Replacement Arthroplasty: Molfetta L

Punzi L, Canesi B, Carrabba M, Cimmino MA, Frizziero L, Lapadula G, Arioli G, Chevallard M, Cozzi F, Cricelli C, Fioravanti A, Giannini S, Iannone F, Leardini G, Mannoni A, Meliconi R, Modena V, Molfetta L, Monteleone V, Nava T, Parente L, Paresce E, Patrignani P, Ramonda R, Salaffi F, Spadaro A, Marcolongo R. · Cattedra ed UOC di Reumatologia, Università di Padova, Padova. · Reumatismo. · Pubmed #15470525 links to  free full text

Abstract: The recommendations for the management of osteoarthritis (OA) of the knee firstly proposed by the EULAR in 2000, have been updated in 2003. One of the most important objectives of the expert charged to provide these recommendations was their dissemination. Thus, the information generated may be used by each individual country to produce their own set of management guidelines and algorithms for treatment in primary care. The Italian Society of Rheumatology (SIR) and the Italian League against Rheumatism (LIMAR) have organised a Consensus on the EULAR recommendations 2003 with the aim to analyse their acceptability and applicability according to our own experience and local situations in the Italy. The results of this Consensus have demonstrated that a large majority of the EULAR recommendations are endorsed by the Italian experts. Furthermore, the final document of the Italian Consensus clearly indicated the need that specialists involved in the management of knee OA strongly encourage the dissemination of the EULAR 2003 recommendations also in Italy.

Molfetta L, Chiapale D, Caldo D, Leonardi F. · School of Medicine, Orthopaedic Clinic, University of Genoa, Genoa - Italy. · Hip Int. · Pubmed #19197874 No free full text.

Abstract: Vascular lesions in hip prosthetic replacement are rare events; it is mandatory to be aware of the risk, though, in order of the vascular bundle's proximity to the surgical field. A 74-year-old patient was admitted to our department for primary hip arthroplasty for osteoarthritis. The patient was healthy but had mild hypertension. A cemented total hip prosthesis was implanted. The patient complained of growing groin pain and swelling from the third postoperative day. The suspicion of a vascular injury arose with worsening pain and low haemoglobin at blood tests. Then ultrasonography scans and digital angiography were performed, showing a superficial femoral artery pseudo-aneurysm. The patient had further surgery to repair the lesion. In the described case, the pseudo-aneurysm might have been caused by the pulling of a Hohmann retractor on arterial vessels possibly affected by atherosclerosis. The final output was favourable, but the authors point out that knowledge of neurovascular anatomy is necessary as well as postoperative surveillance of the clinical presentation of the patient if groin pain or swelling should arise. In the case of suspicion of vascular lesions, ultrasound and angiography will allow diagnosis and confirm the indication for surgical repair.

Molfetta L, Caldo D. · DINOG Department, University of Genoa, Italy. · Knee. · Pubmed #18234498 No free full text.

Abstract: BACKGROUND: There is no evidence in the current literature of any significant improvement in clinical outcome when comparing computer-assisted total knee arthroplasty (CATKA) with conventional implantation. Analyses of alignment and of component orientation have shown both significant and non-significant differences between the two methods. OBJECTIVES: We compared computer-assisted and conventional surgery for TKA at 5.4 years follow-up for patients with varus osteoarthritic knees. Our goal was to assess clinical outcome and restoration of normal limb alignment. MATERIALS AND METHODS: We performed a retrospective case-control study comparing 30 patients who underwent CATKA with 30 subjects who underwent TKA by conventional methods. Patients were matched individually by preoperative clinical conditions and alignment. We analysed intraoperative data (surgical time and intraoperative complications), postoperative complications, lower limb alignment, radiographic complication on X-ray imaging, and clinical outcome through knee and function score and range of motion. RESULTS AND DISCUSSION: We found no significant clinical difference between the two groups at 5 years post-surgery. However there was a statistically significant improvement in the restoration of the mechanical axis of the lower limb in the coronal plane but not in the sagittal plane. Whether or not this leads to a higher survival rate in the longer term requires further investigation.

Molfetta L, Biggi E, Garlaschi G. · Dipartimento di Scienze Motorie e Riabilitative, Università degli Studi, Genova. · Radiol Med. · Pubmed #15343132 links to  free full text

Abstract: In the preoperative radiographic planning of total hip prosthesis implantation, the hip election radiographic plane (HERP) is an essential, "dedicated" tool, i.e. it is indispensable for correct implant planning, especially as regards the femoral component and specifically some types of devices which, like the Biodynamic or CFP prostheses, allow preservation of the femoral neck.