Guest Nation Symposium Takes Place Today

By: Giuseppe Sessa, MD, PhD, and Paolo Cherubino, MD

The 2018 Guest Nation Symposium, organized by the Italian Society of Orthopaedics and Traumatology (SIOT), will address two topics: orthopaedic surgery of the pelvis, and controversies in diagnostics and treatment of infections after total hip arthroplasty (THA): determining the optimal moment for reimplantation. The symposium takes place today, from 4 p.m.–6 p.m. in Theater A.

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Fig. 1 Radiographs illustrating management of severe acetabular bone loss in revision surgery.

Courtesy of Francesco Falez, mD

Both topics are of high interest to the Italian scientific community, especially since surgery around the pelvis and management of infections after THA require dedicated expertise and an integrated approach by orthopaedic surgeons and clinicians.

The SIOT symposium will be a combination of lectures from eminent Italian and U.S. surgeons on the same topic. We look forward to this exciting exchange of ideas, as well as conjoined projects for future work.

Raffaele Pascarella, MD, will begin the surgery of the pelvis session by providing insight into the surgical treatment of complex pelvic ring fractures. Kyle Dickson, MD, will then address the issue of pelvic malunions and nonunions.

Pelvic ring fractures are not frequent among the general population; however, in western countries, the number of patients with multiple injuries has increased while, at the same time, the mortality rate in those patients has recently declined. More specifically, the incidence of pelvic ring fractures has risen due to the increased number of high-speed motor vehicle accidents and the increased survival rates of those patients because of better protective head gear.

Fractures affecting the ring stability are usually treated by surgical stabilization; however, complications of pelvic ring fracture surgery are frequent. Infection, vein thrombosis, chronic pain, residual disability, incontinence, impotence, and dyspareunia are just some of the potential complications that may occur.

The unique challenges in evaluating and managing patients with pelvic fractures involve the determination of the lesion mechanism and the three-dimensional assessment and management of these lesions, while also keeping in mind the potential for associated musculoskeletal and visceral injuries.

Following the discussion on trauma, two well-respected surgeons on the topic of musculoskeletal oncology—Rodolfo Capanna, MD, and John Healey, MD—will share their points of view on the management of tumors of the pelvis. In contrast to tumors of the extremities, pelvic tumors are usually located deep in the body and are therefore larger and more advanced at the time of diagnosis.

Surgery of pelvic tumors requires an interdisciplinary approach, starting with the careful planning of the biopsy. Accurate diagnostic imaging is crucial for the planning of the resection of a pelvic tumor. Refined surgical techniques, including biological reconstruction of the resulting pelvic defect after resection, are used in primary malignant bone tumors. More recently, the implementation of navigation techniques and newer, customized implants have improved the chance of accurate resection in malignant tumors while protecting important functional structures.

Francesco Falez, MD, and Richard Berger, MD, PhD, will address the topic of massive acetabular bone defects in THA revision surgery and illustrate all the possible solutions.

Extensive acetabular bone loss is one of the main challenges in revision THA, a surgery that is performed more frequently because of the increased number of primary THA implants. Restoration of hip biomechanics, including reestablishment of the center of rotation, is a determinant for achieving long-term survival in revision THA. However, in revision THA, the remaining bone stock and its quality determine the reconstruction strategy for the revision of the acetabular component (Fig. 1).

Newer implants are now available. Some of them have proven long-term efficacy, but some more recent procedures and implants still need prospective, long-term studies. A cutting-edge overview on this topic is therefore of interest to most surgeons.

These six keynote speakers from our two countries will go into great detail, covering procedures and techniques that impact many orthopaedic surgeons as well as their patients. We hope to see you at the Guest Nation Symposium.

Giuseppe Sessa, MD, president of SIOT, is internationally recognized for his work in joint replacement and musculoskeletal infections. He is professor of orthopaedic surgery, president of the school of medicine, and chief of the orthopaedic and traumatology department at the University of Catania, Italy.

Paolo Cherubino, MD, retired in 2016 and is the past president of SIOT.

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