Iskandar Mariño - Academia.edu (original) (raw)

Papers by Iskandar Mariño

Research paper thumbnail of Proton Pump Inhibitors and the Risk of Early Aseptic Loosening in Hip and Knee Arthroplasty

Geriatric Orthopaedic Surgery & Rehabilitation, 2022

Research paper thumbnail of Addendum: Effect of acetylcholinesterase inhibitors on post-surgical complications and mortality following a hip fracture: a cohort study

Journal of Musculoskeletal & Neuronal Interactions, Jun 1, 2017

Research paper thumbnail of Acetylcholinesterase inhibitors and risk of bleeding and acute ischemic events in non‐hypertensive Alzheimer's patients

Alzheimer's & Dementia: Translational Research & Clinical Interventions, 2021

Introduction: Acetylcholinesterase inhibitors (AChEIs) are commonly used to treat mild to moderat... more Introduction: Acetylcholinesterase inhibitors (AChEIs) are commonly used to treat mild to moderate cases of Alzheimer disease (AD). To the best of our knowledge, there has been no study estimating the risk of bleeding and cardiovascular events in patients with non-hypertensive AD. Therefore, this study aimed to estimate the association between AChEIs and the risk of bleeding and cardiovascular ischemic events in patients with non-hypertensive AD. Methods: A nested case-control study was conducted to estimate the risk of bleeding and ischemic events (angina, myocardial infarction [MI], and stroke) in patients with AD. This study was conducted using the UK Clinical Practice Research Datalink and Hospital Episode Statistics (HES) databases. The study cohort consisted of AD patients ≥65 years of age. The case groups included all AD subjects in the database who had a bleeding or ischemic event during the cohort follow-up. Four controls were selected for each case. Patients were classified as current users or past users based on a 60-day threshold of consuming the drug. Simple and multivariable conditional logistic regression analyses were used to calculate the adjusted odds ratio for bleeding events and cardiovascular events. Results: We identified 507 cases and selected 2028 controls for the bleeding event cohort and 555 cases and 2220 controls for the ischemic event cohort. The adjusted odds ratio (OR) (95% confidence interval [CI]) for the association of AChEI use was 0.93 (0.75 to 1.16) for bleeding events, 2.58 (1.01 to 6.59) for angina, and 1.89 (1.07 to 3.33) for MI. Past users of AChEIs were also at increased risk of stroke (1.51 [1.00 to 2.27]). Discussion: This is the first study assessing the risk of bleeding and cardiovascular events in patients with non-hypertensive AD. Our findings could be of great interest for clinicians and researchers working on AD.

Research paper thumbnail of A Quantifiable Risk Factor for ACL Injury: Applied Mathematics to Model the Posterolateral Tibial Plateau Surface Geometry

Orthopaedic Journal of Sports Medicine, 2021

Background: The mechanism for traumatic ruptures of the native anterior cruciate ligament (ACL) i... more Background: The mechanism for traumatic ruptures of the native anterior cruciate ligament (ACL) is frequently a noncontact injury involving a valgus moment with internal rotation of the tibia. The abnormal rotation and translation of the lateral femoral condyle posteroinferiorly relative to the lateral tibial plateau is thought to be related to the geometry of the tibial plateau. Purpose/Hypothesis: The purpose of the study was to mathematically model the posterior tibial plateau geometry in patients with ACL injuries and compare it with that of matched controls. The hypothesis was that increased convexity and steepness of the posterior aspect of the lateral plateau would subject knees to higher forces, leading to a potentially higher risk of ACL injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We mathematically modeled the posterior curvature of the lateral tibial plateau in 64 patients with ACL injuries and 68 matched controls. Using sagittal magnetic re...

Research paper thumbnail of Could vagus nerve stimulation influence bone remodeling?

Journal of Musculoskeletal & Neuronal Interactions, 2021

Objectives: To investigate the effect of vagus nerve stimulation (VNS) on the bone mineral densit... more Objectives: To investigate the effect of vagus nerve stimulation (VNS) on the bone mineral density (BMD) in epileptic patients. Methods: A prospective cohort study was conducted on individuals with refractory seizures who underwent VNS surgery between January 2012 and December 2018. BMD was measured preoperatively and between 6 months and one year after surgery. Results: Twenty-one patients (mean age (±SD)=23.6±12.3 years) were recruited for the implantation of a VNS device. The mean absolute increase in lumbar BMD in the 21 patients was 0.04±0.04 g/cm2 resulting in an overall percent increase from baseline of 4.7±6.1%. BMD increased by an amount ≥ the least significant change (LSC) for the lumbar spine in 13 patients (61.9%). The lumbar Z score also increased in these patients from -1.22±1.15 to -0.88±1.22, P=0.006). Pre and Post VNA femoral BMD was measured in only 11 patients and, of those 3 showed a significant increase in BMD, 1 a significant decrease and 7 no change. Conclusio...

Research paper thumbnail of Microsurgical Fenestration of Intracranial Arachnoid Cysts: Volumetric Analysis and Clinical Outcome

Pediatric Neurosurgery, 2021

Introduction: There is paucity of data regarding change in arachnoid cyst (AC) volume following s... more Introduction: There is paucity of data regarding change in arachnoid cyst (AC) volume following surgery. This study aimed at investigating the clinical outcome of ACs and applying 2 volumetric methods for determination of their volume change post microsurgical fenestration. Methods: Twenty-one ACs in 20 patients that underwent microsurgical fenestration were analyzed using 2 volumetric methods; the modified McDonald equation and the picture archiving and communication (PAC) system-based method. Patients were followed up for 23 ± 40.3 months. Results: The majority of the patients (13 or 65%) were children. Preoperative symptoms in children were mainly seizures and less commonly headache. Of the 20 patients, 12 (60%) had complete resolution of their preoperative symptoms with 8 (40.0%) showing partial improvement. Volumetric studies showed a mean reduction in AC size of 73.7% in children and 64.4% in adults using the PAC system versus 67.9% in children and 70.5% in adults using the mo...

Research paper thumbnail of “3D printed titanium pseudo-prosthesis for the treatment of a tumoral bone defect”

JSES Reviews, Reports, and Techniques, 2021

Abstract Langerhans cell histiocytosis (LCH) is a proliferative disease of histiocytic cells that... more Abstract Langerhans cell histiocytosis (LCH) is a proliferative disease of histiocytic cells that rarely affects adults. Different therapeutic options have been used in the treatment of this condition depending on the severity of the disease. However, the management of LCH is often controversial when a resection with clean margins is not achieved. We present a 37-year-old male who was diagnosed with LCH affecting the middle third of the clavicle. The patient was subjected to a wide resection of the lesion creating a large bone defect. The reconstruction was then performed using a 3-D printed porous pseudo-prosthesis (Ti6AL4V) which was fixed using an anatomical clavicular plate (Depuy-Synthes, Raynham, MA, USA) and locking screws. The implant trabeculae were filled with bioactive bone graft substitute (GlassBONETM, Noraker, France). After two years of follow-up the patient was pain free, had a full range of movement, and scored 100 on the Constant Scale and 2.5 points on the disabilities of the arm, shoulder and hand score (DASH). Moreover, in this case, the implantation of the 3-D printed pseudo-prosthesis avoided the use of adjuvant therapies such as radiotherapy. The use of a 3-D printed pseudo-prosthesis achieved an excellent clinical and functional outcome in the treatment of a large bone defect, following a resection of a LCH of the clavicle. 3-D printed pseudo-prostheses could be useful instruments for the treatment of bone defects following large bone resections in musculoskeletal tumors.

Research paper thumbnail of A Prediction Model for Primary Anterior Cruciate Ligament Injury Using Artificial Intelligence

Orthopaedic Journal of Sports Medicine, 2021

Background: Supervised machine learning models in artificial intelligence (AI) have been increasi... more Background: Supervised machine learning models in artificial intelligence (AI) have been increasingly used to predict different types of events. However, their use in orthopaedic surgery has been limited. Hypothesis: It was hypothesized that supervised learning techniques could be used to build a mathematical model to predict primary anterior cruciate ligament (ACL) injuries using a set of morphological features of the knee. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 50 adults who had undergone primary ACL reconstruction between 2008 and 2015. All patients were between 18 and 40 years of age at the time of surgery. Patients with a previous ACL injury, multiligament knee injury, previous ACL reconstruction, history of ACL revision surgery, complete meniscectomy, infection, missing data, and associated fracture were excluded. We also identified 50 sex-matched controls who had not sustained an ACL injury. For all participants, we used the preopera...

Research paper thumbnail of Non-union and use of proton pump inhibitors in the treatment of femoral and tibial shaft fractures: a nested case–control study

European Journal of Orthopaedic Surgery & Traumatology, 2021

Proton pump inhibitors (PPIs) are one of the most frequently used drugs worldwide. Previous resea... more Proton pump inhibitors (PPIs) are one of the most frequently used drugs worldwide. Previous research has shown that they could increase the risk of fracture and interfere with the fracture healing process. In this study, we analyzed the effect of PPIs on the risk of fracture non-union in patients with femoral and tibial shaft fractures. A case–control study was conducted at our institution, including a total of 254 patients who underwent fixation surgery for a femoral or tibial shaft fracture between January 2012 and December 2017. We defined cases as patients who experienced a delayed union (case group A; n = 44), or non-union (cases group B; n = 12). Cases were matched by age, sex, and fractured bone, to 144 controls who did not experience delayed fracture union and did not require further procedures. A conditional logistic regression analysis was performed adjusted to potential confounders, and to the proportion of days covered (PDC) with PPIs. Adjusted ORs (95% CI) for undergoing a nail dynamization following a tibial or femoral shaft fracture were 1.38 (0.70–2.65) for any use PPIs. Patients with a longer PPI treatment courses (PDC ≥ 0.5) had an adjusted OR of 1.86 (0.70–4.76) for undergoing nail dynamization when compared with controls. Contrastingly, patients with a PDC < 0.5 had an adjusted OR of 1.03 (0.43–2.48). The adjusted OR (95% CI) for undergoing additional surgical procedures due to non-union was 4.5 (0.62–32.8) for any use of PPIs, and 12.3 (1.9–81.0) in patients with a PDC ≥ 0.5. A prolonged use of PPIs use was associated with a higher risk of fracture non-union in tibial and femoral shaft fractures.

Research paper thumbnail of Improving the regenerative microenvironment during tendon healing by using nanostructured fibrin/agarose-based hydrogels in a rat Achilles tendon injury model

The Bone & Joint Journal, 2020

Aims Achilles tendon injuries are a frequent problem in orthopaedic surgery due to their limited ... more Aims Achilles tendon injuries are a frequent problem in orthopaedic surgery due to their limited healing capacity and the controversy surrounding surgical treatment. In recent years, tissue engineering research has focused on the development of biomaterials to improve this healing process. The aim of this study was to analyze the effect of tendon augmentation with a nanostructured fibrin-agarose hydrogel (NFAH) or genipin cross-linked nanostructured fibrin-agarose hydrogel (GP-NFAH), on the healing process of the Achilles tendon in rats. Methods NFAH, GP-NFAH, and MatriDerm (control) scaffolds were generated (five in each group). A biomechanical and cell-biomaterial-interaction characterization of these biomaterials was then performed: Live/Dead Cell Viability Assay, water-soluble tetrazolium salt-1 (WST-1) assay, and DNA-released after 48 hours. Additionally, a complete section of the left Achilles tendon was made in 24 Wistar rats. Animals were separated into four treatment groups...

Research paper thumbnail of Lateral Meniscus Height and ACL Reconstruction Failure: A Nested Case–Control Study

The Journal of Knee Surgery, 2021

Previous work has shown that the morphology of the knee joint is associated with the risk of prim... more Previous work has shown that the morphology of the knee joint is associated with the risk of primary anterior cruciate ligament (ACL) injury. The objective of this study is to analyze the effect of the meniscal height, anteroposterior distance of the lateral tibial plateau, and other morphological features of the knee joint on risk of ACL reconstruction failure. A nested case–control study was conducted on patients who underwent an ACL reconstruction surgery during the period between 2008 and 2015. Cases were individuals who failed surgery during the study period. Controls were patients who underwent primary ACL reconstruction surgery successfully during the study period. They were matched by age (±2 years), gender, surgeon, and follow-up time (±1 year). A morphological analysis of the knees was then performed using the preoperative magnetic resonance imaging scans. The anteroposterior distance of the medial and lateral tibial plateaus was measured on the T2 axial cuts. The nonweigh...

Research paper thumbnail of Altered topological blueprint of trabecular bone associates with skeletal pathology in humans

Bone Reports, 2020

Bone is a hierarchically organized biological material, and its strength is usually attributed to... more Bone is a hierarchically organized biological material, and its strength is usually attributed to overt factors such as mass, density, and composition. Here we investigate a covert factor-the topological blueprint, or the network organization pattern of trabecular bone. This generally conserved metric of an edge-and-node simplified presentation of trabecular bone relates to the average coordination/valence of nodes and the equiangular 3D offset of trabeculae emanating from these nodes. We compare the topological blueprint of trabecular bone in presumably normal, fractured osteoporotic, and osteoarthritic samples (all from human femoral head, cross-sectional study). We show that bone topology is altered similarly in both fragility fracture and in joint degeneration. Decoupled from the morphological descriptors, the topological blueprint subjected to simulated loading associates with an abnormal distribution of strain, local stress concentrations and lower resistance to the standardized load in pathological samples, in comparison with normal samples. These topological effects show no correlation with classic morphological descriptors of trabecular bone. The negative effect of the altered topological blueprint may, or may not, be partly compensated for by the morphological parameters. Thus, naturally occurring optimization of trabecular topology, or a lack thereof in skeletal disease, might be an additional, previously unaccounted for, contributor to the biomechanical performance of bone, and might be considered as a factor in the lifelong pathophysiological trajectory of common bone ailments.

Research paper thumbnail of Composition and characteristics of trabecular bone in osteoporosis and osteoarthritis

Bone, 2020

BACKGROUND Bone strength depends on multiple factors such as bone density, architecture and compo... more BACKGROUND Bone strength depends on multiple factors such as bone density, architecture and composition turnover. However, the role these factors play in osteoporotic fractures is not well understood. PURPOSE The aim of this study was to analyze trabecular bone architecture, and its crystal and organic composition in humas, by comparing samples taken from patients who had a hip fracture (HF) and individuals with hip osteoarthritis (HOA). METHODS The study included 31 HF patients and 42 cases of HOA who underwent joint replacement surgery between 1/1/2013-31/12/2013. Trabecular bone samples were collected from the femoral heads and analyzed using a dual-energy X-ray absorptiometry, micro-CT, and solid-state high-resolution magic-angle-spinning nuclear magnetic resonance (MAS-NMR) spectroscopy. RESULTS No differences in proton or phosphorus concentration were found between the two groups using 1H single pulse, 31P single pulse, 31P single pulse with proton decoupling NMR spectroscopy, in hydroxyapatite (HA) c-axis or a-axis crystal length. Bone volume fraction (BV/TV), trabecular number (Tb.N), and bone mineral density (BMD) were higher in the HO group than in the HF group [28.6% ± 10.5 vs 20.3% ± 6.6 (p=0.026); ); 2.58 mm-1 ± 1.57 vs 1.5 mm-1 ± 0.79 (p=0.005); and 0.39 g/cm2 ± 0.10 vs. 0.28 g/cm2 ± 0.05 (p=0.002), respectively]. The trabecular separation (Tp.Sp) was lower in the HO group 0.42 mm ± 0.23 compared with the HF group 0.58 mm ± 0.27 (p=0.036). In the HO group, BMD was correlated with BV/TV (r=0.704, p<0.001), BMC (r=0.853, p<0.001), Tb.N (r=0.653, p<0.001), Tb.Sp (-0.561, p<0.001) and 1H concentration (-0.580, p<0.001) in the HO group. BMD was not correlated with BV/TV, Tb.Sp, Tb.Th, Tb.N, Tb.PF, 1H concentration or HA crystal size in the HF group. CONCLUSIONS Patients with HO who did not sustain previous hip fractures had a higher femoral head BMD, BV/TV, and Tb.N than HF patients. In HO patients, BMD was positively correlated with the BV/TV and Tb.N and negatively correlated with the femoral head organic content and trabecular separation. Interestingly, these correlations were not found in HF patients with relatively lower bone densities. Therefore, osteoporotic patients with similar low bone densities could have significant microstructural differences. No differences were found between the two groups at a HA crystal level.

Research paper thumbnail of Influence of dementia and Alzheimer’s disease over the dislocation of hip hemiarthroplasty

Research paper thumbnail of Fracture liaison service and mortality in elderly hip fracture patients: a prospective cohort study

Osteoporosis International, 2019

Osteoporosis is a metabolic disorder that results in increased bone fragility and risk of fractur... more Osteoporosis is a metabolic disorder that results in increased bone fragility and risk of fractures. Hip fracture is the most important fragility fracture. Fracture Liaison Service (FLS) is a secondary prevention model which identifies patients at risk for fragility fractures. The introduction of an intensive FLS model could decrease 1-year-mortality of hip fracture patients. Introduction Hip fractures are a clinical manifestation of osteoporosis, and these patients are at risk of premature death and suffering subsequent fractures. FLS is an approach for secondary facture prevention by identifying patients with fragility fractures and initiating the appropriate treatment. Our objective is to analyze the effect of the FLS model over the first-year mortality rates following a hip fracture. Methods We conducted a prospective cohort study on patients over 60 years of age who suffered a hip fracture during two consecutive years, before and after the implementation of the FLS in our center (i.e., between January 2016 and December 2017). Patients' information was withdrawn from our local computerized database. Patients were followed for 1 year after the hip fracture. Mortality and re-fracture rates were compared between the two groups using a multivariate Cox proportional hazard model. Results A total of 724 individuals were included in this study (i.e., 357 before FLS implementation and 367 after FLS implementation). Anti-osteoporotic drugs were more frequently prescribed after FLS implementation [275 (74.9%) vs 44 (12.3%); p < 0.01]. A total of 74 (20.2%) patients after FLS implementation and 92 (25.8%) individuals before FLS implementation (p = 0.07) died during the follow-up period. A second fracture occurred in 17 (4.6%) patients after FLS implementation and 13 (3.6%) individuals before FLS implementation (p = 0.50). Patients who were treated with anti-osteoporotic drugs after the implementation of the FLS protocol had a lower 1-year mortality compared with patients managed before the implementation of the FLS protocol (treated or not treated with anti-osteoporotic drugs) [adjusted hazard ratio (HR) 0.66; 95% confidence interval (CI) 0.47-0.94; p < 0.05]. Conclusions We did not observe significant 1-year-mortality differences following a hip fracture between patients treated before the implementation of an FLS protocol and patients treated after its implementation. The application of the FLS did not affect the risk of suffering a second osteoporotic fracture. However, patients treated with anti-osteoporotic drugs in an FLS context had a lower mortality rate compared with patients managed before the implementation of the FLS.

Research paper thumbnail of Obesity and Meniscal Transplant Failure: A Retrospective Cohort Study

The Journal of Knee Surgery, 2019

The purpose of this study was to analyze the effect of obesity and other clinical factors on the ... more The purpose of this study was to analyze the effect of obesity and other clinical factors on the outcome of meniscal allograft transplantation (MAT) with transosseous fixation. A retrospective cohort study was performed on patients who underwent a MAT between 2002 and 2017. All the participants had a minimum follow-up period of 24 months. The variables assessed were age at the time of the transplant, side, sex, transplanted meniscus (lateral/medial), body mass index (BMI), smoking status, and previous surgeries. Lysholm, Tegner, and International Knee Documentation Committee (IKDC) test outcomes, and patient satisfaction were recorded. Image assessment was performed using plain standing X-rays and a follow-up magnetic resonance imaging scan. Thirty-five patients fulfilled the inclusion criteria. The mean follow-up time was of 75.7 standard deviation (SD) 43.4 months. Patients with a BMI ≥ 30 underwent medial meniscal transplants (88.9 vs. 42.3%, p = 0.022, respectively) more frequen...

Research paper thumbnail of Proximal Femoral Nail Antirotation (PFNA) length and postoperative complications: a retrospective cohort study

ACTUALIDAD MEDICA, 2019

©2019. Actual. Med. Todos los derechos reservados postoperatorias? Resumen que el tamaño de estos... more ©2019. Actual. Med. Todos los derechos reservados postoperatorias? Resumen que el tamaño de estos clavos influye en las complicaciones postoperatorias.

Research paper thumbnail of Anterolateral Ligament Injury in Knee Dislocations

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2018

The purpose of this study is to describe the prevalence and associated factors of anterolateral l... more The purpose of this study is to describe the prevalence and associated factors of anterolateral ligament (ALL) injury in knee dislocation (KD). Methods: A retrospective review of charts and radiological images was done for patients who underwent multiligamentous knee reconstruction surgery for KD in the authors' institution from May 2008 to December 2016. The inclusion criteria were both genders, skeletally mature, and first dislocation. Previous anterior cruciate ligament injury or surgery were the exclusion criteria. Magnetic resonance imaging was used to describe the ALL injury. The association of ALL injury with other variables related to the injury and the patient's background features was examined. Results: Forty-eight patients (49 knees) were included. The mean age of the patients was 32.3 AE 10.6 years. High-energy trauma was the mechanism of dislocation in 28 (57.1%) knees. Thirty-one knees (63.3%) were classified as KD type IV. Forty-five (91.8%) knees had a complete ALL injury, and 3 (6.1%) knees had incomplete ALL injury. Forty (81.6%) knees had a complete ALL injury at the proximal fibers of the ALL, while 23 (46.9%) knees had complete distal ALL injury. None of the 46 (93.9%) knees with lateral collateral ligament injury had normal proximal ALL fibers (P ¼ .012). Injury to the distal fibers of the ALL, as well as overall ALL injury, was not associated with any other variables (P > .05). Moreover, all patients with associated tibial plateau fractures (9; 18.4%) had abnormality of the proximal fibers of the ALL (P ¼ .033). Conclusions: ALL injury is highly prevalent among dislocated knees. Most of the injuries are of high grade and involve the proximal, suprameniscal, fibers of the ligament. Level of Evidence: Level IV, retrospective case series with no comparison group.

Research paper thumbnail of Propranolol enhances bone healing and implant osseointegration in rats tibiae

Journal of Clinical Periodontology, 2016

Propranolol, a non-selective β-blocker widely used to treat cardiovascular conditions, favours bo... more Propranolol, a non-selective β-blocker widely used to treat cardiovascular conditions, favours bone accrual. Accordingly, we hypothesized that propranolol could be useful for improving bone healing and osseointegration. This in vivo study was designed to investigate the effect of propranolol on bone healing and osseointegration in rats&amp;amp;amp;amp;amp;amp;amp;amp;#39; tibiae. On 24 Sprague-Dawley rats, a unicortical defect was created in the right tibial metaphysis of each rat and a custom-made titanium implant was placed in the left tibia. Animals were then assigned into two groups (n = 12, each group) and treated daily with either propranolol (5 mg/kg: subcutaneous) or saline, for 2 weeks. Then, after killing, the volume of the cortical defects (mm3) and the percentages of newly formed bone in the defects, were assessed with microcomputed tomography; bone-implant contact percentage and peri-implant bone volume/tissue volume were assessed by histomorphometry. Propranolol-treated rats presented smaller cortical defects (1.56 ± 0.28 mm(3) versus 2.04 ± 0.29 mm(3) , p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) with more bone volume/tissue volume (60.6 ± 7.9% versus 41.1 ± 10.2%, p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) compared to saline-treated rats. Propranolol also enhanced osseointegration as propranolol-treated rats presented higher bone-implant-contact (65.0 ± 13.1% versus 42.5 ± 8.8%, p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and peri-implant bone volume/Tissue volume (73.8 ± 10.1% versus 56.9 ± 5.7%, p = 0.007) than saline-treated rats. Propranolol enhanced bone healing and implant osseointegration.

Research paper thumbnail of Systemic administration of omeprazole interferes with bone healing and implant osseointegration: an in vivo study on rat tibiae

Journal of Clinical Periodontology, 2016

Background: Proton pump inhibitors, over-the-counter drugs taken by millions of patients, diminis... more Background: Proton pump inhibitors, over-the-counter drugs taken by millions of patients, diminish bone accrual. Accordingly, we hypothesized that these drugs could impair bone healing and implant osseointegration. This study investigated the effect of post-operative systemic administration of omeprazole on bone healing and implant osseointegration in rat tibiae. Methods: In 24 Sprague-Dawley rats, a titanium implant was placed in the left tibia, and a bone defect was created in the right tibia. During the 2 weeks following surgery, 12 rats were treated with omeprazole (5 mg/kg, daily) and the other 12 with saline. Then, after euthanasia, the volume (mm 3) of the cortical defect and the percentages of newly formed bone in the defect, were assessed using microcomputed tomography; peri-implant bone volume/tissue volume and boneimplant contact percentage were assessed by histomorphometry. Results: Omeprazole-treated rats presented larger cortical defects (2.75 AE 0.59 mm 3 , p = 0.003 versus 2.11 AE 0.36 mm 3 ; p = 0.002) and a lower percentage of newly formed bone in the defects (28.62 AE 13.12; 45.89 AE 9.73; p = 0.003) than controls. Omeprazole-treated rats presented lower peri-implant bone volume/tissue volume (14.3 AE 7.3% versus 30.8 AE 11.0%; p < 0.001) and bone-implant contact (23.3 AE 10.8% versus 41.8 AE 13.3%; p < 0.001) than controls. Conclusion: Systemically administered omeprazole impairs bone healing and implant osseointegration.

Research paper thumbnail of Proton Pump Inhibitors and the Risk of Early Aseptic Loosening in Hip and Knee Arthroplasty

Geriatric Orthopaedic Surgery & Rehabilitation, 2022

Research paper thumbnail of Addendum: Effect of acetylcholinesterase inhibitors on post-surgical complications and mortality following a hip fracture: a cohort study

Journal of Musculoskeletal & Neuronal Interactions, Jun 1, 2017

Research paper thumbnail of Acetylcholinesterase inhibitors and risk of bleeding and acute ischemic events in non‐hypertensive Alzheimer's patients

Alzheimer's & Dementia: Translational Research & Clinical Interventions, 2021

Introduction: Acetylcholinesterase inhibitors (AChEIs) are commonly used to treat mild to moderat... more Introduction: Acetylcholinesterase inhibitors (AChEIs) are commonly used to treat mild to moderate cases of Alzheimer disease (AD). To the best of our knowledge, there has been no study estimating the risk of bleeding and cardiovascular events in patients with non-hypertensive AD. Therefore, this study aimed to estimate the association between AChEIs and the risk of bleeding and cardiovascular ischemic events in patients with non-hypertensive AD. Methods: A nested case-control study was conducted to estimate the risk of bleeding and ischemic events (angina, myocardial infarction [MI], and stroke) in patients with AD. This study was conducted using the UK Clinical Practice Research Datalink and Hospital Episode Statistics (HES) databases. The study cohort consisted of AD patients ≥65 years of age. The case groups included all AD subjects in the database who had a bleeding or ischemic event during the cohort follow-up. Four controls were selected for each case. Patients were classified as current users or past users based on a 60-day threshold of consuming the drug. Simple and multivariable conditional logistic regression analyses were used to calculate the adjusted odds ratio for bleeding events and cardiovascular events. Results: We identified 507 cases and selected 2028 controls for the bleeding event cohort and 555 cases and 2220 controls for the ischemic event cohort. The adjusted odds ratio (OR) (95% confidence interval [CI]) for the association of AChEI use was 0.93 (0.75 to 1.16) for bleeding events, 2.58 (1.01 to 6.59) for angina, and 1.89 (1.07 to 3.33) for MI. Past users of AChEIs were also at increased risk of stroke (1.51 [1.00 to 2.27]). Discussion: This is the first study assessing the risk of bleeding and cardiovascular events in patients with non-hypertensive AD. Our findings could be of great interest for clinicians and researchers working on AD.

Research paper thumbnail of A Quantifiable Risk Factor for ACL Injury: Applied Mathematics to Model the Posterolateral Tibial Plateau Surface Geometry

Orthopaedic Journal of Sports Medicine, 2021

Background: The mechanism for traumatic ruptures of the native anterior cruciate ligament (ACL) i... more Background: The mechanism for traumatic ruptures of the native anterior cruciate ligament (ACL) is frequently a noncontact injury involving a valgus moment with internal rotation of the tibia. The abnormal rotation and translation of the lateral femoral condyle posteroinferiorly relative to the lateral tibial plateau is thought to be related to the geometry of the tibial plateau. Purpose/Hypothesis: The purpose of the study was to mathematically model the posterior tibial plateau geometry in patients with ACL injuries and compare it with that of matched controls. The hypothesis was that increased convexity and steepness of the posterior aspect of the lateral plateau would subject knees to higher forces, leading to a potentially higher risk of ACL injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We mathematically modeled the posterior curvature of the lateral tibial plateau in 64 patients with ACL injuries and 68 matched controls. Using sagittal magnetic re...

Research paper thumbnail of Could vagus nerve stimulation influence bone remodeling?

Journal of Musculoskeletal & Neuronal Interactions, 2021

Objectives: To investigate the effect of vagus nerve stimulation (VNS) on the bone mineral densit... more Objectives: To investigate the effect of vagus nerve stimulation (VNS) on the bone mineral density (BMD) in epileptic patients. Methods: A prospective cohort study was conducted on individuals with refractory seizures who underwent VNS surgery between January 2012 and December 2018. BMD was measured preoperatively and between 6 months and one year after surgery. Results: Twenty-one patients (mean age (±SD)=23.6±12.3 years) were recruited for the implantation of a VNS device. The mean absolute increase in lumbar BMD in the 21 patients was 0.04±0.04 g/cm2 resulting in an overall percent increase from baseline of 4.7±6.1%. BMD increased by an amount ≥ the least significant change (LSC) for the lumbar spine in 13 patients (61.9%). The lumbar Z score also increased in these patients from -1.22±1.15 to -0.88±1.22, P=0.006). Pre and Post VNA femoral BMD was measured in only 11 patients and, of those 3 showed a significant increase in BMD, 1 a significant decrease and 7 no change. Conclusio...

Research paper thumbnail of Microsurgical Fenestration of Intracranial Arachnoid Cysts: Volumetric Analysis and Clinical Outcome

Pediatric Neurosurgery, 2021

Introduction: There is paucity of data regarding change in arachnoid cyst (AC) volume following s... more Introduction: There is paucity of data regarding change in arachnoid cyst (AC) volume following surgery. This study aimed at investigating the clinical outcome of ACs and applying 2 volumetric methods for determination of their volume change post microsurgical fenestration. Methods: Twenty-one ACs in 20 patients that underwent microsurgical fenestration were analyzed using 2 volumetric methods; the modified McDonald equation and the picture archiving and communication (PAC) system-based method. Patients were followed up for 23 ± 40.3 months. Results: The majority of the patients (13 or 65%) were children. Preoperative symptoms in children were mainly seizures and less commonly headache. Of the 20 patients, 12 (60%) had complete resolution of their preoperative symptoms with 8 (40.0%) showing partial improvement. Volumetric studies showed a mean reduction in AC size of 73.7% in children and 64.4% in adults using the PAC system versus 67.9% in children and 70.5% in adults using the mo...

Research paper thumbnail of “3D printed titanium pseudo-prosthesis for the treatment of a tumoral bone defect”

JSES Reviews, Reports, and Techniques, 2021

Abstract Langerhans cell histiocytosis (LCH) is a proliferative disease of histiocytic cells that... more Abstract Langerhans cell histiocytosis (LCH) is a proliferative disease of histiocytic cells that rarely affects adults. Different therapeutic options have been used in the treatment of this condition depending on the severity of the disease. However, the management of LCH is often controversial when a resection with clean margins is not achieved. We present a 37-year-old male who was diagnosed with LCH affecting the middle third of the clavicle. The patient was subjected to a wide resection of the lesion creating a large bone defect. The reconstruction was then performed using a 3-D printed porous pseudo-prosthesis (Ti6AL4V) which was fixed using an anatomical clavicular plate (Depuy-Synthes, Raynham, MA, USA) and locking screws. The implant trabeculae were filled with bioactive bone graft substitute (GlassBONETM, Noraker, France). After two years of follow-up the patient was pain free, had a full range of movement, and scored 100 on the Constant Scale and 2.5 points on the disabilities of the arm, shoulder and hand score (DASH). Moreover, in this case, the implantation of the 3-D printed pseudo-prosthesis avoided the use of adjuvant therapies such as radiotherapy. The use of a 3-D printed pseudo-prosthesis achieved an excellent clinical and functional outcome in the treatment of a large bone defect, following a resection of a LCH of the clavicle. 3-D printed pseudo-prostheses could be useful instruments for the treatment of bone defects following large bone resections in musculoskeletal tumors.

Research paper thumbnail of A Prediction Model for Primary Anterior Cruciate Ligament Injury Using Artificial Intelligence

Orthopaedic Journal of Sports Medicine, 2021

Background: Supervised machine learning models in artificial intelligence (AI) have been increasi... more Background: Supervised machine learning models in artificial intelligence (AI) have been increasingly used to predict different types of events. However, their use in orthopaedic surgery has been limited. Hypothesis: It was hypothesized that supervised learning techniques could be used to build a mathematical model to predict primary anterior cruciate ligament (ACL) injuries using a set of morphological features of the knee. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 50 adults who had undergone primary ACL reconstruction between 2008 and 2015. All patients were between 18 and 40 years of age at the time of surgery. Patients with a previous ACL injury, multiligament knee injury, previous ACL reconstruction, history of ACL revision surgery, complete meniscectomy, infection, missing data, and associated fracture were excluded. We also identified 50 sex-matched controls who had not sustained an ACL injury. For all participants, we used the preopera...

Research paper thumbnail of Non-union and use of proton pump inhibitors in the treatment of femoral and tibial shaft fractures: a nested case–control study

European Journal of Orthopaedic Surgery & Traumatology, 2021

Proton pump inhibitors (PPIs) are one of the most frequently used drugs worldwide. Previous resea... more Proton pump inhibitors (PPIs) are one of the most frequently used drugs worldwide. Previous research has shown that they could increase the risk of fracture and interfere with the fracture healing process. In this study, we analyzed the effect of PPIs on the risk of fracture non-union in patients with femoral and tibial shaft fractures. A case–control study was conducted at our institution, including a total of 254 patients who underwent fixation surgery for a femoral or tibial shaft fracture between January 2012 and December 2017. We defined cases as patients who experienced a delayed union (case group A; n = 44), or non-union (cases group B; n = 12). Cases were matched by age, sex, and fractured bone, to 144 controls who did not experience delayed fracture union and did not require further procedures. A conditional logistic regression analysis was performed adjusted to potential confounders, and to the proportion of days covered (PDC) with PPIs. Adjusted ORs (95% CI) for undergoing a nail dynamization following a tibial or femoral shaft fracture were 1.38 (0.70–2.65) for any use PPIs. Patients with a longer PPI treatment courses (PDC ≥ 0.5) had an adjusted OR of 1.86 (0.70–4.76) for undergoing nail dynamization when compared with controls. Contrastingly, patients with a PDC < 0.5 had an adjusted OR of 1.03 (0.43–2.48). The adjusted OR (95% CI) for undergoing additional surgical procedures due to non-union was 4.5 (0.62–32.8) for any use of PPIs, and 12.3 (1.9–81.0) in patients with a PDC ≥ 0.5. A prolonged use of PPIs use was associated with a higher risk of fracture non-union in tibial and femoral shaft fractures.

Research paper thumbnail of Improving the regenerative microenvironment during tendon healing by using nanostructured fibrin/agarose-based hydrogels in a rat Achilles tendon injury model

The Bone & Joint Journal, 2020

Aims Achilles tendon injuries are a frequent problem in orthopaedic surgery due to their limited ... more Aims Achilles tendon injuries are a frequent problem in orthopaedic surgery due to their limited healing capacity and the controversy surrounding surgical treatment. In recent years, tissue engineering research has focused on the development of biomaterials to improve this healing process. The aim of this study was to analyze the effect of tendon augmentation with a nanostructured fibrin-agarose hydrogel (NFAH) or genipin cross-linked nanostructured fibrin-agarose hydrogel (GP-NFAH), on the healing process of the Achilles tendon in rats. Methods NFAH, GP-NFAH, and MatriDerm (control) scaffolds were generated (five in each group). A biomechanical and cell-biomaterial-interaction characterization of these biomaterials was then performed: Live/Dead Cell Viability Assay, water-soluble tetrazolium salt-1 (WST-1) assay, and DNA-released after 48 hours. Additionally, a complete section of the left Achilles tendon was made in 24 Wistar rats. Animals were separated into four treatment groups...

Research paper thumbnail of Lateral Meniscus Height and ACL Reconstruction Failure: A Nested Case–Control Study

The Journal of Knee Surgery, 2021

Previous work has shown that the morphology of the knee joint is associated with the risk of prim... more Previous work has shown that the morphology of the knee joint is associated with the risk of primary anterior cruciate ligament (ACL) injury. The objective of this study is to analyze the effect of the meniscal height, anteroposterior distance of the lateral tibial plateau, and other morphological features of the knee joint on risk of ACL reconstruction failure. A nested case–control study was conducted on patients who underwent an ACL reconstruction surgery during the period between 2008 and 2015. Cases were individuals who failed surgery during the study period. Controls were patients who underwent primary ACL reconstruction surgery successfully during the study period. They were matched by age (±2 years), gender, surgeon, and follow-up time (±1 year). A morphological analysis of the knees was then performed using the preoperative magnetic resonance imaging scans. The anteroposterior distance of the medial and lateral tibial plateaus was measured on the T2 axial cuts. The nonweigh...

Research paper thumbnail of Altered topological blueprint of trabecular bone associates with skeletal pathology in humans

Bone Reports, 2020

Bone is a hierarchically organized biological material, and its strength is usually attributed to... more Bone is a hierarchically organized biological material, and its strength is usually attributed to overt factors such as mass, density, and composition. Here we investigate a covert factor-the topological blueprint, or the network organization pattern of trabecular bone. This generally conserved metric of an edge-and-node simplified presentation of trabecular bone relates to the average coordination/valence of nodes and the equiangular 3D offset of trabeculae emanating from these nodes. We compare the topological blueprint of trabecular bone in presumably normal, fractured osteoporotic, and osteoarthritic samples (all from human femoral head, cross-sectional study). We show that bone topology is altered similarly in both fragility fracture and in joint degeneration. Decoupled from the morphological descriptors, the topological blueprint subjected to simulated loading associates with an abnormal distribution of strain, local stress concentrations and lower resistance to the standardized load in pathological samples, in comparison with normal samples. These topological effects show no correlation with classic morphological descriptors of trabecular bone. The negative effect of the altered topological blueprint may, or may not, be partly compensated for by the morphological parameters. Thus, naturally occurring optimization of trabecular topology, or a lack thereof in skeletal disease, might be an additional, previously unaccounted for, contributor to the biomechanical performance of bone, and might be considered as a factor in the lifelong pathophysiological trajectory of common bone ailments.

Research paper thumbnail of Composition and characteristics of trabecular bone in osteoporosis and osteoarthritis

Bone, 2020

BACKGROUND Bone strength depends on multiple factors such as bone density, architecture and compo... more BACKGROUND Bone strength depends on multiple factors such as bone density, architecture and composition turnover. However, the role these factors play in osteoporotic fractures is not well understood. PURPOSE The aim of this study was to analyze trabecular bone architecture, and its crystal and organic composition in humas, by comparing samples taken from patients who had a hip fracture (HF) and individuals with hip osteoarthritis (HOA). METHODS The study included 31 HF patients and 42 cases of HOA who underwent joint replacement surgery between 1/1/2013-31/12/2013. Trabecular bone samples were collected from the femoral heads and analyzed using a dual-energy X-ray absorptiometry, micro-CT, and solid-state high-resolution magic-angle-spinning nuclear magnetic resonance (MAS-NMR) spectroscopy. RESULTS No differences in proton or phosphorus concentration were found between the two groups using 1H single pulse, 31P single pulse, 31P single pulse with proton decoupling NMR spectroscopy, in hydroxyapatite (HA) c-axis or a-axis crystal length. Bone volume fraction (BV/TV), trabecular number (Tb.N), and bone mineral density (BMD) were higher in the HO group than in the HF group [28.6% ± 10.5 vs 20.3% ± 6.6 (p=0.026); ); 2.58 mm-1 ± 1.57 vs 1.5 mm-1 ± 0.79 (p=0.005); and 0.39 g/cm2 ± 0.10 vs. 0.28 g/cm2 ± 0.05 (p=0.002), respectively]. The trabecular separation (Tp.Sp) was lower in the HO group 0.42 mm ± 0.23 compared with the HF group 0.58 mm ± 0.27 (p=0.036). In the HO group, BMD was correlated with BV/TV (r=0.704, p<0.001), BMC (r=0.853, p<0.001), Tb.N (r=0.653, p<0.001), Tb.Sp (-0.561, p<0.001) and 1H concentration (-0.580, p<0.001) in the HO group. BMD was not correlated with BV/TV, Tb.Sp, Tb.Th, Tb.N, Tb.PF, 1H concentration or HA crystal size in the HF group. CONCLUSIONS Patients with HO who did not sustain previous hip fractures had a higher femoral head BMD, BV/TV, and Tb.N than HF patients. In HO patients, BMD was positively correlated with the BV/TV and Tb.N and negatively correlated with the femoral head organic content and trabecular separation. Interestingly, these correlations were not found in HF patients with relatively lower bone densities. Therefore, osteoporotic patients with similar low bone densities could have significant microstructural differences. No differences were found between the two groups at a HA crystal level.

Research paper thumbnail of Influence of dementia and Alzheimer’s disease over the dislocation of hip hemiarthroplasty

Research paper thumbnail of Fracture liaison service and mortality in elderly hip fracture patients: a prospective cohort study

Osteoporosis International, 2019

Osteoporosis is a metabolic disorder that results in increased bone fragility and risk of fractur... more Osteoporosis is a metabolic disorder that results in increased bone fragility and risk of fractures. Hip fracture is the most important fragility fracture. Fracture Liaison Service (FLS) is a secondary prevention model which identifies patients at risk for fragility fractures. The introduction of an intensive FLS model could decrease 1-year-mortality of hip fracture patients. Introduction Hip fractures are a clinical manifestation of osteoporosis, and these patients are at risk of premature death and suffering subsequent fractures. FLS is an approach for secondary facture prevention by identifying patients with fragility fractures and initiating the appropriate treatment. Our objective is to analyze the effect of the FLS model over the first-year mortality rates following a hip fracture. Methods We conducted a prospective cohort study on patients over 60 years of age who suffered a hip fracture during two consecutive years, before and after the implementation of the FLS in our center (i.e., between January 2016 and December 2017). Patients' information was withdrawn from our local computerized database. Patients were followed for 1 year after the hip fracture. Mortality and re-fracture rates were compared between the two groups using a multivariate Cox proportional hazard model. Results A total of 724 individuals were included in this study (i.e., 357 before FLS implementation and 367 after FLS implementation). Anti-osteoporotic drugs were more frequently prescribed after FLS implementation [275 (74.9%) vs 44 (12.3%); p < 0.01]. A total of 74 (20.2%) patients after FLS implementation and 92 (25.8%) individuals before FLS implementation (p = 0.07) died during the follow-up period. A second fracture occurred in 17 (4.6%) patients after FLS implementation and 13 (3.6%) individuals before FLS implementation (p = 0.50). Patients who were treated with anti-osteoporotic drugs after the implementation of the FLS protocol had a lower 1-year mortality compared with patients managed before the implementation of the FLS protocol (treated or not treated with anti-osteoporotic drugs) [adjusted hazard ratio (HR) 0.66; 95% confidence interval (CI) 0.47-0.94; p < 0.05]. Conclusions We did not observe significant 1-year-mortality differences following a hip fracture between patients treated before the implementation of an FLS protocol and patients treated after its implementation. The application of the FLS did not affect the risk of suffering a second osteoporotic fracture. However, patients treated with anti-osteoporotic drugs in an FLS context had a lower mortality rate compared with patients managed before the implementation of the FLS.

Research paper thumbnail of Obesity and Meniscal Transplant Failure: A Retrospective Cohort Study

The Journal of Knee Surgery, 2019

The purpose of this study was to analyze the effect of obesity and other clinical factors on the ... more The purpose of this study was to analyze the effect of obesity and other clinical factors on the outcome of meniscal allograft transplantation (MAT) with transosseous fixation. A retrospective cohort study was performed on patients who underwent a MAT between 2002 and 2017. All the participants had a minimum follow-up period of 24 months. The variables assessed were age at the time of the transplant, side, sex, transplanted meniscus (lateral/medial), body mass index (BMI), smoking status, and previous surgeries. Lysholm, Tegner, and International Knee Documentation Committee (IKDC) test outcomes, and patient satisfaction were recorded. Image assessment was performed using plain standing X-rays and a follow-up magnetic resonance imaging scan. Thirty-five patients fulfilled the inclusion criteria. The mean follow-up time was of 75.7 standard deviation (SD) 43.4 months. Patients with a BMI ≥ 30 underwent medial meniscal transplants (88.9 vs. 42.3%, p = 0.022, respectively) more frequen...

Research paper thumbnail of Proximal Femoral Nail Antirotation (PFNA) length and postoperative complications: a retrospective cohort study

ACTUALIDAD MEDICA, 2019

©2019. Actual. Med. Todos los derechos reservados postoperatorias? Resumen que el tamaño de estos... more ©2019. Actual. Med. Todos los derechos reservados postoperatorias? Resumen que el tamaño de estos clavos influye en las complicaciones postoperatorias.

Research paper thumbnail of Anterolateral Ligament Injury in Knee Dislocations

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2018

The purpose of this study is to describe the prevalence and associated factors of anterolateral l... more The purpose of this study is to describe the prevalence and associated factors of anterolateral ligament (ALL) injury in knee dislocation (KD). Methods: A retrospective review of charts and radiological images was done for patients who underwent multiligamentous knee reconstruction surgery for KD in the authors' institution from May 2008 to December 2016. The inclusion criteria were both genders, skeletally mature, and first dislocation. Previous anterior cruciate ligament injury or surgery were the exclusion criteria. Magnetic resonance imaging was used to describe the ALL injury. The association of ALL injury with other variables related to the injury and the patient's background features was examined. Results: Forty-eight patients (49 knees) were included. The mean age of the patients was 32.3 AE 10.6 years. High-energy trauma was the mechanism of dislocation in 28 (57.1%) knees. Thirty-one knees (63.3%) were classified as KD type IV. Forty-five (91.8%) knees had a complete ALL injury, and 3 (6.1%) knees had incomplete ALL injury. Forty (81.6%) knees had a complete ALL injury at the proximal fibers of the ALL, while 23 (46.9%) knees had complete distal ALL injury. None of the 46 (93.9%) knees with lateral collateral ligament injury had normal proximal ALL fibers (P ¼ .012). Injury to the distal fibers of the ALL, as well as overall ALL injury, was not associated with any other variables (P > .05). Moreover, all patients with associated tibial plateau fractures (9; 18.4%) had abnormality of the proximal fibers of the ALL (P ¼ .033). Conclusions: ALL injury is highly prevalent among dislocated knees. Most of the injuries are of high grade and involve the proximal, suprameniscal, fibers of the ligament. Level of Evidence: Level IV, retrospective case series with no comparison group.

Research paper thumbnail of Propranolol enhances bone healing and implant osseointegration in rats tibiae

Journal of Clinical Periodontology, 2016

Propranolol, a non-selective β-blocker widely used to treat cardiovascular conditions, favours bo... more Propranolol, a non-selective β-blocker widely used to treat cardiovascular conditions, favours bone accrual. Accordingly, we hypothesized that propranolol could be useful for improving bone healing and osseointegration. This in vivo study was designed to investigate the effect of propranolol on bone healing and osseointegration in rats&amp;amp;amp;amp;amp;amp;amp;amp;#39; tibiae. On 24 Sprague-Dawley rats, a unicortical defect was created in the right tibial metaphysis of each rat and a custom-made titanium implant was placed in the left tibia. Animals were then assigned into two groups (n = 12, each group) and treated daily with either propranolol (5 mg/kg: subcutaneous) or saline, for 2 weeks. Then, after killing, the volume of the cortical defects (mm3) and the percentages of newly formed bone in the defects, were assessed with microcomputed tomography; bone-implant contact percentage and peri-implant bone volume/tissue volume were assessed by histomorphometry. Propranolol-treated rats presented smaller cortical defects (1.56 ± 0.28 mm(3) versus 2.04 ± 0.29 mm(3) , p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) with more bone volume/tissue volume (60.6 ± 7.9% versus 41.1 ± 10.2%, p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) compared to saline-treated rats. Propranolol also enhanced osseointegration as propranolol-treated rats presented higher bone-implant-contact (65.0 ± 13.1% versus 42.5 ± 8.8%, p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and peri-implant bone volume/Tissue volume (73.8 ± 10.1% versus 56.9 ± 5.7%, p = 0.007) than saline-treated rats. Propranolol enhanced bone healing and implant osseointegration.

Research paper thumbnail of Systemic administration of omeprazole interferes with bone healing and implant osseointegration: an in vivo study on rat tibiae

Journal of Clinical Periodontology, 2016

Background: Proton pump inhibitors, over-the-counter drugs taken by millions of patients, diminis... more Background: Proton pump inhibitors, over-the-counter drugs taken by millions of patients, diminish bone accrual. Accordingly, we hypothesized that these drugs could impair bone healing and implant osseointegration. This study investigated the effect of post-operative systemic administration of omeprazole on bone healing and implant osseointegration in rat tibiae. Methods: In 24 Sprague-Dawley rats, a titanium implant was placed in the left tibia, and a bone defect was created in the right tibia. During the 2 weeks following surgery, 12 rats were treated with omeprazole (5 mg/kg, daily) and the other 12 with saline. Then, after euthanasia, the volume (mm 3) of the cortical defect and the percentages of newly formed bone in the defect, were assessed using microcomputed tomography; peri-implant bone volume/tissue volume and boneimplant contact percentage were assessed by histomorphometry. Results: Omeprazole-treated rats presented larger cortical defects (2.75 AE 0.59 mm 3 , p = 0.003 versus 2.11 AE 0.36 mm 3 ; p = 0.002) and a lower percentage of newly formed bone in the defects (28.62 AE 13.12; 45.89 AE 9.73; p = 0.003) than controls. Omeprazole-treated rats presented lower peri-implant bone volume/tissue volume (14.3 AE 7.3% versus 30.8 AE 11.0%; p < 0.001) and bone-implant contact (23.3 AE 10.8% versus 41.8 AE 13.3%; p < 0.001) than controls. Conclusion: Systemically administered omeprazole impairs bone healing and implant osseointegration.