Valutazione della morfometria ossea nel paziente affetto da osteoporosi secondaria ad iperparatiroidismo.

L’osteoporosi è l’osteopatia metabolica più diffusa nel mondo occidentale, essa è causata da una patologica riduzione della massa ossea e da alterazioni microarchitetturali dello scheletro che portano ad un marcato aumento del rischio di frattura. Vengono riconosciute due forme prevalenti di osteoporosi: la primaria a tipica insorgenza post menopausale; la secondaia dovuta a patologie di vario tipo e disendocrinie. Abbiamo scelto di valutare un gruppo selezionato di pazienti affetti da osteoporosi secondaria ad iperparatiroidismo, a causa dell’elevato impatto sociale di questa patologia. Si è voluto utilizzare l’indice corticale, che come riportato in letteratura è un parametro che può fornire utili informazioni sulle modificazioni a cui il tessuto osseo va in contro in seguito a patologia osteoporotica, come strumento di raffronto tra i pazienti con osteoporosi secondaria e un gruppo di controllo omogeneo per età e sesso. Le misurazioni sono state effettuate tramite un programma computerizzato che ha permesso la valutazione delle immagini digitalizzate, a livello della seconda metacarpo falangea e dell’omero, ad una distanza dall’epifisi pari al diametro massimo della stessa, correggendo così l’errore legato alla diversa distanza dalla quale vengono effettuati i radiogrammi. I risultati così ottenuti sono stati oggetto di valutazione statistica

Il cotile da revisione in titanio poroso Regenerex™, valutazione clinica e radiografica dei primi 28 casi.

Introduzione : La mobilizzazione della componente acetabolare può essere affrontata con diverse strategie chirurgiche. L'impianto ideale dovrebbe garantire un'ottimale stabilità primaria favorendo l'osteointegrazione. Scopo di questa tesi è riportare i risultati preliminari sull'utilizzo del cotile Regenerex Revision Shell. La rugosità di superficie del titanio Regenerex® permette di avere un elevato scratch-fit iniziale mentre la geometria tridimensionale dei pori risulta ottimale per una precoce osteointegrazione. Nel titanio Regenerex® i pori sono interconnessi con un diametro variabile dai 100 ai 600 micron. Materiali e Metodi : Abbiamo preso in esame la casistica delle revisioni acetabolari dell' Ortopedia e Traumatologia I Universitaria di Pisa dal Gennaio 2009 al Dicembre 2011. Sono stati selezionati i pazienti con follow up minimo > a 12 mesi. I pazienti sono stati sottoposti a valutazione clinica e funzionale utilizzando gli score HHS e WOMAC, e valutazione radiografica. Risultati : La diagnosi iniziale era in 24 pazienti era di mobilizzazione asettica in 4 settica. La dimensione delle coppe Regenerex™ utilizzate varia da 54 a 62 con moda di 54. Tutte le coppe sono state fissate con viti; in 9 pazienti è stata eseguita anche la sostituzione dello stelo. In 15 casi è stato usato innesto con 50% di osso di banca e 50% di trifosfato calcico/idrossiapatite. Nella maggioranza dei casi è stato concesso il carico immediato con ausili e libero dopo 60 gg. I risultati clinici e funzionali ottenuti sono stati soddisfacenti con scarsa/assente sintomatologia (HHS>83; Womac> 75). Dal punto di vista radiografico non sono state evidenziate mobilizzazioni con un buon ripristino della geometria articolare e dismetria sempre inferiore ad 1,5 cm. Discussione : Il cotile in titanio poroso rappresenta secondo noi una valida scelta nei reimpianti perché offre un'elevata rugosità che aumenta la stabilità primaria. Il diametro dei pori come riportato in letteratura risulta essere ottimale per il bone ingrowth garantendo quindi la stabilità secondaria. Sebbene i temi trattati in questa relazione siano già stati oggetto di discussione soprattutto con l'utilizzo di coppe in Trabecular Metal®, a nostro avviso non esistono studi condotti da altri per valutare il cotile Regenerex Revision Shell. Conclusioni : La nostra esperienza con questo tipo di coppa è breve ma i risultati sono molto soddisfacenti. Dai risultati preliminari ottenuti emerge come tale cotile possa essere una valida soluzione nelle revisioni acetabolari nei casi di perdita ossea inferiore al GIR 3 o Paprosky 3 b

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

How to Build a Patient-Specific Hybrid Simulator for Orthopaedic Open Surgery: Benefits and Limits of Mixed-Reality Using the Microsoft HoloLens

Orthopaedic simulators are popular in innovative surgical training programs, where trainees gain procedural experience in a safe and controlled environment. Recent studies suggest that an ideal simulator should combine haptic, visual, and audio technology to create an immersive training environment. This article explores the potentialities of mixed-reality using the HoloLens to develop a hybrid training system for orthopaedic open surgery. Hip arthroplasty, one of the most common orthopaedic procedures, was chosen as a benchmark to evaluate the proposed system. Patient-specific anatomical 3D models were extracted from a patient computed tomography to implement the virtual content and to fabricate the physical components of the simulator. Rapid prototyping was used to create synthetic bones. The Vuforia SDK was utilized to register virtual and physical contents. The Unity3D game engine was employed to develop the software allowing interactions with the virtual content using head movements, gestures, and voice commands. Quantitative tests were performed to estimate the accuracy of the system by evaluating the perceived position of augmented reality targets. Mean and maximum errors matched the requirements of the target application. Qualitative tests were carried out to evaluate workload and usability of the HoloLens for our orthopaedic simulator, considering visual and audio perception and interaction and ergonomics issues. The perceived overall workload was low, and the self-assessed performance was considered satisfactory. Visual and audio perception and gesture and voice interactions obtained a positive feedback. Postural discomfort and visual fatigue obtained a nonnegative evaluation for a simulation session of 40 minutes. These results encourage using mixed-reality to implement a hybrid simulator for orthopaedic open surgery. An optimal design of the simulation tasks and equipment setup is required to minimize the user discomfort. Future works will include Face Validity, Content Validity, and Construct Validity to complete the assessment of the hip arthroplasty simulator

How to Build a Patient-Specific Hybrid Simulator for Orthopaedic Open Surgery: Benefits and Limits of Mixed-Reality Using the Microsoft HoloLens

Orthopaedic simulators are popular in innovative surgical training programs, where trainees gain procedural experience in a safe and controlled environment. Recent studies suggest that an ideal simulator should combine haptic, visual, and audio technology to create an immersive training environment. This article explores the potentialities of mixed-reality using the HoloLens to develop a hybrid training system for orthopaedic open surgery. Hip arthroplasty, one of the most common orthopaedic procedures, was chosen as a benchmark to evaluate the proposed system. Patient-specific anatomical 3D models were extracted from a patient computed tomography to implement the virtual content and to fabricate the physical components of the simulator. Rapid prototyping was used to create synthetic bones. The Vuforia SDK was utilized to register virtual and physical contents. The Unity3D game engine was employed to develop the software allowing interactions with the virtual content using head movements, gestures, and voice commands. Quantitative tests were performed to estimate the accuracy of the system by evaluating the perceived position of augmented reality targets. Mean and maximum errors matched the requirements of the target application. Qualitative tests were carried out to evaluate workload and usability of the HoloLens for our orthopaedic simulator, considering visual and audio perception and interaction and ergonomics issues. The perceived overall workload was low, and the self-assessed performance was considered satisfactory. Visual and audio perception and gesture and voice interactions obtained a positive feedback. Postural discomfort and visual fatigue obtained a nonnegative evaluation for a simulation session of 40 minutes. These results encourage using mixed-reality to implement a hybrid simulator for orthopaedic open surgery. An optimal design of the simulation tasks and equipment setup is required to minimize the user discomfort. Future works will include Face Validity, Content Validity, and Construct Validity to complete the assessment of the hip arthroplasty simulator

Structured reporting for fibrosing lung disease: a model shared by radiologist and pulmonologist

Objectives: To apply the Delphi exercise with iterative involvement of radiologists and pulmonologists with the aim of defining a structured reporting template for high-resolution computed tomography (HRCT) of patients with fibrosing lung disease (FLD). Methods: The writing committee selected the HRCT criteria\ue2\u80\u94the Delphi items\ue2\u80\u94for rating from both radiology panelists (RP) and pulmonology panelists (PP). The Delphi items were first rated by RPs as \ue2\u80\u9cessential\ue2\u80\u9d, \ue2\u80\u9coptional\ue2\u80\u9d, or \ue2\u80\u9cnot relevant\ue2\u80\u9d. The items rated \ue2\u80\u9cessential\ue2\u80\u9d by < 80% of the RP were selected for the PP rating. The format of reporting was rated by both RP and PP. Results: A total of 42 RPs and 12 PPs participated to the survey. In both Delphi round 1 and 2, 10/27 (37.7%) items were rated \ue2\u80\u9cessential\ue2\u80\u9d by more than 80% of RP. The remaining 17/27 (63.3%) items were rated by the PP in round 3, with 2/17 items (11.7%) rated \ue2\u80\u9cessential\ue2\u80\u9d by the PP. PP proposed additional items for conclusion domain, which were rated by RPs in the fourth round. Poor consensus was observed for the format of reporting. Conclusions: This study provides a template for structured report of FLD that features essential items as agreed by expert thoracic radiologists and pulmonologists

Correlation between Gamma Glutamyl Transferase (GGT) and bone quality

The following clinical study has the principal aim to verify the possible correlation between GGT fraction (gamma-glutamyltransferase) values and bone quality. We examined 93 Caucasian patients of both genders and aged between 60 and 85 years who were admitted to our Orthopaedic Unit with a diagnosis of hip osteoarthritis or proximal femoral fracture. Patients were divided in two main groups: Group A including patients who underwent total hip replacement because of hip arthritis and Group B including patients who underwent proximal femoral fracture ostheosynthesis by means of endomedullary nail, plate and screws or hip prosthesis. In all patients a preoperative blood sample was collected to obtain total and GGT fraction values. Furthermore, in all cases of hip prosthesis implantation, femoral head and neck were sampled. Femoral head was submitted to morphological analysis, while femoral neck was submitted to microCT analysis. The results were analysed to assess the possible correlation between abnormal GGT fraction values and bone quality. The final results were compared with data from literature

Generalità fratture da Osteoporosi

L'osteoporosi è una patologia in forte aumento sia per l'incremento della vita media, sia per le moderne abitudini alimentari, motivo per cui le ossa vengono esposte a fratture talvolta spontanee. Questo libro raccolgie le attuali vedute sul trattamento di questa patologia e su alcuni problemi che la frattura da osteoporosi pone, es. lalenta guarigione, la riabilitazione, etc