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Mesenchymal Stem Cell Treatment of Cartilage Lesions in the Hip
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
George Hourston, Stephen McDonnell, Wasim Khan
Repair of articular hyaline cartilage lesions such as those described above is difficult because this tissue is avascular, aneural and alymphatic and exists in the unforgiving biomechanical environment of diarthrodial joints [11]. The definitive treatment for full-thickness cartilage defects and the ensuing end-stage OA is arthroplastic prosthetic replacement. However, this is unsatisfactory in younger patients since these prostheses have finite lifespans [12]. Historically, cartilage surgery has involved pain relief and bone marrow stimulation techniques, such as abrasion arthroplasty, drilling and microfracture [13]. Pain relief can be achieved by arthroscopic lavage to remove any excess fluids and loose bodies, including detached cartilage, and debridement of unviable roughened cartilage, and this has been shown to be a safe procedure and is clinically indicated in patients with mechanical symptoms and persistent pain [4,14].
Arthroscopic anterior instability repair
Published in Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss, Atlas of Advanced Shoulder Arthroscopy, 2017
Hardeep Singh, Andreas Voss, Robert A. Arciero
Depending on the patient, operative management may be undertaken. A spectrum of operative techniques exist, from simple arthroscopic lavage to open stabilization. The consequences of non-operative management need to be taken into account when considering operative treatment. Arthroscopic lavage has been shown in one study to increase the rate of resolution of joint effusions, helping facilitate healing of the labral detachment. Wintzel et al. performed a prospective randomized study with 30 patients with a 2-year follow up and found a 20% redislocation rate in the lavage group versus 60% redislocation rate in the non-operative group.15 However, systematic review of arthroscopic Bankart repair with non-operative treatment or arthroscopic lavage demonstrated lower rate of long term recurrent instability and improved short-term quality of life with arthroscopic Bankart repair.16 The Bankart procedure allows for early return of motion and function with no limitation of shoulder motion in most patients.17 Surgical stabilization of recurrent instability is generally well accepted and requires repair of the capsule–labral disruption and capsulorrhaphy.2,17–20
Acute septic arthritis
Published in Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode, Paediatric Orthopaedics, 2016
The lavage can be done in one of three ways: repeated aspiration and wash-out, lavage at the time of a formal arthrotomy or lavage through an arthroscope. Arthroscopic lavage is particularly useful in the older child with septic arthritis of the knee. In smaller children and for infection of smaller joints arthroscopic lavage may not be feasible.
Assessment of mesenchymental stem cell micropellet as a relevant biomechanical in vitro model devoted to the study of cartilage growth
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
G. Dusfour, M. Maumus, P. Cañadas, D. Ambard, C. Jorgensen, D. Noël, S. Le Floc’h
Cartilage is a non-vascularized organ in which cells (i.e. chondrocytes) represent only 2% of the global volume. Thus, cartilage exhibits a very limited ability to repair. Cartilage diseases represent an important public health problem, whose prevalence increases with the population ageing. Main used treatments (e.g. arthroscopic lavage, synthetic implants, periosteal and perichondral transplantation, osteochondral allograft and autograft…) are generally non-lasting and may lead to inflammatory reactions. Furthermore, mechanical properties of the repaired cartilage are generally inferior to those of the native one. Therefore, there is a need in better understanding the main mechanisms governing the cartilage homeostasis, notably its growth process, and the corresponding major influencing parameters.
Flucloxacillin-induced hypokalaemia: a case report
Published in Acta Clinica Belgica, 2018
We present a case of a 79-year-old woman with a severe hypokalaemia. The patient was admitted to our hospital with an infected surgical wound after recent total hip replacement. Laboratory findings at admission showed an elevated C-reactive protein (214 mg/l), elevated total white blood cell count (28·103/mm3), normal creatinine (0.7 mg/dl) and a normal ionogram with low-normal serum sodium (133 mmol/l) and normal serum potassium (3.5 mmol/l). An arthroscopic lavage was performed. Culture of arthroscopic lavage fluid showed a Staphylococcus aureus, sensitive to flucloxacillin, ciprofloxacin and rifampicin. Antimicrobial treatment with flucloxacillin 6 × 2 g (intravenous) and ciprofloxacin 2 × 750 mg was started with secondary association of rifampicin 2 × 300 mg. On day 5, laboratory evaluation showed severe hypokalaemia (potassium 2.4 mmol/l). The patient showed no signs of muscle weakness and had no abnormalities on electrocardiogram (ECG).
Advances in stem cell therapy for cartilage regeneration in osteoarthritis
Published in Expert Opinion on Biological Therapy, 2018
Leire Iturriaga, Raquel Hernáez-Moya, Itsasne Erezuma, Alireza Dolatshahi-Pirouz, Gorka Orive
OA dramatically diminishes the quality of life of the patients [12] and greatly complicates their daily life. Currently, the available conventional treatments provide little option to reverse the progression of cartilage degeneration, giving symptomatic relief toward inflammation and pain [5,13]. In mild cases, the patients are often treated by medications, diet, exercise, and rehabilitation/physiotherapy, whereas in advanced or end-stage OA total joint arthroplasty is the ultimate solution proposed. However, this prosthetic replacement could potentially give rise to infection, which constitutes one of the most serious of complications of the procedure [2]. Other surgical techniques that can be performed in order to repair and stimulate the renovation of articular cartilage and therefore prevent progression toward OA include arthroscopic lavage and debridement, marrow stimulation by microfracture, abrasion or drilling of the subchondral bone plate, osteochondral auto/allografting, and autologous chondrocyte implantation (ACI) [1,2,11]. Although surgical methods have been proposed to restore normal joint function and minimize further degeneration, they all are associated with complications, side effects, and unsatisfactory progress, leaving in many cases, the lesions inadequately treated and often not offering a long-term clinical solution [2,5,11]. Other disadvantages they present are the high costs associated with some of these procedures and their invasive nature [2]. Unfortunately, none of these approaches have been shown to totally and effectively restore normal functions in the diseased cartilage tissue [14]. As a consequence, great efforts have been made over the past few years to regenerate cartilage in order to mitigate or diminish the degenerative advance of this disease and the pain and disability associated with it.