Aims: To investigate the potential of biological þxation of cementless total hip prosthesis in patients over 75 years old, with diagnosed osteoporosis. Methods: Between 1994Ð2000, 30 patients (mean age 77.3 years) underwent total hip arthroplasty (THA). Twenty-two (22) patients, 10 male and 12 female, were found at the last follow-up, which ranged from 1.5–7 years (mean follow-up, 3 years). THA was performed due to primary osteoarthritis (n=16), subcapital fracture (n=4), or dysplastic hip (n=2). Eight (8) smooth, tapered design (CLS) and 14 proximally porous coated prostheses were implanted. Singh index was used for the evaluation of osteoporosis and modiþed Harris Hip Score was used for the clinical evaluation of each patient. Modiþed Wixon score was used for the evaluation of stability probability of the tapered stem. Engh score was calculated for the evaluation of osseointe-gration of the porous coated implants. Results: Pre and post-operative mean Singh index was grade 4. Mean modiþed Harris Hip Score at the last follow-up was 88.6. For the CLS-Spotorno stem a stable þxation probability was calculated at 74.8%, while possible instability was calculated at 48.17%. Porous coated stems provided +13.45 mean Engh score, implying satisfactory þxation of the implant. Post-operative systematic complications are not reported, in contrast to 3 dislocations in the þrst post-operative period, which were treated by closed reduction. Conclusions: In patients over 75 years old, with possible cardiopulmonary disease, cementless total hip arthroplasty offers a reliable treatment, regardless the presence of osteoporosis. Satisfactory osseointegration and absence of systematic complications is compromised by the high cost of titanium implants.

Aim: To investigate the potential of biological fixation of cementless total hip arthroplasty (THA) in patients over 75 years old, with diagnosed osteoporosis.

Material-Methods: Between 1994–2000, 30 patients (mean age 77.3 years) underwent cementless THA.25 patients were found at the last follow-up, which ranged from 3–7 years (mean follow-up,4 years).THA was performed due to primary osteoarthritis (n=18), subcapital fracture (n=5), or dysplastic hip (n=2).7 Spotorno,9 Synergy and 9 Perfecta prostheses were implanted.Singh index was used for the evaluation of osteoporosis and Harris Hip Score (HHS) was used for the clinical evaluation of each patient.Modified Wixon score was used for the evaluation of stability probability of the tapered stem.Engh score was calculated for the evaluation of osseointegration of the porous coated implants.

Results: Pre and post-operative mean Singh index was grade 4.Mean HHS at the last follow-up was 88.6.For the Spotorno stem a stable fixation probability was calculated at 74.8%.Porous coated stems provided +13.45 mean Engh score,implying satisfactory fixation of the implant.Postoperative systematic complications are not reported.

Conclusions: In patients over 75 years old, with possible cardiopulmonary disease, cementless total hip arthroplasty offers a reliable treatment,regardless the presence of osteoporosis.Satisfactory osseointegration and absence of systematic complications is compromised by the high cost of titanium implants.

Aim:Evaluate the results of primary cemented/cementless THA for the treatment of displaced femoral neck fractures.

Material-Method:121 pts with femoral neck fractures underwent THA 2.1 days on average after their admission.The mean follow up period 4.1 y.112 pts had Garden III-IV fractures,9 pts had Garden II fractures.A cementless THA was applied in 75 pts (Group A,average age 61.4 y),46 pts were treated with cemented THA (Group B,72.4 y).Last follow up evaluation with Harris Hip Score (HHS) and radiological assessment with the Engh/Wixon scores was available in 92 pts.In 25 elderly pts a cementless THA was applied due to established impairment of their cardiopulmonary status.

Results:The mean HHS was 82,3.Radiological score for the cementless THA:+5,8 for the cup and +6,4 for the stem according to Engh scale (satisfactory integration for the prosthesis Perfecta,Synergy) and a 74,8% liability of integration according to Wixon scale (Spotorno).Complications:Early dislocation 3,loosening 5,heterotopic ossification 8,periprosthetic fracture 1,femoral nerve paresis 1,wound infection 1.No systematic complications were noted in the elderly patients with cardiopulmonary disorders,possible due to selection of a cementless THA.

Conclusions:THA (cemented/cementless) for the treatment of displaced femoral neck fractures give very good midterm results.Cementless THA is probably the choice of treatment in elderly pts with cardiopulmonary disorders.

To investigate the potential of biological fixation of cementless total hip prosthesis in patients over 75 years old, with diagnosed osteoporosis.

Between 1994–2000, 30 patients (mean age 77.3 years) underwent total hip arthroplasty (THA). Twenty-two (22) patients, 10 male and 12 female, were found at the last follow-up, which ranged from 1, 5–7 years (mean follow-up, 3 years). THA was performed due to primary osteoarthritis (n=16), subcapital fracture (n=4), or dysplastic hip (n=2). Eight (8) smooth, tapered design (CLS) and 14 proximally porous coated prostheses were implanted. Smgh index was used for the evaluation of osteoporosis and modified Harris Hip Score was used for the clinical evaluation of each patient. Modified Wixon score was used for the evaluation of stability probability of the tapered stem. Engh score was calculated for the evaluation of osseointegration of the porous coated implants.

Pre and post-operative mean Singh index was grade 4. Mean modified Harris Hip Score at the last follow-up was 88.6. For the CLS-Spotomo stem a stable fixation probability was calculated at 74.8%, while possible instability was calculated at 48.17%. Porous coated stems provided +13.45 mean. Engh score, implying satisfactory fixation of the implant. Post-operative systematic complications are not reported, in contrast to 3 dislocations in the first post-operative period, which were treated by closed reduction.

In patients over 75 years old, with possible cardiopulmonary disease, cementless total bip arthroplasty offers a reliable treatment, regardless the presence of osteoporosis. Satisfactory osseointegration and absence of systematic complications is compromised by the high cost of titanium implants.

Aim: To evaluate the midterm results of primary cemented or cementless total hip arthroplasty for the treatment of displaced femoral neck fractures.

Material and Methods: Between 1990–2000, 121 patients with displaced fractures of the femoral neck underwent primary prosthetic replacement 2.1 days on average after their admission. The mean age of the patients was 65,7 years (ranged 33–88) and the mean follow up period 4,1 years (mean 2–10 years), 112 patients had type III–IV femoral neck fractures according to Garden classification while the rest 9 patients had Garden II fractures but with associated osteoarthritis of the hip joint, A cement-less total hip arthroplasty was applied in 75 patients (Group A, average age 61,4 years) while the rest 46 patients were treated with cemented T.H.A (Group B, average age 72.4 years). Last follow up evaluation with the modified Harris Hip Score (HHS) and radiological assessment with the Engh and Wixon et al scores was available in 92 patients. 10,8% of the patients died from reasons unrelated to the implant, In 30 elderly patients (< 75 years old, 22 available in the last follow up) a cementless T.H.A. was applied due to established impairment of their cardiopulmonary status (coronary disease, chronic heart failure, COPD, positive history of myocardial infarction) or systematic diabetes mellitus.

Results: The mean HHS was 82, 3 degrees (52–97). Radiological score for the cementless T.H.A. was +5, 8 for the cup and +6,4 for the stem according to Engh scale (satisfactory integration for the proximal porous prosthesis-Perlecta, Synergy), and a 74,8% liability of integration according to Wixon scale (Sportono type of prosthesis). Complications were recorded in 19 patients: Early T.H.A, dislocation 3, 26% (3 Pi), loosening 5,4% (5 Pt), heterotopic ossification 8,6% (8 Ft), periprosthetic fracture 1,08 % (1 Pt) and femoral nerve paresis 1,08 % (1 Pt). One patient (1, 08%) had superficial wound infection treated with i.v. antibiotics, continuous irrigation and debridement. No systematic postoperative complications (acute renal failure, heart failure, coma) were noted in the elderly patients with cardiopulmonary disorders, possible due to selection of a cementless prosthesis and therefore to the lesser intraoperative time and the avoidance of toxic reactions from the cement.

Conclusion: Total cemented or cementless prosthetic replacement for the treatment of femoral neck fractures in selected cases give very good midterm results. Cementless T.H.A, is probably the choice of treatment in elderly patients with cardiopulrconary disorders, as the integration of the prosthesis is not affected from the degree of osteoporosis and the toxicity of cement is avoided.