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A fracture through the neck of the femoral stem in total hip arthroplasty is extremely rare. We report a neck fracture of a cementless Zweymüller stem, one of the most implanted stems worldwide. According to our knowledge, this is the first thorough case description of a neck fracture of a cementless Zweymüller stem. The case concerns a 53-year-old man, with a body weight of 103 kg and a body mass index of 31. We consider potential risk factors for a femoral stem fracture, such as patient-related factors, suboptimal implant positioning, surgical technique and implant characteristics.

Dissociation of the polyethylene insert after fixed bearing posterior stabilized Genesis II total knee arthroplasty has been rarely described. We present a case series of nine patients with a dissociation of the insert within a period of two years after surgery. Revision surgery was performed in all patients. In this report we discuss clinical presentation, patient characteristics and possible etiologies for tibial insert dissociation seen in the presented cases. In conclusion, tibial insert dissociation does not lead to a uniform clinical presentation. Therefore, in this point of view regular physical examination and imaging after TKA regardless the presence of symptoms seems to be indicated.

Item does not contain fulltext BACKGROUND: We compared the diagnostic reproducibility and accuracy of musculoskeletal radiologists with orthopaedic shoulder surgeons in 2 large medical centers in assessing magnetic resonance arthrograms (MRAs) of patients with traumatic anterior shoulder instability. METHODS: Forty-five surgically confirmed MRAs were assessed by 4 radiologists, 4 orthopaedic surgeons, 2 radiologic teams, and 2 orthopaedic teams. During MRA assessment and surgery, the same 7-lesion scoring form was used. kappa Coefficients, sensitivity, specificity, and differences in percentage of agreement or correct diagnosis (P < .05, McNemar test) were calculated per lesion and overall per the 7 lesion types. RESULTS: The overall kappa between the individual radiologists (kappa = 0.51, kappa = 0.46) and orthopaedic surgeons (kappa = 0.46, kappa = 0.41) was moderate. Although the overall percentage of agreement between the radiologists was slightly higher than that between the orthopaedic surgeons in both centers (80.0% vs 77.5% and 75.2% vs 73.7%), there was no significant difference. In each medical center, however, the most experienced orthopaedic surgeon was exceedingly more accurate than both radiologists per the 7 lesion types (81.9% vs 72.4%/74.6% and 76.5% vs 67.3%/73.7%). In 3 of 4 cases, this difference was significant. Overall accuracy improvement through consensus assessment was merely established for the weakest member of each team. CONCLUSION: Experienced orthopaedic surgeons are more accurate than radiologists in assessing traumatic anterior shoulder instability-related lesions on MRA. In case of diagnosis disagreement, these orthopaedic surgeons should base their treatment decision on their own MRA interpretation.