Early failure of cement with loosening and dislocation of the femoral component in a unicompartmental knee replacement: a case report with microscopic assessment.

Background Medial unicompartimental knee artrhoplasty (UKA) is a valuable and well-known option in the treatment of medial osteoarthritis (OA). Early recovery and good results are usually reported. Failure mechanism include septic and mechanical loosening, bearing dislocation and lateral or patello-femoral joint OA evolution. The rare case of an atraumatic dislocation of the cemented femoral component of a UKA is presented together with a literature review and a microscopic analysis of the loosened component. Methods The case of a 60-years old man who suffered a UKA failure due to a complete loosening and migration of the cemented femoral component 5 months after its implantation is reported. A review of the literature pertaining early similar catastrophic failures is discussed. Furthermore a stereo-microscopic and scanning electronic microscopic evaluation of the femoral component was performed. Results A UKA-to-TKA revision was performed. Septic loosening was ruled out and one-year follow up showed patient satisfaction with good clinical and radiographic results. Few cases of complete dislocation of the UKA femoral component are reported in the literature. Macro- and microscopic evaluation showed an almost completely smooth surface at the cemented surface of the posterior condyle of the femoral component.   Conclusions Whilst mobile bearing dislocation is a well-known complication of UKA, few cases of this potentially catastrophic complication are reported in the literature. Early UKA failure with complete implant loosening may be determined by a suboptimal cementing technique with inadequate cement penetration into the trabecular bone. In the present case, the absence of cement penetration into the posterior condyle may be one of the reason of the component dislocation after standing up starting with the knee in a highly flexed position.

Outcomes in arthroscopic surgery and proposal rehabilitative treatment in femoral acetabular impingement syndrome.

Background and aim of the work Femural Acetabular impingement syndrome (FAIS) is a patologic condition that can lead to hip pain, functional limitation and stiffness. In the last few decades orthopedics and physiotherapists have improved both surgery and riabilitative treatment leading to a better and better treatment. The target of this paper il to verify the efficiency of an early and multimodal physiotherapic treatment after and arthroscopic surgery of the FAIS   Materials and Methods We performed arthroscopic treatment and rehabilitation on 19 patients with mean age of 37±8,3 years, 12 males and 7 females. Each patient has been evaluated preoperatively (T0), postoperatively after 6 week (T1) and after 3 months of follow up (T2), the assessment was carried out by: administration of the VAS and WOMAC score for pain and function and joint examination of active hip movement through an inertial sensor system.   Results VAS score shows a decrease of pain after 6 week (mean decrease was 36%) and after 3 months (mean decrease was 33%). WOMAC score shows an increase of the funcional performance of the hip after 3 weeks and after 3 months (in both phases the mean score increase of the 44%) At last, the analysis of the active movement and of the hip joint showed a generalized increase in all movements both 6 weeks and 3 months after surgery, in particular for flexion (with the knee flexed) and internal rotation movements. of the hip.   Conclusion The results of this study are in line with the current scientific literature and the protocol used represents a valid tool to complete the surgical treatment. The proposal of an early, intensive treatment combined with hydrokinesitherapy seems to be safe and effective, however further studies are needed (increasing the sample size) to investigate the results.

Are vascular grafts at risk of occlusion after total hip replacement? A systematic review of the literature.

Vascular complications during and after total hip replacement are relatively uncommon despite the close relationship between the involved structures. Previous surgical procedure of arterial reconstruction or substitution may be at higher risk of damage due to the modification in the anatomical landmarks or to the mechanical properties of the grafts different from native vessels. In literature few cases of graft occlusion or failure are reported during or soon after a total hip replacement. The aim of this review is to report them highlighting common features and risk factors.

Kinetic and Kinematic analysis of ACL reconstruction in association with lateral-extrarticular tenodesis of the knee in revision surgery: a pilot study.

Background Anterior cruciate ligament reconstructions are a very frequent surgery. The key role of the anterolateral ligament in the knee rotational stability has been undelighted in recent years. Extra-articular tenodesis in association with ACL reconstructions, serves to eliminate anterolateral rotatory instability. The aim of our study is to compare treated knees with the contralateral uninjured knee in those cases whom been treated with ACL arthroscopic reconstruction and lateral extra-articular tenodesis in revision surgery, and evaluate clinical results with kinematic and kinetic examinations methods. Materials and methods Sixteen patients (10 males and 6 females) with ages from 21 to 37 had been treated at the Orthopaedic Clinic of Udine for failure of previous ACL reconstruction. In all patients was performed ACL arthroscopic reconstruction with the association of a lateral extra-articular tenodesis (Coker-Arnold). We have decided to asses the patients at one year after surgery with GNRB arthrometer and Bioval inertial sensor system. Results All patients treated with arthroscopic ACL reconstruction and lateral extra-articular tenodesis have regained pre-injury sagittal knee stability and gait dynamics.

Treatment options for massive rotator cuff tears: a narrative review.

The treatment of massive rotator cuff tears poses a challenge to orthopedic surgeons. The prevalence of massive rotator cuff tears is 40% of all rotator cuff tears. Compared with smaller tears, massive rotator cuff tears are often complicated by structural failure and poor outcomes and present a higher rate of recurrent tearing after surgical repair. Several management options are available but the selection of the most appropriate treatment for each patient can be challenging. To achieve the best outcomes, the orthopedic surgeon should have a good understanding of the indications, the pathomechanics and the clinical outcomes of the various treatment modalities. Treatment options include non-operative management, arthroscopic debridement with a biceps tenotomy or tenodesis, complete or partial repair, patch augmentation, superior capsular reconstruction, muscle/tendon transfer and reverse total shoulder arthroplasty. The purpose of this article is to review treatment options and clinical outcomes for the management of massive rotator cuff tears.

Clinical and radiological outcomes with PEEK suture anchors used in rotator cuff repair: our experience confirm that a perianchor fluid signal on RM does not affect clinical outcome at one year of follow up.

Introduction / objectives  Osteolytic-type reactions of the perianchor bone which in magnetic resonance are manifested as hyperintensity of the signal in T2 images are reported in many studies. T  The objective of the present study is to evaluate and compare to the literature data the clinical and radiological results of a group of patients who underwent arthroscopic suture of a rotator cuff tear using polyetherketone (PEEK) suture anchors. Materials and methods Twenty patients, aged between 44 and 73 years, who underwent arthroscopic repair of the rotator cuff for lesions smaller than 4 cm considered reparaible between August 2017 and January 2019, were enrolled in the present study. Patients were evaluated clinically with clinical examination, Constant scale and ASES scale pre and post surgery. MRI either pre and post operation at one year were evaluated to obtain data about tendon healing and evaluate bone reaction to PEEK anchors. Results: MRI analysis showed a tendon signal according to Sugaya classification of type 1 in the 25% of patients, type 2 in the 60% of cases and type 3 in the remaining 15% . Osteolysis was grade 0 in 65%, grade 1 in 30 % and grade 2 in 5% of cases. No anchors pull out or mobilization were reported. Conclusions: The presence of a T2 hyperintense signal osteolysis like on MRI control using PEEK anchors for the sutur of rotator cuff lesions does not find correlation whit the final clinical result of the procedure.

Capsular management in the arthroscopic treatment of the femoro-acetabular impingement in athletes: our experience.

Background and aim of the work  In the last decade arthroscopic treatment of hip diseases has significantly spread and evolved and currently it represents the gold standard for the treatment of femoral-acetabular impingement in athletes. The function of the joint capsule  has been better understood, opening a heated debate. The aim of the present retrospective study is to assess the influence of different capsulotomy techniques and a possible capsular suture role on the patient's functional outcome in a cohort of patients with femoral-acetabular impingement arthroscopically treated. Methods 36 patients (competitive athletes) treated with hip arthroscopy for femoral-acetabular impingement have been retrospectively enrolled  during a period of two years (2016-2018). Patients have been divided into three equivalent groups, 12 without a suitable capsular management (T-Capsulotomy technique), 12 performing a Longitudinal Capsulotomy but without a final suture and 12 treated with a conservative Longitudinal Capsulotomy and a capsular suture. Patient's post-operative functional outcome has been analysed using the modified Harris Hip Score (mHHS), the Hip Outcome Score-Activity of Daily Living (HOS-ADL) and the Hip Outcome Score-Sport Scale (HOS-SS). Return to sport. Results In our series there was no statistically significant difference in functional scores, however longitudinal capsulotomy seems to be associated with a higher percentage of return to sports activity (91,6% vs 75%). Conclusions The new longitudinal shape capsulotomy technique and a capsular suture with a single side-to-side stitch at the end of the procedure in athletes can positively influence the patient's functional outcome.

Anterior cruciate ligament reconstruction: the role of lateral posterior tibial slope as a potential risk factor for failure.

Background and aim of the work Anterior cruciate ligament (ACL) reconstruction is an extremely frequent surgery. The analysis of anatomical factors is becoming increasingly important and the study of clinical, arthroscopic and radiological methods to evaluate and understand them aims to positively affect the patient's outcome. This work aims to analyze the role of Lateral Posterior Tibial Slope (LPTS) as a potential risk factor for ACL reconstruction failure Materials and Methods At the Clinic of Orthopedic of Udine, between November 2018 and August 2020, 47 revisions of the ACL were performed. We analyzed MRI scans with particular attention to the LPTS. Patient images were analyzed by a single senior orthopedic surgeon who was blinded to patient history, age and gender. Results Comparing with a value reported in literature as normal (LPTS estimated 6.5°) we see how the difference between the average LPTS values ​​in the sample is significantly higher than the normal values ​​(P <.0001). Furthermore, in our cohort, females show a LPTS  significantly higher than males (11,8° vs 8,7°; P <.005). Conclusion The data collected show how an increased posterior lateral tibial slope can be correlated with a higher risk of ACL reconstruction failure. The results are coherent with the literature. Our analysis is absolutely preliminary, but it is intended to be the starting point of a path that allows us to think of the reconstruction of the ACL as an intervention to be planned more carefully based on the individual characteristics of the patient.

Pre-operative and post-operative kinematic analysis in total knee arthroplasty. A pilot study.

INTRODUCTION: Total knee replacement is the treatment of choice in knee osteoarthritis. Despite this, there is still a percentage of unsatisfied patients. Recently, prosthetic designs have been developed to improve the kinematics of the prosthetic knee. MATERIALS AND METHODS: Between June 2016 and November 2016 we enrolled 26 patients underwent to total knee arthroplasty divided in two groups (A and B) treated respectively with Journey 2 implant and the Attune impltant. Each patient was evaluated with functional scores (KOOS and KSS) and with kinematic analysis using the Bioval System. RESULTS: In the group A, compared to the pre-operative, the flexion of the operated knees is significantly increased (31.27°±3.13° → 35.02°±2.1°) as well as that of the unoperated knee (34.34°±2.8° → 35.39°±3.5°). The pre/post-operative comparison of the muscles' activation timing showed an improvement for the unoperated side, which is closed to the physiological pattern, while the operated side showed an incorrect activation of all the investigated muscles. CONCLUSIONS: The Journey 2 prosthesis seems to reach better results in rotational flexion, rotational freedom and muscles activation during free walking. Furthermore, it seems that with this prosthesis the patient can feel his "new prosthetic knee" more similar and closer to the physiological one. More studies are needed to confirm these results.

Comparison between standard technique and image-free robotic technique in medial unicompartmental knee arthroplasty. Preliminary data.

The factors that guarantee the survival of the unicompartmental prosthesis implant seems to be linked to the accurate positioning of the components. The aim of our study is to compare the standard operative technique and the assisted navigation technique to understand if the robotic technology is able to obtain more accurate implants and with a better outcome. In the period between January 2016 and February 2018, in our Clinic, were performed 94 medial unicompartmental knee implants. The implantation of the medial unicompartmental prosthesis was performed in 30 cases with the standard technique and in 29 cases with the image-free robotic technique (Navio Surgical System). The objective of our study was to evaluate the anatomical and mechanical axes, the tibial slope, the coronal inclination of the femoral tibial space, the coronal angulation of the tibial and femoral component and the height of the Joint-Line. Furthermore, to evaluate the outcome we has execute international scores (IKDC and KSS Insall mod.). The advanced navigation seems to allow the implantation of the unicompartmental prosthesis more precisely, although not always with a statistically significant difference compared to the standard technique. further clinical studies are needed to analyze the medium and long-term survival rate, as well as the patient's subjective outcome.

Groin pain caused by iliopsoas synovial cyst treated with endoscopic approach. A case report.

The diagnosis of iliopsoas synovial cyst is a rare finding. The normal approach to treat this condition has been conservative therapies or open surgery, with its associated complications and morbidity. The arthroscopic - endoscopic surgery is less invasive and with an increase in complications and days of hospitalization. We report the case of a 70-year old woman with clinical and imaging signs of a fluid-filled cyst near iliopsoas distal tendon. After fluid aspiration, the patient reported symptom-free interval of several weeks, but then groin pain and swelling feeling return, increased with hip movements. The cyst was removed through arthroscopy approach and the iliopsoas tendon was released. The removal of iliopsoas synovial cyst is necessary to avoid complications such as pain and functional limits. Arthroscopy has the advantage of less soft-tissue damage and quicker recovery. The treatment of associated tendon pathology can be done. Hip arthroscopy can be a safe and effective technique for the removal of iliopsoas synovial cyst.

Computer assisted total knee arthroplasty: a real navigation to better results?

BACKGROUND AND AIM OF THE WORK: Computer assisted surgery in knee replacement is still in discussion, but majority of papers affirm an increase of the accuracy in alignment. Aim of our study is to evaluate the accuracy of mechanical axis, the posterior tibial slope and the femoral component rotation with navigation, x-ray and CT data. METHODS: We have analysed 145 patients who underwent total knee arthroplasty between January 2012 and December 2014. We have checked each patient at 6, 12 and 24 months of follow-up. During each visit, we did a clinical evaluation checking the ROM and a clinical score (KOOS). At 2 years, we did a CT evaluation and a plain x-ray evaluation. RESULTS: 125 patients have completed the follow-up. Mean follow-up time was 2,6 years. Both ROM and KOOS values increased during follow-up. About the mechanical axis, both x-ray and CT data showed a mean deviation <2° from the target. About posterior tibial slope and femoral component rotation, CT data showed a mean deviation of <3° from the target. Mean difference between navigation and CT data was <1°. CONCLUSIONS: According to literature data, our data confirm that computer assisted surgery in knee replacement have a good accuracy of coronal alignment, rotational alignment and posterior tibial slope.

Two-stage revision after total knee arthroplasty.

BACKGROUND AND AIM OF THE WORK: Periprosthetic knee infection is a complication associated with prosthetic failure; incidence change from 0,4-2% of primary total knee replacement and 5,6% in revisions; incidence is increasing over the years. Two-stage revision is the technique used in chronic infection. Aim of the work is to check success rate in our data. Methods. We analyzed retrospectively data of patients who undergone two stage revision surgery between 01/01/2010 to 31/12/2015. We made a clinical and radiological control after 1, 3, 6, 12, 24 months and we evaluate the outcome in December 2016. Results. Between 2010 and 2015 we treated 45 patients with two-stage revision. Mean follow-up was 3,4 years. Success rate is 89,9%. We had failure in 5 patients: everyone had knee surgery before first knee arthroplasty and Charlson Comorbidity Score was greater then 4 in 4 cases. Conclusions. Two stage revision can be considered a successful treatment in chronic periprosthetic knee infection. It has an optimal success rate, but it has some disadvantages as joint stiffness and pain in the interval between stages. This is a technique with two major surgery procedure with associated morbidity, discomfort, cost and prolonged stay in hospital.