Abstract Background This systematic review and meta-analysis aimed to compare postoperative gait and functional outcomes between the Hardinge approach (HA) and the posterolateral approach (PLA) for total hip arthroplasty (THA). Methods A comprehensive literature search was conducted in PubMed and Embase for studies directly comparing HA and PLA. Eligible studies were selected based on predefined inclusion and exclusion criteria. Two reviewers independently performed study screening, quality assessment, and data extraction. Results Twenty-six studies, including 245,620 patients (HA: n = 88,193; PLA: n = 157,427), were included. Compared to the HA group, the PLA group was associated with better gait velocity and abductor muscle strength, while the HA group exhibited a lower hip dislocation rate but higher risks of heterotopic ossification and infection. No significant intergroup differences were found in the Harris Hip Score, stride length, ground reaction force, periprosthetic fracture, or radiographic outcomes. Conclusions This meta-analysis suggests that PLA offers advantages in gait velocity and abductor power recovery, while HA is associated with a lower dislocation rate. This potential benefit of HA must be balanced against its observed higher risks of heterotopic ossification and surgical site infection. These findings, however, are derived from observational studies with inherent confounding factors, such as variations in implant design and surgical technique. Therefore, the reported outcome differences may not be attributable solely to the surgical approach. Trial registration Registration ID, CRD42025634164. Clinical trial number Not applicable.
<b>Background/Objectives</b>: Congenital clubfoot (CC) is one of the most common congenital deformities of the lower limbs, typically presenting as a complex skeletal malformation. It is frequently associated with other congenital anomalies, although the co-occurrence with agenesis of the toes is rare. This case report describes a unique presentation of congenital clubfoot associated with agenesis of the 4th and 5th toes, focusing on clinical management and reviewing the literature on skeletal malformations linked to CC. <b>Methods</b>: A comprehensive literature review was conducted, focusing on studies published in the last decade regarding congenital clubfoot and its association with other skeletal malformations. A clinical analysis of a patient with congenital clubfoot and digital agenesis was performed, including diagnostic methods, treatment approach, and follow-up results. The patient was treated with the Ponseti method, followed by percutaneous Achilles tendon tenotomy due to insufficient correction. Due to persistent equinus deformity, a second intervention involving Achilles tendon lengthening and syndesmotic capsulotomy was performed. <b>Results</b>: The patient presented with unilateral congenital clubfoot and agenesis of the 4th and 5th toes, a rare combination. Initial correction was achieved with the Ponseti method, but further surgical intervention was needed. Follow-up at 2 years showed excellent results, with the patient able to walk without difficulty. The literature review revealed limited cases involving digital agenesis associated with clubfoot. <b>Conclusions</b>: This case report highlights the rare association between congenital clubfoot and agenesis of the 4th and 5th toes. While satisfactory outcomes were achieved, further studies are needed to explore potential worse outcomes in cases with associated malformations and the genetic factors involved.
I previously reported that F-box/leucine-rich repeat protein 14 (FBXL14) expressed in periosteum-derived cells, and F-box and WD-40 domain-containing protein 2 (FBXW2) in the periosteum form a fiber-like structure. Here, two culture medium conditions, that is, media with and without ascorbic acid, were compared during explant culture. In the absence of ascorbic acid, the expression patterns of osteocalcin, FBXW2, and elastin were compared using fluorescent immunostaining during weeks 3–5. By observing the periosteum, cambium layer and bone, I demonstrated FBXL14 expression in micro-vessels and bone lacuna. Fluorescent immunostaining revealed that, without ascorbic acid, the FBXL14 layer was thin. Conversely, in the presence of ascorbic acid, FBXL14 formed a thick membrane-like structure inside the periosteum, and the multilayer of periosteum-derived cells (PDCs) was strong. The expression patterns of osteocalcin and FBXW2 were similar. Elastin retained its fiber structure for up to five weeks. Although osteocalcin and FBXW2 were expressed in regions similar to elastin, they could not retain their fiber structures. In conclusion, FBXL14 appears to play a role in preparing a native scaffold for forming a multilayered sheet of PDCs inside the periosteum. FBXW2 and osteocalcin appear to separate from elastic fibers during calcification.
El tratamiento para la osteoporosis suele ser largo en el tiempo, por lo que es necesario en muchas ocasiones recurrir a una estrategia secuencial de tratamiento. El clínico debe saber no solo seleccionar la mejor terapia disponible en cada situación clínica, sino también cómo discontinuar o cambiar de tratamiento en un momento determinado de la evolución de la enfermedad.
En este documento presentamos de forma resumida una revisión de los mecanismos de acción y las consecuencias de la discontinuación de cada uno de los fármacos para la osteoporosis, así como qué ocurre en las diferentes secuencias de tratamiento.
La discontinuación de denosumab tiene consecuencias claramente negativas para el hueso, y solo los bisfosfonatos, por tener un efecto antirresortivo residual, podrían discontinuarse durante un tiempo limitado (vacaciones terapéuticas).
El cambio de un antirresortivo por otro antirresortivo con diferente mecanismo de acción es una opción que puede ser favorable en el manejo de algunos pacientes con osteoporosis. Cambiar un antirresortivo por un osteoformador puede asociarse a una pérdida inicial de densidad mineral ósea que no parece tener consecuencias negativas en la eficacia antifractura. Empezar con un tratamiento osteoformador (teriparatida o romosozumab) y cambiar posteriormente a un antirresortivo constituye la mejor secuencia de tratamiento, por lo que podría ser la opción preferente en pacientes con muy alto riesgo de fractura.
Joël Coste, Terkia Medkour, Jean-Yves Maigne
et al.
Background: Patients with fibromyalgia (FM) frequently resort to osteopathic or chiropractic treatment, despite very weak supporting evidence. We aimed to assess the efficacy of osteopathic manipulation in FM in a properly controlled and powered randomized clinical trial. Methods: Patients were randomized to osteopathic or sham treatment. Treatment was administered by experienced physical medicine physicians, and consisted of six sessions per patient, over 6 weeks. Treatment credibility and expectancy were repeatedly evaluated. Patients completed standardized questionnaires at baseline, during treatment, and at 6, 12, 24, and 52 weeks after randomization. The primary outcome was pain intensity (100-mm visual analog scale) during the treatment period. Secondary outcomes included fatigue, functioning, and health-related quality of life. We performed primarily intention-to-treat analyses adjusted for credibility, using multiple imputation for missing data. Results: In total, 101 patients (94% women) were included. Osteopathic treatment did not significantly decrease pain relative to sham treatment (mean difference during treatment: −2.2 mm; 95% confidence interval, −9.1 to 4.6 mm). No significant differences were observed for secondary outcomes. No serious adverse events were observed, despite a likely rebound in pain and altered functioning at week 12 in patients treated by osteopathy. Patient expectancy was predictive of pain during treatment, with a decrease of 12.9 mm (4.4–21.5 mm) per 10 points on the 0–30 scale. Treatment credibility and expectancy were also predictive of several secondary outcomes. Conclusion: Osteopathy conferred no benefit over sham treatment for pain, fatigue, functioning, and quality of life in patients with FM. These findings do not support the use of osteopathy to treat these patients. More attention should be paid to the expectancy of patients in FM management.
Marinella Coco, Andrea Buscemi, Paolo Cavallari
et al.
The present study was carried out among 20 healthy young male athletes to determine whether aerobic exercise performed at two different intensities is able to affect executive functions. For this purpose, we used the Stroop Color Word Test (SCWT) to evaluate the ability to inhibit cognitive interference and the Trail Making Test (TMT) to assess organized visual search, set shifting, and cognitive flexibility. Simple Reaction Time (RT), as a measure of perception and response execution, was also evaluated. The experimental protocol included the measure of blood lactate levels with the aim of assessing possible relations between lactate blood values and selected executive functions after a 30-min steady-state test performed at 60% and at 80% of VO2max. The results showed that a 30-min aerobic exercise is not associated with a worsening of executive functions as long as the blood lactate levels stay within the 4 mmol/l threshold.
Objetivo: Las propiedades de los materiales que constituyen el tejido óseo son determinantes en su resistencia mecánica pero los factores que influyen sobre ella son parcialmente desconocidos en la actualidad.
Material y métodos: En esta investigación medimos la dureza ósea mediante ensayos de ultra-microindentación con punta tipo Berkovich y una carga de 150 mN en fémures de ratas Sprague-Dawley sometidas a una fractura transversal o a una osteotomía de sustracción, y comparamos los resultados en diferentes localizaciones óseas y grupos experimentales. El estudio comprende los siguientes cuatro grupos experimentales, cada uno de ellos constituido por cuatro ratas: a) fractura diafisiana estándar; b) fractura más osteotomía de 2 mm; c) osteotomía tratada con hormona paratiroidea humana, PTH (1-84); d) osteotomía tratada con ranelato de estroncio.
Resultados: Encontramos que la dureza del material era consistentemente mayor en el hueso cortical que en el hueso trabecular. También fue consistentemente más alto en las epífisis femorales superiores que en las epífisis inferiores (diferencia de 1,2 desviaciones estándar). La cirugía redujo la dureza en el fémur operado (diferencia de 0,3 desviaciones estándar, p=5,5 x10-2). El tratamiento con PTH indujo un aumento leve pero consistente de la dureza en todos los sitios (p=1,8×10-5) mientras que el efecto del ranelato de estroncio fue inconsistente.
Conclusiones: Estos datos muestran que la microdureza tisular está influida por una variedad de factores, incluyendo la anatomía, el tipo de tejido óseo, la lesión esquelética y la terapia farmacológica. Por lo tanto, los estudios futuros sobre la calidad del tejido deberían diseñarse cuidadosamente teniendo en cuenta estos factores.
Objetivo: El diagnóstico de osteoporosis se ha fundamentado en la medición de la densidad mineral ósea, si bien esta variable tiene una capacidad limitada en la discriminación de pacientes con o sin fracturas. La aplicación del análisis de elementos finitos (FE) sobre imágenes volumétricas de tomografía computarizada ha mejorado la clasificación de sujetos hasta 90%, aunque la dosis de radiación, complejidad y coste no aconsejan su práctica regular. Nuestro objetivo es aplicar el análisis FE a modelos tridimensionales con absorciometría radiológica dual (3D-DXA), para clasificar pacientes con fractura osteoporótica de fémur proximal y sin fractura.
Material y métodos: Se seleccionó una cohorte de 111 pacientes con osteoporosis densitométrica: 62 con fractura y 49 sin ella. Se utilizaron modelos FE sujeto-específicos para el impacto, como la simulación estática de la caída lateral. Las simulaciones de impacto permiten identificar la región crítica en el 95% de los casos, y la respuesta mecánica a una fuerza lateral máxima. Se realizó un análisis mediante un clasificador discriminativo (Support Vector Machine) por tipo de fractura, tejido y género, utilizando las mediciones DXA y parámetros biomecánicos.
Resultados: Los resultados mostraron una sensibilidad de clasificación del 100%, y una tasa de falsos negativos de 0% para los casos de fractura de cuello para el hueso trabecular en las mujeres. Se identifica la variable tensión principal mayor (MPS) como el mejor parámetro para la clasificación.
Conclusión: Los resultados sugieren que el uso de modelos 3D-DXA podría ayudar a discriminar mejor a los pacientes con elevado riesgo de fracturarse.
Abstract Background Limited information is available regarding the profile and clinical practice characteristics of the osteopathy workforce in Australia. This paper reports such information by analysing data from a nationally-representative sample of Australian osteopaths. Methods Data was obtained from a workforce survey of Australian osteopathy, investigating the characteristics of the practitioner, their practice, clinical management features and perceptions regarding research. The survey questionnaire was distributed to all registered osteopaths across Australia in 2016 as part of the Osteopathy Research and Innovation Network (ORION) project. Results A total of 992 Australian osteopaths participated in this study representing a response rate of 49.1%. The average age of the participants was 38.0 years with 58.1% being female and the majority holding a Bachelor or higher degree qualification related to the osteopathy professional. Approximately 80.0% of the osteopaths were practicing in an urban area, with most osteopaths working in multi-practitioner locations, having referral relationships with a range of health care practitioners, managing patients a number of musculoskeletal disorders, and providing multi-model treatment options. Conclusions A total of 3.9 million patients were estimated to consult with osteopaths every year and an average of approximate 3.0 million hours were spent delivering osteopathy services per year. Further research is required to provide rich, in-depth examination regarding a range of osteopathy workforce issues which will help ensure safe, effective patient care to all receiving and providing treatments as part of the broader Australian health system.
Abstract Background Communicating to patients the risks of manual treatment to the spine is an important, but challenging element of informed consent. This scoping review aimed to characterise and summarise the available literature on risks and to describe implications for clinical practice and research. Method A methodological framework for scoping reviews was followed. Systematic searches were conducted during June 2017. The quantity, nature and sources of literature were described. Findings of included studies were narratively summarised, highlighting key clinical points. Results Two hundred and fifty articles were included. Cases of serious adverse events were reported. Observational studies, randomised studies and systematic reviews were also identified, reporting both benign and serious adverse events. Benign adverse events were reported to occur commonly in adults and children. Predictive factors for risk are unclear, but for neck pain patients might include higher levels of neck disability or cervical manipulation. In neck pain patients benign adverse events may result in poorer short term, but not long term outcomes. Serious adverse event incidence estimates ranged from 1 per 2 million manipulations to 13 per 10,000 patients. Cases are reported in adults and children, including spinal or neurological problems as well as cervical arterial strokes. Case-control studies indicate some association, in the under 45 years age group, between manual interventions and cervical arterial stroke, however it is unclear whether this is causal. Elderly patients have no greater risk of traumatic injury compared with visiting a medical practitioner for neuro-musculoskeletal problems, however some underlying conditions may increase risk. Conclusion Existing literature indicates that benign adverse events following manual treatments to the spine are common, while serious adverse events are rare. The incidence and causal relationships with serious adverse events are challenging to establish, with gaps in the literature and inherent methodological limitations of studies. Clinicians should ensure that patients are informed of risks during the consent process. Since serious adverse events could result from pre-existing pathologies, assessment for signs or symptoms of these is important. Clinicians may also contribute to furthering understanding by utilising patient safety incident reporting and learning systems where adverse events have occurred.
Chiropractic, Diseases of the musculoskeletal system
Aim: to assess tolerability and efficacy of cardiovascular comorbidities pharmacotherapy in osteoporotic postmenopausal women.
Methods: cross-sectional study included 112 osteoporotic postmenopausal women aged from 49 to 85.
Results: 95 persons (84.8%) had indications for angiotensine-convertising enzyme inhibitors (ACEI) prescription. Cough was associated with significantly higher odds of coronary heart disease, congestive heart failure and a trend to multiple bone fractures. Valsartan was initiated in 32 coughing patients. Target blood pressure level was reached in 15 women. In 15 cases blood pressure levels decreased by 30% of baseline level.
Conclusion: efficacy of cardiovascular diseases in osteoporotic postmenopausal women treatment needs to be assessed in specially designed clinical trials.
Нарушения в субхондральной кости при асептическом некрозе мыщелков бедренной и большеберцовой костей усиливают дегенерацию гиалинового хряща. Назначение остеотропной терапии может быть целесообразным для восстановления костной ткани мыщелков и снижения риска прогрессирования артроза, в том числе после артроскопической менискэктомии. Цель. Обосновать применение остеотропной терапии при лечении асептического некроза мыщелков бедренной и большеберцовой костей у пациентов с повреждением менисков. Материал и методы. У 23 пациентов (средний возраст 44 года, от 26 до 64 лет) с диагнозом: Повреждение внутреннего или наружного мениска коленного сустава. В предоперационном периоде выполнялось МРТ исследование. В случае выявления сопутствующего асептического некроза мыщелков бедренной или большеберцовой кости, исследовались маркеры костной резорбции (Дезоксипиридинолин утренней мочи, b-cross laps крови) и в случае их повышения в послеоперационном периоде назначалась остеотропная терапия на 1 год: активные метаболиты витамина Д (альфакальцидол в дозе 0.75-1.0 мкг/сут), остеогенон 2 таб 2 раза в день, антирезорбтивный препарат (Ибандроновая кислота 3 мг внутривенно 1 раз в 3 мес, от 1 до 4х инъекций в течение года). Результаты. Асептический некроз мыщелков бедренной или большеберцовой кости имел места у 43% обследованных пациентов. У 57% из них отмечалось повышение маркеров костной резорбции, что свидетельствовало об активности процесса и именно этим лицам была назначена антирезорбтивная терапия. Заключение. Повреждение или дегенеративное изменение мениска нередко сопровождается развитием асептического некроза мыщелков бедренной или большеберцовой кости, что ускоряет прогрессирование дегенеративных изменений и снижает эффективность проведенной менискэктомии. Учитывая высокую активность ремоделирования у части пациентов необходимо назначение антирезорбтивной остеотропной терапии.
A Yu SPIVAKOVSKAYa, Yu V ChERNENKOV, Yu M SPIVAKOVSKIY
Ювенильный идиопатический артрит (ЮИА) - гетерогенная группа хронических воспалительных заболеваний суставов, сопровождающаяся значительным нарушением их функции и высоким риском последующей инвалидизации. Важным патогенетическим звеном течения ЮИА следует считать изменения в костной ткани, проявляющиеся остео-пеническим синдромом, который может формироваться, как в дебюте артрита, так и в ходе его течения. Цель исследования: создание комплексного алгоритма оценки изменений минеральной плотности костной ткани (МПКТ) на доклиническом этапе на примере группы детей с ЮИА, находящихся на терапии генно-инженерным биологическим препаратом (ГИБП) - растворимым рецептором фактора некроза опухоли - a (ФНО-a ). Материал и методы. В группе наблюдения было 20 детей (16 девочек, 4 мальчиков), у которых была установлена суставная форма ЮИА. Средний возраст детей в исследуемой группы составил - 10,8±4,3 года, дебют заболевания был отмечен в возрасте - 4,5±2,9 лет, к моменту проведения исследования длительность терапии ГИБП составляла не менее 1 года. До назначения ГИБП у всех детей исследуемой группы была отмечена высокая степень активности заболевания, СОЭ в среднем составляла 29±10 мм/ч, уровень СРБ - 18,5±5,8 мг/дл (при норме до 5,0 мг/дл). На фоне лечения ГИБП была достигнута минимальная степень активности заболевания по уровню СОЭ и СРБ уже к 2-3 месяцу терапии. Первичным скрининговым методом для оценки метаболизма костной ткана была выбрана ультразвуковая денситометрия. Всем детям исследуемой группы была проведена оценка МПКТ большеберцовой кости с использованием ультразвуковой денситометрии (УЗД) на аппарате Sunhigh Omnisens 7000. Показатели костной резорбции оценивались по концентрации в сыворотке крови продукта деградации коллагена I типа (С-концевые телопептиды) методом ELISA c использованием коммерческой тест-системы CrossLapsTM. В сыворотке крови детей исследуемой группы определяли уровни цитокинов, чьи биологические эффекты связаны с процессами костного метаболизма- про-воспалительных - ИЛ1Р, ИЛ6, противовоспалительных - ИЛ4, ИФН-у методом твердофазного иммунофермент-ного анализа (ИФА) с использованием тест-систем марки «Вектор-Бест» (Новосибирск, РФ) на иммуноферментном анализаторе Stat-Fax-2100., Результаты. По результатам ультразвуковой денситометрии МПКТ у детей в исследуемой группе характеризовалась признаками умеренной остеопении (-2,4+1,44). Показатель С-концевых телопептидов, был, соответственно, на уровне или незначительно превышал верхнюю границу референсного интервала (0,101-1,734 нг/мл). Цитокиновый профиль характеризовался разноплановыми изменениями. Так уровень провоспалительного цитокина ИЛ1β и противовоспалительного ИЛ4 не выходили за пределы референсных значений, в то время как сывороточная концентрация ИЛ6 более чем в 2,5 раза превышала нормальные значения (4,4+0,64пг/мл), уровень ИФНу у всех пациентов (30,2+12,72 пг/мл (64,7-14,5) превышал нормальные значения (21,8 пг/мл (26,5-12,2). Выводы: больным с ЮИА уже на ранних этапах болезни необходимо проводить комплексное обследование для выявления остеопенического синдрома, предложенный комплексный алгоритм к оценке функционального состояния костной ткани и гуморальных факторов активности патологического процесса для детей с ЮИА может быть использован для характеристики доклинических изменений метаболизма в костной ткани. Динамическое наблюдение за изменениями показателей метаболизма костной ткани позволит проводить раннюю профилактику тяжелых осложнений.
V A Vyatkin, M V Sobennikova, O M Kanunnikova
et al.
Introduction: Most of the socio-economic importance of diabetes is an early disability of patients suffering from it. Among the chronic complications of diabetes, there are also abnormal changes in bone tissue. Aim: The aim of our work was to study the changes in the amount of calcium and phosphorus (the main inorganic constituents of bone) in a compact bone tissue in alloxan-induced diabetes in rats at different stages of the disease. Materials and Methods: The experiment was conducted on 70 white mongrel male rats weighing 180 to 220 g. Using the method of atomic emission spectroscopy with inductively coupled plasma we determined the content of calcium and phosphorus in the samples - femoral shafts weighting 5 mg. In homogenates of samples, we determined the activity of alkaline phosphatase. The entire list of measurements was repeated at 7, 14, 21 and 28 days of experiment. Results: The work revealed the decreases in the content of calcium at 7, 14 and 28 days of observation and phosphorus throughout the experiment with maximum changes on the 7th day of the experiment: 25% (p = 0.00002) and 15% (p = 0.002), respectively, compared with control values (median: 1.9 mg -calcium, 0.73 mg - phosphorus). There was a strong direct correlation between calcium and phosphorus (r = 0.086; p <0.01) and an inhibition of activity of alkaline phosphatase on day 28 of the experiment. Conclusions: For the first time, we show that alloxan diabetes in rats is accompanied by a decrease in phosphorus and calcium content of the compact bone with a maximum change at day 7 of the experiment. There are phase changes in the activity of alkaline phosphatase characterized by an increase at day 7 and inhibition by day 28 of the experiment.