Background: Modular stems have been widely studied as they allow intraoperative adjustments (offset, anteversion, limb length) to better restore hip biomechanics. Many authors reported outcomes of revision total hip arthroplasty (THA) using modular stems with metaphyseal-diaphyseal junctions, however, little is known about modular neck femoral stems (MNFS) with metaphyseal-epiphyseal junctions. We therefore aimed to report outcomes and implant survival of a MNFS in a consecutive series of revision THA at a minimum follow-up of 5 years. Methods: We reviewed a consecutive series of 28 revision THAs performed between February 2010 and March 2012 using an uncemented MNFS. The final study cohort included 25 patients living with their original components, at a mean follow-up of 68.4±7.4 months and aged 67.7±11.6 years at index operation. Results: The Harris Hip Score (HHS) improved from 39.1±19.2 pre-operatively to 78.1±18.3 postoperatively, and the Postel Merle d'Aubigné score (PMA) improved from 9.8±3.0 pre-operatively to 14.8±2.8 post-operatively. The postoperative limb length discrepancy (LLD) was >10 mm in 18% of the hips. There were no significant differences of femoral offset and neck shaft angle (NSA) between operated and contralateral hips. Two hips (8.0%) showed new periprosthetic radiolucent lines. Periprosthetic fractures (PPF) occurred in 3 hips (12%). No subluxations, dislocations or implant breakages were reported. One revision (3.6%) was performed with retrieval of the revision stem for infection. The Kaplan-Meier (KM) survival at 5 years, using stem revision as endpoint, was 96.0%. Conclusions: The Optimal ® MNFS provided a satisfactory survival and clinical outcomes at 5 years, with no noticeable adverse effects resulting from the additional modular junction.

We report the long-term patient-reported outcomes and objective outcomes of a homodigital neurovascular island flap for distal phalangeal amputations in the fingers (with the thumb excluded) for 20 patients at a median follow-up of 4.4 years (IQR 2.2 to 12.3). We assessed the global subjective and aesthetic outcomes, range of motion, sensitivity and strength. The patient-reported median subjective global score was 7.5/10 points (IQR 7 to 9) and the aesthetic score was 8/10 points (IQR 8 to 9). Range of motion, sensitivity and strength were similar to the uninjured side. Stiffness was present in more than half of the cases; 14 patients had a hook nail deformity and seven patients reported symptomatic cold intolerance. At a long-term follow-up, the patient-reported outcome measures and objective outcomes of this flap are satisfactory and it is a safe and reliable flap. Level of evidence: IV

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