Periprosthetic fractures are rare complications (0.3%–2.5%) of total knee and hip Arthroplasty. Purpose of this study is to present our experience and the mid-term clinical results of periprosthetic fracture care.

Between 2005 and 2009 nineteen femoral periprosthetic fractures were treated in our department. Seven patients with TKA had supracondylar fractures, type II according to Lewis and Rorabec classification. Twelve patients with THR had type B2 fractures according to Vacouver Classification. Seven patients were men and 12 women with average age 78.15 years. Femoral shaft fractures were treated with ORIF and DCP 4.5mm femoral plate in 8 cases, revision THR in 3 cases and 4.5mm plate with wires in one case. Supracondylar fractures were treated with ORIF abd LCP plate 4.5mm in 5 cases, Ilizarov fixator in one case and DCS plate in the last case. The average follow up was 22 months postoperatively.

Fracture healing observed in 16 patients at an average of 6 months postoperatively. No infection or non union complicated our treatment goal. Three patients died at an average of 2 months postoperatively. One should point out that mobilization and return to previous activity level is very difficult for these patients, despite fracture healing. Best clinical results observed with DCP and LCP 4.5mm plates.

Periprosthetic fractures are serious and complex complications of an arthroplasty that require stable osteosynthesis and primary patient mobilization.

Background: The clinical significance of bone turnover markers is well recognized, at least in several diseases affecting the bone metabolism. However, their clinical significance (if any) remains still unknown in patients undergoing Total Joint Arthroplasty (TJA). Changes in the levels of some markers have been reported in the early postoperative period after Total Hip Arthroplasty; however their exact postoperative course has not been clearly documented yet. In order to assess the clinical value of biochemical markers when trying to determine the fixation of orthopaedic implants, it is necessary to clarify their normal postoperative course.

The aim of this study was to extend the evaluation of the course of bone turnover markers over a longer period (12 postoperative months) following a TJA, and to assess the postoperative course for two of them (RANKL and Osteoprotegerin) for the first time.

Methods: The serum levels of RANKL, Osteocalcin, Osteoprotegerin and bALP were determined one day preoperatively and several times during the first postoperative year in patients suffering from idiopathic osteoarthritis that underwent total knee (n=23) and hip arthroplasties (n=24).

Results: There were statistically significant changes in the serum levels of all markers over time (p< 0,001). RANKL values initially increased and then gradually decreased. Following an initial decrease, Osteocalcin values continuously increased until the 2nd postoperative month and then continuously decreased. Osteoprotegerin initially increased, then decreased until the 4th postoperative month and then increased again reaching a peak 8 months postoperatively. Bone-specific ALP decreased until the 7th postoperative day. After that time it continuously increased, reaching a peak at the 8th month, and then it gradually decreased. There were no major differences in the postoperative course of all markers between the hip and knee arthroplasties.

Conclusions: The levels of all bone markers did not uniformly ‘return’ to their preoperative values one year postoperatively. A one-year period is not enough, when assessing an orthopaedic implant’s fixation with the use of bone turnover markers.

Purpose: The evaluation of the results of the interlocking intramedullary nailing in the treatment of open and closed femoral and tibial fractures.

Material-Methods: During the decade 1996–2005, 408 patients with 429 femoral and tibial shaft fractures were treated with interlocking intramedullary nailing. All the nails inserted after reaming. From the 182 femoral fractures, there were 155 closed,

10 open, 9 pathological fractures and 8 non-unions. Accordingly, from a total of 247 tibial fractures, 190 were closed, 27 were open and there were also 30 non-unions. The average age was 37 years. The patients were assessed clinically and radiologically according to a specific protocol. Follow-up 1–9 years (average of 4, 4 years).

Results: There were 291 men (71%) and 117 women (29%). The mechanism of injury was a car or motor-vehicle accident in 210 cases, fall from a height in 134, direct force injury in 73 and labor accident in 12 cases. The average period of hospitalization was 5, 2 days. The average time to union was 3, 3 months and it was longer in open than the closed fractures. The percentage of union in all the cases was 96%.

Conclusion: Reamed interlocking intramedullary nails have been associated with higher union rates and lower union time without increasing complications in either closed or open fractures These advantages support their application in the treatment of all the closed and most of the open femoral and tibial shaft fractures.

We present a rare case of multifocal Proteus mirabilis osteomyelitis in an HIV-positive patient. Despite the patient’s good immune status as assessed by her CD4 cell count and the aggressive treatment, she eventually underwent bilateral above-knee amputations to eradicate the infection. Multifocal Proteus mirabilis osteomyelitis can have an unpredictable clinical course with a severe outcome in HIV-positive patients.

Objectives: We present the medium-term results of 453 primary, posterior cruciate retaining total knee replacements.

Methods: We used the Genesis I prosthesis to 453 knee-joints between 1993–2001. The patients included were 386 (67 bilateral) with age between 58–87 years (aver. 68,5 yrs). The diagnosis was osteoarthritis in 418 cases, rheumatoid arthritis in 21 cases, post-traumatic arthritis in 9 cases and osteoarhritis combined with rheumatoid disease in 5 cases. The knees flexion was ranged from 60° to 120° and the extension from 0° to 20°. In 423 cases a 5°–30° varus knee and in 31 cases a 5°–20° valgus knee was documented. The Genesis I knee prosthesis was used with cement, without patellar component implantation. The postoperative protocol included early weight bearing and follow up on the 3rd, 6th,12th month and every year.

Results: The follow up period was ranged from 2 to 10 years (aver. 5,2 yrs). Superficial infection was noted in 5 patients with a satisfactory outcome, pneumonic embolism in 3 (1 death) and deep venous thrombosis in 7 patients. The clinical and radiological assessment followed the Knee Society standards. Postoperatively the flexion was ranged from 80° to 130° with full extension of the knees. The preoperative varus & valgus deformity was totally corrected. No signs of mechanical loosening were documented. No revision surgery was needed. All the patients are happy with a good level of every day activity.

Conclusions: Our results eight years postoperatively are quite satisfactory (98%). All the prosthesis exhibit good behaviour and we believe that this type of prosthesis is a positive solution for the arthritis of the knee which needs surgical assessment.

Objectives: We present the level of biological fixation and the medium-term results of the hemispherical porous coated acetabular component.

Methods: A number of 299 acetabular components type Duraloc 100 were placed to equivalent primary hip arthroplasties. The patients were 273 (26 bilateral), 218 women and 55 men with age which ranged between 22–80 years (aver. 52 yrs). We performed a press-fit technique to stabilize the cup and an acetabulum under-reaming of 2 mm. The size of the components we used was ranged between 48–56 mm. 175 cups were combined with the Elite cemented stem (hybrid), whereas 124 cups with the AML cementless stem. In every case a 10° hooded polyethylene liner was required. The postoperative protocol included early partial weight bearing for six weeks, full weight bearing after three months and follow up on the 3rd, 6th, 12th month and every year. The clinical evaluation was performed with D’ Aubigne-Postel system while the radiological evaluation according to the AAOS standards. The follow up period was ranged from 2 to 9 years (aver. 5,2 years).

Results: During the last follow up no mechanical no radiological loosening was detected. The cup was definitely incorporated to the bone substrate.

Conclusions: Eight years postoperatively the results are perfect. We believe that the hemispherical porous coated, press-fit acetabular component exhibits a satisfactory biological behaviour in primary hip replacements.

Aim: The scope of this study is to estimate the blood loss in major orthopaedics operations in the 24 and 48 hours, in order to evaluate the need of drainage for more than 24 hours.

Material-Methods: 100 consecutive in-patients included in this study and we formed 4 groups. Group A: THR (cemented-cementless), group B: TKR, group C: hemiarthroplasty, group D: DHS due to intertrochanteric fracture. We applied a drainage in all the patients for 48 hours and we measured the blood loss in 24 and 48 hours, the Hb for the next three days and the transfusion units.

Results: In group A the mean blood loss is 513, 75 ml in 24 hours and 147,08 ml in 48 hours. In group B the mean blood loss is 559, 62 ml in 24 hours and 91,31 ml in 48 hours. In group C the mean blood loss is 190 ml and 35, 6 ml in 48 hours. In group D the mean blood loss is 140, 48 ml and 16, 4 ml in 48 hours.

Conclusions: There is no need to keep the drainage more than 24 hours in the groups of hemiarthroplasty and DHS since the blood loss after 24 hours is minimum. We suggest to keep the drainage more than 24 hours in the groups of THR and TKR since there is significant blood loss after 24 hours.