Background:Artificial ligaments have been developed and used in the treatment of ligamentous injuries since the 1970s. The early generation of artificial ligaments showed promising short-term results but resulted in high rates of rupture and inflammatory reaction in the surrounding tissues.Purpose:To determine whether the use of Ligament Augmentation and Reconstruction System (LARS) ligaments is associated with the development of intra-articular foreign body reaction.Study Design:Case series; Level of evidence, 4.Methods:LARS ligaments were explanted from 15 patients under 6 consultant orthopaedic surgeons at 8 surgical centers. Of these, 14 explanted samples were sent for macroscopic and histological analysis, with the 1 remaining sample sent for scanning electron microscopy, to assess for inflammatory change as well as the degree of fibrous tissue ingrowth.Results:We observed a foreign body reaction in 10 of 14 explanted LARS ligaments. Seven samples demonstrated fibrous tissue ingrowth, with 5 producing only focal or incomplete ingrowth. The 2 samples with extensive fibrous coverage were completely free of any foreign body reaction, while all 5 remaining samples with only focal or partial fibrous ingrowth were associated with at least some degree of harmful immune response.Conclusion:The LARS ligament is still associated with a clinically significant degree of foreign body reaction despite the LARS Company’s efforts to reduce complications through improved design. The development and completion of fibrous tissue ingrowth may work to reduce the occurrence of a foreign body reaction.

Aims National joint registries under-report revisions for periprosthetic joint infection (PJI). We aimed to validate PJI reporting to the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR) and the factors associated with its accuracy. We then applied these data to refine estimates of the total national burden of PJI. Methods A total of 561 Australian cases of confirmed PJI were captured by a large, prospective observational study, and matched to data available for the same patients through the AOANJRR. Results In all, 501 (89.3%) cases of PJI recruited to the prospective observational study were successfully matched with the AOANJRR database. Of these, 376 (75.0%) were captured by the registry, while 125 (25.0%) did not have a revision or reoperation for PJI recorded. In a multivariate logistic regression analysis, early (within 30 days of implantation) PJIs were less likely to be reported (adjusted odds ratio (OR) 0.56; 95% confidence interval (CI) 0.34 to 0.93; p = 0.020), while two-stage revision procedures were more likely to be reported as a PJI to the registry (OR 5.3 (95% CI 2.37 to 14.0); p ≤ 0.001) than debridement and implant retention or other surgical procedures. Based on this data, the true estimate of the incidence of PJI in Australia is up to 3,900 cases per year. Conclusion In Australia, infection was not recorded as the indication for revision or reoperation in one-quarter of those with confirmed PJI. This is better than in other registries, but suggests that registry-captured estimates of the total national burden of PJI are underestimated by at least one-third. Inconsistent PJI reporting is multifactorial but could be improved by developing a nested PJI registry embedded within the national arthroplasty registry. Cite this article: Bone Jt Open 2022;3(5):367–373.

BackgroundProximal junctional kyphosis (PJK) can cause significant functional impairment and neural compression. Varying rates of PJK and pseudoarthrosis following posterior instrumentation and fusion for adolescent idiopathic scoliosis (AIS) are described with multiple biologic and biomechanical correlations attributed. This retrospective study aims to determine our rate of pseudoarthrosis and PJK in posterior spinal fusion for AIS, along with analysing the influence of autograft and allograft bone volume.MethodsImmediate and 12‐month post‐operative radiographs of 78 patients treated for AIS were analysed along with late complications to a minimum of 2 years. Proximal kyphosis was determined by measuring and comparing the angle between the upper instrumented vertebra and upper instrumented vertebra + 2 for both immediate and 12‐month post‐operative radiographs. Spinal fusion was determined using an accepted grading scale on the 12‐month radiograph. These findings were correlated with known surgical variables in bone grafting technique.ResultsThere was one case of PJK and no cases of pseudoarthrosis. Three patients showed a defect in the fusion mass but were still suggestive of fusion. The rates of fusion and PJK were not significantly different when using different allograft volumes or incorporating autograft.ConclusionRelatively low rates of PJK following AIS correction were observed compared to the literature. Rates were not increased with the use of proximal autograft. The amount of allograft used did not affect fusion rates either.

Background: Anterior cruciate ligament (ACL) reconstruction and meniscal repair are two commonly performed arthroscopic soft tissue surgeries. It can be challenging for training surgeons to become proficient in these techniques. The aim of our study is to investigate the viability of porcine stifles as training models for ACL reconstruction and meniscal repair. Method: A training session was held with various participants comparing the use of porcine stifles vs. sawbone replicas. Tendon harvesting, joint arthroscopy, meniscal repair and ACL reconstruction were performed on both groups of joints. The two training methods were compared by the completion of a questionnaire by four participants. Results: Porcine stifles were found to be a suitable alternative to human knee joints. Tactile sensation of performing these procedures with porcine stifles more closely resembled that of a human knee. Visualisation of the joint and its structures was considerably easier in the saw bone model, but the porcine stifle better resembled real life scenarios. The medial joint compartment was notably more difficult to visualise and access relative to the lateral compartment, increasing procedure time when repairing the medial meniscus. Conclusion:Porcine stifles provide a suitable model for education and surgical training for ACL reconstruction and meniscal repair for trainee surgeons. They are easy to procure, cost-effective, and better replicate the complexities of these procedures in human knees compared to sawbones. We believe that practically this provides an ideal platform for simulation scenarios which are similar to humans and fulfils the ethical mandates of beneficence and non-maleficence.