OTA international : the open access journal of orthopaedic trauma最新文献

{"title":"Development of a small animal bone-anchored limb replacement model for infection interventions.","authors":"Bailey V Fearing, Sarah M Romereim, Kerry Danelson, Matthew Smykowski, Marina Barankevich, Ryan Serbin, Nainisha Chintalapudi, Jana Davis, Susan Appt, Heather Burkart, Rachel B Seymour, Joseph R Hsu","doi":"10.1097/OI9.0000000000000366","DOIUrl":"10.1097/OI9.0000000000000366","url":null,"abstract":"<p><strong>Purpose: </strong>Osseointegration-associated infections are a critical barrier to widespread implementation of osseointegrated (OI) prosthetics. To address this challenge, a preclinical animal model must exist of the human model to test potential interventions. In this article, we describe a novel rabbit model of OI implant-related infection that can act as a platform for rapid translation and development of therapeutic approaches to combat these uniquely challenging infections.</p><p><strong>Methods: </strong>A single-stage amputation was performed by exposure, transection, reaming, and tapping of the tibia, followed by placement of a 75-mm Ti-6Al-4V cortical screw implant. Muscle and skin were closed, and a prosthetic was attached to the screw. Hematology, clinical chemistry, and imaging were performed up to 8 weeks. High-resolution microCT and histology were conducted at terminal end points. Intraosseous vancomycin delivery was compared with intravenous delivery. Serum and bone marrow collection was conducted across a period of 5 hours.</p><p><strong>Results: </strong>Rabbits maintained normal ambulation, mobility, diet, and weight throughout the study period. Clinical chemistry results indicate normal ranges over the study course. microCT and histology demonstrate osseointegration between the threads of the implant within the medullary cavity. Pharmacokinetic data determined that intraosseous vancomycin delivery results in significantly lower vancomycin concentrations systemically compared with intravenous delivery and higher peak vancomycin concentration within the tibial canal.</p><p><strong>Conclusion: </strong>This preclinical translational model represents a reproducible small animal model of OI transtibial amputation that successfully recreates the bone-skin-implant interface, material-bone interactions to match human OI, and a similar immune response. Preclinical efficacy of infection interventions will be further explored with establishment of this model.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e366"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in pain and prosthesis wear following transfemoral osseointegration combined with sciatic nerve RPNI.","authors":"Kirby W Bonvillain, Ainsley K Bloomer, G Dillon Graham, Ryan P Serbin, Rachel B Seymour, Joseph R Hsu, Bryan Loeffler","doi":"10.1097/OI9.0000000000000385","DOIUrl":"10.1097/OI9.0000000000000385","url":null,"abstract":"<p><strong>Background: </strong>Osseointegration (OI) has revolutionized prosthetic rehabilitation for amputees. Despite its contributions, postamputation pain remains a significant problem. This study aims to investigate the role of sciatic nerve regenerative peripheral nerve interface (RPNI) in patients undergoing transfemoral OI, focusing on its impact on pain and prosthetic wear.</p><p><strong>Methods: </strong>Patients underwent OI in a staged manner with RPNI being performed at either stage I or II. Outcome measures included preoperative and postoperative numerical rating scale phantom and residual limb pain (RLP) scores, presence of Tinel sign on physical examination, opioid use, and prosthetic wear. Data were collected through interviews using a standardized script to ensure consistency.</p><p><strong>Results: </strong>A total of 12 patients were included. The patients were reported among cohorts without comorbidities (RPNIw/oC, N = 9) and with comorbidities (RPNIwC, N = 3). The average phantom limb pain (PLP) score decreased by 3.66 in the RPNIw/oC group and 3 in the RPNIw/C group. The RLP score saw an average increase of 0.28 in the RPNIw/oC group and a decrease of 3.33 in the RPNIw/C group. The frequency of a positive Tinel sign went from 2/9 to 0/9 in the RPNIw/oC group and remained constant in the RPNIwC group at 1/3. Finally, the RPNIw/oC group saw an increase in prosthetic wear from 4 h/d preoperatively to 8.2 h/d postoperatively, and the RPNIwC group saw an increase from 2.67 h/d to 7 h/d. No patients required nerve-related revision surgery.</p><p><strong>Conclusion: </strong>This small case series demonstrates improvement in phantom limb pain and prosthesis wear after combined transfemoral OI and sciatic nerve RPNI.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e385"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Basic science review of transcutaneous osseointegration: current status, research gaps and needs, and defining future directions.","authors":"Bailey V Fearing, Ida Leah Gitajn, Sarah M Romereim, Jason S Hoellwarth, Joseph C Wenke","doi":"10.1097/OI9.0000000000000367","DOIUrl":"10.1097/OI9.0000000000000367","url":null,"abstract":"<p><p>Basic science research is vital for advancing the emerging field of bone-anchored limb replacement (BALR), or osseointegration (OI). This article discusses clinical challenges for BALR/OI, summarizes current basic science research regarding those challenges, identifies research gaps, and proposes future directions. OI research draws from related fields such as orthopaedic implants and dentistry. There is a need for small animal models to study critical questions related to osseointegration, including OI implant-associated infections. Small animal models are also critical to ensuring safety and efficacy of novel treatments in this vulnerable population. Key issues include infection prevention through implant surface modifications, biofilm-targeting technologies, and antimicrobial advancements. The skin-implant portal, unique to BALR, also poses significant challenges. Research on skin attachment and inflammatory processes is crucial. Noninfectious inflammatory loosening of implants, though infrequent, needs further investigation. This review emphasizes the need for collaborative efforts to develop effective preclinical models and innovative infection prevention strategies. Addressing these challenges is essential for optimizing patient outcomes and advancing this emerging field.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e367"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus statement on prehabilitation and rehabilitation of osseointegration patients.","authors":"Danielle Melton, Lisa Prasso, Angela Abernethy, Jason S Hoellwarth, Tarey Strickland","doi":"10.1097/OI9.0000000000000371","DOIUrl":"10.1097/OI9.0000000000000371","url":null,"abstract":"<p><p>Rehabilitation protocols vary according to the osseointegration (OI) implant system and the institutions implanting bone-anchored limbs (BALs). While there are limited peer-reviewed OI publications quantifying details for optimizing surgical candidacy and rehabilitation protocols to ensure support across the BAL spectrum, the authors recommend a multidisciplinary team approach over the user's lifetime. Breakout sessions at the Global Collaborative Congress on OI (GCCO) were convened around key topics, including rehabilitation. Current best practice, gaps in the literature, and needs for future research were captured. The authors used these findings along with the available peer-reviewed literature and expert opinion to frame the consensus statements presented in this article. The authors present 3 consensus statements describing each phase of care-preoperative, perioperative, and postoperative.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e371"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus statement on the prevention, diagnosis, and management of infection following transcutaneous osseointegration for patients with limb loss: current state-of-the-art and proposed future studies.","authors":"Jason S Hoellwarth, Colin Harrington, S Robert Rozbruch, Benjamin K Potter","doi":"10.1097/OI9.0000000000000369","DOIUrl":"10.1097/OI9.0000000000000369","url":null,"abstract":"<p><p>The diagnosis, risk factors, treatment algorithms, and long-term sequelae of superficial and deep, implant-related infections in transdermal, bone-anchored osseointegration are not well-defined. In contrast to the robust experience diagnosing and managing periprosthetic joint infections in total joint arthroplasty, osseointegration surgery has only recently been adopted at a small number of osseointegration centers in the United States, contributing to the lack of long-term outcomes. Through the pooled experience from these osseointegration centers, we present a consensus statement on the perioperative management, incidence, treatment, and diagnostic workup for infectious complications following transdermal, bone-anchored osseointegration.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e369"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A conceptual framework for soft tissue management of transdermal bone-anchored implants in extremity prostheses.","authors":"Matthew Wordsworth, Colin J Harrington, Luke Juckett, Jason M Souza","doi":"10.1097/OI9.0000000000000370","DOIUrl":"10.1097/OI9.0000000000000370","url":null,"abstract":"<p><p>Soft tissue complications are among the most common reasons for revision surgery following transdermal, bone-anchored osseointegration. While many orthopaedic surgeons are familiar and experienced with the use of intramedullary implants, the soft tissue management surrounding a percutaneous and permanent implant in continuity with the outside environment remains a challenging problem. With this in mind, we present our rationale and a framework for soft tissue considerations in preparation for bone-anchored osseointegration based on early experiences with most commercially available osseointegration systems.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e370"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rabbit model of a biofilm-contaminated, percutaneous orthopaedic endoprosthesis.","authors":"Christopher Rivet, Jonathan Thomas Elliott, Jason R Gunn, J Scott Sottosanti, Bailey V Fearing, Joseph R Hsu, Ida Leah Gitajn","doi":"10.1097/OI9.0000000000000384","DOIUrl":"10.1097/OI9.0000000000000384","url":null,"abstract":"<p><p>Preclinical models of osseointegrated orthopaedic implants tend to focus on implant stability, surface modifications to enhance integration with host tissue, and reduction in iatrogenic contamination through antibiotic-eluting/bacteria-resistant coatings. While these studies are imperative to early success in osseointegration, continued success of percutaneous devices throughout the lifespan of the patient is also critically important. A perpetual challenge to the implant is formation of bacterial biofilm on the abutment. Once adhered, biofilm-based bacteria are recalcitrant and readily contaminate the subcutaneous soft tissue of the stoma. To this end, the rabbit model reported herein replicates the clinical scenario of a patient with a biofilm-contaminated abutment. This model enables preclinical testing of advanced therapeutics beyond the traditional antibiotic-based approach, potentially increasing the longevity of the device.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e384"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening and patient selection for bone-anchored limb implantation and rehabilitation: what makes a good candidate?","authors":"Jason W Stoneback, Meghan K Wally, Angela Abernethy, Dan Milius, Mohamad E Awad","doi":"10.1097/OI9.0000000000000368","DOIUrl":"10.1097/OI9.0000000000000368","url":null,"abstract":"<p><p>Osseointegration of a bone-anchored limb (BAL) is an emerging rehabilitation technique that offers significant advantages over traditional socket prostheses. By addressing functional limitations and recurrent cutaneous complications, BAL systems have shown an 82%-90% increase in daily prosthesis use among patients, who also report improvements in functional ability, balance, comfort, and overall quality of life. Despite these benefits, the process of patient selection for BAL remains underdeveloped, with evidence-based guidelines still in their infancy. This article aims to propose a workflow for patient selection and screening in BAL osseointegration, leveraging the current literature, interdisciplinary clinical experience, and established models. A comprehensive evaluation process is suggested that incorporates anatomical, physiological, psychological, and lifestyle factors. These include radiological evaluation, amputation history, prosthetic component assessment, laboratory tests, psychiatric history, cognitive assessments, and considerations of home safety and postoperative care. The evaluation should ideally be conducted by an interdisciplinary team to ensure a balanced consideration of risks and benefits for each candidate. As the understanding of BAL osseointegration advances, it is expected that patient indications will expand and contraindications will be more clearly defined. The proposed workflow aims to standardize patient selection, thereby optimizing surgical outcomes and rehabilitation processes. This approach is essential for maximizing the benefits of BAL systems while ensuring patient safety and improving long-term rehabilitation outcomes.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e368"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osseointegration programmatic development: interdisciplinary team with a patient-centered approach.","authors":"Amber Stanley, Meghan K Wally, Christine Churchill, Kristine McGuire, Tarey Strickland, Angela Abernethy, Toby Perkins, Angelica M Melendez, Kevin Hickey, Rachel B Seymour","doi":"10.1097/OI9.0000000000000372","DOIUrl":"10.1097/OI9.0000000000000372","url":null,"abstract":"<p><p>Successful implementation of an osseointegration program requires a skilled and committed interdisciplinary team engaged in supporting patients and their families throughout the OI process. The roles and responsibilities of clinical and ancillary team members are described in detail, along with a discussion of the needed patient and family support resources. Time spent developing the interdisciplinary team, with strong regulatory support and engagement of hospital administration and the health system, will promote higher patient satisfaction and outcomes and innovative future directions.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e372"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of National Orthopaedic Fracture Registries: A Systematic Review.","authors":"Nicolas Jozefowski, Carlo Eikani, Nithya Lingampalli, Patrick Lawler, Athena Barrett, Aaron Hoyt, Andrew Pickles, Elizabeth Huggins, Julie Agel, Rachel Seymour, Mai Nguyen, Meir Marmor, Ashley E Levack","doi":"10.1097/OI9.0000000000000361","DOIUrl":"10.1097/OI9.0000000000000361","url":null,"abstract":"<p><strong>Purpose: </strong>Large-scale registry data efforts are common in orthopaedic surgery; however, there is wide variation between registries and little known about registry impact. The purpose of this study was to assess the publication or \"scholarly\" impact of current national trauma/fracture registries.</p><p><strong>Methods: </strong>A search was executed to identify potential national and international trauma/fracture registries and create a comprehensive list of registries. Thirty-four relevant national registries were identified. Searches were executed to identify any published articles published by or affiliated with the selected registries. Over 13,000 abstracts were screened by at least 2 reviewers. The full text of 650 articles were screened by at least 2 reviewers, and data were extracted from 383 articles. Citations were excluded if they were reviews and meta-analyses; referencing non-trauma-specific, insurance, institutional, or state-wide databases; describing facial, spine, or rib trauma; reporting nonregistry data; and did not report on fracture patients. Data were collected at the article level and registry level.</p><p><strong>Results: </strong>The median number of articles per registry was 3.5 (range: 1-66) with a median impact factor of 3.2 (range per registry: 1.4-11.0). The National Hip Fracture Database (United Kingdom) had the highest publication rate per year of any registry (3.9). Twenty-four percent of registries had a publication rate of greater than 1 article per year, whereas only 8.8% had a publication rate over 2 per year. Only 8 registries had 10 or more publications in total. The National Trauma Data Bank (United States) had the highest number of fracture-specific publications overall (66) and an average citation rate of 29 per publication. The National Hip Fracture Database had the second highest number of article (62) with an average citation per article of 23.6.</p><p><strong>Conclusion: </strong>With the exception of a few registries, most national trauma/fracture registries have low yearly publication and citation rates. Researchers must consider the utility of resources needed to sustain registry efforts in the context of the impact of registry data. Future studies will seek to identify salient features of the highest impact registries.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1","pages":"e361"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}