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We analysed a series of 119 patients presenting with Paget's bone disease treated at the Istituto Ortopedico Rizzoli (Bologna Italy) over 35 years (from 1970 to 2006). Among these, we found 18 cases that had degenerated into sarcoma. The first goal of this study was to underline the potential factors of Paget's disease transformation into sarcoma. In detail we considered: age, gender, duration of disease, clinical expression, levels of total alkaline phosphatase and type of therapy. The results highlighted an interesting correlation between therapy and degeneration into sarcoma; more specifically, malignant transformation occurred both in patients who had not received any therapy and those who had received regular calcitonin treatment; otherwise, no sarcoma degeneration occurred in the patients treated with bisphosphonates. These data seem to indicate a preventing effect of bisphosphonates towards the degeneration of Paget's disease into sarcoma.

Two groups of 24 patients each who had been submitted to osteosynthesis for the treatment of fracture of the acetabulum were evaluated. The first group was submitted to rehabilitation treatment according to the protocol used in the Division of Physiotherapy at the Rizzoli Institute; the second group did not use this protocol. Clinical-radiographic follow-ups were obtained after 1 month, 3 months, 6 months, and 1 year postsurgery. The results of the evaluations carried out showed the usefulness of specific physiokinesitherapy in obtaining more rapid and best possible functional recovery.

Total hip arthroplasty means sacrificing the joint capsule and the mechanoreceptors contained therein. Recent neurophysiological experiences seem to redefine the sensorial and proprioceptive role of the joint capsule in favor of the activity of the muscular mechanoreceptors, particularly in the area of the coxofemoral joint. The authors have examined the sensorial lesion caused by total hip arthroplasty in a group of 20 patients. Clinical testing was conducted prior to surgery, 7 and 40 days later. The tests were aimed at exploring the perceptive and proprioceptive activity of the hip, and showed marked decrease in all of the receptorial activity one week after surgery. After 40 days perceptive function was completely recovered, as the scores for tests conducted were the same as those obtained prior to surgery: proprioceptive activity was instead considerably improved, with significant changes in most parts of the tests. The authors conclude by observing that total hip arthroplasty does not cause permanent lesion of the perception of joint movement; furthermore, renewed coxofemoral mechanics allow for a better proprioceptive response with strengthening of static and dynamic antigravitational reactions.

The authors conducted an experimental study on 32 female rats which had been castrated at 10 months of age in order to verify the ability of pulsating electromagnetic fields to prevent osteoporosis induced by surgical menopause. Two different values of intensity of PEMFs were used: 30 G and 70 G. After 4 months of treatment the following testing was done: monophotonic bone densitometry of the lumbar spine, quantitative measurement of the dry ash weight of the femurs, and hematochemical tests to evaluate bone metabolism. The experimental study showed that the PEMFs supplied at 30 Gauss were capable of slowing down the loss of bone mass, while the PEMFs supplied at 70 Gauss obstructed bone decay, providing values for Bone Mineral Density and dry ash weight which were very similar to those observed in the non-castrated control group. Hematochemical tests did not reveal significant variations between the two groups.

Rehabilitation after hip arthroplasty is aimed at improving the results obtained with surgery and allowing the elderly patient to resume a normal daily life as quickly as possible. The correct use of the prosthesis positively influences its duration. Full weight-bearing on the limb submitted to surgery is allowed at different times: days 7-8 if the prosthesis is cemented. When the prosthesis is cementless the proper time for full weight-bearing is established by the orthopaedist, and it is usually allowed on days 30-40. Walking initially makes use of a walker, followed by parallel, and finally antibrachial support.