Regaining Motion among Patients with Shoulder Pathology - Are All Exercises Equal?

Background: Little information exists to guide the choice of exercise for regaining shoulder range of motion (ROM). The purpose of this study was to compare the maximal ROM reached, pain and difficulty associated with 4 commonly prescribed exercises. Methods: Forty (9 females) patients with various shoulder disorders and a limited flexion ROM performed 4 exercises for regaining shoulder flexion ROM in a randomized order. Exercises included the self-assisted flexion, forward bow, table slide and rope-and-pulley. Participants were videotaped while performing all exercises and the maximal flexion angle reached during each exercise was recorded using Kinovea motion analysis freeware (Kinovea 0.8.15). Pain intensity and the perceived level of difficulty associated with each exercise were also recorded. Results: The forward bow and table slide generated significantly greater ROM compared with the self-assisted flexion and rope-and-pulley (P≤0.005). The self-assisted flexion was associated with a greater pain intensity compared with the table slide and rope-and-pulley (P=0.002) and a greater perceived level of difficulty compared with the table slide (P=0.006). Conclusions: Due to the greater ROM allowed, and similar or even lower level of pain or difficulty, clinicians may wish to initially recommend the forward bow and table slide for regaining shoulder flexion ROM

The supine moving apprehension test—Reliability and validity among healthy individuals and patients with anterior shoulder instability

Background: Performance-based tests for patients with anterior shoulder dislocation are lacking. This study determined the reliability and validity of the supine moving apprehension test designed to assess the ability to control anterior instability loads. Methods: Thirty-six participants were recruited (18 healthy individuals, and 18 patients following anterior shoulder dislocation). Healthy participants performed the supine moving apprehension test on 2 separate occasions to determine test-retest reliability. Patients completed the supine moving apprehension test and the Western Ontario Shoulder Instability index before and 6 months after surgical stabilization of their shoulder. The presence of anterior apprehension was also documented post-operatively. Results: The supine moving apprehension test demonstrated good test-retest reliability (intraclass correlation coefficient =0.74−0.84). Patients performed 18−30 repetitions less than healthy individuals during the supine moving apprehension test (P \u3c 0.01). A strong correlation was found between supine moving apprehension test scores and Western Ontario Shoulder Instability post-operatively (r=−0.74, P ≤ 0.01). Supine moving apprehension test scores significantly improved among patients following surgery (P \u3c 0.01). Patients with a negative apprehension test post-operatively performed the supine moving apprehension test significantly better than patients with a positive apprehension test (P \u3c 0.01). Conclusions: The supine moving apprehension test is reliable and valid among patients with anterior shoulder dislocation and may serve to assess patients’ ability to control shoulder anterior instability loads

Less is better than more with resection of periacetabular tumors – A retrospective 16 years study and literature review

IntroductionWide resections of periacetabular tumors create a sizeable bony defect that inevitably results in severe loss of function. Reconstruction of such defects usually requires using large metal implants, a feature associated with considerable surgery extension and complications. The aim of this study is to report resection with no reconstruction of the bony defect. In this retrospective study, we reviewed a consecutive series of 16 patients diagnosed with malignant periacetabular tumors and underwent en-bloc resection without reconstructing their remaining bone defect.MethodsRecords were reviewed of 16 consecutive patients diagnosed with malignant periacetabular tumors and underwent en-bloc resection without reconstructing their remaining bony defect. Measurements included: the duration of surgery, blood loss, hemoglobin levels and the need for blood transfusions, data on other hospitalization characteristics, and intraoperative and postoperative complications.ResultsSixteen patients with malignant periacetabular bone tumors and extensive bone destruction underwent wide periacetabular tumor resection with a mean follow-up of 75 months and a mean age of 53 years. The average HOOS score was 46 (range: 20 to 76), and the mean MSTS score was 13% (range: 0 to 15). The mean operative time was 4.1 h, and the mean blood loss was 1200 ml. At their most recent follow-up, patients had a mean shortening of their operated extremity of 4.8 cm, and all could ambulate with assisting devices.ConclusionWide resection of periacetabular tumors without reconstruction provides acceptable levels of function and was associated with shorter surgical time, less blood loss and fewer postoperative complications compared to resection with reconstruction. Therefore, this approach may be considered a viable surgical option in patients with an extensive malignant periacetabular.Level IIIRetrospective study

Miniaturized Electromagnetic Device Abutment Improves Stability of the Dental Implants

The overall success and predictability of dental implant treatment hinge on the primary stability, direct bone-to implant contact formation, and quantity and/or quality of residual bone. Pulsed electromagnetic field has been reported to increase bone regeneration in various clinical situations. Therefore, it was hypothesized that devices which could locally generate a Pulsed electromagnetic field would stimulate bone healing and increase bone density surrounding implants

Ранні ускладнення і проміжні результати ендопротезування із застосуванням анатомічних мегаголовок стегнової кістки

Purpose: mechanical complications such as malrestoration of hip anatomy still impede surgical results and patient satisfaction after THA. Anatomical femoral «mega-heads» are a novel approach which enables a surgeon to use a large diameter metal on metal implant to restore hip anatomy. Ability to place femoral head eccentrically on the femoral taper results in possible anteversion, retroversion, offset and lengthening. Our hypothesis is that use of this device will result in more accurate anatomical restoration and clinical results.Methods: 64 anatomical mega-head arthroplasties were evaluated. Preoperative planning was done in order to determine the desired position of the head, restore the anatomy and avoid leg lengthening. Patients were observed at an average of 50-months for both subjective and objective outcomes. Radiograph analysis assessed anatomical restoration. Results: 51 of the 64 hips were available for follow up. In 35 the head was placed eccentrically. In 20 the positioning was inferior, 6 — posterior, 3 — anterior, 1 — superior, and 4 inferior and posterior. Harris Hip and SF-36 scores improved significantly (P < 0.001). Mean radiographic limb and offset discrepancy were 0.1 and 0.01mm respectively. Six patients (11.7 %) underwent revision surgery; elevated metal ion levels and pseudotumor (3), acetabular component loosening (2), and unexplained hip pain (1).Conclusions: The novel anatomical femoral mega-head allows versatility in restoration of normal hip anatomy. Mid-term follow-up showed a higher than anticipated rate of complications for this cup design and reduced longevity of the implant. Novel ways need to be explored to allow such versatility in restoring hip anatomy.Цель: неадекватное восстановление анатомии тазобедренного сустава (ТБС) негативно влияет на результаты тотального эндопротезирования. Использование анатомических мегаголовок бедренной кости в паре трения «металл-металл» является новым подходом, позволяющим восстановить анатомию ТБС. Расположение головки бедренной кости эксцентрично на конусе бедра с уменьшающимся сечением приводит к возможности антеверсии, ретроверсии, офсет и удлинению. Предполагаем, что применение такого устройства обеспечит более точное восстановление анатомии ТБС и улучшит клинические результаты. Методы: оценены объективные и субъективные результаты 64 операций эндопротезирования с применением анатомических мегаголовок в среднем в течение 50 мес. Перед операцией определяли необходимое положение головки, восстановление анатомии и избежание удлинения конечности. Результаты: в динамике проанализировали 51 из 64 прооперированных суставов. В 35 случаях головка располагалась эксцентрично,в 20 — книзу, в 6 — кзади, в 3 — кпереди, в 1 — кверху, в 4 — книзу и кзади. Отмечено значительное улучшение показателей шкалы Harris’a для ТБС и SF-36 (P < 0,001). Средние показатели рентгенологических различий конечностей и офсет были 0,1 и 0,01 мм соответственно. У 6 пациентов (11,7 %) выполнено ревизионное хирургическое вмешательство: у 3 больных выявлен повышенный уровень содержания ионов железа и псевдоопухоль, у 2 — расшатывание вертлужного компонента, у 1 — боли в ТБС. Выводы: новые анатомические мегаголовки бедренной кости обеспечивают универсальность в восстановлении анатомии ТБС. Промежуточные результаты свидетельствуют о более высоком, по сравнению с предполагаемым, уровне осложнений для данного дизайна головки и сниженной долговечности имплантата. Необходим поиск новых путей для получения универсальности восстановления анатомии ТБС.Мета: неадекватне відновлення анатомії кульшового суглоба (КС) негативно впливає на результати тотального ендопротезування. Використання анатомічних мегаголовок стегнової кістки в парі тертя «метал-метал» є новим підходом, який дає змогу відновити анатомію КС. Розташування головки стегнової кістки ексцентрично на конусі стегна зі зменшуваним перетином призводить до можливості антеверсії, ретроверсії, офсету і подовженню. Припускаємо, що застосування такого пристрою забезпечить точніше відновлення анатомії КС і поліпшить клінічні результати. Методи: оцінені об’єктивні та суб’єктивні результати 64 операцій ендопротезування із застосуванням анатомічних мегаголовок у середньому протягом 50 міс. Перед операцією визначали необхідне положення головки, відновлення анатомії і уникнення подовження кінцівки. Результати: у динаміці проаналізували 51 із 64 прооперованих суглобів. У 35 випадках головка розташовувалася ексцентрично, у 20 — вниз, у 6 — назад, у 3 — уперед, в 1 — догори, у 4 — униз і назад. Відзначено значне поліпшення показників шкали Harris'a для КС і SF-36 (Р < 0,001). Середні показники рентгенологічних відмінностей кінцівок і офсет були 0,1 і 0,01 мм відповідно. У 6 пацієнтів (11,7 %) виконано ревізійне хірургічне втручання: у 3 хворих виявлено підвищений рівень вмісту іонів заліза і псевдопухлина, у 2 — розхитування кульшового компоненту, в 1 — болі в КС. Висновки: нові анатомічні мегаголовки стегнової кістки забезпечують універсальність у відновленні анатомії КС. Проміжні результати свідчать про вищий, порівняно з передбачуваним, рівень ускладнень для вказаного дизайну головки і знижену довговічність імплантата. Необхідний пошук нових шляхів для отримання універсальності відновлення анатомії КС

Pulsed electromagnetic fields increase osteogenetic commitment of MSCs via the mTOR pathway in TNF-\u3b1 mediated inflammatory conditions: An in-vitro study

Pulsed electromagnetic fields (PEMFs) have been considered a potential treatment modality for fracture healing, however, the mechanism of their action remains unclear. Mammalian target of rapamycin (mTOR) signaling may affect osteoblast proliferation and differentiation. This study aimed to assess the osteogenic differentiation of mesenchymal stem cells (MSCs) under PEMF stimulation and the potential involvement of mTOR signaling pathway in this process. PEMFs were generated by a novel miniaturized electromagnetic device. Potential changes in the expression of mTOR pathway components, including receptors, ligands and nuclear target genes, and their correlation with osteogenic markers and transcription factors were analyzed. Involvement of the mTOR pathway in osteogenesis was also studied in the presence of proinflammatory mediators. PEMF exposure increased cell proliferation and adhesion and the osteogenic commitment of MSCs even in inflammatory conditions. Osteogenic-related genes were over-expressed following PEMF treatment. Our results confirm that PEMFs contribute to activation of the mTOR pathway via upregulation of the proteins AKT, MAPP kinase, and RRAGA, suggesting that activation of the mTOR pathway is required for PEMF-stimulated osteogenic differentiation. Our findings provide insights into how PEMFs influence osteogenic differentiation in normal and inflammatory environments

Development of a New Model of Humeral Hemiarthroplasty in Rats

Purpose In vivo models are anatomically comparable to humans allowing to reproduce the patterns and progression of the disease and giving the opportunity to study the symptoms and responses to new treatments and materials. This study aimed to establish a valid and cost-effective in vivo rat model to assess the effects of implanted shoulder hemiarthroplasty materials on glenoid articular cartilage wear. Methods Eight adult male Wistar rats underwent right shoulder hemi-arthroplasty. A stainless steel metal bearing was used as a shoulder joint prosthesis. X-rays were performed one week after surgery to verify correct implant position. Additional X-rays were performed 30 and 60 days post-implantation. Animals were sacrificed 24 weeks after implantation. All specimens were evaluated with micro-CT for cartilage and bone wear characteristics as well as histologically for signs of osteoarthritis. Samples were compared to the non-operated shoulders. Results All animals recovered and resumed normal cage activity. All X-rays demonstrated correct implant positioning except for one in which the implant was displaced. Histologic evaluation demonstrated arthritic changes in the implanted shoulder. Decreased Trabecular thickness and Trabecular Spacing were documented among the implanted parties (p < .05). Bone Mineral Density and Tissue Mineral Density were reduced in the operated shoulder although not significantly (p = .07). Conclusions This study demonstrated significant glenoid cartilage wearing in the operated shoulder. Furthermore, the presence of an intra-articular hemiarthroplasty implant diminished underlying glenoid bone quality. This novel, in vivo-model will enable researchers to test implant materials and their effects on cartilage and bone tissue in a cost-effective reproducible rat model