Background. Long-term survival of total knee arthroplasty (TKA) is mainly determined by optimal positioning of the components and prosthesis alignment. Implant positioning can be optimized by computer assisted surgery (CAS). Patient specific cutting blocks (PSCB) seem to have the potential to improve component alignment compared to the conventional technique and to be comparable to CAS. Methods. 113 knees were selected for PSI and included in this study. Pre- and postoperative mechanical axis, represented by the hip-knee-angle (HKA), the proximal tibial angle (PTA), the distal femoral angle (DFA), and the tibial slope (TS) were measured and the deviation from expected ideal values was calculated. Results. With a margin of error of ±3°, success rates were 81.4% for HKA, 92.0% for TPA, and 94.7% for DFA. With the margin of error for alignments extended to ±4°, we obtained a success rate of 92.9% for the HKA, 98.2% for the PTA, and 99.1% for the DFA. The TS showed postoperative results of 2.86 ± 2.02° (mean change 1.76 ± 2.85°). Conclusion. PSCBs for TKA seem to restore the overall leg alignment. Our data suggest that each individual component can be implanted accurately and the results are comparable to the ones in CAS.

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Background Reverse total shoulder arthroplasty (RTSA) has become an established treatment for cuff arthropathy, severe osteoarthritis and in certain fracture cases. Due to the increasingly aging population, patients who have already exceeded their life-expectancy pose a significant challenge to the shoulder surgeon. Methods Patients older than 83 years who received a RTSA were included. Elective cases were compared to fracture cases. Patient demographics, hospital stay length, complication rate, functional outcome, patient reported outcome scores and mortality were assessed retrospectively. Results We included 110 cases, 48 in the elective group and 62 in the fracture group. The average age at time of surgery was 86.6 ± 3.5 years. Mean follow-up was 30 months. Elective cases had a significant shorter hospital stay length (P = .014). Functional outcome scores showed better results for the elective group with ASES 79 ± 12 vs 69 ± 19 (P = .07), QuickDASH 29 ± 16 vs 37 ± 21 (P = .22), subjective shoulder value 86 ± 14 vs 75 ± 19 (P = .04*) and VAS .7 ± 1.5 vs 2.1 ± 2.5 (P = .02*). There was no significant difference in ROM and mean quality-adjusted-life-years (QALY) with 3.2 ± 1.8 vs 3.5 ± 2.5 years (P = .69). The complication rate requiring surgical intervention was 2.4% in the elective and 6.5% in the fracture group. The 1-year mortality was 3 (6%) respectively 9 (15%). Conclusion RTSA in elderly patients can be successful with good functional outcomes. Age should not be a contraindication. Instead, the patient’s activity level and quality of life should be taken into account. Elective RTSA show better functional outcome scores and lower complication rates compared to RTSA in proximal humeral fractures.