Introduction: The Gemini stem (DePuy) is a titanium femoral stem with a modular cobalt chrome femoral head. It has a roughened proximal surface finish to enhance cement bonding and a distal centraliser.

Purpose of the study: A retrospective assessment of the performance of the titanium cemented Gemini femoral component

Patients and Methods: 196 patients underwent a 204 total hip replacements using a titanium cemented Gemini stem and an uncemented cup. All the operations were performed by a lateral approach using modern cementing technique. Patients were assessed clinically (Harris hip score) and radiologically (standard AP and lateral x-rays)

Results: 11 patients with incomplete clinical and radiological follow-up were excluded from the study, leaving 185 patients (193 hips). 36 patients died with their total hip prosthesis in situ. The average age was 71 years and primary diagnosis was OA in the majority. The average follow-up was 70 months (range 35– 121). 29 of the hips have been revised. A further 11 were recognized as radiological failures. In 24, aseptic loosening or a broken stem was an indication for the revision. Mean time to revision was 3.1 years (range 1.5 to 7).

Discussion: Our results indicate that there is a high incidence of early failure associated with these titanium cemented stems, a cumulative failure of approximately 20%. The rough surface finish, titanium alloy and a fixed distal centraliser may all contribute to the early failure by increasing the stresses in the cement. Based on our experience, the continued use of this cemented stem is no longer justified.

Introduction: The main object of acetabular revisions in the presence of bone loss is to restore bone stock to provide adequate support for the cup. Allograft bone has been used to reconstruct the acetabulum with variable results.

Purpose of the study: Prospective assessment of the performance of the uncemented cups with morsellized allograft bone in revision acetabular reconstruction.

Patients and methods: A single surgeon using the lateral approach performed 98 acetabular revisions. An uncemented cup with multiple screw holes and morsellized allograft bone was used in all the patients. Acetabular defects were classified using both AAOS and Paprosky classification systems on standard AP x-rays and clinical assessment was by Harris hip scores.

Results: 93 patients had complete clinical and radiological follow-up. Mean age was 65.3 years (24–87) and majority was female. Mean number of prior operations was 1.7 (1–5). Majority of the acetabular defects belonged to group III (AAOS). The mean follow-up was 98 months (36–145). 13 patients have undergone repeat revisions, 5 for aseptic loosening and 3 each for infection, recurrent dislocation and early technical failures. Bone incorporation was complete within 3 months in all the cases

Discussion: The use of uncemented cups with screws provides the primary stability that is supplemented later by the incorporated allograft bone. The rate of re-operations for aseptic loosening of the cup in our series is low at 6% after 8 years. Even in these cases the repeat revisions were significantly easier due to restoration of the bone stock.

Introduction: Good results have been reported with curettage and cementation in the treatment of giant cell tumours of bone. There is a fear of potential degenerative changes with the long-term presence of methyl methacrylate in a weight bearing subchondral location.

Purpose of the study: To prospectively study the effectiveness of treatment of giant cell tumours by curettage, high speed burring and cementation.

Patients and methods: A single surgeon treated 37 giant cell tumours with meticulous curettage and high speed burring followed by cementation of the resulting cavity. The tumours were graded radiologically after the method of Campanacci et al. All the patients were prospectively followed up clinically by MSTS scoring system and radiologically.

Results: There were 22 women and 15 men with a mean age at operation of 34 years (range 17–72). 26 of the tumors were around the knee. 4 patients were Campanacci grade I, 22 grade II and 11 grade III. In 8 patients with pathological fractures, cementation was supplemented by internal fixation. Mean follow-up was 3.3 years (1.7–14). There were 4 recurrences. All the recurrences occurred within the first year. There have been no degenerative changes in the adjacent joint. All the patients scored either excellent or good in the MSTS scoring system.

Conclusions: Curettage, high speed burring followed by cementation is a useful method in the treatment of giant cell tumours. The advantages include relatively low recurrence rate (10% in our series), immediate stability allowing early mobilization and easier and early radiological diagnosis of recurrence.

Introduction: Osteochondral reconstruction following tumour resections has a high complication rate. We hypothesized that the vascularised fibular graft as a supplement to the allograft reconstruction following tumour resections would provide a biological solution.

Purpose of the study: A prospective study of the results of patients receiving large fragment allografts and vascularised fibular grafts following tumour resections around the hip and the knee.

Patients and methods: 18 patients underwent resection of primary malignant bone tumors followed by reconstruction with large fragment allograft and vascularised fibular graft. 8 patients underwent resection arthrodesis of the hip, six underwent resection arthrodesis of the knee and five underwent intercalary resections around the knee followed by a large fragment allograft and vascularised fibular graft reconstruction to span the gap left by resection. The patients were assessed clinically (MSTS scoring system) and radiologically at regular intervals.

Results: There were 14 males and 4 females, with a mean age of 26 years (12–70). Mean follow-up was 65 months (8–144). Five patients died of metastatic disease but without local recurrence. In six of the patients with resection arthrodesis of the hip, there was evidence of fracture of the allograft but without the failure of the construct. One fibula fractured but eventually healed uneventfully. There were no cases of non-union in cases of intercalary resections. All the patients scored good or excellent in the MSTS scoring system.

Discussion: Our experience clearly indicates that tumour resection followed by reconstruction with large fragment allograft and vascularised fibular graft is a useful limb salvage procedure providing a biological long-term solution with superior results when compared to prosthetic reconstruction.