Background: The management of diaphyseal and distal tibial defects and non-unions is a significant challenge. Traditional treatments, such as distraction osteogenesis or Masquelet, are characterized by extended treatment times and elevated complication rates. Innovative approaches, such as customized 3D-printed titanium implants, are often required to restore structural integrity and function. This systematic review aimed to analyze the results achieved to date with this technique. Methods: A systematic review of the literature written in English was performed in PubMed, Scopus, and Cochrane to identify all cases of tibial non-unions or defects treated with customized 3D-printed titanium implants, excluding defects from tumor resection. Studies with a minimum of 12 months of follow-up were included. Results: The causes of treatment were infection in 10 patients, non-union in 6 patients, and severe bone loss after trauma in 3 cases. The size of the defect ranged from 3 to 8.5 cm. Osteointegration was 100% in all studies. The mean time to union was 5.3 months. The complication rate was 16%. Conclusions: Good results were reported in most patients. However, the data are insufficient to define the role of customized 3D-printed implants compared to traditional techniques. Further studies comparing them are needed to draw explicit guidelines.

Aseptic loosening (AL) represents the leading cause of long-term failure in total joint arthroplasty, often necessitating revision surgery. This review explores the complex mechanisms underlying AL, which involve a multifaceted interaction between the implanted biomaterials and the host immune response. We outline the key inflammatory mechanisms triggered by wear debris from polyethylene, polymethylmethacrylate, metal, and ceramic materials. We also examine emerging biomarkers for early detection and differentiation between stable and loosened implants, including proinflammatory cytokines, bone metabolism markers, extracellular matrix degradation products, microRNAs, and genetic polymorphisms. Lastly, we discuss current and future strategies for prevention and treatment, ranging from surgical optimization and biomaterial selection to pharmacological interventions. A comprehensive understanding of these mechanisms may help reduce the incidence of AL and improve long-term outcomes in arthroplasty patients.

Aseptic loosening (AL) represents the leading cause of long-term failure in total joint arthroplasty, often necessitating revision surgery. This review explores the complex mechanisms underlying AL, which involve a multifaceted interaction between the implanted biomaterials and the host immune response. We outline the key inflammatory mechanisms triggered by wear debris from polyethylene, polymethylmethacrylate, metal, and ceramic materials. We also examine emerging biomarkers for early detection and differentiation between stable and loosened implants, including pro-inflammatory cytokines, bone metabolism markers, extracellular matrix degradation products, microRNAs, and genetic polymorphisms. Lastly, we discuss current and future strategies for prevention and treatment, ranging from surgical optimization and biomaterial selection to pharmacological interventions. A comprehensive understanding of these mechanisms may help reduce the incidence of AL and improve long-term outcomes in arthroplasty patients.

Background: Acetabular defects can be restored using different surgical techniques. Excellent results have been observed with trabecular titanium (TT) which mimic the structure of trabecular bone. The aim of our study is to evaluate the mid-to-long-term outcome in revision surgery due to severe acetabular defect using TT cups. Materials and methods: We performed a retrospective analysis of patients undergoing revision with Paprosky IIa or higher using modular TT cup. We evaluated clinical outcomes using FJS, WOMAC, OHS, and WORQ. Radiolucency and integration were used to assess radiographic results. We collected information on complications and revisions. Results: Data from 217 consecutive patients was collected. Mean age was 71,01 ± 11,40 years. In regard to diagnosis, patients were affected by: aseptic loosening (55,3%); debris-induced osteolysis (18%); infection (11,5%); PPF (7.8%); and dislocation (7.4%). At the final floow-up, we documented the following: OHS 35.06 ± 4,31; WORQ 26.69 ± 4.18; WOMAC 27.59 ± 7.57; FJS of 55.3 ± 10.39 ( p -value < 0.005). Complication rate was 9.2%. The most frequent complication was dislocation, followed by deep infection and aseptic loosening. The Kaplan-Meier survivorship curve showed a 96.3% rate of acetabular implant survival at 12 years. Discussion and conclusions: This is the study with the largest population using TT for acetabular defects. We report good outcomes and an acceptable rate of complications, also due to implant modularity allowing stable fixation with secondary osseointegration.

Introduction: Displaced intra-articular calcaneal fractures (DIACFs) are associated with a high incidence of wound complications. Minimally invasive approaches (MIAs) have enabled earlier intervention compared with the extensile lateral approach (ELA). However, the relationship between surgical timing, approach and outcome remains poorly defined. This systematic review evaluated the relationship between surgical timing, approach, and postoperative outcomes in DIACFs. Materials and Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Studies published between January 1990 and April 2026 were searched through PubMed, Embase and Web of Science. Studies reporting the timing to surgery, approach, and postoperative outcomes in operated DIACFs were included. Patients were stratified into three groups according to timing (0–7 days, 8–21 days, and >21 days). Complication rates, radiographic and functional outcomes were analyzed. Results: A total of 25 studies, encompassing 1915 patients, were included. Patients mostly underwent surgery within seven days (60.1%), followed by 8–21 days (37.8%) and >21 days (2.1%). The complication rate was 21.7%, with wound dehiscence (8.9%) and infection (5.2%) being the most prevalent. Dehiscence and necrosis were predominantly associated with the ELA, particularly between days 8–21. Infection rates increased when the delayed sinus tarsi approach was used. No differences were found in radiographic or functional outcomes. Conclusions: Surgical timing does not appear to be an independent outcomes predictor. Complications depend on the interplay of timing, approach, and soft-tissue condition. An individualized treatment, with no rigid temporal thresholds, is probably the best approach.

Background: Distraction osteogenesis (DO) and the Masquelet technique are currently the preferred treatment options for bone defects larger than 5 cm. Methods: Between January 2019 and December 2023, 19 patients were treated with DO for post-traumatic tibial defects at our institution. The results were evaluated using the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Results: Patients’ mean age was 32.42 years. The mean defect size was 4.8 cm (range 3.2–8.1 cm), and the mean external fixation time was 21.31 weeks. Bone union was reached on average after 25.9 weeks. The mean follow-up time was 3.7 years. The mean leg length discrepancy at the final follow-up was 0.83 cm. Using the ASAMI system, the functional results were excellent in eight patients, good in eight, and fair in two, with one case of failure; the bone results were excellent in ten patients, good in six, fair in two, and poor in one. Conclusions: DO for the treatment of tibial defects has the potential to yield favourable outcomes, provided that the method is performed correctly. Multicentre prospective studies would allow for more definitive conclusions to be made.