The aim of the study was to compare mortalitiy and complication rate after operative treatment of pertrochanteric fractures with primary cemented arthroplasty, dynamic hip screw (DHS) or proximal femoral nail (PFN).

283 patients, which were treated betwen 1992 and 2005 for pertrochanteric femoral fractures, except pathologic fractures and a minimum age of sixty years were included. 132 of these 283 patients were treated by primary arthroplasty.

Up to the end of 1999 all unstable fractures were treated by primary total hip replacement. In the year 2000 the PFN was introduced and only patients with severe osteoarthritis and osteoporosis received primary arthroplasty. I possible, more stable fractures were treated with a DHS.

One year mortality was chosen as main indicator as it depends on the surgical trauma as well as the rapid return to preinjury activity and further complications. A one year period was chosen as the mortality ratio approaches that of an age matched reference population after this interval. Influencing cofactors were eliminated by stepwise logistic regression analysis.

It was shown that restoration of the preoperative ambulatory level correlated with survival rate after one year. As elderly patients are often unable to cooperate with partial weight bearing, the primary stability of the device is crucial to allow early mobilisation

Mortality was significantly influenced by age, gender and comorbidities but not by fracture classification. One-year mortality was significantly higher for primary total hip replacement (34.2 %) than for internal fixation (DHS: 18.4 %; PFN 21.4 %) and hemiarthroplasty (13.3 %). Since the PFN and hemiarthroplasty were introduced the over all mortality was reduced from 29 % to 18 %.

Conclusion: For stable fractures a Dynamic Hip Screw (DHS) and for unstable fractures a short proximal femoral nail (PFN) can be recommended. Primary cemented hemiarthroplasty is a viable option for treatment of intertrochanteric fractures if osteoporosis prevents from full weight bearing or if osteoarthritis makes further operations likely. Primary total hip replacement should be avoided, due to the fact that dislocation and mortality were significantly higher than in the other groups.

Background: The long-term results for uncemented hip arthroplasty have not yet been sufficiently documented for a period of more than 15 years.

Methods: A clinical, phone, and radiological check-up with a mean follow-up of 15 (15–17) years analyzes the clinical results, the rate of aseptic loosening, the survival rate of the prosthesis, and the necessary re-interventions for a group of 320 consecutive total hip surgeries using Zweymüller screw cups and Zweymüller-SL stems in 303 patients from the years 1988 and 1989. The surgery was performed on 183 hips in women and 137 hips in men; 17 patients were operated on both sides. The mean age at the time of operation was 67 (29–99) years. All patients were permitted to put full stress on the leg immediately after the operation, and the prosthesis system was used as universal implant, no matter what the bone quality and the patient’s age. 164 (51.3%) of the hip patients had died at the time of the follow-up examination. Clinical and radiological examinations were available for 97 (30.3%) of the hips, phone interviews and radiological examinations for 4 (1.3%) of the hips, and phone follow-ups for only 49 (15.3%) of the hips. 6 (1.9%) of the hips were assessed as lost to follow-up.

Results: The Harris hip score results in a mean value of 88. The rate of aseptic loosening is 2% for the acetabular component and 1% for the femoral component. The stem and the cup had a survival rate of 98% in the surviving patients each. In 97.8% of the implanted prostheses, no exchange of a prosthesis component became necessary; in 95.2% of the patients, no operative revision of any kind was required.

Conclusions: With the Zweymüller hip endoprosthesis, excellent long-term results can be achieved both from a clinical perspective and regarding the rate of aseptic loosening and the survival rate. The system can be fully stressed immediately after the operation; age and poor bone quality are not contraindications for an implantation.

Introduction: With the advent of thoracoscopy, anterior release procedures in adolescent idiopathic scoliosis (AIS) have come into more frequent use, however, the indication criteria for an anterior release in thoracic AIS are still controversial in the literature. The aim is to achieve a better coronal correction but the benefit as compared to a single posterior approach is not yet clarified.

Material and Methods: Two groups of 15 patients each were matched for sex, age and cobb angle. Patients of group 1 were operated with a staged procedure of an anterior release followed by posterior instrumentation (anterior-posterior spinal fusion, APSF) and patients of group 2 were operated by a single posterior spinal fusion (PSF) with performance of concave sided rib osteotomies (concave thoracoplasty, CTP).

Results: Mean age: 16.2 y (APSF), 17.6 y (PSF). Mean preop curve: 81.7° ± 10.1° (APSF), 84.2° ± 14.1° (PSF). Mean postop curve: 34.9° ± 15.5° (APSF), 34.3° ± 12.2° (PSF) (p=0,49).

Conclusion: The single posterior approach gave the same coronal correction rate as compared to patients operated with a two stage procedure with preceding anterior release. A posterior release with CTP is more effective in increasing spinal flexibility than disc excision. According to our clinical experience, an anterior release prior to posterior instrumentation in AIS should only be considered in hyperkyphosis, coronal imbalance or massive curves.