Bisphosphonate treatment for osteolysis in total hip arthroplasty. A report of four cases.

Aseptic loosening due to wear debris is the most frequent modality of failure in total hip arthroplasty. Bisphosphonates, a class of molecules which inhibit bone resorption showed an inhibitory effects on particles-induced osteolysis in vitro and in animal models. We report the clinical, radiographic and densitometric outcome of four postmenopausal women with total hip arthroplasty affected by peri-prosthetic osteolysis treated with neridronate due to their unwillingness to be operated. After neridronate treatment, there was general improvement in pain and function: VAS decrease 13 points (15%), the Harris Hip Score increase 9 points (15%). An average number of 3.3 x-ray per patients with an average follow-up of 23 months (range 12-34) were collected and evaluated. In all the patients except one, serial radiographs didn't show any progression of radioluciencies lines or periprosthetic osteolysis. Bone density was evaluated by Dual energy X-ray absorptiometry after an average follow-up of 21 months (range 6-46 mo): periprosthetic BMD around the whole stem and the cup increased respectively 2.4% and 7.1%. Treatment was well tolerated and no significant side effects were registered. This retrospective collection of a small group of patients suggest that bisphosphonates should be clinically useful in preventing periprosthetic wear debris mediated osteolysis and claim for dedicated clinical trials.

Pulp thumb defect reconstruction using a twin neurovascular island flaps: a case report.

In this report, we present the functional and cosmetic results of a case with complete loss of the thumb pulp for which the Chen and Noordhoof techniques has been chosen for reconstruction. A 33-year-old man, artisan, had his right thumb caught in a machine during the work, resulting in a degloving injury in the entire pulp of the distal phalanx of the thumb with all other digits of the right hand intact. The patient was a young man, in good health and non-smoker. He was involved in a heavy manual work for which an appropriate soft coverage of the distal thumb was desirable. A reconstruction of the thumb pulp with a twin neurovascular island flaps as described by Chen and Noordhoff was planned and performed the day after his admission to the hospital. The patient turned up to work at 10 weeks after surgery. After 2 years, we obtained a good aesthetic result, a sensitivity in the thumb and at the donor site comparable to the other hand and a complete recovery of normal function of the hand. In focal pulp loss of the thumb, the twin neurovascular island flaps suggested by Chen and Noordhoff could be an easy and efficient method to reconstruct soft tissue coverage and sensibility when microsurgical setting and abilities are not available.