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Article: The third compartment of the knee: an update from diagnosis to treatment.

Barrett, David / Brivio, Angela

2023 Volume 8, Issue 5, Page(s) 313–318

Abstract: The anterior part (third space) of the knee appears important in the soft tissue functional outcome following knee replacement surgery. Native patellofemoral kinematics are complex and variable, and further understanding has led to prosthetic redesign. ... ...

Abstract	The anterior part (third space) of the knee appears important in the soft tissue functional outcome following knee replacement surgery. Native patellofemoral kinematics are complex and variable, and further understanding has led to prosthetic redesign. Attention to soft tissue tension anteriorly (balancing the third space) during knee replacement may maximise post-operative function and avoid issues with understuffing and overstuffing. Patellofemoral compression forces may now be measured dynamically during knee replacement, allowing an objective approach to balancing the third space.
Language	English
Publishing date	2023-05-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2844421-8
ISSN	2058-5241 ; 2058-5241 ; 2396-7544
ISSN (online)	2058-5241
ISSN	2058-5241 ; 2396-7544
DOI	10.1530/EOR-23-0036
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Article ; Online: Debridement, antibiotics and implant retention (DAIR) is successful in the management of acutely infected unicompartmental knee arthroplasty: a case series.

Brivio, Angela / Al-Jabri, Talal / Martin, Jurgen / Barrett, David / Maffulli, Nicola

Annals of medicine

2023 Volume 55, Issue 1, Page(s) 680–688

Abstract: Background: Infections are rare and poorly studied complications of unicompartmental knee arthroplasty (UKA) surgery. They are significantly less common compared to infections after total knee arthroplasties (TKAs). Optimal management of periprosthetic ... ...

Abstract	Background: Infections are rare and poorly studied complications of unicompartmental knee arthroplasty (UKA) surgery. They are significantly less common compared to infections after total knee arthroplasties (TKAs). Optimal management of periprosthetic joint infections (PJIs) after a UKA is not clearly defined in the literature. This article presents the results of the largest multicentre clinical study of UKA PJIs treated with Debridement, Antibiotics and Implant Retention (DAIR). Materials and methods: In this retrospective case series, patients presenting between January 2016 and December 2019 with early UKA infection were identified at three specialist centres using the Musculoskeletal Infection Society (MSIS) criteria. All patients underwent a standardized treatment protocol consisting of the DAIR procedure and antibiotic therapy comprising two weeks of intravenous (IV) antibiotics followed by six weeks of oral therapy. The main outcome measure was overall survivorship free from reoperation for infection. Results: A total of 3225 UKAs (2793 (86.2%) medial and 432 (13.8%) lateral UKAs) were performed between January 2016 and December 2019. Nineteen patients had early infections necessitating DAIR. The mean follow-up period was 32.5 months. DAIR showed an overall survivorship free from septic reoperation of 84.2%, with overall survivorship free from all-cause reoperation of 78.95%.The most common bacteria were Coagulase-negative Conclusions: In infected UKAs, the DAIR procedure produces a high rate of success, with a high survivorship of the implant.Key messagesDebridement, Antibiotics and Implant Retention (DAIR) is a successful and minimally invasive surgical option for the management of periprosthetic joint infections (PJIs) after UKA.The surface area available for bacteria to colonise is much smaller in UKAs compared to total knee arthroplasties (TKAs), and this may account for the higher success rates of the DAIR procedure in infected UKAs versus infected TKAs.A second DAIR procedure can be considered in the management of the early recurrence of PJIs with a well-fixed UKA.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Knee/adverse effects ; Retrospective Studies ; Debridement/adverse effects ; Debridement/methods ; Anti-Bacterial Agents/therapeutic use ; Treatment Outcome ; Prosthesis-Related Infections/drug therapy ; Prosthesis-Related Infections/surgery ; Arthritis, Infectious/drug therapy ; Arthritis, Infectious/microbiology ; Arthritis, Infectious/surgery
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-04-07
Publishing country	England
Document type	Journal Article
ZDB-ID	1004226-x
ISSN	1365-2060 ; 1651-2219 ; 0785-3890 ; 1743-1387
ISSN (online)	1365-2060 ; 1651-2219
ISSN	0785-3890 ; 1743-1387
DOI	10.1080/07853890.2023.2179105
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Article ; Online: Distal femoral replacement for the treatment of periprosthetic distal femoral fractures around a total knee arthroplasty: a meta-analysis.

Wood, Matthew J / Al-Jabri, Talal / Stelzhammer, Thomas / Brivio, Angela / Donaldson, James / Skinner, John A / Barrett, David

Orthopedic reviews

2024 Volume 16, Page(s) 94574

Abstract: Background: Periprosthetic fracture is a rare complication of arthroplasty but can have devastating consequences for the patient and presents a complex surgical challenge. Locking compression plate and retrograde intramedullary nail are both widely ... ...

Abstract	Background: Periprosthetic fracture is a rare complication of arthroplasty but can have devastating consequences for the patient and presents a complex surgical challenge. Locking compression plate and retrograde intramedullary nail are both widely accepted surgical fixation techniques for distal femoral periprosthetic fractures around a total knee arthroplasty. Although there is still a need for further high-quality research into both techniques, there is even less literature concerning the use of distal femoral replacement to treat distal femoral periprosthetic fractures. Interest has been piqued in distal femoral replacements for the treatment of distal femoral periprosthetic fractures due to the theoretical advantages of immediate post-operative weight-bearing and lack of dependence on fracture union, but there are still understandably reservations about performing such an extensive and invasive procedure when an accepted alternative is available. This meta-analysis aims to evaluate the current literature to compare the complication rates and return to pre-operative ambulatory status of distal femoral replacement and locking compression plate. Method: A literature search was performed to identify articles related to the management of distal femoral periprosthetic fractures around a total knee arthroplasty in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Methodological quality was assessed using the methodological index for non-randomized studies (MINORS) criteria. Articles were reviewed, and data extracted for analysis. Results: Five articles met the inclusion criteria, reporting on 345 periprosthetic fractures. The overall rates of complications for distal femoral replacement and locking compression plate were: re-operation (6.1% vs 12.1%), infection (3.0% vs 5.3%), mortality (19.7% vs 19.3%), and return to pre-operative ambulatory status (60.9% vs 71.8%) (respectively). Conclusion: This meta-analysis shows no statistically significant difference in the rates of re-operation, infection, mortality or return to pre-operative ambulatory status when comparing distal femoral replacement to locking compression plate.
Language	English
Publishing date	2024-04-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2508171-8
ISSN	2035-8164 ; 2035-8164
ISSN (online)	2035-8164
ISSN	2035-8164
DOI	10.52965/001c.94574
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Article ; Online: Short-term effects of positive expiratory pressure mask on ventilation inhomogeneity in children with cystic fibrosis: A randomized, sham-controlled crossover study.

Gambazza, Simone / Mariani, Alessandra / Guarise, Riccardo / Ferrari, Beatrice / Carta, Federica / Brivio, Anna / Bizzarri, Sofia / Castellani, Chiara / Colombo, Carla / Laquintana, Dario

Pediatric pulmonology

2024 Volume 59, Issue 5, Page(s) 1354–1363

Abstract: Background: Can physiotherapy with a positive expiratory pressure (PEP) mask improve peripheral ventilation inhomogeneity, a typical feature of children with cystic fibrosis (cwCF)? To answer this question, we used the nitrogen multiple-breath washout ( ... ...

Abstract	Background: Can physiotherapy with a positive expiratory pressure (PEP) mask improve peripheral ventilation inhomogeneity, a typical feature of children with cystic fibrosis (cwCF)? To answer this question, we used the nitrogen multiple-breath washout (N Methods: For this randomized, sham-controlled crossover trial, two N Results: The study sample was 19 cwCF (ten girls), aged 11.4 (2.7) years. The adjusted S Conclusion: Our findings do not support evidence for an immediate effect of PEP mask physiotherapy on S
MeSH term(s)	Humans ; Cystic Fibrosis/physiopathology ; Cystic Fibrosis/therapy ; Cross-Over Studies ; Child ; Female ; Male ; Positive-Pressure Respiration/instrumentation ; Positive-Pressure Respiration/methods ; Adolescent ; Masks
Language	English
Publishing date	2024-02-16
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	632784-9
ISSN	1099-0496 ; 8755-6863
ISSN (online)	1099-0496
ISSN	8755-6863
DOI	10.1002/ppul.26915
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Article ; Online: Management of instability after primary total knee arthroplasty: an evidence-based review.

Al-Jabri, Talal / Brivio, Angela / Maffulli, Nicola / Barrett, David

Journal of orthopaedic surgery and research

2021 Volume 16, Issue 1, Page(s) 729

Abstract: Background: Instability is one of the most common reasons for revision after a total knee replacement. It accounts for 17.4% of all single-stage revision procedures performed in the UK National Joint Registry. Through a careful patient evaluation, ... ...

Abstract	Background: Instability is one of the most common reasons for revision after a total knee replacement. It accounts for 17.4% of all single-stage revision procedures performed in the UK National Joint Registry. Through a careful patient evaluation, physical assessment and review of investigations one can identify the likely type of instability. Aims: To critically examine the different types of instability, their presentation and evidence-based management options. Method: A comprehensive literature search was conducted to identify articles relevant to the aetiology and management of instability in total knee replacements. Results: Instability should be categorised as isolated or global and then, as flexion, mid-flexion, extension or recurvatum types. By identifying the aetiology of instability one can correctly restore balance and stability. Conclusion: With careful judgement and meticulous surgical planning, instability can be addressed and revision surgery can provide patients with successful outcomes.
MeSH term(s)	Arthroplasty, Replacement, Knee/adverse effects ; Humans ; Joint Instability/diagnostic imaging ; Joint Instability/etiology ; Joint Instability/surgery ; Knee Joint/surgery ; Knee Prosthesis ; Range of Motion, Articular ; Reoperation
Language	English
Publishing date	2021-12-20
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2252548-8
ISSN	1749-799X ; 1749-799X
ISSN (online)	1749-799X
ISSN	1749-799X
DOI	10.1186/s13018-021-02878-5
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Article ; Online: Lung clearance index to characterize clinical phenotypes of children and adolescents with cystic fibrosis.

Gambazza, Simone / Ambrogi, Federico / Carta, Federica / Moroni, Laura / Russo, Maria / Brivio, Anna / Colombo, Carla

BMC pulmonary medicine

2022 Volume 22, Issue 1, Page(s) 122

Abstract: Background: Lung clearance index (LCI) is accepted as an early marker of lung disease in cystic fibrosis (CF), however the utility of LCI to identify subgroups of CF disease in the paediatric age group has never been explored. The aim of the study was ... ...

Abstract	Background: Lung clearance index (LCI) is accepted as an early marker of lung disease in cystic fibrosis (CF), however the utility of LCI to identify subgroups of CF disease in the paediatric age group has never been explored. The aim of the study was to characterize phenotypes of children with CF using LCI as a marker of ventilation inhomogeneity and to investigate whether these phenotypes distinguished patients based on time to pulmonary exacerbation (PE). Methods: Data were collected on patients with CF aged < 18 years old, attending the CF Center of Milan during outpatient follow-up visits between October 2014 and September 2019. Cluster analysis using agglomerative nesting hierarchical method was performed to generate distinct phenotypes. Time-to-recurrent event analysis investigated association of phenotypes with PE. Results: We collected 313 multiple breath washout tests on 125 children aged 5.5-16.8 years. Cluster analysis identified two divergent phenotypes in children and adolescents of same age, presenting with almost normal FEV Conclusions: LCI is useful in clinical practice to characterize distinct phenotypes of children and adolescents with mild/normal FEV
MeSH term(s)	Adolescent ; Child ; Cystic Fibrosis/complications ; Humans ; Lung ; Phenotype ; Respiration ; Respiratory Function Tests/methods
Language	English
Publishing date	2022-04-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2059871-3
ISSN	1471-2466 ; 1471-2466
ISSN (online)	1471-2466
ISSN	1471-2466
DOI	10.1186/s12890-022-01903-5
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Article ; Online: Limitations of the dichotomized 6-minute walk distance when computing lung allocation score for cystic fibrosis: a 16-year retrospective cohort study.

Gambazza, Simone / Carta, Federica / Ambrogi, Federico / Bassotti, Giacomo / Brivio, Anna / Russo, Maria / Colombo, Carla

Disability and rehabilitation

2022 Volume 45, Issue 16, Page(s) 2578–2584

Abstract: Purpose: The 2010 Lung Allocation Score (LAS) version considers the estimated survival benefit offered by lung transplantation (LTx) and uses 6-minute Walk Test (6MWT) distance as a dichotomous covariate of whether an individual can walk more than 150 ... ...

Abstract	Purpose: The 2010 Lung Allocation Score (LAS) version considers the estimated survival benefit offered by lung transplantation (LTx) and uses 6-minute Walk Test (6MWT) distance as a dichotomous covariate of whether an individual can walk more than 150 ft or 45.7 m in 6 min. This study aimed to provide evidence that 6MWT gives no clinically meaningful information to be used in the current LAS for candidates to LTx with cystic fibrosis (CF). Materials and methods: We collected data from 6MWTs performed since 2003 at our CF centre. A joint model was fitted to describe the effect of changes in walked distance on the hazard of LTx or death. Results: Up to 2019, 552 6MWTs were performed on 163 individuals with CF. None of the individuals included walked for less than 45.7 m during the 6MWT. Based on the joint modelling, the association of walked distance with the hazard ratio (HR) of LTx or death was significant (HR 0.99, 95% Credible Interval [CI]: 0.99 to 1.00). Conclusions: When adopted dichotomously for LAS calculation, walked distance does not add any useful information about exercise capacity. Longitudinal trajectories of walked distance may provide complementary information about prognosis in individuals with CF.Implications for rehabilitationDichotomized walked distance does not contribute to lung allocation score in candidates to lung transplantation with cystic fibrosisChanges in the longitudinal trajectory of walked distance can be clinically meaningful for prognostication.Sensitive outcomes to be incorporated in the lung allocation scoring system for individuals with CF are yet needed to catch rapid falls in functional capacity.
MeSH term(s)	Humans ; Cystic Fibrosis/surgery ; Retrospective Studies ; Lung Transplantation ; Walking ; Lung/surgery
Language	English
Publishing date	2022-07-13
Publishing country	England
Document type	Journal Article
ZDB-ID	1104775-6
ISSN	1464-5165 ; 0963-8288
ISSN (online)	1464-5165
ISSN	0963-8288
DOI	10.1080/09638288.2022.2099588
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Article ; Online: Perceived burden of respiratory physiotherapy in people with cystic fibrosis taking elexacaftor-tezacaftor-ivacaftor combination: a 1-year observational study.

Blardone, Chiara / Gambazza, Simone / Mariani, Alessandra / Galgani, Rachele / Brivio, Anna / Nobili, Rita Maria / Rizza, Carmela / Tutino, Anna Luisa / Gramegna, Andrea / Daccò, Valeria / Contarini, Martina / Blasi, Francesco / Laquintana, Dario

Therapeutic advances in respiratory disease

2024 Volume 18, Page(s) 17534666241235054

Abstract: Background: To limit the progression of disease, people with cystic fibrosis (pwCF) perform daily respiratory physiotherapy, which is perceived as the most burdensome routine in managing their condition. The elexacaftor-tezacaftor-ivacaftor (ETI) ... ...

Abstract	Background: To limit the progression of disease, people with cystic fibrosis (pwCF) perform daily respiratory physiotherapy, which is perceived as the most burdensome routine in managing their condition. The elexacaftor-tezacaftor-ivacaftor (ETI) combination has changed respiratory management. Objective: To investigate how the perceived treatment burden changed in 1 year of treatment with ETI. Design: Prospective observational study. Methods: Ad hoc Results: The study included 47/184 pwCF aged 21.4 (5.7) years, who completed 1 year of ETI therapy. At 6 months, time on aerosol therapy was decreased by 2.5 (95% CI -32.9 to 27.8) min/day, time on airway clearance therapies (ACTs) was decreased by 8.8 (95% CI -25.9 to 8.3) min/day, and time for cleaning and disinfecting respiratory equipment was decreased by 10.6 (95% CI -26.5 to 5.3) min/day. At 1 year, gains in time saved were nearly 15 min/day on average. At 1 year, 5/47 (10.6%) pwCF reported that they had discontinued positive expiratory pressure mask. Conclusion: PwCF on ETI may note less time engaged in their daily respiratory physiotherapy routine. Nonetheless, aerosol therapy, ACTs and maintaining respiratory equipment were still perceived as time-consuming daily activities.
MeSH term(s)	Humans ; Aminophenols ; Benzodioxoles/therapeutic use ; Cystic Fibrosis/drug therapy ; Indoles ; Physical Therapy Modalities ; Pyrazoles ; Pyridines ; Pyrrolidines ; Quinolones ; Respiratory Aerosols and Droplets
Chemical Substances	Aminophenols ; Benzodioxoles ; elexacaftor (RRN67GMB0V) ; Indoles ; ivacaftor (1Y740ILL1Z) ; Pyrazoles ; Pyridines ; Pyrrolidines ; Quinolones ; tezacaftor
Language	English
Publishing date	2024-03-30
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2476459-0
ISSN	1753-4666 ; 1753-4658
ISSN (online)	1753-4666
ISSN	1753-4658
DOI	10.1177/17534666241235054
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Article: Home physiotherapists assisting follow-up treatment in cystic fibrosis: a multicenter observational study.

Brivio, Anna / Orenti, Annalisa / Barbisan, Mauro / Buonpensiero, Paolo / Ros, Mirco / Gambazza, Simone

Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace

2021 Volume 91, Issue 2

Abstract: Inhaled therapies are relatively simple and easy to be managed however ineffective use of aerosols when self-administered may occur. We described variation of the number of clinic visits, lung function and number of antibiotic courses performed over 12 ... ...

Abstract	Inhaled therapies are relatively simple and easy to be managed however ineffective use of aerosols when self-administered may occur. We described variation of the number of clinic visits, lung function and number of antibiotic courses performed over 12 months in participants with cystic fibrosis (CF), when supervised or not by physiotherapists (PTs) at home. Participants in 8 Italian CF centers with a prescription of dry-powder antibiotic choose whether to be supervised at home (PT-FU) or not (non-PT-FU), in adjunct to routine clinic visits. PTs assisted participants with their inhaled therapies regimen and reviewed the airway clearance program in use. Mixed-effect regression models were fitted to evaluate the variation of selected endpoints over time. A total of 163 participants were included. Lung function declined over time in both groups, at higher extent in the non-PT-FU group at 6 months (-1.8, 95%CI: -4.4 to 0.7 % predicted), without reaching statistical significance, whereas in the PT-FU group only, nearly one visit less was recorded (p=0.027). Regardless the type of supervision adopted, the number of antibiotic courses did not change compared to the previous year. We counted 19/90 (21.1%) drop-out in the PT-FU, double compared to the group followed up at the clinics (p=0.065). Participants under a course of an inhaled antibiotic therapy showed a 1-year decline in lung function, whereas only the group receiving home supervision counted nearly one visit less at the CF center, whose clinical relevance should be further discussed.
MeSH term(s)	Administration, Inhalation ; Anti-Bacterial Agents/therapeutic use ; Cystic Fibrosis/drug therapy ; Cystic Fibrosis/epidemiology ; Follow-Up Studies ; Humans ; Physical Therapists
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2021-04-15
Publishing country	Italy
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	1160940-0
ISSN	1122-0643 ; 1120-0391
ISSN	1122-0643 ; 1120-0391
DOI	10.4081/monaldi.2021.1619
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Article: Time Free From Hospitalization in Children and Adolescents With Cystic Fibrosis: Findings From FEV

Gambazza, Simone / Mariani, Alessandra / Brivio, Anna / Carta, Federica / Blardone, Chiara / Lisiero, Saba / Russo, Maria / Colombo, Carla

Frontiers in pediatrics

2022 Volume 10, Page(s) 926248

Abstract: Background: An exercise test combined with a multiple breath washout nitrogen test (MBWN: Methods: This prospective observational study was carried out at the Lombardia Region Reference Center for Cystic Fibrosis in Milano, Italy. In 2015, we ... ...

Abstract	Background: An exercise test combined with a multiple breath washout nitrogen test (MBWN Methods: This prospective observational study was carried out at the Lombardia Region Reference Center for Cystic Fibrosis in Milano, Italy. In 2015, we consecutively enrolled children and adolescents aged <18 years with spirometry, MBWN Results: Over a median follow-up time of 2.2 years (interquartile range [IQR], 2.01; 3.18), 28 patients aged between 13.0 and 17.4 years were included. When lung functions were outside the normal range, 50% of patients were hospitalized 4 months after the outpatient visit, and their response to exercise was abnormal (100%). Half of the individuals with normal forced expiratory volume in the first second (FEV Conclusion: Maintaining ventilation homogeneity, along with a normal ability to sustain intense work, may have a positive impact on the burden of CF disease, here conceived as time free from hospitalization due to PE.
Language	English
Publishing date	2022-06-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2022.926248
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