How to Manage Metallosis: A Retrospective Cohort Analysis after Revision Hip Surgery.

BACKGROUND: Adverse local tissue reactions to metal debris are due to a metal-on-metal bearing complication caused by micromotions at modular interfaces that induce corrosion of the protective oxide layer. This process could lead to wear, fretting, and abrasion with the release of metal ions locally and systemically, which may cause adverse local reactions in nearby tissues. The aim of this study is to describe a series of patients with painful local adverse tissue reactions secondary to corrosion at the modular neck-body interface, to document the clinical presentation, diagnostic workup, and surgical findings of our research, and to search for a possible correlation between metallosis and infection. METHODS: A retrospective study of patients with adverse local tissue reactions due to metal surface corrosion was performed. Blood samples were collected to identify erythrocyte sedimentation rate, C reactive protein, and procalcitonin, and a magnetic resonance imaging protocol was performed. RESULTS: Serum cobalt and chromium levels of the 43 patients tested were significantly higher on average. However, both erythrocyte sedimentation rate and C-reactive protein were significantly elevated. Magnetic resonance imaging showed adverse reactions to metal debris with large soft tissue masses and surrounding tissue damage. CONCLUSIONS: Corrosion in hip prosthesis can lead to the release of metal ions and debris locally and systemically, resulting in local soft tissue changes. A "tumor-like" debridement can reduce this complication.

Trabecular titanium cups in hip revision surgery: a systematic review of the literature.

Background: Hip revision surgery in extensive acetabular bone defects represents a complex challenge for hip surgeons. The primary goal is to obtain a stable acetabular component and restore the hip biomechanics. Through the years, different prosthetic implants have been developed to perform acetabular revision depending on bone loss location and extension. This systematic review aims to summarize the clinical outcomes and complications reported with trabecular titanium (TT) cups in hip revision surgery. Methods: A literature search of four databases (PubMed, Embase, Scopus and the Cochrane Database of systematic reviews) was performed according to the PRISMA guideline from January 2008 to December 2022. All studies written in English and reporting the clinical outcome of patients undergoing revision total hip arthroplasty using Delta TT cups were included. The initial screening identified 378 studies. Each eligible clinical article was analyzed according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence (LoE), and the papers' methodological quality was evaluated using The Methodological Index for Non-Randomized Studies Criteria (MINORS) score. Results: Eight clinical studies were included in the analysis. A total of 523 hip revisions were analyzed. Delta TT cups were used in 3.9%, Delta TT one cups in 46.8%, and Delta TT revisions in 49.3%. Paprosky IIIa was the most frequent acetabular bone defect reported in 26.4% of cases. The overall survival rate of TT cups was 93.4%. The dislocation was the most frequent complication in 4.1% of patients, while the prevalence of aseptic loosening was 1.5. Conclusions: Managing severe acetabular bone defects remains a complex challenge for hip surgeons. Since their introduction, TT cups have exhibited good clinical results, with complication rates in line with or lower than those reported by similar implants.

Current Reconstruction Options in Periprosthetic Fractures Around the Knee.

BACKGROUND: Periprosthetic fractures are a rare complication after total knee arthroplasty (TKA). However, the incidence of these fractures is growing after the increasing number of TKAs performed every year and the progressive aging of the population. In addition, the surgical treatment and peri-operative management of these complications are demanding, representing a challenge for the orthopedic surgeon. SIGNIFICANCE: A thorough understanding of these fractures and a correct classification are necessary in order to select the most suitable surgical treatment. The aim of this review was to analyze the epidemiology, classification, diagnosis, surgical treatment, and outcomes of periprosthetic knee fractures in order to give an exhaustive overview. RESULTS: Reduction and internal fixation with locking plates or intramedullary nails represents the preferred option in case of a stable prosthetic implant. Conversely, in case of loose tibial and/or femoral component, implant revision is mandatory. Conservative treatment is rarely indicated. CONCLUSION: A deep understanding of the characteristics and patterns of periprosthetic knee fractures, and the determination of the stability of the prosthetic implant are necessary in order to establish the correct treatment.

Short-term air pollution exposure is a risk factor for acute coronary syndromes in an urban area with low annual pollution rates: Results from a retrospective observational study (2011-2015).

BACKGROUND: Epidemiological data suggest that air pollutants are risk factors for cardiovascular disease. Recent studies have questioned the adequacy of current legal pollutant limits, because concentrations lower than those recommended still affect cardiovascular morbidity and mortality. AIM: To investigate the association between short-term exposure to air pollutants and the daily diagnosis of acute coronary syndrome (ACS) at the emergency department (ED) of S. Croce Hospital (Cuneo, Italy), between 2011 and 2015. METHODS: We evaluated the effect of particulate matter (PM2.5-10), nitrogen dioxide and ozone as primary exposure, together with temperature and relative humidity as climatological control variables, on ED admissions for ACS (response variables). We studied residents aged ≥35 years, classified into three age groups (35-64, 65-74 and ≥75 years). Environmental data were analysed according to Poisson's regression, and conventional cardiovascular risk factors (CRFs; hypertension, diabetes, coronary artery disease, smoking and dyslipidaemia) were included as control variables. RESULTS: ED admissions for ACS were 1625/391,689, with 298 in 2011 (0.183%), 305 in 2012 (0.188%), 347 in 2013 (0.214%), 341 in 2014 (0.21%) and 334 in 2015 (0.206%), with a general growth rate of 2.08% (from 2011 to 2015). The CRFs examined were confirmed to be highly associated with occurrence of ACS. Our study identified PM2.5 and temperature in all age groups to be additional risk factors, with PM2.5 exposure (P<0.01) being a particular risk for those aged ≥75 years. Dose-response models confirmed only PM2.5 as the main environmental risk factor in elderly patients (relative risk 1.06, 95% confidence interval 1.02-1.11; lag time 0-3 days). We also found a consistent relative risk for temperature in all age groups. CONCLUSION: This study confirms the importance of PM2.5 as a risk factor for ACS, mostly in elderly patients, even in a city with low annual pollution rates.

In Vivo Computed Tomography Direct Volume Rendering of the Anterior Ethmoidal Artery: A Descriptive Anatomical Study

Abstract Introduction The clinical relevance of the anatomy and variations of the anterior ethmoidal artery (AEA) is outstanding, considering its role as a landmark in endoscopic surgery, its importance in the therapy of epistaxis, and the high risks related to iatrogenic injuries. Objective To provide an anatomical description of the course and relationships of the AEA, based on direct computed-tomography (CT)-based 3D volume rendering. Methods Direct volume rendering was performed on 18 subjects who underwent (CT) with contrast medium for suspected cerebral aneurism. Results The topographical location of 36 AEAs was assessed as shown: 10 dehiscent (27.8%), 20 intracanal (55.5%), 6 incomplete canals (16.7%). Distances from important topographic landmarks are reported. Conclusion This work demonstrates that direct 3D volume rendering is a valid imaging technique for a detailed description of the anterior ethmoidal artery thus representing a useful tool for head pre-operatory assessments.

In Vivo Computed Tomography Direct Volume Rendering of the Anterior Ethmoidal Artery: A Descriptive Anatomical Study.

Introduction The clinical relevance of the anatomy and variations of the anterior ethmoidal artery (AEA) is outstanding, considering its role as a landmark in endoscopic surgery, its importance in the therapy of epistaxis, and the high risks related to iatrogenic injuries. Objective To provide an anatomical description of the course and relationships of the AEA, based on direct computed-tomography (CT)-based 3D volume rendering. Methods Direct volume rendering was performed on 18 subjects who underwent (CT) with contrast medium for suspected cerebral aneurism. Results The topographical location of 36 AEAs was assessed as shown: 10 dehiscent (27.8%), 20 intracanal (55.5%), 6 incomplete canals (16.7%). Distances from important topographic landmarks are reported. Conclusion This work demonstrates that direct 3D volume rendering is a valid imaging technique for a detailed description of the anterior ethmoidal artery thus representing a useful tool for head pre-operatory assessments.

Clinical and radiological outcomes of acetabular revision with the Delta Revision TT cup.

INTRODUCTION:: This study evaluates mid-term results of acetabular revision using a hemispherical acetabular cup in Trabecular Titanium with a cage construct. METHODS:: We reviewed 36 acetabular revisions performed with the Delta Revision TT cup in 34 patients (mean age = 75, range: 45-92 years). Acetabular defect types (Paprosky classification) included (1) 2B ( n = 5), (2) 2C ( n = 7), (3) 3A ( n = 15), and (4) 3B ( n = 9). Morcellised bone allografts were used in 24 cases, and synthetic bone used in 11. Outcomes were evaluated using the Harris Hip Score (HHS), and the Verbal Rating Scale (VRS) for pain measurement. X-ray visualisation of cup position was used to discern signs of mobilisation and bone graft incorporation. Survivorship at post-revision follow-up (mean = 39.8; range 12-91.5 months) was calculated. RESULTS:: HHS increased from 40.5 to 87 ( p < 0.01). 68% of cases were pain free; by comparison, 32% had an average VRS score of 1.9 (range 1-3). The average cup inclination angle was 40.8° (30-52°) postoperatively, compared with 41.2° (30-52°) at follow-up; there were no signs of loosening or mobilisation. Centre of rotation was fully restored in 21 (58.3%) hips. According to Gie classification; bone graft incorporation grades were (1) 3 ( n = 21), (2) 2 ( n = 12) and (3) 1 ( n = 2). The survival rate was 100% for aseptic loosening and 91.7% for any cause of revision. CONCLUSIONS:: The Delta Revision TT cup promises good clinical and radiographic results at short- to mid-term follow-up, with high rates of survival rate and bone integration.

Inhibition of small HA fragment activity and stimulation of A2A adenosine receptor pathway limit apoptosis and reduce cartilage damage in experimental arthritis.

Recent studies have found that the inactivation of small hyaluronan (HA) fragments originating from native HA during inflammation reduced the inflammatory response in models of experimental arthritis. The stimulation of adenosine receptors A2A reduced inflammation by inhibiting NF-kB activation. The combination of both treatments was significantly more effective than either of the individual treatments. The aim of this study was to further investigate the effects of a combined treatment using the HA inhibitor Pep-1 and a selective A2AR agonist (CV-1808) on the structure and ultrastructure of the articular cartilage and on apoptosis in a model of collagen-induced arthritis (CIA) in mice. Arthritic mice were treated with Pep-1 and/or CV-1808 intraperitoneally daily for 20 days. At day 35, the hind limbs were processed for light microscopy (hematoxylin/eosin and Safranin-O-Fast Green) and for transmission and scanning electron microscopy. CIA increased IL-6, caspase-3 and caspase-7 mRNA expression and the related protein levels in arthritic articular cartilage, and significantly increased concentrations of Bcl-2-associated X protein (Bax), while B cell-lymphoma-2 protein (Bcl-2) was markedly reduced. The combined Pep-1/CV-1808 treatment significantly reduced CIA injury, particularly at the highest doses, demonstrated by the presence of Safranin-O-positive cartilage, with a smooth surface and normal chondrocytes in the superficial, intermediate and deep zones. Morphological data and histological scoring were strongly supported by the reduction in inflammation and apoptotic markers. The results further support the role of HA degradation and A2A receptors in arthritis.