Between June 1986 and 1993, 208 Protek CLS total hip replacements were inserted in 174 patients. These have been reviewed clinically and radiologically by independent observers at 3 yearly intervals.

One hundred and sixty six hips in 137 patients were available for review 9 to 15.5 years from insertion (mean just over 10.5 years). There has been no significant clinical or radiological change when compared to reviews three and six years ago with regard to the Harris Hip Score and the pain and function components of this. There has also been no change in subsidence, heterotopic ossification or lucencies. There has been no significant difference in results between males or females, nor between other factors such as pre-operative diagnosis, the use of metal or ceramic heads, age at time of operation or length of follow up. The failure rate remains low, less than 4%, i.e. survival rate greater than 96%. The reasons for failure in general do not relate to the fixation of either the acetabular or femoral components.

The results of this long-term follow up of a large group of relatively young patients at time of insertion of arthroplasty remain very satisfactory.

The purpose of the study was to review and present a series of early failures of the Miller Galante unicom-partmental knee replacement (UKR). Following several early failures all Miller Galante UKR’s inserted by the author (60 patients, 72 knees) were recalled for clinical and radiological review including assessment using the American Knee Society Score and the Oxford Knee Score. All knees with effusions were aspirated and specimens sent for histological analysis.

There were 22 females and 38 males with a mean age of 67 years. The mean follow up was 3.4 years. Six failures were noted with follow up from 10 months to 4 years. These 6 cases will be discussed in more detail including operative findings at revision and possible reasons for failure.

Early failure of this arthroplasty is unacceptable and caution should be exercised if contemplating using this implant unless more definite causative factors are identified.

The effect of hypobaric spinal anaesthesia or narcotic-halothane-relaxant general anaesthesia on the incidence of postoperative deep vein thrombosis was studied in 140 elective total hip replacements in a prospective randomised manner. Deep vein thrombosis was diagnosed using impedance plethysmography and the 125I fibrinogen uptake test, combined, in selected cases, with ascending contrast venography. The overall incidence of deep vein thrombosis was 20%. Nine patients (13%) developed deep vein thrombosis in the spinal group and nineteen (27%) in the general anaesthetic group (p less than 0.05). The incidences of proximal thrombosis and of bilateral thrombi were also less with spinal anaesthesia than with general anaesthesia. It is concluded that spinal anaesthesia reduces the risks of postoperative thromboembolism in hip replacement surgery. The presence of varicose veins, being a non-smoker and having a low body mass index were associated with an increased incidence of deep vein thrombosis.