Antibiotic impregnated hip spacers are popular nowadays and represents the gold standard for treating periprosthetic joint infection (PJI). Although providing excellent results in resolving infection, antibiotic impregnated hip spacers are subject to risks, including mechanical failure, spacer's dislocation, fracture and periprosthetic femoral fractures. In this review, we reviewed the last 10 years literature to valuate the rate of mechanical failures and complications related to spacers use.
This is a new and an effective video-assisted transthoracic approach easing anterior Vertebral Body Tethering for patients with Adolescent Idiopathic Scoliosis. Herein all of the technical steps are described in detail. The results for the study group are discussed thoroughly in the light of literature. This new approach, which requires simultaneous coordination of the Thoracic and Orthopedic surgeons, will inspire and guide both patients and physicians in the related branches.
INTRODUCTION: In recent years, the exercise prescription has given unequivocal benefits in cancer patients. The purpose of this review is to analyze indications of exercise therapy in the patient with bone metastases, analyzing the benefits, limits and appropriate indications of physical activity according to the individual clinical situation of the patient. EVIDENCE ACQUISITION: The present systematic review was conducted using a thorough database search of PubMed, EMBASE and SCOPUS. Authors independently screened all articles identified concerning exercise therapy in metastatic bone patients, to assess their suitability to the research focus. EVIDENCE SYNTHESIS: Authors included 12 articles as full-text in 19 papers, dated from 2000 to 2018. Among these, 8 were randomized controlled trials, 3 single-arm studies and 1 multi-arm interventional study. Aerobic and/or resistance exercise training was prescribed in all the studies analyzed. The mean follow-up was 10.7 +/- 11.2 (range 1-36) months. Significant benefits were reported in fatigue, pain and physical function with no increasing incidence of pathologic fractures. CONCLUSIONS: Exercise therapy in patients with bone metastases is useful in tackling bone loss, showing anticancer effects and increasing patient's quality of life with very low adverse effects rate (2,2%). The prescription of exercises in this kind of patients can be complex for the possible increasing risk of pathological fractures and pain levels. It is therefore strictly necessary to personalize the exercises according to patient's abilities, skeletal site and type of metastatic lesion.
BACKGROUND: The decision to validate the Cincinnati Knee Rating System (CKRS) comes from the necessity of bringing to Italy a specific measurement tool for knee pathologies that can be used as a diagnostic support in medical and rehabilitation areas. Thus, the aim of this study was to translate and culturally adapt the original CKRS into Italian and evaluate its psychometric properties. METHODS: After receiving permission from the developers of the original instrument, the CKRS was translated using international guidelines. The reliability and validity of the culturally adapted scale were assessed following the "Consensus-Based Standards for the Selection of Health Status Measurement Instruments" (COSMIN) checklist. RESULTS: The included participants were 124, population was evaluated telephonically twice, within 24 hours, from the same rater. The Cronbach's Alpha of the entire scale showed a value of 0.76. The test-retest reliability showed values for Intraclass Correlation Coefficient (ICC)>0.70 for all sub-scales, but also for the total scale (0.85), with values ranging from 0.76-0.91. Construct validity was assessed with Pearson correlation coefficient with the Lhysolm Knee Scoring Scale (LKSS). The analysis showed statistically significant data with the first and second subscale and total score. CONCLUSIONS: The present study gives evidence about the reliability and validity of the CKRS for health professionals and researchers. The results confirm that it could be easily used for research and clinical field. This study should encourage rehabilitators worldwide to validate the test in their own cultural context so that it can become a reference measure in assessing knee diseases.
BACKGROUND: The measurement of postsurgery patellar positioning has been the subject of several studies in literature to confirm the influence of the patella alignment on the outcome of knee replacement procedures, considering that ma-lalignment is one of the possible reasons for failure of the prosthesis itself. However, postoperative assessment does not give an accurate picture of the soft tissue tensions prior to surgery, as these are then masked by the new joint structure. This paper aims to assess whether the alteration of patellar positioning and patellofemoral biomechanics in the preoperative stage may be a prognostic factor for the development of knee rigidity in subjects undergoing total knee arthroplasty (TKA). METHODS: This is a prospective, monocentric and randomized observational study. 36 subjects who underwent total knee arthroplasty were randomly selected from the complete patient list by simple computerized randomization. The radiological condition was evaluated in the preoperative stage (time T0, corresponding to 2 months before surgery) by using the Insall-Salvati Index, the Laurin angle and the Merchant angle to assess the positioning of the patella in relation to the femur-tibia joint and by measuring at the same time the Range of Movement (ROM) during flexion. In the postoperative period we checked the changes in ROM and muscle strength using the MRC Scale at T1 (one week after surgery) and T2 (4 weeks after surgery). RESULTS: The patient sample consisted of 26 females and 10 males. The average age was 74.36 years, with a standard deviation of 6.62 years. We found statistically significant correlations between ROM at T1 and T2 (P value 0.0001), and between ROM at T0 and the Merchant angle (P value 0.086). The correlations between ROM at T0 and T1 (directly proportional), and between ROM at T1 and the Laurin angle (inversely proportional) showed interesting albeit not significant trends. CONCLUSIONS: The influence of preoperative ROM on the postoperative level, endorsed by literature, was not significant in our work; however, given the observed trend, it is possible that the result will show positive changes with an increase of the sample size. The preoperative positioning of the patella does not seem to play an important role on postsurgical outcomes: according to our study, a surgical approach to the patella is justified only in extreme cases; much more important seems to be the control of inflammatory factors in the first postsurgical period.
BACKGROUND: Among the various equilibrium quantification techniques, the evaluation scales still represent the most widespread and useful means to evaluate balance in the clinical field, thanks to the fact they are inexpensive and easy to use. The Berg Balance Scale (BBS) is the most frequently cited scale in the literature to detect balance disorders. The aim of this study was to assess the psychometric properties of the 12-item Berg Balance Scale (BBS-12) in individuals who had undergone hip or knee replacement surgery. METHODS: Included participants were individually evaluated twice within 24 hours by the same rater. Two physiotherapists using various measurement instruments evaluated the participants using the BBS-12, the Tinetti balance assessment scale, the Short Falls Efficacy Scale-International (Short FES-I), and the 12-Item Short Form Survey (SF-12) RESULTS: There were 109 individuals included in this study. The BBS-12 showed an optimal internal consistency with a Cronbach's alpha of 0.923 and an intraclass correlation coefficient (ICC) of 0.99 for both the intrarater and interrater reliabilities. Comparisons of the BBS-12 with the gold standards showed that the BBS-12 was positively correlated with the Short FES-I, the Tinetti balance assessment scale, and the physical health portion of the SF-12. CONCLUSIONS: Our study demonstrated the validity and reliability of the BBS-12 in assessing balance in an Italian population for those with a hip or knee prosthesis. It is now possible to use the BBS-12 as a reliable assessment tool for this population.
The worldwide spread of the 2019 novel Coronavirus (SARS-CoV-19) has profoundly affected the way daily healthcare procedures are performed. Italy had a large number of confirmed cases of Coronavirus disease (COVID-19) and related fatalities. Since the beginning of this pandemic, many changes in routine clinical and surgical activity have been made and are described in this short manuscript.
BACKGROUND: In this study we observed the impact of COVID-19 pandemic during March 2020 in four major trauma centers of north-west Italy: ASST Spedali Civili of Brescia (Lombardy), CTO Hospital of Turin (Piedmont region), Circolo Hospital and Macchi Foundation of Varese (Lombardy) and Niguarda Hospital of Milan (Lombardy). METHODS: This retrospective study was realized analyzing data provided by the four hospitals. We observed the impact of lockdown on orthopedics patients on emergency and accident (E&A) departments access, on outpatient visits and on surgical procedures. RESULTS: During the first month of lockdown 2020 patients were admitted for trauma into the four A&E departments examined, with a mean percentage of hospitalization of 26%. 3755 patients were admitted for outpatient visits. 655 surgical procedures were performed. Pure elective procedures were 10% (the majority in the first week of lockdown) while 90% were urgent procedures. We include in these urgent procedures also ontological and spine procedures and postsurgery complications that needed to be taken in charge such as infections and coverage flaps or skin grafts. CONCLUSIONS: The data from the major trauma centers of north-west Italy showed that even there is an undeniable decrease in orthopedics procedures, there are still a certain number of conditions that must be taken in consideration. Trauma center must be identified and protected and, as several authors suggest, teams of anesthetists, orthopedic surgeons and scrub nurses should be trained to operate on patient affected or suspected of COVID-19 positivity.
BACKGROUND: The aim of the study was to translate the Non-arthritic Hip Score (NAHS) questionnaire into the Italian language, to adapt it into the Italian culture and to validate it. METHODS: Translation and cultural adaptation were performed following international guidelines. To assess the reliability of the tool, internal consistency and test-retest reliability were evaluated through Cronbach's alpha and intraclass correlation coefficient (ICC) respectively. Validity was evaluated by Pearson's correlation coefficient between the NAHS, the Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC), that were administered together. These three questionnaires were applied to a population of 64 individuals aged between 19 and 82 years with generic hip injures or diseases. RESULTS: The items of the original version of NAHS are similar or equal to the items of the Italian version of NAHS. Cronbach's alpha was 0.614 (Pain); 0.821 (Symptom); 0.877 (Function); 0.896 (Activity). ICC for total score was 0.905. The correlation with the WOMAC was 0.850 (P<0.01) and with the LISOH was 0.738 (P<0.01). CONCLUSIONS: The NAHS showed positive results for reliability and validity so it was translated into Italian language and was cross-culturally adapted to Italian culture. This questionnaire is a good instrument in clinical practice and scientific research for the evaluation of young and active individuals affected by hip injures or diseases.
BACKGROUND: This open registry study evaluated improvements in symptoms associated with osteoarthrosis (OA) managed with a standardized liquid supplement (Arborvitae (R), Australia [ABV]). METHODS: Two comparable groups of subjects using standard management (SM) for OA were evaluated: one with SM only and another using SM and supplemented with Arborvitae (R) 100 mL/day for 8 weeks followed by 60 mL/day for 4 weeks. Arborvitae Supplement (R) contains Pycnogenol (R), papain and, as accessory components, Aloe Vera, procyanidins, and honey. SM was an evaluation reference. The aim of this study was the evaluation of the efficacy of Arborvitae (R) supplementation on signs/symptoms, particularly pain while walking and in reducing the need for rescue medications in osteoarthritis patients. RESULTS: The two groups were comparable at inclusion. Sixty subjects completed the study: 30 in the SM group as controls and 30 in the Arborvitae (R) group. No tolerability problems or side effects were observed during the observation period. At 3 months, the walking distance was significantly higher in the ABV group in comparison with the control group (P<0.05). The Karnofsky Scale in the supplemented subjects improved more in the ABV group at 3 months (P<0.05); blood oxidative stress was lower with ABV in comparison with controls (P<0.05). The increased temperature of the knee (measurable by thermography) was decreased more with the supplement (P<0.05) considering the maximum temperature of the area and the average temperature of the skin over the affected knee (P<0.05). The use of rescue medications was significantly lower in the ABV group. CONCLUSIONS: This registry indicates that ABV may be an effective supplementary management in controlling mildmoderate signs/symptoms associated with OA in otherwise healthy subjects.
Olecranon multifragmentary fractures may represent a challenge for orthopedic. They need, indeed, a precise anatomical reconstruction and a stable osteosynthesis allowing an early and fast mobilization to get a good functional elbow recovery. When a bone loss is to be managed, different reconstructive techniques using grafts from iliac crest, neighboring bones or ribs are described. We report the case of a large olecranon bone loss in which a partial navicular not vascularized osteochondral autograft was used to fill the bone gap and to reconstruct the articular surface. At 1 year follow up the fracture healed without graft reabsorption with some elbow stiffness due to some peri-articular calcifications. The patient was therefore subjected to surgery for devices removal and elbow arthrolysis, withdrawing calcifications and interposing in the joint a bank tendon graft; immediately post-op elbow range of motion was quite complete. We believe that a tarsal scaphoid combined osteo-chondral graft can be used in these cases of complex olecranon defects because of its shape that can simulate the articular surface of the olecranon with good results.
BACKGROUND: The aim of the study was to translate and cross-culturally adapt the Copenhagen Hip and Groin Outcome Score (HAGOS) into an Italian version (HAGOS-IT) and evaluate the reliability and validity of the HAGOS-IT in individuals who underwent hip arthroplasty surgery. METHODS: A total of 73 participants were recruited for this study. Internal consistency was evaluated using the Cronbach's alpha to assess the homogeneity between the items. The HAGOS-IT was filled out again by 30 participants to explore test-retest reliability which was evaluated through Intraclass Correlation Coefficient (ICC). Construct validity was analysed by evaluating the correlations between HAGOS-IT and Hip disability and osteoarthritis outcome score (HOOS), as well as Visual Analogue Scale (VAS) using Pearson's correlation coefficient (r). RESULTS: The original version of the HAGOS was cross-culturally adapted and translated into Italian. HAGOS-IT resulted to have excellent reliability (ICC=0.965-0.998, Cronbach's alpha =0.81-0.93). Moderate to substantial correlations were proved between HAGOS-IT subscales and HOOS subscales especially in symptoms (r=0.910), and Quality of Life (r=0.947). There was no correlation between HAGOS-IT and VAS Scale. CONCLUSIONS: HAGOS-IT demonstrated to have a quite good reliability and validity, which could be recommended for Italian patients with hip replacement.
Flattening of acetabular roof in skeletally immature patients has been demonstrated in chronic acetabular rim overload but even short-term triggers may transform healthy hip in a dysplastic one around triradiate cartilage closure time frame. We collected three possible causes of acetabular flattening after a short-term overload in patients at the end of their potential growth of the acetabulum: congenital femoral deficiency treated with surgical lengthening, slipped capital femoral epiphysis treated with anatomical reorientations and intra-articular disease. Excessive pressure on the acetabulum for timeframe shorter than one year may lead to acetabular roof flattening in patients between 12 and 14 years old.
Traumatic iliacus muscle injury has been rarely reported in literature as its incidence is very low compared to other muscle injuries. It is usually caused by trauma or inadequate exercise involving the pelvic girdle. It can produce a hematoma with femoral nerve neuropathy. Spontaneous muscle hematomas occur in patients with coagulation disorders. Hip dysplasia is associated with muscle-tendon abnormalities: the reduced acetabular coverage of the femoral head leads to an increased mechanical load on the hip joint and the acting hip muscles. A 14-year-old girl presented to our emergency department complaining left groin pain after sport activity, after the usual warm up routine before an exhibition of rhythmic gymnastics. At the clinical exam presented a complete hip range of motion with a positive FADDIR sign and pain at the flexion of the hip and at the extension of the leg against resistance. The X-rays showed a bilateral mild hip dysplasia. The magnetic resonance imaging (MRI) scan showed an extensive iliacus muscle detachment from the proximal insertion at the iliac fossa with a hematoma lying between the iliacus and the ilium. After 3 months from the injury the patient was completely asymptomatic. A new MRI scan was performed: it showed an almost complete regression of the hematoma and the detachment of iliacus muscle. Groin pain in hip dysplasia frequently has a muscle-tendon-related cause, especially in case of trauma during sports activity, and one of the structures that is most frequently involved is the iliopsoas muscle. A positive clinical evaluation correlates with instrumental evidence (ultrasonography, MRI, computed tomography); in case of hematoma of the psoas muscle, coagulative disorders must be excluded. If there is no functional involvement of vascular and nervous structures adjacent to the hematoma, conservative treatment is recommended.
BACKGROUND: Scientists have recorded a significant increase in a sedentary lifestyle among the middle-aged population. Study aim was to develop a group training program for suspension training and prove its effectiveness in lowering the percentage of bodyfat level for women using unconventional diagnostic equipment. METHODS: Participants: women of 30-40 years old who do not have contraindications to physical aerobic exercises (N.=24). The research period is 12 months. Some women (N.=12) carried out group exercises in suspension training mainly with TRX loops. The indicators of the percentage of bodyfat level were evaluated by following methods: weighing on a smart scale Xiaomi Mi Body Composition Scale, measuring with a caliper and hydrodensitometry. The statistical analysis of data was performed using Student's t-test. RESULTS: A significant (P<0.01 and P<0.05) advantage of women who are engaged in achieving suspension training a higher level of the training process effectiveness for "burning" body fat deposits, compared with other programs of group and independent aerobic fitness has been revealed. CONCLUSIONS: The research has proven on the basis of mathematical and statistical processing of the results that classes in health-improving group suspension training in a stable motor mode of an aerobic nature improves proportional body composition of middle-aged women. The author's recommendations on the implementation of non-traditional diagnostic procedures for the percentage of bodyfat level body composition measuring allows to increase motivation to set individual goals for middle-aged women in the field of body shaping.
KBG Syndrome is a rare syndrome characterized by facial and hand anomalies, postnatal short stature, delayed bone age, intellectual disability and macrodontia. A key role of mutations in ANRKD11 gene was observed not only in central nervous system but also in skeletal development and function. Indeed, a meticulous evaluation of bone metabolism was recommended in KBG Syndrome. We report on a 11-year-old female child affected by KBG Syndrome with a diaphyseal transverse humeral fracture treated surgically and a clavicular fracture treated conservatively. Bone consolidation was observed in both fractures. To the best of our knowledge, no fracture and bone healing were accurately described in KBG patients. Bone healing was observed after surgical treatment of a humeral diaphyseal fracture and after a conservative treatment of a clavicle fracture. These results showed that bone healing was possible also in presence of a mutation of ANKRD11 gene, an important gene in bone metabolism.
Osteoarthritis is a painful and debilitating disease that affects millions of patients. It is defined by a progressive breakdown and loss of cartilage, accompanied by significant pain and functional disability. Joint replacement surgery has proved to be a highly successful method to restore normal function. However, many patients suffer from severe acute postoperative pain, which has immediate implications for early recovery and the possibility of participating in accelerated rehabilitation programs and, although less recognized, many develop chronic pain after surgery, which can be, at least in part, the result of untreated preoperative osteoarthritis pain and/or chronic postoperative pain. Currently, precise indications are available in the literature on the appropriate and effective treatment of pain in the immediate postoperative phase (48-72 hours) after hip or knee arthroplasty. The multimodal management of pain in the perioperative phase includes the use of drugs and other tools to reduce the dosage of opioid analgesics, decrease complications, improve results and increase patient satisfaction. The purpose of this work was to review the problems related to pain and related to the preoperative, the discharge and rehabilitation phase (PRE.DI.RE.) and try to systematise optimal treatment for these patients.
BACKGROUND: Fragility fractures are frequent complications of osteoporosis and are associated with acute pain that very often evolves into chronic pain. METHODS: This prospective, open-label, single-center, observational study evaluated effectiveness and tolerability of tapentadol prolonged release and assessed the association of tapentadol treatment with sleep quality, physical well-being, patient satisfaction and quality of life in patients with pain after vertebral fracture due to bone fragility. RESULTS: Among 35 patients, a total of 29 (83%) achieved a >= 30% reduction of pain intensity and 13 (37%) patients showed a reduction of the pain on movement and at rest >= 50% after 180 days of treatment. A total of 24 adverse events occurred in 16 patients (46%), 15 of them were mild and nine were moderate, the most frequent events were headache and sleepiness. Sleep quality, physical well-being, Brief Pain inventory Questionnaire scores and SF12 Questionnaire scores significantly improved (P<0.01) at the end of the treatment. All patients were "satisfied" or "very satisfied" with the treatment after 20 days. CONCLUSIONS: These results highlighted the beneficial effects of tapentadol prolonged release in terms of pain intensity reduction, quality of life and functionality in patients with vertebral fracture caused by bone fragility.
