Introduction: The revision of a resection arthroplasty of the hip to total hip arthroplasty is a demanding procedure with higher complication rates than those of primary hip arthroplasty. Aim: To evaluate the outcome of revising resection arthroplasties and thereby assist in deciding which patients would benefit from the procedure. Methods: We reviewed the experience of an orthopaedic surgeon (WJMB) who performed revisions of resection arthroplasties to total hip arthroplasties for 10 patients from 1990 to 1999. The reason for resection arthroplasty was established or suspected infection in all patients. Results: The time since the resection arthroplasty ranged from 12 to 36 months, with an average of 14.7 months. The Harris hip scores with the resection arthroplasties ranged from 21 to 44 with an average of 38.3. The follow-up ranged from one to eight years with an average of 4.2 years. Five patients had died from other causes at the time of the study. The Harris hip scores at the latest follow-up ranged from 46 to 89 with an average of 66. The complications included instability requiring a constrained acetabular liner, an intra-operative femoral fracture requiring a long-stem prosthesis, the breaching of a femoral cortex by a prosthesis requiring a revision and recurrence of infection in a patient who was non-compliant with the prescribed antibiotics. Conclusions: The revision of a resection arthroplasty to a total hip arthroplasty is a demanding procedure with a high complication rate and prolonged recovery. Revising only those patients with poorly functioning resection arthroplasties optimises the possibility of a positive surgical outcome, being an improvement in pain and function

Aim. Two stage revision is the most commonly used surgical treatment strategy for periprosthetic hip infections (PHI). The aim of our study was to assess the intra- and postoperative complications during and after two stage revision using resection arthroplasty between ex- and reimplantation. Method. In this retrospective cohort study, all patients treated with a two stage revision using resection arthroplasty for PHI were included from 2008 to 2014. During the first stage, the prosthesis was removed resulting in a resection arthroplasty without the use a PMMA spacer. During second stage, (cemented or uncemented) reimplantation of the hip prosthesis was performed. The cohort was stratified into two groups according to the length of prosthesis-free interval (≤10 weeks and >10 weeks). Data on complications during explantation, prosthesis-free interval, reimplantation, and after reimplantation was collected. The overall complication rate between both groups was compared using the chi-squared test. The revision-free and infection-free survival was estimated using Kaplan-Meier survival analysis. Results. Overall, 93 patients with hip PJI treated with two-stage revision performing resection arthroplasty were included, 49 had a prosthesis-free interval of ≤10 weeks, and 44 an interval of >10 weeks. A total of 146 complications was documented in the cohort. Patients were followed-up for a mean duration of 42.7 months, range: 13.1 – 104.6 months. Blood loss during reimplantation [n=25], blood loss during explantation [n=23], persistent infection during prosthesis-free interval [n=16], leg length discrepancy [n=13], and reinfection [n=9] were the most common complications. No complication showed a statistically significant difference between both groups except for wound healing disorder after reimplantation, which was more often reported in the group with > 10 weeks interval (p=0.009). A statistically significant increase of periprosthetic bone fractures (p=0.05), blood loss (p=0.039), and total number of complications (p=0.008) was seen with increasing acetabular bone defects (after Paprosky). Infection-free survival rate at 24 months was 93.9% (95% CI: 87.2 – 100) in the group with ≤10 weeks interval and 85.9% (95% CI: 75.4 – 96.4) with an interval of > 10weeks. Conclusions. After two years of follow-up, the infection-free survival rate using resection arthroplasty during two stage revision for PHI was higher in the group with ≤10 weeks interval compared to the group with >10 weeks interval. The most common complications during and after a two stage revision using resection arthroplasty were blood loss during the two surgeries, persistent infection during the prosthesis-free interval, leg length discrepancy, and reinfection

Despite considerable legacy issues, Girdlestone's Resection Arthroplasty (GRA) remains a valuable tool in the armoury of the arthroplasty surgeon. When reserved for massive lysis in the context of extensive medical comorbidities which preclude staged or significant surgical interventions, and / or the presence of pelvic discontinuity, GRA as a salvage procedure can have satisfactory outcomes. These outcomes include infection control, pain control and post-op function. We describe a case series of 13 cases of GRA and comment of the indications, peri, and post-operative outcomes. We reviewed all cases of GRA performed in our unit during an 8 year period, reviewing the demographics, indications, and information pertaining to previous surgeries, and post op outcome for each. Satisfaction was based on a binary summation (happy/unhappy) of the patients’ sentiments at the post-operative outpatient consultations. 13 cases were reviewed. They had a mean age of 75. The most common indication was PJI, with 10 cases having this indication. The other three cases were performed for avascular necrosis, pelvic osteonecrosis secondary to radiation therapy and end stage arthritis on a background of profound learning disability in a non-ambulatory patient. The average number of previous operations was 5 (1-10). All 13 patients were still alive post girdlestone. 7 (54%) were satisfied, 6 were not. 3 patients were diabetic. 5 patients developed a sinus tract following surgery. With sufficient pre-op patient education, early intensive physiotherapy, and timely orthotic input, we feel this procedure remains an important and underrated and even compassionate option in the context of massive lysis and / or the presence of pelvic discontinuity / refractory PJI. GRA should be considered not a marker of failure but as a definitive procedure that gives predictability to patients and surgeon in challenging situations

Infection remains a serious complication of total hip replacement (THR). Management options have been developed to improve clearance of infection while maintaining joint function during treatment and improve outcome at reimplantation. The gold standard in management is generally considered to be implant removal and thorough debridement with antibiotic therapy delivered systemically and locally with impregnated spacers. However, some surgeons still prefer to use Girdlestone resection arthroplasty, thus not leaving any foreign body in situ. The aim of this study was to compare infection clearance rates, radiographic and functional outcomes after two-stage revision of total hip arthroplasty with (1) gentamicin-loaded bone cement spacer or (2) Girdlestone resection arthroplasty as the first stage of treatment. We retrospectively reviewed data of 48 patients (20 females, 28 males) with implanted spacers and 53 patients (21 females, 32 males) treated with resection arthroplasty at tertiary care university hospital in the years 2008–2012. Minimum follow-up was three years (range, 3–7 years). Treatment choice was at the operating surgeons's discretion. In the spacer group, mean age at the time of first stage was 62 years (range 24–79 years), time from primary replacement 14 months, and the time from the first to the second stage of the revision 7 months. At latest, minimum 3-year follow-up, two were still ambulating with a spacer in situ, and five were re-revised with another spacer before the reimplantation of the THR. In the resection arthroplasty group, mean age at the time of first stage was 64 years (range, 37–87 years), time from primary replacement 13 months, and the time from the first to the second stage of revision − 10 months. At the latest follow-up, four patients were ambulating with resection arthroplasty, one did not clear his infection and one died of unrelated causes. The cure ratio appeared to be the same within both groups (Fisher exact test, p=0.08). Patients with spacers achieved better functional results, used less supports for ambulation and had less leg length discrepancy after the second stage of revision. In the light of those results, we cannot recommend for the use of resection arthroplasty in the treatment of the infected THR

Purpose: The purpose of this review is to present our experience in prosthetic reconstruction after resection arthroplasty, its outcome and possible complications. Materials and methods: We carried out a retrospective study of 23 hips reconstructed after an average of 2.2 years. Inclusion criteria were: having had a resection arthroplasty, a reconstruction with joint prosthesis and a minimum follow-up of one year. For evaluation we used the Merle d’Aubigne score for pain, walking and range of motion. Results: The operated limb was lengthened 2.9 cm (1.2–4.8). The average for pain was 4.6, for range of motion 4.3 and walking 5.2. The overall outcome, 14.1 points, was considered acceptable. 47% had good or very good outcomes. All the patients improved their ability to walk. Four patients presented dislocation of the prosthesis after reconstruction and only one patient had a reinfection. Conclusions: Prosthetic reconstruction after resection arthroplasty is technically difficult. This is due mainly to wear in the soft tissues and changes in the amount and quality of bone stock as a result of prior surgery. The biggest gain is seen in the ability to walk while there is less improvement in pain and range of motion. Candidates for reconstruction must be carefully selected to prevent complications and/or false expectations of always achieving excellent results

Aim. Decubitus ulcers are found in approximately 4.7% of hospitalized patients, with a higher prevalence (up to 30%) among those with spinal cord injuries. These ulcers are often associated with hip septic arthritis and/or osteomyelitis involving the femur. Girdlestone resection arthroplasty is a surgical technique used to remove affected proximal femur and acetabular tissues, resulting in a substantial defect. The vastus lateralis flap has been employed as an effective option for managing this dead space. The aim of this study was to evaluate the long-term outcomes of this procedure in a consecutive series of patients. Method. A retrospective single-center study was conducted from October 2012 to December 2022, involving 7 patients with spinal cord injuries affected by chronic severe septic hip arthritis and/or femoral head septic necrosis as a consequence of decubitus ulcers over trochanter area. All patients underwent treatment using a multidisciplinary approach by the same surgical team (orthopedic and plastic surgeons) along with infectious disease specialists. The treatment consisted of a one-stage procedure combining Girdlestone resection arthroplasty with unilateral vastus lateralis flap reconstruction, alongside targeted antibiotic therapy. Complications and postoperative outcomes were assessed and recorded. The mean follow-up period was 8 years (range 2-12). Results. Of the 7 patients, 5 were male and 2 were female, with a mean age of 50.3 years at the time of surgery. Minor wound dehiscence occurred in 28.6% of the flap sites, and 2 patients required additional revisional procedures—one for hematoma and the other for bleeding. There were no instances of flap failure, and complete wound healing was achieved in an average of 32 days (range 20-41), with the ability to load over the hip area. No cases of infection recurrence or relapse were observed. Conclusions. An aggressive surgical approach is strongly recommended for managing chronic hip septic arthritis or proximal femur osteomyelitis in patients with spinal cord injuries. A single-stage procedure combining Girdlestone resection arthroplasty with immediate vastus lateralis muscle flap reconstruction proves to be an effective strategy for dead space management and localized antibiotic delivery through the vastus muscle, giving reliable soft tissue coverage around the proximal femur to avoid the recurrence of pressure ulcers. The implementation of a standardized multidisciplinary protocol contributes significantly to the success of reconstruction efforts

The aim of this study was to compare the results of resection arthroplasty with two-stage re-implantation procedure performed for peri-prosthetic infection of the hip. Patients who have had a resection arthroplasty can expect to have less pain, but their functional recovery is inferior to that which can be obtained after a two-stage re-implantation. Resection arthroplasty is usually unacceptable as a definitive solution for relatively young and active patients. Possible options for the operative treatment of a periprosthetic infection include debridement with retention of the prosthesis, immediate one-stage exchange arthroplasty, and excision arthroplasty – either as a definitive procedure or as the first of a two-stage reconstructive procedure. The choice of a particular treatment is influenced by a number of factors. At the Department of Orthopaedic Surgery in Hradec Králové we performed resection arthoplasty of the hip in 67 patients between 1984 and 1998. Mean age was 67 years (range 44–91). We were able to follow-up 33 of these patients in 1999. At follow-up, replacement of the total hip prosthesis in two stages had been carried out in 10 of the 33 patients. In 23 patients (11 male, 12 female) the resection arthroplasty had been present for an average of five years. In the remaining ten patients (3 male, 7 female) a total hip reimplantation had been performed after an average of 17 months (range 3 to 63). Mean follow-up after reimplantation was four years. The Harris hip score was calculated for the individual patients during follow-up. The Harris hip score was 66 in the re-implantation group compared to 57.5 in the patients with resection arthroplasty. Personal satisfaction and hip function were better after the two-stage re-implantation procedure

The aim of this study is to compare the results of resection arthroplasty with two-stage re-implantation procedure performed for peri-prosthetic infection of the hip. Patients who have had a resection arthroplasty can expect to have less pain, but their functional recovery is inferior to that which can be obtained after a two-stage re-implantation. Resection arthroplasty is usually unacceptable as a definitive solution for relatively young and active patients. Possible options for the operative treatment of a periprosthetic infection include debridement with retention of the prosthesis, immediate one-stage exchange arthroplasty, and excision arthroplasty – either as a definitive procedure or as the first of a two-stage reconstructive procedure. The choice of a particular treatment is influenced by a number of factors. At the Department of Orthopaedic Surgery in Hradec Králové we performed resection arthoplasty of the hip in 67 patients between 1984 and 1998. Mean age was 67 years (range 44–91). We were able to follow-up 33 of these patients in 1999. At follow-up, replacement of the total hip prosthesis in two stages had been carried out in 10 of the 33 patients. In 23 patients (11male, 12 female) the resection arthroplasty had been present for an average of five years. In the remaining ten patients (3 male, 7 female) a total hip reimplantation had been performed after an average of 17 months (range 3 to 63). Mean follow-up after reimplantation was four years. The Harris hip score was calculated for the individual patients during follow-up. The Harris hip score was 66 in the re-implantation group compared to 57.5 in the patients with resection arthroplasty. Personal satisfaction and hip function were better after the two-stage re-implantation procedure

For surgical treatment of hallux rigidus many different procedures have been described. Resection arthroplasty (‘Keller procedure’) is a surgical procedure mostly used for older patients suffering from severe osteoarthritis of the first metatarsophalangeal joint. As a modification of this procedure, resection arthroplasty is combined with cheilectomy and interposition of the dorsal capsule and extensor hallucis brevis tendon, which are then sutured to the flexor hallucis brevis tendon on the plantar side of the joint (capsular interposition arthroplasty, IA). Capsular interposition arthroplasty was performed on 22 feet of 14 patients (six male, eight female) suffering from osteoarthritis of the 1st MTP-joint were included in this study (group 1). These results were compared to the outcome of 30 feet of 22 patients (12 male, 10 female) treated with resection arthroplasty (group 2). The indication for resection arthroplasty were the same as for IA. The mean age was 55.3 years (37.6 to 71.2) in group 1 and 57.8 (43.5 to 75.6) in group 2. The age distribution of our patients at surgery did not differ significantly between both groups (p=0.633). The mean follow-up period was 15.1 month, range 6 to 27 months and did not differ between both groups (group 1: 16.5 month, group 2: 14.1 month; p=0.143). The mean follow-up period was 15 months. No statistically significant difference was found between both groups concerning patient’s satisfaction, clinical outcome and increase in range of motion of the first metatarsophalangeal joint. At follow-up, patients who had undergone interposition arthroplasty did not show statistically significant better AOFAS forefoot-scores compared to the Keller procedure group. A high rate of osteonecrosis of the first metatarsal head was found in both groups. These radiological findings did not correlate with the clinical outcome at follow-up. There is no benefit in clinical or radiological outcome for capsular interposition arthroplasty compared to the Keller procedure

In the last months of 2007 we started to retrospectively review 60 patients who had undergone Girdlestone resection arthroplasty of the hip between 1994 to 2006. The most frequent indications for this procedure were sepsis around prosthesis, aseptic loosening, pseudoartrhosis after femoral neck fractures or medical compromised patients who had an high risk of hip reimplantation procedure. The evaluation of patient’s satisfaction ranges a lot in literature and no valid guidelines have been publicated. All our patients were submitted to limb shortening measurement and functional evaluation according to SF-36 score and Harris Hip Score. There were 20 men and 40 women with an average age of 70 years old (range 96-43 years old on operation time), the mean follow up was 133 months (range 14–167 months). Some patients were lost at the follow-up, the main reason was death for related and unrelated causes (overall mortality of 30%). The aim of this study was to analyze patient’s satisfaction and functional outcomes after Girdlestone arthroplasty which appears in our experience, despite the limits, a valid surgical option in order to improve hip function, decrease or cancel pain and control infections when implantation or reimplantation is not possible

Purpose: Resection elbow arthroplasty is a salvage procedure typically considered as a last resort when other reconstructive options have failed. It was the intent of this study to evaluate the long-term outcome of patients following resection elbow arthroplasty. Method: Fifty-four elbow resections performed between 1975 and 2005 were retrospectively reviewed. Pre and post-operative elbow function was evaluated with the Mayo Elbow Performance Score (MEPS) and additional follow-up data was compiled using the Disability of Shoulder and Hand (DASH) score. All patients in this study had a resection following a failed total elbow arthroplasty (TEA). Nineteen patients had died at time of follow-up, and 5 patients were lost to follow-up, leaving 30 of the surviving 34 patients (88%) available for long-term evaluation. Results: The main indication for resection in this study was infection (50 of 54 elbows). The average MEPS prior to resection was 36. The long-term results in 30 patients at an average of 11 yrs (range 2.7–28 yrs) demonstrated an average MEPS score of 60, and a DASH score of 71. Complications were common including persistent infection requiring re-operation (44%), intra-operative fracture (32%), transient (11%) or permanent (5.5%) nerve damage, and one case of vascular injury requiring amputation. Achieving a stable resected elbow correlated strongly with a good long-term MEPS score (r=0.75). Conclusion: This study emphasizes the difficulty in treating patients with a failed total elbow arthroplasty. Resection arthroplasty is a salvage procedure indicated primarily for persistently infected TEA and results in satisfactory outcomes in this population

Background. Osteoarthritis of basal joint of the thumb represents one of the commonest degenerative diseases of the hand and wrist region. Depending on the severity of clinical symptoms surgical treatment is often recommended. Resection arthroplasty of the CMC joint with tendon interposition can be regarded as the gold standard. The aim of our study is to compare the Burton Pellegrini technique with a new modified technique of resection arthroplasty with interposition of local capsule tissue. Materials and Methods. We retrospectively evaluated 2 groups of patients. Two Consultant Surgeons took part in the study, one for each group, with each consultant performing trapeziectomies using only one of the techiniques for all his patients. The first group underwent trapeziectomy and local capsule interposition. It consists of 26 patients with a female/male ratio of 20/6, an average age of 64 years (range 53–88), an average follow up of 3.15 years (range 9–1) and a left/right ratio of 16/10. The second group underwent a standard Burton Pellegrini including flexor tendon interposition. It consists of 13 patients with a female/male ratio of 5/8, an average age of 68 years (range 58–85), an average follow up of 4.46 years (range 9–1) and a left/right ratio of 5/8. The outcomes were compared using the Michigan Hand Outcomes Questionnaire. A 2-tailed independent samples t-test was used for the statistical analysis of our data. Results. We found that there is significant difference between the two procedures only on the ability of working in present, t = 2.153 and p = 0.038. However, there is no significant difference between the other parameters we examined: overall hand function, t = 0.237 and p = 0.814; activities of daily living using the operated hand, t = 0.194 and p = 0.847; activities of daily living using both hands, t = 0.184 and p = 0.855; overall activities of daily living, t = 0.204 and p = 0.839; pain, t = 0.123 and p = 0.903; aesthetics, t = 1.063 and p = 0.295; satisfaction, t = 0.628 and p = 0.534; total score, t = 0.509 and p = 0.613. Furthermore, the overall score for the two procedures suggests that there is no significant difference between them. Conclusions. The new modified procedure is simpler and quicker than the traditional operation and avoids the morbidity of tendon harvesting. The overall outcome score for the two operations is equal, suggesting that there is no advantage to the more complex procedure. We have shown a difference between the two procedures in post op working ability, being better in the group with local capsule interposition

Introduction and purpose: Rhizarthrosis of the thumb is the most common form of osteoarthritis of the hand. In some cases it courses with intense pain and severe functional limitation of the thumb or the entire hand. The purpose of this study is to compare the results of treating rhizarthrosis with a total ARPE trapezio-metacarpal prosthesis and trapezectomy, whether or not associated with tendon interposition and ligament repair. Materials and methods: A retrospective comparative study in which we reviewed cases of rhizarthrosis treated surgically in our hospital between 1994 and 2004. We found 75 cases, of which 28 were treated with resection arthroplasty (group A), 32 with ARPE prosthesis (group B) and 15 with bone fusion (not included in this study). The mean age was 58.85 for group A and 63.16 for group B. Mean follow-up time was 39.5 months. We used the DASH questionnaire for the subjective clinical examination and the Jamar dynamometer for the objective examination. For radiological assessment we used the Eaton classification and Walch radiological criteria. Results: We analysed the results using SPSS statistical software and found no significant differences between the two groups, although the subjective assessment showed better results in terms of mobility and pain remission in group B and strength in group A. Conclusions: The aim of surgical treatment of rhizarthrosis is to achieve a stable, pain-free thumb. Several procedures are available, the success of which depends on correct indication and meticulous surgical technique

Aims

In the treatment of basal thumb osteoarthritis (OA), intra-articular autologous fat transplantation has become of great interest within recent years as a minimally invasive and effective alternative to surgical intervention with regard to pain reduction. This study aims to assess its long-term effectiveness.

Early reports on revision total hip arthroplasty (RTHA) suggested that outcomes of this procedure are as good as those of primary total hip arthroplasty (THA). However, RTHA is associated with longer surgery time, greater blood loss and increased risk of complications (thromboembolism, nerve injury, periprosthetic fractures, recurrent hip dislocations and infections). Aseptic loosening after RTHA was reported in 36% of patients aged over 55 years within 4 years after revision. Infections were reported in 32% and complications during surgery in 23% of patients respectively. Unsatisfactory results of RTHA stimulate the search for alternative procedures. Girdlestone excision arthroplasty (GA) seems to be a good solution for older patients with high risk of complications related to a poor general condition.

Material and method Between 2000 and 2003 we operated 39 patients, 10 for septic (26%) and 29 aseptic (74%) loosening of their THA. All patients complained of painful limb aggravated by weight bearing and the severity of pain was the main indication for the surgery. Average survival time of previous THA was 9 year (range: 1 to 20). We assessed pain, walking distance and the need to use walking aids. The outcomes were measured according to the Harris Hip Scale. The patients had the GA performed. The procedure involved removing implant and bone cement and placing the major trochanter into bone acetabulum. If an infection was present, an antibiotic irrigation system was introduced. No cast or braces were used and walking was started 2–7 days after surgery, depending on patients general condition.

Results Good pain control was reported by 33 (85%) patients. The average Harris Hip Score changed from 25 points preoperatively to 53 at latest follow-up. Average limb shortening was 4 centimetres (range: 2 to 8). Walking aids (one or two crutches) were required by all patients. Eighteen (46%) patients walked more than 500 m, 12 (31%) patients walked 200–500 m and 9 (23%) patients walked less than 200 m, of whom one patient was wheelchair bound.

Infection ceased in 9 cases, 1 patient died because of complications related to chronic infection.

Discussion GA yields satisfactory results in patients who have to have their prostheses removed. It provides a mobile, painless joint. The disadvantages of GA are: limb shortening and unstable gait which requires the use of crutches. This procedure should be indicated for patients with high risk of complications due to poor general health, infection and/or massive loss of bone stock which render more invasive procedures impossible. GA is also advisable in patients with weak hip abductor muscles, when RTHA is associated with a high risk of recurrent hip dislocation. The Girdlestone arthroplasty is a satisfactory salvage procedure in most cases of failed THA, when the choice of reimplantation exposes the patient to a high risk of further failure.

Introduction

There is no consensus on the ideal management of young, active patients with disabling coxarthrosis. Within this group, patients with femoral head defects secondary to cysts or avascular necrosis pose particular challenges. Resurfacing arthroplasty is contraindicated and the results of traditional total hip arthroplasty are suboptimal in this group. The BMHR was designed to offer a bone conserving option for these patients. We report the outcome of this device in the short term.

Introduction Rheumatoid arthritis (RA) commonly affects the forefoot, and pain caused by the deformity of forefoot impairs the walking ability. We have performed resection arthroplasty for all metatarsal heads using modified Lelièvre procedure in affected feet. The aim of the current retrospective study was to investigate the long term results and problems of this procedure. Patients and methods We investigated 45 feet treated by modified Lelièvre procedure in 29 women from 1985 to 2003 at our institute. Their average age at operation was 54.8 years (range 39 – 76 years). They were followed-up more than two years (26 – 203 months). Resection of all five metatarsal heads was performed for the RA forefoot which had severe deformity and persistent pain, using medial approach for first metatarsophalangeal (MTP) joint and plantar approach for lesser MTP joint. The results were evaluated by the rating scale of the American Orthopaedic Foot and Ankle Society (AOFAS), Foot Function Index (FFI), physical examination, radiographic evaluation, as well as subjective assessment using questionnaire for mental and physical disability. Results Pain and walking ability were improved in all but 2 feet; one of which underwent additional surgical treatment. Eight out of 45 feet had recurrence of MTP joint dislocation of thumb at the final follow-up. Re-formation of callosities was seen in 69% of the patients, 50% of which were developed within 3 years after operation, and 78% within 5 years. No superficial infection or delayed wound-healing was noted in any case. Satisfactory surgical outcome was maintained for at least 2 years after operation in all cases, and deteriorated later. At an average of 96 months postoperatively, the average AOFAS forefoot score was 67.9 points. Seven cases were judged to have excellent (25%), 13 cases good (46%), 7 cases (25%) fair, and 1 case poor (4%) results. The average radio graphic hallux valgus angle was 31.3 degrees. Eventually, 70% of patients underwent total hip or knee arthroplasty. Conclusion Resection arthroplasty of all five metatarsal heads using modified Lelièvre procedure in RA patients with pain and deformity of forefoot seemed to be an effective procedure over a long postoperative period, providing reasonable relief of symptoms. Because RA affects multiple joints including hip and knee joints, the forefoot reconstruction alone cannot sustain the improved walking ability

Surgical treatment of Hip PJI by resection of the infected implants and tissue and placement of a “spacer” which elutes antibiotic via antibiotic loaded cement is an accepted treatment option. There is some controversy over whether this “spacer” should be articulating or static. Proponents of the articulating option argue that there is improved function and maintenance of the soft tissue envelop. Critics have suggested that additional biomaterials may compromise eradication of infection. This study compares our results of the 2 treatment options. A review of our institutional PJI database between 2016 and 2021 identified 87 patients who were treated with resection arthroplasty for unilateral total hip PJI. The cohort was analyzed for demographics and type for surgery, as well as medical comorbidities, survivorship, and treatment success. 44 patients were female, the mean age of all patients was 62. 44 patients were treated with Articulating apacers, and 43 patients treated with static spacers. There was no significant difference between ASA or Elixhauser score, and no significant difference between mortality or treatment failure. This study did not show any difference between the patients who receive static spacers, from those who received articulating spacers, and deomstrated similar treatment success rates. From this data there does not appear to be any difference in success rates between those patients that were treated with static spacers and those that were treated with articulating spacers

In reverse shoulder arthroplasty (RSA), a high complication rate is noted in the international literature (24.7%), and limited local literature is available. The complications in our developing health system, with high HIV, tuberculosis and metabolic syndrome prevalence may be different from that in developed health systems where the literature largely emanates from. The aim of this study is to describe the complications and complication rate following RSA in a South African cohort. An analytical, cross-sectional study was done where all patients’ who received RSA over an 11 year period at a tertiary hospital were evaluated. One-hundred-and-twenty-six primary RSA patients met the inclusion criteria and a detailed retrospective evaluation of their demographics, clinical variables and complication associated with their shoulder arthroplasty were assessed. All fracture, revision and tumour resection arthroplasties were excluded, and a minimum of 6 months follow up was required. A primary RSA complication rate of 19.0% (24/126) was noted, with the most complications occurring after 90 days at 54.2% (13/24). Instability was the predominant delayed complication at 61.5% (8/13) and sepsis being the most common in the early days at 45.5% (5/11). Haematoma formation, hardware failure and axillary nerve injury were also noted at 4.2% each (1/24). Keeping in mind the immense difference in socioeconomical status and patient demographics in a third world country the RSA complication rate in this study correlates with the known international consensus. This also proves that RSA is still a suitable option for rotator cuff arthropathy and glenohumeral osteoarthritis even in an economically constrained environment like South Africa

Aim. There are no studies in literature that analyze the effectiveness of closed-incisional negative pressure wound therapy (ciNPWT) in the treatment of bone and joint infections (BJI). The aim of the study was to evaluate the efficacy and the safety of the application of ciNPWT in the postsurgical wound management of patients with osteoarticular infections. Method. We conducted a perspective single-center study on patients with BJI treated between 01/2022 and 10/2022 with ciNPWT dressing application at the end of the surgical procedure. All patients were treated by a multidisciplinary team (MDT) approach and operated by the same surgical equipe. Inclusion criteria were: presence of periprosthetic joint infection (PJI), fracture-related infection (FRI), osteomyelitis (OM), septic arthritis (SA) surgically treated, after which ciNPTW was applied over the closed surgical wound. 30 patients (19M, 11F) have been analyzed with mean age of 56,10±17,11 years old; BJIs were all localized in the lower limb (16 PJI, 12 FRI, 1 SA, 1 OM). Results. We considered the following clinical local pre-operative parameters: presence of fistula (10 patients, 33,33%), presence of erythema (18 patients, 60%), presence of previous flap in the incisional site (7 patients, 23,33%). In 11 cases (36,67%) more than 3 previous surgical procedures were performed in the surgical site. The following surgical procedures were performed: 8 debridement and implants removal, 7 DAIR, 3 one-stage exchange, 6 two-stage exchange, 3 spacer exchange, 3 resection arthroplasty. Nineteen patients (63,34%) showed no occurrence of any local post-operative complication (erythema, hematoma, wound breakdown, wound blister, necrosis). Seven (23,33%) patients showed the presence of one or more postoperative complications that didn't require additional surgery. We observed four (13,33%) failures, defined as the need for further surgical procedures following the onset of a local complication: two patients had a wound breakdown before wound closure and two had a recurrence of infection after an uneventfully wound closure. All failures were within the group of joint infection (PJI+SA) and were affected by a multi drug resistant pathogen. Conclusions. In our series four patients required further surgery, but only two cases were related to incisional wound problems, that is consistent with aseptic joint revision surgeries data that are available in literature (3.4%-6.9%)[1-2]. Patients affected by BJI are a group with significant high risk of failure and therefore the use of ciNPWT should be considered. However, randomized clinical trials are needed to establish the superiority of the ciNPWT dressing over the standard one