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Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_IV | Pages 431 - 431
1 Apr 2004
Croce A Brioschi D Borgo E Milani R Nella S
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In this work we mean explain our clinical experience about the use of a T.R.K. mobile meniscal bearing implanted during the 2000 and 2001 in our institute. The prostheses design allows the motion of the polietilenic component 5mm in the anteroposterior directions and 12.5 degrees in the internal and external rotation.

In association with the shaping of the femural contact surfaces this design allows a huge upgrade of contact surfaces compared with other protheses already in use. We have evaluated 17 patients on short term follow up, patients operated in our division, four males and 13 females. The average ages are 68 ± 8.

The indication was in all cases gonartrosis. The evaluation protocol includes:

§ Pre and post operative x rays (after 60 days);

§ Clinical evaluation of the range of motion;

§ D.E.X.A. mineralometry;

§ Stabilometric evaluation pre operative and after 6 months.

The first results have pointed out the disappearing of pain in all the patients, an optimal recovering of the articular function with no loss of extension, a good prothesic osteointegration (even in an initial phase in our cases) and the stabilometric evaluation confirms a soon proprioceptivity recovering and the motion of the operated limb.

After all this encouraging results we have decided to continue implanting this kind of protheses as we think that not only it warrants a better range of motion, but the utmost null polietilenic debris may allows a longer life to the implant as a consequence of the reduced stress rate.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_IV | Pages 432 - 432
1 Apr 2004
Croce A Brioschi D Borgo E Milani R Nella S
Full Access

The great diffusion of total hip replacement in young patients has generated as a consequence an increasing in the number of prothesic failing associated with more or less extended bone loss. We mean analyze the various surgical solution to this problem. In the planning of the best surgical treatment the evaluation of the degree of osteolysis is the more correct technique; in fact we have supported the classical radiological exams with the miralometry as DEXA (supplying quantitative data on the periprotesic bone stock). Data obtained in this way allow choosing more carefully the best protheses in the preoperative planning: mid or long stem, with or without bone graft, with or without materials which may promote a bone rehabilitation. Anyway the surgeon should have all the possible protheses solutions as it happens to change the operative plan during the operation. These are the criterion of choice of the revision protheses, keepin’ in consideration data acquired by D.E.X.A.:

GIR 1 (loosening and or widing of the femural shaft with reducing of the cortical without interruption of walls): If the mobilized protheses is uncemented and DEXA supplies datas about a good bone stock we try to use a first implant uncemented protheses

GIR 2 (widing of the femural shaft with reducing of the cortical with interruption of one wall): In these cases we use two kind of protheses anatomical or not with an oversized stem which increases the stability of the implant.

GIR 3 (widing of the femural shaft with reducing of the cortical with interruption of two or more walls): In this cases we prefer using a long stem straight protheses, unless there is an increase of the osteolitic lesion; this protheses allows a stable anchorage thanks the optimized lenghts thus opposing to the rotational strenghts and allowing the transmission of translational strenghts both in the proximal and in the distal direction. The new calcar shape assure better adapting to the bone stock. With the increase of the osteolitic region, according to Wagner’s criteria, we have to change plan in orther to find a better anchorage. In fact SL Wagner protheses regains the coesion with the rehabsorbed bone cavity thus creating a relative stability in the immediate post operatory. Lately a high osteodeformation fills in the bone lacks. For this reason the muscolar insertion shouldn’t be receded around the thick cortical. This uncemented revision stem get anchored through a distal anchorage guaranteed by the conical shape, the stem is straight. The pre operative planning is compulsory in order to evaluate the measure of the osteotomic cut.

GIR 4 (massive proximal circumferential bone loss). In the past, in case of complete femoural osteolisys the gold standard was the implant of great resection tumoral-cemented Muller’s stem as well as Kotz’s uncemented stems.

Kotz’s design, on the bases of follow up studies, seem to support Wagner’s theories about the distant anchorage: There is an attempt of periprothesic corticalization even though the huge bone loss. In the last years we have performed a revision modular distally anatomic stem characterized by a metafi sarial leaning on the proximal component.

The weight bearing is progressive on the base of the radiological evolution and DEXA as well. The complete bearing will be allowed only after a sufficient bone restoration.

In our experience uncemented protheses in the stem revision can allow in mid and long term good results expecially keeping in consideration that these patients had already coxofemural problems. The range of motion is difficulty improvable so the results must be weighted on the bases of the previous clinical situation. If patients are monitored in order to operate as soon as possible in case of mobilization, the use of uncemented protheses can be a valid way for the functional recovering of these patients.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_IV | Pages 431 - 431
1 Apr 2004
Croce A Brioschi D Borgo E Milani R Nella S
Full Access

The pre operative evaluation of the degree of osteolisys in cotyle revision in a prothesis is very important in order to plan the best surgical treatment.

In these cases above the traditional radiological and scintigrafic exams we have achieved a evaluation techniques bases on D.E.X.A. This technique allows obtaining data on the periprotheses bone stock. These are the criterion of choice of the revision protheses, keepin’ in consideration data acquired by D.E.X.A.:

GIR 1 (loosening and acetabular widing with persistence of walls). If the cotyle is uncemented and the biological age of the patient allows, we use to treat with a first implant press fit uncemented cotyle.

GIR 2 (loosening and acetabular deformation with losing a wall): uncemented with or without screws or conical screw first implant cotyle.

GIR 3 (loosening and acetabular deformation with losing of one ore more columns and the bottom): oval cotyles with or without bone grafts.

GIR 4 (massive periacetabular loss): oval review components with peripheral supports and obturatory ring, associated or not with bone grafts. As extrema ratio we use a McMinn cotyle.

Conclusions: As a conclusion we can maintain that these indication may supply satisfactory datas thanks to the deep pre operative evaluation by DEXA. We have to keep in consideration that this pathology must be considered urgent: as soon as the operation is achieved the better bone stock will be available to the surgeon. The use of many kind of uncemented cotyle allows us, today more than ever, to restore the correct center of rotation without the risk of further mobilizations.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_I | Pages 3 - 3
1 Jan 2004
Croce A Brioschi D Nella S Borgo E
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The actual data about prevalence of knee osteoarthritis, the concurrent increasing of mean age and therefore the high social costs for the care of this pathology, make particularly important to do the correct choice in knee artroprosthesis. In this work we mean compare three different type of knee prostheses implanted in our institute. We have evaluated 120 patients (98 females, 22 males) treated with TKR in I° Orthopaedic Division of Istituto Ortopedico “Gaetano Pini” – Milano. All patients were affected by primary knee osteoarthritis of high degree and 3 groups were made due to the type of prosthesis implanted.

Our evaluation protocol includes: 1. Local objective examination and evaluation of Range of Motion (R.O.M.); 2. Subjective functional questionnaire (Lequesne Index modified for knee osteoarthritis); 3. Stabilometric evaluation for Proprioceptive knee structures (KAT-2000 Breg Inc. USA); 4. Standard X-Ray, both in AP and lateral planes, with patient in standing position.

The X-Ray controls showed no early mobilisations or malfitting of all implants. In consideration of the short follow-up period we have to do a continuous monitoring for at least 5 years to express a definitive evaluation of implant stability; significatively better results regarding the post-op R.O.M. and subjective results with Lequesne Index have been obtained with the use of mobile plate prosthesis.

The first results have pointed out better results in the use of a fully mobile plate prosthesis, compared with the other results using rotating and fixed plate prostheses.

In our opinion this is obtained through the research of a better reproduction of human anatomy and trying to respect the common kinematics of knee, which has to be the future objective in design and technical development of knee arthroplasty.