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3. Leukocyte scintigraphy has high specificity but low sensitivity in diagnosing persistent periprosthetic joint infection before reimplantation in two-stage revision.

Author

Presti, Mirco Lo, Vasco, Cosimo, Neri, Maria Pia, Solito, Ludovica, Pellicanò, Davide, Minerba, Marco, Goracci, Gabrio, and Zaffagnini, Stefano

Abstract

Introduction: Two-stage revision is considered the gold standard treatment in chronic periprosthetic joint infection (PJI) but no specific criteria or examination exist to determine infection eradication before reimplantation. This study aimed to assess the diagnostic performance of leukocyte scintigraphy after the first-stage procedure in two-stage revision for chronic PJI. Material and methods: Patients studied with leukocyte scintigraphy after cement spacer insertion for knee PJI from January 2012 to December 2021 were retrospectively included. Infection was diagnosed using the criteria of the 2018 International Consensus Meeting. When 1 or more minor criteria were positive but the score was < 6, patients were considered not infected if there was no recurrence of infection at least 24 months after the second-stage procedure. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were found. Results: The final cohort included 67 cases in 61 patients (M: F = 32:35; mean age 74 years). There were 43 true negatives, 8 true positives, 12 false negatives, and 4 false positives. The sensitivity and specificity of leukocyte scintigraphy in diagnosing PJI were respectively 40.0% and 91.5%, PPV was 66.7%, NPV was 78.2%, and accuracy was 76.1%. Staphylococcus Epidermidis was the most frequently isolated microorganism (50%). Conclusion: Due to the high costs and the difficulty in its execution, LLS should not be used routinely but it could represent an additional criterion in doubtful cases. In any case, a thorough evaluation of other pre- and intra-operative tests is essential to determine whether reimplantation or spacer renewal is the best course of action. Special consideration should be given to positive LLS, as its results are highly specific and have a low rate of false positives. Conversely, in over half of infected patients, LLS could give false negatives, making negative LLS results less relevant. [ABSTRACT FROM AUTHOR]

Published
2025
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9. Silver-Coated Distal Femur Megaprosthesis in Chronic Infections with Severe Bone Loss: A Multicentre Case Series

Author

Fiore, Michele, primary, Sambri, Andrea, additional, Morante, Lorenzo, additional, Bortoli, Marta, additional, Parisi, Stefania Claudia, additional, Panzavolta, Francesco, additional, Alesi, Domenico, additional, Neri, Elisabetta, additional, Neri, Maria Pia, additional, Tedeschi, Sara, additional, Zamparini, Eleonora, additional, Cevolani, Luca, additional, Donati, Davide Maria, additional, Viale, Pierluigi, additional, Campanacci, Domenico Andrea, additional, Zaffagnini, Stefano, additional, and De Paolis, Massimiliano, additional

Published
2023
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12. Piezoelectric ultrasonic debridement as new tool for biofilm removal from orthopedic implants: A study in vitro.

Author

Russo, Alessandro, Gatti, Alessandro, Felici, Silvia, Gambardella, Alessandro, Fini, Milena, Neri, Maria Pia, Zaffagnini, Stefano, and Lazzarotto, Tiziana

Subjects
ORTHOPEDIC implants, ULTRAHIGH molecular weight polyethylene, DEBRIDEMENT, JOINT infections, BIOFILMS, METHICILLIN-resistant staphylococcus aureus
Abstract

Pulse lavage (PL) debridement is the standard treatment used in Debridement, Antibiotics and Implant Retention (DAIR) for bacterial biofilm removal during acute and early postoperative cases of periprosthetic joint infection (PJI). The failure rate of DAIR is still high due to the inadequacy of PL in removing the biofilm. Ultrasound‐based techniques are a well‐established tool for PJI diagnosis due to their ability to completely eradicate the biofilm from implant surfaces. Hence, this study investigates the efficiency of a piezoelectric ultrasonic scalpel (PUS) in removing bacterial biofilm from different orthopedic implant materials in vitro and compares the results with PL. Biofilms of methicillin‐resistant Staphylococcus aureus strains were grown on titanium alloy (Ti6Al4V ELI), stainless steel (AISI 316L), and ultrahigh molecular weight polyethylene (UHMWPE) disks for 24 h. The disks of each material were divided into three groups: (i) a control group (no lavage/debridement), (ii) a group treated with PL, (iii) a group treated with PUS. The disks were then sonicated for viable cell count to measure the residual biofilm content. Compared to the initial cell count (105 CFU/mL for each material), PL showed a two‐log reduction of CFU/mL (p < 0.001 for each material), while for PUS a four‐log reduction was found (p < 0.001 for each material). The comparison between the two lavage/debridement displayed a two‐log reduction of CFU/mL (p < 0.001 for each material) of PUS compared with PL. Its increased efficiency compared with PL promotes the use of PUS in removing bacterial biofilm from orthopedic implants, suggesting its implementation to improve the success rate of DAIR. [ABSTRACT FROM AUTHOR]

Published
2023
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17. Custom-Made Devices Represent a Promising Tool to Increase Correction Accuracy of High Tibial Osteotomy: A Systematic Review of the Literature and Presentation of Pilot Cases with a New 3D-Printed System

Author

Zaffagnini, Stefano, primary, Dal Fabbro, Giacomo, additional, Belvedere, Claudio, additional, Leardini, Alberto, additional, Caravelli, Silvio, additional, Lucidi, Gian Andrea, additional, Agostinone, Piero, additional, Mosca, Massimiliano, additional, Neri, Maria Pia, additional, and Grassi, Alberto, additional

Published
2022
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33. DS_10.1177_0363546520932923 – Supplemental material for Long-term Outcomes and Survivorship of Fresh-Frozen Meniscal Allograft Transplant With Soft Tissue Fixation: Minimum 10-Year Follow-up Study

Author

Grassi, Alberto, Macchiarola, Luca, Lucidi, Gian Andrea, Coco, Vito, Romandini, Iacopo, Filardo, Giuseppe, Neri, Maria Pia, Marcacci, Maurilio, and Zaffagnini, Stefano

Subjects
FOS: Clinical medicine, 110323 Surgery, 110604 Sports Medicine, FOS: Health sciences, 110314 Orthopaedics
Abstract

Supplemental material, DS_10.1177_0363546520932923 for Long-term Outcomes and Survivorship of Fresh-Frozen Meniscal Allograft Transplant With Soft Tissue Fixation: Minimum 10-Year Follow-up Study by Alberto Grassi, Luca Macchiarola, Gian Andrea Lucidi, Vito Coco, Iacopo Romandini, Giuseppe Filardo, Maria Pia Neri, Maurilio Marcacci and Stefano Zaffagnini in The American Journal of Sports Medicine

Published
2020
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38. Does revision ACL reconstruction measure up to primary surgery? A meta-analysis comparing patient-reported and clinician-reported outcomes, and radiographic results

Author

Grassi, Alberto, Ardern, Clare, Marcheggiani Muccioli, Giulio Maria, Neri, Maria Pia, Marcacci, Maurilio, Zaffagnini, Stefano, Grassi, Alberto, Ardern, Clare, Marcheggiani Muccioli, Giulio Maria, Neri, Maria Pia, Marcacci, Maurilio, and Zaffagnini, Stefano

Abstract

Purpose To compare patient-reported and clinician-reported outcomes, and radiographic results between patients who had had revision ACL reconstruction and those who had had primary ACL reconstruction. Design Systematic review and meta-analysis Data sources The MEDLINE, CINAHL, EMBASE and SPORTDiscus electronic databases were searched on 6 August 2015, using 3 main concepts: (1) revision ACL reconstruction, (2) primary ACL reconstruction and (3) treatment outcomes. Eligibility criteria for selecting studies Articles that compared patient-reported or clinician-reported outcomes or radiographic results between patients who had had revision ACL reconstruction and those who had had primary surgery with a minimum of 2 years follow-up were included. The outcomes evaluated were the Lysholm Knee Scoring Scale, objective International Knee Documentation Committee (IKDC) classification, Tegner Activity Scale, side-to-side difference in anterior tibial translation measured with KT-1000/2000 arthrometer, pivot shift test, tibiofemoral osteoarthritis grading on plain radiographs and subsequent knee surgeries. Results 8 studies (300 revision ACL reconstructions and 413 primary ACL reconstructions) were included in the meta-analysis. Patients who had had revision surgery reported inferior Lysholm Knee Scoring Scale scores (mean difference: 7.8 points), had inferior clinician-reported knee function as assessed with the objective IKDC classification (IKDC category A: 27% vs 57%; IKDC category C or D: 22% vs 8%) and pivot shift test (grade II or III: 7% vs 2%), and more radiographic evidence of tibiofemoral osteoarthritis (50% vs 25%) compared with patients who had had primary surgery. Conclusions Revision ACL reconstruction restored similar anterior-posterior knee laxity compared with primary ACL reconstruction. Patients who had had revision surgery reported inferior Lysholm Knee Scoring Scale scores, had inferior clinician-reported knee function and more radiographic signs of tibiof

Published
2016
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49. Cell-Based Cartilage Repair Using the Hyalograft Transplant.

Author

Williams, Riley J., Marcacci, Maurilio, Kon, Elizaveta, Zaffagnini, Stefano, Reggiani, Leonardo Marchesini, Neri, Maria Pia, and Iacono, Francesco

Abstract

Autologous chondrocyte implantation (ACI) is an effective means of treating symptomatic articular cartilage defects. This two-stage cartilage repair strategy relies on the cultured expansion of harvested chondrocytes; these cells are subsequently reimplanted into the host defect and covered (periosteum, collagen patch). The ACI technique has been shown by many authors to result in improved clinical outcomes by facilitating the creation of a hyaline-like cartilage repair tissue. However, it has been demonstrated that defect fill can be variable, and that the procedure itself is technically demanding. Over the past few years, so called "second generation" ACI techniques have been available for clinical use in many parts of the world. These second generation techniques rely on the combination of autologous chondrocytes with absorbable scaffolds. It is believed that the addition of a stable matrix scaffold facilitates the creation of a more hyaline-like cartilage repair tissue. We describe, herein, such a technique. The Hyalograft C implant has been used to treat symptomatic cartilage defects at our institution for many years. This implant consists of autologous chondrocytes that are seeded on a hyaluronan-based scaffold. Implantation of the Hyalograft C scaffold simplifies the method by which autologous chondrocytes may be used to repair a cartilage defect. Moreover, we believe this is the first method by which autologous chondrocytes may be implanted using minimally invasive arthroscopic techniques. The Hyalograft C implant effectively treats symptomatic cartilage defects in a manner that is less morbid, simpler, and more predictable than first-generation ACI methods. [ABSTRACT FROM AUTHOR]

Published
2007
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