Simultaneous vs staged bilateral hip arthroplasty: monocentric analysis of satisfaction rate and complications.

PURPOSE: Interest in bilateral total hip arthroplasty (THA) has been increasing over the past decade. This study aims to compare postoperative local and systemic complications, hospital readmissions, and satisfaction assessment in patients undergoing simultaneous versus staged bilateral THA. METHODS: A retrospective observational study was conducted among patients who underwent simultaneous or staged bilateral THA between 2017 and 2020. Data on perioperative parameters, local and systemic complications, and 30-day hospital readmissions were collected. Patient satisfaction was assessed using Forgotten Joint Score (FJS). The comparison of continuous variables with normal distribution of variance was performed by ANOVA; for variables with abnormal distribution, the nonparametric test Mann-Whitney U was adopted. The distribution of dichotomous variables was analyzed by chi-square test, and statistical significance was calculated by Fisher exact test. RESULTS: The study included 199 patients, of whom 156 underwent staged and 43 simultaneous bilateral THA. A total of 44 patients developed complications (21 systemics, 12 locals, and 20 postoperative anemia). There were no significant differences regarding local (simultaneous 5% vs. staged 6%; p = 0.999) or systemic complications (simultaneous 14% vs. staged 10%; p = 0.408). Only the incidence of postoperative anemia was significantly higher in simultaneous group compared with staged group (p = 0.003). There were no significant differences in FJS between the two groups (p = 0.258). CONCLUSION: No differences in local or systemic complications nor readmission rates were observed following simultaneous or staged bilateral THA. Simultaneous bilateral THA is non-inferior to staged implants in terms of safety and patient satisfaction.

Heterotopic hip ossification resection: monocentric experiences of associated factors, outcomes, and complications.

PURPOSE: The exponential increase in total hip arthroplasty (THA) has led to acute and chronic surgery-related complications. Common chronic and local complications are represented by hip ossification (HO). The aim of our study was to assess the clinical and radiological correlates of patients undergoing surgical removal of heterotopic ossifications after THA and the possible association between HO and prosthetic joint infection. METHODS: Data of 26 patients who underwent surgical removal of periprosthetic calcifications after THA from 2000 to 2022 were analyzed and compared with characteristics of 156 subjects without HO. RESULTS: The preoperative radiographs of patients showed a high-grade Brooker, 3 or 4, later reduced to 1 or 2 in the postoperative radiographs. Ten (38.5%) patients underwent radiotherapy prophylaxis, administered as a single dose 24 h before surgery. In 19 (73%) patients, pharmacological prophylaxis with indomethacin was added in the 30 postoperative days. Only one patient who underwent radiotherapy had a recurrence, while new ossifications were found in three patients without prophylaxis (11.5%). Intraoperative cultures were performed for suspected periprosthetic infection in 8 study group patients. In logistic regression, the presence of HO was significantly and inversely associated with the ASA score (OR = 0.27, 95% CI = 0.09-0.82; P = 0.021) after adjusting. CONCLUSION: Surgical HO removal in symptomatic patients with high-grade disease produces good clinical and radiographic results. Radiotherapy was a good perioperative and preventive strategy for recurrence, also associated with NSAIDs and COX-2 inhibitors.

Sport activity as risk factor for early knee osteoarthritis.

There is wide discussion about the association between sport activity and musculoskeletal disorders, as sports-related joint loading increases the risk of osteoarthritis (OA). The present article reviews the current available literature on the connections between participation in several sports and athletic activities and prevalence of knee OA, especially focusing on early knee OA. The study was based on an electronic search through web databases including Medline, Cochrane and Google Scholar. Articles were retrieved and evaluated, and case series, retrospective studies, case-control studies, prospective cohort studies and randomized controlled trials were considered for inclusion. The main data were extracted and summarized in tables and text. Athletic individuals do show an increased prevalence of knee OA, especially for professional athletes when compared to general population or non-professional athletes. Furthermore, several features related to sport activity were associated to increased risk of early knee OA, such as knee ligamentous injury, concussion, high-impact sports and different team roles. Methodology and results of the included studies are barely comparable, thus preventing the authors to carry out an accurate and systematic comparison of the results of the included studies. Only low level evidence studies are available, and better designed studies, with radiological and functional evaluation of the knee based on internationally validated measures, should be planned. Also, follow-up of patients during and after their life-period of sport involvement should be considered.

The use of SAMe in chemotherapy-induced liver injury.

Drug-induced liver injury (DILI) remains the most common cause of acute liver failure in the Western world. Chemotherapy is one of the major class of drugs most frequently associated with idiosyncratic DILI. For this reason, patients who receive chemotherapy require careful assessment of liver function prior to treatment to determine which drugs may not be appropriate and which drug doses should be modified. S-adenosylmethionine (SAMe) is an endogenous agent derived from methionine. Its supplementation is effective in the treatment of liver disease, in particular intrahepatic cholestasis (IHC). The target of this review is to analyze the mechanisms of hepatotoxicity of the principal anticancer agents and the role of SAMe in the prevention of this complication.

Hepatic complications of bariatric surgery : the reverse side of the coin.

BACKGROUND: Even if the jejunoileal bypass has been definitely abandoned due to the high rate of hepatic complications, cases of liver injury after the new bariatric procedures are still reported. We aimed to review the available literature concerning liver damage associated with the older and newer types of bariatric surgeries. METHODS: An extensive literature search of MEDLINE was performed using different combinations of the following terms: "bariatric surgery OR biliopancreatic diversion OR jejunoileal bypass OR roux-en-y gastric bypass OR vertical banded gastroplasty OR laparoscopic adjustable gastric banding" AND "hepatic/liver damage OR hepatic/liver impairment OR hepatic/liver failure". RESULTS: Although weight loss after bariatric surgery frequently induces an improvement of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, and even the regression of hepatic fibrosis, bariatric procedures have been also associated with cases of acute liver failure or of chronic liver disease evolving until cirrhosis. After the jejunoileal bypass has been definitely abandoned, most of the recently described cases concern biliopancreatic diversion with/without duodenal switch, but liver damage has been reported after almost all types of bariatric surgeries. Protein-calorie malnutrition, bacterial overgrowth, lipotoxicity and genetic background are likely to play a central role in the physiopathology of hepatic injury. CONCLUSIONS: Understanding the inner mechanisms underlying acute or chronic liver injury after bariatric surgery can help in the prevention, early recognition and treatment of these rare but concrete cases.