Dario Regis

Preformed acrylic bone cement spacer loaded with antibiotics: Use of two-stage procedure in 10 patients because of infected hips after total replacement

In 10 patients having deep infection after total hip replacement, we used a two-stage revision procedure involving implantation of a preformed spacer with a cylindrical rod coated with acrylic cement containing antibiotics (Spacer-G). This device, which remained in situ for an average of 5 months, permitted healing of the infection in 8 cases and reimplantation of a new prosthesis (mean follow-up 35 months). During treatment, 1 dislocation occurred. The spacer maintained the gap between both bone segments and allowed a certain degree of joint mobility. Use of Spacer-G improved the quality of life of the patients during treatment and accelerated recovery of function after reimplantation.

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.

Metatarsal lengthening by callotasis during the growth phase

Congenital or acquired shortness of a metatarsal may cause pain in adjacent metatarsals. From 1983 to 1990, we performed nine metatarsal lengthenings in seven adolescent patients by metaphyseal osteotomy followed by gradual distraction of callus (callotasis). Two patients required bone grafts after the lengthening. We used a rigid, unilateral external fixator designed for use in the hand and foot. At follow-up, from three to ten years later, healing had been achieved in all with an average healing index of 50 days/cm, and metatarsalgia had been relieved by the restoration of correct metatarsal length.

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.

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.

Clinical and radiologic outcomes of total knee arthroplasty using the Advance Medial Pivot prosthesis. A mean 7 years follow-up

BACKGROUND Medial Pivot total knee prosthesis has been designed according to studies on normal knee kinematics aiming to replicate physiological knee movement. The purpose of this study was to evaluate clinical and radiologic results of the Advance Medial Pivot Total Knee Arthroplasty, at a mean follow-up of seven years. METHODS One hundred seventy two Medial Pivot total knee arthroplasties in 160 consecutive patients have been evaluated using the American Knee Society Score and the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Statistical analysis was performed using the Students t-test and the Wilcoxon matched-pairs signed-rank (Mann-Whitney) test in order to evaluate the significance of differences within the groups of patients. Patients compliance was 93.75% thus only six patients (3.75%) lost to follow-up and four patients (2.5%) died for reasons unrelated to the surgery. RESULTS The mean Knee Society score and range of motion was improved from 77.6 points and 97.7° to 152.8 points and 112.5° respectively (p<.001). In total 85.8% and 82.4% of the knees had an excellent (≥ 80) or good (70-79) functional and knee scores respectively. Relief of pain was satisfactory in 88.9% of the patients, while 96% of the patients return to age-related daily life activities. Stability and comfort during walking was subjectively judged by the patients as satisfactory in about 90%. Anterior knee pain was observed in eight patients (5.4%). The Kaplan-Meier survivorship analysis showed a cumulative success rate of 98.6%. CONCLUSIONS The results are encouraging but longer follow-up of this cohort is necessary in the study of this specific design. Level of evidence IV.

Evaluation of cardiac involvement following major orthopedic surgery

Abstract Background: Cardiovascular morbidity is frequent after non-cardiac surgery and the early recognition of cardiac involvement is an essential tool for clinical risk stratification and management. The aim of this study was to investigate the behavior of traditional and emerging cardiac markers, including NT-prohormone-brain natriuretic peptide (NT-proBNP) and ischemia-modified albumin (IMA), in the perioperative period in patients undergoing major uncomplicated orthopedic surgery. Methods: A total of 37 patients undergoing major orthopedic surgery were longitudinally evaluated for NT-proBNP, IMA, cardiac troponin T (cTnT), creatine kinase isoenzyme MB and myoglobin 3h before surgery and 4 and 72h thereafter. Results: NT-proBNP values were significantly increased at 72h postoperative compared to both 3h preoperative and 4h postoperative (NT-proBNP: 20 vs. 4.5pmol/L, p<0.001 and 20 vs. 5.9pmol/L, p<0.001). IMA levels were significantly increased at 4 and 72h postoperative vs. 3h preoperative (132 vs. 113kU/L, p=0.02 and 151 vs. 113kU/L, p<0.001). In a stepwise regression model, the perioperative liquid amount and degree of modification in postoperative creatinine levels (delta-creatinine) were independently related to the NT-proBNP increase. Conclusions: The significant increase observed in NT-proBNP suggests that patients undergoing major uncomplicated orthopedic surgery may develop subclinical cardiac stress, presumably attributable to the considerable infusion of liquids. The clinical significance of this finding deserves further investigation, especially in patients at higher risk of heart failure. Clin Chem Med Lab 2006;44:1340–6.

Recombinant human erythropoietin facilitates autologous blood collections in children undergoing corrective spinal surgery

We did not discuss the chimeric complex in our original report 1 because it was not possible to test all family members. Therefore, we can provide some additional data in response to Denomme’s questions but a few cannot be answered clearly. Two Y-chromosome-specific variants of the amelogenin system 2 were detected in the twin sister, indicating the presence of “male” white blood cells in her Blackwell Science, LtdOxford, UKTRFTransfusion0041-11322004 American Association of Blood BanksJuly 2004447••••Letters to the Editor LETTERS TO THE EDITORLETTERS TO THE EDITOR

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.