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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: closed (20 September 2023) | Viewed by 21290

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Special Issue Editors

Dr. Tilman Calliess

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Guest Editor

Articon Spezialpraxis für Gelenkchirurgie, Bern, Switzerland
Interests: knee; arthroplasty; biomechanics; knee arthroplasty; anterior cruciate ligament; biomarkers; knee surgery; hip and knee arthroplasty; trauma surgery; orthopedic biomechanics

Prof. Dr. Max Ettinger

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Guest Editor

Hannover Medical School, Department for Orthopedic Surgery at Annastift Hospital, Hanover, Germany
Interests: total knee arthroplasty; total hip arthroplasty; robotic-assisted surgery

Dr. Cécile Batailler

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Co-Guest Editor

Department of Orthopaedic Surgery and Sports Medicine, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France
Interests: orthopaedic surgery; knee and hip surgery

Special Issue Information

Dear Colleagues,

Background: Major developments in orthopedic medicine have taken place. Nevertheless, there are numerous fields of innovation in which improvement and individualization of therapy and patient care are sought.

Aim and Scope: The scope of this Special Issue is to highlight recent advances in musculoskeletal surgery. The aim is to publish articles describing and evaluating new technologies to assist surgery, individualized patient care, or advanced treatment protocols for improved rehabilitation and patient outcome.

History: Musculoskeletal disorders account for a huge proportion of healthcare costs worldwide. Accordingly, low-complication surgical care and optimal rehabilitation are crucial. Recently, numerous new technologies have been focusing on this research area, with computer-assisted surgical procedures and app-supported rehabilitation as examples.

What kind of papers we are soliciting: We encourage the submission of manuscripts which describe latest advances in musculoskeletal orthopedic surgery. Original research papers, reviews or communications related to new technologies in musculoskeletal medicine, or treatment protocols, are also welcome.

Dr. Tilman Calliess
Prof. Dr. Max Ettinger
Dr. Cécile Batailler
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

computer-assisted surgery
robotic-assisted arthroplasty
individualized alignment
individualized prosthesis
individualized treatment
patient-specific instruments
rapid-recovery
outpatient-care
app-based patient care
virtual education
augmented reality

Published Papers (10 papers)

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Research

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9 pages, 596 KiB

Open AccessArticle

Anti-Inflammatory Effect of Vitamin C during the Postoperative Period in Patients Subjected to Total Knee Arthroplasty: A Randomized Controlled Trial

by Ricardo Ramón, Esteban Holguín, José Daniel Chiriboga, Newton Rubio, Carlos Ballesteros and Marco Ezechieli

J. Pers. Med. 2023, 13(9), 1299; https://doi.org/10.3390/jpm13091299 - 25 Aug 2023

Viewed by 2847

Abstract

Vitamin C, a potent reducing and antioxidant agent, plays an important role in the body, aiding in the growth of cartilage and bones. It is also involved in mechanisms that help reduce inflammation and its effects on the body. In addition, vitamin C decreases pro-inflammatory cytokines, such as IL-6, which produce acute-phase proteins such as CRP and influence inflammatory markers such as ESR. We carried out a study with 110 patients who underwent total knee replacement surgery. We divided the patients into two groups, in which the intervention group received 15 g of parenteral vitamin C during the immediate postoperative period while the control group did not. Patients who received 15 g of vitamin C after total knee replacement surgery had decreased inflammatory markers, specifically CRP and ESR. Overall, administering vitamin C in the post-surgical period results in improved management of inflammation, as evidenced by a decrease in CRP and ESR values. This leads to faster recovery and better healing outcomes for patients undergoing total knee replacement surgery. Furthermore, the beneficial effects of vitamin C in reducing proinflammatory cytokines, reducing the need for opioid analgesics, and its mild adverse effects make it a promising adjuvant in managing postoperative recovery. Full article

(This article belongs to the Special Issue Latest Advances in Musculoskeletal (Orthopedic) Surgery)

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11 pages, 2946 KiB

Open AccessArticle

Shock Waves and Therapeutic Exercise in Greater Trochanteric Pain Syndrome: A Prospective Randomized Clinical Trial with Cross-Over

by Angela Notarnicola, Ilaria Ladisa, Paola Lanzilotta, Davide Bizzoca, Ilaria Covelli, Francesco Paolo Bianchi, Giuseppe Maccagnano, Giacomo Farì and Biagio Moretti

J. Pers. Med. 2023, 13(6), 976; https://doi.org/10.3390/jpm13060976 - 10 Jun 2023

Cited by 2 | Viewed by 1627

Abstract

This study aimed to verify the comparative effectiveness of shock wave therapy versus therapeutic exercise, including the possibility of combining both therapies, in patients who did not respond to the first treatment. A prospective randomized clinical trial was carried out, predicting the possibility of a cross-over between the two treatment options, with patients who did not respond to either treatment. Treatments were, respectively, eccentric therapeutic exercise consisting of 30 min sessions of stretching and strengthening exercises, 5 days a week for 4 weeks (Groups A and D) and Extracorporeal Shock Waves Therapy (ESWT) according to a protocol of three sessions, one per week, each of 2000 pulses at a 4 Hz frequency and administering an energy flux density (EFD) varying between 0.03 mJ/mm² and 0.17 mJ/mm² (Groups B and C). Patients were evaluated at baseline (T0), 2 (T1), 4 (T2) and 6 months (T3) after the last session, using the Numeric Rating Scale (NRS), Low Extremity Functional Scale (LEFS) and Roles and Maudsley Scale (RMS). The whole study population demonstrated a progressive clinical reduction in pain according to NRS, a recovery from disability according to LEFS and a perception of recovery according to RMS within 6 months, with no significant differences between the four protocols (exercise; ESWT; exercise + ESWT; and ESWT + exercise). Both therapies are therefore valid options in patients with trochanteritis; the combination of the two therapies could be evaluated for those patients who do not respond to the single treatment. Full article

(This article belongs to the Special Issue Latest Advances in Musculoskeletal (Orthopedic) Surgery)

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11 pages, 764 KiB

Open AccessArticle

Patellofemoral Arthroplasty Is an Efficient Strategy for Isolated Patellofemoral Osteoarthritis with or without Robotic-Assisted System

by Cécile Batailler, Pit Putzeys, Franck Lacaze, Caroline Vincelot-Chainard, Andreas Fontalis, Elvire Servien and Sébastien Lustig

J. Pers. Med. 2023, 13(4), 625; https://doi.org/10.3390/jpm13040625 - 02 Apr 2023

Cited by 1 | Viewed by 2097

Abstract

There is relative paucity in the literature concerning outcomes after robotic-assisted Patellofemoral Arthroplasty (PFA). The aims were (1) to evaluate outcomes in patients undergoing PFA with inlay or onlay components, with or without robotic arm assistance and (2) to identify risk factors of poor outcomes after PFA. This retrospective study included 77 PFA for isolated patellofemoral joint osteoarthritis, assigned to three groups (18 conventional technique, 17 image-free robotic-assisted system and 42 image-based robotic-assisted system). The demographic data were comparable between the three groups. The clinical outcomes assessed were: Visual Analogue Scale, Knee Society Score, Kujala score and satisfaction rate. The radiological measures were: Caton Deschamps index, patellar tilt and frontal alignment of the trochlea. Functional outcomes, satisfaction rate and residual pain were comparable between the three groups. Patellar tilt improvement was superior when a robotic device was used (either image-based or image-free) compared to the conventional technique. There were three revisions (3.9%) at the last follow-up related to femorotibial osteoarthritis progression. Multivariate analysis found no significant risk factors for poor outcomes, with respect to the surgical technique or implant design. Functional outcomes and revisions rate after PFA were comparable between the surgical techniques and implants. Robotic-assisted systems were associated with a superior improvement of the patellar tilt compared to the conventional technique. Full article

(This article belongs to the Special Issue Latest Advances in Musculoskeletal (Orthopedic) Surgery)

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8 pages, 1533 KiB

Open AccessCommunication

Clinical and Radiological Outcome of Disc Arthroplasty for the Treatment of Cervical Spondylotic Myelopathy

by Peter Obid, Anastasia Rakow, Gernot Michael Lang, Wolfgang Marx, Thomas Niemeyer and Tamim Rahim

J. Pers. Med. 2023, 13(4), 592; https://doi.org/10.3390/jpm13040592 - 28 Mar 2023

Cited by 2 | Viewed by 1304

Abstract

Introduction: The aim of this study is to evaluate the clinical and radiological results of cervical disc arthroplasty (CDA) in patients with cervical spondylotic myelopathy (CSM) using the CP ESP^® disc prosthesis. Materials and Methods: Prospectively collected data of 56 patients with CSM have been analyzed. The mean age at surgery was 35.6 years (range: 25–43 years). The mean follow-up was 28.2 months (range: 13–42 months). The range of motion (ROM) of the index segments, as well as upper and lower adjacent segments, was measured before surgery and at final follow-up. The C2-C7 sagittal vertical axis (SVA), C2-C7 cervical lordosis (CL), and T1 slope minus cervical lordosis (T1s-CL) were analyzed as well. Pain intensity was measured preoperatively and during follow-up using an 11-point numeric rating scale (NRS). Modified Japanese Orthopaedic Association (mJOA) score was assessed preoperatively and during follow-up for the clinical assessment of myelopathy. Surgical and implant-associated complications were analyzed as well. Results: The NRS pain score improved from a mean of 7.4 (±1.1) preoperatively to a mean of 1.5 (±0.7) at last follow-up (p < 0.001). The mJOA score improved from a mean of 13.1 (±2.8) preoperatively to a mean of 14.8 (±2.3) at last follow-up (p < 0.001). The mean ROM of the index levels increased from 5.2° (±3.0) preoperatively to 7.3° (±3.2) at last follow-up (p < 0.05). Four patients developed heterotopic ossifications during follow-up. One patient developed permanent dysphonia. Conclusions: CDA showed good clinical and radiological outcome in this cohort of young patients. The motion of index segments could be preserved. CDA may be a viable treatment option in selected patients with CSM. Full article

(This article belongs to the Special Issue Latest Advances in Musculoskeletal (Orthopedic) Surgery)

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13 pages, 2243 KiB

Open AccessArticle

Digital TKA Alignment Training with a New Digital Simulation Tool (Knee-CAT) Improves Process Quality, Efficiency, and Confidence

by Heiko Graichen, Marco Strauch, Michael T. Hirschmann, Roland Becker, Sébastien Lustig, Mark Clatworthy, Jacobus Daniel Jordaan, Kaushik Hazratwala, Rüdiger von Eisenhart-Rothe, Karlmeinrad Giesinger and Tilman Calliess

J. Pers. Med. 2023, 13(2), 213; https://doi.org/10.3390/jpm13020213 - 26 Jan 2023

Cited by 1 | Viewed by 1802

Abstract

Individual alignment techniques have been introduced to restore patients’ unique anatomical variations during total knee arthroplasty. The transition from conventional mechanical alignment to individualised approaches, with the assistance of computer and/or robotic technologies, is challenging. The objective of this study was to develop a digital training platform with real patient data to educate and simulate various modern alignment philosophies. The aim was to evaluate the training effect of the tool by measuring the process quality and efficiency, as well as the post-training surgeon’s confidence with new alignment philosophies. Based on 1000 data sets, a web-based interactive TKA computer navigation simulator (Knee-CAT) was developed. Quantitative decisions on bone cuts were linked to the extension and flexion gap values. Eleven different alignment workflows were introduced. A fully automatic evaluation system for each workflow, with a comparison function for all workflows, was implemented to increase the learning effect. The results of 40 surgeons with different experience levels using the platform were assessed. Initial data were analysed regarding process quality and efficiency and compared after two training courses. Process quality measured by the percentage of correct decisions was increased by the two training courses from 45% to 87.5%. The main reasons for failure were wrong decisions on the joint line, tibia slope, femoral rotation, and gap balancing. Efficiency was obtained with a reduction in time spent per exercise from 4 min 28 s to 2 min 35 s (42%) after the training courses. All volunteers rated the training tool as helpful or extremely helpful for learning new alignment philosophies. Separating the learning experience from OR performance was mentioned as one of the main advantages. A novel digital simulation tool for the case-based learning of various alignment philosophies in TKA surgery was developed and introduced. The simulation tool, together with the training courses, improved surgeon confidence and their ability to learn new alignment techniques in a stress-free out-of-theatre environment and to become more time efficient in making correct alignment decisions. Full article

(This article belongs to the Special Issue Latest Advances in Musculoskeletal (Orthopedic) Surgery)

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14 pages, 7413 KiB

Open AccessEditor’s ChoiceArticle

Functional Alignment Philosophy in Total Knee Arthroplasty—Rationale and Technique for the Valgus Morphotype Using an Image Based Robotic Platform and Individualized Planning

by Jobe Shatrov, Constant Foissey, Moussa Kafelov, Cécile Batailler, Stanislas Gunst, Elvire Servien and Sébastien Lustig

J. Pers. Med. 2023, 13(2), 212; https://doi.org/10.3390/jpm13020212 - 26 Jan 2023

Cited by 4 | Viewed by 4671

Abstract

Functional alignment (FA) is a novel philosophy to deliver a total knee arthroplasty (TKA) that respects individual bony and soft tissue phenotypes within defined limitations. The purpose of this paper is to describe the rationale and technique of FA in the valgus morphotype with the use of an image-based robotic-platform. For the valgus phenotype the principles are personalized pre-operative planning, reconstitution of native coronal alignment without residual varus or valgus of more than 3°, restoration of dynamic sagittal alignment within 5° of neutral, implant sizing to match anatomy, and achievement of defined soft tissue laxity in extension and flexion through implant manipulation within the defined boundaries. An individualized plan is created from pre-operative imaging. Next, a reproducible and quantifiable assessment of soft tissue laxity is performed in extension and flexion. Implant positioning is then manipulated in all three planes if necessary to achieve target gap measurements and a final limb position within a defined coronal and sagittal range. FA is a novel TKA technique that aims to restore constitutional bony alignment and balance the laxity of the soft tissues by placing and sizing implants in a manner that respects variations in individual anatomy and soft tissues within defined limits. Full article

(This article belongs to the Special Issue Latest Advances in Musculoskeletal (Orthopedic) Surgery)

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11 pages, 876 KiB

Open AccessArticle

The Correlation of Carpal Tunnel Pressure with Clinical Outcomes following Ultrasonographically-Guided Percutaneous Carpal Tunnel Release

by Jui-Chien Wang, Chung-Yi Li, Po-Yen Ko, Tung-Tai Wu, Kuo-Chen Wu, Fong-Chin Su, I-Ming Jou and Po-Ting Wu

J. Pers. Med. 2022, 12(7), 1045; https://doi.org/10.3390/jpm12071045 - 27 Jun 2022

Cited by 2 | Viewed by 1414

Abstract

Background: To evaluate the correlation between carpal tunnel pressure (CTP) and the clinical presentations, and to explore the possible predictors for the postoperative recovery pattern in patients with carpal tunnel syndrome (CTS). Materials and Methods: Consecutive patients with idiopathic CTS following percutaneous ultrasound-guided carpal tunnel release (UCTR) were enrolled. CTP was measured preoperatively and immediately after operation. The Boston Carpal Tunnel Questionnaire (BCTQ) and the cross-sectional area (CSA) of median nerve were recorded preoperatively and at 1, 3, and 12 months postoperatively. Results: 37 patients (37 hands; 8 men and 29 females; median age, 59.0 years) were enrolled. CTP significantly decreased immediately from 40.0 (28.0–58.0) to 13.0 (8.0–20.0) mmHg after UCTR. BCTQ scores significantly improved at 1 month postoperatively, and the improvement trend persisted until 12 months postoperatively (p < 0.001). Preoperative CTP was positively correlated with preoperative CSA and preoperative BCTQ scores (p < 0.05, all). Using group-based trajectory modeling, all patients were categorized into the “gradual recovery” or “fast recovery” group. Higher preoperative CTP was significantly associated with a faster recovery pattern (odds ratio: 1.32). Conclusions: Preoperative CTP was well correlated with the clinical presentations and might be a useful predictor for the postoperative clinical recovery pattern. Full article

(This article belongs to the Special Issue Latest Advances in Musculoskeletal (Orthopedic) Surgery)

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12 pages, 1566 KiB

Open AccessStudy Protocol

Early Identification and Treatment of Trochlear Knee Dysplasia

by Joaquin Moya-Angeler, Cristina Jiménez-Soto, Domingo Maestre-Cano, Carlos de la Torre-Conde, Regina M. Sánchez-Jimenez, Cristina Serrano-García, Miguel Alcaraz-Saura, Juan Pedro García-Paños, César Salcedo-Cánovas, Francisco Forriol and Vicente J. León-Muñoz

J. Pers. Med. 2023, 13(5), 796; https://doi.org/10.3390/jpm13050796 - 06 May 2023

Viewed by 1829

Abstract

A shallow sulcus characterizes trochlear dysplasia (TD) of the femoral trochlea, which can lead to chronic pain or instability of the patellofemoral joint. Breech presentation at birth has been identified as a risk factor for developing this condition, which an ultrasound can identify early. Early treatment could be considered at this stage, given the potential for remodelling in these skeletally immature patients. Newborns with breech presentation at birth who meet the inclusion criteria will be enrolled and randomised in equal proportions between treatment with the Pavlik harness and observation. The primary objective is to determine the difference in the means of the sulcus angle between the two treatment arms at two months. Ours is the first study protocol to evaluate an early non-invasive treatment for TD in the newborn with breech presentation at birth using a Pavlik harness. We hypothesised that trochlear dysplasia could be reverted when identified and treated early in life with a simple harness, as it is done with developmental dysplasia of the hip. Full article

(This article belongs to the Special Issue Latest Advances in Musculoskeletal (Orthopedic) Surgery)

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13 pages, 1493 KiB

Open AccessPerspective

Integration of Square Fiducial Markers in Patient-Specific Instrumentation and Their Applicability in Knee Surgery

by Vicente J. León-Muñoz, Joaquín Moya-Angeler, Mirian López-López, Alonso J. Lisón-Almagro, Francisco Martínez-Martínez and Fernando Santonja-Medina

J. Pers. Med. 2023, 13(5), 727; https://doi.org/10.3390/jpm13050727 - 25 Apr 2023

Cited by 1 | Viewed by 1433

Abstract

Computer technologies play a crucial role in orthopaedic surgery and are essential in personalising different treatments. Recent advances allow the usage of augmented reality (AR) for many orthopaedic procedures, which include different types of knee surgery. AR assigns the interaction between virtual environments and the physical world, allowing both to intermingle (AR superimposes information on real objects in real-time) through an optical device and allows personalising different processes for each patient. This article aims to describe the integration of fiducial markers in planning knee surgeries and to perform a narrative description of the latest publications on AR applications in knee surgery. Augmented reality-assisted knee surgery is an emerging set of techniques that can increase accuracy, efficiency, and safety and decrease the radiation exposure (in some surgical procedures, such as osteotomies) of other conventional methods. Initial clinical experience with AR projection based on ArUco-type artificial marker sensors has shown promising results and received positive operator feedback. Once initial clinical safety and efficacy have been demonstrated, the continued experience should be studied to validate this technology and generate further innovation in this rapidly evolving field. Full article

(This article belongs to the Special Issue Latest Advances in Musculoskeletal (Orthopedic) Surgery)

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9 pages, 3060 KiB

Open AccessPerspective

High Complication Rate and High Percentage of Regressing Radiolucency in Magnesium Screw Fixation in 18 Consecutive Patients

by David J. Haslhofer, Tobias Gotterbarm and Antonio Klasan

J. Pers. Med. 2023, 13(2), 357; https://doi.org/10.3390/jpm13020357 - 17 Feb 2023

Cited by 2 | Viewed by 1187

Abstract

(1) Background: Magnesium-based implants use has become a research focus in recent years. Radiolucent areas around inserted screws are still worrisome. The objective of this study was to investigate the first 18 patients treated using MAGNEZIX^® CS screws. (2) Methods: This retrospective case series included all 18 consecutive patients treated using MAGNEZIX^® CS screws at our Level-1 trauma center. Radiographs were taken at 3-, 6- and 9-month follow-ups. Osteolysis, radiolucency and material failure were assessed, as were infection and revision surgery. (3) Results: Most patients (61.1%) had surgery in the shoulder region. Radiolucency regressed from 55.6% at 3-month follow-ups to 11.1% at 9-month follow-ups. Material failure occurred in four patients (22.22%) and infection occurred in two patients, yielding a 33.33% complication rate. (4) Conclusion: MAGNEZIX^® CS screws demonstrated a high percentage of radiolucency that regressed and seems to be clinically irrelevant. The material failure rate and infection rate require further research. Full article

(This article belongs to the Special Issue Latest Advances in Musculoskeletal (Orthopedic) Surgery)

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