Papers by A.Tonino Tonino
Clinical Orthopaedics and Related Research, 2008
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Zeitschrift für Orthopädie und ihre Grenzgebiete, 2008
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Introduction: Investigating the correlations between bone ongrowth and HA resorption on coated im... more Introduction: Investigating the correlations between bone ongrowth and HA resorption on coated implants is important to understand the contribution of resorbable coatings on implant fixation and periprosthetic bone remodelling. It is only possible histomorphometrically and this study measured bone apposition and residual HA on hip stems of one single design. Methods: Post-mortem retrievals of 13 ABG-I (Stryker) hip stems from 13 patients (10f, 3m, age: 58–86yrs, uneventful THA, death unrelated to hip diseases). The time from implantation (stem in-vivo) ranged between 3.3 to 11.2yrs. Three cross sections were cut from the metaphyseal femur and surrounding bone proximal to Gruen zones 2 and 6 (regions with HA coating). The three sections were A (proximal), B (mid-part) and C (distal). Sections were prepared using the Donath technique and then paragon stained for quantitative histomorphometry using an Axioskop microscope (Carl Zeiss, Germany) with image analysing (SAMBA, France). For e...
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Radiology, 1996
To evaluate the findings from magnetic resonance (MR) imaging of the cervical spine and brain aft... more To evaluate the findings from magnetic resonance (MR) imaging of the cervical spine and brain after acute whiplash injury. Within 3 weeks of trauma, 100 patients underwent MR imaging for evaluation of the cervical spine and the brain. In addition, plain radiographs were obtained, including functional images of the cervical spine. Only one patient had an abnormality on the MR image that was related to trauma (ie, prevertebral edema). In 17 patients, functional images showed a kyphotic angle, but no evidence of soft-tissue injury was seen on MR images. There is no role for MR imaging in the routine work-up of patients with acute whiplash injury who have normal plain radiographic findings and no evidence of a neurologic deficit. A kyphotic angle seen on functional images of the cervical spine should not be assumed to indicate soft-tissue injury and is most likely attributable to a compensating mechanism of hypermobility at a level of the spine above that at which hypomobility occurs, w...
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Spine, 1993
Discitis after intradiscal injection of chymodiactin is nearly always associated with an infectio... more Discitis after intradiscal injection of chymodiactin is nearly always associated with an infection introduced by the needle tip. The authors report a patient with a postchemonucleolysis spondylodiscitis who recovered complete without surgery or antibiotics. The clinical findings and results of CRP and MRI suggested an aseptic spondylodiscitis due to chymodiactin.
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Nederlands tijdschrift voor geneeskunde, Jan 20, 1975
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International Orthopaedics, 1999
A premature closure of the physis of the tibial tubercle in a young man has given rise to a short... more A premature closure of the physis of the tibial tubercle in a young man has given rise to a shortening of the tibia, a patella alta and a reversed tibial slope of 20 degrees with clinical genu recurvatum. After a proximal open wedge tibial osteotomy all three postural deformities could be restored. The etiology of this complex deformity is discussed.
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International Orthopaedics, 1983
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Archives of Orthopaedic and Traumatic Surgery, 1984
Eleven posterior tibial tendon transfers were performed in eight patients with spastic equinovaru... more Eleven posterior tibial tendon transfers were performed in eight patients with spastic equinovarus with an average follow-up of 3 years (range 1 1/2-6 1/2 years). The main goals--to eliminate the need for braces and to improve gait--were achieved in all patients. An adequate operation technique kept the well-known postoperative complications, e.g., valgus and calcaneal deformity, to a minimum.
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International Orthopaedics, 1990
Forty-four arthrodeses of the ankle were carried out between 1965 and 1984 in forty-three patient... more Forty-four arthrodeses of the ankle were carried out between 1965 and 1984 in forty-three patients with post-traumatic osteoarthritis or poliomyelitis. Twenty-eight patients, one of whom had a bilateral arthrodesis, were followed up after an average of ten years. Twenty-four were satisfied and the patients with poliomyelitis were better than those with osteoarthritis. The condition of the tarsal joints before the operation influences the result, but the arthrodesis does not cause degenerative changes in these joints.
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The Journal of bone and joint surgery. American volume, 2001
Important questions remain regarding the use of hydroxyapatite-coated acetabular components in to... more Important questions remain regarding the use of hydroxyapatite-coated acetabular components in total hip arthroplasty. What is the relation of resorption of the hydroxyapatite coating to enduring fixation? Will unresorbed or dislodged hydroxyapatite particles cause adverse tissue reactions? Retrieval studies of clinically well-functioning acetabular components should help to answer these questions. We examined six clinically successful hydroxyapatite-coated cementless acetabular components that were retrieved at autopsy between 3.3 and 6.6 years after implantation. All components were of the same design. The prostheses and the surrounding bone were prepared for qualitative histological and quantitative histomorphometric analysis. The percentage of bone growth onto the implant, the relative bone area around the implant, the extent of residual hydroxyapatite coating, and the coating thickness were measured. All of the cups showed bone ongrowth, with a mean bone-implant contact (and st...
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Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1994
A prospective study was performed on 80 patients who had undergone a unilateral hydroxyapatite (H... more A prospective study was performed on 80 patients who had undergone a unilateral hydroxyapatite (HA)-coated total hip arthroplasty to establish the normal periprosthetic uptake of methylenediphosphonate (MDP) as a function of implant age. Patients were imaged periodically while they were asymptomatic at 1, 3, 6 and 12 mo postoperatively. Quantitative measurements were performed with a region of interest (ROI) technique. The HA-coated and uncoated areas were marked in comparison with the normal contralateral femur. The uptake ratios of the MDP were determined postoperatively in the following 12 mo. It was found that a decrease of the uptake ratios occurred in all ROIs. However, for the HA-coated areas, the uptake ratios still remained raised as a result of bony ingrowth. The results of the first year of follow-up were considered to be a normal database that will be used as a reference when the same group of patients are followed up to 5 yr postoperatively to detect any potential modes...
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Clinical orthopaedics and related research, 1995
A hydroxyapatite-coated hip prosthesis designed to stimulate proximal femoral stress transfer was... more A hydroxyapatite-coated hip prosthesis designed to stimulate proximal femoral stress transfer was studied in 222 patients undergoing primary total hip arthroplasty with a minimum followup of 2 years. The femoral component was a roughened titanium alloy with a 50-mu coating of hydroxyapatite applied to the proximal third. A proximal press-fit technique was applied with distal femoral over-reaming as standard procedure. The hydroxyapatite-coated acetabulum was of hemispherical design. Analysis of the clinical results showed a mean Merle D'Aubigné score of 16.7 points at 6 months and 17.4 points at 2 years. Mild residual thigh pain of unknown origin was reported in 3.6% of patients at 2 years. Radiographic evaluation showed complete acetabular and proximal femoral osseointegration without any loosening. No radiolucency or reactive line formation was observed around the hydroxyapatite-coated areas of the prostheses. Femoral bone densification occurred at the coated-uncoated transiti...
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Tribology in Total Hip Arthroplasty, 2011
Explaining the genesis of squeaking in ceramic-on-ceramic (CoC) bearings used for total hip arthr... more Explaining the genesis of squeaking in ceramic-on-ceramic (CoC) bearings used for total hip arthroplasty it has been postulated that audible noise requires amplification via the resonating stem. As in vivo stem resonance would be influenced by the periprosthetic bone this study compared stem fit&fill and periprosthetic bone between noisy and silent CoC hips. In a consecutive series of 186 primary CoC hips with identical stems, cups (Stryker ABG-II) and femoral heads (Alumina V40, 28 mm) a survey identified 38 noisy hips. Stem fit&fill and cortical wall thickness (CWT, medial and lateral) were measured on post-op AP x-rays. The endosteal width and lateral CWT was equal in noisy and silent hips However, medially, noisy hips had higher CWT at proximal and mid-stem level (p<0.05). Also fit&fill was higher and noisy stems were placed more proximal (p<0.05). Periprosthetic bone plays a role in the development of audible noise in CoC hips by providing particular conditions of support, damping and transmission for an oscillating stem which influences noise frequency and intensity.
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Clinical Materials, 1987
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Osteoporosis International, 2004
Periprosthetic bone loss is a major cause of concern in patients undergoing total hip arthroplast... more Periprosthetic bone loss is a major cause of concern in patients undergoing total hip arthroplasty (THA). Further studies are required to identify the factors determining the pattern of bone remodelling following THA and obtain improvements in the design and durability of prostheses. In this study, we monitored periprosthetic bone loss around two different types of hydroxyapatite coated femoral implant over a 3-year period to evaluate their design and investigate the relationship with the preoperative bone mineral density (BMD) at the spine, hip and forearm. Sixty patients (35 F, 25 M, mean age 63 years, range 46-75 years) undergoing THA were randomised to either the Anatomic Benoist Girard (ABG) or Mallory-Head (MH) femoral stem. Preoperative dual-energy X-ray absorptiometry (DXA) scans were acquired of the posteroanterior (PA) and lateral lumbar spine, the contralateral hip and the non-dominant forearm. Postoperative DXA scans were performed to measure periprosthetic BMD at 10 days (treated as baseline), 6 weeks, and 3, 6, 12, 24 and 36 months after THA using a standard Gruen zone analysis. Results were expressed as the percentage change from baseline and the data examined for the differences in bone loss between the different Gruen zones, between the ABG and MH stems, and the relationship with preoperative BMD. A total of 50 patients (24 ABG, 26 MH) completed the study. Three months after THA there was a statistically significant BMD decrease in every Gruen zone that varied between 5.6% and 13.8% for the ABG prosthesis and between 3.8% and 8.7% for the MH prosthesis. Subsequently, in most zones BMD reached a plateau or showed a small recovery. However, BMD continued to fall in Gruen zones 1 and 7 in ABG patients and Gruen zone 1 in MH patients. Bone loss was less in every Gruen zone in MH patients compared with ABG with the largest difference (10%, P=0.018) in Gruen zone 7. Highly significant relationships were found between periprosthetic bone loss and preoperative BMD measured at the PA spine ( P&lt;0.001), total hip ( P=0.004) and total distal radius ( P&lt;0.001). This study showed differences between two different designs of hydroxyapatite-coated implant that confirmed that prosthesis design influences periprosthetic bone loss. The study also showed that patients&#39; bone density measured at the spine, hip or forearm at the time of operation was a major factor influencing bone loss around the femoral stem.
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Journal of Pediatric Orthopaedics, 2001
A Steindler flexorplasty at the elbow was performed in 26 patients with an obstetric brachial ple... more A Steindler flexorplasty at the elbow was performed in 26 patients with an obstetric brachial plexus lesion because of deficient elbow flexion. Follow-up after a mean of 2.9 years (range, 1-7 years) showed a good functional result in 23 cases, whereas 3 primary failures were noted. In one case, a recurrent dislocation of the elbow was seen 3 years after the initial flexorplasty. Steindler flexorplasty is a comparatively simple operation and gives very reliable results. It should be preferred above other, more elaborate muscle transfers for loss of elbow flexion.
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Journal of Orthopaedic Research, 2000
ABSTRACT To investigate the effect of implant type after direct contamination, a hydroxyapatite-c... more ABSTRACT To investigate the effect of implant type after direct contamination, a hydroxyapatite-coated or noncoated Ti-6A1-4V implant was inserted into both tibiae of 32 New Zealand White rabbits. Prior to implantation, the left tibia was contaminated with increasing concentrations of Staphylococcus aureus (10(2)-10(5) colony-forming units), ranging from very low (10(2)) to relatively high (10(5)). Four weeks after implantation, half of the tibial bone adjacent to the implant was harvested for bacteriological examination. Bacterial counts were quantified by plating serial dilutions. For the histological evaluation, sections of the implant with the remaining tibia were examined by semiquantitative scoring of infection parameters. The bacteriological data showed the inoculum dose and implant type to have a significant effect on the culture outcome: more bacteria were retrieved from the hydroxyapatite-coated implants than from the noncoated titanium implants. Histological evaluation showed an increased score for the infected left tibiae compared with their contralateral control. In addition, with increasing inoculum dosage, the difference between the two types of implant increased. We demonstrated that infections can occur with biocompatible, noncemented implants and that they are related to the dose of the original inoculum. Bacteria were more likely to grow onto or next to the hydroxyapatite implants than on titanium implants and resulted in a more severe histopathological characterization of infection.
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Journal of Biomedical Materials Research, 2002
A study was designed to investigate the osseointegration of titanium implants, either noncoated o... more A study was designed to investigate the osseointegration of titanium implants, either noncoated or coated with hydroxyapatite (HA), into rabbit tibiae in the presence of local infection compared with osseointegration in the absence of local infection. HA-coated or noncoated Ti cylinders were implanted into both tibiae of 32 rabbits (New Zealand Whites). Before implantation the left tibia was contaminated with different quantities of Staphylococcus aureus (10(2)-10(5) CFU). Four weeks after surgery the tibiae were explanted and prepared for microbiological and histomorphometrical examination. Histomorphometrical data, as a representation of implant fixation, were obtained by measuring the percentage of bone around the implants (within a radius of 1 mm from the outer diameter of the implants) and the percentage of the circumference of the implant that was in direct contact with bone. Histomorphometry revealed, in particular for the HA implants, a relationship between the inoculum concentration and/or the presence or absence of infection with the bone contact at the distal implant side. This confirms a relationship between peri-implant infection and bone contact or remodeling. HA-coated implants developed, in the presence of bacteria, more easily a more severe infection than noncoated Ti implants, and we show in the present study that local infection will influence histomorphometrical parameters (bone-implant contact) that determine implant fixation. Precautions to prevent contamination (asepsis) and/or infection (perioperative antibiotics) are even more important for the highly biocompatible HA-coated implant.
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The Journal of Arthroplasty, 2003
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Papers by A.Tonino Tonino