Total knee arthroplasty in hemophilic arthropathy: long-term follow up

Severe hemophilia is complicated by recurrent spontaneous joint bleedings, which lead to severe secondary arthrosis, defined as hemophilic arthropathy. Joint pain, unresponsive to medical treatment and impaired function are indications for total knee replacement. A well–balanced homeostasis is the basic requirement for successful operative interventions. The aim of our study is to evaluate the results of a combined series of total knee replacements in 25 patients with severe hemophilia A and one patient with severe hemophilia B, treated at University Orthopaedic Departments of Naples and Bari from 1992 to 2006. We evaluated patients according Knee Score. Review of the patients over a period of 85 months (12–156 months) after operation showed dramatic reduction of pain and maintenance of a satisfactory range of movement. The frequency of hemarthrosis was also markedly reduced and the requirements for replacement FVIII/IX concentrate in the years after operation fell substantially. On the whole, an improvement of the Knee Score from 37 (pre-operative) to 87 (post-operative) has been recorded. In our experience total knee replacement led to a significant clinical improvement in all the patients, with relevant impact on quality of life

Il management clinico e la monitorizzazione dei pazienti con protesi d’anca metallo-metallo. Algoritmo diagnostico e terapeutico

L’accoppiamento protesico metallo-metallo in chirurgia dell’anca è oggetto di recente discussione e preoccupazione a causa dell’evenienza di fallimenti protesici causati da reazioni avverse locali alla metallosi. Le reazioni avverse a tali particelle di usura (Adverse Reaction to Metal Debris - ARMD) rappresentano il più importante meccanismo di fallimento di questa coppia di attrito. In certi casi descritti come catastrofici, i fallimenti di un impianto metallo-metallo dovuti all’aggressione e distruzione dei tessuti periprotesici possono necessitare estese procedure di ricostruzione. Probabilmente uno dei problemi maggiori per il chirurgo ortopedico riguarda la valutazione e monitorizzazione nel tempo dei pazienti portatori di una protesi metallo-metallo, e verso quali procedure diagnostiche e terapeutiche indirizzare quei pazienti che presentino indici di malfunzionamento protesico o complicazioni ascrivibili alla metallosi. Lo scopo di questo articolo è di conferire una visione attuale e d’insieme del problema e descrivere un algoritmo utilizzato nel monitoraggio e trattamento dei pazienti con accoppiamento metallo-metallo

Reversibility of joint thickening in acromegalic patients: an ultrasonography study

Axial and peripheral arthropathy affects the majority of patients with acromegaly, being a leading cause of morbidity and functional disability. Treatment with octreotide (OCT) improves symptoms and signs of acromegalic arthropathy, but objective detection of structural changes in bone and cartilage has not been reported to date. This open prospective study was designed to evaluate the effect of a long term treatment with OCT on acromegalic arthropathy assessed by ultrasonography examination. Articular cartilage thicknesses of shoulder, wrist, and knee as well as sizes of heel tendons were measured in 30 acromegalic patients (18 with active and 12 with inactive disease) and 18 sex-, age-, and body mass index-matched healthy subjects. The thicknesses of shoulder, wrists and knees articular cartilages and that of heel tendons were significantly increased in patients with active acromegaly compared to those in healthy subjects (P < 0.01). With the exception of shoulder cartilage, significant increases in wrist and knee cartilages (P < 0.01) and right and left heel tendon sizes (P < 0.05) were found in patients with active compared to those with inactive disease. After 6 months of OCT treatment, a significant decrease in shoulder, wrist, and left knee articular cartilage was found (P < 0.001). No significant change was recorded in right knee cartilage or heel tendon size. The decrease in thickness of shoulder and wrist cartilages was more pronounced than that measured at the level of left knee (26.3 +/- 3.3% and 27.2 +/- 4.2% vs. 14.2 +/- 4.2%, respectively; P < 0.05). Ultrasonography is able to reveal articular involvement in acromegalic patients and may be useful to monitor the effect of treatment