Purpose Revision surgery for component malrotation in the painful TKA is a relatively novel indication. The purpose of this study was to assess the benefit of revision TKA for component malrotation with regard to the clinical and functional outcomes. Methods Our retrospective case-control study included 51 patients who underwent revision surgery for malrotation with mean follow up of 42 months. They were equally matched to patients who had surgery for aseptic loosening. Results Knee society scores improved from 44/49 to 75/60 (p<0.001) for the study group and 44/47 to 76/57 (p<0.001) for the control group. There was no statistical difference between the groups, including for VAS scores, narcotic reduction or patient satisfaction. Our study showed that revision surgery for malrotation is as beneficial as surgery for aseptic loosening with regard to clinical and functional outcome. Conclusions We recommend CT in painful TKA to assess component malrotation for which revision TKA is beneficial.

We investigated the clinical outcome of internal fixation for pathological fracture of the femur after primary excision of a soft-tissue sarcoma that had been treated with adjuvant radiotherapy. A review of our database identified 22 radiation-induced fractures of the femur in 22 patients (seven men, 15 women). We noted the mechanism of injury, fracture pattern and any complications after internal fixation, including nonunion, hardware failure, secondary fracture or deep infection. The mean age of the patients at primary excision of the tumour was 58.3 years (39 to 86). The mean time from primary excision to fracture was 73.2 months (2 to 195). The mean follow-up after fracture fixation was 65.9 months (12 to 205). Complications occurred in 19 patients (86%). Nonunion developed in 18 patients (82%), of whom 11 had a radiological nonunion at 12 months, five a nonunion and hardware failure and two an infected nonunion. One patient developed a second radiation-associated fracture of the femur after internal fixation and union of the initial fracture. A total of 13 patients (59%) underwent 24 revision operations. Internal fixation of a pathological fracture of the femur after radiotherapy for a soft-tissue sarcoma has an extremely high rate of complication and requires specialist attention.

Use of the anterior allograft strut created a stiffer construct compared with the LCP-LAP for the treatment of a Vancouver B1 periprosthetic femur fracture only in loading modes with increased medial-lateral bending. Although these static load results are indicative of the early postoperative environment, further fatigue testing is required to better understand the importance of the reduced medial-lateral stiffness over a longer period.