Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up

Background Congenital hip dysplasia may lead to severe acetabular and femoral abnormalities that can make total hip arthroplasty a challenging procedure. We assessed a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using cementless tapered stem and here we report the outcomes at long-term follow-up. Materials and methods Twenty-eight patients (24 women and 4 men) aged between 44 and 50 years (mean 47 years) were observed. Clinical evaluation was rated with the Harris Hip Score. Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe’s classification, 16 hips presented dysplasia grade 1, 14 grade 2, and 4 grade 3. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis). Six patients were operated bilaterally, with a totally of 34 hips operated. After surgery, the patients were clinically and radiographically checked at 3, 6, and 12 months and yearly thereafter until an average follow-up of 12 years (range 10–14 years). Results Average Harris Hip Score was 56 ± 9 (range 45–69) preoperatively, 90 ± 9 (range 81–100) 12 months after surgery, and 91 ± 8 (range 83–100) at last follow-up. Radiographic evaluation demonstrated excellent osteointegration of the implants. Signs of bone resorption were present in 6 hips, nevertheless no evidence of loosening was observed and none of the implants has been revised. Conclusions Even in dysplasic femur, the tapered stem allowed adequate stability and orientation of the implant. We consider tapered stem a suitable option for total hip arthroplasty in developmental hip dysplasia, also in case of young patients, thanks to the favourable long-term results

Metal ion levels in patients with metal-on-metal hip resurfacing: a long-term comparison with metal-on-metal total hip arthroplasty

Lo scopo di questo studio è stato quello di determinare se a lungo termine le concentrazioni sieriche di ioni nei pazienti con protesi di rivestimento d’anca metallo-metallo (MOM-HR, metal-on-metal hip resurfacing) fossero differenti da quelle valutate nei pazienti con protesi totale d’anca metallo-metallo e testa del diametro di 28 mm (MOM-THA, metal-on-metal total hip arthroplasty); inoltre è stato valutato se le concentrazioni ioniche fossero al di sopra dei valori di riferimento e se fosse possibile stabilire l’esistenza di una relazione tra sesso e concentrazioni di ioni con riferimento al tipo di impianto. Il gruppo MOM-HR era costituito da 25 pazienti mentre il gruppo MOM-THA era di 16 pazienti. Per poter ricavare i valori di riferimento sono stati reclutati 48 donatori sani. La misurazione delle concentrazioni degli ioni cobalto (Co), cromo (Cr), nickel (Ni) e molibdeno (Mo) è stata effettuata utilizzando la spettrofotometria ad assorbimento atomico su fornace di grafite. A parte il Ni, le concentrazioni di ioni nei pazienti con MOM-HR erano più elevate rispetto ai controlli. Il rilascio di ioni Cr e Co nei pazienti con MOM-HR è risultato superiore rispetto ai soggetti con MOM-THA. Da un’analisi basata sul sesso, è emerso che nelle femmine con MOM-HR i livelli di ioni Cr e Co sono risultati significativamente aumentati rispetto alle femmine con MOM-THA. Indipendentemente dal tipo di impianto, gli accoppiamenti metallo-metallo (MOM) producono concentrazioni di ioni metallici significativamente più alte a follow-up a lungo termine rispetto a quelle osservate nei soggetti sani. Un fattore che deve essere attentamente considerato nella scelta dell’impianto, e in particolar modo nei soggetti giovani, è il cospicuo rilascio di ioni Cr e Co nella popolazione femminile con MOM-HR.The purpose of this study was to determine if long-term serum ion concentrations in patients with metal-on-metal hip resurfacing were different from those assessed in patients with metal-on-metal total hip arthroplasty; moreover we evaluated whether these concentrations would be above the reference values and whether a relation between gender and ion concentrations with regards to implant type was present. Twenty-five and sixteen patients constituted MOM-HR and MOM-THA groups, respectively. Forty-eight healthy donors were recruited for reference values. Cobalt, chromium, nickel and molybdenum were measured by furnace graphite atomic absorption spectrofotometry. Except nickel, ion concentrations in MOM-HR patients, were higher than in controls. Chromium and cobalt release in MOM-HR were higher than in MOM-THA subjects. A gender-based analysis, showed that in MOM-HR females chromium and cobalt were significantly increased compared to MOM-THA ones. Regardless of implant type MOM couplings produce significantly higher metal ion concentrations at the long-term follow-up than those observed in healthy subjects. The conspicuous release of chromium and cobalt in the female MOM-HR population should be carefully considered during implant selection, particularly in young subjects

The SERI Distal Metatarsal Osteotomy and Scarf Osteotomy Provide Similar Correction of Hallux Valgus

Background: Ideal surgical treatment for hallux valgus is still controversial. A traditional distal metatarsal osteotomy with rigid fixation (Scarf procedure) and a more minimally invasive approach to a distal metatarsal osteotomy, termed SERI (Simple, Effective, Rapid, Inexpensive), have proven successful with short-term followup. However, no data are available directly comparing the two procedures. Questions/Purposes: We performed a prospective randomized trial to determine which technique (SERI or Scarf) was associated with (1) better functional outcomes, (2) better radiographic correction, and (3) fewer complications at 2 and 7 years followup. Methods: Twenty patients, 53 \ub1 11 years of age, with bilateral hallux valgus, clinically and radiographically similar, underwent bilateral surgery with Scarf on one side and SERI on the other, at random. Clinical (AOFAS score) and radiographic assessments were considered before surgery, and at 7 years followup. Results: SERI and Scarf techniques provided correction of the hallux valgus angle, intermetatarsal angle, and distal metatarsal angle in the range of normal. Both led to similar clinically important improvements in the AOFAS. No differences were observed between the groups. All osteotomies healed, and two patients who underwent the Scarf procedure required hardware removal. Reduction of ROM with respect to preoperative was observed in three patients for SERI and three patients for Scarf procedures. Conclusions: Scarf and SERI techniques resulted in effective correction of hallux valgus with similar outcomes, however the SERI technique required a shorter skin incision, less surgical time, less expensive fixation device, and was without residual pain attributable to hardware. Level of Evidence: Level II, prospective comparative study. See Guidelines for Authors for a complete description of levels of evidenc

The SERI Distal Metatarsal Osteotomy and Scarf Osteotomy Provide Similar Correction of Hallux Valgus

BACKGROUND: Ideal surgical treatment for hallux valgus is still controversial. A traditional distal metatarsal osteotomy with rigid fixation (Scarf procedure) and a more minimally invasive approach to a distal metatarsal osteotomy, termed SERI (Simple, Effective, Rapid, Inexpensive), have proven successful with short-term followup. However, no data are available directly comparing the two procedures. QUESTIONS/PURPOSES: We performed a prospective randomized trial to determine which technique (SERI or Scarf) was associated with (1) better functional outcomes, (2) better radiographic correction, and (3) fewer complications at 2 and 7 years followup. METHODS: Twenty patients, 53 ± 11 years of age, with bilateral hallux valgus, clinically and radiographically similar, underwent bilateral surgery with Scarf on one side and SERI on the other, at random. Clinical (AOFAS score) and radiographic assessments were considered before surgery, and at 7 years followup. RESULTS: SERI and Scarf techniques provided correction of the hallux valgus angle, intermetatarsal angle, and distal metatarsal angle in the range of normal. Both led to similar clinically important improvements in the AOFAS. No differences were observed between the groups. All osteotomies healed, and two patients who underwent the Scarf procedure required hardware removal. Reduction of ROM with respect to preoperative was observed in three patients for SERI and three patients for Scarf procedures. CONCLUSIONS: Scarf and SERI techniques resulted in effective correction of hallux valgus with similar outcomes, however the SERI technique required a shorter skin incision, less surgical time, less expensive fixation device, and was without residual pain attributable to hardware. LEVEL OF EVIDENCE: Level II, prospective comparative study. See Guidelines for Authors for a complete description of levels of evidence

Fracture healing and drug therapies in osteoporosis

Fracture repair has not been fully optimised and there is opportunity to increase the healing rate and reduce the number of complications using pharmacological means. While most anti-osteoporosis drugs have been widely tested for their ability to decrease the risk of osteoporotic fractures, fragility fractures still occur in patients under medical intervention. The primary purpose of this systematic review is to understand these underlying mechanisms between bone and drug therapies in osteoporosis and the overall promotion of fracture healing and callus formation. Databases such as MEDLINE, Google Scholar, EMBASE and CINAHL were searched and nine articles met all inclusion criteria. We report that there is still large controversy and a need for clinical trials to address the deficiencies found in animal models. There is no clear evidence yet as to whether complications during the course of healing are attributable to implant anchorage problems in osteoporotic bone or to possibly delayed healing in the aged

One-stage Metatarsal Lengthening by Allograft Interposition: A Novel Approach for Congenital Brachymetatarsia

Background Congenital brachymetatarsia, a shortened metatarsal bone, can be corrected surgically by callus distraction or one-stage lengthening using bone graft. Questions/purposes We asked whether one-stage metatarsal lengthening using metatarsal homologous bone graft could improve forefoot function, lead to metatarsal healing, restore metatarsal parabola, and improve cosmetic appearance. Patients and Methods We retrospectively reviewed 29 patients (41 feet) in whom we lengthened 50 metatarsals. Surgery consisted of a transverse proximal osteotomy of the metatarsal shaft and interposition of a metatarsal homologous bone graft (average, 13 mm long) fixed with an intramedullary Kirschner wire. Minimum followup was 3 years (mean, 5 years; range, 3–11 years). Results Bone union was achieved in all cases. The mean preoperative American Orthopaedic Foot and Ankle Society score was 37 points (range, 28–53 points) and the mean postoperative score was 88 points (range, 74–96 points), with an average improvement of 51 points. Radiographically, the mean gain in length was 13 mm (range, 10–15 mm), and the mean percentage increase was 23%. Conclusions One-stage metatarsal lengthening using interposition of metatarsal homologous bone graft to correct congenital brachymetatarsia has low morbidity for the patient, limited complications, short recovery times, and restores forefoot anatomy. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence

Osteosynthetic improvement of osteoporotic bone: prevention surgery

A prior osteoporotic femoral neck fracture (FNF) doubles the risk of a second, contralateral hip fracture. Pharmacological prevention of osteoporotic fractures is cost-effective but medication compliance and persistence rates are suboptimal

Fixation of Winged Scapula in Facioscapulohumeral Muscular Dystrophy

Objective: To verify if stabilizing the scapulothoracic joint without arthrodesis could lead to functional improvement of shoulder range of motion and clinical improvement of winged scapula, we incorporated four additional patients into our previous analysis to determine if the results obtained were long lasting, and to compare this fixation with the other techniques described in the literature, balancing the benefits with the complications

Biomeccanica dell’anca e studio di Gait analysis

Biomeccanica dell'anca e studio gait analysis nell'accesso anteriore mini-invasivo nella chirurgia protesica dell'anca

Biomeccanica dell’anca e studio di Gait analysis

Biomeccanica dell'anca e studio gait analysis nell'accesso anteriore mini-invasivo nella chirurgia protesica dell'anca