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Orthobiologics are biologically derived materials which aim to promote healing and regeneration of tissues that are the focus of orthopedic surgery. Since bones, ligaments, tendons, and cartilage have different healing and regeneration characteristics, treatment strategies and clinical problems related to these tissues greatly differ. Although orthobiolgics are an old concept, most of the advancements in this field have been accomplished within the last two decades. A large number of promising laboratory studies show that orthobiolics hold a great potential in launching the next chapter of orthopedics. In this article, the use, research on this subject, future potential of orthobiologics, and the tissues in focus have been briefly reviewed.

Background and purpose — The nonagenarian (those aged 90 years and older) population is expected to double in the next 20 years. This demographic age quake may have a significant impact on the incidence of total knee arthroplasty (TKA), although current literature provides limited data. We examined death and revision rates, patient-reported outcomes (PROs) and bias on patient selection of nonagenarian patients operated on with TKA for osteoarthritis (OA) between 2000 and 2016.Patients and methods — The Swedish national knee arthroplasty register was used to identify 329 nonagenarians (mean age, 92 years). Each patient was followed-up until death or the end of 2017. PRO data of 22 of these patients were compared with 65- to 74-year-old patients operated in 2015, from the same register.Results — 5 patients (1.5%) died within 90 days and 23 (7%) patients died within 365 days after TKA. 8 patients (2.4%) developed knee complications that needed revision. For patients followed for 5 and 10 years, more than 50% and 10%, respectively, lived without being revised. The patients had statistically significant improvements in PROs, not significantly different from the younger SKAR cohort. However, the material is small and this statistical finding does not preclude that there may be clinically relevant differences. TKA incidence was different amongst the 21 counties in the country (range, 0–5.1/10,000).Interpretation — Our study suggests that nonagenarians with knee OA qualify for TKA, having similar outcomes to younger patients. The data presented may help surgeons and patients assessing the risks and outcome associated with the procedure.

Purpose Whether ultra-congruent (UC) or posterior cruciate ligament-stabilized (PS) inserts should be used in posterior cruciate ligament (PCL)-sacriicing total knee arthroplasty (TKA) remains debatable. Therefore, the aim of this prospective randomized controlled study was to compare the isokinetic performance and clinical outcomes of these inserts in PCLsacriicing TKA. Methods Sixty-six patients diagnosed with primary knee osteoarthritis were randomly assigned to either the UC or the PS group. There were no signiicant diferences between the groups in terms of age, body mass index or sex. The Knee Society score (KSS) and isokinetic performance results for each patient were recorded preoperatively and at 3, 6 and 12 months postoperatively. The physiatrist that performed the isokinetic tests and the patients were blinded to the study groups. Results There were no signiicant diferences between the groups in terms of the preoperative KSS or isokinetic performance. Gradual improvement in the KSS was observed in both groups, but no signiicant diferences were detected between the groups during the whole follow-up period. The UC and PS groups exhibited similar peak extension and lexion torque values normalized to body weight at 3, 6 and 12 months postoperatively (p > 0.05). ConclusionThe use of UC or PS inserts in TKA did not afect the clinical outcomes or isokinetic performance.The clinical relevance of this study is that the potential diferences in clinical outcomes and isokinetic performance between UC and PS inserts do not need to be considered when sacriicing the PCL in TKA. Level of evidence I.

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Objectives The aim of this study was to compare the smartphone- based gait analysis data of patients who underwent total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). Patients and methods Between January 2016 and April 2019, a total of 51 patients (3 males, 48 females; mean age: 60.92 years; range, 51 to 70 years) who were operated with UKA or TKA in our clinic were retrospectively analyzed. The patients were divided into two groups according to the type of procedure as the UKA group (n=17) and unilateral TKA group (n=34). Gait analysis was made via a smartphone application (Gait Analyzer software version 0.9.95.0) with data acquired from the accelerometer of the smartphone. This analysis was performed using data collected from the Acceleration Sensor LSM6DSO into the Samsung Galaxy Note 10 Plus phone. Gait velocity, step time, step length, cadence, step time symmetry, step length symmetry, and vertical COM (vert-COM) parameters were measured. Results There were no statistically significant differences between the groups in respect of age, sex, body mass index, operated side, and follow-up duration. Compared to the TKA group, the UKA patients showed a better gait pattern in gait velocity (p=0.03), step time symmetry (p=0.005), and step length symmetry (p=0.024). No significant difference was detected in step time (p=0.807), step length (p=0.302), cadence (p=0.727) and vert-COM parameters (p=0.608). Conclusion The gait of UKA patients is closer to the physiological pattern with a better gait velocity, step time symmetry, and step length symmetry than TKA patients. The surgical treatment option of UKA for knee medial compartment osteoarthritis leads to a better gait pattern than TKA.

Cartilaginous tumors of the skeleton are amongst the most common; however, differential diagnosis remains to be a challenge. [1,2] These neoplasms range from enchondromas to chondrosarcomas with diagnostic margin being rather vague, particularly between enchondromas and low-grade chondrosarcomas where misdiagnosis may bring burdensome consequences. Currently, clinical discrimination mainly relies on location, radiologic, and pathologic properties of the tumor which yield little agreement between different clinicians for each patient. The need for a reliable and easily generalizable criteria is evident; however, there are no specific biomarkers available in the clinical setting despite ongoing studies. [3,4] Recent decade has seen many reports delivering evidence on the role of inflammation in the development and carcinogenic advancement of neoplasms, although pathways remain mainly unknown up to this date. [5,6] Therefore, blood-based markers of inflammation such as inflammatory cell counts and rates which are derived from those, Objectives: This study aims to evaluate the role of elevated neutrophil-to-lymphocyte ratio (NLR) and monocyte-tolymphocyte ratio (MLR) in differential diagnosis of enchondroma and low-grade chondrosarcoma. Patients and methods: One-hundred-and-one patients (44 males, 57 females; mean age 53.6±11.5 years; range, 21 to 85 years) diagnosed with enchondroma and low-grade chondrosarcoma in Ankara Oncology Training and Research Hospital between January 2010 and December 2019 were included in this retrospective study. Patients' age, gender, location and type of tumor, and pre-treatment complete blood count results were acquired. One-hundred patients (48 males, 52 females; mean age 50.9±13.6 years; range, 19 to 76 years) with complete blood count results admitted to the same center for reasons other than fracture, infection or tumors with similar age and gender to the aforementioned study group were included as healthy controls. Results: Neutrophil-to-lymphocyte ratio and MLR of the study group were found to be significantly higher than the control group (p<0.001). Neutrophil-to-lymphocyte ratio and MLR held diagnostic importance with statistically significant cutoff values. Statistically significant cutoffs for NLR and MLR were ≥2.0 (sensitivity=73.3%, specificity=67%) and ≥0.2 (sensitivity=76.2%, specificity=63%), respectively. Multivariate logistic regression analysis was performed adjusting for age and gender and NLR ≥2 [odds ratio (OR)=3.1] or MLR ≥0.2 (OR=2.9) were found to be associated with approximately threefold risk for diagnosis of enchondroma or low-grade chondrosarcoma. Conclusion: The NLR and MLR have diagnostic value in cartilaginous tumors such as enchondroma and low-grade chondrosarcoma. However, our results do not support utilization of NLR and MLR as diagnostic value for differentiation of enchondroma and low-grade chondrosarcoma.

This study aims to test the feasibility of the Fracture and Mortality Risk Evaluation (FAME) Index. Patients and methods: Two academic centers in Lithuania and Turkey participated in this retrospective study conducted between November 2018 and July 2019. A total of 100 consecutive patients (22 males, 78 females; mean age 78.9 years; range, 45 to 100 years) with low energy proximal femur fractures admitted for surgery were included in the study. Fracture Risk Assessment tool (FRAX) and the Sernbo scores were calculated and patients were classified into one of the nine subcategories of the FAME Index. Results: Demographics and FAME Index classifications were similar between centers. Patients with high risk of fracture and low risk of mortality accounted for 18% of all patients, which is the FAME Index subcategory to theoretically benefit from cancellous bone augmentation during internal fixation of a fragility hip fracture the most. Conclusion: The FAME Index was successfully applied in clinical emergency setting utilizing a simple form, and demonstrated promising potential in stratification of hip fractures most suitable for screw and device augmentation. Larger studies with at least one-year of follow-up are warranted to verify the validity of FAME Index.