Search Results (532)

Introduction: Venous thromboembolism (VTE) remains a major complication following orthopedic trauma and fracture surgery. Low-molecular-weight heparin (LMWH) is widely used for prophylaxis; however, aspirin (ASA) has emerged as a potential alternative due to its ease of administration and cost-effectiveness. This study aimed to compare the efficacy and safety of aspirin (ASA) versus low-molecular-weight heparin (LMWH) in orthopedic trauma patients. Methods: A systematic review and meta-analysis was conducted by searching PubMed, Cochrane Library, and Google Scholar. Randomized controlled trials and comparative observational studies evaluating aspirin (ASA) versus low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis in orthopedic trauma patients were included. Outcomes assessed included overall venous thromboembolism (VTE), deep-vein thrombosis (DVT), pulmonary embolism (PE), fatal PE, mortality, bleeding complications, wound site infection, and hematoma formation. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I(2) statistic. Results: Five studies comprising a heterogeneous orthopedic trauma population were included. No statistically significant difference between aspirin (ASA) and low-molecular-weight heparin (LMWH) in the incidence of venous thromboembolism (VTE) was noted (OR 0.52, 95% CI 0.02–12.25, p = 0.68). No significant differences were observed in the incidence of DVT between aspirin (ASA) and low-molecular-weight heparin (LMWH) (OR 1.00, 95% CI 0.46–2.16, p = 1.00). Pulmonary embolism (PE) (OR 0.96, 95% CI 0.72–1.28, p = 0.80), fatal PE (OR 0.55, 95% CI 0.18–1.65, p = 0.28), and mortality (OR 1.02, 95% CI 0.68–1.54, p = 0.91) were comparable between the two groups. Similarly, no significant differences were observed in bleeding complications (OR 0.95, 95% CI 0.86–1.05, p = 0.33) or wound complications (OR 1.05, 95% CI 0.81–1.37, p = 0.70). Hematoma formation showed a trend favoring aspirin (ASA) (OR 0.36, 95% CI 0.13–1.02, p = 0.05), although this did not reach statistical significance. Conclusions: Aspirin (ASA) may be a reasonable alternative to low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis in selected orthopedic trauma patients, with comparable outcomes for pulmonary embolism (PE), mortality, bleeding and wound complications. Larger high-quality randomized trials with standardized protocols in clearly defined orthopedic trauma populations are warranted to confirm these findings and guide clinical decision-making. Full article

Background: Stress urinary incontinence is one of the most common and debilitating complications following radical prostatectomy. Artificial urinary sphincter (AUS) implantation is the gold standard treatment for moderate to severe post-prostatectomy incontinence. Common complications include device infection, mechanical failure, component migration, urethral erosion, and urethral atrophy, which often require device removal and subsequent reimplantation. To our knowledge, erosion or migration of orthopedic osteosynthesis screws into the lower urinary tract causing new-onset urinary symptoms after AUS implantation has not previously been reported. Case Presentation: A 57-year-old man with an implanted AUS presented to the emergency department with fever, dysuria, and de novo urge incontinence. Intravenous antibiotic therapy was initiated, resulting in resolution of the fever, after which further diagnostic evaluation was performed. Cystoscopy demonstrated normal urethral coaptation and intact urethral mucosa at the cuff site. However, three orthopedic osteosynthesis screws from previous pelvic fracture fixation were identified protruding immediately below the bladder neck. The screws were removed by open surgery during ongoing empirical antimicrobial therapy. Four weeks later, the AUS was reactivated. At 8-month follow-up, the patient remained asymptomatic and maintained the same continence status as following AUS implantation. Conclusions: A detailed history of previous pelvic surgery and orthopedic fixation, together with review of available imaging, is important in candidates for AUS implantation. In patients presenting with new-onset urinary symptoms after AUS implantation, alternative etiologies should be considered, with cross-sectional imaging and cystoscopy used selectively according to the clinical presentation. Full article

Background: The greater omentum is a highly vascularized and biologically active structure with drainage, immunomodulatory, proangiogenic, and proregenerative properties. Although it is widely used in abdominal surgery, its extra-abdominal application in dogs and cats remains less standardized. Methods: This review summarizes the available veterinary literature on extra-abdominal omentalization in small animals, including case reports, case series, experimental studies, and selected comparative data, supplemented by relevant evidence from human reconstructive surgery. Results: Two main surgical strategies are described: transposition of a pedicled omental flap with preservation of vascular continuity and free omental grafting, with or without microvascular anastomosis. Reported applications include thoracic surgery, chronic and infected wounds, orthopedic conditions associated with impaired healing, head and neck reconstruction, and experimental neurosurgical procedures. The omentum may support healing by improving vascularization, filling dead space, promoting drainage, and contributing to infection control. Conclusions: Current evidence suggests that extra-abdominal omentalization may be valuable as an adjunctive technique in selected complex cases, particularly when infection, poor vascularization, dead space, or delayed healing are present. However, further clinical studies are needed to define indications, outcomes, and safety more precisely. Full article

Implant-associated infections (IAIs) persist as a critical complication in biomaterial transplantation, driven by rapid microbial colonization, biofilm encapsulation, and escalating antibiotic resistance. Conventional antibiotic-based treatments and passive antimicrobial coatings often fail to achieve long-term infection control due to limited biofilm penetration, localized cytotoxicity, and active agent depletion. To overcome these limitations, piezoelectric nanocomposite coatings utilize a dynamic, stimulus-responsive framework that converts physiological mechanical forces or external ultrasound into localized electrical signals. These surface-bound electric fields systematically mitigate bacterial adhesion, eradicate mature biofilms via targeted reactive oxygen species (ROS) generation, disrupt microbial metabolic pathways, and favorably modulate the peri-implant immune microenvironment while supporting host tissue repair. This review evaluates the material design principles and classifications of inorganic, organic, and hybrid piezoelectric nanocoatings. We detail their multifaceted antibacterial mechanisms and trace their therapeutic potential in orthopedic and dental implants, as well as wound management. Lastly, we analyze current engineering bottlenecks to chart a clear trajectory for their clinical translation. Full article

Bacterial colonization and biofilm formation on orthopedic and dental implants remain major clinical complications, while conventional systemic antibiotics are often limited by poor penetration into biofilms and infected bone. These limitations have motivated the development of biomaterials with intrinsic antibacterial activity. Hydroxyapatite (HA), a major inorganic component of bone and teeth, possesses excellent biocompatibility, osteoconductivity, and bone-bonding ability but exhibits limited inherent antibacterial activity. Incorporation of therapeutic metal ions, including Ag⁺, Cu²⁺, Zn²⁺, Ti⁴⁺, Co²⁺, Ga³⁺, Sr²⁺, and Ce³⁺, has therefore emerged as a promising strategy for developing multifunctional HA-based biomaterials. This review critically examines the crystal-chemical basis of metal-ion incorporation into HA and discusses how ionic radius, oxidation state, charge-compensation mechanisms, dopant concentration, and synthesis conditions influence lattice occupancy, physicochemical properties, and biological performance. The antibacterial activity of metal-substituted and metal-modified HA systems generally involves interconnected mechanisms, including bacterial membrane damage, intracellular metabolic disruption, interference with enzymes and nucleic acids, reactive oxygen species (ROS)-mediated oxidative stress, and inhibition of bacterial adhesion and biofilm formation. Ag-, Cu-, Zn-, and Ga-containing HA systems show the most consistently reported antibacterial effects, although their efficacy and cytocompatibility depend strongly on dopant concentration and ion-release kinetics. Co-substituted HA may combine antibacterial activity with angiogenic and osteogenic stimulation, whereas Sr-substituted HA is primarily osteogenic and anti-resorptive, with variable antibacterial performance. Ti-modified HA and TiO₂/HA composites exhibit predominantly photoactive antibacterial behavior, while Ce-substituted HA shows concentration-, oxidation-state-, and synthesis-dependent biological effects. The review also evaluates protein adsorption, osteogenic and angiogenic signaling, macrophage-mediated immunomodulation, biological safety, and representative commercial and translational applications. Overall, metal-substituted HA represents a versatile platform for infection-resistant and regenerative hard-tissue biomaterials, provided that composition, phase structure, ion release, antibacterial efficacy, and cytocompatibility are systematically co-optimized before clinical translation. Full article

Background and Objectives: Surgical-site infection remains a major complication of clean orthopedic surgery, particularly when implants or instrumentation are used. Although shorter perioperative prophylaxis is generally accepted for most clean procedures, prolonged postoperative courses continue to be used in selected high-risk orthopaedic settings. This review evaluated whether comparative evidence supports such extension. Methods: PubMed/MEDLINE, Scopus, and Cochrane CENTRAL were searched from inception to 14 May 2026. Randomized trials and non-randomized comparative studies evaluating systemic prophylaxis duration were eligible for qualitative synthesis. The primary meta-analysis was restricted to randomized controlled trials with extractable surgical-site infection data. Risk ratios were pooled using a random-effects model. Subgroup, sensitivity, and publication-bias analyses were performed. Results: Thirty-six studies were included in the qualitative synthesis, and 11 randomized trials involving 3823 participants contributed to the primary meta-analysis. After incorporating the cluster-adjusted estimate from the cluster-randomized trial, prolonged prophylaxis did not demonstrate a statistically significant additional reduction in any surgical-site infection compared with shorter prophylaxis (RR = 1.07, 95% CI 0.86–1.34; prediction interval 0.83–1.38; I² = 0.0%). A sensitivity analysis excluding the cluster-randomized trial produced a similar result (RR = 1.11, 95% CI 0.88–1.40). Exploratory procedure-based subgroup analyses did not identify a statistically significant interaction, although each subgroup contained few trials. Secondary analyses showed no statistically significant difference for superficial or non-deep infection (RR = 1.19, 95% CI 0.79–1.77) or deep or complicated infection (RR = 0.85, 95% CI 0.55–1.32). Conclusions: Prolonged systemic prophylaxis has not demonstrated a consistent additional surgical-site infection-prevention benefit compared with shorter regimens. However, sparse events, wide confidence intervals, clinical heterogeneity, and low certainty preclude conclusions of equivalence or noninferiority. Further adequately powered trials are needed in higher-risk procedures. Full article

Perioperative management of antirheumatic medications in adults with rheumatoid arthritis (RA) undergoing orthopedic surgery requires balancing postoperative infection and impaired wound healing against disease flare, pain, and delayed rehabilitation. This systematic review aimed to evaluate how perioperative continuation, withholding, interruption timing, restart timing, dose modification, or exposure to antirheumatic medications relates to postoperative outcomes in adults with RA undergoing arthroplasty and non-arthroplasty orthopedic procedures. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched from database inception to 18 April 2026 for English-language full-text clinical studies. The primary outcomes were surgical site infection/periprosthetic joint infection, delayed wound healing, and postoperative RA flare. Secondary outcomes included reoperation, revision, readmission, mortality, venous thromboembolism, dislocation, and other procedure-specific complications. Original studies were classified as direct perioperative strategy evidence, medication-exposure evidence, or supportive clinical-context evidence. Forty-three original clinical studies were included, together with six non-original contextual sources. The evidence was predominantly observational, clinically heterogeneous, and of very low certainty. Methotrexate continuation was not associated with an evident increase in early postoperative complications, whereas direct evidence for other conventional synthetic agents was limited. Longer interruption of biologic or targeted synthetic therapy did not consistently reduce infection or wound-healing complications, while several studies associated treatment interruption with postoperative flare. Chronic baseline glucocorticoid exposure was associated with adverse outcomes but was clinically distinct from short-term perioperative administration; stress-dose supplementation was not directly evaluated. Medication decisions should therefore be individualized according to drug class, disease control, glucocorticoid burden, surgical procedure, and patient risk profile. Full article

Background: Bacterial biofilms play a key role in causing periprosthetic joint infection (PJI). Current PJI management strategies commonly combine systemic antibiotic therapy with localized delivery such as antibiotic-loaded cement or beads to achieve effective tissue penetration and high antimicrobial concentrations at the implant site. We hypothesized that antibiotic-loaded calcium sulfate beads would effectively eradicate early Staphylococcus aureus biofilms but exhibit reduced efficacy against mature biofilms formed in synovial fluid (SF). This study evaluated the efficacy of vancomycin combined with gentamicin (V+G) or tobramycin (V+T) against GFP-expressing S. aureus biofilms grown in the presence of SF. Methods: Biofilms were established on clinically relevant orthopedic implant materials such as titanium (Ti), stainless steel (316L), and polyethylene (PE). Early (1-day) and mature (3-day) biofilms were treated with calcium sulfate beads loaded with V+G or V+T. Antimicrobial efficacy was quantified by colony-forming unit (CFU) enumeration. Minimum inhibitory concentration (MIC) testing was performed on surviving populations to assess potential development of antibiotic resistance. Results: Both antibiotic combinations resulted in no detectable viable bacteria in the 1-day biofilm across all tested materials following treatment, demonstrating strong reduction in early biofilm burden below the detection limit. Treatment of mature biofilms resulted in a 4–5 log reduction. MIC analysis of representative bacteria surviving post-treatment indicated no substantial increase in resistance. Conclusions: These findings show that while locally delivered antibiotic combinations eliminate early biofilms, mature biofilms demonstrate significant tolerance. MIC analysis showed little or no change in vancomycin, gentamicin, and tobramycin susceptibility after treatment, indicating no evident increase in planktonic antibiotic resistance among the surviving isolates. Together, these results highlight the importance of early intervention and the need for strategies that disrupt biofilm structure or improve antibiotic penetration to enhance PJI treatment outcomes. Full article

Osteomyelitis is a severe, progressive bone infection affecting approximately 21.8 per 100,000 individuals in the United States and remains a major challenge in orthopedic and reconstructive medicine. Staphylococcus aureus (S. aureus), responsible for nearly 75% of cases, is the most common causative pathogen. Current gold-standard management involves culture-directed antibiotic therapy administered for 4–6 weeks, often combined with surgical debridement and the use of antibiotic-loaded cement spacers. Despite these interventions, treatment frequently fails to achieve complete infection eradication, with recurrent or persistent disease reported in up to 40% of cases, contributing to chronic inflammation, impaired bone healing, and long-term functional deficits. These limitations highlight the need for therapeutic strategies that address infection control and bone regeneration. A narrative literature review was conducted to evaluate emerging tissue-engineered scaffold-based biomaterials as potential alternatives to conventional treatment. Emerging evidence suggests antimicrobial-loaded matrices, bioactive scaffolds, and stimuli-responsive biomaterials can provide localized drug delivery, structural support, and enhanced osteogenesis while improving infection control and osteointegration. Advances in targeted drug delivery, immunomodulatory biomaterials, and computational scaffold design further suggest opportunities for more effective therapies. These findings highlight the potential of scaffold-based biomaterials to improve osteomyelitis management, although further clinical studies are required. Full article

Background: Septic arthritis (SA) is a serious and rapidly progressive condition that can result in significant morbidity and mortality. Current clinical guidelines endorse a combination of surgical debridement and targeted antibiotic therapy as the gold standard treatment for adults with knee SA. Despite the effectiveness of this approach, patients often experience prolonged inflammation, leading to long-term complications such as cartilage degeneration and chronic pain. Since inflammatory cytokines contribute to cartilage destruction, it is considered to be possible that mitigating their levels through the use of steroids could potentially prevent cartilage damage. Methods: This study is designed as a multicenter, open-label, randomized controlled trial aimed at evaluating the efficacy of intravenous dexamethasone as an adjunctive therapy for adults diagnosed with knee joint SA. Participants aged 18 years and older will be randomized to receive either standard treatment (surgical debridement and antibiotics) or the same regimen with the addition of dexamethasone. The primary objective is to assess pain reduction at four days post-surgery using the EQ-VAS scale and knee joint effusion, while secondary objectives will include the evaluation of additional surgical interventions, pain control over time, joint function, normalization of inflammatory markers, and overall healthcare resource utilization. Discussion: While corticosteroids have demonstrated efficacy in pediatric populations with septic arthritis, the evidence for their use in adults remains limited. This trial aims to ascertain whether the anti-inflammatory effects of corticosteroids can mitigate complications and enhance clinical outcomes in adult patients with SA. The findings from this study could provide critical insights into optimizing treatment strategies for this complex condition, ultimately improving patient quality of life. Full article

Prosthetic joint infections (PJIs) remain a major challenge in orthopedic surgery due to the increasing prevalence of antimicrobial-resistant pathogens and their ability to form biofilms on implant surfaces. Local delivery of non-traditional antimicrobials through implant-associated biomaterials represents a promising strategy for preventing bacterial colonization while minimizing systemic antibiotic exposure. This study evaluated the antimicrobial activity and cytocompatibility of two bacteriophages (Phage K and Phage F1) and two antimicrobial peptide dendrimers (AMPDs; TNS18 and G3KL) against clinical isolates of Staphylococcus aureus and Staphylococcus epidermidis recovered from PJIs. Antimicrobial efficacy was assessed using solid and liquid culture assays, while cytocompatibility was evaluated using human osteoblast progenitor cells. Biofilm formation was also investigated under various in vitro conditions. Phages K and F1 demonstrated strong antibacterial activity against S. aureus isolates, whereas TNS18 showed pronounced inhibitory effects against S. epidermidis. All agents exhibited appropriate osteoblast compatibility, except Phage F1, at the highest multiplicity of infection tested. Biofilm formation was observed under several culture conditions, although substantial variability in biofilm stability limited the quantitative assessment of antimicrobial activity. These findings demonstrate complementary antimicrobial activity profiles between bacteriophages and AMPDs and support their further investigation as candidates for implant-associated antimicrobial delivery systems and orthopedic implant coatings. Full article

Infection associated with orthopedic implants remains a major challenge in the development of biomimetic materials for bone tissue engineering. Surface modification strategies are widely employed to transform bioinert metallic substrates into bioactive interfaces that promote tissue integration while preventing bacterial colonization. This study investigated the effect of incorporating silver nanoparticles (nAg) into hydroxyapatite–barium titanate (HA–BT) coatings on their structural, mechanical, piezoelectric, biological, and antibacterial properties. Raw materials were characterized by X-ray diffraction (XRD) and transmission electron microscopy (TEM), whereas coatings were evaluated by XRD, scanning electron microscopy (SEM), tensile adhesion testing, electrochemical analysis, piezoresponse force microscopy (PFM), cell viability, and antibacterial assays. The coatings exhibited secondary phases, including β-tricalcium phosphate (β-TCP), tetracalcium phosphate (TTCP), and calcium oxide (CaO), generated during atmospheric plasma spraying (APS), while no silver oxide phases were detected after nAg incorporation. SEM observations revealed homogeneous phase distribution and strong coating–substrate adhesion. The addition of nAg did not significantly affect adhesive strength (44.58 ± 2.2 MPa for HA30BT and 43.28 ± 2.8 MPa for HA30BT–nAg). Protein adsorption studies indicated moderate albumin affinity (K_ads = 0.45) for nAg-containing coatings. Both coatings exhibited piezodynamic activity with d₃₃ values of approximately 13 pm/V. MTT assays confirmed non-cytotoxic behavior, with viability reductions below 2%. Osteocalcin expression demonstrated comparable osteogenic activity in coatings with and without nAg, regardless of low-intensity pulsed ultrasound stimulation. These findings highlight the potential of HA–BT–nAg coatings as multifunctional surfaces for bone regeneration and infection prevention. Full article

Biofilm-associated infections present a significant but insufficiently acknowledged problem in veterinary medicine because they result in persistent infections that lead to unsuccessful treatments and drive the growth of antimicrobial resistance throughout animal healthcare systems. The extracellular matrix of biofilms together with their resistance mechanisms make traditional antimicrobial methods ineffective against these structures. The development of combination-based biomaterial coatings represents an effective solution for biofilm control since these coatings combine different antimicrobial capabilities into one surface treatment. This review offers an in-depth evaluation of veterinary-focused combination-based coating systems which scientists developed to create solutions for catheterization, orthopedic, dental implant procedures, wound treatment and aquaculture infrastructure. This review also examines various coating methods to determine their effectiveness in creating surfaces that optimize antimicrobial delivery. However, the development of veterinary medical solutions faces major obstacles because the technology needs to overcome some key issues, which include maintaining stability through time, protecting animal health, preventing environmental harm and meeting regulatory standards. Overall, the use of multifunctional biomaterial functional coatings provides veterinary medicine with a revolutionary method to handle biofilm-related infections in animals, which decreases the need for antibiotics while improving infection control according to One Health principles. Full article

Implant-associated infections (IAIs) caused by Staphylococcus aureus are a major cause of orthopedic implant failure, driven by biofilm formation and chronic inflammation. Macrophages regulate bacterial clearance and tissue repair through polarization into pro-inflammatory (M1) and anti-inflammatory (M2) phenotypes. This systematic review evaluated preclinical in vivo studies according to PICO criteria (Population: IAI animal models; Intervention: functionalized biomaterials; Comparator: non-functionalized controls; Outcome: bacterial burden reduction associated with macrophage reprogramming). A PRISMA-guided search of PubMed, Scopus, Web of Science, and Embase (January 2015–December 2025) identified 23 eligible studies, assessed using SYRCLE’s risk-of-bias tool. Due to heterogeneity, a narrative synthesis was performed without meta-analysis. Effect measures included bacterial CFU reduction, macrophage polarization markers, cytokine expression, and histological outcomes. In 87.5% of studies, macrophage modulation was associated with reduced bacterial load, biofilm disruption, and improved peri-implant tissue repair and bone integration. These findings support immunomodulatory biomaterials as promising strategies to manage IAIs through combined antibacterial and immune-regulatory mechanisms. However, further validation in larger animal models is required, particularly for nanomaterials. The protocol of this systematic review was registered on the Open Science Framework. Full article

Orthopedic procedures trigger a complex inflammatory response that plays a central role in tissue repair and postoperative recovery. However, excessive or dysregulated inflammation may contribute to complications such as periprosthetic joint infection, thromboembolic events, delayed healing, or systemic organ dysfunction. Therefore, accurate perioperative monitoring of inflammatory activity has become increasingly important in orthopedic surgery. Evidence discussed in this review was identified through a literature search of PubMed, Scopus, and Web of Science databases covering publications from 2000 to 2026. This narrative review summarizes the current evidence regarding both traditional inflammatory biomarkers, including C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), and D-dimers, as well as emerging biomarkers derived from complete blood count (CBC), such as the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI). Particular attention is devoted to the clinical utility of these biomarkers in orthopedic trauma, fracture healing, total joint arthroplasty, and the early detection of postoperative complications. Increasing evidence suggests that composite CBC-derived indices may provide a practical and cost-effective approach for perioperative risk stratification and prognosis assessment. Nevertheless, their interpretation remains challenging due to the lack of standardized cutoff values and the influence of multiple patient-related factors. Current evidence indicates that assessing biomarker kinetics and interpreting multiple inflammatory indices together may be more clinically valuable than isolated measurements. Future research should focus on standardization, validation in prospective studies, and integration of inflammatory biomarkers into personalized perioperative care pathways in orthopedic surgery. Full article