Promising early outcomes of a novel anatomic knee system.

PURPOSE: The primary aim of this study was to report the early clinical and radiographic outcomes of patients who have been treated with total knee arthroplasty (TKA) using the Persona knee system. The secondary aim was to compare patient-reported outcomes (PROs) of the Persona knee system to those of the NexGen implant. METHODS: A registry-based study of a consecutive series of 112 patients (129 knees) treated with the Persona knee system from a single center was conducted. Preoperative, 1-year, and 2-year radiographs and PROs were analyzed. Postoperative radiographs were assessed for radiolucency and component positioning. Patients were monitored for postoperative complications and revision. Two-year PROs were compared to a 1:1 propensity score-matched cohort of patients treated with the NexGen knee system. RESULTS: Ninety-five percent of knees were within literature-defined safe ranges of the anatomical tibiofemoral axis, tibial varus/valgus angle, femoral flexion/extension angle, and tibial slope. Radiolucency was observed in 0.9% and 1.3% of knees at one and 2 years, respectively. Two-year PRO values demonstrated clinically meaningful improvements from the preoperative values. The cumulative 2-year percent revision was 3.0% (95% confidence interval 1.9-3.8%); there were no revisions due to implant mechanical failure. Patients treated with the Persona knee system had higher KOOS symptom (p = 0.037) and KOOS QOL (p < 0.001) scores compared to patients with the NexGen knee system. CONCLUSIONS: This knee design demonstrates excellent clinical outcomes, similar or better than the NexGen knee system, at early follow-up. LEVEL OF EVIDENCE: III.

Platelet-rich plasma as a therapy for androgenic alopecia: a systematic review and meta-analysis.

OBJECTIVE: The past decade has seen platelet-rich plasma (PRP) become a popular therapy around the world as a treatment for androgenetic alopecia (AGA). These systematic review and meta-analyses assess the effectiveness and adverse effects of PRP to determine the role of PRP as a treatment for AGA among the other non-surgical treatment modalities. METHODS: This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and is registered under the PROSPERO ID CRD42019136329. Seven databases were searched from inception through May 2019. Meta-analyses of randomized controlled trials (RCTs) were performed to evaluate the effect of PRP treatments on hair density and hair thickness. RESULTS: Thirty studies, including 687 patients, met our inclusion criteria. Twenty-nine studies reported beneficial results, and 24 studies reached statistical significance on a measured outcome. Ten RCTs were included. Our meta-analyses show that PRP treatment increases hair density and hair thickness. CONCLUSIONS: PRP is an autologous treatment that lacks serious adverse effects and effectively improves hair density and hair thickness in men and women with AGA. Future research should include low risk-of-bias RCTs to optimize treatment protocols, investigate variability among studies, and to obtain more data on hair thickness changes.

Rejuvenating the periorbital area using platelet-rich plasma: a systematic review and meta-analysis.

Intradermal injection of autologous platelet-rich plasma (PRP) is a non-surgical cosmetic therapy to rejuvenate the periorbital area pathologies of wrinkles, periorbital hyperpigmentation (POH), and photoaging. The past decade has seen the adoption of this novel therapy around the world. This is the first systematic review and meta-analysis evaluating PRP treatment of periorbital pathologies. This is a PRISMA compliant review that includes a comprehensive search of the databases Cochrane Library, Ovid Medline, Ovid Embase, and clinicaltrials.gov. The search was performed in June 2019 to obtain all peer-reviewed articles published in English that describe the application of PRP to periorbital pathologies. A meta-analysis of patient satisfaction was performed for randomized controlled trials. Nineteen studies treating 455 patients (95% female, age range 28-60) were included. Studies were categorized based on reported outcomes: wrinkles (11 studies), POH (7 studies), and photoaging (6 studies). Patients were treated a mean of 3 times (range 1-8) in mean intervals of 23 days (range 14-56 days). Follow-up averaged 3 months (range 1-6 months). Meta-analysis of 3 randomized controlled clinical trials (RCTs) shows that patients treated with PRP have increased satisfaction above controls of saline, platelet-poor plasma, mesotherapy, and as an adjunct to laser therapy (overall effect p = 0.001, heterogeneity I2 = 64%). PRP treatment of periorbital area pathologies results in histologic improvements of photoaging, subjective satisfaction score increases, and blind evaluator assessments of rejuvenated skin appearance. Future studies are needed to address limitations of the current literature and should include long-term follow-up, delineation of the POH etiology that is treated, RCTs with low risk of bias, and be absent conflicts of interest or industry sponsors.Trial registration: Prospero Systematic Review Registration ID: CRD42019135968.

Radiostereometric Analysis of Stability and Inducible Micromotion After Locked Lateral Plating of Distal Femur Fractures.

OBJECTIVES: To evaluate interfragmentary motion over 1 year after distal femoral fracture fixation using radiostereometric analysis (RSA). The secondary aim was to assess whether RSA data are consistent with diagnoses of nonunion. DESIGN: Prospective cohort study. SETTING: Level I urban trauma center. PATIENTS: Sixteen patients between 22 and 89 years of age with distal femoral fracture (OTA/AO type 33). INTERVENTION: All fractures were treated with a lateral locking plate, and tantalum markers were inserted into the main proximal and distal fracture fragments. RSA was performed at 2, 6, 12, 18, and 52 weeks postoperatively. Both unloaded and loaded RSA measurements were performed. MAIN OUTCOME MEASUREMENTS: Unloaded fracture migration over time and inducible micromotion at the fracture site in the coronal plane were determined at each follow-up interval. RESULTS: RSA precision in the coronal plane of interfragmentary motion over time and inducible micromotion were 1.2 and 0.9 mm in the coronal plane, respectively. Two cases required revision surgery for nonunion 1 year postoperatively. For cases of union, unloaded fracture migration stopped being detectable between 12 and 18 weeks, and inducible micromotion was no longer detectable by the 12-week visit. For cases of nonunion, both unloaded migration and inducible micromotion were detected throughout the study period. CONCLUSIONS: RSA may be used to reliably assess distal femoral fracture healing. RSA revealed differences in cases of union and nonunion by 3 months and more consistently than traditional x-rays. LEVEL OF EVIDENCE: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Treating Preoperative Anemia to Improve Patient Outcomes After Orthopaedic Surgery.

For patients undergoing orthopaedic surgery, preoperative risk modification and control of comorbidities can maximize safety and improve outcomes. Anemia is common among orthopaedic patients, and its prevalence increases with patient age. Although surgeons are well versed in intraoperative blood conservation, preoperative anemia treatment is often deferred to primary care physicians, who may not understand the importance of a thorough assessment and treatment. Orthopaedic surgeons should understand the causes and treatments of anemia to advocate that patients receive appropriate preoperative care. Mean corpuscular volume and reticulocyte count can help determine the cause of anemia and assess the bone marrow's ability to produce red blood cells. These values can be used to aid in diagnosis and treatment plans. Iron deficiency anemia, the most common type, is a microcytic anemia easily treated with iron supplementation. In cases of trauma, anemia can be related to acute blood loss and underlying conditions. Fracture patterns and preexisting comorbidities should be assessed. The role of intravenous iron supplementation in this setting has not been clearly shown. Patients needing urgent procedures that might involve substantial blood loss should receive transfusions if they have hemoglobin levels <8 g/dL or symptomatic anemia.

Split-Block Graft Versus Cortico-cancellous Block Graft for Horizontal Ridge Augmentation: Cone Beam Computed Tomography and Histomorphometric Study / Enxerto de bloco dividido versus enxerto de bloco córtico-esponjoso para aumento horizontal do rebordo: imagens de tomografia computadorizada de feixe cônico e estudo histomorfométrico

Objective: The aim of this study was to compare the horizontal dimensional changes of split-bone block and cortico-cancellous block graft in horizontal ridge augmentation using Cone Beam Computed Tomography (CBCT). The quality of the regenerated bone in both groups was compared histologically and histomorphometrically. Material and methods: Twenty patients were randomly divided in two equal groups (n= 10): Split-bone block group which was harvested from the external oblique ridge or cortico-cancellous block graft group which was harvested from the mandibular symphysis. Pre-augmentation crestal ridge width was measured using bone caliper. CBCT scans were taken on the 2nd week and 4th month post-operatively to measure crestal and total horizontal ridge dimensions. A biopsy was collected from the regenerated ridge immediately before implant insertion on the 4thmonth post-operatively. Results: Pre-augmentation crestal bone widths of both groups were comparable (P= 0.870). On the 2nd week and 4th month post-operatively, split-bone block showed a significantly wider crestal (P= 0.028 and P= 0.001 respectively) and total horizontal ridge dimension (P= 0.025 and P= 0.002 respectively), and on the 4th month post-operatively, it showed significantly lesser resorption at crest (P= 0.040) and in total horizontal ridge dimension (P= 0.017) than cortico-cancellous block. Histologically, the regenerated bone quality was similar in both groups. Histomorphometric analysis showed a non-significant difference in percentage of mature (P= 0.365) and immature collagen (P= 0.531) between both groups. Conclusion: Split-bone block maintained a significantly wider ridge and experienced less resorption after 4 months than the cortico-cancellous block graft, with no difference in regenerated bone quality between both groups. (AU)

Objetivo: O objetivo deste estudo foi comparar as mudanças dimensionais horizontais do enxerto de bloco ósseo dividido e do enxerto de bloco córtico-esponjoso no aumento de rebordo horizontal por meio da Tomografia computadorizada de feixe cônico (TCFC). A qualidade do osso regenerado em ambos os grupos foi comparada histológica e histomorfometricamente. Material e Métodos:Vinte pacientes foram divididos aleatoriamente em dois grupos iguais (n=10): Grupo de blocos de osso dividido retirado da crista oblíqua externa ou Grupo de enxerto em bloco córtico-esponjoso retirado da sínfise mandibular. A largura da crista pré-aumentada foi medida usando calibrador ósseo. Os exames de TCFC foram realizados na segunda semana e quarto mês de pós operatório para medir as dimensões da crista e dimensões horizontais totais do rebordo. Uma biopsia foi coletada da crista regenerada imediatamente antes da inserção do implante no quarto mês pós-operatório. Resultados: As larguras do osso crestal pré-aumentado de ambos os grupos eram compatíveis (p = 0,870). Na segunda semana e quarto mês pós-operatórios, o bloco ósseo dividido mostrou uma crista significativamente mais larga (p = 0,28 e p = 0,001 respectivamente) e a dimensão da crista horizontal total (p = 0,025 e p = 0,002 respectivamente), e no quarto mês pós-operatório, apresentou reabsorção significativamente menor na crista (p = 0,040) e na dimensão da crista horizontal total (p = 0,017) em comparação ao bloco córtico-esponjoso. Histologicamente, a qualidade do osso regenerado foi semelhante em ambos os grupos. A análise histomorfométrica mostrou uma diferença não significativa na porcentagem de colágeno maduro (p = 0.365) e colágeno imaturo (p = 0,531) entre ambos os grupos. Conclusão: O bloco ósseo dividido manteve uma crista significativamente mais larga e apresentou menos reabsorção após 4 meses, em comparação ao enxerto em bloco córtico-esponjoso, sem diferença na qualidade do osso regenerado entre ambos os grupos. (AU)