Septic coxitis after an intramuscular injection in a young adult treated by two-steps total hip arthroplasty: a case report

Introduction: Septic arthritis of the hip is a rare condition in adults and its treatment depends on symptoms duration: early onset of infection can be treated with open or arthroscopic debridement, while more aggressive surgery is required when articular damage takes place such as articular resection or total hip replacement (THA). Presentation of case: We report a case of a 30 year old man affect by septic arthritis of the hip after an intramuscular injection of diclofenac successfully treated with a two-steps THA. Discussion: In literature there aren't many cases of septic arthritis of the hip developed after intramuscular injections. Early onset of infection can be treated with an accurate articular debridement, while chronic conditions are traditionally treated by resection arthroplasty. However resection arhtroplasty gives to the patients a significant leg length discrepancy and, especially in young adults, a two-steps surgery with the implant of THA can lead to good results, as reported in recent case series published. Conclusion: In our experience two-stage total hip arthroplasty proved to be a reliable solution for septic arthritis of the hip and may be used in patient with severe joint damage. Furthermore we want underline importance of correct anamnesis to make quickly the right diagnosis and provide the right treatment of septic arthritis of the hip also in difficult clinical cases

Evaluation of orthopaedic fast-track surgery from 2009 to 2013 in an Italian hospital

Each year millions of patients are treated for joint pain with total joint arthroplasty, and the numbers are expected to rise. Total knee arthroplasty (TKA) has an integral role in the treatment of severe knee joint diseases including osteoarthritis and rheumatoid arthritis and long-term results for pain relief and functional improvement have been excellent.The aim of this study was to evaluate whether the application of the Fast-Track method has reduced the LOS during a period of 5 years, while taking care of the patients outcome and the readmission rate in our Department

Use of a Plasma-Sprayed Titanium-Hydroxyapatite Femoral Stem in Hip Arthroplasty in Patients Older than 70 Years. Is Cementless Fixation a Reliable Option in the Elderly?

Background: Although cementless implants are increasing in popularity, the use of cementless femoral stems for total hip arthroplasty (THA) and hip hemiarthroplasty (HH) in elderly patients remains controversial. The aim of this study was to report the outcomes of a cementless stem used in a large multicentric cohort of elderly patients receiving elective THA and HH for displaced femoral neck fracture. Methods: A total of 293 patients (301 hips) aged 70 years or older (mean age, 78 years; range, 70–93) who received the same cementless plasma-sprayed porous titanium–hydroxyapatite stem were retrospectively evaluated after primary THA and HH to investigate stem survival, complications, and clinical and radiographic results. Results: Cumulative stem survival was 98.5% (95% CI, 96.4–99.4%; 91 hips at risks) with revision due to any reason as the end-point at 10-year follow-up (mean 8.6 years, range 4–12). No stem was revised due to aseptic loosening. The mean Forgotten Joint Score was 98.7. Radiographically, the implants showed complete osseointegration, with slight stress-shieling signs in less than 10% of the hips. Conclusion: The use of cementless stems was proven to be a reliable and versatile option even in elderly patients for elective THA and HH for femoral neck fracture

Bilateral shoulder pain after a generalized tonic-clonic seizure: case report of an acute undiagnosed bilateral fracture of proximal humerus

Bilateral shoulder fracture is a rare event and convulsive epileptic seizure is one of the most common causes. Detailed physical and neurovascular examination are important but shoulder’s antero- posterior and axillary radiographs are essential to reveal a possible fracture and/or dislocation. Diagnosis could be difficult and often missed because of the importance given to patient’s neurological issue. We present a case of a young man with an acute undiagnosed bilateral fracture of proximal humerus as complication of a generalized tonic-clonic seizure. After seven days we performed a surgical procedure of bilateral reduction and osteosynthesis with angular stability plate and screws

Early experience about Anteversa® plate for lateral femur fractures

Introduction. The hip fractures appear to be a real epidemic problem, especially in the western world, due primarily to higher average age. The social and economical impact is considerable with a continue social and health costs up-rising. The female-male ratio is approximately 8:1. Purpose. The purpose of this report is to present a system of osteosynthesis for fractures of the lateral femoral neck. This system is a plate developed by INTRAUMA O'nil®, 3-hole plate with an 130° angle of valgus and 7° of anteversion. Materials and methods. At the I Orthopedic Department at the University of Pisa from January 2009 to February 2012 were treated 52 fractures of the femur neck side with this system. All patients undergone to a clinical and X-ray evaluation according to the AO classification: 14 31-A1, 7 31-A2, 4 31-A3. Results. The mean follow-up was 10 months, in all cases we did not have cut-outs with a TAD average of 23 mm. Conclusions. This system offers the possibility to perform surgery quickly with low risk of cut-out thanks to 7° of anteversion. Ensures optimal fixation to the femoral shaft and an equitable distribution of forces, eliminating the risk of breakage of the implant and loosening of the screw

HYDROXYAPATITE IN TOTAL HIP ARTHROPLASTY. OUR EXPERIENCE WITH A TITANIUM AND HYDROXYAPATITE DOUBLE-COATED CEMENTLESS STEM

Introduc on: Total hip arthroplasty (THA) could fail due to many factors and asep c loosening is one of the most common. In order to achieve an e ec ve osseointegra on contact porous bearing surface were developed. Objec vies: Aim of this retrospec ve study was to evaluate clinical and ra- diological mid-term outcomes of a porous tanium alloy/Hydroxyapa te double coa ng manufactured cementless femoral stem and to demonstrate the possibility to use this stem in di erent kind of femoral canals. Methods: Between January 2008 and December 2012, 182 consecu ve primary total hip arthroplas es (THAs) were performed using a porous - tanium alloy/Hydroxyapa te double coa ng manufactured cementless fem- oral stem. 182 pa ents were examined and 136 were female (74.7%) and 46 male (25.2%); average age was 72 years old (26-92). Harris Hip Scores (HHS) and Womac Scores were collected. All X-Ray images were analyzed in order to demonstrate stem survival rate and subsidence. Results: HHS was good or excellent in 85% and mean WOMAC score was 97.5 (73.4-100). No cases of early/late infec on or periprosthe c fracture were no ced, with an excellent implant survival rate (100%) in a mean period of 40 months (24-84). 5 cases presented acute implant disloca on, 2 due to wrong cup posi oning in a dysplas c acetabulum and 3 a er ground level fall. Dorr classi ca on of femoral geometry was used: 51 type A bone, 53 Type B and 78 Type C. Stem subsidence over 2 mm was considered as a risk factor of future implant loosening and was evidenced in 3 female pa ents with type C. Conclusions: This data reported an excellent implant survival rate in a mid- term period with a rate of 1,64% of subsidence. Radiological absence of pedestal has been accepted as sign of no excessive stress transmission to distal cortex due to its tapered diaphyseal region.This double coa ng can be considered a valid choice with an excellent medi- um-term survival and encouraging subsidence results

Synthetic Bone Grafting in Aseptic Loosening of Acetabular Cup: Good Clinical and Radiological Outcomes in Contained Bone Defects at Medium-Term Follow Up

Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study investigated the effectiveness of impaction bone grafting (IBG) of contained acetabular defects (Paprosky 2 and 3a) using a porous ceramic-based hydroxyapatite bone substitute (Engipore, provided by Finceramica Faenza S.p.A., Faenza, Italy) mixed with a low percentage of autologous bone (obtained from reaming when available). We retrospectively assessed 36 patients who underwent acetabular revision using IBG using a porous ceramic-based hydroxyapatite bone substitute with cementless implants with a mean follow-up of 4.4 years. We evaluated, at regular intervals, patients clinically (using the Hip Harris Score and Oxford Score) and radiologically to evaluate the rate of incorporation of the graft, the presence of radiolucent lines or migrations of the cup. Clinical scores significantly improved (WOMAC improved from 49.7–67.30, and the HSS from 56–89). The rate of implants’ survival was 100% at our medium follow-up (4.4 years). We reported five cases of minor migration of the cup, and radiolucent lines were visible in seven patients at the last-follow up. The graft was well-incorporated in all patients. The results presented in this study suggest the HA bone substitute is an effective and safe bone graft when facing hip revision surgery; thus, longer follow-up studies are required

THE USE OF BALLOON CATHETER INTO THE INFRARENAL AORTA FOR PREVENTION OF MASSIVE HEMORRHAGE DURING REVISION HIP REPLACEMENT AT HIGH RISK: A CASE REPORT

Introduc on: Intraopera ve bleeding is one of the most dangerous compli- ca ons of revision surgery of the hip. In this study we present our experience and the method used to prevent a massive hemorrhage during revision sur- gery of hip replacement. Materials and methods: In May 2014 in our department we have performed revision surgery of hip implants in a pa ent with asep c loosening of the cup that had taken con guity for a distance of 2.5 cm with the right external iliac artery. During surgery with the help of an interven onal radiologist using ultrasound guided catheteriza on of the le common femoral artery it was posi oned a valved introducer with apex in infrarenal abdominal aorta. It was later made the revision surgery for hip replacement. Results: The opera on has been carried out and there has not been any bleeding during the extrac on of the cup. The nal angiographic control sup- ports the absence of vascular lesions. Conclusions: The use of this protec on has allowed the team to perform the surgery with less anxiety and stress. In fact, the radiologist in case of bleeding was ready to in ate the ball and create a transient ischemia for the me required to repair the artery and the conclusion of the interven on. Our opinion is that this is a safe and reproducible method to u lize in selected cases at risk of major bleeding

Lessons learnt from COVID 19: An Italian multicentric epidemiological study of orthopaedic and trauma services

Introduction: The Pandemic caused by the SARS-CoV-2 has put a strain on the most of health systems all over the world. Many hospitals had to re-organize to deal with the emergency, so that the non-core activities have been suspended or cancelled, raising management problems. The aim of this multicentre study is to report the epidemiological orthopaedic and traumatological data between COVID and pre-COVID era and to analyse patients' needs and their management. Methods: We reported and compared traumatological and elective orthopaedic surgeries performed in three of the main hospital centres in Tuscany during COVID (March 2020) and pre-COVID (March 2019) era. We also reported the epidemiological data about the number of orthopaedic first aid visits at the main hub, analysing the main differences. For each centre, we reported the number, diagnosis, co-morbidities, treatment, hospital course, complications and outcomes of confirmed COVID 19 patients. We also indicated what kind of PPE were used by medical staff and patients at any visit. Results: The scheduled surgery drastically decreased in all the centres and the most of procedures were carried out for tumours, infections and implant mobilizations during the COVID time, delaying all the other ones. Trauma activities slightly decreased between the two time points: proximal femur fractures continued to engage our hospitals at the same pre-COVID volumes, while minor traumas drastically decreased. We report a decrease of 70.95% in orthopaedic first aid, with first-aid-visits/hospitalization ratio of 13.8 in the pre-COVID time vs 5.8 in the COVID time. A total of 5 confirmed COVID patients were treated for fractures and 4 of them healed without complications. We report just one case of death among COVID patients. All the medical staff members have worn the PPE and no one have developed COVID symptoms. Conclusions: The COVID-19 raised many important issues, such as the optimal management of patients requiring the treatment of conventional diseases during a pandemic. The flow of patients changes from one area to another during a pandemic and an integrated approach within the same geographical area could be useful to better allocate resources and manage the patients' needs. The preventive measures put in place in our country seem to work, but this first experience with COVID-19 crisis highlighted the chronic problems of our health system and we believe that we have to "learn the lesson" to be better prepared in the future