INTRODUCTION: Osteonecrosis of the femoral head usually affects young patients and is caused by disturbance of the femoral head’s blood supply. Bone subchondral necrosis eventually leads to articular incongruity and secondary arthritis of the hip joint.

AIM: To study the adequacy and outcome of tantalum rods implantation in patients with avascular necrosis of the femoral head (up to grade III, according to Ficat’s classification)

PATIENTS AND METHOD: 25 patients with 30 affected hips (5 with bilateral lesions) have been treated, the last 5 years, by tantalum rod implantation. The mean age was 37 years and the mean time of follow up 20 months (6–48), for 24 patients. In four hips we had type III lesions and in the rest type II.

RESULTS: The postoperative evaluation included radiological and clinical (Harris Hip Score – HHS) examination. All patients with type II osteonecrosis had a statistically significant increased HHS score, 6 months and 1 year after tantalum implanting. One patient, with a type III lesion, was subjected in total hip replacement because of disease’s progression, 1 year later. The two others had serious pain relief and improved range of hip motion.

DISCUSSION: Implantation of tantalum rods can be a method of choice in treatment of early stages of AVN of the femoral head. The implant achieves decompression, supports the subchondral plate of the necrotic areas and probably induces bone re-generation. Studies in more patients and with extended follow up time will be helpful for method’s evaluation.

Purpose: The purpose of this prospective investigation is to determine if soft tissue and intra-articular local anaesthetic injection with bupivacaine and adrenaline have beneficial post-operative effects in patients who had total knee replacement (TKR) for osteoarthritis.

Material and Methods: 97 patients were divided randomly into 2 groups. The mean age was 74.7 years. In control group I there were 17 men and 33 women with a mean age of 73.5 years, in group II 16 men and 31 women of mean age of 74.9 years. The patients who were allocated to control group I (n =50) had no intraarticular treatment. We used general anaesthesia in all these patients. The study group II of 47 patients had received intraoperative injection of 0.25% bupivacaine(8ml) with epinephrine (1ml – 1mg) with 2/3 injected into the soft tissues and 1/3 injected into the joint. Clinical parameters evaluated included pain, blood use and bleeding index (calculated by preoperative haemoglobin minus postoperative hemoglobin plus the number of units of packed red blood cells transfused) and range of motion (ROM) at discharge.

Results: Flexion at discharge was improved from 70 (60–90)° in the control group to 90 (80–120)° in study group II (p = 0.005), the difference between the two groups receiving different amounts of analgesics were statistically significant. Number of days until 90 degrees of flexion and until discharge was reduced in group II compared with the control group I (p = 0.003 and 0.002). Also and the blood loss decreased.

Conclusion: This simple method is effective in improving all the postoperative course of primary TKR and should be considered as a part of a perioperative patient treatment program.