Purpose of the study: The purpose of this retrospective study was to present the outcomes observed with the Cedior total knee arthroplasty (TKA), and in particular an embedded patellar implant fixed without cement and cemented titanium backed base plate with a press fit stem.

Material and methods: From January 1993 to December 1996, 155 TKA were implanted in 143 patients for degenerative disease of the knee joint. At last follow-up, 55 patients had died, 28 were lost to follow-up 14 were contacted by phone, and 46 were reviewed clinically. Mean age was 62 years (62–80), BMI: 29.9 (22.6–38.2). Mean follow-up was 12 years (10–13). Posterior stabilised implants were used for 33% of the knees and the posterior cruciate was preserved in 67%. For all knees, the thickness of the polyethylene was > 6mm. Outcome was assessed clinically with the IKS, WOMAC, and Charnley scores and radiographically on the basis f lucent lines, osteolysis, and residual misalignment as measured on the standard films and goniometry. Survival was determined with the Greenwood method.

Results: Two patients (2 posterior stabilised TKA) with residual varus > 6 (> 15 preoperatively) were revised for loosening. At last follow-up, the postoperative IKS was 164, the WOMAC 28. Two patients were dissatisfied. Radiographically residual alignment was less than 3 in 56%, 3 to 6 in 41% and > 6 in 3%. For the femur, there were two lucent lines in a single zone. For the tibia, six lines in zone 7, none around the stem. For the patella, two implants presented significant asymptomatic osteolysis and there were two spontaneous (5 and 8 years) and asymptomatic fractures. Survival was 98.1±4.6% for revision and 96.2±6.9% for aseptic loosening.

Discussion: Our results are comparable with 10-year outcomes published in the literature where the survival has ranged from 92% to 99%. The titanium back cemented under the bas without cementing the sanded stem provides satisfactory results. The two loosening occurred for a residual varus > 6. The embedded, non-cemented patellar implant gave satisfactory results but the two cases of osteolysis led us to propose cementing.

Purpose of the study: The purpose of this work was to report the outcome at minimum ten years follow-up of cemented Muller total hip arthroplasty (THA) with a metal-on-metal bearing and a CLS cup.

Material and methods: From June 1995 to August 1997, 110 THA were implanted in 102 patients for degenerative hip disease. At last follow-up, 23 patients had died, four were lost to follow-up, and 67 were reviewed. Mean age was 56 years (29–71). BMI: 26.2 (17.9–33.6). Mean follow-up was 12 years (10–13). The same operative technique was used for all implantations: transgluteal approach, Palacos Gentamycine^® cement, straight femoral stem, Muller prosthesis made of Protasul^®10, with a Metasul^® head and a CLS cup with a polyethylene sandwich Metasul^® insert. Outcome was assessed clinically with the Merle score, radiographically searching for signs of loosening using the Harris criteria for the femoral component and the Hodgkinson criteria for the acetabular component. Migration was measured with the Nunn method for the cup and the Sutherland method for the femur. Dobbs actuarial survival was determined.

Results: Nine patients (9THA) underwent revision for acetabular migration (n=4), cup fracture by cam effect (n=1), psoas syndrome (n=2), retarded hypersensitivity (n=1), infection (n=1). At last follow-up, the clinical outcome was good or very good (n=64), fair (n=2), poor (n=1). Radiologically, for the femur: lucent lines (n=0), osteolysis (n=4), migration (n=0); for the cup: lucent line < 1mm stable and non migrating (n=3), global lucent line with migration > 5mm (radiological loosening) (n=1). No correlation between clinical and radiographic outcomes. Survival was 89.4±7.6% for revision outside infection and 92.6±6.9% for aseptic loosening.

Discussion: The failures at ten years were all acetabular, but related to various causes. Defective fixation could be related to the implant design or to the use of a hard-on-hard bearing increasing peripheral stress. Hypersensitivity and a cam effect related directly to using the metal-on-metal bearing. The psoas syndrome was not related to the type of cup.

Conclusion: Use of a metal-on-metal bearing, which theoretically improves wear, leads to other constraints in terms of fixation, technique, and context which must be taken into consideration to improve outcomes.