Telerehabilitation Is a Valid Option for Total Knee Arthroplasty Patients: A Retrospective Pilot Study Based on Our Experience during the COVID-19 Pandemic

Introduction: Total knee arthroplasty is an effective operation. Post-surgery rehabilitation, based on early and intensive progressive exercise programs, plays a substantial role and telerehabilitation can be an effective safe option. This retrospective study aimed to compare traditional in-presence rehabilitation and telerehabilitation for total knee arthroplasty, based on our experience during the Italian COVID-19 lockdown. Materials and methods: We retrospectively analyzed 164 patients (94 females and 70 males) enrolled in 2020 within 2 weeks after total knee replacement to perform post-operative outpatient rehabilitation. The clinical results of 82 patients (mean age 66.8 ± 10.2 years) performing telerehabilitation with those obtained from a similar cohort of 82 patients (mean age 65.4 ± 11.8 years) performing traditional in-presence outpatient rehabilitation were compared. Clinical outcomes were examined by comparing the gait speed (Time Up and Go-TUG test), the range of motion, the pain intensity (VAS), the functional status (Oxford Knee Score—OKS and Knee injury and Osteoarthritis Outcome Score—KOOS) and the overall satisfaction (Self-administered patient satisfaction scale) 12 weeks after the beginning of the physiotherapeutic protocol. Results: Telerehabilitation was non-inferior to traditional in-presence rehabilitation in all of the investigated areas and no statistical difference in terms of effectiveness was detected at 12 weeks, as confirmed by the respective patient-reported outcome scores such as TUG test (reduced from 20 ± 2 s to 12 ± 1.5 s for the telerehab cohort and from 18 ± 1.5 s to 13.1 ± 2 s for the in-presence rehabilitation one), pain VAS, OKS (improved from 22 ± 1.3 to 36 ± 2.7 for the telerehab cohort and from 23 ± 2.1 to 35.1 ± 4.2 for the in-presence group), KOOS (improved from 46.2 ± 10.2 to 67.4 ± 3.8 for the telerehabilitation cohort and from 48.4 ± 8.4 to 68.3 ± 6.6 for the other group), and the Self-administered patient satisfaction scale (more than two-thirds of patients globally satisfied with the results of their surgery in both groups). Conclusion: The telerehabilitation program was effective after total knee replacement and yielded clinical outcomes that were not inferior to conventional outpatient protocols

The rise of registry-based research: a bibliometric analysis

Background and purpose — The main purpose of arthroplasty registries is to collect information on patients, techniques, and devices to monitor and improve the outcome of the specific procedure. This study analyses the role played by registries in the orthopedic research community and describes publication trends, characteristics, and patterns of this field of research. Patients and methods — A descriptive-bibliometric review was conducted. Scopus was the database used for the research. All articles published from 1991 to December 2020 containing keywords related to registries and arthroplasty were considered. In particular, the following dimensions were analyzed in detail: (i) papers/year; (ii) journals; (iii) countries; (iv) research growth rate; (v) collaboration among countries. VOSviewer software was used to perform the bibliometric analysis. Finally, the 50 most cited papers of the last 10 years were briefly analyzed. Results — 3,933 articles were identified. There has been growing interest in the topic since 2010. Acta Orthopaedica ranked first for the number of articles published. The country with the largest number of articles citing registries was the United States, followed by the United Kingdom and Sweden. The relative number of articles per 100,000 inhabitants is 0.60 for Europe and 0.38 for the United States. The literature in this research area has an average yearly growth rate of 28%. Interpretation — The publication rate in the field of arthroplasty registries is constantly growing with a noteworthy impact in the evolution of this research and clinical area. The growth rate is significantly higher than that of arthroplasty literature (28% vs. 10%) and the collaboration among countries is strong and increasing with time

The influence of graft placement on clinical outcome in anterior cruciate ligament reconstruction

PURPOSE: the aim of the present study was to investigate the influence of graft tunnel position on both clinical outcome and instrumental knee stability in patients submitted to arthroscopic ACL reconstruction using a bone-patellar tendon-bone (BPTB) graft. METHODS: thirty patients (24 men and 6 women) who underwent ACL reconstruction performed using an autologous bone-patellar tendon-bone graft were studied at a mean follow-up of 18 months. Clinical outcome was assessed on the basis of the Lysholm score, Tegner activity level, International Knee Documentation Committee (IKDC) subjective form and the Short Form-36. Clinical outcomes were correlated with both femoral and tibial tunnel placement measured on standard anteroposterior and lateral knee radiographs, in accordance with established guidelines. RESULTS: tibial tunnel position on the lateral view correlated significantly with both the IKDC subjective form (r = -0.72; p<0.05) and the Lysholm score (r=-0.73; p<0.05). Tibial tunnel position on the lateral view also correlated with stability measured using a KT-1000 arthrometer at 30N of force (r=0.57; p<0.05). No correlation was found between α angle and anteroposterior (AP) laxity measured by KT-1000 arthrometer. No significant correlation was found between femoral tunnel position (on either view) and Lysholm score, IKDC score and Tegner activity level. Similarly, no correlation was found between AP laxity measured by KT-1000 arthrometer and femoral tunnel position. CONCLUSIONS: these results suggest that the more anterior the placement of the tibial tunnel, the better the clinical outcome will be. On the basis of literature data and our findings, we discuss the hypothesis that there exists a "correct area" for tunnel placement, making it possible to obtain the best results. LEVEL OF EVIDENCE: Level IV, case series

Total knee arthroplasty in Italy: reflections from the last fifteen years and projections for the next thirty

Annual rates of knee arthroplasty are increasing in all developed countries, imposing a significant economic and organizational burden; it is crucial to forecast the future need for knee arthroplasty, to assist stakeholders in planning strategies and investments, especially in a country like Italy, with the largest proportion of elderly citizens in Europe. Few epidemiological studies have been performed worldwide to estimate the demand for future knee replacement, and a variety of methods have been proposed

Nuova metodica di terapia genica per indurre l osteogenesi: risultati della sperimentazione in Fase I in tre differenti modelli animali

Numerose tecniche di terapia genica sono state sperimentate negli ultimi anni in campo ortopedico al fine di migliorare la rigenerazione ossea in diverse condizioni patologiche. In questo lavoro presentiamo una nuova metodica di terapia genica ex vivo per indurre l osteogenesi. A tale scopo sono stati utilizzati culture di fibroblasti cutanei autologhi, la cui realizzazione in vitro \ue8 estremamente semplice e che hanno il notevole vantaggio di essere ottenibili rapidamente con una semplice biopsia cutanea. Le cellule cos\uec ottenute sono state poi modificate ex vivo con Ad-LMP-3 (Adenovirus per l espressione della Lim Mineralization Protein-3) e ritrapiantate, tramite uno scaffold osteoconduttivo in idrossiapatite e collagene (HA/Col), in tre differenti modelli animali sperimentali: formazione di osso ectopico nel muscolo tricipite, fusione vertebrale in topi immunocompetenti e guarigione di un modello di difetto osseo critico di mandibola in ratti immunocompetenti. La metodica qui descritta \ue8 risultata efficace in tutti i modelli utilizzati per l induzione di osso, confermando le propriet\ue0 osteoinduttive di hLMP-3 (human Lim Mineralization Protein-3) in vivo, l efficacia del modello di scaffold in HA/Col, ma soprattutto aprendo interessanti prospettive per una possibile sperimentazione clinica sull uomo

Risonanze II. La memoria dei testi dal Medioevo a oggi

Si tratta di un volume che riunisce saggi di autori di varie discipline che seguono il filo rosso della memoria del testo negli anni, dalla semplice traduzione alla trasposizione teatrale o cinematografica, dalla riproduzione nelle arti visive alla rielaborazione musicale. I contributi del saggio, ognuno secondo il proprio ambito di ricerca (dalle lingue e letterature europee antiche e contemporanee, al teatro, alla musica) evidenziano le particolarità intrinseche alla trasmissione di un testo dal medioevo a oggi, e indagano su ampia scala e in prospettiva interdisciplinare il rapporto fra il testo e l’audience, sia in senso diacronico (la tradizione testuale, la ricostruzione del testo, le sue trasformazioni nel tempo a seconda del pubblico) sia in senso sincronico (l’intertestualità, il rapporto autore-pubblico, le forme di comunicazione). Inevitabile è l’intreccio fra traduzione e tradizione dei testi. A ogni lettura si mette in moto un processo di ‘traduzione’: una volta nato il testo è destinato a essere tradotto, ossia trasferito, trascritto, riadattato, reinterpretato o trasposto in un’altra lingua, per ritrovare nuova linfa vitale a ogni nuova lettura, a ogni ascolto, a ogni messa in scena

Risonanze III. La memoria dei testi dal medioevo a oggi

Il volume raccoglie saggi di studiosi di varie discipline sul testo e la sua eco nel tempo (e nello spazio). Il Leitmotiv è il tema della memoria del testo, delle sue riscritture e delle varie forme che assume nel corso della sua storia. Si indaga sul rapporto fra il testo e il pubblico, sia in senso diacronico (tradizione testuale, ricostruzione del testo, trasformazioni del testo che si adatta a un pubblico sempre diverso a seconda delle epoche), sia in senso sincronico (intertestualità, rapporto autore-pubblico, autoriscritture, forme di comunicazione, adattamenti musicali di un testo, passaggio dal testo letterario alle arti visive e, a volte, viceversa)

Diagnostic issues faced by a rare disease healthcare network during Covid-19 outbreak: data from the Campania Rare Disease Registry

Background: The aims of this study were: to investigate the capacity of the rare disease healthcare network in Campania to diagnose patients with rare diseases during the outbreak of Covid-19; and to shed light on problematic diagnoses during this period. Methods: To describe the impact of the Covid-19 pandemic on the diagnosis of patients with rare diseases, a retrospective analysis of the Campania Region Rare Disease Registry was performed. A tailored questionnaire was sent to rare disease experts to investigate major issues during the emergency period. Results: Prevalence of new diagnoses of rare disease in March and April 2020 was significantly lower than in 2019 (117 versus 317, P < 0.001 and 37 versus 349, P < 0.001, respectively) and 2018 (117 versus 389, P < 0.001 and 37 versus 282, P < 0.001, respectively). Eighty-two among 98 rare disease experts completed the questionnaire. Diagnostic success (95%), access to diagnosis (80%) and follow-up (72%), lack of Personal Protective Equipment (60%), lack of Covid-19 guidelines (50%) and the need for home therapy (78%) were the most important issues raised during Covid-19 outbreak. Conclusions: This study describes the effects of the Covid-19 outbreak on the diagnosis of rare disease in a single Italian region and investigates potential issues of diagnosis and management during this period