Unicompartmental knee arthroplasty: all-poly versus metal-backed tibial component-a long-term follow-up study.

INTRODUCTION: While considered a satisfactory solution, unicompartmental knee arthroplasty (UKA) still raises concerns in regard to its durability. These concerns particularly focus on the tibial component. This study aims to compare two different cemented tibial components belonging to the same UKA design: all polyethylene (AP) versus metal backed (MB), at a long-term follow-up. MATERIALS AND METHODS: We retrospectively reviewed 143 successive patients, 83 of which underwent surgery with AP tibial component UKA (37 males, 46 females), and 67 with MB ones (17 males, 50 females). All implants had the same prosthetic design (Accuris UKA, Smith e Nephew) with identical femoral oxinium component but different tibial component, AP or MB. The KSS and KOOS were assessed at a mean of 11.5-year follow-up and compared to pre-operative, post-operative, and one year evaluation. Statistical analysis was performed with SPSS for Mac (version 17.0). To assess potential statistically significant differences, t test was used and significance was set at P < 0.05. RESULTS: Final KSS at a mean of 11.5-year follow-up was 94.27 for the AP group and 96.12 for the MB ones. The final KOOS was 87 for AP components and 89.67 for the MB group. These results demonstrated, in all cases, statistically significant better results for MB tibial components compared to AP regarding KSS (P = 0.048), KOOS (P = 0.000), and pain (P = 0.014) at the 11.5-year follow-up. Survivorship for AP tibial component implants was 97.6%, while it was 89.5% for MB ones. CONCLUSION: While the survivorship rate has been found to be greater for AP implants compared to MB tibial components, this study reveals statistically better functional results according to KSS and KOOS, and pain, at a long-term follow-up for MB implants.

Involvement of pro-inflammatory cytokines and growth factors in the pathogenesis of Dupuytren's contracture: a novel target for a possible future therapeutic strategy?

Dupuytren's contracture (DC) is a benign fibro-proliferative disease of the hand causing fibrotic nodules and fascial cords which determine debilitating contracture and deformities of fingers and hands. The present study was designed to characterize pro-inflammatory cytokines and growth factors involved in the pathogenesis, progression and recurrence of this disease, in order to find novel targets for alternative therapies and strategies in controlling DC. The expression of pro-inflammatory cytokines and of growth factors was detected by immunohistochemistry in fibrotic nodules and normal palmar fascia resected respectively from patients affected by DC and carpal tunnel syndrome (CTS; as negative controls). Reverse transcription (RT)-PCR analysis and immunofluorescence were performed to quantify the expression of transforming growth factor (TGF)-ß1, interleukin (IL)-1ß and vascular endothelial growth factor (VEGF) by primary cultures of myofibroblasts and fibroblasts isolated from Dupuytren's nodules. Histological analysis showed high cellularity and high proliferation rate in Dupuytren's tissue, together with the presence of myofibroblastic isotypes; immunohistochemical staining for macrophages was completely negative. In addition, a strong expression of TGF-ß1, IL-1ß and VEGF was evident in the extracellular matrix and in the cytoplasm of fibroblasts and myofibroblasts in Dupuytren's nodular tissues, as compared with control tissues. These results were confirmed by RT-PCR and by immunofluorescence in pathological and normal primary cell cultures. These preliminary observations suggest that TGF-ß1, IL-1ß and VEGF may be considered potential therapeutic targets in the treatment of Dupuytren's disease (DD).

Interferon-γ Possesses Anti-Microbial and Immunomodulatory Activity on a Chlamydia Trachomatis Infection Model of Primary Human Synovial Fibroblasts.

Chlamydia trachomatis, an obligate intracellular pathogen, is the most common cause of bacterial sexually transmitted diseases, and it is potentially responsible for severe chronic sequelae, such as reactive arthritis. To date, details of the mechanisms by which Chlamydiae induce innate antimicrobial pathways in synovial fibroblasts, are not well characterized; therefore, herein, we investigated the effects of interferon (IFN)α, IFNß, and IFNγ on the infection, and replication phases of the C. trachomatis developmental cycle, as well as on the induction of pattern recognition receptors (PRRs) and IFN-related pathways. To do so, we set up an in vitro chlamydial-infection model of primary human synovial cells treated with IFNs before or after the infection. We then determined the number of chlamydial inclusion forming units and inclusion size, as well as the expression of toll like receptor (TLR)2, TLR3, TLR4, cyclic GMP-AMP synthase (cGAS), stimulator of IFN gene (STING), IRF9, ISG56, and GBP1. The main result of our study is the significant inhibition of C. trachomatis infection and replication in human synovial cells following the treatment with IFNγ, whereas IFN-I proved to be ineffective. Furthermore, IFNγ greatly upregulated all the PRRs and ISGs examined. In conclusion, IFNγ exhibited a potent anti-Chlamydia activity in human synovial cells as well as the ability to induce a strong increase of innate immune pathways.

Efficacy of betamethasone valerate medicated plaster on painful chronic elbow tendinopathy: a double-blind, randomized, placebo-controlled trial.

OBJECTIVE: to investigate the efficacy and safety of a medicated plaster containing betamethasone valerate (BMV) 2.25 mg in patients with chronic elbow tendinopathy. METHODS: randomized, double-blind, placebo-controlled study with assignment 2:2:1:1 to BMV medicated plaster applied daily for 12 hours, daily for 24 hours or matched placebo. 62 patients aged ≥18 years with chronic lateral elbow tendinopathy were randomized. The primary efficacy variable was pain reduction (VAS) at day 28. Secondary objectives included summed pain intensity differences (SPID), overall treatment efficacy and tolerability. RESULTS: mean reduction in VAS pain score at day 28 was greater in both BMV medicated plaster groups, -39.35±27.69 mm for BMV12-h and -36.91±32.50 mm for BMV24-h, than with placebo, -20.20±27.32 mm. Considering the adjusted mean decreases, there was a statistically significant difference between BMV12-h and placebo (p=0.0110). Global pain relief (SPID) and overall treatment efficacy were significantly better with BMV. BMV and placebo plasters had similar local tolerability and there were few treatment-related adverse events. CONCLUSIONS: BMV plaster was significantly more effective than placebo at reducing pain in patients with chronic elbow tendinopathies. The BMV plaster was safe and well tolerated.