Introduction and purpose: Cortical strut autografts provide primary stability to resolve fractures or pseudoarthrosis associated with major bone loss, or fractures close to joint prostheses.

Materials and methods: We present 8 cases in which strut autografts were used: one pseudoarthrosis of the humerus, three periprosthetic fractures in TKR and four fractures associated with hip prosthesis surgery.

We resolved the humeral pseudoarthrosis with struts and a PCL plate plus cancellous tissue graft. For the periprosthetic fractures of the knee and hip we used revision prostheses with extension stems plus struts, held in place with cerclage wires or compression bands, with or without plates.

In all cases functional rehabilitation started early. The mean non-weight-bearing period for lower limbs was 10 weeks (8–12 months).

Results: Primary stability made it possible to begin rehabilitation early in all cases. Total consolidation of the grafts in a mean time of 5 months (4–7 months), with complete recovery of bone stock. Excellent functional outcome with full return to daily activity as before surgery.

Conclusions: The use of strut autografts associated with osteosynthesis and/or revision prosthesis implantation makes it possible to resolve cases that require a large amount of bone graft and provides sufficient primary stability for fast rehabilitation. The proper final consolidation of the grafts and complete recovery of bone stock provides stability with full guarantee of long-term success.

Aims: Analyze the long-term survival of cementless meniscal bearing total knee arthroplasty (TKA). Methods: Two hundred and thirty-two consecutive cementless primary meniscal bearing Low Contact Stress TKA were performed on 203 patients in our institution from November 1988 to June 1996. The diagnosis was osteoarthritis in 192 knees (83%) and rheumatoid arthritis in 40 cases (17%). Mean age at surgery was 66.5 years (range:16–90). Cruciate retaining prosthesis was implanted in 81% and a cruciate sacrificing prosthesis in 19%. Twenty patients died and ten patients (4,3%) were lost to follow-up. The remaining 202 knees (87%) had an average follow-up of 116.7 months (range:70–165). Survival analysis was done using as end point revision surgery or recommended revision. Results: Twenty-six TKAs (11.2%) required revision: infection (3), patelar failure (2), tibial/femoral loosening (2) and polyethylene failure (19). Age, gender, diagnosis and sacrificing cruciate ligaments were not related with prosthesis failure (p> 0.05). The Kaplan-Meier survival analysis showed a mean of 155 months (95%CI:150–159). The life table survival estimate at 10 years was 90.4% (85–95). The cumulative survival rate for patellar failure was 99% (98–100), for mechanical loosening 99% (98–100) and 91.3% (87–96) for polyethylene failure. The Log Rank Test was significant for poliethylene failure (p=0.0005). Conclusions: In our experience overall long-term survival of cementless meniscal bearing TKAwas acceptable. Mobile bearing knee prosthesis satisfactorily resolved problems related with patellar failure or tibial/femoral loosening. Polyethylene failure continues to be the main problem in long-term survival of knee prosthesis.

Aims: The aim of this retrospective study was determine the survivorship of bipolar arthroplasty for femoral neck and what kind of associated factors could inßuence this survival rate. Methods: From 1980 until 2000, a total of 271 bipolar hemiarthroplasties were inserted for displaced femoral neck fractures in 269 patients, 207 were women and 64 were men, 62,4% cemented and 37,6% uncemented. The median age was 67,5 years (range: 28–93). The median follow-up was 74.6 months (range: 1–232). They were excluded pathologic fractures, osteoarthritis and dysplasic hips. We have studied the relationship between survivorship and presumed prognostic factors like age, sex and cementation. We used Kaplan-Meier method for calculating survival rates and Log-Rank test to assess prognostic factors. Results: Twenty-three (8,5%) hips required revision surgery, 3 were septic (1,1%) and 20 were aseptic (7,4%). In aseptic group we could þnd stem loosening (4,1%), polyethylene failure (1,4%), acetabular erosion (1,1%) and dislocation (0,7%). The 5- and 10-year hemiarthroplasty survival (HS) rates were 96% and 93% respectively. We found that only age< 60 years was signiþcant prognostic factor for HS (p< 0.05). Sex and cementation has not inßuenced signiþcantly on survival rate (p> 0,05). Conclusions: According to the outcomes in our group, we feel bipolar arthroplasty should be the technique of choice in patients over 60 years with sufþcient walking ability, when they have a displaced femoral neck fracture.