The surgical treatment of a secondary gonarthrosis caused by haemophilic arthropathy needs high quality in soft tissue balancing and accurate alignment in total knee arthroplasty (TKA), which are essential for good long-term results. Due to the early-onset severe arthropathy, haemophiliacs undergo prosthetic surgery at a younger age than general population; therefore to ensure a longer duration of implantation is a major objective to be reached in this setting. As several prospective randomised studies could show, Computer navigation in prosthetic surgery improve precision concerning geometry of axes, resection planes and implant alignment, by the determination of joint centres (actual axis), amount of bone resection, size of prostheses and check of ligament balance. At our department, since January 2006, we implanted four TKA in four patients (age range 45–52 years) affected by severe Haemophilia B; the same surgeon used a single system (Orthopilot system) in all cases.

The quality of implantation was studied on postoperative standardized long leg coronal and lateral x-rays. Our results showed that CAS had greater consistency and accuracy in implant placement. Complications influencing the clinical outcome did not occur. In our experience, drawbacks of the navigation systems are the additional costs and the additional operation time between 15 and 25 min. However, one of the most important advantages of using of this technique in patient affected by coagulation disease, according to the international literature, is the reduction of blood loss after operation. A long-term follow-up of these and of larger samples of patients is needed for testing cost/risk-benefit ratio of Orthopilot in prosthetic surgery of haemophiliacs. Therefore navigated total knee arthroplasty in haemophilic arthropathy is not yet a standard procedure, but this technique could become an important surgical choice in management of severe secondary osteoarthritis in the future.

Adolescent idiopathic scoliosis is known to aggregate within families; however, the pattern of inherited susceptibility is unclear. A genomic screen and statistical linkage analysis of a genetic isolate including individuals with idiopathic scoliosis is being performed to identify variants responsible for this disease.

Scoliosis does not demonstrate a characteristic pattern of classical genetic (inherited) disorders. The severity of the disease within families can change and sometimes generations are skipped. However, the role of hereditary or genetic factors in the development of this condition is widely accepted. Numerous investigators are currently attempting to locate these genes. Studies based on a wide variety of populations have suggested an autosomal dominant mode of inheritance or sex-linked inheritance pattern. Other authors state that the “genetics link” may be complex, with an interaction of several genes rather than just one.

To identify chromosomal loci encoding genes involved in susceptibility to idiopathic scoliosis and the trasmission way of scoliosis we are studing a genetic isolate. We have generated a 10,600 individual pedigree of the village of Campora, in the Cilento area, starting from the beginning of the 17th century connecting all the 1200 living inhabitants. The actual population of Campora derives from a few founders; therefore, the living inhabitants are all related to each other. The population will undergo clinical and radiographic evaluation for the presence and degree of scoliosis. A genomic screen and statistical linkage analysis of the families with individuals having idiopathic scoliosis will be performed. With this approach we can identify variants responsible for this complex disease and genetic links of scoliosis.

It is well known that tibial osteotomy of arthritic painful genu varum in patients younger than 70 years of age has advantages both for the mechanical effect of symmetrical distribution of joint loading and for the biological effect produced by the bone section on the local venous intraosseus pressure which reduces pain. Patients were selected according to pre-operative X-ray evaluation of the limbs taken with the patient bearing weight on one foot: varus deformity not greater than 25°, knee flexion not greater than 15°, joint movement not less than 90° and absence of femorotibial subluxation or other instabilities. Surgery consists in application of three proximal and two distal screws into the medial side of the tibia. An Orthofix Fixator with self-aligning body is applied and an oblique osteotomy performed medially through a 3-cm skin incision using a drill bit and an osteotome to keep the lateral cortex intact in order to avoid lateral translation of the distal segment.

The patient can correct progressively the deformity himself by distracting the compression-dsistraction unit with an allen wrench. Once the desired correction has been achieved (8°–10°), a control X-ray is taken and the central body locking nut of the fixator tightened. Patients can bear full weight with crutches 4–5 days after surgery.

We have treated a total of 163 patients (92 men, 71 women). Their average age was 60 yearsand average healing time 75 days. Results were excellent in 60%, good in 25%, fair in 10% and poor in 5%. The average post-operative valgus was 9%. The technique and the clinical results are discussed.