Osteonecrosis is a terrible condition that can cause advanced arthritis in a number of joints, including the knee. The three types of osteonecrosis that can affect the knee are secondary, post-arthroscopic, and spontaneous osteonecrosis of the knee (SPONK). Regardless of osteonecrosis classification, treatment for this condition seeks to prevent further development or postpone the onset of knee end-stage arthritis. Joint arthroplasty is the best course of action whenever there is significant joint surface collapse or there are signs of degenerative arthritis. The non-operative options for treatment at the moment include observation, nonsteroidal anti-inflammatory medications (NSAIDs), protective weight bearing, and analgesia if needed. Depending on the severity and type of the condition, operational procedures may include unilateral knee arthroplasty (UKA), total knee arthroplasty (TKA), or joint preservation surgery. Joint preservation techniques, such as arthroscopy, core decompression, osteochondral autograft, and bone grafting, are frequently used in precollapse and some postcollapse lesions, when the articular cartilage is typically unaffected and only the underlying subchondral bone is affected. In contrast, operations that try to save the joint following significant subchondral collapse are rarely successful and joint replacement is required to ease discomfort. This article’s goal is to summarise the most recent research on evaluations, clinical examinations, imaging and various therapeutic strategies for osteonecrosis of the knee, including lesion surveillance, medicines, joint preservation methods, and total joint arthroplasty.

Aims Our objective is to compare the functional results in patients that underwent surgery for recurrent anterior shoulder instability (RAGHI) during the COVID-19 pandemic with remotely-based rehabilitation, to those who had surgery before the pandemic and had in-person rehabilitation therapy. Methods A retrospective case series of 68 patients were included and divided into two groups: In person-group and Home-based group. Western Ontario Shoulder Instability Index (WOSI) and Subjective Shoulder Value (SSV) scores were used to evaluate objective and subjective clinical parameters. Time and level of return to sports was studied by the Subjective Patient Outcome for Return to Sports (SPORTS) score. Results The mean SSV score was 82% (40–100) on the In-Person group compared with 87% (65–100) for the Home-Based group. Results for WOSI score were similar, with an average of 210.42 (90%) for In-Person and 261.45 (88%) for the Home-Based group ( p 0.12). Return to sports was carried out in an average of 6.6 (4–16) months for In-Person group, compared to 6.5 (5–8) months for Home-Based. Conclusion Follow-up and rehabilitation methods for patients who underwent surgery for RAGHI, during COVID-19 lockdown, were not significantly ( p 0.12) affected on functional and athletic return in comparison to traditional methods according to WOSI scale. Level of evidence IV Retrospective series of cases

Introducción: La analgesia preventiva es aquella que se administra horas o días antes de una artroplastia total de rodilla con el fin de reducir el dolor posoperatorio. El objetivo de este estudio fue comparar y analizar la eficacia clínica de la analgesia preventiva en los pacientes sometidos a un reemplazo total de rodilla. Materiales y Métodos: Sesenta y seis pacientes, divididos en dos grupos de 33 pacientes, fueron evaluados prospectivamente y comparados entre noviembre de 2018 y marzo de 2019. El grupo A recibió analgesia preoperatoria con una combinación de etoricoxib, tramadol y paracetamol, por vía oral, 2 horas antes de lacirugía. El grupo B de control no recibió analgesia. El dolor posoperatorio de los pacientes se evaluó de acuerdo con sus propios registros en una escala analógica visual a las 12, 24, 48, 72 h y una semana después de la cirugía. Resultados: Se observó una diferencia significativa a las 24 h entre ambos grupos, el dolor fue significativamente menor en el grupo A (p = 0,001), a las 48 h la diferencia fue estadísticamente menor que a las 24 h (p = 0,016). También se observó que el grupo de control requirió más cantidad de rescates, aunque la diferencia solo fue significativa a las 24 h (p = 0,047). Conclusión: La combinación de etoricoxib, tramadol y paracetamol representa es eficaz, segura, económica y fácil de administrar, y la tasa de efectos adversos de la analgesia es baja; por lo tanto, representa un esquema adecuado para el manejo de la analgesia preventiva.Nivel de Evidencia: IIb

Background: Nail dynamization is a controversial strategy used to treat delayed union in tibial shaft fractures. Reported union rates of nail dynamization varies within a wide range that goes from 19% to 100%. The purpose of this study was to perform a systematic review and a metaanalysis of the literature to explore post-dynamization union rates in cases of delayed union of tibial fractures following locked intramedullary nailing.Methods and Findings: This systematic review was conducted following the PRISMA (Preferred Reported Items for Systematic Reviews and Meta-Analyses) guidelines. We searched the Cochrane Database, PubMed, and the first 100 references of Google Scholar to June 2020. Inclusion criteria were as follows: English-language original research articles that included patients over 14 years of age with tibial shaft fractures treated with locked intramedullary nailing and posterior dynamization of static screws. Methodology quality was assessed using a modified version of Coleman's score.We identified 14 studies that included 1198 fractures for full analysis. The mean age was 35.8 (range; 14-82 years) and the average follow-up period was 27 months (range; 3-100). Statically locked intramedullary nails were found in 922 (76.9%) fractures. Dynamization was reported