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Background: Correct component alignment in total knee arthroplasty (TKA) is crucial for implant functionality and longevity. Several devices have been developed to help surgeons to achieve optimal component positioning. The purpose of our study was to evaluate the accuracy and reliability of a novel inertial-based cutting guide used to perform tibial resection in TKA taking into account users with different levels of experience., Methods: Seven operators (raters) with different levels of experience participated in the study. To evaluate the accuracy, the varus/valgus (VV) and slope (SL) angles obtained with this novel device were compared with the reference angles obtained with the navigation system. To calculate intra-(rater) reliability repeated measurements of VV and SL angles by the same operator were used. To calculate inter-(rater) reliability repeated measurements of VV and SL by different operators were used., Results: A total of 140 acquisitions were performed. In this study both for the VV and for the SL the maximum mean absolute error (MAE) that the inertial system registered was <1°. Intra-inter reliability was evaluated by calculating the Fleiss' Kappa coefficient, which recorded values close to 0.75 (75%) with regard to the VV and the SL for intra-reliability, while values were recorded around 0.9 (90%) for the inter subject reliability., Conclusions: The Perseus system is accurate, reliable and surgeon-friendly and could be very useful in improving results in low-volume centers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Purpose: This work presents a kinematic evaluation of a cruciate retaining highly congruent mobile bearing total knee arthroplasty design using dynamic Roentgen sterephotogrammetric analysis. The aim was to understand the effect of this implant design on the kinematics of prosthetic knees during dynamic activities., Methods: A cohort of 15 patients was evaluated at nine month follow-up after surgery. The mean age was 74.8 (range 66-85) years. The kinematics was evaluated using the Grood and Suntay decomposition and the Low-Point (LP) methods., Results: ?tlsb=-0.15pt?>From sitting to standing up position, the femoral component internally rotated (from -11.3 ± 0.2° to -7.0 ± 0.2°). Varus-valgus rotations were very close to 0° during the whole motor task. LP of medial condyle moved from an anterior position of 12.0 ± 0.2 mm to a posterior position of -12.4 ± 0.2 mm; LP of the lateral condyle moved from an anterior position of 8.1 ± 0.2 mm to a posterior position of -12.4 ± 0.2 mm, showing a bi-condylar rollback where both condyles moved parallel backward. Moreover, the femoral component showed anterior translation with respect to the tibia from 80° to 20° (from -4.9 ± 0.2 mm to 3.3 ± 0.2 mm), then a posterior translation from 20° to full extension was identified (from 3.3 ± 0.2 mm to 0.5 ± 0.2 mm)., Conclusions: Paradoxical anterior femoral translation and absence of medial-pivoting motion were recorded, highlighting the role of the symmetric deep dishes insert as main driver of the kinematic of this TKA design., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2019 Elsevier B.V. All rights reserved.)

This article analyzes the current literature on the use of adipose-derived stem cells (ASCs) to evaluate the available evidence regarding their therapeutic potential in the treatment of cartilage pathology. Seventeen articles were included and analyzed, showing that there is overall a lack of high-quality evidence concerning the use of ASCs. Most trials are case series with short-term evaluation. The most adopted approach consists of an intra-articular injection of the stromal vascular fraction (SVF) rather than the expanded cells. Based on the available data, no specific preparation method or formulation could be considered as the preferred choice in clinical practice., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: The primary aim of the present study is to evaluate the results obtained in challenging knee lesions with the implant of an osteochondral scaffold and concomitant treatment of all comorbidities. The secondary aim is to compare the results obtained with those found when a chondral scaffold was applied., Materials and Methods: Patients affected by complex lesions of the knee articular surface were included. "Complex cases" were defined according to the following criteria: previous clinical history of intra-articular fracture, lesion located at the tibial plateau, concurrent knee axial realignment procedure, concurrent meniscal scaffold or allograft implantation, and multiple articular surface lesions treated. Thirty-three patients were treated with the implantation of an osteochondral scaffold. The results of a homogeneous group of 23 patients previously treated and prospectively evaluated after implantation of a chondral scaffold were analyzed and compared., Results: IKDC subjective score improved significantly from pre-operative (40.4±14.1) to 12months' follow-up (69.6±17.0; p<0.0005) with a further improvement at the final evaluation at 24months (75.5±15.0; p=0.038). The same positive trend was confirmed by the VAS and Tegner scores. At final follow-up the group treated with the osteochondral scaffold presented a better subjective IKDC score with respect to the group treated with the chondral scaffold (p=0.034)., Conclusions: A regenerative procedure to address the entire osteochondral unit, together with the treatment of all comorbidities, might offer good results also in complex cases otherwise doomed to non-biological resurfacing., Level of Evidence Iii: Comparative study., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Introduction: Knee arthrodesis can be an effective treatment after an infected revision Total Knee Arthroplasty (TKA). The main hypothesis of this study is that a two-stage arthrodesis of the knee using a press-fit, modular intramedullary nail and antibiotic loaded cement, to fill the residual gap between the bone surfaces, prevents an excessive limb shortening, providing satisfactory clinical and functional results even without direct bone-on-bone fusion., Material and Methods: The study included 22 patients who underwent knee arthrodesis between 2004 and 2009 because of recurrent infection following revision-TKA (R-TKA). Clinical and functional evaluations were performed using the Visual Analogue Scale (VAS) and the Lequesne Algofunctional Score. A postoperative clinical and radiographical evaluation of the residual limb-length discrepancy was conducted by three independent observers., Results: VAS and LAS results showed a significant improvement with respect to the preoperative condition. The mean leg length discrepancy was less than 1cm. There were three recurrent infections that needed further surgical treatment., Discussion: This study demonstrated that reinfection after Revision of total knee Arthroplasty can be effectively treated with arthrodesis using a modular intramedullary nail, along with an antibiotic loaded cement spacer and that satisfactory results can be obtained without direct bone-on-bone fusion., (Published by Elsevier B.V.)

Environmental metabolomics was applied to assess the metabolic responses in transplanted mussels to environmental pollution. Specimens of Mytilus galloprovincialis, sedentary filter-feeders, were caged in anthropogenic-impacted and reference sites along the Augusta coastline (Sicily, Italy). Chemical analysis revealed increased levels of PAHs in the digestive gland of mussels from the industrial area compared with control, and marked morphological changes were also observed. Digestive gland metabolic profiles, obtained by 1H NMR spectroscopy and analyzed by multivariate statistics, showed changes in metabolites involved in energy metabolism. Specifically, changes in lactate and acetoacetate could indicate increased anaerobic fermentation and alteration in lipid metabolism, respectively, suggesting that the mussels transplanted to the contaminated field site were suffering from adverse environmental condition. The NMR-based environmental metabolomics applied in this study results thus in it being a useful and effective tool for assessing environmental influences on the health status of aquatic organisms., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objectives: The setting time and the expansion in deionized water, phosphate-buffered saline (PBS), 20% fetal bovine serum (FBS)/80% PBS or hexadecane oil of experimental accelerated calcium-silicate cements and ProRoot MTA were evaluated., Study Design: Different compounds such as sodium fluoride, strontium chloride, hydroxyapatite, and tricalcium phosphate were separately added to a basic experimental calcium-silicate cement to test their effect on setting and expansion. The initial and final setting times were determined using appropriate Gilmore needles. A linear variable differential transformer (LVDT) device was used to test the restricted hygroscopic linear expansion over 180 minutes of cements immersed in different solutions. Results were statistically compared using a 2-way ANOVA test (cement type versus solution type)., Results: All experimental cements showed initial setting times between 28 and 45 minutes and final setting times between 52 and 80 minutes. MTA showed a final setting time of 170 minutes. Final setting time of all experimental cements was faster than MTA. All cements showed slight (0.04%-0.77%) expansion in water, PBS, or FBS/PBS. Only fluoride-containing cement showed a significant expansion in water (6.68%) and in PBS (6.72%). The PBS/FBS contamination significantly reduced the expansion of fluoride-containing cement (2.98%) and MTA (0.07%). In contrast, cements showed a slight shrinkage when immersed in hexadecane, especially fluoride-containing cement., Conclusions: The study demonstrated that: (1) the setting time of calcium-silicate cements may be effectively reduced; (2) the expansion is a water dependent mechanism owing to water uptake, because no expansion occurred in cements immersed in oil; (3) a correlation between setting time and expansion in water and PBS exists; (4) fluorine-containing cement showed a significant expansion in water and in PBS; (5) the immersion in FBS/PBS strongly reduced the expansion of MTA and fluoride-doped cement suggesting that fluid contamination (ie, blood) during surgical procedures may greatly affect the expansion of some calcium-silicate cements.

Background: The purpose of this study was to investigate about the reliability of measuring antero-posterior laxity within-subjects for in-vivo studies using a navigation system., Methods: The analysis was performed by enroling 60 patients undergoing anterior cruciate ligament ACL reconstruction, and assessing AP laxity during the Lachman and drawer tests., Results: For the navigation system standard deviation for intra-trial measures was 0.7 mm, thus the intra-trial repeatability coefficient was 2.2 mm; standard deviation for intra-trial measure was 1.2 mm, while the reference inter-trial repeatability coefficient between expert surgeons was 3.4 mm., Conclusions: In conclusion, this study suggests that KIN-Nav may represent a new method to measure and document AP laxity intra-operatively with improved accuracy and test the effect of surgical treatment in-vivo with higher sensitivity than in the past and this study quantify its reliability for within-subjects studies performed by a single expert surgeon.

Revision total knee arthroplasty (RTKA) is a skill-demanding intervention presenting several technical challenges to the surgeon due to bone deficiencies and lack of anatomical references. Computer-assisted navigation systems can potentially solve these problems. An innovative computer-assisted surgical technique for RTKA is presented. The system is image free. Based on anatomical landmarks acquired on the patient, the system automatically plans the intervention, and provides the surgeon with tools to analyse and modify the proposed plan and to accurately reproduce it on the patient. Although we performed few cases with this navigated procedure, early results obtained demonstrated to be very promising.