Introduction: We conducted a retrospective study at our institution to see what effect, if any, the use of impacted morsellised bone allograft technique had on the incidence of early and late infection in revision hip arthroplasty where contemporary measures were taken.

Patients and Methods: This study included 120 patients.

Patients were 36 male and 84 females with the mean age at the time of revision surgery was 71.4 years (range 42 – 89 SD 9.7).

In all the patients their indication for revision surgery was aseptic loosening.

All the patients had impacted morsellised bone allograft as part of the reconstruction used with cemented prostheses.

Clinical and radiological assessments of all patients were conducted for average of four years follow up.

Results: At mean follow up period of 4 years the early infection rate was 0.8% and late infection rate was 0%.

Conclusion: In our study the use of morsellised bone allograft does not appear to have added risk effect on the incidence of early or late hip joint infection provided contemporary measures are taken.

Aim: This study is describes the clinical and radiological results of 28 hips with Paprosky Type 3 acetabular defects treated by impacted morsellised bone allograft technique and followed up for a mean period of 72 months. Method: The complete cohort of 27patients (28 hips) classiþed as severe acetabular deþciencies (Paprosky type 3) and got treated by impacted morsellised bone allograft technique was available for clinical and radiological review at mean follow up of 72 months (range 48 to 91 months). All the patients were assessed clinically according to the Harris hip-score. All radiographs were digitised using high resolution digitiser. Measurements of subsidence and migration were done using image analysis software. All the radiographs were examined for evidence of radiolucent lines in the three zones of DeLee and Charnley and graft incorporation was assessed from serial radiographs. Results: The results of revision surgery using this technique showed a clinical survival of 96.4% and radiological survival rate 92.85%. Conclusion: Our results have shown that the clinical and radiological results using impacted morsellised allograft technique have been extremely gratifying. The morphological changes seen in these grafts would indicate that the bone grafts utilised have not only incorporated but continue to function in a stable manner. The technique of impaction bone allograft using morsellised fresh frozen allograft appears to be a valuable biological option in revising cases with severe acetabular deþciencies with superior mid-term results.

Aim: To assess intra and inter observer variability in classiþcation of cement bone demarcation around a cemented acetabular component. Method: We collected 46 random triplets of radiographs taken six weeks, one year and a mean of 9.5 years post-operatively. Each of the three observers (1,2,3) evaluated all radiographs independently, and the evaluations were repeated by two observers (a, b) after 2 to 4 weeks. Inter and intra-observer variation was evaluated using the kappa coefthorn;cient of agreement. The strength of agreement was interpreted according to the Landis and Koch method. Results: There was substantial agreement in classiþcation of zone 1 for all time points and of all three zones for the þnal radiographs. Classiþcation of zones 2 and 3 were not reliable until after one year of follow-up. Conclusion: We have shown that zone 1 can be assessed reliably by different observers from the þrst follow-up radiograph. Therefore we recommend that zone 1 demarcation should be used as an index of performance comparable between cemented sockets especially where follow up has been less than ten years.

The BOA recommends clinical and radiological follow-up at þve-yearly intervals in order to detect failing implants. We support this recommendation and have shown that with longer followÐup the assessment of demarcation in all three zones has substantial agreement

A study was made of knee stiffness after fractures around the knee in patients with spina bifida. Thirty-one patients with 45 fractures were followed up for 2 to 15 years after the fracture. Knee stiffness was found in 67% of patients; this amounted to loss of up to half the normal range of movement. The stiffness appeared at two months from the time of the fracture and was established by six months. However, in all patients it had resolved by three years, so that their mobility was not affected in the long term. It is concluded that though stiffness is common after fractures in patients with spina bifida, it should be treated expectantly as it will resolve within three years without specific treatment.