Bone methabolic disorders in HIV positive patients: a case report.

Fractures in patients affected by HIV are more frequent than what is reported in patients with no retroviral diseases. Chronic infection with HIV likely contributes to increased systemic inflammation, which has been associated with increased rates of fracture.  We report a case of a 56-year-old male (HIV + in treatment with Atripla) heavy worker, at the beginning affected by intra-articular proximal humerus fracture treated with endoprosthesis replacement and later by periprosthetic fracture treated with plate, screws and cerclages. Follow up was performed with clinical evaluation (ROM, VAS, Quick Dash, ASES, Simple shoulder test, UCLA Score, Constant score) and shoulder radiographs. Bone metabolism disorders in HIV patients lead to low BMD values, changes in bone turnover markers, and histomorphometric abnormalities, especially when HIV is present along with HCV or other hepatopathies. Additional therapy with bisphosphonate and Vitamin D should always be carried out when possible to prevent such types of orthopaedic complications.

Could the tendon degeneration and the fatty infiltration of the gluteus medius affect clinical outcome in total hip arthroplasty?

PURPOSE: The aim of this prospective study was to perform a clinical and radiologic evaluation of patients undergoing total hip arthroplasty (THA). The hypothesis is that there is a correlation between the pre-operative degeneration state of the gluteal muscle-tendinous unit and the clinical outcome in terms of functional recovery. METHODS: Fifty-five patients have met inclusion criteria. All patients included in the sample were subjected to clinical evaluation. The ultrasound examination of the patients of the study was conducted and the following parameters were assessed: Thickness in mm of the gluteus medius tendon; Quality of the gluteus medius tendon; and Trophy and muscular composition. RESULTS: The degree of degeneration of the pre-operative tendon shows a negative statistical correlation with all the pre- and post-operative clinical scales, but presents statistical significance (p < 0.05) only with the post-operative Harris, the post-operative Oxford, the Harris and HOOS-modified post-operative, lameness, and Trendelenburg; it correlates positively with the quality of the macroscopic tendon detected intra-operatively, the degree of the pre-operative contralateral tendon, and the operated and contralateral pre-operative muscle (p < 0.05). The degree of fatty degeneration of the pre-operatively operated muscle correlates negatively (p < 0.05) with all pre- and post-operative clinical scales except for the pre-operative WOMAC and HOOS modified, with the lameness and the Trendelenburg sign; it correlates positively (p < 0.05) with age, the quality of the macroscopic tendon detected intra-operatively, degree of tendon degeneration, fatty infiltration of the contralateral pre- and post-operative muscle and of the post-operative operated muscle. CONCLUSION: Tendon degeneration and fatty infiltration of the gluteus medius muscle appeared to be determinants of the post-operative persistence of lameness and Trendelenburg sign positivity in patients undergoing hip arthroplasty.

Latarjet procedure versus open capsuloplasty in traumatic anterior shoulder dislocation: long-term clinical and functional results.

PURPOSE: To compare the results of two different open surgical techniques (open capsuloplasty and Bristow-Latarjet procedure) at a mid- to long-term follow-up (6 years) in patients with recurrent traumatic anterior shoulder dislocations. METHODS: Seventy-three patients (73 shoulders, 48 males; 25 females) fulfilled inclusion and exclusion criteria. Patients were classified as group A if operated on with a Bristow-Latarjet procedure (40 patients, 24 males; 16 females) or group B if operated on with an open capsuloplasty (33 patients, 24 males; 9 females). All patients were followed up with physical examination and functional evaluation scores (UCLA, ROWE and WOSI). RESULTS: In group A, no further episodes of dislocation or subluxation were reported; in group B, one patient (3.3%) reported a new episode of anterior dislocation as a result of a new trauma. No statistical difference in regard of new episodes of shoulder dislocation was found between the two groups (p > 0.05). At physical examination, two patients (5%) of group A and four patients of group B (13.3%) showed a positive apprehension test (p > 0.05); anterior drawer test was positive in six patients (15%) of group A and in nine patients (30%) of group B (p > 0.05). Statistical analysis showed better external rotation in group A (Latarjet group) than in group B. (p = 0.0176). No statistical differences were detected in regard to the scale scores (UCLA, WOSI, Rowe) (p > 0.05). Regarding the return to sport, 29 patients (72.5%) of group A and 18 patients (60%) of group B reported they resumed the same sports activity at the same pre-operative level (p > 0.05). CONCLUSION: Open capsuloplasty and Bristow-Latarjet procedure are both validated surgical techniques for the treatment of recurrent shoulder anterior instability. We found no statistical difference in terms of recurrent dislocation rates, clinical shoulder stability tests, and scoring scales. The rate of patients returning to sport was similar after both techniques. However, patients with open capsuloplasty reported a significantly lower recovery of external rotation than patients operated via the Latarjet procedure.