The Kotz Modular Femoral Tibial Replacement system has been one of the most widely utilised uncemented modular systems for bone and joint reconstruction after tumour resection. We have identified a significant incidence of mechanical failure and breakage of the prosthesis. The purpose of this investigation is to review the modes of implant failure and the outcomes after prosthetic revision for a broken Kotz prosthesis. Over 20 years there were 121 distal femoral, 55 proximal tibial, 47 proximal femoral and 12 total femoral replacements performed.Background
Methods
Pathologic humerus fractures secondary to metastases are associated with significant pain, morbidity, loss of function, and diminished quality of life. Here we report our experience with stabilisation using intramedullary polymethylmethacrylate (PMMA) cement and non-locking plates. A retrospective review was undertaken of patients treated at a tertiary musculoskeletal oncology centre from 1989 to 2009. Patients who underwent surgery for an impending or completed pathologic humerus fracture with a diagnosis of metastatic disease or myeloma were included. All patients underwent intralesional curettage of the tumour followed by fixation with intramedullary PMMA and plating.Introduction
Methods
Wear of the ultra high molecular weight polyethylene (UHMWPE) cup and the resulting loosening has been shown to limit the long-term results of the Charnley low-frictional torque arthroplasty (LFA). Factors affecting wear rates have been studied: level of patient activity, effective roughness of the stainless steel head, impingement and the possible variations in wear characteristics of UHMWPE. Since patients' activity level cannot be predicted or modified, alternative materials were examined. The Charnley 22.225 mm diameter head of alumina ceramic in combination with chemically cross-linked polyethylene cup has now reached over 23 years of clinical and radiographic follow-up. Of the initial 17 patients (19 hips) in the study, 4 patients (4 hips) have died, 1 hip has been revised for deep infection and 3 patients (3 hips) are unable to attend follow-up due to medical problems unrelated to the hip. Nine patients (11 hips) are still attending follow-up at a mean of 22 years 5 months (21 year 3 months-23 years 6 months). The mean age at surgery in this group was 47 years (26-58) and the mean weight 81kgs (54-102). The mean penetration rate was 0.02mm/year and none have exceeded 0.41mm total penetration.Introduction
Methods and Results
