Luigi Sabatini

Patellofemoral Joint Arthroplasty: Our Experience in Isolated Patellofemoral and Bicompartmental Arthritic Knees

Introduction Isolated patellofemoral (PF) arthritis is rare, and there is no complete agreement about the best surgical treatment. The operative treatments are total knee arthroplasty and patellofemoral replacement (PFR). The incidence of many early complications of PF arthroplasty has decreased with the introduction of newer designs. Nowadays, the main cause of revision surgery is the progression of tibiofemoral osteoarthritis. In the past, PF arthroplasty was contraindicated in patients with evidence of osteoarthritis or pain in medial or lateral tibiofemoral compartments. The improvement in implant designs and surgical techniques has allowed the addition of a monocompartmental arthroplasty for the medial or lateral tibiofemoral compartment. In this work, we evaluate our first experience with PF arthroplasty and its combination with unicompartmental knee arthroplasty. Materials and Methods From May 2014 to March 2016, we treated 14 patients. An isolated PF arthroplasty was performed in six knees (five patients), and a combined PF and unicompartmental knee arthroplasty was performed in nine cases. We observed a significant improvement in the clinical and functional Knee Society Scores (KSSs) after surgery in our patients. Results We obtained good results in our cases both for clinical and functional KSSs. Patellar clunk was recorded in one case. Discussion and Conclusion We are going toward a new attitude in which partial osteoarthritic changes could be treated with partial resurfacing prosthetic solutions such as unicompartmental, bi–unicompartmental or PFR alone, or unicompartmental combined, which respects the cruciates and achieves maximal bone preservation, which is vital, particularly, for young patients.

Medial pivot knee in primary total knee arthroplasty

Total knee arthroplasty (TKA) with a medial pivot design was developed in order to mimic normal knee kinematics; the highly congruent medial compartment implant should improve clinical results and decrease contact stresses. Clinical and radiographic mid-term outcomes are satisfactory, but we need other studies to evaluate long-term results and indications for unusual cases.

Cementless total knee arthroplasty.

Interest for uncemented total knee arthroplasty (TKA) has greatly increased in recent years. This technique, less used than cemented knee replacement in the last decades, sees a revival thanks an advance in prosthetic design, instrumentation and operative technique. The related literature in some cases shows conflicting data on survival and on the revisions rate, but in most cases a success rate comparable to cemented TKA is reported. The optimal fixation in TKA is a subject of debate with the majority of surgeons favouring cemented fixation.

Topical intra-articular and intravenous tranexamic acid to reduce blood loss in total knee arthroplasty

Different blood loss prevention protocols have been adopted after total knee replacement (TKR) because bleeding is a major complication of TKR and transfusions is frequently required. Increased bleeding has been associated with delayed recovery, increased complications, increased costs and decreased patient satisfaction.

Medial Pivot in Total Knee Arthroplasty: Literature Review and Our First Experience:

Background: Traditional total knee implants designs, usually, are not able to reproduce the physiological kinematics of the knee, leaving almost 20% of the patients, those who underwent a total knee arthroplasty (TKA), not fully satisfied. Modern inserts are nowadays designed with a fully congruent medial compartment to reproduce the normal medial pivoting biomechanics of the knee. The aim of this article was to evaluate preliminary clinical improvement using the Medial Congruent (MC) insert as specific level of constraint. Materials and methods: A total of 10 consecutive patients have been enrolled in this study and treated using an MC tibial polyethylene insert. The Oxford Knee Score (OKS) and the Knee Society Score (KSS) have been assessed preoperatively and at 3-month, 6-month, and 1-year follow-up (FU) and used as validated measurements to evaluate early clinical improvements. Postoperative radiological examination was reviewed looking for radiolucent lines or loosening of the components. Results: Average improvement in OKS was from 19.5 to 41.2, whereas KSS improved with an average score from 64.7 preoperatively to 167.5 at the final FU showing good to excellent results in 95% of the treated knees. Evaluating the range of motion, the average maximum active movement was 124° and none of the patients needing for a revision surgery or manipulation under anesthesia. No complications were observed at the final FU as septic or aseptic loosening or vascular or neurologic injury. Discussion and conclusions: Medial Congruent insert showed good to excellent clinical results at 1-year FU. Range of motion and subjective outcomes were satisfying and comparable with results obtained in literature using traditional TKA design.

Static antibiotic spacers augmented by calcium sulphate impregnated beads in revision TKA: Surgical technique and review of literature

Periprosthetic joint infection (PJI) is a serious complication in total knee arthroplasty (TKA) and represents one of the most common causes of revision. The challenge for surgeons treating an infected TKA is to quickly obtain an infection-free joint in order to re-implant, when possible, a new TKA. Recent literature confirms the role of local antibiotic-loaded beads as a strong bactericidal, allowing higher antibiotic elution when compared with antibiotic loaded spacers only. Unfortunately, classical Polymethylmethacrylate (PMMA) beads might allow bacteria adhesion, secondary development of antibiotic resistance and eventually surgical removal once antibiotics have eluted. This article describes a novel surgical technique using static, custom-made antibiotic loaded spacers augmented by calcium sulphate antibiotic-impregnated beads to improve the success rate of revision TKA in a setting of PJI. The use of calcium sulphate beads has several potential benefits, including a longer sustained local antibiotic release when compared with classical PMMA beads and, being resorbable, not requiring accessory surgical interventions.

Gestione delle complicanze dell’apparato estensore nella chirurgia protesica di ginocchio

The management of the patella and knee extensor mechanism failure are serious problems when performing a revision of a total knee arthroplasty. Extensor mechanism failure prevalence is not trascurable, it is more commonly observed as first implant surgery complication and also as a chronic pathology with the patellar tendon often involved. In revision surgery, to replace patella is not difficult if native, then replaced patella can be left in aseptic revision or can be changed in two stage operation; problems in this case depend on residue bone stock. Knee extensor mechanism reconstruction can be performed using allogenic either or synthetic grafts. In this work, we list problems and solutions that can arise in the management of patella and when extensor mechanism lesion is diagnosticated.

Protesi totali di ginocchio vincolate

Rotating-hinge knee implants are used for revision total knee arthroplasty in patients with severe ligament instability and bone loss. They have been available since the 1970s as an improvement of fixed-hinge models. At present, hinged implants are generally used for revision total knee arthroplasty (TKA). They can also be used for primary TKA, but some authors suggest that this type of prosthesis is associated with a greater risk of aseptic loosening because of increased stress to the bone-prosthesis interface.We analysed our experience regarding these kinds of implants. We performed one study on a group of Endo-modell (Lima) and another study on Nexgen RHK (Zimmer) as revision implants. We also performed a study on a group of Endo-modell used as primary implants.Rotating-hinge knee implants provided acceptable mid-term outcomes for revision knee surgery with ligamentous instability. The HSS-KS results showed statistically significant improvements from the preoperative to the postoperative evaluations, average ROM increased and average pain was lower than in the preoperative status.Usually, the high percentage of failure is related to surgery complexity and to patient status rather than to the hinged mechanism. The use of this implant is recommended for revision total knee arthroplasty, especially in patients with severe instability and bone loss. In the group of RHK for primary implant, the overall failure rate was higher than that of unhinged implants; therefore, this prosthesis is recommended for cases of instability and revision rather than primary knee arthroplasty.

Controversies in treatment of early osteoarthritis of the knee

Osteoarthritis of the knee (knee OA) is a common disease with a relatively high prevalence and incidence among middle-old population and it is one of the main causes of walking-related disability in older adults. Early knee OA is an important issue nowadays since many younger patients struggle with the disabling effect of pain too and treatments are extremely varied. Such condition is characterized by cartilage loss, subchondral bone changes, synovial inflammation and meniscal degeneration. Notions about early OA changed greatly over the past few decades thanks to the use of MRI and ultrasound (allowing direct visualization of lesions and the early detection of pre-radiographic structural changes) and the widespread use of arthroscopy that permits direct visualization not only of the peri-articular bone but also of the cartilage, menisci, synovial membrane, ligaments and fat pad.

Bicompartmental knee arthroplasty

Total knee arthroplasty (TKA) is the most worldwide practiced surgery for knee osteoarthritis and its efficacy is mightily described by literature. Concerns about the invasiveness of TKA let the introduction of segmental resurfacing of the joint for younger patients with localized osteoarthritis. Bone stock sparing and ligaments preservation are the essence of both unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BKA). Advantages related to BKA are the respect of knee biomechanics, lower complications rates, shorter hospital stay, faster rehabilitation. Moreover, in case of failure of the first implant the conversion to TKA is undemanding and can be compared to a standard prosthesis. Our experience suggest that BKA is a reliable technique in selected cases and especially younger people with higher functional requests can favourably profit from it. Although those results are encouraging, we still need further prospective, randomized, long-term studies to finally assess BKA indications and outcomes.