Maria Teresa Miscione

Total hip arthroplasty in developmental hip dysplasia using cementless tapered stem. Results after a minimum 10-year follow-up.

Acetabular and femoral abnormalities make total hip arthroplasty in developmental hip dysplasia a challenging procedure. We present details of long-term follow-up of a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using a cementless tapered stem. Thirty-five hips in 20 patients (18 women and 2 men) aged between 44 and 60 years (mean 51 years) were observed. Clinical evaluation was conducted using the Harris Hip Score (HHS). Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowes classification, 25 hips had grade 2 and 10 hips grade 3 dysplasia. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis™). After surgery the patients were clinically and radiographically evaluated at 1, 2, 3, 6 and 12 months and annually thereafter. The average follow-up was 12 years (range 10–14 years). The average HHS was 57±7 (range 45–66) preoperatively, 90±7 (range 81–100) 12 months after surgery and 90±6 (range 83–100) at last follow-up. Radiographic evaluation demonstrated excellent osseointegration of the implants in most cases. Signs of bone resorption were present in 5 hips, but no evidence of loosening was observed and none of the implants have been revised. The tapered stem achieved adequate stability and orientation, and may be a suitable option for total hip arthroplasty for arthritis following developmental hip dysplasia.

Kinematics of the three components of a total ankle replacement: in vivo fluoroscopic analysis.

Background: Careful kinematic analysis of ankle joints with newly developed prostheses should be carried out to assess the actual performance in vivo. This study analyzed the pattern of motion of the three components of a ligament-compatible ankle replacement, developed to replicate normal joint kinematics. Materials and Methods Twelve patients treated with this design were analyzed at 6, 12, and 24 months followup. A series of images were acquired by videofluoroscopy at extremes of the range of motion, and during flexion/extension against gravity and stair-climbing/descending. Three-dimensional positions and orientations of the tibial and talar metal components and of the polyethylene mobile-bearing were obtained from the images by a standard shape-matching procedure. Motion between the three components was calculated and descriptively analyzed. Results Large tibiotalar joint mobility of the replaced ankle was observed in all three anatomical planes, particularly in the sagittal. In flexion/extension against gravity, the mean range of flexion was 17.6, 17.7, and 16.2 degrees, respectively, over the three followups. The inclination angle of the mean axis of joint rotation was 3.7 degrees down and lateral in the frontal plane and 4.7 degrees posterior and lateral in the transverse plane, similar to those in the normal ankle. The corresponding antero-posterior translation of the meniscal-bearing with respect to the tibia was 3.3, 3.3, and 3.2 mm, with statistically significant correlation with joint flexion. Conclusion Physiological motion can be achieved in ligament-compatible ankle joint replacements. The considerable antero-posterior bearing-to-tibial motion and its coupling with flexion support the main original claims of this design. Level of Evidence: IV, Case Series

Single level cervical fusion by an anterior approach using autologous bone graft influences the adjacent levels degenerative changes: clinical and radiographic results at 10-year minimum follow-up

IntroductionCervical degenerative pathology can produce pain and disability and, in case of failure of conservative treatment surgery is indicated.Materials and methods107 patients affected by single level cervical degenerative pathology were surgically treated by Cloward procedure. On radiographs, the sagittal segmental alignment (SSA) of the affected level and sagittal alignment of the cervical spine were measured.Results Preoperatively, mean SSA was 0.6° and at the last follow-up 1.8°. In particular, adjacent-level degeneration occurred more frequently in Group A than in Group B.Conclusion Lordotic SSA angle can be considered a protective factor against adjacent-level degeneration.

Body Composition, Muscle Strength, and Physical Function of Patients with Bethlem Myopathy and Ullrich Congenital Muscular Dystrophy

Objective. To determine the contributions of body mass, adiposity, and muscularity to physical function and muscle strength in adult patients with Bethlem myopathy (BM) and Ullrich congenital muscular dystrophy (UCMD). Materials and Methods. Evaluation involved one UCMD and 7 BM patients. Body composition was determined by body mass index (BMI) and dual-energy-X-ray-absorptiometry (DXA), muscle strength by dynamometry, physical function by the distance walked in 6 minutes (6MWD), forced vital capacity (FVC) by a spirometer. Results. Six participants were of normal weight and 2 overweight based on BMI; all were sarcopenic based on appendicular fat free mass index (AFFMI); and 7 were sarcopenic obese based on AFFMI and % fat mass. Average muscle strength was reduced below 50% of normal. The 6MWD was in BM patients 30% less than normal. FVC was reduced in 4 of the BM patients. Muscle strength had a good correlation with the physical function variables. Correlation between muscle strength and BMI was poor; it was very high with AFFMI. AFFMI was the best single explicator of muscle strength and physical function. Conclusion. Muscle mass determined by DXA explains most of the variability of the measures of muscle strength and physical function in patients with BM and UCMD.

Surgical treatment of symptomatic degenerative lumbar spondylolisthesis by decompression and instrumented fusion

Degenerative spondylolisthesis is characterized by the slippage of one vertebral body over the one below, with association of intervertebral disc degeneration and degenerative arthritis of the facet joints, which cause spinal stenosis. The aim of this study was to evaluate the clinical and radiographic results of 22 patients with symptomatic degenerative spondylolisthesis, operated on by decompressive laminectomy and instrumented posterolateral fusion associated with interbody fusion (PLIF). Mean age at surgery was 64 years (range, 57–72). Clinical results were evaluated on a questionnaire at the last follow-up visit concerning postoperative low back and leg pain, restriction of daily life activities, and resumption of sports activity. Lumbar spine radiographs were used to evaluate the status of fixation devices, the reduction of the spondylolisthesis, the lumbar sagittal balance and the presence of spinal fusion. No intraoperative or postoperative complications were encountered. There were no superficial or deep infections, fixation device loosening, or hardware removal. Mean follow-up time was 4 years (range, 3–6 years). Clinical outcome was excellent or good in 19 patients and fair in 3 patients. Preoperatively, mean forward vertebral slipping on neutral lateral radiographs was 5 mm, while postoperatively it decreased to 3 mm. Preoperatively, mean sagittal motion was 3 mm and angular motion was 8°, while postoperatively these values decreased to 1 mm and 1°, respectively. This study demonstrated that spinal decompression followed by transpedicular instrumentation associated with PLIF technique is a valid surgical option for the treatment of degenerative spondylolisthesis with symptomatic spinal stenosis. Clinical outcome, intended as relief of pain and resumption of activity, was improved significantly and fusion rate was high.

Le protesi totali di tibiotarsica

Riassunto Le protesi di tibiotarsica vengono studiate e impiantate da molti anni; i fallimenti iniziali furono, pero, numerosi, tanto che molti ortopedici le abbandonarono. Inoltre, l’artrodesi continua a essere un trattamento efficace per rimuovere il dolore da grave artrosi della caviglia, anche se elimina completamente il movimento dell’articolazione tibiotarsica e non e privo di rischi. Negli ultimi anni, diversi studi si sono concentrati sull’anatomia e sulla biomeccanica dell’articolazione tibiotarsica e, basandosi anche sull’evoluzione dei modelli protesici passati, si sono sviluppati disegni innovativi, che mostrano risultati incoraggianti; si e creato cosi un nuovo interesse nei confronti della possibilita di protesizzazione dell’articolazione tibiotarsica, come valida alternativa all’artrodesi.