Aim: The early results of cementless femoral components in young patients have been reported, but there are only few reports with more than 10 years follow-up. Methods: We evaluated the clinical and radiographic results of the þrst consecutive 154 implantations of a cementless, double tapered straight femoral stem (cementless Spotorno (CLS), Sulzer Orthopedics) in 141 patients under the age of 55 (mean 47, 13–55) years. Results: After a mean follow-up of 12 (10Ð15) years, 11 patients (11 hips) had died and 7 (7 hips) could not be located. 5 patients (5 hips) underwent femoral revision- 1 for infection, 1 for periprosthetic fracture and 3 for aseptic loosening of the stem. Overall survival was 97% at 12 years (95%-conþdence limits, 93% Ð 100%), survival with femoral revision for aseptic loosening as an end point was 98% (95%-conþdence limits, 95% Ð 100%). The median Harris-Hip-Score at follow-up was 84 points. No thigh pain was found. Radiolucent lines in Gruen regions 1 and 7 were present in 21 hips (17%). 2 hips had radiolucent lines in regions 2 Ð 6 on anterio-posterior (AP) radiographs. No femoral osteolysis was found. Conclusions: The mid- to long-term survival with this type of femoral component is excellent and compares favorably with cemented stems in this age group. However the high rate of cup loosening and the low Harris Hip Scores are concerning in this group of young patients.

Aims: We report the clinical and radiologic outcome after cemented PFC®- TKA at mean follow-up of 9,1 years. Methods: Consecutively all patients with PFC®-TKA between 1989–1993 were investigated. Implant survival was estimated using the method of Kaplan-Meier. Radiologic evaluation was done using the criteria of the American Knee Society. Knee and Function Score of the American Knee Society were used to assess clinical outcome. Hannover Functional Ability Questionaire for Osteoarthritis (FFbH-O) measured limitations in activities of daily living. Visual analogue scale divided pain sensation and a 6-graded scale estimated patient satisfaction. Results: 140 TKA were performed on 122 patients (female:male ratio 3:1, average age 67 years, BMI 27,5). Follow-up rate was 100%. 5-year and 10-year survival was 97% and 92,7%. Radiologic measurements, diagnosis and BMI did not influence survival rate. Clinical results revealed 83 points for knee and 50 points for function score. 88% had a decreased FFbH-O. 57% had no and 33% slight-moderate pain. 72% were extremely or very satisfied. Patient satisfaction correlated well with the knee score, but poorly with the function score. Primary diagnosis (OA/RA) did not influence outcome. Conclusion: PFC®-TKA showed very good survival rates at 5 and 10 years. Knee score was mainly excellent-good, but function score was poor, mainly due to high patient age and associated diseases. Radiologic alignment did not influence outcome.

Aims: Acetabular reinforcement rings have been designed to deal with severe acetabular bone deþciencies in revision arthroplasty of the hip. We report midterm results of 3 different designs. Methods: Between 1986 and 2001, 346 ace-tabular revisions with reinforcement rings were performed at our institution. 20 Burch-Schneider Cages, 135 Ganz and 191 Mueller Rings were implanted. Average Age of the patients at the time of the intervention was 67 years (range 27–93 years). The average follow-up was 4 years (range 1–15 years). Bone defects were classiþed according to the AAOS-Classiþcation. Homologous allografts were used in most cases to reconstruct the acetabulum. Three different techniques were used for allograft preparation: Bone chips, bulk and morselized allografts. Results: Clinical results were moderate in most cases as multiple revisions or other disabling conditions have inßuenced the outcome. Mid-term survival was > 90% at 4 years. An attempt was made to correlate aseptic loosening with allograft preparation methods. Conclusions: Satisfactory results can be achieved at midterm using all three devices. However resorption of allografts leading to migration, dislocation or failure remain a major concern when acetabular reconstruction is used in revision hip arthroplasty.

We followed the first 354 consecutive implantations of a cementless, double-tapered straight femoral stem in 326 patients. Follow-up was at a mean of 12 years (10 to 15). The mean age of the patients was 57 years (13 to 81). At follow-up, 56 patients (59 hips) had died, and eight (eight hips) had been lost to follow-up. Twenty-five hips underwent femoral revision, eight for infection, three for periprosthetic fracture and 14 for aseptic loosening.

The overall survival was 92% at 12 years (95% CI 88 to 95). Survival with femoral revision for aseptic loosening as an endpoint was 95% (95% CI 92 to 98). The median Harris hip score at follow-up was 84 points (23 to 100). Radiolucent lines (< 2 mm) in Gruen zones 1 and 7 were present in 38 (16%) and 34 hips (14%), respectively. Radiolucencies in zones 2 to 6 were found in five hips (2%).

The results for mid- to long-term survival with this femoral component are encouraging and compare with those achieved in primary cemented total hip arthroplasty. The high rate of loosening of the cup and the high rate of pain are, however, a source of concern.