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Our results show that there is an association between the alignment of the knee joint and participation in weight-bearing sports during early adolescence.

Total hip arthroplasty (THA) is regarded as one of the most successful and cost-effective surgical procedures in end-stage hip arthritis [1][2][3] . THA effectively reduces pain, improves function, mobility and quality of life 3) . As health care continues to improve and life expectancy increases, the demand for total joint arthroplasty will rise to reflect this more active, aging population 2) . Internationally, the amount of THAs is expected to increase by 170% between now and 2030. In addition, an increasing number of THA require revision; total hip revisions are also projected to increase by 137% by 2030 2,[4][5][6][7] . Complications after THA can be very challenging for both the surgeon and the

Introduction Hip fractures are one of the most common osteoporotic fractures, and the incidence is expected to increase in the future. Vascular injury of the femoral vessels, although uncommon, is an intermittently reported complication in the treatment of proximal femoral fractures. This may be iatrogenic or less frequently as a result of the fracture itself. The profunda femoris artery is most commonly involved, probably because of its close relationship to the femur in the subtrochanteric region. Case Presentation We report a well-documented case of pseudoaneurysm of the profunda femoris artery after intramedullary nailing of an intertrochanteric femoral fracture. Arterial damage was due to overpenetration when drilling the distal locking hole. Because of the late presentation, pressure on the medial femoral diaphysis caused severe cortical scalloping. This resulted in an obvious radiographic image rarely reported before. Conclusion This case report illustrates the uncommon complication of pseudoaneurysm after intramedullary hip nailing. Because of the risk of potentially limb- and life-threatening complications, we advise careful drilling and placement of the distal locking screw. Excessive screw length should be avoided. The injured limb should be returned to the neutral position and lower-limb traction should be reduced before drilling the distal locking hole.

Purpose The issue of rising healthcare costs and limited resources is a topic of worldwide discussion over the last several decades. We hypothesized that failure of proximal humeral fracture osteosynthesis is presumed to be an important determinant in healthcare resources and related costs. The aim of this study was to calculate the total hospital-related healthcare cost of proximal humeral fracture osteosynthesis over one  year focusing on failure. Methods A total of 121 patients with a proximal humeral fracture treated by angular stable osteosynthesis were included in this retrospective study. All hospital-related healthcare costs were investigated. Five main hospital-related cost categories were defined: hospitalization cost, honoraria, day care admission, materials, and pharmaceuticals. Results A total healthcare cost of € 1,139,448 was calculated for the whole patient group. Twelve patients needed revision surgery due to complications or fixation-related failure. This failure rate alone costed € 190,809 of the healthcare resources. In other words, failure after proximal humeral fracture osteosynthesis costed 17% of the total healthcare expenditure inone year. Conclusion This study demonstrates that a high amount of hospital-related healthcare resources is spent because of failure after proximal humeral fracture osteosynthesis. Further research is necessary and should investigate on how to prevent failure. This is not only in the patient’s interest, but it is also of great importance for maintaining a healthy healthcare system.