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Hip fractures are common in older and frail adults, and the risk of adverse outcomes and mortality is significantly increased in patients affected by osteosarcopenia. Identifying particularly vulnerable subjects is a critical step to act aimed at promoting postoperative recovery and reducing the risk of adverse events. However, the diagnostic criteria that are currently used to establish the severity of osteosarcopenia are not easily applicable in patients with hip fractures and impaired mobility. In this review, the new knowledge on the pathophysiology of osteosarcopenia that provides several cues for studying biomarkers potentially useful in clinical practice is summarized. Although significant progress has been obtained in understanding the biological mechanisms leading to the involution of the bone- muscle unit, further studies are needed to identify clinically relevant biomarkers and their diagnostic accuracy in establishing the severity of the osteosarcopenia, predicting adverse outcomes, and guiding physicians in choosing appropriate therapeutic interventions.Telerehabilitation is defined as a set of tools, procedures, and protocols to deliver rehabilitation programs remotely. It involves the use of various communication technologies to efficiently provide rehabilitation services distantly or via some other remote environment. After an orthopedic procedure, physical rehabilitation is essential to restore joint's function, to improve quality of life as well as to relieve pain, to recovery independence. The effectiveness of telerehabilitation has been studied in literature. The aim of this narrative review is to update the current evidence, evaluate the efficacy of telerehabilitation after hip, and knee prosthesis surgery for end stage arthrosis. Results show that it is useful to integrate traditional interventions with telerehabilitation to accelerate efficiency in existing healthcare delivery systems. Future high-methodological-quality studies should be conducted to evaluate the long-term efficacy and safety of innovative technologies.Marfan syndrome is an autosomal dominant disorder of the connective tissue caused by mutations of the fibrillin-1 gene (FBN1) that primarly involves the cardiovascular, skeletal and ocular systems. We investigated 72 children affected by Marfan syndrome in order to identify possible correlations between some musculoskeletal features and specific mutations of fibrillin-1 gene. The following FBN-1 gene mutations have been observed a missense mutation in 21 children, a stop mutation in 9, a splice mutation in 15 and other mutations in the remaining 27 patients. We observed a statistical significant association between chest asymmetry and splice mutation (p=0.031) and between scoliosis >20° or thoracolumbar kyphosis and stop mutation (p=0.039). However, we did not find a true genotype-phenotype correlation between the fibrillin-1 gene mutations observed and the prognosis of the disease. Future studies are necessary to demonstrate further genotype-phenotype correlations in order to identify early prognostic markers of Marfan syndrome and to plan the most appropriate clinical management accordingly.C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) are the two most commonly serum biomarkers for the diagnosis of periprosthetic joint infections (PJI). We monitored CRP and ESR in 60 patients affected by osteoarthritis who underwent primary total hip or knee arthroplasty to verify their utility for an early diagnosis of periprosthetic hip and knee infections. In all but two patients, both CRP and ESR increased rapidly after surgery, reaching a peak value around the 3rd day postoperatively; CRP decreased rapidly in 20 days, reaching normal value one month after surgery, while ESR decreased slowly, reaching the normal value after three months. In two patients, CRP and ESR were still elevated six months after the surgical procedure and in both cases a diagnosis of PJI was made. Our study confirms that postoperative screening of CRP and ESR values are very useful in making an early diagnosis of this serious complication.Giant cell tumour (GCT) represents 5% of all primitive bone tumours. Standard surgical treatment of GCT includes intralesional excision or segmental resection. find more Curettage has a higher recurrence rate (10-25% in stage 2 or 3 but does preserve adjacent joint function. The use of local adjuvants such as phenol, alcohol, H2O2, Argon or cement may decrease recurrence rate, yet which local adjuvant works best is still, to this day, controversial. A series of 109 patients with GCT of the extremity, surgical treated in a single Institution from 2016 to 2018, were analysed in a retrospective study. The purpose of our study was to report the incidence of recurrence rate in patients with GCT of limbs treated in a single institution with different local adjuvants. The results of the present study suggests that curettage in association to cryoablation seems to reduce the recurrence rate compared to "classic" local adjuvants.Osteoarthritis (OA) is a multifactorial disease, whose exact pathogenesis is still unclear. In recent years, the gut microbiota (GM) has shown to modulate not only local processes but also systemic responses. This narrative review aims to summarize the recent evidence about the link between gut dysbiosis and OA onset and define a potential preventive and therapeutic strategy. OA symptomatic expression, resulting from the complex interplay between mechanical and biological factors, might be enhanced by systemic lowgrade inflammation. It is reported several OA-related risk factors are linked to a systemic inflammatory status and potential GM dysfunctions. Moreover, recent studies have demonstrated the presence of lipopolysaccharides, proteoglycan and bacterial nucleic acids in the synovial fluid of patients undergoing total knee arthroplasty. In the future, microbiota profiling could help predict OA progression and, at the same time, GM could be a potential target in the treatment and prevention of OA.Hip revision surgery in cases with previous multiple reconstructive procedures is a challenging procedure. A custom-made product could be useful to obtain good results. Four cases (2 men and 2 women) of acetabular customized Trabecular Titanium (TT) implants made by 3D printed technology were performed. The mean age at surgery was 51.5 years (range 25-72). Patients were reviewed clinically and radiographically at follow-up. Mean Harris Hip Score increased significantly from 13.9 (range 6.9-20.6) preoperatively to 75.8 (range 53.9-94) at last follow-up (mean 43.5, range 36-59), showing an improvement in terms of both pain relief, function and joint mobility. Radiographically neither signs of instability, migration nor tilting were observed. TT custom-implant made by high performance of the 3D-printing technology, system modularity, and patient-specific surgical tools permitted good clinical results and an effective restoration of the biomechanical joint parameters in these complex revision cases.The aim of this systematic review was to analyze the failure rates among different trapeziometacarpal interposition implants used to treat thumb basal joint osteoarthritis. link2 We searched Medline (PubMed), Web of Science and Scopus databases, to identify articles reporting on thumb interpositional arthroplasty, in English literature. We excluded studies with less than 35 cases and with a follow-up shorter than 24 months. Twenty-one studies were included. We assessed the quality of the studies using the Coleman Methodological Score. The mean quality of the studies was moderate. The total number of procedures included in this review was 1205. The failure rate for interposition implants was 11%. The main longterm complication was dislocation, which is also the major reason for revision.Mesangiogenic Progenitor cells (MPCs) have been isolated from human bone marrow mononuclear cells (hBM-MNCs) and attracted particular attention for their ability to efficiently differentiate into exponentially growing mesenchymal stromal cells (MSCs) and toward endothelial lineage, suggesting the term "mesangiogenic". Coupling mesengenesis and angiogenis, MPCs has been hypothesized retaining a great tissue regenerative potential in musculoskeletal tissues regeneration. Bone marrow and adipose tissue (AT) represent most promising adult multipotent cell sources attempting to repair bone and cartilage, with controversial results regarding advantages applying BM- or AT-derived cells. link3 As different culture determinants as well as tissue of origins, could strongly affect regenerative potential of cell preparations, we hypothesize that MPCs counterpart could have a role in defining efficacy of applying a cell-based medicinal product in musculoskeletal tissue repair. Here we present convincing data demonstrating that the ex vivo progenitors of MPCs are tissue specific and can be detected exclusively in hBM-MNCs.NGF has raised interest as a target molecule in the treatment of OA, after the clinical evidences that antagonization of NGF axis provides symptoms relief in OA. Thus, we conducted a systematic review of the literature to investigate the evidence of NGF being overexpressed during OA. We conducted a database search on Medline using keywords including NGF, serum, synovial fluid, AND osteoarthritis or arthritis. We included study conducted on human, with serum or synovial specimens and an OA cohort. Nine studies met the inclusion criteria. Serum levels ranged from non-detectable to 153.5±28.6 pg/ml. Synovial fluid levels ranged from non-detectable to nearly 210±82 pg/ml. One study supported the evidence of an increased level of NGF in SF and serum of OA patients. The concentration of NGF reported in these studies is controversial and evidence of overexpression of NGF is low.Over the past decade, the incidence of revision arthroplasty due to infection has increased substantially, often resulting in multiple surgical interventions with variable success rates and poor clinical outcome. Intraoperative wound irrigation has been proposed to reduce bacterial bioburden and contamination, but currently there is no widely accepted recommendation for the use of topical antiseptics, whether as separate molecules or as a mixed solution. We reviewed studies regarding the use of intraoperative topical antiseptics, their security profile and efficacy in preventing and treating infections of orthopedic implants and introduced a possible combination that may prove valuable in the future.To evaluate the expression, location and role of progesterone receptors (PRs) A and B in human chondrocytic cell lines, Western blotting, real time PCR analyses, transmission electron microscopy and immunogold assays were performed. By transfection and co-transfection assays, the influence of progesterone (OHPg) on estrogen receptor alpha (ERα) promoter activity was investigated. MTT and pAKT documented OHPg effects on chondrocytes survival. The PR-B and PR-A were both observed in human chondrocytes. The PR-B was evidenced both in the nucleus and in the cytosol of the cells. OHPg, through PR-B, induced ERα expression by acting at the ER promoter level affecting chondrocytes survival. We reported for the first time the expression of PRs in human chondrocytes. Interestingly, we described a novel mechanism via progesterone induction of ERα, which may explain, at least in part, the dramatic rise in OA prevalence among postmenopausal women.
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