Iosif-Aliodor Timofticiuc

Total joint arthroplasty is a surgical procedure with rising global incidence. Although a strong postoperative inflammatory response is necessary for tissue repair following primary arthroplasty, it may prove to be harmful if excessive or prolonged. This could compromise osseointegration, increase pain, and delay the detection of periprosthetic joint infection. This narrative review examines the principal inflammatory pathways activated by primary arthroplasty. Damage-associated molecular patterns produced by injury and cell death, such as High Mobility Group Box 1 Protein, cell-free DNA, extracellular ATP, histones, and heat shock proteins, trigger innate immune activation following surgical trauma. These mediators use inflammasome pathways and pattern recognition receptors to intensify inflammatory signaling. The acute-phase trajectory, characterized by increases in C-reactive protein and erythrocyte sedimentation rate, alongside the role of interleukin-6 as a precursor factor, is examined together with synovial markers to facilitate the differentiation between septic and aseptic inflammation. Cytokine signaling cascades (JAK-STAT, NF-κB, MAPK) and the RANK/RANKL/OPG axis at the bone-immune interface are also considered. This manuscript highlights relevant inflammatory pathways, clinically significant biomarkers, and pathway-guided management strategies to provide an overview of the current research on the biological mechanisms underlying perioperative inflammation in primary arthroplasty. No inflammatory biomarker has yet been validated as a predictor of aseptic loosening.

Background: Arthropathies are a substantial source of global morbidity and healthcare costs, and there is a clinical need for accessible tools capable of detecting inflammatory and metabolic changes beyond conventional structural imaging. This review consolidates the recent evidence on infrared thermography (IRT) as a diagnostic and monitoring adjunct in the major arthropathies. Methods: A structured narrative review was conducted. A literature search of PubMed, Web of Science Core Collection, and Scopus was performed to identify relevant studies published between January 2016 and December 2025 using thermography- and arthropathy-related keywords and controlled-vocabulary terms combined with Boolean operators; only original full-text studies in English published within the previous decade were eligible. The structured search yielded 53 primary studies. Additional sources, including narrative and systematic reviews, methodological references, and book chapters, were drawn upon to inform the Introduction, Discussion, and interpretation but were not included in the primary evidence synthesis. Results: Across the included studies, IRT detected clinically meaningful thermal changes in most cases of osteoarthritis, rheumatoid arthritis, juvenile idiopathic arthritis, Charcot neuroarthropathy, and post-arthroplasty states, with thermal signals correlating moderately with ultrasound-detected synovitis, inflammatory biomarkers, and symptom distribution. Discussion: The evidence base is heterogeneous, however: temperature distributions overlap substantially between patients and controls, well-conducted negative results exist for hand thermography in low-activity rheumatoid arthritis, and reported effect sizes vary widely across devices and protocols. Quantitative thermographic metrics and machine-learning approaches may further refine diagnostic performance and enable remote monitoring. Conclusions: IRT is a promising rapid, non-invasive, radiation-free adjunctive imaging modality, but its clinical adoption is constrained by methodological variability, environmental and vascular confounders, and the absence of prospective validation. Standardised acquisition protocols and prospective multi-site validation are required before routine clinical use.

Background: Artificial intelligence (AI) is becoming increasingly integrated into orthopaedic surgery for tasks such as implant positioning, dislocation risk prediction, and surgical decision-making. However, the current evidence varies widely across anatomical regions and applications. Methods: A structured narrative review was conducted using PubMed and Web of Science Core Collection to identify studies applying machine learning or deep learning in orthopaedic procedures, focusing on parameters such as the anatomical region addressed, data types used, primary AI tasks, evaluation designs, and validation strategies. Reviews and meta-analyses were excluded. Study selection was summarized using a PRISMA-style flow diagram, and included studies were narratively synthesized according to anatomical region, AI task, imaging modality, validation strategy, and clinical relevance. Results: We identified three main application areas: (1) AI in imaging-driven planning and implant positioning, often linked with navigation or robotic systems; (2) postoperative evaluation related to implants; and (3) prediction of clinically relevant outcomes such as dislocation risk. The strongest evidence is found in hip arthroplasty, where AI improves measurement accuracy and workflow efficiency, whereas applications in knee, shoulder, and spine surgery are less developed and often supported by smaller studies. Although existing risk prediction models demonstrate good performance, their generalizability is hindered by limited external validation and inconsistent reporting. Conclusions: Overall, while AI shows significant promise in enhancing various aspects of orthopaedic surgery, stronger links between technical advancements and patient outcomes are needed. Future research should prioritize extensive validations, workflow-aware evaluations, failure analysis, and adherence to AI-specific reporting guidelines to facilitate safe and effective clinical implementation.

Bone diseases such as osteomyelitis, osteosarcoma, and osteoarthritis, as well as conditions caused by metabolic imbalances, including osteoporosis, require more efficient and optimized therapies. Systemic drug administration entails major disadvantages like cytotoxicity and adverse reactions, which can lead to serious complications or death. Therefore, local drug administration alternatives are currently under investigation for different pharmacological therapies. New vectors were created to improve control over administration, and 3D-printed and patient-specific drug delivery systems have been tested, revealing great potential. Moreover, 3D-printed platforms that mimic human tissues for drug testing are innovative solutions emerging for the pharmaceutical industry. Situated between in vitro and in vivo testing on human patients, they offer the advantage of reproducing functional architecture, providing results that are closer to those encountered in clinical trials performed on patients. In our article, we present the two categories of 3D systems, from the perspective of main drug groups (antibiotics, anticancer, and anti-inflammatory) as well as other categories, alongside their advantages, limitations, and their adaptations to 3D printing technologies. This article also highlights the technological drawbacks encountered in both delivery and screening systems, as well as the printing methods and materials used, including their physical and biological properties.

Recent developments in 3D bioprinting offer innovative alternative solutions to classical treatments for head and neck defects. Soft tissues in an anatomical area as diverse in composition as the head and neck are complex in terms of structure and function. Understanding how cellular interaction underlies functionality has led to the development of bioinks capable of mimicking the natural morphology and roles of different human parts. Moreover, from the multitude of recently developed materials, there are now many options for building scaffolds that potentiate the activity of these cells. The fidelity and accuracy of the utilized techniques ensure maximum precision in terms of model construction. Emerging technologies will allow for improved control of the scaffold, facilitating optimal results in the treatment of various pathologies, without concerns about the availability of donors, immunological response, or any other side effects that traditional treatments withhold. This paper explores the current landscape of bioprinted scaffolds and their applications in the head and neck region, with a focus on the properties and use of natural and synthetic bioinks in the attempt to replicate the biomechanical features of native tissues. Customization capabilities that support anatomical precision and biofunctionality are also addressed. Moreover, regulatory requirements, as well as current challenges related to biocompatibility, immune response, and vascularization, are critically discussed in order to provide a comprehensive overview of the pathway to clinical application.

With the development of 3D bioprinting and the creation of innovative biocompatible materials, several new approaches have brought advantages to patients and surgical teams. Increasingly more bone defects are now treated using 3D-bioprinted prostheses and implementing new solutions relies on the ability of engineers and medical teams to identify methods of anchoring 3D-printed prostheses and to reveal the potential influence of bioactive materials on surrounding tissues. In this paper, we described why limb salvage surgery based on 3D bioprinting is a reliable and effective alternative to amputations, and why this approach is considered the new standard in modern medicine. The preliminary results of 3D bioprinting in one of the most challenging fields in surgery are promising for the future of machine-based medicine, but also for the possibility of replacing various parts from the human body with bioactive-based constructs. In addition, besides the materials and constructs that are already tested and applied in the human body, we also reviewed bioactive materials undergoing in vitro or in vivo testing with great potential for human applications in the near future. Also, we explored the recent advancements in clinically available 3D-bioprinted constructs and their relevance in this field.

The incidence of microbial infections in orthopedic prosthetic surgeries is a perennial problem that increases morbidity and mortality, representing one of the major complications of such medical interventions. The emergence of novel technologies, especially 3D printing, represents a promising avenue of development for reducing the risk of such eventualities. There are already a host of biomaterials, suitable for 3D printing, that are being tested for antimicrobial properties when they are coated with bioactive compounds, such as antibiotics, or combined with hydrogels with antimicrobial and antioxidant properties, such as chitosan and metal nanoparticles, among others. The materials discussed in the context of this paper comprise beta-tricalcium phosphate (β-TCP), biphasic calcium phosphate (BCP), hydroxyapatite, lithium disilicate glass, polyetheretherketone (PEEK), poly(propylene fumarate) (PPF), poly(trimethylene carbonate) (PTMC), and zirconia. While the recent research results are promising, further development is required to address the increasing antibiotic resistance exhibited by several common pathogens, the potential for fungal infections, and the potential toxicity of some metal nanoparticles. Other solutions, like the incorporation of phytochemicals, should also be explored. Incorporating artificial intelligence (AI) in the development of certain orthopedic implants and the potential use of AI against bacterial infections might represent viable solutions to these problems. Finally, there are some legal considerations associated with the use of biomaterials and the widespread use of 3D printing, which must be taken into account.

Along with the rapid and extensive advancements in the 3D printing field, a diverse range of uses for 3D printing have appeared in the spectrum of medical applications. Vat photopolymerization (VPP) stands out as one of the most extensively researched methods of 3D printing, with its main advantages being a high printing speed and the ability to produce high-resolution structures. A major challenge in using VPP 3D-printed materials in medicine is the general incompatibility of standard VPP resin mixtures with the requirements of biocompatibility and biofunctionality. Instead of developing completely new materials, an alternate approach to solving this problem involves adapting existing biomaterials. These materials are incompatible with VPP 3D printing in their pure form but can be adapted to the VPP chemistry and general process through the use of innovative mixtures and the addition of specific pre- and post-printing steps. This review’s primary objective is to highlight biofunctional and biocompatible materials that have been adapted to VPP. We present and compare the suitability of these adapted materials to different medical applications and propose other biomaterials that could be further adapted to the VPP 3D printing process in order to fulfill patient-specific medical requirements.