Purpose Short-stem hip arthroplasty preserves femoral bone stock which includes the femoral neck. This implies that the stem has to follow the anatomy of the femoral neck. Therefore, it has been questioned whether biomechanical reconstruction of the hip can be safely achieved with SHA.

Diagnostic study, Level III.

BackgroundCompromised bone stock and heavily impaired structural integrity after multiple endoprosthetic revision surgeries can lead to a comparable condition as encountered in musculoskeletal tumor surgery. Total femoral replacement (TFR) can restore femoral integrity and allow patients to resume ambulation. Even though several authors reported their results of TFR, so far many questions are still on debate: Which patients are at risk to experience low functional outcome? Do complications and clinical outcome after TFR depend on the indication for the surgery (e.g. periprosthetic fractures or aseptic loosening) or the age of the patients? The purpose of the present study was to compare complication rates after TFR performed with modular total femur prosthesis MML (Fa. ESKA/Orthodynamics) in patients without malignant disease.MethodsWe conducted a retrospective chart review and functional investigation of patients treated with a TFR for non-oncologic conditions from 1995 to 2015 and a minimum follow-up of 2 years. Complications were recorded according to the Henderson-Classification; outcome was evaluated with established clinical scores. The indication for TFR was periprosthetic fracture (Group A, n = 11) or aseptic loosening (Group B, n = 7) with massive bone defect of the femur deemed unsuitable for conventional arthroplastic or biologic reconstruction.ResultsEighteen patients matched the inclusion criteria and could be investigated clinically after a mean follow-up of 80 months (range: 28–132). Before TFA, all patients had previously undergone multiple operations (range: 1–8). The overall failure rate for any reason was 72% (n = 13/18), leading to a total of 37 surgical revisions with total exchange of TFR in 22% (n = 4/18). Most common failure mechanism was Type I (soft tissue), followed by Type IV (infection) and Type III (mechanical failure). According to Enneking’s functional evaluation method (MSTS-Score), the function ranged from 1 to 15 with a mean of 10 ± 4 out of 30.ConclusionTFR is a salvage procedure to restore mechanical integrity and regain functional ability after extensive femoral bone loss. Outcome of the patients in the present study did mainly depend on the age at reconstruction and not on the indication for TFR.

BackgroundAlthough self-assessment questionnaires for the wrist joint are numerous, most validation studies focus on a specific pathology and patient collectives. In addition the available questionnaires focus on subjective parameters such as pain, usual and specific activities but the range of motion (ROM) as an essential objective parameter in wrist disorders is rarely considered. Therefore the purpose of the presented study was to develop and validate a new universally applicable self-assessment score, the Munich Wrist Questionnaire (MWQ), which allows for the assessment of subjective as well as objective parameters of the wrist joint.MethodsThe MWQ consists of 16 items addressing three domains: pain, work and activities of daily living and wrist function including range of motion and grip strength. In a prospective clinical study validity, reliability and responsiveness of the MWQ of physical active patients were evaluated.ResultsValidation study included 100 patients (mean age 41 years, SD 16.3 years; range, 18–77 years). Test-retest reliability was substantial, with intraclass correlation coefficients ranging from 0.75 to 0.83 for the three domains. Construct validity and responsiveness were confirmed by correlation coefficients of at least 0.86 for construct validity and for responsiveness ranging from 0.61 to 0.65.ConclusionsThe MWQ presents a valid and reliable instrument for a qualitative self-assessment of subjective and objective parameters (e.g. range of motion) of the wrist joint. Quantitative measurement of wrist function may not longer be limited to specific wrist disorders or patient groups. The MWQ seems to allow for a broad application in clinical research and may facilitate the comparison of treatment results in wrist disorders.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1029-4) contains supplementary material, which is available to authorized users.