Computer-Assisted Navigation in Reverse Shoulder Arthroplasty: Surgical Experience and Clinical Outcomes.

Background: The primary cause of medium- to long-term complications in reverse shoulder arthroplasty (RSA) is the failure of the glenoid component. The purpose of this study was to evaluate both the achievement of planning through computer-assisted navigation and the clinical outcomes at a minimum follow-up (FU) of 12 months. Methods: From December 2019 to December 2022, 57 Equinoxe RSAs with computer-assisted navigation were performed. The average age was 72.8 ± 6.6 years. Using the Orthoblue software, the version and inclination of the glenoid were evaluated from a preoperative CT scan, and planning was performed. Intraoperative navigation data were evaluated, and the clinical outcomes were assessed at a minimum follow-up of 12 months. Results: The average follow-up was 30.7 ± 13.5 months. The planning was reproduced in all implants. No errors in the computer-assisted navigation system were detected. No intraoperative or postoperative complications were recorded. At the final FU, the average active anterior elevation was 143° ± 36°, external rotation was 34° ± 5°, QuickDASH score was 19 ± 16 points, and constant score was 77 ± 18. Conclusions: Computer-assisted navigation is a reliable system for positioning prosthetic implants on challenging glenoids. A longer follow-up period is necessary to confirm the reduction in postoperative complications and the increase in survival compared to traditional RSA.

Reverse Shoulder Megaprosthesis for Massive Proximal Humeral Bone Loss in Fracture Outcome Settings: A Report of Two Cases and Literature Review.

In trauma settings, including the management of outcomes, there is no consensus on the most appropriate reconstructive method in the presence of severe bone loss of the proximal humerus. The objective of this report is to evaluate the short-term functional outcomes of two patients in whom reverse shoulder megaprosthesis was used to treat the failure of trauma surgery with severe bone loss. The secondary objective was to compare the results obtained with the literature regarding the use of megaprosthesis in shoulder trauma surgery. The patients showed a satisfying functional recovery and increased quality of life. At the 12-month follow-up, no complications occurred. Regarding the risk of complications, especially the risks of mobilization of the megaprosthesis, the CT-based intraoperative navigation system optimizes the configuration of the screw for the initial fixation of the glenoid component. Shoulder megaprosthesis appears to be a viable option not only in oncologic surgery but also in cases of failed trauma surgery. The functional results, considering functional score and range of motion, are encouraging and allow patients to improve their quality of life.

The Anterior Lateral Decubitus Intermuscolar and the Postero-Lateral approaches in total hip arthroplasty: a comparative study.

BACKGROUND AND AIM: Recently a modification of the DAA in lateral decubitus, called ALDI, has been proposed to obtain a better surgical exposure and to facilitate surgeons accustomed to the other hip approach. In this paper we report our early experience with the ALDI approach for total hip arthroplasty (THA) and to compare outcomes between ALDI and posterolateral approach (PLA) in a retrospective investigation. METHODS: We have identified THA performed from September 2017 to January 2020. We collected patients demographic, clinical and radiographic data by our electronic hospital database. The ALDI group included 60 hips and the PLA group included 219 hips. These patients underwent to strict follow-up in the first 3 post-operative months. RESULTS: Compared to the PLA, the ALDI approach showed clinical outcomes significantly higher in the first month of follow-up. The PLA group has a lower operative time and a greater mean hospital length of stay. No blood transfusions were administered in the ALDI group while the 1.4% of patients in the PLA group needed blood transfusion. Cup anteversion and inclination angles were significantly wider in the PLA group. THA dislocation occurred in seven patients of the PLA group. No femoral cutaneus nerve palsy was recorded in the ALDI group. CONCLUSIONS: The ALDI approach can represent a quickly and safe solution for surgeons who are accustomed to the PLA who want to perform THA in DAA. Our preliminary experience is encouraging in terms of clinical and radiographic parameters although the operative time needs to be improved.

Arthroscopic treatment of iliopsoas impingement syndrome after hip arthroplasty.

BACKGROUND AND AIM OF THE WORK: Groin pain after hip arthroplasty (HA) ranges from 0.4% to 18.3%. Defining the cause of groin pain after HA can be difficult. Iliopsoas impingement (IPI) has been reported to be the underlying cause of groin pain in up to 4.4% of cases. The purpose of this study is to present arthroscopic surgical outcomes in the treatment of IPI after HA. METHODS: Between September 2013 and March 2018, 13 patients, 11 total hip arthroplasty (THA), 1 hip endoprosthesis and 1 total hip resurfacing affected by groin pain due to unceasing iliopsoas tendinopathy for impingement after HA were treated arthroscopically. The patients underwent to physical examination, blood analysis, hip X-rays, bone scintigraphy and CT assessment. We performed the arthroscopic OUT-IN access to hip joint in all patients. VAS scale, Harris Hip Score (HHS) and Medical Research Council (MRC) scale were performed before surgery and during follow up at 1-3-6-12 months. RESULTS: After 10 months of mean follow-up, average HHS and MRC scale improved significantly from preoperatively to postoperatively. No complications arose in our case series. CONCLUSIONS: Hip arthroscopy after hip arthroplasty is supported in the literature for a variety of indications. Hip arthroscopy is a viable and reproducible technique in treatment of IPI, being less invasive than the classic open technique. This simple arthroscopic release provides satisfactory results and preserves HA function. Moreover an arthroscopic OUT-IN access proves good clinical outcomes, few complications and iatrogenic lesions.

Can UKA after KineSpring system failure be a viable option? A case report.

BACKGROUND AND AIM OF THE WORK: The KineSpring System is an alternative treatment offered in selected symptomatic patients suffering from mild to moderate medial knee osteoarthritis (OA). This device reduces medial compartment loads in the OA knee without compromising the integrity of the lateral or patellofemoral knee compartments, maintaining the normal knee anatomy. Currently, papers about KineSpring System installation show promising results. The current authors describe a case of unicompartmental knee arthroplasty (UKA) employed to treat medial knee OA after Kinespring system failure. METHODS: A 64-year old male patient presented to our hospital after failure of a Kinespring system implantation into his left knee at an external hospital, where the outcomes obtained were not satisfactory. The surgical options discussed with the patient were the TKA or medial UKA. A medial UKA was preferred by the patient. RESULTS: One year from UKA, the patient complained of frequent joint effusions and weight bearing pain despite a good ROM without radiographic signs of implant loosening. Therefore, after two years we replaced UKA with total knee arthroplasty (TKA). CONCLUSIONS: Further experience is needed to provide reliable clinical data about the results of the UKA after KineSpring System discharge.

The SMR reverse shoulder arthroplasty in rotator cuff arthropathy management.

BACKGROUND AND AIM OF THE WORK: Cuff tear arthropathy (CTA) is a well-defined  degenerative pathology  of the shoulder. When conservative treatments are unable to permit a good quality of life, the reverse shoulder arthroplasty (RSA) can guarantee a good restitution of range of motion, function and strength of the shoulder without pain. In this paper we show our clinical, functional and radiological outcomes, as well as complications of RSA in patients with CTA. METHODS: We analyzed 31 patients who underwent to reverse shoulder replacement with Modular Shoulder System (SMR, Systema Multiplana Randelli; Lima-LTO, San Daniele del Friuli, Italy) reverse shoulder system, between August 2010-July 2014. RESULTS: A significant improvement in ROM and functional scores (Constant Shoulder Score and UCLA score) were observed in our cases series. At the time of follow-up  pain relief was detected in 28 patients and 3 patients declared mild pain. Overall, 90.3% of patients rated their satisfaction as good or excellent. Although  complications occur in a high percentage of patients in literature, no postoperative complications was observed in our cases series. CONCLUSIONS: Our results showed how reverse shoulder arthroplasty is a real solution to improve quality of life, to restore pain-free ROM, function and strength of the shoulder in patients where cuff tear arthropathy occurs.

Bone scan in painful knee arthroplasty: obsolete or actual examination?

ptic loosening, instability and infection are the major causes of TKA failure. For many years, nuclear medicine (NM) imaging was helpful to frame a painful total joint arthroplasty. The differentiation of septic from aseptic prosthetic loosening is critical. The latest AAOS guidelines to detect periprosthetic joint infection (PJI) restrict the role of NM scintigraphy. On the other hand, several studies suggest that NM imaging plays an important role in the evaluation of patients with painful prosthesis, but its specificity in differentiating aseptic loosening from infection is low. Moreover, scintigraphic exams showed different diagnostic accuracy in TKA compared to total hip arthroplasty (THA). PURPOSE: To assess and discuss current knowledges about the diagnostic value of the various scans in TKA failure alone. METHODS: We perform a pubmed/medline search to identify all papers published in the literature matching the following key words: "total knee arthroplasty", "bone", "scintigraphy", "imaging", "three-phase", "triple-phase", "99mTc-HDP", "99mTc-MDP", "99mTc-hydroxymethane diphosphonate", and "99m Tc-methylenediphosphonate", "leukocyte scanning", "labeled leukocyte scintigraphy", "antigranulocyte", "nuclear medicine", "septic loosening", "aseptic loosening" and "infection". RESULTS: Three phases bone scintigraphy results an early diagnostic screening test or part of the preoperative tests for painful TKA and when PJI is suspected. Instead, leukocyte/bone marrow scintigraphy is superior to other scintigraphic tools in diagnosis of TKA infections. Granulocyte scintigraphy, seems to be an excellent choice when the diagnosis is unclear. Moreover, nuclear diagnostic tests showed different diagnostic accuracy between TKA and THA. CONCLUSIONS: Although nuclear diagnostic tests for THA failure are superior in  diagnostic accuracy compared to TKA, NM scintigraphy is still an effective tool in the identification of chronic, low grade PJI. To date, scintigraphic exams have an higher levels of sensitivity, specificity and accuracy. Currently, leukocyte/bone marrow scintigraphy is considered the gold standard for this aim.  Nevertheless, further studies are needed to assess and improve the accuracy of the scintigraphic exams in order to discriminate the causes of failure for painful TKA.

Histopathological aspects and staging systems in non-traumatic femoral head osteonecrosis: an overview of the literature.

BACKGROUND: The pathogenesis of non traumatic osteonecrosis of the femoral head (ONFH) has not yet been established. The literature shows a variable nomenclatura for this condition that often leads to confusion. Several risk factors have been identified but histopathological and radiological outcomes are common. PURPOSE: To provide the overview on the current knowledges about the nomenclatura, etiology, disease progression, relationship between histopathological changes and imaging techniques in order to stage the disease accurately. Etiology and pathogenesis: Genetic predisposition, metabolic factors, local factors affecting blood supply such as vascular damage, increased intraosseous pressure and mechanical stress are involved in this desease. The final results are bone ischemia and infarction getting bone deathand FH collapse. Histopathological aspects and staging systems: Several staging systems have been developed to stage ONFH based on imaging techniques.The  subchondral collapse, the size or quantification of the lesion, and the lesion location within the femoral head are identified as the most important prognostic factors in ONFH disease. Histological analysis plays a critical role to evaluate the quality of necrotic area and the differences between microscopic, macroscopic and imaging outcomes were detected. CONCLUSIONS: an ideal staging system is necessary to stage ONFH desease to detect several aspects, but itìs more difficult to create. At the present time we summarize some aspects that are advisable to focus during ONFH for the correct treatment.

Histopathological scores for tissue-engineered, repaired and degenerated tendon: a systematic review of the literature.

PURPOSE: This systematic review analyzes histological scoring systems for degenerative tendon-enthesis changes, ex vivo tendon-enthesis repair and tissue-engineered tendon-enthesis repair. A secondary aim is to establish the validity and applicability of these scores to find a comprehensive and validated histological scoring system for the evaluation of tendon-enthesis tissue. METHODS: We performed a systematic review of the literature by analyzing the following databases: PubMed, Embase, Medline, CINAHL, and Cochrane. The methodology of the study was developed according to the PRISMA guidelines. RESULTS: Twenty-seven articles, describing a total of 9 scores for tendinopathy, 6 scores for tendon ruptures, and 12 scores for tendon regeneration were included. For enthesis changes, 4 studies describe a total of 3 scores for enthesopathy and 1 scores for enthesis regeneration. The Movin score and its modifications seem be the more comprehensive to assess the degenerative changes; the Soslowsky score, the Watkins score, the Novel scoring system and the Burssens score seem be the more comprehensive to assess tendon repair process. Only the Matthys score assesses the histological changes in enthesopathies, and the modified Watkins score has been well applied to assess enthesis repair. CONCLUSION: The assessment of tendon-enthesis structure can be performed with several histological scoring systems previously published in literature. However, no studies have been performed to validate these score in research settings. Further experimental and clinical studies should be developed to provide a comprehensive and validated scoring system for the histological assessment of tendon-enthesis repair.