Complex acetabular reconstruction for oncology and bone loss are challenging for surgeons due to their often hostile biological and mechanical environments. Titrating concentrations of silver ions on implants and alternative modes of delivery allow surgeons to exploit anti-infective properties without compromising bone on growth and thus providing a long-term stable fixation. We present a case series of 12 custom acetabular tri-flange and custom hemipelvis reconstructions (Ossis, Christchurch, New Zealand), with an ultrathin plasma coating of silver particles embedded between layers of siloxane (BioGate HyProtect™, Nuremberg, Germany).

At the time of reporting no implant has been revised and no patient has required a hospital admission or debridement for a deep surgical site infection. Routine follow up x-rays were reviewed and found 2 cases with loosening, both at their respective anterior fixation. Radiographs of both cases show remodelling at the ilium indicative of stable fixation posteriorly. Both patients remain asymptomatic. 3 patients were readmitted for dislocations, 1 of whom had 5 dislocations within 3 weeks post-operatively and was immobilised in an abduction brace to address a lack of muscle tone and has not had a revision of their components.

Utilising navigation with meticulous implant design and construction; augmented with an ultrathin plasma coating of silver particles embedded between layers of siloxane with controlled and long-term generation of silver ion diffusion has led to outstanding outcomes in this series of 12 custom acetabular and hemipelvis reconstructions. No patients were revised for infection and no patients show signs of failure of bone on growth and incorporation. Hip instability remains a problem in these challenging mechanical environments and we continue to reassess our approach to this multifaceted problem.

CaSiO3 has been used a potential bioactive material for bone regeneration. A drawback of the CaSiO3 ceramics is that they possess high dissolution rate of Ca ions leading to a high pH value environment [1], which can disadvantage cell growth. Zn can enhance osteoconductivity of CaP ceramics and stimulate bone formation [2]. The aims of this study are:

In situ preparation and optimization of Zn-CaSiO3 ceramics by the evaluating of physical and chemical properties, osteoblast and osteoclast behavior;

Zn-CaSiO3 ceramics containing zero, ten, 20 and 50-mol% of Zn were sintered at 1260 °C. The dissolution and apatite formation ability were evaluated by soaking in simulated body fluids. Attachment, proliferation and differentiation of human primary bone-derived cells (HBDC) on ceramic disks were evaluated. Human monocytes isolated from buffy coats were differentiated into mature and functional osteoclast (OC) by culturing them for 21 days on ceramic disks. Then, the optimized HT (50%Zn-CaSiO3) coating on Ti-6Al-4V was prepared by sol-gel spinning method.

The incorporation of Zn in CaSiO3 resulted in part of new phase formation (HT) formation in Zn-Ca-Si ceramics. When adding 50 mol% of Zn, only pure HT phase existed.

The incorporation of Zn in CaSiO3 decreased the dissolution and pure 50 mol% of Zn (HT ceramics) resulted in the lowest dissolution.

Zn-CaSiO3 ceramics with different Zn contents supported HBDC attachment. With the increase of Zn contents, HBDC proliferation and differentiation improved. The surface roughness of Sol-gel HT coating is about 0.49 μm. The thickness of coating is about 1 μm. HT coating has a similar dissolution kinetics and stability with hydroxyapatite coating.

Zn decreases the dissolution in Zn-Ca-Si ceramics and enhances HBDC proliferation and differentiation. The optimized HT ceramics (50mol% Zn) support OC resorption and can be used for a stable biomedical coating application.

We reviewed 83 patients after below-knee amputation. In 56 with 69 amputations early management was by plaster-pylon. A plaster cast is applied in the operating room, and a pylon added one week later, after which full weight-bearing is allowed. We compared these patients with 27 who had soft bandaging. The 'healing' time was reduced from 98 days to 40 days, and there were no major complications in the plaster-pylon group. The technique is simple and cheap and can be used by paramedical staff without specialised training or equipment.