Assunta Pozzuoli

Background/Objectives: Cemented femoral stems are a well-established treatment option for femoral neck fractures (FNFs) in elderly patients. This study evaluated mid-term clinical and radiographic outcomes and safety profile in patients undergoing hemiarthroplasty with the CL TRAUMA cemented femoral stem (LimaCorporate) for FNF. Methods: The single-center observational Post-Market Clinical Investigation identified 474 patients who underwent hip arthroplasty between 2017 and 2023. Of these, 54 (11.4%) who were alive, contactable, willing, and physically able to attend were included in the mid-term follow-up (FU) assessment. Perioperative, discharge, and 1-month FU data were collected retrospectively, while mid-term clinical and radiographic FU was performed prospectively after a minimum of 2 years. The primary endpoint was satisfactory status, defined as a Harris Hip Score (HHS) ≥ 80. Secondary endpoints included patient satisfaction assessed using Visual Analogue Scale (VAS), radiographic outcomes, and documented serious adverse events (SAEs). Results: The 54 evaluated patients (54/474; 11.4% of the implanted population) included 49 females and 5 males, with a mean age at surgery of 77.1 ± 9.1 years and a mean FU of 4.4 ± 0.8 years. All patients underwent hemiarthroplasty for FNF. Mean HHS was 80.6 ± 16.9, with 33 patients (61.1%) achieving the primary endpoint. Mean VAS satisfaction was 76.4 ± 29.3. At mid-term FU, RLLs were observed in 38.9% of patients, predominantly of limited thickness. Distal stem migration was observed in one case (1.9%), and bone remodeling in three patients (5.6%). Eleven SAEs occurred in 10 patients (18.5%); three events were related and two possibly related to the surgical procedure, whereas none was considered related to the device. No femoral stem revisions were documented among the 54 evaluated patients during the available FU. Conclusions: Among the selected patients who survived and completed mid-term follow-up after bipolar hemiarthroplasty with the CL TRAUMA cemented femoral stem, satisfactory functional status and patient satisfaction were observed, together with generally stable stem-specific radiographic findings. No SAEs were considered related to the femoral stem, and no femoral stem revisions were documented. These findings should be interpreted cautiously and cannot be extrapolated to the entire implanted population.

Osteoarthritis (OA) is increasingly recognized as a disease involving low-grade inflammation and immune remodeling, yet the contribution of the bone marrow (BM) myeloid compartment to hip OA remains poorly defined. Myeloid-derived suppressor cells (MDSCs) are immature myeloid cells with immunoregulatory activity and potential roles in inflammatory bone disease. Here, we investigated ex vivo BM myeloid composition and the functional properties of BM-MDSCs in elderly patients with hip OA compared with patients undergoing surgery for proximal femoral fracture. BM aspirates from both cohorts were analyzed by flow cytometry and cultured with G-CSF and GM-CSF to induce BM-MDSCs. Despite the lower mean age of the hip osteoarthritis cohort, these patients showed a significantly higher proportion of BM myeloid cells than fracture patients, whereas lymphoid cell frequencies were not significantly different. Analysis of myeloid maturation stages revealed enrichment of CD11b⁺/CD16 ^low metamyelocyte-like cells in hip OA samples both ex vivo and after cytokine-driven expansion. Functional assays demonstrated that inhibition of activated T cell proliferation was confined to the most immature myeloid fraction, which displayed promyelocyte-like features. This suppressive activity was preserved in both hip OA and fracture cohorts, with no significant difference between groups. These findings indicate that hip OA is associated with BM myeloid skewing and selective enrichment of myeloid subsets reassembling metamyelocytes-like cells, while maintaining conserved immunoregulatory function. The BM may represent an active immunological compartment linked to the balance between chronic inflammation and immune regulation in hip OA.

Prompt diagnosis and prognostic assessment of bone metastases (BMs) remain challenging with most studies and prognostic models focusing on a single primary tumor and neglect host-related biomarkers. Therefore, this pan-cancer study aimed to evaluate bone metabolism, inflammatory, and hematological biomarkers in patients undergoing surgery for BMs, identify risk factors for BM development, and create a prognostic nomogram. A prospective cohort of adult patients with histologically confirmed BMs from various cancers was enrolled between 2020 and 2023. Baseline data included demographics, tumor type, and preoperative biomarkers such as bone turnover markers (P1NP, BAP), calcium, LDH, IGFBP-3, HALP, RDW, and NLR. Outcomes were recurrence, metastasis, and overall survival (OS), analyzed with Kaplan–Meier and Cox regression. Prognostic variables were integrated into a nomogram and validated by ROC curves and calibration. Ninety-one patients underwent surgery for BM. The most frequent primary cancers were breast (28.6%), kidney (23.1%), and lung (16.5%). Significant tumor-type differences were observed in BAP ( p = 0.015), IGFBP-3 ( p = 0.008), and HALP ( p = 0.029). Univariate analysis identified P1NP, BAP, calcium, LDH, and RDW as prognostic markers. Multivariate models found age, kidney cancer, IGFBP-3, RDW, and NLR as independent predictors. The nomogram demonstrated strong predictive performance at 12 months (AUC = 82.3) and 24 months (AUC = 81.0). Tumor-specific and host-related biomarkers (IGFBP-3, NLR, and RDW) improved prognostic stratification beyond tumor type. The proposed nomogram demonstrated good discriminatory performance, supporting its potential use in personalized prognostic assessment and treatment planning.

Musculoskeletal diseases (MSDs) are among the leading causes of disability worldwide, placing a significant burden on healthcare systems and reducing patients’ quality of life

Background: Hallux valgus (HV) is a widespread condition that leads to discomfort in daily life. There are different surgical techniques for HV. This retrospective and comparative study aimed to compare the clinical and radiographic outcomes of the Reverdin-Isham osteotomy (RIO) and the Minimally Invasive Intramedullary Nail Device (MIIND) surgical techniques. Methods: One hundred ninety-six patients with mild-to-severe HV were enrolled and divided into two groups: 98 patients with mild-moderate HV and 98 with moderate-severe HV, treated with the RIO and MIIND techniques, respectively. Radiographic and clinical evaluations were assessed preoperatively at 3, 12 and 60 months after surgery. Radiologically, the Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA) and Tibial Sesamoid Position (TSP) were evaluated. Clinically, the AOFAS hallux metatarsophalangeal-interphalangeal scale and the Numeric Rating Scale (NRS-11) for pain were assessed. A propensity score matching (PSM) model was implemented to compare the two techniques. Results: In the RIO group, the mean HVA correction from preoperative value to 60 months of follow-up was 8.69° (p < 0.0001), the mean IMA correction was 2.42° (p < 0.0001), and the mean DMAA correction was 0.09°. In the MIIND group, the mean HVA correction was 24.92° (p < 0.0001), the mean IMA correction was 8.75° (p < 0.0001), and the mean DMAA correction was 6.28° (p < 0.0001). The mean AOFAS score improved over time, and NRS-11 decreased in both groups. After PSM model application, the variables that impacted the allocation to RIO or MIIND techniques were age, preoperative HVA values and HV severity. Conclusion: Our study demonstrates the efficacy of RIO for mild-moderate HV and MIIND for moderate-severe HV. Radiographic and clinical outcomes improved in both groups, but older patients with higher HVA and severe HV should be treated with the MIIND technique to achieve satisfactory outcomes. Level of evidence: III, retrospective cohort study.

Background: Diabetic foot is one of the major complications of diabetes, affecting 15% of patients with diabetes. This study aims to evaluate and compare the clinical and radiographic outcomes of patients with diabetes affected by forefoot plantar preulcerative or ulcerative lesions who have undergone minimally invasive distal metatarsal diaphyseal osteotomy (MIS-DMDO) to assess its efficacy in the prevention and treatment of chronic plantar diabetic foot ulcers (CPDFUs). Methods: The study included 60 patients, 38 with preulcers and 22 with ulcers, with at least 2 years of clinical and radiologic follow-up. Clinical outcomes were assessed using the European Foot and Ankle Society (EFAS) score, the Foot Function Index (FFI), and the Manchester-Oxford Foot Questionnaire (MOXFQ). The radiographic evaluation was performed according to the Maestro criteria. Results: Both groups improved in clinical and radiologic outcomes when comparing baseline measurements to those at the final follow-up. There were no statistical differences between preulcer and ulcer groups in terms of both clinical and radiologic outcomes, with the only exception being FFI, which was lower in the preulcerative group. In multivariate analysis, gender and glycated hemoglobin (HbA_1c) were predictors of better outcomes. Specifically, FFI and MOXFQ ( P < .05) exhibited larger improvements in females, while Maestro 1 and 2 were better in patients with lower HbA_1c ( P < .05). All patients were considered healed at the final follow-up. Conclusion: Carefully performed minimally invasive distal metatarsal diaphyseal osteotomy can be an effective approach to the care of impending or chronically present plantar diabetic foot ulcers.

Plantar adipose tissue is a connective tissue whose structural configuration changes according to the foot region (rare or forefoot) and is related to its mechanical role, providing a damping system able to adsorb foot impact and bear the body weight. Considering this, the present work aims at fully describing the plantar adipose tissue’s behaviour and developing a proper constitutive formulation. Unconfined compression tests and indentation tests have been performed on samples harvested from human donors and cadavers. Experimental results provided the initial/final elastic modulus for each specimen and assessed the non-linear and time-dependent behaviour of the tissue. The different foot regions were investigated, and the main differences were observed when comparing the elastic moduli, especially the final elastic ones. It resulted in a higher level for the medial region (89 ± 77 MPa) compared to the others (from 51 ± 29 MPa for the heel pad to 11 ± 7 for the metatarsal). Finally, results have been used to define a visco-hyperelastic constitutive model, whose hyperelastic component, which describes tissue non-linear behaviour, was described using an Ogden formulation. The identified and validated tissue constitutive parameters could serve, in the early future, for the computational model of the healthy foot.

Musculoskeletal diseases (MSDs) comprise a plethora of different disorders (more than 150 conditions) affecting the locomotor system

Biomechanical studies are expanding across a variety of fields, from biomedicine to biomedical engineering. From the molecular to the system level, mechanical stimuli are crucial regulators of the development of organs and tissues, their growth and related processes such as remodelling, regeneration or disease. When dealing with cell mechanics, various experimental techniques have been developed to analyse the passive response of cells; however, cell variability and the extraction process, complex experimental procedures and different models and assumptions may affect the resulting mechanical properties. For these purposes, this review was aimed at collecting the available literature focused on experimental chondrocyte and chondron biomechanics with direct connection to their biochemical functions and activities, in order to point out important information regarding the planning of an experimental test or a comparison with the available results. In particular, this review highlighted (i) the most common experimental techniques used, (ii) the results and models adopted by different authors, (iii) a critical perspective on features that could affect the results and finally (iv) the quantification of structural and mechanical changes due to a degenerative pathology such as osteoarthritis.