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Biomedical subjects

A Toni

Publications and source records attributed to A Toni.

At least 127 records · Page 7Linked to original sources
PubMed1987

Clinical evaluation of 104 hip resection arthroplasties after removal of a total hip prosthesis.

Functional results of resection arthroplasty are currently considered poor. In 104 hip prosthesis removals after either septic or aseptic loosening, pain, walking, joint motility, life style, and patient's opinion were evaluated. A satisfactory result was recorded in 72% of cases. Prognosis is poorer in patients who are young, have septic loosening, and have poor residual mobility. Resection arthroplasty should be considered a salvage procedure in cases of septic loosening and/or bone stock deficiency after a failed total hip arthroplasty.

Adult↗
PubMed1986

Adriamycin-methotrexate high dose versus adriamycin-methotrexate moderate dose as adjuvant chemotherapy for osteosarcoma of the extremities: a randomized study.

Adjuvant chemotherapy comprising Adriamycin (ADM) and Methotrexate (MTX) with Citrovorum Factor (CF) was administered on a randomization basis to 2 groups of patients with osteosarcoma after surgical ablation of the primary tumor. One group received high dose MTX (regimen I) and the other moderate dose MTX (regimen II). In both groups a short period of heparin treatment was also administered to prevent neoplastic emboli during surgery. All patients were free of metastasis at the beginning of therapy. The efficacy of therapy was determined by recording the percentage of continuously disease-free patients. This was compared to the disease-free survival in 132 patients previously treated with other ADM or ADM-MTX regimens and to a group of 39 patients treated during this period with amputation only. The latter did not receive adjuvant chemotherapy for a variety of reasons and are equated to a concurrent control group. Over the ensuing 27-66 months, 31 of 56 patients (55%) treated with regimen I and 25 of 50 (50%) treated with regimen II were disease-free. The overall disease-free survival in both regimens was 53%. This is similar to the 132 patients treated with previous adjuvant chemotherapy protocols (45-50%). However, the percentage of continuously disease-free patients treated with adjuvant chemotherapy was significantly better than the 39 patients (12%) treated contemporaneously with surgery only (P less than 0.0005). Survival in the latter is similar to that of historical control patients. These results do not suggest any change in the natural history of osteosarcoma and reveal benefits which may accrue with adjuvant chemotherapy. These results also demonstrate that in adjuvant treatment of osteosarcoma performed with ADM and MTX the high and the moderate doses of MTX are equally efficacious.

Adult↗
PubMed1985

Clinical and radiographic long term results of acetabular fractures associated with dislocations of the hip.

The authors carried out a long term review of 246 cases of fracture dislocation of the hip, based on a new classification of these injuries into six types. The average follow-up was 10 years (minimum 4 years). The review was aimed at ascertaining and comparing the clinical and radiographic results in each group in relation to type of treatment, age, sex, quality of reduction and time to weight-bearing. The survey revealed discrepancies between the clinical and radiographic results that underlined the essential difference between idiopathic osteoarthritis and post-traumatic arthritis. The most important factor in reducing the incidence of ischaemic necrosis was reduction of the dislocation within 24 hours. Arthritis was more dependent on the quality of reduction than on the method of treatment used to achieve it, and was also less frequent when weight-bearing had been delayed for 60 days. The overall results were better in younger subjects.

Acetabulum↗
PubMed1985

Total prosthetic replacement in tabetic arthropathy of the hip joint.

The treatment of tabetic arthropathy of the hip by prosthetic replacement has been recorded in the literature in 5 cases, of which only 4 were followed up. The authors present 4 more cases in which follow-up showed that the operation was definitely contraindicated in this condition. All the cases developed recurrent subluxation and/or loosening of the prosthesis.

Aged↗
PubMed1984

Domed (cupola) tibial osteotomy in the treatment of decompensated arthrosis secondary to genu varum.

Decompensated arthrosis secondary to genu varum is always a severely disabling condition. In English speaking countries there is an increasing trend towards prosthetic replacement surgery, but the present paper aims to show that valgising tibial osteotomy is still a valid form of treatment. The authors also discuss the various techniques that have been used and describe the advantages and results of their own preferred technique of "domed" osteotomy.

Arthritis↗
PubMed1984

Arthroprosthesis in old unreduced congenital dislocation of the hip, using the "false" acetabulum. A study of 34 cases.

In adult patients with considerable loss of function due to an unreduced congenital dislocation of the hip with a false acetabulum, the authors posed the question "Is it feasible, with a reasonable chance of success, to perform an arthroprosthesis in the "pathological" position, using the false acetabulum as a seating for the cup?" The aim of this study was to assess, in particular, the holding properties of the cup which has to be fitted after appropriate reaming, into this rather precarious false acetabulum. They define the indications for this procedure and describe their technique. The results of 34 operations, followed up for an average of 5 years, confirm the validity of this procedure.

Acetabulum↗
PubMed1984

Intertrochanteric osteotomy in the treatment of idiopathic osteonecrosis of the head of the femur in adults. A study of 76 cases with a follow-up of 3-16 years.

This study is an evaluation of intertrochanteric osteotomy in cases of idiopathic osteonecrosis of the femoral head (I.O.F.H.) in patients too young to be suitable for prosthetic replacement. The variety of material, the length of follow-up, and the detailed evaluation on a points system, are sufficient for valid comparison with more recently introduced methods of treatment.

Adult↗
PubMed1984

Intramedullary compression osteosynthesis for fractures of the femur.

There are obvious advantages in intramedullary osteosynthesis by closed reduction as compared with open reduction and osteosynthesis using a plate and screws in non-articular fractures of the long bones. This has led to a modification of Küntscher's nail with a view to improving its effectiveness and enlarging the indications.

Bone Nails↗
PubMed1983

Intracapsular metaphyseal osteoid osteoma of the femoral neck.

The authors discuss the 20 cases of intracapsular metaphyseal osteoid osteoma of the neck of the femur found among the total 186 cases of osteoid osteoma on the files of the Tumour Centre of the Rizzoli Orthopaedic Institute. They assess the diagnostic methods that can be used to determine the precise position of the "nidus" with reference to the surgical route to be used. The operation must expose the osteoid osteoma directly by opening the joint.

Adolescent↗
PubMedDate not supplied

An FEA-based protocol for the pre-clinical validation of custom-made hip implants.

Custom-made prostheses are successfully used to treat particular pathologies such as congenital hip dysplasia. The new EC rules on medical devices require a complete technical dossier for each produced custom-made device counter signed by the surgeon who 'prescribes' the custom-made device. Thus, a specific pre-clinical validation protocol must be developed, considering the economical and temporal constraints imposed by the device type. As a first step, in the present study a protocol based on finite element analysis (FEA) was developed and validated, to verify each custom-made hip stem in terms of mechanical strength. The study was carried out on 12 custom-made cementless hip stem designs already produced and implanted, for which the 3D solid model was available. Two of the selected designs were used for the method validation, comparing strain gauges measurements with the stresses predicted by the finite element (FE) model. Once the proposed methodology was verified, all the remaining stem designs were analysed. The developed protocol made possible a complete analysis in less than 4 h; its accuracy (7-8% on the strain gauge measurements) was considered acceptable for the specific application.

Alloys↗
PubMedDate not supplied

The importance of statistics in documentation on hip prostheses.

The authors illustrate the possibilities and the limits of instruments that statistics currently make available in the analysis of a medical series involving hip prosthesis surgery. An analysis of the survival rate constitutes one of the most important tools with regard to data in the study of the effectiveness of implants, but its correct application is influenced by the assumption that so-called censored cases have no differences in survival in relation to those that remain under observation even in periods that follow. Simulation reveals the need to process series with a high number of cases, in order to obtain reliable estimates. Finally, only multivaried techniques allow for a correct evaluation of the incidence that single factors have in causing failure of implants.

Arthroplasty, Replacement, Hip↗
PubMedDate not supplied

Changes in the femoral cortex as related to prosthetic stem.

The need to improve the features of resistance and duration of prosthetic implants, based on the constant increase in the number per year of total hip substitutions has encouraged the study of the causes of aseptic loosening of implants, in particular, any relationship between femoral morphology, features of the implanted prosthesis (size and coating), degree of contact between the latter and the host bone, and the occurrence of changes in bone trophism. The documentation relative to 143 patients, corresponding to 149 primary hip arthroplasties, was evaluated clinically (according to Merle d'Aubigné modified by Charnley) and radiographically, using a computerized radiographic evaluation system devised by our group. In particular, on x-rays (anteroposterior view) obtained in the area corresponding to the upper and lower margins of the smaller trochanter and of the femoral isthmus, measurements relative to femoral diameters, to the distance between them, and to the corresponding flare indexes were obtained; bone thickness, degree of bone-prosthesis correspondence and any changes in bone trophism caused by stress-shielding and stress-concentration were also measured. An analysis of the data was carried out using non-parametric statistical tests, that allowed us to reveal the surgeon's good standardization in preparation of the femur; the tendency for the cortex to thicken for prostheses of the short type, and the narrowing of the standard type prostheses, the influence of the degree of fit of the prosthesis on trophism of the femoral cortex.

Femur Head↗
PubMedDate not supplied

Hip arthroplasty after femoral osteotomy.

The authors report the results of 56 prosthetic implants on previous femoral osteotomy. The cases submitted to surgery, some time after the operation, present with clinical-radiographic results (movement and risk of loosening) that are worse than those cases that had not undergone osteotomy. Among complications, a higher incidence of intraoperative fractures and nerve paralysis were observed. Fractures always occurred when instrumentation was removed during the same prosthetic implantation procedure.

Adolescent↗
PubMedDate not supplied

Preventive cobalt therapy in heterotopic ossification consequent to prosthetic hip reimplantation.

Prosthetic hip reimplantation is considered to be a procedure at risk for the development of periprosthetic heterotopic ossification, which may be responsible for functional limitations of the hip operated on. Preventive treatment may be carried out with radiation or drug therapy. The authors report the results of 54 cases submitted to prosthetic reimplantation and treated by cobalt therapy, as compared to the results of 76 reimplantations (control group) that did not undergo any kind of treatment: the occurrence of high grade ossification (exceeding Brooker grade III) was 2% in cases treated, as compared to 9% in those not treated. Males were more at risk for the development of ossification.

Adult↗