The purpose of this study was to analyse the twenty to twenty-five year outcomes of one hundred and ninetyfive cemented, matte finish, HD-2 THRs performed in one hundred and sixty-six patients with osteoarthritis of the hip by two surgeons.

The one hundred and ninety-five THRs (one hundred and sixty-six patients) were followed prospectively by clinical assessment using the Harris Hip Score (HHS) and radiographic analysis.

One hundred and forty-nine patients (90%) died with their implant still functioning or still had a successful implant at twenty to twenty-five years follow-up. Ten patients (6%) underwent a revision for aseptic loosening of the acetabular (n=2, 1.2%) or femoral (n=4, 2.4%) component, or both (n=4, 2.4%), that was related to wear-induced osteolysis. 7 (4.2%) patients (eight hips) were lost to follow-up. The mean HHS at the latest follow-up (twenty to twenty-five years) was 88±9. Radiographically, twenty-nine (85%) of the acetabular components were well fixed and four (12%) were probably or possibly loose. Two hips (6%) had probable or possible loosening of the femoral component. At twenty five years, the calculated cumulative survival rate (Kaplan-Meier method) revealed excellent results for revisions (83%±6, any cause) and aseptic loosening (86%±6, femoral component, 93%±3, acetabular component).

The surviving patients had a good mean follow-up and radiographic fixation, proving the exceptional long-term success of this implant.

Purpose: The young patient with hip arthritis remains one of the biggest challenges to arthroplasty surgeons. The difficulty of providing a long-lasting total hip arthroplasty (THA) has been clearly documented in the literature. The aim of this study was to assess the outcomes of uncemented THA’s performed in our unit in patients aged under 50.

Methods: In our unit information on all patients is recorded prospectively on an arthroplasty database. From this database we identified 273 uncemented THAs in 237 patients under the age of 50 performed in our unit between 1985 and 2000 with a minimum of 5 year follow up. Outcomes were assessed in terms of 10 and 15-year survival with revision for any reason as the endpoint. Hip scores at routine and most recent follow-up were also reviewed. All surviving implants were radiographically assessed for acetabular wear, component loosening and for the presence of osteolysis.

Results: The mean age of patients at the time of surgery was 41.1 years. 36 patients had bilateral THA. The overall 10 and 15 year survival was 88.7 ± 2.4% and 65.6 ± 4.8 % respectively. Femoral stem survival was significantly higher at 100 % and 98.4 ± 1.6% at 10 and 15 years. Acetabular component survival was 88.6 ± 2.5 % at 10 years and 65.9 ± 4.8 % at 15 years. In unrevised THA’s 56.9% had asymmetric polyethylene wear > 2mm. 2% had definite evidence of acetabular loosening. 25.5% had radiographic evidence of femoral cortical hypertrophy or spot-welds. The mean HHS pre–operatively, at 5 and 10-year follow-up was 46.4 ± 13, 90.7 ± 12.2 and 87.9 ± 14.7 respectively.

Conclusions: Uncemented THA is effective even in young active patients. The main challenges remain ace-tabular polyethylene wear and loosening. Femoral uncemented stems provide long-term functional fixation. Contemporary bearing surfaces in association with such stems may provide long lasting THA’s even in young active patients.

We assessed proprioception in the knee using the angle reproduction test in 20 healthy volunteers, ten patients with acute anterior instability and 20 patients with chronic anterior instability after reconstruction of the anterior cruciate ligament (ACL). In addition, the Lysholm-knee score, ligament laxity and patient satisfaction were determined.

Acute trauma causes extensive damage to proprioception which is not restored by rehabilitation alone. Three months after operation, there remained a slight decrease in proprioception compared with the preoperative recordings, but six months after reconstruction, restoration of proprioception was seen near full extension and full flexion. In the mid-range position, proprioception was not restored. At follow-up, 3.7 ± 0.3 years after reconstruction, there was further improvement of proprioception in the mid-range position. There was no difference between open and arthroscopic techniques. The highest correlation was found between proprioception and patient satisfaction. After reconstruction of the ACL reduced proprioception may explain the poor functional outcome in some patients, despite restoration of mechanical stability.