Background; No data currently exists comparing functional gait asymmetry in young individuals, older subjects and patients after total hip arthroplasty (THA).

Objectives; 1) Provide a reference of gait features during stance in individuals <50, healthy subjects >50 and those after THA and 2) Observe how changing speed and incline alters gait.

Methods;
287 patients were tested on a validated, instrumented treadmill (<50 n=178, >50 n=34 and THA n=75). Participants with relevant comorbidities were excluded. The senior author performed all THAs using a posterior approach. Subjects were tested from 4-7km/h while flat and from 5-15% inclines at 4km/h. Body weight scaling and symmetry indices were calculated using defined protocols. Between group statistical analysis was conducted using an unpaired t-test with p<0.05.

Results
While flat, weight acceptance (WA) and push-off (PO) increased while midstance decreased with increasing speeds in all groups. Lower WA was seen in those <50 at higher speeds of 6km/h (p=0.03 and 0.04) and 7 km/h (p=0.0003 and 0.001). WA was significantly lower in those <50 compared to THA at 5% (p=0.002) and 10% (p=0.01) inclines. No consistent differences were seen in midstance. PO was statistically greater in those <50 across all speeds and inclines. Symmetry indices routinely increased with speed and incline in all groups.

Conclusions; We have produced a reference range of gait asymmetry for young individuals, those >50 and patients following THA. Our results demonstrate decreased concentric and increased eccentric limb loading with advancing age. This data could be used to objectively assess outcomes after THA.

Introduction: The commonest approach for posterior malleolar access is the posterolateral approach. This approach gives good access to the fibula and lateral aspect of the posterior tibia, however; there is little known on the vascular risks with this approach.

Aim: The aim of this study was to assess and describe the anatomy of the peroneal artery and its branches at the ankle region.

Methodology: Eleven cadaveric foot and ankle specimens were dissected in layers, preserving the peroneal artery, anterior tibial artery (ATA) and posterior tibial artery (PTA).

Results: The peroneal artery was consistently found between the peroneal compartment and deep muscular compartment of the posterior leg. A wide range of anatomical variation was found in the peroneal artery, in its location, muscular branches, anastomosis and anterior perforating branch. The peroneal artery was the largest diameter artery in one specimen. There was great variation in number and location of muscular branches.

The mean proximal distance between the medial malleolus and the posterior communicating branch of the peroneal artery was 37.93mm (range: 19.03- 85.43mm). The mean proximal distance from the medial malleolus to the anterior peroneal perforating artery was 44.23mm (range:35.44-62.32mm). Distal to the anterior perforating branch of the peroneal artery, the peroneal artery was immobile.

Conclusion: Understanding the common variations within the ankle’s arterial anatomy can help surgeons protect these vessels from damage during the surgical approach. The posterolateral surgical approach specifically puts the peroneal artery at risk and knowledge of its anatomy and variability is important when undertaking this approach.

Introduction: Many physicians in low-resource, high-volume settings rely on visual estimation techniques to assess dorsiflexion in clubfoot patients. Little is known about the reliability of visual estimation techniques compared to the gold-standard measurement by goniometer. We aim to assess the validity of visual appraisal of ankle dorsiflexion compared to goniometer-based fixed angle jigs. Methods: This study is a cross-sectional observational study. Ankle dorsiflexion measurements were collected by 3 orthopedic surgeons in an outpatient clinic. Children who achieved full correction post-Ponseti casting and attended the clinic for a follow-up consultation were considered for inclusion. Fixed wooden angle jigs were cut referencing goniometer-based angles and measured 0, 5, 10, 15, 20, 25, 30 degrees. Rater one and rater two separately assessed ankle dorsiflexion visually and rater three used goniometer-based fixed-angle jigs. Intra-class correlation (ICC) values and their 95% confidence intervals (CI) were calculated using an absolute-agreement, two-way random-effects model. Results: 43 corrected clubfeet from 21 children were evaluated. Visual estimation of ankle dorsiflexion, compared to gold standard goniometer-based angle jig measurements, showed moderate levels of reliability for rater 1 (ICC: 0.703, CI: 0.427–0.852), and good reliability for rater 2 (ICC = 0.875, CI: 0.756 – 0.938). Inter-rater reliability between both visual raters is considered moderate to good (ICC: 0.742, CI: 0.471–0.876). Conclusion: Visual appraisal of ankle dorsiflexion in children with clubfoot in high volume clinics is a valid measurement technique with reproducible measurement results across different evaluators. These results validate and support clinical practices in many low-resource settings.

Introduction: There is a need for a registry with long term outcome from developing countries. The aim of this study was to evaluate the 12-year outcome of this register in view of survival and complications.
Methods: TKR and THR cases since 2007 till end of 2018 were included. All failure and complications were reported for cases, which have their index procedure recorded in this register. Also, there are revision cases included in the registry while their primary procedures were done in other hospitals that are not included in this registry. Data were collected from registry, follow-up visits and telephone calls.
Results: Implants used were 13 hip and 13 knee from different implant companies. The overall incidence of infection was 1.5 % in the absence of laminar flow, space gown and pulse lavage. However, this rate was as high as 20 % for few cases during certain time, in one hospital by some operators who had much lower rate at other hospitals. Availability and selection of implants was influenced by the cost, training. Few low-cost implants were used and yielded low survival and higher complications rate. Failure related to aseptic loosening was 1.1% for knees and 1% for THR.
Conclusion: The incidence of failure and complications are not as high as expected. Developing countries could have different pathology, demands, time of presentation, economic constraints, level of training, availability and selection of implants. These could have an adverse effect on the outcome and survival of hip and knee arthroplasty.

Introduction: The traditional method of torsional deformities treatment in children is osteotomy with acute correction. On the other hand guided growth is the gold standard for angular deformities correction and recently have been studied for treating torsional deformities, but this method has low prediction rate. The aim of this study was to increase accuracy of torsional guided growth correction and modelling. Materials and methods: The novel technique based on 3D- planning and rapid prototyping was suggested and used in 10 tibias of growing rabbits (age ranging from 6 to 8 weeks). They underwent pre- and postoperative radiological (X-ray and computed tomography) evaluation which included reference lines and angles and torsional profile measurement. Preoperative planning included virtual surgery performance and creating individual navigation templates based upon CT-scans. Results: The average correction time was 12,3 weeks. In all cases external torsional deformity was achieved. Accuracy of correction was > 90% in 6 cases, >80% in 2 cases, >70% in 2 cases. In 3 cases we observed unplanned angular deformities. In all cases decrease of tibial longitudinal growth was detected in average of 10%. Conclusion: The novel torsional guided growth technique demonstrates high efficiency in growing rabbit models and requires further investigation considering the perspective of minimally invasive simultaneous multiplanar deformity correction in children.

Introduction:Tibial slope(TS) is a parameter that is important to recognize in knee kinematics and knee surgery. A very wide range of values governing posterior tibial slope exist in the literature. This study aimed to investigate whether the age, gender, and demographic region of an individual affected TS.

Materials and methods:A total of 1,800 lateral knee radiographies from five different countries (Turkey, Germany, Italy, Spain, and the United Kingdom (U.K)) were utilized to measure the native posterior TS.Participants were categorized in deciles with each decade of age after 40 years was determined as a separate age group. Accordingly, four different age categories were formed in total, namely the 40-49, 50-59, 60-69, and 70-79 year-old groups. The angle between the line tangential to the medial plateau and the proximal anatomical axis of the tibia was measured.

Results:The mean TS values of populations belonging to the same ethnicity, from five different regions and separated into age groups were obtained. The TS values of both males and females in the Turkish population were found to be higher than those in other populations. It was observed that TS values increased with age in females in all populations, except for those in the Spanish and U.K populations. In the male population, it was found that TS values increased with age in all populations except in the Spanish population.

Conclusions:Region, age, and gender affect TS in different populations in various ways. Contrary to previous studies , the region an individual lives in and living conditions affect TS.

Introduction: Various machine learning(ML) platforms were developed to aid in the time-consuming article screening process in systematic reviews. We aim to analyze the efficiency of an ML-assisted platform in screening of articles for selection into systematic review in orthopedic surgery. Methods: We included three previously published systematic reviews in the field of Orthopaedics of increasing levels of difficulty in the structure of research question to assess the efficiency of a platform with active-learning technology for article screening. We compared the efficiency to the traditional screening and also across the various scenarios tested. We performed 5 iterations for each review analyzed. The outcome parameters analyzed were the work saved at 95% recall(WSS-95), work saved at 100% recall(WSS-100), and relevant records found after screening the first 30% of the total records(RRF-30). Results: The ML-assisted screening significantly improved the rate of identifying the relevant records compared to the traditional screening method(p<0.001). The WSS-95 for the easy, intermediate, and advanced screening scenarios were 78%, 59%, and 38% respectively. The WSS-100 for the easy, intermediate, and advanced screening scenarios were 75%, 48%, and 7% respectively. The RRF-30 for the easy, intermediate, and advanced screening scenarios were 97%, 86%, and 64% respectively. We noted a significant reduction(p<0.001) in the efficiency with the increasing level of difficulty of the screening scenarios. Conclusion: The ML platform is significantly better than the traditional method as an assistive technology to aid in article screening. However, the efficiency of the platform significantly decreases as the complexity of the research question increases.

The field of orthopaedic surgery is evolving at an unprecedented pace, with newer procedures and technologies becoming available faster than ever before. It is crucial for orthopaedic surgeons to stay informed about the latest trends and advances in the field to provide optimal treatment options to their patients.
This study presents a comprehensive narrative review of the future trends and advances in orthopaedic surgery. We examined four key areas: preventative technologies, diagnostic tools, non-invasive treatments, and surgical advances. Within each of these areas, we analysed and discussed the potential impact of emerging technologies such as gene therapy, tissue engineering, regenerative medicine, pharmacological drugs, and biomodulators. We also evaluated the role of artificial intelligence, big data processing, robotics, computer navigation, augmented reality, and virtual reality in the future of orthopaedic surgery.
While not exhaustive, this study provides a basic understanding of the potential future developments in the field of orthopaedics. By staying informed about these advancements, orthopaedic surgeons can provide their patients with up-to-date information and participate in informed discussions about potential treatment options.
In conclusion, this study highlights the importance of keeping up-to-date with the latest developments in orthopaedic surgery. We hope that this review provides orthopaedic surgeons with a foundation of knowledge to guide their future practice and decision-making processes.

Osteoarthritis (OA) is an important global public health problem and is the most common degenerative joint disease in which cartilage and synovium are affected. Many inflammatory mediators are upregulated in OA patients. Mitogen-activated protein kinase (MAPK) is a major signal-transducing pathway in osteoarthritis (OA) and its activation by interleukin-1β (IL-1β) plays a critical role in the expression and production of several mediators of cartilage catabolism in OA. This study aimed to clarify the role and mechanism of synovial mesenchymal stem cell (SMSC)-derived exosomes (Exos) in the treatment of OA. We measured and compared the effect of the SMSC-Exo on IL-1β-induced chondrocytes were derived from OA cartilage by analyzing proliferation, anabolism and catabolism, migration and apoptosis in vitro. Gene expression of MAPK was measured by RT-PCR. Western immunoblotting was used to analyze the activation of MAPKs. The results showed SMSCs-Exos prevented severe damage to the articular cartilage in OA model. We confirmed the high efficacy of SMSCs-Exos in promoting chondrocyte proliferation and migration and inhibiting chondrocyte apoptosis. Additionally, SMSCs-Exos could reverse IL-1β-induced injury of chondrocytes and regulate the polarization of macrophages in vitro.Finally, SMSC-Exos inhibited the expression of prostaglandin E2 (PGE2), IL-6, IL-1β, and TNF-α. This SMSC-Exo treatment strategy may offer benefits of stem cell therapy without the need for exogenous stem cell transplantation by stimulating cell proliferation, promoting cell migration, and protecting cells from the degenerative proinflammatory microenvironment.

Aim:to compare basic biological properties and lineage potential of mesenchymal stem cells (MSCs) isolated from reamer irrigator aspirator (RIA) to that of iliac crest bone graft (ICBG).Objectives:To isolate, identify and establish reamer irrigator aspirator derived mesenchymal stem cells (RIA-MSCs) and iliac crest bone graft derived mesenchymal stem cells (ICBG-MSCs), To evaluate and compare the basic biological characteristics of RIA-MSCs with ICBG-MSCs in terms of morphology, viability, proliferation potential, population doubling time (PDT), alkaline phosphatase (ALP) activity, colony-forming-unit ability (CFU),To assess MSCs from RIA and ICBG sources on their phenotypic markers expression and differentiation potential into osteocytes, To analyse and compare the expression of selected genes predominantly implicated in the formation of osteocytes (bone) from RIA and ICBG-MSCs.Materials and methods:descriptive study with analysis of qualitative and quantitative measures in 20 individuals from 2017-2019 at Tejasvini hospital and SSIOT,Mangalore,India who came under inclusion criteria of having fracture non union.Exclusion criteria included patients below 20 years and above 60 years of age,patients with infection or osteomyelitis,history of metabolic bone disorders and patients with history of smoking.Results:the study found that multipotent stem cells were found in both Iliac crest bone graft and RIA and both show high osteogenic potential.RIA bone grafts have higher osteoinductive,osteogenic potential and higher cell proliferation as compared to ICBG samples.In view of associated complications with ICBG, RIA is a better and safer option in long bone non union.

In Ethiopia, where modern orthopedic services are limited, Traditional Bone-Setting (TBS) remains commonly used to treat children who are particularly vulnerable to its complications. Over 9 months, we enrolled 460 children who received TBS before presenting to 8 tertiary hospitals across Ethiopia. Demographics, injury and TBS-treatment details, bone complications (chronic osteomyelitis, malunion, nonunion, avascular necrosis), severe infection (osteomyelitis, septic joint, chronic dislocation, septicemia), and severe complication (missed compartment syndrome, Volkmann’s contracture, gangrene) were analyzed. Median age was eight, 75% were males, 52% urban residents, 69% impoverished. 75% were injured after falling. Injuries were soft tissue only (15%), closed fractures (79%), or open fractures (6%). Children were immobilized (76%) and/or massaged (59%) during TBS. Bone complications were most common (37.6%), followed by severe infection (13.9%) and severe complication (11.3%), with 26 children requiring major amputation. Bone complications were commonest after wrist injuries (OR 3.43; 95% CI 1.12 - 10.52) and delayed presentation: 31-60 days (OR 11.78 95% CI 6.15-22.54), >60 days (OR 11.94; 95% CI 6.78-21.03). Severe infection odds increased with rural residence (OR 5.51, 95% CI 1.97-15.39), visiting health facilities before TBS (OR 3.24 95% CI 1.24-8.45), soft tissue injuries without fracture (OR 6.01 95% CI 2.11-17.10). Severe complication odds increased with rural residence (OR 3.85, 95% CI 1.90 -7.78), soft tissue injuries without fracture (OR 2.77; 95% CI 1.23-6.26). In conclusion, Ethiopian children from rural areas were at highest risk of severe infections and complications after TBS. Measures should be explored to protect this vulnerable population.