Purpose: The quality of the functional result for surgical treatment of lumbar stenosis has been the subject of much debate. The objectives of this retrospective review were to assess functional outcome ten years after surgical treatment of lumbar stenosis and determine the rate of revision in order to identify factors influencing outcome at last follow-up.

Material and methods: One hundred forty-one patients underwent surgery for lumbar stenosis between January 1990 and December 1992. Mean follow-up was ten years. Functional outcome at last follow-up was assessed with a specific questionnaire with items for lumbar and radicular pain and signs of radicular ischemia and with a self-administered satisfaction questionnaire as well as two visual analogue scales (VAS) for lumbar and radicular pain. Other data noted were: epidemiological and morphological features, comorbidity, presence or not of objective signs of neurological involvement, the SF-36, and a self-assessed anxiety-depression score (GHQ28). Two types of analysis were performed. A descriptive analysis to determine the severity of functional signs observed at last follow-up, patient satisfaction and incidence and reasons for surgical revision. Multivariate analysis was designed to search for factors affecting the self-administered senosis score.

Results: During the study period, fifteen patients underwent a revision procedure involving the lumbar spine. At last follow-up the overall satisfaction index was 71%. The best results were obtained for radiculalgia and intermittent neurogenic claudication. Residual lumbalgia was the main complaint at last follow-up. The patient’s psychological profile was the predominant factor affecting functional outcome. Other factors influencing functional outcome were revision surgery, persistent objective neurological disorders, and comorbidity.

Conclusion: Surgical treatment of lumbar stenosis allows satisfactory long-term results in the majority of patients. At ten years, the risk of revision surgery was 10%. A review of the literature shows that these results are better than those obtained with medical treatment and that these surgical interventions enable quality-of-life similar to that observed in an age-matched population.

Purpose: The purpose of this work was to analyse different techniques and outcome of total hip arthroplasty for acetabular degeneration after orthopaedically or surgically treated fracture of the acetabulum.

Material and methods: This retrospective analysis of a consecutive series was conducted by an independent observer. Sixty-four arthroplasties in 63 patients performed between 1979 and 2000 were included. Twenty-eight acetabular fractures had been treated surgically and 36 orthopaedically. Five types of cups were implanted (25 cerafit, 3 cerapress, 17 cemented alumina, 11 screwed, 7 polyethylene). All patients were assessed preoperatively and at last follow-up with the Merle d’Aubigné clinical scale. The postoperative and last follow-up radiograms were assessed according to Charnley and De Lee. Operative difficulties were assessed in terms of operative time, blood loss, and analysis of the operation reports. Actuarial survival was calculated.

Results: Mean follow-up was five years two months. Six patients were lost to follow-up early. Clinical outcome was satisfactory with significant improvement in the Merle d’Aubigné score. The 10-year survival rate was 81% taking aseptic loosening as the endpoint and 74% taking surgical revision as the endpoint. Operative time and blood loss were significantly related to loss of ace-tabular bone stock and to operator experience (p < 0.05). Survival was significantly related to acetabular bone defect (p < 0.05). There was no difference between the treatment modes used for the initial acetabular fracture for peroperative difficulty or survival.

Discussion: Total hip arthroplasty for acetabular degeneration secondary to acetabular fracture has given good functional results. Long-term survival is below that for primary arthroplasty, the only unfavourable factor identified being loss of acetabular bone stock. The surgical procedure is more difficult and requires a certain experience. We did not find any difference related to the type of treatment (orthopaedic or surgical) used for the initial acetabular fracture. It was difficult to interpret the influence of cup type due to the wide range of cups used in this series.

Purpose: Treatment of non-infected nonunion of the leg is a difficult challenge. Several technical solutions have been proposed. The purpose of this work was to assess the results achieved in patients treated with the Kuntscher technique and to detail indications.

Material and methods: Twenty-two patients who underwent surgery between 1987 and 1997 using the Kuntscher technique (reaming, renailing) for tibial nonunion were reviewed. There were 19 men and three women, mean age 36 years (range 16–58). Minimal follow-up was two years. The initial treatment consisted in non-locked cen-tromedular nailing the cruropedious (n=21) and screw-plate fixation (n=1). There were ten open fractures: Gustilo I (n=3), II (n=7). We noted: time to revision, time to healing, preoperative and last follow-up alignment, size and type of bone loss (fragment or segment), complementary procedures, complications.

Results: We had one infectious failure (Kuntschner nine months after screw-plate fixation, infection diagnosed at two months, bone healing after removal of the nail, reaming, external fixation and fibular strut with cancellous graft). There were no other complications. One patient was lost to follow-up at three months; this patient had a medial fragmental gap measuring 1 cm with a radiologically solid fracture at last follow-up. All other patients healed within a mean 3.44 months (2.5–10). Mean time before revision was six months (2.5–12). Segmental loss was 3–8 cm in six patients. There was not defective alignment at healing. A fibular osteotomy was performed in five cases. Complete weight bearing was initiated early in 15 patients (with crutches in seven).

Discussion: In our experience, the Kuntscher technique is a simple and effective method for the treatment of non-infected tibial nonunions. It is indicated for small gaps or small-sized segmental losses. The rapidity of the healing and the generally uneventful healing period suggest this method should be proposed early after diagnosis of nonunion.