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Rinaldi VG, Coliva F, Favero A, Alesi D, Caravelli S, Zaffagnini S, Marcheggiani Muccioli GM. From Diagnosis to Decision-Making: A Systematic Review of the Management of Reverse Hill-Sachs Lesions after Posterior Shoulder Dislocations. J Clin Med 2024; 13:2085. [PMID: 38610850 PMCID: PMC11012447 DOI: 10.3390/jcm13072085] [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: 01/22/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: The aim of this study is to describe all of the possible surgical procedures that intend to treat the McLaughlin lesion (or Reverse Hill-Sachs) in posterior shoulder dislocation. (2) Methods: Google Scholar, Pubmed, and Embase were used as databases in our research. Studies reporting the results of posterior shoulder dislocations surgically treated with procedures addressing the humeral lesion were evaluated. The studies reporting results after fracture-dislocation and multidirectional instability were excluded. (3) Results: A total of 16 studies were included in our review for a total of 207 shoulders with a mean age of 41.7 years that were evaluated at a mean of 62.1 months. The Modified McLaughlin procedure and the Graft procedures were the most commonly performed. No statistically significant difference was found between the two at the evaluation of the clinical score. (4) Conclusions: Our review highlights the importance of a correct diagnosis and an accurate surgical treatment choice based on the surgeon's experience and on the patients' characteristics.
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Affiliation(s)
- Vito Gaetano Rinaldi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Federico Coliva
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Antongiulio Favero
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Silvio Caravelli
- Bentivoglio Orthopaedic Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, 40125 Bologna, Italy
| | - Giulio Maria Marcheggiani Muccioli
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, 40125 Bologna, Italy
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Pagano A, Agostinone P, Alesi D, Caputo D, Neri MP, Grassi A, Zaffagnini S. Almost 79% survival rate at 10-year follow-up for the patellofemoral joint arthroplasty: An Italian prosthetic registry study. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38529690 DOI: 10.1002/ksa.12150] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE The aims of the present study were (1) to evaluate the survival of patellofemoral joint (PFJ) arthroplasty in a large cohort of patients using data obtained from an Italian regional arthroplasty registry and (2) to collect clinical outcomes of a subgroup of patients, with a minimum follow-up of 4 years. The hypotheses were that PFJ arthroplasty is a procedure that had good survival and clinical outcomes, not inferior to those reported in the literature for primary total knee arthroplasty (TKA). METHODS The Register of Orthopaedic Prosthetic Implants (RIPO) of Emilia-Romagna (ER) (Italy) database was searched for the inclusion of all PFJ arthroplasties implanted between 2003 and 2019. PFJ arthroplasties were excluded if they were implanted in patients who lived outside of the ER. The survival information was extrapolated from the RIPO considering the partial or total revision of the implant as failure; moreover, a subgroup of patients was contacted and interviewed by telephone to collect clinical outcomes. Descriptive statistics were used to summarise the data. The survival curve was calculated and plotted using the Kaplan-Meier method. RESULTS A total of 126 arthroplasties in 114 patients were included in the final analysis (mean age at surgery 60.1 ± 11.5 years old). The main causes of patellofemoral arthroplasty were primary osteoarthritis (88%) and posttraumatic arthritis (7%). The survival was 90.4 ± 30.6 and 78.8 ± 51.5 at 5 and 10 years of follow-up, respectively. At the latest follow-up, 23 implants failed (18.3%). The main cause of revision was osteoarthrosis progression (34.8%). A total of 44 patients were contacted by telephone to collect clinical outcomes: Western Ontario and McMaster Universities Osteoarthritis Index, functional Knee Society Score, Forgotten Joint Score and Oxford Knee Score. These patients reported good to excellent scores at a medium follow-up of 10.3 ± 4.7 years. CONCLUSIONS The PFJ showed good survival and clinical outcomes and could be considered a valuable option for patients affected by isolated patellofemoral osteoarthritis. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Anna Pagano
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Piero Agostinone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Domenico Alesi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Dalila Caputo
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Maria Pia Neri
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italia
- Dipartimento di Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italia
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Galteri G, Palanca M, Alesi D, Zaffagnini S, Morellato K, Gruppioni E, Cristofolini L. Reliable in vitro method for the evaluation of the primary stability and load transfer of transfemoral prostheses for osseointegrated implantation. Front Bioeng Biotechnol 2024; 12:1360208. [PMID: 38576443 PMCID: PMC10991734 DOI: 10.3389/fbioe.2024.1360208] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
Osseointegrated transfemoral prostheses experience aseptic complications with an incidence between 3% and 30%. The main aseptic risks are implant loosening, adverse bone remodeling, and post-operative periprosthetic fractures. Implant loosening can either be due to a lack of initial (primary) stability of the implant, which hinders bone ingrowth and therefore prevents secondary stability, or, in the long-term, to the progressive resorption of the periprosthetic bone. Post-operative periprosthetic fractures are most often caused by stress concentrations. A method to simultaneously evaluate the primary stability and the load transfer is currently missing. Furthermore, the measurement errors are seldom reported in the literature. In this study a method to reliably quantify the bone implant interaction of osseointegrated transfemoral prostheses in terms of primary stability and load transfer was developed, and its precision was quantified. Micromotions between the prosthesis and the host bone and the strains on the cortical bone were measured on five human cadaveric femurs with a typical commercial osseointegrated implant. To detect the primary stability of the implant and the load transfer, cyclic loads were applied, simulating the peak load during gait. Digital Image Correlation was used to measure displacements and bone strains simultaneously throughout the test. Permanent migrations and inducible micromotions were measured (three translations and three rotations), while, on the same specimen, the full-field strain distribution on the bone surface was measured. The repeatability tests showed that the devised method had an intra-specimen variability smaller than 6 μm for the translation, 0.02 degrees for the rotations, and smaller than 60 microstrain for the strain distribution. The inter-specimen variability was larger than the intra-specimen variability due to the natural differences between femurs. Altogether, the measurement uncertainties (intrinsic measurement errors, intra-specimen repeatability and inter-specimen variability) were smaller than critical levels of biomarkers for adverse remodelling and aseptic loosening, thus allowing to discriminate between stable and unstable implants, and to detect critical strain magnitudes in the host bone. In conclusion, this work showed that it is possible to measure the primary stability and the load transfer of an osseointegrated transfemoral prosthesis in a reliable way using a combination of mechanical testing and DIC.
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Affiliation(s)
- Giulia Galteri
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Marco Palanca
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | | | | | | | | | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Marcheggiani Muccioli GM, Alesi D, Rinaldi VG, Cerasoli T, Valente D, Zaffagnini S. Conversion of failed revision total knee arthroplasty in arthrodesis with modular nail maintaining the uncemented femoral stem in patient with extensor mechanism insufficiency: a case report. J Med Case Rep 2024; 18:147. [PMID: 38459591 PMCID: PMC10924415 DOI: 10.1186/s13256-024-04380-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/11/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND The transition from revision total knee arthroplasty (RTKA) to arthrodesis involves the replacement of cemented femoral and tibial stems with a modular nail designed for arthrodesis. This conversion process is associated with challenges such as bone loss, blood loss, and prolonged surgical durations. Effectively addressing these complexities through a less invasive surgical approach could be pivotal in enhancing patient outcomes and minimizing associated complications. CASE PRESENTATION A 75-year-old white Caucasian female patient with a revision total knee arthroplasty (RTKA) performed with a modular uncemented rotating-hinge system, reporting an history of recurrent patellar dislocation, was referred to our institution after a fall resulting in periprosthetic tibial plateau fracture. The fracture was treated with open reduction and internal fixation, but afterwards the patient had been unable to walk again. Tibial stem was mobilized, and extensor mechanism was insufficient due to chronic incomplete quadriceps tendon rupture. The femoral stem was stable, so we decided to convert the rotating-hinge in a arthrodesis with an uncemented modular knee fusion nail maintaining the previous femoral stem. CONCLUSIONS The result was a successful arthrodesis with minimal bone and blood loss, reduced operative time, and optimal functional outcome at the one-year follow-up. This case highlights the advantage of using a modular knee revision platform system that gives the opportunity to convert a RTKA in arthrodesis.
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Affiliation(s)
| | - Domenico Alesi
- II Clinica Ortopedica-IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40137, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Vito Gaetano Rinaldi
- II Clinica Ortopedica-IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40137, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Tosca Cerasoli
- II Clinica Ortopedica-IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40137, Bologna, Italy.
| | - Davide Valente
- II Clinica Ortopedica-IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40137, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica-IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40137, Bologna, Italy
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Cammisa E, La Verde M, Coliva F, Favero A, Sassoli I, Fratini S, Alesi D, Lullini G, Zaffagnini S, Marcheggiani Muccioli GM. Low Response Rate to Follow-Up Using Telemedicine after Total Knee Replacement during the COVID-19 Pandemic in Italy. J Clin Med 2024; 13:360. [PMID: 38256494 PMCID: PMC10816610 DOI: 10.3390/jcm13020360] [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: 08/27/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the survival rate and medium-term outcomes of patients after cemented posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasty (TKA) using a telemedicine platform during the COVID-19 pandemic in Italy. METHODS A total of 100 consecutive patients (mean age 73.5 ± 13.2 years) who received a cemented PS MB TKA were enrolled. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. A dedicated software that makes it possible to perform video calls, online questionnaires, and acquire X-rays remotely was used. Subjective clinical scores and objective range-of-motion (ROM) measurements were observed at an average follow-up of 54 ± 11.3 months. RESULTS A total of 42 of 100 enrolled patients (mean age 70.3 ± 8.4 years) completed the telemedicine follow-up. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. Age was found to be a statistically significant difference between the group that completed the telemedicine follow-up and the one that did not (p < 0.004). KOOS scores improved from 56.1 ± 11.3 to 77.4 ± 16.2, VAS scores decreased from 7.2 ± 2.1 to 2.8 ± 1.6, KSSf scores increased from 47.2 ± 13.3 to 77.1 ± 21.1, FJS scores improved from 43.4 ± 12.3 to 76.9 ± 22.9, and OKS scores increased from 31.9 ± 8.8 to 40.4 ± 9.9. All the differences were statistically significant (p < 0.05). The mean flexion improved from 88° ± 8° to 120° ± 12°. A radiographic evaluation showed a mean pre-operative mechanical axis deviation of 5.3 ± 8.0 degrees in varus, which improved to 0.4 ± 3.4 degrees of valgus post-operation. The survivorship at 5 years was 99%. CONCLUSIONS Subject to small numbers, telemedicine presented as a useful instrument for performing remote monitoring after TKA. The most important factor in telemedicine success remains the patient's skill, which is usually age-related, as older patients have much more difficulty in approaching a technological tool.
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Affiliation(s)
- Eugenio Cammisa
- Operational Unit of Orthopedics and Traumatology, Imola Hospital Santa Maria della Scaletta, 40026 Imola, Italy;
| | - Matteo La Verde
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Federico Coliva
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Antongiulio Favero
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Iacopo Sassoli
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Stefano Fratini
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Domenico Alesi
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Giada Lullini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa e Neuroriabilitazione, 40139 Bologna, Italy;
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
| | - Giulio Maria Marcheggiani Muccioli
- II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli—DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.L.V.); (F.C.); (A.F.); (I.S.); (S.F.); (S.Z.)
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Zinno R, Alesi D, Di Paolo S, Pizza N, Zaffagnini S, Marcheggiani Muccioli GM, Bragonzoni L. Wider translations and rotations in posterior-stabilised mobile-bearing total knee arthroplasty compared to fixed-bearing both implanted with mechanical alignment: a dynamic RSA study. Knee Surg Sports Traumatol Arthrosc 2023; 31:4969-4976. [PMID: 37615718 PMCID: PMC10598183 DOI: 10.1007/s00167-023-07541-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/04/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The purpose of this study was to investigate the in vivo kinematics of the same femoral design mechanically aligned posterior-stabilised (PS) total knee arthroplasty (TKA) with either fixed-bearing (FB) or mobile-bearing (MB) inlay, implanted by the same surgeon, using model-based dynamic radiostereometric analysis (RSA). The hypothesis of the present study was that the MB design would show wider axial rotation than the FB design, without affecting the clinical outcomes. MATERIALS AND METHODS A cohort of 21 non-randomised patients (21 DePuy Attune PS-FB) was evaluated by dynamic RSA analysis at a minimum 9-month follow-up, while performing differently demanding daily living activities such as sit to stand (STS) and deep knee lunge (DKL). Kinematic data were compared with those of a cohort of 22 patients implanted with the same prosthetic design but with MB inlay. Anterior-posterior (AP) translations, varus-valgus (VV) and internal-external (IE) rotations of the femoral component with respect to the tibial baseplate were investigated. Translation of medial and lateral compartment was analysed using the low point method according to Freeman et al. Questionnaires to calculate objective and subjective clinical scores were administered preoperatively and during follow-up visit by the same investigator. RESULTS The FB TKA design showed lower AP translation during STS (6.8 ± 3.3 mm in FB vs 9.9 ± 3.7 mm in MB, p = 0.006*), lower VV rotation (1.9 ± 0.8° in FB vs 5.3 ± 3.3° in MB, p = 0.005) and lower IE rotation (2.8 ± 1.1° in FB vs 9.5 ± 4.3° in MB, p = 0.001) during DKL than the mobile-bearing TKA design. Posterior-stabilised FB group showed significant lower translation of the low point of the medial compartment than the MB group (p = 0.008). The percentage of patients performing medial pivot in the FB group was higher compared to MB group in the examined motor tasks. No significant differences in post-operative range of motion (117° ± 16° for FB group and 124° ± 13° for MB group) and in clinical outcomes emerged between the two cohort. CONCLUSIONS The FB and MB designs differed in AP translations, VV rotations and IE rotations of the femoral component with respect to the tibial component in STS and DKL. Furthermore, FB cohort reported a significant higher percentage of medial pivot with respect to MB cohort. Despite this, no differences in clinical outcomes were detected between groups. Both designs showed stable kinematics and represent a viable option in primary TKA. LEVEL OF EVIDENCE Prospective cohort study, II.
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Affiliation(s)
- Raffaele Zinno
- Dipartimento Di Scienze Per La Qualità Della Vita QUVI, University of Bologna, Corso D’Augusto 237, 47921 Rimini, RN Italy
| | - Domenico Alesi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, BO Italy
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, 40125 Bologna, BO Italy
| | - Stefano Di Paolo
- Dipartimento Di Scienze Per La Qualità Della Vita QUVI, University of Bologna, Corso D’Augusto 237, 47921 Rimini, RN Italy
| | - Nicola Pizza
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, BO Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, BO Italy
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, 40125 Bologna, BO Italy
| | - Giulio Maria Marcheggiani Muccioli
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, BO Italy
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, 40125 Bologna, BO Italy
| | - Laura Bragonzoni
- Dipartimento Di Scienze Per La Qualità Della Vita QUVI, University of Bologna, Corso D’Augusto 237, 47921 Rimini, RN Italy
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Fiore M, Sambri A, Morante L, Bortoli M, Parisi SC, Panzavolta F, Alesi D, Neri E, Neri MP, Tedeschi S, Zamparini E, Cevolani L, Donati DM, Viale P, Campanacci DA, Zaffagnini S, De Paolis M. Silver-Coated Distal Femur Megaprosthesis in Chronic Infections with Severe Bone Loss: A Multicentre Case Series. J Clin Med 2023; 12:6679. [PMID: 37892817 PMCID: PMC10607434 DOI: 10.3390/jcm12206679] [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: 09/28/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Periprosthetic joint infections (PJI) and fracture-related infections (FRI) of the distal femur (DF) may result in massive bone defects. Treatment options include articulated silver-coated (SC) megaprosthesis (MP) in the context of a two-stage protocol. However, there is limited evidence in the literature on this topic. A retrospective review of the prospectively maintained databases of three Institutions was performed. Forty-five patients were included. The mean follow-up time was 43 ± 17.1 months. Eight (17.8%) patients had a recurrent infection. The estimated recurrence-free survival rate was 91.1% (93.5% PJI vs. 85.7% FRI) 2 years following MP implantation, and 75.7% (83.2% PJI vs. 64.3% FRI; p = 0.253) after 5 years. No statistically relevant difference was found according to the initial diagnosis (PJI vs. FRI). Among possible risk factors, only resection length was found to significantly worsen the outcomes in terms of infection control (p = 0.031). A total of eight complications not related to infection were found after reimplantation, but only five of them required further surgery. Above-the-knee amputation was performed in two cases (4.4%), both for reinfection. Articulated DF SC MP in a two-stage protocol is a safe and effective treatment for chronic knee infection with severe bone loss.
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Affiliation(s)
- Michele Fiore
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (S.T.)
| | - Andrea Sambri
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.M.); (F.P.); (M.D.P.)
| | - Lorenzo Morante
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.M.); (F.P.); (M.D.P.)
| | - Marta Bortoli
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.M.); (F.P.); (M.D.P.)
| | - Stefania Claudia Parisi
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.M.); (F.P.); (M.D.P.)
| | - Francesco Panzavolta
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.M.); (F.P.); (M.D.P.)
| | - Domenico Alesi
- Second Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (D.A.); (S.Z.)
| | - Elisabetta Neri
- Orthopaedic Oncology Unit, Azienda Ospedaliera Universitaria Careggi, 50134 Firenze, Italy (D.A.C.)
| | - Maria Pia Neri
- Second Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (D.A.); (S.Z.)
| | - Sara Tedeschi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (S.T.)
- Infectious Disease Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Eleonora Zamparini
- Infectious Disease Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Cevolani
- Third Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy (D.M.D.)
| | - Davide Maria Donati
- Third Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy (D.M.D.)
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.F.); (S.T.)
- Infectious Disease Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Stefano Zaffagnini
- Second Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (D.A.); (S.Z.)
| | - Massimiliano De Paolis
- Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.M.); (F.P.); (M.D.P.)
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8
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Di Paolo S, Barone G, Alesi D, Mirulla AI, Gruppioni E, Zaffagnini S, Bragonzoni L. Longitudinal Gait Analysis of a Transfemoral Amputee Patient: Single-Case Report from Socket-Type to Osseointegrated Prosthesis. Sensors (Basel) 2023; 23:4037. [PMID: 37112378 PMCID: PMC10143735 DOI: 10.3390/s23084037] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/24/2023] [Accepted: 04/07/2023] [Indexed: 06/19/2023]
Abstract
The aim of the present case report was to provide a longitudinal functional assessment of a patient with transfemoral amputation from the preoperative status with socket-type prosthesis to one year after the osseointegration surgery. A 44 years-old male patient was scheduled for osseointegration surgery 17 years after transfemoral amputation. Gait analysis was performed through 15 wearable inertial sensors (MTw Awinda, Xsens) before surgery (patient wearing his standard socket-type prosthesis) and at 3-, 6-, and 12-month follow-ups after osseointegration. ANOVA in Statistical Parametric Mapping was used to assess the changes in amputee and sound limb hip and pelvis kinematics. The gait symmetry index progressively improved from the pre-op with socket-type (1.14) to the last follow-up (1.04). Step width after osseointegration surgery was half of the pre-op. Hip flexion-extension range significantly improved at follow-ups while frontal and transverse plane rotations decreased (p < 0.001). Pelvis anteversion, obliquity, and rotation also decreased over time (p < 0.001). Spatiotemporal and gait kinematics improved after osseointegration surgery. One year after surgery, symmetry indices were close to non-pathological gait and gait compensation was sensibly decreased. From a functional point of view, osseointegration surgery could be a valid solution in patients with transfemoral amputation facing issues with traditional socket-type prosthesis.
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Affiliation(s)
- Stefano Di Paolo
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
| | - Giuseppe Barone
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
| | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Agostino Igor Mirulla
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
- Department of Engineering, University of Palermo, 40126 Palermo, Italy
| | - Emanuele Gruppioni
- Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Centro Protesi Inail, 40054 Vigorso di Budrio, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
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9
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Alesi D, Bordini B, Fratini S, Ancarani C, Agostinone P, Grassi A, Marcheggiani Muccioli GM, Viceconti M, Zaffagnini S. Lateral unicompartmental knee arthroplasty (UKA) showed a lower risk of failure compared to medial unicompartmental knee arthroplasty in the Register of Prosthetic Orthopedic Implants (RIPO). Arch Orthop Trauma Surg 2022; 143:3363-3368. [PMID: 36156122 DOI: 10.1007/s00402-022-04631-x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/18/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The present study aimed to investigate differences in survivorship between medial and lateral unicompartmental knee arthroplasty (UKA) by analyzing the data of an Italian regional registry. The hypothesis was that, according to recent literature, lateral implants have comparable survivorship with regard to the medial implants. MATERIALS AND METHODS The Register of Orthopaedic Prosthetic Implants (RIPO) of Emilia-Romagna (Italy) database was searched for all UKAs between July 1, 2000, and December 31, 2019. For both cohorts, subject demographics and reasons for revision were presented as a percentage of the total cohort. Kaplan-Meier survivorship analysis was performed using revision of any component as the endpoint and survival times of unrevised UKAs taken as the last observation date (December 31, 2019, or date of death). RESULTS Patients living outside the region and symmetrical implants (which do not allow the compartment operated to be traced) were excluded. 5571 UKAs implanted on 5172 patients (5215 medial UKAs and 356 lateral UKAs) were included in the study. The survivorship analysis revealed 13 failures out of 356 lateral UKAs (3.7%) at a mean follow-up of 6.3 years and 495 failures out of 5215 medial UKAs (9.5%) at a mean follow-up of 6.7 years. The medial UKAs had a significantly higher risk of failure, with a Hazard Ratio of 2.6 (CI 95% 1.6-4.8; p < 0.001), adjusted for age, gender, weight, and mobility of the insert. Both the groups revealed a good survival rate, with 95.2% of lateral implants and 87.5% of medial implants still in situ at 10 years of follow-up. CONCLUSIONS Lateral UKA is a safe procedure showing longer survivorship than medial UKAs (95.2% and 87.5% at 10 years, respectively) in the present study. LEVEL OF EVIDENCE Level 3, therapeutic study.
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Affiliation(s)
- Domenico Alesi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy
| | - Stefano Fratini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Cristina Ancarani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy
| | - Piero Agostinone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | | | - Marco Viceconti
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
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10
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Fratini S, Meena A, Alesi D, Cammisa E, Zaffagnini S, Marcheggiani Muccioli GM. Does Implant Design Influence Failure Rate of Lateral Unicompartmental Knee Arthroplasty? A Meta-Analysis. J Arthroplasty 2022; 37:985-992.e3. [PMID: 35121088 DOI: 10.1016/j.arth.2022.01.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/29/2021] [Revised: 01/07/2022] [Accepted: 01/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Lateral unicompartmental knee arthroplasty (UKA) is a viable solution for isolated lateral compartment arthritis. Several prosthetic designs are available such as fixed-bearing metal-backed (FB M-B), fixed-bearing all-polyethylene (FB A-P), and mobile-bearing metal-backed (MB M-B) implants. The purpose of this meta-analysis is to compare failure rates of different prosthetic designs. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review was conducted using 4 databases (MEDLINE, EMBASE, Cochrane, and PubMed) to identify all studies that investigate outcomes of lateral UKA. Twenty-one studies met the inclusion criteria, and failure rates were compared by implant type and follow-up time separately in order to assess potential confounding factors. Two separate analyses have been performed among different implant designs (FB M-B vs FB A-P vs MB M-B) and different follow-ups (<5 years, between 5 and 10 years, >10 years). RESULTS The failure rate of FB M-B lateral UKA was significantly lower compared to other lateral UKA designs present in the market (0.8% vs 8.6% and 7.1% for FB M-B, FB A-P, and MB M-B, respectively). No significative difference among groups has been detected when comparing all implants with regard to follow-up time. CONCLUSION Considering actual evidence, for a surgeon approaching lateral UKA, the FB M-B design is preferable, given the lower failure rates and subsequently a longer implant survivorship.
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Affiliation(s)
- Stefano Fratini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Amit Meena
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Domenico Alesi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eugenio Cammisa
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; University of Bologna, Bologna, Italy
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11
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Pizza N, Di Paolo S, Zinno R, Marcheggiani Muccioli GM, Agostinone P, Alesi D, Bontempi M, Zaffagnini S, Bragonzoni L. Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:661-667. [PMID: 33386880 PMCID: PMC8866343 DOI: 10.1007/s00167-020-06398-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 08/25/2020] [Accepted: 11/24/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate if postoperative clinical outcomes correlate with specific kinematic patterns after total knee arthroplasty (TKA) surgery. The hypothesis was that the group of patients with higher clinical outcomes would have shown postoperative medial pivot kinematics, while the group of patients with lower clinical outcomes would have not. METHODS 52 patients undergoing TKA surgery were prospectively evaluated at least a year of follow-up (13.5 ± 6.8 months) through clinical and functional Knee Society Score (KSS), and kinematically through dynamic radiostereometric analysis (RSA) during a sit-to-stand motor task. Patients received posterior-stabilized TKA design. Based on the result of the KSS, patients were divided into two groups: "KSS > 70 group", patients with a good-to-excellent score (93.1 ± 6.8 points, n = 44); "KSS < 70 group", patients with a fair-to-poor score (53.3 ± 18.3 points, n = 8). The anteroposterior (AP) low point (lowest femorotibial contact points) translation of medial and lateral femoral compartments was compared through Student's t test (p < 0.05). RESULTS Low point AP translation of the medial compartment was significantly lower (p < 0.05) than the lateral one in both the KSS > 70 (6.1 mm ± 4.4 mm vs 10.7 mm ± 4.6 mm) and the KSS < 70 groups (2.7 mm ± 3.5 mm vs 11.0 mm ± 5.6 mm). Furthermore, the AP translation of the lateral femoral compartment was not significantly different (p > 0.05) between the two groups, while the AP translation of the medial femoral compartment was significantly higher for the KSS > 70 group (p = 0.0442). CONCLUSION In the group of patients with a postoperative KSS < 70, the medial compartment translation was almost one-fourth of the lateral one. Surgeons should be aware that an over-constrained kinematic of the medial compartment might lead to lower clinical outcomes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Nicola Pizza
- grid.419038.70000 0001 2154 6641Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, BO Italy
| | - Stefano Di Paolo
- Dipartimento Di Scienze Biomediche E Neuromotorie DIBINEM, Università Di Bologna, Via San Vitale, 40125, Bologna, BO, Italy.
| | - Raffaele Zinno
- grid.6292.f0000 0004 1757 1758Dipartimento Di Scienze Biomediche E Neuromotorie DIBINEM, Università Di Bologna, Via San Vitale, 40125 Bologna, BO Italy
| | - Giulio Maria Marcheggiani Muccioli
- grid.419038.70000 0001 2154 6641Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, BO Italy
| | - Piero Agostinone
- grid.419038.70000 0001 2154 6641Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, BO Italy
| | - Domenico Alesi
- grid.419038.70000 0001 2154 6641Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, BO Italy
| | - Marco Bontempi
- grid.419038.70000 0001 2154 6641Laboratorio Di Biomeccanica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, BO Italy
| | - Stefano Zaffagnini
- grid.419038.70000 0001 2154 6641Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, BO Italy ,grid.6292.f0000 0004 1757 1758Dipartimento Di Scienze Biomediche E Neuromotorie DIBINEM, Università Di Bologna, Via San Vitale, 40125 Bologna, BO Italy
| | - Laura Bragonzoni
- grid.6292.f0000 0004 1757 1758QUVI, Università Di Bologna, Corso D’Augusto 237, 47921 Rimini, RN Italy
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12
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Zinno R, Di Paolo S, Ambrosino G, Alesi D, Zaffagnini S, Barone G, Bragonzoni L. Migration of the femoral component and clinical outcomes after total knee replacement: a narrative review. Musculoskelet Surg 2021; 105:235-246. [PMID: 33315156 PMCID: PMC8578080 DOI: 10.1007/s12306-020-00690-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
Loosening is considered as a main cause of implant failure in total knee replacement (TKR). Among the predictive signs of loosening, migration is the most investigated quantitative parameter. Several studies focused on the migration of the tibial component in TKR, while no reviews have been focused on the migration of the femoral component and its influence on patients' clinical outcomes. The aim of this narrative review was (1) to provide information about of the influence of migration in femoral component of TKR prostheses, (2) to assess how migration may affect patient clinical outcomes and (3) to present alternative solution to the standard cobalt-chrome prostheses. A database search was performed on PubMed Central® according to the PRISMA guidelines for studies about Cobalt-Chrome femoral component migration in people that underwent primary TKR published until May 2020. Overall, 18 articles matched the selection criteria and were included in the study. Few studies investigated the femoral component through the migration, and no clear migration causes emerged. The Roentgen Stereophotogrammetric Analysis has been mostly used to assess the migration for prognostic predictions. An annual migration of 0.10 mm seems compatible with good long-term performance and good clinical and functional outcomes. An alternative solution to cobalt-chrome prostheses is represented by femoral component in PEEK material, although no clinical evaluations have been carried out on humans yet. Further studies are needed to investigate the migration of the femoral component in relation to clinical outcomes and material used.
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Affiliation(s)
- R Zinno
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy
| | - S Di Paolo
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy.
| | - G Ambrosino
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - D Alesi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - S Zaffagnini
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Via Giulio Cesare Pupilli, 1, 40136, Bologna, BO, Italy
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - G Barone
- Dipartimento di Scienze per la Qualità della Vita QuVi, Università di Bologna, Bologna, Italy
| | - L Bragonzoni
- Dipartimento di Scienze per la Qualità della Vita QuVi, Università di Bologna, Bologna, Italy
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13
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Zaffagnini S, Di Paolo S, Meena A, Alesi D, Zinno R, Barone G, Pizza N, Bragonzoni L. Causes of stiffness after total knee arthroplasty: a systematic review. Int Orthop 2021; 45:1983-1999. [PMID: 33821306 DOI: 10.1007/s00264-021-05023-3] [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] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Knee stiffness after total knee arthroplasty (TKA) often leads to pain and discomfort, failing to meet patients' expectations on the surgical procedure. Despite the growing debate on the topic, a comprehensive literature analysis of stiffness causes has never been conducted. Thus, the purpose of the present study was to systematically review the literature regarding the main causes of stiffness after TKA. METHODS Pubmed Central, Scopus, and EMBASE databases were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for studies on stiffness and pain or discomfort after TKA through November 2020. Overall, 25 articles matched the selection criteria and were included in the study. Clinical relevance and strength of evidence of the included studies were graded using the risk of bias and the methodological index for non-randomized studies quality assessment tools. RESULTS The main causes of pain and discomfort due to stiffness were surgery-related issues, i.e., component malpositioning and over-voluming, implant loosening, psychological distress, and obesity, which could be considered "modifiable" factors, and expression of profibrotic markers, high material hypersensitivity-related cytokines level, male gender, previous contralateral TKA, and high pre-operative pain, which could be considered "non-modifiable" factors. CONCLUSION The use of alternative technologies such as surgical robots, anatomy-based devices, and more inert and less stiff component materials could help in reducing stiffness caused by both modifiable and even some non-modifiable factors. Furthermore, early diagnostic detection of stiffness onset could consistently support surgeons in patient-specific decision-making.
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Affiliation(s)
- Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.,University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | | | - Amit Meena
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| | - Domenico Alesi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.
| | - Raffaele Zinno
- University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | - Giuseppe Barone
- University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | - Nicola Pizza
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
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14
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Alesi D, Meena A, Fratini S, Rinaldi VG, Cammisa E, Lullini G, Vaccari V, Zaffagnini S, Marcheggiani Muccioli GM. Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021? Musculoskelet Surg 2021; 106:1-8. [PMID: 33587251 PMCID: PMC8881420 DOI: 10.1007/s12306-021-00695-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 10/12/2020] [Accepted: 01/02/2021] [Indexed: 10/31/2022]
Abstract
Total knee arthroplasty in valgus knee deformities continues to be a challenge for a surgeon. Approximately 10% of patients who undergo total knee arthroplasty have a valgus deformity. While performing total knee arthroplasty in a severe valgus knee, one should aware with the technical aspects of surgical exposure, bone cuts of the distal femur and proximal tibia, medial and lateral ligament balancing, flexion and extension gap balancing, creating an appropriate tibiofemoral joint line, balancing the patellofemoral joint, preserving peroneal nerve function, and selection of the implant regarding constraint. Restoration of neutral mechanical axis and correct ligament balance are important factors for stability and longevity of the prosthesis and for good functional outcome. Thus, our review aims to provide step by step comprehensive knowledge about different surgical techniques for the correction of severe valgus deformity in total knee arthroplasty.
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Affiliation(s)
- D Alesi
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - A Meena
- VMMC and Safdarjung Hospital, Central Institute of Orthopedics, New Delhi, 110029, India
| | - S Fratini
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - V G Rinaldi
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - E Cammisa
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - G Lullini
- UO Medicina Riabilitativa e Neuroriabilitazione, IRCCS Istituto delle Scienze Neurologiche, Via Altura 3, 40139, Bologna, Italy
| | - V Vaccari
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - S Zaffagnini
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - G M Marcheggiani Muccioli
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy. .,University of Bologna, Bologna, Italy.
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15
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Alesi D, Marcheggiani Muccioli GM, Roberti di Sarsina T, Bontempi M, Pizza N, Zinno R, Di Paolo S, Zaffagnini S, Bragonzoni L. In vivo femorotibial kinematics of medial-stabilized total knee arthroplasty correlates to post-operative clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2021; 29:491-497. [PMID: 32253483 DOI: 10.1007/s00167-020-05975-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 12/22/2019] [Accepted: 03/30/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate if there was a correlation between in vivo kinematics of a medial-stabilized (MS) total knee arthroplasty (TKA) and post-operative clinical scores. We hypothesized that (1) a MS-TKA would produce a medial pivot movement and that (2) this specific pattern would be correlated with higher clinical scores. METHODS 18 patients were evaluated through clinical and functional scores evaluation (Knee Society Score clinical and functional, Womac, Oxford), and kinematically through dynamic radiostereometric analysis (RSA) at 9 months after MS-TKA, during the execution of a sit-to-stand and a lunge motor task. The anteroposterior (AP) Low Point translation of medial and lateral femoral compartments was compared through Student's t test (p < 0.05). A correlation analysis between scores and kinematics was performed through the Pearson's correlation coefficient r. RESULTS A significantly greater (p < 0.0001) anterior translation of the lateral compartment with respect to the medial one was found in both sit-to-stand (medial 2.9 mm ± 0.7 mm, lateral 7.1 mm ± 0.6 mm) and lunge (medial 5.3 mm ± 0.9 mm, lateral 10.9 mm ± 0.7 mm) motor tasks, thus resulting in a medial pivot pattern in about 70% of patients. Significant positive correlation in sit-to-stand was found between the peak of AP translation in the lateral compartment and clinical scores (r = 0.59 for Knee Society Score clinical and r = 0.61 for Oxford). Moreover, we found that the higher peak of AP translation of the medial compartment correlated with lower clinical scores (r = - 0.55 for Knee Society Score clinical, r = - 0.61 for Womac and r = - 0.53 for Oxford) in the lunge. A negative correlation was found between Knee Society Score clinical and VV laxity during sit-to-stand (r = - 0.56) and peak of external rotation in the lunge motor task (r = - 0.66). CONCLUSIONS The MS-TKA investigated produced in vivo a medial pivot movement in about 70% of patients in both examined motor tasks. There was a correlation between the presence of medial pivot and higher post-operative scores. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Domenico Alesi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Giulio Maria Marcheggiani Muccioli
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy. .,University of Bologna, Bologna, Italy.
| | - Tommaso Roberti di Sarsina
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Marco Bontempi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Nicola Pizza
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Raffaele Zinno
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Stefano Di Paolo
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.,University of Bologna, Bologna, Italy
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Marcheggiani Muccioli GM, Pizza N, Di Paolo S, Zinno R, Alesi D, Roberti Di Sarsina T, Bontempi M, Zaffagnini S, Bragonzoni L. Multi-radius posterior-stabilized mobile-bearing total knee arthroplasty partially produces in-vivo medial pivot during activity of daily living and high demanding motor task. Knee Surg Sports Traumatol Arthrosc 2020; 28:3773-3779. [PMID: 31955237 DOI: 10.1007/s00167-020-05846-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of the present study was to assess the kinematical behavior of a multi-radius posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasty (TKA) during an activity of daily living (Sit-To-Stand-STS) and a high demanding motor task (Deep-Knee-Lunge-DKL) using model-based dynamic RSA. We hypothesized the achievement of medial pivoting movement in both motor tasks due to the congruent geometry of the inlay with the femoral component, which should allow good stability of the medial compartment, and to the high magnitude of rotations guaranteed by the MB on the tibial side. METHODS Twenty-two randomly selected patients were recruited and prospectively evaluated. The PS MB cemented TKA was implanted with the standard technique (medial parapatellar approach, adjusted mechanical alignment). At minimum 9-month follow-up, patients were examined with model based Dynamic RSA developed in our Institute (BI-STAND DRX 2) during the execution of two motor tasks: STS and DKL. The motion parameters were evaluated using the Grood and Suntay decomposition and the low-point kinematics methods. RESULTS In the extension phase of DKL femur performed a greater antero posterior translation of 3.8 mm compared to STS between 0° and 20° of knee flexion (p < 0.05). Low-point analysis showed a medial pivoting movement in both motor tasks: in 62% of patients during STS and 48% during DKL. Varus-valgus rotations were lower than 1° during all the range-of-motion in both motor tasks without differences. CONCLUSIONS Medial pivot was partially produced by this multi-radius PS MB TKA with some differences during activity of daily living (STS) and high demanding motor task (DKL). LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Nicola Pizza
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Stefano Di Paolo
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Raffaele Zinno
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Domenico Alesi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Tommaso Roberti Di Sarsina
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Marco Bontempi
- Laboratorio di Biomeccanica, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, BO, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Laura Bragonzoni
- QUVI, Università di Bologna, corso D'Augusto 237, 47921, Rimini, RN, Italy
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Cardinale U, Bragonzoni L, Bontempi M, Alesi D, Roberti di Sarsina T, Lo Presti M, Zaffagnini S, Marcheggiani Muccioli GM, Iacono F. Knee kinematics after cruciate retaining highly congruent mobile bearing total knee arthroplasty: An in vivo dynamic RSA study. Knee 2020; 27:341-347. [PMID: 31874820 DOI: 10.1016/j.knee.2019.11.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 10/23/2019] [Accepted: 11/05/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This work presents a kinematic evaluation of a cruciate retaining highly congruent mobile bearing total knee arthroplasty design using dynamic Roentgen sterephotogrammetric analysis. The aim was to understand the effect of this implant design on the kinematics of prosthetic knees during dynamic activities. METHODS A cohort of 15 patients was evaluated at nine month follow-up after surgery. The mean age was 74.8 (range 66-85) years. The kinematics was evaluated using the Grood and Suntay decomposition and the Low-Point (LP) methods. RESULTS ?tlsb=-0.15pt?>From sitting to standing up position, the femoral component internally rotated (from -11.3 ± 0.2° to -7.0 ± 0.2°). Varus-valgus rotations were very close to 0° during the whole motor task. LP of medial condyle moved from an anterior position of 12.0 ± 0.2 mm to a posterior position of -12.4 ± 0.2 mm; LP of the lateral condyle moved from an anterior position of 8.1 ± 0.2 mm to a posterior position of -12.4 ± 0.2 mm, showing a bi-condylar rollback where both condyles moved parallel backward. Moreover, the femoral component showed anterior translation with respect to the tibia from 80° to 20° (from -4.9 ± 0.2 mm to 3.3 ± 0.2 mm), then a posterior translation from 20° to full extension was identified (from 3.3 ± 0.2 mm to 0.5 ± 0.2 mm). CONCLUSIONS Paradoxical anterior femoral translation and absence of medial-pivoting motion were recorded, highlighting the role of the symmetric deep dishes insert as main driver of the kinematic of this TKA design.
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Affiliation(s)
| | | | | | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic - IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Mirco Lo Presti
- II Orthopaedic and Traumatologic Clinic - IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic - IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy.
| | | | - Francesco Iacono
- Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, Rozzano, Milan 20089, Italy; Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milan 20089, Italy
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Bragonzoni L, Marcheggiani Muccioli GM, Bontempi M, Roberti di Sarsina T, Cardinale U, Alesi D, Iacono F, Neri MP, Zaffagnini S. New design total knee arthroplasty shows medial pivoting movement under weight-bearing conditions. Knee Surg Sports Traumatol Arthrosc 2019; 27:1049-1056. [PMID: 30368560 DOI: 10.1007/s00167-018-5243-5] [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: 05/20/2018] [Accepted: 10/17/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess, using model-based dynamic radiostereometric analysis (RSA), the biomechanical behaviour of a new design posterior-stabilized (PS) fixed-bearing (FB) total knee arthroplasty (TKA) in vivo while patients performing two common motor tasks. The hypothesis was that model-based dynamic RSA is able to detect different behaviour of the implant under weight-bearing and non-weight-bearing conditions. METHODS A cohort of 15 non-consecutive patients was evaluated by dynamic RSA 9 months after TKA implantation. The mean age of patients was 73.4 (65-72) years. The kinematic evaluations were performed using an RSA device (BI-STAND DRX 2) developed in our Institute. The patients were asked to perform two active motor tasks: sit-to-stand in weight-bearing condition; range of motion (ROM) while sitting on the chair. The motion parameters were evaluated using the Grood and Suntay decomposition and the low-point kinematics methods. RESULTS The dynamic RSA evaluation showed a significant difference (p < 0.05) between the biomechanical behaviour of the prosthesis during the two motor tasks. When subjected to the patient weight (in the sit-to-stand) the low point of the medial compartment had a shorter motion (5.7 ± 0.2 mm) than the lateral (11.0 ± 0.2 mm). This realizes a medial pivot motion as in the normal knee. In the ROM task, where the patient had no weight on the prosthesis, this difference was not present: the medial compartment had a displacement of 12.7 ± 0.2 mm, while the lateral had 17.3 ± 0.2 mm. CONCLUSIONS Model-based RSA proved to be an effective tool for the evaluation of TKA biomechanics. In particular, it was able to determine that the fixed-bearing posterior-stabilized TKA design evaluated in this study showed a medial pivoting movement under weight-bearing conditions that was not present when load was not applied. Under loading conditions what drives the pattern of movement is the prosthetic design itself. By the systematic use of this study protocol future comparisons among different implants could be performed, thus contributing significantly to the improvement of TKA design. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Giulio Maria Marcheggiani Muccioli
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Lab. di Biomeccanica via di Barbiano 1/10, 40136, Bologna, Italy. .,University of Bologna, Bologna, Italy.
| | | | - Tommaso Roberti di Sarsina
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Lab. di Biomeccanica via di Barbiano 1/10, 40136, Bologna, Italy
| | | | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Lab. di Biomeccanica via di Barbiano 1/10, 40136, Bologna, Italy
| | - Francesco Iacono
- Prosthetic Surgery and Articular Biological Reconstruction, Humanitas Clinical Institute, Milan, Italy
| | - Maria Pia Neri
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Lab. di Biomeccanica via di Barbiano 1/10, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Lab. di Biomeccanica via di Barbiano 1/10, 40136, Bologna, Italy
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Marcheggiani Muccioli GM, Guerra E, Roberti di Sarsina T, Alesi D, Fratini S, Cammisa E, Rinaldi VG, Lullini G, Rotini R, Zaffagnini S. Diagnosis and Treatment of Infected Shoulder Arthroplasty: Current Concepts Review. Joints 2018; 6:173-176. [PMID: 30582106 PMCID: PMC6301844 DOI: 10.1055/s-0038-1675800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 03/02/2018] [Accepted: 10/07/2018] [Indexed: 11/02/2022]
Abstract
Periprosthetic shoulder infection (PSI) is an emerging pathology which requires many improvements in diagnosis and treatment to obtain a satisfying success rate. Different approaches have been described. This article summarizes current concepts of diagnostic process and main treatments described in the literature.
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Affiliation(s)
| | - Enrico Guerra
- Shoulder and Elbow Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Fratini
- II Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eugenio Cammisa
- II Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Vito Gaetano Rinaldi
- II Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giada Lullini
- Laboratory of Movement Analysis and Functional-Clinical Evaluation of Prosthesis, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberto Rotini
- Shoulder and Elbow Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
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