Publications (5)0.76 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: The management of severe femoral bone loss associated with hip infection is a major problem in joint replacement surgery. Femoral megaprostheses have been rarely reported in reconstructive procedure for this complex condition. The aim of the study was to evaluate clinical re - sults observed after such uncommon reconstruction in our case series and in a similar group of patients extracted by literature review. Methods: We evaluated clinical outcomes and eradication of sepsis in five patients who underwent femoral revision with modular femoral resection stems at our institution, and we reviewed the literature about this topic. In our case series, the femoral bone loss was grade III-B in three cases and grade IV in two cases according to the Paprosky clas - sification. One patient was operated with one-stage revision, and four patients were operated with two-stage revision. The mean age was 72 years (range: 60 to 81 years), and the mean time of follow-up was 62 months (range: 36 to 82 months). Results: We observed sepsis eradication in four out of five patients in our series, and clinical results were satisfactory with a mean Harris Hip Score of 74 points (range: 46 to 95 points). Cumulative results obtained considering our series and data obtained by literature review showed a mean Harris Hip Score of 75 points (range: 42 to 95 points) in patients able to walk and an overall incidence of recurrent infec - tion in 33% of patients. Complications were observed in 8 out of 20 patients (dislocation, 6 cases; greater trochanter displacement 2 cases; and transient sciatic palsy, 1 case). Conclusions: Revision with megaprostheses in case of infected total hip arthroplasty with severe femoral bone loss have a high risk of complication and should be carefully evaluated and used in selected patients when other surgical procedures are not feasible.
- [Show abstract] [Hide abstract] ABSTRACT: Pseudotumors associated with total hip arthroplasty have been associated with metal-on-metal and metal-on-polyethylene total hip arthroplasties due to a granulomatous foreign-body reaction to methyl methacrylate, polyethylene, or metal ion release, but they have not been related to prosthetic joint infections. In this paper, we report an unusual case of Candida albicans total hip arthroplasty infection, causing a large inflammatory pseudotumor of the hip joint. Fungal periprosthetic joint infections are a rare clinical entity and difficult to diagnose, and a pseudotumor may be part of their clinical presentation. They should be suspected in immunodeficient host patients when clinical symptoms of prosthetic joint infections are observed.
- [Show abstract] [Hide abstract] ABSTRACT: The application of modular femoral stems is constantly increasing in revision hip surgery. From March 2001 to March 2006, we employed the Profemur R modular stem in 35 cases of femoral component revision (31 first revisions and 4 re-revisions). The reasons for revision surgery included aseptic loosening in 17 cases, periprosthetic femoral fracture in 8 cases, stem fracture in 3 cases, septic loosening in 2 cases and recurrent dislocation in 1 case. According to the Merle d'Aubugne-Postel score clinical results were very good in 11 cases, good in 9 cases, medium in 5 cases, fair in 4 cases and poor in 4 cases. The main complications included 2 intraoperative diaphyseal fractures treated with multiple cerclage wires and 2 early infections treated with debridement and prolonged antibiotic therapy. One fracture healed in association with temporary wound discharge, and the other resulted in non-union with a femoral varus deformity. This required revision with internal fixation (LCP plate) at 3 months, with a successful result. In one case of stem subsidence femoral revision with a larger Profemur R implant was required. In our retrospective study the Profemur R modular stem has been an effective prosthetic system for femoral reconstruction in case of loosening with Paprosky grade III bone loss and following periprosthetic femoral fractures.
Article: Tecnica delle artrodesi di ginocchio[Show abstract] [Hide abstract] ABSTRACT: Knee arthrodesis was a common procedure before development of prosthetic replacement surgery. At present the most important indication for this intervention is septic failure of knee prosthesis. Several techniques can be used and each procedure may offer advantages and disadvantages which have to be analyzed before surgery according to the patient. Intramedullary nailing and external fixation are the most common techniques used for knee arthrodesis and both procedures show favorable results in most patients. Persistent infection and incomplete bone fusion are the main complications of knee arthrodesis. Because of residual functional impairment, all the candidates to knee arthrodesis should be informed about the results expected after the operation and possible alternative methods of treatment.
Article: Knee arthrodesis technique