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Objective. The gynecologist often involves the orthopaedic surgeon in the evaluation of pregnant women with previous medical history of pelvic surgery who will give birth. Young women can receive pelvic surgery for proximal femoral fractures, sacro-iliac or pelvic ring fractures, avascular necrosis of the femoral head, hip dysplasia and severe ankylosing spondylitis. The aim of this study is to determine whether such women can accomplish a natural delivery or should have caesarean delivery (C-section). Methods. Pubmed and the Cochrane Database of Reviews were searched for manuscripts including the years 1970 to present. Results. It is important to discriminate between pathological and/or post-surgical conditions affecting the coxo-femoral joint which constitute an absolute contraindication to vaginal delivery from other circumstances that may have a relative contraindication. Orthopaedic relative indications for C-section may include coxo-femoral pathologies where coxo-femoral joint range of motion is limited and women cannot assume a given position that is deemed necessary by the obstetric specialist for natural delivery. Conditions requiring C-section are those producing an insufficient width of the bony birth canal; when the transverse mid-pelvis diameter is <9.5 cm, then the probability of C-section is increased. Conclusions. It is not mandatory to perform a C-section in all women with a past medical history of pelvic surgery; accurate medical history collection, imaging technologies and ultrasound make it possible decide if a C-section is compulsory. [ABSTRACT FROM AUTHOR]

Objective: Femoroacetabular impingement (FAI) is a condition that has been increasingly recognized as a source of hip pain and a possible risk factor to early development of hip osteoarthritis (OA). To our knowledge, the use of HA in the treatment of femoroacetabular FAI has been investigated only by two studies, both using a high molecular weight HA. The aim of this study was to evaluate the efficacy of two weekly injections of an hexadecylamide derivative of HA (HYADD4-G, HYMOVIS, Fidia Farmaceutici) in FAI. Methods: All patients received two weekly intra-articular injections of Hymovis at baseline and after 7 days. Clinical and functional assessments were performed at baseline and was repeated after 1, 3, 6 and 12months. Functional measures included visual analogue scale (VAS) for pain, Harris Hip score (HHS), Lequesne Index (LI), Tegner activity level scale (TALS) and monthly consumption of nonsteroidal anti-inflammatory drugs (NSAIDs). Results: Twenty-one hips (19 patients, 2 bilateral cases) were treated. The variables VAS, HHS as well as Lequesne improved significantly from T0 to T4 (at 12months) with the best improvement between T0 and T1. At the same time, a reduction in NSAIDs monthly intake was registered. On the other hand, a significant improvement in Tegner scale was not observed. No adverse events were registered. Conclusion: This study states that one cycle of HYADD4-G could be a safe and effective treatment in patients with FAI, showing significative results in term of pain control as well as hip functionality and quality of life up to 1 year. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the potential ability of autologous conditioned serum (ACS) to decrease pain and improve joint functionality in patients affected by knee osteoarthritis (OA). Methods: Fifteen patients with clinical and radiological signs of OA of the knee were recruited for this study. Each patient received 4 injections of ACS (Orthokine; orthogen, Dusseldorf, Germany) at the site of OA once per week for 4weeks. Clinical and functional evaluation was performed using the VAS scale for pain, WOMAC scale and KSS functional and clinical scores before the first injection, at one week, at two weeks, at three weeks, at one month and at six months. Statistical analysis was done with the Wilcoxon Signed-Rank Test. Results: Our results show an improvement of all the evaluation scales at 6months follow-up. Particularly, VAS scales among all patients decreased by 35.8% (p=.00148), KSS functional scores improved by 38.2% (p=.00148), KSS clinical scores improved by 28.9% (p=.00236) and WOMAC scores were reduced by 19.8% (p=.00188). Few adverse effects were observed in our sample. The most common complaint was pain and swelling in the subsequent days after performing the intraarticular injection. Only one patient reported rigidity following the injection of the ACS. Conclusion: Our results, in conjunction with preexisting studies in the medical literature regarding ACS, demonstrate the viability of this therapy for the treatment of knee OA, showing positive influence on pain and joint function without significant adverse effects. [ABSTRACT FROM AUTHOR]

Hematopoietic stem and progenitor cells (HSPC) reside in the bone marrow (BM) niche and serve as a reservoir for mature blood cells throughout life. Aging in the BM is characterized by low‐grade chronic inflammation that could contribute to the reduced functionality of aged HSPC. Mesenchymal stromal cells (MSC) in the BM support HSPC self‐renewal. However, changes in MSC function with age and the crosstalk between MSC and HSPC remain understudied. Here, we conducted an extensive characterization of senescence features in BM‐derived MSC from young and aged healthy donors. Aged MSC displayed an enlarged senescent‐like morphology, a delayed clonogenic potential and reduced proliferation ability when compared to younger counterparts. Of note, the observed proliferation delay was associated with increased levels of SA‐β‐galactosidase (SA‐β‐Gal) and lipofuscin in aged MSC at early passages and a modest but consistent accumulation of physical DNA damage and DNA damage response (DDR) activation. Consistent with the establishment of a senescence‐like state in aged MSC, we detected an increase in pro‐inflammatory senescence‐associated secretory phenotype (SASP) factors, both at the transcript and protein levels. Conversely, the immunomodulatory properties of aged MSC were significantly reduced. Importantly, exposure of young HSPC to factors secreted by aged MSC induced pro‐inflammatory genes in HSPC and impaired HSPC clonogenic potential in a SASP‐dependent manner. Altogether, our results reveal that BM‐derived MSC from aged healthy donors display features of senescence and that, during aging, MSC‐associated secretomes contribute to activate an inflammatory transcriptional program in HSPC that may ultimately impair their functionality. [ABSTRACT FROM AUTHOR]

Wnt signaling, a major regulator of bone formation and homeostasis, might be involved in the bone loss of osteoporotic patients and the consequent impaired response to fracture. Therefore we analyzed Wnt-related, osteogenic, and adipogenic genes in bone tissue of elderly postmenopausal women undergoing hip replacement for either femoral fracture or osteoarthritis. Bone specimens derived from the intertrochanteric region of the femurs of 25 women with fracture (F) and 29 with osteoarthritis without fracture (OA) were analyzed. Specific miRNAs were analyzed in bone and in matched blood samples. RUNX2, BGP, and OPG showed lower expression in F than in OA samples, while OSX, OPN, BSP, and RANKL were not different. Inhibitory genes of Wnt pathway were lower in F versus OA. 𝛽-Catenin protein levels were higher in F versus OA, whereas its cotranscriptional regulator (Lef1) was lower in F group. miR-204, which targets RUNX2, and miR-130a, which inhibits PPAR𝛾, were lower and higher, respectively, in F versus OA serum samples. The present study showed an inefficient Wnt signal transduction in F group despite higher 𝛽-catenin protein levels, consistent with the expected overall postfracture systemic activation towards osteogenesis. This transcriptional inefficiency could contribute to the osteoporotic bone fragility. [ABSTRACT FROM AUTHOR]

The article reports on the possible treatment for posterior impingement that affect ballet dancers because they perform demipointe work and en pointe positions. It suggests to conduct clinical examinations and to use modified x-rays to identify the affected area and entity of the impingement. It also recommends to perform standard and modified magnetic resonance imaging when the disease is already properly diagnosed. Moreover, it stresses that the loss of mobility, together with the pain in the posterior aspect of the ankle, is the most common symptom of posterior impingement.

Background and Aim: The aim of this study was to compare the efficacy of a single Bone Marrow Aspirate Concentrate (BMAC) with a cycle of 4 Autologous Conditioned Serum (ACS) injections in the treatment of early-stage knee osteoarthritis (OA)., Methods: Two groups of 12 patients with degenerative knee OA were treated with a single BMAC injection and with a cycle of 4 ACS injections respectively. Follow-up was set at baseline (t0), one-month (t1) and six-months (t2) evaluating VAS for pain, WOMAC index and range of motion (ROM)., Results: We reported a significant improvement in WOMAC after BMAC injection both at t1 (p= 0,001) as well as t2 (p< 0,001), plus a reduction of VAS values in BMAC group at six months follow-up (p = 0,024). In contrast, no significant differences in ROM between the two groups were observed., Conclusions: Both the approaches are safe and effective in the treatment of knee OA, with a major efficacy of BMAC.