We describe 88 knees (79 patients) with lateral unicompartmental osteoarthritis which had been treated by the St Georg Sled prosthesis. At a mean follow-up of nine years (2 to 21) 15 knees had revision surgery, nine for progression of arthritis, six for loosening, four for breakage of a component and four for more than one reason. Six patients complained of moderate or severe pain at the final follow-up. Only five knees were lost to follow-up in the 21-year period. We performed survivorship analysis on the group using revision for any cause as the endpoint. At ten years the cumulative survival rate was 83%, and at 15 years, when ten knees were still at risk, it was 74%. Based on our clinical results and survival rate the St Georg Sled may be considered to be a suitable unicompartmental replacement for isolated lateral compartment osteoarthritis

We report the results of 24 acetabular reconstructions in which cemented polyethylene cups and tamped corticocancellous allografts were used for severe acetabular bone deficiency. Eleven hips had type-II (cavitary) bone deficiency and 13 had type-III (combined) defects. At a mean follow-up of 5.8 years, two components had migrated more than 5 mm and had accompanying radiolucent zones of more than 2 mm width. A radiolucency 5 mm wide was also seen in zone III of an acetabular implant which had not migrated. None of the patients had required revision because of loosening or infection

We carried out 71 primary total hip arthroplasties using porous-coated, hemispherical press-fit Duraloc ‘100 Series’ cups in 68 consecutive patients; 61 were combined with the cementless Spotorno stem and ten with the cemented Lubinus SP II stem. Under-reaming of 2 mm achieved a press-fit. Of the 71 hips, 69 (97.1%) were followed up after a mean of 2.4 years. Migration analysis was performed by the Ein Bild Röntgen Analyse method, with an accuracy of 1 mm. The mean total migration after 24 months was 1.13 mm. Using the definition of loosening as a total migration of 1 mm, it follows that 30 out of 63 cups (48%) were loose at 24 months

We reviewed 80 patients (87 hips) who were older than 80 years of age at the time of cementless total hip arthroplasty. An Alloclassic SL stem had been implanted in all patients. A variety of cementless acetabular components was used. After a mean follow-up of 69.3 months (39.2 to 94.1) 48 hips in 43 patients were analysed clinically and radiologically. One patient had sustained a traumatic periprosthetic fracture of the femur with subsequent exchange of the stem 73 months after operation. Thirty-two patients (34 hips) had died and five patients (five hips) were unavailable for follow-up because of health reasons (four patients) or lack of co-operation (one patient). If the endpoint is defined as removal of the prosthesis because of aseptic loosening, the survival rate was 100% for the cup and stem after 78 months. The mean Harris hip score was 81.9 points. Radiolucent lines and osteolysis were seldom found

We report the preliminary findings of the use of roentgen stereophotogrammetric analysis to evaluate the early migration of five femoral components after revision for mechanical loosening using impacted cancellous allograft and cement. All hips were examined at one week, four to six months and one year after surgery. All the components subsided by 0.4 to 4.9 mm during the first year. In four hips the prosthetic head was displaced 1.1 to 6.9 mm posteriorly. Fixation of the femoral components was less secure than after primary arthroplasty but the incidence and magnitude of early migration were similar to those after revision with cement alone

Four hundred and fifteen patients with cementless acetabular components of either a smooth threaded (130) or porous surfaced (285) variety were compared for clinical symptoms and radiographic signs of component loosening. At a mean 4.8 year follow-up none of the patients with porous acetabular components had signs of component instability. At a mean 3.9 year follow-up 27 (21%) of the patients with a smooth threaded acetabular component showed radiographic signs of instability and 33 (25%) had clinical symptoms. The disappointing short-term results with these threaded cups in our hands have prompted us to abandon their use in favour of the porous surfaced hemispherical cups

Torsional instability of femoral components has not received much attention, and is difficult to detect in conventional radiographs. To test this we designed a system to apply a load in an anteroposterior direction to the head of a femoral component, implanted into a cadaveric femur. Rotation within the bone was measured, using a purpose built transducer, with and without preservation of the neck, with and without cement, and with longitudinal ridges but no cement. The results show that torsional instability may be a problem in uncemented replacement. Preservation of the femoral neck and the use of a ridged prosthesis increases resistance to rotation. Rotational movements occurring in vivo during such activities as climbing stairs and rising from the seated position may contribute to mechanical loosening

We describe a method of internal fixation for femoral neck fractures which has been newly developed to reduce the frequency of early complications. Two cannulated screws are inserted in the axis of the femoral neck to reach into the subchondral bone of the femoral head. The screws are inserted over guide pins and the tip of the screw is self-tapping and designed to provide good anchorage in the femoral head. We used this method in 44 consecutive patients in a prospective study with no exclusions, followed for a minimum of 24 months. All fractures healed within 12 months, and there were no cases of early loosening or nonunion. In four cases, late segmental collapse had developed during the mean follow-up period of 30 months

Between 1969 and 1985 26 patients with destructive lesions of the distal humerus were treated by endoprosthetic replacement; each implant was custom-made and incorporated part of the distal humerus or the entire bone as well as a hinged total elbow replacement. Recurrence occurred in three of the patients with tumours, and three prostheses were removed because of deep infection in patients with previously compound injuries of the elbow. Another three loosened without infection, but none needed revision or removal and no amputations resulted. Other complications included nerve palsies, but the only deaths were from metastases. A useful range of elbow movement, with a stable arm and good hand function, was achieved in every patient

We report a retrospective study of 62 total ankle arthroplasties performed between 1972 and 1981. Forty-one of these have been reviewed clinically after an average follow-up of five and a half years; only 13 can be described as satisfactory. The complications encountered in all 62 arthroplasties are detailed, the most significant being superficial wound healing problems, talar collapse, and loosening of the components; 13 prosthetic joints have already been removed and arthrodesis attempted. The management of the complications is discussed. In view of the high complication rate and the generally poor long-term clinical results, we recommend arthrodesis as the treatment of choice for the painful stiff arthritic ankle, regardless of the underlying pathological process

Ten patients underwent endoprosthetic replacement of the distal humerus for bone tumours over a period of 30 years. There were eight primary and two secondary tumours in four men and six women with a mean age of 47.5 years (15 to 76). The mean follow-up was eight years (9 months to 31 years). Four patients required further surgery, three having revision for aseptic loosening; two of these and one other later needing a rebushing. There were no cases of postoperative nerve palsy, infection, local recurrence or mechanical failure of the implant. Four patients died from their disease, all with the prosthesis functioning satisfactorily. At follow-up the mean flexion deformity of the elbow was 15° (0 to 35) and the mean range of flexion was 115° (110 to 135). The functional results showed a mean Toronto extremity salvage score of 73% of normal. Endoprosthetic replacement of the distal humerus and elbow is a satisfactory method of treating these rare tumours

1. Forty-five arthroplasties of the knee with the Walldius prosthesis are reported in forty-two patients, thirty-seven with rheumatoid arthritis and five with osteoarthritis. 2. There has been no structural failure of the prosthesis. 3. Sepsis required removal of the prosthesis in three cases, but arthrodesis was obtained in two of the three. 4. Serious loosening of the prosthesis occurred in one case only. Varus deformity occurred in one patient. 5. Radiological evidence of some movement of the prosthesis was present in six other cases but this did not seem to affect function. 6. It is concluded that this operation has a place in the treatment of the more seriously disabled patient, but should not be used when heavy demands are likely to be made on the joint

Compression testing of cadaver specimens showed that excision of the radial head allowed proximal radial displacement. The insertion of a metallic radial head restored normal mechanics, while a silicone rubber implant did not. We reviewed 31 of 36 comminuted fractures of the radial head, 21 associated with dislocation or ulnar fracture, which had been treated by primary replacement with a Vitallium prosthesis. At a mean follow-up of 4.5 years, there was reliable restoration of stability and prevention of proximal radial migration. There had been no dislocations or prosthetic failures, but two implants had been removed for loosening. The prosthesis is recommended for use as a spacer to stabilise the elbow after severe injuries while the soft tissues heal

Non-traumatic osteonecrosis of the femoral head is a potentially devastating condition, the prevalence of which is increasing. Many joint-preserving forms of treatment, both medical and surgical, have been developed in an attempt to slow or reverse its progression, as it usually affects young patients.

However, it is important to evaluate the best evidence that is available for the many forms of treatment considering the variation in the demographics of the patients, the methodology and the outcomes in the studies that have been published, so that it can be used effectively.

The purpose of this review, therefore, was to provide an up-to-date, evidence-based guide to the management, both non-operative and operative, of non-traumatic osteonecrosis of the femoral head.

Cite this article: Bone Joint J 2017;99-B:1267–79.

We treated 43 patients (38 women and 5 men) with osteoarthritis of the basal joint of the thumb by non-cemented arthroplasty of the first carpometacarpal joint as described by Ledoux. The probability of a patient avoiding revision for 12 months was 62% and for 16 months 59%. The indications for revision were aseptic loosening in 83% and luxation in 17%. The surviving prostheses were reviewed clinically and radiologically at a mean follow-up of 25.3 months. Pain on loading, movement or at rest was seen in 75% of the patients. There was significant reduction in the range of movement of the trapeziometacarpal joint and of wrist strength. Radiological assessment showed significant subsidence of the stem in the first metacarpal and migration of the cup, with the stem loose in 15% and the cup in 46%. We no longer recommend this method of joint replacement

The production of particulate wear debris is a recognised complication of joint arthroplasty, but interest has concentrated on local tissue reactions and a possible association with implant loosening. The fate of wear products in the body remains unknown, although some of the metals used in the construction of orthopaedic implants are known to have toxic and oncogenic properties. We report histological and electron-microscopic evidence from two cases which shows that metallic debris can be identified in the lymphoreticular tissues of the body distant from the hip some years after joint replacement. The increase in the use of total arthroplasty in younger patients, the development of new alloys and the use of porous coatings must raise concern for the long-term effects of the accumulation of wear debris in the body

We studied the stability of cemented all-polyethylene keeled glenoid components by radiostereometric analysis (RSA) in 16 shoulders which had received a total shoulder replacement. There were 14 women (one bilateral) and one man with a mean age of 64 years. The diagnosis was osteoarthritis in eight and rheumatoid arthritis in seven. Two of the shoulders were excluded from the RSA study because of loosening of the tantalum markers. Three tantalum markers were inserted in the glenoid socket, two in the coracoid process and two in the acromion. The polyethylene keeled glenoid component was marked with three to five tantalum markers. Conventional radiological and RSA examinations were carried out at five to seven days, at four months and at one and two years after operation. Radiolucent lines were found in all except three shoulders. Migration was most pronounced in the distal direction and exceeded 1 mm in four shoulders. In ten shoulders rotation exceeded 2° in one or more axes with retroversion/anteversion being most common. No correlation was found between migration and the presence of radiolucencies on conventional radiographs

Our aim was to analyse the influence of the size, shape and number of particles on the pathogenesis of osteolysis. We obtained peri-implant tissues from 18 patients having revision surgery for aseptically loosened Freeman total knee replacements (10), Charnley total hip replacements (3) and Imperial College/London Hospital double-cup surface hip replacements (5). The size and shape of the polyethylene particles were characterised using SEM and their concentration was calculated. The results were analysed with reference to the presence of radiological osteolysis. The concentration of polyethylene particles in 6 areas with osteolysis was significantly higher than that in 12 areas without osteolysis. There were no significant differences between the size and shape of the particles in these two groups. We conclude that the most critical factor in the pathogenesis of osteolysis is the concentration of polyethylene particles accumulated in the tissue

We present the results of 506 consecutive Howse hip arthroplasties with a minimum follow-up of 10 years. The mortality within one month of surgery was 0.79%. The early dislocation rate was 1.38%, two hips requiring revision. Nine hips developed deep sepsis (1.78%), eight of which required revision. At 10 years 42 hips (8.3%) had required revision, including 14 with aseptic acetabular loosening and 11 with femoral stem fractures. We feel that as judged by the dislocation rate and the need for subsequent revision, the Howse arthroplasty is an acceptable form of total hip replacement, particularly in the older patient and in those requiring total replacement for femoral neck fractures

The results of 75 total hip replacements in 42 children with juvenile chronic arthritis are reported after a mean follow-up of 5.4 years. Their ages ranged from 11 to nearly 17 years at operation and many had active disease. Severe pain and marked stiffness of the hips were limiting their independence. At least half of the children were still growing and continued to grow after operation. The patients were carefully selected and gratifying results were obtained, but pre-operative assessment and overall supervision by a rheumatologist are important. Technical difficulties related to the size and maldevelopment of the hip are discussed. There was no infection and the single case of loosening of a femoral component after nine years has been successfully revised