The purpose of this paper was to assess the incidence of pelvic osteolysis following the use of a one piece all polyethylene titanium plasma spray backed acetabular component a mean of 9.6 years following implantation.

The radiographs of 86 hips followed for a mean of 9.6 years were reviewed. All had primary total hips using a titanium plasma spray backed all polyethylene uncemented acetabular component. Radiographs were assessed for osteolysis in the three zones described by DeLee and Charnley.

There was no osteolysis seen in any cup in any of the zones. There were no loose cups and no obvious cup migration.

This acetabular component shows superior performance compared with all two piece cups in terms of the development of periacetabular osteolysis. The use of two piece cups should be reconsidered.

The management of periprosthetic femoral fractures associated with a total hip arthroplasty remains controversial. The 2003 AAOS Instructional Course Lecture states “Regardless of the method of fixation, the fracture site should be bone grafted with morcellised allograft.” We do not believe bone grafting is necessary to obtain union .

Forty six periprosthetic femoral fractures associated with a total hip were reviewed retrospectively. Follow up included chart and radiographic review, Oxford Hip Score, and SF-12. All fractures were classified acording to the Vancouver classification.

There were 31 type B fractures and 15 type C fractures. All fractures healed. The mean healing time was 15 weeks. No allograft was used. The mean Oxford Hip Score was 26, and the SF-12 33. There were a number of complications, primarily dislocation in the more severe fractures.

The results of this series indicate that bone graft is not necessary to obtain union in periprosthetic femoral fractures. The use of allograft is associated with possible disease and infection transmission and increased cost, risks that we do not believe are justified.

Forty six periprosthetic femoral fractures adjacent to a hip prosthesis have been retrospectively reviewed. Follow up included chart and radiograph review, Oxford Hip Score and SF-12 Global Function Score. Fractures were treated with internal fixation or revision arthroplasty without the use of allograft.

All the fractures united and functional outcome was good. The mean Oxford Hip Score was 26 and the SF-12 was 33. Complications were related to the severity of the fracture according to the Vancouver classification.

These results and a review of the literature support the ongoing management of periprosthetic femoral fractures without allograft.

This prospective study was designed to audit the introduction of this new technique for the treatment of club-feet in New Zealand. Although well proven in Iowa, USA the Ponseti Technique has rarely been practiced outside of this state.

Fifty feet in 32 consecutive patients have prospectively been followed since September 1999. All the patients have been treated by one surgeon in an identical fashion to that described by Dr Ponseti. The only difference was that the percutaneous tenotomies were preferentially performed under a general anaesthetic. Twenty four feet have had a detailed radiographic analysis as well. There have been 2 patients lost to follow-up. Twenty three patients were of Maori or Polynesian ethnicity. The pre treatment Pirani score averaged 5.0. The first cast was usually applied within 2 weeks of birth and the average number of casts was 6.0. The Achilles tendon tenotomy was not preformed in 4 feet. The mean follow-up Pirani score was 0.5. Four feet in 2 patients have required posteromedial release at 11 months of age. One patient has required a tibialis tendon transfer at 2 1/2 years of age. There have been minor skin complications from the boot wearing. The compliance with boot wearing is low with more than 50% of the patients wearing them less that 50% of the prescribed time.

The Ponseti Technique demands attention to detail if it is to be successful. These excellent early clinical and radiographic results support this method of treatment for idiopathic talipes equinovarus. Our concern is the long-term outcome in the patients with poor boot wearing compliance.

Introduction: The management of idiopathic talipes equino varus remains controversial. Excellent long term results have been reported with non operative management using the Ponseti technique.

Aim: To assess prospectively the early radiologic and clinical results in idiopathic club feet treated in New Zealand by the Ponseti technique.

Method: We have reviewed prospectively 29 feet in 19 consecutive patients presenting with idiopathic club feet. The initial assessment consisted of a clinical examination, assessment of the Pirani score and clinical photographs. At follow-up the Pirani score, ankle range of motion, foot length and calf circumference were measured and radiographs were taken. Follow-up was at an average age of 7.3 months.

Results: The Pirani score improved from an average of 4.9 to 0.5. The range of motion averaged 32 degrees dorsiflexion and 42 degrees plantar flexion. Radiographs showed good correction of the hindfoot with a mean talocalcaneal index of 55 degrees, and a dorsiflexion tibiocalcaneal angle of 62 degrees. A normal mean AP talo-first metatarsal, AP calcaneo-fifth metatarsal angle, and lateral talo-first metatarsal angle showed good correction of midfoot adductus and cavus. Forced dorsiflexion radiographs showed that ⅗ ths of dorsiflexion motion occurred in the hindfoot and ⅖ ths in the midfoot. Complications were all minor. One non-compliant patient required bilateral posteromedial releases.

Conclusions: This is the largest reported series outside of Iowa City using this technique and the first to show the early radiographic findings. Excellent early clinical and radiographic results have been shown.