Vittorio Calvisi | Università Degli Studi Dell'Aquila (original) (raw)
Papers by Vittorio Calvisi
Journal of biological regulators and homeostatic agents, 2021
Infection with SARS-CoV2 leads to COVID-19, the severity of which derives from the host’s immune ... more Infection with SARS-CoV2 leads to COVID-19, the severity of which derives from the host’s immune response, especially the release of a storm of pro-inflammatory cytokines. This coronavirus infects by first binding to the ectoenzyme Angiotensin Converting Enzyme 2 (ACE2), a serine protease acting as the receptor, while another serine protease is necessary for priming the viral spike “S” protein required for entering the cells. Repurposing existing drugs for potential anti-coronavirus activity have failed. As a result, there were intense efforts to rapidly produce ways of providing prophylactic active immunization (vaccines) or abortive passive (convalescent plasma or monoclonal antibodies) neutralizing antibodies. The availability of vaccines for COVID-19 have been largely successful, but many questions still remain unanswered. In spite of the original enthusiasm, clinical studies using convalescent serum or monoclonal antibodies have shown limited benefit. Moreover, the emergence of...
Journal of Clinical Medicine
The emphasis on value-based payment models for primary total hip replacement (THA) results in a g... more The emphasis on value-based payment models for primary total hip replacement (THA) results in a greater need for orthopaedic surgeons and hospitals to better understand actual costs and resource use. Time-Driven Activity-Based Costing (TDABC) is an innovative approach to measure expenses more accurately and address cost challenges. It estimates the quantity of time and the cost per unit of time of each resource (e.g., equipment and personnel) used across an episode of care. Our goal is to understand the true cost of a THA using the TDABC in an Italian public hospital and to comprehend how the adoption of this method might enhance the process of providing healthcare from an organizational and financial standpoint. During 2019, the main activities required for total hip replacement surgery, the operators involved, and the intraoperative consumables were identified. A process map was produced to identify the patient’s concrete path during hospitalization and the length of stay was also...
Lo Scalpello - Otodi Educational
Objective. The purpose of the present study was to estimate the diagnostic accuracy of a spectrum... more Objective. The purpose of the present study was to estimate the diagnostic accuracy of a spectrum of physical examination tests, explaining how to perform them and compare them with arthroscopic findings to identify which have the best ability to accurately detect a subscapularis tear in a population of primary care patients with shoulder pain. Methods. Three established clinical tests were evaluated in 56 consecutive patients prior to shoulder arthroscopy. The tests included the Lift Off test, Napoleon test, and Bear Hug test. The integrity or not of the subscapularis tendon at surgery was considered as the gold standard. Lesions to the subscapularis were graded according to Lafosse. Results. Among the 56 patients there were 17 with arthroscopic diagnosis of subscapularis lesions accounting for an incidence of 30%. The sensitivity for subscapularis tears for the Lift-off test, Napoleon test, and Bear Hug test was 80.15, 58.82, and 82.35%, respectively. Specificity was 54.55, 56.82, and 55.56%, respectively. A significant correlation was found between arthroscopic findings and physical examination only for the Bear Hug. Conclusions. In the present study, the Bear Hug test was found to have the highest sensitivity of all tests studied. Nevertheless, it appears advisable to perform more than one clinical test to further improve the clinical ability to detect subscapularis tears.
Lo Scalpello - Otodi Educational
Introduction. Arthroplasty registries are widely recognized as an effective tool, providing a con... more Introduction. Arthroplasty registries are widely recognized as an effective tool, providing a constant flow of data that can guide the clinical practice of orthopedic surgeons. Despite their usefulness, their implementation in Italy has historically proved to be laborious. In fact, many surgeons are unwilling to participate, claiming as reason for this inertia the additional work needed in an already overloaded clinical practice. Material and methods. Five operators from five different hospitals without any previous experience with arthroplasty registries entered all the data relevant to the joint replacements performed in their structures in a dedicated online platform and measured the time needed for any input. The learning curve for each operator was then drawn. Results. After the input of 20 procedures, all operators reached a plateau of about 2-3 minutes to record a single intervention. Conclusions. The modest amount of time required to compile registry data sheet should not represent a limitation for surgeons to enter the information into a national registry.
Lo Scalpello - Otodi Educational, 2021
The persistence of pain at the fracture site and the absence of bone callus at X-ray controls are... more The persistence of pain at the fracture site and the absence of bone callus at X-ray controls are the univocal criteria for diagnosis of nonunion. When this failure befalls, the healing process has stopped and the fracture is no longer able to consolidate without surgery. The aim of this review is to investigate the use and outcomes of the Exchange Reamed Nailing (ERN) technique for aseptic tibial shaft nonunion. Replacement surgery with an oversized reamed nail showed 91% success. After a tibial fracture, nonunion is to be expected in 17% of cases, with a majority of the hypertrophic type (82%). To avoid further failures, the following is essential: to increase the mechanical stability by implanting an oversize nail and lock it with 2 distal static screws and a proximal dynamic screw; to ream the canal to promote vascularisation with osteoinductive and osteoconductive effects; to ensure the absence of a latent infection, which can lead to osteomyelitis in 18% of failures. Autologous bone grafting and fibula osteotomy are useful in specific cases.
Journal of Clinical Medicine, 2022
The Italian government on the 8th of march in response to the increased global prevalenceof sever... more The Italian government on the 8th of march in response to the increased global prevalenceof severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stated a national quarantine. In this period the absence of rapid and sure screening tests for COVID-19 made necessary more attention for presence of fever in hospitalized patients, like continuous use of surgical, FFP2, and FFP3 masks (PPE) by nurses, physicians, and patients; moreover, patients visits were restricted. In this period, during the daily activities in our orthopedic department we observed an empirical decreased incidence of post-operative fever in patients admitted for trauma surgery. The aim of this study is to compare the prevalence of post-operative fever in this period with the same period in 2019. We analyzed the presence of post-operative fever in 110 patients admitted in 2020 and 129 admitted in 2019. The results show a significant decrease of the prevalence and duration of post-operative fever in patients admi...
HIP International, 2020
Introduction: The aim of this study is to evaluate clinical, radiographic and laboratory results ... more Introduction: The aim of this study is to evaluate clinical, radiographic and laboratory results of ceramic-on-metal (CoM) (hybrid hard bearing) in total hip arthroplasty (THA), associated with a short stem implant. Methods: From a cohort of 37 patients suffering from primary or secondary hip osteoarthritis who underwent THA using CoM bearing, 19 were suitable for this study. All procedures were performed by the same surgeon using a posterior-lateral approach. All patients were compared clinically using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF12F/M), and radiographically (offset, CD angle, limb length discrepancy, cup inclination and anteversion, subsidence, osseointegration, heterotopic ossification). Blood samples were collected in order to evaluate chromium (Cr) and cobalt (Co) ions level. Radiographic evaluations were carried out by 3 different blinded sur...
Journal of Clinical Orthopaedics and Trauma, 2020
Background: The number of periprosthetic joint infections (PJI) is continuously increasing becaus... more Background: The number of periprosthetic joint infections (PJI) is continuously increasing because of the increasing number of arthroprostheses performed every year. Two-stage revision, using antibioticloaded spacers, remains the gold standard for their treatment. The aim of our study is to compare the use of preformed vs handmade spacers in hip arthroplasty infections evaluating infection eradication, bone loss and clinical/functional outcomes. Methods: From January 2010 to December 2017 we performed a prospective nonrandomized study. We pooled 50 patients affected by infected hip joint replacements, and divided them in 2 groups, one receiving commercially preformed spacers and the other receiving handmade spacers. The study endpoint was set at 12 months. Intra-operative and peri-operative complications, Harris Hip Score (HHS), Short Form 12 Health Survey, intra-operative and radiological evaluation of bone loss were collected. Data were analyzed using descriptive statistics, T-test and Fisher Exact test. Results: We found a statistically significant differences (p < 0.05) between the two groups in favour of the VancogenX group for the following variables: surgical time, first and second stage intraoperative complication rates, infection eradication. Moreover, the preformed-spacers group had better results in the preservation of bone stock, even though the difference was not statistically significant (p > 0.05). Conclusion: Our results support the use of preformed antibiotic spacers, even though more studies are needed.
Journal of Clinical Orthopaedics and Trauma, 2019
Background: Metal-on-Metal (MoM) total hip arthroplasty (THA) represents a very controversial pro... more Background: Metal-on-Metal (MoM) total hip arthroplasty (THA) represents a very controversial procedure because of the possibility of postoperative adverse local tissue reaction (ALTR). This study investigates the reliability of the ultrasound scan as a diagnostic tool to quantify a clinically useful threshold in the level of periprosthetic fluid collection to suggest implant revision. Methods: This study includes 116 patients (123 implants) who received an Articular Surface Replacement XL (ASRTMXL, De Puy Synthes, USA) MoM THA. The study group included 56 males and 60 females with a mean age of 66.6 years (range, 15e86 years). All patients were clinically and radiologically annually evaluated (according to the Harris Hip Score) up to a mean follow-up of 7.5 years (min. 1.4 e max. 10.3 years) from the primary surgery: all patients underwent standard ultrasound evaluation of the affected hip and Cobalt/Chromium blood detection testing according to a custom-made diagnostic algorithm for MoM THA revision. Results: At final follow-up, 51 (43.1%) of 117 implants underwent revision after a mean of 6 years (1.79 e9.26) from the primary ASR implant. The authors found a statistically significant correlation between Cr (p ¼ 0.015) and Co (p ¼ 0.009) blood values and different ultrasound grades. Statistical analysis showed a significant association between periprosthetic fluid collection and revision surgery (p < 0.0001) and the final revision risk was estimated to be 7 times greater in patients with ultrasound grade 2 (periprosthetic collection 20 mm). Conclusions: This study confirms the reliability of ultrasound evaluation in detecting clinically significant peri-prosthetic joint effusions: a new diagnostic algorithm for MoM THA revision is here presented. Longer follow up studies are mandatory to better understand the potential advantages of this diagnostic protocol.
Revue de Chirurgie Orthopédique et Traumatologique, 2014
Single bundle, single tunnel reconstruction of ACL seems to be an “old procedure” after the recen... more Single bundle, single tunnel reconstruction of ACL seems to be an “old procedure” after the recent development and knowledge about anatomical reconstructions of ACL (single or double bundle). Despite the new trend, prospective long-term follow-up studies on the single bundle reconstruction are necessary to get more information on a technique that has occupied the last 20 years and has been executed on millions of patients. Methods From January 2002 and February 2003, hundred eight patients were recruited for a prospective randomized trial. The exclusion criteria were previous knee operations, chondral lesions, varus deformity more than 10 degrees, limb imbalance, meniscal lesion extension more than on third of the meniscus and history of knee tendinopathies. Three groups of 36 patients each were selected by the arthroscopically assisted surgical procedure: A B-PT-B reconstruction, B hamstrings (endobutton CL-reabsorbable interference screw), and C hamstrings (endobutton CL-evolgate). A dice method was used for the graft randomization. A standard rehabilitation protocol was used for all the patients, including immediate postoperative mobilisation with a knee brace just for walking (first 3 weeks), protected weight bearing for 2 weeks, and return to full activity at 6–12 months postoperatively. The patients were followed up at 6 months, 1 year and then each year until the tenth year postoperative. Six patients in group A, 8 in group B and 11 in group C were lost at the final follow-up. The methods of evaluation included clinical and instrumented laxity testing (Rolimeter), isokinetic muscle torque measurements (Cybex II), International Knee Documentation Committee II ratings, Lysholm score, Tegner activity level, Kujala patellofemoral knee scores, and radiological tunnel enlargement measure. Results The results revealed no statistically significant differences with respect to IKDC II, Lysholm score, Isokinetic test and Kujala patellofemoral knee scores. There was an enlargement of the tunnels, statistically significant in the hamstring tendon groups, and more evident in the group B. Any widening of the tunnels from 3 to 5 years was recorded into each group. The measurement of laxity using the Rolimeter showed better results for group A without any difference statistically significant. Differently, the Tegner score was statistically favourable for PT group for the first 4 years after surgery. Radiological narrowing of the joint spaces (IKDC) from 1 to 10 years postoperatively was seen in all the groups, At 10 years follow-up, radiological findings were worse for the PT group (P Conclusions PT and hamstrings ACL reconstruction seem to show similar functional and clinical results at long-term follow-up. Tunnel widening in hamstrings groups, may be a complication in case of revision. The patellar tendon group seems to be more prone to develop osteoarthritis after 5 years postoperatively.
BMC Musculoskeletal Disorders, 2013
BackgroundAmong the various complications described in literature, the patellar tendon ossificati... more BackgroundAmong the various complications described in literature, the patellar tendon ossification is an uncommon occurrence in anterior cruciate ligament (ACL) reconstruction using bone – patellar tendon – bone graft (BPTB). The heterotopic ossification is linked to knee traumatism, intramedullary nailing of the tibia and after partial patellectomy, but only two cases of this event linked to ACL surgery have been reported in literature.Case presentationWe present a case of a 42-year-old Caucasian man affected by symptomatic extended heterotopic ossification of patellar tendon after 20 months from ACL reconstruction using BPTB. The clinical diagnosis was confirmed by Ultrasound, X-Ray and Computed Tomography studies, blood tests were performed to exclude metabolic diseases then the surgical removal of the lesion was performed. After three years from surgery, the patient did not report femoro-patellar pain, there was not range of motion limitation and the clinical-radiological exami...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2012
The os acetabuli (OSA) is a bone fragment located at the acetabular rim. In most cases, it is obs... more The os acetabuli (OSA) is a bone fragment located at the acetabular rim. In most cases, it is observed at the anterior or anterosuperior edge of the acetabular rim. The etiology has been discussed for a long time. It could be the result of a stress fracture (rim fracture) due to acetabular rim overloading in some case of dysplasia or femoroacetabular impingement (FAI). It can be excised or fixed in case of low acetabular coverage. For this purpose, a careful radiological preoperative planning is needed. This chapter aims to provide an overview of os acetabuli and some indications, tips, and tricks for its treatment.
Muscles, Ligaments and Tendons Journal, 2016
Background: The gastrocnemius-semimembranosus bursa may communicate with the knee joint. The arth... more Background: The gastrocnemius-semimembranosus bursa may communicate with the knee joint. The arthroscopic anatomy of the posteromedial aspect varies depending on the angle of the oblique popliteal ligament, the level at which it crosses the medial gastrocnemius tendon, and its relationship with the capsular joint and synovia. The aim of this paper is to identify possible patterns, and to evaluate their characteristics and their relationship with Baker's cyst. Methods: data archived from 185 consecutive arthroscopies were evaluated; an anatomic description and classification was carried out; the percentages of association with BC and the associated pathologies were reported. Results: The different anatomies were classified into six groups based on the relationship above the medial gastrocnemius tendon, the capsular joint and synovia. The prevalence of Baker's cyst was 28.3%. The main associated intra-articular pathological condition was the contemporary presence of a meniscal tear and chondropathy. Conclusion: Exploration of the posterior aspect of the knee must be performed routinely. Knowing the possible anatomy patterns of the posteromedial arthroscopic aspect of the knee joint could help to identify the cyst and its gateway, thus facilitating its treatment. Level of the evidence: III.
International Journal of Immunopathology and Pharmacology, 2008
The diagnosis of septic arthritis following arthroscopic anterior cruciate ligament (ACL) reconst... more The diagnosis of septic arthritis following arthroscopic anterior cruciate ligament (ACL) reconstruction is often elusive and can only be confirmed by joint aspiration, although arthrocentesis carries a risk for superinfection. C-reactive protein (CRP) may prove a useful laboratory test to substantiate clinical suspicion. The present study investigated the post-operative variations of CRP in 58 patients (age range 15–52, median age 25) undergoing ACL reconstruction with either bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) who did not develop infection at 6 months follow-up. CRP titre was determined on the 1st, 3rd, 7th, 15th, and 30thpost-operative day by immunoprecipitation in patients divided according to the type of autograft (BPTB: 13 patients; HT: 45 patients). Mean CRP significantly increased on the 1stpost-operative day, peaked on the 3rdday and decreased on the 7thday, while levels on the 15thand 30thdays did not differ from baseline. The trend of CRP changes did...
Current radiopharmaceuticals, Jan 17, 2016
The aim of the present prospective study was to evaluate the usefulness of labeled leukocyte scan... more The aim of the present prospective study was to evaluate the usefulness of labeled leukocyte scan as a guide to open biopsy for the management of hip and knee prosthesis infection in patients without loosening of orthopedic device. Twenty-six patients with suspected hip (24) and knee (2) prosthesis infection underwent routine analysis of blood, plain radiography and 99m Tc-HMPAO labelled leukocyte scan (WBCS). On these basis, patients were subdivided in the following groups: bone infection without loosening (n°=14), septic loosening (n°=8), superficial infection (n°=2), no infection (n°=2). Patients with septic loosening underwent empirical antibiotic therapy in order to avoid two-stage re-implantation. When the medical treatment was effective patients were submitted to one-stage operation. Patients without loosening of prosthesis but positive WBCS results underwent open biopsy: bone samples and periprosthetic tissues were taken from the regions showing pathological leukocyte uptake...
Journal of biological regulators and homeostatic agents, 2021
Infection with SARS-CoV2 leads to COVID-19, the severity of which derives from the host’s immune ... more Infection with SARS-CoV2 leads to COVID-19, the severity of which derives from the host’s immune response, especially the release of a storm of pro-inflammatory cytokines. This coronavirus infects by first binding to the ectoenzyme Angiotensin Converting Enzyme 2 (ACE2), a serine protease acting as the receptor, while another serine protease is necessary for priming the viral spike “S” protein required for entering the cells. Repurposing existing drugs for potential anti-coronavirus activity have failed. As a result, there were intense efforts to rapidly produce ways of providing prophylactic active immunization (vaccines) or abortive passive (convalescent plasma or monoclonal antibodies) neutralizing antibodies. The availability of vaccines for COVID-19 have been largely successful, but many questions still remain unanswered. In spite of the original enthusiasm, clinical studies using convalescent serum or monoclonal antibodies have shown limited benefit. Moreover, the emergence of...
Journal of Clinical Medicine
The emphasis on value-based payment models for primary total hip replacement (THA) results in a g... more The emphasis on value-based payment models for primary total hip replacement (THA) results in a greater need for orthopaedic surgeons and hospitals to better understand actual costs and resource use. Time-Driven Activity-Based Costing (TDABC) is an innovative approach to measure expenses more accurately and address cost challenges. It estimates the quantity of time and the cost per unit of time of each resource (e.g., equipment and personnel) used across an episode of care. Our goal is to understand the true cost of a THA using the TDABC in an Italian public hospital and to comprehend how the adoption of this method might enhance the process of providing healthcare from an organizational and financial standpoint. During 2019, the main activities required for total hip replacement surgery, the operators involved, and the intraoperative consumables were identified. A process map was produced to identify the patient’s concrete path during hospitalization and the length of stay was also...
Lo Scalpello - Otodi Educational
Objective. The purpose of the present study was to estimate the diagnostic accuracy of a spectrum... more Objective. The purpose of the present study was to estimate the diagnostic accuracy of a spectrum of physical examination tests, explaining how to perform them and compare them with arthroscopic findings to identify which have the best ability to accurately detect a subscapularis tear in a population of primary care patients with shoulder pain. Methods. Three established clinical tests were evaluated in 56 consecutive patients prior to shoulder arthroscopy. The tests included the Lift Off test, Napoleon test, and Bear Hug test. The integrity or not of the subscapularis tendon at surgery was considered as the gold standard. Lesions to the subscapularis were graded according to Lafosse. Results. Among the 56 patients there were 17 with arthroscopic diagnosis of subscapularis lesions accounting for an incidence of 30%. The sensitivity for subscapularis tears for the Lift-off test, Napoleon test, and Bear Hug test was 80.15, 58.82, and 82.35%, respectively. Specificity was 54.55, 56.82, and 55.56%, respectively. A significant correlation was found between arthroscopic findings and physical examination only for the Bear Hug. Conclusions. In the present study, the Bear Hug test was found to have the highest sensitivity of all tests studied. Nevertheless, it appears advisable to perform more than one clinical test to further improve the clinical ability to detect subscapularis tears.
Lo Scalpello - Otodi Educational
Introduction. Arthroplasty registries are widely recognized as an effective tool, providing a con... more Introduction. Arthroplasty registries are widely recognized as an effective tool, providing a constant flow of data that can guide the clinical practice of orthopedic surgeons. Despite their usefulness, their implementation in Italy has historically proved to be laborious. In fact, many surgeons are unwilling to participate, claiming as reason for this inertia the additional work needed in an already overloaded clinical practice. Material and methods. Five operators from five different hospitals without any previous experience with arthroplasty registries entered all the data relevant to the joint replacements performed in their structures in a dedicated online platform and measured the time needed for any input. The learning curve for each operator was then drawn. Results. After the input of 20 procedures, all operators reached a plateau of about 2-3 minutes to record a single intervention. Conclusions. The modest amount of time required to compile registry data sheet should not represent a limitation for surgeons to enter the information into a national registry.
Lo Scalpello - Otodi Educational, 2021
The persistence of pain at the fracture site and the absence of bone callus at X-ray controls are... more The persistence of pain at the fracture site and the absence of bone callus at X-ray controls are the univocal criteria for diagnosis of nonunion. When this failure befalls, the healing process has stopped and the fracture is no longer able to consolidate without surgery. The aim of this review is to investigate the use and outcomes of the Exchange Reamed Nailing (ERN) technique for aseptic tibial shaft nonunion. Replacement surgery with an oversized reamed nail showed 91% success. After a tibial fracture, nonunion is to be expected in 17% of cases, with a majority of the hypertrophic type (82%). To avoid further failures, the following is essential: to increase the mechanical stability by implanting an oversize nail and lock it with 2 distal static screws and a proximal dynamic screw; to ream the canal to promote vascularisation with osteoinductive and osteoconductive effects; to ensure the absence of a latent infection, which can lead to osteomyelitis in 18% of failures. Autologous bone grafting and fibula osteotomy are useful in specific cases.
Journal of Clinical Medicine, 2022
The Italian government on the 8th of march in response to the increased global prevalenceof sever... more The Italian government on the 8th of march in response to the increased global prevalenceof severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stated a national quarantine. In this period the absence of rapid and sure screening tests for COVID-19 made necessary more attention for presence of fever in hospitalized patients, like continuous use of surgical, FFP2, and FFP3 masks (PPE) by nurses, physicians, and patients; moreover, patients visits were restricted. In this period, during the daily activities in our orthopedic department we observed an empirical decreased incidence of post-operative fever in patients admitted for trauma surgery. The aim of this study is to compare the prevalence of post-operative fever in this period with the same period in 2019. We analyzed the presence of post-operative fever in 110 patients admitted in 2020 and 129 admitted in 2019. The results show a significant decrease of the prevalence and duration of post-operative fever in patients admi...
HIP International, 2020
Introduction: The aim of this study is to evaluate clinical, radiographic and laboratory results ... more Introduction: The aim of this study is to evaluate clinical, radiographic and laboratory results of ceramic-on-metal (CoM) (hybrid hard bearing) in total hip arthroplasty (THA), associated with a short stem implant. Methods: From a cohort of 37 patients suffering from primary or secondary hip osteoarthritis who underwent THA using CoM bearing, 19 were suitable for this study. All procedures were performed by the same surgeon using a posterior-lateral approach. All patients were compared clinically using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF12F/M), and radiographically (offset, CD angle, limb length discrepancy, cup inclination and anteversion, subsidence, osseointegration, heterotopic ossification). Blood samples were collected in order to evaluate chromium (Cr) and cobalt (Co) ions level. Radiographic evaluations were carried out by 3 different blinded sur...
Journal of Clinical Orthopaedics and Trauma, 2020
Background: The number of periprosthetic joint infections (PJI) is continuously increasing becaus... more Background: The number of periprosthetic joint infections (PJI) is continuously increasing because of the increasing number of arthroprostheses performed every year. Two-stage revision, using antibioticloaded spacers, remains the gold standard for their treatment. The aim of our study is to compare the use of preformed vs handmade spacers in hip arthroplasty infections evaluating infection eradication, bone loss and clinical/functional outcomes. Methods: From January 2010 to December 2017 we performed a prospective nonrandomized study. We pooled 50 patients affected by infected hip joint replacements, and divided them in 2 groups, one receiving commercially preformed spacers and the other receiving handmade spacers. The study endpoint was set at 12 months. Intra-operative and peri-operative complications, Harris Hip Score (HHS), Short Form 12 Health Survey, intra-operative and radiological evaluation of bone loss were collected. Data were analyzed using descriptive statistics, T-test and Fisher Exact test. Results: We found a statistically significant differences (p < 0.05) between the two groups in favour of the VancogenX group for the following variables: surgical time, first and second stage intraoperative complication rates, infection eradication. Moreover, the preformed-spacers group had better results in the preservation of bone stock, even though the difference was not statistically significant (p > 0.05). Conclusion: Our results support the use of preformed antibiotic spacers, even though more studies are needed.
Journal of Clinical Orthopaedics and Trauma, 2019
Background: Metal-on-Metal (MoM) total hip arthroplasty (THA) represents a very controversial pro... more Background: Metal-on-Metal (MoM) total hip arthroplasty (THA) represents a very controversial procedure because of the possibility of postoperative adverse local tissue reaction (ALTR). This study investigates the reliability of the ultrasound scan as a diagnostic tool to quantify a clinically useful threshold in the level of periprosthetic fluid collection to suggest implant revision. Methods: This study includes 116 patients (123 implants) who received an Articular Surface Replacement XL (ASRTMXL, De Puy Synthes, USA) MoM THA. The study group included 56 males and 60 females with a mean age of 66.6 years (range, 15e86 years). All patients were clinically and radiologically annually evaluated (according to the Harris Hip Score) up to a mean follow-up of 7.5 years (min. 1.4 e max. 10.3 years) from the primary surgery: all patients underwent standard ultrasound evaluation of the affected hip and Cobalt/Chromium blood detection testing according to a custom-made diagnostic algorithm for MoM THA revision. Results: At final follow-up, 51 (43.1%) of 117 implants underwent revision after a mean of 6 years (1.79 e9.26) from the primary ASR implant. The authors found a statistically significant correlation between Cr (p ¼ 0.015) and Co (p ¼ 0.009) blood values and different ultrasound grades. Statistical analysis showed a significant association between periprosthetic fluid collection and revision surgery (p < 0.0001) and the final revision risk was estimated to be 7 times greater in patients with ultrasound grade 2 (periprosthetic collection 20 mm). Conclusions: This study confirms the reliability of ultrasound evaluation in detecting clinically significant peri-prosthetic joint effusions: a new diagnostic algorithm for MoM THA revision is here presented. Longer follow up studies are mandatory to better understand the potential advantages of this diagnostic protocol.
Revue de Chirurgie Orthopédique et Traumatologique, 2014
Single bundle, single tunnel reconstruction of ACL seems to be an “old procedure” after the recen... more Single bundle, single tunnel reconstruction of ACL seems to be an “old procedure” after the recent development and knowledge about anatomical reconstructions of ACL (single or double bundle). Despite the new trend, prospective long-term follow-up studies on the single bundle reconstruction are necessary to get more information on a technique that has occupied the last 20 years and has been executed on millions of patients. Methods From January 2002 and February 2003, hundred eight patients were recruited for a prospective randomized trial. The exclusion criteria were previous knee operations, chondral lesions, varus deformity more than 10 degrees, limb imbalance, meniscal lesion extension more than on third of the meniscus and history of knee tendinopathies. Three groups of 36 patients each were selected by the arthroscopically assisted surgical procedure: A B-PT-B reconstruction, B hamstrings (endobutton CL-reabsorbable interference screw), and C hamstrings (endobutton CL-evolgate). A dice method was used for the graft randomization. A standard rehabilitation protocol was used for all the patients, including immediate postoperative mobilisation with a knee brace just for walking (first 3 weeks), protected weight bearing for 2 weeks, and return to full activity at 6–12 months postoperatively. The patients were followed up at 6 months, 1 year and then each year until the tenth year postoperative. Six patients in group A, 8 in group B and 11 in group C were lost at the final follow-up. The methods of evaluation included clinical and instrumented laxity testing (Rolimeter), isokinetic muscle torque measurements (Cybex II), International Knee Documentation Committee II ratings, Lysholm score, Tegner activity level, Kujala patellofemoral knee scores, and radiological tunnel enlargement measure. Results The results revealed no statistically significant differences with respect to IKDC II, Lysholm score, Isokinetic test and Kujala patellofemoral knee scores. There was an enlargement of the tunnels, statistically significant in the hamstring tendon groups, and more evident in the group B. Any widening of the tunnels from 3 to 5 years was recorded into each group. The measurement of laxity using the Rolimeter showed better results for group A without any difference statistically significant. Differently, the Tegner score was statistically favourable for PT group for the first 4 years after surgery. Radiological narrowing of the joint spaces (IKDC) from 1 to 10 years postoperatively was seen in all the groups, At 10 years follow-up, radiological findings were worse for the PT group (P Conclusions PT and hamstrings ACL reconstruction seem to show similar functional and clinical results at long-term follow-up. Tunnel widening in hamstrings groups, may be a complication in case of revision. The patellar tendon group seems to be more prone to develop osteoarthritis after 5 years postoperatively.
BMC Musculoskeletal Disorders, 2013
BackgroundAmong the various complications described in literature, the patellar tendon ossificati... more BackgroundAmong the various complications described in literature, the patellar tendon ossification is an uncommon occurrence in anterior cruciate ligament (ACL) reconstruction using bone – patellar tendon – bone graft (BPTB). The heterotopic ossification is linked to knee traumatism, intramedullary nailing of the tibia and after partial patellectomy, but only two cases of this event linked to ACL surgery have been reported in literature.Case presentationWe present a case of a 42-year-old Caucasian man affected by symptomatic extended heterotopic ossification of patellar tendon after 20 months from ACL reconstruction using BPTB. The clinical diagnosis was confirmed by Ultrasound, X-Ray and Computed Tomography studies, blood tests were performed to exclude metabolic diseases then the surgical removal of the lesion was performed. After three years from surgery, the patient did not report femoro-patellar pain, there was not range of motion limitation and the clinical-radiological exami...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2012
The os acetabuli (OSA) is a bone fragment located at the acetabular rim. In most cases, it is obs... more The os acetabuli (OSA) is a bone fragment located at the acetabular rim. In most cases, it is observed at the anterior or anterosuperior edge of the acetabular rim. The etiology has been discussed for a long time. It could be the result of a stress fracture (rim fracture) due to acetabular rim overloading in some case of dysplasia or femoroacetabular impingement (FAI). It can be excised or fixed in case of low acetabular coverage. For this purpose, a careful radiological preoperative planning is needed. This chapter aims to provide an overview of os acetabuli and some indications, tips, and tricks for its treatment.
Muscles, Ligaments and Tendons Journal, 2016
Background: The gastrocnemius-semimembranosus bursa may communicate with the knee joint. The arth... more Background: The gastrocnemius-semimembranosus bursa may communicate with the knee joint. The arthroscopic anatomy of the posteromedial aspect varies depending on the angle of the oblique popliteal ligament, the level at which it crosses the medial gastrocnemius tendon, and its relationship with the capsular joint and synovia. The aim of this paper is to identify possible patterns, and to evaluate their characteristics and their relationship with Baker's cyst. Methods: data archived from 185 consecutive arthroscopies were evaluated; an anatomic description and classification was carried out; the percentages of association with BC and the associated pathologies were reported. Results: The different anatomies were classified into six groups based on the relationship above the medial gastrocnemius tendon, the capsular joint and synovia. The prevalence of Baker's cyst was 28.3%. The main associated intra-articular pathological condition was the contemporary presence of a meniscal tear and chondropathy. Conclusion: Exploration of the posterior aspect of the knee must be performed routinely. Knowing the possible anatomy patterns of the posteromedial arthroscopic aspect of the knee joint could help to identify the cyst and its gateway, thus facilitating its treatment. Level of the evidence: III.
International Journal of Immunopathology and Pharmacology, 2008
The diagnosis of septic arthritis following arthroscopic anterior cruciate ligament (ACL) reconst... more The diagnosis of septic arthritis following arthroscopic anterior cruciate ligament (ACL) reconstruction is often elusive and can only be confirmed by joint aspiration, although arthrocentesis carries a risk for superinfection. C-reactive protein (CRP) may prove a useful laboratory test to substantiate clinical suspicion. The present study investigated the post-operative variations of CRP in 58 patients (age range 15–52, median age 25) undergoing ACL reconstruction with either bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) who did not develop infection at 6 months follow-up. CRP titre was determined on the 1st, 3rd, 7th, 15th, and 30thpost-operative day by immunoprecipitation in patients divided according to the type of autograft (BPTB: 13 patients; HT: 45 patients). Mean CRP significantly increased on the 1stpost-operative day, peaked on the 3rdday and decreased on the 7thday, while levels on the 15thand 30thdays did not differ from baseline. The trend of CRP changes did...
Current radiopharmaceuticals, Jan 17, 2016
The aim of the present prospective study was to evaluate the usefulness of labeled leukocyte scan... more The aim of the present prospective study was to evaluate the usefulness of labeled leukocyte scan as a guide to open biopsy for the management of hip and knee prosthesis infection in patients without loosening of orthopedic device. Twenty-six patients with suspected hip (24) and knee (2) prosthesis infection underwent routine analysis of blood, plain radiography and 99m Tc-HMPAO labelled leukocyte scan (WBCS). On these basis, patients were subdivided in the following groups: bone infection without loosening (n°=14), septic loosening (n°=8), superficial infection (n°=2), no infection (n°=2). Patients with septic loosening underwent empirical antibiotic therapy in order to avoid two-stage re-implantation. When the medical treatment was effective patients were submitted to one-stage operation. Patients without loosening of prosthesis but positive WBCS results underwent open biopsy: bone samples and periprosthetic tissues were taken from the regions showing pathological leukocyte uptake...