Purpose: Managing substantial acetabular defects during revision total hip arthroplasty (rTHA) poses significant challenges, with a range of techniques available and ongoing discussions regarding their efficacy. This meta‐analysis aimed to assess the failure rates associated with Paprosky type III and American Academy of Orthopaedic Surgeons (AAOS) types III–IV acetabular defects treated with structural allografts in conjunction with cemented cups, cementless cups, or reinforcement devices.Methods: A systematic review was performed utilising PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews to identify pertinent studies published from January 1980 to 1 April 2024. The search employed terms related to acetabular impaction bone grafting, rTHA, and associated techniques. The main outcome measure was the implant failure rate over an 8‐year period.Results: Twenty‐eight studies met the established inclusion criteria, covering three therapeutic approaches: (1) structural allograft with a cemented cup (four studies), (2) structural allograft with a cementless cup (10 studies), and (3) structural allograft with reinforcement devices (21 studies). The overall 8‐year implant failure rate was found to be 16% (95% CI, 11%–21%), with significant differences noted among the treatment modalities (p = 0.017). The failure rate was lowest for reinforcement devices (12%) and highest for cemented cups (30%). The predominant failure mechanism was aseptic loosening (68.9%), followed by infection (20.3%) and dislocation (10.8%). Rates of aseptic loosening were greater with cemented cups compared to cementless cups and reinforcement devices (19% vs. 13% and 6%, respectively; p = 0.023).Conclusions: Structural allografts combined with reinforcement devices yield favourable outcomes for managing large acetabular defects during revision THA, demonstrating significantly lower failure rates compared to other techniques. The addition of reinforcement devices substantially reduces the risk of implant failure.Level of Evidence: Level III.

One of the greatest challenges of hip revision surgery is the need to restore extensive bone loss by creating a stable reconstruction with long-term durability. The present observational, investigator-initiated prospective study was carried out to evaluate the clinical and radiological results of the use of a commercial biomimetic collagen–hydroxyapatite composite biomaterial (RegenOss) applied in hip revision surgery. Thirty-three patients who underwent hip revision were included in this study, and 29 received up to 2 years of follow-up. The acetabulum was reconstructed using an uncemented hemispherical shell both with or without an iliac fixation stem. Functional recovery was assessed according to the Harris Hip Score (HHS) at the pre-hospitalisation check-up, and at 6-, 12-, and 24-month follow-ups. Radiological evaluation consisting of X-ray analyses (6, 12, and 24 month follow-ups) and CT scan exams (within 10 weeks post-surgery and at 12-month follow-up) were performed to evaluate the reduction in bone defect and new bone regeneration. All the patients reported a complete recovery and a considerable improvement in functional outcome assessed by the HHS, which was significantly higher at all the follow-ups than at pre-hospitalisation. Moreover, radiological assessments revealed good scaffold integration. Overall, collected data suggest that RegenOss is a valid and safe alternative to restoring acetabular bone loss in revision hip arthroplasty.

Purpose: Many treatment options are available for the revision of large acetabular defects. Debate continues as to which technique is most effective. This meta‐analysis aimed to determine the rates of failure of acetabular bone defects Paprosky type III or American Academy of Orthopaedic types III–IV treated with morselized allograft in association with cemented cup or cementless cup or reinforcement devices.Methods: The US National Library of Medicine (PubMed/MEDLINE), EMBASE and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to 1 April 2024 utilizing keywords pertinent to total hip arthroplasty (THA), acetabular impaction bone grafting and revision THA. The main outcome measure was the 9‐year implant failure rate.Results: Thirty‐nine articles were eligible for inclusion in the current study. We found 41 treatment approaches that we grouped into three different treatment options: 1 = morselized allograft and cemented cup (10 studies); 2 =morselized allograft and cementless cup (nine studies); 3 = morselized allograft and device (22 studies). The overall implant failure rate was 2.1% (95% confidence interval [CI], 1.6%–2.8%) at a mean of 9.2 years. There was no significant difference in failure rates between different treatment options (1.6% [95% CI, 0.9%–2.6%]) for morselized allograft and cemented cup; 2.1% (95% CI, 1.4%–3.2%) for morselized allograft and cementless cup; 2.5% (95% CI, 1.7%–3.7%) for morselized allograft and device) between the three different types of treatment (heterogeneity between groups p = 0.351).It was determined that the number one cause of failure was aseptic loosening (80.5%), followed by infection (13.1%) and dislocation (6.4%). THA with reinforcement devices has a higher incidence of infection (3.6 vs. 0.7%, p = 0.001) and dislocation (1.4 vs. 0.6%, p = 0.010) than THA with a cemented cup.Conclusions: The use of morselized allograft in hip revision of large acetabular defects has low implant failure rates, independently of the associated type of implant. Reinforcement devices increase the risk of re‐revision for infection and dislocation.Level of Evidence: Level III.

Background: Native joint septic arthritis is a severe infection associated with considerable morbidity. The data about the microbiological spectrum, treatment methods, and long-term outcomes are heterogeneous. Methods: We performed a decade-long retrospective study encompassing all patients with native joint septic arthritis treated at our institution, a tertiary orthopedic center. Data on demographics, clinical parameters, microbiology, surgical interventions, and antibiotic use were gathered. Outcomes included reoperation, persistent infection and mortality during follow-up. We used logistic regression to identify predictors of adverse outcomes, and Kaplan–Meier analyses to evaluate reoperation-free survival among microbiologic groups. Results: A total of 114 patients (103 adults and 11 children) were included. Cultures yielded positive results in 72 out of 103 (70%) adults and 8 out of 11 (73%) children. Staphylococcus aureus was the primary pathogen in adults (49% of positives) and children (88%), followed by coagulase-negative staphylococci. Antibiotics were administered to all patients, with combinations of at least two molecules in 68% of adults and 91% of children, while surgical intervention predominantly consisted of debridement alone. In adults, an elevated preoperative white blood cell count was associated with unfavorable outcomes in univariate analysis (odds ratio 1.14, 95% confidence interval 1.01–1.30, p = 0.040). The Kaplan–Meier analysis revealed no significant differences in reoperation-free survival across microbiologic groups (log-rank p = 0.361). Conclusions: Over a ten-year period, Staphylococcus aureus remained the predominant cause of native joint septic arthritis; however, culture-negative cases and coagulase-negative staphylococci were also common. Only preoperative leukocytosis was a predictor of poor outcomes, while microbiologic etiology did not significantly influence the risk of reoperation, potentially indicating early and effective therapy. These findings highlight the intricacy of native joint septic arthritis and the necessity for enhanced diagnostics and prognostic stratification.

Purpose: Total hip arthroplasty (THA) is a widely performed surgery with growing demand globally. This study aims to evaluate the effectiveness of a fast track (FT) protocol compared to standard care (SC) in patients undergoing THA. Methods: Ninety patients aged 18–70 years with primary unilateral hip osteoarthritis, American Society of Anesthesiologists (ASA) score <3, body mass index (BMI) ≤ 32 and no cognitive or psychiatric disorders were prospectively enrolled from March 2018 to January 2020. All patients provided informed consent and were randomised to the FT or SC groups. The FT protocol consisted of preoperative education, oral analgesic pain management and early intensive rehabilitation. Functional autonomy was assessed on postoperative Day 3 using the Iowa Level of Assistance (ILOA) scale. Follow‐up assessments at 6 weeks, 3, 6, 12 and 60 months included the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: Forty‐six patients were assigned to the FT group. Both groups were comparable in baseline demographics. The FT group showed significantly faster early functional recovery, with lower ILOA scores on postoperative Day 3 (9.60 ± 5.2 vs. 11.7 ± 3.4; p = 0.024), and a shorter hospital stay (3.54 ± 1.25 vs. 6.39 ± 1.59 days; p < 0.0001). WOMAC scores were significantly better in the FT group at 6 weeks (10.38 ± 9.18 vs. 14.21 ± 8.76; p = 0.035) and remained superior at 60 months (0 ± 0 vs. 0.27 ± 0.81; p = 0.027). Although baseline HHS was higher in the FT group, greater improvements from baseline were seen in the SC group at later follow‐ups, likely due to a ceiling effect. Conclusions: The FT protocol enhances early postoperative recovery and significantly reduces hospital stay after THA without compromising safety. Long‐term functional outcomes favour the FT approach, supporting its implementation to improve recovery in appropriately selected patients undergoing hip arthroplasty. Level of Evidence: Level II.

Introduction: Evidence on early functional recovery and inpatient physiotherapy after lower limb salvage surgery for bone sarcomas is limited. Objective: This study aims to describe early ambulation and explore potential prognostic factors. Methods: A retrospective cohort study was conducted, including patients aged 12–70 years with bone and soft-tissue sarcoma who underwent lower limb resection and reconstruction between 2019 and 2023. The primary outcome was time to ambulation, and the secondary outcome was length of hospital stay. Results: A total of 84 patients were included in this study. The median time to ambulation was 4 post-operative days (interquartile range [IQR], 4), and the median length of stay was 8 (IQR, 4). In multivariable Cox regression, earlier ambulation was associated with tumor location in the diaphysis/other sites (hazard ratio [HR] = 4.39, p=0.002), older age (HR = 1.02 per year, p=0.006), and higher physiotherapy intensity when initiated on post-operative day 1 (HR = 1.74, p=0.001). Bone graft/other procedures were associated with a lower hazard of ambulation compared with prosthetic reconstruction (HR 0.46, p=0.037). Each additional day of ambulation was associated with a 12% lower hazard of discharge (HR = 0.88, p=0.009). Conclusion: Early mobilization and intensive physiotherapy appear to facilitate functional recovery following lower limb salvage surgery for bone and soft-tissue sarcomas. These findings emphasize the value of structured, staff-led rehabilitation programs that actively encourage and guide recovery, highlighting the role of clinical staff in optimizing post-operative outcomes and may improve patients’ independence.