Cold physical plasma (CPP) technology is of high promise for various medical applications. The interplay of specific components of physical plasma with living cells, tissues and organs on a structural and functional level is of paramount interest with the aim to induce therapeutic effects in a controlled and replicable fashion. In contrast to other medical disciplines such as dermatology and oromaxillofacial surgery, research reports on CPP application in orthopaedics are scarce. The present implementation of CPP in orthopaedics involves surface modifications of orthopaedic materials and biomaterials to optimize osseointegration. In addition, the influence of CPP on musculoskeletal cells and tissues is a focus of research, including possible adverse reactions and side effects. Its bactericidal aspects make CPP an attractive supplement to current treatment regimens in case of microbial inflammations such as periprosthetic joint infections. Attributed anticancerogenic and pro-apoptotic effects underline the clinical relevance of CPP as an additive in treating malignant bone lesions. The present review outlines ongoing research in orthopaedics involving CPP; it distinguishes considerations for safe application and the need for more evidence-based research to facilitate robust clinical implementation.

Psychologic comorbidities have been identified as risk factors for poor outcomes in orthopedic procedures, but their influence on the outcome of hip-preserving periacetabular osteotomy (PAO) remains uncertain. This retrospective cohort study aimed to assess the impact of patients’ psychological health on the outcome of PAO in patients with hip dysplasia (HD) and acetabular retroversion (AR). The study included 110 patients undergoing PAO for HD or AR between 2019 and 2021. Standardized questionnaires were administered to assess psychological factors, postoperative hip function, and activity level (mean follow-up: 25 months). Linear regression analyses were used to examine the associations between psychological factors and postoperative hip function and activity level. Both HD and AR patients showed improved postoperative hip function and activity levels. Linear regression analyses revealed that depression significantly impaired postoperative outcomes in both groups, whereas somatization negatively influenced the outcome in AR patients. General health perceptions significantly contributed to an improved postoperative outcome. These findings highlight the importance of concomitantly addressing psychologically relevant factors in order to improve patient outcomes after PAO procedures. Future prospective studies should continue to investigate the impact of various psychological factors and explore possibilities of incorporating psychological support into routine postoperative care for these patient cohorts.

Zusammenfassung Hintergrund Die Hüftdysplasie stellt die häufigste Ursache der sekundären Koxarthrose dar. Die periazetabuläre Osteotomie (PAO) nach Ganz ist ein etabliertes Therapieverfahren, welches eine reproduzierbare Korrektur der dreidimensionalen Pathologie erlaubt. Den mittel- und langfristigen guten Behandlungsergebnissen stehen potenzielle Komplikationsrisiken eines invasiven Beckeneingriffes gegenüber. In Anbetracht des vornehmlich jungen Alters der Patient*innen ist eine Kenntnis der möglichen Komplikationen und der daraus resultierenden adäquaten Therapie wichtig. Therapieentwicklung Die kontinuierliche Weiterentwicklung der Operationstechnik und die zunehmende Erfahrung der Operateur*innen – mit dem sich hieraus ergebenden wachsenden Verständnis bezüglich kritischer Operationsschritte – haben zu einer wesentlichen Reduktion schwerwiegender Komplikationen geführt. Um darüber hinaus das Outcome für die Patient*innen zu verbessern, sind neben der Reduktion der Komplikationsrate auch ein besseres Verständnis bezüglich der hüftdysplasieassoziierten Begleitpathologien essenziell.

A 43-year-old female patient reported persistent iliopsoas-related groin pain following periacetabular osteotomy (PAO) combined with femoroplasty via a direct anterior approach due to CAM morphology. Concomitantly with the planned removal of screws, hip arthroscopy was performed, and the iliopsoas tendon was found to run intraarticularly, resulting in the tendon being impaired in its mobility and being entrapped. The tendon was arthroscopically released. The patient reported relief of the groin pain after the arthroscopic tendon debridement. During PAO combined with capsulotomy, the postoperatively observed intraarticular position of the iliopsoas tendon should be prevented by careful closure of the joint capsule.