Introduction: Primary operative stabilisation of Grade III injuries of the acromio-clavicular (AC) joint remains controversial, with recent literature providing support for conservative management. The aim of this research was to compare the clinical and radiological outcome of operative and non-operative treatment of this injury.

Materials and Methods: 56 patients (51 men, 5 women, aged 18 – 78 years) with an acromio-clavicular dislocation Tossy III were recruited into the study. 28 were managed surgically with a hook plate, and 28 were treated non-operatively with a sling until they were pain-free after a few days. The mean follow-up time was 23 months (8 – 31 months). At follow-up the patients were either examined clinically and radiologically or they were surveyed by phone. Clinical results were expressed in the Constant score and the subjective satisfaction of each patient was recorded.

Results: Eleven patients were lost to follow-up. Five patients were operated at their home hospital after initial treatment at our clinic, and four non-surgical patients were later treated with a modified Weaver-Dunn procedure.

Of the remaining 36 patients, 25 were examined clinically and radiologically and 11 were surveyed by telephone. The clinical outcome showed a mean Constant score of 87 in the operative group and 96 in the non-operative group. 30 of 36 patients were highly satisfied or satisfied (19 in the operative group, 11 in the non-operative group), 5 were mostly satisfied (operative group), 1 was unsatisfied (operative group). Radiologically, all of the operated patients showed changes of the AC-joint including widening of the joint, redislocation of the distal clavicle, and degenerative changes. In the non-operative group, three patients showed a decreasing clavicular elevation.

Conclusion: Clinical outcomes were comparable between operative and non-operative treatment of AC-dislocations grade III. Some conservatively treated patients did, however, require a secondary stabilisation. The hook plate was observed to cause additional local injury to the AC-joint, and must be removed after recovery to prevent rotator cuff damage. This procedure incurs high risk of loss of reduction. In our opinion, it is disputable to operate twice on the AC-joint to achieve similar results as those obtained with conservative treatment. We prefer a secondary anatomical reconstruction in cases of failed conservative treatment.

Introduction: The non-cemented, extramedullary anchored Thrust Plate Prosthesis (TPP) was conceived as an implant for younger people with osteoarthrosis of the hip. The proximal part of the femur is loaded as physiologically as possible by transmitting the hip joint force directly to the cortex of the femoral neck, enabling the bone stock in the proximal femur to be preserved.

Materials and methods: We prospectively followed-up 102 hip replacements radiologically and clinically in 84 patients (63 men and 21 women) with a mean follow-up time of nine years (6–12 years). The mean age at operation was 54 years for the men and 47 years for the women.

Results: Four implants were revised: two because of an infection and two because of aseptic loosening. In 85 implants major contact was maintained between the thrust plate and bone, in ten implants partial contact prevailed, and in only three instances did the bone retract from the thrust plate so that a gap appeared. The average Harris hip score (HHS) increased from 51 points preoperatively to 96 points postoperatively.

Conclusions: Our long-term results with the TPP are similar to those for conventional prostheses of the stem type. The detected radiological changes normally take place in the first two years after implantation. After the prosthesis is osseointegrated aseptic loosening of the prosthesis is very unlikely. Bone remodelling underneath the thrust plate is in 85% of the cases as expected from the biomechanical principles. These long-term results confirm our encouraging medium-term observations. The TPP is a prosthesis of first choice when revision might be expected, as in the case of younger patients.