Introduction

Up to date there are only few reports in literature on the long term survival of uncemented stems. As for cemented THA, 10 year survival of at least 90% is required for any THA.

Introduction: THA in young and active patients remains a major challenge. Uncemented femoral components have been advocated in young patients, but there are only few reports with more than 10 years follow-up.

Materials and Methods: We followed the first 153 consecutive implantations of an uncemented, straight femoral stem (CLS, Zimmer Inc, Warsaw, USA) in 141 patients. Mean time of follow-up evaluation was 17 years (range, 15–20 years), mean age at surgery was 47 years (23–55).

Results: At follow-up, 20 patients (20 hips) had died, and 7 (7 hips) were lost to follow-up. 10 patients (10 hips) underwent femoral revision–1 for infection, 4 for periprosthetic fracture, and 5 for aseptic loosening of the stem. Overall survival was 91% at 17 years (95%-confidence limits, 88%-94%), survival with femoral revision for aseptic loosening as an end point was 95% (95%-confidence limits, 93%–98%). The mean Harris-Hip-Score at follow-up evaluation was 84 points. 116 hips were available for radiolographic evaluation. Radiolucent lines (< 2mm) in Gruen zones 1 and 7 were present in 12,9% (15 hips) and 13,8% (16 hips), respectively. Radiolucencies in zones 2–6 were found in 0,9% (1 hip) – 2,6% (3 hips) on ap x-rays. Only one case of distal osteolysis was found after a previous Wagner resurfacing. No case of severe femoral osteolysis was found at follow-up.

Conclusions: The long-term results with this type of uncemented femoral component are encouraging and compare favorably with those achieved in primary cemented total hip arthroplasty in this group of young and active patients.

Introduction: Despite improved cementing techniques, the long term survival of hip arthroplasty in younger patients have been disappointing. THA in this group of young and active patients remains a major challenge. Consequently, cementless components have been developed. Longer implant survival, preservation of bone stock and ‘easier’ revisions have been advocated as potential benefits of cementless stems. Up to date there are only few reports in the literature on the long term results of uncemented stems. Like in cemented THA, 10 year survival of at least 90% is required for any THA.

Materials and Methods: We followed 133 implantations of an uncemented, grit blasted straight titanium stem (CLS, Zimmer Inc, Warsaw, USA). The mean follow-up evaluation was 14 (10 – 20) years. The mean age at surgery was 37 (16 – 45) years.

Results: At follow-up, 14 patients (10,5%) had died, and 10 (7,5%) were lost to follow-up. 3 patients under-went femoral revision. One for infection an two for aseptic loosening of the stem. There was no case of clinical or radiographic loosening at the time of follow-up. Overall survival was 96% at 14 years, survival with femoral revision for aseptic loosening as an end point was 97% at 14 years. The mean Harris-Hip-Score at follow-up was 81 points (range 45–100). 96 hips were available for radiolographic evaluation. Radiolucent lines (< 2mm) in Gruen zone 1 were present in 7 hips and in Gruen zone 7 in 2 hips, respectively. Small osteolytic lesions (< 1cm) in Gruen zone 1 were present in one hip and in Gruen zone 7 in 5 hips. Larger lesions (> 1cm) were present in one case in Gruen zone 1 and 7. No osteolysis or radiolucency was found in zones 2 – 6. No case of severe femoral osteolysis was found.

Conclusions: The long-term results with this type uncemented stem in a young and active patient group are encouraging and better than those of cemented stems in this age group. We recommend the uncemented CLS stem for hip arthroplasty in young demanding patients.

Aim: Stress-shielding is a common problem after uncemented THA that may lead to proximal femoral atrophy and consecutive aseptic loosening.

Methods: In 143 patients with 154 uncemented CLS-stems periprosthetic bone mineral density (BMD) was measured using DXA after a mean of 12 years (10–15) postoperatively (T1). Five years later the same group of patients was examined at a mean of 17 years (range: 15–20) (T2) using the identical protocol.

Results: We obtained a complete prospective set of data of two consecutive DXA measurements in 76 cases (32 men, 44 women). In all cases regular bone ongrowth did occur and there were no signs of radiographic loosening (T1 and T2). On radiographic evaluation there was no significant change in periprosthetic bone formation in all Gruen zones between T1 and T2. There was no significant change in activity and BMD. In male patients we found no significant changes in periprosthetic BMD (netavg T1–T2: −1,19%, p< 0,01), in female patients there was no significant difference either (netavg T1–T2: −1,32%,p< 0,01). We analyzed the differences in BMD in all Gruen zones (zone 1–7) comparing T1 and T2 and found no significant differences in any zone (p< 0,01).

Conclusion: This study showed that there is no significant change in periprosthetic bone mineral density in the long term using the uncemented CLS stem. There was not a single case of stress shielding in the long term. Once osseous integration has occurred the periprostethic BMD changes remain minimal in the long term.

Introduction: THA in young and active patients remains a major challenge. Uncemented femoral components have been advocated in young patients, but there are only few reports with more than 10 years follow-up.

Materials and Methods: We followed the first 153 consecutive implantations of an uncemented, straight femoral stem (CLS, Zimmer Inc, Warsaw, USA) in 141 patients. Mean time of follow-up evaluation was 17 years (range, 15 – 20 years), mean age at surgery was 47 years (23–55).

Results: At follow-up, 20 patients (20 hips) had died, and 7 (7 hips) were lost to follow-up. 10 patients (10 hips) underwent femoral revision- 1 for infection, 4 for periprosthetic fracture, and 5 for aseptic loosening of the stem. Overall survival was 91% at 17 years (95%-confidence limits, 88%–94%), survival with femoral revision for aseptic loosening as an end point was 95% (95%-confidence limits, 93% – 98%). The mean Harris-Hip-Score at follow-up evaluation was 84 points. 116 hips were available for radiolographic evaluation. Radiolucent lines (< 2mm) in Gruen zones 1 and 7 were present in 12,9% (15 hips) and 13,8% (16 hips), respectively. Radiolucencies in zones 2 – 6 were found in 0,9% (1 hip) – 2,6% (3 hips) on ap x-rays. Only one case of distal osteolysis was found after a previous Wagner resurfacing. No case of severe femoral osteolysis was found at follow-up.

Conclusions: The long-term results with this type of uncemented femoral component are encouraging and compare favorably with those achieved in primary cemented total hip arthroplasty in this group of young and active patients.

There are only a limited number of long term studies of total knee arthroplasty and few with a minimum fifteen year survivorship of a modular fixed bearing posterior cruciate-retaining prosthesis. This consecutive series of 139 total knee arthroplasties (109 patients), using the non-conforming posterior cruciate-retaining Press Fit Condylar (PFC®) system was followed for a minimum of 15 years (range 15.0 to 16.9 years). The patella were resurfaced with an all-polyethylene component in 83% of knees. The tibial component was always cemented, while a porous-coated femoral component was used in 84% of knees. Fifty-nine knees (45 patients) were followed up for a minimum of 15 years. Fifty-seven patients (70 knees) had died and five (8 knees) were too ill to assess. Survivorship of the prosthesis was confirmed for 98.6% of the prosthesis, as only two patients (2 knees) were lost to follow-up.

The mean Knee Society Score and Function Score were 96 and 78 respectively. The total incidence of radiolucent lines was 13%, with 2% around the femur, 11% around the tibia, and 0% around the patella. None of these lines were of any clinical relevance. There was no evidence of progressive radiolucent lines or component loosening, and one case of zone 4 femoral osteolysis.

There were five re-operations for any indication, of which four were for polyethylene insert wear. There was also one loose cemented femoral component after more than 15 years. The survival without need for revision for any reason was 99% at 10 years and 95.6% (worst-case scenario of 94.2%) at 15 years.

This single-surgeon series with a minimum 15 year follow-up shows that the modular fixed bearing posterior cruciate retaining total knee arthroplasty of the PFC system can provide excellent and predictable long term results in tri-compartmental arthritis of the knee.

We reviewed 39 patients with displaced three- and four-part fractures of the humerus. In 21 patients (group A) we had used an anatomical prosthesis for the humeral head and in 18 (group B) an implant designed for fractures.

When followed up at a mean of 29.3 months after surgery the overall Constant score was 51.9 points; in group A it was 51.5 and in group B 52.4 points. The subjective satisfaction of the patients was assessed using a numerical rating scale and was similar in both groups. In group A complete healing of the tuberosities was found in 29% and 50% in group B. Partial integration was seen in 29% of group A and in only one patient in group B, while resorption was noted in 43% of group A and 44% of group B. The functional outcome was significantly better in patients with complete or partial healing of the tuberosities (p = 0.022). The specific trauma prosthesis did not lead to better healing of the tuberosities. The difference in clinical outcome obtained by the two designs did not reach statistical significance.

A consecutive series of 139 total knee arthroplasties (109 patients, average age 67 years), using a non-conforming posterior cruciate-retaining prosthesis was followed for 15 years (range, 15.0 to 16.9 years).

Forty-five patients (59 knees) were clinically and radiographically evaluated, 57 (70 knees) had died, five patients (8 knees) were too ill to assess, two patients (2 knees) were considered lost to follow-up. Survivorship analysis was performed using worst case scenario analysis and failure defined as re-operation for any reason.

Results: In this series there were five re-operations for any indication, four of which were for polyethylene insert wear. One loose cemented femoral component was revised at 15 years. The survival without revision or need for any re-operation was 92.6% at 15 years. The mean Knee Society Score and Function Score at 15 year follow-up are 96 and 78 respectively. The prevalence of radiolucent lines was 13%. None of these lines were clinically relevant. There was no evidence of progressive radiolucent lines, and one case of asymptomatic femoral osteolysis.

Conclusions: This single-surgeon series with a minimum 15 year follow-up shows good clinical and radiological results with excellent survivorship of a modular fixed bearing posterior cruciate retaining total knee arthroplasty system.

Introduction There are only a limited number of long term studies of total knee arthroplasty but none with a minimum 15 year survivorship of a modular fixed bearing posterior cruciate-retaining prosthesis.

Methods We present a consecutive series of 139 total knee arthroplasties (109 patients, average age 67 years), using a non-conforming posterior cruciate-retaining prosthesis, followed for a minimum of 15 years (range, 15.0 to 16.9 years). The patella was resurfaced with an all-polyethylene component in 83% of knees. The tibial component was always cemented, while a porous coated femoral component was used in 84% of knees. Fortyfive patients (59 knees) were followed-up for a minimum of 15 years, 57 (70 knees) had died, five patients (8 knees) were too ill to assess, two patients (two knees) were considered lost to follow-up.

Results In this series there were five re-operations, four of which were for polyethylene insert wear. At two of these, the patella was exchanged for early surface wear and one patella was resurfaced for the first time. There was one loose cemented femoral component after more than 15 years. The survival without revision or need for revision for any reason was 99% at 10 years and 95.6% (worst case scenario of 94.2%) at 15 years. The mean Knee Society Score and Function Score at 15 year follow-up was 96 and 78 respectively. The total incidence of radiolucent lines was 13%, with two percent around the femur, 11% around the tibia and zero percent around the patella. None of these lines were of any clinical relevance. There was no evidence of progressive radiolucent lines or component loosening, and one case of zone four femoral osteolysis.

Conclusions This single-surgeon series with a minimum 15 year follow-up, and excellent clinical, radiological and survivorship results provides a benchmark upon which other long term studies of modular fixed bearing posterior cruciate retaining total knee arthroplasty can be compared.

In relation to the conduct of this study, one or more of the authors is in receipt of a research grant from a non-commercial source.

We have investigated the effect of multisegmental spinal fusion on the long-term functional and radiological outcome in patients with scoliosis. We compared these patients both with those whose spine had not been fused, and with a control group.

We studied 68 patients with idiopathic scoliosis (34 operative and 34 non-operative) who had been followed up for a minimum of five years after treatment. They were matched for age (mean 44 years) and Cobb angle (mean 54°) at follow-up. An age- and gender-matched control group of 34 subjects was also recruited.

All participants completed a questionnaire to assess spinal function and to grade the severity of back pain using a numerical rating scale. Radiographs of the spine were taken in the patients with scoliosis and lumbar degenerative changes were recorded.

The spinal function scores for the patients with scoliosis who had had a fusion were similar to those who had not. Both scoliosis groups, however, had lower scores than the control group (p < 0.001). The frequency and severity of back pain were lower for patients with scoliosis and fusion than for those without, but higher for both scoliosis groups compared with the control group. Radiographs showed similar degenerative changes in both scoliosis groups.