Purpose: To prospectively compare the efficacy and safety of intra-articular injections of platelet-rich plasma (PRP) with hyaluronic acid (HA) and glucocorticosteroid (CS) control groups for knee osteoarthritis (KOA) in a randomized, triple-parallel, single-center clinical trial. Methods: A total of 75 patients were randomly assigned to one of three groups receiving a single injection of either leukocyte-poor platelet-rich plasma (25 knees), hyaluronic acid (25 knees), or glucocorticosteroid (25 knees). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was collected at baseline and 6, 12, and 26 weeks after treatment. Results: After 6 weeks of PRP administration, a decrease in the mean WOMAC value was observed in all three study groups. Three months after administration, the greatest decrease in the mean WOMAC value was obtained in the PRP group. The results in the HA and CS groups were similar (p = 0.681). In the one-way analysis of variance and post hoc analysis using the HSD Tukey test, a significantly greater improvement was shown by comparing the PRP and CS groups (p = 0.001), and the PRP and HA groups (p = 0.010). After intra-articular injection of CS, the reduction in pain was greatest 6 weeks after administration, and the mean value was the lowest among all groups. During subsequent visits, the value of the pain subscale increased, and after 6 months, it was the highest among the studied groups. Using the Wilcoxon paired test, no PRP effect was found to reduce stiffness at the 6-month follow-up (p = 0.908). Functional improvement was achieved in all groups, i.e., a decrease in the value of this subscale 6 months after administration. The largest decrease was seen in the group that received PRP (p < 0.001) and then in the HA group. The smallest decrease among the investigated methods was shown in the CS group. Conclusions: Intra-articular injections of PRP can provide clinically significant functional improvement for at least 6 months in patients with mild to moderate KOA which is superior to HA or CS injections.
The purpose of this study was to investigate whether smoking is associated with neovascularization in the tendinopathy of the long head of the biceps tendon (LHBT).The study included 40 consecutive patients who underwent arthroscopic biceps tenotomy/tenodesis due to chronic biceps tendinopathy and divided into three groups: (1) non-smokers, (2) former smokers, (3) smokers. LHBT tissue samples were stained with H&E, Alcian blue and Trichrome staining. Immunohistochemical examination was performed using anti-CD31 and anti-CD34. The neovessel density score (NDS) was scored by Bonar criteria.The mean period of smoking was 15.50 years with an average number of 24 cigarettes/day in the former smokers and 21.69 years with an average number of 15 cigarettes/day in the active smokers. The mean NDS was 2.23/3 in non-smokers, whereas it was 1.60/3 in former smokers and 1.31/3 in active smokers. The mean American Shoulder and Elbow Surgeons score equaled 46 in never smoked patients, 43.60 in former smokers, and 41.46 in active smokers. In the patients with smoking history, the disorganized tendinous tissue islands were avascular and composed of compact acidic polysaccharides and mucopolysaccharides. We observed negative correlation between the NDS and the smoking indexes, including cigarettes per day (p = 0.0150), smoking years (p = 0.0140), pack-years (p = 0.0088).In conclusion, the present study revealed that smoking impairs the vascularization of the biceps tendon in chronic tendinopathy. Clinically, we observed a negative correlation between smoking and neovascularization. Furthermore, there was no correlation between neovascularization and functional preoperative status.
Routine resection of the infrapatellar fat pad (IFP) during total knee arthroplasty (TKA) is controversial, as it may result in shortening of the patellar tendon (PT) and anterior knee pain. This prospective study examined whether IFP excision during TKA affects joint function, anterior knee pain, PT dimensions and sonographic structure. A total of 65 consecutive patients undergoing TKA for osteoarthritis were randomized into two groups: IFP was resected in one and retained in the other. Patients were examined preoperatively, at 6 weeks and 6 months postoperatively: pain (Numerical Rating Scale-NRS), range of motion (ROM) and knee function (Knee Injury and Osteoarthritis Outcome Score-KOOS score) were evaluated; sonographic examination determined the length, structure and vascularity of the PTs. In both groups there were postoperative improvements in NRS and KOOS scores, although IFP resection did not influence clinical outcomes or sonographic parameters. At 6 weeks and 6 months postoperatively for both groups there were no differences between NRS scores (Mann-Whitney test, p = 0.511 and p = 0.579), ROM scores (Mann-Whitney test, p = 0.331, p = 0.180) or all KOOS subscores. IFP excision had no effect on sonographic parameters. This study suggests that IFP resection during TKA does not influence postoperative functional outcomes, pain scores, patellar tendon length and thickness, or sonographic structure.
Background: An abnormally high body mass index is strongly associated with knee osteoarthritis. Usually, obese patients are excluded from clinical trials involving PRP intra-articular injections. Growth factors have been demonstrated to have a disease-modifying effect on KOA treatment, even though data on their influence on treatment effectiveness in obese patients are lacking. Purpose: To prospectively compare the level of selected growth factors including transforming growth factor-b (TGF-β), epidermal growth factor (EGF), fibroblast growth factor, insulin-like growth factor-1 (IGF-1), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and fibroblast growth factor-2 (FGF-2) in platelet-rich plasma (PRP) in obese patients and patients with normal BMI. Methods: A total of 49 patients were included in the study according to inclusion and exclusion criteria. The groups strongly differed in body mass index (median values 21.6 vs. 32.15). Concentrations of growth factors were measured with an enzyme-linked immunosorbent assay. Statistical significance was determined with the Mann-Whitney U test. The compliance of the distribution of the results with the normal distribution was checked using the Shapiro–Wilk test separately for both groups. Results: There were no statistically significant differences in median marker levels between groups. Statistically significant Pearson correlations were observed between IGF-1 serum level and age (weak negative, r = −0.294, p = 0.041) and gender (moderate positive, r = 0.392, 0.005). Conclusions: BMI does not influence the level of selected growth factors in patients with knee osteoarthritis. Obese and non-obese patients had similar compositions of PDGF, TGF-β, EGF, FGF-2, IGF-1, and VEGF. PRP can be used in both groups with similar effects associated with growth factors’ influence on articular cartilage.
Background: Periprosthetic joint infections are severe complications of arthroplasty, difficult to manage due to biofilm formation on the components. Recently, the use of silver nanoparticles (SNs) has emerged as a method of preventing biofilm formation on orthopaedic implants, however little is known about the systematic toxicity of SNs.Aim: This study used a rabbit model to examine the tissue response of bone, liver and kidney to prototype components with SN doped hydroxyapatite (HA) coatings.Materials and methods: Twelve prototype implants (six with HA, six with SN doped HA coatings) were implanted into the femora of twelve New Zealand Rabbits. After 6 weeks, the animals were euthanised, their femora and samples of livers and kidneys harvested to prepare microscopic slides. The slides were examined for the presence inflammatory or toxic reactions to SNs, implants were examined using scanning electron microscopy (SEM) to determine structural changes related to implantation and verify retention of SNs in vivo.Results: SEM demonstrated that SNs formed submicron conglomerates, which were retained after 6 weeks in vivo and did not interfere with osseointegration. Histologic studies of bone fragments demonstrated no signs of acute toxicity and inflammation. No inflammatory reaction was observed in kidneys, although in some samples signs of acute renal failure related to euthanasia were found. No severe toxic reaction was found in liver samples, however fatty degeneration of liver was found in some animals.Conclusions: This study documented good osteointegration of implants with SN doped HA coatings with low systematic toxicity of SNs.
Locked bucket-handle tears of both medial and lateral menisci, called in literature "Jack and Jill lesion", with simultaneous anterior cruciate ligament (ACL) injury is an extremely unusual phenomenon. It was reported only in a few cases in literature, which were unfortunately highly differentiated in the field of trauma mechanism, treatment options and postoperative care. Authors presented a clinical case of patient with a locked knee joint, by the torn both menisci, what masked the simultaneous ACL rupture and supremely imitated a stable joint. The locked knee is a clinical case demanding the urgent intervention to prevent further damages to the joint structures. Surprisingly, the patient after locking of the menisci and migration of their inner fragments to the intercondylar notch, started to feel the affected joint stabile and dismissed from the further treatment for next 2 years. Complex trauma needs a complex treatment, and a single-stage or multi-stage surgical approach is performed. Authors chose a two-steps surgical procedure with primary meniscal repair and secondary, early ACL reconstruction.
Objective: the aim of this study was to document the occurrence of THA after acetabulum surgery and examine the factors that predict its occurrence. Methods: This study included 77 consecutive patients who were admitted for acetabulum fracture surgery between 2012 and 2019. The inclusion criteria were acetabular fractures and indications for operative management. The exclusion criteria were acetabular fractures treated non-operatively, fractures requiring primary THA, and periprosthetic acetabular fractures. Data concerning demographics, date of injury, date of surgery, surgical approach, stabilization, and further reconstructive surgery were collected retrospectively. The number of patients who underwent THA and their risk factors were recorded. The minimum follow-up for each patient was 2 years of observation. A total of 77 patients with a mean age of 53 years were included. Results: At a mean follow-up of 2 years, THA was performed in 16 (20.8%) patients due to post-traumatic arthritis. An analysis of the surgical approaches showed that the Kocher–Langenbeck approach increased the risk of THA nearly 12 times compared with the ilioinguinal approach (p = 0.016). Furthermore, the duration of the waiting period for surgery significantly impacted the occurrence of THA, with each additional day leading to an 89% increase in the risk of prosthesis usage (p = 0.001). Conclusions: This study suggests that acetabular fractures may lead to post-traumatic hip osteoarthritis. The surgical approach and the waiting time for surgery are potential factors that may predict secondary hip osteoarthritis and the need for subsequent THA. However, further investigations should be performed to establish predictors for secondary hip osteoarthritis, and especially to determine the impact of the surgical approach.
