Intra-articular hyaluronic acid injections and oral collagen supplementation for knee OA: A case report of an elite female soccer player

Soccer players are susceptible to repeated trauma that could lead to a precocious development of knee osteoarthritis (OA). Intra-articular hyaluronic acid (IA-HA) injections have been proposed as a valid treatment for knee OA. Objectives: To describe the effects of IA-HA injections and oral collagen supplementation in a female soccer goalkeeper playing in Italian Women’s Serie A with secondary OA in her knee. Design: Case report. Setting: The athlete underwent three IA-HA injections (1 per week for 3 weeks in a row) together with oral collagen supplementation for one month. Treatment outcomes were evaluated using five scoring scales. Results: One week after the first IA-HA injection all the scores improved. One week after the second injection, compared with the first week, two scores improved, two remained the same, and one worsened. One week after the third injection, compared with the second week, all the scores worsened. At one month, compared with the third week, one score remained the same and all the others worsened. From baseline to one month, three scores improved, one remained the same, and one worsened. Conclusions: In our study, IA-HA injections and oral collagen supplementation showed short-term effects on pain and functional impairment for knee OA

Preventing postsurgical venous thromboembolism: pharmacological approaches

The use of antithrombotic drugs for the prevention of venous thromboembolism (VTE) in patients undergoing surgery is presently based on solid principles and high-level scientific evidence. This article reviews current strategies of pharmacological thromboprophylaxis. The level of VTE risk following surgery depends on a variety of factors that the surgeon should take into account, including the type of surgery and the presence of additional risk factors, such as elderly age and cancer. In patients undergoing minor general surgery, early mobilization is sufficient as prophylaxis, whereas in those undergoing major general surgery, thromboprophylaxis with low molecular weight heparin (LMWH), low-dose unfractionated heparin, or the pentasaccharide fondaparinux is recommended. Patients undergoing major orthopedic surgery have a particularly high risk of VTE, and routine thromboprophylaxis with LMWH, fondaparinux, or a vitamin K antagonist (international normalized ratio target: 2.0 to 3.0) is the standard of care in this group of patients. Recently, two new oral anticoagulants, rivaroxaban (a factor Xa inhibitor) and dabigatran etexilate (a direct thrombin inhibitor) have been licensed to be used for thromboprophylaxis after orthopedic surgery in Europe. Mechanical methods of thromboprophylaxis (compression stockings, intermittent pneumatic compression, vena cava filters), not discussed in detail in this review, should always be considered in patients at high thrombotic risk, in association with the pharmacolocical strategies, or in cases of contraindications to antocoagulants, as in patients or procedures at high risk of bleeding

Importance of spinal deformity index in risk evaluation of VCF (vertebral compression fractures) in obese subjects: prospective study.

Introduction Obesity and osteoporosis share many features and recent studies have identified many similarities suggesting common pathophysiological mechanisms. Obesity is associated with a higher risk of non-traumatic fractures despite bone mineral density (BMD) being normal or even increased. Materials and methods 54 obese subjects were analyzed (51 ± 16 years, 10 males, 44 females). Spinal deformity index (SDI) is a semi-quantitative method that may be a surrogate index of bone microarchitecture. SDI index was higher in patients than in controls. In 87.5 % of patients and 10 % of controls we found morphometric vertebral fractures, despite a DEXA Tscore not diagnostic of osteoporosis. Conclusion The objective of this study was to assess in obese patients levels of 25OH vitamin D, parathyroid hormone, serum and urinary calcium (Ca) and phosphorus (P), BMD, and SDI. 87.5 % of the obese subjects present nontraumatic vertebral fractures and reduced bone quality as measured by SDI