We report the results of 62 hips in 62 patients (17 males, 45 females) with mean age of 62.4 years (37 to 81), who underwent revision of the acetabular component of a total hip replacement due to aseptic loosening between May 2003 and November 2007. All hips had a Paprosky type IIIa acetabular defect. Acetabular revision was undertaken using a Procotyl E cementless oblong implant with modular side plates and a hook combined with impaction allografting.

At a mean follow-up of 60.5 months (36 to 94) with no patients lost to follow-up and one died due to unrelated illness, the complication rate was 38.7%. Complications included aseptic loosening (19 hips), deep infection (3 hips), broken hook and side plate (one hip) and a femoral nerve palsy (one hip). Further revision of the acetabular component was required in 18 hips (29.0%) and a further four hips (6.4%) are currently loose and awaiting revision.

We observed unacceptably high rates of complication and failure in our group of patients and cannot recommend this implant or technique.

Introduction: Two stage revision procedures is the gold standard in management of periprosthetic infections. Cement spacers impregnated with antibiotics have long been used to preserve the space created during resection procedure and to release antiobiotics within the created dead space. However, the problems related to cement as an antibiotic carrier are well recognised (random porosity, thermal necrosis, unspecified antibiotic delivery rate). The rationale of this study is that calcium hydroxyapatite antibiotic carrier (PerOssal) overlaps the known disadvantages of cement spacers, and leads to better outcome in terms of clinical parameters and re-infection rate.

Purpose: Our purpose was to identify specific clinical and laboratory differences between cases submitted to conventional two stage revision arthroplasty vs cases treated with PerOssal as an antibiotic carrier.

Material & Methods: During 2004 to 2008, 46 patients (38 females and 8 males, mean age 65.3 years, range 32 to 84) with infected TKR were revised using a two-stage revision protocol. In 31 patients (group A – 25 females and 6 males) a conventional articulating spacer impregnated with antibiotics was used, whereas in the remaining 15 patients (group B – 13 females, 2 males) a combination of an articulating spacer and PerOssal as antibiotic carrier was used. All patients were reviewed with laboratory exams (WBC, ESR, CRP) every 7 days and joint fluid aspiration prior to re-implantation, which was performed at mean 8 months post 1st stage (range, 6 to 12 months).

Results: At a mean follow-up of 36 months (range, 8 to 60 months) no patient was lost or died. WBC count and ESR showed no statistically significant differences at any time interval (p> 0.05). However, CRP values had a statistically significant difference between the two groups after the second week postoperatively (p3rd week= 0.042) and group B had significantly lower CRP values compared to group A at every check point thereafter (p4th week=0.038, p5th week=0.031, p6th week=0.034). Re-infection rate was 16.12% in group A and 6.6% in group B (p=0.192).

Conclusions: PerOssal can be used as an additional antibiotic carrier in cases of periprosthetic infections of TKR. It is associated with more rapid reduction of CRP levels, probably due to greater porosity and better antibiotic delivery comparing to impregnated cement. Larger series of patients could reveal potential differences in the re-infection rates as indicated by our study.

Introduction: Two-stage revision procedure is the gold standard in management of periprosthetic joint infections. Cement spacers have long been used to preserve the space created during resection procedure and to release antiobiotics within the created dead space. However, the problems related to cement as an antibiotic carrier are well recognised (thermal necrosis, random porosity, unspecified antibiotic delivery rate).

Purpose: To present the concept of using PerOssal as a canal filling spacer and local antibiotic delivery system in two-stage revisions of hip and knee infected arthroplasty.

Material & Methods: 8 patients (6 females, 2 males) with infected arthroplasty (4 TKRs, 4 THRs) were managed with two-stage revision procedures during the years 2006–2008 (minimum FU: 12 months). Our protocol consisted of:

Preoperative determination of the causative organism its sensitivity to antibiotics

Results: We had 7 cases with eradication of infection, 2 with delayed wound closure, and 1 late recurrence of disease.

Conclusion: We think that PerOssal can offer a very useful additional and genuine support in managing infected joint arthroplasties with so far good clinical results with respect to infection control.

To study the use of TSF system in treating trauma and bone deformities in children. To determine the difficulties of this process and the risk factors that lead to complications.

From January 2004, in 61 children (37 male and 24 female), 67 extremities, with a mean age 8.9 years children a TSF external fixator was applied for the treatment of trauma or bone deformities. 21 children were operated for angular deformity, 19 for bone lengthening, 10 for rotational deformity, 6 for combined angular deformity and lengthening and 11 for pseudoarthrosis. Intra and postoperative difficulties were classified using the Palay method in problems, obstacles and complications.

The rate of difficulties was 22.2 %. Problems were presented in 5.9% (4/67) consisting of 2 non-axial deformities, 1 pin fracture and 1 subluxation of the knee. Obstacles were presented in 10.4% (9/67) including 3 cases with delayed bone healing that needed infusion DBM, 1 peroneal nerve palsy due to hematoma formation treated with decompression of the region, 1 early bone fusion that needed re-operation and 2 cases of percutaneous achilles lengthening. Complications presented in 5.9% of (4/67) the cases including 1 fracture, 1 pseudoarthrosis, 1 peroneal nerve palsy and 1 limitation of range of motion in the knee (0–45 0).

The problems, obstacles and complications that presented during treatment influenced the final therapeutic objective. Initial deformity, preoperative planning and surgeon’s experience are associated with reducing the rate of all difficulties

We report the use of an allograft prosthetic composite for reconstruction of the skeletal defect in complex revision total hip replacement for severe proximal femoral bone loss. Between 1986 and 1999, 72 patients (20 men, 52 women) with a mean age of 59.9 years (38 to 78) underwent reconstruction using this technique.

At a mean follow-up of 12 years (8 to 20) 57 patients were alive, 14 had died and one was lost to follow-up. Further revision was performed in 19 hips at a mean of 44.5 months (11 to 153) post-operatively. Causes of failure were aseptic loosening in four, allograft resorption in three, allograft nonunion in two, allograft fracture in four, fracture of the stem in one, and deep infection in five. The survivorship of the allograft-prosthesis composite at ten years was 69.0% (95% confidence interval 67.7 to 70.3) with 26 patients remaining at risk. Survivorship was statistically significantly affected by the severity of the pre-operative bone loss (Paprosky type IV; p = 0.019), the number of previous hip revisions exceeding two (p = 0.047), and the length of the allograft used (p = 0.005).