Patients requiring early surgical treatment for wound-healing problems after primary total knee arthroplasty are at significantly increased risk for further complications, including deep infection and/or major subsequent surgery, specifically, resection arthroplasty, amputation, or muscle flap coverage. These results emphasize the importance of obtaining primary wound-healing after total knee arthroplasty.

Patients who return to the operating room within thirty days after the index total knee arthroplasty for evacuation of a postoperative hematoma are at significantly increased risk for the development of deep infection and/or undergoing subsequent major surgery. These results support all efforts to minimize the risk of postoperative hematoma formation.

Disc bulging increases with the severity of disc degeneration. Grade I discs demonstrate the expected sagittal migration in response to postural load. However, more degenerative discs behave less predictably, and spine extension may result in significant posterior disc bulging. Degenerative changes in the intervertebral disc significantly affect the kinematic patterns under postural load in vivo. kMRI is a useful tool to quantify the kinematic behavior of degenerative intervertertebral discs.

Previous studies have explored the link between bone regeneration and skeletogenesis. Although a great deal is known regarding tissue and cell based events, especially those involving ossification and chondrogenesis, much remains unknown about the molecular similarity of repair and development. Since the functional significance of Homeobox (Hox) genes in embryonic skeletogenesis has been well documented through knockout and deficiency studies, we chose to investigate whether members of this family are reactivated during fracture repair. Specifically, we examined the temporal and spatial expression of Msx-1, Msx-2, rHox, Hoxa-2 and Hoxd-9, because of their involvement in limb development. Utilizing quantitative reverse transcriptase RT-PCR (qPCR), mRNA levels from all five genes were shown to be upregulated during fracture repair at all times tested (post-fracture day 3-21), as compared to intact bone. Further, using in situ hybridization and immunohistochemistry, spatial expression of these genes was localized to osteoblasts, chondrocytes and periosteal osteoprogenitor cells found within the fracture callus, the foremost cells responsible for the reparative phase of the healing process. Given the contribution of Hox genes in skeletal development, our results suggest that these genes are involved in either the patterning or formation of the fracture callus, further supporting the notion that bone regeneration recapitulates skeletal deirelopment .

BBP may reduce the time to fusion and more thoroughly control the distribution of bone healing in spinal fusion. Further study is ongoing to explore clinical applications.

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