Femoral neck fracture fixation in rhombic versus inverted triangle configuration in young adults: A systematic review.

Objective: This review evaluated the outcomes of rhombic versus inverted triangle configuration fixation of femoral neck fractures. Methods: Six databases, PubMed, Embase, Scopus, Web of Science, Cochrane Library databases, and China National Knowledge Infrastructure (CNKI), were comprehensibly searched for the comparative studies of two configurations (rhombic versus inverted triangle) of neck femur fracture fixation. Ultimately seven studies were included in this systematic review for qualitative and quantitative analysis. A meta-analysis was performed with the software RevMan 5.4.1. Results: Fewer nonunion (OR 0.46 with 95 % CI 0.23, 0.94; p = 0.03), and early full weight bearing (MD -3.09 with 95 % CI -5.41, -0.77; p = 0.009) were seen in the rhombic than in the inverted configuration; however, a better hip function (MD 3.72 with 95 % CI 0.99, 6.44; p = 0.008), and lesser less blood loss (MD 3.84 with 95 % CI 1.19, 6.49; p = 0.004) during surgery were found in the inverted triangle configuration. There was no difference between the two fixation configurations regarding the duration of surgery, fracture union time, overall complications, femoral neck shortening, length of hospital stay, fluoroscopy times, and incision size. Conclusion: The rhomboid configuration showed fewer non-union, early weight bearing, better hip function and comparable complications rate than the inverted triangle configuration; however, there was more blood loss intraoperatively than inverted triangle configuration. Hence, the addition of a fourth screw in the rhombic configuration have an added advantage over the inverted triangle configuration in femoral neck fracture.

Posterior-only fixation in pelvic fractures: Is it sufficient in lateral compression injuries?

PURPOSE: Lateral compression (LC) injuries account for more than two-thirds of all pelvic fractures. The goal of surgical treatment is to provide adequate stability and early mobilization. The consensus on posterior fixation of such injuries is strong in the literature; however, the necessity of anterior ring fixation is not clear. Therefore, this study was formulated to determine the practicability of posterior-only fixation in LC injuries. METHODS: Between March 2015 and May 2020, all patients with LC type pelvic ring fractures who were admitted and operated upon in a single level 1 trauma center were included in this cross-sectional observational study. Demographic data, co-morbidities, treatment, types of surgical fixation, concomitant injuries and surgeries, surgical complications, length of hospital stay, injury to weight bearing duration, and follow-up period were documented. Functional outcome and quality of life were assessed using Majeed score and SF-36 questionnaire. Non-normally distributed data were presented as median (Q1, Q3) and normally distributed data were presented as mean ± SD. Spearman's rank correlation coefficient was used for correlation analysis. RESULTS: A total of 25 patients were included, with a mean age of 29.8 years. All patients were managed operatively with posterior-only fixation. The median Majeed score was 90 (76, 95). The median physical component summary score was 69.37 (38.75, 85.62). The median mental component summary score was 63.95 (39.25, 87.87). There was no significant difference compared to population norms of both physical component summary and mental component summary. Injury to weight bearing time correlated significantly (p = 0.002) with Majeed score as well as SF-36 score (p = 0.044). No other variable had a significant association with outcomes. CONCLUSION: Posterior-only fixation is sufficient for fixing LC injuries with up to 80% of cases having good to excellent functional outcomes. However, comparative studies with larger sample sizes are needed for further validation.

Irreducible Complex Posterior Elbow Dislocation with Varus Posteromedial Rotary Instability - A Case Report.

Introduction: Elbow dislocations, particularly those associated with varus posteromedial rotary instability, are relatively uncommon. We present the case of a 25-year-old male initially managed nonoperatively for a posterior elbow dislocation, who subsequently experienced irreducible re-dislocation with characteristic fractures of the anteromedial facet and tip of the coronoid, indicative of varus posteromedial rotary instability. Case Report: Following an unsuccessful attempt at closed reduction under general anesthesia, open reduction was performed, revealing the interposition of the posterior capsule of the humero-ulnar joint as the cause of irreducibility. Fixation of the coronoid fracture was undertaken, and the patient exhibited excellent functional outcomes at a 4.5-year follow-up. Conclusion: This case underscores the rarity of irreducible elbow dislocation in the context of varus posteromedial rotary instability and highlights the crucial role of capsular interposition in such cases. Successful open reduction, coronoid fixation, and attentive postoperative care contributed to the patient's favorable long-term functional outcome.

Choice of Entry Point Does Not Affect Clinical and Radiological Outcomes in Antegrade Intra-medullary Nailing in Patients with Shaft of Femur Fracture: A Prospective Randomized Controlled Trial.

Purpose: The choice of entry point, Greater trochanter (GT), or Piriformis entry (PE) for antegrade intramedullary nailing (IMN) of the femur is crucial. This study was performed to compare these two entry points in the patients with shaft of femur fractures regarding intra-operative parameters, radiological and functional outcomes. Materials and Methods: Twenty-four patients underwent GT entry nailing, while 25 patients underwent PE nailing. Surgical time, Intra-operative blood units transfused, Intra-operative fluoroscopy exposure by number of C-arm shots taken, mean drop in hemoglobin, and incidence of iatrogenic fracture were recorded. Patients were followed up at 4 weeks, 6 weeks, and 6 months to look for radiological healing and improvements in functional outcome using Modified Harris Hip Score (MHHS). MRI of bilateral hips with pelvis was done in 25 patients at 6 months of follow-up to detect any preliminary signs of AVN. Results: The mean drop in hemoglobin in the GT group was significantly lesser than the PE group (p = 0.02). Mean MHHS at 4 weeks post-op was also significantly higher in the GT group (p = 0.01). There was no significant difference between both the groups regarding surgical duration, fluoroscopy exposure, radiological and functional outcomes in the long term. None of the patients who underwent MRI displayed any preliminary sign of AVN. Conclusion: GT entry nails lead to lesser surgical time, fluoroscopy exposure, and intra-operative blood loss. Both the nailing systems achieve excellent fracture unions and comparable functional outcomes in the long term, and there is a minuscule risk of AVN in adult patients undergoing IMN.

Microfluidic Point-of-Care Diagnostics for Multi-Disease Detection Using Optical Techniques: A Review.

The lifestyle of modern society is a major contributing factor for the majority of patients suffering from more than one disease. To Screen and diagnose each of those diseases, there is a great need for portable, and economical diagnostic tools, which are highly stipulated to yield rapid and accurate results using a small volume of the samples such as blood, saliva, sweat, etc. Point-of-care Testing (POCT) is one of the approaches to harvest prompt diagnosis of numerous diseases. The Majority of Point-of-Care Devices (POCD) are developed to diagnose one disease within the specimen. On the other hand, multi-disease detection capabilities in the same point-of-care devices are considered to be an efficient candidate to execute the state-of-the-art platform for multi-disease detection. Most of the literature reviews in this field focus on Point-of-Care (POC) devices, their underlying principles of operation, and their potential applications. It is evident from a perusal of the scholarly works that no review articles have been written on multi-disease detection POC devices. A review study analyzing the current level and functionality of multi-disease detection POC devices would be of great use to future researchers and device manufacturers. This review paper is addressing the above gap by focusing on various optical techniques like fluorescence, Absorbance, and Surface Plasmon Resonance (SPR) for multi-disease detection by harnessing the microfluidic-based POC device.

A comparison of outcomes of locking versus non-locking plate fixation for the distal fibula fractures: a systematic review and meta-analysis.

PURPOSE: A locking plate (LP) or non-locking plate (NLP) can be used for distal fibula fracture fixation. However, the advantages of LP over NLP in patients with distal fibula fractures are not clear. In terms of indications, the role of the two plates probably differs; however, to draw comparative conclusions, we conceptualized this systematic review and meta-analysis of studies that directly compared the two plates, wherein both groups' indications and baseline parameters were similar. METHODS: An electronic literature search was performed using PubMed/Medline, Embase, Scopus, and Cochrane Library databases for studies comparing the LP versus NLP fixation for the lateral malleolus fracture. A total of 18 studies were included in qualitative and quantitative analysis. A subgroup analysis was performed for patients aged < 55 years and patients aged > 55 years. The statistical analysis was performed by Review Manager Software version 5.4.1. RESULTS: A meta-analysis of 4243 fractures was performed across 18 studies. The rate of fracture union and overall complication rates did not differ between the two fixation groups with an OR of 0.71 (95% CI 0.26, 1.96, p = 0.51 and 1.11 (95% CI 0.84, 1.47, p = 0.47, respectively. There is no difference in the reoperation rate due to minor or major complications between the two groups. There was no difference in functional outcome (MD -0.85, with 95% CI -5.63, 3.93, p = 0.73), but NLP has a shorter surgical duration (MD 3.0, with 95% CI 0.26, 5.75, p = 0.03). A leave-one-out sensitivity analysis performed for overall complications affected the final outcome of the meta-analysis. CONCLUSION: This meta-analysis demonstrates no clear benefit in selecting LP over NLP for the fixation of lateral malleolus fractures.

Efficacy of undenatured collagen in knee osteoarthritis: review of the literature with limited meta-analysis.

BACKGROUND: Early knee osteoarthritis (OA) treatment is multimodal, with physical therapy and pharmacotherapy commonly used. Although popular, oral supplements like glucosamine and diacerein have not been reported to have high efficacy. Undenatured collagen type II (UC-II) has been introduced for therapy in early OA; it helps in cartilage repair and preservation. The present review was done to ascertain its efficacy in pain relief and knee function. MATERIALS AND METHODS: A systematic literature search was performed on MEDLINE (PubMed), Embase, Scopus, and Cochrane Library for published literature; studies comparing the outcome of UC-II supplementation with placebo/control in adult humans with early knee OA were included. The outcomes evaluated were VAS Score, quality of life - Western Ontario and McMaster Universities (WOMAC-score), Knee function, Knee range of motion, and any complications during the course of treatment. RESULTS: A total of 293 results were obtained after a primary search; 8 randomized control trials (RCT) were finally included. A total of 243 patients received UC-II supplementation (91 men and 152 women). The overall mean age range for the intervention group was 53.5±0.99 to 68.7±5.3 years across all included studies, and the mean follow-up duration was 3 to 6 months. Outcome measures like WOMAC and VAS scores showed better outcomes with UC-II in comparison to placebo. Walking measurements improved significantly from the baseline, reflected in improved timed up-and-go and 6-minute walk tests (6MWT). The overall complications were similar to other supplements. CONCLUSION: With limited literature, UC-II has shown promise as a potent supplement in early knee OA with good pain relief and improved function. However, further large-scale studies are needed to substantiate these findings.

Exploring Injury Profiles in Non-elite Cricketers: Harnessing Online Surveys for Effective Assessment.

Background: An increase in the on-field intensity in modern cricket, results in an increased number of player injuries. Integration and easy access to professional physiotherapy, technology, rehab protocols, and mental/physical conditioning aid in early return to sports in the injured; however, at the grassroots, these facilities may not be available with untrained support staff and limited funds. Injuries can go unnoticed and, therefore, there is a need for an easy process of identification and documentation of such injuries. We devised a questionnaire-based survey to evaluate its effectiveness at the junior level of professional cricket. Materials and Methods: An Online self-administered questionnaire was prepared and the link was given to active Union Territory Cricket Academy (UTCA), Chandigarh, cricketers of any gender between 15 and 35 years of age, through different online platforms like WhatsApp, Telegram and emails, for the submission of their responses. Results: The questionnaire was administered to 98 participants out of which 77 participants' responses were evaluated (41 males and 36 females). 74/77 participants were below 30 years of age. There were 18 wicketkeepers, 33 bowlers and 26 batsmen as per their major role in the team. 37/77 cricketers (20 males, 17 females) had injuries during the previous 2 years; this included 17 bowlers, 11 batsmen and 9 wicketkeepers. The most common body part injured in the survey were fingers (12) followed by the back (7). The amount of training time lost, reported in the survey ranged from a week up to 1 year. Conclusion: Online surveys could be the first step to accumulating data and making initial player profiles, starting even at junior levels of cricket. Further detailed evaluations may be performed after this, and coaches and administrators could potentially profile cricket injuries and identify chronic issues. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-023-00995-3.

Comparison of Outcomes of Long Versus Short Cephalomedullary Nails for the Fixation of Intertrochanteric Femur Fractures: A Systematic Review and Meta-analysis of 14,547 Patients.

Purpose: Intertrochanteric Femur Fractures (IFF) fixation could be done with short or long Cephalomedullary Nails (CMNs). Nevertheless, despite several studies in the literature, there has been a continued lack of consensus on which design of CMN is better than the other. Hence, the current review aimed to evaluate the evidence about short versus long CMNs for the fixation of IFF. Methodology: PRISMA guidelines were followed, and the protocol for the study was registered to PROSPERO. Four databases, Medline/PubMed, Embase, Scopus, and Cochrane Library, were searched. A total of 31 studies with 6 randomized trials (RCTs) and 25 non-randomized studies were included. Demographic data, follow-up period, and primary and secondary outcomes were extracted and evaluated from each of the included studies; statistical analysis was done by Review Manager Software version 5.4.1. Results: Fourteen thousand five hundred forty-seven patients were included in this review. Primary Outcomes: Long CMNs showed statistically significant lower rates of ipsilateral shaft femur refracture (OR 1.60, 95% CI 1.14, 2.24, p = 0.007); however, the difference was not statistically significant between the two groups for mortality at 30 days and within 1 year. Secondary Outcomes: Statistically significant shorter duration of surgery (MD-17.83 (95% CI - 22.03, - 13.63, p < 0.05), less intra-operative blood loss (MD - 62.65, 95% CI - 97.13 to - 28.17, p = < 0.05), and lower blood transfusion rates (OR 0.71, 95% CI 0.62, 0.83, p < 0.05) for short CMNs; no statistically significant difference for the length of hospital stay, implant-related complications, overall complications, re-operation rates, fluoroscopy time, and functional outcome between two groups of CMNs was seen. Conclusion: With shorter operative time, lesser intra-operative blood loss, and lower postoperative transfusion rates for short CMNs, they have certain benefits over longer CMNs. However, more distal shaft femur fractures were seen in the shorter version of nail, which should be considered before offering these nails to a patient; careful and individualized postoperative weight-bearing protocol could minimize the same. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-023-00915-5.

Surface Engineering of a Bioartificial Membrane for Its Application in Bioengineering Devices.

Membrane technology is playing a crucial role in cutting-edge innovations in the biomedical field. One such innovation is the surface engineering of a membrane for enhanced longevity, efficient separation, and better throughput. Hence, surface engineering is widely used while developing membranes for its use in bioartificial organ development, separation processes, extracorporeal devices, etc. Chemical-based surface modifications are usually performed by functional group/biomolecule grafting, surface moiety modification, and altercation of hydrophilic and hydrophobic properties. Further, creation of micro/nanogrooves, pillars, channel networks, and other topologies is achieved to modify physio-mechanical processes. These surface modifications facilitate improved cellular attachment, directional migration, and communication among the neighboring cells and enhanced diffusional transport of nutrients, gases, and waste across the membrane. These modifications, apart from improving functional efficiency, also help in overcoming fouling issues, biofilm formation, and infection incidences. Multiple strategies are adopted, like lysozyme enzymatic action, topographical modifications, nanomaterial coating, and antibiotic/antibacterial agent doping in the membrane to counter the challenges of biofilm formation, fouling challenges, and microbial invasion. Therefore, in the current review, we have comprehensibly discussed different types of membranes, their fabrication and surface modifications, antifouling/antibacterial strategies, and their applications in bioengineering. Thus, this review would benefit bioengineers and membrane scientists who aim to improve membranes for applications in tissue engineering, bioseparation, extra corporeal membrane devices, wound healing, and others.

Strategies To Modify the Surface and Bulk Properties of 3D-Printed Solid Scaffolds for Tissue Engineering Applications.

3D printing is one of the effective scaffold fabrication techniques that emerged in the 21st century that has the potential to revolutionize the field of tissue engineering. The solid scaffolds developed by 3D printing are still one of the most sought-after approaches for developing hard-tissue regeneration and repair. However, applications of these solid scaffolds get limited due to their poor surface and bulk properties, which play a significant role in tissue integration, loadbearing, antimicrobial/antifouling properties, and others. As a result, several efforts have been directed to modify the surface and bulk of these solid scaffolds. These modifications have significantly improved the adoption of 3D-printed solid scaffolds and devices in the healthcare industry. Nevertheless, the in vivo implant applications of these 3D-printed solid scaffolds/devices are still under development. They require attention in terms of their surface/bulk properties, which dictate their functionality. Therefore, in the current review, we have discussed different 3D-printing parameters that facilitate the fabrication of solid scaffolds/devices with different properties. Further, changes in the bulk properties through material and microstructure modification are also being discussed. After that, we deliberated on the techniques that modify the surfaces through chemical and material modifications. The computational approaches for the bulk modification of these 3D-printed materials are also mentioned, focusing on tissue engineering. We have also briefly discussed the application of these solid scaffolds/devices in tissue engineering. Eventually, the review is concluded with an analysis of the choice of surface/bulk modification based on the intended application in tissue engineering.

Comparison of outcomes of retrograde intramedullary nailing versus locking plate fixation in distal femur fractures: A Systematic Review and Meta-analysis of 936 patients in 16 studies.

Background: The surgical treatment for distal femur fractures has evolved over time, and it depends upon certain factors; open or closed fracture type, the pattern of fracture, presence of metaphyseal comminution, intra-articular extension, and the bone quality are some of the crucial ones. Both retrograde intramedullary nails (RIMN) and locking plates (LP) can be used for the fixation of these fractures. However, the optimal method among the two devices is still a topic of debate, the superiority of one over the other being unclear. Hence, this systematic review and meta-analysis was conceptualized to compare the outcomes of RIMN with distal femur LP. Methods: The primary electronic search was conducted on Medline (PubMed), Scopus, Embase, Cinahl, and Cochrane Library databases for the published literature from the inception to 25th February 2022. The studies compared outcomes of RIMN versus LP fixation of the acute supracondylar or distal femur fracture (AO/OTA type-33A, B, and C) and reported at least one primary (mean fracture union time, complications, implant-related complications, and re-operation rate) or secondary outcome (duration of surgery, intra-operative blood loss, and knee range of motion), were included. Results: Six randomized control trials, 2 prospective and 8 retrospective studies with 936 patients with 8 bilateral cases (467: RIMN; 477: LP) were included. Our analysis demonstrated no statistically significant difference in terms of mean fracture union time, overall complications, implant-related complications, re-operation rates, and duration of surgeries. Although a better knee range of motion was seen in the LP group, however, it also showed more nonunion and infection than the RIMN group. Conclusion: The present review shows that there are significantly lesser nonunions and infections, in the RIMN group as compared to LP for distal femur fractures, although a better postoperative knee range of motion was seen in the latter. However, in terms of fracture union time, the overall rate of complications, re-operation rates, and duration of surgeries, there is no difference between the two surgical options.

Ilioinguinal versus modified Stoppa approach for open reduction and internal fixation of displaced acetabular fractures: a systematic review and meta-analysis of 717 patients across ten studies.

BACKGROUND: Acetabulum fracture is one of the most challenging fractures to manage and operate for orthopaedic surgeons; anatomical reduction of fractures and reconstruction of the joint is of utmost importance. These factors in turn are dependent on the appropriate surgical approach used to improve the clinical outcomes and reduce associated complications. Hence, this meta-analysis aims to compare the outcomes of ilioinguinal versus modified Stoppa approach for open reduction and internal fixation (ORIF) of displaced acetabular fractures. METHODS: Medline (PubMed), Embase, Scopus, and Cochrane Library databases were searched from their inception to 10th of June 2021 for both randomized clinical trials (RCTs) and or non-randomized studies comparing the outcomes of ilioinguinal approach and modified Stoppa approach for the ORIF of acetabular fractures. The estimates of treatment effects were described by mean difference (MD) for continuous variables and odds ratio (OR) for dichotomous variables with corresponding 95% confidence (95% CI) intervals. The risk of bias was assessed by MINORS tool for the non-randomized, and the Cochrane Collaboration's risk of bias tool for RCTs. RESULT: A total of ten studies (717 patients), three RCTs and seven retrospective studies, were included. Modified Stoppa approach showed shorter mean duration of surgery (MD 47.13, 95% CI: 27.30-66.96), lesser number of overall complications (OR 2.14, 95% CI: 1.46-3.13), less intraoperative blood loss (MD 259.65, 95% CI: 152.66-366.64), and lower rates of infection (OR 2.17, 95% CI: 1.14-4.15). However, ilioinguinal approach showed a better quality of fracture reduction (OR 0.59, 95% CI: 0.42-0.82). Results were equivocal in terms of vascular injuries (OR 1.88 (95% CI: 0.86-4.09), nerve injuries (OR 1.77, 95% CI: 0.99-3.17), heterotopic ossification (OR1.74, 95% CI: 0.63-4.82), and clinical outcome (OR 0.81, 95% CI: 0.45-1.47) between the two groups. CONCLUSION: Modified Stoppa approach carries a lesser duration of surgery, lesser intraoperative blood loss, fewer overall complications, and lesser postoperative infection rates compared to ilioinguinal approach. Although a better anatomical reduction is achieved by ilioinguinal approach, however, this does not translate into better clinic functional outcomes which remain comparable between the two approaches. So overall, modified Stoppa approach seems a better alternative for managing these fractures.

Core decompression combined with intralesional autologous bone marrow derived cell therapies for osteonecrosis of the femoral head in adults: A systematic review and meta-analysis.

BACKGROUND: Core decompression (CD) is beneficial in the early stage of osteonecrosis of the femoral head (ONFH). Adjunctive bone marrow derived cell therapies (BMDCT) have been advocated which potentially aid the regenerative process. QUESTION/PURPOSE: This study was conducted to determine potential benefit of CD + BMDCT in ONFH, in terms of disease progression, conversion to arthroplasty (primary outcomes), and functional outcomes and complication rates (secondary outcomes). METHODS: A systematic review of literature was performed on 3 databases. Studies reporting CD + BMDCT (intralesional instillation) in ONFH, with a minimum follow up of 1 year and reporting the pre-defined outcome measures were included in the review. Meta-analysis consisted of two different arms: a comparative arm, to compare CD + BMDCT to CD alone, and a non-comparative meta-analysis arm, to determine pooled rates of disease progression, conversion to arthroplasty and complication rates. RESULTS: A total of 18 studies were included in the systematic review. CD + BMDCT had lower rates of disease progression (OR 0.19 [95% CI, 0.09, 0.40]) and conversion to arthroplasty (OR 0.20 [95% CI, 0.11, 0.40]) as compared to CD alone. Functional score (MD = -7.07 [95% CI, -12.28, -1.86]) and visual analog scale also showed better improvement with the use of CD + BMAC (MD = -10.39 [95% CI, -12.87, -7.90]). Increasing age and post-collapse stage at presentation were noted to have an adverse effect on the outcomes. CONCLUSION: CD + BMDCT was found to decrease disease progression and conversion to arthroplasty, and was noted to have better functional outcome scores as compared to CD alone.

Wound alpha defensin levels are significantly higher in patients with fracture related infection: A pilot, prospective cohort study.

BACKGROUND: In absence of frank purulence, wound cultures represent 'gold-standard' for diagnosis of fracture related infection (FRI). However, these are time-intensive, and may be falsely negative, necessitating the need for accurate and rapid biomarker-based diagnosis. We conducted this study to determine the accuracy of 3 wound-based biomarkers for the diagnosis of FRI. METHODS: This was a prospective cohort study on adult patients who underwent an operative procedure for an upper or lower limb fracture. Wound fluid levels of alpha-defensin (AD), neutrophil elastase (NE) and IL-6 were evaluated on post-operative day 2, and patients were followed up for one month. Patients were categorized as cases (FRI) or controls (no FRI), on the basis of the consensus definition of FRI. Univariate analysis, along with receiver operating characteristic (ROC) analysis was performed. RESULTS: 48 patients were included. AD levels showed a 2.6-fold elevation in cases (n = 26, Median = 23.74 µg/ml) as compared to controls (n = 22, Median = 8.78 µg/ml). The area under the curve for this variable was 0.71 (95% Confidence Intervals = 0.56 - 0.86). The levels of NE and IL-6 were not significantly different between cases and controls. CONCLUSION: Wound AD levels are significantly elevated in patients with FRI. However, these results need to be validated in a larger cohort of patients before it can be used as a biomarker of FRI.

Complications and mid to long term outcomes for hip resurfacing versus total hip replacement: a systematic review and meta-analysis.

INTRODUCTION: The long-term results of total hip replacement (THR) are excellent; however, it has higher failure rates in young and active patients. Hip resurfacing arthroplasty (HRA) is an alternative in such patients and gaining popularity. This review was done to compare complications and outcomes between HRA and THA by assessing the latest level 1 studies comparing the two from the past 10 years. METHOD: A systematic review and meta-analysis was conducted using three databases (PubMed, EMBASE and SCOPUS) to compare the complications between THR and HRA in medium to long term follow up. The primary outcome of interest included the complication and revision rate between the two techniques. Functional outcomes and ionic levels at follow up were also compared as secondary outcomes. Risk of bias assessment was done using the Cochrane risk of bias tool. RESULT: The present review included 6 level 1 studies. These included 308 THR and 304 HRA. On meta-analysis, overall complications rates were significantly lower in HRA compared to the THA group with an Odds ratio (OR) of 2.17 (95% CI 1.21, 3.88; p = 0.009). No difference was seen between the two groups in terms of revision rate (OR 1.06 95% CI 0.57, 1.99; p = 0.85). Functional outcomes in both the groups were satisfactory but the Harris Hip Score was found to be significantly better in the resurfacing group (MD 2.99 95% CI - 4.01, - 1.96, p < 0.00001). There were increased cobalt and chromium ions in the resurfacing group but no detrimental effect was seen in terms of reported poisoning. CONCLUSION: Despite similar function and revision rates, HRA was seen to have lesser associated complications and ionic levels may not be a detrimental issue. Hip resurfacing provides relative ease during revisions, especially in younger patients and it may be an alternative to THR in the younger population.

Polystyrene-Based Slippery Surfaces Enable the Generation and Easy Retrieval of Tumor Spheroids.

Multicellular tumor spheroids are the most well-characterized organotypic models for cancer research. Generally, scaffold-based and scaffold-free techniques are widely used for culturing spheroids. In scaffold-free techniques, the hanging drop (HD) method is a more versatile technique, but the retrieval of three-dimensional (3D) cell spheroids in the hanging drop method is usually labor-intensive. We developed oil-coated polystyrene nanofiber-based reusable slippery surfaces for the generation and easy retrieval of 3D spheroids. The developed slippery surfaces facilitated the rolling and gliding of the cell medium drops as well as holding the hydrophilic drops for more than 72 h by the virtue of surface tension as in the hanging drop method. In this study, polystyrene nanofibers were developed by the facile technique of electrospinning and the morphological evaluation was performed by scanning electron microscopy (SEM) and cryo-FESEM. We modeled the retrieval process of 3D spheroids with the ingredients of 3D spheroid generation, such as water, cell culture media, collagen, and hyaluronic acid solution, demonstrating the faster and easy retrieval of 3D spheroids within a few seconds. We created MCF-7 spheroids as a proof of concept with a developed slippery surface. 3D spheroids were characterized for their size, homogeneity, reactive oxygen species, proliferative marker (Ki-67), and hypoxic inducing factor 1ά (HIF-1ά). These 3D tumor spheroids were further tested for evaluating the cellular toxicity of the doxorubicin drug. Hence, the proposed slippery surfaces demonstrated the potential alternative of culturing 3D tumor spheroids with an easy retrieval process with intact 3D spheroids.

Intraosseous Infiltration of Platelet-Rich Plasma for Knee Osteoarthritis: A Systematic Review of Literature and Limited Meta-analysis.

Background: The role of subchondral bone as a key mediator in pathogenesis of osteoarthritis (OA) is emerging and various injectable modalities are being tried to address the subchondral pathology. Intraosseous (IO) infiltrations of PRP is biological way of addressing the pathology. This review aimed to explore the role of IO PRP in OA knees. Methods: A systematic literature search was conducted on the electronic databases of PubMed, Embase, Scopus, Web of Science and Ovid for relevant articles on IO PRP with a predefined search strategy. Data from eligible studies were extracted and was analyzed. Results: There were only five studies on the study topic which included 112 patients (112 knees) who received IO PRP injection. IO PRP was associated with significant improvements in VAS, KOOS and WOMAC scores. The most commonly reported complication was pain at injection site. Meta-analysis revealed that combined intraarticular (IA) and IO PRP were associated with significantly better WOMAC scores, compared to only IA PRP. However, VAS and KOOS scores were equivocal. Conclusion: IO PRP infiltration for OA knees is safe and effective and results in improved patient-reported outcome scores based on the current limited literature. However, its added advantage over only IA PRP is not well established and clear due to limited available published data.

Angiogenic stimulation strategies in bone tissue regeneration.

Current tissue engineering strategies in bone repair and regeneration have limitations regarding tissue rejection, insufficient blood supply, and tissue integration. Specific host response results in isolation, degeneration, and subsequent loss of function of the implanted/scaffold biomaterial. Therefore, strategies to increase the interplay between angiogenesis and complex bone tissue formation are required to develop fully functional vascularized bone tissue. Angiogenesis is essential for oxygen/nutrient supply, waste removal, endothelial/stem cell homing, and the release of mitogenic/angiogenic/osteogenic factors. Hence, the challenge lies in understanding the complex interdependence of angiogenesis with neo-bone formation. Therefore, recent bone tissue regeneration strategies have focused on biomaterial development concerning induction of neovascularization and subsequent angiogenesis. Scaffold architecture (macro/micro/nano) scales, culture conditions (3-Dimension, hypoxia, etc), stimuli-dependent delivery of angiofactors, and gene delivery may significantly modulate vascularization in tissue-engineered products. Therefore, the current review discusses the key mechanisms/steps involved in defining the relationship between angiogenic and osteogenic factors. The recent strategies incorporating the above understanding in the development of bone tissue-engineered constructs are also deliberated. Eventually, these strategies may give the potential way forward to develop a bioengineered, vascularized bone tissue construct for implant applications.