Philipp Schippers

Background: Aseptic loosening remains a leading cause of revision in total hip arthroplasty (THA), with polyethylene wear representing a key contributing factor. Vitamin E–blended highly cross-linked polyethylene (VEPE) has been introduced to improve oxidative stability and long-term wear performance; however, long-term clinical data remain limited. Methods: This retrospective study evaluates long-term polyethylene wear and component positioning in a cohort of patients who underwent primary THA using a vitamin E–blended polyethylene monoblock acetabular component (RM Pressfit vitamys®). Patients were followed for a minimum of ten years. Radiographic assessment was performed using a fully automated, observer-independent CAD-based software (RayMatch®), enabling measurement of cup inclination, anteversion, and polyethylene wear through 2D–3D registration of implant CAD models. Results: A total of 57 hips with complete radiographic follow-up were analyzed. Mean polyethylene wear rates were 26.9 µm/year at five years and 18.2 µm/year at ten years, remaining well below commonly reported thresholds associated with osteolysis. Cup inclination remained stable over time, whereas a gradual increase in measured anteversion was observed during follow-up. Conclusion: At a minimum ten year follow-up, the investigated vitamin E–blended polyethylene monoblock cup demonstrated favorable long-term wear characteristics and stable component positioning. Further comparative studies are warranted to compare its long-term performance with other acetabular cup and liner designs.

Wunderlich F, et al. Clin Orthop Surg. 2026 Jun;18(3):439-448. https://doi.org/10.4055/cios25047

Purpose A pronounced loss of function of the lower limb of various origins, especially with an infection-related course, may require a minor (MIN) or major (MAJ) amputation of the lower limb. Our aim was to contrast the underlying etiology, including previous trauma, surgical procedure, and the subsequent function. Methods Between 2012 and 2022, 366 lower limb amputations were considered. After excluding isolated toe amputations and knee disarticulations, 80 amputations of 77 patients (66 male; 11 female; mean age: 57.2 years) were included in this monocentric retrospective study and their clinical outcome was evaluated. Briefly, 23 patients underwent MIN and 54 patients, including three bilateral cases, underwent MAJ. Patient demographics, etiology, level of amputation, prosthesis fitting, mobility based on the K-Level categories, SF-12 questionnaire, PLUS-M 12-item short form, and problems in coping with everyday life were recorded. The mean follow-up period was 3.9 years. Results The mean SF-12 score of all patients was 36.9 (MIN: 37.24; MAJ: 36.85) for the physical summary component and 50.0 (MIN: 52.32; MAJ: 48.46) for the mental summary component; the mean Plus-M 12 score was 49.5 (MIN: 50,08; MAJ: 48,46) (p > 0.05). K-level 3 was the most common in all patients (MIN: 47.8%, MAJ: 42.6%), defined as an unrestricted outdoor walker. Conclusion With MIN and MAJ results comparable in all scores and queries, it emphasizes the fact that even supposedly lower-limb MIN represents a considerable impairment of coping with daily life. If there is no prospect of preserving the limb, early transtibial amputation should be considered. However, our results support the good outcome despite lower-limb MAJ through modern prosthetic fitting.

Aims: Optimal glenoid positioning in reverse shoulder arthroplasty (RSA) is crucial to provide impingement-free range of motion (ROM). Lateralization and inclination correction are not yet systematically used. Using planning software, we simulated the most used glenoid implant positions. The primary goal was to determine the configuration that delivers the best theoretical impingement-free ROM.Methods: With the use of a 3D planning software (Blueprint) for RSA, 41 shoulders in 41 consecutive patients (17 males and 24 females; means age 73 years (SD 7)) undergoing RSA were planned. For the same anteroposterior positioning and retroversion of the glenoid implant, four different glenoid baseplate configurations were used on each shoulder to compare ROM: 1) no correction of the RSA angle and no lateralization (C-L-); 2) correction of the RSA angle with medialization by inferior reaming (C+M+); 3) correction of the RSA angle without lateralization by superior compensation (C+L-); and 4) correction of the RSA angle and additional lateralization (C+L+). The same humeral inlay implant and positioning were used on the humeral side for the four different glenoid configurations with a 3 mm symmetric 135° inclined polyethylene liner.Results: The configuration with lateralization and correction of the RSA angle (C+L+) led to better ROM in flexion, extension, adduction, and external rotation (p ≤ 0.001). Only internal rotation was not significantly different between groups (p = 0.388). The configuration where correction of the inclination was done by medialization (C+M+) led to the worst ROM in adduction, extension, abduction, flexion, and external rotation of the shoulder.Conclusion: Our software study shows that, when using a 135° inlay reversed humeral implant, correcting glenoid inclination (RSA angle 0°) and lateralizing the glenoid component by using an angled bony or metallic augment of 8 to 10 mm provides optimal impingement-free ROM.Cite this article: Bone Jt Open 2024;5(10):851–857.