Total Hip Arthroplasty (THA) is a common surgical procedure used to treat hip osteoar-thritis and other joint conditions that cause pain and functional limitation. Traditionally, THA has been most performed in elderly patients, but in recent years there has been an in-crease in hip arthroplasties in young patients. Femoral prosthesis rupture is a rare but sig-nificant complication that can also occur in young patients undergoing total hip arthro-plasty (THA). Some of the factors that can contribute to femoral prosthesis ruptures include abnormal overload, defects in the design lack of geometric fit, type of materials used in the stem and femoral head connection. The aim of this study is to analyze the criticalities in the contact between the femoral head and the stem neck. In particular, the two types of con-tacts will be taken into consideration: proximal and distal and through the finite element method (FEA) the criticalities will be defined. The results show that in the proximal contact the voltages are higher than 500 Mpa. This is due to the fact that there are higher circum-ferential voltages. In addition, to prevent bacterial infiltration or debris from the outside, the distal connection is the recommended one.

Arthroplasty is commonly performed to treat advanced osteoarthritis or other degenerative joint conditions, but it can also be considered for young patients with severe joint damage that significantly limits their functionality and quality of life. Young patients are still at risk of aseptic mobilization and bone resorption due to the phenomenon of stress-shielding that causes an uneven distribution of tensions along the femoral contact surface prosthesis. This phenomenon can be limited by appropriately choosing the material of the prosthesis or by varying its stiffness, making sure that its mechanical behavior simulates that of the femur as much as possible. The aim of this study is to evaluate the mechanical behavior of a prosthesis optimized both in shape and material and in comparing the results with a standard titanium prosthesis. Methods: Through three-dimensional modeling and the use of software finite element method (FEM) such as ANSYS we simulate the mechanical behavior of traditional prosthesis and prosthesis optimized topologically respecting the ASTM F2996-13 standard Results: With topological optimization there is a stress reduction from 987 Mpa to 810 Mpa with a mass reduction of 30%. With the use of carbon fiber, it is possible to further reduce stress to 509 Mpa. Conclusions: The reduction of stress on the femoral stem allows an optimal distribution of the load on the cortical bone thus decreasing the problem of stress-shielding.

Hip replacement has significantly improved the quality of life of patients with symptomatic hip osteoarthritis. Metal-on-metal (MoM) bearings have been used with conventional total hip re-placement (THR) for several decades with promising results from early applications. Wear and corrosion of these implants may lead to a release of metal products into surrounding tissue and body fluids. From the 1980s onwards, the search for increasingly better coupling materials with low levels of wear led to the rise of hard-on-hard couplings such as ceramic-on-ceramic (CoC). The latter is currently the coupling with the longest known duration and with a wear rate close to zero. MoM coupling has been for a long time the most significative alternative, but systemic and local complications linked to the release of chromium and cobalt ions, determine the withdrawn from the market. One other alternative proposed over the time has been Ceramic-on-Metal (CoM) bearing. Preliminary results have been described as favourable, but due to the failures of metal on metal it has been withdrawn from the market, without causing significant clinical complications. In this narrative review, we analysed risks and benefits associated with the implantation of hybrid hard-on-hard bearings, such as CoM.

This observational study aims to depict the impact of gender and socio-economic issues on the health status of Italian Orthopaedic patients during the COVID-19 lockdown. An Ad Hoc ques-tionnaire was developed and online administered. The following data were extracted from the questionnaire: age, body mass index (BMI), education level, distance from hospital, orthopaedic disease, concomitant medical comorbidities, living status (with/without cohabitants) and physical activity level (according to Tegner Activity Scale). The impact of the COVID-19 lockdown was studied analyzing differences related to the above-mentioned parameters. A significant increase of the call number to general practitioner and to the orthopaedic surgeon was observed during the COVID-lockdown, especially in patients with higher education level. Nonetheless, a reduced compliance in drugs assumption was observed in patients with higher education level during lockdown (p=0.007). Almost all the analyzed items were significantly in-fluenced by the distance between patient’s domicile and the nearest hospital. However, no sig-nificant differences were observed comparing pre-COVID to COVID lockdown. In the present study patients’ gender and education level revealed a significant impact on the social behavior during the COVID lockdown, compared with the pre-COVID period.

Low back pain (LBP) is a leading cause of disability. It significantly impacts the patient’s quality of life, limits their daily living activities, and reduces work productivity. To reduce the burden of LBP, several pharmacological and non-pharmacological treatment options are available. This review summarizes the role of heat therapy in the management of LBP. First, we outline the common causes of LBP, then discuss the general mechanisms of heat therapy on (LB)P, and finally review the published evidence regarding the impact of heat therapy in patients with acute or chronic non-specific LBP. This review demonstrates that continuous, low-level heat therapy provides pain relief, improves muscular strength, and increases flexibility. Therefore, this effective, safe, easy-to-use, and cost-effective non-pharmacological pain relief option is still relevant in modern clinical practice.