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Background: Prosthetic joint infection (PJI) is one of the most frequent and devastating causes of short-term revision total knee arthroplasty (TKA). In vitro evidence suggests ceramic surfaces demonstrate resistance to biofilm, but the clinical effect of bearing surface modifications on the risk of PJI remains unclear. This premier registry-based study examines the influence of ceramic bearing surface coatings on the outcome in cemented primary TKA.Methods: In total, 117,660 cemented primary TKAs in patients with primary osteoarthritis recorded in the German arthroplasty registry since 2012 were followed up for a maximum of 3 years. The primary endpoint was risk of revision for PJI on ceramic coated and uncoated cobalt-chromium-molybdenum femoral components. Propensity score matching for age, gender, obesity, diabetes mellitus, depression and Elixhauser comorbidity index, and substratification on common design twins with and without coating was performed.Results: In total, 4637 TKAs (85.1% female) with a ceramic-coated femoral component were identified, 42 had been revised for PJI and 122 for other reasons at 3 years. No survival advantage due to the risk of revision for PJI could be determined for ceramic-coated components. Revision for all other reasons demonstrated a significant higher rate for TKAs with ceramic-coated components. However, the results of this were confounded by a strong prevalence (20.7% vs 0.3%) of metal sensitivity in the ceramic-coated group.Conclusion: No evidence of reduced risk for PJI due to ceramic-coated implants in cemented primary TKA was found. Further analysis for revision reasons other than PJI is required. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the influence of autologous bursal tissue derived from the Achilles bursa on tendon-to-bone healing after rotator cuff tear repair in a rat model. A total of 136 Sprague-Dawley rats were randomly assigned to either an untreated or a bursal tissue application group or biomechanical testing and histologic testing after rotator cuff repair. After separating the supraspinatus tendon close to the greater tuberosity, the tendon was reattached either unaltered or with a bursal tissue interposition sewn onto the interface. Immunohistologic analysis was performed 1 and 7 weeks after supraspinatus tendon reinsertion. Biomechanical testing of the tendon occurred 6 and 7 weeks after reinsertion. Immunohistologic results demonstrated a significantly higher percentage of Type II collagen (P =.04) after 1 and 7 weeks in the tendon-to-bone interface using autologous bursal tissue in comparison to control specimens. The bursa group showed a significantly higher collagen I to III quotient (P =.03) at 1 week after surgery in comparison to the 7-week postsurgery bursa groups and controls. Biomechanical assessment showed that overall tendon stiffness (P =.002) and the tendon viscoelasticity in the bursa group (P =.003) was significantly improved after 6 and 7 weeks. There was no significant difference (P =.55) in force to failure between the bursa group and the control group after 6 and 7 weeks. Autologous bursal tissue derived from the Achilles bursa and implanted to the tendon-to-bone interface after rotator cuff repair facilitates a faster healing response to re-establish the biologic and biomechanical integrity of the rotator cuff in rats. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the ability of ropivacaine, bupivacaine, and triamcinolone to induce apoptosis and necrosis in fibroblasts, tenocytes, and human mesenchymal stem cells.Methods: Human dermal fibroblasts, adipose-derived human mesenchymal stem cells (hMSCs), and tenocytes gained from the rotator cuff tendon were seeded with a cell density of 0.5 × 104/cm2. One specimen of ropivacaine, bupivacaine, and triamcinolone was tested separately on the cells with separate concentrations of 0.5%, 0.25%, and 0.125% for each specimen. The negative control received no agent, only a change of medium. The incubation period for each agent was 30 minutes. After a change of medium and 1 hour, 24 hours, and 7 days of incubation, 104 cells were harvested and analyzed via fluorescence-activated cell sorting with double-staining with annexin V and propidium iodide. Statistical analysis to determine significant difference (P < .05) between the groups with SPSS statistics 23 through one-way analysis of variance with a univariate general linear model was performed.Results: Bupivacaine showed necrosis-inducing effects on fibroblasts and tenocytes, with the necrotic effect peaking at 0.5% and 0.25%. Ropivacaine and triamcinolone caused no significant necrosis. Compared with fibroblasts and tenocytes, hMSCs did not show significant necrotic or apoptotic effects after exposure to bupivacaine. Overall, no significant differences in apoptosis were detected between different cell lines, varying concentrations, or time measurements.Conclusions: Bupivacaine 0.5% and 0.25% have the most necrosis-inducing effects on fibroblasts and tenocytes. Ropivacaine caused less necrosis than bupivaine. Compared with fibroblasts and tenocytes, hMSCs were not affected by necrosis using any of the tested agents. A significant apoptosis-inducing effect could not be detected for the different cell lines.Clinical Relevance: Possible cell toxicity raises questions of concern for intra-articular injections using local anesthetics and corticosteroids. The present study demonstrates the necrotic and apoptotic effects of ropivacaine, bupivacaine, and triamcinolone and may give recommendations for intra-articular use of local anesthetics and corticosteroids. [ABSTRACT FROM AUTHOR]

The bone-preservation by UKA in medial osteoarthritis constitutes only an advantage if in the case of revision an unconstrained TKA can be implanted. The aim of this study was to evaluate a revision technique using an autologous bone slice from the lateral to the medial proximal tibia. We report on 17 patients with a mean follow up of 3.1 years. Patient's satisfaction and pain, WOMAC- and Oxford-Knee-Score, radiological and clinical knee symptoms/function were assessed. No loosening, wear or implant subsidence could be detected during the follow up. In comparison with results after primary TKA in the literature we found our clinical results to be within the range. The study demonstrates that thismethod is safe and produces good midterm results. [ABSTRACT FROM AUTHOR]

Purpose: The purpose was to evaluate whether the knot security of sliding and nonsliding knots with different sutures is influenced by dry or wet conditions. Methods: We tested 5 suture materials, all of them US Pharmacopeia No. 2: PDS (polydioxanone) II (Ethicon, Somerville, NJ), Ethibond (Ethicon), and 3 ultrahigh–molecular weight polyethylene (UHMWPE) sutures—FiberWire (Arthrex, Naples, FL), Orthocord (DePuy Mitek, Raynham, MA), and Herculine (Linvatec, Largo, FL). Testing was performed under dry and wet conditions with sutures soaked in a saline solution. Cyclic loading was performed to simulate physiologic conditions. We started with a tensile load of 25 N. After 100 cycles, the load was increased to 50 N for another 100 cycles. The tensile load was gradually increased by 25 N per 100 cycles until suture rupture or knot slippage, defined as lengthening over 3 mm. Results: Under dry conditions, 170 suture ruptures and 30 knot slippages were reported; and under wet testing conditions, 186 suture ruptures and 14 knot slippages were reported, with P < .044 and P < .027, respectively. Failure by knot slippage (n = 44) was seen under dry and saline solution conditions mainly with UHMWPE sutures, in particular with the Herculine suture using a Roeder knot showing comparable maximum failure loads in dry (274.5 ± 58.2 N) and saline solution (312.5 ± 14.2 N) conditions (P > .056). Knot slippage occurred only with sliding knots. With the Ethibond suture, no knot slippage was found regardless of the testing conditions and knot type. Across all knot types, the UHMWPE sutures were significantly stronger with respect to clinical and maximum failure loads in ultimate load to failure than Ethibond and PDS II under dry and wet testing conditions (P < .001 for both). Conclusions: We conclude that testing of different suture materials and knot types is different in wet versus dry conditions and believe that biomechanical testing might be more realistic in a wet environment. Clinical Relevance: Suture knots behave differently in a wet versus dry environment, and testing of knot mechanics might better be carried out in wet environments. [Copyright &y& Elsevier]

Background and Objectives: Epidural injections are popular therapies for sciatica and low back pain. Local anesthetics and corticosteroids are commonly used for most injections techniques, but some treatments use a specific combination of several agents. The epidural lysis of adhesions procedure (Racz) uses a combination of bupivacaine, hyaluronidase, a corticosteroid, and hypertonic saline. Because severe complications, some with permanent neurologic deficits, have been observed, we considered the possibility that individual agents or a combination thereof might be capable of damaging or destroying cells in primarily the epidural tissues. Methods: We used monolayer cell cultures of human fibroblasts in Dulbecco modified Eagle medium to study these pharmacological agents alone or in combination. Cell viability and proliferation were assessed by Trypan blue staining, cell counts, and the WST-1 assay. Time and concentration series were performed. Results: With the corticosteroid, we observed the previously described proliferation-retarding effects. Hyaluronidase was not found to have a relevant effect on fibroblast proliferation. Bupivacaine and hypertonic saline were found to have a time- and concentration-dependent effect on cell viability and proliferation. Both were found to be toxic at concentrations well below the ones used clinically. Conclusions: We identified a potential for harm caused by commonly used pharmacological agents when applied epidurally. Animal studies will have to show whether the same can be observed in living tissues. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to correlate anatomic and nonanatomic tibial and femoral tunnel positions after anterior cruciate ligament (ACL) reconstruction with clinical outcome by use of bone–patellar tendon–bone (BPTB) single-bundle (SB) and semitendinosus-gracilis (STG) double-bundle (DB) techniques. Methods: The 3-dimensional computed tomography scans of 53 patients'' knees (27 BPTB-SB and 26 STG-DB) were prepared and measured by 2 examiners according to their tibial and femoral tunnel positions. We evaluated these radiologic constructions and measurements by use of the Cohen κ interobserver and intraobserver coefficient for 2 observers. Patients undergoing both techniques were divided into anatomic and nonanatomic reconstructions according to the findings of Zantop and Petersen. We correlated anatomically and nonanatomically reconstructed patients with clinical outcome by the Tegner score, Western Ontario and McMaster Universities Osteoarthritis Index score, International Knee Documentation Committee score, KT-1000 arthrometer (MEDmetric, San Diego, CA), and pivot-shift test in both techniques. Results: The radiologic constructions and measurements of 53 computed tomography scans were achieved with a good agreement of interobserver and intraobserver coefficients for 2 observers. We found significantly superior clinical outcome in anatomic ACL reconstructions in both techniques in terms of higher clinical scores (Tegner and International Knee Documentation Committee), higher anterior posterior stability, and less pivot shift. We observed the best outcome in anatomic STG-DB reconstructions. Conclusions: This investigation showed that better clinical results are associated with anatomic ACL reconstructions. Level of Evidence: Level II, prospective comparative study [Copyright &y& Elsevier]

Abstract: Poly(ether ether ketone) (PEEK) and its composites are recognized as alternative bearing materials for use in arthroplasty because of their mechanical properties. The objective of this project was to evaluate the biological response of two different kinds of carbon fiber-reinforced (CFR) PEEK compared with ultra-high molecular weight polyethylene (UHMWPE) in vivo as a standard bearing material. Wear particles of the particulate biomaterials were injected into the left knee joint of female BALB/c mice. Assessment of the synovial microcirculation using intravital fluorescence microscopy as well as histological evaluation of the synovial layer were performed 7days after particle injection. Enhanced leukocyte–endothelial cell interactions and an increase in functional capillary density as well as histological investigations revealed that all tested biomaterials caused significantly (P <0.05) increased inflammatory reactions compared with control animals (injected with sterile phosphate-buffered saline), without any difference between the tested biomaterials (P >0.05). These data suggest that wear debris of CFR-PEEK is comparable with UHMWPE in its biological activity. Therefore, CFR-PEEK represents an alternative bearing material because of its superior mechanical and chemical behavior without any increased biological activity of the wear particles, compared with a standard bearing material. [ABSTRACT FROM AUTHOR]

Abstract: The objective of our wear simulator study was to evaluate the suitability of two different carbon fibre-reinforced poly-ether-ether-ketone (CFR-PEEK) materials for fixed bearing unicompartmental knee articulations with low congruency. In vitro wear simulation was performed according to ISO 14243-1:2002 (E) with the clinically introduced Univation® F fixed bearing unicompartmental knee design (Aesculap AG, Tuttlingen, Germany) made of UHMWPE/CoCr29Mo6 in a direct comparison to experimental gliding surfaces made of CFR-PEEK pitch and CFR-PEEK PAN. Gliding surfaces of each bearing material (n =6+2) were γ-irradiated, artificially aged and tested for 5 million cycles with a customized four-station knee wear simulator (EndoLab, Thansau, Germany). Volumetric wear assessment, optical surface characterization and an estimation of particle size and morphology were performed. The volumetric wear rate of the reference PE1–6 was 8.6±2.17mm3 per million cycles, compared to 5.1±2.29mm3 per million cycles for PITCH1–6 and 5.2±6.92mm3 per million cycles for PAN1–6; these differences were not statistically significant. From our observations, we conclude that CFR-PEEK PAN is obviously unsuitable as a bearing material for fixed bearing knee articulations with low congruency, and CFR-PEEK pitch also cannot be recommended as it remains doubtful wether it reduces wear compared to polyethylene. In the fixed bearing unicompartmental knee arthroplasty examined, application threshold conditions for the biotribological behaviour of CFR-PEEK bearing materials have been established. Further in vitro wear simulations are necessary to establish knee design criteria in order to take advantage of the biotribological properties of CFR-PEEK pitch for its beneficial use to patients. [Copyright &y& Elsevier]

Purpose: The primary stability of 5 new knotless suture anchors was compared in healthy and osteopenic humeri by use of the following anchor systems: Opus Magnum 2 (ArthroCare, Austin, TX), PushLock (Arthrex, Naples, FL), SwiveLock (Arthrex), Kinsa RC (Smith & Nephew, London, England), and Versalok (DePuy Mitek, Raynham, MA). Methods: Twenty healthy and 20 osteopenic, macroscopically intact humeri with mean ages of 47 and 72 years, respectively, and mean bone mineral densities of 139.8 mg of calcium hydroxyapatite (Ca2+-HA) per milliliter and 51.8 mg of calcium hydroxyapatite per milliliter, respectively, were used. Cyclic loading was performed to simulate postoperative conditions. The maximum failure load (Fmax), the system displacement, and the modes of failure were recorded. Results: SwiveLock had the highest mean Fmax in healthy humeri, followed by Versalok, PushLock, Kinsa RC, and Opus Magnum 2, with SwiveLock and Versalok being statistically superior to Opus Magnum 2. In osteopenic humeri Versalok had the highest mean Fmax, followed by Opus Magnum 2, SwiveLock, Kinsa RC, and PushLock, with no significant differences between all tested anchors. The Versalok anchor showed the shortest system displacement in healthy humeri, with 1.06 mm, and in osteopenic humeri, with 1.47 mm. In healthy humeri the system displacement of all anchors lay under the clinical failure threshold of 5 mm. In osteopenic humeri the PushLock clearly exceeded the clinical failure threshold, with 16.11 mm, whereas the other anchors were notably below the 5-mm threshold, with solitary measurements exceeding it. Conclusions: Every tested anchor presented different problems that may lead to premature failure of the rotator cuff reconstruction. Knotless suture anchors show differences in primary stability depending on the bone quality of the greater tuberosity, the anchorage mechanism in the bone, the suture-retaining mechanism, and the anchor design. Nevertheless, cortical screw type and subcortical wedging anchors tend to show better primary stability than other designs. Clinical Relevance: Anchor design and bone quality play important roles in the stability of the rotator cuff repair. [Copyright &y& Elsevier]

Various suture anchors are available for rotator cuff repair. For arthroscopic application, a knotless anchor was developed to simplify the intra-operative handling. We compared the new knotless anchor (BIOKNOTLESS™ RC; DePuy Mitek, Raynham, MA) with established absorbable and titanium suture anchors (UltraSorb™ and Super Revo 5mm™; ConMed Linvatec, Utica, NY). Each anchor was tested on 6 human cadaveric shoulders. The anchors were inserted into the greater tuberosity. An incremental cyclic loading was performed. Ultimate failure loads, anchor displacement, and mode of failure were recorded. The anchor displacement of the BIOKNOTLESS™ RC (15.3 ± 5.3 mm) after the first cycle with 75 N was significantly higher than with the two other anchors (Super Revo 2.1 ± 1.6 mm, UltraSorb: 2.7 ± 1.1 mm). There was no significant difference in the ultimate failure loads of the 3 anchors. Although the Bioknotless™ RC indicated comparable maximal pullout strength, it bares the risk of losing contact between the tendon-bone-interface due to a significantly higher system displacement. Therefore, gap formation between the bone and the soft tissue fixation jeopardizes the repair. Bioknotless™ RC should be used in the lateral row only when a double row technique for rotator cuff repair is performed, and is not appropriate for rotator cuff repair if used on its own. [Copyright &y& Elsevier]

Purpose: The aim of this study was to evaluate the usefulness of serum procalcitonin (PCT) to differentiate between septic and nonseptic acute arthritis. Methods: Thirty-three patients who presented to our outpatient clinics with the symptoms of acute arthritis of unknown origin were enrolled in this study. We determined the serum concentrations of PCT and C-reactive protein and performed a white blood cell count. The definitive diagnosis was determined by microbiologic examination of a joint aspirate. Results: Microbiologic cultures showed that 15 patients had septic arthritis. In these patients the PCT levels were significantly increased compared with those in the 18 patients with nonseptic arthritis (mean ± SD, 1.18 ± 1.66 ng/mL v 0.078 ± 0.073 ng/mL; P = .001). On the basis of the normal range (<0.5 ng/mL), the test sensitivity in our series was 53.3% with a specificity of 100%. C-reactive protein levels in patients with septic arthritis were also significantly elevated compared with the nonseptic group. Because in either group no value was within the normal range (<0.5 mg/dL), the specificity was 0%. Conclusions: In this study serum PCT levels of patients with septic arthritis were significantly higher than those of patients with nonseptic arthritis (P = .001). However, the sensitivity when referencing the normal upper limit of PCT (0.5 ng/mL) is not high enough to establish a diagnosis based exclusively on serum parameters. This reflects the results of other studies examining localized infections without generalized bacteremia. The data suggest that a specific PCT cutoff level for localized infections could be helpful in the future. Level of Evidence: Level III, diagnostic study of nonconsecutive patients without consistently applied reference gold standard. [Copyright &y& Elsevier]

• Primary lymphoma of bone is a rare entity with unspecific symptoms. • Typical radiology is a large soft-tissue tumor around non-destructed bone. • Treatment is based on systemic chemotherapy. • Chemotherapy seems to produce a better outcome than radiotherapy alone. • Positiv factors: age<60 y, solitary lesion, low LDH, favourable ECOG and IPI scores. Primary lymphoma of bone (PBL) is a rare entity. Due to unspecific clinical signs and equivocal radiographs diagnosis may be delayed. This retrospective report of 109 PBL cases demonstrates typical aspects of the lesion. Treatment and prognostic factors are evaluated. Retrospectively patient records were reviewed. All patients were followed for evidence of local or distant recurrence. Overall survival (OS) was used as clinical outcome. The median age of the 109 patients was 62.8 years. The most common symptoms were pain (76%), swelling (29%), neurologic symptoms and pathological fracture (16% each). Mean duration of symptoms was 8 months (0–197 months). 19% of patients had indolent NHL subtypes, 72% aggressive NHL subtypes and 7% cases Hodgkin disease. Cyclophosphamid, doxorubicin, vincristine and prednisone (CHOP) or CHOP plus rituximab (RCHOP) were given in 88 (81%) of patients. Radiotherapy was delivered in 67 (61%) of cases. 51 (47%) patients received both. Surgical interventions were restricted to cases with complications as fractures. The 5-year OS was 66%. The 5-year OS was 66%. In the subgroup of 78 patients with aggressive NHL subtype there was a highly significant benefit for chemotherapy or chemotherapy and radiation in comparison to no treatment or radiation alone. Raised LDH, age, IPI and ECOG performance were prognostic factors. In multivariate analysis, age and raised LDH levels only kept significance. In our series of primary bone lymphoma, chemotherapy resulted in a better outcome than Radiotherapy alone. Long-term survival is based on the stage of the disease, favoring younger (<60 years) patients with solitary bone lesions, low level of LDH and favourable ECOG performance status and IPI scores. [ABSTRACT FROM AUTHOR]

Malposition of implant components in total knee arthroplasty (TKA) has consequences on tibiofemoral kinematics, contact forces and ligament tensions. To evaluate the impact of tibial baseplate malpositioning in the same knee, we conducted a computer simulation. An established weight-bearing finite element model of a fixed bearing TKA was used for the computer simulation. To evaluate the influence of tibial baseplate malposition, calculations were consecutively performed in neutral position, at 3° and 6° of internal and external rotation and at 3 mm and 6 mm of medial and lateral translation. The highest effect of malposition was observed for ligament tensions, with a tendency of a greater influence for the 6 mm translation compared to 6° of rotation. Changes in contact forces and tibiofemoral kinematics were according to the alterations of ligament tensions. The highest ligament tension, contact force and femoral roll-back were registered for 6 mm medialization of the tibial baseplate. Tibial baseplate malposition effects ligament tensions, tibiofemoral contact forces and kinematics and has a risk of unfavorable clinical results due to postoperative pain, reduced range of motion, instability and a higher rate of early loosening. Therefore, surgeons should aim for a neutral position of the tibial baseplate. Image 1 • Biomechanical differences of total knee arthroplasty with tibial baseplate malposition. • Finite element methods to determine kinematics, contact forces and ligament tensions. • Tibial position highly alters tension of posterior cruciate and collateral ligaments. • Tibial baseplate malposition affects inlay stresses and knee kinematics. [ABSTRACT FROM AUTHOR]

Clear cell chondrosarcoma (CCC) is a rare subtype of chondrosarcoma and it is commonly considered a low-grade tumor and less aggressive than atypical cartilaginous tumor (grade 1 central chondrosarcoma). However, the experience even of musculoskeletal tumor centres with this rare entity is limited. The aim of this study is to analyse our own treatment results and those of the literature regarding the therapy and outcome of this lesion. 7 cases of CCC have been treated in our department between 2003 and 2015. Their follow-up data were collected retrospectively. 187 literature cases with histopathological and clinical characteristics were retrieved by means of a PubMed search with the key word "clear cell chondrosarcoma". The data pertaining to treatment and follow up were extracted. We analysed the survival of patient and the risk factors for local recurrence (LR) as well as metastatic disease (MD). The mean age at the time of diagnosis was 40 years. Two thirds of the patients were male. The mean follow-up time was 109 months. To our surprise, there was a high rate of LR (30%) and of MD (20%) when compared to low-grade conventional chondrosarcomas. 15% of LR and 20% of metastatic disease were observed after more than 10 years follow-up. Uncommon locations of MD such as in the spine is a unique observation in chondrosarcomas and underlines the high aggressiveness of this tumor. 10-year overall survival was almost 80%, 10-years disease free survival 60%. Positive margins (p = 0.038) and metastases (p = 0.006) impaired the overall survival significantly. The rate of local recurrence was significantly dependent on resection margin (p < 0.001); however there was no correlation with the grade of differentiation of the tumor. The development of MD was affected by local recurrence (p = 0.006), but we could not detect a significant association with margin status (p = 0.184). A wide resection is the advocated treatment option. Long term follow-up for at least 10 years is necessary in order to not overlook late LR or MD. This work demonstrates for the first time the apparent aggressiveness of the CCC. [ABSTRACT FROM AUTHOR]

Aneurysmal bone cysts (ABC) are benign but locally aggressive lesions. The treatment of ABC has evolved over the years, but curettage with or without local adjuvants still represents the standard. Less invasive methods such as embolization, sclerotherapy or RANKL inhibitors (Denosumab) are also established. The aim of this study was to report and compare the results of a series of patients mainly treated with curettage with and without subsequent phenolization. 65 patients with the unequivocal diagnosis of primary ABC were treated. 61 of them were located within the bone whereas 4 patients had an ABC of the soft tissues. All patient were treated surgically by means of curettage with or without adjuvants, resection, or with minimally invasive methods such as Polidocanol injections, embolizations or Denosumab treatment. In total 80 procedures had been performed. Our patients had a mean age of 25.3 ± 16.0 years, ranging from 4 to 74 years. The most common skeletal locations were the pelvis in 23%, the femur in 18%, the tibia in 16% and the spine in 10%. Six lesions were resected and showed no recurrence. 5 patients were treated with polidocanol injections (n = 3) or embolization plus systemic treatment with Denosumab (n = 2). With embolization and Denosumab both patients showed stable disease and required no further treatment. Polidocanol injections resulted in stable disease with no further treatment required in one patient and in subsequent curettage with adjuvant phenolization in two other patients. In 54 initial curettages 21 were performed with adjuvant phenolization. In this group, 16 lesions healed (76%), 3 showed persistent disease and 2 patients had a local recurrence (9%). Out of 33 patients without phenolization 21 (64%) healed, 3 showed stable persistent disease and 9 (27%) experienced a recurrence. In total we performed 66 curettages, 27 with and 39 without adjuvant phenol treatment. Resolution was achieved in 19 (70%) and 25 (64%) of cases. respectively. Persistent disease was evident in 5 cases each and recurrence in 3 and 9 cases, respectively (n.s.). Curettage is still the standard of treatment for ABC. Local recurrence does not depend on the use of adjuvant phenol as shown in this and other studies. Minimally invasive methods such as selective embolization and injections of sclerosing agents may result in healing or at least in tolerable persistence of residual lesions but needs repetitive treatments and does not show homogenous results throughout the institutions. Denosumab appears to be an additional option, especially in surgically critical locations such as the spine or the sacrum. [ABSTRACT FROM AUTHOR]

Abstract: Injuries to the foot caused by foreign bodies are a frequent cause of local wounds and infections. In most cases, removal of the debris is easy and no comprehensive surgical care is needed. This case report is about a patient who stepped on a toothpick 10 years ago. The toothpick penetrated the intermetatarsal region I/II of the patient''s right foot without any harm to bone or tendon. Assuming total removal of the toothpick only a partial removal was performed. Eight years after the injury a painless swelling occurred for the first time. The tumor was removed surgically. The histologic workup showed a pigmented villonodular synovitis. In the subsequent year swelling occurred again. Under the impression of recurrent pigmented villonodular synovitis a surgical revision was performed. Surprisingly, an almost completely preserved toothpick surrounded by a distinct reaction of a foreign body granuloma was found. In conclusion, foreign-body injuries, as easy as they might seem, need a careful diagnostic workup and sufficient therapy. With injuries documented in medical history, the possibility of a retained foreign body should be considered. [Copyright &y& Elsevier]