Biomedical subjects
Publications and source records attributed to D Luppino.
A case of arthroplasty of the knee with fascia lata is presented, in a young patient who was followed up after more than ten years, with a very satisfactory functional result. This operation is certainly not new and has been abandoned by most surgeons. In our case, however, it was shown to be still effective.
After a brief historical review of the surgical treatment of long-established stiffness of the knee, and a discussion of the related indications, the authors describe the surgical technique used in their Division of the Rizzoli Institute. Basically, we use Judet's arthromyolysis, but we often perform, as an initial stage, medial arthrolysis without particular concern for the medial collateral ligament. Our results prove that this does not cause instability. Twenty-seven of the thirty knees in our series presented as sequelae of fractures of the femur where there had been complications, or in which immobilisation had been unduly prolonged. Analysis of the results shows that: a) average pre-operative flexion of 25 degrees was increased to 95 degrees, without sacrificing stability; b) section of the collateral ligaments does not cause long term instability; c) proximal disinsertion of the rectus femoris tendon may lead to loss of active extension, although this was always well tolerated; d) persisting pain is always due to the development of arthrosis; e) The age of the patient, the duration and aetiology of the stiffness have no effect on the results. The complications consisted of two cases of skin necrosis and one of infection, but these were quickly resolved and did not affect the end results.
The authors present a long term review of thirty cases of massive homogenous bone grafts carried out at the Istituto Ortopedico Rizzoli between 1967 and 1971. Thirty one of these were either complete or partial diaphyseo- articular grafts. The lesions for which the operations were performed were: twelve giant cell tumours; one Ewing's tumour; two reticulosarcomas; eight osteosarcomas; six chondrosarcomas; one loss of bone substance from trauma, one echinococcosis of the femur and one aneurysmal bone cyst. In some of these cases amputation or disarticulation had been advised but refused by the patient. Follow up three and a half to five years after operation showed complete incorporation of the graft in eight cases, partial incorporation in live, and resorption in four. In the remaining fifteen cases the follow up was terminated by early death, recurrences, infection or intolerance with rejection. In conclusion, the authors recommend that massive osteoarticular homogenous grafts should be confined to the substitution of unicondylar lesions as these offer greater contact with the host bone and therefore a greater possibility of incorporation. The same indications exist in cases involving only diaphyseal substitution where osteogenetic invasion of the graft can occur from both ends. In all the other cases, they recommend either resection arthrodesis or prosthetic replacement.
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