No abstract

Orthobiologics are biologically derived materials which aim to promote healing and regeneration of tissues that are the focus of orthopedic surgery. Since bones, ligaments, tendons, and cartilage have different healing and regeneration characteristics, treatment strategies and clinical problems related to these tissues greatly differ. Although orthobiolgics are an old concept, most of the advancements in this field have been accomplished within the last two decades. A large number of promising laboratory studies show that orthobiolics hold a great potential in launching the next chapter of orthopedics. In this article, the use, research on this subject, future potential of orthobiologics, and the tissues in focus have been briefly reviewed.

Background and purpose — The nonagenarian (those aged 90 years and older) population is expected to double in the next 20 years. This demographic age quake may have a significant impact on the incidence of total knee arthroplasty (TKA), although current literature provides limited data. We examined death and revision rates, patient-reported outcomes (PROs) and bias on patient selection of nonagenarian patients operated on with TKA for osteoarthritis (OA) between 2000 and 2016.Patients and methods — The Swedish national knee arthroplasty register was used to identify 329 nonagenarians (mean age, 92 years). Each patient was followed-up until death or the end of 2017. PRO data of 22 of these patients were compared with 65- to 74-year-old patients operated in 2015, from the same register.Results — 5 patients (1.5%) died within 90 days and 23 (7%) patients died within 365 days after TKA. 8 patients (2.4%) developed knee complications that needed revision. For patients followed for 5 and 10 years, more than 50% and 10%, respectively, lived without being revised. The patients had statistically significant improvements in PROs, not significantly different from the younger SKAR cohort. However, the material is small and this statistical finding does not preclude that there may be clinically relevant differences. TKA incidence was different amongst the 21 counties in the country (range, 0–5.1/10,000).Interpretation — Our study suggests that nonagenarians with knee OA qualify for TKA, having similar outcomes to younger patients. The data presented may help surgeons and patients assessing the risks and outcome associated with the procedure.

Purpose Whether ultra-congruent (UC) or posterior cruciate ligament-stabilized (PS) inserts should be used in posterior cruciate ligament (PCL)-sacriicing total knee arthroplasty (TKA) remains debatable. Therefore, the aim of this prospective randomized controlled study was to compare the isokinetic performance and clinical outcomes of these inserts in PCLsacriicing TKA. Methods Sixty-six patients diagnosed with primary knee osteoarthritis were randomly assigned to either the UC or the PS group. There were no signiicant diferences between the groups in terms of age, body mass index or sex. The Knee Society score (KSS) and isokinetic performance results for each patient were recorded preoperatively and at 3, 6 and 12 months postoperatively. The physiatrist that performed the isokinetic tests and the patients were blinded to the study groups. Results There were no signiicant diferences between the groups in terms of the preoperative KSS or isokinetic performance. Gradual improvement in the KSS was observed in both groups, but no signiicant diferences were detected between the groups during the whole follow-up period. The UC and PS groups exhibited similar peak extension and lexion torque values normalized to body weight at 3, 6 and 12 months postoperatively (p > 0.05). ConclusionThe use of UC or PS inserts in TKA did not afect the clinical outcomes or isokinetic performance.The clinical relevance of this study is that the potential diferences in clinical outcomes and isokinetic performance between UC and PS inserts do not need to be considered when sacriicing the PCL in TKA. Level of evidence I.