Pulsed electromagnetic fields improve pain management and clinical outcomes after medial unicompartmental knee arthroplasty: A prospective randomised controlled trial.

BACKGROUND: To assess pain relief and clinical outcomes in patients undergoing unicompartmental knee arthroplasty (UKA) stimulated with pulsed electromagnetic fields (PEMFs) compared to a control group. METHODS: A prospective randomised controlled trial (RCT) was performed in which 72 patients undergoing medial UKA were randomised into a control group or an experimental PEMFs group. The patients allocated to the experimental group were instructed to use PEMFs for 4 h per day for 60 days. They were evaluated before a surgery and then during the time points corresponding to 1 month, 2 months, 6 months, 12 months, and 36 months after the surgery. No placebo group was included in the RCT. Clinical assessment included the Visual Analogue Scale (VAS) for pain, Oxford Knee Score (OKS), the Short Form 36 (SF-36) health survey questionnaire, and joint swelling. During each follow-up visit, the consumption of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) was recorded. RESULTS: The VAS decreased on follow-up visits in both the groups; a statistically significant difference between the groups was observed during the 6 (p = 0.0297), 12 (p = 0.0003), and 36 months (p = 0.0333) follow-ups in favour of the PEMFs group. One month after UKA, the percentages of patients using NSAIDs in the PEMFs and control group were 71% and 92%, respectively (p = 0.0320). At the 2 months point, 15% of the patients in the PEMFs group used NSAIDs compared to 39% in the control group (p = 0.0317). The objective knee girth evaluation showed a statistically significant difference at 6 (p = 0.0204), 12 (p = 0.0005), and 36 (p = 0.0005) months with improved values observed in the PEMFs group. The subjective assessment of the swelling demonstrated a statistically significant difference at 2 (p = 0.0073), 6 (p = 0.0006), 12 (p = 0.0001), and 36 (p = 0.0011) months with better values noted in the PEMFs group. Last, the OKS result was significant higher in the experimental group during all the follow-ups (1mth: p = 0.0295; 2mths: p = 0.0012; 6mths: p = 0.0001; 12mths: p < 0.0001; 36mths: p = 0.0061). CONCLUSIONS: The use of PEMFs leads to significant pain relief, better clinical improvement, and lower NSAIDs consumption after medial UKA when compared to the control group. LEVEL OF EVIDENCE: II.

Patellar height after unicompartmental knee arthroplasty: comparison between fixed and mobile bearing.

PURPOSE: The purpose of this study was to determine the changes in patellar heights by comparing standardised pre- and post-operative radiographs in a consecutive series of patients undergoing unicompartmental knee arthroplasty (UKA) with two different approaches and implant designs [fixed bearing (FB) vs mobile bearing (MB)] and to correlate the patellar heights with clinical outcomes. METHODS: One hundred and seventy-two UKA patients were prospectively enrolled in the study. 75 patients underwent a minimally invasive FB medial UKA (referred to hereinafter as the 'FB group'); 97 patients were treated with a minimally invasive MB medial UKA. The pre-operative and mid-term (1-year) post-operative patellar heights and clinical scores of these groups of patients were compared using the Insall-Salvati (IS) and Caton-Deschamps (CD) indices and the Oxford Knee Score (OKS). RESULTS: No differences were found between the two groups either with regard to the pre-operative data (p > 0.05) or between pre- and post-operative radiographic scores at the time of each follow-up (p > 0.05). Both the groups reported a significant clinical improvement (p<0.05) as did all the sub-groups (p < 0.05). In the MB group, a higher CD index in females was found at the final follow-up stage (p = 0.043) and a higher pre-operative CD index was found in patients with BMI ≥ 28 (p = 0.040). A statistically negative correlation was found between the pre-operative OKS and pre-operative IS index (rho=- 0.165; p=0.031). CONCLUSIONS: Both FB and MB arthroplastys with different surgical approaches did not change the patellar height regardless of the age, gender and BMI at short-medium-term follow-up. The post-operative patellar height seems not to be correlated with the clinical outcomes. A higher pre-operative IS index was correlated with knee pain and function. LEVEL OF EVIDENCE: Level II-prospective comparative study. STUDY REGISTRATION: Researchregistry6433- www.researchregistry.com .

Total Hip Arthroplasty in an Inveterate Femoral Neck Fracture in a Patient with Congenital Insensitivity to Pain with Anhidrosis.

Congenital insensitivity to pain with anhidrosis (CIPA) is an extremely rare disorder characterized by autonomic and sensory nerves malfunction with insensitivity to both deep and superficial painful stimuli, inability to sweat and produce tears, and mild to moderate mental retardation with self-mutilating behavior. Related consequences of inveterate musculoskeletal injuries represent a major issue for these patients, since pain cannot act as a protection mechanism. For the same reason, the patients are at risk during postoperative rehabilitation, which should be taken into account when selecting an orthopaedic implant. To our knowledge, only one case of total hip arthroplasty has been reported in the literature to date. A 21-year-old Caucasian male patient affected with CIPA arrived at our attention complaining about a functional limitation of the left hip. No history of trauma was reported. The X-rays showed an inveterate femoral neck fracture with a severe necrosis and resorption of the femoral head. We decided to perform a total hip arthroplasty with a cemented stem and a cemented dual mobility cup. The postoperative course and rehabilitation were satisfactory, with excellent clinical results, measured with the Harris Hip Score at 1 year.

Shoulder disorders in female working-age population: a cross sectional study.

BACKGROUND: Musculoskeletal disorders (MSDs) are among the most common pathologies in the general population. However, research into the prevalence of upper arm MSDs is hampered by a lack of uniformity in case definition, and by the absence of a gold standard for measurement. Furthermore, some sectors of the population have benefited from extensive research whilst others have largely been ignored. STUDY DESIGN: Cross-sectional study. OBJECTIVES: to investigate the prevalence of shoulder MSDs in a working age female population not exposed to specific occupational risk factors such as heavy and/or repetitive work, assessing the differences in prevalence recorded by using three different standard measurement tools. METHODS: 302 working aged women were enrolled in this study (age 20-55 years). Each subject underwent three different assessments: standardized questionnaires for symptoms and disability and the SF36 health survey, a clinical assessment performed by a blinded orthopaedic specialist, and an imaging assessment by means of ultrasound (US) and Magnetic Resonance (MR) if indicated. RESULTS: According to the questionnaire 77 subjects (25.5%) complained of shoulder pain whilst 225 (74.5%) were asymptomatic. According to the clinical examination, 31 subjects (10.3%) resulted positive, whereas 271 subjects (89.7%) had normal shoulders. According to the imaging findings, 26 subjects (8.6%) had alterations to the anatomical structures of the shoulder, whilst 276 subjects (91.4%) had no detectable abnormalities in either shoulder. In all assessments, the prevalence increased with age (p = 0.001). CONCLUSION: Depending on the outcome measure used, the prevalence of reported MSDs of the shoulder varies considerably. There is a striking difference between the prevalence of subjective reported symptoms and the standardized clinical/imaging examinations. However, the results of all the assessments did concur in one aspect; there was a significant trend of increased prevalence of shoulder MSDs with age. When looking at reported prevalence, this study shows the importance of noting the measurement method used before making comparisons, as it can vary considerably. The epidemic of shoulder pain reported is not indicative of an epidemic of shoulder pathology.

Can we improve the reliability of the Constant-Murley score?

HYPOTHESIS: The Constant-Murley score (CMS) is one of the most used scales for shoulder dysfunction. The aim of this study is to determine whether the reliability of the CMS can be improved by enhancing the standardization of the items. METHODS: Two consecutive series of 55 patients with shoulder dysfunction were enrolled in a test-retest study and examined by 2 orthopedic surgeons with different levels of expertise. The following scores were measured: CMS, individual relative CMS, relative CMS, and standardized CMS. For each variable, the intraobserver and interobserver reliability was calculated. RESULTS: The less experienced observer had worse intraobserver reliability using the CMS (error, 4 points; 95% limit of agreement, 22) than the expert observer (error, 2.4 points; 95% limit of agreement, 16). The standardized CMS showed better intraobserver reliability, with an error of 0.4 points and 95% limits of agreement of 9 for the expert observer and 13 for the less experienced observer. The correction against the contralateral unaffected side and the reference population determined a worsening of reliability in both observers. Interobserver reliability showed an improvement similar to that of intraobserver reliability (systematic error, 4; 95% limit of agreement, 24) by use of the CMS and improved to 1 point when the standardized CMS was adopted (95% limit of agreement, 12). CONCLUSIONS: This study showed that the standardization of the items significantly improved both the intraobserver reliability and interobserver reliability of the CMS. The level of expertise of the observer has less of an effect on reliability when the score is applied with a higher level of standardization.

Arthroscopic treatment of stiff elbow.

Contracture of the elbow represents a disabling condition that can impair a person's quality of life. Regardless of the event that causes an elbow contracture, the conservative or surgical treatment is usually considered technically difficult and associated with complications. When the conservative treatment fails to restore an acceptable range of motion in the elbow, open techniques have been shown to be successful options. More recently the use of arthroscopy has become more popular for several reasons. These reasons include better visualization of intra-articular structures, less tissue trauma from open incisions, and potentially the ability to begin early postoperative motion. The purpose of this paper is to review the indications, complications, and results of arthroscopic management of a stiff elbow.

The hybrid technique: potential reduction in complications related to pins mobilization in the treatment of proximal humeral fractures.

BACKGROUND: Proximal humeral fracture fixation has a high incidence of complications especially when pins are used in elderly patients. In 2005, we introduced a new technique that augmented osteosutures by using 2.5-mm fully threaded pins and an external fixator (hybrid technique). The purpose of this study is to compare the outcomes of the hybrid technique (HT) with traditional pins fixation. METHODS: A prospective nonrandomized study was organized on 2 consecutive series of patients: 51 patients treated with percutaneous fixation using 2.5-mm terminally threaded pins and 55 patients treated with the Hybrid technique. In both groups, an open reduction and osteosutures augmented with percutaneous fixation was used when closed reduction was insufficient to provide anatomical reduction. The patients were assessed at 6- and 12-month follows-ups using DASH score, Constant score, and Modified Constant score (MCS). RESULTS: Sixteen patients treated with traditional pins experienced complications compared to 6 patients in the HT group (P = .006). The revision rate was 19% for the traditional pins group and 4% for the HT group (P = .04). Pins migration affected 8 patients in the traditional pins group and 1 case in the hybrid group (P = .01). The MCS at the 12-month follow-up was 89 ± 9 in the HT group and 77 ± 14 in the traditional pins group (P = .03). The MCS was negatively affected by complications and malreduction (P = .001). CONCLUSION: The study suggests that the HT is a valuable option for the treatment of proximal humeral fractures. It has benefits compared to the traditional technique.