Search Results (185)

Background/Objectives: Patellar instability in adolescents is a significant cause of short- and long-term morbidity and disability. Traditionally, patients with first-time patellar dislocation are managed nonoperatively, although most studies are not focusing on the adolescent athletic population. The primary objective of the current study was to compare patient-reported outcomes and complications in adolescent athletes who underwent surgery either after the first patellar dislocation or after the recurrence of the dislocation with a minimum postoperative follow-up of 48 months (48–75 months). Methods: A total of 39 adolescent athletes who underwent medial patellofemoral ligament (MPFL) reconstruction (Group A, after the first dislocation, and Group B, recurrent patella dislocation) were included in this study. In all the patients, the same MPFL reconstruction technique was applied using a semitendinosus autograft. The graft was fixed on the patella using a transverse tunnel and adjustable loop button fixation and, in the femur, using a tunnel and absorbable screw fixation. The tunnel was drilled obliquely to prevent penetration of the distal femoral physis. The preoperative and postoperative clinical and functional evaluations of the patients were conducted via the visual analog scale (VAS), the Lysholm Knee Scoring System, the Kujala Anterior Knee Pain Scale, and the Pediatric International Knee Documentation Committee (Pedi-IKDC), and the return to sports score was assessed via the Tegner Activity Scale (TAS). Results: At the latest follow-up, both groups demonstrated significant improvement in the Lysholm scores, with Group A achieving a mean of 92.57 ± 6.21 and Group B achieving a mean of 90.53 ± 8.21 (p = 0.062). Postoperatively, Group A achieved a mean Kujala score of 94.21 ± 9.23, whereas Group B reached 92.76 ± 12.39, with no statistically significant difference (p = 0.08). The Pedi-IKDC score improved postoperatively in both groups. In Group A, it increased from 67.98 ± 12.29 to 93.65 ± 4.1, and in Group B, from 56.21 ± 13.6 to 91.67 ± 6.21 (p = 0.067). The preoperative visual analog scale (VAS) score for pain was significantly lower in Group A (3.1 ± 1.13) than in Group B (4.2 ± 3.01, p < 0.01). At the latest follow-up, the VAS scores improved in both groups, with Group A reporting a mean score of 0.47 ± 1.01 and Group B 0.97 ± 1.32 (p = 0.083). The Tegner activity scores were similar between the groups preoperatively, with Group A at 7.72 ± 1.65 and Group B at 7.45 ± 2.09 (p = 0.076). Postoperatively, Group A had a mean score of 7.28 ± 2.15, whereas Group B had a mean score of 6.79 ± 3.70 (p = 0.065). The mean time to return to sports was significantly shorter in Group A (5.1 ± 1.3 months) than in Group B (7.6 ± 2.1 months) (p < 0.01). Overall, 84.61% of the patients returned to their previous activity level. Specifically, 95.2% (20/21) of patients in Group A achieved this outcome, whereas 72.22% (13/18) achieved it in Group B. Patient satisfaction was generally high, with 76% (16/21) of patients in Group A reporting being satisfied or very satisfied, compared with 77% (14/18) in Group B. Conclusions: MPFL reconstruction is a safe and effective procedure for both acute and recurrent patellar dislocation in adolescent athletes. While patients who underwent acute reconstruction returned to sport more quickly and showed higher absolute postoperative scores, the greatest overall improvement from preoperative to final follow-up was observed in those treated for recurrent instability. Both surgical approaches demonstrated high satisfaction rates and minimal complications, supporting MPFL reconstruction as a reliable option in both acute and recurrent cases. Full article

Background/Objectives: Limb malalignment disrupts physiological joint forces and predisposes individuals to the development of osteoarthritis. Surgical interventions such as distal femur or high tibial osteotomy aim to restore mechanical balance on weight-bearing joints, thereby reducing long-term morbidity. Accurate alignment is crucial since it cannot be adjusted after stabilization with plates and screws. Recent advances in personalized medicine offer the opportunity to tailor surgical corrections to each patient’s unique anatomy and biomechanical profile. This study evaluates the benefits of 3D planning and patient-specific cutting guides over traditional 2D planning with standard implants for alignment correction procedures. Methods: We assessed limb alignment parameters pre- and postoperatively in patients with varus and valgus lower limb malalignment undergoing acute realignment surgery. The cohort included 23 opening-wedge high tibial osteotomies and 28 opening-wedge distal femur osteotomies. We compared the accuracy of postoperative alignment parameters between patients undergoing traditional 2D preoperative X-ray planning and those using 3D reconstructions of CT data. Outcome measures included mechanical axis deviation and tibiofemoral angles. Results: 3D reconstructions of computerized tomography data and patient-specific cutting guides significantly reduced the variation in postoperative limb alignment parameters relative to preoperative goals. In contrast, traditional 2D planning with standard non-custom implants resulted in higher deviations from the targeted alignment. Conclusions: Utilizing 3D CT reconstructions and patient-specific cutting guides enhances the accuracy of postoperative limb realignment compared to traditional 2D X-ray planning with standard non-custom implants. Patient-specific instrumentation and personalized approaches represent a key step toward precision orthopedic surgery, tailoring correction strategies to individual patient anatomy and potentially improving long-term joint health. This improvement may reduce the morbidity associated with lower limb malalignment and delay the onset of osteoarthritis. Level of Evidence: Therapeutic Level III. Full article

Background: Osteotomies around the knee aim to correct varus or valgus malalignment and improve biomechanics. However, little is known about their effect on knee phenotypes, as defined by the Coronal-Plane-Alignment-of-the-Knee (CPAK) and Hirschmann’s functional classification. This study evaluated pre- and postoperative phenotypes in patients undergoing high-tibial-osteotomy (HTO) or distal-femoral-osteotomy (DFO). Methods: We retrospectively analysed 214 osteotomies around the knee (HTO: 145; DFO: 69) of 188 patients from our institutional registry. Radiographic parameters were measured using a validated artificial intelligence software, with phenotypes classified by CPAK and Hirschmann classification. Preoperative osteotomy planning was compared to postoperative alignment. Regression was used to assess the influence of demographic and radiographic factors. Results: CPAK types changed in 95.3% of cases. Medial opening HTOs most frequently shifted from CPAK type I (73.8%) to VI (42.3%), while medial closing DFOs transitioned from type III (81.5%) to V (24.1%). Concordance between planned and achieved CPAK types was highest for types III, IV, and V. Postoperative angles were generally smaller than planned for joint-line-obliquity (JLO), lateral-distal-femur-angle, and medial-proximal-tibial-angle (p < 0.001). Neutral JLO was restored in only 48.1%. Preoperative phenotypes NEUmLDFA0° (40.1%) and VARmMPTA3° (32.3%) were most common, while postoperative phenotypes included VALmLDFA3° (52.4%) and VALmMPTA3° (37.7%). Age, sex, and BMI significantly influenced alignment outcomes. Conclusions: Postoperative CPAK classifications shifted significantly across all osteotomy types, with minimal retention of preoperative types. Although most procedures achieved correction within the target HKA range, restoration of a neutral JLO was observed in only half of the cases, emphasizing the importance of phenotype-specific planning and highlight potential limitations of CPAK classification. Full article

Introduction: Cold welding is an anecdotally well-known complication of removal of metalwork, most commonly at the screw–plate interface, and can often complicate extraction of implants after fracture fixation. Even though this phenomenon is familiar amongst the orthopedic community, there is relatively little formalized discussion or literature pertaining to its identification and management clinically. In addition, as far as we can establish, there does not seem to be a paper that discusses the various techniques described in the literature that are employed to combat cold welding. Methods: A systematic review was carried out in accordance with the PRISMA guidance, with two independent reviewers and a third person to arbitrate for any discrepancies. Manuscripts were identified using a search of PubMed/MEDLINE and Google Scholar. Studies eligible for inclusion were tabulated and the results categorized qualitatively with respect to the technique described for removal of the implants. Results: A total of 272 manuscripts were identified using a search of PubMed/MEDLINE and Google Scholar, and of these 14 were ruled to be eligible for inclusion reporting on 292 patients. Common locations of the cold-welded screws included femur, tibia, distal radius and clavicle. The most common technique for metalwork removal was using either bolt cutters or burrs to cut the plates between the screws and mobilize the screw and plate as one unit. Other techniques included using specialized removal tools and cutting between the screw head and body. There was no appreciable correlation between the specific anatomic location of the welded implant and the technique used in its removal. From the studies, it was found that, of the total number of screws (n = 1654), 58 (3.5%) were cold welded. The mean time to metalwork removal was 1104 days (36.8 months). Conclusions: As far as we can tell, this is the first systematic review pertaining to the phenomenon of cold welding specifically, and with this project we have collated the techniques used to remove implants affected by cold welding from a variety of different articles. Our work aims to highlight the relative paucity of literature in this area and provide a number of accessible and safe techniques to facilitate the removal of cold-welded implants in fracture fixation. Full article

Background: The optimal treatment for proximal tibial osteosarcoma (OS) in skeletally immature patients remains controversial. A custom hinged endoprosthesis has been used to preserve the growth potential of the distal femur. This study aims to report (1) the 2-year follow-up outcomes after surgery for pediatric proximal tibial OS; (2) the complications associated with this endoprosthesis; and (3) the extent to which the growth potential of the adjacent open physis can be preserved. Methods: Seven skeletally immature patients (mean age, 11.1 years; range, 9–13 years) with proximal tibial OS were included between November 2020 and December 2022. All underwent tumor resection and reconstruction by this custom endoprosthesis. Postoperative limb function was evaluated by the Musculoskeletal Tumor Society (MSTS) score system and complications were recorded. Overall leg length and femoral length were measured radiographically to determine the growth rate. Results: The mean follow-up time was 34.7 months (standard deviation (SD), 8.9 months). One patient presented with local recurrence 12 months after surgery, and another patient had pulmonary metastasis 3 months postoperatively. The range of flexion of the knee after rehabilitation was between 90° and 125°, with an average of 103.6° (SD, 12.5°). The average MSTS score of the patients after surgery was 27.4 (SD, 1.5). Wound dehiscence took place in three patients after chemotherapy. At the last follow-up, the overall limb length discrepancy was 2.1 cm (SD, 2.4 cm). Growth at the distal femoral physis after surgery was observed in all patients during follow-up, with an average of 81.4% (range, 57.78–100%) of growth of the contralateral distal femoral physis. Conclusions: This custom hinged endoprosthesis can preserve the growth potential of the adjacent distal femur and provide satisfying functional outcomes with lower postoperative complication rate. It could serve as an alternative for proximal tibial OS in skeletally immature children. Full article

Background and Clinical Significance: Non-prosthetic peri-implant fractures (NPPIFs) are rare injuries occurring around internal fixation devices, and are distinct from periprosthetic fractures. While most studies focus on the femur, humeral NPPIFs remain poorly documented. This case illustrates a complex humeral NPPIF and highlights key surgical considerations. Case Presentation: A 62-year-old woman presented with a spiral humeral shaft fracture (AO 12B2) after a fall. Following closed reduction and antegrade intramedullary nailing, an intraoperative peri-implant fracture occurred at the distal interlocking screw. CT imaging revealed a complex fracture extending from the lateral condyle to the proximal humerus. Treatment included implant removal and open reduction with dual plate fixation—lateral distal and helically contoured proximal plates—plus cerclage bands and antibiotic-loaded beads. Recovery was uneventful, with a full range of motion achieved at six months. At one year, the DASH score and MEPS were 86 and 75, respectively. Conclusions: Humeral NPPIFs are challenging and require individualized, biomechanically sound strategies. This case reinforces the importance of intraoperative assessment and careful implant selection in humeral fracture management. Full article

This case presents the first documented successful medical management of chronic nonbacterial osteomyelitis (CNO) in a small dog—a condition rarely described in veterinary medicine. A 4-year-old castrated male Pomeranian dog weighing 4.6 kg was presented with a 3-week history of right hindlimb lameness. Radiographic examination revealed osteolytic lesions, periosteal reactions, and decreased muscle mass in the affected limb. Microbial and blood culture tests showed negative results, whereas cytological and histopathological analyses of the right distal femur confirmed neutrophilic inflammation and osteomyelitis, leading to a diagnosis of CNO. Clinical and radiographic improvements were observed following administration of bisphosphonates, disease-modifying anti-rheumatic drugs, and glucocorticoids. This case underscores the possibility of non-infectious osteomyelitis in dogs and suggests that adapting human treatment strategies may be beneficial. Further research is needed to clarify the diagnostic criteria and pathophysiology of CNO in veterinary medicine. Full article

Micro-computed tomography assessment of osteochondral microstructural properties of the distal femur and proximal tibia was comprehensively conducted to compare adult patients with knee rheumatoid arthritis (RA) and primary knee osteoarthritis (KOA), with special focus on the effects of knee malalignment. This study encompassed 402 bone samples divided into three groups: the RA group [patients who were subjected to total knee arthroplasty (TKA) due to RA, n = 23, age: 61 ± 10 years], the KOA group [individuals subjected to TKA due to KOA, n = 24, age: 71 ± 9 years] and the control group [sex-matched cadavers without degenerative knee diseases, n = 20, age: 67 ± 11 years]. Our data revealed that the RA, KOA, and control groups differ significantly in osteochondral microstructural properties depending on the knee alignment. Specifically, increasing femoral and tibial cortical porosity, coupled with thinner articular cartilage, were noted in the RA and KOA groups, compared to the controls. Furthermore, larger femoral and tibial cortical pores, lower tibial and femoral subchondral trabecular bone fraction, and thinner tibial articular cartilage were noted in the RA group in comparison to the KOA group, implying that the medial-to-lateral load distribution in the knee joint could be most affected in these patients. Our data illustrated that the thinnest cartilage, a thicker and less porous cortex, along with lower trabecular bone volume, were present in the lateral femoral and tibial condyles of RA individuals with valgus knee alignment. Observed subchondral trabecular microarchitectural alterations could be morphological factors contributing to different effects of surgical treatment and variable implant stability in individuals with RA, warranting further research. Full article

Objective: The increasing number of aging patients with total hip arthroplasties (THA) causes an increased incidence of periprosthetic fractures (PPF). The study aimed to evaluate the impacts of two different materials in the same-sized cemented stems on PPF in bone models. Methods: This study compared the maximum rotational torque leading to PPF when stems made of cobalt–chromium–molybdenum (Co–Cr–Mo) alloy and stainless use steel (SUS) were implanted using simulated bone models (Sawbones, 3403). The maximum destruction torque was compared statistically for each material (Co–Cr–Mo alloy vs. SUS stainless steel) in this model, and fracture patterns were examined. Results: The PPF occurred with a spiral propagation from the proximal femur towards the diaphysis, with breakage occurring near the distal end of the stem. There were no significant differences in the destruction torque values between the Co–Cr–Mo alloy (103.0 ± 14.9 Nm) and SUS (98.7 ± 15.1 Nm) samples (p = 0.575). The fractures using the bone models exhibited similar patterns in all specimens, resembling clinical PPF fracture types clinically, specifically Vancouver classification B2. Conclusions: The comparison of the maximum destruction torques of the Co–Cr–Mo alloy and SUS cemented stems in simulating PPF showed no significant differences. The results suggest that the materials of the cemented stems might not significantly affect the occurrence of PPF in THA. Full article

Background: Curettage represents a reliable therapeutic option for large-sized benign and locally aggressive bone tumors. In cases of impending fractures, internal fixation with plates and screws can be necessary to stabilize the treated bone after curettage. Metal plates have been the only fixation devices available on the market for decades, but Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) now represents an alternative in orthopedic oncology. Methods: We reviewed our patients with benign or locally aggressive bone tumors treated with curettage and fixation with CFR-PEEK plates. Plate length and curettage technique were chosen considering the characteristics of each lesion. We recorded the size and location of the lesions, adjuvant treatments and fillers used after curettage, complications, and local recurrences. Postoperative functionality was assessed using the MSTS score. Results: Forty cases were included in our study. The tumors were located in the distal femur (19 cases), femur shaft (1), humerus (17), or proximal tibia (3). Local adjuvants were used in 20 cases. Cavities were filled with bone allografts in 30 cases and cement in 10 cases. Only four cases suffered postoperative complications, and two developed local recurrences. The mean postoperative follow-up was 29.2 months. The mean postoperative upper and lower limb MSTS was 28.0 and 26.7, respectively. Conclusions: After an accurate curettage and an adequate filling of the resulting bone gap, CFR-PEEK plates can provide good mechanical resistance, and their radio-transparency can ease the early diagnosis of local recurrences. CFR-PEEK plates should be considered in selected cases, in a personalized surgical approach. Full article

Introduction: Chronic osteomyelitis is a persistent infection of the bone that poses significant challenges, particularly when associated with pathological fractures and extensive bone defects. This case report highlights the application of Masquelet’s induced membrane technique (MIMT) in managing a complex distal femur defect in a 50-year-old male with a long-standing history of chronic osteomyelitis. The patient presented with a non-union fracture, severe osseous destruction, and infection, requiring a multidisciplinary approach. Case report: The first stage involved radical debridement of necrotic tissue and stabilization with a titanium plate and an antibiotic-impregnated polymethylmethacrylate spacer to induce a bioactive membrane. The second stage, performed 30 days later, after infection resolution, entailed removing the spacer, harvesting an autologous iliac crest bone graft, and filling the defect within the preserved membrane. Postoperative care included a tailored antibiotic regimen and gradual weight-bearing, leading to favorable clinical and radiological outcomes. Conclusions: This case demonstrates the utility of MIMT in reconstructing extensive bone defects while addressing infection. The technique provides a reliable and effective alternative to amputation, offering high success rates and functional restoration in complex cases. Full article

Background and Objectives: To date, the gold standard of care for bone sarcomas is limb salvage surgical resection. In cases where the tumor arises in the distal femur or proximal tibia near the joint line, knee-sacrificing surgery is typically performed, followed by reconstruction with oncological megaprostheses. This study aims to evaluate the effectiveness of a precise 3D-based surgical approach for knee-sparing tumor resections, assessing its feasibility and its impact on surgical, oncological, and functional outcomes. Materials and Methods: This single-center retrospective study presents the surgical and oncological outcomes of knee-sparing surgeries following bone sarcoma resections. All patients underwent either intercalary or geographic resection, and reconstruction was tailored to each patient, using either an allograft or a titanium alloy Ti64 implant, depending on the specific requirements of the case. Results: A total of 23 patients (average age 21.04 years, 14 males) were included, with an average postoperative follow-up of 58 months (range: 12–102 months). Clear surgical margins were achieved in all patients, with 16 patients (69.5%) showing wide negative margins (R0) and the rest showing close negative margins (R1). Resections were primarily intercalary (17 patients, 73.9%), with 6 patients (26.1%) undergoing geographic resections. Reconstruction methods included allografts (9 patients, 39.3%), vascularized fibula and allograft (8 patients, 34.7%), and printed Ti64 cage reconstructions (6 patients, 26.0%). At the last follow-up, 19 patients (82.6%) were disease-free, 3 patients (13.4%) were alive with evidence of disease, and 1 patient (4%) was dead of disease. Complications included four cases of non-union that required revision surgery, as well as two local recurrences, which necessitated revision surgery to a modular endoprosthesis and above-knee amputation. The average MSTS at the final follow-up was 23.16 ± 5.91. Conclusions: The use of 3D-printed PSIs for knee-sparing bone tumor resections has emerged as the gold standard, enhancing both surgical and oncological outcomes. A future challenge lies in improving reconstruction techniques, shifting from traditional allografts to customized Ti64 printed lattice implants. As personalized healthcare and additive manufacturing continue to advance, the future of orthopedic oncology will likely see more precise, durable, and biologically integrated implants, further improving patient outcomes. Full article

Background and Objectives: The superficial femoral artery (SFA) can be injured during an intramedullary femoral nailing procedure with proximal and distal cross fixation, performed for proximal femoral fractures and intertrochanteric fractures. The aim of this study was to determine the safe and dangerous zones for the SFA during operative interventions on the femoral body in Turkish society and to define the relationship of these zones with femur length and sex. Materials and Methods: Using a computed tomography angiography, the relationship between the SFA and the medial shaft of the femur was examined in 160 limbs of 80 patients. The upper and lower cut points of the medial part of the SFA in the sagittal plane were defined. The distance of these points to the adductor tubercle was measured and the ratio of this value to the femur length was calculated. Results: The average distance of the SFA to the adductor tubercle in women was 214.2 ± 25.9 mm at the anterior border of the femur, while in men it was 229.8 ± 26.2 mm (p = 0.000). The danger zone length was 85 mm in women and 102 mm in men, and the difference was statistically significant (p = 0.000). The average distance of the SFA to the adductor tubercle at the anterior border of the femur was 223.1 ± 27.3 mm, the average femur length was 374.9 ± 30.2 mm, and a moderate correlation was found between them (r = 0.568). Conclusions: When determining the intraoperative danger zone using anatomical reference points in surgical approaches to the femur, variables such as sex and femur length should not be ignored. Full article

Dysregulated iron metabolism-induced ferroptosis is considered a key pathological mechanism in the development of osteoporosis (OP). G protein-coupled receptor 30 (GPR30, also known as Gper1) is an estrogen-binding receptor that has shown therapeutic benefits in patients with certain degenerative diseases. Moreover, several studies have demonstrated the anti-ferroptotic effects of estrogen receptor activation. However, its role in the prevention and treatment of OP remains unclear, and there are currently no reports on the anti-ferroptotic function of GPR30 in OP. Therefore, this study aimed to investigate the ferroptosis-related effects and mechanisms of GPR30 in the context of OP. In vivo and in vitro experiments were conducted using wild-type (WT) C57BL/6 female mice and GPR30-knockout (GPR30-KO) C57BL/6J female mice. The microarchitecture of the distal femur was assessed using micro-computed tomography (micro-CT), and histomorphological changes were analyzed via hematoxylin and eosin (H&E) staining. Bone marrow mesenchymal stem cells (BMSCs) were isolated and cultured to establish an iron overload model using ferric ammonium citrate (FAC). Interventions included GPR30 overexpression via transfection and BMP-6 inhibition using LDN-214117. Cell viability was evaluated with the CCK-8 assay, while osteogenic differentiation and mineralization levels were assessed using ALP and Alizarin Red S (ARS) staining. Iron accumulation was detected via Prussian blue staining, oxidative stress levels were evaluated using ROS staining, and mitochondrial membrane potential changes were analyzed using JC-1 staining. Transmission electron microscopy (TEM) was employed to observe mitochondrial ultrastructural changes. Additionally, key gene and protein expression levels were measured using immunofluorescence and Western blotting. The micro-CT analysis revealed significant bone microarchitecture deterioration and bone loss in the GPR30-KO mouse model. At the cellular level, GPR30 overexpression markedly reduced iron accumulation and oxidative stress in BMSCs, restored the mitochondrial membrane potential, and improved the mitochondrial ultrastructure. Furthermore, GPR30 enhanced osteogenic differentiation in BMSCs by promoting the activation of the BMP-6/HEP/FPN signaling pathway, leading to increased expression of osteogenic markers. The protective effects of GPR30 were reversed by the BMP-6 inhibitor LDN-214117, indicating that BMP-6 is a critical mediator in GPR30-regulated iron metabolism and ferroptosis inhibition. GPR30 inhibits ferroptosis in BMSCs and enhances osteogenic differentiation by activating the BMP-6/HEP/FPN signaling pathway. This provides new insights and potential therapeutic targets for the treatment of osteoporosis OP. Full article

Limb-sparing techniques for appendicular primary bone tumors are still associated with a high rate of complications. Three-dimensional (3D)-printed patient-specific instruments could reduce these complications. The aim of this study is to describe a limb-sparing surgery using 3D-printed patient-specific guides (PSGs) and an endoprosthesis (PSE) to treat femoral chondrosarcoma in a dog. An eight-year-old female Golden Retriever presented with persistent lameness of the right hind limb, reluctance to move and difficulty in maintaining a standing position. Palpation of the right femur revealed an approximately 4 cm painful lesion. Cytological analysis of the needle aspiration supported the clinical and radiological suggestion of a cartilaginous bone neoplasm. Computed tomography (CT) scans suggested the presence of an aggressive lesion on the right distal femur. CT scans of the femur and tibia were then reconstructed using a bone tissue algorithm and processed with computer-aided design (CAD) software, which allowed for performing virtual surgical planning (VSP) and the fabrication of both the PSG and the PSE. Anti-inflammatory drugs and monoclonal antibodies were used for pain management while waiting for surgery. Adjuvant chemotherapy was also administered. An ostectomy of the distal third of the femur to completely remove the tumor was performed with the designed PSG, while the bone defect was filled with the designed PSE. Histopathological examination of the osteotomized bone segment confirmed a grade 2 central chondrosarcoma. There was no excessive tumor growth during the 28 days between the CT scans and surgery. Both PSG and PSE fitted perfectly to the bone surfaces. PSG eliminated the need for intraoperative imaging and ensured a faster and more accurate osteotomy. PSE optimized load sharing and eliminated the complications of the commercial endoprosthesis, such as incongruity and the need for manual intraoperative adjustment. Overall, the use of VSP, 3D-printed PSG and PSE significantly reduced surgical time, risk of infection and intra- and postoperative complications. Full article