Purpose: The reputation of unicompartmental knee prostheses (UKP) has suffered from “errors of youth” but within the limits of the indication and with precise implantation, they have provided excellent results with miminal morbidity. We evaluated the five-year clinical and radiological outcomes with the Alpina-UNI prosthesis.

Material and methods: Fifty-eight Alpina-UNI prostheses (88% medial) were implanted in 1995 by two operators. Radiographic analysis was performed by an independent observer. The mean patient age at implantation was 72 years. Patients were evaluated at three months and one and five years. The Knee Society knee score as well as radiographic findings were noted. Indications were essential, traumatic, and necrotic non-displaced lateralised degeneration. Cemented implants were used for 92% of the knees. Results were analysed with SPSS software.

Results: At five years, 51 patients were reviewed, there were four deaths, one patient lost to follow-up and two early failures (secondary ACL tear, anterior descent of the tibial baseplate). Follow-up at 70 months was 95%. The KSS was significantly improved (+61%, p< 0.001) and remained stable during follow-up. Mean flexion at five years was 131°. Radiographic findings were satisfactory: no degradation of the contralateral compartment or the patellofemoral joint, no implant loosening or migration, no abnormal polyethylene wear. Stable lucent lines were observed for 17% of the implants, all measuring less than 1 mm. The mean tibial slope was 5°. There was no significant difference between the pre- and postoperative femoroatibial epiphyseal inclinations. The mechanical axis (HKA) was significantly improved (p< 0.001) and remained unchanged throughout follow-up, maintaining a 1°–5° undercorrection.

Discussion: The conclusions of the 1995 SOFCOT symposium emphasised the importance of indications and precise implant position for the prevention of early failure. The Alpina-UNI system has enabled reproducible accuracy for the femoral and tibial epiphyseal inclinations in the cuts allowing restoration of the initial anatomy, the correction of the HKA being explained solely by wear correction. This can explain the low rate of loosening and wear in this series. Unicompartmental replacement remains an excellent solution in the older patient due to the lesser morbidity. Mid-term results are encouraging. Further ten-year evaluation will provide information on implant longevity.

Purpose: We report a retrospective series of 98 consecutive total hip prostheses implanted without cement: the Aura stem and the Alizé cup coated with hydroxyapatite; reviewed at mean 9.6 years. The purpose of this analysis was to examine implant stability and wear.

Material and methods: Total hip prostheses implanted in 98 patients from January 1991 to January 1992 were reviewed: 60 women and 38 men, operated on by the same surgeon using an Alizé cup and an Aura stem without cement. Mean age at implantation was 66.5 years (30–85). Mean follow-up was 9.67 years. We retained 56 patients for this analysis (17 patients had died, 13 were lost to follow-up, 9 could not be followed, and 3 stem removals (3.1%)). This was the first procedure in all patients. Clinical outcome was assessed with the Postel-Merle-d’Aubigné (PMA) score and with a self-administered questionnaire. Radiologically, we assessed stability (tilt, implant displacement) and implant wear using MetrOs software data processing of digitalized radiograms. We also searched for qualitative radiographic signs of bone reaction to the implant.

Results: The overall PMA score improved from 11.96 preoperatively to 17.42 at the 5-year assessment and then fell to 15.67 at last follow-up. At five years 94% of the patients (92 hips) were satisfied and 98.3% (56 hips) were reviewed at 10 years. There were two fractures of the ceramic head after direct fall on the greater trochanter (requiring replacement of the femoral implant, the head and the polyethylene insert). There was one infra-prosthetic fracture which required stem replacement. Analysis of the radiograms did not demonstrate any abnormal ossification or lucency. MetrOs was used on 52 files: mean wear was 0.77 mm at 10 years (0.16–2.24 mm): wear and impaction (0.789 mm) of the stem were significantly correlated at 10 years while stem tilt was negligible.

Discussion: This radioclinical analysis demonstrated that these hydroxyapatite coated implants are stable over time. The clinical results are satisfactory with a small regression of the PMA score related to patient ageing. The radiographic measurements obtained with a precise rigorous tool were very encouraging. We compared our results with those of series using comparable implants.

Aims:ACL revision surgery is a second-generation type of knee ligament surgery. The artificial ligaments, the imperfect mastering of arthoscopic assisted surgery and the absence of clinical and radiological analysis of peripheral laxities are among the main factors for failures. Methods:43 patients of a mean age of 29y were previously operated between 1 and 5 times.14 artificial ligaments, 23 patellar tendons and 4 hamstrings tendons failed as a first ACL reconstruction. The mean time between the first operation and the index revision was 44 months. In 6 cases an additional HTO was used. Different tendon grafts were used: quadriceps 11, patellar 19 and hamstrings 8. In 3 occasions an additional extra articular reefing was used. The patients were reviewed by one independent observer using KT 1000, Stress X rays, IKDC form (2000). The mean follow up is 35 months (11–123)Results:The IKDC score in pre operative time was 19 D, 21 C and 1B. At the review the score is 2A, 28 B, 9C, 2D. The functional IKDC form show 37.5% of remaining pain, 44% of stiffness sensation and 12.5% of instability. The mean functional improvement is 44%. The mean laxity improvement is 5.3mm for KT1000 and 4.5mm for stress X rays. Conclusions:Revision ACL surgery is not as good as primary surgery. The reconstruction is technically difficult and must be ‘à la carte’ in order to take in account several simultaneous problems: bone defect, cartilage abnormalities, skin and ligament insufficiencies.

Purpose: We report a retrospective continuous series of 107 total hip arthroplasties using a hydroxyapatite-coaated cup followed for a mean 9.67 years. We studied implant stability and component wear.

Material and methods: One hundred total hip arthroplasties were performed between January 1991 and January 1992. The series included 67 women and 40 men operated by the same surgeon who used the same Alizé cup and Aura cementless stem. Mean age at surgery was 66.5 years (range 30–85). Mean follow-up at review was 9.6 years. We retained 63 hips for analysis excluding 17 deaths, 16 patients lost to follow-up, 10 patients who could not be followed correctly, and only one implant ablation (0.9%). The implant was a first intention prosthesis in 90.7% of the cases and a second operation to replace a loosened primary prosthesis.

The Postel Merle d’Aubigné score was used to assess clinical outcome and all patients responded to a self administered questionnaire. Radiographically, we searched for signs of instability (tilt, displacement) and implant wear using precise digitalized measurements on successive digitalized x-rays with MetrOs software. We searched for qualitative radiological signs of bone reaction in contact with the implant.

Results: The overall PMA score improved from 10.63 preoperatively to 16.98 at the intermediary 5-year follow-up and was 15.77 at the 10-year follow-up. Satisfactory results were obtained in 93.9% of the patients at five years and 98.5% of the patients (64 hips) at 10 years. There were two fractures of the ceramic head after direct fall on the greater trochanter (requiring changing the femoral implant, the head and the polyethylene insert). There was one cup loosening at 9.5 years with verticalisation of the implant in an active athlete. Analysis of the x-rays did not demonstrate any abnormal condensation or lucent lines. Bony defects were observed in one case. The MetrOs radiographic data were available for 55 hips. At five years, mean wear was 0.53 mm, which increased to 0.76 mm at ten years (range 0.16 – 2.24 mm). Cup ascension was 0.15 mm at five years and 0.76 mm at 10 years. Mean cup tilt was 46.2° immediately after implantation and varied a mean 0.7° at five years and 1° at ten years.

Discussion and conclusion: This radioclinical study at ten years follow-up demonstrates that the hydroxyapa-tite surfaced Alizé implant is stable over time. The clinical results in this study were satisfactory with minimal regression of the PMA score related to patient ageing. The x-rays analysed with a rigorous and precise measurement instrument provided reassuring results. We discussed the one cup loosening and the clinical course of the two patients who underwent revision procedures after trauma-induced fracture of the ceramic head.