Polymethyl methacrylate (PMMA) bone cement has been a transformative material in orthopedics since its introduction in the mid-20th century. Originally used in dental medicine, PMMA was adopted for orthopedic applications by Sir John Charnley in the 1950s, significantly enhancing joint replacement surgeries. The primary appeal of PMMA lies in its biocompatibility, mechanical strength, and ease of handling, making it a favored choice for various orthopedic procedures, including arthroplasties and limb-salvage surgeries. However, the exothermic polymerization process of PMMA poses a risk of thermal necrosis in the surrounding bone tissue, as local temperatures can exceed 70 °C, causing damage to osteocytes. Research has sought to mitigate these risks by optimizing mixing techniques, reducing cement mantle thickness, and incorporating cooling methods. Recent advancements, such as the use of phase-change materials (PCMs) and alternative monomers, have shown promise in lowering the exothermic peak during polymerization. Other strategies include pre-cooling the cement and prosthetic components and using composite cement. Despite these innovations, managing the balance between minimizing heat generation and maintaining mechanical properties remains a challenge. The impact of thermal necrosis is significant, compromising implant stability and osseointegration. Understanding the complex interactions between PMMA’s thermal properties and its clinical outcomes is essential for improving orthopedic surgical practices and patient recovery.

Background: The proliferation of both general purpose and health care–specific large language models (LLMs) has intensified the challenge of effectively evaluating and comparing them. Data contamination plagues the validity of public benchmarks, self-preference distorts LLM-as-a-judge approaches, and there is a gap between the tasks used to test models and those used in clinical practice. Objective: In response, we propose CLEVER (Clinical Large Language Model Evaluation–Expert Review), a methodology for blind, randomized, preference-based evaluation by practicing medical doctors on specific tasks. Methods: We demonstrate the methodology by comparing GPT-4o (OpenAI) against 2 health care–specific LLMs, with 8 billion and 70 billion parameters, over 3 tasks: clinical text summarization, clinical information extraction, and question answering on biomedical research. Results: Medical doctors prefer the medical model–small LLM trained by John Snow Labs over GPT-4o 45% to 92% more often on the dimensions of factuality, clinical relevance, and conciseness. Conclusions: The models show comparable performance on open-ended medical question answering, suggesting that health care–specific LLMs can outperform much larger general purpose LLMs in tasks that require understanding of clinical context. We test the validity of CLEVER evaluations by conducting interannotator agreement, interclass correlation, and washout period analysis.

Autologous cell therapy uses patients’ own cells to deliver precise and ideal treatment through a personalized medicine approach. Isolation of patients’ cells from residual tissue extracted during surgery involves specific planning and lab steps. In the present manuscript, a path from isolation to in vitro research with human mesenchymal stem cells (MSCs) obtained from residual bone tissues is described as performed by a medical unit in collaboration with a research center. Ethical issues have been addressed by formulating appropriate harvesting protocols according to European regulations. Samples were collected from 19 patients; 10 of them were viable and after processing resulted in MSCs. MSCs were further differentiated in osteoblasts to investigate the biocompatibility of several 3D scaffolds produced by electrospinning and 3D printing technologies; traditional orthopedic titanium and nanostructured titanium substrates were also tested. 3D printed scaffolds proved superior compared to other substrates, enabling significantly improved response in osteoblast cells, indicating that their biomimetic structure and properties make them suitable for synthetic tissue engineering. The present research is a proof of concept that describes the process of primary stem cells isolation for in vitro research and opens avenues for the development of personalized cell platforms in the case of patients with orthopedic trauma. The demonstration model has promising perspectives in personalized medicine practices.

Background: Transarterial embolization (TAE) of genicular artery branches is a relatively new technique that has emerged as a promising method for delaying invasive knee surgery in patients suffering from degenerative knee osteoarthritis (OA). In mild to moderate OA, invasive major surgery can be safely postponed, and patients with major risk factors now have an alternative. Our aim was to examine the impact of TAE on clinical outcomes in individuals with degenerative knee OA over a 12-month period. Methods: A case series of 17 patients diagnosed with knee OA and treated with TAE was included in the study. Every patient was clinically evaluated at different timeframes according to the Western Ontario and McMaster Universities’ arthritis index, knee injury, and osteoarthritis outcome scores, and the 36-item short-form survey (WOMAC, KOOS, and SF-36). Results: At the first follow-up (1 month), KOOS and WOMAC improved from 46.6 ± 13.2 (range 27.3–78.2) to 56.5 ± 13.9 (range 32.3–78.4; p = 0.023) and 49.5 ± 13.2 (range 29.3–82.3) to 59.8 ± 12.6 (range 39.3–83.5, p = 0.018), respectively. Physical SF-36 improved significantly from 42.1 ± 7.75 (range 30.3–57.3) to 50.5 ± 9.9 (range 35.6–67.9; p = 0.032). No significant changes in scores were observed at three, six, or twelve months after TAE. Conclusions: TAE provided early pain reduction and considerable improvement in quality of life without complications for a consecutive sample of Romanian patients with mild to severe knee OA.

Background: Prior trials investigating the treatment of symptomatic osteoarthritis (OA) with hyaluronic-acid-derived products injections have provided optimistic results. The study was directed to assess the effectiveness of an innovative hyaluronic-acid-based hydrogel (Hymovis^®) in the treatment of symptomatic knee OA. Methods: A prospective, single-center, clinical trial was performed. Thirty-five patients with degenerative knee OA were included. Inclusion criteria were: age between 45–80, radiographic Kellgren grade II or III osteoarthritis, minimum 35 mm score on the Visual Analogue Scale (VAS), pain for at least 6 months and agreement to participate in the study. Patients received two injections at a one-week interval. The evaluator assessed the patients using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and VAS. Evaluation was performed before, at 2 and 6 months after the injections. Results: A significant improvement on the WOMAC Index pain subscale was observed at 6 months after the injection. At two months, pain subscale score decreased from 10.34 to 9.34. At six months, a significant decrement in pain parameters compared to baseline was observed (from 10.34 to 7.72; p = 0.0004). Median points on VAS significantly ameliorated after 6 months (from 74.2 to 57.3 cm; p < 0.0001). Regarding physical function, a statistically significant difference compared to baseline was observed at the end of the study (from 29.74 to 25.18; p = 0.0025). WOMAC Index stiffness component did not differ from baseline at any time during follow-up. Conclusions: Pain relief installed with a delayed on-set but had a prolonged duration. The novel hyaluronic acid-based hydrogel (Hymovis^®) had effective results, particularly after six months post-injections and offers a therapeutic advancement in the treatment of moderate to severe osteoarthritis.

From a surgical point of view, quantification cannot always be achieved in the developmental deformity in hip joints, but finite element analysis can be a helpful tool to compare normal joint architecture with a dysplastic counterpart. CT scans from the normal right hip of an 8-year-old boy and the dysplastic left hip of a 12-year-old girl were used to construct our geometric models. In a three-dimensional model construction, distinctions were made between the cortical bone, trabecular bone, cartilage, and contact nonlinearities of the hip joint. The mathematical model incorporated the consideration of the linear elastic and isotropic properties of bony tissue in children, separately for the cortical bone, trabecular bone, and articular cartilage. Hexahedral elements were used in Autodesk Inventor software version 2022 (“Ren”) for finite element analysis of the two hips in the boundary conditions of the single-leg stance. In the normal hip joint on the cartilaginous surfaces of the acetabulum, we found a kidney-shaped stress distribution in a 471,672 mm² area. The measured contact pressure values were between 3.0 and 4.3 MPa. In the dysplastic pediatric hip joint on a patch of 205,272 mm² contact area, the contact pressure values reached 8.5 MPa. Furthermore, the acetabulum/femur head volume ratio was 20% higher in the dysplastic hip joint. We believe that the knowledge gained from the normal and dysplastic pediatric hip joints can be used to develop surgical treatment methods and quantify and compare the efficiency of different surgical treatments used in children with hip dysplasia.