Treatment of comminuted patellar fracture with the nitinol patellar concentrator.

AIM: To evaluate the clinical effect of the nitinol (NiTi)-patellar concentrator (NT-PC) for the treatment of comminuted patellar fractures. MATERIAL AND METHODS: A total of 32 patients with acute comminuted patellar fracture accepted open reduction and internal fixation with the NT-PC, and the curative effects were evaluated using the Böstman clinical grading scale. RESULTS: All fractures were anatomically reduced by surgery and all cases were followed-up for six to 18 months. The mean score of patients according to the Böstman clinical grading scale was 25.6, with 29 of 32 (90.7%) patients achieving excellent or good results. Two patients had traumatic arthritis, one had slippage of the NT-PC, and all patients received pharmacotherapy. CONCLUSIONS: The application of the NT-PC is a satisfactory approach to the treatment of comminuted patellar fractures.

Fabrication of hydroxyapatite on pure titanium by micro-arc oxidation coupled with microwave-hydrothermal treatment.

Porous hydroxyapatite (HA)-containing composite films were prepared by a novel method consisting of micro-arc oxidation (MAO) combined with microwave-hydrothermal (M-H) treatment. The morphology, composition and phase composition of the bioactive films were investigated with scanning electron microscopy with energy dispersive X-ray spectroscopy and X-ray diffraction. MTT assay was carried out to investigate the in vitro effects of the different surfaces on bone integration properties. The prepared MAO films consisted mainly of anatase, rutile and tricalcium phosphate along with amorphous calcium (Ca) and phosphorus (P) phases. The M-H-treated composite films were composed primarily of anatase, rutile and HA. As the time and temperature of the M-H treatment increased, the number of HA crystals gradually increased. Using the M-H method, HA was obtained at a lower temperature and in a shorter period of time compared to the conventional hydrothermal method. The results suggest that the M-H method significantly decreases the hydrothermal reaction temperature and also greatly shortens the reaction time. Due to the nanocrystallinity and porosity of the prepared composite films, the method presented here shows promise for the formation of bioactive materials for medical applications.

Cu-Co Co-Doped Microporous Coating on Titanium with Osteogenic and Antibacterial Properties.

Titanium (Ti) and its alloys are widely used in bone surgery by virtue of their excellent mechanical properties and good biocompatibility; however, complications such as loosening and sinking have been reported post-implantation. Herein we deposited a copper-cobalt (Cu-Co) co-doped titanium dioxide (TUO) coating on the surface of Ti implants by microarc oxidation. The osteogenic and antimicrobial properties of the coating were evaluated by in vitro experiments, and we also assessed ß-catenin expression levels on different sample surfaces. Our results revealed that the coating promoted the adhesion, proliferation, and differentiation of MG63 osteoblasts, and TUO coating promoted ß-catenin expression; moreover, the proliferation of Staphylococcus aureus was inhibited. To summarize, we report that Cu-Co co-doping can enhance the osteogenic and antibacterial activities of orthopedic Ti implants, leading to potentially improved clinical performance.

Enhanced osteogenic activity and antibacterial ability of manganese-titanium dioxide microporous coating on titanium surfaces.

Titanium (Ti) and its alloys are widely used in clinical practice as preferred materials for bone tissue repair and replacement because of their good mechanical properties; however, as Ti lacks biological activity, clinical application has been limited. Herein, we prepared a manganese-titanium dioxide (Mn-TiO2) microporous biotic coating on Ti surfaces by micro-arc oxidation (MAO). The coating showed good surface topography and was uniformly doped with Mn, and the Mn ions were slowly released. In vitro, the Mn-TiO2 microporous biotic coating promoted the adhesion, proliferation, differentiation, and mineralization of MC3T3-E1 osteoblasts. Moreover, in vivo experiments showed that the coating promoted early osseointegration. We also conducted a preliminary investigation to explore the molecular mechanism underlying the regulation of the function of osteoblasts by the coating. Furthermore, we found that the coating could inhibit the growth of Escherichia coli in vitro, demonstrating reliable antibacterial ability. To conclude, Mn-TiO2 microporous biotic coating can improve the biological activity of Ti implants, which can potentially improve their clinical applications.

Can Platforms Affect the Safety and Efficacy of Drug-Eluting Stents in the Era of Biodegradable Polymers?: A Meta-Analysis of 34,850 Randomized Individuals.

OBJECTIVE: In the era of bare metal stents (BMSs), alloys have been considered to be better materials for stent design than stainless steel. In the era of biodegradable polymer drug-eluting stents (BP-DESs), the safety and efficacy of BP-DESs with different metal platforms (stainless steel or alloys) have not yet been reported, although their polymers are eventually absorbed, and only the metal platforms remain in the body. This study sought to determine the clinical safety and efficacy of BP-DESs with different platforms compared with other stents (other DESs and BMSs). METHODS: PubMed, Embase and Clinical Trials.gov were searched for randomized controlled trials (RCTs) that compared BP-DESs with other stents. After performing pooled analysis of BP-DESs and other stents, we performed a subgroup analysis using two classification methods: stent platform and follow-up time. The study characteristics, patient characteristics and clinical outcomes were abstracted. RESULTS: Forty RCTs (49 studies) comprising 34,850 patients were included. Biodegradable polymer stainless drug-eluting stents (BP-stainless DESs) were superior to the other stents [mainly stainless drug-eluting stents (DESs)] in terms of pooled definite/probable stent thrombosis (ST) (OR [95% CI] = 0.76[0.61-0.95], p = 0.02), long-term definite/probable ST (OR [95% CI] = 0.73[0.57-0.94], p = 0.01), very late definite/probable ST (OR [95% CI] = 0.56[0.33-0.93], p = 0.03) and long-term definite ST. BP-stainless DESs had lower rates of pooled, mid-term and long-term target vessel revascularization (TVR) and target lesion revascularization (TLR) than the other stainless DESs and BMSs. Furthermore, BP-stainless DESs were associated with lower rates of long-term death than other stainless DESs and lower rates of mid-term myocardial infarction than BMSs. However, only the mid-term and long-term TVR rates were superior in BP-alloy DESs compared with the other stents. CONCLUSION: Our results indirectly suggest that BP-stainless DESs may offer more benefits than BP-alloy DESs in the era of BP-DESs. Further well-designed RCTs comparing BP-stainless with BP-alloy DESs are needed to confirm which platform is better.