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Dual mobility in primary total hip arthroplasty:A temptation from the devil or a blessing from above

World Journal of Orthopedics 2024年第6期15卷 512-519页

作者： Raymond Klumpp Linda Boerci Francesco Buonanotte Marco Zeppieri unita operativa Complessa ortopedia e traumatologia Ospedale Treviglio-Caravaggio ASSTBergamo Ovest 24047Italy Department of Orthopedics Universitàdegli Studi di Milano-BicoccaMonza 20090Italy Department of Ophthalmology University Hospital of UdineUdine 33100Italy

Dual mobility(DM)bearings have gained significant attention in the field of total hip arthroplasty(THA)as a valid treatment option in cases of revision for instability after THA whereas its use in primary THA is still a matter of *** manuscript explores the pathology,incidence,diagnosis,treatment options,prognosis,ongoing studies in the literature,and future perspectives related to the use of DM bearings employed in primary *** bearings are primarily designed to address one of the major concerns in THA:Instability of the prosthetic *** is both for the surgeon and the patient a devastating postoperative complication,leading to significant pain and subsequent apprehension by the patient and may require revision *** use of DM implants poses the worry of wear-related complications,such as accelerated polyethylene wear and osteolysis,which also pose challenges to long-term implant *** technique has seen a steady rise in recent years,with multiple studies reporting favorable *** incidence of their utilization varies among institutions and surgeons,reflecting differing preferences and patient *** diagnosis of instability and wear-related complications in THA often involves clinical assessment,imaging modalities such as X-rays,computed tomography scans,and sometimes advanced imaging techniques like magnetic resonance *** bearings can be considered as an option when patients present neurologic pathologies such as Parkinson's disease or recurrent dislocations after *** bearings provide an additional articulation point within the implant,facilitating a greater range of motion and inherent *** design allows for reduced risk of dislocation and improved functional *** implant manufacturers offer different designs and sizes of DM bearings to suit individual patient *** literature suggests that the use of DM bearings in primary THA has demonstrated promising outcomes in terms

关键词： Dual mobility First implant Hip arthroplasty Surgical technique differential diagnosis

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Comparison between Care Strategies for Patients with Osteoarthritis of the Hands Based on the Use of Joint Protection, Assistive Technology and exercises

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Open Journal of Orthopedics 2024年第7期14卷 295-311页

作者： Daniele dos Santos Scarcella Talita dias da Silva Victoria Yanara Hernandes da Silva Maria Cândida de Miranda Luzo Selma Lancman Marcia Uchoa de Rezende Carlos Bandeira de Mello Monteiro Instituto de ortopedia e traumatologia Hospital das Clnicas HCFMUSP Faculdade de Medicina Universidade de So Paulo So Paulo Brazil Programa de Ps-Graduao em Cincias da Reabilitao Faculdade de Medicina Universidade de So Paulo So Paulo Brazil escola de Artes Cincias e Humanidades Universidade de So Paulo So Paulo Brazil

Background: Osteoarthritis (OA) is a disabling disease that can affect 6% to 12% of the adult population and more than a third of people over 65 years of age. Purpose: To assess whether a group of people with hand osteoarthritis (hOA) who received different types of treatment improved their function after two years of follow-up. Method: The entire sample (n = 97) underwent three follow-up assessments regarding anthropometric parameters of the upper limbs and ability to perform functional activities. Subsequently, the sample was divided into two groups for the intervention periods, called the First Period (n = 73) and the Second Period (n = 24);the First Period kept the same protocol with orientations, and the Second Period went to an intervention with orientation strength exercises and use of orthosis. Findings: In the separate analysis of the three questions of the DASH pain module, no differences were found between the assessment moments for groups of guidelines, treatment, or symptoms. Significant effects were observed for F(2, 162) = 3.5, p = 0.033, η2 = 0.04, and interaction for moments and intervention F(2, 162) = 4.3, p = 0.016, η2 = 0.05. Implications: It can be concluded that only guidance treatment does not benefit patients with hand osteoarthritis. In contrast, guidance, exercise, and orthosis treatment can significantly improve the disease.

关键词： Hand Osteoarthritis Hand Deformities Occupational Therapy

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Taper-wedge stem suitable for anterior approach total hip arthroplasty:Adequate biomechanical reconstruction parameters and excellent clinical outcome at mid-term follow-up

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World Journal of Orthopedics 2022年第12期13卷 1047-1055页

作者： Carlo Trevisan Antonino Salvatore Lombardo Gianluca Gallinari Marco Zeppieri Raymond Klumpp UOC ortopedia e traumatologia Ospedale Bolognini Seriate ASSTBergamo Est 24068Italy Department of Ophthalmology University Hospital of UdineUdine 33100Italy UOC ortopedia e traumatologia Ospedale Treviglio-Caravaggio ASSTBergamo Ovest 24047Italy

BACKGROUND The direct anterior approach(DAA) for total hip arthroplasty(THA) is a less invasive and muscle-sparing approach that seems to improve early function and patient satisfaction. Several studies, however, have reported high complication and revision rates due to the technical difficulties related to the femoral *** To evaluate the usefulness and safety of a new stem equipped with a morphometric design and a size-specific medial curvature in DAA for *** This retrospective study was based on 130 patients that underwent mini-invasive DAA procedures for THA using the Accolade Ⅱ stem. A total of 144 procedures were included in the assessment, which was based on postoperative complications, survival rates, functional parameters, and patient related *** Overall complications were recorded in 6 procedures(4.2%). There were no complications related to the stem implantation and no intraoperative fractures. Only one patient was revised for deep infection. On radiographs, biomechanical hip reconstruction was satisfactory and no stem showed any subsidence greater than 2 mm. Full osseointegration based on engh scores was seen in all of the implanted stems. Median Harris hip score at final follow-up was 99 points(range 44-100 points), which resulted excellent in 91.3% of patients. The median values of the osteaorthritis outcome score ranged from 87.5 to *** The mid-term positive outcomes and low complication rate in our consecutive series of patients support the safety and suitability of this new stem design in DAA for THA.

关键词： Total hip arthroplasty Orthopedics direct anterior approach Orthopedic surgery Stem implantation Accolade II stem

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Preoperative and postoperative risk factors for periprosthetic joint infection in primary total hip arthroplasty:A 1-year experience

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World Journal of Orthopedics 2022年第10期13卷 903-910页

作者： Giuseppe Ferdinando Tella Cesare Donadono Francesco Castagnini Barbara Bordini Monica Cosentino Michele di Liddo Francesco Traina ortopedia-traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio IRCCS Istituto Ortopedico RizzoliBologna 40125Italy Laboratorio di Tecnologia Medica IRCCS Istituto Ortopedico RizzoliBologna 40125Italy

BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a *** the incidence of PJI is very low(0.69%)in our department,with an average follow-up of 595 d,this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after *** To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential *** We counted 583 THR for 578 patients and observed only 4 cases of infection(0.69%)with a mean follow-up of 596 d(min 30,max 1451).We reviewed all medical records to collect the data:duration and time of the surgery,presence,type and duration of the antibiotic therapy,preoperative diagnosis,blood values before and after surgery,transfusions,presence of preoperative drugs(in particularly anticoagulants and antiaggregant,corticosteroids and immunosuppressants),presence of some comorbidities(high body mass index,blood hypertension,chronic obstructive pulmonary disease,cardiac ischemia,diabetes,rheumatological conditions,previous local infections).ReSULTS No preoperative,intraoperative,or postoperative analysis showed a higher incidence of *** did not find any class with evident major odds of *** our study,we did not find any border value to predict PJI and all patients had similar values in both groups(non-PJI and PJI).Only some categories,such as female patients,showed more frequency of PJI,but this difference related to sex was not statistically *** We did not find any category with a higher risk of PJI in THR,probably due to the lack of few cases of infection.

关键词： Primary total hip replacement Periprosthetic joint infection Preoperative risk factors Postoperative risk factors Preoperative and postoperative blood value Total hip arthroplasty

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Triggering,clicking,locking and crepitus of the finger:A comprehensive overview

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World Journal of Orthopedics 2023年第10期14卷 733-740页

作者： Pieter W Jordaan Raymond Klumpp Marco Zeppieri Department of Orthopaedic Garden Route Hand UnitGeorge 6530South Africa UOC ortopedia e traumatologia Ospedale Treviglio-Caravaggio ASSTBergamo Ovest 24047Italy Department of Ophthalmology University Hospital of UdineUdine 33100Italy

Triggering,locking,clicking,and crepitus of the fingers are common symptoms patients present *** though crepitus and triggering can occur as part of the same underlying diagnosis,it is important to differentiate between them,as they usually indicate different possible *** differential diagnoses that should be considered include trigger finger,metacarpophalangeal joint(MCPJ)arthritis,fractures or dislocations,extensor digitorum communis subluxation or dislocation,locked MCPJ,avascular necrosis of the metacarpal head,and Dupuytren’s disease.A thorough clinical examination with appropriate special investigations can permit the clinician to make the correct *** management of a confirmed diagnosis is successful in providing symptomatic improvement.

关键词： Trigger finger Locking Crepitus Metacarpophalangeal joint dislocation differential diagnosis

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Off-the-shelf 3D printed titanium cups in primary total hip arthroplasty

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World Journal of Orthopedics 2021年第6期12卷 376-385页

作者： Francesco Castagnini Filippo Caternicchia Federico Biondi Claudio Masetti Cesare Faldini Francesco Traina Department of ortopedia-traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio IRCCS Istituto Ortopedico RizzoliBologna 40136Italy Department of Clinica I di ortopedia e traumatologia Rizzoli Orthopedic InstituteUniversity of BolognaBologna 40136Italy Department of diBINeM Scienze Biomediche e Neuromotorie Alma Mater Studiorum Universitàdi BolognaBologna 40139Italy

Three-dimensional(3D)-printed titanium cups used in primary total hip arthroplasty(THA)were developed to combine the benefits of a low elastic modulus with a highly porous *** aim was to improve local vascularization and bony ingrowth,and at the same time to reduce periprosthetic stress *** manufacturing,starting with a titanium alloy powder,allows serial production of devices with large interconnected pores(trabecular titanium),overcoming the drawbacks of tantalum and conventional manufacturing *** date,3D-printed cups have achieved dependable clinical and radiological outcomes with results not inferior to conventional sockets and with good rates of *** mechanical failures and no abnormal ion release and biocompatibility warnings have been *** this review,we focused on the manufacturing technique,cup features,clinical outcomes,open questions and future developments of off-the-shelf 3D-printed titanium shells in THA.

关键词： Socket Highly porous Additive manufacturing Ultraporous Trabecular Beam melting

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Reporting rotator cuff tears on magnetic resonance arthrography using the Snyder's arthroscopic classification

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世界放射学杂志：英文版（电子版） 2017年第3期9卷 126-133页

作者： Alberto Aliprandi Carmelo Messina Paolo Arrigoni Michele Bandirali Giovanni di Leo Stefano Longo Sandro Magnani Chiara Mattiuz Filippo Randelli Silvana Sdao Francesco Sardanelli Luca Maria Sconfienza Pietro Randelli Servizio di Radiologia IRCCS Policlinico San Donato Scuola di Specializzazione in Radiodiagnostica Università degli Studi di Milano unità operativa di ortopedia e traumatologia ⅱ IRCCS Policlinico San Donato dipartimento di Scienze Biomediche per la Salute Università degli Studi di Milano unità operativa di ortopedia e traumatologia V IRCCS Policlinico San Donato unità operativa di Radiologia/diag-nostica per Immagini con Servizio di Radiologia Interventistica IRCCS Istituto Ortopedico Galeazzi unità operativa Complessa I Divisione Istituto Ortopedico Gaetano Pini

AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for *** One hundred and twenty-six patients(64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder's classification was recorded. MRA examinations were evaluated by two independent radiologists(14 and 5 years' experience) using Snyder's classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial-and fullthickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa *** On arthroscopy, 71/126 patients(56%) had a fullthickness RCT. The remaining 55/126 patients(44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed fullthickness RCTs, 66(93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent(k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases(92%); in the remaining 5/66 cases(8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total(k = 1.000).CONCLUSION MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder's classification for reporting. Snyder's classification may be adopted for routine reporting of MRA.

关键词： Arthroscopy Magnetic resonance imaging Shoulder Arthrography Supraspinatus tendon Rotator cuff tear

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Quantitative alpha-defensin testing: Is synovial fluid dilution important?

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World Journal of Orthopedics 2022年第8期13卷 760-767页

作者： Rodrigo Calil Teles Abdo Riccardo Gomes Gobbi Chilan Bou Ghosson Leite Sandra Gofinet Pasoto elaine Pires Leon Ana Lucia Lei Munhoz Lima eloisa Bonfa JoséRicardo Pécora Marco Kawamura Demange Instituto de ortopedia e traumatologia Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSao Paulo 05403-010Brazil Orthopaedic Department HCor-Hospital do CoraçãoSao Paulo 04004-030Brazil division of Rheumatology Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSao Paulo 05403-010Brazil

BACKGROUND Alpha-defensin has been widely studied for the diagnosis of periprosthetic joint infection(PJI).However,there is a lack of detailed information regarding the proper laboratory technique of the enzyme-linked immunosorbent assay(eLISA)method,such as sample *** To assess the influence of dilution in the synovial fluid during eLISA for the diagnosis of knee PJI;and determine which dilution presents a better *** Forty samples of synovial fluid from arthroplasty knees were included,17 in the infected group and 23 in the aseptic group,according to Musculoskeletal Infection Society ***,five synovial fluid samples from each group were assessed for quantitative analysis of alpha-defensin using *** dilution ratios(1:10,1:100,1:500,1:1000 and 1:5000)were tested based on the predetermined cutoff value of 5.2 mg/*** dilutions that performed better were used to compare the results of all *** For infected cases,a gradual increase in the dilution of synovial fluid samples led to an equivalent increase in alpha-defensin *** same was not observed in the aseptic *** 1:1000 and 1:5000 dilutions presented satisfactory results to differentiate infected and aseptic *** analyses were performed using 1:1000 and 1:5000 for all 40 *** 1:1000 dilution resulted in a sensitivity of 88.2%(95%CI,66%-98%)and specificity of 95.7%(95%CI,79%-99%),whereas the 1:5000 dilution presented a sensitivity of 94.1%(95%CI,73%-99%)and a specificity of 100%(95%CI,86%-100%).CONCLUSION The synovial fluid dilution had an important influence on the alpha-defensin eLISA *** of 1:5000 showed the best performance for the diagnosis of knee *** results of this study set the basis for a more reliable and reproducible alpha-defensin eLISA during the investigation of PJI,contributing to the expansion of this technique in different treatment centers worldwide.

关键词： Alpha-defensin enzyme-linked immunosorbent assay Periprosthetic joint infection Laboratory findings

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expanding the horizons of clinical applications of proximal humerus locking plates in the lower extremities:A technical note

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Chinese Journal of Traumatology 2020年第6期23卷 331-335页

作者： Robinson e.Pires Richard S.Yoon Frank A.Liporace Daniel Balbachevsky Rogerio CBitar Vincenzo Giordano Andre Wajnsztejn Mauricio Kfuri Departamento do Aparelho Locomotor-Universidade Federal de Minas Gerais Belo HorizonteMGBrazil division of Orthopedic Trauma&Adult Reconstruction Department of Orthopedic SurgeryJersey City Medical Center-RWJ Barnabas Health Jersey CityNJUnited States Departamento de ortopedia e traumatologia Universidade Federal de São PauloSão PauloSPBrazil Departamento de ortopedia e Anestesiologia Universidade de São PauloRibeirão PretoSPBrazil Serviço de ortopedia e traumatologia Prof.Nova Monteiro Hospital Municipal Miguel CoutoRio de JaneiroRJBrazil Serviço de ortopedia e traumatologia Hospital Israelita Albert Einstein HospitalSão PauloSPBrazil Missouri Orthopaedic Institute University of MissouriColumbiaUnited States

Pre-contoured anatomical locking plates were designed to address the clinical need of fixing small epiphyseal segments with a larger number of *** plates match the contour and shape of a variety of bones allowing for optimal buttress *** aim of this manuscript is to highlight the benefits of applying proximal humerus locking plates in the fixation of lower extremity *** designed for the proximal humerus,the low-profile plate shape and anatomic contour also provides versatile use in certain areas of the lower *** technical narrative highlights the versatile and reliable use of this plate for other anatomical areas than the one to which it has been originally conceived.

关键词： Proximal humerus Locking plate distal femur Proximal tibia distal tibia

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Successful hip revision surgery following refracture of a modern femoral stem using a cortical window osteotomy technique:A case report and review of literature

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World Journal of Methodology 2023年第5期13卷 502-509页

作者： Carlos M Lucero Juan B Luco Agustin Garcia-Mansilla Pablo A Slullitel Gerardo Zanotti Fernando Comba Martin A Buttaro Centro de Cadera"Sir John Charnley" Instituto de Ortopedia y Traumatologia Prof.Dr.Carlos E.OttolenghiHospital Italiano de Buenos AiresCapital federal C1198AAWBuenos AiresArgentina Instituto de ortopedia y traumatologia Prof.Dr.Carlos e.Ottolenghi Hospital Italiano de Buenos AiresCiudad Autonoma de Buenos Aires C1198AAWBuenos AiresArgentina Centro de Cadera"Sir John Charnley" Instituto de Ortopedia y Traumatología“Prof.Dr.Carlos E.Ottolenghi”Hospital Italiano de Buenos AiresCiudad Autónoma de Buenos Aires C1198AAWBuenos AiresArgentina

BACKGROUND The exeterTM Universal cemented femoral component is widely used for total hip replacement *** there have been few reports of femoral component fracture,removal of a broken femoral stem can be a challenging *** SUMMARY A 54-year-old man with a Dorr A femur sustained a refracture of a primary exeterTM stem,two years after receiving a revision using a cement-within-cement technique(CWC)through an extended trochanteric osteotomy(eTO).The technical problems related to the CWC technique and the eTO played a major role in the stem fatigue *** performed revision surgery and removed the distal cement using a cortical femoral window technique,followed by reimplantation with an uncemented,modular,distally-fixed uncemented *** patient experienced an uneventful postoperative *** Re-fracture of a modern femoral exeterTM stem is a rare event,but technical complications related to revision surgery can lead to this *** cortical window osteotomy technique can facilitate the removal of a broken stem and cement,allowing for prosthetic reimplantation under direct vision and avoiding eTO-related complications.

关键词： exeter stem Femoral stem breakage Femoral osteotomy Total hip arthroplasty Case seport

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