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Abstracts of the Panhellenic Conference of the Hellenic Journal of Research and Practice on the Musculoskeletal System JOURNAL OF RESEARCH AND PRACTICE ON THE MUSCULOSKELETAL SYSTEM Proceedings Abstracts of the Panhellenic Conference of the Hellenic Osteoporosis Foundation 13th-15th September 2019, Volos, Greece Organizer: George Kapetanos Emeritus Professor of Orthopaedics, Faculty of Medicine, Aristotle University of Thessaloniki, Greece President of Hellenic Osteoporosis Foundation SARCOPENIA-FALLS AND HIP FRACTURES issue. Reduction in physical function can lead to loss of Styliani Papakosta independence, need for hospital and long-term nursing “ΕΥ PRATTEIN- KENTAVROS” & ΕΛ.Ε.Π.Α.Π. Volou Rehabilitation home care and premature death. Prevention of sarcopenia Center, Greece and falls includes exercises, cognitive and physical training, dietary and psychological support. Additional Sarcopenia is the degenerative loss of skeletal muscle research, preferably by means of controlled randomized mass, quality, strength and functionality associated with trials, is needed to confirm these findings. aging. It is a component of the frailty syndrome. Severity of sarcopenia is associated with postural balance and falls especially among community older people. Falls of A COMPREHENSIVE MANAGEMENT OF SARCOPENIA elderly people cause severe injuries such as femoral neck AND BONE LOSS - OSTEOSARCOPENIA SCHOOL fracture and can lead the patient to become bed-ridden. Frailty, sarcopenia and falls are strongly correlated and Yannis Dionyssiotis st both are predictors of negative health outcomes such 1 Physical Medicine & Rehabilitation Department, National as falls, disability, hospitalization and death. Multiple Rehabilitation Center EKA-KAT, Athens, Greece factors contribute collectively to frailty, sarcopenia and In older persons, the combination of osteopenia/ falls, which include cellular and tissue changes, as well osteoporosis and sarcopenia - known as osteosarcopenia as environmental and behavioral factors. Potentially - has been proposed as a subset of frailer individuals at treatable social factors are alcoholism, inability to shop, higher risk of institutionalization, falls, and fractures. prepare and cook meals or to feed self, poverty, social Osteosarcopenic patients have very particular clinical, isolation etc. Common medical factors are sensory biochemical, diagnostic, and functional characteristics impairment - vision/hearing, poorly managed pain, that could be identified in clinical practice. In addition, especially lower limb pain, thyroid disease, cardiac failure, new therapies targeting both muscle and bone are gastrointestinal disease affecting absorption, poorer BMD being developed. In this session, a clinical definition and bone architecture, lack of vitamin D. More difficult of osteosarcopenia aiming to describe the clinical, to treat are cognition - dementia, catabolism, gastritis, functional, and biochemical features that are unique cancer, mood- depression, paranoia, medications/ to these patients will be presented. The use of imaging polypharmacy. Measures of muscle strength and physical combined with functional assessments for the diagnosis function may help discriminate the risk of falls-related of osteosarcopenia will be discussed. In addition, we hospitalization. For patient assessment muscle mass will analyze preventive measures and therapeutic (BIA, DXA, anthropometry), muscle strength (handgrip interventions that can benefit both muscle and bone strength, knee flexion/ extension, peak expiratory flow) simultaneously. We intend to go over the translational and physical performance (Short Physical Performance aspects of sarcopenia and osteoporosis research and Battery, usual gait speed, timed get up and go test) can highlight expected outcomes from different interventions be used. As the number of older people increases, their for both conditions. Finally, the new holistic concept called needs will become an increasingly important health Osteosarcopenia school will be presented. Published under Creative Common License CC BY-NC-SA 4.0 (Attribution-Non Commercial-ShareAlike) Common License CC BY-NC-SA 4.0 (Attribution-Non Creative Published under www.jrpms.eu 10.22540/JRPMS-03-143 JRPMS | December 2019 | Vol. 3, No. 4 | 143-159 143 Abstracts of the Panhellenic Conference of the HELIOST, 13-15/9/2019, Volos, Greece ETIOPATHOGENESIS OF OSTEOARTHRITIS d. The injury begins a cascade of events leading to Nikolaos Galanopoulos degenerative joint disease. Outpatient Department University General Hospital of e. Accelerated in the end stage arthritis Alexandroupolis, Thrace, Greece Surgical intervention In the etiopathogenesis of osteoarthritis (OA) participate It was launched with the application of arthroscopic factors genetics, demographics (the increase of age, the techniques. female sex), the heavy professional or athletic activities The invasive treatment include: and the trauma of musculoskeletal system, the smoking, a. Debridement the diet (the Mediterranean diet is related with the low risk b. Microfractures as well as the better outcome of the disease) and the low c. Subchondral drilling levels of vitamin D of the serum (with higher risk and the d. Osteochondral autografts worse progress of the disease). Important is the role of e. Osteochondral allografts the increase secretion of the proinflammatory cytokines f. ACI (as IL-1β, IL-6, IL-15, IL-17, IL-18, TNFα, etc.) and the g. Mosaicplasty oxidative stress. The disturbance of the diversity of the enteric microbiota (dysbiosis) is also related with the h. Bio-Materials high risk and the worse outcome of the OA. Also the use Surgical interventions in the early stages have some position of probiotics and prebiotics can lead to decrease of the most involve removal of mechanical symptoms. All this inflammation and the symptoms with amelioration of the performs a repair on the fibrous cartilage and may affect the functional ability of the patients. integrity of the subchondral plate. Cartilage Damage Treatment algorithm a. Grade I: Conservative treatment SURGICAL ALGORITHM FOR THE TREATMENT OF b. Grade II: ARTHRITIS KNEE IN YOUNG ADULTS 1. Debridement George Ath. Colonel Gkouvas 2. Extensive rehabilitation program Orthopaedic Department, 424 General Military Training Hospital, c. Grade III & Grade IV: Thessaloniki - Greece 1. Lesion < 1 cm: Monitoring or Microfractures Knee Osteoarthritis is a very common condition that occurs 2. Lesion 1-2 cm: Microfractures in the middle age mainly in women. When the condition 3. Lesion 1.5-4 cm: Mosaicplasty progresses towards then the only therapeutic approach is 4. Lesion 3-10 cm: Autologous bone marrow the total knee replacement. transplantation (ACI, MACI), Osteochondral allografts. But when the condition occurs in young adults after an injury or pathological condition, the data changes and the Analysis of arthroscopic techniques therapeutic strategies include a multitude of interventions to 1. Arthroscopic Cleansing which we will refer to this article. Arthroscopic cleansing of the includes: Causes of cartilage injury are a. Rinsing a. High-speed sports b. Partial meniscectomy b. RTA c. Synovectomy c. Osteochondritis dissecans d. Removal of the osteophytes or free loose bodies d. Other conditions e. Shaving Arthroscopic classification by ICRS f. Chondroplasty a. Grade 0: normal cartilage The objectives of arthroscopy are: b. Grade I: Surface lesions a. The reduction of pain and symptoms c. Grade II: The depth of lesions reaches half of the thickness b. The delay of partial or total arthroplasty of the cartilage d. Grade III: The depth of lesions is more than half the 2. Advanced Techniques thickness of the cartilage but does not reach the a. Marrow Stimulation Techniques (MST) subchondral bone b. Autologous Chondrocyte Implantation (ACI) e. Grade IV: Lesions reach a subchondral plaque c. Matrix induced Autologous Chondrocyte Implantation Pathology (MACI) a. The lesion of the articular cartilage is a permanent lesion d. Osteochondral Autografts Transplantation (OATS) - b. The cartilage has no vascularity and no prospect of healing. (Mosaicplast) c. Adult chondrocytes cells do not reproduce and migrate. e. Osteochondral Allograft Transplantation (cadaveric) 144 JRPMS Abstracts of the Panhellenic Conference of the HELIOST, 13-15/9/2019, Volos, Greece Figure. Cartilage lesions treatment algorithm in young adults. Osteotomies f. Vascular lesions - anterior tibial artery, perineal artery The treatment of choice of OA lesions of the knee with shaft g. Peroneal nerve palsy deformities in young adults is the HTO. Coventry and Insall, h. Delayed or non-union refined and popularized the lateral closed wedge (HTO) in the i. Compartment syndrome high osteotomy of the tibia. j. TKR more difficult Indications k. Varus laxity (loose LCL) a. Patients With Varus Limb Alignment Epilogue b. Patients With Valgus Limb Alignment “From the time of Hippocrates to the present, it is universally c. Osteochondritis Dissecans permissible that cartilage ulcers are a problem and that d. Medial compartment overload following meniscectomy something that was once destroyed, not repaired” HUNTER e. Osteonecrosis 1743. f. Posterolateral Instability g. Osteochondral defects Osteotomy Techniques are: THE ROLE AND RESPONSIBILITY OF ORTHOPAEDIC a. Lateral closing wedge osteotomy SURGEONS IN MANAGING OSTEOPOROSIS b. Medial opening wedge osteotomy Athanasios Karponis c. Dome osteotomy Orthopaedic surgeon, Thessaloniki, Greece Coventry report Outcome Osteoporosis has been recognized as a serious public a. 5-year survival
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