Total knee and hip arthroplasty are major surgical procedures performed in patients with severe osteoarthritis and their incidence has significantly increased in the last 30 years. A number of etiological factors such as low grade infections, stress shielding and degradation products have been, however, shown to endanger the survival of the implants. The prevention of mechanically induced implant loosening has been the aim of many studies investigating, among other things, whether pharmaceutical agents used for the treatment of osteoporosis can positively influence the survival of the arthroplasty implants. We conducted a search of the published literature (PubMed) to identify studies that assessed the effects of anti-resorptive agents (bisphosphonates, denosumab, raloxifene, bazedoxifene, calcitonin) on the outcome and longevity of total arthroplasty of the hip and knee. We found 24 studies for THR, 8 studies for TKR and 2 studies with reference in both hip and knee arthroplasty. Most studies assessed the effects of oral bisphosphonates. Significant difference in BMD is observed after 6 months of postoperative antiosteoclastic therapy with better results and lower revision rate in cemented TKA. Only 2 studies were found assessing the effects of denosumab on implant survival, while no studies were found on SERMs and calcitonin.

“Frailty syndrome“ is usually associated with the elderly and is regarded as a generalized state of increased sensitivity that affects mainly the muscular as whell as the cardiovascular system. The correlation between osteoporosis and the poor state of the muscular system, the loss of muscle strength that occurs with aging creates an increased propensity for falls. The correlation between cardiovascular disease and osteoporosis has been vastly attributed to the effects of osteogenic factors such as BMP’s (bone morphogenetic proteins), ALP (alkaline phosphatas), OPN (osteopontin) and MPG (matrix Gla protein) on vascular calcifications.Currently, a number of studies are seeking to establish a common pathway also between frailty and cardiovascular disease and the importance of interactions between those two systems. in this short article we are presenting some of these new data.

Anesthesia, and, more specifically, regional anesthesia which is the focus of this review, is the most commonly used method in orthopedic surgery and is considered a rather complicated and delicate procedure. Therefore, nurses working in the anesthesiology department are of great importance due to the services and support they provide to both doctors and patients, by facilitating the anesthesiologist during the procedure as well as by monitoring, treating and supporting the patient. Nonetheless, the role of these nurses is generally understudied in scientific research and needs further investigation. For the purpose of this review a variety of articles relevant to orthopedic surgery, regional anesthesia and the role of nurse working in anesthesiology departments were gathered and analyzed in order to highlight the importance of the services they provide, using empirical evidence.

Osteonecrosis of the femoral head is a progressively destructive disease of multifactorial origin. The etiology and pathogenesis of osteonecrosis of the femoral head are not yet clear. Management alternatives for the treatment of osteonecrosis of the femoral head consist of non-operative and operative treatment. The efficacy of non-operative treatment alone is the subject of heated debate in the literature. The purpose of this article is to review, update and summarize the non-operative treatment, particularly physical therapy modalities in patients with avascular necrosis of the femoral head in early stages. According to current literature these methods mainly include restriction techniques, electromagnetic stimulation, shockwave, immobilization-traction and rehabilitation training. Despite the evidence that these modalities when applied alone improve motor-function, pain relief and delay disease progression mainly through angiogenesis, osteogenesis and tissue regeneration, there is need for more research to elucidate their role and duration in early stages of avascular necrosis of the femoral head.

The present article is a mini review on the multi-faceted role of the nurse in relation to the education of the patient with diabetic foot disease, a severe medical condition with worldwide prevalence and immense financial and clinical implications. We present a mini review based on scientific articles written in English concerning the role of the nurse in the areas of prevention, care and rehabilitation focusing on their contribution in educating the diabetic foot patients and their relatives to recognize the symptoms of diabetic foot, helping them follow simple and basic rules that will prevent the onset or further development of the disease, informing them as to the available treatment options during care and eventually supporting them in the road to lead a fulfilling life.

In the last few decades, all the countries aim to combine the improvement of the quality of health care with the reduction of health costs. In order to harmonize the above-mentioned contradictory goals, newly enhanced roles, as in the case of Advanced Nursing Practice, have been introduced, initially in the private sector and more recently in the public hospital setting. The orthogeriatric advanced nursing practitioners’ role is valuable for providing pain relief, diagnosing and treating postoperative delirium, deep vein thrombosis, and secondary infections, preventing subsequent injuries and pressure sores, helping patients deal with postoperative constipation, and assist them in early mobilizing. After patients’ discharge from the hospital, their role is essential for ensuring the patients are adhering to their osteoporotic treatment and have the adequate skills to prevent falls. Their role is significant for older adults living in nursing homes or long-term care facilities. Their care is cost-effective compared to regular care.

Objectives: The objective of this study was to evaluate and compare the efficacy of teriparatide (osteoanabolic agent) versus vitamin D₃ supplementation to improve functional outcomes in osteoporotic patients with distal end radius fractures (DERF). Methods: We conducted a prospective, randomized clinical study to compare the functional outcomes. Sixty osteoporotic DERF patients, treated with either conservative or surgical management were randomized to receive either teriparatide (20 mcg/day) or vitamin D₃ (1000 IU/day) for a period of 3 months, along with calcium (500 mg/day) supplementation. The treatment outcomes were evaluated pre and post-management (1-month and 3-months) by Green and O’Brien scale, Patient-rated Wrist Evaluation (PRWE) scale, and Sarmiento scale. Results: There was a significant difference between the two groups at 3-months post-management. Teriparatide showed a significantly greater improvement of functional outcome (P=0.036) and patient-reported outcome (P<0.001) in comparison to vitamin D₃ in total Green and O’Brien score and PRWE score, respectively. Conclusion: Teriparatide supplementation was effective and resulted in greater improvement in functional and radiologic outcomes in comparison to vitamin D₃. Adjuvant teriparatide therapy may be a therapeutic option to improve the functional outcomes in DERF of osteoporotic patients.

Objectives: The risk of musculoskeletal pain increases when there is an imbalance between work demands and physical capacity. Work in elder care requires frequent periods of high mechanical loading. Body weight can further amplify this load, while muscle strength may lessen the relative strain on the musculoskeletal system. The purpose of this study was to assess the correlation between body composition, muscular strength and localized musculoskeletal pain intensity in overweight female health care professionals. Methods: A sample of 139 overweight female health care professionals working in elder care were included in the analyses. Associations between BMI, fat percentage, waist circumference, muscle strength and localized pain intensity were assessed using Kendall’s rank correlation. Results: Significant associations were found between musculoskeletal pain in the right shoulder and BMI (r_τ=0.194; p=0.035), whereas upper back pain was associated with fat percentage and waist circumference (r_τ=0.212; p=0.023 and r_τ=0.212; p=0.024, respectively). Conclusions: Results indicate high BMI, fat percentage, and waist circumference may be contributing factors of localized musculoskeletal pain intensity of the upper body in overweight female health care professionals. These results may help guide the design of future workplace health promotion programmes.

Objectives: Medial para-patellar is common approach for TKA; Subvastus approach is technically demanding and spares the quadriceps mechanism. Does the subvastus approach significantly improve outcomes compared to medial para-patellar approach in simultaneous bilateral total knee arthroplasty (SBTKA)? Methods: The study conducted on 100 patients between Jan 2018 to June 2019 matched in base demographics and clinical parameters divided in two equal groups; medial para-patellar approach and subvastus approach. VAS and PROM assessed in early post-operative period. Functional outcomes assessed using WOMAC scores and KSS postoperatively up to 01 year. Results: VAS at 3^rd week was significantly higher in para-patellar group. At 3 weeks, 6 weeks and 3 months follow-up WOMAC score was higher and KSS was lower in para-patellar group. At 06 months and 01 year both WOMAC and KSS scores were similar. Measured functional outcomes were consistently better in subvastus group. Conclusion: Subvastus approach had less post-operative pain, faster recovery and better functional outcomes after surgery as compared to medial para-patellar approach in early post-operative period. There was no difference in outcomes at 01 year. The complication rates, transfusion rate, hospital stay, requirement of physiotherapy and rehabilitation was similar for both groups. We conclude the subvastus approach significantly improves early outcomes in SBTKA cases.

The biomechanics of walking seems to be affected in the elderly compared to young adults. These adjustments are likely to be associated with an increase in the risk of falling. This review aims to investigate the effect of age on walking ability specifically focusing on studies that have assessed spatiotemporal, kinematics and kinetics variables using three-dimensional (3D) analysis. A systematic review of the research literature was applied until January 2019 across Pubmed electronic database. A targeted search strategy traced full papers that fulfilled the inclusion and exclusion criteria. Eleven of 214 articles met the predetermined inclusion criteria and were included in the review. Differences between older and young adults were found in the most parameters which were evaluated. Changes in the lower-limb walking kinematics in elderly during walking may compromise the quality of gait. However, there is a bibliographic gap, as there are no articles that assess the risk of falling taking into account joint kinematic and kinetic parameters.

Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a term that is used to describe a wider clinical syndrome that can be developed as a systemic metabolic mineral bone disturbance, due to the chronic kidney disease, and it manifests itself as metabolic mineral bone anomalies or extra-skeletal calcifications. Metabolic acidosis is considered to be the most widespread acid-base disorder that is found in the majority of CKD patients. Hemodialysis patients seem to be more prone to MBD due to acid base disorders. This article aims to review the available literature about the acid-base disorders and their impact on MBD in hemodialysis patients. We have conducted an electronic literature research, where titles and abstracts of relevant papers were validated by the authors for further inclusion in this work. Finally, full texts of the included articles were retrieved. The findings of our literature research have concluded that at the age of 55, the relative risk of hip fractures increases and in CKD patients is high; after 4 years of undergoing dialysis, the age-specific relative risk of suffering a hip fracture was 9.83 for males and 8.10 for females. The average relative risk of mortality associated with hip fracture was 1.99. Our review has highlighted that CKD and MBD are closely related and they consist of a phenomenon requiring further research.

Obstetric brachial plexus palsy (OBPP) is a pathological situation that is defined as a birth complication with the frequency of occurrence 1-3 per 1000 live births globally. The prime mechanism of injury is the complexion and/or traction of the brachial plexus and may occur in utero through the birth canal or during the process of delivery. This pathology can result in a variety of injuries with that affect the range of motion, the mobility and the use of the upper limb. Management alternatives for the treatment of OBPP consist of non-operative and operative treatment. There is a controversy regarding the selection of the appropriate rehabilitation method for the management of OBPP. The objective of the current research is the search of the literature for the current scientific evidence about the effectiveness of physiotherapy as a conservative method of treatment of infants with OBPP. According to current literature the physiotherapy methods that were used varied form passive exercise to splints and traction. There is little evidence regarding the use of physiotherapy as a primary method of conservative management of OBPP, there is need for more research to elucidate their role

Osteoporosis is a chronic disease requiring prompt and accurate diagnosis. The most widely used quantitative bone imaging technique for estimating Bone Mineral Density (BMD) both for research purposes and in the clinical practice according to WHO, is DXA (dual-energy X-ray absorptiometry). DXA may be performed at the axial (lumbar spine, proximal femur) and appendicular skeleton (distal forearm) for the diagnosis of osteoporosis. In this review, we summarize basic considerations concerning the technique, as well as recommendations for scanning sites in different individuals.

Objectives: The study aimed to estimate the incidence of SSI in clean orthopaedic surgeries, while identifies the associated risk factors and prevalent infective microorganisms. Methods: This was a prospective, observational study conducted in patients who underwent orthopaedic surgeries during the period between October-2019 to March-2020. Adult patients admitted in the in-patient wards of Orthopedics and underwent (category 1) clean wound type of orthopaedic surgeries (elective or emergency) were included in the study. Patients’ demographics details, clinical history, characteristics of disease, surgery-related variables, pre/ post management, hospital stay details and laboratory indexes were inquired and documented. We excluded other categories of surgical wounds (category 2, 3 and 4). Results: In this study, incidence of SSI in clean wound orthopaedic surgeries was 6.84 %. The male to female ratio was 1.8. In this study, SSI was associated significantly with age, comorbid condition, and pre-op hair removal technique. The most common infective organisms identified on culture were Klebsiella pneumonia and Methicillin-resistant Staphylococcus aureus. Conclusion: Incidence of SSI in clean orthopaedic surgeries was high. Proper identification and optimization of modifiable risk factors needs to be done prior to orthopaedic surgeries to reduce the risk of SSI.

Objectives: The purpose of this study was to evaluate outcomes after TKA using Knee injury and Osteoarthritis Outcome Score (KOOS). Methods: We retrospectively reviewed 60 knees. KOOS was conducted before surgery, 3 weeks, 3 months, 6 months, and 1 year after surgery. Each score was evaluated and compared using a multiple comparison test. Besides, we evaluated the correlation between KOOS and the patient’s objective factors. Results: Regarding the total score, the value was improved at any point of post-operation (p<0.001). Especially, pain score and quality of life score were improved between 6 months and 1 year after surgery (pain score: p=0.04, quality of life score: p=0.007). The correlation between patient’s factors and KOOS, concerning age, showed that there was a positive correlation with preoperative symptom/stiffness score (p=0.004) and the pain score (p=0.04). Also, the preoperative knee extension range was correlated with symptom/stiffness score and sports/recreation score at 3 weeks after surgery (p=0.03), and quality of life score at 6 months (p=0.04). The preoperative knee flexion range showed a significant correlation with the sports/recreation score at 1 year after surgery (p=0.006). Conclusions: In conclusion, it is necessary to follow the progress of 1 year or more even for cases with a seemingly poor outcome at 6 months after surgery.

This study aimed to investigate whether childhood fractures are associated with future risk of osteoporosis and fracture occurrence in adult life. Bone is a dynamic organ which is modified by bone modeling and remodeling. Peak bone mass is obtained in early adulthood and it is affected by a variety of modifiable and non-modifiable factors. In the last decades, childhood fractures have been increased by 35-65% due to many variable factors. Pediatric fractures are 10-25% of all pediatric injuries, their most common site is distal forearm and they are most frequent during the prepubertal and pubertal period of life. According to some cohort studies, childhood fractures are considered a risk factor for osteoporosis and future bone fragility. Most of the available data from published studies suggest that pediatric low-energy fractures are linked to decreased bone mass. However, based on our literature search the prognostic value of positive pediatric fracture history in osteoporosis and skeletal fragility is still debated.

Knee cartilage lesions are a common source of pain and progressive debilitation affecting individuals in all age groups. Treatment of these lesions remains a challenge due to the poor healing capacity of the articular cartilage. Numerous techniques with various improvements in terms of pain and function have been published and only few of them have been proven to be valuable. Mesenchymal stem cells provide a new option for treatment due to their differentiation properties into several connective tissues. They can be isolated from several human tissues such as bone marrow, adipose tissue, synovial tissue, peripheral blood and periosteum. When applied in combination with proper biomaterials used as scaffolds as well as growth and other stimuli factors, they represent a promising treatment strategy. Aim of our study is to review the clinical trials which evaluate the current status of MSCs application for the management of knee cartilage lesions.

Fracture healing is a biological route that may not always lead to bone healing. Delayed union or even nonunion of a fracture is possible to have devastating socio-economic impact on patients and healthcare systems. Except of surgical treatment, other non-invasive methods have been proposed for the management of non-united fractures commonly known as biophysical enhancement. This includes low-intensity pulsed (LIPUS), extra-corporeal shockwave therapy (ESWT) and pulsed electromagnetic fields (PEMF) stimulation. The utility and efficacy of biophysical enhancement is a matter of question and no safe conclusion can be drawn especially because of great heterogeneity present in literature.

Objectives: The objective of this study was to evaluate the functional outcome of intramedullary Kirschner wire (K-wire) nailing technique in proximal phalanx fractures. Methods: We conducted a prospective, randomized clinical study to evaluate the functional outcome. 30 patients of isolated proximal phalangeal fracture were treated with intramedullary nailing using K-wire technique. Outcomes were assessed radiologically as well as clinically based on range of movement according to the American Society for Surgery of Hand (ASSH) and QuickDASH Scoring system. Results: Radiologically, all patients showed fracture union at 6-8 weeks. No complications were reported except in one patient who developed bursitis. Conclusion: Treating an unstable proximal phalangeal fracture with intramedullary nailing using K-wire shows outstanding results with minimal to negligible complications.

Enchondroma is a slow growing benign cartilaginous tumour arising from the medullary cavity. These tumours are more of an incidental finding, while screening for surrounding pathologies. Enchondroma of the rib is a rare finding. A 29 year-old Asian male, presented to the outpatient department with complaints of; Right sided chest tenderness since a year. There was no history of fall or trauma. Chest X-ray revealed a well-circumscribed lytic lesion of around 4x2x2 cm, located on the right 5^th rib. After surgery, patient’s histopathology report revealed an enchondroma of the rib (5x2x1.5 cm with a lytic area of 2x1 cm). Despite enchondromas being benign, the ones in the ribs should be closely examined for signs of enchondrosarcoma. Complete surgical excision is the treatment of choice.

The finite element analysis (FEA), is an engineering computational method of mechanical analysis for complicated structure and it has been employed for the study of the mechanics of human bone. QCT (Quantitative computed tomography) offers three-dimensional data concerning the geometry of bone and how the bone mineral is allocated in terms of space. Depictions acquired with quantitative CT can be utilized to create FE (finite element) models, which enable the analysis of how strong the bone is and how the mechanical stress is distributed, as well as the physical distortion. This methodology can be applied so that the various mechanical loading scenarios can be investigated (stance and fall arrangements) and for the estimation of the entire strength of the bone and the proportional mechanical assistance of bone parts. In this review we research the published literature concerning the effects of various pharmacological agents on parameters of bone strength as measured by FEA in patients with postmenopausal osteoporosis. After selection based on our inclusion and exclusion criteria we evaluated 17 original articles on various pharmacological agents (bisphosphonates, denosumab, teriparatide, PTH 1-84, romosozumab). Although not many studies are currently available an increased value of FEA is definitively seen.

Osteoporosis is a common disease, characterized by loss of bone mass and increased incidence of fractures, due to increased bone resorption through osteoclasts and decreased bone production through osteoblasts. MicroRNA (miRNA) is a type of short non-coding RNA with a length of 20-25 nucleotides, which exerts post-transcriptional control by inhibiting or degrading target genes. Recently, it has been noticed that miRNAs may play a significant role in the pathophysiology of osteoporosis as they influence the process of bone remodeling by regulating the differentiation and function of osteoblasts and osteoclasts. More specifically, miRNAs promote apoptosis and inhibit the proliferation and differentiation of osteoblasts. At the same time, there are miRNAs that promote osteoclast apoptosis, thus delaying bone loss in patients with osteoporosis, while also affecting the osteogenetic differentiation of mesenchymal stem cells. MiRNAs-based treatments for osteoporosis have not yet been in the clinical stage, so more studies are needed.

As the world population grows, the life expectancy of the elderly will continue to grow. With the growing prevalence of various chronic diseases, the incidence of fragility fractures caused by osteoporosis is expected to further increase in the future. DXA is a simple, inexpensive and safe technique currently used for the diagnosis of osteoporosis, but numerous osteoporotic fractures also present in patients with osteopenia. Other techniques using the DXA technology also currently employed, such as the assessment of bone quality by analyzing bone microarchitecture with Trabecular Bone Score (TBS), or geometrical properties of the femur with Hip Structural Analysis (HSA) contribute to the prediction of fracture risk and bone strength, while Vertebral Fracture Assessment (VFA) serves in assessing prevalent vertebral fractures by replacing conventional X-ray.