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Ciapini G, Varchetta G, Bizzocchi F, Gadsby G, Lombardi L, Sgadò F, Ipponi E, Scaglione M, Parchi PD. All-Inside Arthroscopic Meniscus Repair for Patients Over 40 Years of Age: Is Forty the New Twenty? Cureus 2024; 16:e56413. [PMID: 38638784 PMCID: PMC11024730 DOI: 10.7759/cureus.56413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Meniscal injuries are a common challenge in orthopedic surgery. For decades, partial or total meniscectomy has been the primary surgical treatment for meniscal tears. In recent years, the increased recognition of menisci's biomechanical importance has progressively shifted the paradigm towards meniscus repair. However, meniscus-sparing surgery remains the treatment of choice for selected lesions in young and active patients, especially for young and active patients. In this study, we evaluated the effectiveness of all-inside sutures in treating meniscus tears in patients over 40. METHODS In our retrospective evaluation, we evaluated the clinical and functional outcomes of cases over 40 years of age with post-traumatic acute meniscus tears that received meniscus repairs using the all-inside technique. The pre-operative and post-operative functionality of treated patients were assessed using the knee injury and osteoarthritis outcome score (KOOS) score. Major complications were recorded. RESULTS Twenty-three cases met our inclusion criteria. Eight females and fifteen males with a mean age of 44.9 were included in our study. Their mean follow-up was 35.1 months. Before surgery, our patients' mean KOOS score was 55.4 (18-80). At the patients' latest follow-up, the value had risen to 87.4 (63-100). There was no statistical correlation between patients' age and their functional recovery. No surgical failure was recorded at the latest follow-up. CONCLUSION The all-inside suture technique can represent a suitable and reliable solution for suturable meniscal tears, even for patients over 40. Preserving the meniscus and restoring patients' functionality allows patients to return to their daily activities and promote their quality of life.
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Affiliation(s)
- Gianluca Ciapini
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Giorgio Varchetta
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Federico Bizzocchi
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Giulio Gadsby
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Leonardo Lombardi
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Francesca Sgadò
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
| | - Edoardo Ipponi
- Department of Orthopedics and Traumatology, University of Pisa, Pisa, ITA
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Carbone M, Viglialoro RM, Stagnari S, Condino S, Gesi M, Scaglione M, Parchi PD. Design, Fabrication, and Preliminary Validation of Patient-Specific Spine Section Phantoms for Use in Training Spine Surgeons Outside the Operating Room/Theatre. Bioengineering (Basel) 2023; 10:1345. [PMID: 38135936 PMCID: PMC10740604 DOI: 10.3390/bioengineering10121345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Pedicle screw fixation (PSF) demands rigorous training to mitigate the risk of severe neurovascular complications arising from screw misplacement. This paper introduces a patient-specific phantom designed for PSF training, extending a portion of the learning process beyond the confines of the surgical room. Six phantoms of the thoracolumbar region were fabricated from radiological datasets, combining 3D printing and casting techniques. The phantoms were employed in three training sessions by a fifth-year resident who performed full training on all six phantoms; he/she placed a total of 57 pedicle screws. Analysis of the learning curve, focusing on time per screw and positioning accuracy, revealed attainment of an asymptotic performance level (around 3 min per screw) after 40 screws. The phantom's efficacy was evaluated by three experts and six residents, each inserting a minimum of four screws. Initial assessments confirmed face, content, and construct validity, affirming the patient-specific phantoms as a valuable training resource. These proposed phantoms exhibit great promise as an essential tool in surgical training as they exhibited a demonstrable learning effect on the PSF technique. This study lays the foundation for further exploration and underscores the potential impact of these patient-specific phantoms on the future of spinal surgical education.
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Affiliation(s)
- Marina Carbone
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Rosanna Maria Viglialoro
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Sara Stagnari
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Sara Condino
- Department of Information Engineering, University of Pisa, 56126 Pisa, Italy;
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Marco Gesi
- Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa, 56121 Pisa, Italy;
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Michelangelo Scaglione
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
| | - Paolo Domenico Parchi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, 56100 Pisa, Italy; (S.S.); (M.S.); (P.D.P.)
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Andreani L, Ipponi E, Falcinelli F, Barderi S, Vannucci L, Campo FR, D’Arienzo A, Parchi PD. Distal Femur Megaprostheses in Orthopedic Oncology: Evaluation of a Standardized Post-Operative Rehabilitation Protocol. Healthcare (Basel) 2023; 11:2984. [PMID: 37998476 PMCID: PMC10671754 DOI: 10.3390/healthcare11222984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Megaprostheses are the most used reconstructive approach for patients who have undergone massive resection of their distal femurs due to bone tumors. Although the literature about their outcomes has flourished in recent decades, to date, a consensus on rehabilitative treatment is yet to be established. In this study, we report on our experience with our latest standardized rehabilitation program, evaluating our results in a mid-to-long-term scenario. MATERIALS AND METHODS We evaluated the functional results of all our oncologic patients treated between 2016 and 2022 who could follow our standardized post-operative rehabilitative approach, consisting of progressive knee mobilization and early weight-bearing. RESULTS Sixteen cases were included in our study. The average duration of the patients' hospitalization was 12.2 days. A standing position was reached on average 4.1 days after surgery, while assisted walking was started 4.5 days after surgery. After a mean post-operative follow-up of 46.7 months, our patients' mean MSTS score was 23.2 (10-30). Our data suggest that the sooner patients could achieve a standing position (R = -0.609; p = 0.012) and start walking (R = -0.623; p = 0.010), the better their final functional outcomes regarding their MSTS scores. CONCLUSIONS Rehabilitation should be considered a pivotal factor in decreeing the success of distal femur megaprosthetic implants in long-surviving oncologic patients. Correct rehabilitation, focused on early mobilization and progressive weight-bearing, is crucial to maximizing the post-operative functional outcomes of these patients.
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Affiliation(s)
- Lorenzo Andreani
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
| | - Edoardo Ipponi
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
| | - Federico Falcinelli
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
| | - Sara Barderi
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
| | - Lorenzo Vannucci
- Department of Rehabilitation and Physical Therapy, University of Pisa, 56126 Pisa, Italy;
| | - Francesco Rosario Campo
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
| | - Antonio D’Arienzo
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
| | - Paolo Domenico Parchi
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
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Andreani L, Ipponi E, Serrano E, De Franco S, Cordoni M, Bechini E, D’Arienzo A, Parchi PD. Aneurysmal Bone Cyst of the Pelvis in Children and Adolescents: Effectiveness of Surgical Treatment with Curettage, Cryotherapy and Bone Grafting. Healthcare (Basel) 2023; 11:2658. [PMID: 37830695 PMCID: PMC10572795 DOI: 10.3390/healthcare11192658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Aneurysmal bone cysts (ABCs) are benign but locally aggressive cystic lesions of the bone. Pelvic ABCs are extremely rare and hard to treat due to their high risk of local recurrence and the tough access to pelvic bones. METHODS In this retrospective study, we evaluated pediatric cases with pelvic ABC treated with curettage, cryotherapy and bone grafting treated in our institution between 2016 and 2022. Complications were recorded, as well as local recurrences. Patients' post-operative functionality was assessed with the MSTS score. RESULTS Fourteen consecutive cases were included in our study. Their mean age at surgery was 13.5 years. The mean lesion size was 55 mm. The mean follow-up was 38 months. Two cases (11.8%) had local recurrences, which were successfully treated with further curettage. At their latest FU, 13 cases were continuously disease free (CDF), and one had no evidence of disease (NED). Only one case had a post-operative compilation (wound dehiscence). Patients' mean post-operative MSTS score was 29.6. CONCLUSIONS Pelvic ABCs are a challenge, even for the most experienced orthopedic surgeon. Our study suggests that the association of an accurate curettage, intraoperative cryotherapy and bone grafting can be a reliable and effective therapeutic option for large-sized ABCs of the pelvis.
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Affiliation(s)
| | - Edoardo Ipponi
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (E.S.); (S.D.F.); (M.C.); (E.B.); (A.D.); (P.D.P.)
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D’Arienzo A, Scognamiglio B, Campo FR, Cosseddu F, Ruinato DA, Ipponi E, Carbone M, Condino S, Ferrari V, Andreani L, Capanna R, Parchi PD. Preliminary Results of Preoperative Planning Using 3D Printing and Augmented Reality in Cryotherapy Treatment of Giant Cell Tumor of Bone-CRIO2AR Project. Healthcare (Basel) 2023; 11:2629. [PMID: 37830669 PMCID: PMC10572172 DOI: 10.3390/healthcare11192629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
Giant Cell Tumor of Bone is a benign tumor with high local aggressive expansion, which, in rare cases, spreads metastasis. Surgical treatment, which often consists of wide curettage to reduce recurrence risk, can lower the quality of life for those affected. Along with aggressive surgery, adjuvant intraoperative techniques have been implemented such as PMMA and cryotherapy. One of the most widely used cryotherapy techniques involves the use of probes to generate ice balls, which have been scientifically shown to have various impacts on the tumor. Although this has been acknowledged, no one has yet tested a way to accurately plan the positioning of cryotherapy probes before surgery, according to the research conducted by the authors. CRIO2AR is a randomized clinical prospective ongoing study by which it will be experimented via preoperative planning of ice probes placement using AR and 3D printing technologies. By studying a single clinical case with these technologies, the surgeon gains better awareness of patient's anatomy and tumor localization. Preliminary results are shown in the article. The first results are confirming that these technologies are applicable in clinical practice. Secondly, preoperative planning is proving to be reliable, easily replicable, and useful for the surgeon.
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Affiliation(s)
- Antonio D’Arienzo
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56124 Pisa, Italy; (A.D.); (F.R.C.); (F.C.); (D.A.R.); (E.I.); (L.A.); (R.C.); (P.D.P.)
| | - Branimir Scognamiglio
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56124 Pisa, Italy; (A.D.); (F.R.C.); (F.C.); (D.A.R.); (E.I.); (L.A.); (R.C.); (P.D.P.)
| | - Francesco Rosario Campo
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56124 Pisa, Italy; (A.D.); (F.R.C.); (F.C.); (D.A.R.); (E.I.); (L.A.); (R.C.); (P.D.P.)
| | - Fabio Cosseddu
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56124 Pisa, Italy; (A.D.); (F.R.C.); (F.C.); (D.A.R.); (E.I.); (L.A.); (R.C.); (P.D.P.)
| | - Damiano Alfio Ruinato
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56124 Pisa, Italy; (A.D.); (F.R.C.); (F.C.); (D.A.R.); (E.I.); (L.A.); (R.C.); (P.D.P.)
| | - Edoardo Ipponi
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56124 Pisa, Italy; (A.D.); (F.R.C.); (F.C.); (D.A.R.); (E.I.); (L.A.); (R.C.); (P.D.P.)
| | - Marina Carbone
- Department of Information Engineering, University of Pisa, 56124 Pisa, Italy; (M.C.); (S.C.); (V.F.)
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy
| | - Sara Condino
- Department of Information Engineering, University of Pisa, 56124 Pisa, Italy; (M.C.); (S.C.); (V.F.)
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy
| | - Vincenzo Ferrari
- Department of Information Engineering, University of Pisa, 56124 Pisa, Italy; (M.C.); (S.C.); (V.F.)
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy
| | - Lorenzo Andreani
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56124 Pisa, Italy; (A.D.); (F.R.C.); (F.C.); (D.A.R.); (E.I.); (L.A.); (R.C.); (P.D.P.)
| | - Rodolfo Capanna
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56124 Pisa, Italy; (A.D.); (F.R.C.); (F.C.); (D.A.R.); (E.I.); (L.A.); (R.C.); (P.D.P.)
| | - Paolo Domenico Parchi
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56124 Pisa, Italy; (A.D.); (F.R.C.); (F.C.); (D.A.R.); (E.I.); (L.A.); (R.C.); (P.D.P.)
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De Franco S, Ipponi E, Ruinato AD, Parchi PD, Andreani L, Scaglione M, Capanna R. Femoral neck fractures treated with cannulated screws: can surgeons predict functional outcomes and minimize the risk of necrosis? Acta Biomed 2023; 94:e2023013. [PMID: 36786271 PMCID: PMC9987480 DOI: 10.23750/abm.v94i1.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/06/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND AIM Femoral neck fractures are among the most frequent in mankind. Screw fixation is considered a suitable approach specially for undisplaced or slightly displaced fractures that occur to young patients. We conducted our study in order to evaluate both functional outcomes and complication rates of patients who received this treatment in our institution. A particular focus was given to the aseptic necrosis of the head, trying to identify if anamnestic, clinical or radiological data could play a significant role as prognostic factors. METHODS For each case who was treated with screw fixation due to a femoral neck fracture, we recorded data regarding, among the others, BMI and whether they used tobacco products or corticosteroids on a regular basis. Necrosis of the femoral head and mechanical complications were recorded. Functional outcome was evaluated using the Harris Hip Score. Results: 74 cases were included in our study. The mean Harris Hip score was 89.5. Aseptic necrosis of the femoral head occurred in 9 cases (12.2%). Regular use of tobacco was associated with a higher risk to develop necrosis (p=0.007). The Body Mass Index was significantly higher in cases who had necrosis compared to the rest of our population (p=0.043) and was inversely proportional to the post-operative Harris hip score (p=0.001). CONCLUSIONS While considering screw fixation to treat cases with femoral neck fractures, patient's weight and use of tobacco should be considered as prognostic factors. (www.actabiomedica.it).
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Affiliation(s)
- Silvia De Franco
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy .
| | | | | | | | - Lorenzo Andreani
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy .
| | | | - Rodolfo Capanna
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa, Italy .
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Ciapini G, Simonettii M, Giuntoli M, Varchetta G, De Franco S, Ipponi E, Scaglione M, Parchi PD. Is the Combination of Platelet-Rich Plasma and Hyaluronic Acid the Best Injective Treatment for Grade II-III Knee Osteoarthritis? A Prospective Study. Adv Orthop 2023; 2023:1868943. [PMID: 36938102 PMCID: PMC10023227 DOI: 10.1155/2023/1868943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/21/2023] Open
Abstract
Background Knee osteoarthritis is a common disease with increasing incidence and prevalence in western countries. It can cause severe pain and functional limitations, thereby representing a threat for patients' quality of life and a burden for national health systems. Intra-articular injections with hyaluronic acid (HA) and platelet-rich plasma (PRP) have been used for decades in order to reduce the symptoms caused by osteoarthritis. In recent years, a combination of HA and PRP has been introduced in clinical practice with the aim to minimize the clinical presentation of osteoarthritis and potentially delay articular degeneration. Materials and Methods Sixty cases with grade II-III knee osteoarthritis according to the Kellgren-Lawrence classification were included in a prospective study, focused on the evaluation of clinical and functional outcomes after intra-articular knee injections. Cases were randomly divided into three groups. Twenty cases (Group A) were injected with HA, 20 (Group B) had PRP, and the remaining 20 (Group C) received a combination of HA and PRP. Basal WOMAC score and VAS score were recorded before the treatment and repeated within 3 and 6 months after the treatment. Results At 6-month follow-up, Group C (PRP + HA) was the one with the lowest WOMAC and VAS mean values. It was also the only group that reported a reduction in the two values both in the first three months and in the following three months. No major complication was recorded. Conclusion The combination of platelet-rich plasma and hyaluronic acid can be effective in the treatment of grade II-III knee osteoarthritis in a short-to-mid-term scenario. It represents an innovative and valuable alternative to the administration of its two components alone.
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Affiliation(s)
- Gianluca Ciapini
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Matteo Simonettii
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Michele Giuntoli
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Giorgio Varchetta
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Silvia De Franco
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
| | - Edoardo Ipponi
- Department of Orthopedics and Trauma Surgery, University of Pisa, Pisa 56124, Italy
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Mendicino AR, Condino S, Carbone M, Cutolo F, Cattari N, Andreani L, Parchi PD, Capanna R, Ferrari V. Augmented Reality as a Tool to Guide Patient-Specific Templates Placement in Pelvic Resections. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:3481-3484. [PMID: 36086331 DOI: 10.1109/embc48229.2022.9871766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Patient-specific templates (PST) have become a useful tool for guiding osteotomy in complex surgical scenarios such as pelvic resections. The design of the surgical template results in sharper, less jagged resection margins than freehand cuts. However, their correct placement can become difficult in some anatomical regions and cannot be verified during surgery. Conventionally, pelvic resections are performed using Computer Assisted Surgery (CAS), and in recent years Augmented Reality (AR) has been proposed in the literature as an additional tool to support PST placement. This work presents an AR task to simplify and improve the accuracy of the positioning of the template by displaying virtual content. The focus of the work is the creation of the virtual guides displayed during the AR task. The system was validated on a patient-specific phantom designed to provide a realistic setup. Encouraging results have been achieved. The use of the AR simplifies the surgical task and optimizes the correct positioning of the cutting template: an average error of 2.19 mm has been obtained, lower than obtained with state-of-the-art solutions. In addition, supporting PST placement through AR guidance is less time-consuming than the standard procedure that solely relies on anatomical landmarks as reference.
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Del Chiaro A, Marchetti S, Parchi PD, Caprili G, Ipponi E, Scaglione M. Use of Statins and Hip Fracture Risk: a Case-Control Study. Acta Chir Orthop Traumatol Cech 2022; 89:104-107. [PMID: 35621399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE OF THE STUDY To evaluate a possible association between hip fracture and statin use. MATERIAL AND METHODS In this case-control study we compared the use of statins between two groups of 210 patients: the first group (case group) included patients hospitalized for hip fractures while the second group (control group) included patients who did not suffer femur bone injuries. The two groups were matched for age, sex, year of hospitalization and possible confounding factors. Inside the group of cases, we also evaluated the differences in terms of fracture type, presence of previous fragility fracture and mortality between statin users and non-users. RESULTS The use of statins was most common among patients without previous fractures (OR=0.54; 95% CI=0.33-0.89; p=0.0138), especially in older patients (OR=0.40; 95% CI=0.22-0.76). We did not find any significant difference in statin intake between men and women in the control group. In the case group, those who did not use statins were more likely to undergo a medial hip fracture (28.5% vs 16.1%). Patients from case group also presented a greater mortality (27.9% vs 19.35%) and an higher percentage of previous hip fractures (20.11% vs 9.7%). However, they didn't presented a significant higher rate of fragility fractures in other sites. DISCUSSION AND CONCLUSIONS Our study suggests a reduced hip fracture risk, especially in cases aged 80 or more, a different fracture pattern (lower percentage of medial fractures) and a reduced mortality at 9 months in patients treated with HMG-CoA reductase inhibitors, confirming the previous evidences reported in literature. Key words: statin, hip fractures, fracture risk, osteoporosis.
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Affiliation(s)
- A Del Chiaro
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - S Marchetti
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - P D Parchi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - G Caprili
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - E Ipponi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - M Scaglione
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
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Mani O, Nucci AM, Scaglione M, Bonicoli E, Parchi PD, Piolanti N. Bibliometric trend analysis in a decade of European Orthopaedic literature. Acta Biomed 2021; 92:e2021280. [PMID: 34212934 PMCID: PMC8343746 DOI: 10.23750/abm.v92i3.9512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022]
Abstract
Purpose: The purpose of this bibliometric study was to summarize European orthopedic literature produced by EFORT memberships between 2009 and 2019 and to identify the 100 most cited articles, analyzing the characteristics that made them so interesting for the orthopedic scientific world. Method: A search of the literature was conducted using Clarivate Analytics Web of Science in the subject category “orthopaedics”; then the results were summarized using Web of Science tools. Results: A total of 160.375 articles were found: most of these were produced by England. In particular the most prolific institution was the University of London. Analyzing in detail the 100 most cited publications emerged that most of them were review published in journal with high impact factor (Q1). The University of Oxford was the institution with the greatest number of contributions (13%). The most cited topics were osteoarthritis (24%), followed by orthopedic basic science (22%). Bio-materials was the most common topic by ordering the 100 analyzed articles according to “usage count”, a recent indicator of the level of interest in a specific item. Conclusion: This bibliometric study can be useful to identify topics of interest for future scientific research and to outline the features that make some publications more interesting than others. (www.actabiomedica.it)
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Condino S, Cutolo F, Cattari N, Colangeli S, Parchi PD, Piazza R, Ruinato AD, Capanna R, Ferrari V. Hybrid Simulation and Planning Platform for Cryosurgery with Microsoft HoloLens. Sensors (Basel) 2021; 21:s21134450. [PMID: 34209748 PMCID: PMC8272062 DOI: 10.3390/s21134450] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
Cryosurgery is a technique of growing popularity involving tissue ablation under controlled freezing. Technological advancement of devices along with surgical technique improvements have turned cryosurgery from an experimental to an established option for treating several diseases. However, cryosurgery is still limited by inaccurate planning based primarily on 2D visualization of the patient’s preoperative images. Several works have been aimed at modelling cryoablation through heat transfer simulations; however, most software applications do not meet some key requirements for clinical routine use, such as high computational speed and user-friendliness. This work aims to develop an intuitive platform for anatomical understanding and pre-operative planning by integrating the information content of radiological images and cryoprobe specifications either in a 3D virtual environment (desktop application) or in a hybrid simulator, which exploits the potential of the 3D printing and augmented reality functionalities of Microsoft HoloLens. The proposed platform was preliminarily validated for the retrospective planning/simulation of two surgical cases. Results suggest that the platform is easy and quick to learn and could be used in clinical practice to improve anatomical understanding, to make surgical planning easier than the traditional method, and to strengthen the memorization of surgical planning.
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Affiliation(s)
- Sara Condino
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (F.C.); (V.F.)
- Correspondence:
| | - Fabrizio Cutolo
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (F.C.); (V.F.)
| | - Nadia Cattari
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (N.C.); (R.P.); (A.D.R.)
| | - Simone Colangeli
- Orthopaedic and Traumatology Division, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56124 Pisa, Italy; (S.C.); (P.D.P.); (R.C.)
| | - Paolo Domenico Parchi
- Orthopaedic and Traumatology Division, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56124 Pisa, Italy; (S.C.); (P.D.P.); (R.C.)
| | - Roberta Piazza
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (N.C.); (R.P.); (A.D.R.)
| | - Alfio Damiano Ruinato
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (N.C.); (R.P.); (A.D.R.)
| | - Rodolfo Capanna
- Orthopaedic and Traumatology Division, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56124 Pisa, Italy; (S.C.); (P.D.P.); (R.C.)
| | - Vincenzo Ferrari
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (F.C.); (V.F.)
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12
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Barachini S, Pacini S, Montali M, Panvini FM, Carnicelli V, Piolanti N, Bonicoli E, Scaglione M, Parchi PD. Mesangiogenic Progenitor Cells and musculoskeletal tissue regeneration: differences between adipose-derived and bone marrow-derived cells? J BIOL REG HOMEOS AG 2020; 34:33-38. IORS Special Issue on Orthopedics. [PMID: 33739002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Mesangiogenic Progenitor cells (MPCs) have been isolated from human bone marrow mononuclear cells (hBM-MNCs) and attracted particular attention for their ability to efficiently differentiate into exponentially growing mesenchymal stromal cells (MSCs) and toward endothelial lineage, suggesting the term "mesangiogenic". Coupling mesengenesis and angiogenis, MPCs has been hypothesized retaining a great tissue regenerative potential in musculoskeletal tissues regeneration. Bone marrow and adipose tissue (AT) represent most promising adult multipotent cell sources attempting to repair bone and cartilage, with controversial results regarding advantages applying BM- or AT-derived cells. As different culture determinants as well as tissue of origins, could strongly affect regenerative potential of cell preparations, we hypothesize that MPCs counterpart could have a role in defining efficacy of applying a cell-based medicinal product in musculoskeletal tissue repair. Here we present convincing data demonstrating that the ex vivo progenitors of MPCs are tissue specific and can be detected exclusively in hBM-MNCs.
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Affiliation(s)
- S Barachini
- Hematology Division, Dept. Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Pacini
- Hematology Division, Dept. Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Montali
- Hematology Division, Dept. Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F M Panvini
- Hematology Division, Dept. Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - V Carnicelli
- Dept. Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - N Piolanti
- First Orthopedic Division University of Pisa, Italy
| | - E Bonicoli
- First Orthopedic Division University of Pisa, Italy
| | - M Scaglione
- First Orthopedic Division University of Pisa, Italy
| | - P D Parchi
- First Orthopedic Division University of Pisa, Italy
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13
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Colangeli S, Capanna R, Bandiera S, Ghermandi R, Girolami M, Parchi PD, Pipola V, Sacchetti F, Gasbarrini A. Is minimally-invasive spinal surgery a reliable treatment option in symptomatic spinal metastasis? Eur Rev Med Pharmacol Sci 2020; 24:6526-6532. [PMID: 32633339 DOI: 10.26355/eurrev_202006_21636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Up to 70% of patients with cancer are likely to develop spine metastasis. Radiation therapy is the standard of care for painful spinal metastases in absence of unstable or impending fractures. More frequently these patients require open palliative surgery for pain, vertebral collapse and neurological deficits. Minimally Invasive Spine Surgery (MISS) techniques using percutaneous pedicle screw fixation may be considered as an alternative to open surgery in selected cases. MISS techniques are thought to be associated with fewer tissues damages resulting in early pain relief, they also allow for early mobilization and optimization of function. PATIENTS AND METHODS From 2011 to 2018, 52 patients affected by spinal metastasis were treated with MISS techniques in Rizzoli Orthopaedic Institute of Bologna and in Cisanello Hospital of Pisa, Italy. All patients underwent percutaneous pedicle screw fixations (PPSF) coupled with mini-decompressions in case it was required by spinal cord compressions. All patients were evaluated pre and post-operatively by Frenkel classification and VAS scores. RESULTS Mean follow-up time was 19,4 months. Preoperatively, Frankel scores were E in 37 patients, D3 in 6 patients, D2 in 3 cases, D1 in 3 patients, B in one patient and C in two. The Frankel score improved in 10 patients, remained stable in 40 patients and worsened in two patients. Preoperatively, the mean VAS score in 29 patients treated with PPSF procedure with spinal decompression was 7, while postoperatively, it became 5. In 23 patients who underwent only PPSF procedure without spinal decompression mean VAS score was 5, postoperatively it became 3. CONCLUSIONS In selected cases, MISS surgeries may be considered as a valid alternative to open surgery. Although the efficacy of PPSF has been well documented in trauma or degenerative spine surgery, there is not sufficient literature about MISS techniques in spinal metastasis and further studies are needed to elucidate the most appropriate patient in which this approach could represent the gold standard of treatment.
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Affiliation(s)
- S Colangeli
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy.
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14
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Cosseddu F, Shytaj S, Sacchetti F, Capanna R, Manca M, Parchi PD, Scaglione M, Andreani L. Total hip replacement: a retrospective multicentric analysis on re-intervention rate after single component revision. J BIOL REG HOMEOS AG 2020; 34:191-196. Congress of the Italian Orthopaedic Research Society. [PMID: 33261276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Total hip arthroplasty (THA) revision is a procedure consisting in the replacement of a single or multiple implant components and could take place once or more times (re-revision). The aim of this multicentre study is to evaluate the benefits of single component revision in respect of the principles that define implant stability. Two hundred and forty-two patients underwent THA revision at Orthopaedic Clinic of Pisa and Versilia (ITA) from January 2007 to December 2016. We have systematically excluded revisions due to septic or traumatic prosthesis loosening, revisions of both implant components (cotyle and stem) and replacement alone. To evaluate implant stability, we used preoperative X ray and intra-operative mechanical stress tests, applying accredited criteria. Two hundred and twenty-six patients (93%) underwent a single procedure of THA revision: 193 had cotyle replacement and 33 had femoral stem replacement. The remaining 16 (7 %) underwent at least two procedures: 10 of them had consecutive failure of the same component, while the other 6 had revision of the other component after the first procedure. Considering our cases series, we can assert that single component revision is the best choice when no signs of loosening are present on the remaining component. Nevertheless, an accurate evaluation with unanimous radiological criteria and intraoperative testing is essential for the surgeon to choose the most suitable treatment.
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Affiliation(s)
- F Cosseddu
- 2nd Orthopedic Division University of Pisa, Italy
| | - S Shytaj
- 2nd Orthopedic Division University of Pisa, Italy
| | - F Sacchetti
- 1st Orthopedic Division University di Pisa, Italy
| | - R Capanna
- 2nd Orthopedic Division University of Pisa, Italy
| | - M Manca
- Orthopedic Division, Versilia Hospital, Lido di Camaiore (LU), Italy
| | - P D Parchi
- 1st Orthopedic Division University di Pisa, Italy
| | - M Scaglione
- 1st Orthopedic Division University di Pisa, Italy
| | - L Andreani
- 2nd Orthopedic Division University of Pisa, Italy
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15
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Grossi S, D'Arienzo A, Sacchetti F, Ceccoli M, Cosseddu F, Neri E, Colangeli S, Parchi PD, Andreani L, Capanna R. One-Step Reconstruction with Custom-made 3D-printed Scapular Prosthesis After Partial or Total Scapulectomy. Surg Technol Int 2020; 36:341-346. [PMID: 32190898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
En bloc scapulectomy with covering muscles was historically considered the only procedure available for surgical treatment of bone and soft tissue tumors of the scapula. When possible, reconstruction with scapular allograft is the gold standard, and gives satisfactory functional, cosmetic, and oncological outcomes. While good results have recently been reported with 3D-printed prostheses for reconstruction of bone loss, there is little information available in the medical literature regarding scapula reconstruction with a 3D-printed prosthesis. Between 2016 and 2018, we performed four scapular resections (two total and two involving the superior 1/3) followed by reconstruction with a 3D-printed prosthesis made of a porous titanium alloy (Ti-6Al-4V, diameter between 100 and 400 mm), using computer-aided design (CAD) and patient-specific implants (PSI) with previously acquired CT-MR fusion images. At 2 years follow-up, the patients with partial scapulectomy had an MSTS score of 76%, no local or systemic recurrence, good clinical results and no pain. At 1 year 6 months follow-up, the patients with total scapulectomy had an MSTS score of 46%, no local or systemic recurrence, fair clinical results and no pain. Thus, custom-made 3D-printed prostheses appear to be valuable in orthopedic surgery. However, a larger cohort and longer-term analysis are needed to evaluate the scapular 3D-printed prosthesis as a reliable reconstruction technique.
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Affiliation(s)
- Stefano Grossi
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Antonio D'Arienzo
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Federico Sacchetti
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Matteo Ceccoli
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Fabio Cosseddu
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Elisabetta Neri
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Simone Colangeli
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | | | - Lorenzo Andreani
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
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16
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Leonetti S, Tuvo B, Campanella B, Legnaioli S, Onor M, Bramanti E, Totaro M, Baggiani A, Giorgi S, Privitera GP, Piolanti N, Parchi PD, Casini B. Evaluation of Microbial Adhesion and Biofilm Formation on Nano-Structured and Nano-Coated Ortho-Prosthetic Materials by a Dynamic Model. Int J Environ Res Public Health 2020; 17:ijerph17031013. [PMID: 32033480 PMCID: PMC7036942 DOI: 10.3390/ijerph17031013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/18/2022]
Abstract
The bio-engineering technologies of medical devices through nano-structuring and coating was recently proposed to improve biocompatibility and to reduce microbial adhesion in the prevention of implantable device-related infections. Our aim was to evaluate the ability of new nano-structured and coated materials to prevent the adhesion and biofilm formation, according to the American Standard Test Method ASTM-E2647-13. The materials composition was determined by X-ray Fluorescence and Laser Induced Breakdown Spectroscopy. Silver release was evaluated by Inductively Coupled Plasma Mass Spectrometry analysis. The gene expression levels of the Quorum Sensing Las and Rhl system were evaluated by the ΔΔCt method. The Log bacterial density (Log CFU/cm2) on TiAl6V4 was 4.41 ± 0.76 and 4.63 ± 1.01 on TiAl6V4-AgNPs compared to 2.57 ± 0.70 on CoCr and 2.73 ± 0.61 on CoCr-AgNPs (P < 0.0001, A.N.O.V.A.- one way test). The silver release was found to be equal to 17.8 ± 0.2 µg/L after the batch phase and 1.3 ± 0.1 µg/L during continuous flow. The rhlR gene resulted in a 2.70-fold increased expression in biofilm growth on the silver nanoparticles (AgNPs) coating. In conclusion, CoCr showed a greater ability to reduce microbial adhesion, independently of the AgNPs coating. The silver release resulted in promoting the up-regulation of the Rhl system. Further investigation should be conducted to optimize the effectiveness of the coating.
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Affiliation(s)
- Simone Leonetti
- Department of Translational Research, N.T.M.S., University of Pisa, via San Zeno, 37/39-56127 Pisa, Italy; (S.L.); (B.T.); (M.T.); (A.B.); (S.G.); (G.P.P.)
| | - Benedetta Tuvo
- Department of Translational Research, N.T.M.S., University of Pisa, via San Zeno, 37/39-56127 Pisa, Italy; (S.L.); (B.T.); (M.T.); (A.B.); (S.G.); (G.P.P.)
| | - Beatrice Campanella
- Institute of Chemistry of Organometallic Compounds, National Research Council, via Giuseppe Moruzzi, 1-56124 Pisa, Italy; (B.C.); (S.L.); (M.O.); (E.B.)
| | - Stefano Legnaioli
- Institute of Chemistry of Organometallic Compounds, National Research Council, via Giuseppe Moruzzi, 1-56124 Pisa, Italy; (B.C.); (S.L.); (M.O.); (E.B.)
| | - Massimo Onor
- Institute of Chemistry of Organometallic Compounds, National Research Council, via Giuseppe Moruzzi, 1-56124 Pisa, Italy; (B.C.); (S.L.); (M.O.); (E.B.)
| | - Emilia Bramanti
- Institute of Chemistry of Organometallic Compounds, National Research Council, via Giuseppe Moruzzi, 1-56124 Pisa, Italy; (B.C.); (S.L.); (M.O.); (E.B.)
| | - Michele Totaro
- Department of Translational Research, N.T.M.S., University of Pisa, via San Zeno, 37/39-56127 Pisa, Italy; (S.L.); (B.T.); (M.T.); (A.B.); (S.G.); (G.P.P.)
| | - Angelo Baggiani
- Department of Translational Research, N.T.M.S., University of Pisa, via San Zeno, 37/39-56127 Pisa, Italy; (S.L.); (B.T.); (M.T.); (A.B.); (S.G.); (G.P.P.)
| | - Serena Giorgi
- Department of Translational Research, N.T.M.S., University of Pisa, via San Zeno, 37/39-56127 Pisa, Italy; (S.L.); (B.T.); (M.T.); (A.B.); (S.G.); (G.P.P.)
| | - Gaetano Pierpaolo Privitera
- Department of Translational Research, N.T.M.S., University of Pisa, via San Zeno, 37/39-56127 Pisa, Italy; (S.L.); (B.T.); (M.T.); (A.B.); (S.G.); (G.P.P.)
| | - Nicola Piolanti
- Orthopaedic and Traumatology Division, Azienda ospedaliera-Universitaria Pisana, via Roma, 67-56126 Pisa, Italy;
| | - Paolo Domenico Parchi
- Department of Translational Research, N.T.M.S., University of Pisa, via San Zeno, 37/39-56127 Pisa, Italy; (S.L.); (B.T.); (M.T.); (A.B.); (S.G.); (G.P.P.)
- Orthopaedic and Traumatology Division, Azienda ospedaliera-Universitaria Pisana, via Roma, 67-56126 Pisa, Italy;
| | - Beatrice Casini
- Department of Translational Research, N.T.M.S., University of Pisa, via San Zeno, 37/39-56127 Pisa, Italy; (S.L.); (B.T.); (M.T.); (A.B.); (S.G.); (G.P.P.)
- Correspondence: ; Tel.: +39-050-221-3590
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17
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Novi M, Vanni C, Parchi PD, Di Paolo M, Piolanti N, Scaglione M. Claims in total hip arthroplasty: analysis of the instigating factors, costs and possible solution. Musculoskelet Surg 2019. [PMID: 30758765 DOI: 10.1007/s12306-019-00590-6.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Over the years, the number of total hip replacements has been steadily increasing. Despite the improvement in surgical results, the number of claims for malpractice is higher. The primary endpoint of this work is to provide an analysis of litigation after hip replacement, to outline what are the instigating causes and costs. The secondary endpoint is to propose a possible preventive strategy for an improved care and a reduction in legal proceedings. MATERIALS AND METHODS The data of this study were collected from medical and legal files and from professional liability insurance of our institution from January 2005 to December 2016. RESULTS Out of a total of 4770 THA, 40 claims were received. Peripheral nerve injuries represent the first cause of litigation (37%), followed by infectious complications, leg length discrepancy, metallosis, dislocations of the implant and a case of deep vein thrombosis. From the analysis of the past trial judgment, complications such as nerve lesions and infections are almost always recognized, as a medical error, with a high percentage of claims settled. CONCLUSION This study shows the necessity of preventive strategies to reduce the higher number of claims for malpractice in total hip arthroplasty. Some complications such as nerve injuries and infection are frequently considered directly dependent on physician's errors. Litigations can be reduced providing evidence of a diligent execution of the surgical procedure and of a proper postoperative management: the correct compilation of a specific informed consent and adequate doctor-patient communication.
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Affiliation(s)
- M Novi
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy.
| | - C Vanni
- Law Medicine Unit, University Hospital of Pisa, Pisa, Italy
| | - P D Parchi
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
| | - M Di Paolo
- Law Medicine Unit, University Hospital of Pisa, Pisa, Italy
| | - N Piolanti
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
| | - M Scaglione
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
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18
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Novi M, Vanni C, Parchi PD, Di Paolo M, Piolanti N, Scaglione M. Claims in total hip arthroplasty: analysis of the instigating factors, costs and possible solution. Musculoskelet Surg 2019; 104:43-48. [PMID: 30758765 DOI: 10.1007/s12306-019-00590-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Over the years, the number of total hip replacements has been steadily increasing. Despite the improvement in surgical results, the number of claims for malpractice is higher. The primary endpoint of this work is to provide an analysis of litigation after hip replacement, to outline what are the instigating causes and costs. The secondary endpoint is to propose a possible preventive strategy for an improved care and a reduction in legal proceedings. MATERIALS AND METHODS The data of this study were collected from medical and legal files and from professional liability insurance of our institution from January 2005 to December 2016. RESULTS Out of a total of 4770 THA, 40 claims were received. Peripheral nerve injuries represent the first cause of litigation (37%), followed by infectious complications, leg length discrepancy, metallosis, dislocations of the implant and a case of deep vein thrombosis. From the analysis of the past trial judgment, complications such as nerve lesions and infections are almost always recognized, as a medical error, with a high percentage of claims settled. CONCLUSION This study shows the necessity of preventive strategies to reduce the higher number of claims for malpractice in total hip arthroplasty. Some complications such as nerve injuries and infection are frequently considered directly dependent on physician's errors. Litigations can be reduced providing evidence of a diligent execution of the surgical procedure and of a proper postoperative management: the correct compilation of a specific informed consent and adequate doctor-patient communication.
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Affiliation(s)
- M Novi
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy.
| | - C Vanni
- Law Medicine Unit, University Hospital of Pisa, Pisa, Italy
| | - P D Parchi
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
| | - M Di Paolo
- Law Medicine Unit, University Hospital of Pisa, Pisa, Italy
| | - N Piolanti
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
| | - M Scaglione
- 1° Orthopaedic and Traumatology Unit, Department of Translational Research and New Technology in Medicine and Surgery, University Hospital of Pisa, Via Paradisa, 2, 56100, Pisa, Italy
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19
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Piolanti N, Poggetti A, Nucci AM, Nesti A, Marchetti S, Parchi PD, Scaglione M. The 50 most cited articles about wrist surgery. Orthop Rev (Pavia) 2018; 10:7715. [PMID: 30662683 PMCID: PMC6315303 DOI: 10.4081/or.2018.7715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/07/2018] [Indexed: 11/23/2022] Open
Abstract
The purpose was to establish a ranking of the 50 most cited articles about wrist surgery and analyse their features. Science Citation Index Expanded was used to identify the 50 most frequently cited orthopaedic journal articles written in English, searching for the topic “wrist surgery” in the subject category ‘‘Orthopaedics’’. Then, we analysed the number of citations, citation density, authorship, article institution, the year of publication, the country of origin of the article, name and impact factor of the journal, and publication type of the article. The 50 most cited articles were published in only 6 of the 74 journals included under the category “orthopaedics”. Citation count ranged from 256 for the first one to 67 for the 50th article. Most of them were written by American authors. These articles were published between 1991 and 2011. “Distal Radius Fractures” was the most common issue. This type of bibliographic analysis could be particularly useful for other young Authors who would like to improve their research in wrist and hand surgery and make their publications more citable and appreciated by the scientific community.
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Affiliation(s)
- Nicola Piolanti
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Andrea Poggetti
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Anna Maria Nucci
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Agnese Nesti
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Stefano Marchetti
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Paolo Domenico Parchi
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
| | - Michelangelo Scaglione
- Department of Translational Research on New Technologies in Medicine and Surgery, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy
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20
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Parchi PD, Ciapini G, Paglialunga C, Giuntoli M, Picece C, Chiellini F, Lisanti M, Scaglione M. Anterior Cruciate Ligament Reconstruction with LARS Artificial Ligament-Clinical Results after a Long-Term Follow-Up. Joints 2018; 6:75-79. [PMID: 30051101 PMCID: PMC6059861 DOI: 10.1055/s-0038-1653950] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/08/2018] [Indexed: 02/08/2023]
Abstract
Purpose
The aim of this retrospective study was to evaluate the subjective and functional outcome of anterior cruciate ligament (ACL) reconstruction with the synthetic Ligament Advanced Reinforcement System (LARS) ligament.
Methods
Twenty-six patients were reviewed at an average follow-up of 11.6 years. Objective clinical evaluation was performed with stability tests. Patient-reported outcomes (Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score, and Cincinnati Knee Rating Scale) were used to assess subjective and functional outcomes.
Results
Overall satisfactory results were obtained in 22 cases (84.6%). Four patients (15.4%) showed mechanical failure of the graft. No cases of synovitis or infection were reported.
Conclusion
LARS ligament can be considered a safe and suitable option for ACL reconstruction in carefully selected cases, especially elderly patients needing a rapid postoperative recovery.
Level of Evidence
Level IV, retrospective case series.
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Affiliation(s)
- Paolo Domenico Parchi
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gianluca Ciapini
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Carlo Paglialunga
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michele Giuntoli
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Carmine Picece
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Fabio Chiellini
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michele Lisanti
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michelangelo Scaglione
- 1st Orthopedic Division of Pisa University, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Piolanti N, Giuntoli M, Nucci AM, Bonicoli E, Parchi PD, Scaglione M. Septic coxitis after an intramuscular injection in a young adult treated by two-steps total hip arthroplasty: a case report. International Journal of Surgery Open 2018. [DOI: 10.1016/j.ijso.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Franzini M, Nesti A, Panetta D, Fierabracci V, Marchetti S, Parchi PD, Caponi L, Paolicchi A, Musetti V, Salvadori P, Edmin M, Pucci A, Bonicoli E, Scaglione M, Piolanti N. Correlation between gamma glutamyltransferase fractions and bone quality. J BIOL REG HOMEOS AG 2017; 31:14. [PMID: 29186945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Gamma-glutamyltransferase (GGT) has been recently identified as a bone-resorbing factor. The aim of this study was to investigate the association between plasma GGT fractions levels and bone quality. Plasma GGT fractions were analysed by gel-filtration chromatography. Bone quality was established quantitatively by two micro-CT derived microarchitectural parameters: the BV/TV (mineralised bone volume/total volume), and the SMI (structure model index) that describes the rod-like (low resistant) or plate-like (high-resistant) shape of bone trabeculae. We enrolled 93 patients hospitalised for elective total hip replacement (group Arthrosis, n=46) or for proximal femoral fracture (group Fracture, n=47). Patients within the first quartile of BV/TV (Q1, osteoporotic patients, n=6) showed higher levels of b-GGT fraction [median (min-max): 3.37 (1.42–6.81)] compared to patients with normal bone density (fourth quartile Q4, n=10; 1.40 (0.83–4.36); p=0.0393]. Also, according to SMI, b-GGT value was higher in the subgroup with bone fragility [Q1, n=8: 1.36 (0.43–4.36); Q4, n=8: 5.10 (1.4 –7.60); p=0.0117]. In conclusion, patients characterised by fragile bone structure showed specifically higher levels of plasma b-GGT activity thus suggesting fractional GGT analysis as a possible biomarker in the diagnosis of osteoporosis.
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Affiliation(s)
- M Franzini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - A Nesti
- Department of Orthopaedics and Traumatology I, University of Pisa
| | - D Panetta
- Institute of Clinical Physiology of National Research Council (IFC-CNR) of Pisa
| | - V Fierabracci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - S Marchetti
- Department of Orthopaedics and Traumatology I, University of Pisa
| | - P D Parchi
- Department of Orthopaedics and Traumatology I, University of Pisa
| | - L Caponi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - A Paolicchi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - V Musetti
- Department of Laboratory Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - P Salvadori
- Institute of Clinical Physiology of National Research Council (IFC-CNR) of Pisa
| | - M Edmin
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - A Pucci
- Histopathology Department, University Hospital, Pisa, Italy
| | - E Bonicoli
- Department of Orthopaedics and Traumatology I, University of Pisa
| | - M Scaglione
- Department of Orthopaedics and Traumatology I, University of Pisa
| | - N Piolanti
- Department of Orthopaedics and Traumatology I, University of Pisa
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23
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Bonicoli E, Piolanti N, Giuntoli M, Polloni S, Ciapini G, Parchi PD, Scaglione M. Clinical and radiographic short mid-term outcomes of primary total stabilizer knee arthroplasty. J BIOL REG HOMEOS AG 2017; 31:7-14. [PMID: 29172300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A successful Total Knee Arthroplasty (TKA) requires stability, but rarely in primary TKA, a prosthesis with more constraint than a posterior-stabilizer (PS) is necessary. In patients with severe varus/valgus deformities with incompetent collateral ligaments or in knees that cannot be adequately balanced after ligaments release, a total-stabilizer (TS) prosthesis may be required. The purpose of our retrospective study is to evaluate clinical and radiographic outcomes at short mid-term follow-up in patients treated with a TS TKA. Between January 2013 and August 2016, 36 patients (38 knees) were treated with Stryker Triathlon TS cemented implants. Clinical and radiographic evaluation were performed preoperatively and postoperatively at 1 month, 3 months, 6 months, 1 year and at 1-year intervals thereafter. At final follow-up, 33 patients (35 knees) remained and were included in this study and followed with a mean follow-up of 26.6 months. Clinical evaluation was performed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC score) and the Knee Society rating system that is subdivided into a knee score (KS) that rates only the knee joint itself and a functional score (FS). Knee Score (KS) and Functional Score (FS) increased significantly from a mean pre-operative value of 48 and 45, respectively, to a post-operative value at last follow-up of 86 and 82, respectively. Also WOMAC score improved significantly: the mean pre-operative WOMAC score was 45, while the mean post-operative WOMAC score, at last follow-up, was 19. The difference between pre- and post- operative results was significant at statistical analysis. In our opinion, when the adequately prosthesis balancing isn’t possible, because of primary or secondary severe varus/valgus deformity or severe soft tissues retraction, an available option is to perform a total knee arthroplasty with a total stabilizer polyethylene insert. TS prosthesis gives more stability during the most of ROM and, in addition, Triathlon system provides surgeons the possibility to choose a more constrained implant, than a standard PS one, during surgical procedure saving the bone stock. Our experience with this kind of prosthesis has provided good clinical and radiographic outcomes at a short mid-term follow-up with a low-rate of complications.
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Affiliation(s)
- E Bonicoli
- First Orthopaedic Division, University of Pisa, Pisa, Italy
| | - N Piolanti
- First Orthopaedic Division, University of Pisa, Pisa, Italy
| | - M Giuntoli
- First Orthopaedic Division, University of Pisa, Pisa, Italy
| | - S Polloni
- First Orthopaedic Division, University of Pisa, Pisa, Italy
| | - G Ciapini
- First Orthopaedic Division, University of Pisa, Pisa, Italy
| | - P D Parchi
- First Orthopaedic Division, University of Pisa, Pisa, Italy
| | - M Scaglione
- First Orthopaedic Division, University of Pisa, Pisa, Italy
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24
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Giannotti S, Parchi PD, Colasanti GB, Agostini G, Moreschini F, Cataldi C, Ferrata P, Capanna R. Use of autologous bone marrow cells concentrate enriched with platelet-fibrin on extensor mechanism allograft reconstruction for extensor mechanism failure following total knee arthroplasty. J BIOL REG HOMEOS AG 2017; 31:107-111. [PMID: 29186946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Allografts techniques remain the best reconstructive strategy for chronic extensor mechanism lesions after total knee arthroplasty (3) but outcomes depend strictly on the host tissue-allograft junctions healing. The purpose of this study is to evaluate if modern techniques of adding autologous bone marrow cells concentrate enriched with platelet-rich fibrin, provide better healing of the allograft. We present the case of an 86 years old patient affected by patellar tendon rupture after TKA. A whole extensor mechanism allograft was performed adding a bone marrow cells concentrate enriched with platelet-rich fibrin on the host tissue-allograft junctions. Preoperatively and at each follow-up the value of Knee Society Score and radiographic consolidation signs were recorded. Radiographic controls showed clear signs of consolidation already at 1 months follow-up and a solid fusion at 3 months. This case report describes a valid method to improve healing using a tissue-construct engineered with stem cells and growth factors.
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Affiliation(s)
- S Giannotti
- U.O.C. Ortopedia e Traumatologia Università degli Studi di Siena
| | - P D Parchi
- U.O. Ortopedia e Traumatologia Università degli Studi di Pisa
| | - G B Colasanti
- U.O.C. Ortopedia e Traumatologia Università degli Studi di Siena
| | - G Agostini
- U.O. Ortopedia e Traumatologia Università degli Studi di Pisa
| | - F Moreschini
- U.O.C. Ortopedia e Traumatologia Università degli Studi di Siena
| | - C Cataldi
- U.O.C. Ortopedia e Traumatologia Università degli Studi di Siena
| | - P Ferrata
- U.O.C. Ortopedia e Traumatologia Università degli Studi di Siena
| | - R Capanna
- U.O. Ortopedia e Traumatologia Università degli Studi di Pisa
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25
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Castellini I, Andreani L, Parchi PD, Bonicoli E, Piolanti N, Risoli F, Lisanti M. Hydroxyapatite in total hip arthroplasty. Our experience with a plasma spray porous titanium alloy/hydroxyapatite double-coated cementless stem. ACTA ACUST UNITED AC 2017; 13:221-227. [PMID: 28228786 DOI: 10.11138/ccmbm/2016.13.3.221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE Total hip arthroplasty could fail due to many factors and one of the most common is the aseptic loosening. In order to achieve an effective osseointegration and reduce risk of lossening, the use of cemented implant, contact porous bearing surface and organic coating were developed. Aim of this study was to evaluate clinical and radiological mid-term outcomes of a porous titanium alloy/hydroxyapatite double coating manufactured cementless femoral stem applied with "plasma spray" technique and to demonstrate the possibility to use this stem in different types of femoral canals. METHODS Between January 2008 and December 2012, 240 consecutive primary total hip arthroplasties (THAs) were performed using a porous titanium alloy/hydroxyapatite double coating manufactured cementless femoral stem. 182 patients were examined: 136 were females (74.7%) and 46 males (25.2%); average age was 72 years old (ranging from 26 to 92 years old). For each patient, Harris Hip Scores (HHS) and Womac Scores were collected. All X-ray images were analyzed in order to demonstrate stem survival rate and subsidence. RESULTS Harris Hip Score was good or excellent in 85% of the cases (average 90%) and mean WOMAC score was 97.5 (ranging from 73.4 to 100). No cases of early/late infection or periprosthetic fracture were noticed, with an excellent implant survival rate (100%) in a mean period of 40 months (ranging from 24 and 84 months). 5 cases presented acute implant dislocation, 2 due to wrong cup positioning in a dysplastic acetabulum and 3 after ground level fall. Dorr classification of femoral geometry was uses and the results were: 51 type A bone, 53 type B bone and 78 type C bone. Stem subsidence over 2 mm was considered as a risk factor of future implant loosening and was evidenced in 3 female patients with type C of Dorr classification. No radiolucencies signs around the proximally coated portion of stem or proximal reabsorption were visible during the radiographic follow-up. CONCLUSIONS Concerning the use of porous titanium alloy/hydroxyapatite double coating, this study reported an excellent implant survival rate in a mid-term period with a rate of 1,64% of subsidence in patients with type C of femoral canal but with an optimal HHS and Womac Score results. Regarding this stem, primary stability is guaranteed by trapezoid shape of proximal region and tapering in frontal plane through press-fit technique. Radiological absence of pedestal has been accepted as sign of no excessive stress transmission to distal cortex due to its tapered diaphyseal region. Thanks to the reported data, Authors can consider this double coating a valid choice with an excellent medium-term survival and encouraging subsidence results. Further studies are needed to ensure these results can be replicated.
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Affiliation(s)
- Iacopo Castellini
- Orthopaedics and Traumatology 1st Department, University of Pisa, Pisa, Italy
| | - Lorenzo Andreani
- Orthopaedics and Traumatology 1st Department, University of Pisa, Pisa, Italy
| | | | - Enrico Bonicoli
- Orthopaedics and Traumatology 1st Department, University of Pisa, Pisa, Italy
| | - Nicola Piolanti
- Orthopaedics and Traumatology 1st Department, University of Pisa, Pisa, Italy
| | - Francesca Risoli
- Orthopaedics and Traumatology 1st Department, University of Pisa, Pisa, Italy
| | - Michele Lisanti
- Orthopaedics and Traumatology 1st Department, University of Pisa, Pisa, Italy
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26
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Poggetti A, Battistini P, Parchi PD, Novelli M, Raffa S, Cecchini M, Nucci AM, Lisanti M. How to Direct the Neuronal Growth Process in Peripheral Nerve Regeneration: Future Strategies for Nanosurfaces Scaffold and Magnetic Nanoparticles. Surg Technol Int 2017; 30:458-461. [PMID: 28182823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Currently, the gold standard to repair large nerve defects is the autologous nerve graft. These solutions offer a mechanical support, adhesion substrates, and, with Schwann cells (SC), a source of neurotropic factors for axonal growth. The technical limits are the donor side damage, multiple surgical accesses, and the unavailability of large amounts of grafts. In recent years, several researchers focused their attention on the interaction between cells (nervous and glial) and physic-chemical cues that arise from the extracellular milieu. Nanotechnologies produce surfaces that mimic the topographical signals (physical stimuli) that arise from enterprise content management (ECM) to modulate the forces acting during axonal elongation. The use of magnetic nanoparticles (MNPs) seems to be able to guide and to boost the nerve regeneration. Both research areas could be improved through surfaces functionalization by biological molecules (proteins/peptides, growth factors, etc.). In the future, the aim will be to help recovery after peripheral nerve lesion by producing a tridimensional structured conduit, then repeat the ECM architecture and take advantage of MNPs internalized by cells and guide them through tension forces by external magnetic fields to stimulate and direct axon growing. The aims of this review were to evaluate the findings of studies that used physical stimuli (nanoscaffold surfaces and MNPs) used for peripheral nerve regeneration support. The future trends in the field of peripheral nerve regeneration continue to produce a wide variety of new techniques to improve the opportunity for advances to treat peripheral nerve injuries.
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Affiliation(s)
| | | | | | | | - Simona Raffa
- Institute for Medical Science, and Technology, Scotland, United Kingdom
| | - Marco Cecchini
- NEST Istituto Nanoscienze-CNR, University of Pisa, Pisa, Italy
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27
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Niccolai F, Parchi PD, Vigorito A, Pasqualetti G, Monzani F, Lisanti M. The correlation between preoperative levels of albumin and tlc and mortality in patients with femoral neck fracture. J BIOL REG HOMEOS AG 2016; 30:187-191. [PMID: 28002918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A femoral neck fracture in an elderly patient often represents a major challenge for the orthopaedic surgeon who has to face not only the fracture, but also all the multiple issues related to age. Among others, malnutrition has been recognised as an important factor associated with severe aggravation in these patients. One-hundred-and-forty-seven patients were enrolled to investigate the use of two markers of patient nutritional status, i.e. serum albumin level and total leukocyte count (TLC), as predictors of mortality in the elderly patient suffering from proximal femur fracture. We found that low preoperative values of serum albumin and TLC proved to be directly related to worse outcomes. Therefore, these exams can be useful to identify patients with a femoral neck fracture that have higher risk of malnutrition and consequent higher mortality and that can benefit from some measures, such as albumin or protein nutritional supplement.
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Affiliation(s)
- F Niccolai
- 1st Orthopedic Division, University of Pisa, Pisa, Italy
| | - P D Parchi
- 1st Orthopedic Division, University of Pisa, Pisa, Italy
| | - A Vigorito
- 1st Orthopedic Division, University of Pisa, Pisa, Italy
| | | | - F Monzani
- Geriatric Division, University of Pisa, Pisa, Italy
| | - M Lisanti
- 1st Orthopedic Division, University of Pisa, Pisa, Italy
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28
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Parchi PD, Evangelisti G, Andreani L, Girardi F, Darren L, Sama A, Lisanti M. Postoperative Spine Infections. Orthop Rev (Pavia) 2015; 7:5900. [PMID: 26605028 PMCID: PMC4592931 DOI: 10.4081/or.2015.5900] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/22/2015] [Accepted: 07/22/2015] [Indexed: 12/14/2022] Open
Abstract
Postoperative spinal wound infection is a potentially devastating complication after operative spinal procedures. Despite the utilization of perioperative prophylactic antibiotics in recent years and improvements in surgical technique and postoperative care, wound infection continues to compromise patients’ outcome after spinal surgery. In the modern era of pending health care reform with increasing financial constraints, the financial burden of post-operative spinal infections also deserves consideration. The aim of our work is to give to the reader an updated review of the latest achievements in prevention, risk factors, diagnosis, microbiology and treatment of postoperative spinal wound infections. A review of the scientific literature was carried out using electronic medical databases Pubmed, Google Scholar, Web of Science and Scopus for the years 1973-2012 to obtain access to all publications involving the incidence, risk factors, prevention, diagnosis, treatment of postoperative spinal wound infections. We initially identified 119 studies; of these 60 were selected. Despite all the measures intended to reduce the incidence of surgical site infections in spine surgery, these remain a common and potentially dangerous complication.
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Affiliation(s)
| | | | | | - Federico Girardi
- Spine Care Institute Hospital For Special Surgery , New York, NY, USA
| | - Lebl Darren
- Spine Care Institute Hospital For Special Surgery , New York, NY, USA
| | - Andrew Sama
- Spine Care Institute Hospital For Special Surgery , New York, NY, USA
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29
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Piolanti N, Nesti A, Andreani L, Parchi PD, Cervi V, Castellini I, Marchetti S. The fifty most cited Italian articles in the orthopaedic literature. Musculoskelet Surg 2015; 99:105-11. [PMID: 25845671 DOI: 10.1007/s12306-015-0352-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/22/2015] [Indexed: 11/24/2022]
Abstract
PURPOSES It is widely known that in Orthopaedics, as in each specialty, the academic influence of an article is also determined by the number of times the article is cited. The aim of this study was to identify the 50 most frequently cited Italian orthopaedics journal articles and to analyse the characteristics that might have made them more citable. METHODS Science Citation Index Expanded was searched for the 50 most frequently cited Italian orthopaedics journal articles between 1988 and 2013 in the subject category "Orthopaedics". RESULTS The 50 most frequently cited articles were all published in English and were published in 12 of the 67 journals in the subject category "Orthopaedics" in the Institute for Scientific Information Web Science (Thomson Reuters, New York, New York, USA). One half of the articles were published before 2000 and the other half later. The number of citations ranged from 423 of the first article (mean citation/years 21.15) to 83 of the fiftieth (mean citation/years 16.60). The articles were all categorized under orthopaedic field, but each of them spanned from orthopaedics to a specific sub-specialty. The majority was clinical articles (n = 39), and the most common fields were sport orthopaedic surgery (including arthroscopy and cartilage) (n = 19) and biomechanics (n = 12). CONCLUSIONS This list of 50 most frequently cited Italian articles is, to our knowledge, significantly important for the general orthopaedic scientific community, particularly for the Italian orthopaedic community. Researchers and doctors may use this work to make their future publications more influential and citable.
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Affiliation(s)
- N Piolanti
- 1st Orthopedic Division, Department of Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, 56124, Pisa, PI, Italy,
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Parchi PD, Cervi V, Piolanti N, Ciapini G, Andreani L, Castellini I, Poggetti A, Lisanti M. Densitometric evaluation of periprosthetic bone remodeling. ccmbm 2014. [PMID: 25568658 DOI: 10.11138/ccmbm/2014.11.3.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Paolo Domenico Parchi
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Valentina Cervi
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Nicola Piolanti
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gianluca Ciapini
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Lorenzo Andreani
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Iacopo Castellini
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Andrea Poggetti
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michele Lisanti
- 1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
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Parchi PD, Ferrari V, Piolanti N, Andreani L, Condino S, Evangelisti G, Lisanti M. Computer tomography prototyping and virtual procedure simulation in difficult cases of hip replacement surgery. Surg Technol Int 2013; 23:228-234. [PMID: 23975443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Each year approximately 1 million total hip replacements (THR) are performed worldwide. A percentage of failure due to surgical approach and imprecise implant placement still exists. These result in several serious complications. We propose an approach to plan, to simulate, and to assist prosthesis implantation for difficult cases of THR based on 3-D virtual models, generated by segmenting patients' CT images, 3-D solid models, obtained by rapid prototyping (RP), and virtual procedure simulation. We carried out 8 THR with the aid of 3-D reconstruction and RP. After each procedure a questionnaire was submitted to the surgeon to assess the perceived added value of the technology. In all cases, the surgeon evaluated the 3-D model as useful in order to perform the planning. The clinical results showed a mean increase in the Harris Hip Score of about 42.5 points. The mean time of prototyping was 7.3 hours, (min 3.5 hours, max 9.3 hours). The mean surgery time was 65 minutes (min 50 minutes, max 88 minutes). Our study suggests that meticulous preoperative planning is necessary in front of a great aberration of the joint and in absence of normal anatomical landmarks, CT scan is mandatory, and 3-D reconstruction with solid model is useful.
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Affiliation(s)
| | - Vincenzo Ferrari
- EndoCAS Center for Computer Assisted Surgery University of Pisa, Pisa, Italy
| | | | | | - Sara Condino
- EndoCAS Center for Computer Assisted Surgery University of Pisa, Pisa, Italy
| | | | - Michele Lisanti
- Chief of the 1st Orthopaedic Department of Pisa University of Pisa, Pisa, Italy
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Parchi PD, Gianluca C, Dolfi L, Baluganti A, Nicola P, Chiellini F, Lisanti M. Anterior cruciate ligament reconstruction with LARS™ artificial ligament results at a mean follow-up of eight years. Int Orthop 2013; 37:1567-74. [PMID: 23812539 DOI: 10.1007/s00264-013-1917-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 04/25/2013] [Indexed: 01/24/2023]
Abstract
PURPOSE The aim of this study was to review patients that underwent ACL reconstruction with the LARS™ ligament in the First Orthopaedic Division of Pisa University during the period between January 2003 and December 2005. METHODS Twenty-six patients were reviewed with an average follow-up of 95.3 months (7.9 years). The review protocol was articulated in three phases: (1) a subjective evaluation using three grading scales: VAS, KOOS and the Cincinnati knee rating scale, (2) a clinical and objective evaluation, and (3) a biomechanical evaluation of the knee stability. RESULTS A global positive result was obtained in 92.3 % of the patients (16 optimal results and eight good results), with a fast functional recovery and a high knee stability. A global poor result was reported in two cases. In our series we did not record cases of infection or knee synovitis. We recorded only one case of mechanical graft failure. The results obtained from our study are encouraging and similar to those in the literature. CONCLUSIONS We conclude that the LARS™ ligament can be considered a suitable option for ACL reconstruction in carefully selected cases, especially for older patients needing a fast functional recovery.
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