Short- to mid-term follow-up effectiveness of US-guided focal extracorporeal shock wave therapy in the treatment of elbow lateral epicondylitis

BACKGROUND

Lateral epicondylitis of the elbow is a common and disabling overuse syndrome. Several treatment modalities are currently available for this condition, but the optimal treatment method remains undefined. Extracorporeal shock wave therapy (ESWT) has been widely used in the last 10 years, although conflicting results are present in the literature.

MATERIALS AND METHODS

In this study, we evaluated 36 patients (37 elbows), with a mean follow-up time of 24.8 months. Focal ESWT was administered by means of an electromagnetic generator equipped with in-line ultrasound guidance, during one or more cycles of 3-4 weekly sessions. In the setting of the study, patients were clinically evaluated and subjective satisfaction and rate of relapse were investigated.

RESULTS

A positive response was described in 75.7 % of the patients after treatment. Mean quickDASH score and VAS attested at 5.5 and 1.1, respectively. Roles and Maudsley score was rated as I or II in 33 cases. Four patients resulted not responders to the therapy, while 5 patients complained one or more episodes of symptoms relapse. No influence on the final outcome was evident with respect to demographic features and previous therapies as well. Response rate to further ESWT cycles in patients refractory to the first cycle of ESWT was 33.3 %.

CONCLUSIONS

Focal ESWT represents a valuable and safe solution in case of elbow lateral epicondylitis, both in newly diagnosed and previously treated cases, representing a definitive treatment in the majority of patients. Patients refractory to a 3- to 4-session ESWT cycle have lower chances of positive response after further ESWT cycles.

Total knee arthroplasty with rotating-hinge Endo-Model prosthesis: clinical results in complex primary and revision surgery

INTRODUCTION

Rotating-hinge knee implants are highly constrained devices able to provide the stability needed for arthroplasty in case of severe bone loss and complex instability. Notable doubts still exist in using rotating-hinge devices, mainly due to risk of mechanical failure and risk of infection.

MATERIALS AND METHODS

We retrospectively evaluated the functional and clinical outcomes in a series of patients treated with the rotating-hinge Endo-Model prosthesis either for primary or revision total knee arthroplasty. Between 1997 and 2009 we implanted 123 Endo-Model prosthesis (118 patients) at our institution. At the time of this study we could evaluate 45 prosthesis (25 primary and 20 revision TKAs) from the clinical and radiological site, with average follow-up of 42.2 months.

RESULTS

During the follow-up period, three patients reported complications, which in two cases finally led to revision with explantation. Mean survival of the implants attested at 93.3 %. The average post-operative clinical Knee Society score in the evaluated series was 94.2, the functional one 78.7. The average range of motion was 0°-108°. No signs of joint instability or misalignment were noted. Pain was present in a minority of patients, but always at a mild/occasional extent. No evidences of loosening or implant failure have been reported. No substantial divergences in the outcomes have been found across different patient categories after stratification in agreement with the Knee Society.

CONCLUSIONS

Coherent with previously published works, we confirm the Endo-Model prosthesis to provide excellent pain relief, restoration of walking capacity and intrinsic knee stability both in complex primary and in revision knee arthroplasty, with good or excellent results in the majority of patients and acceptable complication rate.

Shoulder hemiarthroplasty for complex humeral fractures: a 5 to 10-year follow-up retrospective study

BACKGROUND

Shoulder hemiarthroplasty is considered a standard treatment in case of complex proximal humeral fractures. However, great variability affects the clinical outcomes. In this work, we examined the clinical and radiographic outcomes in a series of patients treated with hemiarthroplasty for 3- and 4-part humeral fractures and focused on factors affecting the final result.

MATERIALS AND METHODS

In this study, we included 27 patients who had received a shoulder hemiarthroplasty between 2001 and 2005 at our institution. These patients were evaluated at an average of 7.2 years after surgery. All patients were managed within 10 days from trauma by the same surgeon and underwent the same time-scheduled rehabilitation program. Average age at surgery was 71.9 years.

RESULTS

Implant survival was 88.9 %. At the latest follow-up, mean DASH and SST-12 scores were 26.8 and 6.5, respectively. Mean Constant-Murley score was 52.4. Tuberosities complications and reduction in the acromion-humeral distance were negatively related to clinical outcome. Age at surgery displayed a negative correlation with clinical outcome, despite not reaching the statistical significance. This is mainly due to great variability in the elder group of patients.

CONCLUSIONS

Shoulder hemiarthroplasty is a useful and effective solution for complex humeral fractures, with good results in the majority of patients. However, outcomes display a great variability in relation to X-ray alterations and age at surgery. A careful attention in patient selection is needed in order to standardize the clinical results associated with this kind of prosthetic implant.

Prevalence of HFE and TFR2 gene mutation in 118 Ligurian rheumatic patients

AIM

HFE gene is associated to haemochromatosis, an inherited autosomal recessive disorder responsible of an overload of iron in intestine, liver, pancreas, heart, cutis and joints. Articular and periarticular calcifications may occur. H63D mutation may play a role in the pathogenesis of rheumatoid arthritis.

METHODS

DNA of 118 consecutive patients (28 males, 90 females, mean age 58.5+/-13.44) living in Liguria and affected by different rheumatic diseases was examined to evaluate the presence of HFE mutations.

RESULTS

Analysis data showed that in 45% (53/118) of patients almost one mutation of HFE gene was present and the presence of H63D mutation in the rheumatic patients was particularly elevated. Data obtained in this study have permitted to reveal that 25 patients of 53 (47.1%) with 1 of 11 HFE mutations suffered from symptomatic or silent chondrocalcinosis.

CONCLUSIONS

The conclusion is drawn that this mutation may be correlated to various rheumatic diseases.

Joint involvement patterns in nodal versus erosive osteoarthritis of the hands

The aim of this study was to evaluate the joint count for affected joints and involvement distribution in erosive osteoarthritis (EOA) versus nodal osteoarthritis (NOA) of the hands in patients matched for sex, age, and disease duration. After recruitment of 101 consecutive outpatients affected with EOA, 101 patients affected by NOA were selected and matched for age, sex, and disease duration. Joint count for distal interphalangeal (DIP), proximal interphalangeal (PIP), and first carpo-metacarpal (CMC-1) joints, presenting Kellgren and Lawrence grade 2-4 OA, was performed. In our study, the number of affected joints was higher in NOA, with significant differences for some articular districts, especially in PIP joints of the fourth finger, and DIP joints of the second, third and fourth fingers.

The treatment of infantile coxa vara with the external circular fixator

Coxa vara worsens as it evolves, and is often accompanied by other femoral deformities, such as hypometria, axial knee deviations, and rotational deformity. Traditional surgical techniques, especially intracapsular femoral neck osteotomy, are difficult to execute and often cause joint stiffness while not sufficiently correcting the coxa vara or the other deformities, in particular hypometria. For these reasons this study used the external circular fixator to simultaneously correct these deformities. The results are presented after discussion of technical details.

Derotation osteotomy in the treatment of congenital dislocation of the hip: a review of long-term results

The authors clinically and radiographically evaluate the long-term results of 257 femoral derotation osteotomies performed between 1959 and 1970 for congenital dysplasia and dislocation of the hip. Tracing the patients was very difficult because of the prolonged follow-up, yet a group of 36 patients was finally gathered. These patients were then uniformly studied and classified through precise quantification, with a numeric reference value, of clinical deficits and radiographic changes. The evaluation of the results confirmed that the effectiveness of femoral derotation osteotomy depends upon its timeliness, correct execution, and potential association with corrective surgery of the acetabular dome. Finally, both preexistent joint damage and the presence of genetic factors in the disease, which often causes relapse in spite of a technically perfect operation, are very important in determining the final result.

Arthrodesis of the wrist with mini-fixators in infantile cerebral palsy

The authors report the methods used and results obtained in the treatment of 12 cases of severe flexion deformity of the wrist in infantile cerebral palsy. They discuss the various surgical methods that have been proposed and describe an original method of wrist arthrodesis and its attendant advantages.

["Double-blind" clinical study of a non-steroid anti-inflammatory drug: glucametacine]

A double blind clinical study has been carried out with two non-steroid anti-inflammatory drugs, glucametacine and phenylbutazone in 40 patients suffering from inflammatory and degenerative type arthrorheumopathies, selected and randomised into two groups. Examination of results shows the greater effectiveness of glucametacine (78%)over phenylbutazone (60%). Glucametacine was also statistically (p < 0,05) better from the tolerance point of view.