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degeneration is common in the aged, and aged chondrocytes are inferior to juvenile chondrocytes in producing cartilage-specific extracellular matrix. Mesenchymal stem cells (MSCs) are an alternative cell type that can differentiate toward the chondrocyte phenotype. Aging may influence MSC chondrogenesis but remains less well studied, particularly in the bovine system. The objectives of this study were (1) to confirm age-related changes in bovine articular cartilage, establish how age affects chondrogenesis in cultured pellets for (2) chondrocytes and (3) MSCs, and (4) determine age-related changes in the biochemical and biomechanical development of clinically relevant MSC-seeded hydrogels. Native bovine articular cartilage from fetal (n = 3 donors), juvenile (n = 3 donors), and adult (n = 3 donors) animals was analyzed for mechanical and biochemical properties (n = 3–5 per donor). Chondrocyte and MSC pellets (n = 3 donors per age) were cultured for 6 weeks before analysis of biochemical content (n = 3 per donor). Bone marrow-derived MSCs of each age were also cultured within hyaluronic acid hydrogels for 3 weeks and analyzed for matrix deposition and mechanical properties (n = 4 per age). Articular cartilage mechanical properties and collagen content increased with age. We observed robust matrix accumulation in three-dimensional pellet culture by fetal chondrocytes with diminished collagen-forming capacity in adult chondrocytes. Chondrogenic induction of MSCs was greater in fetal and juvenile cell pellets. Likewise, fetal and juvenile MSCs in hydrogels imparted greater matrix and mechanical properties. Donor age and biochemical microenvironment were major determinants of both bovine chondrocyte and MSC functional capacity. In vitro model systems should be evaluated in the context of age-related changes and should be benchmarked against human MSC data.",{"EN":867},"Cartilage Matrix Formation by Bovine Mesenchymal Stem Cells in Three-dimensional Culture Is Age-dependent",{"VOID":869},"[\"11396654653306463327\"]",{"VOID":871},"Adkisson HD, Gillis MP, Davis EC, Maloney W, Hruska KA. In vitro generation of scaffold independent neocartilage. Clin Orthop Relat Res. 2001;391(Suppl):S280–294.\nArcher CW, Dowthwaite GP, Francis-West P. Development of synovial joints. Birth Defects Res C Embryo Today. 2003;69:144–155.\nAteshian GA, Hung CT. Patellofemoral joint biomechanics and tissue engineering. Clin Orthop Relat Res. 2005;436:81–90.\nBaksh D, Song L, Tuan RS. Adult mesenchymal stem cells: characterization, differentiation, and application in cell and gene therapy. J Cell Mol Med. 2004;8:301–316.\nBarbero A, Grogan S, Schafer D, Heberer M, Mainil-Varlet P, Martin I. Age related changes in human articular chondrocyte yield, proliferation and post-expansion chondrogenic capacity. Osteoarthritis Cartilage. 2004;12:476–484.\nBarry F, Boynton RE, Liu B, Murphy JM. Chondrogenic differentiation of mesenchymal stem cells from bone marrow: differentiation-dependent gene expression of matrix components. Exp Cell Res. 2001;268:189–200.\nBelow S, Arnoczky SP, Dodds J, Kooima C, Walter N. The split-line pattern of the distal femur: a consideration in the orientation of autologous cartilage grafts. Arthroscopy. 2002;18:613–617.\nBernardo ME, Emons JAM, Karperien M, Nauta AJ, Willemze R, Roelofs H, Romeo S, Marchini A, Rappold GA, Vukicevic S, Locatelli F, Fibbe WE. Human mesenchymal stem cells derived from bone marrow display a better chondrogenic differentiation compared with other sources. Connect Tissue Res. 2007;48:132–140.\nBullough P, Goodfellow J. The significance of the fine structure of articular cartilage. J Bone Joint Surg Br. 1968;50:852–857.\nBurdick JA, Chung C, Jia X, Randolph MA, Langer R. Controlled degradation and mechanical behavior of photopolymerized hyaluronic acid networks. Biomacromolecules. 2005;6:386–391.\nCharlebois M, McKee MD, Buschmann MD. Nonlinear tensile properties of bovine articular cartilage and their variation with age and depth. J Biomech Eng. 2004;126:129–137.\nChung C, Burdick JA. Influence of three-dimensional hyaluronic acid microenvironments on mesenchymal stem cell chondrogenesis. Tissue Eng Part A. 2009;15:243–254.\nClarke IC. Articular cartilage: a review and scanning electron microscope study. 1. The interterritorial fibrillar architecture. J Bone Joint Surg Br. 1971;53:732–750.\nCoipeau P, Rosset P, Langonne A, Gaillard J, Delorme B, Rico A, Domenech J, Charbord P, Sensebe L. Impaired differentiation potential of human trabecular bone mesenchymal stromal cells from elderly patients. Cytotherapy. 2009;11:584–594.\nDetterline AJ, Goldberg S, Bach BR Jr, Cole BJ. Treatment options for articular cartilage defects of the knee. Orthop Nurs. 2005;24:361–366; quiz 367–368.\nDressler MR, Butler DL, Boivin GP. Effects of age on the repair ability of mesenchymal stem cells in rabbit tendon. J Orthop Res. 2005;23:287–293.\nErickson IE, Huang AH, Chung C, Li RT, Burdick JA, Mauck RL. Differential maturation and structure-function relationships in mesenchymal stem cell- and chondrocyte-seeded hydrogels. Tissue Eng Part A. 2009;15:1041–1052.\nErickson IE, Huang AH, Sengupta S, Kestle S, Burdick JA, Mauck RL. Macromer density influences mesenchymal stem cell chondrogenesis and maturation in photocrosslinked hyaluronic acid hydrogels. Osteoarthritis Cartilage. 2009;17:1639–1648.\nFarndale RW, Buttle DJ, Barrett AJ. Improved quantitation and discrimination of sulphated glycosaminoglycans by use of dimethylmethylene blue. Biochim Biophys Acta. 1986;883:173–177.\nFrankowski JJ, Watkins-Castillo S. Primary Total Knee and Hip Arthroplasty Projections for the US Population to the Year 2030. Rosemont, IL: American Academy of Orthopaedic Surgeons, Department of Research and Scientific Affairs; 2002:1–8.\nGiannoni P, Pagano A, Maggi E, Arbico R, Randazzo N, Grandizio M, Cancedda R, Dozin B. Autologous chondrocyte implantation (ACI) for aged patients: development of the proper cell expansion conditions for possible therapeutic applications. Osteoarthritis Cartilage. 2005;13:589–600.\nHuang AH, Farrell MJ, Kim M, Mauck RL. Long-term dynamic loading improves the mechanical properties of chondrogenic mesenchymal stem cell-laden hydrogel. Eur Cell Mater. 2010;19:72–85.\nHuang AH, Stein A, Mauck RL. Evaluation of the complex transcriptional topography of mesenchymal stem cell chondrogenesis for cartilage tissue engineering. Tissue Eng Part A. 2010;16:2699–2708.\nHuang AH, Stein A, Tuan RS, Mauck RL. Transient exposure to transforming growth factor beta 3 improves the mechanical properties of mesenchymal stem cell-laden cartilage constructs in a density-dependent manner. Tissue Eng Part A. 2009;15:3461–3472.\nHuang AH, Yeger-McKeever M, Stein A, Mauck RL. Tensile properties of engineered cartilage formed from chondrocyte- and MSC-laden hydrogels. Osteoarthritis Cartilage. 2008;16:1074–1082.\nKempson GE. Age-related changes in the tensile properties of human articular cartilage: a comparative study between the femoral head of the hip joint and the talus of the ankle joint. Biochim Biophys Acta. 1991;1075:223–230.\nKleemann RU, Schell H, Thompson M, Epari DR, Duda GN, Weiler A. Mechanical behavior of articular cartilage after osteochondral autograft transfer in an ovine model. Am J Sports Med. 2007;35:555–563.\nKnutsen G, Engebretsen L, Ludvigsen TC, Drogset JO, Grontvedt T, Solheim E, Strand T, Roberts S, Isaksen V, Johansen O. Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am. 2004;86:455–464.\nKopesky PW, Lee HY, Vanderploeg EJ, Kisiday JD, Frisbie DD, Plaas AH, Ortiz C, Grodzinsky AJ. Adult equine bone marrow stromal cells produce a cartilage-like ECM mechanically superior to animal-matched adult chondrocytes. Matrix Biol. 2010;29:427–438.\nKretlow J, Jin Y-Q, Liu W, Zhang W, Hong T-H, Zhou G, Baggett LS, Mikos A, Cao Y. Donor age and cell passage affects differentiation potential of murine bone marrow-derived stem cells. BMC Cell Biology. 2008;9:60.\nMartin JA, Buckwalter JA. Telomere erosion and senescence in human articular cartilage chondrocytes. J Gerontol A Biol Sci Med Sci. 2001;56:B172–179.\nMauck RL, Soltz MA, Wang CC, Wong DD, Chao PH, Valhmu WB, Hung CT, Ateshian GA. Functional tissue engineering of articular cartilage through dynamic loading of chondrocyte-seeded agarose gels. J Biomech Eng. 2000;122:252–260.\nMauck RL, Yuan X, Tuan RS. Chondrogenic differentiation and functional maturation of bovine mesenchymal stem cells in long-term agarose culture. Osteoarthritis Cartilage. 2006;14:179–189.\nMicheli L, Curtis C, Shervin N. Articular cartilage repair in the adolescent athlete: is autologous chondrocyte implantation the answer? Clin J Sport Med. 2006;16:465–470.\nMicheli LJ, Browne JE, Erggelet C, Fu F, Mandelbaum B, Moseley JB, Zurakowski D. Autologous chondrocyte implantation of the knee: multicenter experience and minimum 3-year follow-up. Clin J Sport Med. 2001;11:223–228.\nMorrison EH, Ferguson MW, Bayliss MT, Archer CW. The development of articular cartilage: I. The spatial and temporal patterns of collagen types. J Anat. 1996;189:9–22.\nMurphy JM, Dixon K, Beck S, Fabian D, Feldman A, Barry F. Reduced chondrogenic and adipogenic activity of mesenchymal stem cells from patients with advanced osteoarthritis. Arthritis Rheum. 2002;46:704–713.\nNeuman RE, Logan MA. The determination of hydroxypoline. J Biol Chem. 1950;184:299–306.\nNg KW, Lima EG, Bian L, O’Conor CJ, Jayabalan PS, Stoker AM, Kuroki K, Cook CR, Ateshian GA, Cook JL, Hung CT. Passaged adult chondrocytes can form engineered cartilage with functional mechanical properties: a canine model. Tissue Eng Part A. 2010;16:1041–1051.\nPark S, Nicoll S, Mauck R, Ateshian G. Cartilage mechanical response under dynamic compression at physiological stress levels following collagenase digestion. Ann Biomed Eng. 2008;36:425–434.\nPayne KA, Didiano DM, Chu CR. Donor sex and age influence the chondrogenic potential of human femoral bone marrow stem cells. Osteoarthritis Cartilage. 2010;18:705–713.\nRoura S, Farre J, Soler-Botija C, Llach A, Hove-Madsen L, Cairo JJ, Godia F, Cinca J, Bayes-Genis A. Effect of aging on the pluripotential capacity of human CD105(+) mesenchymal stem cells. Eur J Heart Fail. 2006:555–563.\nScharstuhl A, Schewe B, Benz K, Gaissmaier C, Bühring H-J, Stoop R. Chondrogenic potential of human adult mesenchymal stem cells is independent of age or osteoarthritis etiology. Stem Cells. 2007;25:3244–3251.\nSteadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001;391(Suppl):S362–369.\nStegemann H, Stalder K. Determination of hydroxyproline. Clin Chim Acta. 1967;18:267–273.\nStenderup K, Justesen J, Clausen C, Kassem M. Aging is associated with decreased maximal life span and accelerated senescence of bone marrow stromal cells. Bone. 2003;33:919–926.\nStolzing A, Jones E, McGonagle D, Scutt A. Age-related changes in human bone marrow-derived mesenchymal stem cells: consequences for cell therapies. Mechanisms of Ageing and Development. 2008;129:163–173.\nTemple MM, Bae WC, Chen MQ, Lotz M, Amiel D, Coutts RD, Sah RL. Age- and site-associated biomechanical weakening of human articular cartilage of the femoral condyle. Osteoarthritis Cartilage. 2007;15:1042–1052.\nTokalov SV, Gruner S, Schindler S, Wolf G, Baumann M, Abolmaali N. Age-related changes in the frequency of mesenchymal stem cells in the bone marrow of rats. Stem Cells and Development. 2007;16:439–446.\nTran-Khanh N, Hoemann CD, McKee MD, Henderson JE, Buschmann MD. Aged bovine chondrocytes display a diminished capacity to produce a collagen-rich, mechanically functional cartilage extracellular matrix. J Orthop Res. 2005;23:1354–1362.\nWilliamson AK, Chen AC, Masuda K, Thonar EJ, Sah RL. Tensile mechanical properties of bovine articular cartilage: variations with growth and relationships to collagen network components. J Orthop Res. 2003;21:872–880.\nWilliamson AK, Chen AC, Sah RL. Compressive properties and function-composition relationships of developing bovine articular cartilage. 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2002, Discharge against medical advice: sociodemographic, clinical and financial perspectives., Int J Clin Pract, 56, 325, 10.1111\u002Fj.1742-1241.2002.tb11268.x",{"doi":1274},"10.1111\u002Fj.1742-1241.2002.tb11268.x",{"id":18,"text":1276,"url":18,"identifiers":1277},"Anis, 2002, Leaving hospital against medical advice among HIV-positive patients., CMAJ, 167, 633",{},{"id":18,"text":1279,"url":18,"identifiers":1280},"Dalrymple, 1993, Cross-validating factors associated with discharges against medical advice., Can J Psychiatry, 38, 285, 10.1177\u002F070674379303800411",{"doi":1281},"10.1177\u002F070674379303800411",{"id":18,"text":1283,"url":18,"identifiers":1284},"Edwards, 2013, Discharge against medical advice: how often do we intervene?, J Hosp Med, 8, 574, 10.1002\u002Fjhm.2087",{"doi":1285},"10.1002\u002Fjhm.2087",{"id":18,"text":1287,"url":18,"identifiers":1288},"Hwang, 2003, What happens to patients who leave hospital against medical advice?, CMAJ, 168, 417",{},{"id":18,"text":1290,"url":18,"identifiers":1291},"Lubell, 2007, Its more expensive there. Health spending 20 higher in Northeast: CMS., Mod Healthc, 37, 10",{},{"id":18,"text":1293,"url":18,"identifiers":1294},"Marquez-Lara, 2014, Sentinel events in cervical spine surgery. Spine (Phila Pa 1976)., , 39, 715",{},{"id":18,"text":1296,"url":18,"identifiers":1297},"Seaborn Moyse, 2004, Discharges against medical advice: a community hospitals experience., Can J Rural Med, 9, 148",{},{"id":1299,"createTime":1300,"updateTime":1301,"relativeEntities":1302,"slug":1303,"properties":1304,"entityType":240,"verifyStatus":241,"verifyTime":1315,"verifyNote":242,"languages":18,"translateLanguages":18,"viewCount":19,"primaryUrl":1316,"fullTextUrl":18,"authors":1317,"publicationType":281,"publisherRelationship":1346,"citationCount":18,"citationInfo":18,"publishDate":1404,"publishYear":1027,"citationAnalyzeStatus":1405,"lastCitationAnalyze":1406,"indexDatabases":1407,"openAccess":18,"references":18,"isForceReanalyzing":363},"75af06ba-94b1-4b06-815d-462d2bc251af","2024-01-20T04:47:28.024+00:00","2026-07-22T11:53:59.316+00:00",[],"Surgical-Technique-Lower-Limb-length-Equalization-by-Periosteal-Stripping-and-Periosteal-Division",{"abstract":1305,"title":1307,"gsPaper":1309,"references":1311,"doi":1313},{"EN":1306},"Stimulating growth in the shorter limb in patients with a lower limb length discrepancy (LLD) theoretically is a better alternative than retarding growth in the longer limb since it would not lead to loss of height. Periosteal stripping and\u002For division (PSPD) have been studied in animal models and in humans with encouraging results. We combined these procedures and used it to equalize lower limb length. The procedure consists of total circumferential stripping followed by transverse division of the periosteum at the proximal, middle, and distal shafts of the femur, tibia, and fibula of the shorter limb. We retrospectively reviewed 11 children with LLD who underwent PSPD. The average LLD was 6 ± 3.8 cm (range, 3–13 cm). The average age of the patients was 9 ± 2.5 years (range, 7–13 years). Orthoroentgenograms were obtained every 6 to 12 months after the surgery. The minimum followup was 24 months (mean, 52 months; range, 24–108 months). Limb length equalization (LLE) was achieved in eight of 11 patients in an average of 25 ± 17.2 months (range, 12–60 months) and was maintained throughout the followup. LLE was not achieved in three children whose discrepancy was greater than 10 cm, however, PSPD helped decrease the amount of the discrepancy in all three patients. No major complications were observed in any patients. PSPD stimulates limb length and LLE is achieved in approximately 2 years after the procedure in the majority of the patients. We believe PSPD should be considered as a surgical option for a LLD up to 6 cm. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.",{"EN":1308},"Surgical Technique: Lower Limb-length Equalization by Periosteal Stripping and Periosteal Division",{"VOID":1310},"[]",{"VOID":1312},"Blount WP, Clarke GR. Control of bone growth by epiphyseal stapling: a preliminary report. J Bone Joint Surg Am. 1949;31:464–478.\nChan KP, Hodgson AR. Physiologic leg lengthening: a preliminary report. Clin Orthop Relat Res. 1970;68:55–62.\nCrilly RG. Longitudinal overgrowth of chicken radius. J Anat. 1972;112:11–18.\nD’Souza H, Shah NM. Circumferential periosteal sleeve resection: results in limb-length discrepancy secondary to poliomyelitis. J Pediatr Orthop. 1999;19:215–221.\nDe Bastiani G, Aldegheri R, Renzi-Brivio L, Trivella G. Limb lengthening by callus distraction (callotasis). J Pediatr Orthop. 1987;7:129–134.\nDimitriou CG, Kapetanos GA, Symeonides PP. The effect of partial periosteal division on growth of the long bones: an experimental study in rabbits. Clin Orthop Relat Res. 1988;236:265–269.\nEdwards DJ, Bickerstaff DB, Bell MJ. Periosteal stripping in achondroplastic children: little effect on limb length in 10 cases. Acta Orthop Scand. 1994;65:333–334.\nGofton JP, Trueman GE. Studies in osteoarthritis of the hip: II. Osteoarthritis of the hip and leg-length disparity. Can Med Assoc J. 1971;104:791–799.\nGreen WT, Anderson M. Experiences with epiphyseal arrest in correcting discrepancies in length of the lower extremities in infantile paralysis: a method of predicting the effect. J Bone Joint Surg Am. 1947;29:659–675.\nHoughton GR, Rooker GD. The role of the periosteum in the growth of long bones: an experimental study in the rabbit. J Bone Joint Surg Br. 1979;61:218–220.\nJenkins DH, Cheng DH, Hodgson AR. Stimulation of bone growth by periosteal stripping: a clinical study. J Bone Joint Surg Br. 1975;57:482–484.\nKaufman KR, Miller LS, Sutherland DH. Gait asymmetry in patients with limb-length inequality. J Pediatr Orthop. 1996;16:144–150.\nKawamura B, Hosono S, Takahashi T, Yano T, Kobayashi Y, Shibata N, Shinoda Y. Limb lengthening by means of subcutaneous osteotomy: experimental and clinical studies. J Bone Joint Surg Am. 1968;50:851–878.\nLynch MC, Taylor JF. Periosteal division and longitudinal growth in the tibia of the rat. J Bone Joint Surg Br. 1987;69:812–816.\nMoseley C. Leg-length discrepancy. In: Morrissy RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopaedics. Ed 6. Philadelphia, PA: Lippincott William & Wilkins; 2005:1213–1256.\nPaley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res. 1990;250:81–104.\nRush WA, Steiner HA. A study of lower extremity length inequality. Am J Roentgenol Radius Ther. 1946;56:616–623.\nSabharwal S, Zhao C, McKeon J, Melaghari T, Blacksin M, Wenekor C. Reliability analysis for radiographic measurement of limb length discrepancy: full-length standing anteroposterior radiograph versus scanogram. J Pediatr Orthop. 2007;27:46–50.\nSansone JM, Wilsman NJ, Leiferman EM, Noonan KJ. The effect of periosteal resection on tibial growth velocity measured by microtransducer technology in lambs. J Pediatr Orthop. 2009;29:61–67.\nShapiro F. Fractures of the femoral shaft in children: the overgrowth phenomenon. Acta Orthop Scand. 1981;52:649–655.\nSilberman FS, Sola CK, Cabrini RL. A study of the vascular distribution after periosteal stripping of the long bones. Surg Gynecol Obstet. 1967;125:1311–1315.\nSola CK, Silberman FS, Cabrini RL. Stimulation of the longitudinal growth of long bones by periosteal stripping: an experimental study on dogs and monkeys. J Bone Joint Surg Am. 1963;45:1679–1684.\nTaylor JF, Warrell E, Evans RA. The response of the rat tibial growth plates to distal periosteal division. J Anat. 1987;151:221–231.\nWarrell E, Taylor JF. The role of periosteal tension in the growth of long bones. J Anat. 1979;128:179–184.\nWilde GP, Baker GC. Circumferential periosteal release in the treatment of children with leg-length inequality. J Bone Joint Surg Br. 1987;69:817–821.\nWu YK, Miltner LJ. A procedure for stimulation of longitudinal growth of bone: an experimental study. J Bone Joint Surg Am. 1937;19:909–921.",{"VOID":1314},"10.1007\u002Fs11999-011-2013-9","2024-06-25T19:32:31.133+00:00","https:\u002F\u002Fjournals.lww.com\u002Fclinorthop\u002Ffulltext\u002F2011\u002F11000\u002Fsurgical_technique__lower_limb_length_equalization.31.aspx",[1318,1333],{"id":1319,"sortIndex":19,"researcher":18,"roles":1320,"affiliations":1321,"properties":1330,"displayName":1332,"givenName":18,"familyName":18},"32ab69d1-46c8-4c15-ac2e-1de034532757",[383],[1322],{"id":1323,"sortIndex":19,"affiliation":1324,"properties":18},"8b197927-8592-40bc-8217-cc06d2506a26",{"id":1323,"createTime":18,"updateTime":18,"relativeEntities":1325,"slug":18,"properties":1326,"entityType":18,"verifyStatus":18,"verifyTime":18,"verifyNote":18,"languages":18,"translateLanguages":18,"viewCount":18,"url":18,"parentIds":1329,"statistic":18},[],{"title":1327},{"VI":1328},"Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, 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advancements have produced many challenges to intramedullary implants for unstable pertrochanteric fractures. Helical blade fixation of the femoral head has the theoretical advantages of higher rotational stability and cutout resistance and should have a lower rate of reoperation than a locked plating technique. We asked whether (1) helical blade nailing reduces the rate of reoperation within 24 months compared with locked plating and (2) any of various preoperative, intraoperative, or postoperative factors predicted failure in these two groups. We prospectively enrolled 108 patients with unstable pertrochanteric fractures in a surgeon-allocated study between November 2005 and November 2008: 54 with percutaneous compression plates (PCCP) and 54 with proximal femoral nail antirotation (PFNA). We evaluated patients regarding reoperation, mortality, and function. Seventy-four patients had a minimum followup of 24 months (mean, 26 months; range, 24–30 months). We found no differences in the number of reoperations attributable to mechanical problems in the two groups: PCCP = six and PFNA = five. Despite a greater incidence of postoperative lateral wall fractures with helical blade nailing, only postoperative varisation of the neck-shaft angle and tip-apex distance (33 mm versus 28 mm) predicted reoperation. Mortality and function were similar in the two groups. Our data suggest unstable pertrochanteric fractures may be fixed either with locked extramedullary small-diameter screw systems to avoid lateral wall fractures or with the new intramedullary systems to avoid potential mechanical complications of a broken lateral wall. Tip-apex distance and preservation of the preoperative femoral neck-shaft angle are the key technical factors for prevention of reoperation. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.",{"EN":1418},"Is Helical Blade Nailing Superior to Locked Minimally Invasive Plating in Unstable Pertrochanteric 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L, Hanson B, Swiontkowski MF. Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-plate versus dynamic screw-intramedullary nail devices. Int Orthop. 2003;27:197–203.","https:\u002F\u002Flink.springer.com\u002F10.1007\u002Fs10440-022-00541-7",{"doi":1567},"10.1007\u002Fs10440-022-00541-7",{"id":18,"text":1569,"url":18,"identifiers":1570},"Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJ. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO\u002FOTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am. 2010;92:792–798.",{},{"id":1563,"text":1572,"url":1565,"identifiers":1573},"Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995;77:1058–1064.",{"doi":1567},{"id":18,"text":1575,"url":18,"identifiers":1576},"Browner BD, Alberta FG, Mastella DJ. A new era in orthopedic trauma care. Surg Clin North Am. 1999;79:1431–1448.",{},{"id":1563,"text":1578,"url":1565,"identifiers":1579},"Cooper C, Barker DJ, Hall AJ. Evaluation of the Singh index and femoral calcar width as epidemiological methods for measuring bone mass in the femoral neck. Clin Radiol. 1986;37:123–125.",{"doi":1567},{"id":1563,"text":1581,"url":1565,"identifiers":1582},"d’Aubigné RM, Postel M. The classic: functional results of hip arthroplasty with acrylic prosthesis. 1954. Clin Orthop Relat Res. 2009;467:7–27.",{"doi":1567},{"id":18,"text":1584,"url":18,"identifiers":1585},"Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. 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J Bone Joint Surg Am. 1998;80:618–630.",{"doi":1567},{"id":1563,"text":1599,"url":1565,"identifiers":1600},"Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.",{"doi":1567},{"id":1563,"text":1602,"url":1565,"identifiers":1603},"Janzing HM, Houben BJ, Brandt SE, Chhoeurn V, Lefever S, Broos P, Reynders P, Vanderschot P. The Gotfried PerCutaneous Compression Plate versus the Dynamic Hip Screw in the treatment of pertrochanteric hip fractures: minimal invasive treatment reduces operative time and postoperative pain. J Trauma. 2002;52:293–298.",{"doi":1567},{"id":1605,"text":1606,"url":1607,"identifiers":1608},"9fac8930-18c8-4506-968e-728c6382aa26","Jones HW, Johnston P, Parker M. Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures. Int Orthop. 2006;30:69–78.","https:\u002F\u002Flink.springer.com\u002Farticle\u002F10.1007\u002Fs00264-005-0028-0",{"doi":1609},"10.1007\u002Fs00264-005-0028-0",{"id":18,"text":1611,"url":18,"identifiers":1612},"Knobe M, Münker R, Schmidt-Rohlfing B, Sellei RM, Schubert H, Erli HJ. [Surgical outcome in pertrochanteric femur fracture: the impact of osteoporosis. Comparison between DHS and percutaneous compression plate] [in German]. Z Orthop Unfall. 2008;146:44–51.",{},{"id":18,"text":1614,"url":18,"identifiers":1615},"Knobe M, Münker R, Sellei RM, Schmidt-Rohlfing B, Erli HJ, Strobl CS, Niethard FU. Unstable pertrochanteric femur fractures. Failure rate, lag screw sliding and outcome with extra- and intramedullary devices (PCCP, DHS and PFN). Z Orthop Unfall. 2009;147:306–313.",{},{"id":1563,"text":1617,"url":1565,"identifiers":1618},"Kosygan KP, Mohan R, Newman RJ. The Gotfried percutaneous compression plate compared with the conventional classic hip screw for the fixation of intertrochanteric fractures of the hip. J Bone Joint Surg Br. 2002;84:19–22.",{"doi":1567},{"id":1563,"text":1620,"url":1565,"identifiers":1621},"Langford J, Pillai G, Ugliailoro AD, Yang E. Perioperative lateral trochanteric wall fractures: sliding hip screw versus percutaneous compression plate for intertrochanteric hip fractures. J Orthop Trauma. 2011;25:191–195.",{"doi":1567},{"id":1563,"text":1623,"url":1565,"identifiers":1624},"Lenich A, Vester H, Nerlich M, Mayr E, Stöckle U, Füchtmeier B. Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip: blade vs screw. Injury. 2010;41:1292–1296.",{"doi":1567},{"id":1563,"text":1626,"url":1565,"identifiers":1627},"Liu Y, Tao R, Liu F, Wang Y, Zhou Z, Cao Y, Wang H. Mid-term outcomes after intramedullary fixation of peritrochanteric femoral fractures using the new proximal femoral nail antirotation (PFNA). Injury. 2010;41:810–817.",{"doi":1567},{"id":1563,"text":1629,"url":1565,"identifiers":1630},"Madsen JE, Naess L, Aune AK, Alho A, Ekeland A, Stromsoe K. Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw. J Orthop Trauma. 1998;12:241–248.",{"doi":1567},{"id":18,"text":1632,"url":18,"identifiers":1633},"Mak PH, Campbell RC, Irwin MG; American Society of Anesthesiologists. The ASA Physical Status Classification: inter-observer consistency. American Society of Anesthesiologists. Anaesth Intensive Care. 2002;30:633–640.",{},{"id":18,"text":1635,"url":18,"identifiers":1636},"Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audigé L. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 suppl):S1–S133.",{},{"id":1638,"text":1639,"url":1640,"identifiers":1641},"de96c213-49d0-4658-9ffe-575a9facfba1","Mereddy P, Kamath S, Ramakrishnan M, Malik H, Donnachie N. The AO\u002FASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury. 2009;40:428–432.","https:\u002F\u002Fwww.sciencedirect.com\u002Fscience\u002Farticle\u002Fpii\u002FS0020138308004804",{"doi":1642},"10.1016\u002Fj.injury.2008.10.014",{"id":18,"text":1644,"url":18,"identifiers":1645},"Olsson O, Ceder L, Hauggaard A. Femoral shortening in intertrochanteric fractures: a comparison between the Medoff sliding plate and the compression hip screw. J Bone Joint Surg Br. 2001;83:572–578.",{},{"id":18,"text":1647,"url":18,"identifiers":1648},"Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P; Hip Fracture Study Group. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg Am. 2007;89:470–475.",{},{"id":1563,"text":1650,"url":1565,"identifiers":1651},"Palm H, Lysén C, Krasheninnikoff M, Holck K, Jacobsen S, Gebuhr P. Intramedullary nailing appears to be superior in pertrochanteric hip fractures with a detached greater trochanter: 311 consecutive patients followed for 1 year. Acta Orthop. 2011;82:166–170.",{"doi":1567},{"id":1563,"text":1653,"url":1565,"identifiers":1654},"Panesar SS, Mirza S, Bharadwaj G, Woolf V, Ravikumar R, Athanasiou T. The percutaneous compression plate versus the dynamic hip screw: a meta-analysis. Acta Orthop Belg. 2008;74:38–48.",{"doi":1567},{"id":1563,"text":1656,"url":1565,"identifiers":1657},"Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD000093.",{"doi":1567},{"id":1563,"text":1659,"url":1565,"identifiers":1660},"Pervez H, Parker MJ, Vowler S. Prediction of fixation failure after sliding hip screw fixation. Injury. 2004;35:994–998.",{"doi":1567},{"id":1563,"text":1662,"url":1565,"identifiers":1663},"Peyser A, Weil YA, Brocke L, Sela Y, Mosheiff R, Mattan Y, Manor O, Liebergall M. A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip. J Bone Joint Surg Br. 2007;89:1210–1217.",{"doi":1567},{"id":1563,"text":1665,"url":1565,"identifiers":1666},"Rudicel S, Esdaile J. The randomized clinical trial in orthopaedics: obligation or option? J Bone Joint Surg Am. 1985;67:1284–1293.",{"doi":1567},{"id":18,"text":1668,"url":18,"identifiers":1669},"Schipper IB, Marti RK, van der Werken C. Unstable trochanteric femoral fractures: extramedullary or intramedullary fixation. Review of literature. Injury. 2004;35:142–151.",{},{"id":1563,"text":1671,"url":1565,"identifiers":1672},"Simmermacher RK, Ljungqvist J, Bail H, Hockertz T, Vochteloo AJ, Ochs U, Werken C; AO - PFNA study group. The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury. 2008;39:932–939.",{"doi":1567},{"id":1674,"text":1675,"url":1676,"identifiers":1677},"23c19a0f-b955-4d8c-a8c9-1c41022e839a","Strauss E, Frank J, Lee J, Kummer FJ, Tejwani N. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury. 2006;37:984–989.","https:\u002F\u002Fwww.sciencedirect.com\u002Fscience\u002Farticle\u002Fpii\u002FS002013830600369X",{"doi":1678},"10.1016\u002Fj.injury.2006.06.008",{"id":1563,"text":1680,"url":1565,"identifiers":1681},"Thomas AP. Dynamic hip screws that fail. Injury. 1991;22:45–46.",{"doi":1567},{"id":1683,"text":1684,"url":1685,"identifiers":1686},"191b2fc7-b89c-4c8f-9ef8-9c9198b26090","Varela-Egocheaga JR, Iglesias-Colao R, Suárez-Suárez MA, Fernández-Villán M, González-Sastre V, Murcia-Mazón A. Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail. Arch Orthop Trauma Surg. 2009;129:1401–1407.","https:\u002F\u002Flink.springer.com\u002Farticle\u002F10.1007\u002Fs00402-009-0955-0",{"doi":1687},"10.1007\u002Fs00402-009-0955-0",{"id":1689,"text":1690,"url":1691,"identifiers":1692},"8ebc71a4-a3f3-442f-b91f-7b33cf3f24d4","Yaozeng X, Dechun G, Huilin Y, Guangming Z, Xianbin W. Comparative study of trochanteric fracture treated with the proximal femoral nail anti-rotation and the third generation of gamma nail. Injury. 2010;41:1234–1238.","https:\u002F\u002Fwww.sciencedirect.com\u002Fscience\u002Farticle\u002Fpii\u002FS002013831000183X",{"doi":1693},"10.1016\u002Fj.injury.2010.03.005",{"id":1695,"createTime":1696,"updateTime":1697,"relativeEntities":1698,"slug":1699,"properties":1700,"entityType":240,"verifyStatus":241,"verifyTime":1711,"verifyNote":242,"languages":18,"translateLanguages":18,"viewCount":19,"primaryUrl":1712,"fullTextUrl":18,"authors":1713,"publicationType":281,"publisherRelationship":1800,"citationCount":19,"citationInfo":1859,"publishDate":1861,"publishYear":579,"citationAnalyzeStatus":1030,"lastCitationAnalyze":1862,"indexDatabases":1863,"openAccess":18,"references":18,"isForceReanalyzing":363},"ab5ef693-ab8b-44e3-815f-526bca39a31e","2023-12-09T10:31:57.034+00:00","2026-07-21T01:48:01.567+00:00",[],"What-Factors-Influence-the-Success-of-Medial-Gastrocnemius-Flaps-in-the-Treatment-of-Infected-TKAs-",{"abstract":1701,"title":1703,"gsPaper":1705,"references":1707,"doi":1709},{"EN":1702},"Soft tissue defects after TKA are a potentially devastating complication. Medial gastrocnemius flaps occasionally are used to provide soft tissue coverage, most commonly with a periprosthetic joint infection. We asked: (1) What were the rates of persistent or recurrent infection, implant survivorship, flap-related complications, and reoperation for patients who underwent medial gastrocnemius flap reconstruction for soft tissue coverage after TKA? (2) What were the Knee Society clinical and functional scores for patients who underwent medial gastrocnemius flap reconstruction for soft tissue defects after TKA? (3) What were the risk factors for failure of medial gastrocnemius flap reconstruction after TKA, with failure defined as recurrent or new periprosthetic joint infection or inability to reimplant the TKA prosthesis? Between 2003 and 2011, four surgeons at one institution performed 31 medial gastrocnemius flaps for soft tissue coverage over an infected TKA. Of those, 27 (87%) were available for followup at a minimum of 2 years (mean, 4 years; range, 2–6 years), although patients experiencing complications or treatment failures before two years were included. The study group consisted of 15 men and 12 women with a mean age of 61 years at the time of surgery (range, 36–86 years). The general indication for using a gastrocnemius flap in this setting was full-thickness soft tissue deficiency over the anterior knee during the course of treatment for concomitant deep infection. Six flaps were performed at prosthetic explantation and antibiotic spacer placement, eight at a spacer exchange, eight at second-stage TKA prosthesis reimplantation, and five at débridement with polyethylene exchange. The decision regarding when during staged treatment to place the flap was based solely on when the soft tissues were deemed insufficient, and not based on a belief that placement at one stage versus another was advantageous. Failure was defined as inability to undergo reimplantation of a TKA prosthesis or recurrence of periprosthetic joint infection. Patient and procedural characteristics were tested for association with failure. Survivorship was calculated by Cox proportional hazards modeling. Outcomes scores were drawn from a longitudinal institutional registry. Fourteen of 27 (52%) patients had a persistent or recurrent infection; survivorship of the TKA prosthesis at 4 years was 48% (95% CI, 31%–66%). Although there were no flap-related complications, 12 patients had a total of 19 reoperations during the study period. Overall, the mean (± SD) Knee Society knee (38 ± 18 vs 65 ± 20; p \u003C 0.001) and function (20 ± 22 vs 37 ± 25; p = 0.002) scores were improved at most recent followup. No factors were identified as associated with failure when a Bonferroni correction was applied. Gastrocnemius flaps were used to address difficult soft tissue defects in this series, in the presence of deep infections; the high proportion of patients experiencing persistent or recurrent infections reflects the case complexity and not necessarily a problem with the flaps. However, this series highlights the need to continue to explore alternative approaches to managing this difficult clinical problem. Future studies should aim to establish an evidence-based reconstructive algorithm, focusing on host, wound, and timing characteristics that may maximize outcomes. Level IV, therapeutic study.",{"EN":1704},"What Factors Influence the Success of Medial Gastrocnemius Flaps in the Treatment of Infected TKAs?",{"VOID":1706},"[\"14782296044039339109\"]",{"VOID":1708},"Alexiades M, Sands A, Craig S, Scott WN. Management of selected problems in revision knee arthroplasty. Orthop Clin North Am. 1989;20:211–219.\nAsif S, Choon DS. Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system. J Orthop Surg (Hong Kong). 2005;13:280–284.\nCasanova D, Hulard O, Zalta R, Bardot J, Magalon G. Management of wounds of exposed or infected knee prostheses. Scand J Plast Reconstr Hand Surg. 2001;35:71–77.\nCharlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245–1251.\nConway JD, Mont MA, Bezwada HP. Arthrodesis of the knee. J Bone Joint Surg Am. 2004;86:835–848.\nCorten K, Struelens B, Evans B, Graham E, Bourne RB, MacDonald SJ. Gastrocnemius flap reconstruction of soft-tissue defects following infected total knee replacement. Bone Joint J. 2013;95:1217–1221.\nGalat DD, McGovern SC, Larson DR, Harrington JR, Hanssen AD, Clarke HD. Surgical treatment of early wound complications following primary total knee arthroplasty. J Bone Joint Surg Am. 2009;91:48–54.\nGerwin M, Rothaus KO, Windsor RE, Brause BD, Insall JN. Gastrocnemius muscle flap coverage of exposed or infected knee prosthesis. Clin Orthop Relat Res. 1993;286:64–70.\nGoldman RT, Scuderi GR, Insall JN. 2-stage reimplantation for infected total knee replacement. Clin Orthop Relat Res. 1996;331:118–124.\nGreenberg B, LaRossa D, Lotke PA, Murphy JB, Noone RB. Salvage of jeopardized total-knee prosthesis: the role of the gastrocnemius muscle flap. Plast Reconstr Surg. 1989;83:85–89, 97–99.\nHarris IE, Leff AR, Gitelis S, Simon MA. Function after amputation, arthrodesis, or arthroplasty for tumors about the knee. J Bone Joint Surg Am. 1990;72:1477–1485.\nInsall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.\nJones RE, Russell RD, Huo MH. Wound healing in total joint replacement. Bone Joint J. 2013;95(11 suppl A):144–147.\nKurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.\nLian G, Cracchiolo A 3rd, Lesavoy M. Treatment of major wound necrosis following total knee arthroplasty. J Arthroplasty. 1989;4(suppl):S23–32.\nLidwell OM, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, Lowe D. Infection and sepsis after operations for total hip or knee-joint replacement: influence of ultraclean air, prophylactic antibiotics and other factors. J Hyg (Lond). 1984;93:505–529.\nMarkovich GD, Dorr LD, Klein NE, McPherson EJ, Vince KG. Muscle flaps in total knee arthroplasty. Clin Orthop Relat Res. 1995;321:122–130.\nMcCraw JB, Fishman JH, Sharzer LA. The versatile gastrocnemius myocutaneous flap. Plast Reconstr Surg. 1978;62:15–23.\nMcPherson EJ, Patzakis MJ, Gross JE, Holtom PD, Song M, Dorr LD. Infected total knee arthroplasty: two stage reimplantation with a gastrocnemius rotational flap. Clin Orthop Relat Res. 1997;341:73–81.\nMenderes A, Demirdover C, Yilmaz M, Vayvada H, Barutcu A. Reconstruction of soft tissue defects following total knee arthroplasty. Knee. 2002;9:215–219.\nMittal Y, Fehring TK, Hanssen A, Marculescu C, Odum SM, Osmon D. Two-stage reimplantation for periprosthetic knee infection involving resistant organisms. J Bone Joint Surg Am. 2007;89:1227–1231.\nMortazavi SM, Vegari D, Ho A, Zmistowki B, Parvizi J. Two-exchange arthroplasty for infected total knee arthroplasty: predictors of failure. Clin Orthop Relat Res. 2011;469:3049–3054.\nNahabedian MY, Mont MA, Orlando JC, Delanois RE, Hungerford DS. Operative management and outcome of complex wounds following total knee arthroplasty. Plast Reconstr Surg. 1999;104:1688–1697.\nNahabedian MY, Orlando JC, Delanois RE, Mont MA, Hungerford DS. Salvage procedures for complex soft tissue defects of the knee. Clin Orthop Relat Res. 1998;356:119–124.\nPanni AS, Vasso M, Cerciello S, Salgarello M. Wound complications in total knee arthroplasty: which flap is to be used? With or without retention of prosthesis? Knee Surg Sports Traumatol Arthrosc. 2011;19:1060–1068.\nParvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469:2992–2994.\nRies MD. Skin necrosis after total knee arthroplasty. J Arthroplasty. 2002;17(4 suppl 1):74–77.\nRies MD, Bozic KJ. Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty. Clin Orthop Relat Res. 2006;446:186–192.\nSanders R, O’Neill T. The gastrocnemius myocutaneous flap used as a cover for the exposed knee prosthesis. J Bone Joint Surg Br. 1981;63:383–386.\nSherrell JC, Fehring TK, Odum S, Hansen E, Zmistowski B, Dennos A, Kalore N; Periprosthetic Infection Consortium. The Chitranjan Ranawat Award: fate of two-stage reimplantation after failed irrigation and débridement for periprosthetic knee infection. Clin Orthop Relat Res. 2011;469:18–25.\nTan KJ, Lim CT, Lim AY. The use of muscle flaps in the salvage of infected exposed implants for internal fixation. J Bone Joint Surg Br. 2010;92:401–405.\nTetreault MW, Wetters NG, Aggarwal VK, Moric M, Segreti J, Huddleston JI 3rd, Parvizi J, Della Valle CJ. Should draining wounds and sinuses associated with hip and knee arthroplasties be cultured? 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