Introduction and Objective

Kinematic Alignment (KA) is a surgical technique that restores the native knee alignment following Total Knee Arthroplasty (TKA). The association of this technique with a medial pivot implant design (MP) attempts to reestablish the physiological kinematics of the knee. Aim of this study is to analyze the clinical and radiological outcomes of patients undergoing MP-TKA with kinematic alignment, and to assess the effect of the limb alignment and the orientation of the tibial component on the clinical outcomes.

In the past the prevailing view believed that there was an inverse relationship between osteoarthritis and osteoporosis; a recent study showed that elderly women with advanced osteoarthritis requiring total hip replacement had an evidence of osteoporosis and vitamin-D deficiency. An altered metabolic bone status as induced by low level of vitamin D could be one of the major causes of aseptic bone loosening and consequently failure of the implant. We studied the bone mineral metabolism of thirty elderly women with osteoarthritis undergoing total hip replacement in order to identify whether or not there were a bone metabolic alterations.

All the subjects included in the study were over than 70 years old (mean age 74 ± 2.5). The results showed that six (20%) subjects had a hypovitaminosis D status and eighteen (60%) had a vitamin D deficiency status. Five subjects (16%) had a secondary iperparathyroidism. The bone mineral metabolism of elderly women with osteoarthritis undergoing total hip replacement is characterised by a high prevalence of vitamin D deficiency and in a less percentage of the cases by a secondary iperparathyroidism. Both of these metabolic conditions could compromise the bone integration of the implant and lead to aseptic bone loosening.

Nowadays it is well known that both a clinical examination and an imaging investigation (MRI/CT scans) are useful in order to provide surgeons with complete informations about the proposed treatment for shoulder pain. The purpose of this study was to evaluate the diagnostic sensitivity of the Neer, Hawkins, Jobe, Lift-off and Infraspinatus tests in diagnosing rotator cuff tears and compare this with what was found during surgery.

From 2001 to 2003, data from 430 patients who underwent shoulder open surgery, performed by a single surgeon, were documented. The results showed that the Jobe test has a sensitivity of 97.5% and positive prognostic value (PPV) of 80.3% and negative prognostic value (NPV) of 90.9% for the presence of a supraspinatus lesion; the Neer, Hawkins and Yokum tests have a sensitivity close to 95% for assessing subacromial bursitis; the Lift-off and Infraspinatus tests have a sensitivity close to 70% for assessing the degree of lesion and identify a severe lesion with a NPV over 83%. The Lift-off and Infraspinatus tests also provide information concerning muscular trophism and concerning retraction and degeneration of tendons.

According to our results, clinical evaluation of shoulder pain should be supported by imaging investigations for diagnosis of rotator cuff tear.

Two-part surgical neck fractures, two-part greater tuberosity fractures and three- and four-part fractures of the proximal humerus represent a frequently encountered clinical problem. Many types of conservative treatments have been proposed, with a poor functional outcome, however; when the fracture fragments are displaced, surgery is required.

Because the open reduction and the internal fixation disrupts soft tissue and increases the risk of avascular necrosis of the humeral head, closed or minimally open reduction and percutaneous pin fixation should represent an advantage.

We report on 31 patients affected by fractures of the proximal humerus (n=6, two-part surgical neck fractures; n=5, with two-part greater tuberosity fractures; n=10, three-part fractures; and n=11, four- part fractures) treated with minimally open reduction and percutaneous fixation. The average age was 57 years. Most of the four-part fractures were of the valgus type with no significant lateral displacement of the articular segment. A small skin incision was performed laterally at the shoulder and a rounded-tipped instrument was introduced to obtain the fracture reduction; this latter was stabilised by percutaneous pins and cannulate screws.

A satisfactory reduction was achieved in most cases. The average follow-up was 24 months (range 18–47). Only one patient, with four-part fractures associated with lateral displacement of the humeral head, showed avascular necrosis and received a prosthetic implant.

Minimally open reduction and percutaneous fixation is a non-invasive technique with a low risk of avascular necrosis and infection. This surgical technique allows a stable reduction with minimal soft tissue disruption and facilitates postoperative mobilisation.