Substantial bone loss following failed total knee arthroplasty (TKA) represents a major challenge in revision arthroplasty, that can require distal femoral reconstruction (DFR). In this study, we aimed to assess the clinical outcome and the complication frequencies of individuals who underwent DFR with modular megaprostheses. Additionally, we aimed to compare functional outcome measures after DFR in these sophisticated cases to an age-matched control group of total knee prostheses to quantify the potential loss of function. A retrospective chart review of 30 consecutive patients after DFR from 1997 to 2017 with a mean age of 74.38 years (± 10.1) was performed. Complications were classified according to the Henderson classification. Knee Society Score (KSS) was calculated and range of motion (ROM) was assessed. Thirteen (43.3%) patients had at least one complication requiring revision surgery. Revision-free survival was 74.8% at one year, 62.5% at three and 40.9% at 10 years post-op. Soft-tissue failure complications were found in three (10.0%) patients, aseptic loosening in four (13.3%) patients, structural failure in one (3.3%) patient and infection in eight (26.6%) patients. Of those with infection, five (16.6%) experienced ongoing prosthetic joint infection and three (10.0%) developed new infection after distal femur reconstruction. Patients with DFR achieved 69.3% of KSS pain score, 23.1% KSS function score and 76.2% of ROM compared to patients with primary TKA. DFR after failed TKA represents a treatment procedure with high risk for complication in this particular group. Despite the prospect of rapid postoperative mobilization, reduced functionality, range of motion and mobilization have to be considered when choosing this treatment option.

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.

Background: Balance and gait are critical for functional recovery and fall prevention following total hip (THA) and knee arthroplasty (TKA). Despite improvements in pain and joint function, residual impairments often persist. The Timed Up and Go (TUG) test and Tinetti Performance-Oriented Mobility Assessment (POMA) objectively measure postoperative mobility and balance, while patient-reported outcome measures (PROMs) assess perceived function and well-being. This study longitudinally evaluates functional measurement and PROMs to explore their interrelationships and compare recovery trajectories in THA and TKA cohorts. Methods: In this prospective study, 22 THA and 21 TKA patients were assessed preoperatively and at 4–6 days, 6 weeks, 3 months, and 12 months postoperatively using TUG, Tinetti, Hip Disability and Osteoarthritis Outcome Score (HOOS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and clinical scores (Harris Hip Score (HHS) for THA, Knee Society Score (KSS) for TKA). Pearson correlation assessed relationships between measures. Results: Both cohorts demonstrated significant immediate postoperative declines in balance and mobility, recovering to baseline by 6 weeks and surpassing it by 3 and 12 months (p < 0.001). PROMs showed earlier and sustained improvements. Objective balance and mobility measures showed minimal correlation with PROMs but were highly interrelated from 6 weeks onward. Conclusions: THA and TKA patients experience early postoperative balance impairments, suggesting heightened fall risk, with functional recovery lagging behind perceived well-being, highlighting the need for cautious rehabilitation strategies.

Background/Objectives: We evaluated the outcomes of patients undergoing en bloc total vertebrectomy at our institution within the last three decades. The aim of our study was to analyse the oncological and neurological outcomes and the changes over time. Methods: We included 22 consecutive patients treated with a total vertebrectomy at our institution between January 1990 and December 2022. The standard follow-up protocol for sarcoma patients was performed. Early complications were defined as complications within the first three months postoperatively. Local recurrence was defined as the reoccurrence of a tumour at least four months after surgery. Adequate statistical methods were applied to evaluate the survival rates and the influence of potential risk factors. A p-value of <0.05 was considered statistically significant. Results: From 1990 to 2010, five total vertebrectomies were performed each decade, whereas twelve patients underwent the procedure in the period from 2010 to 2022. The mean follow-up period was 101.25 months (±112; 2–339). The one-, five- and ten-year overall survival rates were 91% (CI = (0.79; 1.00)), 59% (CI = (0.37; 0.81)) and 51% (CI = (0.27; 0.75)), respectively. For soft tissue tumours, the average overall survival was 6.2 years, whereas, for bone sarcomas, it was 13.6 years. None of the patients with wide surgical margins developed local recurrence. Complications necessitating revision procedures occurred in 54% of all cases. Conclusions: A total vertebrectomy is a highly demanding procedure, requiring accurate patient selection, meticulous preoperative planning and a highly collaborative interdisciplinary team. Adequate surgical treatment seems to be indispensable when aiming for curative treatment. Owing to the rarity of the indications, this procedure should be restricted to large tumour centres.

Background: Artificial intelligence (AI), particularly AI-based large language models (LLM) like ChatGPT, is increasingly shaping how information is accessed, offering patients a new source for understanding complex medical conditions. Given the physical, emotional, and logistical challenges that parents are faced when their baby is diagnosed with developmental dysplasia of the hip (DDH), the demand for clear and accessible educational resources is high. This study aimed to evaluate the quality and reliability of ChatGPT's responses to frequently asked questions about DDH. Methods: This study assessed the quality of responses generated by the AI chatbot ChatGPT 4o to eight frequently asked questions about DDH, derived from real consultations in a pediatric orthopedic clinic Responses were generated during one interaction per question using a ChatGPT account not previously exposed to medical information. Responses were evaluated by two individual readers using a standardized rating system, comparing them to current literature, patient education resources, and consensus guidelines. Each response was categorized by its level of informational accuracy and completeness, and descriptive statistics were calculated to quantify performance. Results: ChatGPT 4o was able to generate structured responses to all eight parental questions. The responses were rated in 12.5% excellent, 25.0% satisfactory with minimal clarification, 50.0% satisfactory with moderate clarification, and 12.5% unsatisfactory due to missing or inaccurate information. Conclusion: ChatGPT provided satisfactory answers to questions about DDH and may serve as a useful supplementary information resource for parents. However, due to limitations in presenting detailed diagnostic and treatment pathways, it should be viewed as an adjunct to, not a replacement for, specialist medical consultation.