101,863 research outputs found
Artrodesi STT nelle artrosi scafotrapeziotrapezoidali: revisione della casistica e risultati
No full textClinical and radiographic short mid-term outcomes of primary total stabilizer knee arthroplasty
No full textA successful Total Knee Arthroplasty (TKA) requires stability, but rarely in primary TKA, a prosthesis with more constraint than a posterior-stabilizer (PS) is necessary. In patients with severe varus/valgus deformities with incompetent collateral ligaments or in knees that cannot be adequately balanced after ligaments release, a total-stabilizer (TS) prosthesis may be required. The purpose of our retrospective study is to evaluate clinical and radiographic outcomes at short mid-term follow-up in patients treated with a TS TKA. Between January 2013 and August 2016, 36 patients (38 knees) were treated with Stryker Triathlon TS cemented implants. Clinical and radiographic evaluation were performed preoperatively and postoperatively at 1 month, 3 months, 6 months, 1 year and at 1-year intervals thereafter. At final follow-up, 33 patients (35 knees) remained and were included in this study and followed with a mean follow-up of 26.6 months. Clinical evaluation was performed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC score) and the Knee Society rating system that is subdivided into a knee score (KS) that rates only the knee joint itself and a functional score (FS). Knee Score (KS) and Functional Score (FS) increased significantly from a mean pre-operative value of 48 and 45, respectively, to a post-operative value at last follow-up of 86 and 82, respectively. Also WOMAC score improved significantly: the mean pre-operative WOMAC score was 45, while the mean post-operative WOMAC score, at last follow-up, was 19. The difference between pre- and post- operative results was significant at statistical analysis. In our opinion, when the adequately prosthesis balancing isn’t possible, because of primary or secondary severe varus/valgus deformity or severe soft tissues retraction, an available option is to perform a total knee arthroplasty with a total stabilizer polyethylene insert. TS prosthesis gives more stability during the most of ROM and, in addition, Triathlon system provides surgeons the possibility to choose a more constrained implant, than a standard PS one, during surgical procedure saving the bone stock. Our experience with this kind of prosthesis has provided good clinical and radiographic outcomes at a short mid-term follow-up with a low-rate of complications
Evaluation of the effects of the stem design on periprosthetic bone remodelling in total hip arthroplasties
No full textAnterior cruciate ligament reconstruction with LARS artificial ligament: review and results at medium-term follow-up
No full textAnterior cruciate ligament reconstruction with LARSTM artificial ligament results at a mean follow-up of eight years
No full textPurpose The aim of this study was to review patients that
underwent ACL reconstruction with the LARSTM ligament
in the First Orthopaedic Division of Pisa University during
the period between January 2003 and December 2005.
Methods Twenty-six patients were reviewed with an average
follow-up of 95.3 months (7.9 years). The review protocol
was articulated in three phases: (1) a subjective evaluation
using three grading scales: VAS, KOOS and the Cincinnati
knee rating scale, (2) a clinical and objective evaluation, and
(3) a biomechanical evaluation of the knee stability.
Results A global positive result was obtained in 92.3 % of the
patients (16 optimal results and eight good results), with a fast
functional recovery and a high knee stability. A global poor
result was reported in two cases. In our series we did not record
cases of infection or knee synovitis.We recorded only one case
ofmechanical graft failure. The results obtained fromour study
are encouraging and similar to those in the literature.
Conclusions We conclude that the LARSTMligament can be
considered a suitable option for ACL reconstruction in
carefully selected cases, especially for older patients needing a fast functional recovery
Knee arthroplasty: hospital length of stay and co-morbidity
No full textIntroduction Total knee replacement (TKR) is one of the most
common orthopaedic procedures performed in Italy with an increase
practice of 11 % from 2001 to 2009. The current need is therefore to
reduce hospital length of stay in order to meet the increased demand
and lower the costs of hospitalization.
Materials and methods Post-operative outcomes of patients who
underwent TKR at the 1st Orthopaedic Division of Pisa University
between April 2008 and September 2009 were evaluated retrospectively.
The sample consisted of 100 patients with a mean age of
70 years. All patients diagnosed with knee osteoarthritis undertaking
a primary TKR were included in the study. Referring to fast-track
protocols we have considered: age, sex, BMI, co-morbidities and
ASA score, number of blood units transfused, post-operative analgesia
protocol, physiotherapy protocol, day of the week when surgical
procedure was performed, surgical access route. Each parameter was
correlated with length of stay in order to identify whether, and how it
would influence the post-operative period. The physiotherapy protocol
for all patients began the first post-operative day. Post-operative
analgesia was based on the use of ketorolac and morphine in elastomeric
pump for 48 h, with paracetamol as rescue treatment. The
surgical route was Midvastus in all patients and all surgical procedures
were performed by the same operator.
Results In our series (2008–2009), the average length of hospital stay
was 9.25 days. Among analyzed factors, the following resulted to be
predictive of length of stay (p\0.05): ASA score C3 (+1.5 days),
BMI C 30 (+2.3 days), need for blood transfusion C2 (+3.26 days),
age C75 (+2.12 days).
Discussion Bleeding was shown to be the most important amendable
variable that if controlled could lead to a significant reduction in
length of stay. Obesity and consequently reduced mobilization could
be addressed with a more aggressive and early rehabilitation protocol.
ASA and age which had a significant impact with length of stay are
not modifiable.
Conclusions The identification of the variables influencing length of
stay is important to reduce costs and deliver a better care for patients.
In view of the results of this audit, we have monitored more closely bleeding by introducing the use of the tranexamic acid and promotingearly mobilization in obese patients, in agreement with the most
recent literature. The preliminary results obtained, following this new approach, appear to be satisfactory (TKR mean hospital length of stay reduced of 2 days)
VALUTAZIONE DEL RIASSORBIMENTO OSSEO PERIPROTESICO DOPO PRIMO IMPIANTO DI PROTESI D’ANCA CON STELO CORTO B-BRAUN METHA: RISULTATI DOPO 48 MESI DI FOLLOW-UP
No full textIntroduzione: L’Artroprotesi totale di anca è una procedura di
chirurgia ortopedica maggiore molto comune per il trattamento
delle patologie degenerative dell’articolazione coxo-femorale.
L’elevato numero di pazienti coinvolti, il grande impatto della procedura
sulla qualità della vita e la gravità delle conseguenze del
fallimento, rendono ragione degli sforzi ancora oggi eseguiti per
lo sviluppo di protesi sicure e durature nel tempo. Il successo a
lungo termine di un impianto protesico è frutto di delicati meccanismi
che si creano tra osso e protesi: “interazione osso-protesi
favorevole”. Il riassorbimento osseo periprotesico a medio-lungo termine, che si sviluppa principalmente a livello della porzione
metafisaria prossimale di femore, rappresenta uno dei maggiori
rischi di fallimento dell’impianto. Per lo studio in vivo di tale
fenomeno la Moc DEXA viene descritta in letteratura come la
metodica più sensibile nel rilevare anche le minime variazioni di
densità ossea già in fase precoce (> del 3-4%), al contrario della
RX che rileva variazioni di densità solo se >del 30-40%. Lo scopo
di questo studio è valutare gli effetti esercitati dallo stelo corto
con conservazione di collo a presa metafisaria BBraun Metha
sulla densità ossea priprotesica in tutte le 7 aree di Gruen, così
da definire il trend che questo stelo esercita sul riassorbimento
osseo periprotesico. Tale valutazione può predire la longevità e
la stabilità dell’impianto a lungo termine. A tale proposito, i pazienti
sono stati valutati con un follow-up densitometrico, clinico
e radiografico segnalando le alterazioni evidenziate nel corso di
48 mesi.
Materiali e Metodi: In accordo con i criteri di inclusione e di
esclusione prestabiliti, 20 pazienti (10 uomini e 10 donne) con
età media di 59 anni (range 43-74), sono stati arruolati nello studio.
Tutti i pazienti sono stati operati dallo stesso chirurgo e con
la medesima via d’accesso (Accesso postero-laterale secondo
Gibson-Moore). Tutti sono stati valutati clinicamente (Harris Hip
Score e Womac Score), radiograficamente (Rx in AP e in LL) e
tramite Dexa (7 zone di Gruen) secondo un protocollo definito:
a T0 (entro sei mesi dall’impianto), a T12 (dopo 12 mesi dall’impianto)
a T24 (dopo 24 mesi dall’impianto) a T36 (dopo 36 mesi
dall’impianto) a T48 (dopo 48 mesi dall’impianto).
Risultati: Harris hip score (HHS) e il Womac score sono migliorati
significativamente. Radiograficamente non si sono verificate
aree di radiolucenza in tutti i controlli. Abbiamo avuto 2 casi di
calcificazioni visibili radiograficamente, ma clinicamente non rilevanti.
Nessuno stelo è stato revisionato. Non si sono verificati
episodi di lussazione. Non sono state documentate infezioni. Il
BMD periprotesico da T0 a T48 ha mostrato il seguente andamento:
(R1 aumentato da 0.73 g/cm2 a 0.73 g/cm2; R2 aumentato
da 1.3 g/cm2 a 1.49 g/cm2; R3 aumentato da 1.57 g/cm2
a 1.64 g/cm2; R4 aumentato da 1.57 g/cm2 a 1.59 g/cm2; R5
aumentato da 1.52 g/cm2 a 1.68 g/cm2; R6 aumentato da 1.29
g/cm2 a 1.52 g/cm2; R7 è lievemente calato da 1.07 g/cm2 a
1.02 g/cm2).
Discussione: Dopo un follow-up a lungo termine di 48 mesi è
possibile affermare che il trend del BMD periprotesico è stato
positivo in tutte le aree di Gruen ad eccezione della zona del
Calcar (R7), evitando il riassorbimento delle aree prossimali metafisarie
che potrebbe a lungo, minare la stabilità e la longevità
dell’impianto stesso. Si evidenzia inoltre che i cambiamenti della
densità ossea periprotesica si sono verificati principalmente dal
24 mese in poi. Risultati statisticamente significativi (Wilcoxon
signed-ranks test, P<0.05) si sono documentati nelle regioni R5
e R6 a 24, 36 e 48 mesi.
Conclusioni: Lo stelo Metha® quindi, grazie alla presa metafisaria
con conservazione del collo, riesce a ridurre il riassorbimento
periprotesico prossimale tipico degli steli lunghi tipo Zwiemuller,
prospettando una maggior longevità dell’impianto stesso.
Purtroppo però è stata riscontrata, dal confronto dei nostri
risultai coi risultati di altri studi presenti in letteratura, una discreta
variazione dei valori densitometrici in base all’orientamento dello stelo (in varo e in valgo), evidenziandosi una variabilità dei risultati
operatore dipendente. Secondo il nostro studio, quindi si
può concludere che lo Stelo Metha® BBraun dopo 48 mesi di
follow-up ha influenzato positivamente il riassorbimento osseo
periprotesico specialmente nelle aree più prossimali anche se i
valori Dexa possono essere influenzati dal diverso orientamento
dello stelo operatore dipendente. Quindi, si dimostra una protesi
sicura e presumibilmente longeva, ma difficile e variabile in base
alle capacità del chirurgo
ACL reconstruction with LARS artificial ligament: review and results at medium term follow-up
No full textIs the Combination of Platelet-Rich Plasma and Hyaluronic Acid the Best Injective Treatment for Grade II-III Knee Osteoarthritis? A Prospective Study
No full textBackground. Knee osteoarthritis is a common disease with increasing incidence and prevalence in western countries. It can cause severe pain and functional limitations, thereby representing a threat for patients' quality of life and a burden for national health systems. Intra-articular injections with hyaluronic acid (HA) and platelet-rich plasma (PRP) have been used for decades in order to reduce the symptoms caused by osteoarthritis. In recent years, a combination of HA and PRP has been introduced in clinical practice with the aim to minimize the clinical presentation of osteoarthritis and potentially delay articular degeneration. Materials and Methods. Sixty cases with grade II-III knee osteoarthritis according to the Kellgren-Lawrence classification were included in a prospective study, focused on the evaluation of clinical and functional outcomes after intra-articular knee injections. Cases were randomly divided into three groups. Twenty cases (Group A) were injected with HA, 20 (Group B) had PRP, and the remaining 20 (Group C) received a combination of HA and PRP. Basal WOMAC score and VAS score were recorded before the treatment and repeated within 3 and 6 months after the treatment. Results. At 6-month follow-up, Group C (PRP + HA) was the one with the lowest WOMAC and VAS mean values. It was also the only group that reported a reduction in the two values both in the first three months and in the following three months. No major complication was recorded. Conclusion. The combination of platelet-rich plasma and hyaluronic acid can be effective in the treatment of grade II-III knee osteoarthritis in a short-to-mid-term scenario. It represents an innovative and valuable alternative to the administration of its two components alone
Bibliographie Hilarion G. Petzold 1958 – 2009 mit Anhang als Einführung
No full textDieses Archiv enthält die Gesamtbibliographie der Werke des Autors nebst einiger Texte „Über H. G. Petzold“ im Schlussteil der Bibliographie sowie einen Anhang mit einer Einführung in die Architektur des Werkes in seinem wissenslogischen Aufbau als Ausarbeitung seines „Tree of Science Modells“ (2007).This archive contains the complete bibliography of the author and some texts about H. G. Petzold, moreover an epilogue with an introduction to the architecture of the works in its epistemological structure and composition and as an elaborations of Petzold’s „Tree of Science Modell (2007).https://www.fpi-publikation.de/polyloge/01-2009-petzold-h-g-gesamtbibliographie-h-g-petzold-1958-2009-updating-november2009/peerReviewedpublishedVersio
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