Purpose: The cruciate four-strand flexor tendon repair technique has been advocated for its ease of use and biomechanical strength. However, the in vivo efficacy of the cruciate 4-strand repair has not been reported; no has this method of repair been assessed for its ability to allow for an early active motion rehabilitation protocol. The purpose of this study was to report early clinical results using the cruciate 4-strand repair for proximal zone I and zone II flexor tendon lacerations. Method: Thirty-five digits in thirty-one patients had proximal zone I (3 digits) or zone II (32 digits) flexor tendon lacerations which were repaired using the cruciate 4-strand technique and an epitendinous state. Average patient age was 30.8 years (range 9.7–63.7). An early active motion rehabilitation protocol was initiated an average of 1.5 days following tendon repair. The supervised therapy program was continued for 12 weeks post-operatively. Assessment of total active motion (TAM), as well as PIP and DIP TAM, grip strength, and joint contractures were recorded at 3 months and at 6 months or greater post-operatively. Functional assessments (using the Strickland and American Society of Surgery for the Hand criteria) were performed for each patient at 3 and 6 month intervals. Results: All patients were followed for a minimum three-month period. At 3 months postoperatively, there were 16 excellent, 7 good, 6 fair, and 6 poor results by the Strickland criteria, and 12 excellent, 15 good, 7 fair, and 1 poor by the ASSH criteria. Total active motion averaged 225° (±44°), PIP and DIP motion averaged 136° (±40°). Grip strength was available for 17 patients and averaged 60% of the contralateral, uninvolved hand. By 6 months or greater postoperatively there were 18 digits available for follow-up. There were 15 excellent results and 3 good results by the Strickland criteria, and 11 excellent and 7 good results by the ASSH criteria. Six patients had PIP contractures averaging 11° (range 3–15°), and two patients had DIP contractures averaging 13° (range 5–20°). Total active motion averaged 257° (±22°), and PIP and DIP motion averaged 166° (±22°). Grip strength was available on 14 patients and averaged 91% of the contralateral hand. To date, of the patients followed up to 6 months or longer, there have been no ruptures, no re-operations for tenolysis, and no loss of motion. Conclusion: Early clinical results using the cruciate 4-strand suture technique for flexor tendon repair have demonstrated outcomes equivalent or superior to other methods. The relative simplicity of the technique, with biomechanical strength properties facilitating a modified early active motion rehabilitation protocol, may make this method of repair attractive. Further clinical studies will need to be performed to determine the long-term efficacy of this method of tendon repair

Aims. Ilium is the most common site of pelvic Ewing’s sarcoma (ES). Resection of the ilium and iliosacral joint causes pelvic disruption. However, the outcomes of resection and reconstruction are not well described. In this study, we report patients’ outcomes after resection of the ilium and iliosacral ES and reconstruction with a tibial strut allograft. Methods. Medical files of 43 patients with ilium and iliosacral ES who underwent surgical resection and reconstruction with a tibial strut allograft between January 2010 and October 2021 were reviewed. The lesions were classified into four resection zones: I. 1. , I. 2. , I. 3. , and I. 4. , based on the extent of resection. Functional outcomes, oncological outcomes, and surgical complications for each resection zone were of interest. Functional outcomes were assessed using a Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS). Results. The mean age of the patients was 17 years (SD 9.1). At a mean follow-up of 70.8 months (SD 50), the mean functional outcomes were 24.2 points (SD 6.3) for MSTS and 81 points (SD 11) for TESS. The mean MSTS and TESS scores were associated with the iliac resection zone (< 0.001). Nine patients (20.9%) had local recurrence. The recurrence was not associated with the zone of iliac resection (p = 0.324). The two-year disease-free survival of the patients was 69.4%. The mean time to graft union was longer in patients with the I. 4. resection zone (p < 0.001). The complication rate was 34.9%, and nerve palsy (11.6%) was the most common. The rate of surgical complications was not associated with the resection zone. Conclusion. Reconstruction using tibial strut allograft is an efficient procedure after the resection of the ilium and iliosacral ES. Functional outcomes and complications of iliac ES depend on the resection zone, and inferior outcomes could be generally expected when more segments of the pelvic ring are resected, even if it is reconstructed. Cite this article: Bone Jt Open 2024;5(5):385–393

Stem loosening can be associated with a wide spectrum of bone loss and deformity that represent key factors for choosing the most appropriate revision implant. The aim of this study was to evaluate the clinical outcomes and the survivorship of a consecutive series of THA revisions using a taper rectangular cementless stem for primary implants (Alloclassic® Zweymuller®, Zimmer Warsaw US) at medium-term follow-up. We retrospectively evaluated 113 patients (115 revisions) who underwent femoral revision with Zweymuller stem with a preoperative Paprosky I (86) or II (29) defects from January 2011 to December 2020. The mean follow up was 6 years (2–10). The median age at time of surgery was 71(41–93) with 60 males and 53 females. Osteolysis/radiolucency were observed in the following Gruen zones: I (91), II (3), III (2), VII (15), V (3), VI (1). Clinical assessment was performed by means of Harris Hip Score (HHS) and Visual Analogic Scale (VAS), whereas for the radiological analysis we used conventional x-rays of the hips. The statistical analysis was performed using Graphpad Prism v5.0 and data distribution was assessed by Shapiro-Wilk test, and Wilcoxon matched paired test was used to test the differences between preoperative and postoperative score. 9 patients were lost to fu (deceased or not available), 104 (106 hips) were evaluated. The mean HHS and VAS significantly improved at final follow-up, going from 33,84 and 5,78 preoperatively to 66,42 and 2,05 postoperatively, respectively. 28 patients (25%) showed unprogressive radiolucent lines in Gruen zones 1 and 7 with no other radiological nor clinical signs of loosening. One patient suffered from recurrence of the infection. The survivorship with stem revision as endpoint was 100%. Alloclassic Zweymüller primary stem showed good medium-term results and survival rate in revision THA for aseptic loosening and second stages of two stage revisions

Aim of this work is to critically analyze the current mandatory trend to adapt femoral cementless implant shape as to allow their use through mini-invasive anterior hip approach (MIS-AA). During decades, designers of cementless stems tried to adapt implant shapes to patient anatomy, that led to various classification systems (straight, curved, anatomic, etc …). Another way to classify cementless stems is according to their longevity, outcome quality and long-term results. This is the goal of the Orthopaedic Data Evaluation Panel (ODEP) that provided in 2017 an approved list of prostheses that meet at least the NICE 10y revision rate standard. In the last available ODEP 2020 issue, the best rating (13y experience “13”, with strong evidence “A” and < 6.5% rev rate “∗”) was achieved by only 10 cementless implant: Mallory-Head®, Taperloc®, Bimetric®, Accolade®, SL-Alloclassic®, Corail®, CLS Spotorno®, Furlong®, Synergy® & Versys Fibermetal®. All 10 are Ti straight tapers with large metaphyseal morphology in particular in Gruen Zone I. All these 10 ODEP 13A∗ cementless stems can universally be implanted through postero-lateral (PL), MIS-PL, lateral & conventional anterior approaches, but not safely through MIS-AA. Conversely, only new short and curved stems can be inserted safely through MIS-AA. Indeed, surgeons who promote MIS-AA cannot routinely use those successful femoral implants classified ODEP 13A∗. Obviously, surgical approach determines the choice of femoral component. Surgeons who promote MIAA can only bet/hope that these new short curved implants with currently very few clinical evidence will reach the same success and longevity that ODEP 13A∗ conventional straight tapers. Only future long-term studies will address that concern

Introduction. Patients under the age of 50 who undergo a total hip arthroplasty (THA) are at high risk for wear-related complications due to their higher activity level. Previous studies have shown that highly crosslinked polyethylene (HXLPE) is more durable with no evidence of loosening compared to conventional polyethylene due to its improved wear characteristics. Unfortunately, there are few studies with long term follow-up of HXLPE in this patient population. The purpose of this study was to evaluate two questions related to this population of patients undergoing THA. First, what were the clinical outcomes for HXLPE in patients 50 years or younger at an average follow-up of 15 years? Second, was osteolysis observed in any of these hips?. Methods. Between November 1999 and April 2005, 105 THAs were performed for 90 patients 50 years of age or younger (mean, 42 years; range, 20–50 years). The mean body mass index (BMI) was 30 kg/m2 (range, 17–51 kg/m2). The mean follow-up was 15.25 years (range, 12–19 years). Eight patients (two bilateral) were lost to follow-up, which left 82 patients with 95 hips for analysis. HXLPE was the acetabular bearing for all hips. Harris Hip Scores were collected from all patients. Radiographs were obtained on all patients to evaluate for wear and osteolysis. Results. Clinical outcomes show excellent results in 81 hips, good results in ten, fair results in three, and a poor result in one hip using the Harris Hip Score. There have been no revisions, infections, or dislocations in this cohort of patients. Fourteen hips developed radiolucent lines in zone I, II, or III of the acetabulum, but none were circumferential. Two hips developed radiolucent lines in zones I and VII in the femur. None of the hips in our study developed osteolysis. Conclusions. The use of HXLPE in patients under the age of 50 who undergo THA shows excellent clinical and radiographic results at an average of 15 years follow-up

Purpose: With appropriate software, dual energy x-ray absorptiometry (DEXA) provides a means of measuring periprosthetic bone mineral density (BMD) reliably and reproducibly in a single plane. The current method has been improved since the first reports by MacCarthy in 1991. Material and methods: Since 1992, two series of total hip arthroplasty femoral prostheses using a ceramic-polyethylene cup with a TA6V4 stem were implanted with cement (group A 25 SAS crystal anatomic stems, 22.2 head) or without cement (group B, 27 Euroform stems with hydroxyapatite surfacing on the upper 2/5, 28 head). The patients were followed prospectively with DEXA to measure BMD in the seven Gruen zones immediately after surgery, at six and twelve months, then every year to last follow-up. Mean follow-up was 74 months (36–166). A visual analogue scale was used for subjective assessment of pain. The clinical Harris score and radiological findings were also recorded. Results: At last follow-up none of the prostheses had required revision surgery. The Harris score was greater than 90 for both groups (mean 91.4 and 95.4 for groups A and B respectively). Radiologically, there were no progressive lucent lines in the two groups but there were three stable lines (zone V, VII, VII, II) without clinical expression in group A and two (zone II, I) with persistent thigh pain in group B. Two migrations of less than 3 mm were also found in group A and four of more than 3 mm in group B. For the two groups, DEXA showed a diffuse reduction in BMD during the first six months that was statistically significant only for zones I and VII for the Euroform implant and for zone VII for the SAS Crystal implant. There was also a significant difference between the two prostheses for zone I. Modifications were not significant at three years and a last follow-up for the distal regions (II, II, V, VI). For group A (SAS Crystal), the reduction was 5.8% at three years and 5.7% at last follow-up for zone I and 18% at three years and 19% at last follow-up for zone VII. For group B, the reduction was 12.6 at three years and 11.4% at last follow-up for zone I and 17.4% at three years and 21.3% at last follow-up for zone VII. Discussion: The correlations showed that variations in BMD were independent of the initial bone mineral content, patient age or sex, and were not significantly different between the two cemented or non-cemented implants. Patients with painful thighs (two in group A and six in group B) had a different pattern of BMD over time, showing less pronounced reduction in the proximal zones I and VII and marked bone resorption in zones III and V, an expression of different stress transmission. Conclusion: This study provided the longest longitudinal radiological and clinical follow-up reported in the literature which, despite the bias introduced by the different types of implants, shows the reliability and reproducibility of DEXA of periprosthetic bone mineral density used to assess implant tolerance and quality of cementing

Introduction. THA for patient's 50 years and younger is a procedure at high risk for complications and failure because of the high level of activity of this population. Highly cross linked polyethylene (HXLPE) has greatly improved the durability of the implant because of the improved wear characteristics. Few studies have followed this population into the second decade and therefore the purpose of this investigation was to evaluate the clinical outcome for the patients 5o years of age and younger at a minimum of 15 years. The second purpose was to evaluate the radiographic findings secondary to wear or mechanical failure of the implant. Methods. Between October 1999 and December 2005, 105 THAs were performed in 95 patients (53 female, 42 male) age 50 years and younger (mean 42 years; range 20–50). Ten patients (10 hips) were lost to follow-up or deceased. The remaining 95 hips and 85 patients were followed for a minimum of 15 years (mean of 16.8, range 15–20.5) for analysis. HXLPE (Longevity, Zimmer Biomet) was the acetabular bearing for all hips. Radiographs were evaluated for radiolucent lines and osteolysis. Results. Clinical outcomes showed excellent results in 80 hips, good results in 10 hips, fair in 3 hips and poor in 2 hips. One hip was revised for recurrent instability, one patient suffered a DVT and there were no infections. None of the hips were revised for mechanical loosening or osteolysis. Radiolucent lines were present in Zone I of the acetabulum in 23 hips and Zone II in 6 and Zone III 7. Osteolysis was not present in any of the hips. Conclusions. The use of HXLPE in THA for patients 50 years of age and younger has performed exceptionally well without evidence of wear causing mechanical loosening or necessitating revision. Radiographic evidence of osteolysis was not identified, but progressive radiolucent lines of the acetabular component were noted

Introduction Significant cortical bone mass has been demonstrated at the proximo-lateral flare of the femur (. Fetto et al. ). Experiments have shown that if a femoral stem has a medial and lateral flare proximally, the loads are transferred to the proximal femur and stress protection in this area is avoided. Furthermore, the results suggested that a stem below the lesser trochanter was unnecessary (. Walker et al. ). Methodology This paper reports on two cohorts of ten patients that had either a short stemmed fully coated implant (Group I) or an unstemmed metaphyseal implant on which all but the polished tip was coated (Group II). All implants were customised based on pre-operative CT data. All hips had serial post-operative AP and lateral radiographs and bone densitometry was assessed with DEXA scanning. Results The most recent post-operative radiographs of all patients in Group I revealed buttressing in zone IV with trabeculae streaming from the cortices onto the tip of the stem. Qualitatively there appeared to be osteope-nia in Gruen zones I and VII. The x-rays of the Group II patients revealed good condensation of bone along the textured surface in zone I and VII with preservation of bone density in these regions. These findings were confirmed by the DEXA results which showed a reduction of the BMD in zones I and VII in Group I, while Group II revealed preservation of the BMD in these zones. Conclusion A conservative prosthesis without a stem which effectively loads both medial and lateral proximal femoral flares not only removes less bone at the index operation but preserves proximal bone stock in the longer term

Purpose: The purpose of this work was to analyse and compare survival in patients with osteosarcoma (OS) or Ewing sarcoma (EW) of the pelvis as a function of treatment. Material and methods: This retrospective series included 31 patients with OS (n=15) or EW (n=16) of the pelvis who were given a homogeneous therapeutic sequence associating chemotherapy, surgery and/or radiotherapy. Mean follow-up was 37 months (2–144). Mean age was 20 years for EW and 28 years for OS. Localisations in the pelvis were: zone I (n=12), zone I and II (n=4), zone II (n=1), zone II and III (n=7), zone III (n=1), and zone I, II and III (n=6). All patients were given chemotherapy, 15 underwent surgery, and 16 were given radiotherapy alone. Five patients were given complementary radiotherapy after surgery. Actuarial survival curves were compared with the logrank test. Comparison factors were presence of surgical resection, presence of initial or secondary metastasis, tumour response (radiographic measure), and pathology (good or poor responder) after chemotherapy. Results: Five-year survival rate for patients with EW was 53%, 31% for OS. There was no significant difference in survival rates between tumour type. The only factor significantly correlated with lower survival rate was presence of initial metastasis. Discussion and conclusion : The pelvic localisation of osteosarcoma and Ewing sarcoma is a factor of poor prognosis. Unlike data reported in the literature, surgery did not appear to influence outcome, not being found to be a factor of better prognosis. Surgery does however appear to improve short-term survival. In the pelvic localisation, osteosarcoma appears to have a poorer prognosis in terms of survival than Ewing tumour

Introduction. The mid- or long-term results of acetabular revision total hip arthroplasty (THA) in Korea are rare. The purpose of this study is to report the mid-term radiographic results (> 5 years) of acetabular revision THA with porous-coated cementless Trilogy. ®. cup (Zimmer, Warsaw, IN, USA). Materials and Methods. Between 1999 and 2010, 77 patients (79 hips) had underwent acetabular revision THA with Trilogy. ®. cup. Eight patients (8 hips) were excluded due to death before 5-year follow-up, and 22 patients (23 hips) were excluded due to less than 5-year follow-up or follow-up loss. Forty-seven patients (48 hips) were included in our study. The mean age was 57.9 years (range, 36 to 76 years) and the mean follow-up was 9.8 years (range 5.0 to 16.2 years). The causes of revision were aseptic loosening in 40 hips, and septic loosening in 8 hips, respectively. Both acetabular and femoral revisions were performed in 14 hips and isolated acetabular revision was done in 34 hips. Preoperetive acetabular bone defect according to Paprosky classification was; 1 in type I, 6 in IIA, 11 in IIB, 9 in IIC, 15 in IIIA, and 6 in IIIB. Results. Radiolucent lines less than 2mm were found in 2 hips; one in zone I, another in zone I, II, III. Four hips (1 in type IIC, 1 in IIIA and 2 in IIIB) showed cup migration greater than 5 mm accompanying change of position greater than 5 degrees. However, these patients did not complain pain and showed fixation by secondary stabilization. The Kaplan-Meier survivorship with aseptic loosening as the end point at 10 years was 92.6% (95% confidence interval [CI], 82.6 – 100) and at 15 years was 83.8 % (95% CI, 69.1 – 98.6), respectively. Non-recurrent dislocations occurred in 4 hips. There were no other complication such as sciatic nerve palsy, infection and deep vein thrombosis. Conclusion. Mid-term radiographic results (>5 years) of acetabular revision THA with porous-coated cementless Trilogy. ®. cup showed durable longevity. However, other options such as anti-protrusio cage or cup-cage construct should be considered in severe acetabular bone defect

Purpose: Surgery is the mainstay treatment for chondro-sarcoma. About 35–40% of these tumours are located in the pelvis. Treatment requires significant sacrifices to ensure acceptable survival. Material and methods: This retrospective analysis of ten patients treated between 1993 and 2001 for pelvic chon-drosaromas was undertaken to examine survival and functional sequelae as a function of treatment and tumour grade. All patients had primary chondrosarcoma. The population included seven men and three women, mean age 50.9 years (range 28–77). Mean survival was 39.7 months. A biopsy was obtained in all cases (seven under scan guidance). Six patients required complementary surgical biopsy. According to the O’Neel and Ackermann classification, the tumours were grade I in five patients, grade II in two, grade III in three. Tumour classification according to the Enneking topography was: zone I one patient, zone I and II one patient, zone I+II+III one patient, zone II three patients, zone II+III three patients, and zone III one patient. Careful search for extension failed to identify metastasis preoperatively in any patient. For six patients, tumour resection was performed without reconstruction. Resection was associated with a Pugent reconstruction in three patients. All patients were reviewed with an AP view of the pelvis and a chest x-ray. Results: In sano resection was achieved in eight out of nine patients. For the ninth patient, resection was marginal according to the pathology report. Postoperative survival revealed the presence of metastasis in three patients. One patient developed recurrent tumour. At last follow-up, two patients had died and one had multiple metastases. Seven are currently disease free. Early postoperative complications occurred in 80% of the patients. Discussion: Currently, surgery remains the treatment of choice for pelvic chondrosarcoma, despite the major perioperative morbidity. Reconstruction, if attempted must always respect the rules of carcinological resection. Reconstruction does not appear to be mandatory since the rate of secondary and late complications remains particularly high in the case of extensive reconstruction. Histological grade, tumour size and quality of surgical resection are the predominant prognostic factors

Purpose: The authors would like to report a technical innovation in cemented hip arthroplasty. The new device, a “rim cutter” (patent pending) was designed in Exeter and aims at improving the surgical technique of insertion of cemented sockets. The principle aim of this innovation is to cut a rim around the periphery of the acetabulum to a set depth so that the flange of the socket seats into this rim and thus by sealing the space underneath the flange, there is a sustained rise in cement injection pressure behind the socket during implantation. This, improves cement macro and micro interlock, creates a congruent cement mantle with no radioluciencies, especially in the highly predictive DeLee-Charnley Zone I. Materials and methods: A retrospective clinical study was performed in order to assess the radiological result of the use of the rim cutter. Two groups of patients with 30 in each group (consecutive cases) were enrolled in the present study. In group A, the rim cutter device was used while in group B, the acetabulum was prepared without the use of the rim cutter. In all cases an Exeter contemporary cup and stem were used. All cases were evaluated with postoperative radiographs which were analysed to record the anatomic measurements with regard to:. i) centre of rotation of the socket (COR),. ii) height of the centre of rotation from the teardrop,. iii) lateralisation of the centre of rotation from the teardrop, and iv) the width of the cement mantle in the three acetabular zones. These values were compared with the equivalent measurements made for a normal contralateral hip. In addition to these measurements, any radiolucent line in any zone was recorded. The post-operative film was templated using Orthoview (TM, Southampton, Hampshire) software, which is a digital X ray templating system. Results: The group where the rim cutter was used showed significantly improved radiological parameters. In this group (group A) the socket was placed closer to the normal centre of rotation (COR) compared to the other group (group B) where the rim cutter was not used. This difference was statistically significant (p< 0.0001). Two cases in the non rim cutter group showed radioluciencies in Zone I. Similarly, with regard to the lateralisation of the COR, the implants in the rim cutter group were closer to the COR of the contralateral normal hip The cement mantle was found to be more concentric in the rim cutter group (in group A, more patients had the same width of cement mantle in all Zones) than the non rim cutter group. This difference between the two groups was statistically significant (p< 0.0001). Conclusions: The introduction of the new “rim cutter” represents a progression in the technique for the preparation of the acetabulum in cemented hip arthroplasty. It indicates a further step, following the introduction of flanged sockets

Introduction and Objectives: At present, cementless cups offer a reliable alternative for survival of total hip prostheses (THP). This study analyzes the clinical and radiographic results obtained using the Balgrist conical stem cup in patients with an average follow-up time of 10 years. Materials and Methods: This is a study of 100 cement-less THP (Balgrist cups, SL stems) implanted between June 1991 and February 1995 in 93 patients (7 bilateral). Patients were 55% male and 45% female, with an average age of 58.5 years (20–74). Diagnoses were 72% coxarthrosis, 13% avascular necrosis, 5% fractures, 4% rheumatism, 2% Perthes disease, 2% dysplasia, and 2% post-infection sequelae. Two deaths occurred during the follow-up period (unrelated to THP). No cases were lost. Average follow-up time was 10 years (range: 8–12 years). Clinical evaluation was done using the Merle D’Aubigné scale as modified by Kramer and Maichl, to numerically evaluate degree of pain and walking capacity. Radiographic evaluation included determining radiolucent lines, sclerosis, osteolysis in the Lee and Chanley zones, stem subsidence, heterotopic ossification, and deterioration of polyethylene. Survival analysis was done according to Kaplan-Meier at 10 years using prosthetic revision as the endpoint. Results: Clinical evaluation based on the modified Merle D’Aubigné scale was as follows: 81% very good results, 2% good, 3% satisfactory, 2% fair, and 11% poor (this last group included revision THP). Radiographic evaluation showed Zone I sclerotic lines in 4%, zone II lines in 1%, and zone I radiolucency in 2%. These lines did not correlate with cup migration. There were 28% of patients with heterotopic ossification, 3 cases with poly-ethylene deterioration, and 4 cases with migration. Survival analysis revealed 7 revisions: 4 of the cup, one due to pain from malpositioning (vertical cup), 2 for ring breakage and pain, one for ring breakage without pain, 2 THP due to septic loosening (Staphylococcus epider-midis), and one stem head revision. All of this resulted in 10–year survival rates of 92% (0.92 +/− 0.06; p< 0.05) for THP and 93% (0.93 +/−0.06; p< 0.05) for the Balgrist cup. Discussion and Conclusions: Compared with other cementless cups, the Balgrist cup has a high survival rate. Both clinical and radiographic results obtained in this study are similar to other studies published on the use of this same type of cup

Introduction:. Jumbo cups (58 mm or larger diameter in females and 62 mm or larger diameter in males), theoretically have lowered the percentage of bleeding bone that is required for osseointegration in severe acetabular defects. The purpose of this study was to analyze the safety and efficacy of Tritanium jumbo cups in patients with major acetabular defects (Paprosky type IIIa and IIIb) and assess the extent of osseointegration. Material and Methods:. From February 2007 and August 2010, 28 consecutive hips (26 patients, mean age of 69 years) underwent acetabular revision arthroplasty for treatment of Paprosky type IIIa and IIIb defects using Tritanium jumbo cups (Stryker, Mahwah, New Jersey). Results:. 14% of the hips had pelvic discontinuity. There was no intra-operative fracture. The initial stability was achieved in all hips, supplemented by screws. No Tantalum augments or bulk bone grafts were used in any of the cases. At mean follow-up of 4 years, there were no failures due to loosening or cup migration. Radiographic assessment showed osseointegration in all cups, ranging from 30% to 75% of the cup surface area as assessed in both anteroposterior and false profile views in Charnley zones I through VI. Discussion and conclusion:. In Paprosky type IIIb defect with pelvic discontinuity, jumbo cup can be used safely without the use of any augments. In pelvic dissociation, the fibrous tissue is stretched with jumbo cups in an under-reamed socket to achieve a fixation by distraction, especially in failed cemented sockets

Aims

To systematically review qualitative studies of patients with distal tibia or ankle fracture, and explore their experience of injury and recovery.

We reviewed 81 consecutive ABG primary total hip replacements in 72 patients operated between January 1993 to December 1998. The mean follow-up was 8.2 years (7 to 12 years). The mean age of the patients was 52 years (range: 28 to 65 years). The mean pre-operative Harris hip score of 42 (range: 24 to 48) improved to a post-operative 80 (range: 58 to 86). At the latest follow-up 2 patients had died through causes not related to surgery. 3 cups had been revised for aseptic loosening. However, 69 of the remaining 75 acetabular cups showed excessive superolateral wear of polyethylene liner. The wear was most pronounced in cups size 46 with a 28 mm head. 16 of the acetabular cups showed significant osteolysis in zone I and II of the acetabulum (Gruen) and are awaiting a revision. None of the stems has been revised to date. The cumulative survival of prosthesis is as follows:. Stem survival with revision being the end point: 100%. Acetabular cups with revision & aseptic loosening: 72% (95% CI: 61 to 78%). Acetabular liner with significant wear: 32% (95% CI: 28 to 52%). The failure of cups is related to the poor locking mechanism of the polyethylene liner. In spite of significant radiological failures of the cups most patients continued to have good Harris hip scores and remained fairly asymptomatic. The results of ABG stem in this series are good but in view of the cup failures we now no longer use the ABG I cups but advocate a long term regular follow-up of these hips

Background: There area some controversies about the need for revision of well fixed femoral stem during the revision total hip arthroplasty. The purpose of this study is to evaluate the state of unretrieved femoral stem, in revision total hip arthroplasty where only acetabular component was revised. Methods: From January 1998 to December 2004, thirty-one patients underwent revision total hip arthroplasty whose well fixed femoral stem was retained and acetabular components revised. Twenty-six patients(29hips) with a minimum follow-up of three years were included in this study. Out of those twenty-six patients, sixteen patients(18hips) were male and ten patients(11hips) were female with an average age of 54.3 years for the study group. The average time from the primary operation until the revision surgery was 9.2 years and the average follow-up period after the revision was 5 years. The femoral head component was exchanged in all cases and same size femoral head component was used in eleven hips. The clinical results wee analyzed using Harris Hip Score, and the radiographs were reviewed for stability of acetabular components, femoral stem, and degree of osteolysis and radiolucent lines. Results: The average Harris Hip score improved from 56.3 points preoperatively to 89.8 points postoperatively. Femoral stems were found to be stable in all hips. Sixteen hips(55.2%) showed evidence of osteolysis and seven hips(24.1%) showed non-progressive radiolucent lines. The osteolysis was detected at Gruen Zone I and VII in most of the affected hips except for two hips which showed distal osteolysis. The average life of femoral stem from primary operation until the final follow up varied from 10.8 years to 18.2 years, with the average being 14.2 years. Conclusions: We recommended that well fixed, stable femoral components can be retained at the time of revision total hip arthroplasty. Level of evidence: Therapeutic Level IV

Purpose. This study analyzed the long-term results of cementless total hip arthroplasty using an extensively porous coated stem in patients younger than 45 years old. Materials and Methods. The clinical and radiographic results of 45 hips from 38 patients who underwent cementless total hip replacement arthroplasty with an AML prosthesis were reviewed retrospectively. The average follow-up was 12 years (range, 10–15 years). Result. The average Harris hip score was 87.3 (range77-94) points at the final follow-up. Hip scores at the last follow-up were; excellent in 32 out of 45 hips(71.1%), good in 10 (22.2%) hips and fair in 3(6.7%) hips. The prevalence of thigh pain was initially 15.6%(7 hips) and the pain in all hips disappeared 3 years after surgery. Thirty-eight (84.4%) stems had good canal fill; 37 hips of these showed bone ingrowth and one hip had stable fibrous ingrowth. Seven (15.6%) hips had a poor canal fill. Four of these showed bone ingrowth, and 3 hips showed stable fibrous ingrowth. There was no unstable stem. Osteolysis was observed around the stem in 20 hips(44.4%) and around the cup in 26 hips(57.8%). Most of the osteolysis in the femoral side was in zones I and VII. Stress-mediated femoral resorption was observed in 30 hips at 3 years after surgery, 32 hips at 5 years after surgery and 33 hips (73.3%) at 10 years after surgery: first degree in 15 hips(33.3%), second degree in 11 hips (24.4%) and third degree in 7 hips(15.6%), respectively. The demographic data (age, weight and stem size) of the 35 hips showing evidence of stress shielding were compared with the group not showing stress shielding. There was no apparent difference between the two groups. The resorption did not progress to the third degree from either the first or second degree after 5 years postoperatively. There was no stem loosening. Four hips were revised. One hip was revised at 5 years after surgery because of an unstable fixation of the acetabular component. Three hips were revised due to osteolysis around the cup and excessive polyethylene wear; posteoperative 10 years in two hips and 11 years in one hip. Conclusion. The long term results of total hip arthroplasty using an extensively porous coated stem were acceptable, and there was no case involving the progression of proximal bone resorption

Introduction and Objectives: The goal of cementless endoprosthetic hip surgery is to improve bone attachment. The gold standard method for evaluating periprosthetic bone characteristics is densitometry. This study was designed to compare periprosthetic bone mass in 2 groups of patients: less than 3 years and more than 3 years after implantation. Materials and Methods: A total of 195 type ABG-II total hip prostheses were implanted from November 1997 to March 2003. This implant is a hemispheric cup coated with hydroxyapatite, which can additionally be anchored with screws and a short anatomic stem with metaphyseal fixation. DeLee and Gruen zones were analysed. Results: During the study period, patients with implants less than 3 years old showed no significant changes in bone mineral density around the stem or the cup. In area 7, a statistically significant reduction was noted after 3 years (0.5218g/cm3, p< 0.001). In Gruen’s zones 3 and 4 a non-significant gain was observed after 3 years (1.1618g/cm3). Discussion and Conclusions: In cup studies, a statistically insignificant increase in density was observed in zone I after 3 years. Noteworthy findings included a loss of function in DeLee zone III and Gruen zones 1 and 7, which has not yet had clinical consequences (at a maximum 6 year follow-up time)

Aim: To evaluate the clinical and radiological results of hydroxyapatite stem in primary total hip replacement. Method: A prospective review was performed on 22 osteoporotic patients (Singh index 1–3) with hydroxyapatite-coated total hip replacements. These results were compared with a control group (Singh index 4–6) of 45 patients (48 hips) with respect to clinical and radiographic data. Surgery was performed over a six year period (1991–1996) and the time to follow-up evaluation averaged 5 years (range 2–7 years). Clinical evaluation was based on the Harris Hip score and radiographic evaluations using Engh’s criteria. Results: There was no significant difference between the final average Harris hip score in the osteoporotic bone group which was 87 points and that for the control group which was 91 points (p> 0.05). Radiographic evaluation demonstrated confirmed bone ingrowths in all patients except for one patient in each group, each with suspected bone ingrowth. There were no stems revised for aseptic loosening and no endosteal lysis was found. Progressive bone formation was seen around the femoral stem proximally. The acetabular components demonstrated no sign of mechanical loosening or osteolysis. Bone formation was found in most patients in zone I, and less in zone III. Conclusion: The basis of the results of this study, it is believed that osteoporotic bone as a factor by itself should not compromise the early results of hydroxyapatite total hip arthroplasty and hopefully give as good results n the long term