Joint Repair and Replacement: Clinical Updates and Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (25 January 2023) | Viewed by 32846

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A printed edition of this Special Issue is available here.

Special Issue Editors

U.O. Ortopedia Bentivoglio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
Interests: foot and ankle; total ankle replacement; trauma; foot and ankle deformities; sports medicine
Special Issues, Collections and Topics in MDPI journals
U.O. Ortopedia Bentivoglio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
Interests: foot and ankle; total ankle replacement; foot and ankle trauma; foot and ankle deformities; sports trauma; cartilage; foot and ankle osteoarthritis
Special Issues, Collections and Topics in MDPI journals
II Clinic of Orthoapedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
Interests: knee; knee ligamentous injury; sports medicine; knee osteoarthritis; knee trauma; knee deformities; cartilage; knee reconstruction

Special Issue Information

Dear Colleagues,

Primary and secondary osteoarthritis, post-traumatic and oncological sequelae, and articular avascular necrosis have always represented a challenging management problem for orthopaedic surgeons and traumatologists. The bone tissue loss, characteristic of these clinical pictures, has conditioned operational choices in favour of more invasive and sometimes disabling interventions. Often, the poor quality or quantity of bone substance does not allow standard prosthetic devices to be implanted or requires large amounts of cadaveric or autologous bone grafts, with related risks and complications.

Today, thanks to technological improvement in terms of planning and implants, the possibilities of joint reconstruction and replacement, as well as of treatment of malalignments and loss of periarticular bone substance, have been considerably extended. This is due to new approaches including, for example, computerized navigation and 3D printed custom-made surgery.

We are therefore proud to present this Special Issue of the Journal of Clinical Medicine, a reliable and serious journal, always committed to scientific divulgation in many fields of medical knowledge—in this case, serving orthopaedics and traumatology.

The aim of this Special Issue is to share the personal experience of groups and authors currently working on articular and periarticular treatment solutions, their impressions on opportunities and limits, the results obtained, and the problems that have arisen. All this can be achieved through valid research articles that prove to be of high impact and interest to the orthopaedic community.

Dr. Massimiliano Mosca
Dr. Silvio Caravelli
Dr. Alberto Grassi
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Custom-made implant
  • 3D-printing device
  • Osteoarthritis
  • Avascular necrosis
  • Articular and periarticular bone loss
  • Custom-made total joint replacement
  • Custom-made arthrodesis/reconstruction
  • Custom-made osteotomy

Published Papers (16 papers)

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Editorial

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2 pages, 172 KiB  
Editorial
Osteochondral Lesions of Ankle and Knee. Will Future Treatments Really Be Represented by Custom-Made Metal Implants?
by Massimiliano Mosca, Alberto Grassi and Silvio Caravelli
J. Clin. Med. 2022, 11(13), 3817; https://doi.org/10.3390/jcm11133817 - 01 Jul 2022
Viewed by 873
Abstract
Knee and ankle osteochondral lesions are structural defects of the cartilaginous surface and underlying subchondral bone which still represent a daily challenge for the orthopedic surgeon [...] Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)

Research

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12 pages, 1963 KiB  
Article
Joint Response to Exercise Is Affected by Knee Osteoarthritis: An Infrared Thermography Analysis
by Luca De Marziani, Angelo Boffa, Simone Orazi, Luca Andriolo, Alessandro Di Martino, Stefano Zaffagnini and Giuseppe Filardo
J. Clin. Med. 2023, 12(10), 3399; https://doi.org/10.3390/jcm12103399 - 11 May 2023
Cited by 1 | Viewed by 1225
Abstract
Infrared thermography can be used to evaluate the inflammation characterizing the joint environment of OA knees, but there is limited evidence on the response to physical exercise. Identifying the response to exercise of OA knees and the influencing variables could provide important information [...] Read more.
Infrared thermography can be used to evaluate the inflammation characterizing the joint environment of OA knees, but there is limited evidence on the response to physical exercise. Identifying the response to exercise of OA knees and the influencing variables could provide important information to better profile patients with different knee OA patterns. Sixty consecutive patients (38 men/22 women, 61.4 ± 9.2 years) with symptomatic knee OA were enrolled. Patients were evaluated with a standardized protocol using a thermographic camera (FLIR-T1020) positioned at 1 m with image acquisition of an anterior view at baseline, immediately after, and at 5 min after a 2-min knee flexion–extension exercise with a 2 kg anklet. Patients’ demographic and clinical characteristics were documented and correlated with the thermographic changes. This study demonstrated that the temperature response to exercise in symptomatic knee OA was affected by some demographic and clinical characteristics of the assessed patients. Patients with a poor clinical knee status presented with a lower response to exercise, and women showed a greater temperature decrease than men. Not all evaluated ROIs showed the same trend, which underlines the need to specifically study the different joint subareas to identify the inflammatory component and joint response while investigating knee OA patterns. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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10 pages, 1521 KiB  
Article
Femoral Anteversion in Total Hip Arthroplasty: Retrospective Comparison of Short- and Straight-Stem Models Using CT Scans
by Sebastian Martin Klim, Patrick Reinbacher, Maria Anna Smolle, Andrzej Hecker, Michael Maier, Joerg Friesenbichler, Andreas Leithner, Lukas Leitner, Alexander Draschl, Jan Lewis, Kevin Brunnader and Werner Maurer-Ertl
J. Clin. Med. 2023, 12(6), 2391; https://doi.org/10.3390/jcm12062391 - 20 Mar 2023
Viewed by 1332
Abstract
Data on reconstruction of the femoral anteversion (FA) and the center of rotation after total hip arthroplasty (THA) are rare. We aimed to answer whether a short-stem fixation enables improved anatomical reconstruction of the FA compared to a straight-stem. Methods: One hundred and [...] Read more.
Data on reconstruction of the femoral anteversion (FA) and the center of rotation after total hip arthroplasty (THA) are rare. We aimed to answer whether a short-stem fixation enables improved anatomical reconstruction of the FA compared to a straight-stem. Methods: One hundred and thirty patients who underwent short- (n = 89, group A, prospective) or straight-stem THA (n = 41, group B, retrospective) were included. CT scans of the hip, knee, and ankle were performed pre- and postoperatively in group A and in group B during the last follow-up. Femoral torsion was determined using three-dimensional models. Results: The mean preoperative FA was 22.4° ± 11.0°, and the mean postoperative FA was 23.4° ± 10.1°. The relative difference was −0.8° ± 8°, and the absolute difference was 6.4° ± 4.9°. Gender analysis revealed significant differences in preoperative FA between female (f) and male (m) patients (28.1° ± 11.2° (f) vs. 18.4° ± 8.3° (m); p > 0.001) as well as in postoperative FA (26.7° ± 23.5° (f) vs. 21.0° ± 9.7° (m); p < 0.007) in group A. Postoperative FA was higher in group A (mean 6.8°; 23.9° ± 10.1° (f) vs. 16.6° ± 8.6° (m); p < 0.001). Conclusions: The study’s findings suggest that short-stem THA leads to improved anatomical FA reconstruction; however, a substantial postoperative gender-related FA difference was detectable, which may warrant consideration by surgeons when determining the final stem anteversion. It should be noted that the impact of the postoperative gender-related FA difference on clinical outcomes is not entirely clear, and further research is warranted to elucidate this relationship. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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11 pages, 10816 KiB  
Article
Infrared Thermography in Symptomatic Knee Osteoarthritis: Joint Temperature Differs Based on Patient and Pain Characteristics
by Luca De Marziani, Angelo Boffa, Lucia Angelelli, Luca Andriolo, Alessandro Di Martino, Stefano Zaffagnini and Giuseppe Filardo
J. Clin. Med. 2023, 12(6), 2319; https://doi.org/10.3390/jcm12062319 - 16 Mar 2023
Cited by 4 | Viewed by 1714
Abstract
The aim of this study was to evaluate osteoarthritis (OA) patients with infrared thermography to investigate imaging patterns as well as demographic and clinical characteristics that influence knee inflammation. Forty patients with one-sided symptomatic knee OA were included and evaluated through knee-specific PROMs [...] Read more.
The aim of this study was to evaluate osteoarthritis (OA) patients with infrared thermography to investigate imaging patterns as well as demographic and clinical characteristics that influence knee inflammation. Forty patients with one-sided symptomatic knee OA were included and evaluated through knee-specific PROMs and the PainDETECT Questionnaire for neuropathic pain evaluation. Thermograms were captured using a thermographic camera FLIR-T1020 and temperatures were extracted using the software ResearchIR for the overall knee and the five ROIs: medial, lateral, medial patella, lateral patella, and suprapatellar. The mean temperature of the total knee was 31.9 ± 1.6 °C. It negatively correlated with age (rho = −0.380, p = 0.016) and positively correlated with BMI (rho = 0.421, p = 0.007) and the IKDC objective score (tau = 0.294, p = 0.016). Men had higher temperatures in the knee medial, lateral, and suprapatellar areas (p = 0.017, p = 0.019, p = 0.025, respectively). Patients with neuropathic pain had a lower temperature of the medial knee area (31.5 ± 1.0 vs. 32.3 ± 1.1, p = 0.042), with the total knee negatively correlating with PainDETECT (p = 0.045). This study demonstrated that the skin temperature of OA symptomatic knees is influenced by demographic and clinical characteristics of patients, with higher joint temperatures in younger male patients with higher BMI and worst objective knee scores and lower temperatures in patients affected by neuropathic pain. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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10 pages, 1267 KiB  
Article
Elbow Arthroscopy for the Treatment of Radial Head Fractures: Surgical Technique and 10 Years of Follow Up Results Compared to Open Surgery
by Enrico Guerra, Alessandro Marinelli, Fabio Tortorella, Michelle Dos Santos Flöter, Alice Ritali, Andrea Sessa, Giuseppe Carbone and Marco Cavallo
J. Clin. Med. 2023, 12(4), 1558; https://doi.org/10.3390/jcm12041558 - 16 Feb 2023
Cited by 3 | Viewed by 1151
Abstract
Background: This study aimed to describe the ARIF (Arthroscopic Reduction Internal Fixation) technique for radial head fractures and to compare the results with ORIF (Open Reduction Internal Fixation) at mean 10 years. Methods: A total of 32 patients affected by Mason II or [...] Read more.
Background: This study aimed to describe the ARIF (Arthroscopic Reduction Internal Fixation) technique for radial head fractures and to compare the results with ORIF (Open Reduction Internal Fixation) at mean 10 years. Methods: A total of 32 patients affected by Mason II or III fractures of the radial head who underwent ARIF or ORIF by screws fixation were retrospectively selected and evaluated. A total of 13 patients were treated (40.6%) by ARIF and 19 patients (59.4%) by ORIF. Mean follow-up was 10 years (7–15 years). All patients underwent MEPI and BMRS scores at follow-up, and statistical analysis was performed. Results: No statistical significance was reported in Surgical Time (p = 0.805) or BMRS (p = 0.181) values. Significative improvement was recorded in MEPI score (p = 0.036), and between ARIF (98.07, SD ± 4.34) and ORIF (91.57, SD ± 11.67). The ARIF group showed lower incidence of postoperative complications, especially regarding stiffness (15.4% with ORIF at 21.1%). Conclusions: The radial head ARIF surgical technique represents a reproducible and safe procedure. A long learning curve is required, but with proper experience, it represents a tool that might be beneficial for patients, as it allows a radial head fracture to be treated with minimal tissue damage, evaluation and treatment of the concomitant lesions, and with no limitation of the positioning of screws. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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8 pages, 255 KiB  
Article
Simultaneous Bilateral Total Hip Arthroplasty with Straight-Stems and Short-Stems: Does the Short One Do a Better Job?
by Patrick Reinbacher, Andrzej Hecker, Joerg Friesenbichler, Maria Smolle, Lukas Leitner, Sebastian Klim, Alexander Draschl, Danijel Colovic, Kevin Brunnader, Andreas Leithner and Werner Maurer-Ertl
J. Clin. Med. 2023, 12(3), 1028; https://doi.org/10.3390/jcm12031028 - 29 Jan 2023
Cited by 2 | Viewed by 1292
Abstract
Background: Total hip arthroplasty (THA) is known to be the most successful orthopaedic surgery of the last century, but it is still struggling with controversies concerning one-stage bilateral THA. The current study aimed to compare the clinical outcome of patients with unilateral or [...] Read more.
Background: Total hip arthroplasty (THA) is known to be the most successful orthopaedic surgery of the last century, but it is still struggling with controversies concerning one-stage bilateral THA. The current study aimed to compare the clinical outcome of patients with unilateral or simultaneous bilateral THA by using short-stem and straight-stem designs and focusing on operation time, blood loss, and length of hospital stay (LOS). Material and Methods: Between 2006 and 2018, 92 patients were enrolled in this study. Forty-six patients underwent a bilateral THA in one session, and forty-six matched patients underwent a unilateral THA. In each of the two groups (unilateral vs. bilateral), 23 patients received either a straight (unilateral: 10 females, 13 males, mean age 63; bilateral: 12 females, 11 males, mean age 53 years) or short stem (unilateral: 11 females, 12 males, mean age 60 years; bilateral: 12 females, 11 males, 53 mean age 62 years). The blood count was checked preoperatively as well as one and three days after surgery. Furthermore, the operation time and LOS were investigated. Results: Compared to THA with straight-stems, short-stem THA showed significantly less blood loss; there was no difference in the LOS of both groups. A significantly shorter operative time was only observed in the bilateral THA. Conclusion: The current study showed that simultaneous bilateral THA appears to be safe and reliable in patients without multiple comorbidities. In addition, short-stem THA appears to be beneficial in terms of clinical performance and outcome, and it appears to be superior to straight-stem THA, regardless of whether the patient underwent unilateral or simultaneous bilateral THA. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
14 pages, 2330 KiB  
Article
A 20-Year Retrospective Study of Children and Adolescents Treated by the Three-in-One Procedure for Patellar Realignment
by Giovanni Trisolino, Alessandro Depaoli, Giovanni Gallone, Marco Ramella, Eleonora Olivotto, Paola Zarantonello, Stefano Stallone, Valentina Persiani, Giacomo Casadei and Gino Rocca
J. Clin. Med. 2023, 12(2), 702; https://doi.org/10.3390/jcm12020702 - 16 Jan 2023
Cited by 2 | Viewed by 3299
Abstract
Background: Patellar instability is the most common disorder of the knee during childhood and adolescence. Surgical treatment significantly reduces the rate of redislocation, but the underlying pathologies and pattern of instability may affect the results. We aimed to report the clinical and functional [...] Read more.
Background: Patellar instability is the most common disorder of the knee during childhood and adolescence. Surgical treatment significantly reduces the rate of redislocation, but the underlying pathologies and pattern of instability may affect the results. We aimed to report the clinical and functional outcomes of the three-in-one procedure for patellar realignment in a cohort of skeletally immature patients with or without syndromes and various patterns of chronic patellar instability. Methods: We retrospectively investigated 126 skeletally immature patients (168 knees) affected by idiopathic or syndromic patellar instability, who underwent patella realignment through a three-in-one procedure. We classified the instability according to the score proposed by Parikh and Lykissas. Results: Patellar dislocation was idiopathic in 71 patients (94 knees; 56.0%) and syndromic in 55 (74 knees; 44.0%). The mean age at surgery was 11.5 years (range 4–18) and was significantly lower in syndromic patients. Syndromic patients also exhibited more severe clinical pattern at presentation, based on the Parikh and Lykissas score. The mean follow-up was 5.3 years (range 1.0–15.4). Redislocation occurred in 19 cases, with 10 cases requiring further realignment. The Parikh and Lykissas score and the presence of congenital ligamentous laxity were independent predictors of failure. A total of 22 knees in 18 patients required additional surgical procedures. The post-operative Kujala score was significantly lower in patients with syndromic patellar instability. Conclusions: The type of instability and the presence of underlying syndromes negatively affect the rate of redislocation and the clinical and functional outcome following patellar realignment through the three-in-one procedure. We recommend the consideration of alternative surgical strategies, especially in children with severe syndromic patellar dislocation. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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11 pages, 947 KiB  
Article
Could Short Stems THA Be a Good Bone-Saving Option Even in Obese Patients?
by Michela Saracco, Andrea Fidanza, Stefano Necozione, Giulio Maccauro and Giandomenico Logroscino
J. Clin. Med. 2022, 11(23), 7114; https://doi.org/10.3390/jcm11237114 - 30 Nov 2022
Cited by 5 | Viewed by 1234
Abstract
Short femoral stems, with preservation of the femoral bone stock, are commonly used in recent years for hip replacement in younger and more active patients. Obesity is increasingly spreading even in the younger population. The aim of this case-series study is to evaluate [...] Read more.
Short femoral stems, with preservation of the femoral bone stock, are commonly used in recent years for hip replacement in younger and more active patients. Obesity is increasingly spreading even in the younger population. The aim of this case-series study is to evaluate short stems compared to traditional hip prostheses in the obese population. A total of 77 consecutive patients with a BMI greater than or equal to 30 Kg/m2 were enrolled in this prospective study and were divided into two groups: 49 patients have been implanted with short stems while 28 patients were implanted with traditional stems. All the patients were treated for primary osteoarthritis or avascular necrosis and all the stems were implanted by the same surgeon using a posterior approach. Clinical (Harris Hip Score—HHS, Western Ontario and McMaster Universities Osteoarthritis Index—WOMAC, visual analogue scale—VAS, 12-item Short Form Health Survey—SF-12) and radiographic outcomes were recorded. Radiological evaluations were carried out by three different blinded surgeons. A statistical analysis was performed (chi-square, t-test, Wilcoxon Rank Sum Test, 2-factor ANOVA). At a mean follow-up of 42.6 months both groups showed a marked improvement in pain and in the clinical scores between pre- and post-surgical procedures (p < 0.05) with no significant differences between the two groups at last follow-up (p > 0.05). The radiological evaluations, with high concordance correlation between the three blinded surgeons (ICC consistently >0.80), showed good positioning and osseointegration in all cases, with no significant differences in the restoration of the joint geometry and complications. No revisions were recorded during the follow-up period. In conclusion, short stems appear to be a good option for bone preservation even in obese patients, showing comparable results to traditional implants. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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10 pages, 453 KiB  
Article
What Is the Inpatient Cost of Hip Replacement? A Time-Driven Activity Based Costing Pilot Study in an Italian Public Hospital
by Andrea Fidanza, Irene Schettini, Gabriele Palozzi, Vasileios Mitrousias, Giandomenico Logroscino, Emilio Romanini and Vittorio Calvisi
J. Clin. Med. 2022, 11(23), 6928; https://doi.org/10.3390/jcm11236928 - 24 Nov 2022
Cited by 4 | Viewed by 1547
Abstract
The emphasis on value-based payment models for primary total hip replacement (THA) results in a greater need for orthopaedic surgeons and hospitals to better understand actual costs and resource use. Time-Driven Activity-Based Costing (TDABC) is an innovative approach to measure expenses more accurately [...] Read more.
The emphasis on value-based payment models for primary total hip replacement (THA) results in a greater need for orthopaedic surgeons and hospitals to better understand actual costs and resource use. Time-Driven Activity-Based Costing (TDABC) is an innovative approach to measure expenses more accurately and address cost challenges. It estimates the quantity of time and the cost per unit of time of each resource (e.g., equipment and personnel) used across an episode of care. Our goal is to understand the true cost of a THA using the TDABC in an Italian public hospital and to comprehend how the adoption of this method might enhance the process of providing healthcare from an organizational and financial standpoint. During 2019, the main activities required for total hip replacement surgery, the operators involved, and the intraoperative consumables were identified. A process map was produced to identify the patient’s concrete path during hospitalization and the length of stay was also recorded. The total inpatient cost of THA, net of all indirect costs normally included in a DRG-based reimbursement, was about EUR 6000. The observation of a total of 90 patients identified 2 main expense items: the prosthetic device alone represents 50.4% of the total cost, followed by the hospitalization, which constitutes 41.5%. TDABC has proven to be a precise method for determining the cost of the healthcare delivery process for THA, considering facilities, equipment, and staff employed. The process map made it possible to identify waste and redundancies. Surgeons should be aware that the choice of prosthetic device and that a lack of pre-planning for discharge can exponentially alter the hospital expenditure for a patient undergoing primary THA. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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12 pages, 8775 KiB  
Article
Custom-Made 3D-Printed Implants for Anterior Column Reconstruction in the Upper Cervical Spine after Intralesional Extracapsular Excision—Report of 2 Cases and Literature Review
by Marco Girolami, Cristiana Griffoni, Emanuela Asunis, Luigi Falzetti, Stefano Bandiera, Giovanni Barbanti Brodano, Riccardo Ghermandi, Valerio Pipola, Silvia Terzi, Eleonora Pesce, Donato Monopoli Forleo, Marco Cianchetti, Maria Rosaria Fiore, Livio Presutti, Milena Fini and Alessandro Gasbarrini
J. Clin. Med. 2022, 11(20), 6058; https://doi.org/10.3390/jcm11206058 - 13 Oct 2022
Cited by 3 | Viewed by 1447
Abstract
The use of three-dimensional (3D)-printed custom-made implants is spreading in the orthopedics field for the reconstruction of bone losses or for joint replacement, thanks to their unparalleled versatility. In particular, this novel technology opens new perspectives to formulate custom-made fixation strategies for the [...] Read more.
The use of three-dimensional (3D)-printed custom-made implants is spreading in the orthopedics field for the reconstruction of bone losses or for joint replacement, thanks to their unparalleled versatility. In particular, this novel technology opens new perspectives to formulate custom-made fixation strategies for the upper cervical region, sacrum and pelvis, where reconstruction is challenging. We report and analyze the literature concerning upper cervical reconstruction with 3D-printed personalized implants after tumor surgery, and discuss two cases of patients where this technology was used to reconstruct the anterior column after extracapsular debulking of C2 recurrent chordoma at our institution. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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12 pages, 2443 KiB  
Article
Periacetabular Tumour Resection under Anterosuperior Iliac Spine Allows Better Alloprosthetic Reconstruction than Above: Bone Contact Matters
by Alessandro Bruschi, Luca Cevolani, Benedetta Spazzoli, Marco Focaccia, Stefano Pasini, Tommaso Frisoni and Davide Maria Donati
J. Clin. Med. 2022, 11(15), 4499; https://doi.org/10.3390/jcm11154499 - 02 Aug 2022
Cited by 1 | Viewed by 2372
Abstract
Background: Periacetabular resections are more affected by late complications than other pelvic resections. Reconstruction using bone allograft is considered a suitable solution. However, it is still not clear how the bone-allograft contact surface impacts on mechanical and functional outcome. Materials and methods: This [...] Read more.
Background: Periacetabular resections are more affected by late complications than other pelvic resections. Reconstruction using bone allograft is considered a suitable solution. However, it is still not clear how the bone-allograft contact surface impacts on mechanical and functional outcome. Materials and methods: This paper presents the results of a retrospective analysis of 33 patients with resection of the entire acetabulum and reconstruction with an allograft-prosthetic composite for the period 1999 to 2010. Patients were divided in two groups, based on type of resection. In Group 1. patients had resections under anterosuperior iliac spine allowing the highest bone-allograft surface contact in reconstruction, while in Group 2 patients had resections over it. Results: Mechanical survival of the implant and Musculoskeletal Tumor Society functional score were calculated. Impact of age and artificial ligament were investigated as well. Patients in Group 1 had 38% mechanical failure rate of the implant while patients in Group 2 had 88%. Average functional score was higher in Group 1 compared with patients in Group 2. An artificial ligament was shown to have non-significant impact on survival of the reconstruction in Group 1, while significantly improving survival of reconstruction in Group 2. Conclusion: Bone-allograft contact matters: resection under anterosuperior iliac spine allows better mechanical survival and offers better reconstruction functional scores. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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9 pages, 3308 KiB  
Article
Custom 3D-Printed Cutting Guides for Femoral Osteotomy in Rotational Malalignment Due to Diaphyseal Fractures: Surgical Technique and Case Series
by Jaime Oraa, Maider Beitia, Nicolás Fiz, Sergio González, Xabier Sánchez, Diego Delgado and Mikel Sánchez
J. Clin. Med. 2021, 10(15), 3366; https://doi.org/10.3390/jcm10153366 - 29 Jul 2021
Cited by 7 | Viewed by 2222
Abstract
Femoral shaft fractures are one of the most common injuries in trauma patients. The gold standard treatment consists of closed reduction and intramedullary nailing, providing a high fracture healing rate and allowing early mobilization. However, rotational malalignment is a well-known complication following this [...] Read more.
Femoral shaft fractures are one of the most common injuries in trauma patients. The gold standard treatment consists of closed reduction and intramedullary nailing, providing a high fracture healing rate and allowing early mobilization. However, rotational malalignment is a well-known complication following this procedure, and excessive femoral anteversion or femoral retroversion can trigger functional complaints. In order to achieve the ideal degree of femoral rotation, a 3D planning and printing cutting guides procedure was developed to correct femoral malrotation. A patient series with malalignment after a femoral diaphyseal fracture was operated on with the customized guides and evaluated in this study. Computed tomography scans were performed to accurately determine the number of degrees of malrotation, allowing the design of specific and personalized surgical guides to correct these accurately. Once designed, they were produced by 3D printing. After surgery with the customized guides to correct femoral malrotation, all patients presented a normalized anteversion angle of the femur (average −10.3°, range from −5° to −15°), according to their contralateral limb. These data suggest that the use of customized cutting guides for femoral osteotomy is a safe and reproducible surgical technique that offers precise results when correcting femoral malrotation. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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Review

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11 pages, 1422 KiB  
Review
Reconstructive Surgery and Joint-Sparing Surgery in Valgus and Varus Ankle Deformities: A Comprehensive Review
by Silvio Caravelli, Giulia Puccetti, Emanuele Vocale, Marco Di Ponte, Camilla Pungetti, Annalisa Baiardi, Alberto Grassi and Massimiliano Mosca
J. Clin. Med. 2022, 11(18), 5288; https://doi.org/10.3390/jcm11185288 - 08 Sep 2022
Viewed by 3478
Abstract
Osteoarthritis (OA) of the ankle affects about 1% of the world’s adult population, causing an important impact on patient lives and health systems. Most patients with ankle OA can show an asymmetrical wear pattern with a predominant degeneration of the medial or the [...] Read more.
Osteoarthritis (OA) of the ankle affects about 1% of the world’s adult population, causing an important impact on patient lives and health systems. Most patients with ankle OA can show an asymmetrical wear pattern with a predominant degeneration of the medial or the lateral portion of the joint. To avoid more invasive ankle joint sacrificing procedures, joint realignment surgery has been developed to restore the anatomy of the joints with asymmetric early OA and to improve the joint biomechanics and symptoms of the patients. This narrative, comprehensive, all-embracing review of the literature has the aim to describe the current concepts of joint preserving and reconstructive surgery in the treatment of the valgus and varus ankle early OA, through an original iconography and clear indications and technical notes. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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24 pages, 3388 KiB  
Review
Are Static Spacers Superior to Articulated Spacers in the Staged Treatment of Infected Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis
by Michele Fiore, Andrea Sambri, Matteo Filippini, Lorenzo Morante, Claudio Giannini, Azzurra Paolucci, Claudia Rondinella, Renato Zunarelli, Pierluigi Viale and Massimiliano De Paolis
J. Clin. Med. 2022, 11(16), 4854; https://doi.org/10.3390/jcm11164854 - 18 Aug 2022
Cited by 4 | Viewed by 1383
Abstract
In the treatment of knee periprosthetic joint infection with a two-stage protocol, static spacers allow for the local delivery of high doses of antibiotics and help to preserve soft tissue tension. Articulated spacers were introduced to better preserve flexion after the reimplantation. The [...] Read more.
In the treatment of knee periprosthetic joint infection with a two-stage protocol, static spacers allow for the local delivery of high doses of antibiotics and help to preserve soft tissue tension. Articulated spacers were introduced to better preserve flexion after the reimplantation. The aim of this systematic review is to provide a comprehensive data collection of the results of these different spacers. An in-depth search on the main clinical databases was performed concerning the studies reporting data on the topic. A total of 87 studies and 4250 spacers were included. No significant differences were found both in pooling data analysis and meta-analysis of comparative studies about infection recurrences, complications, and clinical scores. Mean active knee flexion at last follow-up after total knee reimplantation was found to be significantly higher using articulated spacers (91.6° ± 7° for static spacers vs. 100.3° ± 9.9° for articulated spacers; p < 0.001). Meta-analysis also recognized this strong significant difference (p < 0.001). This review has confirmed that articulated spacers do not appear to be inferior to static spacers regarding all clinical outcomes, while they are superior in terms of active flexion. However, the low quality of the studies and the risk for selection bias with complex patients preferentially treated with static spacers need to be accounted for. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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9 pages, 226 KiB  
Systematic Review
Bilateral Knee Arthroplasty in Patients Affected by Windswept Deformity: A Systematic Review
by Eugenio Cammisa, Iacopo Sassoli, Matteo La Verde, Stefano Fratini, Vito Gaetano Rinaldi, Giada Lullini, Vittorio Vaccari, Stefano Zaffagnini and Giulio Maria Marcheggiani Muccioli
J. Clin. Med. 2022, 11(21), 6580; https://doi.org/10.3390/jcm11216580 - 06 Nov 2022
Cited by 2 | Viewed by 1337
Abstract
Background: “Windswept” deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes [...] Read more.
Background: “Windswept” deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes of bilateral knee arthroplasty in patients with WSD and to discuss the surgical challenges that this condition might pose. Methods: A systematic review of the literature following the PRISMA guidelines was conducted. The relevant studies between 1979 and 2021 were identified. Four studies with a total of 68 patients were included for analysis. The mean follow-up for varus knees was 3.3 years, 3.1 years for valgus knees. The quality and rigor of the included studies was assessed using the Methodological index for non-randomized studies (MINORS). Results: All the studies reported improvement in knee function following knee replacement surgery, and a reduction in axial deviation of both knees, with similar results in valgus and varus knees in terms of patient satisfaction. The most relevant data were that unicompartmental knee arthroplasty (UKA) allowed for limited axial correction with slightly inferior functional results. Kinematic alignment (KA) allowed for similar results in both knees. Conclusion: The present review shows how satisfactory results can be achieved in both knees in patients with WSD and osteoarthrosis (OA). However, the operating surgeon should be aware of the importance of the implant choice in terms of functional outcomes. In the absence of extra-articular deformities, calipered KA total knee arthroplasty (TKA) can be performed on both knees with good axial correction and functional outcome. Level of evidence: II —Systematic review of cohort studies. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
10 pages, 774 KiB  
Systematic Review
Conservative vs. Surgical Management for Femoro-Acetabular Impingement: A Systematic Review of Clinical Evidence
by Giuseppe Anzillotti, Alberto Iacomella, Matteo Grancagnolo, Enrico Maria Bertolino, Maurilio Marcacci, Cristiano Sconza, Elizaveta Kon and Berardo Di Matteo
J. Clin. Med. 2022, 11(19), 5852; https://doi.org/10.3390/jcm11195852 - 02 Oct 2022
Cited by 7 | Viewed by 5058
Abstract
Femoro-acetabular impingement (FAI) syndrome is one of the most studied conditions in sports medicine. Surgical or conservative approaches can be proposed for treating FAI, although the best standard of care is not established yet. Our aim is to provide a comprehensive review of [...] Read more.
Femoro-acetabular impingement (FAI) syndrome is one of the most studied conditions in sports medicine. Surgical or conservative approaches can be proposed for treating FAI, although the best standard of care is not established yet. Our aim is to provide a comprehensive review of the best treatment for FAI syndrome evaluating differences in outcomes between surgical and non-operative management. A literature search was carried out on the PubMed, EMBASE, Scopus, and PEDro databases, using the following keywords: “femoroacetabular impingement”, “FAI”, in association with “surgery”, “arthroscopy”, “surgical” and “conservative”, “physiotherapy”, “physical therapy”, “rehabilitation”, “exercise”. Only Level I RCTs were included. Four articles were selected for this systematic review. Our analysis showed different therapeutic protocols, follow-up periods, and outcomes; however, three out of the four studies included favored surgery. Our study demonstrates beneficial effects for both arthroscopic treatment and a proper regimen of physical therapy, nevertheless a surgical approach seemed to offer superior short-term results when compared to conservative care only. Further trials with larger sample sizes and longer follow-ups are needed to assess the definitive approach to the FAI condition. Full article
(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)
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