Publications (30)26.61 Total impact
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Article: La nuova coppa a stelo iliaco nelle revisioni acetabolari
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ABSTRACT: In case of revision of an acetabular component, it is difficult to get stable fixation if a serious loss of bone substance is present. Among proposed systems, the use of an acetabular component with an iliac stem seems to be a good solution. The stem, positioned along the physiological lines of load, allows a good primary stability by tranforming most of the tangential stresses into peaks of pressure, and so avoiding loosening. The stemmed-cup, then, allows an optimal restoration of the rotation centre, in association to the technique of impaction grafting. The grafts, if correctly pressurized, are not overloaded (and reabsorbed) but they integrate, recreating a good bone stock. In our retrospective study of 368 cases (92 for CDH), 276 revision cases have been re-examined with a high percentage of good results (93%). Despite the good clinical results reported in this and in other studies, the surgical approach is considered difficult and limits the use of this technique. Potential adverse events are damages to the sacro-iliac joint, intra-operatory fractures, false roads with perforation of the bone and therefore the risk of possible vascular damage. The introduction of a completely cannulated instrumentation, united to a correct operating technique, has shown that such fears can be considered unfounded.LO SCALPELLO-OTODI Educational 04/2012; 23(2):118-125. -
Article: Mid-term results of a custom-made short proximal loading femoral component.
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ABSTRACT: Bone preservation and physiological distribution of forces on the proximal femur are key elements in introducing a successful uncemented total hip replacement. In order to achieve this, in the mid 1990s, we developed an ultra short proximal loading custom-made component with a lateral flare, a high femoral neck osteotomy and without a diaphyseal stem. We report the outcome of 129 custom-made hydroxyapatite-coated uncemented short femoral components inserted into 109 patients between June 1995 and May 2004. The mean age of the patients was 51 years (21 to 71) and the mean follow-up was eight years (4.9 to 14.1). Bone behaviour around the implant was studied on the post-operative radiographs. The mean Harris hip score improved from 44 (8 to 66) pre-operatively to 95 (76 to 100) at final follow-up. The Western Ontario MacMaster University Osteoarthritis index was 93 of 100 at final review. None of the patients reported thigh pain. A total of five hips were revised, three for polyethylene liner exchange and two for complete revision of the acetabular component. No femoral components were revised. The radiological changes in the proximal femur were generally good, as evidenced by spot welds both on the medial and lateral aspects of the femur. No component migrated. The presence of a lateral flare and use of a high osteotomy of the femoral neck provided good clinical and radiological results. The absence of a diaphyseal portion of the stem did not impair stability.Journal of Bone and Joint Surgery - British Volume 09/2010; 92(9):1231-7. · 2.83 Impact Factor -
Article: Bone remodelling in THA: A comparative DXA scan study between conventional implants and a new stemless femoral component. A preliminary report.
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ABSTRACT: Periprosthetic bone loss is a major cause for concern in patients undergoing total hip arthroplasty (THA). There are many different factors that may determine the pattern of bone loss and bone remodelling following THA, such as the quality of the bone before the hip replacement, skeletal bone mass at the time of the operation, material and method of fixation and implant design. Recent developments in dual-energy X-ray absorptiometry (DXA) have made it possible to quantify bone mineral density (BMD) to evaluate changes around the prosthesis and to measure bone stock and bone density redistribution after a total hip replacement. In this cross-sectional multicentre clinical study the DXA method was used to compare bone mass after uncemented THA of a custom-made stemless design with five groups of conventional cementless implants (Alloclassic, Mayo, CFP, IPS, ABG). The adaptive bone changes of the proximal femur three years after implantation were evaluated. Periprosthetic BMD was measured in 130 subjects in the seven regions of interest (ROI) based on Gruen zones. Significant differences were found between the stemless implant and the other five groups in zones 1, 4 and 7. The CFP, IPS, and ABG groups showed decreased BMD in ROI 1, and the Mayo, IPS and Alloclassic in ROI 7. An increased BMD in ROI 4 was observed in the Mayo, IPS, ABG and Alloclassic groups. The results of the present study suggest that a conservative stemless implant with complete proximal load transfer produces a homogeneous and more physiological redistribution of bone density, allowing maintenance of proximal periprosthetic bone stock.Hip international: the journal of clinical and experimental research on hip pathology and therapy 02/2006; 16 Suppl 3:9-15. · 0.34 Impact Factor -
Article: Bone preservation with a conservative metaphyseal loading implant.
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ABSTRACT: Proximal load transfer and the absence of distal fixation of the stem are crucial to obtain the best behaviour of the femoral bone after total hip replacement. In this study, dual energy X-ray absorptiometry (DEXA) was employed to understand and compare the bone density changes and thus the re-distribution of mechanical forces in two different extra short stems. Two cohorts of ten patients were included in this retrospective study. Both implants are custom-made and present a well defined lateral flare. The first model is fully coated and presents a short stem (Group A), the second is an unstemmed metaphyseal implant with a polished tip (Group B). DEXA scans were obtained in all patients at the two-year follow-up. A higher BMD was detected in ROIs 1, 2, 4, 5 in Group B confirming a preservation of the proximal bone mass and thus indirectly a more proximal load transfer. The results obtained confirm the importance of the geometry of the implant on proximal bone density. Loading both medial and lateral proximal femoral flares and the complete absence of the diaphyseal portion of the stem provide the optimal bone remodelling of the femur after total hip replacement.Hip international: the journal of clinical and experimental research on hip pathology and therapy 02/2006; 16 Suppl 3:16-21. · 0.34 Impact Factor -
Article: Ultra-short stems with proximal load transfer: Clinical and radiographic results at five-year follow-up.
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ABSTRACT: Bone stock preservation is crucial when performing THR in young patients. Following this philosophy, an original ultra-short custom-made implant with extensive proximal load transfer was developed. It presents three very innovative features: absence of the diaphyseal portion of the stem, a well defined lateral flare with load transfer on the lateral column of the femur and a very high femoral neck cut. These innovations resulted in a very conservative implant both of the bone stock and the soft tissues. In this study we reviewed the X-rays of 111 patients with 131 primary total hip replacements performed with this implant. The average pain score using the Harris Hip Score system, at an average of five years after surgery, was 42 of 44 points; 95 per cent (124) of the patients had no or slight pain. We had no cases of thigh pain. None of the patients required a femoral stem revision. Two cases had to be re-operated for polyethylene liner exchange but the femoral implant was stable and left in place. At five years, all implants appeared radiographically stable with well maintained proximal bone stock. It was concluded that the geometry of this implant provides significant initial stability, which seems to be preserved throughout a long follow-up period. This study validates the assumption that torsional loads can be controlled even without the diaphyseal portion of the stem and that neck preservation combined with lateral flare support guarantees a more natural loading of the femur.Hip international: the journal of clinical and experimental research on hip pathology and therapy 02/2006; 16 Suppl 3:31-9. · 0.34 Impact Factor -
Article: Proximal load transfer with a stemless uncemented femoral implant
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ABSTRACT: Bone stock preservation is crucial when performing total hip replacement in young patients. The aim is to save good bone stock for a possible revision procedure. Furthermore, there is an increasing demand from young and active patients to receive a new joint which allows a normal or nearly normal life style. With this in mind, we began, in 1993, to develop a new femoral implant. The purpose of this ultra-short stem was a physiologic strain distribution on the proximal femur with a proximal load transfer from the implant to the femoral bone. Main features were an almost complete absence of the diaphyseal portion of the stem, a well defined lateral flare with load transfer on the lateral column of the femur, and a very high femoral neck cut. These innovations resulted in a conservative implant on both the bone stock and the soft tissues. This implant, in the first years, was recommended only for young and active patients. Over the last thirteen years, this project has undergone several modifications but the basic principles of the implant have remained the same. In the present review, we present the rationale, the surgical technique and the clinical and experimental results so far obtained with this implant.Journal of Orthopaedics and Traumatology 01/2006; 7(3):154-160. -
Article: Results of the anatomic cementless prosthesis with different types of hydroxyapatite coating.
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ABSTRACT: This study evaluates the clinical and radiographic results and the bone-implant osteointegration obtained with the Anatomic (Zimmer, Warsaw, Ind) cementless total hip prosthesis using three different types of surface coating. Two hundred twenty-seven patients underwent total hip arthroplasty using the Anatomic prosthesis. Patients were divided into groups based on the type of surface coating: in group A (69 patients), prostheses were uncoated; in group B (90 patients), the metaphyseal region of the prostheses was coated with calcicoat (a mixture of hydroxyapatite and tricalcium phosphate) (Zimmer); and in group C (68 patients), the fiber mesh and proximal stem of the prostheses were coated with calcicoat. Prostheses coated with calcicoat yielded better clinical and radiographic results than uncoated prostheses, especially in regard to thigh pain. No significant difference was observed between groups B and C. These results obtained with the Anatomic prosthesis are promising and encourage the use of implants coated with calcicoat.Orthopedics 01/2002; 24(12):1147-50. · 2.66 Impact Factor -
Article: [Clinical usefulness of a computerized tomography study of morphology of the femoral canal in patients candidates for hip prosthesis].
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ABSTRACT: In the last few years hip arthroplasty has been increasingly used and both metaphysis and diaphysis of the proximal femur are studied preoperatively for best compliance between prosthesis and bone. Indeed, the best results can be obtained by reducing the risk of stem end mobilization, which means to choose the prosthesis fitting the femoral canal best and to limit the use of cement prostheses, which are at high risk of mobilization in time, to advanced osteoporosis patients. We used a simple and repeatable CT technique to study femoral canal structure and size. After accurately positioning the patients inside the gantry, we acquired some axial scans at scheduled levels referring to the horizontal midline of the lesser trochanter. The axial scans were acquired 2 cm above and 5 and 10 cm below the horizontal midline in 105 patients. Measurements were bilateral in 13 patients. Finally, the results were compared with the surgical outcome. Femoral canal cross-diameters and cortical bone width varied greatly, which variations were confirmed in bilateral measurements and in the same patient between the two femurs. Femoral canal structure, which can be remodelled, influences the choice of the stem and thus the amount of cement. We believe this method to be fundamental for correct surgical planning and for best treatment outcome.La radiologia medica 11/1995; 90(4):378-82. · 1.44 Impact Factor -
Article: Prophylaxis against deep-vein thrombosis in total hip replacement. Comparison of heparin and foot impulse pump.
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ABSTRACT: We performed a randomised controlled study to compare heparin with the A-V Impulse System in the prevention of deep-vein thrombosis (DVT) in 132 consecutive patients undergoing total hip replacement. After the operation, all patients had compression stockings, 65 were treated with calcium heparin and 67 with the intermittent plantar pump. DVT was diagnosed by Doppler ultrasound and thermography, followed by phlebography. There were 23 cases of DVT (35.4%) in the heparin group, with 16 major and seven minor thromboses. In the impulse pump group there were nine cases (13.4%) with three major and six minor thromboses. The differences for all thromboses and for major thromboses were both significant at p < 0.005. In the heparin group there was one fatal pulmonary embolism and nine patients (13.8%) had excessive bleeding or wound haematomas, as against none in the impulse pump group.Journal of Bone and Joint Surgery - British Volume 08/1994; 76(4):579-83. · 2.83 Impact Factor -
Article: Conversion of the arthrodesed hip to a total hip arthroplasty. Indications and limitations.
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ABSTRACT: Arthrodesis of the hip is thought to achieve satisfactory clinical and functional results in the adult despite the loss of articular mobility involved (Santori et al., 1986; Russel, 1987; Weber, 1987). Over the long term, however, most patients develop secondary degenerative arthritis in the spine, contralateral hip, and knees due to overloading. The deteriorating condition of these joints eventually causes the onset of pain, which often requires further intervention. Surgery on these joints may yield satisfactory short-term results, but these will not last if the arthrodesed hip is not converted to total hip arthroplasty either prior to or at the same time as such operations.Italian journal of orthopaedics and traumatology 02/1992; 18(2):145-53. -
Article: The cementless PCA primary total hip system. Medium-term follow-up of 235 cases.
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ABSTRACT: The Porous Coated total hip Arthroplasty (PCA), used by the authors since August 1984, represents a considerable advancement in the field of prosthetic replacement. Its original design and biological fixation give it long-lasting stability not only in young patients, but also patients with initial osteoporosis. Its use in cases of advanced osteoporosis, however, is more controversial. The 8-year results are quite satisfactory from both a clinical and radiographic standpoint, confirming, as other authors have reported, that the medium and long-term results of cementless total hip replacement tend to stabilize because there is a lack of late reactions, which are more common in cemented implants.Italian journal of orthopaedics and traumatology 02/1992; 18(3):287-95. -
Article: Epiphyseal chondroblastoma of bone. Long-term effects on skeletal growth and articular function in 15 cases treated surgically.
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ABSTRACT: The authors describe the long-term sequelae of chondroblastoma in 15 patients with open growth plates, whose age at operation ranged from 8 to 15 years. At follow-up, the youngest patient was 21 and the oldest 48 years old. Upper limb length discrepancy ranging from 2 cm to 10 cm was present in the four patients who had a proximal humeral epiphyseal location; in three of them, the range of motion of the shoulder was also limited and X-rays showed marked irregularities of the humeral head. Lower limb length discrepancy ranging from 0.5 cm to 2 cm was found in five of the eight patients in whom the tumor affected lower limb epiphyses. One patient with proximal tibial epiphyseal involvement also had mild genu valgum. Radiographic osteoarthritis was present only in the trapeziometacarpal joint of a patient in whom the first metacarpal bone affected by the tumor was replaced by a free fibular graft. The abnormalities observed did not cause important functional loss in either the everyday or the working activities of any of our patients.Archives of Orthopaedic and Trauma Surgery 02/1992; 111(6):327-32. · 1.37 Impact Factor -
Article: Epiphyseal chondroblastoma of bone
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ABSTRACT: The authors describe the long-term sequelae of chondroblastoma in 15 patients with open growth plates, whose age at operation ranged from 8 to 15 years. At follow-up, the youngest patient was 21 and the oldest 48 years old. Upper limb length discrepancy ranging from 2 cm to 10 cm was present in the four patients who had a proximal humeral epiphyseal location; in three of them, the range of motion of the shoulder was also limited and X-rays showed marked irregularities of the humeral head. Lower limb length discrepancy ranging from 0.5 cm to 2 cm was found in five of the eight patients in whom the tumor affected lower limb epiphyses. One patient with proximal tibial epiphyseal involvement also had mild genu valgum. Radiographic osteoarthritis was present only in the trapeziometacarpal joint of a patient in whom the first metacarpal bone affected by the tumor was replaced by a free fibular graft. The abnormalities observed did not cause important functional loss in either the everyday or the working activities of any of our patients.Archives of Orthopaedic and Trauma Surgery 01/1992; 111(6):327-332. · 1.37 Impact Factor -
Article: [The prevention and treatment of skeletal deformities in fibrous dysplasia].
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ABSTRACT: Fibrous dysplasia generally leads to skeletal deformity over time, particularly when the lower extremities are affected. The authors describe their experience in this field, proposing mainly preventive treatment of progressive deformities and pathological fractures. They prefer intramedullary nailing, which by strengthening the affected bone allows free and early mobilization of the limb. Moreover, full weight-bearing prevents the onset of "ex non usu" osteoporosis, which is quite often responsible for pathological fractures.Archivio "Putti" di chirurgia degli organi di movimento 02/1990; 38(2):388-93. -
Article: [Osteosarcoma. A new diagnostic approach in presurgical loco-regional staging].
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ABSTRACT: The value of Magnetic Resonance (MR) imaging was examined in the anatomical staging of bone osteosarcomas. Eleven patients were studied--8 central and 3 parosteal osteosarcomas. The accuracy of MR imaging was compared to that of plain film, scintigraphy, CT, and angiography. MR imaging was superior to both CT and radionuclide scanning in defining intramedullary extension and in showing skip metastases. Cortical erosion in central osteosarcomas was demonstrated by MR imaging, CT, and plain film; in 1 case of parosteal osteosarcoma MR imaging was superior to CT in showing cortical penetration. In two cases MR imaging did not accurately demonstrate the relationship of the tumor to the major vessels; only angiography showed vascular involvement. MR imaging was useful in delineating extraosseous extension. The importance is stressed of a correct use of MR imaging towards an accurate diagnosis. In fact, intramedullary extension and skip metastases were better demonstrated on T1-weighted images with large fields, while T2-weighted images and small fields were needed for the best overall evaluation of extraosseous involvement. In conclusion, MR imaging should be used for preoperative staging of osteosarcomas in those cases where diagnosis was made on the basis of clinical, radiographic, and bioptic findings.La radiologia medica 11/1988; 76(4):249-54. · 1.44 Impact Factor -
Article: Nuclear magnetic resonance in the diagnosis of lumbar herniated disc.
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ABSTRACT: The morphological study of lumbar herniated discs, aimed at ascertaining the appropriate type of surgical treatment to be used, is commonly based on the results of CT scan and/or radiculography, which are not without risks and disadvantages. An investigation of the pathological pictures of lumbar disc hernia obtained by N.M.R. and their comparison with those obtained by other methods shows that nuclear magnetic resonance is currently able to provide all the required information. In most patients, and especially young ones, it is possible to directly diagnose disc hernia with N.M.R. Radiculography is a more suitable method only in a small number of cases, namely, elderly patients with multiple discopathies which have been radiographically ascertained, and with atypical symptomatology.Italian journal of orthopaedics and traumatology 07/1988; 14(2):243-55. -
Article: [Chondrosarcoma of the bone. Differential pre- and postoperative diagnosis using magnetic resonance].
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ABSTRACT: Twelve patients were studied by means of Magnetic Resonance Imaging (MRI) in order to demonstrate either loco-regional recurrence of central chondrosarcomas or degenerative evolutions of exostoses. MRI findings were compared with plain film, scintigraphy, and Computed Tomography. MRI showed loco-regional recurrences by demonstrating their site, extent, and relationship with adjacent structures. In showing the degenerative evolution of exostoses MRI--confirmed at surgery--was superior to plain film in 3 cases out of 7, and to Computed Tomography in 2 cases. The authors discuss MRI findings: chondrosarcomas have low-intensity signal in T1-weighted sequences and high-intensity signal in T2-weighted. Thanks to its high contrast resolution MRI always allowed the detection of the chondrosarcoma. Nevertheless, MRI did not allow the tumor grading--which is due either to a difficult evaluation of the morphology of neoplastic calcifications, or to non-specific-intensity signal.La radiologia medica 06/1988; 75(5):465-9. · 1.44 Impact Factor -
Article: Role of hyperthermic perfusion in the treatment of limb osteogenic sarcoma.
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ABSTRACT: The role of hyperthermic perfusion (HP) for the treatment of limb osteogenic sarcoma was evaluated in 76 patients. Twelve patients were treated with HP alone, and a 5- and 10-year survival rate of 25.5% was obtained. When amputation was systematically associated to HP (12 patients), a 5- and 10-year survival rate of 50.9% was achieved. Twenty-seven patients were treated with hyperthermic antiblastic perfusion (HAP) followed by amputation 4 weeks later. With this treatment, the 5- and 10-year actuarial rates rose to 71.4 and 65%, respectively, with a 5-year disease-free survival rate of 67.4%. Fifteen patients were treated with HAP followed by an 'en bloc' resection and bone reconstruction. The 5- and 10-year actuarial survival rate obtained was 63.5% with a 5-year disease-free survival rate of 53.6%. These results seem to indicate that HAP permits carrying out conservative rather than ablative surgery for the treatment of limb osteogenic sarcoma.Oncology 02/1987; 44(1):1-5. · 2.27 Impact Factor -
Article: Dynamic endomedullary nailing in the treatment of extensive bone cysts in young patients. A pathogenetic interpretation.
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ABSTRACT: The authors discuss the treatment of 6 cases of extensive bone cysts in young patients (10-18 years of age) by elastic endomedullary nailing, all of which were successful, with complete remodelling of the bone. They advance the hypothesis that this was probably due to dispersion of the fluid by drainage along the nails, followed by natural remodelling in these young patients. The technique is illustrated. The advantages claimed are its simplicity of execution, and the reliability of the results.Italian journal of orthopaedics and traumatology 01/1987; 12(4):411-7. -
Article: Idiopathic chondrolysis of the hip: an ultrastructural study of the articular cartilage of the femoral head.
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ABSTRACT: Core biopsies obtained from the articular cartilage of the femoral head of a 16-year-old girl with idiopathic chondrolysis of the hip were subjected to an ultrastructural study. Zone I was missing and zone II was the most superficial layer present in the articular cartilage of our patient. Collagen fibrils were thinner than normal and more uniform in diameter, and proteoglycans were normally distributed among them. Degenerating chondrocytes were found, as well as debris of dead cells, but many chondrocytes were still vital and engaged in active synthesis. Most of the chronic degenerative changes observed in ultrastructural studies on osteoarthritis were not observed in this case of idiopathic chondrolysis which seems to be, on the basis of our findings, a pathological process which develops and runs its course very quickly.Orthopedics 11/1986; 9(10):1383-7. · 2.66 Impact Factor
Top co-authors
Top Journals
Institutions
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1992–2012
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Ospedale San Pietro Fatebenefratelli
Roma, Latium, Italy
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1988–1990
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Sapienza University of Rome
Roma, Latium, Italy
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