Lo Scalpello - Journal

Introduction

Stefano Giaretta — 2025-09-24

It is with genuine enthusiasm and pride that we present the project strongly desired by the entire Board of Directors and the OTODI scientific committee:

“Hip fractures in the elderly: medial femoral neck fractures in patients over 75 years of age – A multicenter analysis of 1,500 cases in Italy”

This work is not only one of the largest investigations of its kind in our country and probably throughout the world’s orthopedic field but also a clear demonstration of what can be achieved when competence, collaboration and vision converge towards a common goal.

Fractions of the proximal femur remain a dramatic turning point in the lives of elderly patients, often marking the line between independence and loss of autonomy.
Facing this challenge requires not only the technical excellence present in the Orthopedics departments in Italy but requires a shared effort that unites orthopedists, anesthesialists, geriatricians, rehabilitation specialists to improve not only survival but also functional recovery and quality of life for thousands of elderly patients
every year.

Scientific investigations of this relevance can demonstrate how good clinical practices based on scientific evidence are to be pursued to continue to improve the level of care we provide to our patients.

Multicentric analysis by OTODI on 1500 Italian patients

Stefano Giaretta — 2025-09-24

Among the initiatives undertaken by the OTODI Executive Board for the 2023-2025 term, an important in-depth scientific analysis has been approved and initiated. This project was inspired by the fundamental principles of OTODI: inclusiveness and the promotion of open peer debate. The federation, composed of 17 regional societies, successfully established an extensive national network aimed, among other objectives, at systematic information and data collection.
In this recent endeavor, the coordination capacity of the society was evaluated from a scientific perspective, with the objective of generating robust research outcomes that can be readily applied in clinical practice. The Executive and Scientific Boards identified a widely relevant topic capable of engaging numerous centers while ensuring significant scientific interest on both national and international levels. The chosen subject was the “treatment of medial femoral neck fractures in elderly patients over 75 years”, with a specific focus on comparing “press-fit” versus “cemented” femoral implants.

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Robot-assisted vs conventional TKA: a retrospective observational study of clinical-functional outcomes

Laura Maria Dell'Aera — 2025-09-24

Introduction. Total knee arthroplasty (TKA) is increasingly performed worldwide due to population aging, rising life expectancy, and higher functional demands among elderly patients affected by advanced knee osteoarthritis. While conventional manual TKA remains the standard approach, robotic-assisted techniques both image-based and imageless, have been developed to enhance surgical precision and reproducibility. These technologies promise improved alignment and soft tissue balance, but their actual clinical advantages
remain under debate.
Materials and methods. This retrospective study compared clinical and functional outcomes between two cohorts of patients undergoing TKA with the same posterior-stabilized (PS) implant: 114 patients treated with conventional TKA (Persona PS, Zimmer and Biomet) and 64 patients receiving robot-assisted TKA (using the MAKO system). All procedures were performed over a 12-month period, and patients were assessed preoperatively and at 3, 6, and 12 months postoperatively using the WOMAC, VAS, and KOOS scores.
Results. Both groups showed significant clinical improvement at one year. However, no statistically significant differences were found between the two techniques regarding patient-reported outcomes at any time point. The average operative time was significantly longer in the robotic group (80 minutes vs. 55 minutes for the conventional group), without a corresponding benefit in short- to mid-term outcomes.
Conclusions. Although robotic-assisted TKA enhances surgical accuracy and is widely adopted by both experienced and novice surgeons, it does not appear to offer superior clinical or functional results compared to conventional TKA within the first postoperative year. Further long-term studies are required to determine whether these technological advancements translate into improved implant survival or patient satisfaction over time.

Comparison of set-up time between suprapatellar and infrapatellar tibial nailing: are we saving time?

Paolo Bastia — 2025-09-24

Objective. Tibial shaft fractures are typically managed with intramedullary nailing (IMN). The suprapatellar (SP) approach allows easier reduction of proximal tibial fractures and a more precise entry point when compared to the infrapatellar (IP) technique. The aim of this work is to compare the set-up time of the operating room between SP and IP approaches.
Methods. A retrospective observational study was performed by consulting our surgical register. In all, 65 patients underwent IMN on through an SP approach and semi-extended knee, and 65 patients had an IP approach with a flexed knee on a traction table. The elapsed time from admission to the operating room and the beginning of the surgical procedure was noted for each patient.
Results. The average time in the group treated with the IP approach was 39.6 minutes, while in the group treated with the SP approach it was 12.5 minutes with an average time saving of 27.1 minutes per patient.
Conclusions. The potential superiority of the SP approach for IMN of the tibia is the subject of ongoing debate, but its advantages are widely reported in the literature. The result of our study suggests that the quicker and simpler set-up of the SP approach can facilitate the surgeon during the operation and allow significant time savings.

Bone quality and thickness of femoral cortices in hip fractures

Giuseppe Gargano — 2025-09-24

Background. Hip osteoarthritis and femoral neck fractures are two of the most prevalent orthopedic disorders afflicting the elderly, and both have major impact on overall health and quality of life. The thickness of femoral cortices appears to be of different dimensions in patients with osteoarthritis and femoral neck fracture.
Sources of data. This study was conducted at the San Francesco D’Assisi Hospital in Oliveto Citra (SA) from September 2023 to September 2024. Forty patients over 65 years of age were selected, divided into two groups of 20 patients each, respectively with femoral neck fracture and advanced hip osteoarthritis.
Areas of agreement. An important role in femoral neck fracture seems to be played by the thickness of the femoral cortices. This difference in thickness could be linked to greater fragility and susceptibility to fracture.
Areas of controversy. It is not yet possible to determine a certain relationship between the thickness of the femoral cortices and which of them has a greater impact on the possibility of fracture.
Growing points. In the analyzed patients who had a fracture of the femoral neck, it was seen that the thickness of the posterior cortex was significantly reduced.
Areas timely for developing research. To date, due to the lack of specific screening protocols, it is not possible to ascertain a direct relationship between thickness of the femoral cortices and the probability of femoral neck fracture in the elderly.

Isolated greater trochanter fractures in THA: a narrative review

Marco Selmo — 2025-09-24

Isolated fractures of the greater trochanter (Vancouver type AG) in total hip arthroplasty (THA) are quite rare but can significantly affect outcomes. These fractures may occur intraoperatively or postoperatively, with pain and impaired function. Treatment remains controversial with debate on the choice of conservative management or surgical fixation.
Objective. This review summarizes the available evidence on incidence, risk factors, outcomes, and different kinds of surgical techniques.
Methods. A PRISMA-guided search across four databases identified 24 relevant studies
from an initial pool of 389.
Results. While nonoperative management yields good results for minimally displaced fractures, surgical fixation may be required for displaced or unstable cases, although complications and reoperations are not uncommon.
Conclusions. No technique has shown clear superiority. More high-quality studies are needed to guide treatment strategies for this uncommon but impactful complication.

Treatment of a multi-ligament knee injury in a patient with Parkinson’s disease. A case report

Gianpaolo Chitoni — 2025-09-24

Multi ligament knee injury can be associated or not with knee dislocation. Among irreducible knee dislocations, postero-lateral (PL) dislocations are the most common, with a higher rate of complications. We report on 63-year-old patient, with severe Parkinson’s disease, who had a traumatic PL knee dislocation with a multi-ligament knee injury. After a failed reconstruction procedure, due to severe dyskinesias (uncontrollable and involuntary muscular movements), the knee was still unstable, and a hinged total knee replacement was performed. PL dislocations can lead to very serious knee instability. Some conditions, like Parkinson’s disease, can complicate the treatment. A hinged prosthesis, although not representing the gold standard, can be considered as an alternative in complicated and highly selected cases, when repair or reconstruction is not possible.

Intraarticular injection of autologous microfragmented adipose tissue in knee osteoarthritis (preliminary results)

Ivano Valentino — 2025-09-24

Objective. The aim of the study is to evaluate clinical and functional short-term outcomes in patients with mild-moderate knee osteoarthritis treated with intra-articular injection of autologous microfragmented adipose tissue. The results are analyzed considering body max index (BMI), Numeric Pain Rating Scale (NRS) and instrumental tests (X-ray, MRI).
Material and methods. 34 patients with mild or moderate knee osteoarthritis (stages I, II and III of the Kellgren-Lawrence grading scale) underwent joint injection with autologous microfragmented adipose tissue (MF-AT), from December 2022 to December 2024. All the patients were selected considering the level of pain (number rate scale, NRS), functional abilities assessed via the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) at baseline, 6 months and 1 year. The results were analyzed considering age,
gender and imaging.
Results. The average value of the Womac score in 34 patients with knee osteoarthritis parameters decreased from 64.85 points pre-operatively to 44.97 points at 6 months, while 22 patients showed 47.95 points of mean Womac score at one year. The average NRS values went from 4.15 points pre-operatively to 2.79 points at 6 months and 3.55 points at one year.
Non-significant differences in terms of improvement of the Womac score and the NRS scale were found in patients of different ages, gender, and BMI. Twenty-one of 34 (62%) patients expressed total or almost total satisfaction in terms of functional improvement, pain relief and ability to climb stairs. The treated lipoaspirate of 6 patients (18%), after informed and written consent submission, was collected and cryopreserved at Lipobank (Lipobank srl Viale Bianca Maria 24 – 20129 Milan).
Conclusions. Intra-articular infiltration of autologous MF-AT is associated with a significant improvement in clinical and functional scores in patients with mild and moderate osteoarthritis at 6 months and 1 year of follow-up. Womac score and NRS were not significantly influenced by age, sex, or BMI. No adverse events were recorded during the procedure or post-operatively.