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Purpose: The use of tranexamic acid (TXA) in total hip arthroplasty (THA) can significantly reduce blood losses with many clinical and economical advantages. However, no consensus has been reached regarding the optimal regimen for TXA administration. The aim of this study is to analyse and compare the haemostatic effect of two different intravenous (IV) regimens of TXA. Materials and methods: We planned a single-centre, prospective, randomized study including 80 patients who underwent primary unilateral minimally invasive THA because of a hip osteoarthritic degeneration. We divided patients into two groups: the G10 group received two IV doses of 10 mg/kg of TXA, and the G20 group received two doses of 20 mg/kg. Results: No significant differences in mean minimum levels of Hb and HcT stratified by days after surgery were uncovered between the two groups despite the use of two different dosages of TXA. Also the mean blood volume loss was statistically similar between two groups. No differences were also observed regarding the occurrence of adverse effects. Conclusions: In two IV bolus regimens of TXA administration, the use of a dose of 10 or 20 mg/kg provides statistically similar results in blood loss sparing. Therefore, the use of two 10 mg/kg doses could be considered more advisable in order to reduce the potential thromboembolic risks related to this drug. [ABSTRACT FROM AUTHOR]

Osteoarthritis of the hip is a common pathology and involves forms of disability and need for treatments that affect the quality of life of patients and their families, and in general of the whole society. It should be considered as such degenerative joint disease is increasing as the increase in life expectancy and musculoskeletal trauma, the latter responsible for secondary forms of osteoarthritis. The treatment of osteoarthritis of the hip has changed a lot over the years, since the earlier diagnosis and, before, with prevention through proper lifestyle. More in-depth knowledge of the biology of the tissues involved, first of all hyaline cartilage, has lead to non-surgical treatments such as infiltration with hyaluronic acid (viscosupplementation) and autologous growth factors derived from platelets (platelet rich plasma). Surgical therapy with prosthetic replacement is finally a choice to share with the patient based on pain and functional limitation, bearing in mind always the best technology and tribology and the possibility of less invasive surgical access, while recognizing that there are not still eternal prosthesis. Of particular importance then is the age of the patient. There are also other types of surgery (hip arthroscopy, forage) for other pathologies of the hip which can be resolutive, or, in a sense, can delay the arrival to the prosthetic replacement. We will discuss below the decision-making process that leads the surgeon with the patient to the surgery option. [ABSTRACT FROM AUTHOR]

Regenerative medicine is the science that studies the regeneration of biological tissues obtained through use of cells, with the aid of support structures and with biomolecules such as growth factors. As regards the growth factors the PRP, or the platelet-rich plasma, obtained from a withdrawal of autologous blood, concentrating the platelets, represents a safe, economical, easy to prepare and easy to apply source of growth factors. Numerous growth factors are in fact within the platelets and in particular a large number of them have a specific activity on neoproliferation, on cartilage regeneration and in particular also an antiapoptotic effect on chondroblasts: The PDGF which regulates the secretion and synthesis of collagen; - The EGF that causes cellular proliferation, endothelial chemotaxis and angiogenesis; - The VEGF that increases angiogenesis and vascular permeability; - The TGF-beta that stimulates the proliferation of undifferentiated MSC, stimulates chemotaxis of endothelial cells and angiogenesis; - The bFGF that promotes the growth and differentiation of chondrocytes and osteoblasts stimulates mitogenesis of mesenchymal cells, chondrocytes and osteoblasts. These properties have led to the development of studies that evaluated the efficacy of treatment of infiltrations in the knee and hip with platelet-derived growth factors. Regarding the knee it was demonstrated that in patients with moderate degree of gonarthrosis, the PRP is able to significantly reduce the pain and improve joint function, both on placebo and towards infiltrations with hyaluronic acid. The success of the treatment was proportional to the age of and inversely proportional to the severity of osteoarthritis according to Kellgren and Lawrence classification. The possibility of infiltrations guided with ultrasound into the hip led us to extend the indications also to hip arthrosis, as already showed by Sanchez. Even in coxarthrosis preliminary results at 6 and 12 months show that a cycle of 3 infiltrations of PRP has significantly decreased the pain and increased range of motion and joint function. [ABSTRACT FROM AUTHOR]

Bone-grafting techniques either with autografts or allografts still represent a challenge for reconstructive surgery. Allografts and autografts are the current strategies for filling bone defects and subsequent repair but each have drawbacks. Synthetic bone-graft substitutes, developed in an effort to overcome the inherent limitations of autograft and allograft, represent an alternative strategy. Synthetic bone graft substitutes have the goal of mimicking the physical and mechanical nature of native tissue and to promote osteoconduction for bone regeneration. In addition these substitutes are capable to release drugs or growth factors in a temporally and spatially manner. Some biomaterials are employed to design biomimetic scaffold such as natural and synthetic polymers, ceramics, metallics and composites. The purpose of this paper is to provide an overview of the main biomaterials used for bone reconstruction. [ABSTRACT FROM AUTHOR]

Patients affected by Multiple Sclerosis are often treated by pulsed intravenous corticosteroids to manage acute relapses with positive outcomes. The intravenous administration is frequently associated to avascular necrosis of several bones, particularly the femur. The present report regards a case of an underage MS patient with a bilateral ANFH secondary to pulsed administrations of steroids, managed by a conservative approach on a hip, and by a novel surgical technique on the contralateral side. [ABSTRACT FROM AUTHOR]

Background: Proximal humerus fracture in elderly osteoporotic patients usually leads to severe displaced and multifragmentary fractures. Associated comorbidities may limit surgical options and conservative treatment is commonly indicated, however, with variable results. In most cases, surgery is the treatment of choice in order to restore anatomical integrity, and allow early functional recovery. Several techniques were used over the years, each with specific indication. Percutaneous pinning after closed reduction, a mini-invasive technique and fixation by use of K-wires is not preferred commonly. We present our experience with this approach, focusing on its indications and advantages. Patients and Methods: A study group of 41 consecutive patients with a mean age of 65.5 years were evaluated clinically (VAS, Constant-Murley score, range of motion) , and with radiological analysis: 35 patients finally completed a minimum followup of 24 months. Results: K-wires were removed after a mean interval of 4 weeks. Clinical and radiographic healing occurred in a mean time of 8.2 weeks in all fractures but one, with improvements in mean Constant-Murley score of 87.6 points, mean VAS of 2.3. In 33 patients, the reduction was considered satisfactory. In two cases, reduction was poor, but the patients however presented acceptable functional outcome. Conclusions: Percutaneous pinning may represent a suitable option of treatment for 2-or 3-part proximal humerus fractures in selected subjects. [ABSTRACT FROM AUTHOR]

Platelet-rich plasma (PRP) is defined as a portion of the plasma fraction of autologous blood having platelet concentrations above baseline. When activated the platelets release growth factors that play an essential role in bone healing such as Platelet-derived Growth Factor, Transforming Growth Factor-β, Vascular Endothelial Growth Factor and others. Multiple basic science and in vivo animal studies agree that PRP has a role in the stimulation of the healing cascade in ligament, tendon, muscle cartilage and in bone regeneration in the last years PRP had a widespread diffusion in the treatment of soft tissue and bone healing. The purpose of this review is to describe the biological properties of platelets and its factors, the methods used for producing PRP, to provide a background on the underlying basic science and an overview of evidence based medicine on clinical application of PRP in bone healing. [ABSTRACT FROM AUTHOR]

Purpose: Total knee arthroplasty is one of the most successful procedures of modern orthopedics. Several implants have been proposed over the years with different designs, kinematics, and cementing techniques, with good results. The aim of the study was to assess the clinical and radiographic long-term follow-up of a series of patients undergoing total knee replacement that used a specific design of knee implant with cemented femoral and patellar components, and a hybrid fixation technique for tibial trays that used a cemented base plate and press-fit keels., Methods: A total of 145 implants in 135 patients were studied with clinical and radiologic evaluations. The mean follow-up was 17.1 years., Results: Seven failures for aseptic loosening and four failures for infection were registered. Twenty-nine implants showed nonprogressive radiolucencies, mostly at a single component, which did not need revision. The overall survivorship at the mean follow-up of 15 years considering aseptic loosening as the endpoint was 92.1%., Conclusions: The authors confirm the good rates of success and the long-term survival of this specific implant and the effectiveness of the tibial hybrid cementing technique, which is still debated among researchers.

Fragility fractures typically occur in elderly patients. They are related to osteoporosis, because of the weakening of the bone structure, and are the result of low-energy injuries and often involve the metaphyseal segments of bone. The fracture of the upper extremity of the femur are one of the most typical of the elderly patients. They may be intracapsular (femoral neck fractures) or extracapsular (intertrochanteric fractures). Each kind of fracture can be treated in several ways: the intracapsular fracture can be treated with screws, unipolar or bipolar hemiarthroplasty or even with total arthroplasty. The extracapsular fractures instead can be treated with sliding hip screw, intramedullary nail, femoral neck screws, helical blade or primary arthroplasty. What must be remembered is that osteoporotic bone has distinct morphologic characteristics that influence its biomechanical properties and therefore the choices and techniques for internal fixation. Therefore only a complete understanding of the biology of the osteoporotic bone will lead to a good quality of the treatment of the fragility fractures.