Cementless modular intramedullary nail without bone-on-bone fusion as a salvage procedure in chronically infected total knee prosthesis: long-term results.

PURPOSE: Our purpose was to evaluate long-term results of two-stage cementless intramedullary nailing without achieving bone-to-bone fusion for treating chronically infected total knee arthroplasty (TKA). METHODS: Thirty-eight patients treated according to the same protocol were retrospectively evaluated for clinical, functional, laboratory and radiological outcomes. RESULTS: Spacer exchange was necessary for infection persistence in one case. At a minimum two year follow-up, 34 patients (89.5%) showed no infection recurrence; among these 34 patients, 29 (85.3%) reported no or moderate pain [visual analogue scale (VAS) ≤3]; mild to moderate handicap (Lequesne Algofunctional Index < 7.5) was observed in 18 patients (52.9%). No patient underwent revision for aseptic loosening, and no nail breakage was observed. CONCLUSIONS: Two-stage cementless intramedullary nailing without achieving bone-to-bone fusion is a viable option for treating chronically infected TKA in selected, complex cases.

Recent developments in muscle synergy analysis in young people with neurodevelopmental diseases: A Systematic Review.

The central nervous system simplifies motor control by sending motor commands activating groups of muscles, known as synergies. Physiological locomotion can be described as a coordinated recruitment of four to five muscle synergies. The first studies on muscle synergies in patients affected by neurological diseases were on stroke survivors. They showed that synergies can be used as biomarkers for motor impairment as they vary in patients with respect to healthy people. Likewise, muscle synergy analysis has been applied to developmental diseases (DD). The need for a comprehensive view of the present findings is crucial for comparing results achieved so far and promote future directions in the field. In the present review, we screened three scientific databases and selected thirty-six papers investigating muscle synergies extracted from locomotion in children affected by DD. Thirty-one articles investigate how cerebral palsy (CP) influences motor control, the currently exploited method in studying motor control in CP and finally the effects of treatments in these patients in terms of synergies and biomechanics; two articles investigate how muscle synergies vary in Duchenne muscular dystrophy (DMD), and three other articles assess other developmental pathologies, such as chronic and acute neuropathic pain. For CP, most of the studies demonstrate that the number of synergies is lower and that the synergy composition varies in the affected children with respect to normal controls. Still, the predictability of treatment's effects and the etiology of muscle synergy variation are open questions, as it has been reported that treatments minimally modify synergies, even if they improve biomechanics. The application of different algorithms in extracting synergies might bring about more subtle differences. Considering DMD, no correlation was found between non-neural muscle weakness and muscle modules' variation, while in chronic pain a decreased number of synergies was observed as a possible consequence of plastic adaptations. Even if the potential of the synergistic approach for clinical and rehabilitation practices is recognized, there is not full consensus on protocols nor widely accepted guidelines for the systematic clinical adoption of the method in DD. We critically commented on the current findings, on the methodological issues and the relative open points, and on the clinical impact of muscle synergies in neurodevelopmental diseases to fill the gap for applying the method in clinical practice.

Knee arthrodesis by the Ilizarov method in the treatment of total knee arthroplasty failure.

BACKGROUND: Currently, the main indication for knee arthrodesis is septic failure of a total knee arthroplasty (TKA). The purpose of this study was to evaluate the results of knee arthrodesis by circular external fixation performed in the treatment of TKA failure in which revision arthroplasty was not indicated. METHODS: The study involved 19 patients who underwent knee arthrodesis by the Ilizarov method. Clinical and functional assessments were performed, including Knee Society Score (KSS). A postoperative clinical and radiographic evaluation was conducted every three months until the end of the treatment. Postoperative complications and eventual leg shortening were recorded. RESULTS: KSS results showed a significant improvement with respect to the preoperative condition. Of the 16 patients in the final follow-up, 15 patients (93.7%) achieved complete bone fusion. Major complications occurred in patients treated for septic failure of TKA and most occurred in patients over 75years of age; the mean final leg shortening was four centimeters. CONCLUSION: In our experience, the Ilizarov method is effective for performing a knee arthrodesis in the case of extensive bone loss. At the same time, it is possible to correct the associated leg deformities or limb length difference. In addition, only the Ilizarov method provides a mechanical stimulus for bone formation and improves the quality of the bone and of the microcirculation, which enhances the host response against infection. Despite these attributes, knee arthrodesis by the Ilizarov method must be considered a 'salvage procedure' in cases of severe outcomes from knee surgery in which revision arthroplasty is not indicated.

Intra-observer and inter-observer errors in CT measurement of torsional profiles of lower limbs: a retrospective comparative study.

BACKGROUND: The purpose of this study was to determine errors in measurement of torsional profiles (TP) (torsional femoral angle, torsional tibial angle, and femoral ankle angle) among four orthopedic surgeons, experts, and non-experts in measurement, and the learning curve. METHODS: Twenty-six lower extremities of 13 patients with spastic diplegia candidates for femoral/tibial derotational osteotomy had preoperative bilateral computer tomography (CT) scan grams to establish the TP. Each measurement was done by four orthopedic surgeons, two experienced clinicians and interpreters of CT imaging and two with limited clinical and imaging assessment experiences. Images were blinded and the surgeons made three determinations at least 5 days apart; the three angles were measured each time for each limb. Intra-observer and inter-observer variability were determined using bias, standard deviation, and interclass correlation coefficient. RESULTS: Significant inter-observer variability and bias were noted between experts and non-experts (average variability: ICC experts: 0.88 ± 0.15; ICC non-experts: 0.91 ± 0.09). For non-experts, excessive bias (25° and 14°) was observed. An associated improvement in bias with additional measurement experience indicated a potential significant learning curve for interpreting these studies. Less inter-observer variability was observed between experts. CONCLUSIONS: Measurement of TP is a reliable tool when used by experienced personnel, and their use as a preoperative tool should be reserved to ones with experience with such image assessments. Non-experts' measurements produced a weak agreement when compared to experts'.

Role for irrigation and debridement in periprosthetic infections.

Irrigation and debridement (I&D) has been described as a possible option to eradicate early postoperative periprosthetic hip and knee infections, as well as late, acute, and hematogenous ones. Still, the literature fails to uniquely assess the effectiveness of this procedure and often provides conflicting evidence. To reconcile this difference, a systematic review of the available literature from 1970 to 2013 was undertaken. Fifteen articles, for a total of 796 patients, met the inclusion criteria; the average success rate was 44.9 and 52% after a single or repeated I&D procedures, respectively, at an average of 4 years follow-up. Despite the methodological differences and the heterogeneity of the material reviewed, this study demonstrates that this procedure only attains a relatively low success rate of infection eradication, depending on when patients are selected for surgical intervention according to the timeframe of their symptoms.

Correction of poliomyelitis foot deformities with Ilizarov method.

Poliomyelitis is an infectious disease caused by a neurotrophic virus targeting anterior horn cells of lower motor neurons resulting in flaccid paralysis and represents a common condition in developing countries, and even nowadays, most of both treated and untreated cases result in foot deformities. Between 1994 and 2007, 27 patients were treated by classic ring Ilizarov fixator, aiming at producing a stable plantigrade and cosmetically acceptable foot and followed up for meanly 7.17 years. Additional procedures were performed if needed. The mean time in frame was 4.2 months. All the patients were satisfied with their gait, compared to preoperative status. A painless and plantigrade foot was obtained in all patients, and limb-length discrepancy was always corrected where present. No major complications were encountered. In conclusion, the Ilizarov method allows simultaneous progressive correction of all components of severe foot deformities associated with limb-lengthening discrepancy with minimal surgery, reducing risks of cutaneous or neurovascular complications and avoiding important shortening of the foot.