The long-term survival of the cementless Spotorno CLS femoral component in patients aged > 50 years at the time of arthroplasty was investigated. Survivorship analysis of a consecutive series of 85 patients (100 hips; under 50 years of age at a mean follow-up of 18.4 years (16.3 to 20.8)) was performed. The clinical and radiographic outcomes were satisfactory. The overall rate of survival of the femoral component was 93.5% (95% confidence interval (CI), 90.9 to 96.1) after 19 years. Survival with revision for aseptic loosening as the end point was 95.7% (95% CI 93.6 to 97.8%) at 19 years.

This study demonstrates an excellent long-term survival of the Spotorno CLS femoral component after 16 to 20 years in young patients undergoing total hip arthroplasty.

Cite this article: Bone Joint J 2015;97-B:160–3.

In 2012 we reviewed a consecutive series of 92 uncemented THRs performed between 1986 and 1991 at our institution using the CLS Spotorno stem, in order to assess clinical outcome and radiographic data at a minimum of 21 years. The series comprised 92 patients with a mean age at surgery of 59.6 years (39 to 77) (M:F 43;49). At the time of this review, seven (7.6%) patients had died and two (2.2%) were lost to follow-up. The 23-year Kaplan–Meier survival rates were 91.5% (95% confidence intervals (CI) 85.4% to 97.6%; 55 hips at risk) and 80.3% (95% CI, 71.8% to 88.7%; 48 hips at risk) respectively, with revision of the femoral stem or of any component as endpoints. At the time of this review, 76 patients without stem revision were assessed clinically and radiologically (mean follow-up 24.0 years (21.5 to 26.5)). For the 76 unrevised hips the mean Harris hip score was 87.1 (65 to 97). Femoral osteolysis was detected in five hips (6.6%) only in Gruen zone 7. Undersized stems were at higher risk of revision owing to aseptic loosening (p = 0.0003). Patients implanted with the stem in a varus position were at higher risk of femoral cortical hypertrophy and thigh pain (p = 0.0006 and p = 0.0007, respectively). In our study, survival, clinical outcome and radiographic data remained excellent in the third decade after implantation. Nonetheless, undersized stems were at higher risk of revision owing to aseptic loosening. Cite this article: Bone Joint J 2014;96-B:455–61

In cementless Total Hip Arthroplasty (THA), some discussion persist in different continents, weather straight double tapered stems providing proximal metaphyseal fixation are preferable to more diaphyseal cylindrical fixation designs. With the objective of studying the grade of loosening of a straight double tapered stem and its survival rate, the authors analysed 257 THA with implanted Spotorno stems, followed up for a maximum of over 18 years (221 months), with an average of 110±57 months. The age of patients was 62±10 years in average, ranging from 18 to 86. Demographic data is analysed including, sex, height, weight and BMI. Main diagnosis was Primary Degenerative Osteoarthritis in 56% and Avascular Necrosis in 13% of all patients. Other diagnosis occurrence is presented, as well as the affected side, type of cup, head and stem size distributions. Clinical and functional evaluation of the THA showed Very Good and Good patient satisfaction grading in 78% of the cases and the average Harris Hip Score was 87, ranging from 49 to 98. In the Radiological evaluation, stem positioning, migration, osteolysis and distribution of radiolucent lines are quantified and described. 79 patients included in this study with 84 THA, died or were lost after a minimum of five years of complete clinical and radiological follow up. The most significant early and late complications of THA are presented and commented. THA requiring revision of the cup or stem for any cause, were 1 severe deep infection (0.4%), 4 cups loosened and migrated but not requiring revision of the stems (1.6%), 1 femoral osteolysis and loosening (0.4%) and 2 late traumatic femoral fractures (0.8%). From these, considering stem survival alone, a total of four stems (1.6%) underwent femoral revision as previously described, one due to infection, one due to loosening and two due to femoral fractures. Kaplan-Meyer cumulative survival analyses of the THA show a Spotorno stem survival rate of 98.4% at 18 years, with a confidence interval of 95%. In the experience of the authors, the Spotorno double tapered straight stem provides excellent clinical results, with high survival rate at longterm evaluation. The design of the stem allows for immediate progressive weight bearing without significant migration or thigh pain. Femoral proximal osteolysis or radiolucent lines are almost always associated with wear or loosening of the cup, that very often allow for revision of the cup without the need for revision of the stem

Introduction: The treatment of “congenital hip disease” by total hip arthroplasty is now well established, but the indications for this type of surgery, the preoperative planning, the selection of the stem and the technique to be followed are still open to debate. Aim of the study: The purpose of this study is to analyse the long-term follow up after use of the cementless-system (CLS) femoral component designed by Spotorno in dysplastic or congenitally dislocated hips. Material and Methods: Our study includes 70 hips in 59 patients, 49 females and 10 males, 36 left hips and 34 right hips that treated with total hip arthroplasty from 1987 to 2000. The mean age of the patients was 48.5 years (range 34–74 years). Forty-one hips were congenitally dislocated and twenty-nine were severe dysplastic. Preoperative planning with CT and CAD-CAE system were used for selection of the stem. 11 patients had bilateral total hip arthroplasties with Spotorno CLS stem. Many different cups were used. Results: The mean follow up was 8.1 years (range 2–14 years). No patients were lost during the follow-up period. Patients were evaluated clinically with Merle d’ Aubigne and Postel hip score. There was a significant postoperative clinical improvement of the mean pain score by 3.7 points, of walking ability by 2.2 points and of motion by 2, 6 points. Thigh pain was not reported. There were no deep infections or mechanical loosening that required revision of the femoral component. Conclusions: Although, the femoral component Spotorno CLS is used to every kind of hip diseases, had excellent long-term clinical results in adults, with dysplasia or congenital hip dislocation. Spotorno CLS uncemented femoral component represents an attractive option for adults with “congenital hip disease”

INTRODUCTION: The treatment of “congenital hip disease” by total hip arthroplasty is now well established, but the indications for this type of surgery, the preoperative planning, the selection of the stem and the technique to be followed are still open to debate. AIM OF THE STUDY: The purpose of this study is to analyse the long-term follow up after use of the cementless-system (CLS) femoral component designed by Spotorno in dysplastic or congenitally dislocated hips. MATERIAL AND METHODS: Our study includes 70 hips in 59 patients, 49 females and 10 males, 36 left hips and 34 right hips that treated with total hip arthroplasty from 1987 to 2000. The mean age of the patients was 48.5 years (range 34–74 years). Forty-one hips were congenitally dislocated and twenty-nine were severe dysplastic. Preoperative planning with CT and CAD-CAE system were used for selection of the stem. 11 patients had bilateral total hip arthroplasties with Spotorno CLS stem. RESULTS: The mean follow up was 8.1 years (range 2–14 years). No patients were lost during the follow-up period. Patients were evaluated clinically with Merle d’ Aubigne and Postel hip score. There was a significant postoperative clinical improvement of the mean pain score by 3.7 points, of walking ability by 2.2 points and of motion by 2,6 points. Thigh pain was not reported. There were no deep infections or mechanical loosenings that required revision of the femoral component. CONCLUSIONS: Although, the femoral component Spotorno CLS is used to every kind of hip diseases, had excellent long-term clinical results in adults, with dysplasia or congenital hip dislocation. Spotorno CLS uncemented femoral component represents an attractive option for adults with “congenital hip disease”

CLS Spotorno expansion acetabular cup is in use since 1984 for uncemented Metal-Polyethylene (PE) total hip arthroplasties (THA). Metal-PE articulations are notoriously known to wear and lead to failure of THA. However, catastrophic breakage of expansion acetabular cup is rare. Our 74-year-old male who was diagnosed with bilateral osteonecrosis of femoral head, underwent bilateral THA using CLS Spotorno metal expansion acetabular cups (Protek, AG, Bern) in 1991. He had irregular follow-up since then. In 2005, he presented with right hip pain and inability to walk without support. Anteroposterior (AP) hip radiographs established the diagnosis of catastrophic failure of right THA secondary to severe liner wear and acetabular osteolysis. Patient chose to postpone the revision surgery and opted for wheel chair ambulation. He presented 4 years later, when the right hip pain became unbearable. Anteroposterior as well as lateral hip radiographs showed worsening of cup breakage with superolateral migration of metal femoral head. Pelvic CT scans confirmed severe acetabular osteolysis in DeLee and Charnley's Zone 1, 2 & 3 with secondary loss of bony support to the expansion cup [Fig. 1]. A revision THA was strongly advised. However, patient sought for a pain-free rather than a fully ambulatory right hip and decided against a second THA. We performed resection arthroplasty of right hip with bone cement loading, respecting patient's decision. Intra-operatively, the metal femoral head was lying in the huge osteolytic defect in the roof of acetabulum. The 3 cranial wings of metal expansion shell were broken with corresponding wear of the cranial pole of polyethylene liner [Fig. 2]. We were able to gratify patient's expectations and patient is able to ambulate with the aid of one crutch at latest follow-up. However, it is clearly evident that a timely and regular follow-up would have identified the initial PE wear and secondary osteolysis. Additionally, it can avoid extensive procedures like a revision THA or resection arthroplasty by allowing simple procedures like modular PE liner and the femoral head exchange. A comprehensive review of literature for catastrophic acetabular component breakage revealed 10 such cases, although with different cup designs. To the best of our knowledge, this is the first case of CLS expansion cup breakage for metal-PE articulation. Majority of these cases have a presence of extensive liner wear and pelvic osteolysis along with a post-operative irregular follow up. This case stresses on importance of regular follow-up even after many years of index THA to identify early PE wear and prevent secondary catastrophic complications

Introduction: Analysis of the clinical outcome and survivalrate of the Harris/Galante 1 cup combined with two different stems. Material and methods: Retrospective study on patients who underwent surgery in the years 1986–1989. There was a total of 544 patients with 593 total hip replacements (THR), 264 patients died prior to investigation (285 THR). All deceased were checked in the danish patient registration system for revision. 113 patients with 128 THR were operated with the Spotorno CLS stem, and 431 patients with 465 THR with the Mller straight stem. 270 patients with 297 THR were assessed radiographically and according to a modified Harris Hip Score (ROM was not used). Some were due to age or other illnes not able to attend the examination. If possible they were interviewed by telephone. The median age was 69,4 (range 18,3 – 88,1) for all, for the Spotorno CLS group 55 years (range 18–72) and for the Mller group 72 years (41–88). Male/female ratio: 0,56. Average follow-up was 13 years (range 9,1 -15.1). The primary diagnosis was osteoarthritis 538 hips, RA 10, fracture sequelae 15, congenital dislocation 14, others contributed with 16 hips. The survival rates were calculated using the Kaplan-Meier method. Results: 35 patients have had a revision: 21 because of aseptic loosening, 4 because of femoral fracture, 5 because of dislocation, and 1 because of infection. 4 liners were revised because of polyethylene wear. Only one was in the Mueller group, 3 in the CLS group. After 13 years the survival rate for the cups was 96.8% including reoperations for polyethylene wear, for the femoral Mueller stem 90.7% and for Spotorno CLS 96.1 %. Conclusion: The Harris/Galante cup and Spotorno show excellent survival after 13 years, and for the Mueller stem the survival rate is comparable to others. The relative high rate of polyethylene wear in the CLS group we believe to be a consequense of the younger patients more active lifestyle

Background. The clinical results of total hip arthroplasty (THA) with a cementless prosthesis have been constantly improving due to progress in the area of stem design and surface finish. However, majority of stems are well-fixed with canal filling or diaphyseal fit, and cortical hypertrophy or metaphyseal bone atrophy has been often observed. Cementless Spotorno stem (CLS stem; Zimmer, Warsaw, USA) is a double-tapered rectangular straight stem. The purpose of this study is to investigate the mean 13 years' results of CLS stem and to evaluate the press-fit stability of CLS stem. Methods. Between 1999 and 2004, we treated 134 patients (142 hips) with CLS stem. Of those patients, 86 females (92 hips) and 13 males (14 hips), in total 99 patients (106 hips) were available at minimum of 11 years after surgery. At the time of follow-up, six females and five males were dead. The follow-up rate was 82% and the mean follow-up period was 13 years (SD; 20, range; 11–16). The mean age at the time of surgery was 65 years (SD; 10, range; 38–86). The mean body mass index was 24 (SD; 1.8, range; 19 to 28). Preoperative diagnoses were osteoarthritis in 92 patients, osteonecrosis in five patients, and rheumatoid arthritis in two patients. Majority of the patients were female because 84 patients of osteoarthritis suffered from hip dysplasia. For cementless acetabular reconstruction, APR cups (Zimmer, Warsaw, USA) were implanted in 10 hips, IOP cups (Zimmer, Warsaw, USA) in 22 hips, and Converge cups (Zimmer, Warsaw, USA) in 74 hips. As the liner of acetabular component, conventional UHMWPE (Sulene: Zimmer, Warsaw, USA) was used in APR cup and highly crosslinked UHMWPE (Durasul: Zimmer, Warsaw, USA) in IOP and Converge cups. The lipped liner was chosen in all cases, and lipped lesion was placed posteriorly. The radiographic stability of the femoral stem was determined by Engh's criteria. The ascertained period of spot welds was noted by Gruen zones on the femoral side. The presence of stress shielding, and subsidence was also evaluated. Results. A stable stem with bony on-growth was identified in all cases. The mean period of expression of spot welds was 11 months in zone 2, 10 months in zone 3, 9 months in zone 5, and 9 months in zone 6. Stress shielding of more than grade 2 was observed in only 8 hips, which was non-progressive at 1 year after surgery. Subsidence of more than 2mm was not observed in any of the hips. The cortical hypertrophy at the tip of stem was not observed. The postoperative dislocation occurred in six hips (6%) and periprosthetic femoral fracture occurred in two hips (2%). Revised surgery was performed in three hips for a recurrent dislocation and two periprosthetic femoral fracture. Conclusions. Excellent stability of CLS stem has been maintained without abnormal bone reaction at proximal femur. CLS stem is considered to achieve not only press-fit stability at trochanteric and subtrochanteric level, but bony fixation by osseointegration within 1 year after THA

Aim: A ten-year review of uncemented hip arthroplasty using the Spotorno (CLS) stem, Morscher (Mathys) cup and a ceramic head in patients under the age of 60. Method: 113 hips implanted in 104 patients (mean age 50.5: range 19–60) between 1987 and 1995. Mean follow-up: 9.7 years. A postal questionnaire, based on the modiþed Harris Hip Score was followed by clinical and radiographic examination. Results: 3 patients had died and 18 (17%) could not be traced. Complications: sepsis 2%; aseptic loosening 5%; gross polyethylene wear 1%; fractured ceramic head 1%; periprosthetic fracture 1%. Pain was ñabsentñ or ñmildñ in 90%,and ñmoderateñ in 10%. 59.7% had a modiþed Harris Hip Score above 90, 35.8% between 70 and 90, and 4.5% less than 70 (mean 89.4%). According to Enghñs criteria, femoral stems had Ôingrowth conþrmedñ in 94%, suspected in 5% and þbrous encapsulation in 1%. None was predicted as unstable. Osteolysis was absent around 65.8% of stems, conþned to the neck in 14.8%, present proximally in 17.1% and distally in 2.3%. According to ARA criteria, acetabular þxation was Ôexcellentñ in 72.1%, Ôfairñ in 12.8% and Ôpoorñ in Osteolysis around the cup was Ôabsentñ or in Ôminimal in 91.8%, Ômoderateñ in 3.5% and Ôsevereñ in 4.7% Conclusions: We observed an association between acetabular polyethylene wear rates and radiographic evidence of osteolysis, which was greater around the rough-blasted stem than the hydroxyapatite-coated cup. Where osteolysis is present, the linear wear rate is consistently greater than 0.1mm/year, which may seem high but is comparable to other currently-used cement-less combinations

Aim: The early results of cementless femoral components in young patients have been reported, but there are only few reports with more than 10 years follow-up. Methods: We evaluated the clinical and radiographic results of the þrst consecutive 154 implantations of a cementless, double tapered straight femoral stem (cementless Spotorno (CLS), Sulzer Orthopedics) in 141 patients under the age of 55 (mean 47, 13–55) years. Results: After a mean follow-up of 12 (10Ð15) years, 11 patients (11 hips) had died and 7 (7 hips) could not be located. 5 patients (5 hips) underwent femoral revision- 1 for infection, 1 for periprosthetic fracture and 3 for aseptic loosening of the stem. Overall survival was 97% at 12 years (95%-conþdence limits, 93% Ð 100%), survival with femoral revision for aseptic loosening as an end point was 98% (95%-conþdence limits, 95% Ð 100%). The median Harris-Hip-Score at follow-up was 84 points. No thigh pain was found. Radiolucent lines in Gruen regions 1 and 7 were present in 21 hips (17%). 2 hips had radiolucent lines in regions 2 Ð 6 on anterio-posterior (AP) radiographs. No femoral osteolysis was found. Conclusions: The mid- to long-term survival with this type of femoral component is excellent and compares favorably with cemented stems in this age group. However the high rate of cup loosening and the low Harris Hip Scores are concerning in this group of young patients

We followed the first 354 consecutive implantations of a cementless, double-tapered straight femoral stem in 326 patients. Follow-up was at a mean of 12 years (10 to 15). The mean age of the patients was 57 years (13 to 81). At follow-up, 56 patients (59 hips) had died, and eight (eight hips) had been lost to follow-up. Twenty-five hips underwent femoral revision, eight for infection, three for periprosthetic fracture and 14 for aseptic loosening.

The overall survival was 92% at 12 years (95% CI 88 to 95). Survival with femoral revision for aseptic loosening as an endpoint was 95% (95% CI 92 to 98). The median Harris hip score at follow-up was 84 points (23 to 100). Radiolucent lines (< 2 mm) in Gruen zones 1 and 7 were present in 38 (16%) and 34 hips (14%), respectively. Radiolucencies in zones 2 to 6 were found in five hips (2%).

The results for mid- to long-term survival with this femoral component are encouraging and compare with those achieved in primary cemented total hip arthroplasty. The high rate of loosening of the cup and the high rate of pain are, however, a source of concern.

Peri-prosthetic femoral fracture after total hip replacement (THR) is associated with a poor outcome and high mortality. However, little is known about its long-term incidence after uncemented THR. We retrospectively reviewed a consecutive series of 326 patients (354 hips) who had received a CLS Spotorno replacement with an uncemented, straight, collarless tapered titanium stem between January 1985 and December 1989. The mean follow-up was 17 years (15 to 20). The occurrence of peri-prosthetic femoral fracture during follow-up was noted. Kaplan-Meier survival analysis was used to estimate the cumulative incidence of fracture. At the last follow-up, 86 patients (89 hips) had died and eight patients (eight hips) had been lost to follow-up. A total of 14 fractures in 14 patients had occurred. In ten hips, the femoral component had to be revised and in four the fracture was treated by open reduction and internal fixation. The cumulative incidence of peri-prosthetic femoral fracture was 1.6% (95% confidence interval 0.7 to 3.8) at ten years and 4.5% (95% confidence interval 2.6 to 8.0) at 17 years after the primary THR. There was no association between the occurrence of fracture and gender or age at the time of the primary replacement. Our findings indicate that peri-prosthetic femoral fracture is a significant mode of failure in the long term after the insertion of an uncemented CLS Spotorno stem. Revision rates for this fracture rise in the second decade. Further research is required to investigate the risk factors involved in the occurrence of late peri-prosthetic femoral fracture after the implantation of any uncemented stem, and to assess possible methods of prevention

Introduction: The Spotorno cementless femoral stem relies on proximal press-fit at time of surgery and subsequent osseointegration for long-term fixation. The aim of the study is to assess the long-term survivorship and clinical outcome of the Spotorno stem used in primary hip replacement surgery in younger patients. Materials and Methods: 74 patients were identified who had undergone 90 THRs using the Spotorno CLS stem between January 1987 and May 1992. There was variation in the acetabular components used. 5 patients (6 hips) were lost to follow-up, leaving a study group of 84 hips. The patients were assessed using the Harris Hip Score and the Oxford Hip Score. Results: Mean age at operation was 40.1years (range 23–65years). Commonest diagnoses were primary osteoarthritis, developmental dysplasia of the hip and rheumatoid arthritis. Mean duration of follow-up was 12.25 years (range 8½ – 15yrs 3months). At most recent follow-up, the mean Oxford Hip Score was 23.8 and mean Harris Hip Score was 81. Taking revision for any cause as an end point, 19 hips from the initial group of 84 had undergone some form of revision surgery at most recent review. 15 of the 19 hips that failed had aseptic loosening of the acetabular component, which was the Mecring component, and underwent revision of acetabulum only. Four stems were revised, 2 for loosening and 2 for infection. 80 out of 84 of stems originally implanted remained intact at most recent review, which represents a stem survivorship of 95.2% at mean 12.25yrs follow-up when used in young patients. Conclusion: Our findings indicate excellent long-term survival of this titanium alloy stem when used in patients under 65years. We attribute this to stem design and the principle of proximal press-fit fixation. Careful consideration must be given to acetabular component selection in cementless total hip arthroplasty

CLS Spotorno cotyle consists of an expansible hemispheric external component with troncoconic internal thin thread of Protasul Titanium. It also has a polyethylene UHMW internal threaded element which adapts prosthesic femoral heads (28–32 mm of diameter). The implant procedure is technically simple. First of all, the acetabulum is prepared by milling the cartilaginous surface with hemispheric mills. The external element is inserted pressthorn;t, later it is expanded with a troncoconic thread, the high density polyethylene is threaded inside the expanded component. The aim of this comunication is to expose the clinical and radiological outcome of 50 patients whom a CLS Spotorno expansible cotyle were implanted with a mean clinical follow up of 14 years. The indications are exposed considering the age, cotyle morphology and bone quality. The evaluation included both clinical and radiographic parameter. Test of Postel and Merle DñAubigne were assessed for this clinical outcome. Radiological evaluation included: Acetabular angle desviation, periprosthesic osteolysis, proximal and medial migration of the cotyle and polyethylene wear. The primary stability of the acetabular stems were found excellent. Good osteointegration and biocompatibility were demostrated by serial radiographic and funtional scores. We also present the surgical procedure, the complications and the conclusions of the study

Aim: To investigate the potential of biological fixation of cementless total hip arthroplasty (THA) in patients over 75 years old, with diagnosed osteoporosis. Material-Methods: Between 1994–2000, 30 patients (mean age 77.3 years) underwent cementless THA.25 patients were found at the last follow-up, which ranged from 3–7 years (mean follow-up,4 years).THA was performed due to primary osteoarthritis (n=18), subcapital fracture (n=5), or dysplastic hip (n=2).7 Spotorno,9 Synergy and 9 Perfecta prostheses were implanted.Singh index was used for the evaluation of osteoporosis and Harris Hip Score (HHS) was used for the clinical evaluation of each patient.Modified Wixon score was used for the evaluation of stability probability of the tapered stem.Engh score was calculated for the evaluation of osseointegration of the porous coated implants. Results: Pre and post-operative mean Singh index was grade 4.Mean HHS at the last follow-up was 88.6.For the Spotorno stem a stable fixation probability was calculated at 74.8%.Porous coated stems provided +13.45 mean Engh score,implying satisfactory fixation of the implant.Postoperative systematic complications are not reported. Conclusions: In patients over 75 years old, with possible cardiopulmonary disease, cementless total hip arthroplasty offers a reliable treatment,regardless the presence of osteoporosis.Satisfactory osseointegration and absence of systematic complications is compromised by the high cost of titanium implants

Only someone with good common sense paired with a grain of fortune-telling might be able to foresee further improvements of THR implants adequately. After carefully reviewing the studies of the past, we have evolved our personal belief of what future improvements could look like. A new, improved stem should be made of titanium alloy, have a sandblasted surface structure with a tapered proximal fit stem design. Further advantages would be to allow a certain amount of bony restitution in the metaphyseal region and minimise the stress shielding effects on the femur. As an example of the often-difficult way from the idea on the drawing board to a commercially exploitable implant, we demonstrate the development of our newly designed “hollow-stem” prosthesis. In an animal study a tapered cementless hollow-stem prosthesis was implanted in 10 foxhounds and subsequently analysed after 12 and 24 weeks. As a result, mineralisation occurred between the titanium stays of the prosthesis, as well as in the central hollow area as early as two to four weeks after implantation. After 12 weeks, density of cancellous bone between the titanium stays and in the hollow centre was considerably higher than on the contralateral untreated side. Load bearing within the centre of the stem was obvious due to the regular orientation of the trabecular bone. After these positive results we began the conversion to a production line human stem prosthesis. With the help of a finite-element analysis, the stem was then modified in critical areas, resulting in an improved prototype which was subjected to a fatigue test according to ISO 7206-3 of 10.000.000 cycles without any damage. After careful deliberation with our ethics committee, we were finally able to commence with our pilot study consisting of the implantation of 20 hollow-stems and 20 Spotorno stems as a matched pairs study design. The clinical and radiological evaluation after a minimum 12-month follow-up shows comparably good clinical results in both groups. Radiologically, some degree of subsidence was seen in three hollow stems compared to two Spotorno stems without being clinically relevant. The next step will be a larger randomized study using the hollow-stem as well as a solid stem of the same design. We will consider a more widespread utilisation of the hollow-stem only if this randomised study proves the hollow-stem to be superior

We have updated our previous randomised controlled trial comparing release of chromium (Cr) and cobalt (Co) ions and included levels of titanium (Ti) ions. We have compared the findings from 28 mm metal-on-metal total hip replacement, performed using titanium CLS/Spotorno femoral components and titanium AlloFit acetabular components with Metasul bearings, with Durom hip resurfacing using a Metasul articulation or bearing and a titanium plasma-sprayed coating for fixation of the acetabular component. Although significantly higher blood ion levels of Cr and Co were observed at three months in the resurfaced group than in total hip replacement, no significant difference was found at two years post-operatively for Cr, 1.58 μg/L and 1.62 μg/L respectively (p = 0.819) and for Co, 0.67 μg/L and 0.94 μg/L respectively (p = 0.207). A steady state was reached at one year in the resurfaced group and after three months in the total hip replacement group. Interestingly, Ti, which is not part of the bearing surfaces with its release resulting from metal corrosion, had significantly elevated ion levels after implantation in both groups. The hip resurfacing group had significantly higher Ti levels than the total hip replacement group for all periods of follow-up. At two years the mean blood levels of Ti ions were 1.87 μg/L in hip resurfacing and and 1.30 μg/L in total hip replacement (p = 0.001). The study confirms even with different bearing diameters and clearances, hip replacement and 28 mm metal-on-metal total hip replacement produced similar Cr and Co metal ion levels in this randomised controlled trial study design, but apart from wear on bearing surfaces, passive corrosion of exposed metallic surfaces is a factor which influences ion concentrations. Ti plasma spray coating the acetabular components for hip resurfacing produces significantly higher release of Ti than Ti grit-blasted surfaces in total hip replacement

Introduction:. Total endoprosthetic replacement of hip and knee joints in patients with degenerative or inflammatory disease is a reliable treatment in orthopedic surgery since many years. However patients with oligo- or polyarticular disease are still a problem because of several operations within repeated periods of hospitalisation. Patients who need multiple joint replacements reject surgical procedures considering long time of suffering and hospitalisation by being treated in following one step after the other. Offering simultaneous surgery in two joints is often a probate opportunity to avoid this problem. To resolve this problem we decided one stage procedure in selected cases. Method and results:. Between 01. 01. 99 and 31. 12. 01 we supplied 57 patients with 2 endoprosthesis (hip or knee) in one single surgical procedure. In 26 cases we implanted total hip replacement bilateral. 11 patients were female and 15 patients were male. The age differed between 26 and 73 years with an average of 64 years. One patient got hybridendoprosthesis (Muenchner socket/MEM stem). The others got a cementless model (Fitek or ACA socket/Weill or Spotorno stem). The average time of hospitalisation was 23, 5 days. In 3 cases allogenic packed human bloodcells (up to 960 ml in one case) were necessary. The mean time of operation was 142 min. In 25 cases we did total knee alloarthroplasty on both sides. 17 patients received all cemented Wallaby-I knees and 1 patient received all cemented PFC prosthesis. 7 patients got got an all cemented Scorpio knee prsthesis. 14 of these patients were female and 11 patients were male. The age differed between 35 and 75 years with an average of 66. The average time of hospitalisation was 21, 5 days and the average time of operation took 123 min. Allogenic packed human bloodcells were not necessary in any case. In 6 cases we did total alloarthroplasty on knee and hip simultaneous. All patients received all cemented Wallaby-I knees and different cementless or hybrid-hip-prosthesis (Fitek or ACA socket/MEM, Weill or Spotorno stem). 4 of these patients were female and 2 patients were male. The age differed between 39 and 79 years with anaverage of 61. The average time of hospitalisation was 24, 5 days. The mean time of operation was 132 min. Transfusion of allogenic packed human blood-cells was necessary in one case. By standard all patients underwent praeoperative blood donation and postoperative autologous retransfusion (mean 640 ml) within 6 hours. In four cases we saw an increase of the inflammatory test results one week postoperative, which we treated with Tavanic 500 1 - 0 - 0 orally. Other complications didn′t occur. All patients were able to leave the hospital with full weight bearing. Conclusion:. Compared to single hip joint replacement the average time of hospitalisation was only 4, 1 days longer, in case of simultaneous knee replacement we saw an increase of 3, 3 days. Considering the high acceptance due to the above mentioned advantages we recomand simultaneous replacement of two joints as an approbiate procedure in patients suffering from multiple joint destructions

Aims

Although the Fitmore Hip Stem has been on the market for almost 15 years, it is still not well documented in randomized controlled trials. This study compares the Fitmore stem with the CementLeSs (CLS) in several different clinical and radiological aspects. The hypothesis is that there will be no difference in outcome between stems.