AIM OF STUDY: The mid and long-term clinical and radiological evaluation of patients with degenerative arthritis secondary to congenital hip diseases with placement of the cup proximal to the true acetabulum.

MATERIAL AND METHODS: We operated on a total of 99 hips (90 patients) with arthritis due to CHD from 1996 to 2006. In 48 of these hips (mean age 55.8 yrs), the cup was inserted high.

The procedure was always performed with the patient in lateral position through a lateral transgluteal approach. We did not perform osteotomies of the greater trochanter or femur shortening osteotomies and the cup was placed where there was sufficient bone stock. The major determining factor in cup stability was the presence of sufficient anterior and posterior column. We also tried to insert the cup as medial as possible although in about half the group (25 out of 48), cup placement was superior and lateral. The limb length discrepancy was corrected by varying the neck length of the implant. A special stem was used in 5 cases.

The mean intraoperative time was 65 mins with minimal soft tissue disruption as compared with the classic methods. The patients were mobilized postoperatively in a couple of days.

RESULTS: Despite the higher rates described in literature, cup loosening occurred in only two hips and there was no incidence of stem loosening. There were no neurological complications. There were three complications in total: one DVT and two dislocations due to cup loosening as a result of mal-positioning.

CONCLUSIONS: The extremely low rate of cup loosening, improvement of Harris Hip Score and back pain, decreased intraoperative time are significant advantages of managing congenital hip diseases with the above technique using the uncemented Zweymüller implants. The long period of follow up (8 to 11 years for 31% of the patients) in this study is significant.

The purpose of this study is to present the clinical and radiological evaluation of 632 resurfacing total knee arthroplasties of Foundation-Solution type, performed in 550 patients (437 women and 113 men), from 1994 to 2003. In the majority of cases (569 knees) the operation was performed because of degenerative osteoarthritis. Cement-free implantation was performed in 209, cemented in 117 and hybrid implantation in 306 procedures. We were able to retrospectively review 442 (80.4%) of the patients (498 knees), for a follow-up time of 6 months to 10 years. The Knee Insall Rating Scale was improved from 60 points (34–70) preoperatively, to 92 points (74–100) postoperatively. The range of flexion at the latest follow-up was between 75 to 130 degrees (mean 98 degrees). Extension lag more than 10 degrees was found in 3 patients (0.68%). The radiological evaluation was performed according to Knee Society Röentgenographic Evaluation and Scoring System. Partial periprothetic radiolucent lines (< 1mm) were observed in 35 knees (7%), with no statistical significant difference between the three groups and no progression during the follow-up. No further clinical and radiological evidence of mechanical failure and no significant loss of the mechanical axis were noticed. There was a case of fatal pulmonary embolism, and a case of peroneal nerve palsy that fully recovered. Three knees were revised as a result of septic loosening.