Osteoporosis (OP) is one of the most significant causes of morbidity, particularly in post-menopausal women and older men. Despite its remarkable occurrence, the search for an effective treatment is still an open challenge. Here, we systematically reviewed the preclinical and clinical progress in the development of nano-based materials as drug delivery systems against OP, considering the effects on bone healing and regeneration, the more promising composition and manufacturing methods, and the more hopeful drugs and delivery methods. The results showed that almost all the innovative nano-based delivery systems developed in the last ten years have been assessed by preclinical investigations and are still in the preliminary/early research stages. Our search strategy retrieved only one non-randomized controlled trial (RCT) on oligosaccharide nanomedicine of alginate sodium used for degenerative lumbar diseases in OP patients. Further investigations are mandatory for assessing the clinical translation and commercial purposes of these materials. To date, the main limits for the clinical translation of nano-based materials as drug delivery systems against OP are probably due to the low reproducibility of the manufacturing processes, whose specificity and complexity relies on an adequate chemical, structural, and biomechanical characterization, as the necessary prerequisite before assessing the efficacy of a given treatment or process. Finally, an unsatisfactory drug-loading capacity, an uncontrollable release kinetic, and a low delivery efficiency also limit the clinical application.

Enhanced recovery after surgery (ERAS) protocols have led to improvements in outcomes in several surgical fields, through multimodal optimization of patient pathways, reductions in complications, improved patient experiences and reductions in the length of stay. However, their use has not been uniformly recognized in all orthopedic fields, and there is still no consensus on the best implementation process. Here, we evaluated pre-, peri-, and post-operative key elements and clinical evidence of ERAS protocols, measurements, and associated outcomes in patients undergoing different orthopedic surgical procedures. A systematic literature search on PubMed, Scopus, and Web of Science Core Collection databases was conducted to identify clinical studies, from 2012 to 2022. Out of the 1154 studies retrieved, 174 (25 on spine surgery, 4 on thorax surgery, 2 on elbow surgery and 143 on hip and/or knee surgery) were considered eligible for this review. Results showed that ERAS protocols improve the recovery from orthopedic surgery, decreasing the length of hospital stays (LOS) and the readmission rates. Comparative studies between ERAS and non-ERAS protocols also showed improvement in patient pain scores, satisfaction, and range of motion. Although ERAS protocols in orthopedic surgery are safe and effective, future studies focusing on specific ERAS elements, in particular for elbow, thorax and spine, are mandatory to optimize the protocols.

Calcium phosphate (CaP) coatings are commonly employed to improve the bioactivity of bone and dental metal implants, due to the chemical–physical similarity with the mineral phase of bone, envisaged to enhance the integration with the surrounding bone tissue. However, growing concerns about the use of commercial thick CaP coatings, mainly related to their weak mechanical properties, poor interface strength and micro-structural inhomogeneity, are leading the investigation of new and alternative CaP deposition techniques. In this study the feasibility to deposit tough and well adherent CaP thin films by a novel Pulsed Plasma Deposition (PPD) method on Ti alloy was investigated. Microstructural, chemical and morphological properties of the coatings as well as the nano-mechanical properties and their adhesion to the Ti-alloy substrate were extensively characterized. In vitro biocompatibility was also preliminary assessed evaluating the adhesion and proliferation of primary mouse osteoblasts. As-deposited CaP films were amorphous and exhibited dense and uniform surface composed of sub-micrometric aggregated globular particles. Noteworthy, mechanical properties of as-deposited films were comparable to the ones of commercial plasma-sprayed coatings despite the significant difference of thickness (a few hundred nanometers vs. tens of micrometers). After the thermal annealing of the as deposited films at 600 °C for 1 h in air, a transformation from amorphous calcium phosphate to crystalline hydroxyapatite (HA) phase occurred. The mechanical properties as well as the adhesion to substrate of the annealed films strongly improved respect to those of the as deposited films, displaying interesting high hardness, elastic strain to failure and plastic deformation resistance values. Finally, biological in vitro tests indicated good biocompatibility of both as-deposited and annealed films, with this latter showing better cells adhesion and proliferation compared to the former.

The carrying angle value and its pathological variations are important in the management of elbow fractures and in the diagnosis of diseases of lateral and medial epicondyles. Few investigators have studied the carrying angle in-vivo. In clinical practice, the carrying angle of the elbow is assessed by radiographs or goniometers, to evaluate reduction of distal humerus or radial head fractures and epicondyles pathologies. This article presents a noninvasive procedure to estimate the carrying angle in full-extension by a 3D digitizer suitable for orthopedic applications. We also performed an experimental analysis of reliability, by comparing repeated acquisitions both by the same operator and by two different operators. Two operators performed the acquisitions on 37 healthy patients. Mean carrying angle was 12.7°±3.8°. Women and men presented a mean carrying angle value of 12.90°±3.95° and 12.40°±3.64°, respectively. Right and left carrying angle values were respectively 12.55°±3.50° and 12.81°±4.11°. Neither limb side ( P =0.76) nor gender significant differences ( P =.57) were found. Mean values were consistent to the literature, interoperator repeatability was good (ICC=0.7) and intraoperator repeatability excellent (ICC=0.85). A further advantage of this methodology is the automatic inclusion of the calculation of the flexion and pronation angle. This evaluation was never included in previous approaches and it could be useful in clinical and rehabilitative fields.

A previous study reported the structural characterization of biogenic apatite (BAp) thin films realized by a pulsed electron deposition system by ablation of deproteinized bovine bone. Thin films annealed at 400°C exhibited composition and crystallinity degree very close to those of biogenic apatite; this affinity is crucial for obtaining faster osseointegration compared to conventional, thick hydroxyapatite (HA) coatings, for both orthopedics and dentistry. Here, we investigated the adhesion, proliferation, and osteogenic differentiation of human dental pulp stem cells (hDPCS) on as-deposited and heat-treated BAp and stoichiometric HA. First, we showed that heat-treated BAp films can significantly promote hDPSC adhesion and proliferation. Moreover, hDPSCs, while initially maintaining the typical fibroblast-like morphology and stemness surface markers, later started expressing osteogenic markers such as Runx-2 and OSX. Noteworthy, when cultured in an osteogenic medium on annealed BAp films, hDPSCs were also able to reach a more mature and terminal commitment, with respect to HA and as-deposited films. Our findings suggest that annealed BAp films not only preserve the typical biological properties of stemness of, hDPSCs but also improve their ability of osteogenic commitment.