Osteosynthesis, hemiarthroplasty, total hip arthroplasty in hip fractures: All I need to know.

Recent data from the UK's National Hip Fracture Database (NHFD) demonstrate an upward trajectory in the incidence of hip fractures, a trend which is expected to persist. In 2023 alone, the NHFD reported 72,160 cases, underscoring the prevalence of these injuries. These fractures are associated with significant morbidity, mortality, and economic costs. National guidelines for the surgical management of these fractures are established, although the implementation of total hip arthroplasty (THA) as a primary treatment modality varies. This review offers a narrative synthesis of contemporary literature on hip fractures, focusing on epidemiology, classification systems, and treatment options, with a particular emphasis on the outcomes of THA.

Morphology-Tailored Dynamic State Transition in Active-Passive Colloidal Assemblies.

Mixtures of active self-propelled and passive colloidal particles promise rich assembly and dynamic states that are beyond reach via equilibrium routes. Yet, controllable transition between different dynamic states remains rare. Here, we reveal a plethora of dynamic behaviors emerging in assemblies of chemically propelled snowman-like active colloids and passive spherical particles as the particle shape, size, and composition are tuned. For example, assembles of one or more active colloids with one passive particle exhibit distinct translating or orbiting states while those composed of one active colloid with 2 passive particles display persistent "8"-like cyclic motion or hopping between circling states around one passive particle in the plane and around the waist of 2 passive ones out of the plane, controlled by the shape of the active colloid and the size of the passive particles, respectively. These morphology-tailored dynamic transitions are in excellent agreement with state diagrams predicted by mesoscale dynamics simulations. Our work discloses new dynamic states and corresponding transition strategies, which promise new applications of active systems such as micromachines with functions that are otherwise impossible.

Active self-assembly of colloidal machines with passive rotational parts via coordination of phoresis and osmosis.

The organization of microscopic objects into specific structures with movable parts is a prerequisite for building sophisticated micromachines with complex functions, as exemplified by their macroscopic counterparts. Here we report the self-assembly of active and passive colloids into micromachinery with passive rotational parts. Depending on the attachment of the active colloid to a substrate, which varies the degrees of free freedom of the assembly, colloidal machines with rich internal rotational dynamics are realized. Energetic analysis reveals that the energy efficiency increases with the degrees of freedom of the machine. The experimental results can be rationalized by the cooperation of phoretic interaction and osmotic flow encoded in the shape of the active colloid, which site-specifically binds and exerts a torque to passive colloids, supported by finite element calculations and mesoscale simulations. Our work offers a new design principle that utilizes nonequilibrium interfacial phenomena for spontaneous construction of multiple-component reconfigurable micromachinery.

Fabrication of three-lobed magnetic microrobots for cell transportation.

Mobile microrobots have the potential to transform medical treatments based on therapeutic delivery. Specifically, microrobots are promising candidates for cell transportation in cell-based therapies. Despite recent progress in cellular manipulation by microrobots, there is a significant need to design and fabricate microrobots to advance the field further. In this work, we present a facile approach to manufacturing three-lobed microrobots by a bench-top procedure. The microrobots are actuated by a harmless magnetic field which makes them biofriendly. Chemically, these microrobots are made of organosilica. The microrobots showed equally good control in both the open-loop and closed-loop settings. The three-lobed microrobots have two modes of motion during the open-loop control experiments. We employed these two modes for single-cell transportation. Our results show that the three-lobed microbots are very promising for cell transportation in a fluid.

Artificial intelligence in orthopaedics surgery: transforming technological innovation in patient care and surgical training.

Artificial intelligence (AI) is an exciting field combining computer science with robust data sets to facilitate problem-solving. It has the potential to transform education, practice and delivery of healthcare especially in orthopaedics. This review article outlines some of the already used AI pathways as well as recent technological advances in orthopaedics. Additionally, this article further explains how potentially these two entities could be combined in the future to improve surgical education, training and ultimately patient care and outcomes.

Fabrication and open-loop control of three-lobed nonspherical Janus microrobots.

In this study, we propose a simple and efficient method to fabricate three-lobed nonspherical Janus microrobots. These microrobots can be actuated by a harmless magnetic field. Utilizing organosilica as the material of choice, we leverage its versatile silane chemistry to enable various surface modifications and functionalities. The fabricated microrobots demonstrate two distinct modes of motion, making them well-suited for cell transportation and drug delivery tasks. Their unique shape and motion characteristics allow for precise and targeted movement. Integrating these microrobots into therapeutic delivery platforms can revolutionize medical treatments, offering enhanced precision, efficiency, and versatility in delivering therapies to specific sites.

Multistimuli-responsive microrobots: A comprehensive review.

Untethered robots of the size of a few microns have attracted increasing attention for the potential to transform many aspects of manufacturing, medicine, health care, and bioengineering. Previously impenetrable environments have become available for high-resolution in situ and in vivo manipulations as the size of the untethered robots goes down to the microscale. Nevertheless, the independent navigation of several robots at the microscale is challenging as they cannot have onboard transducers, batteries, and control like other multi-agent systems, due to the size limitations. Therefore, various unconventional propulsion mechanisms have been explored to power motion at the nanoscale. Moreover, a variety of combinations of actuation methods has also been extensively studied to tackle different issues. In this survey, we present a thorough review of the recent developments of various dedicated ways to actuate and control multistimuli-enabled microrobots. We have also discussed existing challenges and evolving concepts associated with each technique.

Inorganic-Organic Hybrid Copolymeric Colloids as Multicolor Emission, Fuel-Free, UV- and Visible-Light-Actuated Micropumps.

Light-actuated micromachines are of enormous interest due to their ability to harvest light for triggering catalytic reactions to acquire free energy for mechanical work. This work presents an inorganic-organic hybrid copolymeric poly(cyclotriphosphazene-co-barbituric acid) colloid, which displays multiwavelength excited emission and catalytic activities, exploiting the unique structural, chemical, and optical features of inorganic heterocyclic ring hexachlorocyclotriphosphazene and organic co-monomer barbituric acid. Specifically, this work reveals particle-resolved unusual multicolor emission under excitation with the same or different wavelengths of light using fluorescence microscopy. The result is rationalized by density functional theory studies. In this work, the authors find that emission is coincident with fluorometric measurements, and the photocatalytic properties are anticipated from the overall band structure. This work also demonstrates the use of these colloids as micropumps, which can be remotely activated by UV, blue, and green lights under fuel-free conditions, and ascribe the behavior to ionic diffusiophoresis arising from light-triggered generation of H+ and other charged species. This work offers a new class of polymeric colloids with multiple-wavelength excited emission and catalytic activities, which is expected to open new opportunities in the design of fuel-free, photo-actuated micromachines and active systems.

Extended reality anatomy undergraduate teaching: A literature review on an alternative method of learning.

BACKGROUND: The majority of undergraduate anatomy learning has shifted online, or to a mixture of virtual and face-to-face teaching, due to the COVID-19 pandemic. Cadaveric shortages have also influenced the need for alternative methods of anatomical education. This study examines the current literature on the use of extended reality technologies (XR) such as Virtual reality (VR), Augmented reality (AR), and Mixed reality (MR) for anatomy teaching and explores its potential for implementation in medical education. METHODS: A literature review was performed of PubMed, ProQuest, Science Direct, and Springer databases. Included studies were assessed for user satisfaction, perceived effectiveness, cost, acceptability and side effects. RESULTS: The database search identified 1687 papers, of which 45 papers were included in this review. Both AR and VR had high rates of satisfaction and acceptability as a supplementary teaching aid amongst undergraduate participants. AR was found to have higher effectiveness than VR. VR is more expensive than AR. Results and comparisons were limited due to short length of study. CONCLUSIONS: VR is a popular choice with undergraduates as an aid to supplement teaching, in spite of the associated cost and side effects such as nausea. AR has shown the most potential for independent study. Larger and long-term studies are required to determine true effectiveness, and consideration of the clinical relevance of these technologies.

Ionic Effects in Ionic Diffusiophoresis in Chemically Driven Active Colloids.

We study experimentally the effect of added salt in the phoretic motion of chemically driven colloidal particles. We show that the response of passive colloids to a fixed active colloid, be it attractive or repulsive, depends on the ionic strength, the ζ potential, and the size of the passive colloids. We further report that the direction of self-propulsion of Janus colloids can be reversed by decreasing their ζ potential below a critical value. By constructing an effective model that treats the colloid and ions as a whole subjected to the concentration field of generated ions and takes into account the joint effect of both generated and background ions in determining the Debye length, we demonstrate that the response of the passive colloids and the velocity of the Janus colloids can be quantitatively captured by this model under the ionic diffusiophoresis theory beyond the infinitely-thin-double-layer limit.

Magnetic Manipulation and Assembly of Nonmagnetic Colloidal Rods in a Ferrofluid.

We investigated experimentally and theoretically the interactions and assembly of rodlike colloids in a ferrofluid confined at solid/liquid interface by the gravity under external magnetic fields. We first derived analytical expressions for the interaction energy of a single rod with the external magnetic field and the interaction between two rods using classical electromagnetism. The theory well captured the experimentally observed alignment of a single rod along the field direction under an in-plane field and switching between the horizontal and the vertical configurations in an out-of-plane field due to the competition between the magnetic energy and the gravitational energy. The theory can also predict the symmetric position fluctuations of a free rod on a fixed one at 90° and the gradual bias toward the end of the fixed rod as the angle was reduced to 0°, favoring the tip-toe arrangement. Finally, we showed that this anisotropic interaction led to the formation of chain-like structures, whose growth kinetics followed a simple scaling behavior with time. This work provides a theoretical framework for understanding the behaviors of rodlike colloids in ferrofluids and highlights the importance of shape anisotropy in manipulating colloids and their self-assembly.

Highly efficient chemically-driven micromotors with controlled snowman-like morphology.

We report the synthesis of silver-based Janus micromotors that self-propel at 3.5 µm s-1 and speed up to 45 µm s-1 in 0.044 and 1.5 mM of H2O2, respectively, via ionic diffusiophoresis. Morphology optimization further accelerates the speed to 90 µm s-1, which leads to a force of 1 pN and a power of 0.1 fW, similar to biomolecular motors. Their efficiency reaches 10-5, at least two orders of magnitude higher than other chemically-driven micromotors. These micromotors hold great promises in various applications.

Design and One-Pot Synthesis of Capsid-like Gold Colloids with Tunable Surface Roughness and Their Enhanced Sensing and Catalytic Performances.

Viral capsid-like particles tiled with mosaic patches have attracted great attention as they imitate nature's design to achieve advanced material properties and functions. Here, we develop a facile one-pot soft-template method to synthesize biomimetic gold capsid-like colloids with tunable particle size and surface roughness. Uniform submicron-to-micron-sized hollow gold colloidal particles are successfully achieved by using tannic acids as soft templates and reducing agents, which first self-assemble into spherical complex templates before the reduction of Au3+ ions via their surface hydroxyl groups. The surface roughness, the size, and the total number of the patches of the prepared gold particles are further tuned, utilizing a mechanism that offers morphology control by varying the number of surface hydroxyl groups participating in the reduction reactions. Among different capsid-like gold colloids, those possessing a rough surface display superior catalytic properties and show promising results as surface-enhanced Raman spectroscopy (SERS) solid substrates for detecting small organic molecules and biomimetic enzymes in a liquid phase for sensing biomolecules in real samples. These capsid-like gold colloids are also expected to find practical applications in delivery systems, electronics, and optics. We believe that our strategy of imitating nature's design of capsid-like structures should also be used in the design and fabrication of other functional colloidal particles.

Robotics in total hip arthroplasty: a review of the evolution, application and evidence base.

Robotic systems used in orthopaedics have evolved from active systems to semi-active systems.Early active systems were associated with significant technical and surgical complications, which limited their clinical use.The new semi-active system Mako has demonstrated promise in overcoming these limitations, with positive early outcomes.There remains a paucity of data regarding long-term outcomes associated with newer systems such as Mako and TSolution One, which will be important in assessing the applicability of these systems.Given the already high satisfaction rate of manual THA, further high-quality comparative studies are required utilizing outcome scores that are not limited by high ceiling effects to assess whether robotic systems justify their additional expense. Cite this article: EFORT Open Rev 2020;5:866-873. DOI: 10.1302/2058-5241.5.200037.

Using implementation science to develop and implement a guideline to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective arthroplasty.

Introduction: Guidelines and consensus statements do not support routine preoperative testing for asymptomatic bacteriuria (ASB) prior to elective arthroplasty. Despite this, urine testing remains commonplace in orthopaedic practice. This mixed methods stepwise quality improvement project aimed to develop and implement a guideline to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective arthroplasty within a single centre. Methods: Step 1 - description of current practice in preoperative urine testing prior to arthroplasty within a single centre; Step 2 - examination of the association between preoperative urine culture and pathogens causing prosthetic joint infection (PJI); Step 3 - co-design of a guideline to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective arthroplasty; Step 4 - implementation of a sustainable guideline to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective arthroplasty. Results: Retrospective chart review showed inconsistency in mid-stream urine (MSU) testing prior to elective arthroplasty (49 % preoperative MSU sent) and in antimicrobial prescribing for urinary tract infection (UTI) and ASB. No association was observed between organisms isolated from urine and joint aspirate in confirmed cases of PJI. Co-design of a guideline and decision support tool supported through an implementation strategy resulted in rapid uptake and adherence. Sustainability was demonstrated at 6 months. Conclusion: In this stepwise study, implementation science methodology was used to challenge outdated clinical practice, achieving a sustained reduction in unnecessary preoperative urine testing for ASB prior to elective arthroplasty.

Accuracy of the relationship between the centre of the femoral head and tip of greater trochanter.

INTRODUCTION: There have been many techniques described to measure limb length discrepancy and methods to correct this during total hip arthroplasty; preoperative and intraoperative. These techniques have been either inconsistent, cumbersome or not readily available due to expense. There is a lack of evidence to support one particular approach. The aim of this study is to assess the accuracy of the relationship between the centre of the femoral head and tip of the greater trochanter. METHODS: A prospective observational cross-sectional study, with patients undergoing Positron emission tomography-CT (PET-CT) scan between 20th January 2016 to 31st December 2016. Exclusion criteria were patients undergoing PET-CT scan for musculoskeletal condition, those found to have existing pathology of the hip (including previous trauma) and those aged younger than 18 years and over 50 years. RESULTS: There was a total of 116 participants, giving 232 hips for assessment and 184 hips were measured by two observers. The mean age of the sample was 40.51 years. The mean distance of the centre of the femoral head from the tip of the greater trochanter was 8.53 mm distal (with a standard deviation of 4.97). Analysis of the right and left hip measurements gave a Pearson correlation coefficient of 0.87, suggesting a good correlation. Interobserver analysis demonstrated fair agreement with intraclass correlation coefficient of 0.52. CONCLUSION: The evidence of this study and that in literature suggests that this landmark is unreliable and should no longer be used.

Knee surgery: Trends and the 50 most cited articles.

Knee Surgery is one of the most commonly performed orthopedic procedures, and a rapidly evolving area of research. A bibliographic analysis was conducted to explore the characteristics of the top 50 most cited articles in knee surgery. The Web of Science Core Collection Database was used to search for Knee AND Surgery, further refined for orthopedic surgery, yielding 1,660 articles. After inclusion and exclusion criteria were applied, the top 50 cited articles were statistically and thematically analyzed. Year of publication ranged from 1982 to 2014. The highest volume of research came from USA, with the Journal of Bone and Joint Surgery having the highest number of papers in the top 50. The most common theme of research was Knee Arthroplasty Outcomes. Our study elucidates trends and popular areas of research in the field of knee surgery, and provides researchers with an overview of areas to focus, where there is scope for high-impact original research.

Current practice of BHS members in the treatment of osteonecrosis of the femoral head in adults.

INTRODUCTION: The management of osteonecrosis (ON) of the femoral head remains controversial. It is unclear the extent to which non-arthroplasty procedures are used and there has been no previous report of the trends in operative management of ON in the UK. Our objective is to report current trends in management of ON of the femoral head amongst specialist hip surgeons in the UK. METHODS: A single-stage internet-based survey was e-mailed to 352 eligible members of the British Hip Society (BHS). This consisted of 10 question stems including 16 hypothetical clinical scenarios with imaging. RESULTS: 115 active Consultant members of the BHS completed the survey. For symptomatic pre-collapse ON we found core decompression (CD) was the most common operative intervention and for post-collapse ON we found that total hip arthroplasty (THA) was the most common operative intervention. We found no difference in the rate of operative intervention between 24 and 48-year-old patients at any stage of ON but joint preserving procedures were more often selected for the younger patient and arthroplasty for the older patient. Surgeons were more likely to offer arthroplasty to a 48-year-old patient at an earlier stage of disease. CONCLUSIONS: Our respondents would offer different operative interventions dependent on stage of ON and patient age. Core decompression (CD) and arthroplasty were common but variation in treatment options offered suggests a lack of consensus amongst UK hip surgeons. We suggest that further research such as a prospective RCT is needed to gain consensus on management of this condition.

PtNi/NiO Clusters Coated by Hollow Sillica: Novel Design for Highly Efficient Hydrogen Production from Ammonia-Borane.

Ammonia-borane (NH3·BH3; AB) has been considered as an excellent chemical material for hydrogen storage. However, developing highly efficient catalysts for continuous hydrogen generation from AB is still a challenge for future fuel cell applications. The combination of Pt with Ni is an effective strategy to achieve active bimetallic nanocatalyst, and the particle size has proved to play a crucial role in determining its final activity. However, the synthesis of PtNi bimetallic catalyst in the size of highly dispersed clusters has always been a challenge. In this report, PtNi/NiO clusters coated by small-sized hollow silica (R-PtNi/NiO@SiO2) were designed for efficient hydrogen generation from the hydrolysis of ammonia-borane. The newly designed catalysis system showed extremely high activity with the initial turnover frequency value reaching 1240.3 mol of H2·mol-1 of Pt·min-1, which makes it one the most active Pt-based catalysts for this reaction. Detailed characterization by means of scanning transmission electron microscopy, X-ray photoelectron spectroscopy, energy-dispersive X-ray spectroscopy element mapping, etc. revealed that the excellent performance of R-PtNi/NiO@SiO2 is derived from the highly dispersed PtNi/NiO clusters and the reduction of extra Pt4+ on the surface of PtNi/NiO clusters to Pt0 at relatively low temperature.

A Patient-Focused Technology-Enabled Program Improves Outcomes in Primary Total Hip and Knee Replacement Surgery.

BACKGROUND: A patient-engagement and pathway-management program for patients undergoing primary total hip and knee replacement was evaluated. Health-service and multimedia features supported by technology were integrated with existing enhanced recovery after surgery (ERAS) practices. The primary objective was to demonstrate the impact on length of stay. The secondary objective was to assess the impact on clinical, patient-focused, and financial outcomes. METHODS: Two thousand and eighty consecutive patients undergoing primary total hip replacement (n = 1,034) and total knee replacement (n = 1,046) were classified into "pre-program" (retrospectively assessed [n = 1,038]) and "program" (prospectively assessed [n = 1,042]) cohorts. Patients in the program cohort were subdivided according to those who were eligible for criteria-based outreach support (OS) (n = 401) and those who were ineligible for this service (NOS) (n = 641). Clinical outcomes were assessed for all patients, and patient-focused outcomes were assessed for a subset (n = 223). RESULTS: The mean reduction in length of stay ranged from 20% (1.2 days) to 42% (2.5 days) following total hip replacement and from 9% (0.6 day) to 31% (2 days) following total knee replacement (p < 0.001). Clinical outcomes (readmissions, complications, emergency department re-attendance rates) were not significantly negatively impacted. The Oxford Hip Score had numerically larger improvement after total hip replacement in the OS group than in the pre-program group (4.1-point increase), and the Oxford Knee Score had numerically larger improvement after total knee replacement in the NOS group than in the pre-program group (0.8-point increase). The patients in the program cohort (either OS or NOS) rated overall health gain as higher than those in the pre-program cohort (gain in numerical rating scale, 1.4 points for patients managed with total hip replacement, 0.6 points for patients managed with total knee replacement). Older patients and those with higher comorbidity indices benefited most with respect to length of stay and multiple clinical outcomes. Patient experience was significantly improved across domains (p < 0.001 to p = 0.003). Potential savings for patients managed with total hip replacement (£401.64 [$267.76] per patient) exceeded estimated program charges of £50 [$33.33] to £60 [$40] per patient, whereas the potential savings for patients managed with total knee replacement (£76.67 [$51.11] per patient) were sufficient to achieve a reduction of total system costs. CONCLUSIONS: Technology-enabled programs may deliver enhanced care at lower costs for patients undergoing lower-limb arthroplasty. Shorter durations of inpatient stay without a negative impact on clinical outcomes and improved patient-focused outcomes and experience can deliver substantial value that can be especially beneficial for older patients and those with greater medical complexity. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.