In 1997 the “step-less” SL Plus (Endoprothetik, Rotkreuz, Switzerland) cementless total hip arthroplasty was introduced to our unit. During the passed 12 months, a retrospective study has been performed in order to evaluate the clinical and radiographic results of this arthroplasty. The preliminary results of the first 50 patients to have completed the clinical and radiographic follow-up have been evaluated. Of the 50 patients, 56 primary total hip arthroplasties were performed, in all cases the SL Plus stem was used. In 52 cases the cementless Doetz acetabular cup, made by the same manufacturer, was used. The other 4 acetabular components were: 2 long stemmed cementless components for developmental dysplasia, 1 standard cementless cup and 1 cemented cup, made by other manufacturers. All patients were reviewed clinically and radiographically. The mean follow-up time was 3 years, range 2 – 5 years. The mean Harris Hip Score was 90 (37 – 100). Patient satisfaction was: 98% satisfied, 2% dissatisfied (p < 0.001). Radiographic assessment demonstrated that all 52 (100%) Doetz acetabular cups osseointegrated, with 53 (95%) acetabular cups osseointegrating in total (p < 0.002). Of the SL Plus stems, 44 (79%) osseointegrated (p < 0.002). The following post-operative complications were observed: 2 dislocations, 2 superficial wound infections, 1 myocardial infarction, 1 sciatic nerve palsy and 1 deep vein thrombosis. The overall complication rate is high at 13%, but with no implant related failures. Nevertheless, the preliminary clinical and radiographic results of the SL Plus stem and Doetz acetabu-lar cup total hip arthroplasty are encouraging.

1. Evidence is presented which suggests that after total joint replacement bone necrosis and consequent loosening of the prosthesis may be due to the development of sensitivity to the metals used.

2. Nine patients, from a total of fourteen with loose prostheses, were found to be metal sensitive by skin-patch testing. In twenty-four patients with intact prostheses no sensitivity was demonstrated.

3. In material from the joints of sensitive patients the metal content was raised.

4. Examination of this material showed necrosis of bone and soft tissue following obliterative changes in the vascular supply.

5. Similar reactions were found following the injection of cobalt into a sensitive patient.

6. The release of metal around a prosthesis is greatest where metal rubs against itself.

7. We conclude that prostheses in which metal articulates with polyethylene should be preferred; that any patient in whom loosening or fragmentation occurs should be patch tested; and that if sensitivity is found the implant should be removed.

1. A method of treatment of posterior malleolar fracture is described which restores the proximal surface of the ankle joint to its normal position.

2. Reduction is achieved with a special clamp and the position held with a strong plate. Early ankle movements may therefore be encouraged without fear of redisplacing the fracture.

3. Perfect reduction is necessary to avoid the later onset of arthritis, and this was achieved in five of six patients reported.

1. Nine cases of stress fracture of the pelvis after total hip replacement are reported, five after Ring replacement and four after a McKee. In none of the cases did the fractures unite.

2. In three cases infection was probably an important cause of the fracture. In six cases there was no infection. Only one presented a history of injury.

3. The combination of the various factors that might have caused the stress fractures is discussed.