Luciano Ceciliani

METAL DETERMINATION IN ORGANIC FLUIDS OF PATIENTS WITH STAINLESS STEEL HIP ARTHROPLASTY

In 20 stainless steel Charnley hip arthroplasties (with a follow-up of 10-13 years) nickel, chromium and manganese levels were measured in blood, plasma and urine by atomic absorption spectrophotometry. Skin patch tests for these metals, and clinical and roentgenographic results of arthroplasty were also assessed. Metal levels in organic fluids were plotted against a control population homogeneous for age, residence and anamnestic conditions with the first, but which had never undergone a prosthesis or other metallic implant surgical procedure. Nickel levels in blood, plasma and urine, manganese levels in blood and urine and chromium levels in plasma were significantly higher in the hip prostheses population. Metal ion release from stainless steel prostheses is discussed with regard to implant failure, metal sensitivity and carcinogenesis.

Metal ions in body fluids after arthroplasty

We measured levels of metal ions in urine and plasma of 17 patients 7-15 years after they had a Co-Cr-Mo alloy total hip replacement. They had higher levels of cobalt and chromium than controls. No case of skin sensitivity to the investigated metals was observed. The values of cobalt and chromium in plasma and urine were considerably lower than in professionally exposed groups and do not represent a toxic hazard for the patients.

Achilles' tendon tendinitis and heel pain

Achilles tendinopathies are one of most common overuse problems seen in athletes. Inflammation or pathologic degeneration of the Achilles tendon itself is one of the causes of heel pain. In those athletes, refractory to nonoperative management, a surgical treatment is indicated in order to increase the likelihood of reaching preinjury activity levels. Circulatory, metabolic, and mechanical factors are involved in the pathogenesis of the alteration of tendons and peritendinous layers. We distinguish clinically, instrumentally (ultrasonography, computed tomography, and magnetic resonance imaging), and histologically the following clinical and anatomopathologic forms of Achilles tendinopathy: acute peritendinitis, chronic peritendinitis, peritendinitis with tendinosis, tendinosis, insertion tendinopathy, and peritendinitis of the entire tendon with insertion tendinopathy. Our experience has resulted in standardization of the surgical techniques used for the different types of Achilles tendinopathy. In chronic peritendinitis, we can adopt different techniques based on the extension of the adhesions and the thickening of the paratenon, removing the shoots and/or the fibrotic rinds of the fascia, the hypertrophic parts of the paratenon except the ventral fibrous shoots. In peritendinitis with tendinosis, and in simple tendinosis, we make the tendon free from fibrotic adhesions and we may remove degenerated nodules. Longitudinal scarifications are performed to re-establish tendon nutrition. Moreover, in order to improve the blood supply in greatly degenerated tendons we propose the placement of muscle tissue (an isolated bundle of soleus) within the tendon. In insertion tendinopathy the inflamed preachilles bursa is removed together with the proximal and lateral-medial outgrowth of bone and cartilage of the posterior border of the calcaneus. The same treatment is reserved to a true Haglund deformity. The smoothened border no longer impinge the tendon insertion. In our opinion is possible to obtain a good clinical result and a resumption of sport at competitive level with a timely and precise surgical treatment.

Evaluation of reimplant total hip prostheses and resection arthroplasty.

Results of reimplanted total hip prostheses and resection arthroplasty were compared. Using the Iowa hip rating scale, the reimplanted prostheses population was rated higher for function, gait, and absence of deformity, however, the resection arthroplasty population rated better in freedom from pain. Radiographic findings in the reimplanted prostheses population included radiolucent lines around the cement, loosening, and cortex bone stock loss. These findings cause concern for the future of these implants. Repair and remodeling of the bone lesions were observed in resection arthroplasties. It was concluded that if healing of infection is achieved or if resection is performed for mechanical failure, the results may be considered permanent.

Failure of the stem in total hip replacement

SummaryThirteen failed stem of Total Hip Replacement were studied: 9 were Charnley THR from an homogeneous series, which gives an incidence of 2.4% of stem fractures with a follow-up of 9–16 years; 4 were Mueller THR. Fatigue fracture of the stem occurred by defective support of the proximal part of the femur, following resorption of the calcar. In all cases reactive tissue to foreign body particles, metal and polyethylene, was found where bone resorption occurred. In Mueller THR wear of the cup produced the large amount of polyethylene particles; in Charnley THR metal particles prevailed and corrosion of the stem is suggested to be the initiating factor.

Pathogenesis of membranous lipodystrophy: case report and review of the literature

Membranous lipodystrophy occurred in a 35-year-old woman and membrane-like material was found in her epiphyses and short bones. Electron microscopy allowed a study of the relationship between the pathologic tissue and normal fat, suggesting that the membrane-like material is derived from degenerated cells. Nucleation of hydroxyapatite crystals was also observed in the membranous material. Because basal ganglia calcifications were demonstrated with the use of computed tomography, brain and bone lesions may be assumed to share the same pathogenesis. Lipid and mucopolysaccharide metabolism was found to be normal.

An epiphyseal giant cell tumor associated with early Paget's disease. A case report.

An epiphyseal giant cell tumor occurred in a 50-year-old woman in the absence of roentgeno-graphic signs of Pagets disease adjacent to the tumor area. Only one case with similar features has been previously reported. Treatment increased bone remodeling changes in the whole femur. Two years later the high bone turnover of the femur was arrested. This case suggests that a giant cell tumor of the epiphysis developed in an early phase of Pagets disease.

Reaction to methylmethacrylate in bone metastases treated by surgical curetting and filling with acrylic cement

SummaryA femur bone metastasis from breast carcinoma was treated by curetting and filling with acrylic cement and osteosynthesis.The histological study of the resected proximal third of the femur five months after surgery shows a thin layer of connective tissue between bone and cement.There are no neoplastic cells in this connective tissue nor in the spongious bone of the proximal femur.Instead the diaphyseal channel is fully invaded with neoplastic cells.Pathogenesis and validity of surgical treatment by the emptying and filling with acrylic cement of bone metastases are discussed.ZusammenfassungEine, von einem Mammacarcinom ausgehende, solitäre, osteolytische Skelettmetastase im Femur führte zur pathologischen Fraktur. Die Osteolysezone wurde auskürettiert, mit autopolymerisierendem Methylmethacrylat aufgefüllt und die Fraktur durch eine zusätzliche Osteosynthese stabilisiert. Fünf Monate nach diesem Eingriff mußte das proximale Femurende wegen Bruches der Osteosyntheseplatte reseziert werden. Die histologische Untersuchung des Resektates ergab eine dünne Schicht von Bindegewebe zwischen Knochenzement und Knochen. Weder in diesem Bindegewebe noch im spongiösen Knochen des proximalen Teiles des Femur fanden sich neoplastische Zellen. Dagegen war der Femurdiaphysenkanal vollkommen von Tumorgewebe ausgefüllt. Die Pathogenese der Knochenmetastase und die Wirksamkeit der chirurgischen Behandlung durch Kürettage und Füllung mit Knochenzement werden diskutiert.