We present a case of osteolytic lesion in Gruen Zone 2, 3 in a six-month post-operative cemented THR initially diagnosed as early loosening-?Septic. Investigations and biopsy revealed metastatic renal cell carcinoma.

A 79 year old gentleman had a Left cemented THR and was symptom free post-operative. Six months later he had pain in the left groin and thigh. Examination revealed painless hip movements. X-ray showed lytic area in zone 2 and 3. ESR -90 mm and CRP – 50 mg/dl. Hip aspiration excluded sepsis. Bone scan showed increased uptake of left femoral shaft, right scapula and L1 vertebra. Bone chemistry, renal & liver Assay and tumour markers were normal.

Open biopsy showed erosion of lateral cortex, with friable soft tissue mass with profuse bleeding. Histopathological report showed classical clear cell renal cell carcinoma. CT abdomen and chest revealed multiple nodules in lung fields, multiple nodules in liver, mass in both kidneys consistent with Renal cell carcinoma, multiple skeletal lytic lesions.

Patient was referred to oncologist for palliative treatment

DISCUSSION: In case of osteolytic erosive lesions at cement bone interface, the possibility of metastatic lesions should be considered.

In old age groups Biopsy is recommended to exclude malignancy after exclusion of septic and aseptic loosening and abdominal ultrasound to exclude primaries.

Aim of the study: To assess the results of the uncemented oblong shaped Bofor cup in acetabular revision.

Methods & materials: A prospective study from January 2001 to July 2006.15 cases of acetabular revision in 14 patients is studied. Paprosky classification for the acetabular defects is used. Final outcome assessed clinically and radiologically. Both Harris hip and Oxford hip functional scoring is used to assess the patients. None of the cases are lost in follow up.

Results: The average follow-up was 36 months (range 8–52 months). All the cases were of aseptic loosening. 1case of type 2a, 6 cases of type 2b, 5 cases of type 2c, 3cases of type 3 defect and 4 cases with medial wall defect were noted. Stem was revised in 8 cases.

In 4 cases auto graft from iliac crest was used. allograft was not used in any cases. In 12 cases 15 degree hooded insert was used. Average HHS improved from 30 points (range 20–38) to 84 points (range 70–90). Average OHS improved from 24 points (range 18–40) to 82 points (range 74–92). There were no cases of dislocation& infection.1 patient had sciatic nerve neuropraxia.1 case of severe Ankylosing spondylitis failed which was revised.

Conclusion: Assemytical shape and design of the Boforcup makes it an useful cup for segmental and cavitatory acetabular defects. Pre operative classification of acetabular defects is inconsistent and unreliable. Allograft usage is not essential for these defects.

We reviewed 35 patients who underwent a medial unicondylar knee replacement, with an average follow up of 4 years (for functional assessment). All patents had a weight bearing AP and lateral X rays and were clinically assessed using Hospital for Special surgery score, Bristol Knee Score and SF 36 health assessment form. Five angles were measured on the x-rays to assess the alignment of the tibial and femoral alignment. There was a significant relation between the femoral component varus/valgus angle and three sub scores (fixed flexion contracture, maximum valgus/varus and range of movement) in Bristol Knee scores. The best functional out come correlated with femoral components of 4–8 degrees of valgus.

We report 10 cases of supracondylar periprotheitc fractures following TKR; all were treated using a retrograde intramedualry nailing. There were 7 females and 3 males, the mean age at surgery was 76 years (range from 68–85). The average time since the primary TKR to surgery was 5.3 years (range 2–9.4). All patients had locked intramedualry nail, and knee was immobilized in a splint for few months post op. Partial weight bearing was started 2 weeks post op. There was no intraoperative complication. One patient had superficial infection, which was treated by IV antibiotics. There was no cases of septic arthritis.

One patient was lost for follow up and one patient died from myocardial infarction 8 months post op.

Eight patients were reviewed and assessed clinically and radiologicaly. The average range of movement in the knee was 97 (range 75–110) and all patient achieved clinical and radiological healing.

To ascertain the effect of the site and number of loose bodies on the functional outcome of Outerbridge-Kashiwagi (O-K) procedure in management of osteoarthritis of the elbow.

12 patients were reviewed after having O-K procedure, and assessed using Mayo Elbow Performance score, and radiographs assessed using Derby Elbow Osteoarthritis Radiography score.

There were 10 male and 2 female patients with mean age of 47 years. The mean follow up was 24 months. In 8 (66%) patients the diagnosis was primary osteoarthritis, and 4 (34%) had post-traumatic arthritis. Nine (75%) patients had osteoarthritis of the dominant elbow, and three were non-dominant. Nine patients had locking and catching symptoms. 7 patients had < 2 loose bodies, and 5 had > 2 loose bodies. 7 had anterior loose bodies alone and 5 had both anterior and posterior loose bodies.

The Mayo Elbow Performance score improved from a mean preoperative value of 51 to 85 points postoperatively (p< 0.0001). There were 3 excellent, 7 good, 2 fair, and no poor results. Visual analogue pain score improved from a mean of 7.4 to 2.6 postoperatively (p< 0.001). The Derby Elbow Osteoarthritis Radiography score improved from preoperative mean of 6.5 to 5.3 postoperatively (p< 0.013). There was no significant difference between functional outcome of primary osteoarthritis and post-traumatic arthritis (p> 0.42). Number of loose bodies had no significance on the functional outcome (p> 0.39), neither did the site of the loose bodies (p> 0.44). There was no significant difference of the number of loose bodies on the overall total score of Derby Osteoarthritis Elbow Score (p> 0.2). In two patients revision had to be undertaken due to persistent locking that improved postoperatively.

The number and site of loose bodies, the type of osteoarthritis and the duration of symptoms have no significant prognostic value in predicting functional outcome