Lo Scalpello - Journal

Two-peg versus flat tibial tray design in cemented unicompartmental knee arthroplasty

Vincenzo Sessa — 2023-12-21

Objective. Suboptimal fixation of the tibial component is one of the main factors leading to aseptic loosening in unicompartmental knee arthroplasty (UKA). Improvements in primary fixation in cemented UKA have been suggested to be a key issue for long-term survival. In this context, it has been questioned whether specific implant design features influence interface strength, lowering aseptic loosening and post-operative pain rates. The aim of this study is to compare two different tibial tray designs in cemented UKA in terms of clinical outcome, failures, implant survival, and complications.
Materials and methods. This is a prospective consecutive study of two different tibial component fixation in 100 cemented UKA. 50 patients received a flat cemented tibial tray design, and 50 a two-peg cemented tibial component UKA. Both groups were similar in terms of age, sex, comorbidities, and BMI.
Results. No significant difference was found in clinical outcomes and overall failure rates. In the flat tray group, the mean preoperative KSS was 57.2, which increased at 1-year follow-up after surgery to 92.28, and remained stable at the 3 and 6 year control visits. In parallel, the mean pre-operative KOOS of 59 increased to 87.20. The mean preoperative KSS score in the 2 pegs group was 56.8 and the mean KOOS 58.1. At 1-year follow-up the KSS score increased to 94.1 and the KOOS score to 89.22, remaining stable at the 3- and 6-year follow-ups. Two-peg tibial component showed a significantly lower rate of persistent pain on the tibial side, 8% of patients at 1 year follow-up and 2% at 2 years, compared to 20% at 1 year and 6% at 2-year follow-up in the flat tray group (p < 0.05). In both groups, patients with pain at the 2-year control, 4 patients in total, still complained of mild and intermittent pain, VAS 1 to 2, at the 6 year visit. There was also a lower incidence of radiolucent lines compared to flat design prosthesis, none versus 6 at 3-yeas radiographic control. Radiolucent lines were not related to pain. No difference was detected regarding range of motion between the two groups.
Conclusions. This study reveals that the clinical results and failure rates arising from the use of two different tibial components, one flat and one with 2 pegs, are similar. However, a lower rate of pain and radiolucent lines are detected on the tibial side with the use of a two-peg tibial component design. This outcome could denote a better fixation of the 2 peg metal-backed tibial component implant.

Heterotopic ossification after total hip arthroplasty: a narrative review of modifiable risk factors

Pietro Spolettini — 2024-01-30

Total hip arthroplasty is a popular procedure for treatment of osteoarthritis of the hip, aseptic necrosis of femoral head and femur neck and head fractures. It is a highly successful procedure with high satisfaction of the patients, however sometimes the success rate might be limited by the development of heterotopic ossification around the hip. This narrative review aims to analyse the peri-operative modifiable risk factors for heterotopic ossification formation to help especially young surgeons in choosing the correct way to prevent this problematic complication. The search was conducted on PubMed and the final set includes 32 academic articles. Results are grouped in five paragraphs: nonsteroidal anti-inflammatory drugs and radiation therapy, surgical approach, surgical time and use of drainage and type of implant. In light of this narrative review, we suggest the systematic use of NSAIDs as preventive therapy, the adoption of minimally invasive surgical approaches aiming to reduce both surgical time and soft tissue damage and we discourage the use of drainage and short stems in total hip arthroplasty.

Fixation options in Felix type IIIA periprosthetic tibial fractures: our experience and review of literature

Paolo Bastia — 2023-12-19

Objective. Periprosthetic tibial fractures are rare injuries with few studies in the literature. With an increasing number of total knee arthroplasties performed, these injuries are expected to become more common. These fractures are difficult to treat due to complex fracture morphology, high proportions of injuries associated, and the variability of injury patterns. The aim of this work is to report our experience and results in the fixation of Felix type IIIA periprosthetic tibial fractures.
Methods. We treated by osteosynthesis three patients who sustained a Felix type IIIA periprosthetic tibial fracture using three different devices. Patients were clinically and radiographically followed up at 1, 3, 6, and 12 months from the surgery.
Results. All patients had a good clinical and radiographic outcome with almost complete recovery of joint function. Complete bone healing was radiographically seen on average 6 months after surgery. No signs of infection were observed.
Conclusions. Although the incidence of periprosthetic tibial fractures is growing, evidence- based guidelines for their treatment are still lacking. We report our experience in the treatment of these complex fractures, but larger studies in this area are needed to better guide our knowledge and choices of treatment.

Case report of closed reduction of an irreducible postero-lateral knee dislocation and review of the literature

Marco Focaccia — 2024-01-30

Objectives. Knee dislocation is an uncommon injury. This study aims to describe the treatment of a postero-lateral knee dislocation.
Case presentation. We report on a 71-year-old man, who accessed the emergency department for direct-rotational trauma to his left knee. X-rays showed a postero-lateral knee dislocation associated with multiple traction fractures.
Results. Under fluoroscopy a closed reduction was performed in the operating room by flexing the knee to 120°, internal rotation of the lower extremity and valgus stress at the distal thigh. Due to the instability, a knee-spanning external fixation at 30° of flexion was performed. Post-operatively the patient fell, causing disassemblation of the external fixator and recurrence of medial knee dislocation. Only a partial re-alignment was obtained with a second closed reduction and spanning. The knee was later reconstructed with hinged knee prosthesis and the deformity was corrected.
Conclusions. This case report is the third instance of closed reduction for a postero-lateral knee dislocation. Furthermore, this case report highlights possible complications of the treatment of this rare injury and how definitive treatment must be tailored to the patient’s age, function, clinical conditions, radiological findings and joint stability.

Ultrasound-guided lumbar facet injections. Technique and literature review

Yuri Lepenne — 2024-01-30

This review examines the current state-of-the-art of ultrasound-guided lumbar facet joint injections (FJI), highlighting its emergence as a novel and increasingly successful approach. The literature underscores its growing popularity owing to practical advantages such as low cost, absence of radiation, real-time needle visualisation and tracking, and a low rate of complications. The procedure serves a dual purpose: as a diagnostic test for facet joint syndrome-related low back pain and as a therapeutic intervention for pain alleviation. Ultrasound guidance is particularly advantageous when coupled with needle guidance systems, ensuring precise needle direction for deep structure penetration with heightened accuracy. In conclusion, ultrasound-guided lumbar FJI is a non-invasive, cost-effective, and radiation- free alternative to intrarticular injections guided by fluoroscopy and computed tomography. This comprehensive review aims to serve as an insightful resource for practitioners, providing valuable insights into the procedural nuances and clinical benefits of this procedure.

Healthcare-associated infections in an orthopaedic setting: a multidisciplinary approach

Liana Miccolis — 2024-01-30

Healthcare-associated infections (HAIs) are a significant problem in healthcare facilities, resulting in longer hospital stays, additional costs and inconvenience for patients. Surgical site infections are one of the most common types of HAIs. In this context, orthopaedics appears to be the surgical area that is most involved in claims for HAIs. This narrative review explores the landscape of HAIs, their prevalence, associated adverse events, preventive measures and overall impact by providing an overview of infections in elective orthopaedic surgery. In summary, a significant proportion of surgical site infections can be prevented by a comprehensive, multidisciplinary approach.

Mini-invasive technique for Achilles tendon rupture: BarTur technique. A new simple and inexpensive technique

Marco Baglioni — 2024-01-30

Objective. The aim of this study is to describe and evaluate clinical and subjective outcomes of our mini-invasive technique: the “BarTur technique”, and to consider it as a viable surgical treatment option for Achilles tendon rupture (ATR).
Methods. We included 69 patients who underwent the Bartur technique from January 2019 to December 2022. We analyzed the rate of satisfaction, quality of life and functional clinical outcomes with a minimum of 6 months of follow-up.
Results. The final study population consisted of 69 patients with a mean age of 49 years and a mean follow-up of 16.5 months. During follow‐up no complications were observed, and no workers changed their job. They returned at work after a mean of 3.2 months. Only 27 patients returned to practice sport after a mean of 8.8 months; 21 of these changed the type of sport. Our population had good results in clinical scores (92.6% AOFAS, 92.6% FAAM, 4.7% FFI, 91.4 ATRS); their satisfaction was 8.5 and they had a good quality of life (95 EQ-5L).
Conclusions. The BarTur method is a simple, inexpensive and good option for surgical treatment of ATR. This treatment offers a lower risk of complications, high rate of satisfaction, good clinical outcomes and a few limitations in sports.