1. A total of 120 Moore's arthroplasties in 111 patients were reviewed one to nine years after operation. 2. There was striking reduction in the severity of pain in 105 out of the 120 hips reviewed. Range of movement was improved in most patients but the degree of independence was improved less often. The reasons for this are discussed. 3. We draw the following conclusions regarding the place of Moore's arthroplasty. Firstly, it was a natural step in the evolution towards total hip replacement, an operation which promises to give more complete relief of symptoms and which seems likely to replace Moore's arthroplasty as the treatment of choice in osteoarthritis of the hip in the elderly. Secondly, Moore's arthroplasty is still a rational procedure for the treatment of degeneration if the acetabulum is not involved—for instance, in idiopathic avascular necrosis of the femoral head. Thirdly, it is certainly a valuable operation for some cases of recent fracture of the femoral neck. Avascular necrosis of the femoral head after trifin nailing can be satisfactorily treated by Moore's arthroplasty, particularly in the early stages before the acetabulum becomes involved. Finally, Moore's arthroplasty gave many fairly elderly patients considerable relief of pain at a time when nothing better was available. Much of the relief afforded has proved to be lasting, but deterioration sometimes occurred with time. In the few patients whose deterioration amounted to failure a definite cause for the failure was found. In the majority the deterioration was slight, and it seems likely that the operation will last most of these elderly patients for the rest of their lives.
1. The term "bumper fracture" is colourful but usually inaccurate. The injury is a valgus split or crush. 2. A series of sixty bumper fractures is reported: forty-eight were treated without operation or plaster. 3. Twenty-seven of the forty-eight patients treated without splintage have been followed up for more than five years, and seventeen of these for more than ten years. 4. The results are satisfactory and there is no evidence that there is any late deterioration of the joint. 5. It is suggested that bumper fractures should be treated without operation and without fixation in plaster.
1. Arthrodesis of the hip is satisfactory provided a good range of knee flexion is preserved. 2. The hip is best arthrodesed in its deformed position, and the deformity corrected by a high femoral osteotomy. Knee range can readily be retained by treating the patient on traction for the first six weeks instead of using plaster. 3. Thirty-three arthrodeses were attempted without osteotomy. Only thirteen were satisfactory. Even our best method without osteotomy gave sound fusion in only seven out of ten cases. 4. In a series of twenty-three unselected cases in which osteotomy was performed in addition to other methods, fusion occurred in twenty-two.
