Thromboembolic complications after shoulder arthroscopy are rare and their cause has not been well determined.

The addition of antibiotic to cement is a frequent practice in aseptic revision hip surgery There is concern about adding vancomycin to cement due to potential effects on mechanical properties and prolonged elution of subtherapeutic levels antibiotic. Bone allografts can store and provide high levels of vancomycin to surrounding tissues. We analyzed the incidence of infection after one-stage aseptic revision hip reconstruction utilizing acetabular and/or femoral vancomycin-impregnated impacted bone allograft and a THA fixed with cement containing no antibiotic. We hypothesized that the infection rate may be similar to that reported in the literature following traditional impaction grafting using antibiotic loaded cement. Seventy five consecutive patients (80 hips) with a preoperative Merle D'Aubigné and Postel functional score averaging 4.8 points were followed up for a mean of 36 months (range 24 - 59 months). The incidence of infection was 1.25% (CI 95%=96.26-100%). A deep infection (thought to be haematognous in origin) occurred in 1 patient 2 years after the index surgery. The average postoperative Merle D´Aubigne score was 16.2 points. The last radiographic evaluation demonstrated a less than 5 mm acetabular migration and a less than 5 mm femoral subsidence in all cases. Vancomycin-supplemented allografts restored bone stock and provided sound fixation with a low incidence of infection. This incidence of deep sepsis is similar to that reported with antibiotic-loaded PMMA but without the reported mechanical and pharmacological disadvantages.

When the proximal femur is absent due to a failed femoral stem in total hip arthroplasty, impacted bone grafts contained within circumferential meshes could be an alternative reconstructive method. The purpose of this study was to analyse the initial resistance to axial and rotational forces in a fresh frozen bovine model with complete loss of the proximal femur reconstructed with a circumferential metal mesh, impacted bone allografts and a long cemented stem. Four bovine femurs with a complete proximal bone defect were reconstructed with a circumferential mesh, impacted bone grafts and a cemented stem. The results were compared with four intact femurs using the same implant. Under axial load, subsidence was observed at an average of 617 kg in the experimental group, and a cortical fracture occured at 1335 kg in the control group. Under rotational load, experimental femurs failed at an average of 79 kg and the control femurs fractured at 260 kg. This model provided 50% of the resistance to axial load and 30% of the resistance to rotational load compared to an intact femur, which is enough to resist physiological load. This stability encourages the use of circumferential meshes, impacted bone allografts and cemented stems in revision hip surgery with massive bone loss.Résumé Dans l'arthroplastie totale de hanche les pertes de substances fémorales secondaires à un descellement de la pièce fémorale peuvent être traitées par des greffes impactées. Il s'agit d'une méthode de reconstruction alternative et satisfaisante. Le propos de cette étude est d'analyser la résistance axiale et en rotation d'allogreffes fraîches impactées d'origine bovine et servant de lit à une pièce fémorale longue. 4 fémurs bovins ont été reconstruits de la sorte, les résultats ont été comparés à 4 fémurs intacts avec le même implant en charge axiale, la migration de la prothèse est observée avec une charge de 617 kg dans le groupe des fémurs greffés et une fracture corticale est survenue à 1335 kg dans le groupe contrôle. En rotation, la pièce fémorale présente une mobilité en moyenne à 79 kg alors que dans le groupe contrôle ceci ne survient qu'à 260 kg. Ce modèle présente donc une résistance de 50% en charge axiale et de 30% en rotation, si on le compare à un modèle fémoral sur fémur intact. Cette stabilité nous encourage à utiliser une telle technique d'allogreffes impactées avec une pièce fémorale cimentée dans les révisions de prothèses totales de hanches avec pertes osseuses massives.

We present the case of a 60-year-old man who had metastasis of a nodular squamous cell carcinoma from a laryngeal carcinoma that mimicked an infected sinus in a 4-month postoperative revision total hip arthroplasty scar. A diagnosis was made at the time of frozen section. The patient died 3 months after tumor resection as a result of multiorgan failure. Nodular squamous cell carcinoma metastasis in a total hip arthroplasty scar is extremely uncommon. However, this association must be considered in a patient with a known tumor after revision surgery. In such patients, we recommend obtaining an intraoperative frozen section to avoid misdiagnosis in cases of infected sinuses associated with implants.

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