Publications by authors named "Alberto Martino"

88 Publications

Survival rates and reasons for revision of different stem designs in total hip arthroplasty for developmental dysplasia: a regional registry study.

J Orthop Traumatol 2021 Jul 18;22(1):29. Epub 2021 Jul 18.

Clinica Ortopedica E Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy.

Introduction: Total hip arthroplasty (THA) in dysplastic hips is challenging, and each specific implant used in this context has been associated with specific complications. A registry study was performed to query survival rates, hazard ratios, and reasons for revision of different stem designs in THAs after developmental dysplasia of the hip.

Materials And Methods: A regional arthroplasty registry was inquired about cementless THAs performed for hip dysplasia from 2000 to 2017. Patients were stratified according to stem design in tapered (TAP; wedge and rectangular), anatomic (ANAT), and conical (CON), and divided on the basis of modularity (modular, M; nonmodular, NM). In total, 2039 TAP stems (548 M and 1491 NM), 1435 ANAT (1072 M and 363 NM), and 2287 CON (1020 M and 1267 NM) implants were included. Survival rates and reasons for revisions were compared.

Results: The groups were homogeneous for demographics, but not fully comparable in terms of implant features. NM-CON stems showed the highest risk of failure (significant) and a high risk for cup aseptic loosening (2.5%). The adjusted risk ratio showed that NM-CON was more prone to failure (HR versus NM-ANAT: 3.30; 95%CI 1.64-7.87; p = 0.0003). Revision rates for dislocations and stem aseptic loosening did not differ between cohorts.

Conclusions: NM-CON stems showed the highest risk of failure, especially high rates of cup aseptic loosening. NM-CON implants were not more prone to dislocations and stem aseptic loosening. Clinical comparative studies are required to investigate the causes of NM-CON failures, which may be due to abnormal acetabular morphology or imperfect restoration of the proximal biomechanics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s10195-021-00590-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286209PMC
July 2021

The Casuccio-Santacroce-Banfo knee arthroscope: an avant-garde Italian tale in the history of arthroscopy.

Int Orthop 2021 Jun 23. Epub 2021 Jun 23.

1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.

Purpose: This brief historical note describes an arthroscopic instrument presented in Italy in 1950, and still preserved to this day at the library of the Rizzoli Orthopedic Institute in Bologna, Italy.

Material And Methods: A research on Casuccio, Santacroce, and Banfo prolific scientific collaboration was performed.

Results: The arthroscopic instrument was designed and utilized at the Orthopedic Clinic of the University of Bari, directed by Professor Casuccio, in collaboration with his assistant, Antonio Santacroce, and Giorgio Banfo, an orthopedist, entrepreneur, and owner of a modern establishment dedicated to the production of orthopaedic products and medical instruments.

Conclusion: Much like America and Japan, 1950s Italy offered avant-garde arthroscopic instruments, which resulted from a masterful collaboration of research and development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-021-05118-xDOI Listing
June 2021

Fibromyalgia syndrome - a risk factor for poor outcomes following orthopaedic surgery: A systematic review.

Semin Arthritis Rheum 2021 Jun 9;51(4):793-803. Epub 2021 Jun 9.

Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy. Electronic address:

Background: Fibromyalgia (FM) is a complex syndrome incorporating many features associated with poor outcome in orthopaedic surgery. Aim of the present review was to comprehensively characterize the available evidence on the consequences of pre-existent FM on the outcomes of orthopaedic surgery.

Methods: We performed a systematic search in MedLine and Web of Science (WOS) to identify studies evaluating the effect of FM on patient-centred outcomes, opioids consumption and postoperative complications.

Results: The search strategy identified 519 records in PubMed and 507 in WOS. A total of 27 articles were deemed eligible for inclusion in qualitative synthesis. Based on quality assessment, 10 studies were rated as good quality, 10 as fair quality and 7 as poor quality. Studies reporting the prevalence of FM in consecutive patients undergoing orthopaedic surgery (n = 19) were included in quantitative synthesis. The pooled prevalence of FM in patients undergoing orthopaedic surgery was 4.1% (95% CI: 2.4-6.8) in those receiving hip or knee surgery, 10.1% (95% CI: 5.7-17.2) in those receiving shoulder or elbow surgery and 21.0% (95% CI: 18.5-23.7) in those receiving spinal surgery. The results of our systematic review consistently report FM as a significant risk factor for less satisfaction, higher pain, worse functional outcome, increased risk for postoperative opioids prescription and higher rate of medical and surgical complications following orthopaedic surgery.

Conclusion: Identifying pre-existing FM in patients scheduled for elective orthopaedic surgery may help to better assess the benefit/risk ratio, improve patients' awareness and minimize any discrepancy between expectancy and results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.semarthrit.2021.05.016DOI Listing
June 2021

Erratum: Efficacy and safety of gastric exposed endoscopic full-thickness resection without laparoscopic assistance: a systematic review.

Endosc Int Open 2020 Sep 16;8(9):C4. Epub 2021 Jun 16.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT Palermo, Italy.

[This corrects the article DOI: 10.1055/a-1198-4357.].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1527-7164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208834PMC
September 2020

Hi-PoAD technique for Adolescent Idiopathic Scoliosis in Adult: Personal case series.

Eur Spine J 2021 Jun 17. Epub 2021 Jun 17.

Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

Purpose: The aim of this article is to present an original surgical technique for the treatment of rigid Adult Idiopathic Scoliosis (AdIS) and the results at minimum 2 years follow-up in a cohort of 40 patients.

Methods: We retrospectively reviewed 40 patients affected by rigid AdIS, older than 40 years and operated with a posterior one stage surgical technique summarized with the acronym Hi-PoAD, (high-density pedicle screws, Ponte osteotomies, asymmetric rods contouring, direct vertebral rotation). The demographic and surgical data were collected, and the improvement of clinical scores and radiologic parameters was obtained after surgery, at 1 and 2 years and at final follow-up, to assess deformity correction, coronal and sagittal balance and clinical outcome.

Results: The average follow-up was 2.9 years (range 2-3.5). Average coronal Cobb angle decreased from 65.0° ± 8.4 to 18.9° ± 3.9 (p < 0.01). Rotation sagittal angle decreased from 26.2° ± 4.4° to 12.4° ± 2.8° (p < 0.01). Mean thoracic kyphosis improved from 23.1° ± 3.6° to 36.0° ± 3.9°. SRS-22 improved form 2.9 ± 0.4 to 3.7 ± 0.6 (p < 0.01). Four early post-operative deep wound infections were observed, all healed after debridement and implant retention. No mechanical complication, junctional kyphosis, deformity progression or non-union were recorded at the last follow-up.

Conclusions: Hi-PoAD technique proved to be safe and effective in the treatment of rigid Adult Idiopathic Scoliosis. The reason for the success is related to the combined strategies adopted, that dissipates corrective forces over several levels, reducing mechanical stress at the screw-bone interface and optimizing corrective potential.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00586-021-06897-yDOI Listing
June 2021

Gastrointestinal exposed endoscopic full-thickness resection in the era of endoscopic suturing: a retrospective single-center case series.

Wideochir Inne Tech Maloinwazyjne 2021 Jun 15;16(2):321-328. Epub 2021 Mar 15.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy.

Introduction: Exposed endoscopic full thickness resection (EFTR) is a minimally invasive technique that has shown promising efficacy and safety in the removal of both gastrointestinal (GI) submucosal tumors (SMTs) arising from the muscularis propria (MP) and select epithelial tumors (ETs) unsuitable for conventional resection techniques. Given the chance of realizing endosurgical full-thickness suturing, the Endoscopic Suturing System (ESS) can be used to close wall defects in this setting. However, data concerning its use in EFTR are still limited.

Aim: This study was conducted to evaluate the safety and efficacy of exposed EFTR with defect closure using the ESS for the removal of both GI SMTs and select ETs unsuitable for conventional resection techniques.

Material And Methods: This was a retrospective, single-center, observational cohort study of patients who underwent GI exposed EFTR.

Results: Seven patients (M : F 6 : 1) with a mean age of 56 ±14.5 years were identified. The indications were MP-originating SMTs of the stomach (n = 2) and duodenum (n = 2), and from submucosa of the rectum (n = 1), and 2 ETs of the rectum. Exposed EFTR and defect closure were successfully performed in 6/7 patients. One case was converted to laparoscopic gastric wedge resection due to technical unfeasibility. We performed an R0 resection in all cases, with the exception of 1 case of rectal EFTR. No macroscopic recurrence was detected at 6-month endoscopic follow-up.

Conclusions: GI exposed EFTR with defect closure by the ESS appears to be feasible, effective, and safe in referral centers. Further studies are necessary to clarify the role of the ESS for post-EFTR wall defect closure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/wiitm.2021.104496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193753PMC
June 2021

Blinded Oral Challenges with Lactose and Placebo Accurately Diagnose Lactose Intolerance: A Real-Life Study.

Nutrients 2021 May 13;13(5). Epub 2021 May 13.

Department of Clinical Medicine and Surgery, Gastroenterology, University Federico II of Naples, 80131 Naples, Italy.

Lactose intolerance (LI) is characterized by diarrhea, abdominal pain, or bloating occurring after lactose consumption in patients with lactose malabsorption. The National Institute of Health (NIH) proposed a double-blind placebo testing to identify LI individuals correctly. However, until now, no study used this approach in a real-life setting. We aimed to assess double-blind placebo challenge accuracy in diagnosing LI in patients with self-reported symptoms of LI. 148 patients with self-reported LI were consecutively enrolled and blindly underwent hydrogen breath test (HBT) after 25 g lactose or 1 g glucose (placebo) load. One week later, the subjects were challenged with the alternative substrate. Each subject completed a validated questionnaire, including five symptoms (diarrhea, abdominal pain, vomiting, bowel sounds, and bloating) scored on a 10-cm visual analog scale. Home questionnaire (HQ) referred to symptoms associated with the consumption of dairy products at home, while lactose questionnaire (LQ) and placebo questionnaire (PQ) referred to symptoms perceived throughout the 4-h after the administration of the substrates, respectively. After lactose load, HBT was positive in 81 patients (55%), of whom 60 (74%) reported relevant symptoms at LQ (lactose malabsorbers, LM). After placebo challenge, 45 out of 60 with a positive lactose challenge did not complain of symptoms and therefore were diagnosed as lactose intolerant, according to NIH definition. The blinded oral challenges with lactose and placebo accurately diagnose LI and identify patients who will likely benefit from a lactose-free diet.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu13051653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8153320PMC
May 2021

Clinical and radiological outcomes of total hip arthroplasty in patients affected by Paget's disease: a combined registry and single-institution retrospective observational study.

J Orthop Traumatol 2021 Mar 17;22(1):13. Epub 2021 Mar 17.

1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy.

Background: Total hip arthroplasty (THA) in patients with Paget's disease can be associated with technical difficulties related to deformities and altered mechanical bone properties, and hypervascularity leads to significative intra-operative bleeding. The purpose of this registry and single-institution study was to investigate overall survival and causes of failure of THA in pagetic patients, together with an analysis of the clinical and radiological complications.

Material And Methods: Registry-based survival and complication analysis, type of fixation, intra- and post-operative complications, clinical (pharmacological history, blood transfusions, Harris hip score [HHS]) and radiographic (cup orientation, stem axial alignment, osteolysis around the cup and the stem and heterotopic ossification [HO]) data were reviewed.

Results: In total, 66 patients (27 males and 39 females, mean age at surgery 71.1 years for males and 74.8 years for female) from the registry study presented a 10-year survival of 89.5%. In the institutional study, involving 26 patients (14 males and 12 females, 69 years average) and 29 THAs, hip function improved significantly. Average cup orientation was 40.5°, while varus stem alignment was 13.8%. In total, 52% of hips had heterotopic ossifications. Peri-acetabular osteolysis was in 13.8% of implants and in 45% of hips was found around the stem. Allogenic and autologous blood transfusion rate were 68.2% and 31.8%, respectively, with an average transfusion of 2 units of blood (range 1-6 units). HHS improved by an average of 34 points, with excellent result in 64.3% of patients. Two implants failed, one due to traumatic ceramic head fracture 64 months after surgery, and one due to mobilization of the cup on the second post-operative day.

Conclusion: THA surgery in Paget's patients is a safe procedure, and implant survival is only partly affected by bone remodelling and choice of fixation. The post-operative functional outcome is largely similar to that of other patients. Bleeding-related complications are the main complications; a careful pharmacological strategy should be recommended to decrease the risk of transfusions and of HO development.

Level Of Evidence: Level III.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s10195-021-00574-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969678PMC
March 2021

Does total hip arthroplasty have a higher risk of failure in patients who undergo lumbar spinal fusion?

Bone Joint J 2021 Mar;103-B(3):486-491

First Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

Aims: Total hip arthroplasty (THA) patients undergoing or having a prior lumbar spine fusion (LSF) have an increased risk of mechanical complications. The aim of this registry-based, retrospective comparative cohort study is to assess the longer term survival of THA in patients who have undergone a LSF during a 17-year period (2000 to 2017).

Methods: A registry-based population study was conducted on 679 patients who underwent both THA and LSF surgeries. Patients were identified from the regional arthroplasty data base and cross linked to patients with LSF from the regional hospital discharge database between 2000 and 2017. Demographic data, diagnosis leading to primary THA, primary implant survival, perioperative complications, number and causes of failure, and patients requiring revision arthroplasty were collated and compared. For comparison, data from 67,919 primary THAs performed during the same time time period were also retrieved and analyzed.

Results: Patients undergoing THA and LSF showed homogeneous demographic data compared to those undergoing THA alone, but a significantly lower eight-year THA implant survival (96.7 vs 96.0, p = 0.024) was observed. Moreover, THA plus LSF patients showed increased incidence of mechanical complications in the first two years after THA surgery compared to THA alone patients.

Conclusion: This registry-based population study shows that approximately 679 (1%) THA patients were subjected to LSF. Patients undergoing THA and LSF have an increased risk of mechanical complications with their THA and a slightly increased risk of revision arthroplasty. Cite this article:  2021;103-B(3):486-491.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1302/0301-620X.103B3.BJJ-2020-1209.R1DOI Listing
March 2021

Effect of pedicle screw angles on the fracture risk of the human vertebra: A patient-specific computational model.

J Mech Behav Biomed Mater 2021 04 29;116:104359. Epub 2021 Jan 29.

Department of Biomedical and Neuromotor Science DIBINEM, University of Bologna, Bologna, Italy; 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

The assessment of a human vertebra's stability after a screws fixation procedure and its fracture risk is still an open clinical problem. The accurate evaluation of fracture risk requires that all fracture mechanical determinants such as geometry, constitutive behavior, loading modes, and screws angulation are accounted for, which requires biomechanics-based analyses. As such, in the present work we investigate the effect of pedicle screws angulation on a patient-specific model of non osteoporotic lumbar vertebra, derived from clinical CT images. We propose a novel computational approach of fracture analysis and compare the effects of fixation stability in the lumbar spine. We considered a CT-based three-dimensional FE model of bilaterally instrumented L4 vertebra virtually implanting pedicle screws according to clinical guidelines. Nine screws trajectories were selected combining three craniocaudal and mediolateral angles, thus investigated through a parametric computational analysis. Bone was modeled as an elastic material with element-wise inhomogeneous properties fine-tuned on CT data. We implemented a custom algorithm to identify the thin cortical layer correctly from CT images ensuring reliable material properties in the computational model. Physiological motion (i.e., flexion, extension, axial rotation, lateral bending) was further accomplished by simultaneously loading the vertebra and the implant. We simulated local progressive damage of the bone by using a quasi-static force-driven incremental approach and considering a stress-based fracture criterion. Ductile-like and brittle-like fractures were found. Statistical analyses show significant differences comparing screws trajectories and averaging the results among six loading modes. In particular, we identified the caudomedial trajectory as the least critical case, thus safer from a clinical perspective. Instead, medial and craniolaterally oriented screws entailed higher peak and average stresses, though no statistical evidence classified such loads as the most critical scenarios. A quantitative validation procedure will be required in the future to translate our findings into clinical practice. Besides, to apply the results to the target osteoporotic population, new studies will be needed, including a specimen from an osteoporotic patient and the effect of osteoporosis on the constitutive model of bone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmbbm.2021.104359DOI Listing
April 2021

Long-term results of subtalar arthroereisis for the treatment of symptomatic flexible flatfoot in children: an average fifteen year follow-up study.

Int Orthop 2021 03 14;45(3):657-664. Epub 2021 Jan 14.

1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.

Aim Of The Study: The aim of this study is to report the long-term outcomes of a homogenous series of patients who underwent subtalar arthroereisis (STA) for the treatment of symptomatic flexible flatfoot (FFF).

Methods: Thirty-four pediatric patients who underwent STA with a bioabsorbable implant were enrolled and radiographic measurements, clinical outcomes, and patients' satisfaction were evaluated.

Results: At a mean 180 months follow-up, radiographic measurements showed significant improvement. A physiological footprint and a proper hindfoot alignment were shown in more than 70% of patients. Mean AOFAS score was 90.4 ± 9.2 (72-100), mean SF-12 was 44.7 with 30 out of 34 patients (88.2%) satisfied with the procedure.

Conclusion: STA with a bioabsorbable implant showed satisfactory long-term results. Based on the data subgroup analysis, nine to 11.5 years for female and nine to 13.5 years for male appeared to be the most appropriate age for surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-020-04911-4DOI Listing
March 2021

Efficacy and safety of gastric exposed endoscopic full-thickness resection without laparoscopic assistance: a systematic review.

Endosc Int Open 2020 Sep 31;8(9):E1173-E1182. Epub 2020 Aug 31.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT Palermo, Italy.

Exposed endoscopic full-thickness resection (Eo-EFTR) without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery (NOTES) technique that has shown promising efficacy and safety in resection of gastric submucosal tumors (G-SMTs) arising from muscularis propria (MP). However, data on the efficacy and safety of gastric Eo-EFTR mostly come from relatively small retrospective studies and concern regarding its use still exists. The aim of our systematic review was to assess the efficacy and safety of gastric Eo-EFTR without laparoscopic assistance. A detailed MEDLINE and EMBASE search was performed for papers published from January 1998 to November 2019 and reporting on gastric Eo-EFTR without laparoscopic assistance. The search strategy used the terms "endoscopic full thickness resection" and "gastric" or "stomach". The primary outcomes were complete resection and surgical conversion rates. The secondary outcomes were overall major adverse events, delayed bleeding, delayed perforation, peritonitis, abdominal abscess and/or abdominal infection and successful Eo-EFTR. Fifteen Asian studies were included in our final review, providing data on 750 Eo-EFTR-treated G-SMTs. The per-lesion rate of complete resection and surgical conversion were 98.8 %\0.8 %, respectively. The per-lesion rate of major adverse events, delayed bleeding, delayed perforation and peritonitis, abdominal abscess and/or abdominal infection was 1.6 %\0.5 %\0.1 %\0.9 %, respectively. The per-lesion rate of successful Eo-EFTR (i. e. complete tumor resection and effective endoscopic defect closure) was 98.3 %. Eo-EFTR without laparoscopic assistance appears to be highly effective and safe NOTES for removing deep G-SMTs, particularly those arising from MP layer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1198-4357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458762PMC
September 2020

Primary aortogastric fistula: an extraordinary rare endoscopic finding in the setting of upper gastrointestinal bleeding.

Endoscopy 2021 Feb 19;53(2):E60-E61. Epub 2020 Jun 19.

Department of Gastroenterology and Digestive Endoscopy, AORN "Antonio Cardarelli", Napoli, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1180-7701DOI Listing
February 2021

Trauma service reorganization in Bologna (Italy) during COVID-19 pandemic.

Injury 2020 07 28;51(7):1684. Epub 2020 Apr 28.

DIBINEM, University of Bologna, I Orthopaedic and Traumatologic Clinic - IRCCS Istituto Ortopedico Rizzoli. Via G.C. Pupilli, 1 - 40136 Bologna, Italy. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2020.04.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187857PMC
July 2020

Full-thickness gastric plication with Overstitch endoscopic suturing device for postsurgical chronic gastroparesis.

Endoscopy 2020 07 22;52(7):E235-E236. Epub 2020 Jan 22.

IRCCS - ISMETT, Endoscopy Service, Department of Diagnostic and Therapeutic Services, Palermo, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1076-0652DOI Listing
July 2020

Thyroid ectopia of the liver: An unusual diagnosis with contrast-enhanced EUS (with video).

Endosc Ultrasound 2019 Nov-Dec;8(6):430-431

Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS - ISMETT), Palermo, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/eus.eus_71_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927141PMC
December 2019

Surgical repair for abductor lesion after revision total hip arthroplasty: a systematic review.

Hip Int 2020 Jul 28;30(4):380-390. Epub 2019 Nov 28.

1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy.

Background: Abductor mechanism lesions represent a severe complication after revision total hip arthroplasty (rTHA). The resulting abductor insufficiency can cause limping, pain, instability, and a higher rate of failure, thus requiring further revision surgery. In case of severe degeneration and retraction of the abductor mechanism, several different surgical treatments are needed.

Aim: To systematically review all studies reporting on surgical treatment of severe abductor lesion after rTHA, focusing on surgical techniques, and clinical and functional results.

Method: Scientific databases were accessed in December 2018 to identify studies addressing the surgical management of severe abductor disruption after rTHA. The PRISMA guidelines were followed. Data were extracted from the identified articles and summarised. Only data about patients with symptoms of abductor insufficiency after rTHA were included in the database.

Results: 9 retrospective studies were included, all being retrospective case series reporting on a total of 92 patients. Several surgical strategies have been described and performed: a repair using a synthetic mesh was reported in 1 study; 2 studies reported on local muscle transfer (gluteus maximus transfer or advancement); vastus lateralis advancement was described in 4 studies while in 2 studies the injury was repaired with the use of an allograft. Overall positive results have been reported in terms of pain reduction, while poor to mild functional scores with persistent limping have often been observed in the postoperative period.

Conclusions: The short follow-up time of the reviewed studies is inadequate to uncover any late dislocation, implant failure or different complications related to abductor mechanism reconstruction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1120700019888863DOI Listing
July 2020

Conversion to laparoscopy in gastric endoscopic full-thickness resection: adverse event or routine step-up approach?

Endoscopy 2020 04 25;52(4):E130-E131. Epub 2019 Oct 25.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-1024-3664DOI Listing
April 2020

Endoscopic management of post-surgical GI wall defects with the overstitch endosuturing system: a single-center experience.

Surg Endosc 2020 09 3;34(9):3805-3817. Epub 2019 Oct 3.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Via Tricomi 5, 90127, Palermo, Italy.

Background And Aims: Post-GI surgical wall defects are frequent and life-threatening complications, with limited literature regarding current treatment. This case series aims to assess the safety, feasibility, and outcomes of endoluminal therapy with the overstitch endoscopic suturing system (Apollo Endosurgery Inc, Austin).

Materials And Methods: All patients who underwent endoscopic suturing for post-surgical wall defect management at IRCCS-ISMETT Palermo from October 2017 until January 2019 were retrospectively enrolled. Stratification therapy was applied according to the clinical scenario, time from surgery to endoscopic intervention, and structural condition of the wall defect layers (tissue status and suture feasibility). The therapeutic endoscopic strategy was divided into three groups (A: pure endoscopic direct suture; B: combined therapy with endoscopic direct suture + FC-SEMS placement + anchoring; C: FC-SEMS placement + anchoring). Success was considered the resolution of symptoms and the presence of a regular intestinal transit after a period of 4-6 weeks.

Results: Twenty (20) patients (male/female 7/13; mean age 54 ± 13.43 years) were included in the study (group A: 9 patients, group B: 7 patients, group C: 4 patients). The types of operative procedures were bariatric (9/20), post-tracheostomy (3/20), post-operative GI surgery (8/20). The post-surgical defects were predominantly intermediate and chronic (24-72 h: 1/20; 3-30 days: 13/20; > 30 days: 6/20). The overall clinical success was 80% (17/20 patients), with a success of 94% (16/17 patients) when excluding the three cases of tracheo-esophageal fistula. No evidence of migration was detected. The only complication was short stenosis of the distal esophagus, present in 4 patients (19%) and successfully treated with a novel lumen-apposing metal stent.

Conclusions: In our experience, considering the absence of clear guidelines, the endoluminal approach with the overstich endoscopic suturing system is a valid alternative to conventional therapy, offering mini-invasiveness, and presenting promising opportunities in terms of technical feasibility and clinical efficacy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00464-019-07145-7DOI Listing
September 2020

Endoscopic closure of gastrocolocutaneous fistula following percutaneous endoscopic gastrostomy, by OverStitch Endoscopic Suturing System.

Endoscopy 2019 12 5;51(12):E384-E385. Epub 2019 Jul 5.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-0956-6792DOI Listing
December 2019

Iatrogenic perforation during colonoscopy in the endoscopic suturing era: surgical emergency or endoscopic clinical practice?

Endoscopy 2019 12 1;51(12):E366-E367. Epub 2019 Jul 1.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT, Palermo, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-0948-3960DOI Listing
December 2019

Mini-invasive treatment of sump syndrome: OverStitch choledochoduodenostomy revision.

Endoscopy 2019 11 4;51(11):E337-E338. Epub 2019 Jun 4.

Digestive Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-0919-4318DOI Listing
November 2019

When neurosurgery and orthopedics were close in the past: Harvey Cushing and Vittorio Putti.

J Neurosurg Sci 2020 Aug 6;64(4):389-392. Epub 2019 May 6.

First Clinic of Orthopedics and Traumatology, Rizzoli Orthopedic Institute and IRCCS, Bologna, Italy.

Harvey Cushing and Vittorio Putti are well-recognized medical authorities. The Italian orthopedic surgeon Vittorio Putti was an advocate of modern orthopedics and a scholar in orthopedic history. Putti was a frequent traveler and an esteemed lecturer, and a close friend of the American neurosurgeon, pathologist, and writer Dr. Harvey Cushing. Correspondence between the two can be found at the Yale Medical Historical Library, in New Haven, CT, and at the Rizzoli Institute in Bologna. A research was performed, which yielded an extensive documentation on the correspondence between the two surgeons. The research allowed to analyze and confirm the strong relationship between the two surgeons and highlighted their passion for collecting antique medical books. This paper is a tribute to two great surgeons in the history of medicine and aims at describing their personality and witnessing their great friendship through an unprecedented documentation. Both surgeons still live on through those who can continue to admire and study the fruit of their passion, as both men donated their precious collection of antique texts to public institutions, Putti to the Rizzoli Orthopedic Institute in Bologna, and Cushing to Yale University.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.23736/S0390-5616.19.04688-5DOI Listing
August 2020

Should evoked potential monitoring be used in degenerative cervical spine surgery? A systematic review.

J Orthop Traumatol 2019 04 2;20(1):19. Epub 2019 Apr 2.

Department of Orthopaedic and Trauma Surgery, University Campus Bio-Medico of Rome, Via Alvaro Del Portillo, 200, 00128, Rome, Italy.

Background: Intraoperative somatosensory evoked potential (SSEP) and transcranial motor evoked potential (tcMEP) monitoring are frequently used in spinal as well as spinal cord surgery for so-called intraoperative neuromonitoring (IONM), while the combination of these techniques is known as concomitant multimodal intraoperative monitoring (MIOM). The aim of this review is to collect available evidence concerning use of IONM and MIOM in cervical decompression surgery in the degenerative setting and attempt to identify the best practice to be advocated.

Materials And Methods: A review of the PubMed and MEDLINE databases and Cochrane Central Registry of Controlled Trials was performed. Studies were included if they involved patients who underwent cervical spine decompression surgery for degenerative stenosis with use of IONM or MIOM and where sensitivity/specificity was reported.

Results: In the identified studies, the sensitivity of SSEP was estimated to be between 22 and 100% with constant specificity of 100%. In the included studies, the sensitivity of MEP was estimated to be between 78 and 100% with specificity ranging from 83.2 to 100%.

Conclusions: On the basis of available evidence, MIOM could be a helpful tool in decompression cervical spine surgery in patients affected by degenerative spinal stenosis, since it is associated with high specificity and sensitivity for detection of intraoperative neural damage. However, evidence is still lacking regarding patient selection to identify individuals in whom monitoring is indicated.

Level Of Evidence: IV (systematic review of studies with LOE II to IV).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s10195-019-0524-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445897PMC
April 2019

Third supplement of the Italian Orthopaedic Society: "Trauma care in Italy: A country-related approach with interregional variability".

Injury 2019 07 26;50 Suppl 2:S1. Epub 2019 Mar 26.

Department of Neuroscience and Organs of Sense, Orthopaedic Unit, Faculty of Medicine and Surgery, University of Bari "Aldo Moro", Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2019.03.035DOI Listing
July 2019

Mechanical behavior of metastatic femurs through patient-specific computational models accounting for bone-metastasis interaction.

J Mech Behav Biomed Mater 2019 05 30;93:9-22. Epub 2019 Jan 30.

Department of Orthopaedics and Trauma Surgery, Campus Bio-Medico University of Rome, Italy.

This paper proposes a computational model based on a finite-element formulation for describing the mechanical behavior of femurs affected by metastatic lesions. A novel geometric/constitutive description is introduced by modelling healthy bone and metastases via a linearly poroelastic constitutive approach. A Gaussian-shaped graded transition of material properties between healthy and metastatic tissues is prescribed, in order to account for the bone-metastasis interaction. Loading-induced failure processes are simulated by implementing a progressive damage procedure, formulated via a quasi-static displacement-driven incremental approach, and considering both a stress- and a strain-based failure criterion. By addressing a real clinical case, left and right patient-specific femur models are geometrically reconstructed via an ad-hoc imaging procedure and embedding multiple distributions of metastatic lesions along femurs. Significant differences in fracture loads, fracture mechanisms, and damage patterns, are highlighted by comparing the proposed constitutive description with a purely elastic formulation, where the metastasis is treated as a pseudo-healthy tissue or as a void region. Proposed constitutive description allows to capture stress/strain localization mechanisms within the metastatic tissue, revealing the model capability in describing possible strain-induced mechano-biological stimuli driving onset and evolution of the lesion. The proposed approach opens towards the definition of effective computational strategies for supporting clinical decision and treatments regarding metastatic femurs, contributing also to overcome some limitations of actual standards and procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmbbm.2019.01.014DOI Listing
May 2019

The 8th Supplement of the Italian Spine Society/Scoliosis Study Group (SICV&GIS).

Eur Spine J 2018 06 6;27(Suppl 2):149. Epub 2018 Jun 6.

Orthopaedics, La Sapienza University of Rome, Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00586-018-5647-4DOI Listing
June 2018

Pharmacological treatment of gastrointestinal bleeding due to angiodysplasias: A position paper of the Italian Society of Gastroenterology (SIGE).

Dig Liver Dis 2018 Jun 15;50(6):542-548. Epub 2018 Feb 15.

Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy.

Angioectasias (AD) belong to benign vascular malformations of the gastrointestinal tract and are responsible for about 4-7% of upper non variceal bleeding, 30-40% of small bowel occult bleeding and 3-40% of colonic bleeding episodes. Gastrointestinal haemorrhage secondary to AD represents an important diagnostic and therapeutic problem that negatively impacts on the quality of life of patients and heath care costs. Endoscopic interventions are the mainstay in both diagnosis and treatment of vascular malformations. However, in a substantial percentage of the cases, age of the patients, comorbidities, clinical severity of anaemia and blood loss as well as size, site and number of lesions prevent this therapeutic approach. Hormonal therapy, thalidomide and somatostatin analogues have been investigated for their potential role as rescue therapies in controlling AD bleeding although, thus far, no recommendations have been provided on their use in this clinical setting. In order to implement appropriate prescription of pharmacological agents to manage gastrointestinal bleeding due to ADs, the Italian Society of Gastroenterology (SIGE) nominated a panel of experts who reviewed the available clinical literature and produced practical clinical recommendations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dld.2018.02.004DOI Listing
June 2018

Screw migration and oesophageal perforation after surgery for osteosarcoma of the cervical spine.

BMC Musculoskelet Disord 2017 12 29;18(1):552. Epub 2017 Dec 29.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.

Background: Even though internal fixation has expanded the indications for cervical spine surgery, it carries the risks of fracture or migration, with associated potential life threatening complications. Removal of metal work from the cervical spine is required in case of failure of internal fixation, but it can become challenging, especially when a great amount of scar tissue is present because of previous surgery and radiotherapy.

Case Presentation: We report a 16 year old competitive basketball athlete who underwent a combined anterior and posterior approach for resection of an osteosarcoma of the sixth cervical vertebra. Fourteen years after the index procedure, the patient eliminated spontaneously one screw through the intestinal tract via an oesophageal perforation and developed a severe dysphagia. Three revision surgeries were performed to remove the anterior plate because of the great amount of post-surgery and post-irradiation fibrosis.

Conclusions: Screw migration and oesophageal perforation after cervical spine surgery are uncommon potentially life-threatening occurrences. Revision surgery may be challenging and it requires special skills.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12891-017-1906-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747111PMC
December 2017

Carbon-fiber reinforced intramedullary nailing in musculoskeletal tumor surgery: a national multicentric experience of the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group.

Injury 2017 Oct;48 Suppl 3:S55-S59

The Italian Orthopaedic Society (SIOT), Rome, Italy.

Introduction: Carbon fiber reinforced (CFR) implants have been proposed for the treatment of fractures or impending fractures of the long bones in the oncology patient. Aim of this study is to present the largest cohort of oncology patients operated by CFR nailing by the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group.

Methods: 53 adult oncology patients were operated on with a CFR-PEEK nail. All the data from adjuvants therapies were collected. Bone callus formation, response to radiotherapy, relapse or progression of the osteolysis were recorded. Hardware survival and failure, breakage and need for implant revision were also analysed.

Results: Anatomical implantation of nails include humerus (n = 35), femur (n =11) and tibia (n = 7). The most frequent tumors affecting the bone were myeloma (n = 13), breast (n = 11), lung (n = 8), and renal cell cancer (n = 7). Acrylic cement reinforcement was used in 2 patients. One patient was subjected to electrochemotherapy after nail insertion. Intraoperative and early postoperative complications occurred in 13.2% and 7.54% of patients respectively. Eight patients had local progression and one developed a stress fracture proximally to the distal static screw. Radiographic union occurred in 14 patients; one screw loosening was recorded.

Discussion: There is currently a lack of solid evidence on the clinical use of CFR nails in oncologic patients. This is the first and largest study of CFR nailing, with the longest available follow up.

Conclusions: Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients' survival and complications with respect to surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S0020-1383(17)30659-9DOI Listing
October 2017