Impact of a Novel Antiseptic Lavage Solution on Acute Periprosthetic Joint Infection in Hip and Knee Arthroplasty.

Background: Periprosthetic joint infection (PJI) represents a challenge following hip or knee arthroplasty, demanding immediate intervention to prevent implant failure and systemic issues. Bacterial biofilm development on orthopedic devices worsens PJI severity, resulting in recurrent hospitalizations and significant economic burdens. The objective of this retrospective cohort study is to evaluate the efficacy of this novel antiseptic solution, never previously evaluated in vivo, in managing early post-operative or acute hematogenous PJI following primary hip and knee joint replacements. Methods: The inclusion criteria consist of patients with total hip arthroplasty (THA) or knee arthroplasty diagnosed with acute PJI through preoperative and intraoperative investigations, in accordance with the MSIS ICM 2018 criteria. The minimum required follow-up was 12 months from the cessation of antibiotic therapy. This novel antiseptic lavage solution is composed of ethanol, acetic acid, sodium acetate, benzalkonium chloride and water. Data included demographic characteristics, diagnostic criteria, surgical techniques, post-operative treatment and follow-up outcomes. Results: A total of 39 patients treated with Debridement, Antibiotics Pearls and Retention of the Implant (DAPRI) procedures using this solution between May 2021 and April 2023 were analyzed. At a mean follow-up of 24.6 ± 6.4 months, infection recurrence-free survival rates were 87.2%, with no local allergic reactions or relevant systemic adverse effects detected. Persistent PJI necessitated two-stage revision surgery. Conclusions: This novel antiseptic lavage solution shows promise as an adjunctive tool in the treatment of PJI, demonstrating support in infection control while maintaining a favorable safety profile.

Angle-Adjustable Dynamic Hip Screw Plate for Unstable Trochanteric Fractures in Middle-Aged Patients: Mid-Term Outcomes and Return to Sport.

BACKGROUND: There are conflicting results in the literature regarding the superiority of proximal femoral nails over dynamic hip screw (DHS) plates. The primary aim of this study is to evaluate mid-term post-injury patient-reported outcome measures (PROMs) and return to sport (RTS) in middle-aged patients treated with the DHS plate for unstable trochanteric fractures. METHODS: Fifty-seven middle-aged patients (35-64 years) treated for proximal femoral fractures of type 31-A2 and 31-A3 according to the AO/OTA classification with the DMS Dynamic Martin Screw (KLS Martin Group, Jacksonville, FL, USA) between January 2017 and December 2019 were enrolled. RESULTS: Forty-nine patients were included in this retrospective study, and the average age was 54.1 years (SD 8.4). The average follow-up duration at final follow-up was 60.5 months (SD 8.6). Post-operative complications included only one case of aseptic loosening of the implant, with a complication rate of 2%. There were no infections, peri-implant fractures, or other complications reported. Two out of the forty-nine patients (4.1%) required treatment with a total hip arthroplasty due to post-traumatic arthritis. The Harris Hip Score at final follow-up was 77.1 (SD 20.1), and the Western Ontario and McMaster Universities Osteoarthritis Index was 21.6 (SD 13.7). The overall rate of RTS was 57.7%. CONCLUSIONS: Treatment with DHS for unstable trochanteric fractures is a safe option in middle-aged patients, ensuring a good functional recovery.

The Role of Artificial Intelligence in Anterior Cruciate Ligament Injuries: Current Concepts and Future Perspectives.

The remarkable progress in data aggregation and deep learning algorithms has positioned artificial intelligence (AI) and machine learning (ML) to revolutionize the field of medicine. AI is becoming more and more prevalent in the healthcare sector, and its impact on orthopedic surgery is already evident in several fields. This review aims to examine the literature that explores the comprehensive clinical relevance of AI-based tools utilized before, during, and after anterior cruciate ligament (ACL) reconstruction. The review focuses on current clinical applications and future prospects in preoperative management, encompassing risk prediction and diagnostics; intraoperative tools, specifically navigation, identifying complex anatomic landmarks during surgery; and postoperative applications in terms of postoperative care and rehabilitation. Additionally, AI tools in educational and training settings are presented. Orthopedic surgeons are showing a growing interest in AI, as evidenced by the applications discussed in this review, particularly those related to ACL injury. The exponential increase in studies on AI tools applicable to the management of ACL tears promises a significant future impact in its clinical application, with growing attention from orthopedic surgeons.

Uncemented hemiarthroplasty may have a role in the treatment of unstable intertrochanteric fractures in elderly patient. A survival complications and functional outcomes analysis.

BACKGROUND: Fractures of the proximal femur account for 30% of all fractures requiring surgical treatment. The optimal treatment for per- and intertrochanteric fractures, particularly associated with trochanter instability, is still open to debate. For these reasons, some authors have recently supported the use of bipolar arthroplasty or hemiarthroplasty as a treatment capable of reducing the risk of complications and obtaining a better functional result. The purpose of this study was to evaluate the functional and clinical outcomes at minimum six months of follow up of bipolar hemiarthroplasty as the primary treatment for intertrochanteric fracture in older patients. A secondary objective was to study the risk of early and intraoperative complications. METHODS: From November 2020 to April 2022, 102 patients with lateral proximal femur fracture underwent surgical operation with implant of a long-stemmed bipolar hemiarthroplasty. 86 patients were enrolled. The average age at the time of fracture was 87.4 ± 4.6 (range 77-98) years. Of the patients, 76.7% were female. For all patients intra- and perioperative data were extracted. All available patients were evaluated at a minimum 6-months follow-up to investigate: Charlson Comorbidity Index, autonomy (Barthel Index), use of walking aids (Koval Grade), memory quality or dementia (Mental Score), subsequent hospitalizations for surgical operations relating to the operated hip. RESULTS: The average time from trauma to surgery was 1 ± 0.7 days. The surgical time was 78.9 ± 21.9 minutes. At least one cerclage was used in 73.3% of patients. 87.5% of patients were verticalized on the first day. The average hospitalization time was 5.5 ± 2.9 days. During follow-up 20 deaths occurred, with a distance to surgery of 6.6 ± 7.2 (range 0.3-22.7) months. Six months after surgery, out of 86 patients, 12 deaths occurred, corresponding to 13.95%. 12 months after surgery, out of 57 patients, 15 deaths occurred, corresponding to 26.31%. CONCLUSIONS: Long stemmed bipolar hemiarthroplasty following intertrochanteric fracture can be considered a safe procedure, especially in patients over 80 with associated comorbidities and short life expectancy.

High accuracy of a new robotically assisted technique for total knee arthroplasty: an in vivo study.

PURPOSE: Over the last decade, robotic TKA gained popularity for improving the accuracy of implant positioning and reducing outliers in limb alignment comparing to conventional jig-based TKA. Hypothesis of this study was that this newly designed robotically assisted system will achieve a high level of accuracy for bone resection. Purpose of the study was to evaluate the accuracy of the system. METHODS: For this study, 75 knees in 75 patients were operated using a new, robotic system (ROSA® Knee System; Zimmer Biomet, Warsaw, IN) with a Posterior Stabilized Total Knee Arthroplasty (Persona® Knee System). The planned, validated and measured angles and cuts for the distal and posterior femur, for the proximal tibia and for the final coronal alignment on long standing x-rays were compared. RESULTS: A statistically significant difference was found only between the average planned and the average validated angle for femoral flexion, tibial coronal axis, medial and lateral cuts; the average difference was in any case below 1 mm or under 1 degree with SD < 1. No statistical difference was found between planned validated and measured cuts. Average difference between planned HKA and measured was 1.2 ± 1.1. No statistically significant difference was found. CONCLUSIONS: The results of this study demonstrated that using this new surgical robot in total knee arthroplasty it is possible to perform accurate bone cuts and to achieve the planned angles and resections.

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.

High survival rate at mid-term follow up of porous tantalum cones for bone defects in revision total knee replacement: A 3-11 years follow up report.

BACKGROUND: Large metaphyseal bone losses are commonly encountered in revision total knee arthroplasty (rTKA). Anderson Orthopaedic Research Institute (AORI) type 2 and 3 defects generally require some metaphyseal fixation or augmentation. This study evaluates the midterm results of Porous Tantalum Trabecular Metal™ (TM) cones in revision TKA addressing severe bone loss. METHODS: Patients who underwent revision TKA using metaphyseal cones and a varus-valgus constrained (VVC) implant from January 2010 to January 2018 at our institution were identified from a prospective research database. Pre-operative patient characteristics and operative data were reviewed. Postoperative outcomes were compared with pre-operative values. Primary study aims were to evaluate outcomes, including complications and re-operations, radiographic assessment of cones osteointegration, and survivorship. RESULTS: A total of 101 knees (101 patients) underwent revision TKA with 139 metaphyseal cones (80 tibial, 59 femoral). AORI defect classification was assessed intraoperatively. All patients were available for a minimum of 2 years of clinical and radiographic follow up. Mean follow up was 7.5 years (range 3-11 years). All patients showed significant improvement of clinical outcomes. Fifteen knees required re-operation and nine required revision of the implants, most commonly for recurrent infection (six of nine revisions) with cones removal. Kaplan-Meier survival analysis show a survival rate of 93.9% at 2 years and a survival rate of 90.2% at 5 and 11 years. CONCLUSIONS: This large series illustrates the utility of porous metaphyseal cones in revision TKA with promising clinical and radiographic results and a high survival rate at mid-term follow up.

The epidemiology of proximal femur fractures during COVID-19 emergency in Italy: a multicentric study.

BACKGROUND AND AIM: After the first Italian case of Covid-19, the Government imposed the complete closure of all areas involved by the spread of the virus to contain transmissions. There was a massive reorganization of Hospitals, a stop of all elective activities and a convertion of many hospitals in "Covid Centers''. AITOG (Associazione Italiana Traumatologia e Ortopedia Geriatrica) conducted a retrospective study on all proximal femur fractures surgeries that occurred in this period, to find out whether the pandemic and the correlated lockdown somehow changed the incidence of these events.  Methods: 10 Italian orthopedic centers were involved in the study. Considering the geographic location, three groups were created (North, Centre and South). The considered period is the Italian "Phase 1" (February 23rd - May 3rd 2020). RESULTS: the cohort is composed of 412 patients, 116 male and 296 female (mean age 81.1 ± 9.1 years). The same period of 2019 has been used as control group, with 558 patients, 156 male and 402 female (mean age 84.2 ± 8.0 years). In 2020 we counted 323 (78.4%) fractures occurred at home, 61 (14.8%) in retirement houses and 28 (6.8%) in different locations. We mainly treated fractures with intramedullary nails (n.237 57.5%). Among all patients we had 46 (11.1%) Covid-19 positive. The mortality rate within 30 days was of 51 patients (12.4%); 23 of these died because of complications related to Covid-19 while 31 of  these were in treatment with anticoagulant/antiaggregant. CONCLUSIONS: AITOG analysis demonstrates a decrease in surgical interventions for proximal femur fractures from 2019 to 2020, a reduction in patients mean age and an increase in trauma occurred in domestic environment. We also registered a consistent difference between the North, Center and South of the Country.

A ligament tensor-guided extramedullary alignment technique for distal femoral cut in total knee replacement: results at a minimum 3 years follow-up.

BACKGROUND: Femoral intramedullary canal referencing is used by most knee arthroplasty systems for distal femoral cut; to avoid the opening of the femoral canal different solutions have been presented such as navigation, patient-specific instruments (PSI) or the use of an extramedullary device. The FuZion® system is a tensor device, created to merge the two main techniques for performing a total knee arthroplasty: the ligament balancing and measured resection techniques. Our idea was to use the tensor as an extramedullary cutting guide for the distal femoral cut, based on a 90° tibial resection. METHODS: A total of 110 patients were operated on with this technique. Patients were evaluated with weight-bearing long-standing X-rays, knee a-p and lateral views, validated PROMs (Oxford Knee Score, EQ-5D and EQ-VAS), the Knee Society Scoring System (KSS) and the Forgotten Joint Score (FJS). Minimum follow up was 3 years (range 38-50 months). RESULTS: Complete results were available for 104 patients (5 were lost in follow up and 1 died). Significant improvements were registered for all the evaluated scores from pre-op to the final follow up. Pre-op long-standing X-rays showed 21 valgus knees (20%) with a mean HKA of 187.6° (± 3.2°), 70 varus knees (62%) with a mean 172.2° (± 3.7°) HKA and 19 neutrally aligned knees, with a mean HKA of 179.5° (0 ± 2°). The radiographic evaluation at 3 months post-op showed 20 valgus knees (mean HKA 183.7° ± 1.5°), 67 varus knees (mean HKA 176.1° ± 1.8°) and 23 neutrally aligned knees with a mean HKA of 179.3° (0 ± 2°). At final follow up the survival rate was 100% for revision of the implant as the endpoint. With any reoperation as the endpoint Kaplan-Meier survival estimate showed a survival rate of 95.1% at 3 years. CONCLUSIONS: This technique for performing a ligament driven alignment in total knee arthroplasty showed encouraging clinical outcomes at mid-term follow up leaving a residual deformity on the coronal plane.

Mid- to long-term follow-up of combined small implants.

AIMS: In the last decade, interest in partial knee arthroplasties and bicruciate retaining total knee arthroplasties has increased. In addition, patient-related outcomes and functional results such as range of movement and ambulation may be more promising with less invasive procedures such as bicompartmental arthroplasty (BCA). The purpose of this study is to evaluate clinical and radiological outcomes after a third-generation patellofemoral arthroplasty (PFA) combined with a medial or lateral unicompartmental knee arthroplasty (UKA) at mid- to long-term follow-up. METHODS: A total of 57 procedures were performed. In 45 cases, a PFA was associated with a medial UKA and, in 12, with a lateral UKA. Patients were followed with validated patient-reported outcome measures (Oxford Knee Score (OKS), EuroQol five-dimension questionnaire (EQ-5D), EuroQoL Visual Analogue Scale (EQ-VAS)), the Knee Society Score (KSS), the Forgotten Joint Score (FJS), and radiological analysis. RESULTS: The mean follow-up was nine years (6 to 13). All scores significantly improved from preoperatively to final follow-up (mean and SD): OKS from 23.2 (8.1) to 42.5 (3.5), EQ-5D from 0.44 (0.25) to 0.815 (0.1), EQ-VAS from 46.7 (24.9) to 89.1 (9.8), KSS (Knee) from 51.4 (8.5) to 94.4 (4.2), and KSS (Function) from 48.7 (5.5) to 88.8 (5.2). The mean FJS at final follow-up was 79.2 (4.2). All failures involved the medial UKA + PFA group. Overall, survival rate was 91.5% for all the combined implants at ten years with 95% confidence intervals and 22 knees at risk. CONCLUSION: Excellent clinical and radiological outcomes were achieved after a third-generation PFA combined with a medial or lateral UKA. BCA with unlinked partial knee prostheses showed a good survival rate at mid- to long-term follow-up. Cite this article: Bone Joint J 2021;103-B(5):840-845.

Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects.

BACKGROUND: This prospective study aims to evaluate the mid-term clinical outcomes and radiographic stability of two different types of cementless trabecular titanium acetabular components in total hip revision surgery. METHODS: Between December 2008 and February 2017, 104 cup revisions were performed using trabecular titanium revision cups. Mean age of patients was 70 (range 29-90; SD 11) years. The majority of revisions were performed for aseptic loosening (86 cases, 82.69%), but in all the other diagnoses (18 cases), a significant bone loss (Paprosky type II or III) was registered preoperatively. Bone defects were classified according to Paprosky acetabular classification. We observed 53 type II defects and 42 type III defects. Cups were chosen according to the type of defect. RESULTS: Average follow-up was 91 (range 24-146) months. Mean Harris Hip Score (HHS) improved from 43.7 (range 25-70; SD 9) preoperatively to 84.4 (range 46-99; SD 7.56) at last follow-up. One (1.05%) cup showed radiographic radiolucent lines inferior to 2 mm and was clinically asymptomatic. One (1.05%) cup was loose and showed periacetabular allograft reabsorption. Kaplan-Meier survivorship was assessed to be 88.54% (95% CI 80.18-93.52%) at 71 months, with failure of the cup for any reason as the endpoint. CONCLUSION: Trabecular titanium revision cups showed good clinical and radiographic results at mid-term follow-up in Paprosky type II and III bone defects. LEVEL OF EVIDENCE: Level IV prospective case series.

Modular tapered conical revision stem in hip revision surgery: mid- term results.

BACKGROUND: The aim of this paper is to evaluate the clinical and radiological outcomes of a fluted tapered modular distal-fixation stem at medium to long-term follow-up. The hypothesis of this investigation was to verify if the use of this implant design may have provided potential advantages in femoral revisions and post-traumatic instances where the restoration of the anatomy was the prime concern. METHODS: We retrospectively reviewed 62 cases of femoral revision surgeries, performed in Paprosky type IIIA and IIIB bone defects between January 2001 and December 2011 with a mean follow-up of 8.5 ± 1.5 years (range 5.1-15.9 years) where a modular fluted stem was used. The clinical assessment was performed with the Harris Hip Score (HHS), and the radiographic evaluation was carried in order to assess the stability of the femoral component. Intra-operative and postoperative complications were recorded, and the rates of complications and revisions for any cause were determined. RESULTS: Mean HHS improved 35.4 points from the preoperative assessment. Radiographic evaluation showed a stable stem anchorage in 90.3% of the cases at the last follow-up. Five (8%) implants required additional surgery. Neither breakage of the stem nor loosening of the taper junction were recorded. Kaplan-Meier survivorship was 89.4% (CI: 88.8-90%) for any complication and 92.3% (CI: 91.8-92.7%) according to revision for any causes at 81 months follow-up. CONCLUSIONS: Our findings suggest that this stem design is a reliable option in cases of complex femoral bone defects, as well as in cases with high functional deficiencies, with promising survivorship.

Customized intraoperatively molded articulating cement spacers for two-stage revisions TKA with major bone defects.

BACKGROUND: The use of articulating spacers, molded or prefabricated, becomes difficult in case of severe bone losses. Our idea was to customize the Molded Articulating Cement Spacers with cement stem extensions and if necessary metaphyseal cement augmentations in order to use them also in case of major bone defects. METHODS: Fifty-four knees in fifty-three patients undergoing 2-stage exchange arthroplasty were divided in 4 groups, treated with 4 different types of spacers (Static, articulating molded, customized molded and metal on Poly) and evaluated in terms of Range of Motion (ROM), Knee Society Score (KSS), patients' related outcome measures (PROMs), rate of complication and ease of the surgical exposure at the time of reimplantation. RESULTS: At final follow-up, no statistical differences in terms of ROM and KSS were found between the articulating groups. Static Spacers showed statistically significant lower results both in terms of ROM and KSS comparing to the other 3 groups (P < 0.05). Considering PROMs, statistically better outcomes for all articulating spacers were found both when spacer was in place and at final follow-up comparing to the static spacers group (P < 0.05). No statistically significant difference was found between the 3 articulating spacers groups. Radiographic analysis did not show signs of loosening, migration or major bone loss. CONCLUSIONS: Customized Intraoperatively Molded Articulating Cement Spacers are a safe solution for two-stage revisions TKA with major bone defects and may provide a better quality of life for patients when in place comparing to static ones.

Controversy: supporting patellar resurfacing in total knee arthroplasty - do it.

Patellar resurfacing during total knee arthroplasty remains a controversial topic.Some surgeons routinely resurface the patella to avoid the increased rates of postoperative anterior knee pain and reoperation for secondary resurfacing, whilst others selectively resurface based on the presence of preoperative anterior knee pain, damaged articular cartilage, inflammatory arthritis, isolated patellofemoral arthritis, and patellar subluxation and/or maltracking. A third group of surgeons never resurface the patella.The anatomy and biomechanics of the patellofemoral joint as well as the advances in surgical techniques and prosthetic design must be taken into account when making a decision about whether to resurface the patella. Accurate component implantation if the patella is resurfaced becomes crucial to avoid complications.In our institution before 2008 we were performing a selective resurfacing of the patella, but in the last decade we have decided to always resurface it, with good outcomes and low complication rate. A reproducible surgical technique may be helpful in reducing the risk of postoperative anterior knee pain and complications related to implants.In this article we analyse the current trend and controversial topics in dealing with the patella in total knee arthroplasty, and discuss the available literature in order to sustain our choice. Cite this article: EFORT Open Rev 2020;5:785-792. DOI: 10.1302/2058-5241.5.190075.

Unstable total hip replacement: why? Clinical and radiological aspects.

INTRODUCTION: Dislocation after total hip arthroplasty (THA) is the most common cause of revision hip surgery in the United States, ahead of aseptic loosening and infection, and is responsible for considerable economic cost related to frequent readmission and/or revision surgery. The aim of this article is to identify the clinical and radiological factors related to the unstable total hip replacement. METHODS: We performed a literature search to assess current strategies to define clinical and radiological characteristics of dislocation after primary THA using the PubMed platform. The characteristics related to THA instability were divided into patient related factors, implant related factors and surgeon experience. RESULTS: Patient-related factors for instability identified are: age; inflammatory joint disease; prior hip surgery; preoperative diagnosis; comorbidity; ASA score; presence of spino-pelvic abnormality; and neurological disability. Gender, simultaneous bilateral THA and restrictive postoperative precautions do not influence rate of THA dislocation. Implant related factors identified are: surgical approach; component malposition; femoral head size; and the use of dual-mobility or constrained solution. Surgeon experience also reduces the rate of dislocation. DISCUSSION: Dislocation is a major complication of THAs, and causes include patient-derived factors, surgical factors, or both. It is imperative to determine the cause of the instability via a complete patient and radiographic evaluation and to adjust the reconstruction strategy accordingly.

Ten-year outcomes of a nitrided Ti-6Al-4V titanium alloy fixed-bearing total knee replacement with a highly crosslinked polyethylene-bearing in patients with metal allergy.

BACKGROUND: Metal hypersensitivity in patients with a total knee arthroplasty (TKA) is a rare condition and a very controversial topic. Despite the lack of data concerning the real effective impact of allergy on TKA failures, most of the manufactures offer the choice of 'non-allergenic' implants both for primary and revision TKA, some of which provide the same designs and surgical techniques as the conventional ones. Only a few studies are available on outcomes on these 'hypersensitivity-friendly' implants and even fewer specifically on allergic patients with a mid- to long-term follow-up. METHODS: Between 2007 and 2015, we enrolled 72 patients (57 females, 15 males), who underwent TKA treated with a non-allergenic posterior-stabilized (PS) total knee implant for a declared and proven metal allergy. Patients were followed clinically and radiographically for a mean 10 years of follow-up. RESULTS: With revision as an endpoint the Kaplan-Meier survival estimate showed a survival rate of 97.2% at five years and 95.1% at 10 years. Significant improvements in range of motion (ROM), Knee Society Scoring (KSS) and Hospital for Special Surgery (HSS) knee scores were registered at final follow-up (P < 0.0001). At final follow-up validated Patient-Reported Outcome Measures (PROMs) showed the following scores: Oxford Knee Score (OKS) 42.1, EQ5D 0.80, EQ VAS 80.1, Forgotten Joint Score 71.2. CONCLUSIONS: This nitrided Ti-6Al-4V titanium alloy fixed-bearing total knee replacement with a highly crosslinked polyethylene-bearing showed interesting results and survival rates in patients with metal allergy at mid- to long-term follow-up.

Double-tapered conical taper in primary and revision surgery: rationale and short-term follow-up.

BACKGROUND:: The new double-conical tapered stem is a novel cementless modular system, which is indicated for both primary and revision surgeries. It has been designed with different angles at the proximal (5°) and distal sections (1° 36') in order to obtain optimal fixation by proximal and distal fit and fill of the femoral canal. AIM:: The aim of this prospective study was to evaluate the short-term clinical and radiographic outcomes of primary and revision hip surgery with the new double-conical stem. METHODS:: 61 stems were implanted (December 2013 to September 2016) in 42 cases of primary and in 19 cases of revision surgery. The mean age of patients was 64.7 (17-94; standard deviation [SD] 21.9) years. RESULTS:: The mean body mass index of the patients was 24.6 (17-34.6). In 3 cases of developmental dysplasia of the hip we performed femoral shortening osteotomy. The mean follow-up was 26 (8-40) months. 3 patients died due to causes unrelated to surgery. Postoperative complications included 3 hip dislocations, 2 infections and 1 case of stem explant for metastatic tumour. For all other cases, at the last follow-up radiographs showed no loosening, no radiolucent lines nor subsidence. The mean Harris Hip Score significantly improved from 45 (range 35-58) preoperatively to 87 (range 75-94). Leg length discrepancy was found in 10% of cases but never >1 cm. CONCLUSIONS:: Radiographic analysis showed the bone-stem contact full at 2 levels of taper. The double-tapered prosthetic stem can therefore be usefully employed both in primary and in revision surgeries.

Platelet-rich plasma in the treatment of acute hamstring injuries in professional football players.

PURPOSE: muscle injuries have a high incidence in professional football and are responsible for the largest number of days lost from competition. Several in vitro studies have confirmed the positive role of platelet-rich plasma (PRP) in accelerating recovery and in promoting muscle regeneration, and not fibrosis, in the healing process. This study examines the results of intralesional administration of PRP in the treatment of primary hamstring injuries sustained by players belonging to a major league football club. METHODS: twenty-five hamstring injuries (grade 2 according to MRI classification) sustained by professional football players during a 31-months observation period were treated with PRP and analyzed. Sport participation absence (SPA), in days, was considered to correspond to the healing time, and we also considered the re-injury rate, and tissue healing on MRI. The mean follow-up was 36.6 months (range 22-42). RESULTS: there were no adverse events. The mean SPA for the treated muscle injuries was 36.76±19.02 days. The re-injury rate was 12%. Tissue healing, evaluated on MRI, was characterized by the presence of excellent repair tissue and a small scar. CONCLUSIONS: this study confirmed the safety of PRP in treating hamstring lesions in a large series of professional football players. PRP-treated lesions did not heal more quickly than untreated lesions described in the literature, but they showed a smaller scar and excellent repair tissue. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Clinical and radiographic outcomes of a trabecular titanium™ acetabular component in hip arthroplasty: results at minimum 5 years follow-up.

BACKGROUND: Aim of this prospective study was to evaluate mid-term clinical and radiographic outcomes in total hip arthroplasty using an acetabular cup made of an innovative biomaterial, Trabecular Titanium™, whose highly porous structure and mechanical properties have been designed to mimic those of the natural bone, thus promoting a more physiological load transfer and a more durable fixation. METHODS: Between September 2007 and November 2009, 134 total hip replacements and eight revisions were carried out using DELTA-TT primary cups (Lima Corporate, Villanova di San Daniele del Friuli, Italy) in 133 consecutive patients. Mean age was 57.5 ± 14.7 SD (18-92) years. Diagnosis was primarily hip osteoarthritis in 85 (63 %) cases, developmental dysplasia of the hip (DDH) in 24 (18 %) and hip avascular necrosis (AVN) in 10 (7 %). All the revision procedures were due to aseptic loosening of the original implant. Approval of the Institutional Review Board of the IRCCS Policlinico San Matteo in Pavia was obtained for this study. RESULTS: Mean follow-up was 72.7 ± 7.9 SD (60-86) months. Average Harris Hip Score (HHS) significantly increased from 44.2 ± 5.4 SD (35-52) preoperatively to 95.9 ± 3.5 SD (88-100) at the last follow-up. No major post-operative complications were observed. 99.3 % of the acetabular components were radiographically stable at the last follow-up, without any radiolucent lines, sclerotic areas or periprosthetic osteolysis. Kaplan-Meier survival rate was 99.3 % at 5 years (95 % confidence interval). CONCLUSIONS: This first account on the mid-term clinical performance of the DELTA-TT cup shows primary and secondary stability, thus representing an optimal solution for patients with high demands or affected by severe hip conditions.