Aim. In the last years, many short hip stem variants were developed, almost always sharing the principle of metaphyseal and proximal diaphyseal anchorage. In this study, we analyzed the midterm results after implanting short cementless hip stem of ESKA. Methods. A total of 380 total hip replacements using the ESKA-short cementless stems were performed in a series of 340 patients between November 2002 till May 2008. The clinical and radiological evaluation of the patients was done in September 2008. The mean follow up was 37 months (3–54 months). Results. The mean age of the patients was 65 years (35–85 years). The indications varied between osteoarthritis (n=342), avascular necrosis (n=23) and aseptic loosening of stem (n=15). Good clinical and radiological outcome without complications was observed in 361 cases. However, complications were recorded in 19 cases. Aseptic loosening was noted in 4 cases and was treated with stem exchange. Deep infection occurred in 5 cases, 3 of which had direct exchange and 2 had two-stage delayed reconstruction. Dislocation was noted in 2 cases, which were revisions after aseptic loosening. 8 patients suffered intraoperative femur fissures, 7 of which healed completely after prolonged partial weight bearing postoperatively (n=4 without osteosynthesis, n=3 needed adjunctive cerclage around the proximal femur). Only 1 spiral fracture was recorded and needed a periprosthetic NCB-plate. Conclusion. Our own experience with cementless short hip stems is, in accordance with other studies, also encouraging. Based on the metaphyseal and proximal diaphyseal anchorage, short stems established themselves as a surgical option in the hip replacement surgery. There was no increase in the postoperative complication rate compared with standard total hip arthoplasty. It is also an option for elderly population. However, long-term outcome is still to be investigated

INTRODUCTION. Limb salvage surgery is a common treatment for patients who suffer from bone tumors. In the case of pelvic tumors this creates a challenge for the surgeon and the treatment remains controversial because the oncologic complications like local recurrence, dissemination and orthopaedic ones, like infection, haemorrhage, and mechanical problems of reconstructions Tumors affecting the acetabulum are a challenge for the surgeon because of the impact in the function of the extremity. There are many reconstruction techniques described in the literature like prosthesis, allograft systems, arthrodesis, etc…, but still there is not a gold standard due to the poor functional results at long term follow up, and the associated complications of all techniques. In this study we show the experience in our center on pelvic reconstructions after tumors affecting the acetabulum area (zone II). MATERIAL AND METHODS. We surgically treated 81 pelvic tumors from 1997 to 2009 following the Enneking and Dunham calssification attending to the localization of the tumor: Zone I 38 (iliac bone)Zone II 25 (acetabulum)Zone III 18 (pelvic branches)In zone II tumors we performed pelvic reconstruction in eight cases, with different type of prosthesis. In 5 cases we performed saddle prosthesis (group A) and in 3 cases we performed Coned-Stanmore Implants type prosthesis with sacro-iliac anchorage. The mean follow up of the serie was 3,5 years (1–6 years). In group A the mean follow up was 5 years and in group A and in group B the mean follow up was 1 year due to the recent implantation in our center of Coned type prosthesis for pelvic reconstruction. We evaluated our results with these two types of prosthesis. RESULTS. Oncologic: group A we had a local recurrence of 25% and 25% of the patients died. group B we had no cases of local or systemic recurrence and we didn't registered any death. Functional: In group A the patients showed local pain and difficulty to walk probably due to the change of the center of rotation of the hip and instability of the saddle prosthesis. In group B all patient's followed physical therapy programs without problems and were able to walk with crutches ten months after surgery. Complications:group A we had a 25% of perioperative infection and a 25% of dislocation of the prosthesis. In group B we did not have any of these complications. CONCLUSIONS. Saddle prosthesis mantain the length of the extremity and allow weight bearing but they do not give a good stability. Even if we only have one year follow up with this Coned prosthesis with sacro iliac anchorage we achieved much better functional results and a lower rate of complications

INTRODUCTION. Management of neglected residually displaced acetabular fractures is a big challenge. ORIF is often doomed to failure so a primary total hip replacement is usually kept in mind as a method of choice. However THR is a technically difficult and results are quiet unpredictable. OBJECTIVE. To present our experience with THR in maltreated grossly displaced acetabular fractures and to discuss operative technique and prognostic factors in that complicated surgery. MATERIAL. THR was applied in 14 patients (11 males and 3 females, mean age 51 years) with at least three-months old and significantly displaced acetabular fractures. In 12 cases preceding treatment was conservative, and in 2 it was operative. Fracture nonunion was recognized in 5 cases, old hip dislocation in 4 and protusion in 3. Large interfragmentary gaps and local bone defect were detected in almost all cases. METHOD. THR was performed 3–31 months after injury. Extensile iliofemoral or Y-shaped approach with trochanteric osteothomy was used in most cases. Depending of particular situation a variety of techniques were applied to provide adequate bone stock for the cup, such as an approximate ORIF, periacetabular osteotomy, structural or morcelised bone grafting. Reinforcement ring was used in 6 cases. The cup fixation was cemented in 12 procedures and uncemented in 2. Cemented stem was introduced in 10 cases and uncemented in 4. Preoperative selective embolisation of superior gluteal artery was carried out in 1 patient. RESULTS. The operative duration was 3–7 hours and blood loss was 850–2200 ml. The only intraoperative accidentwas jatrogenic lesion of superior gluteal artery required embolisation. The follow up was a 16–94 months. Average postoperative Harris Hip Score was 78, compared with 54 before surgery (P<0.01). There was 2 aceptic and 1 septic loosenings with subsequent revisions (21.4%). In 2 cases sight asymptomatic migration of the cap was noted. DISCUSSION. The most difficult but most important stage of operation is a creating of sufficiently stable bone stock for the acetabular cap, impeded by by fragment displacement, nonunion or prolonged hip dislocation. If nonuion the achievement of bone healing is essential. Any instability should be overcomed by stable osteosynthesis. The gaps should be filled by ORIF or bone grafting. We consider cemented fixation possibly with reinforcement ring as a most secure way to provide strong cup anchorage. Uncemented pess-fit cup may be used in cases with lesser initial displacement. In spite of all late results are considerable worse than in conventional hip replacement. CONCLUSION. THR after neglected acetabular fractures is a challenging and demanding procedure. Successful outcome may be only expected if a solid bone stock is made using various surgical techniques

Magnesium calcium alloys are promising candidates for an application as biodegradable osteosynthesis implants [1,2]. As the success of most internal fracture fixation techniques relies on safe anchorage of bone screws, there is necessity to investigate the holding power of biodegradable magnesium calcium alloy screws. Therefore, the aim of the present study was to compare the holding power of magnesium calcium alloy screws and commonly used surgical steel screws, as a control, by pull-out testing. Magnesium calcium alloy screws with 0.8wt% calcium (MgCa0.8) and conventional surgical steel screws (S316L) of identical geometries (major diameter 4mm, core diameter 3mm, thread pitch 1mm) were implanted into both tibiae of 40 rabbits. The screws were placed into the lateral tibial cortex just proximal of the fibula insertion and tightened with a manual torque gauge (15cNm). For intended pull-out tests a 1.5mm thick silicone washer served as spacer between bone and screw head. Six animals with MgCa0.8 and four animals with S316L were followed up for 2, 4, 6 and 8 weeks, respectively. Thereafter the rabbits were sacrificed. Both tibiae were explanted, adherent soft tissue and new bone was carefully dissected around the screw head. Pull-out tests were carried out with an MTS 858 MiniBionix at a rate of 0.1mm/sec until failure of the screw or the bone. For each trial the maximum pull-out force [N] was determined. Statistical analysis was performed (ANOVA, Student's t-test). Both implant materials were tolerated well. Radiographically, new bone was detected at the implantation site of MgCa0.8 and S316L, which was carefully removed to perform pull-out trials. Furthermore, periimplant accumulations of gas were radiographically detected in MgCa0.8. The pull-out force of MgCa0.8 and S316L did not significantly differ (p = 0.121) after two weeks. From 6 weeks on the pull-out force of MgCa0.8 decreased resulting in significantly lower pull-out values after 8 weeks. Contrary, S316L pull-out force increased throughout the follow up. Thus, S316L showed significantly higher pull-out values than MgCa0.8 after 4, 6 and 8 weeks (p<0.001). MgCa0.8 showed good biocompatibility and pull-out values comparable to S316L in the first weeks of implantation. Thus, its application as biodegradable osteosynthesis implant is conceivable. Further studies are necessary to investigate whether the reduced holding power of MgCa0.8 is sufficient for secure fracture fixation. In addition, not only solitary screws, but also screw-plate-combinations should be examined over a longer time period. Acknowledgements. The study is part of the collaborative research centre 599 funded by the German Research Foundation

Aims

Osseointegrated prosthetic limbs allow better mobility than socket-mounted prosthetics for lower limb amputees. Fractures, however, can occur in the residual limb, but they have rarely been reported. Approximately 2% to 3% of amputees with socket-mounted prostheses may fracture within five years. This is the first study which directly addresses the risks and management of periprosthetic osseointegration fractures in amputees.

Aims

The aim of this study was to describe implant and patient-reported outcome in patients with a unilateral transfemoral amputation (TFA) treated with a bone-anchored, transcutaneous prosthesis.

Aims

The aim of this study was to compare the cost-effectiveness of treatment with an osseointegrated percutaneous (OI-) prosthesis and a socket-suspended (S-) prosthesis for patients with a transfemoral amputation.

Objectives

Because of the contradictory body of evidence related to the potential benefits of helical blades in trochanteric fracture fixation, we studied the effect of bone compaction resulting from the insertion of a proximal femoral nail anti-rotation (PFNA).