Aims: A polyethylene free, metal on metal acetabular system (Hofer-Imhof cup; Lubrimet metal on metal articulation made of CoCr-forge alloy) was designed in an effort to improve total hip arthroplasty longevity. This study was undertaken to review the clinical performance of this implant and to determine if acetabular loosening or revision and wear and osteolysis were prevalent.

The long term results (mean follow up period 110 months) are presented in this study.

Methods: In this prospective, randomized study a minimum of 90 months follow up results involving the first 100 implanted metal liner total hip arthroplasties are presented. The mean follow up was 110 months. Between April 1995 and November 1996 ninety-eight patients (100 hips) had a total hip replacement consisting of a titanium cementless self reaming, parabolic cup, a cementless titanium stem and the Lubrimet® metal on metal articulation.

Two acetabular and one femoral component had to be revised due to aseptic loosening without showing macroscopic evidence of metallosis and no histological evidence of excessive metal wear. One patient hat to be revised by a complete change of the total hip (acetabular component and stem) showing histologic evidence of a metal induced hyperergic immunologic reaction. One patient presented with a broken neck of the stem and had to be revised by stem exchange.

As a none device related orthopedic complication one acetabular component required revision surgery due to a periprosthetic fracture.

Conclusions: The long term results of the Hofer-Imhof Lubrimet®Metal-on-metal articulation are satisfying and so the system represented a viable alternative for total hip arthroplasty in younger higher demand patients in the past. Due to the possible development of a hyperergic immunologic reaction to the metal on metal articulation and the availibility of a ceramic on ceramic articulation we do not implant this liner anymore.

Introduction: Pressure relief is essential in treating plantar neuropathic ulcers in the diabetic foot. This can be achieved in an excellent way by total contact casting, therefore especially the longstanding, problematic ulcer-nonresponding to common methods (such as insoles, special shoeware etc,) is adressed by this method.A second indication for total contact casting is presented by the acute stage of neuroosteoarthropathy (Charcot’s foot) with or without ulceration. Methods: 19 patients with diabetes type II were treated by total contact casting. The mean age was 55 (46–75) years. Only 4 out of 19 patients were women We found plantar ulcers 12 of the 19 cases, 7 cases had no ulcer, but a Charcot’s foot stage I was present. Most ulcerations were classified as Wagner stage II and III without any sign of infection. The mean duration of casting was 8 (1–22) weeks. All patients were treated in an outpatient-clinc, no admission to the hospital was needed. The method of casting is exactly presented. Results: Complications were seen in only one of the cases due to skin problems.8 of the 12 ulcers healed completely under casting, 4 healed by a mean of 4 weeks later due to further treatment after casting. All the cases of osteoathropathy could be treated until reaching stage II without any progression of the foot-deformity. Conclusions: The total contact cast gives us the possibility to treat patients with plantar neuropathic ulceration and/or Charcot’s foot stage I with the advantage of good plantar pressure reduction and upkeeping the patient’s full mobility at the same time.

Aims: A polyethylene free, metal on metal acetabular system (Hofer-Imhof cup; Lubrimet¨ metal on metal articulation made of CoCr-forge alloy) was designed in an effort to improve total hip arthroplasty longevity. This study was undertaken to review the clinical performance of this implant and to determine if early ace-tabular loosening or revision and wear and osteolysis were prevalent. The mid term results (mean follow up period 62,7 months) are presented in this study. Methods: In this prospective, randomized study a minimum of 55 months follow up results involving the þrst 100 implanted metal liner total hip arthroplasties are presented. The mean follow up was 62,7 months. Between April 1995 and November 1996 ninety-eight patients (100 hips) had a total hip replacement consisting of a titanium cementless self reaming, parabolic cup, a cementless titanium stem and the Lubrimet¨ metal on metal articulation. 98 patients (100 hips) had complete clinical and radiographic data 55 to 89 months after the operation. One acetabular and one femoral component had to be revised due to aseptic loosening without showing macroscopic evidence of metallosis and no histological evidence of excessive metal wear. As a none device related orthopedic complication one acetabular component required revision surgery due to a peri-prosthetic fracture. Conclusions: The mid-term results of the Hofer-Imhof Lubrimet¨Metal-on-metal articulation are encouraging and so the system may represent a viable alternative for total hip arthroplasty in younger higher demand patients.