Cementless total hip arthroplasty in the treatment after acetabular fractures.

INTRODUCTION: The outcomes of total hip arthroplasty (THA) for the treatment of posttraumatic arthritis after acetabular fractures were inferior to those after primary non-traumatic THA. METHODS: This study was performed in academic level I trauma center. From January 2011 to December 2014, a consecutive series of 21 patients (9 females), with average age of 56.7 years (range 29-75 years) who had posttraumatic hip joint arthritis after acetabular fractures, were included in our study. All patients underwent cementless THA. The average duration of follow-up was 26 months (range 24-36 months). RESULTS: At the latest follow-up, all patients could walk independently, thirteen (62%) patients had excellent Harris hip score, five (24%) had good HHS, and 3 (14%) had fair score. WOMAC scale decreased from 63 (range 42-92) to 4 (range 0-19). Two patients (9.5%) had heterotopic bone formation which did not affect the activity of the patients. There were no signs of loosening of the acetabular cups or around the femoral stem. CONCLUSION: Cementless THA is an ideal treatment for posttraumatic hip arthritis with anatomic restoration of the hip center to improve the functional results and decrease the incidence of complications and revision rate.

Periacetabular bone densitometry after total hip arthroplasty with highly porous titanium cups: a 2-year follow-up prospective study.

INTRODUCTION: Trabecular Titanium is an advanced cellular solid structure, composed of regular multiplanar hexagonal interconnected cells that mimic the morphology of the trabecular bone. This biomaterial demonstrated improved mechanical properties and enhanced osteoinduction and osteoconduction in several in vitro and in vivo studies. The aim of this study was to assess Trabecular Titanium osseointegration by measuring periacetabular changes in bone mineral density (BMD) with dual-emission X-ray absorptiometry (DEXA). METHODS: 89 patients (91 hips) underwent primary total hip arthroplasty (THA) with acetabular Trabecular Titanium cups. Clinical (Harris Hip Score (HHS), SF-36) and radiographic assessment were performed preoperatively, and postoperatively at 7 days and at 3, 6, 12 and 24 months. DEXA analysis was performed only postoperatively, using the BMD values measured at 7 days as baselines. RESULTS: After an initial decrease from baseline to 6 months, BMD increased and progressively stabilised in all 3 regions of interest (ROIs). Median (IQR) HHS and SF-36 increased from 48 (39-62) and 49 (37-62) preoperatively to 99 (96-100) and 86 (79-92) at 24 months, indicating a considerable improvement in terms of pain relief, functional recovery and quality of life. BMD patterns and radiographic evaluation showed evident signs of periacetabular bone remodelling and osseointegration; all cups were stable at the final follow-up without radiolucent lines, loosening or osteolysis. No revisions were performed. CONCLUSIONS: After an initial reduction in periacetabular BMD, all 3 ROIs exhibited stabilisation or slight recovery. Although clinical outcomes and functional recovery proved satisfactory, longer follow-ups are necessary to assess this cup long-term survivorship.

Tripled semitendinosus with single harvesting is as effective but less invasive compared to standard gracilis-semitendinosus harvesting.

INTRODUCTION: The anterior cruciate ligament (ACL) reconstruction with pes anserinus tendons has been increasingly used throughout the last years. Although less invasive compared to other autologous grafts, a reduction of internal rotation and flexion strength after gracilis and semitendinosus harvesting has been reported. Harvesting one tendon instead of two from the pes anserinus can reduce the deficit of the knee flexor strength and improve the functional recover without weakening the reconstructed ligament. METHODS: Forty-five (45) patients who had ACL reconstruction with triple semitendinosus graft (ST3) have been compared with other 45 similar patients who had ACL reconstruction with double gracilis-semitendinosus tendons (GST). Patients have been evaluated at a minimum of 12 months after surgery: IKDC scale, KT-1000, One Leg Hop Test for the objective stability; Isokinetic test for the strength; Tegner scale, Lysholm and IKDC subjective evaluation form for the function. RESULTS: No differences have been detected between the groups for the objective item assessed. Male patients' subjective IKDC score was statistically better for the ST3 group. Recreational soccer players showed a higher Lysholm and subjective IKDC score in ST3 group compared to GST group. There was no difference regarding the return to sport. CONCLUSION: ST3 guarantees the same objective knee stability compared to a GST. It is a viable option for ACL reconstruction that allows a better preservation of patient's anatomy and a less invasive harvesting surgery. LEVEL OF EVIDENCE: III b, case control study.

Simultaneous open reduction and internal fixation and total hip arthroplasty for the treatment of osteoporotic acetabular fractures.

INTRODUCTION: Surgical treatment of acetabular fractures in elderly people is challenging. The main aim of this study is to evaluate retrospectively the indications, results and the complications of simultaneous open reduction and internal fixation (ORIF) and acute total hip replacement (THR) in the management of displaced acetabular fractures. METHODS: This study was performed in an academic level I trauma centre. From January 2011 to December 2014, a consecutive series of 18 patients (eight females), with average age of 66 years (range 35-81 years) who had displaced acetabular fractures were included in our study. All patients underwent ORIF and simultaneous acute THR. The average duration of follow up was 21.7 months (range 12-36 months). RESULTS: At the latest follow up, all patients could walk independently. Thirteen patients (72.7 %) had excellent Harris hip scores HHS, five, patients (27.7 %) had good results. All fractures were healed and the acetabular autologous bone grafts were well incorporated. There were no delayed unions or non-unions. Two patients (11 %) had heterotropic bone formation which did not affect the activity of the patients. There were no signs of loosening of the acetabular cups however one patient had 2 mm medial migration of the cup. No vertical migration was observed, and there were no signs of loosening around the femoral stem. CONCLUSION: ORIF and simultaneous THR is a good option for the treatment of certain types of acetabular fractures particularly in elderly population.

Altered nitric oxide/cGMP platelet signaling pathway in platelets from patients with acute coronary syndromes.

This study was aimed at evaluating whether the nitric oxide (NO)/cyclic GMP (cGMP) signaling pathway is altered in platelets from patients with an acute coronary syndrome (unstable angina and acute myocardial infarction). We investigated 10 patients with unstable angina (UA), 14 with acute myocardial infarction (AMI) and 14 age and sex-matched healthy subjects. The serum markers of platelet activation (sP-selectin), inflammation (TNF-alpha and erythrocyte sedimentation rate), thrombotic state (fibrinogen) and plaque disruption were significantly higher in both UA and AMI patients compared to the healthy controls. In their platelets we assessed the cGMP levels in basal conditions and after stimulation with sodium nitroprusside (SNP), and performed Western blot analysis of homogenates to measure the expression of soluble guanylate cyclase isoforms. Basal levels of cGMP (pmol/10(10) platelets) were significantly higher in platelets from UA patients (1,097 +/- 111; p < 0.0001) and AMI (1,122 +/- 77; p < 0.0001) compared to those collected from healthy controls (497 +/- 80). The platelets of AMI patients exhibited a lack of cGMP increase after SNP stimulation in comparison with UA patients. The phosphorylation of upstream (Akt1 protein kinase alpha and endothelial NO synthase) and downstream (vasodilator-stimulated phosphoprotein, VASP) signaling proteins of the NO/cGMP pathway was investigated: serine phosphorylation in Akt1, eNOS and VASP was enhanced in platelets from UA and AMI patients when compared to controls. Furthermore, in AMI patients the inhibitors of guanylate cyclase and cGMP-dependent protein kinase did not revert the VASP phosphorylation. These data suggest that platelets from AMI patients are more resistant to SNP stimulation, not only as cGMP production, but also in terms of VASP activation. From these ex vivo results we hypothesize that the increased inflammatory state which often accompanies patients with cardiovascular diseases might promote a platelet preactivation resulting in their reduced sensitivity to NO.

Spinal cord stimulation and 30-minute heart rate variability in refractory angina patients.

BACKGROUND: Spinal cord stimulation (SCS) has proven antianginal and antiischemic effects in severe coronary artery disease patients, minimizing frequency, intensity, and duration of pain. The mechanism explaining these effects has been detected in a sympathicolytic effect of the SCS. We monitored 30-minute-long recordings of the heart rate variability (HRV) and its spectral power parameters to evaluate the influence of SCS on the sympathetic/parasympathetic balance. METHODS AND RESULTS: Eight patients underwent HRV recordings in controlled environmental conditions. The patients were seated in a relaxed position and isolated from external contacts. During three consecutive 30-minute periods, the SCS was programmed, in a randomized fashion, to stimulate at a level generating paresthesias (ON), at a subliminal level (SUB, amplitude 80% of ON), or switched off (OFF). The low-frequency/high-frequency ratio during stimulation (ON) was significantly lower compared to that found while the SCS was turned OFF (0.54, 0.35-1.04 vs 1.21, 0.80-2.48; P = 0.036). The stimulation resulted in a median 52% (33-65%) reduction of the sympathetic activity compared to basal (ON vs OFF, P = 0.049). CONCLUSION: No difference emerged instead comparing OFF versus SUB (P = 0.575). The stimulation effect was not influenced by the randomized sequence. Thirty-minute SCS significantly influenced the sympathetic/parasympathetic balance reducing sympathetic modulation.