Francesco Traina - Academia.edu (original) (raw)

Papers by Francesco Traina

International orthopaedics, Jan 27, 2015

During growth, hallux valgus could present associated with flatfoot. Considering the current disa... more During growth, hallux valgus could present associated with flatfoot. Considering the current disagreement about correction of hallux valgus during growth and the lack of reports about simultaneous correction of hallux valgus associated with flexible flatfoot, we present simultaneous treatment of both deformities during growth combining subtalar arthroeresis and SERI first metatarsal osteotomy, reporting results at an average five-year follow-up. Thirty-two children (64 feet, age range 8-12 years) affected by hallux valgus associated with flexible flatfoot underwent surgical treatment combining SERI first metatarsal osteotomy and subtalar arthroereisis with bioabsorbable endorthotic implant. Clinical evaluation was summarized with AOFAS score, and standard standing radiographs were performed. AOFAS score ranged from 86 ± 2 to 98 ± 2 (hindfoot) and from 80 ± 4 to 98 ± 2 (forefoot). HVA ranged from 21° ± 2 to 5° ± 2, IMA from 14° ± 2 to 7° ± 2, DMAA from 18° ± 2 to 2° ± 2, and Meary&#3...

Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, Jan 26, 2015

We reviewed a series of newborns, toddlers and ambulating children affected by idiopathic congeni... more We reviewed a series of newborns, toddlers and ambulating children affected by idiopathic congenital talipes equinovarus (clubfoot). Taking into account the time of diagnosis, stiffness of the deformity and walking age, nonsurgical or surgical treatment was considered. This study reports clinical outcomes, early complications and relapse at mid-term follow-up. Fifty-two clubfeet were diagnosed at birth, 12 in non-ambulating children aged between 4 and 12 months and 24 in ambulating children. Feet were classified using the Pirani score. Newborns and toddlers were treated with serial casting (Ponseti); however, toddlers also underwent open Achilles tendon lengthening (2 feet) and posteromedial release (3 feet). In all ambulating children, surgical treatment was always performed: selective medial release combined with cuboid subtraction osteotomy (1 foot), posteromedial release (6 feet), and posteromedial release combined with cuboid subtraction osteotomy (17 feet). The average follow-...

International Orthopaedics, 2015

A minimally invasive anterior approach appears to be an attractive alternative to achieve capital... more A minimally invasive anterior approach appears to be an attractive alternative to achieve capital realignment without violating femoral head vascular supply and avoiding hip dislocation in slipped capital femoral epiphysis. The aim of this study was to detail the technical steps of subcapital realignment through a minimally invasive anterior approach and to report the preliminary results of this procedure in a prospective cohort of patients with stable slips. Nine patients underwent subcapital cuneiform wedge resection through a minimally invasive anterior approach without hip dislocation for moderate or severe stable slips between April 2012 and April 2013. Prophylactic stabilization of the contralateral hip was performed in all cases. A minimum 18 months follow-up was available. Clinical course was assessed using the Harris hip score and the hip range of motion. The degree of slippage as proposed by Southwick, the lateral α angle and the epiphyseal-metaphyseal distance allowed radiographic assessment. No patients were lost during follow-up, which was on average 28 months. No intraoperative complications occurred; one postoperative transient apraxia of the femoral cutaneous nerve, which completely recovered in six months, was recorded. Southwick angle, lateral α angle and epiphyseal-metaphyseal distance all improved substantially postoperatively. No cases of avascular necrosis were detected. Subcapital cuneiform wedge resection through a minimally invasive anterior approach without hip dislocation can be an easier alternative to restore proximal femoral anatomy in moderate to severe stable slips. Prospective case control studies are required to confirm these preliminary results.

European Spine Journal, 2015

Surgery of adult scoliosis was based upon coronal plane radiographical analysis using Cobb angle ... more Surgery of adult scoliosis was based upon coronal plane radiographical analysis using Cobb angle measurements, but recently it has been demonstrated that sagittal spinopelvic alignment plays a critical role in determining the final outcome. The aim of this paper is to compare the clinical and radiological results of 81 patients affected by adult scoliosis, treated with short or long fusions, and followed for 2-5 year follow-up. 81 patients affected by degenerative lumbar scoliosis managed by posterior-only surgery were retrospectively evaluated. Fifty-seven patients underwent to a short fusion procedure, while 24 had a long fusion. Clinical and radiographic coronal and sagittal spinopelvic parameters were compared between the two groups. Coronal Cobb angle was 24° preoperatively and passed to 12° in the short fusion group, while changed from 45° to 10° in the long fusion group. Lumbar lordosis was 45° preoperatively and 60° at final follow-up in the short fusion group passed from 24° to 55° in the long fusion group. Sacral slope passed from 25° to 45° in the short fusion group, while from 10° to 40° in the long fusion group. Pelvic tilt passed from 24° to 13° in the short fusion group, and from 28° to 23° in the long fusion group. Surgical treatment of degenerative lumbar scoliosis improved balance and alignment of the spine, and also the coronal plane in terms of Cobb angle. These results were associated to a consistent clinical improvement and an acceptable rate of complications.

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, Jan 6, 2015

To analyze changes in sagittal spinopelvic parameters (SSPs) after surgical treatment of Scheuerm... more To analyze changes in sagittal spinopelvic parameters (SSPs) after surgical treatment of Scheuermann's Kyphosis (SK). We analyzed 20 patients affected by SK and subjected to posterior correction of the kyphosis by facetectomy, Ponte osteotomy, fusion and multilevel instrumentation with pedicle screw system. Four spinal and three pelvic parameters were measured: sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis, lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS) and pelvic tilt (PT). Analysis of changes in postprocedural SSPs compared to preoperative values was performed. TK passed from 78.6° preoperatively to 45.8° (p = 0.003). LL passed from 74.5° preoperatively to 53.5° (p = 0.01). No significant changes occurred in SVA, SS, PT and PI compared to preoperative values. We confirm the positive effect of surgery by Ponte osteotomy and posterior spinal fusion on TK and LL in patients with SK. In our experience, pelvic parameters did not change...

The Journal of bone and joint surgery. American volume, Jan 18, 2015

Charcot-Marie-Tooth disease is the single most common diagnosis associated with cavus foot. The i... more Charcot-Marie-Tooth disease is the single most common diagnosis associated with cavus foot. The imbalance involving intrinsic and extrinsic muscles has been suggested as the main pathogenetic cause of cavus foot in this disease. The goal of surgical treatment is to correct the deformity to obtain a plantigrade foot. In the presence of a flexible deformity and the absence of degenerative arthritis, preserving as much as possible of the overall range of motion of the foot and ankle is advisable. Twenty-four cavus feet in twelve patients with Charcot-Marie-Tooth disease were included in the study. Clinical evaluation was summarized with the Maryland Foot Score. Radiographic evaluation assessed calcaneal pitch, Meary angle, Hibb angle, and absence of degenerative joint changes. Only patients who had a flexible deformity, with varus of the heel reducible in the Coleman-Andreasi test, and did not have degenerative joint arthritis were included in this study. Surgical treatment consisted i...

Musculoskeletal surgery, Jan 8, 2015

Hamstring graft (HG) used in anterior cruciate ligament (ACL) reconstruction undergoes a biologic... more Hamstring graft (HG) used in anterior cruciate ligament (ACL) reconstruction undergoes a biological modification process called "ligamentization" in the early postoperative period that proceeds through three different phases: an early graft-healing phase with central graft necrosis, a phase of proliferation, and finally, a ligamentization phase toward the properties of the intact ACL. The fastening of this process could result in more aggressive rehabilitation protocols as well as faster sport resumption. A recent literature supports the preservation of HG tibial attachment in order to enhance "ligamentization" process. Aim of this literature review is to describe all the techniques described that spare HG tibial insertion and the obtained results in order to evaluate evidence that would substantiate the maintenance of HG tibial insertion in ACL reconstruction. A search was performed using the following keywords "ACL reconstruction" in combination with ...

Hip international : the journal of clinical and experimental research on hip pathology and therapy

The aim of this study was to detect risk factors for ceramic liner fractures. 26 cementless ceram... more The aim of this study was to detect risk factors for ceramic liner fractures. 26 cementless ceramic on ceramic (COC) total hip arthroplasties (THA) revised because of ceramic liner fracture in 24 patients were compared with 49 well-functioning COC THA performed in 49 patients. Demographic parameters, type of ceramic of the liner, size and neck length of the femoral head, cup abduction angle, cup anteversion, femoral off-set, height of the centre of rotation and the incidence of noisy hips during follow-up examination were compared. A greater number of cups placed outside the optimal range of cup anteversion was found in the fracture group (p = 0.03). An audible noise was detected in 21 cases (80.7%) in the fracture group and in 3 cases (6.1%) in the non-fracture group (p = 0.001). A cup anteversion angle out of the optimal range of 15˚+/-10˚ was found to be a risk factor for ceramic liner fracture and the presence of a noisy hip frequently anticipated the failure. In our opinion nec...

Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2011

Neuropathic arthropathy (Charcot's joint) is a degenerative process that affects peripheral o... more Neuropathic arthropathy (Charcot's joint) is a degenerative process that affects peripheral or vertebral joints as a consequence of a disturbance in proprioception and pain perception. The knee is one of the most frequently affected joints, but even when the diagnosis is made at an early stage there is no consensus on the best treatment options. An early diagnosis of neurosyphilis was made in a 55-year-old woman presenting a delayed union of an asymptomatic Schatzker type IV fracture of the proximal tibia. A medial opening wedge tibial osteotomy was performed to achieve fracture healing, to correct the medial depression of the articular surface, and possibly to avoid an early arthritis typical of the disease. To our knowledge, a knee osteotomy has never been reported at an early stage of neuropathic arthropathy. Even though the clinical and radiographic evaluation performed at 4 months follow-up showed a good stage of healing of the osteotomy and no typical features of neuropath...

La Chirurgia degli Organi di Movimento, 2008

Brucella infection in arthroplasties is a rare event. An unspecific clinical symptomatology is as... more Brucella infection in arthroplasties is a rare event. An unspecific clinical symptomatology is associated with unclear radiographic peri-prosthetic signs of bone halisteresis. Only a positive anamnesis, combined with an antibiogram of the joint liquid and a high serum antibody titre, can lead to a definitive diagnosis. We report a case of Brucella melitensis infection in a total knee arthroplasty implanted 2 years earlier. With the absence of radiological signs of prosthetic loosening and thanks to a systemic antibiotic combined therapy (rifampicin + doxycycline) extended for 8 weeks, we were able to solve the infection avoiding surgery.

International Orthopaedics, 2015

Adequate treatment of forearm nonunion should achieve both biological stimulation of the bone and... more Adequate treatment of forearm nonunion should achieve both biological stimulation of the bone and mechanical stability. The use of bone graft could enhance the healing of a nonunion providing osteogenic, osteoconductive and osteoinductive stimulation and an optimal stability of the fixation. We retrospectively reviewed two cohorts of patients affected by forearm nonunion and treated with plate and opposite bone graft to determine whether the use of autograft versus allograft differs in terms of (1) rate of healing of the nonunion and (2) time of healing. Thirty-four patients were treated for aseptic forearm nonunion with cortical graft strut with opposite plate and intercalary graft in case of segmental bone defect. In 20 patients an autograft harvest from the fibula (group A) and in 14 (group B) an allograft provided by the bone bank of our institution were used. All the nonunions healed in a mean of four months in both groups, ranging from two to 12 months in group A and from three to ten months in group B. At the latest follow up forearm function and pain were satisfactory in both groups. The use of plate and opposite bone graft demonstrated to be effective in promoting the healing of forearm nonunions, without significant differences in terms of rate and time of healing in the two groups. Considering the higher surgical time and the comorbidity of the donor site, if a bone bank is available, we suggest to use homologous cortical bone strut graft with opposite plate and screw fixation for the treatment of aseptic forearm nonunion rather than autograft.

Success of cementless hip stems implantation depends mainly on primary stability which, in turn, ... more Success of cementless hip stems implantation depends mainly on primary stability which, in turn, depends on the degree of press-fitting achieved, and optimal medullary canal filling by the selected stem size. Stem size, based on templating and pre-operative planning software, only partially avoids stem mis-sizing. Mis-sizing can produce implant instability and/or wasting the wrong-sized stem. An intra-operative device was designed that enabled real-time measurement of rasp-bone micromotions by applying torque manually. Rasp stability was assessed in vitro in seven femurs after femoral canal preparation when the rasp was fully seated. Then, primary implant stability was assessed with the stem press-fitted in the position indicated as optimal by the surgeon. Torque-micromotion curves were compared for the rasp and the stem. Finally, the protocol was applied to two hip patients. Rasp stability micromotions were successfully measured in all in vitro specimens and all patients. The slope of the initial part of the rasp torque-micromotion curve was correlated with the slope of the stem curve (correlation coefficient=0.798, P-value=0.001). The entire procedure for measuring rasp stability added less than two minutes to the 75-80-min operating time. This study indicates that the rasp stability can be used to predict the maximal primary stability that can eventually be achieved by the selected stem size. Early prediction of stem stability enables correcting the stem size, if necessary, before the press-fitting procedure is initiated, thus saving operating time and the cost of a new stem.

The Scientific World Journal, 2013

Background: A musculoskeletal tumor biopsy can involve fine needle aspiration, core needle biopsy... more Background: A musculoskeletal tumor biopsy can involve fine needle aspiration, core needle biopsy, or incisional biopsy.

Ceramics in Orthopaedics, 2005

Metal staining of alumina ceramic femoral heads can occur during implantation of total hip compon... more Metal staining of alumina ceramic femoral heads can occur during implantation of total hip components and during reduction of a dislocated total hip. To determine whether or not such staining results in surface damage to alumina ceramic femoral heads in vivo, we examined two groups of explanted femoral heads. Group 1 consisted of four femoral heads with surface metal staining

La Chirurgia degli Organi di Movimento, 2008

We report two cases of bilateral cementless total hip arthroplasty in two young women affected by... more We report two cases of bilateral cementless total hip arthroplasty in two young women affected by Morquio-Brailsford syndrome. Morquio-Brailsford disease belongs to the mucopolysaccharidoses; it shows growth retardation with disproportional dwarfism. Usually patients are affected by a severe joint degeneration from their 2nd or 3rd decade. Young age, severe dysplasia, and joint size are the main technical problems for a total hip replacement. Accurate radiographic and CT planning allows the use of standard prostheses instead of custom-made ones.

La Chirurgia degli Organi di Movimento, 2008

In dwarfism hip arthritis, usually secondary to hip dysplasia, is a common finding at an early ag... more In dwarfism hip arthritis, usually secondary to hip dysplasia, is a common finding at an early age. In these patients a joint replacement is a demanding procedure due to the peculiar joint deformity and the small size of the bones. We present a case of a bilateral hip replacement in a dwarf patient. In order to reduce intraoperative complications and improve the joint kinematics a thorough preoperative planning was performed by a CT based computerised system. On the basis of the planning we chose a conical shaped stem that enable as to restore limb length and offset with a low risk of femoral fracture. In conclusion, we consider total hip replacement in dwarfism a safe and effective procedure if an accurate preoperative planning is performed.

Hip International, 2011

The effect of obesity on the long-term survival of total hip arthroplasty remains under discussio... more The effect of obesity on the long-term survival of total hip arthroplasty remains under discussion. Reviewing meta-analyses of large cohort studies a high body mass index has been correlated with a higher incidence of complications but not univocally with a lower implant survival rate. It has been suggested that body weight rather than body mass index might be a better parameter to evaluate prosthesis outcome. We reviewed 27,571 patients retrospectively with primary arthritis as a preoperative diagnosis. Patients were divided into 4 categories based on their body mass index, or into two groups based on the body weight (<80 kg and =80 kg). Implant survivorship was estimated with use of the Cox proportional hazards model with revision for aseptic loosening as the end point. Results were stratified for sex and implant tribology. When body mass index was used the 10 years implant survival in obese versus non-obese patients was not statistically different (p=0.058), but when body weight was used a statistically different implant survivorship was found for men (p=0.009). Therefore, weight rather than than body mass index influences survival of hip prostheses, and should be used as the discriminant parameter for further studies.

Bioceramics and Alternative Bearings in Joint Arthroplasty, 2006

International Scholarly Research Notices, 2014

Duchenne muscular dystrophy is a progressive disease with loss of ambulation at around 9-10 years... more Duchenne muscular dystrophy is a progressive disease with loss of ambulation at around 9-10 years of age, followed, if untreated, by development of scoliosis, respiratory insufficiency, and death in the second decade of life. This review highlights the natural history of the disease, in particular, with regard to the development of the spinal deformity and how this complication has been modified by surgical interventions and overall by corticosteroid treatment. The beneficial effect of corticosteroids may have also an impact on the clinical trial design of the new emerging causative therapies.

International orthopaedics, Jan 27, 2015

During growth, hallux valgus could present associated with flatfoot. Considering the current disa... more During growth, hallux valgus could present associated with flatfoot. Considering the current disagreement about correction of hallux valgus during growth and the lack of reports about simultaneous correction of hallux valgus associated with flexible flatfoot, we present simultaneous treatment of both deformities during growth combining subtalar arthroeresis and SERI first metatarsal osteotomy, reporting results at an average five-year follow-up. Thirty-two children (64 feet, age range 8-12 years) affected by hallux valgus associated with flexible flatfoot underwent surgical treatment combining SERI first metatarsal osteotomy and subtalar arthroereisis with bioabsorbable endorthotic implant. Clinical evaluation was summarized with AOFAS score, and standard standing radiographs were performed. AOFAS score ranged from 86 ± 2 to 98 ± 2 (hindfoot) and from 80 ± 4 to 98 ± 2 (forefoot). HVA ranged from 21° ± 2 to 5° ± 2, IMA from 14° ± 2 to 7° ± 2, DMAA from 18° ± 2 to 2° ± 2, and Meary&#3...

Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, Jan 26, 2015

We reviewed a series of newborns, toddlers and ambulating children affected by idiopathic congeni... more We reviewed a series of newborns, toddlers and ambulating children affected by idiopathic congenital talipes equinovarus (clubfoot). Taking into account the time of diagnosis, stiffness of the deformity and walking age, nonsurgical or surgical treatment was considered. This study reports clinical outcomes, early complications and relapse at mid-term follow-up. Fifty-two clubfeet were diagnosed at birth, 12 in non-ambulating children aged between 4 and 12 months and 24 in ambulating children. Feet were classified using the Pirani score. Newborns and toddlers were treated with serial casting (Ponseti); however, toddlers also underwent open Achilles tendon lengthening (2 feet) and posteromedial release (3 feet). In all ambulating children, surgical treatment was always performed: selective medial release combined with cuboid subtraction osteotomy (1 foot), posteromedial release (6 feet), and posteromedial release combined with cuboid subtraction osteotomy (17 feet). The average follow-...

International Orthopaedics, 2015

A minimally invasive anterior approach appears to be an attractive alternative to achieve capital... more A minimally invasive anterior approach appears to be an attractive alternative to achieve capital realignment without violating femoral head vascular supply and avoiding hip dislocation in slipped capital femoral epiphysis. The aim of this study was to detail the technical steps of subcapital realignment through a minimally invasive anterior approach and to report the preliminary results of this procedure in a prospective cohort of patients with stable slips. Nine patients underwent subcapital cuneiform wedge resection through a minimally invasive anterior approach without hip dislocation for moderate or severe stable slips between April 2012 and April 2013. Prophylactic stabilization of the contralateral hip was performed in all cases. A minimum 18 months follow-up was available. Clinical course was assessed using the Harris hip score and the hip range of motion. The degree of slippage as proposed by Southwick, the lateral α angle and the epiphyseal-metaphyseal distance allowed radiographic assessment. No patients were lost during follow-up, which was on average 28 months. No intraoperative complications occurred; one postoperative transient apraxia of the femoral cutaneous nerve, which completely recovered in six months, was recorded. Southwick angle, lateral α angle and epiphyseal-metaphyseal distance all improved substantially postoperatively. No cases of avascular necrosis were detected. Subcapital cuneiform wedge resection through a minimally invasive anterior approach without hip dislocation can be an easier alternative to restore proximal femoral anatomy in moderate to severe stable slips. Prospective case control studies are required to confirm these preliminary results.

European Spine Journal, 2015

Surgery of adult scoliosis was based upon coronal plane radiographical analysis using Cobb angle ... more Surgery of adult scoliosis was based upon coronal plane radiographical analysis using Cobb angle measurements, but recently it has been demonstrated that sagittal spinopelvic alignment plays a critical role in determining the final outcome. The aim of this paper is to compare the clinical and radiological results of 81 patients affected by adult scoliosis, treated with short or long fusions, and followed for 2-5 year follow-up. 81 patients affected by degenerative lumbar scoliosis managed by posterior-only surgery were retrospectively evaluated. Fifty-seven patients underwent to a short fusion procedure, while 24 had a long fusion. Clinical and radiographic coronal and sagittal spinopelvic parameters were compared between the two groups. Coronal Cobb angle was 24° preoperatively and passed to 12° in the short fusion group, while changed from 45° to 10° in the long fusion group. Lumbar lordosis was 45° preoperatively and 60° at final follow-up in the short fusion group passed from 24° to 55° in the long fusion group. Sacral slope passed from 25° to 45° in the short fusion group, while from 10° to 40° in the long fusion group. Pelvic tilt passed from 24° to 13° in the short fusion group, and from 28° to 23° in the long fusion group. Surgical treatment of degenerative lumbar scoliosis improved balance and alignment of the spine, and also the coronal plane in terms of Cobb angle. These results were associated to a consistent clinical improvement and an acceptable rate of complications.

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, Jan 6, 2015

To analyze changes in sagittal spinopelvic parameters (SSPs) after surgical treatment of Scheuerm... more To analyze changes in sagittal spinopelvic parameters (SSPs) after surgical treatment of Scheuermann's Kyphosis (SK). We analyzed 20 patients affected by SK and subjected to posterior correction of the kyphosis by facetectomy, Ponte osteotomy, fusion and multilevel instrumentation with pedicle screw system. Four spinal and three pelvic parameters were measured: sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis, lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS) and pelvic tilt (PT). Analysis of changes in postprocedural SSPs compared to preoperative values was performed. TK passed from 78.6° preoperatively to 45.8° (p = 0.003). LL passed from 74.5° preoperatively to 53.5° (p = 0.01). No significant changes occurred in SVA, SS, PT and PI compared to preoperative values. We confirm the positive effect of surgery by Ponte osteotomy and posterior spinal fusion on TK and LL in patients with SK. In our experience, pelvic parameters did not change...

The Journal of bone and joint surgery. American volume, Jan 18, 2015

Charcot-Marie-Tooth disease is the single most common diagnosis associated with cavus foot. The i... more Charcot-Marie-Tooth disease is the single most common diagnosis associated with cavus foot. The imbalance involving intrinsic and extrinsic muscles has been suggested as the main pathogenetic cause of cavus foot in this disease. The goal of surgical treatment is to correct the deformity to obtain a plantigrade foot. In the presence of a flexible deformity and the absence of degenerative arthritis, preserving as much as possible of the overall range of motion of the foot and ankle is advisable. Twenty-four cavus feet in twelve patients with Charcot-Marie-Tooth disease were included in the study. Clinical evaluation was summarized with the Maryland Foot Score. Radiographic evaluation assessed calcaneal pitch, Meary angle, Hibb angle, and absence of degenerative joint changes. Only patients who had a flexible deformity, with varus of the heel reducible in the Coleman-Andreasi test, and did not have degenerative joint arthritis were included in this study. Surgical treatment consisted i...

Musculoskeletal surgery, Jan 8, 2015

Hamstring graft (HG) used in anterior cruciate ligament (ACL) reconstruction undergoes a biologic... more Hamstring graft (HG) used in anterior cruciate ligament (ACL) reconstruction undergoes a biological modification process called "ligamentization" in the early postoperative period that proceeds through three different phases: an early graft-healing phase with central graft necrosis, a phase of proliferation, and finally, a ligamentization phase toward the properties of the intact ACL. The fastening of this process could result in more aggressive rehabilitation protocols as well as faster sport resumption. A recent literature supports the preservation of HG tibial attachment in order to enhance "ligamentization" process. Aim of this literature review is to describe all the techniques described that spare HG tibial insertion and the obtained results in order to evaluate evidence that would substantiate the maintenance of HG tibial insertion in ACL reconstruction. A search was performed using the following keywords "ACL reconstruction" in combination with ...

Hip international : the journal of clinical and experimental research on hip pathology and therapy

The aim of this study was to detect risk factors for ceramic liner fractures. 26 cementless ceram... more The aim of this study was to detect risk factors for ceramic liner fractures. 26 cementless ceramic on ceramic (COC) total hip arthroplasties (THA) revised because of ceramic liner fracture in 24 patients were compared with 49 well-functioning COC THA performed in 49 patients. Demographic parameters, type of ceramic of the liner, size and neck length of the femoral head, cup abduction angle, cup anteversion, femoral off-set, height of the centre of rotation and the incidence of noisy hips during follow-up examination were compared. A greater number of cups placed outside the optimal range of cup anteversion was found in the fracture group (p = 0.03). An audible noise was detected in 21 cases (80.7%) in the fracture group and in 3 cases (6.1%) in the non-fracture group (p = 0.001). A cup anteversion angle out of the optimal range of 15˚+/-10˚ was found to be a risk factor for ceramic liner fracture and the presence of a noisy hip frequently anticipated the failure. In our opinion nec...

Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2011

Neuropathic arthropathy (Charcot's joint) is a degenerative process that affects peripheral o... more Neuropathic arthropathy (Charcot's joint) is a degenerative process that affects peripheral or vertebral joints as a consequence of a disturbance in proprioception and pain perception. The knee is one of the most frequently affected joints, but even when the diagnosis is made at an early stage there is no consensus on the best treatment options. An early diagnosis of neurosyphilis was made in a 55-year-old woman presenting a delayed union of an asymptomatic Schatzker type IV fracture of the proximal tibia. A medial opening wedge tibial osteotomy was performed to achieve fracture healing, to correct the medial depression of the articular surface, and possibly to avoid an early arthritis typical of the disease. To our knowledge, a knee osteotomy has never been reported at an early stage of neuropathic arthropathy. Even though the clinical and radiographic evaluation performed at 4 months follow-up showed a good stage of healing of the osteotomy and no typical features of neuropath...

La Chirurgia degli Organi di Movimento, 2008

Brucella infection in arthroplasties is a rare event. An unspecific clinical symptomatology is as... more Brucella infection in arthroplasties is a rare event. An unspecific clinical symptomatology is associated with unclear radiographic peri-prosthetic signs of bone halisteresis. Only a positive anamnesis, combined with an antibiogram of the joint liquid and a high serum antibody titre, can lead to a definitive diagnosis. We report a case of Brucella melitensis infection in a total knee arthroplasty implanted 2 years earlier. With the absence of radiological signs of prosthetic loosening and thanks to a systemic antibiotic combined therapy (rifampicin + doxycycline) extended for 8 weeks, we were able to solve the infection avoiding surgery.

International Orthopaedics, 2015

Adequate treatment of forearm nonunion should achieve both biological stimulation of the bone and... more Adequate treatment of forearm nonunion should achieve both biological stimulation of the bone and mechanical stability. The use of bone graft could enhance the healing of a nonunion providing osteogenic, osteoconductive and osteoinductive stimulation and an optimal stability of the fixation. We retrospectively reviewed two cohorts of patients affected by forearm nonunion and treated with plate and opposite bone graft to determine whether the use of autograft versus allograft differs in terms of (1) rate of healing of the nonunion and (2) time of healing. Thirty-four patients were treated for aseptic forearm nonunion with cortical graft strut with opposite plate and intercalary graft in case of segmental bone defect. In 20 patients an autograft harvest from the fibula (group A) and in 14 (group B) an allograft provided by the bone bank of our institution were used. All the nonunions healed in a mean of four months in both groups, ranging from two to 12 months in group A and from three to ten months in group B. At the latest follow up forearm function and pain were satisfactory in both groups. The use of plate and opposite bone graft demonstrated to be effective in promoting the healing of forearm nonunions, without significant differences in terms of rate and time of healing in the two groups. Considering the higher surgical time and the comorbidity of the donor site, if a bone bank is available, we suggest to use homologous cortical bone strut graft with opposite plate and screw fixation for the treatment of aseptic forearm nonunion rather than autograft.

Success of cementless hip stems implantation depends mainly on primary stability which, in turn, ... more Success of cementless hip stems implantation depends mainly on primary stability which, in turn, depends on the degree of press-fitting achieved, and optimal medullary canal filling by the selected stem size. Stem size, based on templating and pre-operative planning software, only partially avoids stem mis-sizing. Mis-sizing can produce implant instability and/or wasting the wrong-sized stem. An intra-operative device was designed that enabled real-time measurement of rasp-bone micromotions by applying torque manually. Rasp stability was assessed in vitro in seven femurs after femoral canal preparation when the rasp was fully seated. Then, primary implant stability was assessed with the stem press-fitted in the position indicated as optimal by the surgeon. Torque-micromotion curves were compared for the rasp and the stem. Finally, the protocol was applied to two hip patients. Rasp stability micromotions were successfully measured in all in vitro specimens and all patients. The slope of the initial part of the rasp torque-micromotion curve was correlated with the slope of the stem curve (correlation coefficient=0.798, P-value=0.001). The entire procedure for measuring rasp stability added less than two minutes to the 75-80-min operating time. This study indicates that the rasp stability can be used to predict the maximal primary stability that can eventually be achieved by the selected stem size. Early prediction of stem stability enables correcting the stem size, if necessary, before the press-fitting procedure is initiated, thus saving operating time and the cost of a new stem.

The Scientific World Journal, 2013

Background: A musculoskeletal tumor biopsy can involve fine needle aspiration, core needle biopsy... more Background: A musculoskeletal tumor biopsy can involve fine needle aspiration, core needle biopsy, or incisional biopsy.

Ceramics in Orthopaedics, 2005

Metal staining of alumina ceramic femoral heads can occur during implantation of total hip compon... more Metal staining of alumina ceramic femoral heads can occur during implantation of total hip components and during reduction of a dislocated total hip. To determine whether or not such staining results in surface damage to alumina ceramic femoral heads in vivo, we examined two groups of explanted femoral heads. Group 1 consisted of four femoral heads with surface metal staining

La Chirurgia degli Organi di Movimento, 2008

We report two cases of bilateral cementless total hip arthroplasty in two young women affected by... more We report two cases of bilateral cementless total hip arthroplasty in two young women affected by Morquio-Brailsford syndrome. Morquio-Brailsford disease belongs to the mucopolysaccharidoses; it shows growth retardation with disproportional dwarfism. Usually patients are affected by a severe joint degeneration from their 2nd or 3rd decade. Young age, severe dysplasia, and joint size are the main technical problems for a total hip replacement. Accurate radiographic and CT planning allows the use of standard prostheses instead of custom-made ones.

La Chirurgia degli Organi di Movimento, 2008

In dwarfism hip arthritis, usually secondary to hip dysplasia, is a common finding at an early ag... more In dwarfism hip arthritis, usually secondary to hip dysplasia, is a common finding at an early age. In these patients a joint replacement is a demanding procedure due to the peculiar joint deformity and the small size of the bones. We present a case of a bilateral hip replacement in a dwarf patient. In order to reduce intraoperative complications and improve the joint kinematics a thorough preoperative planning was performed by a CT based computerised system. On the basis of the planning we chose a conical shaped stem that enable as to restore limb length and offset with a low risk of femoral fracture. In conclusion, we consider total hip replacement in dwarfism a safe and effective procedure if an accurate preoperative planning is performed.

Hip International, 2011

The effect of obesity on the long-term survival of total hip arthroplasty remains under discussio... more The effect of obesity on the long-term survival of total hip arthroplasty remains under discussion. Reviewing meta-analyses of large cohort studies a high body mass index has been correlated with a higher incidence of complications but not univocally with a lower implant survival rate. It has been suggested that body weight rather than body mass index might be a better parameter to evaluate prosthesis outcome. We reviewed 27,571 patients retrospectively with primary arthritis as a preoperative diagnosis. Patients were divided into 4 categories based on their body mass index, or into two groups based on the body weight (<80 kg and =80 kg). Implant survivorship was estimated with use of the Cox proportional hazards model with revision for aseptic loosening as the end point. Results were stratified for sex and implant tribology. When body mass index was used the 10 years implant survival in obese versus non-obese patients was not statistically different (p=0.058), but when body weight was used a statistically different implant survivorship was found for men (p=0.009). Therefore, weight rather than than body mass index influences survival of hip prostheses, and should be used as the discriminant parameter for further studies.

Bioceramics and Alternative Bearings in Joint Arthroplasty, 2006

International Scholarly Research Notices, 2014

Duchenne muscular dystrophy is a progressive disease with loss of ambulation at around 9-10 years... more Duchenne muscular dystrophy is a progressive disease with loss of ambulation at around 9-10 years of age, followed, if untreated, by development of scoliosis, respiratory insufficiency, and death in the second decade of life. This review highlights the natural history of the disease, in particular, with regard to the development of the spinal deformity and how this complication has been modified by surgical interventions and overall by corticosteroid treatment. The beneficial effect of corticosteroids may have also an impact on the clinical trial design of the new emerging causative therapies.