Revision reverse shoulder arthroplasty in failed shoulder arthroplasties for rotator cuff deficiency

PURPOSE: the aim of this systematic literature review is to report clinical outcomes of reverse shoulder arthroplasty (RSA) used as a revision surgery following failure of the primary implant due to rotator cuff insufficiency. METHODS: a systematic review was performed using the following key words: revision, shoulder, rotator cuff deficiency, outcome assessment, treatment outcome, complications. Studies eligible for inclusion in the review were clinical trials investigating patients in whom a primary shoulder arthroplasty implant with an incompetent rotator cuff was replaced with a reverse shoulder prosthesis. RESULTS: nine articles were identified and further reviewed. The results refer to a total of 226 shoulders that were treated with RSA as revision surgery. The patients in the studies had a mean age ranging from 64 to 72 years and the longest follow-up was 3.8 years. Improvements in function and reduction of pain were shown by many studies, but the mean Constant score ranged from 44.2 to 56. High complication rates (of up to 62%) were recorded, and a mean reoperation rate of 27.5%. CONCLUSIONS: RSA as revision surgery for patients with rotator cuff deficiency is a valid option, and often the only solution available, but it should be limited to elderly patients with poor function and severe pain. LEVEL OF EVIDENCE: level IV, systematic review of level I-IV studies

Italian consensus conference on guidelines for conservative treatment on lower limb muscle injuries in athlete.

Provide the state of the art concerning (1) biology and aetiology, (2) classification, (3) clinical assessment and (4) conservative treatment of lower limb muscle injuries (MI) in athletes. Seventy international experts with different medical backgrounds participated in the consensus conference. They discussed and approved a consensus composed of four sections which are presented in these documents. This paper represents a synthesis of the consensus conference, the following four sections are discussed: (i) The biology and aetiology of MIs. A definition of MI was formulated and some key points concerning physiology and pathogenesis of MIs were discussed. (ii) The MI classification. A classification of MIs was proposed. (iii) The MI clinical assessment, in which were discussed anamnesis, inspection and clinical examination and are provided the relative guidelines. (iv) The MI conservative treatment, in which are provided the guidelines for conservative treatment based on the severity of the lesion. Furthermore, instrumental therapy and pharmacological treatment were discussed. Knowledge of the aetiology and biology of MIs is an essential prerequisite in order to plan and conduct a rehabilitation plan. Another important aspect is the use of a rational MI classification on prognostic values. We propose a classification based on radiological investigations performed by ultrasonography and MRI strongly linked to prognostic factors. Furthermore, the consensus conference results will able to provide fundamental guidelines for diagnostic and rehabilitation practice, also considering instrumental therapy and pharmacological treatment of MI. Expert opinion, level IV

Italian consensus conference on guidelines for conservative treatment on lower limb muscle injuries in athlete

Provide the state of the art concerning (1) biology and aetiology, (2) classification, (3) clinical assessment and (4) conservative treatment of lower limb muscle injuries (MI) in athletes. Seventy international experts with different medical backgrounds participated in the consensus conference. They discussed and approved a consensus composed of four sections which are presented in these documents. This paper represents a synthesis of the consensus conference, the following four sections are discussed: (i) The biology and aetiology of MIs. A definition of MI was formulated and some key points concerning physiology and pathogenesis of MIs were discussed. (ii) The MI classification. A classification of MIs was proposed. (iii) The MI clinical assessment, in which were discussed anamnesis, inspection and clinical examination and are provided the relative guidelines. (iv) The MI conservative treatment, in which are provided the guidelines for conservative treatment based on the severity of the lesion. Furthermore, instrumental therapy and pharmacological treatment were discussed. Knowledge of the aetiology and biology of MIs is an essential prerequisite in order to plan and conduct a rehabilitation plan. Another important aspect is the use of a rational MI classification on prognostic values. We propose a classification based on radiological investigations performed by ultrasonography and MRI strongly linked to prognostic factors. Furthermore, the consensus conference results will able to provide fundamental guidelines for diagnostic and rehabilitation practice, also considering instrumental therapy and pharmacological treatment of MI. Expert opinion, level IV

A COBALT-PHOSPHINE COMPLEX AS MEDIATOR IN THE FORMATION OF CARBON-CARBON BONDS

The tetrakis(trimethylphosphine)cobalt(0) complex, [Co{P(CH3)3}4], in either stoichiometric or catalytic amounts, was shown to be an efficient mediator for a one-pot Reformatsky-type reaction between activated halogen derivatives (esters, amides, lactones) and carbonyl compounds (aldehydes, ketones) to produce a variety of alcohols

Reproducibility of the minimally invasive approach in unicompartmental knee replacement : 5-year follow-up of oxford phase III prosthesis

Aim. The Oxford III unicompartmental knee replacement (Biomet, UK) has proved to be efficacious in the treatment of the antero-medial arthritis of the knee. The aim of this study is to verify the reproducibility of the minimally invasive approach at an average follow-up of more than 5 years. Methods. Twenty patients (15 women and 5 men, mean age 66.7 years, range 59 to 79) with anteromedial arthritis of the knee were referred to our Institution for prosthetic knee replacement. We implanted 20 Oxford III (Biomet) prostheses with mobile bearing using antibiotic-loaded cement (Palamed G, Biomet). Results. At follow-up the HSS score averaged 87.4 (range 50 -100), with 13 excellent, 3 good, 1 adequate and 3 poor. In the radiological analysis the geometrical parameters indicated in the surgical technique relative to this prosthesis were reproduced in all the implants. The average ROM reported is 133.85\ub0. No cases of infection, nor more serious complications were found; in the 3 patients (15%) with unsatisfactory outcome this was due to the progression of the arthritis in the lateral compartment at the last 5 years follow-up. Conclusion, the Oxford unicompartmental prosthesis is a reliable and reproducible treatment option for arthritis of the anteromedial compartment of the knee