Aim: Failed primary hip arthroplasty often results in significant loss of host bone. Revision surgery may require bone grafting to restore bone stock prior to insertion of a new cup. A two to five year follow up of one method of acetabular revision for severe bone stock loss is presented

Materials and Methods: Seventeen patients had acetabular revision with the use of impacted morcellised bone and a cage reconstruction with a cemented cup. The average age at the time of revision was 62. All patients were followed prospectively with regular X-rays. A variety of cages were employed and bone graft was hand morcellised from femoral heads or cadaver distal femurs.

Introduction: Infected hip arthroplasties have usually been managed with either one or two stage revisions using antibiotic impregnated cement to fix the components. The use of cementless fixation has been less widely reported. The results on the femoral side have been less encouraging.

Aim: To present the short to medium term results of cementless revision for infected hip arthroplasty.

Methods: Ten patients who had undergone cementless revisions for infected hip arthroplasties have been followed prospectively. There were eight males and two females with an average age of 67 years. Nine of the 10 patients were treated with two-stage revisions with one female undergoing a one-stage revision for medical reasons. The diagnosis of sepsis was made on the basis of bacterial cultures and positive histology from all patients. Removal of the prosthesis was followed by the administration of intravenous antibiotics for six weeks and, in some, cases oral antibiotics for several months. The reconstructions were undertaken following the Girdlestone’s arthroplasties with a range from eight weeks to three years, (with the exception of the one stage exchange).

Results: The patients were examined from 18 to 64 months after the surgery with none lost to follow-up. All prostheses remained in situ with improvements in the Charnley and Oxford hip scores. There had been no recurrence of infection and no clinical or radiological evidence of loosening.

Discussion: Debate still exists about the merits of one-stage versus two-stage reconstruction for an infected hip arthroplasty. The use of antibiotic-impregnated cement has been recommended, especially for the femoral component. This series demonstrated that cementless reconstruction for infected hip arthroplasty was successful in providing an infection free, stable hip in the short to medium term.

Purpose: As part of the step-wise introduction of a meniscal-bearing total knee replacement (Oxford TMK) we needed to know, before proceeding to longer term studies, whether its early clinical results were at least as good as those of an established fixed bearing device (AGC).

Material and Methods: With ethical approval, patients requiring bilateral knee replacement for osteoarthritis consented to have the operations under one anaesthetic using one of each prosthesis; to accept random choice of knee; and to remain ignorant which side was which. American Knee Society Scores, Oxford Knee Scores, ROM and pain scores were to be recorded preoperatively and at one year. By January 2001, 40 patients had reached one year and data is available for 36.

Results: Preoperatively there was no difference between the two knees. One patient died in the peri-operative period.

Results at one year (TMK first): AKSS(Knee) 91.6 / 84.1 (p=0.003), OKS 39.8 / 37.6 (p=0.006), ROM 104 / 104 (p=0.364), Pain (AKSS) 47.3 / 41.7 (p=0.01), Pain (OKS) 3.5 / 2.9 (p=0.006).

Conclusion: The TMK performed as well as the AGC. Its AKSS, OKS and pain scores were significantly better. We believe this controlled, blinded trial is the first to have compared the function of a new knee prosthesis with a standard implant before marketing; and the first to have demonstrated a significant clinical advantage for a meniscal-bearing over a fixed bearing TKR. The comparison of bilateral implants in the same patient can reveal significant differences while putting at risk many fewer subjects than would be needed for a classical twocohort RCT.