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9. Anterior Knee Pain

Author

Schiavone-Panni, Alfredo, Perisano, Carlo, Del Regno, Chiara, Corona, Katia, D’Amelio, Antonio, Vasso, Michele, and Volpi, Piero, editor

Published
2016
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12. Periprosthetic knee infection: treatment options

Author

VASSO, MICHELE, CAPASSO, LUIGI, CORONA, KATIA, POLA, ENRICO, TORO, GIUSEPPE, SCHIAVONE PANNI, ALFREDO, Vasso, Michele, Capasso, Luigi, Corona, Katia, Pola, Enrico, Toro, Giuseppe, and SCHIAVONE PANNI, Alfredo

Subjects
Orthopedics and Sports Medicine, General
Abstract

Infection is one of the most catastrophic complication following total knee arthroplasty (TKA) and represents the second most common cause of TKA failure. Treatment of a patient with periprosthetic joint infection (PJI) could require often costly and prolonged hospital stays, weeks or months of antibiotic therapy, and multiple surgical procedures. The best management is still highly debating, whereas many treatment options are available. These include suppressive antibiotics, arthroscopic irrigation and debridement, open debridement with insert exchange, single-stage reimplantation and two-stage reimplantation. The choice of the treatment depends on many variables, including integrity of implant, timing of the infection, host factors (age, health, immunologic status), virulence of the infecting organism and wishes of the patient. The aim of this review is to provide a comprehensive understaning of the different options for knee PJIs.

Published
2022
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29. Prevention of periprosthetic joint infection (PJI): a clinical practice protocol in high-risk patients

Author

Iannotti, Ferdinando, Prati, Paolo, Fidanza, Andrea, Iorio, Raffaele, Ferretti, Andrea, Pérez Prieto, Daniel, Kort, Nanne, Violante, Bruno, Pipino, Gennaro, Schiavone Panni, Alfredo, Hirschmann, Michael, Mugnaini, Marco, Indelli, Pier Francesco, Universitat Autònoma de Barcelona, Iannotti, Ferdinando, Prati, Paolo, Fidanza, Andrea, Iorio, Raffaele, Ferretti, Andrea, Pèrez Prieto, Daniel, Kort, Nanne, Violante, Bruno, Pipino, Gennaro, Schiavone Panni, Alfredo, Hirschmann, Michael, Mugnaini, Marco, and Indelli, Pier Francesco

Subjects
medicine.medical_specialty, Resuscitation, Local delivery, PJI, medicine.medical_treatment, MEDLINE, lcsh:Medicine, Periprosthetic, knee, Review, DAPRI, Cochrane Library, 03 medical and health sciences, 0302 clinical medicine, TKA, hip, infection, local delivery, musculoskeletal infections, periprosthetic joint infections, prevention, septic loosening, Internal medicine, Medicine, Knee, 030212 general & internal medicine, Antibiotic prophylaxis, Musculoskeletal infections, 030222 orthopedics, Septic loosening, Hip, General Immunology and Microbiology, business.industry, Kknee, Prevention, lcsh:R, Public Health, Environmental and Occupational Health, Perioperative, Infectious Diseases, Smoking cessation, business, Infection, Tranexamic acid, Periprosthetic joint infections, medicine.drug
Abstract

Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk patients. Methods: Multiple databases (Pubmed/MEDLINE, EMBASE, Scopus, Cochrane Library) and recommendations on TKA PJI prevention measures from the International Consensus Meetings on PJI from the AAOS and AAHKS were reviewed. This represents a Level IV study. Results: Strong evidence was found on poor glycemic control, obesity, malnutrition, and smoking being all associated with increased rates of PJI. In the preoperative period, patient optimization is key: BMI < 35, diet optimization, Hemoglobin A1c < 7.5, Fructosamine < 292 mmol/L, smoking cessation, and MRSA nasal screening all showed strong evidence on reducing PJI risk. Intraoperatively, a weight-based antibiotic prophylaxis, accurate fluid resuscitation, betadine and chlorhexidine dual skin preparation, diluted povidone iodine solution irrigation, tranexamic acid administration, and monofilament barbed triclosan-coated sutures for soft tissues closure all represented effective prevention measures. In the postoperative period, failure to reach normalization of ESR, CRP, D-dimer, and IL-6 six weeks postoperatively suggested early PJI. Conclusion: The current recommendations from this group of experts, based on published evidence, support risk stratification to identify high-risk patients requiring implementation of perioperative measures to reduce postoperative PJI.

Published
2020

32. Natural History of Scoliosis in Children with NF1: An Observation Study

Author

Toro, Giuseppe, primary, Santoro, Claudia, additional, Ambrosio, Daniele, additional, Landi, Giovanni, additional, Scilipoti, Martina, additional, Moretti, Antimo, additional, Paoletta, Marco, additional, Liguori, Sara, additional, Schiavone Panni, Alfredo, additional, Picariello, Stefania, additional, and Iolascon, Giovanni, additional

Published
2021
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35. The application of negative pressure wound therapy in orthopedics: current concepts.

Author

Landi, Giovanni, Mottola, Luciano, Braile, Adriano, Pezzella, Raffaele, De Cicco, Annalisa, Conza, Gianluca, Toro, Giuseppe, and Schiavone Panni, Alfredo

Abstract

We conducted a literature review to better understand the correct application and indications of negative pressure wound therapy (NPWT) in orthopedics and traumatology. A literature search was conducted on PubMed and all articles in English, Spanish, and Italian were included. Relevant articles, references, data, and relevant findings were identified, reviewed, extracted, and accepted by consensus of at least 66% of the researchers. Relevant articles were discussed by the research group. NPWT has several beneficial effects on the wound that contribute to the maintenance of a favorable biochemical and cellular environment, to the formation of granulation tissue and to faster healing. NWPT can be useful in the treatment of septic wounds after initial debridement surgery and removal of the septic foci, and in necrotizing fasciitis in the presence of gas gangrene, venous or pressure ulcers. NPWT can also be used "for prophylactic purposes" (incisional NPWT) in patients with risk factors for skin dehiscence and with a high risk of wound drainage in the post-operative period and after prosthetic surgery or internal fixation to protect the surgical scar. However, the available evidence is mostly unclear. The appropriate use of NPWT seems to reduce the number of dressing changes in complex wounds, reduce hospitalization times, and offer greater comfort to the patient; when applied on surgical incisions, it may reduce the risk of delayed healing and the risk of infections. [ABSTRACT FROM AUTHOR]

Published
2022
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36. Computer-assisted surgery and patient-specific instrumentation improve the accuracy of tibial baseplate rotation in total knee arthroplasty compared to conventional instrumentation: a systematic review and meta-analysis.

Author

Tandogan, Reha N., Kort, Nanne P., Ercin, Ersin, van Rooij, Floris, Nover, Luca, Saffarini, Mo, Hirschmann, Michael T., Becker, Roland, Dejour, David, European Knee Associates (EKA), Indelli, Pier-Francesco, Liebensteiner, Michael C., Muller, Jacobus H., Chen, Antonia F., Attal, René, Arnold, Markus P., and Schiavone-Panni, Alfredo

Abstract

Purpose: To determine whether patient-specific instrumentation (PSI), computer-assisted surgery (CAS) or robot-assisted surgery (RAS) enable more accurate rotational alignment of the tibial baseplate in primary total knee arthroplasty (TKA) compared to conventional instrumentation, in terms of deviation from the planned target and the proportion of outliers from the target zone. Methods: The authors independently conducted three structured electronic literature searches using the PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases from 2007 to 2020. Studies were included if they compared rotational alignment of the tibial baseplate during TKA using conventional instrumentation versus PSI, CAS, and/or RAS, and reported deviation from preoperatively planned rotational alignment of the tibial baseplate in terms of absolute angles and/or number of outliers. Methodological quality of eligible studies was assessed by two researchers according to the Downs and Black Quality Checklist for Health Care Intervention Studies. Results: Fifteen studies, that reported on 2925 knees, were eligible for this systematic review, of which 6 studies used PSI, and 9 used CAS. No studies were found for RAS. Of the studies that reported on angular deviation from preoperatively planned rotational alignment, most found smaller deviations using PSI (0.5° to 1.4°) compared to conventional instrumentation (1.0° to 1.6°). All studies that reported on proportions of outliers from a target zone (± 3°), found lower rates of outliers using PSI (0 to 22%) compared to conventional instrumentation (5 to 96%). Most studies reported smaller angular deviation from preoperatively planned rotational alignment using CAS (0.1° to 6.9°) compared to conventional instrumentation (1.1° to 7.8°). Of the studies that reported on proportions of outliers from a target zone (± 3°), most found fewer outliers using CAS (10 to 61%) compared to conventional instrumentation (17 to 78%). Conclusion: This systematic review and meta-analysis revealed that both CAS and PSI can improve the accuracy of rotational alignment of the tibial baseplate by decreasing angular deviation from the preoperatively planned target and reducing the proportion of outliers from the target zone. The clinical relevance is that PSI and CAS can improve alignment, though the thresholds necessary to grant better outcomes and survival remain unclear. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Published
2022
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37. Fractures around Trochanteric Nails: The “Vergilius Classification System”

Author

Toro, Giuseppe, primary, Moretti, Antimo, additional, Ambrosio, Daniele, additional, Pezzella, Raffaele, additional, De Cicco, Annalisa, additional, Landi, Giovanni, additional, Tammaro, Nicola, additional, Florio, Pasquale, additional, Cecere, Antonio Benedetto, additional, Braile, Adriano, additional, Medici, Antonio, additional, Siano, Antonio, additional, Di Maggio, Bruno, additional, Calabrò, Giampiero, additional, Gagliardo, Nicola, additional, Di Fino, Ciro, additional, Bruno, Gaetano, additional, Pellegrino, Achille, additional, Negri, Giacomo, additional, Monaco, Vincenzo, additional, Gison, Michele, additional, Toro, Antonio, additional, Schiavone Panni, Alfredo, additional, Tarantino, Umberto, additional, and Iolascon, Giovanni, additional

Published
2021
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38. Prevention of Periprosthetic Joint Infection (PJI): A Clinical Practice Protocol in High-Risk Patients

Author

Iannotti, Ferdinando, primary, Prati, Paolo, additional, Fidanza, Andrea, additional, Iorio, Raffaele, additional, Ferretti, Andrea, additional, Pèrez Prieto, Daniel, additional, Kort, Nanne, additional, Violante, Bruno, additional, Pipino, Gennaro, additional, Schiavone Panni, Alfredo, additional, Hirschmann, Michael, additional, Mugnaini, Marco, additional, and Indelli, Pier Francesco, additional

Published
2020
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40. Systematic Review and Meta-Analysis of the Clinical Evidence on the Use of Autologous Matrix-Induced Chondrogenesis in the Knee

Author

Steinwachs, Matthias R., primary, Gille, Justus, additional, Volz, Martin, additional, Anders, Sven, additional, Jakob, Roland, additional, De Girolamo, Laura, additional, Volpi, Piero, additional, Schiavone-Panni, Alfredo, additional, Scheffler, Sven, additional, Reiss, Eric, additional, and Wittmann, Udo, additional

Published
2019
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42. Systematic Review and Meta-Analysis of the Clinical Evidence on the Use of Autologous Matrix-Induced Chondrogenesis in the Knee

Author

Steinwachs, Matthias R., Gille, Justus, Volz, Martin, Anders, Sven, Jakob, Roland, De Girolamo, Laura, Volpi, Piero, Schiavone-Panni, Alfredo, Scheffler, Sven, Reiss, Eric, and Wittmann, Udo

Abstract

Objective A systematic review and meta-analysis of Autologous Matrix-Induced Chondrogenesis (AMIC®) outcomes for grade III/IV chondral and osteochondral lesions of the knee treated with Chondro-Gide®.Design Studies with a minimum follow-up of 1 year providing clinical results of AMIC repair in the knee were included based on PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Methodological quality was assessed by the modified Coleman Methodology Score (mCMS). The meta-analysis was comparing pain VAS (Visual Analog Scale), Lysholm score, and IKDC score (International Knee Documentation Committee) between baseline and follow-up after 1 or 2 years and after >3 years.Results Twelve studies (375 patients) were included. The mCMS demonstrated a suboptimal study design (ranking between 52 and 80). The mean age was 36.2 years (14-70 years). The mean defect size was 4.24 cm2(0.8-22 cm2). The results from the random effects model indicated a clinically significant (P< 0.05) improvement of pain VAS from baseline to follow-up at year 1 to 2 of −4.02(confidence interval −4.37; −3.67), still significant after 3 years. Lysholm score at year 1 or 2 improved significantly and remained highly significant after 3 years. IKDC score showed highly significant improvement of 32.61 between 1 and 2 years versus baseline values maintained after 3 years.Conclusions The AMIC procedure significantly improved the clinical status and functional scoring versus preoperative values. Evidence was obtained in a non-selected patient population, corresponding to real-life treatment of knee chondral and osteochondral defects. The evidence is sufficient to recommend AMIC in this indication.

Published
2021
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