Can porous tantalum acetabular cups and augments restore the hip centre of rotation in revision hip arthroplasty? Long-term results.

BACKGROUND AND AIM: Loss of bone stock is the main problem in revision hip arthroplasty. Porous tantalum cups and augment constructs are possible solutions. The aim of this study was to describe results at an average follow-up of 10 years using these cups. METHODS: 25 patients underwent to revision hip arthroplasty with porous tantalum cups. Acetabular bone defects were classified according to Paprosky's in type II and III. All patients were reviewed clinically and radiographically at an average follow-up of 10 years (range 8.5 to 13 years). Changes in inclination angle of the cup and position of the hip centre of rotation (COR - measured and calculated using Pierchon's method), and possible periacetabular radiolucency lines were assessed. RESULTS: A statistically significant improvement in Harris Hip Score and hip range of motion was observed. The hip COR had been lowered by 19.33 mm after revision and no changes in COR position had been measured at follow-up. Kaplan-Meier survivorship was 100% at an average follow-up of 10 years, considering acetabular revision for any reasons as primary endpoint. 88% of patients was satisfied. Complications were 3 dislocations, 4 asymptomatic heterotopic ossifications and 1 partial reabsorption of greater trochanter. CONCLUSIONS: Porous tantalum cups and augments can be considered a valid solution in acetabular revisions for addressing massive bone defects and restoring the hip COR.

Complex open elbow fracture-dislocation with severe proximal ulna bone loss: a case report of massive osteochondral allograft surgical treatment.

We report a case of a 69-year-old right-dominant man who had an open Monteggia-like lesion of the right elbow (Gustilo-Andersen IIIA) with severe proximal ulna bone loss associated with an ipsilateral ulnar shaft fracture due to a motorcycle accident. The patient underwent two-stage surgery. Wound debridement and bridging external fixation were performed at first. Three months later, a frozen massive osteochondral ulnar allograft was implanted and fixed with a locking compression plate. A superficial wound infection appeared 5 weeks after the second surgery. Superficial wound debridement, negative pressure therapy, and antibiotics were administered for 3 months, achieving infection healing. At 3 years post-surgery, the elbow range of motion was satisfactory with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 16.7. Radiographs and computed tomography scans showed good allograft-bone integration without allograft reabsorption or hardware loosening. Although not complication-free, massive ulna osteochondral allograft implantation can be considered a valid option in cases of open Monteggia-like lesions associated with ulnar shaft fracture and severe bone loss in active patients, whenever osteosynthesis or joint replacement is not a proper solution. This type of bone stock restoration allows for future surgery, if needed.

Factors influencing results and complications in proximal periprosthetic femoral fractures: a retrospective study at 1- to 8-year follow-up.

BACKGROUND AND AIM: Proximal periprosthetic femoral fractures (PPFFs) are gradually increasing and surgical management is often associated to high risk of complications, due to elderly population and associated comorbidities. We retrospectively assessed 79 patients at 1- to 8-years follow-up, focusing on factors that may have affected results and complications. METHODS: Seventy-nine PPFFs were classified according to Vancouver classification in: 4 type B1, 22 type B2, 29 type B3, 24 type C. The average age of the patients was 81.5 year-old (61-95). 37 PPFFs (12 type B2 and 25 type B3) were treated with uncemented tapered fluted revision stems (Link MP Recostruction Stem, Waldermar Link GmbH) and 42 patients with open reduction and internal fixation (ORIF). Patients were clinically and radiographically assessed at a mean 5-year follow-up (1-8 years). Elixhauser Comorbidity index was analysed. RESULTS: All PPFFs, except two, healed within 10 months. Harris Hip score at follow-up was 65.6 in ORIF group and 79.8 in revision hip group (p<0.05). 35.7% and 32.4% had blood transfusions in ORIF and revision hip group respectively (p> 0.05). 5 patients in ORIF group and 2 patients in revision hip group died within 12 months from surgery (p<0.05). CONCLUSIONS: Both ORIF and hip revision arthroplasty with modular uncemented tapered fluted stems are valid procedures for Vancouver B2 and B3 PPFFs. Restricted weight-bearing, high number of comorbidities with elevated Elixhauser Comorbidity Index and ORIF are associated to high 12-month mortality.

Trapezio-metacarpal arthritis: functional and radiographic results at an average 5-year follow-up using trapeziectomy associated to a modified Ceruso's suspensionplasty.

BACKGROUND AND AIM: Trapezial-metacarpal arthritis (TMA) is a common and highly disabling pathology. Trapeziectomy and Ceruso's suspensionplasty is described for moderate-severe stages. The aim of the present study was to assess functional and radiographic results at an average 5-year follow-up using a modified Ceruso's technique where the Abductor Pollicis Longus (APL) is passed twice around the Flexor Carpi Radialis (FCR) and a suture mini-anchor in the base of the first metacarpal is used to further stabilize the thumb. METHODS: 85 consecutive modified Ceruso's suspensionplasty were performed from 2012 and 2018. All the patients were evaluated at an average 5.1-year follow-up (21-96 months). Subjective patient satisfaction rate, NRS, DASH score, abduction angle, Kapandji score and pinch strength using functional tests were assessed. The scapho-metacarpal distance was measured at follow-up radiographs. RESULTS: 90.6% of the patients were satisfied by the treatment. The NRS and the DASH score improved (from 8.5 pre-operatively to 1.53 and from 87.5 to 24.6 respectively-p<0.001). The Kapandji test was rated from 7 to 10 in 65.9% of the patients. The pinch strength was good in 75.3% of the patients at follow-up. The abduction angle of the thumb was 38.2° (20°-55°). The mean scapho-trapezial distance decreased of 2.45 mm (from 9.87 mm to 7.42 mm - p<0.05). 8 patients had persistent pain and thumb disfunction, 1 patient had De Quervain's tenosynovitis. CONCLUSIONS: Suspensionplasty according to Ceruso's is a relatively simple and reproducible technique for moderate-severe TMA. It improves pain and thumb function, giving good stability without significant shortening.

Fracture of Cobalt-Crome Modular Neck in Total Hip Arthroplasty.

Despite the advantages of modular total hip arthroplasty in terms of neck version, offset and length precise reproduction, titanium necks breakage became a concern. Consequently, titanium has been replaced by cobalt-chrome (Co-Cr). However, four cases of Co-Cr modular neck breakage have been reported in the literature. In the present paper, two cases of Co-Cr modular neck fractures are described together with a literature review. The aim of this work is to discuss the risk factors and characteristics of this rare complication. We described two cases of fracture of long varus Co-Cr modular femoral neck connected with cementless press-fit stem. Some risk factors, such as long varus type of modular neck, overweight and/or high demanding physical activity, might have contributed to implant failure.

Do tourniquet and drainage influence fast track in total knee arthroplasty? Our results on 151 cases.

BACKGROUND: Fast track in total knee replacement (TKR) is a widely used protocol. Tranexamic acid proved to be effective in reducing perioperative bleeding without increasing thromboembolic risk. The aim of this study was to assess if tourniquet and suction drainage might affect perioperative blood loss and postoperative functional recovery after TKR. METHODS: 151 patients, who underwent to TKR, were assessed and divided into three homogeneous groups: group A (51 patients) in which both tourniquet and suction drainage have been applied (tourniquet has been release before wound closure); group B (50 patients) in which neither tourniquet nor suction drainage have been used; group C (50 patients) in which only tourniquet has been used. Perioperative intravenous tranexamic acid and post-operative low-molecular-weight heparin have been administered. Trend of haemoglobin values, transfusion rate, pain, ability to obtain 90 degrees of flexion and length of stay were analysed. RESULTS: The average intra-operative blood loss was statistically higher in group B in comparison to other two groups. Haemoglobin values were lower in group A in comparison to group C in the third and fifth post-operative days. Patients in group A had higher transfusion rate, higher pain and had more difficulties in reaching a 90 degrees of knee flexion than the other two groups. There was one infection in group A. No differences in length of stay. CONCLUSION: Suction drain seems to be associated to lower haemoglobin values, higher transfusion rate, higher pain and slower functional recovery. Short-term tourniquet does not influence post-operative bleeding and rehabilitation program.

Arthroscopic Posterior Stabilization of the Shoulder Using a Percutaneous Knotless Mattress Suture Technique.

Posterior shoulder instability is far less common than anterior instability, and its arthroscopic treatment can be technically demanding. We describe a percutaneous arthroscopic technique for posterior shoulder stabilization using mattress sutures and knotless anchors. Spinal needles are used to pass the sutures percutaneously in a mattress fashion. Knotless anchors are used to secure the sutures under the labrum. These anchors can be used without cannulas, giving easier access to the posterior glenoid. This procedure is simple, cost-effective, and safe, avoiding the presence of both knots and suture strands in contact with the humeral head.