Elective orthopaedic procedures, and particularly total hip arthroplasty (THA), in octogenarians and nonagenarians patients are burdened of several implications. Besides the comorbidities and the anesthesiological issues, legal and ethical implications are present. Some literature data show the clinical improvement of THA in elderly patient but the psychological aspects are not yet evaluated. Aim of this study is to evaluate the clinical aspects and the psychological impact in daily living in octogenarians and nonagenarians patients addressing THA.

We conducted a retrospective evaluation of 81 THA in 81 patients of age more than 85 years with a minimum follow-up of 6 months. Clinical aspects were evaluated using the Hip disability and Osteoarthritis Outcome Score (HOOS). The psychological issues were evaluated with the Short Form 12 (SF-12) using both the Physical Component Summary (PCS) and the Mental Component Summary (MCS). From the starter cohort of 81 patients, 8 patients were died for causes unrelated to surgery, 13 were lost to follow-up, 1 patient was revised for periprosthetic fracture; 59 patients composed the final cohort. Mean HOOS rased from 18,07 ± 17,81 to 92,36 ± 5,74 with statistically significant distribution both in the global score than in all of the different subscales. The PCS raised from 26,81 ± 10,81 to 51,86 ± 4,45 and The MCS raised from 34,84 ± 10,81 to 56,70 ± 5,04, but none of them showed a statistically significant distribution. THA in octogenarians and nonagenarians patients could be a safe procedure with positive results for clinical and psychological aspects.

Fractures of the prosthetic components after total knee arthroplasty (TKA) are rare but dangerous complications, sometimes difficult to diagnose and to manage. Aim of this study is to evaluate the incidence of component breakage and its treatment in our single institution's experience. We retrospectively review our institution registry. From 605 revision knee arthroplasties since 2000 to 2018, we found 8 cases of component breakage, of these 3 belonged to UKA, and 5 belonged to TKA. The UKA fractures were all on the metal tibial component; while 4 TKA fractures were ascribed to the liner (2 Posterior-Stabilized designs and 2 constrained designs) and only one case was on the femoral component. For every patient a revision procedure was performed, in two cases a tibial tubercle osteotomy was performed, while in one case (where the fracture was of the post cam) an arthroscopy was performed prior to the arthrotomy. All of the UKA fractures were treated with a standard revision implant. As regard the TKA, 2 liner fractures were treated with the only liner exchange, while the other 2 liner fractures and the fracture of the metallic component were treated with total knee revision. No intra- and post-operative complications were found. Component breakage after TKA is a serious complication. Its treatment, always surgical, can hide pitfalls, especially if the timing is not correct; indeed apart from the revision of one or more components, the surgeons must address any issues of management of bone defect and ligamentous stability.

Introduction and Objective

A proper restoration of hip biomechanics is fundamental to achieve satisfactory outcomes after total hip arthroplasty (THA). A global hip offset (GO) postoperatively reduction of more than 5 mm was known to impair hip functionality after THA. This study aimed to verify the restoration of the GO radiographic parameter after primary THA by the use of a cementless femoral stem available in three different offset options without length changing.

Introduction and Objective

Difficult primary total knee arthroplasty (TKA) and revision TKA are high demanding procedures. Joint exposure is the first issue to face off, in order to achieve a good result. Aim of this study is to evaluate the clinical and radiological outcomes of a series of patients, who underwent TKA and revision TKA, where tibial tubercle osteotomy (TTO) was performed.

Background: This report presents the long term (over 20 years) experience with the use of a grit-blasted, press-fit femoral prosthesis.

Methods: The first 300 consecutive primary THA procedures using a collarless, three-dimensional tapered, straight, titanium alloy stem with a grit-blasted surface (performed in 299 patients) were evaluated up to twentytwo years. A cementless all-polyethylene socket in 80 percent of the cases, were used. Radiographic evaluation, performed by an independent observer using a zonal analysis method, included assessment of component migration, Engh’s implant-bone femoral fixation score, implant-bone demarcations, and periprosthetic osteolysis. The average duration of long-term radiographic follow-up was 12.6 years (range; 10 to 16 years).

Results: At last examination only five hips were lost to follow-up and 84 patients were deceased. The femoral revision rate was 7 percent (two hips for aseptic loosening, five hips for septic loosening, and twelve hips with osseointegrated stems for severe progressive femoral osteolysis) and the acetabular revision rate was 28% (revised for either socket migration or progressive peri-acetabular osteolysis or both). Survivorship, based on any revision (femoral or acetabular) was 89% at ten years and 65% at twenty years; survivorship of the femoral component was 95% at ten years and 89% at twenty years. The incidence of femoral periprosthetic osteolysis, was 47%, with 5% of distal endosteal osteolysis. Radiographic femoral implant-bone fixation was stable, bone-ongrowth in 97%; stable, fibrous-fixation in 1%.

Conclusions: The grit-blasted, press-fit, collarless, tapered femoral component continued to perform well clinically and radiographically up to twenty years of follow-up despite the challenging environment of peri-prosthetic osteolysis associated with the acetabular component design. This implant is still in use virtually without design modifications. This study demonstrates the durability of the results of the grit-blasted femoral component and indicates that such an implant offers a viable alternative for fixation without bone cement.

Background. Total hip replacement (THR) has become the ideal treatment for any disorder causing joint destruction. Surgery-related infections are reported only in 1–2 % of THR, but antibiotic prophylaxis is necessary because infections are associated with significant morbidity and occasionally death. 1st and 2nd –generation cephalosporin or, in hospital with methicillin-R Staphylococcus spp (MRSA, MRSE) high prevalence, vancomycin, are the most frequently drug emplojed. The most frequent side effects of antibiotic prophylaxis are allergic reaction and pseudomembranous enterocolitis.

The objective of the present study was to assess the efficacy and tolerability of antibiotic prophylaxis for THR at S. Corona Hospital Pietra Ligure SV (Italy).

In our hospital the majority of prostethic device infections are due to MRSA, but recently we have described increment of infection due to Pseudomonas spp and other gram-. For this reason we used association of vancomycin plus pefloxacin in primary prophylaxis.

Methods. Retrospective analysis of 1118 THR performed in the period 2003–2004, receiving surgical prophylaxis with a single dose of the association vancomycin 1000 mg plus pefloxacin 400 mg. Data collection regarded patients’ age at surgery and reasons for THR. The presence of a surgery-related infection was investigated by means of a phone interview about the function of the hip device (presence of pain, deambulation impairment, fever). Patients with pain or other problems were submitted to physical exam, laboratory tests, plain radiograph and if necessary to exclude of infection, radioisotopic scans.

Results. We report the preliminary data on 218 THR in 211 patients (81 M, 122 F, median age 67.49 aa, range 29–91). THR was performed for: osteoarthrites in 168 cases, trauma in 26, osteonecrosis in 9, displasia in 4 cases, previous osteotomy in 4. 167/211 patients were submitted to a phone interview and 44 to a clinical examination.

Conclusions. In our center, the association of vancomycin-pefloxacin resulted effective and well tolerated as single dose prophylaxis for THR.

Unstable knee caused by an axial deformity mainly occurs in serious valgus cases, which is the result of a femoral external hypoplastic condylus defect and often seen in association with marked debris of the tibial plate and bone –loss. Tibial rotation related to the deficit causes lateral patellar subluxation, and soft tissue retraction fixes the deformity while the preconditions for an anteromedial ligamentous laxity are being created. On replacement the deformities develop because of bone-stock defects as well as ligamentous defects, which are often secondary to debris and/or to primary component misrotations.

In primary surgery the approach is medial for varus and lateral for valgus, in order to help the release. We use the GAP technique to implant semibonded prostheses. In revisions the previous approach is always followed. From 2000 to 2003 52 LCCK Zimmer were implanted. Tuberosity detachment was required in 20 cases.

The increase in TKS was significant.: from 40 to 180. The radiographic alignment supported by taproots centrage is excellent, and there are no signs of radiographical mobilisation in any of the cases.

There were two cases of intolerance, with decubitus of a screw utilised for the tibial tuberosity synthesis. A flexion-extension defect had to be repaired afterwards by surgery and two cases of endostal reaction to the tibial taproot were observed.

Despite the difficulty of treated cases, results appear promising; the combination between prosthesis type and GAP technique confers high stability to the system.