Reconstruction of the anatomic defect following extra-articular shoulder resection is a challenging problem, particularly in cases when function of the deltoid muscle and rotator cuff are compromised. Standard reconstruction techniques often result in either instability or rigidity. Constrained implants have been used to overcome these problems; however, they have been associated with a high rate of aseptic loosening. Recently, a novel double-constrained implant has been introduced, yielding promising functional results. Nonetheless, this implant exhibited a cosmetic defect related to protrusion of the humeral component that becomes apparent with time as result of surrounding muscle atrophy. An updated improved design of the implant has been developed to counteract this.We report the case of a 15-year-old patient who underwent an extra-articular (Malawer type V) shoulder resection due to osteosarcoma and received an innovated custom-made double-constrained implant. Moreover, we describe a new modification of the Malawer utilitarian approach to the shoulder girdle that enhances tumor visibility and allows safer dissection. The patient recovered well with satisfactory outcomes at 18 months follow-up, highlighting the potential benefits of this implant design and surgical approach.

• MeSH
• Arthroplasty, Replacement, Shoulder * methods   MeSH
• Humans MeSH
• Adolescent MeSH
• Bone Neoplasms * surgery   pathology   MeSH
• Shoulder Prosthesis * MeSH
• Osteosarcoma * surgery   pathology   MeSH
• Proof of Concept Study MeSH
• Prognosis MeSH
• Prosthesis Design * MeSH
• Shoulder Joint * surgery   pathology   MeSH
• Treatment Outcome MeSH
• Plastic Surgery Procedures * methods   MeSH
• Check Tag
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

BACKGROUND: Extensive surgical resection of the thoracic aorta in patients with type A aortic dissection (TAAD) is thought to reduce the risk of late aortic wall degeneration and the need for repeat aortic operations. OBJECTIVES: We evaluated the early and late outcomes after aortic root replacement and supracoronary ascending aortic replacement in patients with TAAD involving the aortic root. DESIGN: Retrospective, multicenter cohort study. METHODS: The outcomes after aortic root replacement and supracoronary ascending aortic replacement in patients with TAAD involving the aortic root, that is dissection flap located at least in one of the Valsava segments, were herein evaluated. In-hospital mortality, neurological complications, dialysis as well as 10-year repeat proximal aortic operation, and mortality were the outcomes of this study. RESULTS: Supracoronary ascending aortic replacement was performed in 198 patients and aortic root replacement in 215 patients. During a mean follow-up of 4.0 ± 4.0 years, 19 patients underwent 22 repeat procedures on the aortic root and/or aortic valve. No operative death occurred after these reinterventions. The risk of proximal aortic reoperation was significantly lower in patients who underwent aortic root replacement (5.5% vs 12.9%, adjusted subdistributional hazard ratio (SHR) 0.085, 95% CI 0.022-0.329). Aortic root replacement was associated with higher rates of in-hospital (14.4% vs 12.1%, adjusted odds ratio 2.192, 95% CI 1.000-4.807) and 10-year mortality (44.5% vs 30.4%, adjusted hazard ratio 2.216, 95% CI 1.338-3.671). Postoperative neurological complications and dialysis rates were comparable in the study groups. CONCLUSION: Among patients with TAAD involving the aortic root, its replacement was associated with a significantly lower rate of repeat proximal aortic operation of any type compared to supracoronary aortic replacement. Still, aortic root replacement seems to be associated with an increased risk of mortality in these patients. UNLABELLED: ClinicalTrials.gov: NCT04831073 (https://clinicaltrials.gov/study/NCT04831073).

• MeSH
• Aortic Aneurysm, Thoracic * surgery   mortality   diagnostic imaging   MeSH
• Time Factors MeSH
• Blood Vessel Prosthesis Implantation * adverse effects   mortality   MeSH
• Aortic Dissection * surgery   mortality   MeSH
• Adult MeSH
• Risk Assessment MeSH
• Middle Aged MeSH
• Humans MeSH
• Hospital Mortality * MeSH
• Postoperative Complications * epidemiology   etiology   mortality   MeSH
• Reoperation MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Comparative Study MeSH

PURPOSE: Revision total hip arthroplasty (rTHA) is an increasingly common procedure due to the growing number of primary total hip arthroplasties (THAs) performed worldwide. This study evaluates the long-term implant survival, functional outcomes, and radiographic performance of cemented femoral stem (Beznoska s.r.o., Kladno, Czechia) in rTHA. METHODS: A retrospective analysis was conducted on 183 patients who underwent rTHA with cemented stem between March 2012 and December 2023. The mean follow-up duration was 71.26(± 39.31) months. Implant survival was analyzed using Kaplan-Meier survival estimates, and failure modes were assessed. Radiographic changes were classified using the Gruen Zones system. Functional outcomes were evaluated using the Harris Hip Score (HHS). Cox proportional hazard models were applied to identify prognostic factors influencing implant survival. RESULTS: The five-year implant survival rate was 98.1%, declining to 83.9% at twelve years. The overall failure rate was 3.83%, with periprosthetic infection (4 cases) being the most common cause, followed by aseptic loosening (2 cases). Radiographic changes were observed in 24.03% of cases, predominantly in Gruen Zones 2, 6, and 1. Functional outcomes were favorable, with a mean HHS of 81.28(± 5.74), comparable to outcomes reported for uncemented revision stems. Age, stem diameter, and stem length did not significantly impact implant survival. CONCLUSION: The cemented stem demonstrated favourable long-term survival, with high implant retention rates. Functional outcomes indicated overall satisfactory performance. Radiographic evaluation revealed localized changes around the implant, predominantly in Gruen Zones 2, 6, and 1. Implant failure was relatively rare, with periprosthetic infection being the most common cause.

• MeSH
• Cementation MeSH
• Adult MeSH
• Kaplan-Meier Estimate MeSH
• Bone Cements MeSH
• Hip Joint diagnostic imaging   surgery   MeSH
• Hip Prosthesis * adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Arthroplasty, Replacement, Hip * methods   instrumentation   adverse effects   MeSH
• Prosthesis Design MeSH
• Radiography MeSH
• Reoperation * MeSH
• Retrospective Studies MeSH
• Prosthesis Failure * MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECTIVES: The aim of this study was to investigate the long-term effects of computer-assisted CiTM navigation on clinical, radiological, and functional results versus conventional total knee arthroplasty (TKA). PATIENTS AND METHODS: Between January 2005 and July 2011, a total of 85 patients (36 males, 49 females; mean age: 66.2±5.2 years; range, 59 to 84 years) who underwent P.F.C. SigmaTM knee system implantation using computer-assisted CiTM navigation system (BrainLAB®, DePuy International, Leeds, UK) and completed a minimum follow-up of eight years were included in the study. In the control group, a total of 100 patients (40 males, 60 females; mean age: 68.3±3.9 years; range, 60 to 79 years) who completed a minimum follow-up of eight years were randomly selected from a dataset of implanted P.F.C. SigmaTM knee systems in the same period using Specialist® 2 instrumentation without navigation. An implant survival analysis was used to compare implant survivorship between the groups throughout 12 years. The Knee Society Score (KSS) and range of motion (ROM) were assessed. Based on long-format X-ray images, the implant position in the frontal and sagittal planes was evaluated. RESULTS: The ratio for navigation to control group survival is approximately 1.01 at 12 years. The clinical outcomes showed no significant difference between the groups (knee scores, p=0.707 and functional scores, p=0.485). In the measured angles analysis, we observed a consistent pattern in both groups. In the control group, there was a trend toward implanting the tibial component with slight varus alignment (p=0.038) and a higher posterior slope (p<0.001). On average, the operation was prolonged by 13 min in the navigated group (p<0.001). CONCLUSION: In conclusion, our study results demonstrate that while kinematic navigation in TKA improves the precision of implant alignment, it does not provide significant benefits in terms of long-term implant survival or functional outcomes compared to conventional TKA methods. The use of the computer-assisted CiTM navigation system is associated with prolonged operation duration, although no technical complications related to the navigation device's software can be observed. Therefore, although navigation offers theoretical advantages in component positioning, its use may be more justifiable in cases with challenging alignment requirements rather than as a routine practice.

• MeSH
• Osteoarthritis, Knee * surgery   physiopathology   diagnostic imaging   MeSH
• Time Factors MeSH
• Surgery, Computer-Assisted * adverse effects   methods   instrumentation   MeSH
• Knee Joint * surgery   diagnostic imaging   physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Recovery of Function MeSH
• Knee Prosthesis MeSH
• Retrospective Studies MeSH
• Range of Motion, Articular MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Arthroplasty, Replacement, Knee * methods   instrumentation   adverse effects   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH

BACKGROUND: Acute Stanford type A aortic dissection is a severe emergency condition that, if left untreated, is associated with a high mortality rate. The extent of surgical repair may impact the outcomes of these patients. METHOD: Patients operated for acute type A aortic dissection from a multicentre European registry were included. Patients were categorized based on the following types of surgical intervention: isolated ascending aortic replacement, ascending aortic replacement with concomitant aortic valve replacement, aortic root replacement, partial or total arch replacement, and partial or total arch replacement with concomitant aortic root replacement. The primary outcome was mortality rate, both in-hospital and at 10 years. Secondary outcomes were acute kidney injury requiring dialysis, neurological complications, a composite endpoint including in-hospital death, neurological complications and/or dialysis, and proximal endovascular or surgical aortic re-operations at 10 years. RESULTS: 3702 patients were included. The adjusted risk of in-hospital mortality was higher in all subsets of patients compared to those who underwent isolated ascending aortic replacement. The adjusted rates of in-hospital mortality ranged from 16.4% (95% c.i. 15.3 to 17.4) among patients who underwent isolated ascending aortic replacement to 27.7% (95% c.i. 23.3 to 31.2) among those who underwent aortic arch and concomitant aortic root replacement. The adjusted risks of neurological complications, renal replacement therapy and of the composite endpoint were significantly higher in patients who underwent partial/total aortic arch replacement. The adjusted risk estimates of 10-year mortality rate were markedly higher in patients who underwent partial/total aortic arch replacement with or without concomitant aortic root replacement. Extensive aortic repair did not significantly reduce the risk of distal or proximal aortic reoperations. CONCLUSION: These findings suggest that, when feasible, limiting the extent of aortic replacement for acute type A aortic dissection may be beneficial in reducing mortality rate and major complications both in the short and long term. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04831073.

• MeSH
• Aortic Aneurysm surgery   mortality   MeSH
• Blood Vessel Prosthesis Implantation * adverse effects   mortality   methods   MeSH
• Aortic Dissection * surgery   mortality   MeSH
• Middle Aged MeSH
• Humans MeSH
• Hospital Mortality * MeSH
• Postoperative Complications * epidemiology   mortality   etiology   MeSH
• Registries * MeSH
• Reoperation statistics & numerical data   MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH

PURPOSE OF THE STUDY: Rhizarthrosis-osteoarthritis of the thumb carpometacarpal (CMC) joint is usually a primary idiopathic disease. Total joint arthroplasty (TJA) is one of the surgical treatment options for symptomatic advanced thumb CMC arthritis. This retrospective study aims to evaluate the mid-term functional and radiological results of TJA with the minimum follow-up period of 3 years after the surgery. MATERIAL AND METHODS: Presented are the results of 136 total trapeziometacarpal joint replacements in the group of 105 patients consisted of 96 women and 9 men. Used prostheses were ELiS® implant (27 cases), Ivory® implant (42 cases), Touch® Dual mobility (67 cases). The follow-up period was minimally 3 years postoperatively. In all the patients, along with range of motion and radiologic evaluation of implant position, the function and pain of operated joint were evaluated using DASH and VAS score at regular intervals pre- and postoperatively. RESULTS: At a mean of 85 months (range 38-126 months) post-operatively, patients in 116 cases (85%) reported full satisfaction and absence of symptoms and difficulties. In 12 cases (9%) some slight residual post-exercise pain was reported. In eight cases (6%) patients suffered from episodic rest-pain, but with a lower intensity than in the preoperative period. Postoperatively, the patients declared subjective improvement in hand function. The total DASH score and VAS score decreased in all patients, while ROM increased. The course of all of TJA surgeries was complication-free. Five patients needed revision surgery. In two patients a dislocation has occurred and in three cases a loosening of the cup's implant was reported. The most frequent postoperative complication was the occurrence of transient paraesthesias of the thumb in eight cases (6%). CONCLUSIONS: TJA is the method of choice in management of advanced symptomatic osteoarthritis of the thumb CMC joint. Mastering surgical technique, TJA represents safe and effective treatment method in advanced degenerative changes of the thumb CMC joint and it's benefits exceed possible perioperative and postoperative risks.

• MeSH
• Arthroplasty, Replacement * methods   MeSH
• Adult MeSH
• Carpometacarpal Joints * surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Osteoarthritis * surgery   MeSH
• Thumb * surgery   MeSH
• Joint Prosthesis MeSH
• Retrospective Studies MeSH
• Range of Motion, Articular MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH