Matteo Ghiara

Partial knee arthroplasty: patellofemoral arthroplasty and combined unicompartmental and patellofemoral arthroplasty implants – general considerations and indications, technique and clinical experience

BACKGROUND Unicompartmental and patellofemoral arthroplasty (PFA) are not new concepts as shown by different authors, and nowadays surgical solutions other than total knee arthroplasty (TKA) must be considered, exploiting the technical possibilities offered by the new designs of prostheses which have improved the results of already used, old fashioned implants. The aim of our study was to present our experience with PFA and its combination with unicompartmental knee arthroplasty (UKA). METHODS From March 2007 to May 2012 we have treated 55 patients with a patellofemoral joint arthroplasty; in 25 cases we have performed an isolated PFA and in 30 cases a combined UKA and PFA. The mean follow-up in the group of isolated patellofemoral joint arthroplasty was 56.5 months; in the combined implant the mean follow-up was 59 months. RESULTS In both group we found an significant improvement of HSS, KSS and OKS scores with results at final follow-up ranging from good to excellent. CONCLUSIONS Partial knee arthroplasty shows promising results at mid-term follow-up.

Total knee replacement in acute and chronic traumatic events.

Total knee replacement (TKR) is a widely used procedure for the treatment of post-traumatic arthritis. This type of solution has also been used recently for the treatment of acute fractures around the knee, particularly in joints that were already arthritic before the trauma. The purpose of this paper is to present our experience with TKR in both acute and chronic traumatic events, highlighting the main problems associated with these conditions and focussing on the indications, principles of technique, tips, tricks and pitfalls of this procedure. The main issues related to post-traumatic arthritis and the problem of TKR in acute fractures are discussed, and our case series of both groups of patients is presented.

Topical versus intravenous tranexamic acid in total knee arthroplasty: A meta-analysis of randomized controlled trials

Purpose: The aim of this meta-analysis is to examine the efficacy and safety of intra-articular tranexamic acid (TXA) when compared to intravenous (IV) route. Methods: The literature search was conducted using PubMed, Cochrane Library, MEDLINE, EMBASE and China National Knowledge Infrastructure (CNKI). All randomized controlled trials evaluating the effectiveness of topical route and IV route of TXA administration were included. Results: Eight randomized clinical trials comprising of 857 patients were included in this analysis. We found no statistically significant difference in terms of total blood loss, drain output, transfusion requirement, thromboembolic complication, tourniquet time and surgical duration. Conclusion: Topical TXA has a similar efficacy to IV-TXA in reducing total blood loss, drain output, transfusion rate and haemoglobin drop without any increase in thromboembolic complications.

Knee replacement in chronic post-traumatic cases

Post-traumatic knee arthritis is a challenging condition. Prosthetic surgery is demanding and the risk of complications is relatively high. Planning is an essential element of this surgery; correct diagnosis (to exclude latent infection) and adequate considerations regarding approach, axis, bone loss, choice of implant and level of constraint are indispensable. There are two main categories of post-traumatic arthritis: extra-articular deformities and articular deformities. Use of an algorithms can support the surgeon’s choice of implant. Correct implant positioning and limb alignment restoration is associated with very good results, similar to those achieved with standard total knee arthroplasty. Cite this article: Benazzo F, Rossi SMP, Combi A, Meena S, Ghiara M. Knee replacement in chronic post-traumatic cases. EFORT Open Rev 2016:1:211-218. DOI: 10.1302/2058-5241.1.000025.

Clinical and radiological analysis of a personalized total knee arthroplasty system design

PurposeThe objectives of this study were to determine the radiological outcome of a new personalized total knee arthroplasty (TKA) design and also to analyze the radiological reproducibility of the surgical technique.Patients and methodsA total of 100 consecutive TKAs performed in 99 patients using Persona knee system were recruited. Weight-bearing standing anteroposterior and lateral radiographs were done in all the patients, both pre-operatively as well as post-operatively, and various radiological parameters were analyzed and compared.ResultsThe full correction of the limb mechanical axis was achieved in 97% of patients, and the radiological parameters of coronal and sagittal alignment of femoral and tibial components showed good results. There were no substantial differences between the mean pre-operative and post-operative patellar height indices, and data were in the normal range. Posterior condylar offset (PCO) and posterior condylar offset ratio (PCOR) had increased as expected after TKA. The coverage of tibia was optimal with data in the normal range.ConclusionsRadiological assessment of the new personalized knee system design showed excellent results with various parameters restored to the normal values. Therefore, the prosthesis can be considered anatomic, and the surgical technique is reproducible allowing the prosthesis to be implanted easily and with high precision.

Fratture periprotesiche: la revisione del ginocchio in acuto

Periprosthetic fractures are an increasingly common complication following total knee arthroplasty, especially in geriatric patients. Supracondylar fracture is the most frequent type and it is often linked to femoral notching. The correct classification of the fracture prompts the surgical decision; however, the loosening of a prosthetic implant needs revision surgery in the acute setting. The purpose of the treatment includes bone defect reconstruction and the stability of the implant, to allow for immediate weight-bearing and fast patient rehabilitation.

Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study

Background Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. Methods The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. Results 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. Conclusions This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.

Il trattamento del ginocchio protesizzato instabile

Instability following total knee arthroplasty is one of the major causes of revision surgery. In most cases, it may be prevented by using an appropriate prosthesis and a good surgical technique. Particular attention should be given to confirmation of diagnosis for which thorough history taking, complete physical examination and radiographic evaluation are needed. Concerning the treatment, an accurate diagnosis and identification of the aetiology of instability is crucial for establishing proper treatment plans; instability would persist without correction of the cause of the initial instability. For successful revision surgery, balanced medio-lateral and flexion-extension gaps should be achieved. The correct level of constraint must be chosen: constrained or rotating-hinge total knee prosthesis should also be considered as an alternative option for certain subsets of patients with instability.

Treatment of pain in total knee arthroplasty favoring post-op physical activity

Total knee arthroplasty (TKA) is a successful procedure which has been performed with progressively increasing frequency to improve the functional outcome of arthritic patients. The initial period after surgery may be painful and slow postoperative rehabilitation which can compromise the longterm outcome of the arthroplasty. In an effort to provide more effective pain management, a multimodal approach to the treatment of postoperative pain has been introduced recently with the aim of reducing opioid consumptions, and its associated side effects, to permit improved range of motion and ambulatory ability. The combination of different intraoperative and postoperative analgesic techniques, associated with drug administration, seems to improve the satisfaction of the patient and of the surgeon. Exercise in older patients is associated with improvement in cardiovascular fitness and reduction in the risk of adverse effects of immobilization. Younger patients can also to return to sports activity after total knee arthroplasty. Exercise, if not excessive, may help to prevent the development of pain and maintain favorable durability of the arthroplasty.

Protesi di ginocchio in acuto

Total knee arthroplasty is a reliable solution not only for the primary arthritic knee but also for severe knee fractures, either affected by osteoarthritis or not, or in case of severe bone loss in young patients. In this paper we present our experience and we suggest different technical solutions related to different segmental bones involved.