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Thursday April 24, 2008

World’s First Shoulder Transplant in Bologna

Operation at Rizzoli hospital used advanced, non-mechanical prosthetic technique
BOLOGNA – The world’s first complete transplant of a shoulder joint has been carried out by a team from the Rizzoli hospital’s sixth orthopaedic surgery division, led by Professor Sandro Giannini. The Bologna hospital already holds a number of records for knee, ankle and big toe transplants.
BIOLOGICAL PROSTHESIS – The prosthesis, a two centimetre-thick piece of bone and cartilage attached to the humerus and collar bone with tiny pins, was inserted into the left shoulder of Giampiero Cocchini, 47, a municipal council worker from Pescara who lives at Montesilvano. Mr Cocchini, a former amateur weightlifter, had for some time been suffering from severe post-traumatic arthrosis, which as Professor Giannini explains, had completely eroded the cartilage covering the end of the bone. Previously, joint transplants were carried out with mechanical prostheses, which involved grafting frozen bones as supports. These were used mainly in limb-sparing surgery for cancer patients but with the drawback, as Professor Giannini points out, of transplanting “dead, very fragile bones” that are liable to fracture, leaving the patient’s arthrosis unresolved.
NEW TECHNIQUE – The new technique developed by the Rizzoli team used a compound biological prosthesis. Professor Giannini explains that the prosthesis was made from a two centimetre-thick layer of bone and cartilage, taken, via the Rizzoli bone bank, from a 38-year-old donor who died about ten days ago. A CT scan was carried out to ensure that the bone implanted was the right size and that there would be no infection or virus-related problems. According to Professor Giannini, the thin layer encourages revascularisation because the material implanted “maintains cell vitality in the cartilage” and enables integration and consolidation with the recipient’s bones. The end result is “a joint that is similar to the one the patient had before”, hence the name “biological prosthesis”.
SLING FOR 30 DAYS – Professor Giannini added that the patient has no need of any special immunosuppressive therapy because the rejection reaction to bone and cartilage is limited. Mr Cocchini will have to wear a restraining sling for 30 days and may be discharged within 24 hours. Professor Giannini points out that these operations will not replace standard graft prostheses but are suitable for patients under 50 with debilitating arthrosis, whose age means they could need more operations in the future as their prosthesis wears out. The Rizzoli team is set to perform a second transplant on another patient using the same donor’s right shoulder joint.