Prosthetic Replacement Research Articles

Percutaneous cementoplasty of periprosthetic aseptic hip loosening

Progressive population aging and improved healthcare have led to a significant increase in patients with hip arthroplasty (HA). In this patient group, the proportion of those who require a new arthroplasty (prosthetic replacement or secondary revision of the hip), has also increased. For this subgroup of patients in whom surgical prosthetic replacement should be considered but is contraindicated, a new technique has been developed since 2010: percutaneous injection of periprosthetic cement under fluoroscopic or CT control ("femoroplasty; FMP") as an alternative and less invasive treatment compared to surgery to stabilize the HA without replacing it, with excellent results on patients' quality of life. In this brief communication, we describe our positive experience regarding FMP, which we have performed for the first time in Spain on four patients (age range between 74–83 years, 2 female and 2 male patients, 3 right HA and 1 left HA), without post-complications. We highlight both the relative simplicity of this technique, which can be incorporated into radiological intervention even in regional hospitals, and the significant clinical improvement observed in all patients. In conclusion, we hope that our experience can contribute to the increased adoption of this innovative technique within the scientific community.

Chondrogen™ Injection for Knee Osteoarthritis using Stem Cells from Wharton's Jelly

Knee osteoarthritis constitutes a prominent source of pain and functional impairment, with its prevalence showing a consistent yearly increase. Current therapeutic strategies primarily revolve around addressing symptoms and, in severe cases, resorting to prosthetic joint replacement, yet they fail to target the underlying pathophysiological mechanisms driving degeneration. In this context, there is a growing interest in investigating mesenchymal stem cell (MSC) therapy as a potential remedy for osteoarthritis. Among the various MSC types under scrutiny, using Wharton's Jelly-derived mesenchymal stem cells (WJ-MSCs) has garnered relatively scant attention. The present study represents a Phase I clinical trial of an open-label, single-arm design within this context. Its principal aim is to assess the safety and efficacy of administering mesenchymal stem cells derived from Wharton's Jelly via intra-articular injection for patients diagnosed with knee osteoarthritis. Throughout six months, this investigation discerned a statistically significant overall improvement in clinical presentation relative to baseline. This improvement manifested as reduced analgesic consumption, diminished Visual Analog Scale (VAS) scores (19.5 to 18.7 mm, p = .00), and augmented functional assessment scores, including the IKDC Score (enhanced from 62.2 to 100, p = .00), KOOS Symptoms and Stiffness subscales (elevated from 76.8% to 10.6%, p = .00), as well as KOOS Pain subscale (upgraded from 74.4% to 10.1%, p = .00). The study encouragingly reported no significant adverse effects during the observation period. However, upon radiographic evaluation, no significant alterations were observed in terms of deformity angle (p = 0.957) or medial (p = 0.871) and lateral (p = 0.520) compartment joint space widths. To further elucidate the comparative efficacy of this treatment, it is prudent to contemplate a randomised controlled trial comparing it against the conventional hyaluronic acid regimen, thereby contributing to an enriched understanding of its therapeutic potential.

Long-term study using of short stems with ceramic-on-metal bearing in hip replacement

Abstract Background Osteoarthritis is a disease that affects about 300 million people in the world. Surgery is indicated in cases where all other treatments have failed, in economic terms expenses are between 1 and 2.5% of the GDP of the most industrialized countries in the world. Hip prosthetic replacement surgery is the gold standard for patients affected by symptomatic osteoarthritis. The ceramic-on-metal (C-M) hybrid hard-on-hard bearing was initially launched on the market with the purpose of reducing adhesive and corrosion wear, loss of metal debris and ions and risk of fracture and squeaking. However, this bearing was withdrawn from the market, in the apprehension of local and systemic toxicity. The aim of this study is to evaluate the reliability and safety of ceramic-on-metal bearing at long term follow-up. Methods From 2 cohorts of patients suffering of hip osteoarthritis who underwent total hip arthroplasty using ceramic-on-metal bearing with two different short stems, 19 of the GROUP A and 25 of the GROUP B were suitable for this study. All compared clinically using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF12P/M), and radiographically. The two groups were compared in terms of metal ions blood levels (chromium and cobalt), and finally all the implanted prostheses were compared with a healthy control group. Results All the implanted stems were well osseointegrated at a mean follow-up of 114 months. Radiographical and clinical scores performed well. Chromium and cobalt ion analysis revealed values below the safety threshold except for 3. No revision occurred. Conclusions Ceramic-on-metal bearing is safe and reliable at long term follow-up in association to short stems arthroplasty, if the implant is correctly positioned. Chromium and cobalt metal ions blood levels evaluation should be performed annually. Key messages • Metal ions evaluations is mandatory in patients with ceramic-on-metal bearing. • Ceramic-on-metal bearing is safe and reliable at long term follow-up, if the implant is correctly positioned.

Bone Tumour Sterilization Using Pasteurization for Autologous Bone Reconstruction

Primary bone malignancies have incidence of 0.2% among all malignant tumours and 15% in all primary tumours. The commonest primary bone malignancy is osteosarcoma which the frequency had increased by 0.3% yearly over the last decade. Improvement in treatment of bone sarcoma by multidisplinary protocols involving diagnostic imaging, chemotherapy and surgical technique has improved the survival rate from 20% to 80%, hence paradigm of treatment shifted from amputation to limb preserving surgery. Bone reconstruction techniques varies from prosthetic replacement, allograft and bone autograft method. Bone autograft method needed sterilizing technique to devitalised tumour cells and pasteurization is a good option in maintaining its biomorphogenic properties when heated to 60°C -70°C for 30-40 minutes. This article will be discussing on histopathology findings, biomechanical outcome and clinical outcome of bone reconstruction using pasteurized autograft bone method. The advantages of pasteurization include less risk of disease transmission, no risk of allogenic immunogenicity, readily available, simple, less expensive and satisfactory bone remodelling. However, in certain cases it also shows deteriorating outcome in long term follow up due to issues with graft fracture, infection and resorption.

The dental technician as a member of the hypodontia multidisciplinary team, with practical considerations for anterior restoration design

Most patients seeking treatment for hypodontia will require prosthetic replacement of their missing teeth. This will be in the form of dentures, bridges and implant restorations. As these are created by one or more dental technicians who supports the clinical team, a close working relationship between these colleagues is likely to improve the quality of treatment outcome. This interaction will usually occur towards the end of the patient's treatment process, when definitive restorations are prescribed. However, appropriately trained and experienced dental technicians should be involved throughout the patient's treatment process as an integral part of the multidisciplinary team approach to effectively manage these patients.This paper describes the contribution of dental technicians to patient care with particular focus on communication between the restorative dentistry clinical team and the dental technician to improve the quality of anterior restorations. As missing maxillary lateral incisor teeth are a common presentation for this patient group, further technical detail relating to planning resin-bonded bridges for replacement of these teeth is included.

Primary total elbow arthroplasty, is there a correlation between smoking and postoperative complications? A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program Database

BackgroundSmoking has been suggested to be correlated with increased rates of several postoperative complications following total joint arthroplasty. As the utilization of total elbow arthroplasty (TEA) continues to rise, identifying modifiable factors to best optimize the patient is crucial. The goal of this study is to identify if a correlation exists between smoking status and 30-day postoperative complications following TEA. MethodsData were obtained from the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2021 using Current Procedural Terminology code 24363 (Arthroplasty, elbow, with distal humeral and proximal ulnar prosthetic replacement; total elbow). Patients were placed into 1 of 2 cohorts based on smoking status. A multivariate logistic regression was used to compare rates of postoperative complications between cohorts and odds ratios (ORs) were calculated to evaluate risk of postoperative complications. ResultsSmoking was not found to be significantly correlated with any recorded complication, including surgical site infection (OR = 1.98, P = .219), sepsis (OR = 0.84, P = .879), hospital readmission (OR = 1.9, P = .136), return to operating room (OR = 1.06, P = .913), pulmonary embolism (OR = 0.91, P = .933), and blood loss requiring transfusion (OR = 0.36, P = .211). DiscussionThis study suggests no significant correlation between smoking and increased rates of complications following TEA in the 30-day postoperative window, such as postoperative surgical site infection, hospital readmission, or sepsis. ConclusionThis study found no significant correlation between smoking and complications within the 30-day postoperative window, supporting the safety of TEA procedures for smokers. However, perioperative smoking cessation is still recommended as part of medical optimization before surgery. The results provide a valuable tool for risk stratification in TEA patients, especially smokers, during the acute postoperative phase. Decisions regarding TEA surgery should involve shared decision-making between the surgeon and patient, considering multiple factors.

Critical Appraisal on the Role of Warfarin in the Current Era.

Warfarin has been the most extensively used oral anticoagulant (OAC) in medical settings for over 60 years. Its uses, potential adverse effects, and methods for reversing its effects have been firmly established, rendering it a routine medication in medical settings where most professionals feel at ease employing it. Compared to other vitamin K antagonists (VKAs), such as acenocoumarol, warfarin offers benefits like diminished prothrombin time (PT) assays leading to enhanced oral anticoagulation. Observations over the past few years have seen the inclusion of novel/direct OACs (NOACs/DOACs) in the anticoagulant armamentarium. Although DOACs have several advantages, warfarin still has an important role in subsets of patients where DOACs are contraindicated, not well-tolerated, or cannot afford DOACs due to higher costs. Moreover, there are patient profiles where warfarin is still considered a superior choice compared to DOACs, such as age group of >75 years, kidney failure with creatinine clearance (CrCl) below 30 mL/minute, and prosthetic mechanical valve replacement. Precise management of the international normalized ratio (INR) is crucial for the effectiveness of warfarin treatment. INR monitoring is the major concern in the Indian context due to the lack of laboratories for standardized measurement. Adopting strategies such as point-of-care INR monitoring devices and anticoagulation clinics can help to improve clinical outcomes with warfarin therapy. The present review provides a critical overview of the role of warfarin therapy in the current OAC arsenal and strategies for improving therapeutic control and patient adherence. How to cite this article: Nair T. Critical Appraisal on the Role of Warfarin in the Current Era. J Assoc Physicians India 2023;71(10):31-36.

Bleeding Death after Prosthetic Blood Vessel Replacement Surgery and Being Awarded Compensation

Bleeding Death after Prosthetic Blood Vessel Replacement Surgery and Being Awarded Compensation

Geriatric proximal humerus fracture operative management: a Truven Health Analytics database study (2015-2020)

The purpose of this study is to assess the trends in operative management of geriatric (≥65 years) proximal humerus fractures during a six-year period (2015-2020) within an insurance claims database. This retrospective database cohort study utilized data gathered from the 2015-2020 IBM Truven MarketScan Commercial and IBM Truven MarketScan Medicare Supplemental databases. The ICD10 data was correlated to the CPT code for shoulder arthroplasty [proximal humeral prosthetic replacement (23616), shoulder hemiarthroplasty (HA)(23470), reverse total shoulder arthroplasty (rTSA)(23472)] or open reduction internal fixation (ORIF) [open treatment of proximal humerus fracture with internal fixation (23615), open treatment of proximal humerus fracture-dislocation with internal fixation (23680)] We investigated the number of proximal humerus fracture operative cases per year, percent arthroplasty used per year, rTSA and HA per year, hospital cost information as well as percent arthroplasty per US geographic region. A total of 8,057 operative proximal humerus fractures cases were identified in 7,697 patients over 65 years of age, with 0.45% (360/8,057) being bilateral. There was a 40.8 % decrease in the rate of operative management of proximal humerus fractures between the first half (2015-2017, 1687.3 +/- 146.6) and second half of the study period (2018-2020, 998.3 +/- 258.7). Arthroplasty accounted for 78.7% of all surgeries, and 91% of those being rTSA. The total number of cases, rTSA and ORIF performed decreased per year (p=.01). The downward trend of percent ORIF per year approached significance (p=.054). Arthroplasty was a more expensive payment for total case option by almost $850.00 (p=.001). There was a larger percentage of arthroplasty performed in the Northeast, and North central US geographic regions. Despite the rise of both the elderly population and related geriatric proximal humerus fractures, there were less operatively represented in this insurance claims database across the six-year period. There may be a trend to utilize less ORIF when addressing these fractures. Although it incurred a higher in-hospital cost, Arthroplasty was being performed at a higher percentage in the Northeast, and North central regions of the United States.

Wide-Awake Local Anesthesia No Tourniquet for Rhizarthrosis Surgery: Technique and Experience for 16 Consecutive Cases.

Since it was described, wide-awake local anaesthesia no tourniquet (WALANT) has gainedpopularity. Our department has started using WALANT for hand surgery with increasing complexity.We present our results with WALANT rhizarthrosis surgery, including prosthetic replacement, trapeziectomy with suture button suspensionplasty and revision surgery. Aretrospective review of all rhizarthrosis procedures underWALANT was performed from April 2021 to July 2022. We included patients who fulfilled inclusioncriteria and had adequate imaging and clinical follow-up. A satisfaction survey was performed by telephone. Surgical time, complications, conversion to conventional anesthesia, pain, anxiety and global satisfaction were recorded. Tumescent anesthesia is performed 20-25 minutes before surgery, and isperformed in four or five strategic locationsthat allow adequate anesthesia and vasoconstriction for the procedure to be comfortably carried out. We observed a series of 16 sequential surgeries involving 14 patients. All were female with a mean age of 65 years. Fourteen cases were performed due to primary rhizarthrosis, eight trapeziectomies with suture button suspensionplasty, six prosthetic replacements, and two revision surgeries.One patient needed to be converted to conventional anaesthesia due to anxiety during the procedure. Mean procedure time was 73 minutes.There were no WALANT-related complications.Mean patient-reported satisfaction with the anesthetic technique was a 9 (on a scale from 1 to 10) and 100% of patients would choose to undergo surgery with WALANT anesthesia for a future procedure.We find it useful to actively engage the patients during surgery to keep them comfortable and also help the surgeons assess stability and functional results.After wound closure, the hand is shown to the patient and he performs various tasks.There is somewhat of a learning curve for rhizarthrosis surgery under WALANT; patient comfort can be achieved through an adequate anesthetic technique and reassurance before and during surgery. We recommend that the first few cases be done in the presence of an anesthesiologist and a fasting patient in case there is a need to convert to conventional anesthesia. Wide awake rhizarthrosis surgery,even revision surgery, is safe and pain-free. Patient-reported satisfaction is also high. The authorsfind that including patient participation in their own surgery might be promising for post-op rehabilitation. There are limitations in this study such as the absence of a control conventional anesthesia group, the satisfaction questionnaire was not done immediately post-operatively, as such, a memory bias cannot be excluded, and it is not yet validated for the Portuguese population.

Salmonella Enteritidis ST11 Prosthetic Valve Endocarditis Complicated by a Paravalvular Abscess: Case Report and Literature Review

Salmonella infection typically causes self-limiting gastroenteritis. However, in rare cases, it can lead to prosthetic valve endocarditis (PVE), especially in older adults with a history of valve replacement surgery. In this case study, we describe a case of Salmonella PVE in a man with a prosthetic aortic valve. Complications of PVE include abscess formation, which is associated with increased mortality. If a patient with a history of prosthetic valve replacement presents with symptoms suggestive of gastroenteritis or bacteremia, a thorough investigation should be conducted with suspicion of PVE. The prognosis of Salmonella PVE can be improved by promptly initiating appropriate antibiotics and administering them for an adequate duration, as well as by considering surgical intervention when necessary. Additionally, confirming negative blood cultures after treatment of Salmonella bacteremia is important to prevent the development of PVE and paravalvular abscesses.

Multiple Emboli Caused by Mechanical Mitral Valve Thrombosis: A Case Report

We present the case of a 51-year-old woman with a history of atrial fibrillation and rheumatic heart disease who underwent a prosthetic mitral valve replacement two years ago. Despite receiving anticoagulant therapy, this patient experienced embolisms, including embolic strokes and a coronary embolus, over a month. Following a cardiology evaluation, it was determined that mechanical valve thrombosis was the primary source of embolism, and embolisms ceased following a replacement. This case report illustrates the difficulty in diagnosing prosthetic valve thrombosis as a source of multiple emboli in patients receiving adequate anticoagulant therapy, a rare but potentially fatal complication of mechanical valve replacement.

Proximal Humerus and Proximal Femur Fractures with Nasu-Hakola Disease Treated with Prosthetic Replacements: A Case Report

Proximal Humerus and Proximal Femur Fractures with Nasu-Hakola Disease Treated with Prosthetic Replacements: A Case Report

The use of radiographs to assess the impact of the distance between the contact area and the crest of the bone to predict the presence or absence of interdental papilla: an in vivo study.

Introduction Black triangles (interdental papilla) pose an aesthetic problem for both the patient and the clinician. They also can have an impact on phonetics and periodontal health. It is useful to predict the presence of a black triangle to inform the patient of potential aesthetic compromises. The aim of this study to assess whether the risk of black triangle formation can be predicted using radiographs.Material and methods In total, 404 interproximal sites from 80 random patients attending for a periodontal assessment were measured after radiographs were digitised. The percentage of black triangles within the range of measurements of the crestal bone to the contact area from <5 mm up to 8 mm and over was then calculated.Results At a distance of 5 mm or less, the papilla was present 87.5% of the time. At 6 mm, a black triangle was present 51.4% of the time, and at 7 mm or greater, a black triangle was present 72.7% of the time. When these results were compared to other studies that had different criteria and methods, they were all very similar.Conclusion Using radiographs appears to be useful in assessing the presence or absence of a black triangle in patients who are assessed for periodontal disease, prosthetic replacement, implants in the aesthetic zone, or cosmetic treatment.

Occult deterioration of an aortic annular abscess: how do we diagnose a pseudoaneurysm periaortic valve? A case report

BackgroundInfectious endocarditis (IE) is a disease caused by the colonization of toxic microorganisms on the endocardium of heart valves [1]. Although much progress has been made in the diagnosis and treatment of IE, its complications, such as annular abscesses [2], still have a high mortality rate. In this case, we describe a patient with infective endocarditis complicated by occult deteriorated aortic annular abscess.Case presentationA 44-year-old man was admitted due to weakness of his right limbs and unclear speech for 10 h. He had recurrent fevers for 1 month before admission. Transthoracic echocardiography showed a mix-echoic vegetation attached to the bicuspid aortic valve, moderate aortic regurgitation and a possible aortic annular abscess. Blood cultures were negative and empiric antibiotic therapy was begun. The patient did not have fever again and seem to be clinically improved. However, follow-up transesophageal echocardiography revealed a large periaortic abscess led to aortic sinus pseudoaneurysm. The patient underwent mechanical prosthetic valve replacement and annulus reconstruction successfully. Perivalvular abscess may be insidious deterioration in patients who seem to be clinically improved, which requires us to pay more attention.DiscussionOccult deterioration of an aortic annular abscess is rare and more attention should be paid. Re-evaluation of echocardiography is required even if the patient’s symptoms improve.

The impact of orthodontic treatment on a young person’s quality of life, esthetics, and self-esteem in hypodontia: A longitudinal study

This research aimed to evaluate the impact of orthodontic treatment on a young person's oral health-related quality of life, self-esteem, and esthetics concerning hypodontia. A prospective longitudinal hospital-based study recruited 97 participants with hypodontia, aged 11-18 years. Forty-one participants (42%) originally planned to have space closure and the remainder space opening, with subsequent prosthetic replacement. The following questionnaires were completed before and after orthodontic treatment: the child perception questionnaire, Bristol condition-specific questionnaire for hypodontia (BCSQ), the child health questionnaire, and the Oral Aesthetic Subjective Impact Scale (OASIS). The Wilcoxon and matched pairs t tests approach was applied to compare before and after orthodontic treatment for significant testing (P<0.05). Fifteen participants were lost to follow-up, resulting in 82 participants completing orthodontic treatment, with an average age of 13.8 ± 1.71 years. A total of 282 teeth were missing in the sample. Treatment resulted in significantly lower indexes (P<0.001) to overall BCSQ, OASIS, appearance, and how others would treat them. In comparing the 2 subgroups, those treated with space closure had significantly reduced functional limitations (child perception questionnaire), appearance concerns, self-esteem (child health questionnaire), OASIS, and overall BCSQ scores. Orthodontic treatment in participants with hypodontia appears to significantly impact a range of psychological and esthetic scales. In particular, space closure appears to significantly improve the quality of life of participants compared with those undergoing space opening.

Cone repair after tricuspid valve replacement in Ebstein anomaly.

Cone repair after tricuspid valve replacement in Ebstein anomaly.

FEMORAL NECK FRACTURES, EPIDEMIOLOGY, ANATOMICAL DESCRIPTION, MECHANISM OF ACTION, CLASSIFICATION, CLINICAL EVALUATION, IMAGING EVALUATION, TREATMENT AND COMPLICATIONS

Introduction: Femoral neck fractures (FNF) are frequent and devastating injuries in orthopedics and traumatology. It usually has several therapeutic options depending on the type of fracture and the comorbidities of the affected individual, among the conservative treatment alternatives are bed rest with or without traction and among the surgical alternatives are internal fixation. Objective: to detail the current information related to femoral neck fractures, epidemiology, anatomical description, mechanism of action, classification, clinical evaluation, imaging evaluation, treatment and complications. Methodology: a total of 40 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 31 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: fractures, femur, femoral neck, prosthesis, trauma. Results: 80% are generated in women, and the incidence doubles every 5 to 6 years in women over 30 years of age. It presents bimodal incidence. The risk factors are female sex, white race, advanced age, poor health, smoking, alcohol consumption, previous fractures, history of falls and low estrogen concentrations. Magnetic resonance imaging (MRI) is the test of choice for the diagnosis of undisplaced or occult fractures not observable on plain radiographs. Up to 40% of impacted or nondisplaced fractures will displace if they do not undergo internal fixation. Secondary displacement is 5% following internal fixation. Pseudarthrosis may complicate up to 5% of non-displaced fractures and up to 25% of displaced fractures; furthermore, osteonecrosis complicates up to 10% of non-displaced fractures and up to 30% of displaced fractures. Conclusions: femoral neck fractures present a high incidence, the mechanism of action mostly presented in young people is high energy trauma, in the elderly the most common mechanism is low energy falls. Patients with displaced femoral neck fractures are unable to walk and show shortening and external rotation of the lower limb. Anteroposterior projections of the pelvis are indicated, as well as anteroposterior and cross lateral projections of the affected proximal femur. The goals of treatment are to relieve the patients pain, restore hip function and have rapid mobilization through anatomical reduction and internal fixation or by prosthetic replacement. Conservative treatment of fractures is recommended in individuals at extreme surgical risk; it can also be considered in individuals with dementia, who do not maintain the ability to walk and have little symptomatology due to hip pain. Among the most important complications are pseudarthrosis and osteonecrosis. Surgery to treat nondisplaced femoral neck fractures is associated with a higher number of consolidation and associated with less avascular necrosis compared to conservative treatment. KEY WORDS: fractures, femoral neck, trauma, prosthesis.

Study of Functional Outcome and Postoperative Complications Among Proximal Humerus Fracture Patients Treated With Proximal Humerus Internal Locking System (PHILOS) Plating.

Background Proximal humerus fractures comprise nearly 4%-5% of all fracture types and nearly 25% of fracture humerus. These fractures are commonly seen in the elderly population (people aged 60 years or more). The best way to treat elderly people who have three- or four-part fractures of the proximal humerus is debatable, with many in favour of prosthetic humeral head replacements. This study aimed to assess the functional outcome of proximal humerus fractures managed with a proximal humerus locking plate and to investigate the incidence of complications in these patients. Methodology This retrospective study included 32 cases of proximal humerus fractures managed surgically at a tertiary care teaching hospital in Rajasthan between July 2016 to July 2022 with a proximal humerus internal locking system (PHILOS) plate. NEER scoring system was used to categorise the fractures. Functional assessment was done using Constant Murley's shoulder score. Constant Murley shoulder score was graded as failure (0-69 points), unsatisfactory (70-79), satisfactory (80-89), and excellent (90-100). Subjects having metastatic and pathological fractures; associated fractures in the ipsilateral limb; having major nerve injury and cases of open fracture were excluded from this study. Results The mean age was 54.5±6.4 years. Of the total 32 cases of proximal humerus fractures, 12 cases of two-part fractures received an excellent grade, compared to seven cases of three-part fractures. Three two-part fracture cases and two three-part fracture cases all received satisfactory grades. Excellent results (score > 89) were noticed in 62.5% (n = 20) of the instances, satisfactory results (scoring 80-89) in 21.87% (n=7), poor results (score 70-79) in 9.38% (n=3), and failure results (score 70) in 6.25% (n=2). In 65.6% of cases, follow-up showed no complications. Shoulder stiffness and malunion (9.38%) were the most frequent consequences, followed by avascular necrosis (6.25%). Conclusions Based on the findings of this retrospective study, it can be opined that PHILOS plaiting appears to be a secure option for proximal humerus fracture cases. It offers solid fixation, prompt mobilisation, and excellent functional outcomes as observed in this study. Additionally, very few post-operative complication rates again support our conclusion.

Interposition Arthroplasty versus Dual Cup Mobility Prosthesis in Treatment of Trapeziometacarpal Joint Osteoarthritis: A Prospective Randomized Study.

Osteoarthritis (OA) of the trapeziometacarpal (TMC) joint is a common cause of pain and functional disability of the hand and is the second most frequent site in the hand of OA. This prospective randomized study analyses and compares the outcomes and global assessment of 2 different surgical techniques for rhizarthrosis treatment: trapeziectomy with tendon interposition arthroplasty and total joint replacement with Touch® (KeriMedical; Geneva, Switzerland) TMC prosthesis. The enrolled patients were randomly divided into 2 groups: group A included 71 patients (75 hands) treated with tendon interposition arthroplasty, while group B included 65 patients (72 hands) treated with total joint replacement. Clinical and radiological outcomes were collected before surgery and at 1, 3, 6, 12, and 24 months of follow-up. Although the values of all clinical tests performed during follow-up demonstrated statistically significant improvement over preoperative ones in both groups, patients treated with prosthesis showed faster improvement, especially in tests of strength and range of motion, which showed better results than patients treated with trapeziectomy and tendon interposition arthroplasty throughout the follow-up. Our study suggests that joint replacement should be preferred to interposition arthroplasty as the treatment of rhizarthrosis, choosing the latter in case of prosthetic replacement complications or scaphoid-trapezium-trapezoid OA.