Hip arthroplasties is one of the most frequent surgical procedures in Spain and are conducted mainly in elderly subjects. We aim to analyze changes in incidence, co-morbidity profile, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients undergoing primary total hip arthroplasty (THA) over an 8-year study period in Spain.

Background: Dislocation following total knee arthroplasty (TKA) is the worst form of instability. The incidence is from 0.15 to 0.5%. We report six cases of TKA dislocation and analyze the patterns of dislocation and the factors related to each of them. Materials and Methods: Six patients with dislocation of knee following TKA are reported. The causes for the dislocations were an imbalance of the flexion gap (n=4), an inadequate selection of implants (n=1), malrotation of components (n=1) leading to incompetence of the extensor mechanism, or rupture of the medial collateral ligament (MCC). The patients presented complained of pain, giving way episodes, joint effusion and difficulty in climbing stairs. Five patients suffered posterior dislocation while one anterior dislocation. An urgent closed reduction of dislocation was performed under general anaesthesia in all patients. All patients were operated for residual instability by revision arthroplasty after a period of conservative treatment. Results: One patient had deep infection and knee was arthrodesed. Two patients have a minimal residual lag for active extension, including a patient with a previous patellectomy. Result was considered excellent or good in four cases and fair in one, without residual instability. Five out of six patients in our series had a cruciate retaining (CR) TKA designs: four were revised to a posterior stabilized (PS) TKA and one to a rotating hinge design because of the presence of a ruptured MCL. Conclusion: Further episodes of dislocation or instability will be prevented by identifying and treating major causes of instability. The increase in the level of constraint and correction of previous technical mistakes is mandatory.

Background and purpose The most reliable results when treating an infected total knee arthroplasty have been obtained with a two-stage reimplantation protocol. We have used a simple technique for hand-made spacers and now report the outcome. Patients and methods 30 patients with an infected total knee arthroplasty (TKA) were treated with a 2- stage reimplantation protocol. Spacers were built and customized to the type of defect using only 2 retractors and a high-speed tip burr. Partial weight bearing and discharge from the hospital were encouraged in the time between surgeries. 29 of 30 patients (97%) had successful reimplantations and they were followed for an average of 3 (2–5) years. Results Range of motion with the articulating spacer averaged 80° (55–100) and 21 of the 30 patients achieved motion greater than 75°. At the latest follow-up, there were no reinfections. According to the Knee Society score (KSS), the results were considered excellent or good in 25 patients, and fair or poor in 4 of the 29 patients with reimplantations. Motion after reimplantation averaged 107° (90–120). Interpretation One of the key factors related to a successful outcome with a two-stage reimplantation procedure is to keep the joint mobile and functional in the time between surgeries. Hand-made articulating spacers retain most of the advantages of more complex spacers in terms of mobility, pain, bone loss, success, or re-infection rate—with the major advantages of price and universal availability. Limitations related to this technique include potential knee instability, the need to walk with an orthosis, and the risk of subluxations.

Pelvic discontinuity is a complex entity with a high surgical complication rate and no standardized treatment to date. Revision hip arthroplasty in cases of massive bone loss remains a difficult and unsolved problem. The goal of the surgeon is to preserve limb function by restoring bone stock and the biomechanics of the hip. In cases of severe acetabular bone loss, biologic fixation is often inadequate, requiring extensive bone grafting and reconstructive cages. Reconstructive cages are the most commonly used devices and are designed to bridge bone defects, protect the bone graft, and reestablish the rotation center of the hip. A major limitation of current cages is that they do not allow for biologic fixation. We review the options for treating patients with massive bone loss and pelvic discontinuity and discuss therapeutic options and the clinical and radiological criteria for success.

The standard treatment for late infections of knee prostheses is a two-stage reimplantation with a temporary articulating spacer between operations, but there is no universal agreement as to the best type of spacer to be used and surgeons have created modifications according to their technical and economic resources. We describe our modified technique for custom-made articulating spacers. Spacers have evolved from simple monoblock designs made of acrylic cement alone to articulated, modular, complex and expensive designs with different grades of constriction. Many surgeons are reluctant to use these devices because of the costs and the potential risks of inserting metallic or plastic elements into a septic joint. Further refinements for customization of articulating spacers have been attempted (Rand , Goldman et al. ). We have found no reports describing a technique for making custom hand-made articulating spacers.