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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_5 | Pages 93 - 93
1 Apr 2018
Boffano M Pellegrino P Ratto N Giachino M Albertini U Aprato A Boux E Collo G Ferro A Marone S Massè A Piana R
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Introduction and Purposes

Custom made acetabular prosthesis are a valid option for the reconstruction after the resection of pelvic tumors. They should guarantee a stable and reliable reconstruction for the expected survival of the patient. Nevertheless in many cases periacetabular metastatic lesions have been compared to high grade (IIIA-B) Paprosky defects, but treated with low or intermediate longevity implants. Some complex post-traumatic scenarios or total hip arthroplasty (THA) multiple failures need a reconstruction according to oncologic criteria to fill in the huge defect and to obtain an acceptable function. The aim of the study is to compare 3D custom-made implants for tumors and for THA failures.

Materials and Methods

Three custom-made implants after tumor resection (group A: 1 chondroblastic osteosarcoma, 1 bifasic synovialsarcoma, 1 high grade chondrosarcoma) were evaluated and compared to 3 acetabular complex reconstructions after non-oncologic bone defect (group B: 3 cases of aseptic loosening after at least 2 revisions). All the implants were case-based designed, 3D printed, and realized with porous or trabecular surfaces on a Titanium base prosthesis. Age range 16–70 ys in oncologic patients and 60–75 ys in non-oncologic patients. The bone defect to be reconstructed after tumor resection was classified according to Enneking zones (1 type 1-2-3 resection, 1 type 2 resection, 1 partial type 2 resection). Non-oncologic cases were comparable in term of remaining bone stock and classified according to Paprosky classification for acetabular defects as 1 type IIIA an 2 type IIIB. Complications, MSTS functional score, necessity of walking-aids were evaluated at minimum follow up of 1 year.


Bone & Joint Research
Vol. 6, Issue 5 | Pages 307 - 314
1 May 2017
Rendon JS Swinton M Bernthal N Boffano M Damron T Evaniew N Ferguson P Galli Serra M Hettwer W McKay P Miller B Nystrom L Parizzia W Schneider P Spiguel A Vélez R Weiss K Zumárraga JP Ghert M

Objectives

As tumours of bone and soft tissue are rare, multicentre prospective collaboration is essential for meaningful research and evidence-based advances in patient care. The aim of this study was to identify barriers and facilitators encountered in large-scale collaborative research by orthopaedic oncological surgeons involved or interested in prospective multicentre collaboration.

Methods

All surgeons who were involved, or had expressed an interest, in the ongoing Prophylactic Antibiotic Regimens in Tumour Surgery (PARITY) trial were invited to participate in a focus group to discuss their experiences with collaborative research in this area. The discussion was digitally recorded, transcribed and anonymised. The transcript was analysed qualitatively, using an analytic approach which aims to organise the data in the language of the participants with little theoretical interpretation.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_3 | Pages 48 - 48
1 Feb 2017
Boffano M Albertini U Marone S Boux E Ferracini R Pellegrino P Mortera S Manfrini M Piana R
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Introduction

The reconstruction of the knee in growing children considers many options and the chosen solution is often patient (or surgeon) based. Megaprostheses represent a reliable solution but quite expensive in the non-invasive growing version and not free from complications. In an Italian reference center for Bone and Soft tissue sarcomas, following the experience of Rizzoli Institute in Bologna, we performed the reconstruction with a resurfaced allograft for the distal femur or the proximal tibia in selected patients. The aim of the study is to confirm the reliability of this technique and to identify its potential advantages and indications.

Methods

Among 60 children below 16 years old with bone sarcomas (39 osteosarcomas, 21 Ewing's sarcomas, age range 4–16) treated since 2007, 35 cases were around the hip and the knee. 7 pediatric knees (age range 5–12 ys) with the tumor involving the epiphysis were reconstructed using a resurfaced allograft for distal femur (2) or proximal tibia (6) leaving intact the other half of the joint. Functional outcome (MSTS score), complication rate, and oncologic follow up were evaluated.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 83 - 83
1 Jul 2014
Bistolfi A Bracco P Banche G Allizond V Boffano M Cimino A del Prever EB Cuffini A
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Summary

Prosthetic UHMWPE added with vitamin E and crosslinked UHMWPE are able to decrease significantly the adhesion of various bacterial and fungal strains limiting biomaterial associated infection and consequent implant failure.

Introduction

Polyethylene abrasive and oxidative wear induces overtime in vivo a foreign-body response and consequently osteolysis, pain and need of implant revision. To solve these problems the orthopaedic research has been addressed to develop new biomaterials such as a crosslinked polyethylene with a higher molecular mass than standard Ultra High Molecular Weight Polyethylene (UHMWPE), and consequently a higher abrasive wear resistance and an antioxidant (vitamin E)-added UHMWPE to avoid oxidative wear. Nevertheless a feared complication of implant surgery is bacterial or fungal infection, initiated by microbial adhesion and biofilm formation, and related to the biomaterial surface characteristics. Staphylococci are the most common microorganisms causing biomaterial associated infection (BAI), followed by streptococci, Gram-negative bacilli and yeasts. With the aim to prevent BAI, the purpose of this study was to evaluate the adhesion of various microbial strains on different prosthetic materials with specific surface chemical characteristics, used in orthopaedic surgery.


The Bone & Joint Journal
Vol. 96-B, Issue 4 | Pages 497 - 501
1 Apr 2014
Banche G Allizond V Bracco P Bistolfi A Boffano M Cimino A Brach del Prever EM Cuffini AM

We have assessed the different adhesive properties of some of the most common bacteria associated with periprosthetic joint infection on various types of ultra high molecular Weight Polyethylene (UHMWPE). Quantitative in vitro analysis of the adhesion of biofilm producing strains of Staphylococcus aureus and Escherichia coli to physically and chemically characterised standard UHMWPE (PE), vitamin E blended UHMWPE (VE-PE) and oxidised UHMWPE (OX-PE) was performed using a sonication protocol. A significant decreased bacterial adhesion was registered for both strains on VE-PE, in comparison with that observed on PE, within 48 hours of observation (S. aureus p = 0.024 and E. coli p = 0.008). Since Vitamin E reduces bacterial adhesive ability, VE-stabilised UHMWPE could be valuable in joint replacement by presenting excellent mechanical properties, while reducing bacterial adhesiveness.

Cite this article: Bone Joint J 2014;96-B:497–501.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 443 - 443
1 Jul 2010
Albertini U Piana R Gino G Boux E Marone S Boffano M Linari A Faletti C del Prever EB
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Giant cell tumor (GCT) of bone is an aggressive tumor with high rate of recurrence. Bad prognosis factors were inquired, without a definite identification: type of treatment, soft tissue invasion, high proliferation rate at histology, pathologic fracture.

From January 2000 to February 2008, 38 patients affected by GCT were treated in a regional reference centre, 17 male, mean age 32 (range 16–69, median 29); one patient had 2 localizations (tarsal bone and proximal tibia); 3 were recurrences previously treated in other hospitals. Seven cases were in upper limb, 1 case in the sacrum, 30 in lower limb (20 around the knee); fracture at presentation was present in 6 cases; bone aneurismal cyst (ABC) was associated in 4 cases. Five cases in stage 3 were treated by bone resection followed in 4 cases by allograft and/or prosthesis (no reconstruction in 1 proximal fibula excision); 33 cases were treated by curettage, local chemical (phenole) and mechanical adjuvants (burring), filling with bone grafts in 13 cases, cement in 8 cases, cement and allografts in subchondral area in 11 cases. The sacral lesion was only curetted.

Seven patients developed a local recurrence, in 2 patients twice, for a total of 9 recurrences (19% of treatments). Recurrences occurred in 2 proximal tibia, in 2 distal femurs, in 1 proximal femur, in 1 distal radius and in 1 proximal fibula. The first treatment was bone grafts in 3 cases (23% of recurrence), bone cement and grafts in 2 cases (18% of recurrence), cement in 1 case (12% of recurrence), resection in the proximal fibula with severe soft tissue invasion. Two patients with associated ABC developed a recurrence and two with fracture at presentation.

In this study, increased rate of recurrences occurred with pathologic fracture at presentation, soft tissue invasion and ABC association.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 273 - 274
1 May 2009
del Prever EB Biondi A Bracco P Bistolfi A Boffano M Costa L
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Introduction: Packaging of Muscolo-Skeletal Tissues (MST) stored at −80°C must assure safety and sterility in order to minimize any risk of bacterial contamination and/or mechanical failure. Polymeric bags demonstrated problem of integrity at −80°C; gamma ray sterilisation induce oxidation decreasing mechanical properties, whereas Ethylene Oxide (EtO) does not. Antioxidant biocompatible additive, as Vitamin E, could improve mechanical resistance.

Objectives: Based on a previous paper presented at EATB 2005 congress, to analyse mechanico-chemical properties of plastic bags routinely used in MST Banks and new samples in order to identify and solve possible problems arising from the chemical composition and/or sterilisation.

Materials and Methods: Five different polymeric sterile bags used in three International Banks (three gamma and two EtO sterilised) and four experimental sample, manufactured on purpose from a Linear Low Density PolyEthylene (LLDPE) 150 microns thick films (EtO and e-beam sterilised), two added of Vitamin E, were analysed. Impact resistance was evaluated both on frozen and unfrozen material (in oven at 37°C); results were related to chemical composition, Tg, sterilisation and Fourier Transformed InfraRed Spectroscopy (FTIR).

Results: Three samples routinely used (one gamma and one EtO) showed severe macroscopic modification (glassy behaviour) at frozen temperature with no resistance to any mechanical stress Two samples (EtO) did not resist to mechanical tests at frozen state. The four experimental LLDPE, EtO and e-beam sterilised, resisted to mechanical tests. FTIR analysis confirmed the chemical composition declared by the commercial film: pure LLDPE, without any toxic additive and LLDPE with vitamin E.

Discussion: Packaging must use polymers with adeguate glass transition temperature (Tg) in order to maintain at −80° the rubbery state, not stiff nor fragile (not to pass to glassy state). High energy radiation oxidize polymer and decrease their mechanical resistance. LLDPE combine low Tg of the amorphous phase and low crystallinity, resulting in good mechanical properties at working temperature and at −80°C. Addition of Vitamin E protect against oxidation. EtO sterilisation does not modify the structure.

Conclusion: A LLDPE added of Vitamin E, sterilised by EtO and e-beam could improved packaging and storage of tissues at −80°C, with increased resistance to oxidation.