Introduction: Instability of THR is a problem both for the patient and the surgeon. Its frequency varies from 3 to 20% in multioperated patients. When the cause is known treatment usually gives good results and one way of preventing dislocation is to increase the size of the prosthetic head. The cause for instability is multifactorial and sometimes the patients have predisposing factors: muscular weakness or neurological alterations that determine the need for constrained and bipolar cups.

Materials and methods: Constrained cups capture the prosthetic head preventing dislocation and studies have been published with widely differing results. The bipolar cup introduced by Busquet is based on a metal cup coated with hydroxyapatite that is fixated by means of 2 plots to the ischium and the pubis. The polyethylene insert captures a head of 22.2 or 28 mm. Dislocation, when it takes place, is between the metal cup and the insert, and a force much greater than that needed to dislocate a head of 22.2 or 28 mm in diameter is needed.

Results: In a multi-center study carried out on 238 bipolar cups, Leclerc reports a 3.3 % failure rate. Philippot using 106 bipolar cups, reports no dislocation and a survival of 94.6% at 10 years. Our personal series comprised 75 cases, (54 primary and 21 revisions) with only one episode of dislocation due to significant trauma.

Conclusions: The bipolar cup can be used in primary and revision surgery and is effective in decreasing dislocations in high-risk patients and is our option of choice in patients with neuromuscular alterations or multiple surgeries.

Purpose: To assess the use of abdominal aorta cryopreserved allografts as guided regeneration membranes in long bone defects.

Materials and methods: This is a prospective randomized blind study of 10 White New Zealand rabbits. 10 mm-long diaphyseal defects were created in both radii: on one side the defect was separated from the surrounding tissue by means of a tube-shaped cryopreserved aortic allograft; the contralateral radius (control) was left to develop spontaneously with no membrane. The animals were put down after 6, 12, 24 and 30 months. A whole range of different studies were made: x-rays, CT, MRI, morphodensitometric techniques and optical and electronic microscopy.

Results: No complete bone regeneration was observed in any of the controls. In 9 out of the 10 defects for which an aortic allograft was used complete bone regeneration was achieved as well as a restoration of continuity with a corticomedullary pattern. A progressive increase in density and thickness was observed in the regenerated cortex, which reached values similar to those of normal bone. A gradual reduction of the medullary/cortical thickness index was also detected.

Discussion: The microscopic images taken suggest that cryopreserved arterial allografts used in guided regeneration behave like barrier membranes and as osteoinductive agents because of the osteoblastic differenciation of endothelial and/or muscular cells and/or ossification secondary to proteic changes in the extracellular matrix of the artery. This could be regarded as the application of artery calcification and ossification (usually associated with arteriosclerosis, ageing, diabetes and renal failure) to the regeneration of bone defects.

Conclusions: It is possible to use cryopreserved aortic allografts as osteostimulating membranes in the guided regeneration of bone defects.