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IV.

The press-fit technique is an efficient procedure. Its outcome was comparable with the interference screw group. Furthermore it has unlimited bone-to-bone healing, no need for removal of hardware, ease for revision and cost effectiveness.

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Post-operative total hip arthroplasty surgical wound infections are associated with substantial morbidity, mortality, and economic burden. Intra-wound vancomycin powder application may prevent infections after hip surgery. The objectives of this study is to answer the question as to whether the application of 2 gram intra-wound vancomycin powder In patients undergoing total hip arthroplasty, lead to reduced rates of postoperative surgical site infections or not? From April 2013, 125 patients had consent prior to their hip surgery. These 125 patients had total hip arthtoplasty by three different surgeons at Imam Hossein hospital. All patients received either 2 grams of IV Cefazolin one hour prior to the incision or 1 gram of IV Vancomycin one hour prior to the incision in patient with a Penicillin allergy. Near the end of the procedure, the wound was thoroughly irrigated with normal saline. for All patients befor surgical wound closure 2 gram of Vancomycin powder was poured into the wound. Postoperatively, patients continued on intravenous antibiotics for twenty-four hours. All patients underwent routine postoperative surgical care including physical therapy, routine radiographs, and routine managment of pain medications. Laboratory tests include Hb , BUN, Cr and electrolits were done before surgery and postoperatively after 48 hours and 7 days. All patients were discharged within the first 3 days after surgery and follow-up at weeks 2 and 4 and one year after surgery was performed. During the course of follow up that has ranged from one months to one year, sixteen of patients experienced surgical site infection. 10 patients were lost to follow up. No allergic reactions or adverse outcomes were reported from the use of 2 gram of Vancomycin powder prior to closure. Although intra-wound application of Vancomycin is known to minimize infections in spinal surgery little previous studies reported if Vancomycin application will reduce surgical site infection in hip surgeries. This study demonstrates that intra-wound application of Vancomycin reduces surgical site infection in total hip arthroplasty without any adverse complications.

Bone-related diseases are major contributors to morbidity and mortality in elderly people and the current treatments result in insufficient healing and several complications. One of the promising areas of research for healing bone fractures and skeletal defects is regenerative medicine using stem cells. Differentiating stem cells using agents that shift cell development towards the preferred lineage requires activation of certain intracellular signaling pathways, many of which are known to induce osteogenesis during embryological stages. Imitating embryological bone formation through activation of these signaling pathways has been the focus of many osteogenic studies. Activation of osteogenic signaling can be done by using small molecules. Several of these agents, e.g., statins, metformin, adenosine, and dexamethasone have other clinical uses but have also shown osteogenic capacities. On the other hand, some other molecules such as T63 and tetrahydroquinolines are not as well recognized in the clinic. Osteogenic small molecules exert their effects through the activation of signaling pathways known to be related to osteogenesis. These pathways include more well-known pathways including BMP/Smad, Wnt, and Hedgehog as well as ancillary pathways including estrogen signaling and neuropeptide signaling. In this paper, we review the recent data on small molecule-mediated osteogenic differentiation, possible adjunctive agents with these molecules, and the signaling pathways through which each small molecule exerts its effects. Graphical Abstract

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