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Aim In the osteoarthritis (OA) disease, all structures of the joint are involved. The infrapatellar Hoffa fat pad is rich in macrophages and granulocytes, which also represents a source of adipose mesenchymal progenitor cells (ASC) cells. In our study, we analyze how OA affects the ability of ASC-derived from Hoffa's fat pad to differentiate into chondrocytes. Material and methodology We took knee Hoffa's pad samples and adipose tissue from the proximal thigh from 6 patients diagnosed with severe OA and from another 6 patients with an anterior cruciate ligament (ACL) rupture without OA. From all the patients, we took subcutaneous adipose tissue from the thigh, as the control group. Samples of synovial fluid (SF) were also extracted. The gene expression was analyzed by real-time quantitative polymerase chain reaction. Results PTH1R and MMP13 expression during chondrogenic differentiation were similar between OA and ACL groups, while the expression of OPG, FGF2, TGFβ, MMP3 were significantly lower in the OA group. Exposure of differentiated ASC to OA SF induced an increase in the expression of OPG, PTH1R, and MMP13 and a decrease in the expression of FGF2 in cell culture of the ACL group. However, expression of none of these factors was altered by the OA synovial fluid in ASC cells of the OA group. Conclusion OA of the knee also affects the mesenchymal stem cells of Hoffa fat, suggesting that Hoffa fat is a new actor in the OA degenerative process that can contribute to the origin, onset, and progression of the disease.

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Purpose:SARS-CoV-2 new scenario has forced health systems to work under extreme stress urging to perform a complete reorganization of the way our means and activities were organized. Orthopedic and trauma have rescheduled their activities to help SARS-CoV-2 units, but trauma patients require also treatment, and no standardized protocols have been established.Methods: Single-center cross-sectional study was performed in a tertiary hospital. Two different periods of time were analyzed: a two-week period time in March 2019 (pre-SARS-CoV-2) and the same period of March 2020 (SARS-CoV-2 pandemic time). Outpatient’s data, emergency activity, surgical procedures and admissions were evaluated. Surgeons and patient´s opinion was also evaluated using a survey.Results:A total of ~16k (15.953) patients were evaluated. Scheduled clinical appointments decreased by ~22%. Urgent consultations and discharge from clinics also descended (~37% and ~20% respectively). Telemedicine was used in 90% of outpatient clinical evaluations. No elective surgical procedures during SARS-CoV-2 time were scheduled, and subtracting the effect of elective surgeries, a reduction of inpatient surgeries, from ~85% to ~59%. Patients delayed trauma assistance more than 48 hours in 13 cases (35%). Preoperative admission for hip fractures decreased in 10 hours on average. Finally surveys stated that patients were more in favor than surgeons to this new way to evaluate orthopedic and trauma patients based strongly on telemedicine.ConclusionDetailed protocols should be standardized for surgical departments during the pandemic. This paper offers a general view in how this virus affects an orthopedic unit and could serve as a protocol and example for orthopedic and trauma units. Even in the worst scenario, an orthopedic and Trauma unit could offer an effective, efficient and quality service. SARS-CoV-2 will set up a new paradigm for health care in orthopedics and trauma.

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