Decompression of the lumber spine for spinal stenosis is the most commonly performed spinal surgical procedure in patients over 60 years old. The aims of surgery are to relieve compression of the spinal nerves and retain integrity of the structural elements of the spinal column and its function as a supportive structure. In trying to avoid excessive removal of the posterior supportive structures of the spinal column without compromising full and safe decompression of the spinal nerves, techniques are being developed to reduce bone removal but also allow access to the spinal canal.

One such micro-decompression involves a hemi-laminectomy and lateral recess decompression on the more symptomatic side followed by undercutting the spinous processes and decompressing the opposite side from within the canal aided by the use the operating microscope, a high speed burr and a copper moldable retractor to protect the dura and nerves.

We have reviewed our first 100 consecutive patients who have had a spinal micro-decompression over a period of 5 years. 58 Female and 42 male patients are included in this series. Mean age was 65 years. Patients were assessed by a combination of clinical review and self-assessment questionnaires. After a follow-up period of up to five years (mean 3.5 years) we have seen symptomatic late instability develop in four patients requiring a further surgical procedure in two of these. Symptoms typically developed two years after the original operation following an initial improvement in radicular symptoms and back pain.

This compares favourably with published results for wide decompression where re-operation rates of 18% are reported. We have analysed the cases of delayed instability in more detail to evaluate whether the late deterioration could have been predicted.

Micro-decompression is shown to be safe with few complications and has advantages over wide decompression without compromising safety.

Introduction: The Thrust Plate Prosthesis (TPP) is a neck preserving femoral component in total hip arthroplasty (THA), allowing direct load transfer to the medial cortex of the femoral neck. We present an evaluation of its use in young patients with hip arthritis.

Methods: A consecutive series of patients were reviewed at a minimum of 5 years after THA using the TPP. Harris Hip Score (HHS) and Oxford Hip Score (OHS) were recorded pre-operatively and at the last clinical review. Radiographic analysis was performed and patient satisfaction levels and complications were recorded.

Results: Between 1996 and 2000 we implanted 41 prostheses in 38 consecutive patients (3 bilateral). The mean age at time of surgery was 56 years (41–67) and the mean length of follow up was 71 months. The HHS improved from a mean of 42 points pre-operatively to 88 points at the last clinical review and the mean OHS also improved from 40 points to 18 points. 83% of patients expressed that they were ‘very satisfied’ with the procedure. Three cases have since required revision surgery secondary to peri-prosthetic fracture, early deep infection and aseptic loosening (1 case each). Only one other case has radiological evidence of loosening or poor cortical contact with the collar of the TPP. Two patients have experienced sub-luxation or dislocation of the prosthesis. Eight patients suffer discomfort when lying on the operated side.

Discussion: These are the first results of the TPP from the United Kingdom. Whilst many of these young patients treated with the TPP show excellent improvement in clinical outcome scores and a high level of patient satisfaction, the complication rate gives some concern. We support the selective use of the TPP to treat young patients with hip osteoarthritis.