Andrea Sandri

Long-Term Results of Anti-Protrusio Cage and Massive Allografts for the Management of Periprosthetic Acetabular Bone Loss

From 1992 to 1995, 71 total hip arthroplasties with extensive acetabular bone loss underwent revision using bulk allografts and Burch-Schneider anti-protrusion cages. Twelve patients died of unrelated causes and 3 were lost to follow-up. Fifty-six hips were available for clinical and radiographic follow-up examination at an average of 11.7 years after surgery. The average final Harris hip score was 75. X-ray signs of incorporation of massive bone graft were observed in 49 hips. Two cases developed deep infection that required resection arthroplasty. Aseptic loosening of the acetabular cage occurred in 5 patients, and 2 of them underwent re-revision. With a total survival rate of 87.5%, anti-protrusion cages and structural allografts compare favorably with other techniques in the long-term reconstructive treatment of extensive loss of acetabular bone stock.

A Minimum of 10-Year Follow-Up of the Burch-Schneider Cage and Bulk Allografts for the Revision of Pelvic Discontinuity

Eighteen consecutive hips with pelvic discontinuity and associated periprosthetic bone deficiency were treated with bulk allografts and Burch-Schneider antiprotrusio cage. Clinical and radiographic follow-up was performed at an average of 13.5 (range, 10.5-16.6) years. Three cages required re-revision because of infection (1) and aseptic loosening (2). Average Harris hip score improved from 31.9 to 77.0 points (P < .001). A severe resorption of the bone graft occurred in 2 hips. The stability of the cage was detected in 13 cases. The cumulative survival rate at 16.6 years with acetabular revision for any reason, radiographic loosening, or unhealing of the discontinuity as the end point was 72.2%. The use of Burch-Schneider cage and bulk allografts is an effective technique for the treatment of pelvic discontinuity.

One-stage Posterior Decompression-Stabilization and Trans-sacral Interbody Fusion after Partial Reduction for Severe L5-S1 Spondylolisthesis

Study Design. A retrospective clinical study was conducted. Objectives. To evaluate the clinical and radiologic outcomes of one-stage posterior decompression-stabilization after partial reduction and trans-sacral interbody fusion with a titanium cage for severe L5–S1 spondylolisthesis. Summary of the Background Data. Trans-sacral interbody fusion for the management of severe L5–S1 spondylolisthesis with or without partial reduction and pedicular fixation has been previously described. The use of a trans-sacral titanium cage has not been previously reported. Methods. Fifteen patients with severe L5–S1 spondylolisthesis were treated consecutively with posterior decompression, partial reduction, pedicular fixation, and posterior lumbar interbody fusion using a trans-sacral titanium cage. The mean age at the time of surgery was 22.4 years (range, 11–37 years). The mean follow-up period was 31.4 months (range, 12–58 months). Nine patients had severe back pain and six patients radicular pain. Three patients had a partial unilateral L5 motor deficit and two an L5 sensory deficit. Five patients had extremely tight hamstrings. The mean preoperative percentage of slipping was 69.3% (range, 53–91%). Patients were evaluated for complications and fusions, and outcomes were collected using the modified Scoliosis Research Society Outcomes Instrument. Results. At follow-up, all patients, except one with major vascular complications, were extremely or reasonably satisfied with the surgery. All patients showed improvements in radiologic indexes and stable fusion at the final follow-up examination. Conclusions. Posterior decompression and partial reduction followed by circumferential stabilization performed in one stage combining pedicle fixation with trans-sacral titanium cage interbody fusion is an effective and safe technique for the management of severe spondylolisthesis.

Leap Motion Gesture Control With OsiriX in the Operating Room to Control Imaging: First Experiences During Live Surgery

Dear Editor, We would like to present our first experiences with the use of an innovative system to control the imaging in the operation room, the Leap Motion gesture control and OsiriX. Touch-free systems are useful where the contact between the surgeon and computer is disadvantageous; in the operating room a touch-less system is an ideal solution. These solutions reduce surgery time, minimize the risk of infections (in some hospitals, PC monitors are located on the wall and the surgeon must leave the operating table to go there). During surgery, changing gloves each time the computer system has to be operated interrupts the workflow and can result in longer surgery times with higher risk for the patient and higher costs. A Swiss group presented a good prototype: they use Orisix and Microsoft Kinect to perform the touch-free control in the operation room and during autopsy. This solution, in our opinion, can neither be placed on the market nor in operation rooms. The vocal control had several limitations, the Kinect is quite expensive, intraoperative 3-dimensional (3D) imaging was difficult to control, and the working distance of ~1.2 m required a screen of appropriate size. They concluded by suggesting that using more advanced methods, such as recognition of finger gestures, could solve these problems.

Video in Operating Room GoPro HERO3 Camera on Surgeon’s Head to Film Operations—A Test

Dear Editor, I would like to present the good results of a simple and small commercial camera (GoPro HERO3 Silver Edition) situated on a surgeon’s head to film operations. Not all hospitals provide an imaging service in the operating room, so a personal device is often necessary. Technologies help us with many devices (cameras, smartphones, and tablets), each one with different characteristics. We chose this camera because it’s one of the most popular and smallest extreme cameras used by common people, is easy to find in shops, and is economically reasonable. Taking videos during surgery has some difficulties: the surgeon must work with a body position that allows a good video point-of-view and an additional person around the patient’s body is usually necessary to film, increasing the risk of infections. Pictures and videos during surgical operations are useful to document lesions or local conditions or to film surgical procedures. Sometimes imaging is necessary for legal reasons (Black Box), the education of students, or personal use.

Three-Dimensional Printing of Bone Fractures: A New Tangible Realistic Way for Preoperative Planning and Education.

Dear Editor: We would like to present the first report in the literature of the use of 3-dimensional (3D) printed models of bone fractures. Actually, X-rays and computed tomography (CT) are used today to evaluate bone fractures. Understanding the dislocation of fragments, the amount of displacement, and the joint involvement is necessary for a successful treatment. Three-dimensional printing is a new low-cost technology that uses a 3D computer representation to create solid objects; 3D-printed models for orthopedic conditions can improve understanding of anatomy and pathology by means of tactile and visual experience to complement images displayed on a computer monitor.

Release of Gentamicin and Vancomycin from Preformed Spacers in Infected Total Hip Arthroplasties: Measurement of Concentrations and Inhibitory Activity in Patients’ Drainage Fluids and Serum

Gentamicin (G) and vancomycin (V) concentrations in drainage fluids obtained from patients during the first 24 hours after implantation of antibiotic-loaded polymethylmethacrylate (PMMA) spacers in two-stage revision of infected total hip arthroplasty were studied. The inhibitory activity of drainage fluids against different multiresistant clinical isolates was investigated as well. Seven hips were treated by implantation of industrial G-loaded spacers. Vancomycin was added by manually mixing with PMMA bone cement. Serum and drainage fluid samples were collected 1, 4, and 24 hours after spacer implantation. Antibiotics concentrations and drains bactericidal titer of combination were determined against multiresistant staphylococcal strains. The release of G and V from PMMA cement at the site of infection was prompt and effective. Serum levels were below the limit of detection. The local release kinetics of G and V from PMMA cement was similar, exerting a pronounced, combined inhibitory effect in the implant site. The inhibitory activity of drainage fluids showed substantial intersubject variability related to antibiotic concentrations and differed according to the pathogens tested. Gentamicin and vancomycin were released from temporary hip spacers at bactericidal concentrations, and their use in combination exerted strong inhibition against methicillin-resistant S. aureus and Coagulase Negative Staphylococci strains.

Combined radiofrequency and kyphoplasty in painful osteolytic metastases to vertebral bodies

PurposeThe aim of this study was to assess retrospectively the safety and efficacy of combined radiofrequency (RF) and kyphoplasty (KP) in managing painful osteolytic metastases to vertebral bodies resistant to conservative treatments.Materials and methodsEleven patients (9 women and 2 men; mean age 68 years; age range 58–82) with painful osteolytic vertebral body metastases unresponsive to conservative treatments underwent RF combined with KP under general anaesthesia. Primary neoplasms were kidney carcinoma (n=1), breast carcinoma (n=1), thyroid carcinoma (n=2) and multiple myeloma (n=7). Lesion levels were cervical (n=1), thoracic (n=9) and lumbar (n=1). Combined RF and KP was well-tolerated by all patients. The procedures were performed using fluoroscopic guidance and intraoperative neurophysiology monitoring. Pain relief with the visual analogue scale (VAS) pain score and analgaesic consumption were evaluated before and after treatment.ResultsNo complication occurred. In one case, we observed an asymptomatic cement leakage. Pain significantly decreased after treatment: the mean VAS pain score before treatment was 8 (range 7–10) vs. 1.8 (range 0–3) and 1.9 (range 1–3), respectively, 72 h and 6 weeks after the treatment. Analgaesic reduction was achieved in all patients.ConclusionsRF combined with KP represents a potential alternative method for palliation of painful spinal osteolytic metastases in selected patients. The procedures are safe and provide pain relief with bone augmentation and improvement in quality of life.RiassuntoObiettivoScopo di questo studio è stato valutare retrospettivamente la sicurezza e l’efficacia dell’utilizzo combinato di radiofrequenza (RF) e cifoplastica (CP) per il trattamento del dolore correlato a lesioni osteolitiche metastatiche del corpo vertebrale resistente ai trattamenti conservativi standard.Materiali e metodiUndici pazienti (9 donne e 2 uomini), con età media di 68 anni (range 58–82), affetti da metastasi osteolitiche del soma vertebrale associate a dolore resistente ai trattamenti conservativi standard, sono stati sottoposti all’utilizzo combinato di RF e CP in anestesia generale. Le neoplasie primitive erano di origine renale (n=1), mammaria (n=1), tiroidea (n=2), e mielomatosa (n=7). Il livello della lesione era cervicale (n=1), toracico (n=9) e lombare (n=1). La procedura combinata di RF e CP è stata ben tollerata da tutti i pazienti. Le procedure sono state eseguite con l’ausilio dell’amplificatore di brillanza e del monitoraggio neurofisiologico intraoperatorio. La riduzione del dolore, considerata secondo la scala analogica del dolore (VAS), e l’assunzione di farmaci analgesici, sono stati valutati prima del trattamento, dopo 72 ore e a 6 settimane dalla procedura.RisultatiNon si sono verificate complicazioni. Il dolore è significativamente diminuito dopo il trattamento: il valore medio era di 8 (range 7–10) prima del trattamento, passando a 1,8 (range 0–3) 72 ore dopo il trattamento e quindi a 1,9 (range 1–3) a 6 settimane dalla procedura. La riduzione nell’assunzione di farmaci analgesici è stata documentata in tutti i pazienti.ConclusioniL’utilizzo combinato di RF e CP rappresenta una potenziale alternativa di trattamento palliativo per le lesioni osteolitiche metastatiche del corpo vertebrale in pazienti selezionati. La procedura si dimostra sicura, permettendo di ottenere una significativa riduzione del dolore, un effetto di stabilizzazione del corpo vertebrale ed un miglioramento della qualità di vita.

Delayed Diagnosis of Low-symptomatic Ceramic Acetabular Liner Fracture in Ceramic-on-Ceramic Total Hip Arthroplasty

Alumina ceramics in total hip arthroplasty (THA) have been used in Europe since 1970. Over the years, ceramic-on-ceramic coupling became a valid option in THA because of excellent biocompatibility and tribological properties. The major disadvantages are possible squeaking and risk of breakage, usually disclosed by pain and functional impairment. Squeaking is an audible noise arising from ceramic-on-ceramic bearings, the incidence of which is reported to range from 1% to 7% of THAs. Component positioning, stripe wear, and edge loading have all been implicated. Clicking sounds and scratching have also been anecdotally described. Breakage of a ceramic component due to brittleness of the material is a rare complication. Trauma, high activity level, and obesity may increase the risk of fracture. Defective ceramic manufacture, inadequate implant design, and errors in surgical technique may contribute to breakage. Asian population lifestyle, including squatting, kneeling, and sitting cross-legged, has been correlated to liner rim impingement and fracture. Additional reports concerning failure of various ceramic liners have recently been described.

Acetabular reconstruction with the Burch-Schneider antiprotrusio cage and bulk allografts: minimum 10-year follow-up results.

Reconstruction of severe pelvic bone loss is a challenging problem in hip revision surgery. Between January 1992 and December 2000, 97 hips with periprosthetic osteolysis underwent acetabular revision using bulk allografts and the Burch-Schneider antiprotrusio cage (APC). Twenty-nine patients (32 implants) died for unrelated causes without additional surgery. Sixty-five hips were available for clinical and radiographic assessment at an average follow-up of 14.6 years (range, 10.0 to 18.9 years). There were 16 male and 49 female patients, aged from 29 to 83 (median, 60 years), with Paprosky IIIA (27 cases) and IIIB (38 cases) acetabular bone defects. Nine cages required rerevision because of infection (3), aseptic loosening (5), and flange breakage (1). The average Harris hip score improved from 33.1 points preoperatively to 75.6 points at follow-up (P < 0.001). Radiographically, graft incorporation and cage stability were detected in 48 and 52 hips, respectively. The cumulative survival rates at 18.9 years with removal for any reason or X-ray migration of the cage and aseptic or radiographic loosening as the end points were 80.0% and 84.6%, respectively. The use of the Burch-Schneider APC and massive allografts is an effective technique for the reconstructive treatment of extensive acetabular bone loss with long-lasting survival.