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Revision total knee arthroplasty is a challenging procedure for every orthopaedic surgeon, especially when a megaprosthesis is involved. Possible surgical solutions in case of distal femur megaprosthesis revision are total femoral replacement (TFR) or amputation/disarticulation. TFR is affected by an extremely high rate of complications, while amputation/ disarticulation leads to unacceptable functional results. We report the case of a 59-year-old woman who underwent a staged left knee megaprosthesis revision for infection with massive femoral and tibial bone loss and complete disruption of extensor mechanism following 7 prior surgeries. To manage these problems, we developed a new, custom porous titanium endofemoral sleeve for the femoral side and a custom porous titanium cone for tibial reconstruction that were tailored to the patient’s specific bone loss and matched with the tumor prosthetic design used. A custom-made endofemoral sleeve may be a viable solution introducing an intermediate step between distal femur megaprosthesis and total femur substitution. Accurate and detailed surgical planning as well as intraoperative management of soft tissues and residual bone stock are key factors for optimal outcomes.

Isolated ulnar head dislocation is a rare and frequently misdiagnosed clinical entity. To our knowledge, few cases of volar ulnar dislocation have been reported in literature and a well-defined treatment does not exist. This case report describes the management of an acute isolated volar ulna dislocation in a 64-year-old patient. We also performed a systematic review of the available English literature in order to evaluate management of volar ulna dislocation. Among 86 eligible articles, 13 were included and fully evaluated. Isolated distal radioulnar joint (DRUJ) dislocation with only ligamentous involvement are uncommon injuries. If diagnosis is uncertain and X-ray are not informative, further imaging with CT or MRI can be performed because it is mandatory to recognise these lesions and to manage them properly. The first step is to reduce the DRUJ dislocation. The second is to evaluate the stability of the joint. If multidirectional instability is noted, direct repair of the ligament or Triangular Fibrocartilaginous Complex (TFCC) is indicated. Management of the acute lesion initially consists of an attempt of closed reduction, but if closed reduction is impossible in our opinion the only option is to restore the normal anatomy of the DRUJ with operative treatment. Herein, we summarise the available evidence on this lesion, based on this case and after a systematic review of the literature. We propose operative management for this lesion, with open reduction and reconstruction of ligaments to allow a rapid functional recovery and to avoid secondary complications.

The combination of arachnoiditis ossificans, isthmic spondylolisthesis and calcific pseudomeningocele is an extremely unusual condition. In the current literature, there is no previous report of this intricate clinical scenario, and therefore there are no clear indications on the best treatment. In the reported surgical case, the excision of calcific pseudomeningocele, L4 bilateral laminectomy and foraminotomy and posterolateral fusion were performed. L4L5 interbody fusion was aborted for impossibility of neural elements mobilization and a consequent intraoperative dural tear. The aims of the adopted surgical procedure are the decompression of neural elements and the stability due to bone fusion.