Analysis of retrieved shoulder prostheses

In the last years the number of shoulder arthroplasties has been increasing. Simultaneously the study of their shape, size and strength and the reasons that bring to a possible early explantation have not yet been examined in detail. The research carried out directly on explants is practically nonexistent, this means a poor understanding of the mechanisms leading the patient and so the surgeon, to their removal. The analysis of the mechanisms which are the cause of instability, dislocation, broken, fracture, etc, may lead to a change in the structure or design of the shoulder prostheses and lengthen the life of the implant in situ. The idea was to analyze 22 explants through three methods in order to find roughness, corrosion and surface wear. In the first method, the humeral heads and/or the glenospheres were examined with the interferometer, a machine that through electromagnetic waves gives information about the roughness of the surfaces under examination. The output of the device was a total profile containing both roughness and information on the waves (representing the spatial waves most characteristic on the surface). The most important value is called "roughness average" and brings the average value of the peaks found in the local defects of the surfaces. It was found that 42% of the prostheses had considerable peak values in the area where the damage was caused by the implant and not only by external events, such as possibly the surgeon's hand. One of the problems of interest in the use of metallic biomaterials is their resistance to corrosion. The clinical significance of the degradation of metal implants has been the purpose of the second method; the interaction between human body and metal components is critical to understand how and why they arrive to corrosion. The percentage of damage in the joints of the prosthetic components has been calculated via high resolution photos and the software ImageJ. The 40% and 50% of the area appeared to have scratches or multiple lines due to mechanical artifacts. The third method of analysis has been made through the use of electron microscopy to quantify the wear surface in polyethylene components. Different joint movements correspond to different mechanisms of damage, which were imprinted in the parts of polyethylene examined. The most affected area was located mainly in the side edges. The results could help the manufacturers to modify the design of the prostheses and thus reduce the number of explants. It could also help surgeons in choosing the model of the prosthesis to be implanted in the patient.

On the Mediterranean conveyor belt system

The Mediterranean Sea is a semi-enclosed sea, connected to the Atlantic Ocean through the Gibraltar Strait and subdivided in two different regions by the Sicily Strait. The geographical extension of the basin, the surface heat flux, and the water inflow from the Gibraltar Strait are some of the basic factors determining its horizontal and vertical circulation. In the Mediterranean strong salinity and temperature zonal gradients contribute to maintain the zonal-vertical circulation, while meridional-vertical cells are equally forced by winds and deep water mass formation in three regions, the Gulf of Lyon, the southern Adriatic and the Cretan Sea areas. The objective of this thesis is to study how these cells combine together to form the Mediterranean conveyor belt system. This has never been attempted before so the conclusions are necessarily preliminary. In the first part we discuss the vertical zonal and meridional circulation by reconstructing the Wust Mediterranean vertical salinity and temperature structures in an attempt to evaluate the water mass structure consistent with modern data. Our results confirm that Wust depicted vertical circulation from scarce data is reproduced by the past 27 years observations. The structure of both meridional and zonal circulations was discussed using velocity vertical streamfunctions with two different methods. The first one, eulerian, allowed us to observe vertical structures that were already reported in the literature. Recent studies in the Atlantic Ocean have shown that gyres and eddies have an important influence in the isopycnal vertical circulation. This is called the residual circulation which was computed in this study for the first time. A possible interpretation of horizontal connection between the meridional and zonal cells was discussed using horizontal streamfunction. In the last part of the thesis we have been developing an idealized numerical model to study the vertical circulation in the Mediterranean.

Shoulder kinematic evaluation in patients with rotator cuff tears using inertial and magnetic sensors.

Questo progetto di tesi fa parte di un più ampio studio clinico condotto all’interno dell’azienda NCS Lab (Carpi,(MO)), in collaborazione con il Dr. Claudio Chillemi (ICOT, Latina (RM)) che mira ad eseguire un confronto tra diverse tecniche chirurgiche per la riparazione della cuffia dei rotatori. Lo studio clinico in questione durerà circa due anni: per questo motivo i dati analizzati in questo progetto di tesi provengono solo dal gruppo di pazienti acquisiti nella fase preoperatoria. Tutti i dati sono stati acquisiti utilizzando i sensori magneto-inerziali WISE (tecnologia proprietaria dell’azienda NCS Lab). Questo lavoro di tesi si propone, quindi, di valutare la ripetibilità del movimento in termini di coefficiente di correlazione multipla e di estrapolare alcuni parametri di interesse clinico come, ad esempio, i range di movimento (ROM) della scapola e dell’omero e il ritmo scapolo-omerale (SHR). Questi parametri sono stati poi caratterizzati da un punto di vista statistico al fine di valutare le differenze tra arto patologico e controlaterale. Sono state calcolate, inoltre, le prediction bands con lo scopo di descrivere le differenze tra arto patologico e controlaterale nella coordinazione scapolo-omerale dei pazienti. Per quanto riguarda la ripetibilità del movimento, i risultati ottenuti in questo lavoro di tesi mostrano che la rotazione medio-laterale è caratterizzata da un eccellente CMC sia per l'arto patologico che per il controlaterale. Inoltre, sono state riscontrate differenze significative dal punto di vista statistico tra le distribuzioni dei range di movimento dell'arto patologico e controlaterale. Tali differenze sono state trovate anche per quanto riguarda il ritmo scapolo-omerale.

A medical imaging-based approach for total shoulder replacement

Ogni anno in Italia, migliaia di protesi convenzionali vengono impiantate con successo in pazienti affetti da artrosi alla spalla, tuttavia è stato dimostrato che questa tipologia di protesi non funziona in quei pazienti che soffrono contemporaneamente anche di grandi lesioni alla cuffia dei rotatori, ricorrendo successivamente a un impianto di protesi di spalla inversa. La scelta sul miglior tipo di protesi da parte del chirurgo è quindi fondamentale e necessaria per evitare futuri stress e operazioni al paziente. Nel corso degli anni si è fatto affidamento a protocolli che non considerano in maniera specifica la componente tissutale ossea. In questa tesi si cerca di dimostrare che attraverso l’utilizzo delle immagini mediche è possibile ricavare dati e grafici specifici sulla componente ossea del paziente per ottimizzare poi la scelta della protesi da parte del chirurgo e la fase pre/intra operatoria.