Background: The number of joint revision arthroplasties has increased in the elderly population, which is burdened by several perioperative risks. Methods: Patients who underwent hip and knee revision arthroplasty were retrospectively included, and they were divided into two groups by age: <80 years old (Group 1) and ≥80 years old (Group 2). The primary outcome was to compare perioperative complication rates. The secondary outcome was to compare the 30-day, 90-day, and 1-year readmission rates. Results: In total, 74 patients in Group 1 and 75 patients in Group 2 were included. Postoperative anemia affected 13 patients in Group 1 (17.6%) and 25 in Group 2 (33.3%, p 0.027); blood units were transfused in 20 (26.7%) and 11 (14.9%, p 0.076) patients, respectively. In Group 1, two (2.7%) patients reported wound infection. In Group 2, eight (10.7%) patients presented hematomas, and two (2.7%) patients reported dislocations. No significant differences in the two groups were observed for 30-day (p 0.208), 90-day (p 0.273), or 1-year readmission rates (p 0.784). Conclusion: The revision arthroplasty procedure in patients over 80 years old is not associated with a higher risk of perioperative complications, or higher readmission rate compared with younger patients undergoing hip and knee revision surgery.

Background: Single-stage hardware removal and total hip arthroplasty is a complex surgical procedure, comparable to revision surgery. The purpose of the current study is to evaluate single-stage hardware removal and THA outcomes, compare this technique with a matched control group that has undergone primary THA and assess the risk of periprosthetic joint infection with a 24-month minimum follow-up. Methods: This study included all those cases treated with THA and concomitant hardware removal from 2008 to 2018. The control group was selected on a 1:1 ratio among patients who underwent THA for primary OA. The Harris Hip (HHS) and University of California at Los Angeles Activity (UCLA) scores, infection rate and early and delayed surgical complications were recorded. Results: One hundred and twenty-three consecutive patients (127 hips) were included, and the same number of patients was assigned to the control group. The final functional scores were comparable between the two groups; a longer operative time and transfusion rate were recorded in the study group. Finally, an increased incidence of overall complications was reported (13.8% versus 2.4%), but no cases of early or delayed infection were found. Conclusions: Single-stage hardware removal and THA is a safe and effective but technically demanding technique, with a higher incidence of overall complications, making it more similar to revision THA than to primary THA.

Background/Objectives: A missed periprosthetic joint infection (PJI) diagnosis can lead to implant failure. However, to date, no gold standard for PJI diagnosis exists, although several classification scores have been developed in the past years. The primary objective of the study was the evaluation of inter-rater reliability between five PJI classification systems when defining a patient who is infected. Two secondary outcomes were further examined: the inter-rater reliability assessed by comparing the classifications in pairs, and the evaluation of each classification system within the subcategories defined by the World Association against Infection in Orthopaedics and Trauma (WAIOT) definition. Methods: Retrospectively collected data on patients with knee and hip PJIs were used to assess the agreement among five PJI scoring systems: the Musculoskeletal Infection Society (MSIS) 2013 definition, the Infection Consensus Group (ICG) 2018 definition, the European Bones and Joints Infection Society (EBJIS) 2018 definition, the WAIOT definition, and the EBJIS 2021 definition. Results: In total, 203 patients with PJI were included in the study, and the agreement among the examined scores was 0.90 (Krippendorff’s alpha = 0.81; p-value < 0.001), with the MSIS 2013 and ICG 2018 classification systems showing the highest agreement (Cohen’s Kappa = 0.91; p-value < 0.001). Conclusions: There is a strong agreement between the major PJI classification systems. However, a subset of patients (n = 11, 5.42%) still falls into a diagnostic grey zone, especially in cases of low-grade infections. This highlights the need for enhanced diagnostic criteria that incorporate tools that are available even with limited resources, and the potential of artificial intelligence-based techniques in improving early detection and management of PJIs.

Background: Acetabular microfractures for cartilage lesions have been shown to be a safe procedure able to improve patient reported outcomes (PROs). Nevertheless, the return to sport activity rate represents a crucial outcome to be investigated in these young athletic patients. Methods: Patients undergoing acetabular microfracture for full chondral acetabular lesions were compared to a 1:1 matched-pair by age and gender control group undergoing hip arthroscopy without microfractures. Clinical assessment was performed with PROs and participation in sports in terms of type and level of activities was evaluated preoperatively and at 2-years follow-up. Results: A total of 62 patients with an average age of 35.1 ± 8.1 (microfracture group) and 36.4 ± 6.3 (control group) were included. In both groups, the average values of PROs significantly increased from preoperatively to the last follow-up. There was no significant difference between the two groups in the number of patients playing at the amateur and elite level preoperatively and at the last follow-up. Conclusions: Microfractures for the management of full-thickness acetabular chondral defect provides good clinical results at a minimum follow-up of two years, which are not inferior to a matched-pair control group. Patients undergoing this procedure are likely able to return at the same level of sport before surgery.

Background: The pre-operative three-dimensional (3D) assessment of acetabular bone defects may not be evaluated properly with conventional radiographic and computed tomography images. This paper reports mid-term clinical and radiographic outcomes of complex revision total hip arthroplasty (r-THA) based on a 3D life-sized printed model. Methods: Patients who underwent r-THA for septic or aseptic acetabular loosening with acetabular defects Paprosky types IIc, IIIa, and IIIb between 2019 and 2021 were included. The outcomes of the study were to determine clinical and radiographic assessment outcomes at the time of the last follow-up. Results: 25 patients with mean age of 62.9 ± 10.8 (18–83) years old were included. The mean Harris hip score improved from 34.8 ± 8.1 pre-operative to 81.6 ± 10.4 points (p < 0.001). The mean visual analog scale decreased from 6.7 ± 1.4 points pre-operative to 2.4 ± 1.0 points (p < 0.001). The mean limb length discrepancy improved from −2.0 ± 1.2 cm pre-operative to −0.6 ± 0.6 cm (p < 0.001). The mean vertical position of the center of rotation (COR) changed from 3.5 ± 1.7 cm pre-operative to 2.0 ± 0.7 cm (p < 0.05). The mean horizontal COR changed from 3.9 ± 1.5 cm pre-operative to 3.2 ± 0.5 cm (p < 0.05). The mean acetabular component abduction angle changed from 59.7° ± 29.6° pre-operative to 46° ± 3.9 (p < 0.05). Conclusions: A three-dimensional-printed model provides an effective connection between the pre-operative bone defects’ evaluation and the intraoperative findings, enabling surgeons to select optimal surgical strategies.