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The failure of hip prostheses is a problem that requires further investigation and analysis. Although total hip replacement is an extremely successful operation, the number of revision surgeries needed after this procedure is expected to continue to increase due to issues with both bone cement types and cementation techniques (depending on the producer). To conduct a comparative analysis, as a surgeon prepared the bone cement and introduced it in the body, this study’s team of researchers prepared three types of commercial bone cements with the samples mixed and placed them in specimens, following the timeline of the surgery. In order to evaluate the factors that influenced the chemical composition and structure of each bone cement sample under specific intraoperative conditions, analyses of the handling properties, mechanical properties, structure, and composition were carried out. The results show that poor handling can impede prosthesis–cement interface efficacy over time. Therefore, it is recommended that manual mixing be avoided as much as possible, as the manual preparation of the cement can sometimes lead to structural unevenness.

The use of resorbable magnesium alloys in the design of implants represents a new direction in the healthcare domain. Two main research avenues are currently explored for developing or improving metallic biomaterials: (i) increase of their corrosion resistance by designed compositional and structural modifications, and (ii) functionalization of their surfaces by coating with ceramic or polymeric layers. The main objective of this work was to comparatively assess bio-functional coatings (i.e., highly-crystallized hydroxyapatite and silica-rich glass) deposited by radio-frequency magnetron sputtering (RF-MS) on a biodegradable Mg-0.8Ca alloy (0.8 wt.% of Ca). After probing their morphology (by scanning electron microscopy) and structure (by Fourier transform infrared spectroscopy and grazing incidence X-ray diffraction), the corrosion resistance of the RF-MS coated Mg-0.8Ca substrates was electrochemically tested (in synthetic biological media with different degrees of biomimicry), and their cytocompatibility was assessed in osteoblast and fibroblast cell cultures. By collective assessment, the most promising performances, in terms of mass loss (~7% after 12 days), hydrogen release rate (~6 mL/cm2 after 12 days), electrochemical corrosion parameters and cytocompatibility, were obtained for the crystalline HA coating.

One of the most popular and effective orthopedic surgical interventions for treating a variety of hip diseases is total hip arthroplasty. Despite being a radical procedure that involves replacing bone and cartilaginous surfaces with biomaterials, it produces excellent outcomes that significantly increase the patient’s quality of life. Patient factors and surgical technique, as well as biomaterials, play a role in prosthetic survival, with aseptic loosening (one of the most common causes of total hip arthroplasty failure) being linked to the quality of biomaterials utilized. Over the years, various biomaterials have been developed to limit the amount of wear particles generated over time by friction between the prosthetic head (metal alloys or ceramic) and the insert fixed in the acetabular component (polyethylene or ceramic). An ideal biomaterial must be biocompatible, have a low coefficient of friction, be corrosion resistant, and have great mechanical power. Comprehensive knowledge regarding what causes hip arthroplasty failure, as well as improvements in biomaterial quality and surgical technique, will influence the survivability of the prosthetic implant. The purpose of this article was to assess the benefits and drawbacks of various biomaterial and friction couples used in total hip arthroplasties by reviewing the scientific literature published over the last 10 years.

Background: A critical-sized bone defect (CsBD) is considered one that will not heal spontaneously and requires reconstruction. This study aims to compare the results of using different bone reconstructive techniques and to study the potential of platelet-rich fibrin (PRF) to enhance the healing properties of a bone substitute (BS). Methods: In this experimental study on rats, the treatment of critical-sized bone defects was carried out by analysing four groups: a control group in which the bone defect was left empty; a group treated with Bio-Gen®; another group in which the defect was treated with PRF in combination with Bio-Gen®; and the last that was treated with autologous bone graft (ABG). The defects were evaluated by microcomputed tomography (µCT) and then histomorphometrically. Results: From both the histological and imagistic point of view, the best results were registered in the ABG group, followed by the group treated with Bio-Gen® with PRF, Bio-Gen® group, and control group, with statistically significant differences. Conclusions: A 5 mm defect in the rat radius can be considered critical. ABG showed the best results in treating the bone defect. PRF significantly enhanced the efficacy of Bio-Gen®.

The aim of this study was to evaluate the factors associated with the occurrence of oral infection sources in patients scheduled for total hip or knee arthroplasty, with the purpose of establishing standardized preoperative dental triage criteria. Materials and Methods: A retrospective research was conducted on a study group of 89 patients diagnosed with hip osteoarthritis and knee osteoarthritis at the Clinical Rehabilitation Hospital (Iasi, Romania). Patients were divided according to the status of their oral cavity: study group (n = 51)—patients with diagnosed oral infection sites (oral foci of infection); control group (n = 38)—patients without oral foci of infection. The statistical analysis included a univariate stage followed by a multivariate binary logistic regression to identify demographic and clinical factors associated with the presence of oral foci of infection. Results: The strongest predictor of the presence of oral foci of infection was and Oral Hygiene Index (OHI) scorer of 2, which increased the risk 14.583-fold, followed by being aged between 50 and 65 years (OR = 4.038), tooth brushing once a day or less (OR = 3.488), and male sex (OR = 3.433). An OHI score of 2 raises the probability of oral infectious pathology to 30.3%, which increases to 85.1% when combined with being aged between 50 and 65 years. Conclusions: The risk factors for the presence or oral foci of infection in patients scheduled for total knee or hip arthroplasty support the inclusion of the preoperative assessment and management of these factors in order to reduce the risk of the postoperative periprosthetic joint infections.

Background and Objectives: Total hip replacement and total knee arthroplasty carry a high risk of postoperative venous thromboembolism (VTE); therefore, anticoagulation prophylaxis is recommended in these patients. Unfortunately, there are no guidelines about VTE prophylaxis in patients with hemophilia who underwent these high-risk surgeries. To determine whether these patients have a high risk of VTE, we conducted a retrospective study on patients with hemophilia who underwent elective arthroplasty at our hospital in 2016. Materials and Methods: There were 11 patients with hemophilia A and B who underwent high-risk surgeries. Recombinant factor VIII or IX and also active recombinant Factor VII were used for perioperative hemostasis, and LMWH was administered for thromboembolic prophylaxis. Postoperatively, we collected information on the duration of factor VIII/IX infusion, VTE-prophylaxis, and complications. Results: Postoperative bleeding was minimal in most cases, with an average blood loss of 500 mL. No major thrombotic events were reported, and the need for transfusion was low, with only one patient requiring additional blood products. The VTE prophylaxis included prophylactic enoxaparin and hemostatic treatment. At the 1-year follow-up, we did not find any evidence of clinical VTE in our patients. Conclusions: Better risk stratification is needed to identify patients who would benefit from pharmacological prophylaxis. Total arthroplasty in hemophilic patients is feasible and safe when managed by a multidisciplinary team and supported by tailored antithrombotic prophylaxis protocols. The use of recombinant coagulation factors and LMWH ensures effective bleeding control and thromboembolic prevention, enhancing patient outcomes. These findings underscore the importance of individualized care in this high-risk population.

Numerous studies report the success and outcomes of the total knee arthroplasty (TKA); however, few papers present patients with knee osteoarthritis and ipsilateral hip fusion. One controversy when treating patients requiring a TKA with prior ipsilateral hip fusion is whether to first perform a total hip arthroplasty (THA) of the fused hip, followed by the ipsilateral TKA, or to proceed with the TKA without replacing the hip; studies suggest that the position of the fused hip is a key factor when making this therapeutical decision. In addition, performing a TKA in patients with an ipsilateral fused hip may require modifications to the surgical technique generated by the lack of joint mobility in the hip. We identified 12 studies encompassing 30 patients with hip fusion and ipsilateral TKA in current orthopedic literature, but only six offered insights on patient positioning on the operating table during surgery. This study aims to review the current literature on patients with knee osteoarthritis and prior ipsilateral hip fusion and to present some technical considerations when performing a TKA on a 75-year-old patient with hip ankylosis who underwent a total ipsilateral knee arthroplasty in our clinic.

Campanacci grade III giant cell tumors of the distal radius frequently require en bloc resection to achieve adequate oncologic control. Reconstruction of the resulting defect remains challenging, particularly with respect to preservation of distal radioulnar joint stability and forearm rotation. Although proximal fibular autograft reconstruction is well established, ligamentous stabilization of the distal radioulnar joint is rarely incorporated in oncologic settings. This technical note describes an integrated reconstructive strategy combining proximal fibular autograft with distal oblique bundle reconstruction, illustrated by a representative clinical case. The technique involves segmental en bloc resection of the distal radius followed by reconstruction using an ipsilateral, nonvascularized proximal fibular autograft including the fibular head. Distal radioulnar joint stability is addressed through reconstruction of the distal oblique bundle using an autologous palmaris longus tendon graft. Surgical indications, operative steps, donor site stabilization, and perioperative management are detailed. Functional evolution was assessed using the Musculoskeletal Tumor Society scoring system and range-of-motion measurements. Histopathological examination confirmed negative oncologic margins. Early postoperative events included donor-site common peroneal nerve dysfunction and radiocarpal instability requiring temporary Kirschner wire stabilization. At nine months, the Musculoskeletal Tumor Society score reached 80%, with forearm rotation preserved at 68.8% pronation and 81.3% supination of normal values. Combined osseous and ligamentous reconstruction following distal radius resection is technically feasible and may allow preservation of distal forearm mechanics while maintaining oncologic principles. Broader validation will require application in larger clinical series and longer follow-up.

Fractures of the pelvic ring are among the most severe injuries in orthopaedic practice and Tile type C lesions are characterized by complete disruption of the posterior arch with both vertical and rotational instability. The optimal construct for posterior ring fixation remains a matter of debate. The aim of this study was to compare, by means of finite element analysis, the biomechanical performance of three different methods of osteosynthesis for Tile type C1.2 pelvic ring fractures: a transiliac plate, one iliosacral screw and two anterior reconstruction plates on the sacroiliac joint. A three-dimensional model of an intact pelvis was reconstructed from computed tomography images of a healthy adult male. A Tile type C1.2 injury pattern was created virtually, and three fixation constructs were designed in Ansys SpaceClaim according to manufacturer specifications. All materials were assumed to be homogeneous, isotropic and linearly elastic. Vertical loads of 400 N and 800 N were applied to the sacral endplate to simulate partial and full weight bearing, while the acetabular regions were constrained to represent standing stance. In this study, mechanical stability was operationally defined as resistance to global displacement under applied vertical load, with lower displacement indicating higher construct stiffness. Construct stiffness, total deformation and von Mises stress were assessed for bone and implants. For both loading conditions, the iliosacral screw construct showed the lowest overall displacement and provided the greatest stiffness. The transiliac plate construct presented larger displacements, whereas the anterior reconstruction plate construct provided intermediate stability with higher stresses at the sacroiliac joint. Among the analyzed constructs, the iliosacral screw provided the greatest stiffness and lowest overall displacement, suggesting superior mechanical performance under vertical loading conditions.

Introduction: Chronic osteomyelitis is a persistent infection of the bone that poses significant challenges, particularly when associated with pathological fractures and extensive bone defects. This case report highlights the application of Masquelet’s induced membrane technique (MIMT) in managing a complex distal femur defect in a 50-year-old male with a long-standing history of chronic osteomyelitis. The patient presented with a non-union fracture, severe osseous destruction, and infection, requiring a multidisciplinary approach. Case report: The first stage involved radical debridement of necrotic tissue and stabilization with a titanium plate and an antibiotic-impregnated polymethylmethacrylate spacer to induce a bioactive membrane. The second stage, performed 30 days later, after infection resolution, entailed removing the spacer, harvesting an autologous iliac crest bone graft, and filling the defect within the preserved membrane. Postoperative care included a tailored antibiotic regimen and gradual weight-bearing, leading to favorable clinical and radiological outcomes. Conclusions: This case demonstrates the utility of MIMT in reconstructing extensive bone defects while addressing infection. The technique provides a reliable and effective alternative to amputation, offering high success rates and functional restoration in complex cases.