The aim of this retrospective cohort study was to investigate the reasons for total knee arthroplasty (TKA) revisions at a tertiary hospital over a four-year period. The study aimed to identify the primary causes of TKA revisions and shed light on the implications for patient care and outcomes.

The study included 31 patients who underwent revisions after primary knee arthroplasty between January 2017 and December 2020. A retrospective approach was employed, utilizing medical records and radiological findings to identify the reasons for TKA revisions. The study excluded oncology patients to focus on non-oncologic indications for revision surgeries. Patient demographics, including age and gender, were recorded. Data analysis involved categorizing the reasons for revision based on clinical assessments and radiological evidence.

Among the 31 patients included in the study, 9 were males and 22 were females. The age of the patients ranged from 43 to 81, with a median age of 65 and an interquartile range of 18.5. The primary reasons for TKA revisions were identified as aseptic loosening (10 cases) and prosthetic joint infection (PJI) (13 cases). Additional reasons included revision from surgitech hemicap (1 case), patella osteoarthritis (1 case), stiffness (2 cases), patella maltracking (2 cases), periprosthetic fracture (1 case), and patella resurfacing (1 case). The findings of this retrospective cohort study highlight aseptic loosening and PJI as the leading causes of TKA revisions in the examined patient population.

These results emphasize the importance of optimizing surgical techniques, implant selection, and infection control measures to reduce the incidence of TKA revisions. Future research efforts should focus on preventive strategies to enhance patient outcomes and mitigate the need for revision surgeries in TKA procedures.

Purpose of the study: The purpose of using distal metaphyso-epiphyseal osteotomy to shorten the ulna is to reduce healing time compared with diaphyseal shortening and to adapt the osteotomy to the distal radioulnar anatomy and associated conditions by using a variably oblique cut.

Material and methods: Oblique metaphyso-eiphyseal osteotomy of the distal ulna was performed in sixteen patients since 2000. Fourteen presented ulnocarpal pain. Among these, eight had associated distal radioulnar pain. Two patients had pain essentially limited to the distal radioulnar area. Radiographically, there was ulnocarpal impingement in fourteen wrists, and signs of early-stage distal radioulnar osteoarthritis in five. Local regional anesthesia was used in thirteen patients who underwent surgery in an outpatient clinic. The dorsoulnar approach was used. The direction of the osteotomy cut depended on the individual condition, and distal radioulnar anatomy and stability. Two headless canulated screws were used for fixation. The elbow and wrist were immobilized for three weeks followed by self-education of pronosupination beginning with a removable orthesis to stabilize the wrist.

Results: Outcome was assessed at maximum follow-up of four years. Preoperative pain had totally resolved in fourteen wrists with residual pain at forced pronosupination in two. Wrist motion was not modified in the frontal and sagittal planes. Complete pronosupination range of motion was achieved in thirteen patients, two patients had supination limited to 20° and one had pronation and supination limited to 30°. Force was 90% compared to the opposite side. Bone healing was achieved in all patients, in 3–4 weeks for fourteen wrists and after two months of elbow and wrist immobilization in two.

Discussion: Oblique metaphyso-epiphyseal osteotomy of the distal ulna reduced the healing time compared with diaphyseal shortening osteotomies. This technique enables adaptation of the direction and orientation of the ulnar cut to the individual distal radioulnar anatomy. Favorable clinical outcome in patients with early-stage distal radioulnar osteoarthritis has led us to progressively abandon certain indications for distal resection of the ulna and the Sauvé-Kapankji operation.

Reconstruction of deficient bone stock during total elbow arthroplasty in rheumatoid arthritis represents a challenge for the surgeon. Fracture and osteolysis of the olecranon process is a very rare condition in rheumatoid arthritis. The consequence of a deficient olecranon is an instable and painful elbow. We report a case of successful olecranon reconstruction with bone graft associated to total elbow arthroplasty with a 8 years follow up and discuss surgical aspects.

This case concerns a 44 years old woman with a very severe rheumatoid arthritis. She complains of pain and instability of her right elbow. X-rays show fracture and major osteolysis of the olecranon process with only some persistent bone at the insertion of the triceps tendon. The humeral condyles were subluxated posteriorly.

We performed a total elbow replacement with a GSB3 implant and reconstruction of the olecranon with two cancellous iliac bone strut fixed by 2.7 diameter screws to the proximal ulna. The triceps tendon with remnant olecranon bone chips was secured to the bone graft by tension band wiring. Postoperatively, the elbow was immobilized for 3 weeks.

With a follow up of more than 8 years the elbow is pain free with excellent function. The active range of motion of flexion – extension is 140° / −20°. The elbow is stable and triceps function is very satisfying authorizing the use of crutches. X-rays show good bony integration of the reconstructed olecranon process and no signs of loosening of the GSB3 implant.

The literature concerning olecranon reconstruction during total elbow arthroplasty in rheumatoid patients is very poor. Kamineni and Morrey reported on one case of olecranon reconstruction with strut allograft in revision total elbow arthroplasty with an unsatisfying result. Their fixation technique was different. We prefer an autograft whenever it is possible and we recommend our fixation technique using screws and tension band wiring.

In the first year of existence of the Acute Spinal Injury Unit, 162 patients were admitted. A large number of injuries were the result of interpersonal violence. Case notes and radiographs of 49 consecutive patients with gunshot injuries to the spine were reviewed.

The mean age of the 38 male and 11 female patients was 27.5 years (15 to 51). The mean length of stay in the unit was 30 days (4 to 109). The 46 associated injuries were 11 fractures, 14 haemopneumothoraces, and one soft palate, nine visceral, two vascular, four brachial plexus, three oesophageal and two tracheal injuries. Non-spinal surgery was required in 17 patients. The spinal injury was complete in 38 patients and incomplete in eight. Three had no neurological deficit. The involved level was cervical in 13, thoracic in 24 and lumbar in 12. The spine was considered stable in 43 patients. Six patients underwent surgical stabilisation. In 11 patients the bullets were in the canal and were removed. One case of discitis was debrided. Complications included three deaths, discitis in three patients, pneumonia in six and pressure sores in six. The ASIA motor score improved marginally in nine patients and one patient had true functional improvement.

Gunshot injuries lead to a high incidence of permanent severe neurological deficit, but usually the spine remains mechanically stable. Most of the management revolves around the associated injuries and consequences of the neurological deficit.

Purpose: Transfer of the vascularised fibula causes an imbalance in the lower limb due to the small calibre of the bone compared with the recipient bone (femur, tibia). “Femorisation” or “tibialisation” is slow, requiring prolonged protection with an orthesis. The doubled fibula or “shotgun” technique which maintains fibular periosteal vascularisation may overcome this inconvenience.

Material and methods: We report a series of eight free vascular shotgun fibular transfers at a mean four years follow-up (1–11). The recipient site was the lower limb in all patients who had undergone multiple operations, seven for chronic osteitis and one for chondrosarcome (five femoral supracondylar grafts, one knee arthrodesis, two metaphyseal tibial grafts). A cortico-cancellous autologous graft was associated during the same operation for six patients; Osteo-synthesis was achieved in seven cases with an external fixator and in one case with locked centromedullary nailing.

Results: The bone scintigraphy obtained in all cases at the third postoperative day showed intense uptake in the graft in six cases. We had seven cases of osteitis with no case of recurrent sepsis. Mean delay to bone healing assessed radiographically was 5.2 months. Hypertrophy of the fibula was noted at last follow-up in four cases. The external fixator was removed on the average at 6.8 months (5–9). Weight bearing was allowed in all cases with an adjustable protective orthesis. There was one fracture of the graft in a patient with a knee arthordesis which was treated with a corticocancellous autologous bone graft.

Conclusion: This series demonstrates the interest of doubling the free fibular transplant compared with other bone transfers to the lower limbs, improving the balance of the bone calibre and resistance. For patients with loss of supracondylar femoral bone, we describe a widened posterior access allowing the preparation of the recipient site with a single installation for the graft harvesting and fibular transfer.