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Introduction:: This study evaluates mid-term results of acetabular revision using a hemispherical acetabular cup in Trabecular Titanium with a cage construct., Methods:: We reviewed 36 acetabular revisions performed with the Delta Revision TT cup in 34 patients (mean age = 75, range: 45-92 years). Acetabular defect types (Paprosky classification) included (1) 2B ( n = 5), (2) 2C ( n = 7), (3) 3A ( n = 15), and (4) 3B ( n = 9). Morcellised bone allografts were used in 24 cases, and synthetic bone used in 11. Outcomes were evaluated using the Harris Hip Score (HHS), and the Verbal Rating Scale (VRS) for pain measurement. X-ray visualisation of cup position was used to discern signs of mobilisation and bone graft incorporation. Survivorship at post-revision follow-up (mean = 39.8; range 12-91.5 months) was calculated., Results:: HHS increased from 40.5 to 87 ( p < 0.01). 68% of cases were pain free; by comparison, 32% had an average VRS score of 1.9 (range 1-3). The average cup inclination angle was 40.8° (30-52°) postoperatively, compared with 41.2° (30-52°) at follow-up; there were no signs of loosening or mobilisation. Centre of rotation was fully restored in 21 (58.3%) hips. According to Gie classification; bone graft incorporation grades were (1) 3 ( n = 21), (2) 2 ( n = 12) and (3) 1 ( n = 2). The survival rate was 100% for aseptic loosening and 91.7% for any cause of revision., Conclusions:: The Delta Revision TT cup promises good clinical and radiographic results at short- to mid-term follow-up, with high rates of survival rate and bone integration.

The treatment of anterior cruciate ligament (ACL) injuries in children and adolescents is challenging. Preclinical and clinical studies investigated ACL repairing techniques in skeletally immature subjects. However, intra-articular bioenvironment following ACL tear has not yet been defined in skeletally immature patients. The aim of this study was to measure cytokine concentrations in the synovial fluid in adolescent population. Synovial levels of IL-1 β , IL-1ra, IL-6, IL-8, IL-10, and TNF- α were measured in 17 adolescent patients (15 boys) with ACL tears who underwent ACL reconstruction including acute (5), subacute (7), and chronic (5) phases. Femoral growth plates were classified as "open" in three patients, "closing" in eight, and "closed" in six. Eleven patients presented an ACL tear associated with a meniscal tear. The mean Tegner and Lysholm scores (mean ± SD) of all patients were 8 ± 1 and 50.76 ± 26, respectively. IL-8, TNF- α , and IL-1 β levels were significantly greater in patients with "open" physes. IL-1ra and IL-1 β levels were significantly higher in patients with ACL tear associated with a meniscal tear. Poor Lysholm scores were associated with elevated IL-6 and IL-10 levels. IL-10 levels positively correlated with IL-6 and IL-8 levels, whereas TNF- α concentration negatively correlated with IL-6 levels. Skeletally immature patients with meniscal tears and open growth plates have a characteristic cytokine profile with particularly elevated levels of proinflammatory cytokines including IL-8, TNF- α , and IL-1 β . This picture suggests that the ACL tear could promote an intra-articular catabolic response in adolescent patients greater than that generally reported for adult subjects. The study lacks the comparison with synovial samples from healthy skeletally immature knees due to ethical reasons. Overall, these data contribute to a better knowledge of adolescent intra-articular bioenvironment following ACL injuries.

Objective: To evaluate the efficacy of a rehabilitation programme including balance task-specific training in improving physical function, pain, activities of daily living (ADL), balance and quality of life in subjects after a hip fracture., Design: Randomized controlled trial., Subjects: A total of 52 older subjects selected for internal fixation due to extra-capsular hip fracture were randomized to be included in an experimental ( n = 26) and control group ( n = 26)., Interventions: The experimental group underwent a rehabilitation programme based on balance task-specific training. The control group underwent general physiotherapy, including open kinetic chain exercises and walking training. Both groups individually followed programmes of 90-minute sessions five times/week for three weeks., Outcome Measures: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a Pain Numerical Rating Scale, the Berg Balance Scale, the Functional Independence Measure and the 36-item Short-Form Health Survey. The participants were evaluated before and after training, and after 12 months., Results: Significant effects of time, group and time × group were found for all outcome measures in favour of the experimental group. A clinically important between-group difference of 25 points was achieved after training and at follow-up in terms of the primary outcome (WOMAC function before treatment, after treatment and at follow-up was 84.8 (3.7), 39.8 (4.9) and 35.7 (6.2) for the experimental group and 80.9 (5.7), 65.2 (7.1) and 61.0 (11.1) for the control group)., Conclusion: An inpatient rehabilitation programme based on balance task-specific training is useful in improving physical function, pain, ADL and quality of life in older patients after hip fracture.

Background: The aim of the study was to compare the mini-open to the classic open repair techniques for Achilles tendon ruptures., Methods: We retrospectively evaluated at a minimum of 2 years follow-up 32 subcutaneous Achilles tendon ruptures; 17 underwent mini-open surgery (Group A) and 15 the open technique (Group B)., Results: No difference in Achilles Tendon Total Rupture Score and in modified Leppillahti score was observed. With respect to the contralateral side the width of the operated Achilles tendon was 4.07 mm thicker in Group A and 7.67 mm in Group B ( p <.05); the calf circumference reduction was respectively 10 mm and 23.75 mm ( p <.05). Iso-kinetic peak force measurement of the calf muscle strength showed a loss of 8.21% in Group A versus 17.25% in Group B ( p <.05). The mean Patient Satisfaction Score was 96.76 in Group A and 88.67 in Group B ( p <.01); respectively 82.3% vs 66.7% of patients were able to return to previous levels of sporting activity. There were two post-operative complications in Group B and one in Group A., Conclusion: Mini-open technique minimizes the risk of complications, leads to an improved tendon healing process and functional recovery with higher patient satisfaction., Level of Evidence: IV.

Aim: To investigate the association between sports hernias and femoroacetabular impingement (FAI) in athletes., Methods: PubMed, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism., Results: FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone (89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries., Conclusion: The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy.

Background: Age is one of the most robust risk factors for hip fracture. Recent projections indicate that almost half of hip fractures are occurring with an increasing trend among the "oldest old" (i.e., in those aged >85 years)., Aims: To compare clinical characteristics, outcomes, and risk factors for 6-month mortality in two groups of "oldest old" patients (group 1 = 85-89, group 2 > 90 years), after hip fracture surgery., Methods: Observational prospective cohort study with 6-month follow-up, performed in an Orthogeriatric Unit of an academic hospital between March 2007 and November 2012., Results: Two hundred seventy-five patients (group 1: N = 171; group 2: N = 104) underwent a comprehensive geriatric assessment, including demographics, clinical, functional, nutritional, and mental status. The 6-month rehospitalization and mortality rates after surgery were assessed through structured telephone interviews with patient's caregivers. Multivariate logistic regression models were used to evaluate predictors of 6-month mortality, adjusting for relevant covariates. Fifty-eight patients died at follow-up. The in-hospital and 6-month mortality rates were significantly higher for patients of group 2 than for those of group 1. After adjusting for covariates, the multivariate logistic regressions showed that severe disability (OR 2.24, 95 % CI 1.08-4.65) and postoperative delirium (POD) (OR 3.80, 95 % CI 1.72-8.39) were predictors of 6-month mortality., Conclusions: Patients aged >90 years who underwent hip fracture surgery are more likely to die at 6 months than those aged 85-89 years. Pre-fracture disability and POD are predictors of this excess of mortality.

Objectives: To evaluate the association between number of days with delirium and 6-month mortality in elderly adults after hip fracture surgery., Design: Prospective cohort study with 6-month follow-up., Setting: Orthogeriatric Unit (OGU)., Participants: Individuals (mean age = 84.3 ± 6.4) admitted to the OGU between October 2011 and April 2013 with hip fracture (N = 199)., Measurements: Postoperative delirium (POD) was assessed daily using the Confusion Assessment Method algorithm and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria. Multivariable Cox regression models were used to evaluate the association between POD of and 6-month mortality after surgery, after adjustment for covariates including age, prefracture residence, Katz activity of daily living score, New Mobility score, diagnosis of prefracture dementia, American Society of Anesthesiologists score, albumin serum levels, Charlson Comorbidity Index, and length of OGU stay., Results: Fifty-seven participants (28.6%) developed POD. In the 6-month period after surgery, 35 (17.6%) participants died: 16 of 57 (28.1%) with POD and 19/ of 142 (13.4%) with no POD. The average duration of POD was 2.0 ± 3.2 days for participants who died and 0.7 ± 1.8 days for those who survived (P < .001). After adjusting for covariates, each day of POD in the OGU increased the hazard of dying at 6 months by 17% (hazard ratio = 1.17, 95% confidence interval = 1.07-1.28)., Conclusion: In older adults undergoing hip fracture surgery, duration of POD is an important prognostic factor for 6-month mortality. Efforts to reduce duration of POD are therefore crucial for these individuals., (© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.)

Objective: To evaluate the efficacy of an in-hospital programme based on task-oriented exercises associated with early full weight-bearing in patients with multiple comorbidities undergoing total hip replacement., Design: Randomized controlled trial., Setting: Specialised rehabilitation centre., Subjects: A total of 100 patients (mean age of 69 (8) years; 40 males, 60 females)., Interventions: The experimental group underwent task-oriented exercises and was encouraged to abandon any walking aids by the end of their in-hospital stay. The control group underwent open chain kinetic exercises, and was recommended to use partial weight-bearing and walking aids until three months after surgery. Both groups individually followed programmes of 90-minute sessions five times a week for three weeks., Outcome Measures: Western Ontario and McMaster Universities Osteoarthritis Index, Pain Numerical Rating Scale, Functional Independence Measure, and Short-Form Health Survey. The participants were evaluated before, after training, and after a further 12 months., Results: There were no significant between-group differences at baseline. After training, a between-group difference of 12 points was found for the Western Ontario and McMaster Universities Osteoarthritis Index - functional subscale, indicating a clinically tangible treatment effect on disability. The Functional Independence Measure increased by 31 and 15 points in the experimental and control group, respectively. A linear mixed model revealed significant effects of time, group, and time by group interaction on disability, pain, activities of daily living, and most of the physical quality of life domains., Conclusion: Task-oriented exercises associated with early full weight-bearing improve disability, pain, activities of daily living, and quality of life after total hip replacement., (© The Author(s) 2014.)

Background: Delayed surgery (ie, >48 hours from arrival in hospital) and pre-fracture disability are thought to be long-term risk factors for mortality in patients with hip fracture (HF). However, the combined effect on mortality of these two conditions has not been satisfactorily assessed in previous studies., Objective: To assess the combined effect of pre-fracture disability and delayed surgery on 12-month mortality in a population of elderly patients after HF surgical treatment., Design: Retrospective cohort study with 12-month follow-up., Setting: An orthogeriatric unit (OGU) in a university hospital in Italy., Methods: All patients (n = 390) admitted to an OGU from March 2007 to December 2010 who underwent proximal HF surgery and who were not transferred to other hospitals were considered for the analyses. Pre-fracture disability was defined as having an impairment in more than one activity of daily living (ADL). The 12-month mortality was assessed by a Kaplan-Meyer analysis and by a Cox proportional hazards regression models adjusting for relevant potential confounders., Results: After adjusting for potential confounders, patients with both delayed surgery and pre-fracture disability had a significantly higher 12-month mortality (hazard ratio [HR] = 5.80; 95% confidence interval [CI] = 2.11-15.92) than patients with neither delayed surgery nor disability (reference group). Patients with disability but not delayed surgery had a nearly 4-fold increased mortality risk (HR, 3.98; 95% CI 1.41-11.27) than patients in the reference group., Conclusions: Patients with both pre-fracture disability and delayed HF surgical treatment had a nearly six-fold increased 12-month mortality risk than did patients with neither disability nor delayed surgery., (Copyright © 2012 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)

Background and Aims: Hip fracture in older people is an event associated with a high incidence of morbidity and mortality. In this study we compared the clinical outcomes of two groups of orthogeriatric patients in an orthogeriatric care (OC) programme. The OC course, developed into the GeriatricWard, starts from the Emergency Department (OC-1, n=174) or from the Orthopaedic Department after surgery (OC-2, n=87)., Methods: For this purpose, OC patients were prospectively enrolled from March 2007 to June 2009, following OC criteria. Door-to-bed time, time to surgery, mobilisation time, length of stay, and post-operative complications were compared between the OC groups., Results: OC-1 patients differ from OC-2 ones only for residence at admission (14.4% vs 4.6% lived in nursing homes, p=0.02). Concerning outcomes, in the OC-1 group only mobilization time was significantly lower (p=0.01). No differences were observed in post-operative complications., Conclusions: In frail older people, hip fracture co-management, with the geriatrician as primary attendant, leads to satisfying outcomes. The OC-1 and OC-2 courses exhibit similar clinical results. An improvement in several organisational aspects, including coordination between hospital and rehabilitation services, is warranted.

A retrospective review was conducted to evaluate the mid-term results (8.5 years follow-up) of the Versys ET stem (Zimmer, Warsaw, Indiana, USA). From 1995 to 2000, 225 total hip arthroplasties (THA) were performed using this device. All patients were evaluated clinically by the Harris Hip Score, and radiographically. The Hip Score increased from 54 preoperatively to 97 points postoperatively. The stem displayed a varus alignment between 5 degrees and 10 degrees in 17 cases without any clinical consequences (HHS 96.8). We recorded one case of septic loosening and one case of aseptic loosening. The stability of the stem was radiographically evaluated according to Engh's criteria, confirming bone ongrowth in all other cases.