Objective: Radicular symptoms of the cervical spine are usually effectively managed by cervical decompressive surgery when the symptomatic nerve root corresponds to the level of maximal radiological compression. The response is less predictable when the symptomatic level and the level of radiological compression are mismatched. The aim of this study was to retrospectively assess the efficacy of surgery in cases where symptom level and the level of radiological compression were mismatched.

Design: We conducted a casenote review of patients who underwent cervical decompressive surgery for radicular symptoms over a five year period with an average follow-up period of 3.5 years.

Subjects’ outcome: Three hundred and thirty-nine patients underwent cervical decompression during this period. Of these, 76 had surgery for isolated radicular symptoms. Nineteen of these patients had radiological and symptomatic mismatch.

Results: Seventy-five percent of those with mismatch initially had a good response to surgery, but 31% subsequently required a further operation. Comparable figures for those whose symptoms and radiology matched are 63% and 6%.

Conclusions: Patients who have radicular symptoms, which do not correspond to the level of radiological compression, do benefit from surgical decompression, but have an increased likelihood of requiring a second operation.

Purpose: To assess the clinical and radiological performance of the Ultima THR.

Material-Methods: Between January 1991 and July 1994, 147 consecutive patients (154 hips) underwent a primary THR using an all-polyethylene cemented cup and the Ultima Ti alloy smooth, collarless, double tapered, straight stem. 65% were females and primary diagnosis was OA or RA in the majority. The average age at operation was 66.4 years. At average follow-up of 76 months, 34 patients (35 hips) were dead and 5 were lost. Patients were annually assessed clinically (HSS) and radiologically. Radiographs were digitized and migration analysis and cup wear was performed using the EBRA method.

Results: There were 9 aseptic failures (5 stems, 1 cup and 3 both components). Cup migration analysis was possible in 106 cases. Migration was detected in 62 of them (18 proximal, 15 medial, and 29 combined). Proximal migration ranged from 0.8 mm-4.0 mm and medial migration from 1.0 mm–3.5 mm. The average cumulative linear cup wear was 0.2 mm. Stem migration analysis was possible in 114 cases. At 2 years, 35 stems subsided less than 1.5 mm. Migration of more than 1.5 mm was observed in 16 stems. Early subsidence of more than 1.5 mm was highly predictive for later revision.

Conclusions: Ti-stems have been criticised for high failure rate but the exact mechanism of loosening is multifactorial. Our revision rate and the low incidence of focal osteolysis, even in the presence of a small degree of stem subsidence, indicate that a smooth double tapered Ti-alloy cemented stem may offer a durable long-term solution.