques can affect the outcomes of cancer surgery. We investigated the association between anesthetic techniques and patient outcomes after elective limb-salvage surgery for osteosarcoma (OS). This was a retrospective cohort study of patients who underwent elective limb-salvage surgery for OS between January 2007 and December 2018. Patients were grouped according to the administration of propofol-based total intravenous anesthesia (TIVA) or desflurane (DES) anesthesia. Kaplan-Meier analysis was performed, and survival curves were constructed from the date of surgery to death. Univariate and multivariate Cox regression models were applied to compare the hazard ratios (HRs) for death after propensity matching. Subgroup analyses were done for postoperative recurrence, metastasis, and tumor-node-metastasis (TNM) staging. A total of 30 patients (17 deaths, 56.7%) who received DES anesthesia and 26 (4 deaths, 15.4%) who received TIVA were eligible for analysis. After propensity matching, 22 patients were included in each group. In the matched analysis, patients who received TIVA had better survival with a HR of 0.30 (95% confidence interval [CI], 0.11-0.81; P = .018). Subgroup analyses also showed significantly better survival in the presence of postoperative metastasis (HR, 0.24; 95% CI, 0.06-0.87; P = .030) and with TNM stage II to III (HR, 0.26; 95% CI, 0.09-0.73; P = .011) in the matched TIVA group. In addition, patients administered with TIVA had lower risks of postoperative recurrence and metastasis than those administered with DES anesthesia in the matched analyses. Propofol-based TIVA was associated with better survival in patients who underwent elective limb-salvage surgery for OS than DES anesthesia. Prospective studies are needed to assess the effects of TIVA on oncological outcomes in patients with OS.

Effects of Surgical Intervention for Bone Metastases on Survival in Patients with Advanced Cancer: A Nationwide Population-Based Cohort Study.

PURPOSE: With recent advances in surgical techniques and instruments, orthopedic surgeons are better equipped to treat metastatic bone disease. There has also been considerable progress in the non-surgical treatment of cancers, specifically in improving the survival rate of patients with advanced cancer. However, it remains unclear whether surgical resection of a metastatic bone lesion poses additional risk to the survival of patients with advanced cancer. PATIENTS AND METHODS: This study utilized data from the National Health Insurance Research Database (NHIRD) in Taiwan between 2000 and 2015. Patients aged ≥18 years, who had been recently diagnosed with bone metastases (BM), were enrolled and assigned to either the surgery or non-surgery groups. The demographic characteristics were analyzed, and the adjusted hazard ratios (aHR) of mortality were calculated using Cox regression analysis. RESULTS: Of the 4,549,226 individuals in the inpatient database of the NHIRD, 83,536 patients with BM were enrolled in this study. Among them, 8802 underwent surgical resection for skeletal metastatic lesion and 66,098 did not. Altogether, 28,691 patients died, including 2798 (31.8%) in the surgery group and 25,893 (39.2%) in the non-surgery group. The aHR for mortality was 0.7-fold lower in the surgery group (p < 0.001). CONCLUSION: This study demonstrates that surgical resection of metastatic bone lesions did not pose any additional risk to survival outcomes. Thus, we believe that surgery, if indicated, could have a competitive role in the management of metastatic bone disease.

Biomechanical comparison of Cross-pin and Endobutton-CL femoral fixation of a flexor tendon graft for anterior cruciate ligament reconstruction--a porcine femur-graft-tibia complex study.

BACKGROUND: A stable fixation of the graft is imperative for early aggressive rehabilitation after anterior cruciate ligament (ACL) reconstruction. The suspension devices such as Endobutton-CL and Cross-pin system are common techniques of femoral fixation for the hamstring tendon graft and provide superior initial biomechanical properties than the screws system. It remains unclear how such implants perform under cyclic loading and initial pull-out strength. MATERIALS AND METHODS: Cross-pin and Endobutton-CL femoral fixation devices were tested for initial fixation strength in porcine knee joints by cyclic loads following a load-to-failure test. The Cross-pin and Endobutton-CL were used for femoral fixation of a porcine profundus flexor digitorum tendon autograft in 20 porcine knees. Ten specimens of femoral-graft-tibia complex in each group were loaded cyclically to between 0 and 150 N at 1 Hz for 1000 cycles following a load-to-failure test at a rate of 150 mm/min. RESULTS: The amount of total femur-graft-tibia complex graft displacement was significantly lower in the Cross-pin fixation group (5.37 +/- 0.28 mm) than in Endobutton-CL fixation group (6.08 +/- 0.61 mm: P < 0.05). There were no significant differences in the maximal failure load, yield load, and stiffness between the Cross-pin and Endobutton-CL fixation groups. CONCLUSIONS: This biomechanical study reveals that the Endobutton-CL and Cross-pin femoral fixation devices have an equally strong and safe fixation for ACL reconstruction. However, the Cross-pin fixation has significantly less displacement of femur-graft-tibia complex than that of Endobutton-CL fixation in response to the cyclic loading test. It indicates that the Cross-pin fixation is more suitable for early aggressive rehabilitation following ACL reconstruction.