Alfredo Schiavone Panni

University of Molise | Università del Molise · Department of Health Sciences (S.Pe.S.)

We identified 39 patients (23 female and 16 male) underwent hip revisions through mega-prosthesis. The most common causes were periprosthetic fractures, periprosthetic osteolysis and consequences of infected arthroplasty. The average follow-up was 5 years (2.1 to 6.5), and average age was 69 years (47 to 78). At the final follow-up all the implants...

Purpose This study aimed to report the clinical and functional results of a series of patients with isolated primary patellofemoral osteoarthritis (PFOA) treated with intraarticular injection of microfragmented autologous adipose tissue plus knee arthroscopy. The results were also analyzed in relation to the age and body mas index (BMI) of patients...

Background Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors’ aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction...

Infection is one of the most catastrophic complication following total knee arthroplasty (TKA) and represents the second most common cause of TKA failure. Treatment of a patient with periprosthetic joint infection (PJI) could require often costly and prolonged hospital stays, weeks or months of antibiotic therapy, and multiple surgical procedures....

Background Femoral neck fractures (FNF) are associated to patient’s disability, reduced quality of life and mortality. None of the fixation devices commonly used for extracapsular (EC) FNF (i.e., dynamic hip screws (DHS) and intramedullary nails (IN)) is clearly superior to the other, especially in case of unstable fractures (31.A2 and 31.A3 accord...

The management of vertebral compression fractures (VCFs) is based on conservative treatment and minimally invasive vertebral augmentation procedures. However, the role of vertebral augmentation is now being questioned by clinical trials and extensive studies. The aim of this review is to report the most relevant evidences on effectiveness, safety,...

We conducted a literature review to better understand the correct application and indications of negative pressure wound therapy (NPWT) in orthopedics and traumatology. A literature search was conducted on PubMed and all articles in English, Spanish, and Italian were included. Relevant articles, references, data, and relevant findings were identifi...

Introduction Grown in the worldwide population of over 50 of age individuals who remain in good health and continue to engage in sports has led to an increase of anterior cruciate ligament (ACL) tears in this aged population. ACL reconstruction was reserved for young and active athletes, but seems to produce good outcomes also in over 50s. Purpose...

The aim of the present systematic review was to provide a clear overview of the clinical current research progress in the use of adipose-derived mesenchymal stem cells (ASCs) as an effective therapeutic option for the management of tendinopathies, pathologies clinically characterized by persistent mechanical pain and structural alteration of the te...

The incidence of fragility fractures of the acetabulum (FFA) is constantly increasing. Generally, these fractures are related to a fall on the greater trochanter involving the anterior column. The management of FFA is extremely difficult considering both patients' comorbidities and poor bone quality. Both non-operative and several operative treatme...

Introduction Distal femur osteotomies (DFOs) are well-accepted procedures in treating unicompartmental knee osteoarthritis associated with valgus malalignment. This study aims to investigate the Return to sport (RTS) after DFO. Materials and methods We conducted a systematic review of the literature according to the PRISMA guidelines, including al...

Often senior knee surgeons leave the wound closure to their less experienced residents. Clearly, this does not reflect the importance of proper and meticulous wound closure. Optimal wound closure helps to minimize complications such as extensor apparatus insufficiency, wound leakage, and periprosthetic joint infection. It also improves postoperativ...

Background Several modifications to the original Grammont reverse shoulder arthroplasty (RSA) design have been proposed to prevent distinctive issues, such as both glenoid and humeral lateralization. The aim of this systematic review was to determine rates of problems, complications, reoperations, and revisions after onlay lateralized humeral stem...

Background Several modifications to the original Grammont reverse shoulder arthroplasty (RSA) design have been proposed to prevent distinctive issues, such as both glenoid and humeral lateralization. The aim of this systematic review was to determine rates of problems, complications, reoperations, and revisions after onlay lateralized humeral stem...

Purpose: Periprosthetic joint infections (PJIs) represent a devastating consequence of total joint arthroplasty. The European Knee Associates (EKA), the American Association of Hip and Knee Surgeons (AAHKS) International Committee, and the Arthroplasty Society in Asia (ASIA) board members were interested in quantifying differences in arthroplasty...

Introduction The treatment of intracapsular femoral neck fractures (FNFs) in the elderly is usually based on hip replacement, both total hip arthroplasty (THA) and hemiarthroplasty (HA). Recently, several tissue-sparing approaches for hip arthroplasty had been described with promising results in terms of hospitalization length, blood loss and dislo...

: (1) Background. Scoliosis is the most common musculoskeletal manifestation of Neurofibromatosis type 1 (NF1), and it might be dystrophic (D) or non-dystrophic (ND) depending on the presence of dysplastic changes of the spine. The aim of our study was to describe the characteristics and natural history of patients with NF1 and scoliosis. (2) Metho...

Purpose: X-linked hypophosphatemic rickets (XLH) is a rare genetic disease characterized by an increase in fibroblast growth factor 23 (FGF23) expression. The skeleton is one of the systems most affected and deformities of the lower limbs are one of the first reasons for consulting an orthopedic surgeon. The aim of the present study was to offer pr...

Introduction : Long-term use of bisphosphonates (BPs) is associated with Atypical Femoral Fracture (AFF). Theoretically, periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, recently several studies reported the occurrence of PPFs around a hip arthroplasty presenting features of an AFF. The present study des...

BACKGROUND First metatarsophalangeal joint arthritis (FMTPA), also known as hallux rigidus, is the most frequent degenerative disease of the foot. Diagnosis is made through both clinical and radiological evaluation. Regenerative medicine showed promising results in the treatment of early osteoarthritis. The aim of the present study was to repo...

Introduction: The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patients' outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was base...

Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk patients. Methods:...

Introduction: Long-term use of bisphosphonates (BPs) has been associated with a specific type of tensile side femoral stress fracture known as Atypical Femoral Fracture (AFF). Theoretically periprosthetic femoral fractures (PFF) should be excluded from the diagnosis of AFF. However, emerging evidence correlates prolonged BPs use with the occurrence...

Introduction The differential diagnosis between aseptic and septic total joint arthroplasty (TJA) revision is fundamental in order to be successful in the surgical treatment. Several serum biomarkers have been proposed as gold standards in the diagnosis of Periprosthetic Joint Infections (PJI). The aim of the current study was (1) to evaluate serum...

Metal allergy is an uncommon and not completely understood cause of failure in total joint arthroplasty (TJA). However, either immunopathology neither histologic studies clarified the mechanisms through which the metal ions could lead to the complications related to them. The lack of evidence around this topic also reflects the difficulties to diag...

Proximal humeral fractures (PHF) are the third most common non-vertebral fragility fractures after hip and distal radius. It still controversial which treatment might be more appropriate, and surgically treated outcomes depends also on an appropriate technique. In order to clarify surgical indications, tips and pitfall a narrative review was conduc...

PurposeBucket handle tears of the meniscus are common and can lead to locking, extension deficit and functional impairment. The diagnosis is determined by a combination of physical examination and imaging, but in some cases the diagnosis may be challenging since specific clinical tests are lacking. The aim of the present study was to assess the val...

Patellofemoral instability occurs commonly in young and active patients. A spectrum of clinical entities can be identified according to the Dejour classification [1]: objective patellar instability (OPI), potential patellar instability (PPI), and the painful patellar syndrome (PPS). OPI is defined by the observation of at least one patellar disloca...

Patellar lateral retinaculum release represent an useful procedure and a relatively frequent treatment performed in knee surgery. Indication to patellar lateral retinaculum release, both as an isolated procedure or associated with other techniques, include different disorders of the extensor mechanism, such as acute or chronic patellar instability,...

PurposeProper rotational alignment of the femoral component is critical for a successful total knee arthroplasty (TKA). The aim of this systematic review was to analyse the available literature to examine the effect of the TKA femoral component malrotation on clinical outcomes and assess a cut-off value for femoral rotation leading to revision surg...

Hip fractures are severe conditions with a high morbidity and mortality, especially when the diagnosis is delayed, and if formulated over 30 days after the injury, is termed a ‘neglected femoral neck fracture’ (NFNF). Cerebral palsy (CP) is probably one of the major risk factors for NFNF in Western countries, mainly because of both cognitive and mo...

First patellar dislocation is a common injury of the knee, involving often adolescents and the active population. The consequences of the first episode can be various and potentially disabling. Among these, acute patellar dislocation can often result in recurrent patellar instability. Recurrent patellar instability is certainly multifactorial but d...

Severe bone loss is a critical issue in trauma and it requires complex techniques to preserve limb form and function. Regenerative medicine, using stem cells and molecular biology, might be useful to enhance bone healing in severe bone loss. Between 2017 and 2018, 4 patients showed severe bone loss. In all of them, the use of stem cells was added t...

OBJECTIVE: The increasing number of total knee arthroplasties performed yearly worldwide has resulted in a concomitant rise in bacterial infections. Two-stage reimplantation has been reported as the most successful method of treating periprosthetic knee infections. The purpose of this study was to describe all the phases of the two-stage reimplanta...

Objective: The increasing number of total knee arthroplasties performed yearly worldwide has resulted in a concomitant rise in bacterial infections. Two-stage reimplantation has been reported as the most successful method of treating periprosthetic knee infections. The purpose of this study was to describe all the phases of the two-stage reimplant...

Introduction Humeral shaft is a common site of fracture non-union. Biology and bone quality represent some of the problems that the orthopaedic surgeon has to face up in the elderly. The goals of treatment of humeral shaft non-union are the achievement of mechanical stability and creation of a favourable biologic environment. Bone graft and stem ce...

Purpose The purpose of this study was to report the clinical and functional results of a series of patients with early knee osteoarthritis (KOA) treated with the intra-articular injection of autologous adipose-derived stem cells (aASCs) plus arthroscopic debridement. The hypothesis was that protocol would significantly improve the clinical and func...

PurposeThe aim of this systematic review is to analyze the effect of tibial rotational alignment after total knee arthroplasty (TKA) on clinical outcomes and assess the eventual cut-off values for tibial TKA rotation leading to poor outcomes. MethodsA detailed and systematic search from 1997 to 2017 of the Pubmed, Medline, Cochrane Reviews, and the...

Medial patellofemoral ligament (MPFL) represents the main restraint against lateral patellar displacement. The MPFL insertion at the patella is up to 30 mm wide and is located along the upper half of the medial patellar rim. The femoral insertion of the MPFL is approximately 10 mm distal to the apex of the adductor tubercle and 16 mm proximal to th...

Primary traumatic patellar dislocation is common, particularly in young active individuals. A consensus on its management is still lacking. The present work provides easily accessible guidelines to be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, to...

PurposeThe purpose of this study was to retrospectively analyse the clinical, functional and radiological outcomes, and the long-term survivorship of the NexGen Legacy Posterior Stabilised (LPS) knee prosthesis (Zimmer Biomet, Warsaw, IN, USA). Methods Between 1996 and 2001, 197 primary NexGen LPS total knee arthroplasties (TKAs) were implanted by...

PurposeAutologous matrix-induced chondrogenesis (AMIC) is a treatment for focal full-thickness cartilage defects combining microfracturing with an exogenous I/III collagen matrix (Chondro-Gide). The aim of the present study was to determine the 7 years outcomes of patients treated with the AMIC technique for knee chondral defects larger than 2 cm2....

Despite the excellent success rates of the modern unicompartmental knee arthroplasty (UKA), results of knee replacement registries still shows a relatively high revision and failure rate for UKA, especially when compared with traditional total knee arthroplasty (TKA). Bearing dislocation continues to be advocated as the predominant mechanism of fai...

PurposeAntibiotic-loaded bone cement has been widely used for the treatment of infected knee replacement, but its routine use in primary TKA remains controversial. The aim of this systematic review was to analyze the literature about the antimicrobial efficacy and safety of antibiotic-loaded bone cement for its prophylactic use in primary TKA. Meth...

Purpose The purpose of this study was to determine the long-term outcome in patients who underwent two-stage reimplantation with an articulated spacer following a chronic periprosthetic knee infection. The hypothesis was that the use of an articulated spacer provides significant improvement of clinical results and knee functionality through a long...

Background: The aim of the study was to evaluate whether the use of preventive osteosynthesis after curettage in benign and primitive low-grade malignant bone tumor localized in the distal femur in adult patients provides sufficient mechanical stability to the system as to allow weight-bearing and reduce the risk of postoperative fracture. Additio...

Purpose: Management of anterior cruciate ligament injuries in skeletally immature patients (in Tanner stages 2 and 3) is controversial. Conventional reconstruction used in adults can cause iatrogenic growth disturbance due to physeal damage, and studies that report long-term results using a specific technique are scarce. The aim of this study is t...

Purpose The aim of the present paper was to determine (1) the incidence of failure (defined as the persistence or the recurrence of the infection), (2) the incidence of prosthesis (or even limb) loss (defined as the final need for an arthrodesis, resection arthroplasty or amputation) and (3) what factors could influence the failure in patients trea...

Anterior knee pain (AKP) is a prevalent musculoskeletal condition characterised by a mechanical pain perceived in the anterior region of the knee exacerbated by activity and relieved by rest. AKP often has a poor prognosis and can significantly impact daily activities as well as participation in physical activity. The incidence of “anterior knee pa...

The purpose of this brief paper is to present the preliminary results of a modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus. In this procedure, the dorsal arm of the osteotomy is performed orthogonal to the horizontal plane of the first metatarsal, the main advantage being that this allows much easier and more acc...

the aim of this study was to investigate the relationship between positive painful forced internal rotation (FIR) and lateral pulley instability in the presence of a pre-diagnosed posterosuperior cuff tear. The same investigation was conducted for painful active internal rotation (AIR). a multicenter prospective study was conducted in a series of p...

Unicompartmental knee arthroplasty (UKA) presents low morbidity and complication risk and provides excellent outcomes and fast recovery. Despite these facts, knee-replacement registries have shown high failure rates for UKA, especially when compared with traditional TKA. The purpose of this study was therefore to report outcomes, complications, and...

Low-grade infection after total knee replacement (TKR) is generally caused by methicillin-sensitive staphylococci, streptococci and anaerobic cocci. Diagnosis of these low-grade infections is challenging and treatment controversial. The best management of low-grade infections following TKR is still a matter of debate and many treatment options are...

Introduction: Few data exist regarding the outcome and survivorship of medial UKA in patients with minor varus alignment. The purpose of this study was therefore to analyse the clinical results of medial UKA implanted with no more than 7° of varus, and to verify whether there was a relationship between limb alignment and overall outcomes. Materia...

Microbiological diagnosis is crucial for the appropriate management of implant-associated orthopedic infections (IAOIs). Sonication of biomaterials for microbiological diagnosis has not yet been introduced in routine clinical practice. Aim of this study was to describe the advantages and feasibility of this procedure in the clinical setting. We pro...

An already existing large volume of work on kinematics documents a reduction of step length during unusual gaits, such as backward walking. This is mainly explained in terms of modifications of some biomechanical properties. In the present study, we propose that the proprioceptive information from the knee may be involved in this change of motor st...

Diagnosis and management of low-grade periprosthetic knee infection are still controversial and debatable. The diagnosis of low-grade infection after total knee arthroplasty is often complex, as clinical symptomatology and diagnostic studies are highly conflicting and knees often exhibit well-fixed components. Although the criterion standard for st...

The efficacy of medial capsule reefing in the treatment of patellar instability is well documented. Aim of the present study was to prospectively evaluate the outcomes of an all-arthroscopic medial capsule reefing technique in young patients with painful patella syndrome and potential patellar instability. Thirty patients with painful patellar synd...

Extensive blood loss after total knee arthroplasty (TKA) may be a potential problem since it leads to anaemia, increased need for transfusion and prolonged hospitalization. Aim of this study was to investigate the effects of postoperative knee flexion after TKA on blood loss and the need for transfusion. One hundred consecutive patients undergoing...

Educational Objectives As a result of reading this article, physicians should be able to: 1. Delineate the indications for high tibial osteotomy (HTO) and report on its functional results in relation to the conversion to total knee arthroplasty (TKA). 2. Outline the principles and anatomic implications of opening- and closing-wedge HTO. 3. Describe...

The management of bone loss is a crucial aspect of the revision knee arthroplasty. Bone loss can hinder the correct positioning and alignment of the prosthetic components, and can prevent the achievement of a stable bone-implant interface. There is still controversy regarding the optimal management of knee periprosthetic bone loss, especially in la...

The ideal management of the patella during total knee arthroplasty (TKA) is still controversial. Patellar retention is generally associated with an increased rate of anterior knee pain; however, patient satisfaction is similar in cases of replacement or retention. When the patella is replaced, potential severe complications can occur. Aim of this s...

Purpose: Along with the increase in primary total knee arthroplasty, there has been an increase in the number of revisions. The aim of this study was to propose a selection algorithm for the knee revision constraint according to the state of ligaments and to the bone defects Anderson Orthopaedic Research Institute Classification [AORI] classificat...

Instability of the patella is a relatively frequent occurrence in adolescents. Its pathogenesis, which is multi-factorial, is still much debated. Stability of the patella is guaranteed by a delicate balance of a series of factors (osteo-cartilaginous, ligamentous and muscular), and it is not surprising that alteration of one or more of these can le...

Background Deep venous thrombosis (DVT) or pulmonary embolism (PE) is a rare, but not exceptional presentation of soft tissue sarcomas (STSs). Due to the remarkable difference in the incidence between DVT or PE and STSs, this type of STS presentation is usually associated with a considerable delay in tumor diagnosis and treatment. Case Presentatio...

Acute patellar dislocation is a common knee injury that occurs most often in adolescents, frequently associated with sporting and physical activities. Patellar re-dislocation after the first episode appears to depend primarily on the medial patellofemoral ligament injury which represents the primary ligamentous restraint, providing about 50-60 % of...

Purpose: Controversy exists about the real effectiveness of modular augmentation to manage bone defects in revision total knee arthroplasty. The purpose of this study was to determine whether use of modular augmentation to reconstruct severe defects (1) significantly increased overall outcomes, (2) caused radiolucency or osteolysis and (3) affecte...

Le complicanze della ferita chirurgica in seguito a intervento di artroprotesi totale di ginocchio sono infrequenti ma possono causare necrosi della cute e dei tessuti molli periprotesici con possibile esposizione dell’osso e/o dell’impianto, con alto rischio di infezione della protesi. In presenza di complicanze a carico della ferita chirurgica, è...

The mucopolysaccharidoses (MPS) are a group of rare diseases characterized by deficiencies in different enzymes required for degradation of complex carbohydrates. The enzymatic deficiencies lead to lysosomal accumulation of dermatan sulphate, heparan sulphate, and keratan sulphate in different tissue resulting in multi-system complications. Six dif...

The medial patellofemoral ligament (MPFL) is the primary passive restraint to lateral patellar dislocation and there is increasing awareness of its role in recurrent lateral patellar instability. This study was conducted to prospectively analyze the functional results of a modified MPFL reconstruction technique in recurrent patellar dislocation. Ca...

Unicompartmental knee replacement preserves uninvolved osteocartilaginous and soft tissue structures, thereby allowing a more physiological and early clinical and functional recovery. The aim of this study was to report the results of ZUK unicompartmental fixed metal-back prosthesis and how these results change over time. Between 2005 and 2007, 80...

Metallosis represents a rare and severe complication of knee replacement surgery. It is caused by the infiltration and accumulation of metallic debris into the peri-prosthetic structures, deriving from friction between metallic prosthetic components. In knee arthroplasty, this event generally occurs as a result of polyethylene wear of the tibial or...

Cartilage defects represent a common problem in orthopaedic practice. The knee is frequently involved and the medial femoral condyle is the most common localization. Predisposing factors are: traumas, inflammatory conditions and biomechanics alterations. Several surgical options are available once correct diagnosis is given and accurate patient eva...

Predisposing factors to objective patellar instability include trochlear dysplasia, patella alta, patellar tilt and elevated tibial tuberosity-femoral groove distance. The shape of the patella is classically not considered a predisposing factor. Anomalies of dynamic and static factors, including excessive patellar height, tibial tubercle lateralisa...

The aim of our review paper is to present a possible algorithm of treatment of knee periprosthetic soft tissue defects, relative to their extent and depth. Different management of exposed total joints is also proposed, depending on the presence or loss of deep infection and on the timing of infection itself. In accordance with literature and the ex...

Patellar problems are relatively frequent in young and active patients. Since they include different situations a precise classification is needed. We believe that the one proposed by Dejour [4] is useful for a precise diagnosis and correct treatment. It includes three groups: the objective patellar instability (OPI), the potential patellar instabi...

Abtsract D 799

Stiffness is a relatively uncommon complication after total knee arthroplasty. It has been defined as a painful limitation in the range of movement (ROM). Its pathogenesis is still unclear even if some risk factors have been identified. Patient-related conditions may be difficult to treat. Preoperative ROM is the most important risk factor, but an...