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Quevedo Gonzalez FJ, Lipman JD, Sculco PK, Sculco TP, De Martino I, Wright TM. An Anterior Spike Decreases Bone-Implant Micromotion in Cementless Tibial Baseplates for Total Knee Arthroplasty: A Biomechanical Study. J Arthroplasty 2024; 39:1323-1327. [PMID: 38000515 DOI: 10.1016/j.arth.2023.11.020] [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: 06/14/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Cementless tibial baseplates in total knee arthroplasty include fixation features (eg, pegs, spikes, and keels) to ensure sufficient primary bone-implant stability. While the design of these features plays a fundamental role in biologic fixation, the effectiveness of anterior spikes in reducing bone-implant micromotion remains unclear. Therefore, we asked: Can an anterior spike reduce the bone-implant micromotion of cementless tibial implants? METHODS We performed computational finite element analyses on 13 tibiae using the computed tomography scans of patients scheduled for primary total knee arthroplasty. The tibiae were virtually implanted with a cementless tibial baseplate with 2 designs of fixation of the baseplate: 2 pegs and 2 pegs with an anterior spike. We compared the bone-implant micromotion under the most demanding loads from stair ascent between both designs. RESULTS Both fixation designs had peak micromotion at the anterior-lateral edge of the baseplate. The design with 2 pegs and an anterior spike had up to 15% lower peak micromotion and up to 14% more baseplate area with micromotions below the most conservative threshold for ingrowth, 20 μm, than the design with only 2 pegs. The greatest benefit of adding an anterior spike occurred for subjects who had the smallest area of tibial bone below the 20 μm threshold (ie, most at risk for failure to achieve bone ingrowth). CONCLUSIONS An anteriorly placed spike for cementless tibial baseplates with 2 pegs can help decrease the bone-implant micromotion during stair ascent, especially for subjects with increased bone-implant micromotion and risk for bone ingrowth failure.
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Affiliation(s)
| | - Joseph D Lipman
- Department of Biomechanics, Hospital for Special Surgery, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York
| | - Thomas P Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York
| | - Ivan De Martino
- Department of Geriatric Science and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York
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Giustra F, Cacciola G, Pirato F, Bosco F, De Martino I, Sabatini L, Rovere G, Camarda L, Massè A. Indications, complications, and clinical outcomes of fixation and acute total hip arthroplasty for the treatment of acetabular fractures: A systematic review. Eur J Orthop Surg Traumatol 2024; 34:47-57. [PMID: 37640795 PMCID: PMC10771595 DOI: 10.1007/s00590-023-03701-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: 06/22/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Acetabular fracture fixation can be challenging, especially in the elderly. Open reduction and internal fixation (ORIF) alone may not allow for early weight bearing and is associated with a high rate of secondary osteoarthritis; therefore, a combined hip procedure (CHP) or ORIF with acute total hip arthroplasty, may be beneficial in this population. The objective of this study was to perform a systematic review of all reported cases of CHP. METHODS PubMed, Embase, Scopus, and Cochrane databases were searched for studies analyzing acetabular fractures in the elderly managed with a combined hip procedure (CHP). The research was performed following the PRISMA guidelines. The included studies' methodological quality was evaluated using the MINORS score. The present study was registered on PROSPERO. RESULTS Eleven clinical studies were included in the final analysis. The mean age was 74.4 (63.2-78) years. Low-energy trauma was the most common mechanism of injury (64%). The most prevalent fracture pattern was the anterior column and posterior hemitransverse (ACPHT) (30.6%). The Kocher-Langenbeck approach was preferred for ORIF of posterior fractures and hip arthroplasty. The ilioinguinal approach and modified Stoppa were generally used for anterior fractures. The overall complication rate was 12.2%, and hip dislocation was the most frequent cause of reoperation (4.4%). The average Harris Hip Score reported postoperatively was 81.6 points, which was considered "good." CONCLUSIONS CHP is a safe treatment for elderly acetabular fractures with an acceptable complication and reoperation rate that results in good clinical outcomes. LEVEL OF EVIDENCE Level of evidence IV.
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Affiliation(s)
- Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | - Giorgio Cacciola
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Francesco Pirato
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy.
| | - Ivan De Martino
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Luigi Sabatini
- Ortopedia Protesica e Robotica - Humanitas Gradenigo, Turin, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lawrence Camarda
- Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy
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Cacciola G, Giustra F, Bosco F, De Meo F, Bruschetta A, De Martino I, Risitano S, Sabatini L, Massè A, Cavaliere P. Trabecular titanium cups in hip revision surgery: a systematic review of the literature. Ann Jt 2023; 8:36. [PMID: 38529221 PMCID: PMC10929389 DOI: 10.21037/aoj-23-28] [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] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/24/2023] [Indexed: 03/27/2024]
Abstract
Background Hip revision surgery in extensive acetabular bone defects represents a complex challenge for hip surgeons. The primary goal is to obtain a stable acetabular component and restore the hip biomechanics. Through the years, different prosthetic implants have been developed to perform acetabular revision depending on bone loss location and extension. This systematic review aims to summarize the clinical outcomes and complications reported with trabecular titanium (TT) cups in hip revision surgery. Methods A literature search of four databases (PubMed, Embase, Scopus and the Cochrane Database of systematic reviews) was performed according to the PRISMA guideline from January 2008 to December 2022. All studies written in English and reporting the clinical outcome of patients undergoing revision total hip arthroplasty using Delta TT cups were included. The initial screening identified 378 studies. Each eligible clinical article was analyzed according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence (LoE), and the papers' methodological quality was evaluated using The Methodological Index for Non-Randomized Studies Criteria (MINORS) score. Results Eight clinical studies were included in the analysis. A total of 523 hip revisions were analyzed. Delta TT cups were used in 3.9%, Delta TT one cups in 46.8%, and Delta TT revisions in 49.3%. Paprosky IIIa was the most frequent acetabular bone defect reported in 26.4% of cases. The overall survival rate of TT cups was 93.4%. The dislocation was the most frequent complication in 4.1% of patients, while the prevalence of aseptic loosening was 1.5. Conclusions Managing severe acetabular bone defects remains a complex challenge for hip surgeons. Since their introduction, TT cups have exhibited good clinical results, with complication rates in line with or lower than those reported by similar implants.
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Affiliation(s)
- Giorgio Cacciola
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino – ASL Città di Torino, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino – ASL Città di Torino, Turin, Italy
| | - Federico De Meo
- Orthopaedic Institute of Southern Italy “Franco Scalabrino”, Messina, Italy
| | | | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Salvatore Risitano
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
| | - Pietro Cavaliere
- Orthopaedic Institute of Southern Italy “Franco Scalabrino”, Messina, Italy
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Cacciola G, Mancino F, Holzer LA, De Meo F, De Martino I, Bruschetta A, Risitano S, Sabatini L, Cavaliere P. Predictive Value of the C-Reactive Protein to Albumin Ratio in 30-Day Mortality after Hip Fracture in Elderly Population: A Retrospective Observational Cohort Study. J Clin Med 2023; 12:4544. [PMID: 37445579 DOI: 10.3390/jcm12134544] [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: 03/04/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND C-reactive protein (CRP) to Albumin ratio (CAR) has been used in multiple clinical settings to predict early mortality. However, there is a lack of evidence on the predictive role of CAR in 30-day mortality after a hip fracture. The purpose of this study was to establish a potential association between CAR and 30-day mortality and to assess if the CAR Receiving Operating Characteristics curve (ROC) can be a reliable predictor of early mortality. METHODS We retrospectively reviewed the charts of 676 patients (>65 years) treated for hip fracture between 2006 and 2018. All hip fractures were included. Treatment strategies included closed reduction and internal fixation, open reduction and internal fixation, hemiarthroplasty, or total joint arthroplasty. Statistical analysis included T-test, Pearson correlation for CAR and other markers, ROC curves and area under the curve, Youden Model, and Odds Ratio. RESULTS The 30-day mortality rate analysis showed that higher preoperative levels of CAR were associated with higher early mortality. When analyzing the area under the ROC curve (AUROC) for 30-day mortality, the reported value was 0.816. The point of the ROC curve corresponding to 14.72 was considered a cut-off with a specificity of 87% and a sensibility of 40.8%. When analyzing values higher than 14.72, the 30-day mortality rate was 17.9%, whilst, for values lower than 14.72, the 30-day mortality rate was 1.8%. CONCLUSIONS Patients older than 65 years affected by a hip fracture with increased preoperative levels of CAR are associated with higher 30-day mortality. Despite a moderate sensibility, considering the low cost and the predictivity of CAR, it should be considered a standard predictive marker.
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Affiliation(s)
- Giorgio Cacciola
- Orthopaedic Institute of Southern Italy "Franco Scalabrino", 98165 Messina, Italy
| | - Fabio Mancino
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
| | - Lukas A Holzer
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
| | - Federico De Meo
- Orthopaedic Institute of Southern Italy "Franco Scalabrino", 98165 Messina, Italy
| | - Ivan De Martino
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
- Adult Reconstruction and Joint Replacement Unit, Division of Sports Traumatology and Joint Replacement, Department of Ageing, Orthopaedic and Rheumatologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | | | - Salvatore Risitano
- A.O.U. Città della Salute e della Scienza, Centro Traumatologico Ortopedico (C.T.O.), Universitá di Torino, 10024 Turin, Italy
| | - Luigi Sabatini
- A.O.U. Città della Salute e della Scienza, Centro Traumatologico Ortopedico (C.T.O.), Universitá di Torino, 10024 Turin, Italy
| | - Pietro Cavaliere
- Orthopaedic Institute of Southern Italy "Franco Scalabrino", 98165 Messina, Italy
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Mancino F, Jones CW, Benazzo F, Singlitico A, Giuliani A, De Martino I. Where are We Now and What are We Hoping to Achieve with Robotic Total Knee Arthroplasty? A Critical Analysis of the Current Knowledge and Future Perspectives. Orthop Res Rev 2022; 14:339-349. [PMID: 36274930 PMCID: PMC9586165 DOI: 10.2147/orr.s294369] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022] Open
Abstract
Robotic-assisted total knee arthroplasty (rTKA) has been developed to improve knee kinematics and functional outcomes, expedite recovery, and improve implants long-term survivorship. Robotic devices are classified into active, semi-active, and passive, based on their degree of freedom. Their capacity to provide increased accuracy in implants positioning with reduced radiographic outliers has been widely proved. However, these early advantages are yet to be associated with long-term survivorship. Moreover, multiple drawbacks are still encountered including a variable learning curve, increased setup and maintenance costs, and potential complications related to the surgical technique. Despite recent technologies applied to TKA have failed to prove substantial improvements, robotic-assisted surgery seems to be here to stay and revolutionize the field of TKA. To support its consistent usage on a daily basis, long-term results are still awaited, and further improvements are necessary to reduce the expenses related to it.
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Affiliation(s)
- Fabio Mancino
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Christopher W Jones
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, Western Australia, Australia,Curtin University, Perth, Western Australia, Australia
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, Fondazione Poliambulanza, Brescia, Italy,IUSS, Istituto di Studi Superiori, Pavia, Italy
| | | | | | - Ivan De Martino
- Università Cattolica del Sacro Cuore, Roma, Italy,Unità di Ortopedia e Traumatologia, Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy,Correspondence: Ivan De Martino, Unità di Ortopedia e Traumatologia, Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, Roma, 00168, Italy, Tel +39 3512412491, Email ;
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Vitiello R, Perisano C, Greco T, Cianni L, Polichetti C, Comodo RM, De Martino I, La Vergata V, Maccauro G. Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study. BMC Musculoskelet Disord 2022; 22:1069. [PMID: 36100879 PMCID: PMC9472329 DOI: 10.1186/s12891-022-05728-5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extracapsular proximal femur metastasis could be treated by synthesis or resection and megaprosthesis. No universal accepted guidelines are present in the literature. The aim of our study is to analyze of patients with metastases in the trochanteric region of the femur treated by a single type of intramedullary nailing or hip megaprosthesis. METHODS We retrospectively reviewed all patients affected by extracapsular metastases of proximal femur. Anthropometric and anamnestic data, routine blood exams and complications were collected. VAS score and MSTS score was administered before the surgery, ad 1-6-12 months after surgery. An un-paired T test and Chi-square were used. Multiple linear regression and logistic regression was performed. Significance was set for p < 0.05. RESULT Twenty patients were assigned in intramedullary Group, twenty-five in megaprostheses Group. The mean operative time is shorter in intramedullary group. Differential shows a higher anemization in megaprostheses group (2 ± 2 vs 3.6 ± 1.3; p = 0.02). The patients of intramedullary group showed malnutrition (Albumin: 30.5 ± 6.5 vs 37.6 ± 6 g/L; p = 0.03) and pro-inflammatory state (NLR: 7.1 ± 6.7 vs 3.8 ± 2.4; p = 0.05) (PLR: 312 ± 203 vs 194 ± 99; p = 0.04) greater than megaprostheses group. The patients in intramedullary groups shows a higher functional performance score than megaprostheses group at 1 month follow-up (MSTS: 16.4 ± 6.3 vs 12.2 ± 3.7; p = 0.004). A multivariate analysis confirms the role of type of surgery (p = 0.001), surgery duration (p = 0.005) and NLR (p = 0.02) in affecting the MSTS. Globally eight complications were recorded, no statistical difference was noticed between the two groups (p = 0.7), no predictor was found at logistic analysis. CONCLUSION Intramedullary nailing guarantees a rapid functional recovery, compared to patients undergoing hip megaprosthesis who instead improve gradually over time. The selection of patients with poor prognosis allows the correct surgical indication of nailing, while in the case of a more favorable prognosis, the intervention of hip megaprosthesis is to be preferred.
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Affiliation(s)
- Raffaele Vitiello
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- Università Cattolica Del Sacro Cuore, Rome, Italy.
| | - Carlo Perisano
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Tommaso Greco
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Luigi Cianni
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Chiara Polichetti
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | | | - Ivan De Martino
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Vincenzo La Vergata
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Giulio Maccauro
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
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Mancino F, Di Matteo V, Mocini F, Pietramala S, Singlitico A, De Fazio A, La Vergata V, Gasparini G, Maccauro G, De Martino I. Short-Term Survivorship of 3D-Printed Titanium Metaphyseal Cones in Revision Total Knee Arthroplasty: A Systematic Review. Orthop Rev (Pavia) 2022; 14:35891. [PMID: 35769657 DOI: 10.52965/001c.35891] [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: 11/08/2021] [Accepted: 12/28/2021] [Indexed: 11/06/2022] Open
Abstract
Background Several studies have evaluated the outcomes of tantalum cones in revision knee arthroplasty with moderate-to-severe metaphyseal bone defects. However, recent innovations have led to the development of 3-D printed titanium cones to better adapt to host bone, there remains no consensus on their overall performance. Objective We therefore performed a systematic review of the literature to examine short-term survivorship and complication rates of their usage in revision TKAs. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles using various combinations of keywords. Results In all, 7 articles met the inclusion criteria. A total of 687 cones were implanted in 557 revision TKAs. The all-cause revision-free survivorship of the implants was 95.3% (26 revisions), and of the cones was 95.5% (31 cones revised) at mean 24 months follow-up. The cones revision-free survivorship from aseptic loosening was 99.7%. The overall complication rate was 19.7% with infection as the most common complications observed and the most frequent reason for revision with an incidence of 10.4% and 4.1%, respectively. Overall, functional outcomes improved as documented by postoperative knee scores. Conclusion 3-D printed metal cones represent a reliable option in metaphyseal bone defects reconstruction that provides high fixation, good short-term survivorship, and complications rates in line with similar devices. In addition, they are associated with lower intraoperative complications, and higher survivorship from aseptic loosening.
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Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Vincenzo Di Matteo
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Fabrizio Mocini
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Silvia Pietramala
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessandro Singlitico
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea De Fazio
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Vincenzo La Vergata
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giorgio Gasparini
- Orthopedic Surgery Division, Department of Medical and Surgical Sciences, University of Catanzaro Magna Græcia, Viale Europa, Germaneto, 88100 Catanzaro, CZ, Italy
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Malahias MA, Mancino F, Gu A, Adriani M, De Martino I, Boettner F, Sculco PK. Acetabular impaction grafting with mesh for acetabular bone defects: a systematic review. Hip Int 2022; 32:185-196. [PMID: 33147103 DOI: 10.1177/1120700020971851] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In conjunction with impaction bone grafting (IBG), metal meshes have been proposed to minimise defects of the medial and superolateral walls in order to convert combined complex uncontained segmental defects into contained cavitary defects to facilitate IBG. METHODS The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to March 2019 utilising keywords pertinent to total hip arthroplasty (THA), acetabular impaction bone grafting, clinical or functional outcomes, revision THA, or postoperative complications. RESULTS 7 articles were found to be suitable for inclusion in the present study. The mean modified Coleman methodology score for methodological deficiencies of the studies was 45.3 (range 38-59). Severe acetabular bone loss was present in 56% of cases having moderate bone loss in 18%, and mild in 26%. The all-cause reoperation rate was 7.4%, while the all-cause revision rate of the acetabular component was 6.2%. CONCLUSIONS IBG with mesh is effective for selected patients with acetabular bone defects. Most patients with moderate bone loss as well as selected patients with large superolateral defects can be successfully treated with IBG combined with mesh. There is limited data to show that IBG with mesh might be associated with decreased survival rates in patients with severe lateral defects (Paprosky IIIA) combined with ischial or medial wall osteolysis who require combined medial and lateral meshes. In addition, patients with severe superomedial migration of the cup (Paprosky IIIB) should not be treated with IBG and mesh.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Fabio Mancino
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Marco Adriani
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Ivan De Martino
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Friedrich Boettner
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
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9
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Greenberg A, Nocon A, De Martino I, Mayman DJ, Sculco TP, Sculco PK. Serum Metal Ions in Contemporary Monoblock and Modular Dual Mobility Articulations. Arthroplast Today 2021; 12:51-56. [PMID: 34761094 PMCID: PMC8567330 DOI: 10.1016/j.artd.2021.08.021] [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: 08/15/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background Questions exist about the release of cobalt and chromium ions from dual mobility (DM) cups. Modular implants, with potential backside wear between the cobalt-chromium liner and titanium cup, are of particular concern. This study compares the metal ion profile of patients with contemporary monoblock and modular DM articulations from two commonly used designs. Methods Cobalt and chromium serum levels were measured one year after surgery in a prospective cohort of patients undergoing total hip arthroplasty with a DM construct. Ion levels were detected above 1 μg/L. Clinical and surgical data were correlated with the ion levels for analysis. Results Overall, 29% of the patients had levels above 1 μg/L of either ion. More patients with modular cups had detectable ions than patients with monoblock cups (39% vs 20%, P = .05). Cobalt was more commonly detected in the monoblock group, and chromium was more commonly detected in the modular group (P = .05). There were no differences in the actual ion levels between the groups (1.35 μg/L vs 1.64 μg/L, P = .44, for cobalt and 1.35 μg/L vs 1.31 μg/L, P = .77, for chromium). No patient underwent revision during the follow-up period. Conclusions We found similar cobalt and chromium levels in patients with monoblock and modular DM cups. More patients in the modular group had detectable ions. Cobalt was more frequently detected in the monoblock group. These results suggest that both implants are performing well in the short term, but further follow-up is needed to determine whether the differences found are of clinical significance.
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Affiliation(s)
- Alexander Greenberg
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedic Surgery, Hadassah Mount Scopus Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Allina Nocon
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Ivan De Martino
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA.,Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Roma, Italy
| | - David J Mayman
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Thomas P Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Peter K Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
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10
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Mancino F, Di Matteo V, Mocini F, Cacciola G, Malerba G, Perisano C, De Martino I. Survivorship and clinical outcomes of proximal femoral replacement in non-neoplastic primary and revision total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 2021; 22:933. [PMID: 34749680 PMCID: PMC8576938 DOI: 10.1186/s12891-021-04711-w] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Several studies have evaluated the survivorship and clinical outcomes of proximal femoral replacement (PFR) in complex primary and revision total hip arthroplasty with severe proximal femoral bone loss; however, there remains no consensus on the overall performance of this implant. We therefore performed a systematic review of the literature in order to examine survivorship and complication rates of PFR usage. METHODS A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles using various combinations of keywords. RESULTS In all, 18 articles met the inclusion criteria. A total of 578 PFR were implanted. The all-cause reoperation-free survivorship was 76.6%. The overall complication rate was 27.2%. Dislocation was the most common complication observed and the most frequent reason for reoperation with an incidence of 12.8 and 7.6%, respectively. Infection after PFR had an incidence of 7.6% and a reoperation rate of 6.4%. The reoperation rate for aseptic loosening of the implant was 5.9%. Overall, patients had improved outcomes as documented by postoperative hip scores. CONCLUSION PFR usage have a relatively high complication rate, however, it remains an efficacious treatment option in elderly patients with osteoporotic bone affected by severe proximal femoral bone loss. Modular designs have shown reduced dislocations rate and higher survivorship free from dislocation. However, PFR should only be used as salvage procedure when no other reconstruction options are available.
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Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.
- Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168, Rome, Italy.
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico, Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Roma, RM, Italy.
| | - Vincenzo Di Matteo
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
- Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Fabrizio Mocini
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
- Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Giorgio Cacciola
- Orthopaedic Institute of Southern Italy "Franco Scalabrino", Messina, Italy
| | - Giuseppe Malerba
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Carlo Perisano
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
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11
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Cacciola G, Mancino F, De Meo F, Bruschetta A, De Martino I, Cavaliere P. Current Reconstruction Options in Periprosthetic Fractures Around the Knee. Geriatr Orthop Surg Rehabil 2021; 12:21514593211023996. [PMID: 34471568 PMCID: PMC8404675 DOI: 10.1177/21514593211023996] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/21/2021] [Accepted: 05/17/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Periprosthetic fractures are a rare complication after total knee arthroplasty (TKA). However, the incidence of these fractures is growing after the increasing number of TKAs performed every year and the progressive aging of the population. In addition, the surgical treatment and peri-operative management of these complications are demanding, representing a challenge for the orthopedic surgeon. Significance: A thorough understanding of these fractures and a correct classification are necessary in order to select the most suitable surgical treatment. The aim of this review was to analyze the epidemiology, classification, diagnosis, surgical treatment, and outcomes of periprosthetic knee fractures in order to give an exhaustive overview. Results: Reduction and internal fixation with locking plates or intramedullary nails represents the preferred option in case of a stable prosthetic implant. Conversely, in case of loose tibial and/or femoral component, implant revision is mandatory. Conservative treatment is rarely indicated. Conclusion: A deep understanding of the characteristics and patterns of periprosthetic knee fractures, and the determination of the stability of the prosthetic implant are necessary in order to establish the correct treatment.
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Affiliation(s)
- Giorgio Cacciola
- Orthopaedic Institute of Southern Italy "Franco Scalabrino," Messina, Italy
| | - Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federico De Meo
- Orthopaedic Institute of Southern Italy "Franco Scalabrino," Messina, Italy
| | | | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Pietro Cavaliere
- Orthopaedic Institute of Southern Italy "Franco Scalabrino," Messina, Italy
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12
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Malahias MA, Gu A, Richardson SS, De Martino I, Sculco PK, McLawhorn AS. Hip arthroscopy for hip osteoarthritis is associated with increased risk for revision after total hip arthroplasty. Hip Int 2021; 31:656-662. [PMID: 32126841 DOI: 10.1177/1120700020911043] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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
BACKGROUND It has not been determined yet whether hip arthroscopy (HA) leads to adverse outcomes after total hip arthroplasty (THA). The purpose of this study was to (1) determine 2-year conversion rate of HA done for osteoarthritis (OA) to THA and (2) explore the relationship between HA performed in patients with hip osteoarthritis and the risk of revision THA within 2 years of index arthroplasty. METHODS Data was collected from the Medicare Standardized Analytic Files insurance database using the PearlDiver Patient Records Database from 2005-2016. Patients were stratified into 2 groups based upon a history of hip arthroscopy prior to THA. RESULTS The 2-year conversion to THA rate for hip arthroscopy in patients with OA was 68.4% (95% CI, 66.2-70.6%). Multivariate analysis demonstrated that OA patients who underwent HA prior to THA were at an increased risk of revision surgery (OR 3.72; 95% CI, 3.15-4.57; p = 0.012), periprosthetic joint infection (OR 1.86; 95% CI, 1.26-2.77, p = 0.010) and aseptic loosening (OR 2.81; 95% CI, 1.66-4.76; p < 0.001) within 2 years of THA. CONCLUSIONS Analysis of a large insurance database found the conversion rate from HA performed in Medicare OA patients to THA within 2 years is unacceptably high. Hip arthroscopy prior to THA also significantly increased the risk of THA revision within 2 years after index THA. These results suggest that arthroscopic hip surgery should not be performed in patients with a diagnosis of OA as conversion rates are high and revision rates post THA are significantly increased.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Shawn S Richardson
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Ivan De Martino
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Alexander S McLawhorn
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
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13
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Malahias MA, Gu A, Richardson SS, De Martino I, Mayman DJ, Sculco TP, Sculco PK. Association of Lumbar Degenerative Disease and Revision Rate following Total Knee Arthroplasty. J Knee Surg 2021; 34:1126-1132. [PMID: 32074655 DOI: 10.1055/s-0040-1701651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recently, a variety of studies have analyzed the potential correlation between lumbar degenerative disease (LDD) and inferior clinical outcomes after total hip arthroplasty. However, there has been limited data concerning the role of LDD as a risk factor for failure after total knee arthroplasty (TKA). The aim of our study was to determine: (1) what is the association of LDDs with TKA failure (all-cause revision) within 2 years of index arthroplasty and (2) if patients with LDD and lumbar fusion are at increased risk of TKA revision within 2 years compared with LDD patients without fusion. Data were collected from the Humana insurance database using the PearlDiver database from 2007 to 2017. To assess aim 1, patients were stratified into two groups based on a prior history of LDD (International Classification of Diseases [ICD]-9 or -10 diagnostic codes). To analyze aim 2, patients within the LDD cohort were stratified based on the presence of lumbar fusion (lumbar fusion Current Procedural Terminology code). All-cause revision rate was 3.4% among LDD patients versus 2.4% of patients with non-LDD (p < 0.001) at 2 years. Following multivariate analysis, LDD patients were at increased risk of all-cause revision surgery at 2 years (odds ratio [OR]: 1.361; 95% confidence interval [CI]: 1.238-1.498; p < 0.001) as well as aseptic loosening (OR: 1.533; 95% CI: 1.328-1.768; p < 0.001), periprosthetic joint infection (OR: 1.245; 95% CI: 1.129-1.373; p < 0.001), and periprosthetic fracture (OR: 1.521; 95% CI: 1.229-1.884; p < 0.001). Among LDD patients, patients who have a lumbar fusion had an all-cause revision rate of 5.0%, compared with 3.2% among LDD with no lumbar fusion patients at 2 years (p = 0.021). Following multivariate analysis, lumbar fusion patients were at increased risk of all-cause revision surgery (OR: 1.402; 95% CI: 1.362-1.445; p = 0.028), aseptic loosening (OR: 1.432; 95% CI: 1.376-1.489; p = 0.042), and periprosthetic fracture (OR: 1.302; 95% CI: 1.218-1.392; p = 0.037). Based on these findings, TKA candidates with preoperative LDD should be counseled that TKA outcome may be impaired by the coexistence of lumbar spine degenerative disease. This is Level III therapeutic study.
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Affiliation(s)
- Michael-Alexander Malahias
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Alex Gu
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Shawn S Richardson
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Ivan De Martino
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Thomas P Sculco
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
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14
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Mancino F, Jones CW, Sculco TP, Sculco PK, Maccauro G, De Martino I. Survivorship and Clinical Outcomes of Constrained Acetabular Liners in Primary and Revision Total Hip Arthroplasty: A Systematic Review. J Arthroplasty 2021; 36:3028-3041. [PMID: 34030877 DOI: 10.1016/j.arth.2021.04.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/28/2021] [Revised: 04/08/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Several studies have evaluated the survivorship and clinical outcomes of constrained acetabular liners (CALs) in complex primary and revision total hip arthroplasty with hip instability; however, there remains no consensus on the overall performance of this constrained implant. We therefore performed a systematic review of the literature to examine survivorship and complication rate of CAL usage. METHODS A systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles using various combinations of keywords. RESULTS In all, 37 articles met the inclusion criteria. A total of 4152 CALs were implanted. The all-cause reoperation-free survivorship was 79.9%. The overall complication rate was 22.2%. Dislocation was the most common complications observed and the most frequent reason for reoperation with an incidence of 9.4% and 9.2%, respectively. Infection after CAL placement had an incidence of 4.6%. The reoperation rate for aseptic acetabular component loosening was 2.9%. Overall, patients had improved outcomes as documented by postoperative hip scores. CONCLUSION CALs usage have a relatively high complication rate, particularly when compared with current bearing alternatives (dual mobility cups and large diameter femoral heads), however, it remains a valuable salvage procedure in complex patients affected by recurrent dislocation and implant instability. Newer designs have shown reduced impingement and higher survivorship free from dislocation. However, CALs should only be used when the reasons of instability have been correctly recognized and optimized.
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Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christopher W Jones
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Thomas P Sculco
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy; Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
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15
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Perino G, De Martino I, Zhang L, Xia Z, Gallo J, Natu S, Langton D, Huber M, Rakow A, Schoon J, Gomez-Barrena E, Krenn V. The contribution of the histopathological examination to the diagnosis of adverse local tissue reactions in arthroplasty. EFORT Open Rev 2021; 6:399-419. [PMID: 34267931 PMCID: PMC8246109 DOI: 10.1302/2058-5241.6.210013] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Indexed: 12/21/2022] Open
Abstract
The histopathological examination of the periprosthetic soft tissue and bone has contributed to the identification and description of the morphological features of adverse local tissue reactions (ALTR)/adverse reactions to metallic debris (ARMD). The need of a uniform vocabulary for all disciplines involved in the diagnosis and management of ALTR/ARMD and of clarification of the parameters used in the semi-quantitative scoring systems for their classification has been considered a pre-requisite for a meaningful interdisciplinary evaluation. This review of key terms used for ALTR/ARMD has resulted in the following outcomes: (a) pseudotumor is a descriptive term for ALTR/ARMD, classifiable in two main types according to its cellular composition defining its clinical course; (b) the substitution of the term metallosis with presence of metallic wear debris, since it cannot be used as a category of implant failure or histological diagnosis; (c) the term aseptic lymphocytic-dominated vasculitis- associated lesion (ALVAL) should be replaced due to the absence of a vasculitis with ALLTR/ALRMD for lymphocytic-predominant and AMLTR/AMRMD for macrophage-predominant reaction. This review of the histopathological classifications of ALTR/ARMD has resulted in the following outcomes: (a) distinction between cell death and tissue necrosis; (b) the association of corrosion metallic debris with adverse local lymphocytic reaction and tissue necrosis; (c) the importance of cell and particle debris for the viscosity and density of the lubricating synovial fluid; (d) a consensus classification of lymphocytic infiltrate in soft tissue and bone marrow; (e) evaluation of the macrophage infiltrate in soft tissues and bone marrow; (f) classification of macrophage induced osteolysis/aseptic loosening as a delayed type of ALTR/ARMD; (g) macrophage motility and migration as possible driving factor for osteolysis; (h) usefulness of the histopathological examination for the natural history of the adverse reactions, radiological correlation, post-marketing surveillance, and implant registries. The review of key terms used for the description and histopathological classification of ALTR/ARMD has resulted in a comprehensive, new standard for all disciplines involved in their diagnosis, clinical management, and long-term clinical follow-up.
Cite this article: EFORT Open Rev 2021;6:399-419. DOI: 10.1302/2058-5241.6.210013
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Affiliation(s)
- Giorgio Perino
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lingxin Zhang
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, Canada
| | - Zhidao Xia
- Centre for Nanohealth, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, University Hospital, Palacky University Olomouc, Czech Republic
| | - Shonali Natu
- Department of Pathology, University Hospital of North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - David Langton
- Orthopaedic Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Monika Huber
- Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Wien, Austria
| | - Anastasia Rakow
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Janosch Schoon
- Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Enrique Gomez-Barrena
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik-GmbH, Trier, Germany
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16
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Mancino F, Falez F, Mocini F, Sculco PK, Maccauro G, De Martino I. Is varus-valgus constraint a reliable option in complex primary total knee arthroplasty? A systematic review. J Orthop 2021; 24:201-211. [PMID: 33746421 DOI: 10.1016/j.jor.2021.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/17/2021] [Accepted: 02/28/2021] [Indexed: 10/22/2022] Open
Abstract
Purpose Knee instability is considered one of the most frequent cause of failure after primary total knee arthroplasty (TKA). In order to address intraoperative instability, varus-valgus constrained knee implants (VVC) are increasingly utilized in primary TKA. Despite an increased risk of mechanical failure, short to mid-term results seem to be encouraging, but long-term results are still lacking. Methods A systematic review of prospective and retrospective studies that reported clinical outcomes of patients with VVC systems in primary TKAs between 1990 and 2020 was performed. Results In all, 28 articles met our inclusion criteria. A total of 2798 VVC implants were used in primary TKA. The all-cause revision-free survivorship was 95.2% at a mean follow-up of 7 years. Infection and aseptic loosening were the most common reasons for reoperation with an incidence of 1.8% and 1.7%, respectively. Overall complication rate was 9.6%, the most common complications were knee stiffness and infection with an incidence of 2.8% and 2.5%, respectively. Conclusions VVC implants in primary TKA are associated with improved functional outcomes and good mid-term survivorship, comparable to lower level of constraint implants. Non-modular stemless seem to be reliable implants at mid-term follow-up. However, given the lack data coming from long-term studies, VVC implants should be used cautiously in primary TKA.
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Affiliation(s)
- Fabio Mancino
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, RM, 00168, Italy.,Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, RM, 00168, Italy
| | - Francesco Falez
- Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital, Via G. Martinotti 20, 00135, Rome, Italy
| | - Fabrizio Mocini
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, RM, 00168, Italy.,Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, RM, 00168, Italy
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, United States
| | - Giulio Maccauro
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, RM, 00168, Italy.,Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, RM, 00168, Italy
| | - Ivan De Martino
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, RM, 00168, Italy
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Cacciola G, Mancino F, De Meo F, Di Matteo V, Sculco PK, Cavaliere P, Maccauro G, De Martino I. Mid-term survivorship and clinical outcomes of the medial stabilized systems in primary total knee arthroplasty: A systematic review. J Orthop 2021; 24:157-164. [PMID: 33716421 DOI: 10.1016/j.jor.2021.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/14/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Medial Pivot Total Knee Arthroplasty was introduced in clinical practice in 1990s to reproduce the in vivo-natural knee kinematics. This design is characterized by an asymmetric constraint profile, with aa highly congruent medial compartment, and a less congruent lateral compartment. Short-term outcomes of the medial pivot systems in primary knee arthroplasty have been widely reported in the current literature, however, only few studies have described results beyond 5-year follow-up. Objectives The primary objectives of this systematic review of the literature is to analyze the mid-term studies on medial pivot total knee arthroplasty focusing on the reoperation rate, survivorship and clinical outcome scores. Methods The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to December 2019 utilizing the following keywords: "medial pivot", "medial stabilized", "medial rotating", "medial congruent", medial ball and socket", "arthroplasty", "TKA", "TKR", and "knee surgery". Results 18 articles met the inclusion criteria for the present study. The average quality was 11.4 for non-comparative studies and 21.7 for comparative studies based on MINORS criteria. A total 2832 knee arthroplasties were included for the final analysis with an average age of 69 years, and an average follow-up of 8.1 years (minimum 5 years). The overall reoperation rate was 2.4%, with periprosthetic joint infection as the leading cause of revision in 0.9% of cases, followed by aseptic loosening in 0.4% of cases. The average Knee Society Score improved to a mean preoperative score of 40.1 to a mean postoperative score of 89.2. The functional knee society score improved from a mean preoperative score of 44.8 to an average postoperative score of 82.9. The global range of motion improved from 104.8° preoperatively to 115.6° postoperatively. Conclusion We found that medial pivot system in primary total knee arthroplasty provide overall mid-term survivorship comparable to other standard implasnts. In addition, medial pivot system is associated with better high-end function compared to standard implants.
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Affiliation(s)
- Giorgio Cacciola
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Via Consolare Pompea, 98165, Messina, ME, Italy
| | - Fabio Mancino
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, RM, 00168, Italy.,Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, RM, 00168, Italy
| | - Federico De Meo
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Via Consolare Pompea, 98165, Messina, ME, Italy
| | - Vincenzo Di Matteo
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, RM, 00168, Italy.,Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, RM, 00168, Italy
| | - Peter K Sculco
- Stavros Niarchos Foundation, Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Pietro Cavaliere
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Via Consolare Pompea, 98165, Messina, ME, Italy
| | - Giulio Maccauro
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, RM, 00168, Italy.,Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, RM, 00168, Italy
| | - Ivan De Martino
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, RM, 00168, Italy
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18
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Mancino F, De Martino I, Burrofato A, De Ieso C, Saccomanno MF, Maccauro G, De Santis V. Satisfactory mid-term outcomes of condylar-constrained knee implants in primary total knee arthroplasty: clinical and radiological follow-up. J Orthop Traumatol 2020; 21:22. [PMID: 33263831 PMCID: PMC7710834 DOI: 10.1186/s10195-020-00561-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/18/2020] [Indexed: 12/04/2022] Open
Abstract
Background The purpose of this study was to evaluate (1) the reoperation rates and survivorship for septic and aseptic causes, (2) radiographic outcomes, and (3) clinical outcomes of condylar-constrained knee (CCK) implants used in primary total knee arthroplasty (TKA) with severe coronal deformity and/or intraoperative instability. Materials and methods A consecutive series of CCK implants in primary TKA was retrospectively evaluated in patients with severe coronal deformities. Forty-nine patients (54 knees) were included with a mean follow-up of 9 years (range 6–12). All patients were treated with a single-design, second-generation CCK implant. The primary diagnosis was osteoarthritis in 36 knees, post-traumatic arthritis in 7 knees, and rheumatoid arthritis in 4 knees. Preoperatively, standing femorotibial alignment was varus in 22 knees and valgus in 20 knees. Results At a mean follow-up of 9 years, overall survivorship was 93.6%. Two knees (4.3%) required revision for periprosthetic joint infection. One knee (2.1%) required subsequent arthroscopy due to patellar clunk syndrome. At final follow-up, no evidence of loosening or migration of any implant was reported, and the mean Knee Society knee scores improved from 43 to 86 points (p < 0.001). The mean Knee Society function scores improved to 59 points (p < 0.001). The average flexion contracture improved from 7° preoperatively to 2° postoperatively and the average flexion from 98° to 110°. No knees reported varus–valgus instability in flexion or extension. Conclusion CCK implants in primary TKA with major coronal deformities and/or intraoperative instability provide good midterm survivorship, comparable with less constrained implants. In specific cases, CCK implants can be considered a viable option with good clinical and radiographic outcomes. However, a higher degree of constraint should be used cautiously, leaving the first choice to less constrained implants. Level of evidence Therapeutic study, level IV.
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Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy. .,Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Aaron Burrofato
- Department of Orthopaedics, Children's Hospital "Bambino Gesù", Rome, Italy
| | - Carmine De Ieso
- Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Rome, Italy
| | - Maristella F Saccomanno
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Vincenzo De Santis
- Department of Orthopaedics and Traumatology, Mater Olbia Hospital, Olbia, Italy
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19
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Malahias MA, Bauer TW, Gu A, Nocon AA, De Martino I, Sculco PK. Questioning the Clinical Relevance of Positive Post-implantation Allergy Testing for Metal Hypersensitivity in Total Knee Arthroplasty: A Didactic Case Report. HSS J 2020; 16:485-489. [PMID: 33380984 PMCID: PMC7749884 DOI: 10.1007/s11420-019-09710-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/02/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Michael-Alexander Malahias
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA
| | - Thomas W. Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021 USA
| | - Alex Gu
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA
| | - Allina A. Nocon
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA
| | - Ivan De Martino
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA
| | - Peter K. Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA
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20
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Mancino F, Cacciola G, Malahias MA, De Filippis R, De Marco D, Di Matteo V, A G, Sculco PK, Maccauro G, De Martino I. What are the benefits of robotic-assisted total knee arthroplasty over conventional manual total knee arthroplasty? A systematic review of comparative studies. Orthop Rev (Pavia) 2020; 12:8657. [PMID: 32913593 PMCID: PMC7459388 DOI: 10.4081/or.2020.8657] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022] Open
Abstract
Total knee arthroplasty (TKA) is a highly successful operation that improves patients' quality of life and functionality. Yet, up to 20% of TKA patients remain unsatisfied with the functional outcomes. Robotic TKA has gained increased attention and popularity in order to improve patient satisfaction and implant survivorship by increasing accuracy and precision of component implantation. The current systematic review was run in order to compare implant survivorship, complication rates, clinical outcomes, and radiological outcomes between robotic-assisted TKA (RA) and conventional manual TKA (CM). Articles were referenced from the US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews. Nine comparative studies with 1199 operated knees in 1159 patients were included, 614 underwent active or semiactive robotic-assisted TKA compared to 585 CM-TKA. Improvements in the RA group were reported for early functional outcomes, radiographic outliers (RA 16% vs CM 76%) and radiolucent lines (RA 0% vs CM 35%). No significant differences between the two groups were reported in overall survivorship (RA 98.3% vs CM 97.3%), complication rate (RA 2.4% vs CM 1.4%) and operative time (RA 88 min vs CM 79 min). Despite higher costs, roboticassisted TKA offers better short-term clinical outcomes when compared to conventional manual technique with reduction in radiographic outliers and reduced risks of iatrogenic soft tissues injuries (reduced blood loss and postoperative drainage). Further high-quality long-term studies of modern robotic systems are required in order to evaluate how the increased accuracy and reduced outliers affect the long-term survivorship of the implants and the clinical outcomes.
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Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Cacciola
- GIOMI Istituto Ortopedico del Mezzogiorno d’Italia Franco Scalabrino, Ganzirri, Messina, Italy
| | - Michael-Alexander Malahias
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | | | - Davide De Marco
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Di Matteo
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gu A
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Peter K. Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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21
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Mancino F, Cacciola G, Di Matteo V, De Marco D, Greenberg A, Perisano C, MA M, Sculco PK, Maccauro G, De Martino I. Reconstruction options and outcomes for acetabular bone loss in revision hip arthroplasty. Orthop Rev (Pavia) 2020; 12:8655. [PMID: 32913591 PMCID: PMC7459368 DOI: 10.4081/or.2020.8655] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022] Open
Abstract
Revision total hip arthroplasty in the setting of acetabular bone loss is a challenging procedure and requires a solid understanding of current acetabular reconstruction options. Despite major developments in the field of revision hip surgery in recent decades, reconstruction of acetabular defects remains a major problem in order to achieve primary stability and durable fixation without sacrificing additional bone stock. Although there are several ways to classify acetabular bone defects, the Paprosky classification system is the most commonly used to describe the defects and guide treatment strategy. An understanding of the bone defects associated with detailed pre-operative assessment and planning are essential elements in order to achieve satisfactory outcomes. Multiple acetabular reconstructive options are currently available including impaction bone grafting with metal mesh, reinforcement rings and antiprotrusio cage, structural allografts, cementless hemispherical cups, extra-large "jumbo cups", oblong cups, modular porous metal augments, cup-cage constructs, custom- made triflange cups, and acetabular distraction. To date, debate continues as to which technique is most effective due to the lack of long-term studies of modern reconstruction systems. Further long-term studies are necessary to assess the longevity of the different implants. The purpose of this study was to review the current literature and provide a comprehensive understanding of the available reconstruction options with their clinical outcomes.
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Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Cacciola
- GIOMI Istituto Ortopedico del Mezzogiorno d’Italia Franco Scalabrino, Ganzirri, Messina, Italy
| | - Vincenzo Di Matteo
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide De Marco
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexander Greenberg
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY, USA
| | - Carlo Perisano
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Malahias MA
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY, USA
| | - Peter K. Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY, USA
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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22
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Vitiello R, Greco T, Cianni L, Careri S, Oliva MS, Gessi M, De Martino I, Bocchi MB, Maccauro G, Perisano C. Bifocal parosteal osteoma of femur: A case report and review of literature. Orthop Rev (Pavia) 2020; 12:8673. [PMID: 32913604 PMCID: PMC7459375 DOI: 10.4081/or.2020.8673] [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: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 11/24/2022] Open
Abstract
Osteoma is a benign, slowly growing, asymptomatic, bone-forming tumor arising from cancellous or compact bone. Osteoma usually is a solitary lesion, but in patients with Gardner’s Syndrome it may be multiple. osteoma may rarely have a parosteal localization. Parosteal osteoma has peculiar radiographic, histologic and clinical features. We describe a case report of a 51- years old man with a bifocal parosteal osteoma of the femur in a non-syndromic patient. This is the first described patient with a bifocal lesion. In literature only 24 cases of paraosteal osteoma are found. Our patient underwent surgery and the lesions were fully excised. At one year follow-up there was no evidence of recurrence.
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Affiliation(s)
- Raffaele Vitiello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Università Cattolica del Sacro Cuore, Rome
| | - Tommaso Greco
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Università Cattolica del Sacro Cuore, Rome
| | - Luigi Cianni
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Università Cattolica del Sacro Cuore, Rome
| | - Silvia Careri
- Department of Orthopaedics and Traumatology, Institute of Scientific Research, Children's Hospital Bambino Gesù, Rome, Italy
| | - Maria Serena Oliva
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Università Cattolica del Sacro Cuore, Rome
| | - Marco Gessi
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Università Cattolica del Sacro Cuore, Rome
| | - Ivan De Martino
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Maria Beatrice Bocchi
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Università Cattolica del Sacro Cuore, Rome
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Università Cattolica del Sacro Cuore, Rome
| | - Carlo Perisano
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
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23
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Mancino F, Cacciola G, Di Matteo V, Perna A, Proietti L, Greenberg A, Ma M, Sculco PK, Maccauro G, De Martino I. Surgical implications of the hip-spine relationship in total hip arthroplasty. Orthop Rev (Pavia) 2020; 12:8656. [PMID: 32913592 PMCID: PMC7459374 DOI: 10.4081/or.2020.8656] [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: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 12/28/2022] Open
Abstract
Total hip arthroplasty (THA) is considered the most successful orthopedic surgical procedure of the last century with excellent survivorship up to 20-years. However, instability remains a major issue representing the most common reason for revision after THA. Hip-spine relationship has gained progressive interest between arthroplasty surgeons and its understanding is crucial in order to identify high-risk patients for postoperative dislocation. Spinal deformity and abnormal spinopelvic mobility have been associated with increased risk for instability, dislocation and revision THA. Preoperative workup begins with standing anteroposterior pelvis x-ray and lateral spinopelvic radiographs in the standing and sitting position. Hip-spine stiffness needs to be addressed before THA in consideration of adapting the preoperative planning to the patient's characteristics. Acetabular component should be implanted with different anteversion and inclination angles according to the pattern of hip-spine motion in order to reduce the risk of impingement and consequent dislocation. Different algorithmic approaches have been proposed in case of concomitant hip-spine disease and in case of altered sagittal balance and pelvic mobility. The aim of this review is to investigate and clarify the hip-spine relationships and evaluate the impact on modern total hip arthroplasty.
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Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Cacciola
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Messina, Italy
| | - Vincenzo Di Matteo
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexander Greenberg
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Malahias Ma
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Malahias MA, Gu A, Richardson SS, De Martino I, Ast MP, Sculco PK. Hospital Discharge Within a Day After Total Hip Arthroplasty Does Not Compromise 1-Year Outcomes Compared With Rapid Discharge: An Analysis of an Insurance Claims Database. J Arthroplasty 2020; 35:S107-S112. [PMID: 31785964 DOI: 10.1016/j.arth.2019.10.059] [Citation(s) in RCA: 11] [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: 09/20/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND As health care costs continue to rise, same-day and rapid discharge have become popular options for total hip arthroplasty (THA). However, it remains unclear if there is a difference between within-a-day discharge and early discharge for 1-year clinical outcomes. METHODS Data were collected from the Humana insurance database using the PearlDiver Patient Records Database from 2007 to 2017, identifying patients receiving a primary THA. Patients were then stratified into three groups: (1) discharge within a day (length of stay [LOS] <24 hours), (2) rapid discharge (LOS: 1-2 days), and (3) traditional discharge (LOS: 3-4 days). The outcomes assessed were all-cause revision surgery, periprosthetic joint infection, prosthetic loosening, prosthetic dislocation, and periprosthetic fracture at 1 year postoperatively. RESULTS In total, 40,038 patients met inclusion criteria. Among those, 754 (1.88%) patients were discharged within a day, 13,670 (34.14%) patients were in the rapid discharge cohort, and 25,614 (63.97%) patients were in the traditional discharge cohort. After multivariate analysis, no significant differences were observed between the within-a-day discharge group and either the rapid discharge or the traditional discharge group. Rapid discharge patients were at decreased risk of periprosthetic joint infection (odds ratios: 0.747, 95% confidence interval: 0.623-0.896) and readmission (odds ratios: 0.778; 95% confidence interval: 0.735-0.824, P < .001) compared with traditional discharge patients. CONCLUSIONS No significant differences were observed in the one-year outcomes of primary THA between within-a-day discharge patients, rapid discharge, and traditional discharge. For those that qualify after careful selection, outpatient THA might be a feasible alternative to the traditional inpatient THA.
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Affiliation(s)
- Michael-Alexander Malahias
- Department of Orthopaedic Surgery, Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Alex Gu
- Department of Orthopaedic Surgery, Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Shawn S Richardson
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ivan De Martino
- Department of Orthopaedic Surgery, Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Michael P Ast
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
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Cacciola G, De Martino I, De Meo F. Does the medial pivot knee improve the clinical and radiographic outcome of total knee arthroplasty? A single centre study on two hundred and ninety seven patients. Int Orthop 2019; 44:291-299. [PMID: 31865446 DOI: 10.1007/s00264-019-04462-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 12/06/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) is a cost-effective surgery with a survival rate higher than 90% after 15 years. Nevertheless, patients are unsatisfied in more than 15% of cases. Medial pivot (MP) prosthetic designs were introduced in late 90's with the aim to reproduce natural knee kinematics. The purpose of this study is to evaluate the survivorship and clinical outcomes of a novel design of MP knee with a minimum follow-up of five years. METHODS This is a retrospective review of all patients who underwent primary TKA using the K-Mod dynamic congruence implant (Gruppo Bioimpianti, Peschiera Borromeo, Milan, Italy) between 2012 and 2013 at a single institution. A total of 339 patients (351 knees) were included with a mean age of 74 years (range 41-89). The Knee Society score, the global range of movement, the Western Ontario and McMaster Universities Osteoarthritis score, Forgotten Joint score, and the short-term form 12 health survey were collected. FJS and SF-12 were collected only post-operatively. Radiographic outcomes were evaluated according to the Knee Society's roentgenographic evaluation system. Kaplan-Meyer (KM) curves were performed to evaluate implant survivorship. A two-tailed paired t test was performed to evaluate the differences between pre-operative and post-operative score. RESULTS A total 297 patients (315 knees) were available for clinical and radiographic analysis, and the mean follow-up was 66.4 months. A total of 17 patients (17 knees 5.4%) experienced a post-operative complication, and a reoperation was performed in five patients (5 knees 1.6%). Four patients had a periprosthetic joint infection, and two patients had a post-traumatic periprosthetic femoral fracture. The KM survivorship at five years was 98.2% (95% CI 0.96 to 0.99) for revision for any reason. There was a statistically significant improvement (p < 0.05) in all the objective and subjective outcomes measured. CONCLUSION The K-Mod dynamic congruence design has shown an excellent clinical, radiographic, and patient-reported outcome in primary TKAs.
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Affiliation(s)
- Giorgio Cacciola
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, Messina, Italy.
- Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Messina, Italy.
| | - Ivan De Martino
- Dipartimento Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federico De Meo
- Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Messina, Italy
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Malahias MA, De Martino I, Gu A, Baral E, Wright TM, Sculco PK. Complete wear-through of a metal-backed acetabular cup in an ambulatory patient. Arthroplast Today 2019; 5:394-400. [PMID: 31886378 PMCID: PMC6920715 DOI: 10.1016/j.artd.2019.09.008] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/17/2019] [Accepted: 09/27/2019] [Indexed: 01/20/2023] Open
Abstract
We present a rare case of a patient who presented with complete and rapid wear-through of a ceramic femoral head through a polyethylene liner and titanium acetabular cup. In addition, this patient exhibited significantly elevated serum titanium ion levels, which may serve as a marker of severe metallosis in cases where the preoperative plain radiographs underestimate signs of periarticular metal debris. The unique findings of this case include the rapid (less than 1 year time) wear-through of the femoral head in interval radiographs and the dramatic progression of metallosis and pelvic and femoral osteolysis that required both component revision. In addition, the markedly elevated titanium levels secondary to cup wear-through are also of interest and demonstrate a systemic manifestation of abrasive wear of a titanium alloy component.
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Affiliation(s)
- Michael-Alexander Malahias
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Ivan De Martino
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Elexis Baral
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
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Addona JL, Gu A, De Martino I, Malahias MA, Sculco TP, Sculco PK. High Rate of Early Intraprosthetic Dislocations of Dual Mobility Implants: A Single Surgeon Series of Primary and Revision Total Hip Replacements. J Arthroplasty 2019; 34:2793-2798. [PMID: 31402075 DOI: 10.1016/j.arth.2019.06.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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: 03/04/2019] [Revised: 05/16/2019] [Accepted: 06/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Dual mobility (DM) articulations have become an increasingly popular bearing choice in efforts to reduce dislocation rates in high risk primary and revision total hip arthroplasties (THA). However, DM dislocations can still occur. Intraprosthetic dislocation (IPD) is a unique failure mode for DM compared to standard femoral heads. Currently, the incidence of this phenomenon during attempted hip reduction is unknown. METHODS A retrospective analysis of a consecutive series of all primary, revision, and conversion THA procedures performed by a single surgeon was collected. For all dislocations, patient demographics, location where reduction was performed, type of anesthetic used was recorded. For DM dislocations, the rate of successful closed reduction, reoperation due to failure of closed reduction, and incidence of IPD at time of reduction was recorded. Descriptive statistics were conducted on the data. RESULTS In total, 527 cases were included for analysis. The overall rate of dislocation (with and without DM) was 2.85%. Among DMs, the dislocation rate was 4.55%. The rate of IPD after closed reduction was 5/7 (71%) with all five requiring revision surgery to either another DM bearing or constrained liner. CONCLUSIONS We report a high rate of early IPD after DM dislocation. This study supports alternative treatment protocols for these patients including regional or general anesthesia to be administered in the operating room and for the reduction to be performed under fluoroscopy. Dislocated DM components handled in this manner could reduce the high incidence of IPD reported.
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Affiliation(s)
- Jacqueline L Addona
- Department of Orthopedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Alex Gu
- Department of Orthopedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Ivan De Martino
- Department of Orthopedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Michael-Alexander Malahias
- Department of Orthopedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Thomas P Sculco
- Department of Orthopedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Peter K Sculco
- Department of Orthopedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
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De Martino I, Strigelli V, Cacciola G, Gu A, Bostrom MP, Sculco PK. Survivorship and Clinical Outcomes of Custom Triflange Acetabular Components in Revision Total Hip Arthroplasty: A Systematic Review. J Arthroplasty 2019; 34:2511-2518. [PMID: 31213338 DOI: 10.1016/j.arth.2019.05.032] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [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: 03/04/2019] [Revised: 04/30/2019] [Accepted: 05/16/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several studies have evaluated the survivorship and clinical outcomes of custom triflange acetabular component (CTAC) usage in complex acetabular revision; however, there remains no consensus on the overall performance of this custom implant design. We therefore performed a systematic review of the literature in order to examine survivorship and complication rate of CTAC usage. METHODS A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles using various combinations of the keywords "custom triflange," "custom-made triflange," "acetabular triflange," "THA," "THR," "revision," "bone loss," "bone defect," and "pelvic discontinuity." RESULTS In all, 17 articles met our inclusion criteria. A total of 579 CTACs were implanted. The all-cause revision-free survivorship was 82.7%. The overall complication rate was 29%. Dislocation and infection were the most common complications observed with an incidence of 11% and 6.2%, respectively. Nerve injuries following CTAC placement had an incidence of 3.8%. The incidence of CTAC aseptic loosening was 1.7%. Overall, patients had improved outcomes as documented by postoperative hip scores. CONCLUSION Based on the current data, CTACs have a high complication rate but remain an efficacious treatment option in complex acetabular reconstructions. When dealing with patients with significant acetabular bone loss for revision total hip arthroplasty, surgeons should continue to consider CTACs as a viable option but educate patients as to the increased risk of postoperative complications and reoperations.
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Affiliation(s)
- Ivan De Martino
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Vanni Strigelli
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Giorgio Cacciola
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Alex Gu
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Mathias P Bostrom
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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Quevedo González FJ, Lipman JD, Lo D, De Martino I, Sculco PK, Sculco TP, Catani F, Wright TM. Mechanical performance of cementless total knee replacements: It is not all about the maximum loads. J Orthop Res 2019; 37:350-357. [PMID: 30499604 DOI: 10.1002/jor.24194] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 08/08/2018] [Accepted: 11/13/2018] [Indexed: 02/04/2023]
Abstract
Finite element (FE) models are frequently used to assess mechanical interactions between orthopedic implants and surrounding bone. However, FE studies are often limited by the small number of bones that are modeled; the use of normal bones that do not reflect the altered bone density distributions that result from osteoarthritis (OA); and the application of simplified load cases usually based on peak forces and without consideration of tibiofemoral kinematics. To overcome these limitations, we undertook an integrated approach to determine the most critical scenario for the interaction between an uncemented tibial component and surrounding proximal tibial bone. A cementless component, based on a modern design, was virtually implanted using computed-tomography scans from 13 patients with knee OA. FE simulations were performed across a demanding activity, stair ascent, by combining in vivo experimental forces from the literature with tibiofemoral kinematics measured from patients who had received the same design of knee component. The worst conditions for the bone-implant interaction, in terms of micromotion and percentage of interfacial bone mass at risk of failure, did not arise from the maximum applied loads. We also found large variability among bones and tibiofemoral kinematics sets. Our results suggest that future FE studies should not focus solely on peak loads as this approach does not consistently correlate to worst-case scenarios. Moreover, multiple load cases and multiple bones should be considered to best reflect variations in tibiofemoral kinematics, anatomy, and tissue properties. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:350-357, 2019.
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Affiliation(s)
| | - Joseph D Lipman
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, New York
| | - Darrick Lo
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, New York
| | - Ivan De Martino
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, New York
| | - Peter K Sculco
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, New York
| | - Thomas P Sculco
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, New York
| | - Fabio Catani
- University of Modena and Reggio Emilia, Largo del Pozzo 71, 41124 Modena, Italy
| | - Timothy M Wright
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, New York
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De Laurentis M, De Martino I, Lazkoz R. Modified gravity revealed along geodesic tracks. Eur Phys J C Part Fields 2018; 78:916. [PMID: 30881208 PMCID: PMC6394300 DOI: 10.1140/epjc/s10052-018-6401-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Abstract
The study of the dynamics of a two-body system in modified gravity constitutes a more complex problem than in Newtonian gravity. Numerical methods are typically needed to solve the equations of geodesics. Despite the complexity of the problem, the study of a two-body system in f(R) gravity leads to a new exciting perspective hinting the right strategy to adopt in order to probe modified gravity. Our results point out some differences between the semiclassical (Newtonian) approach, and the relativistic (geodesic) one thus suggesting that the latter represents the best strategy for future tests of modified theories of gravity. Finally, we have also highlighted the capability of forthcoming observations to serve as smoking gun of modified gravity revealing a departure from GR or further reducing the parameter space of f(R) gravity.
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Affiliation(s)
- Mariafelicia De Laurentis
- Dipartimento di Fisica “E. Pancini”, Universitá di Napoli “Federico II”, Compl. Univ. di Monte S. Angelo, Edificio G, Via Cinthia, 80126 Naples Italy
- INFN Sez. di Napoli, Compl. Univ. di Monte S. Angelo, Edificio G, Via Cinthia, 80126 Naples Italy
- Institute for Theoretical Physics, Goethe University, Max-von-Laue-Str. 1, 60438 Frankfurt, Germany
- Laboratory for Theoretical Cosmology, Tomsk State University of Control Systems and Radioelectronics (TUSUR), 634050 Tomsk, Russia
| | - Ivan De Martino
- Donostia International Physics Center (DIPC), 20018 Donostia-San Sebastian, Gipuzkoa Spain
| | - Ruth Lazkoz
- Department of Theoretical Physics and History of Science, Faculty of Science and Technology, University of the Basque Country UPV/EHU, Barrio Sarriena s/n, 48940 Leioa, Spain
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De Martino I, D'Apolito R, Nocon AA, Sculco TP, Sculco PK, Bostrom MP. Proximal femoral replacement in non-oncologic patients undergoing revision total hip arthroplasty. Int Orthop 2018; 43:2227-2233. [PMID: 30415464 DOI: 10.1007/s00264-018-4220-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Proximal femoral replacements (PFRs) have been recently utilized in complex revision arthroplasties where proximal femoral bone is compromised. The purpose of this study is to evaluate the clinical outcomes, complications, and survivorship of PFRs as a salvage treatment for severe bone loss after non-oncologic revision total hip arthroplasty. METHODS This is a retrospective review of all patients who underwent femoral revision surgery using a single design PFR between 2004 and 2013 at our institution. Forty patients (41 hips) were included with a mean age of 64 years (29-90). According to Paprosky classification, 15 femurs had type IIIB defect, and 26 had type IV defect. Patients were followed for a mean of five years (2-10). The average length of reconstruction was 150 mm (81-261). A Kaplan-Meier analysis was used to determine the survival of the PFR. RESULTS A total of nine patients (9 PFRs, 22%) were re-operated upon. Three re-operations were for infection, two for dislocation, two for aseptic loosening, and two for periprosthetic fracture. The survivorship at five years was 95.1% for revision of the femoral stem for aseptic loosening. We did not find length of the segmental reconstruction or the indication for revision, to be a risk factor for implant failure or re-revision. CONCLUSIONS Proximal femoral replacements have shown an acceptable survivorship in non-oncologic revision hip arthroplasties for severe proximal femoral bone loss. The frequent use of constrained liners may decrease the risk of dislocation due to the loss of the abductor mechanism encountered in these complex reconstructions.
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Affiliation(s)
- Ivan De Martino
- Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Rocco D'Apolito
- Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Allina A Nocon
- Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Thomas P Sculco
- Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Peter K Sculco
- Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Mathias P Bostrom
- Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Abstract
The effect of obesity in shoulder arthroplasty has been recently reported in the literature with different and conflicting results. This review analyzes the role of obesity on outcomes and complications in shoulder arthroplasty. Morbid obesity (body mass index >40 kg/m2), more than standard obesity, is associated with a longer operative time, higher complication rate, reoperation rate and superficial infection. Obesity does not have a detrimental effect on functional outcomes. The magnitude of functional improvement in obese patients, however, can be inferior to that in nonobese patients. Obesity and morbid obesity do not increase hospital charges.
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Affiliation(s)
- Ivan De Martino
- Sports and Shoulder Service, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA
| | - Lawrence V Gulotta
- Sports and Shoulder Service, Hospital for Special Surgery, East River Professional Building, 523 East 72nd Street, 6th Floor, New York, NY 10021, USA.
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Abstract
PURPOSE OF REVIEW Swimmer's shoulder is the term used to describe the problem of shoulder pain in swimmers. Originally described as supraspinatus tendon impingement under the coracoacromial arch, it is now understood that several different pathologies can cause shoulder pain in competitive swimmers, including subacromial impingement syndrome, overuse and subsequent muscle fatigue, scapular dyskinesis, and laxity and instability. RECENT FINDINGS Swimmers may develop increased shoulder laxity over time due to repetitive use. Such excessive laxity can decrease passive shoulder stability and lead to rotator cuff muscle overload, fatigue, and subsequent injury in order to properly control the translation of the humeral head. Generalized laxity can be present up to 62% of swimmers, while a moderate degree of multi-directional instability can be present in the majority. Laxity in swimmers can be due to a combination of underlying inherent anatomical factors as well as from repetitive overhead activity. The role of excessive laxity and muscle imbalance are crucial in the swimmer's shoulder and should be well understood since they are the primary target of the training and rehabilitation program.
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Affiliation(s)
- Ivan De Martino
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
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De Martino I, D'Apolito R, Waddell BS, McLawhorn AS, Sculco PK, Sculco TP. Response to letter to the editor on "Early intraprosthetic dislocation in dual-mobility implants: a systematic review". Arthroplast Today 2018; 4:133-134. [PMID: 29560410 PMCID: PMC5859558 DOI: 10.1016/j.artd.2017.11.005] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ivan De Martino
- Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.,Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Rocco D'Apolito
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Bradford S Waddell
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Alexander S McLawhorn
- Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.,Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Peter K Sculco
- Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.,Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Thomas P Sculco
- Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.,Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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De Martino I, Broadhurst T, Tye SHH, Chiueh T, Schive HY, Lazkoz R. Recognizing Axionic Dark Matter by Compton and de Broglie Scale Modulation of Pulsar Timing. Phys Rev Lett 2017; 119:221103. [PMID: 29286820 DOI: 10.1103/physrevlett.119.221103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Indexed: 06/07/2023]
Abstract
Light axionic dark matter, motivated by string theory, is increasingly favored for the "no weakly interacting massive particle era". Galaxy formation is suppressed below a Jeans scale of ≃10^{8} M_{⊙} by setting the axion mass to m_{B}∼10^{-22} eV, and the large dark cores of dwarf galaxies are explained as solitons on the de Broglie scale. This is persuasive, but detection of the inherent scalar field oscillation at the Compton frequency ω_{B}=(2.5 months)^{-1}(m_{B}/10^{-22} eV) would be definitive. By evolving the coupled Schrödinger-Poisson equation for a Bose-Einstein condensate, we predict the dark matter is fully modulated by de Broglie interference, with a dense soliton core of size ≃150 pc, at the Galactic center. The oscillating field pressure induces general relativistic time dilation in proportion to the local dark matter density and pulsars within this dense core have detectably large timing residuals of ≃400 nsec/(m_{B}/10^{-22} eV). This is encouraging as many new pulsars should be discovered near the Galactic center with planned radio surveys. More generally, over the whole Galaxy, differences in dark matter density between pairs of pulsars imprints a pairwise Galactocentric signature that can be distinguished from an isotropic gravitational wave background.
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Affiliation(s)
- Ivan De Martino
- Department of Theoretical Physics, University of the Basque Country, UPV/EHU, E-48080 Bilbao, Spain
| | - Tom Broadhurst
- Department of Theoretical Physics, University of the Basque Country, UPV/EHU, E-48080 Bilbao, Spain
- Ikerbasque, Basque Foundation for Science, E-48011 Bilbao, Spain
| | - S-H Henry Tye
- Institute for Advanced Study and Department of Physics, Hong Kong University of Science and Technology, Hong Kong
| | - Tzihong Chiueh
- Department of Physics, National Taiwan University, Taipei 10617, Taiwan
- National Center for Theoretical Sciences, National Taiwan University, Taipei 10617, Taiwan
| | - Hsi-Yu Schive
- National Center for Supercomputing Applications, Urbana, Illinois 61801, USA
| | - Ruth Lazkoz
- Department of Theoretical Physics, University of the Basque Country, UPV/EHU, E-48080 Bilbao, Spain
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Affiliation(s)
- Peter K Sculco
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Alexander S McLawhorn
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Keith A Fehring
- Hip and Knee Center, OrthoCarolina, 2001 Vail Avenue Suite 200A, Charlotte, NC, 28207, USA
| | - Ivan De Martino
- Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Abstract
PURPOSE OF REVIEW Physician to physician communication is essential for the transfer of ideas, surgical experience, and education. Social networks and online video educational contents have grown exponentially in recent years changing the interaction among physicians. RECENT FINDINGS Social media platforms can improve physician-to-physician communication mostly through video education and social networking. There are several online video platforms for orthopedic surgery with educational content on diagnosis, treatment, outcomes, and surgical technique. Social networking instead is mostly centered on sharing of data, discussion of confidential topics, and job seeking. Quality of educational contents and data confidentiality represent the major drawbacks of these platforms. Orthopedic surgeons must be aware that the quality of the videos should be better controlled and regulated to avoid inaccurate information that may have a significant impact especially on trainees that are more prone to use this type of resources. Sharing of data and discussion of confidential topics should be extremely secure according the HIPAA regulations in order to protect patients' confidentiality.
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Affiliation(s)
- Keith A Fehring
- Hip & Knee Center, OrthoCarolina, 2001 Vail Avenue Suite 200A, Charlotte, NC, 28207, USA.
| | - Ivan De Martino
- Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander S McLawhorn
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Abstract
PURPOSE OF REVIEW Social media is increasingly utilized by patients to educate themselves on a disease process and to find hospital, physicians, and physician networks most capable of treating their condition. However, little is known about quality of the content of the multiple online platforms patients have to communicate with other potential patients and their potential benefits and drawbacks. RECENT FINDINGS Patients are not passive consumers of health information anymore but are playing an active role in the delivery of health services through an online environment. The control and the regulation of the sources of information are very difficult. The overall quality of the information was poor. Bad or misleading information can be detrimental for patients as well as influence their confidence on physicians and their mutual relationship. Orthopedic surgeons and hospital networks must be aware of these online patient portals as they provide important feedback on the patient opinion and experience that can have a major impact on future patient volume, patient opinion, and perceived quality of care.
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Affiliation(s)
- Ivan De Martino
- Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Rocco D'Apolito
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander S McLawhorn
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Keith A Fehring
- Hip & Knee Center, Ortho Carolina, 2001 Vail Avenue Suite 200A, Charlotte, NC, 28207, USA
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Giorgio Gasparini
- Orthopedic Surgery Division, Department of Medical and Surgical Sciences, University of Catanzaro Magna Græcia, Viale Europa, Germaneto, 88100, Catanzaro, CZ, Italy
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Abstract
Utilization of social media both in the private and professional arenas has grown rapidly in the last decade. The rise of social media use within health care can be viewed as the Internet-based corollary of the patient-centered care movement, in which patient perspectives and values are central to the delivery of quality care. For orthopedic surgeons and their practices, general-purpose online social networks, such as Facebook and Twitter, are convenient platforms for marketing, providing patient education and generating referrals. Virtual health communities are used less frequently by orthopedic surgeons but provide forums for patient engagement and active surgeon-to-patient communication via blogs and ask-the-doctor platforms. This commentary reviews the current state of social media use in orthopedic practice, with particular emphasis on managing the extension of the surgeon-patient relationship online, including the unique practice risks social media poses, such as privacy concerns, potential liability, and time consumption.
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Affiliation(s)
- Alexander S McLawhorn
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Ivan De Martino
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Keith A Fehring
- Hip & Knee Center, OrthoCarolina, 2001 Vail Avenue Suite 200A, Charlotte, NC, 28207, USA
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Vasso M, Schiavone Panni A, De Martino I, Gasparini G. Prosthetic knee infection by resistant bacteria: the worst-case scenario. Knee Surg Sports Traumatol Arthrosc 2016; 24:3140-3146. [PMID: 26831859 DOI: 10.1007/s00167-016-4010-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 10/14/2015] [Accepted: 01/18/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of the present paper was to determine (1) the incidence of failure (defined as the persistence or the recurrence of the infection), (2) the incidence of prosthesis (or even limb) loss (defined as the final need for an arthrodesis, resection arthroplasty or amputation) and (3) what factors could influence the failure in patients treated with a two-stage reimplantation for periprosthetic knee infections caused by resistant bacteria. METHODS The authors retrospectively reviewed 29 total knee arthroplasties infected by resistant bacteria in 29 patients who underwent a two-stage revision. Between the stages, intravenous-targeted antibiotics were administered for a median period of 8 (range 6-12) weeks. Median follow-up was 10 (range 7-14) years. RESULTS The authors found that failure occurred in 5 of 29 patients (17.2 %). When methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MR-CoNS) were involved, failure rate was 10 % (2 of 20). When vancomycin-resistant enterococcus (VRE), multidrug-resistant (MDR) Acinetobacter baumannii and MDR Pseudomonas aeruginosa were involved, the failure rate was 33.3 % (3 of 9). Of those five patients, two underwent amputations, one chronic suppressive antibiotic therapy, one arthrodesis and one resection arthroplasty; among them, three lost the limb (10.3 % of the overall group). Timing of reimplantation and patient comorbidities did not significantly influence the failure. CONCLUSIONS Two-stage protocol resulted in a viable option for patients with infections by some resistant organisms (MRSA and MR-CoNS). However, when highly resistant organisms were involved (VRE, MDR Acinetobacter Baumannii and MDR Pseudomonas aeruginosa), the failure rate was much higher. In all cases of failure of the two-stage reimplantation, prosthesis (or even limb) loss occurred. Consequently, patients should be counselled that when highly resistant bacteria are involved, two-stage reimplantation could not be successful, with high final risk of prosthesis (or even limb) loss. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Michele Vasso
- Department of Medicine and Health Sciences, University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy.
| | - Alfredo Schiavone Panni
- Department of Medicine and Health Sciences, University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy
| | - Ivan De Martino
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, Mater Domini University Hospital, Viale Europa, 88100, Catanzaro, Italy
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De Martino I, D'Apolito R, Sculco PK, Poultsides LA, Gasparini G. Total Knee Arthroplasty Using Cementless Porous Tantalum Monoblock Tibial Component: A Minimum 10-Year Follow-Up. J Arthroplasty 2016; 31:2193-8. [PMID: 27172865 DOI: 10.1016/j.arth.2016.03.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 01/18/2016] [Revised: 03/10/2016] [Accepted: 03/28/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cementless fixation in total knee arthroplasty (TKA) was introduced to improve the longevity of implants but has yet to be widely adopted because of reports of higher failure rates in some series. The cementless tantalum monoblock tibial component, in contrast, has shown successful short-term results, but long-term survivorship with this design is still lacking. The purpose of this study was to investigate the minimum 10-year clinical and radiographic results of the cementless tantalum monoblock tibial component in primary TKA. METHODS From March 2002 to March 2005, 33 patients (33 knees) underwent primary TKA with a cementless tantalum monoblock tibial component. All patients were followed clinically and radiographically for a minimum of 10 years (mean 11.5 years, range 10-13 years). No patients were lost to follow-up. The underlying diagnosis that led to the primary TKA was primary osteoarthritis in 31 knees and post-traumatic osteoarthritis in 2 knees. RESULTS None of the components was revised. At a minimum 10-year follow-up, the survivorship with reoperation for any reason as end point was 96.9%. With tibial component revision for aseptic loosening or osteolysis as the end point survivorship was 100%. There was no radiographic evidence of tibial component loosening, subsidence, osteolysis, or migration at the time of the latest follow-up. The mean Knee Society knee scores improved from 56 points preoperatively to 93 points at the last clinical visit. CONCLUSION The porous tantalum tibial monoblock component demonstrated excellent clinical and radiographic outcomes with no component revisions for aseptic loosening at a minimum follow-up of 10 years.
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Affiliation(s)
- Ivan De Martino
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Rocco D'Apolito
- Orthopedic Surgery Division, Department of Geriatrics, Neurosciences, and Orthopedics, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital, Roma, Italy
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Lazaros A Poultsides
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Giorgio Gasparini
- Orthopedic Surgery Division, Department of Medical and Surgical Sciences, University of Catanzaro Magna Græcia, Catanzaro, Italy
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Waddell BS, De Martino I, Sculco T, Sculco P. Total Hip Arthroplasty Dislocations Are More Complex Than They Appear: A Case Report of Intraprosthetic Dislocation of an Anatomic Dual-Mobility Implant After Closed Reduction. Ochsner J 2016; 16:185-190. [PMID: 27303232 PMCID: PMC4896666] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Total hip arthroplasty is a successful operation for the treatment of hip pain. One of the common complications of hip arthroplasty is dislocation. While reduction of standard prosthetic dislocations is highly successful, new prostheses add the potential for new complications. CASE REPORT We present the case of a patient who experienced intraprosthetic dislocation of an anatomic dual-mobility total hip prosthesis after a closed hip reduction and include the prereduction and postreduction radiographic findings. CONCLUSION Emergency department physicians should be aware of intraprosthetic dislocation. This complication can be easily missed because the metal/ceramic femoral head appears to be reduced in the acetabulum.
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Affiliation(s)
- Bradford S. Waddell
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Ivan De Martino
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Thomas Sculco
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Peter Sculco
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
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De Martino I, Assini JB, Elpers ME, Wright TM, Westrich GH. Corrosion and Fretting of a Modular Hip System: A Retrieval Analysis of 60 Rejuvenate Stems. J Arthroplasty 2015; 30:1470-5. [PMID: 25817187 DOI: 10.1016/j.arth.2015.03.010] [Citation(s) in RCA: 66] [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: 11/12/2014] [Revised: 02/18/2015] [Accepted: 03/07/2015] [Indexed: 02/08/2023] Open
Abstract
Femoral stems with dual-taper modularity were introduced to allow independent control of length, offset, and version. Corrosion and fretting related to micromotion at the neck-stem junction are thought to stimulate an adverse local tissue reaction (ALTR). Analysis of 60 consecutively retrieved modular-neck stem implants (Rejuvenate, Stryker) revised primarily for ALTR was done to determine the variables influencing corrosion and fretting patterns at the neck-stem interface. Taper damage evaluation was performed with stereomicrocopic analysis with two observers. Evidence of fretting and corrosion was seen at the neck-stem taper in all implants, including three implants revised for periprosthetic fractures within four weeks of the index surgery indicating that this process starts early. Femoral stems paired with the long overall neck lengths had significantly higher corrosion scores. Correlation of the corrosion severity at particular locations with the length of implantation suggests that the neck-stem junction experiences cyclic cantilever bending in vivo. The positive correlation between the length of implantation and fretting/corrosion scores bodes poorly for patients who still have this implant. Scanning electron microscopy on a subset of specimens was also performed to evaluate the black corrosion material. We strongly urge frequent follow-up exams for every patient with this particular modular hip stem.
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Affiliation(s)
- Ivan De Martino
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York; Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Joseph B Assini
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
| | - Marcella E Elpers
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
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De Martino I, Sculco PK. In Response to "Treatment of Severe Bone Defects During Revision Total Knee Arthroplasty with Structural Allografts and Porous Metal Cones - A Systematic Review". J Arthroplasty 2015; 30:1287-9. [PMID: 25660613 DOI: 10.1016/j.arth.2015.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/14/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Ivan De Martino
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York; Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York
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De Martino I, Triantafyllopoulos GK, Sculco PK, Sculco TP. Dual mobility cups in total hip arthroplasty. World J Orthop 2014; 5:180-187. [PMID: 25035820 PMCID: PMC4095010 DOI: 10.5312/wjo.v5.i3.180] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/21/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in orthopaedics. With the increase in the number of THAs performed in the world in the next decades, reducing or preventing medical and mechanical complications such as post-operative THA instability will be of paramount importance, particularly in an emerging health care environment based on quality control and patient outcome. Dual mobility acetabular component (also known as unconstrained tripolar implant) was introduced in France at the end of the 1970s as an alternative to standard sockets, to reduce the risk of THA dislocation in patients undergoing primary THA in France. Dual mobility cups have recently gained wider attention in the United States as an alternative option in the prevention and treatment of instability in both primary and revision THA and offer the benefit of increased stability without compromising clinical outcomes and implant longevity. In this article, we review the use of dual mobility cup in total hip arthroplasty in terms of its history, biomechanics, outcomes and complications based on more than 20 years of medical literature.
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