Purpose of the study: Reconstruction of the acetabulum is becoming increasingly necessary due to the longer life expectancy of patients with a total hip arthroplasty (THA); it can also be needed after trauma or resection of a bone tumour.

Material and methods: For 39 cases, we used a bone bank acetabulum with variable size for simple reconstruction of a part of the acetabulum (n=6) or to replace the entire acetabulum (n=19) or even an entire hemi-pelvis (n=14) in patients with more or less extensive bone loss. For 18 cases, resection was necessary to remove a bone tumour (16 chondrosarcomas and two giant-cell tumours), in 19 cases the reconstruction was necessary after multiple operations, and in four others due to traumatic destruction.

Results: Allograft integration was successful in nearly all patients (two cases of necrosis required a secondary prosthesis, 12.5%) and in two cases we noted immunological reactions with a serous effusion. There were no local infections. For osteocartilaginous acetabuli (n=7) the integration was quite satisfactory, certain patients have been followed for more than 26 years with no evidence of osteoarthritis.

Discussion: Use of a well-established protocol for hypothermia and the absence of secondary sterilisation yields grafts with preserved mechanical properties. The use of cyropreserved osteocartilaginous allografts offers hip for good integration free from degenerative osteoarthritis.

Purpose: The rate of failure knee arthrodesis can be high when performed after an infectious complication of a total knee arthroplasty. We evaluated, in 14 patients at a mean 19 months (3–44 months) follow-up, a technique for knee arthrodesis using a custom-made endomedullary implant.

Material and methods: Mean age of these eight women and six men was 68 years. There were 11 patients with an infected prosthesis, one with post-trauma arthritis, one with aseptic loosening of a hinge prosthesis, and one with pseudarthrodesis. For the 12 patients with ongoing infection, surgery was performed in two times with insertion of a spacer (with antibiotics) between the operations. Mean delay between the two operations was 18 weeks. The surgical procedure was associated with a two-drug antibiotic regimen given for a mean three months after arthrodesis. All arthrodeses were stabilised with a custom-made femora-tibial implant with reaming and fixation with two screws. A graft was always used, composed of the reaming products and powder bone substitute in seven cases, reaming products alone in three, and bone-bank heads in four.

Results: Morbitiy: There was one misalignment of the tibial insertion that was not revised. One skin cover problem was treated with a vastus medius flap. One nonunion evolved favourably after a new graft. There were two recurrent infections: chronic fistulae that were controlled by local care and adapted antibiotic therapy. Weight-bearing was started during the first postoperative week in 13 patients. Bone healing (assessed radiographically with resolution of pain) was achieved at a mean three months (2–6 months) in 13 cases. At last follow-up all patients had achieved a satisfactory level of independence.

Discussion: According to the literature, intramedullary devices are superior for consolidating knee arthrodeses, with a lower rate of complications. Use of custom-made endo-medullary implants facilitates the operation and assures better stabilisation of the arthrodesis, allowing rapid weight-bearing. The infection must be controlled before using these implants. The results in our patients are in agreement with the most recent series reported (Barry, Stephen, Kuoan).

Conclusion: In our hands, this type of implant provides an effective means of attaining bony fusion, including in patients who require arthrodesis for an infected prosthesis.