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Intra-articular injection-based therapy is often used aside conservative treatment and lifestyle modifications to manage knee osteoarthritis (KO) patients. Conventional injections contain steroids and hyaluronic acid, while more recently multipotential adult stem cell, platelet-rich plasma (PRP), and platelet lysate (PL) injections have been used to promote cartilage regeneration or repair. The aim of the current study is to analyse current evidence on PL injections for the treatment of KO and to determine if these are effective and how these perform compared to other injection regimens. The databases of Scopus, Embase, PubMed, Web of Science, and Cochrane Library were searched on 30 June 2023. Risk of bias was assessed using the SYRCLE tool for animal studies and Cochrane RoB 2 as well as ROBINS-I tool for human studies. Studies were included if these were in English, any year, and regarded animals with osteoarthritis (OA) or human adult patients with OA. In vitro trials and non-adult human studies were excluded. Results on OA symptom stage and severity, and pain were recorded. The research retrieved three human studies (n = 48, n = 25, n = 58) and four animal studies: one rabbit, two studies, and one rat study. PL was found to decrease KO symptoms at follow-up ≤ 1 year with respect to baseline levels and when compared to hyaluronic acid or platelet-rich plasma. Symptoms returned 6 months–1 year after the final administration, with studies showing peak efficacy at approximately 6 months. Animal studies showed clinical improvements, reduction of lameness, and partial effect on the cartilage regeneration of the seven studies, two had a high risk of bias, four were associated to some concerns, and one had low risk. A major source of bias in these studies was the use of questionnaires and scoring that could be subject to interpretation. Overall, PL was well-tolerated and showed efficacy comparable to PRP; when pain control was assessed, it showed similar efficacy compared to hyaluronic acid. These findings may support its use in clinical trials to confirm these initial findings; future research should also focus on the comparison with other non-surgical treatments, on a more detail of the potential regenerative properties, and to optimise the treatment schedule. [ABSTRACT FROM AUTHOR]

Purpose: Pigmented Villonodular Synovitis (PVNS) is a proliferative disease arising from the synovial membrane, mainly affects large joints such as the knee (almost 80% of total). Prostheses implanted in PVNS osteoarthritis show a higher revision rate when compared to primary osteoarthritis, due to the recurrence of disease and the overall surgical complications. The purpose of this systematic review is to summarize and compare indications, clinical and functional outcomes, disease-related and surgical-related complications of total knee arthroplasty in PVNS osteoarthritis. Materials and methods: A systematic review of the literature was performed with a primary search on Medline through PubMed. The PRISMA 2009 flowchart and checklist were used to edit the review. Screened studies had to provide preoperative diagnosis, previous treatments, main treatment, concomitant strategies, mean follow-up, outcomes and complications to be included in the review. Results: A total of 8 articles were finally included. Most of papers reported the use of non-constrained design implants, mainly posterior stabilized (PS) and in case of PVNS with extensive joint involvement implants with higher degree of constraint to obtain a fulfilling balancing. Recurrence of PVNS has been indicated as the major complication, followed by aseptic loosening of the implant and difficult post-operative course with an increased risk of stiffness. Conclusion: Total knee arthroplasty represents a valid treatment for patients with PVNS end-stage osteoarthritis, with good clinical and functional results, even in longer follow-up. It would be advisable a multidisciplinary management and a meticulous rehabilitation and monitoring following the procedure, to reduce the emergence of recurrence and overall complications. [ABSTRACT FROM AUTHOR]

Purpose: Patella maltracking is among the most frequent causes of poor outcomes and early failure after total knee arthroplasty (TKA), with an incidence that ranges from 1 to 20%. Even if there is agreement between authors regarding the preoperative and intraoperative management of patella maltracking in TKA, less clear are postoperative conducts. The purpose of this systematic review is to summarize and compare surgical techniques used to treat patella maltracking after TKA. Methods: A systematic review of the literature was performed with a primary search on Medline through PubMed. The PRISMA 2009 flowchart and checklist were used to edit the review. Screened studies had to provide clinical, functional and radiological results and complications of the proposed treatment to be included in the review. Results: A total of 21 articles were finally included. Three main types of surgical procedures and other minor techniques have been identified to manage patella maltracking after TKA. The choice of the proper technique to use in the specific case depends on several factors, first of all the malpositioning of the prosthetic components. Conclusion: Patella maltracking after TKA represents a frequent and challenging problem for orthopedic surgeons. Treatments described in the literature are often able to correct an abnormal patellar tracking; nevertheless, authors report variable percentages of residual knee pain and dissatisfaction in re-treated patients. Therefore, it would be desirable to prevent the maltracking condition at the time of primary arthroplasty, using proper surgical precautions. [ABSTRACT FROM AUTHOR]

Templating plays a key role in surgery that is often underestimated. There is a difference between planning and templating: in the first not only the hip is considered but involves the evaluation of the patient in its entirety. Templating instead consists of calculating the position of the implant in order to place it in the best possible position. Fundamental is a correct X-ray of the pelvis, which must follow certain standards. For traditional templating, drawings on appropriately enlarged transparent implants were provided by the prosthesis manufacturer. The implementation of digital software into clinical practice has improved the accuracy and reproducibility of templating, which in most surgical units is performed by standard 2D radiographic images. Thanks to digital preoperative templating in a digital radiology environment, the hip reconstructive surgeon can perform preoperative planning and implant sizing quickly, consistently, and affordably. Currently, 3D templating can also be performed by software used initially to create personalized stems for THA. Aim of the current review is to outline the essentials of correct templating in THA performance, and to report the updates since the introduction of digital and 3D technologies in this setting. [ABSTRACT FROM AUTHOR]