Aims:This study aims to evaluate the diagnostic performance of serum parameters, synovial fluid analysis, tissue and sonication fluid cultures, and histology to identify persistent infection, and to predict reinfection at reimplantation of two-stage exchange arthroplasty. Methods:From January 2015 to January 2023, a total of 133 patients with completed two-stage exchange arthroplasty for periprosthetic joint infection (PJI) following total hip or knee arthroplasty were eligible for inclusion in this retrospective study. Diagnostic values of serum parameters (CRP, white blood cell count (WBC), differential, fibrinogen), synovial fluid WBC (SF-WBC), culture (synovial fluid, tissue, sonication fluid), and histology were evaluated prior to or at the second stage. Additionally, Kaplan-Meier curves were used to determine infection-free prosthesis survival rates for all parameters. Results:Serum CRP showed the highest area under the receiver operating characteristic curve (AUC; 0.624) among all analyzed test methods (serum WBC: 0.501; serum % polymorphonuclear neutrophils (PMN): 0.605; fibrinogen: 0.533; SF-WBC: 0.601; SF culture: 0.566; tissue culture: 0.463; sonication fluid culture: 0.473; histology: 0.492). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CRP were 51.7% (95% CI 35 to 69), 73.1% (95% CI 64 to 81), 34.9% (95% CI 21 to 49), and 84.4% (95% CI 77 to 92), respectively. In 35% (n = 15/43) of patients with an elevated serum CRP (≥ 10 mg/l), reinfection occurred, while the reinfection rate was only 16% (n = 14/90) in patients with a normal CRP (< 10 mg/l, p = 0.012). Reinfection rates in patients with all-negative cultures at 23% were not significantly different from cases with positive cultures at 13% (p = 0.352). Conclusion:Although CRP showed the best diagnostic value among all analyzed test methods, none of them could reliably identify persistent infection or predict reinfection. Additionally, a positive culture may not justify a further intervention (spacer exchange, prolonged antibiotics). In case of positive culture or elevated CRP, a further thorough debridement at the second stage is recommended to increase the chance of infection eradication.

Die vorliegende aktualisierte Leitlinie soll einen praxisnahen Leitfaden für die Diagnostik und Therapie von Personen mit Hämophilie (Persons with Haemophilia, PwH) in Österreich darstellen. In der Hämophilie-Therapie gibt es wenige vergleichende Interventionsstudien, daher haben die Empfehlungen einen meist niedrigen Evidenzgrad und beruhen auf einem Expertenkonsensus. Als wesentliche Grundlage dieser Leitlinie dienen die internationalen Guidelines der „World Federation of Hemophilia (WFH)“ aus dem Jahr 2020. Diese wurden den nationalen Gegebenheiten und Erfahrungen angepasst. Behandelt werden Diagnostik und Verlaufskontrollen, medikamentöse sowie begleitende Therapieoptionen und Prophylaxe, weiters spezielle Aspekte bei Kindern und Erwachsenen mit schwerer Hämophilie, Messung von Outcomes, die Vorgehensweise bei Traumen, speziellen Blutungen und Eingriffen einschließlich Zahnextraktionen, das Thema Hemmkörper sowie mögliche Probleme bei Konduktorinnen und psychosoziale Aspekte bei Hämophilie.

Background: Persistent knee synovitis leads to joint discomfort, incapacitating inflammation, and functional limitations. The conventional approach has involved surgical procedures to eliminate the actively inflamed synovial membrane. This study aims to investigate the recurrence-free survival and functional outcome after synovectomy and subsequent radiosynoviorthesis (RSO) in patients with knee synovitis. Methods: Thirty-seven knees diagnosed with pigmented villonodular synovitis (PVNS), rheumatoid arthritis (RA), and peripheral spondyloarthritis underwent synovectomy and subsequent RSO between May 2005 and October 2016. The mean age was 34.9 ± 15.1 years, and the mean follow-up period was 84 ± 36.4 months. Clinical outcomes were assessed using the Oxford Knee Score and the presence of swelling and pain at the last follow-up. Recurrence-free survival denotes the duration from synovectomy to surgical re-synovectomy. Results: In general, twelve knees underwent re-synovectomy after a mean follow-up of 34.8 ± 24.9 months. The recurrence-free survival was 83.8% at two years, 71.3% at five years, and 61.7% at ten years. The subgroup analysis revealed recurrence-free survival at two years in 63.6% of patients with PVNS, 86.7% of those with RA, and 100% of individuals with peripheral spondyloarthritis. Conclusions: This study demonstrates that combined therapy for synovitis is an effective approach, significantly improving clinical outcomes.

Aims: Serum inflammatory parameters are widely used to aid in diagnosing a periprosthetic joint infection (PJI). Due to their limited performances in the literature, novel and more accurate biomarkers are needed. Serum albumin-to-globulin ratio (AGR) and serum CRP-to-albumin ratio (CAR) have previously been proposed as potential new parameters, but results were mixed. The aim of this study was to assess the diagnostic accuracy of AGR and CAR in diagnosing PJI and to compare them to the established and widely used marker CRP. Methods: From 2015 to 2022, a consecutive series of 275 cases of revision total hip (n = 129) and knee arthroplasty (n = 146) were included in this retrospective cohort study. Based on the 2021 European Bone and Joint Infection Society (EBJIS) definition, 144 arthroplasties were classified as septic. Using receiver operating characteristic curve (ROC) analysis, the ideal thresholds and diagnostic performances were calculated. The areas under the curve (AUCs) were compared using the z-test. Results: AGR, CAR, and CRP were associated with PJI (p < 0.001). Sensitivities were 62.5% (95% CI 54.3 to 70.0), 73.6% (95% CI 65.8 to 80.1), and 71.5% (95% CI 63.6 to 78.3), respectively. Specificities were calculated with 84.7% (95% CI 77.5 to 89.9), 86.3% (95% CI 79.2 to 91.2), and 87.8% (95% CI 80.9 to 92.4), respectively. The AUC of CRP (0.797 (95% CI 0.750 to 0.843)) was significantly higher than the AUC of AGR (0.736 (95% CI 0.686 to 0.786), p < 0.001), and similar to AUC of CAR (0.799 (95% CI 0.753 to 0.846), p = 0.832). Decreased sensitivities were observed in PJIs caused by low-virulence organisms (AGR: 60%, CAR: 78%) compared to high-virulence pathogens (AGR: 80%, p = 0.042; CAR: 88%, p = 0.158). Higher sensitivities were seen in acute haematogenous (AGR: 83%, CAR: 96%) compared to chronic PJIs (AGR: 54%, p = 0.001; CAR: 65%, p < 0.001). Conclusion: Serum AGR and CAR showed limited diagnostic accuracy (especially in low-grade and chronic infections) and did not outperform the established marker CRP in our study. Hence, neither parameter can be recommended as an additional tool for diagnosing PJI. Cite this article: Bone Joint Res 2024;13(8):372–382.

Background: In comparison to titanium screws, novel cortical bone allograft screws may come with advantages in osseointegration and with avoidance of potential material removal surgery after scarf osteotomy. Methods: A scarf osteotomy with allograft bone screws as fixation was performed in 21 patients (30 feet). Clinical and radiological parameters were prospectively collected until one year after surgery. A retrospective control group, consisting of 75 patients (82 feet) after scarf osteotomy using headless compression screws, was used to compare clinical outcomes. Results: After fixation with allograft bone screws, the mean preoperative AOFAS score increased from 51.5 points preoperatively to 93.5 points one year after surgery. In radiological assessments, a continuous osseointegration with the remodeling of the bone screw was observed in all patients that finished follow-up. However, four metatarsal fractures occurred early postoperatively after fixation using allograft bone screws. There were only three material removal surgeries in patients treated with headless compression screws. Conclusions: Allograft bone screws display a safe fixation and are a biological alternative for scarf osteotomy. Enough distance between the screw and the proximal osteotomy should be ensured to avoid fractures.

This guideline is intended to provide practical guidance for the diagnosis and treatment of haemophilia in Austria. Few randomized controlled interventional trials are available addressing the treatment of haemophilia, therefore recommendations are usually based on low level of evidence and represent expert consensus.This guideline is based on the WFH guideline, published in 2020, and adapted according to the national circumstances and experience.It includes recommendations and suggestions for diagnosis and follow-up visits and pharmacological therapies for treatment and prophylaxis. Further topics comprise special aspects in children and adults with severe haemophilia, outcome measurement, and management of trauma, special bleedings and interventions, including dental procedures, inhibitors, management of haemophilia carriers, and psychosocial aspects.

Lateroplantar foot pain may be caused by various entities, whereby painful os peroneum syndrome should be included in the differential diagnosis. Physical examination and multimodal imaging enable a definitive diagnosis. We report on a 59-year-old man with severe, load-dependent pain, corresponding to an os peroneum syndrome, triggered by a pes planovalgus with consecutively induced focal inflammation and tendovaginitis of the tendon of the peroneus longus muscle. Multifactorial conservative measures including infiltration and shockwave therapy finally led to a restoration of the original condition.

BACKGROUND:A variety of treatment options for unicameral bone cysts (UBC) exist. The controversy of open management of UBC is discussed. The aim of this study was to analyze a single institution's experience in the open surgical treatment of UBC. PATIENTS AND METHODS:By retrospective analysis of the Vienna Bone and Soft Tissue Tumor Registry, 119 patients with open surgery and histologically verified UBC with a mean follow up of 4.8 years (range 1-30 years) were included. Lesion treatment failure was defined as surgically addressed UBC undergoing revision surgery due to persistence or recurrence. RESULTS:Local revision-free survival for lesion treatment failure was 93% after 1 year, 80% after 2 years, 60% after 5 years and 57% after 10 years. Of the patients 34 (29%) had at least 1 revision surgery due to lesion treatment failure. We found that patients with lesion treatment failure were younger (p = 0.03), had UBC with less minimal distance to the growth plate (p = 0.02) and more septation chambers in radiologic imaging (p = 0.02). Patients with open revision surgery were less likely to require a second revision due to lesion treatment failure than patients with percutaneous revision surgery (p = 0.03). CONCLUSION:Open surgery for UBC can only be recommended as reserve treatment in younger children with actively growing lesions. Open UBC surgery carries a relatively high risk of almost 30% of lesion treatment failure and therefore the indications should be limited to extensive osteolysis with high risk of pathological fractures, lesions with displaced pathological fractures, and lesions with an ambiguous radiological presentation that require tissue collection.

Summary Background A variety of treatment options for unicameral bone cysts (UBC) exist. The controversy of open management of UBC is discussed. The aim of this study was to analyze a single institution’s experience in the open surgical treatment of UBC. Patients and methods By retrospective analysis of the Vienna Bone and Soft Tissue Tumor Registry, 119 patients with open surgery and histologically verified UBC with a mean follow up of 4.8 years (range 1–30 years) were included. Lesion treatment failure was defined as surgically addressed UBC undergoing revision surgery due to persistence or recurrence. Results Local revision-free survival for lesion treatment failure was 93% after 1 year, 80% after 2 years, 60% after 5 years and 57% after 10 years. Of the patients 34 (29%) had at least 1 revision surgery due to lesion treatment failure. We found that patients with lesion treatment failure were younger ( p = 0.03), had UBC with less minimal distance to the growth plate ( p = 0.02) and more septation chambers in radiologic imaging ( p = 0.02). Patients with open revision surgery were less likely to require a second revision due to lesion treatment failure than patients with percutaneous revision surgery ( p = 0.03). Conclusion Open surgery for UBC can only be recommended as reserve treatment in younger children with actively growing lesions. Open UBC surgery carries a relatively high risk of almost 30% of lesion treatment failure and therefore the indications should be limited to extensive osteolysis with high risk of pathological fractures, lesions with displaced pathological fractures, and lesions with an ambiguous radiological presentation that require tissue collection.

Background Injectable biphasic ceramic bone substitutes (BCBSs) represent a modern alternative to conventional options for bone defect filling, as they further open the possibilities for percutaneous cavity reconstruction. Although recent studies have shown good surgical outcomes after treatment with BCBSs, mid-term follow-up data are still missing. Patients and methods Between 2013 and 2017, 18 patients were [1] treated with BCBS [2] for benign bone lesions and [3] had a complete set of retrospective information, including surgical protocols, imaging, patient dismission letters and outpatient clinic protocols, [4] with a minimum follow-up time of one year. Eleven patients received percutaneous surgery, while 7 patients had open curettage and BCBS filling. The median follow-up time was 36.5 (range 12-80) months. Results Local recurrence was reported in four patients. A distinctive bone remodelling pattern was noted on follow-up X-ray and magnetic resonance imaging showing a double-line phenomenon and continuously increasing cortical thickness one year after treatment in nine of thirteen patients. Regarding surgical complications, one patient suffered from a septic complication that required BCBS removal and lavage. One patient experienced superficial surgical site inflammation with redness and swelling, while two other patients had prolonged wound secretion. Conclusion In a limited case series, the studied BCBS demonstrated acceptable surgical outcomes. Initial wound leakage and recurrence seemed to be associated with percutaneous injection. Further studies are needed to compare recurrence and bone graft resorption after open and percutaneous bone cyst surgeries and to further evaluate postoperative surgical site inflammation, which appears self-limiting in most cases.

ZusammenfassungDie Arthrose des oberen Sprunggelenks stellt eine weitverbreitete degenerative Erkrankung der unteren Extremität dar. Obwohl sie in vielen Fällen auf eine vorhergehende Verletzung zurückgeführt werden kann, können auch chronisch-entzündliche Erkrankungen zu degenerativen Veränderungen des oberen Sprunggelenks führen. Nach umfangreicher Abklärung des Patienten zur Indikationsstellung kann die Sprunggelenksprothese im fortgeschrittenen Arthrosestadium als Behandlungsoption für Patienten gesehen werden, da die prothetische Versorgung sowohl die Lebensqualität und Funktion des Gelenks verbessert als auch Schmerzen lindert. Da es sich hierbei, im Vergleich zu anderen Endoprothesen, um eine seltene Operation handelt, ist eine umfangreiche präoperative Abklärung beim Spezialisten oder in einem spezialisierten Zentrum notwendig.

Aneurysmal bone cysts (ABC) are benign tumors mostly occurring in children and young adults. Different open and minimal invasive surgical approaches have been proposed for the treatment of ABCs and yet no consensus is defined to date. The aim of this study was to retrospectively review data of a large single center series of ABCs with patients treated by open curettage with or without filling of the cavity or en-bloc resection. We asked: (1) What was the local recurrence rate of ABC after surgical treatment at our institution? (2) What were positive or negative predictors for local recurrence? (3) Was there a benefit from adjuvant burring, phenolization or filling, respectively? (4) Where there changes in recurrence free survival in different time periods of primary surgery? By retrospective data analysis of the Vienna Bone and Soft Tissue Tumor Registry, 123 patients surgically treated for primary aneurysmal bone cysts were identified. After exclusion of 33 patients (27%) due to a postoperative follow up below one year, 90 patients who were treated for primary ABCs between 1986 and 2009 were evaluated. These included 50 males and 40 females with a mean age of 16 years (SD 10 years; range: 2 to 51 years). The mean follow-up was 99 months. (SD 72 months, range: 13 to 329 months) Curettage was performed in 84 patients, while 45 patients received adjuvant phenolization. Local recurrence occurred in 28 patients after a mean time of 16 months, with a corresponding local recurrence free survival (RFS) of 83% after one year, 77% after 2 years and 66% after 5 years. ABCs located in hands and feet (p = 0.044) showed a superior RFS, while younger patients (p = 0.001) displayed an inferior RFS. Regarding adjuvant surgical techniques, mechanical cavity burring (p = 0.004) and filling with autologous cancellous bone graft (p = 0.024) showed protective effects on RFS. Patients treated between 1986 and 1999 (n = 47) had a higher RFS than patients treated between 2000 and 2009 (n = 43, p = 0.011), as surgeons and surgical indications changed over time. Although curettage, burring, phenolization and reconstruction with bone grafts came with a relatively high risk of local recurrence, open surgery is still justified in aggressively growing ABCs of critical localizations. IV; therapeutic study.

Background. - Aneurysmal bone cysts (ABC) are benign tumors mostly occurring in children and young adults. Different open and minimal invasive surgical approaches have been proposed for the treatment of ABCs and yet no consensus is defined to date. The aim of this study was to retrospectively review data of a large single center series of ABCs with patients treated by open curettage with or without filling of the cavity or en-bloc resection. Questions/purposes We asked: (1) What was the local recurrence rate of ABC after surgical treatment at our institution? (2) What were positive or negative predictors for local recurrence? (3) Was there a benefit from adjuvant burring, phenolization or filling, respectively? (4) Where there changes in recurrence free survival in different time periods of primary surgery? Methods. - By retrospective data analysis of the Vienna Bone and Soft Tissue Tumor Registry, 123 patients surgically treated for primary aneurysmal bone cysts were identified. After exclusion of 33 patients (27%) due to a postoperative follow up below one year, 90 patients who were treated for primary ABCs between 1986 and 2009 were evaluated. These included 50 males and 40 females with a mean age of 16 years (SD 10 years; range: 2 to 51 years). The mean follow-up was 99 months. (SD 72 months, range: 13 to 329 months)Results. - Curettage was performed in 84 patients, while 45 patients received adjuvant phenolization. Local recurrence occurred in 28 patients after a mean time of 16 months, with a corresponding local recurrence free survival (RFS) of 83% after one year, 77% after 2 years and 66% after 5 years. ABCs located in hands and feet (p = 0.044) showed a superior RFS, while younger patients (p = 0.001) displayed an inferior RFS. Regarding adjuvant surgical techniques, mechanical cavity burring (p = 0.004) and filling with autologous cancellous bone graft (p = 0.024) showed protective effects on RFS. Patients treated between 1986 and 1999 (n = 47) had a higher RFS than patients treated between 2000 and 2009 (n = 43, p = 0.011), as surgeons and surgical indications changed over time.Conclusion. - Although curettage, burring, phenolization and reconstruction with bone grafts came with a relatively high risk of local recurrence, open surgery is still justified in aggressively growing ABCs of critical localizations. Level of evidence. - IV; therapeutic study.(c) 2021 L'Auteur(s). Publie par Elsevier Masson SAS. Cet article est publie en Open Access sous licence CC BY (http://creativecommons.org/licenses/by/4.0/).

The adult acquired flatfoot is a deformity with slow progression, which may leads to pain and restrictions of activities of daily living if untreated. Various treatment strategies, depending on the clinical and radiological presentation, exist. Therefore, an individual therapy approach is necessary for optimal treatment. This article covers etiopathologic aspects, conservative and operative treatments as well as postoperative mobilization and rehabilitation.

Accurate preoperative diagnosis of periprosthetic joint infections (PJIs) can be very challenging, especially in patients with chronic PJI caused by low-virulence microorganisms. Serum parameters, such as serum C-reactive protein (CRP) or the erythrocyte sedimentation rate (ESR), are-among other diagnostic test methods-widely used to distinguish septic from aseptic failure after total hip or knee arthroplasty and are recommended by the AAOS in the preoperative setting. However, they are systemic parameters, and therefore, unspecific. Nevertheless, they may be the first and occasionally the only preoperative indication, especially when clinical symptoms are lacking. They are easy to obtain, cheap, and are available worldwide. In the last decade, different novel serum biomarkers (percentage of neutrophils, neutrophils to lymphocytes ratio, platelet count to mean platelet volume ratio, fibrinogen, D-Dimer, Il-6, PCT) were investigated to find a more specific and accurate serum parameter in the diagnosis of PJI. This article reviews the diagnostic value of established (serum CRP, ESR, WBC) and 'novel' serum inflammatory biomarkers (fibrinogen, D-dimer, interleukin-6 (IL-6), procalcitonin, percentage of neutrophils (%N), neutrophils to lymphocytes ratio (NLR), platelet count to mean platelet volume ratio (PC/mPV)) for the preoperative diagnosis of periprosthetic joint infections.

Introduction Multiple revision hip arthroplasties and critical trauma might cause severe bone loss that requires proximal femoral replacement (PFR). The aim of this retrospective study was to analyse complication- and revision-free survivals of patients who received modular megaprostheses in an attempt to reconstruct massive non-neoplastic bone defects of the proximal femur. Questions/purposes (1) What were general complication rates and revision-free survivals following PFR? (2) What is the incidence of complication specific survivals? (3) What were risk factors leading to a diminished PFR survival? Materials and methods Twenty-eight patients with sufficient follow-up after receiving a modular proximal femoral megaprosthesis were identified. The indications for PFR included prosthetic joint infection (PJI), periprosthetic fracture, aseptic loosening, non-union and critical femoral fracture. Complications were grouped according to the ISOLS-classification of segmental endoprosthetic failure by Henderson et al. Results Overall, the complication-free survival was 64.3% at one year, 43.2% at five years and 38.4% at ten years, with 16 patients (57%) suffering at least one complication. Complications were dislocation in eight patients (29%), PJI in 6 patients (21%), periprosthetic fracture in five patients (18%), and aseptic loosening in six patients (21%). Prosthesis stem cementation showed a lower risk for revision in a cox proportional hazard model (95% CI 0.04–0.93, HR 0.2, p = 0.04). Conclusion PFR with modular megaprostheses represents a viable last resort treatment with high complication rates for patients with severe proximal femoral bone loss due to failed arthroplasty or critical fractures. In revision arthroplasty settings, PFR cementation should be advocated in cases of impaired bone quality.

Introduction Limb salvage surgery for periacetabular malignancies is technically demanding and associated with a considerable likelihood of postoperative complications and surgical revision. Reconstruction using custom-made implants represents the treatment of choice. This study was conducted to analyze treatment outcomes of custom-made implants in a single orthopaedic tumor center. Patients and Methods Twenty patients with a histologically verified periacetabular malignancy and a median follow up time of 5 (1–17) years were included. Results The median number of revision surgeries per patient was 1.5 (0–7). Complications were dislocations in 3 patients, aseptic loosening in 4 patients, deep infections in 9 patients, thromboembolic events in 5 patients and sciatic nerve lesions in 4 patients. Overall survival was 77% after one year, 69% after two years and 46% after five years. Median Harris Hip Score was 81 (37–92) points at last follow up. Conclusion Although internal hemipelvectomy and reconstruction using custom-made implants is linked with a high risk of postoperative complications, good functional outcomes can be regularly achieved. This information may help treating surgeons to find adequate indications, as eligible patients need to be critically selected and integrated into the decision-making process.

Die MTP-I-Arthrodese stellt ein orthopädisches Standardverfahren zur primären Operation des Großzehengrundgelenks bei schwerer Fehlstellung oder Gelenksdestruktion oder zur Revision nach fehlgeschlagenem Ersteingriff oder Infektion dar. Dieser Review dient als Übersichtsarbeit der MTP-I-Arthrodese mit Fokus auf die rezente Komplikationsliteratur. Mittels Erhebung der kombinierten Begriffe „MTP Arthrodesis“, „Metatarsophalangeal arthrodesis“, „Complication“, „Pseudarthrosis“, „Non-Union“, „Malposition“, „Transfermetatarsalgia“, „Thrombosis“ und „Infection“ in PubMed wurden nach Durchsicht der Zusammenfassungen und vertiefender Recherche rezenter Originalarbeiten 31 wissenschaftliche Arbeiten in den Review miteinbezogen. In den letzten Jahrzehnten konnten deutliche wissenschaftliche Fortschritte des historischen Operationsprinzips getroffen werden, so setzten sich die Fixierungen mittels gekreuzter Schrauben oder mittels dorsaler Platte und Zugschraube gegen andere Methoden durch. Die „cup-and-cone“ Technik ermöglicht eine Ausrichtung des Großzehens auch nach Gelenkspräparation. Im Zentrum der rezenten Komplikationsliteratur steht die Pseudarthrose und deren Risikofaktoren. In Hinblick auf Komplikationen zeigt sich die MTP-I-Arthrodese als sichere Operation, schwere Komplikationen sind selten. Diese Operationssicherheit spiegelt sich auch in der vorhandenen Primärliteratur wider, da insbesondere umfassend prospektive Arbeiten nur spärlich vorhanden sind. Nichtsdestotrotz sind sowohl das frühzeitige Erkennen von als auch der korrekte Umgang mit Komplikationen nach MTP-I-Arthrodese zur Sicherstellung des Operationserfolges von Bedeutung. The arthrodesis of the first metatarsophalangeal joint is an orthopaedic standard procedure for primary surgery of severe deformities or joint destruction or for revision of failed surgery or infection. This review highlights scientific trends around the first metatarsophalangeal arthrodesis with a focus on the recent complication literature. After PubMed inquiry of the terms „MTP Arthrodesis“, „Metatarsophalangeal arthrodesis“, „Complication“, „Pseudarthrosis“, „Non-Union“, „Malposition“, „Transfermetatarsalgia“, „Thrombosis“ and „Infection“ and review of relevant abstracts and papers, 31 scientific works have been included. In the last decades, significant scientific progress of the historic surgical principle has been made. The fixations using crossed screws or using a dorsal plate and compression screw prevailed against other methods. The „cup-and-cone“ technique allows a positioning of the great toe even after joint preparation. Non-union and its risk factors are in the center of recent complication literature. Regarding complications, the first metatarsophalangeal joint arthrodesis is a safe procedure and severe complications are rare. This surgical safety is reflected in primary literature, as comprehensive prospective studies are rare. Nevertheless, a fast recognition and proper management of complications following MTP-I-Arthrodesis are important to secure surgical success.

BACKGROUND:There is scant evidence to guide decision-making for patients considering total femoral replacement (TFR). We aimed to identify the indication, patient, disease, and surgical technique-related factors associated with failure. We hypothesized that failure occurs more frequently in the setting of revision surgical procedures, with infection as the predominant failure mode. METHODS:We performed a retrospective cohort study of patients receiving total femoral endoprostheses for oncological and revision arthroplasty indications; 166 patients met these criteria. Our primary independent variable of interest was TFR for a revision indication (arthroplasty or limb salvage); the primary outcome was failure. Analyses were performed for patient variables (age, sex, diagnosis group, indication), implant variables (model, decade, length, materials), and treatment variables. We analyzed TFR failures with respect to patient factors, operative technique, and time to failure. We conducted bivariate logistic regressions predicting failure and used a multivariate model containing variables showing bivariate associations with failure. RESULTS:Forty-four patients (27%) had treatment failure. Failure occurred in 24 (23%) of 105 primary TFRs and in 20 (33%) of 61 revision TFRs; the difference was not significant (p = 0.134) in bivariate analysis but was significant (p = 0.044) in multivariate analysis. The mean age at the time of TFR was 37 years in the primary group and 51 years in the revision group (p = 0.0006). Of the patients who had mechanical failure, none had reoccurrence of their original failure mode, whereas all 8 patients from the nonmechanical cohort had reoccurrence of the original failure mode; this difference was significant (p = 0.0001). CONCLUSIONS:TFR has a high failure rate and a propensity for deep infection, especially in the setting of revision indications and prior infection. All failed TFRs performed for revision indications for infection or local recurrence failed by reoccurrence of the original failure mode and resulted in amputation. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.