Aims: The purpose of this study is to answer the question, whether local femoral head bone banks are still suitable and how to manage and make them safe. Methods: Surgical donors (THR) are selected by medical history, clinical examination and internationally standardized serological testing. Femoral heads are prucured during THR under OR-sterile conditions. Two different viral and bacterial inactivation methods are performed regularly. Either heads are devided into halves and then autoclaved in an open sterile hot and cold resistant box (121°C,20min,1,4 bar) or entirely processed in a closed sterile box in a water bath (80°C,100min-Marburger bone bank system) and stored in a refrigerator (−80°C). Validation of inactivation has been performed using measurement of the temperature in the center of the bones. Results: 867 bone allografts processed in the described method have been transplanted between 1993 and 2001 in our hospital. Autoclaved grafts have been used in limited bone defects with good surrounding bone stock quality. Water bath treated entire femoral heads have been used in total joint revision surgery. Temperature measurement in autoclaved bones confirmed the biological validation performed by Ph. Chiron (EAMST 1993). Water bath treatment has previously been validated. These grafts proved to be safe, effective and affordable and avoid the higher infection risks of bones procured from organ donors. By the described method we are able to meet a big part of the bone allograft demand in our institution. Conclusions: Using the described method local femoral head bone banks can procure safe and reasonable bone allografts from living surgical donors (THR). Allografts from organ donors cause higher risks and should be used where structural grafts are needed.

Aim: In Germany an ultrasound screening examination to determine CDH is recommended for all children in the first 6 weeks of life. We evaluated this ultrasound-screening-program together with the German Association of health insurance carriers over five years to show if an early ultrasound of the hip can reduce the number and the required operative procedures of children with CDH.

Methods: From 1997 to 2002, we documented monthly all children with CDH aged ten weeks up to five years from all German paediatric orthopaedic departments with a registration card and questionnaire. Children with neuromuscular diseases or teratologic dislocation of the hip, enrolled in out-patient treatment programs, as well as children born abroad were excluded.

Results: Overall we registered 645 children, 534 with single operative procedure. 68% received a closed reduction of the hip, 11% open, while 21% required an oste-otomy of the acetabulum and/or femur. The percentage of the single operative procedures did not change over the years. The number of children, who underwent no ultrasound of the hip before diagnosis decreased from 20% in the first year to 10% in the last. The first ultrasound examination revealed no pathological findings in 20% of the cases. During the five years children received the first screening more and more at the age four to six weeks than during the first days of life. Nevertheless, the yearly number of cases declined by 50%.

Conclusion: Despite the German ultrasound-screening-program late or undiagnosed CDH still exists in our country. A possible reason can be the quality of ultrasound examination, the form of treatment as well as a later worsening of CDH and the so-called endogenous dysplasia. The aim must be the improvement of diagnosis and treatment.