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Linari S, Pieri L, Carulli C, Demartis F, Fjerza R, Prisco D, Castaman G. Is pharmacological thromboprophylaxis necessary in persons with haemophilia undergoing major orthopaedic surgery? Haemophilia 2024. [PMID: 38575529 DOI: 10.1111/hae.15012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Silvia Linari
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Lisa Pieri
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Christian Carulli
- Orthopedic Clinic, Orthopedic Traumatologic Center, Careggi University Hospital, Florence, Italy
| | - Francesco Demartis
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Rajmonda Fjerza
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Domenico Prisco
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
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Bisciotti GN, Zini R, Aluigi M, Aprato A, Auci A, Bellinzona E, Benelli P, Bigoni M, Bisciotti A, Bisciotti A, Bona S, Brustia M, Bruzzone M, Canata GL, Carulli C, Cassaghi G, Coli M, Corsini A, Costantini A, Dallari D, Danelli G, Danesi G, Della Rocca F, DE Nardo P, DI Benedetto P, DI Marzo F, DI Pietto F, Eirale C, Ferretti A, Fogli M, Foglia A, Guardoli A, Guglielmi A, Lama D, Maffulli N, Manunta AF, Massari L, Mazzoni G, Moretti B, Moretti L, Nanni G, Niccolai R, Occhialini M, Panascì M, Parra MF, Pigalarga G, Randelli F, Sacchini M, Salini V, Santori N, Tenconi P, Tognini G, Vegnuti M, Zanini A, Volpi P. Groin Pain Syndrome Italian Consensus Conference update 2023. J Sports Med Phys Fitness 2024; 64:402-414. [PMID: 38126972 DOI: 10.23736/s0022-4707.23.15517-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Groin pain syndrome (GPS) is a controversial topic in Sports Medicine. The GPS Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athletes was organized by the Italian Society of Arthroscopy in Milan, on 5 February 2016. In this Consensus Conference (CC) GPS etiology was divided into 11 different categories for a total of 63 pathologies. The GPS Italian Consensus Conference update 2023 is an update of the 2016 CC. The CC was based on a sequential, two-round online Delphi survey, followed by a final CC in the presence of all panelists. The panel was composed of 55 experts from different scientific and clinical backgrounds. Each expert discussed 6 different documents, one of which regarded the clinical and imaging definition of sports hernias, and the other 5 dealt with 5 new clinical situations thought to result in GPS. The panelists came to an agreement on the definition of a sports hernia. Furthermore, an agreement was reached, recognizing 4 of the 5 possible proposed pathologies as causes to GPS. On the contrary, the sixth pathology discussed did not find consensus given the insufficient evidence in the available scientific literature. The final document includes a new clinical and imaging definition of sports hernia. Furthermore, the etiology of GPS was updated compared to the previous CC of 2016. The new taxonomic classification includes 12 categories (versus 11 in the previous CC) and 67 pathologies (versus 63 in the previous CC).
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Affiliation(s)
| | - Raul Zini
- Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | | | | | | | | | | | | | | | - Andrea Bisciotti
- Kinemove Rehabilitation Centers, Pontremoli, La Spezia, Italy
- Humanitas Research Hospital, Milan, Italy
| | | | | | - Marco Bruzzone
- University of Brescia, Brescia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
- Unione Sportiva Sassuolo Calcio, Sassuolo, Modena, Italy
| | - Gian L Canata
- Center of Sports Traumatology, Koelliker Hospital, Turin, Italy
| | | | | | | | | | | | - Dante Dallari
- Reconstructive Orthopedic Surgery and Innovative Techniques Musculoskeletal Tissue Bank, Rizzoli IRCCS Orthopedic Institute, Bologna, Italy
| | | | | | | | | | | | | | | | | | - Andrea Ferretti
- Istituto Medicina e Scienza dello Sport Comitato Olimpico Nazionale Italiano, Rome, Italy
| | | | - Andrea Foglia
- Centers of Rehabilitative Phisiotherapy, Civitanova Marche, Macerata, Italy
| | | | | | | | - Nicola Maffulli
- La Sapienza University, Rome, Italy
- Centre for Sport and Exercise Medicine, Queen Mary University of London, London, UK
- Barts and the London School of Medicine, Surgery and Dentistry, London, UK
- Keele University School of Medicine, Stoke on Trent, UK
| | - Andrea F Manunta
- Orthopedic Clinic Sassari, Fondo Ateneo Ricerca 2020, Sassari, Italy
| | | | | | - Biagio Moretti
- Unit of Orthopedics and Traumatology, Polyclinic University Hospital, Bari, Italy
| | - Lorenzo Moretti
- Unit of Orthopedics and Traumatology, Polyclinic University Hospital, Bari, Italy
| | | | | | | | - Manlio Panascì
- Nancy Gvm Care and Research, S. Carlo Hospital, Rome, Italy
| | - Maria F Parra
- Kinemove Rehabilitation Centers, Pontremoli, La Spezia, Italy
| | | | - Filippo Randelli
- Hip Department (CAD), Gaetano Pini-CTO Orthopaedic Institute, University of Milan, Milan, Italy
| | | | | | | | | | | | - Marco Vegnuti
- Kinemove Rehabilitation Centers, Pontremoli, La Spezia, Italy
| | - Antonio Zanini
- San Clemente Nursing Home, S. Anna Clinica Institute, Brescia, Italy
| | - Piero Volpi
- Humanitas Research Hospital, Milan, Italy
- FC Internazionale Milano, Milan, Italy
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Innocenti M, Leggieri F, Secci G, Carulli C, Del Prete A, Civinini R. A dual telescoping lag screw nailing system for intertrochanteric fractures: retrospective analysis of clinical and radiologic outcomes. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03906-w. [PMID: 38555541 DOI: 10.1007/s00590-024-03906-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to evaluate whether this system is associated with a reduced rate of failure and complications in patients treated for proximal femoral fractures with intramedullary nailing. MATERIALS AND METHODS 742 Patients with AO-OTA 31-A intertrochanteric fractures were enrolled at a single Institution. Functional evaluation was assessed through the Functional Independence Measure (FIM™) instrument and Parker's New Mobility Score (NMS). Radiological follow-up included the degree of the reduction according to the Baumgartner criteria, the Tip-Apex Distance, and the shortening of the telescoping screws and its lateral protrusion. RESULTS Pre-operative mean FIM™ and NMS were 4.3 (range 1-9) and 98.7 (range 22-126), respectively. At the 12-month follow-up the average FIM™ and NMS were 95.3 (range 22-126) and 3.7 (range 1-9), respectively. Mean shortening of the lag screws was 4.3 mm (range 1-8) and mean lateral protrusion was 1.7 mm (range 0-3). 3 Cases (0.70%) of non-consolidation requiring reoperation were recorded. 1 Case (0.24%) of these cases was also characterized by nail breakage. No case of cut-out has been reported at our follow-up. CONCLUSIONS This dual telescoping nail system is effective and safe. The sliding of the telescoping screws within the barrel is able to decrease strain from the femoral head during weight bearing reducing the risk of cut-out.
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Affiliation(s)
- Matteo Innocenti
- Department of General Orthopedic, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Filippo Leggieri
- Department of General Orthopedic, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy.
| | - Gregorio Secci
- Department of General Orthopedic, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Christian Carulli
- Department of General Orthopedic, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Armando Del Prete
- Department of General Orthopedic, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Roberto Civinini
- Department of General Orthopedic, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
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Cortesi PA, Fornari C, Conti S, Pollio B, Boccalandro E, Buzzi A, Carulli C, Coppola A, De Cristofaro R, Di Minno MND, Dolan G, Ferri Grazzi E, Fornari A, Gualtierotti R, Hermans C, Jiménez-Juste V, Kenet G, Lupi A, Martinoli C, Mansueto MF, Nicolò G, Tagliaferri A, Gringeri A, Molinari AC, Mantovani LG, Castaman G. The value-based healthcare approach to haemophilia: Development of outcome measures for the evaluation of care of people with haemophilia. Haemophilia 2024; 30:437-448. [PMID: 38314918 DOI: 10.1111/hae.14943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/16/2023] [Accepted: 11/12/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Considering the advances in haemophilia management and treatment observed in the last decades, a new set of value-based outcome indicators is needed to assess the quality of care and the impact of these medical innovations. AIM The Value-Based Healthcare in Haemophilia project aimed to define a set of clinical outcome indicators (COIs) and patient-reported outcome indicators (PROIs) to assess quality of care in haemophilia in high-income countries with a value-based approach to inform and guide the decision-making process. METHODS A Value-based healthcare approach based on the available literature, current guidelines and the involvement of a multidisciplinary group of experts was applied to generate a set of indicators to assess the quality of care of haemophilia. RESULTS A final list of three COIs and five PROIs was created and validated. The identified COIs focus on two domains: musculoskeletal health and function, and safety. The identified PROIs cover five domains: bleeding frequency, pain, mobility and physical activities, Health-Related Quality of Life and satisfaction. Finally, two composite outcomes, one based on COIs, and one based on PROIs, were proposed as synthetic outcome indicators of quality of care. CONCLUSION The presented standard set of health outcome indicators provides the basis for harmonised longitudinal and cross-sectional monitoring and comparison. The implementation of this value-based approach would enable a more robust assessment of quality of care in haemophilia, within a framework of continuous treatment improvements with potential added value for patients. Moreover, proposed COIs and PROIs should be reviewed and updated routinely.
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Affiliation(s)
- Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Carla Fornari
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Berardino Pollio
- Regional Reference Centre for Inherited Bleeding and Thrombotic Disorders, Transfusion Medicine, "Regina Margherita" Children Hospital, Turin, Italy
| | - Elena Boccalandro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | | | | | - Antonio Coppola
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Raimondo De Cristofaro
- Haemorrhagic and Thrombotic Disease Service, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Matteo Nicola Dario Di Minno
- Department of Clinical Medicine and Surgery, Regional Reference Center for Coagulation Disorders, Federico II University, Naples, Italy
| | | | | | - Arianna Fornari
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberta Gualtierotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Victor Jiménez-Juste
- Thrombosis and Haemostasis Unit - IdiPAZ, University Hospital La Paz, Madrid, Spain
| | - Gili Kenet
- National Hemophilia Center, Thrombosis Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Angelo Lupi
- Federation of Haemophilia Associations (FedEmo), Milan, Italy
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Gabriella Nicolò
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Department of Healthcare Professions, Milan, Italy
| | - Annarita Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | | | - Angelo Claudio Molinari
- Regional Reference Centre for Haemorrhagic Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
- CHARTA Foundation, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giancarlo Castaman
- Department of Oncology, Centre for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
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Lazzarini F, Paoli T, Cozzi Lepri A, Secci G, Zanna L, Innocenti M, Matassi F, Carulli C, Civinini R. Accuracy of radiographic projections to guide cephalic screw position in pertrochanteric fracture: a cadaveric study. Eur J Orthop Surg Traumatol 2024; 34:479-487. [PMID: 37624410 PMCID: PMC10771593 DOI: 10.1007/s00590-023-03690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between the Löwenstein Lateral view and the True Lateral view for the positioning of the cephalic hip screw, through a cadaveric study. MATERIALS AND METHODS We placed two Kirschner wires in eight femur specimens using an Antero-Posterior view, Löwenstein Lateral view and True Lateral view. The distances between the Kirschner wires and the anterior, posterior, superior and inferior cortex were measured in all projections. The head of the femur was then sectioned, and the same macroscopic distances were measured. Finally, we could calculate the accuracy of the two radiographic lateral projections. RESULTS When the Kirschner wire was placed in the center of the head using the Antero-Posterior and the True Lateral view, the accuracy of Antero-Posterior view was 0.9705 while the accuracy of True Lateral view and Löwenstein Lateral view was 1.1479 and 1.1584, respectively. When the Kirschner wire was placed superior on the Antero-Posterior and centrally on the True Lateral view, the accuracy of Antero-Posterior view was 0.9930 while the accuracy of True Lateral view and Löwenstein Lateral view was 1.1159 and 0.7224, respectively. CONCLUSION When the Kirschner wire was positioned proximal in Antero-Posterior view and central in True Lateral view, only the True Lateral view showed high accuracy.
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Affiliation(s)
- Francesco Lazzarini
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital,, Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Tommaso Paoli
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital,, Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Andrea Cozzi Lepri
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
| | - Gregorio Secci
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy.
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital,, Via Antella 58, 50012, Bagno a Ripoli, Italy.
| | - Luigi Zanna
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital,, Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
| | - Fabrizio Matassi
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
| | - Christian Carulli
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
| | - Roberto Civinini
- Orthopaedic Clinic, University of Florence, Careggi University Hospital, Largo Palagi 1, 50139, Florence, Italy
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Zanna L, Innocenti M, Secci G, Cipolleschi L, Carulli C, Civinini R. Acetabular Morphology Predicts the Risk of Dislocation Following Hemiarthroplasty for Femoral Neck Fractures in the Elderly. J Arthroplasty 2023; 38:1773-1778. [PMID: 36822447 DOI: 10.1016/j.arth.2023.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Hip hemiarthroplasty dislocation is a devastating complication. Among other preoperative risk factors, acetabular morphology has been rarely studied. The purpose of the study was to evaluate the influence of preoperative native acetabular morphology on hemiarthroplasty dislocation. METHODS We retrospectively reviewed 867 patients who underwent hip hemiarthroplasty for femoral neck fracture between January 1, 2014 and January 1, 2019. The 380 included patients were treated with an anterior-based muscle-sparing approach. The central-edge angle (CEA) and acetabular depth-to-width ratio (ADWR) of the fractured hip were measured preoperatively on the anteroposterior pelvic view. Receiver operating characteristic curves were performed to analyze the optimal cutoff for CEA and ADWR. Hemiarthroplasty dislocation occurred in 18 patients (4.7%), and the remaining 362 patients were used as the control group. RESULTS No significant differences in terms of sex, age, dementia, neuromuscular disease, and body mass index were found between the 2 groups. The 18 patients who had a hip dislocation had significantly smaller mean CEA than the control group (P = .0001) (mean 36.1 ± 7.5° and 43.2 ± 5.6°, respectively) as well as ADWR (mean 34 ± 6 versus 37 ± 4, respectively) (P = .001). Using the receiver operating characteristic analysis, we report significant cutoffs of 38.5° for CEA (P = .0001) and 34.5 for the ADWR (P = .017). CONCLUSION Higher rates of hemiarthroplasty dislocation were observed in patients who had a preoperative CEA of less than 38.5° and an ADWR of less than 34.5. Patients who have preoperative acetabular morphological risk factors for dislocation might be better candidates for a total hip arthroplasty.
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Affiliation(s)
- Luigi Zanna
- Department of Orthopaedic Surgery, Aou Careggi, University Hospital of Florence, Florence, Italy
| | - Matteo Innocenti
- Department of Orthopaedic Surgery, Aou Careggi, University Hospital of Florence, Florence, Italy
| | - Gregorio Secci
- Department of Orthopaedic Surgery, Aou Careggi, University Hospital of Florence, Florence, Italy
| | - Leonardo Cipolleschi
- Department of Orthopaedic Surgery, Aou Careggi, University Hospital of Florence, Florence, Italy
| | - Christian Carulli
- Department of Orthopaedic Surgery, Aou Careggi, University Hospital of Florence, Florence, Italy
| | - Roberto Civinini
- Department of Orthopaedic Surgery, Aou Careggi, University Hospital of Florence, Florence, Italy
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Carulli C, Innocenti M, Tambasco R, Perrone A, Civinini R. Total Knee Arthroplasty in Haemophilia: Long-Term Results and Survival Rate of a Modern Knee Implant with an Oxidized Zirconium Femoral Component. J Clin Med 2023; 12:4356. [PMID: 37445391 DOI: 10.3390/jcm12134356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/17/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Total Knee Arthroplasty (TKA) in patient with haemophilia (PWH) has usually been performed with the use of cobalt-chrome femoral and titanium tibial components, coupled with standard polyethylene (PE) inserts. The aim of this retrospective study was to evaluate the long-term outcomes and survival rates of TKA in a series of consecutive PWH affected by severe knee arthropathy at a single institution. (2) Methods: We followed 65 patients undergoing 91 TKA, implanted using the same implant, characterized by an oxidized zirconium femoral component, coupled with a titanium tibial component, and a highly crosslinked PE. At 1, 6, and 12 months; then every year for 5 years; and finally, every other 3 years, all patients were scored for pain (VAS), function (HJHS; KSS), ROM, and radiographic changes. Kaplan-Meier survivorship curves were used to calculate the implant survival rates. (3) Results: The mean follow-up was 12.3 years (4.2-20.6). All clinical and functional scores improved significantly from preoperatively to the latest follow-up (VAS: from 6.9 to 1.3; HJHS: from 13.4 to 1.9; KSS: from 19.4 to 79; ROM: from 42.4° to 83.6°). The overall survivorship of the implants was 97.5% at the latest follow-up. (4) Conclusions: The present series showed a high survival rate of specific implants potentially linked to the choice of an oxidized zirconium coupled with a highly crosslinked PE. We promote the use of modern implants in these patients in order to ensure long-lasting positive outcomes.
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Affiliation(s)
| | - Matteo Innocenti
- Orthopaedic Clinic, University of Florence, 50139 Florence, Italy
| | - Rinaldo Tambasco
- Orthopaedic Clinic, University of Florence, 50139 Florence, Italy
| | | | - Roberto Civinini
- Orthopaedic Clinic, University of Florence, 50139 Florence, Italy
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Morfini M, Agnelli Giacchiello J, Baldacci E, Carulli C, Castaman G, Giuffrida AC, Malcangi G, Rocino A, Siragusa S, Zanon E. Managing Relevant Clinical Conditions of Hemophilia A/B Patients. Hematol Rep 2023; 15:384-397. [PMID: 37367088 DOI: 10.3390/hematolrep15020039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/21/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
The Medical Directors of nine Italian Hemophilia Centers reviewed and discussed the key issues concerning the replacement therapy of hemophilia patients during a one-day consensus conference held in Rome one year ago. Particular attention was paid to the replacement therapy needed for surgery using continuous infusion (CI) versus bolus injection (BI) of standard and extended half-life Factor VIII (FVIII) concentrates in severe hemophilia A patients. Among the side effects, the risk of development of neutralizing antibodies (inhibitors) and thromboembolic complications was addressed. The specific needs of mild hemophilia A patients were described, as well as the usage of bypassing agents to treat patients with high-responding inhibitors. Young hemophilia A patients may take significant advantages from primary prophylaxis three times or twice weekly, even with standard half-life (SHL) rFVIII concentrates. Patients affected by severe hemophilia B probably have a less severe clinical phenotype than severe hemophilia A patients, and in about 30% of cases may undergo weekly prophylaxis with an rFIX SHL concentrate. The prevalence of missense mutations in 55% of severe hemophilia B patients allows the synthesis of a partially changed FIX molecule that can play some hemostatic role at the level of endothelial cells or the subendothelial matrix. The flow back of infused rFIX from the extravascular to the plasma compartment allows a very long half-life of about 30 h in some hemophilia B patients. Once weekly, prophylaxis can assure a superior quality of life in a large severe or moderate hemophilia B population. According to the Italian registry of surgery, hemophilia B patients undergo joint replacement by arthroplasty less frequently than hemophilia A patients. Finally, the relationships between FVIII/IX genotypes and the pharmacokinetics of clotting factor concentrates have been investigated.
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Affiliation(s)
- Massimo Morfini
- Italian Association of Haemophilia Centers (AICE), 21121 Milan, Italy
| | - Jacopo Agnelli Giacchiello
- Hemostasis and Thrombosis Center, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Erminia Baldacci
- Haematology, "Umberto I" Policlinico, Department of Translational and Precision Medicine, Sapienza University of Rome, 00118 Rome, Italy
| | - Christian Carulli
- Department of Orthopaedic Surgery, Orthopaedic Clinic, University of Florence, 50121 Florence, Italy
| | - Giancarlo Castaman
- Department of Oncology, Center for Bleeding Disorders and Coagulation, Careggi University Hospital, 50121 Florence, Italy
| | | | - Giuseppe Malcangi
- UOSD Centro Emofilia e Trombosi, Azienda Ospedaliero Universitaria Policlinico di Bari, 70121 Bari, Italy
| | - Angiola Rocino
- Haemophilia and Thrombosis Centre, Haematology, S.M. di Loreto Nuovo Hospital, 80121 Naples, Italy
| | - Sergio Siragusa
- Department PROMISE, University of Palermo, 90121 Palermo, Italy
| | - Ezio Zanon
- Haemophilia Centre, General Medicine, Padua University Hospital, 35121 Padua, Italy
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Castaman G, Linari S, Pieri L, Carulli C, Prosperi P, Tonelli P, Demartis F, Fjerza R, Attanasio M, Coppo M, Salvianti F. Safe and Successful Surgical Outcome in Persons with Hemophilia A with and without Inhibitors Treated with Emicizumab: A Large, Single Center, Real-World Experience. J Clin Med 2023; 12:jcm12062317. [PMID: 36983317 PMCID: PMC10055920 DOI: 10.3390/jcm12062317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Emicizumab is a humanized recombinant bispecific antibody, bridging together activated factor IX (FIXa) and factor X (FX), thus mimicking the activity of FVIII in vivo. Emicizumab is designed for long-term prophylaxis in patients with severe hemophilia A with and without inhibitors. This approach provides constant protection, with significant reduction in bleeding rate and improved quality of life. However, protection provided by emicizumab is not absolute, and clotting factor concentrates (FVIII, rFVIIa, aPCC) may be necessary for post-traumatic bleeding or surgery, with a potential thrombotic risk or difficulty in preventing bleeding. Real world evidence is still scanty, especially for managing major surgery. In this study, 75 surgeries were managed in 28 patients (27 major procedures in 15 patients and 48 minor procedures in 20 patients. In 17 patients without inhibitors, 30 minor surgeries were carried out by using FVIII in 5, with only a bleeding event, which was successfully treated with FVIII concentrate. Six major surgeries were uneventfully performed with FVIII concentrate. Eleven PWHA and high-titer inhibitors underwent 39 surgical procedures (18 minor and 21 major surgeries). Minor surgeries were mostly performed without prophylaxis with rFVIIa, with only a single bleeding complication. All 21 major surgeries were covered with a homogeneous protocol using rFVIIa. In four instances, bleeding complications occurred, treated with rFVIIa. Of them, a single patient only failed to respond and died because of an uncontrollable bleeding from a large ruptured retroperitoneal pseudotumor. Surgery in patients with emicizumab can be safely carried out with the use of appropriate replacement therapy protocols.
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Affiliation(s)
- Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
- Correspondence: ; Tel.: +39-55-7947587
| | - Silvia Linari
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
| | - Lisa Pieri
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
| | - Christian Carulli
- Department of Orthopedic Surgery, University Hospital of Florence, 50139 Florence, Italy
| | - Paolo Prosperi
- Emergency Surgery Department, Careggi University Hospital, 50134 Florence, Italy
| | - Paolo Tonelli
- Department of Surgery and Translational Medicine, University of Florence, 50121 Florence, Italy
| | - Francesco Demartis
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
| | - Rajmonda Fjerza
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
| | - Monica Attanasio
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
| | - Mirella Coppo
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
| | - Francesca Salvianti
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
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Castaman G, Carulli C, De Cristofaro R, Follino M, Lupi A, Mancuso ME, Mansueto MF, Molinari AC, Pasquetti P, Santoro C, Santoro RC, Siragusa S, Solimeno LP, Tripodi A, Zanon E, Minno GD. Laying the foundations for gene therapy in Italy for patients with haemophilia A: A Delphi consensus study. Haemophilia 2023; 29:435-444. [PMID: 36469855 DOI: 10.1111/hae.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/24/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Current treatment for haemophilia A involves factor VIII replacement or non-replacement (emicizumab) therapies, neither of which permanently normalise factor VIII levels. Gene therapy using adeno-associated viral (AAV) vectors is an emerging long-term treatment strategy for people with severe haemophilia A (PwSHA) that is likely to be available for clinical use in the near future. AIM This article proposes practical guidelines for the assessment, treatment, and follow-up of potential PwSHA candidates for AAV-based gene therapy. METHOD Using the Delphi method, a working group of Italian stakeholders with expertise in and knowledge of the care of adults with haemophilia A analysed literature for AAV-based gene therapy and drafted a list of statements that were circulated to a panel of Italian peers. During two rounds of voting, panel members voted on their agreement with each statement to reach a consensus. RESULTS The Delphi process yielded 40 statements regarding haemophilia A gene therapy, across five topics: (1) organisational model; (2) multidisciplinary team; (3) patient engagement; (4) laboratory surveillance; and (5) patient follow-up and gene therapy outcomes. The consensus was reached for all 40 statements, with the second round of voting needed for five statements. CONCLUSION Use of the hub-and-spoke organisational model and multidisciplinary teams are expected to optimise patient selection for gene therapy, as well as the management of dosing and patient follow-up, patient engagement, laboratory surveillance, and patient expectations regarding outcomes. This approach should allow the benefits of AAV-based gene therapy for haemophilia A to be maximised.
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Affiliation(s)
- Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
| | | | - Raimondo De Cristofaro
- Section of Haemorrhagic and Thrombotic Diseases, Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Medicine and Translational Surgery, Sacred Heart University, Rome, Italy
| | | | - Angelo Lupi
- Federation of Haemophilia Associations (FedEmo), Milan, Italy
| | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maria Francesca Mansueto
- "P. Giaccone" University Hospital, University of Palermo Haemophilia Centre and Haematology Unit, Palermo, Italy
| | - Angelo Claudio Molinari
- Regional Reference Centre for Haemorrhagic Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Pietro Pasquetti
- Recovery and Rehabilitation Agency, University Hospital of Careggi, Florence, Italy
| | - Cristina Santoro
- Division of Haematology, Umberto I University Hospital, Rome, Italy
| | - Rita Carlotta Santoro
- Haemophilia, Haemostasis and Thrombosis Unit, Regional Reference Centre for Bleeding and Thrombosis Disorders, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Sergio Siragusa
- "P. Giaccone" University Hospital, University of Palermo Haemophilia Centre and Haematology Unit, Palermo, Italy
| | - Luigi Piero Solimeno
- Division of Orthopaedic Surgery and Traumatology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Armando Tripodi
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ezio Zanon
- Haemophilia Centre, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, "Federico II University; Hub" Centre for Congenital Thrombotic and Haemorrhagic Disorders, Naples, Italy
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11
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Cozzi Lepri A, Innocenti M, Galeotti A, Carulli C, Villano M, Civinini R. Trabecular titanium cups in acetabular revision arthroplasty: analysis of 10-year survivorship, restoration of center of rotation and osteointegration. Arch Orthop Trauma Surg 2022; 142:3523-3531. [PMID: 34782910 DOI: 10.1007/s00402-021-04243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
AIMS In case of severe bone loss, acetabular revision can be challenged using extra porous pure trabecular titanium (TT) revision cups designed to ensure enhanced iliac and ischiatic purchase. Aim of the study is to report on the clinical and radiological results of a TT acetabular component, evaluating functional outcome, restoration of the hip center of rotation and osteointegration. METHODS 85 patients, who underwent acetabular revision with a TT revision cup system between October 2009 and December 2018, were included in a retrospective study. Clinical outcome were assessed with Harris Hip Score (HHS). The hip rotation center was measured using the Pierchon method on the AP pelvis film. Loosening of the cup was determined according to the Kosashvili modification of Gill's criteria. Kaplan- Meier survivorship curve was performed. Results The mean follow-up was 6.12 years. The average HHS improved from 54.7 points to 89.7 points (p < 0.05). Two acetabular components (2.3%) were re-revised after a mean of 5.6 years, for aseptic loosening and for infection, with a progressive radiolucency and a > 5 mm vertical migration, respectively. The radiographic evaluation of the position of the hip rotation center revealed a statistically significant difference (p < 0.05) between the pre- and post-operative values. The hip rotation center was correctly restored within 5% of the reference Pierchon values in a percentage of 85.4% relative to horizontal parameters and within 8% in a percentage of 66.7% relative to vertical parameters. 5-year and 10-year survivorships were, respectively, 100% and 88%. CONCLUSIONS In case of severe bone loss, TT revision cup system allows for good restoration of center of rotation and osteointegration showing good 10-year survival rate.
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Affiliation(s)
- Andrea Cozzi Lepri
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy.
| | - Matteo Innocenti
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Alberto Galeotti
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Christian Carulli
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Marco Villano
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Roberto Civinini
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
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Villano M, Innocenti M, Civinini R, Carulli C, Civinini A, Taha ZA, Cozzi Lepri A. The lesser trochanter "Sling fixation technique" in proximal intramedullary nailing of unstable intertrochanteric fractures: A polymer-based cerclage wiring. J Orthop 2022; 34:94-99. [PMID: 36046757 PMCID: PMC9421174 DOI: 10.1016/j.jor.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 08/06/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Lesser trochanter (LT) fixation to restore the continuity of the posteromedial fragment using a cerclage wire has been reported to provide a more stable reduction in the treatment of unstable femoral neck fractures with LT involvement. However, LT fixation is not commonly performed due to the complications associated with the traditional monofilament cerclage metal wires. In this study, we investigate the clinical and radiological outcomes of a new technique for LT fixation in conjunction with Intramedullary (IM) fixation with nail and screws when compared to isolated IM fixation. The Sling Fixation Technique involves a new wiring technique and the use of a polymer-based cerclage cable characterized by iso-elastic properties that is hypothesized to provide better clinical and radiographic outcomes. Patients and methods This prospective observational study included 30 patients who underwent proximal IM nailing from July 2019 to April 2020. Thirty consecutive patients (30) were assigned to 2 different treatment groups. Fifteen (15) patients were treated with the IM Nailing and Sling Fixation Technique and 15 with IM nailing only. Patients were comparable for demographic features, fracture pattern, age, gender and associated medical comorbidities. Clinical outcomes were analyzed in terms of time needed to achieve complete weight bearing, Harris hip score (HHS), Barthel Index (BI) and Radiographic Union Scale for Hip (RUSH). The follow-up period was one year. Results Time for fracture healing and to achieve weight-bearing in the "Sling" group were shown to be significantly shorter than in the IM group. The Sling group showed furthermore better HHS, BI and RUSH scores when compared to the IM group at 1, 3, 6, and 12 months from the surgery. No complications such as wiring breakage, cut-outs, breakage or pullout of the fixation screws were observed; one case of heterotrophic ossification was reported. Conclusion In cases of unstable intertrochanteric fractures of the proximal femur with lesser trochanter involvement, the Sling fixation technique using an isoelastic polymer-based wire showed superior results in terms of stability and consequently better clinical and radiographic outcomes than IM nailing only.
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Affiliation(s)
- Marco Villano
- Department of Health Sciences, Orthopedic Unit, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Matteo Innocenti
- Department of Health Sciences, Orthopedic Unit, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Roberto Civinini
- Department of Health Sciences, Orthopedic Unit, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Christian Carulli
- Department of Health Sciences, Orthopedic Unit, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Alessandro Civinini
- Department of Health Sciences, Orthopedic Unit, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Zyad Ayman Taha
- Department of Health Sciences, Orthopedic Unit, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Andrea Cozzi Lepri
- Department of Health Sciences, Orthopedic Unit, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
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Suardi C, Stimolo D, Zanna L, Carulli C, Fabrizio M, Civinini R, Innocenti M. Varus morphology and its surgical implication in osteoarthritic knee and total knee arthroplasty. J Orthop Surg Res 2022; 17:299. [PMID: 35659012 PMCID: PMC9166439 DOI: 10.1186/s13018-022-03184-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Knee varus alignment represents a notorious cause of knee osteoarthritis. It can be caused by tibial deformity, combined tibial-femoral deformity and/or ligament imbalance. Understanding malalignment is crucial in total knee arthroplasty to restore frontal plane neutral mechanical axis. The aim of this study was to determine which factor contributes the most to varus osteoarthritic knee and its related surgical implications in performing a total knee arthroplasty. METHODS We retrospectively evaluated 140 patients operated for total knee arthroplasty due to a varus knee. Full-leg hip to ankle preoperative X-rays were taken. Radiological parameters recorded were: mechanical axis deviation, hip-knee-ankle, anatomical-mechanical angle, medial neck shaft angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), lateral proximal femoral angle, lateral distal tibial angle (LDTA), femoral bowing, and length of tibia and femur. We also determined ideals tibial and femoral cuts in mm according to mechanical alignment technique. A R2 was calculated based on the linear regression between the predicted values and the observed data. RESULTS The greatest contributor to arthritic varus (R = 0.444) was MPTA. Minor contributors were mLDFA (R = 0.076), JLCA (R = 0.1554), LDTA (R = 0.065), and femoral bowing (R = 0.049). We recorded an average of 7.6 mm in lateral tibial cut thickness to restore neutral alignment. CONCLUSIONS The radiological major contributor to osteoarthritic varus knee alignment is related to proximal tibia deformity. As a surgical consequence, during performing total knee arthroplasty, the majority of the correction should therefore be made on tibial cut.
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Affiliation(s)
- Chiara Suardi
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Davide Stimolo
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Luigi Zanna
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Christian Carulli
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Matassi Fabrizio
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Roberto Civinini
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy.
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Capone A, Cavaliere P, Campacci A, Carulli C, Pignatti G, Randelli F, Marelli B, Esopi P, Congia S, Marongiu G. Current Practice of Italian Association of Revision Surgery Members in the Treatment of Unified Classification System Type B Periprosthetic Femoral Fracture Around Hip Arthroplasty: A Cross-Sectional Survey. Geriatr Orthop Surg Rehabil 2022; 13:21514593221080341. [PMID: 35360669 PMCID: PMC8961355 DOI: 10.1177/21514593221080341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/22/2021] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Periprosthetic femoral fracture around hip arthroplasty are growing in the
world, nevertheless management and treatment options for fractures “around
the stem” are still debated due to lack of high-level studies. Materials and method A 85-item survey were fill out by 40 Italian Orthopedic Surgeon member of
SIOT (Società Italiana di Ortopedia e Traumatologia) and AIR (Associazione
Italiana Riprotesizzazione) to assess their current opinion in the
management of type B periprosthetic femoral fractures. Responses were
summarized using proportions, and further stratified by practice type, case
volume, surgeon age, and fellowship training. Results Vancouver/UCS fracture classification showed a good interobserver agreement
(k value = .76). ORIF were the treatment of choice for UCS type B1 fractures
(100%), revision stem for B2 (85%) and B3 (100%). Locked plates were
preferred to cable plate and cerclage without a plate for B1 fractures (50%
vs 40% vs 10%); revision with modular stem was preferred to monoblock stem
for B2 fractures (50% vs 35%) and B3 (75% vs 15%). Responders tended to
postpone at 1-month weight-bearing in patients with B1 fractures. Regarding
postoperative pharmacological treatment there was absolute lack of
consensus. Discussion The primary finding of our survey confirmed the preference of ORIF for B1
fractures and stem revision for B2 and B3 fractures. However, there is no
definitive operative technique for all UCS B fractures. Surgeons tended to
favor locked plating over cable plating, although only slightly. This
general lack of consensus coincides with the inconclusive evidence that
currently exists in the literature, which demonstrates both favorable and
unfavorable outcomes for both techniques Conclusions The absence of complete homogeneity among participants showed the need for
prospective randomized studies to set up stronger guidelines for
classification, management, surgical treatment, rehabilitation, and
pharmacological support of periprosthetic femoral fractures.
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Affiliation(s)
- Antonio Capone
- Orthopaedic Clinic, Department of Surgical Sciences, Cagliari State University, Cagliari, Sardegna, Italy
| | - Pietro Cavaliere
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Faggiana", Reggio Calabria, Italy
| | - Antonio Campacci
- IRCCS Ospedale Classificato Equiparato Sacro Cuore, Don Calabria, Negrar, Verona, Italy
| | - Christian Carulli
- Centro Traumatologico Ortopedico, AOU Careggi, Università degli Studi di Firenze, Florence, Italy
| | | | - Filippo Randelli
- Centro Specialistico Ortopedico Traumatologico, ASST Gaetano Pini, Milan, Italy
| | | | - Paolo Esopi
- U.O.C. Ortopedia e Traumatologia, Ospedale di Dolo, ULSS 3, Dolo, Venice, Italy
| | - Stefano Congia
- Orthopaedic Clinic, Department of Surgical Sciences, Cagliari State University, Cagliari, Sardegna, Italy
| | - Giuseppe Marongiu
- Orthopaedic Clinic, Department of Surgical Sciences, Cagliari State University, Cagliari, Sardegna, Italy
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Di Minno MND, Napolitano M, Giuffrida AC, Baldacci E, Carulli C, Boccalandro E, Bruno C, Forneris E, Ricca I, Passeri W, Martinelli M, Rivolta GF, Solimeno LP, Martinoli C, Rocino A, Pasta G. Diagnosis and treatment of chronic synovitis in patients with haemophilia: consensus statements from the Italian Association of Haemophilia Centres. Br J Haematol 2021; 196:871-883. [PMID: 34923621 PMCID: PMC9299781 DOI: 10.1111/bjh.17919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/28/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023]
Abstract
Although synovitis is recognized as a marker of joint disease activity, its periodic assessment is not included in routine clinical surveillance of patients with haemophilia (PwH). In order to evaluate the current knowledge and to identify controversial issues, a preliminary literature search by the Musculoskeletal Committee of the Italian Association of Haemophilia Centres (AICE) has been conducted. Statements have been established and sent to the Italian AICE members to collect their level of agreement or disagreement by a Delphi process. Thirty‐seven consensus recommendations have been drafted. We found a general agreement on the indication to consider the presence of synovitis as a marker of joint disease activity in PwH. Accordingly, there was agreement on the indication to search for synovitis both in patients reporting joint pain and in asymptomatic ones, recognizing ultrasound as the most practical imaging technique to perform periodic joint screening. Interestingly, after detection of synovitis, there was agreement on the indication to modify the therapeutic approach, suggesting prophylaxis in patients treated on demand and tailoring treatment in patients already under prophylaxis. Whereas the need of an early consultation with a physiotherapist is recommended for PwH affected by chronic synovitis, the exact timing for an orthopaedic surgeon consultation is currently unknown.
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Affiliation(s)
| | - Mariasanta Napolitano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | | | - Erminia Baldacci
- Hematology, University Hospital Policlinico Umberto I, Rome, Italy
| | - Christian Carulli
- Department of Health Sciences, Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Elena Boccalandro
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, IRCCS Cà Granda Foundation, Maggiore Hospital Policlinic, Milan, Italy
| | - Clarissa Bruno
- Haemophilia Center and Thrombosis, Policlinico, Bari, Italy
| | - Eleonora Forneris
- Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Irene Ricca
- Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Walter Passeri
- Rehabilitation Service, "Domus Salutis" Casa di Cura, "Teresa Camplani" Foundation, Brescia, Italy
| | - Marco Martinelli
- Rehabilitation Service, "Domus Salutis" Casa di Cura, "Teresa Camplani" Foundation, Brescia, Italy
| | - Gianna Franca Rivolta
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Luigi Piero Solimeno
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, IRCCS Cà Granda Foundation, Maggiore Hospital Policlinic, Traumatology and Orthopaedic Unit, Milan, Italy
| | - Carlo Martinoli
- Department of Health Science (DISSAL), University of Genoa, Unit of Radiology and IRCCS San Martino Hospital, Genoa, Italy
| | - Angiola Rocino
- Haemophilia and Thrombosis Centre, Haematology, Ospedale del Mare, ASL Napoli 1 Centro, Naples, Italy
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Innocenti M, Guido D, Cozzi Lepri A, Maritato E, Carulli C, Matassi F, Civinini R. Proximal femoral replacement: A salvage treatment of cephalomedullary nails' mechanical failures in the elderly population. Injury 2021; 52:1868-1874. [PMID: 33910684 DOI: 10.1016/j.injury.2021.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of proximal femoral replacements (PFR) has been recently described for catastrophic internal fixation failures. PFR is an attractive treatment option because it is technically straightforward and allows for immediate mobilization of the patient. The aim of the study was to determine the survivorship, functional outcome and complications' rate in a group of elderly patients who underwent proximal femoral replacement as a salvage treatment after femur cephalomedullary nails' mechanical failures. METHODS We evaluated 21 patients who underwent salvage of a failed cephalomedullary nail by using a single design PFR at our institution between 2014-2017. A cemented stem was used in all cases. Radiographs were assessed for fractures, sign of loosening, presence of heterotopic ossification and leg length discrepancy. Functional evaluation was performed through Harris Hip Score (HHS), FIM™ and Time Up and Go test (TUG). Kaplan-Meier estimator was used to determine the overall implants' survival. RESULTS The average age at the time of surgery was 83years. The mean follow-up was 3.1years. We recorded 3 dislocations of which 2 required a revision. No case of septic or aseptic failure was reported. Two patients died respectively at 11 and 14 months after surgery. At the last follow-up the mean HHS, FIM™, and the TUG improved significantly (p<0.05). CONCLUSION Immediate weight bearing, good functional outcomes, low complications' and one-year mortality rate make the proximal femur replacement with megaprostheses a potential first line treatment of intertrochanteric/subtrochanteric fixations' failures among elderly, osteoporotic, frail patients. Dislocation is the most common complication to bear in mind within the first six months after surgery.
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Affiliation(s)
- Matteo Innocenti
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy.
| | - Davide Guido
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy
| | - Andrea Cozzi Lepri
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy
| | - Ernesto Maritato
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy
| | - Christian Carulli
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy.
| | - Fabrizio Matassi
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy
| | - Roberto Civinini
- University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy.
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Abstract
PURPOSE The Watson-Jones interval plane between tensor fascia lata (TFL) and the gluteus medius (GM) has come back into fashion in the past few years - Röttinger described the anterolateral minimal invasive approach (ALMI) for use in total hip replacement, in which the standard Watson-Jones interval was used, but with a completely intermuscular plane. However, the term anterolateral is often still utilised to describe intramuscular approaches in which the GM was violated, thus creating a potential misunderstanding in the literature. Accordingly, we have designed a study to answer the following questions: (1) are there articles in the recent literature that use the term "anterolateral" to describe different approaches; (2) which would be the correct description of the anterolateral approach? METHODS We did a systematic review of the literature based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to look for peer reviewed papers of any evidence level focusing on the definition of anterolateral approach; MEDLINE and EMBASE were searched. RESULTS 73 manuscripts met the criteria of the systematic search. 53 papers (72.6%) reported the term anterolateral approach to describe a complete intermuscular approach between the interval between GM and TFL. Nonetheless, in the remaining 20 papers (27.4%) the term anterolateral was used to describe intramuscular approaches in which the gluteus medius was violated. CONCLUSION In about 1 out of 4 papers in the recent literature, the term anterolateral was utilised to describe approaches that are completely different both in terms of anatomy and function.
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Affiliation(s)
- Andrea Cozzi Lepri
- Department of Health Sciences, Orthopaedic Unit, University of Florence, Italy
| | - Marco Villano
- Department of Health Sciences, Orthopaedic Unit, University of Florence, Italy
| | - Fabrizio Matassi
- Department of Health Sciences, Orthopaedic Unit, University of Florence, Italy
| | - Christian Carulli
- Department of Health Sciences, Orthopaedic Unit, University of Florence, Italy
| | - Massimo Innocenti
- Department of Health Sciences, Orthopaedic Unit, University of Florence, Italy
| | - Roberto Civinini
- Department of Health Sciences, Orthopaedic Unit, University of Florence, Italy
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Carulli C, Innocenti M, Linari S, Morfini M, Castaman G, Innocenti M. Joint replacement for the management of haemophilic arthropathy in patients with inhibitors: A long-term experience at a single Haemophilia centre. Haemophilia 2020; 27:e93-e101. [PMID: 32997896 DOI: 10.1111/hae.14169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/05/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The association between haemophilia and the so-called 'inhibitors', alloantibodies against the infused factor able to neutralize its clotting activity, is a very rare condition. Those sporadic patients suffer of an even more severe arthropathy and performing primary or revision arthroplasty become truly challenging. Literature about this topic is scarce, consisting in small case series, high rates of complications and mid-term follow-ups. AIM The purpose of this study is the assessment of the long-term outcomes of primary and revision arthroplasty performed in a population of patients with inhibitors, the more consistent to date reported at a single haemophilia centre. METHODS We reviewed the records of 18 patients with inhibitors (26 procedures) between 1999 and 2017, divided in two groups. Group A [primary total Knee-Hip arthroplasty (TKA-THA)]: 13 patients underwent 19TKA and 2THA; and B (revision): 5 subjects underwent 3rTKA and 2rTHA. All patients received the same haematological prophylaxis (rFVIIa). Haemophilic Joint Health score and VAS, and X-rays were recorded pre- and postoperatively. The survival rate of all primary implants was assessed. RESULTS The median follow-up was 12.2 years (3-21) for group A, 8.6 years (4-12) for B. Few complications have been reported; the overall survival rate was 94.7% at 15 years. All patients reported satisfaction, pain reduction and improved functional ability. CONCLUSION Primary and revision TKA/THA in haemophilic subjects and inhibitors may be nowadays considered safe and effective if performed in dedicated multidisciplinary centres. The use of continuous infusion of rFVIIa showed an adequate haemostatic effect and low rate of complications. As expected, revisions are more prone to complications compared to primary arthroplasty.
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Affiliation(s)
- Christian Carulli
- Department of Orthopaedic Surgery, University Hospital of Florence, Florence, Italy
| | - Matteo Innocenti
- Department of Orthopaedic Surgery, University Hospital of Florence, Florence, Italy
| | - Silvia Linari
- Center for Bleeding Disorders and Coagulation, University Hospital of Florence, Florence, Italy
| | | | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, University Hospital of Florence, Florence, Italy
| | - Massimo Innocenti
- Department of Orthopaedic Surgery, University Hospital of Florence, Florence, Italy
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Pratelli E, Apicella L, Bertaccini B, Petrocelli A, Petrai V, Carulli C, Innocenti M, Pasquetti P. [Results of a vertebral deformity screening in the students of the district of Florence (Tuscany Region, Central Italy)]. Epidemiol Prev 2020; 44:154-161. [PMID: 32631015 DOI: 10.19191/ep20.2-3.p154.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to observe the prevalence of vertebral deformities in an adolescent population in the 178 schools of the District of Florence (Tuscany Region, Central Italy), correlating these results with clinical aspects as ligamentous laxity and verifying if these data are in agreement with what emerged in literature in studies of the same type. DESIGN prevalence study. SETTING AND PARTICIPANTS report of the results of a school screening for vertebral deformities in an adolescent population of 11,820 students of the Schools of District of Florence held between November 2010 and June 2013. MAIN OUTCOMES MEASURES asymmetry of waist triangle; trunk imbalance using plumb-line from C7; leg length discrepancies; presence of gibbus and measurement of Angle of Trunk Rotation using Bunnell scoliometer; measure of thoracic kyphosis (a value of kyphosis> 50° was considered to be at high risk of hyperkyphosis making it necessary to request an X-ray); ligamuentuos laxity using Beighton Score. RESULTS 11,820 students were screened; 85.95% of them had no significant spinal deformities; 14,05% of the students showed significant clinical signs of scoliosis; 28.46% of the students had a thoracic hyperkyphosis (>40°), 1.55% of those presented a non-reducible thoracic hyperkyphosis. Results show a statistically significant correlation between the severity of the deformities and the score of the Beighton Score. CONCLUSIONS the results confirm the association between vertebral deformities and ligament laxity. The prevalence of vertebral deformities in the school age population of the Municipality of Florence is 14.05%, in accordance with what emerged in the literature from similar studies.
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Affiliation(s)
- Elisa Pratelli
- Unità di riabilitazione, Centro traumatologico ortopedico, Azienda ospedaliero universitaria Careggi, Firenze
| | - Lorenzo Apicella
- Unità di riabilitazione, Centro traumatologico ortopedico, Azienda ospedaliero universitaria Careggi, Firenze;
| | - Bruno Bertaccini
- Dipartimento di statistica, informatica, applicazioni "G. Parenti", Università di Firenze
| | - Antonio Petrocelli
- Unità di riabilitazione, Centro traumatologico ortopedico, Azienda ospedaliero universitaria Careggi, Firenze
| | - Veronica Petrai
- Unità di riabilitazione, Centro traumatologico ortopedico, Azienda ospedaliero universitaria Careggi, Firenze
| | - Christian Carulli
- Clinica ortopedica, Centro traumatologico ortopedico, Azienda ospedaliero universitaria Careggi, Firenze
| | - Massimo Innocenti
- Clinica ortopedica, Centro traumatologico ortopedico, Azienda ospedaliero universitaria Careggi, Firenze
| | - Pietro Pasquetti
- Unità di riabilitazione, Centro traumatologico ortopedico, Azienda ospedaliero universitaria Careggi, Firenze
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20
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Civinini R, Cozzi Lepri A, Carulli C, Matassi F, Villano M, Innocenti M. Patients Following Revision Total Hip Arthroplasty With Modular Dual Mobility Components and Cobalt-Chromium Inner Metal Head are at Risk of Increased Serum Metal Ion Levels. J Arthroplasty 2020; 35:S294-S298. [PMID: 32197964 DOI: 10.1016/j.arth.2020.02.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/14/2020] [Accepted: 02/24/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Modular dual-mobility (MDM) total hip arthroplasty (THA) is designed with a cobalt-chromium liner inserted into a titanium acetabular component. The purpose of this study is to investigate the potential risks for fretting corrosion at this junction, by measuring serum metal ions, after MDM acetabular revision. METHODS Thirty-seven patients with well-functioning revision THAs participated in a cross-sectional study at mean 5.1 (2-10) years after surgery. All received a trabecular titanium MDM acetabular component. The serum levels of cobalt and chromium were measured using mass spectrometry. RESULTS The mean values of chromium and cobalt were 2.08 μg/L (95% confidence interval 0.9-3.2, range 0.02-11.8) and 1.99 μg/L (95% confidence interval 0.81-3.17, range 0.07-16.05), respectively. Eleven patients (29, 7%) had ion levels above the normal range, with 6 (16.2%) above 5 μg/L and 5 (13.5%) between 1 and 5 μg/L. A significant correlation was found between an elevated serum metal ion level and University of California Los Angeles score (P = .016). CONCLUSION We conclude that serum metal level elevation may occur secondary to metal debris resulting from corrosion of the index MDM THA. This potential risk should be included in the decision-making process when dealing with revision arthroplasty in young and active patients.
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Affiliation(s)
- Roberto Civinini
- Orthopedic Unit, Department of Health Sciences, University of Florence, Firenze, Italy
| | - Andrea Cozzi Lepri
- Orthopedic Unit, Department of Health Sciences, University of Florence, Firenze, Italy
| | - Christian Carulli
- Orthopedic Unit, Department of Health Sciences, University of Florence, Firenze, Italy
| | - Fabrizio Matassi
- Orthopedic Unit, Department of Health Sciences, University of Florence, Firenze, Italy
| | - Marco Villano
- Orthopedic Unit, Department of Health Sciences, University of Florence, Firenze, Italy
| | - Massimo Innocenti
- Orthopedic Unit, Department of Health Sciences, University of Florence, Firenze, Italy
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21
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Carulli C, Sani G, Matassi F, Civinini R, Innocenti M. A Mid- to Long-Term Follow-Up Experience with a Specific Metal-on-Metal Total Hip Arthroplasty Design. Joints 2020; 7:91-97. [PMID: 34195536 PMCID: PMC8236331 DOI: 10.1055/s-0040-1710388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/04/2020] [Indexed: 11/09/2022]
Abstract
Purrpose
Metal-on-metal (MoM) total hip arthroplasty (THA) has been a subject of recent discussion and concern due to the early failures caused by local and systemic adverse reactions related to specific designs. The aim of this study is to analyze the outcomes and survival rates of a single brand of MoM implants implanted in a consecutive series of patients at a single institution.
Methods
Between 2007 and 2012, 116 (118 hips) patients were evaluated at a mean follow-up of 6.6 years after primary THA. The diagnosis leading to surgery was osteoarthritis (80 patients) and proximal femoral fracture (36 patients). A single design of THA was implanted. All patients were evaluated before surgery and postoperatively at 1, 3, 6, and 12 months by clinical scores and radiographic studies. The data analysis was made using Student's
t
-test.
Results
The minimum follow-up was of 4 years, with a mean follow-up of 6.6 years. Two aseptic loosenings of the acetabular component were recorded (one per group), which were not associated with local or systemic complications related to metal ion release. Both were revised by an isolated acetabular cup substitution with metal-on-polyethylene couplings. Nonprogressive radiolucency lines < 2 mm in zone 2 were observed in other six patients around the acetabular component without clinical manifestation (four in the arthritis group and two in the fracture group). Postoperative Harris Hip Score and SF-36 (36-Item Short Form Survey) score improved in both groups.
Conclusion
Despite several MoM implants showing early complications and failures, a specific MoM design may be associated with good clinical results at a mid- to long-term follow-up.
Level of Evidence
This is a therapeutic case series, Level 4 study.
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Affiliation(s)
| | - Giacomo Sani
- Orthopaedic Clinic, University of Florence, Florence, Italy
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22
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Carulli C, Rizzo AR, Innocenti M, Civinini R, Castaman G, Innocenti M. Viscosupplementation in symptomatic haemophilic arthropathy of the knee and ankle: Experience with a high molecular weight hyaluronic acid. Haemophilia 2020; 26:e198-e200. [PMID: 32227384 DOI: 10.1111/hae.13979] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/28/2020] [Accepted: 03/09/2020] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | | | - Giancarlo Castaman
- Center for Haemorragic and Coagulative Disorders, Careggi University Hospital, Florence, Italy
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23
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Carulli C, Innocenti M, Roselli G, Sirleo L, Matassi F, Innocenti M. Partial rupture of anterior cruciate ligament: preliminary experience of selective reconstruction. J Orthop Traumatol 2020; 21:5. [PMID: 32222861 PMCID: PMC7103020 DOI: 10.1186/s10195-020-0544-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/28/2020] [Indexed: 01/13/2023] Open
Abstract
Background Partial lesions of the anterior cruciate ligament (ACL) are more common than is generally thought, accounting for about 10–12% of ACL injuries. Selective reconstruction may be considered as an option in isolated bundle rupture. The purpose of this study is to evaluate both subjective and objective clinical results, as well as functional recovery time, after selective arthroscopic single-bundle reconstruction in a consecutive series of patients affected by partial ACL rupture. Materials and methods Thirty-six patients undergoing selective reconstruction of a single ACL bundle were retrospectively evaluated from a series of 354 ACL reconstructions performed over a 3-year period. Although the suspicion of partial lesions was present at clinical and magnetic resonance imaging (MRI) evaluation, final diagnosis was obtained during arthroscopy. All patients were operated using the same technique and type of fixation, and undergoing the same functional recovery protocol. Results Mean follow-up was 64 months (48–84 months). All patients but one achieved good functional recovery and returned to their sports within a mean period of 6.1 months. A single patient complained of postoperative instability 1 year after the index operation and needed further surgery. No complications were recorded. Conclusions Selective reconstruction of partial ACL injury is a method to bear in mind because it offers quick functional recovery. Specific technical and diagnostic steps should be performed and discussed with patients preoperatively. Level of evidence Level 4, retrospective study.
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Affiliation(s)
- Christian Carulli
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy.
| | - Giuliana Roselli
- Department of Radiology at Orthopaedic Clinic CTO, University of Florence, Florence, Italy
| | - Luigi Sirleo
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Fabrizio Matassi
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
| | - Massimo Innocenti
- Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139, Florence, Italy
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24
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Fortina M, Maniscalco P, Carulli C, Meccariello L, Colasanti GB, Carta S. Jockey injuries during the Siena "Palio". A 72-year analysis of the oldest horse race in Italy. Injury 2019; 50 Suppl 4:S56-S59. [PMID: 30910241 DOI: 10.1016/j.injury.2019.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Horse racing is a hazardous sport. We analyzed the incidence and characteristics of jockey injuries in a typical horse race. METHODS We analyzed all injuries sustained by 224 jockeys in the last 72 years. RESULTS It was found that in 96.1% of the races there was at least one fall and in 28.6% of the races 50% or more of the jockeys fell. In 43.4% of the falls, the jockey was taken to the emergency room. Comparing the Palio with traditional races in other countries, a higher injury incidence rate was observed for every 100 falls (109.884 vs 27-59) and a lower concussion rate/100 falls (0.97 vs 1.8-7.4). CONCLUSION The Palio is one of the most threatening races that continues today. Jockeys are at greater risk for a fall than any other race in the world.
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Affiliation(s)
- Mattia Fortina
- Department of Orthopaedics and Traumatology, University Hospital of Siena, V.le Bracci, n°14-16, 53100 Siena, Italy.
| | - Pietro Maniscalco
- Department of Orthopaedics and Traumatology, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | | | - Luigi Meccariello
- Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
| | - Giovanni Battista Colasanti
- Department of Orthopaedics and Traumatology, University Hospital of Siena, V.le Bracci, n°14-16, 53100 Siena, Italy.
| | - Serafino Carta
- Department of Orthopaedics and Traumatology, University Hospital of Siena, V.le Bracci, n°14-16, 53100 Siena, Italy.
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25
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Pierannunzii L, Di Benedetto P, Carulli C, Fiorentino G, Munegato D, Panascì M, Potestio D, Randelli F, Della Rocca F, Rosolen V, Giangreco M, Santori N. Mid-term outcome after arthroscopic treatment of femoroacetabular impingement: development of a predictive score. Hip Int 2019; 29:303-309. [PMID: 29987953 DOI: 10.1177/1120700018786025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To build a post-arthroscopy outcome-predictive score (POPS) associated with the likelihood of lasting benefit after arthroscopic treatment of femoroacetabular impingement (FAI) and based solely on unambiguous preoperative information. METHODS A population of 220 FAI patients, operated on with standard techniques by orthopaedic surgeons trained in hip arthroscopy in 6 different centres, was evaluated physically or by telephone interview 2 to 5 years after surgery. The criteria of successful mid-term outcome (SMO) were agreed upon by all authors. A multivariate logistic regression, adjusted for patient's age and centre, was applied to predict SMO. In the model, the variables associated with the outcome were included and the relative ORs (odds ratios) were used to compute the FAI-POPS (FAI - post-arthroscopy outcome-predictive score). A ROC (receiver operating characteristic) curve was plotted and the optimum cut-off was calculated. RESULTS 155 patients out of 220 showed a successful mid-term outcome. The optimum cut-off of FAI-POPS was calculated to be 6.3 and with this threshold it proved a sensitivity of 0.66 and a specificity of 0.69, a positive predictive value of 0.84 and a negative predictive value of 0.46. CONCLUSIONS The standard arthroscopic treatment of FAI resulted in satisfactory persistent symptom relief for about 70% of patients. No or minimal osteoarthritis, short time elapsed from the appearance of symptoms and high preoperative modified Harris Hip Score are independent predictive factors of SMO. The FAI-POPS is obtained as sum of 3 odds ratios corresponding to the above prognostic factors and is a useful predictor of mid-term outcome after conventional arthroscopic FAI treatment.
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Affiliation(s)
| | - Paolo Di Benedetto
- 2 Clinica Ortopedica, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | | | - Gennaro Fiorentino
- 4 Department of Orthopaedics and Traumatology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Daniele Munegato
- 5 Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | | | - Filippo Randelli
- 8 Hip Department and Trauma, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy
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26
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Fortina M, Maniscalco P, Carulli C, Meccariello L, Colasanti GB, Carta S. WITHDRAWN: Jockey injuries during the Siena "Palio". A 72-year analysis of the oldest horse race in Italy. Injury 2019; 50:365-368. [PMID: 30580929 DOI: 10.1016/j.injury.2018.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 02/02/2023]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published in Injury, 50(2) 2019 365–368, https://doi.org/10.1016/j.injury.2018.12.014. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Mattia Fortina
- Department of Orthopaedics and Traumatology, University Hospital of Siena, V.le Bracci, n̊14-16, 53100 Siena, Italy.
| | - Pietro Maniscalco
- Department of Orthopaedics and Traumatology, Guglielmo da Saliceto Hospital, PiacenzaItaly.
| | | | - Luigi Meccariello
- Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, LecceItaly.
| | - Giovanni Battista Colasanti
- Department of Orthopaedics and Traumatology, University Hospital of Siena, V.le Bracci, n̊14-16, 53100 Siena, Italy.
| | - Serafino Carta
- Department of Orthopaedics and Traumatology, University Hospital of Siena, V.le Bracci, n̊14-16, 53100 Siena, Italy.
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27
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Carulli C, Innocenti M, Lazzarini F, Villano M, Pasta G, Brandi ML, Innocenti M. The biomolecular interactions between endothelium and bone cells: an overview. J BIOL REG HOMEOS AG 2018; 32:173-179. [PMID: 30644299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Bone turnover is a complex set of different molecules pathways and it is strictly connected with bone vasculature. It includes every bone process concerning bone modelling and remodelling such us skeletal growth and healing process. A fundamental component of this bone architecture is played by the endothelium, that acts in a paracrine fashion on other bone stromal cells via humoral factors, growth factors and chemokines/cytokines. The alteration of those biochemical interactions between endothelium, vasculature and bone tissue may cause various pathological manifestations. Understanding the bases of the interaction between those different pathways could provide novel therapeutic strate¬gies for bone disease. The Authors present an updated overview of the most common communication biomolecules between bone cells and endothelium and their interactions both in healthy and pathological conditions. Furthermore, focusing on gene and related therapies, possible future therapeutic strategies for bone vasculature/metabolic diseases are presented.
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Affiliation(s)
- C Carulli
- Orthopaedic Clinic, University of Florence
| | | | | | - M Villano
- Orthopaedic Clinic, University of Florence
| | - G Pasta
- Operative Unit of Orthopaedics and Traumatology, Fond. IRCCS Policlinico S.an Matteo, Pavia
| | - M L Brandi
- Bone Metabolic Disease Unit, University of Florence
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Civinini R, Cozzi Lepri A, Carulli C, Matassi F, Villano M, Innocenti M. The anterior-based muscle-sparing approach to the hip: the "other" anterior approach to the hip. Int Orthop 2018; 43:47-53. [PMID: 30284607 DOI: 10.1007/s00264-018-4190-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/26/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE The purpose of this study was to evaluate safety, efficacy, and learning curves of anterior-based muscle-sparing total hip arthroplasty (ABMS-THA) in the supine position. Furthermore, early functional outcome was evaluated and compared to direct anterior approach (DAA) by measuring surface electromyography (sEMG). METHODS We present a prospective cohort study of 343 hips. The safety and learning curve were assessed by recording operative time and peri-operative adverse events. For assessment of efficacy, functional and radiological outcomes were evaluated. A selected group of 32 patients have been studied by sEMG and compared to a matched group of 32 patients who received a THA using DAA approach. RESULTS There was one dislocation (0.3%); two (0.6%) patients had an intra-operative fractures of the greater trochanter; two patients (0.6%) experienced a self-limited femoral nerve palsy. Physical therapy milestones for hospital discharge were reached on an average of 1.7 days. sEMG showed that ABMS and DAA have a similar muscle recruitment pattern and functional recovery after THA. One patient was revised for infection, 16 were lost, and 326 hips were available with a median follow-up of 42 months (range 24-60). The mean Harris Hip Score (HSS) increased from 44.3 to 91.9. Ninety-six percent of the hips had a leg length discrepancy (LLD) < 5 mm. There were no radiological signs of mechanical loosening or osteolysis. CONCLUSIONS The ABMS approach in the supine position is clinically effective and safe; special advantages include a very low dislocation rate and a great control of LLD.
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Affiliation(s)
- Roberto Civinini
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy.
| | - Andrea Cozzi Lepri
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy
| | - Christian Carulli
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy
| | - Fabrizio Matassi
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy
| | - Marco Villano
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy
| | - Massimo Innocenti
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, C.T.O. Largo Palagi 1, 50139, Florence, Italy
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29
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Grassi A, Carulli C, Innocenti M, Mosca M, Zaffagnini S, Bait C. New Trends in Anterior Cruciate Ligament Reconstruction: A Systematic Review of National Surveys of the Last 5 Years. Joints 2018; 6:177-187. [PMID: 30582107 PMCID: PMC6301855 DOI: 10.1055/s-0038-1672157] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 08/10/2018] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to analyze national surveys of orthopaedic surgeons on anterior cruciate ligament (ACL) reconstruction to determine their preferences related to the preferred graft, femoral tunnel positioning, fixation and tensioning methods, antibiotic and anti-thromboembolic prophylaxis, and use of tourniquet and drains. A systematic search of PubMed, Web of Science, and Cochrane Library was performed. Inclusion criteria were surveys of ACL reconstruction trends and preferences published in the past 5 years (2011–2016), involving members of national societies of orthopaedics. Information regarding survey modalities, population surveyed, graft choice both in the general or in the athletic population, surgical technique, fixation, use of antibiotic, tourniquet, drains, and anti-thromboembolic prophylaxis was extracted. Eight national surveys were included from Europe (three), North or Latin America (three), and Asia (two). Overall, 7,420 questionnaires were sent, and 1,495 participants completed the survey (response rate ranging from 16 to 76.6%). All surveys reported the hamstring tendon (HT) autograft as the preferred graft, ranging from 45 to 89% of the surveyed population, followed by bone-patellar tendon-bone (BPTB) graft (2–41%) and allograft (2–17%). Only two surveys focusing on graft choice in athletic population underlined how in high-demand sportive population the graft choices changes in favor of BPTB. Single-bundle reconstruction was the preferred surgical technique in the four surveys that investigated this issue. Five surveys were in favor of anteromedial (AM) portal and two in favor of trans-tibial technique. Suspension devices for femoral fixation were the preferred choice in all but one survey, while interference screws were the preferred method for tibial fixation. The two surveys that investigated graft tensioning were in favor of manual tensioning. The use of tourniquet, antibiotics, drains, and anti-thromboembolic prophylaxis were vaguely reported. A trend toward the preference of HT autograft was registered in all the surveys; however, sport participation has been highlighted as an important variable for increased use of BPTB. Single-bundle reconstruction with AM portal technique and suspension femoral fixation and screws fixation for the tibia seem the preferred solution. Other variables such as tensioning, antibiotic, anti-thromboembolic prophylaxis, tourniquet use, and drains were investigated scarcely among the surveys; therefore, no clear trends could be delineated. This is a Level V, systematic review of expert opinion study.
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Affiliation(s)
- Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Christian Carulli
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Massimiliano Mosca
- II Clinica Ortopedica e Traumatologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Corrado Bait
- Joint Surgery and Sport Medicine Unit, Istituto Clinico Villa Aprica, Como, Italy
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Carulli C, Tonelli F, Melani T, Pietragalla M, De Renzis AGD, Caracchini G, Innocenti M. Diagnostic Accuracy of Magnetic Resonance Arthrography in Detecting Intra-articular Pathology Associated with Femoroacetabular Impingement. Joints 2018; 6:104-109. [PMID: 30051107 PMCID: PMC6059867 DOI: 10.1055/s-0038-1660839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 05/13/2018] [Indexed: 11/08/2022]
Abstract
Purpose
The aim of this study was to assess the diagnostic accuracy of magnetic resonance arthrography (MRA) in the detection of intra-articular lesions of the hip in patients affected by femoroacetabular impingement (FAI) by using arthroscopy as reference standard.
Methods
Twenty-nine consecutive hip arthroscopies performed in 24 patients were considered for the study. Patients had a mean age of 38.3 years. Ultrasound-guided 1.5-T MRA was performed with precontrast short tau inversion recovery, T1-weighted and PD coronal, T1-weighted, and T2-weighted axial with 3-mm-thick slice sequences, and postcontrast T1-weighted fat saturation MRA (Fat-SAT) axial, coronal and oblique sagittal, and T1-weighted Vibe 3D coronal sequences with MPR sagittal, axial, and radial reconstructions with 2-mm-thick slice and coronal density protonil (DP) Fat-SAT. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRA were evaluated by comparison arthroscopy for the following intra-articular findings: acetabular and femoral chondral lesions, labral degeneration, labral tears, synovitis, ligamentum teres (LT) tears, CAM lesions, pincer lesions, loose bodies, and osteophytes.
Results
An absolute per cent agreement (100%) was observed for all the variables in the assessment of CAM lesions. Sensitivity, specificity, PPV, and NPV of MRA were 100, 68.4, 72.7, and 100%, respectively, for acetabular chondral lesions; 100, 50, 47.3, and 100%, respectively, for femoral chondral lesions; 33, 85, 20, and 91.6%, respectively, for labral tears; 95, 71, 91.3, and 83.3%, respectively, for labral degeneration; 100, 88, 57.1, and 100%, respectively, for LT tears; 33.3, 85, 50, and 73.9%, respectively, for pincer lesions; 50, 96, 66.6, and 92.3%, respectively, for intra-articular loose bodies; and 100, 73.9, 50, and 100%, respectively, for osteophytes.
Conclusion
MRA may play an important role in detecting intra-articular lesions associated with FAI. This might be helpful for the preoperative planning before hip arthroscopy.
Level of Evidence
This is a Level 2, diagnostic accuracy study compared with gold standard.
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Affiliation(s)
- Christian Carulli
- Orthopaedic Clinic, Orthopaedic Traumatologic Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Filippo Tonelli
- Orthopaedic Clinic, Orthopaedic Traumatologic Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Tommaso Melani
- Orthopaedic Clinic, Orthopaedic Traumatologic Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michele Pietragalla
- Radiology Unit, Orthopaedic Traumatologic Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Giuseppe Caracchini
- Radiology Unit, Orthopaedic Traumatologic Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Massimo Innocenti
- Orthopaedic Clinic, Orthopaedic Traumatologic Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Macera A, Carulli C, Sirleo L, Innocenti M. Postoperative Complications and Reoperation Rates Following Open Reduction and Internal Fixation of Ankle Fracture. Joints 2018; 6:110-115. [PMID: 30051108 PMCID: PMC6059857 DOI: 10.1055/s-0038-1653949] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 04/08/2018] [Indexed: 12/11/2022]
Abstract
Purpose
The purpose of this study was to determinate the overall postoperative complication and reoperation rates related to open reduction and internal fixation (ORIF) of ankle fractures.
Methods
All patients who had undergone an ankle fracture operation at our institution from January 2005 through December 2013 were identified by querying the hospital surgical procedure database for diagnoses codes. Medical records, surgical procedure, and outpatient control reports were reviewed to collect pre-, intra-, and postoperative details. All data obtained were retrospectively analyzed by the authors to evaluate the postoperative complications and the type of further surgical treatment required to treat them.
Results
A total of 378 consecutive patients were included in the study. Overall complications rate was 36.0%. Minor complications (4.5%) were represented by superficial infection (1.3%) and impaired wound healing (3.2%). All these patients required advanced wound care and prolonged oral antibiotics. Major complications (31.5%) included: residual pain (17.2%), deep infection (3.4%), malunion (2.4%), posttraumatic ankle osteoarthritis (5.0%), implant breakage (0.3%), complex regional pain syndrome (1.3%), and arthrofibrosis (1.9%). Note that 21.7% of major complications required further surgical procedure. Reoperations included arthroscopic debridement (15.1%), hardware removal and debridement of all necrotic tissue (4.5%), and ankle fusion (2.1%). Surgery was necessary mainly for pain removal and function recovery.
Conclusion
Ankle fracture ORIF represents a satisfying surgical treatment. Nevertheless, postoperative complications are not uncommon. Minor complications can be easily managed with medications and repeated outpatient controls. Reoperation is occasionally required to treat major complications. Revision surgery is mandatory to ensure pain relief and function improvement.
Level of Evidence
Level II, retrospective cohort study.
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Affiliation(s)
| | | | - Luigi Sirleo
- Orthopaedic Clinic, University of Florence, Florence, Italy
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Abstract
Tarsal coalitions have an incidence of 2% and are often underdiagnosed. These are considered to be one of the causes of chronic ankle and foot pain. Among all tarsal coalitions, the talonavicular type represents a rare and uncommon condition. The purpose of this article was to present the case of a 35-year-old male patient with a bilateral talonavicular coalition treated conservatively. A review of the literature was also performed to understand the management of this rare condition.
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Affiliation(s)
- Armando Macera
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | - Francesca Teodonno
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | - Christian Carulli
- Orthopedic Clinic, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alberto Frances Borrego
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | - Massimo Innocenti
- Orthopedic Clinic, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Innocenti M, Mancini M, Faccio M, Carulli C, Buselli P, Messina S, Quattrone G, Spaggiari P. The Use of a High-Tech Knee Pad for Reduction of the Postoperative Effusion after Total Knee Arthroplasty. Joints 2017; 5:7-11. [PMID: 29114623 PMCID: PMC5672854 DOI: 10.1055/s-0037-1601406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Purpose
After total knee arthroplasty (TKA), pain and swelling, especially in older and less cooperative patients, can limit the retrieval of a good range of motion and muscle tone and consequently the achievement of an optimal function outcome. A high-tech knee pad made of metal fibers emitting infrared energy was used in a group of patients undergoing TKA to assess its efficacy in the postoperative period with respect to a group with a placebo.
Methods
Twelve patients used knee pads after surgery for 3 weeks and were evaluated using visual analog scale (VAS), Knee Society Rating Score, Cincinnati Knee Rating Score, and painkillers at specific timings.
Results
At 3 weeks, all scores improved in a significant manner in the treated group compared with the placebo group. At 2 months after surgery, VAS was better in the study group than the control group, whereas other parameters were similar. However, the use of rescue drugs was less in the study group than in the placebo group.
Conclusion
A high-tech knee pad may contribute to a faster recovery within the first week after a knee replacement, limiting the use of painkillers and allowing a quick functional recovery by the control of pain and postoperative effusion.
Level of Evidence
Level II, randomized prospective study with small sample size.
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Affiliation(s)
| | - Michele Mancini
- Department of Orthopaedics, University of Florence, Florence, Italy
| | - Marina Faccio
- Department of Orthopaedics, University of Florence, Florence, Italy
| | | | - Paolo Buselli
- Department of Rehabilitation, Azienda Ospedaliera Istituti Ospitalieri, Cremona, Italy
| | - Sara Messina
- Department of Rehabilitation, Azienda Ospedaliera Istituti Ospitalieri, Cremona, Italy
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Matassi F, Paoli T, Civinini R, Carulli C, Innocenti M. Oxidized zirconium versus cobalt-chromium against the native patella in total knee arthroplasty: Patellofemoral outcomes. Knee 2017; 24:1160-1165. [PMID: 28601393 DOI: 10.1016/j.knee.2017.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/27/2017] [Accepted: 04/19/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Oxidized zirconium (OxZr) has demonstrated excellent mechanical properties in vitro when used against articular cartilage; less coefficient of friction and less chondral damage have been found when compared with cobalt-chromium (CoCr) implants. However, controversy exists as to whether implants with a zirconium femoral component articulate safely with a native patella in total knee arthroplasty (TKA). To answer this question, the clinical and radiographic results were analysed from a group of patients who underwent a TKA with patella retention; the OxZr versus CoCr femoral components were compared. METHODS The present study prospectively evaluated 83 knees of 74 patients from 2009 to 2010. Each patient was evaluated clinically (visual analogue scale, Knee Society score, patellar score) and radiographically (long leg standing radiograph, anterior-posterior and latero-lateral projections, axial view of the patella) pre-operatively and postoperatively with a mean follow-up of 4.47years. The patellar tilt and shift, and progression of patellofemoral osteoarthritis were calculated with the axial view. RESULTS There were no patient reported adverse reactions and none of the evaluated prostheses failed. Both the clinical and radiographic evaluations showed no statistically significant between-group differences. CONCLUSION No adverse events were observed clinically or radiologically. These results justify pursuing the use of oxidized zirconium as an alternative bearing surface for a femoral component associated with patellar retention in TKA.
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Affiliation(s)
- Fabrizio Matassi
- Orthopaedic Clinic, University of Florence, Department of Surgery and Translational Medicine, Florence, Italy
| | - Tommaso Paoli
- Orthopaedic Clinic, University of Florence, Department of Surgery and Translational Medicine, Florence, Italy.
| | - Roberto Civinini
- Orthopaedic Clinic, University of Florence, Department of Surgery and Translational Medicine, Florence, Italy
| | - Christian Carulli
- Orthopaedic Clinic, University of Florence, Department of Surgery and Translational Medicine, Florence, Italy
| | - Massimo Innocenti
- Orthopaedic Clinic, University of Florence, Department of Surgery and Translational Medicine, Florence, Italy
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Carulli C, Zago M, Rizzo AR, Innocenti M. Reconstructive techniques for revision and limb salvage surgery in persons with haemophilia. J BIOL REG HOMEOS AG 2017; 31:15-19. [PMID: 29180271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Haemophilia is an inherited haemorrhagic disease characterized by the lack of coagulative factors associated nowadays mostly to musculoskeletal complications, particularly severe secondary arthritis in specific joints. Recurrent traumatic or spontaneous joint bleeding, induce severe arthropathy at a young age that can be treated only by joint replacement. Total knee or hip arthroplasty in young subjects may fail earlier due to wear or infections and in the haemophilic population, this means bone loss, pseudo tumours and the need of revision or even limb salvage surgery. Modern modular implants and the use of bone graft enriched by tissue engineering techniques such as a concentration of autologous mesenchymal cells or PRP may be helpful to compensate all bone loss and anatomic alterations due to failures of orthopaedic implants. The authors present their experience with this type of surgery and their biological approach to these challenging cases.
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Affiliation(s)
- C Carulli
- Orthopaedic Clinic, Department of Surgery and Translational Medicine University of Florence, Italy
| | - M Zago
- Orthopaedic Clinic, Department of Surgery and Translational Medicine University of Florence, Italy
| | - A R Rizzo
- Orthopaedic Clinic, Department of Surgery and Translational Medicine University of Florence, Italy
| | - M Innocenti
- Orthopaedic Clinic, Department of Surgery and Translational Medicine University of Florence, Italy
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Abstract
The question of whether to use cemented or cementless fixation for a total knee arthroplasty (TKA) is still debated. Discouraging preliminary results of cementless TKAs have determined the worldwide use of cemented implants. However, with the development of biotechnologies and new biomaterials with high osteoconductive properties, biological fixation is now becoming an attractive option for improving the longevity of TKAs, especially in young patients.There is no evidence in the current literature to support the use of one method of fixation. The extensive clinical experience with cemented implants gathered over the years justifies their widespread use. New randomized clinical trials are necessary to compare cementless fixation based on the new ingrowth surfaces with standard cemented implants.
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Civinini R, Capone A, Carulli C, Matassi F, Nistri L, Innocenti M. The kinetics of remodeling of a calcium sulfate/calcium phosphate bioceramic. J Mater Sci Mater Med 2017; 28:137. [PMID: 28785889 DOI: 10.1007/s10856-017-5940-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/27/2017] [Indexed: 06/07/2023]
Abstract
In the last years considerable research and development activity have been expended to find new ceramic bone substitutes for the treatment of bone defects. However in many cases the drawback of synthethic bone substitutes are the slow graft incorporation and remodelling into the host bone. The purpose of this study was to analyze the kinetics of resorption and new bone formation of new calcium sulfate (CaSO4)/calcium phosphate (CaPO4) bioceramic engineered to enhance its bone forming properties. We prospectively evaluated the results of a series of 15 hips with osteonecrosis of the femoral head (ONFH) treated at with core decompression and injection of the CaSO4/CaPO4 composite. In all hips, a quantitative computed tomography (QTC) scan was taken within one week after the surgery, at 12 months, 2 years and finally with a minimum of 4 years follow-up. The mean HU in the immediate post-operative period was 1445 (Range 1388-1602); At one year the mean HU strongly decrease at 556.6 HU (P < 0.01); The mean HU at 2 years follow-up further decreased to 475.1. The mean HU at 4 years was unchanged. The quantitative and qualitative CT scan data of this series indicates that the CaSO4-CaPO4 ceramic composite resorbs over a narrow timeframe and the gradual resorption of the graft within the defect provides an ideal environment for the direct new bone growth that propagates across the defect.
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Affiliation(s)
- Roberto Civinini
- Department of Surgery and Translational Medicine, University of Florence, CTO - Largo Palagi 1, 50139, Florence, Italy.
| | - Antonio Capone
- Department of Surgery and Translational Medicine, University of Florence, CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Christian Carulli
- Department of Surgery and Translational Medicine, University of Florence, CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Fabrizio Matassi
- Department of Surgery and Translational Medicine, University of Florence, CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Lorenzo Nistri
- Department of Surgery and Translational Medicine, University of Florence, CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Massimo Innocenti
- Department of Surgery and Translational Medicine, University of Florence, CTO - Largo Palagi 1, 50139, Florence, Italy
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Abstract
Purpose
This study aims to analyze the risk factors and type of injuries occurring in Taekwondo athletes participating in a national competition.
Methods
Out of the 127 competitors, 18 athletes got injured during a Taekwondo championship who were analyzed for the following parameters: modality of training; age, weight; belt color; and the type of injury.
Results
Around 89% of the injuries were due to bruising and were found mainly on the lower limbs (61%) during the elimination rounds and during the first match of the day. The higher probability of injury was in the second round (56%), and during the first match of the day (72%). Nearly all the athletes were able to complete the game in which they were injured (83%). Comparing the average age of the athletes suffering an injury (23.6 ± 2.06 years) with their average years of training (8.4 ± 7.05 years) it can be noted that these athletes began this discipline rather late. The more is the training age and the weekly hours of training, the more are the numbers of matches completed, even as injured. Beginners with a low-level belt suffered more injuries than the experienced subjects did.
Conclusion
The following risk factors for injury were found: starting to practice in late age, weekly training sessions with a few number of hours, male sex, low-level belt, elimination rounds, the first match of the day, and second round.
Level of Evidence
Level III, observational analytic study without a control group.
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Affiliation(s)
- Mattia Fortina
- University Department of Orthopaedic and Traumatology, Hospital of Siena, Siena, Italy
| | - Simone Mangano
- Department of Physical Medicine and Rehabilitation, University Hospital of Milan, Milan, Italy
| | - Serafino Carta
- University Department of Orthopaedic and Traumatology, Hospital of Siena, Siena, Italy
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Abstract
Background and aim of the work: Hypersensitivity to metals in the general population has an incidence of about 15%, and in rising also for the higher number of joint replacements in the last decades. Total Knee Arthroplasty (TKA) represents the most performed orthopaedic procedure during last years, and it seems to be particularly associated with sensitization after surgery. On the other hand, there is a rising amount of patients with painful but well implanted and functioning TKAs: in certain cases, after the exclusion of the most frequent causes of failure, a condition of hypersensitivity may be found, and a revision with anallergic implants is mandatory. The present study is a review of the potential problems related to hypersensitivity in TKA, its possible diagnostic procedures, and the surgical options to date available. Methods: Medical history, patch testing, and other specific laboratory assays are useful to assess a status of metals hypersensitivity before surgery in subjects undergoing a knee replacement, or even after TKA in patients complaining pain in otherwise well implanted and aligned prostheses. However, few groups worlwide deal with such condition, and all proposed diagnostic protocols may be considered still today conjectural. On the other hand, these represent the most updated knowledge of this condition, and may be useful for both the patient and the orthopaedic surgeon. Once assessed a possible or ascertained allergy to metals, several options are available for primary andr revision knee surgery, in order to avoid the risk of hypersensitivity. Results: A review of the recent publications on this topic and an overview of the related aspects has been made to understand a condition to date considered negligible. Conclusions: Hypersensitivity to metals has not to be nowadays considered a “fiction”, but rather a possible preoperative risk or a postoperative cause of failure of TKA. Crucial is the information of patients and the medical history, associated in suspect cases to laboratory testings. Today in the market several knee implants are available and safe for allergic patients undergoing TKA. (www.actabiomedica.it)
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Innocenti M, Vieri B, Melani T, Paoli T, Carulli C. Metal hypersensitivity after knee arthroplasty: fact or fiction? Acta Biomed 2017; 88:78-83. [PMID: 28657568 DOI: 10.23750/abm.v88i2 -s.6517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIM OF THE WORK Hypersensitivity to metals in the general population has an incidence of about 15%, and in rising also for the higher number of joint replacements in the last decades. Total Knee Arthroplasty (TKA) represents the most performed orthopaedic procedure during last years, and it seems to be particularly associated with sensitization after surgery. On the other hand, there is a rising amount of patients with painful but well implanted and functioning TKAs: in certain cases, after the exclusion of the most frequent causes of failure, a condition of hypersensitivity may be found, and a revision with anallergic implants is mandatory. The present study is a review of the potential problems related to hypersensitivity in TKA, its possible diagnostic procedures, and the surgical options to date available. METHODS Medical history, patch testing, and other specific laboratory assays are useful to assess a status of metals hypersensitivity before surgery in subjects undergoing a knee replacement, or even after TKA in patients complaining pain in otherwise well implanted and aligned prostheses. However, few groups worlwide deal with such condition, and all proposed diagnostic protocols may be considered still today conjectural. On the other hand, these represent the most updated knowledge of this condition, and may be useful for both the patient and the orthopaedic surgeon. Once assessed a possible or ascertained allergy to metals, several options are available for primary andr revision knee surgery, in order to avoid the risk of hypersensitivity. RESULTS A review of the recent publications on this topic and an overview of the related aspects has been made to understand a condition to date considered negligible. CONCLUSIONS Hypersensitivity to metals has not to be nowadays considered a "fiction", but rather a possible preoperative risk or a postoperative cause of failure of TKA. Crucial is the information of patients and the medical history, associated in suspect cases to laboratory testings. Today in the market several knee implants are available and safe for allergic patients undergoing TKA.
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Carulli C, Piacentini F, Paoli T, Civinini R, Innocenti M. A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw. Clin Cases Miner Bone Metab 2017; 14:40-47. [PMID: 28740524 DOI: 10.11138/ccmbm/2017.14.1.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Trochanteric fractures are frequent and generally associated with bone fragility. There is still debate on the best fixation device to treat stable or rather stable trochanteric fractures: we report our clinical and radiological results of fixation with Proximal Femoral Nail "antirotation" (PFNa) in a population of patients compared to a control group treated by Sliding Hip Screw (SHS). MATERIALS AND METHODS A prospective study was conducted in 71 consecutive patients treated by PFNa (group A), and 69 by a SHS (group B), with a mean age of 81.6 and 83.4 years respectively. Short Form 12 was administered to check postoperative results, and the following parameters were evaluated: range of motion, evaluation of pain, gait ability, X-rays, and Tip Apex Distance Index. RESULTS A minimum follow-up was conducted in 128 patients: 66 subjects belonging to the PFNa group and 62 to the DHS group. All patients in the group A were able to reach partial or full weight-bearing on the operated leg before leaving the hospital. Forty-four patients (63.8%) of the group B were able to walk with partial weight-bearing before discharge. We recorded 17 complications with a final overall percentage of 17.2% on the overall study population with one single case of failure in both the two groups. DISCUSSION A statistical significance (p<0.01) of superiority for PFNa was demonstrated regarding surgical time, amplioscope time, intraoperative blood loss, hospital stay, recovery of weight-bearing before discharge. Less significant results (p<0.05) were found for walking ability at the three-months follow-up and patients' satisfaction 6 months after surgery. CONCLUSIONS PFNa may be considered an useful choice for the treatment of stable or rather stable trochanteric fractures as well as DHS. The light superiority of PFNa may be principally related to its mechanical advantages.
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Affiliation(s)
| | | | - Tommaso Paoli
- Orthopaedic Clinic, University of Florence, Florence, Italy
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Abstract
Haemophilia may nowadays be considered an "ortho paedic" disease given due to the involvement of musculoskeletal system in almost all haemophilic subjects. The modern haematological prophylaxis has dramatically improved the quality of life reducing bleedings and life-threatening complications; however, joint bleedings, progressive and irreversible arthropathy and osteoporosis are still now common challenging issues to be faced. One of the tissues involved by Haemophilia is the bone, particularly in the periarticular zone: poor bone quality and decrease of bone stock are typical patterns, and the worse is the arthropathy, the greater the bone loss. The orthopaedic management of such condition is now mandatory and characterized by several surgical techniques. The purpose of this work is to provide an overview of these options derived from our experience in managing haemophilic patients.
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Affiliation(s)
- Anna Rosa Rizzo
- Orthopaedic Clinic, Department of Medicine and Translational Medicine, University of Florence, Italy
| | - Manuel Zago
- Orthopaedic Clinic, Department of Medicine and Translational Medicine, University of Florence, Italy
| | - Christian Carulli
- Orthopaedic Clinic, Department of Medicine and Translational Medicine, University of Florence, Italy
| | - Massimo Innocenti
- Orthopaedic Clinic, Department of Medicine and Translational Medicine, University of Florence, Italy
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Abstract
Hip arthropathy in haemophilic patients is disabling for hip and other common target joints. Even if bleedings in the hip are not frequent, femoroacetabular alterations may affect the functional ability of patients at a very young age. A haematologic prophylaxis combined with an adequate lifestyle and regular and low-traumatic physical activity are the keys to preventing such arthropathy. In the early stages of arthropathy, anti-inflammatory drugs and physical therapy may be sufficient to limit its progression. In cases of recurrent symptoms, viscosupplementation with hyaluronic acid, and chemical synoviorthesis are useful options. In more advanced stages, hip arthroscopy may be treated by synovectomy or loose body removal. For late stages, total hip arthroplasty (THA) is mandatory. Until a few decades ago, the clinical outcomes after hip arthroplasty were variable, due to the different management of patients and the use of old generation implants and couplings. In the last decade, the introduction of the multidisciplinary management and the use of modern cementless implants with high performing materials and less invasive surgical techniques have dramatically improved the functional results. Nowadays, as is the case for other target joints, the purpose of the management in haemophilia centers is the early detection of any hip alterations—by clinical and ultrasound (US) evaluations of patients in childhood—to reveal any early articular damage and to provide adequate treatment in case of symptoms. The present paper represents an updated review of the several approaches to hip arthropathy in haemophilia.
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Affiliation(s)
| | - Anna Rosa Rizzo
- Orthopaedic Clinic, University of Florence, Florence 50139, Italy.
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Abstract
Until the late 1980s, proximal interphalangeal (PIP) joint reconstruction
had been almost exclusively performed by the use of monobloc silicone
spacers and associated with acceptable to good clinical outcomes. More recently, new materials such as metal-on-polyethylene and pyrocarbon
implants were proposed, associated with good short-term and mid-term
results. Pyrocarbon is a biologically inert and biocompatible material with a low
tendency to wear. PIP pyrolytic implants are characterised by a graphite
core, visible on radiographs and covered by a radiolucent outer layer of
pyrocarbon. New surgical techniques and better patient selection with tailored
rehabilitative protocols, associated with the knowledge arising from the
long-term experience with pyrocarbon implants, has demonstrated noteworthy
clinical outcomes over the years, as demonstrated by recent studies.
Cite this article: EFORT Open Rev 2017;2:21–27. DOI:
10.1302/2058-5241.2.160041
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Affiliation(s)
- Massimo Ceruso
- Hand Surgery Unit, Centro Traumatologico Ortopedico, Azienda Ospedliero-Universitaria Careggi, Florence, Italy
| | - Sandra Pfanner
- Hand Surgery Unit, Centro Traumatologico Ortopedico, Azienda Ospedliero-Universitaria Careggi, Florence, Italy
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Civinini R, Carulli C, Matassi F, Lepri AC, Sirleo L, Innocenti M. The Survival of Total Knee Arthroplasty: Current Data from Registries on Tribology: Review Article. HSS J 2017; 13:28-31. [PMID: 28167870 PMCID: PMC5264570 DOI: 10.1007/s11420-016-9513-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 06/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Polyethylene (PE) wear is a major contributor to implant loosening following total knee arthroplasty (TKA), and advanced bearings in TKA are being investigated with hopes of reducing or eliminate wear-related loosening. Currently, information on knee tribology is available from national joint registries and may be the best tools to evaluate the efficacy and safety of design innovations in joint arthroplasty. QUESTIONS/PURPOSES We performed a review of national joint registries trying to answer the following questions: "Which is the main factor directly related to revisions rate in TKA?" and "Are there new bearing options better than conventional ones?" METHODS A review was performed of all published annual reports of National Joint Registers, as well as of the literature. The search was carried out using and comparing the National Joint Registers. RESULTS Current data from registries for total knee arthroplasty indicates that age is the major factor affecting the outcome of primary total knee replacement. The 10-year cumulative revision rate for non-cross-linked PE was 5.8% and for XLPE it was 3.5%. The effect of cross-linked polyethylene was more evident in the younger patients. The survival of the oxidized zirconium (OxZr) femoral component appears better when compared to a similar age group of patients with conventional group of prostheses. Our review suggests that the revision rates are half for the OxZr components compared to conventional CoCr femoral components. CONCLUSIONS Age is the most relevant single factor related to revision rate. Cross-linked PE has a statistical lower revision rate at 10 years compared to conventional PE and, in the OxZr group, the revision rate is 2 times lower than Co-Cr in the same group of age.
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Affiliation(s)
- Roberto Civinini
- Department of Surgical Science and Translational Medicine, Orthopedic Clinic, University of Florence, Largo P. Palagi 1, 50139 Florence, Italy
| | - Christian Carulli
- Department of Surgical Science and Translational Medicine, Orthopedic Clinic, University of Florence, Largo P. Palagi 1, 50139 Florence, Italy
| | - Fabrizio Matassi
- Department of Surgical Science and Translational Medicine, Orthopedic Clinic, University of Florence, Largo P. Palagi 1, 50139 Florence, Italy
| | - Andrea Cozzi Lepri
- Department of Surgical Science and Translational Medicine, Orthopedic Clinic, University of Florence, Largo P. Palagi 1, 50139 Florence, Italy
| | - Luigi Sirleo
- Department of Surgical Science and Translational Medicine, Orthopedic Clinic, University of Florence, Largo P. Palagi 1, 50139 Florence, Italy
| | - Massimo Innocenti
- Department of Surgical Science and Translational Medicine, Orthopedic Clinic, University of Florence, Largo P. Palagi 1, 50139 Florence, Italy
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Lepri AC, Giorgini M, Signorini C, Carulli C, Civinini R, Brandi ML, Innocenti M. Densitometric evaluation of bone-prosthetic counterface in hip and knee arthroplasty with modern implants. Clin Cases Miner Bone Metab 2016; 13:144-150. [PMID: 27920813 DOI: 10.11138/ccmbm/2016.13.2.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Recent acquisitions of the complex mechanisms of osseointegration between implants and host bone have gained attention, accordingly to the methods of evaluation of these interactions. DEXA analysis is considered an useful tool to assess such phenomena, in order to analyse in a quantitative manner the local metabolic activity of the bone, and to evaluate over the time the integration between host bone and prosthetic components. The purpose of the present study is to report about a preliminary experience in the analysis of osseointegration processes of patients undergoing a primary Total Hip Arthroplasty (THA) or a revision Total Knee Arthroplasty (rTKA). MATERIALS AND METHODS Thirty patients undergoing THA and nineteen undergoing rTKA were included in this study. In fifteen cases of THA a standard cementless stem was used; in the other fifteen a short cementless stem was chosen. In all cases a cementless cup was implanted. In all patients undergoing rTKA, all implants had pressfit femoral and tibial diaphyseal stems; only the femoral component and the tibial plateau were cemented. DEXA evaluation was performed preoperatively, and at 3, 6, 12, and 24 months postoperatively for rTKA, and at 6 and 12 months for THA. RESULTS DEXA in THA showed a significant decrease at the femoral ROIs 1 and 7, and an increase in ROI 4. In rTKA a reduction of femoral BMD in R1, R7, and R4 was found, with maximum values of -13.6% in R1 and -11.89% in R7 at 24 months and a value of -2.55% in R4 at 12 months. On the tibial side, an increase in BMD R4 (with values of 2.18% still at 24 months), and a reduction in R7 (progressively lesser over the time) and in R1 (progressively higher) were found. CONCLUSIONS After a joint replacement a full adhesion of the prosthetic surface to the host bone should be achieved through a local biological process named osseointegration. In some cases this process may not fully realize, so the secondary stability of the implant may fail. DXA is a valuable tool to follow over time the bone remodelling at the bone-prosthesis counterface in THA and in rTKA, in order to early detect any alterations of such phenomenon.
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Affiliation(s)
| | - Marco Giorgini
- Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Carla Signorini
- Bone Metabolic Diseases Unit, University of Florence, Florence, Italy
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Carossino AM, Carulli C, Ciuffi S, Carossino R, Zappoli Thyrion GD, Zonefrati R, Innocenti M, Brandi ML. Hypersensitivity reactions to metal implants: laboratory options. BMC Musculoskelet Disord 2016; 17:486. [PMID: 27881114 PMCID: PMC5120482 DOI: 10.1186/s12891-016-1342-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022] Open
Abstract
Background All implant compounds undergo an electrochemical process when in contact with biological fluids, as well as mechanical corrosion due to abrasive wear, with production of metal debris that may inhibit repair processes. None of the commonly-used methods can diagnose implant allergies when used singly, therefore a panel of tests should be performed on allergic patients as pre-operative screening, or when a postoperative metal sensitisation is suspected. Methods We analysed patients with painful prostheses and subjects prone to allergies using the Patch Test in comparison with the Lymphocyte Transformation Test. Cytokine production was evaluated to identify prognostic markers for early diagnosis of aseptic loosening. Metal debris endocytosis and cytoskeletal rearrangement was visualised by confocal microscopy. Results Our results demonstrate that the Lymphocyte Transformation Test can identify patients who have a predisposition to develop allergic reactions and can confirm the diagnosis of hypersensitivity in patients with painful prostheses. The prevalence of a Th2-cytokine pattern may be used to identify predisposition to the development of allergic diseases, while the selective presence of osteoclastogenic cytokines may be used as predictor of a negative outcome in patients with painful prosthesis. The hypothesis of the prognostic value of these cytokines as early markers of aseptic loosening is attractive, but its confirmation would require extensive testing. Conclusions The Lymphocyte Transformation Test is the most suitable method for testing systemic allergies. We suggest that the combined use of the Patch Test and the Lymphocyte Transformation Test, associated with cytokine detection in selected patients, could provide a useful tool for preventive evaluation of immune reactivity in patients undergoing primary joint replacement surgery, and for clinical monitoring of the possible onset of a metal sensitization in patients with implanted devices.
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Affiliation(s)
- Anna Maria Carossino
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Christian Carulli
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Simone Ciuffi
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Roberto Carossino
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | | | - Roberto Zonefrati
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Massimo Innocenti
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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Macera A, Carulli C, Matassi F, Veneziani C, Innocenti M. Traumatic bilateral Achilles tendon rupture in a young athlete treated with percutaneous tenorrhaphy. Joints 2016; 3:218-20. [PMID: 26904529 DOI: 10.11138/jts/2015.3.4.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
While rupture of the Achilles tendon is one of the most frequent injuries sustained in sports and physical activity, bilateral Achilles tendon rupture is uncommon. We present the case of a 33-year-old man who sustained a bilateral Achilles tendon rupture in the absence of predisposing factors. The lesions were managed by percutaneous tenorrhaphy and casting. Six months after surgery he was able to return to his daily-life activities and to perform light sports activity. The Authors review the current literature on the management of this rare condition in young people, with or without risk factors.
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Carulli C, Nistri L, Bracco L, Giannini M, Amato MP. A steroid-induced bilateral avascular necrosis of the femoral head in an underage patient affected by multiple sclerosis. Clin Cases Miner Bone Metab 2015; 12:257-9. [PMID: 26811707 DOI: 10.11138/ccmbm/2015.12.3.257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients affected by Multiple Sclerosis are often treated by pulsed intravenous corticosteroids to manage acute relapses with positive outcomes. The intravenous administration is frequently associated to avascular necrosis of several bones, particularly the femur. The present report regards a case of an underage MS patient with a bilateral ANFH secondary to pulsed administrations of steroids, managed by a conservative approach on a hip, and by a novel surgical technique on the contralateral side.
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Affiliation(s)
- Christian Carulli
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Lorenzo Nistri
- Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Laura Bracco
- Neurologic Unit, Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Marta Giannini
- Neurologic Unit, Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Maria Pia Amato
- Neurologic Unit, Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
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Melchiorre D, Linari S, Manetti M, Romano E, Sofi F, Matucci-Cerinic M, Carulli C, Innocenti M, Ibba-Manneschi L, Castaman G. Clinical, instrumental, serological and histological findings suggest that hemophilia B may be less severe than hemophilia A. Haematologica 2015; 101:219-25. [PMID: 26494839 DOI: 10.3324/haematol.2015.133462] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/15/2015] [Indexed: 11/09/2022] Open
Abstract
Recent evidence suggests that patients with severe hemophilia B may have a less severe disease compared to severe hemophilia A. To investigate clinical, radiological, laboratory and histological differences in the arthropathy of severe hemophilia A and hemophilia B, 70 patients with hemophilia A and 35 with hemophilia B with at least one joint bleeding were consecutively enrolled. Joint bleedings (<10, 10-50, >50), regimen of treatment (prophylaxis/on demand), World Federation of Hemophilia, Pettersson and ultrasound scores, serum soluble RANK ligand and osteoprotegerin were assessed in all patients. RANK, RANK ligand and osteoprotegerin expression was evaluated in synovial tissue from 18 hemophilia A and 4 hemophilia B patients. The percentage of patients with either 10-50 or more than 50 hemarthrosis was greater in hemophilia A than in hemophilia B (P<0.001 and P=0.03, respectively), while that with less than 10 hemarthrosis was higher in hemophilia B (P<0.0001). World Federation of Hemophilia (36.6 vs. 20.2; P<0.0001) and ultrasound (10.9 vs. 4.3; P<0.0001) score mean values were significantly higher in hemophilia A patients. Serum osteoprotegerin and soluble RANK ligand were decreased in hemophilia A versus hemophilia B (P<0.0001 and P=0.006, respectively). Osteoprotegerin expression was markedly reduced in synovial tissue from hemophilia A patients. In conclusion, the reduced number of hemarthrosis, the lower World Federation of Hemophilia and ultrasound scores, and higher osteoprotegerin expression in serum and synovial tissue in hemophilia B suggest that hemophilia B is a less severe disease than hemophilia A. Osteoprotegerin reduction seems to play a pivotal role in the progression of arthropathy in hemophilia A.
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Affiliation(s)
- Daniela Melchiorre
- Department of Experimental and Clinical Medicine, Section of Internal Medicine, University of Florence, Rheumatology Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Linari
- Center for Bleeding Disorders, Careggi University Hospital, Florence, Italy
| | - Mirko Manetti
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Florence, Italy
| | - Eloisa Romano
- Department of Experimental and Clinical Medicine, Section of Internal Medicine, University of Florence, Rheumatology Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Section of Internal Medicine, University of Florence, Rheumatology Unit, Careggi University Hospital, Florence, Italy
| | - Christian Carulli
- First Orthopedic Clinic, Careggi University Hospital, Florence, Italy
| | - Massimo Innocenti
- First Orthopedic Clinic, Careggi University Hospital, Florence, Italy
| | - Lidia Ibba-Manneschi
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, Florence, Italy
| | - Giancarlo Castaman
- Center for Bleeding Disorders, Careggi University Hospital, Florence, Italy
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