Andrea Fidanza

Background: Genicular Artery Embolization (GAE) is an emerging minimally invasive procedure for the treatment of pain due to knee osteoarthritis (OA) in patients who are not candidates for joint replacement surgery. The aim of this study is to evaluate the clinical and functional outcomes of GAE performed with a temporary embolic agent and the persistence of its benefits up to 6 months of follow-up. Methods: In this prospective study, 15 consecutive patients (mean age 64.5 ± 6.7 years) with Kellgren–Lawrence grade III–IV knee OA, severe pain refractory to conservative treatments, and not eligible for joint replacement surgery were enrolled. All patients underwent GAE with selective embolization of hypervascular genicular branches using an imipenem/cilastatin suspension as a temporary embolic agent. Patients were evaluated before the procedure, on the first postoperative day, and at 3 and 6 months of follow-up using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), and the Visual Analog Scale (VAS). Results: All clinical scores showed a significant improvement over time (p < 0.05). WOMAC decreased from 55.6 ± 7.3 to 16.3 ± 4.1 at 6 months; KOOS increased from 40.7 ± 8.1 to 70.3 ± 6.4; OKS improved from 18.4 ± 4.2 to 38.9 ± 4.6; VAS decreased from 7.8 ± 1.0 to 1.5 ± 0.8. No major complications were observed. Two patients (13.3%) developed a subcutaneous hematoma at the femoral access site, which resolved spontaneously. In two patients, pain recurred at the 1-month follow-up. Conclusions: GAE with a temporary embolic agent appeared to be a safe and effective procedure in improving pain and function in patients with advanced knee OA who are not candidates for joint replacement surgery. The clinical benefit was progressive and sustained up to 6 months, supporting the role of synovitis modulation as a therapeutic target.

Periprosthetic Joint Infection (PJI) remains one of the most serious and challenging complications following Total Knee Arthroplasty (TKA), with a substantial impact on patient outcomes and healthcare systems. Despite advances in surgical techniques and perioperative management, the incidence of PJI has not significantly declined, highlighting the need for more effective preventive strategies. This review aims to provide a comprehensive and clinically oriented overview of current infection prevention strategies in TKA, with a particular focus on risk stratification, perioperative optimization, and the development of a practical clinical algorithm to guide decision-making. A narrative review of the literature was conducted using major medical databases to identify relevant studies on PJI prevention in TKA. Priority was given to recent systematic reviews, meta-analyses, and high-quality clinical studies addressing patient-related risk factors, intraoperative measures, and postoperative management. PJI is a multifactorial complication influenced by the interaction between patient-related, surgical, and postoperative factors. Modifiable risk factors such as obesity, diabetes, malnutrition, and smoking play a pivotal role and should be optimized preoperatively. Intraoperative strategies, including strict aseptic technique, appropriate antibiotic prophylaxis, and minimization of operative time, are essential to reduce contamination risk. Postoperative measures focusing on wound management, hematoma prevention, and early detection of complications further contribute to infection prevention. Several aspects remain controversial, including the role of laminar airflow systems, antibiotic-loaded bone cement in primary TKA, and optimal decolonization strategies for Staphylococcus aureus. Effective prevention of PJI requires a structured, multimodal approach integrating all phases of care. Risk stratification enables personalized preventive strategies and improved perioperative planning. The clinical algorithm proposed in this review provides a practical framework to support decision-making and may help standardize infection prevention pathways. Future research should focus on validating risk-based approaches and emerging technologies to further reduce the burden of PJI in TKA.

Background/Objectives: Rotator cuff repair (RCR) is a common orthopedic procedure, with healing outcomes strongly influenced by patient-specific factors such as tissue quality, tear characteristics, and biological healing potential. Bioinductive collagen implants have shown great results in enhancing tendon healing and reducing retear rate. This study aimed to evaluate the clinical and imaging outcomes of RCR augmented with a xeno-derived collagen membrane over 24 months and to assess complications or implant failures. Methods: Patients underwent arthroscopic RCR using anchors (single or double-row) with additional xeno-derived matrix augmentation. The study included patients older than 40 years with full-thickness supraspinatus and/or infraspinatus tendon tears (DeOrio–Cofield grade 3–4) who were candidates for arthroscopic rotator cuff repair and provided informed consent. Clinical outcomes were assessed using the Constant–Murley Score (CMS), Disabilities of the Arm, Shoulder and Hand score (DASH), and Visual Analogue Score (VAS) at baseline, 3, 6, 12, and 24 months. MRI was performed preoperatively and at 24 months to assess tendon thickness. Results: All scores improved significantly. CMS increased from 16.3 ± 4.1 to 82.9 ± 5.8, VAS decreased from 7.8 ± 1.0 to 1.5 ± 0.8, and DASH improved from 70.3 ± 6.4 to 12.4 ± 4.5 (p < 0.05). Tendon thickness in the supraspinatus (T3) increased from 4.2 ± 0.9 mm to 6.8 ± 1.2 mm (p < 0.05). Retear rate was 7.55%, with no major complications. Conclusions: The bioinductive collagen implant showed notable results in improving tendon thickness, healing, and excellent clinical outcomes in RCR, without membrane-related complications. The study was designed as a prospective single-arm case series without a control group and that was the main limitation; The absence of adverse reactions in this cohort further supports the favorable safety profile of this implant in the present study population.

Burundi remains one of the most socioeconomically challenged countries globally, facing profound limitations in healthcare infrastructure, workforce, and access. In this context, the Italian Medical Foundation for Central Africa (FIMAC) has conducted humanitarian orthopaedic missions for over two decades in Bubanza, addressing critical musculoskeletal conditions in both paediatric and adult populations. This essay provides a comprehensive overview of the operational, clinical, and ethical dimensions of these missions. Commonly treated pathologies include chronic osteomyelitis, neglected fractures, open injuries, and congenital or acquired limb deformities—conditions frequently encountered in advanced stages due to delayed access to care. Resource-sensitive protocols guide interventions and rely heavily on collaboration with local healthcare workers, who receive targeted training in trauma management, postoperative care, and basic surgical techniques. The aim is not just to deliver urgent care but to foster sustainable improvements through capacity building and knowledge exchange. Major challenges include a lack of surgical infrastructure, limited availability of diagnostics and sterile equipment, as well as sociocultural barriers to care, such as language and traditional beliefs. Despite these constraints, the missions yield significant functional and psychosocial outcomes, particularly among paediatric patients. Ethical considerations, including informed consent, scope of practice, and cultural humility, are central to responsible practice in this setting. The personal and professional impact on participating surgeons is profound, often reshaping clinical priorities and reinforcing the humanistic foundations of the medical profession. The paper concludes by advocating for the establishment of permanent surgical facilities, structured deployments, and scalable innovations to enhance the continuity of care and address surgical inequities in low-resource settings.

Total knee arthroplasty (TKA) remains a cornerstone of orthopedic surgery, with optimal coronal alignment playing a pivotal role in determining both clinical outcomes and implant longevity. Traditionally, mechanical alignment has been regarded as the gold standard. However, the emergence of alternative philosophies—such as kinematic alignment and hybrid techniques—has shifted the focus toward individualized approaches. Recent advancements in robotic and computer-assisted systems have significantly enhanced the precision of implant positioning, allowing surgeons to better replicate native knee biomechanics and improve patient satisfaction. This narrative review examines current alignment philosophies in TKA, including mechanical, kinematic, and hybrid methods. It analyzes each technique’s principles, functionalities, benefits, and limitations while highlighting ongoing debates regarding their clinical application. Special attention is given to the role of technology in enabling more accurate, patient-specific surgical execution. Despite promising developments, challenges remain in standardizing these techniques and validating their long-term efficacy. To ensure a comprehensive evaluation relevant literature was reviewed, focusing on studies that explore alignment strategies, biomechanical outcomes, and the integration of technology in TKA. This review aims to synthesize current evidence, identify gaps in knowledge, and outline directions for future research needed to optimize alignment strategies in modern knee arthroplasty.

Purpose: Acetabular fractures in elderly patients are increasing and present complex management challenges. This multicentric retrospective study compares mid-term clinical and radiographic outcomes of acute “fix and replace” versus ORIF, focusing on implant survival, complications, and functional performance at a minimum five-year follow-up, addressing the current lack of extended outcome data. Methods: This study is an update of a previously published multicentric retrospective cohort including patients aged ≥ 60 years with acetabular fractures treated surgically at three hospitals in central Italy between 2013 and 2025. Patients received either acute “fix and replace” (ORIF combined with acute THA) or ORIF alone, with a minimum clinical and radiographic follow-up of five years. Functional outcomes were assessed using PROMs (SF-12, PDI) and clinician-based scores (HHS, Modified Merle d’Aubigné and Postel). Radiographs were reviewed for healing, implant integrity, osteolysis, loosening, osteoarthritis, and heterotopic ossifications. Complications and implant survival were analyzed using Kaplan–Meier curves with revision surgery as the endpoint. Results: A total of 41 patients (21 ORIF, 20 CHP) completed a minimum five-year follow-up. No significant differences were found between groups regarding age, BMI, or follow-up duration. Two revisions to total hip arthroplasty occurred in the ORIF group, with no revisions in the CHP group. Radiographic findings, including heterotopic ossifications and implant loosening, were comparable. Functional scores (HHS, MAPM, SF-12 PCS and MCS) showed no significant differences between groups at both two and five years. The CHP group, however, demonstrated significantly lower pelvic discomfort index (PDI) scores at 60 months ( p = 0.04). No significant intra-group variations were observed over time. Conclusion: Both ORIF and CHP provide satisfactory mid-term outcomes in elderly patients with acetabular fractures. However, CHP demonstrated fewer reoperations and better pelvic discomfort scores at five years. These findings support the growing evidence favoring acute fix-and-replace strategies in this population.