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Schmidutz F, Schreiner AJ, Ahrend MD, Stöckle U, Maier S, Histing T, Hemmann P. Risk of Periprosthetic Joint Infection after Posttraumatic Hip Arthroplasty following Acetabular Fractures. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:671-677. [PMID: 35605966 DOI: 10.1055/a-1810-7379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Raised complication rates have been reported for total hip arthroplasty (THA) in posttraumatic hip joints after acetabular fractures with prior open reduction and internal fixation (ORIF). The present study evaluated (I) postoperative surgical site infection and the risk of early infection following THA in posttraumatic hip joints after acetabular fractures and (II) the discriminatory ability of preoperative C-reactive protein (CRP) blood levels for periprosthetic joint infection (PJI). MATERIALS AND METHODS Patients were included who had undergone THA (2014-2019) after prior ORIF, and nonsurgically treated acetabular fractures. Patients' demographics and the duration between fracture and THA implantation were assessed. Preoperative diagnostic testing (laboratory results, hip aspirations) as well as the results of intraoperative microbiological swabs and sonication were also evaluated. Postoperative complications were recorded. RESULTS Sixty-seven patients (51 men/16 women) were included, with a mean age of 54.7 ± 14.0 years (range: 18.0-82.9). The mean time between acetabular fracture and THA was 13.5 ± 14.9 years (0.2-53.5). Four subgroups were classified: subgroup I (nonsurgical, n = 15), subgroup II (complete removal of osteosynthesis, n = 8), subgroup III (partial removal of osteosynthesis, n = 15), and subgroup IV (remaining osteosynthesis, n = 29). Preoperative CRP blood levels were normal. CRP levels had no discriminatory ability to predict PJI (AUC: 0.43). Positive microbiological swabs were assessed in subgroups III (n = 1) and IV (n = 2). Complications during follow-up occurred in subgroups I (one aseptic loosening [6.7%]), III (one wound revision [6.7%], two low-grade infections [13.3%]), and IV (three low-grade infections [10.3%]). CONCLUSION High infection rates were found in patients with THA after acetabular fracture with remaining implants or partial implant removal. Serum CRP alone seems to be a poor predictor. Therefore, an extensive diagnostic algorithm can help to detect an occult infection, including preoperative hip aspiration (microbiological samples and measurements of synovial CRP, WBC, and alpha-defensin levels). Intraoperative tissue samples and sonication results should be obtained during THA implantation.
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Affiliation(s)
- Florian Schmidutz
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Ludwig-Maximilians-Universität München, München, Germany
| | - Anna Janine Schreiner
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany
| | - Marc-Daniel Ahrend
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany
| | - Ulrich Stöckle
- Center for Musculoskeletal Surgery (CMSC), Charite University Hospital Berlin, Berlin, Germany
| | - Sven Maier
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany
| | - Tina Histing
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany
| | - Philipp Hemmann
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen, Germany
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Salášek M, Pavelka T, Rezek J, Šídlo K, Šimánek M, Whitley A, Džupa V. Mid-term functional and radiological outcomes after total hip replacement performed for complications of acetabular fractures. Injury 2023:110916. [PMID: 37394328 DOI: 10.1016/j.injury.2023.110916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/14/2023] [Accepted: 06/25/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Acetabular fractures can lead to serious complications such as avascular necrosis of the femoral head (AVN), osteoarthritis, non-union. Total hip replacement (THR) is a treatment option for these complications. The purpose of this study was to assess the functional and radiological outcomes of THR at least 5 years after the primary implantation. METHODS This retrospective study analysed clinical data from 77 patients (59 males, 18 females) who were treated from 2001 to 2022. Data was collected on the incidence of AVN of the femoral head, complications, interval from fracture to THR, reimplantation. The modified Harris Hip Score (MHHS) was used to evaluate outcome. RESULTS The mean age at the time of fracture was 48 years. Avascular necrosis developed in 56 patients (73%), with 3 cases of non-union. Osteoarthritis without AVN developed in 20 patients (26%), non-union without AVN in one patient (1%). The mean time from fracture to THR was 24 months for AVN with non-union, 23 months for AVN alone, 22 months for AVN with arthritis, 49 months for hip osteoarthritis without AVN. The time interval was significantly shorter for cases of AVN than for cases of osteoarthritis without AVN (p = 0.0074). Type C1 acetabular fracture was found to be a risk factor for femoral head AVN (p = 0.0053). Common complications of acetabular fractures included post-traumatic sciatic nerve paresis (17%), deep venous thrombosis (4%), infections (4%). Hip dislocation was the most common complication of THR (17%). There were no cases of thrombosis following THR. According to Kaplan-Meier analysis, the proportion of patients without revision surgery within 10-year period was 87.4% (95% CI 86.7-88.1). The results of the MHHS after THR: 59.3% of patients had excellent results, 7.4% good, 9.3% satisfactory results, and 24.0% had poor results. The mean MHHS was 84 points (95% CI 78.5-89.5). Paraarticular ossifications were observed in 69.4% of patients in the radiological evaluation. CONCLUSION Total hip replacement is an effective treatment for serious complications of acetabular fracture treatment. Its results are comparable to THR peformed for other indications, although it is associated with a higher number of paraarticular ossifications. Type C1 acetabular fracture was found to be a significant risk factor for early femoral head AVN.
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Affiliation(s)
- Martin Salášek
- Department of Orthopaedics and Traumatology, Faculty of Medicine of Charles University, and University Hospital, Pilsen, Czech Republic; New Technologies for the Information Society, Facult of Applied Sciences, University of West Bohemia, Pilsen, Czech Republic.
| | - Tomáš Pavelka
- Department of Orthopaedics and Traumatology, Faculty of Medicine of Charles University, and University Hospital, Pilsen, Czech Republic
| | - Jan Rezek
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Kryštof Šídlo
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Miroslav Šimánek
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic; Department of Orthopaedics, Hospital Sokolov, Czech Republic
| | - Adam Whitley
- Department of Surgery, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic; Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Valér Džupa
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic; Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Perez Alamino L, Garabano G, Rodriguez JA, Cullari M, Del Sel H, Pesciallo CA. Effectiveness of two-stage revision with commercial polymethylmethacrylate articulated hip spacer: similar outcomes against monomicrobial and polymicrobial hip periprosthetic joint infections. J Bone Jt Infect 2023. [DOI: 10.5194/jbji-8-51-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract. Background: orthopaedic surgeons still struggle against a devastating complication – periprosthetic joint infection (PJI). A two-stage revision is
considered the gold standard for chronic PJI for several authors, with
success rates over 90 %. This strategy implies the remotion of the
prosthesis and the implantation of an antibiotic-impregnated cement spacer
in the joint. The primary objective of this study was to assess the
effectiveness of a two-stage revision approach using a commercial
prefabricated antibiotic-impregnated cement hip spacer for the treatment of
hip PJI regarding monomicrobial and polymicrobial infections. Secondly, to
assess risk factors for failure of two-stage revision. Material and methods:
we conducted a retrospective study on patients that underwent revision of
total hip arthroplasty (THA) between January 2002 and January 20218. We included adult patients with a diagnosis of chronic hip PJI that underwent two-stage revision using a
prefabricated gentamicin-impregnated cement of polymethylmethacrylate (PMMA)
hip spacer. We assessed whether it was monomicrobial or polymicrobial infections and comorbidities. Treatment success was defined when eradication of the
infection was observed and no further procedures or mortality were
registered after the second stage. Persistence or recurrence of infection
was considered a failure of treatment. Results: the final series consisted
of 84 patients treated with the same hip spacer: 60 (71.4 %) monomicrobial
and 24 (28.6 %) polymicrobial joint infections with an overall follow-up
of 59.0 (36.0–84.0) months. The overall success rate was 90.5 %. Eight
(9.5 %) patients failed. Smoking and BMI greater than 30 m kg−2 were
identified independent risk factors for failure in multivariate analysis.
Conclusion: our study suggests that prefabricated gentamicin-impregnated
PMMA spacer is an effective tool for the treatment of PJI, achieving similar
outcomes whether it is monomicrobial or polymicrobial infections. Randomized prospective studies are needed to obtain more reliable conclusions.
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O’Driscoll CS, Davey MS, Hughes AJ, O’Byrne JM, Leonard M, O’Daly BJ. Total Hip Arthroplasty in the Setting of Post-Traumatic Arthritis Following Acetabular Fracture: A Systematic Review. Arthroplast Today 2023; 19:101078. [PMID: 36691464 PMCID: PMC9860422 DOI: 10.1016/j.artd.2022.101078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 01/17/2023] Open
Abstract
Background Acetabular fractures are frequently associated with post-traumatic arthritis (PTA), for which total hip arthroplasty (THA) has emerged as the established procedure. The purpose of this systematic review is to report the patient outcomes, complications, and implant survival of delayed THA for patients with PTA following acetabular fracture. Methods A systematic review was performed in December 2021 as per Preferred Reporting Items for Systematic Review and Meta-Analysis Guidelines to identify all studies reporting outcomes of delayed THA performed for PTA with a history of acetabular fracture. From an initial screen of 893 studies, 29 studies which met defined inclusion criteria including minimum 12 months of follow-up and minimum 10 THA were included in the final review. Results A total of 1220 THA were reported across 29 studies, with 1174 THA completing a minimum of 1-year follow-up at a mean of 86 months. All 29 studies reported upon complications, with a control included in 6 for comparison. Higher complication rates were observed both in patients who had prior open reduction internal fixation and conservative treatment, most notably infection which was observed following 3.6% THA. The total joint revision rate was 9.7%. An improvement was noted in all 25 studies which recorded patient-reported outcomes, with a mean rise in the Harris hip score from 45 to 86 across 18 studies. Conclusions THA may reduce reported pain levels and improve functional outcomes in selected patients experiencing PTA following acetabular fractures. There is an increased risk of complications, necessitating careful consideration when planning the operation and open discussion with prospective patients and caregivers.
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Affiliation(s)
- Conor S. O’Driscoll
- Irish National Pelvic and Acetabular Centre, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Galway University Hospital, Galway, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,Corresponding author. Royal College of Surgeons of Ireland, 123 St. Stephens Green, Dublin 2, Ireland. Tel.: +353857884714.
| | - Martin S. Davey
- Department of Trauma & Orthopaedics, Galway University Hospital, Galway, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Andrew J. Hughes
- Irish National Pelvic and Acetabular Centre, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,Rothman Orthopedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John M. O’Byrne
- Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,Irish National Orthopaedic Hospital, Cappagh, Dublin, Ireland
| | - Michael Leonard
- Irish National Pelvic and Acetabular Centre, Tallaght University Hospital, Dublin, Ireland
| | - Brendan J. O’Daly
- Irish National Pelvic and Acetabular Centre, Tallaght University Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
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Yuan Q, Wang X, Cai Y, Yang M, Zheng H, Zhao X, Ma H, Xu P. Total hip arthroplasty for posttraumatic osteoarthritis secondary to acetabular fracture: An evidence based on 1,284 patients from 1970 to 2018. Front Surg 2022; 9:953976. [PMID: 36439540 PMCID: PMC9684333 DOI: 10.3389/fsurg.2022.953976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/19/2022] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Posttraumatic osteoarthritis (PTOA) can be a crippling sequela of acetabular fracture (AF), and total hip arthroplasty (THA) is often necessary to alleviate the clinical progression of symptoms. The purpose of this study was to summarize the existing clinical evidence concerning the surgical management of AF with THA through meta-analyses. METHODS Databases were searched for articles published between 1995 and January 2022 that contained the keywords "acetabular," "fracture," "arthroplasty," and "osteoarthritis." Our study was registered in PROSPERO under number CRD42022314997. RESULTS We screened 3,125 studies and included data from 31 studies with 1,284 patients. The median patient age at the time of THA was 52 years and ranged from 19 to 94 years. The pooled overall survival rate was 88% [86%-90%, 95% confidence interval (CI)] and could reach 83% at ≥15-year follow-up. For the Harris Hip Score, we pooled 22 studies with an overall mean difference of 43.25 (40.40-46.10, 95% CI; P < 0.001), indicating a large clinical effect. The pooled complications (incidence rates) across studies were: heterotopic ossification (22.53%), implant dislocation (4.66%), implant infection (3.44%), and iatrogenic nerve injury (1.07%). CONCLUSION THA in patients with PTOA following AF leads to significant improvement in symptoms and function at ≥15-year follow-up. Survival rates of implants free from re-operation or revision after THA decreased with follow-up time and could still reach 83% at ≥15-year follow-up. THA might be an effective therapeutic method for patients with PTOA due to AF.
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Affiliation(s)
- Qiling Yuan
- Department of Joint Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Xinyi Wang
- Department of Rehabilitation, Shaanxi Provincial Rehabilitation Hospital, Xi’an, China
| | - Yongsong Cai
- Department of Joint Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Mingyi Yang
- Department of Joint Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Haishi Zheng
- Department of Joint Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Xiaoming Zhao
- Department of Orthopedics of the First Affiliated Hospital, Medical School, Xi’an Jiaotong University, Xi’an, China
| | - Hongyun Ma
- Department of Orthopedics of the First Affiliated Hospital, Medical School, Xi’an Jiaotong University, Xi’an, China
| | - Peng Xu
- Department of Joint Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
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Duta A, Popa DL, Vintila DD, Buciu G, Dina NA, Ionescu A, Berceanu MC, Calin DC. An Experimental and Virtual Approach to Hip Revision Prostheses. Diagnostics (Basel) 2022; 12:diagnostics12081952. [PMID: 36010302 PMCID: PMC9406961 DOI: 10.3390/diagnostics12081952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Introduction: The changes in the joint morphology inevitably lead to prosthesis, but the hip pathology is complex. The hip arthroplasty is a therapeutic solution and can be caused, most frequently, by primary and secondary coxarthrosis due to or followed by traumatic conditions. The main aim of this study was to find the method of revision hip prosthesis that preserves as much bone material as possible and has sufficiently good mechanical strength. (2) Materials and Methods: In this study, in a first step, the two revision prostheses were performed on bone components taken from an animal (cow), and then, they were tested on a mechanical testing machine until the prostheses physically failed, and the force causing their failure was determined. (3) Results: These prostheses were then modelled in a virtual environment and tested using the finite element method (FEM) in order to determine their behaviour under loading from normal human gait. Displacement, strain, and stress maps were obtained. (4) Discussion: Discussions on hip revision prostheses, method, and theory analysis are presented at the end of the paper. (5) Conclusions: Important conclusions are drawn based on comparative analyses. The main conclusion shows that the both orthopaedic prostheses provide a very good resistance.
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Affiliation(s)
- Alina Duta
- Faculty of Mechanics, University of Craiova, 200512 Craiova, Romania
| | - Dragos-Laurentiu Popa
- Faculty of Mechanics, University of Craiova, 200512 Craiova, Romania
- Correspondence: (D.-L.P.); (G.B.)
| | | | - Gabriel Buciu
- Faculty of Nursing, Titu Maiorescu University, 210102 Targu Jiu, Romania
- Correspondence: (D.-L.P.); (G.B.)
| | | | - Adriana Ionescu
- Faculty of Mechanics, University of Craiova, 200512 Craiova, Romania
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Xu T, Zhang J. Effect of Operation Room Nursing Intervention and Ceramic Prosthesis on Total Hip Arthroplasty. SCANNING 2022; 2022:2421723. [PMID: 35832302 PMCID: PMC9239831 DOI: 10.1155/2022/2421723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
In order to solve the problems of large trauma, many postoperative complications, and complex operation of artificial hip arthroplasty, a method to analyze the application effect of operating room nursing intervention in artificial hip arthroplasty was proposed. Firstly, 120 patients who underwent hip arthroplasty in our hospital from January to December 2017 were selected; Secondly, they were randomly divided into routine group (60 cases) and intervention group (60 cases); finally, on this basis, the intervention group strengthened the nursing in the operating room and used nanoceramic prosthesis. The Harris score of hip joint, the incidence of postoperative complications, and the satisfaction with nursing services were compared between the two groups. The results showed that the Harris score of hip joint and the satisfaction score of nursing service in the intervention group were significantly higher than those in the routine group (P < 0.05); the incidence of postoperative complications in the intervention group was significantly lower than that in the routine group (P < 0.05). It is proved that actively carrying out nursing intervention in the operating room and using nanoceramic prosthesis can not only improve the clinical efficacy and nursing service satisfaction of patients undergoing total hip arthroplasty but also reduce the incidence of complications.
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Affiliation(s)
- Ting Xu
- Marine Police Hospital of Anesthesiology Department, Jiaxing, Zhejiang 314000, China
| | - Jie Zhang
- Marine Police Hospital of Anesthesiology Department, Jiaxing, Zhejiang 314000, China
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Trisolino G, Stallone S, Castagnini F, Bordini B, Cosentino M, Lucchini S, Zarantonello P, Ferrari D, Dallari D, Traina F. Cementless Ceramic-on-Ceramic Total Hip Replacement in Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8100858. [PMID: 34682123 PMCID: PMC8534320 DOI: 10.3390/children8100858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023]
Abstract
Background: total hip replacement (THR) is a rare surgical option in children and adolescents with disabling hip diseases. The aim of this study is to report results from a retrospective cohort of patients aged 18 years or less who underwent cementless Ceramic-on-Ceramic (CoC) THR at a single institution, investigating clinical and radiographic outcomes, survival rates, and reasons for revision of the implants. Materials and methods: we queried the Registry of Prosthetic Orthopedic Implants (RIPO) to identify all children and adolescents undergoing THR between 2000 and 2019 at a single Institution. Inclusion criteria were patients undergoing cementless CoC THR, aged less than 18 years at surgery, followed for at least 2 years. Sixty-eight patients (74 hips) matched all the inclusion criteria and were enrolled in the study. We assessed the clinical and radiographic outcomes, the rate of complications, the survival rate, and reasons for revision of the implants. Results: The mean follow-up was 6.6 ± 4.4 years (range 2-20). The most frequent reason for THR was post-traumatic or chemotherapy-induced avascular necrosis (38%). The overall survival rate of the cohort was 97.6% (95% CI: 84.9-99.7%) at 5 years of follow-up, 94.4% (95% CI: 79.8-98.6%) at 10 years and 15 years of follow-up. Two THR in two patients (2.7%) required revision. With the numbers available, Cox regression analysis could not detect any significant interaction between preoperative or intraoperative variables and implant survivorship (p-value 0.242 to 0.989)." The average HOOS was 85 ± 14.3 (range 30.6-100). Overall, 23 patients (48%) reported excellent HOOS scores (>90 points), 21 patients (44%) reported acceptable HOOS scores (60-90 points) while 4 patients (8%) reported poor outcomes (<60 points). Twenty-one patients (43%) were regularly involved into moderate- to high-intensity sport activities (UCLA ≥ 6). Conclusions: Cementless CoC THR is a successful procedure in children and teenagers, having demonstrated high implant survivorship and low rates of complications and failure. A meticulous preoperative planning and implant selection is mandatory, to avoid implant malposition, which is the main reason of failure and revision in these cases. Further studies are needed to assess the impact of the THR on the psychosocial wellbeing of teenagers, as well as risks and benefits and cost-effectiveness in comparison to the hip preserving surgical procedures.
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Affiliation(s)
- Giovanni Trisolino
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.Z.); (D.F.)
- Correspondence: (G.T.); (S.S.)
| | - Stefano Stallone
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.Z.); (D.F.)
- Correspondence: (G.T.); (S.S.)
| | - Francesco Castagnini
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.C.); (S.L.); (F.T.)
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (B.B.); (M.C.)
| | - Monica Cosentino
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (B.B.); (M.C.)
| | - Stefano Lucchini
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.C.); (S.L.); (F.T.)
| | - Paola Zarantonello
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.Z.); (D.F.)
| | - Daniele Ferrari
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.Z.); (D.F.)
| | - Dante Dallari
- Conservative Orthopedic Surgery and Innovative Techniques, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Francesco Traina
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.C.); (S.L.); (F.T.)
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