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Background: Non-unions after intramedullary nailing of femoral shaft fractures are a significant problem. Treatment options such as augmenting with plates or exchange nailing have been proposed. The ideal treatment remains controversial. Methods: Augmentative plating using a 4.5 mm LCP or a 3.2 mm LCP leaving the nail in situ was tested biomechanically and compared to exchange intramedullary nailing in a SawboneTM model of a femoral shaft non-union. Results: The difference of fracture gap motion in axial testing was small. In rotational testing, the exchange nail allowed for the largest amount of motion. The 4.5 mm augmentative plate was the most stable construct in all loading conditions. Conclusions: Augmentative plating using a 4.5 mm LCP plate while leaving the nail in situ is biomechanically superior to exchange intramedullary nailing. A small fragment 3.2 mm LCP is undersized and does not reduce fracture motion sufficiently in a femoral shaft non-union. [ABSTRACT FROM AUTHOR]

Over the last two decades, there has been a growing emphasis on the publication quality in Foot & Ankle research. A level-of-evidence rating system for clinical scientific papers has been proposed by the Centre for Evidence-based medicine in Oxford, United Kingdom. As opposed to other subspecialities, foot & ankle surgery deals with a wide variety of clinical problems and surgical solutions, which in turn leads to a generally low number of patients available for study groups. However, level III and IV studies still have a valuable place in orthopaedic research, given the challenges in running high-level studies.The measurement of outcomes in medicine from the patients' perspective (PROMS:(patient reported outcome measures) has grown almost exponentially in all surgical specialties including foot & ankle surgery. There are many PROMs available to foot & ankle surgeons, but there is little consensus on which assessment is most appropriate for a given procedure or diagnosis. Their use in research and clinical practice offers many advantages in clinical practice and research, however, besides the advantages there are also some downsides. [ABSTRACT FROM AUTHOR]

Purpose: Two-stage revision hip arthroplasty using an antibiotic-loaded spacer is the most widely performed procedure for infected hip arthroplasties. The clinical outcome of this type of surgery compared with aseptic joint revision with exchange of femoral and acetabular components is still controversial due to the relative lack of medium- to long-term follow-up. Therefore, we analysed clinical and radiological outcomes of septic two-stage revisions compared with aseptic hip revision surgeries.Methods: In this retrospective study we assessed 82 consecutive patients who underwent two-stage revision for septic total hip (45 patients) or one-stage aseptic revision arthroplasty (37 patients). The average follow-up was 53 months for the aseptic group and 55 months for the septic group. For clinical evaluation, we used the Harris Hip Score (HHS) and the Merle d'Aubigné and Postel score. The postoperative pain level was determined with the visual analogue pain scale.Results: The surgeries were performed 124 months (aseptic group) and 119 months (septic group) after primary total hip arthroplasty on average. The main indications for aseptic revision surgeries were aseptic loosening (96%), dislocation (2.2%), and periprosthetic fracture (2.2%). In the clinical outcome patients achieved 75.5 points in the aseptic group and 73.4 points in the septic group in the Harris Hip Score. The Merle d'Aubigné and Postel Score revealed 12.5 points for the aseptic group and 13.1 points for the septic group. Mean level of persisting pain was 0.8 (aseptic group) and 0.4 (septic group) on the visual analogue scale (VAS). Overall survival in the aseptic group was 85.6% at 9.8 years 82.7% at 10.1 years for the septic group, with a repeat revision rate of 8.1% and 6.7%, respectively.Conclusions: Performing aseptic acetabular and femoral revision hip arthroplasty showed equal clinical outcomes in relation to septic two-stage revision hip surgeries. Our results showed a tendency for better outcome in comparison with the information given in the literature for septic and nonseptic exchange arthroplasties, including a lower rate of re-revisions. [ABSTRACT FROM AUTHOR]

Purpose: Revision hip arthroplasty using a modular head-neck adapter gives the possibility of keeping a well-fixed femoral component while revising the acetabular prosthesis or femoral head and adapt leg length and femoral offset to the individual anatomy intraoperatively. The success of this kind of surgery is still unclear due to the lack of medium- to long-term follow-up. Therefore, we analyzed the clinical and radiological outcome of the modular Merete BioBall© adapter system in revision hip surgery.Methods: In this retrospective study, we included 95 consecutive patients with a Merete BioBall© adapter system implanted during revision hip arthroplasty. The average follow-up was 52.5 months. For clinical evaluation, we used the Harris Hip Score. The health-related quality of life was determined with the visual analog pain scale.Results: The surgeries were performed 97 months after prior hip arthroplasty on average. The main indications for the Merete BioBall© adapter system were dislocation, acetabular loosening, and wear. In the clinical outcome, patients achieved 80.9 points in the Harris Hip Score. The mean level of persisting pain was 1.4 (VAS). The overall survival of the Merete BioBall© system in revision hip arthroplasty revealed 92.8 % survival at 8.17 years follow-up with a repeat revision rate of 5.2 %.Conclusions: Performing revision hip arthroplasty using the Merete BioBall [ABSTRACT FROM AUTHOR]

Purpose: Revision hip arthroplasty using a modular tapered design gives the possibility for customising the prostheses to the individual anatomy intra-operatively. The success of this kind of surgery is still controversial due to the relative lack of medium- to long-term follow-up. Therefore we analysed the clinical and radiological outcome of the modular MRP-TITAN stem with diaphyseal fixation in revision hip surgery. Methods: In this retrospective study we included 136 consecutive patients with MRP-TITAN stem implanted during revision hip arthroplasty. The average follow-up was 55 months. For clinical evaluation we used the Harris Hip Score and the Merle d'Aubigné and Postel score. The health-related quality of life was determined with the visual analogue pain scale. Results: The surgeries were performed 109 months after primary total hip arthroplasty on average. The main indications for the MRP-TITAN revision stem were aseptic loosening, infection, and periprosthetic fracture. In the clinical outcome, patients achieved 75.1 points in the Harris Hip Score and 14.4 points in the Merle d'Aubigné and Postel Score. Mean level of persisting pain was 0.7 (VAS). The overall survival of the MRP stem in revision hip arthroplasty revealed 85.6 % survival at 9.75 years' follow-up with a repeat revision rate of 6.8 %. Conclusions: Performing revision hip arthroplasty using the MRP-TITAN stem revealed a good clinical outcome. There is a tendency for better results in comparison with the information given in literature for cementless modular revision stems including a lower rate in re-revisions. [ABSTRACT FROM AUTHOR]

Purpose: Total knee arthroplasty using a modular design gives the possibility for an isolated exchange of the tibial polyethylene insert in patients with failed total knee arthroplasty. The success of this kind of surgery is still controversial. We analysed the clinical outcome after isolated tibial polyethylene insert exchange. Methods: In this retrospective study we included 62 consecutive patients with an isolated tibial polyethylene insert exchange at our institution. The average follow-up was 35 months. For clinical evaluation we used the Oxford Knee score, the Knee Society score, the Turba score, and the Kujala score. The health-related quality of life was determined with the SF-36 score and the visual analogue pain scale. Results: The operations were performed 73 months after primary total knee arthroplasty on average. The main reasons for isolated tibial polyethylene insert exchange were instability and wear. In the clinical outcome patients achieved 31.5 points in the Oxford Knee score, 120.5 points in the Knee Society score, 9.3 points in the Turba score, and 49.0 points in the Kujala score. Mean level of persisting pain was 2.2. In the SF-36 score patients achieved 36.3 points physical and 51.7 points mental. The overall survival for isolated tibial insert exchange revealed 72.2 % survival at 6.25 years follow-up with a repeat revision rate of 11 %. Conclusions: Isolated tibial polyethylene insert exchange revealed a good clinical outcome. There is a tendency for better results in comparison with the information given in literature for most of the parameters including a lower rate in repeat revision. [ABSTRACT FROM AUTHOR]