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Total Knee Arthroplasty versus Mesenchymal Stem Cell Therapy for Moderate Knee Osteoarthritis: An Umbrella Analysis of Clinical Outcomes, Quality of Life, and Safety
(2026-03-31)
Angthong, Chayanin
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Vichayabhai, Tyler
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Tatiya-Apitham, Phurin
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Angthong, Wirana
Background. Moderate knee osteoarthritis (Kellgren-Lawrence [KL] Grade 2-3) represents a critical therapeutic crossroads where patients must choose between regenerative strategies and surgical replacement. This umbrella analysis synthesizes current evidence regarding the clinical efficacy, quality of life, and safety profiles of mesenchymal stem cell (MSC) therapy relative to total knee arthroplasty (TKA). Material and methods. Following PRISMA 2020 guidelines, we systematically searched seven databases (2016-2026). Screening of 1,211 records identified 242 unique papers for full-text assessment. Eligible studies included systematic reviews, meta-analyses, and large prospective cohorts (>50 participants) evaluating intra-articular MSCs or TKA in KL Grade 2-3 populations with ≥12-month follow-up. Results. Our analysis reveals a profound evidence gap: zero studies directly compared MSC therapy to TKA in this population. Data from 30 high-quality studies demonstrate that MSC therapy significantly outperforms placebo and conservative management, yielding VAS pain reductions of 20-40 points and WOMAC functional improvements of 15-35 points at 12-24 months. Adipose-derived MSCs showed superior analgesia, while umbilical cord-derived MSCs optimized functional recovery. MSC therapy significantly reduced the hazard of TKA conversion (HR 0.52, p<0.001). At 36-60 months, conversion rates were 12.4% for MSCs versus 22.7% for control groups. Safety profiles remained favorable with serious adverse event rates <5%.  Conclusions. 1. While MSC therapy is a demonstrably effective bridge for delaying TKA in selected KL Grade 2-3 patients, its comparative effectiveness and long-term durability relative to arthroplasty remain uncharacterized. 2. High-quality randomized controlled trials directly benchmarking MSCs against TKA are urgently required to resolve this clinical impasse and inform treatment algorithms..
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Unlocking the Future of Orthopaedic Imaging: A Comprehensive Update on the Role and Benefits of The Medical Open Network for AI (MONAI)
(2025-12-31)
Angthong, Chayanin
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Angthong, Wirana
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Pongsakonpruttikul, Napat
BACKGROUND: Deep learning (DL) has revolutionized orthopaedic imaging, transitioning from traditional radiomics-based analysis to powerful, data-driven diagnostic and prognostic models. However, a persistent lack of methodological standardization has limited clinical translation. The Medical Open Network for AI (MONAI), an open-source PyTorch-based framework, addresses this gap by providing domain-specific tools optimized for medical imaging. This review evaluates MONAI's role and benefits in orthopaedics across diagnosis, treatment planning, and outcomes prediction. MATERIAL AND METHODS: A comprehensive literature synthesis was conducted, examining studies utilizing MONAI for musculoskeletal imaging. We assessed technical attributes including architecture, data handling, loss functions, and multimodal integration and their applications in fracture detection, disease grading, surgical planning, and prognostic modeling. RESULTS: MONAI demonstrated superior efficiency in handling 3D/4D orthopaedic imaging data and managing class imbalance using specialized medical loss functions (e.g., Dice and Tversky). Diagnostic models achieved near-expert accuracy in fracture detection and quantitative osteoarthritis grading, providing explainable, and reproducible outputs. MONAI enabled automated, high-fidelity 3D reconstruction for personalized implant design and 3D printing integration. Prognostically, it outperformed surgeons in predicting arthroplasty complications, revealing latent imaging biomarkers. The framework's evolution into MONAI Multimodal - with agentic AI and radiomics integration - enhanced personalized, multimodal risk assessment. CONCLUSIONS: 1. MONAI establishes a standardized, transparent infrastructure that accelerates orthopaedic AI research and clinical translation. Its integration of domain-optimized architectures, multimodal data fusion, and explainable AI tools enables accurate diagnosis, individualized surgical planning, and reliable outcome prediction. 2. Adoption of MONAI-based pipelines is strongly recommended to promote reproducibility, regulatory readiness, and clinician trust in next generation of precision orthopaedic care.
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S53P4 Bioactive Glass Granules for the Management of Bone, Joint, and Related Soft-Tissue Infections: An Updated Review
(2025-07-31)
Angthong, Chayanin
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Vichayabhai, Tyler
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Tatiya-Apitham, Phurin
BACKGROUND: Bioactive glass S53P4 has drawn increasing interest for its use in managing chronic osteomyelitis, infected non-unions, and related soft-tissue infections. This review synthesizes clinical evidence with emphasis on comparative studies versus autologous bone grafts, allografts, and antibiotic carriers. MATERIAL AND METHODS: We performed a comprehensive search of PubMed, EMBASE, and Scopus (January 2013 to September 2025) that identified human clinical studies reporting outcomes of S53P4 in bone, joint, and related soft-tissue infections. Search terms combined 'S53P4' OR 'bioactive glass' with 'osteomyelitis', 'bone infection', 'infected non-union', 'joint infection', and 'dead space management'. The data were screened, reviewed, extracted, and analyzed in accordance with the PRISMA guideline. RESULTS: Across heterogeneous cohorts, infection eradication rates typically range from 80-95% with S53P4, bone healing is comparable to autograft, and complication rates are low. Comparative data suggest non-inferior infection control and bone consolidation relative to autograft/antibiotic-polymethylmethacrylate, with potential advantages for one-stage care and reduced length of stay. CONCLUSION: S53P4 bioactive glass provides infection control and bone regeneration outcomes comparable to autograft and selected antibiotic carriers in chronic osteomyelitis and infected non-unions. Its antimicrobial and osteoconductive properties enable effective one-stage treatment in many cases, with a favorable safety profile and potential cost savings. High-quality randomized trials remain limited, but current evidence supports S53P4 as a viable, cost-effective adjunct in orthopedic infection surgery.
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Association of Coronavirus Infection with Higher Mortality Rate and Longer Hospital Stay in Patients with Major Extremity Fractures
(2025-04-30)
Chawla, Ashwin
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Angthong, Chayanin
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Ratta-Apha, Khanatchet
BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has significantly affected healthcare systems, raising concerns about patient outcomes, particularly for those with coexisting conditions. Despite various studies on orthopedic injuries during the COVID-19 pandemic, differences in treatment outcomes remain insufficiently known. This retrospective cohort study investigated the effects of SARS-CoV-2 infection on patients with major extremity fractures requiring surgery. We hypothesized that patients with COVID-19 would experience longer hospital stays (LOS) and higher mortality rates. MATERIAL AND METHODS: Data from 500 patients (mean age 47.1 years; 69.8% male) admitted to our hospital between March 2020 and July 2022 were analyzed. We collected demographic data, COVID-19 test results, fracture-related data, LOS, and mortality-related data. RESULTS: Of the patients, 23 (4.6%) had COVID-19. While overall LOS showed no significant prolongation in patients with COVID-19, a significantly longer LOS was observed for patients with COVID-19 and lower extremity fractures (14.62 vs. 11.39 days, p<0.00001) and upper extremity fractures (11.90 vs. 5.73 days, p=0.0271). CONCLUSIONS: 1. Patients with COVID-19 exhibited a markedly longer LOS than those without COVID-19, with this effect being more pronounced in patients with lower extremity fractures. 2. When all patients had major extremity fractures, patients with COVID-19 had a significantly higher mortality rate than those with out COVID-19.
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Talus Fracture - a Pathomechanical Study Using Finite Element Analysis
(2025-04-30)
Kaewbumrung, Mongkol
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Angthong, Chayanin
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Rajbhandari, Prasit
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Rungrattanawilai, Naruebade
BACKGROUND: The talus is a peculiar bone in the human body that plays a key role in load transfer due to its unique shape and characteristics. Fractures involve challenging treatment and potential complications. We aimed to simulate the talus using real-world data and analyze its biomechanical responses to potential forces that might cause its fracture. MATERIAL AND METHODS: We retrieved a three-dimensional (3D) file of the intact talus, submitted it to a 3D finite element analysis (FEA) using software (ANSYS Mechanical V2023R2), and then set the elastic modulus or Young's modulus values of the talus based on a previous study. To analyze talar fractures, we employed both positive and negative force directions to examine fracture behavior. The talar configurations were 0 , 15, 30, and 45 cases. Force applied in the y-direction compressed the top of the talus. The bottom surface of the talus, subjected to compression, supports the boundary conditions that mimic realistic talus motion mechanics. RESULTS: FEA demonstrated that the neck of the talus exhibited the highest magnitude of total deformation, suggesting susceptibility to crack initiation. A sudden increase in force in the positive direction increased the likelihood of a talar fracture. Stress analysis depicted the maximum equivalent (von Mises) stress on the talus, indicating that the highest stress occurred when the force was applied in the positive direction, particularly at 15 (posterosuperior to the anteroinferior direction). Our analysis underscores that the angle of force is the primary contributor to talar fractures. CONCLUSION: Our 3D FEA study concluded that the talar neck area was the most vulnerable to fracture in the axial force simulation, especially in the 15 force direction. Safety measures should be implemented for people performing risky activities related to axial force injuries.
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Outcomes of Tibiotalocalcaneal Arthrodesis vs Talar Body Prosthesis as Treatment of Collapsed Avascular Necrosis of the Talus: A 10- to 13-Year-Follow-up Retrospective Comparative Study
(2024-05-01)
Harnroongroj, Thos
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Arunakul, Marut
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Reingrittha, Pissanu
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Chuckpaiwong, Bavornrit
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Angthong, Chayanin
Background: Joint salvage surgeries such as tibiotalocalcaneal arthrodesis and talar prosthesis are commonly used in the surgical treatment of collapsed avascular necrosis of the talus (AVNT). However, differences in outcomes of these 2 surgical treatments are still inconclusive. This study compared the 10- to 13-year outcomes and 10-year survivorship rates of tibiotalocalcaneal arthrodesis and talar body prosthesis in the surgical treatment of collapsed AVNT. Methods: A retrospective comparative study was conducted of patients who underwent either tibiotalocalcaneal arthrodesis or talar body prosthesis implantation between 2005 and 2012. The demographic matching process resulted in 24 patients per treatment group. Clinical outcomes were evaluated using a numeric rating scale (NRS) of 2 hours of activities of daily living (ADL) and Foot and Ankle Ability Measure (FAAM) for ADL. Radiographic assessments included the incidence of nonunion, adjacent joint arthritis, and prosthesis loosening. The 10-year survivorship of both surgical treatments was calculated. A P value of less than.05 was considered statistically significant. Results: The median NRS of 2 hours of ADL and FAAM score for ADL were statistically significantly better in the talar body prosthesis group, with P values of.001 and <.001, respectively. The statistically significant differences in FAAM score for ADL exceeded the minimum clinically important difference. In the tibiotalocalcaneal arthrodesis group, nonunion was observed in 7 of 24 patients (29.2%). No prosthesis loosening was reported in the talar body prosthesis group. The 10-year survivorship was statistically significantly higher in talar body prosthesis than tibiotalocalcaneal arthrodesis (95.8% vs 70.8%), P =.023. Conclusion: Talar body prosthesis implantation in selected eligible patients demonstrated statistically significantly better 10- to 13-year clinical outcomes and higher 10-year survivorship compared with tibiotalocalcaneal arthrodesis in the surgical treatment of collapsed AVNT. Level of Evidence: Level III, retrospective cohort comparative study.
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Arthroscopy-assisted Minimally Invasive Tarsometatarsal and Lisfranc Arthrodesis. A Case Series
(2024-04-30)
Angthong, Chayanin
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Rajbhandari, Prasit
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Veljkovic, Andrea
BACKGROUND: First tarsometatarsal arthrodesis is an effective procedure for the correction of hallux valgus deformities. Traditionally, first to third tarsometatarsal and Lisfranc arthrodesis is performed via an open approach. Little is known about the role of combined arthroscopic and minimally invasive techniques. MATERIAL AND METHODS: We present a case series of complicated hallux valgus deformities and other conditions managed using arthroscopically assisted minimally invasive arthrodesis. We first performed a minimally invasive surgical procedure that allowed easy and unhindered access for the introduction of an arthroscopic instrument over the joint surface. RESULTS: The mean Visual Analogue Score - Foot and Ankle and Short Form-36 scores indicated satisfactory and acceptable postoperative outcomes, respectively. The mean patient satisfaction score was 94.44 and the mean follow-up duration was approximately 17.7 months. CONCLUSION: The described procedure has been preliminarily shown to be useful in terms of its minimal invasiveness, reproducibility, safety, and effectiveness.
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Comparative analyses of arthroscopic and open repairs of lateral ligament complex injuries of the ankle: a systematic review and meta-analysis of the medium-term outcomes
(2024-04-01)
Tonsuthanluck, Sora
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Handoyo, Henry Ricardo
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Tharincharoen, Ramita
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Angthong, Chayanin
Purpose: Little is known regarding the comparative analyses of the medium-term outcomes (with a mean minimum follow-up period of 24 months), between arthroscopic and open repairs of lateral ligament complex (LLC) injuries of the ankle. Thus, in this study, we aimed to explore the comparative analyses regarding the medium-term follow-up outcomes of these repairs, by conducting a systematic review and meta-analysis. Methods: The systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; data were extracted from the PubMed and Google Scholar databases. From an initial search, a total of 1182 abstracts (280 and 902 abstracts, from PubMed and Google Scholar, respectively) were found and screened in accordance with the eligibility criteria. Subsequently, six articles were found to be eligible for further review. Results: A total of 419 patients underwent surgical repairs; 205 and 214 patients underwent arthroscopic and open repairs, respectively. The mean minimum follow-up period was 29.2 months. The medium-term follow-up for arthroscopic LLC repairs was found to be superior to that of open LLC repairs, with more favorable outcomes; as evidenced by better clinical scores, lower pooled complication rates, earlier return times to pre-injury sport, and higher early sport ratios. Conclusions: The findings of this systematic review and meta-analysis support near-future developments validating arthroscopic repair as the new gold standard for LLC repairs, similarly to arthroscopic ligament and tendon repairs, as well as arthroscopic reconstruction surgeries, of the knee and shoulder.
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A Novel Update on the Management of Müller-Weiss Disease: Presentation of a Treatment Algorithm
(2024-03-01)
Angthong, Chayanin
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Younger, Alastair S.E.
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Chuckpaiwong, Bavornrit
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Harnroongroj, Thos
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Veljkovic, Andrea
Objective: Müller-Weiss disease (MWD) is a challenging condition involving the perinavicular region in the initial stages and subsequently the entire foot in the later stages. The goal of this article is to describe the pathomechanics, clinical evaluation, and nonoperative and operative treatment, including a treatment algorithm, based on current evidence and the combined authors’ experience. Design: We review the related articles and summarize the information about this condition. Results: A number of related articles reveal that the treatments should focus on the management of degenerative regions and deformity correction to restore normal foot alignment and provide pain relief. Conclusion: This systematic review proposes a treatment algorithm that is comprehensive and practical to apply for the management of MWD.
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Silver Nanoparticle-Based Dressings for Various Wounds: Benefits and Adverse Effects
(2024-01-01)
Phatanodom, Korapin
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Angthong, Chayanin
Introduction: Silver nanoparticles (AgNP) are a novel therapeutic approach to wound dressings because of their antibacterial properties. Silver has been used throughout history for many purposes. However, evidence-based information about the benefits of AgNP-based wound dressings and potential adverse effects is still required. This study is to comprehensively review the benefits and complications of AgNP-based wound dressings for different wound types and address the knowledge gaps. Material and methods: We collected and reviewed the relevant literature from available sources. Results: AgNP-based dressings have antimicrobial activity and promote healing with only minor complications, making them suitable for several types of wounds. However, we could not identify any reports on AgNP-based wound dressings for common acute traumatic wounds, such as lacerations and abrasions; this includes comparative studies of AgNP-based and conventional wound dressings for such wound types. Conclusions: AgNP-based dressings are beneficial in traumatic, cavity, dental, and burn wounds’ treatment with only minor complications. However, further studies are needed to discern their benefits for specific traumatic wound types.

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