Analysis of Results After Surgical Application of Bone Marrow Aspirate Stem Cell Concentrate in the Treatment of Avascular Necrosis of the Femoral Head.

Introduction: Avascular necrosis or osteonecrosis of the femoral head is defined as a pathological process that results in a critical reduction in the blood supply to the hip head with increased intraosseous pressure. Avascular necrosis is a multifactorial disease. The treatment used so far consists of transosseous decompression of the femoral head and is the most commonly used method in the early stages of osteonecrosis. Aim: The aim of this study was to evaluate the results after application of bone marrow stem cells obtained from the pelvic ridge, which was applied to the necrotic zone after previous decompression. Material and methods. The study is of prospective character and included 30 patients with first, second, and third degrees of AVN according to the Ficat classification, determined with X-ray. The range of motion in the hip was examined preoperatively by using a goniometer, a radiological evaluation of the degree of AVN was performed, according to the Ficat classification, and the VAS scale and the Harris Hip Score were examined preoperatively and postoperatively. Results: The average value for the Harris Hip Score (HHS) preoperatively was: for Ficat I -66.32±5.1, for Ficat II - 49.19±3.4 and for Ficat III - 33.71±2.1. At the 3-month postoperative follow-up, the average HHS values were: 87.92±4.3 for Ficat I, 78.64±6.6 for Ficat II and 76.48±2.6 for Ficat III. The same values for HHS were obtained in the control examinations at the 6th and 12th month postoperatively, indicating the fact that good bone regeneration was achieved and the progression of the condition was prevented. A decrease in the HHS value was observed at the control examination at 1 year after the surgical treatment, in 3 patients according to the Ficat classification of grade III, in whom a total hip replacement surgery was performed. Conclusion: The use of stem cells in the treatment of avascular necrosis of the femoral head has achieved good functional results and reduced pain in operated patients. Radiographically, good bone regeneration was achieved and the progression of necrosis to a higher degree was prevented.

Effect of Exercises on Quality of Life in Patients with Postmenopausal Osteoporosis - Randomized Trial.

BACKGROUND: Osteoporosis is a systemic skeletal disease characterised by a low bone density and microarchitectural deterioration of bone tissue leading to decrease of its strength and increased risk of fracture. Drug therapy decreases the risk of fracture, thus influencing on the mechanism of bone remodelling. Non-pharmacological interventions include specific exercises for osteoporosis that improve muscle strength and balance, decrease pain and improve quality of life. AIM: To compare the quality of life in patients with postmenopausal osteoporosis who practice exercises with those who do not practice on the beginning and after a year. MATERIJAL AND METHODS: A randomised Single-blind randomised controlled prospective trial study, which included 92 women with postmenopausal osteoporosis diagnosed and treated at the Institute of Physical Medicine and Rehabilitation in Skopje, Republic of Macedonia. Patients were randomly assigned to three groups: the first group of patients with exercises and physical modalities (gr. I), the second group with exercises (gr. II), and the third control group of patients who did not practice exercises (gr. III). Exercises were practised 3 times a week; each exercise was repeated for 5-8 times. Patients regularly took bisphosphonates, calcium and vitamin D. The follow-up period lasted for one year. Quality of life was determined with a specific questionnaire Qualeffo-41. RESULTS: The results showed, significant statistical difference in terms of pain, physical activity, social life, the perception of own health were shown between the groups (p < 0.0001), only in term of mental function were no significant (p < 0.3). CONCLUSION: Patients who practice exercises for osteoporosis have a significantly better quality of life than patients who do not perform exercises.

Effects of High - Intensity Laser in Treatment of Patients with Chronic Low Back Pain.

BACKGROUND: Chronic low back pain lasts longer than 12 weeks and is characterised by pain, muscle weakness, reduced functional ability and psychosocial burden. AIM: To compare the effects of two physical modalities, high-intensity laser against ultrasound therapy in the treatment of patients with chronic low back pain. MATERIAL AND METHODS: This was a prospective, monocentric, controlled clinical study comprising a group of 54 patients at the age between 25 and 65 years. Patients were divided into two groups: an examined group of 27 patients (high-intensity laser and exercises) and a control group of 27 patients (ultrasound therapy and exercises). The results were evaluated by the Numeric Pain Rating Scale, Oswestry Disability Index and Schober's test. Clinical findings were evaluated at the same time points for all patients, before treatment, at two weeks and three months following treatment. Statistical analyses were made to compare the differences between the results obtained on admission and the two consecutive control check-ups. Statistical significance was defined as a P value < 0.05. RESULTS: The examined group showed statistically significantly better results than the control group after completion of the treatment (at two weeks) and at follow up after three months. CONCLUSION: This study has shown that patient with chronic low back pain treated with a high-intensity laser has significantly reduced low back pain, reduced disability and improved range of motion. Its positive effect maintained for three months. It seems to be an effective, safe and useful physical modality in the treatment of a patient with chronic low back pain.

The Effectiveness of Radial Extracorporeal Shock Wave Therapy for Chronic Achilles Tendinopathy: A Case Report with 18 Months Follow-Up.

BACKGROUND: Achilles tendinopathy (AT) is a pathological state resulting from repetitive loading or stress on the tendon. The article aims to evaluate the effects of the low - energy radial extracorporeal shockwave therapy (RESWT) in the treatment of the adult with chronic insertional Achilles tendinopathy (AT) after the unsuccessful conservative treatment, with 18 months follow - up evaluation. CASE REPORT: We report the case of a 55 years - old male suffering from severe right posterior heel pain for 4 months. For his chronic insertional Achilles tendinopathy on the right heel, he received conservative treatment in the Institute of Physical Medicine and Rehabilitation. For outcome assessment, Numerical Rating Scale (NRS) for pain, the range of motion in the ankle, and Roles-Maudsley Score (RMS) for assessment of function were used. At the baseline the pain was severe, and he received physical therapy treatment. After unsuccessful conservative treatment, he underwent RESWT treatment. Numeric Rating Scale was significantly decreased at immediate, short-term and long-term follow-up. After the last treatment, the patient had no pain, and function assessed by Roles-Maudsley Score was excellent. At the follow-up check-up at 3, 6, 12 and 18 months the patient had no pain and excellent functional results. CONCLUSION: Radial ESWT is a safe and effective treatment even for a longer period for patients with chronic insertional Achilles tendinopathy.