Interposition arthroplasty with bovine collagenous membrane for hallux rigidus: A long-term results retrospective study.

BACKGROUND: Hallux rigidus (HR) is a degenerative arthritis of the first metatarsophalangeal joint (MTP1) with progressive loss of range of movement (ROM). Interposition arthroplasty (IA) is a technique widely used for the treatment of HR;however, few studies reported long-term clinical results. This study aims to report the clinical results of IA using a bovine pericardium collagen matrix for HR with a minimum 10-years follow-up. METHODS: Thirty patients (31 feet) who underwent IA using a bovine pericardium collagen matrix from 2001 to 2009 were retrospectively evaluated with a mean follow up of 154.1 ± 28.6 (range 124-218) months. All HR ranged from grade II to grade III, according to Regnauld classification. All patients were clinically assessed with the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal- Interphalangeal Scale, a pain Visual Analog Scale, and the Foot and Ankle Disability Index. Scores before and after treatment, respectively achieved from clinical records and clinical evaluation at final follow-up were compared. RESULTS: At final follow-up, an improvement of all the considered scores (p < 0.01) was recorded. The overall rate of unsatisfying results was 16.1 %. Two (6.4 %) patients complained discomfort due to first ray shortening and 3 (9.7 %) cases of persistent metatarsal pain. There was one (3.2 %) case of Complex Regional Pain Syndrome (CPRS). No revision surgeries, infection, or other adverse events were reported. CONCLUSION: Interposition arthroplasty using bovine collagenous membrane is a reliable solution for high-grade HR with durable results over 10 years in more than 80 % of patients.

Rotator cuff repair with single row technique provides satisfying clinical results despite consistent MRI retear rate.

BACKGROUND: The number of shoulder arthroscopies is steadily increasing to treat glenohumeral joint disorders, among which the rotator cuff tear is the most common. The prevalence of this condition ranges from 13% to 37% in the general population without considering the number of asymptomatic patients. The gold standard procedure for rotator cuff repair is still undefined. The purpose of this study is to evaluate a population who underwent a single row (SR) rotator cuff repair and correlate their clinical results with MRI findings. MATERIALS AND METHODS: Sixty-seven consecutive rotator cuff procedures were retrospectively selected. All patients were diagnosed with a full-thickness rotator cuff tear and subsequently treated with an arthroscopic SR repair technique. Each patient was clinically assessed with the DASH questionnaire and the Constant-Murley Score to grade their satisfaction. Moreover, rotator cuff repair integrity was evaluated by MRI and graded using the Sugaya score. RESULTS: Mean follow-up was 19.5 ± 5.7 months. The mean Constant score was 82.8 ± 13.0 points, with 55 patients reporting excellent results. No patient scored less than 30 points, which could be deemed as unsatisfying. Meanwhile, on the DASH questionnaire, 6.1% of our patients rated their clinical outcome as unsatisfying, whereas 75.8% rated their outcome as excellent. Postoperative MRI classified 45 patients (83.3%) as either Sugaya type I, II, or III, whereas 9 patients (16.7%) presented a Sugaya type IV consistent with a full-thickness cuff retear. Of these nine patients, five (55.6%) and three (33.3%) reported excellent results for the Constant score and DASH questionnaire, respectively. The Mann-Whitney test reported that the retear group had worse scores than the intact repaired cuff group for pain (8.3 ± 5.0 versus 13.1 ± 3.4), Constant Score (68.8 ± 18.5 versus 83.1 ± 11.6), and DASH (66.2 ± 22.1 versus 44.2 ± 14.9). Still, range of motion (ROM) differences were not significant, except for better forward flexion in the intact group (p < 0.039). CONCLUSIONS: Both groups with intact repaired and retorn cuffs showed improvement in their condition, but unexpectedly, there is no significant  correlation between patient satisfaction and rotator cuff integrity. LEVEL OF EVIDENCE: IV.

Effectiveness of corticosteroid injections in Civinini-Morton's Syndrome: A systematic review.

BACKGROUND: The aim of this paper is to analyze the effectiveness of corticosteroid injections (CI), in combination with or without a local anaesthetic, for Civinini-Morton's Syndrome to determine which protocol could be the most appropriate among conservative treatments. METHODS: All selected articles were screened using a thorough database search of PubMed, EMBASE and SCOPUS to assess their suitability to the research focus. RESULTS: Selection produced 10 articles as full-text, for a total of 590 patients, with a mean follow-up of 14 ± 14.2 (range 3-48) months. Johnson satisfaction scale, resulting from 6 studies, scored 25.6% (range 5-38) and 39.4% (range 15-51.8), respectively completely satisfied and satisfied with minor reservations. Mean VAS, declared in 5 studies, decreased from 70.7 ± 16.5 (range 67-89) to 33.4 ± 7.6 (26-42.5) points (p < 0.01). Most common complication was skin depigmentation in 7 (2.6%) cases. CONCLUSIONS: CI appear to be a safe treatment allowing good results with a very low complications rate. A neuroma of 6.3 mm seems to be the cut-off size; below which CI could have best indications and be considered as an intermediate treatment between shoe modifications and more invasive procedures such as percutaneous alcoholization or surgery. LEVEL OF EVIDENCE: Level II, systematic review.

Valenti resection arthroplasty for hallux rigidus: A systematic review.

BACKGROUND: Valente Valenti proposed in 1976 a "V" resection of the first metatarsophalangeal joint (MPT1) on the sagittal plane for advanced stages of hallux limitus/rigidus, preserving length of the first ray, flexor hallux brevis and sesamoid function. The available literature concerning correct indications, management and clinical outcomes of the Valenti procedure (VP) and its modifications in patients affected by hallux limitus/rigidus was systematically analyzed. METHODS: Titles and abstracts of all selected articles were independently screened by two authors to assess their suitability to the research focus. RESULTS: Selection produced 8 articles as full-text, for a total of 347 patients, with a mean follow-up of 6±7.1 (range 0.2-17.5) years. Most common complication was transient sesamoiditis in 21 (7.4%) patients. No substantial differences in clinical outcomes were found between the original and modified techniques. CONCLUSIONS: VP appears to allow an early recovery with few complications, if compared to fusion, interposition arthroplasties or osteotomies. The wide joint resection does not prevent, if necessary, further procedures such as fusion or implants. LEVEL OF EVIDENCE: Level I, systematic review.

Can percutaneous alcoholization of Morton's neuroma with phenol by electrostimulation guidance be an alternative to surgical excision? Long-term results.

BACKGROUND: Percutaneous alcoholization with phenol by electrostimulation guidance for the treatment of Morton's neuroma is proposed to determine a permanent chemical neurolysis. METHODS: 115 patients for 125 Morton's neuromas were treated. Ten patients were affected by multiple neuromas. Visual Analogue Scale and AOFAS score were used for the clinical assessment. RESULTS: The mean follow-up was 8,3 years. The pre-alcoholization VAS was 85.84 ± 12.00, while at follow-up scored 28.85 ± 31.35, showing a significant decrease improving in 113/125 cases (90.4%). Treatment was considered successful with a reduction of the VAS value superior to 50% in 89 out of 125 patients (71.2%). The mean overall AOFAS score at -up was 85.09 ± 13.41. CONCLUSIONS: Needle-electrode guided percutaneous alcoholization is an outpatient, minimally invasive procedure with low rate of complications. Better results of those obtained with traditional conservative treatments and comparable with those reported with other alcohols injections or surgical nerve excision were observed. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Correlation between hip osteoarthritis and proximal femoral fracture site: could it be protective for intracapsular neck fractures? A retrospective study on 320 cases.

Proximal femoral fractures affect elderly people, showing high morbidity and mortality incidence resulting in a major economic burden on national healthcare systems. Understanding the causes of these injuries is of paramount importance to prevent the serious consequences of these fractures. INTRODUCTION: Hip osteoarthritis and proximal femoral fractures mainly affect elderly patients. Several authors, in their studies, tried to document a correlation between these conditions, but the results are conflicting. The aim of this study was to evaluate the relationship between hip osteoarthritis and the fracture site. Secondly, to evaluate if the grade of osteoarthritis could influence the fracture pattern. METHODS: A retrospective study on 320 patients admitted for hip fracture between June 2015 and December 2016 was carried on. Radiographic images were evaluated, assessing the type of fracture, presence and grade of osteoarthritis according to Kellgren-Lawrence and Tönnis classifications, and their correlations. RESULTS: Osteoarthritis was found to affect the fracture site showing a higher prevalence among subjects with extracapsular than those with intracapsular fractures (p < 0.00001). Patients with radiographic signs of arthritis had mainly trochanteric fracture. Conversely, patients without arthritis more frequently presented a femoral neck fracture. This correlation was even more significant as the severity of the OA increased. CONCLUSIONS: Results support the hypothesis that hip osteoarthritis could represent a protective factor for intracapsular fractures and a risk factor for trochanteric ones. The severity of arthritis is also associated with the fracture pattern.

Below- vs above-elbow cast for distal radius fractures: is elbow immobilization really effective for reduction maintenance?

PURPOSE: The choice of the cast length in conservative management of distal radius fractures still represents a debated controversy. Historically, the elbow is immobilized to reduce the risk of secondary displacement; however, short-arm casts are currently felt to be equally effective with less complications and better patient comfort. This paper investigates whether immobilization of the elbow is actually effective in reducing the risk of loss of reduction in conservatively manipulated distal radius fractures. METHODS: We retrospectively studied 297 consecutive patients with distal radius fractures requiring manipulation and subsequently immobilized with above-elbow cast or below-elbow cast. Maintenance of reduction, radial height, radial inclination, and volar tilt were assessed after the reduction and at 35 days. Appropriate statistical analysis was performed to correct data selection bias and to assess any difference in the effectiveness among the two treatments. RESULTS: The mean difference of loss of radial height, inclination, and volar tilt between the two groups was 0.8 mm, 0.4°, and 0.9° respectively, being not statistically significant. Average difference in reduction maintenance probability between the two groups stratified with a statistical propensity score was 1.2%. CONCLUSIONS: Above- and below-elbow casts had comparable performance in maintaining reduction of manipulated distal radius fractures.

Minimally invasive distal first metatarsal osteotomy can be an option for recurrent hallux valgus.

BACKGROUND: Recurrence rate of surgical treatment of hallux valgus ranges in the literature from 2.7% to 16%, regardless of used procedure. In this study, long-term results of a minimally invasive distal osteotomy of the first metatarsal bone for treatment of recurrent hallux valgus are described. METHODS: 32 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 26 patients for treatment of recurrent hallux valgus. Primary surgery had been soft tissue procedures in 8 cases (25%), first metatarsal or phalangeal osteotomies in 19 cases (59.4%) and Keller procedures in 5 cases (15.6%). RESULTS: Patients were assessed with a mean follow-up of 9.8±4.3 years. All patients reported the disappearance or reduction of the pain. The mean overall AOFAS score improved from 46.9±17.8 points to 85.2±14.9 at final follow-up. The mean hallux valgus angle decreased from 26.1±9.1 to 9.7±5.4°, the intermetatarsal angle decreased from 11.5±4.5 to 6.7±4.0°. No major complications were recorded with a re-recurrence rate of 3.1% (1 case). CONCLUSIONS: Percutaneous distal osteotomy of the first metatarsal can be a reliable and safe surgical option in the recurrent hallux valgus with low complication rate and the advantages of a minimally invasive surgery. LEVELS OF EVIDENCE: IV, Retrospective Case Series.

Percutaneous distal osteotomy of lesser metatarsals (DMMO) for treatment of metatarsalgia with metatarsophalangeal instability.

BACKGROUND: Clinical and radiological results of percutaneous distal metatarsal minimally invasive osteotomy (DMMO) of the lesser rays for surgical treatment of primary metatarsalgia due to plantar overpressure with metatarsophalangeal instability are described. The aim of this prospective study was to assess the efficacy, feasibility and safety of this minimally invasive surgical (MIS) technique, verifying the possibility to lower the complication rate related to surgical exposures, to reduce operating times with comparable functional and cosmetic results to those reported with traditional open procedures. METHODS: Hundred and six consecutive percutaneous distal osteotomies without fixation (DMMO) of the second, third or fourth metatarsal bones were performed in 57 patients (70ft) with a mean age at the surgery of 60.2 years (30-81) for treatment of metatarsalgia with metatarsophalangeal instability. Patients were clinically assessed with the AOFAS and Coughlin's Scores, the latter classifying the results in relation to the patient's subjective satisfaction. RESULTS: The mean follow-up was of 45.0±13.3months (24-68). All patients reported the disappearance or reduction of the pain that they had experienced prior to the operation around the metatarsal heads. The mean overall AOFAS score improved from 42.7±13.4 points (9-77) to 92.8±8.6 points (44-100) at the time of final follow-up. Patient subjective satisfaction according to Coughlin's classification was excellent in 62ft (88.6%), good in 7ft (10.0%), fair in 0ft and poor in one foot (1.4%). CONCLUSIONS: We consider the percutaneous distal lesser metatarsal osteotomy without fixation (DMMO) a reliable surgical option in metatarsalgia due to metatarsophalangeal instability in early stages as in grade I and II according to Coughlin classification.

The pathogenesis of Achilles tendinopathy: a systematic review.

Achilles tendinopathy is a degenerative, not an inflammatory, condition. It is prevalent in athletes involved in running sports. A systematic literature review on Achilles tendon tendinopathy has been performed according to the intrinsic (age, sex, body weight, tendon temperature, systemic diseases, muscle strength, flexibility, previous injuries and anatomical variants, genetic predisposition and blood supply) and extrinsic risk factors (drugs and overuse), which can cause tendon suffering and degeneration. Different theories have been found: Neurogenic, Angiogenic, Impingement and "Iceberg" Hypotheses. Multiple databases were utilized for articles published between 1964 and 2013. The different hypothesis were analyzed, differently considering those concerning the pathogenesis of tendinopathy and those concerning the etiology of complaints in patients. This review of the literature demonstrates the heterogeneity of Achilles tendinopathy pathogenesis. Various risk factors have been identified and have shown an interaction between them such as genes, age, circulating and local cytokine production, sex, biomechanics and body composition.

Dislocation of primary total hip arthroplasty: Analysis of risk factors and preventive options.

Total hip arthroplasty (THA) is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease. However, dislocation continues to be a troublesome complication after THA, as it is a leading cause of revision and is associated with substantial social, health, and economic costs. It is a relatively rare, usually early occurrence that depends on both the patients' characteristics and the surgical aspects. The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility, which is closely related to the incidence of dislocation. Consequently, clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup. Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA. Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size, dual mobility constructs, constrained liners, and modular neck stems.

Release of gentamicin and vancomycin from preformed spacers in infected total hip arthroplasties: measurement of concentrations and inhibitory activity in patients' drainage fluids and serum.

Gentamicin (G) and vancomycin (V) concentrations in drainage fluids obtained from patients during the first 24 hours after implantation of antibiotic-loaded polymethylmethacrylate (PMMA) spacers in two-stage revision of infected total hip arthroplasty were studied. The inhibitory activity of drainage fluids against different multiresistant clinical isolates was investigated as well. Seven hips were treated by implantation of industrial G-loaded spacers. Vancomycin was added by manually mixing with PMMA bone cement. Serum and drainage fluid samples were collected 1, 4, and 24 hours after spacer implantation. Antibiotics concentrations and drains bactericidal titer of combination were determined against multiresistant staphylococcal strains. The release of G and V from PMMA cement at the site of infection was prompt and effective. Serum levels were below the limit of detection. The local release kinetics of G and V from PMMA cement was similar, exerting a pronounced, combined inhibitory effect in the implant site. The inhibitory activity of drainage fluids showed substantial intersubject variability related to antibiotic concentrations and differed according to the pathogens tested. Gentamicin and vancomycin were released from temporary hip spacers at bactericidal concentrations, and their use in combination exerted strong inhibition against methicillin-resistant S. aureus and Coagulase Negative Staphylococci strains.

Diagnosis of periprosthetic hip infection: a clinical update.

Periprosthetic joint infection (PJI) is a serious complication following hip arthroplasty, which is associated with significant health cost, morbidity and mortality. There is currently no consensus in the optimal definition of PJI, and establishing diagnosis is challenging because of conflicting guidelines, numerous tests, and limited evidence, with no single test providing a sensitivity and specificity of 100%. Consequently, the diagnosis of PJI is based on a combination of clinical data, laboratory results from peripheral blood and synovial fluid, microbiological culture, histological evaluation of periprosthetic tissue, radiological investigations, and intraoperative findings. Usually, a sinus tract communicating with the prosthesis and two positive cultures for the same pathogen were regarded as major criteria for the diagnosis, but, in recent years, the availability of new serum and synovial biomarkers as well as molecular methods have shown encouraging results. Culture-negative PJI occurs in 5-12% of cases and is caused by low-grade infection as well as by previous or concomitant antibiotic therapy. Unfortunately, delay in diagnosis of PJI is associated with poorer outcomes. In this article, the current knowledge in epidemiology, pathogenesis, classification, and diagnosis of prosthetic hip infections is reviewed.

Cemented and uncemented stems for displaced femoral neck fracture in the elderly. Retrospective study with a minimum 1-year follow-up.

BACKGROUND AND AIM: Displaced femoral neck fracture (FNF) is a common and significant health issue especially in older population because of the high rates of mortality and complications. The standard surgical treatment is total or partial hip replacement, including a cemented or uncemented stem. The cemented prosthesis is considered the safer option because of a lower rate of periprosthetic fractures (PPFs) as well as an actually reduced risk of bone cement implantation syndrome (BCIS). This retrospective study aims to assess the efficacy and safety of cemented versus uncemented femoral stem for FNF in patients ≥70 years. METHODS: 139 patients affected by displaced FNF underwent hip replacement, receiving 89 cemented (64%) and 50 uncemented (36%) stems. Inclusion criteria were: ≥70 years of age, an ICD-9-CM diagnose code 820.00, 820.01, 820.02, 820.03, 820.10, 820.8, and a minimum 1-year follow-up. A p value <0.05 was considered statistically significant. RESULTS: Surgical time, overall perioperative complication rate with a particular focus on the thromboembolic events, and PPFs incidence were evaluated comparing cemented and uncemented group. No difference in duration of surgery was found. Intraoperative complications were not detected. Pulmonary embolism and deep vein thrombosis were observed each in 1 case of cemented prosthesis. Periprosthetic femoral fractures occurred only in the uncemented group postoperatively, with a statistically significant difference (p<0.05). CONCLUSIONS: The low incidence of BCIS and the higher risk of postoperative PPFs in cemented and uncemented stems, respectively, suggest that the use of cementation is a safer procedure.

The influence of first ray instability and hindfoot valgus in the development of hallux rigidus: state of art.

Hallux rigidus (HR) is a painful condition associated with degenerative arthritis of the first metatarsophalangeal (MTP1) joint, leading to a progressive loss of dorsiflexion. The etiological factors leading to the development of the condition are not yet fully understood in the literature. When the hindfoot is aligned in excessive valgus, the medial border of the foot tends to roll over, which brings to increased stress on the medial side of the MTP1 joint, and consequently on the first ray (FR), thus potentially influencing the development of HR deformity. This state of art aims to analyze the influence of FR instability and hindfoot valgus in HR development. From the results of the analyzed studies, it appears that a FR instability may predispose the big toe to increased stress and to narrow the proximal phalanx motion on the first metatarsal, which brings to compression and ultimately degeneration of the MTP1 joint, mostly in advanced stages of disease, less in mild or moderate HR patients. A strong correlation between a pronated foot and MTP1 joint pain was found; forefoot hypermobility during the propulsion phase may promote MTP1 joint instability and increase pain. Thus, the increased moment of pronation of the foot with the overload of the medial column, when present, should be corrected conservatively or surgically; this, most likely, would be useful not only to eliminate or at least limit the painful symptoms but above all to prevent the worsening of the condition, also after the surgical treatment of HR.

Anterior shoulder instability: comparison between Latarjet open procedure and arthroscopic capsuloplasty.

BACKGROUND: Latarjet surgery and capsuloplasty are both valid alternatives for the treatment of anterior shoulder instability with limited glenoid bone loss, although in literature there is extensive discussion on it. The purpose of this study was to compare the outcomes of these procedures in patients with similar lesions. METHODS: Between January 2000 to October 2020, 59 nonconsecutive patients suffering from anterior shoulder instability were treated, 33 had arthroscopic capsuloplasty (Group 1) and 26 had open Latarjet procedure (Group 2). The Group 1 was composed by 12% of female and 88% of males with the mean age at surgery 25.6 +/- 9.07 (15-49 years). In the Group 2, the 100% of patients were males with mean age 32.42 +/- 10.74 (16-56). Rowe Score, UCLA score and WOSI score were used to test patients. RESULTS: Only UCLA (average was 22.18 ± 6.13 for the Capsuloplasty and 26.76 ± 6.57 in the Latarjet, p = 0.01) and ROWE scores (average was 70.15 ± 24.75 in Latarjet and 50.15 ± 24.70 in Capsuloplasty, p = 0.002) showed a statistically significant difference between the two procedures, while the WOSI (mean results of Latarjet 0.31 ± 0.16 against 0.24 ± 0.09 of the capsuloplasty, p = 0.069) there was no significant difference between the two groups in question. CONCLUSIONS: Apparently, the Latarjet surgery is better in terms of instability recurrence compared to capsuloplasty but has higher rate of shoulder joint osteoarthtritis. However, there are no significant differences that could decree which procedure is better. (www.actabiomedica.it).

Efficacy and Long-Term Outcomes of Intra-Articular Autologous Micro-Fragmented Adipose Tissue in Individuals with Glenohumeral Osteoarthritis: A 36-Month Follow-Up Study.

BACKGROUND: Glenohumeral osteoarthritis (GOA) is associated with disabling shoulder pain that affects everyday life. Its management comprises various treatment approaches, both conservative and surgical. Regenerative medicine has gained a major role in the conservative treatment of osteoarthritis. Intra-articular injection of adipose-derived mesenchymal stem cells (ADMSCs) is a widely used regenerative medicine approach. The aim of this retrospective study was to report the safety and clinical outcomes of intra-articular injection of ADMSCs in patients with GOA over 36-months. METHODS: This retrospective observational study involved patients with chronic shoulder pain resistant to standard conservative treatment and a diagnosis of concentric GOA, who received an intra-articular injection of autologous micro-fragmented adipose tissue (µFAT). The values of the Constant-Murley score (CMS), the visual analog scale (VAS), and the simple shoulder test (SST), collected at baseline and at 12, 24, and 36 months, were analyzed to assess treatment efficacy. The single assessment numeric evaluation (SANE) was used to rate patient satisfaction. The Friedman test was used to compare observations of CMS, VAS, and SST values repeated on the same subjects. The significance threshold was set at 0.05. RESULTS: The participants were 65 patients with a mean age of 54.19 years and a nearly equal gender distribution. Most had mild concentric GOA classified as Samilson-Prieto grade 1. The mean follow-up duration was 44.25 months. The postoperative clinical scores showed significant improvement. At 36 months, the CMS was 84.60, the VAS score was 3.34, and the SST score was 10.15 (all p < 0.0001). The SANE score at 36 months indicated that 54 patients (83.08%) were completely satisfied with the treatment. CONCLUSION: ADMSC treatment exerted favorable effects on the clinical outcomes of patients with GOA, providing pain relief and improving shoulder function. Our data support its use as a conservative treatment option for osteoarthritis.

Short-term clinical and radiological comparisons between two Medial Pivot Total Knee Arthroplasty implants with different geometries.

BACKGROUND AND AIM: Different total knee arthroplasty (TKA) implants were created for the treatment of severe symptomatic gonarthrosis and Medial Pivot TKA (MP TKA) seem to reproduce the normal kinematics of the knee. We compare two different prosthetic designs of MP TKA in order to identify whether there is a difference between the two in terms of degree of patient satisfaction.  Methods: A total of 89 patients were analyzed. A group of 46 patients who benefited from a TKA with the Evolution® prosthesis and one of 43 patients who received a TKA with the Persona® prosthesis. KSS, OKS, FJS and the ROM were analyzed at follow up. RESULTS: The values of KSS and OKS were similar between the two groups (p>0,05). Our statistical analysis revealed a statistically significant increase (p <0.05) in ROM in the Persona® group and in FJS in the Evolution® group. No radiolucent lines were observed in both groups at the radiological final follow-up.  Conclusions: MP TKA models analysed are a valuable tool to achieve satisfactory clinical outcomes. This study demonstrates that the FJS is an important score for the evaluation of patient's satisfaction: a ROM's limitation can be accepted by the patient in exchange for a more natural perceived knee.

Late intraprosthetic dislocation of a monoblock dual-mobility cup cemented into a well-fixed cementless acetabular shell. A case report.

Intraprosthetic dislocation (IPD) is a specific implant-related complication of dual mobility (DM) implants, which is defined as a dissociation of polyethylene (PE) liner from the femoral head. We report a unique case of  late IPD of a monoblock DM cup cemented into a well-fixed cementless acetabular shell for recurrent dislocation of total hip arthroplasty (THA). A 77-year-old woman was admitted to our department for acute right hip pain, functional impairment and inability to bear weight without any trauma. Three years earlier, she underwent revision THA for recurrent dislocation with a monoblock DM cup cemented into a well-fixed cementless acetabular shell according to the "double-socket" technique. Three months after that revision the patient experienced an anterior THA dislocation, which was managed by closed reduction under sedation in the emergency room. No additional episodes of prosthesis instability occurred. Upon admission, radiographic evaluation showed  right THA dislocation. X-rays performed  after closed reduction revealed eccentric positioning of the head inside the cup, and a direct contact between the metal head and the cup was revealed by subsequent CT scan, confirming the suspicion of IPD. The patient underwent revision surgery, during which the PE liner was found lodged within the cup in a subluxated position, disassembled from the inner head. Both the acetabular cup and modular femoral stem proved well-fixed and impossible to remove, therefore they were retained. The explanted DM components were replaced with new ones of the same size and, thanks to the femoral neck's modular nature, it was substituted with a longer one, which resulted in improved stability against intraoperative stress maneuvers. The postoperative course was uncomplicated. At 1-year follow-up, the patient had a good functional recovery.

Short arm cast is as effective as long arm cast in maintaining distal radius fracture reduction: Results of the SLA-VER noninferiority trial.

BACKGROUND: Distal radius fractures (DRFs) are a common challenge in orthopaedic trauma care, yet for those fractures that are treated nonoperatively, strong evidence to guide cast treatment is still lacking. AIM: To compare the efficacy of below elbow cast (BEC) and above elbow cast (AEC) in maintaining reduction of manipulated DRFs. METHODS: We conducted a prospective, monocentric, randomized, parallel-group, open label, blinded, noninferiority trial comparing the efficacy of BEC and AEC in the nonoperative treatment of DRFs. Two hundred and eighty patients > 18 years of age diagnosed with DRFs were successfully randomized and included for analysis over a 3-year period. Noninferiority thresholds were defined as a 2 mm difference for radial length (RL), a 3° difference for radial inclination (RI), and volar tilt (VT). The trial is registered at Clinicaltrials.gov (NCT03468023). RESULTS: One hundred and forty-three patients were treated with BEC, and 137 were treated with AEC. The mean time of immobilization was 33 d. The mean loss of RL, RI, and VT was 1.59 mm, 2.83°, and 4.11° for BEC and 1.63 mm, 2.54°, and 3.52° for AEC, respectively. The end treatment differences between BEC and AEC in RL, RI, and VT loss were respectively 0.04 mm (95%CI: -0.36-0.44), -0.29° (95%CI: -1.03-0.45), and 0.59° (95%CI: -1.39-2.57), and they were all below the prefixed noninferiority thresholds. The rate of loss of reduction was similar. CONCLUSION: BEC performs as well as AEC in maintaining the reduction of a manipulated DRF. Being more comfortable to patients, BEC may be preferable for nonoperative treatment of DRFs.