Elbow Reconstruction with Megaprosthesis: An Effective Strategy for Salvage Surgery in Trauma Patients.

Delayed fracture healing can have devastating functional consequences, including pseudoarthrosis. Many factors can contribute to delayed healing, including decreased vascularity, micro-motion at the fracture site, large fracture gaps, multiple traumas at the same site, compromised metabolic status, surgical complications, and other conditions. A 61-year-old female patient was referred to our hospital with left distal humeral pseudarthrosis, accompanied by chronic pain and disability. Two years prior, the patient suffered a traumatic incident. At another medical facility, the patient underwent open reduction and internal fixation surgery with simultaneous ulnar nerve transposition. She showed favorable postoperative recovery. Unfortunately, approximately one year later, the patient sustained a second trauma to the same arm. This led to peri-implant fracture and post-traumatic aseptic degradation of the osteosynthesis system which was subsequently removed. Twelve months after the last surgery, the patient was referred to our hospital and, after thorough consideration of the therapeutic options, we decided to perform left elbow arthroplasty with left distal humeral reconstruction by using Zimmer's Comprehensive Segmental Revision System. This approach is generally reserved for tumors, and only a handful of cases of megaprostheses for non-tumoral indications have been previously reported. The surgery and perioperative care of our patient were optimal, there were no complications, and the patient recovered arm functionality following rehabilitation.

Etiology of Total Knee Arthroplasty Revisions: A Two-Decade Institutional Perspective.

Total knee arthroplasty (TKA) implant survival time is determined by various patient and implant-related factors and varies significantly in recent worldwide reports. In our study, we have included 247 TKA revisions in 203 patients performed in our hospital over the last 20 years. Multiple etiologies of revisions were identified and classified into 10 categories. Time to failure was analyzed with regard to etiology, patient demographics, and other relevant data. The overall average time to revision was 44.08 months (95% confidence interval (CI) between 33.34 and 49.82 months). Age at primary implant was negatively correlated with time to revision (hazard ratio (HR) = 1.0521 and 95% CI of HR = 1.0359 to 1.0685) and female patients showed a 1.59 times higher risk of implant failure than males. Periprosthetic joint infection was the cause of 46.56% (n=115) of revisions (out of which 12.55% (n=31) were early infections, diagnosed within the first three months), while aseptic loosening was found in 31.98% (n=79) of cases. Infection correlated with a shorter time to revision compared to aseptic loosening (p<0.05). These findings emphasize the need to intensify efforts to deliver the best patient care, select the best antibiotic regimen, and improve surgical techniques to decrease the incidence of infectious complications.

Megaprosthesis for a Rare Case of Bone Metastasis of Thyroid Carcinoma: Case Management and Surgical Approach.

We present the case of a 56-year-old male patient diagnosed with Hürthle cell carcinoma (HCC) that developed widespread metastasis in bone, lung, and lymph nodes with a larger tumor located in the right tibia. The patient was only disturbed by the pain, discomfort, and disability linked to the tibial metastasis. After careful consideration, the best course of action was considered to be the surgical excision of the proximal right tibia with arthroplasty using the C LINK Megaprosthesis tumor revision system. Histological and immunohistochemical analyses were conducted on the tibial resection specimen. In addition, a comprehensive review of prior histological specimens from the primary thyroid tumor, lymph nodes, and lung was undertaken to evaluate the prognosis and provide guidance for the postoperative management of the patient.

Initial Learning Curve for Robot-Assisted Total Knee Arthroplasty in a Dedicated Orthopedics Center.

Background and objectives: Our study aimed to assess the learning curve for robot-assisted (RA) total knee arthroplasty (TKA) in our hospital, compare operative times between RA-TKAs and manual TKAs, and assess the early complications rate between the two approaches. Methods: We included 39 patients who underwent RA-TKA and 45 control patients subjected to manual TKA in the same period and operated on by the same surgical staff. We collected demographic and patient-related data to assess potential differences between the two groups. Results: No statistical differences were recorded in regard to age, BMI, sex, Kellgren-Lawrence classification, or limb alignment between patients undergoing RA-TKA and manual TKA, respectively. Three surgeons transitioned from the learning to the proficiency phase in our study after a number of 6, 4, and 3 cases, respectively. The overall operative time for the learning phase was 111.54 ± 20.45 min, significantly longer compared to the average of 86.43 ± 19.09 min in the proficiency phase (p = 0.0154) and 80.56 ± 17.03 min for manual TKAs (p < 0.0001). No statistically significant difference was recorded between the global operative time for the proficiency phase TKAs versus the controls. No major complications were recorded in either RA-TKA or manual TKA groups. Conclusions: Our results suggest that experienced surgeons may adopt RA-TKA using this platform and quickly adapt without significant complications.

Overall Accuracy of Radiological Digital Planning for Total Hip Arthroplasty in a Specialized Orthopaedics Hospital.

Preoperative radiological planning is a key factor in the prediction of implant size and positioning that influences surgical time, the risk of complications, and functional outcomes. We have tested the accuracy of the digital templating performed in our hospital for a sample of 215 patients that underwent total hip arthroplasty. We assessed the accuracy of correctly predicting implant size for the femoral and acetabular components, as well as the stem neck length. We found that our method of templating proved accurate (within one size) in 95.8% of cases for the stem and 94.9% for the cup when using the anteroposterior view only, while the lateral view was accurate in 95.8% of cases for the stem and 97.2% for the cup. Exact prediction of the stem size was obtained in 77.7% of cases using the anteroposterior view and 67.0% of cases on the lateral view, and 73.0% and 74.4% of cases for the cup on the AP and LL views, respectively. Stem neck size was predicted exactly in 75.35% of cases and within one size in 93.49% of cases. We concluded that our method of digital templating using dedicated software is highly effective in accurately predicting implant size.