Cementless porous-coated anatomic (PCA) total hip arthroplasty: the first 100 consecutive cases with a minimum 2-year follow up.
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Biomedical subjects
Publications and source records attributed to P G Marchetti.
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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.
A total of 187 random cases of untreated idiopathic scoliosis, seen from a minimum of 15 to a maximum of 47 years after the end of growth, were reviewed. All curves increased after skeletal maturity (average progression: 0.4 degrees per year). Thoracic curves tend to progress more than lumbar, lumbar more than thoracolumbar, and thoracolumbar more than double major curves. Pain was present in 114 cases (61%) and appeared more frequently in women, after pregnancies, and with fatigue. Cardiopulmonary symptoms were present in 42 patients (22%), especially those with thoracic and thoracolumbar curves greater than 40 degrees. Psychologic disturbances were found in 35 cases (19%), mostly female patients with thoracic curves greater than 40 degrees. The cosmetic appearance of these patients at long-term follow-up was better compared with that at the end of growth, even though the curves progressed. Patients with decompensation of the trunk at the end of growth seemed to improve with time. In an unselected group of patients with severe curves a mortality rate of 17% was found, twice as much as in the Italian general population.
Extremely favorable results are obtained with the use of microcrystals of methylprednisolone acetate for treatment of bone cysts. These results have led to a complete suspension of surgical treatment of bone cysts since 1974. On the basis of these results with corticosteroids, a surgical procedure that involves an incision at the fracture location and bone graft inserted is not indicated. Results following surgery indicate a recurrence rate of approximately 25% to 30%. Since we are as yet unable to explain the mechanism by which the local injection of MPA promotes bone replacement of the cyst, the present observations only reaffirm the hypothesis (presented in our early publications) that the corticosteroid exerts a destructive action on the pathological tissue of the lesion, thus favoring a progressive process of repair. We consider this explanation valid even for lesions, e.g., eosinophilic granulomas and nonossifying fibromas, in which this method of treatment has had varying degrees of success.
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The treatment of bone cysts by topical injection of methylprednisolone acetate was initiated at the end of 1973, and the late results are reported in this paper. In seventy-two cases followed up for one to three years favourable results have been obtained in about 90 per cent. The technique of local injection and the surgical equipment employed, in the case of focal recurrences, are considered. With this method, surgical treatment of bone cysts in youth is seldom necessary.
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