Marco Villano

Total knee arthroplasty after complex tibial plateau fractures

Total knee arthroplasty following complex fractures of the tibial plateau is considered a challenge for orthopaedic surgeons and clinical outcomes may vary. A total of 29 total knee replacements were performed after a tibial plateau fracture: 25 patients (16 women, 9 men; average age: 57 years; mean follow-up: 92 months) were available. We had two significative complications: one partial avulsion of the patellar tendon, conservatively treated by bracing, and one case of deep venous thromboembolism, managed with low molecular weight heparin. In two cases (8%) there was a failure of the implant; nine cases were excellent, nine good, four fair and one poor. A percentage of patients with previous complex proximal tibia fractures had an increased rate of postoperative complications due to anatomical deformity, functional deficiency and post-traumatic arthritis and required solutions similar to revision surgery. Total knee arthroplasty is a suitable solution for the treatment of these challenging cases: compared to primary knee replacement, final KSS score is generally lower, but improvement is similar due to poorer pre-operative scores.

Joint line position in revision total knee arthroplasty: the role of posterior femoral off-set stems

BACKGROUND Elevation of the joint line frequently occurs in revision total knee arthroplasty (RTKA) because of a wider flexion space than extension space. One solution to balance this flexion-extension space involves the introduction of couplers between the stem and femoral components, and the use of posteriorly offset femoral stems that we hypothesized would improve gap balancing and facilitate joint line restoration. METHODS We retrospectively reviewed a selected series of 43 RTKA. Postoperative joint line height was subtracted from intended height using postoperative lateral radiographs. The value was negative if the joint line position was lowered, and positive if raised. RESULTS Forty knees were followed for a mean of 3.5years. Mean postoperative joint line position change from intended position was 1.5mm (range -2.5-7.5mm). In 28 knees (70%), the joint line position was restored to within ±2mm of the intended position; in eight knees (20%), from 2-4mm; and in four knees (10%), >4mm. Joint line position was raised in 32 knees (80%) and lowered in eight (20%). In the offset stem knees, the intended joint line position was 0.9mm (range -1.2-3.4mm) as compared with 3.2mm (range -2.5-7.5mm) for the straight stem knees. CONCLUSIONS A coupler system between the femoral stem and femoral component restored the joint line in 70% of cases. The posterior offset stem provided increased posterior condylar offset, addressed the wider flexion space, provided better positioning of the stem, and restored the joint line. LEVEL OF EVIDENCE Therapeutic Study Level IV.

Surgical treatment of a complete symptomatic ossification of quadratus femoris muscle in a young haemophilic patient

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Planning for minimally invasive unicompartmental knee arthroplasty

Unicompartmental knee arthroplasty (UKA) is considered the treatment of choice in patients with single compartment arthritis of the knee at early stages or with osteonecrosis limited to one compartment. However, results in the literature are still controversial and it is a technically difficult procedure. The main goal of UKA is to restore the articular space of the afflicted compartment, without influencing the limb alignment. Selection of patients and pre-operative planning are crucial. The necessity to improve functional results and to reduce immobilization of the patients has led to the development of minimally invasive surgery. Applied to UKA, this approach reduces blood loss and surgical time, causes fewer symptomatic postoperative complications, and permits earlier recovery compared to the traditional incision. The shorter incision makes careful pre-operative planning essential. We briefly review the indications for UKA, the pre-operative clinical and radiological assessment, and the surgical procedure.

La chirurgia mini-invasiva nelle protesi totali di ginocchio

L’applicazione della chirurgia mini-invasiva (MIS) alla protesi totale di ginocchio costituisce una tendenza non eludibile nel momento in cui la opportunita di conservare quanto piu possibile le strutture anatomiche, ampiamente accettata concettualmente, si stia affermando anche nel riscontro clinico.

The Rationale of a Porous Tantalum Implant in the Treatment of Early Stages of Avascular Necrosis of the Femoral Head

The natural history of symptomatic osteonecrosis of the femoral head is a relentless progression to collapse and eventually incongruity of the joint. Several forms of intervention have been advocated for the treatment of the early stages of avascular necrosis of the femoral head [1–6].