High tibial osteotomy is an efficient treatment for medial compartment osteoarthritis of the knee; its used for middle aged patients with high activity levels and can delay the need for total arthroplasty.

The results of total knee arthroplasty after failed high tibial osteotomy are controversies; several authors reported inferior outcomes, but others have concluded that tibial osteotomy doesn't bias following total arthroplasty. The aim of this study was to evaluate the results of failed high tibial osteotomy subsequently converted to total knee arthroplasty and compare the results to group of patients underwere primary arthroplasty; the authors evaluate some of technical problems that a previous high tibial osteotomy can generate, like scar tissue, patellar tendon shortening and changes of proximal tibial anatomy.

High tibial osteotomy is an efficient treatment for medial compartment osteoarthritis of the knee; its used for middle aged patients with high activity levels and can delay the need for total arthroplasty.

The results of total knee arthroplasty after failed high tibial osteotomy are controversies; several authors reported inferior outcomes, but others have concluded that tibial osteotomy doesn’t bias following total arthroplasty. The aim of this study was to evaluate the results of failed high tibial osteotomy subsequently converted to total knee arthroplasty and compare the results to group of patients underwere primary arthroplasty; the authors evaluate some of technical problems that a previous high tibial osteotomy can generate, like scar tissue, patellar tendon shortening and changes of proximal tibial anatomy.

Methods: 50 total knee arthroplasty performed after a previous closed wedge osteotomy were matched with 50 patients operated with a primary knee prosthesis for osteoarthritis. The time from a proximal tibial osteotomy to a prosthesis operation was in mean eight years.

Results: the Knee Society clinical and radiographic score system and W.O.M.A.C. evaluation were used to evaluate knees before surgery and at each follow up (average 5 years).

At an average of five years follow up, the clinical results of total knee arthroplasty after high tibial osteotomy were similar to those of primary knee prosthesis.

Discussion: in our study revision of failed proximal tibial osteotomy appears to have more technical difficulties but with overall outcomes that remain comparable at results after primary total knee arthroplasty, so tibial osteotomy is considered a valid option in younger and very active patients with unicompartmental arthritis.

High tibial osteotomy is an efficient treatment for medial compartment osteoarthritis of the knee; its used for middle aged patients with high activity levels and can delay the need for total arthroplasty.

The results of total knee arthroplasty after failed high tibial osteotomy are controversies; several authors reported inferior outcomes, but others have concluded that tibial osteotomy doesn’t bias following total arthroplasty. The aim of this study was to evaluate the results of failed high tibial osteotomy subsequently converted to total knee arthroplasty and compare the results to group of patients underwere primary arthroplasty; the authors evaluate some of technical problems that a previous high tibial osteotomy can generate, like scar tissue, patellar tendon shortening and changes of proximal tibial anatomy.

Methods: 50 total knee arthroplasty performed after a previous closed wedge osteotomy were matched with 50 patients operated with a primary knee prosthesis for osteoarthritis. The time from a proximal tibial osteotomy to a prosthesis operation was in mean eight years.

Results: the Knee Society clinical and radiographic score system and W.O.M.A.C. evaluation were used to evaluate knees before surgery and at each follow up (average 5 years).

At an average of five years follow up, the clinical results of total knee arthroplasty after high tibial osteotomy were similar to those of primary knee prosthesis.

Discussion: in our study revision of failed proximal tibial osteotomy appears to have more technical difficulties but with overall outcomes that remain comparable at results after primary total knee arthroplasty, so tibial osteotomy is considered a valid option in younger and very active patients with unicompartmental arthritis.

Introduction: A prospective study was done to compare the early clinical, radiographic outcomes between the Scorpio CR and Scorpio Flex CR primary total knee replacement.

Methods: 130 Scorpio CR and 40 Scorpio Flex CR were implanted. Patients were prospectively evaluated with a mean follow-up of 3,9 years (2–8 years). Knee Society Score, W.O.M.A.C., range of motion and knee pain was compared. Patients age, level of activity, BMI, were criteria selection for implant of Scorpio Flex CR.

Results: There was more pain in Scorpio CR group, mean flexion was greater in Scorpio Flex CR (112 vs 108); Knee Society score and WOMAC was better in Scorpio Flex CR group.

Conclusion: The Scorpio Flex CR new design may be allow the significant increase in Knee Society score and the better ROM in Scorpio Flex CR group.

Introduction MRI accuracy in detecting knee lesions is a discussed controversy. Not always different knee lesions, diagnosed by MRI are confirmed by arthroscopy. The aim of this study is to correlate the accuracy of history, physical examination and MRI in evaluating meniscal and ACL lesions.

Methods A prospective comparative study was performed to compare anamnestic and clinical data, MRI findings and arthroscopic findings to better understand the role of these methods and to assess if there are significative differences between various knee disorders. One hundred patients undergoing to arthroscopy for knee injuries were evaluated before surgery, registering anamnestic data, clinical examination and MRI findings. At the time of surgery every finding was registered and then compared with the previous acquired data.

Results The most accurate data for diagnosis appears from history and clinical examination. The study showed a statistically significative differences between the RMI and arthroscopic findings. Differences between radiologist were detected in MRI data.

Conclusion The results of such type of study, underlining the reliability and accuracy of patient’s history, clinical examination and MRI, comparing the different results among them and in various knee injuries. The accuracy of every test is the first step for an evidence based decision analysis process and represent a step forward an efficacious and economical pattern in diagnosis.

Shoulder replacement has increased exponentially over the past decades due to good results reported in literature and improvement of surgical technique and devices efficacy. Previous studies suggested the effectiveness of shoulder replacement in fractures, assessing objective parameters as range of motion and radiographic images and evaluating the of postoperative complications and subsequent revision; pain relief, physical function level and health related quality of life (QoL) improvement were often left out. A prospective study was conducted on 21 patients surgically treated with shoulder emiarthroplasty for proximal humeral fractures (18 women and 3 men, mean age at follow-up 70 years – range: 57–82). The purpose of the present study is to collect the patient-relevant outcomes in a homogeneous sample (for surgeon, surgery, implant, inclusion-exclusion criteria, neurological status) of patients who underwent shoulder replacement for proximal humeral fractures. Preoperatively patients were evaluated through x-rays (trauma series), Ct-scans were performed when necessary for surgical decision. Postoperatively, two independent examiners examined all patients clinically and radiographically. For patient-oriented standardized measure SF-36, DASH (Disability of Arm, Shoulder and Hand questionnaire), ASES (American Shoulder and Elbow Surgeon), OSQ (Oxford Shoulder Questionnaire) and SST (simple Shoulder test) were chosen. Outcomes of our series were statistically compared with literature data and widely analyzed. This kind of data are unavailable in literature and could represent the first step towards the definition of outcome for this kind of procedure.

Hip arthroscopy is a well-established technique becoming more and more an indispensable tool in institutions specialized in hip diseases. Several surgeons around the world have developed and refined the proper instruments and the surgical technique for this operation. By now, the indications have been well formulated for both diagnostic and interventional purposes.

My personal experience is of 98 hip arthroscopies performed in the last 6 years. Most common preoperative indication has been chronic hip pain after failure of conservative treatment. Other indications or arthroscopic findings have been: labral pathology, hip dysplasia, synovial chondromatosis, initial osteoarthritis, calcium pyrophosphate disease, ligamentum teres damage, chondral damage, post-traumatic loose bodies, avascular necrosis, sepsis, villonodular synovitis.

More recent, indications for hip arthroscopy are staging of avascular necrosis of the femoral head and shaving of polyethylene debris after total hip replacement.

Contraindications to arthroscopy include recent fracture of the pelvis osteoarthritis with osteophytosis, AVN with head collapse.

Hip arthroscopy can facilitate both comprehensive access to and treatment of an evolving series of conditions that affect the hip joint. Purpose of this presentation is to show the surgical technique and present the results obtained. New indications and potential future evolutions are also discussed.

Purpose: Operative treatment of diaphyseal humeral fractures is indicated for transverse displaced fractures, pathological or impending fractures, non unions, fractures with radial nerve palsy and oblique fractures after conservative treatment failure.

Different techniques are available but many surgeons have recently expressed a preference for retrograde nailing. We present our results with new generation retrograde self-locking nail.

Methodology: From 1998 to 2004, we treated 112 patients with the cannulated retrograde EXP nail (LIMA LTO). All patient have been operated in the prone position on a conventional orthopaedic table.

Proximal locking, in this device, is obtained by the angled protrusion of a wire from the nail proximal extremity. Experimental tests in the lab have confirmed the excellent torsion stability of this mechanism.

Distally, the EXP nail has two little wings shaped to sit on the medial and lateral columns of the olecranic fossa and to thus provide an effective rotational and traction control.

We treated 67 traumatic fracture, 15 pathological fractures, 10 impending fracture and 20 a non-unions. 10 patients in this series were obese.

Results: Average surgical time was 40 minutes (min 30 – max 110). Average radiation exposure was 1 minute and 15 seconds (20 seconds for proximal locking).

Union was obtained in all the 67 primary fractures and stability was secured for all the impending and pathological cases. All but 1 non-union healed after an average of 2.6 months. In 2 patients of the primary fractures and in 3 patients of the non-union group we had a delayed union. The 3 non-union patients healed after 5, 7 and 9 months respectively. Overall 9 of the 10 obese patients healed. No patients suffered shoulder pain. In 8 cases a reduction of less than 10 degrees of elbow extension was detected. Forty-five nails have been removed so far after an average of 11 months after nailing. No major problems in nail removal have been encountered.

Conclusions: Retrograde nailing of the humerus presents significant advantages over other techniques and is meeting more and more consensus. The nail employed in this series provides satisfactory stability, it is cannulated and requires minimal radiation exposure.

High tibial osteotomy is an efficient treatment for medial compartment osteoarthritis of the knee; its used for middle aged patients with high activity levels and can delay the need for total arthroplasty.

The results of total knee arthroplasty after failed high tibial osteotomy are controversies; several authors reported inferior outcomes, but others have concluded that tibial osteotomy doesn’t bias following total arthroplasty. The aim of this study was to evaluate the results of failed high tibial osteotomy subsequently converted to total knee arthroplasty and compare the results to group of patients underwere primary arthroplasty; the authors evaluate some of technical problems that a previous high tibial osteotomy can generate, like scar tissue, patellar tendon shortening and changes of proximal tibial anatomy.

Methods: 50 total knee arthroplasty performed after a previous closed wedge osteotomy were matched with 50 patients operated with a primary knee prosthesis for osteoarthritis. The time from a proximal tibial osteotomy to a prosthesis operation was in mean eight years.

Results: the Knee Society clinical and radiographic score system and W.O.M.A.C. evaluation were used to evaluate knees before surgery and at each follow up (average 5 years).

At an average of five years follow up, the clinical results of total knee arthroplasty after high tibial osteotomy were similar to those of primary knee prosthesis.

Discussion: in our study revision of failed proximal tibial osteotomy appears to have more technical difficulties but with overall outcomes that remain comparable at results after primary total knee arthroplasty, so tibial osteotomy is considered a valid option in younger and very active patients with unicompartmental arthritis.

Aims: Most diaphyseal humeral fractures must be treated conservatively. Surgery is indicated for transverse displaced fractures, pathological or impending fractures, non unions, fractures with radial nerve palsy and oblique fractures after conservative treatment failure. Methods: Between March 1998 and July 2001 we operated on 80 patients with a diaphyseal humeral fracture. The cannulated retrograde EXP nail (LIMA LTO) was always employed. Proximal locking is obtained through the nail by causing angled protrusion of a wire from the proximal end of it and into the spongious (cancellous) bone of the humeral head. Distally the EXP nail has two little wings shaped to sit on the medial and lateral columns of the olecranic fossa and to thus provide a very effective rotational and traction control. In 51 cases it was a traumatic fracture; transverse, oblique unstable or polytrauma. In 10 cases a pathological fractures, in 7 an impending fracture, in 12 a nonunion. Nonunion cases had had a previous average of 2.5 operations. 10 patients were obese. Results: Average surgical time was 40 minutes. Average radiation exposure was 1 minute and 40 seconds. Union was obtained in all the 51 primary fractures and stability was secured for all the impending and pathological cases. All but 1 of the non-unions healed after an average of 2.6 months. The one failure was in an obese 65 yrs old lady with an oblique unstable non-union. No patients suffered shoulder pain. In 4 cases a reduction of less than 10 degrees of elbow extension was detected. Conclusions: The EXP humeral nail provides satisfactory stability, it is cannulated and requires minimal radiation exposure.

Introduction: Quality of life is becoming in the last years an essential element of evaluation of treatments. The aimof this prospective cohort study is to assess the quality of life and the speciþc patient perspective on knee replacement. A pre- and post-operative patient-oriented study was conducted on patients operated on knee replacement for symptomatic knee arthritis to measure their quality of life. Material and Methods: There were 50 patients, mean age 71.3 (5.1 SD) years, affected by knee arthritis. The SF-36 questionnaire (ofþcial Italian version) and Oxford validated Italian version questionnaire (OKQ) were administered preoperatively and post-operatively (at 2 years of follow-up Ð SD 1.5). The results were compared within and with those of an age-matched and sex healthy sample (n=351) published in Literature. The appropriated statistical analysis was used on results data. Results: The SF-36 domain scores for the pre- and post-operative data were respectively the following: PF 32.50±24.43 and 50,81±27.21; RF 13.63±28.58 and 63.09±47.18; BP 14.47±11.44 and 50.45±28.61; GH 55.08±15.36 and 56.71±20.29; VT 44.77±15.77 and 58.19±16.84; SF 55.08±25.15 and 71.81±25.60; RE 42.00±46.31 and 65.09±40.14; MH 58.72±16.85 and 61.71±20.14; PCS 27.00±6.22 and 38.71±9.51; MCS 46.13±11.10 and 47.76±9.43. The OKQ respectively 47.00±7.86 and 27.72±10.66. Appropriated statistical tests were performed. Conclusions: Knee replacement signiþcantly improve patientsñ perception of their own health. Moreover the patient-oriented speciþc measure give results really reassuring on knee replacement results. A better knowledge of the health status changes induced by knee replacement might help further deþne the indications to surgery and cost-beneþt relationship.

Aims: Up to 91% of patients have been reported to have bony fragments and debris in the hip joint after reduction of a fracture dislocation (Epstein 1991). Removal of these loose bodies is believed to delay the onset of osteoarthritis and minimize its severity. In some patients, either the good position of the acetabular fracture or excessive comminution of the posterior wall make open removal of the loose bodies a very unattractive procedure. Methods: We present a series of 11 arthroscopic loose bodies removal after fracture dislocation of the hip. The indication for arthroscopic removal was given in the presence of a single fragment in a relatively intact joint, comminution of the posterior wall with a stable hip, impossibility of early ORIF because of associated injuries. Results: In all cases the procedure was performed within the þrst 60 days after dislocation. In none of the cases the acetabular ßoor was interrupted. The procedure took an average of 85 minutes. In two cases arthroscopic removal was not possible and open surgery was required. Conclusions: Arthroscopic removal of loose bodies from the hip is a very demanding procedure. It is indicated only in very selected cases. Problems encountered includes bleeding, difþculties in recognising the normal anatomy and the loose fragment, impossibility to grasp and take out the fragment. We discuss the indications/controindications, and the technical tips to perform a successful removal with this mini-invasive approach.