Interposition Arthroplasty in the Treatment of End-Stage Hallux Rigidus: A Systematic Review.

PURPOSE: Patients affected by moderate to severe hallux rigidus may opt for interposition arthroplasty to avoid the movement restrictions of arthrodesis and the complications related to prosthetic replacement. The propose of this article was to review the current literature about interposition arthroplasty to examine the overall outcomes and to evaluate the advantages and disadvantages of different types of technique, compared with more consolidated procedures. METHODS: A literature PubMed search was performed. Studies reporting the results of interposition arthroplasty in moderate to severe hallux rigidus were included. The data were pooled and weighted for number of patients in every study. RESULTS: The overall results for interposition arthroplasties are comparable to other alternatives for end-stage hallux rigidus, providing better plantar load distribution than arthrodesis and avoiding the drawbacks of prosthetic replacement. Among the various interposition arthroplasty techniques, the Modified Oblique Keller Capsular Interposition Arthroplasty technique preserves toe length and flexor hallucis brevis function, showing the highest satisfaction rate, with lowest metatarsalgia and revision rate. CONCLUSION: Although long-term randomized controlled trials are lacking for interposition arthroplasty, it represents a valid alternative for the treatment of end-stage hallux rigidus also in the young active patient who wants to avoid a definitive intervention immediately. LEVEL OF EVIDENCE: III (systematic review of level III-IV-V studies).

Custom-Made Implants in Ankle Bone Loss: A Retrospective Assessment of Reconstruction/Arthrodesis in Sequelae of Septic Non-Union of the Tibial Pilon.

Background and Objectives: Treating segmental tibial and ankle bone loss after radical surgery for chronic osteomyelitis is one of the most challenging problems encountered by orthopaedic surgeons. Open tibia and ankle fractures occur with an incidence of 3.4 per 100,000 and 1.6 per 100,000, respectively, and there is a high propensity of developing fracture-related infection with associated chronic osteomyelitis in patients. Segmental tibial and ankle bone loss have recently received new and improved treatments. Materials and Methods: Above all, 3D printing allows for the customization of implants based on the anatomy of each patient, using a personalized process through the layer-by-layer deposition of materials. Results: This article presents different cases from the authors' experience. Specifically, four patients suffered tibia and ankle fractures and after radical surgery for chronic osteomyelitis combined with high-performance antibiotic therapy underwent ankle reconstruction/arthrodesis with custom-made tibial spacers. Conclusions: Thanks to 3D-printed patient-specific devices, it is possible to perform surgical procedures that, for anatomical reasons, would have been impossible otherwise. Moreover, an improvement in overall functionality and an important reduction in pain were shown in the last follow-up in all patients.

SERI Technique for Isolated Juvenile Hallux Valgus Patients: A Retrospective Evaluation With Mid-term to Long-term Follow-up.

INTRODUCTION: Many different operative procedures have been described to treat hallux valgus, but many of them are inappropriate for active, skeletally immature patients. This retrospective evaluation aimed to show the efficacy of SERI (Simple, Effective, Rapid, Inexpensive) technique in young patients affected by mild to moderate hallux valgus deformity at a mid-term to long-term follow-up. METHODS: All patients were clinically and radiographically evaluated, independently by 2 researchers, by American Orthopaedic Foot and Ankle Society (AOFAS) Hallux-Metatarsophalangeal-Interphalangeal score and radiographic examination. RESULTS: Twenty-nine feet, undergone SERI procedure, have been reviewed at a mean follow-up of 5 years. The mean AOFAS score was significantly improved from 59.7 preoperatively to a mean value of 90.7 at last follow-up. Mean correction degrees have been recorded for both angles (hallux valgus angle [HVA] -13.7° and intermetatarsal angle [IMA] -6.7°). CONCLUSIONS: The SERI technique represents a powerful surgical procedure for the treatment of painful, mild to moderate, juvenile hallux valgus. Recurrence and complication rate make this surgical approach effective, repeatable, and safe. LEVEL OF EVIDENCE: Level IV, Retrospective case series.

Reconstructive Surgery and Joint-Sparing Surgery in Valgus and Varus Ankle Deformities: A Comprehensive Review.

Osteoarthritis (OA) of the ankle affects about 1% of the world's adult population, causing an important impact on patient lives and health systems. Most patients with ankle OA can show an asymmetrical wear pattern with a predominant degeneration of the medial or the lateral portion of the joint. To avoid more invasive ankle joint sacrificing procedures, joint realignment surgery has been developed to restore the anatomy of the joints with asymmetric early OA and to improve the joint biomechanics and symptoms of the patients. This narrative, comprehensive, all-embracing review of the literature has the aim to describe the current concepts of joint preserving and reconstructive surgery in the treatment of the valgus and varus ankle early OA, through an original iconography and clear indications and technical notes.

Associated Corrective Procedures of Extra-Articular Asymptomatic Foot Malalignments in Total Ankle Replacement: Are They Really Mandatory?

In recent years, total ankle replacement (TAR) has undergone a series of evolutions and changes in terms of materials, prosthetic designs, and surgical techniques [...].

Enhanced recovery (fast-track surgery) after total ankle replacement: The state of the art.

The post-operative results of a total ankle replacement are not determined solely by an optimal surgical technique, but by an appropriate anesthesiological and rehabilitative post-operative approach. Enhanced functional recovery often depends on a multidisciplinary approach based on a correct framework of the patient and his needs, requests, and characteristics. Extensive bibliographical research has been performed on Pubmed, Google Scholar, Scopus. This comprehensive and inclusive review of the literature aims to examine the state of the art of "fast-track" protocols employed in total ankle replacement (TAR), considering pre-operative preparation, anesthetic management, intraoperative and surgical factors, post-operative rehabilitative care and reduction of hospitalization time.

Enhanced Atmospheric Water Harvesting with Sunlight-Activated Sorption Ratcheting.

The global challenge of clean water scarcity needs to be confronted with novel sustainable, climate neutral solutions, over the entire spectrum of possible clean water availability. Atmospheric moisture represents a major untapped resource that can be harvested by sorbents, enabling water production in dry inland regions where it is needed. While benefiting from the utilization of an important renewable energy source, solar-driven, sorbent-based atmospheric water harvesting systems are inseparably based on a single water harvesting cycle per day, which severely limits the daily water productivity and the competitiveness of this very promising technology. Here, we rationally design an atmospheric water harvesting strategy, using durable hydrogel sorbents, that operates with sorption "ratcheting"─a large sequence of rapid adsorption and subsequent desorption steps─activated by direct sunlight. Employing theoretical considerations, we tailor the ratcheting timescales to the inherent sorption properties of the hydrogels, optimally exploiting their natural harvesting capabilities, while maintaining the sustainable utility of the daily cycle. Amplified by the favorable sorption properties and ratcheting stability of the sorbent, this strategy demonstrates an impressive ∼80% increase in water harvesting yield over the daily cycle systems. The generic nature of the ratcheting concept shows great potential to advance the water harvesting capabilities of a range of related systems.

Clinical Radiographical Outcomes and Complications after a Brand-New Total Ankle Replacement Design through an Anterior Approach: A Retrospective at a Short-Term Follow Up.

Recently, the progress in techniques and in projecting new prosthetic designs has allowed increasing indications for total ankle replacement (TAR) as treatment for ankle osteoarthritis. This retrospective work comprehended 39 subjects aged between 47 and 79 years old. The patients, observed for at least 12 months (mean follow up of 18.2 ± 4.1 months), have been evaluated according to clinical and radiological parameters, both pre- and post-operatively. The AOFAS and VAS score significantly improved, respectively, from 46.2 ± 4.8 to 93.9 ± 4.1 and from 7.1 ± 1.1 to 0.7 ± 0.5 (p value < 0.05). At the final evaluation, the mean plantarflexion passed from 12.2° ± 2.3° to 18.1° ± 2.4° (p value < 0.05) and dorsiflexion from a pre-operative mean value of 8.7° ± 4.1° to 21.7° ± 5.4° post-operatively (p value < 0.05). This study found that this new total ankle replacement design is a safe and effective procedure for patients effected by end-stage ankle osteoarthritis. Improvements have been demonstrated in terms of range of motion, radiographic parameters and patient-reported outcomes. However, further studies are needed to assess the long-term performance of these prostheses.

An innovative mindfulness and educational care approach in an adult patient affected by gastroesophageal reflux: the IARA model.

Patients affected by gastroesophageal reflux disease (GERD) have a poor quality of life caused by several manifestations such as cough, asthma, laryngitis and dental erosion. The clinical conditions are highly disabling for patients and symptoms are difficult to manage. These conditions lead to many discomforts which contribute to an increase of the disease perception. For these reasons, it is important to improve the interventions on psychological aspects that ameliorate the patients' quality of life. The application of IARA model has proven useful to decrease GERD symptoms, distress and medication intake and to increase adherence to care, improving the patient's quality of life.

Short-term effect of low-intensity, pulsed, electromagnetic fields on gait characteristics in older adults with low bone mineral density: a pilot randomized-controlled trial.

AIM: To evaluate the short-term effects of a 10-min exposure to low-intensity, pulsed, electromagnetic fields (PEF) on gait characteristics in older adults with low bone mineral density. METHODS: In a single-center, double-blind, randomized-controlled trial, community-dwelling older adults aged ≥ 70 years were randomized (3:2 ratio) to receive a 10-min treatment with PEF (mean intensity 1.5 mW) or placebo. The following gait parameters were assessed at baseline and just after the intervention/placebo with the GAITRite Portable Walkway system: self-selected gait speed (cm/s), stride length (cm), support base (cm) and double support phase (s). RESULTS: In the intervention group (25 patients), both self-selected gait speed and stride length increased significantly from baseline, whereas the double support phase decreased. In the placebo group, all gait parameters except for support base remained unchanged. The mean percent increase (± standard deviation) of self-selected gait speed was significantly (P = 0.010) greater in the intervention group (20.1 ± 15.6) compared with the placebo group (10.5 ± 13.1), whereas no significant difference in the mean percent variation of the other parameters was found between the two groups. During the intervention, no adverse event was observed. A similar proportion of patients in the two groups reported one fall in the 30 days after the intervention/placebo. CONCLUSIONS: This is the first randomized-controlled trial showing the potential beneficial effects of PEF on gait characteristics in older adults. Further phase III randomized trials are warranted to establish their potential benefits (e.g. fall prevention) on fall-related health outcomes in elderly patients.

Representações e práticas de cuidado com a ferida crônica de membro inferior: uma perspectiva antropológica / Representations and care practices with a chronic wound of the inferior member: an anthropological perspective

O objetivo deste estudo foi interpretar as manifestações e representações culturais de cuidado de usuáriosportadores de ferida crônica de membro inferior. Trata-se de pesquisa clínico-qualitativa realizada de fevereiro a março de 2010. Utilizou-se a entrevista individual semiestruturada a 8 usuários de serviço ambulatorial; as entrevistas foram analisadas por meio da técnica de análise de conteúdo. Do estudo emergiram as categorias temáticas: Não vejo a hora de sarar para trabalhar! - impacto da ferida na vida cotidiana; O povo vai me ensinando as coisas e eu faço! - práticas de cuidado com a ferida crônica; É o nervoso! - um modelo explicativo. Pode-se considerar que os diversos problemas de saúde que se tornam visíveis na materialidade do corpo físico são, igualmente, permeados por questões simbólicas quese inscrevem no plano da vida cotidiana dos seus portadores, reafirmando o caráter social do processo saúde-doença.

Physical activity and bone turnover markers: a cross-sectional and a longitudinal study.

Strenuous physical activity in young individuals has an important effect on both bone mass and bone turnover but the effect of moderate physical activity in adults remains uncertain. In a large cohort (N = 530) of healthy premenopausal women, bone formation markers (osteocalcin and N-terminal propeptide of type 1 procollagen [P1NP]), but not serum C-telopeptide of type 1 collagen (sCTX), were found to be significantly associated with the level of physical activity, and this association remained significant after adjusting the data (ANCOVA) by age and body mass index. Mean spine and hip bone mineral density (BMD) values were positively associated with physical activity but this was statistically significant (P = 0.050) only for adjusted values of spine BMD. Twenty-four healthy sedentary premenopausal women, subscribing to participate in a community exercise program lasting a month, and 18 age-matched controls were included in the longitudinal study. Serum osteocalcin and P1NP, but not sCTX, rose significantly, by ca. 25%, only in the active group after a month of exercise. The changes in the two bone formation markers remained statistically significant for values adjusted for body weight, which fell significantly in the exercise group. In conclusion, both the cross-sectional and the longitudinal parts of our study demonstrate that even minor changes in physical activity are associated with a clear effect on bone formation markers.