Recently the evolution of prosthesis technology allows the surgeon to replace entire limbs. These special prostheses or megaprostheses were born for the treatment of severe oncological bone loss. Recently, however, the indications and applications of these devices are expanding to other orthopaedic and trauma situations. Since some years we are implanting megaprostheses in non-oncological conditions such as septic post-traumatic failures represented by complex non-unions and critical size bone defects. The purpose of this study is to retrospectively evaluate the clinical outcome of this treatment and register all the complications and infection recurrence. Between January 2008 and January 2016 we have treated 55 patients with septic post-traumatic bone defects In 48/55 cases we perform a 2 steps procedure: 1° step: resection, debridment, devices removal and antibiotic spacer implantation; 2° step: spacer removal and megaprosthesis implantation. In 7/55 patients in whom all the femur was infected, we performed a one step procedure by the complete removal of the femur and a megaprosthesis (Total Femur) implantation.INTRODUCTION
MATERIAL AND METHOD
Various anti-infective agents can be added to the surface of orthopaedic implants to actively kill bacteria and prevent infection. Silver (Ag) is a commonly used agent in various anti-infective applications. Silver disrupts bacterial membranes and binds to bacterial DNA and to the sulfhydryl groups of metabolic enzymes in the bacterial electron transport chain, thus inactivating bacterial replication and key metabolic processes. Recently we are implanting Silver coated megaprosthesis for the treatment of post-traumatic septic non unions/bone defects and for infected hip or knee prosthesis revision. We treat these complications utilizing a two steps procedure: 1° step: devices removal, resection, debridment and antibiotic spacer implantation; 2° step: spacer removal and megaprosthesis implantation. This technique produce a reactive pseudosynovial membrane, well known in traumatology (Masquelet technique), following the Chamber Induction Technique principles. This chamber creates the perfect environment in which implant the prosthesis with safety. We are nowadays investigating if this membrane could optimize the Silver antimicrobical effects reducing the Silver ions dispersion and reducing toxicity on the human body. The aim of this study is to perform a review of the literature about Silver coated implants in Orthopaedics and Trauma and to analyze our cases treated with this implants in order to measure their efficacy and the ion dispersion in urine and blood.Introduction
Objectives
Throughout the world the number of large joint arthroprosthetic implants continues to increase and consequently the number of septic complications with prosthesis mobilizations, periprostehtic bone loss or non-unions. The implant of large resection prosthesis (megaprosthesis) in selected patients could be a good solution both in hip and knee infected prosthesis with bone defects. The two stage techniques with a first operation to debride, prosthesis components removal and antibiotic spacer implantation followed by a subsequent final prosthetic implant offer great results even in highly complex patients. The purpose of this study is to evaluate retrospectively the outcome after the implantation of megaprosthesis of the lower limbs in prosthetic infected revision.Introduction
Objectives
In orthopaedics one of the most common complications is infection. The occurrence of a postoperative infection significantly increases the failure rate; both in the case of prosthetic and trauma surgery. Some patients despite a meticulous antiseptic procedures, a close monitoring of controls peri- and post-operative undergo the development of infection of the fixation devices with the risk of developing osteomyelitis. This risk is highly increased in the distal leg because of the known problems with blood supply and poor muscle coverage. The functionality of the affected segment is impaired, quoad fuctionem, with increased risk of amputation and sometimes with poor prognosis, quoad vitam. The therapeutic strategy proposed by our group is to treat an osteomyelitic site as a pseudo-tumor with a megaimplant following a ladder strategy driven by the NUSS classification. This work shows our experience with a developing system by Waldemar-LINK highlighting critical issues and preliminary results. The purpose of this study is to evaluate retrospectively the early outcome after the implantation of this megaprosthesis of the lower leg in infected post-traumatic bone defects and septic peri-device bone loss. We registered all the complications and infection recurrence.Introduction
Objectives
The hip arthroplasty implant is currently growing up both in orthopedic and trauma practice. This increases the frequency of prosthesis revision due to implant loosening often associated with periprosthetic osteolysis that determine the failure and lead to a loss of bone substance. Nowadays there are numerous biotechnologies seeking to join or substitute the autologous or omologous bone use. These biotechnologies (mesenchymal stromal cells, growth factors and bone substitutes) may be used in such situations, however, the literature doesn't offer class 1 clinical evidences in this field of application. We performed a literature review using the universally validated search engines in the biomedical field: PubMed / Medline, Google Scholar, Scopus, EMBASE. The keywords used were: “Growth Factors”, “Platelet Rich Plasma”, “OP-1”, “BMP”, “BMP-2”, “BMP-7”, “Demineralized Bone Matrix”, “Stem Cell”, “Bone Marrow”, “Scaffold”, “Bone Substitutes” were crossed with “hip”, “revision”, “replacement” / “arthroplasty”, “bone loss” / “osteolysis.”INTRODUCTION
MATERIALS AND METHODS
Our department is responsible specifically for complex cases resulting from trauma. Our experience does not want to add what has been clearly demonstrated by multicenter studies on the efficacy of rivaroxaban but aims to demonstrate how the use of this molecule was effective also in mega-prosthesis and how it has proven to be flexible and safe in dealing with difficulties and surgical complications more common in such difficult cases. From January 2010 to date DVT prophylaxis in THR / TKR and revision was routinely performed with rivaroxaban. To date, in addition to first implant/revision in THR/TKR we treated over 30 cases of large segments replacements (large segments+mega-prosthesis) and we have not highlighted complications attributable to rivaroxaban.Introduction
Materials and Methods
The development of new megaprosthesis for the treatment of large bone defects has offered important opportunities to orthopedic oncologic surgeons for the replacement of skeletal segments such as the long bones of the upper and lower limbs and the relative joints. Our experience, treating non union and severe bone loss, has brought us, sometimes, to be confronted with the reality of some failures after unsuccessful attempts to reconstruct. Faced with certain radiological and / or clinical drastic situations we wanted to apply the principles of Biological Chamber and oncologic surgery with megaprosthetic replacement solutions. We implanted megaprosthesis with either 1 step or 2 steps (previous antibiotated spacer) technique depending on the septic patient conditions. The aim of this study is to retrospectively evaluate both clinical and radiological outcomes in patients underwented to a lower limb megaprosthesis implant and complications were recorded. In total, we treated 58 patients with megaprosthesis mono-and bi-articular subdivided as follows: proximal femur, distal femur, proximal tibia and total femur. The mean follow-up of patients is about 24 months (5 yrs max, min 6 months) with clinical and serial radiographic revaluations with standard methods (X-ray in 45 days, 3–6-12-18-24 months) as well as monitoring of blood parameters of inflammation for at least 2 monthsIntroduction
Materials and Methods
The development of new prostheses due to large resections has offered important opportunities to orthopedic surgeons mainly in oncology. A medline research can easily underline how poor is the international experience about this cases in nonunion: 75 results for megaprosthesis just 7 works in nonunion. It is proposed the experience of our department, which deals specifically with the treatment of nonunion, in cases of repeated failures to treatment. One of the most significant problems in the treatment of relapsing nonunion is the consequent worsening of joint function. Critical bone defects, sepsis, joint fractures and unclear relapsing nonunions are the most common cases for a megaprosthesis treatment. In these cases, even if it obtains the healing of nonunion the functional result would be presumptively poor. This radiological or clinical situation drove us, in such cases, to drastic solutions following the principles of cancer cases. We implanted megaprosthesis with either techniques: 1 stage or 2 stages depending on the clinical findings. In nonunion the main decision making was the septic or aseptic status. we treated 32 patients with megaprosthesis replacing the nearest joint to the nonunion segment or both the proximal e distal one as follows: proximal femur, distal femur, proximal tibia, and total femur. The mean follow-up of patients is 12 months (2 yrs max, min 3 months). Clinical and serial radiographic evaluations with standard methods (RX in 45 days, 3-6-12-24 months) was performed; as well as monitoring of blood parameters for 2 months.Introduction:
Materials and Methods:
A 980 nm Diode (Biolitec AG) Laser energy introduced via a 21G needle under C-arm or CT-Scan guidance and local anesthesia, vaporizes a small amount of nucleous polposus with a disc shrinkage and a relief of pressure on nerve root. The procedure in the disc herniation treatment over the years had several changes, not only related to the different types of lasers (Ho:YAG, Nd: YAG, Er:YAG), but also in the types of optical fibers employed and in the neuronavigation systems. In our department starting under C-arm, realized that the only way to visualize the nerve root and increase the total energy delivered in several points of disc herniation, was to use a CT-Scan guidance (Aquilion 64 Slices Toshiba).
In conclusion, CT-Scan guidance appear to be the best way to practice PLDD not only in terms of resolution, treating succesfully non contained disc herniation, but also because the visualization of the nerve root permits a safe application of the laser energy and the effectiveness of the procedure give a faster return to normal life.
