Introduction: The cemented MS-30 stem (Morscher-Spotorno) has been introduced with a matte surface in clinical practice in 1990. Since it has been shown that tappered collarless stems with a polished surface show better results than those with a matte surface , the MS-30 stem was also manufactured in a polished version from 1994 on. Because no prospective study comparing the two surfaces was published until then and our own results with this stem with a matte surface revealed excellent results with no revision and no osteolysis during a 4 year period, we decided to perform such a study including 125 implants in each group. The only variable was the characteristics of the surface.

Patients and Methods: In the first group with a matte surface there are 61 men with a mean age of 65 (41–86) years and 66 women with 73 (54–89) years. In the second group there are 63 men with a mean age of 64 (35–88) years, and 65 women with 70 (40–91) years. In 21 patients, the MS-30 stem was inserted bilaterally during the index period. All patients were followed up for a minimum of 8 years. The average observation time was 8.6 (8.0–10.3) years. No patients were lost to the follow-up. Ninety-two MS-30 stems with a matte and 103 with a polished surface had a minimum 8-year clinical and radiological check. As an acetabular component the Press-Fit Cup was used.

Results: The overall results were excellent and good in the group with the matte surface in 92% and in 91% with a polished surface. Two revisions each had to be done for aseptic loosening Two hips had to be revised for recurrent early dislocation. The overall revision rate is thus 6/255 (2.4%), and 4/244 (1.5%) for aseptic loosening. Six osteolyses (one confluent) in the group with the matte suface and 7 in the group of polished stems were detected. Subsidence of 2–5mm occured in 10 cases each. There was no osteolysis and no revision for aseptic loosening, however, two revisions for dislocation for the Morscher Press-Fit Cup.

Conclusion: No significant difference in the outcome of MS-30 stems in each group could be found during a 8–10-year observation period. The main reason for the almost equally excellent performance may be the design of the centralizer, which resists both a debonding of the stem from the cement and subsequent subsidence as a precondition for fretting between the two surfaces at the metal/cement interface. Another reason is the cement and the good cement mantle which influence the final result of a cemented THR more than the design of the implant, as it is shown by the Swedish and Norwegian implant register.

Introduction: A consecutive series of 280 total hip replacements in 261 patients using the Morscher Press-Fit Cup with a minimum follow up of 5 years was presented 1997 in the clinical orthopaedics. Now the clinical and radiological results of the same cohort after an observation time of 15 years are reported.

Material and Methods: 136 women and 125 men with 280 hip replacements have been followed up again after 15 years. The mean age at the 15 year follow up was 76 (57–90) years in women and 73 (48–90) years in men. 63 women (66 hips) and 60 men (62 hips) died during the observation period. 17 patients with 18 hips could only interviewed by phone. 121 patients with 134 hips (48%) have been clinically und radiologically followed up. The mean observation period is 14.7 (12.8–15.8) years.

Results: The clinical outcomes are excellent and good in 117 patients (97%). Nineteen femoral stems (6.8%) and 12 cups (4.3%) had to be revised: 7 due to aseptic loosening – two after 4 and 10 years in patients with rheumatoid arthritis, 4 after a SULMESH-damage after 10, 13 (2 pat.) and 14 years and 1 after big osteolyses in the zones I-III acc. to Charnley/DeLee after 13 years -, 1 due to a late infection after 9 years, 3 because of deterioration of the inlay after 11 und 12 years (2 pat.) and one owing to recurrent dislocations followed from a fracture of the greater trochanter after 9 year follow up. The 15 year survivalrate is therefore 95.5%, for aseptic loosening 97.5%. Seven hips dislocated; two patients had a closed and 5 an open reduction.

Radiological assessment revealed a complete osseoin-tegration in all 3 zones according to DeLee and Charnley in 98%. 1 cup with a continuous radiolucent line implanted after a acetabulum fracture had to be revised after a 13 year follow-up. 10 cups migrated either in the vertical or horizontal plane 2–5 mm without any progression after 2 years postoperatively. One cup had expansile osteolyses and had therefore to be revised after 13 years. With this exception there was no evidence of osteolyses in the periacetabular pelvic bone. Brooker III and IV ectopic ossifications was seen in decentration of the head of the stem as a sign of increased polyethylene-wear. Discussion: The excellent clinical and radiological results are supported by histologic investigations of 27 autopsy-specimens which show throughout a perfect osseoin-tegration with reinforcement of the osseous anchoring in the peripheral zones of the press-fit cup. We explain the wide absence of osteolyses with the disclaiming of a metal backing (preservation of elasticity and avoiding of stress shielding) and the disclaiming of using screws.

Aims: The outcome analysis of different revision techniques should provide guidelines for future stem revisions. Methods: Between 1989 and 2000 revisions of 478 femoral stems were performed. 252 of them with cemented components and 226 without cement. In 86 cases a Wagner revision stem was used. The mean observation time was 6.4 years. Success and failures were analysed and classified. Results: Four types of defects and remaining bone stock patterns could be distinguished: Type I with normal diaphyseal bone and minor lesions at themetaphyseal side, type II with a regular isthmus but defects, mostly contained ones, of the proximal femur, type III a wide isthmus with a thin and cylindrical cortical wall, type IV with destructions of the proximal femur which need structural allografting to provide sufficient initial stability. Type I revisions can be performed with regular components as used in primary cases, type II revisions need a slightly longer revision stem with either conical or cylindrical diaphyseal part, type III should be treated with components, that allow for axial load transmission proximally and can take rotational loads distally (the “load sharing concept”). Type IV needs a long revision stem in combination with an appropriate choice of structural allografts. Conclusions: If the type and length of the revision stem is chosen according to this classification, the failure rate of stem revisions can be reduced and the us of expensive allografts can be limited.

Introduction: The operation method selected for acetabular revisions depends on the type of deþciency; Type 1: contained cavitary; the acetabular rim is preserved and thus supportive. Type 2: non-contained deþciencies; the acetabular rim and the peripheral zones are non- supportive defects. In non-contained, rim non-supportive defects acetabular reinforcement rings are used as a rule. Material and methods: Between July 1988 and December 1997 465 acetabular revisions with 229 Reinforcement Rings and 236 Press- Fit Cups (4 bilaterally) were performed. A 7.5 (5.0–10.8) year clinical and radiological follow-up of the Press-Fit Cup inserted in 130 women and 102 men was effected. Mean age at revisions surgery was 70 in women and 73 in men. 39 patients (17%) died without needing a re-revision, and 17 (7%) could only be interviewed by phone. One patient was lost to follow-up. Of the remaining 175 patients (75%) with 179 hips (76%) were available for complete evaluation. Results: The clinical results (according to Merle dñAubignŽ) was excellent and good in 82% 143 pts), moderate in 17% (30 pts) and poor in 1% (2 pts). 22 (9%) reinterventions were noted during the observation period: 12 for dislocations, 5 for aseptic stem loosening, 1 for septic loosening, 2 for secondary periprosthetic fractures and 2 for removal of heterotopic ossiþcations. Conclusions: No Press-Fit Cup had to be re-revised for aseptic loosening. Reconstruction for contained, rim supportive defects with the Press-Fit Cup provides excellent results, comparable to those of primary arthroplasties.

Aims: We report 10-year results of the THR hybrid system. Femoral Component: Morscher-Spotorno MS-30¨, stainless steel, tapered, with- out collar with matte surface, þxed with Palakos¨+ Gentamycine bone cement. Cup: non-cemented Morscher Press-Fit Cup¨. Material and methods: A consecutive series of 123 THRs in 120 patients (75 female, 45 male) operated on between January 1990 and December 1992 were subjected to follow-up at 10 years. Mean age at surgery was 69 in women, 71 in men. No patients were lost to follow-up. 23 patients (19%) died without needing a revision, and 12 (10%) could only be inter- viewed by phone. Of the remaining 85 patients (71%) with 88 hips (70%) were available for complete evaluation. Mean follow-up was 9.8 (8.0 Ð 12.2 years).Results: Harris Hip scores were excellent and good in 84% (71 pts), moderate in 14% (12 pts) and poor in 2% (2 pts with rheumatoid arthritis). No stems or cups had to be revised. Radiographically 15 hips (13%) had femoral stem-related osteolyses Ð mostly in Gruen zones 2, 6 and 7. 8 stems subsided 2 Ð 5 mm. No infection and no acetabular osteolysis was observed. Conclusion: In 1990, the MS-30 stem was only available with a matte surface, which can impede settling and consequent maintenance of proximal load transfer to bone. Thus, although no revisions were necessary, the 13% osteolyses may relate to the matte surface. From 1994 on, the MS-30 stem has been available with a polished surface. The excellent outcome for the Morscher Press-Fit Cup corresponds to results in other series.

The need for supplementary screw fixation in acetabular revisions is still widely debated. We carried out 439 acetabular revisions over an eight-year period. In 171 hips with contained or small segmental defects, the Morscher press-fit cup was used. These revisions were followed prospectively. No screws were used for additional fixation.

A total of 123 hips with a mean follow-up of 7.4 years (5 to 10.5) were available for clinical and radiological review. There was no further revision of a press-fit cup for aseptic loosening. Radiological assessment revealed osteolysis in three hips. Of the original 171 hips there was cranial and medial migration of up to 6 mm at two years in 44 (26%). No further migration was seen after the second post-operative year. Acetabular revision without screws is possible with excellent medium-term results in well selected patients.