Paolo Cherubino

Follow-up of collagen meniscus implant patients: clinical, radiological, and magnetic resonance imaging results at 5 years.

This study investigated at medium term follow-up the clinical outcomes and any progression of knee osteoarthritis in a population of patients that underwent arthroscopic placement of a collagen meniscus implant. Thirty-four patients underwent arthroscopic placement of a collagen meniscus implant for a symptomatic deficiency of medial meniscal tissue. Follow-up evaluation included Lysholm II score and Tegner activity scores and MR arthrography of the knee at 2 and 5 years after surgery. Plain radiographs were also obtained at 5 years. Six patients were excluded. In eight cases arthroscopic second look evaluation was performed. Lysholm and Tegner activity scores at 2 and 5 years after surgery improved significantly compared to the preoperative score. These patients showed good to excellent clinical results after 5 years from a CMI placement. The chondral surfaces of the medial compartment had not degenerated further since placement of the CMI. MR signal had continued to mature between 2 and 5 years after implant, progressively decreasing signal intensity but in any case comparable to the low signal of a normal meniscus. In most of cases the CMI-new tissue complex had a slight reduction in size, compared to a normal medial meniscus, but the new tissue had no apparent negative effects.

Multiple subtotal somatectomy: Technique and evaluation of a series of 39 cases

The authors describe a surgical procedure called multiple subtotal somatectomy. This operation is indicated when canal stenosis is caused by posterior protrusions of the anterior wall of the spinal canal (due to osteophytes, posttraumatic deformities, or tumoral lesions) Involving three or more cervical segments. The procedures principal phases are (1) removal up to the posterior longitudinal ligament of the central portion of three or more vertebral bodies, and (2) insertion into the prepared trench (15-mm wide) of an autologous graft, previously obtained from the Iliac wing. Thirty-nine cases are presented (29 spondylosic myelopathies, 10 posttraumatic myelopathies), with follow-up periods varying from 6 months to 13 years. All grafts united, and 36 patients were benefited, while only three failed to improve

Italian cross-cultural adaptation and validation of the Oxford shoulder score

BACKGROUND The Oxford Shoulder Score (OSS) is an English-language questionnaire specifically designed to evaluate patients affected by shoulder pain. Although this scoring system has been translated into other languages, an Italian version of it is still not available. The aim of the present study was to translate, culturally adapt, and validate the Italian version of the OSS. MATERIALS AND METHODS We recruited 140 patients with shoulder pain caused by degenerative or inflammatory state or disorder of the shoulder. Patients completed the following questionnaires: Italian OSS, University of California, Los Angeles (UCLA) Shoulder Rating Scale, Constant-Murley shoulder assessment, and the Medical Outcome Study Short-Form 36 Health Survey (MOS SF-36). Internal consistency was tested using Cronbach coefficient alpha. Reproducibility was assessed by asking 110 patients to complete another OSS 48 hours after the first. Correlation between the total results of both tests was determined by the Pearson correlation coefficient. Validity was assessed by calculating the Pearson correlation coefficient between the OSS and the UCLA, Constant-Murley, and SF-36 assessments. RESULTS Cronbach alpha was 0.95. The Pearson correlation coefficient was r=0.97. With respect to validity, there was a significant correlation between the Italian OSS and the individual scores of UCLA, Constant-Murley, and SF-36. DISCUSSION Psychometric properties of the Italian OSS compared well with those reported for the English OSS. As demonstrated by the high values of Cronbach alpha and Pearson correlation coefficients, in accordance with the English version of the OSS, the Italian version proved to be a reliable, valid, and reproducible measure of shoulder pain perception in Italian-speaking patients.

Bilateral iliopsoas intramuscular bleeding following anticoagulant therapy with heparin: a case report

Iliopsoas haematoma is an uncommon complication that may arise during anticoagulant therapy, especially with heparin and warfarin. Besides determining patient distress secondary to femoral nerve compression, this event may progress to life-threatening complications and require expensive treatments. We describe the case of a 70-year-old healthy man complaining of severe bilateral groin, lumbar and thigh pain, and paralytic ileus after therapy with heparin. The angio-computed tomography scan observed bilateral iliopsoas haematomas. In view of the clinical and radiological scenarios, we ordered a diagnostic and therapeutic angiography of the bleeding vessels by trans-catheter arterial embolization of the fourth right lumbar artery trunk. The treatment proved to be beneficial from a clinical, radiological and laboratory point of view. To the best of our knowledge, this is the first reported case of bilateral iliopsoas haematoma occurring in a male treated with therapeutic levels of heparin alone.

Revision in Cemented and Cementless Infected Hip Arthroplasty

Infection is a frequent cause of failure after joint replacement surgery. The infection rate after total hip arthroplasty (THA) has been reduced to 1-2% in the last years. However, it still represents a challenging problem for the orthopedic surgeon. Difficulty of therapeutic approach, and poor functional outcomes together with length of treatment and overall cost are the main burden of this issue. Even the diagnosis of an infected hip could be challenging although it is the first step of an accurate treatment. At the end, many cases require removing the implants. Afterwards, the treatment strategy varies according to authors with three different procedures: no re-implantation, immediate placement of new implants or a two-stage surgery re-implantation. Based on the most recently systematic review there is no suggestion that one- or two-stage revision methods have different re-infection outcomes. The two-stage implant-exchange protocol remains the gold standard. It is considered as the most efficacious clinical approach for the treatment of periprosthetic infection, especially in patients with sinus tracts, swelling, extended abscess formation in depth and infection of Methicillin Resistant Staphylococcus Aureus (MRSA), and other multidrug-resistant bacteria as reported in recent consensus documents.

The incidence of fragility fractures in Italy.

Osteoporosis can significantly impact on the risk of developing a fracture. Thus, fragility fractures represent a challenge for health professionals and decision makers of the twenty-first century. The aim of this work is to review the literature concerning osteoporotic fractures in Italy in terms of incidence, rate of hospitalization, relative risk of a new fragility fracture, and costs for the national health system. It was estimated that the costs of treating proximal femur fragility fractures in 2002 summed up to 1 billion Euros. The number of fragility fractures in Italy was calculated as follows: 91.494 hip fractures, 61.009 clinical vertebral fractures, 57.401 humeral fragility fractures, and 94.045 forearm/wrist fragility fractures. The incidence of fragility fractures in Italy is very high, and osteoporosis is the leading cause of morbidity in the Italian population.

Radiographic evaluation of the "conus" uncemented stem

The purpose of this study was to evaluate 54 “Conus” uncemented stems both clinically and radiologically. The radiological evaluation was carried out to verify the stability of this rounded cross-section stem in terms of bone ingrowth and axial subsidence. Clinically, 39 hips (72%) were rated excellent, 13 (24%) were rated good, 2 (4%) were rated fair or poor. The average Harris Hip Score increased from 53 before operation to 93 at the time of the last follow-up (average FU 22.5 months). None was reoperated. Radiologically, 13 stems (24%) were judged to have subsided using a method described by Loudon and Charnley (6). Calcar modification, observed in 22 hips (41%), consisted of a slight rounding off of the proximal medial edge at the cut femoral neck. These results encourage the use of this versatile stem which revealed good primary and secondary stability, with good load distribution along the femur.

Evaluation of hollow and full stems implanted in the rabbit tibia: preliminary results

Full and hollow stems were implanted in the right and left tibiae of five rabbits to study the effects of the implant shape on revascularization and remodelling of the bone after 6 months. No significant difference of periosteal and endosteal circumference was observed when the left and right tibiae of each group were compared. Medullary area was, not surprisingly, significantly smaller in the full stem implanted tibiae. The cortical bone area result was significantly higher in the hollow stem group. In hollow stems, vessels were present both inside and outside the implant with connections through the holes of the implant. The observed differences of cortical bone area can be explained in terms of increased vascular spaces inside the cortical bone of full stem implanted tibiae. This supports the hypothesis that hollow implants provide more space for medullary revascularization and are consequently capable of inducing less endosteal remodelling. Cementless prostheses rely for mechanical fixation on a large interface of the implant with bone. Two factors, i.e. revascularization of the medullary canal and stiffness of the stem, can have a relevant effect on the quality of interface. This non-weight-bearing model suggests the relevance of vascular factors.

Long-term outcome of Rockwood capsular shift for recurrent shoulder dislocation

Purpose To review the long-term outcome of Rockwood capsular shift for recurrent shoulder dislocation secondary to trauma. Methods Records of 30 males and 4 females who underwent Rockwood capsular shift for recurrent (≥2 episodes) anterior shoulder dislocation were reviewed. An additional Bankart repair with different techniques was performed in 24 of the patients by 2 different surgeons. The outcome was assessed using the Western Ontario Shoulder Instability Index (WOSI) and the Western Ontario Osteoarthritis of the Shoulder (WOOS) index questionnaires, the modified Rowe score, and the Constant-Murley score. Shoulder range of motion (ROM) was measured. Degenerative joint changes were evaluated on radiographs. Results During a mean follow-up of 13 (range, 10–16) years, 6 (18%) patients had a mean of 1.2 recurrent dislocations. Four of the patients reported a traumatic event during recurrent dislocation. Of the 6 patients, 3 had undergone a Bankart lesion repair. Better Rowe and adjusted Constant scores were associated with lower age at first dislocation, at the index surgical procedure, and at follow-up. Four patients developed glenohumeral osteoarthritis: 2 were mild or moderate and 2 were severe and symptomatic. Glenohumeral osteoarthritis was associated with follow-up duration (p=0.03) and poorer Rowe score (p=0.012), adjusted Constant score (p=0.001), and WOOS score (p=0.006). Conclusion Rockwood capsular shift can preserve shoulder ROM, with rates of recurrent dislocation and degenerative joint changes comparable with other techniques.

Femoral Bone Plug in Total Knee Replacement

The intramedullary alignment guides used in total knee replacement disrupt the intramedullary vessels, resulting in greater postoperative blood loss. The use of an autologous bone plug to seal the intramedullary femoral canal has been shown to be effective in reducing postoperative bleeding. The authors present a simple technique to create a bone plug from the anterior chamfer femoral cut to perfectly seal the intramedullary canal of the femur.