Day 2 :
Keynote Forum
Rachel W Li
Australian National University, Australia
Keynote: Heparanase regulates inflammatory mediators in rheumatoid arthritis
Time : 10:00 - 10:30
Biography:
Rachel W Li has completed her PhD in Australia and gained her Postdoctoral experiences in Molecular Pharmacology focusing on immune regulation of metabolic diseases at the University of Hawaii, USA. She returned to Australia joining the Trauma and Orthopaedic Research Unit (TORU) at the Australian National University Medical School and has established TORU Laboratory. She is currently leading her team with a focus on osteoimmunology, biomaterials and 3D printing for orthopedic implants.
Abstract:
Statement of the Problem: Heparanase is the only known mammalian endoglycosidase capable of degrading the heparan sulfate (HS) glycosaminoglycan, both in extracellular space and within the cell. HS is reported to control inflammatory responses at multiple levels, including the sequestration of cytokines/chemokines in the extracellular space, the modulation of the leukocyte interaction with the endothelium and ECM, and the initiation of innate immune responses. We have reported heparanase expression in synovium of rheumatoid arthritis (RA) patients and this new finding may offer a new insight of the potential regulatory role of heparanase in the disease activity of RA. However, the precise mode of action by heparanase in inflammatory reactions of RA remains largely unknown.
Aim: The purpose of this study is examine the heparanase activity, its expression and correlation with the inflammatory mediatory and angiogenic gene expression in plasma and synovium of RA patients, with an ultimate goal of developing heparanase as a potential predictor of RA progression and a new therapeutic target.
Methodology & Theoretical Orientation: HPSE activity was detected using ELISA. HPSE mRNA expression and osteogenic gene expression were measured by RT-qPCR Array assay.
Findings: Heparanase activity and its expression in synovial fluid and synovial tissue of RA patients were significantly increased and an increase of the heparanase activity positively correlated with the inflammatory and angiogenic gene expression.
Conclusion & Significance: We also have some evidence to support a postulation that the involvement of heparanase in gene regulation in the development of pannus in RA may be reflected in a patient’s blood, thus heparanase can be a potential predictor of RA progression and a novel therapeutic target.
Keynote Forum
Samo K Fokter
University Medical Center Maribor, Slovenia
Keynote: The innovation trap: A nation-wide problem of modularity in primary total hip arthroplasty
Time : 10:30 - 11:00
Biography:
Samo K Fokter is a board certified Consultant Orthopedic Surgeon at the Department of Orthopedic Surgery of Maribor University Clinical Centre. He is currently the President of the Expert Council for Orthopedics at Slovenian Medical Association and dedicates a large part of his free time to voluntary work in Mountain Rescue Service of Slovenia. His bibliography contains over 260 units, among them scientific and professional articles, published in high-quality international medical journals. He is a Founding Member of Slovenian Spine Society, Honorary Member of Club Italiano dell’ Osteosintesi (CIO) and also a Chairperson of AOSpine Society. He serves as the Deputy Editor of Springer’s European Journal of Orthopedic Surgery and Traumatology (EJOST), and Editorial Board Member of Zdravniski Vestnik, the central Slovenian medical journal.
Abstract:
Statement of the Problem: Innovations play the key role in the success of orthopedic surgery. However, even minor modifications in the established concepts and proven designs may result in disasters. The endemic of modular femoral neck fracture (23 cases) in fully modular total hip arthroplasty, popular in Central Europe for the last 15 years, seems to challenge us with such an unfortunate consequences.
Methodology & Theoretical Orientation: Literature search for problems associated with Profemur Z (MicroPort Orthopedics Inc., Arlington, TN, USA) fully-modular femoral stem made of titanium alloy (Ti6Al4V) was performed and hip arthroplasty registries were searched to evaluate the failure rates of this specific stem design. Mechanisms of failure were studied to get in-depth understanding of this particular hip reconstruction device.
Findings: Since 2010 onwards, several case reports on catastrophic modular femoral neck fractures of Profemur Z were published. The first Slovenian case was described in 2012. Two small series of patients with sudden modular femoral neck fractures were published in 2016. The Australian Joint Replacement Registry was the first to discover increased revision rates due to fractures of this hip reconstruction system. Corrosion at the neck-taper interface, where two equal or different materials are subject to constant wear in the presence of body fluids, is assumed to be responsible for the unacceptable high failure rate.
Conclusion & Significance: Manufacturers are responsible to produce and market only safe devices. However, orthopedic surgeons should carefully monitor any adverse effect of innovations. As late as in 2015, an urgent field safety corrective notice was sent from the manufacturer indicating that all lots of long modular necks made from cobalt-chromium alloy should be withdrawn. A national arthroplasty registry would probably warn orthopedic community on this questionable innovation earlier.
- Pharmacological Treatment | Physiotherapy | Orthopedic Degenerative Diseases | Connective Tissue Disorders and Soft Tissue Rheumatism
Session Introduction
Kryssa Justine Agpoon
Korea University Medical Center-Guro Hospital, South Korea
Title: Osteoinduction regeneration using tooth bone graft with BMP-2
Time : 11:30 - 12:00
Biography:
Kryssa Justine Agpoon has her expertise in Oral and Maxillofacial Surgery. She has dedication and pursues her passion to clinical and research of the chosen field. She has completed her Master’s degree and Hospital training at Philippine General Hospital, Korea University Graduate School and Korea University Medical Center for her dedication to academic preparation. She has recently published an article at British Journal of Oral and Maxillofacial Surgery about mandibular stability using sliding or conventional four hole plates for fixation after bilateral split osteotomy for mandibular setback. She intends to do more research about oral and maxillofacial surgery.
Abstract:
Despite the fact that improved biomaterials are needed to match the affectivity of autogenous bone grafts, as this is still superior to that of synthetic bone grafts, osteoinductive materials such as BMP-2 would be perfect candidates for combination with biomaterials to achieve this task. However, different sizes of biomaterials have shown insufficient consideration for important prerequisite for its development. This study aimed to investigate the estimated increase in osteoinductive activity of different shapes of tooth bone grafts (TBGs) with BMP-2 in rabbit calvarial defects compared with synthetic bone grafts based on histomorphometric and histological analysis. We randomly divided a total of 40 calvarial defects in 10 male New Zealand rabbits into four experimental groups: Group-1: Powder-type graft+BMP; Group-2: Block-type graft+BMP; Group-3: Block-type graft only; and Control group: Synthetic bone+BMP. In each rabbit calvarium, we formed four circular bi-cortical defects with a diameter of 8 mm and filled them with bone graft materials. After four weeks (n=5) and eight weeks (n=5), we conducted histomorphometric and histological analyses to determine the changes in bone area in the different groups. We assessed the tissue volume, bone volume and percent bone volume in each group; the BMP-2/tooth powder-type graft and the TBG alone stimulated mesenchymal cells to create endochondral ossiï¬cation and direct bone formation and showed significant differences between groups (p<0.05). The changes in bone volume ranged from 12 to 23% with powder type tooth biomaterial and tissue volume ranged from 113-123 mm3 in the different groups. We concluded that powder-type TBG was effective as a carrier of BMP-2, which significantly accelerated bone formation in the acid-insoluble TBG carrier system
Ahmad Alqahtani
King Khaled University, Saudi Arabia
Title: Acute compartment syndrome
Time : 12:00 - 12:30
Biography:
Abstract:
Acute compartment syndrome (ACS) is one of the most serious emergencies cases in orthopedics and trauma cases. It is a painful condition caused by the increase interstitial pressure within a closed osteofascial  compartment which impairs local circulation. We have analyzed associated factors, causes and complications in 79 patients with acute compartment syndrome whom we diagnosed and treated in Assir Central Hospital over a period of five years. In 77% there was an associated fracture, 65% of which were open fractures. Men were involved in 90% of the cases, 63% of which were under 30 years of age. In about 60%, the cause was road traffic accidents. The other 40% caused by fall from height, crush injuries, gunshot, snakebites and burns. Acute compartment syndrome of the leg, with associated fracture of the tibia, was seen in most of the cases (45%) followed by the forearm (25%). In the remaining 30% the thigh, foot and hand were involved. Seven patients had amputation as a complication of acute compartment syndrome of the leg, three of which were diabetic and hypertensive. No amputation done for the upper limbs. Infection (14%) and loss of function (10%) were among the complications of acute compartment syndrome. From this study, we found that young patients, especially men, were at risk of acute compartment syndrome after injury. When treating such injured patients, the clinical diagnosis should be made early to improve the outcome and lessen the complications.
Ranjeet Kumar
Liaquat Medical University of health Science, Pakistan
Title: Outcome of Ponseti treatment in idiopathic club foot in school age children
Time : 12:30 - 13:00
Biography:
Dr. Ranjeet Kumar has completed his medical education from Liaquat Medical University of health Science, Pakistan. He was Sr. Causality Medical Officer for one years at Ziauddin University Hospital, Pakistan. He has visited to South Korea in 2015 to present his research work in Korean Orthopaedic Association.
Abstract:
Introduction & Aim: The Ponseti method of treating club foot has been shown to be effective in children up to two years of age. However, it is not known whether it is successful in older children or not. The goal of treatment is to correct all components of deformity so that the patient has a pain-free, plantigrade foot with good mobility, without calluses and without need to wear special or modified shoes. The purpose of this study is to determine outcome of Ponseti treatment in idiopathic club foot in school age children.
Method: This study was conducted in Jinnah Postgraduate Medical Centre, Karachi, Pakistan from 1st Jan 2013 to 31st April 2015. Total number of cases was 49. The study included 67 feet of 49 patients (29 boys, 20 girls; mean age 6 years; range 3 years to 10 years) with idiopathic clubfoot deformities of Pirani score of IV, V and VI. All patients had manipulation casting in accordance with the Ponseti technique and percutaneous Achilles tenotomy was performed in the presence of persistent equinus under local anesthesia. The data was analyzed using software SPSS version 13 and presented in form of tables and charts.
Results: We followed the functional Ponseti Scoring System and got good to excellent results in 44 patients - 89.79% (58 clubfeet - 86.56%) at mean 2 year of follow up. Improvements for each separate component (varus, medial rotation of calcaneo-pedal block and adducts) were found to be statistically significant. Painless, supple, plantigrade and cosmetically acceptable feet were achieved in 44 (89.79) clubfeet.
Conclusion: The Ponseti method is an effective method in correcting the deformities of clubfeet even in school age children.