Implant sonication versus intraoperative tissue sample cultures for periprosthetic joint infection (PJI) of shoulder arthroplasty

Introduction: Periprosthetic joint infection (PJI) is the most problematic complications after shoulder arthroplasty. Many diagnostic tools have been identified to find infection, such as hystopatologic examination of tissue sections or cultures of intraoperative tissue. Implant sonication fluid culture showed good results in order to enhance diagnostic accuracy, but literature results are still controversial. Aim of our study is to compare the results of sonication with intraoperative tissue sample cultures. Patients and Methods: From February 2016 to January 2018 we performed 102 revisions of Total Shoulder Arthroplasty (TSA) for suspected PJI. Sixty-five patients respected the criteria for admission to the study and were enrolled. In each case periprostethic specimens were collected and explanted prosthesis were put inside sterile fluid, sonicated and then placed under culture. Results: Among the sixty-five patients, 36 were considered as possible, probable or certain infection. Tissue cultures were positive for infection in thirty-four cases (52,3%) and in nineteen cases was found the positivity for Cutibacterium acnes. Sonication fluid cultures were positive in forty cases (61,5%), with a positivity for Cutibacterium acnes in twenty-seven cases. The sensitivities of sonication and tissue cultures for the diagnosis of shoulder PJI were 83.3% and 88,9% (P = 0,08); the specificities were 65.5% and 93,1% (P < 0.01) respectively. Conclusion: Our results suggest that sonication technique had not shown a clear advantage in postoperative shoulder PJI diagnosis, but it’s a real aid to detect Cutibacterium acnes. In any case, sensitivity and mostly specificity were higher with tissue cultures. (www.actabiomedica.it)

The incidence of hip, forearm, humeral, ankle, and vertebral fragility fractures in Italy: results from a 3-year multicenter study

INTRODUCTION: We aimed to assess the incidence and hospitalization rate of hip and "minor" fragility fractures in the Italian population. METHODS: We carried out a 3-year survey at 10 major Italian emergency departments to evaluate the hospitalization rate of hip, forearm, humeral, ankle, and vertebral fragility fractures in people 45 years or older between 2004 and 2006, both men and women. These data were compared with those recorded in the national hospitalizations database (SDO) to assess the overall incidence of fragility fractures occurring at hip and other sites, including also those events not resulting in hospital admissions. RESULTS: We observed 29,017 fractures across 3 years, with hospitalization rates of 93.0% for hip fractures, 36.3% for humeral fractures, 31.3% for ankle fractures, 22.6% for forearm/wrist fractures, and 27.6% for clinical vertebral fractures. According to the analyses performed with the Italian hospitalization database in year 2006, we estimated an annual incidence of 87,000 hip, 48,000 humeral, 36,000 ankle, 85,000 wrist, and 155,000 vertebral fragility fractures in people aged 45 years or older (thus resulting in almost 410,000 new fractures per year). Clinical vertebral fractures were recorded in 47,000 events per year. CONCLUSIONS: The burden of fragility fractures in the Italian population is very high and calls for effective preventive strategies

Grammont humeral design versus onlay curved-stem reverse shoulder arthroplasty: comparison of clinical and radiographic outcomes with minimum 2-year follow-up

Background: There are few investigations comparing lateralized and medialized reverse total shoulder arthroplasty (RTSA) in patients with cuff tear arthropathy. This study assessed the outcomes of 2 RTSA designs. Methods: Sixty-eight consecutive cuff tear arthropathy patients (74 shoulders) with a follow-up of at least 24 months received a Grammont or an onlay curved short-stem humeral component, with or without glenoid lateralization; a cementless humeral stem was implanted in >90%. Clinical outcome measures included active range of motion (anterior and lateral elevation, external and internal rotation), pain, and the Constant-Murley score. Radiologic outcomes included radiolucency, condensation lines, cortical thinning, spot weld, loosening and subsidence, and tuberosity resorption for the humeral component and radiolucency, scapular notching, formation of scapular bone spurs, ossifications, and loosening for the glenoid component. Results: Both prostheses provided significant differences between preoperative and postoperative scores and showed a similar complication rate. Scapular fractures were found only in the patients who received the curved short-stem implant. Glenoid bone grafting did not significantly affect clinical scores. Both implants provided similar postoperative shoulder mobility, even though the lateralized curved stem was associated with higher delta scores for external rotation (P =.002) and lower rates of scapular notching (P =.0003), glenoid radiolucency (P =.016), and humeral bone remodeling (P =.004 and P =.030 for cortical thinning and spot weld, respectively). Conclusions: Medialized and short-stem lateralized RTSA implants provided similar midterm clinical outcomes and range of motion. The curved short stem was associated with higher delta scores for external rotation and a lower rate of radiographic risk factors

I.S.Mu.L.T. hyaluronic acid injections in musculoskeletal disorders guidelines

Intra-articular and peri-articular hyaluronic acid (HA) injections are widely used to treat several musculoskeletal pathologies. Although clinical outcomes are often positive for different conditions, an holistic consensus on this topic is still lacking. Our work is divided in two main sessions: in the first section we analyzed the preclinical bases for HA treatment in musculoskeletal pathologies, while in the second part we discussed the evidence on the use of HA injections in each district of musculoskeletal system. The aim of this work is to provide to the physician a feasible guideline rapidly to consult in the clinical practice. Level of evidence: Ia

I.S.Mu.L.T. hyaluronic acid injections in musculoskeletal disorders guidelines

Intra-articular and peri-articular hyaluronic acid (HA) injections are widely used to treat several musculoskeletal pathologies. Although clinical outcomes are often positive for different conditions, an holistic consensus on this topic is still lacking. Our work is divided in two main sessions: in the first section we analyzed the preclinical bases for HA treatment in musculoskeletal pathologies, while in the second part we discussed the evidence on the use of HA injections in each district of musculoskeletal system. The aim of this work is to provide to the physician a feasible guideline rapidly to consult in the clinical practice. Level of evidence: Ia

I.S.Mu.L.T. hyaluronic acid injections in musculoskeletal disorders guidelines

Intra-articular and peri-articular hyaluronic acid (HA) injections are widely used to treat several musculoskeletal pathologies. Although clinical outcomes are often positive for different conditions, an holistic consensus on this topic is still lacking. Our work is divided in two main sessions: in the first section we analyzed the preclinical bases for HA treatment in musculoskeletal pathologies, while in the second part we discussed the evidence on the use of HA injections in each district of musculoskeletal system. The aim of this work is to provide to the physician a feasible guideline rapidly to consult in the clinical practic