Total shoulder replacement is a successful procedure for degenerative or some inflammatory diseases of the shoulder. However, fixation of the glenoid seems to be the main weakness with a high rate of loosening. The results using all-polyethylene components have been better than those using metal-backed components. We describe our experience with 35 consecutive total shoulder replacements using a new metal-backed glenoid component with a mean follow-up of 75.4 months (48 to 154).

Our implant differs from others because of its mechanism of fixation. It has a convex metal-backed bone interface and the main stabilising factor is a large hollow central peg. The patients were evaulated with standard radiographs and with the Constant Score, the Simple Shoulder Test and a visual analogue scale. All the scores improved and there was no loosening, no polyethylene-glenoid disassembly and no other implant-related complications.

We conclude that a metal-backed glenoid component is a good option in total shoulder replacement with no worse results than of those using a cemented all-polyethylene prosthesis.

The purpose of this study was to investigate the effects of extra corporeal shock waves (ESW) therapy on the metabolism of healthy and osteoarthritic human chondrocytes, and particularly on the expression of IL-10, TNF-α and β1 integrin.

Human adult articular cartilage was obtained from 9 patients (6 male and 3 females), with primary knee osteoarthritis (OA), undergoing total joint replacement and from 3 young healthy donors (HD) (2 males, 1 female) with joint traumatic fracture. After isolation, chondrocytes underwent ESW treatment (Electromagnetic Generator System, Minilith SL1, Storz Medical) at different parameters of impulses, energy levels and energy fluxes. After that, chondrocytes were cultured in 24-well plate in DMEM supplemented with 10% FCS for 48 hours and then β1 integrin surface expression and intracellular IL-10 and TNF-α levels were evaluated by flow-cytometry.

At baseline, osteoarthritic chondrocytes expressed significantly lower levels of β1 integrin and higher levels and IL-10 and TNF-α levels. It has been recently reported that ESW may be useful to treat OA in dogs, and veterinarians have begun to use ESW also to treat OA in horses.

Following ESW application, while β1 integrin expression remain unchanged, a significant decrease of IL-10 and TNF-α intracellular levels was observed both in osteoarthritic and healthy chondrocytes. IL-10 levels decreased at any impulses and energy levels, while a significant reduction of TNF-α was mainly found at middle energies.

Our study confirmed that osteoarthritic chondrocytes express low β1 integrin and high TNF-α and IL-10 levels. Nonetheless, ESW treatment application down-regulate the intracellular levels of TNF-α and IL-10 by chondrocytes, suggesting that ESW might restore TNF-α and IL-10 production by osteoarthritic chondrocytes at normal levels thus potentially interfering with the pathologic mechanisms causing cartilage damage in OA and representing the theoretical rationale for using ESW as therapy of OA.

Endoscopic methods of ACL reconstruction have shown some disadvantages such as the inability to freely position the femoral tunnel. Moreover, this technique dictates relatively vertical and central non anatomical graft placement compared to the more horizontal and lateral course of the native ACL. The ACL presents a collection of individual fibers that are grouping in two distinct bands, anteromedial (AM) and posterolateral (PL). The most anterior fibers of AM band are the most isometric. The majority of ACL fibers lie posteriorly to the isometric point on the medial wall of the femoral condyle. These fibers are lax during flexion and tight in extension. This behaviour was defined “favourable non isometry”. The “favourable non isometry” is very interesting because increased knee loading often occurs at flexion angles of less than 60 degrees. Classic two-incision technique, using a rear-entry drill, our two-incision technique, or the Clancy anatomic endoscopic technique using flexible reamers and use of different not commonly arthroscopic portals seems to allow a predictable, near-anatomic placement of femoral tunnel.

Background: Extracapsular fractures of proximal femur are known to have a significatively high morbidity and mortality rate at one year, and this rate is higher in case of non operative treatment. The standard gamma nail (SGN) was originally designed to provide a stable implant which allows early mobilisation and weight bearing of the elderly patients. The design of SGN however, appeared to be associated with intraoperative or postoperative femoral shaft fractures in up to 17%, requiring further surgery and compromising the outcome in these elderly patients. The trochanteric nail (TGN) was developed to overcome the problems encountered with the use of the SGN.

We report our experience in the use of the TGN in the treatment of extracapsular fractures of proximal femur. Methods: Between December 1999 and January 2001, eighty-seven consecutive patients with an extra-capsular fracture of the femur (in one case bilateral) and one patient with a proximal femoral metastasis were treated with a TGN. Nine patients died within four months of the operation and 3 were lost at follow-up. Seventy-five patients, for a total of 76 fractures were followed clinically and radiographically until the end of treatment, for a mean follow-up period of 10 months. Results: In none of 88 cases did an intraoperative shaft femur fracture occur, nor was this complication observed in the 76 femurs evaluated at follow-up. Postoperative infection was never found and union was achieved in every case. Two cases of cutting-out were reported and both were caused by incorrect placement of implant. Only nine patients (12%) required two crutches or walker at the last follow-up. Conclusion: The TGN is a promising alternative for the treatment of extracapsular fractures of the proximal femur. This implant enables the surgeon to treat most of intertrochanteric and high subtrochanteric fractures with a less invasive technique, and permits early mobilisation and unprotected weight-bearing, without the complications observed with the use of the SGN.

Background: We evaluate the role of percutaneous þxation of Acetabular fractures in a selected group of patients in which conservative management seemed unlikely to yield a satisfying outcome. Method: Between July 1998 and July 2001, 17 consecutive patients having suffered an Acetabular fracture underwent ßuoroscopic guided percutaneous þxation to stabilize the fracture. The mean age of the patients was 81 years (range 67 to 90). In all cases the fracture was non-displaced or minimally displaced (< 2 mm). The operative indication was based on our experience that these patients would have a less favorable outcome with conservative management due to their diminished general health and important associated morbidity. Percutaneous þxation was performed at a mean of four days post injury (range 2–6). In all cases, 2 cannulated cancellous 7.3 mm were used, one to þx the anterior column and the other, inserted in a retrograde fashion to stabilize the posterior column. Bed to armchair transfer began after 24 hours. Weight bearing as tolerated was allowed at 4 weeks from surgery. Two patients died of unrelated causes in the postoperative period and one patient was lost to follow-up, leaving fourteen patients who could be followed for a mean of 1,5 years (range 6 months-3 years). Results: Soft tissue dissection was minimal. There were no intra-operative or post-operative complications. At latest follow-up there was no evidence radiographically of displacement of fragments, degenerative changes or screw failure. Fracture union was achieved at a mean period of 12 weeks (range, 8–15 weeks) after surgery. In one case the tip of the posterior screw penetrated the sacroiliac joint, but no clinical adverse effects were noted. Clinical results was satisfactory in thirteen patients, and fair in one patient, as assessed by the Matta modiþcation of the rating system described by dñAubigne and Postel. Conclusion: Our results show that the percutaneous þxation is a valid therapeutic option in selected Acetabular fractures, and in the future broader indications may be found for this technique.