Aim: Periprosthetic fracture-related infections (PFRIs) are a serious complication of total arthroplasty, with incidence rates increasing in line with the growing number of joint replacements. PFRI can lead to prolonged hospitalization, multiple surgical procedures and suboptimal functional outcomes. The diagnosis of PFRI remains challenging due to the overlap of clinical symptoms with other post-traumatic conditions, and identification of the pathogen often fails through conventional methods. This study also highlights the importance of a personalized medicine approach in managing PFRI, where diagnostic and therapeutic decisions are tailored to the individual patient’s comorbidities, immune status and bone healing capacity. By integrating clinical, microbiological and imaging data, our findings support precision-based strategies to optimize outcomes and minimize complication. Methods: This retrospective case series was conducted at the Unit of Osteoarticular Infection of the University of Turin, Italy, from January 2018 to December 2023. Patients who developed septic complications after open reduction and internal fixation (ORIF) of periprosthetic fractures involving hip or knee implants were included. The infection was diagnosed in accordance with established guidelines, and treatment decisions were based on clinical, microbiological and radiological findings. Results: In the present study, periprosthetic fractures complicated by infections were identified in nine patients (5.4%), constituting a small but significant subset of cases. The cases were then categorized into four clinical scenarios based on the following variables: joint involvement, fracture healing and infection progression. Scenario A, involving fractures without prosthetic involvement and unhealed fractures, included three patients (33%) and was treated with debridement and change of the fixation device. Scenario B, involving fractures without prosthetic involvement but with healed fractures, involved one patient (11%), where the ongoing infection was confirmed despite the healed fracture and where the device could be removed. The third scenario (C), which pertains to cases involving prosthetic involvement, included three patients (33%) who required replacement or removal of the prosthesis and, in some cases, a second stage. The fourth scenario, involving patients with limited operability, included two patients (22%) for whom no surgery was performed. Despite the significant clinical challenges encountered, the paucity of literature on the management of periprosthetic fractures with septic complications is limited, highlighting the need for further research in this understudied area. Conclusions: PFRI remains a challenging complication that necessitates a multidisciplinary approach to diagnosis and treatment. Despite advances in imaging and microbiological testing, the early detection and identification of pathogens remain challenging, emphasizing the necessity for enhanced diagnostic methods. This study offers valuable insights into the management of PFRI and provides a foundation for future research to develop optimal diagnostic and therapeutic strategies.

Background/Objectives: The rate of periprosthetic joint infection (PJI) is expected to increase in the next years worldwide, mainly due to increasing volume of total joint replacement, longer prosthesis lifespans, and patients with multiple comorbidities. The aim of this study is to describe our personal technique, the modified Hofmann Articulated Spacer (mHAS), in which a CR femoral shield and a partially threaded cannulated screw are inserted into the liner replicating a tibial stem, and to evaluate the efficacy of the spacer as a definitive treatment option in selected patients with knee infections. Methods: A consecutive series of 132 patients were treated for orthopedic infection at the Orthopedic and Trauma Center, University of Turin, between November 2023 and May 2025. All patients included in the study had undergone knee prosthesis removal followed by the implantation of a modified Hofmann Articulated Spacer (mHAS). Functional recovery was evaluated through clinical examination, particularly knee range of motion, and patient-reported outcome measures (PROMs), including the Knee Society Score (KSS), Oxford Knee Score (OKS), and the EQ-5D-5L Visual Analogue Scale (VAS). Results: Nine patients were enrolled in the study, at a mean follow-up of 8.12 months (range: 3–13). The mean range of motion of the knee was 95 degrees (range: 80–120°, SD: 15°). The Knee Society Score (KSS) presented a mean value of 71.9 (SD: 18.11). The Oxford Knee Score (OKS) showed a mean value of 30.8 (SD: 8.5). The EuroQol-5 Dimension-5 Level Visual Analogue Scale (EQ-5D-5L VAS) scores demonstrated an excellent quality of life among the participants. Conclusions: The Modified Hofmann Articulated Spacer demonstrated good functional, qualitative outcomes and eradication rates in patients who underwent the first-stage revision TKA for PKI. This has led us to propose it as a definitive treatment option for more critical and low-demand patients and to postpone the second-stage surgery in the remaining cohort due to satisfactory spacer joint function without pain.

Background/Objectives: The purpose of this study was to evaluate the outcomes of meniscal suture repair in patients over 50 years of age with a minimum follow-up of 6 months, following failure of at least 6 months of conservative treatment. Methods: We retrospectively reviewed patients older than 50 years treated between 1 January 2017 and 30 June 2023 at the Orthopaedics and Traumatology Division of ASST Papa Giovanni XXIII (Bergamo, Italy) who underwent meniscal repair after failed conservative management. Patients underwent clinical, radiological and functional assessments. Meniscal healing was evaluated by MRI at 6 months postoperatively. Patient-reported outcome measures (PROMs), including KOOS, IKDC, Lysholm and Tegner Activity Scale, were collected preoperatively and at final follow-up. Results: Eleven patients were included, with a mean age of 53.4 ± 4.1 years (range, 50–64). Nine patients had lateral meniscus tears, and two had medial meniscus tears. At a mean follow-up of 22.0 ± 16.8 months (range, 6–66), significant improvements were observed in KOOS, IKDC and Lysholm scores (p < 0.05), with mean postoperative values of 95.4 ± 5.1, 87.5 ± 8.3 and 97.1 ± 3.5, respectively. All patients returned to their pre-injury activity level according to the Tegner scale. One complete failure and one partial failure were observed, both in patients with medial meniscus tears. Conclusions: In this small cohort, arthroscopic meniscal repair in patients over 50 years of age was associated with significant improvements in clinical and functional outcomes, with a failure rate of 18.2%. These findings suggest that meniscal repair may be a viable joint-preserving option in carefully selected middle-aged patients, particularly in lateral meniscus lesions. However, results should be interpreted cautiously given the limited sample size and retrospective design.