Development cooperation is part of an international system characterised by fragmentation and limitations in global problem solving. Drawing on the term beyond aid, this article explores the transformation of development cooperation within this system. The article distinguishes four dimensions of beyond aid -actors, finance, regulation and knowledge -where aid loses relevance relative to other fields of international cooperation. Creating links to these beyond aid dimensions is at the core of the transformation of development cooperation. Understanding this transformation as a learning process, the article identifies 'specialisation' and 'integration' as two options for the future of development cooperation.

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(1) Background: Modular megaprosthetic reconstruction using a proximal humerus replacement has emerged as a commonly chosen approach after bone tumor resection. However, the long-term risk for revision surgery is relatively high. One factor that might be associated with mechanical failures is periprosthetic osteolysis around the stem, also known as stress shielding. The frequency, potential risk factors, and the effect on implant survival are unknown. (2) Methods: A retrospective single-center study of 65 patients with sarcoma who underwent resection of the proximal humerus and subsequent reconstruction with a modular endoprosthesis. Stress shielding was defined as the development of bone resorption around the prosthesis stem beginning at the bone/prosthesis interface. The extent of stress shielding was measured with a new method quantifying bone resorption in relation to the intramedullary stem length. All patients had a minimum follow-up of 12 months with conventional radiographs available and the median follow-up amounted to 36 months. (3) Results: Stress shielding was observed in 92% of patients (60/65). The median longitudinal extent of stress shielding amounted to 14% at last follow-up. Fifteen percent (10/65) showed bone resorption of greater than 50%. The median time to the first radiographic signs of stress shielding was 6 months (IQR 3–9). Patients who underwent chemotherapy (43/65) showed a greater extent of stress shielding compared to those without chemotherapy. Three percent (2/65) of patients were revised for aseptic loosening, and one patient had a periprosthetic fracture (1/65, 1.5%). All these cases had >20% extent of stress shielding (23–57%). (4) Conclusions: Stress shielding of the proximal humerus after shoulder reconstruction with modular megaprosthesis is common. It occurs within the first year of follow-up and might be self-limiting in many patients; however, about one third of patients shows progression beyond the first year. Still, mechanical complications were rare, but stress shielding might be clinically relevant in individual cases. The extent of stress shielding was increased in patients who underwent perioperative chemotherapy. Stress shielding can be quantified with an easy method using the stem length as a reference.

Purpose Megaprosthetic distal femoral reconstruction (DFR) is a limb-salvage procedure to address bone loss following two-stage revision for periprosthetic knee joint infection (PJI). The purpose of this study was to analyze the survival of DFR compared to hinged total knee arthroplasty (TKA). It was hypothesized that DFR was associated with a poorer survival. Methods In this retrospective single-center study, 97 subjects who underwent two-stage revision of chronic knee PJI were included. Among these, 41 were DFR. The diagnosis of PJI was established using the Musculoskeletal Infection Society (MSIS) criteria. Implant survival was calculated using Kaplan–Meier method and compared with the log-rank test as well as multivariate Cox regression at a minimum follow-up period of 24 months. Results The median follow-up period was 59 (interquartile range (IQR) 45–78) months. Overall, 24% (23/97) of patients required revision surgery for infection. The infection-free survival of rotating hinge revision TKA was 93% (95% Confidence Interval (CI) 86–100%) at five years compared to 50% (95% CI 34–66%) for DFR. In multivariate analysis, the risk factors for reinfection were DFR reconstruction (HR 4.7 (95% CI 1–22), p = 0.048), length of megaprosthesis (HR 1.006 (95% CI 1.001–1.012), p = 0.032) and higher BMI (HR 1.066, 95% CI 1.018–1.116), p = 0.007). 10% (4/41) of patients undergoing DFR underwent amputation to treat recurrent infection. Conclusion Megaprosthetic DFR as part of a two-stage exchange for PJI is a salvage treatment that has a high risk for reinfection compared to non-megaprosthetic TKA. Patients must therefore be counseled accordingly. Level of evidence Retrospective observational study, Level IV.

Motivation:After generating considerable momentum in the period 2005-2011, policy debates on the aid effectiveness agenda-including the core principle of ownership-witnessed a sharp decline. Current trends raise questions about the continuing relevance of ownership as a fundamental principle for development co-operation. Purpose: This article analyses how approaches to managing development co-operation have evolved in Rwanda and Liberia, two aid-dependent postconflict states that were previously at the forefront of the aid effectiveness agenda. It presents new evidence on how ownership features and is promoted in development co-operation relations. Approach and Methods: The article draws on 48 semi-structured interviews, complemented by a review of academic literature, policy documents and grey sources concerning the two countries and the broader subject matter. Findings: Recent years have shown considerable drift in Liberia's approach to development co-operation management, while Rwanda retained its established system to manage its external partnerships and incentivize donor behaviour. Both cases illustrate challenges in promoting ownership among all relevant stakeholders, with a key shift being that donors increasingly favour the "what" of co-operation over the "how." Policy implications: In view of the importance of ownership for the sustainability of development co-operation, policy-makers should consider reinvigorating and repositioning a self-standing development effectiveness agenda. Such an international initiative should adjust to new co-operation trends, notably the increased practice of predetermining co-operation themes and the promotion of multi-stakeholder approaches. K E Y W O R D Said effectiveness, development co-operation, foreign aid, Liberia, ownership, post-conflict states, Rwanda