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Papers by Andrea Fidanza

Microorganisms, Jan 26, 2024

Journal of orthopaedics and traumatology, Feb 28, 2024

Healthcare

The aim of this study was to investigate clinical and instrumental outcomes of the autologous mat... more The aim of this study was to investigate clinical and instrumental outcomes of the autologous matrix-induced chondrogenesis (AMIC) technique for the treatment of isolated traumatic condyle and femoropatellar cartilage lesions. A total of 25 patients (12 males, 13 females, mean age 47.3 years) treated between 2018 and 2021 were retrospectively reviewed and subdivided into two groups based on age (Group A, age < 45 years; Group B, age > 45 years). A clinical evaluation was performed using the International Knee Documentation Committee (IKDC), Lysholm score and Visual Analogue Score (VAS). Cartilage regeneration was evaluated via magnetic resonance (1.5 Tesla) and classified according to a Magnetic resonance Observation of CArtilage Repair Tissue (MOCART) scoring system. At a minimum follow-up of 2 years, Group A patients obtained greater instrumental results in comparison to group B: in fact, the MOCART score was statistically significantly correlated with IKDC (r = 0.223) (p &l...

PubMed, Jun 23, 2023

Background/Aim of the study: The periprosthetic or superficial site infections are one of the mos... more Background/Aim of the study: The periprosthetic or superficial site infections are one of the most catastrophic and difficult to manage complications following total hip arthroplasty. Recently, in addition to well know systemic markers of inflammation, the blood and synovial fluid biomarkers are focused to have a possible role in the infection diagnosis. The long Pentraxin 3 (PTX3) seems to be a sensitive biomarker of acute phase inflammation. The objectives of this prospective and multicentre study were (1) to establish the plasma trend effectiveness of PTX3 in patients undergoing primary hip replacement, and (2) to evaluate the diagnostic accuracy of blood and synovial PTX3 in patients undergoing prosthetic revision of infected hip arthroplasty. Methods: Human PTX3 was measured by ELISA in two cohorts of patients, 10 patients undergoing primary hip replacement for osteoarthritis and 9 patients with infected hip arthroplasty. Results: The Authors were able to demonstrate that PTX3 is a viable biomarker for acute phase inflammation. Conclusions: An increase in PTX3 protein concentration in the synovial fluid of patients undergoing implant revision has a strong diagnostic capacity for periprosthetic joint infection, showing 97% specificity.

Hip International, Sep 1, 2020

In this article the authors describe a modified surgical technique developed to enhance the class... more In this article the authors describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining a total hip arthroplasty (THA) undergoing acute periprosthetic joint infection (PJI). This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulphate antibiotic-added beads. The combination of 3 different surgical techniques (tumour-like synovectomy, Argon Beam application and chlorhexidine gluconate brushing) might enhance the disruption and removal of the bacterial biofilm which is the main responsible of antibiotics and antibodies resistance. The timing of the diagnosis (6 weeks from the original surgery or 1 week from clinical symptoms appearance in the case of an hematogenous infection) and the preoperative isolation of the germ are fundamental in order to obtain a satisfactory outcome. A 12week course of postoperative antibiotic therapy (6 weeks I.V. and 6 weeks oral) complete the postoperative protocol used by the authors. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous PJI.

Knee Surgery, Sports Traumatology, Arthroscopy, Feb 13, 2020

Purpose Modern total knee arthroplasty (TKA) systems are designed to reproduce the normal knee ki... more Purpose Modern total knee arthroplasty (TKA) systems are designed to reproduce the normal knee kinematics and improve patient outcome. The authors compared two different third-generation medial pivot TKA implants, having a single-radius or a J-curve design in their sagittal plane, hypothesizing no clinical differences. Methods Two cohorts of 50 patients who underwent primary TKA were first preoperatively matched by sex, deformity, body mass index (BMI), Oxford Knee Score (OKS), Knee society score (KSS) and range of motion (ROM) and then statistically analyzed at a minimum follow-up (FU) of 2 years. An identical surgical technique, which aimed to reproduce a slightly tighter medial than lateral compartment, was used in all knees. Results At a minimum follow-up of 2 years (range 24-34 months) there were no statistically significant differences in OKS and KSS between the two implant groups. The final ROM differed statistically between the two groups: the average maximum active flexion was 123° in the J-curve femoral design group with an adapted "medially-congruent" polyethylene insert, and 116° in the single radius femoral design with a medial "ball-in-socket" articulation. Conclusion No clinical and radiological differences were found when the two cohorts of patients were compared. This study showed that the implant design played a minor role in the final outcome as opposed to a precise surgical technique. Level of evidence Retrospective case-control study, Level III.

Lo Scalpello, Sep 1, 2022

Background. The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MAL... more Background. The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has recently been proposed as novel alpha-defensins test for diagnosis of peri-prosthetic joint infections (PJIs). The aim of the current study is to assess the diagnostic accuracy of alpha-defensins MALDI-TOF MS in case of acute PJIs. Methods. This prospective study included a series of 10 consecutive patients affected by PJIs according to the 2018 MSIS criteria. Synovial fluids were assessed for routine synovial fluid tests and alpha-defensins measurement with MALDI-TOF MS. Sensitivity, specificity, positive, and negative predictive values (PPV and NPV) were assessed. Results. Six females and 4 males with acute PJIs were included. The mean age was 72.5 (range 67-79), and the mean time elapsed from primary arthroplasty to PJIs was 52 days (range 13-90). Eight TKA and 2 THA were evaluated. The involved bacteria were Staphylococcus aureus in 4 patients, coagulase-negative Staphylococcus species in 3 patients, Enterococcus species in 3 patients, and Pseudomonas aeruginosa in 1 patient. Three cases were characterized by polymicrobial infection. The MALDI-TOF alpha-defensin test correctly identified all 10 patients with acute PJIs. According to the current preliminary results the MALDI-TOF assay showed a 100% sensitivity, specificity, PPV, and NPV. Conclusions. The novel alpha-defensins MALDI-TOF MS test showed promising results with high sensitivity and specificity in the diagnosis of acute PJIs. The reliability of the test in case of acute PJI could allow surgeons to manage the infection with a less invasive procedure with several advantages for patients. The findings of the present study seemed to confirm that the novel assay, which needs only few milliliters of sample, provides rapid results, and has substantial cost-effectiveness, and thus may be a useful diagnostic tool in clinical practice, even in case of acute PJIs. Further studies are needed to confirm these results on a larger series of patients.

Minerva orthopedics, Sep 1, 2022

PubMed, Jul 24, 2023

The purpose of this report is to present the clinical and radiological findings of a young patien... more The purpose of this report is to present the clinical and radiological findings of a young patient affected by proximal femoral and acetabular osteochondroma. This benign primary tumor of the long bones occurs in childhood and is localized in the proximal femur only with low incidence. As far as we know, there are only 30 other cases in the literature of an osteochondroma involving the entire hip joint. Out of these 30, only 17 patients were treated with lesion excision and joint replacement. However this is the first patient treated with a short stem total hip replacement. The innovative short stems allow the bone saving of the proximal femur, a necessary condition to have a good bone stock in the event of a future prosthetic revision in a highly demanding young patient. Preoperative planning and specific rehabilitation are mandatory to achieve good outcomes.

PubMed, Jun 14, 2023

Background and aim: Cyclops Syndrome, first described by Jackson and Schaefer in 1990, is known a... more Background and aim: Cyclops Syndrome, first described by Jackson and Schaefer in 1990, is known as a complication of anterior cruciate ligament reconstruction (ACLR). However further researches have demonstrated that cyclops can be present even without symptoms and/or in absence of ACLR, simply configuring itself as a lesion in patients with rupture of the native ligament. Methods: This is a retrospective cohort study in which we report our experience of 13 cyclops lesions found between 126 patients during a primary arthroscopic ACLR. Preoperative examination with tests of joint stability and range of movement measurement was performed and recorded. Accurate joint examination was performed during arthroscopy and the cyclops lesions found were removed and analyzed with haematoxylin-eosin coloration. Post-operative clinical examination was performed until 6 months of follow-up. Results: Histological analysis showed proliferation of dense fibroelastic polypoid nodules with a macroscopically histological aspects of a "blue eye", hence the name Cyclops. At 6 months of follow-up after surgery, none of the patients reported pain at terminal extension or instability and they were all able to resume their previous activities. Conclusions: Our study confirmed that surgical reconstruction of the ACL is not the only condition in which the Cyclops Syndrome develops; in fact our histological analysis indicate that the Cyclops lesions develop like a reactive fibroproliferative process following the rupture of the native ACL fibers, as scar reaction to the trauma: for this reason an accurate arthroscopic detection of these Cyclops lesions is crucial during primary ACL reconstruction in order to obtain the best surgical outcomes.

EFORT open reviews, Mar 1, 2023

Partial wrist denervation can be performed by isolated posterior interosseous nerve (PIN) or comb... more Partial wrist denervation can be performed by isolated posterior interosseous nerve (PIN) or combined PIN plus (+) anterior interosseous nerve (AIN) neurectomy procedures. • The purpose of the current systematic review is to investigate any differences in clinical outcomes and failures in patients undergoing AIN + PIN vs isolated PIN neurectomy. • Methods: A review of the English Literature was performed on Medline, WOS and Scopus according to PRISMA protocol combining 'wrist denervation', 'PIN neurectomy', 'AIN neurectomy', anterior interosseous nerve neurectomy' and 'posterior interosseous nerve neurectomy'. Studies were assessed with a modified Coleman Methodology Score (CMS). The primary outcome for meta-analysis was 'Failures', including all patients who have required a second surgery or those who are left with pain (defined as 'bad'). • Results: Overall, 10 studies totalling 347 wrists were included in this systematic review, with a 'moderate' CMS. The isolated PIN neurectomy technique showed a 15.1% pooled failure rate at a median follow-up of 22 months, while the combined AIN+PIN denervation had a pooled failure rate of 23.6% at a follow-up with a median of 29 months. The combined analysis of both procedures did not show significantly better results in favour of either technique, with a general failure rate of 21.6% (P = 0.0501). • Conclusion: Partial denervation for chronic wrist pain is a salvage procedure that leads to an overall success of 78.4% for pain relief, with no substantial complications. Apparently, performing the neurectomy also of the AIN does not offer greater advantages compared to the isolated PIN neurectomy.

Lo Scalpello, Sep 1, 2022

In the last few years, as the COVID-19 pandemic put in the spotlight the flaws of the Italian Nat... more In the last few years, as the COVID-19 pandemic put in the spotlight the flaws of the Italian National Health System (INHS), the Italian National Residency Program (NRP) has aroused more and more interest among several stakeholders. The persistent burden on the Welfare System, caused by the systemic shortage of Specialized Practitioners, inevitably influenced the recent major reforms of the NRP, eventually affecting its quality. Within this emergency scenario, the urge to critically analyze the postgraduate educational program and its methods, became impellent. As the Orthopedics and Traumatology Italian Residents Association (AISOT) showed, despite the newly introduced DL Calabria, in 2020, almost 50% of the Orthopedic Residents would not feel comfortable to be challenged as independent specialists. However, the lack of methodological involvement of Residents in daily practice activities, from their Mentors, if matched with the positive feedback provided from residents who, conversely, experienced the DL Calabria conveniences, raised some concerns about the standard of quality of future Orthopedics. Modern times and technologies may allow a more efficient redesign and less nebulous educational methods and goals, and eventually guarantee a Nationwide equality among each Orthopedic School. A shared future with exhaustive objectives and fair opportunities between all Italian Orthopedic Residents is the key to build a righteous collective intelligentsia and harmony between practitioners of a glorious discipline, with ancient roots, such as Italian Orthopedics.

International Orthopaedics, Feb 22, 2023

Purpose Synovial fluid cultures of periprosthetic joint infections (PJI) may be limited by bacter... more Purpose Synovial fluid cultures of periprosthetic joint infections (PJI) may be limited by bacteria living in the fluids as biofilm-aggregates. The antibiofilm pre-treatment of synovial fluids with dithiotreitol (DTT) could improve bacterial counts and microbiological early stage diagnosis in patients with suspected PJI. Methods Synovial fluids collected from 57 subjects, affected by painful total hip or knee replacement, were divided into two aliquots, one pre-treated with DTT and one with normal saline. All samples were plated for microbial counts. Sensitivity of cultural examination and bacterial counts of pre-treated and control samples were then calculated and statistically compared. Results Dithiothreitol pre-treatment led to a higher number of positive samples, compared to controls (27 vs 19), leading to a statistically significant increase in the sensitivity of the microbiological count examination from 54.3 to 77.1% and in colony-forming units count from 1884 ± 2.129 CFU/mL with saline pre-treatment to 20.442 ± 19.270 with DTT pre-treatment (P = 0.02). Conclusions To our knowledge, this is the first report showing the ability of a chemical antibiofilm pre-treatment to increase the sensitivity of microbiological examination in the synovial fluid of patients with peri-prosthetic joint infection. If confirmed by larger studies, this finding may have a significant impact on routine microbiological procedures applied to synovial fluids and brings further support to the key role of bacteria living in biofilm-formed aggregates in joint infections.

Applied sciences, Mar 23, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Orthopaedic Proceedings, Feb 21, 2018

Introduction Failure rates of Metal-on-Metal (MoM) ASR XL hip implants have been unacceptably hig... more Introduction Failure rates of Metal-on-Metal (MoM) ASR XL hip implants have been unacceptably high compared with other bearing surfaces, so patients must be monitored over the time checking for disorders in clinical condition, blood tests or in diagnostic imaging. Objectives We have carried out a continuing prospective investigation to evaluate the relationship between blood metal ions measurements and ultrasound levels and to evaluate if ultrasound score can predict a future indication to revision. Materials and methods From DePuy Recall of 2010 we have monitored 106 patients (51 males, 55 females, mean age 63.6) with ASRXL implants. The controls were performed annually. The following scales were used for patients evaluation: Ultrasound score: 0 none; 1 fluid collection <20 mm, 2 fluid collection <20 mm, 3 solid mass: metallosis. Blood metal levels of Chromium-Cobalt (Cr-Co) (μg/l = ppb): normal <3 ppb, alert between 3 and 7 ppb, pathologic <7 ppb. Clinical Score: Harris Hip Score. Rx score, evaluating the prosthetic-bone integration and the inclination of acetabular component. Patients who presented positive clinical-instrumental conditions and values of Cr and Co > 3 mg/l were checked every 6 months. Statistical analysis was carried out with Non-parametric Kruskal-Wallis test and two factors Analysis of Variance using SAS System vers. 9.4 Results The follow-up included 110 implants (4 are bilateral case). 43 patients (39,1 %) underwent revision surgery for failed MoM utilizing ceramic-on-polyethylene devices. At a mean time of 65,7 +/− 15,9 months, 47 patients had a ultrasound score of 0 (13 revised), 32 patients had a ultrasound score of 1 (9 revised), 20 patients had a ultrasound score of 2 (15 revised), 7 patients had a ultrasound score of 3 (6 revised); 44 patients had Cr value 3 ppb (37 revised). A positive correlation between blood metal ions values and ultrasound levels (p<0,001) and a statistically significant interaction between ultrasound score and indication to revision (p=0,037) were found. Discussion and Conclusion As reported in literature also in our experience the ASR XL implant was afflicted by an excessive revision rate, associated with levels of metal ions significantly higher than other hip bearing surfaces. Our results demonstrate a positive correlation between blood Cr and Co levels and the amount of fluid collection: at higher levels of fluid collection correspond higher levels of blood metal ions. Since statistical analysis confirmed that the level of ultrasound score is correlated with indication to revision it is suggested to use ultrasounds, if the score is 2 or more, as parameter to revise MoM implants even in absence of pathologic blood ions levels.

Journal of Clinical Medicine, Nov 30, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

PubMed, Jun 14, 2023

Sacral fractures with concomitant unstable pelvic ring injuries are severe conditions which occur... more Sacral fractures with concomitant unstable pelvic ring injuries are severe conditions which occur in patients involved in high-energy trauma. When operative treatment is required, high surgical experience on the field is mandatory, especially in a sub-polpulation of obese patients which have increased risk of complications. The aim of this multicentric retroscpective study was to describe and analyze clinical and radiological outcomes of sacral vertical fractures in obese patients with a minimum of 2 years follow-up. Methods: A total of 121 pelvic fractures admitted to Emergency Departments of three II level trauma centres from April 2015 to April 2021 were retrospectively reviewed. Demographics, injury mechanism, surgical data and complications were collected. The quality of life and the pelvic function were respectively measured by SF-12 questionnaires, Denis Work Scale and Majeed Score. The inter-rater agreement between the clinical scores and the Denis Work Scale was assessed. Results: A total of 19 patients were included in the study. The average follow up was 41.16 months. The average BMI was 38.63 and the mean abdominal circumference was 128.10 cm. The average Majeed and SF-12 scores were respectively 66.47 and 74.32. Five patients were able to return to their previous employment. The post traumatic life's quality and related dysfunctions are influenced by the high BMI. Conclusions: Faster recovery and early weight-bearing should be persued in order to minimize complications, expecially in obese patients. In these sample of patients, "triangular osteosynthesis" was the best treatment choice for sacral vertical fractures.

EFORT Open Reviews

Purpose Partial wrist denervation can be performed by isolated posterior interosseous nerve (PIN)... more Purpose Partial wrist denervation can be performed by isolated posterior interosseous nerve (PIN) or combined PIN plus (+) anterior interosseous nerve (AIN) neurectomy procedures. The purpose of the current systematic review is to investigate any differences in clinical outcomes and failures in patients undergoing AIN + PIN vs isolated PIN neurectomy. Methods A review of the English Literature was performed on Medline, WOS and Scopus according to PRISMA protocol combining ‘wrist denervation’, ‘PIN neurectomy’, ‘AIN neurectomy’, anterior interosseous nerve neurectomy’ and ‘posterior interosseous nerve neurectomy’. Studies were assessed with a modified Coleman Methodology Score (CMS). The primary outcome for meta-analysis was ‘Failures’, including all patients who have required a second surgery or those who are left with pain (defined as ‘bad’). Results Overall, 10 studies totalling 347 wrists were included in this systematic review, with a ‘moderate’ CMS. The isolated PIN neurectomy ...

Journal of Clinical Medicine

Short femoral stems, with preservation of the femoral bone stock, are commonly used in recent yea... more Short femoral stems, with preservation of the femoral bone stock, are commonly used in recent years for hip replacement in younger and more active patients. Obesity is increasingly spreading even in the younger population. The aim of this case-series study is to evaluate short stems compared to traditional hip prostheses in the obese population. A total of 77 consecutive patients with a BMI greater than or equal to 30 Kg/m2 were enrolled in this prospective study and were divided into two groups: 49 patients have been implanted with short stems while 28 patients were implanted with traditional stems. All the patients were treated for primary osteoarthritis or avascular necrosis and all the stems were implanted by the same surgeon using a posterior approach. Clinical (Harris Hip Score—HHS, Western Ontario and McMaster Universities Osteoarthritis Index—WOMAC, visual analogue scale—VAS, 12-item Short Form Health Survey—SF-12) and radiographic outcomes were recorded. Radiological evalua...

Microorganisms, Jan 26, 2024

Journal of orthopaedics and traumatology, Feb 28, 2024

Healthcare

The aim of this study was to investigate clinical and instrumental outcomes of the autologous mat... more The aim of this study was to investigate clinical and instrumental outcomes of the autologous matrix-induced chondrogenesis (AMIC) technique for the treatment of isolated traumatic condyle and femoropatellar cartilage lesions. A total of 25 patients (12 males, 13 females, mean age 47.3 years) treated between 2018 and 2021 were retrospectively reviewed and subdivided into two groups based on age (Group A, age < 45 years; Group B, age > 45 years). A clinical evaluation was performed using the International Knee Documentation Committee (IKDC), Lysholm score and Visual Analogue Score (VAS). Cartilage regeneration was evaluated via magnetic resonance (1.5 Tesla) and classified according to a Magnetic resonance Observation of CArtilage Repair Tissue (MOCART) scoring system. At a minimum follow-up of 2 years, Group A patients obtained greater instrumental results in comparison to group B: in fact, the MOCART score was statistically significantly correlated with IKDC (r = 0.223) (p &l...

PubMed, Jun 23, 2023

Background/Aim of the study: The periprosthetic or superficial site infections are one of the mos... more Background/Aim of the study: The periprosthetic or superficial site infections are one of the most catastrophic and difficult to manage complications following total hip arthroplasty. Recently, in addition to well know systemic markers of inflammation, the blood and synovial fluid biomarkers are focused to have a possible role in the infection diagnosis. The long Pentraxin 3 (PTX3) seems to be a sensitive biomarker of acute phase inflammation. The objectives of this prospective and multicentre study were (1) to establish the plasma trend effectiveness of PTX3 in patients undergoing primary hip replacement, and (2) to evaluate the diagnostic accuracy of blood and synovial PTX3 in patients undergoing prosthetic revision of infected hip arthroplasty. Methods: Human PTX3 was measured by ELISA in two cohorts of patients, 10 patients undergoing primary hip replacement for osteoarthritis and 9 patients with infected hip arthroplasty. Results: The Authors were able to demonstrate that PTX3 is a viable biomarker for acute phase inflammation. Conclusions: An increase in PTX3 protein concentration in the synovial fluid of patients undergoing implant revision has a strong diagnostic capacity for periprosthetic joint infection, showing 97% specificity.

Hip International, Sep 1, 2020

In this article the authors describe a modified surgical technique developed to enhance the class... more In this article the authors describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining a total hip arthroplasty (THA) undergoing acute periprosthetic joint infection (PJI). This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulphate antibiotic-added beads. The combination of 3 different surgical techniques (tumour-like synovectomy, Argon Beam application and chlorhexidine gluconate brushing) might enhance the disruption and removal of the bacterial biofilm which is the main responsible of antibiotics and antibodies resistance. The timing of the diagnosis (6 weeks from the original surgery or 1 week from clinical symptoms appearance in the case of an hematogenous infection) and the preoperative isolation of the germ are fundamental in order to obtain a satisfactory outcome. A 12week course of postoperative antibiotic therapy (6 weeks I.V. and 6 weeks oral) complete the postoperative protocol used by the authors. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous PJI.

Knee Surgery, Sports Traumatology, Arthroscopy, Feb 13, 2020

Purpose Modern total knee arthroplasty (TKA) systems are designed to reproduce the normal knee ki... more Purpose Modern total knee arthroplasty (TKA) systems are designed to reproduce the normal knee kinematics and improve patient outcome. The authors compared two different third-generation medial pivot TKA implants, having a single-radius or a J-curve design in their sagittal plane, hypothesizing no clinical differences. Methods Two cohorts of 50 patients who underwent primary TKA were first preoperatively matched by sex, deformity, body mass index (BMI), Oxford Knee Score (OKS), Knee society score (KSS) and range of motion (ROM) and then statistically analyzed at a minimum follow-up (FU) of 2 years. An identical surgical technique, which aimed to reproduce a slightly tighter medial than lateral compartment, was used in all knees. Results At a minimum follow-up of 2 years (range 24-34 months) there were no statistically significant differences in OKS and KSS between the two implant groups. The final ROM differed statistically between the two groups: the average maximum active flexion was 123° in the J-curve femoral design group with an adapted "medially-congruent" polyethylene insert, and 116° in the single radius femoral design with a medial "ball-in-socket" articulation. Conclusion No clinical and radiological differences were found when the two cohorts of patients were compared. This study showed that the implant design played a minor role in the final outcome as opposed to a precise surgical technique. Level of evidence Retrospective case-control study, Level III.

Lo Scalpello, Sep 1, 2022

Background. The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MAL... more Background. The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has recently been proposed as novel alpha-defensins test for diagnosis of peri-prosthetic joint infections (PJIs). The aim of the current study is to assess the diagnostic accuracy of alpha-defensins MALDI-TOF MS in case of acute PJIs. Methods. This prospective study included a series of 10 consecutive patients affected by PJIs according to the 2018 MSIS criteria. Synovial fluids were assessed for routine synovial fluid tests and alpha-defensins measurement with MALDI-TOF MS. Sensitivity, specificity, positive, and negative predictive values (PPV and NPV) were assessed. Results. Six females and 4 males with acute PJIs were included. The mean age was 72.5 (range 67-79), and the mean time elapsed from primary arthroplasty to PJIs was 52 days (range 13-90). Eight TKA and 2 THA were evaluated. The involved bacteria were Staphylococcus aureus in 4 patients, coagulase-negative Staphylococcus species in 3 patients, Enterococcus species in 3 patients, and Pseudomonas aeruginosa in 1 patient. Three cases were characterized by polymicrobial infection. The MALDI-TOF alpha-defensin test correctly identified all 10 patients with acute PJIs. According to the current preliminary results the MALDI-TOF assay showed a 100% sensitivity, specificity, PPV, and NPV. Conclusions. The novel alpha-defensins MALDI-TOF MS test showed promising results with high sensitivity and specificity in the diagnosis of acute PJIs. The reliability of the test in case of acute PJI could allow surgeons to manage the infection with a less invasive procedure with several advantages for patients. The findings of the present study seemed to confirm that the novel assay, which needs only few milliliters of sample, provides rapid results, and has substantial cost-effectiveness, and thus may be a useful diagnostic tool in clinical practice, even in case of acute PJIs. Further studies are needed to confirm these results on a larger series of patients.

Minerva orthopedics, Sep 1, 2022

PubMed, Jul 24, 2023

The purpose of this report is to present the clinical and radiological findings of a young patien... more The purpose of this report is to present the clinical and radiological findings of a young patient affected by proximal femoral and acetabular osteochondroma. This benign primary tumor of the long bones occurs in childhood and is localized in the proximal femur only with low incidence. As far as we know, there are only 30 other cases in the literature of an osteochondroma involving the entire hip joint. Out of these 30, only 17 patients were treated with lesion excision and joint replacement. However this is the first patient treated with a short stem total hip replacement. The innovative short stems allow the bone saving of the proximal femur, a necessary condition to have a good bone stock in the event of a future prosthetic revision in a highly demanding young patient. Preoperative planning and specific rehabilitation are mandatory to achieve good outcomes.

PubMed, Jun 14, 2023

Background and aim: Cyclops Syndrome, first described by Jackson and Schaefer in 1990, is known a... more Background and aim: Cyclops Syndrome, first described by Jackson and Schaefer in 1990, is known as a complication of anterior cruciate ligament reconstruction (ACLR). However further researches have demonstrated that cyclops can be present even without symptoms and/or in absence of ACLR, simply configuring itself as a lesion in patients with rupture of the native ligament. Methods: This is a retrospective cohort study in which we report our experience of 13 cyclops lesions found between 126 patients during a primary arthroscopic ACLR. Preoperative examination with tests of joint stability and range of movement measurement was performed and recorded. Accurate joint examination was performed during arthroscopy and the cyclops lesions found were removed and analyzed with haematoxylin-eosin coloration. Post-operative clinical examination was performed until 6 months of follow-up. Results: Histological analysis showed proliferation of dense fibroelastic polypoid nodules with a macroscopically histological aspects of a "blue eye", hence the name Cyclops. At 6 months of follow-up after surgery, none of the patients reported pain at terminal extension or instability and they were all able to resume their previous activities. Conclusions: Our study confirmed that surgical reconstruction of the ACL is not the only condition in which the Cyclops Syndrome develops; in fact our histological analysis indicate that the Cyclops lesions develop like a reactive fibroproliferative process following the rupture of the native ACL fibers, as scar reaction to the trauma: for this reason an accurate arthroscopic detection of these Cyclops lesions is crucial during primary ACL reconstruction in order to obtain the best surgical outcomes.

EFORT open reviews, Mar 1, 2023

Partial wrist denervation can be performed by isolated posterior interosseous nerve (PIN) or comb... more Partial wrist denervation can be performed by isolated posterior interosseous nerve (PIN) or combined PIN plus (+) anterior interosseous nerve (AIN) neurectomy procedures. • The purpose of the current systematic review is to investigate any differences in clinical outcomes and failures in patients undergoing AIN + PIN vs isolated PIN neurectomy. • Methods: A review of the English Literature was performed on Medline, WOS and Scopus according to PRISMA protocol combining 'wrist denervation', 'PIN neurectomy', 'AIN neurectomy', anterior interosseous nerve neurectomy' and 'posterior interosseous nerve neurectomy'. Studies were assessed with a modified Coleman Methodology Score (CMS). The primary outcome for meta-analysis was 'Failures', including all patients who have required a second surgery or those who are left with pain (defined as 'bad'). • Results: Overall, 10 studies totalling 347 wrists were included in this systematic review, with a 'moderate' CMS. The isolated PIN neurectomy technique showed a 15.1% pooled failure rate at a median follow-up of 22 months, while the combined AIN+PIN denervation had a pooled failure rate of 23.6% at a follow-up with a median of 29 months. The combined analysis of both procedures did not show significantly better results in favour of either technique, with a general failure rate of 21.6% (P = 0.0501). • Conclusion: Partial denervation for chronic wrist pain is a salvage procedure that leads to an overall success of 78.4% for pain relief, with no substantial complications. Apparently, performing the neurectomy also of the AIN does not offer greater advantages compared to the isolated PIN neurectomy.

Lo Scalpello, Sep 1, 2022

In the last few years, as the COVID-19 pandemic put in the spotlight the flaws of the Italian Nat... more In the last few years, as the COVID-19 pandemic put in the spotlight the flaws of the Italian National Health System (INHS), the Italian National Residency Program (NRP) has aroused more and more interest among several stakeholders. The persistent burden on the Welfare System, caused by the systemic shortage of Specialized Practitioners, inevitably influenced the recent major reforms of the NRP, eventually affecting its quality. Within this emergency scenario, the urge to critically analyze the postgraduate educational program and its methods, became impellent. As the Orthopedics and Traumatology Italian Residents Association (AISOT) showed, despite the newly introduced DL Calabria, in 2020, almost 50% of the Orthopedic Residents would not feel comfortable to be challenged as independent specialists. However, the lack of methodological involvement of Residents in daily practice activities, from their Mentors, if matched with the positive feedback provided from residents who, conversely, experienced the DL Calabria conveniences, raised some concerns about the standard of quality of future Orthopedics. Modern times and technologies may allow a more efficient redesign and less nebulous educational methods and goals, and eventually guarantee a Nationwide equality among each Orthopedic School. A shared future with exhaustive objectives and fair opportunities between all Italian Orthopedic Residents is the key to build a righteous collective intelligentsia and harmony between practitioners of a glorious discipline, with ancient roots, such as Italian Orthopedics.

International Orthopaedics, Feb 22, 2023

Purpose Synovial fluid cultures of periprosthetic joint infections (PJI) may be limited by bacter... more Purpose Synovial fluid cultures of periprosthetic joint infections (PJI) may be limited by bacteria living in the fluids as biofilm-aggregates. The antibiofilm pre-treatment of synovial fluids with dithiotreitol (DTT) could improve bacterial counts and microbiological early stage diagnosis in patients with suspected PJI. Methods Synovial fluids collected from 57 subjects, affected by painful total hip or knee replacement, were divided into two aliquots, one pre-treated with DTT and one with normal saline. All samples were plated for microbial counts. Sensitivity of cultural examination and bacterial counts of pre-treated and control samples were then calculated and statistically compared. Results Dithiothreitol pre-treatment led to a higher number of positive samples, compared to controls (27 vs 19), leading to a statistically significant increase in the sensitivity of the microbiological count examination from 54.3 to 77.1% and in colony-forming units count from 1884 ± 2.129 CFU/mL with saline pre-treatment to 20.442 ± 19.270 with DTT pre-treatment (P = 0.02). Conclusions To our knowledge, this is the first report showing the ability of a chemical antibiofilm pre-treatment to increase the sensitivity of microbiological examination in the synovial fluid of patients with peri-prosthetic joint infection. If confirmed by larger studies, this finding may have a significant impact on routine microbiological procedures applied to synovial fluids and brings further support to the key role of bacteria living in biofilm-formed aggregates in joint infections.

Applied sciences, Mar 23, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Orthopaedic Proceedings, Feb 21, 2018

Introduction Failure rates of Metal-on-Metal (MoM) ASR XL hip implants have been unacceptably hig... more Introduction Failure rates of Metal-on-Metal (MoM) ASR XL hip implants have been unacceptably high compared with other bearing surfaces, so patients must be monitored over the time checking for disorders in clinical condition, blood tests or in diagnostic imaging. Objectives We have carried out a continuing prospective investigation to evaluate the relationship between blood metal ions measurements and ultrasound levels and to evaluate if ultrasound score can predict a future indication to revision. Materials and methods From DePuy Recall of 2010 we have monitored 106 patients (51 males, 55 females, mean age 63.6) with ASRXL implants. The controls were performed annually. The following scales were used for patients evaluation: Ultrasound score: 0 none; 1 fluid collection <20 mm, 2 fluid collection <20 mm, 3 solid mass: metallosis. Blood metal levels of Chromium-Cobalt (Cr-Co) (μg/l = ppb): normal <3 ppb, alert between 3 and 7 ppb, pathologic <7 ppb. Clinical Score: Harris Hip Score. Rx score, evaluating the prosthetic-bone integration and the inclination of acetabular component. Patients who presented positive clinical-instrumental conditions and values of Cr and Co > 3 mg/l were checked every 6 months. Statistical analysis was carried out with Non-parametric Kruskal-Wallis test and two factors Analysis of Variance using SAS System vers. 9.4 Results The follow-up included 110 implants (4 are bilateral case). 43 patients (39,1 %) underwent revision surgery for failed MoM utilizing ceramic-on-polyethylene devices. At a mean time of 65,7 +/− 15,9 months, 47 patients had a ultrasound score of 0 (13 revised), 32 patients had a ultrasound score of 1 (9 revised), 20 patients had a ultrasound score of 2 (15 revised), 7 patients had a ultrasound score of 3 (6 revised); 44 patients had Cr value 3 ppb (37 revised). A positive correlation between blood metal ions values and ultrasound levels (p<0,001) and a statistically significant interaction between ultrasound score and indication to revision (p=0,037) were found. Discussion and Conclusion As reported in literature also in our experience the ASR XL implant was afflicted by an excessive revision rate, associated with levels of metal ions significantly higher than other hip bearing surfaces. Our results demonstrate a positive correlation between blood Cr and Co levels and the amount of fluid collection: at higher levels of fluid collection correspond higher levels of blood metal ions. Since statistical analysis confirmed that the level of ultrasound score is correlated with indication to revision it is suggested to use ultrasounds, if the score is 2 or more, as parameter to revise MoM implants even in absence of pathologic blood ions levels.

Journal of Clinical Medicine, Nov 30, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

PubMed, Jun 14, 2023

Sacral fractures with concomitant unstable pelvic ring injuries are severe conditions which occur... more Sacral fractures with concomitant unstable pelvic ring injuries are severe conditions which occur in patients involved in high-energy trauma. When operative treatment is required, high surgical experience on the field is mandatory, especially in a sub-polpulation of obese patients which have increased risk of complications. The aim of this multicentric retroscpective study was to describe and analyze clinical and radiological outcomes of sacral vertical fractures in obese patients with a minimum of 2 years follow-up. Methods: A total of 121 pelvic fractures admitted to Emergency Departments of three II level trauma centres from April 2015 to April 2021 were retrospectively reviewed. Demographics, injury mechanism, surgical data and complications were collected. The quality of life and the pelvic function were respectively measured by SF-12 questionnaires, Denis Work Scale and Majeed Score. The inter-rater agreement between the clinical scores and the Denis Work Scale was assessed. Results: A total of 19 patients were included in the study. The average follow up was 41.16 months. The average BMI was 38.63 and the mean abdominal circumference was 128.10 cm. The average Majeed and SF-12 scores were respectively 66.47 and 74.32. Five patients were able to return to their previous employment. The post traumatic life's quality and related dysfunctions are influenced by the high BMI. Conclusions: Faster recovery and early weight-bearing should be persued in order to minimize complications, expecially in obese patients. In these sample of patients, "triangular osteosynthesis" was the best treatment choice for sacral vertical fractures.

EFORT Open Reviews

Purpose Partial wrist denervation can be performed by isolated posterior interosseous nerve (PIN)... more Purpose Partial wrist denervation can be performed by isolated posterior interosseous nerve (PIN) or combined PIN plus (+) anterior interosseous nerve (AIN) neurectomy procedures. The purpose of the current systematic review is to investigate any differences in clinical outcomes and failures in patients undergoing AIN + PIN vs isolated PIN neurectomy. Methods A review of the English Literature was performed on Medline, WOS and Scopus according to PRISMA protocol combining ‘wrist denervation’, ‘PIN neurectomy’, ‘AIN neurectomy’, anterior interosseous nerve neurectomy’ and ‘posterior interosseous nerve neurectomy’. Studies were assessed with a modified Coleman Methodology Score (CMS). The primary outcome for meta-analysis was ‘Failures’, including all patients who have required a second surgery or those who are left with pain (defined as ‘bad’). Results Overall, 10 studies totalling 347 wrists were included in this systematic review, with a ‘moderate’ CMS. The isolated PIN neurectomy ...

Journal of Clinical Medicine

Short femoral stems, with preservation of the femoral bone stock, are commonly used in recent yea... more Short femoral stems, with preservation of the femoral bone stock, are commonly used in recent years for hip replacement in younger and more active patients. Obesity is increasingly spreading even in the younger population. The aim of this case-series study is to evaluate short stems compared to traditional hip prostheses in the obese population. A total of 77 consecutive patients with a BMI greater than or equal to 30 Kg/m2 were enrolled in this prospective study and were divided into two groups: 49 patients have been implanted with short stems while 28 patients were implanted with traditional stems. All the patients were treated for primary osteoarthritis or avascular necrosis and all the stems were implanted by the same surgeon using a posterior approach. Clinical (Harris Hip Score—HHS, Western Ontario and McMaster Universities Osteoarthritis Index—WOMAC, visual analogue scale—VAS, 12-item Short Form Health Survey—SF-12) and radiographic outcomes were recorded. Radiological evalua...