Introduction. Intra articular distal tibia fractures can lead to post-traumatic osteoarthritis. Joint distraction has shown promise in elective cases. However, its application in acute fractures remains unexplored. This pilot study aims to fill this knowledge gap by investigating the benefits of joint distraction in acute fractures. Materials & Methods. We undertook a restrospective cohort study comprising patients with intra-articular distal tibia and pilon fractures treated with a circular ring fixator (CRF) at a single center. Prospective data collection included radiological assessments, Patient-Reported Outcome Measures (PROM), necessity for additional procedures, and Kellgren and Lawrence grade (KL) for osteoarthritis (OA). 137 patients were included in the study, 30 in the distraction group and 107 in the non-distraction group. There was no significant difference between the groups. Results. Mean follow-up was 3.73 years. There was no significant difference between the groups in overall complications or need for further procedures. There was no significant difference in progression of KL between the groups (1.81 vs 2.0, p=0.38) mean follow up 1.90 years. PROM data was available for 44 patients (6 distraction, 38 non-distraction) with a mean follow-up of 1.71 years. There was no significant difference in EQ5D (p=0.32) and C Olerud-H Molander scores (p=0.17). Conclusions. This pilot study suggests that joint distraction is safe in the acute setting. However, the study's impact is constrained by a relatively small patient cohort and a short-term follow-up period. Future investigations should prioritise longer-term follow-ups and involve a larger patient population to more comprehensively evaluate the potential benefits of joint distraction in acute fractures

Over half of postpartum women experience pelvic ring or hip pain, with multiple anatomic locations involved. The sacroiliac joints, pubic symphysis, lumbar spine and pelvic girdle are all well documented pain generators. However, despite the prevalence of postpartum hip pain, there is a paucity of literature regarding underlying soft tissue intra-articular etiologies. The purpose of this systematic review is to document and assess the available evidence regarding underlying intra-articular soft tissue etiologies of peri- and postpartum hip pain. Three online databases (Embase, PubMed and Ovid [MEDLINE]) were searched from database inception until April 11, 2021. The inclusion criteria were English language studies, human studies, and those regarding symptomatic labral pathology in the peri- or postpartum period. Exclusion criteria were animal studies, commentaries, book chapters, review articles and technical studies. All titles, relevant abstracts and full-text articles were screened by two reviewers independently. Descriptive characteristics including the study design, sample size, sex ratio, mean age, clinical and radiographic findings, pathology, subsequent management and outcomes were documented. The methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) instrument. The initial search identified 2472 studies. A systemic screening and assessment of eligibility identified 5 articles that satisfied the inclusion criteria. Twenty-two females were included. Twenty patients presented with labral pathology that necessitated hip arthroscopy with labral debridement or repair with or without acetabuloplasty and/or femoroplasty. One patient presented with an incidental labral tear in the context of osteitis condensans illi. One patient presented with post-traumatic osteoarthritis necessitating a hip replacement. The mean MINORS score of these 5 non-comparative studies was 2.8 (range 0-7) demonstrating a very low quality of evidence. The contribution of intra-articular soft tissue injury is a documented, albeit sparse, etiology contributing to peri- and postpartum hip pain. Further research to better delineate the prevalence, mechanism of injury, natural history and management options for women suffering from these pathologies at an already challenging time is necessary to advance the care of these patients

It is unclear why ACL rupture increases osteoarthritis risk, regardless of ACL reconstruction. Our aims were: 1) to establish the reliability and accuracy of a direct method of determining tibiofemoral contact in vivo with UO-MRI, 2) to assess differences in knees with ACL rupture treated nonoperatively versus operatively, and 3) to assess differences in knees with ACL rupture versus healthy knees. We recruited a convenience sample of patients with prior ACL rupture. Inclusion criteria were: 1) adult participants between 18–50 years old; 2) unilateral, isolated ACL rupture within the last five years; 3) if reconstructed, done within one year from injury; 4) intact cartilage; and 5) completed a graduated rehabilitation program culminating in return to sport or recreational activities. Participants were excluded if they had other ligament ruptures, osteoarthritis, an incompletely rehabilitated injury, were prohibited from undergoing MRI, or had a history of ACL re-rupture. Using the UO-MRI, we investigated tibiofemoral contact area, centroid location, and six degrees of freedom alignment under standing, weightbearing conditions with knees extended. We compared patients with ACL rupture treated nonoperatively versus operatively, and ACL ruptured knees versus healthy control knees. We assessed reliability using the intra-class correlation coefficient, and accuracy by comparing UO-MRI contact area with a 7Tesla MRI reference standard. We used linear mixed-effects models to test the effects of ACL rupture and ACL reconstruction on contact area. We used a paired t test for centroid location and alignment differences in ACL ruptured knees versus control knees, and the independent t test for differences between ACL reconstruction and no reconstruction. Analyses were performed using R version 3.5.1. We calculated sample size based on a previous study that showed a contact area standard deviation of 13.6mm2, therefore we needed eight or more knees per group to detect a minimum contact area change of 20mm2with 80% power and an α of 0.05. We recruited 18 participants with ACL rupture: eight treated conservatively and 10 treated with ACL reconstruction. There were no significant differences between the operative and nonoperative ACL groups in terms of age, gender, BMI, time since injury, or functional knee scores (IKDC and KOOS). The UO-MRI demonstrated excellent inter-rater, test-retest, and intra-rater reliability with ICCs for contact area and centroid location ranging from 0.83–1.00. Contact area measurement was accurate to within 5% measurement error. At a mean 2.7 years after injury, we found that ACL rupture was associated with a 10.4% larger medial and lateral compartment contact areas (P=0.001), with the medial centroid located 5.2% more posterior (P=0.001). The tibiae of ACL ruptured knees were 2.3mm more anterior (P=0.003), and 2.6° less externally rotated (P=0.010) relative to the femur, than contralateral control knees. We found no differences between ACL reconstructed and nonreconstructed knees. ACL rupture was associated with significant mechanical changes 2.7 years out from injury, which ACL reconstruction did not restore. These findings may partially explain the equivalent risk of post-traumatic osteoarthritis in patients treated operatively and nonoperatively after ACL rupture

Introduction. The incidence of osteochondral lesions following ankle fractures varies in the literature between 17-70%. They are commonly associated with chronic pain and swelling in patients diagnosed with such pathology. There is less evidence about the relationship between OCL and the development of post-traumatic osteoarthritis, the most common type of ankle arthritis. Methods. Through the use of MRI 8 weeks following ankle fractures, we investigated the incidence of OCL in patients treated both surgically and conservatively for ankle fractures of all AO subtypes. Results. 29 patients met our inclusion criteria, 16 females: 13 males with a mean age of 36 (range 16-64). Twelve patients required surgery with seventeen treated conservatively. The majority of patients (11) were classified as 44B1 fractures with the 44C1 and 44B2 the next most common. We did not detect any OCL in any patient but 65% of patients had both a tibiotalar effusion and associated bone bruising. Conclusion. Contrary to the current literature, we did not associate ankle fractures of any subtype with the development of OCL. Future evaluation of this same cohort will be necessary to evaluate the incidence of post traumatic ankle osteoarthritis

Total hip arthroplasty (THA) is frequently performed as a salvage procedure for the acetabular fracture when posttraumatic osteoarthritis, posttraumatic avascular necrosis, or fixation failure with subluxation develop. Special considerations for this situation include previous surgical exposure with dense scar tissue, the type and location of implants, the location and amount of heterotopic ossification, indolent infection, previous sciatic nerve palsy, and the pathoanatomy of existing acetabular defect. These factors can influence the choice of surgical exposure and the reconstructive method. The outcomes of THA after acetabular fracture are generally less favorable than those of the nontraumatic degenerative arthritis. Reason for this high failure is the low mean age and the high activity level of the patient. Other important reasons for failure include the problem of acetabular bone deficiency and compromised bone quality. We evaluated the results of cementless THA in patient who had previous acetabular fracture. We also compared this result with those of patients with posttraumatic avascular necrosis of the femoral head. Forty-five consecutive cementless THAs were performed for the treatment of post-traumatic osteoarthritis after acetabular fracture between December 1993 and December 2008. Of these patients, 15 patients were died or lost to follow-up monitoring before the end of the minimum one year follow-up period. This left 30 patients (30 hips) as the subjects of our retrospective review. We evaluated the clinical and radiographic results of these patients and compared with the results of THA in patients with post-traumatic AVN of the femoral head which had without acetabular damage. Two hips required revision of the cup secondary to early migration of the acetabular cup (1 hip) and postoperative deep infection (1 hip). There was no significant difference in clinical and radiographic results between two groups except implanted acetabular component size and required bone graft (p<0.05). The Kaplan-Meier ten-year survival rate, with revision as the end-point, was 90% and 96.7% with loosening of acetabular component as the end-point. Our series suggested that compared with cemented components, uncemented sockets may improve the results of arthroplasty after previous acetabular fracture. In conclusion, cementless THA following acetabular fracture presents unique challenge to the surgeon, careful preoperative assessment and secure component fixation with proper bone grafting is essential to minimize problems

INTRODUCTION. Since July 2008 we are experimenting a new cup with iliac screw fixation, developed on the idea of Ring and Mc Minn. Iliac fixation is permitted by a polar screw of large diameter, coated by HA, which allows a compression to bone and a firm primary stability. Moreover it's possible to increase primary stability with further smaller peripherals screws. We present this new cup and report the preliminary results. MATERIALS AND METHOD. Since July 2008 to April 2010, 51 cups were implanted. The diagnosis was aseptic loosening in 36 cases, septic loosening treated by two-stage revision in 7, hip congenital dislocation in 5, one case of post-traumatic osteoarthritis, one case of instability due to cup malposition and a case was an outcome of Girdlestone resection arthroplasty. Mean age was of 66 years (31-90). RESULTS. We report the results of our first 23 cases, with a minimal follow-up of 12 months. Patients were preoperatively evaluated from both clinical and radiological point of view. Bone defect was analyzed according to the system of Paprosky. In 7 cases bone defect belonged to type 2C, in 8 cases to type 3A and in 8 cases to type 3B. We didn't observe any case of early loosening nor mechanical failure of the implant. The functional outcome, evaluated by Harris Hip Score, was good with a mean score of 82 (72-91)

Purpose:. Interposition arthroplasty is a salvage procedure for patients with severe osteoarthritis of the elbow where conservative treatment failed. It is mostly performed in younger patients where total joint replacement is contraindicated and an arthrodesis is unattractive. Although one of the oldest reconstructive options for elbow arthritis, the procedure is not without complications. There are only a few case series described in the literature. The purpose of our study is to review our cases and report their outcome. Method. We retrospectively reviewed 18 consecutive cases of interposition arthroplasty between 2001 and 2010. 2 cases were excluded due to incomplete records. The mean patient age was 41.3 (19.4–58.6) years at time of surgery. The primary diagnosis was post-traumatic osteoarthritis in 11 cases and inflammatory osteoarthritis in 5 cases. The mean follow up was 4.7 (0.4–10) years. Pre- and post-operative pain and function was evaluated using the Visual Analogue Scale (VAS) and Mayo Elbow Performance Score (MEPS). The complications and the number of re-operations and revisions were recorded. Summary of results:. In 12 (75%) cases at least one revision operation was performed, because of sepsis, ulnar nerve symptoms, instability and unsatisfactory clinical results. Sepsis rate was 25%. In 7 cases there was an unsatisfactory clinical result (i.e. ongoing pain and poor function), resulting in revision by total elbow replacement in 4 cases, arthrodesis in 2 cases and a re-do interposition in 1 case. The mean interval from the interposition to revision procedure was 2.6 (0.6–7.4) years. In 9 patients with the interposition currently in situ, mean VAS improved from 7.4 to 2.4 and mean MEPS from 42 (30–60) to 75 (40–100). Conclusion:. Interposition arthroplasty offered improvement in pain and function, but at a high cost. It is associated with a high rate of complications and need for revision surgery that we feel might be unacceptable

Introduction. Malrotation of a femoral component is a cause of patellofemoral maltracking after total knee arthroplasty (TKA). We have developed a balanced gap technique in posterior stabilized total knee arthroplasty (PS-TKA) using an original tensor instrument. One of characteristics of this instrument is the ability to measure gaps even if there is a bone defect, because it has two paddles, and we can attach block augmentations. In addition it can measure the gap after a reduction of the patella with an offset mechanism. In the balanced gap technique, the femoral component rotation is decided by a tibial cut surface and ligaments balance using the tensor device. This study investigated retrospectively whether rotational alignment of femoral component rotation influenced patellofemoral joint congruency in PS- TKA. Material and Methods. We evaluated the radiographs of 52 knees of 42 patients, who underwent TKA (NexGen LPS-Flex, fixed surface, Zimmer) by one surgeon (S.A.) for osteoarthritis or rheumatoid arthritis. All procedures were performed through a medial parapatellar approach and a balanced gap technique using a developed versatile tensor device. We measured lateral patella tilt and lateral patella shift at post-op. 6 months. To assess the rotational alignment of femoral component rotation, condylar twist angle (CTA) was measured, and to assess the postoperative flexion gap balance, a condylar lift-off angle (LOA) was measured using the epicondylar view radiographs. Results. We performed the lateral release on 4 knees (7.6%). The average lateral patella tilt and CTA, and LOA were 3.00 ± 3.2°, 0.95 ± 2.5°, 1.50 ± 1°, respectively. There were two cases which had more than 10°tilt. We did not find any case of lateral patella shift. There was no statistical correlation with lateral patella tilt and CTA (r=0.17, p=0.2) (figure 1). There was no statistical correlation with the patella tilt and LOA (r=-0.1, p=0.9) (figure2). The case with 13.4°patella tilt was post-traumatic osteoarthritis (ACL and MCL injury). There were two cases which were cut patella obliquely, and each patella tilt was 13.0°and 3.3°. Discussion. Previously we reported that the rate of a lateral release decreased by a balanced gap technique compared with a conventional measured resection technique. Although the balanced gap technique resulted in a patient's specific wide variability for femoral component rotation, this variable rotation was not found to be associated with abnormal patella tilt and patella shift

Background. Comminuted radial head fractures are challenging to treat with open reduction and internal fixation. Complicating matters further, radial head fractures are often associated with other elbow fractures and soft tissue injuries. Radial head arthroplasty is a favorable technique for the treatment of radial head fractures. The purpose of this study was to evaluate the functional outcomes of radial head arthroplasty using Modular Pyrocarbon radial head prosthesis in patients with unreconstructible radial head fractures. Methods. This single surgeon, single centre study retrospectively reviewed the functional and radiological outcomes of 21 consecutive patients requiring radial head arthroplasty for unreconstructible radial head fractures between July 2003 and July 2009. Patients were at least one year post-op and completed a Short-Form 36 (SF-36) questionnaire, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and the Mayo Elbow Performance Index (MEPI). These patients were independently physically examined and their post-operative radiographs were independently reviewed. Results. 21 patients (9 males and 12 females) were reviewed at a minimum of 12 months follow-up. The mean DASH score was 10.8 (0-34.1), the mean SF-36 physical score was 76.9 (35-96), the mean SF-36 mental score was 83.8 (60-94), and their MEPI score was 86.4 (70-100). Patients maintained 90% of their grip strength in their injured arm when compared to their un-injured arm and had 17. o. of fixed flexion in the affected arm. Radiologically, 14 cases had some degree of post-traumatic osteoarthritis, 12 cases had evidence of heterotrophic ossification, 5 had some evidence of periprosthetic lucency and 3 of our cases were radiologically but not functionally ‘overstuffed’. Conclusion. Radial Head Arthroplasty with Pyrocarbon Radial Head Prosthesis is a safe and effective option when treating unreconstructable comminuted radial head fractures yielding good functional and radiological outcomes and remains the treatment option of choice at our institution

Early methods of treating high-energy tibial plateau fractures by open reduction and internal fixation led to high infection rates and complications. Alternative treatment methods include minimally invasive techniques and implants, external fixator stabilisation (monolateral and circular) and temporary external fixation followed by delayed definitive surgery. A clear understanding of the different fracture types is critical in achieving optimum results with minimally invasive techniques. The Chertsey classification system is based on the direction of force at the time of injury and helps with surgical planning. There are three groups: valgus, varus or axial fracture patterns. 124 tibial plateau fractures have been surgically treated in our hospital since 1995; there were 62 valgus, 14 varus and 48 axial type fracture patterns. Seventy-nine underwent open reduction with internal fixation, and forty-five had an Ilizarov frame. For valgus fractures the average IOWA knee score was 88 if internally fixed or 86 with an Ilizarov frame, range of motion was 140 and 131 degrees and time to union was 81 versus 126 days respectively. Varus fractures had an IOWA score of 83 (ORIF) and 95 (Ilizarov), ROM of 138 and 130 degrees and time to union of 95 versus 82 days. For axial fractures the average IOWA knee score was 85 (ORIF) compared to 82 (Ilizarov), the ROM was 124 degrees for both groups and time to union was 102 days and 141 days respectively. Deep vein thrombosis occurred in 9% of cases with an Ilizarov and one patient required a total knee replacement for painful post-traumatic osteoarthritis. The infection rate for those internally fixed was 2.5%, three patients required a total knee replacement and 2.5% suffered a DVT. Our results are comparable to the literature and the Chertsey classification of tibial plateau fractures helps with surgical planning

BACKGROUND. Reverse total shoulder arthroplasty (RTSA) provides an alternative to standard total shoulder arthroplasty in the treatment of selected complex shoulder problems including failed shoulder replacements. The purpose of this report is to present outcome of RTSA using Comprehensive Reverse System (CRS) as either primary or revision treatment choice. PATIENTS AND MATERIALS. Between September 2010 and April 2012, 54 patients (36 females, 18 males) with the mean age of 68.4 (±10) underwent RTSA-CRS. In 27 patients RTSA-CRS was performed as a revision due to failed previous arthroplasty. Primary underlying conditions included AVN (2), massive irreparable rotator cuff tear (2), primary osteoarthritis (7), post-traumatic osteoarthritis (2), rheumatoid arthritis (6), and rotator cuff arthropathy (8). It was not possible to complete the operation in 6 patients (4 revisions group 2 AVN cases) due to substantial glenoid erosion. Preoperative CT scan was performed in 50% of patients to assess the bony stock of the glenoid. In some patients ultrasound and MRI were performed to acquire additional information. A total of 46 patients were followed-up by means of antroposterior and axial plain X-rays, pain and satisfaction level (VAS/0–10), stiffness, Constant Score, Oxford Shoulder Score, SF-12 (Physical and mental Subscales), and range of movement for a mean duration of 6.5 months (±4.2). RESULTS. The table presents the pre- and postoperative outcome variables for both primary and revision RTSA-CRS groups. The majority of outcome measures indicated a considerable improvement in both groups during the short term follow-up. Significant correlations were noted in-between some key outcome variables. However; due to the short period of follow-up and continuity of collecting data, we intend to produce a more realistic picture of the results s and outcome of the RTSA-CRS in coming years. COMPLICATIONS. There was no vascular complication. Disassociation of glenosphere from the base-plate happened in one patient 8 weeks post-op due to technical mistake, this was repaired later with a satisfactory outcome. One case had enormous hematoma formation 72 hours post-op due to anticoagulants administration leading to second stage evacuation and increased stiffness of shoulder. One patient sustained deltoid partial rupture due to recurrent falls and managed by conservatively. Another patient sustained a type C periprosthetic fracture and was later revised to custom-made stem prosthesis. CONCLUSION. The results of this short-term report indicate a satisfactory and acceptable outcome for RTSA-CRS as reflected in the assessment tools in both primary and revision cases, however with superior results in the primary group. Long-term follow-up is essential to have a more rational assessment of the clinical outcome as well as associated complications

Introduction. Total Hip Arthroplasty (THA) is currently one of the most widely performed surgical procedures in clinical orthopaedic practice. Despite the recorded number of uncemented implants has steadily increased in recent years, cemented fixation still remains the benchmark in THA, accounting for most of the procedures performed nowadays. The Friendly Short is a novel cemented short-stem that grants a less invasive and more bone conservative approach due to its shortened height and innovative cementing technique. It is indicated to treat elderly patients with the aim of preserving bone diaphysis while decreasing postoperative recovery times. Its instrument set allows to optimize the cement mantle thickness via an improved pressurization and stem centralization system. Objectives. Aim of this prospective study was to evaluate functional recovery and implant stability after THA with this cemented short-stem. Methods. Between June 2011 and October 2012, 96 consecutive patients (100 hips) underwent THA with the Friendly Short stem (Lima Corporate). All patients received DELTA-PF cups with UHMWPE cross-linked liners and CoCrMo femoral heads (Lima Corporate). A minimally invasive postero-lateral surgical approach was used in all cases. There were 60 women and 36 men, with a mean age and BMI of 72.6 ± 6.2 (59–85) years and of 26.6 ± 3.9 (18.7–35.6) kg/m2. Most patients were retired (87%) and led a moderately active lifestyle (79%). Underlying pathology was mostly primary coxarthrosis (94%), followed by aseptic necrosis (AVN) (4%) and post-traumatic osteoarthritis (2%). Radiographic and clinical evaluation (Harris Hip Score HHS, Oxford Hip Score OHS) were performed preoperatively, and postoperatively, at 45 days, and at 6, 12, and 24 months. Results. Mean HHS and OHS improved from 36.0 ± 11.3 (7–57) and 10.9 ± 4.9 (0–24) preoperatively, to 96.4 ± 6.1 (78–100) and 46.5 ± 3.1 (33–48) at 2 years. Most significant improvements were recorded already at 45 days after surgery, with a mean HHS of 78.6 ± 9.9 (27–100) and a mean OHS of 34.0 ± 7.4 (18–48). Despite old age, all patients reported remarkable early recovery, especially in terms of joint functionality [Mean flexion: preoperative 77.7 ± 11.1 (40–90), 101.7 ± 8.9 (70–110) at 45 days] and pain relief [Mean HHS pain domain: preoperative 9.6 ± 4.2 (0–20), 41.4 ± 3.6 (20–44) at 45 days); mean OHS pain sub-domain: preoperative 0.2 ± 0.5 (0–4), 3.4 ± 0.8 (1–4) at 45 days)]. X-rays demonstrated good implant stability thanks to optimal cement fixation; there was only 1 case of non-progressive 1-mm radiolucent lines, but no osteolytic areas, subsidence or loosening were observed. Absence of fatigue fractures in the cement mantle proved that there was good stress distribution. Acetabular cups were all stable: only 1 case of non-progressive 1-mm radiolucent lines was reported, but no case of either sclerosis or osteolysis was observed. No revision or implant failure occurred up to 2-year follow-up. Conclusions. Clinical and patient-subjective outcomes were very satisfactory, indicating a significant early functional recovery. Although longer follow-up is required, radiographic assessment demonstrated good implant stability already at 2 years as result of this innovative cementing technique

Hardware in or about the knee joint presents a number of challenges to the surgeon in performance of Total Knee Arthroplasty (TKA). Conventional instrumentation usually requires a modification of technique or removal of the metallic implants. Computer-Assisted TKA (CAOS) is another option, but adds complexity and time to the procedure. MRI-based Patient-Specific Instrumentation (PSI) cannot be used as metal causes unwanted artifact and renders the images for planning, useless. However, CT scans are not affected by metal and thus CT-based PSI can be used in TKA patients with pre-existing hardware. The present IRB approved study evaluates 12 consecutive knees (10 patients) with pre-existing hardware using CT-based PSI (MyKnee®, Medacta International, SA, Castel San Pietro, Switzerland). In this technique, CT scan of the lower extremity is obtained, and from these images, the knee is reconstructed 3-dimensionally. Surgical and implant-size planning are performed according to surgeon preference, with the goal to create a neutral mechanical axis. Once planned and approved, the blocks are made [Fig 1]. During surgery, the PSI cutting block is registered on the femur first and secured with smooth pins. The distal femoral resection is performed directly through the block. An appropriate sized 4-in-1 block is placed and the remaining femoral resections are performed. The tibial resection block is registered and resection performed. Final bone preparation, patella resurfacing, and trialing is performed as is standard to all surgical techniques. Of the 12 TKAs, there were 5 left and 7 right knees performed in 6 females and 6 males. The average BMI was 33.19 and average age was 53 (range 44–63). All diagnoses were either osteoarthritis or post-traumatic osteoarthritis. Follow-up averaged 59 weeks (range 18.6–113.7). Nine patients had pre-operative varus deformities with HKA deformities average of 171.9° (range 154°–178.5°). One patient had pre-operative valgus deformity of 184.5°. Two patients were neutral (180°). Post-operative alignment for all patients (n = 11) was 179° (range 177°–180°). All patients were within 3° neutral, post operatively. Four patients measured 180°, 4 measured at 179°, 2 measured at 178°, and only one at 177°. Hardware consisted of 5 patients with femur or tibia staples, 3 with plate(s) and screws [Fig. 2], 3 patients with ACL interference screws, and one titanium rod. No hardware was removed unless necessary for implantation. Only 3 patients required some hardware removal. The pre-operative Range of Motion (ROM) averaged 2.9° to 98.3° (Extension range 0–15° and flexion range 30–115°). Post-operative ROM was 2.9° to 101.3°. (Extension range 0–5° and flexion range 65–125°). Knee Society Score (KSS) improved from 42.3 to 82.3, and KSS Function Score improved from 52.1 to 77.5. No intraoperative complications were recorded. Average tourniquet time was 42.1 minutes (range 28–102). Regardless of the deformity, the patient's post-operative mechanical axes HKA averaged 179° (range 177–180). Clinical scores were typical for TKA patients with improvement in both KSS and ROM. In conclusion, early results using PSI in patients with pre-existing hardware in or about the joint, is safe, efficient, and accurate in performance of TKA

Hardware in or about the knee joint presents a number of challenges to the surgeon in performance of Total Knee Arthroplasty (TKA). Conventional instrumentation usually requires a modification of technique or removal of the metallic implants. Computer-Assisted TKA (CAOS) is another option, but adds complexity and time to the procedure. MRI-based Patient-Specific Instrumentation (PSI) cannot be used as metal causes unwanted artifact and renders the images for planning, useless. However, CT scans are not affected by metal and thus CT-based PSI can be used in TKA patients with pre-existing hardware. The present IRB approved study evaluates 12 consecutive knees (10 patients) with pre-existing hardware using CT-based PSI (MyKnee®, Medacta International, SA, Castel San Pietro, Switzerland). In this technique, CT scan of the lower extremity is obtained, and from these images, the knee is reconstructed 3-dimensionally. Surgical and implant-size planning are performed according to surgeon preference, with the goal to create a neutral mechanical axis. Once planned and approved, the blocks are made. During surgery, the PSI cutting block is registered on the femur first and secured with smooth pins. The distal femoral resection is performed directly through the block. An appropriate sized 4-in-1 block is placed and the remaining femoral resections are performed. The tibial resection block is registered and resection performed. Final bone preparation, patella resurfacing, and trialing is performed as is standard to all surgical techniques. Of the 12 TKAs, there were 5 left and 7 right knees performed in 6 females and 6 males. The average BMI was 33.19 and average age was 53 (range 44–63). All diagnoses were either osteoarthritis or post-traumatic osteoarthritis. Follow-up averaged 59 weeks (range 18.6–113.7). Nine patients had pre-operative varus deformities with HKA deformities average of 171.9° (range 154°–178.5°). One patient had pre-operative valgus deformity of 184.5°. Two patients were neutral (180°). Post-operative alignment for all patients (n=11) was 179° (range 177°–180°). All patients were within 3° neutral, post operatively. Four patients measured 180°, 4 measured at 179°, 2 measured at 178°, and only one at 177°. Hardware consisted of 5 patients with femur or tibia staples, 3 with plate(s) and screws, 3 patients with ACL interference screws, and one titanium rod. No hardware was removed unless necessary for implantation. Only 3 patients required some hardware removal. The pre-operative Range of Motion (ROM) averaged 2.9° to 98.3° (Extension range 0–15° and flexion range 30–115°). Post-operative ROM was 2.9° to 101.3°. (Extension range 0–5° and flexion range 65–125°). Knee Society Score (KSS) improved from 42.3 to 82.3, and KSS Function Score improved from 52.1 to 77.5. No intraoperative complications were recorded. Average tourniquet time was 42.1 minutes (range 28–102). Regardless of the deformity, the patient's post-operative mechanical axes HKA averaged 179° (range 177–180). Clinical scores were typical for TKA patients with improvement in both KSS and ROM. In conclusion, early results using PSI in patients with pre-existing hardware in or about the joint, is safe, efficient, and accurate in performance of TKA

Introduction. Trabecular Titanium™ is a highly porous biomaterial with a regular hexagonal cell structure, which has shown excellent mechanical properties. Several in vitro studies reported promising data on its osteoinductive and osteoconductive properties. Furthermore, it has demonstrated in vivo to enhance bone in-growth. Aim of this multicentre prospective study was to assess Trabecular Titanium™ osseointegration by measuring change in bone mineral density (BMD) around a cementless DELTA-TT cup with dual-emission X-ray absorptiometry (DXA). Methods. 89 patients (91 hips) underwent primary THA with DELTA-TT cups (Lima Corporate) between 2009 and 2010. There were 46 (52%) men and 43 (48%) women, with a median (IQR) age of 67 (57–70) years and a median (IQR) BMI of 26 (24–29) kg/m. 2. Right side and left side were affected in 44 (48%) and 47 (52%) cases, respectively. Underlying pathology was primary osteoarthritis in 80 (88%) cases, osteonecrosis in 5 (6%), post-traumatic osteoarthritis in 3 (3%), developmental dysplasia of the hip in 2 (2%) and oligoarthritis in 1 (1%). BMD was determined by DXA using DeLee and Charnley 3 Regions of Interest (ROI) at 7 days, 3, 6, 12 and 24 months. Clinical evaluation (Harris Hip Score, HHS), patient health status survey (SF-36) and radiographic assessment were performed preoperatively and at the same time-points. Data were analyzed using non-parametric tests (Mann-Whitney, Wilcoxon signed-rank) and a p < 0.05 as threshold for statistical significance. Results. Excellent results were observed in terms of pain relief and functional recovery. Median (IQR) HHS improved from 48 (39–62) before surgery, to 99 (96–100) at 24 months, with a statistical significant increase of 96% (p < 0.05, Wilcoxon signed-rank). Median (IQR) SF-36 improved from 49 (37–62) preoperatively to 86 (79–92) at 24 months, with a statistical significant increase of 95% (p < 0.05, Wilcoxon signed-rank), indicating a considerable improvement in patients' quality of life. After an initial decrease of BMD values from baseline at 7 days (median [IQR] ROI I: 1.44 [1.21–1.67]; ROI II: 1.23 [0.99–1.49]; ROI III: 1.11 [0.85–1.48] g/cm. 2. ) to 6 months (ROI I: 1.27 [1.08–1.52]; ROI II: 1.14 [0.89–1.37]; ROI III: 1.05 [0.73–1.35] g/cm. 2. ), BMD slightly increased in ROI I, the most loaded area, and stabilized in ROI III. BMD in ROI II increased after 12 months and stabilized at 24 months (ROI I: 1.30 [1.11–1.55]; ROI II: 1.12 [0.96–1.36]; ROI III: 1.04 [0.80–1.25] g/cm. 2. ). Radiographic analysis showed evident signs of bone remodeling and osseointegration, with presence of supero-lateral and infero-medial bone buttress and of radial trabeculae perpendicular to the cup surface in ROI I/II. No radiolucent lines, loosening or osteolysis were observed. All cups were stable and no revision was carried out. Conclusion. BMD patterns and radiographic evaluation showed signs of an effective osseointegration around DELTA-TT cups at 24 months. Although clinical outcomes, functional recovery and stability are very satisfactory, longer follow-ups are necessary to assess survivorship

Injury to the sciatic nerve is one of the more serious complications of acetabular fracture and traumatic dislocation of the hip, both in the short and long term. We have reviewed prospectively patients, treated in our unit, for acetabular fractures who had concomitant injury to the sciatic nerve, with the aim of predicting the functional outcome after these injuries.

Of 136 patients who underwent stabilisation of acetabular fractures, there were 27 (19.9%) with neurological injury. At initial presentation, 13 patients had a complete foot-drop, ten had weakness of the foot and four had burning pain and altered sensation over the dorsum of the foot. Serial electromyography (EMG) studies were performed and the degree of functional recovery was monitored using the grading system of the Medical Research Council. In nine patients with a foot-drop, there was evidence of a proximal acetabular (sciatic) and a distal knee (neck of fibula) nerve lesion, the double-crush syndrome.

At the final follow-up, clinical examination and EMG studies showed full recovery in five of the ten patients with initial muscle weakness, and complete resolution in all four patients with sensory symptoms (burning pain and hyperaesthesia). There was improvement of functional capacity (motor and sensory) in two patients who presented initially with complete foot-drop. In the remaining 11 with foot-drop at presentation, including all nine with the double-crush lesion, there was no improvement in function at a mean follow-up of 4.3 years.