Bone & Joint Research最新文献

{"title":"The impact of cementing technique in polished taper fit hip stems : a modelling analysis of implant-cement interface.","authors":"Bernard H van Duren, Mohamad Taufiqurrakhman, Alison Jones, Mark Higgins, Andrew R Manktelow, Benjamin V Bloch, Hemant Pandit","doi":"10.1302/2046-3758.147.BJR-2024-0408.R1","DOIUrl":"10.1302/2046-3758.147.BJR-2024-0408.R1","url":null,"abstract":"<p><strong>Aims: </strong>Cemented polished taper fit (PTF) stems are the femoral implant of choice for total hip arthroplasty (THA) in many locations worldwide. There is increasing evidence that periprosthetic fracture may be the single major contributor to reoperation with these stems. The aim of this study was to demonstrate how mismatches at the implant-cement interface may occur and the subsequent effect of these incongruities on the contacting area and the forces transmitted to the cement mantle.</p><p><strong>Methods: </strong>A parametric equation-based model was developed to determine the contact mismatch relative to axial stem rotations. This model was also used to calculate the restoration of contact surface area with stem subsidence for both a dual-taper and triple-taper geometry. A finite element analysis (FEA) was used to compare the effects of reduced contact area due to the incongruent hip implant-cement interface.</p><p><strong>Results: </strong>The contact model showed a large decrease in surface contact area with even only a small rotation going from 100% at 0° to 50.00% at 2.5° for the dual-taper geometry, and from 100% at 0° to 50.20% at 2.5° for the triple-taper geometry. There was a gradual but small ongoing decrease in contact surface with increasing rotation for both the dual-taper and triple-taper geometries. For both taper designs, there was an increase in contact surface area with an increase in subsidence resulting in contact for up to a 5° mismatch being restored with 2 mm subsidence. FEA showed that with increasing mismatches and consequent contact area reduction, there was an increase in von Mises stress in the implant-cement interface of up to 235%.</p><p><strong>Conclusion: </strong>With increasing mismatch, there was an increase in maximum stresses, total strain, and subsidence in the cement mantle, highlighting the importance of achieving an optimal implant-cement interface at the time of implantation of cemented PTF femoral stems.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 7","pages":"642-655"},"PeriodicalIF":4.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Damage control orthopaedics is associated with impaired fracture healing and delayed recovery in a rodent model of severe multiple trauma.","authors":"Changlin Qi, Nils Becker, Nan Zhou, Diana Möckel, Twan Lammers, Rebecca Halbgebauer, Johannes Greven, Maximilian Praster, Frank Hildebrand, Klemens Horst, Elizabeth R Balmayor","doi":"10.1302/2046-3758.147.BJR-2024-0364.R1","DOIUrl":"10.1302/2046-3758.147.BJR-2024-0364.R1","url":null,"abstract":"<p><strong>Aims: </strong>Polytraumatized patients with severe limb injuries often develop complications, which are influenced by the surgical treatment strategy. For the initial fracture stabilization, Early Total Care (ETC) and Damage Control Orthopedics (DCO) are competing concepts, with the treatment choice depending on the patient's condition. Clear guidance factors remain lacking. Our study aimed to compare the effects of ETC and DCO strategies on fracture healing and functional gait behaviour in a rat multiple-trauma model.</p><p><strong>Methods: </strong>A standardized rat multiple-trauma model was established, which included haemorrhagic shock, blunt chest trauma, and a femur fracture with subsequent reduction and fixation by group-specific operative strategies. Adult Sprague-Dawley male rats (n = 45) were randomly allocated to three groups: Sham (n = 9), ETC (primary intramedullary nailing (IN); n = 18), and DCO-IN (external fixation with conversion to IN at day 6 after the trauma; n = 18). Postoperative gait changes at different timepoints were analyzed using the CatWalk system. At seven, 21, and 42 days, the animals were euthanized to assess bone formation of the femur fracture histologically and via micro-CT. Biomechanical stability was assessed by a three-point bending test.</p><p><strong>Results: </strong>Fixation conversion surgery in the DCO-IN group decreased callus formation, resulting in delayed fracture healing with reduced callus quality and poorer biomechanical properties compared to the ETC group. The DCO-IN group also exhibited poorer weightbearing and locomotor-function rehabilitation compared to the ETC group, consistent with the impaired fracture healing process.</p><p><strong>Conclusion: </strong>These results demonstrate that conversion of the fixation method in the DCO strategy delays the callus formation process up to six weeks after trauma, potentially contributing to delayed rehabilitation and higher risk of nonunion in multiple-trauma patients. DCO should be limited to patients with contraindications for ETC, underlining the need for clear identification factors.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 7","pages":"619-632"},"PeriodicalIF":4.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased loading of the lateral knee compartment in the unamputated knee during gait in people with unilateral transfemoral/through-knee amputations.","authors":"Diana Toderita, Clement D Favier, David P Henson, Vasiliki Vardakastani, Natalie L Egginton, Alexander N Bennett, Anthony M J Bull","doi":"10.1302/2046-3758.147.BJR-2024-0301.R1","DOIUrl":"10.1302/2046-3758.147.BJR-2024-0301.R1","url":null,"abstract":"<p><strong>Aims: </strong>People with unilateral transfemoral/through-knee amputations (UTF) are at risk of mechanically mediated contralateral knee osteoarthritis (OA). This study aims to identify the mechanical indicators of the development and progression of unamputated knee OA in the UTF population.</p><p><strong>Methods: </strong>Level-ground gait data were collected from 14 male traumatic UTF participants and 14 uninjured matched controls using optical motion capture systems and force plates. Inverse kinematics, inverse dynamics, and static optimization musculoskeletal modelling simulations were conducted.</p><p><strong>Results: </strong>UTF demonstrated higher unamputated ankle plantarflexion angles (by 4.9°, p = 0.012), peak-to-peak pelvic obliquity angles (by 2.9°, p = 0.040), and unamputated limb second peak ground reaction force (by 0.1 body weight (BW), p = 0.002) than controls. The UTF unamputated knee maximum loading rate was 0.9 Nm/kg.s higher than controls (p = 0.002). Additionally, UTF presented higher loading of the lateral compartment of the unamputated knee than controls, as characterized by the first peak (by 0.3 BW, p = 0.033), second peak (by 0.8 BW, p = 0.008), and impulse (by 22.0 BW.s/m, p < 0.001).</p><p><strong>Conclusion: </strong>Traumatic UTF need to adopt new movement strategies to account for the limb loss. Although beneficial for successful ambulation, these compensatory movement strategies increase joint loading in the unamputated knee, which may increase the risk of OA and soft-tissue injuries. Mitigation strategies need to be proposed to improve ambulatory biomechanics with a view to improving long-term musculoskeletal health, while maintaining optimal functional levels.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 7","pages":"633-641"},"PeriodicalIF":4.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12248132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Account of synovial terminal nerve endings affects the clinical function of patients with chronic ankle instability : a retrospective cohort study.","authors":"Xingyu Wang, Shengxuan Cao, Yungu Chen, Yun Bao, Chao Zhang, Xu Wang, Xin Ma","doi":"10.1302/2046-3758.147.BJR-2024-0339.R2","DOIUrl":"10.1302/2046-3758.147.BJR-2024-0339.R2","url":null,"abstract":"<p><strong>Aims: </strong>Previous studies have reported synovial hypertrophy and synovitis in the ankle joint of patients with chronic ankle instability (CAI) and osteochondral lesion of the talus (OLT). The present study aimed to explore the correlation between pain level, clinical function of CAI patients with or without OLT, and the quantity of neurons and microvessels of synovium in the ankle joint.</p><p><strong>Methods: </strong>A total of 32 subjects (14 without OLT and 18 with OLT) were included. The Cumberland Ankle Instability Tool (CAIT), American Orthopaedic Foot and Ankle Society (AOFAS), and visual analogue scale (VAS)-pain score of every patient were assessed via questionnaire, and the quantity of their terminal nerve endings and microvessels in the stained synovium section were counted under microscope. Statistical analysis was conducted to determine surgical effects (arthroscopic Broström-Gould and bone marrow stimulation) and to evaluate the association between the quantity of terminal nerve endings and microvessels with function and pain level in the ankle joint.</p><p><strong>Results: </strong>No significant differences were found in demographics, clinical assessment, and concomitant intra-articular pathologies between the two groups (all p > 0.05). The CAIT, AOFAS, and VAS-pain (respectively at rest and at sport) scores of preoperative patients were significantly poorer than those of postoperative patients (all p < 0.01). Account of neurons was positively correlated with preoperative VAS in sport (<i>r</i> = 0.915, p < 0.001), and negatively correlated with preoperative CAIT (<i>r</i> = -0.677, p < 0.001), postoperative CAIT (<i>r</i> = -0.546, p = 0.001), and preoperative AOFAS (<i>r</i> = -0.615, p < 0.001).</p><p><strong>Conclusion: </strong>There were no significant differences, either pre- or postoperatively, between CAI patients and CAI with OLT patients in CAIT, AOFAS, and VAS-pain. The CAIT, AOFAS, and VAS-pain were markedly improved after arthroscopic treatment. The quantity of terminal nerve endings was positively correlated with pain level and negatively correlated with clinical function.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 7","pages":"609-618"},"PeriodicalIF":4.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of tranexamic acid on the efficacy of vancomycin and meropenem against periprosthetic joint infections : an in vitro analysis.","authors":"Liqin Yao, Youcai Ma, Qiangde Hu, Rui Liu, Boyong Xu, Xuebin Sun, Li Cao, Wenbo Mu","doi":"10.1302/2046-3758.147.BJR-2024-0508.R1","DOIUrl":"10.1302/2046-3758.147.BJR-2024-0508.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study investigated the effects of tranexamic acid (TXA) on the efficacy of vancomycin and meropenem against common periprosthetic joint infection (PJI)-associated pathogens in vitro. The aim was to uncover valuable insights that can be used for clinical decision-making and enhanced management of PJI in orthopaedic surgery.</p><p><strong>Methods: </strong>We evaluated the minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), minimum biofilm inhibitory concentration (MBIC), and minimum biofilm eradication concentration (MBEC) for vancomycin and meropenem, both with and without TXA, against various bacterial strains.</p><p><strong>Results: </strong>In the planktonic bacterial phase, TXA increased the MIC and MBC of vancomycin for <i>Staphylococcus aureus</i> and <i>Staphylococcus epidermidis</i>, decreased the MIC and MBC of meropenem for <i>S. aureus</i>, and increased the MIC and MBC of vancomycin combined with meropenem for <i>S. aureus</i>. In biofilms, TXA in combination with vancomycin synergistically decreased the MBIC and MBEC values of methicillin-resistant <i>S. aureus</i> (MRSA) and <i>S. aureus</i>.</p><p><strong>Conclusion: </strong>TXA influences antibiotic efficacy against both planktonic bacteria and biofilms, with effects varying by antibiotic and bacterial strain. These findings underscore the complexity of drug interactions in PJI treatment, highlighting the need for tailored therapeutic strategies based on strain-specific responses.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 7","pages":"601-608"},"PeriodicalIF":4.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"G-protein-coupled estrogen receptor-1 facilitates chondrocyte proliferation in pubertal epiphyseal growth plate via PTHrP/Ihh regulation.","authors":"Ya-Shuan Chou, Sung-Yen Lin, Shu-Chun Chuang, Pei-Yin Shih, Chung-Hwan Chen, Mei-Ling Ho, Je-Ken Chang","doi":"10.1302/2046-3758.147.BJR-2024-0347.R1","DOIUrl":"10.1302/2046-3758.147.BJR-2024-0347.R1","url":null,"abstract":"<p><strong>Aims: </strong>Oestrogen drives long-bone development through various oestrogen receptors. G-protein-coupled oestrogen receptor-1 (GPER-1), a membrane oestrogen receptor, mediates longitudinal bone growth during early puberty; however, the underlying mechanisms remain unclear. Therefore, this study elucidated the mechanisms underlying GPER-1-mediated bone growth.</p><p><strong>Methods: </strong>A GPER-1 agonist (G1), GPER-1 antagonist (G15), and chondrocyte-specific GPER-1 knockout experiment (<i>Col2a1-Cre; GPER-1^f/f</i>, CKO) were used to investigate the role of GPER-1 in growth plate chondrocytes from C57BL/6 mice (total number = 48). We investigated the effects of GPER-1 activation or inhibition on the tibial growth plate and bone growth, including changes in proliferation and hypertrophy, and the expression of parathyroid hormone-related peptide (PTHrP), Indian hedgehog (Ihh), and their ratio (PTHrP/Ihh).</p><p><strong>Results: </strong>G1 treatment-induced GPER-1 activation increased tibial growth plate thickness, proliferative zone thickness, and chondrocyte proliferation in mice. The hypertrophic zone thickness and type X collagen-stained area decreased in four-week-old G1-treated mice compared with the control group. GPER-1 activation increased the PTHrP/Ihh ratio in the growth plates of four- and eight-week-old mice. In contrast, blocking or deleting GPER-1 decreased the proliferative zones of the growth plate, proliferative chondrocytes, and PTHrP/Ihh. Additionally, the hyperopic zones of the growth plates increased with GPER-1 deficiency. In vitro micromass-3D cultured chondrocyte studies confirmed that G1 treatment increased proliferation, decreased hypertrophy, and increased PTHrP/Ihh protein levels.</p><p><strong>Conclusion: </strong>This study demonstrates that GPER-1 maintains proliferation but suppresses chondrocyte hypertrophy in growth plates by upregulating PTHrP/Ihh during early puberty in male and female mice. Our findings suggest that GPER-1 may serve as a potential target for therapeutic modulation of linear bone growth during puberty.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 7","pages":"589-600"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and clinical application of extendable prostheses in limb salvage surgery for primary malignant bone tumours in children : a systematic review of functional outcomes and complications.","authors":"Ningkai Tang, Jiake Yang, Siyi Huang, Xiaodong Tang, Tao Ji","doi":"10.1302/2046-3758.146.BJR-2024-0275.R3","DOIUrl":"10.1302/2046-3758.146.BJR-2024-0275.R3","url":null,"abstract":"<p><strong>Aims: </strong>Extendable prostheses have developed rapidly over the decades to solve limb length discrepancy (LLD) following limb salvage surgery in children and adolescents who have suffered primary malignant bone tumours. In this study, we performed a systematic review of the literature on extendable prostheses to investigate their developments and clinical outcomes, to provide evidence-based recommendations for enhancing clinical implementation and refinement.</p><p><strong>Methods: </strong>A systematic review of 46 studies with 709 invasive cases and 556 noninvasive cases was performed after searching the PubMed, EMBASE, and Web of Science databases. Results of the prosthesis survival rate, functional outcomes, and complications were extracted, recategorized, and analyzed.</p><p><strong>Results: </strong>With the increase in publication year, there was no significant change in the five-year prosthesis survival rate, while the Musculoskeletal Tumour Society (MSTS) score exhibited an upward trend. Apart from infection, the incidence of mechanical complications increased as follow-up time extended. Failed structure of invasive prosthesis was higher than in those who received a noninvasive extendable prosthesis (25.1% (123/491) vs 15.0% (70/466); p < 0.001, Power = 0.972). The mean number of additional procedures in patients who received an invasive prosthesis was higher than those who received a noninvasive extendable prosthesis (2.4 (1.3 to 3.4) vs 1.4 (0.1 to 2.7); p = 0.021), and there was no obvious clinical difference between invasive prostheses and noninvasive prostheses in infection (15.0% (88/586) vs 13.4% (68/508); p = 0.442, Power = 0.125). Infection (44/361, 12.2%) was the most common complication associated with the Stanmore JTS prosthesis, while the incidence of aseptic loosening (14/296, 4.7%) was the lowest. The mean incidence of complications in the Stanmore Mark I-IV group was higher than that in the Stanmore JTS group (68.9% (104/151) vs 36.6% (49/134); p < 0.001, Power = 0.9998).</p><p><strong>Conclusion: </strong>Despite decades of progress, extendable prostheses have shown promising results but still face challenges such as high infection rates, requiring further technological innovation for better outcomes.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 6","pages":"578-588"},"PeriodicalIF":4.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overcoming the detrimental impact of volumetric muscle loss on segmental fracture healing via the induced membrane technique.","authors":"Andrew R Clark, Michael S Valerio, Jonathan Kulwatno, Sergey S Kanovka, Andrew L Ferrer, Christopher L Dearth, Stephen M Goldman","doi":"10.1302/2046-3758.146.BJR-2024-0334.R1","DOIUrl":"10.1302/2046-3758.146.BJR-2024-0334.R1","url":null,"abstract":"<p><strong>Aims: </strong>Open fractures pose a substantial treatment challenge, with adjacent muscle loss being a major complication. The induced membrane (IM) technique has shown promise in treating complicated fractures. The aim of this study is to investigate the impact of adjacent muscle trauma on segmental fracture healing using recombinant human bone morphogenetic protein-2 (rhBMP-2) via the IM technique.</p><p><strong>Methods: </strong>Skeletally mature male rats (n = 10 to 11 per group) underwent unilateral 3 mm segmental bone defects (SBD) of the tibial diaphysis or a composite tissue injury (CTI), which included a SBD along with volumetric muscle loss (VML). A polymethyl methacrylate (PMMA) spacer was formed within the SBD of each rat. After a four-week period, the PMMA spacer was removed, and the defect was treated with a rhBMP2-impregnated collagen sponge. Longitudinal micro-CT (µCT) imaging was conducted at baseline (Day 0) and at weeks 2, 4, 8, and 12 post-spacer removal to monitor fracture healing progress. At the 12-week postoperative mark, a comprehensive analysis was conducted, including endpoint µCT analysis, evaluation of neuromuscular function, tibia torsional testing, and histological examination.</p><p><strong>Results: </strong>Longitudinal µCT scans revealed no differences in bone formation or bone mineral density (BMD) at any timepoint between the SBD and CTI groups. High-resolution µCT analysis at the endpoint also showed no variations in bone quality. Torsion testing confirmed that VML did not affect bone strength. Notably, CTI animals exhibited an irreversible reduction in muscle mass and neuromuscular function, which was not observed in the SBD group.</p><p><strong>Conclusion: </strong>Introducing the additional challenge of VML alongside SBD did not hinder the effectiveness of the induced membrane technique in healing a critical-sized defect.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 6","pages":"568-577"},"PeriodicalIF":4.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection limitations of bacteria in tissue samples.","authors":"Tim Holm Jakobsen, Julius Bier Kirkegaard, Mads Lichtenberg, Lasse Andersson Kvich, Hans Gottlieb, Martin McNally, Thomas Bjarnsholt","doi":"10.1302/2046-3758.146.BJR-2024-0410.R1","DOIUrl":"10.1302/2046-3758.146.BJR-2024-0410.R1","url":null,"abstract":"<p><strong>Aims: </strong>Successful identification of bacteria in tissue samples requires careful consideration of multiple factors, including sample type and quality, the type of bacteria being detected, and the sensitivity and specificity of the detection method. Here, we address the issues of detecting a small number of bacteria, often found in biofilms and heterogeneously distributed in a large volume (the surgical site with suspected infection). Specifically, the study seeks to address the difficulties in detecting small numbers of bacteria, and to evaluate the impact of bacterial aggregation on the probability of successful detection.</p><p><strong>Methods: </strong>We present simple formulae for the probability of detecting bacteria in different infection scenarios where the number of bacteria and size of bacterial aggregates are incorporated as variables. We define a critical aggregation parameter, above which the probability of sampling bacteria decreases dramatically.</p><p><strong>Results: </strong>Our calculations demonstrate that aggregation of bacteria in tissues can strongly impact the probability of detection, where an increase in aggregate size results in a reduced probability of obtaining a positive biopsy. Our calculations underscore the challenges in effectively sampling tissue for diagnostic purposes, particularly in low-grade infections characterized by small bacterial quantities within aggregates. Below the critical aggregation parameter, obtaining five tissue specimens is associated with a high probability of detecting infection, but at a higher aggregation level, increasing the number of specimens is rendered ineffective, resulting in culture-negative diagnoses.</p><p><strong>Conclusion: </strong>We hypothesize that the high false-negative rate in diagnosing orthopaedic surgical site infections, such as periprosthetic joint infections, could be partly influenced by the heterogeneous bacterial distribution and the sampling complexities of such populations outlined here. Homogenization of tissue specimens is a technique to enhance the surface area which potentially could increase the detection of heterogeneously distributed bacteria.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 6","pages":"560-567"},"PeriodicalIF":4.7,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing reaming depth enhances implant stability while minimizing bone strain.","authors":"Monil Karia, Ruben Doyle, Adam Reynolds, Jonathan Jeffers, Justin Cobb","doi":"10.1302/2046-3758.146.BJR-2024-0118.R3","DOIUrl":"10.1302/2046-3758.146.BJR-2024-0118.R3","url":null,"abstract":"<p><strong>Aims: </strong>Increasing the interference fit of the acetabular component can increase primary stability, but it introduces excessive periacetabular strain during impaction, which can lead to fractures. An optimal outcome following cementless acetabular component impaction is maximal primary implant stability with minimal periacetabular bone strain. The aim of this study was to investigate whether a simple modification to a surgeon's reaming technique can achieve this desirable outcome.</p><p><strong>Methods: </strong>A custom drop rig simulated impaction strikes, seating acetabular components of either 1 mm or 2 mm interference fit into synthetic sawbones with cavities reamed to either a true hemisphere or a hemisphere with an enhanced reaming depth of 2 mm or 4 mm. Synthetic bone strain was recorded using strain gauges, and push-out tests were conducted to assess implant stability. Polar gaps were measured using optimal trackers.</p><p><strong>Results: </strong>Compared to a true hemispherical cavity, enhancing the reaming depth significantly increased the primary stability of the implant (p < 0.001) while reducing both the periacetabular strain and strain deterioration for both 1 mm and 2 mm interference fit components. A 4 mm reaming depth enhanced the primary stability of 1 mm press-fit components to a level almost equivalent to a 2 mm press-fit, albeit reducing strain to the bone. Enhancing reaming depth did not significantly affect polar gap.</p><p><strong>Conclusion: </strong>Enhancing cavity reaming depth is a simple technique to increase the implant primary stability of press-fit uncemented acetabular components, while avoiding any excess in periacetabular strain and the associated fracture risk.</p>","PeriodicalId":9074,"journal":{"name":"Bone & Joint Research","volume":"14 6","pages":"551-559"},"PeriodicalIF":4.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}