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Background: Minimally invasive surgery (MIS) in medial displacement calcaneus osteotomy (MDCO) has been proposed for surgical correction of adult-acquired flat foot deformity (AAFD) to reduce complications of open approaches. The aim of our study is to systematically analyze complications and the clinical and radiological results of MIS- MDCO. Methods: A systematic review of the English literature was performed on 30th October 2023. Randomized controlled trials and non-randomized trials, cohort studies, case–control studies and case series concerning surgical correction of AAFD with MIS-MDCO and with at least 15 patients were included. Case reports, technical notes, animal or cadaveric studies were excluded. The quality and risk of bias of the studies included were evaluated using GRADE and MINORS systems. Complications rate, clinical and radiological results were inferred from the studies included. Results: Nine articles were included. A total of 501 cases treated with MIS-MDCO were analysed with a mean follow-up of 11.9 ± 5.1 months. The reported wound infection rate was about 3% and sural neuropathy was rated about 1%. Only 4% of the cases required removal of the screw for pain. In the comparative studies (MIS versus Open MDCO), comparable clinical results but with significant differences (P < 0.001) in infection rates (1% versus 14%) and sural neuropathy (2% versus 1%) were observed. Conclusion: AAFD correction performed with MIS-MDCO, with the limitation of a poor quality and high risk of bias of the included studies, seems to provide good clinical results and high subjective satisfaction with a lower complication rate compared to open approach. Further high-quality long-term comparative studies could better clarify complications and clinical and radiological outcomes of the MIS technique in the treatment of AAFD. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: Report clinical and radiological long-term follow-up (FU) outcome of bone impaction grafting (BIG) and anti-protrusio cage (APC) technique in hip revision surgery. Materials and methods: We analysed data on complications, as well as the clinical and radiological outcome of patients treated using this technique at our institution. We evaluated the acetabular bone stock renovation, acetabular component stability and its radiological migration. The clinical parameters considered were the Visual Analogue Scale (VAS) and the modified Harris Hip Score (mHHS). Results: Forty hips, with a mean 14.3-year FU, were included. This technique showed good clinical long-term results in an elderly and low-demanding population (mean age at surgery 71.4 ± 12.1 years). The radiological results were not as good as clinical results: 67.5% of cases had a radiographic evidence of resorption of less than 1/3 of the bone graft; 27.5% had a resorption ranging from 1/3 and ½ of the graft, and 5% had more than ½ of the graft. Paprosky type III B reported worse results in terms of graft resorption and a greater migration of the APC (p < 0.001). The survival rate was 95% and a 2.5% rate of septic failure was recorded. Conclusion: Impaction grafting with femoral head and APC is an effective technique for treating high-grade acetabular defects. APC reconstructs the hip centre of rotation, avoiding loading forces on the underlying bone graft that can be correctly integrated. At long-term FU, satisfactory clinical results, not strictly correlated to radiological signs of integration, were observed; Paprosky type III B reported worse results in terms of graft resorption and a greater migration of the APC. [ABSTRACT FROM AUTHOR]

Introduction: Rotating-hinge knee implants are highly constrained devices able to provide the stability needed for arthroplasty in case of severe bone loss and complex instability. Notable doubts still exist in using rotating-hinge devices, mainly due to risk of mechanical failure and risk of infection. Materials and methods: We retrospectively evaluated the functional and clinical outcomes in a series of patients treated with the rotating-hinge Endo-Model prosthesis either for primary or revision total knee arthroplasty. Between 1997 and 2009 we implanted 123 Endo-Model prosthesis (118 patients) at our institution. At the time of this study we could evaluate 45 prosthesis (25 primary and 20 revision TKAs) from the clinical and radiological site, with average follow-up of 42.2 months. Results: During the follow-up period, three patients reported complications, which in two cases finally led to revision with explantation. Mean survival of the implants attested at 93.3 %. The average post-operative clinical Knee Society score in the evaluated series was 94.2, the functional one 78.7. The average range of motion was 0°-108°. No signs of joint instability or misalignment were noted. Pain was present in a minority of patients, but always at a mild/occasional extent. No evidences of loosening or implant failure have been reported. No substantial divergences in the outcomes have been found across different patient categories after stratification in agreement with the Knee Society. Conclusions: Coherent with previously published works, we confirm the Endo-Model prosthesis to provide excellent pain relief, restoration of walking capacity and intrinsic knee stability both in complex primary and in revision knee arthroplasty, with good or excellent results in the majority of patients and acceptable complication rate. [ABSTRACT FROM AUTHOR]