Background: Modularity in revision THA (RTHA) has become accepted during the last three decades. Nevertheless, specific risks of modularity of current revision devices such as breakage of taper junctions occur during follow-up. Data reporting failure rates are predominantly given by the manufacturers but independent data acquisition is missing so far. Questions/Purposes: 1. What time-related risk of breakage of taper junction between neck and body of an established modular revision device can be expected in a consecutive single institutional series and a mid-term follow-up? 2. Are there specific factors influencing breakage in this cohort? Materials and Methods: A retrospective analysis was performed of a consecutive series of 89 cases after femoral revision using a tapered modular revision stem. Mean follow-up period was 7.1 (range: 3.0–13.7) years. Breakage of stem as failure criteria of the implant was investigated with a Kaplan–Meier analysis. Results: Breakage of taper junctions occurred in four patients during follow-up showing a time-depending implant survival of 94.2 (95% CI: 88.6–100%) after 13.7 years. Implant survival of stems with lateralized necks of 87.4 (95% CI: 75.6–100%) after 13.7 years was significantly lower compared to the standard offset variant with 100% after 13.5 years (log rank test p = 0.0283). Chi square test also revealed a significantly higher risk of breakage of lateralized necks compared to standard offset pieces (p = 0.0141). Three of four patients were obese with a mean BMI of 37.9 kg/m². Grade of obesity (grade 1 or higher) had significant influence on risk of breakage. Survival of the implant was significantly lower in obese patients with at least grade 1 obesity compared to patients with a BMI < 30 kg/m² (82.9 (95% CI: 64.9–100%) after 11.6 years vs. 98.4 (95% CI: 95.3–100%) after 13.7 years; log-rank p = 0.0327). Conclusions: Cumulative risk for failure of taper junctions was high in this consecutive single institutional cohort and may further increase during follow-up. As independent data acquisition in registries is missing, failure rate may be higher than reported data of the manufacturers. The use of lateralized offset necks in obese patients of at least grade 1 obesity showed a significantly higher risk of breakage. The use of monobloc revision devices may be an option, but randomized control trials are currently missing to establish standardized treatment protocols considering individual risks for both monobloc and/or modular implants.

Background: There is little conformity regarding the surgical treatment of metastasis of the proximal femur, especially in palliative patients with limited life expectancy. Patients and Methods: En-bloc resection of secondary bone malignancies of the proximal femur and reconstruction by modular arthroplasty was performed in a consecutive series of 45 patients. The mean follow-up period was 16.4 months (0.6–74.7). Results: The survival rate of all patients was 6.6% (95% CI: 0–14.9) at 74.7 months. There was no significant difference in patients with a solitary or disseminated disease at index operation (log-rank p = 0.1214). Recurrent dislocation was the most frequent local complication (n = 6) necessitating an open reduction in four cases. The use of a Trevira tube showed a higher risk of dislocation compared to the simple bonding of remaining soft tissue (6 out of 28 vs. 0 out of 17; Fisher test: p = 0.0463). The worst-case survival rate with the removal of the arthroplasty for any cause and/or loss to follow-up was 80.0% (95% CI: 44.9–100) at 74.7 months (n = 1 due to low-grade infection). Conclusions: En-bloc resection of metastases and reconstruction by modular arthroplasty is reliable even in patients with very limited life expectancy. Local complications due to tumor growth or instability after intralesional surgery could be managed successfully but recurrent dislocation as the most frequent complication has to be taken into account. The simple bonding of remaining soft tissue around the prosthesis without the use of an attachment tube may reduce the dislocation rate and reoperation risk.

Background: Although tapered and fluted stems are frequently used in revision total hip arthroplasty (RTHA), major complications following the implantation of these implants, like periprosthetic fractures, are less investigated. As epidemiological data do not exist yet, the incidence of PPF in a mid- to long-term follow-up is unknown and potential risk factors have not been detected. Methods: Propensity score matching (PSA) of two retrospectively investigated cohorts after femoral RTHA with either modular (n = 130) or monobloc prosthesis (n = 129) was executed. A total of 186 cases, including 93 of each device, were finally analyzed during a mean follow-up period of 9.1 (0.5–23.1) years. The time-dependent risk of PPF was calculated using a Kaplan–Meier analysis. Results: The cumulative risk for PPF of the whole cohort was 5.7% (95% CI: 1.7–9.8%) at 23.1 years, for the modular device, 13.0% (95% CI: 0–26.0%) after 13.7 years and the monobloc stem, 3.4% (95% CI: 0–7.1%) after 23.1 years, without a significant difference between the two designs (log-rank p = 0.1922). All eight fractures occurred in women and there was one collapse of the fracture after open reduction and internal fixation. The cumulative risk was 10.1% (95% CI: 3.1–17.1%) at 23.1 years compared to 0% after 21.4 years in men (log-rank p = 0.0117). Diabetes was significantly associated with the presence of PPF during follow-up (non-diabetic, 4.4% (95% CI: 0–8.2%) after 21.3 years vs. diabetic, 16.6% (96% CI: 0–34.5%) after 13.3 years; log-rank p = 0.0066). Longer reconstructions showed also a significantly higher fracture risk (equal or longer than median implant length vs. shorter; 10.5% (95% CI: 3.1–17.1%) after 21.4 years vs. 1.0% (95% CI: 0–3.1%) after 23.1 years; log-rank p = 0.0276) but did not correlate with a preoperative defect situation. Conclusions: The cumulative risk for PPF after femoral revision with tapered and fluted devices is a relevant failure reason in this mid- to long-term investigation. There was no difference between the monobloc stem or modular implant. Women and diabetics are at risk, and the choice of a longer implant than necessary is neither prophylactical for PPF nor useful in the case of the operative treatment of a PPF after femoral RTHA with these revision devices.

Background: Treatment methods for low back pain (LBP) can be divided into conservative, invasive and surgical treatment approaches with traction therapy as a non-surgical therapeutic option. A clinical study analysed the effect of using a traction-bed-device (Movento) on 35 patients suffering from osteoarthritis/spondylosis of the lumbar spine. Methods: The study was performed as a multicentric, double-blind, randomised, controlled interventional study. The patients were treated over three weeks while staying in rehabilitation clinics. All patients were assessed initially at study entry, weekly and after 3 weeks as well as 12 weeks after discharge. The following outcome measures were used: Numerical Rating Scale (NRS), Roland-Morris Disability Questionnaire (RMDQ), (12) Progressive Isoinertial Lifting Evaluation (PILE-Tests) and the 36-Item Short Form Health Survey (SF36). One hundred ten patients between 40 and 75 years of age with a diagnosed osteochondrosis/spondylarthrosis with chronification stadium 1 and 2 according to Gerbershagen were enrolled in the study. Both study groups received conventional rehabilitation therapy. The intervention group additionally received additional therapy with a minimum of five hours with the Movento traction device per night with seven sessions per week and a duration of 21 days. The therapy is based on the unloading and loading of spinal tissueThe duration of the treatment was limited to a minimum of 5 h and a maximum of 8 h. Results: The intervention group was able to show significantly better results in pain reduction (NRS) (p < 0.05), the Roland-Morris Questionnaire (p < 0.05), the PILE-Test (p < 0.05), the morning start-up time and the Finger-Floor-Distance measurement (p < 0.05) as well as the improvements in quality of life (SF-36). Conclusions: The presented results show that an additional traction device can improve pain score, function, clinical scores as well as improvements in quality of life in patients with spondylosis.

Background: The use of tapered monobloc stems in revision total hip arthroplasty (RTHA) has shown excellent results, with low implant-dependent failures due to aseptic loosening. Infection is one of the main failure reasons, but further problems, like periprosthetic fractures (PPFs), may endanger the function and duration of the implant in the long run. Methods: A consecutive series of 121 cases after femoral RTHA with a monobloc device was retrospectively investigated, and a Kaplan–Meier analysis was performed. The mean follow-up was 13.0 (range: 0.8–23.8) years. Results: PPF occurred in six patients during follow-up. The cumulative risk for PPF was 5.2% (95% CI: 1.1–9.4%) after 23.8 years. Female gender was associated with a significantly higher risk compared to male gender (9.1% (95% CI: 2.1–16.1%) after 23.1 years vs. 0% after 23.8 years; log-rank p = 0.0034). Patients operated with stems with a length equal to or longer than the calculated median length were also at a significantly higher risk of PPF during follow-up (10.2% (95% CI: 2.4–17.9%) after 23.8 years vs. 0% after 23.1 years; log-rank p = 0.0158). Diabetes at the time of index operation also significantly influenced the occurrence of a PPF during follow-up (n = 4 patients with PPF out of 107 without (4.0% (95% CI: 0.2–7.8%) after 23.8 years vs. n = 2 out of 14 with diabetes (15.4% (95% CI: 0–35.0%) after 21.1 years; log-rank p = 0.0368). The failure rate with implant removal as an endpoint due to aseptic loosening was 0%, and with infection it was 3.4% (95% CI: 0.1–6.7%), after 23.8 years. Conclusions: Although no removal of the implant due to a PPF was necessary, the cumulative risk for PPF after femoral revision with a tapered and fluted monobloc stem was higher in this long-term follow-up series compared to implant failure due to infection or aseptic loosening. Female gender and diabetes was associated with a significantly higher risk of PPF during follow-up. The use of longer stems than necessary is not preventive of PPF, and should be avoided.