Introduction and purpose: The purpose of the study is to look at the progress of fixed implants with osteolysis and bone defects treated and to set ground rules for treatment guidelines.

Materials and methods: We reviewed 204 hips between March 1996 and March 2003, in 40 of which femoral osteolysis was treated with fixed prostheses.

The reasons for the revisions were 20 aseptic cup loosenings and 20 cases of worn polyethylene, with presence of femoral osteolysis. Thirty of the stems were biological, nine mini-madreporic and one cemented.

The mean follow-up was 5 years and 2 months.

We used morsellised impacted bone graft held in place with cement, metal laminas or bone stock.

Results: Clinically the outcome was excellent or good in 92.5% of the cases, with no migration or revision of the stem.

All the grafts took. There was very limited partial resorption in 20% of the cases and radiolucent lines in 20.6%.

Among the complications were two new cases of wear with osteolysis and a fractured femur caused by a fall, with no infection or dislocation.

Conclusions: Femoral osteolysis must be watched and treated surgically if it progresses, even though the implant is fixed.

Impacted morsellised bone grafts in the femoral canal with a fixed stem, even with extensive, unchecked osteolysis, held in place with metal cages are a reliable means of recovering bone stock and holding the femoral component firmly in place for the long term, with good clinical and radiological outcome, minimal risk and shorter surgery.

Introduction and purpose: The ARC-2F cup used in this study is made of a rough titanium alloy with HA coating. It is a hemispherical cup fixed by means of a thread and screws. The study analyzes the cup’s long term clinical and radiological performance.

Materials and methods: 51 cups were studied in 49 patients. Mean follow-up was 9 years and 10 months (min. 7– max. 13). The patients’ mean age was 62.2 years, 27 were female and 22 were male. The preop diagnosis was: cup movement in 25 uncemented cups and 16 cemented ones; 8 cups with partial protrusions and 2 infections. 19.6% had segmentary bone defects, 37.3% had cavitary bone defects and 43.1% had a combination of the two, according to the AAOS classification. An autologous graft (either freeze-dried or of bank origin) was used in 72.5% of cases. Use was made of the Johnston et al. clinical and radiological protocol and of Merle D’Aubigne’s score.

Results: 76.5% of patients had no pain, 60.8% of results were excellent, 29.4% good, 7.8% fair and 2% poor. A total of 50 cups were osseointegrated; there had been two migrations in the first three months and 1 cup had moved, but no cups had to be re-revised. The number of radiolucent lines was maximal in the V zone (5.9%) – this includes the displaced cup. As regards complications, there were three dislocations and 5.9% of patients presented with pelvic osteolysis.

Conclusions: Use of the ARC-2F cup leads to excellent results in revision surgery since it is conducive to good primary fixation and a degree of osseointegration with is not lost in the long-term.