Trabecular Titanium is a biomaterial characterized by a regular three-dimensional hexagonal cell structure imitating trabecular bone morphology. Components are built via Electron Beam Melting technology in aone- step additive manufacturing process. This biomaterial combines the proven mechanical properties of Titanium with the elastic modulus provided by its cellular solid structure (Regis 2015 MRS Bulletin). Several in vitro studies reported promising outcomes on its osteoinductive and osteoconductive properties: Trabecular Titanium showed to significantly affect osteoblast attachment and proliferation while inhibiting osteoclastogenesis (Gastaldi 2010 J Biomed Mater Res A, Sollazzo 2011 ISRN Mater Sci); human adipose stem cells were able to adhere, proliferate and differentiate into an osteoblast-like phenotype in absence of osteogenic factors (Benazzo 2014 J Biomed Mater Res A). Furthermore, in vivo histological and histomorphometric analysis in a sheep model indicated that it provided bone in-growth in cancellous (+68%) and cortical bone (+87%) (Devine 2012 JBJS). A multicentre prospective study was performed to assess mid-term outcomes of acetabular cups in Trabecular Titanium after Total Hip Arthroplasty (THA). 89 patients (91 hips) underwent primary cementless THA. There were 46 (52%) men and 43 (48%) women, with a median (IQR) age and BMI of 67 (57–70) years and 26 (24–29) kg/m2, respectively. Diagnosis was mostly primary osteoarthritis in 80 (88%) cases. Radiographic and clinical evaluations (Harris Hip Score [HHS], SF-36) were performed preoperatively and at 7 days, 3, 6, 12, 24 and 60 months. Bone Mineral Density (BMD) was determined by dual-emission X-ray absorptiometry (DEXA) according to DeLee &Charnley 3 Regions of Interest (ROI) postoperatively at the same time-points using as baseline the measureat 1 week. Statistical analysis was carried out using Wilcoxon test.Introduction
Methods
The aim of the study is to evaluate the specificity and sensibility of leukocyte esterase for the diagnosis of periposthetic joint infection (PJI). Between October 2016 and April 2017 we enrolled 65 patients underwent to hip and knee revision arthroplasty due to uncertain joint infection. Synovial fluid was obtained from 64 joints that underwent revision arthroplasty. Each patient was evaluated in the preoperative time with CRP, ESR and leukoscan, in the intraoperative time with frozen section and leukocyte esterase strip and post-operative with sonication fluid culture, periprosthetic tissues cultures and histological examination. Results of all of these exams were compared to assess the specificity, the sensibility, the positive and negative predicting values of leukocyte esterase for the diagnosis of PJI.Aim
Method
The purpose of this study was to evaluate the accuracy of the sonication fluid cultures (SFC) for the diagnosis of prosthetic joint infection and compare it with frozen section and periprosthetic tissue cultures. 108 patients underwent revision or explantation procedure for any reason. Frozen sections of intraoperative specimen were analized and multiple periprosthetic samples (at least 5) were collected and cultured. All explanted prosthesis components were subject to sonication and cultured. All cultures were incubated for 14 days. PJI was diagnosed in 52 patients (48%). Sonication achieved the highest sensivity with 95% and specificity of 98%. Frozen section showed low sensivity (44%) and specificity (80%) and periprosthetic tissue cultures showed sensivity of 75% and specificity of 98%. Sonication fluid culture is a cheap, easy, accurate and sensitive diagnostic method and helps to detect about 30% more PJI compared to frozen section and 16% more compared to periprosthetic tissue cultures. It also detect about 25% more pathogens than periprosthetic tissue cultures
The clinical success and long-term outcomes of total knee arthroplasty (TKA) depend not only on the accuracy of femoral and tibial components positioning, but also on the restoration of a proper mechanical axis (MA). Coronal and rotational mal-alignment may affect significantly the final result of a knee replacement. Patient specific cutting guides and intra-operative Computer-Assisted Surgery (CAS) have recently been introduced as options to improve implant alignment during TKA. The purpose of this study was to compare the alignment accuracy and implant positioning of Patient Matched technique to CAS system in patients with primary TKA. A cohort of 68 consecutive patients who underwent TKA was enrolled for this study: 34 patients received a TKA using CAS system while 34 patients received a TKA using a MRI-based Patient Matched system. Mechanical axis and kinematics were digitally measured pre- and post-operatively in all knees using the intra-operative navigation system but data were blinded for the operating surgeon in the Patient Matched group. A post-operative CT-scan evaluation was performed in all patients to analyse the prosthetic components alignment (coronal, sagittal and axial alignment according to Perth Protocol from CT-scan). CT-scan measurements were used as landmarks as this tool is considered the gold standard. MA, posterior tibial slope (PTS) and femoral component rotation (FCR) in CAS group were compared to data of Patient Matched group. All patients also underwent a clinical evaluation with Knee Society Score (KSS) and Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 and 12 months of follow up. KSS, KOOS and range of motion were comparable in the two groups after surgery. Operative time was significantly shorter in the Patient Matched group. No differences were found regarding complications rate. Mean angles, respectively for CAS and Patient Matched groups, were the following: MA was 1,7° (SD 0,9°) vs 0.8° (SD 2.1°); PTS was 3.1° (SD 0.9°) vs 3.4° (SD 2.1°); FCR was 1.5° (SD 2.2°) vs 1.36° (DS 1.2°). The outcomes of the CT scan evaluation were the following: MA was 1.5° (SD 0.8°) vs 1.0° (DS 1.5°); PTS was 2.3° (SD 0.8°) vs 3.0° (SD 2.6°); FCR was 0.4° (SD 0.8°) vs 0.2° (SD 0.3°). MA was within 3° of neutral alignment in 94% of patients for CAS group and in 97% of knees for Patient Matched group. After a short follow up, there weren't statistically significant differences between CAS and Patient Matched techniques as regards clinical and functional scores. Both the systems achieved the goal of neutral alignment within 3° of varus and valgus. We only observed greater precision for Patient Matched technique in optimizing femoral component rotation. Actually it is unpredictable if this difference may determine long term effects. Patient Matched technique and CAS for TKA surgery will certainly continue to have an impact in the future. Studies are needed to define which technique is better, in terms of long term results, failure rate and cost-effectiveness.
Trabecular Titanium™ is a highly porous biomaterial with a regular hexagonal cell structure, which has shown excellent mechanical properties. Several 89 patients (91 hips) underwent primary THA with DELTA-TT cups (Lima Corporate) between 2009 and 2010. There were 46 (52%) men and 43 (48%) women, with a median (IQR) age of 67 (57–70) years and a median (IQR) BMI of 26 (24–29) kg/m2. Right side and left side were affected in 44 (48%) and 47 (52%) cases, respectively. Underlying pathology was primary osteoarthritis in 80 (88%) cases, osteonecrosis in 5 (6%), post-traumatic osteoarthritis in 3 (3%), developmental dysplasia of the hip in 2 (2%) and oligoarthritis in 1 (1%). BMD was determined by DXA using DeLee and Charnley 3 Regions of Interest (ROI) at 7 days, 3, 6, 12 and 24 months. Clinical evaluation (Harris Hip Score, HHS), patient health status survey (SF-36) and radiographic assessment were performed preoperatively and at the same time-points. Data were analyzed using non-parametric tests (Introduction
Methods
Trabecular TitaniumTM is a tri-dimensional material composed by multi-planar regular hexagonal cells and characterised by a highly open porosity that has been studied to optimise bone osteointegration. The aim of this study is to evaluate bone remodelling measuring BMD changes around an acetabular cup made from Trabecular TitaniumTM in primary total hip arthroplasty (THA). Between February 2009 and December 2010, 89 patients (91 hip) underwent primary THA with a modular acetabular cup in Trabecular TitaniumTM (DELTA-TT cup, Limacorporate, Villanova di San Daniele, Italy). The average age was 63.5± 9.4 years, the average height and weight were 75.9± 12.9 kg and 168.8± 8.9 cm, respectively (av. BMI 26.8± 4.2). There were 46 (51.7%) males and 43 (48.3%) females affected by primary coxarthrosis in 80 (87.9%) cases, avascular necrosis in 5 (5.5%), posttraumatic coxarthrosis in 3 (3.3%), dysplasia in 2 (2.2) and oligoarthritis in 1 (1.1%) case. The study includes the clinical evaluation with Harris Hip Score (HHS) and SF-36, radiographic evaluation and dual-energy x-ray absorptiometry (DEXA) analysis preoperatively and postoperatively at 1 week, 3, 6, 12 and 24 months. Preliminary results are currently available for 47 patients at 12 months, 68 at 6 months and 80 at 3 months. The average HHS significantly improved from 48.7± 14.99 preoperatively to 93.8± 5.91 at 12 months, with a constant progression in the intermediate follow-ups. All patients showed a significant ROM increase, with an average flexion from 86.6°± 15.9° preoperatively to 105°±13.14 at 12 months. Sf-36 highlighted a satisfactory improvement of general health status from an average preoperative value of 50.8± 18.7 to 80.7± 12.9 at 12 months (from 42.9 to 80.1 for physical health; from 58.4 to 81.3 for mental one). All cups were stable at 12 months with no radiolucent lines. Preliminary DXA analysis reported an initial bone mineral density decrease from 1 week baseline values (BMD R1: 1.40± 0.37; R2: 1.20± 0.45; R3:1.16± 0.31) to 3 months (BMD R1: 1.31± 0.41; R2: 1.17± 0.3; R3: 1.06± 0.37) followed by BMD recovery up to initial values (BMD R1: 1.37± 0.3; R2:1.18± 0.34; R3: 1.12± 0.36) at 12 months. Trabecular TitaniumTM demonstrates a good primary and secondary stability. Preliminary densitometric outcome confirms an optimal osseointegration of the DELTA-TT cup and early clinical and patient subjective results are very promising at a short term follow-up. However, the completions of follow-up evaluation are necessary to draw a conclusive analysis.
Trabecular Titanium™ is an innovative material characterised by an high open porosity and composed by multi-planar regular hexagonal cells. It is not a traditional coating and its tri-dimensional structure has been studied to optimise osteointegration. Furthermore, it has excellent mechanical properties, as a very high tensile and fatigue resistance and an elastic module very similar to the that of the trabecular bone. The aim of this study is to evaluate the osteointegration and bone remodelling measuring the longitudinal pattern of change in BMD around a cementless acetabular cup made from Trabecular Titanium™ (Delta TT cup, Lima Corporate, Italy) in primary total hip arthroplasty (THA). Dual-energy x-ray absorptiometry (DEXA) analysis, radiographic evaluation on standard AP and lateral views and clinical evaluation with Harris Hip Score (HHS) and SF-36 were performed at 1 week, 3, 6, 12 months after surgery.INTRODUCTION
METHODS
The chioce of the graft and its fixation in LCA reconstruction is basic for the outcome of the surgical procedure. Several solutions have been proposed; each of them had advantages and disavantages. The choice of the graft and the surgical technique is often due to surgeon’s opinion. The goal of the fixation is stability which allowes incorporation of the graft in the bone tunnels. Bone-patellar tendon-bone graf has the advantage of bone to bone fixation which is impossible using tendon grafts. Femoral fixation techniques for hamstrings can be classified in: compression tecniques, expansion tecniques and suspension tecniques (cortical or canellous). TTS (Top Traction System) is a new tecnique for femoral fixation using hamstrings. The fixation is achieved by a retrograde screw that allowes fixation to the antero-lateral cortex of the femur. A ring is fixed to the screw to allow tendons passing. The screw is sefl-threading, its lenght is 28 millimeters and its diameter is 6,5 millimeter; its pull-out strenght is 1350 N. The screw is built in titanium alloy and only one size. Surgical technique is simple an reproducible and the instruments are easy to use. The positioning of the screw is fully guided by instruments that minimize errors. This fixation device allowes further graft traction after tibial fixation without twisting hamstrings. Results after 5 years are good but we need long term follow-up for final opinion.
The success of total knee replacement depends on several factors, however, surgical technique is particularly important. In fact mistakes in alignment of prosthtic components are common causes of aseptic loosening. Serious improper alignment (more than 3°) was found out, according to several papers, in about 10% of the implants; this appears not correlated with surgeon’s experience when they use mechanical alignment devices either extra medullary or intra medullary. The development of computer-based systems to achieve correct prosthetic components alignement has the purpose to solve the problems of traditional mechanical alignement systems. At present computer-assisted navigation systems, either they areimage-free or imege-based, are widely empolied while robotic systems are not so commonly used. The Authors describe in this paper the features of the computer-assisted navigation system they at present employ. They moreover emphasize its precision and the reproducibility of the results they can achive. The features of this system (it is based on an image-free navigation method; it allows quantification of the kinematics of the knee; it allows the use of either specially designed cutting bolcks or standar instruments), are an intresting evolution of computer-assisted navigation systems for knee replacement.
The degenerative processes of the glenohumeral joint can be derived from primitive glenohumeral arethrosis, post traumatic arthrosis, neurogenic arthropaty and rotator-cuff arthropaty with inveterate cuff tears. These conditions have shared characteristics but the arthropaty from an inveterate tear of the rotator cuff estabilishes a characteristic connected to the distinctive lesions that culminate in the well-known radiologic imaging of ace-tabularization. Our experience of prothesization of the shoulder referring to this final result, with wich we previously tented toward using a bipolar endoprothesis, often with comforting but at time also decidedly disappointing results. Overall, our dissatifaction was attributed to the insufficient mobility regained with modest remaining muscle-tendons available, and to the anterior instability of the implant if not contained in a valid coracoacromiale arch. For this reason we are tending toward ageo-metric inverse prothesis with the supposition of intrinsic stability and a lever arm favorable to the contraction of slight muscolar recruitment. The inverse Delta prothesis provide an innovative therapeutic option for many patients with serious glenohumerale arthrosis associated with massive tear of the rotator cuff with the rising up of the humeral head. Our work intends to show which are the advantages and the limits, including surgical ones, of using the result of the prothesization of eight specially selected patients treated with the Delta prothesis. Without doubt the innovative architecture and the recent modification ofthe prothesis become clear; it becomes possible to do certain manouvers very easily which in the past were more complicated; also highlighted is the immediate symptomatic benefit that the patient obtain from the joint-substitution operation with this type of prothesis. On the other hand, it is therefore fundamental to select the patients in a very precise way who can undergo this operation, to have a notable improvement in their lifestyle. The modest but significant esperience derived from these first cases treated with the geometri inverse prothesis have introduced us to a relative simple prosthetic system, but just a bit more invasive than the endoprosthetic surgery; it is stable and well-tolerated, able to adequately satisfy the modest functional request permitted by the residual anatomic substratum. The autors, based on this limited but significant experience, intented tomention same technological problems inherent to the various od the implantation including the dif-ficulties occasionally met and resolved.
Graft fixation in anterior cruciate ligament reconstruction is a basic criterion for the outcome of the surgical procedure. Several solutions have been proposed; each of them had advantages and disadvantages, and the choice of a surgical technique often represents the surgeon’s opinion. The goal of the fixation is stability and incorporation of the graft in the bone tunnels. Bone-patellar tendon-bone graft has the advantage of bone to bone fixation, which is impossible using tendon grafts. Femoral fixation techniques for hamstrings can be classified as follows: compression techniques, expansion techniques and suspension techniques (cortical or cancellous). Top Traction System (TTS) is a new technique for femoral fixation using hamstrings. Here, a retrograde screw is fixed to the anterolateral cortex of the femur. A ring is fixed to the screw to pass the tendons.The screw is self-threading, 28 mm long and 6.5 mm in diagmeter; its pull-out strength is 1350 N. The screw is made from a titanium alloy and only available in one size. Surgical technique is simple and reproducible and the instruments are easy to use. The positioning of the screw is fully guided by instruments that minimise errors. With this fixation device further graft traction is possible after tibial fixation without twisting the hamstrings. Results are good at the short-term evalutation but a long-term follow-up is required before a final recommendation can be made.
