Treatment of the trapeziometacarpal osteoarthritis by arthroplasty with a pyrocarbon implant.

PURPOSE: Trapeziometacarpal (TM) osteoarthritis is the most common type of arthritis of the hand. To date, among surgical alternatives proposed, no one type has been proven superior to others. In this prospective study we evaluated the efficacy of treating arthroplasty with a latest-generation pyrocarbon implant (Pyrocardan). METHODS: Thirty-six patients with TM arthritis were treated using Pyrocardan implant arthroplasty. Results were evaluated through thumb radial and palmar abduction assessment, key pinch strength evaluation, thumb opposition assessment according to Kapandji classification, the visual analogue scale, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Patient's Satisfaction Index. RESULTS: There was substantial pain reduction and a satisfying increase in range of motion and strength (p < 0.01) and improvement in DASH score (p < 0.01). Average Patient's Satisfaction Index was 8 out of 10. CONCLUSIONS: TM arthroplasty with Pyrocardan implantation is a suitable option in treating Eaton-Littler grade II or III TM osteoarthritis.

Italian experience on use of E.S.W. therapy for avascular necrosis of femoral head.

Osteonecrosis (avascular necrosis) of the femoral head is a clinical disease due to a severe bone vascular alteration associated with intense pain and loss of joint function, with an incidence of 0.1% and unknown aetiology. Many classifications exist to describe it and in the final stages the patient will need a total hip arthroplasty. In the early stages, ESWT has given excellent responses. The Neapolitan school studied more than 600 patients who had very good results in I and II stages of Ficat and Arlet Classification, with an improve of outcomes in VAS and HSS scores. Moreover it has shown a complete restoration of the signal intensity of the femoral head in MRI.