Is Pseudo-Patella Baja Really a Serious Complication of Total Knee Arthroplasty?

Background: The available evidence on pseudo-patella baja (PPB) is limited. The purpose of this study is to investigate prospectively the occurrence of PPB after primary total knee arthroplasty and its clinical consequences in a large series of patients with a minimum follow-up of 2 years. PPB was defined as a patella distally displaced in relationship to the femoral trochlea with absence of patellar tendon shortening (Grelsamer RP.

A Large Extraskeletal Chondroma: An Unusual Location in the Lower Extremity, Huge Extraskeletal Chondroma: An Unusual Localization in the Leg.

Introduction: Extraskeletal chondroma (EC) is a rare benign neoplasm predominantly composed of mature hyaline cartilage; it develops in the soft tissues without any connection to bone cortex, intra-articular synovium, or periosteum. To date, only few cases have been reported in the leg, mainly in the knee, thigh, and popliteal region.

Case Report: We describe herein the case of a 42-year-old woman with a 4-year history of a slow-growing, painful swelling on the posteromedial region of her left leg.

Conservative Treatment of Spondylodiscitis: Possible Therapeutic Solution in Case of Failure of Standard Therapy.

Introduction: Spondylodiscitis (SD) is an uncommon disease but not rare, because it represents around 3-5% of all cases of osteomyelitis. Late diagnosis and/or inadequate treatment often cause irreversible damage to cause neurological deficit. Most require only conservative treatment, sometimes a surgical approach is required.

Anterior cruciate ligament reconstruction in association with medial unicompartmental knee replacement: a retrospective study comparing clinical and radiological outcomes of two different implant design.

Purpose: Unicompartmental knee arthroplasty (UKA) combined with anterior cruciate ligament (ACL) reconstruction has recently been suggested as a feasible treatment option for young and active patients with medial compartment osteoarthritis (OA) and ACL deficiency. The aim of this study is to evaluate retrospectively the outcomes of two different implant designs in patients with medial OA secondary to traumatic ACL rupture, who underwent combined ACL reconstruction and unicompartmental knee replacement.

Methods: From January 2007, to December 2013, 24 patients with medial OA secondary to ACL rupture underwent medial unicompartmental knee arthroplasty (UKA) and ACL reconstruction.

Femoral Expandable Prosthesis In Bone Tumor of an Adult: A Case Report.

Management of bone tumors of the limbs is still a field to be explored. The problems to be faced are diff erent, especially when the lower limbs are the point of interest, due to the diff erent leg length residual. A possible solution, provided by new technologies, is the use of electromagnetic expandable prosthesis.

Adjacent Single-level Combined Fixation Using Kyphoplasty and Percutaneous Pedicle Screws in Type A3 Unstable Vertebral Fractures in Elderly Patients.

We present a series of cases of type A3.1.2 unstable fractures of the thoracolumbar hinge treated percutaneously with third-generation kyphoplasty and only one next level percutaneous screws.

A prospective, randomized, comparative study of intravenous alone and combined intravenous and intraarticular administration of tranexamic acid in primary total knee replacement.

Background: Studies on the use of tranexamic acid (TXA) to improve clinical outcomes after joint arthroplasty have reported contrasting results between intravenous (IV) TXA alone and combined IV and intraarticular (IA) administration. We compared the effectiveness of the 2 methods in providing higher postoperative hemoglobin (Hb) levels in patients undergoing primary total knee arthroplasty (TKA).

Methods: A total of 100 TKA patients were randomly assigned to receive either IV TXA alone (group 1) or combined IV and topical IA TXA (group 2).

All-Arthroscopic Treatment of Intra- and Extra-Articular Localized Villonodular Synovitis of Knee.

Pigmented villonodular synovitis (PVNS) is a rare, benign, proliferative neoplastic condition affecting synovial-lined anatomic spaces. PVNS is characterized by hypertrophy of a synovial membrane by villous, nodular, and villonodular proliferation, with pigmentation secondary to hemosiderin deposition. The two forms of PVNS that have been described are diffuse (DPVNS) and localized (LPVNS).

The patellofemoral joint: from dysplasia to dislocation.

Patellofemoral dysplasia is a major predisposing factor for instability of the patellofemoral joint. However, there is no consensus as to whether patellofemoral dysplasia is genetic in origin, caused by imbalanced forces producing maltracking and remodelling of the trochlea during infancy and growth, or due to other unknown and unexplored factors.The biomechanical effects of patellofemoral dysplasia on patellar stability and on surgical procedures have not been fully investigated.

Peri-Prosthetic Knee Infection Management: Spacers Loaded with Two or Three Antibiotic Agents.

Background: The purpose of this work was to compare pre-made antibiotic-loaded spacers with two commercially available antibiotic agents and custom-made cements with three antibiotic agents added. We evaluated: (a) the validity of our procedures, (b) the control of the rate of infection in the long term, (c) complications, and (d) quality of life and patient satisfaction.

Methods: A retrospective cohort study was performed on 112 consecutively treated patients between January 2010 and December 2013; 56 patients were treated with a pre-formed cement spacer (clindamycin + gentamicin), and 56 patients were treated with a spacer loaded with three antibiotic agents (clindamycin + gentamicin + vancomycin).

Single-Bundle versus Double-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Controlled Trial with 6-Year Follow-up.

Single-bundle (SB) anterior cruciate ligament (ACL) reconstruction is increasingly used in a large number of patients and it allows obtaining very good clinical and subjective results; however, functional tests show a persistent rotational instability. Biomechanical studies seem to indicate that double-bundle (DB) ACL reconstruction allows to obtain increased anterior and rotational stability compared with SB. The aim of this prospective randomized controlled study was to compare the clinical outcome and the possible osteoarthritic evolution of patients treated either with a SB (freehand transtibial femoral tunnel) or with a DB technique (outside-in for posterolateral femoral tunnel/inside-out for anteromedial femoral tunnel) at a final follow-up of 6 years.

The Management of Extensor Mechanism Disruption After Total Knee Arthroplasty: A Systematic Review.

We performed a literature search on PubMed, Web of Science, Science Direct/Scopus, Google Scholar, and Google to evaluate results of several techniques to manage disruption of the extensor mechanism after total knee arthroplasty. Different methods to manage extensor mechanism disruption are available at present, with no level I studies informing surgeons in an evidence-based fashion. Primary repair is not indicated.

Catastrophic metallosis after tumoral knee prosthesis failure: A case report.

Introduction: Metallosis is a condition characterized by an infiltration of periprosthetic soft tissues and bone by metallic debris resulting from wear or failure of joint arthroplasties.

Presentation Of Case: Authors describe a case of a 45-year-old man treated for an osteosarcoma of the distal femur with a modular prosthesis when he was 18 years old, he developed massive metallosis with skin dyspigmentation after 17 years. His medical\surgical history was remarkable for a left tumoral knee prosthesis implanted 21 years ago.

Central sensitization in chronic low back pain: A narrative review.

Low back pain is one of the four most common disorders in all regions, and the greatest contributor to disability worldwide, adding 10.7% of total years lost due to this health state. The etiology of chronic low back pain is, in most of the cases (up to 85%), unknown or nonspecific, while the specific causes (specific spinal pathology and neuropathic/radicular disorders) are uncommon.

Medial collateral ligament reconstruction during TKA: a new approach and surgical technique.

Medial collateral ligament (MCL) injuries during total knee arthroplasty are rare but severe complications. They can be treated conservatively, by increasing prosthetic constraint, by using a thicker polyethylene insert, or by directly suturing the ligament. A prosthesis is successful to the extent that it ensures long-term knee stability.

Morpho-structural alterations of sub-chondral bone tissue in patients with osteoarthritis: a scanning electron microscopy study.

Osteoarthritis focuses principally on the degeneration of articular cartilage as a primary cause of the disease. The pathophysiological process of osteoarthritis is characterized by alteration of chondrocytes and the increased bone formation by sub-chondral osteoblasts. Infiltration of macrophages and perivascular T and B lymphocytes is observed, and these infiltrates have been demonstrated in both early and advanced disease.

Clear Cell Sarcoma Of Metatarsus.

We report a case of clear cell sarcoma in the third metatarsus of the right foot. This type of tumor is very rare and scantily reported in literature. A 42-year-old Caucasian male presented with a nodular ulcerated mass on the dorsal side of the left foot.

Surgical Site Infection In Orthopaedic Surgery: Correlation Between Age, Diabetes, Smoke And Surgical Risk.

Introduction: Surgical site infection is a common complication after orthopaedic surgery. It can be associated with increased morbidity rate and social cost. The accurate identification of risk factors is essential so that strategies to prevent these potentially devastating infections can be developed.

How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient populations.

Background: We recently developed a clinical decision support tool, capable of estimating the likelihood of survival at 3 and 12 months following surgery for patients with operable skeletal metastases. After making it publicly available on www.PATHFx.

Corticosteroid Treatment Impact on Spinal Deformity in Duchenne Muscular Dystrophy.

Duchenne muscular dystrophy is a progressive disease with loss of ambulation at around 9-10 years of age, followed, if untreated, by development of scoliosis, respiratory insufficiency, and death in the second decade of life. This review highlights the natural history of the disease, in particular, with regard to the development of the spinal deformity and how this complication has been modified by surgical interventions and overall by corticosteroid treatment. The beneficial effect of corticosteroids may have also an impact on the clinical trial design of the new emerging causative therapies.

Total hip arthroplasty by using a cementless ultrashort stem: a subject-specific finite element analysis for a young patient clinical case.

In this article, a subject-specific finite element analysis has been developed to study a clinical case of a surgically misaligned hip prosthesis with an ultrashort stem. It was set out to study the strain energy density pattern, comparing the results obtained with computed tomography images. The authors developed two other numerical models: the first one analyzes the stress and strain distributions in the healthy femur (without prosthesis) and the second one analyzes the same boneimplant biomechanical system of the clinical case but assuming the prosthesis in the proper position.

Physiopathology of spine metastasis.

The metastasis is the spread of cancer from one part of the body to another. Two-thirds of patients with cancer will develop bone metastasis. Breast, prostate and lung cancer are responsible for more than 80% of cases of metastatic bone disease.

Does lactoferrin behave as an immunohistochemical oncofetal marker in bone and cartilage human neoplasms?

By immunohistochemistry, lactoferrin (LF) has been extensively investigated in human neoplastic tissues; moreover, LF is able to promote bone growth in a murine model. Until now, no systematic studies on human osteocartilagineous fetal samples have been performed in comparison to corresponding neoplastic specimens to verify if LF may represent an oncofetal marker in this field of pathology. By a monoclonal antibody (clone 1A1; Biodesign International; w.

Supra-acetabular brown tumor due to primary hyperparathyroidism associated with chronic renal failure.

A 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months' duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restriction of the right hip's articular function in the maximum degrees of range of motion.

Neoadjuvant multidrug chemotherapy including high-dose methotrexate modifies VEGF expression in osteosarcoma: an immunohistochemical analysis.

Background: Angiogenesis plays a role in the progression of osteosarcoma, as well as in other mesenchymal tumors and carcinomas, and it is most commonly assessed by vascular endothelial growth factor (VEGF) expression or tumor CD31-positive microvessel density (MVD). Tumor VEGF expression is predictive of poor prognosis, and chemotherapy can affect the selection of angiogenic pattern. The aim of the study was to investigate the clinical and prognostic significance of VEGF and CD31 in osteosarcoma, both at diagnosis and after neoadjuvant chemotherapy, in order to identify a potential role of chemotherapy in angiogenic phenotype.