Trabecular metal patella in total knee arthroplasty with patella bone deficiency.

This study evaluates results following patellar resurfacing using trabecular metal (TM) patella in marked deficiency or weakness of patellar bone that precludes patellar resurfacing with a standard cemented patellar button. Ten consecutive patients undergoing primary (3 cases) or revision (7 cases) total knee arthroplasty with patella augmentation were evaluated at a mean follow-up of 45 months (range 18-65). Nine patients had marked patellar bone deficiency and one had had previous patellectomy. No intra-operative complications occurred. There was no displacement of the patellar component and no patellar fractures when at least 50% of bone contact was possible. We observed loosening of the patella augmentation 17 months after the index procedure only in the case of previous patellectomy. When bone was present the fixation appeared excellent by radiographic evaluation already at 3 to 6 months after surgery; afterward bone contact was uniform in the peripheral regions in both lateral and Merchant radiographic views without signs of loosening. Finally, the mean Knee Society scores improved in all patients.

Hip arthroplasty in coxarthrosis secondary to Paget's disease.

A total of 5 hip arthroplasties implanted between 1997 and 2000 in 5 patients affected with coxarthrosis secondary to Paget's disease were reviewed. The quality of the pagetic bone (sclerotic and very vascularized) resulted in a slightly longer amount of time required for surgery because of the difficulty preparing prosthetic placement and intra- and postoperative blood loss exceeding the norm. Complications were not observed. Clinical results were good in 100% of cases. Radiographically, 2 stems were assembled in varus.

Primary bone tumors of the spine: a survey of the evaluation and treatment at the Istituto Ortopedico Rizzoli.

The experience at Istituto Rizzoli with 366 primary bone tumors of the spine focuses on the criteria for planning and treatment. An accurate preoperative evaluation by standard radiograph, computerized tomography scan, and magnetic resonance imaging allow the classification of benign lesions as latent (not requiring treatment), active (curettage), or aggressive (curettage plus adjuvants or marginal resection). The malignant lesions are classified as intracompartmental or extracompartmental (both low and high grade). Wide resection is attempted, but seldom is feasible. An angiographic study of the spinal cord is compulsory for lesions located in the thoracolumbar region. The value of embolization is enhanced, primarily in highly vascular lesions. An accurate preoperative study of the vital parameters of the patient, together with a continuous intraoperative monitoring, is mandatory.

Resection of the vertebral arch in the treatment of neoplasms of the spine.

The authors describe the surgical technique of en bloc resection of musculoskeletal neoplasms that originate and invade the posterior arch of the thoracolumbar spine. Surgery is indicated for the treatment of aggressive benign tumors (Enneking stage 3) and malignant tumors. For surgical margins to be adequate, both pedicles must be free of the tumor.

Surgical technique: dorsal vertebral hemiresection for bone tumors.

The authors describe the technique of sagittal vertebral hemiresection used for the treatment of tumors of the thoracic spine involving one or more hemivertebrae. This type of treatment is not frequently indicated because of the rare asymmetrical distribution of vertebral tumors.

Intramedullary osteosynthesis with Grosse-Kempf nailing for the treatment of distal fractures of the femur.

The authors report the results they obtained in a homogeneous series of fractures of the distal third of the femur treated by Grosse-Kempf nailing. Of the 67 fractures (58 closed, 9 exposed) treated with closed surgery (except for 1 case treated by nailing 35 days after trauma) non-union was never observed. The two cases of delay in consolidation (one related to an infection) did not require a change in method. Bone grafting was never necessary. Only in 3 cases (2 with multiple trauma, 1 treated by open reduction) was moderate reduction in range of movement of the knee observed.

Low back pain in tumors: diagnosis and treatment.

On the basis of the authors' experience in the treatment of 257 skeletal neoplasms of the lumbar spine, the features of back pain, which in 96% of the cases constitutes the first symptom of these diseases, are discussed. The overall clinical aspects firstly depend on the stage of the primary tumor: latent, active, aggressive for benign tumors; intra- and extra-compartmental for malignant tumors. Symptoms may include elements which suggest specific lesions, such as osteoid osteoma, eosinophilic granuloma, aneurysmal bone cyst, or high-grade malignant tumors such as Ewing's sarcoma, while lumbar metastasis from carcinoma do not seem to have distinctive features. Site and localization of the tumor are also important variables. The treatment of neoplastic back pain depends on diagnosis, and cannot be adequate if it is not planned on the basis of a complete preoperative study, taking into account not only surgery, but also adjuvant therapy.