Twenty-Six total hip arthroplasties were performed in Crowe grade 3 or 4 hip dysplasia using subtrochanteric shortening osteotomy with 2-kinds of femoral stem(Primary monoblock and modular femoral stem). The average age was 46.2 years, and the average follow-up was 4.1 years. Acetabular reconstruction with structural autograft was used in 13 hips. Radiologically, hip centers were nearly normalized by vertical height of 10.6mm elevation and horizontal lengths of 1.7mm compared with uninvolved sites. Three of four osteotomy nonunions were managed with bone graft and other one wating for surgery. One acetabular revision was performed for migration. One postoperative dislocation was managed successfully with closed reduction and abduction brace. One patient (> 7cm) showed postoperative neurologic complications was noted. Harris hip score was improved from 35.6 to 81.7. A cementless modular distal fluted femoral stem is a useful device in these patients.

There was used cement in first generation total ankle arthroplasty, but first generation of ankle arthroplasty was abandoned because of aseptic loosening of component. For the treatment of aseptic loosening of ankle arthroplasty, there had been many methods. One of methods of revisional ankle arthroplasty is the ankle arthodesis. The authors report a case of revisional ankle arthroplasty using allograft with hybrid external fixation.

45 year old male had surgery of cemented total ankle arthroplasty on his right ankle 20 years ago. He went to our clinics because of motionless and pain of his right ankle. He got the mild pain on his right ankle after 5 years surgery. His pain was managed by oral NSAIDS for 15 years. The pain was aggravated recently. There were osteophytes on posterior aspect of ankle joint and radiolucency around the implant, subtalar arthrosis at the radiograph. There was also sclerosis around the ankle joint.

The authors decided revisional surgery. At the operative findings, we can see the loosening of talar and tibial component and large posterior osteophyte bridging between remained talus and tibial bone. There were no infection signs. After remove the implant, there was big space remained. For the regaining the limb length, we used femoral head allograft. The graft was fixed with 6.5 mm cannulated screws and addition fixed with ilizarov external fixation. Also additional auto bone graft from the osteophytes was applied. Compression over the ilizarov external fixation was done at the end of the operation. Weight bearing was allowed immediate after surgery. Ilizarov ring was removed 6 weeks after surgery. At the 3 months after surgery, bony union was obtained on radiographs.

AOFAS score was improved from 30 to 70 6 mo after surgery. There was no pain on his right ankle. Patient satisfied with arthrodesis with allograft at final follow-up.

The purpose of this study is to compare the two prosthesis which were used for total ankle arthroplasty. From Sept. 2003 to Jun 2007, 13 patients and 14 ankles that could be follow up more than 2 years. Semiconstrained type (Group I, 7cases) and Unconstrained type (Group II, 7cases) were used for total ankle arthroplasty. Mean age was 63.2 year-old, 12 ankles are men and 2 ankles were women. Mean follow up periods were 31.1 months. The criteria to compare the clinical result were postoperative range of motion (ROM), AOFAS foot score and residual bone stock of medial malleolus.

Postoperative ROM of group I was 37.5±7.1 degree and of group II was 51.4±8.9. Postoperative AOFAS score of group I was 76.1±13.8 and of group II was 86.0±5.7. Residual bone stock in medial malleolus of group I was 6.1mm±0.7 and of group II was 11.5mm±0.9. Total number of complication in our study was 9 cases. 3 cases were a malleolar fracture, two occurred at intra-operation, the other at follow-up period. Re-operation was done in 6 cases, 3 cases were calcaneal corrective osteotomy, 2 cases were resection of a heterotopic bone and one case was pedicular flap operation for skin problem.

In our hospital, mobile bearing type prosthesis showed good result than a semiconstrained type in respect of ROM improvement and of residual bone stock in medial malleolus. AOFAS score between two groups showed no definite difference. But small number of patients and short term follow up period is a defect in our study, afterward more population and long term follow up period are needed.