Aims. Limb-lengthening nails have largely replaced external fixation in limb-lengthening and reconstructive surgery. However, the adverse events and high prevalence of radiological changes recently noted with the STRYDE lengthening nail have raised concerns about the use of internal lengthening nails. The aim of this study was to compare the prevalence of radiological bone abnormalities between STRYDE, PRECICE, and FITBONE nails prior to nail removal. Methods. This was a retrospective case series from three centres. Patients were included if they had either of the three limb-lengthening nails (STYDE, PRECICE, or FITBONE) removed. Standard orthogonal radiographs immediately prior to nail removal were examined for bone abnormalities at the junction of the telescoping nail parts. Results. In total, 306 patients (168 male, 138 female) had 366 limb-lengthening nails removed. The mean time from nail insertion to radiological evaluation was 434 days (36 to 3,015). Overall, 77% of STRYDE nails (20/26) had bone abnormalities at the interface compared with only 2% of FITBONE (4/242) and 1% of PRECICE nails (1/98; p < 0.001). Focal osteolysis in conjunction with periosteal reaction at the telescoping interface was only observed in STRYDE nails. Conclusion. Bone abnormalities at the interface of telescoping nail parts were seen in the majority of STRYDE nails, but only very rarely with FITBONE or PRECICE nails. We conclude that the low prevalence of radiological changes at the junctional interface of 242 FITBONE and 98 PRECICE nails at the time of nail removal does not warrant clinical concerns. Cite this article: Bone Joint J 2021;103-B(11):1731–1735

Aims

Will Hydroxyapatite ceramic coated (HAC) arthroplasty perform well in patients under the age of fifty?

Introduction. The purpose of this study is to evaluate the radiological and clinical outcomes in Northern Ireland of free vascularised fibular bone grafting for the treatment of humeral bone loss secondary to osteomyelitis. Upper limb skeletal bone loss due to osteomyelitis is a devastating and challenging complication to manage for both surgeon and patient. Patients can be left with life altering disability and functional impairment. This limb threatening complication raises the question of salvage versus amputation and the associated risk and benefits of each. Free vascularised fibula grafting is a recognised treatment option for large skeletal defects in long bones but is not without significant risk. The benefit of vascularised over non-vascularised fibula grafts include preservation of blood supply lending itself to improved remodeling and osteointegration. Materials & Methods. Sixteen patients in Northern Ireland had free vascularised fibula grafting. Inclusion criteria included grafting to humeral defects secondary to osteomyelitis. Six patients were included in this study. Patients were contacted to complete DASH (Disabilities of the Arm, Shoulder and Hand) questionnaires as our primary outcome measure. Secondary outcome measures included radiological evaluation of osteointegration and associated operative complications. Complications were assessed via review of Electronic Care Record outpatient and in-patient documents

Introduction. Open tibial fractures (OTF) rank first among lower limb fractures in sub-Saharan Africa and bone infection remains the main challenge. The aim of this study was to identify the factors associated with chronic bone infection after OTF in a limited-resource setting. Methods. Patients aged 18 years and older, who underwent OTF treatment in a tertiary care hospital during the period from December 2015 to December 2020 were included in this retrospective study. Patients were contacted via phone calls and invited for a final clinical and radiological evaluation. Patients who met diagnostic criteria of chronic osteomyelitis were identified. Logistic regression was used to determine the predictive factors of OTF related chronic osteomyelitis. Results. With a mean follow-up period of 29.5±16.6 months, 33 patients out of 105 (31.4%) presented with chronic osteomyelitis. We found that time to first debridement within 6 hours (OR=0.18, 95% CI: 0.05 – 0.75, p=0.018) and severity of OTF according to Gustilo-Anderson classification (OR=2.06, 95% CI:1.34 – 3.16, p=0.001) were the independent predictive factors of chronic bone infection. Neither age, gender, socio-economic level, polytrauma, HIV status, diabetes mellitus, time to definitive surgery, were associated with chronic osteomyelitis. Conclusion. The rate of chronic bone infections after OTF is still high in the sub-Saharan African context. In addition to the overall improvement in the management of open leg fractures in those settings, emphasis should be placed on very early initial debridement to reduce the burden of these infections. Keys words. open tibial fractures, chronic bone infection, predictive factors

Myxofibrosarcoma (MFS) is the second most common subtype of soft tissue sarcoma (STS) and is associated with a high rate of local recurrence after resection. These tumours frequently present with peri-lesional edema, termed “tumour tails” on staging MRI scans [1]. Tumour tails(TT) may contain satellite neoplastic cells or can represent benign reactive edema. There are no clear radiological features to distinguish malignant from reactive peri-lesional edema which limits accurate surgical planning, resulting in either high rates of inadvertently positive resection margins and local recurrences or overly-aggressive resections which negatively impact function and increase morbidity [2]. The objective of this pilot study was to prospectively study a cohort of MFS patients with TTs in an attempt to identify radiological features that predict which type of edema is malignant and requires resection together with the main tumour mass. Patients diagnosed with MFS on biopsy at an orthopaedic oncology referral centre between January 1-December 31 2018 who also had TTs on staging MRI scans were prospectively recruited for the study. Tumours were treated with wide surgical excision, including the TTs, and (neo)adjuvant radiotherapy as per institutional protocol. Staging MRI scans were reviewed in a blinded fashion by two musculoskeletal radiologists to distinguish malignant from reactive TTs. The main tumour mass underwent standard histological evaluation while the regions encompassing the TTs were photographed and sectioned into grids. Each tissue section was examined histologically for the presence of satellite neoplastic cells based on morphological criteria. Radiological and histological findings were compared. Six patients met the inclusion criteria and underwent analysis. All tumours were located in the extremities and were deep to fascia. Mean age at presentation was 67 years (range 51 – 85), with a male:female ratio of 4:2. All patients received radiotherapy (50 Gy), either pre- (n=4) or post-operatively (n=2) based on multidisciplinary tumor board discussion or enrolment in a prospective clinical trial. Radiologically, TTs were labelled as malignant in four patients (66.7%) and as benign TTs in two others. The tails were recognised to be malignant due to the differing signal characteristics to reactive edema on mixed MRI sequences. The radiological evaluation correlated exactly with histological analysis, as satellite neoplastic cells were identified microscopically in the same four cases in which the TTs were designated to be malignant by MRI (specificity&sensitivity=100%). Surgical resection margins were microscopically positive in 50% of cases in the TTs themselves, and 75% of cases in which TTs were designated as malignant on staging MRI. “The malignant nature of peri-lesional edema in MFS, also known as the TT, was accurately predicted in this small pilot study based on specific radiological features which correlated exactly with histologic identification of isolated tumor cells. These findings validate development of a larger prospective study to recruit additional patients with tumor tails beyond just MFS, in order to more robustly study the correlation between the MRI appearance and histological distribution of satellite sarcoma cells in peri-lesional edema in STS. We are already recruiting to this expanded radiological-histological investigation including evaluation of additional novel MRI sequences

Aim. We evaluated the efficacy and safety of treatment regimens in a pathogen and surgery specific mode according to a standardized algorithm for the treatment of periprosthetic joint infection (PJI) based on combinations with 15g/d intravenous fosfomycin followed by oral antibiotics for totally 12 weeks. Method. Consecutive patients with PJI caused by at least one of the following isolates were prospectively included: staphylococci (MIC ≤32 mg/l), streptococci (MIC ≤128 mg/l), enterococci (MIC ≤128 mg/l), Enterobacteriaceae (MIC ≤32 mg/l) and Pseudomonas spp. (MIC ≤128 mg/l). PJI was defined by the proposed European Bone and Joint Infection Society (EBJIS) criteria. Follow up with clinical (joint function and quality of life scores), laboratory and radiological evaluation at 3, 12 and 24 months after last surgery is performed. Infection outcome was assessed as the proportion of infection-free patients. The probability of infection-free survival was estimated using the Kaplan-Meier survival method. Results. 50 patients were screened for eligibility, of which 2 were excluded due to intolerance or allergy to fosfomycin, 1 due to isolation of fosfomycin resistant pathogen and 2 patients died due to unrelated cause to infection. The remaining 45 patients were included. Due to persistence of infection, 3 patients underwent prosthesis explantation after initial debridement and retention, 1 patient underwent debridement of Girdlestone-situation; all 4 infections were caused by S. aureus. At 2 patients debridement of hematoma after Girdlestone approach was performed. 41 patients were infection-free (91%) after a median follow-up of 6 month (range, 1 – 14 months). Nausea (n=14) and hypokalemia (n=13) were the most frequent adverse events and resolved after fosfomycin discontinuation; 5 patients had diarrhea and vomiting was observed in 2 patients. Isolated pathogens were staphylococci (n=30), streptococci (n=3), enterococci (n=5) and gram-negative rods (n=2). Cultures were negative in 9 patients and polymicrobial in 2 patients. The infection occurred postoperatively in 31 patients (69%) and hematogenously in 14 (31%). Two-stage exchange was performed in 27 (60%), debridement with retention in 13 (29%) and one-stage exchange in 5 patients (11%). Conclusions. The applied PJI treatment algorithm including intravenous fosfomycin in the initial postoperative period was associated with infection-free outcome of 91% after a median follow-up of 6 month. The Kaplan-Meier survival method showed the probability of infection-free survival of 88.5% after 1 year. Adverse events occurred in 21 patients (46%) mostly nausea and hypokalemia were reported. Adverse events were mild and resolved completely

Purpose. Minimally invasive anterolateral approach (ALA) for total hip arthroplasty (THA) has gained popularity in recent years as better postoperative functional recovery and lower risk of postoperative dislocation are claimed. However, difficulties for femur exposure and intraoperative complications during femoral canal preparation and component placement have been reported. This study analyzes the anatomical factors likely to be related with intraoperative complications and the difficulties of access noted by the surgeons through a modified minimally invasive ALA. The aim is to define the profile for patient at risk of intraoperative complications during minimally invasive ALA. Methods. We retrospectively included 310 consecutive patients (100 males, 210 females) who had primary unilateral THA using the same technique in all cases. The approach was performed between the tensor fascia lata and the gluteus medius and minimus, without incising or detaching muscles and tendons. Posterior translation was combined to external rotation for proximal femur exposure (Fig. 1). All patients were reviewed clinically and radiologically. For the radiological evaluation, all patients underwent pre- and postoperative standing and sitting full-body EOS acquisitions. Pelvic [Sacral slope, Pelvic incidence (PI), Anterior pelvic plane angle] and femoral parameters were measured preoperatively. We assessed all intraoperative and postoperative complications for femoral preparation and implantation. Intraoperative complications included the femoral fractures and difficulties for femoral exposure (limitations for exposure and lateralization of the proximal femur). The patients were divided into two groups: patients with or without intraoperative complications. Results. Ten patients (3.2%) had intraoperative femoral fractures (greater trochanter: 2 cases, calcar: 8 cases). Five fractures required additional wiring. Difficult access to proximal femur was reported in the operative records for 10 other patients (3.2%). There was no difference in diagnosis, age, sex, BMI between the patients with or without intraoperative complications. No significant group differences were found for surgical time, and blood loss. Patients with intraoperative complication, presented a significantly lower pelvic incidence than patients without intraoperative complications (mean PI: 39.4° vs 56.9°, p<0.001). The relative risk of intraoperative complications in patients with low PI (PI<45°) was more than thirteen times (relative risk; 13.3, 95% CI= 8.2 to 21.5. p<0.001) the risk for patients with normal and high PI (PI>45°). Conclusions. Anterolateral approach for THA implantation in lateral decubitus is reported to have anatomical and functional advantages. Nevertheless, the exposure of the femur remains a limitation. This study highlights a significant increased risk in case of low PI less than 45°. This specific anatomical pattern reduces the local working space as the possibility for posterior translation and elevation of the proximal femur is less on a narrow pelvis. This limitation is due to the length and the orientation of the hip abductor and short external rotator muscles related to the relative positions of iliac wing and greater trochanter (Fig. 2). This study points out the importance of pelvic incidence for the detection of anatomically less favourable patients for THA implantation using ALA. For any figures or tables, please contact the authors directly

Introduction. Limb-length discrepancy (LLD) is a common postoperative complication after total hip arthroplasty (THA). This study focuses on the correlation between patients’ perception of LLD after THA and the anatomical and functional leg length, pelvic and knee alignments and foot height. Previous publications have explored this topic in patients without significant spinal pathology or previous spine or lower extremity surgery. The objective of this work is to verify if the results are the same in case of stiff or fused spine. Methods. 170 patients with stiff spine (less than 10° L1-S1 lordosis variation between standing and sitting) were evaluated minimum 1 year after unilateral primary THA implantation using EOS® images in standing position (46/170 had previous lumbar fusion). We excluded cases with previous lower limbs surgery or frontal and sagittal spinal imbalance. 3D measures were performed to evaluate femoral and tibial length, femoral offset, pelvic obliquity, hip-knee-ankle angle (HKA), knee flexion/hyperextension angle, tibial and femoral rotation. Axial pelvic rotation was measured as the angle between the line through the centers of the hips and the EOS x-ray beam source. The distance between middle of the tibial plafond and the ground was used to investigate the height of the foot. For data with normal distribution, paired Student's t-test and independent sample t-test were used for analysis. Univariate logistic regression was used to determine the correlation between the perception of limb length discrepancy and different variables. Multiple logistic regression was used to investigate the correlation between the patient perception of LLD and variables found significant in the univariate analysis. Significance level was set at 0.05. Results. Anatomical femoral length correlated with patients’ perception of LLD but other variables were significant (the height of the foot, sagittal and frontal knee alignment, pelvic obliquity and pelvic rotation more than 10°). Interestingly some factors induced an unexpected perception of LLD despite a non-significant femoral length discrepancy less than 1cm (pelvic rotation and obliquity, height of the foot). Conclusions. LLD is a multifactorial problem. This study showed that the anatomical femoral length as the factor that can be modified with THA technique or choice of prosthesis is not the only important factor. A comprehensive clinical and radiological evaluation is necessary preoperatively to investigate spinal stiffness, pelvic obliquity and rotation, sagittal and coronal knee alignment and foot deformity in these patients. Our study has limitations as we do not have preoperative EOS measurements for all patients. We cannot assess changes in leg length as a result of THA. We also did not investigate the degree of any foot deformities as flat foot deformity may potentially affect the patients perception of the leg length. Instead, we measured the distance between the medial malleolus and ground that can reflect the foot arch height. More cases must be included to evaluate the potential influence of pelvis anatomy and functional orientation (pelvic incidence, sacral slope and pelvic tilt) but this study points out that spinal stiffness significantly decreases the LLD tolerance previously reported in patients without degenerative stiffness or fusion

Introduction. In our institution, we started to perform THA with SuperPATH approach, including preservation of soft tissue around the hip (James Chow et al. Musculoskelet Med 2011) since July 2014, aiming for fast recovery and prevention of hip dislocation. For minimally-invasive approaches, however, there have been a few reports on malalignment of the implants related to shortage of operative field. The purpose of this study is to examine the short-term results of THA using SuperPATH, especially implant alignment. Materials and methods. We performed a study of 45 patients (45 hips) with osteoarthritis of the hip joint who had a THA with SuperPATH approach. There were 8 men and 37 women with an average age of 73 years, which were minimally 24 months followed. Dynasty Bioform cup and Profemur Z stem (Microport Orthopaedics) were used for all cases. Patients were clinically assessed with Merle d'Aubigne score and complications. Implant alignment and stability were radiologically evaluated by annual X-ray and CT acquired two months after surgery. Results. Merle d'Aubigne score was 10.2 (pain:2.8, mobility:4.4 walking ability:3.0) preoperatively and 16.6(pain:5.8, mobility:5.8, walking ability:5.0) at the latest follow-up. There were no dislocation and infection, but intraoperative proximal femoral fracture was found for two cases, which was managed to treat with additional circulating wire intraoperatively. Latest follow-up X-ray image showed 95% of the stem A-P alignment to be within 2 degrees and 5% to be more than 2 degrees and less than 5 degrees, while 44% of the stem lateral alignment to be within 2 degrees, 47% to be more than 2 degrees and less than 5 degrees, and 8% to be more than 5 degrees. From CT images averaged cup position found to be 40±5 degrees for inclination, and 19±5 degrees for anatomic anteversion, averaged stem anteversion to be 33±9 degrees. Annual X-ray evaluation showed no radiolucent line and less than Grade 2 stress-shielding (Engh classification) around the implants for all cases. One case had more than 5mm subsidence of the stem in early postoperative period, but not progressively subsided. No loosening of components was evident. Discussion and Conclusion. Many minimally-invasive approaches have developed, there have been many reports on fast recovery and low incidence of postoperative hip dislocation, however, the risk of complications or malalignment related to shortage of operative field has been pointed out. In this study, intraoperative proximal femoral fracture occurred for two cases. Also, though there were no loosening and the components position seemed excellent but lateral view of the X-ray showed 8% to be more than 5 degrees tilting alignment, resulting from femoral broaching required before femoral neck resection. SuperPATH approach, including pass way from between the Gluteus Medius and the piriformis tendon, can preserve the whole short external rotators and capsule of the hip joint, leading to fast recovery and low incidence of postoperative dislocation. Moreover, this approach may be friendly to the surgeons familiar with the posterior approach because of easily conversion to the conventional posterior approach

Object. Although single-radius designs have theoretical advantages in some aspects, there has been a paucity of evaluation studies. The purpose of this study was to compare 10-year clinical, radiological, survivorship outcomes of single radius and multi radius posterior stabilized prosthesis in total knee arthroplasty(TKA) with Rheumatoid Arthritis (RA). Method. In this retrospective observational study, we reviewed 240 patients (240 knees) with RA who underwent TKA between Oct 2005 and Dec 2007: SR group (120 patients, 120 knees, Stryker Scorpio NRG) and MR group (120 patients, 120 knees, Depuy sigma RP). A 1 : 1 matched case control study was conducted in two groups which were similar in terms of age, gender, BMI, ASA classification and operation team. Mean follow-up periods were 10.73±1.13 (range: 8–13) years and 10.82±1.09 (range: 7–13) years. Results. In SR group, the mean HSS score improved significantly from 38.63±8.76 to 87.67±6.62, the mean VAS score decreased significantly from 7.37±0.24 to 0.45±0.12. the mean range of motion improved significantly from 105.52°±7.78°to 124.32°±8.12° (p<0.001). In MR group, the mean HSS score improved significantly from 38.75±8.34 to 89.29±5.21, the mean VAS score decreased significantly from 7.62±0.26 to 0.33±0.10. the mean range of motion improved significantly from 104.18°±7.62° to 122.52°±8.03°(p<0.001). (See Figure 1) Clinical and functional improvements had no significant differences between the two groups. 6 complications were noted in SR group, including 2 cases of prosthetic loosening, 1 case of periprosthetic osteolysis, 3 cases of periprosthetic bright lines.6 complications were noted in MR group, including 2 cases of prosthetic loosening and 4 cases of periprosthetic bright lines. No case of infection was observed in two groups. Survivorship using Kaplan-Meier survival analysis was 97.5% (95% confidence interval [CI]: 96.8–98.3%) for the SR at 10 years and 98.3% (95% CI: 97.3–99.5%) for the MR group at 10 years, with no significant difference (p=0.755). (See Figure 2). Conclusion. This study suggested that both single-radius and multi-radius posterior stabilized prostheses can lead to satisfactory outcomes for clinical function, radiological evaluation and survivorship among RA patients undergoing TKA, and no significantly clinical differences was shown in two types of prostheses

Objective. We performed total knee arthroplasty (TKA) without patella resurfacing in patients with osteoarthritis (OA) of the knee. The purpose of the present study was to evaluate the clinical results and the appropriateness TKA without patella resurfacing. Methods. A total of 61 patients (61 affected knees) who had undergone a Low Contact Stress mobile − bearing knee arthroplasty (LCS− TKA) (Depuy, Warsaw, IN. USA) 10 years or more before the present study were enrolled. The LCS− TKAs did not include patella resurfacing. The patients' mean age was 77.7 ± 6.1 years (range: 59−94 years). The mean follow-up period was 121 ± 2.4 months (range: 120−129 months). The clinical evaluation used the scoring system for OA of the knees issued by the Japanese Orthopaedic Association (JOA score). We defined patellofemoral (PF) pain, crepitation, patellar clunk syndrome, spin-out, and reoperation as complications. We also used X-Ray imaging to measure the component angle, patella height, lateral shift ratio, tilting angle, femorotibial angle, posterior condylar offset and joint line, and evaluated the localization of sclerotic changes in the patella. All of the LCS− TKAs were performed by one surgeon using the midvastus approach. During the operation, the osteophyte around the patella was resected, and the osteophyte on the articular surface was shaped using a bone saw. For statistical analysis we performed Mann-Whitney's U test and adopted a significance level of P<5%. Results. The average JOA score improved significantly from 46.2 ± 10.4 before the LCS− TKA to 82.6 ± 6.1 after the LCS− TKAs (P = 0.0002). No cases of patellar clunk syndrome or spin-out. occurred. Revision surgery was performed for two cases, one involved an infection, and the other involved a patella fracture. Postoperative PF pain was found in 6 patients (6 affected knees) at the final evaluation. However, in these patients, the pain was less severe than it had been preoperatively, and revision surgery for PF pain was needed or performed. The postoperative radiological evaluation was favorable on the whole. The localization of sclerotic changes in the patella on X-ray were in 32 cases around tip of the patella, on the other no remarkable change were in 29 cases. Conclusion. The clinical and radiological evaluations of the patella non−resurfacing mobile bearing total knee arthroplasty was favorable overall. Treatment of the patella in total knee arthroplasty remains controversial. We suggest that the patella in LCS−TKAs does not always need to be resurfaced

Introduction. Many minimally-invasive approaches have been described in an effort to improve short-term results of total hip arthroplasty (THA), aiming for fast recovery and prevention of dislocation. In our institution, we started to perform THA with SuperPATH approach, including preservation of soft tissue around the hip (James Chow et al. Musculoskelet Med 2011) since July 2014. The purpose of this study is to examine the short-term results of THA using SuperPATH, especially treatment progress of rehabilitation. Materials and methods. We performed a study of 30 patients (30 hips) with osteoarthritis of the hip joint who had a THA with SuperPATH approach. There were 4 men and 26 women with an average age of 71 years, which were followed up for 24 months. Patients were clinically assessed with Merle d'Aubigne score, postoperative hip pain during walking by Numerical Rating Scale (NRS:0–10), complications and treatment progress of rehabilitation in regard to moving and activities of daily living. Implant alignment and stability were radiologically evaluated by annual X-ray and CT acquired two months after surgery. Results. Merle d'Aubigne score was 10.4 (pain:2.9, mobility:4.5 walking ability:3.0) preoperatively and 16.8(pain:5.9, mobility:5.9, walking ability:5.0) at the latest follow-up. NRS showed less than 3 points for more than 50% of the THA patients next day postoperatively. For more than 80%, NRS showed less than 1 point at 7 days after surgery, and most patients acquired the ability of level ground walking for 100 meters independently by 4 days postoperatively, climbing up and down stairs independently by 5 days and wearing/taking off their socks independently by 7 days. There were no dislocation and infection, but intraoperative proximal femoral fracture was found for two cases, which was managed to treat with additional circulating wire intraoperatively. From CT images averaged cup position found to be 39±5 degrees for inclination, and 21±6 degrees for anatomic anteversion, averaged stem anteversion to be 33±9 degrees. No loosening of components was evident. Discussion and Conclusion. Many minimally-invasive approaches have developed, there have been many reports on fast recovery and low incidence of postoperative hip dislocation, however, the risk of complications related to shortage of operative field has been pointed out. In this study, intraoperative proximal femoral fracture occurred for two cases, but the components position seemed excellent and NRS showed less pain postoperatively and most of the patients acquired walking ability in a few days. SuperPATH approach, including pass way from between the Gluteus Medius and the piriformis tendon, can preserve the whole short external rotators and capsule of the hip joint, leading to fast rehabilitation progress. Moreover, this approach may be friendly to the surgeons familiar with the posterior approach because of easily conversion to the conventional posterior approach

Purpose. The purpose of this study is to compare the mid-term outcomes between rotating platform(RP) and posterior cruciate substitute(PS) bearings in LCS-total knee arthroplasty (TKA). Methods. This is a prospective randomized matched-pairs case–control study of patients who underwent primary TKAs with a minimum 2 years follow-up. The inclusion criteria was degenerative arthritis, and exclusion criteria was arthritis other than degeneration, previous operations such as osteotomy, body mass index (BMI) over 30 kg/m. 2. The matching criteria were set as age, BMI, preoperative ROM, gender, and the Knee Society (KS) and Hospital for Special Surgery (HSS) scores. After 1:1 matching, 50 cases involved the LCS RP bearing system as group 1 and 50 cases involved LCS PS bearing system group as group 2. Clinical and radiographic outcomes were evaluated. Results. The overall survival was 100% at final follow up. There were no complications between groups, such as infection, dislocation of bearing. The postoperative ROM was 122.3° ± 9.3 in group 1, 121.2° ± 9.7 in group 2. The KSKS scores were 93.5±7.2 in group 1, 92.8±3.6 in group 2 at final follow up. The KSFS scores were 87.5±7.7 in group 1, 86.9±6.8 in group 2 at final follow up. The HSS scores were 93.1±8.8 in group 1, 91.7±6.1 in group 2 at final follow up. There was no statistical difference in Hospital for Special Surgery Scores (HSS), Knee Society Scores (KSS) score evaluations between groups. However, the improvement of KSS and HSS scores was faster in group 1, the final scores were achieved at 3 to 6 months in group 1, at 6 to 1 year in group 2. Moreover, the KSFS scores were improved continuously until 2 years follow up. The postoperative mechanical axis was found as 1.2° ± 1.2 in group 1, 0.9° ± 0.9 in group 2. There were no statistical differences between groups in radiological evaluations including radiolucent lines. Conclusion. This study demonstrated that the PS-LCS prosthesis could provide satisfactory performance compared with that of the RP-LCS prosthesis with minimum 2-year follow-up, however, there could be disadvantages in PS-LCS prosthesis due to more bone loss in box cut in femur

INTRODUCTION. Total knee arthroplasty (TKA) is considered a highly successful procedure. Survival rates of more than 90% after 10 years are generally reported. However, complications and revisions may still occur for many reasons, and some of them may be related to the operative technique. Computer assistance has been suggested to improve the accuracy of implantation of a TKA (Jenny 2005). Short term results are still controversial (Roberts 2015). However, few long term results have been documented (Song 2016). The present study was designed to evaluate the long-term (more than 10 years) results of a TKA which was routinely implanted with help of a non-image based navigation system. The 5- to 8-year of this specific TKA has already been documented (Jenny 2013). The hypothesis of this study will be that the 10 year survival rate of this TKA will be improved in comparison to historical papers when analyzing survival rates and knee function as evaluated by the Knee Society Score (KSS). MATERIAL AND METHODS. All patients operated on between 2001 and 2004 for implantation of a navigated TKA were eligible for this study. Usual demographic and peri-operative items have been record. All patients were prospectively followed with clinical and radiological examination. All patients were contacted after the 10 year follow-up for repeat clinical and radiological examination (KSS, Oxford knee questionnaire and knee plain X-rays). Patients who did not return were interviewed by phone call. For patients lost of follow-up, family or general practitioner was contacted to obtain relevant information about prosthesis survival. Survival curve was plotted according to Kaplan-Meier. RESULTS. 247 TKAs were implanted during the study time-frame. 225 cases had an optimal lower limb axis (HKA angle between 177° and 183°) after TKA (91%). Final follow-up (including death or revision) was obtained for 200 cases (81%). Clinical status after 10 years was obtained for 146 cases (59%) (KSS, 102 cases – Oxford questionnaire, 146 cases – radiologic evaluation, 94 cases). 4 prosthetic revisions were performed for mechanical reasons during the follow-up time (1%). The 10 year survival rate was 98%. The mean KSS was 188 points. The mean Oxford score was 55 points. No component was considered loose at the final radiographic evaluation. No polyethylene wear was detected at the final radiographic evaluation. DISCUSSION. This study confirms our initial hypothesis, namely quite satisfactory results of navigated implanted TKA after more than 10 years. Navigation, whose precision is no longer to be demonstrated, probably contributed to the quality of the results. A more consistent anatomical reconstruction and ligamentous balance of the knee should lead to more consistent survival of the TKA. Other authors did observe similar results (Baumbach 2016). However, superiority of navigated TKA in comparison to conventional implanted TKA is difficult to prove because of the subtle differences expected in mostly underpowered studies. Longer term follow-up may be required

Purpose. To compare and analyze the long term follow up clinical & radiological result after utilization of fixed-type & rotating-type implant for high flex both total knee replacement. Subject & Method. This paper targeted 45 patients, 90 cases that got high flex both total knee replacement with utilization of fixed-type implant(LPS-flex. ®). & rotating-type implant(P.F.C. ®. Sigma RP-F) for 1 patient by 1 operator(C.C.H) in our hospital from 2005.01 to 2006.11. Preoperative diagnoses were degenerative arthritis (43 patients, 86 cases), rheumatic arthritis (2 patients, 4 cases), mean age at the operation was 66.4 years old(54∼78), 3 men, 42 women, mean follow up period was 110.8months(97∼120). We compared and estimated Hospital for Special Surgery(HSS) score and Knee Society Score(KSS), Western Ontario and MacMaster Universities Osteoarthritis(WOMAC) score and mean range of motion of knee joint at pre-operation and last follow up for functional & clinical evaluation. And we compared and estimated change of femorotibial angle and radiolucency through erect AP & lateral x-ray at pre-, post-operation and last follow up using American Knee Society Roentgen Graphic Evaluation for radiological evaluation. Result. On the result of clinical and functional evaluation, it showed improving outcome in both group(fixed-type implant, rotating-type implant), and there was no statistically significant difference. Mean HSS score was increased from 43.0, 37.1(pre-operation) to 93.2, 92.1(last follow-up), mean KSS score was increased from 37.1, 37.2(pre-operation) to 88.8, 87.6(last follow-up), WOMAC score was also increased from 104.8, 104.4(pre-operation) to 126.1, 128.4(last follow-up). Mean joint range of motion was increased from 104.8, 104.4(pre-operation) to 126.1, 128.4(last follow-up), but there was no significant difference between 2 groups. The change of femorotibial angle was corrected from average introversion 8.2°(pre-operation) to extroversion 4.8°(post-operation) in fixed-type implant group, and average introversion 8.3°(pre-operation) to extroversion 4.8°(post-operation) in rotating-type implant group, and there was no significant difference between 2 groups. And in all cases, there was no change of radiolucency, loosening of implant, or osteolysis at the last follow-up. Conclusion. It showed good functional, clinical and radiological result on long term follow-up in both groups that got both total knee replacement with utilization of fixed-type implant and rotating-type implant for 1 patient, and there was no statistically significant difference between 2 groups. As a result, it is considered that the selection of implant will be up to the condition of patient and experience of operator and so on

Introduction. Total knee arthroplasty (TKA) is the second most common and successful joint replacement in orthopedics. Due to long-term results the problem of aseptic loosening, implant failure and hypersensitivity to metal ions remain. Therefore the introduction of a new TKA with ceramic tibial and femoral components is introduced. Methods. It is the aim of this prospective study to compare a full delta ceramic unconstrained TKA with its conventional counterpart (Brehm BPK-S). Each group includes 40 patients without demopgraphic differenve. All TKAs are cemented with the same surgical technique using a rotating polyethylene insert. Clinical and radiological evaluation were performed preoperatively, and 3, 12 and 24 months postoperatively using the oxford knee score, the KSS, the VAS and the EQ-5d. Results. The mean prroperative knee scores improved significantly in both groups without difference. The VAS increased from 53,4 points to 73,9 in the ceramic group and from 53,8 to 81,0 in the conventional (n.s. p=0,14) and the EQ-5d. The oxford knee score increased from 38,6 points to 21,9 in the ceramic group and from 37,6 to 20,0 in the conventional (n.s.). There were no radiolucent lines for the femur or tibia, no infections and no revisions or implant associated complications with a 12 month survival rate of 100%. Discussion. The observed clinical and radiological results are promising for the future of cermic tibial and femoral components in TKA. The ceramic components can be a solution for patients with metal ion hypersensitivity, because this is the first TKA completely metal free. Long-term results will show a possible superority of ceramic implants concerning wear, loosening and survivorship. Based on this it might also be a reliable alternative for osteoarthiritic knee joints

Aims

This study aims to enhance understanding of clinical and radiological consequences and involved mechanisms that led to corrosion of the Precice Stryde (Stryde) intramedullary lengthening nail in the post market surveillance era of the device. Between 2018 and 2021 more than 2,000 Stryde nails have been implanted worldwide. However, the outcome of treatment with the Stryde system is insufficiently reported.

Purpose. The purpose of this study was to examine the progression of osteoarthritis (OA) on patella-femoral joint (PFJ) after open wedge high tibial osteotomy (OWHTO) and unicondylar knee arthroplasty (UKA) in correlation with pain and functional outcomes. Methods. We conducted a retrospective analysis of 101 knees (89 patients), which received an OWHTO in 42 knees and UKA in 59 knees between 2003 and 2008 with minimum 5-years follow-up. Preoperative and the last follow-up radiologic evaluations were performed on the specific radiographic parameters that reflect the patella and knee alignment. Progressions of OA on PFJ at pre-operation and the last follow up were assessed and compared with modified OA grading system. The patella-femoral (PF) pain and function score were recorded using modified PF scoring system at the last follow up. Results. Among the radiologic parameters, mechanical axis (MA) and lateral patella tilt (LPT) showed statistically significant differences between OWHTO and UKA. Most of cases showed no progression or just only 1 grade step-up progression on PFJ in both groups and the amount of progression showed no statistical significant between OWHTO and UKA. In comparison of the preoperative and the final follow-up OA grades, medial PFJ in UKA group showed statistically significant differences. The PF pain and function score were comparable in both groups at the final follow up which showed no statistical differences regardless of OA progression. Conclusions. Overall, 40 ∼ 70% of cases did not occurred the progression of OA in PFJ after OWHTO and UKA. Additionally, at last follow up, the most cases showed the grade 0 or 1 OA in PFJ of both groups. Compared with HTO group, in UKA group, there were tendency of more progression of PFJ compared with preoperative OA status. Finally the degree of OA progressions did not affect the PF pain and functional outcomes

BACKGROUND CONTEXT. Ceramic bearings are widely used in total hip arthroplasty (THR) along with metal and polyethylene bearings. There were several studies in past few years evaluating the advantage of one over the other. The young population with high activity levels has an increased risk of wear debris production at bearing surface and subsequent implant failure. Recently, interest and use of a ceramics with high wear resistance has been growing. Early reports on ceramic on ceramic THR have demonstrated excellent clinical and radiological results. PURPOSE. To evaluate clinical, functional and radiological outcomes of cement-less ceramic on ceramic primary total Hip Replacement (THR) in young patients (<50 years age) with diagnosis of avascular necrosis femoral head. STUDY DESIGN. Single - centre, prospective comparative study of prospectively collected outcomes, with a minimum of 12 month follow-up. PATIENT SAMPLE. 30 patients who underwent cement-less ceramic on ceramic primary THR in young patients (< 50 years age) for avascular necrosis of femoral head. OUTCOME MEASURES. For clinical evaluation, Harris hip scores was measured pre-operatively and post-operatively at predefined intervals. For radiological evaluation, Post- operative radiographs were checked for alignment of femoral stem, loosening of stem, presence of heterotopic ossification, loosening of acetabular component at predefined regular intervals. METHOD. This study included 30 patients, who underwent cement-less ceramic on ceramic primary THR in young patients (< 50 years age) for avascular necrosis of femoral head between July 2013 to April 2015 with a minimum of 12 month follow –up. RESULTS. The mean Harris hip score in our study increased from 32.73 pre-operatively to 87.8 post-operatively at the latest follow up with 90% hips having good to excellent results. This improvement was statistically significant (p<0.005). On evaluation of alignment of femoral stem 27 stems were central (90%) and 3 stems found to be in valgus (10%) and none to be in varus position. There was no significant correlation between stem alignment and clinical outcome based on Harris hip score. Not a single case of focal osteolysis, stem loosening or heterotopic ossification was seen in our study till latest follow-up. None of the major complication was noticed during evaluation of our cases except minor chronic hip pain in one patient which did not restricted his daily living activities. CONCLUSION. In our study, we found better results of ceramic on ceramic THR for younger patients(<50 years age) comparable to previous studies with no serious complication found in any patient. Based on our study, we recommend ceramic on ceramic THR for younger patients in the age group of less than 50 years of age. We need a study of large sample size with long term follow up to further confirm the findings of our study

Purpose. Proximal femoral osteotomy is an attractive joint preservation procedure for osteonecrosis of the femoral head. The purpose of this study was to investigate the cause of failure of proximal femoral osteotomy in patients with osteonecrosis of the femoral head. Patients and Methods. Between 2008 and 2014, proximal femoral osteotomy was performed by one surgeon in 13 symptomatic hips. Ten trans-trochanteric rotational osteotomies (anterior: 7, posterior: 3) and 3 intertrochanteric curved varus osteotomy were performed. Of the patients, 9 were male and 1 was female, with a mean age at surgery of 36.9 years (range, 25–55 years). The mean postoperative follow-up period was 38 months (range, 12–72 months). Three patients (4 hips) had steroid-induced osteonecrosis, and 7 (9 hips) had alcohol-associated osteonecrosis. At 6 postoperative weeks, partial weight bearing was permitted with the assistance of 2 crutches. At more than 6 postoperative months, full weight bearing was permitted. Patients who had the potential to achieve acetabular coverage of more than one-third of the intact articular surface on preoperative hip radiography, computed tomography, and magnetic resonance imaging were considered suitable for this operation. A clinical evaluation using the Japanese Orthopaedic Association (JOA) scoring system and a radiologic evaluation were performed. Clinical failure was defined as conversion to total hip arthroplasty (THA) or progression to head collapse and osteoarthritis. The 13 hips were divided into two groups, namely the failure and success groups. Results. The mean preoperative JOA score was 59 points. The score in the success group (7 hips) improved to 89 points at the time of final follow-up. In the failure group (6 hips), 5 hips were converted to THA because of progression to secondary collapse or osteoarthritis in a mean postoperative period of 35 months (range, 24–51 months). After converting to THA, good clinical and radiographic results were achieved, except in 1 patient who had incomprehensible severe pain around the affected hip. Advanced osteoarthritis was observed in 1 hip awaiting THA. Various factors cause failure of proximal femoral osteotomy, such as difficulty in controlling the underlying disease with less than 10 mg of steroid (Fig. 1), overuse of the affected hip within 6 postoperative months without the physician's consent, vascular occlusion after total necrosis of the femoral head as a result of damage to the nutritional vessel during or after the operation, and incorrect judgement of the indication of the operation and the extent of the intact load-bearing area. Conclusion. We think that full weight bearing should be permitted postoperatively only after more than 6 months, and heavy work and sport, only after more than 1 year. Efforts should be made to improve surgeons' skill in proximal femoral osteotomy and accurate judgement of imaging data. For steroid-induced osteonecrosis of the femoral head, proximal femoral osteotomy is an acceptable procedure for relieving pain if the underlying disease can be controlled with not more than 5 mg of steroid