The analysis of synovial fluid has proved to be of crucial importance in the diagnostic process of prosthetic joint infections (PJI), suggesting the presence of an infection before the microbiological culture results. In this context, several studies illustrated the efficacy of synovial calprotectin in supporting the diagnosis of PJI [1, 2]. However, several testing methods have been explored to detect synovial calprotectin levels, emphasizing the need to use a standardized, rapid and rapid test. In this study, synovial calprotectin was analyzed by means of a commercial stool test [3] to explore whether the detected levels might predict PJIs and, therefore, being a promising tool for the fast and reliable diagnosis of this complication. The synovial fluid of 55 patients underwent to revision of the prosthetic implant were analyzed. The measurement of calprotectin was carried out by of commercial stool test, following the protocol for liquid samples. Calprotectin levels were then compared to other synovial biomarkers of PJI such as leucocyte esterase and count and percentage of polymorphonuclear cells. Data analysis were performed using R software v4.1.1 (R Core Team) and package “pROC” [4]. Receiver operator characteristics curves were designed using culture test as gold standard to evaluate the area under curve (AUC) of each method (with DeLong method for confidence-interval calculation). Thresholds were calculated to maximize Youden's index; sensitivity and specificity were reported. One-to-one Pearson's correlations coefficient were calculated for each pair of methods. P value <0.05 were considered statistically significant.Aim
Method
Total shoulder replacement is a successful treatment for gleno-humeral osteoarthritis. However, components loosening and painful prostheses, related to components wrong positioning, are still a problem for those patients who underwent this kind of surgery. CT-based intraoperative navigation system is a suitable option to improve accuracy and precision of the implants as previously described in literature for others district. Eleven reverse shoulder prostheses were performed at Modena Polyclinic from October 2018 to April 2019 using GPS CT-based intraoperative navigation system (Exactech, Gainsville, Florida). In the preoperative planning, Walch classification was used to assess glenoid type. The choice of inclination of the glenoid component, the screw length, as well as the inclination of the reamer was study and recorded using specific software using the CT scan of shoulder of each patient (Fig.1, Fig.2). Intraoperative and perioperative complications were recorded. Three patients were male, eight were female. Mean age was 72 years old (range 58=84). Three glenoid were type B2, six cases were B1, two case were type C1.Introduction
Method
Septic knee prosthesis revision is particularly challenging either for the eradication of the infection and for functional recovery of the patient. 18 patients treated from year 2000 to 2003, treated according to the same medical and surgical protocol have been reviewed. In all cases the following steps have been followed:
- removal of the septic prosthesis, debridement and implant of an articulated pre-formed cement spacer; - at 2 months, removal of the spacer and implant of a modular PFC knee revision prosthesis; - when appropriate osteotomy and synthesis of the anterior tibial tuberosity; - double antibiotic therapy, parentheral and oral, for 2 months after the first and after the second stage procedure. At a mean 18 months follow-up, we observed:
- no infection recurrence in all cases (one patient is lost to follow-up); - range of motion: flexion 73° +− 25°, extension – 5° +− 3°; - 1 dislocation of the articulated spacer; - 1 femoral fracture. Two-stage septic knee prosthesis revision, according to a the described protocol, allows to obtain high infection eradication rate and acceptable functional recovery, in the medium term follow-up.
A modular neck allows to choose the offset of the femoral head and the degree of anti-retroversion, lateralization and varus-valgus intraoperatively. At the G. Pini Institute we have been using modular necks in custom prostheses since 1989. Excellent results in this application did open the way to a larger use in off-the-shelf prostheses. Modular necks can be now coupled with different stems, leaving the surgeon free to use the preferred prosthetic stem design. Modular necks have been implanted in more than 50,000 in the world. Medium term results in custom prosthesis and the experience in off-the-shelf non-cemented stems are presented, together with further improvements of this technology under study. From 1989 to December 1999, 481 custom stems have been implanted. All patients but ten received modular necks. The prostheses were made of a titanium alloy and HA coated. 61 % of patients had dysplastic oxarthrosis. 372 implants performed between 1989 and 1996 were retrospectively evaluated. Data from off-the-shelf prosthesis, at a shorter follow-up, are also reported. Laboratory data showed that the use of an elliptical Morse cone of the neck reduced wear debris production to less than 1 mg/year. In custom implants, (mean follow-up: 7 years), we did not observe any thigh pain or radiological signs of osteolysis or fretting. Mean leg-length discrepancy was 2.8 cm pre-op and 0.3 cm post-operatively. Off-the-shelf implants also showed good clinical and radiological results. New design modular necks will increase the possible range of motion and provide more solutions for positioning the center of rotation. Modular neck is a safe and reliable solution to obtain the correct position of the center of rotation intra-operatively, without side effects. Applications in off-the-shelf prostheses allow to reduce costs while maintaining the advantages of this technology.
