Marco Basso - Academia.edu (original) (raw)

Papers by Marco Basso

Musculoskeletal Surgery, Jun 26, 2020

Introduction Medial unicompartmental knee arthroplasty (UKA) is considered the most effective tre... more Introduction Medial unicompartmental knee arthroplasty (UKA) is considered the most effective treatment for anteromedial knee osteoarthritis. Cementless fixation of UKA was developed to reduce aseptic loosening. We performed a review of the recent literature to assess the latest outcomes of cementless UKA. Methods A review of English literature was performed on Medline through Pubmed. Retrospective or prospective studies with at least 2 years of follow-up (FU) and at least 20 patients were included. The PRISMA 2009 flowchart and checklist were considered to edit the review. Survival rate, revision rate, time for revision, incidence of radiolucent lines and reasons for revision (such as aseptic loosening, osteoarthritis progression, bearing dislocation or periprosthetic fracture) were extrapolated from the papers. Results Nineteen articles were included in the review, only 2 with a level of evidence of I. A total of 3432 UKA with a FU range of 24-132 months were analyzed. The studies showed good clinical and functional outcomes. In 12 studies, survival rate were more than 90%. Revision rate for aseptic loosening were lower than 2% for 15 studies. Conclusion Cementless UKA represents a surgical option allowing low revision rate. Further high-quality long-term studies would better clarify complications, clinical and radiological results of this promising fixation method.

Musculoskeletal Surgery, Jul 1, 2017

Introduction: The use of a primary cementless component is a tempting option for revision total h... more Introduction: The use of a primary cementless component is a tempting option for revision total hip arthrosplasty (reTHA), however, the results of this type of revision have not been clearly determined. The goal of this retrospective study was to determine: if revision with a primary anatomical cementless femoral stem gives adequate bone fixation; the rate of secondary subsidence or recurrent loosening; the survival rate with this device. Hypothesis: Revision with a primary anatomical cementless femoral stem results in a low rate of subsidence and recurrent loosening. Materials and methods: This retrospective series of 43 reTHA performed between 1994 and 2012 included 43 patients, mean age 66 years old (37-90) with a minimum follow-up of 24 months. There were grade 1 (n = 24) or 2A (n = 19) bone defects according to the Paprosky classification. The causes of revision were: aseptic loosening in 27, septic loosening in 6, malposition of the implant in 7 and periprosthetic fractures in 3. Clinical (Postel Merle d'Aubigné [PMA] and Harris scores), and radiological (subsidence) assessment was performed, as well as survival analysis (with a 95% confidence interval). Results: All components were changed through posterolateral approach without femorotomy. In four cases de-escalation (use of a primary component for secondary revision of a prior revision component) was performed. There were no perioperative fractures or perforations. After a mean 47 months (24-134), the mean PMA score increased from 10 (5-15) to 16 (11-18), and the Harris score from 58 (20-80) to 85 (66-96). Radiological assessment did not show any extensive radiolucencies or secondary subsidence. Only 3 components were placed in a varus position, with no clinical consequences. One patient had subsequent revision for recurrent dislocations. Estimated survival at 80 months by Kaplan-Meier analysis was 85% (CI 95%: 64-100%). Discussion: There are very few studies in the literature (7 series) on this topic, which shows the reluctance of surgeons to use this technique. Placement of a primary femoral stem requires good metaphyseal bone quality for primary stability. Thus, the indication is limited to Paprosky 1 and 2A stages. Revision surgery must be performed by endofemoral approach requiring good preoperative planning, as well as knowledge of the explanted component and a revision component must be available, if necessary, in the operating room. Level of evidence: Retrospective study, level 4.

International Orthopaedics, Nov 26, 2016

The aim of our study is to evaluate long-term outcomes from a cohort of patients treated with col... more The aim of our study is to evaluate long-term outcomes from a cohort of patients treated with collum femoris preserving (CFP) stem correlating neck resorption with comorbidities, clinical outcomes, and complications. One hundred seventy-six patients (194 hips) were retrospectively reviewed with a minimum follow-up (f.u.) of ten years. Demographic and surgical data were collected. Clinical and radiological evaluation was performed at the last follow up. We calculated a neck resorption ratio (NRR) for each patient. Main complications were recorded. A p-value of &amp;amp;amp;lt;0.05 was considered significant. The mean Harris hip score (HHS) was 89.1 ± 5.7. The mean visual analogue scale (VAS) and Oxford hip score (OHS) values were 1.1 ± 1 and 41.3 ± 5.1, respectively. The mean leg length discrepancy was 1.5 mm ± 1.9. The mean NRR was 0.35. We observed six cases of aseptic loosening, two cases of infection, one implant revision for recurrent dislocation, and one stem revision after periprosthetic femoral fracture. The overall survival rate of the stem was 94.8%. Statistically significant associations were found between NRR and steroid therapy/stem malposition. Correlation between aseptic loosening and NRR was also statistically significant. Correlations between NRR and HHS/OHS were -0.34 and -0.28 respectively. Odds ratio for aseptic loosening were: 4.6 if NRR &amp;amp;amp;gt; 0.25; 16.9 if &amp;amp;amp;gt; 0.50 and 24.1 if &amp;amp;amp;gt; 0.75. CFP hip stem provided excellent long-term outcomes. NRR is correlated to steroid therapy and stem malposition. The risk of stem aseptic loosening rises according to NRR increase. Patients with an NRR &amp;amp;amp;gt; 0.5, especially if under steroid therapy or with stem malposition, should be strictly monitored.

Musculoskeletal Surgery, Feb 13, 2017

Purpose This review aims to explore and summarize the current clinical evidence about the use of ... more Purpose This review aims to explore and summarize the current clinical evidence about the use of regenerative medicine such as mesenchymal stem cells or platelet-rich plasma in intervertebral disc regeneration, in order to clarify the state of art of these novel approaches. Materials and methods We performed a research of the available literature about regenerative medicine strategies aiming to prevent intervertebral disc degeneration. All preclinical trials and in vitro studies were excluded. Only clinical trials were critically analysed. Results The manuscript selection produced a total of 7 articles concerning the use of regenerative therapies in intervertebral disc degeneration, covering the period between 2010 and 2016. Articles selected were 4 about the injection of mesenchymal stem cells-related results and 3 using platelet-rich plasma. The total population of patients treated with regenerative medicine strategies were 104 patients. Conclusions Regenerative medicine, such as the use of mesenchymal stem cells or platelet-rich plasma, in intradiscal disc degeneration has shown preclinical and clinical positive results. Randomized clinical trials studying the potential of MSCs intradiscal injection have not been conducted, and PRP effect has been studied only preliminarily. Additional more powered high-quality studies are needed to really appreciate the long-term safety and efficacy of regenerative medicine approaches in IDD. Keywords Intervertebral disc degeneration Á Mesenchymal stem cells Á Platelet-rich plasma Á Intervertebral disc regeneration Á Tissue engineering & M. Basso

Archives of Orthopaedic and Trauma Surgery, Apr 18, 2018

Introduction Revision knee arthroplasty is increasing, and in that case, bone loss management is ... more Introduction Revision knee arthroplasty is increasing, and in that case, bone loss management is still a challenging problem. In the last years, the body of literature and interest surrounding porous metal cones has grown, but few systematic evaluations of the existing evidence have been performed. The aim of our systematic review is to collect and critically analyze the available evidence about metal cones in revision knee arthroplasty especially focusing our attention on indications, results, complications, and infection rate of these promising orthopaedic devices. Materials and methods We performed a systematic review of the available English literature, considering the outcomes and the complications of tantalum cones. The combinations of keyword were "porous metal cones", "knee revision", "bone loss", "knee arthroplasty", "periprosthetic joint infection", and "outcome". Results From the starting 312 papers available, 20 manuscripts were finally included. Only one included study has a control group. The main indication for metal cones is type IIb and III defects according AORI classification. Most of the papers show good clinical and radiological outcomes with low rate of complications. Conclusion The examined studies provide encouraging clinical and radiological short-to-mid-term outcomes. Clinical studies have shown a low rate of aseptic loosening, intraoperative fractures, infection rate and a lower failure rate than the previous treatment methods. Higher quality papers are needed to draw definitive conclusions about porous metal cones.

European Spine Journal, Oct 5, 2015

Purpose of the study To evaluate the results of a novel rigid-dynamic stabilization technique in ... more Purpose of the study To evaluate the results of a novel rigid-dynamic stabilization technique in lumbar degenerative segment diseases (DSD), expressly pointing out the preservation of postoperative lumbar lordosis (LL). Materials and methods Forty-one patients with one level lumbar DSD and initial disc degeneration at the adjacent level were treated. Circumferential lumbar arthrodesis and posterior hybrid instrumentation were performed to preserve an initial disc degeneration above the segment that has to be fused. Clinical and spino-pelvic parameters were evaluated pre-and postoperatively. Results At 2-year follow-up, a significant improvement of clinical outcomes was reported. No statistically significant difference was noted between postoperative and 2-year follow-up in LL and in disc/vertebral body height ratio at the upper adjacent fusion level. Conclusions When properly selected, this technique leads to good results. A proper LL should be achieved after any hybrid stabilization to preserve the segment above the fusion.

Archives of Orthopaedic and Trauma Surgery, May 29, 2018

Introduction Total knee arthroplasty revision (TKAr) is increasing of relevance in orthopaedic su... more Introduction Total knee arthroplasty revision (TKAr) is increasing of relevance in orthopaedic surgeon daily practice and will become more and more relevant in the future. The aim of this study is to summarize indications, complications, clinical and radiological mid-term results of metaphyseal sleeves in management of bone defects in TKAr. Methods A systematic review of English literature was performed on Medline. Retrospective or prospective studies with 2 years of follow-up (FU) were included. The PRISMA 2009 flowchart and checklist were considered to edit the review. Rates of intraoperative fractures, aseptic loosening, periprosthetic joint infection (PJI), reoperations and re-revisions were extrapolated by the papers. Results 13 articles with a level of evidence of IV were included in the systematic review. 1079 TKAr (1554 sleeves) with a mean FU of 4.0 ± 1.1 years were analysed. The studies showed good clinical and functional outcomes. Sleeves allowed a stable metaphyseal fixation and osseointegration with an implant and sleeves aseptic survival rate of 97.7 and 99.2%, respectively. The incidence of PJI was 2.7 ± 2.4%. The estimated rate of reoperations and re-revisions were 14.2 ± 9.2 and 7.1 ± 4.8%, respectively. Conclusion Metaphyseal sleeves represent a viable option in management of types IIb and III AORI bone defects in TKAr. Further high-quality log-term studies would better clarify complications, clinical and radiological results of this promising technique in total knee arthroplasty revision.

European Spine Journal, May 9, 2017

Purpose of the study To evaluate clinical outcomes and complications of extreme lumbar interbody ... more Purpose of the study To evaluate clinical outcomes and complications of extreme lumbar interbody fusion (XLIF) in spinal revision surgery comparing our data with the available literature evidence about other fusion techniques. Materials and methods Retrospective analysis of patients underwent revision surgery with XLIF as interbody fusion technique. Demographic, comorbidity, surgical data, clinical results, and intraoperative and postoperative complications were recorded. Results 36 patients, with a minimum follow-up of 28 ± 11.5 months, were included in the analysis. 41 levels were fused with XLIF. The mean number of previous spine surgery was 1.5 ± 0.7. Mean improvement in back pain and leg pain on VAS was 5.6 ± 1.4 (p \ 0.01) and 3.5 ± 2 (p \ 0.01), respectively. Mean improvement in the ODI score was 30.3 ± 7.3 (p \ 0.01). 1 vertebral endplate fracture during interbody space preparation was reported during lateral approach. 5 patients (13.8%) complained quadriceps weakness and anterior thigh hypoesthesia fully recovered after 3 months from surgery, and in one case, a transient contralateral radiculopathy was observed. No implant failure was detected at final follow-up. Conclusions XLIF is a reasonably safe and effective fusion technique in revision surgery that allows valid arthrodesis avoiding scarred tissue created by previous surgical approaches. Especially, XLIF reduces the risk of nerve root lesions, postoperative radiculitis, and durotomies compared to posterior fusion techniques.

Journal of Orthopaedics and Traumatology, Jul 6, 2017

Background The purpose of this study was to summarize the available evidence about total lumbar d... more Background The purpose of this study was to summarize the available evidence about total lumbar disc replacement (TDR), focusing our attention on four main topics: clinical and functional outcomes, comparison with fusion surgery results, rate of complications and influence on sagittal balance. Materials and methods We systematically searched Pubmed, Embase, Medline, Medscape, Google Scholar and Cochrane library databases in order to answer our four main research questions. Effective data were extracted after the assessment of methodological quality of the trials. Results Fifty-nine pertinent papers were included. Clinical and functional scores show statistically significant improvements, and they last at all time points compared to baseline. The majority of the articles show there is no significant difference between TDR groups and fusion groups. The literature shows similar rates of complications between the two surgical procedures. Conclusions TDR showed significant safety and efficacy, comparable to lumbar fusion. The major advantages of a lumbar TDR over fusion include maintenance of segmental motion and the restoration of the disc height, allowing patients to find their own spinal balance. Disc arthroplasty could be a reliable option in the treatment of degenerative disc disease in years to come. Level of evidence II.

European Spine Journal, Apr 16, 2018

Purpose To present a classification system for vertebral body osteonecrosis (VBON) based on imagi... more Purpose To present a classification system for vertebral body osteonecrosis (VBON) based on imaging findings and sagittal alignment and consequently to propose treatment guidelines. Methods Chart review and classification of imaging and clinical findings. An analysis of literature about VBON has been evaluated to conceive the classification. The current data allows to correlate radiological findings with different stages of the pathophysiological process and consequently to propose a patient-tailored treatment plan. Results The classification identifies 4 stages: stage 0 (theoretical phase), stage 1 (early phase), stage 2 (instability phase) and stage 3 (fixed deformity phase). Local (angular kyphosis expressed as anterior-posterior wall height ratio) and global (sagittal vertical axis and pelvic tilt) sagittal alignment are considered as complementary modifiers to tailor the most suitable treatment. Stage 1 is generally managed conservatively. Stage 2 and 3 often require different surgical approaches according to local and global sagittal alignment. Conclusions The classification allows a systematic staging of this disease and can help establish a proper and patient-oriented treatment plan. Further researches are advocated to fully validate the proposed classification system. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.

Asian Spine Journal, Jun 30, 2018

Osteonecrosis (ON) is a clinical entity characterized by a pattern of cell death and complex proc... more Osteonecrosis (ON) is a clinical entity characterized by a pattern of cell death and complex process of bone resorption and formation. Studies related to ON have largely focused on certain anatomical sites; however, the evidence on vertebral body ON (VBON) is largely inconsistent and fragmented. The aim of this study was to clarify the pathophysiology, risk factors, imaging findings, and available treatment modalities for VBON. A systematic review of the relevant articles published in English was performed using PubMed, Embase, Medline, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases. A total of 81 articles were included in this study. Three main topics about VBON were identified: (1) pathophysiology and risk factors, (2) diagnosis, and (3) treatment. Forty-five studies were based on the pathophysiology, 52 on diagnosis, and 38 on the treatment options for VBON. The literature on VBON was limited and mainly focused on post-traumatic cases with a considerable overlap with nonunion and pseudoarthrosis.

$Research paper thumbnail of Segmental kyphosis after short segment thoracolumbar fracture fixation with intermediate screws: who is at risk?$

The Spine Journal, Oct 1, 2016

MUSCULOSKELETAL SURGERY, 2020

The aim of this meta-analysis and systematic review is to summarize and critically analyze the in... more The aim of this meta-analysis and systematic review is to summarize and critically analyze the influence of surgery-related factors in lumbar interbody fusion for degenerative spine diseases. A systematic review of the literature was carried out with a primary search being performed on Medline through PubMed. The 2009 PRISMA flowchart and checklist were taken into account. Sixty-seven articles were included in the analysis: 48 studies were level IV of evidence, whereas 19 were level III. All interbody fusion techniques analyzed have proved to reach a good fusion rate. An overall mean fusion rate of 93% (95% CI 92-95%, p < 0.001) was estimated pooling the selected studies. The influence of sagittal parameters and cages features in fusion rate was not clear. Autograft is considered the gold standard material. The use of synthetic bone substitutes and biological factors alone or combined with bone graft have shown conflicting results. Low level of evidence studies and high heterogeneity (χ 2 = 271.4, df = 72, p < 0.001; I 2 = 73.5%, τ 2 = 0.05) in data analysis could result in the risk of bias. Further high-quality studies would better clarify these results in the future.

European Spine Journal, 2015

Journal of Novel Physiotherapies, 2014

Introduction : Low back pain (LBP) is one of the most common complaints in the general population... more Introduction : Low back pain (LBP) is one of the most common complaints in the general population, affecting about 70-80% of the population at some point in life. LBP management comprises a wide range of different intervention strategies. One of the treatment options is traction therapy. The aim of our short review is to summarize and analyze the latest result reporting the use of lumbar traction in LBP treatment in order to evaluate the real effectiveness and indications of this specific physical therapy. Materials and methods: A comprehensive search of PubMed, Medline, Cochrane, Embase, and Google Scholar databases was performed, covering the period between 2006 and 2013. 54 citations were obtained. Relevant data from each included study were extracted and recorded. Results: A total of 14 studies were included in the review. Among these 14 studies, 11 were randomized clinical trials, 1 was a retrospective cohort study and 2 were case series. The majority of included studies used traction on patients that suffered nerve root compression symptoms. The mean number of traction sessions was 19. At most, the duration of each session was 30 min (range 3-30 min). The mean period of traction treatment was 6 weeks (range 3-12 weeks). 11 studies coupled with traction other therapies. Only 3 studies used traction as a single treatment. The mean follow up period was 16,5 weeks from the end of treatment. Conclusion: Several biases can be introduced by limited quality evidence from the included studies. Lumbar traction seems to produce positive results in nerve root compression symptoms. Data in degenerative and discogenic pain are debatable. To date, the use of lumbar traction therapy alone in LBP management is not recommended by the best available evidence.

$Research paper thumbnail of Unilateral external fixator in the treatment of humeral shaft fractures: results of a single center retrospective study$

Musculoskeletal Surgery, Apr 17, 2017

Background The aim of our work is to evaluate and critically analyze long-term clinical and radio... more Background The aim of our work is to evaluate and critically analyze long-term clinical and radiological data of a new unilateral external fixator (MIKAI KIT FEPÓ-Mikai S.p.A, Genoa, Italy), in the treatment of humeral shaft fractures. Materials and methods We reviewed 47 patients affected by humeral fractures that underwent surgery from July 2010 to March 2016 with unilateral external fixator. Demographic characteristics of the patients were recorded, which included age, sex and baseline comorbidities and mechanism of injury. Surgical data such as time of surgery and time of fixation according to AO-type of fracture, clinical objective and subjective outcomes were collected. Results The mean follow-up was 50.4 months (range 12-74). The patients' average age was 41.8 years (range 14-92). Mean surgical time was 66.8 (±37.7 min); and mean time of fixation was 4.5 (±1.7 months). We observed five delayed union (10.6%); one refracture (2.1%); and one case of non-union (2.1%) who underwent a revision surgery with nailing. No malunion was detected. Average quick-DASH was 11.7 (±14.8). The mean Constant Score at final follow-up was 81.5 (±14). 95.8% of patients were satisfied of our treatment. According to SF-12 scores, we observed 44 (93.6%) good results and 3 (6.4%) poor results. Conclusion We suggest the use of MIKAI KIT FEPÓ as a feasible option in the treatment of humeral shaft fractures. We reported optimal clinical and radiological outcomes at long-term follow-up. We advocate more powerful evidence to validate this new possible approach.