The options for treatment of the young active patient with isolated symptomatic osteoarthritis of the medial compartment and pre-existing deficiency of the anterior cruciate ligament are limited. The indications for the unicompartimental knee prosthesis are selective. Misalignment femoral-tibia, varo-valgus angle more than 7°, over-weight, and knee instability were considered to be a contraindication.

The potential longevity of the implant and levels of activity of the patient may preclude total knee replacement, and tibial osteotomy and unicompartmental knee arthroplasty are unreliable because of the ligamentous instability.

Therefore, we combined reconstruction of the anterior cruciate ligament first and unicompartmental arthroplasty of the knee.

We included in this study six patients, three males and three female, mean age 53.6 years, that presented only osteoarthritis of medial femoral condyle and ACL deficiency.

In the first group included 2 patients, we performed arthroscopy ACL reconstruction with hamstring and unicompartimental knee prosthesis one-step, and in the second group included 4 patients, we performed the same surgical procedure in two-step.

The clinical and radiological data at a minimum of 1.5 years at follow-up. We evaluated all patients with KOOS score, and IKDC score.

At the last follow-up, no patient had radiological evidence of component loosening, no infection, no knee remainder instability. The subjective and objective outcome assessed with the scale documented satisfactory average results, both in patients of first group and in those of second group.

ACL deficiency induced knee osteoarthritis for incorrect knee biomechanics, and all patients could be submit a total knee replacement.

What method for preventing it? This combined surgical treatment seems to be a viable treatment option for young active patients with symptomatic arthritis of the medial compartment, in whom the anterior cruciate ligament has been ruptured.

Future developments and more data are necessary for standardised surgical approach.

Long-term stability of total hip arthroplasty (THA) depends on the integration between osseous tissue and the biomaterial implant. Integrity of the osseous tissue requires the contribution of mesenchymal stem cells and their continuous differentiation into an osteoblastic phenotype.

Some studies, like Wang ML et al., show that chronic exposure to titanium and zirconium oxide wear debris may contribute to decreased bone formation at the bone/implant interface by reducing the population of viable human mesenchymal stem cells (hMSCs) and compromising their differentiation into functional osteoblasts.

On the basis of our good experience in the use of Exeter technique in revision surgery of THA, two years ago we started to utilize bone grafts mixed with growth factors in order to improve grafts incorporation and implant fixation. At the moment we are studying the use of hMSCs during hip revision surgery, employing polyethylene cup to reduce the possible titanium and zirconium oxide debris. hMSCs are obtained with MarrowsStim Concentration Kit (Biomet Biologics Europe) by 60 ml of patient’s bone marrow.

Clinical outcomes and quality of life are evaluated on the basis of Harris Hip Score, Womac score and SF-36 score, while bone graft incorporation features are assessed with post operative computed tomography (CT) examination and further CT controls at two, four and eight months after surgery.

In the last months of 2007 we started to retrospectively review 60 patients who had undergone Girdlestone resection arthroplasty of the hip between 1994 to 2006.

The most frequent indications for this procedure were sepsis around prosthesis, aseptic loosening, pseudoartrhosis after femoral neck fractures or medical compromised patients who had an high risk of hip reimplantation procedure. The evaluation of patient’s satisfaction ranges a lot in literature and no valid guidelines have been publicated.

All our patients were submitted to limb shortening measurement and functional evaluation according to SF-36 score and Harris Hip Score. There were 20 men and 40 women with an average age of 70 years old (range 96-43 years old on operation time), the mean follow up was 133 months (range 14–167 months). Some patients were lost at the follow-up, the main reason was death for related and unrelated causes (overall mortality of 30%).

The aim of this study was to analyze patient’s satisfaction and functional outcomes after Girdlestone arthroplasty which appears in our experience, despite the limits, a valid surgical option in order to improve hip function, decrease or cancel pain and control infections when implantation or reimplantation is not possible.

Femoral off-set is the perpendicular distance between femur longitudinal axle and the femoral head’s rotation’s centre. Femoral off-set influences following yardsticks: stability of the joint, range of movement (ROM), muscular forcibleness, solicitations on the femoral component and acetabular component’s usury. From numerous radiographies studies, is shown as off-set is not an indefeasible measure, but an average with a range of variability. Offset is one of the most important yardsticks to consider during the pre-operating planning since, as is broadly documented, it has a positive effect on the functionality of the prosthesis; difficulty remains to individualize the optimal offset value in patient with bilateral coxofemural pathology or carriers of opposite side total hip prosthesis. Modular necks act indipendently in three spatial variables allowing to reach 27 points in the space, disposing of heads with three lenghts the real disponibility become of 81 points.

Usually we estimate the sizes and the orientation of the components manually and through a radiographic intra-operative control in order to choose the best match head-neck.

If we make a minimum mistake in cup position, the use of modular necks allow to correct this failure to obtain the most correct anatomic position producing negligible debris and the reduction of the mechanic stress.

Basing on our experience we think that the possibility to change length and version independently and sequentially is the unique technique avaible to correct the implant’s orientation, even if in our series we have choose neutral neck in most cases. To obtain better functional outcome we are studing a device based on gait analysis and superficial electromyography to calculate pre and post operative off-set. The data that we have achieved are still too few to be able to produce results; if there is possible, presenting them in future editions.

Aims: The treatment of long bone non-union now days finds its gold standard in autologous bone grafting. Since this technique is affected by a high morbidity rate of the donor site, many studies tried to find valid alternatives to this procedure, but during the last few years the advances made in tissue engineering techniques opened new frontiers.

In this study BMPs/AGFs were used in posttraumatic long bone non-union and osseous defects to test their clinical and radiological effectiveness in order to find a valid alternative to autologous bone grafting.

Methods: The cases selected can be divided in two groups. Group A: Patients affected by long bones Non Union, 9 months minimum duration, who are judged not to heal by simply changing the osteosynthesis device. Group B: Patients with non neoplastic, posttrauma or post-resection osseous defects of a critical size that will probably not heal using traditional surgical techniques or for which such techniques are considered to be unsuitable.

Moreover, the overall recruitment period is 3 years during which 40 patients/year will be enrolled up to a total of 120 cases; half of these will be treated with rhBMP-7 and the other half with PRP.

Results: Only 66 patients can be evaluated as they have completed the minimum follow-up period of 9 months, 35 of whom have been treated with rhBMP-7 and 31 treated with PRP. Advanced results indicate the RX Healing rate was 85% for BMP-7 and 68% for PRP with a Clinical Healing rate of 88.5% and 68%; therefore a higher efficiency of BMP-7 over PRP was found, confirmed by a significant failure rate of 15% versus 32,3% between BMP-7 and PRP, respectively.

Conclusions: According to our results, the use of growth factors showed a similar effectiveness to autologous bone grafting with better tolerability, moreover, a relevant difference in healing/failure rate between rhBMP-7 and PRP is observed.

The purpose of this study was to assess the physical, biochemical and biomechanical properties of a cartilage matrix-chondrocyte-fibrin glue composite as biological tool for cartilage repair.

Chondrocytes were enzymatically isolated from pig joints and resuspended in fibrinogen solution. Articular cartilage was harvested from pig joints, chopped into small chips and lyophiliaed. Cartilage chips were rehydrated and mixed with the cell/fibrinogen solution and with thrombin, in order to form a fibrin glue gel composite with cells and chips (group A). Control composites were made from lyophilised cartilage chips assembled with fibrin glue, but not containing chondrocytes (group B). Other control groups included fibrin glue/chondrocyte specimens without cartilage chips (group C) and specimens made of the fibrin glue alone (group D). All samples were weighed and implanted into subcutaneous pouches of nude mice. Animals were sacrificed at 2 and 9 weeks. Samples were evaluated grossly and the final/initial mass ratio was calculated. Samples were evaluated histologically, biomechanically, and biochemically.

Upon retrieval, only the samples in experimental group A retained their original pre-implantation mass. Histological analysis showed newly formed cartilage matrix in the specimens from group A and C. Biomechanical analysis showed significantly higher modulus in experimental samples, with respect to the other groups at the latest time point. Analysis of hydraulic permeability showed significantly decreasing values for all groups throughout the experimental times and lowest values for the experimental samples of group A in the latest time point, although there was no statistically significant difference among the groups. Biochemical analysis demonstrated higher values in the latest time point for samples prepared with cells for water and GAG content, whereas highest values for hydroxyproline were recorded for samples assembled with cartilage chips. DNA analysis showed higher values of samples prepared with chondrocytes and fibrin glue and also an important increase in values of the samples made of fibrin glue only, indicating a possible host fibroblast growth inside the samples over time. This tissue-engineered composite presents cartilaginous appearance and biomechanical integrity after 9 weeks in vivo.