Antonio Timoncini

Efficacy of Ultrasound-guided Intra-articular Injections of Platelet-rich Plasma Versus Hyaluronic Acid for Hip Osteoarthritis

Intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) represent efficacious medical treatments for osteoarthritis (OA), although no comparative study on long-term efficacy in hip OA exists. The goals of the current study were to compare the clinical efficacy of PRP vs HA at 12 months of follow-up in patients with hip OA and evaluate the influence of the type of infiltration and patient age, sex, body mass index, and degree of OA on temporal clinical evolution. One hundred patients with chronic unilateral symptomatic hip OA were consecutively enrolled and randomly assigned to 1 of 2 groups: group A received PRP and group B received HA administered via intra-articular ultrasound-guided injections. Patients were evaluated at baseline and after 1, 3, 6, and 12 months using the Harris Hip Score (HHS) and visual analog scale (VAS). An overall improvement was detected in both groups between 1- and 3-month follow-up. Despite a slightly progressive worsening between 6- and 12-month follow-up, the final clinical scores remained higher compared with baseline (P<.0005), with no significant differences between PRP and HA. Regarding clinical temporal evolution, multivariate analysis showed that HHS was not influenced by the type of infiltration, patient age, sex, body mass index, or degree of OA, whereas a significant association was detected between OA grade IV and VAS evolution (P<.0005). Intra-articular injections of PRP are efficacious in terms of functional improvement and pain reduction but are not superior to HA in patients with symptomatic hip OA at 12-month follow-up.

Combined Arthroscopic Treatment of Tibial Plateau and Intercondylar Eminence Avulsion Fractures

Fractures of the tibial plateau represent 1% of all fractures and 8% of fractures in the elderly population1. These fractures represent a surgical challenge because of the variety of fracture patterns and the associated soft-tissue injuries. If not adequately treated, these fractures often cause persistent knee pain, arthritis, and angular deformity. In one study, posttraumatic knee arthritis following a tibial plateau fracture was reported, after a seven-year follow-up, in 74% of patients with an associated meniscal tear and in 34% of patients with intact menisci2. Intercondylar eminence avulsion fractures are relatively uncommon. First described by Poncet in 1875, this injury usually has been considered to be the childhood equivalent of anterior cruciate ligament rupture in adults3. As an isolated injury, these fractures are most frequent in pediatric patients between the ages of eight and fourteen years4-9. These lesions also can occur in adults in association with another periarticular injury or a tibial plateau fracture3,5. In our experience, 19.4% of tibial plateau fractures have been associated with an intercondylar eminence fracture whereas 84.3% of tibial spine fractures in adults have been associated with a tibial plateau fracture (unpublished data). Associated tibial plateau and intercondylar eminence avulsion fractures are complex articular lesions that vary widely from one patient to another, and therefore treatment requires personalized solutions. When determining the best treatment, anatomic joint reconstruction with minimally invasive techniques should be considered. Arthroscopic reduction and internal fixation have demonstrated various advantages over open reduction and internal fixation in terms of surgical morbidity, time of hospital stay, recovery, and complications such as infection and loss of knee motion10-12. The high prevalence of associated intra-articular lesions justifies the use of arthroscopy to evaluate and treat all of …

Three-dimensional implant position and orientation after total knee replacement performed with patient-specific instrumentation systems

Patient‐specific instrumentation systems are entering into clinical practice in total knee replacement, but validation tests have yet to determine the accuracy of replicating computer‐based plans during surgery. We performed a fluoroscopic analysis to assess the final implant location with respect to the corresponding preoperative plan. Forty‐four patients were analyzed after using a patient‐specific system based on CT and MRI. Computer aided design implant models and models of the femur and tibia bone portions, as for the preoperative plans, were provided by the manufacturers. Two orthogonal fluoroscopic images of each knee were taken after surgery for pseudo‐biplane imaging; 3D component locations with respect to the corresponding bones were estimated by a shape‐matching technique. Assuming that the corresponding values at the preoperative plan were equal to zero, discrepancies were taken as an indication of accuracy for the systems. A repeatability test revealed that the technique was reliable within 1 mm and 1°. The maximum discrepancies for all the patients for the femoral component were 5.9 mm in a proximo‐distal direction and 4.2° in flexion. Good matching was found between final implantations and preoperative plans with mean discrepancies smaller than 3.1 mm and 1.9°.

La cinematica femoro-rotulea nell’artroplastica di ginocchio navigata

Despite a large percentage of total knee arthroplasty failures in disorders at the patellofemoral joint, current navigation systems do not track the patella. A new navigated technique has been developed recently, which includes a novel instrumentation. The aim of this study is to report an early experience of intra-operative patellar motion assessment.

Tecnica artroscopica del trapianto di condrociti autologhi nella caviglia

Riassunto Il trattamento delle lesioni osteocondrali della superficie articolare della caviglia rappresenta un problema di estrema attualita per la chirurgia ortopedica. Il trapianto di condrociti autologhi (TCA) si e imposto, negli ultimi anni, come una delle metodiche di elezione nel trattamento di tali difetti. Questo e stato inizialmente impiegato a livello dell’articolazione del ginocchio e solo in un secondo tempo e stato applicato con successo anche a livello dell’articolazione tibiotarsica. Le tecniche descritte in letteratura prevedono un accesso chirurgico artrotomico alla caviglia e la fissazione di un lembo periostale al di sopra del difetto, con successivo riempimento di quest’ultimo con una soluzione liquida contenente condrociti. Con l’avvento di un nuovo scaffold (Hyalograft C), dotato di consistenza solida e proprieta adesive intrinseche, e stata sviluppata una tecnica di TCA per l’articolazione del ginocchio con accesso artroscopico. Gli Autori hanno sviluppato una tecnica di TCA artroscopico per l’articolazione tibiotarsica che si avvale dell’uso di uno scaffold contenente condrociti coltivati ed espansi e di uno strumentario appositamente ideato. Tale tecnica consente di evitare una chirurgia artrotomica riducendo quindi il tasso di morbilita e di complicanze di cui si grava la chirurgia invasiva. La durata dell’intervento e la degenza postoperatoria sono anch’esse ridotte, conducendo dunque a una diminuzione dei costi.

Trattamento artroscopico delle fratture del piatto tibiale

Riassunto Le fratture del piatto tibiale rappresentano i’1% di tutte le fratture. Il trattamento di queste fratture rappresenta una sfida chirurgica a causa della varieta e della complessita dei tipi di frattura e delle lesioni associate dei tessuti molli. Il trattamento incruento e riservato ai casi di frattura stabile con minima scomposizione o riduzione della congruita articolare, oppure in pazienti per i quali l’eta e le condizioni cliniche controindichino altri trattamenti. Il trattamento chirurgico tradizionale consiste nella riduzione artrotomica della frattura con osteosintesi interna. Attualmente pero questo tipo di trattamento e riservato alle fratture complesse pluriframmentarie, mentre in tutti gli altri casi si preferisce la riduzione artroscopica con sintesi percutanea. Il trattamento artroscopico, mini-invasivo, apre nuove frontiere nella riduzione chirurgica delle fratture del piatto tibiale.