Pre-operative factors affecting the indications for anatomical and reverse total shoulder arthroplasty in primary osteoarthritis and outcome comparison in patients aged seventy years and older

Background: We evaluated the pre-operative factors affecting anatomical and reverse total shoulder arthroplasty (TSA and RTSA) indications in primary osteoarthritis and compared outcomes in patients aged 70 years and older. Methods: Fifty-eight patients received a TSA with an all-polyethylene glenoid component (APGC) or an RTSA with/without glenoid lateralization and the same curved short-stem humeral component. Active anterior and lateral elevation (AAE, ALE), internal and external rotation (IR, ER), pain, and the Constant–Murley score (CS) were recorded pre and post-operatively. Pre-operative rotator cuff (RC) fatty infiltration (FI) and modified Walch glenoid morphology were assessed. Humeral and glenoid component radiological outcomes were recorded. Results: RTSA were older than TSA patients (p = 0.006), had lower pre-operative AAE (p < 0.001), ALE (p < 0.001), IR (p = 0.002), pain (p = 0.008) and CS (p < 0.001), and greater supraspinatus FI (p < 0.001). At a mean of 28.8 months, both implants yielded significantly different post-operative scores and similar complication rates. Both groups achieved similar post-operative AAE, ER, and IR; ALE was higher in TSA (p = 0.006); and AAE and ALE delta scores were higher in RTSA (p = 0.045 and p = 0.033, respectively). Radiolucent line rates were higher around the TSA APGC than the RTSA baseplate (p = 0.001). High-grade RC FI adversely affected mobility improvement. Humeral cortical thinning was significantly higher in TSA (p = 0.001). Conclusion: RTSA patients were older, had poorer pre-operative active mobility, and had greater RC FI than TSA. Both devices provided good mid-term clinical and ROM improvement

Protesi inversa. Risultati di uno studio multicentrico.

Lo scopo di questo studio è stato di valutare il risultato funzionale, e le complicazioni a medio termine di spalle con artropatia da cuffia sottoposte ad artroplastica con protesi inversa. II campione di studio era costituito da 92 pazienti con rottura massiva della cuffia ed artropatia eccentrica gleno-omerale. L'età media era di 71 anni. Tutti i pazienti sono stati sottoposti, da 5 equipes chirurgiche, ad artroplastica con protesi inversa. Gli accessi chirurgici utilizzati sono stati quello superiore ed il deltoideo pettorale. La valutazione funzionale della spalla operata è stata effettuata con il metodo di Constant (follow-up medio: 3.5 anni). Al follow-up, i valori di tutti i parametri considerati nella scheda di valutazione funzionale di Constant erano aumentati. II valore medio del dolore postoperatorio era di 13 (su 15) punti ed era superiore di 5 unità rispetto alia condizione preoperatoria. Analogamente, il valore medio attribuito all'abilità a compiere le comuni attività quotidiane era salito da 6 (preop) a 16 (postop) unità (su 20). Al movimento preoperatorio di flessione, abduzione intra ed extrarotazione era stato attribuito un punteggio medio, rispettivamente, di 2.9, 2.8, 2.3 e 2.1; quello postoperatorio era salito, invece, a 8.3, 7.4, 3.6, e 6.3 (totale: 25.6 su 40). II Constant score medio totale preoperatorio era di 22.5; quello postoperatorio di 66.8. Dopo l'intervento, 2 pazienti hanno avuto una pseudoartrosi dell'acromion; 1 lo svitamento della glenosfera; 1 un'intolleranza al metallo; 1 un'infezione superficiale, 1 una mobilizzazione della metaglena, 1 una lussazione, 1 un riassorbimento della corticale mediale al terzo prossimale dell'omero ed una frattura post-traumatica della corticale laterale. Le incisure sul collo della scapola sono state frequenti, ma non tutte responsabili di dolore. I risultati a medio termine dopo impianto di protesi inversa ottenuti in pazienti con artropatia da cuffia sono soddisfacenti. II Constant score medio postoperatorio 6 di poco superiore a quello calcolato, in altri .studi, in pazienti con endoprotesi. Sia il valore del dolore che quello dell'abilità a compiere attività quotidiane aumentano di circa 3 volte rispetto alia condizione preoperatoria. Dei movimenti della spalla, I'intrarotazione è quello che meno si incrementa dopo l'impianto protesico. Questo dato è analogo a quanto riportato da altri autori. Durante i 3 anni di follow-up, il 9% dei pazienti ha avuto una complicazione che ha spesso richiesto un reintervento. Questa percentuale non comprende le incisure del collo scapolare la cui formazione non è sempre spiegabile con la posizione della componente omerale

Trattamento ottimale delle lesioni degli arti superiori nel polifratturato

In the last decades there has been an increase in the rate of high-energy traumas. They lead to multiple traumatic injuries, affecting different organs and body systems. The approach to these multi-trauma patients is complex and requires the cooperation of a multi-disciplinary team of experts working together. Orthopaedic treatment is generally considered after vital parameters have been stabilized, but should not be excessively postponed to avoid complications at the time of surgery. Upper limb injuries are frequent but often misdiagnosed and not adequately treated. The authors describe the current treatment of the most frequent injuries of shoulder, elbow, wrist and hand in polytrauma patients

Hidradenitis Suppurativa in a Large Cohort of Italian Patients: Evaluation of the Burden of Disease

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually occurs after puberty with painful, deep-seated, inflamed nodules and sinus tracts in the apocrine gland-bearing areas of the body, most commonly the axillae and inguinal and anogenital regions, with a relevant impact on patients' quality of life (QoL). OBJECTIVE: To evaluate how the burden of HS disease impacts on patient well-being and working activities in a large Italian population over a period of 9 months. METHODS: A multicenter, prospective, epidemiologic cohort study was conducted in adult Italian patients with HS. HS severity was assessed through Hurley stage and HS Physician's Global Assessment (HS-PGA), clinical improvement by HS Clinical Response (HiSCR) and partial response, and disease burden through QoL questionnaires (HIDRAdisk, Skindex-16, Dermatology Life Quality Index [DLQI]), and Work Productivity and Activity Impairment - General Health (WPAI:GH). RESULTS: A total of 308 patients (56.2% women; mean age 35.2 ± 12.9 years) were enrolled in 27 dermatologic clinics. Men were older (37.4 years vs. 33.5), more smoking addicted (74.1% vs. 60.1%), and alcohol consumer (34.1% vs. 13.9%), while more women were obese (34.10% vs. 22.22%). At baseline, most patients had a Hurley severity stage of 2 (43.9%), a moderate HS-PGA score (57.1%), and poor QoL (HIDRAdisk: 65.7 ± 23.3, Skindex-16: 60.3 ± 26.9, and DLQI: 10.8 ± 8.1). Patients with more severe disease showed worse QoL. Mean values for the variables related to HS severity decreased during the study period. The achievement of HiSCR and partial response increased during the study. CONCLUSION: This study offers insight into the disease burden of HS in an Italian population. Our results underline the impact of QoL evaluation, also with the use of the HIDRAdisk, in clinical routine as a support to validated severity clinical and instrumental indexes for a "360-degree" assessment of HS patient's burden of disease