Flexible idiopathic flatfoot is very common in growing age and rarely causes pain or disability. Surgery is indicated only in severe symptomatic cases that are resistant to conservative treatment, and numerous surgical procedures have been proposed. Lateral column calcaneal lengthening as described by Evans and modified by Mosca is a widely used surgical technique for the correction of severe symptomatic flexible flatfoot. In the present study, we report the long-term clinical and radiographic results in 14 adolescent patients (mean age: 12.8 years) affected by severe symptomatic flexible flatfoot, surgically treated by Evans–Mosca procedure, for a total of 26 treated feet (12 cases bilateral and 2 unilateral). In all cases, surgery was indicated for the presence of significant symptoms resistant to nonsurgical management. Clinical evaluation was made according to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Foot and Ankle Disability Index (FADI) Score, and Yoo et al.’s criteria. Radiographic evaluation was made using anteroposterior and lateral weight-bearing radiographs of the feet to evaluate Meary’s angle and Costa–Bertani’s angle and to evaluate possible osteoarthritic changes in the midtarsal joints. At follow-up (mean: 7 years and 7 months), we observed a satisfactory result in all patients. The mean average score of the AOFAS Ankle-Hindfoot Scale improved from 60.03 points to 95.26; the mean FADI score improved from 71.41 to 97.44; and according to Yoo et al.’s criteria, the average clinical outcome score was 10.96. At radiographic examination, nonunion of the calcaneal osteotomy was never observed. Meary’s angle improved from an average preoperative value of 25° to 1.38° at follow-up; Costa–Bertani’s angle improved from an average preoperative value of 154.2° to 130.9° at follow-up. In no case, significant radiographic signs of midtarsal joint arthritis were observed. According to our results, we believe that Evans–Mosca technique is a valid option of surgical treatment for severe idiopathic flexible flatfoot and allows a satisfactory correction of the deformity with a low rate of complications.

The authors report the long-term outcome in a series of 26 patients surgically treated for a fracture-dislocation of the ankle by open reduction and internal fixation (ORIF), reviewed after an average followup of 5.2 years. The average age of the patients was 46.8 years; 17 were female and 9 male; the right side was involved in 22 patients and the left side in 4; 10 patients had a unimalleolar fracture, 11 a bimalleolar fracture, and 5 a trimalleolar fracture. The quality of reduction was excellent in 14 cases and good in 12. The functional results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, while radiographic results followed the Van Dijk classification. At followup, the AOFAS score ranged from 75 to 98 points with an average of 87.9, while the radiographic results were evaluated as grade 0 in 16 ankles and grade I in 10. Fracture-dislocations of the ankle occurred more frequently after high-energy traumas in younger patients on the right side, but they were also observed in older females after low-energy trauma. Excellent reduction was correlated with better radiographic results at long term followup. However, these injuries may lead to a poor functional outcome, despite an anatomical reduction and good radiographic results; in fact, in nine of our cases (34.6 percent), the AOFAS score was less than 90 points.

Introduction: Neck-preserving total hip arthroplasty (THA) has gained interest for conserving bone stock, restoring biomechanics, and facilitating revision surgery. The Nanos^® femoral stem, designed for metaphyseal fixation while preserving the femoral neck, represents a reliable alternative to conventional THA. This study reports 15-year clinical and radiographic outcomes of the Nanos implant. Materials and Methods: We retrospectively reviewed 53 patients (35 males, 18 females) who underwent THA with the Nanos stem between 2008 and 2010. Patients were stratified into two groups according to age: <50 years (n = 24) and ≥50 years (n = 29). The primary diagnosis was osteoarthritis (95%), with a few cases of avascular necrosis or dysplasia. Clinical evaluation included the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Radiographic assessment focused on implant stability, osteolysis, and heterotopic ossifications. Kaplan–Meier survival analysis was performed with revision for any reason as the endpoint. Results: At 15 years of follow-up, both groups showed significant improvement (p < 0.001). In patients <50 years, HHS increased from 53.3 to 94.8 and WOMAC decreased from 79.9 to 3.5. In patients ≥50 years, HHS improved from 47.5 to 95.2 and WOMAC from 81.5 to 3.2. Radiographs confirmed stable fixation without osteolysis. Complications included two dislocations and one cortical perforation requiring revision. Kaplan–Meier survivorship at 15 years was 100% (<50) and 96.6% (≥50). Conclusions: The Nanos stem provided excellent long-term outcomes with low complication and revision rates. It should be considered one of several reliable short-stem options for younger, active patients, offering durable function while preserving bone stock.

Background: Hip resurfacing arthroplasty (HRA) was developed as a bone-preserving alternative to conventional total hip arthroplasty (THA), particularly for young and physically active patients. However, concerns regarding metal-on-metal bearings have substantially restricted its use. This study evaluated the long-term clinical, functional, radiographic, and implant survivorship outcomes of HRA. Methods: This retrospective cohort study included all 53 consecutive primary HRA procedures performed at a single institution between January 2001 and December 2010. No patients were excluded or lost to follow-up. The mean age at surgery was 43.2 years (range, 18–56 years), and the mean follow-up was 20 years (range, 15–25 years). Clinical outcomes were assessed using the Harris Hip Score (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Paired preoperative and final scores were analyzed only in the 47 patients who retained their HRA implant. Radiographic evaluation included implant fixation, radiolucent lines, osteolysis, component alignment, and heterotopic ossification. Implant survivorship was estimated using the Kaplan–Meier method, with revision of any component for any reason as the endpoint. Results: Among the 47 patients with retained HRA implants, the mean HHS increased from 31.3 ± 17.9 preoperatively to 95.3 ± 7.4 at final follow-up, while the mean total WOMAC score decreased from 65.9 ± 10.4 to 11.5 ± 3.5 (both p < 0.001). Six hips (11.3%) underwent revision to conventional THA: three for metallosis, two for femoral neck fracture, and one for persistent pain associated with acetabular radiolucency. One additional patient developed postoperative thrombophlebitis that did not require implant revision. Radiographic assessment of unrevised hips demonstrated stable component fixation without progressive radiolucency, clinically significant osteolysis, implant migration, or aseptic loosening. Kaplan–Meier implant survivorship was 88.7% (95% confidence interval, 76.5–94.8%) at approximately 20 years. Conclusions: In this selected cohort of predominantly young and active patients, HRA provided substantial long-term clinical improvement, with an HHS of 95.3 ± 7.4, a WOMAC score of 11.5 ± 3.5, and implant survivorship of 88.7% at approximately 20 years. Nevertheless, the 11.3% revision rate and complications associated with metal-on-metal bearings support restricting HRA to carefully selected patients and maintaining long-term clinical, radiographic, and metal-ion surveillance.

Introduction. Severe symptomatic idiopathic flexible flatfoot in adolescence may require surgical correction when conservative treatment fails. The Evans-Mosca procedure has been reported to provide satisfactory clinical and radiographic correction, but podiatric functional findings after surgery are less frequently described. Case Presentation. This case series reports long-term podiatric findings in 14 adolescents, corresponding to 26 surgically treated feet, who had previously undergone treatment for idiopathic flexible flatfoot. The same cohort was previously described from orthopedic, clinical, and radiographic perspective. Intervention. All patients underwent lateral column calcaneal lengthening according to the Evans-Mosca technique, associated with medial soft-tissue correction and Achilles tendon lengthening where indicated. Outcome. At a mean follow-up of 7 years and 7 months, podiatric assessment showed no lower-limb length discrepancy, preserved ankle dorsiflexion, satisfactory subtalar mobility, physiological first-ray motion, positive Jack’s and tip-toe tests, and plantigrade support on podoscopic examination. Static baropodometry showed balanced load distribution between left and right feet and physiological rearfoot-forefoot distribution. Dynamic baropodometry showed similar plantar contact surfaces between feet and generally physiological gait-line progression. One case of functional hallux limitus was detected. Conclusion. Evans-Mosca correction achieved satisfactory long-term functional outcomes in this series of 26 feet. Beyond the clinical and radiographic improvements already reported for this cohort, podiatric evaluation revealed preserved joint mobility, plantigrade support, balanced weight distribution, and physiological gait patterns in most patients. One case of functional hallux limitus was identified during dynamic testing.

Introduction: Infection after a total knee arthroplasty (TKA) is one of the most severe complications, with an incidence that ranged from 0,5 % to 1,8 %, while the incidence of a quadriceps tendon tear after total knee arthroplasty range from 0.1 % to 1.1 %. Dislocation of a TKA is another rare but very serious complication with an incidence of 0.5 %. After all, the association of these three complications, that quickly occur together, is extremely rare condition. Presentation of case: Ninety years old man underwent to TKA for right knee osteoarthritis. During rehabilitation, the patient had quadriceps tendon rupture and underwent to tenorrhaphy. Three months after tenorrhaphy, on suspicion of infection, the patient received a surgical debridement. At this time total knee prosthesis was well fixed and was not removed. After another five months, the patient felt again and the radiographs of the right knee showed a posterior dislocation of the TKA treated by closed reduction in operating room, under general anesthesia. At the latest follow-up, clinical and radiological examinations showed good alignment of the TKA prosthesis, without loosening and good functional capacity. Discussion: Orthopedic surgical treatment in an elderly patient could expose to many complications. We could speculate that musculo-tendinous lesion and infection favored the TKA dislocation. Conclusion: Infection, tendon injuries and dislocation are serious complications after TKA. Poor outcomes are often described for each of these complications in the current literature, however our patient recovered a good quality of life after treatment, despite the complexity of these complications and the old age. Highlights: