1,721,023 research outputs found
Assessment of the initial stability of the Symax femoral stem with EBRA-FCA: a multicentric study of 85 cases
No full textWe report a study of 85 Symax femoral stems that were followed at regular intervals with radiographs at 6, 12, 24 and 36 months. The radiological migration of each stem was measured using the computer-assisted EBRA -FCA method. In 30 cases in which the EBRA method did not provide a complete measurement another computer-assisted method (Roman version 1.7) was employed. In all cases the distal migration of the stems was minimal, The threshold migration value used to define the stability of a stem was 1.5 mm at 24 months. The mean migration within the first two years was -0.17 mm (+/- 0.3) at 6 months, -0.31 mm (+/- 0.4) at 12 months and -0.45 mm (+/- 0.5) at 24 months. Only two cases exceeded the threshold limit of 1.5 mm at the two-year follow-up, but both values were lower than 2 mm. In the 25 cases which reached three-year follow-up the mean distal migration was -0.84 (+/-0.7). In four of them the subsidence exceeded 1.5 mm, but only one exceeded 2 mm. These data represent a positive predictive factor for the minimal risk of future aseptic loosening
Bone Substitution in Spine Fusion: The Past, the Present, and the Future
No full textThe problem of bone fusion is of long duration, and the ideal solution has
not yet been found, in particular, in pathological conditions (nonunion,
osteomyelitis, critical size defects) in which the biological responses are
lower than normal. This is why recently basic research has been focused
on this field and new and innovative products have been introduced into
clinical practice. Spinal fusion can be defined as the bony union between
two vertebral bodies after surgical treatment. Bone fusion is the main
indication for spinal pathologies such as scoliosis, kyphosis, fractures,
dislocations, spondylolisthesis, and intervertebral discs disease. Each
year in the USA, more than 200,000 spine fusions are performed. From
1993 to 2001, the rate of cervical spine fusion increased to 433 %, while
the rate of thoracolumbar fusion increased from 52 to 352 %. Despite the
advances in surgical techniques and the increasing use of stabilization
systems, the incidence of nonunion for lumbar fusions remains high (10–
40 %) [1, 2]
Bone Substitution in Spine Fusion: The Past, the Present, and the Future.
No full textThe problem of bone fusion is of long duration, and the ideal solution has
not yet been found, in particular, in pathological conditions (nonunion,
osteomyelitis, critical size defects) in which the biological responses are
lower than normal. This is why recently basic research has been focused
on this field and new and innovative products have been introduced into
clinical practice. Spinal fusion can be defined as the bony union between
two vertebral bodies after surgical treatment. Bone fusion is the main
indication for spinal pathologies such as scoliosis, kyphosis, fractures,
dislocations, spondylolisthesis, and intervertebral discs disease. Each
year in the USA, more than 200,000 spine fusions are performed. From
1993 to 2001, the rate of cervical spine fusion increased to 433 %, while
the rate of thoracolumbar fusion increased from 52 to 352 %. Despite the
advances in surgical techniques and the increasing use of stabilization
systems, the incidence of nonunion for lumbar fusions remains high (10–
40 %) [1, 2]
Spine fusion: cages, plates and bone substitutes. Biomaterials for spinal surgery
No full textAbstract: Spine fusion is the surgical procedure to obtain bony union between two vertebrae, required in the treatment of many pathologies. The necessity for this procedure is increasing, and complications such as non-union remain high in spite of the great progress that has been made in recent years. Many surgical techniques have improved the effectiveness of this procedure in the past, involving very sophisticated techniques. Bone substitutes may enhance bone healing, though many are not especially effective. Bone grafts still remain the best option, but many concerns are raised about their safety, stockage, availability and properties. Synthetic bone substitutes were proposed as a resolution to this problem, but none of them have achieved the ideal standard. Growth factors are the ‘new’ expected ideal bone substitutes, but little is known about their function, and results are contradictory, except for BMP-2 and BMP-7 in spine fusion. This chapter will discuss these problems and evaluate the options and the advantages and disadvantages of bone substitutes that are available in spine fusion
Spine fusion: cages, plates and bone substitutes. Biomaterials for spinal surgery
No full textAbstract: Spine fusion is the surgical procedure to obtain bony union between two vertebrae, required in the treatment of many pathologies. The necessity for this procedure is increasing, and complications such as non-union remain high in spite of the great progress that has been made in recent years. Many surgical techniques have improved the effectiveness of this procedure in the past, involving very sophisticated techniques. Bone substitutes may enhance bone healing, though many are not especially effective. Bone grafts still remain the best option, but many concerns are raised about their safety, stockage, availability and properties. Synthetic bone substitutes were proposed as a resolution to this problem, but none of them have achieved the ideal standard. Growth factors are the ‘new’ expected ideal bone substitutes, but little is known about their function, and results are contradictory, except for BMP-2 and BMP-7 in spine fusion. This chapter will discuss these problems and evaluate the options and the advantages and disadvantages of bone substitutes that are available in spine fusion
Biomimetic Materials in Spinal Surgery: A Clinical Perspective
No full textThe biomaterials designed to replace the bone tissue are
indispensible in many medical and surgical fields. Often, spinal
surgery requires a large amount of bone tissue for bone fusion so
as to obtain a complete and stable correction over time. Autologous
grafts are still the gold standard, but their availability is limited.
The homologous bone tissue from the bank is a valid alternative,
but there are risks related to infectious diseases. The best solution
is to have an unlimited amount of “synthetic bone” without the
risk of transmissible diseases, but synthetic materials cannot
yet replicate the ability of bone tissue to be osteoconductive,
osteoinductive, and mechanically resistant. The science of
biomaterials is continuously evolving. In the last few years, there has been a progressive improvement of bone substitutes. In the
late 1990s, scientists developed some materials designed to
reproduce the chemical components of the inorganic matrix of the
bone, based using hydroxyapatite. Since then, research has taken
major steps forward in the development of artificial materials
that are very similar to bone from the biological point of view.
The aim was to “deceive” the area around the graft to accept it as
its own. This marked the beginning of the era of biomimetic
materials, of tissue engineering and of gene therap
Stemless hip prosthesis: notes of surgical technique
No full textIntroduction
The concept of minimally invasive hip replacement is based on the use of stemless prostheses and the use of surgical techniques with limited bone loss and maximum respect of the soft tissues.
Aim of the study
Evaluate the average bleeding related to the time of surgery and the correct positioning between two minimally invasive hip implants.
Materials and methods
We evaluated 41 patients, mean age 74 years, affected by primary hip osteoarthritis treated with stemless prosthetic implant. In 21 patients a Proxima (De-Puy-J & J) hip prosthesis was used, while in the remaining 20 one other stemless implant (Parva-Adler) was used. All surgeries were performed by the same surgeon. Patients were evaluated by blood count preoperatively and in the immediate postoperative period. The evaluation of the correct positioning of the implant was calculated by the radiographic cervico-diaphyseal angle. In all the cases, the duration of the procedure was registered (end-incision procedure) and evaluated in comparison with 19 cases of traditional stems surgeries (Synergy-S & N, Stryker ABG-, Mercurius-Adler).
Results
In patients treated with Proxima operative time was approximately 153 minutes, while in patients treated with Parva it was 140 minutes. The average time for the long stems was 142 minutes. The decrease in hemoglobin was 3.49 g / dl for Proxima, and 2.86 g / dl for the Parva.
In 11 of 21 patients treated with Proxima, cervical diaphyseal angle appeared slightly valgus (> 130 °), in the remaining corresponded to 130 °. In patients treated with Parva, 11 were considered to have a slightly valgus angle. No varus was found.
Discussion and Conclusions
The minimally invasive techniques are proving to be of great success. Stemless hip prosthesis allow, limited bone sacrifice. The disadvantages are represented by a greater operative time , and a longer learning curve.
Our study showed that surgical time was not statistically different between long stems and stemless prostheses, in experienced hands . Among the various minimally invasive stems studied , Parva ( Adler) showed fewer surgical time ( <13 min.) and blood loss (< 0.60 g / dl). Both stems were " respectful " of the anatomical cervical diaphyseal angle ensuring proper biomechanics and load distribution .
In conclusion, the implantation of hip stemless prostheses with minimally invasive technique , allows a correct positioning in a surgical time comparable to traditional stems . Differences between the two stemless implants (surgical time and blood loss) are related to the instrumentation and to the particular type of system , which results D in greater surgical complexity and a higher learning curve. In both cases, the conservative approach and the bone sparing , represent a real advantage , such as to justify their use
Proximal Humerus: Surgical Approaches
No full textTHE MOST COMMON SURGICAL APPROACHES IN PROXIMAL HUMERUS FRACTURE TREATMENT ARE DESCRIBED
Clinical and radiological outcomes and analysis of failures of modular revisions stems at long-term follow-up: a systematic review and meta-analysis
Full text linkBackground: Increasingly hip replacements at young age exposes the patient to an increased risk of failure of the implant over the years. In case of failure, revision specific stems were designed to overcome bone loss. Modularity of these devices is an important resource for the surgeon as they allow the new implant to be better adapted to the patient's anatomy. The purpose of this systematic review is to provide data about the outcome at long-term follow-up (>8 years) of hip modular revision femoral stems. Methods: This systematic review and meta-analysis were conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. PubMed and Google Scholar databases were systematically and independently searched, according to the inclusion and exclusion criteria. Two reviewers performed the data extraction independently. In case of disagreement, the senior authors were sought to resolve the divergences. Quality of the involved studies was evaluated with National Institute for Health and Care Excellence (NICE) guidelines (eight-item list) and the Newcastle-Ottawa scale (NOS). Primary and secondary outcomes were evaluated. The statistical analysis of this meta-analysis was performed by using Excel Microsoft and the software STATA.Results: The primary outcome was the re-revision rate of modular revision stems at long-term follow-up. It ranged from 1.4% to 45.6%: random effect pooled estimate was 5.5% [95% confidence interval (CI): 4% to 7%], with a I2 of 12.3% (P=0.332). Mean Harris Hip Score (HHS) was 83 [min: 79; max: 87.6; standard deviation (SD): 3.55]. Secondary evaluated outcomes were: subsidence >5 mm, rate of periprosthetic infection or fractures (intra -and post-operative) and dislocations. The mean value for the NICE tool was 5.5 (SD: 1.13) and 7.3 (SD: 0.79) for the NOS tool. The survival rate was >90% at long-term follow-up (min: 60%; max: 97%).Conclusions: The modular femoral revision stems have demonstrated good long-term reliability and efficacy. This meta-analysis demonstrates that the re-revision rate after 8 years of follow-up is low and 90% of the implants did not fail
Stemless hip arthroplasty versus traditional implants: a comparative observational study at 30 months follow-up
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