Asian Journal of Orthopaedic Research

Total Hip Arthroplasty Following Failed Internal Fixation of Hip Fractures: Clinical and Radiological Outcomes in a Retrospective Study of 14 Cases

Moutaoukil Walid — 2026-06-05

Background: Total hip arthroplasty (THA) is the reference salvage procedure for failed internal fixation of hip fractures. This revision surgery is technically demanding and carries a higher complication rate than primary THA.

Aim: The aim of this retrospective study was to evaluate clinical and radiological outcomes at short-to-medium term follow-up.

Methods: A retrospective single-center study including 14 patients who underwent THA after failed internal fixation of femoral neck, trochanteric or acetabular fractures (June 2017 – January 2021) at Mohamed V Hospital, Tangier. The mean follow-up was 18 months. Functional assessment was performed using the Postel-Merle d'Aubigné (PMA) score.

Results: The patient’s mean age was 63 years Old; the mean operative time was 130 minutes. Six patients required blood transfusion. One intraoperative complication occurred (periprosthetic fracture, 7%). No postoperative dislocation or deep infection was recorded. The radiological outcomes were satisfying, 93% of acetabular cups were correctly positioned within the 40–45° inclination range Heterotopic ossification was observed in 2 patients (14.3%). Excellent PMA score was achieved in 71.5% of patients. Our results, consistent with the international literature, confirm that conversion THA is the only reliable salvage option for failed hip fracture fixation, permitting restoration of ambulatory capacity and pain relief.

Conclusion: THA after failed hip fracture fixation is a technically challenging but effective salvage procedure. With adequate preoperative planning and appropriate implant selection, it allows restoration of hip function in the vast majority of patients and should be considered the only valid salvage option over re-osteosynthesis.

A Multisensory Feedback Framework for Prosthetic Gait Rehabilitation: Analysis of Gait-synchronized Vibrotactile and Thermal Stimuli

D. Dharshini — 2026-06-03

Lower-limb prosthetic rehabilitation increasingly emphasizes the restoration of sensory feedback to compensate for the loss of natural proprioceptive and tactile perception following amputation. Recent developments in multisensory human–machine interfaces have demonstrated the potential of integrating complementary feedback modalities, such as vibrotactile and thermal stimulation, to improve gait stability, user embodiment, and motor adaptation during prosthetic-assisted ambulation. Lower-limb prosthetic users often experience impaired gait symmetry, reduced proprioceptive awareness, and elevated cognitive load during ambulation. Sensory substitution and augmentation have emerged as promising strategies to restore afferent feedback lost due to amputation. This paper presents a comprehensive multisensory feedback framework integrating gait-synchronized vibrotactile and thermal stimuli to support prosthetic gait rehabilitation. The proposed system maps real-time gait events to spatially and temporally congruent vibrotactile cues, augmented with controlled thermal feedback to reinforce stance-phase awareness and load perception. A detailed system architecture, signal processing pipeline, control strategies, and experimental protocol are described. Quantitative gait metrics and qualitative user-reported outcomes are analyzed to evaluate efficacy. Results indicate improvements in temporal gait symmetry, stance stability, and perceived embodiment, suggesting that multimodal sensory feedback can enhance motor learning and rehabilitation outcomes for lower- limb amputees.

Retained Fractured Epidural Catheters: A Case Series and a Proposed Management Algorithm

S. C. Satpal — 2026-06-01

Retained fractured epidural catheter fragments are a rare but potentially serious complication of neuraxial anaesthesia, with reported incidences ranging from 0.002% to 0.055%. Despite their infrequency, management remains controversial, particularly in asymptomatic patients, due to the balance between risks of surgical retrieval and potential long-term complications such as migration, infection, granuloma formation, and neurological compromise.

Methods and Objective: This was a 2 -centre retrospective study of nine patients with retained epidural catheter fragments following lumbar epidural anaesthesia from 2023-2025. The objective of the study is to describe and evaluate the outcomes of treatment and to design a management guideline.

Results: Computed tomography (CT) scan successfully localized the retained fragments in all cases, with fragment lengths ranging from 0.9 cm to 15 cm, and locations including intra-canal, interlaminar, and paraspinal regions. Seven patients underwent surgical removal within 2–5 days of the incident, while two were managed conservatively. Surgical outcomes were rather favorable.

Conclusion: Our findings support CT scan as the primary imaging modality for accurate localization of retained catheter fragments. Clinical decisions should be guided by symptomatology, fragment location, length, and age factors. Based on expert consensus, we propose a structured management algorithm emphasizing early imaging, risk stratification, and shared decision-making. This approach aims to standardize care, reduce morbidity, and address medicolegal considerations in both tertiary and resource-limited settings.

A Six-case Series of Pelvic Bone Tumor Resection with Limb Preservation: Prosthetic Reconstruction, Osteosynthesis, and Conservative Surgical Approaches

Hamza Betmi — 2026-06-11

Background: Pelvic bone tumors are rare, complex lesions whose management is challenging due to delayed diagnosis, intricate anatomy, and proximity to critical neurovascular structures, requiring multimodal imaging, biopsy confirmation, and individualized surgical resection with reconstruction when needed.

Aims: To report the diagnostic and therapeutic features of six patients managed for pelvic bone tumors in a Moroccan tertiary orthopedic unit, highlighting surgical approaches, reconstructive choices, functional outcomes, and specific challenges in a resource-limited setting.

Study Design: Retrospective descriptive case series.

Place and Duration of Study: Department of Orthopedic Surgery and Traumatology, Mohammed VI University Hospital, Tangier, Morocco, January 2023 – December 2025.

Methodology: Six patients (5 women, 1 man; mean age 35.7 years; range 16–67) operated for histologically confirmed pelvic bone tumors. Data on clinical presentation, multimodal imaging, histological diagnosis, neoadjuvant and adjuvant treatments, surgical resection type (Enneking–Dunham classification), reconstructive strategy, complications, functional outcomes (MSTS score), and follow-up were collected via REDCap database.

Results: Histological subtypes: Ewing sarcoma (n=3), chondrosarcoma (n=1), intraosseous cavernous hemangioma with aneurysmal changes (n=1), bone metastasis from breast carcinoma (n=1). Mean diagnostic delay: 17 months. All patients underwent limb-sparing surgery. Reconstructions: ilio-femoral ice-cream cone prosthesis (n=1), plate osteosynthesis (n=2), cement + T-plate (n=1), hernia mesh filling (n=1), no reconstruction (n=1). Four patients (67%) in complete remission (7 months to 2 years follow-up). One death from Ewing sarcoma metastatic relapse. One locoregional recurrence (metastatic carcinoma). Functional recovery satisfactory in survivors.

Conclusion: Limb-preserving pelvic surgery is achievable across diverse histological subtypes and reconstructive needs in a resource-limited Moroccan tertiary center, though conclusions are necessarily limited by the small and heterogeneous sample size. The 17-month mean diagnostic delay remains the primary obstacle in the Moroccan context. Multidisciplinary tumor boards, improved imaging access, and national referral networks are essential.

Orthopaedic Management in Cerebral Palsy: A Narrative Review

Made Agus Maharjana — 2026-06-03

Background: Cerebral palsy (CP) is a permanent disorder of movement and posture caused by a non-progressive injury to the developing brain. Despite the static nature of the neurological insult, musculoskeletal complications often progress with growth, leading to spasticity, contractures, skeletal deformities, hip instability, gait abnormalities, and spinal deformities that may significantly limit function and quality of life.

Aims: This review aims to summarize key principles of orthopaedic management in CP and highlight practical approaches for clinical assessment, surveillance, and treatment planning to optimize function and prevent secondary deformities.

Methods: A narrative review was conducted using published literature focusing on the definition and classification of CP, diagnostic evaluation, hip surveillance, gait assessment, and orthopaedic interventions. Both conservative and surgical strategies were included, with emphasis on decision-making frameworks used in contemporary clinical practice.

Results: Orthopaedic management in CP is best delivered through a multidisciplinary approach. Non-operative measures such as physiotherapy, orthoses, serial casting, and spasticity control are essential to maintain range of motion, improve alignment, and enhance functional performance. Surgical intervention is indicated for fixed deformities, progressive hip displacement, severe gait dysfunction, and scoliosis, with single-event multilevel surgery increasingly applied to correct multiple deformities in one operative session. Ongoing clinical evaluation, standardized hip surveillance, and gait analysis support timely intervention and improved outcomes.

Conclusion: Orthopaedic care plays a central role in improving mobility, reducing pain, and enhancing quality of life in children with CP. Individualized treatment based on functional classification, careful surveillance, and appropriately timed conservative or surgical interventions is critical to achieve optimal long-term outcomes.

Contemporary Diagnostic and Therapeutic Strategies for Knee Meniscal Injuries: A Review

Mamajonov Shavkat Taxirjanovich — 2026-06-17

Meniscal injuries represent one of the most prevalent and clinically consequential musculoskeletal conditions encountered in orthopaedic and sports medicine practice, affecting a broad demographic spectrum ranging from young competitive athletes to elderly patients with degenerative joint disease. The menisci fulfil indispensable biomechanical roles within the tibiofemoral joint, including load transmission, shock absorption, stabilisation, and lubrication, and their preservation is increasingly recognised as fundamental to the long-term health of the knee. Over the past two decades, the management of meniscal injuries has undergone significant evolution, driven by robust clinical trial evidence that has challenged longstanding surgical conventions and redirected practice towards conservative, tissue-preserving approaches. This review critically appraises current knowledge across the full spectrum of meniscal injury, encompassing pathoanatomy, tear classification, clinical diagnosis, imaging assessment, and the complete range of therapeutic strategies from structured rehabilitation to arthroscopic intervention, allograft transplantation, biological augmentation, and emerging tissue engineering technologies. Particular attention is given to randomised controlled trials demonstrating the equivalence of exercise-based rehabilitation to arthroscopic partial meniscectomy for degenerative tears, and to the growing evidence base supporting meniscal repair as the preferred surgical strategy for appropriate lesions. The roles of platelet-rich plasma, mesenchymal stem cell therapy, scaffold-based implants, and three-dimensional bioprinting in meniscal regeneration are reviewed alongside the current limits of the clinical evidence. The article identifies critical gaps in knowledge and proposes future research priorities to guide practice in this rapidly advancing field.

Therapeutic Strategies Targeting the Gut-Bone Axis: The Role of Probiotics and Faecal Microbiota Transplantation

Mohamed Khaled Talaat Youssef Hassan — 2026-06-18

The gut microbiota is an important modulator of skeletal homeostasis through immune regulation, microbial metabolite production, intestinal barrier integrity, endocrine signalling and mineral handling. Dysbiosis may contribute to bone loss by increasing intestinal permeability, promoting systemic low-grade inflammation, enhancing osteoclastogenic cytokine activity and reducing bone-protective metabolites, particularly short-chain fatty acids. This narrative review synthesises mechanistic, preclinical and clinical evidence on microbiome-directed strategies targeting the gut-bone axis, with emphasis on probiotics, prebiotics, synbiotics and faecal microbiota transplantation. Experimental studies suggest that selected probiotic strains may influence bone remodelling by increasing short-chain fatty acid production, improving gut barrier function, modulating Treg/Th17 balance and reducing inflammatory bone resorption. Prebiotics and synbiotics may further support skeletal health by enhancing calcium absorption, stimulating beneficial microbial activity and promoting metabolite-mediated regulation of osteoblast and osteoclast function. Human studies provide preliminary evidence for modest improvements in bone mineral content, preservation of bone mineral density and reductions in biochemical markers of bone resorption. However, most trials remain limited by small sample sizes, heterogeneous formulations, short follow-up periods and reliance on surrogate outcomes rather than fracture endpoints. Faecal microbiota transplantation provides useful experimental insight into the causal relevance of microbial communities in host metabolic and skeletal physiology, but its application to osteoporosis remains investigational because donor variability, recipient compatibility, pathogen transmission, long-term ecological stability and regulatory oversight remain unresolved. Overall, targeting the gut-bone axis is biologically plausible and may complement established skeletal care, but current evidence supports further investigation rather than immediate clinical replacement of standard osteoporosis therapies.

Revision Anterior Cruciate Ligament Surgery Using MacIntosh Technique with Patellar Tendon Reconstruction via Contralateral Patellar Tendon Graft: A Case Report

O. Memdouh — 2026-06-01

Background: ACL reconstruction using the Kenneth Jones bone-patellar tendon-bone technique is a well-established procedure with excellent functional outcomes, although rare complications such as patellar tendon rupture may occur. In revision settings, alternative reconstructive approaches like the MacIntosh technique can provide effective management for complex postoperative failures.

Aims: To report a rare case of early patellar tendon rupture following ACL reconstruction using the Kenneth Jones bone-patellar tendon-bone technique, and to describe the iterative surgical management using the MacIntosh technique combined with simultaneous patellar tendon reconstruction via a contralateral patellar tendon graft.

Presentation of Case: A 22-year-old male patient (BMI 29) presented with complete loss of active knee extension in the immediate postoperative period following open ACL reconstruction using the Kenneth Jones technique. MRI confirmed complete rupture of the right patellar tendon and absence of the ACL. Revision surgery was performed combining ACL reconstruction using an ipsilateral fascia lata graft (MacIntosh technique) and patellar tendon reconstruction using a contralateral patellar tendon graft.

Discussion: Patellar tendon rupture following ACL reconstruction represents a rare but serious complication. Mechanical, histological, and vascular alterations of the residual two-thirds of the harvested patellar tendon are implicated in this risk. The MacIntosh technique provides a reliable alternative in revision settings, with favourable functional outcomes.

Conclusion: This case underscores the importance of rigorous surgical technique, careful postoperative surveillance, and thorough informed consent — encompassing the risk of patellar tendon rupture, donor-site morbidity, and the potential need for revision surgery — prior to ACL reconstruction using the Kenneth Jones procedure.

Mirror Chondroblastoma of the Distal Femur and Proximal Tibia: A Rare Case of Synchronous Epiphyseal Lesions with an Occult Tibial Component on MRI

O. Msahli — 2026-06-10

Background: Chondroblastoma is a rare benign but locally aggressive epiphyseal bone tumor that primarily affects adolescent males, most commonly involving the distal femur, proximal tibia, and proximal humerus. Although MRI is valuable for evaluating these lesions, small synchronous lesions may remain occult, and no previous reports have described “mirror” chondroblastoma involving both sides of the same joint.

Aims: To report an exceptionally rare case of synchronous "mirror" chondroblastoma affecting both the distal femoral medial condyle and the proximal tibial plateau, with the tibial lesion remaining occult on preoperative MRI.

Presentation of Case: A 16-year-old male presented with a 9-month history of progressive right knee pain and partial functional impairment. A surgical biopsy performed 6 months prior at another institution had confirmed chondroblastoma of the distal femoral medial condyle. Preoperative MRI, performed one month before surgery, revealed the femoral lesion but failed to identify a synchronous tibial plateau lesion. Intraoperatively, a second chondroblastoma was discovered at the medial tibial plateau — a so-called "mirror" lesion not visible on MRI. Both cavities were treated by extended curettage and filling with calcium phosphate cement (CPC).

Discussion: Synchronous chondroblastoma involving both sides of the same joint (mirror lesions) is an unreported finding in the literature. MRI limitations in detecting small or early epiphyseal lesions are discussed. The surgical management of both lesions was achieved in a single operative session.

Conclusion: This case highlights the importance of thorough intraoperative inspection of all articular surfaces in chondroblastoma surgery, and raises the question of systematic arthroscopic exploration. Mirror chondroblastoma may represent a novel, previously undescribed entity.

Concurrent Posterosuperior Hip Dislocation and Ipsilateral Diaphyseal Femoral Fracture: Staged Surgical Management and Twelve-Month Outcome

Y. Sebai — 2026-06-22

Background: Concurrent posterosuperior hip dislocation with ipsilateral femoral diaphyseal fracture is a rare, high-energy orthopaedic injury in which the femoral shaft fracture may mask the associated hip dislocation, increasing the risk of delayed reduction and femoral head vascular compromise.

Case Presentation: A 54-year-old previously healthy male pedestrian presented to the emergency department at 21:30 hours after being struck by a motorcycle. Examination showed shortening, external rotation, inability to bear weight, and intact distal neurovascular status. Radiographs confirmed a closed right mid-diaphyseal femoral fracture with concurrent right posterosuperior hip dislocation, without plain radiographic evidence of femoral neck or posterior acetabular wall fracture. Urgent closed reduction was performed under general anaesthesia using a modified Allis technique, with the proximal femoral fragment used as a traction handle because shaft continuity was lost. Fluoroscopy confirmed concentric reduction. Definitive fixation of the femoral shaft fracture was then completed in the same operative session using an antegrade centromedullary interlocking nail.

Outcome: Rehabilitation progressed from initial non-weight-bearing mobilisation to partial weight-bearing at 6 weeks and full weight-bearing at 12 weeks. At twelve months, radiographs showed complete femoral fracture consolidation, preserved femoral head sphericity, and no radiographic evidence of avascular necrosis. The Harris Hip Score was 91.

Conclusion: This case supports systematic pelvic imaging in high-energy femoral fractures and prioritisation of urgent hip reduction before definitive fracture fixation.