Past and present of interposition arthroplasties for joint repair with special tribute to the contribution by Vittorio Putti

Abstract

Several techniques have been proposed to restore the compromised function of a joint. These include the arthroplasty by placing various tissues or materials between the articular surfaces. An important contribution to the diffusion of arthroplasty techniques was made by Vittorio Putti, head of the Rizzoli Orthopedic Institute in Bologna from 1912 to 1940. Interposition arthroplasty is still used for some non-weight-bearing joints, such as wrist and elbow, and gives good results. This type of surgery has been further developed by the improvement in biomaterials, biomechanical studies and the regenerative medicine. This paper describes the development starting from a historical survey particularly focused on Putti's contribution and ending with the state of the art of regenerative medicine in the treatment of joint diseases. Level of evidence V.

The Waterfall Fascia Lata Interposition Arthroplasty “Grika Technique” as Treatment of Posttraumatic Osteoarthritis of the Elbow in a High-Demand Adult Patient: Validity and Reliability

“…The interposition arthroplasty is one of the oldest reconstructive options for elbow arthritis and other joints, described for a variety of disorders [ 6 ]. For years, different elbow interposition tissues have been utilized, varying from synthetic grafts to Achilles tendon allografts [ 2 ], free rectus abdominis muscle flaps [ 7 ], scapular flaps [ 2 , 6 ], and the anconeus muscle [ 6 , 8 , 9 ], with or without the addition of a hinged external fixator [ 1 , 10 , 11 ]. This procedure is considered as a salvage option in patients for whom conservative treatment failed, and total elbow arthroplasty is contraindicated [ 12 ].…”

“…In this specific case, our decision to return to the past, to the Vittorio Putti technique, is based on discoveries that interposition grafts microscopically form a zone with endothelial lined sacs [ 6 , 13 ]. Melvin Henderson already in 1918 reported that the outcomes of interposition arthroplasty were better in the temporomandibular joint (93% of good outcomes), compared to the elbow (78%), the hip (57%), and the knee (15%) [ 6 ]. The high rate of failures in the lower limbs was probably caused by weight bearing [ 13 ].…”

“…The high rate of failures in the lower limbs was probably caused by weight bearing [ 13 ]. In reexamining the scientific articles published by Vittorio Putti, it is interesting to notice his emphasis placed on the use of the fascia lata [ 6 ]. The preference of fascia lata originates from the composition of the fascia lata, as it is rich in collagen.…”