Arthrosis of the knee (gonarthrosis) is a chronic inflammatory-based disease involving a degenerative process associated with remodeling of the articular surfaces of the knee itself. (Fig.1-2)

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Fig.1 Normal knee
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Fig.2 Osteoarthritis knee

The specific causes are unknown, presenting, however, a multifactorial origin (genetic, environmental and mechanical factors). Patients most predisposed to the development of gonarthrosis are individuals over 65 years of age, female. It has also been shown that previous total/subtotal meniscectomy surgery can accelerate the arthritic process.[2]Pain appears gradually, as does joint stiffness and swelling. These three symptoms make it difficult to use the limb to perform normal daily actions such as wal
king, climbing or descending stairs to, in more advanced cases, making it difficult to flexion-extension movement of the leg.
The diagnosis is made with a specialist examination, during which a clinical examination is performed and instrumental investigations (mainly X-rays) are performed.
Currently, knee replacement surgery is the most effective therapy for medium/severe cases of knee osteoarthritis. When performed with the most innovative minimally invasive techniques, damaged joint surfaces can be replaced with metal prosthetic implants. The surgical procedure takes about 1 hour and a half on average.

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Fig.3 Axial deformity of the knee: Varus Knee (A) and Valgus Knee (B)
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Fig.4 Total knee prosthesis

Depending on the spread of the arthritic process and the patient’s characteristics, the surgeon may decide whether to implant a total prosthesis (i.e., one that replaces all the joint surfaces of the knee) (Fig.3-5) [1] or a monocompartmental prosthesis (one that replaces only one of the three compartments of the knee)(Fig.6). [2]

The choice of implant type [3-5] and the technique of performing [6] the implant (see also computer- and robot-assisted knee replacements) are very important in order to be able to reproduce as closely as possible a movement similar to that of the healthy knee. Minimally invasive mono-compartmental implants also allow a return to (noncontact) sports. [7]

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Post-operative radiographic control following total knee prosthesis surgery
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Unicompartmental Knee Prosthesis surgery

This is precisely why at the Rizzoli Orthopaedic Institute, where I do my research, I am involved in Dynamic RSA, a cutting-edge technology that allows us to understand the advantages and disadvantages of various prosthetic models during in-vivo testing. [3-5]There is no absolute age or weight limitation for knee prosthetic surgery although it is good to remember that these implants do not last forever (on average 15-20 years) and that excessive body weight may be the cause of reduced longevity of your prosthesis. Knee implant revisions can still be performed up to 3-4 times, replacing the previous prosthesis with a more stable one.
From the day after surgery, the rehabilitation course will begin, allowing you to return to normal daily life about 45-60 days after surgery.

Curriculum of Prof. Marcheggiani Muccioli

Giulio Maria Marcheggiani Muccioli, MD, PhD has distinguished himself in the field of orthopedics, starting with a degree with honors in Medicine and Surgery, obtained from the University of Bologna in 2006, followed by a specialization with honors in Orthopedics and Traumatology at the Rizzoli Orthopedic Institute of Bologna and a PhD in Surgical Sciences.

His career includes the academic role of Associate Professor in Orthopedics at the Faculty of Medicine and Surgery of the University of Bologna, where he researches in the field of biomechanics and pathology of the lower and upper limbs.

He has expanded his skills through international fellowships, including experiences in the United Kingdom, Japan and USA, consolidating himself as an Orthopedic Surgeon with extensive practical experience (he performs over 250 operations per year).

Finally, he contributes significantly every year to the training of new generations of doctors through university teaching in multiple medical and surgical disciplines.

He is one of the 10 Italian surgeons who over the last 20 years have been selected by the American Knee Society to participate in the prestigious John Insall Fellowship on Prosthetic Knee Surgery.

His wrote over 250 scientific publications. He attended more than 100 international meetings. This demonstrates his commitment towards innovation in the treatment of knee and shoulder pathologies, and in the advancement of new surgical techniques.

Bibliography
  1. Total knee replacement: intraoperative and postoperative kinematic assessment. Bontempi M, Cardinale U, Bragonzoni L, Macchiarola L, Grassi A, Signorelli C, Marcheggiani Muccioli GM, Zaffagnini S. Acta Biomed. 2017 Jun 7;88(2S):32-37.
  2. Minimally invasive unicompartmental knee replacement: retrospective clinical and radiographic evaluation of 83 patients. Bruni D, Iacono F, Russo A, Zaffagnini S, Marcheggiani Muccioli GM, et al. Knee Surg Sports Traumatol Arthrosc. 2010 Jun;18(6):710-7.
  3. New design total knee arthroplasty shows medial pivoting movement under weight-bearing conditions. Bragonzoni L, Marcheggiani Muccioli GM, Bontempi M, et al. Knee Surg Sports Traumatol Arthrosc. 2019 Apr;27(4):1049-1056.
  4. J-curve design total knee arthroplasty: the posterior stabilized shows wider medial pivot compared to the cruciate retaining during chair raising. Bontempi M, Roberti di Sarsina T, Marcheggiani Muccioli GM, et al. Knee Surg Sports Traumatol Arthrosc. 2019 Aug 3. doi: 10.1007/s00167-019-05645-6.
  5. Multi-radius posterior-stabilized mobile-bearing total knee arthroplasty partially produces in-vivo medial pivot during activity of daily living and high demanding motor task. Marcheggiani Muccioli GM, Pizza N, Di Paolo S, et al. Knee Surg Sports Traumatol Arthrosc. 2020 Jan 18. doi: 10.1007/s00167-020-05846-4.
  6. Two different posterior-stabilized mobile-bearing TKA designs: navigator evaluation of intraoperative kinematic differences. Marcheggiani Muccioli GM, Fratini S, Roberti Di Sarsina T, et al. Musculoskelet Surg. 2020 Jan 28. doi: 10.1007/s12306-020-00643-1.
  7. Return to Sports after Unicompartmental Knee Arthroplasty: Reality or Utopia? A 48-Month Follow-Up Prospective Study. Lo Presti M, Costa GG, Cialdella S…, Marcheggiani Muccioli GM, Zaffagnini S. J Knee Surg. 2019 Feb;32(2):186-191.

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