Aim

There are no studies in literature that analyze the effectiveness of closed-incisional negative pressure wound therapy (ciNPWT) in the treatment of bone and joint infections (BJI). The aim of the study was to evaluate the efficacy and the safety of the application of ciNPWT in the postsurgical wound management of patients with osteoarticular infections.

Aims

It has been hypothesized that proximal radial neck resorption (PRNR) following press-fit radial head arthroplasty (RHA) is due to stress-shielding. We compared two different press-fit stems by means of radiographs to investigate whether the shape and size of the stems are correlated with the degree of PRNR.

Chondrosarcomas are malignant neoplasms that form an exclusively chondroid matrix. These generally slow-growing cartilage-based tumors most commonly occur in patients between 30 and 60 years old.

In this article, we describe our retrospective clinical study, performed on 21 patients (11 males and 10 females) who were affected by conventional chondrosarcoma (Grade 1) and underwent surgery between 1997 and 2008. The patients’ average age was 45,5 (29 to 71 years old) with an average follow-up of 68,4 months.

All low grade chondrosarcomas were treated with curettage, phenolization and reconstruction with acrylic bone cement.

Assessment of the limb functional recovery in treated patients has been performed through the Musculoskeletal Tumour Society scoring system (MSTS).

Patients’ average score six months after surgery was 76, 4% (between 61% and 87%) - low scores were reported in four patients following to complications (three fractures and one local recurrence).

Another evalutation has been carried out through the MSTS scoring system at the end of our study, showing a value improvement, with an average score of 79.9% (between 63.3% and 88%).

In conclusion, we see large intralesional curettage with chemical adjuvants (phenol and polimetilmetacrilate) as an effective treatment for low-grade chondrosarcoma of bones, allowing for a better patients’ compliance and a faster functional recovery. It is important, however, to prepare a surgical strategy according to the results of an accurate biopsy and a correct interpretation of the radiological imaging.

Introduction A wide range of stress-shielding phenomena following THA have been described in the past 20 years. Bone densitometry (DXA) stars as a golden standard in evaluating bone stock and bone density redistribution after total hip replacement.

In this study, DXA scan was employed to evaluate and compare the behaviour of different femoral components including a recently developed stemless implant which features complete stress transfer over the proximal femur.

Methodology A total of 120 patients, operated with six different femoral implants, were included in the present study. Five of these stems are widely commercially available (ABG, CFP, IPS, Mayo, Zweymueller) and present different patterns of stress distribution. The sixth is a custom made implant and features a pronounced lateral flare and complete femoral neck preservation. Rationale of this design is to obtain full load transfer on the proximal femur.

Average interval between the operation and the DXA exam was 3 years, each group included 20 patients. Bone mineral density was measured by DXA in the seven Gruen femoral regions (ROI), using the software metal removal (Hologic QDR 4500 W, MA-USA).

Results Differences in bone density were found in each group as well as between different groups. Significant differences (p< 0.001) were found between the stemless implant and the other five groups in zone I, IV and VII.

CFP, IPS and ABG groups showed decreased bone density in ROI I, while Mayo, IPS, ABG and Zweym-ueller were osteopenic in ROI VII. An increased bone density in ROI IV was found in Zweymueller, Mayo, ABG and IPS groups.

Conclusion Our data suggest that a conservative stemless implant with complete proximal load transfer, produces a homogeneous and more physiologic redistribution of bone density, allowing maintenance of proximal periprosthetic bone stock.

Systematic and prospective collection of data (Registro degli Interventi di Protesi d’Anca – RIPA-L) on hip replacement operations is underway in the Lazio Region (Italy) as part of a multi-regional registry on orthopaedic prosthetic surgery. The project is partially funded by the Ministry of Health and includes five regions of Italy, coordinated by Istituti Ortopedici Rizzoli, Bologna, in co-operation with the Italian National Institute of Health. The aim of the project is to create – as a first attempt in Italy – a national database on hip replacement operations in order to monitor adverse events related to orthopaedic prostheses. First, in the Lazio region, standardised methods and data collection instruments were developed and assessed in a pilot study at three hospitals in Rome (teaching, public and private). The case report form (CRF) includes identification data, clinical findings, details of the operation (duration, grade of surgeon, and operative technique) and characteristics of the prosthesis. A web-based CRF facilitates data registration (www.asplazio.it). Second, 32 orthopaedic centres agreed to participate in the initiative and started collecting data. Indeed, 53% of all hip replacement operations in the Lazio region are performed in these centres (n=6355, source: Regional Hospital Information System, 2003).

RIPA-L represents an important instrument to monitor the quality of hip replacement surgery in the Lazio region and to collect information on types of orthopaedic prostheses, contributing to the national database and, more generally, promoting quality in orthopaedic surgery.