Elective orthopaedic procedures, and particularly total hip arthroplasty (THA), in octogenarians and nonagenarians patients are burdened of several implications. Besides the comorbidities and the anesthesiological issues, legal and ethical implications are present. Some literature data show the clinical improvement of THA in elderly patient but the psychological aspects are not yet evaluated. Aim of this study is to evaluate the clinical aspects and the psychological impact in daily living in octogenarians and nonagenarians patients addressing THA.

We conducted a retrospective evaluation of 81 THA in 81 patients of age more than 85 years with a minimum follow-up of 6 months. Clinical aspects were evaluated using the Hip disability and Osteoarthritis Outcome Score (HOOS). The psychological issues were evaluated with the Short Form 12 (SF-12) using both the Physical Component Summary (PCS) and the Mental Component Summary (MCS). From the starter cohort of 81 patients, 8 patients were died for causes unrelated to surgery, 13 were lost to follow-up, 1 patient was revised for periprosthetic fracture; 59 patients composed the final cohort. Mean HOOS rased from 18,07 ± 17,81 to 92,36 ± 5,74 with statistically significant distribution both in the global score than in all of the different subscales. The PCS raised from 26,81 ± 10,81 to 51,86 ± 4,45 and The MCS raised from 34,84 ± 10,81 to 56,70 ± 5,04, but none of them showed a statistically significant distribution. THA in octogenarians and nonagenarians patients could be a safe procedure with positive results for clinical and psychological aspects.

Fractures of the prosthetic components after total knee arthroplasty (TKA) are rare but dangerous complications, sometimes difficult to diagnose and to manage. Aim of this study is to evaluate the incidence of component breakage and its treatment in our single institution's experience. We retrospectively review our institution registry. From 605 revision knee arthroplasties since 2000 to 2018, we found 8 cases of component breakage, of these 3 belonged to UKA, and 5 belonged to TKA. The UKA fractures were all on the metal tibial component; while 4 TKA fractures were ascribed to the liner (2 Posterior-Stabilized designs and 2 constrained designs) and only one case was on the femoral component. For every patient a revision procedure was performed, in two cases a tibial tubercle osteotomy was performed, while in one case (where the fracture was of the post cam) an arthroscopy was performed prior to the arthrotomy. All of the UKA fractures were treated with a standard revision implant. As regard the TKA, 2 liner fractures were treated with the only liner exchange, while the other 2 liner fractures and the fracture of the metallic component were treated with total knee revision. No intra- and post-operative complications were found. Component breakage after TKA is a serious complication. Its treatment, always surgical, can hide pitfalls, especially if the timing is not correct; indeed apart from the revision of one or more components, the surgeons must address any issues of management of bone defect and ligamentous stability.

Introduction and Objective

Difficult primary total knee arthroplasty (TKA) and revision TKA are high demanding procedures. Joint exposure is the first issue to face off, in order to achieve a good result. Aim of this study is to evaluate the clinical and radiological outcomes of a series of patients, who underwent TKA and revision TKA, where tibial tubercle osteotomy (TTO) was performed.

Introduction and Objective

A proper restoration of hip biomechanics is fundamental to achieve satisfactory outcomes after total hip arthroplasty (THA). A global hip offset (GO) postoperatively reduction of more than 5 mm was known to impair hip functionality after THA. This study aimed to verify the restoration of the GO radiographic parameter after primary THA by the use of a cementless femoral stem available in three different offset options without length changing.

Introduction: Acetabular bone defects are critical and frustrating issue; indeed is possible to obtain good reconstruction with conventional Methods: (i.e. bulk graft, cage and cement) but good results are limited to short and mid term. Aim of this paper is to present reconstructive method based on filling the defect with an augment made of tantalum (augmentation technique).

Methods: We analized 42 cases from February 2005 to March 2009 with an average age of 63 years old with acetabular defect, scored 3A or more (4 patients had pelvic disjunction) according Paprosky classification.

The average age was very low, with 12 cases under 60 years (28,57%) and 21 under 70 (50%). 18 patients were re-revision (at time of surgery were at third or fourth surgical procedure) representing 54,2% of cases. Complete clinical, radiographic evaluation and survivorship analysis for the entire study cohort was performed from an average follow up of 26 months (min 6–max 55 months).

Results and Discussion: Preliminar results are encouraging: in only two case we had poor results with step pain and prescribed partial load and walking with two crutches, slight radiographic sign of migration where present at the last follow-up. These patients were previously submitted to many surgical procedures with significant bone loss, soft tissue damages and both with history of previous infection, classified as pelvic disjunction. One of these reported a ischiatic palsy.

In the remaining cases we obtained good functional recover, no failures at two years average of follow-up. 40 patients didn’t show hip or groin pain during stance position or walking, no bone resorption or implant mobilization were seen at radiographic follow-up. The HHS increases from 23,04 pre op to 85,15 post op. In no case were found clinical, radiographic, or biochemical signs of infection.

According with literature the rationale of augmentation technique with trabecular metal should give long lasting favourable results for its excellent bone ingrowth and mechanical properties.

Our results almost match the results of other authors. These brilliant results, partially due to osteoconductive proprieties of tantalum (despite we require time to confirmate), are certainly obtained thank to the optimal centre of rotation reconstruction, always close the physiological one.