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Loppini M, Gambaro FM, di Maio M, Grappiolo G. Femoral bone defect classifications in revision total hip arthroplasty: a comprehensive review and proposal of a new algorithm of management. EFORT Open Rev 2024; 9:160-172. [PMID: 38457928 PMCID: PMC10958244 DOI: 10.1530/eor-21-0088] [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] [Indexed: 03/10/2024] Open
Abstract
The number of primary total hip arthroplasties (THAs) and revisions is expected to steadily grow in the future. The femoral revision surgery can be technically demanding whether severe bone defects need to be addressed. The femoral revision aims to obtain a proper primary stability of the stem with a more proximal fixation as possible. Several authors previously proposed classification systems to describe the morphology of the bony femoral defect and to drive accordingly the surgeon in the revision procedure. The previous classifications mainly considered cortical and medullary bone at the level of the defect of poor quality by definition. Therefore, the surgical strategies aimed to achieve a distal fixation bypassing the defect or to fill the defect with bone impaction grafting or structured bone grafts up to the replacement of the proximal femur with megaprosthesis. The consensus on a comprehensive and reliable classification system and management algorithm is still lacking. A new classification system should be developed taking into account the bone quality. The rationale of a new classification is that 'functional' residual bone stock could be present at the level of the defect. Therefore, it can be used to achieve a primary (mechanical) and secondary (biological) stability of the implants with a femoral fixation more proximal as possible.
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, Italy
| | - Francesco Manlio Gambaro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy
| | - Marco di Maio
- Università degli Studi di Trieste, Piazzale Europa 1, Trieste, Italy
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, Italy
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Di Matteo V, La Camera F, Carfì C, Morenghi E, Grappiolo G, Loppini M. Clinical and Radiographic Outcomes of Hip Revision Surgery and Cerclage Wires Fixation for Vancouver B2 and B3 Fractures: A Retrospective Cohort Study. J Clin Med 2024; 13:892. [PMID: 38337586 PMCID: PMC10856565 DOI: 10.3390/jcm13030892] [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: 11/13/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The number of patients presenting with periprosthetic hip fractures has increased in recent decades. METHODS Patients who underwent hip revision arthroplasty procedures for Vancouver type B2 and B3 fractures between 2010 and 2021 were included. The primary intended outcome of this study was to determine the reintervention-free survival rate. The secondary intended outcome was to determine clinical and radiographic assessment outcomes at the time of follow-up, and the correlation between time to surgery and postoperative Harris hip score (HHS). RESULTS A total of 49 patients with mean age of 71.2 ± 2.3 (37-88) years old were included. Overall, the Kaplan-Meier method estimated a survival rate of 95.8% (CI 84.2% to 98.9%) at one year, 91.1% (CI 77.9% to 96.6%) at two years, and 88.5% (CI 74.4% to 95.1%) at three, and up to 10, years. The mean limb length discrepancy (LLD) improved from -13.3 ± 10.5 (range -39 to +10) mm at the preoperative stage to -1.16 ± 6.7 (range -17 to +15) mm, p < 0.001 postoperative. The mean HHS improved from 31.1 ± 7.7 (range 10 to 43) preoperative to 85.5 ± 14.8 (range 60 to 100), p < 0.001 postoperative. Postoperative HHS was not affected by preoperative time to surgery. CONCLUSIONS Revision arthroplasty is an effective treatment for Vancouver type B2 and B3 fractures.
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Affiliation(s)
- Vincenzo Di Matteo
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (V.D.M.); (C.C.)
- Adult Reconstruction and Joint Replacement Service, Division of Orthopedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy; (F.L.C.); (G.G.)
| | - Francesco La Camera
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy; (F.L.C.); (G.G.)
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Carla Carfì
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (V.D.M.); (C.C.)
| | | | - Guido Grappiolo
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy; (F.L.C.); (G.G.)
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (V.D.M.); (C.C.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy; (F.L.C.); (G.G.)
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
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Grappiolo G, Guazzoni E, Gambaro FM, Loppini M. Letter to the editor: 'The history of the development of the regular straight stem in hip arthroplasty'. EFORT Open Rev 2024; 9:146-147. [PMID: 38306797 PMCID: PMC10873245 DOI: 10.1530/eor-23-0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2024] Open
Affiliation(s)
- Guido Grappiolo
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via
| | - Edoardo Guazzoni
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Orthopaedics and Traumatology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesco Manlio Gambaro
- Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Bulloni M, Gambaro FM, Chiappetta K, Grappiolo G, Corino V, Loppini M. AI-based hip prosthesis failure prediction through evolutional radiological indices. Arch Orthop Trauma Surg 2024; 144:895-907. [PMID: 37787910 DOI: 10.1007/s00402-023-05069-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/03/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION This study aimed to develop artificial intelligence models for predicting hip implant failure from radiological features. Analyzing the evolution of the periprosthetic bone and implant's position throughout the entire follow-up period has shown the potential to be more relevant in outcome prediction than simply considering the latest radiographic images. Thus, we investigated an AI-based model employing a small set of evolutional parameters derived from conventional radiological features to predict hip prosthesis failure. MATERIALS AND METHODS One hundred sixty-nine radiological features were annotated from historical anteroposterior and lateral radiographs for 162 total hip arthroplasty patients, 32 of which later underwent implant failure. Linear regression on each patient's chronologically sorted radiological features was employed to derive 169 corresponding evolutional parameters per image. Three sets of machine learning predictors were developed: one employing the original features (standard model), one the evolutional ones (evolutional model), and the last their union (hybrid model). Each set included a model employing all the available features (full model) and a model employing the few most predictive ones according to Gini importance (minimal model). RESULTS The evolutional and hybrid predictors resulted highly effective (area under the ROC curve (AUC) of full models = 0.94), outperforming the standard one, whose AUC was only 0.82. The minimal hybrid model, employing just four features, three of which evolutional, scored an AUC of 0.95, proving even more accurate than the full one, exploiting 173 features. This tool could be shaped to be either highly specific (sensitivity: 80%, specificity: 98.6%) or highly sensitive (sensitivity: 90%, specificity: 92.4%). CONCLUSION The proposed predictor may represent a highly sensitive screening tool for clinicians, capable to predict THA failure with an advance between a few months and more than a year through only four radiological parameters, considering either their value at the latest visit or their evolution through time.
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Affiliation(s)
- Matteo Bulloni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Ponzio 34/5, 20133, Milan, Italy
| | - Francesco Manlio Gambaro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Katia Chiappetta
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100, Savona, Italy
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100, Savona, Italy
| | - Valentina Corino
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Ponzio 34/5, 20133, Milan, Italy
- Cardio Tech-Lab, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy.
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100, Savona, Italy.
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Rocchi C, Di Matteo V, Chiappetta K, Grappiolo G, Loppini M. Results of Utilizing Cerclage Wires in the Management of Intraoperative Vancouver B1 Fractures in Primary Total Hip Arthroplasties: A Retrospective Cohort Investigation into Clinical and Radiographic Outcomes. J Clin Med 2024; 13:819. [PMID: 38337513 PMCID: PMC10856186 DOI: 10.3390/jcm13030819] [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: 12/24/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Due to an increase in total hip arthroplasties (THAs), the incidence of periprosthetic hip fractures (PPHFs) is forecast to rise considerably in the next decades, with Vancouver B1 fractures (VB1) accounting for one third of total cases. Femur fixation with cerclages (with or without screws) is considered the current treatment option for intraoperative VB1. METHODS The study retrospectively includes data from patients who developed VB1 PPHFs during THAs from 3 December 2020 to 30 November 2022. The primary outcome of this study was to identify the reintervention-free survival rate. The secondary aim was to determine clinical and radiographic assessment at follow-up, based on Harris hip score (HHS) and limb length discrepancy (LLD). RESULTS Thirty-seven patients with a mean age of 60.03 ± 15.49 (22 to 77) years old were included. Overall, the Kaplan-Meier analysis estimated a reoperation-free survival rate of 99% (CI 95%) at 6 months. The mean limb length discrepancy (LLD) improved from -3.69 ± 6.07 (range -27.9 to 2.08) mm to 0.10 ± 0.67 (range -1.07 to 1.20) mm. The mean HHS improved from 42.72 ± 14.37 (range 21.00-96.00) to 94.40 ± 10.32 (range 56.00-100.00). CONCLUSIONS The employment of cerclage wires represents an effective strategy for handling intraoperative VB1 fractures. Level III retrospective cohort study.
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Affiliation(s)
- Caterina Rocchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (C.R.); (V.D.M.)
| | - Vincenzo Di Matteo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (C.R.); (V.D.M.)
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy;
| | | | - Guido Grappiolo
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy;
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (C.R.); (V.D.M.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy;
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
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Anzillotti G, Guazzoni E, Conte P, Di Matteo V, Kon E, Grappiolo G, Loppini M. Using Three-Dimensional Printing Technology to Solve Complex Primary Total Hip Arthroplasty Cases: Do We Really Need Custom-Made Guides and Templates? A Critical Systematic Review on the Available Evidence. J Clin Med 2024; 13:474. [PMID: 38256607 PMCID: PMC10816635 DOI: 10.3390/jcm13020474] [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: 12/14/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
The burden of osteoarthritis (OA) is around 300 million people affected worldwide, with the hip representing a commonly affected joint. Total hip arthroplasty (THA) has been used with notable success as a definitive treatment to improve pain and function in hip OA patients. The recent advent of new technologies, such as 3D printing, has pushed the application of these new concepts toward applications for the well-known THA. Currently, the evidence on the use of 3D printing to aid complex primary THA cases is still scarce. METHODS An extensive literature review was conducted to retrieve all articles centered on the use of 3D printing in the setting of primary THA. RESULTS A total of seven studies were included in the present systematic review. Four studies investigated the use of 3D-printed surgical guides to be used during surgery. The remaining three studies investigated the benefit of the use of 3D-printed templates of the pelvis to simulate the surgery. CONCLUSIONS The use of 3D printing could be a promising aid to solve difficult primary total hip arthroplasty cases. However, the general enthusiasm in the field is not supported by high-quality studies, hence preventing us from currently recommending its application in everyday practice.
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Affiliation(s)
- Giuseppe Anzillotti
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Edoardo Guazzoni
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università Degli Studi di Genova, 17100 Savona, Italy
| | - Pietro Conte
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Vincenzo Di Matteo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Elizaveta Kon
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov University, Moscow 119991, Russia
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università Degli Studi di Genova, 17100 Savona, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università Degli Studi di Genova, 17100 Savona, Italy
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Grappiolo G, Gambaro FM, Spera M, Chiappetta K, Morenghi E, Loppini M. Clinical and radiological outcomes of an uncemented metaphyseal short stem at minimum 10 years of follow-up: a prospective observational study. Arch Orthop Trauma Surg 2024; 144:425-431. [PMID: 37526737 DOI: 10.1007/s00402-023-05012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE There is growing interest around short stems as they provide a less invasive approach for total hip arthroplasty preserving bone stock for a possible revision surgery if required. The main purpose of this work was to assess the long-term performance of an uncemented metaphyseal short stem in terms of survival rate and in addition its clinical and radiological outcomes. MATERIALS AND METHODS From January to December 2010, we prospectively enrolled all consecutive patients undergoing primary total hip arthroplasty with an uncemented metaphyseal short stem in our institution with a minimum follow-up of 10 years. The radiographic features investigated were the varus-valgus stem orientation, areas of osteolysis and radiolucencies, stress shielding, and heterotopic calcifications. The clinical outcomes were measured using the HHS. RESULTS A total of 163 patients (172 hips) were finally included and the measured survival rate at 10 years was 99.6%. The average HHS increased from 55.0 preoperatively to 97.8 at the last follow-up (p < 0.0001). Among them, 137 patients (164 hips) were also available for radiographic assessment. Mild varus malalignment was observed in 40% of cases and remained stable in the serial X-rays and was not associated with step loosening. Mild stress shielding was observed around 13 stems (9%) and moderate only around 3 implants. CONCLUSION In conclusion, the uncemented metaphyseal short stems showed excellent survival and clinical results at 10 years and at a radiographical level very low stress shielding was observed; moreover, besides the high frequency of varus alignment the implanted stems was not associated with revision surgery or with worse clinical outcomes.
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Affiliation(s)
- Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona-Università degli Studi di Genova, Via Magliotto 2, 17100, Savona, Italy
| | - Francesco Manlio Gambaro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Marco Spera
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Katia Chiappetta
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona-Università degli Studi di Genova, Via Magliotto 2, 17100, Savona, Italy
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
- Fondazione Livio Sciutto Onlus, Campus Savona-Università degli Studi di Genova, Via Magliotto 2, 17100, Savona, Italy.
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Longo UG, De Salvatore S, Zollo G, Calabrese G, Piergentili I, Loppini M, Denaro V. Magnetic resonance imaging could precisely define the mean value of tendon thickness in partial rotator cuff tears. BMC Musculoskelet Disord 2023; 24:718. [PMID: 37689653 PMCID: PMC10492299 DOI: 10.1186/s12891-023-06756-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/25/2023] [Indexed: 09/11/2023] Open
Abstract
PURPOSE Rotator Cuff (RC) lesions are classified in full-thickness and partial-thickness tears (PTRCTs). To our knowledge, no studies investigated the mean size of shoulder tendons in healthy and PTRCT patients using MRI scans. The aim of the study was to provide data to obtain and compare the mean value of tendon sizes in healthy and PTRCTs groups. METHODS From 2014 to 2020, 500 were included in the study. They were divided into two groups: Group 1 (100 subjects) was composed of people positive for partial-thickness rotator cuff tears (PTRCTs), while the 400 subjects in Group 2 were negative for PTRCTs. RESULTS Overall, of the patients included in the study, 231 were females and 269 were males. The mean age of the patients was 49 ± 12.7 years. The mean thickness of the supraspinatus tendon (SSP) was 5.7 ± 0.6 mm in Group 1, 5.9 ± 0.6 mm in Group 2 (p < 0.001). The mean length of the ISP tendon was 27.4 ± 3.2 mm in Group 1, 28.3 ± 3.8 mm in Group 2 (p = 0.004). The mean width of the SSP tendon was 17 ± 1.6 mm in Group 1, 17.6 ± 2 mm in Group 2 (p = 0.004). The mean width of the infraspinatus tendon (ISP) tendon was 17.7 ± 1.4 mm in Group 1, 18.3 ± 2.1 mm in Group 2 (p = 0.02). CONCLUSION The anatomical data present in this paper may serve as a tool for surgeons to properly manage PTRCTs. The findings of the present study aimed to set the first step towards reaching unanimity to establish international cut-off values to perform surgery. Additionally, they could widely increase diagnostic accuracy, improving both conservative and surgical approaches. Lastly, further clinical trials using more accurate diagnostic MRI tools are required to better define the anatomical differences between PTRCT and healthy patients. LEVEL OF EVIDENCE Level II, Retrospective Comparative Trial.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
- Department of Orthopedics, Children’s Hospital Bambino Gesù, Palidoro, Rome, 00165 Italy
| | - Giuliano Zollo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
| | - Giovanni Calabrese
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
| | - Ilaria Piergentili
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
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Logroscino G, Fidanza A, Giusti I, Poppa G, Troianello L, Calafiore F, Saracco M, Avigni R, Leone R, Mantovani A, Bottazzi B, Grappiolo G, Loppini M. Pentraxin 3, a new biomarker for the diagnosis and management of PJI in primary and revision hip arthroplasty. Acta Biomed 2023; 94:e2023100. [PMID: 37366188 DOI: 10.23750/abm.v94is2.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/22/2023] [Indexed: 06/28/2023]
Abstract
Background/Aim of the study: The periprosthetic or superficial site infections are one of the most catastrophic and difficult to manage complications following total hip arthroplasty. Recently, in addition to well know systemic markers of inflammation, the blood and synovial fluid biomarkers are focused to have a possible role in the infection diagnosis. The long Pentraxin 3 (PTX3) seems to be a sensitive biomarker of acute phase inflammation. The objectives of this prospective and multicentre study were (1) to establish the plasma trend effectiveness of PTX3 in patients undergoing primary hip replacement, and (2) to evaluate the diagnostic accuracy of blood and synovial PTX3 in patients undergoing prosthetic revision of infected hip arthroplasty. METHODS Human PTX3 was measured by ELISA in two cohorts of patients, 10 patients undergoing primary hip replacement for osteoarthritis and 9 patients with infected hip arthroplasty. RESULTS The Authors were able to demonstrate that PTX3 is a viable biomarker for acute phase inflammation. CONCLUSIONS An increase in PTX3 protein concentration in the synovial fluid of patients undergoing implant revision has a strong diagnostic capacity for periprosthetic joint infection, showing 97% specificity.
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Affiliation(s)
| | | | | | | | | | | | - Michela Saracco
- a:1:{s:5:"en_US";s:45:"Università Cattolica del Sacro Cuore di Roma";}.
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Belgiovine C, Pellegrino L, Bulgarelli A, Lauta FC, Di Claudio A, Ciceri R, Cancellara A, Calcaterra F, Mavilio D, Grappiolo G, Chiappetta K, Loppini M, Rusconi R. Interaction of Bacteria, Immune Cells, and Surface Topography in Periprosthetic Joint Infections. Int J Mol Sci 2023; 24:ijms24109028. [PMID: 37240374 DOI: 10.3390/ijms24109028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
The incidence of periprosthetic joint infections (PJIs) is ~2% of total procedures and it is expected to rise due to an ageing population. Despite the large burden PJI has on both the individual and society, the immune response to the most commonly isolated pathogens, i.e., Staphylococcus aureus and Staphylococcus epidermidis, remains incompletely understood. In this work, we integrate the analysis of synovial fluids from patients undergoing hip and knee replacement surgery with in-vitro experimental data obtained using a newly developed platform, mimicking the environment of periprosthetic implants. We found that the presence of an implant, even in patients undergoing aseptic revisions, is sufficient to induce an immune response, which is significantly different between septic and aseptic revisions. This difference is confirmed by the presence of pro- and anti-inflammatory cytokines in synovial fluids. Moreover, we discovered that the immune response is also dependent on the type of bacteria and the topography of the implant surface. While S. epidermidis seems to be able to hide better from the attack of the immune system when cultured on rough surfaces (indicative of uncemented prostheses), S. aureus reacts differently depending on the contact surface it is exposed to. The experiments we performed in-vitro also showed a higher biofilm formation on rough surfaces compared to flat ones for both species, suggesting that the topography of the implant could influence both biofilm formation and the consequent immune response.
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Affiliation(s)
- Cristina Belgiovine
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Luca Pellegrino
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Alberto Bulgarelli
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | | | - Alessia Di Claudio
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Roberta Ciceri
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Unit of Clinical and Experimental Immunology, Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20089 Rozzano, Italy
| | - Assunta Cancellara
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Unit of Clinical and Experimental Immunology, Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20089 Rozzano, Italy
| | - Francesca Calcaterra
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Unit of Clinical and Experimental Immunology, Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20089 Rozzano, Italy
| | - Domenico Mavilio
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Unit of Clinical and Experimental Immunology, Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20089 Rozzano, Italy
| | - Guido Grappiolo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Fondazione Livio Sciutto Onlus, Università Degli Studi Di Genova, 17100 Savona, Italy
| | - Katia Chiappetta
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Fondazione Livio Sciutto Onlus, Università Degli Studi Di Genova, 17100 Savona, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Fondazione Livio Sciutto Onlus, Università Degli Studi Di Genova, 17100 Savona, Italy
| | - Roberto Rusconi
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
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11
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Muscato F, Corti A, Manlio Gambaro F, Chiappetta K, Loppini M, Corino VDA. Combining deep learning and machine learning for the automatic identification of hip prosthesis failure: Development, validation and explainability analysis. Int J Med Inform 2023; 176:105095. [PMID: 37220702 DOI: 10.1016/j.ijmedinf.2023.105095] [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: 03/13/2023] [Revised: 04/26/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
AIM Revision hip arthroplasty has a less favorable outcome than primary total hip arthroplasty and an understanding of the timing of total hip arthroplasty failure may be helpful. The aim of this study is to develop a combined deep learning (DL) and machine learning (ML) approach to automatically detect hip prosthetic failure from conventional plain radiographs. METHODS Two cohorts of patients (of 280 and 352 patients) were included in the study, for model development and validation, respectively. The analysis was based on one antero-posterior and one lateral radiographic view obtained from each patient during routine post-surgery follow-up. After pre-processing, three images were obtained: the original image, the acetabulum image and the stem image. These images were analyzed through convolutional neural networks aiming to predict prosthesis failure. Deep features of the three images were extracted for each model and two feature-based pipelines were developed: one utilizing only the features of the original image (original image pipeline) and the other concatenating the features of the three images (3-image pipeline). The obtained features were either used directly or reduced through principal component analysis. Both support vector machine (SVM) and random forest (RF) classifiers were considered for each pipeline. RESULTS The SVM applied to the 3-image pipeline provided the best performance, with an accuracy of 0.958 ± 0.006 in the internal validation and an F1-score of 0.874 in the external validation set. The explainability analysis, besides identifying the features of the complete original images as the major contributor, highlighted the role of the acetabulum and stem images on the prediction. CONCLUSIONS This study demonstrated the potentialities of the developed DL-ML procedure based on plain radiographs in the detection of the failure of the hip prosthesis.
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Affiliation(s)
- Federico Muscato
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20131 Milan, MI, Italy
| | - Anna Corti
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Francesco Manlio Gambaro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy
| | - Katia Chiappetta
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy
| | - Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, MI, Italy; Fondazione Livio Sciutto Ricerca Biomedica in Ortopedia-ONLUS, Via A. Magliotto 2, 17100 Savona, SV, Italy
| | - Valentina D A Corino
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20131 Milan, MI, Italy; Cardio Tech-Lab, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy.
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Pugliese M, Loppini M, Vanni E, Longo UG, Castagna A. Correction to: Cost-effectiveness analysis of arthroscopic Bankart repair versus open Latarjet reconstruction in anterior shoulder instability. Int Orthop 2023:10.1007/s00264-023-05811-z. [PMID: 37097302 DOI: 10.1007/s00264-023-05811-z] [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] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- Mattia Pugliese
- Trauma & Orthopaedics Department, Ospedale Maggiore C.A. Pizzardi, Bologna, Italy.
| | - Mattia Loppini
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Elena Vanni
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy
| | - Alessandro Castagna
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Clinical and Research Center, Humanitas University, IRCCS, HumanitasRozzano, Milan, Italy
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Pugliese M, Loppini M, Vanni E, Longo GU, Castagna A. Cost-effectiveness analysis of arthroscopic Bankart repair versus open Latarjet reconstruction in anterior shoulder instability. Int Orthop 2023:10.1007/s00264-023-05736-7. [PMID: 36973428 DOI: 10.1007/s00264-023-05736-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/13/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE The ideal surgical treatment for anterior shoulder instability is still under debate. In the healthcare setting, both clinical and economic factors must be considered for optimal resource allocation. From the clinical perspective, the Instability Severity Index Score (ISIS) is a helpful and validated tool for surgeons, although a gray area between 4 and 6 exists. In fact, patients with an ISIS < 4 and > 6 can be treated effectively with arthroscopic Bankart repair and open Latarjet, respectively. The purpose of this study was to conduct a cost-effectiveness analysis of arthroscopic Bankart repair versus open Latarjet in patients with an ISIS between 4 and 6. METHODS A decision-tree model was constructed to simulate the clinical scenario of an anterior shoulder dislocation patient with an ISIS between 4 and 6. Based on previously published literature, outcome probabilities and utility values in the form of Western Ontario Instability Score (WOSI) were assigned to each branch of the tree, alongside institutional cost. The primary outcome assessed was an Incremental cost-effectiveness ratio (ICER) of the two procedures. Eden-Hybbinette was also considered in the model as a salvage procedure for failed Latarjet. A two-way sensitivity analysis was performed to identify the most impactful parameters on the ICER upon their variation within a pre-determined interval. RESULTS Base case cost was 1245.57 € (1220.48-1270.65 €) for arthroscopic Bankart repair, 1623.10 € (1580.82-1665.39 €) for open Latarjet and 2.373.95 € (1940.81-2807.10 €) for Eden-Hybbinette. Base-case ICER was 9570.23 €/WOSI. Sensitivity analysis showed that the most impactful parameters were the utility of arthroscopic Bankart repair, the probability of success of open Latarjet, the probability of undergoing surgery after post-operative recurrence of instability and the utility of Latarjet. Of these, utility of arthroscopic Bankart repair and Latarjet had the most significant impact on the ICER. CONCLUSION From a hospital perspective, open Latarjet was more cost-effective than arthroscopic Bankart repair in preventing further shoulder instability in patients with an ISIS between 4 and 6. Despite its several limitations, this is the first study to analyze this subgroup of patients from a European hospital setting from both an economic and clinical perspective. This study can help surgeons and administrations in the decision-making process. Further clinical studies are needed to prospectively analyze both aspects to further delineate the best strategy.
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Affiliation(s)
- Mattia Pugliese
- Trauma & Orthopaedics Department, Ospedale Maggiore C.A. Pizzardi, Bologna, Italy.
| | - Mattia Loppini
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Elena Vanni
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Giuseppe Umile Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Alessandro Castagna
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Clinical and Research Center, Humanitas University, IRCCS, HumanitasRozzano, Milan, Italy
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Di Matteo V, Di Pilla M, La Camera F, Morenghi E, Grappiolo G, Loppini M. Perioperative Complications after Hip and Knee Revision Arthroplasty in the over 80 Years Old Population: A Retrospective Observational Case–Control Study. J Clin Med 2023; 12:jcm12062186. [PMID: 36983188 PMCID: PMC10053815 DOI: 10.3390/jcm12062186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/13/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Background: The number of joint revision arthroplasties has increased in the elderly population, which is burdened by several perioperative risks. Methods: Patients who underwent hip and knee revision arthroplasty were retrospectively included, and they were divided into two groups by age: <80 years old (Group 1) and ≥80 years old (Group 2). The primary outcome was to compare perioperative complication rates. The secondary outcome was to compare the 30-day, 90-day, and 1-year readmission rates. Results: In total, 74 patients in Group 1 and 75 patients in Group 2 were included. Postoperative anemia affected 13 patients in Group 1 (17.6%) and 25 in Group 2 (33.3%, p 0.027); blood units were transfused in 20 (26.7%) and 11 (14.9%, p 0.076) patients, respectively. In Group 1, two (2.7%) patients reported wound infection. In Group 2, eight (10.7%) patients presented hematomas, and two (2.7%) patients reported dislocations. No significant differences in the two groups were observed for 30-day (p 0.208), 90-day (p 0.273), or 1-year readmission rates (p 0.784). Conclusion: The revision arthroplasty procedure in patients over 80 years old is not associated with a higher risk of perioperative complications, or higher readmission rate compared with younger patients undergoing hip and knee revision surgery.
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Affiliation(s)
- Vincenzo Di Matteo
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marina Di Pilla
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Francesco La Camera
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, Via Magliotto 2, 17100 Savona, Italy
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, Via Magliotto 2, 17100 Savona, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, Via Magliotto 2, 17100 Savona, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
- Correspondence:
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La Camera F, de Matteo V, Di Maio M, Verrazzo R, Grappiolo G, Loppini M. Clinical Outcomes and Complication Rate after Single-Stage Hardware Removal and Total Hip Arthroplasty: A Matched-Pair Controlled Study. J Clin Med 2023; 12:jcm12041666. [PMID: 36836201 PMCID: PMC9958733 DOI: 10.3390/jcm12041666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/17/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Single-stage hardware removal and total hip arthroplasty is a complex surgical procedure, comparable to revision surgery. The purpose of the current study is to evaluate single-stage hardware removal and THA outcomes, compare this technique with a matched control group that has undergone primary THA and assess the risk of periprosthetic joint infection with a 24-month minimum follow-up. METHODS This study included all those cases treated with THA and concomitant hardware removal from 2008 to 2018. The control group was selected on a 1:1 ratio among patients who underwent THA for primary OA. The Harris Hip (HHS) and University of California at Los Angeles Activity (UCLA) scores, infection rate and early and delayed surgical complications were recorded. RESULTS One hundred and twenty-three consecutive patients (127 hips) were included, and the same number of patients was assigned to the control group. The final functional scores were comparable between the two groups; a longer operative time and transfusion rate were recorded in the study group. Finally, an increased incidence of overall complications was reported (13.8% versus 2.4%), but no cases of early or delayed infection were found. CONCLUSIONS Single-stage hardware removal and THA is a safe and effective but technically demanding technique, with a higher incidence of overall complications, making it more similar to revision THA than to primary THA.
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Affiliation(s)
- Francesco La Camera
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Italy
- Fondazione Livio Sciutto Ricerca Biomedica in Ortopedia-ONLUS, Via A. Magliotto 2, 17100 Savona, Italy
| | - Vincenzo de Matteo
- Section of Orthopaedic Surgery Department of Public Health, School of Medicine, “Federico II” University of Naples, via Sergio Pansini 5, 80131 Naples, Italy
| | - Marco Di Maio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
| | - Raffaele Verrazzo
- Section of Orthopaedic Surgery Department of Public Health, School of Medicine, “Federico II” University of Naples, via Sergio Pansini 5, 80131 Naples, Italy
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Italy
- Fondazione Livio Sciutto Ricerca Biomedica in Ortopedia-ONLUS, Via A. Magliotto 2, 17100 Savona, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano, Italy
- Fondazione Livio Sciutto Ricerca Biomedica in Ortopedia-ONLUS, Via A. Magliotto 2, 17100 Savona, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
- Correspondence:
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Loppini M, La Camera F, Gambaro FM, Ruggeri R, Grappiolo G, Della Rocca F. Sport Activity and Clinical Outcomes after Hip Arthroscopy with Acetabular Microfractures at a Minimum 2-Year Follow-Up: A Matched-Pair Controlled Study. Life (Basel) 2022; 12:life12081107. [PMID: 35892909 PMCID: PMC9331773 DOI: 10.3390/life12081107] [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] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022]
Abstract
Background: Acetabular microfractures for cartilage lesions have been shown to be a safe procedure able to improve patient reported outcomes (PROs). Nevertheless, the return to sport activity rate represents a crucial outcome to be investigated in these young athletic patients. Methods: Patients undergoing acetabular microfracture for full chondral acetabular lesions were compared to a 1:1 matched-pair by age and gender control group undergoing hip arthroscopy without microfractures. Clinical assessment was performed with PROs and participation in sports in terms of type and level of activities was evaluated preoperatively and at 2-years follow-up. Results: A total of 62 patients with an average age of 35.1 ± 8.1 (microfracture group) and 36.4 ± 6.3 (control group) were included. In both groups, the average values of PROs significantly increased from preoperatively to the last follow-up. There was no significant difference between the two groups in the number of patients playing at the amateur and elite level preoperatively and at the last follow-up. Conclusions: Microfractures for the management of full-thickness acetabular chondral defect provides good clinical results at a minimum follow-up of two years, which are not inferior to a matched-pair control group. Patients undergoing this procedure are likely able to return at the same level of sport before surgery.
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy;
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.L.C.); (R.R.); (G.G.); (F.D.R.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy
- Correspondence:
| | - Francesco La Camera
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.L.C.); (R.R.); (G.G.); (F.D.R.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy
| | | | - Riccardo Ruggeri
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.L.C.); (R.R.); (G.G.); (F.D.R.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.L.C.); (R.R.); (G.G.); (F.D.R.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy
| | - Federico Della Rocca
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (F.L.C.); (R.R.); (G.G.); (F.D.R.)
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Nasca V, Frezza AM, Morosi C, Buonomenna C, Parafioriti A, Zappalà G, Bini F, Casali PG, Loppini M, Stacchiotti S. Rechallenge of denosumab in advanced giant cell tumor of the bone after atypical femur fracture: A case report and review of literature. Front Oncol 2022; 12:953149. [PMID: 35928864 PMCID: PMC9343706 DOI: 10.3389/fonc.2022.953149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 12/27/2022] Open
Abstract
Giant cell tumor of the bone (GCTB) is a locally aggressive neoplasm where surgery is often curative. However, it can rarely give rise to distant metastases. Currently, the only available active therapeutic option for unresectable GCTB is denosumab, an anti-RANKL monoclonal antibody that dampens the aggressive osteolysis typically seen in this disease. For advanced/metastatic GCTB, denosumab should be continued lifelong, and although it is usually well tolerated, important questions may arise about the long-term safety of this drug. In fact, uncommon but severe toxicities can occur and eventually lead to denosumab discontinuation, such as atypical fracture of the femur (AFF). The optimal management of treatment-related AFF is a matter of debate, and to date, it is unknown whether reintroduction of denosumab at disease progression is a clinically feasible option, as no reports have been provided so far. Hereinafter, we present a case of a patient with metastatic GCTB who suffered from AFF after several years of denosumab; we describe the clinical features, orthopedic treatment, and oncological outcomes, finally providing the first evidence that denosumab rechallenge after AFF occurrence may be a safe and viable option at GCTB progression.
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Affiliation(s)
- Vincenzo Nasca
- Department of Medical Oncology, Fondazione Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
| | - Anna Maria Frezza
- Department of Medical Oncology, Fondazione Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
| | - Ciriaco Buonomenna
- Department of Radiology, Fondazione Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
| | - Antonina Parafioriti
- Department of Pathology, Aziende Socio Sanitarie Territoriali (ASST) Pini – Centri Traumatologici Ortopedici (CTO), Milano, Italy
| | - Giorgio Zappalà
- Department of Orthopaedic Surgery, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Federica Bini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Giovanni Casali
- Department of Medical Oncology, Fondazione Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | - Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
- Department of Orthopaedic Surgery, Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milano, Italy
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione Instituti Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
- *Correspondence: Silvia Stacchiotti,
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Agnelli B, Oldani S, Loppini M, Cananzi F, Chiari D, Montagna L, Vinci V. Blended practical learning in compliance with COVID-19 social distancing. SN Soc Sci 2022; 2:57. [PMID: 35499068 PMCID: PMC9035286 DOI: 10.1007/s43545-022-00358-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022]
Abstract
COVID-19 pandemic has imposed great changes in everyday life. Starting from January 2020, Humanitas University proposed to students digital instruction for continuing medical education, in particular, concerning practical activities. The latter, defined as Professionalizing activities, were transformed into complete online learning. From September 2020, in accordance to the imposed rules of social distancing, we modified the approach to Professionalizing activities. Despite following the new constrains, we came up with a blend online and face-to-face education program. The Kirkpatrick's evaluation model has been followed for validation of the project. Two ad hoc satisfaction questionnaires have been proposed to evaluate the project. Different approaches to blended learning have been described in literature; however, we propose a new method application, which fits to the post-pandemic era, with the purpose of sharing our experience in the field. Advantages and limitations are described. According to students, the overall satisfaction was rated 6.8, while tutors evaluated it with 7.4. The qualitative analysis of data confirms the advantage of the blended learning activities in order to guarantee a continuation of the clinical curriculum. Although it highlighted the necessity for, an increased technical support and an improvement in organization of the meetings. Blended learning is becoming more accepted among academic communities because it combines “the best of both worlds.” However, its effectiveness depends on several factors. With our approach, we propose a method, specifically designed to make effective this kind of teaching, which can be considered essential in the pandemic era we are facing.
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Affiliation(s)
- Benedetta Agnelli
- Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Silvia Oldani
- Office of Medical Education, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Humanitas Clinical and Research Center—IRCCS, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Mattia Loppini
- Office of Medical Education, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Humanitas Clinical and Research Center—IRCCS, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Ferdinando Cananzi
- Office of Medical Education, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Humanitas Clinical and Research Center—IRCCS, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Damiano Chiari
- Office of Medical Education, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Department of General Surgery, Istituto Clinico Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Licia Montagna
- Office of Medical Education, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Valeriano Vinci
- Office of Medical Education, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
- Humanitas Clinical and Research Center—IRCCS, via Manzoni 56, Rozzano, 20089 Milan, Italy
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19
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Abstract
The study investigated the existing guidelines on the quality and frequency of the follow-up visits after total hip replacement surgery and assessed the level of evidence of these recommendations. The review process was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Additional works were retrieved by direct investigation of the available guidelines of the most important orthopedic societies and regulatory agencies. The current systematic review of the literature resulted in zero original papers, four guidelines for routine follow-up and three guidelines for special cases. Concerning the quality of evidence behind them, these guidelines were not evidence based but drafted from expert consensus. The most important finding of this review is the large variation of recommendations in the follow-up schedule after total hip arthroplasty and the lack of evidence-based indications. Indeed, all the above-reported guidelines are the result of a consensus among experts in the field (level of recommendation class D 'very low') and not based on clinical studies.
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Savona, Italy
| | | | - Rob G H H Nelissen
- Landelijke Registratie Orthopedische Implantaten (Dutch Arthroplasty Register), 's Hertogenbosch, The Netherlands.,Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Savona, Italy
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20
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Loppini M, Pisano A, Ruggeri R, Della Rocca A, Grappiolo G. Pelvic tilt and functional acetabular position after total hip arthroplasty: an EOS 2D/3D radiographic study. Hip Int 2022; 33:365-370. [PMID: 35073774 DOI: 10.1177/11207000211073668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE In total hip arthroplasty (THA), the functional anatomy of the spinopelvic unit should be taken into account to provide the correct functional positioning of the implant. The relationship between the spine and the pelvis in the sagittal plane is represented by pelvic tilt (PT). The sacral slope (SS) has been proposed as a more reliable parameter than the anterior pelvic plane (APP) to express the PT. This study investigated the relationship between the APP and the SS; and the relationship between the APP and the SS, respectively, with the postoperative acetabular orientation. METHODS 45 patients undergoing primary THA were prospectively enrolled. The EOS 2D/3D system was used to perform the radiographic evaluation before and 3 months after surgery. The following parameters were measured in both standing and sitting position: SS, APP, acetabular anteversion (AA) and inclination (AI). RESULTS The SS values did not show any correlation with the values of the APP angle. The changes of the SS in the transition from the standing to the sitting position significantly correlated with the changes of the AA (r = -0.61; p < 0.0001). A weak correlation was found between the APP angle and the AA in standing position (r = -0.35; p = 0.02). CONCLUSIONS The SS accurately expresses the functional orientation of the pelvis in the sagittal plane, and the functional orientation of the cup after hip replacement. Therefore, SS could be taken into account by navigation systems in order to achieve a patient-specific functional position of the acetabular cup.
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy.,Livio Sciutto Onlus Foundation, Savona Campus, University of Genova, Savona, Italy
| | - Alessandro Pisano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Riccardo Ruggeri
- IRCCS Humanitas Research Hospital, Milan, Italy.,Livio Sciutto Onlus Foundation, Savona Campus, University of Genova, Savona, Italy
| | - Antonello Della Rocca
- IRCCS Humanitas Research Hospital, Milan, Italy.,Livio Sciutto Onlus Foundation, Savona Campus, University of Genova, Savona, Italy
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Milan, Italy.,Livio Sciutto Onlus Foundation, Savona Campus, University of Genova, Savona, Italy
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21
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Loppini M, Temporiti F, Furone R, Galli M, Grappiolo G, Gatti R. Static and dynamic pelvic kinematics after one-stage bilateral or unilateral total hip arthroplasty. Hip Int 2021; 31:729-734. [PMID: 32363933 DOI: 10.1177/1120700020921120] [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] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The pelvis rotates simultaneously around both hips along sagittal, frontal and transversal planes and its kinematics change in patients after total hip arthroplasty (THA). Consequently, it is reasonable to expect different pelvic kinematic profiles in bilateral or unilateral THA. Therefore, the aim of this study was to compare pelvic kinematics in patients with bilateral or unilateral THA. METHODS 40 patients undergoing bilateral (n = 20) or unilateral (n = 20) THA were evaluated for pelvic kinematics during standing and walking tasks using an optoelectronic system. Mean pelvic orientation was assessed during standing, whereas the Gait Variable Score (GVS), maximum and minimum peaks, range and values of pelvic tilt, obliquity and rotation during Heel-Strike and Toe-Off phases of gait cycle were calculated during walking. Data were collected the day before and at seven days after surgery. RESULTS At baseline, no between-group differences were found. At 7 days, GVS for pelvic tilt (p = 0.029) and rotation (p = 0.046) were closer to normative data in bilateral patients, who also revealed lower maximum peak of anterior tilt (p = 0.013) and lower range of pelvic tilt during gait (p = 0.031) with respect to unilateral cases. No between-group differences were found for pelvic orientation during standing at any time-point. CONCLUSIONS Bilateral patients revealed more physiological pelvic kinematics than unilateral cases. These findings underline the advantage of patients undergoing 1-stage bilateral THA and may be helpful in selecting personalised rehabilitative approaches.
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Affiliation(s)
- Mattia Loppini
- Hip and Knee Orthopaedic Surgery Department, Humanitas Clinical and Research Centre, Milan, Italy.,Humanitas University, Milan, Italy
| | - Federico Temporiti
- Humanitas University, Milan, Italy.,Physiotherapy Unit, Humanitas Clinical and Research Centre, Milan, Italy
| | - Roberta Furone
- Physiotherapy Unit, Humanitas Clinical and Research Centre, Milan, Italy.,BTS S.p.A., Milan, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Guido Grappiolo
- Hip and Knee Orthopaedic Surgery Department, Humanitas Clinical and Research Centre, Milan, Italy
| | - Roberto Gatti
- Humanitas University, Milan, Italy.,Physiotherapy Unit, Humanitas Clinical and Research Centre, Milan, Italy
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22
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Parente R, Possetti V, Schiavone ML, Campodoni E, Menale C, Loppini M, Doni A, Bottazzi B, Mantovani A, Sandri M, Tampieri A, Sobacchi C, Inforzato A. 3D Cocultures of Osteoblasts and Staphylococcus aureus on Biomimetic Bone Scaffolds as a Tool to Investigate the Host-Pathogen Interface in Osteomyelitis. Pathogens 2021; 10:pathogens10070837. [PMID: 34357987 PMCID: PMC8308613 DOI: 10.3390/pathogens10070837] [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] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022] Open
Abstract
Osteomyelitis (OM) is an infectious disease of the bone primarily caused by the opportunistic pathogen Staphylococcus aureus (SA). This Gram-positive bacterium has evolved a number of strategies to evade the immune response and subvert bone homeostasis, yet the underlying mechanisms remain poorly understood. OM has been modeled in vitro to challenge pathogenetic hypotheses in controlled conditions, thus providing guidance and support to animal experimentation. In this regard, traditional 2D models of OM inherently lack the spatial complexity of bone architecture. Three-dimensional models of the disease overcome this limitation; however, they poorly reproduce composition and texture of the natural bone. Here, we developed a new 3D model of OM based on cocultures of SA and murine osteoblastic MC3T3-E1 cells on magnesium-doped hydroxyapatite/collagen I (MgHA/Col) scaffolds that closely recapitulate the bone extracellular matrix. In this model, matrix-dependent effects were observed in proliferation, gene transcription, protein expression, and cell–matrix interactions both of the osteoblastic cell line and of bacterium. Additionally, these had distinct metabolic and gene expression profiles, compared to conventional 2D settings, when grown on MgHA/Col scaffolds in separate monocultures. Our study points to MgHA/Col scaffolds as biocompatible and bioactive matrices and provides a novel and close-to-physiology tool to address the pathogenetic mechanisms of OM at the host–pathogen interface.
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Affiliation(s)
- Raffaella Parente
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.P.); (V.P.); (M.L.S.); (M.L.); (A.D.); (B.B.); (A.M.)
| | - Valentina Possetti
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.P.); (V.P.); (M.L.S.); (M.L.); (A.D.); (B.B.); (A.M.)
| | - Maria Lucia Schiavone
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.P.); (V.P.); (M.L.S.); (M.L.); (A.D.); (B.B.); (A.M.)
- National Research Council-Institute for Genetic and Biomedical Research (CNR-IRGB), Milan Unit, 20089 Rozzano, Italy;
| | - Elisabetta Campodoni
- National Research Council-Institute of Science and Technology for Ceramics (CNR-ISTEC), 48018 Faenza, Italy; (E.C.); (M.S.); (A.T.)
| | - Ciro Menale
- National Research Council-Institute for Genetic and Biomedical Research (CNR-IRGB), Milan Unit, 20089 Rozzano, Italy;
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.P.); (V.P.); (M.L.S.); (M.L.); (A.D.); (B.B.); (A.M.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Andrea Doni
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.P.); (V.P.); (M.L.S.); (M.L.); (A.D.); (B.B.); (A.M.)
| | - Barbara Bottazzi
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.P.); (V.P.); (M.L.S.); (M.L.); (A.D.); (B.B.); (A.M.)
| | - Alberto Mantovani
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.P.); (V.P.); (M.L.S.); (M.L.); (A.D.); (B.B.); (A.M.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- The William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK
| | - Monica Sandri
- National Research Council-Institute of Science and Technology for Ceramics (CNR-ISTEC), 48018 Faenza, Italy; (E.C.); (M.S.); (A.T.)
| | - Anna Tampieri
- National Research Council-Institute of Science and Technology for Ceramics (CNR-ISTEC), 48018 Faenza, Italy; (E.C.); (M.S.); (A.T.)
- National Research Council-Institute of Nanostructured Material (CNR-ISMN), 40129 Bologna, Italy
| | - Cristina Sobacchi
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.P.); (V.P.); (M.L.S.); (M.L.); (A.D.); (B.B.); (A.M.)
- National Research Council-Institute for Genetic and Biomedical Research (CNR-IRGB), Milan Unit, 20089 Rozzano, Italy;
- Correspondence: (C.S.); (A.I.); Tel.: +39-028-224-5153 (C.S.); +39-028-224-5132 (A.I.)
| | - Antonio Inforzato
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.P.); (V.P.); (M.L.S.); (M.L.); (A.D.); (B.B.); (A.M.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Correspondence: (C.S.); (A.I.); Tel.: +39-028-224-5153 (C.S.); +39-028-224-5132 (A.I.)
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23
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Longo UG, Loppini M, Fumo C, Lanotte A, Trovato U, Risi Ambrogioni L, Candela V, Forriol F, DiGiovanni CW, Denaro V. Deep deltoid ligament injury is related to rotational instability of the ankle joint: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 2021; 29:1577-1583. [PMID: 33044605 DOI: 10.1007/s00167-020-06308-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 03/14/2020] [Accepted: 09/28/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE In the athletic population, the prevalence of isolated syndesmotic lesions is high. To detect potential instability of the ankle is crucial to define those lesions in need of surgical management. The aim was to define how the extent of tibio-fibular syndesmotic ligament injury influences the overall stability of the ankle joint in a cadaver model. METHODS Twenty fresh-frozen through knee cadaveric leg specimens were subjected to different simulated syndesmotic ligament lesions. In Group 1 (n = 10), the order of ligament sectioning was: anterior tibio-fibular ligament (ATFL), superficial deltoid ligament (SDL), deep deltoid ligament (DDL), posterior tibio-fibular ligament (PTFL), and progressive sectioning at 10, 50 and 100 mm of the distal interosseous membrane (IOM). In Group 2 (n = 10), the sequence was: ATFL, PITFL, 10 and then 50 mm of the distal IOM, SDL, DDL, and 100 mm of the distal IOM. Diastasis of 4 mm in the coronal or sagittal plane and external rotation of the ankle greater than 20° were considered indicative of instability. RESULTS Both coronal and sagittal diastasis exceeded 4 mm with injury patterns characterized by IOM lesions extending beyond 5 cm. External rotation of the ankle exceeded 20° with injury patterns characterized by a DDL lesion. CONCLUSION Coronal and sagittal plane diastases of the tibio-fibular syndesmosis are particularly affected by sequential lesions involving the IOM, whereas increased external rotation of the ankle most depends on DDL. The identification of the specific syndesmotic and deltoid ligament injuries is crucial to understanding which lesions need operative management. The knowledge of which pattern of tibio-fibular syndesmotic ligament injury influences the ankle joint stability is crucial in defining which lesions need for surgical management.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Trigoria, Italy.
| | - Mattia Loppini
- Humanitas University, Via Alessandro Manzoni 113, 20089, Milan, Rozzano, Italy
- Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, 20089, Milan, Rozzano, Italy
| | - Caterina Fumo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Trigoria, Italy
| | - Angela Lanotte
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Trigoria, Italy
| | - Ugo Trovato
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Trigoria, Italy
| | - Laura Risi Ambrogioni
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Trigoria, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Trigoria, Italy
| | - Francisco Forriol
- Orthopaedic Surgery Department, University Foundation San Pablo CEU, Madrid, Spain
| | - Christopher W DiGiovanni
- Department of Orthopaedic Surgery, Massachusetts General Hospital and Newton Wellesley Hospital, Boston, Massachusetts, US
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Trigoria, Italy
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Loppini M, Borroni M, Delle Rose G. Editorial Commentary: Recurrence After Arthroscopic Bankart Repair: What the Instability Severity Index Score Will and Will Not Predict. Arthroscopy 2021; 37:1397-1399. [PMID: 33896495 DOI: 10.1016/j.arthro.2021.02.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
The recurrence of shoulder instability is a challenging complication after anterior open or arthroscopic stabilization in patients with glenohumeral instability. Use of the arthroscopic Bankart procedure has increased over the last decade, because of its less invasiveness and low complication rates compared with the Latarjet procedure. However, arthroscopic repair has the possibility of a greater recurrent instability rate. The Instability Shoulder Index Score (ISIS) has been developed to predict the success of isolated arthroscopic Bankart repair for the management of recurrent anterior shoulder instability. The risk factors associated with the recurrence of instability are age, level and type of sports participation, shoulder hyperlaxity, and humeral and glenoid bony lesions. The ISIS is a validated tool to predict the recurrence of dislocation after arthroscopic surgery in patients with shoulder instability. The arthroscopic Bankart procedure can be performed in patients with ISIS ≤3 with a low risk of recurrence of glenohumeral instability. The Latarjet procedure should be recommended in patients with ISIS >6. The management of patients with ISIS between 4 and 6 is still controversial and ranges from arthroscopic Bankart procedure with the addition of remplissage to the Latarjet procedure. Because advanced imaging techniques, such as computed tomography scans, allow us to assess appropriately the glenoid and humeral bone defect, their use is recommended in addition to ISIS.
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25
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La Camera F, Loppini M, Della Rocca A, de Matteo V, Grappiolo G. Total Hip Arthroplasty With a Monoblock Conical Stem in Dysplastic Hips: A 20-Year Follow-Up Study. J Arthroplasty 2020; 35:3242-3248. [PMID: 32600818 DOI: 10.1016/j.arth.2020.05.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty in patients with hip dysplasia is challenging as a result of complex anatomic deformities in the hip. The aim of the study was to evaluate the survivorship, the clinical and radiographic outcomes of cementless Wagner Cone stem in patients with dysplastic hip. METHODS This retrospective study reports on 102 patients (135 hips) who have undergone total hip arthroplasty between 1993 and 1997. The mean age of patients was 51 years (range, 21-73). Minimum follow-up was 20 years. According to the Crowe classification, 38 hips presented dysplasia of grade I, 41 of grade II, 37 of grade III, and 19 of grade IV. RESULTS Kaplan-Meier survivorship for aseptic loosening was 97% (95% confidence interval, 94.4-99.6) at 20 years. The average Harris hip score increased from 43.4 points (range, 22-51) to 86.4 points (range, 39-100) (P < .0001) and average Merle d'Aubignè score increased from 8.4 (range, 4-13) to 15 (range, 5-18) (P < .0001); at the last follow-up, average University of California at Los Angeles activity score and visual analog score were 4.53 (range, 1-9) and 1.25 (range, 0-6), respectively; 17% of heterotopic ossification and 19.2% of radiolucency lines around the stem were reported. CONCLUSION Monoblock Wagner Cone stem is a reliable option in dysplastic hip with an excellent survivorship and good clinical and radiographic outcome in the long term.
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Affiliation(s)
- Francesco La Camera
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Mattia Loppini
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Antonello Della Rocca
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Vincenzo de Matteo
- Section of Orthopaedic Surgery Department of Public Health, School of Medicine, "Federico II" University of Naples, Naples, Italy
| | - Guido Grappiolo
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
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Abstract
Context: Chordomas are rare primary tumors of bone characterized by local aggressiveness and poor prognosis. The surgical exeresis plays a critical role for their management. Objective: The aim was to provide an overview of the surgical management of chordomas of the mobile spine and sacrum, describing the most common surgical approaches, the role of surgical margins, the difficulties of en block resection, the outcomes of surgery, the recurrence rate and the use of associated therapies. Methods: We performed a systematic search using the keywords "chordoma" in combination with "surgery", "spine", "sacrum" and "radiotherapy". Results: Fifty-eight studies, describing 1359 patients with diagnosis of chordoma were retrieved. 17 studies were performed on subjects with cervical chordomas and 49 focused on patients with sacrococcygeal chordomas. The remaining studies included patients with chordomas in cranial region and/or mobile spine and/or sacroccygeal region. The recurrence rate ranged from 25% to 60% for cervical chordomas, and from 18% to 89% for sacrococcygeal chordomas. Conclusion: Despite the remarkable advances in the local management of chordoma performed in the last decades, the current results of surgery alone are still unsatisfactory. The radical en bloc excision of tumour is technically demanding, particularly in the cervical spine. Although radical surgery must still be considered the gold standard for the management of chordomas, a multidisciplinary approach is required to improve the local control of the disease in patients who undergo both radical and non-radical surgery. Adjuvant radiation therapy increases the continuous disease-free survival and the local recurrence-free survival. Level of evidence: Systematic review; level III.
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Affiliation(s)
- Luca Denaro
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Mauro Ciuffreda
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | | | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
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27
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Loppini M, Della Rocca A, Ferrentino D, Pizzi C, Grappiolo G. Blood loss in primary total hip arthroplasty with a short versus conventional cementless stem: a retrospective cohort study. Arch Orthop Trauma Surg 2020; 140:1551-1558. [PMID: 32743702 DOI: 10.1007/s00402-020-03561-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/24/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION To evaluate the impact of short cementless stem on several clinical and radiographic outcomes, with particular focus on blood loss, in comparison with conventional cementless stem in total hip arthroplasty (THA). MATERIALS AND METHODS Patients undergoing THA with GTS short stem or CLS conventional stem were included. Clinical data were retrospectively collected including preoperative and postoperative day 1 value for haemoglobin (HB); rate of postoperative blood transfusions; intraoperative bone infractions; stem alignment; 5-year follow-up Harris Hip Score (HHS) and rate of stem revision at 5 years of follow-up of the short and conventional cementless stem. RESULTS GTS and CLS stem group included 374 and 321 patients, respectively. The mean difference between the preoperative and postoperative day 1 HB value was 3.98 g/dL (SD 1.12) and 3.67 g/dL (SD 1.19) in the GTS and CLS group, respectively, which correspond to a crude effect (β) of 0.32 (95% CI 0.15; 0.49) and adjusted effect of 0.11 (95% CI - 0.08; 0.3). GTS group reported a significantly higher number of patients with excellent results in terms of HHS (p = 0.001). The rate of intraoperative bone infractions was 1.6% and 0.3% in the GTS and CLS group, respectively (p = 0.013). At radiographic assessment, the rate of varus position of the stem was 14% in the GTS group and 6% in the CLS group (p < 0.0001). The rate of stem revision at 5 years of follow-up was 0.8% and 0.4% in the GTS and CLS group, respectively (p = 0.63). CONCLUSIONS GTS short stem was not associated with a clinically significant lower blood loss in the immediately postoperative period. Unadjusted exploratory analyses show that GTS stem provides the same results of CLS stem in terms of HHS and rate of stem revision at 5 years of follow-up.
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
- Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Antonello Della Rocca
- Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Davide Ferrentino
- Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Costanza Pizzi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Guido Grappiolo
- Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
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Longo UG, Petrillo S, Candela V, Rizzello G, Loppini M, Maffulli N, Denaro V. Arthroscopic rotator cuff repair with and without subacromial decompression is safe and effective: a clinical study. BMC Musculoskelet Disord 2020; 21:24. [PMID: 31926559 PMCID: PMC6955088 DOI: 10.1186/s12891-019-3032-z] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 12/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Subacromial decompression, that consists of the release of the coracoid-acromial ligament, subacromial bursectomy and anterior-inferior acromioplasty, has traditionally been performed in the management of this pathology. However, the purpose of subacromial decompression procedure is not clearly explained. Our reaserch aimed to analyse the differences among the outcomes of arthroscopic rotator cuff repair (RCR) made with suture anchors, with or without the subacromial decompression procedure. METHODS 116 shoulders of 107 patients affected by rotator cuff (RC) tear were treated with Arthroscopic RCR. In 54 subjectes, the arthroscopic RCR and the subacromial decompression procedure (group A) were executed, whereas 53 took only arthroscopic RCR (group B). Clinical outcomes were evaluated through the use of the modified UCLA shoulder rating system, Wolfgang criteria shoulder score and Oxford shoulder score (OSS). Functional outcomes were assessed utilizing active and passive range of motion (ROM) of the shoulder, and muscle strength. The duration of the follow up and the configuration of the acromion were used to realize the comparison between the two groups. RESULTS In patients with 2 to 5 year follow up, UCLA score resulted greater in group A patients. In subjectes with longer than five years of follow up, group B patients showed considerably greater UCLA score and OSS if related with group A patients. In subjectes that had the type II acromion, group B patients presented a significant greater strength in external rotation. CONCLUSION The long term clinical outcomes resulted significantly higher in patients treated only with RCR respect the ones in patients underwent to RCR with subacromial decompression.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy. .,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - Stefano Petrillo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Italy.,Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, 20089, Milan, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.,Keele University Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
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Brambilla L, Bianchi A, Malerba F, Loppini M, Martinelli N. Lateral ankle ligament anatomic reconstruction for chronic ankle instability: Allograft or autograft? A systematic review. Foot Ankle Surg 2020; 26:85-93. [PMID: 30578157 DOI: 10.1016/j.fas.2018.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To investigate if there is any evidence in favour of autograft or allograft use for anatomic reconstruction of lateral ankle ligaments in patients with symptomatic chronic ankle instability. METHODS A literature search was performed in PubMed MEDLINE, Cochrane Library, EMBASE and Google Scholar databases, over the years 1994-2017, to identify the studies presenting clinical results of anatomic lateral ankle ligaments reconstruction using various combinations of the keywords "lateral ankle ligaments reconstruction", "anatomic reconstruction", "chronic ankle instability", "allograft", "autograft". The surgical procedure was considered anatomic if consistent with the description of lateral ankle ligaments made by Burks and Morgan in 1994. RESULTS Among the 89 papers matching the search terms, only 12 could be included in which 357 anatomic lateral ankle ligaments reconstructions were performed. One was a comparative case series (level of evidence III - LOE III) while other papers were retrospective case series (LOE IV), the mean Modified Coleman Methodology Score (MCMS) was fair: 56.7 (SD±5.2). Due to the low level of evidence of the available literature only a qualitative analysis was performed. The limited evidence from the studies analysed suggests that there is no difference in graft survivorship, graft-dependent variables, patient's satisfaction, clinical outcome measures and radiographic results between allograft and autograft. CONCLUSIONS Given the low number of studies, their poor methodology score and their low level of evidence it is not possible to determine if allograft is better or safer than autograft. LEVEL OF EVIDENCE Level IV, review paper of level III and level IV studies.
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Affiliation(s)
- L Brambilla
- Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy.
| | - A Bianchi
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy.
| | - F Malerba
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy.
| | - M Loppini
- Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - N Martinelli
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy.
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Longo UG, Petrillo S, Loppini M, Candela V, Rizzello G, Maffulli N, Denaro V. Metallic versus biodegradable suture anchors for rotator cuff repair: a case control study. BMC Musculoskelet Disord 2019; 20:477. [PMID: 31653247 PMCID: PMC6815043 DOI: 10.1186/s12891-019-2834-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 05/27/2018] [Accepted: 09/13/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUNDS Repair of full-thickness rotator cuff (RC) tears is routinely performed using suture anchors, which produce secure and effective soft tissue fixation to bone. The aim of this prospective study is to compare the long-term outcomes of single row arthroscopic rotator cuff repair (RCR) performed using metal or biodegradable suture anchors. The null hypothesis is that there is no difference in shoulder function using metal or biodegradable suture anchors as evaluated by UCLA shoulder score, Wolfgang criteria, and Oxford shoulder score. METHODS Arthroscopic RCR was performed in 110 patients included in this case control study. They were divided into 2 groups of 51 and 59 patients respectively. Metal suture anchors were used in group 1, and biodegradable suture anchors in group 2. Results were obtained at a mean follow up of 4.05 + 2 years. Clinical outcomes and functional outcomes were evaluated. RESULTS The mean modified UCLA shoulder score was 26.9 + 7.1 in group 1, and 27.7 + 6.5 in group 2 (P = 0.5); the mean Wolfgang score was 13.3 + 3.3 in group 1, and 14 + 2.6 in group 2 (P = 0.3); the mean OSS was 23.7 + 11.4 in group 1, and 20.7 + 9.2 points in group 2 (P = 0.1). The mean active anterior elevation was 163.5° + 28.2° in group 1 and 163.6° + 26.9 in group 2 (P = 0.9); the mean active external rotation was 46° + 19.7° in group 1 and 44.6° + 16.3° in group 2 (P = 0.7). The mean strength in anterior elevation was 4.8.02 + 23.52 N in group 1, and 43.12 + 17.64 N in group 2 (P = 0.2); the mean strength in external rotation was 48.02 + 22.54 N in group 1 and 46.06 + 17.64 N in group 2 (P = 0.6); the mean strength in internal rotation was 67.62 + 29.4 N in group 1, and 68.6 + 25.48 N in group 2 (P = 0.9). CONCLUSIONS There are no statistically significant differences at a mean follow-up of 4.05 + 2 years in clinical and functional outcomes of single row arthroscopic RCR using metallic or biodegradable suture anchors for RC < 5 cm.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy. .,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - Stefano Petrillo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.,Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.,Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
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Loppini M, Delle Rose G, Borroni M, Morenghi E, Pitino D, Domínguez Zamora C, Castagna A. Is the Instability Severity Index Score a Valid Tool for Predicting Failure After Primary Arthroscopic Stabilization for Anterior Glenohumeral Instability? Arthroscopy 2019; 35:361-366. [PMID: 30611589 DOI: 10.1016/j.arthro.2018.09.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 04/25/2018] [Revised: 09/08/2018] [Accepted: 09/08/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the validity of the Instability Severity Index Score in predicting the rate of recurrence of dislocation in patients undergoing arthroscopic Bankart repair. METHODS The inclusion criteria were recurrent anterior traumatic glenohumeral instability and a minimum follow-up of 5 years. According to the preoperative Instability Severity Index Score, patients were divided into the following groups: ≤3 points (A), 4 to 6 points (B), and >6 points (C). The recurrence rate was determined by telephone interviews. The estimated overall rate of success at 5 years was defined as the estimated overall percentage of patients free of recurrence at 5 years. RESULTS Six hundred seventy patients (572 men and 98 women) were included. The average age was 27 years (range, 18 to 39 years) at the time of surgery. One hundred fourteen of 670 patients had a recurrence of instability, with an overall recurrence rate of 17% (95% confidence interval [CI] 14.2%-19.9%). The Instability Severity Index Score had a significant association with recurrence. Compared with patients in group A, those in group B had double the risk of recurrence (hazard ratio [HR] = 2.43, 95% CI 1.38-4.28, P = .002), and patients in group C a 9 times greater risk of recurrence (HR = 9.42, 95% CI 5.20-17.7, P < .001). The estimated overall rate of success at 5 years was 84.8% (95% CI 81.8-87.3). The rate of success with an Instability Severity Index Score ≤3 points was 93.7% (95% CI 89.6-96.2), but it dropped to 85.7% (95% CI 81.7-88.9) in those with an Instability Severity Index Score of 4 to 6 points and became 54.6% (95% CI 42.8-64.9) in those with an Instability Severity Index Score >6 points. On multivariable analysis, the Instability Severity Index Score was found to significantly affect the risk of recurrence, corrected by type of sport and glenoid bone loss. CONCLUSIONS The Instability Severity Index Score is a validated tool with which to assess the recurrence rate of dislocation after arthroscopic surgery in patients with shoulder instability. Arthroscopic stabilization in patients with an Instability Severity Index Score ≤3 is associated with a significantly lower risk of recurrence of glenohumeral instability compared with that in patients with an Instability Severity Index Score >3 points. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
| | - Giacomo Delle Rose
- Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Mario Borroni
- Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Emanuela Morenghi
- Biostatistic Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Dario Pitino
- Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | - Alessandro Castagna
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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Affiliation(s)
- N. Maffulli
- Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK Department of Physical and Rehabilitation Medicine, University of Salerno, Italy
| | - K. Marigotti
- Department of Surgical Pathology, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - U.G. Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - M. Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - V.M. Fazio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - V. Denaro
- Physioterapy Department, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Maffulli N, Oliva F, Loppini M, Aicale R, Spiezia F, King J. The Royal London Hospital Test for the clinical diagnosis of patellar tendinopathy. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.02.2017.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- N. Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospita, London, England
| | - F. Oliva
- Department of Orthopedics and Traumatology, University of Rome “Tor Vergata” School of Medicine, Rome, Italy
| | - M. Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Rome, Italy
| | - R. Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - F. Spiezia
- Department Upper and Lower Limb Surgery Unit, University Campus Bio-Medico, Rome, Italy
| | - J.B. King
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospita, London, England
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Loppini M, Schiavi P, Rocca AD, Traverso F, Rocca FD, Mazziotta G, Astore F, Grappiolo G. Double-trabecular metal cup technique for the management of Paprosky type III defects without pelvic discontinuity. Hip Int 2018; 28:66-72. [PMID: 30755117 DOI: 10.1177/1120700018813208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: Modular reconstruction systems based on trabecular metal (TM) prosthetic components have been increasingly used in the last decade for the management of severe acetabular bone defects. The aim of this study was to assess the clinical and radiographic outcomes of double-cup technique for the management of Paprosky type III defects without pelvic discontinuity. METHODS: A retrospective review was performed for all patients undergoing acetabular reconstruction with 2 TM cups at a tertiary referral centre between 2010 and 2015. Harris Hip Scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at the latest follow-up. Radiographic assessment of the hip centre of rotation (COR) position and leg length discrepancy (LLD) was performed preoperatively and postoperatively. Osteolysis and radiolucencies, loosening of the implants, and heterotopic ossifications were evaluated with the latest follow-up radiographs. RESULTS: Patients included 5 men and 11 women (16 hips) with an average age of 68 (45-81) years. Acetabular bone defects included 9 Paprosky type IIIB and 7 type IIIA defects. No pelvic discontinuities were registered. The mean follow-up was 34 (24-72) months. HHS and WOMAC scores, LLD and COR position significantly improved after surgery. In only 1 (6.3%) hip a not progressive radiolucent line adjacent the acetabular construct was noted. Heterotopic ossifications were found in 2 (12.5%) hips. No patients underwent acetabular components revision surgery for any reason. CONCLUSION: The double-cup technique could be considered an effective management of selected Paprosky type III defects without pelvic discontinuity providing excellent clinical and radiographic outcomes in the short term.
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Affiliation(s)
- Mattia Loppini
- 1 Department of Biomedical Sciences, Humanitas University, Milan, Italy.,2 Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Milan, Italy
| | | | - Antonello Della Rocca
- 2 Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Milan, Italy
| | - Francesco Traverso
- 2 Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Milan, Italy
| | - Federico Della Rocca
- 2 Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Milan, Italy
| | - Giuseppe Mazziotta
- 2 Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Milan, Italy
| | - Franco Astore
- 2 Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Milan, Italy
| | - Guido Grappiolo
- 2 Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Milan, Italy
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Grappiolo G, La Camera F, Della Rocca A, Mazziotta G, Santoro G, Loppini M. Total hip arthroplasty with a monoblock conical stem and subtrochanteric transverse shortening osteotomy in Crowe type IV dysplastic hips. Int Orthop 2018; 43:77-83. [PMID: 30187098 DOI: 10.1007/s00264-018-4122-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This series assessed the clinical and radiographic outcomes of total hip arthroplasty (THA) with femoral shortening osteotomy for the management of patients with Crowe type IV hip dysplasia. METHODS Only patients with Crowe type IV hip dysplasia who underwent primary THA combined with a subtrochanteric transverse osteotomy with an uncemented monoblock conical stem were included. The clinical and radiographic evaluations were performed before and immediately after surgery, and at last follow-up. The hip function was assessed with the Harris Hip Score (HHS). RESULTS Seventy-four patients (102 hips) with a mean age of 53.9 (range, 20-83) were evaluated at an average follow-up of 11.3 years (range, 5-25). Stem revision occurred in two (1.9%) cases, with a survivorship of 95.9% (95%IC, 91.9-99.9%) at ten years. The average HHS increased from 44 (range, 15-78) pre-operatively to 90.3 (range, 62-100) at last follow-up (p < 0.001). Osteotomy site non-union and early dislocation were observed in 3.9 and 3.8%, respectively. No cases of nerve palsy were reported. CONCLUSIONS THA with a monoblock conical stem associated with subtrochanteric transverse osteotomy provides good long-term survival, clinical and radiographic results. It may be considered an effective management of patients with Crowe IV hip dysplasia.
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Affiliation(s)
- Guido Grappiolo
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Francesco La Camera
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Antonello Della Rocca
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Giuseppe Mazziotta
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Giuseppe Santoro
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Mattia Loppini
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
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Abstract
Over the last two decades, several conservative femoral prostheses have been designed. The goals of conservative stems include: the spearing of the trochanteric bone stock; a more physiological loading in the proximal femur reducing the risk of stress shielding; and to avoid a long stem into the diaphysis preventing impingement with the femoral cortex and thigh pain. All stems designed to be less invasive than conventional uncemented stems are commonly named ‘short stems’. However, this term is misleading because it refers to a heterogeneous group of stems deeply different in terms of design, biomechanics and bearing. In the short-term follow-up, all conservative stems provided excellent survivorship. However, variable rates of complications were reported, including stem malalignment, incorrect stem sizing and intra-operative fracture. Radiostereometric analysis (RSA) studies demonstrated that some conservative stems were affected by an early slight migration and rotation within the first months after surgery, followed by a secondary stable fixation. Dual-energy x-ray absorptiometry (DEXA) studies demonstrated an implant-specific pattern of bone remodelling. Although the vast majority of stems demonstrated a good osseointegration, some prostheses transferred loads particularly to the lateral and distal-medial regions, favouring proximal stress shielding and bone atrophy in the great trochanter and calcar regions.
Cite this article: EFORT Open Rev 2018;3:149-159. DOI: 10.1302/2058-5241.3.170052
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Italy; Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Italy
| | - Guido Grappiolo
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, Italy
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Maffulli N, Oliva F, Loppini M, Aicale R, Spiezia F, King JB. The Royal London Hospital Test for the clinical diagnosis of patellar tendinopathy. Muscles Ligaments Tendons J 2017; 7:315-322. [PMID: 29264343 DOI: 10.11138/mltj/2017.7.2.315] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To ascertain whether the Royal London Hospital test is reproducible, sensitive, and specific for diagnosis of patellar tendinopathy. Methods Fifteen consecutive athletes with patellar tendinopathy were prospectively enrolled and compared with a control group of 15 non consecutive athletes with Achilles tendinopathy. Two testers examined separately each patient, using manual palpation and the Royal London Hospital test for diagnosis of patellar tendinopathy. High resolution real time ultrasonography was used as standard for diagnosis of tendinopathy and assessment of tendon thickness. Results The palpation test presented significantly higher sensitivity compared to the Royal London Hospital test (98 vs 88%; P=0.01); specificity was 94% for the palpation test and 98% for the Royal London Hospital test (P>0.05). Positive and negative predictive values were 94 and 98% for palpation test, 98 and 89% for the Royal London Hospital test, respectively. The two tests showed good to very good intra-tester and inter-tester agreement. At ultrasonography, pathological patellar tendons were significantly thicker compared to controlateral healthy tendon (P<0.001). Conclusions In symptomatic patients with patellar tendinopathy, the Royal London Hospital test showed lower sensitivity and higher specificity than manual palpation. Both tests should be performed for a correct clinical diagnosis of patellar tendinopathy. Imaging assessment should be performed as a confirmatory test. Level of Evidence III.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospita, London, England
| | - Francesco Oliva
- Department of Orthopedics and Traumatology, University of Rome "Tor Vergata" School of Medicine, Rome, Italy
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Rome, Italy
| | - Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Filippo Spiezia
- Department Upper and Lower Limb Surgery Unit, University Campus Bio-Medico, Rome, Italy
| | - John B King
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospita, London, England
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Loppini M, Longo UG, Caldarella E, Rocca AD, Denaro V, Grappiolo G. Femur first surgical technique: a smart non-computer-based procedure to achieve the combined anteversion in primary total hip arthroplasty. BMC Musculoskelet Disord 2017; 18:331. [PMID: 28764697 PMCID: PMC5539744 DOI: 10.1186/s12891-017-1688-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 07/21/2016] [Accepted: 07/24/2017] [Indexed: 11/17/2022] Open
Abstract
Background The relevance of prosthetic component orientation to prevent dislocation and impingement following total hip arthroplasty (THA) has been widely accepted. We investigated the use of a non-computer-based surgery to address the reciprocal orientation of the acetabular and femoral components. Methods In the femur first technique, the cup is positioned relative to the stem. When the definitive antetorsion of femoral component is fixed, the cup is positioned in a compliant anteversion to the stem. Clinical and radiographic assessments were performed before and 3 months after THA. Radiographic assessment was performed in standing position with the EOS 2D/3D radiography system. 3D images were used to preoperative anterior pelvic plane (APP) angle, postoperative acetabular inclination (AI) and anteversion (AA), and postoperative stem antetorsion. Clinical assessment was performed with Harris Hip Score (HHS). Results Forty patients (40 hips) underwent primary THA with an average age of 61 years (range, 36–84). Average HHS increased from 43 ± 5 (range, 37–52) preoperatively to 97 ± 6 (range, 86–100) at the last follow-up (P < 0.0001). Average combined anteversion value of cup with liner and stem was 38° ± 9° (range, 12°-55°). Average AI value of cup with liner was 39° ± 6° (range, 30°-55°) in the group with standard stem and 45° ± 7° (range, 39°-58°) in the group with varized stem (P = 0.007). Relationship analysis showed no correlation between the combined anteversion values of the cup with liner and stem with APP angle values (r = 0.26, P = 0.87). Conclusions Femur first technique allows the surgeon to achieve a combined anteversion ranging from 25° to 50° with a cup inclination ranging from 30° to 50°. The cup is positioned according to the functional plane of the patient regardless the preoperative pelvic tilt.
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Affiliation(s)
- Mattia Loppini
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy. .,Humanitas University, Via Alessandro Manzoni 113, 20089, Rozzano, Milan, Italy.
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Trigoria, Rome, Italy
| | - Emanuele Caldarella
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Antonello Della Rocca
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Trigoria, Rome, Italy
| | - Guido Grappiolo
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
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Longo UG, Loppini M, Del Vescovo R, Cazzato L, Zobel BB, Maffulli N, Denaro V. Safety of dorsal wrist arthroscopy portals: A magnetic resonance study. Surgeon 2016; 16:101-106. [PMID: 27856161 DOI: 10.1016/j.surge.2016.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/02/2016] [Accepted: 09/10/2016] [Indexed: 10/20/2022]
Abstract
In wrist arthroscopy, the standard dorsal portals are the most commonly used. However, their placement can be associated with injuries to the neurovascular structures of the radiocarpal joint. The present study assessed and compared the distance of commonly used dorsal portals to radial and ulnar neurovascular structures. Forty patients (20 males, 20 females) were evaluated with T1-weighted spin-echo (SE) magnetic resonance (MR) sequences. We measured the distance between 1-2 and 3-4 portals and radial vascular bundle and the nearest branch of the superficial branch of radial nerve (SBRN). We also measured the distance between 4 and 5, 6/U and 6/R and ulnar vascular bundle and the nearest branch of the dorsal ulnar nerve (DUN). The median age of patients was 39 years (95% IC 36.97-43.32 years). The 3-4 portal was farther away from the vascular structure than the 1-2 portal (P < 0.0001), 4-5 portal (P = 0.008), 6/R (P < 0.0001), and 6/U portals (P < 0.0001). Moreover, the 3-4 portal was farther away from the nerve branch than the 1-2 portal (P < 0.0001), 4-5 portal (P < 0.0001), 6/R (P < 0.0001), and 6/U portals (P < 0.0001). No statistical significant differences were found between the two genders. The 3-4 and 4-5 portals are the farthest away from the neurovascular structures, and likely reduce the risk to damage these structures. On the other hand, the 1-2 and 6/U portals likely increase the risk of neurovascular damage, because of their proximity to neurovascular structures. LEVEL OF EVIDENCE Diagnostic study; Level III.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Riccardo Del Vescovo
- Department of Radiology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Luigi Cazzato
- Department of Radiology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Bruno Beomonte Zobel
- Department of Radiology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84081 Baronissi, Salerno, Italy; Centre for Sport and Exercise Medicine, Queen Mary University of London, London, England, United Kingdom.
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy
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Vadalà G, Russo F, Ambrosio L, Loppini M, Denaro V. Stem cells sources for intervertebral disc regeneration. World J Stem Cells 2016; 8:185-201. [PMID: 27247704 PMCID: PMC4877563 DOI: 10.4252/wjsc.v8.i5.185] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [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: 10/30/2015] [Revised: 12/18/2015] [Accepted: 02/16/2016] [Indexed: 02/06/2023] Open
Abstract
Intervertebral disc regeneration field is rapidly growing since disc disorders represent a major health problem in industrialized countries with very few possible treatments. Indeed, current available therapies are symptomatic, and surgical procedures consist in disc removal and spinal fusion, which is not immune to regardable concerns about possible comorbidities, cost-effectiveness, secondary risks and long-lasting outcomes. This review paper aims to share recent advances in stem cell therapy for the treatment of intervertebral disc degeneration. In literature the potential use of different adult stem cells for intervertebral disc regeneration has already been reported. Bone marrow mesenchymal stromal/stem cells, adipose tissue derived stem cells, synovial stem cells, muscle-derived stem cells, olfactory neural stem cells, induced pluripotent stem cells, hematopoietic stem cells, disc stem cells, and embryonic stem cells have been studied for this purpose either in vitro or in vivo. Moreover, several engineered carriers (e.g., hydrogels), characterized by full biocompatibility and prompt biodegradation, have been designed and combined with different stem cell types in order to optimize the local and controlled delivery of cellular substrates in situ. The paper overviews the literature discussing the current status of our knowledge of the different stem cells types used as a cell-based therapy for disc regeneration.
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Maffulli N, Loppini M, Spiezia F, D'Addona A, Maffulli GD. Single minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg. J Orthop Surg Res 2016; 11:61. [PMID: 27221671 PMCID: PMC4878063 DOI: 10.1186/s13018-016-0395-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 10/09/2015] [Accepted: 04/24/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chronic exertional compartment syndrome (CECS) involves a painful increase in compartment pressure caused by exercise and relieved by rest, common in athletes. The most common site for CECS in the lower limbs is the anterior leg compartment. The aim of this study is to evaluate the outcomes of a single minimal incision fasciotomy in athletes and their capability to return to high level sport activity. METHODS The study reports mid-term results in a series of 18 consecutive athletes with chronic exertional compartment syndrome of the leg who had undergone minimally invasive fasciotomy. Between 2000 and 2007, we prospectively enrolled 18 consecutive athletes (12 males and six females, median age 27 years) with unilateral or bilateral chronic exertional compartment syndrome undergoing unilateral or bilateral minimally invasive fasciotomy. Clinical outcomes were assessed with Short-Form Health Survey-36 (SF-36) and European Quality of Life-5 Dimension (EQ-5D) scale. The ability to participate in sport before and after surgery and the time to return to training (RTT) and to sport (RTS) were recorded. RESULTS The median follow-up after surgery was 36 months. Both questionnaires showed a statistically significant improvement (P < 0.0001) after surgery. At the time of the latest follow-up, 17 of 18 patients (94 %) had returned to pre-injury or higher levels of sport. Only one patient (6 %) returned to sport at lower levels than those of pre-injury status. The median time to return to training and to return to sport was 8 and 13 weeks, respectively. No severe complications or recurrence of the symptoms were recorded. CONCLUSIONS Minimally invasive fasciotomy is effective and safe for athletes suffering from unilateral or bilateral chronic exertional compartment syndrome of the anterior and lateral compartments of the leg with good results in the mid-term.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Filippo Spiezia
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Alessio D'Addona
- Department of Public Health, Section of Orthopaedic and Trauma Surgery, University of Naples "Federico II", School of Medicine and Surgery, Naples, Italy
| | - Gayle D Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
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Longo UG, van der Linde JA, Loppini M, Coco V, Poolman RW, Denaro V. Surgical Versus Nonoperative Treatment in Patients Up to 18 Years Old With Traumatic Shoulder Instability: A Systematic Review and Quantitative Synthesis of the Literature. Arthroscopy 2016; 32:944-52. [PMID: 26921126 DOI: 10.1016/j.arthro.2015.10.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [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: 05/21/2015] [Revised: 08/11/2015] [Accepted: 10/27/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the outcome of surgical and nonoperative treatment in patients aged 18 years or younger with traumatic shoulder instability. METHODS A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A complete search of PubMed, Medline, Cochrane, CINAHL, Embase, and Google Scholar databases was performed using various combinations of the keywords "shoulder," "instability," "glenohumeral instability," "pediatric," "adolescent," "skeletally immature," "young," "open physis," "children," "management," "treatment," "surgical," "stabilization," and "recurrence." There was no time restriction. RESULTS Fifteen articles met our inclusion criteria, including a total of 693 patients with 705 shoulders aged 18 years or younger. Of 411 shoulders, 293 (71.3%) treated with a nonoperative approach experienced a redislocation compared with 55 of 314 shoulders (17.5%) that received surgical treatment. The results of the quantitative synthesis showed that the recurrence rate was significantly lower in the surgical group compared with the nonoperative group. CONCLUSIONS The recurrence rate is lower in patients undergoing surgical treatment. Further studies are necessary to clarify several points in the treatment of skeletally immature patients with traumatic shoulder instability. LEVEL OF EVIDENCE Level III, systematic review of Level II and III studies and 1 case series.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Rome, Italy.
| | - Just A van der Linde
- Onze Lieve Vrouwe Gasthuis, Joint Research, Department of Orthopaedic and Trauma Surgery, Postbus, Amsterdam, The Netherlands
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Humanitas Research Hospital, Via Alessandro Manzoni, Rozzano, Milan, Italy
| | - Vito Coco
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Rome, Italy
| | - Rudolf W Poolman
- Onze Lieve Vrouwe Gasthuis, Joint Research, Department of Orthopaedic and Trauma Surgery, Postbus, Amsterdam, The Netherlands
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Rome, Italy
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Longo UG, Rizzello G, Ciuffreda M, Loppini M, Baldari A, Maffulli N, Denaro V. Elmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and Other Distal Realignment Procedures for the Management of Patellar Dislocation: Systematic Review and Quantitative Synthesis of the Literature. Arthroscopy 2016; 32:929-43. [PMID: 26921127 DOI: 10.1016/j.arthro.2015.10.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [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: 04/27/2015] [Revised: 08/11/2015] [Accepted: 10/27/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate clinical outcomes, rate of recurrence, and complications following distal realignment procedures (Elmslie-Trillat, Maquet, Fulkerson, Roux Goldthwait, and other distal realignment procedures) performed alone or in combination with proximal procedures for the management of patellar dislocation. METHODS A systematic literature review was performed following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A search in PubMed, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, and Google Scholar databases using various combinations of the keywords "patellar," "dislocation," "tibial transfer," "Elmslie-Trillat," "Roux Goldthwait," "tibial tubercle osteotomy," "Fulkerson," "Maquet," "procedure," "clinical," and "outcome." RESULTS Thirty-eight articles were included in the systematic review. A total of 1,182 knees belonging to 1,023 patients were grouped according to the duration of the follow-up period. The overall rate of recurrence was 7% (83 of 1,182 knees). Approximately 5.3% (28 of 520 knees) of the redislocation occurred in the short-medium term, and 8.3% (55 of 662 knees) occurred in the long-term. CONCLUSIONS Distal realignment procedures performed alone or in combination with proximal procedures for the management of patellar dislocation have shown good clinical outcomes and a low rate of recurrence highlighting the efficacy of these procedures. To date no randomized controlled clinical trials are available on the topic. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy.
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Mauro Ciuffreda
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Angelo Baldari
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, England; Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Salerno, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
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van Dijk CN, Longo UG, Loppini M, Florio P, Maltese L, Ciuffreda M, Denaro V. Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc 2016; 24:1200-16. [PMID: 26704800 DOI: 10.1007/s00167-015-3942-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [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: 09/13/2015] [Accepted: 12/09/2015] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of the present study was to perform a systematic review of the current classification systems, and the clinical and radiological tests for the acute isolated syndesmotic injuries to identify the best method of classification and diagnosis allowing the surgeon to choose the appropriate management. METHODS A systematic review of the literature according to the PRISMA guidelines has been performed. A comprehensive search using various combinations of the keywords "classification", "grading system", "ankle injury", "ligament", "syndesmotic injury", "internal fixation", "acute", "synostosis", "ligamentoplasties", "clinical", "radiological" over the years 1962-2015 was performed. The following databases were searched: MEDLINE, Google Scholar, EMBASE and Ovid. RESULTS The literature search resulted in 345 references for classification systems and 308 references for diagnosis methods, of which 283 and 295 were rejected due to off-topic abstract and/or failure to fulfil the inclusion criteria. After reading the remaining full-text articles, we included 27 articles describing classification systems and 13 articles describing diagnostic tests for acute isolated syndesmotic injuries. CONCLUSIONS The ESSKA-AFAS consensus panel recommends distinguishing acute isolated syndesmotic injury as stable or unstable. Stable injuries should be treated non-operatively with a short-leg cast or brace, while unstable injuries should be managed operatively. The recommended clinical tests include: tenderness on palpation over the anterior tibiofibular ligament, the fibular translation test and the Cotton test. Radiographic imaging must include an AP view and a mortise view of the syndesmosis to check the tibiofibular clear space, medial clear space overlap, tibial width and fibular width. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- C Niek van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Pino Florio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Ludovica Maltese
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Mauro Ciuffreda
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
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van Dijk CN, Longo UG, Loppini M, Florio P, Maltese L, Ciuffreda M, Denaro V. Conservative and surgical management of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc 2016; 24:1217-27. [PMID: 26846658 DOI: 10.1007/s00167-016-4017-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 09/13/2015] [Accepted: 01/20/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Correct management of syndesmotic injuries is mandatory to avoid scar tissue impingement, chronic instability, heterotopic ossification, or deformity of the ankle. The aim of the present study was to perform a systematic review of the current treatments of these injuries to identify the best non-surgical and surgical management for patients with acute isolated syndesmotic injuries. METHODS A review of the literature was performed according to the PRISMA guidelines. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases was performed using the following keywords: "ankle injury", "syndesmotic injury", "chronic", "acute", "treatment", "conservative", "non-operative" "operative", "fixation", "osteosynthesis", "screw", "synostosis", "ligamentoplasties" over the years 1962-2015. RESULTS The literature search and cross-referencing resulted in a total of 345 references, of which 283 were rejected due to off-topic abstract and/or failure to fulfil the inclusion criteria. After reading the remaining full-text articles, we included four studies, describing non-surgical management, and only two studies investigating surgical management of acute isolated injuries. CONCLUSIONS The ESSKA-AFAS consensus panel provided recommendations to improve the management of patients with isolated acute syndesmotic injury in clinical practice. Non-surgical management is recommended for stable ankle lesions and includes: 3-week non-weight bearing, a below-the-knee cast, rest and ice, followed by proprioceptive exercises. Surgery is recommended for unstable lesions. Syndesmotic screw is recommended to achieve a temporary fixation of the mortise. Suture-button device can be considered a viable alternative to a positioning screw. Partial weight bearing is allowed 6 weeks after surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- C Niek van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Pino Florio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Ludovica Maltese
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Mauro Ciuffreda
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
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Abstract
PURPOSE To analyze outcomes of surgical and conservative treatment options for multidirectional instability (MDI). METHODS A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. A comprehensive search of the PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar databases using various combinations of the keywords "shoulder," "multidirectional instability," "dislocation," "inferior instability," "capsulorrhaphy," "capsular plication," "capsular shift," "glenoid," "humeral head," "surgery," and "glenohumeral," over the years 1966 to 2014 was performed. RESULTS Twenty-four articles describing patients with open capsular shift, arthroscopic treatment, and conservative or combined management in the setting of atraumatic MDI of the shoulder were included. A total of 861 shoulders in 790 patients was included. The median age was 24.3 years, ranging from 9 to 56 years. The dominant side was involved in 269 (58%) of 468 shoulders, whereas the nondominant side was involved in 199 (42%) shoulders. Patients were assessed at a median follow-up period of 4.2 years (ranging from 9 months to 16 years). Fifty-two of 253 (21%) patients undergoing physiotherapy required surgical intervention for MDI management, whereas the overall occurrence of redislocation was seen in 61 of 608 (10%) shoulders undergoing surgical procedures. The redislocation event occurred in 17 of 226 (7.5%) shoulders with open capsular shift management, in 21 of 268 (7.8%) shoulders with arthroscopic plication management, in 12 of 49 (24.5%) shoulders undergoing arthroscopic thermal shrinkage, and in 11 of 55 (22%) shoulders undergoing arthroscopic laser-assisted capsulorrhaphy. CONCLUSIONS Arthroscopic capsular plication and open capsular shift are the best surgical procedures for treatment of MDI after failure of rehabilitative management. Arthroscopic capsular plication shows results comparable to open capsular shift. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Joel Locher
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Stefan Buchmann
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, London, England; Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Salerno, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
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Longo UG, Loppini M, Petrillo S, Berton A, Maffulli N, Denaro V. Management of cervical fractures in ankylosing spondylitis: anterior, posterior or combined approach? Br Med Bull 2015; 115:57-66. [PMID: 25800241 DOI: 10.1093/bmb/ldv010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2015] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Ankylosing spondylitis (AS) can lead to an increased risk of cervical fractures. SOURCES OF DATA A systematic review was undertaken using the keywords 'ankylosing spondylitis', 'spine fractures', 'cervical fractures', 'surgery' and 'postoperative outcomes' on Medline, Pubmed, Google Scholar, Ovid and Embase, and the quality of the studies included was evaluated according to the Coleman Methodology Score. AREAS OF AGREEMENT Surgery ameliorates neurological function in patients with unstable AS-related cervical fractures. The combined anterior/posterior and the posterior approaches are more effective than the anterior approach. AREAS OF CONTROVERSY The optimal approach, anterior, posterior or combined anterior/posterior, for the management of AS related cervical fractures has not been defined. GROWING POINTS Open reduction and internal fixation allows avoiding worsening and enhances neurological function in AS patients with cervical fractures. AREAS TIMELY FOR DEVELOPING RESEARCH Adequately powered randomized trials with appropriate subjective and objective outcome measures are necessary to reach definitive conclusions.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Stefano Petrillo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Salerno, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
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Longo UG, Loppini M, Margiotti K, Salvatore G, Berton A, Khan WS, Maffulli N, Denaro V. Unravelling the genetic susceptibility to develop ligament and tendon injuries. Curr Stem Cell Res Ther 2015; 10:56-63. [PMID: 25012736 DOI: 10.2174/1574888x09666140710112535] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/19/2014] [Accepted: 07/07/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE In the last decades, new evidences supported the relationship polymorphisms and the susceptibility to develop ligament and tendon injuries. We performed a review of the genetic factors involved in tendon and ligament injuries. METHODS A review of the literature has been performed in a systematic fashion by using the terms "sports", "ligaments", "injuries", "tendon" and "genetics". PubMed, Embase, CINAHL, Cochrane, Medline and Google Scholar databases were screened over the years 1984-2014. RESULTS The genes currently associated with tendon and ligament injuries include gene encoding for collagen, tenascin, matrix metallopeptidase, and growth factors. CONCLUSIONS Tendon and ligament injuries do not have a single genetic cause. Predictive genomics DNA profiling for athletic performance and sport injuries allows to understand what genetic advantages have to be exploited, and which genetic barriers have to be overcome. Although these findings could explain why an individual is able to excel in one sport discipline rather than in a different one, and why an individual develops more injuries than another one, many other factors should be taken into account. Indeed, environment and lifestyle play a critical role in combination with gene profile in determing tendon and ligament injuries.
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Affiliation(s)
| | | | | | | | | | | | | | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
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Garcia D, Longo UG, Vaquero J, Forriol F, Loppini M, Khan WS, Denaro V. Amniotic membrane transplant for articular cartilage repair: an experimental study in sheep. Curr Stem Cell Res Ther 2015; 10:77-83. [PMID: 25012733 DOI: 10.2174/1574888x09666140710120012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 06/23/2014] [Accepted: 07/07/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of the present study was to compare the potential for cartilage repair of fresh amniotic membrane (AM), cryopreserved AM and cryopreserved AM previously cultured with bone marrow mesenchymal stem cells (BM-MSCs) in an in vivo sheep animal model. METHODS A full-thickness cartilage defect was surgically produced in 12 adult sheep, in the bearing region of the lateral femoral condyle. The animals were randomized into 4 groups (n=3): no treatment of the defect (G1); filling with fresh AM (G2); with cryopreserved AM previously cultivated with BM-MSCs (G3); with cryopreserved AM alone (G4). Postoperatively, the full load was possible. At two months, the animals were euthanized. The quality of the new synthesized tissue was evaluated with the macroscopic, by using International Cartilage Repair Society (ICRS) scale, and histological analyses, by using O'Driscoll scale. RESULTS The control samples showed an ICRS grade III (abnormal); while the samples of Groups 2, 3 and 4 reported a grade II (similar to healthy cartilage). The mean value of O'Driscoll scale in the control group (3.3) was significantly lower compared to the treatment groups (G2: 10.7; G3: 8; G4: 11.3) (P <0.05). No significant differences were found between the experimental groups. CONCLUSION AM could be a suitable material for the management of articular cartilage defects. Stem cells within AM demonstrated to be able to differentiate in chondrocytes in vivo. Fresh AM, cryopreserved AM and cryopreserved AM previously cultivated with BM-MSCs showed similar regenerative properties.
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Longo UG, Loppini M, Trovato U, Rizzello G, Maffulli N, Denaro V. No difference between unicompartmental versus total knee arthroplasty for the management of medial osteoarthtritis of the knee in the same patient: a systematic review and pooling data analysis. Br Med Bull 2015; 114:65-73. [PMID: 25743408 DOI: 10.1093/bmb/ldv009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION One-third of patients with knee osteoarthritis (OA) has involvement of only one compartment, especially the medial one. SOURCES OF DATA We performed a comprehensive search of studies comparing unicompartmental knee arthoplasty (UKA) and total knee arthroplasty (TKA) in the same patient on PubMed, OVID/Medline, Cochrane, CINAHL, Google scholar and Embase databases. AREAS OF AGREEMENT UKA is indicated in knee with medial OA, no flexion deformity, no joint instability and no varus deformity. AREAS OF CONTROVERSY Although high tibial osteotomy, UKA and TKA have been proposed to address medial OA of the knee, the best management is still controversial. GROWING POINTS Studies investigating surgical management of medial OA of the knee are increasingly frequent. AREAS TIMELY FOR DEVELOPING RESEARCH Large, multicentre, powered, randomized trials comparing UKA and TKA are needed to identify the best management for medial OA of the knee. Moreover, new score systems for satisfaction of the patient should be formulated.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
| | - Ugo Trovato
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Via Salvador Allende, Baronissi, Salerno 84081, Salerno, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, Rome 00128, Italy
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