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AimsThe aim of the study was to analyze the results of primary tendon reinsertion in acute and chronic distal triceps tendon ruptures (DTTRs) in the general population.Patients and MethodsA total of 28 patients were operated on for primary DTTR reinsertions, including 21 male patients and seven female patients with a mean age of 45 years (14 to 76). Of these patients, 23 sustained an acute DTTR and five had a chronic injury. One patient had a non-simultaneous bilateral DTTR. Seven patients had DTTR-associated ipsilateral fracture or dislocation. Comorbidities were present in four patients. Surgical treatment included transosseous and suture-anchors reinsertion in 22 and seven DTTRs, respectively. The clinical evaluation was performed using Mayo Elbow Performance Score (MEPS), the modified American Shoulder and Elbow Surgeons Score (m-ASES), the Quick Disabilities of the Arm, Shoulder and Hand score (QuickDASH), and the Medical Research Council (MRC) Scale.ResultsA total of 27 patients (28 DTTRs) were available for review at a mean of 47.5 months (12 to 204). The mean MEPS, QuickDASH, and m-ASES scores were 94 (60 to 100), 10 (0 to 52), and 94 (58 to 100), respectively. Satisfactory results were observed in 26 cases (93%). Muscle strength was 5/5 and 4/5 in 18 and ten DTTRs, respectively. One patient with chronic renal failure experienced a traumatic rerupture of distal triceps. One patient (1 DTTR) experienced mild elbow stiffness.ConclusionPrimary repair of acute and chronic DTTRs in a general population yields satisfactory results in the majority of patients with a low rerupture rate.Cite this article: Bone Joint J2018;100-B:610–16.

Modern metal-on-metal bearings produce less wear debris and osteolysis, but have the potential adverse effect of release of ions. Improved ceramic-on-ceramic bearings have the lowest wear of all, but the corrosion process has not been analysed.Our aim was to measure the serum ion release (ng/ml) in 23 patients having stable hip prostheses with a ceramic-on-ceramic coupling (group A) and to compare it with the release in 42 patients with a metal-on-metal bearing (group B) in the medium term. Reference values were obtained from a population of 47 healthy subjects (group C). The concentrations of chromium, cobalt, aluminium and titanium were measured.There was a significant increase of cobalt, chromium and aluminium levels (p < 0.05) in group B compared with groups A and C. Group A did not differ significantly from the control group. Despite the apparent advantage of a metal-on-metal coupling, especially in younger patients with a long life expectancy, a major concern arises regarding the extent and duration of ion exposure. For this reason, the low corrosion level in a ceramic-on-ceramic coupling could be advantageous.

We aimed to assess whether the immunological abnormalities which have been observed in patients with loose total hip replacements (THRs) are present in patients with a well-fixed prosthesis.We examined blood samples from 39 healthy donors, 22 patients before THR and 41 with well-fixed THRs of different types (15 metal-on-metal, 13 metal-on-polyethylene, 13 ceramic-on-ceramic). Before THR, the patients showed a decrease in leukocytes and myeloid cells in comparison with healthy donors, and a prevalence of type-1 T lymphocytes, which was confirmed by the increase in ratio of interferon-? to interleukin 4. Moreover, patients with metal-on-metal or metal-on-polyethylene implants showed a significant decrease in the number of T lymphocytes and a significant increase in the serum level of chromium and cobalt, although no significant correlation was observed with the immunological changes. In the ceramic-on-ceramic group, leukocytes and lymphocyte subsets were not significantly changed, but a significant increase in type-2 cytokines restored the ratio of interferon-? to interleukin 4 to normal values.We conclude that abnormalities of the cell-mediated immune response may be present in patients with a well-fixed THR, and that the immunological changes are more evident in those who have at least one metal component in the articular coupling.

Polyethylene (PE) wear has been shown to be a problem in long‐term joint replacement using metal‐on‐PE bearing. The use of metallic heads articulating with metallic cups could solve this problem: success will be enhanced if wear and corrosion of the articulating surfaces are maintained at a low level. New models with metal‐on‐metal bearing have been proposed, to be used mainly for young subjects: such coupling seems to have a reduced release, but it is unclear yet if the medium‐term corrosion rate is really negligible or, on the contrary, it is significantly higher than in the metal‐on‐PE bearing. Aim of our study was the comparison of ion release in the serum of two groups of patients who had the same type of stable cementless prosthesis, but different bearing: twenty‐six patients with metal‐on‐metal (Group A) and fifteen patients with metal‐on‐PE bearing (Group B) were examined. The follow‐up was 14‐38 months for group A and 18‐34 months for group B. The serum concentration of chromium (Cr), cobalt (Co) and molybdenum (Mo) was measured. Twenty‐two patients before surgery were used for comparison (Group C). The reference values were obtained from a population of twenty‐two healthy subjects (Group D). Our findings indicate that metal‐on‐metal bearings produce a significantly higher systemic release of cobalt and chromium (ng/ml) when compared with levels found in metal‐on‐PE, pre‐surgery and reference groups. Such a high release should induce to improve the bearing materials or, at least, to study the biologic fate of metal ions and consequently their long‐term effects. In such a way a risk‐to‐benefit ratio for the patient could be established. © 2002 Wiley Periodicals, Inc. J Biomed Mater Res (Appl Biomater) 63: 467–474, 2002

In this study twentytwo patients who had revision surgery for aseptic loosening of joint prostheses were examined. The concentration in serum of soluble products of corrosion from the implant, that is, chromium Cr, cobalt Co, and nickel Ni ions, and the number of white blood cells leucocytes, myeloid cells, lymphocyte subpopulations were measured. Twenty patients with no implants were used as controls. The patients who had revision surgery showed normal Ni concentration whereas by statistical analysis that same patient group was shown to have serum Cr and Co levels significantly higher than those of the control. By flow cytometry, a significant decrease of leucocytes, myeloid cells, lymphocytes, and CD16 populations as found in patients versus controls whereas CD3, CD4, CD8, and CD20 positive cells were decreased, but not significantly. In the arthroplasty patients the Cr concentrations were inversely correlated with some of the immunologic parameters while no significant correlation was found between Co levels and decreased lymphocyte subpopulations. Only in revision surgery patients with high Cr concentrations did we find a significant decrease of lymphocytes, namely of CD4 and CD16 positive cells; revision surgery patients with normal Cr concentrations did not show a significant decrease of lymphocyte subpopulations. These data suggest that the presence of metal ions, especially chromium, released from prosthesis components could be associated with changes of lymphocyte subpopulations in patients with loosening of joint prostheses. © 1999 John Wiley & Sons, Inc. J Biomed Mater Res, 47, 543–550, 1999.

The Authors report the results of the First Italian Multi-center Study Group evaluation of the efficacy of Low Frequency Pulsing Electromagnetic Fields (LFPEFs) for the treatment of congenital and acquired pseudoarthroses and of delayed unions. 153 patients have been treated since 1978. the success rate has been 86 %. With the technique used, unlike the results reported by other researchers, the formation of solid periosteal bone callus during the pseudoarthrosis consolidation process was observed. the LFPEF treatment seems to be capable of triggering the repair process rather than shortening the treatment time. During the first three months of stimulation significant changes in the morphology of the X-ray picture of the pseudoarthrosis are noticeable. the clinical implications of these observations are discussed.

We report our experience in the use of cancellous bone grafts and stimulation with pulsing electromagnetic fields (PEMFs) in the treatment of acquired pseudarthrosis in 28 patients, including 17 patients with active infections. Stimulation was begun immediately after the grafting, and all patients healed in an average time of 4 months.

Our aim was to determine if the serum levels of bone-resorbing cytokines (IL-1ß, TNF-a, IL-6, GM-CSF) are altered in patients with aseptic loosening of a total hip prosthesis, and if such levels are influenced by the type of implant. We determined cytokine levels in sera from 35 patients before revision for failed total hip arthroplasty and compared them with those in 25 healthy donors. We also assessed the soluble receptor of interleukin-2 (sIL-2r) in serum as an indication of a specific immune reaction against the implant.Our findings showed that the sIL-2r and TNF-a serum level did not change. The IL-6 level was not significantly altered, but was higher in patients with TiAlV prostheses than in those with a CrCoMo implant and in patients with cemented prostheses. The IL-1ß level was found to be higher in those with a TiAlV cemented prosthesis than in the control group (p = 0.0001) and other groups of patients (p = 0.003 vuncemented TiAlV, p = 0.01 vcemented CrCoMo, p = 0.001 vuncemented CrCoMo). The GM-CSF level significantly increased in patients compared with healthy subjects (p = 0.008), and it was higher in those with cemented than with uncemented implants (p = 0.01). Only patients with cementless CrCoMo prostheses had levels of GM-CSF similar to those of the control group. The highest GM-CSF concentrations were observed in patients treated with non-steroidal anti-inflammatory drugs (NSAIDs) in the last months before revision (p = 0.04). In addition, when massive osteolysis was observed, the level of GM-CSF tended to decrease to that of the control group.