Search Results (285)

Background/Objectives: The aim of this study is to investigate how the joint, the number and the type of prior revision surgeries influence the diagnostic thresholds for synovial cell count for patients who undergo their first total hip or knee arthroplasty revision compared to re-revisions, as different cutoffs might substantially influence treatment courses. Methods: In this retrospective single-center register analysis, data from 214 revised THAs (total hip arthroplasties) and TKAs (total knee arthroplasties) were collected, of which 103 (48.1%) have so far undergone at least one revision surgery. Diagnosis was based on the EBJIS criteria, and we identified 163 (76.2%) septic and 51 (23.8%) aseptic cases. Data on synovial cell count were collected and analyzed for their diagnostic accuracy and optimal cutoffs. For re-revisions, a covariate-adjusted ROC (receiver operating characteristic) for the joint, type of previous surgery and number of surgeries was created. Results: We found no significant differences in cell counts between patients before first revision compared to those undergoing re-revision for septic (p = 0.40) and aseptic indications (p = 0.84). The overall diagnostic accuracy was high for all re-revision cases, with a sensitivity of 0.86, specificity of 0.91, AUC (area under the curve) of 0.92, at an optimal cutoff value of 2439.50 G/L. As for re-revised hip joints, the optimal cutoffs were higher compared to knee joints (2439.5 G/L vs. 2626.5 G/L, hip AUC = 0.90, knee AUC = 0.93, p = 0.14). Furthermore, the AUCs for cell count differed significantly depending on the type of previous surgery in re-revision (p = 0.03). The covariate-adjusted analysis showed no significant differences compared to the unadjusted analysis. Conclusions: Cell count remains reliable for diagnosing periprosthetic joint infection in patients with prior revisions, with minor threshold variations from the EBJIS (European Bone and Joint Infection Society) criteria. While the type of preceding revision affects accuracy, the diagnostic value remains consistently high overall. Full article

Background/Objectives: This study was designed to verify the hypothesis that graphical cell differentiation of synovial cell count analysis is helpful for diagnosis of acute periprosthetic joint infection (PJI) and that the additional erythrocyte field has advantages to differentiate PJI from hematoma. Methods: A total of 77 total knee arthroplasties and 31 total hip arthroplasties underwent aspiration within six weeks of primary implantation. The aspirate was analyzed with the cell counter Yumizen H500 and examined by cultivation. Serum CRP was also determined. A total of 43 patients underwent revision and microbiological and histological analysis of the periprosthetic tissue, according to Morowitz and Krenn, was performed. The ICM criteria for diagnosing PJI were used. Results: Thirty-two cases (29.6%) were classified as acute infection. The graphical type differentiation LMNE (leukocyte–monocyte–neutrophil–eosinophil) showed 28 cases with type II (infection type), 63 cases with type IV (indifferent type), 13 cases with type V (hematoma type with a peak in the erythrocyte field) and 4 cases with type VI (mixed infection and hematoma). The LMNE matrix assessment had an accuracy of 98.7%, sensitivity of 96.9%, specificity of 98.7%, positive predictive value of 96.9%, negative predictive value of 98.7%, a positive likelihood ratio of 73.62, and a negative likelihood ratio of 0.03. Only one single non-infectious hematoma sample was misclassified as type VI (mixed infection/hematoma). Conclusions: The graphical type differentiation of the cell count analysis of synovial aspirates is a helpful method for diagnosis of acute periprosthetic joint infection and differentiating between hematoma and real early periprosthetic infections. This report shows that the new erythrocyte field of the Yumizen H500 is a useful additional diagnostic tool. Full article

Background: Septic arthritis of the hip (SAH) requires emergent surgical intervention. While open arthrotomy has been the traditional approach, arthroscopic treatment is emerging as an effective alternative. Tractionless techniques in adult populations remain understudied. Methods: Twenty-one patients (22 hips) met inclusion criteria. Six patients (7 hips) were excluded for age < 18 years, post-COVID osteomyelitis, prior hip surgery, or insufficient records, resulting in a final cohort of 15 patients. All fifteen patients underwent tractionless arthroscopic irrigation and debridement for suspected SAH (2014–2023). Inclusion required ≥2 clinical criteria (hip pain, limited range of motion, inability to bear weight, fever > 38 °C) AND ≥ 1 laboratory criterion (leukocytosis, elevated CRP, synovial WBC > 50,000, positive culture). Primary outcomes included Visual Analog Scale pain scores, inflammatory markers, and complications. Results: Median age was 33 years (range 20–76); 60% were female. VAS scores improved from 7 (6–10) to 1 (0–3) at discharge (p < 0.001). CRP levels decreased from 115 mg/L (35–206) to <5 mg/L (<5–9) postoperatively (p < 0.001). Positive cultures were obtained in 26.7% of cases, predominantly methicillin-sensitive Staphylococcus aureus. No perioperative complications occurred. Histopathological analysis revealed tenosynovial giant cell tumor (TGCT) in 33.3% of cases, representing an important differential diagnosis. Among non-TGCT cases, the culture-positive rate was 40%. No infection recurrence was observed during a minimum one-year follow-up. Conclusions: Tractionless arthroscopic irrigation and debridement appears effective for managing suspected SAH in adults, achieving significant improvements in pain scores and inflammatory markers without perioperative complications. This technique offers potential advantages by eliminating traction-related risks while maintaining effective joint debridement. Additionally, TGCT should be considered in the differential diagnosis of suspected SAH with culture-negative inflammatory arthropathy. Full article

Parkinson’s disease is a neurodegenerative disorder disease that worsens over time and involves the deterioration of nerve cells in the brain. Gait analysis has emerged as a promising tool for early detection and monitoring of Parkinson’s disease. However, the accurate classification of Parkinsonian gait is often compromised by missing body keypoints, particularly in critical regions like the hip and legs that are important for motion analysis. In this study, we propose RecovGait, a novel method that combines a gated initialization technique with unscented tracking to recover missing human body keypoints. The gated initialization provides initial estimates, which are subsequently refined through unscented tracking to enhance reconstruction accuracy. Our findings show that missing keypoints in the hips and legs significantly affect the classification result, with accuracy dropping from 0.8043 to 0.5217 in these areas. By using the gated initialization with an unscented tracking method to recover these occluded keypoints, we achieve an MAPE value as low as 0.4082. This study highlights the impact of hip and leg keypoints on Parkinson’s disease gait classification and presents a robust solution for mitigating the challenges posed by occlusions in real-world scenarios. Full article

Pearl color is the primary determinant of its value, and the mantle donor tissue (saibo) used in pearl culture plays a critical role in color formation. To elucidate the molecular mechanisms underlying nacre color, we performed comparative transcriptomic analyses of saibo tissues from Sinohyriopsis cumingii displaying three representative phenotypes: white (W), purple (P), and golden (G). A total of 364 differentially expressed genes (DEGs) (102 upregulated and 162 downregulated genes) were identified in W vs. P. A total of 770 DEGs (467 upregulated and 303 downregulated genes) were identified in W vs. G. KEGG pathway analysis revealed significant differences in the expression of genes mainly involved in pigment-based and structural coloration, including amino sugar and nucleotide sugar metabolism (ko00520), cell adhesion molecules (ko04514), tyrosine metabolism (ko00350), ECM-receptor interaction (ko04512), and PI3K-Akt signaling pathway (ko04151). Subsequent integrative analyses across W vs. P and W vs. G groups identified 45 key regulatory genes, which were classified into four functional categories: extracellular matrix protein synthesis and biomineralization (e.g., chit, silkmaxin, bmp2/7, profilin, perlucin2), organic pigment metabolism (e.g., tyr, typ, dbh, bco2, gst5, ldlr, cpox, pks-like 1, pks15), metal ion metabolism and accumulation (e.g., hip-like, fcr1, ferritin 2), and epigenetic regulation (e.g., metK, mbd4/6, mettl24/27, alkbh6). Taken together, our findings reaffirm the complex nature of pearl coloration and reveal that structural coloration, pigment biosynthesis, and epigenetic modulation collectively shape nacre color formation, which paves the way for further functional elucidation of color-related genes and facilitates selective breeding practices in S. cumingii. Full article

Osteoarthritis (OA), a degenerative joint disease primarily affecting the hips and knees, is characterized by multifactorial dysregulation of chondrocyte homeostasis and currently lacks curative treatment options. Intra-articular hyaluronic acid (HA) injections have clinically provided symptomatic relief for three decades; however, HA’s rapid in vivo degradation by free radicals and hyaluronidases limits its efficacy. We hypothesized that adding niacinamide (vitamin B3) to linear HA hydrogels would provide ancillary anti-inflammatory and anti-catabolic properties, thereby improving HA-based viscosupplementation therapy. This preliminary preclinical mechanistic study investigated the functional effects of incorporating niacinamide into linear HA-based hydrogels using in vitro cellular models. Initially, Raw 264.7 macrophages and C28/I2 or SW1353 human chondrocytes were pre-treated with varying concentrations of HA/B3, with or without lipopolysaccharide (LPS) or interleukin-1β (IL-1β), respectively. Subsequently, pro-inflammatory and pro-catabolic markers were quantified biochemically. Results demonstrated that HA/B3 hydrogels exhibited enhanced functional stability compared to HA alone and possessed significant anti-inflammatory and anti-catabolic properties, without inducing cytotoxicity in either cell line. In Raw 264.7 macrophages, HA/B3 inhibited LPS-induced tumor necrosis factor-α (TNF-α) release and suppressed cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) protein expression. In vitro, HA/B3 hydrogels reduced IL-1β-induced IL-6 production in primary chondrocytes by 16% and suppressed PGE₂ concentration in both macrophages and chondrocytes by 60%, effects superior to HA alone. Finally, a rat primary articular chondrocyte model suggested slight anti-hypertrophic effects of HA/B3 in vitro. Collectively, these findings suggest that HA/B3 hydrogels possess anti-arthritic potential, highlighting a novel strategy for next-generation viscosupplement systems. Full article

Background: Sickle cell disease (SCD) affects more than 100,000 people in the United States and 8 million people worldwide, with high morbidity and mortality and musculoskeletal (MSK) complications that contribute to functional disability. However, MRI-based characterization of musculoskeletal manifestations remains limited in high-prevalence regions, including the Middle East. This study aimed to review MRI findings of MSK manifestations in SCD patients and assess associations with clinical characteristics. Methods: A retrospective study was conducted on 96 patients with SCD who underwent MSK MRI between 2012 and 2022 at King Abdulaziz University Hospital. Patient demographics, clinical characteristics, and imaging findings were reviewed. The prevalence and distribution of MSK complications were analyzed across age, gender, and BMI categories. Results: Of the 96 patients (47% males; 53% females; mean age 28.9 years), the hip was the most frequently scanned region (46%), followed by the leg, femur, shoulder, and knee. Bone infarction was the most common complication, observed in 57 patients (59.3%), and was more prevalent among older adults. Osteomyelitis was identified in 16 patients (16.7%), with higher rates in children and underweight individuals. Decreased bone marrow signal intensity was seen in 11 patients (11.4%), particularly in older age groups. Other findings and unremarkable scans each accounted for 6 cases (6.3%). Gender analysis showed broadly similar patterns, although decreased marrow signal intensity was more common in females. Conclusions: MRI is an effective imaging modality for detecting and differentiating MSK complications in SCD. Routine use of MRI in follow-up care is recommended to facilitate early diagnosis, guide management, and prevent long-term disability. Larger prospective studies are needed to validate these findings and establish MRI as a routine diagnostic tool for SCD. Full article

Background: Osteonecrosis of the femoral head is a progressive disorder leading to femoral head collapse and early disability, often affecting young adults. Core decompression (CD) is the most established hip-preserving treatment for early-stage disease, yet the comparative benefits of biological and structural augmentation remain uncertain. Methods: This systematic review and meta-analysis, registered in PROSPERO (CRD420251108396), evaluated 14 studies encompassing 1210 patients treated with CD alone or CD combined with biological (e.g., platelet-rich plasma, mesenchymal stem cells, bone marrow aspirate concentrate) or structural (e.g., bone grafting, fibular support) augmentation. Results: Pooled random-effects models demonstrated that biological augmentation yielded significant improvements in Harris Hip Score and pain reduction (VAS) up to 24 months, with early peaks and subsequent stabilization, whereas structural augmentation showed no functional advantage at any time point. Radiological progression and conversion to total hip arthroplasty were not significantly reduced, though long-term trends favored biologically augmented CD. Conclusions: Overall, biological augmentation provides durable functional and symptomatic benefits in early-stage osteonecrosis, supporting its use as a first-line adjunct to CD, while structural augmentation appears less consistent and warrants further evaluation through large, standardized trials. Full article

Background/Objectives: Aseptic loosening (AL) is among the most common causes of late failure following total hip arthroplasty (THA), often necessitating complex revision surgery. Current diagnostic tools, mainly based on clinical and radiological findings, are primarily able to identify advanced changes of periprosthetic osteolysis (PPOL). Therefore, early detection of AL remains a challenge. Circulating microRNAs (miRNAs) have emerged as promising, minimally invasive biomarkers in musculoskeletal disorders. This study investigates the expression of inflammation-related miRNAs let-7i-5p, let-7e-5p, miR-15a-5p, miR-30a-3p and miR-130a-3p in patients with confirmed AL after THA to evaluate their potential role in AL. Methods: AL patients undergoing revision were compared with asymptomatic post-THA individuals and controls with degenerative osteoarthritis. Preoperative, peripheral blood samples were collected; total RNA was extracted; and quantitative real-time PCR (qRT-PCR) was performed to quantify miRNA expression. The relative expression of miRNAs was calculated using the 2–ΔΔCt method after proper normalization of Ct values. Statistical analysis assessed differences between groups. Results: The under investigation miRNAs exhibited distinct expression patterns. Several targets demonstrated significant downregulation in AL patients, suggesting a potential link to inflammatory and osteolytic pathways like Toll-like receptor 4 (TLR4)–Nuclear Factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling, NLRP3 inflammasome activation and macrophage polarization. Conclusions: The observed alterations in circulating miRNAs support their capability as biomarkers for early detection of AL following THA. Larger cohorts could facilitate translation into routine clinical diagnostics. Full article

Background/Objectives: Low-cost portable load cell dynamometers allow for real-time assessment of muscular strength. This study evaluated the reliability and repeatability of the G-Force load cell system during isometric hip abduction and adduction in young physically active Chilean adults. Methods: In total, 24 participants (19 men, 5 women) performed two maximal voluntary contractions per movement, repeated after a 24 h interval. Measured variables included Peak Force, peak rate of force development (Peak RFD), RFD at 50, 100, and 200 ms (RFD50, RFD100, RFD200), and maximum jerk. Reliability was assessed using intraclass correlation coefficients (ICCs), standard error of measurement (SEM), coefficient of variation (CV%) and Bland–Altman plots. Results: Peak Force showed excellent within-day (ICC = 0.94–0.96) and high between-day reliability (ICC = 0.87–0.89; CV = 20–30%). Bland–Altman analysis indicated negligible bias for Peak Force in abduction (−6.54 N; 95% CI −19.55 to 6.47) and adduction (−17.57 N; 95% CI −37.24 to 2.09), confirming the absence of systematic error. Peak RFD, RFD50–200, and maximum Jerk showed moderate repeatability and lower between-day reliability (ICCs = 0.39–0.70; CVs = 34–57%), indicating higher variability in explosive force indices compared with maximal strength. Conclusions: The G-Force load cell reliably measures maximal isometric hip strength, while Peak RFD, RFD50–200, and maximum jerk should be interpreted cautiously. These findings support the device as a practical, low-cost tool for sports and rehabilitation, though future studies should validate dynamic indices in larger and more diverse populations. Full article

Background: Nutritional status affects bone fragility and related fractures. We investigated the relationships between bone fragility fractures and nutritional indicators, including the Geriatric Nutrition Risk Index (GNRI), Prognostic Nutrition Index (PNI), Control Nutrition Status (CONUT) score, and body mass index (BMI). Methods: Postmenopausal female outpatients aged 75 or older who experienced a hip fracture 2 to 4 weeks ago (hip fracture group; G-HF) or who have no history of hip fracture without secondary osteoporosis but have a T-score of bone mineral density less than −2.5 (primary osteoporosis group; G-POP) were studied using both cross-sectional and longitudinal methods. Variables, including blood test results, T-scores, and nutritional indicators at baseline, were compared between the two groups using a crude dataset and after propensity score matching (PSM). Correlations between hip fracture (HF) and baseline variables were statistically analyzed. The relationship between nutritional indicators and the development of subsequent major osteoporotic fractures (MOFs) after baseline was examined, and the relationship between dietary indicators and functional capacity was also investigated. Results: A total of 1201 patients were recruited from these 113 G-HF and 1088 G-POP groups (crude dataset), of whom 113 were included after PSM. There were many differences between the two groups using the crude dataset. However, no items were significantly different after PSM except for white blood cell count (WBC) and serum phosphorus levels. GNRI < 105.5 demonstrated a typical regression curve regarding prevalent hip fractures. Developing MOF was significantly correlated with T-scores in the femoral neck and the presence of a prevalent fragility fracture. PNI and GNRI demonstrated a significant correlation between functional capacity; however, there was no correlation with the development of MOF. Conclusions: GNRI < 105.5 was significantly correlated with the presence of hip fracture, although no significant association was found with the development of MOF. Full article

In children under 4, septic arthritis of the hip (SAH) caused by Kingella kingae (SAH-KK) can be misdiagnosed, as it does not meet classic septic joint criteria (fever > 38.5°, pain, limited range of motion, and inability to bear weight). The objective of this study was to report clinical and paraclinical characteristics in a large cohort of children with confirmed SAH-KK and to evaluate the reliability of the Kocher (KC) and Caird criteria (CC) in predicting SAH-KK. Medical records of 140 children with confirmed SAH-KK were collected. Data on sex, age, temperature on admission, weight-bearing status, white blood cell (WBC) count, platelet count, C-reactive protein (CRP) value, and erythrocyte sedimentation rate (ESR) were extracted. The study focused on the sensitivity of KC (body temperature, refusal to bear weight, leukocytosis, and ESR) and CC (KC criteria plus CRP level). All patients had bacteriologically confirmed SAH-KK; most had mild symptoms and near-normal inflammatory markers. CRP (76.2%) had the highest sensitivity, followed by weight-bearing status (73.8%) and WBC count (69.6%). Body temperature and ESR exceeded cutoff values in less than 50% of cases. Among 77 patients fulfilling all KC, 49 (63.5%) had less than a 40% probability of SAH. Of 50 children with complete CC, 20 (40%) had a 62.4% or lower probability of SAH. KC and CC are not sufficiently accurate to confidently exclude SAH-KK in preschool-aged children due to heterogeneous clinical presentations. Further studies are needed to redefine diagnostic criteria based on patient age and causative pathogens. Full article

Background: Radiation-induced lower motor neuron syndrome (LMNS) represents a rare but significant delayed complication of oncologic treatment. Methods: We present the case of a 56-year-old female who developed LMNS, myokymia, and osteoradionecrosis of the hip nearly two decades after receiving pelvic radiation therapy for cervical carcinoma. To the best of our knowledge, no previous reports have described this particular triad of neurological and tissue changes following radiation therapy. This clinical presentation is analyzed within the framework of a systematic review encompassing 58 documented cases, including our own. Results: The database searches yielded 530 records. In total, 32 studies were included in the qualitative synthesis, reporting 57 unique cases of post-radiation LMNS. With the addition of our present case, the final analysis comprised 58 cases. The majority of analyzed patients were male (77.2%), and the most frequent primary malignancies were germ cell tumors (57.9%). The mean age of the analyzed patients at symptom onset was 40.5 ± 13 years, with radiotherapy administered at a mean age of 30.3 ± 12.5 years. The latency period between radiation exposure and the emergence of neurological symptoms averaged 10.2 ± 8.7 years. The mean cumulative radiation dose was 49.0 ± 14.0 Gy. Myokymic discharges were identified in 6 patients (10.3% of cases). Comparative analysis revealed no significant clinical or radiological differences across malignancy subtypes in the manifestation of post-radiation LMNS. Conclusions: These findings highlight the need for long-term surveillance of irradiated patients. Full article

Inflammaging has been implicated in age-related bone loss and fragility fractures through immune-mediated effects on bone turnover. We aimed to explore the relationship between systemic inflammatory markers and bone health in older adults, focusing on the differences between patients with osteoporotic fractures and non-fractured controls. We retrospectively analyzed 40 older patients (20 with hip fractures and 20 with osteoarthritis without prior fragility fractures). We compared routine inflammatory markers, including red cell distribution width (RDW), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and the composite CRP–albumin–lymphocyte index (CALLY), between groups. Bone mineral density (BMD) at the hip, lumbar spine, and wrist, as well as the FRAX score, were assessed. Correlations between inflammatory markers, BMD, and FRAX scores were evaluated using Spearman’s coefficient. Patients with fractures exhibited significantly elevated CRP (66.2 ± 70.3 vs. 3.8 ± 4.0 mg/L, p = 0.0008) and SII (1399.7 ± 1143.4 vs. 751.4 ± 400.8, p = 0.025) compared to controls. RDW, NLR, and CALLY scores did not differ significantly between the groups. Higher CRP levels were associated with lower BMD at all sites (hip: r ≈ −0.63, p = 0.002; spine: r ≈ −0.60, p = 0.005; wrist: r ≈ −0.60, p = 0.005). No significant correlations were observed between the SII and BMD or FRAX values. Elevated systemic inflammation, particularly indicated by CRP and SII, was associated with osteoporotic fracture status and low bone density in our cohort. These findings support the concept that inflammatory pathways may contribute to osteoporosis and fracture risk and suggest that inflammatory markers could serve as adjunctive tools in fracture risk assessment. Further studies are required to clarify the causality and evaluate whether targeting chronic inflammation can improve bone health in older adults. Full article

Purpose: To investigate the therapeutic potential of inducible pluripotent stem cell (hiPSC)-based vascular repair, we evaluated two vascular reparative cell populations, CD34⁺ cells derived from hiPSC (hiPSC-CD34⁺) and endothelial colony forming cells (ECFCs) derived from hiPSC (iPS-ECFCs), alone and in combination, in a type 2 diabetic (db/db) mouse model of DR. Methods: hiPSC-CD34⁺ cells (1 × 10⁴) or iPSC- ECFCs (1 × 10⁵) alone or in combination (1.1 × 10⁵) were injected into the vitreous of immunosuppressed db/db mice with six months of established diabetes. One month post-injection, mice underwent electroretinography (ERG) and optical coherence tomography (OCT) to evaluate functional and structural retinal recovery with iPSC administration. Immunohistochemistry (IHC) was used to assess recruitment and incorporation of cells into the retinal vasculature. Retinas from the experimental groups were analyzed using Functional Proteomics via Reverse Phase Protein Array (RPPA). Results: Functional assessment via ERG demonstrated significant improvements in retinal response in the diabetic cohorts treated with either hiPSC-derived CD34⁺ cells or hiPSC-ECFCs. Retinal thickness, assessed by OCT, was restored to near-nondiabetic levels in mice treated with hiPSC-CD34⁺ cells alone and the combination group, whereas hiPSC-ECFCs alone did not significantly affect retinal thickness. One month following intravitreal injection, hiPSC-CD34⁺ cells were localized to perivascular regions, whereas hiPSC-ECFCs were observed to integrate directly into the retinal vasculature. RPPA analysis revealed interaction-significant changes, and this was interpreted as a combination-specific, non-additive host responses (m⁶A, PI3K–AKT–mTOR, glycolysis, endothelial junction pathways). Conclusions: The studies support that injection of hiPSC-CD34⁺ cells and hiPSC-ECFCs, both individually and in combination, showed benefit; however, iPSC combination-specific effects were identified by measurement of retinal thickness and by RPPA. Full article