We present 11 cases of total femur implanted in patients affected by severe bone defects in septic or aseptic prosthesis failures or tumours. Good results were obtained with a precise preoperative technical and surgical planning, without septic complications. We reported results and complications of our series.

From June 2003 we have elaborated a new procedure consisting in an osteoinductive-antibiotic gel, positioned on the spongiosametal surfaces of the implant. The gel contains five elements: Cancellous bone chips, Platelet-Rich Plasma, Bone marrow, Fibrin glue, Vancomycin and Tobramycin. Blood loss, operative time Hemoglobin drop values and clinical results were collected. Our procedure shows a quickly osteointegration of the implants without septic complications due to the local delivery of antibiotics. The procedure is safe and easy because includes only autologous factors without risks of disease transmission or immune response.

Aim: Unstable lateral fractures of the proximal femur (type A2 and A3 of AO classiþcation) present a controversial problem for surgical treatment, due to the difþculty to achieve an adequate mechanically stable bone-device system, so to allow an early weight-bearing. To improve the stability of bone-device complex, a trochanteric stabilizing plate (TSP) has been introduced. The properties of TSP is to avoid shaft medialization in the postoperative. The aim of our study was report results of surgical treatment of unstable trochanteric fractures using a dynamic hip screws in association with TSP. Methods: From January 2000 to March 2002, 51 patients affected by this kind of fractures (type A2 of the AO classiþcation 37 cases and type A3 14 cases) were treated with the association of dynamic hip screw and trochanteric stabilizing plate. Results: The average time that patients spent in the hospital was 7.8 days for the group A2,2, 8.5 days for the group A2,3, 9.9 days for A3,1 and 10.3 days for A3,2. The average healing time was 6 weeks for A2 fractures and 7.2 weeks for the A3. According to the HSS at 6 months for the group A2,2 the average score was 85,5 for the group A2,3 was 81,7 for the group A3,1 was 74,4 and for the group A3,2 was 70,1. The main postoperative complications were 3 superþcial infection of surgical wound, 3 deep vein trombosis and 1 pulmonary embolism. Conclusions: Our series show that this device, although it interferes with trochanteric structures, is a real aid for the dynamic hip screw system in the treatment of unstable lateral fractures of proximal femur due to the possibility of stabilizing the great trochanter and the lateral cortex in order to avoid the medialization forces of the femoral shaft.

Aims: The aim of our study was to assess results of treatment of trochanteric fractures using a speciþc algorythm Methods: From January 2000 to March 2002, 215 patients affected by fractures of trochanteric region were treated. 130 were female and 85 male, the average age was 72,5 (5–96). Author used an algorythm based on the analysis of stability of the bone-device system considering three groups: GROUP 1: stable fractures (A1 and A2.1 according to AO classiþcation) in which dynamic hip screw was employed, GROUP 2: unstable fractures (A2.2, A2.3, A3.1) in which dynamic hip screw and trochanteric stabilizing plate were employed, GROUP 3:unstable fractures (A3.2 and A3.3) in which intramedullary nailing was performed. Results: The average healing time was 6 weeks for GROUP 1 and GROUP 2 and 7,2 weeks for GROUP 3. According to the HHS at 12 months the average score for GROUP 1 was 83,1, with 72% of excellent results, 20% good, 4% fair and 4% poor; for GROUP 2 the average score was 79,7 with 56% of excellent results, 25% good, 10% fair and 9% poor; for GROUP 3 the average score was 77,2 with 40% of excellent results, 29% good, 18% fair and 13% poor. In GROUP 2 we observed 2 cases of limb shortening more then 2 cm and 9 cases of pain due to trochanteric plate. In 2 cases of cut-out of the lag screw cemented endoprosthesis was required. In GROUP 3 we observed 5 cases of limb shortening more then 2 cm and 4 cases of persistent trochanteric pain. Conclusions: Following this algorythm a low rate of complication were observed specially in GROUP 2.

The problem of early mechanical stability and late biological osseointegration of the tibial component is still a debated issue in total knee arthroplasty. We are among those authors that stress the necessity of cementing the tibial component to avoid the risk of failure due to the high torque stresses at this interface. In fact while on the femoral edge a good stability can be achieved even in uncemented implants, the stability of traditional tibial components is harder to obtain even in cemented implants.

To solve this problem it has been proposed to use additional devices such as screws, pegs or keels to better fix the tibial plateau. Tantalum monobloc tibial tray is a new answer to this problem. It consists in a cement-less tibial tray made of porous tantalum with monobloc polyethylene. Chemical, physical and biological properties of the raw tantalum are very similar to those of titanium. Porosity of the processed material is 80% (2–3 times compared to plasma spray, beads and fiber mesh coatings) and pores, which diameter is 650 mm, are fully interconnected in the whole bulk of the implant. This trabecular spongy structure, that is not a coating, allows the bone at the interface to deeply grow into the pores, and to achieve optimal stability. In addiction, the fusion of polyethylene into the tantalum mesh completely abolish the back side wear problem. With this technology is yet in use an acetabular component, with which we have a 5 years experience in 150 implants, and now is available a new tibial plateau; the first implant in Europe was performed in our department.

Despite our short series and follow up (6 implants in 2 months) the properties of porous tantalum, already tested in acetabular implants, represent an alternative to the traditional ways of tibial tray fixation.

Aseptic loosening is one of the most frequent cause of total knee arthroplasty (TKA) failure; it is related to a fatigue-type wear which can rapidly break up a tibial polyethylene (PE) inlay. PE debris production is the result of this wear and depend on contact stress between the components. This crucial parameter is more related to conformity than to load tranfer. That is why mobile bearing TKA seems to represent a valid solution to the PE debris production. In fact this implant offers great tibio-femoral conformity without an increased risk of loosening due to increased axial torque. Mobile bearing TKA also eneables the surgeon to self correct tibial component malrotation. On the other hand this implant could lead to new problems such as bearing dislocation or breakage and a possible new wear pattern at the PE-tibial metal tray interface.

We performed 100 consecutive cemented posterior stabilised TKA using randomly in 50 cases a mobile bearing and in 50 cases the same implant with a fixed bearing. The mean follow up was 15 months. The results in mobile bearing group are the following. Hospital for Special Surgery (HSS) score improved from 38 to 91 after the surgery. Preoperative Range of Movement (ROM) was 71 while the post op value was 107. No lucencies > 1 mm were observed. There were no statistically significant differences among the mobile bearing group and the fixed bearing one. Despite our short follow up, this implant offers the same good clinical results if compared to other devices, and allows the surgeons to correct errors in positioning the implant.

In future we have to consider that this possibility will lead to an abnormal load stresses distribution and to a higher risk of late loosening.