Introduction

seeking full compliance with the Tissue Sparing Surgery principles, we introduced this new surgical approach to the coxa-femoral joint via the medial inguinal region.

Introduction

seeking full compliance with the Tissue Sparing Surgery principles, we introduced this new surgical approach to the coxa-femoral joint via the medial inguinal region.

We present 11 cases of total femur implanted in patients affected by severe bone defects in septic or aseptic prosthesis failures or tumours. Good results were obtained with a precise preoperative technical and surgical planning, without septic complications. We reported results and complications of our series.

From June 2003 we have elaborated a new procedure consisting in an osteoinductive-antibiotic gel, positioned on the spongiosametal surfaces of the implant. The gel contains five elements: Cancellous bone chips, Platelet-Rich Plasma, Bone marrow, Fibrin glue, Vancomycin and Tobramycin. Blood loss, operative time Hemoglobin drop values and clinical results were collected. Our procedure shows a quickly osteointegration of the implants without septic complications due to the local delivery of antibiotics. The procedure is safe and easy because includes only autologous factors without risks of disease transmission or immune response.

In primary total hip arthroplasty in patients affected by congenital dysplasia of the hip, stabilisation of the cup because of the altered shape of the acetabulum presents a problem. We have obviated this by creating a standard protocol with a press-fit classification that helps us to resolve such problems. In 269 cases (from 1994 to 2004) of patients affected by congenital dysplasia of the hip, we have always reconstructed the acetabulum using autologous bone grafts. After the right preparation of the acetabulum, when the cover of the metal back is complete and the stability is optimal (type I), bone grafts are not required (106 cases). After positioning of the cup, if we find defects that leave less than 30% of the external surface of the metal back uncovered but the stability is good (type II) (138 cases), we reconstruct such defects with small bone grafts (bone chips) captured by the femoral head of the patient. Greater bony defects that, after positioning of the metal back, do not allow an adequate stability and leave more than 30% of the cup (type III) uncovered (25 cases), we reconstruct the acetabulum with part of the femoral head fixed with screws. The follow-up at more than 5 years is between good and excellent (89–100) in all pateitns according to the Harris Hip Score.

In cementless joint arthroplasty, the first goal is stabilisation of the prosthetic components, due to bone ingrowth. In the past, to achieve the best fixation, orthopaedic surgeons used osteoconductive materials (HA, TriCa-Ph). To accelerate the fixation process, we have developed an osteoinductive procedure with growth factors. A product created from cancellous bone (BMP’s), bone marrow (stem cells) and platelet-rich plasma (growth factors) is applied to the tri-dimensional fixation surface (spongiosametal) of the prosthesis. Since June 2003, we have treated 15 arthroplasties with this procedure (11 THA, four TKA). The average duration of clinical follow-up was 6 months (range from 2 to 9 months). In case of THA, the average Harris Hip Score was 96 (Range from 91 to 100). In case of TKA, the average of HSS scoring was 90 (range from 85 to 100). The radiographic examinations were good. DEXA and RSA evaluations are underway.