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Jun Zhang, Erhu Li, and Yuan Zhang

  • The number of primary and revision total knee arthroplasties (rTKAs) continues to increase annually. To date, most of the literature has focused on the surgical technique and outcome of revision prostheses. Thanks to the contributions of surgeons, engineers, and researchers, the design of prostheses has reached a prominent milestone. However, very limited discussion regarding the design, rationale and constitution of prostheses has been documented at present.

  • An electronic search of four online databases (Embase, MEDLINE, PubMed, and Google Scholar) was conducted to identify eligible resources. Forty-four review articles were acquired by searching the terms ‘prosthesis selection’, ‘prosthesis option’, and ‘prosthesis determination’ in rTKA. Sixty-eight research articles investigating the factors affecting prosthesis options in rTKA were screened and integrated with the authors’ perspective to reach a final recommendation.

  • This article first discusses the pathological, individual, and other factors affecting prosthesis options in rTKA and further illustrates the classification, geometry, biomechanics, and constitution of the revision system from the authors’ perspective. An evidence-based recommendation in the form of a matching algorithm was formulated.

  • This review offers special value for decision-making regarding prosthesis options in rTKA. Particularly, it presents specific recommendations regarding unclear practical issues, such as the optimal level of constraint, individualized design, length, and fixation of extension stem, as well as the pros and cons of modularity.

Filippo Maria Anghilieri, Ilaria Morelli, Giuseppe M Peretti, Fabio Verdoni, and Domenico Curci

  • The aim of this systematic review is to assess the role of the prophylactic fixation of contralateral unaffected hip in unilateral slipped capital femoral epiphysis (SCFE) in children, focusing on the possible complications of this surgical procedure.

  • A systematic review of medical literature was conducted, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement, to analyse the complications of prophylactic contralateral hip fixation in unilateral paediatric SCFE. We registered the complications reported in the included studies, scoring their severity according to the orthopaedic adaptation of Clavien–Dindo classification.

  • From 1695 studies primarily identified, 14 studies were finally included: 1 prospective cohort study, 4 retrospective case-control studies and 9 retrospective case series, with a total of 811 children diagnosed with unilateral SCFE and treated on the unaffected contralateral hip. Grade IV complications were very rare (0.37%), while the rate of grade III events was 8%. No death was recorded. The most frequent complication was unplanned further surgery (6.29%) that was an epiphyseal refixation, owing to the physiologic growth of the proximal femur, in 42 cases. Cannulated screws fixation showed to have a lower major complication rate than pinning with K-wires, 5.37% vs 17.95%.

  • The prophylactic fixation of contralateral unaffected hip in paediatric unilateral SCFE is a safe procedure. Although a benefit-cost analysis on this topic has not been published yet, considering the low rate of complications, prophylactic hip fixation is a viable option for patients presenting with unilateral SCFE, to prevent the occurrence of severe hip deformity and avoid future invasive surgeries.

Ulrike Wittig, Gloria Hohenberger, Martin Ornig, Reinhard Schuh, Andreas Leithner, and Patrick Holweg

  • The aim of this study was to determine whether all-arthroscopic repair would lead to improved clinical outcomes, lower complication rates, shorter postoperative immobilization and earlier return to activity compared to open Broström repair in the surgical treatment of chronic lateral ankle instability (CLAI).

  • A systematic literature search was conducted using Pubmed and Embase to identify studies dealing with a comparison of outcomes between all-arthroscopic and open Broström repair for CLAI. The search algorithm was ‘ankle instability’ AND ‘Brostrom’ AND ‘arthroscopic’ AND ‘open’. The study had to be written in English language, include a direct comparison of all-arthroscopic and open Broström repair to treat CLAI and have full text available. Exclusion criteria were former systematic reviews, biomechanical studies and case reports.

  • Overall, eight studies met the inclusion criteria and were included in the analysis. Clinical outcomes did not differ substantially between patients treated with either arthroscopic or open Broström repair. Studies that reported on return to activity and sports following surgery suggested that patients that had all-arthroscopic Broström repair returned at a quicker rate. Overall complication rate tended to be lower after arthroscopic Broström repair.

  • Similar to open repair, all-arthroscopic ligament repair for CLAI is a safe treatment option that yields excellent clinical outcomes.

  • Level of Evidence: Level III evidence (systematic review of level I, II and III studies).

Michael Millrose, Markus Gesslein, Till Ittermann, Simon Kim, Hans-Christoph Vonderlind, and Mike Ruettermann

  • Arthrodesis of the proximal interphalangeal (PIP) joint of the finger is an established procedure for advanced osteoarthritis. As there are different techniques of fusion, it seems necessary to evaluate the results.

  • Primary outcome of this review was to evaluate different arthrodesis methods of the PIP joint and describe different numbers of non-unions. Secondary outcome was to evaluate time to consolidation. Respective complications, if mentioned, were listed additionally.

  • The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The selected databases were PubMed, Medline, Embase, Google Scholar and Cochrane Library. Studies reporting outcomes of the arthrodesis with a defined technique and radiological consolidation were included. Complication rates and types were recorded. In total, 6162 articles could be identified, 159 full-texts were assessed and 64 studies were included. Methodological quality was assessed using Methodological Index for Non-Randomized Studies.

  • A total of 1923 arthrodeses of the PIP joint could be identified. Twelve different surgical techniques were described, four of these techniques with compression at the arthrodesis site. The most frequently used techniques were K-wires (n = 743, 14 studies), tension-band (n = 313, 15 studies) and compression screws (n = 233, 12 studies). The lowest rate of described non-unions in compression techniques was 3.9% with the compression screw. The highest non-union rate of 8.6% was achieved by interosseous wiring.

  • All the described techniques can achieve the goal of fusing an osteoarthritic joint. There is a tendency in the more recent literature for the use of compression techniques.

Habeeb Bishi, Joshua B V Smith, Vipin Asopa, Richard E Field, Chao Wang, and David H Sochart

  • There are advocates of both two-dimensional (2D) and three-dimensional (3D) templating methods for planning total hip replacement.

  • The aim of this study was to compare the accuracy of implant size prediction when using 2D and 3D templating methods for total hip arthroplasty, as well as to compare the inter- and intra-observer reliability in order to determine whether currently available methods are sufficiently reliable and reproducible.

  • Medline, EMBASE and PubMed were searched to identify studies that compared the accuracy of 2D and 3D templating for total hip replacement.

  • Results were screened using the PRISMA flowchart and included studies were assessed for their level of evidence using the Oxford CEBM criteria. Non-randomized trials were critically appraised using the MINORS tool, whilst randomized trials were assessed using the CASP RCT checklist.

  • A series of meta-analyses of the data for accuracy were also conducted.

  • Ten studies reported that 3D templating is an accurate and reliable method of templating for total hip replacement. Six studies compared 3D templating with 2D templating, all of which concluded that 3D templating was more accurate, with three finding a statistically significant difference.

  • The meta-analyses showed that 3D CT templating is the most accurate method.

  • This review supports the hypothesis that 3D templating is an accurate and reliable method of preoperative planning, which is more accurate than 2D templating for predicting implant size. However, further research is needed to ascertain the significance of this improved accuracy and whether it will yield any clinical benefit.

Maria Anna Smolle, Sandra Bösmüller, Paul Puchwein, Martin Ornig, Andreas Leithner, and Franz-Josef Seibert

  • The aim of this systematic review and meta-analysis was to assess risk for iatrogenic radial nerve palsy (iRNP), non-union, and post-operative infection in humeral shaft fractures.

  • A PubMed search including original articles comparing different treatments for humeral shaft fractures published since January 2000 was performed. Random effect models with relative risks (RR) and 95% CIs were calculated for treatment groups and outcomes.

  • Of the 841 results, 43 studies were included in the meta-analysis (11 level II, 5 level III, 27 level IV). Twenty-seven compared intramedullary nailing (IM) with ORIF, nine conservative with operative treatment, four ORIF with minimally invasive plate osteosynthesis (MIPO), and three anterior/anterolateral with posterior approach. iRNP risk was higher for ORIF vs IM (18 studies; RR: 1.80; P  = 0.047), ORIF vs MIPO (4 studies; RR: 5.60; P  = 0.011), and posterior vs anterior/anterolateral approach (3 studies; RR: 2.68; P  = 0.005). Non-union risk was lower for operative vs conservative therapy (six studies; RR: 0.37; P  < 0.001), but not significantly different between ORIF and IM (21 studies; RR: 1.00; P  = 0.997), or approaches (two studies; RR: 0.36; P  = 0.369). Post-operative infection risk was higher for ORIF vs IM (14 studies; RR: 1.84; P  = 0.004) but not different between approaches (2 studies; RR: 0.95; P  = 0.960).

  • Surgery appears to be the method of choice when aiming to secure bony union, albeit risk for iRNP has to be considered, particularly in case of ORIF vs IM or MIPO, and posterior approach. Due to the limited number of randomised studies, evidence on the best treatment option remains moderate, though.

Andrea Angelini, Nicolò Mosele, Elisa Pagliarini, and Pietro Ruggieri

  • Patients with Gorham–Stout disease (GSD) present progressive destruction and resorption of bone.

  • Typical bone-related symptoms include swelling, pain and functional impairment in the region involved.

  • The three aspects of GSD etiopathology are osteoclasts, angiogenesis/lymphangiogenesis and osteoblast function.

  • Multi-targeted pharmacological approach includes innovative options and represent milestones of treatment, sometimes associated with radiotherapy.

  • Surgery is mainly used to treat complications: pathologic/impending fractures, spinal instability or deformities and chylothorax.

  • In this narrative review, we highlight current standards in diagnosis, clinical management and therapeutic strategies.

Luigi Zagra, Francesco Benazzo, Dante Dallari, Francesco Falez, Giuseppe Solarino, Rocco D’Apolito, and Claudio Carlo Castelli

  • Hip, spine, and pelvis move in coordination with one another during activity, forming the lumbopelvic complex (LPC).

  • These movements are characterized by the spinopelvic parameters sacral slope, pelvic tilt, and pelvic incidence, which define a patient’s morphotype.

  • LPC kinematics may be classified by various systems, the most comprehensive of which is the Bordeaux Classification.

  • Hip–spine relationships in total hip arthroplasty (THA) may influence impingement, dislocation, and edge loading.

  • Historical ‘safe zones’ may not apply to patients with impaired spinopelvic mobility; adjustment of cup inclination and version and stem version may be necessary to achieve functional orientation and avert complications.

  • Stem design, bearing surface (including dual mobility), and head size are part of the armamentarium to treat abnormal hip–spine relationships.

  • Special attention should be directed to patients with adult spine deformity or fused spine because they are at increased risk of complications after THA.

Christof Audretsch, Alexander Trulson, Andreas Höch, Steven C Herath, Tina Histing, Markus A Küper, and Working Group on Pelvic Fractures of the German Trauma Society

  • Treatment of acetabular fractures is challenging and risky, especially when surgery is performed. Yet, stability and congruity of the hip joint need to be achieved to ensure early mobilization, painlessness, and good function. Therefore, coming up with an accurate decision, whether surgical treatment is indicated or not, is the key to successful therapy.

  • Data from the German pelvic Trauma Registry (n  = 4213) was evaluated retrospectively, especially regarding predictors for surgery. Furthermore, a logistic regression model with surgical treatment as the dependent variable was established.

  • In total, 25.8% of all registered patients suffered from an acetabular fracture and 61.9% of them underwent surgery. The fracture classification is important for the indication of surgical therapy. Anterior wall fractures were treated surgically in 10.2%, and posterior column plus posterior wall fractures were operated on in 90.2%. Also, larger fracture gaps were treated surgically more often than fractures with smaller gaps (>3 mm 84.4%, <1 mm 20%). In total, 51.4% of women and 66.0% of men underwent surgery. Apart from the injury severity score (ISS), factors that characterize the overall picture of the injury were of no importance for the indication of a surgical therapy (isolated pelvic fracture: 62.0%, polytrauma: 58.8%). The most frequent reason for non-operative treatment was ‘minimal displacement’ in 42.2%.

  • Besides fracture classification and fracture characteristics, no factors characterizing the overall injury, except for the ISS, and unexpectedly gender, are important for making a treatment decision. Further studies are needed to determine the relevance of these factors, and whether they should be used for the decision-making process, in particular surgeons with less experience in pelvic surgery, can orient themselves to.

George D Chloros, Christos D Kakos, Ioannis K Tastsidis, Vasileios P Giannoudis, Michalis Panteli, and Peter V Giannoudis

  • Even though fifth metatarsal fractures represent one of the most common injuries of the lower limb, there is no consensus regarding their classification and treatment, while the term ‘Jones’ fracture has been used inconsistently in the literature.

  • In the vast majority of patients, Zone 1 fractures are treated non-operatively with good outcomes.

  • Treatment of Zone 2 and 3 fractures remains controversial and should be individualized according to the patient’s needs and the ‘personality’ of the fracture.

  • If treated operatively, anatomic reduction and intramedullary fixation with a single screw, with or without biologic augmentation, remains the ‘gold standard’ of management; recent reports however report good outcomes with open reduction and internal fixation with specifically designed plating systems.

  • Common surgical complications include hardware failure or irritation of the soft tissues, refracture, non-union, sural nerve injury, and chronic pain.

  • Patients should be informed of the different treatment options and be part of the decision process, especially where time for recovery and returning to previous activities is of essence, such as in the case of high-performance, elite athletes.