1,721,479 research outputs found
Effect of age on cost-effectiveness of unicompartimental knee arthroplasty compared with total knee arthroplasty in the US
No full textOriginally conceived as a treatment for joint disease in the
elderly, joint replacement surgery grew substantially during
1990s and 2000s in both the elderly and the younger patient
population, with an increasing utilization expected to exceed
one million annually by 2020 (1).
Arthroplasties are major orthopaedic procedures that are
reliable and cost-effective and deliver excellent long clinical
and patient-reported outcomes (2,3) with extensive medical
and non-medical benefits for patients and society. In fact,
working-age individuals may gain a higher likelihood of
employment and a higher mean annual income with fewer
missed work days (4)
Intra-articular platelet-rich plasma for the treatment of osteoarthritis
No full textPlatelet-rich plasma (PRP) is an autologous blood derivative
that has been used in different medical fields, ranging from
dermatology to ophthalmology and orthopaedic surgery,
with the aim of stimulating tissue healing through the local
administration of a milieu of platelet-derived growth factors
and other bioactive molecules (1). In the orthopaedic
practice its main application is in sports medicine (2,3) and
in the treatment of degenerative disorders, in particular
osteoarthritis (OA) (4). Due to its intrinsic features, PRP is
believed to play a beneficial role in joint tissue homeostasis,
exerting a positive modulation on all the articular tissues
involved in the OA degenerative process, i.e., cartilage,
menisci, and synovia (5)
Reciprocity : where art meets the community : action research in response to artistic encounters and relationships
No full textThis practice-led research project examines some of the factors and issues facing artists working in the public domain who wish to engage with the community as audience. Using the methodology of action research, the three major creative projects in this study use art as a socio-political tool with the aim of providing an effective vehicle for broadening awareness, understanding forms of social protest and increasing tolerance for diversity. The three projects: Floodline November 7, 2004, Look in, Look out, and The Urban Terrorist Project, dealt with issues of marginalisation of communities, audiences and graffiti artists respectively. The artist/researcher is outlined as both creator and collaborator in the work. Processes included ephemeral elements, such as temporary installation and performance, as well as interactive elements that encouraged direct audience involvement as part of the work. In addition to the roles of creator and collaborator, both of which included audience as well as artist, the presence of an outside entity was evident. Whether local, legal authorities or prevailing attitudes, outside entities had an unavoidable impact on the processes and outcomes of the work. Each project elicited a range of responses from their respective audiences; however, the overarching concept of reciprocity was seen to be the crucial factor in conception, artistic methods and outcomes
Bone marrow edema and results after cartilage repair
Full text linkBone marrow edema (BME) has been described in several areas of both knee pathology and treatment, with the first reports dating back more than two decades ago. However, even
though a very long time has passed since the first description by Wilson et al. in 1988 (1), BME remains a controversial entity not only in terms of clinical impact, but also for its still
unknown significance in etiopathological processes
Electrochemical incineration of oxalic acid in the presence of NaCl
Full text linkRecent researches have demonstrated that electrochemical methods offer an attractive alternative to traditional routes for treating wastewaters containing toxic or/and refractory organic pollutants. The effectiveness of the electrochemical treatment depends on many factors including the presence in solution of specie able to act as mediators. In particular, the effect of chloride ions on the performances of the process has been the object of numerous researches. However, up to now, many practical and theoretical aspects about this argument are not completely clear. In the present work, the anodic incineration of oxalic acid (OA) in the presence of NaCl has been investigated with the aim of studying in a systematic way the influence of numerous parameters, such as the current density, the flow rate, the OA, the NaCl concentrations and the pH on the performances of the process and to individuate the optimal operative conditions. Oxalic acid was chosen as model substrate for its low reactivity toward anodic oxidation, which also results in an incomplete mineralization of more complex organics. Furthermore, the oxidation of this simple molecule does not involve the formation of stable intermediates thus giving rise to a more easy rationalizing of experimental results. Since the effect of NaCl on the process is expected to depend on the nature of the electrodic material, two very different anodes were used: the Ti/IrO2-Ta2O5 which presents a quite low oxygen overpotential and boron doped diamond (BDD) which is probably one of the more promising materials for the electrochemical incineration
Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy-a systematic review
No full textPlatelet-rich plasma (PRP) has been introduced in the clinical practice to treat a growing number of different musculoskeletal pathologies. It is currently applied in the treatment of Achilles and patellar tendinopathies, which are common sport-related injuries very challenging to manage. Aim of the present paper was to review systematically the available clinical evidence concerning the application of PRP in the treatment of patellar and Achilles tendinopathy. A systematic review of the literature was performed according to the following inclusion criteria for relevant articles: (1) clinical reports of any level of evidence, (2) written in the English language, (3) with no time limitation and (4) on the use of PRP to treat conservatively Achilles and patellar tendinopathy. Twenty-two studies were included and analyzed. Two studies on patellar tendinopathy were randomized controlled trials (RCTs), whereas just one RCT was published on Achilles tendon. All the papers concerning patellar tendon reported positive outcome for PRP, which proved to be superior to other traditional approaches such as shock-wave therapy and dry needling. In the case of Achilles tendon, despite the encouraging findings reported by case series, the only RCT available showed no significant clinical difference between PRP and saline solution. The main finding of this study was the paucity of high-level literature regarding the application of PRP in the management of patellar and Achilles tendinopathy. However, the clinical data currently available, although not univocal, suggest considering PRP as a therapeutic option for recalcitrant patellar and Achilles tendinopathies
Second generation issues in cartilage repair
No full textIn recent years, regenerative techniques, such as autologous chondrocyte implantation (ACI), have emerged as a potential therapeutic option for the treatment of chondral lesions. However, the good results reported have to be weighed against the number of problems that can be observed with traditional ACI methods. To address these problems, the so-called second generation ACI techniques have been developed. Autologous chondrocyte transplantation on a 3-dimensional matrix was introduced in clinical practice from 1998 to 1999 and results at short to medium-term follow-up are well documented for different types of scaffolds. These techniques may be used for the treatment of large chondral lesions in the young, active population and highly competitive athletes, but long-term and randomized controlled studies will be needed to confirm reliability of these procedure
Meniscal allograft transplantation combined with anterior cruciate ligament reconstruction provides good mid-term clinical outcome
No full textPurpose: Aim of this study is to document if combined meniscal allograft transplantation (MAT) and ACL reconstruction can improve knee function, reduce pain and allow patients with meniscal defect and ACL lesion to resume sport activities. Methods: Fifty MAT, arthroscopically performed without bone plugs and combined with one-stage primary or revision ACL reconstruction, with or without high tibial osteotomy (HTO), were included. Patients (aged 38.2 ± 10.6 years, 87% males) were evaluated at a mean follow-up of 5 years with Lysholm, Tegner and VAS scores. Patient satisfaction was also recorded, together with complications and failures. Results: VAS and Lysholm scores improved significantly (from 63.7 to 24.5 and from 60.6 to 82.7, respectively, p < 0.001), while the Tegner score did not reach pre-injury values (p < 0.001), but it improved significantly compared to pre-surgery values (from 2.8 to 4.6, p < 0.001). Medial MAT reported significantly better results compared to lateral MAT. Patients undergoing concomitant HTO reported a significantly higher decrease of VAS. Younger patients with higher pre-operative pain and lower activity level presented higher satisfaction. Eight patients needed a reoperation. Three patients were considered surgical failures while four were considered clinical failures, for a total of 15% failures. Conclusions: Meniscal allograft transplantation combined with ACL reconstruction represents a safe and suitable treatment, which should be considered as a suitable option in the clinical practice. All evaluated patient profiles, ACL injury in a patient with post-meniscectomy syndrome, failed ACL reconstruction in patients with a meniscus defect, and ACL reconstruction in patients with malalignment due to meniscal defect, benefited from the combined MAT procedure at medium-term follow-up. Level of evidence: IV
Cartilage failures. Systematic literature review, critical survey analysis, and definition
No full textWhile midterm results of matrix-assisted autologous chondrocyte transplantation (MACT) are now available, less attention has been paid to the evaluation of failures of this surgical approach. Aim of this study was to analyse how "failures" are generally defined in cartilage surgery, in order to understand how the survival rate may change according to different definitions of failure.A systematic review on MACT in the knee was conducted to report failure rates as well as different failure definitions in the available literature. Afterwards, we analysed the survival curve at 8.5-year follow-up of a survey of 193 patients treated with MACT. Using different definitions to identify failures, we compared how the survival rate changed according to the different definitions of failure.The systematic review on 93 papers showed that the average failure rate reported on 3,289 patients was 5.2 \% at a mean 34 months of follow-up. However, 41 studies (44.1 \%) did not even consider this aspect, and failures were variously defined, thus generating confusing data that make a meta-analysis or a study comparison meaningless. The failure analysis of the MACT survey showed that the survival curve changed significantly depending on the definition applied; in fact, the failure rate ranged from 3.6 to 33.7 \%. According to a critical literature and survey analysis, we proposed a combined surgical- and improvement-based definition which led to a failure rate of 25.9 \% at midterm/long-term follow-up.Nowadays, failure definitions of cartilage treatments differ in scientific articles, thus generating confusion and heterogeneous data even when applied to the same cohort of patients. While the literature analysis shows a low number of failures, this study demonstrated that if properly addressed with a comprehensive definition, the real failure rate of cartilage surgical procedures in the knee is higher than previously reported. Recognizing failures would give a better understanding and a more realistic prognosis to patients and physicians seeking treatment for cartilage lesions. LEVEL OF EVIDENCE: IV
- …
