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This paper continues our previous work on a nanostructural evolution model for Fe-C alloys under irradiation, using Object Kinetic Monte Carlo modeling techniques. We here present a number of sensitivity studies of parameters of the model, such as the carbon content in the material, represented by generic traps for point defects, the importance of traps, the size dependence of traps and the effect of the dose rate. [ABSTRACT FROM AUTHOR]

Highlights: [•] We can model the accumulation of radiation damage in Fe–C. [•] The effect of carbon is to form C–vacancy complexes that in turn trap SIA clusters. [•] The model was successfully used to simulate irradiation at <370K and post-irradiation annealing. [Copyright &y& Elsevier]

Highlights: [•] We developed a model that describes well the defects produced in Fe–C under irradiation. [•] The effect of carbon is effectively described in terms of traps for radiation defects. [•] The model is based on physical considerations and uses only a couple of calibration parameters. [•] Two types of interstitial clusters are simulated using an effective migration energy. [ABSTRACT FROM AUTHOR]

Highlights: [•] The sink strength for dislocations and loops are calculated using OKMC. [•] The master curves for the 1D to 3D defect migration transition are well reproduced. [•] We find that OKMC and theory are in good agreement for low volume fractions. [ABSTRACT FROM AUTHOR]

Helium (He) is present in fusion reactor wall materials, and its effect on radiation damage must be taken into account. The effect of He on displacement cascades in tungsten (W) has been studied using molecular dynamics simulations. Three different W-W potentials were compared and found to differ, especially for the clustering of the vacancies formed in the cascades. While there are differences in the amounts of damage depending on the potential, the overall effect of He in interstitial positions was to increase the amount of damage, while He in substitutional positions reduces it, due to the effect He has on the recombination of tungsten interstititals. [ABSTRACT FROM AUTHOR]

Introduction. Increasing interest developed in the use of carbon-fiber-reinforced-poly-ether-ether-ketones (CFR-PEEK) as an alternative bearing material in knee arthroplasty. The effects of CFR-PEEK wear in in vitro and animal studies are controversially discussed, as there are no data available concerning human tissue. The aim of this study was to analyze human tissue containing CFR-PEEK as well as UHMWPE wear debris. The authors hypothesized no difference between the used biomaterials. Methods and Materials. In 10 patients during knee revision surgery of a rotating-hinge-knee-implant-design, synovial tissue samples were achieved (tibial inserts: UHMWPE; bushings and flanges: CFR-PEEK). One additional patient received revision surgery without any PEEK components as a control. The tissue was paraffin-embedded, sliced into 2 μm thick sections, and stained with hematoxylin and eosin in a standard process. A modified panoptical staining was also done. Results. A “wear-type” reaction was seen in the testing and the control group. In all samples, the UHMWPE particles were scattered in the tissue or incorporated in giant cells. CFR-PEEK particles were seen as conglomerates and only could be found next to vessels. CFR-PEEK particles showed no giant-cell reactions. In conclusion, the hypothesis has to be rejected. UHMWPE and PEEK showed a different scatter-behavior in human synovial tissue. [ABSTRACT FROM AUTHOR]

Background Unicompartmental knee arthoplasty is a well-established treatment modality for anteromedial osteoarthritis and can be implanted minimally-invasive. However, the operation is technically demanding, which might lead to an increased failure rate. This study was conducted to determine the influence of a minimally-invasive approach on biomechanical fixation strength and morphological cement penetration. Methods Tibial unicompartmental knee arthroplasties were implanted in 8 cadaver knees. On the medial side, implantation was performed minimally-invasive (group A). The lateral side was operated in an open way (group B). Biomechanical stability was testes using dynamic compression-shear load to failure. Cement penetration was analyzed on serial cuts through the implant–cement–bone interface in the frontal plane. Findings Mean load to failure was 2438 N (SD 968 N) in group A and 2231 N (SD 1044 N) in group B ( P = 1.0). The area proportion of the cement–bone interface without cement penetration was 24.2% (SD 18.8%) in group A and 7.7% (SD 5.9%) in group B ( P < 0.05). In group A, cement mantle increased in thickness from 0.21 mm (SD 0.18 mm) in the anterior section of the tibial head to 1.35 mm (SD 0.33 mm) in its posterior section ( P < 0.0001). Interpretation The study demonstrates no inferiority of minimally-invasive surgery with respect to fixation strength. However, the higher area proportion of the cement–bone interface without penetration and the increasing thickness of cement mantle from anterior to posterior indicate further room for improvement of the minimally-invasive approach in unicompartmental knee arthroplasty. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty (TKA) is a successful procedure for osteoarthritis. However, some patients (19%) do have pain after surgery. A finite element model was developed based on boundary conditions of a knee rig. A 3D-model of an anatomical full leg was generated from magnetic resonance image data and a total knee prosthesis was implanted without patella resurfacing. In the finite element model, a restarting procedure was programmed in order to hold the ground reaction force constant with an adapted quadriceps muscle force during a squat from 20° to 105° of flexion. Knee rig experimental data were used to validate the numerical model in the patellofemoral and femorotibial joint. Furthermore, sensitivity analyses of Young’s modulus of the patella cartilage, posterior cruciate ligament (PCL) stiffness, and patella tendon origin were performed. Pearson’s correlations for retropatellar contact area, pressure, patella flexion, and femorotibial ap-movement were near to 1. Lowest root mean square error for retropatellar pressure, patella flexion, and femorotibial ap-movement were found for the baseline model setup with Young’s modulus of 5 MPa for patella cartilage, a downscaled PCL stiffness of 25% compared to the literature given value and an anatomical origin of the patella tendon. The results of the conducted finite element model are comparable with the experimental results. Therefore, the finite element model developed in this study can be used for further clinical investigations and will help to better understand the clinical aspects after TKA with an unresurfaced patella. [ABSTRACT FROM PUBLISHER]

Objectives: Cationic lipid complexes bind to angiogenic endothelial cells of solid tumours and microvessels of chronic inflammatory tissue. Methotrexate (MTX) is one of the drugs used in the therapy of rheumatoid arthritis (RA); it is applied systemically but can have serious side-effects. The aim of this study was to investigate the impact of MTX encapsulated in cationic liposomes (EndoMTX) in comparison to treatment with free MTX.Method: We used an antigen-induced arthritis (AiA) model and investigated the leucocyte- and platelet-endothelial cell interaction in arthritic female C57/Bl6 mice and in healthy controls. The arthritic animals were divided into four different groups receiving either trehalose, free MTX, EndoMTX placebo, or EndoMTX. These parameters and functional capillary density (FCD) were measured and assessed by intravital microscopy (IVM). We controlled clinical parameters such as the knee joint diameter (KJD) throughout the observation period.Results: Animals treated with EndoMTX showed a significant and superior reduction in leucocyte- and platelet-endothelial cell interaction, FCD, and KJD. Free MTX or empty liposomes also showed a reduction in these parameters but not to a significant level. FCD decreased in the EndoMTX group in comparison to using free drugs or empty carrier-like liposomes.Conclusions: This study demonstrates the advantage of using MTX encapsulated in cationic liposomes in contrast to free and generic MTX, with a higher efficacy in anti-inflammatory and anti-angiogenic abilities. Targeting with cationic liposomes may be a promising treatment option and should be elucidated in further experiments regarding dose reduction and side-effects due to MTX usage. [ABSTRACT FROM AUTHOR]

Objectives: The use of statins in the prevention and treatment of cardiovascular diseases is well established. Their use as anti-inflammatory and immunomodulatory agents in the treatment of rheumatoid arthritis (RA) has also been investigated, with several clinical and experimental studies indicating an anti-inflammatory effect of statins for RA, but other studies showing no effect or even the opposite. The current study was designed to examine the effect of simvastatin in an in vivo murine model of arthritis using intravital microscopy. Method: We assigned four groups (n = 7, female C57Bl6 mice), two with and two without antigen-induced arthritis (AiA), from which one of the non-AiA groups and one of the AiA groups were treated with simvastatin 40 mg/kg i.p. daily for 14 consecutive days after induction of arthritis. Platelet- and leucocyte-endothelial cell interaction was assessed by measurement of rolling and adherent fluorescence-labelled platelets and leucocytes, functional capillary density (FCD) was evaluated, and knee joint diameter was determined as a clinical parameter. Results: In arthritic mice treated with simvastatin, a significant reduction in platelet- and leucocyte-endothelial cell interaction was observed in comparison to arthritic mice treated with vehicle. In addition, a significant reduction in FCD was seen in arthritic mice treated with simvastatin, along with a reduction in knee joint swelling of the AiA mice. Conclusions: Treatment of AiA mice with simvastatin showed significant reductions in platelet- and leucocyte-endothelial cell interactions, in FCD, and in the swelling of the knee joint. These results support the hypothesis of the anti-inflammatory effects of statins in the treatment of RA. [ABSTRACT FROM AUTHOR]

Purpose: In the last 15 years, vertebroplasty and kyphoplasty have become established operative procedures for treating osteoporotic vertebral-body fractures and vertebral bodies afflicted with metastases. These procedures are quickly performed with few personnel and material resources and have a low rate of complications. However, cases of neurological impairment are reported in the scientific literature. We analysed whether potentially harmful heat is radiated/conducted by the polymerisation temperature of polymethylmethacrylate (PMMA) bone cement in the spinal canal.Methods: We performed vertebroplasty on 25 vertebral bodies and measured the temperature distribution during polymerisation of bone cement within the spinal canal using heat probes placed in the respective areas. The vertebral bodies were located in a circulating water bath at 37°C.Results: During polymerisation of the bone cement, a temperature rise was measured. The peak temperature was reached after few minutes. Temperature curves differed; a maximum temperature of up to 43.16°C was detected for a few seconds only.Conclusion: When vertebroplasty is performed correctly, there is no temperature development that could eventually damage the spinal cord or spinal nerves. [ABSTRACT FROM AUTHOR]

Purpose: The posterior tibial slope has a huge influence on the kinematics of the knee. In several orthopedic interventions such as high tibial osteotomy and unicondylar or bicondylar knee replacement changing, the tibial slope can result in altered knee mechanics. Therefore, an exact preoperative measurement of the posterior tibial slope is mandatory. Several methods are used on conventional radiographs and CT scans, but until now there is no standard validated method. The aim of this study was to compare several methods and imaging techniques to measure the posterior tibial slope and to establish a standard and reliable measurement method by radiography. Methods: Fourteen knees (seven cadavers) were scanned by a 64-slice CT, a 3T-MRI, and true lateral radiographs were performed. The anatomical references (TPAA = tibial proximal anatomical axis; ATC = anterior tibial cortex; PTC = posterior tibial cortex) and the new computed reference (MPA = mean of PTA and ATC) were compared by short as well as long radiographs, CT scan and MRI. The influence of a malrotation in radiographs of the knees was also analyzed. Results: CT scan and MRI are suitable for the measurement of the medial and lateral posterior tibial slopes, the results of the radiographs varied depending on the method used. The new method (MPA) showed the best correlation to the CT scan ( r = 0.997), even on short radiographs (10 cm distal the joint line). Conclusion: The measurement of the posterior tibial slope on a short lateral radiograph using the MPA is a reliable method and should be established as a standard. Level of evidence: Diagnostic study, Level II. [ABSTRACT FROM AUTHOR]

Patients with multiple myeloma are often treated surgically as though they have bone metastases. Due to major differences in oncological therapy and comparatively long survival times these patients should be considered separately. Seventy-five multiple myeloma patients were treated surgically (83 interventions) for skeletal complications of the disease. Location and dissemination, symptoms, method of surgery, complications, recurrence and survival time were evaluated retrospectively. Most of the lesions were in the axial skeleton or the proximal extremities apart from one distal lesion of the fibula, and most surgery was performed in the spine (35 patients). The mean follow-up of patients was 5.4 years (range 1-25 years). Survival proved to be very favourable (37% at five years). Patients with a single bone lesion, a negative bone marrow biopsy, no paraproteinaemia in serum or a Salmon-Durie-stage I had a better survival probability. Surgical treatment in patients with multiple myeloma was mostly limited to a palliative approach but survival time was better (37% at five years) than in patients with metastatic bone disease which has to be considered in their surgical treatment. [ABSTRACT FROM AUTHOR]

Background: Crosslinked polyethylene (XPE) was developed to reduce the wear rate in hip as well as knee arthroplasty. The crosslinking process reduces the mechanical properties of ultra-high-molecular-weight polyethylene (UHMWPE), particularly its fatigue strength. UHMWPE fatigue occurs more frequently in the knee than in the hip joint due to its changing tribocontact areas (TCAs) combined with high weight bearing. This is why XPE is still controversially discussed for use in total knee arthroplasty. Therefore, the potential advantage of using XPE in the knee was analysed in a simulator study with a focus on potential fatigue wear mechanisms. Methods: Three different kinds of XPE and one conventional UHMWPE were tested over 5 million cycles in fixed-bearing knee designs. The TCAs were examined by replicas, and their extent was measured. The wear mechanism was analysed by scanning electron microscopy. Results: The extent of the TCAs was less than 5% for all XPEs, whereas 35% for the conventional UHMWPE. Fatigue wear mechanisms were not observed. Conclusion: The measured small extent of the TCAs as a predictor of a low wear rate without any fatigue wear mechanism shows a possible advantage for the use of XPE even in knee arthroplasty. [ABSTRACT FROM AUTHOR]

Abstract: There is a persisting need for effective therapies of femoral head necrosis, a common bone disease. Promising clinical results have been stated for the treatment with extracorporeal shock waves (ESW). However, the effective remaining pressure in the target region inside the femoral head has never been determined. Aim of this study was to investigate whether ESW are able to propagate through bone without an excessive loss of pressure. The remaining ESW pressure generated by an electromagnetic device after passing a certain intraosseous distance within the femoral head was measured. Standardized holes were drilled in porcine femora and the absorption in relation to reference measurements in degassed water was determined. The results showed continuous attenuation of shock waves in bone. After a clinical relevant intraosseous distance of 10mm an ESW pressure of ∼50% remained. In conclusion, ESW have the potential to reach necrotic regions with therapeutic pressure levels and to effectively treat femoral head necrosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Compared to conventional ultra-high molecular weight polyethylene (UHMWPE), crosslinked polyethylene showed significantly reduced wear rate in hip simulation and early prospective-randomized clinical studies. The crosslinking process can reduce the mechanical properties of UHMWPE, particularly the fatigue strength. UHMWPE fatigue occurs more frequently in the knee joint than in the hip joint due to its higher contact stresses and there is therefore an increased concern of mechanical failure. Therefore, the purpose of this study was to determine the wear behaviour and the wear rates of different current knee designs and bearing materials. METHODS: In a knee-joint-simulator four kinds of crosslinked polyethylene (one produced by sequential irradiation and annealing process, three by different remelting processes, including fixed- and mobile-bearing-types) and two UHMWPE- (fixed- and mobile-bearing) inserts were tested with the appropriate femoral and tibial component recommended from the manufacturer. FINDINGS: All types of crosslinked polyethylene produced statistically significant (P<0.05) lower wear rates than the conventional UHMWPEs without any traces of fatigue. There were no differences in the wear rates between fixed-and mobile-bearings (crosslinked polyethylenes and UHMWPEs; P>0.05). The crosslinked polyethylene tibial inserts manufactured by sequential irradiation and annealing (X3) combined with the Scorpio((R))-knee-design had the lowest wear rates (P<0.05) overall. INTERPRETATION: Fixed- as well as mobile-bearing crosslinked polyethylene tibial inserts are suitable for total knee arthroplasty and showed reduced wear rates compared with conventional UHMWPE. The combination of the fixed-bearing Scorpio((R))-knee-design with a sequential irradiated and annealed crosslinked polyethylene tibial insert (X3) seems to have an advantage in wear generation compared with other fixed- and mobile-bearing knee designs. [ABSTRACT FROM AUTHOR]

While no gold standard exists for the management of Achilles tendon ruptures, surgical repair is common in healthy and active patients. Minimally invasive repair methods have become increasingly popular, while biomechanical equivalency hasn't been proven yet. A mid-substance Achilles tendon rupture was created 6 cm proximal to the calcaneal insertion in 27 fresh-frozen cadaveric ankles. Specimens were randomly allocated to 1 of 3 repair techniques: Huttunen et al. (2014) (1) PARS Achilles Jig System, Nyyssönen et al. (2008) (2) Achilles Midsubstance SpeedBridge™, Schipper and Cohen (2017) (3) Dresdner Instrument and subsequently subjected to cyclic loading with 250 cycles each at 1 Hz with 4 different loading ranges (20–100 N, 20–200 N, 20–300 N, and 20–400 N). After 250 cycles no significant differences in elongation were observed between PARS and Dresdner Instrument(p = 1.0). Furthermore, SpeedBridge™ repairs elongated less than either Dresdner Instrument (p = 0.0006) or PARS (p = 0.102). Main elongation (85%) occurred within the first 10 cycles with a comparable elongation in between 10 and 100 and 100–250 cycles. While all repairs withstood the first 250 cycles of cyclic loading from 20 to 100 N, only the PARS (468 ± 175) and Midsubstance SpeedBridge™ (538 ± 208) survived more cycles. Within all 3 groups suture cut out was seen to be the most common failure mechanism. Within all groups early repair elongation was seen. While this was least obvious within the SpeedBridge™ technique, ultimate strengths of repairs (cycles to failure) were comparable across PARS and SpeedBridge™ with a decline in the Dresdner Instrument group. • All repairs survived the first 250 cycles, while none survived all 4 loading stages. • Dresdner Instrument repair completed significantly less cycles prior to failure. • Suture cutout at the suture-tendon interface was the primary failure mechanism. • The model presents a simplified representation of the biomechanical characteristics. [ABSTRACT FROM AUTHOR]

The minimally invasive implantation of unicompartmental knee arthroplasty (UKA) leads to excellent functional results, but due to the reduced intraoperative visibility the removal of excessive cement may be difficult. In a retrospective study we assessed radiologically the incidence of loose and excess bone cement in 120 UKAs and correlated it to the thickness of the tibial cement layer. In 25 cases loose or attached excess cement was seen. Two of these patients with loose cement bodies required revision surgery. An additional 2 patients not operated at our institution required revision because of pain and loss of motion. The average thickness of the tibial cement layer was 3.1 (1.7–5.0) mm in all the patients. But it was significantly higher in the group with excess cement bodies [3.3 (2.3–5.0) mm] compared to the group without excess cement [3.0 (1.7–4.1) mm] ( P < 0.05). Symptomatic free cement bodies need to be removed immediately, if necessary arthroscopically, in order to avoid damage to the implants. To avoid this problem in minimally invasive UKA, intraoperative fluoroscopy, a dental mirror or a nerve hook seem to be useful tools to identify and remove loose or excess cement. [ABSTRACT FROM AUTHOR]

A new femoral stem was developed with a design that leads to compression of cancellous bone in the calcar region which results in proximal loading. The cross-sectional design of the implant provides rotational stability. In the first clinical investigation ten patients underwent uncemented total hip arthroplasty between January 1999 and May 1999 using the CR-stem® (Implantcast GmbH, Buxtehude, Germany). Results were investigated using the Harris-hip-score (HHS) and antero-posterior and lateral radiographs. Migration was evaluated with the EBRA-FCA-method with a follow-up of 7 years. We demonstrated a mean subsidence rate of 2.23 ± 1.13 mm 7 years after implantation thus providing basic data for extensive testing in a clinical environment. As small subsidence rates are regarded as predictor for superior long-term results in uncemented total hip arthroplasty according to the literature, the CR-stem shows promise for excellent long-term results. [ABSTRACT FROM AUTHOR]

Facet joint pain is an important aspect of degenerative lumbar spine disease, and radiofrequency medial branch neurotomy remains an established therapy, while cryodenervation has still been poorly examined. This study was undertaken to examine the effects of medial branch cryodenervation in the treatment of lumbar facet joint pain. This was a prospective clinical case series. Patient selection was based on the history, physical examination and positive medial branch blocks. Percutaneous medial branch cryodenervation was performed using a Lloyd Neurostat 2000. Target parameters were low back pain (VAS), limitation of activity (McNab) and overall satisfaction. Fifty patients were recruited, and 46 completed the study. The follow-up time was 1 year. At 6 weeks, 33 patients (72%) were pain free or had major improvement of low back pain; 13 (28%) had no or little improvement. Including failures, mean low back pain decreased significantly from 7.7 preoperatively to 3.2 at 6 weeks, 3.3 at 3 months, 3.0 at 6 months and 4.2 at 12 months ( P<0.0001). Limitation of the activities of daily living improved parallel to reduced pain. Our results suggest that medial branch cryodenervation is a safe and effective treatment for lumbar facet joint pain. [ABSTRACT FROM AUTHOR]

There is growing evidence that platelets play an important role in the development and maintenance of rheumatoid arthritis. Activation and adherence of platelets in the synovial microcirculation might be in part responsible for endothelial damage and activation of leukocytes. Recent findings show a direct influence of P-selectin on platelet- and leukocyte-endothelial cell interaction in mice with Antigen-induced Arthritis (AiA). P-selectin is only expressed by platelets and endothelial cells, not by leukocytes. Therefore, the aim of the present study was to investigate the differential influence of platelet and endothelial P-selectin on the extent of inflammation in AiA. AiA was induced in wild-type mice and in P-selectin-deficient mice from the same genetic background (four groups: each n = 7). Intravital fluorescence microscopy (IVM) was used to visualize platelets and leukocytes in the synovial microcirculation at day 8 after AiA. Platelets from either strain were fluorescence-labelled ex vivo and transferred into either strain. We were able to demonstrate a significant decrease of platelet- and leukocyte-endothelial cell interaction in P-selectin-deficient mice with AiA in comparison to wild-type mice with AiA. When wild-type platelets were donated into P-selectin-deficient AiA recipients, the leukocyte-endothelial cell interaction was significantly increased compared to the group consisting of P-selectin-deficient recipient and donor mice. These are the first in vivo results showing that the P-selectin stored in platelets is at least partly responsible for the leukocyte-endothelial cell interaction and the resulting tissue damage in AiA. In the future, a suppression of platelet P-selectin could potentially become a treatment option for reducing the effects of rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Objective: Platelets are thought to participate in the pathogenesis of chronic inflammatory diseases such as rheumatoid arthritis (RA). We showed recently an in vivo increase in platelet-endothelial cell interactions in mice with antigen-induced arthritis (AiA). The underlying mechanisms are not yet clear. The aim of this study was to investigate the impact of P-selectin in AiA by means of intravital fluorescence microscopy (IVM). Methods: C57/Bl6 mice and P-selectin-deficient mice were divided into four groups (n = 7; control/AiA per strain). The extent of AiA was assessed by measuring knee joint swelling and by histological scoring. Rolling and adherent fluorescence-labelled platelets and leucocytes were investigated by IVM. Results: In arthritic P-selectin-deficient mice (rolling: 0.05±0.01; adherent: 130±20 mm-2), compared to arthritic C57/Bl6 mice (rolling: 0.20±0.04; adherent: 1910±200 mm-2), platelet interaction was significantly reduced (p<0.05) and reached the level of both control groups without AiA. In addition, interaction of leucocytes in P-selectin-deficient arthritic animals (rolling: 0.12±0.06; adherent: 387±37 mm-2) was significantly decreased in comparison to arthritic C57/Bl6 animals (rolling: 0.21±0.06; adherent: 1492±284 mm-2; p<0.05). Swelling of the knee joint and histological scoring were reduced in arthritic P-selectin-deficient mice compared to arthritic C57/Bl6 mice. Conclusion: We have demonstrated for the first time in vivo a significant decrease in the interaction of platelets and leucocytes with the endothelium in P-selectin-deficient mice with AiA and a reduction in clinical and histological symptoms of arthritis. These findings suggest that leucocyte-endothelial cell interactions depend at least partially on platelet P-selectin and therefore platelets may be responsible for the leucocyte tissue damage in AiA. [ABSTRACT FROM AUTHOR]

We studied 10 patients by means of pre- and postoperative CT who underwent computer-assisted total hip replacement using the CASPAR-system (OrthoMaquet GmbH, Rastatt, Germany). The anteversion angles of the stem and translational deviations measured after surgery were compared to the preoperatively planned ones as a quality control. We found an average difference of 7.80 (SD 6.3; 95% CI 3.3°-12.3°) in the angles and an average difference of 1.8 (SD 1.7; 95% CI 0.6-3.0) mm and 1.2 (SD 1.4: 95% CI 0.25-2.2), respectively, in the medial and lateral deviation. In conclusion, we could not confirm the same accuracy of implant position as that claimed by the manufacturer. [ABSTRACT FROM AUTHOR]

Background. The problem of metal sensitivity (Ni, Cr, and Co) in arthroplasty is still unsolved. To prevent the risk of allergy in cases with proved metal allergy in an epicutaneous test, a Natural Knee total knee arthroplasty, made totally from titanium (Ti-6Al-4V) and polyethylene, can be implanted. The results of this device have to be compared to the results of normal knee arthroplasty designed with a femoral component out of CrCoNi alloy. The mechanical resistance of this alloy is much higher than that of titanium, and therefore it is the standard for the femoral components of most knee-resurfacing devices. Methods. Thirty-five patients with a titanium Natural Knee were examined retrospectively after a mean follow-up of 2 years and 5 months (range 6 months to 5 years and 4 months). In comparison, 36 patients with a Genesis-I knee with a CrCoNi alloy femoral component were studied after a mean follow-up of 2 years and 4 months (range 8 months to 6 years and 2 months). Results. In spite of the lower mechanical resistance of titanium, the Natural Knee showed better results (knee score 84.1 points, function score 77.7 points, HSS score 80.1 points, 82.9% excellent and good results) than the Genesis-I knee (knee score 80.6 points, function score 76.4 points, HSS score 76.4 points, 68.5% excellent and good results), although these differences had no statistical significance. Conclusions. The titanium Natural Knee prosthesis has proven to be a reliable knee joint replacement in the medium term. [ABSTRACT FROM AUTHOR]

Introduction. The two available computer-assisted surgery robotic systems consist of a preoperative planning computer workstation and an industrial robot with a high speed milling device. During the computed tomography (CT) scan of the hip and the ipsilateral knee for planning the hip arthroplasty, the patient's movements are registered by a bar that is fixed at the patient's leg along its axis. Despite the companies' claim that a high accuracy of implant position can be achieved by this method, misplacements of implants are reported in the literature. Materials and methods. In an experimental study, a cadaver femoral bone was rotated during the CT scan strictly around this bar to simulate a rotational movement of the patient. Using the CT data, the planning of the hip stem and the following preparation of the femur by the robot was possible without detection of the patient's movements by the system. According to the system manual, the computer should stop the planning or give a warning in case of patient movement during the CT scan. Results. The postoperative CT scan of the cadaver femoral bone revealed a rotary deviation and a shift of the stem compared with the original planning, caused by the rotation during the CT scan. Conclusion. We propose using a second bar during the CT scan to detect these movements and thus avoiding misplacement of the implant. [ABSTRACT FROM AUTHOR]

Introduction/Background Ropivacaine, bupivacaine and triamcinolone are used daily in injections during surgeries and pain therapy. The purpose was to analyze the ability of local anesthetics and cortisone to induce apoptosis and necrosis in fibroblasts, tenocytes and human mesenchymal stem cells (hMSC). Material and method Fibroblasts, tenocytes and adipose-derived hMSC were seeded in T25 flasks at a cell density of 0.5 × 10 4 /cm 2 . Ropivacaine, bupivacaine and triamcinolone were added individually to the cells using concentrations of 0.5%, 0.25% and 0.125%. No addition of specimen was used as negative control. After 30 minutes incubation and medium change the cells were harvested at 1 hour, 24 hours and 7 days of incubation. Analysis via fluorescence-activated cell sorting (FACS) using double-staining with Annexin V and PI was performed. Annexin V stains apoptotic cells while PI enables necrotic cells to be differentiated. Therefore the FACS method allows a quantitative as well as a qualitative analysis of each cell population. SPSS was used for statistical analysis to determine significant difference ( P > 0.05) between specimen and control groups. Results Bupivacaine shows necrosis-inducing effects on fibroblasts and tenocytes, the necrotic effect peaking at 0.5%. Ropivacaine and triamcinolone cause no significant necrosis. In comparison to fibroblasts and tenocytes, hMSC did not show significant necrotic or apoptotic effects after exposure to bupivacaine. Overall, no significant difference in apoptosis was detected between different cell lines, varying concentrations of the specimen or time of measurements. Conclusion Bupivacaine 0.5% has the highest necrosis-inducing effect on fibroblasts and tenocytes in comparison to ropivacaine, which causes less necrotic tissue. hMSC exhibited less necrosis compared to fibroblast and tenocytes. This may advise to prefer ropivacaine over bupivacaine for clinical practice. [ABSTRACT FROM AUTHOR]