The proper diagnosis and treatment of patients with concurrent hip and spine pathological processes can be challenging because of the substantial overlap in symptomatology.There is no consensus on which pathological condition should be addressed first.Factors such as advanced spinal degeneration, deformity, and prior fusion alter the biomechanics of the spinopelvic unit. Attention should be paid to recognizing these issues during the work-up for a total hip arthroplasty as they can result in an increased risk of dislocation.In patients with concurrent spine and hip degeneration, the surgeon must pay close attention to appropriate implant positioning and have consideration for implants with enhanced stability to minimize the risk of dislocation.A proper understanding of sagittal balance and restoration of this balance is integral to improving patient outcomes following spinal surgery.The advent of new imaging modalities, increased awareness of spinopelvic mobility, as well as a better understanding of sagittal alignment will hopefully improve our treatment of patients with hip-spine syndrome.
Osteoporosis screening, diagnosis, and treatment have gained much attention in the health care community over the past 2 decades. During this time, creation of multispecialty awareness programs (eg, “Own the Bone,” American Orthopedic Association; “Capture the Fracture,” International Osteoporosis Foundation) and improvements in diagnostic protocols have been evident. Significant advances in technology have elucidated elements of genetic predisposition for decreased bone mineral density in the aging population. Additionally, several novel drug therapies have entered the market and provide more options for primary care and osteoporosis specialists to medically manage patients at risk for fragility fractures. Despite this, adherence to osteoporosis screening and treatment protocols has been surprisingly low by health care practitioners, including orthopedic surgeons. Continued awareness and education of this skeletal disorder is crucial to effectively care for our aging population. [ Orthopedics . 2023;46(1):e20–e26.]
Cold plasmas induce angiogenesis, enhance coagulation and wound healing, and selectively ablate microbes without harming eukaryotes. Work on bone tissue has been minimal; initial studies show enhanced osseointegration, increased gene transcription, and mesenchymal stem cell growth. Mesenchymal stem cell osteoblastic differentiation is required for bone formation and healing. The present study employs a novel device to assess whether cold argon plasma induces osteogenic differentiation of human mesenchymal stem cells. Human ionized argon gas, argon plasma, and argon plasma with osteogenic stimulation. Known osteoblastic differentiation markers (alkaline phosphatase, osteocalcin, RANKL) were assessed on days 1, 10, and 28. Cellular DNA production was measured for normalization. Novel dielectric distance 22 mm, and duration 30 sec. Alkaline phosphatase level was decreased compared to line phosphatase (p < 0.0014) compared to other groups. Osteogenic stimulation did not result in difference from growth. Changes in osteocalcin or receptor activator of nuclear factor kappa-B ligand (RANKL) were not observed. plasma to induce osteoblastic differentiation cannot be made. Lack of-glycerophosphate addition on day 14 prevented osteogenic media from responding as expected. Interestingly, nonpossibly due to argon shielding or shear force production, merits further study.
Objective:Cefazolin is a heat-labile antibiotic that is not usually added to polymethylmethacrylate (PMMA) cement spacers because it is believed to be inactivated by the high polymerization temperatures. The purpose of this study was to compare cefazolin versus vancomycin high-dose antibiotic cement spacers.Methods:High-dose antibiotic PMMA spacers with either cefazolin or vancomycin were fabricated. Setting time, compressive strength, and compression modulus of spacers were measured. Spacers were emerged in saline, and the eluent was tested on days 1, 2, 3, 7, 14, and 30 to determine the zone of inhibition of methicillin-sensitive Staphylococcus aureus and estimate the cumulative antibiotic released.Results:Cefazolin, compared with vancomycin-loaded spacers, had significantly shorter setting time [mean difference (MD) −1.8 minutes, 95% confidence interval (CI), −0.6 to −3.0], greater compressive strength (MD 20.1 megapascal, CI, 15.8 to 24.5), and compression modulus (MD 0.15 megapascal, CI, 0.06 to 0.23). The zone of inhibition of eluent from PMMA-C spacers was significantly greater than PMMA-V spacers at all time points, an average of 11.7 ± 0.8 mm greater across time points. The estimated cumulative antibiotic released from cefazolin spacers was significantly greater at all time points (P < 0.0001).Conclusions:Cefazolin was not inactivated by PMMA polymerization and resulted in spacers with superior antimicrobial and biomechanical properties than those made with vancomycin, suggesting that cefazolin could play a role in the treatment of infected bone defects with high-dose antibiotic PMMA spacers.
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