Coherent with previously published works, we confirm the Endo-Model prosthesis to provide excellent pain relief, restoration of walking capacity and intrinsic knee stability both in complex primary and in revision knee arthroplasty, with good or excellent results in the majority of patients and acceptable complication rate.

BackgroundSurgical site infections are important complications in orthopedic surgery. A mobile laminar air flow (LAF) screen could represent a useful addition to an operating room (OR) with conventional turbulent air ventilation (12.5 air changes/h), as it could decrease the bacterial count near the operating field. The purpose of this study was to evaluate LAF efficacy at reducing bacterial contamination in the surgical area during 34 total knee arthroplasties (TKAs).Materials and methodsThe additional unit was used in 17 operations; the LAF was positioned beside the operating table between two of the surgeons, with the air flow directed towards the surgical area (wound). The whole team wore conventional OR clothing and the correct hygiene procedures and rituals were used. Bacterial air contamination (CFU/m3) was evaluated in the wound area in 17 operations with the LAF unit and 17 without the LAF unit.ResultsThe LAF unit reduced the mean bacterial count in the wound area from 23.5 CFU/m3 without the LAF to 3.5 CFU/m3 with the LAF (P < 0.0001), which is below the suggested limit for an OR with ultraclean laminar ventilation. There were no significant differences in the mean bacterial count in the instrument table area: 28.6 CFU/m3 were recorded with the LAF (N = 6) unit and 30.8 CFU/m3 (N = 6) without the LAF unit (P = 0.631). During six operations with LAF and six without LAF, particle counts were performed and the number of 0.5 μm particles was analyzed. The particle counts decreased significantly when the LAF unit was used (P = 0.003).ConclusionWhen a mobile LAF unit was added to the standard OR ventilation, bacterial contamination of the wound area significantly decreased to below the accepted level for an ultraclean OR, preventing SSI infections.

Focal ESWT represents a valuable and safe solution in case of elbow lateral epicondylitis, both in newly diagnosed and previously treated cases, representing a definitive treatment in the majority of patients. Patients refractory to a 3- to 4-session ESWT cycle have lower chances of positive response after further ESWT cycles.

Shoulder hemiarthroplasty is a useful and effective solution for complex humeral fractures, with good results in the majority of patients. However, outcomes display a great variability in relation to X-ray alterations and age at surgery. A careful attention in patient selection is needed in order to standardize the clinical results associated with this kind of prosthetic implant.

IntroductionLong-term survivorship of total hip arthroplasty is strictly related to the bone-host interaction, where bone remodeling is the main factor [1]. The evaluation of bone mass surrounding the implant is the most reliable method, starting from the common observation that bone reacts to stable and well functioning implants with bone apposition according to Wolff's law, while bone resorption is the typical response to an unstable and mal-loading implant [2][3][4].In the last ten years, dual energy X-ray absorptiometry (DEXA) has become more popular among investigators of bone mineral density (BMD) around femoral stems, making it possible to quantify the bone filling, the space between bone and stem (interface bone growth), and the dynamic process of reabsorption, apposition and transformation which involves the whole bone segment containing the implant (bone remodeling) [5][6][7].The first experience with DEXA started in the early 1990s, with observations regarding application and limits and then moving to clinical trials [8,9]. The new concept of minimally invasive surgery in the field of total hip arthroplasty means, in our opinion, not only a small incision, but also a physiological load transfer from the stem to the bone with a conservative stem design, like CFP prosthetic stem (Waldemar Link, Hamburg, Germany).Abstract Periprosthetic bone remodeling, and its evaluation, are the keys of long-term survival of cementless total hip arthroplasty. Dual energy X-ray absorptiometry (DEXA) is the most accurate method to measure bone mineral density, evaluating the effects of bone-prosthesis interactions. We studied, 4 years after implantation, 10 patients who underwent total hip arthroplasty with the CFP prosthetic stem and TOP acetabular cup (Waldemar Link, Hamburg, Germany). Our results demonstrate minimal periprosthetic bone loss compared to that normally observed with conventional stems. A few cases exhibited an increase in BMD. We believe that primary stability, prosthetic design, preservation of natural neck anteversion and off-set, better function related to muscle lever arm, and physiological bone loading with natural stress distribution are the keys of this succesful mini-invasive total hip replacement system.