Using a computer-based quality assurance program, we analysed peri-operative data on 160 patients undergoing one-stage bilateral hip or knee arthroplasties under regional anaesthesia with routine anaesthetic monitoring and only using peripheral intravenous access for peri-operative safety. We monitored defined intra-operative adverse events such as hypotension, myocardial ischaemia, arrhythmias, hypovolaemia, hypertension and early post-operative complications. We also determined post-operative hip and knee function, and patient satisfaction with different aspects of the anaesthetic management. Those patients undergoing one-stage bilateral arthroplasties were matched according to a cross-stratification which used three variables (American Society of Anesthesiologists’ physical status scoring system, age and joint replaced) to patients undergoing unilateral hip or knee arthroplasties. Serious intra-operative adverse events were, with the exception of intra-operative hypotension, very infrequent in patients undergoing bilateral (nine adverse events) as well as unilateral arthroplasties (five adverse events). Early post-operative complications were also infrequent in both groups. However, the risks of receiving a heterologous blood transfusion (odds ratio 2.5; 95% confidence interval (CI) 1.3 to 5.0, estimated by exact conditional logistic regression) or vasoactive drugs (odds ratio 3.9; 95% CI 2.0 to 7.8) were significantly greater for patients undergoing bilateral operations. Patient satisfaction with anaesthesia was high; all patients who underwent the one-stage bilateral operation would choose the same anaesthetic technique again.

Aims: The outcome analysis of different revision techniques should provide guidelines for future stem revisions. Methods: Between 1989 and 2000 revisions of 478 femoral stems were performed. 252 of them with cemented components and 226 without cement. In 86 cases a Wagner revision stem was used. The mean observation time was 6.4 years. Success and failures were analysed and classified. Results: Four types of defects and remaining bone stock patterns could be distinguished: Type I with normal diaphyseal bone and minor lesions at themetaphyseal side, type II with a regular isthmus but defects, mostly contained ones, of the proximal femur, type III a wide isthmus with a thin and cylindrical cortical wall, type IV with destructions of the proximal femur which need structural allografting to provide sufficient initial stability. Type I revisions can be performed with regular components as used in primary cases, type II revisions need a slightly longer revision stem with either conical or cylindrical diaphyseal part, type III should be treated with components, that allow for axial load transmission proximally and can take rotational loads distally (the “load sharing concept”). Type IV needs a long revision stem in combination with an appropriate choice of structural allografts. Conclusions: If the type and length of the revision stem is chosen according to this classification, the failure rate of stem revisions can be reduced and the us of expensive allografts can be limited.

Introduction: The operation method selected for acetabular revisions depends on the type of deþciency; Type 1: contained cavitary; the acetabular rim is preserved and thus supportive. Type 2: non-contained deþciencies; the acetabular rim and the peripheral zones are non- supportive defects. In non-contained, rim non-supportive defects acetabular reinforcement rings are used as a rule. Material and methods: Between July 1988 and December 1997 465 acetabular revisions with 229 Reinforcement Rings and 236 Press- Fit Cups (4 bilaterally) were performed. A 7.5 (5.0–10.8) year clinical and radiological follow-up of the Press-Fit Cup inserted in 130 women and 102 men was effected. Mean age at revisions surgery was 70 in women and 73 in men. 39 patients (17%) died without needing a re-revision, and 17 (7%) could only be interviewed by phone. One patient was lost to follow-up. Of the remaining 175 patients (75%) with 179 hips (76%) were available for complete evaluation. Results: The clinical results (according to Merle dñAubignŽ) was excellent and good in 82% 143 pts), moderate in 17% (30 pts) and poor in 1% (2 pts). 22 (9%) reinterventions were noted during the observation period: 12 for dislocations, 5 for aseptic stem loosening, 1 for septic loosening, 2 for secondary periprosthetic fractures and 2 for removal of heterotopic ossiþcations. Conclusions: No Press-Fit Cup had to be re-revised for aseptic loosening. Reconstruction for contained, rim supportive defects with the Press-Fit Cup provides excellent results, comparable to those of primary arthroplasties.

The need for supplementary screw fixation in acetabular revisions is still widely debated. We carried out 439 acetabular revisions over an eight-year period. In 171 hips with contained or small segmental defects, the Morscher press-fit cup was used. These revisions were followed prospectively. No screws were used for additional fixation.

A total of 123 hips with a mean follow-up of 7.4 years (5 to 10.5) were available for clinical and radiological review. There was no further revision of a press-fit cup for aseptic loosening. Radiological assessment revealed osteolysis in three hips. Of the original 171 hips there was cranial and medial migration of up to 6 mm at two years in 44 (26%). No further migration was seen after the second post-operative year. Acetabular revision without screws is possible with excellent medium-term results in well selected patients.