The management of upper cervical spine (UCS) fractures is unclear concerning the role of fusion versus non-fusion fixation and the need for implant removal following fracture healing. This international AO Spine expert survey (Level IV study) evaluated the current trends, and practice preferences among experienced surgeons in the management of UCS fractures. A structured questionnaire was answered by AO Spine Knowledge Forum Trauma and Infection (KF T I) members (n = 24). The survey collected data regarding demographics, classification use, fixation vs. fusion preferences, and implant removal practices for UCS fractures (C1, C2 odontoid, and Hangman’s fractures). Descriptive statistics were analysed. Majority were from North America and Europe (54
BACKGROUND:Stacked metaphyseal cone constructs can be used to address extensive metaphyseal and metadiaphyseal bone loss encountered during complex primary or revision total knee arthroplasty (TKA). Our study reports the 5-year outcomes of a multicenter cohort of stacked-cone constructs used to manage extensive bone loss encountered during primary or revision TKA. METHODS:A retrospective review was conducted to identify patients who underwent primary or revision TKA with tibial and/or femoral stacked-cone constructs between July 2016 and September 2025 at 4 tertiary academic institutions. Demographic, operative, clinical, and radiographic data were obtained and analyzed. Five-year implant survivorship free from all-cause reoperation, all-cause revision, and stacked-cone construct revision for aseptic loosening was analyzed using Kaplan-Meier estimation. RESULTS:Eighty-four cases with a mean patient age of 67.3 years and a mean follow-up of 20.85 months were identified. Five-year survivorship was 56.5% (95% confidence interval [CI], 22.7% to 78.3%) free from all-cause reoperation, 65.2% (95% CI, 25.8% to 87.1%) free from all-cause revision, and 91.7% (95% CI, 52.5% to 99.8%) free from stacked-cone construct revision for aseptic loosening. Stacked-cone revision due to aseptic loosening was performed on the tibial side in 1 case (1.2%) at 3.6 years following the index surgery. Five other stacked cones were revised for periprosthetic joint infection (4 all femoral stacked-cone cases) and tibial implant fracture (1 tibial stacked-cone case). CONCLUSIONS:Stacked-cone constructs demonstrated excellent 5-year survivorship free from aseptic loosening. However, all-cause reoperations and revisions were common in this cohort, reflecting the complex nature of this patient population. LEVEL OF EVIDENCE:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Background: Stacked metaphyseal cone constructs can be used to address extensive metaphyseal and metadiaphyseal bone loss encountered during complex primary or revision total knee arthroplasty (TKA). Our study reports the 5-year outcomes of a multicenter cohort of stacked-cone constructs used to manage extensive bone loss encountered during primary or revision TKA. Methods: A retrospective review was conducted to identify patients who underwent primary or revision TKA with tibial and/or femoral stacked-cone constructs between July 2016 and September 2025 at 4 tertiary academic institutions. Demographic, operative, clinical, and radiographic data were obtained and analyzed. Five-year implant survivorship free from all-cause reoperation, all-cause revision, and stacked-cone construct revision for aseptic loosening was analyzed using Kaplan-Meier estimation. Results: Eighty-four cases with a mean patient age of 67.3 years and a mean follow-up of 20.85 months were identified. Five-year survivorship was 56.5% (95% confidence interval [CI], 22.7% to 78.3%) free from all-cause reoperation, 65.2% (95% CI, 25.8% to 87.1%) free from all-cause revision, and 91.7% (95% CI, 52.5% to 99.8%) free from stacked-cone construct revision for aseptic loosening. Stacked-cone revision due to aseptic loosening was performed on the tibial side in 1 case (1.2%) at 3.6 years following the index surgery. Five other stacked cones were revised for periprosthetic joint infection (4 all femoral stacked-cone cases) and tibial implant fracture (1 tibial stacked-cone case). Conclusions: Stacked-cone constructs demonstrated excellent 5-year survivorship free from aseptic loosening. However, all-cause reoperations and revisions were common in this cohort, reflecting the complex nature of this patient population. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
To examine whether clinical outcomes and patient-reported outcomes (PROMs) differ when patients are stratified by operative level in 3-level ACDF procedures. In this retrospective single-institution cohort study, patients undergoing 3-level ACDF (2014–2020) were reviewed for demographics, clinical outcomes, and PROMs. Patients with operative indications of infection/cancer/trauma/deformity were excluded. Patients with incomplete preoperative or 1-year postoperative PROMs were also excluded. PROMs, including SF-12, VAS Neck, VAS Arm, mJOA, and NDI, were assessed preoperatively and at 3, 6, and 12 months postoperatively. One-year MCID achievement was calculated using established thresholds. Patients were stratified and compared by construct level (C3-C6, C4-C7, and C5-T1). Patients undergoing C3–C6 fusions were older than those in the C4–C7 group (62.7 versus 58.1 years, P = 0.007). The C5–T1 cohort had a higher 2-year reoperation rate compared to the C4–C7 cohort (18.2
Background Total ankle arthroplasty (TAA) has become a reliable option for end-stage ankle arthritis management with good to excellent survivorship with modern 4th generation implant designs. In cases of implant failure, an array of revision implant options is necessary but not readily available to address all the nuanced requirements. We put forth a case series of revision total ankle arthroplasty (rTAA) to report the early experience and feasibility of 3D printed custom stemmed tibial trays (CSTT). Methods Six unique patients (7 ankles) who underwent revision TAA due to primary implant failure were retrospectively identified. The patient population was with a single surgeon at a tertiary care center from May 2023-March 2024. At time of revision, all patients had a CSTT inserted onto a total talus replacement, and a minimum 1-year follow-up. Demographic data and pertinent medical history were recorded. Alignment was recorded with the medial distal tibial angle (MDTA) and anterior distal tibial angle (ADTA) at first weight bearing radiograph and most recent follow-up. Other key outcomes included reoperation, visual analog scale (VAS) pain score, and radiographic evidence of lucency or subsidence. Results Six patients (7 ankles) underwent revision TAA with a custom implant with an average final follow-up of 21.0 months (range 13-30.3). On average, patients were 61 years old with a BMI of 25.7 kg/m2. All 7 revisions underwent concomitant total talus replacements, and 6 underwent subtalar arthrodesis. Mean VAS at final follow-up was 3.3 out of 10 (range 3-5.5). MDTA and ADTA were comparable between immediately postoperative and most recent radiographs. No patients required reoperation. Conclusion CSTTs can be a viable option in the armamentarium of a foot and ankle surgeon in the setting of rTAA and allow for minimal bone loss due to patient-specific instrumentation designed to fit unique morphologies. Further follow-up is necessary to examine implant longevity at mid- and long-term intervals.
