Trabecular titanium tailored implants in complex acetabular revision surgeries: our experience at minimum 3 years follow-up.

Hip revision surgery in cases with previous multiple reconstructive procedures is a challenging procedure. A custom-made product could be useful to obtain good results. Four cases (2 men and 2 women) of acetabular customized Trabecular Titanium (TT) implants made by 3D printed technology were performed. The mean age at surgery was 51.5 years (range 25-72). Patients were reviewed clinically and radiographically at follow-up. Mean Harris Hip Score increased significantly from 13.9 (range 6.9-20.6) preoperatively to 75.8 (range 53.9-94) at last follow-up (mean 43.5, range: 36-59), showing an improvement in terms of both pain relief, function and joint mobility. Radiographically neither signs of instability, migration nor tilting were observed. TT custom-implant made by high performance of the 3D-printing technology, system modularity, and patient-specific surgical tools permitted good clinical results and an effective restoration of the biomechanical joint parameters in these complex revision cases.

Megaprostheses in the treatment of complex fractures of the distal femur.

Total knee replacement (TKR) is a widely used procedure for the treatment of post-traumatic arthritis. This type of solution has also been used recently for the treatment of acute fractures around the knee, particularly in joints that already presented arthritis before the trauma. In case of complex fractures of the distal femur especially in older or very compromised patients, the use of a segmental implant can be an option of treatment in order to obtain a quicker recovery of the patient allowing early mobilization and weight bearing. The purpose of this paper is to present our experience with segmental TKR in the treatment of complex fractures of the distal femur highlighting the main problems associated with these conditions and focusing on the indications, principles of technique, tips, tricks and pitfalls of this procedure.

How to obtain better results, choice of implant or surgical technique? A new surgical technique with an extramedullary referenced cutting guide and a blended alignment method.

Measured resection and ligament balancing techniques are the most used in TKA; both require, in the majority of knee arthroplasty systems, a femoral intramedullary canal referencing for the distal femoral cut. Fat embolism, activation of coagulation and bleeding may occur from the reamed canal; this can be avoided with different solutions such as navigation, patient specific instruments or the use of an extramedullary device. The FuZionTM tensor was created as a blended method with the purpose to overcome the downsides of both techniques by fusing them. The aim of our study is to present the technique and the preliminary results of a cohort of patients where this instrument was customized and used as an extramedullary cutting guide for the distal femur, matching the distal femoral cut with the proximal tibial cut in order to obtain a guided, kinematically adjusted, alignment and a reduction of post-op blood loss.

Treatment of Vancouver B1, C periprosthetic hip fractures with periprosthetic polyaxial locking plate system: A 3-year follow-up.

The incidence of periprosthetic fractures after primary knee and hip arthroplasty is around 2.5% and is increasing after revision surgery up to 4%. Management of these fractures is often particularly demanding and expensive. The primary aim of the presented study is to describe our experience in using a precontoured periarticular polyaxial standard plating system in a cohort of patients with homogeneous fracture type (Vancouver B1, C), comparing our experience with other surgical solutions. In stable implants, the primary strategies aim for fracture stabilization, leaving the original prosthesis in place. The results of conventional non-locking implants have been mostly poor with complication rates up to 53%. Therefore, today, monoaxial locking plates are strongly recommended. From May 2013 to December 2014, 30 "non-contact bridging plate" (NCB-PP®) were implanted. All fractures were periprosthetic Vancouver B1 or C fractures. In 24 patients, NCB-PP® plating was performed after periprosthetic femoral fracture as primary treatment, in 6 patients, it was performed as secondary fracture treatment after primary plating failure. All surgeons performed lateral femoral approach with ORIF. Average follow up was 36 months. Bony consolidation was confirmed in all patients, bar one, in an average time of 4 months; none of the patients bar one developed mechanical failure or implant breakage. The GOS at 52 weeks was back to the preoperative level in 18 patients and it did not improve at 24 months. The Harris Hip Score at 52 weeks showed a mean score of 80.14 points. Full weight bearing was allowed at mean time of 100 days. None of the patients developed complications that needed subsequent surgery. The use of NCBPP plates has given excellent results in our clinical practice, allowing early postoperative mobilization and recovery.