Autologous chondrocyte implantation using a bilayer collagen membrane: A preliminary report

Purpose. To present preliminary clinical experience with Matrix-induced autologous chondrocyte implantation, a new tissue-engineering technique for treatment of deep cartilage defects, in which autologous chondrocytes are seeded on a tridimensional scaffold provided by a bilayer type I–III collagen membrane. Methods. From December 1999 to January 2001, 13 patients underwent implantation procedure for deep cartilage defects. Age of patients ranged from 18 to 49 years (mean age, 35 years). The mean defect size was 3.5 cm 2 (range, 2.0–4.5 cm 2 ). Clinical and functional evaluation were performed using various score systems for the ankle and the knee, and magnetic resonance imaging was performed at 6 and 12 months postoperatively. Membrane structure and cellular population were investigated by light microscopy, scanning electron microscopy, and electrophoresis before implantation. Results. The mean follow-up was 6.5 months (range, 2–15 months). No complications were observed in the postoperative period. The 6 patients with a minimum follow-up of 6 months showed an improvement in clinical and functional status after surgery. Magnetic resonance images showed the presence of hyaline-like cartilage at the site of implantation; there was evidence of chondroblasts and type II collagen inside the seeded membrane. Conclusion. Matrix-induced autologous chondrocyte implantation offers several advantages with respect to the traditional cultured cell procedure. These include technical simplicity, short operating time, minimal invasiveness, and easier access to difficult sites. It appears to be a reliable method for the repair of deep cartilage defects

Lateral parapatellar approach in primary total knee arthroplasty of the valgus knee

Background Anatomic and pathological characteristics of the valgus knee deformity represent a challenging issue for the implant of a total knee arthroplasty. The surgical approach in such cases should allow a direct ad easy exposure of the joint, easy lateral soft tissue balancing and adequate patellar tracking. Materials and Methods Twenty-four total knee arthroplasties were implanted in valgus knees between January 2002 and September 2005. A mean preoperative valgus deformity of 18\ub0 was assessed on standing x-rays. Four posterior stabilized, eighteen posterior stabilized rotating platform prosthesis and two superstabilized prosthesis were implanted in 21 patients. The surgical approach has been in all cases a lateral parapatellectomy. Follow-up assessments were obtained for all patients at a mean 23 months. They consisted of a Knee Society Score and a Patellar Score evaluation, standing AP and lateral radiograms and skyline x-rays obtained at a flection of 45\ub0. Results A mean preoperative Knee Society Clinical Score of 32,7 points (range, -4 to 64 points) significantly improved at follow-up to an average 88,8 points (range, 57 to 99 points; p<0,05). The Knee Society Function Score significantly increased from a preoperative mean score of 32,7 points (range, -20 to 75 points) to an average followup score of 81,2 points (range, 30 to 100 points; p<0.05). The Patella Score revealed absence of anterior pain in all cases but one that reported severe pain. A satisfactory patello-femoral alignement of 4.7\ub0 (range, 1\ub0 to 10\ub0) was obtained at last follow-up x-rays. One intraoperative condilar fracture occured and was treated with a single screw. Discussion The lateral approach of valgus knees led to satisfactory results in primary total knee arthroplasties in a percentage of cases comparable or superior to those presented in literature for different approaches. In addition, lateral release is performed as a part of the approach itself, allows preservation of the blood supplies of the extensor apparatus and an optimal patellar tracking in most cases. Conclusions In conclusion, the lateral approach for a primary total knee arthroplasty could be recommended in valgus knees affected by osteoarthritis because as it proved to be effective in achieving a satisfactory implant positioning and functional outcome while reporting minor complications

Femoral revision with the modular ZMR stem. Clinical and x-rays results at medium term follow-up

A retrospective review was conducted to evaluate the medium-term results of the ZMR modular revision taper stem. From March 1999 to December 2002, 65 consecutive hip revision surgeries were performed mostly for aseptic loosening. Femoral bone stock defects were classified according to AAOS\u2019s criteria and consisted mainly in type II and type III. A Wagner osteotomy was performed in 25 cases to remove primary implants that were cemented in 35 cases. Mean post-operative follow-up was 69 months (range, 36 to 91months). Clinical assessment at follow-up showed a significantly improved mean Harris Hip Score from 42 points preoperatively to 81 points postoperatively, while the x-ray examination did show a satisfactory distal integration of the stem in all cases and satisfactory reconstitution of the femoral bone stock in 47% of cases. The average subsidence of the stem at follow-up was under one millimeter. According to the data leg length discrepancy exceeding 15 millimeters caused significantly higher functional impairment and more pain

The proximal ulnar perforator flap (PUPF) for hand digital reconstruction: an anatomical study

Degloving injuries of the fingers represent a reconstructive challenge. Even if poorly described in literature, the proximal ulnar perforator flap (PUPF), based on perforator of the anterior ulnar recurrent artery or directly on a perforator branch of the ulnar artery, meets the requested criteria for the ideal coverage. We performed a cadaveric study in order to clarify the anatomical basis and vascularization of the PUPF flap. Eight injected upper limb specimens were dissected for this study: perforators were followed down to their origin and classified in terms of number, length, diameters and distances between their emergence and specific pre-determined landmarks as the medial humeral epicondyle. At least one ulnar perforator in the proximal third of the forearm was identified in all the specimens. In 50% of the upper limbs, the perforator branch came directly from the ulnar artery, while in the 87.5% a perforator branch came from the anterior recurrent ulnar artery; in 3 out of 8 cases both perforator branches were described. Mean lengths of the perforator branch were 57.9 mm and 44.3 mm, respectively and the mean diameters measured at their origin were 0.99 mm and 1.17 mm respectively. Our data illustrate the consistency of at least one perforator branch from the proximal third of the ulnar artery, most commonly coming from the anterior recurrent ulnar artery. Considering our results, the PUPF could be a good alternative to the classical free flaps for the resurfacing of the finger defects

Treatment of periprosthetic femoral fractures with distal fixation modular revision stems

Background Late periprosthetic fractures of the femur are the third most frequently reported cause of surgery after total hip artroplasty. Revision total hip artroplasty can be difficult, especially when poor bone stock is encountered. The aim of this study was to examine the results of late periprosthetic fractures complicated with primary implant loosening performed with distal fixation modular revision stem. Methods From November 1999 to May 2006, 16 late periprosthetic fractures were treated with distal-fixation, modular, straight stem. There were 13 females (82%) and 3 males (18%) whose mean age at surgery was 76.7 years (range, 48 to 95 years). Femoral revision surgery was performed with the Revitan (2 cases) and ZMR (14 cases) to get a stable distal primary fixation. X-rays were assessed accordingly to the Vancouver classification: there were 3 type B2 and 13 type B3 fractures. Mean post-operative follow-up was 52 months (range, 10 to 88 months). At the time of the last follow-up visit 4 patients already passed away, all of them for causes unrelated to the procedure. The clinical outcome was monitored with the Harris Hip Score, subjective VAS, pain and satisfaction evaluation. Standard AP and lateral x-rays of the hip were obtained at each follow-up visit. Leg-length discrepancy was also investigated as a factor possibly affecting outcome. Complications included one septic loosening that was treated with a two-stage revision. Results All the patients but one were finally able to walk and had minimal to no pain at all. A satisfactory functional outcome was achieved with an average 76 (range, 25 to 100) Harris Hip Scores points. The subjective pain and satisfaction scores were respectively 2.4 and 7.8 points. As far as radiograms are concerned, all the sixteen femur did show a good healing of the fracture, with no secondary stem subsidence. Discussion Generally, considering the severity of an event such as a periprosthetic late fracture in an elderly patient, results were satisfactory. The average Harris Hip Score and subjective satisfaction would have been even higher if one patient wouldn\u2019t have been so much disappointed because of her severe leg-length discrepancy, dependent on the acetabular side. From a surgical point of view, the employed devices proved to be handy in bridging the fracture with distal fixation while adequately stabilizing it. Conclusions According to the reported results, straight modular-revison stems provide an adequate treatment option of Vancouver type B3 and in selected cases of B2 type periprosthetic femoral fracture

The “Sombrero-Shape” Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier’s Gangrene

When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name “sombrero” as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months’ follow-up. The ALT flap design “sombrero” modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure

Initial experience with Vanguard(R) total knee arthroplasty

Introduction Biomet Vanguard(R) Complete Knee System is a total knee replacement system, introduced into the market in 2003: thissystem boasts a designed kneecap track or groove which allows for greater mobility and decreased loss of healthy bone during the replacement process. Clinical and radiographic results in Varese Orthopaedics Unit initial experience are reported. Materials and methods Clinical and radiographic parameters are evaluated in 29 patients who underwent TKA (Vanguard(R) Complete Knee System- Biomet Inc.) for primary gonarthrosis during the last 2 years at Orthopaedics and Traumatology Unit of Ospedale di Circolo\u2014Fondazione Macchi in Varese. ROM, type of anaesthesia, patellar pain, clinical and functional Knee Score (pre-operative), size of implant, ROM, blooding, patellar pain, VAS, clinical and func- tional Knee Score (post-operative) are analyzed. Radiographic follow-up is made at 6 and 12 months. Results Clinical and Functional Knee Score respectively improve from 47 to 88 pts and from 51 to 88 pts in pre- and post-operative period (p\0.001). Post-operatively no patellar pain, 2 pts VAS and 1215 cc blooding are reported. ROM doesn\u2019t significantly improve from pre- to post-operative. No relevant complications are reported. Due to the short follow-up, radiographic evaluation does not allow to demonstrate polyethylene liner wear. Conclusions Vanguard(R) Knee Replacement significantly shows a clinical and functional improvement in patients affected by primary gonarthrosis. Moreover, post-operative pain decrease allows early mobilization and rehabilitation

Experimental model in vivo for quantitative assessment of bone resorption inhibition.

Quantitative assessment of bone resorption inhibition in vivo is not easily accomplished; methods relying on a count of osteoclasts are questionable, and histomorphometric evaluation of the bone mass presents several technical problems as well. The authors developed a simple method to measure the inhibition of bone resorption by study of the proximal tibial metaphysis of growing rats: the height of the perichondrial bone ring was taken as an index of the balance between osteoblastic and osteoclastic activity because any agent that inhibits osteoclasts (without interference with osteoblasts) produces an increase in the height of this anatomical structure. Since the ring is well demarcated by surrounding tissues, its height can be measured with accuracy and used for quantitative assessment of bone resorption inhibition. This model was tested with salmon calcitonin, and it provides evidence in vivo that this hormone inhibits osteoclastic bone resorption

Acetabular revision surgery in the presence of severe bone loss: surgical technique and early results with modular porous tantalum augments and cups

Subject: In the presence of minimal acetabular bone loss most revision procedures can be done with the use of an uncemented hemispheric device with or without morselized allograft. The use of modular porous tantalum augments and cups has been recently introduced to address more severe bone deficiencies. The purpose of this study is to describe the surgical technique and early clinical results obtained with trabecular metal acetabular augments in cases of acetabular revision with severe bone loss. Materials and Methods: Since November 2003 seven acetabular revisions have been done by means of TMT\uae augments and cups: the primary indication for acetabular revision was aseptic loosening in five patients and septic loosening in two patients. According to Paprosky classification the acetabular bone defects were classified as follows: 2B in two hips, 2C in one hip, 3A in two hips and 3B in three hips. In two cases it was the first surgical hip replacement procedure. Five cases were multiple revisions. Results: At an average follow-up of 24 months no implant had evidence of loosening or migration. No dislocations occurred. Discussions and Conclusions: Augments provide mechanical support to hemispheric cups of various dimensions. This surgical technique avoids the use of structural allograft, helps to restore the center of hip rotation and increases contact area between the implant and the host bone for biological fixation. Longer follow-up is required to verify survival of these implants and potential mechanical and biologic complications related to use of this modular TMT\uae system

Solitary metastasis of the patella as the first manifestation of lung cancer. A case report.

A man of 71 was seen with a solitary metastasis in the patella as the first presentation of carcinoma of the lung