Two-stage total hip arthroplasty for septic arthritis through the minimally invasive direct anterior approach.

The use of minimally invasive direct anterior approach to perform total hip arthroplasty is gaining increasing popularity for its short-term advantages, compared to other approaches. Nevertheless, its use in hip revision surgery has been criticized. We report here the first case of hip septic arthritis treated with two-stage THA through this tissue-sparing approach, with good implant positioning and functional results.

Bilateral total hip arthroplasty through minimally invasive direct anterior approach after Legg-Calvé-Perthes disease.

Bilateral secondary osteoarthritis of the hip may affect also young patients following bilateral hip diseases such as slipped capital femoral epiphysis and developmental hip dysplasia. We report the case of an 18- year old male with a previous diagnosis of Legg-Calvé-Perthes disease who underwent a bilateral total hip arthroplasty through minimally invasive direct anterior approach, with optimal results at 1-year follow up.

Kinematic versus mechanical alignment in total knee arthroplasty: a preliminary study.

Despite the great advances of the technology in the joint prosthesis and the high execution rate of total knee arthroplasty (TKA), there are still about 15% of clinical unsatisfactory rate in this surgery. TKAs are currently performed using a mechanical alignment of the knee, correcting varus/valgus deformities with the purpose to achieve a longer implant survivorship, but this surgical technique results in an alteration of the normal knee kinematics. Nowadays, the idea to restore the pre-arthritic alignment of the knee with the goal to obtain a normal kinematics and better functional results becomes more and more consistent and the kinematic alignment (KA) was developed as alternative to the mechanical one. The aim of this preliminary study is to analyse the functional outcomes in patients who underwent KA-TKA in the short-term follow-up and to compare them with those obtained in patients treated by the mechanical alignment (MA) TKA. Therefore, skeletally mature patients, with no history of previous knee surgical procedures, who underwent isolated TKA for knee osteoarthritis, were included in this study. The patients were prospectively divided into two homogeneous groups according to the different surgical techniques performed (KA-TKA and MA-TKA groups). Clinical and functional scores (VAS, KOOS-PS, MCS-12, Final KSS, and Functional KSS) were collected pre- and postoperatively at a mean follow-up of 3 three months. As a result, 26 patients were included in the study, with a mean age of 69.3±7.61 years old (range: 55 - 84 years old). There were 38.5% male and 61.5% female. There were 13 patients in KA-TKA and 13 patients in MA-TKA. Three months after surgery each of the scores tested demonstrated statistically significant better outcomes in KA-TKA, compared to the MA-TKA group. MCS-12 resulted comparable in the two study groups. This preliminary study compares the short-term clinical and functional outcomes between KA and MA in total knee replacement. Further studies are required to confirm these results and to extend the sample size to obtain reliable clinical evidences.

Bilateral THA in the same sitting for avascular necrosis of the head of the femur in sickle cell patient: our African experience.

Sickle cell anemia is protective against the malaria protozoan. The heterozygous form of the disease is not fatal, and may cause musculoskeletal disorders when sickling occurs, and small vessels are occluded. When the head of the femur is involved, this may result in hip arthritis, often bilateral, at a young age. This article describes three patients in whom bilateral total hip arthroplasty (THA) was performed in the context of a humanitarian mission in Togo, Africa.

Periprosthetic joint infection from Mycobacterium Tuberculosis in Togo, Africa.

Mycobacterium Tuberculosis infections are moderately frequent in developing countries. Because of migratory flows, these diseases will always have an increasing prevalence even in those countries that do not usually present these types of cases. Extra-pulmonary tuberculosis often affects the musculoskeletal system. The sites most involved are the spine (Pott's disease) and the large joints, especially hips and knees. We describe a patient with tuberculosis of the hip, who underwent total hip arthroplasty.

One-stage Bilateral Total Hip Arthroplasty in patient with sickle cell disease and previous Girdlestone procedure on the right side: First presentation in Togo.

80% of Sickle Cell Disease cases are estimated to be in Sub-Saharan Africa. It can lead to various acute and chronic complications and osteonecrosis of the femoral head is one of these. Girdlestone procedure is an option to treat osteonecrosis in patients who could not afford arthroplasty. We report here the first case of bilateral total hip arthroplasty in a patient with a previous Girdlestone procedure on the right side and an osteonecrosis of the femoral hip on the left side.

Total hip arthroplasty for osteonecrosis of the femoral head in sickle cell disease: a case series from our African experience.

Sickle cell disease causes osteonecrosis (20% to 50% of patients) and collapse of the femoral head that result in secondary osteoarthritis. Total hip arthroplasty (THA) is a valid alternative for these patients. We define the difficulties that can be encountered when undertaking THA in sickle cell disease patients and give advice on how to deal with these technically demanding procedures. We undertook total hip arthroplasty procedures on 12 patients (4 females and 8 males) with osteonecrosis of the femoral head. Two bilateral prostheses were performed. We had only one type of stem, only one type of acetabular cup and only 28 mm cobalt chrome heads. The procedures were performed through either an anterior or a direct lateral approach. The average size of the Cup was 46 (Versafit, Medacta), the average size of the femoral stem was 0 (Amistem, Medacta), the most used size of the modular head was a S. Standard stem that was used in nine patients, while three patients received a lateralizing stem. Three patients had periprosthetic fracture, treated by cerclage. Total hip replacement is an excellent alternative for patients with osteonecrosis from sickle cell disease. The preparation of the acetabulum and the femur is difficult and requires attention, time and appropriate equipment.

Comparison of early functional outcomes between two different surgical approaches for total hip arthroplasty.

Total Hip Arthroplasty (THA) is considered the most successful treatment for advanced hip osteoarthritis. Different surgical approaches for THA are available and they have shown excellent outcomes in the long-term follow-ups. However, few studies have analyzed the functional outcomes in the first days after a THA surgery. The purpose of this study was to compare the early functional outcomes between two different surgical techniques: a minimally invasive direct anterior approach (mini-DAA) and a postero-lateral approach (PL). Twelve patients for each group were analyzed. Pre- and postoperative (3, 10, 30 and 90 days after surgery) Patient-Reported Outcome Measures (PROMs) were administered: HOOS, HHS, VAS and SF-12-v2 scores. Moreover, comparison between surgical operation time and blood loss were examined. PROMs showed a significant improvement in the SF-12-v2 in the mini-DAA group compared to the PL group at 3 days after surgery: this difference was maintained also after 10 and 30 days. In addition, HOOS and HHS were significantly ameliorated in the mini-DAA group starting 10 days from surgery. In both groups, a physiological pain reduction was observed in the first days after surgery; comparing it to the pre-surgical VAS values, we found a significant improvement in the scores for the mini-DAA group after 30 days. Moreover, we demonstrated a significant reduction in blood loss for the mini-DAA group. Surgical operation times were similar in the two groups; however, the duration of the mini-DAA procedure was shorter compared with the known literature. In this preliminary study, we demonstrated that the minimally invasive direct anterior approach for THA may lead to benefits in the early postoperative time, as it allows for an improvement in functional outcomes, a reduction of postoperative pain, a reduction of hospitalization time and consequent reduction of postoperative complications; therefore, this surgical approach may consent an early return to work and daily activities.

Comparison of three intravenous regimens of clodronate in Paget disease of bone.

We compared the effects of three different regimens of intravenous clodronate in a retrospective study of 60 patients with Paget disease. A total dose of 1500 mg of clodronate was given as 300 mg for 5 consecutive days (n = 20), 1500 mg as a single infusion (n = 20), or 300 mg as a single infusion for 5 consecutive months (n = 20). The response to treatment and the duration of the effect were assessed from sequential changes in the activity of serum alkaline phosphatase. Treatment with clodronate induced a significant response in 85% of patients. The response rate was comparable in patients treated with 5 daily infusions (90%), with a single infusion (75%), and with 5 monthly infusions (90%). The median duration of response from the start of treatment was 11 months for those treated with five daily infusions and 12 months for the other two regimens. At one year, 22, 40, and 44% of patients had maintained their response in the daily, single, and monthly infusion regimen, respectively (NS). Six patients (32%) treated with 5 daily infusions achieved a remission (complete response) compared with 3 patients treated with a single infusion and 5 monthly infusions, respectively (16 and 15% respectively, NS). Patients attaining a complete response had a significantly longer duration of response compared with partial responders (median time 15.0 versus 11.5 months, respectively, p < 0.05). We conclude that intravenous clodronate (total dose 1500 mg) suppresses disease activity in the majority of patients with Paget disease of bone. The degree and duration of response were similar for the three regimens. Thus, in the treatment of Paget disease, the choice of regimen is a matter of convenience.

[Influence of nutrition, age and vitamin D status on fasting urinary excretion of calcium in postmenopausal women]. / Influenza della nutrizione, dell'età e dell'assetto vitaminico D sull'escrezione urinaria del calcio a digiuno nelle donne in menopausa.

The purpose of the present study was to evaluate the influence of nutrition, age, and Vitamin D status on fasting urinary calcium (Ca) as a function of creatinine excretion (Ca/Cr) and of glomerular filtration rate (Ca/GFR) in postmenopausal women. Fasting urinary calcium, urinary Cr and GFR were measured in 18 women aged 54 to 91 years before and after six days of a calcium (400 mg/die) and sodium (100 mEq/die) restricted diet with a controlled content of proteins, lipids and glucides. Aged (over 64 y.) women having an adequate vitamin D status showed fasting urinary Ca/Cr and Ca/GFR after the controlled diet significantly lower than those showed before. It is concluded that fasting Ca/Cr and Ca/GFR may be nutrition-dependent. A revision of the significance of the fasting urinary Ca excretion is consequently suggested.

[Nutrients, anthropometric characteristics and osteoporosis in women in the recent and late postmenopausal period]. / Nutrienti, caratteristiche antropometriche ed osteoporosi delle donne in età postmenopausale recente e remota.

Bone mineral content (BMC) at two different radial sites (mid-diaphysis and ultra-distal epiphysis), anthropometric measurements (Body Mass Index, Lipidic Area, and Muscular Area) and nutrients intake were measured in two populations of women selected on the basis of early (< 9 years) or remote (> 15 years) menopause. The results show the presence of positive relationships between BMC, and protein and lipid intakes in the population of women in early menopause; in the other population no relationships were found. Glucid, fibre and calcium intakes were not related to the BMC of both populations. The positive relationships between BMC, and protein and lipid intakes in the population of women in early menopause is likely mediated by anthropometric characteristics as Body Mass Index and Muscular Area.

[Rehabilitative physiotherapy in Soviet medicine]. / La fisioterapia riabilitativa nella medicina sovietica.

There are three different levels of rehabilitational physical therapy in heart diseases in the Soviet Union. Natural methods are used such as climate therapy, baths, sunshine and physiotherapy as well as artificial methods including laser, electric and mechanical energy, etc. Artificially produced mineral waters which are identical to natural ones are also applied. All these methods yield good results in myocardial infarction, cerebral ictus, coronary diseases, cerebral ischemia, hypothyroidism, etc.

[Climate and psychosomatic medicine]. / Clima e medicina psicosomatica.

In the last few years, psychosomatic medicine has accomplished very important and interesting analyses of several medical syndromes. On the contrary, medical climatology, even with the development of new tools for climate research, has remained linked to old ideas which need to be revised in order to keep pace with the latest discoveries in this field. It is therefore desirable to undertake research on the action of different climates and microclimates on the human organism, and also to take into account the patients, tendencies and aspirations, because "the climate that will yield the best results is the climate the patient likes best". In conclusion, taking into account a patient's personality and aspirations, thermal therapies and climate treatments may be coupled. As a matter of fact, in our country it is possible to find spas with the same kind of waters but with completely different climates.

[Effects of beta blocking agent iontophoresis by modulated sinusoidal current]. / Effetti della ionoforesi con beta-bloccanti con corrente sinusoidale modulata.

The action of the transcutaneous application of propranolol using modulated sinusoidal current iontophoresis was studied. When this way of administration is used, the drug, while maintaining its negative chronotropic effect, loses the negative inotropic one. Investigations were performed on 58 men aged 32 to 62 who underwent an aortocoronary bypass for myocardial ischemia. Thirty-four patients had already had myocardial infarction. The drug reduced the heart rate and increased cardiac contractility. Moreover, the study showed that only the levogyral isomer of propranolol (the only active one) passes through the skin.

[Effects of short-wave therapy in patients with chronic pyelonephritis]. / Effetto della marconiterapia in pazienti con pielonefrite cronica.

One hundred and twenty patients (64 men and 56 women, aged 19 to 63) with chronic pyelonephritis were subdivided into two groups: a control group of 30 subjects and an experimental one of 90 subjects. Experimental subjects underwent short wave therapy (460 MHz, 50-60 W, for 8-20 minutes) in the lumbar area. Lumbosacral pain disappeared in 87 out of 90, subjects, intercostal pain in 20 out of 28, headache mitigated in 40 out of 53, asthenia was markedly reduced in 49 out of 50. Systolic and diastolic hypertension was reduced, as well as the Kakorski-Addis count in urine. Diurnal diuresis and lysozyme increased, while IgG, IgA and IgM were reduced.

[Cardiovascular effects of sodium chloride bath and underwater shower in coronary ischemia]. / Effetti cardiovascolari del bagno cloruro-sodico e della doccia subacquea nell'ischemia coronarica.

Two hundred and eighteen patients (209 males and 9 females, mean age 57.1 +/- 0.6 years) with I class coronary ischemia were subdivided into two groups of 109 subjects each. Group I received NaCl baths, group II underwater massage-showers. On days 2-3 and 23-24 of treatment all underwent incremental stress testing until exhaustion. In group I, only subjects with moderate maximal muscular power improved their stress endurance. In group II, stress endurance significantly improved in all subjects: all hemodynamic indices (cardiac, output, stroke volume, systemic vascular resistances) showed variations indicative of improved cardiorespiratory function and peripheral blood supply.

[Effects of sauna on the values of blood circulation studied by the isometric exercise test]. / Effetto della sauna sui valori della circolazione del sangue studiata con il test a carico isometrico.

Cardiovascular responses to isometric muscular exercise were evaluated during sauna. Nine healthy men aged 26 to 46 underwent testing during 5-6 saunas with one week interval between sessions. Each sauna included 2-6 heatings of 8-15 minutes (80-85 degrees C, humidity 15%) followed by complete cooling. Cardiovascular response during handgrip (45 seconds) were measured before sauna, after the first interval and 25 minutes after the end of sauna treatment.

[The effect of the use of sinusoidal modulated currents on the recovery of athletes]. / Effetto dell'applicazione delle correnti sinusoidali modulate nel recupero degli atleti.

Modular sinusoidal currents were used to optimize the recovery process of the force of athletes' muscles. 113 elite athletes were analyzed. They were participants in rowing, cycling, tennis and Greco-Roman wrestling. In all cases the modular sinusoidal currents were applied to the dorso-cervical and lumbar regions. It was found that applications to the dorso-cervical regions normalize the altered parameters of the cardiovascular system and increase the capacity of the humeral muscles to contract. Furthermore they stabilize the adrenergic sympathetic zone and stimulate the immune system.

[Correction by physiotherapy of immune disorders in high-grade athletes]. / Correzione mediante fisioterapia dei disturbi immunitari negli atleti di alto livello.

It is well known that during intense training and competitions athletes show a remarkable reduction of their immunological responses. As a matter of fact, during these periods athletes very frequently (five to ten times more than average) fall ill. In order to correct this situation, in the USSR immunomodulator drugs are used together with high frequency electromagnetic waves which are applied on the body surface corresponding to the adrenal glands. In this way body desensitisation is accelerated. One hundred high-level athletes received an application of electromagnetic waves on the body surface corresponding to the thyroid gland and thymus, so as to lower glucocorticoid activity and activate lymphoid tissue. Indices of immunologic reactivity and hormonal levels after electromagnetic treatment were measured in all athletes.

[Meteoropathy: a syndrome continuously on the increase]. / Meteoropatia: una sindrome in continuo aumento.

The authors describe the different kinds of meteoropathies, pointing out how these disorders are becoming ever more frequent in countries belonging to the consumer and welfare society due to the progressive lowering of body resistance and immunologic responses. These "unfavourable meteosyndromes", as meteoropathies should be called, develop when wave disturbances arrive, and are more manifest and persistent in subjects with neurologic disturbances, i.e. in the presence of anxiety, stress, hypertension, coronary artery disease, arthropathy, hyperthyroidism, etc. The different moments in which meteoropathies are more frequent and the possible therapies are also discussed.