Acta orthopaedica Belgica最新文献

Natural compounds such as curcumin (C), resveratrol (R), and eggshell membrane (EM) have demonstrated anti- inflammatory and chondroprotective properties. This study aimed to evaluate the effects of these compounds, administered either individually or in combination, on cartilage and synovial tissues in a surgically induced rat osteoarthritis (OA) model. Forty-eight male Wistar rats were randomly assigned to eight groups (n = 6 per group). OA was induced by destabilization of the medial meniscus (DMM) in the right knee. After a 4-week postoperative period, C, R, EM, their pairwise combinations (CR, REM, CEM), and the triple combination (CREM) were administered daily via oral gavage for 4 weeks. A sham-operated group served as the healthy control. Histological evaluation was performed using H&E and Safranin O/Fast Green staining. OA severity was assessed using the OARSI scoring system and semiquantitative synovial parameters. All treatment groups demonstrated varying degrees of histopathological preservation within the experimental OA model. Among single-agent treatments, resveratrol demonstrated the most consistent protective profile. The triple combination group demonstrated favorable histopathological findings, including reduced cartilage degeneration and minimal synovial inflammatory changes. However, no statistically significant differences were observed between the triple combination and key monotherapy groups. The relatively small sample size may have limited the statistical power to detecting subtle intergroup differences. Resveratrol and eggshell membrane demonstrated consistent chondroprotective effects. The combination therapy was associated with favorable histological outcomes, suggesting possible additive rather than truly synergistic effects. Further studies incorporating molecular, biochemical, and functional analyses are warranted to confirm these findings.

Liposclerosing myxofibrous tumor (LSMFT) is a rare fibro-osseous lesion with a strong predilection for the proximal femur, rarely seen in clinical practice and often diagnostically challenging. A 29-year-old woman who presented with left hip pain after a fall is reported. Multimodal imaging - plain radiographs, computed tomography, and magnetic resonance imaging (MRI) - was performed, followed by intraoperative frozen section analysis and curettage. The residual cavity was filled with a synthetic bioactive-glass bone substitute, and the proximal femur was stabilised with a dynamic hip screw (DHS). Plain radiographs showed a geographic lytic lesion in the subtrochanteric femur with a thick sclerotic rim. Computed tomography confirmed well-defined medullary expansion with heterogeneous mineralisation. MRI demonstrated marked T2 hyperintensity consistent with myxoid stroma. Intraoperative frozen section showed a benign-appearing spindle-cell lesion; permanent histopathology on a 10×8×2 cm curettage specimen confirmed LSMFT, demonstrating the characteristic polymorphic combination of xanthomatous foci, mature adipocytes, fibrous stroma, and myxoid areas without malignant features. At the latest follow-up, 4 months postoperatively, the patient was pain-free (visual analogue scale 0) with a full, unrestricted hip range of motion and a Harris Hip Score of 99.8; full weight-bearing had been resumed by the second postoperative month. Follow-up radiographs demonstrated incorporation of the graft without evidence of local recurrence, and no complications were recorded. This case highlights the diagnostic challenges of LSMFT, the limitations of intraoperative frozen section in polymorphic fibro-osseous lesions, and the importance of structural fixation at the subtrochanteric level. Although the short-term outcome was excellent, lifelong surveillance is warranted given the reported risk of malignant transformation.

This study evaluated whether three-dimensional (3D) bioprinted spherical, porous poly-L-lactic acid (PLLA) drug- loaded implants, combined with bone marrow mesenchymal stem cells (BMSCs) overexpressing transforming growth factor-β1 (TGF-β1) and interleukin-10 (IL-10), can enhance the repair of osteoarthritis (OA)-related cartilage defects. Rat BMSCs were transduced with lentiviral vectors to achieve dual overexpression of TGF-β1 and IL-10, induced toward chondrogenic differentiation, and assessed for chondrogenic marker expression (COL2A1, SOX-9, and aggrecan). Spherical porous PLLA drug-loaded implants were fabricated by 3D bioprinting and characterized for drug loading, porosity, cytocompatibility, skin sensitization, biodegradation, and in vivo release behavior. Histology, micro-computed tomography (micro-CT), and molecular assays evaluated cartilage repair and subchondral bone remodeling. Dual-gene transduction markedly promoted BMSC chondrogenic differentiation with significant up-regulation of COL2A1, SOX-9, and aggrecan. The PLLA scaffolds exhibited high porosity (88.88 ± 2.87%), meeting biomaterial requirements, showed no evident cytotoxicity or skin sensitization, and achieved a 12-week mass-loss (biodegradation) of 42.65%. In vivo, the combined treatment group displayed superior cartilage regeneration and subchondral bone repair compared with controls, accompanied by increased BMP2 and type II collagen (COL-2) expression. 3D-bioprinted porous PLLA drug-loaded implants combined with TGF-β1/IL-10 dual-gene-transduced BMSCs effectively promote repair of OA cartilage defects, indicating satisfactory biocompatibility and potential for clinical translation.

Background: Synovial biopsy, an important diagnostic tool to evaluate chronic monoarthritis, undifferentiated inflammatory arthritis and neoplasms, remains underutilized in clinical practice due to perceived invasiveness and limited access to specialized techniques. This study evaluates the diagnostic utility and histopathological spectrum of synovial biopsies in a tertiary care centre.

Materials and methods: This retrospective and prospective observational study was conducted over three years (June 2020-June 2023) in a tertiary care institute. Synovial biopsies obtained via needle biopsy or arthrotomy received in the Department of Pathology, were routinely processed and evaluated using Hematoxylin and Eosin (H&E) stain, with special stains wherever indicated.

Results: Total 148 synovial biopsies were analysed. The mean age was 49.9 years, M:F ratio was 1.7:1. The most common site was the knee joint (69.5%). Common histopathological diagnosis were chronic non-specific synovitis (46.6%), rheumatoid arthritis (RA) (16.2%), septic arthritis (12.8%), and tuberculous synovitis (11.5%). Diagnostic revision following histopathological examination occurred in 16 /148 cases (10.8%), significantly altering the clinical management. This included seven cases of tuberculosis (TB) initially presenting as acute synovitis, three cases of post-total knee replacement which were originally managed as bacterial infections but reclassified as TB following synovial biopsy and six cases of RA which were initially misclassified as osteoarthritis.

Conclusion: Synovial biopsy is a valuable investigation that can be incorporated into diagnostic algorithms for atypical presentations to improve patient outcomes and reduce clinical misclassification. In TB endemic regions, histopathological examination of synovial biopsy can prevent delayed diagnosis and suboptimal management.

or mzyjp23@nottingham.ac.uk Body Protective Compound-157 (BPC-157) is a synthetic pentadecapeptide popular among athletic populations for musculoskeletal injury recovery, despite lacking regulatory approval for human use and evidence being largely limited to animal models. This PRISMA-compliant systematic review, prospectively registered with PROSPERO (CRD420261406325), aimed to evaluate the efficacy and safety of BPC-157 for orthopaedic and regenerative purposes in humans. Electronic databases (Embase, PubMed, Cochrane Library and ClinicalTrials.gov) were searched up to 1 June 2026. Eligibility included quantitative and qualitative studies investigating BPC-157 for any indication in human participants. Methodological quality and certainty of evidence was assessed using the National Institutes of Health Quality Assessment Tool for Before-After Studies With No Control Group and GRADE framework respectively. Findings were narratively synthesised in accordance with SWiM guidance. Three studies (n=30) met the inclusion criteria, consisting of a retrospective study of intra-articular BPC-157 injections for knee pain (n=16), a retrospective pilot study of intravesical BPC-157 for interstitial cystitis (n=12), and a prospective pilot study evaluating intravenous BPC-157 safety (n=2). All studies reported symptom improvement in most participants without treatment-related adverse events, but were judged to be of poor methodological quality. Overall certainty of evidence was rated very low due to serious risk of bias, indirectness and imprecision. Accordingly, BPC-157 should not be used clinically in humans outside ethically approved, regulated, high-quality clinical trials.

Background: MiR-551a has been implicated in various biological processes, but its role in fracture healing remains unclear. This study aimed to investigate the role of miR-551a in fracture healing.

Objective: This study is intended to examine the regulatory role of miR-551a in fracture healing through its interaction with SKI.

Methods: The osteogenic differentiation potential of human bone marrow-derived mesenchymal stem cells (hBMSCs) was assessed through quantification of alkaline phosphatase activity using a commercial alkaline phosphatase (ALP) assay kit and measurement of osteogenic marker gene expression levels, including Osteocalcin (OCN), Runt-related transcription factor 2 (RUNX2), and Collagen I via RT-qPCR and Western blot experiments. dual-luciferase reporter assay was utilized to examine the regulatory interaction between miR-551a and SKI.

Results: Serum levels of miR-551a were significantly elevated in treated fracture patients. Functional analysis revealed that miR-551a overexpression enhanced ALP activity and elevated expression of osteogenic markers, whereas miR-551a inhibition reduced ALP activity and downregulated these markers; SKI knockdown reversed the inhibitory effects of miR-551a suppression. Mechanistically, miR-551a directly targets and negatively regulates SKI.

Conclusions: In vitro evidence suggests that miR-551a may promote osteogenic differentiation of hBMSCs by directly targeting and downregulating SKI, which may be relevant to fracture repair.

Dongbin Qu, Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P. R. China. Email: nfyy_qu@126.com Canyang Huang, Division of Spine Surgery, Department of Orthopaedics, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian 362000, P. R. China. Email: huangcy0595@sina.com Purpose: This study biomechanically compared a novel semi-cannulated lateral mass screw with cement augmentation against conventional solid screws for stabilizing loosened cervical lateral masses under cyclic loading.

Methods: Eight fresh human cervical specimens underwent μCT scanning for BMD assessment. Each specimen received both screw types: on the augmentation side, semi-cannulated screws were initially loosened via pull-out testing then reinserted with cement; on the (contralateral) primary side, conventional solid screws were placed Awithout augmentation. After cyclic loading, vertical displacement, toggling angle, and rotation center distance (ORC) at the screw-bone interface were measured, followed by final pull-out force tests.

Results: The mean BMD of the lateral masses was 305.05 ± 48.33 mg/cm³. Following cyclic loading, the augmentation side exhibited a significantly higher pull-out force than its initial state (P < 0.01), though not statistically greater than the primary side. Under cyclic loading, the augmentation side demonstrated significantly superior stability: vertical displacement increased by only 6.25%, compared to a 70.69% increase on the primary side (P < 0.05). The toggling angle decreased by 2.36% on the augmentation side, versus a significant 79.92% increase on the primary side (P < 0.05). The ORC increased by 2.13% on the augmentation side, markedly lower than the 38.03% increase on the primary side.

Conclusion: The novel semi-cannulated lateral mass screw with cement augmentation demonstrated superior dynamic stability and significantly improved fixation strength after cyclic loading compared to conventional solid screws, offering a promising revision strategy for cervical spines with screw loosening or osteoporosis.

The isolated effect of preoperative patient education on hospital length of stay (LOS) is controversial. Various educational modalities exist, yet evidence of their comparative effectiveness remains limited. We compared the effect of different preoperative education methods on LOS, postoperative outcomes, and patient satisfaction in patients undergoing primary THA. In this prospective, randomized controlled trial, 79 patients scheduled for primary THA were allocated to one of three groups: 29 received only a booklet and information during the preoperative outpatient clinic, 24 received an additional live information session and 26 used an additional mobile application. The primary outcomes were LOS and patient satisfaction regarding the information method. Secondary outcomes included Oxford Hip Score, EQ-5D-3L and EQ-VAS. Mean LOS was 4.25 ± 3 days, with no significant difference between groups (p = 0.525). Overall, there were no significant differences in satisfaction with the education method (p = 0.997) and its informational content (p = 0.365) between the groups. Patients in the mobile application group reported slightly higher motivation for pre- and postoperative exercises, though this was not statistically significant. All groups showed significant improvements in PROMs postoperatively (p < 0.001), with no significant differences in the magnitude of change between groups. The method of preoperative education did not significantly influence LOS, patient satisfaction, or postoperative outcomes in THA patients. The additional cost of implementing preoperative live sessions and mobile applications to provide additional information must be weighed against the limited benefits.

Background and study aims: Pedicle screw placement accuracy is critical for safe spinal fixation, and robot- assisted techniques aim to improve precision. This study evaluated the accuracy of robot-assisted posterior pedicle screw placement in the lower thoracic and lumbar spine using a CBT trajectory as well as determine what factors are associated with accuracy of screw placement.

Materials and methods: A retrospective single-centre cohort study included 100 consecutive patients undergoing Aposterior spinal instrumentation with pedicle screws between August 2022 and August 2023. Preoperative CT- based planning and robotic guidance (ExcelsiusGPS) were used. Postoperative CT assessed 511 screws using the Gertzbein-Robbins classification, including breach direction. Clinically acceptable placement was defined as grades or B. Interobserver agreement was evaluated using Cohen's kappa and Gwet's AC1. Multivariable analyses were performed using generalized estimating equations and mixed-effects models.

Results: Clinically acceptable screw placement exceeded 96% at all spinal levels. Perfect placement ranged from 86.7% to 100%. No clinically relevant (Grade C-E) medial, superior, or inferior breaches were observed; lateral breaches occurred in 1.4%. Interobserver agreement was high (AC1 0.953-0.994). For perfect placement (Grade A), L5 showed higher odds compared to L4.

Conclusion: Robot-assisted pedicle screw placement using CBT demonstrates high accuracy and safety, with absence of clinically relevant medial breaches. These findings support the use of robotic guidance as an effective adjunct in spinal instrumentation.

Optimal timing of definitive fracture fixation in polytrauma patients remains controversial. This study aimed to compare clinical outcomes between Early Total Care (ETC) and Damage Control Orthopedics (DCO). A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, CENTRAL, Scopus, and Web of Science were searched through August 2025. Observational and interventional studies comparing ETC and DCO were included. Outcomes included mortality, sepsis, acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS), infections, delayed union, hospital stay, and number of surgical procedures. Methodological quality of observational studies was assessed using the Newcastle-Ottawa Scale, while risk of bias for randomized controlled trials was assessed using the Cochrane RoB 2 tool. The NIH Quality Assessment Tool was used for the included case series. Twenty studies (18,852 patients) were analyzed. ETC was associated with reduced hospital stay (WMD = -4.91 days, 95% CI: -6.89 to -2.93), surgical procedures (WMD = -3.39, 95% CI: -3.57 to -3.22), sepsis risk (OR = 0.63, 95% CI: 0.48 to 0.81), and delayed union (OR = 0.23, 95% CI: 0.06 to 0.93). No significant differences existed for mortality (OR = 0.59, 95% CI: 0.28 to 1.24), MODS (OR = 0.85, 95% CI: 0.55 to 1.30), ARDS (OR = 1.18, 95% CI: 0.64 to 2.17), or infections (OR = 1.38, 95% CI: 0.92 to 2.07). ETC was associated with a lower risk of sepsis, shorter hospital stay, and fewer surgical procedures in patients with polytrauma. Major complications and mortality, however, were similar between the two approaches. These findings highlight the importance of patient selection and individualized decision-making based on physiological status.