Autologous conditioned serum for chronic pain in patients with osteoarthritis: A feasibility observational study.

Background: Autologous conditioned serum is a product of blood origin, with fragmented evidence of therapeutic properties in osteoarthritis chronic pain. This pilot observational prospective study aimed to evaluate the feasibility of a treatment with conditional autologous serum (ACS) in patients with severe chronic pain and grade I-III osteoarthritis and to describe its cytokine content. Methods: We prospectively collected data on consecutive patients affected by osteoarthritis grade I to III and treated with four weekly injections of ACS at our outpatient pain service. The primary outcome was pain intensity, measured with the visual analogic scale (VAS). Additional outcomes were symptoms evaluated using joint district-specific scales. The study also evaluated concentrations of 48 cytokines and chemokines involved in the balance pro-inflammation/anti-inflammation and tissue repair in the ACS. Results: We included 26 patients, mostly female (65.4%), with a median age of 63.5 years [IQR 58.25-73]. A median reduction of VAS of -3 cm [-5; -1.25] was observed 6 months after the first injection of ACS. The analysis showed a statistically significant difference between the values of VAS (p < .01; X2 = 69.6; df = 6, N = 26) at the different time points. No adverse events were observed or reported by patients during the entire study period. Conclusions: Conditional autologous serum may be a feasible option for patients with chronic pain due to grade I-III osteoarthritis refractory to other treatments. These preliminary findings should be confirmed in studies with adequate design.

Efficacy of botulinum toxin type A treatment of functional impairment of degenerative hip joint: Preliminary results.

OBJECTIVE: The aim of this study was to investigate the effect of botulinum toxin type A injection into the adductor muscles in reducing pain and improving joint mobility and quality of life in patients affected by hip osteoarthritis. METHODS: A total of 39 outpatients, mean age 68 years (age range 41-82 years), were evaluated using the Harris Hip Score to test hip function, a visual analogue scale to measure pain intensity and the Short Form 36 (SF-36) questionnaire to assess patient well-being and quality of life at baseline, 2, 4 and 12 weeks after treatment with botulinum toxin type A. A total of 400 U of botulinum toxin type A (Dysport) was injected into the adductor longus muscle and the adductor magnus muscle. RESULTS: The Harris Hip Score increased significantly after 2, 4 and 12 weeks (df 3, chi2 = 45.1; p < 0.0001). A significant decrease in pain intensity was detected at all the follow-up visits, after 2, 4 and 12 weeks (df 3; chi2 = 27.8; p < 0.001). The SF-36 score was significantly higher 4 and 12 weeks after treatment. At each evaluation visit a significant correlation was detected between decreased pain and improved hip mobility. CONCLUSION: Botulinum toxin type A induced a reduction in pain, indicating that this might be an innovative, less invasive treatment in patients affected by severe hip osteoarthritis, with remarkable effects on the clinical management of this disease.

A preformed temporary antibiotic-loaded cement spacer for the treatment of destructive septic hip arthritis: a case report.

Preformed spacers have proved to be effective in the two-stage revision of infected total hip replacements. In the treatment of septic arthritis of the hip, the use of a temporary device has occasionally been described, but the implantation of a preformed antibiotic-loaded spacer has not yet been reported. A 71-year-old man with a destructive Staphylococcus aureus septic arthritis of the hip joint was admitted to hospital. Given the persistence of local infection regardless of all antibiotics and the worsening of joint damage, an aggressive surgical treatment including early placement of a preformed temporary spacer loaded with antibiotics was performed. Two months later an uncemented total hip replacement was successfully implanted. Two years after surgery the patient had a complete functional recovery with no signs of recurrence. The advantages of a preformed device include an effective and predictable local release of antibiotics and a mechanically tested resistance that allows early partial weight bearing and immediate joint mobilization.

Late fracture of a Burch-Schneider acetabular cage: rare occurrence following polyethylene cup wear.

We report a case of a 46-year-old male patient who sustained a fracture of the Burch-Schneider anti-protrusio cage (APC) that was implanted 13 years before. The fracture occurred in the transitional area to the proximal flange and was caused by direct and recurrent contact between the prosthetic metal head and the acetabular device. Late failure was related to increased wear of the polyethylene cup further aggravated by vertical orientation of the cage. Revision surgery included acetabular reconstruction using a new APC and cross-linked polyethylene cup, and replacement of the 36 mm diameter ball head. At 18 months follow-up the patient showed a complete functional recovery. When a reconstruction device is used, particularly in a young patient, special attention should be paid to the correct positioning of the cage in order to prevent accelerated polyethylene wear. Furthermore, cross-linked polyethylene cups that have become available in recent years must be used.

Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability.

There is still controversy regarding the value of arthroscopic suture of triangular fibrocartilage complex (TFCC) peripheral tears compared with open transosseous repair because only the latter method restores foveal insertions of TFCC in case of distal radioulnar joint (DRUJ) instability. Five classes of TFCC peripheral tears are recognized in a treatment-oriented algorithm based on arthroscopic findings, and indications to proper treatment are set accordingly. Complete repairable tears (class 2) and proximal repairable tears (class 3) are associated with DRUJ instability and require foveal reattachment of the TFCC. We describe a new arthroscopic technique to repair the foveal attachment of the TFCC with the use of a suture anchor, which is indicated for class 2 and 3 TFCC peripheral tears, instead of an open repair. This technique requires a dedicated working portal to approach the fovea ulnaris. This Direct Foveal portal is used to prepare the ligament and bone and to drill and insert a suture anchor loaded with a pair of sutures. Under arthroscopic vision, a suture is passed through each limb of the ligament and tied using a small knot-pusher. This arthroscopic technique restores original TFCC anatomy and adequate DRUJ stability with less morbidity and potentially accelerated rehabilitation compared with open repair.