scholarly journals Clinical Application of Antimicrobial Bone Graft Substitute in Osteomyelitis Treatment: A Systematic Review of Different Bone Graft Substitutes Available in Clinical Treatment of Osteomyelitis

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
T. A. G. van Vugt ◽  
J. Geurts ◽  
J. J. Arts
Keyword(s):  
Bone Graft ◽  
Clinical Studies ◽  
Local Treatment ◽  
Complication Rates ◽  
Success Rates ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
Systemic Antibiotic Therapy ◽  
Eradication Of Infection ◽  
Bone Graft Substitutes

Osteomyelitis is a common occurrence in orthopaedic surgery, which is caused by different bacteria. Treatment of osteomyelitis patients aims to eradicate infection by debridement surgery and local and systemic antibiotic therapy. Local treatment increases success rates and can be performed with different antimicrobial bone graft substitutes. This review is performed to assess the level of evidence of synthetic bone graft substitutes in osteomyelitis treatment. According to the PRISMA statement for reporting systematic reviews, different types of clinical studies concerning treatment of osteomyelitis with bone graft substitutes are included. These studies are assessed on their methodological quality as level of evidence and bias and their clinical outcomes as eradication of infection. In the fifteen included studies, the levels of evidence were weak and in ten out of the fifteen studies there was a moderate to high risk of bias. However, first results of the eradication of infection in these studies showed promising results with their relatively high success rates and low complication rates. Due to the low levels of evidence and high risks of bias of the included studies, these results are inconclusive and no conclusions regarding the performed clinical studies of osteomyelitis treatment with antimicrobial bone graft substitutes can be drawn.

Current Updates on Bone Grafting Biomaterials and Recombinant Human Growth Factors Implanted Biotherapy for Spinal Fusion: A Review of Human Clinical Studies

2018 ◽  
Vol 16 (2) ◽  
pp. 94-110 ◽  
Author(s):  
Guanbao Li ◽  
Pinquan Li ◽  
Qiuan Chen ◽  
Hnin Ei Thu ◽  
Zahid Hussain
Keyword(s):  
Bone Graft ◽  
Spinal Fusion ◽  
Bone Grafting ◽  
Demineralized Bone Matrix ◽  
Donor Site ◽  
Bone Matrix ◽  
Great Promise ◽  
Level Of Evidence ◽  
Bone Fusion ◽  
Bone Graft Substitutes

Background:Owing to their great promise in the spinal surgeries, bone graft substitutes have been widely investigated for their safety and clinical potential. By the current advances in the spinal surgery, an understanding of the precise biological mechanism of each bone graft substitute is mandatory for upholding the induction of solid spinal fusion.Objective:The aim of the present review is to critically discuss various surgical implications and level of evidence of most commonly employed bone graft substitutes for spinal fusion.Method:Data was collected via electronic search using “PubMed”, “SciFinder”, “ScienceDirect”, “Google Scholar”, “Web of Science” and a library search for articles published in peer-reviewed journals, conferences, and e-books.Results:Despite having exceptional inherent osteogenic, osteoinductive, and osteoconductive features, clinical acceptability of autografts (patient’s own bone) is limited due to several perioperative and postoperative complications i.e., donor-site morbidities and limited graft supply. Alternatively, allografts (bone harvested from cadaver) have shown great promise in achieving acceptable bone fusion rate while alleviating the donor-site morbidities associated with implantation of autografts. As an adjuvant to allograft, demineralized bone matrix (DBM) has shown remarkable efficacy of bone fusion, when employed as graft extender or graft enhancer. Recent advances in recombinant technologies have made it possible to implant growth and differentiation factors (bone morphogenetic proteins) for spinal fusion.Selection of a particular bone grafting biotherapy can be rationalized based on the level of spine fusion, clinical experience and preference of orthopaedic surgeon, and prevalence of donor-site morbidities.

Emergent urinary decompression in acute stone-related urinary obstruction: A systematic review and meta-analysis

2021 ◽  
pp. 205141582110170
Author(s):  
David Eugenio Hinojosa-Gonzalez ◽  
Mauricio Torres-Martinez ◽  
Sergio Uriel Villegas-De Leon ◽  
Cecilia Galindo-Garza ◽  
Andres Roblesgil-Medrano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Operative Time ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Percutaneous Nephrostomy ◽  
Complication Rates ◽  
Success Rates ◽  
Level Of Evidence ◽  
Cell Counts

Introduction: Emergent urinary decompression through percutaneous nephrostomy (PCN) or ureteric stent (URS) remains a mainstay in the management of urethral calculi-related obstruction with associated signs of infection or renal injury. Available evidence has shown similar performance, and current guidelines endorse both treatment strategies. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria up until August 2020. Studies included data on stone size and location, operative time, complications, length of stay, analgesic consumption, quality of life (QoL), and clinical outcomes between URS and PCN. Results: Ten studies with a total population of 772, of which 420 were treated with URS and 352 with PCN, were included. No statistical difference in operative time between both techniques was found. Nevertheless, length of stay in PCN was longer than in USR, with a mean difference of −1.87 days ((95% CI −2.69 to −1.06), Z=4.50, p=0.00001). No differences were found in the time to normalization of temperature or white blood cell counts. There were no significant differences in success rates, with an overall odds ratio (OR) of 0.60 ((95% CI 0.26 to −1.40), Z=1.17, p=0.24), or spontaneous passage after emergent drainage between groups. Complication rates ranged from 5% to 25% in URS and from 0% to 38% in PCN. In the studied population, out of the 157 patients from four studies describing complications, only 5% of URS procedures presented complications compared to 2% in PCN, showing a relatively low complication rate for either group (OR=2.07 (95% CI 0.89–4.84), Z=1.68, p=0.09). Differences in QoL were not significant. Conclusion: Both methods are equally effective, with no clear advantage for PCN over URS. Level of evidence: IV

scholarly journals The Effect on Implant Fixation of Soaking Tricalcium Phosphate Granules in Bisphosphonate

2012 ◽  
Vol 6 (1) ◽  
pp. 371-375 ◽  
Author(s):  
Thomas Jakobsen ◽  
Jørgen Baas ◽  
Joan E Bechtold ◽  
Brian Elmengaard ◽  
Kjeld Søballe
Keyword(s):  
Bone Graft ◽  
Local Treatment ◽  
Proximal Part ◽  
Bone Substitutes ◽  
Allogeneic Bone ◽  
Implant Fixation ◽  
Treatment Groups ◽  
Bone Graft Substitutes ◽  
Biomechanical Parameters ◽  
Push Out

The use of bone grafting is a well-established way to enhance initial implant fixation in situations with reduced bone stock. Ceramic bone substitutes are inferior alternatives to autogenous or allogeneic bone graft. Improvement of bone graft substitutes is needed. We investigated whether biomechanical implant fixation and osseointegration of experimental implant grafted with β-TCP granules (Conduit) could be improved by soaking the β-TCP granules in bisphosphonate (zoledronate). In 10 dogs, a pair of titanium coated implants surrounded by a 2.5 mm gap was inserted into the proximal part of each tibia. The gap was grafted with β-TCP granules either soaked with zoledronate or saline. At 12 weeks, the implants were evaluated with biomechanical push-out test and histomorphometrical analysis. We found that bisphosphonate increased one of the three biomechanical parameters, but found no difference in the amount of new bone or β-TCP granules between the two treatment groups. This study indicates that local treatment of β-TCP granules with zoledronate not only has the potential to increase implant fixation but also calls for further experimental research in order to optimize the dose of zoledronate.

scholarly journals Triple Arthrodesis for Adult-Acquired Flatfoot Deformity

2019 ◽  
Vol 4 (3) ◽  
pp. 247301141984960
Author(s):  
MAJ Uma E. Erard ◽  
MAJ Andrew J. Sheean ◽  
Bruce J. Sangeorzan
Keyword(s):  
Diagnostic Imaging ◽  
Bone Graft ◽  
Foot Deformities ◽  
Triple Arthrodesis ◽  
Level Of Evidence ◽  
The Past ◽  
Bone Graft Substitutes ◽  
Adult Acquired Flatfoot Deformity

Originally described as a means to address fixed deformities or uncontrolled movement of the hindfoot observed in paralytic foot deformities, triple arthrodesis has evolved into a powerful procedure for the correction of a variety of foot deformities. Over the past decade, multiple advances have been made with respect to diagnostic imaging, fixation options, bone graft substitutes, and postoperative regimens. While this operation requires experience and skill to execute, when properly performed, it allows for correction of deformity and a plantigrade and ideally pain-free foot for ambulation. The purpose of this review is to highlight advances in the procedure and its application to the rigid planovalgus foot. Level of Evidence: Level V, review.

scholarly journals ROLE OF BONE GRAFTS AND BONE GRAFT SUBSTITUTES IN ISOLATED SUBTALAR JOINT ARTHRODESIS

2017 ◽  
Vol 25 (5) ◽  
pp. 183-187 ◽  
Author(s):  
ASHISH SHAH ◽  
SAMEER NARANJE ◽  
IBUKUNOLUWA ARAOYE ◽  
OSAMA ELATTAR ◽  
ALEXANDRE LEME GODOY-SANTOS ◽  
...  
Keyword(s):  
Bone Graft ◽  
Demineralized Bone Matrix ◽  
Bone Matrix ◽  
Case Series ◽  
Bone Grafts ◽  
Union Rate ◽  
Level Of Evidence ◽  
Subtalar Arthrodesis ◽  
Significant Difference ◽  
Bone Graft Substitutes

ABSTRACT Objectives: The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. Methods: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all surgeries. Graft materials included b-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft, and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. Results: There was an 88% (37/42) union rate without graft use and an 83% (78/93) union rate with bone graft use. Odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the non-graft group, with no statistically significant difference detected (p = 0.56). Conclusion: Graft use did not improve union rates for subtalar arthrodesis. Level of Evidence IV, Case Series.

scholarly journals The Use of Bone Grafts, Bone Graft Substitutes, and Orthobiologics for Osseous Healing in Foot and Ankle Surgery

2019 ◽  
Vol 4 (3) ◽  
pp. 247301141984901 ◽  
Author(s):  
Jonathan R. Peterson ◽  
Fangyu Chen ◽  
Eugene Nwankwo ◽  
Travis J. Dekker ◽  
Samuel B. Adams
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Bone Grafts ◽  
Bone Graft Substitute ◽  
Autologous Bone Graft ◽  
Donor Site Morbidity ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
Bone Graft Substitutes

Achieving fusion in osseous procedures about the foot and ankle presents unique challenges to the surgeon. Many patients have comorbidities that reduce osseous healing rates, and the limited space and high weightbearing demand placed on fusion sites makes the choice of bone graft, bone graft substitute, or orthobiologic agent of utmost importance. In this review, we discuss the essential characteristics of grafts, including their osteoconductive, osteoinductive, osteogenic, and angiogenic properties. Autologous bone graft remains the gold standard and contains all these properties. However, the convenience and lack of donor site morbidity of synthetic bone grafts, allografts, and orthobiologics, including growth factors and allogenic stem cells, has led to these being used commonly as augments. Level of Evidence: Level V, expert opinion.

Effectiveness of Telementoring in Surgery Compared With On-site Mentoring: A Systematic Review

2017 ◽  
Vol 24 (4) ◽  
pp. 379-385 ◽  
Author(s):  
Elif Bilgic ◽  
Sena Turkdogan ◽  
Yusuke Watanabe ◽  
Amin Madani ◽  
Tara Landry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Distance Learning ◽  
Educational Intervention ◽  
Clinical Encounter ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Training Tool ◽  
Levels Of Evidence ◽  
Technical Issues

Background. Mentorship is important but may not be feasible for distance learning. To bridge this gap, telementoring has emerged. The purpose of this systematic review was to evaluate the effectiveness of telementoring compared with on-site mentoring. Methods. A search was done up to March 2015. Studies were included if they used telementoring between surgeons during a clinical encounter and if they compared on-site mentoring and telementoring. Results. A total of 11 studies were included. All reported no difference in complication rates, and 9 (82%) reported similar operative times; 4 (36%) reported technical issues, which was 3% of the total number of cases in the 11 studies. No study reported on higher levels of evidence for effectiveness of telementoring as an educational intervention. Conclusion. Studies reported that telementoring is associated with similar complication rates and operative times compared with on-site mentoring. However, the level of evidence to support the effectiveness of telementoring as a training tool is limited. There is a need for studies that provide evidence for the equivalence of the effectiveness of telementoring as an educational intervention in comparison with on-site mentoring.

Complications following local anaesthetic transperineal prostate biopsies without antibiotic prophylaxis: An institution’s experience

2021 ◽  
pp. 205141582098766
Author(s):  
Joseph B John ◽  
Angus MacCormick ◽  
Ruaraidh MacDonagh ◽  
Mark J Speakman ◽  
Ramesh Vennam ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Local Anaesthetic ◽  
Complication Rate ◽  
Admission Rate ◽  
Prophylactic Antibiotics ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Hospital Admission Rate ◽  
Prostate Biopsies ◽  
Disease Characteristics

Objectives: This study aimed to describe a UK institution’s experience with local anaesthetic (LA) transperineal (TP) prostate biopsies (PB), and to report 30-day complications following LATPPB, including a large cohort that did not receive antibiotic prophylaxis. Patients and methods: A prospective database of 313 consecutive patients undergoing LATPPB was maintained, describing patient and disease characteristics, and complications. From September 2019 to January 2020, antibiotic prophylaxis was given before LATPPB ( n=149). Following a change to routine care, from January 2020 to July 2020, prophylactic antibiotics were not given before LATPPB ( n=164). A comparative analysis was performed to determine complication rates following antibiotic prophylaxis discontinuation using electronic hospital and primary care records. Results: Patient and disease characteristics were comparable in antibiotic and non-antibiotic cohorts, and representative of PB and prostate cancer cohorts described in the urological literature. The infection-related complication rate was 0.32% across all patients, and 0% for those not receiving antibiotic prophylaxis. The overall complication rate was 0.64%, and 0.61% for those not receiving antibiotic prophylaxis. There were no severe (Clavien–Dindo 3–5) complications. The unplanned hospital admission rate was 0.64%. Conclusion: The complication rate after LATPPB was low, with no infection-related complications in patients who did not receive antibiotic prophylaxis. This provides further evidence supporting the discontinuation of routine prophylactic antibiotics before TPPB. Level of evidence: Level 2b.

Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions

2017 ◽  
Vol 38 (5) ◽  
pp. 485-495 ◽  
Author(s):  
Riccardo D’Ambrosi ◽  
Camilla Maccario ◽  
Chiara Ursino ◽  
Nicola Serra ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Bone Graft ◽  
Repeated Measures ◽  
Osteochondral Lesion ◽  
Young Patients ◽  
Case Series ◽  
Autologous Bone Graft ◽  
Lesion Size ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Autologous Bone

Background: The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT). Methods: Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. Results: Mean lesion size measured during surgery was 1.1 cm3 ± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0 to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2 preoperatively to 77.9 ± 15.8 mm2 ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2 to 85.3 ± 14.5 mm2 ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011). Conclusions: The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life. Level of Evidence: Level IV, retrospective case series.

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