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repOrt – Periodico online di SICOOP – 16/07

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Periodico online di SICOOP – 16/07

SLAP lesions: a treatment algorithm

Tears of the superior labrum involving the biceps anchor are a common entity, especially in athletes, and may highly impair shoulder function. The clinical results of SLAP repairs in middle-aged and older patients are mixed, with worse results and higher revision rates as compared to younger patients. The type of lesion, age of patient, concomitant lesions, and functional requirements, as well as sport activity level of the patient, need to be considered. The suggestion for a treatment algorithm includes: type I: conservative treatment or arthroscopic debridement, type II: SLAP repair or biceps tenotomy/tenodesis, type III: resection of the instable bucket-handle tear, type IV: SLAP repair (biceps tenotomy/tenodesis if >50 % of biceps tendon is affected), type V: Bankart repair and SLAP repair, type VI: resection of the flap and SLAP repair, and type VII: refixation of the anterosuperior labrum and SLAP repair.
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Effect of one-year post-operative alendronate treatment on periprosthetic bone after total knee arthroplasty. A seven-year randomised controlled trial of 26 patients.

Total knee arthroplasty (TKA) is known to lead to a reduction in periprosthetic bone mineral density (BMD). We hypothesised that treatment with bisphosphonates and calcium would lead to improved BMD and clinical outcomes compared with treatment with calcium supplementation alone following TKA. Mean femoral metaphyseal BMD was significantly higher in the bisphosphonate group compared with controls, up to four years following surgery in some areas of the femur (p = 0.045). BMD was observed to increase in the lateral tibial metaphysis in the bisphosphonate group until seven years (p = 0.002), and was significantly higher than that observed in the control group throughout (p = 0.024). There were no significant differences between the groups in the central femoral metaphyseal, tibial medial metaphyseal or diaphyseal regions of interest (ROI) of either the femur or tibia.
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TClinical and biochemical characteristics after intra-articular injection for the treatment of osteoarthritis of the knee: prospective randomized study of sodium hyaluronate and corticosteroid.

Some studies have discussed the effectiveness of intra-articular drug injection therapy in terms of the clinical results, but no cohort studies have performed evaluations of effectiveness based on changes in joint biomarkers. This prospective randomized study compared the efficacy of Na-HA and CS injections based on clinical scores and levels of biochemical markers for osteoarthritis.
A total of 51 patients with knee osteoarthritis received intra-articular injections of either Na-HA or CS and were followed for 6 months after treatment.
In both groups, injection therapy significantly improved pain/inflammation scores and visual analog scale scores with time (P < 0.01). HA levels were significantly increased after injection only in the Na-HA group (P < 0.05); and the MMP-9 level decreased significantly after injection only in the Na-HA group (P < 0.01). Considering the results of the measurement of biomarkers, compared with CS injection therapy Na-HA injection therapy may have protective effects on the articular cartilage by increasing the HA concentration in synovial fluid, as well as inhibitory effects on the catabolism of articular cartilage by reducing the MMP-9 concentration.
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Optimising Theatre Utilization: Assessing Theatre Staff Orthopaedic Surgical Time Estimate Accuracy

The efficient use of hospital theatre time is important for members of the community to have their operations performed in a timely manner, reducing cancellations and the monetary cost wasted in under-utilised theatre time [1]. The Australian Institute of Health and Welfare reported a 4.2% increase in elective case admissions during the period of 2013-2014 [2]. These increases cite the need for more efficient use of hospital resources, particularly in the operating theatre environment with an emphasis on improved surgical scheduling [3]. Whilst theatre booking programs have been utilised in an attempt to improve this, these have been shown to be less accurate than surgeon estimations, and are more irrelevant when considering Our data was taken in a situation where the majority of cases were pre booked on an orthopaedic list, which avoids the situation where a surgeon is booking a case after hours and/or competing with other surgical specialities.
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Impact of hip fracture on hospital care costs: a population-based study

The purpose of this study was to estimate hospi- tal costs of hip fracture up to 2 years post-fracture and com- pare costs before and after the index fracture.
A cohort of patients aged over 60 years admitted with a hip fracture in a UK region between 2003 and 2013 were identified from hospital records and followed until death or administrative censoring. A generalised linear model examined the main predictors of hospital costs.
The main predictors of 1-year hospital costs were second hip fracture, other non-hip fragility fractures requiring hospitalisation and hip fracture-related complications. Total UK annual hospital costs associated with incident hip fractures were estimated at £1.1 billion.
Hospital costs following hip fracture are high and mostly occur in the first year after the index hip fracture. Experiencing a second hip fracture after the index fracture accounted for much of the increase in costs. There is a strong economic incentive to prioritise research funds towards iden- tifying the best approaches to prevent both index and subse- quent hip fractures.
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