Extended distal femur resection: Megaprosthesis with telescopic bone allograft augmentation versus total femur prosthesis.

BACKGROUND AND OBJECTIVE: Oncological distal femur resections can leave a proximal femur too short to host a stem. Reconstructive techniques are then challenging. The purpose of the study is to compare implant survival, complication rate and MSTS of two different options. METHODS: We retrospectively divided 33 patients with primary bone tumours of distal femur in Group 1 (16 patients reconstructed with knee megaprosthesis with proximal bone augmentation, APC) and Group 2 (17 patients reconstructed with total femur prosthesis, TFP). Less than 12 cm of remaining proximal femur were planned for all resections. RESULTS: MSTS score at 2 years is 25 ± 5 for Group 1 and 19 ± 7 for Group 2 (confidence interval [C.I.] 95%, p = 0.02). At 5 years it is 27 ± 2 for Group 1 and 22 ± 6 for Group 2 (C.I. 95%, p = 0.047). Failure and complication rates are lower for Group 1, but no statistical significance was reached. In APC reconstruction, union at the host-allograft junction was achieved in 16 out of 16 patients using the telescopic bone augmentation technique. CONCLUSIONS: APC provides higher functional results compared to TFP after extended distal femur resection. In APC reconstruction, telescopic augmentation is excellent for achieving union at the host-allograft junction.

What to choose in bone tumour resections? Patient specific instrumentation versus surgical navigation: a systematic review.

Patient specific instrumentation (PSI) and intraoperative surgical navigation (SN) can significantly help in achieving wide oncological margins while sparing bone stock in bone tumour resections. This is a systematic review aimed to compare the two techniques on oncological and functional results, preoperative time for surgical planning, surgical intraoperative time, intraoperative technical complications and learning curve. The protocol was registered in PROSPERO database (CRD42023422065). 1613 papers were identified and 81 matched criteria for PRISMA inclusion and eligibility. PSI and SN showed similar results in margins (0-19% positive margins rate), bone cut accuracy (0.3-4 mm of error from the planned), local recurrence and functional reconstruction scores (MSTS 81-97%) for both long bones and pelvis, achieving better results compared to free hand resections. A planned bone margin from tumour of at least 5 mm was safe for bone resections, but soft tissue margin couldn't be planned when the tumour invaded soft tissues. Moreover, long osteotomies, homogenous bone topology and restricted working spaces reduced accuracy of both techniques, but SN can provide a second check. In urgent cases, SN is more indicated to avoid PSI planning and production time (2-4 weeks), while PSI has the advantage of less intraoperative using time (1-5 min vs 15-65 min). Finally, they deemed similar technical intraoperative complications rate and demanding learning curve. Overall, both techniques present advantages and drawbacks. They must be considered for the optimal choice based on the specific case. In the future, robotic-assisted resections and augmented reality might solve the downsides of PSI and SN becoming the main actors of bone tumour surgery.

Use of dual-mobility cup in primary total hip arthroplasties: an Italian regional register (RIPO) study on three thousand, seven hundred and ten cases.

PURPOSE: The purpose of the study was to investigate the outcome of dual-mobility cup (DM) compared with a standard cup (SC) in primary total hip arthroplasty (THA) in the long-term follow-up based on a regional Italian joint registry (RIPO). METHODS: The Registry of Prosthetic Orthopaedic Implant (RIPO) was consulted, looking for all primary THAs implanted from 2000 to 2019. Three thousand seven hundred ten were dual-mobility cup (DM) total hip arthroplasties (THA) and 85.816 were standard cup (SC) THAs, on a total of 89.526 primary THA. Demographics, survival rates and causes of revision were evaluated and compared between the two groups. RESULTS: The use of DM progressively increased from 0.4% in 2000 to 7.5% in 2018 of all primary THAs. Revision rate was 3.5% (128 on 3710) for DMC and 4.7% (4061 on 85,816) for SC. DM presented lower dislocation rate if compared to SC with 22-28-mm femoral head diameter. However, DM showed a higher risk of revision for any causes than SC with 32-mm femoral head diameter in long-term follow-up. Nevertheless, no significant difference was measured in terms of demographics and surgical approach for dislocation rate. CONCLUSIONS: The DM cup represents a valid implant solution and has a lower dislocation rate than 22-28-mm SC. A slight increase in the use of DM implants over time was observed in the RIPO. However, a larger population and a longer follow-up are needed to further monitor the survival rate of new-generation DM implants.

Periacetabular Tumour Resection under Anterosuperior Iliac Spine Allows Better Alloprosthetic Reconstruction than Above: Bone Contact Matters.

BACKGROUND: Periacetabular resections are more affected by late complications than other pelvic resections. Reconstruction using bone allograft is considered a suitable solution. However, it is still not clear how the bone-allograft contact surface impacts on mechanical and functional outcome. MATERIALS AND METHODS: This paper presents the results of a retrospective analysis of 33 patients with resection of the entire acetabulum and reconstruction with an allograft-prosthetic composite for the period 1999 to 2010. Patients were divided in two groups, based on type of resection. In Group 1. patients had resections under anterosuperior iliac spine allowing the highest bone-allograft surface contact in reconstruction, while in Group 2 patients had resections over it. RESULTS: Mechanical survival of the implant and Musculoskeletal Tumor Society functional score were calculated. Impact of age and artificial ligament were investigated as well. Patients in Group 1 had 38% mechanical failure rate of the implant while patients in Group 2 had 88%. Average functional score was higher in Group 1 compared with patients in Group 2. An artificial ligament was shown to have non-significant impact on survival of the reconstruction in Group 1, while significantly improving survival of reconstruction in Group 2. CONCLUSION: Bone-allograft contact matters: resection under anterosuperior iliac spine allows better mechanical survival and offers better reconstruction functional scores.

Is Silver the New Gold? A Systematic Review of the Preclinical Evidence of Its Use in Bone Substitutes as Antiseptic.

Antibiotic-laden bone substitutes represent a viable option in the treatment of bone and joint infections with bone defects. In particular, the addition of silver ions or silver nanoparticles to bone substitutes to achieve local antiseptic activity could represent a further contribution, also helping to prevent bacterial resistance to antibiotics. An in-depth search of the main scientific databases was performed regarding the use of silver compounds for bone substitution. The available evidence is still limited to the preclinical level: 22 laboratory studies, 2 animal models, and 3 studies, with both in vitro and in vivo analysis, were found on the topic. Numerous biomaterials have been evaluated. In vitro studies confirmed that silver in bone substitutes retains the antibacterial activity already demonstrated in coatings materials. Cytotoxicity was generally found to be low and only related to silver concentrations higher than those sufficient to achieve antibacterial activity. Instead, there are only a few in vivo studies, which appear to confirm antibacterial efficacy, although there is insufficient evidence on the pharmacokinetics and safety profile of the compounds investigated. In conclusion, research on bone substitutes doped with silver is in its early stages, but the preliminary findings seem promising.

The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review.

BACKGROUND: Italy has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy. METHODS: A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19. RESULTS: Of the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine. CONCLUSIONS: Our work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios.

Dielectric Elastomer Actuators, Neuromuscular Interfaces, and Foreign Body Response in Artificial Neuromuscular Prostheses: A Review of the Literature for an In Vivo Application.

The inability to replace human muscle in surgical practice is a significant challenge. An artificial muscle controlled by the nervous system is considered a potential solution for this. Here, this is defined as a neuromuscular prosthesis. Muscle loss and dysfunction related to musculoskeletal oncological impairments, neuromuscular diseases, trauma or spinal cord injuries can be treated through artificial muscle implantation. At present, the use of dielectric elastomer actuators working as capacitors appears a promising option. Acrylic or silicone elastomers with carbon nanotubes functioning as the electrode achieve mechanical performances similar to human muscle in vitro. However, mechanical, electrical, and biological issues have prevented clinical application to date. Here materials and mechatronic solutions are presented which can tackle current clinical problems associated with implanting an artificial muscle controlled by the nervous system. Progress depends on the improvement of the actuation properties of the elastomer, seamless or wireless integration between the nervous system and the artificial muscle, and on reducing the foreign body response. It is believed that by combining the mechanical, electrical, and biological solutions proposed here, an artificial neuromuscular prosthesis may be a reality in surgical practice in the near future.