Because of bony lesions, revision surgery in the acetabulum is not always easy. We have a revision cross that we use to strengthen the bone cement and give extra stability in the presence of defects.

So far, two surgeons have performed operations on 60 patients. Follow-up times range from six months to five years. One patient has been lost because of sepsis.

We conclude that this is an effective way to augment revisions.

In cases of tumours, severe bone loss, etc., special pros-theses are sometimes required. It is also important to have a prosthesis that permits a switch from a primary knee system to a revision knee to a hinged knee.

This paper discusses and demonstrates some locally-manufactured prostheses.

In the question of shoulder arthroplasty, the indications for hemi-arthroplasty or total arthroplasty have been well described. There are advantages and disadvantages to each.

This paper reviews 30 cases of use of the Elite® shoulder prosthesis over three years. Results have been good. The procedure calls for few instruments but is effective.

The longevity of hip arthroplasty is especially important in young patients. High quality polythene and metals, coupled with improved bone cement and cementing techniques, have led to increased longevity. Of particular importance has been the cross-linking of ultra-high molecular weight polyethylene, which almost completely eliminates implant wear and projects the lifespan beyond the second decade.

In a three to four-year follow-up of patients, including a random sample of females under the age of 20 years, we have found the entire arthroplasty unchanged. The interface often becomes better integrated with time. The fact that there is no polythene debris is likely to have a direct effect on the longevity of the arthroplasty.

These results suggest that surgery can be contemplated in very young patients.

Discussion about the use of posterior stabilised or posterior retaining knee prostheses is likely to continue, although there seems to be an international trend towards posterior-sacrificing prosthesis. The remaining controversy hinges on whether stability in flexion is important, whether it is the condylar or epicondylar axis that is important, and whether platform orientation important.

This paper discusses the importance of stability. It suggests that neither the epicondylar nor the condylar axis can be used as absolutes, and that platform orientation plays an important role with rotational platform knee systems.

We give the preliminary results of 22 consecutive shoulder replacements done over a two-year period using a locally-produced prosthesis. Most of the replacements were done for traumatic reasons.

In the past, many high tibial osteotomies were done to relieve symptoms of osteoarthritis. These osteotomies have largely been replaced by total knee arthroplasty (TKA).

This paper presents the long-term results of 270 osteotomies followed up for 10 years and discusses the complications involved in subsequent conversion to TKA.

At the same time as the LCS knee, the ARD knee was developed. We aimed to assess whether over a 10 to 15-year period the SS 86 rotational platform knee system stood the test of time.

In a retrospective study, we followed up 250 patient, assessing patient satisfaction, range of motion and radiological appearance. Patient satisfaction was high and range of motion and radiological appearances very good.

Thromboembolism is a potentially fatal complication of total joint replacement. Some surgeons follow a ‘prophylaxis without compromise’ policy, while others, who realise that there are risks attached to the use of prophylactic drugs, go to the opposite extreme and administer no prophylaxis and no anti-thrombotic drugs, even for pulmonary embolism.

We believe the results of surveillance should determine the administration of anticoagulation therapy. In over 1 500 patients, anticoagulants have been administered only when clinically indicated and after positive Duplex diagnosis. Death due to pulmonary embolism has occurred in only two patients in six years, a reduction from 1.0% to less than 0.05%.

Our treatment protocol divides our patients into high and low risk cases. The results of Doppler and blood tests dictate the method and extent of prophylaxis for high-risk cases, and the therapeutic handling of positive clot formation in the low-risk population.

In a retrospective study, we examine the occurrence and management of sepsis in total knee arthroplasty. Histological examination and MCS play important roles.

In the past many high tibial osteotomies were done to relieve symptoms of osteoarthritis. Total knee arthroplasty (TKA) has largely taken the place of these osteotomies.

Aiming to evaluate the long-term results of these osteotomies and assess the complications involved on conversion to TKA, we followed up 207 patients over a 10-year period.

Wear of ultra-high molecular weight polyethylene (UHMWP) acetabular cups is a well-known cause of osteolysis and loosening of the components. Improvement of the wear resistance of UHMWP could extend the clinical life of total hip arthroplasty (THA). Chemical cross-linking in acetylene with gamma radiation is a cheap and effective way of increasing wear resistance of UHMWP.

This study is a report on 263 patients (123 males and 140 females) on whom Dr Weber performed THA between 1977 and 1984, using the Pretoria (Grobbelaar) monobloc stainless steel hip with 30-mm metal head. There were 96 patients (107 prostheses) available for follow-up at a mean of 18.3 years, with 89 surviving prosthesis in 79 patients (83.2%).

We collected complete sets of radiographs of 54 patients (mean age 71.4 years) for a radiological survey in 1999. In 41 patients (76%) we found no wear. The mean age of these patients was 72 years. Wear was noted in the other 13 patients (24%), whose mean age was 75 years. The mean follow-up time was 16 years (8 to 23). The mean magnification in the radiological study was 18%. Mean wear for the total group was 1.29 mm and mean annual wear 0.17 mm.

A similar analysis performed on a group of 64 of Dr Grobbelaar’s patients at 15.5 year mean follow-up shows remarkable similarity, with mean wear of 0.172 mm for a group of 64 patients and annual wear 0.11 mm. Dr Oonishi of Japan, who has conducted the only other long-term follow-up, found similarly promising results.

At the same time as the LCS knee, the ARD knee was developed. We aimed to assess whether over a 10 to 15-year period the SS 86 rotational platform knee system stood the test of time.

In a retrospective study, we followed up 250 patient, assessing patient satisfaction, range of motion and radiological appearance. Patient satisfaction was high and range of motion and radiological appearances very good.