Vascularized fibular grafts for the treatment of long bone defects: pros and cons. A systematic review and meta-analysis.

PURPOSE: To quantify union rate, complication rate, reintervention rate, as well as functional outcome after vascularized fibular bone grafts (VFGs) for the treatment of long-bone defects. METHODS: A comprehensive search was performed in the PubMed, Web of Science, and Cochrane databases up to August 18, 2020. Randomized controlled trials, comparative studies, and case series describing the various techniques available involving VFGs for the reconstruction of segmental long-bone defects were included. A meta-analysis was performed on union results, complications, and reinterventions. Assessment of risk of bias and quality of evidence was performed with the Downs and Black's "Checklist for Measuring Quality". RESULTS: After full-text assessment, 110 articles on 2226 patients were included. Among the retrieved studies, 4 were classified as poor, 83 as fair, and 23 as good. Overall, good functional results were documented and a union rate of 80.1% (CI 74.1-86.2%) was found, with a 39.4% (CI 34.4-44.4%) complication rate, the most common being fractures, non-unions and delayed unions, infections, and thrombosis. Donor site morbidity represented 10.7% of the total complications. A 24.6% reintervention rate was documented (CI 21.0-28.1%), and 2.8% of the patients underwent amputation. CONCLUSIONS: This systematic review and meta-analysis documented good long-term outcomes both in the upper and lower limb. However, VFG is a complex and demanding technique; this complexity means an average high number of complications, especially fractures, non-unions, and vascular problems. Both potential and limitations of VFG should be considered when choosing the most suitable approach for the treatment of long-bone defects.

Preoperative Osteoarthritic Grade Affects Forgotten Joint Status and Patient Acceptable Symptom State After Robotic Arm-Assisted Unicompartmental Knee Arthroplasty.

BACKGROUND: This retrospective observational study was designed to investigate the association between radiographic Ahlbäck osteoarthritis (OA) grade and postoperative joint perception in a cohort of patients undergoing medial robotic arm-assisted unicompartmental knee arthroplasty (RA-UKA), using the Forgotten Joint Status and Patient Acceptable Symptom State (PASS) as outcomes. METHODS: Between January 2014 and May 2019, 660 patients (719 knees) underwent medial RA-UKA at 2 centers. Ahlbäck OA grade was measured on preoperative knee radiographs. Postoperatively, patients were administered the Forgotten Joint Score-12 (FJS-12) and 5-level Likert scale to assess patients' satisfaction. Correlations were described among FJS-12, satisfaction, and Ahlbäck OA grade by means of logistic regression models. RESULTS: A total of 547 patients (602 knees) were assessed at a mean follow-up of 3.5 years (standard deviation 1.4). A total of 293 cases were graded as Ahlbäck 1 (Group A) and 309 knees were graded as Ahlbäck>1 (Group B). Statistically significant difference was detected in mean FJS-12 (P < .001), but not in the postoperative satisfaction level (P = .06) between the 2 groups. Patients in Group B had a significantly higher probability of attaining a "forgotten knee" after the operation, compared to Group A (P < .05). Cases in Group A had a significantly lower probability of achieving the PASS (P < .01). CONCLUSION: Patients with higher grades of OA (Ahlbäck>1) were more likely to attain a "forgotten knee," while patients with less severe OA (Ahlbäck 1) were less likely to achieve the PASS after RA-UKA. Although patients with less severe OA reported fairly good outcome, cases in which the results will be poorer are currently difficult to predict.

Infrared Thermography for the Evaluation of Inflammatory and Degenerative Joint Diseases: A Systematic Review.

OBJECTIVE: Inflammation plays a central role in the pathophysiology of rheumatic diseases as well as in osteoarthritis. Temperature, which can be quantified using infrared thermography, provides information about the inflammatory component of joint diseases. This systematic review aims at assessing infrared thermography potential and limitations in these pathologies. DESIGN: A systematic review was performed on 3 major databases: PubMed, Cochrane library, and Web of Science, on clinical reports of any level of evidence in English language, published from 1990 to May 2021, with infrared thermography used for diagnosis of osteoarthritis and rheumatic diseases, monitoring disease progression, or response to treatment. Relevant data were extracted, collected in a database, and analyzed for the purpose of this systematic review. RESULTS: Of 718 screened articles 32 were found to be eligible for inclusion, for a total of 2094 patients. Nine studies reported the application to osteoarthritis, 21 to rheumatic diseases, 2 on both. The publication trend showed an increasing interest in the last decade. Seven studies investigated the correlation of temperature changes with osteoarthritis, 16 with rheumatic diseases, and 2 with both, whereas 2 focused on the pre-post evaluation to investigate treatment results in patients with osteoarthritis and 5 in patients with rheumatic diseases. A correlation was shown between thermal findings and disease presence and stage, as well as the clinical assessment of disease activity and response to treatment, supporting infrared thermography role in the study and management of rheumatic diseases and osteoarthritis. CONCLUSIONS: The systematic literature review showed an increasing interest in this technology, with several applications in different joints affected by inflammatory and degenerative pathologies. Infrared thermography proved to be a simple, accurate, noninvasive, and radiation-free method, which could be used in addition to the currently available tools for screening, diagnosis, monitoring of disease progression, and response to medical treatment.