Studio retrospettico su 208 impianti di protesi di ginocchio: ruolo della pseudo-patella baja nel dolore e nella riduzione del ROM

L’artroplastica totale di ginocchio (TKA) è una procedura chirurgica ormai piuttosto comune che, nonostante sia estremamente vantaggiosa per il benessere del paziente, può apportare delle modifiche alla biomeccanica del ginocchio con possibili complicazioni. Tra le complicanze meno trattate merita un cenno la pseudo-patella baja (PPB): evenienza in cui vi è l'abbassamento della rotula, in assenza di accorciamento del Tendine Rotuleo. Caratteristiche della PPB sono: 1) patella in posizione normale rispetto alla troclea femorale; 2) tendine rotuleo di normale lunghezza; 3) ridotta distanza dall'interlinea articolare tibiale. Risulta chiaro, quindi, come la problematica centrale di questa alterazione iatrogena sia dovuta principalmente all’innalzamento dell’interlinea articolare, evenienza che può insorgere quando si ha un eccessivo taglio femorale o un importante release dei tessuti [1-8]. In questi casi, infatti, si è soliti utilizzare un inserto di polietilene di maggiore spessore per controbilanciare la possibile instabilità dell’impianto. Importante, al fine di trattare nel miglior modo possibile questo argomento, è la differenza tra la PPB e la patella baja vera (PB). In questo secondo caso, infatti, si osserva un accorciamento del tendine rotuleo, tale da ridurre quello che è uno degli “index” più usati per la valutazione dell’altezza rotulea: l'Insall-Salvati. Sebbene la rotula baja dopo TKA è stata riportata tra il 34%, 37% e il 65% in diversi studi [9-13], ed è stata correlata ad una serie di complicanze come il dolore anteriore del ginocchio a causa di conflitto rotuleo sull'inserto in polietilene tibiale, e limitazione della flessione del ginocchio [8-12], pochissimi studi si sono concentrati sulla PPB e la sua implicazione nella presenza di dolore anteriore e limitazione del ROM articolare nelle TKA. Il nostro studio ha lo scopo, per l’appunto, di valutare gli effetti della PPB in una serie di impianti di TKA

The damage control in tibial pilon open fractures with a new external fixator delta frame

Objective: To evaluate the effectiveness of the damage control, in emergency to treat the open tibial pilon fractures with Dolphix® External Fixator Frame(CITIEFFE®, Calderara di Reno, Bologna, Italy).Methods: From January 2017 to August 2017, at the Department of Orthopedics and Traumatology of Vito Fazzi Hospital Lecce, we treated 23 open tibial pilon fractures with Dolphix® External Fixator Frame(CITIEFFE®, Calderara di Reno, Bologna, Italy). The evaluation criteria of the case series were: the time needed to assemble the external fixator; the time taked to treat the ankle associated lesions; the time of skin healing; the ankle alignment; the subjective/objective Ovadia and Beals score; and complications. The Endpoint assessment was set at the days of the definitive surgery.Results: The results in terms of alignment, biomechanical stability of the frame, healing of soft tissue, complications were as good as the objective and subjective results according Ovadia and Beals score.Conclusion: Pilon fractures are complex and often present complications; the damage control treatment, in emergency, with Dolphix® External Fixator Frame(CITIEFFE®, Calderara di Reno, Bologna, Italy) permits a stable osteotaxis with minimal soft tissue damage and permit the repair of muscles, blood vessels and nerves with a stable bone and the soft tissue healing with vaccum therapy

Pseudo-patella baja: a minor yet frequent complication of total knee arthroplasty

Purpose: One of the complications in total knee arthroplasty (TKA) is pseudo-patella baja (PPB). PPB is present when there is no shortening of the patellar tendon, but the joint line is elevated. The purpose of this study is to investigate the incidence of PPB after TKA and its clinical effects. Methods: A case series of 158 patients undergoing TKA surgery between 1999 and 2012 at the 2nd Department of Orthopaedics and Traumatology, Pisa were retrospectively reviewed. Surgeries were performed by three senior surgeons, using the same surgical procedure for the implantation of a cemented posterior stabilized prosthesis. Lateral radiographs at 30° knee flexion were evaluated and the presence of PPB defined as modified Blackburne–Peel Index (mBPI) of < 0.54. All the patients were clinically evaluated using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC). Anterior knee pain was evaluated by visual analogue scale (VAS) and range of motion (ROM) was assessed through clinical examination. Results: The cohort group consisted of 158 patients, 109 (69.0%) female and 49 (31.0%) male. Median age at time of surgery was 74 years (range 36–87) and median follow-up was 66 months (range 12–163 months). Bilateral TKA surgery was performed in 50 patients, resulting in a total of 208 implants for investigation. On radiological evaluation, 139 (66.8%) showed no abnormalities (no joint line elevation and no patellar tendon shortening) and 55 (26.4%) presented joint line elevation with absence of patellar tendon shortening (PPB). No significant differences were found between the groups in terms of the KSS, WOMAC score, VAS or ROM. Conclusion: Post TKA PPB is a relatively common complication. Careful preoperative planning, adequate soft tissue release, optimal cutting of bone components, on the femoral side in particular, and the use of thin polyethylene inserts can help to avoid this complication. Level of evidence: IV. © 2017, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)