Acetabular revisions using a cementless oblong cup: five to ten year results.

The purpose of this paper was to evaluate the results of acetabular revisions with the use of an oblong revision cup that is designed with its longitudinal diameter elongated relative to its transverse diameter. Between 1996 and 2001, 62 hips in 60 patients underwent an acetabular revision with the insertion of a LOR acetabular component. Seven hips were lost to follow-up or the patients died; the remaining 55 hips (53 patients) remained in follow-up for an average of 7.2 years (range: 5.0-10.1 years). One socket was revised for aseptic loosening, and another was operated on for a late polyethylene liner dissociation. The average Harris hip score (HHS) improved from 34 to 79. Results were rated as excellent in 16 hips, good in 28, fair in six and poor in three. Radiographic analysis demonstrated an improvement in the average vertical displacement of the hip centre: 49 hips had a well-fixed, bone-ingrown cup and four had a stable fibrous union. For large superolateral acetabular bone deficiencies, this implant facilitated a complex reconstruction without the need for bulk structural acetabular bone grafts, provided good clinical results and showed satisfactory stability at the midterm follow-up.

Ganz reinforcement rings in acetabular revision: indications and medium-term results.

Metal reinforcement rings, systems used widely in the past for prosthetic revision surgery, are still effective, in that they allow us to restore the correct hip rotation center and protect the bone grafts used to increase acetabular bone stock. To provide a better definition of the current indications for use of reinforcement rings in acetabular revisions we conducted a retrospective study in a group of 25 patients in whom a Ganz reinforcement ring was used in association with autoclaved cancellous bone grafts. The Ganz ring is made of titanium and it has a lower hook that contributes to the mechanical stability of the implant. Mean age of patients was 72.5 years. Pre-revision acetabular bone defects were divided according to the Paprosky classification system: type 2A: 2 cases; type 2B: 6 cases; type 2C: 6 cases; type 3: 6 cases; type 3B: 5 cases. Clinical and radiographic results were evaluated after a mean follow-up of 4.6 years. Score based on the Harris evaluation form went from a mean preoperative value of 45 points to 92 points after revision. Overall, clinical results were excellent in 9 cases (36%), good in 12 cases (48%), fair in 3 cases (12%), poor in 1 case (4%). Radiographically, we observed a significant reduction (62%) in mean vertical distance of the hip rotation center after revision, that contributed to reduction in hypometria of the limb submitted to surgery, ranging from a mean preoperative value of 2.2 cm to 0.72 cm after surgery. Stability of the implant in time was evaluated based on the Gill criteria. None of the cases required further revision surgery; in 3 cases (12%) with type 3 preoperative defects, the implant was judged to be probably or possibly loosened because of the presence of radiolucent lines.

The rationale for total hip replacement in over 60-year-old patients.

The total hip replacement (THR) survival potential is linked to the material, to surgical technique and to patient's characteristics. Cemented and cementless systems exist in a wide variety of shapes, sizes, configurations, materials and surface treatments. Aseptic loosening remain the principal mechanism of prosthetic failure and the choice of right matching for each prosthesis-patient is the main issue to obtain a very good long-term implant fixation. Cement fixation is always solidly achieved but it can break down under mechanical and biological pressure. Stability with cementless fixation must be created by the initial bone response to the implant. Clinical studies and long-term results with THR showed that in patients with age between 60 and 70 years, it is important to analyze several parameters (bone quality and morphology, life-limiting diseases and levels of activity) to make the appropriate selection of components and type of fixation.

The spacer block technique in revision of total knee arthroplasty with septic loosening.

Five cases of septic loosening of total knee arthroplasty were treated by two-stage revision using a cement mixed with antibiotic. The spacer block was responsible for greater mechanical stability of the joint in the interval between the two stages of the operation, and the association of the antibiotic favored resolution of septic complications, allowing at the same time for systemic antibiotic treatment at doses lower than usual. In all of the cases treated reimplantation was performed in conditions of apparent sterility. The minimum amount of time between the first operation and reimplantation was 3 months, maximum was 5 months. Four to 18 months after reimplantation there was no recurrence of infection. Despite the short follow-up, the technique used appears to constitute a valid solution for septic complications in total knee arthroplasty.

The screwed acetabulum in acetabular reimplantations: long-term results.

The authors report the method used and long-term results for 61 acetabular reimplantations involving screwed truncated-conical acetabula and bone grafts. Mean follow-up was 6.3 years. From a clinical point of view the cases classified as excellent were 14 (24.1%), good 26 (44.8%), fair 12 (20.7%), and poor 6 (10.4%). As for radiographic evaluation, the acetabulum appeared to be stable in 37 cases (63.8%), there was fibrous stability in 13 cases (22.4%), the radiographic findings had shown uncertain stability in 5 cases (8.6%), and the acetabulum was unstable in 3 cases (5.2%). Long-term results show that the biological stabilization and, in particular, the implantation of screwed acetabula, when technically correct, may constitute a valid solution in revision surgery for the acetabular component.

Indications and limits of hybrid hip prostheses (cementless acetabulum and cemented stem).

The authors report the indications and short-term results obtained in a series of 99 total hip prostheses with a screwed acetabulum and cemented stem. The principles which inspired their choice and the criteria used to select patients are discussed. The results obtained, evaluated both clinically and radiographically, are satisfactory, particularly with regards to percentage of pain symptoms in the femur.

[Reinterventions with cementless P.M. prostheses]. / Reinterventi con protesi non cementate P.M.

The authors state the indications and report the results of 43 revision arthroplasties performed with cementless total hip implants. They describe both the criteria leading to this therapeutic decision and the technique employed given the bone loss caused by the failure of the previous arthroplasty. The long-term results are analyzed with particular reference to radiographic evidence of implant stability.

[The AGC 2000 knee prosthesis: observations on the first 35 cases]. / La protesi di ginocchio AGC 2000: osservazioni sui primi 35 casi.

The authors state the indications and report the results of their first 35 consecutive AGC total knee arthroplasties. Both the characteristic of the prosthesis and the modalities of the application technique are analyzed. The results are evaluated from a clinical and radiographic point of view.

[The organization and utilization of a bone bank with femur heads]. / Organizzazione ed utilizzazione di una banca dell'osso con teste femorali.

In 1984 a "bone bank" containing femoral heads taken from live donors was created at the 2nd Orthopaedic Department of the University of Florence. The authors emphasize that these bones are very easy and inexpensive to obtain and store. They describe the organization of the "bone bank" and present the results of its first four years of activity.

[A rare case of massive osteolysis (Ghoram's syndrome)]. / Su di un raro caso di "osteolisi massiva" (sindrome di Ghoram).

The authors report a case of massive osteolysis of the right shoulder in a woman aged 53 years, characterised by progressive evolution with spontaneous arrest 8 months after onset. The diagnosis of Ghoram's syndrome was based on a histologic examination revealing evident vascular neoformation, radiographic and clinical evolution.

[Physiokinesitherapeutic management of traumatic lesions of the brachial plexus. Indications and results]. / Il trattamento fisiokinesiterapico delle lesioni traumatiche del plesso brachiale. Indicazioni e risultati.

An account is given of the indications and results of physical and rehabilitative management of brachial plexus lesions when used electively or as a complement to surgery. Material from the Florence Traumatological and Orthopaedics Centre and the V. Putti Mutilated Patients Centre, Bologna (formerly directed by Prof. O. Scaglietti) dating from 1940 to 1980 is used to explain the indications for conservative and surgical management, in the conviction that sound results depend on exact indication. A selected sample of 51 patients treated conservatively and 194 surgically is presented. The results were satisfactory in about 50% of each group, with a slight advantage in favour of physiotherapy, this being obviously employed when lesions were less severe.

[Proglumetacin: possible first choice in the treatment of orthopedic- traumatologic disorders]. / La proglumetacina: potenziale farmaco di prima scelta nella terapia dei disturbi ortopedico-traumatologici.

Ninety-seven patients (44 males and 53 females of mean age 42.6 +/- 12,9 years) with orthopedic-traumatologic disorders (osteoarthritis, 38; painful joints, 26; fibrositis, painful shoulder, 20; peri- and extra-articular disorders, 13) had been treated during 7 to 30 days with two suppositories (400 mg) or three capsules (450 mg) proglumetacin (Proxil Rorer). Most patients responded well to very well to the treatment with significant improvement of pain and inflammatory symptoms as well as restoring of limited function. Such a response resulted proportional to the dose (53% of good responders among those given the lower dose and 82% among those at the higher dose) and to the kind of pathology. The patients with acute disorders (7) responded all very well in 7 days; those with subacute disorders (57) responded well to very well in a proportion of 57% within 15 days; those with chronic disorders responded to a proportion of 48% within 30 days. Tolerance resulted very good anyway: in no case had the treatment to be withdrawn, nor allergic or C.S.N. reactions were observed, so that the overall tolerance was defined excellent to good in 90% of patients. Thirty-three patients complained of accessory symptoms, mainly epigastric pain and nausea, almost always mild and anyway transient. Proglumetacin can therefore be properly defined as a firstchoice treatment for the management, also ambulatory, of orthopedic-traumatologic disorders.