Aim: The purpose of this report was to analyse the clinical and survivorship results and revision rates of Bichat III uncemented total hip arthroplasty in a community hospital setting. Poor results are rarely published what may have effect on the results of meta-analyses done on hip replacement surgery. At the time of selecting the prosthesis there were no reports published on this particular model. Methods: Between 1987 and 1990 þftyþve patients (57 hips) were operated using the Bichat III endoprosthesis. The prosthesis has a ßuted, anatomic and non-porous Ti femur, and a threaded nonporous acetabular cup. There were 25 male and 30 female patients. Mean age of the male patients was 62 (40–75) and that for the female 61 years (43–82). The indication for operation was primary arthrosis in 45, posttraumatic arthrosis in 5, LPC in 2 cases, and rheumatoid arthritis, AVN and CHD one each. All the operations were made using the Hardingen approach. For the survivorship analysis the patients were traced from the Finnish Arthroplasty Register and Kaplan-Meir survival was calculated for all the 57 patients with the 95% Cl. Those not revised until 31st December 2001 were called for clinical and radiological examination. The mean follow-up time was 12,7 years (11,4–14,2). Results: During the follow-up 16 patients died (28%), and revision was done on 21 patients (37%) after a mean follow-up time of 7,2 years (3,6–11,3). Seventeen patients arrived to the clinical follow-up; of those only 10 cases were without any radiological signs of loosening. For all the patients re-examined the Mayo Clinics Hip Score was 50.8 in average ((5–75), and that for those with radiological signs of loosening 46,3 (16–71). The survivorship calculated at ten years was 57,0% (95%Cl 42,5–71,6; 22 hips at risk). Typical features at revision were total loosening of both components, marked metallosis and breakage of the polyethylene liner. Conclusions: Our results are in accordance with other reports with uncemented, non-porous coated components, as well as with those of the screw þxed acetabular cups. Also the reports from other Nordic arthroplasty registers speak favour of the non-acceptable results with such concepts of THA. Publication of also the negative results of THA may decrease risk of sc. publication bias. We conclude that until now there is sufþcient evidence that porous coating on both components of hip endoprosthesis is crucial for reliable þxation of uncemented components. Prosthesis selection should be made on a well documented basis and trials should be made in arthroplasty centers and on a prospective and randomized basis.

We sought to determine the effect, if any, the presence of an untreated articular cartilage defect observed during ACL reconstruction would have on the results following surgery.

From 1987 to 1997, 34 of 2264 ACL reconstructions were found to have an isolated articular cartilage defect of the femoral condyles that were Fairbanks grade 3 or 4. This study group (DEF group) comprised 28 men and 6 women with a mean age of 28. 3 + 10. 1 years. These patients were matched for sex, age at time of surgery, injury type and sport played at time of injury from our prospective ACL database. None of the control group (CONT group) had any associated meniscus or chondral damage and had a mean age of 27. 3 + 8. 8 years. Routine subjective, objective and radiological prospective follow-up was undertaken.

The mean subjective follow up was 7. 2 + 3. 3 years and 7. 1 + 2. 9 in the DEF and CONT groups respectively with objective follow up similarly being 5. 4 + 3. 3 years and 5. 4 + 2. 5 years respectively. The annual mean subjective scores for the two groups were the same (all above 90) each year after surgery up to 12 years. 96% in the DEF group and 100% of patients in the CONT group returned to their same sports. The IKDC radiographic rating had 31 patients in the DEF group and 32 in the CONT group with normal or nearly normal knees.

Radiographic arthritic progression was seen in 6 patients in each group. Stability, range of motion and strength were similar in the two groups during follow-up. We found no significant difference between the two groups in any variable studied.

This study show that patients with chondral defects do not differ subjectively, objectively or radiographically from a matched control group for up to 12 years after surgery.

Between 1992 and 1997, we undertook a prospective, targeted clinical and ultrasonographic hip screening programme to assess the relationship between ultrasonographic abnormalities of the hip and clinical limitation of hip abduction. A total of 5.9% (2 of 34) of neonatal dislocatable hips and 87.5% (7 of 8) of ‘late’ dislocated hips seen after the age of six months, presented with unilateral limitation of hip abduction. All major (Graf type III) and 44.5% of minor (Graf type II) dysplastic hips presented with this sign.

Statistically, bilateral limitation of hip abduction was not a useful clinical indicator of underlying hip abnormality because of its poor sensitivity, but unilateral limitation of abduction of the hip was a highly specific (90%) and reasonably sensitive sign (70%). It was more sensitive than the neonatal Ortolani manoeuvre, which has been considered to be the method of choice. It was, however, not sensitive enough to be of value as a routine screening test in developmental dysplasia of the hip.

We consider unilateral limitation of hip abduction to be an important clinical sign and its presence in an infant over the age of three to four months makes further investigation essential.

We describe four women and two men who had persistent wrist pain and reduced function after minor operations on the dorsum, usually for ganglia. They had diffuse pain and paraesthesia over the dorsum of the wrist, thumb, index and middle fingers, which was worse and different from that before operation.

They all had temporary relief of symptoms after block of the posterior interosseous nerve with bupivacaine. Later, excision of the terminal branches of the nerve at the wrist cured three patients completely and gave marked improvement in the other three, with no complications.

Great care is required at operations on the dorsum of the wrist, but pain from a neuroma can be relieved by local excision.