Vitamin E-stabilized polyethylene shows similar survival rates at minimum 7-year follow-up compared to conventional polyethylene in primary total knee arthroplasty.

Purpose: The aim of this cross-sectional study was to compare survival, clinical and radiographic results of total knee arthroplasty (TKA) with vitamin E-stabilized polyethylene (VEPE) or conventional polyethylene (CPE) at a minimum of 7-year follow-up. Methods: Patients who underwent primary TKA between 2011 and 2015, receiving the same cemented rotating platform knee design with VEPE or CPE tibial inserts, were identified. Patients were contacted for clinical and radiographic follow-up. American Knee Society Score (KSS), Forgotten Joint Score (FJS-12), presence of periprosthetic radiolucent lines (RLLs) and osteolysis were evaluated at the last follow-up. Any revision, reintervention or other complications were recorded. Results: Among 350 TKAs initially identified, 102 VEPE and 97 CPE knees were included for analysis with mean follow-up of 8.5 and 8.3 years, respectively. No significant difference was found in survival rates at 10-year follow-up with revision due to aseptic loosening (95.0% vs. 97.8%, p = 0.29) or due to any reason (87.6% vs. 89.6%, p = 0.78) between VEPE and CPE TKA. KSS function score resulted significantly higher in the VEPE group over CPE (77 vs. 63, p = 0.01). RLLs were more frequent in VEPE than CPE (54% vs. 32%, p = 0.05), mainly noticed medially and posteriorly beneath the tibial plate, adjacent to the trochlear shield and the posterior condyles. Osteolysis was observed in one knee per group, but patients were asymptomatic with stable implants. Conclusion: TKA with VEPE and CPE tibial inserts showed comparable survival rates, complications and clinical and radiographic results up to 10-year follow-up. Level of Evidence: Level III.

Management of Paprosky type three B acetabular defects by custom-made components: early results.

PURPOSE: Our study aims at the evaluation of the recently introduced Lima Promade custom-made acetabular device for the treatment of complex acetabular Paprosky 3B defects. METHODS: Between 2016 and 2018, eight patients with major acetabular osteolysis and multiple revisions history were treated with a custom-made implant in a single centre and by a single surgeon. We assessed patients' demographics, peri-operative data, and complications and a specific questionnaire was submitted to the surgeon after each procedure. RESULTS: All the devices were correctly positioned. In two over eight cases, a post-operative dislocation occurred, where extensive soft tissue impairment was present. The questionnaire showed a good pre-operative and intra-operative experience of the surgeon. CONCLUSIONS: The Promade custom-made acetabular system showed encouraging results for complex defects and the entire procedure was positively rated. Further analysis with a higher number of cases and a longer follow-up should be performed for a complete clinical and cost-effective evaluation.

Survival in patients operated on for pathologic fracture: implications for end-of-life orthopedic care.

PURPOSE: Life expectancy is routinely used as part of the decision-making process in deciding the value of surgery for the treatment of bone metastases. We sought to investigate the validity of frequently used indices in the prognostication of survival in patients with metastatic bone disease. METHODS: The study prospectively assessed 191 patients who underwent surgery for metastatic bone disease. Diagnostic, staging, nutritional, and hematologic parameters cited to be related to life expectancy were evaluated. Preoperatively, the surgeon recorded an estimate of projected life expectancy for each patient. The time until death was recorded. RESULTS: Kaplan-Meier survival analyses indicated that the survival estimate, primary diagnosis, use of systemic therapy, Eastern Cooperative Oncology Group (ECOG) performance status, number of bone metastases, presence of visceral metastases, and serum hemoglobin, albumin, and lymphocyte counts were significant for predicting survival (P < .004). Cox regression analysis indicated that the independently significant predictors of survival were diagnosis (P < .006), ECOG performance status (P < .04), number of bone metastases (P < .008), presence of visceral metastases (P < .03), hemoglobin count (P < .009), and survival estimate (P < .00005). Diagnosis, ECOG performance status, and visceral metastases covaried with surgeon survival estimate. Linear regression and receiver-operator characteristic assessment confirmed that clinician estimation was the most accurate predictor of survival, followed by hemoglobin count, number of visceral metastases, ECOG performance status, primary diagnosis, and number of bone metastases. Nevertheless, survival estimate was accurate in predicting actual survival in only 33 (18%) of 181 patients. CONCLUSION: A better means of prognostication is needed. In this article, we present a sliding scale for this purpose.