Accuracy of radiographic projections to guide cephalic screw position in pertrochanteric fracture: a cadaveric study.

PURPOSE: The aim of this study was to evaluate the relationship between the Löwenstein Lateral view and the True Lateral view for the positioning of the cephalic hip screw, through a cadaveric study. MATERIALS AND METHODS: We placed two Kirschner wires in eight femur specimens using an Antero-Posterior view, Löwenstein Lateral view and True Lateral view. The distances between the Kirschner wires and the anterior, posterior, superior and inferior cortex were measured in all projections. The head of the femur was then sectioned, and the same macroscopic distances were measured. Finally, we could calculate the accuracy of the two radiographic lateral projections. RESULTS: When the Kirschner wire was placed in the center of the head using the Antero-Posterior and the True Lateral view, the accuracy of Antero-Posterior view was 0.9705 while the accuracy of True Lateral view and Löwenstein Lateral view was 1.1479 and 1.1584, respectively. When the Kirschner wire was placed superior on the Antero-Posterior and centrally on the True Lateral view, the accuracy of Antero-Posterior view was 0.9930 while the accuracy of True Lateral view and Löwenstein Lateral view was 1.1159 and 0.7224, respectively. CONCLUSION: When the Kirschner wire was positioned proximal in Antero-Posterior view and central in True Lateral view, only the True Lateral view showed high accuracy.

Functional Outcomes of Anterior-Based Muscle Sparing Approach Compared to Direct Lateral Approach for Total HIP Arthroplasty Following Acute Femoral Neck Fractures.

Introduction: Total hip arthroplasty (THA) performed for femoral neck fractures (FNFs) is becoming a more frequent treatment in the active elderly population. Since there is limited research available presenting clinical outcomes after THA using the anterior-based muscle sparing (ABMS) approach, the aim of this study was to compare this surgical approach to the direct lateral (DL) approach in patients treated by THA for FNFs. Materials and Methods: We retrospectively reviewed the data prospectively collected as a part of our "Hip Fracture Unit" and included 163 patients who underwent THA from January 2016 to January 2019 for acute displaced FNFs. Results: A total of 132 patients who completed a minimum 2-years follow up (69 in the ABMS group and 63 in DL group) were included. The ABMS group demonstrated significantly shorter time to reach milestone for hospital discharge (1.5 Days vs 2.1 days, P = .018), while no statistically significant differences were detected in peri-operative complications. At 3 months, the timed up and go test, the Harris Hip Score (HHS) and the Oxford ip Score (OHS) were significantly better (P = .024, .032 and .034, respectively) in the ABMS group compared to the DL group. No differences were found in functional outcomes (HHS and OHS) nor in complication rate at 6, 12 and 24 months. Discussion: This is one of the first studies to analyze functional results of THA performed for FNFs through an ABMS approach. Results are in line with those already present in the Literature. Conclusion: ABMS approach allows earlier mobilization and better early functional outcomes, compared to DL approach, in patients undergoing THA for acute displaced FNF. No differences are found after 6 months in functional results and complications rate.

The lesser trochanter "Sling fixation technique" in proximal intramedullary nailing of unstable intertrochanteric fractures: A polymer-based cerclage wiring.

Introduction: Lesser trochanter (LT) fixation to restore the continuity of the posteromedial fragment using a cerclage wire has been reported to provide a more stable reduction in the treatment of unstable femoral neck fractures with LT involvement. However, LT fixation is not commonly performed due to the complications associated with the traditional monofilament cerclage metal wires. In this study, we investigate the clinical and radiological outcomes of a new technique for LT fixation in conjunction with Intramedullary (IM) fixation with nail and screws when compared to isolated IM fixation. The Sling Fixation Technique involves a new wiring technique and the use of a polymer-based cerclage cable characterized by iso-elastic properties that is hypothesized to provide better clinical and radiographic outcomes. Patients and methods: This prospective observational study included 30 patients who underwent proximal IM nailing from July 2019 to April 2020. Thirty consecutive patients (30) were assigned to 2 different treatment groups. Fifteen (15) patients were treated with the IM Nailing and Sling Fixation Technique and 15 with IM nailing only. Patients were comparable for demographic features, fracture pattern, age, gender and associated medical comorbidities. Clinical outcomes were analyzed in terms of time needed to achieve complete weight bearing, Harris hip score (HHS), Barthel Index (BI) and Radiographic Union Scale for Hip (RUSH). The follow-up period was one year. Results: Time for fracture healing and to achieve weight-bearing in the "Sling" group were shown to be significantly shorter than in the IM group. The Sling group showed furthermore better HHS, BI and RUSH scores when compared to the IM group at 1, 3, 6, and 12 months from the surgery. No complications such as wiring breakage, cut-outs, breakage or pullout of the fixation screws were observed; one case of heterotrophic ossification was reported. Conclusion: In cases of unstable intertrochanteric fractures of the proximal femur with lesser trochanter involvement, the Sling fixation technique using an isoelastic polymer-based wire showed superior results in terms of stability and consequently better clinical and radiographic outcomes than IM nailing only.

New Inhibitors of the Human p300/CBP Acetyltransferase Are Selectively Active against the Arabidopsis HAC Proteins.

Histone acetyltransferases (HATs) are involved in the epigenetic positive control of gene expression in eukaryotes. CREB-binding proteins (CBP)/p300, a subfamily of highly conserved HATs, have been shown to function as acetylases on both histones and non-histone proteins. In the model plant Arabidopsis thaliana among the five CBP/p300 HATs, HAC1, HAC5 and HAC12 have been shown to be involved in the ethylene signaling pathway. In addition, HAC1 and HAC5 interact and cooperate with the Mediator complex, as in humans. Therefore, it is potentially difficult to discriminate the effect on plant development of the enzymatic activity with respect to their Mediator-related function. Taking advantage of the homology of the human HAC catalytic domain with that of the Arabidopsis, we set-up a phenotypic assay based on the hypocotyl length of Arabidopsis dark-grown seedlings to evaluate the effects of a compound previously described as human p300/CBP inhibitor, and to screen previously described cinnamoyl derivatives as well as newly synthesized analogues. We selected the most effective compounds, and we demonstrated their efficacy at phenotypic and molecular level. The in vitro inhibition of the enzymatic activity proved the specificity of the inhibitor on the catalytic domain of HAC1, thus substantiating this strategy as a useful tool in plant epigenetic studies.

Robotic-Assisted Unicompartmental Knee Arthroplasty Reduces Components' Positioning Differences among High- and Low-Volume Surgeons.

Robotic-assisted medial unicompartmental knee arthroplasty (mUKA) has been introduced to improve accuracy in implant positioning and limb alignment, overcoming the reported high failure rates of conventional UKA. Indeed, mUKA is a technically challenging procedure strongly related to surgeons' skills and expertise. The purpose of this study was to evaluate the likelihood of robotic-assisted surgery in reducing the variability of coronal and sagittal component positioning between high- and low-volume surgeons. We evaluated a prospective cohort of 161 robotic mUKA implanted between May 2018 and December 2019 at two high-volume robotic centers. Patients were divided into two groups: patients operated by "high-volume" (group A) or "low-volume" (group B) surgeons. We recorded intraoperative lower-limb alignment, component positioning, and surgical timing. Postoperatively, every patient underwent a radiographical protocol to assess coronal and sagittal femoral/tibial component alignment. Range of motion and other clinical outcomes were assessed pre- and 12 months postoperatively by using oxford knee score, forgotten joint score, and visual analog scale. Of 161 recruited knees, 149 (A: 101; B: 48) were available for radiographic analysis at 1 month, and clinical evaluation at 12 months. No clinical difference neither difference in mechanical alignment nor coronal/sagittal component positioning were found (p > 0.05). A significant difference was recorded in surgical timing (A: 57 minutes; B: 86 minutes; p < 0.05). No superficial or deep infections or other major complications have been developed during the follow-up. Robotics surgery in mUKA confirmed its value in improving the reproducibility of such technical procedure, with satisfactory clinical outcomes. Moreover, it almost eliminates any possible differences in component positioning, and lower limb alignment among low-and high- volume knee surgeons.

Trabecular titanium cups in acetabular revision arthroplasty: analysis of 10-year survivorship, restoration of center of rotation and osteointegration.

AIMS: In case of severe bone loss, acetabular revision can be challenged using extra porous pure trabecular titanium (TT) revision cups designed to ensure enhanced iliac and ischiatic purchase. Aim of the study is to report on the clinical and radiological results of a TT acetabular component, evaluating functional outcome, restoration of the hip center of rotation and osteointegration. METHODS: 85 patients, who underwent acetabular revision with a TT revision cup system between October 2009 and December 2018, were included in a retrospective study. Clinical outcome were assessed with Harris Hip Score (HHS). The hip rotation center was measured using the Pierchon method on the AP pelvis film. Loosening of the cup was determined according to the Kosashvili modification of Gill's criteria. Kaplan- Meier survivorship curve was performed. Results The mean follow-up was 6.12 years. The average HHS improved from 54.7 points to 89.7 points (p < 0.05). Two acetabular components (2.3%) were re-revised after a mean of 5.6 years, for aseptic loosening and for infection, with a progressive radiolucency and a > 5 mm vertical migration, respectively. The radiographic evaluation of the position of the hip rotation center revealed a statistically significant difference (p < 0.05) between the pre- and post-operative values. The hip rotation center was correctly restored within 5% of the reference Pierchon values in a percentage of 85.4% relative to horizontal parameters and within 8% in a percentage of 66.7% relative to vertical parameters. 5-year and 10-year survivorships were, respectively, 100% and 88%. CONCLUSIONS: In case of severe bone loss, TT revision cup system allows for good restoration of center of rotation and osteointegration showing good 10-year survival rate.

Proximal femoral replacement: A salvage treatment of cephalomedullary nails' mechanical failures in the elderly population.

BACKGROUND: The use of proximal femoral replacements (PFR) has been recently described for catastrophic internal fixation failures. PFR is an attractive treatment option because it is technically straightforward and allows for immediate mobilization of the patient. The aim of the study was to determine the survivorship, functional outcome and complications' rate in a group of elderly patients who underwent proximal femoral replacement as a salvage treatment after femur cephalomedullary nails' mechanical failures. METHODS: We evaluated 21 patients who underwent salvage of a failed cephalomedullary nail by using a single design PFR at our institution between 2014-2017. A cemented stem was used in all cases. Radiographs were assessed for fractures, sign of loosening, presence of heterotopic ossification and leg length discrepancy. Functional evaluation was performed through Harris Hip Score (HHS), FIM™ and Time Up and Go test (TUG). Kaplan-Meier estimator was used to determine the overall implants' survival. RESULTS: The average age at the time of surgery was 83years. The mean follow-up was 3.1years. We recorded 3 dislocations of which 2 required a revision. No case of septic or aseptic failure was reported. Two patients died respectively at 11 and 14 months after surgery. At the last follow-up the mean HHS, FIM™, and the TUG improved significantly (p<0.05). CONCLUSION: Immediate weight bearing, good functional outcomes, low complications' and one-year mortality rate make the proximal femur replacement with megaprostheses a potential first line treatment of intertrochanteric/subtrochanteric fixations' failures among elderly, osteoporotic, frail patients. Dislocation is the most common complication to bear in mind within the first six months after surgery.

"Anterolateral" approach to the hip: a systematic review of the correct definition of terms.

PURPOSE: The Watson-Jones interval plane between tensor fascia lata (TFL) and the gluteus medius (GM) has come back into fashion in the past few years - Röttinger described the anterolateral minimal invasive approach (ALMI) for use in total hip replacement, in which the standard Watson-Jones interval was used, but with a completely intermuscular plane. However, the term anterolateral is often still utilised to describe intramuscular approaches in which the GM was violated, thus creating a potential misunderstanding in the literature. Accordingly, we have designed a study to answer the following questions: (1) are there articles in the recent literature that use the term "anterolateral" to describe different approaches; (2) which would be the correct description of the anterolateral approach? METHODS: We did a systematic review of the literature based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to look for peer reviewed papers of any evidence level focusing on the definition of anterolateral approach; MEDLINE and EMBASE were searched. RESULTS: 73 manuscripts met the criteria of the systematic search. 53 papers (72.6%) reported the term anterolateral approach to describe a complete intermuscular approach between the interval between GM and TFL. Nonetheless, in the remaining 20 papers (27.4%) the term anterolateral was used to describe intramuscular approaches in which the gluteus medius was violated. CONCLUSION: In about 1 out of 4 papers in the recent literature, the term anterolateral was utilised to describe approaches that are completely different both in terms of anatomy and function.

Precision and accuracy of robot-assisted technology with simplified express femoral workflow in measuring leg length and offset in total hip arthroplasty.

BACKGROUND: Semi-active robot-assisted total hip arthroplasty (THA) has two options to measure the leg length discrepancy (LLD) and combined offset (CO), the 'enhanced' femoral workflow and the so-called 'express' simplified workflow. The purpose of this study was to determine the precision and accuracy of intraoperative LLD and CO measurement with express workflow robotic THA. METHODS: Between February 2018 and December 2019, 30 patients underwent an express workflow robot-assisted primary THA for intraoperative LLD and CO measurements. Postoperative radiographs were used for LLD and CO measurement. In order to examine the accuracy of the robotic system assessment, the absolute difference between the robotic assessments and radiographic evaluations was calculated. RESULTS: Intraoperative robotic measurements reported a mean error of 0.2-0.6 mm for each registration, with no significant difference between them (p = 0.311). The average absolute discrepancies between the robotic and radiographic assessments in the LLD and CO measurements were 1.3 ± 1.5 mm (p = 0.17) and 1.1 ± 0.9 mm (p = 0.11), respectively, while the Pearson's correlation coefficients were 0.69 and 0.71. CONCLUSIONS: An external marker without a femoral array inserted into a screw positioned in the greater trochanter would be an easier and faster method to measure LLD and CO. Our study showed that the measured values of LLD and CO obtained by intraoperative express workflow robot-assisted THA system were precise and accurate.

Patients Following Revision Total Hip Arthroplasty With Modular Dual Mobility Components and Cobalt-Chromium Inner Metal Head are at Risk of Increased Serum Metal Ion Levels.

BACKGROUND: Modular dual-mobility (MDM) total hip arthroplasty (THA) is designed with a cobalt-chromium liner inserted into a titanium acetabular component. The purpose of this study is to investigate the potential risks for fretting corrosion at this junction, by measuring serum metal ions, after MDM acetabular revision. METHODS: Thirty-seven patients with well-functioning revision THAs participated in a cross-sectional study at mean 5.1 (2-10) years after surgery. All received a trabecular titanium MDM acetabular component. The serum levels of cobalt and chromium were measured using mass spectrometry. RESULTS: The mean values of chromium and cobalt were 2.08 µg/L (95% confidence interval 0.9-3.2, range 0.02-11.8) and 1.99 µg/L (95% confidence interval 0.81-3.17, range 0.07-16.05), respectively. Eleven patients (29, 7%) had ion levels above the normal range, with 6 (16.2%) above 5 µg/L and 5 (13.5%) between 1 and 5 µg/L. A significant correlation was found between an elevated serum metal ion level and University of California Los Angeles score (P = .016). CONCLUSION: We conclude that serum metal level elevation may occur secondary to metal debris resulting from corrosion of the index MDM THA. This potential risk should be included in the decision-making process when dealing with revision arthroplasty in young and active patients.

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence.

BACKGROUND: The healing of long bones diaphyseal fractures can be often impaired and eventually end into delayed union and non-union. A number of therapeutic strategies have been proposed in combination with surgical treatment in order to enhance the healing process, such as scaffolds, growth factors, cell therapies and systemic pharmacological treatments. Our aim was to investigate the current evidence of bone healing enhancement of acute long bone diaphyseal fractures. METHODS: A systematic review was conducted by using Pubmed/MEDLINE; Embase and Ovid databases. The combination of the search terms "long-bones; diaphyseal fracture; bone healing; growth factors; cell therapies; scaffolds; graft; bone substitutes; orthobiologics; teriparatide". RESULTS: The initial search resulted in 4156 articles of which 37 papers fulfilled the inclusion criteria and were the subject of this review. The studies included 1350 patients (837 males and 513 females) with a mean age of 65.3 years old. CONCLUSIONS: General lack of high-quality studies exists on the use of adjuvant strategies for bone healing enhancement in acute shaft fractures. Strong evidence supports the use of bone grafts, while only moderate evidence demineralized bone matrix and synthetic ceramics. Conflicting results partially supported the use of growth factors and cell therapies in acute fractures. Teriparatide showed promising results, particularly for atypical femoral fractures and periprosthetic femoral fractures.

The DOF Transcription Factors in Seed and Seedling Development.

The DOF (DNA binding with one finger) family of plant-specific transcription factors (TF) was first identified in maize in 1995. Since then, DOF proteins have been shown to be present in the whole plant kingdom, including the unicellular alga Chlamydomonas reinhardtii. The DOF TF family is characterised by a highly conserved DNA binding domain (DOF domain), consisting of a CX2C-X21-CX2C motif, which is able to form a zinc finger structure. Early in the study of DOF proteins, their relevance for seed biology became clear. Indeed, the PROLAMIN BINDING FACTOR (PBF), one of the first DOF proteins characterised, controls the endosperm-specific expression of the zein genes in maize. Subsequently, several DOF proteins from both monocots and dicots have been shown to be primarily involved in seed development, dormancy and germination, as well as in seedling development and other light-mediated processes. In the last two decades, the molecular network underlying these processes have been outlined, and the main molecular players and their interactions have been identified. In this review, we will focus on the DOF TFs involved in these molecular networks, and on their interaction with other proteins.

From the Outside to the Inside: New Insights on the Main Factors That Guide Seed Dormancy and Germination.

The transition from a dormant to a germinating seed represents a crucial developmental switch in the life cycle of a plant. Subsequent transition from a germinating seed to an autotrophic organism also requires a robust and multi-layered control. Seed germination and seedling growth are multistep processes, involving both internal and external signals, which lead to a fine-tuning control network. In recent years, numerous studies have contributed to elucidate the molecular mechanisms underlying these processes: from light signaling and light-hormone crosstalk to the effects of abiotic stresses, from epigenetic regulation to translational control. However, there are still many open questions and molecular elements to be identified. This review will focus on the different aspects of the molecular control of seed dormancy and germination, pointing out new molecular elements and how these integrate in the signaling pathways already known.

Accelerometer-Based Navigation in Total Knee Arthroplasty for the Management of Extra-Articular Deformity and Retained Femoral Hardware: Analysis of Component Alignment.

Purpose Recent advances in total knee arthroplasty (TKA) include an accelerometer portable system designed to improve component position and alignment. The purpose of this study is to evaluate whether accelerometer navigation system can be a valuable option in complex TKAs for extra-articular deformity of the lower limb or in case of retained femoral hardware. Methods A group of 13 patients underwent TKA with an accelerometer navigation system. Three patients had a tibial extra-articular deformity, six had a femoral extra-articular deformity, and four had an intramedullary nail in the femur. Preoperative and postoperative mechanical axes were measured from full-length lower extremity radiographs to evaluate alignment. The alignment of prosthetic components in the frontal and sagittal planes was determined by postoperative radiographs. Results At 30-days postoperative radiographic check, the hip knee ankle angle was within 2.0° (0 ± 1) of the neutral mechanical axis. The alignment of the tibial component on the frontal plane was 90.0° (range 89-91) and on the sagittal plane 5.0° (range 3-7). The alignment of the femoral component on the frontal plane was 90.0° (range 89-91) and on the sagittal plane 3.0° (range 0-5). Conclusion The alignment of the prosthetic components has been accurate and comparable to other navigation systems in literature without any increase in surgical times. The accelerometer-based navigation system is therefore a useful technique that can be used to optimize TKA alignment in patients with extra-articular deformity or with lower limb hardware, where the intramedullary guides cannot be applied. Level of Evidence This is an observational study without a control group, Level III.

Total Knee Arthroplasty in Patients With Extra-Articular Deformity: Restoration of Mechanical Alignment Using Accelerometer-Based Navigation System.

BACKGROUND: Total knee arthroplasty (TKA) in patients with post-traumatic extra-articular deformity (EAD) is difficult to manage using conventional instrumentation techniques. In this study, we evaluate whether accelerometer navigation system can be a valuable option to make accurate bone resections and restore the neutral mechanical axis in complex TKA patients with EAD. METHODS: From May 2015 to June 2017, 18 consecutive TKA were performed in 18 patients with knee osteoarthritis with associated EAD. An accelerometer-based navigation system was used to guide tibial and femoral resection in the coronal and sagittal plane. Postoperative lower limb alignment in coronal plane and component position in coronal and sagittal plane was measured through full-leg weight-bearing X-ray. Clinical score were recorded using the Knee Society Score at the final follow-up. RESULTS: The mean hip-knee-ankle angle was 0.9° ± 1.4° varus alignment. The coronal alignment of the femoral component was 89.2° ± 1.9°, and the coronal alignment of the tibial component was 89.4° ± 2.1°. The sagittal alignment of the femoral component was 93.2°± 1.9°, and the sagittal alignment of the tibial component was 84.4° ± 3.1°. At the final follow-up, the Knee Society Score was 89 points (range, 82-100), and the functional score was 86.7 points (range, 60-100). No intraoperative and postoperative surgical complications were reported using this technology. CONCLUSION: Accelerometer-based navigation is accurate in achieving neutral mechanical alignment and optimal implant position after TKA in patients with EAD. This system should be considered a valuable option to the more complex technique of computer navigation or robotic surgery.

The anterior-based muscle-sparing approach to the hip: the "other" anterior approach to the hip.

PURPOSE: The purpose of this study was to evaluate safety, efficacy, and learning curves of anterior-based muscle-sparing total hip arthroplasty (ABMS-THA) in the supine position. Furthermore, early functional outcome was evaluated and compared to direct anterior approach (DAA) by measuring surface electromyography (sEMG). METHODS: We present a prospective cohort study of 343 hips. The safety and learning curve were assessed by recording operative time and peri-operative adverse events. For assessment of efficacy, functional and radiological outcomes were evaluated. A selected group of 32 patients have been studied by sEMG and compared to a matched group of 32 patients who received a THA using DAA approach. RESULTS: There was one dislocation (0.3%); two (0.6%) patients had an intra-operative fractures of the greater trochanter; two patients (0.6%) experienced a self-limited femoral nerve palsy. Physical therapy milestones for hospital discharge were reached on an average of 1.7 days. sEMG showed that ABMS and DAA have a similar muscle recruitment pattern and functional recovery after THA. One patient was revised for infection, 16 were lost, and 326 hips were available with a median follow-up of 42 months (range 24-60). The mean Harris Hip Score (HSS) increased from 44.3 to 91.9. Ninety-six percent of the hips had a leg length discrepancy (LLD) < 5 mm. There were no radiological signs of mechanical loosening or osteolysis. CONCLUSIONS: The ABMS approach in the supine position is clinically effective and safe; special advantages include a very low dislocation rate and a great control of LLD.

Clinical Results of Oxidized Zirconium Femoral Component in TKA. A Review of Long-Term Survival: Review Article.

BACKGROUND: Oxidized zirconium (OxZr) femoral component for total knee arthroplasty (TKA) have been introduced in an attempt to reduce polyethylene wear and secondary osteolysis and improve longevity of implants. QUESTIONS/PURPOSES: We reviewed clinical studies in literature evaluating OxZr femoral component for TKA. The aim of this review was to evaluate the clinical outcome and survival rate of TKA with an OxZr femoral component. METHODS: A review of the existing literature was undertaken to collect data on the OxZr femoral component in order to provide a better understanding of its performance. Of 34 studies published in the literature, 8 met the eligibility criteria and were included in the final analysis. RESULTS: Findings indicated that the mean Knee Society knee score improved in all series from preoperative to postoperative evaluation. The postoperative Knee Society knee score reported range from 84 to 95 and mean postoperative Knee Society functional score range from 74 to 90. The revision rate with this implant is low with up to 12.6 years of follow-up, with three revisions in total. The survival rate ranged from 100-98.7% at 5-7 years to 97.8% at 10 years. CONCLUSIONS: Excellent clinical outcome and high survival rate has been demonstrated for OxZr femoral component in TKA. No adverse reaction has been described for this new material.

The Survival of Total Knee Arthroplasty: Current Data from Registries on Tribology: Review Article.

BACKGROUND: Polyethylene (PE) wear is a major contributor to implant loosening following total knee arthroplasty (TKA), and advanced bearings in TKA are being investigated with hopes of reducing or eliminate wear-related loosening. Currently, information on knee tribology is available from national joint registries and may be the best tools to evaluate the efficacy and safety of design innovations in joint arthroplasty. QUESTIONS/PURPOSES: We performed a review of national joint registries trying to answer the following questions: "Which is the main factor directly related to revisions rate in TKA?" and "Are there new bearing options better than conventional ones?" METHODS: A review was performed of all published annual reports of National Joint Registers, as well as of the literature. The search was carried out using and comparing the National Joint Registers. RESULTS: Current data from registries for total knee arthroplasty indicates that age is the major factor affecting the outcome of primary total knee replacement. The 10-year cumulative revision rate for non-cross-linked PE was 5.8% and for XLPE it was 3.5%. The effect of cross-linked polyethylene was more evident in the younger patients. The survival of the oxidized zirconium (OxZr) femoral component appears better when compared to a similar age group of patients with conventional group of prostheses. Our review suggests that the revision rates are half for the OxZr components compared to conventional CoCr femoral components. CONCLUSIONS: Age is the most relevant single factor related to revision rate. Cross-linked PE has a statistical lower revision rate at 10 years compared to conventional PE and, in the OxZr group, the revision rate is 2 times lower than Co-Cr in the same group of age.

Densitometric evaluation of bone-prosthetic counterface in hip and knee arthroplasty with modern implants.

INTRODUCTION: Recent acquisitions of the complex mechanisms of osseointegration between implants and host bone have gained attention, accordingly to the methods of evaluation of these interactions. DEXA analysis is considered an useful tool to assess such phenomena, in order to analyse in a quantitative manner the local metabolic activity of the bone, and to evaluate over the time the integration between host bone and prosthetic components. The purpose of the present study is to report about a preliminary experience in the analysis of osseointegration processes of patients undergoing a primary Total Hip Arthroplasty (THA) or a revision Total Knee Arthroplasty (rTKA). MATERIALS AND METHODS: Thirty patients undergoing THA and nineteen undergoing rTKA were included in this study. In fifteen cases of THA a standard cementless stem was used; in the other fifteen a short cementless stem was chosen. In all cases a cementless cup was implanted. In all patients undergoing rTKA, all implants had pressfit femoral and tibial diaphyseal stems; only the femoral component and the tibial plateau were cemented. DEXA evaluation was performed preoperatively, and at 3, 6, 12, and 24 months postoperatively for rTKA, and at 6 and 12 months for THA. RESULTS: DEXA in THA showed a significant decrease at the femoral ROIs 1 and 7, and an increase in ROI 4. In rTKA a reduction of femoral BMD in R1, R7, and R4 was found, with maximum values of -13.6% in R1 and -11.89% in R7 at 24 months and a value of -2.55% in R4 at 12 months. On the tibial side, an increase in BMD R4 (with values of 2.18% still at 24 months), and a reduction in R7 (progressively lesser over the time) and in R1 (progressively higher) were found. CONCLUSIONS: After a joint replacement a full adhesion of the prosthetic surface to the host bone should be achieved through a local biological process named osseointegration. In some cases this process may not fully realize, so the secondary stability of the implant may fail. DXA is a valuable tool to follow over time the bone remodelling at the bone-prosthesis counterface in THA and in rTKA, in order to early detect any alterations of such phenomenon.

Angiomatous reaction Kaposi-sarcoma-like as a side effect of topical corticosteroid therapy in lichen sclerosus of the penis.

Lichen sclerosus (LS) is a chronic inflammatory skin condition usually located in the anogenital area. Topical corticosteroid therapy is the first choice treatment which may arrest or delay the progression of the disorder. We report the case of a 74-year-old man presented with a 6-month history of nodular lesions localized on penis. The man had a previous history of genital lesions that had been diagnosed as LS and treated with long-term topical corticosteroid therapy. After 3 months of corticosteroid therapy, the patient observed the appearance of several nodular erythematous lesions on the penis with progressive disappearance of the clinical symptoms of LS. These purple to red asymptomatic angiomatoid nodules resembled the clinical features of Kaposi sarcoma.