Teriparatide and clodronate combination as a potential treatment for complex regional pain syndrome type I in delayed consolidation after foot surgery: a case report and review of the literature

BACKGROUND

Complex regional pain syndrome type I is a pathological condition characterized by an exaggerated response of tissues to low or moderate pain stimuli. The exact pathogenesis and optimal medical treatment for complex regional pain syndrome type I are still not fully understood, although bisphosphonates have shown positive effects in reducing pain. Foot surgery can be complicated by the development of complex regional pain syndrome type I, leading to functional decline and difficulties in weight-bearing.

CASE PRESENTATION

The authors present a clinical case involving complex regional pain syndrome type I that developed after surgical foot arthrodesis. The patient, a 42-year-old Caucasian male, did not respond to clodronate treatment but experienced successful outcomes upon the addition of teriparatide, which effectively stimulated the healing of arthrodesis.

CONCLUSION

Teriparatide cannot be considered the primary treatment for complex regional pain syndrome due to insufficient solid clinical data. However, when complex regional pain syndrome is associated with or caused by delayed union, teriparatide can be used to address the underlying cause of complex regional pain syndrome.

Clinical and radiographic short mid-term outcomes of primary total stabilizer knee arthroplasty

A successful Total Knee Arthroplasty (TKA) requires stability, but rarely in primary TKA, a prosthesis with more constraint than a posterior-stabilizer (PS) is necessary. In patients with severe varus/valgus deformities with incompetent collateral ligaments or in knees that cannot be adequately balanced after ligaments release, a total-stabilizer (TS) prosthesis may be required. The purpose of our retrospective study is to evaluate clinical and radiographic outcomes at short mid-term follow-up in patients treated with a TS TKA. Between January 2013 and August 2016, 36 patients (38 knees) were treated with Stryker Triathlon TS cemented implants. Clinical and radiographic evaluation were performed preoperatively and postoperatively at 1 month, 3 months, 6 months, 1 year and at 1-year intervals thereafter. At final follow-up, 33 patients (35 knees) remained and were included in this study and followed with a mean follow-up of 26.6 months. Clinical evaluation was performed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC score) and the Knee Society rating system that is subdivided into a knee score (KS) that rates only the knee joint itself and a functional score (FS). Knee Score (KS) and Functional Score (FS) increased significantly from a mean pre-operative value of 48 and 45, respectively, to a post-operative value at last follow-up of 86 and 82, respectively. Also WOMAC score improved significantly: the mean pre-operative WOMAC score was 45, while the mean post-operative WOMAC score, at last follow-up, was 19. The difference between pre- and post- operative results was significant at statistical analysis. In our opinion, when the adequately prosthesis balancing isn’t possible, because of primary or secondary severe varus/valgus deformity or severe soft tissues retraction, an available option is to perform a total knee arthroplasty with a total stabilizer polyethylene insert. TS prosthesis gives more stability during the most of ROM and, in addition, Triathlon system provides surgeons the possibility to choose a more constrained implant, than a standard PS one, during surgical procedure saving the bone stock. Our experience with this kind of prosthesis has provided good clinical and radiographic outcomes at a short mid-term follow-up with a low-rate of complications.