Therapeutic exercise and radiofrequency in the rehabilitation project for hip osteoarthritis pain: a case series.

BACKGROUND: Severe hip osteoarthritis is responsible for disabling pain and functional impairment of the joint. Although total hip arthroplasty (THA) is a successful treatment, some patients have multiple comorbidities that represent contraindications for THA. Conventional drug therapies are often ineffective or responsible for numerous side effects. For these patients, it is difficult to draw up an acceptable rehabilitation path, as the main limitation is intense pain. New rehabilitation strategies need to be developed that relieve pain and improve articular function. The combination of traditional treatments such as education and therapeutic exercise with innovative, minimally-invasive therapies such as continuous radiofrequency (CRF) appears to reduce hip pain by determining the neurolysis of the joint. AIM: The aim of our study was to describe the reduction in pain and improvements in joint function when CRF is combined with the therapeutic exercise in rehabilitation of patients with severe hip osteoarthritis. DESIGN: Case series study. SETTING: Rehabilitation service outpatients. POPULATION: Twenty-five patients with severe hip osteoarthritis causing disabling pain and with contraindications to THA, and for whom conventional drug therapies were ineffective or responsible for numerous side effects. METHODS: The study design included: initial clinical-functional assessment using the Harris Hip Score (HHS), the Numeric Rating Scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); a pre-lesion anaesthetic block; hip neuroablation with CRF; a three-week kinesitherapy protocol (3 sessions per week); two further assessments using the same scales one month (T1) and six months (T2) after CRF. RESULTS: Improvements at T1 and T2 follow-ups, after CRF (p=0.000) were recorded for articular pain and function. However, results at T2 were worse than those at T1 (p=0.000). CONCLUSIONS: CRF combined with therapeutic exercise in rehabilitation of severe hip osteoarthritis is an attractive option for significant pain relief as it allows patients to carry out kinesitherapy more easily. CLINICAL REHABILITATION IMPACT: CRF could represent a valid alternative in the rehabilitation of patients with severe hip osteoarthritis especially when other therapeutic approaches are unworkable

La radiofrequenza continua come primo step del progetto riabilitativo della coxartrosi avanzata

La coxartrosi è una patologia molto frequente nei pazienti anziani ed è responsabile di dolore cronico e di impotenza funzionale. La termoablazione dell’anca con radiofrequenza è un trattamento antalgico efficace, sicuro e pressoché privo di controin- dicazioni 2,3. Essa consiste nell’ablazione tramite termocoagulazione dei rami sensitivi intra-articolari del nervo femorale e del nervo otturatorio. Lo copo dello studio è stato quello descrivere gli effetti del trattamento combinato e sequenziale della termoablazione dell’anca seguito dalla riabilitazione al fine di ridurre il dolore e migliorare la funzionalità articolare in pazienti con severa coxartrosi. Sono stati reclutati 25 pazienti, tre con coxartrosi bilateralmente tutti sottoposti a neuroablazione dell’anca con Radiofrequenza continua e a successivo protocollo riabilitativo di chinesiterapia della durata di tre settimane (3 sedute a settimana). Sono stata valutata in questi pazienti rispettivamente ad un mese (T1) e sei mesi (T2) dalla procedura di radiofrequenza le scale Harris Hip Score(HHS), Numeric Rating Scale (NRS) e Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). È stato registrato un miglioramento del dolore e della funzionalità articolare sia al T1 che al T2 (p=0.000). Conclusioni La radiofrequenza continua ha consentito di limitare notevolmente il dolore da coxartrosi, rendendo il percorso riabilitativo molto più agevole ed efficace nel recupero funzionale. I due interventi terapeutici possono dunque integrarsi, potenziandosi vicendevolmente

Deep-water paleoenvironmental changes based on early-middle Miocene benthic foraminifera from Malta Island (Central Mediterranean)

A detailed quantitative, statistical and isotopic study on benthic foraminiferal assemblages from the upper Burdigalian - lower Langhian of Malta Island (St. Peter's Pool section) was carried out in order to gain more insights on paleoenvironmental changes that affected the central part of the Mediterranean Basin during the early-middle Miocene. The most abundant and/or palaecologically significant taxa were grouped into Group A (oxic/oligotrophic and oxic/oligo-mesotrophic opportunistic behaving) and Group B (hypoxic/eutrophic) and, on the base of their microhabitat in superficial microhabitat taxa (epifaunal + epifaunal to shallow infaunal taxa), intermediate microhabitat taxa (shallow infaunal + shallow to intermediate infaunal taxa) and deep microhabitat taxa (deep infaunal species). The changes in the structure of the benthic foraminiferal assemblages, together with isotopic data and statistical analysis results, identify five main intervals SPP1-SPP5, testifying the evolution of bottom water conditions between 16.12 and 15.36 Ma, corresponding to warm climate conditions due to the onset of the Miocene Climatic Optimum (MCO). The main benthic foraminiferal turnover occurred between 16.01 and 15.91 Ma. It has been recorded in both the palaecological and geochemical data and can be related to the Miller's Mi2 cooling event. This turnover correlates to a sea level falling that we believe caused an increase of the primary productivity due to runoff intensification. We suggest that the fluctuations of superficial microhabitat oxic/oligo/oligo-mesotrophic Group A, opposite to those of intermediate and deep microhabitat hypoxic/eutrophic Group B, and the occurrence of the superficial microhabitat, oxic/oligo-mesothrophic opportunistic behaving species are indicative of increased seasonality, which in turn affect food flux and oxygenation at the sea-floor. Moreover, the calculation of %P and the well-defined depth distribution range of some significant species allowed us to estimate a middle bathyal paleodepth, ranging from 600 m to 1000 m for the entire composite section