susanna stea - Academia.edu (original) (raw)
Papers by susanna stea
Knee (Oxford), 2014
Since 2000, the Register of Prosthetic Orthopedic Implants (RIPO) has been following all hip, kne... more Since 2000, the Register of Prosthetic Orthopedic Implants (RIPO) has been following all hip, knee, and shoulder arthroplasties in the Emilia-Romagna region, comprising 4.5 million inhabitants, in northern Italy. The aim of the present analysis was to present the main figures of unicompartmental knee implants processed from the Registry. During the period 2000-2011, 3929 unicompartmental knee arthroplasties were performed on 3645 resident patients, of which 71% were females. The medial condyle was treated in 94% of cases, where mean age at surgery was 67.3 years and mean body weight was 76.6 kg. The main outcome measure was time to revision of at least one single component. The Kaplan-Meier survival and Cox multivariate analyses have been applied. At 10-year follow-up, the percentage of survival was 86.8% (confidence interval (CI) at 95% was 84.1-89.5); total aseptic loosening represented 42% of the causes of failure, pain represented 15%, and sepsis represented 11%. Age at surgery significantly influences the survival of the prosthesis, whatever the reason for revision, while the type of tibial component (monoblock or metal tray) does not appear to be a determinant. Septic failure is not prevented by the use of antibiotic-loaded cement. Results are comparable to main orthopedic registries from Scandinavia, Australia, and New Zealand, even if some differences can be highlighted.
Copyright © 2014 Susanna Stea et al. This is an open access article distributed under the Creativ... more Copyright © 2014 Susanna Stea et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aromatherapy is the controlled use of plant essences for therapeutic purposes. Its applications are numerous (i.e., wellbeing, labour, infections, dementia, and anxiety treatment) but often they have not been scientifically validated.The aim of the present study is to review the available literature to determine if there is evidence for effectiveness of aromatherapy in surgical patients to treat anxiety and insomnia, to control pain and nausea, and to dress wound. Efficacy studies of lavender or orange and peppermint essential oils, to treat anxiety and nausea, respectively, have shown positive results. For other aspects, such as pain control, essential oils therapy has shown uncertain results. Finally, there are encouraging data for t...
Relationship between obesity and early failure of total knee prostheses
Personalized Hip and Knee Joint Replacement, 2020
Stem modularity can be classified according to the coupling location: distal, mid-stem, and proxi... more Stem modularity can be classified according to the coupling location: distal, mid-stem, and proximal [1]. Mid-stem and proximal modularity have been more frequently used. Either the junction is located proximal or distal (mid-stem) to the neck osteotomy (Fig. 8.1). Proximal modularity with modular necks was introduced in 1987 by Cremascoli Ortho (Milan, Italy), in order to provide independent combinations of version, offset, and length [1]. Rationale of modular necks. The rationale for proximal modularity with modular necks was the achievement of a better soft tissue balancing and was to reduce the occurrence of prosthetic impingement [1, 2]. The best candidates for neck modularity, where the most remarkable benefits are obtained, are subjects with unconventional hip anatomies and biomechanics [1, 2]. In these cases, standard acetabular and femoral compo
Journal of Bone and Joint Surgery-british Volume, 2016
The RIPO register collects data of all primary and revision hip replacement surgeries performed i... more The RIPO register collects data of all primary and revision hip replacement surgeries performed in Region Emilia-Romagna, Italy since 1stJanuary 2000. The present study is aimed to analyze the survival rate of patients with Biolox®delta and Biolox®forte components, (CeramTec, Plochingen Germany) considering possible confounding factors. Only patients living in the region are considered in analysis, to avoid the bias resulting from the ‘loss’ of non-resident patients. The analysis has been conducted only on uncemented THA and monoblock, double mobility cups as well as such with pre-assembled inserts were excluded. Therefore, the finally analyzed database consists of 30’617 cases; 13’323 Biolox®forte and 17’294 Biolox®delta heads, articulating against ceramic or PE. Unadjusted survival analysis was calculated according to Kaplan Meier method; with prosthesis failure as end point, defined as the revision of any prosthetic component for any cause. To avoid a possible bias, revision of t...
Alternatives to Laboratory Animals, 1992
In order to evaluate in vitro the suitability of various prosthetic materials for endothelial see... more In order to evaluate in vitro the suitability of various prosthetic materials for endothelial seeding, human endothelial cells derived from the umbilical vein were placed in direct contact with a variety of polymers. As a control, endothelial cells were cultured in the absence of material. After 24, 48, 72 and 96 hours, the cells were counted and a viability test with neutral red was performed. Assays of 6-keto prostaglandinFla (6-keto-PGF1a), tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) were carried out on the supernatants. The cell counting technique demonstrated growth inhibition in the cell populations in contact with Woven Dacron® and Double Velour Dacron® in comparison with control cell cultures. Vital staining with neutral red, always sharply positive in the controls, was weak in the cells placed in contact with the materials. The 6-keto-PGF1a concentration in the supernatant was similar to the control level in the populations in contact wi...
Journal of Materials Science: Materials in Medicine, 2020
Introduction Ceramic-on-ceramic couplings demonstrated to be reliable bearings in primary total h... more Introduction Ceramic-on-ceramic couplings demonstrated to be reliable bearings in primary total hip arthroplasty (THA), with long-term remarkable results. Like-on-like configurations were widely described. On the contrary, mixed material combinations from the same manufacturer, Delta-on-Forte or Forte-on-Delta, were poorly studied. In particular, it is unknown whether mixed ceramic combinations are more at risk of ceramic fractures. Thus, a registry study was conducted to investigate the long-term survival rates and reasons for revision of mixed ceramic combinations. A comparison with Deltaon-Delta couplings was also performed. Materials and methods The regional arthroplasty registry RIPO was enquired about three cohorts of ceramic bearings (headon-liner: Delta-on-Forte, Forte-on-Delta, Delta-on-Delta). Demographics, survival rates and reasons for revision were evaluated and compared. Results In total, 346 (1.5%) implants had a Delta-on-Forte coupling (mean follow-up: 6.4 years). In total, 1163 (5%) THAs had a Forte-on-Delta articulation (mean follow-up: 8.2 years). Delta-on-Delta surfaces were implanted in 21,874 (93.5%) hips (mean follow-up: 3.9 years). Mixed material combinations were implanted between 2003 and 2007. The survival rates of the three cohorts were similar and were higher than 95% at 10 years. In Forte-on-Delta group, four liners failed (0.3% of the implants), whereas ceramic fractures occurred in 15 cases (0.1%) in Delta-on-Delta couplings (3 heads and 12 liners). Considering ceramic fracture as endpoint, there was no significant difference between the three survival rates. Conclusions Mixed ceramic bearing configurations from the same manufacturer in primary THA showed mid-to-longterm dependable outcomes, not inferior to the most recent like-on-like ceramic bearings. No additional risks of ceramic fractures were evident. Thus, closer follow-ups are not required.
Orthopaedics & Traumatology: Surgery & Research, 2019
The Journal of Arthroplasty, 2018
Background: Reducing polyethylene (PE) wear by increasing the cross-linking encouraged surgeons t... more Background: Reducing polyethylene (PE) wear by increasing the cross-linking encouraged surgeons to hope for increased total knee arthroplasty (TKA) survival rates. Different methods of manufacturing cross-linked polyethylene (XLPE) were introduced, following promising in vitro results. Is there a measurable effect of cross-linking on TKA survival? Methods: A registry study was conducted, focusing on fixed tibial inserts in primary TKA. Conventional PE represented 87% of the liners, 10% were cross-linked and 2% were antioxidant PE. Sixty-four percent of the liners were posterior-stabilized (PS). Survival of the different PE groups and survival of the main XLPE available were successively compared. We also looked for differences in the same brand implant groups with regard to PE type, as well as differences between cruciate retaining and PS knees. Results: No differences were found when looking at survival for any cause or for aseptic loosening only (P ¼ .96). When comparing the XLPE available, X3 was found to have a better survival than Prolong or Smith & Nephew XLPE (P ¼ .036). When the same implants and X3 or conventional PE were used, no difference could reach a statistical significance. With Zimmer LPS Flex, Prolong XLPE was even associated with a lower survival compared with conventional PE. On Stryker implants, only the Cox regression model allowed highlighting a difference between X3 XLPE and conventional PE, only in PS knees. Conclusion: Increasing the cross-linking seems to only have a low effect, if any, on knee arthroplasty survival. Differences between brands could be found; the manufacturing process could play a role.
Orthopaedics & Traumatology: Surgery & Research, 2019
BACKGROUND Body mass index is used by the World Health Organization to classify obesity. While ob... more BACKGROUND Body mass index is used by the World Health Organization to classify obesity. While obesity influences the onset of arthritis and type-2 diabetes, its effect on implant survival is still open to debate, with conflicting results from clinical and registry studies, as well as meta-analyses. Other known factors such as gender or diabetes status could ponderate or mask the effect of BMI on implant survival. HYPOTHESIS Our hypothesis was BMI influenced hip and knee arthroplasty survival, when results were made independent of gender and diabetes status. PATIENT AND METHODS A registry study was designed on 30733 Total Hip Arthroplasties (THA), 28483 Total Knee Arthroplasties (TKA), 3754 Uni compartmental Knee Arthroplasties (UKA) and 649 Hinged Knee arthroplasties (HK), from 01/01/2003 to 31/12/2015. Mean follow-up was 5.5 years. Diabetes status was added to the model. Each arthroplasty survival was tested for age at implantation, gender, diabetes status, implant characteristics and specifically BMI, taking into account gender and diabetes status. RESULTS Gender had a strong influence on arthroplasty results. Age also influenced arthroplasty survival, especially aseptic loosening; a young age would lower implant survival. Diabetes had an influence in hip survival, but its influence on septic loosenings in TKA wasn't proven (p=0.065). A mobile liner and/or a cruciate retaining knee were factors increasing the risk of revision. Weight influenced THA survival, especially aseptic loosening, but didn't have a measurable effect in any other arthroplasty. BMI was not found to influence any arthroplasty survival, whatever the endpoint, when diabetes and gender were taken into account. DISCUSSION Gender, age and diabetes influenced survival of the lower limb arthroplasties, whereas BMI did not. Only weight did influence THA results and should be used instead of BMI. CONCLUSION Studies on arthroplasty survival should systematically mention gender and diabetes status and beware of potential group incomparability. LEVEL OF EVIDENCE III, cohort study.
HIP International, 2019
Introduction:Noise in ceramic-on-ceramic (CoC) total hip arthroplasty (THA) is a potential sympto... more Introduction:Noise in ceramic-on-ceramic (CoC) total hip arthroplasty (THA) is a potential symptom of abnormal bearing wear. Squeaking and other prosthetic hip noises are multi-factorial phenomena that can be analysed and may provide prognostic information.Methods:46 patients with noisy CoC bearings were investigated using X-ray, computed tomography and joint fluid analysis, and classified into either high or low risk of ceramic liner fracture groups according to previously published guidelines. Noise events from the bearings of 16 high risk cases which were subsequently revised were compared with 30 patients in the low risk control group who did not undergo revision. Noise events were analysed for their physical characteristics using a standardised protocol and classified as either low frequency and short duration ‘clicking’ or long duration and high frequency ‘squeaking’.Results:The peak frequency of squeaking during forward walking was significantly higher for patients in the cas...
Clinical Laboratory, 2019
BACKGROUND Ischemia-modified albumin (IMA) derives from naive albumin, modified in the binding re... more BACKGROUND Ischemia-modified albumin (IMA) derives from naive albumin, modified in the binding region of bivalent ions, as cobalt and iron. The cobalt, released from some types of hip prosthesis seems to be metabolized differently in males and females but the iron ion is more prevalent than cobalt and is detectable in the healthy population. Our aim was to verify if there are any gender- and age-related differences in IMA concentrations and if IMA correlates with cobalt and iron-related proteins. METHODS IMA, albumin, iron, ferritin, transferrin, and cobalt were measured in 50 men and 50 women divided into two age/fertility-homogeneous groups. RESULTS Men < 45-years-old showed a statistically significant lower IMA concentration than men ≥ 45 and fertile and menopausal women. Considering all the population studied, IMA does not seem to be correlated with age and is distributed differently by gender; also, Co distribution was different between males and females. CONCLUSIONS IMA did not correlate with cobalt, iron, ferritin, and transferrin in any group, except for fertile women where IMA presented a statistically significant correlation with serum iron values. Minor expression of IMA in young males together with the results obtained on serum iron in fertile females, could explain the higher accumulation of circulating Co in women compared to men and their different cobalt metabolism.
The International Journal of Artificial Organs, 2006
The authors analyzed the case of a patient with a non-cemented hip prosthesis with a ceramic-cera... more The authors analyzed the case of a patient with a non-cemented hip prosthesis with a ceramic-ceramic coupling. As a consequence of trauma the head fractured. Although the patient could feel the joint grinding, there was no pain and he continued daily living activities for nearly six months, which led to marked wearing of the ceramic head. SEM analysis with microprobe showed “planed” surfaces on the ceramic head, suggesting repeated movements between the fractured components. Inside the cone of the head, signs of TiAlV, which is an alloy of the prosthetic stem, could be seen. Periprosthetic tissues were packed with ceramic wear particles of sizes ranging between 0.2 and 10 microns, according to the harvest site. Metal and mixed particles were also found. IL1, IL6, IL8 and IL10 assays in the synovial liquid confirmed the inflammatory state and a modest induction of bone resorption, which was less than that observed in patients with loosened metal-polyethylene couplings. The humoral pi...
Journal of Orthopaedic Science, 2019
Background: In ceramic-on-ceramic (CoC) total hip arthroplasty (THA), component positioning demon... more Background: In ceramic-on-ceramic (CoC) total hip arthroplasty (THA), component positioning demonstrated to influence the bearing damage: however the connection between angles and clinical outcomes at long-term follow-ups is currently lacking. Aims of this study were: the computer tomography (CT) assessment of component positioning in CoC THAs; the correlation analysis between positioning and ceramic damage; the identification of safe zones. Methods: 91 consecutive post-operative CT scans including two types of CoC implants, with a mean follow-up of 12 ± 4.4 years, were evaluated. III generation (74.2%) and IV generation (25.8%) CoC surfaces were included. The angle measurements (cup abduction, anteversion, cup tilt, stem antetorsion, sacral slope) were automated using a CT-based software. The combined anteversion was assessed as well as the cup-neck position at À15 , 0 , 45 and 90 of flexion. Ceramic damage was diagnosed using synovial fluid analyses and radiological criteria. Results: 63.7% of THAs was inside the cup abduction target 30 e45 and 68.1% was inside the cup anteversion target 5 e25. 19 patients (20.9%) showed signs of ceramic damage. High cup abduction and high cup-neck 45 minimum angle (which stood for high abduction and extreme combined version) significantly correlated with ceramic damage. No demographical features apart III generation ceramic bearings influenced the results. No safe zones could be detected. Conclusions: In CoC THA, no safe zones can be described. However it is important to avoid cup inclination over 45 and a combination of steep cup and extreme combined version.
Knee Surgery, Sports Traumatology, Arthroscopy, 2018
The aim of this study was to assess whether preoperative valgus or varus deformity affected survi... more The aim of this study was to assess whether preoperative valgus or varus deformity affected survivorship after total knee arthroplasty (TKA) and to quantify the risk factors for implant failure in a registry-based population. Methods The Emilia-Romagna Registry of Prosthetic Orthopedic Implants was examined regarding TKAs performed on patients with a preoperative diagnosis of valgus or varus deformity. Demographics, implant characteristic and survivorships were investigated and compared. A total of 2327 TKA procedures performed from 2000 to 2016 were included in the study. Six hundred and forty primary TKAs with a diagnosis of valgus deformity were evaluated with a median follow-up of 3.3 years; 1687 primary TKAs with a diagnosis of varus deformity were evaluated with a median follow-up of 2.5 years. Results Bi-compartmental, cemented posterior stabilised fixed-bearing implants were preferred. For both diagnoses, the implant survivorship rate was greater than 98% in the first year. However, the survival curve of the TKAs implanted for valgus deformity showed a greater slope in the first 3 years as compared to the survival curve of those implanted for varus deformity. Valgus deformity had a 2.1-fold higher risk for revision as compared with varus deformity. Infection was a major cause of implant failure in TKAs for varus deformity, 9/24 (37.5%), while its incidence was lower for valgus deformity, 1/21 (4.8%). Conclusions Preoperative valgus alignment showed a twofold risk of failure as compared to varus alignment after TKA. This should be considered in daily practice, and surgeons are called on to pay more attention when performing TKAs on such patients. Prospective randomised controlled trials are, therefore, necessary to better understand the role of preoperative coronal knee deformity in implant failure. Level of evidence Prognostic study, level III.
The International Journal of Artificial Organs, 1998
One-hundred-eighty cylindrical monocortical titanium implants, 4mm diameter and 12mm long, with t... more One-hundred-eighty cylindrical monocortical titanium implants, 4mm diameter and 12mm long, with three different coatings: fluorohydroxyapatite (group A), hydroxyapatite (group B), and titanium oxide (group C), all applied by vacuum plasma spray were bilaterally, randomly implanted into the femurs and tibiae of twelve adult mongrel sheep. The sheep were divided into four groups (1, 2, 3 and 4) numbering three sheep each. Sheep of groups 1, 2, 3 and 4 were euthanized at two weeks, one month, three and nine months after implantation, respectively. Biomechanical and histomorphological analysis were performed. Extraction torque increased over time in all groups until the nine months period. At all the studied periods, the bone-implant contact was higher in Groups A and B compared to Group C. However, only at nine months did this difference reach statistical significance (p<0.005 comparing Groups A and B to C). The results of this study show that all the three coatings could be recomme...
International Orthopaedics, 2018
Purpose Periprosthetic hip infection (PHI) is a devastating complication. The association between... more Purpose Periprosthetic hip infection (PHI) is a devastating complication. The association between PHI and bearing surfaces as well as patient-related factors has been recently investigated, with contradictive outcomes. The dataset of Emilia-Romagna region Registry for Orthopaedic Prosthetic Implants (RIPO) has been assessed to investigate, if the bearing choice influenced the risk of septic loosening occurrence. Methods RIPO data about 39,206 cementless total hip arthroplasties (THA), collected since 2003, were analysed. Age, gender, BMI, diabetes and bearing surfaces were evaluated. The end point of the study was the revision of at least a single component due to sepsis. Results Adjusted and unadjusted survival rates showed that ceramic-on-ceramic (COC) implants had the lower incidence of PHIs, whereas metal-on-metal (MOM) THAs were significantly more prone to infection. In MOM cohort, stemmed implants were involved in 28 out of 30 cases. Among the demographical features and comorbid conditions, only diabetes statistically influenced the rate of sepsis. Conclusions Bearing surfaces influenced the rate of PHI; in particular, stemmed MOM implants were at higher risk, probably due to metal debris consequent to taperosis. Despite the preliminary results, stemmed MOM THAs should be used with care, and diabetic patients should be warned about increased septic risks.
Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, 2009
Modification of knee joint wear simulation methods has included ‘anatomic attachment’ of unicondy... more Modification of knee joint wear simulation methods has included ‘anatomic attachment’ of unicondylar knee replacements (UKR) onto synthetic femurs with material properties and morphology similar to human femurs. The present study assesses the effect of such modification by comparing the damage patterns on UKR polyethylene inserts after in vitro simulation using standard and modified simulation methods with those on inserts retrieved after in vivo function. Three groups of UKR inserts were evaluated after retrieval (Explant Group, n = 17) or after knee joint wear simulation with the components attached to standard metal blocks (Standard Group, n = 6) or synthetic femurs (Anatomic Group, n = 6). All UKR had similar non-conforming articular surfaces. Articular damage patterns (mode, frequency, and area) were quantified using digital image photogrammetry. Although some common damage modes were noted, knee joint wear simulation with standard or ‘anatomic’ attachment did not generate dama...
Knee (Oxford), 2014
Since 2000, the Register of Prosthetic Orthopedic Implants (RIPO) has been following all hip, kne... more Since 2000, the Register of Prosthetic Orthopedic Implants (RIPO) has been following all hip, knee, and shoulder arthroplasties in the Emilia-Romagna region, comprising 4.5 million inhabitants, in northern Italy. The aim of the present analysis was to present the main figures of unicompartmental knee implants processed from the Registry. During the period 2000-2011, 3929 unicompartmental knee arthroplasties were performed on 3645 resident patients, of which 71% were females. The medial condyle was treated in 94% of cases, where mean age at surgery was 67.3 years and mean body weight was 76.6 kg. The main outcome measure was time to revision of at least one single component. The Kaplan-Meier survival and Cox multivariate analyses have been applied. At 10-year follow-up, the percentage of survival was 86.8% (confidence interval (CI) at 95% was 84.1-89.5); total aseptic loosening represented 42% of the causes of failure, pain represented 15%, and sepsis represented 11%. Age at surgery significantly influences the survival of the prosthesis, whatever the reason for revision, while the type of tibial component (monoblock or metal tray) does not appear to be a determinant. Septic failure is not prevented by the use of antibiotic-loaded cement. Results are comparable to main orthopedic registries from Scandinavia, Australia, and New Zealand, even if some differences can be highlighted.
Copyright © 2014 Susanna Stea et al. This is an open access article distributed under the Creativ... more Copyright © 2014 Susanna Stea et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aromatherapy is the controlled use of plant essences for therapeutic purposes. Its applications are numerous (i.e., wellbeing, labour, infections, dementia, and anxiety treatment) but often they have not been scientifically validated.The aim of the present study is to review the available literature to determine if there is evidence for effectiveness of aromatherapy in surgical patients to treat anxiety and insomnia, to control pain and nausea, and to dress wound. Efficacy studies of lavender or orange and peppermint essential oils, to treat anxiety and nausea, respectively, have shown positive results. For other aspects, such as pain control, essential oils therapy has shown uncertain results. Finally, there are encouraging data for t...
Relationship between obesity and early failure of total knee prostheses
Personalized Hip and Knee Joint Replacement, 2020
Stem modularity can be classified according to the coupling location: distal, mid-stem, and proxi... more Stem modularity can be classified according to the coupling location: distal, mid-stem, and proximal [1]. Mid-stem and proximal modularity have been more frequently used. Either the junction is located proximal or distal (mid-stem) to the neck osteotomy (Fig. 8.1). Proximal modularity with modular necks was introduced in 1987 by Cremascoli Ortho (Milan, Italy), in order to provide independent combinations of version, offset, and length [1]. Rationale of modular necks. The rationale for proximal modularity with modular necks was the achievement of a better soft tissue balancing and was to reduce the occurrence of prosthetic impingement [1, 2]. The best candidates for neck modularity, where the most remarkable benefits are obtained, are subjects with unconventional hip anatomies and biomechanics [1, 2]. In these cases, standard acetabular and femoral compo
Journal of Bone and Joint Surgery-british Volume, 2016
The RIPO register collects data of all primary and revision hip replacement surgeries performed i... more The RIPO register collects data of all primary and revision hip replacement surgeries performed in Region Emilia-Romagna, Italy since 1stJanuary 2000. The present study is aimed to analyze the survival rate of patients with Biolox®delta and Biolox®forte components, (CeramTec, Plochingen Germany) considering possible confounding factors. Only patients living in the region are considered in analysis, to avoid the bias resulting from the ‘loss’ of non-resident patients. The analysis has been conducted only on uncemented THA and monoblock, double mobility cups as well as such with pre-assembled inserts were excluded. Therefore, the finally analyzed database consists of 30’617 cases; 13’323 Biolox®forte and 17’294 Biolox®delta heads, articulating against ceramic or PE. Unadjusted survival analysis was calculated according to Kaplan Meier method; with prosthesis failure as end point, defined as the revision of any prosthetic component for any cause. To avoid a possible bias, revision of t...
Alternatives to Laboratory Animals, 1992
In order to evaluate in vitro the suitability of various prosthetic materials for endothelial see... more In order to evaluate in vitro the suitability of various prosthetic materials for endothelial seeding, human endothelial cells derived from the umbilical vein were placed in direct contact with a variety of polymers. As a control, endothelial cells were cultured in the absence of material. After 24, 48, 72 and 96 hours, the cells were counted and a viability test with neutral red was performed. Assays of 6-keto prostaglandinFla (6-keto-PGF1a), tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) were carried out on the supernatants. The cell counting technique demonstrated growth inhibition in the cell populations in contact with Woven Dacron® and Double Velour Dacron® in comparison with control cell cultures. Vital staining with neutral red, always sharply positive in the controls, was weak in the cells placed in contact with the materials. The 6-keto-PGF1a concentration in the supernatant was similar to the control level in the populations in contact wi...
Journal of Materials Science: Materials in Medicine, 2020
Introduction Ceramic-on-ceramic couplings demonstrated to be reliable bearings in primary total h... more Introduction Ceramic-on-ceramic couplings demonstrated to be reliable bearings in primary total hip arthroplasty (THA), with long-term remarkable results. Like-on-like configurations were widely described. On the contrary, mixed material combinations from the same manufacturer, Delta-on-Forte or Forte-on-Delta, were poorly studied. In particular, it is unknown whether mixed ceramic combinations are more at risk of ceramic fractures. Thus, a registry study was conducted to investigate the long-term survival rates and reasons for revision of mixed ceramic combinations. A comparison with Deltaon-Delta couplings was also performed. Materials and methods The regional arthroplasty registry RIPO was enquired about three cohorts of ceramic bearings (headon-liner: Delta-on-Forte, Forte-on-Delta, Delta-on-Delta). Demographics, survival rates and reasons for revision were evaluated and compared. Results In total, 346 (1.5%) implants had a Delta-on-Forte coupling (mean follow-up: 6.4 years). In total, 1163 (5%) THAs had a Forte-on-Delta articulation (mean follow-up: 8.2 years). Delta-on-Delta surfaces were implanted in 21,874 (93.5%) hips (mean follow-up: 3.9 years). Mixed material combinations were implanted between 2003 and 2007. The survival rates of the three cohorts were similar and were higher than 95% at 10 years. In Forte-on-Delta group, four liners failed (0.3% of the implants), whereas ceramic fractures occurred in 15 cases (0.1%) in Delta-on-Delta couplings (3 heads and 12 liners). Considering ceramic fracture as endpoint, there was no significant difference between the three survival rates. Conclusions Mixed ceramic bearing configurations from the same manufacturer in primary THA showed mid-to-longterm dependable outcomes, not inferior to the most recent like-on-like ceramic bearings. No additional risks of ceramic fractures were evident. Thus, closer follow-ups are not required.
Orthopaedics & Traumatology: Surgery & Research, 2019
The Journal of Arthroplasty, 2018
Background: Reducing polyethylene (PE) wear by increasing the cross-linking encouraged surgeons t... more Background: Reducing polyethylene (PE) wear by increasing the cross-linking encouraged surgeons to hope for increased total knee arthroplasty (TKA) survival rates. Different methods of manufacturing cross-linked polyethylene (XLPE) were introduced, following promising in vitro results. Is there a measurable effect of cross-linking on TKA survival? Methods: A registry study was conducted, focusing on fixed tibial inserts in primary TKA. Conventional PE represented 87% of the liners, 10% were cross-linked and 2% were antioxidant PE. Sixty-four percent of the liners were posterior-stabilized (PS). Survival of the different PE groups and survival of the main XLPE available were successively compared. We also looked for differences in the same brand implant groups with regard to PE type, as well as differences between cruciate retaining and PS knees. Results: No differences were found when looking at survival for any cause or for aseptic loosening only (P ¼ .96). When comparing the XLPE available, X3 was found to have a better survival than Prolong or Smith & Nephew XLPE (P ¼ .036). When the same implants and X3 or conventional PE were used, no difference could reach a statistical significance. With Zimmer LPS Flex, Prolong XLPE was even associated with a lower survival compared with conventional PE. On Stryker implants, only the Cox regression model allowed highlighting a difference between X3 XLPE and conventional PE, only in PS knees. Conclusion: Increasing the cross-linking seems to only have a low effect, if any, on knee arthroplasty survival. Differences between brands could be found; the manufacturing process could play a role.
Orthopaedics & Traumatology: Surgery & Research, 2019
BACKGROUND Body mass index is used by the World Health Organization to classify obesity. While ob... more BACKGROUND Body mass index is used by the World Health Organization to classify obesity. While obesity influences the onset of arthritis and type-2 diabetes, its effect on implant survival is still open to debate, with conflicting results from clinical and registry studies, as well as meta-analyses. Other known factors such as gender or diabetes status could ponderate or mask the effect of BMI on implant survival. HYPOTHESIS Our hypothesis was BMI influenced hip and knee arthroplasty survival, when results were made independent of gender and diabetes status. PATIENT AND METHODS A registry study was designed on 30733 Total Hip Arthroplasties (THA), 28483 Total Knee Arthroplasties (TKA), 3754 Uni compartmental Knee Arthroplasties (UKA) and 649 Hinged Knee arthroplasties (HK), from 01/01/2003 to 31/12/2015. Mean follow-up was 5.5 years. Diabetes status was added to the model. Each arthroplasty survival was tested for age at implantation, gender, diabetes status, implant characteristics and specifically BMI, taking into account gender and diabetes status. RESULTS Gender had a strong influence on arthroplasty results. Age also influenced arthroplasty survival, especially aseptic loosening; a young age would lower implant survival. Diabetes had an influence in hip survival, but its influence on septic loosenings in TKA wasn't proven (p=0.065). A mobile liner and/or a cruciate retaining knee were factors increasing the risk of revision. Weight influenced THA survival, especially aseptic loosening, but didn't have a measurable effect in any other arthroplasty. BMI was not found to influence any arthroplasty survival, whatever the endpoint, when diabetes and gender were taken into account. DISCUSSION Gender, age and diabetes influenced survival of the lower limb arthroplasties, whereas BMI did not. Only weight did influence THA results and should be used instead of BMI. CONCLUSION Studies on arthroplasty survival should systematically mention gender and diabetes status and beware of potential group incomparability. LEVEL OF EVIDENCE III, cohort study.
HIP International, 2019
Introduction:Noise in ceramic-on-ceramic (CoC) total hip arthroplasty (THA) is a potential sympto... more Introduction:Noise in ceramic-on-ceramic (CoC) total hip arthroplasty (THA) is a potential symptom of abnormal bearing wear. Squeaking and other prosthetic hip noises are multi-factorial phenomena that can be analysed and may provide prognostic information.Methods:46 patients with noisy CoC bearings were investigated using X-ray, computed tomography and joint fluid analysis, and classified into either high or low risk of ceramic liner fracture groups according to previously published guidelines. Noise events from the bearings of 16 high risk cases which were subsequently revised were compared with 30 patients in the low risk control group who did not undergo revision. Noise events were analysed for their physical characteristics using a standardised protocol and classified as either low frequency and short duration ‘clicking’ or long duration and high frequency ‘squeaking’.Results:The peak frequency of squeaking during forward walking was significantly higher for patients in the cas...
Clinical Laboratory, 2019
BACKGROUND Ischemia-modified albumin (IMA) derives from naive albumin, modified in the binding re... more BACKGROUND Ischemia-modified albumin (IMA) derives from naive albumin, modified in the binding region of bivalent ions, as cobalt and iron. The cobalt, released from some types of hip prosthesis seems to be metabolized differently in males and females but the iron ion is more prevalent than cobalt and is detectable in the healthy population. Our aim was to verify if there are any gender- and age-related differences in IMA concentrations and if IMA correlates with cobalt and iron-related proteins. METHODS IMA, albumin, iron, ferritin, transferrin, and cobalt were measured in 50 men and 50 women divided into two age/fertility-homogeneous groups. RESULTS Men < 45-years-old showed a statistically significant lower IMA concentration than men ≥ 45 and fertile and menopausal women. Considering all the population studied, IMA does not seem to be correlated with age and is distributed differently by gender; also, Co distribution was different between males and females. CONCLUSIONS IMA did not correlate with cobalt, iron, ferritin, and transferrin in any group, except for fertile women where IMA presented a statistically significant correlation with serum iron values. Minor expression of IMA in young males together with the results obtained on serum iron in fertile females, could explain the higher accumulation of circulating Co in women compared to men and their different cobalt metabolism.
The International Journal of Artificial Organs, 2006
The authors analyzed the case of a patient with a non-cemented hip prosthesis with a ceramic-cera... more The authors analyzed the case of a patient with a non-cemented hip prosthesis with a ceramic-ceramic coupling. As a consequence of trauma the head fractured. Although the patient could feel the joint grinding, there was no pain and he continued daily living activities for nearly six months, which led to marked wearing of the ceramic head. SEM analysis with microprobe showed “planed” surfaces on the ceramic head, suggesting repeated movements between the fractured components. Inside the cone of the head, signs of TiAlV, which is an alloy of the prosthetic stem, could be seen. Periprosthetic tissues were packed with ceramic wear particles of sizes ranging between 0.2 and 10 microns, according to the harvest site. Metal and mixed particles were also found. IL1, IL6, IL8 and IL10 assays in the synovial liquid confirmed the inflammatory state and a modest induction of bone resorption, which was less than that observed in patients with loosened metal-polyethylene couplings. The humoral pi...
Journal of Orthopaedic Science, 2019
Background: In ceramic-on-ceramic (CoC) total hip arthroplasty (THA), component positioning demon... more Background: In ceramic-on-ceramic (CoC) total hip arthroplasty (THA), component positioning demonstrated to influence the bearing damage: however the connection between angles and clinical outcomes at long-term follow-ups is currently lacking. Aims of this study were: the computer tomography (CT) assessment of component positioning in CoC THAs; the correlation analysis between positioning and ceramic damage; the identification of safe zones. Methods: 91 consecutive post-operative CT scans including two types of CoC implants, with a mean follow-up of 12 ± 4.4 years, were evaluated. III generation (74.2%) and IV generation (25.8%) CoC surfaces were included. The angle measurements (cup abduction, anteversion, cup tilt, stem antetorsion, sacral slope) were automated using a CT-based software. The combined anteversion was assessed as well as the cup-neck position at À15 , 0 , 45 and 90 of flexion. Ceramic damage was diagnosed using synovial fluid analyses and radiological criteria. Results: 63.7% of THAs was inside the cup abduction target 30 e45 and 68.1% was inside the cup anteversion target 5 e25. 19 patients (20.9%) showed signs of ceramic damage. High cup abduction and high cup-neck 45 minimum angle (which stood for high abduction and extreme combined version) significantly correlated with ceramic damage. No demographical features apart III generation ceramic bearings influenced the results. No safe zones could be detected. Conclusions: In CoC THA, no safe zones can be described. However it is important to avoid cup inclination over 45 and a combination of steep cup and extreme combined version.
Knee Surgery, Sports Traumatology, Arthroscopy, 2018
The aim of this study was to assess whether preoperative valgus or varus deformity affected survi... more The aim of this study was to assess whether preoperative valgus or varus deformity affected survivorship after total knee arthroplasty (TKA) and to quantify the risk factors for implant failure in a registry-based population. Methods The Emilia-Romagna Registry of Prosthetic Orthopedic Implants was examined regarding TKAs performed on patients with a preoperative diagnosis of valgus or varus deformity. Demographics, implant characteristic and survivorships were investigated and compared. A total of 2327 TKA procedures performed from 2000 to 2016 were included in the study. Six hundred and forty primary TKAs with a diagnosis of valgus deformity were evaluated with a median follow-up of 3.3 years; 1687 primary TKAs with a diagnosis of varus deformity were evaluated with a median follow-up of 2.5 years. Results Bi-compartmental, cemented posterior stabilised fixed-bearing implants were preferred. For both diagnoses, the implant survivorship rate was greater than 98% in the first year. However, the survival curve of the TKAs implanted for valgus deformity showed a greater slope in the first 3 years as compared to the survival curve of those implanted for varus deformity. Valgus deformity had a 2.1-fold higher risk for revision as compared with varus deformity. Infection was a major cause of implant failure in TKAs for varus deformity, 9/24 (37.5%), while its incidence was lower for valgus deformity, 1/21 (4.8%). Conclusions Preoperative valgus alignment showed a twofold risk of failure as compared to varus alignment after TKA. This should be considered in daily practice, and surgeons are called on to pay more attention when performing TKAs on such patients. Prospective randomised controlled trials are, therefore, necessary to better understand the role of preoperative coronal knee deformity in implant failure. Level of evidence Prognostic study, level III.
The International Journal of Artificial Organs, 1998
One-hundred-eighty cylindrical monocortical titanium implants, 4mm diameter and 12mm long, with t... more One-hundred-eighty cylindrical monocortical titanium implants, 4mm diameter and 12mm long, with three different coatings: fluorohydroxyapatite (group A), hydroxyapatite (group B), and titanium oxide (group C), all applied by vacuum plasma spray were bilaterally, randomly implanted into the femurs and tibiae of twelve adult mongrel sheep. The sheep were divided into four groups (1, 2, 3 and 4) numbering three sheep each. Sheep of groups 1, 2, 3 and 4 were euthanized at two weeks, one month, three and nine months after implantation, respectively. Biomechanical and histomorphological analysis were performed. Extraction torque increased over time in all groups until the nine months period. At all the studied periods, the bone-implant contact was higher in Groups A and B compared to Group C. However, only at nine months did this difference reach statistical significance (p<0.005 comparing Groups A and B to C). The results of this study show that all the three coatings could be recomme...
International Orthopaedics, 2018
Purpose Periprosthetic hip infection (PHI) is a devastating complication. The association between... more Purpose Periprosthetic hip infection (PHI) is a devastating complication. The association between PHI and bearing surfaces as well as patient-related factors has been recently investigated, with contradictive outcomes. The dataset of Emilia-Romagna region Registry for Orthopaedic Prosthetic Implants (RIPO) has been assessed to investigate, if the bearing choice influenced the risk of septic loosening occurrence. Methods RIPO data about 39,206 cementless total hip arthroplasties (THA), collected since 2003, were analysed. Age, gender, BMI, diabetes and bearing surfaces were evaluated. The end point of the study was the revision of at least a single component due to sepsis. Results Adjusted and unadjusted survival rates showed that ceramic-on-ceramic (COC) implants had the lower incidence of PHIs, whereas metal-on-metal (MOM) THAs were significantly more prone to infection. In MOM cohort, stemmed implants were involved in 28 out of 30 cases. Among the demographical features and comorbid conditions, only diabetes statistically influenced the rate of sepsis. Conclusions Bearing surfaces influenced the rate of PHI; in particular, stemmed MOM implants were at higher risk, probably due to metal debris consequent to taperosis. Despite the preliminary results, stemmed MOM THAs should be used with care, and diabetic patients should be warned about increased septic risks.
Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, 2009
Modification of knee joint wear simulation methods has included ‘anatomic attachment’ of unicondy... more Modification of knee joint wear simulation methods has included ‘anatomic attachment’ of unicondylar knee replacements (UKR) onto synthetic femurs with material properties and morphology similar to human femurs. The present study assesses the effect of such modification by comparing the damage patterns on UKR polyethylene inserts after in vitro simulation using standard and modified simulation methods with those on inserts retrieved after in vivo function. Three groups of UKR inserts were evaluated after retrieval (Explant Group, n = 17) or after knee joint wear simulation with the components attached to standard metal blocks (Standard Group, n = 6) or synthetic femurs (Anatomic Group, n = 6). All UKR had similar non-conforming articular surfaces. Articular damage patterns (mode, frequency, and area) were quantified using digital image photogrammetry. Although some common damage modes were noted, knee joint wear simulation with standard or ‘anatomic’ attachment did not generate dama...