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van Erp JHJ, Kuperus JS, Bekkers JEJ, Kruyt MC. Bilateral Slipped Capital Femoral Epiphysis in a Young Girl Treated With Chemotherapy: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00003. [PMID: 38579020 DOI: 10.2106/jbjs.cc.23.00650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
CASE A 1-year-old girl was treated with chemotherapy and hematopoietic stem cell transplantation because of CD40 ligand deficiency. Four years later, she presented with pain in her right leg, diagnosed as atypical acute slipped capital femoral epiphysis, without a clear cause, besides chemotherapy possibly. She was treated with fixation of the epiphysis with a cannulated screw. Two years later, the same diagnosis was made for the left hip and the same surgery was applied. After the 2-year follow-up, clinical outcomes were good. CONCLUSION Chemotherapy may be a risk factor for atypical slipped capital femoral epiphysis, even without the combination with radiotherapy.
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Affiliation(s)
- J H J van Erp
- Clinical Orthopedic Research Center-mN, Zeist, The Netherlands
- Department of Orthopedics, Diakonessenhuis Utrecht, The Netherlands
- Department of Orthopedics, UMC Utrecht, The Netherlands
| | - J S Kuperus
- Department of Orthopedics, UMC Utrecht, The Netherlands
| | - J E J Bekkers
- Clinical Orthopedic Research Center-mN, Zeist, The Netherlands
- Department of Orthopedics, Diakonessenhuis Utrecht, The Netherlands
- Department of Orthopedics, UMC Utrecht, The Netherlands
| | - M C Kruyt
- Department of Orthopedics, UMC Utrecht, The Netherlands
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Faldini C, Di Martino A, Brunello M, Stefanini N, Puteo N, Pilla F, Geraci G, Traina F. The Medium- to Long-Term Results of Vascular-Sparing Subcapital Osteotomy (VASSCO) for Pediatric Patients with Chronic Slipped Capital Femoral Epiphysis. J Clin Med 2024; 13:1021. [PMID: 38398334 PMCID: PMC10889773 DOI: 10.3390/jcm13041021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Background: In patients affected by chronic slipped capital femoral epiphysis (C-SCFE), the performance of a subcapital osteotomy is an effective procedure to correct the deformity at the proximal femur. However, the rate of postoperative complications is very high, with iatrogenic avascular necrosis of the femoral head (AVN) being the most bothersome. To overcome the risk of AVN, the modified Dunn procedure according to Ganz and, more recently, the Vascular Sparing Subcapital Osteotomy (VASSCO) technique have been proposed; however, only short-term follow-up studies are available on the latter technique being used. The aim of this study is therefore to show our mid-term clinical and radiological results with the VASSCO technique. Materials and Methods: A total of 26 patients underwent VASSCO for moderate or severe stable C-SCFE between 2012 and April 2016 with an average 10-year follow-up (range 8-12 years). The outcomes was evaluated using the HHS and pre- and postoperative ROM. The radiological outcomes and complications were collected. Results: No major intraoperative complications occurred; three patients reported postoperative transient apraxia of the lateral femoral cutaneous nerve, which completely recovered in six months. All the radiological outcomes showed substantial improvement postoperatively. One case patient developed AVN of the femoral head and required a total hip arthroplasty after 12 years. Conclusions: The current data suggest that VASSCO osteotomy is a reliable technique with very good clinical results at mid-term follow-up; it could be considered a valuable alternative to using more complex techniques to restore the proximal femoral anatomy in moderate to severe C-SCFE.
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Affiliation(s)
- Cesare Faldini
- Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (M.B.); (N.S.); (F.P.); (G.G.); (F.T.)
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Alberto Di Martino
- Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (M.B.); (N.S.); (F.P.); (G.G.); (F.T.)
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Matteo Brunello
- Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (M.B.); (N.S.); (F.P.); (G.G.); (F.T.)
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy;
| | - Niccolò Stefanini
- Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (M.B.); (N.S.); (F.P.); (G.G.); (F.T.)
| | - Nicole Puteo
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy;
- Ortopedia, Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Pilla
- Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (M.B.); (N.S.); (F.P.); (G.G.); (F.T.)
| | - Giuseppe Geraci
- Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (M.B.); (N.S.); (F.P.); (G.G.); (F.T.)
| | - Francesco Traina
- Orthopaedic Department, IRCCS—Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136 Bologna, Italy; (C.F.); (M.B.); (N.S.); (F.P.); (G.G.); (F.T.)
- Ortopedia, Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Chatziravdeli V, Psaroulaki E, Rodiftsis G, Katsaras G. Slipped Capital Femoral Epiphysis Pathogenesis and Its Relation to Obesity—Where Do We Stand? A Narrative Review. SURGERIES 2023. [DOI: 10.3390/surgeries4020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Slipped capital femoral epiphysis (SCFE) is the most common adolescent hip disorder in children 9–15 years old with an incidence that ranges from 0.33:100,000 to 24.58:100,000. Idiopathic SCFE is strongly associated with obesity, while atypical SCFE is associated with endocrinopathies, metabolic and renal disease, radiation therapy, and chemotherapy. In this review, we summarized the current data regarding the pathogenesis of SCFE and its association to obesity. In the last years, there have been increasing evidence regarding the implication of obesity in the pathogenesis of SCFE, but no definitive mechanism has been proven. The etiology is probably multifactorial, with both mechanical and metabolic factors contributing to the disease, with the later gaining more ground, especially in obese patients. Understanding what causes the disease will help paediatricians and orthopaedists develop more efficient strategies for treating patients and diminishing complication rates.
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Affiliation(s)
- Vasiliki Chatziravdeli
- Orthopaedic Department, “Ippokrateio” Hospital of Thessaloniki, 54643 Thessaloniki, Greece
| | - Evdokia Psaroulaki
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece
| | - Grigoriοs Rodiftsis
- Orthopaedic Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece
| | - Georgios Katsaras
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece
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Longo UG, Papalia R, De Salvatore S, Piccioni V, Tancioni A, Piergentili I, Denaro V. Have Elbow Arthroscopy Hospitalizations Decreased over the Years? An Epidemiological Italian Study from 2001 to 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3638. [PMID: 36834331 PMCID: PMC9959056 DOI: 10.3390/ijerph20043638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
This study describes the trends of elbow arthroscopy in Italy and other countries in order to evaluate the yearly rates of EA. Its purpose is for future epidemiological studies to be able to compare their data between countries in order to understand the reasons for the increasing and decreasing trends. Data for this study were obtained from National Hospital Discharge records (SDO) at the Italian Ministry of Health (INHS). Data regarding sex, age, region of residence, region of surgery, length of hospitalization, and procedure codes were included. In total, 2414 elbow arthroscopies were performed in Italy from 2001 to 2016 in the adult population. The highest number of procedures was found in the 40-44 and 45-49 years age groups. Males represented the majority of patients undergoing EA both in total and over the years. An increase from 2001 to 2010 and a decrease from 2010 to 2016 were reported in the present analysis. According to other studies, males of 40-44 and 45-49 years age groups represent the most treated patients. Further epidemiological studies would provide data that could be compared between countries, reaching a general consensus on the best indications for this procedure.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Valentina Piccioni
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Alessandro Tancioni
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Ilaria Piergentili
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Longo UG, Papalia R, Castagna A, De Salvatore S, Guerra E, Piergentili I, Denaro V. Shoulder replacement: an epidemiological nationwide study from 2009 to 2019. BMC Musculoskelet Disord 2022; 23:889. [PMID: 36180858 PMCID: PMC9526311 DOI: 10.1186/s12891-022-05849-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Shoulder replacement (SR) constitutes the gold standard treatment for severe shoulder diseases, including osteoarthritis, rheumatoid arthritis, complex fractures, avascular necrosis and rotator cuff arthropathy. Although several countries have national registries, there is a lack of epidemiological data on SR. Sharing national statistics and correlating those to other countries could be helpful to compare outcomes and costs internationally. This paper aims to evaluate the trend of hospitalizations for SR (both first implants and revisions of anatomical and reverse prosthesis) in Italy from 2009 to 2019, based on the National Hospital Discharge Reports (S.D.O) provided by the Italian National Health Service (INHS). Moreover, the economic impact on the healthcare system of SR and SR revisions was assessed, providing a statistical prediction for the next ten years. Methods The data used in this paper were about patients who underwent Total Shoulder Replacement (TSR), Shoulder Hemiarthroplasty (SH) or Revision of shoulder joint replacement (RSR) from 2009 to 2019 in Italy. Information about patients was anonymous and included age, sex, days of hospitalization, procedures and diagnoses codes. Results From 2009 to 2019, 73,046 TSR and SH were performed in adult Italian residents, with a cumulative incidence of 13.6 cases per 100,000 adult Italian residents. While, 2,129 revisions of shoulder replacement were performed, with a cumulative incidence of 0.4 cases per 100,000 residents. Overall, females represented the majority of the cases (72.4% of patients who underwent TSR or SH and 59.1% of patients who underwent RSR). From 2009 to 2019, has been assessed an overall cost of 625,638,990€ for TSR or SH procedures in Italy. While, an overall cost of 9,855,141€ for RSR procedures in Italy was calculated. Conclusions The incidence of SR and RSR is expected to increase in the following years, constituting a burden for the healthcare systems. Overall, in Italy, the females represented the majority of patients. Further prospective studies on this topic in different countries can be con-ducted to make comparisons.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy. .,Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy.
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy.,Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy
| | | | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy.,Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy
| | - Enrico Guerra
- Chirurgia Della Spalla E del Gomito, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ilaria Piergentili
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy.,Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy.,Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy
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Ruzzini L, De Salvatore S, Longo UG, Marino M, Greco A, Piergentili I, Costici PF, Denaro V. Prenatal Diagnosis of Clubfoot: Where Are We Now? Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11122235. [PMID: 34943470 PMCID: PMC8700252 DOI: 10.3390/diagnostics11122235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/23/2021] [Accepted: 11/28/2021] [Indexed: 12/28/2022] Open
Abstract
The primary methods for prenatal diagnosis of Clubfoot are ultrasound (US) and magnetic resonance imaging (MRI). An ultrasound is performed between the 1st trimester and the 28th week of pregnancy and it is reported to be used as a diagnostic method alone or in combination with MRI. So far, an international consensus on the most effective screening method has not been reached. This systematic review and meta-analysis were performed to establish the most effective and reliable exam for prenatal diagnosis of Clubfoot. The literature search was conducted using a PIOS-approach from May 2021 to June 2021. Studies reporting cases of prenatal diagnosis of Clubfoot made through US and MRI conducted from January 2010 to June 2021 were included in the study and reviewed by 2 authors. The 23 selected studies included 2318 patients. A total of 11 of the studies included details on the accuracy, while the rest were used to obtain information about the primary methodology utilized. In all the selected studies, US was used as the primary diagnostic instrument. Thirteen of the studies used the US exclusively, while three used MRI in addition to US and seven performed karyotyping after US diagnosis. The US has been shown to be the instrument of choice for the prenatal diagnosis of Clubfoot. International guidelines for an ultrasonography classification of congenital clubfoot are required to reduce the inter-variability accuracy of this procedure.
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Affiliation(s)
- Laura Ruzzini
- Department of Orthopedics, Children’s Hospital Bambino Gesù, Palidoro, 00165 Rome, Italy; (L.R.); (P.F.C.)
| | - Sergio De Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (M.M.); (A.G.); (I.P.); (V.D.)
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (M.M.); (A.G.); (I.P.); (V.D.)
- Correspondence: ; Tel.: +39-06-225-411-613
| | - Martina Marino
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (M.M.); (A.G.); (I.P.); (V.D.)
| | - Alessandra Greco
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (M.M.); (A.G.); (I.P.); (V.D.)
| | - Ilaria Piergentili
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (M.M.); (A.G.); (I.P.); (V.D.)
| | - Pier Francesco Costici
- Department of Orthopedics, Children’s Hospital Bambino Gesù, Palidoro, 00165 Rome, Italy; (L.R.); (P.F.C.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (S.D.S.); (M.M.); (A.G.); (I.P.); (V.D.)
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