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This study aimed to determine the effects of bovine amniotic fluid combined with bone graft in treating peri-implant bone defects with guided bone regeneration. Twenty female Sprague–Dawley rats were divided into two groups. Bone sockets with a diameter of 4 mm in the coronal part and a diameter of 2.5 mm in the apical part of the implant were created into the corticocancellous bone in the metaphyseal parts of the right tibia bones of all subjects. Implants with a length of 4 mm and a diameter of 2.5 mm were placed in the bone sockets. In the sham surgery group (n = 10) was the circumferential bone defect equivalent to half of the 4-mm implant length, which occurred between the implant and the bone, filled with bovine xenograft. Bovine xenografts were filled with amniotic fluid mixture in the experimental group (n = 10). After 8 weeks of recovery, all rats were sacrificed. The implants were extracted from the soft tissues and the surrounding bone. Subsequently, the bones were decalcified and prepared for histological analysis. The percentage of newly regenerated bone (NRB) formation and fibrosis in the bone defect area around the implant was calculated from all sections. NRB was found in 37.4±4.4% of controls and 41.4±2.63% of test animals (P

This study aimed to determine the effects of bovine amniotic fluid combined with bone graft in treating peri-implant bone defects with guided bone regeneration. Twenty female Sprague-Dawley rats were divided into two groups. Bone sockets with a diameter of 4 mm in the coronal part and a diameter of 2.5 mm in the apical part of the implant were created into the corticocancellous bone in the metaphyseal parts of the right tibia bones of all subjects. Implants with a length of 4 mm and a diameter of 2.5 mm were placed in the bone sockets. In the sham surgery group (n = 10) was the circumferential bone defect equivalent to half of the 4-mm implant length, which occurred between the implant and the bone, filled with bovine xenograft. Bovine xenografts were filled with amniotic fluid mixture in the experimental group (n = 10). After 8 weeks of recovery, all rats were sacrificed. The implants were extracted from the soft tissues and the surrounding bone. Subsequently, the bones were decalcified and prepared for histological analysis. The percentage of newly regenerated bone (NRB) formation and fibrosis in the bone defect area around the implant was calculated from all sections. NRB was found in 37.4±4.4% of controls and 41.4±2.63% of test animals (P<0.05 and P=0.024, respectively). Fibrosis formation was found at a rate of 38.6±5.06% in the control group and 33.2±5.38% in the test group (P<0.05 and P=0.033, respectively). It was considered that combining bovine amniotic fluid with bone transplant could be a useful way of treating bone abnormalities. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of Danggui Sini decoction combined with tibia transverse transport guided by three dimensional(3D) guide plate in the treatment of diabetic foot. Methods A total of 40 patients with diabetic foot who visited Jiangxi Provincial People′s Hospital from January 2020 to December 2021 were selected and divided into the osteotomy group(group A) and the osteotomy combined with Danggui Sini decoction group(group B), with 20 cases in each group. The changes of wound healing time, other therapeutic indexes(wound size, depth, skin temperature, wound condition score) and lower limb ischemia index score after treatment were observed. Results No infection spread amputation occurred in all patients, and the wound healing time in the group B was shorter than that in the group A, with statistical significance(P<0. 05). On 14th day after surgery, the reduction value of wound area, increase value of wound skin temperature, reduction value of wound condition score and lower limb ischemia index score in the group B were higher than those in the group A,with statistical significance(P<0. 05). The reduction value of wound depth in the group B was higher than that in the group A,but the difference was not statistically significant(P>0. 05). Conclusion Danggui Sini decoction combined with tibia transverse transport guided by 3D guide plate can better promote diabetic foot wound healing than osteotomy alone. [ABSTRACT FROM AUTHOR]

Objective: Investigations of the effects of proton pump inhibitors (PPIs) on bone healing have revealed that they affect bone regeneration negatively. The exact mechanism by which this adverse effect on bone tissue is not known. The aim of this study is to biomechanic and biochemical investigation of the effects of the PPIs on guided periimplant bone regeneration. Material & methods: Spraque dawley rats were divided controls (n = 8): there is no treatment during 8 week experimental period, PPI- Dosage 1 (n = 8) and Dosage 2 (n = 8): 5 mg/kg and 10 mg/kg omeprazol applied 3 times in a week with oral gavage during 8 weeks respectfully. Bone defects created half of the implant length circumferencial after implant insertion and defects filled with bone grafts. After experimental period the rats sacrified and implants with surrounding bone tissues were removed to reverse torque analysis (Newton), blood samples collected to biochemical analysis (glucose, AST, ALT, ALP, urea, creatinin, calcium, P). Results: Biomechanic reverse torque values did not revealed any statistical differences between the groups (P > 0,05). Conclusion: According the biomechanical and biochemical parameters PPIs does not effect the periimplant guided bone regeneration.

The kinematic alignment (KA) approach to total knee arthroplasty (TKA) has recently increased in popularity. Accordingly, a number of derivatives have arisen and have caused confusion. Clarification is therefore needed for a better understanding of KA-TKA. Calipered (or true, pure) KA is performed by cutting the bone parallel to the articular surface, compensating for cartilage wear. In soft-tissue respecting KA, the tibial cutting surface is decided parallel to the femoral cutting surface (or trial component) with in-line traction. These approaches are categorized as unrestricted KA because there is no consideration of leg alignment or component orientation. Restricted KA is an approach where the periarthritic joint surface is replicated within a safe range, due to concerns about extreme alignments that have been considered ‘alignment outliers’ in the neutral mechanical alignment approach. More recently, functional alignment and inverse kinematic alignment have been advocated, where bone cuts are made following intraoperative planning, using intraoperative measurements acquired with computer assistance to fulfill good coordination of soft-tissue balance and alignment. The KA-TKA approach aims to restore the patients’ own harmony of three knee elements (morphology, soft-tissue balance, and alignment) and eventually the patients’ own kinematics. The respective approaches start from different points corresponding to one of the elements, yet each aim for the same goal, although the existing implants and techniques have not yet perfectly fulfilled that goal.

Aims: This study aimed to identify the effect of anatomical tibial component (ATC) design on load distribution in the periprosthetic tibial bone of Koreans using finite element analysis (FEA). Methods: 3D finite element models of 30 tibiae in Korean women were created. A symmetric tibial component (STC, NexGen LPS-Flex) and an ATC (Persona) were used in surgical simulation. We compared the FEA measurements (von Mises stress and principal strains) around the stem tip and in the medial half of the proximal tibial bone, as well as the distance from the distal stem tip to the shortest anteromedial cortical bone. Correlations between this distance and FEA measurements were then analyzed. Results: The distance from the distal stem tip to the shortest cortical bone showed no statistically significant difference between implants. However, the peak von Mises stress around the distal stem tip was higher with STC than with ATC. In the medial half of the proximal tibial bone: 1) the mean von Mises stress, maximum principal strain, and minimum principal strain were higher with ATC; 2) ATC showed a positive correlation between the distance and mean von Mises stress; 3) ATC showed a negative correlation between the distance and mean minimum principal strain; and 4) STC showed no correlation between the distance and mean measurements. Conclusion: Implant design affects the load distribution on the periprosthetic tibial bone, and ATC can be more advantageous in preventing stress-shielding than STC. However, under certain circumstances with short distances, the advantage of ATC may be offset. Cite this article: Bone Joint Res 2022;11(5):252–259.

Aims Unicompartmental and total knee arthroplasty (UKA and TKA) are successful treatments for osteoarthritis, but the solid metal implants disrupt the natural distribution of stress and strain which can lead to bone loss over time. This generates problems if the implant needs to be revised. This study investigates whether titanium lattice UKA and TKA implants can maintain natural load transfer in the proximal tibia. Methods In a cadaveric model, UKA and TKA procedures were performed on eight fresh-frozen knee specimens, using conventional (solid) and titanium lattice tibial implants. Stress at the bone-implant interfaces were measured and compared to the native knee. Results Titanium lattice implants were able to restore the mechanical environment of the native tibia for both UKA and TKA designs. Maximum stress at the bone-implant interface ranged from 1.2 MPa to 3.3 MPa compared with 1.3 MPa to 2.7 MPa for the native tibia. The conventional solid UKA and TKA implants reduced the maximum stress in the bone by a factor of 10 and caused > 70% of bone surface area to be underloaded compared to the native tibia. Conclusion Titanium lattice implants maintained the natural mechanical loading in the proximal tibia after UKA and TKA, but conventional solid implants did not. This is an exciting first step towards implants that maintain bone health, but such implants also have to meet fatigue and micromotion criteria to be clinically viable. Cite this article: Bone Joint Res 2022;11(2):91–101.

Investigations of the effects of proton pump inhibitors (PPIs) on bone healing have revealed that they affect bone regeneration negatively. The exact mechanism by which this adverse effect on bone tissue is not known. The aim of this study is to biomechanic and biochemical investigation of the effects of the PPIs on guided periimplant bone regeneration. Spraque dawley rats were divided controls (n = 8): there is no treatment during 8 week experimental period, PPI- Dosage 1 (n = 8) and Dosage 2 (n = 8): 5 mg/kg and 10 mg/kg omeprazol applied 3 times in a week with oral gavage during 8 weeks respectfully. Bone defects created half of the implant length circumferencial after implant insertion and defects filled with bone grafts. After experimental period the rats sacrified and implants with surrounding bone tissues were removed to reverse torque analysis (Newton), blood samples collected to biochemical analysis (glucose, AST, ALT, ALP, urea, creatinin, calcium, P). Biomechanic reverse torque values did not revealed any statistical differences between the groups (P > 0,05). According the biomechanical and biochemical parameters PPIs does not effect the periimplant guided bone regeneration. [ABSTRACT FROM AUTHOR]

A trial was conducted to study the effects of probiotic (Miaclost) supplement on experimentally induced hypocalcemic rickets in broiler chicks, a total of 180 one-day-old broiler chicks (Ross 308) were randomly divided into three equal groups 60 chicks per group with 3 replicates (20 birds /replicate) the dietary treatments consisted of a normal ration for G1, calcium-deficient ration 5% for G2 and calcium-deficient ration with addition of probiotics in drinking water for G3.Initial signs of rickets have been observed at 35-day of age in G2.while, in G1 and G3 no clinical signs observed, the gross lesions appeared enlargement of parathyroid gland, costochondral junction and increase in the width of growth plate of tibial bone of G2 whereas no gross lesions recorded in G1 and G3, the histopathological examination of parathyroid gland in G2 there were a focal parathyroid hyperplasia and increasing in numbers of syncytial cells and normal in G1 and G3, no intestinal histopathological changes in G1 and G2 and increase in height and width of the intestinal villi in probiotic group G3. Marked increase in the thickness of proliferation zone within growth plate of tibia bone in G2 and normal thickness in G1 and G3. the serum biochemical analysis of calcium of G2 recorded significantly low level in G2 and high level in G3 comparatively with G1, finally the serum alkaline phosphatase values were high significantly in G2 and normal in G3, it is concluded that probiotic (MiaClost) can be used as prophylaxis to prevent hypocalcemic rickets in broiler chicks [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to determine the risk of tibial eminence avulsion intraoperatively for bi-unicondylar knee arthroplasty (Bi-UKA), with consideration of the effect of implant positioning, overstuffing, and sex, compared to the risk for isolated medial unicondylar knee arthroplasty (UKA-M) and bicruciate-retaining total knee arthroplasty (BCR-TKA)., Methods: Two experimentally validated finite element models of tibia were implanted with UKA-M, Bi-UKA, and BCR-TKA. Intraoperative loads were applied through the condyles, anterior cruciate ligament (ACL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), and the risk of fracture (ROF) was evaluated in the spine as the ratio of the 95 th percentile maximum principal elastic strains over the tensile yield strain of proximal tibial bone., Results: Peak tensile strains occurred on the anterior portion of the medial sagittal cut in all simulations. Lateral translation of the medial implant in Bi-UKA had the largest increase in ROF of any of the implant positions (43%). Overstuffing the joint by 2 mm had a much larger effect, resulting in a six-fold increase in ROF. Bi-UKA had ~10% increased ROF compared to UKA-M for both the male and female models, although the smaller, less dense female model had a 1.4 times greater ROF compared to the male model. Removal of anterior bone akin to BCR-TKA doubled ROF compared to Bi-UKA., Conclusion: Tibial eminence avulsion fracture has a similar risk associated with Bi-UKA to UKA-M. The risk is higher for smaller and less dense tibiae. To minimize risk, it is most important to avoid overstuffing the joint, followed by correctly positioning the medial implant, taking care not to narrow the bone island anteriorly.Cite this article: Bone Joint Res  2022;11(8):575-584.

Aims: This study investigated the effects of β-caryophyllene (BCP) on protecting bone from vitamin D deficiency in mice fed on a diet either lacking (D-) or containing (D+) vitamin D., Methods: A total of 40 female mice were assigned to four treatment groups (n = 10/group): D+ diet with propylene glycol control, D+ diet with BCP, D-deficient diet with control, and D-deficient diet with BCP. The D+ diet is a commercial basal diet, while the D-deficient diet contains 0.47% calcium, 0.3% phosphorus, and no vitamin D. All the mice were housed in conditions without ultraviolet light. Bone properties were evaluated by X-ray micro-CT. Serum levels of klotho were measured by enzyme-linked immunosorbent assay., Results: Under these conditions, the D-deficient diet enhanced the length of femur and tibia bones (p < 0.050), and increased bone volume (BV; p < 0.010) and trabecular bone volume fraction (BV/TV; p < 0.010) compared to D+ diet. With a diet containing BCP, the mice exhibited higher BV and bone mineral density (BMD; p < 0.050) than control group. The trabecular and cortical bone were also affected by vitamin D and BCP. In addition, inclusion of dietary BCP improved the serum concentrations of klotho (p < 0.050). In mice, klotho regulates the expression level of cannabinoid type 2 receptor (Cnr2) and fibroblast growth factor 23 (Fgf23) through CD300a. In humans, data suggest that klotho is connected to BMD. The expression of klotho is also associated with bone markers., Conclusion: These data indicate that BCP enhances the serum level of klotho, leading to improved bone properties and mineralization in an experimental mouse model.Cite this article: Bone Joint Res  2022;11(8):528-540.

Aims: This study aimed to identify the effect of anatomical tibial component (ATC) design on load distribution in the periprosthetic tibial bone of Koreans using finite element analysis (FEA)., Methods: 3D finite element models of 30 tibiae in Korean women were created. A symmetric tibial component (STC, NexGen LPS-Flex) and an ATC (Persona) were used in surgical simulation. We compared the FEA measurements (von Mises stress and principal strains) around the stem tip and in the medial half of the proximal tibial bone, as well as the distance from the distal stem tip to the shortest anteromedial cortical bone. Correlations between this distance and FEA measurements were then analyzed., Results: The distance from the distal stem tip to the shortest cortical bone showed no statistically significant difference between implants. However, the peak von Mises stress around the distal stem tip was higher with STC than with ATC. In the medial half of the proximal tibial bone: 1) the mean von Mises stress, maximum principal strain, and minimum principal strain were higher with ATC; 2) ATC showed a positive correlation between the distance and mean von Mises stress; 3) ATC showed a negative correlation between the distance and mean minimum principal strain; and 4) STC showed no correlation between the distance and mean measurements., Conclusion: Implant design affects the load distribution on the periprosthetic tibial bone, and ATC can be more advantageous in preventing stress-shielding than STC. However, under certain circumstances with short distances, the advantage of ATC may be offset. Cite this article: Bone Joint Res  2022;11(5):252-259.

The kinematic alignment (KA) approach to total knee arthroplasty (TKA) has recently increased in popularity. Accordingly, a number of derivatives have arisen and have caused confusion. Clarification is therefore needed for a better understanding of KA-TKA. Calipered (or true, pure) KA is performed by cutting the bone parallel to the articular surface, compensating for cartilage wear. In soft-tissue respecting KA , the tibial cutting surface is decided parallel to the femoral cutting surface (or trial component) with in-line traction. These approaches are categorized as unrestricted KA because there is no consideration of leg alignment or component orientation. Restricted KA is an approach where the periarthritic joint surface is replicated within a safe range, due to concerns about extreme alignments that have been considered 'alignment outliers' in the neutral mechanical alignment approach. More recently, functional alignment and inverse kinematic alignment have been advocated, where bone cuts are made following intraoperative planning, using intraoperative measurements acquired with computer assistance to fulfill good coordination of soft-tissue balance and alignment. The KA-TKA approach aims to restore the patients' own harmony of three knee elements (morphology, soft-tissue balance, and alignment) and eventually the patients' own kinematics. The respective approaches start from different points corresponding to one of the elements, yet each aim for the same goal, although the existing implants and techniques have not yet perfectly fulfilled that goal.

Aims: Unicompartmental and total knee arthroplasty (UKA and TKA) are successful treatments for osteoarthritis, but the solid metal implants disrupt the natural distribution of stress and strain which can lead to bone loss over time. This generates problems if the implant needs to be revised. This study investigates whether titanium lattice UKA and TKA implants can maintain natural load transfer in the proximal tibia., Methods: In a cadaveric model, UKA and TKA procedures were performed on eight fresh-frozen knee specimens, using conventional (solid) and titanium lattice tibial implants. Stress at the bone-implant interfaces were measured and compared to the native knee., Results: Titanium lattice implants were able to restore the mechanical environment of the native tibia for both UKA and TKA designs. Maximum stress at the bone-implant interface ranged from 1.2 MPa to 3.3 MPa compared with 1.3 MPa to 2.7 MPa for the native tibia. The conventional solid UKA and TKA implants reduced the maximum stress in the bone by a factor of 10 and caused > 70% of bone surface area to be underloaded compared to the native tibia., Conclusion: Titanium lattice implants maintained the natural mechanical loading in the proximal tibia after UKA and TKA, but conventional solid implants did not. This is an exciting first step towards implants that maintain bone health, but such implants also have to meet fatigue and micromotion criteria to be clinically viable. Cite this article: Bone Joint Res  2022;11(2):91-101.

Aims: Prompt and sufficient broad-spectrum empirical antibiotic treatment is key to preventing infection following open tibial fractures. Succeeding co-administration, we dynamically assessed the time for which vancomycin and meropenem concentrations were above relevant epidemiological cut-off (ECOFF) minimal inhibitory concentrations (T > MIC) in tibial compartments for the bacteria most frequently encountered in open fractures. Low and high MIC targets were applied: 1 and 4 µg/ml for vancomycin, and 0.125 and 2 µg/ml for meropenem., Methods: Eight pigs received a single dose of 1,000 mg vancomycin and 1,000 mg meropenem simultaneously over 100 minutes and 10 minutes, respectively. Microdialysis catheters were placed for sampling over eight hours in tibial cancellous bone, cortical bone, and adjacent subcutaneous adipose tissue. Venous blood samples were collected as references., Results: Across the targeted ECOFF values, vancomycin displayed longer T > MIC in all the investigated compartments in comparison to meropenem. For both drugs, cortical bone exhibited the shortest T > MIC. For the low MIC targets and across compartments, mean T > MIC ranged between 208 and 449 minutes (46% to 100%) for vancomycin and between 189 and 406 minutes (42% to 90%) for meropenem. For the high MIC targets, mean T > MIC ranged between 30 and 446 minutes (7% to 99%) for vancomycin and between 45 and 181 minutes (10% to 40%) for meropenem., Conclusion: The differences in the T > MIC between the low and high targets illustrate how the interpretation of these results is highly susceptible to the defined MIC target. To encompass any trauma, contamination, or individual tissue differences, a more aggressive dosing approach may be considered to achieve longer T > MIC in all the exposed tissues, and thereby lower the risk of acquiring an infection after open tibial fractures. Cite this article: Bone Joint Res  2022;11(2):112-120.