Current approach to the conservative management of arthrosis: results of the "Osteo-Experience" project.

BACKGROUND: Arthrosis is now intended as a multifactorial pathology that involves various joints and is caused by different biological functional alterations at the basis of the joints damage. Considering this new evidence, the prevention and the conservative treatment of arthrosis acquire an important role with respect to a surgical approach. The "Osteo-Experience" project was designed to collect, describe and compare the personal experiences of osteoarticular specialists in the field of the conservative treatment of the various forms of arthrosis. In addition, some useful insights for a correct management of conservative therapy in respect to the various forms of arthrosis were provided. METHODS: A group of Italian osteoarticular specialists with experience in the treatment of arthrosis were asked to describe their routine clinical practice regarding their more usual therapeutic schemes. The type of patients normally being treated by the osteoarticular specialists were described. An electronic question-and-answer form was provided. Each form simulates a patient visit, that must be imagined based on the most common personal experience. RESULTS: Seven hundred sixty-five forms were considered. A frequent use of NSAIDs and COX-2 inhibitors emerged, especially for early arthrosis and in older subjects with advanced osteoarthritis. Hyaluronic acid and chondroprotectors are used with great frequency in all types of osteoarthritis. A reduction of pain is reported in all settings of patients. Problems related to the conservative therapies are reported only in a small minority of cases, along with a good degree of satisfaction by doctors and patients. CONCLUSIONS: Observations collected within the "Osteo-Experience" project show that a more conscious use of the conservative therapy should be pursued for arthrosis. The present study denotes how it is necessary to better define some therapeutic schemes based on the different clinical characteristics of the patient, to improve the clinical outcome.

Autologous conditioned serum (ACS) for intra-articular treatment in Osteoarthritis: Retrospective report of 28 cases.

INTRODUCTION: Autologous conditioned serum (ACS) is a novel blood product developed for intra-articular injection as a novel therapy for Osteoarthritis (OA). This study is a retrospective evaluation of 28 cases (25 Knee-OA and 3 hip-OA) treated with ACS between November 2013 and February 2016. MATERIALS AND METHODS: ACS was prepared according to standards in an accredited Cell Manipulation Lab, and applied by an expert clinician (2 ml injection once weekly over 4 weeks). At any injection visit (Timepoints 1-4), and after a follow-up of 1 (Timepoint 5) and 6 months (Timepoint 6), patients were asked to describe the intensity of their pain with the VAS (visual analog scale) psychometric scale, and the objective parameter ROM (Range Of Motion) was recorded in case of injection in the knee. RESULTS: Pain (VAS) reduced in all cases since the first injection up to Timepoint 5. A significant improvement was observed in VAS between Timepoint 1 and 6 (primary objective), with a median VAS decrease of 60 mm (range 20-100, p < 0.01). A significant difference was also recorded in ROM between Timepoint 1 and 6 (secondary objective), with a median increase of 25° (range 5-40, p < 0.01). Ten out of 14 patients (71%) who were undergoing a chronic therapy to relieve pain were able to interrupt it. No serious adverse events were recorded. CONCLUSIONS: Treatment with ACS produced a rapid decline in pain, accompanied by a large improvement in ROM. These results suggest that ACS is a valid option for the treatment of OA.

Adhesive capsulitis of the shoulder in human immunodeficiency virus-positive patients during highly active antiretroviral therapy.

Many adverse events have been described in patients treated with highly active antiretroviral therapy (HAART). Recently, among these, adhesive capsulitis of the shoulder has been described in some patients using protease inhibitors. We report our experience with 6 human immunodeficiency virus-positive patients in whom adhesive capsulitis of the shoulder developed during HAART. All 6 patients were treated with the same antiretroviral drug combination (HAART) including nucleoside reverse transcriptase (stavudine and lamivudine) and protease inhibitors (indinavir). The clinical pattern of adhesive capsulitis during HAART is similar to the classical form of adhesive capsulitis. Examining our case studies, we postulate a correlation between HAART and adhesive capsulitis. Discontinuation or reduction of the dosage of protease inhibitors associated with conventional conservative treatment is effective in reducing the symptoms and resolving the disease.

An unusual cause of popliteal cyst.

We describe a surgical treatment for popliteal cyst in a 41-year-old woman affected by diffuse pigmented villonodular synovitis (PVNS) of the knee with extra-articular spreading. The treatment consists of an arthroscopic synoviectomy followed immediately by an open removal of the cyst. At 28-month follow-up, the patient is asymptomatic and no evidence of recurrence of PVNS has been seen. We believe that this double surgical approach may reduce the probability of recurrence of PVNS.

Result of arthroscopic treatment of pigmented villonodular synovitis of the knee.

PURPOSE: We report 10 years' experience in arthroscopic treatment of pigmented villonodular synovitis (PVNS) of the knee in a series of patients affected by the localized or diffuse form of the disease. The purpose of the study is to critically examine the results of arthroscopic synovectomy in the knee affected by PVNS, to determine the safety and effectiveness of the procedure. TYPE OF STUDY: Retrospective case analysis. METHODS: The study population consists of 19 patients, with an average follow-up of 60 months (minimum, 12; maximum, 128). All patients underwent knee arthroscopy. The 3 standard portals were used; posteromedial and posterolateral portals were added if required. Four patients were affected by localized PVNS and were subject to partial synovectomy with excision of the pathologic tissue. The remaining 15 patients presented a diffuse form of PVNS; 7 of them underwent extended arthroscopic synovectomy and 8 underwent partial synovectomy. The diagnosis was confirmed by synovial biopsy. RESULTS: In the group affected by the localized form of PVNS, the arthroscopic local excision resulted in a complete and persistent regression of the pathology. Among the patients affected by the diffuse form of PVNS, clinical results were better and the recurrence rate was lower in the group treated with extended synovectomy. No relevant complications were encountered. In particular, no cases of infection, stiffness, or neurovascular lesions were seen. CONCLUSIONS: Arthroscopic synovectomy is an appropriate treatment for knee PVNS. Extended synovectomy must be performed in all cases of diffuse PVNS.

Two cases of tibial nerve compression caused by uncommon popliteal cysts.

We report 2 cases of a popliteal mass of very unusual origin that induced compression neuropathy. The signs and symptoms could have been mistaken for those of a common Baker's cyst. Several recent studies have shown that the cause of Baker's cyst formation should be sought within the joint because of a communication between the gastrocnemio-semimembranosus bursa and the joint cavity. These 2 cysts had no communication with the articular joint, thus suggesting that the surgeon perform an open exploration of the popliteal fossa in the search for other cystic formations with origins and features different from Baker's cysts.