We report the results of a 4- to 17-year clinical and radiological follow-up of 264 Charnley first-generation stems in comparison with those of 402 second- and subsequent-generation stems. The incidence of fracture was 4.1% in first-generation stems and 0.5% in second- and subsequent-generation stems. The incidence of stem loosening requiring or likely to require revision was 3.1% in first-generation and 11.4% in second-generation stems. We believe that the increased loosening rate in second- and subsequent-generation stems is due to their larger cross-sectional area, which produces an increase in flexural stiffness.

We reviewed the results of 14 total hip replacements in patients with juvenile chronic arthritis. The mean age at operation was 16 years (range 12 to 22 years); follow-up was from four to 11 years (mean 8.5 years). Postoperatively pain relief was sustained in all but one hip, while movement generally remained significantly restricted. No hip has as yet required a revision operation, although eight hips (57%) show radiological changes suggestive of impending failure. All patients had severe polyarticular involvement with associated restriction of locomotor activity. Potential causes contributing to loosening such as continuing diaphyseal bone growth and increased immunocompetence in adolescence are discussed.

Exposure of the hip by osteotomy of the anterior part of the greater trochanter is described. This maintains the continuity of the tendinous junction between the anterior half of gluteus medius and the vastus lateralis and preserves intact the insertion of gluteus minimus into the anterior surface of the trochanter. The nerve supply to these muscles is not compromised and good abductor function is retained. The approach can be extracapsular or intracapsular. Reattachment of the osteotomised fragment is simple, and upward displacement after operation, as sometimes seen after complete osteotomy of the greater trochanter, cannot occur.

In comparison with monofilament wire, multifilament cable was found to be a more suitable material for fixation of the greater trochanter. It is versatile, easy to work with and has superior mechanical properties. The "trochanter cable-grip system" was developed to exploit the use of multifilament cable as a means of reattaching the greater trochanter and experimental studies have yielded excellent results. This system was subjected to clinical trials for over four years in 321 hips and, at its present state of development, the incidence of detachment has been reduced to 1.5 per cent and that of cable breakage to 3.1 per cent.

1. Intertransverse fusion in the lumbar spine appears to have many advantages over previously described techniques.

2. The disadvantage of profuse bleeding can be overcome by the use of a Hastings frame and by an operative technique designed to demonstrate constant muscular and articular branches of the lumbar arteries.

3. Coagulation of these vessels by cautery and avoidance of dissection anterior to the plane of the transverse processes ensure that the operative procedure can be carried out with a blood loss averaging less than 500 millilitres.