Operative Management of Sciatic Nerve Palsy due to Impingement on the Metal Cage after Total Hip Revision: Case Report

This paper discusses a sciatic nerve palsy developed after a right total hip revision with a Burch-Schneider metal cage. A sciatalgic nerve pain appeared after surgery, while the palsy developed in about fifteen days. An electromyography showed the delay of the nerve impulse gluteal level. During the surgical exploration of the hip, a compression of the nerve on the metal cage was observed. The nerve was isolated, released from the fibrotic tissue and from the impingement, and was protected with a muscular flap. The recover from the pain was immediate, while the palsy recovered one month later

UHMWPE for arthroplasty: past or future?

Wear debris related osteolysis is recognised as being the main cause of failure in joint replacements based on UHMWPE inserts. However, many solutions and “new” polyethylenes have been suggested in order to address this issue. This review discusses “historical” issues associated with UHMWPE, such as oxidation, sterilization method and storage, as well as “new” topics, such as crosslinking and stabilization. The final aim is to aid orthopaedic surgeons in their selection of polyethylene inserts and in the information given to the patients. The main problem for the polymer is degradative oxidation, which is caused by the combination of the irradiation used for sterilization and oxygen, and which leads to a decrease in wear resistance and mechanical properties. Irradiation and packaging in the absence of oxygen can only reduce the oxidation, while sterilization with gas (EtO or gas plasma) is the only method that effectively eliminates it. Manufacturing processes are of great relevance to the clinical duration and must be considered by surgeons. Crosslinked polyethylene has been developed for joint inserts due to its superior wear resistance compared to conventional UHMWPE; to prevent the oxidation, crosslinked polyethylene requires post-irradiation thermal treatment, which reduces its mechanical properties and which depends on the producer. Several good clinical results from the use of crosslinked acetabular cups have reported at mid-term, while early results for knee replacements are also encouraging. Recently, the use of the antioxidant vitamin E (alpha-tocopherol) has been introduced for joint prostheses in order to prevent the oxidation of both crosslinked and noncrosslinked UHMWPE

Adult Congenital Permanent Bilateral Dislocation of the Patella with Full Knee Function: Case Report and Literature Review

Congenital permanent dislocation of the patella is a rare disorder of the knee joint in which the patella is permanently displaced, even in extension and is fixed on the lateral aspect of the femoral condyle. The dislocation is irreducible without surgical techniques. This rare condition is usually detected within the first decade of life, because of inability of active extension in the knee and impaired ability during walking. This report presents an unusual case of a 51-year-old man with bilateral congenital permanent dislocation of the patella. The pathology had never been treated because there were few symptoms. The patient presented with right knee pain caused by a fall on the knee during his work. The right knee was painful on the lateral side and the clinical signs were positive for pathology of the lateral meniscus, confirmed by MRI. The clinical and the imaging findings suggested a lesion of the lateral meniscus as the probable cause of the pain. Therefore we performed a knee arthroscopy, whose intra-operative findings confirmed the MRI findings. During the surgery we performed just a selective arthroscopic meniscectomy, without correcting patella dislocation, because the condition was unusually asymptomatic before the trauma

Bicruciate-retaining total knee arthroplasty: What's new?

Primary total knee arthroplasty (TKA) is a widespread procedure to address end stage osteoarthritis with good results, clinical outcomes, and long-term survivorship. Although it is frequently performed in elderly, an increased demand in young and active people is expected in the next years. However, a considerable dissatisfaction rate has been reported by highly demanding patients due to the intrinsic limitations provided by the TKA. Bicruciate-retaining (BCR) TKA was developed to mimic knee biomechanics, through anterior cruciate ligament preservation. First-generation BCR TKA has not gained popularity due to its being a challenging technique and having poor survival outcomes. Thanks to implant design improvement and surgeon-friendly instrumentation, second-generation BCR TKA has seen renewed interest. This review will focus on surgical indications, kinematical basis, clinical results and latest developments of second-generation BCR TKA

Regeneration of articular cartilage: Scaffold used in orthopedic surgery. A short handbook of available products for regenerative joints surgery

Introduction: Restoring defects of load-bearing connective tissues such as articular cartilage resulting from traumas, degenerative or age-related diseases remains a significant clinical challenge for clinicians due to the limited inherent repair capacity of articular cartilage. Tissue engineering has emerged as a potential alternative to the traditional surgical techniques, as it can be effectively used to regenerate bone, cartilage and the bone-cartilage interface. Several scaffold strategies have been developed and evaluated for osteochondral defect repair. Materials and methods: The classes of polymers (scaffold-based proteins, scaffold-base polysaccharides and synthetic scaffolds) and Hydrogels have been reviewed trough literature and market search. The study focused on their respective properties and analyzed advantages and disadvantages of each of them. Discussion: Clinical studies demonstrated improved cartilage regeneration thanks to the implantation of biomaterials after bone marrow stimulation. New cartilage can be engineered in vivo by transplanting chondrocytes seeded into a three-dimensional scaffold and this novel scaffold has mechanical properties that can be comparable to native cartilage and could be used to repair large osteochondral joints defects. Anyway, there is still space for improvement regarding clinical outcome and tissue quality

Ultra High Molecular Weight Polyethylene is Cytotoxic and Causes Oxidative Stress, Even When Modified:

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