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Purpose Since its introduction in 1988, the double-tapered polished Exeter cemented stem has been widely adopted in primary total hip arthroplasty (THA). Despite the results coming from the arthroplasty registries have proven great survivorship, the aim of this study was to dig deeper and describe the modes of failure of the Exeter stem at 15 years follow-up while reporting the clinical and radiographic outcomes. Methods A search of PubMed, MEDLINE, and Embase was performed using the Preferred Reporting Items for Systematic Review and Meta-Analyses since inception of database to January 2022. A meta-analysis was performed on stem’s failure rates and clinical outcomes using random effects models. Publication bias was assessed with funnel plots. Results Overall, ten studies met the inclusion criteria with 2167 hips at mean 14.8 ± 4.1 years follow-up. The meta-effect estimate for revision rate for stem-related reasons was 3.8% (CI 95% 2.1–5.6, p < 0.01). The meta-effect for revision rate for stem aseptic loosening (AL) was 0.22% (CI 95% 0–0.4, p = 0.048) and for periprosthetic fracture was 0.6% (CI95% 0.3–0.9, p < 0.001). The meta effect estimate for Oxford Hip Score (OHS) at final follow-up was 32.4 (moderate; CI 95% 23.2–41.6, p

Abstract Background The double-bundle technique with two points of patellar fixation in the upper half of the patella replicating the broad attachment site of the native medial patellofemoral ligament (MPFL) is the most commonly performed procedure for MPFL reconstruction. Complete transverse patella tunnels pose a threat to the integrity of the patella. We present an implant-free, double-bundle technique for MPFL reconstruction with gracilis autograft, overcoming the problem of complete patella bone tunnels and over-drilling. Methods After standard gracilis graft harvesting, the anteromedial side of the patella is exposed. With the guidance of an anterior-cruciate-ligament (ACL) tibia-aiming device, two 2-mm parallel guide pins are inserted from medial to lateral at the upper half of the patella. The two guide pins are over-drilled with a cannulated 4.5-mm drill bit 2-cm deep, to create two transverse blind semi-patellar tunnels. For the femoral fixation, a 2.4-mm guide pin with an eyelet is drilled at the Schöttle point and over-reamed with a 6-mm cannulated reamer to a depth of 30 mm. The two free ends of the graft (with two running Krakow sutures placed) are pulled into the two patella tunnels and the graft sutures are tied together with tension for stable graft fixation at the lateral patella rim. With the help of a femoral suture loop (which is inserted in the femoral bone tunnel), the graft-loop is advanced into the femoral bone tunnel and the graft is finally fixed with a 7-mm interference screw at 30° of knee flexion. Results The utilization of blind transverse tunnels (not trans-patellar tunnels) offers the advantage of avoiding stress risers at the patella. Thanks to the ACL tibia aiming device, multiple drilling, and breaching of the anterior patellar cortex or articular surface of the patella is avoided. Conclusions This implant-free, and consequently affordable technique, isolated or combined with bony procedures, minimizes possibilities for perioperative bony complications at the patella fixation site.

We present a rare case of a patient who presented with complete and rapid wear-through of a ceramic femoral head through a polyethylene liner and titanium acetabular cup. In addition, this patient exhibited significantly elevated serum titanium ion levels, which may serve as a marker of severe metallosis in cases where the preoperative plain radiographs underestimate signs of periarticular metal debris. The unique findings of this case include the rapid (less than 1 year time) wear-through of the femoral head in interval radiographs and the dramatic progression of metallosis and pelvic and femoral osteolysis that required both component revision. In addition, the markedly elevated titanium levels secondary to cup wear-through are also of interest and demonstrate a systemic manifestation of abrasive wear of a titanium alloy component. Keywords: Total hip arthroplasty, Revision arthroplasty, Wear-through cup failure, Catastrophic failure, Osteolysis, Ceramic on poly

Abstract Background While arthroscopic complete repair of massive rotator cuff tears (MRCT) back to their anatomic footprint is preferential, there are cases where this type of repair is not applicable due to the contraction of the torn tendons. In such cases, a non-anatomic incomplete or partial repair can be performed. A number of clinical studies have investigated the clinical and functional outcomes of arthroscopic partial repair for irreparable MRCT. To our knowledge, no systematic review has been published yet to synthetically evaluate these results. Methods Two reviewers independently conducted the search in a PRISMA-compliant systematic way using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms “arthroscopy”[MeSH Terms] OR arthroscopic surgical procedure [Text Word (tw)] AND massive rotator cuff tears [tw] AND arthroscopic partial repair [tw]. Results From the 55 initial studies, we finally chose 11 clinical studies which were eligible to our inclusion-exclusion criteria. The mean modified methodology Coleman score was 58/100, whereas it ranged from 41/100 to 78/100. In total, 643 patients were included in this review. All postoperative mean clinical and functional subjective scores, as well as muscle strength of patients treated with arthroscopic partial repair, were found significantly improved, when compared with the respective mean preoperative values. The rate of structural failure of the partial repair, as it was estimated by postoperative imaging modalities, was 48.9%. The overall reoperations’ rate was 2.9% regarding the patients who were treated with partial repair. Conclusions Arthroscopic partial repair might be a safe and effective alternative treatment for irreparable contracted MRCT, where a complete repair cannot be performed. The methodological quality of the relevant, available literature is low to moderate; therefore, further studies of higher quality are required to confirm these results.

Abstract Purpose To measure the safe range of angles during tunnel drilling and map ideal patella tunnel placement with the use of preoperative computed tomography (CT) scan and compare results after medial patellofemoral ligament (MPFL) reconstruction using a hardware‐free patellar fixation technique with two semi‐patellar tunnels between a) a free‐hand technique, and b) its modification with the use of an anterior cruciate ligament (ACL) tibia aiming device. Methods CT scan was performed on 30 fresh‐frozen cadaveric knees a) prior to any intervention and b) after MPFL reconstruction. For MPFL reconstruction, specimens were randomly allocated to 1) Group A, which consisted of knees operated with free‐hand, hardware‐free patellar fixation technique with two semi‐patellar tunnels and 2) Group B, which consisted of knees operated on with a technique modification with the ACL tibia device. Patellar measurements L1 was the maximal patellar length. L2 was the minimum possible distance of placement for the upper tunnel from the proximal pole of the patella. The maximum bone bridge between tunnels was calculated as half of L1 minus the L2 distance (L1/2‐L2). We also measured R1 and R2 angles at the proximal and distal tunnel that represent safe angles at the entry point during tunnel drilling (without breaching the anterior cortex or articular cartilage). Results Preoperatively, mean L1 was 3.45 cm (range 3.05–4.52). Mean L2 was 0.62 cm (range 0.49–0.89). The mean maximum possible bone bridge between tunnels (L1/2‐L2) was 1.1 cm (range 0.77–1.58). R1 was 6.050 (range 4.78–7.44), R2 was 6.640 (range 4.57–9.03), and their difference reached statistical significance (p = 0.03). Postoperatively, in group A, in 4 out of 15 patellas, multiple attempts were made during tunnel drilling in order to avoid anterior cortex or cartilage breaching. In group B, all tunnels were correctly drilled with the first attempt. Bone bridge between tunnels was significantly shorter postoperatively (0.93 cm, p

This study was performed to determine whether Autologous Matrix-Induced Chondrogenesis (AMIC) is an effective and safe treatment option for patients with symptomatic Osteochondral defects of the Talus (OCTs) and to identify factors that influence the clinical outcome. A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three reviewers independently conducted the literature search using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. The databases were queried using the terms “autologous” AND “matrix” AND “induced” AND “chondrogenesis.” Thirteen studies were eligible for review. All studies that compared the preoperative and postoperative mean values of different clinical/functional scores showed significant clinical improvement. The final postoperative mean Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score ranged from 50.9 to 74.5. The included studies indicated that age and body mass index may have a detrimental impact on the postoperative outcome. A higher re-intervention rate is expected with the open technique, mainly because of hardware removal after malleolar osteotomy. This data analysis demonstrated that both arthroscopic and open AMIC procedures are effective and safe for the treatment of OCTs. Level IV, systematic review of therapeutic studies.

Total knee arthroplasty (TKA) is a highly successful operation that improves patients’ quality of life and functionality. Yet, up to 20% of TKA patients remain unsatisfied with the functional outcomes. Robotic TKA has gained increased attention and popularity in order to improve patient satisfaction and implant survivorship by increasing accuracy and precision of component implantation. The current systematic review was run in order to compare implant survivorship, complication rates, clinical outcomes, and radiological outcomes between robotic-assisted TKA (RA) and conventional manual TKA (CM). Articles were referenced from the US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews. Nine comparative studies with 1199 operated knees in 1159 patients were included, 614 underwent active or semiactive robotic-assisted TKA compared to 585 CM-TKA. Improvements in the RA group were reported for early functional outcomes, radiographic outliers (RA 16% vs CM 76%) and radiolucent lines (RA 0% vs CM 35%). No significant differences between the two groups were reported in overall survivorship (RA 98.3% vs CM 97.3%), complication rate (RA 2.4% vs CM 1.4%) and operative time (RA 88 min vs CM 79 min). Despite higher costs, roboticassisted TKA offers better short-term clinical outcomes when compared to conventional manual technique with reduction in radiographic outliers and reduced risks of iatrogenic soft tissues injuries (reduced blood loss and postoperative drainage). Further high-quality long-term studies of modern robotic systems are required in order to evaluate how the increased accuracy and reduced outliers affect the long-term survivorship of the implants and the clinical outcomes.

Constrained acetabular liners have been developed for patients who are at high risk for dislocation or who are undergoing revision surgery for recurrent dislocations. We report on 2 cases of failure of tripolar constrained liners due to severe backside polyethylene wear after dissociation of the outer polyethylene liner without dislocation, a mode of failure not previously reported. The backside of the inserts suffered severe polyethylene deformation, wear, and scratching due to dissociation from the locking mechanism. In patients with tripolar constrained liners, radiographic evidence of eccentric wear should be considered as possible occult dissociation of the polyethylene liner within the shell. Conversion to a modular dual mobility liner appears to be a viable solution in this setting. Keywords: Revision total hip arthroplasty, Dislocation, Tripolar constrained liner, Modular dual mobility

Abstract Recently, four different operative techniques, referring to the primary anterior cruciate ligament (ACL) repair, were described. These are the dynamic intraligamentary stabilization (DIS) with Ligamys™, the Bridge-enhanced repair (BEAR), the use of internal brace, and the refixation with suture anchors. The purpose of this study was to assess the already-published, clinical, and pre-clinical results of those techniques. A literature review was conducted and implemented by three independent researchers. Inclusion criteria were clinical or cadaveric or animal studies about patients suffering from ACL rupture, who were treated with one of those four different arthroscopic techniques of primary ACL repair. There were 10 clinical trials dealing with the different techniques of primary ACL repair and 12 cadaveric or animal studies. The majority of the published clinical trials investigated the dynamic intraligamentary stabilization (DIS), while only four studies referred to the three other surgical techniques. Most of the clinical trials suggested that primary ACL repair should be done during the first 14–21 days after a proximal ACL rupture and not later. Further clinical evidence is needed for the techniques of bridge-enhanced ACL repair, internal brace, and suture anchors ACL refixation in order to support the animal and cadaveric biomechanical studies. Till now, the existing clinical trials were not enough to establish the use of those techniques in the ACL-ruptured patients. On the contrary, the Dynamic intraligamentary stabilization with Ligamys™ device demonstrated very promising results in different types of clinical studies.

The aim of the study was to investigate whether subscapularis muscle atrophy is a negative prognostic factor leading to increased risk of retears in patients treated with an arthroscopic subscapularis tendon repair. We hypothesized that fatty infiltration of the subscapularis muscle deteriorates the clinical and sonographic outcome of the arthroscopic repair and inhibits reparability of the ruptured tendons. A double- center, multinational, retrospective, blind (in the follow-up) clinical study regarding 32 patients who underwent an arthroscopic subscapularis repair was conducted. Patients were divided into two groups according to the preoparative fatty infiltration grade of subscapularis muscle (group A: grade

We aimed to investigate whether combined reverse total shoulder arthroplasty (RTSA) and subscapularis repair leads to improved clinical and functional outcome in comparison with RTSA alone. Two reviewers independently conducted a systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms “reverse” AND “shoulder” AND “arthroplasty” AND “with” AND “subscapularis” AND “repair”. From the 72 initial studies, we finally chose five studies which were eligible to our inclusion-exclusion criteria. The total mean modified Coleman methodology test was 55/100 (range: 47/100 to 60/100). The eligible studies included 1087 patients, in total. Regarding the subjective functional scores as well as range of motion (ROM), the differences amongst groups were insignificant in almost all studies. The mean complications’ rate of the repair group was 10.4%, whereas the respective rate of the non-repair group was 10.2%. All studies concluded that the repair of subscapularis did not affect the complications’ rate of patients who were treated with RTSA. The mean dislocations’ rates of the repair and the non-repair group were 1.5% and 2.3%, respectively. Although subscapularis repair was proven safe and effective for the augmentation of RTSA, it did not offer any additional clinical or functional benefit in the outcome of patients treated with lateralized RTSA. Therefore, it is not supported its routine use for patients who have a preoperatively sufficient subscapularis tendon.

Augmented reality (AR) comprises special hardware and software, which is used in order to offer computer-processed imaging data to the surgeon in real time, so that real-life objects are combined with computer-generated images. AR technology has recently gained increasing interest in the surgical practice. Preclinical research has provided substantial evidence that AR might be a useful tool for intra-operative guidance and decision-making. AR has been applied to a wide spectrum of orthopedic procedures, such as tumor resection, fracture fixation, arthroscopy, and component's alignment in total joint arthroplasty. The present study aimed to summarize the current state of the application of AR in orthopedics, in preclinical and clinical level, providing future directions and perspectives concerning potential further benefits from this technology.

Several studies have reported that minimally- invasive total hip arthroplasty (MISTHA) may significantly reduce postoperative pain and results in faster postoperative rehabilitation when compared with the traditional lateral or posterior approach. Regarding bilateral hip osteoarthritis, there is still no consensus whether simultaneous bilateral MIS-THA can be established as the treatment of choice. Therefore, we searched the international databases of Pubmed, Medline, and Cochrane Database of Systematic Reviews using the key words minimally invasive bilateral total hip arthroplasty. From the initial 23 articles we found five clinical studies which met our inclusion criteria. From the perspective of possible intra- and postoperative complications, one-stage bilateral MIS THA was equally safe or safer than two-stage interventions. In addition, from a clinical outcome perspective, the one-stage procedure can be considered to be preferable. Higher blood transfusion requirements, which were expected following the standard bilateral simultaneous THA, seemed to be minimized with the simultaneous bilateral MIS THA. The supine position of the patient minimized the mean operation time. Approaches using the lateral decubitus position of the patient should be avoided in simultaneous bilateral THA due to the increased operation time. There is a lack of randomized, controlled clinical trials, comparing simultaneous bilateral MIS THA with staged bilateral MIS THA. Although simultaneous bilateral MIS THA seems to be efficacious, cost-effective and safe, more clinical trials are required to establish its superiority over the sequential MIS THA.

The focal metallic cartilage resurfacing is a surgical method that offers an appropriate step between the biological techniques and arthroplasty in middle-aged patients with full-thickness cartilage defects. The advantages of this technique are that it addresses the defect, respects healthy tissues and provides stability and contoured surface similar to a full arthroplasty. A systematic review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers (MM and DC) independently conducted the search using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews (CDSR). These databases were searched for the terms hemicap knee implant and unicap knee implant and knee focal metallic implant. From the initial 21 studies that were evaluated, 10 were eligible for analysis. Considering both the HemiCAP focal implant and the HemiCap® Wave patellofemoral prosthesis, we found a lack of mid- to long-term clinical outcomes in well-designed prospective clinical studies. No Level I or II studies were found, while the limited number of patients who were included undermines the overall clinical results of these studies. The progression of osteoarthritis, the persisting pain and the subsequent high revision or failure rates in the limited available studies with long-term follow-up, seem to be the major drawbacks of these partial resurfacing techniques. Utilization of partial resurfacing for femoral or patellofemoral compartments results in good short-term outcome for middle-aged patients as a step between biological technique and total knee arthroplasty. The surgeon should be cognizant and also notify the patient of the high failure rates that are reported in the literature in mid- to longterm follow-up and ultimately, the decision to perform partial resurfacing should be taken by both the patient and the orthopedic surgeon.

Both in vitro and in vivo experiments have confirmed that platelet-rich plasma has therapeutic effects on many neuropathies, but its effects on carpal tunnel syndrome remain poorly understood. We aimed to investigate whether single injection of platelet-rich plasma can improve the clinical symptoms of carpal tunnel syndrome. Fourteen patients presenting with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study. Under ultrasound guidance, 1-2 mL of platelet-rich plasma was injected into the region around the median nerve at the proximal edge of the carpal tunnel. At 1 month after single injection of platelet-rich plasma, Visual Analogue Scale results showed that pain almost disappeared in eight patients and it was obviously alleviated in three patients. Simultaneously, the disabilities of the arm, shoulder and hand questionnaire showed that upper limb function was obviously improved. In addition, no ultrasonographic manifestation of the carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve. During 3-month follow-up, the pain was not greatly alleviated in three patients. These findings show very encouraging mid-term outcomes regarding use of platelet-rich plasma for the treatment of carpal tunnel syndrome.

Aim: To investigate the effectiveness of ultrasound-guided release of the first annular pulley and compare results with the conventional open operative technique., Methods: In this prospective randomized, single-center, clinical study, 32 patients with trigger finger or trigger thumb, grade II-IV according to Green classification system, were recruited. Two groups were formed; Group A (16 patients) was treated with an ultrasound-guided percutaneous release of the affected A1 pulley under local anesthesia. Group B (16 patients) underwent an open surgical release of the A1 pulley, through a 10-15 mm incision. Patients were assessed pre- and postoperatively (follow-up: 2, 4 and 12 wk) by physicians blinded to the procedures. Treatment of triggering (primary variable of interest) was expressed as the "success rate" per digit. The time for taking postoperative pain killers, range of motion recovery, QuickDASH test scores (Greek version), return to normal activities (including work), complications and cosmetic results were assessed., Results: The success rate in group A was 93.75% (15/16) and in group B 100% (16/16). Mean times in group A patients were 3.5 d for taking pain killers, 4.1 d for returning to normal activities, and 7.2 and 3.9 d for complete extension and flexion recovery, respectively. Mean QuickDASH scores in group A were 45.5 preoperatively and, 7.5, 0.5 and 0 after 2, 4, and 12 wk postoperatively. Mean times in group B patients were 2.9 d for taking pain killers, 17.8 d for returning to normal activities, and 5.6 and 3 d for complete extension and flexion recovery. Mean QuickDASH scores in group B were 43.2 preoperatively and, 8.2, 1.3 and 0 after 2, 4, and 12 wk postoperatively. The cosmetic results found excellent or good in 87.5% (14/16) of group A patients, while in 56.25% (9/16) of group B patients were evaluated as fair or poor., Conclusion: Treatment of the trigger finger using ultrasonography resulted in fewer absence of work days, and better cosmetic results, in comparison with the open surgery technique. It is a promising method that represents excellent results without major complications, so that it could be possibly be established as a first-line treatment in the trigger finger's disease., Competing Interests: Conflict-of-interest statement: There are no conflicts of interest related to the present study.